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Robert H. Hawes - One of the best experts on this subject based on the ideXlab platform.

  • a prospective blinded study of diagnostic Esophagoscopy with a superthin stand alone battery powered esophagoscope
    The American Journal of Gastroenterology, 2003
    Co-Authors: Mahesh S. Mokhashi, Stephan M. Wildi, Tammy Glenn, Michael B. Wallace, Christian Jost, Bora Gumustop, Christopher Y. Kim, Peter B. Cotton, Robert H. Hawes
    Abstract:

    Abstract Objectives A more widely available, well-tolerated, and cost-effective technique is needed to screen a broad population at risk for esophageal cancer. An ideal solution might be to perform unsedated Esophagoscopy with an entirely self-contained, small-caliber endoscope. In a prospective, blinded study in three phases, we compared the feasibility, patient tolerance, and diagnostic accuracy of Esophagoscopy performed with a prototype, superthin, battery-powered esophagoscope (BPE) with standard video esophagogastroduodenoscopy (SVE). Methods In phase I, 10 healthy volunteers underwent both peroral and transnasal Esophagoscopy with BPE to evaluate the technical feasibility of the examination. For phases II and III, patients were recruited to have BPE before SVE. In phase II, both procedures were performed with conscious sedation. In phase III, the BPE was performed with only topical anesthesia. Two endoscopists assessed the technical performance of the endoscope and patient tolerance and recorded the esophageal findings independently. Results In phase I, all endoscopists reported adequate visualization of the esophagus in the 10 volunteers. A total of 181 patients were evaluated in phases II and III (89 in phase II, 92 in phase III). The sensitivity for detecting columnar lined esophagus was 94% in phase II and 95% in phase III. The sensitivity for all esophageal findings was 87% and 86% in phases II and III, respectively. The technical performance of the endoscope was significantly worse for BPE compared with the SVE. The patient tolerance as evaluated by the endoscopist was similar for both procedures. Ninety-five percent of the patients undergoing unsedated BPE were willing to have the procedure repeated under similar circumstances. Conclusions Unsedated Esophagoscopy with a 3.1-mm, battery-powered, stand-alone esophagoscope is feasible, well tolerated, and accurate in detecting esophageal pathologies. It might be an efficient and cost-effective screening tool for the detection of columnar lined esophagus.

  • Original contributionA prospective, blinded study of diagnostic Esophagoscopy with a superthin, stand-alone, battery-powered esophagoscope
    The American journal of gastroenterology, 2003
    Co-Authors: Mahesh S. Mokhashi, Stephan M. Wildi, Tammy Glenn, Michael B. Wallace, Christian Jost, Bora Gumustop, Christopher Y. Kim, Peter B. Cotton, Robert H. Hawes
    Abstract:

    Objectives A more widely available, well-tolerated, and cost-effective technique is needed to screen a broad population at risk for esophageal cancer. An ideal solution might be to perform unsedated Esophagoscopy with an entirely self-contained, small-caliber endoscope. In a prospective, blinded study in three phases, we compared the feasibility, patient tolerance, and diagnostic accuracy of Esophagoscopy performed with a prototype, superthin, battery-powered esophagoscope (BPE) with standard video esophagogastroduodenoscopy (SVE).

  • Accuracy of Esophagoscopy performed by a non-physician endoscopist with a 4-mm diameter battery-powered endoscope.
    Gastrointestinal endoscopy, 2003
    Co-Authors: Stephan M. Wildi, Mahesh S. Mokhashi, Tammy Glenn, Michael B. Wallace, Christopher Y. Kim, Robert H. Hawes
    Abstract:

    Abstract Background: A cost-effective technique is needed for screening of a broad population at risk for esophageal cancer. A solution would be to have non-physician endoscopists perform Esophagoscopy with small-caliber battery-powered endoscopes. Methods: In a prospective blinded study, the diagnostic accuracy of sedated Esophagoscopy performed by a trained nurse practitioner with a battery-powered 4-mm diameter endoscope was compared with that for a sedated standard video-endoscopy performed by a gastroenterologist. Patients were recruited to undergo peroral Esophagoscopy by the nurse practitioner followed by sedated standard endoscopy by the supervising gastroenterologist, each blinded to the findings of the other. Major esophageal findings of nurse practitioner and gastroenterologist were compared. Results: Findings in 40 patients were analyzed. In 4 patients both endoscopists could not assess the presence or absence of columnar-lined esophagus because of severe erosive esophagitis (n = 3) or severe candida-esophagitis (n = 1). By using sedated standard endoscopy as the standard, on a per finding basis, Esophagoscopy by the nurse practitioner had a sensitivity for columnar-lined esophagus of 89%: 95% CI [75%, 97%] and specificity of 96%: 95% CI [84%, 99%]. The missed columnar epithelium was a 3 × 3-mm island. For all lesions, the sensitivity of endoscopy performed by the nurse practitioner with the battery-powered endoscope was 75%: 95% CI [67%, 82%] and specificity 98%: 95% CI [96%, 99%]. The nurse practitioner missed all of 4 rings (3 considered clinically irrelevant). Conclusion: Esophagoscopy with a battery-powered 4-mm diameter endoscope by a non-physician endoscopist is feasible and accurate in detecting esophageal pathologies. It may be an efficient screening method for the detection of columnar-lined esophagus. There was a distinct underestimate of the presence of esophageal rings. (Gastrointest Endosc 2003;57:305-10.)

  • 7127 Can a 3.1 mm stand-alone battery powered esophagoscope (bpe) screen the esophagus for esophagitis and barrett's ? a prospective blinded comparison with a standard videoendoscope (sve).
    Gastrointestinal Endoscopy, 2000
    Co-Authors: Mahesh S. Mokhashi, Tammy Glenn, Michael B. Wallace, Christian Jost, Christopher Y. Kim, Peter B. Cotton, Yuko Y Palesch, Robert H. Hawes
    Abstract:

    Intro: There exist several indications (varices, Barrett's, GERD) where an Esophagoscopy alone would suffice rather than a complete endoscopy. Feasibility of Esophagoscopy using a prototype battery powered flexible fiberoptic esophagoscope (Olympus XEF-DP) with an outer diameter of 3.1 mm has been reported (GI Endo 1999;49: AB157). Aim: In a prospective blinded study, compare esophageal visualization between the BPE & the SVE. Methods: 95 consecutive pts. underwent sedated Esophagoscopy with the BPE foll. by SVE, done by 2 endoscopists, each blinded to the findings of the other. On a visual analogue scale, the 2 endoscopists rated pt. tolerance & instrument performance. Results: 89 (M 57) pts. (mean age 56 yr.) were analyzed. Mean duration of Esophagoscopy was 4.4 mins (range 2-10). Sensitivity : specificity (%) with BPE was 94 : 96 (Barrett's) & 87 : 94 (all lesions). Measures of pt. tolerance were (BPE : SVE, p value): intubation ease 96 : 93, 0.06; gagging 98 : 91, 0.0012; coughing 98 : 96, 0.08; belching 89 : 92, 0.02 (higher scores indicate better rating). Measures of scope performance were (BPE : SEV, p value): visibility 90 : 98, 0.0001; air insufflation 92 : 98, 0.001; maneuverability 87 : 99, 0.001. Concl: The esophagus can be accurately visualized in under 5 min with the BPE. Inter-observer variability may account for some of the disagreements. Being a standalone instrument, not needing a light source, processor or a monitor, it could facilitate Esophagoscopy outside of the conventional GI lab setting. Its tolerance unsedated, use transnasally & potential in a true screening environment are being studied.

David C Shonka - One of the best experts on this subject based on the ideXlab platform.

  • development and evaluation of a rigid Esophagoscopy simulator for residency training
    Laryngoscope, 2016
    Co-Authors: Amir Allak, Yizhen E Liu, Marianna S Oliynyk, Kai H Weng, Mark J Jameson, David C Shonka
    Abstract:

    Objectives/Hypothesis Rigid Esophagoscopy is performed less frequently by resident trainees. Nonetheless, it remains important for certain indications, including foreign body extraction. This study describes the construction of a simulator and evaluates its utility in training residents. Study Design Simulator development, fabrication, and procedural evaluation of postgraduate trainees. Methods A simulator was developed and constructed in collaboration with a biomedical engineering team. Residents with varied experience in upper aerodigestive procedures performed rigid Esophagoscopy on the model. Key steps and Accreditation Council for Graduate Medical Education's Objective Structured Assessment of Technical Skills (OSATS) criteria for rigid Esophagoscopy were evaluated by a faculty surgeon. Pressure measurements were obtained from force sensors at the tip of the endoscope and incisors. Results Fourteen trainees were evaluated. Operative rigid Esophagoscopy and direct laryngoscopy case numbers were noted for each subject. OSATS scores and key steps of the procedure correlated with resident experience (R2 = 0.75, P < .0001 and R2 = 0.66, P < .001, respectively). Maximal pressure exerted on the simulator esophagus by the esophagoscope was inversely correlated with case number and was statistically significant (R2 = 0.51, P = .02), whereas length of procedure did not correlate (R2 = 0.04, P = .49). Maximal pressure on the incisors did not correlate (R2 = 0.25, P = .15). Conclusions A simulator for training residents to perform rigid Esophagoscopy was developed and utilized by a faculty proctor to objectively evaluate trainees. OSATS scores, performance of key procedural steps, and pressure exerted on the simulator tissue correlated with upper aerodigestive cases performed, demonstrating validity of the simulator. Level of Evidence NA Laryngoscope, 2015

  • Development and evaluation of a rigid Esophagoscopy simulator for residency training.
    The Laryngoscope, 2015
    Co-Authors: Amir Allak, Yizhen E Liu, Marianna S Oliynyk, Kai H Weng, Mark J Jameson, David C Shonka
    Abstract:

    Objectives/Hypothesis Rigid Esophagoscopy is performed less frequently by resident trainees. Nonetheless, it remains important for certain indications, including foreign body extraction. This study describes the construction of a simulator and evaluates its utility in training residents. Study Design Simulator development, fabrication, and procedural evaluation of postgraduate trainees. Methods A simulator was developed and constructed in collaboration with a biomedical engineering team. Residents with varied experience in upper aerodigestive procedures performed rigid Esophagoscopy on the model. Key steps and Accreditation Council for Graduate Medical Education's Objective Structured Assessment of Technical Skills (OSATS) criteria for rigid Esophagoscopy were evaluated by a faculty surgeon. Pressure measurements were obtained from force sensors at the tip of the endoscope and incisors. Results Fourteen trainees were evaluated. Operative rigid Esophagoscopy and direct laryngoscopy case numbers were noted for each subject. OSATS scores and key steps of the procedure correlated with resident experience (R2 = 0.75, P 

Mahesh S. Mokhashi - One of the best experts on this subject based on the ideXlab platform.

  • a prospective blinded study of diagnostic Esophagoscopy with a superthin stand alone battery powered esophagoscope
    The American Journal of Gastroenterology, 2003
    Co-Authors: Mahesh S. Mokhashi, Stephan M. Wildi, Tammy Glenn, Michael B. Wallace, Christian Jost, Bora Gumustop, Christopher Y. Kim, Peter B. Cotton, Robert H. Hawes
    Abstract:

    Abstract Objectives A more widely available, well-tolerated, and cost-effective technique is needed to screen a broad population at risk for esophageal cancer. An ideal solution might be to perform unsedated Esophagoscopy with an entirely self-contained, small-caliber endoscope. In a prospective, blinded study in three phases, we compared the feasibility, patient tolerance, and diagnostic accuracy of Esophagoscopy performed with a prototype, superthin, battery-powered esophagoscope (BPE) with standard video esophagogastroduodenoscopy (SVE). Methods In phase I, 10 healthy volunteers underwent both peroral and transnasal Esophagoscopy with BPE to evaluate the technical feasibility of the examination. For phases II and III, patients were recruited to have BPE before SVE. In phase II, both procedures were performed with conscious sedation. In phase III, the BPE was performed with only topical anesthesia. Two endoscopists assessed the technical performance of the endoscope and patient tolerance and recorded the esophageal findings independently. Results In phase I, all endoscopists reported adequate visualization of the esophagus in the 10 volunteers. A total of 181 patients were evaluated in phases II and III (89 in phase II, 92 in phase III). The sensitivity for detecting columnar lined esophagus was 94% in phase II and 95% in phase III. The sensitivity for all esophageal findings was 87% and 86% in phases II and III, respectively. The technical performance of the endoscope was significantly worse for BPE compared with the SVE. The patient tolerance as evaluated by the endoscopist was similar for both procedures. Ninety-five percent of the patients undergoing unsedated BPE were willing to have the procedure repeated under similar circumstances. Conclusions Unsedated Esophagoscopy with a 3.1-mm, battery-powered, stand-alone esophagoscope is feasible, well tolerated, and accurate in detecting esophageal pathologies. It might be an efficient and cost-effective screening tool for the detection of columnar lined esophagus.

  • Original contributionA prospective, blinded study of diagnostic Esophagoscopy with a superthin, stand-alone, battery-powered esophagoscope
    The American journal of gastroenterology, 2003
    Co-Authors: Mahesh S. Mokhashi, Stephan M. Wildi, Tammy Glenn, Michael B. Wallace, Christian Jost, Bora Gumustop, Christopher Y. Kim, Peter B. Cotton, Robert H. Hawes
    Abstract:

    Objectives A more widely available, well-tolerated, and cost-effective technique is needed to screen a broad population at risk for esophageal cancer. An ideal solution might be to perform unsedated Esophagoscopy with an entirely self-contained, small-caliber endoscope. In a prospective, blinded study in three phases, we compared the feasibility, patient tolerance, and diagnostic accuracy of Esophagoscopy performed with a prototype, superthin, battery-powered esophagoscope (BPE) with standard video esophagogastroduodenoscopy (SVE).

  • Accuracy of Esophagoscopy performed by a non-physician endoscopist with a 4-mm diameter battery-powered endoscope.
    Gastrointestinal endoscopy, 2003
    Co-Authors: Stephan M. Wildi, Mahesh S. Mokhashi, Tammy Glenn, Michael B. Wallace, Christopher Y. Kim, Robert H. Hawes
    Abstract:

    Abstract Background: A cost-effective technique is needed for screening of a broad population at risk for esophageal cancer. A solution would be to have non-physician endoscopists perform Esophagoscopy with small-caliber battery-powered endoscopes. Methods: In a prospective blinded study, the diagnostic accuracy of sedated Esophagoscopy performed by a trained nurse practitioner with a battery-powered 4-mm diameter endoscope was compared with that for a sedated standard video-endoscopy performed by a gastroenterologist. Patients were recruited to undergo peroral Esophagoscopy by the nurse practitioner followed by sedated standard endoscopy by the supervising gastroenterologist, each blinded to the findings of the other. Major esophageal findings of nurse practitioner and gastroenterologist were compared. Results: Findings in 40 patients were analyzed. In 4 patients both endoscopists could not assess the presence or absence of columnar-lined esophagus because of severe erosive esophagitis (n = 3) or severe candida-esophagitis (n = 1). By using sedated standard endoscopy as the standard, on a per finding basis, Esophagoscopy by the nurse practitioner had a sensitivity for columnar-lined esophagus of 89%: 95% CI [75%, 97%] and specificity of 96%: 95% CI [84%, 99%]. The missed columnar epithelium was a 3 × 3-mm island. For all lesions, the sensitivity of endoscopy performed by the nurse practitioner with the battery-powered endoscope was 75%: 95% CI [67%, 82%] and specificity 98%: 95% CI [96%, 99%]. The nurse practitioner missed all of 4 rings (3 considered clinically irrelevant). Conclusion: Esophagoscopy with a battery-powered 4-mm diameter endoscope by a non-physician endoscopist is feasible and accurate in detecting esophageal pathologies. It may be an efficient screening method for the detection of columnar-lined esophagus. There was a distinct underestimate of the presence of esophageal rings. (Gastrointest Endosc 2003;57:305-10.)

  • 7127 Can a 3.1 mm stand-alone battery powered esophagoscope (bpe) screen the esophagus for esophagitis and barrett's ? a prospective blinded comparison with a standard videoendoscope (sve).
    Gastrointestinal Endoscopy, 2000
    Co-Authors: Mahesh S. Mokhashi, Tammy Glenn, Michael B. Wallace, Christian Jost, Christopher Y. Kim, Peter B. Cotton, Yuko Y Palesch, Robert H. Hawes
    Abstract:

    Intro: There exist several indications (varices, Barrett's, GERD) where an Esophagoscopy alone would suffice rather than a complete endoscopy. Feasibility of Esophagoscopy using a prototype battery powered flexible fiberoptic esophagoscope (Olympus XEF-DP) with an outer diameter of 3.1 mm has been reported (GI Endo 1999;49: AB157). Aim: In a prospective blinded study, compare esophageal visualization between the BPE & the SVE. Methods: 95 consecutive pts. underwent sedated Esophagoscopy with the BPE foll. by SVE, done by 2 endoscopists, each blinded to the findings of the other. On a visual analogue scale, the 2 endoscopists rated pt. tolerance & instrument performance. Results: 89 (M 57) pts. (mean age 56 yr.) were analyzed. Mean duration of Esophagoscopy was 4.4 mins (range 2-10). Sensitivity : specificity (%) with BPE was 94 : 96 (Barrett's) & 87 : 94 (all lesions). Measures of pt. tolerance were (BPE : SVE, p value): intubation ease 96 : 93, 0.06; gagging 98 : 91, 0.0012; coughing 98 : 96, 0.08; belching 89 : 92, 0.02 (higher scores indicate better rating). Measures of scope performance were (BPE : SEV, p value): visibility 90 : 98, 0.0001; air insufflation 92 : 98, 0.001; maneuverability 87 : 99, 0.001. Concl: The esophagus can be accurately visualized in under 5 min with the BPE. Inter-observer variability may account for some of the disagreements. Being a standalone instrument, not needing a light source, processor or a monitor, it could facilitate Esophagoscopy outside of the conventional GI lab setting. Its tolerance unsedated, use transnasally & potential in a true screening environment are being studied.

Amir Allak - One of the best experts on this subject based on the ideXlab platform.

  • development and evaluation of a rigid Esophagoscopy simulator for residency training
    Laryngoscope, 2016
    Co-Authors: Amir Allak, Yizhen E Liu, Marianna S Oliynyk, Kai H Weng, Mark J Jameson, David C Shonka
    Abstract:

    Objectives/Hypothesis Rigid Esophagoscopy is performed less frequently by resident trainees. Nonetheless, it remains important for certain indications, including foreign body extraction. This study describes the construction of a simulator and evaluates its utility in training residents. Study Design Simulator development, fabrication, and procedural evaluation of postgraduate trainees. Methods A simulator was developed and constructed in collaboration with a biomedical engineering team. Residents with varied experience in upper aerodigestive procedures performed rigid Esophagoscopy on the model. Key steps and Accreditation Council for Graduate Medical Education's Objective Structured Assessment of Technical Skills (OSATS) criteria for rigid Esophagoscopy were evaluated by a faculty surgeon. Pressure measurements were obtained from force sensors at the tip of the endoscope and incisors. Results Fourteen trainees were evaluated. Operative rigid Esophagoscopy and direct laryngoscopy case numbers were noted for each subject. OSATS scores and key steps of the procedure correlated with resident experience (R2 = 0.75, P < .0001 and R2 = 0.66, P < .001, respectively). Maximal pressure exerted on the simulator esophagus by the esophagoscope was inversely correlated with case number and was statistically significant (R2 = 0.51, P = .02), whereas length of procedure did not correlate (R2 = 0.04, P = .49). Maximal pressure on the incisors did not correlate (R2 = 0.25, P = .15). Conclusions A simulator for training residents to perform rigid Esophagoscopy was developed and utilized by a faculty proctor to objectively evaluate trainees. OSATS scores, performance of key procedural steps, and pressure exerted on the simulator tissue correlated with upper aerodigestive cases performed, demonstrating validity of the simulator. Level of Evidence NA Laryngoscope, 2015

  • Development and evaluation of a rigid Esophagoscopy simulator for residency training.
    The Laryngoscope, 2015
    Co-Authors: Amir Allak, Yizhen E Liu, Marianna S Oliynyk, Kai H Weng, Mark J Jameson, David C Shonka
    Abstract:

    Objectives/Hypothesis Rigid Esophagoscopy is performed less frequently by resident trainees. Nonetheless, it remains important for certain indications, including foreign body extraction. This study describes the construction of a simulator and evaluates its utility in training residents. Study Design Simulator development, fabrication, and procedural evaluation of postgraduate trainees. Methods A simulator was developed and constructed in collaboration with a biomedical engineering team. Residents with varied experience in upper aerodigestive procedures performed rigid Esophagoscopy on the model. Key steps and Accreditation Council for Graduate Medical Education's Objective Structured Assessment of Technical Skills (OSATS) criteria for rigid Esophagoscopy were evaluated by a faculty surgeon. Pressure measurements were obtained from force sensors at the tip of the endoscope and incisors. Results Fourteen trainees were evaluated. Operative rigid Esophagoscopy and direct laryngoscopy case numbers were noted for each subject. OSATS scores and key steps of the procedure correlated with resident experience (R2 = 0.75, P 

Michael B. Wallace - One of the best experts on this subject based on the ideXlab platform.

  • a prospective blinded study of diagnostic Esophagoscopy with a superthin stand alone battery powered esophagoscope
    The American Journal of Gastroenterology, 2003
    Co-Authors: Mahesh S. Mokhashi, Stephan M. Wildi, Tammy Glenn, Michael B. Wallace, Christian Jost, Bora Gumustop, Christopher Y. Kim, Peter B. Cotton, Robert H. Hawes
    Abstract:

    Abstract Objectives A more widely available, well-tolerated, and cost-effective technique is needed to screen a broad population at risk for esophageal cancer. An ideal solution might be to perform unsedated Esophagoscopy with an entirely self-contained, small-caliber endoscope. In a prospective, blinded study in three phases, we compared the feasibility, patient tolerance, and diagnostic accuracy of Esophagoscopy performed with a prototype, superthin, battery-powered esophagoscope (BPE) with standard video esophagogastroduodenoscopy (SVE). Methods In phase I, 10 healthy volunteers underwent both peroral and transnasal Esophagoscopy with BPE to evaluate the technical feasibility of the examination. For phases II and III, patients were recruited to have BPE before SVE. In phase II, both procedures were performed with conscious sedation. In phase III, the BPE was performed with only topical anesthesia. Two endoscopists assessed the technical performance of the endoscope and patient tolerance and recorded the esophageal findings independently. Results In phase I, all endoscopists reported adequate visualization of the esophagus in the 10 volunteers. A total of 181 patients were evaluated in phases II and III (89 in phase II, 92 in phase III). The sensitivity for detecting columnar lined esophagus was 94% in phase II and 95% in phase III. The sensitivity for all esophageal findings was 87% and 86% in phases II and III, respectively. The technical performance of the endoscope was significantly worse for BPE compared with the SVE. The patient tolerance as evaluated by the endoscopist was similar for both procedures. Ninety-five percent of the patients undergoing unsedated BPE were willing to have the procedure repeated under similar circumstances. Conclusions Unsedated Esophagoscopy with a 3.1-mm, battery-powered, stand-alone esophagoscope is feasible, well tolerated, and accurate in detecting esophageal pathologies. It might be an efficient and cost-effective screening tool for the detection of columnar lined esophagus.

  • Original contributionA prospective, blinded study of diagnostic Esophagoscopy with a superthin, stand-alone, battery-powered esophagoscope
    The American journal of gastroenterology, 2003
    Co-Authors: Mahesh S. Mokhashi, Stephan M. Wildi, Tammy Glenn, Michael B. Wallace, Christian Jost, Bora Gumustop, Christopher Y. Kim, Peter B. Cotton, Robert H. Hawes
    Abstract:

    Objectives A more widely available, well-tolerated, and cost-effective technique is needed to screen a broad population at risk for esophageal cancer. An ideal solution might be to perform unsedated Esophagoscopy with an entirely self-contained, small-caliber endoscope. In a prospective, blinded study in three phases, we compared the feasibility, patient tolerance, and diagnostic accuracy of Esophagoscopy performed with a prototype, superthin, battery-powered esophagoscope (BPE) with standard video esophagogastroduodenoscopy (SVE).

  • Accuracy of Esophagoscopy performed by a non-physician endoscopist with a 4-mm diameter battery-powered endoscope.
    Gastrointestinal endoscopy, 2003
    Co-Authors: Stephan M. Wildi, Mahesh S. Mokhashi, Tammy Glenn, Michael B. Wallace, Christopher Y. Kim, Robert H. Hawes
    Abstract:

    Abstract Background: A cost-effective technique is needed for screening of a broad population at risk for esophageal cancer. A solution would be to have non-physician endoscopists perform Esophagoscopy with small-caliber battery-powered endoscopes. Methods: In a prospective blinded study, the diagnostic accuracy of sedated Esophagoscopy performed by a trained nurse practitioner with a battery-powered 4-mm diameter endoscope was compared with that for a sedated standard video-endoscopy performed by a gastroenterologist. Patients were recruited to undergo peroral Esophagoscopy by the nurse practitioner followed by sedated standard endoscopy by the supervising gastroenterologist, each blinded to the findings of the other. Major esophageal findings of nurse practitioner and gastroenterologist were compared. Results: Findings in 40 patients were analyzed. In 4 patients both endoscopists could not assess the presence or absence of columnar-lined esophagus because of severe erosive esophagitis (n = 3) or severe candida-esophagitis (n = 1). By using sedated standard endoscopy as the standard, on a per finding basis, Esophagoscopy by the nurse practitioner had a sensitivity for columnar-lined esophagus of 89%: 95% CI [75%, 97%] and specificity of 96%: 95% CI [84%, 99%]. The missed columnar epithelium was a 3 × 3-mm island. For all lesions, the sensitivity of endoscopy performed by the nurse practitioner with the battery-powered endoscope was 75%: 95% CI [67%, 82%] and specificity 98%: 95% CI [96%, 99%]. The nurse practitioner missed all of 4 rings (3 considered clinically irrelevant). Conclusion: Esophagoscopy with a battery-powered 4-mm diameter endoscope by a non-physician endoscopist is feasible and accurate in detecting esophageal pathologies. It may be an efficient screening method for the detection of columnar-lined esophagus. There was a distinct underestimate of the presence of esophageal rings. (Gastrointest Endosc 2003;57:305-10.)

  • 7127 Can a 3.1 mm stand-alone battery powered esophagoscope (bpe) screen the esophagus for esophagitis and barrett's ? a prospective blinded comparison with a standard videoendoscope (sve).
    Gastrointestinal Endoscopy, 2000
    Co-Authors: Mahesh S. Mokhashi, Tammy Glenn, Michael B. Wallace, Christian Jost, Christopher Y. Kim, Peter B. Cotton, Yuko Y Palesch, Robert H. Hawes
    Abstract:

    Intro: There exist several indications (varices, Barrett's, GERD) where an Esophagoscopy alone would suffice rather than a complete endoscopy. Feasibility of Esophagoscopy using a prototype battery powered flexible fiberoptic esophagoscope (Olympus XEF-DP) with an outer diameter of 3.1 mm has been reported (GI Endo 1999;49: AB157). Aim: In a prospective blinded study, compare esophageal visualization between the BPE & the SVE. Methods: 95 consecutive pts. underwent sedated Esophagoscopy with the BPE foll. by SVE, done by 2 endoscopists, each blinded to the findings of the other. On a visual analogue scale, the 2 endoscopists rated pt. tolerance & instrument performance. Results: 89 (M 57) pts. (mean age 56 yr.) were analyzed. Mean duration of Esophagoscopy was 4.4 mins (range 2-10). Sensitivity : specificity (%) with BPE was 94 : 96 (Barrett's) & 87 : 94 (all lesions). Measures of pt. tolerance were (BPE : SVE, p value): intubation ease 96 : 93, 0.06; gagging 98 : 91, 0.0012; coughing 98 : 96, 0.08; belching 89 : 92, 0.02 (higher scores indicate better rating). Measures of scope performance were (BPE : SEV, p value): visibility 90 : 98, 0.0001; air insufflation 92 : 98, 0.001; maneuverability 87 : 99, 0.001. Concl: The esophagus can be accurately visualized in under 5 min with the BPE. Inter-observer variability may account for some of the disagreements. Being a standalone instrument, not needing a light source, processor or a monitor, it could facilitate Esophagoscopy outside of the conventional GI lab setting. Its tolerance unsedated, use transnasally & potential in a true screening environment are being studied.