Evgeny Fedorov

Standardized endoscopic reporting

The need for standardized language is increasingly obvious, also within gastrointestinal endoscopy. A systematic approach to the description of endoscopic findings is vital for the development of a universal language, but systematic also means structured, and structure is inherently a challenge when presented as an alternative to the normal spoken word.

Development of an E-learning System for the Endoscopic Diagnosis of Early Gastric Cancer: An International Multicenter Randomized Controlled Trial

Background In many countries, gastric cancer is not diagnosed until an advanced stage. An Internet-based e-learning system to improve the ability of endoscopists to diagnose gastric cancer at an early stage was developed and was evaluated for its effectiveness. Methods The study was designed as a randomized controlled trial. After receiving a pre-test, participants were randomly allocated to either an e-learning or non-e-learning group. Only those in the e-learning group gained access to the e-learning system. Two months after the pre-test, both groups received a post-test. The primary endpoint was the difference between the two groups regarding the rate of improvement of their test results. Findings 515 endoscopists from 35 countries were assessed for eligibility, and 332 were enrolled in the study, with 166 allocated to each group. Of these, 151 participants in the e-learning group and 144 in the non-e-learning group were included in the analysis. The mean improvement rate (standard deviation) in the e-learning and non-e-learning groups was 1·24 (0·26) and 1·00 (0·16), respectively (P < 0·001). Interpretation This global study clearly demonstrated the efficacy of an e-learning system to expand knowledge and provide invaluable experience regarding the endoscopic detection of early gastric cancer (R000012039).

Endoscopic removal of a giant double-headed fibrovascular esophageal polyp

re 1. A, Upper-GI endoscopic view of giant fibrovascular polyp arising from the upper esophagus just near the level of the cricopharyngeus. Note submucosal appearance that occupies approximately the whole esophagus and has a smooth overlying mucosa of the body. B-E, General scheme of emoval of the giant esophageal fibrovascular polyp. B, C, Two endoloops, one after another, applied at the level of the ramification of the polyp body. first portion of the polyp is cut. D, E, Another 2 endoloops are placed at the very base of the stalk and securely tightened. The remaining portion of olyp is resected. F, First nylon endoloop is placed at the level of the ramification of the polyp body and tightened securely. The scope is then anged for a double-channel therapeutic gastroscope. Grasping forceps are used to manipulate the polyp in view of the difficulty of placing the edempolyp through the second loop. G, Resection of the first 75-mm portion of the giant fibrovascular polyp above 2 endoloops in endocut mode with 5-mm electrosurgical snare. H, The second loop is applied right over the first loop and tightened strongly, mainly to prevent possible profuse ing and perforation. The second portion of the polyp is removed above the loops. Resected giant fibrovascular polyp. I, Overall appearance of polyp. length, 13,5 cm; distal head, 32 mm in diameter with 2 ulcerations on the apex; proximal head, 25 mm in diameter. J, Cross-section at the level of the of the polyp, 18 mm in diameter (note the large vessels). K, Ligated 10-mm stalk stump of the polyp left in place. L, M, Histologic appearance ing mixture of fibrous and adipose tissues accompanied by abundant network of large vessels, covered by normal squamous epithelium. &E, orig. mag. 5; M, H&E, orig. mag. 20.) N, Surveillance gastroscopic view at 18 months revealing no changes of esophageal wall and mucosa, no evidence of recurrence.

Quality of colonoscopy in an emerging country: A prospective, multicentre study in Russia

Background The quality of colonoscopy has been related to a higher risk of interval cancer, and this issue has been addressed extensively in developed countries. The aim of our study was to explore the main quality indicators of colonoscopy in a large emerging country. Methods Consecutive patients referred for colonoscopy in 14 centres were prospectively included between July and October 2014. Before colonoscopy, several clinical and demographic variables were collected. Main quality indicators (i.e. caecal intubation rate, (advanced) adenoma detection rate, rate of adequate cleansing and sedation) were collected. Data were analysed at per patient and per centre level (only for those with at least 100 cases). Factors associated with caecal intubation rate and adenoma detection rate were explored at multivariate analysis. Results A total of 8829 (males: 35%; mean age: 57 + 14 years) patients were included, with 11 centres enrolling at least 100 patients. Screening (including non-alarm symptoms) accounted for 59% (5188/8829) of the indications. Sedation and split preparation were used in 26% (2294/8829) and 25% (2187/8829) of the patients. Caecal intubation was achieved in 7616 patients (86%), and it was ≥85% in 8/11 (73%) centres. Adenoma detection rate was 18% (1550/8829), and it was higher than 20% in five (45%) centres, whilst it was lower than 10% in four (33%) centres. At multivariate analysis, age (OR: 1.020, 95% CI: 1.015–1.024), male sex (OR: 1.2, 95% CI: 1.1–1.3), alarm symptoms (OR: 1.8, 95% CI: 1.7–2), split preparation (OR: 1.4, 95% CI: 1.2–1.6), caecal intubation rate (OR: 1.6, 95% CI: 1.3–1.9) and withdrawal time measurement (OR: 1.2, 95% CI: 1.6–2.1) were predictors of a higher adenoma detection rate, while adequate preparation (OR: 3.4: 95% CI: 2.9–3.9) and sedation (OR: 1.3; 95% CI: 1.1–1.6) were the strongest predictors of caecal intubation rate. Conclusions According to our study, there is a substantial intercentre variability in the main quality indicators. Overall, the caecal intubation rate appears to be acceptable in most centres, whilst the overall level of adenoma detection appears low, with less than half of the centres being higher than 20%. Educational and quality assurance programs, including higher rates of sedation and split regimen of preparation, may be necessary to increase the key quality indicators.

International core curriculum for capsule endoscopy training courses

Capsule endoscopy (CE) has become a first-line noninvasive tool for visualisation of the small bowel (SB) and is being increasingly used for investigation of the colon. The European Society of Gastrointestinal Endoscopy (ESGE) guidelines have specified requirements for the clinical applications of CE. However, there are no standardized recommendations yet for CE training courses in Europe. The following suggestions in this curriculum are based on the experience of European CE training courses directors. It is suggested that 12 hours be dedicated for either a small bowel capsule endoscopy (SBCE) or a colon capsule endoscopy (CCE) course with 4 hours for an introductory CCE course delivered in conjunction with SBCE courses. SBCE courses should include state-of-the-art lectures on indications, contraindications, complications, patient management and hardware and software use. Procedural issues require approximately 2 hours. For CCE courses 2.5 hours for theoretical lessons and 3.5 hours for procedural issued are considered appropriate. Hands-on training on reading and interpretation of CE cases using a personal computer (PC) for 1 or 2 delegates is recommended for both SBCE and CCE courses. A total of 6 hours hands-on session- time should be allocated. Cases in a SBCE course should cover SB bleeding, inflammatory bowel diseases (IBD), tumors and variants of normal and cases with various types of polyps covered in CCE courses. Standardization of the description of findings and generation of high-quality reports should be essential parts of the training. Courses should be followed by an assessment of traineesʼ skills in order to certify readers’ competency.