{"title":"Best of both worlds - combining water-exchange and cap assisted colonoscopy.","authors":"Amit Rastogi","doi":"10.4161/jig.23731","DOIUrl":"https://doi.org/10.4161/jig.23731","url":null,"abstract":"","PeriodicalId":89416,"journal":{"name":"Journal of interventional gastroenterology","volume":"2 3","pages":"120-121"},"PeriodicalIF":0.0,"publicationDate":"2012-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3655364/pdf/jig0203_0120.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31538184","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}
Catherine Ngo, Joseph W Leung, Surinder K Mann, Cecilia Terrado, Christopher Bowlus, Drew Ingram, Felix W Leung
{"title":"Interim report of a randomized cross-over study comparing clinical performance of novice trainee endoscopists using conventional air insufflation versus warm water infusion colonoscopy.","authors":"Catherine Ngo, Joseph W Leung, Surinder K Mann, Cecilia Terrado, Christopher Bowlus, Drew Ingram, Felix W Leung","doi":"10.4161/jig.23736","DOIUrl":"https://doi.org/10.4161/jig.23736","url":null,"abstract":"<p><strong>Background: </strong>The applicability of water method colonoscopy in trainee education is not known.</p><p><strong>Aim: </strong>To compare the water method vs. usual air method in teaching novice trainee colonoscopy.</p><p><strong>Method: </strong>An IRB approved prospective randomized cross-over study (NCT01482546) in a university setting with diverse patient population.</p><p><strong>Design: </strong>Three first year GI fellows consented to participate in the study. Trainees were randomized to learn with either usual air method or the water method in performing colonoscopy with a dedicated endoscopy attending during their weekly outpatient endoscopy clinics for the initial six months of training and then cross-over to the other method for the remaining six months.</p><p><strong>Patients: </strong>Patients undergoing screening, surveillance or diagnostic colonoscopy.</p><p><strong>Results: </strong>The interim data revealed no significant difference in age, gender, and body mass index (BMI). Trainees rated the water method colonoscopy as significantly easier to learn compared to the air method (p=0.007).</p><p><strong>Conclusions: </strong>The interim data demonstrate positive effects of using the water method in training novice endoscopists who reported a significant ease of learning colonoscopy using this method. Training programs could consider joining us in evaluating the use of warm water infusion in colonoscopy education.</p>","PeriodicalId":89416,"journal":{"name":"Journal of interventional gastroenterology","volume":"2 3","pages":"135-139"},"PeriodicalIF":0.0,"publicationDate":"2012-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3655369/pdf/jig0203_0135.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31538189","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":"Chromocolonoscopy for colorectal cancer screening: Dive into the Big Blue.","authors":"Charles J Kahi","doi":"10.4161/jig.23729","DOIUrl":"https://doi.org/10.4161/jig.23729","url":null,"abstract":"","PeriodicalId":89416,"journal":{"name":"Journal of interventional gastroenterology","volume":"2 3","pages":"112-113"},"PeriodicalIF":0.0,"publicationDate":"2012-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3655362/pdf/jig0203_0112.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31538182","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}
Joseph W Leung, Anne Thai, Andrew Yen, Gregory Ward, Ovanes Abramyan, Jason Lee, Brandon Smith, Felix Leung
{"title":"Magnetic endoscope imaging (ScopeGuide) elucidates the mechanism of action of the pain-alleviating impact of water exchange colonoscopy - attenuation of loop formation.","authors":"Joseph W Leung, Anne Thai, Andrew Yen, Gregory Ward, Ovanes Abramyan, Jason Lee, Brandon Smith, Felix Leung","doi":"10.4161/jig.23738","DOIUrl":"https://doi.org/10.4161/jig.23738","url":null,"abstract":"<p><strong>Background: </strong>The explanation why water exchange colonoscopy produces a significant reduction of pain during colonoscopy is unknown. A recent editorial recommended use of magnetic endoscope imaging (MEI) to elucidate the explanation.</p><p><strong>Objective: </strong>In unselected patients to show that MEI documents less frequent loop formation when water exchange is used.</p><p><strong>Design: </strong>Observational, performance improvement.</p><p><strong>Setting: </strong>Veterans Affairs outpatient endoscopy.</p><p><strong>Patients: </strong>Routine colonoscopy cases.</p><p><strong>Interventions: </strong>Colonoscopy using air or water exchange method was performed as previously described. The MEI equipment (ScopeGuide, Olympus) with built-in magnetic sensors displays the configuration of the colonoscope inside the patient. During sedated colonoscopy the endoscopist was blinded to the ScopeGuide images which were recorded and subsequently reviewed.</p><p><strong>Main outcome measures: </strong>Loop formation based on a visual guide provided by Olympus.</p><p><strong>Results: </strong>There were 41 and 32 cases in the water exchange and air group, respectively. The sigmoid N loop was most common, followed by the sigmoid alpha loop, and exaggeration of scope curvature at the splenic flexure/transverse colon. Of these, 20/32 vs. 9/41 patients (p=0.0007) had sigmoid looping, and 17/32 vs. 9/41 patients (p=0.0007) had sigmoid/splenic looping when the scope tip was in the transverse colon, in the air and water exchange group, respectively.</p><p><strong>Limitations: </strong>Colonoscopy method was not blinded and non randomized.</p><p><strong>Conclusion: </strong>MEI data objectively demonstrated significantly fewer loops during water exchange colonoscopy, elucidating its mechanism of pain alleviation - attenuation of loop formation. Since MEI feedback enhances cecal intubation by trainees, the role of MEI combined water exchange in speeding up trainee learning curves deserves further evaluations.</p>","PeriodicalId":89416,"journal":{"name":"Journal of interventional gastroenterology","volume":"2 3","pages":"142-146"},"PeriodicalIF":0.0,"publicationDate":"2012-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3655371/pdf/jig0203_0142.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31538191","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":"Benchmarking and quality-screening colonoscopy.","authors":"Felix W Leung","doi":"10.4161/jig.23726","DOIUrl":"https://doi.org/10.4161/jig.23726","url":null,"abstract":"","PeriodicalId":89416,"journal":{"name":"Journal of interventional gastroenterology","volume":"2 3","pages":"100-102"},"PeriodicalIF":0.0,"publicationDate":"2012-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3655359/pdf/jig0203_0100.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31537187","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":"Re-learning colonoscopy: just a matter of time.","authors":"Francisco C Ramirez","doi":"10.4161/jig.23735","DOIUrl":"https://doi.org/10.4161/jig.23735","url":null,"abstract":"","PeriodicalId":89416,"journal":{"name":"Journal of interventional gastroenterology","volume":"2 3","pages":"133-134"},"PeriodicalIF":0.0,"publicationDate":"2012-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3655368/pdf/jig0203_0133.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31538188","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}
Fw Leung, R Cheung, Rs Fan, Ls Fischer, S Friedland, Sb Ho, Yh Hsieh, I Hung, Mk Li, S Matsui, Kr McQuaid, G Ohning, A Ojuri, T Sato, Ak Shergill, Ma Shoham, Tc Simons, Mh Walter, A Yen
{"title":"The water exchange method for colonoscopy-effect of coaching.","authors":"Fw Leung, R Cheung, Rs Fan, Ls Fischer, S Friedland, Sb Ho, Yh Hsieh, I Hung, Mk Li, S Matsui, Kr McQuaid, G Ohning, A Ojuri, T Sato, Ak Shergill, Ma Shoham, Tc Simons, Mh Walter, A Yen","doi":"10.4161/jig.23732","DOIUrl":"https://doi.org/10.4161/jig.23732","url":null,"abstract":"<p><p>The growing popularity of water immersion is supported by its long history as an adjunct to air insufflation; after facilitating colonoscope passage, the infused water is conveniently removed during withdrawal. Water exchange, a modification of water immersion to minimize discomfort in scheduled unsedated patients in the U.S. is new. Even though it may be superior in reducing pain and increasing adenoma detection, the paradigm shift to complete exclusion of air during insertion necessitates removal of infused water containing residual feces, a step often perceived as laborious and time-consuming. The nuances are the efficient steps to remove infused water predominantly during insertion to maintain minimal distension and deliver salvage cleansing. Mastery of the novel maneuvers with practice returns insertion time towards baseline. In this observational study the impact of direct verbal coaching on the primary outcome of intention-to-treat cecal intubation was assessed. The results showed that 14 of 19 (74%) experienced colonoscopists achieved 100% intention-to-treat cecal intubation. Initiation of the examination with water exchange did not preclude completion when conversion to the more familiar air insufflation method was deemed necessary to achieve cecal intubation (total 98%). The overall intention-to-treat cecal intubation rate was 88%, 90% in male and 87% in female. Only 2.7% of bowel preparation was rated as poor during withdrawal. The mean volume of water infused and cecal intubation time was 1558 ml and 18 min, respectively. Direct coaching appears to facilitate understanding of the nuances of the water exchange method. Studies of individual learning curves are necessary.</p>","PeriodicalId":89416,"journal":{"name":"Journal of interventional gastroenterology","volume":"2 3","pages":"122-125"},"PeriodicalIF":0.0,"publicationDate":"2012-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3655365/pdf/jig0203_0122.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31538185","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 new method for screening and surveillance colonoscopy: Combined water-exchange and cap-assisted colonoscopy.","authors":"Andrew W Yen, Joseph W Leung, Felix W Leung","doi":"10.4161/jig.23730","DOIUrl":"https://doi.org/10.4161/jig.23730","url":null,"abstract":"<p><strong>Background & aims: </strong>Colonoscopy plays an important and central role in current colorectal cancer screening and prevention programs, but it is an imperfect tool. Adjunct techniques may help improve the performance of colonoscopy to increase the detection of polyps with neoplastic potential. This study investigates the novel approach of combined water-exchange and cap-assisted colonoscopy (WCC) and its impact on adenoma detection.</p><p><strong>Methods: </strong>A single-center single-colonoscopist consecutive group observational study to compare WCC with conventional air insufflation colonoscopy was performed. Data were collected from 50 consecutive patients undergoing outpatient colorectal cancer screening or polyp surveillance with WCC. Adenoma detection rates (ADR) and adenomas detected per colonoscopy (APC) were compared to a control group of 101 consecutive patients examined with conventional air colonoscopy during the immediate prior period.</p><p><strong>Results: </strong>Cecal intubation was achieved in all patients. As an emerging and alternative quality metric for colonoscopy, APC was significantly higher in the WCC group (3.08 vs. 1.50, p=0.0021). The conventional quality metric, overall ADR, was higher in the WCC group compared to the air colonoscopy group (70.0% vs. 59.4%, p=0.22). This difference was not statistically significant, likely due to a type II error.</p><p><strong>Conclusion: </strong>The observational data suggest APC is a more sensitive indicator of quality colonoscopy than ADR. WCC shows promise as a novel technique that merges two simple adjunct methods to help improve the performance of colonoscopy. The data suggest larger, prospective studies are necessary to determine the true impact of water-exchange combined with cap-assisted maneuvers.</p>","PeriodicalId":89416,"journal":{"name":"Journal of interventional gastroenterology","volume":"2 3","pages":"114-119"},"PeriodicalIF":0.0,"publicationDate":"2012-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3655363/pdf/jig0203_0114.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31538183","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}
Boon Eu Andrew Kwek, Tiing Leong Ang, Eng Kiong Teo, Kwong Ming Fock
{"title":"Making ERCP training safe: A protocol-based strategy to minimize complications during selective biliary cannulation.","authors":"Boon Eu Andrew Kwek, Tiing Leong Ang, Eng Kiong Teo, Kwong Ming Fock","doi":"10.4161/jig.22199","DOIUrl":"https://doi.org/10.4161/jig.22199","url":null,"abstract":"<p><strong>Background and aims: </strong>Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced procedure with significant complication rate of 5 to 10%. Scant data is available on quality indicators for trainee-involved ERCP. In our study, we evaluated the outcome of trainee-involved ERCPs in which a protocol-based strategy to minimize complications during selective biliary cannulation was adopted.</p><p><strong>Patients and methods: </strong>Hands-on training was excluded if patients had ASA grade > 3. The trainee's attempts at selective biliary cannulation were stopped and the procedure taken over by the supervising expert endoscopist if the following factors were encountered: (1) failed cannulation after 5 attempts; (2) unsuccessful cannulation after 10 minutes; (3) edematous papilla; (4) pancreatic duct cannulation ≥ 2 times. After successful ductal cannulation, the trainee was allowed to continue additional hands on training in other aspects such as stone extraction and stenting.</p><p><strong>Results: </strong>During the study period, 331 patients underwent ERCP. Trainee group (TG) consisted of 85 patients; mean age 70 (range 27-99). Expert group (EG) consisted of 246 patients; mean age 65 (range 19-98). The overall technical success rate was 97.9% and there was no significant difference between TG (98.8%) and EG (97.6%). The overall complication rate was 3.9% and there was no difference between TG (3.5%) and EG (4%). In TG, although inadvertent pancreatic duct cannulation occurred in 12/85 (14.1%), acute pancreatitis developed only in 3/85 (3.5%).</p><p><strong>Conclusion: </strong>The high success and low complication rates in trainee-involved and expert-only ERCP procedures were similar. While using a protocol-based strategy, good clinical outcome during the provision of hands-on training for ERCP was observed.</p>","PeriodicalId":89416,"journal":{"name":"Journal of interventional gastroenterology","volume":"2 2","pages":"66-69"},"PeriodicalIF":0.0,"publicationDate":"2012-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3655343/pdf/jig0202_0066.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31535279","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}