Jason D. Conway

Endoscopic mucosal resection and endoscopic submucosal dissection

The American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methods are used, with a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the ‘‘related articles’’ feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but in many cases data from randomized controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. For this review the MEDLINE database was searched through September 2007 by using the key words ‘‘endoscopic lesion removal,’’ ‘‘endoscopic mucosal resection,’’ ‘‘EMR,’’ ‘‘endoscopic submucosal dissection,’’ and ‘‘ESD.’’ Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the Governing Board of the ASGE. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment.

Endoscopic hemostatic devices

The American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, with a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (US Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the ‘‘related articles’’ feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but, in many cases, data from randomized, controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the Governing Board of the ASGE. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review, the MEDLINE database was searched through September 2008 for articles related to endoscopic hemostatic devices by using the keywords ‘‘multipolar electrocautery,’’ ‘‘bipolar electrocautery,’’ ‘‘heater probe,’’ ‘‘hemostatic grasper,’’ ‘‘argon plasma coagulator,’’ ‘‘injection needle,’’ ‘‘endoloop,’’ ‘‘clip,’’ paired with ‘‘complication,’’ ‘‘perforation,’’ ‘‘peptic ulcer disease,’’ ‘‘gastric antral vascular ectasia,’’ ‘‘Dieulafoy lesion,’’ ‘‘Mallory-Weiss tear,’’ ‘‘radiation induced angioectasias,’’ ‘‘diverticular bleeding,’’ ‘‘angiodysplasia,’’ and ‘‘postpolypectomy bleeding.’’ Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requir-

Confocal laser endomicroscopy

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Overtube use in gastrointestinal endoscopy.

The American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, with a MEDLINE literature search to identify pertinent clinical studies on the topic, and a MAUDE (Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the ‘‘related articles’’ feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but, in many cases, data from randomized controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the governing board of the ASGE. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review, the MEDLINE database was searched through March 2009 for articles related to overtube use in GI endoscopy by using the keywords overtube, intubation, enteral access, enteroscopy, and foreign bodies, paired with endoscopy, gastrointestinal. Practitioners should continue to monitor the medical literature for subsequent data about the efficacy, safety, and socioeconomic aspects of these technologies. Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment.

Diagnosis and Management of Gallbladder Polyps

Gallbladder polyps are frequently encountered on cross-sectional imaging, often in asymptomatic patients. Most are benign and of little clinical importance. However, some polyps do have a malignant potential. This article discusses the clinical presentation, diagnosis, and natural history of gallbladder polyps and risk factors for malignant polyps and indications for cholecystectomy.

Capsule endoscopy of the colon

The American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee provides reviews of emerging endoscopic technologies that have the potential to impact the practice of GI endoscopy. Evidence-based methodology is used, by performing a MEDLINE and PubMed literature search to identify pertinent clinical studies on the topic. Because many topics have limited peer-reviewed articles, abstracts from scientific meetings are used to supplement the review. The reports focus on the current status of the technologies, areas in need of further research, and barriers to incorporation into the mainstream practice of GI endoscopy. Reports on Emerging Technologies are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the governing board of the ASGE. These reports are scientific reviews provided solely for educational and informational purposes. Reports on Emerging Technologies are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment. Although the use of capsule endoscopy in the small bowel has become widespread, with a variety of accepted clinical indications, the dedicated application of these devices in the colon has only recently been undertaken. The use of capsule endoscopy in the colon has been proposed as an alternative colorectal cancer screening test and as a device to investigate patients for other forms of colorectal pathology. The PillCam Colon capsule (Given Imaging, Yoqneam, Israel) is the only capsule endoscope currently in use for colonic investigation. The U.S. Food and Drug Administration recently rejected the initial 510K application , but the device is available in Israel and parts of Eu-rope. The device has some technical differences from the small-bowel capsule from the same manufacturer. The capsule itself is 11  32 mm compared with the 11-mm  26-mm small-bowel device. There are video-capture components on both ends of the capsule, similar to that seen in the companys esophageal device. The optics provide an angle of view that is 21% wider than that found in the companys esophageal device, which permits greater imaging coverage of the larger cross-sectional diameter of the large intestine relative to the esophagus or the small bowel. The capsule captures images at a rate of 4 frames per second versus 2 frames per second for the small-bowel capsule. After initial activation, the colon capsule captures images for 5 minutes …

Biliary and pancreatic stone extraction devices

The American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is employed by using a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the ‘‘related articles’’ feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but in many cases data from randomized controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the governing board of the ASGE. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review the MEDLINE database was searched through February 2009 for articles related to endoscopy in patients with pancreatic and biliary stones requiring removal, by using the keywords choledocholithiasis, pancreaticolithiasis, stone, and extraction paired with ERCP, endoscopy, and gastrointestinal. Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment. Biliary and pancreatic duct stones are a major cause of morbidity. Choledocholithiasis, if left untreated, can lead to pain, cholangitis, gallstone pancreatitis, and secondary sclerosing cholangitis. Pancreatic stones, most commonly

Endoscopic retrieval devices

The American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, with a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (US Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the ‘‘related articles’’ feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but, in many cases, data from randomized, controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. For this review, the MEDLINE database was searched through September 2008 using the keywords ‘‘retrieval,’’ ‘‘retrieval device,’’ ‘‘extraction,’’ ‘‘endoscopic,’’ ‘‘gastrointestinal endoscopy,’’ and ‘‘foreign body.’’ The Science Direct search engine (www.ScienceDirect.com) was also used with the search terms ‘‘retrieval’’ and ‘‘foreign body.’’ The MAUDE database (http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/ cfMAUDE/TextSearch.cfm) was searched using text search mode for ‘‘retrieval,’’ ‘‘retrieval device,’’ and ‘‘foreign body.’’ Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the Governing Board of the ASGE. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment.

The yield of EUS‐FNA in undiagnosed upper abdominal adenopathy is very high

Endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA) allows sampling of abdominal adenopathy easily and safely from locations that were previously deemed too risky and inaccessible. The efficacy of EUS‐FNA in a large cohort of patients with abdominal adenopathy has not been previously described in the literature.

EUS and EUS-Guided Interventions Alter Clinical Management in Children With Digestive Diseases.

Objectives: Endoscopic ultrasound (EUS) ± fine needle aspiration (FNA) is a useful tool to evaluate gastrointestinal tract disorders in adults because of its established feasibility and safety. Its role in children has not been well established and continues to evolve. Our objective was to evaluate the utility and impact on clinical management of EUS and EUS-guided interventions in the pediatric population at our institution. Methods: Retrospective, single-center study including 43 patients undergoing EUS and EUS-FNA between August 2005 and January 2012. Results: Fifty-one EUS procedures were performed in 43 patients, 30 girls, median age 14.5 (range 4–18). The most common indications were suspected biliary obstruction in 11 of 51 (22%), pancreatic cysts in 10 of 51 (20%), acute or recurrent pancreatitis in 9 of 51 (18%), and abdominal pain in 8 of 51 (16%). The most common findings of EUS included normal 11 of 51 (22%), pancreas cyst 6 of 51 (12%), pancreatic pseudocyst 5 of 51 (10%), biliary system sludge or stones 9 of 51 (18%), and acute and chronic pancreatitis 5 of 51 (10%). EUS-FNA was performed in 13 cases: 7 solid masses or nodes, 4 pancreatic pseudocyst, 1 pancreatic cyst, and 1 celiac plexus block. FNA cyst drainage was successful in resolving all 4 pancreatic pseudocysts. EUS prompted a surgical procedure in 13 cases (25%), ERCP in 5 cases (10%), and repeat EUS in 5 cases (10%). EUS led to a new diagnosis in 34 of 43 (79%) patients and prompted further intervention in 24 of 51 (47%) procedures. Conclusions: In this large cohort study, we found that EUS and EUS-guided interventions assist in diagnosing and altering clinical management in pediatric patients and should be considered in cases with vexing pancreaticobiliary disorders.