Yuwadee Ponauthai

Success rate and cannulation time between precut sphincterotomy and double-guidewire technique in truly difficult biliary cannulation.

Background and Aim:u2002 Precut sphincterotomy (PS) is usually indicated in failed standard biliary cannulation (BC). PS requires experienced endoscopists, and contains significant risk. Double‐guidewire (DG) cannulation seems to be easier, and might be useful after failed standard BC. We aimed to compare cannulation time, success rate, and complication rates between the two techniques.

Non-sequential narrow band imaging for targeted biopsy and monitoring of gastric intestinal metaplasia.

AIMnTo evaluate the efficacy of non-sequential narrow band imaging (NBI) for a better recognition of gastric intestinal metaplasia (GIM).nnnMETHODSnPreviously diagnosed GIM patients underwent targeted biopsy from areas with and without GIM, as indicated by NBI, twice at an interval of 1 year. The authors compared the endoscopic criteria such as light blue crest (LBC), villous pattern (VP), and large long crest (LLC) with standard histology. The results from two surveillance endoscopies were compared with histology results for sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratio of positive test (LR+). The number of early gastric cancer cases detected was also reported.nnnRESULTSnNBI targeted biopsy was performed in 38 and 26 patients during the first and second surveillance endoscopies, respectively. There were 2 early gastric cancers detected in the first endoscopy. No cancer was detected from the second study. Surgical and endoscopic resections were successfully performed in each patient. Sensitivity, specificity, PPV, NPV, and LR+ of all 3 endoscopic criteria during the first/second surveillance were 78.8%/91.3%, 82.5%/89.1%, 72.8%/77.8%, 86.8%/96.1, and 4.51/8.4, respectively. LBC provided the highest LR+ over VP and LLC.nnnCONCLUSIONnNon-sequential NBI is useful for GIM targeted biopsy. LBC provides the most sensitive reading. However, the optimal duration between two surveillance requires further study.

Cocktail sedation containing propofol versus conventional sedation for ERCP: a prospective, randomized controlled study.

BackgroundERCP practically requires moderate to deep sedation controlled by a combination of benzodiazepine and opiod. Propofol as a sole agent may cause oversedation. A combination (cocktail) of infused propofol, meperidine, and midazolam can reduce the dosage of propofol and we hypothesized that it might decrease the risk of oversedation. We prospectively compare the efficacy, recovery time, patient satisfactory, and side effects between cocktail and conventional sedations in patients undergoing ERCP.MethodsERCP patients were randomized into 2 groups; the cocktail group (nu2009=u2009103) and the controls (nu2009=u2009102). For induction, a combination of 25u2009mg of meperidine and 2.5u2009mg of midazolam were administered in both groups. In the cocktail group, a bolus dose of propofol 1u2009mg/kg was administered and continuously infused. In the controls, 25u2009mg of meperidine or 2.5u2009mg/kg of midazolam were titrated to maintain the level of sedation.ResultsIn the cocktail group, the average administration rate of propofol was 6.2u2009mg/kg/hr. In the control group; average weight base dosage of meperidine and midazolam were 1.03u2009mg/kg and 0.12u2009mg/kg, respectively. Recovery times and patients’ satisfaction scores in the cocktail and control groups were 9.67u2009minutes and 12.89u2009minutes (Pu2009=u20090.045), 93.1and 87.6 (P <0.001), respectively. Desaturation rates in the cocktail and conventional groups were 58.3% and 31.4% (P <0.001), respectively. All desaturations were corrected with temporary oxygen supplementation without the need for scope removal.ConclusionsCocktail sedation containing propofol provides faster recovery time and better patients’ satisfaction for patients undergoing ERCP. However, mild degree of desaturation may still develop.Trial registrationClinicalTrials.gov, NCT01540084

Stent-in-stent through a side hole to prevent biliary metallicstent migration

The covered self-expandable metallic stent (SEMS) has been developed to overcome the problem of tissue in-growth, However, stent migration is a well-known com--plication of covered SEMS placement. Use of a double pigtail stent to lock the movement of the SEMS and prevent migration has been advised by many ex-perts. Unfortunately, in our case this technique led to an in-cidental upward migration of the SEMS. We used APC to create a side hole in the SEMS for plastic stent insertion as stent-in-stent. This led to a successful pre-ven-tion of stent migration.