James Egan

ASGE guideline: The role of endoscopy in the diagnosis and the management of cystic lesions and inflammatory fluid collections of the pancreas.

This is one of a series of statements discussing the utilization of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy prepared this text. In preparing this guideline, a MEDLINE literature search was performed and additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When little or no data exist from well-designed prospective trials, emphasis is given to results from large series and reports from recognized experts. Guidelines for appropriate utilization of endoscopy are based on a critical review of the available data and expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data appear Clinical consideration may justify a course of action at variance to these recommendations.

ASGE guideline: guidelines for credentialing and granting privileges for capsule endoscopy.

This is one of a series of statements discussing the utilization of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy prepared this text. In preparing this guideline, a MEDLINE literature search was performed and additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When little or no data exist from welldesigned prospective trials, emphasis is given to results from large series and reports from recognized experts. Guidelines for appropriate utilization of endoscopy are based on a critical review of the available data and expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data appear. Clinical consideration may justify a course of action at variance to these recommendations. This document is intended to provide the principles by which credentialing organizations may create policy and practical guidelines for granting privileges to perform capsule endoscopy. For information on credentialing for other endoscopic procedures, please refer to ‘‘Guidelines for Credentialing and Granting Privileges for Gastrointestinal Endoscopy.’’

Unsedated colonoscopy: patient characteristics and satisfaction in a community-based endoscopy unit

BACKGROUND Patients who have a colonoscopy performed in the United States are usually given moderate to deep sedation. OBJECTIVE We report our prospective experience with patients willing to have colonoscopy performed without analgesia or sedation. DESIGN From June 6, 2006, to December 7, 2006, a total of 2091 patients underwent colonoscopy in our ambulatory endoscopy unit and were offered their procedure with sedation or no sedation. SETTING Single-center outpatient ambulatory surgery unit. PATIENTS Consecutive patients who had colonoscopy in our outpatient unit, excluding those who had combined-procedure EGD and colonoscopy. INTERVENTIONS Patients who elected to start colonoscopy without medications could request medication at any point during the procedure. Those who requested medication received narcotics or benzodiazepines. MAIN OUTCOMES MEASUREMENTS Time to cecum, extent of examination, pain level experienced, and willingness to have the procedure with the same, more, or less medication in the future were evaluated. RESULTS A total of 578 patients (27.6%) chose to start without sedation; 470 of those (81.1%, 95% CI, 77.9%-89.3%) completed the examination without medication, 353 men (85%, 95% CI, 84.0%-90.5%) and 117 women (67%, 95% CI, 59.6%-73.4%). Cecal intubation was 1501 of 1512 (99.3%, 95% CI, 98.7%-99.6%) for medicated, 467 of 470 (99.4%, 95% CI, 98.1%-99.8%) for unsedated, and 107 of 108 (99.1%, 95% CI, 93.5%-99.5%) for those who were medicated during the procedure. A total of 458 of the 470 unsedated patients (97.4%, 95% CI, 95.6%-98.5%) were satisfied with their comfort level during the procedure and are willing to have their next colonoscopies without sedation. LIMITATIONS The study is not randomized or blinded. CONCLUSIONS Colonoscopy without sedation is feasible, effective, and well tolerated in a typical U. S. population.

Randomized, prospective study of cyanoacrylate injection, sclerotherapy, or rubber band ligation for endoscopic hemostasis of bleeding canine gastric varices

The purpose of this randomized, nonblinded study was to compare the effectiveness, safety, and technical ease of three different endoscopic techniques for the treatment of bleeding gastric varices in a canine model. Twenty dogs with large, bleeding gastric varices underwent endoscopic hemostasis with rubber band ligation, sclerotherapy, and cyanoacrylate injection. The time and number of attempts required to achieve definitive hemostasis were evaluated for each technique, and each method was assessed for ease of use. Ulceration rates, ulcer size and depth, and stigmata of ulcer hemorrhage were assessed at 1 week. Intravariceal sclerotherapy was the fastest and easiest to perform. Rubber band ligation was intermediate in technical ease, but it caused the largest and deepest ulcers and had the highest rates of stigmata of ulcer hemorrhage and secondary bleeding. Cyanoacrylate injection was the most cumbersome endoscopic method to perform. All three treatments were effective for controlling gastric variceal bleeding. Intravariceal sclerotherapy had the most favorable results overall because of its technical ease, efficacy, and modest complication rates.