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Zhang YL, Bai L, Li Z, Ji R, Li CQ, Zuo XL, Yin YF, Du JX, Zhai ZZ, Gao XZ, Li YQ. A lower dose of fluorescein sodium is more suitable for confocal laser endomicroscopy: a feasibility study. Gastrointest Endosc 2016; 84:917-923.e5. [PMID: 27189657 DOI: 10.1016/j.gie.2016.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 05/04/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Image quality can be guaranteed with the conventional dosage of fluorescein sodium in probe-based confocal laser endomicroscopy (pCLE). However, yellow discoloration of the skin seriously affects daily life and simultaneously increases the risk of adverse events such as allergic reactions. The aim of this study was to test whether a lower dosage of fluorescein sodium can provide satisfactory image quality and to compare the diagnostic accuracy of gastric intestinal metaplasia (GIM) through a randomized blind controlled trial. METHODS Consecutive patients were randomly assigned to different doses of fluorescein sodium. Image quality was determined by the endoscopists' subjective assessments and signal-to-noise ratio (SNR) assessment systems. Skin discoloration was tested using a neonatal transcutaneous jaundice detector. In addition, consecutive patients with a known or suspected diagnosis of GIM were examined by pCLE with the lower dose and the traditional dose. RESULTS Only 0.01 mL/kg dose of 10% fluorescein sodium led to a significant decrease in image quality (P < .05), and a dose of 0.02 mL/kg had the highest SNR value (P < .05). There were no significant differences in skin discoloration between the 0.01 mL/kg and 0.02 mL/kg doses (P = .148) and no statistical difference in the diagnostic accuracy of pCLE for GIM between the 0.02 mL/kg and 0.10 mL/kg doses (P > .05). The kappa values for the correlation between pCLE and histopathology were 0.867 (95% confidence interval, 0.782-0.952) and 0.891 (95% confidence interval, 0.811-0.971). CONCLUSIONS The 0.02 mL/kg dose of 10% fluorescein sodium seems to be the best dose for pCLE in the upper GI tract, with comparable image quality with the conventional dose and insignificant skin discoloration. This dose is also very efficient for the diagnosis of GIM.
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Affiliation(s)
- Ya-Lin Zhang
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, Shandong, China; Department of Gastroenterology, Weihai Municipal Hospital, Weihai, Shandong, China
| | - Liang Bai
- Department of Hepatobiliary Surgery, Weihai Municipal Hospital, Weihai, Shandong, China
| | - Zhen Li
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Rui Ji
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Chang-Qing Li
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Xiu-Li Zuo
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Ya-Fei Yin
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Jia-Xin Du
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Zhen-Zhen Zhai
- Department of Gastroenterology, Dezhou People's Hospital, Dezhou, Shandong, China
| | - Xiao-Zhong Gao
- Department of Gastroenterology, Weihai Municipal Hospital, Weihai, Shandong, China
| | - Yan-Qing Li
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, Shandong, China
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Fu ZJ, Wang X, Ji NL, Liu JJ, Ding WX, Xi HJ. Training program for nurse specialists of digestive endoscopy department: A qualitative research. Shijie Huaren Xiaohua Zazhi 2015; 23:2671-2676. [DOI: 10.11569/wcjd.v23.i16.2671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the needs of specialized nursing training for nurses of digestive endoscopy department and to investigate the current situation of specialized nursing training in digestive endoscopy department, so as to provide a reference for establishing standardized training program for nurses of digestive endoscopy department.
METHODS: Based on analyzing literature review and authoritative sources, the research group confirmed the interview framework. Totally, 17 head nurses who came from digestive endoscopy centers in different provinces and cities participated in this qualitative study. Focus group interview was used in this study.
RESULTS: It is necessary for nurses of digestive endoscopy department to receive specialized nursing training. Current training programs are lack of standardization and accordance. The training content should include two parts: comprehensive nursing skills and endoscopic specialist skills. The training methods can be showed as theoretical study, video study, simulation training, and teaching by doing and so on. These methods match different levels of training.
CONCLUSION: There should be a unified regulation in the training program of nurse specialists from digestive endoscopy department in which trainers should pay more attention to the cultivation of comprehensive ability on the basis of handling specialized skills. The training program should be divided into different grades according to nurses' ability.
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Li CQ, Zuo XL, Guo J, Zhang JY, Liu JW, Li YQ. Comparison between two types of confocal laser endomicroscopy in gastrointestinal tract. J Dig Dis 2015; 16:279-85. [PMID: 25762057 DOI: 10.1111/1751-2980.12245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Confocal laser endomicroscopy (CLE) consists of endoscope-based CLE (eCLE) and probe-based CLE (pCLE). This study aimed to compare eCLE and pCLE in their diagnostic yield in different parts of the gastrointestinal (GI) tract. METHODS Consecutive patients were scheduled for CLE examination due to GI symptoms. All patients were randomly assigned to eCLE or pCLE group and underwent a programmed procedure using one type of CLE. Differences in procedure time, complication rate, CLE image quality and image acquisition feasibility between these two types of CLE for esophagogastroduodenoscopy (EGD) and colonoscopy were calculated. RESULTS Altogether 513 CLE procedures were performed, including 324 EGD and 189 colonoscopy. The procedure time of pCLE was significantly shorter than that of eCLE both in EGD and colonoscopy (16.78 min vs 18.13 min for EGD, P = 0.027; 32.48 min vs 39.89 min for colonoscopy, P < 0.001). No significant difference was found between these two types of CLE in diagnostic utility, including the detection and prediction of histopathological results of the lesions. The CLE image quality of both eCLE and pCLE were comparable in the stomach and colon, but eCLE seemed to be superior to pCLE in examining the esophagus. Colonoscopy using pCLE had a higher complete rate than that of eCLE, although the difference was not statistically significant (P = 0.065). CONCLUSIONS pCLE is more flexible in diagnosing GI diseases with a shorter procedure time than eCLE regardless of comparable diagnostic yields, except the diagnosis of esophageal diseases in which eCLE provides better image quality.
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Affiliation(s)
- Chang Qing Li
- Department of Gastroenterology, The Translational Gastroenterology Laboratory, Shandong University Qilu Hospital, Jinan, Shandong Province, China
| | - Xiu Li Zuo
- Department of Gastroenterology, The Translational Gastroenterology Laboratory, Shandong University Qilu Hospital, Jinan, Shandong Province, China
| | - Jing Guo
- Department of Gastroenterology, The Translational Gastroenterology Laboratory, Shandong University Qilu Hospital, Jinan, Shandong Province, China
| | - Jing Yuan Zhang
- Department of Gastroenterology, The Translational Gastroenterology Laboratory, Shandong University Qilu Hospital, Jinan, Shandong Province, China
| | - Jian Wei Liu
- Department of Gastroenterology, The Translational Gastroenterology Laboratory, Shandong University Qilu Hospital, Jinan, Shandong Province, China
| | - Yan Qing Li
- Department of Gastroenterology, The Translational Gastroenterology Laboratory, Shandong University Qilu Hospital, Jinan, Shandong Province, China
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Amin S, Dimaio CJ, Kim MK. Advanced EUS imaging for early detection of pancreatic cancer. Gastrointest Endosc Clin N Am 2013; 23:607-23. [PMID: 23735106 DOI: 10.1016/j.giec.2013.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Endoscopic ultrasound (EUS)-fine needle aspiration remains the gold standard for diagnosing pancreatic malignancy. However, in a subset of patients, limitations remain in regards to image quality and diagnostic yield of biopsies. Several new devices and processors have been developed that allow for enhancement of the EUS image. Initial studies of these modalities do show promise. However, cost, availability, and overall incremental benefit to EUS-fine needle aspiration have yet to be determined.
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Affiliation(s)
- Sunil Amin
- Division of Gastroenterology, Department of Medicine, Mount Sinai School of Medicine, 5 East 98th Street, 11th Floor, New York, NY 10029, USA
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Zhang XL, Lu ZS, Tang P, Kong JY, Yang YS. Current application situation of gastrointestinal endoscopy in China. World J Gastroenterol 2013; 19:2950-2955. [PMID: 23704828 PMCID: PMC3660820 DOI: 10.3748/wjg.v19.i19.2950] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 03/27/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the current application situation of gastrointestinal (GI) endoscopy in mainland China.
METHODS: From 12 August, 2011 to 15 February, 2012, draft questionnaires were sent by e-mail to 289 hospital-based GI endoscopy units, including units with three levels (provincial, prefecture and county level) in mainland China. All the surveyed GI endoscopy units were state-owned and hospital-based. Proportions were compared using χ2 tests. Comparisons between groups were performed using the Mann-Whitney U test. A probability of P < 0.05 was considered to represent a statistically significant difference.
RESULTS: Based on satisfactory replies, 169/279 (60.6%) of units were enrolled in the survey, which covered 28 provinces (90.3%, 28/31) in mainland China. Compared with published survey data, the number of GI endoscopes per unit has increased by nearly three times (from 2.9 to 9.3) in the past decade. About 33 of 169 (19.5%) endoscopy units possessed an X-ray machine, which was mainly owned by provincial endoscopy units (43.2%, 19/44). Video capsule endoscopes, which were almost unavailable ten years ago, were owned by 20.7% (35/169) of GI endoscopy units. Endoscopic submucosal dissection could be performed by 36.4% (19/44) of the provincial units, which was significantly higher than the prefecture level (9.9%, P < 0.01) and county level (0.0%, P < 0.01) units, respectively.
CONCLUSION: Rapid development in GI endoscopy has been made in mainland China, and major diagnostic endoscopes and therapeutic endoscopy procedures are predominantly used in large endoscopy units.
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Bang BW, Kim HG. Endoscopic Classification of Intestinal Metaplasia. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2013. [DOI: 10.7704/kjhugr.2013.13.2.78] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Byoung Wook Bang
- Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Hyung Gil Kim
- Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
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Vrochides D, Ntinas A, Kardassis D, Miliaras D, Metrakos P, Papalois A. Single-Stitch Telescopic Bilioenterostomy in an Animal Model. J INVEST SURG 2012; 25:317-25. [DOI: 10.3109/08941939.2011.652729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Seltenreich H, Van Den Bogaerde J, Sorrentino D. The race for mainstream gastrointestinal endoscopy: frontrunners. Expert Rev Gastroenterol Hepatol 2012; 6:467-79. [PMID: 22928899 DOI: 10.1586/egh.12.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In recent years, gastrointestinal endoscopy has evolved and branched out from a primary naked-eye diagnostic technique to a multitude of sophisticated investigative and therapeutic procedures. While many of the new endoscopic techniques are currently too complex or expensive to make it to mainstream clinical practice, others are already bringing major progress to the management of digestive diseases. In this review we will discuss a selected group of the emerging techniques and technologies used to increase the diagnostic yield in the colon and small intestine, including Third Eye® Retroscopes®, colon capsule endoscopy, spiral enteroscopy and confocal laser endomicroscopy. We will also discuss over-the-scope clip devices, a relatively simple and inexpensive tool potentially capable of noninvasive closing intestinal perforations and allowing the removal of infiltrating tumors.
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Affiliation(s)
- H Seltenreich
- Department of Gastroenterology, Nambour General Hospital, Nambour, QLD, Australia
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Kiesslich R, Goetz M, Hoffman A, Galle PR. New imaging techniques and opportunities in endoscopy. Nat Rev Gastroenterol Hepatol 2011; 8:547-53. [PMID: 21894196 DOI: 10.1038/nrgastro.2011.152] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gastrointestinal endoscopy is undergoing major improvements, which are driven by new available technologies and substantial refinements of optical features. In this Review, we summarize available and evolving imaging technologies that could influence the clinical algorithm of endoscopic diagnosis. Detection, characterization and confirmation are essential steps required for proper endoscopic diagnosis. Optical and nonoptical methods can help to improve each step; these improvements are likely to increase the detection rate of neoplasias and reduce unnecessary endoscopic treatments. Furthermore, functional and molecular imaging are emerging as new diagnostic tools that could provide an opportunity for personalized medicine, in which endoscopy will define disease outcome or predict the response to targeted therapy.
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Affiliation(s)
- Ralf Kiesslich
- Department of Internal Medicine, Johannes Gutenberg University of Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
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