Ja Kidwell

Mucosal iodine staining improves endoscopic visualization of squamous dysplasia and squamous cell carcinoma of the esophagus in linxian, china

In previous studies in the high risk population of Linxian, China, the majority of foci of high grade (moderate and severe) squamous dysplasia (HGD) and invasive squamous carcinoma (CA) of the esophagus were associated with endoscopically visible lesions that could be targeted for biopsy, but some foci of HGD were missed by routine endoscopic examination. This study examined whether spraying the mucosa with Lugols iodine solution, which stains normal epithelium brown but leaves dysplasia and carcinoma unstained, could improve endoscopic detection and delineation of these lesions.

Tissue band ligation followed by snare resection (band and snare): A new technique for tissue acquisition in the esophagus

echoendoscopy), use of easy and safe techniques for mucosectomy, careful histologic analysis of resected specimens, close follow-up, and cont inuous oncologic reassessment . REFERENCES 1. Nakamura K, Sugano H. Microcarcinoma of the stomach measuring less than 5 mm in the largest diameter and its histogenesis. Thirteenth International Cancer Congress, Part D: research and treatment. New York: Alan R Liss, Inc., 1983: 107-16. 2. Kudo S, Hayashi T, Miura K, et al. The clinicopathological features of flat and depressed types of early colorectal cancer. Stomach and Intestine 1989;24:317-29. 3. Tada M, Shimada M, Yanai H, et al. A new technique of gastric biopsy. Stomach and Intestine 1984;17:1107-16. 4. Inoue H, Takeshita K, Hori H, et al. Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach and colon mucosal lesions. Gastrointest Endosc 1993;39:58-61. 5. Chaves DM, Sakai P, Mester M, et al. A new endoscopic technique for the resection of flat polypoid lesions. Gastrointest Endosc 1994;40:224-6. 6. Stieg~nann GV, Cambre T, Sun JH. A new endoscopic elastic band ligation device. Gastrointest Endosc 1986;32:230-3. 7. Takekoshi T, Baba Y, Ota H, et al. Endoscopic resection of early gastric carcinoma: results of a retrospective analysis of 308 cases. Endoscopy 1994;26:352-8. 8. Amouyal G, Amouyal P. Echoendoscopie digestive pratique. Paris: Editions Medicales MSD, 1992:40-54.

Prospective evaluation of complications in an endoscopy unit: use of the A/S/G/E quality care guidelines

In 1989, the American Society for Gastrointestinal Endoscopy released a quality assurance monograph in which a procedure review process was outlined. The major elements of the program for quality assurance in gastrointestinal endoscopy included: (1) procedure reports, (2) an endoscopic unit record, and (3) a procedure review. This study was designed to use the procedure review process to determine the incidence of complications, to identify quality assurance issues, and to determine whether audits and/or studies would result from this process. To make a meaningful interpretation as to what constitutes an important complication, a classification to define potential problems was established. Using this classification, a complication was identified in 64 of 3287 procedures (1.9%). These complications were discussed in a monthly morbidity and mortality conference. Additionally, 21 quality assurance issues were identified that led to four studies addressing these quality assurance issues.

Limited benefit of atropine as premedication for colonoscopy

A prospective double-blind trial was performed comparing atropine (0.5 mg) by slow intravenous administration to placebo as premedication for colonoscopy, to assess the possible beneficial effects of this vagolytic agent on the performance and safety of the procedure. A total of 77 patients was randomly assigned to receive atropine (38 patients) or placebo (39 patients) before colonoscopy in conjunction with our standard initial medications for conscious sedation (meperidine, 0.4 mg/kg and midazolam, 0.03 mg/kg). Total procedure time was 31 min for the atropine group and 35 min for the placebo group (p greater than 0.05), and there was no overall difference in the total amount of intra-procedural medications required. No statistically significant differences were observed relative to the number or severity of vagal episodes, and neither the endoscopist nor the patients noted any differences in the ease or tolerance of the procedure (p greater than 0.05). Although these results fail to demonstrate a significant benefit of atropine when given routinely as premedication for colonoscopy, this study does not rule out the potential usefulness of atropine in counteracting vagal episodes when they occur.