David Zagalsky

Electromagnetic interference with implantable cardiac pacemakers by video capsule

BACKGROUND Electromagnetic fields, such as those generated by cellular phones and metal detectors, may interfere with normal pacemaker function. However, it remains unclear whether the wireless capsule endoscope interacts with implanted pacemakers. This prospective study evaluated potential interactions between the M2A video capsule (Given Imaging, Yoknam, Israel) and implanted pacemakers. METHODS A total of 100 consecutive patients (70 men, 30 women) with an implanted pacemaker (95 on bipolar mode) were studied. The testing was performed with a functional testing device (Test Cap) for the Given Diagnostic System that reproduces the effect of the video capsule by transmitting at exactly the same frequency. During continuous electrocardiographic monitoring and recording, 100 tests were carried out without changing the pacemaker settings. Those with a positive result were retested 1 week later. RESULTS The 100 pacemakers evaluated in the study population included the following: 70 dual chamber (11 DDD, 56 DDDR, 3 VDD) and 30 ventricular inhibited (12 VVI, 18 VVIR). In 4 of the 100 patients, pacemaker interference (noise-mode function forcing a synchronous mode) was registered during the Test Cap operation. Three patients had a dual-chamber pacemaker, and one had a single-chamber pacemaker. The interference was reproducible in all cases 1 week later. None of the implanted pacemakers tested was affected by oversensing. CONCLUSIONS Electromagnetic interferences with pacemakers from the M2A video capsule can occur, but this is without clinical significance. No potentially dangerous pacemaker inhibition was observed.

Early precut is as efficient as pancreatic stent in preventing post-ERCP pancreatitis in high-risk subjects: a randomized study

BACKGROUND The most common adverse event of endoscopic retrograde cholangiopancreatography is pancreatitis. Precut sphincterotomy has been regarded as a risk factor. Some authors have stated that early precut may actually reduce post-ERCP pancreatitis risk. However, early precut as a preventive measure has not been compared to other preventive measures, such as pancreatic duct stent placement. AIM To compare the efficacy of early precut sphincterotomy versus pancreatic duct stent placement in high-risk subjects undergoing endoscopic retrograde cholangiopancreatography for the prevention of post-endoscopic cholangiopancreatography. MATERIALS AND METHODS This was a single-blinded, randomized trial that took place in two tertiary referral centers in Buenos Aires, from November 2011 to December 2013. ERCP subjects presented at least one of the following risk factors: female sex, age less than 40 years, clinical suspicion of sphincter of Oddi dysfunction, previous pancreatitis, and/or common bile duct diameter of less than 8 mm. Only those who presented a difficult biliary cannulation were randomized into two groups: those who received early precut sphincterotomy and those in whom persistency of biliary cannulation was intended, with subsequent pancreatic duct stent placement after cholangiography was achieved. The incidence of post-ERCP pancreatitis, as well as other adverse events incidence, was compared. RESULTS Overall, 101 patients were enrolled, 51 in the pancreatic duct stent group and 50 in the early precut group. Pancreatitis rate was similar in both groups (3.92% vs 4%, p NS). In all cases, pancreatitis was classified as mild. There were no deaths registered. CONCLUSION Early precut was associated with an incidence of adverse events similar to pancreatic duct stent placement.

Su1613 Reuse of Medical Devices Labeled for Single Use: Accepting and Overcoming a Need As a Cost-Saving Measure in an ERCP Unit

ablation length and microscopic maximal injury depth of 10 watts using 33mm RFA electrode is significantly longer and deeper than 7 watts using 18mm electrode (24.3 2.0 vs. 18.5 3.3 mm,pZ0.015; 2.93 0.67 vs. 2.05 0.27 mm, pZ0.002). Microscopic ablation area(microscopic ablation length x maximal injury depth) of 10 watts is also significantly larger than 7 watts (55.0 13.3 vs. 36.5 8.0 mm, pZ0.015). However, there are no statistically differences of macroscopic/microscopic ablation related parameters according to target temperatures. In addition, the assessment of resected specimen at 24 hour after RFA did not show any perforation or bleeding. Conclusion: Endobiliary radiofrequency ablation with novel RFA catheter (ELRA ) successfully ablates the normal bile duct wall without complications in vivo swine model. The optimal power setting of radiofrequency ablation was 7-10 watts at target temperature of 75-80 C for 2 minutes. Further prospective human clinical studies are warranted in order to validate the effectiveness of EB-RFA treatment in patients with malignant biliary obstruction. Efficacy of endobiliary RFA according to power and electrode length Table 1. Patient Rad Category Fluoroscopic Time, min

Flat lesion detection as a surrogate for colonoscopy quality.

We read with interest the article by Reinhart et al. [1] on the prevalence of colonic flat lesions, their malignant potential, and the correlation between flat polyps and adenoma detection rate (ADR). Much attention has focused on the reduction of colonic lesion miss rates. It is true, as the authors highlighted, that the ADR has gained a pivotal role as a colonoscopy quality index [2]. However, other quality measures, such as polyp detection rate, have been proposed [3]. The main advantage of the polyp detection rate is that its calculation is easier for the endoscopist because it does not require the histopathology of the lesion to be known. In a similar fashion, flat polyp detection rate (FPDR) seems to be a practical colonoscopic quality index. However, the authors showed that the FPDR correlated weaklywith the ADR. This fact is noteworthy because a better correlation could be expected. As flat polyps can be frequently overlooked, their detection would imply a thorough examination of the colonic mucosa; thus, the more flat lesions an endoscopist finds, the better the examination of the colonic mucosa. Moreover, FPDR calculation does not require the histology of the lesion to be known, making it easier to calculate in everyday practice. More evidence may be necessary in order to confirm the findings of the authors on the performance of FPDR as a colonoscopy quality index.