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News Article | May 5, 2017
Site: www.eurekalert.org

CHICAGO - May 5, 2017 - Don't miss these American Society for Gastrointestinal Endoscopy (ASGE) programs at Digestive Disease Week®: ASGE Presidential Plenary: "Hot Coffee, Doughnuts, Debates...and Our Best Science" 8:00 to 10:30 am, McCormick Place, room S100AB Presidential address by Kenneth R. McQuaid, MD, FASGE; inauguration of incoming president Karen L. Woods, MD, FASGE; and a series of brief presentations of the top abstracts submitted to DDW. Each will be followed by a lively talk or debate featuring eminent experts on each subject. ASGE Topic Forum: "Advancing the Scope of Pediatric Endoscopy" 8:00 to 9:30 am, McCormick Place, Room S402 Highlighted study: High Frequency of Non-Classical Endoscopic Findings in Children and Adolescents Diagnosed With Ulcerative Colitis: The PROTECT Study ASGE Topic Forum: "Adenoma Detection - Where Are We Now and Where Are We Going? 2:00 to 3:30 pm, McCormick Place, Room E450A Highlighted presentation: "Increasing Adenoma Detection Rate Over Time in a National Benchmarking Registry" ASGE Topic Forum: "Clean Endoscopes: A Continual Quality Improvement Effort" 8:00 to 9:30 am, McCormick Place, Room E450A Highlighted study: "A Randomized Trial of Single Versus Double High-Level Disinfection (HLD) of Duodenoscopes and Linear Echoendoscopes Using Standard Automated Reprocessing" ASGE Topic Forum: "Advances in Diagnosis and Management of Gastroduodenal Pathology" 2:00 to 3:30 pm, McCormick Place, S100C Highlighted study: "Clinical Outcome of Endoscopic Mucosal Resection of Sporadic, Non-Ampullary Duodenal Adenoma: Predictor Analysis of Safety and Efficacy From a High-Volume U.S. Tertiary Referral Center" ASGE Topic Forum: Recent Advances in Bariatric Endoscopy 8:00 to 9:30 am, McCormick Place, Room S401 Highlighted study: "Single Fluid-Filled Intragastric Balloon for Weight Loss: U.S. Post-Regulatory Approval Multicenter Clinical Experience in 245 Patients" ASGE Topic Forum: Barrett's Screening and Surveillance 8:00 to 9:30 am, McCormick Place, Room S404 Highlighted study: "Incidence of Malignant Progression in Persistent Nondysplastic Barrett's Esophagus, a Dutch Nationwide Cohort Study" ASGE Topic Forum: New Technology I: Novel Interventions, Devices and Techniques 10:00 to 11:30 am, McCormick Place, Room E350 Highlighted study: "Over-the-Scope Clip Versus Standard Endoscopic Therapy in Patients With Recurrent Peptic Ulcer Bleeding - A Prospective Randomized Multicenter Trial (STING)" ASGE Topic Forum: Advanced Esophageal Endoscopy Including Anti-Reflux Mucosectomy 10:00 to 11:30 am, McCormick Place, Room S404 Highlighted study: "Clinical Results of Anti-Reflux Mucosectomy (ARMS) for Refractory GERD" Saturday through Tuesday, 9:30 am to 4:00 pm, McCormick Place, South Hall A ASGE poster session program Authors will be available from noon to 2:00 pm on the day their poster is displayed "The Association Between Diet and Bowel Preparation Quality," Sa1067 "BMI Is Not a Significant Risk Factor for Colorectal Adenomas in a Predominantly African American, Female Inner-City Population," Su1666 "70 Percent of Average-Risk Persons of Screening Age Have Colon Adenomas -ADR in a Community Cohort With Biopsies Read by Academic GI Pathologists," Su1684 "Evaluation of a Novel Disposable Upper Endoscope for Unsedated Bedside (Non-Endoscopy Unit-Based) Assessment of the Upper Gastrointestinal Tract," Su1180 "The First Autonomously Controlled Capsule Robot for Colon Exploration," Mo1962 "Comparison of Endoscopic Dysplasia Detection Strategies in Patients With Ulcerative Colitis: A Systematic Review and Network Meta-Analysis," Mo2040 "Impact of Chromoendoscopy on Outcomes in Inflammatory Bowel Disease Patients With a History of Low Grade Dysplasia on White-Light Endoscopy," Tu1307 "Ensuring Quality of Information in an Era of Multidisciplinary Care: Compliance With Established Quality Indicators for the Initial Endoscopic Assessment of Esophageal Cancer Patients," Tu1036 Since its founding in 1941, the American Society for Gastrointestinal Endoscopy (ASGE) has been dedicated to advancing patient care and digestive health by promoting excellence and innovation in gastrointestinal endoscopy. ASGE, with more than 15,000 members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy, and is the foremost resource for endoscopic education. Visit http://www. and http://www. for more information and to find a qualified doctor in your area. Endoscopy is performed by specially-trained physicians called endoscopists using the most current technology to diagnose and treat diseases of the gastrointestinal tract. Using flexible, thin tubes called endoscopes, endoscopists can access the human digestive tract without incisions via natural orifices. Endoscopes are designed with high-intensity lighting and fitted with precision devices that allow viewing and treatment of the gastrointestinal system. Digestive Disease Week® (DDW®) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Society for Gastrointestinal Endoscopy (ASGE), American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA) Institute and the Society for Surgery of the Alimentary Tract (SSAT), DDW takes place May 6 - 9, 2017, at McCormick Place, Chicago, Illinois. The meeting showcases more than 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology. More information can be found at http://www. .

Bruno S.,A.O. Fatebenefratelli e Oftalmico | Crosignani A.,University of Sao Paulo | Facciotto C.,A.O. Fatebenefratelli e Oftalmico | Rossi S.,A.O. Fatebenefratelli e Oftalmico | And 5 more authors.
Hepatology | Year: 2010

The incidence of de novo development of esophageal varices (EV) in patients with compensated liver cirrhosis has been determined by few studies in the short term and never in the long term. The aims of the present study were to determine the incidence and the risk factors associated with the development of EV and to assess whether antiviral treatment and achievement of sustained virologic response (SVR) may prevent de novo EV development in patients with HCV-induced cirrhosis. We studied 218 patients with compensated EV-free, HCV-induced cirrhosis consecutively enrolled between 1989 and 1992 at three referral centers in Milan, Italy. Endoscopic surveillance was performed at 3-year intervals according to international guidelines. SVR was defined as undetectable serum HCV-RNA 24 weeks after treatment discontinuation. During a median follow-up of 11.4 years, 149/218 (68%) patients received antiviral treatment and 34 (22.8%) achieved SVR. None of the SVR patients developed EV compared with 22 (31.8%) of the 69 untreated subjects (P < 0.0001) and 45 (39.1%) of the 115 non-SVR patients (P < 0.0001). On multivariate analysis, HCV genotype 1b (hazard ratio [HR] 2.40; 95% confidence interval [CI] 1.17-4.90) and baseline model for end-stage liver disease (MELD) score (HR 1.20; 95% CI 1.07-1.35 for 1 point increase) were independent predictors of EV. Conclusion: In the long term, the achievement of SVR prevents the development of EV in patients with compensated HCV-induced cirrhosis. Therefore, in these patients, endoscopic surveillance can be safely delayed or avoided. Genotype 1b infection and MELD score identify the subset of patients at higher risk of EV development who need tailored endoscopic surveillance. Copyright © 2010 by the American Association for the Study of Liver Diseases.

Monkemuller K.,Endoscopy Unit | Monkemuller K.,Marienhospital | Peter S.,Endoscopy Unit | Toshniwal J.,Marienhospital | And 5 more authors.
Digestive Endoscopy | Year: 2014

Background and Aim The 'bear-claw' or over-the-scope-clip system (OTSC; Ovesco Endoscopy, Tübingen, Germany) is a new clipping device developed for closure of large luminal gastrointestinal (GI) defects. The aim of the present study was to evaluate the clinical outcomes of patients treated with the OTSC. Methods The present study was an observational, open-label, retrospective, single-arm case series conducted at two hospitals with tertiary care endoscopy. It involved 20 clip applications in 16 patients (median age 65.8 years [range 51-90 years], seven women) with GI defects from fistulas and anastomotic dehiscence and peptic ulcer bleeding. Results The range of indications included gastrointestinal bleeding (n=6), gastrocutaneous fistulas (n=3), esophagotracheal and/or esophagopleural fistulae (n=3), resection ofsubmucosal tumor (n=2), stent fixation (n=1), and anastomotic leak after esophagectomy (n=1). The overall success rate for the OTSC device was 75% (12 out of 16 patients). The overall per case success rate was 70% (14 of 20 applications). Mean follow up was 10 months (range 1-10). There were no complications (0%) related to endoscopy, sedation or application of the clipping device. Conclusions The OTSC system is a useful device in a variety of clinical scenarios including the management of larger GI leaks and fistulas, GI bleeding, full-thickness resection of tumors, and stent anchoring, even in very old and frail patients. © 2013 Japan Gastroenterological Endoscopy Society.

Ustundag Y.,Zonguldak Karaelmas University | Saritas U.,Medikal Park Hospital | Ponchon T.,Endoscopy Unit
Turkish Journal of Gastroenterology | Year: 2011

Small caliber endoscopes are one of the best examples of fantastic technological advancements in gastrointestinal endoscopy. First designed for pediatric patients in the 1970s, current small caliber videoendoscopes were used for unsedated transnasal gastrointestinal endoscopy after 1994. Nowadays, unsedated endoscopy can be successfully done using small caliber endoscopes via transoral or transnasal route in nearly 90% of cases. Several large studies have shown that small caliber endoscopy is feasible, safe and well-tolerated. These devices can decrease the potential risks of upper gastrointestinal endoscopy by eliminating the need for sedation since these ultrathin endoscopes induce much less gag reflex or choking sensation in patients. Moreover, gastrointestinal endoscopy with small caliber endoscopes results in less sympathetic system activation as well as less oxygen desaturation compared to standard endoscopy, especially in aged, severely ill, bedridden patients. Nevertheless, there is no overall consensus on its cost effectiveness. Though indications are similar with standard endoscopy, small caliber endoscopy can be preferred in patients with gastrointestinal stenosis. Less common indications include transnasal endoscopic retrograde cholangiography and postpyloric feeding tube insertion. The esophagogastroduodenoscopy procedure with small caliber endoscopes is easy to perform, and there is generally no need for further training for this technique. However, the additional cost of equipment and some medicolegal and technical issues have resulted in the unpopularity of small caliber endoscopy in most countries other than France and Japan. However, sharing information about this technique and stressing its potential advantages can help in its widespread use in various countries including Turkey. We believe that routine use of small caliber endoscopes during daily gastrointestinal endoscopy practice is not far away in many countries.

Pilotto A.,Geriatric Unit and Gerontology Geriatrics Research Laboratory | Franceschi M.,Endoscopy Unit | Maggi S.,CNR Institute of Neuroscience | Addante F.,Geriatric Unit and Gerontology Geriatrics Research Laboratory | Sancarlo D.,Geriatric Unit and Gerontology Geriatrics Research Laboratory
Drugs and Aging | Year: 2010

Recent data report that the incidence of peptic ulcer is decreasing in the general population; conversely, the rates of gastric and duodenal ulcer hospitalization and mortality remain very high in older patients. Two major factors that might explain this epidemiological feature in the elderly population are the high prevalence of Helicobacter pylori infection and the increasing prescriptions of gastroduodenal damaging drugs, including NSAIDs andor aspirin (acetylsalicylic acid). The main goals for treating peptic ulcer disease in old age are to reduce recurrence of the disease and to prevent complications, especially bleeding and perforation. The available treatments for peptic ulcer are essentially based on gastric acid suppression with antisecretory drugs and the eradication of H. pylori infection. The aim of this article is to report the available data on clinical efficacy and tolerability of peptic ulcer treatments in elderly patients and provide recommendations for their optimal use in this special population.Proton pump inhibitor (PPI)-based triple therapies for 7 days are highly effective for the cure of H. pylori-positive peptic ulcers as well as for reducing ulcer recurrence. Antisecretory drugs are also the treatment of choice for NSAID- or aspirin-related peptic ulcers and are useful as preventive therapy in chronic users of NSAIDs and low-dose aspirin as antiplatelet therapy. Antisecretory PPI therapy has a favourable tolerability profile in geriatric patients; however, monitoring is suggested in older patients with frequent pulmonary infections, gastrointestinal malabsorption, unexplained chronic diarrhoea, osteoporosis or those taking concomitant cytochrome P450 2C19-metabolized medications.The overall approach to the geriatric patient should include a comprehensive geriatric assessment that ensures multidimensional evaluation of the patient in order to better define the clinical risk of adverse outcomes in the older patient with peptic ulcer and its complications. © 2010 Adis Data Information BV. All rights reserved.

Seehofer D.,Charite Campus Virchow | Seehofer D.,Endoscopy Unit | Eurich D.,Charite Campus Virchow | Eurich D.,Endoscopy Unit | And 4 more authors.
American Journal of Transplantation | Year: 2013

Due to a vulnerable blood supply of the bile ducts, biliary complications are a major source of morbidity after liver transplantation (LT). Manifestation is either seen at the anastomotic region or at multiple locations of the donor biliary system, termed as nonanastomotic biliary strictures. Major risk factors include old donor age, marginal grafts and prolonged ischemia time. Moreover, partial LT or living donor liver transplantation (LDLT) and donation after cardiac death (DCD) bear a markedly higher risk of biliary complications. Especially accumulation of several risk factors is critical and should be avoided. Prophylaxis is still a major issue; however no gold standard is established so far, since many risk factors cannot be influenced directly. The diagnostic workup is mostly started with noninvasive imaging studies namely MRI and MRCP, but direct cholangiography still remains the gold standard. Especially nonanastomotic strictures require a multidisciplinary treatment approach. The primary management of anastomotic strictures is mainly interventional. However, surgical revision is finally indicated in a significant number of cases. Using adequate treatment algorithms, a very high success rate can be achieved in anastomotic complications, but in nonanastomotic strictures a relevant number of graft failures are still inevitable. Prevention and treatment of anastomotic and non-anastomotic biliary complications become increasingly important in liver transplantation, since these mainly occur after transplantation from living donors, marginal donors, or non-heart-beating donors, which represent a large part of liver transplantation in many countries. © Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons.

Swan M.P.,Endoscopy Unit | Moore G.T.C.,Endoscopy Unit | Sievert W.,Endoscopy Unit | Devonshire D.A.,Endoscopy Unit
Gastrointestinal Endoscopy | Year: 2010

Background: Chronic radiation proctitis (CRP) manifests as rectal bleeding 12 to 24 months after pelvic radiotherapy. No criterion standard of treatment has been established, although argon plasma coagulation (APC) has increasingly become the treatment of choice. Previous studies have applied APC over multiple sessions, necessitating increased numbers of treatments. Objective: To assess the safety and efficacy of large-volume APC application in the treatment of CRP with the intention of a single-session treatment protocol. Design: Prospective study. Setting: Tertiary referral hospital. Patients: Over an 8-year period, consecutive patients with CRP with rectal bleeding were prospectively enrolled. Intervention: Large-volume APC application to affected rectal mucosa. Main Outcome Measurements: Number of treatments, bleeding scores, complications. Results: Fifty patients (mean age 72.1 years; range 51-87 years) were treated; 45 were men (prostate cancer). The mean period between radiotherapy and initial APC treatment was 23 months (range 4-140 months). Seventeen (34%) patients had grade A endoscopic severity, 23 (46%) grade B, and 10 (20%) grade C. Other therapies failed in 16 (32%) patients. The mean number of treatments was 1.36 (range 1-3) with a mean follow-up of 20.6 months (range 6-48 months). Sixty-eight percent of patients were successfully treated after 1 session and 96% after 2 sessions. Bleeding scores improved in all patients (P < .001). Seventeen (34%) patients experienced short-term, self-limiting complications; 1 (2%) patient experienced a long-term complication. Limitations: Nonrandomized study. Conclusions: Large-volume APC treatment was successful in the treatment of CRP, including those in whom other therapies had previously failed, and resulted in a decreased number of treatments compared with other published studies. The benefits were offset by an increased incidence of short-term complications but no increase in long-term complications. © 2010 American Society for Gastrointestinal Endoscopy.

Da Costa M.,Endoscopy Unit | Mata A.,Endoscopy Unit | Espinos J.,Endoscopy Unit | Vila V.,Endoscopy Unit | And 3 more authors.
Obesity Surgery | Year: 2011

Background and aims: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the most frequent technique performed in bariatric surgery. Gastrojejunal anastomotic stricture is one of the most common postoperative complications. The aims of this study were to evaluate the efficacy and safety of endoscopic balloon dilation in the treatment of the gastrojejunal anastomotic strictures after LRYGB and to look for predicting factors that would indicate the need of repeated dilations. Methods: We included all patients with morbid obesity who underwent a LRYGB at our institution between January 2002 and July 2007. All patients who developed symptoms compatible with stricture of the gastrojejunostomy were referred to upper gastrointestinal endoscopy and underwent endoscopic balloon dilation. Results: One hundred and five out of the 1,330 patients (7.8%) developed an anastomotic stricture. The mean time to diagnosis was 3 months after the surgery. The mean diameter of the stricture was 5 mm. Sixty out of the 105 patients required only one dilation (57%), 29 required two dilations (27,6%), 13 required three dilations, and 3 patients underwent a fourth dilation. Clinical success was achieved in 100% of the cases, with an average of 1.6 dilations. The statistical analysis showed that only the time from surgery to stricture formation (p∈=∈0.007) and the diameter achieved at the first dilation (p∈=∈0.015) had statistical significance as predictors of the need of one or more dilations. Conclusions: Endoscopic balloon dilation is a safe and effective method. Most of the patients are successfully managed with one or two dilations. The longer time from surgery to the appearance of symptoms ant the largest diameter achieved at the first dilation are the only predicting factors of success with only one dilation. © 2010 Springer Science + Business Media, LLC.

Fabbri C.,AUSL Bologna Bellaria Maggiore Hospital | Luigiano C.,AUSL Bologna Bellaria Maggiore Hospital | Cennamo V.,University of Bologna | Polifemo A.M.,AUSL Bologna Bellaria Maggiore Hospital | And 5 more authors.
Endoscopy | Year: 2012

Endoscopic ultrasound-guided transmural drainage (EUS-GTD) has become the standard procedure for treating symptomatic pancreatic fluid collections. The aim of this series was to evaluate the efficacy and safety of covered self-expanding metal stent (CSEMS) placement for treating infected pancreatic fluid collections. From January 2007 to May 2010, 22 patients (18 M/4F; mean age 56.9) with infected pancreatic fluid collections (mean size, 13.2 cm) at two Italian centers were evaluated for EUS-GTD. In 20 of the 22 patients, EUS-GTD with CSEMS placement was indicated. Early complications occurred in two patients: one patient developed a superinfection, which was managed conservatively, and one experienced stent migration and superinfection, and was managed surgically. The CSEMSs were removed without difficulty in 18 patients after a median of 26 days, while stent removal failed in one patient due to inflammatory tissue ingrowth; instead it was removed during surgery performed for renal cancer. Clinical success was achieved without additional intervention in 17 patients during a mean follow-up of 610 days; only one symptomatic recurrence was observed. In our experience, EUS-GTD with CSEMS placement appears safe for the treatment of infected pancreatic fluid collections. © Georg Thieme Verlag KG Stuttgart New York.

Gornals J.B.,Hospital Universitari Of Bellvitge Idibell Bellvitge Biomedical Research Institute | Gornals J.B.,Hospital Universitari Of Bellvitge | De La Serna-Higuera C.,Rio Hortega Hospital | Sanchez-Yague A.,Endoscopy Unit | And 3 more authors.
Surgical Endoscopy and Other Interventional Techniques | Year: 2013

Background: The purpose of this study is to report our initial experience with a new fully covered metallic stent with a novel design (AXIOS) to prevent migration and fluid leakage, in the drainage of pancreatic fluid collections (PFC). Methods: We included nine patients from four Spanish centers undergoing endoscopic ultrasound (EUS)-guided drainage of PFC with placement of an AXIOS stent. The lesions were accessed via transgastric (n = 7), transesophageal (n = 1), and transduodenal (n = 1) by using a novel access device (NAVIX) in six cases or a 19-G needle in three. Patients were individually followed prospectively for procedure indications, demographic data, previous imaging techniques, technical aspects, clinical outcomes, complications, and follow-up after endoscopic drainage. Results: The mean size of lesions was 105 ± 26.3 mm (range, 70-150). In six cases, cystoscopy was performed through the stent, including necrosectomy in two. Median procedure time was 25 ± 13 min. A median number of two sessions were performed. The technical success rate was 88.8 % (8/9) due to one failure of the delivery system. One patient developed a tension pneumothorax immediately after transesophageal drainage. No migrations were reported, and all stents were removed easily. All patients had a successful treatment outcome achieving complete cyst resolution. Mean time to stent retrieval was 33 ± 40 days. Mean follow-up was 50 ± 1.3 weeks (range, 45-55), and only one patient presented a recurrence 4 weeks after the stent removal. Furthermore, comparison with ten previous consecutively recruited PFC cases drained by EUS-guided using plastic pigtail stents was done. Technical and clinical successes were similar. However, two stent migrations, two recurrences, and two complications were found. The number of stents used (n = 15) and the median procedure time (42.8 ± 3.1 min) were significantly higher. Conclusions: Drainage of PFC using dedicated devices as this novel metallic stent with special design seems to be an effective, feasible and safe alternative technique. © 2012 Springer Science+Business Media New York.

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