The Experts below are selected from a list of 24381 Experts worldwide ranked by ideXlab platform
J Obeirne - One of the best experts on this subject based on the ideXlab platform.
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systematic review with meta analysis ultra thin Gastroscopy compared to conventional Gastroscopy for the diagnosis of oesophageal varices in people with cirrhosis
Alimentary Pharmacology & Therapeutics, 2019Co-Authors: Tehara Wickremeratne, Stephanie Turner, J ObeirneAbstract:Background: Haemorrhage from ruptured oesophageal varices is a common cause of death in people with cirrhosis. Guidelines recommend screening for varices at time of cirrhosis diagnosis and throughout the course of the disease. Conventional gas ‐troscopy is the criterion standard for variceal screening; however, is invasive, costly, and carries risks related to use of sedation. Ultra‐thin Gastroscopy (using endoscopes with a shaft diameter ≤6 mm) has been proposed as an alternative method of variceal screening that mitigates these risks.Aim: To determine the diagnostic accuracy of ultra‐thin Gastroscopy compared to conventional Gastroscopy for the diagnosis of varices in people with cirrhosis.Methods: MEDLINE, EMBASE and Cochrane library databases were searched for studies that evaluated the accuracy of ultra‐thin Gastroscopy compared to conven‐tional Gastroscopy in the diagnosis of oesophageal varices.Results: Ten studies, 7 in known cirrhosis, with 752 participants were included in this systematic review. The overall prevalence of oesophageal varices was 42%. On bivariate modelling, pooled estimates of sensitivity and specificity were 98% (95% CI 93%‐99%) and 96% (95% CI 91%‐99%) respectively. The positive and negative likelihood ratios were 28 (95% CI 10.7‐73.2) and 0.02 (95% CI 0.01‐0.72) respectively. Kappa coefficient for inter‐observer agreement for any varices ranged from 0.45 to 0.90. No serious adverse events related to ultra‐thin Gastroscopy were reported.Conclusions: Ultra‐thin Gastroscopy is accurate in the diagnosis of oesophageal varices, safe and well tolerated. It is a valid alternative to conventional Gastroscopy for the screening and surveillance of varices in people with cirrhosis.
Tehara Wickremeratne - One of the best experts on this subject based on the ideXlab platform.
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systematic review with meta analysis ultra thin Gastroscopy compared to conventional Gastroscopy for the diagnosis of oesophageal varices in people with cirrhosis
Alimentary Pharmacology & Therapeutics, 2019Co-Authors: Tehara Wickremeratne, Stephanie Turner, J ObeirneAbstract:Background: Haemorrhage from ruptured oesophageal varices is a common cause of death in people with cirrhosis. Guidelines recommend screening for varices at time of cirrhosis diagnosis and throughout the course of the disease. Conventional gas ‐troscopy is the criterion standard for variceal screening; however, is invasive, costly, and carries risks related to use of sedation. Ultra‐thin Gastroscopy (using endoscopes with a shaft diameter ≤6 mm) has been proposed as an alternative method of variceal screening that mitigates these risks.Aim: To determine the diagnostic accuracy of ultra‐thin Gastroscopy compared to conventional Gastroscopy for the diagnosis of varices in people with cirrhosis.Methods: MEDLINE, EMBASE and Cochrane library databases were searched for studies that evaluated the accuracy of ultra‐thin Gastroscopy compared to conven‐tional Gastroscopy in the diagnosis of oesophageal varices.Results: Ten studies, 7 in known cirrhosis, with 752 participants were included in this systematic review. The overall prevalence of oesophageal varices was 42%. On bivariate modelling, pooled estimates of sensitivity and specificity were 98% (95% CI 93%‐99%) and 96% (95% CI 91%‐99%) respectively. The positive and negative likelihood ratios were 28 (95% CI 10.7‐73.2) and 0.02 (95% CI 0.01‐0.72) respectively. Kappa coefficient for inter‐observer agreement for any varices ranged from 0.45 to 0.90. No serious adverse events related to ultra‐thin Gastroscopy were reported.Conclusions: Ultra‐thin Gastroscopy is accurate in the diagnosis of oesophageal varices, safe and well tolerated. It is a valid alternative to conventional Gastroscopy for the screening and surveillance of varices in people with cirrhosis.
Enric Brullet - One of the best experts on this subject based on the ideXlab platform.
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Transnasal Gastroscopy compared to conventional Gastroscopy: a randomized study of feasibility, safety, and tolerance.
Endoscopy, 1998Co-Authors: Rafel Campo, Antonia Montserrat, Enric BrulletAbstract:BACKGROUND AND STUDY AIMS Gastroscopy is often an unpleasant procedure for the patient. Sedation improves the tolerance, but it causes inconvenience both for patients and for endoscopy units. The aim of the present study was to compare the feasibility, safety, and tolerance of transnasal Gastroscopy using a thin endoscope with conventional oral Gastroscopy. PATIENTS AND METHODS One hundred eighty-one consecutive outpatients referred for diagnostic Gastroscopy were randomized to undergo transnasal or oral conventional Gastroscopy. The tolerance (discomfort, retching, throat pain, and desire for sedation in any further procedures) and examination difficulty (intubation, examination, aspiration, and visibility) were assessed by the patients and the endoscopists, respectively, using visual analogue scales and a questionnaire. RESULTS Endoscope insertion failed in six patients (four transnasal, two conventional). The tolerance was significantly better with transnasal Gastroscopy in comparison to conventional oral Gastroscopy. Only 3% of patients undergoing transnasal Gastroscopy desired sedation in any further examinations, compared to 15% in the conventional oral Gastroscopy group (P = 0.01). The examination time was longer in the transnasal group (5 min 25 sec +/- 1 min 46 sec vs. 3 min 22 sec +/- 1 min 9 sec, P < 0.001). Visualization capability and aspiration using the thin endoscope were considered more difficult by the endoscopists. CONCLUSIONS Nasal introduction of thin endoscopes is better tolerated by patients than conventional Gastroscopy, minimizing the need for sedation. However, technical improvements in thin endoscopes (a wider working channel, increased length and better image quality) would increase their usefulness.
Stephanie Turner - One of the best experts on this subject based on the ideXlab platform.
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systematic review with meta analysis ultra thin Gastroscopy compared to conventional Gastroscopy for the diagnosis of oesophageal varices in people with cirrhosis
Alimentary Pharmacology & Therapeutics, 2019Co-Authors: Tehara Wickremeratne, Stephanie Turner, J ObeirneAbstract:Background: Haemorrhage from ruptured oesophageal varices is a common cause of death in people with cirrhosis. Guidelines recommend screening for varices at time of cirrhosis diagnosis and throughout the course of the disease. Conventional gas ‐troscopy is the criterion standard for variceal screening; however, is invasive, costly, and carries risks related to use of sedation. Ultra‐thin Gastroscopy (using endoscopes with a shaft diameter ≤6 mm) has been proposed as an alternative method of variceal screening that mitigates these risks.Aim: To determine the diagnostic accuracy of ultra‐thin Gastroscopy compared to conventional Gastroscopy for the diagnosis of varices in people with cirrhosis.Methods: MEDLINE, EMBASE and Cochrane library databases were searched for studies that evaluated the accuracy of ultra‐thin Gastroscopy compared to conven‐tional Gastroscopy in the diagnosis of oesophageal varices.Results: Ten studies, 7 in known cirrhosis, with 752 participants were included in this systematic review. The overall prevalence of oesophageal varices was 42%. On bivariate modelling, pooled estimates of sensitivity and specificity were 98% (95% CI 93%‐99%) and 96% (95% CI 91%‐99%) respectively. The positive and negative likelihood ratios were 28 (95% CI 10.7‐73.2) and 0.02 (95% CI 0.01‐0.72) respectively. Kappa coefficient for inter‐observer agreement for any varices ranged from 0.45 to 0.90. No serious adverse events related to ultra‐thin Gastroscopy were reported.Conclusions: Ultra‐thin Gastroscopy is accurate in the diagnosis of oesophageal varices, safe and well tolerated. It is a valid alternative to conventional Gastroscopy for the screening and surveillance of varices in people with cirrhosis.
M E Mcalindon - One of the best experts on this subject based on the ideXlab platform.
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ptu 034 double blind randomised controlled trial of magnetically steerable gastric capsule endoscopy msgce vs conventional Gastroscopy for detection of beads in a porcine stomach
Gut, 2014Co-Authors: Melissa F Hale, I Rahman, K Drew, Reena Sidhu, Stuart A Riley, P Patel, M E McalindonAbstract:Introduction Gastroscopy is uncomfortable for patients and incurs the risks of intubation and sedation. Capsule endoscopy is well tolerated and recently a handheld magnet has been developed to enable steering of the capsule to visualise all areas of the capacious stomach. Our preliminary data suggests that a novice can identify all beads sewn into a porcine stomach within 4 min after 40 consecutive examinations. 1 We performed a double blind randomised controlled trial comparing MSGCE with conventional Gastroscopy in the detection of beads in the same model. Methods Ex-vivo porcine stomach models were used in a standard housing unit. MSGCE was performed according to a standard protocol using 1000mls of water to distend each stomach and a combination of positional change (head down, 30° left lateral, 30° right lateral) and magnetic control to steer the capsule. Each model was examined in a standard fashion by Gastroscopy and subsequently MSGCE using MiroCam Navi (Intromedic Ltd). Two blinded investigators (MFH and IR) competent to perform both procedures were allocated randomly to perform either Gastroscopy or MSGCE on each model. This was performed as a non-inferiority study with an expected sensitivity of 90% for both (0 estimated difference), a specificity of 100% and a difference of interest 10 percentage points (i.e., 80% is significantly worse). A sample size of 85 beads was needed to achieve this statistical power. Twelve porcine stomachs were prepared with beads as follows: 2 × 0 beads, 2 × 1 bead, 2 × 2 beads, 2 × 3 beads, 2 × 4 beads, 2 × 5 beads, giving a total of 30 beads. The study was conducted in three rounds, giving a total of 90 beads to be identified. Number of beads identified and procedure duration was recorded. Results Gastroscopy correctly identified 88% (79/90) beads, MSGCE correctly identified 89% (80/90) beads and thus is non-inferior to Gastroscopy in this setting (95% CI 82.54–95.46%). Mean examination times for Gastroscopy and MSGCE were 3.34 min and 9.90 min respectively. MSGCE overestimated the number of beads present on a single occasion. Conclusion MSGCE is equivalent to conventional Gastroscopy in the detection of beads placed in a porcine stomach model. Procedure duration was longer for MSGCE compared to Gastroscopy. Further studies in humans are necessary to define the scope and utility of this exciting new technique. Reference Hale MF, Drew K, Baldacchino T, Anderson S, Sanders DS, Riley SA, Sidhu R, McAlindon ME. Gastroscopy without a gastroscope! Feasibility in a porcine stomach model using a magnetic capsule. Abstract. British Society of Gastroenterology Annual Meeting , Jun 2013 Disclosure of Interest None Declared.
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pwe 062 Gastroscopy without a gastroscope feasibility in a porcine model using a magnetic capsule
Gut, 2013Co-Authors: Melissa F Hale, K Drew, Reena Sidhu, Stuart A Riley, Tara Baldacchino, Sean R Anderson, David Sanders, M E McalindonAbstract:Introduction There is little evidence that Gastroscopy affects patient outcomes 1 , but it is uncomfortable and incurs the risk of intubation and sedation. Capsule endoscopy is a non-invasive tool used primarily to image the small and large bowel. Although a large volume organ, examination of the stomach might be enabled by magnetic control allowing manoeuvrability and positional change. Methods A standard porcine stomach model, commonly used for endoscopy training purposes was used in a feasibility study of magnetically steerable capsule endoscopy. Different coloured/shaped beads were sewn into each major location of the stomach (cardia, fundus, greater and lesser curve, anterior and posterior wall, antrum and D1). The stomach was distended with 1000mls of water. Endoscopy was performed according to a set protocol using a handheld magnet, Mirocam Navi (Intromedic Ltd), positional changes (supine, 30° right lateral, head down, 30° left lateral) and a “real time” viewer. The order and time each tag was identified was recorded alongside the total procedure time. Results All stomach tags were identified in 87.2% (41/47) of examinations. Missed tags (marked in figure as red dots, representing an incomplete examination) included antrum (3/6), cardia (2/6) and posterior wall (1/6): none were missed in the latter 25 procedures. Mean examination times for the first 23, second 23 and all procedures were 10.28, 6.26 (p Conclusion Examination of the upper gastrointestinal tract is feasible using a magnet and positional change as demonstrated in this porcine model. A learning curve was evident and this model might be used for training in the future. Further investigation using porcine models and in humans is necessary to fully realise the scope of this exciting novel technology. Disclosure of Interest None Declared. Reference Offman JJ, Rabeneck L The effectiveness of endoscopy in the management of dyspepsia: a qualitative systematic review. Am J Med. 1999 Mar; 106(3):335–46.
