148 results found
Glover B, Teare J, Patel N, 2019, A Review of New and Emerging Techniques For Optical Diagnosis of Colonic Polyps., J Clin Gastroenterol, Vol: 53, Pages: 495-506
BACKGROUND AND AIMS: Endoscopic imaging is a rapidly progressing field and benefits from miniaturization of advanced imaging technologies, which may allow accurate real-time characterization of lesions. The concept of the "optical biopsy" to predict polyp histology has gained prominence in recent years and may become clinically applicable with the advent of new imaging technology. This review aims to discuss current evidence and examine the emerging technologies as applied to the optical diagnosis of colorectal polyps. METHODS: A structured literature search and review has been carried out of the evidence for diagnostic accuracy of image-enhanced endoscopy and emerging endoscopic imaging technologies. The image-enhanced endoscopy techniques are reviewed, including their basic scientific principles and current evidence for effectiveness. These include the established image-enhancement technologies such as narrow-band imaging, i-scan, and Fuji intelligent chromoendoscopy. More recent technologies including optical enhancement, blue laser imaging, and linked color imaging are discussed. Adjunctive imaging techniques in current clinical use are discussed, such as autofluorescence imaging and endocytoscopy. The emerging advanced imaging techniques are reviewed, including confocal laser endomicroscopy, optical coherence tomography, and Raman spectroscopy. CONCLUSIONS: Large studies of the established image-enhancement techniques show some role for the optical diagnosis of polyp histology, although results have been mixed, and at present only the technique of narrow-band imaging is appropriate for the diagnosis of low-risk polyps when used by an expert operator. Other image-enhancement techniques will require further study to validate their accuracy but show potential to support the use of a "resect-and-discard" approach to low-risk polyps. New technologies show exciting potential for real-time diagnosis, but further clinical studies in humans have yet
Radhakrishnan ST, Ruban A, Uthayakumar AK, et al., Haemolytic Uraemic Syndrome - a rare case report of bloody diarrhoea in adults, BMC Gastroenterology, ISSN: 1471-230X
Background: Haemolytic uraemic syndrome is a rarely seen in adults often leading to critical illness.This case highlights how difficult it can be to establish a diagnosis and treat when a patient presentswith bloody diarrhoea.Case Presentation: A 17-year-old Iraqi man presented to the emergency department with abdominalpain and bloody diarrhoea. He was initially treated as acute appendicitis, undergoing anappendectomy but following a recurrence in his symptoms a colonoscopy was performed. Adiagnosis of shiga toxin-producing Escherichia coli leading to HUS was suspected following histologyobtained at colonoscopy and this was confirmed on antibody testing. Despite intravenous fluids andsupportive therapy the patient's symptoms and condition deteriorated. He developed seizures andacute renal failure requiring intubation and plasma exchange in the intensive care setting. Heeventually required treatment with ecluzimab therapy; a monoclonal antibody and subsequentlymade a full recovery.Conclusions: Haemolytic uraemic syndrome is a triad of progressive renal failure, thrombocytopeniaand haemolytic anaemia which is a condition rarely seen in adults. It is usually associated with an E.coli infection and supportive therapy remains the mainstay of treatment.
Glover B, Teare J, Patel N, A systematic review of the role of non-magnified endoscopy for the assessment of H. pylori infection., Endoscopy International Open, ISSN: 2196-9736
BackgroundThere is growing interest in the endoscopic recognition of H. pylori infection, and application to routine practice. We present a systematic review of the current literature regarding diagnosis of H. pylori during standard (non-magnified) endoscopy, including adjuncts such as image enhancement and computer-aided diagnosis.MethodThe Medline and Cochrane databases were searched for studies investigating the performance of non-magnified optical diagnosis for H. pylori, or those which characterised mucosal features associated with H. pylori infection. Studies were preferred with a validated reference test as the comparator, although were included if at least one validated reference test was used.Results20 suitable studies were identified and included for analysis. In total, 4,703 patients underwent investigation including white light endoscopy, narrow band imaging, i-scan, blue-laser imaging, and computer-aided diagnostic techniques. The endoscopic features of H. pylori infection observed using each modality are discussed and diagnostic accuracies reported. The Regular Arrangement of Collecting Venules (RAC) is an important predictor of the H. pylori naïve stomach. ‘Mosaic’ and ‘Mottled’ patterns have a positive association with H. pylori infection. The ‘Cracked’ pattern may be a predictor of an H. pylori negative stomach following eradication.ConclusionsThis review summarises the current progress made in endoscopic diagnosis of H. pylori infection. At present there is no single diagnostic approach that provides validated diagnostic accuracy. Further prospective studies are required, as is the development of a validated classification system. Early studies in Computer-Aided Diagnosis suggest potential for a high level of accuracy but real-time results are awaited.
Scott AJ, Alexander JL, Merrifield CA, et al., 2019, International Cancer Microbiome Consortium consensus statement on the role of the human microbiome in carcinogenesis, Gut, ISSN: 0017-5749
Objective In this consensus statement, an international panel of experts deliver their opinions on key questions regarding the contribution of the human microbiome to carcinogenesis.Design International experts in oncology and/or microbiome research were approached by personal communication to form a panel. A structured, iterative, methodology based around a 1-day roundtable discussion was employed to derive expert consensus on key questions in microbiome-oncology research.Results Some 18 experts convened for the roundtable discussion and five key questions were identified regarding: (1) the relevance of dysbiosis/an altered gut microbiome to carcinogenesis; (2) potential mechanisms of microbiota-induced carcinogenesis; (3) conceptual frameworks describing how the human microbiome may drive carcinogenesis; (4) causation versus association; and (5) future directions for research in the field.The panel considered that, despite mechanistic and supporting evidence from animal and human studies, there is currently no direct evidence that the human commensal microbiome is a key determinant in the aetiopathogenesis of cancer. The panel cited the lack of large longitudinal, cohort studies as a principal deciding factor and agreed that this should be a future research priority. However, while acknowledging gaps in the evidence, expert opinion was that the microbiome, alongside environmental factors and an epigenetically/genetically vulnerable host, represents one apex of a tripartite, multidirectional interactome that drives carcinogenesis.Conclusion Data from longitudinal cohort studies are needed to confirm the role of the human microbiome as a key driver in the aetiopathogenesis of cancer.
Obesity is a major health and economic crisis facing the modern world. It is associated with excess mortality and morbidity and is directly linked to common conditions such as type 2 diabetes mellitus, coronary heart disease and sleep apnoea. The management of obesity and its associated complications has evolved in recent years, with a shift towards more definitive strategies such as bariatric surgery. This review encompasses the dietary, pharmacological and surgical strategies currently available for the management of obesity.
Glover B, Patel N, Teare J, et al., 2019, Diagnostic accuracy of i-scan image enhancement for real-time endoscopic diagnosis of small colorectal polyps: a meta-analysis, Therapeutic Advances in Gastroenterology, Vol: 11, ISSN: 1756-2848
Objective:i-Scan is a digital image enhancement technology, reported to improve diagnostic performance during endoscopy. Previous studies have investigated the accuracy of i-scan for distinguishing between neoplastic and non-neoplastic colonic polyps and suggested diagnostic accuracy close to that required for use in routine clinical practice. The aim of this study was to perform a meta-analysis of the available literature investigating diagnostic accuracy for i-scan optical diagnosis when made in real time for colorectal polyps <10 mm in size.
Alexander JL, Scott AJ, Pouncey AL, et al., 2018, Colorectal carcinogenesis: an archetype of gut microbiota-host interaction, Ecancermedicalscience, Vol: 12, ISSN: 1754-6605
Sporadic colorectal cancer (CRC) remains a major cause of worldwide mortality. Epidemiological evidence of markedly increased risk in populations that migrate to Western countries, or adopt their lifestyle, suggests that CRC is a disease whose aetiology is defined primarily by interactions between the host and his environment. The gut microbiome sits directly at this interface and is now increasingly recognised as a modulator of colorectal carcinogenesis. Bacteria such as Fusobacterium nucleatum and Escherichia coli (E. Coli) are found in abundance in patients with CRC and have been shown in experimental studies to promote neoplasia. A whole armamentarium of bacteria-derived oncogenic mechanisms has been defined, including the subversion of apoptosis and the production of genotoxins and pro-inflammatory factors. But the microbiota may also be protective: for example, they are implicated in the metabolism of dietary fibre to produce butyrate, a short chain fatty acid, which is anti-inflammatory and anti-carcinogenic. Indeed, although our understanding of this immensely complex, highly individualised and multi-faceted relationship is expanding rapidly, many questions remain: Can we define friends and foes, and drivers and passengers? What are the critical functions of the microbiota in the context of colorectal neoplasia?
Ruban A, Ashrafian H, Teare JP, 2018, The EndoBarrier: Duodenal-Jejunal Bypass Liner for Diabetes and Weight Loss, GASTROENTEROLOGY RESEARCH AND PRACTICE, Vol: 2018, ISSN: 1687-6121
The rapid rise of obesity and type 2 diabetes poses a global threat to healthcare and is a major cause of mortality and morbidity. Bariatric surgery has revolutionised the treatment of both these conditions but is invasive and associated with an increased risk of complications. The EndoBarrier is a device placed endoscopically in the duodenum, which is designed to mimic the effects of gastric bypass surgery with the aim of inducing weight loss and improving glycaemic control. This review outlines the current clinical evidence of the device, its efficacy, potential mechanisms of action, and utility in clinical practice.
Patel N, Mohanaruban A, Ashrafian H, et al., 2018, EndoBarrier®: a safe and effective novel treatment for obesity and type 2 diabetes?, Obesity Surgery, Vol: 28, Pages: 1980-1989, ISSN: 0960-8923
BACKGROUND AND AIMS: Obesity associated with diabetes mellitus is a significant worldwide problem associated with considerable health care costs. Whilst surgical intervention is effective, it is invasive, costly and associated with complications. This study aims to evaluate the safety and efficacy of the EndoBarrier®, a duodenal-jejunal sleeve bypass as an alternative treatment of diabetes mellitus in obese patients. MATERIALS AND METHODS: This was a multi-centre, non-randomised trial recruiting obese patients with type 2 diabetes from three sites in the UK. Eligible participants had a BMI of 30-50 kg/m2and HbA1c levels of 7.5-10%. The study comprised a 12-month period with the EndoBarrier® inserted and a 6-month follow-up period after it had been explanted. The primary study outcomes were weight, BMI, HbA1c levels and fasting insulin and glucose levels. RESULTS: Forty-five patients were recruited and 31 patients (69%) completed the 12-month study period. Significant reductions in weight (95%CI 0.62-29.38; p < 0.05) and BMI (95%CI 1.1-8.7; p < 0.005) were documented 12 months after device insertion. The mean HbA1c was significantly reduced (95%CI 0.1-1.6; p < 0.05) after the device insertion period and reductions in metabolic parameters (fasting insulin and glucose levels) were also documented during the study. Adverse events were also assessed in all patients, the vast majority of which were reported as mild. CONCLUSIONS: The EndoBarrier® appears to be a safe and effective treatment strategy in overweight patients with poor glycaemic control despite medical therapy, or in those who are eligible but decline bariatric surgery.
Ruban A, Uthayakumar A, Ashrafian H, et al., Endoscopic interventions in the treatment of obesity and diabetes, Digestive Diseases and Sciences, ISSN: 1573-2568
Alexander JL, Scott A, Poynter LR, et al., 2018, THE COLORECTAL CANCER MUCOSAL MICROBIOME IS DEFINED BY DISEASE STAGE AND THE TUMOUR METABONOME, Annual Meeting of the American-Society-for-Gastrointestinal-Endoscopy / Digestive Disease Week, Publisher: W B SAUNDERS CO-ELSEVIER INC, Pages: S415-S415, ISSN: 0016-5085
Alexander JL, Scott A, Poynter LR, et al., 2018, Sa1840 - The colorectal cancer mucosal microbiome is defined by disease stage and the tumour metabonome, Digestive Disease Week 2018, Publisher: Elsevier, Pages: S415-S415, ISSN: 0016-5085
Glaysher M, Mohanaruban A, Prechtl CG, et al., 2017, A randomised controlled trial of a duodenal-jejunal bypass sleeve device (EndoBarrier) compared with standard medical therapy for the management of obese subjects with type 2 diabetes mellitus, BMJ Open, Vol: 7, ISSN: 2044-6055
Introduction The prevalence of obesity and obesity-related diseases, including type 2 diabetes mellitus (T2DM), is increasing. Exclusion of the foregut, as occurs in Roux-en-Y gastric bypass, has a key role in the metabolic improvements that occur following bariatric surgery, which are independent of weight loss. Endoscopically placed duodenal-jejunal bypass sleeve devices, such as the EndoBarrier (GI Dynamics, Lexington, Massachusetts, USA), have been designed to create an impermeable barrier between chyme exiting the stomach and the mucosa of the duodenum and proximal jejunum. The non-surgical and reversible nature of these devices represents an attractive therapeutic option for patients with obesity and T2DM by potentially improving glycaemic control and reducing their weight.Methods and analysis In this multicentre, randomised, controlled, non-blinded trial, male and female patients aged 18–65 years with a body mass index 30–50 kg/m2 and inadequately controlled T2DM on oral antihyperglycaemic medications (glycosylated haemoglobin (HbA1c) 58–97 mmol/mol) will be randomised in a 1:1 ratio to receive either the EndoBarrier device (n=80) for 12 months or conventional medical therapy, diet and exercise (n=80). The primary outcome measure will be a reduction in HbA1c by 20% at 12 months. Secondary outcome measures will include percentage weight loss, change in cardiovascular risk factors and medications, quality of life, cost, quality-adjusted life years accrued and adverse events. Three additional subgroups will investigate the mechanisms behind the effect of the EndoBarrier device, looking at changes in gut hormones, metabolites, bile acids, microbiome, food hedonics and preferences, taste, brain reward system responses to food, eating and addictive behaviours, body fat content, insulin sensitivity, and intestinal tissue gene expression.
Mohanaruban A, Patel N, Ashrafian H, et al., 2017, ENDOBARRIER (R) : A SAFE AND EFFECTIVE NOVEL TREATMENT FOR OBESITY AND TYPE 2 DIABETES?, Annual General Meeting of the British-Society-of-Gastroenterology (BSG), Publisher: BMJ PUBLISHING GROUP, ISSN: 0017-5749
Introduction Obesity is a modern pandemic. One of the major complications of obesity is the development of diabetes which leads to considerable mortality, morbidity and enormous health care costs.1The EndoBarrier is an endoscopically implantable duodenal-jejunal sleeve bypass (DJSB); anchored in the duodenum, preventing ingested food from coming into contact with the proximal intestine and induces weight loss and improvement in glycaemic control. The aim of this prospective study was to assess the safety and efficacy of the EndoBarrier in obese patients with type 2 diabetes.Method This was a non-randomised study conducted at three investigational sites (Southampton, London, and Manchester) over an 18 month period with clinical and biochemical assessments carried out at 3 monthly intervals. The device was implanted for 12 months with 6 months follow up. All patients were obese with poorly controlled diabetes. Adverse events were recorded and statistical analysis was performed.Results A total of 45 subjects were enrolled into the studyAt 12 months following implant:1) HbA1c significantly reduced from baseline at 0.8% below the mean at baseline (95% CI 0.1–1.6; p<0.05).2) Mean weight loss was 15 kg (95% CI 0.62–29.38; p<0.05)3) BMI was reduced by 4.9kg/m2 (95% CI 1.1–8.7; p<0.005).14 patients withdrew from the study, 6 required premature EndoBarrier removal. Of these, only 2 patients presented with device related complications (device migration and gastrointestinal bleeding), the others withdrew due to unrelated medical adverse events.Conclusion The EndoBarrier appears to be a safe and effective treatment strategy in those who are overweight and have poor glycaemic control despite medical therapy, or in those who are eligible but decline bariatric surgery. Larger randomised controlled trials with longer follow-up periods post-explant of the device need to be performed to investigate the device’s effect
Alexander J, Perdones-Montero A, Scott A, et al., 2017, A PROSPECTIVE MULTI-NATIONAL STUDY OF THE COLORECTAL CANCER MUCOSAL MICROBIOME REVEALS SPECIFIC TAXONOMIC CHANGES INDICATIVE OF DISEASE STAGE AND PROGNOSIS, Annual General Meeting of the British-Society-of-Gastroenterology (BSG), Publisher: BMJ PUBLISHING GROUP, Pages: A32-A33, ISSN: 0017-5749
Alexander J, Poynter L, Scott A, et al., 2017, A prospective multi-centered analysis of the rectal cancer mucosal microbiome during neoadjuvant long course chemoradiotherapy, Annual Scientific Meeting of the American Society of Colon and Rectal Surgeons, Publisher: Lippincott, Williams & Wilkins, Pages: E118-E118, ISSN: 0012-3706
Kinross JM, Alexander J, Perdones-Monter A, et al., 2017, A Prospective Multi-National Study of the Colorectal Cancer Mucosal Microbiome Reveals Specific Taxonomic Changes Indicative of Disease Stage and Prognosis, DDW
Mylonas G, patel N, teare J, et al., 2017, CYCLOPS: An endoscope attachment for Endoscopic Submucosal Dissection, SAGES 2017 Annual Meeting
Alexander JL, Wilson ID, Teare J, et al., 2017, Gut microbiota modulation of chemotherapy efficacy and toxicity., Nat Rev Gastroenterol Hepatol, Vol: 14, Pages: 356-365
Evidence is growing that the gut microbiota modulates the host response to chemotherapeutic drugs, with three main clinical outcomes: facilitation of drug efficacy; abrogation and compromise of anticancer effects; and mediation of toxicity. The implication is that gut microbiota are critical to the development of personalized cancer treatment strategies and, therefore, a greater insight into prokaryotic co-metabolism of chemotherapeutic drugs is now required. This thinking is based on evidence from human, animal and in vitro studies that gut bacteria are intimately linked to the pharmacological effects of chemotherapies (5-fluorouracil, cyclophosphamide, irinotecan, oxaliplatin, gemcitabine, methotrexate) and novel targeted immunotherapies such as anti-PD-L1 and anti-CLTA-4 therapies. The gut microbiota modulate these agents through key mechanisms, structured as the 'TIMER' mechanistic framework: Translocation, Immunomodulation, Metabolism, Enzymatic degradation, and Reduced diversity and ecological variation. The gut microbiota can now, therefore, be targeted to improve efficacy and reduce the toxicity of current chemotherapy agents. In this Review, we outline the implications of pharmacomicrobiomics in cancer therapeutics and define how the microbiota might be modified in clinical practice to improve efficacy and reduce the toxic burden of these compounds.
Clancy NT, Elson DS, Teare J, 2017, Hyperspectral imaging of colonic polyps in vivo (Conference Presentation), Conference on Advanced Biomedical and Clinical Diagnostic and Surgical Guidance Systems XV, Publisher: SPIE-INT SOC OPTICAL ENGINEERING, ISSN: 0277-786X
Cundy TP, Burns EM, Cohen P, et al., 2016, Duplication cyst of the appendix: a proposal for modification of the Cave-Wallbridge classification., ANZ Journal of Surgery, Vol: 86, Pages: 731-732, ISSN: 1445-1433
Alexander J, Gildea L, Balog J, et al., 2016, A novel methodology for in vivo endoscopic phenotyping of colorectal cancer based on real-time analysis of the mucosal lipidome: a prospective observational study of the iKnife, Surgical Endoscopy and Other Interventional Techniques, Vol: 31, Pages: 1361-1370, ISSN: 1432-2218
Background:This pilot study assessed the diagnostic accuracy of rapid evaporative ionization mass spectrometry (REIMS) in colorectal cancer (CRC) and colonic adenomas.Methods:Patients undergoing elective surgical resection for CRC were recruited at St. Mary’s Hospital London and The Royal Marsden Hospital, UK. Ex vivo analysis was performed using a standard electrosurgery handpiece with aspiration of the electrosurgical aerosol to a Xevo G2-S iKnife QTof mass spectrometer (Waters Corporation). Histological examination was performed for validation purposes. Multivariate analysis was performed using principal component analysis and linear discriminant analysis in Matlab 2015a (Mathworks, Natick, MA). A modified REIMS endoscopic snare was developed (Medwork) and used prospectively in five patients to assess its feasibility during hot snare polypectomy.Results:Twenty-eight patients were recruited (12 males, median age 71, range 35–89). REIMS was able to reliably distinguish between cancer and normal adjacent mucosa (NAM) (AUC 0.96) and between NAM and adenoma (AUC 0.99). It had an overall accuracy of 94.4 % for the detection of cancer versus adenoma and an adenoma sensitivity of 78.6 % and specificity of 97.3 % (AUC 0.99) versus cancer. Long-chain phosphatidylserines (e.g., PS 22:0) and bacterial phosphatidylglycerols were over-expressed on cancer samples, while NAM was defined by raised plasmalogens and triacylglycerols expression and adenomas demonstrated an over-expression of ceramides. REIMS was able to classify samples according to tumor differentiation, tumor budding, lymphovascular invasion, extramural vascular invasion and lymph node micrometastases (AUC’s 0.88, 0.87, 0.83, 0.81 and 0.81, respectively). During endoscopic deployment, colonoscopic REIMS was able to detect target lipid species such as ceramides during hot snare polypectomy.Conclusion:REIMS demonstrates high diagnostic accuracy for tumor type and for established histological featur
Patel N, Alexander J, Ashrafian H, et al., 2016, Meta-analysis comparing differing methods of endoscopic therapy for colorectal lesions, WORLD JOURNAL OF META-ANALYSIS, Vol: 4, Pages: 44-54, ISSN: 2308-3840
Clancy NT, Teare J, Hanna GB, et al., Flexible Multimode Endoscope for Tissue Reflectance and Autofluorescence Hyperspectral Imaging, OSA Topical Meetings, Biomedical Optics
Patel N, Patel K, Ashrafian H, et al., 2016, Colorectal endoscopic submucosal dissection: Systematic review of mid-term clinical outcomes., Digestive Endoscopy, Vol: 28, Pages: 405-416, ISSN: 0915-5635
With a drive towards minimally invasive surgery, endoscopic submucosal dissection (ESD) is now gaining popularity. In a number of East Asian countries, ESD is now the treatment of choice for early non-metastatic gastric cancer, but the outcomes of ESD for colorectal lesions are unclear. The present review summarizes the mid-term outcomes of colorectal ESD including complication and recurrence rates. A systematic literature search was done in May 2014, identifying 20 publications reporting the outcomes of colorectal ESD which were included in this review. En-bloc resection rates, complete (R0) resection rates, endoscopic clearance rates, complication and recurrences rates were analyzed. Statistical pooling was done to calculate weighted means using random effects modeling. Twenty studies reporting the outcomes of 3060 colorectal ESD procedures were reported. Overall weighted en-bloc resection rate was 89% (95% CI: 83-94%), R0 resection rate 76% (95% CI: 69-83%), endoscopic clearance rate 94% (95% CI: 90-97%) and recurrence rate 1% (95% CI: 0.5-2%). Studies that followed up patients for over 1 year were found to have an en-bloc resection rate of 91% (95% CI: 86-96%), R0 resection rate of 81% (95% CI: 75-88%), endoscopic clearance rate 93% (95% CI: 90-97%) and recurrence rate of 0.8% (95% CI: 0.4-1%). Colorectal ESD can be carried out effectively and safely with a 1% recurrence rate. Further studies with longer follow-up periods are required to determine whether colorectal ESD is a viable alternative to conventional surgical therapy.
Alexander JL, Scott A, Mroz A, et al., 2016, Mass Spectrometry Imaging (MSI) of Microbiome-Metabolome Interactions in Colorectal Cancer, Digestive Disease Week (DDW), Publisher: W B SAUNDERS CO-ELSEVIER INC, Pages: S23-S23, ISSN: 0016-5085
Edmondson MJ, Pucher PH, Sriskandarajah K, et al., 2016, Looking towards objective quality evaluation in colonoscopy: Analysis of visual gaze patterns, JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Vol: 31, Pages: 604-609, ISSN: 0815-9319
Background and AimThere are currently limited training and assessment tools available to novice endoscopists. A potential tool for the objective assessment of endoscopist visual search strategy is eye‐tracking technology. The aim of this study is to assess whether eye‐tracking technology can be used to differentiate the visual gaze patterns (VGP) of experienced and novice endoscopists, and to characterize any differences arising between the two groups.MethodWith the use of portable eye‐tracking glasses, VGP of novice (n = 20) and experienced (n = 14) endoscopists were compared while viewing a colonoscopy withdrawal through the hepatic flexure. Analysis was performed by comparing the central versus peripheral distribution and the horizontal distribution of novice and experienced endoscopist fixations, along with comparison of basic eye‐tracking metrics.ResultsThis study found that experienced endoscopists had a significantly higher percentage of fixations within the periphery of the screen (13.4% vs 23.0%, P = 0.013). Experienced endoscopists also had a significantly greater percentage of fixations on the left side of the screen (18.6% vs 33.5%, P = 0.005) that displayed the poorly visualized “inside bend” of the hepatic flexure.ConclusionThis study has detailed specific VGP acquired through expertise, which can potentially explain why adenomas are regularly missed at the hepatic flexure during colonoscopy. These may be useful for the training of novice colonoscopists, and further validation may utilize VGP in the development of an objective proficiency based curriculum to improve the detection of pathology and overall quality in endoscopy.
Penny HA, Mooney PD, Burden M, et al., 2016, High definition endoscopy with or without I-Scan increases the detection of celiac disease during routine endoscopy, Digestive and Liver Disease, Vol: 48, Pages: 644-649, ISSN: 1878-3562
BACKGROUND AND AIMS: Celiac disease remains underdiagnosed at endoscopy. We aimed to assess the utility of I-Scan (virtual chromo-endoscopy) to improve sensitivity of endoscopy to detect markers of villous atrophy in this condition. METHODS: Patients from 2 UK hospitals were studied in 3 groups. Group 1: standard high definition, white light endoscopy (WLE); Group 2: WLE plus I-Scan; Group 3: non-high definition control group. The presence of endoscopic markers was recorded. At least 4 duodenal biopsies were taken from all patients. Serology was performed concurrently and observations were compared with histology. RESULTS: 758 patients (62% female, mean age 52) were recruited (Group 1: 230; Group 2: 228; Group 3: 300). 135 (17.8%) new diagnoses of coeliac disease were made (21 Group 1; 24 Group 2; 89 Group 3). The sensitivity for detection of endoscopic markers of villous atrophy was significantly higher in both Group 1 (85.7%, p=0.0004) and Group 2 (75%, p=0.005) compared to non-high definition controls (41.6%). There was no significant difference between high definition only and I-Scan groups (p=0.47). In non-high definition endoscopy a missed diagnosis was associated with lesser degrees of villous atrophy (p=0.019) and low tTG titre (p=0.007). CONCLUSIONS: High definition endoscopy with or without I-Scan increases the detection of celiac disease during routine endoscopy.
Patel N, Seneci CA, Shang J, et al., 2015, Evaluation of a novel flexible snake robot for endoluminal surgery, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 29, Pages: 3349-3355, ISSN: 0930-2794
Teare J, Le Roux CW, Chiquette E, et al., 2015, Metabolic improvements observed in subjects receiving EndoBarrier: a pooled analysis of clinical trials, 51st Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), Publisher: SPRINGER, Pages: S304-S305, ISSN: 0012-186X
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