10 research outputs found
Motion training on a validated mechanical ERCP simulator improves novice endoscopist performance of selective cannulation: a multicenter trial
No full textBackground and study aims Current data show that traditional training methods in endoscopic retrograde cholangiopancreatography (ERCP) fall short of producing competent trainees. We aimed to evaluate whether a novel approach to simulator-based training might improve the learning curve for novice endoscopists training in ERCP.Methods We conducted a multicenter, randomized controlled trial using a validated mechanical simulator (the Bokoski-Costamagna trainer). Trainees with no experience in ERCP received either standard cannulation training or motion training before undergoing standard cannulation training on the mechanical simulator. Trainees were timed and graded on their performance in selective cannulation of four different papilla configurations.Results Thirty-six trainees (16 in the motion training group, 20 in the standard group) performed 720 timed attempts at cannulating the bile duct on the simulator. Successful cannulation was achieved in 698 of 720 attempts (96.9%), with no significant difference between the two study groups ( P =0.37). Trainees in the motion training group had significantly lower median cannulation times compared to the standard group (36 vs. 48 seconds, P =0.001) and better technical performance on the first papilla type ( P =0.013).Conclusions Our findings suggest that motion training could be an innovative method aimed at accelerating the learning curve of novice trainees in the early phase of their training. Future studies are needed to establish its role in ERCP training programs
Combined Use of Clips and Nylon Snare (“Tulip-Bundle”) as a Rescue Endoscopic Bleeding Control in a Mallory-Weiss Syndrome
No full textMallory-Weiss syndrome (MWS) accounts for 6–14% of all cases of upper gastrointestinal bleeding. Prognosis of patients with MWS is generally good, with a benign course and rare recurrence of bleeding. However, no strict recommendations exist in regard to the mode of action after a failure of primary endoscopic hemostasis. We report a case of an 83-year-old male with MWS and rebleeding after the initial endoscopic treatment with epinephrine and clips. The final endoscopic control of bleeding was achieved by a combined application of clips and a nylon snare in a “tulip-bundle” fashion. The patient had an uneventful postprocedural clinical course and was discharged from the hospital five days later. To the best of our knowledge, this is the first case report showing the “tulip-bundle” technique as a rescue endoscopic bleeding control in the esophagus
Pharmaceutical principles of acid inhibitors: unmet needs
No full textDespite the well-established benefits of currently approved delayed-release proton pump inhibitors (PPIs) in the treatment of acid-related diseases, the unmet needs are still present and although often frustrating, they challenge clinicians. The unmet needs relate to the lack of complete control of acid secretion with oral PPI administration in the management of patients with gastroesophageal symptoms. These substantial groups of patients, who do not respond completely to standard doses of PPIs, are nonresponders, and their lack of response should be considered as PPI failure. Several mechanisms could explain PPI failure: differences in pharmacokinetics, PPI formulation, dosing time and diet, noncompliance, transient lower esophageal sphincter relaxations, esophageal hypersensitivity, and nocturnal acid breakthrough. To increase the quality of life of these patients and avoid multiple medical consultations and unnecessary investigations, we have to go one step forward and use combined therapy or look towards new treatments beyond acid suppression
Endoscopic ligation ("Loop-And-Let-Go") is effective treatment for large colonic lipomas: a prospective validation study
No full textBACKGROUND:
Colonic lipomas (CL) are rare benign adipose tumours usually found incidentally during colonoscopy. Endoscopic resection of symptomatic large CL remains controversial, since significant rates of perforation have been reported. In recent years, a novel technique for removal of large CL has been described, consisting of looping and ligating the lipoma with a nylon snare. The aim of our study was to evaluate the safety and efficacy of the "loop and let go" technique for large colon lipomas in a large case series. ----- METHODS:
Consecutive patients referred to our institution for colonoscopy were eligible for the study. The diagnosis of CL was confirmed endoscopically by "pillow" and "naked fat" signs. Following diagnosis, lipomas were looped and ligated by endoloop. Follow-up colonoscopies were scheduled at 1- and 3-months interval. ----- RESULTS:
A total of 11 patients with large CL were enrolled in study. The indications for the colonoscopy included altered bowel habits (7 patients, 64%), screening for colorectal neoplasm (3 pts, 27%) and lower gastrointestinal bleeding (1 pts, 9%). The median lesion size was 3 cm (range 2,5-6 cm). Lesions were located at the hepatic flexure in 4 patients (36%), cecum and ascending colon (4 pts, 36%), rectosigmoid (2 pts, 18%) and transverse colon (1 pts, 9%). There were no immediate and late complications. On follow-up (median follow-up time 11.9 months, range 8-24), there was one small residual lipoma (<1 cm). ----- CONCLUSION:
The results of this study confirm that "loop-and-let-go" technique is safe and efficacious treatment of large colonic lipomas
Дизайн печатного издания «В арбузном сахаре» по мотивам романа Ричарда Бротигана
No full text"ЭТО ВХОД
В ЗАБЫТЫЕ ДЕЛА!
ОСТОРОЖНО!
МОЖНО ПОТЕРЯТЬСЯ!"
В своем романе "В арбузном сахаре" Ричард Бротиган рассказывает о быте и повседневной жизни людей в мире из арбузного сахара. Знакомство читателя с причудами "нововещественной" Вселенной происходит в парадигме повествования от первого лица. Фактически книга представляет собой дневник-расследование о жизни рассказчика, "инкрустированной" в весьма специфичный сюжет.
Однако главной идеей данного проекта становится не иллюстрирование хронологической цепочки событий или определенной образной системы-романа. Основной замысел состоит как раз в том, чтобы отказаться от нарратива, предлагаемого автором, показав собственно мир из арбузного сахара, а не историю, происходящую в нем. И вместе с тем важно отринуть семантические маркеры: своим названием новые вещи восходят лишь к прообразу, к Идее, но никак не к понятию.
Таким образом, разработанное издание представляет собой карту абстрактных графических образов, практически лишенных семантики.
Книга-настроение, книга-бред, книга-мечта.
Уже не дневник-расследование, а своего рода книга-исследование: насколько сильное и понятное зрителю Впечатление о мире из нового Вещества – "арбузного сахара" – возможно передать с помощью беспредметных композиций?"THIS IS THE ENTRANCE
TO THE FORGOTTEN WORKS
BE CAREFUL
YOU MIGHT GET LOST"
In his novel "In Watermelon Sugar", Richard Brautigan depicts the daily life of people in the world of watermelon sugar. The reader is introduced to the peculiarities of the new-mattered Universe in the first-person narrative paradigm. In fact, the book is an investigative diary about the life of the narrator, encrusted in a very specific plot.
However, the main idea of this project is not to illustrate a chronological chain of events or a certain system of images of the novel. The intention is to abandon the narrative proposed by the author, showing the actual world of watermelon sugar, and not the story that takes place in its framework. And at the same time, it is important to abandon any semantic markers: with their names, new things go back only to their prototype, to the Idea, but not to the concept itself.
Thus, this printed matter is a map of abstract graphic images, almost devoid of semantics.
A mood-book, a delirium-book, a dream-book.
No longer an investigative diary, but a kind of book-research: how vivid and understandable of an Impression of the world created from the new Matter - "watermelon sugar" - can be conveyed to the reader through the help of non-objective compositions
A pilot study of transrectal endoscopic ultrasound elastography in inflammatory bowel disease
No full textBACKGROUND:
Using standard diagnostic algorithms it is not always possible to establish the correct phenotype of inflammatory bowel
disease which is essential for therapeutical decisions. Endoscopic ultrasound elastography is a new endoscopic procedure
which can differentiate the stiffness of normal and pathological tissue by ultrasound. Therefore, we aimed to investigate
the role of transrectal ultrasound elastography in distiction between Crohn's disease and ulcerative colitis. ----- METHODS:
A total 30 Crohn's disease, 25 ulcerative colitis, and 28 non-inflammatory bowel disease controls were included. Transrectal
ultrasound elastography was performed in all patients and controls. In all ulcerative coltis patients and 80% of Crohn's
disease patients endoscopy was performed to assess disease activity in the rectum. ----- RESULTS:
Significant difference in rectal wall thickness and strain ratio was detected between patients with Crohn's disease and
controls (p = 0.0001). CD patients with active disease had higher strain ratio than patients in remission (p = 0.02). In
ulcerative colitis group a significant difference in rectal wall thickness was found between controls and patients with
active disease (p = 0.03). A significant difference in rectal wall thickness (p = 0.02) and strain ratio (p = 0.0001) was
detected between Crohn's disease and ulcerative colitis patient group. Crohn's disease patients with active disease had a
significantly higher strain ratio compared to ulcerative colitis patients with active disease (p = 0.0001). ----- CONCLUSION:
Transrectal ultrasound elastography seems to be a promising new diagnostic tool in the field of inflammatory bowel
disease. Further study on a larger cohort of patients is needed to definitely assess the role of transrectal ultrasound
elastography in inflammatory bowel disease
Performance measures for endoscopy services: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative
No full textThe European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology present a list of key performance measures for endoscopy services. We recommend that these performance measures be adopted by all endoscopy services across Europe. The measures include those related to the leadership, organization, and delivery of the service, as well as those associated with the patient journey. Each measure includes a recommendation for a minimum and target standard for endoscopy services to achieve. We recommend that all stakeholders in endoscopy take note of these ESGE endoscopy services performance measures to accelerate their adoption and implementation. Stakeholders include patients and their advocacy groups; service leaders; staff, including endoscopists; professional societies; payers; and regulators.sponsorship: The authors gratefully acknowledge the contributions from: Dr. Stuart Gittens, ECD Solutions in the development and running of the web platform; Iwona Escreet and all at Hamilton Services for project administrative support; Debbie Johnston, Craic Consultancy Ltd, for support creating the minimum and target standards; the Scottish Intercollegiate Guidelines Network for hosting the critical appraisal module; and the Research Foundation-Flanders (FWO) for providing funding for Professor Raf Bisschops; also thank you to all members of the wider working group who attended meetings, participated in discussions, and voted on the measures including Bamakhrama K. (UAE), Fretwell I. (UK), Hamoudi W. (Jordan), Kariis T. (Estonia), Lauri A. (Italy), Madacsy L. (Hungary), Narra Figueiredo P. (Portugal), Nashat A. (Egypt), Ormeci N. (Turkey), Paraskeva K. (Greece), Patchett S. (Ireland), Stefanovic M. (Slovenia), Wurm Johansson G.G. (Sweden), Seebach L. (Switzerland), Stirna D. (Latvia); Nurses: Bakic B. (Croatia), Beilenhoff U. (Germany), Christensen J. S. (Denmark), Jorgensen A. (Norway), Martisen K. (Norway), Petraki S. (Greece); Patient representative: Gore-Booth J. (France -EuropaColon). United European Gastroenterology (UEG) supplied co-funding and additional project governance to this endeavor. (Research Foundation-Flanders (FWO), United European Gastroenterology (UEG))status: Publishe
