GE Portuguese Journal of Gastroenterology最新文献

{"title":"Best Practices in Esophageal, Gastroduodenal, and Colonic Stenting.","authors":"Renato Medas,&nbsp;Joel Ferreira-Silva,&nbsp;Mohit Girotra,&nbsp;Monique Barakat,&nbsp;James H Tabibian,&nbsp;Eduardo Rodrigues-Pinto","doi":"10.1159/000527202","DOIUrl":"https://doi.org/10.1159/000527202","url":null,"abstract":"<p><p>Endoscopic stenting is an area of endoscopy that has witnessed noteworthy advancements over the last decade, resulting in evolving clinical practices among gastroenterologists around the world. Indications for endoscopic stenting have progressively expanded, becoming a frequent part of the management algorithm for various benign and malignant conditions of the gastrointestinal tract, from esophagus to rectum. In addition to expanded indications, continuous technological enhancements and development of novel endoscopic stents have resulted in an increased success of these approaches and, in some cases, allowed new applications. This review aimed to summarize best practices in esophageal, gastroduodenal, and colonic stenting.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"30 Suppl 1","pages":"19-34"},"PeriodicalIF":0.9,"publicationDate":"2022-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/17/f1/pjg-0030-0019.PMC10561327.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41219857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastric Peroral Endoscopic Myotomy as a Therapeutic Option in Refractory Gastroparesis: A Step-By-Step Description.","authors":"Carolina Chálim Rebelo,&nbsp;Nuno Nunes,&nbsp;Diogo Bernardo Moura,&nbsp;Francisca Corte-Real,&nbsp;José Renato Pereira,&nbsp;Maria Antónia Duarte","doi":"10.1159/000527016","DOIUrl":"10.1159/000527016","url":null,"abstract":"Gastroparesis is a chronic disorder characterized by delayed gastric emptying without evidence of stomach or proximal small intestine obstruction [1]. Its pathophysiology is unclear, although gastric arrhythmias, fundal and antral hypocontractility, pylorospasm, and antropyloroduodenal incoordination might be involved [1]. Dietary modifications and prokinetics are first-line treatments. When refractory gastroparesis is present, surgical or endoscopic treatment must be considered. We present a case of a 68-year-old female patient, followed in gastroenterology consult due to nausea, persistent postprandial vomiting, early satiety, and belching. She has no relevant past medical or surgical history or medication. Esophagogastroduodenoscopy revealed food stasis but was otherwise normal. Gastric emptying scintigraphy (GES) showed emptying of 30% at 156 min, 46% at 217 min, and 54% at 260 min, with significant radiopharmaceutical retention (46% at 4 h 18 min), translating scintigraphic evidence of delayed gastric emptying (Fig. 1). The diagnosis of gastroparesis was made, and medical therapy was optimized. She had no improvement after 6 months, traducing a Gastroparesis Cardinal Symptom Index (GCSI) score of 3.33 points (0–5 points) [2]. Idiopathic refractory gastroparesis was admitted, and gastric peroral endoscopic myotomy (G-POEM) was proposed. The procedure was performed with an endoscope (GIF-HQ190; Olympus Medical Systems, Tokyo, Japan), with a transparent distal cap (DH28GR; Fujifilm, Tokyo, Japan) and insufflation with CO2. The patient was under general anesthesia and orotracheal intubation. The VIO®3 (Erbe Elektromedizin GmbH, Tuebingen, Germany) was used as the electrosurgical unit. Antibiotic (cefotaxime 1 g) was administered. The procedure began with submucosal injection, in the greater gastric curvature, 5 cm proximal to the pylorus with a solution of 100","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"30 5","pages":"387-389"},"PeriodicalIF":0.9,"publicationDate":"2022-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4d/1a/pjg-0030-0387.PMC10586216.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49693799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of a Structured Virtual Reality Simulation Training Curriculum for Novice Endoscopists.","authors":"Sofia Silva Mendes,&nbsp;Miguel Areia,&nbsp;Mário Dinis Ribeiro,&nbsp;Carla Rolanda","doi":"10.1159/000519927","DOIUrl":"https://doi.org/10.1159/000519927","url":null,"abstract":"<p><strong>Background: </strong>Current evidence supports the use of virtual reality (VR) simulation-based training for novice endoscopists. However, there is still a need for a standardized induction programme which ensures sufficient preparation, with knowledge and basic skills, before their approach to patient-based training. We designed a structured progressive programme in upper endoscopy and colonoscopy and aimed to determine its impact on cognitive and technical performance.</p><p><strong>Methods: </strong>Prospective, multicentre study, focused on \"Endoscopy I, 2018,\" a course with a theoretical and a hands-on module (20 h) in the GI Mentor II®. Gastroenterology residents of the 1st year were enrolled. A pre-test and test were applied to evaluate the cognitive component, and a pre-training and post-training esophagogastroduodenoscopy (EGD) and colonoscopy VR cases were used to evaluate the technical component. The hands-on training included psychomotor exercises (Navigation I, Endobubble I), 4 EGD, and 4 colonoscopy VR cases. The metrics applied for technical skills evaluation were time to reach the second portion of duodenum (D2)/cecum (seconds), efficiency of screening (%), and time the patient was in pain (%).</p><p><strong>Results: </strong>Twenty-three participants were included, majority female (67%), 26 ± 0.7 years old. Comparing the pre-test versus test, the cognitive score significantly improved (11/15 vs. 14/15; <i>p</i> < 0.001). Considering the technical assessment after training: in EGD, the time to D2 was significantly lower (193 vs. 63 s; <i>p</i> < 0.001), and the efficiency of screening significantly better (64 vs. 91%; <i>p</i> < 0.001); in colonoscopy, the time to reach the cecum was significantly lower (599 vs. 294 s; <i>p</i> = 0.001), the time the patient was in pain was significantly lower (27 vs. 10%; <i>p</i> = 0.005), and the efficiency of screening had a tendency towards improvement (50 vs. 68%; <i>p</i> = 0.062).</p><p><strong>Conclusion: </strong>The proposed training curriculum in basic endoscopy for novices is aligned with international recommendations and demonstrated a significant impact on cognitive and technical skills learning achievements.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"29 6","pages":"385-392"},"PeriodicalIF":0.9,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/68/17/pjg-0029-0385.PMC9761362.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10479397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NAFLD Nutritional Management: Results from a Multidisciplinary Approach.","authors":"Sara Raquel Osório Policarpo,&nbsp;Mariana V Machado,&nbsp;David Barreira,&nbsp;Helena Cortez-Pinto","doi":"10.1159/000519932","DOIUrl":"https://doi.org/10.1159/000519932","url":null,"abstract":"<p><strong>Introduction: </strong>Lifestyle changes are the mainstay treatment of nonalcoholic fatty liver disease (NAFLD). We aimed to assess the magnitude of weight loss in a group of NAFLD patients followed on a combined lifestyle intervention by a multidisciplinary team.</p><p><strong>Methods: </strong>Patients were assessed before and after a 12-month dietary intervention (Mediterranean diet aiming at weight loss). Patients who received a structured dietary plan along with general lifestyle recommendations were designated as the multidisciplinary treatment (MdT) group. Patients who declined follow-up still received general lifestyle recommendations and were designated as the conventional treatment group, being used as a control group.</p><p><strong>Results: </strong>From the 77 patients with documented NAFLD, 31.2% of patients were overweight and 55.8% obese; 66 patients constituted the MdT group and 11 the conventional treatment group. After 3 months, 89% of patients lost weight; at 6 months, 75.4% maintained the weight lost. At 12 months, 65% of patients still decreased their weight, with 92.2% of patients in the MdT group still maintaining a lower weight than baseline versus just 50% in the conventional group (<i>p</i> = 0.008). Only patients in the MdT group presented a weight loss higher than 10% (9.6%; <i>n</i> = 6). At 12 months patients in the MdT group presented an average reduction of 4.2 kg versus a reduction of just 0.6 kg in the conventional treatment group (<i>p</i> = 0.016). The MdT group, but not the conventional group, presented significant differences in liver enzymes at 12 months compared to baseline.</p><p><strong>Conclusion: </strong>Adherence to a multidisciplinary approach, compared to management solely by a hepatologist, in NAFLD patients, is effective with greater weight loss after a 12-month follow-up and a lower rate of weight gain recurrence.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"29 6","pages":"401-408"},"PeriodicalIF":0.9,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/42/f8/pjg-0029-0401.PMC9761363.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10479391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Office-Based Procedures in the Management of Hemorrhoidal Disease: Rubber Band Ligation versus Sclerotherapy - Systematic Review and Meta-Analysis.","authors":"Paulo Salgueiro,&nbsp;Maria Inês Ramos,&nbsp;Fernando Castro-Poças,&nbsp;Diogo Libânio","doi":"10.1159/000522171","DOIUrl":"https://doi.org/10.1159/000522171","url":null,"abstract":"<p><strong>Introduction: </strong>The most frequently used office-based procedures in hemorrhoidal disease (HD) are rubber band ligation (RBL) and sclerotherapy. Few studies have been published comparing the various types of instrumental therapy. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of sclerotherapy and RBL.</p><p><strong>Methods: </strong>Three online databases were searched. Efficacy (control of symptoms, prolapse, bleeding and pain, patients' satisfaction, and disease recurrence) and safety (complications, such as pain and bleeding) were the assessed outcomes. Pooled relative risks (RR) were computed for each outcome using a random-effects model, and heterogeneity was assessed by Cochran's Q test and <i>I</i>².</p><p><strong>Results: </strong>Six RCTs and three cohort studies were included. Control of prolapse and bleeding was significantly higher with RBL (93.1% RBL vs. 66.4% sclerotherapy, RR 1.34, 95% CI 1.12-1.60 and 89.1% RBL vs. 78.7% SCL, RR 1.17, 95% CI 1.02-1.34, respectively). Both techniques had similar results in terms of pain relief, overall control of symptoms, and risk of recurrence at 3 months. Although patient satisfaction was significantly higher with RBL (77.8% RBL vs. 46.7% sclerotherapy, RR 1.59, 95% CI 1.01-2.50), post-procedural pain was significantly higher with this technique (24% RBL vs. 14% sclerotherapy, RR 1.74, 95% CI 1.32-2.28). There was no significant difference regarding post-procedure bleeding (11.1% RBL vs. 8.7% sclerotherapy, RR 1.29, 95% CI 0.86-1.94). In the subgroup analysis, according to the HD grade, post-procedure pain was higher with RBL only in HD grade II (vs. HD grade I-III).</p><p><strong>Conclusions: </strong>RBL performs better than sclerotherapy in controlling HD symptoms, specifically prolapse and bleeding, although post-procedural pain is a frequent complication. Recurrence is similar with both procedures. While waiting for the publication of results with sclerotherapy with new sclerosants, RBL remains the office-based treatment of choice in HD.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"29 6","pages":"409-419"},"PeriodicalIF":0.9,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a8/eb/pjg-0029-0409.PMC9761374.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9585564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Predictive Model for Avoiding Follow-Up Paracentesis in Spontaneous Bacterial Peritonitis.","authors":"Ana Luísa Santos,&nbsp;Rosa Coelho,&nbsp;Marco Silva,&nbsp;Rui Morais,&nbsp;Hélder Cardoso,&nbsp;Guilherme Macedo","doi":"10.1159/000519934","DOIUrl":"https://doi.org/10.1159/000519934","url":null,"abstract":"<p><strong>Background: </strong>Recent studies suggest that follow-up paracentesis (FuP) in cases of spontaneous bacterial peritonitis (SBP) should only be performed if there is a clinical and/or analytic worsening. We aimed to evaluate which patients with SBP would benefit from the FuP.</p><p><strong>Métodos: </strong>This retrospective study included consecutive patients diagnosed with SBP between January 2011 and June 2018 in our tertiary center. Clinical and analytical data were obtained at baseline and on the third day of antibiotic therapy. An adequate response on the third day of treatment was defined by a decrease of ≥25% in the neutrophil count of the ascitic fluid (AF).</p><p><strong>Results: </strong>Ninety-six episodes of PBE in 75 patients (79% male sex, mean age 61 ± 11 years old) were included. At admission, a higher serum neutrophil count (<i>p</i> = 0.043), a lower level of serum total proteins (<i>p</i> = 0.040), a positive culture in AF (<i>p</i> < 0.001) and a previous diagnosis of diabetes mellitus (<i>p</i> = 0.035) were related to inadequate response (IR). At day 3, acute kidney injury (<i>p</i> = 0.023), C-reactive protein >100 mg/L (<i>p</i> < 0.001), the presence of fever (<i>p</i> = 0.047) and abdominal pain (<i>p</i> < 0.001) were also associated with IR. In multivariate analysis, the presence of respiratory insufficiency (OR = 16.403; 95% CI: 2.315-116.222; <i>p</i> = 0.005) and abdominal pain (OR = 10.381; 95% CI: 1.807-59.626; <i>p</i> = 0.009) at admission, serum white blood cell count >9 × 10⁹ (OR = 5.832; 95% CI: 1.275-26.669; <i>p</i> = 0.023), and CRP >100 mg/L (OR = 5.043; 95% CI: 1.267-20.076; <i>p</i> = 0.022) at day 3 of antibiotic therapy were predictors of IR. The predictive model presented good accuracy [AUROC of 0.893 (<i>p</i> < 0.001)] - a cutoff of 0.090 had a sensitivity, specificity, positive predictive value, and negative predictive value for IR of 97, 46, 83, and 77%, respectively.</p><p><strong>Conclusions: </strong>The performance of FuP on day 3 after the beginning of empiric therapy should be individualized, according to clinical and analytic variables of this predictive model.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"29 6","pages":"393-400"},"PeriodicalIF":0.9,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/16/ab/pjg-0029-0393.PMC9761355.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10479394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whipple's Disease with Colonic Involvement: A Rare Endoscopic Documentation.","authors":"Verónica Gamelas,&nbsp;Ines Canha,&nbsp;João Pimentel,&nbsp;Sara Santos,&nbsp;Verónica Borges,&nbsp;Carlos Bernardes","doi":"10.1159/000518900","DOIUrl":"https://doi.org/10.1159/000518900","url":null,"abstract":"A 78-year-old woman presented with watery diarrhea and weight loss – 20 kg, 33% of body weight – in the previous 5 months. She denied fever or relevant epidemiological context. Her previous history was unremarkable. Blood analysis showed anemia (hemoglobin 8.4 g/dL), leukocytosis with neutrophilia and high C-reactive protein (73.8 mg/L). Fecal analysis was negative for microbiological, parasitological and Giardia presence; fecal calprotectin was unchanged. Magnetic resonance enterography described normal small bowel and colon appearance, mesenteric fat densification and prominent mesenteric ganglia. Upper endoscopy revealed enlarged duodenal folds, lymphangiectasias, focal hyperemia and friability of the duodenal mucosa (Fig. 1a, b). Ileocolonoscopy revealed continuous edema, hyperemia and friability of the distal ascending colon, associated with erosions and superficial ulcers, as well as a reduced distensibility (Fig. 2b, c). There were no endoscopic alterations in the remaining segments, including the terminal ileum (Fig. 2a). Histological examination of duodenal (Fig. 1c–e), ileal and ascending colonic samples (Fig. 2d–f) identified the presence of foamy macrophages, with periodic acid-Schiff (PAS)positive intracytoplasmic granules, which were Ziehl-Neelsennegative. Despite having no clinical neurological involvement, Tropheryma whipplei DNA was detected in the cerebrospinal fluid (CSF). The patient completed a 14-day course of once daily 2 g intravenous ceftriaxone, followed by a 12-month course of twice daily 800 + 160 mg oral trimethoprim-sulfamethoxazole, which is currently under way. Diarrhea resolved in the first weeks of antibiotic therapy, and full weight recovery occurred after 4 months.","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"29 6","pages":"436-438"},"PeriodicalIF":0.9,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/89/f5/pjg-0029-0436.PMC9761353.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10420079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recognizing Barotrauma during Colonoscopy: A Cat Scratch Colon.","authors":"Luiz Eduardo Miranda,&nbsp;Matheus Stillner,&nbsp;Ana Clara Miranda,&nbsp;Diego Laurentino Lima","doi":"10.1159/000518460","DOIUrl":"https://doi.org/10.1159/000518460","url":null,"abstract":"A 75-year-old woman underwent an elective colonoscopy for chronic abdominal pain and anemia. She had a history of hypertension, hypothyroidism, and anxiety and had been taking losartan, hydrochlorothiazide, and thyrotoxin for 6 years. The patient did not have a history of collagenous disease or cholestasis and denied having diarrhea, bleeding, weight loss, or family history of cancer colon. Physical examination of the abdomen showed no masses, pain, or tenderness. Routine blood tests revealed a white blood cell count of 7,810/mm2, a hemoglobin level of 10.6 g/dL, a platelet count of 327,000/mm2, a serum creatinine level of 1.02 mg/dL, TSH 1.34 μIU/mL, and ferritin 365.1 ng/mL. The colonoscopy revealed reddish, flat, bright streaks with sharp boundaries and dotted surfaces suggesting small bleeding points located in the ascending colon and cecum close to the ileocecal valve. The streaks did not follow the arrangement of submucosal vessels and were distributed in parallel and perpendicular to each other (Fig. 1). The remaining cecum, colon, and rectum presented normal vascular and mucous patterns. The colonoscopy, which had been easy up to this point, was ended after the diagnosis of cat scratch colon because of the risk of barotrauma and perforation [1]. McDonnel et al. [2] first described “Cat scratch” in 2007 and reported an 81% prevalence in females that was related to barotrauma from overdistension. Although this finding has no clinical implications, it may be a useful sign to prevent colonic perforation during colonoscopy. Cat scratch is associated with the following conditions that lead to a less complacent colon or bleeding: collagenous colitis, a chronic inflammatory bowel disease that causes mucosal atrophy and impaired colonic compliance [2]; ischemic colitis because intestinal ischemia creates an edematous and fragile mucosa [3]; chronic cholestasis, which can impair absorption of vitamins K and A and cause bleeding predisposition and damage to the intestinal mucosal barrier integrity [4]; and chronic use of anti-inflammatory drugs that can lead to gastrointestinal toxicity and mucosal injury in the form of erosions and ulcers [5]. It is widely accepted by most authors that the marks are caused by intramural bleeding associated with intestinal distension that is caused by insufflated air during the colo-","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"29 6","pages":"434-435"},"PeriodicalIF":0.9,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/99/a1/pjg-0029-0434.PMC9761352.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10479396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rare Cause of Food Impaction: Heterotopic Gastric Mucosa.","authors":"Inês Marques de Sá,&nbsp;Ana Marques,&nbsp;Pedro Pimentel-Nunes","doi":"10.1159/000519928","DOIUrl":"https://doi.org/10.1159/000519928","url":null,"abstract":"a Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal; b IPATIMUP Diagnostics, Institute of Molecular Pathology and Immunology of Porto University, Porto, Portugal; c Department of Pathology, Centro Hospitalar Universitário de São João EPE, Porto, Portugal; d Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal; e CINTESIS (Center for Health Technology and Services Research), Faculty of Medicine, University of Porto, Porto, Portugal Received: July 9, 2021 Accepted: August 23, 2021 Published online: November 4, 2021","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"29 6","pages":"439-441"},"PeriodicalIF":0.9,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c6/83/pjg-0029-0439.PMC9761347.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10479395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Skills Training: The Impact of Virtual Exercises on Simulated Colonoscopy.","authors":"Rita Morato,&nbsp;Luís Tomé,&nbsp;Mário Dinis-Ribeiro,&nbsp;Carla Rolanda","doi":"10.1159/000520237","DOIUrl":"https://doi.org/10.1159/000520237","url":null,"abstract":"<p><strong>Background: </strong>A previous study suggested that psychomotor training improves the performance on colonoscopy. Since then, newer exercises have been included in the latest generation of GI Mentor®. In order to optimize a colonoscopy training program, we aimed to determine the impact of 3 virtual exercises in simulated colonoscopy skills.</p><p><strong>Methods: </strong>This was a prospective and randomized study. Nineteen residents completed a pre-training questionnaire and a colonoscopy trial before randomization in a study group (<i>n</i> = 10) that performed three exercises (Endobubble I, Navigation I, and Mucosal Evaluation I) until they achieved expert level, and a control group (<i>n</i> = 9). Both groups performed 10 repetitions of a simulated colonoscopy and were assessed on a final case. Learning curves and skills transfer were assessed by four parameters: mucosal surface examined (%), time to reach the cecum (s), screening efficiency (%), and time the patient was in pain (%). We also evaluated the construct validity for the exercises.</p><p><strong>Results: </strong>Construct validity was confirmed for Endobubble I and verified in Navigation I (experts were faster than novices; 5 vs. 7 s, <i>p</i> = 0.040), but not for Mucosal Evaluation I. Analyzing the learning curves and performance in the 10 repetitions<b>,</b> the study group reached the cecum faster (278 vs. 356 s, <i>p</i> = 0.035) and achieved a higher screening efficiency (83% vs. 75%, <i>p</i> = 0.019). Concerning skills transfer, the control group took longer to reach the cecum (241 vs. 292 s, <i>p</i> = 0.021) and the percentage of time the patient was in pain was higher (6% vs. 9%, <i>p</i> = 0.021). General performances of the study group had smaller interquartile variations.</p><p><strong>Conclusion: </strong>Psychomotor training has a significant impact on the homogeneous acquisition and assimilation of colonoscopy skills. Endobubble I and Navigation I should be considered in the training programs for novices.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"29 6","pages":"374-384"},"PeriodicalIF":0.9,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/db/39/pjg-0029-0374.PMC9761354.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10479392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}