Environmental and health outcomes of single-use versus reusable duodenoscopes.

Background And Aims: The large-scale effects of duodenoscopes on the environment and public health have not been quantified. Our aim was to perform an exploratory life cycle assessment comparing environmental and human health effects of single-use duodenoscopes (SDs) and reusable duodenoscopes (RDs).

Methods: We evaluated 3 duodenoscopes: conventional RDs, RDs with disposable endcaps, and SDs.

An international study of interobserver variability of "string sign" of pancreatic cysts among experienced endosonographers.

Background And Objectives: No single optimal test reliably determines the pancreatic cyst subtype. Following EUS-FNA, the "string sign" test can differentiate mucinous from nonmucinous cysts. However, the interobserver variability of string sign results has not been studied.

Do Nontechnical Skills Affect Legal Outcomes After Endoscopic Perforations?

Introduction: Health systems often emphasize technical skills to reduce iatrogenic injuries. Nontechnical skills such as clinical and communication skills are mostly overlooked or not readily retrievable from medical records. Our aim was to estimate the association of technical and nontechnical skills of endoscopists with indemnity payments to patients after endoscopic perforations.

Longitudinal assessment of colonoscopy quality indicators: a report from the Gastroenterology Practice Management Group.

Background: There is increasing demand for colonoscopy quality measures for procedures performed in ambulatory surgery centers. Benchmarks such as adenoma detection rate (ADR) are traditionally reported as static, one-dimensional point estimates at a provider or practice level.

Objective: To evaluate 6-year variability of ADRs for 370 gastroenterologists from across the nation.

A pilot study of endoluminal US for stool liquefaction.

Background: There is a need to cleanse patients who are poorly prepared for colonoscopy safely and efficiently during the procedure to minimize rescheduling. US is already being used in catheter-based intravascular thrombolysis, and time-reversal acoustic (TRA) has been explored in assisting drug delivery to the brain.

Objective: To explore the efficacy and safety of a miniaturized endoluminal US device in stool dissolution as a means to salvage poor bowel preparation.

Clinical decision making in the management of pancreatic cystic neoplasms.

Pancreatic cystic lesions continue to pose diagnostic and management dilemmas for physicians. This may be related, in part, to the fact that these lesions represent a range of diagnostic possibilities, from inflammatory cysts and nonmucinous cysts to mucinous cysts, which may or may not have foci of invasive malignancy. Adequate characterization of cystic lesions is necessary to help devise a management plan.

Malpractice claims for endoscopy.

Aim: To summarize the magnitude and time trends of endoscopy-related claims and to compare total malpractice indemnity according to specialty and procedure.

Methods: We obtained data from a comprehensive database of closed claims from a trade association of professional liability insurance carriers, representing over 60% of practicing United States physicians. Total payments by procedure and year were calculated, and were adjusted for inflation (using the Consumer Price Index) to 2008 dollars.

Quality-adjusted life expectancy benefits of laparoscopic bariatric surgery: a United States perspective.

Objectives: The method of choice for bariatric surgery remains controversial. The aim of this study was to compare the outcome of laparoscopic Roux-en-Y gastric bypass (L-RYGB) versus laparoscopic adjustable gastric banding (LAGB) using quality-adjusted life-years (QALYs).

Methods: We developed a Markov model of the quality of life and survival of L-RYGB and LAGB in obese patients.

Anatomic-manometric correlation of the upper esophageal sphincter: a concurrent US and manometry study.

Background: The pharyngoesophageal segment commonly referred to as the upper esophageal sphincter (UES) generates a high-pressure zone (HPZ) between the pharynx and the esophagus. However, the exact anatomical components of the UES-HPZ remain incompletely determined.

Objective: To systematically define the US signature of various components of the pharyngoesophageal junction and to determine how these structures contribute to the development of the UES-HPZ.

EUS in the diagnosis of early-stage chronic pancreatitis.

Chronic pancreatitis (CP) is a progressive inflammatory disease that is difficult to diagnose due to the paucity of a diagnostic gold standard. For almost two decades, early-stage CP has been recognised in the context of endoscopic ultrasound (EUS) when a patient presents with typical pancreatic-type pain, normal conventional imaging examinations, and subtle findings of CP by EUS. Whether these EUS findings represent true early-stage CP that will progress or whether they are false positive findings remain unclear.

EUS-guided FNA aspiration of kidney masses: a multicenter U.S. experience.

Background: Tissue sampling of renal lesions is traditionally performed with percutaneous US or CT guidance. To date, only 3 known cases of EUS-guided FNA (EUS-FNA) of a renal mass have been reported.

Objective: To describe a multicenter experience with the indications, yield, and complications from attempted EUS-FNA of a kidney mass.

Emerging applications of endoscopic ultrasound in gastrointestinal cancers.

Endoscopic ultrasound (EUS) has been adopted into numerous interventional techniques and strategies that promise to improve diagnosis and management of gastrointestinal (GI) cancers. EUS-guided fine-needle aspiration (EUS-FNA) is recommended as a procedure of choice for tissue diagnosis of pancreatic cancer. Potential benefits of EUS-FNA in diagnosis of pancreatic cancer include the ability to detect small, discrete lesions compared with conventional imaging and the ability to provide staging information by examination of blood vessels surrounding the pancreas.