Table of Contents

Volume 2, Issue 1

  January/February/March 2012

  Pages 1 - 50

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 Issue Catalogue (MARC XML)

EDITOR'S CORNERS

Open Access Article

Meet our Senior Associate Editor: Professor Felix W. Leung

Felix W. Leung
Page 1
http://dx.doi.org/10.4161/jig.20370
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Open Access Article

Introduction to the Volume 2, first issue

Joseph W. Leung
Page 2
http://dx.doi.org/10.4161/jig.20371
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ORIGINAL PAPERS

Open Access Article

Recognition of changes in microvascular and microstructural patterns upon magnifying endoscopy predicted the presence of extranodal gastric MALToma

Philip Wai Yan Chiu, Tiffany Cho Lam Wong, Anthony Yuen Bun Teoh, Kai Fai To, Shirley Yuk Wah Liu, Simon Kin Hung Wong, Francis Ka Leung Chan and Enders Kwok Wai Ng
Pages 3 - 7
http://dx.doi.org/10.4161/jig.20125
Abstract | PDF

Background and objectives: Gastric MALToma is difficult to recognize upon endoscopy. The aim of this study is to evaluate the application of microstructural and microvascular patterns in recognizing gastric MALToma on magnifying endoscopy. Method: All patients with diagnosis of gastric MALToma upon histology were recruited. They received magnifying endoscopy to observe for changes in microstructural and microvascular patterns. For patients with H pylori, eradication therapy would be given. For those without, appropriate treatments including gastrectomy or chemotherapy were commenced accordingly. Patients treated with H pylori eradication and non-operative treatments received follow-up magnifying endoscopy, and the same features were observed to predict the response to these treatments. Results: From 2004 to 2007, nine patients presented to with epigastric pain, dyspepsia and belching. All patients were confirmed to have MALToma upon initial biopsy. Five patients had H pylori infection and received eradication. Two patients without H pylori were treated with Laparoscopic total gastrectomy. Two patients had pulmonary metastasis and treated with chemotherapy. Under magnifying endoscopy, all the lesions demonstrated either absence or irregular gastric pits. Moreover, there was consistently appearance of spider-shaped vascular pattern. Five patients with H pylori eradication had follow-up magnifying endoscopy, four of them showed resolution of abnormal vascular pattern and recovery of gastric pits. Conclusion: Abnormal spider like vasculature and disappearance of gastric pits are diagnostic features upon magnifying endoscopy for gastric MALToma. These features enhanced the diagnosis and assessment of extent of involvement during primary endoscopy, as well as follow-up surveillance for response to non-operative treatments.

Open Access Article

Complication rates of colonic polypectomy in relation to polyp characteristics and techniques: a district hospital experience

Wai Kah Choo and Javaid Subhani
Pages 8 - 11
http://dx.doi.org/10.4161/jig.20126
Abstract | PDF

Background: Colonic polypectomy reduces the subsequent rate of development of colonic cancer but is not without its risks. We aimed to examine our complication rates in relation to the characteristics of polyps and techniques employed. Methods: A database for all colonic polypectomies performed over a 3½-year period between 2006 and 2009 was matched against all patients readmitted after an endoscopy. Serious complications post-polypectomy were defined as events leading to readmission within 14 days. Results: We performed 2106 polypectomies on 1252 patients in this period. Fourteen patients or 24 (1.1%) polypectomies experienced complications. Two patients (0.09%) experienced perforation, 10 (0.47%) had bleeding and 3 (0.14%) had post-polypectomy syndromes. Our bleeding rate was 1:211, lower than the national standard of 1:100. No deaths were reported. Complication rates rose from 1% in the smallest group (1-10 mm) to 4.9% in the largest (>31 mm) but the difference was not statistically significant (p=0.067). Right-colon polypectomies had a higher tendency of developing post-polypectomy syndrome and bleeding (p=0.002). Complication rates in snare polypectomies were not significantly different from that of hot biopsies (p=0.64). However, endoscopic mucosal resections (EMR) had significantly more complications compared to snares (p=0.045) and hot biopsies (p=0.026). Conclusion: We achieved lower bleeding rates than that published nationally. Hot biopsies did not carry a higher risk unlike EMRs. Although polyp size may be an important risk factor, statistical significance was not met. Ascending and transverse colon polypectomies carried the highest risks of complications.




CASE REPORTS

Open Access Article

Utility of single balloon enteroscopy (SBE) for difficult cases of total colonoscopy

Yoshinori Arai, Tomohiro Kato, Seiji Arihiro, Munenori Itagaki, Nobuhiko Komoike, Isao Odagi, Masayuki Saruta, Mika Matsuoka, Takeshi Suzuki and Hisao Tajiri
Pages 12 - 14
http://dx.doi.org/10.4161/jig.20127
Abstract | PDF

Balloon enteroscopy (BE) was originally developed for observation of the deep small intestine, and has recently been utilized for difficult cases of total colonoscopy due to reasons such as adhesions and elongation. In this report, we present our experience with single balloon enteroscopy (SBE) to facilitate successful colonoscopy when standard techniques failed. In two cases, early colon cancers were detected in the cecum by SBE and were removed endoscopically or surgically. A third case is discussed in which SBE was attempted but was ultimately not successful. In that case, total colonoscopy was not performed because of looping in the sigmoid and transverse colon. A fourth case in which SBE was performed in order to remove colonic gas in a patient with megacolon. In that case, total colonoscopy could not be completed because the SBE balloon could not “grab” the dilated colon and therefore could not advance. SBE is a useful adjunct to standard colonoscopy in challenging cases, but has limitations and does not always ensure success.

Open Access Article

Retained capsule endoscopy causing intestinal obstruction—Endoscopic retrieval by retrograde single-balloon enteroscopy

Lei Xin, Zhuan Liao, Yi-qi Du, Yue-Ping Jiang and Zhao-Shen Li
Pages 15 - 18
http://dx.doi.org/10.4161/jig.20128
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Open Access Article

Tapeworm infection identified on capsule endoscopy

Shao-Qi Yang, Rui Huang, Li-Na Zhang, Jian-Guo Hu and Li Yang
Page 19
http://dx.doi.org/10.4161/jig.20129
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RAPID COMMUNICATION

Open Access Article

A pilot study to assess feasibility of the water method to aid colonoscope insertion in community settings in the United States

Donald J. Portocarrero, Kendrick Che, Snorri Olafsson, Michael H. Walter, Christian S. Jackson, Felix W. Leung and Ariel Malamud
Pages 20 - 22
http://dx.doi.org/10.4161/jig.20130
Abstract | PDF

Background: The water method decreases patient discomfort and sedation requirement. Applicability in non-veteran community settings in the United States (U.S.) has not been reported. Aims: Our aim is to perform a pilot study to establish feasibility of use the water method at 2 community sites. We tested the hypothesis that compared with air insufflation patients examined with the water method would require less sedation without adverse impact on outcomes. Methods: Two performance improvement projects were carried out. Consecutive patients who consented to respond to a questionnaire after colonoscopy were enrolled. Project 1: The design was single-blinded (patient only); quasirandomized – odd days (water), even days (air). Colonoscopy was performed by a staff attending. Project 2: A supervised trainee performed the reported procedures. In both, patient demographics (age, gender and body mass index), amount of sedation required during colonoscopy and procedure-related variables were recorded. The patients completed a questionnaire that enquired about discomfort during colonoscopy and willingness to repeat the procedure within 24 hours after the procedure. Results: Project 1: Significantly lower doses of fentanyl and midazolam were used and a higher adenoma detection rate (ADR) was demonstrated in the water group. Project 2: 100% cecal intubation rate was achieved by the supervised trainee. Conclusion: This is the first pilot report in the U.S. documenting feasibility of the water method as the principal modality to aid colonoscope insertion in both male and female community patients. In a head-to-head comparison, significant reduction of sedation requirement is confirmed as hypothesized. No adverse impact on outcomes was noted.




REVIEWS

Open Access Article

Endoscopic ampullectomy: A practical guide

Milan Bassan and Michael Bourke
Pages 23 - 30
http://dx.doi.org/10.4161/jig.20131
Abstract | PDF

Endoscopic ampullectomy is a minimally invasive method of treating superficial lesions of the ampulla of Vater. With careful patient selection and lesion assessment it is a safe and efficacious therapeutic procedure that can obviate the need for potentially major surgical intervention. Strategies for safe and successful endoscopic ampullectomy with a focus on resection technique and recognition and management of complications are presented.

Open Access Article

How to improve the success of endoscopic ultrasound guided fine needle aspiration cytology in the diagnosis of pancreatic lesions

Antonio Z. Gimeno-García and Ahmed Elwassief
Pages 31 - 36
http://dx.doi.org/10.4161/jig.20132
Abstract | PDF

Endoscopic ultrasonography (EUS) is highly accurate for assessing the pancreatic parenchyma and ductal system. Currently, it is the most sensitive imaging procedure for detecting small solid pancreatic masses. EUS-guided fine needle aspiration cytology (EUS-FNA) is a safe and highly accurate tool for the diagnosis of pancreatic malignancy. Prior to perform an EUS-FNA one should wonder whether the benefits outweigh the potential risks of the procedure. Therefore, it is important to take into account whether the procedure will influence patient management. The diagnostic yield and success rate of EUS-FNA in pancreatic lesions varies greatly depending on many factors including: the characteristics of the lesion itself (location of the mass and consistency of the lesion), technical factors (type of needle size, use of stylet, use of suction and number of needle passes performed) and the availability of immediate cytological assessment of the specimen. The aim of this review is to analyze all these factors for optimizing specimen collection and diagnostic efficiency in dealing with solid pancreatic masses.

Open Access Article

The role of upper gastrointestinal endoscopy in treating postoperative complications in bariatric surgery

Richdeep S. Gill, Kevin A. Whitlock, Rachid Mohamed, Koroush Sarkhosh, Daniel W. Birch and Shahzeer Karmali
Pages 37 - 41
http://dx.doi.org/10.4161/jig.20133
Abstract | PDF

There are an estimated 500 million obese individuals worldwide. Currently, bariatric surgery has been shown to result in clinically significant weight loss. With increasing demand for bariatric surgery, endoscopic techniques used intra and postoperatively continue to evolve. Endoscopic evaluation of anastomotic integrity following RYGB allows for early detection of anastomotic leaks. Furthermore, endoscopy is a valuable tool to diagnose and treat RYGB postoperative surgical complications such as anastomotic leakage, hemorrhage and stricture formation. Early evidence suggests that endoscopic management of upper gastrointestinal hemorrhage following RYGB is effective. In addition, endoscopic balloon dilatation is able to effectively treat obstruction in the setting of gastrojejunal anastomotic strictures. With successful endoscopic management of these complications, bariatric patients may avoid more invasive surgical procedures.

Open Access Article

Interventional balloon-enteroscopy

Jörg G. Albert
Pages 42 - 50
http://dx.doi.org/10.4161/jig.20134
Abstract | PDF

Balloon assisted enteroscopy (BE) expands greatly the therapeutic options in interventional endoscopy; bleeding sites, strictures, polyps, and other small bowel lesions are increasingly been treated by use of BE in the last 10 years. Treatment options for small bowel bleeding include Argon plasma coagulation (APC), injection therapy, and application of TTS metal clips, and thereby bleeding is stopped in most cases. Dilating symptomatic strictures, resecting polyps as seen in Peutz-Jeghers syndrome (PJS), and removing foreign bodies, BE carries most endoscopic treatment techniques to the small bowel. Another new indication field for BE are interventions at the biliary system in patients with surgically modified anatomy such as Roux-Y anastomosis. This review offers a full overview on indications of BE and refers to the practical use of the method for all endoscopic interventions.