Ken C. Trimble

Three-dimensional representation software as image enhancement tool in small-bowel capsule endoscopy: a feasibility study.

BACKGROUND Three-dimensional imaging in capsule endoscopy is not currently feasible due to hardware limitations. However, software algorithms that enable three-dimensional reconstruction in capsule endoscopy are available. METHODS Feasibility study. A phantom was designed to test the accuracy of three-dimensional reconstruction. Thereafter, 192 small-bowel capsule endoscopy images (of vascular: 50; inflammatory: 73; protruding structures: 69) were reviewed with the aid of a purpose-built three-dimensional reconstruction software. Seven endoscopists rated visualisation improved or non-improved. Subgroup analyses performed for diagnostic category, diagnosis, image surface morphology and colour and SBCE equipment used (PillCam(®) vs. MiroCam(®)). RESULTS Overall, phantom experiments showed that the three-dimensional reconstruction software was accurate at 90% of red, 70% of yellow and 45% of white phantom models. Enhanced visualisation for 56% of vascular, 23% of inflammatory and <10% of protruding structures was noted (P=0.007, 0.172 and 0.008, respectively). Furthermore, three-dimensional software application enhanced 53.7% of red, 21.8% of white, 17.3% of red and white, and 9.2% of images of lesions with colour similar to that of the surrounding mucosa, P<0.0001. CONCLUSIONS Application of a three-dimensional reconstruction software in capsule endoscopy leads to image enhancement for a significant proportion of vascular, but less so for inflammatory and protruding lesions. Until optics technology allows hardware-enabled three-dimensional reconstruction, it seems a plausible alternative.

Macroscopic findings in collagenous colitis: A multi-center, retrospective, observational cohort study

Background Collagenous colitis (CC) is by definition a histological diagnosis. However, colonoscopy often reveals characteristic endoscopic findings. The aim of this study was to evaluate the frequency and type of endoscopic findings in patients diagnosed with CC in 4 participating centers. Methods This was a retrospective study; the databases of 2 university hospitals in Edinburgh (Scotland) and Malmö (Sweden), and 2 district general hospitals in Tomelloso (Spain) and Gateshead (England) were interrogated for patients diagnosed with CC between May 2008 and August 2013. Endoscopy reports and images were retrieved and reviewed; data on lesions, sedation, bowel preparation and endoscopist experience were abstracted. Categorical data are reported as mean±SD. Fischer’s exact, chi-square and t (unpaired) tests were used to compare datasets. A two-tailed P-value of <0.05 was considered statistically significant. Results 607 patients (149 male, mean age 66.9±12.25 years) were diagnosed with CC. A total of 108/607 (17.8%) patients had one or more suggestive endoscopy findings: i.e., mucosal erythema/edema, 91/607 (15%); linear colonic mucosal defects, 12/607 (2%); or mucosal scarring, 5/607 (0.82%). For colonic mucosa erythema, there was no difference in the odds of finding erythema with the use of different bowel preparation methods (P=0.997). For colonic mucosal defects there was some evidence (P=0.005) that patients colonoscoped by experienced endoscopists had 87% less odds of developing such defects. Moreover, there was evidence that analgesia reduced the odds of developing mucosal defects by 84%. Conclusion A significant minority of patients with CC have endoscopic findings in colonoscopy. The description of such findings appears to be related to the endoscopist’s experience.

OC-025 The first report of the UK multicentre double balloon enteroscopy registry: broadening the international deep enteroscopy experience

Introduction Double balloon enteroscopy (DBE) has been a pivotal endoscopic technology, transforming the investigation and management of small bowel (SB) disorders by facilitating direct endoscopic access of the entire small bowel. Methods We report the initial experience of the UK multicentre registry (six centres) since the introduction of DBE in the UK in 2005. Results 550 cases (322 men) were performed. Mean age was 56 years (16–94 years). 189 cases were done under general anaesthesia, 361 cases done under conscious sedation. 372 cases were performed via the oral route, 175 were performed via the rectal route while three cases were performed via an ileostomy. Calculated mean depth of insertion was 270±80 cm and 190±75 cm for oral and rectal routes, respectively. Mean time taken to complete procedures was 74±20 min. Carbon dioxide was used as the insufflating gas in 344 cases while air was used in the remaining 206 cases. DBE was preceded by capsule endoscopy (CE) in 403 cases. Concordance of diagnoses at CE and DBE was 66% and the overall diagnostic yield for DBE was 61%. The indications and therapies applied at DBE are shown (Abstract 025). Significant lesions missed by CE but diagnosed by DBE included large vascular lesions, polyps and other small bowel tumours. Endoscopic therapy at DBE was applied in 38% of procedures. There were three reported complications (2 perforations and 1 acute coronary syndrome); all complications occurred during therapeutic procedures. The overall complication rate for DBE in the series was 0.5%, with a complication rate for therapeutic procedures of 1.4%. There were no cases of acute pancreatitis. Limitations to DBE procedures included patient intolerance, the presence of adhesions and poor bowel preparation. Abstract OC-025 Indications and endotherapy applied Indictn. Cases Indictn. Cases Endo. Rx Cases OGIB 347 Rx-en-Y 2 - - APC 147 CD 58 - - Plpectmy 36 Polyps 49 - - Dilation 18 Strictr. 36 - - DPEJ 7 ?Tumour 28 - - Endoclip 2 Coeliac 15 - - Thrombin 1 DPEJ 8 - - Intussus 4 - - Ret. CE 3 - - Conclusion The initial UK experience is favourable and echoes the results of other national series published to date, showing that DBE is a feasible and safe and endoscopic advancement that enhances the management of small bowel disorders.

RANDOMISED PROSPECTIVE TRIAL OF TRANSNASAL VS STANDARD UPPER DIAGNOSTIC ENDOSCOPY UNDER LOCAL ANAESTHETIC

Introduction Transnasal upper gastrointestinal endoscopy (TNE) using ultrathin endoscopes is considered less invasive, thus an attractive alternative, if not a first choice option, for diagnostic upper endoscopy. This is the first prospective, randomised study, in a UK population to assess tolerability, acceptability and quality of TNE, in comparison with standard upper endoscopy (SOGD) under local anaesthetic. Methods We prospectively recruited up to date 125 patients [59 male/66 female] mean age 57 years. The Fujinon EG530N (5.9 mm) and EG530WR (9.4 mm) endoscopes were used. The endoscopist and all patients completed detailed questionnaires regarding tolerability, acceptance and quality of each endoscopy using standard visual analogue scales (VAS). Oxygen saturation [SaO2], heart rate [HR] and systolic blood pressure [SBP] were recorded during procedure. SOGD group received O2 2 lt/min. Quality of biopsies was evaluated blindly by the reporting pathologists. Results Trial interim analysis included 129 endoscopies in 125 patients [TNE=65, SOGD=64]. In all patients intubation of D2 was achieved. VAS scores for patient comfort (higher score=greater comfort) were significantly better in the TNE compared to SOGD group (7 vs 5.6, respectively, p=0.0013). 40 patients had previous experience of standard endoscopy, and 22(55%) reported gagging as main reason of discomfort. 22/40 were randomised to TNE. 21 of these 22 patients [95.5%] stated preference to transnasal endoscopy in the future. Gagging score (higher score=more gagging) was significantly less in the TNE compared with SOGD group (0.05 vs 3.22 respectively, p2 (98 % vs 98.3%, respectively, p=0.22). Only 2 (5.4%) of TNE biopsies did not permit a definite diagnosis, but when standard biopsies were later taken, also failed to confirm diagnosis. Conclusion TNE is equal to SOGD in image quality, endoscope handling and length of procedure. It is superior to SOGD in the ability to perform a panendoscopy and in terms of comfort and patient acceptance. Importantly it induced significantly less stress to the heart, thus should be considered as the endoscopic diagnostic method of choice in patients with significant cardio-respiratory problems. Competing interests E Alexandridis conflict with: fellowship received from Fujinon, Imotech, K Trimble: None declared, P Hayes: None declared, J Plevris grant/research support from: Fujinon, Imotech, Conflict with: Fuji Provided Loan Equipment for trial.

THE FIRST REPORT OF THE UK MULTICENTRE DOUBLE BALLOON ENTEROSCOPY REGISTRY

Introduction Double balloon enteroscopy (DBE) has been a pivotal endoscopic technology, transforming the investigation and management of small bowel (SB) disorders by facilitating direct endoscopic access of the entire small bowel. Methods We report the initial experience of the UK multicentre registry (six centres) since the introduction of DBE in the UK in 2005. Results 550 cases (322 men) were performed. Mean age was 56 years (16–94 years). 189 cases were done under general anaesthesia, 361 cases done under conscious sedation. 372 cases were performed via the oral route, 175 were performed via the rectal route while three cases were performed via an ileostomy. Calculated mean depth of insertion was 270±80 cm and 190±75 cm for oral and rectal routes, respectively. Mean time taken to complete procedures was 74±20 min. Carbon dioxide was used as the insufflating gas in 344 cases while air was used in the remaining 206 cases. DBE was preceded by capsule endoscopy (CE) in 403 cases. Concordance of diagnoses at CE and DBE was 66% and the overall diagnostic yield for DBE was 61%. The indications and therapies applied at DBE are shown (Abstract 025). Significant lesions missed by CE but diagnosed by DBE included large vascular lesions, polyps and other small bowel tumours. Endoscopic therapy at DBE was applied in 38% of procedures. There were three reported complications (2 perforations and 1 acute coronary syndrome); all complications occurred during therapeutic procedures. The overall complication rate for DBE in the series was 0.5%, with a complication rate for therapeutic procedures of 1.4%. There were no cases of acute pancreatitis. Limitations to DBE procedures included patient intolerance, the presence of adhesions and poor bowel preparation. Abstract OC-025 Indications and endotherapy applied Indictn. Cases Indictn. Cases Endo. Rx Cases OGIB 347 Rx-en-Y 2 - - APC 147 CD 58 - - Plpectmy 36 Polyps 49 - - Dilation 18 Strictr. 36 - - DPEJ 7 ?Tumour 28 - - Endoclip 2 Coeliac 15 - - Thrombin 1 DPEJ 8 - - Intussus 4 - - Ret. CE 3 - - Conclusion The initial UK experience is favourable and echoes the results of other national series published to date, showing that DBE is a feasible and safe and endoscopic advancement that enhances the management of small bowel disorders.

OC-025 The first report of the UK multicentre double balloon enteroscopy registry: broadening the international deep enteroscopy experience: Abstract OC-025

Introduction Double balloon enteroscopy (DBE) has been a pivotal endoscopic technology, transforming the investigation and management of small bowel (SB) disorders by facilitating direct endoscopic access of the entire small bowel. Methods We report the initial experience of the UK multicentre registry (six centres) since the introduction of DBE in the UK in 2005. Results 550 cases (322 men) were performed. Mean age was 56 years (16–94 years). 189 cases were done under general anaesthesia, 361 cases done under conscious sedation. 372 cases were performed via the oral route, 175 were performed via the rectal route while three cases were performed via an ileostomy. Calculated mean depth of insertion was 270±80 cm and 190±75 cm for oral and rectal routes, respectively. Mean time taken to complete procedures was 74±20 min. Carbon dioxide was used as the insufflating gas in 344 cases while air was used in the remaining 206 cases. DBE was preceded by capsule endoscopy (CE) in 403 cases. Concordance of diagnoses at CE and DBE was 66% and the overall diagnostic yield for DBE was 61%. The indications and therapies applied at DBE are shown (Abstract 025). Significant lesions missed by CE but diagnosed by DBE included large vascular lesions, polyps and other small bowel tumours. Endoscopic therapy at DBE was applied in 38% of procedures. There were three reported complications (2 perforations and 1 acute coronary syndrome); all complications occurred during therapeutic procedures. The overall complication rate for DBE in the series was 0.5%, with a complication rate for therapeutic procedures of 1.4%. There were no cases of acute pancreatitis. Limitations to DBE procedures included patient intolerance, the presence of adhesions and poor bowel preparation. Abstract OC-025 Indications and endotherapy applied Indictn. Cases Indictn. Cases Endo. Rx Cases OGIB 347 Rx-en-Y 2 - - APC 147 CD 58 - - Plpectmy 36 Polyps 49 - - Dilation 18 Strictr. 36 - - DPEJ 7 ?Tumour 28 - - Endoclip 2 Coeliac 15 - - Thrombin 1 DPEJ 8 - - Intussus 4 - - Ret. CE 3 - - Conclusion The initial UK experience is favourable and echoes the results of other national series published to date, showing that DBE is a feasible and safe and endoscopic advancement that enhances the management of small bowel disorders.