AIM:To validate high definition endoscopes with Fujinon intelligent chromoendoscopy(FICE) in colonoscopy.METHODS:The image quality of normal white light endoscopy(WLE),that of the 10 available FICE filters and that of...AIM:To validate high definition endoscopes with Fujinon intelligent chromoendoscopy(FICE) in colonoscopy.METHODS:The image quality of normal white light endoscopy(WLE),that of the 10 available FICE filters and that of a gold standard(0.2% indigo carmine dye) were compared.RESULTS:FICE-filter 4 [red,green,and blue(RGB) wavelengths of 520,500,and 405 nm,respectively] provided the best images for evaluating the vascular pattern compared to white light.The mucosal surface was best assessed using filter 4.However,the views obtained were not rated significantly better than those observed with white light.The "gold standard",indigo carmine(IC) dye,was found to be superior to both white light and filter 4.Filter 6(RGB wavelengths of 580,520,and 460 nm,respectively) allowed for exploration of the IC-stained mucosa.When assessing mucosal polyps,both FICE with magnification,and magnification following dye spraying were superior to the same techniques without magnification and to white light imaging.In the presence of suboptimal bowel preparation,observation with the FICE mode was possible,and endoscopists considered it to be superior to observation with white light.CONCLUSION:FICE-filter 4 with magnification improves the image quality of the colonic vascular patterns obtained with WLE.展开更多
AIM:To assess whether the use of porcine models is useful for learning endoscopic submucosal dissection(ESD),thus contributing to its subsequent application in human patients.METHODS:This study/learning process was ca...AIM:To assess whether the use of porcine models is useful for learning endoscopic submucosal dissection(ESD),thus contributing to its subsequent application in human patients.METHODS:This study/learning process was carried out in 3 phases:PhaseⅠ:Ex vivo animal;PhaseⅡ:In vivo animal;PhaseⅢ:Humans.One endoscopist performed 30 gastric ESDs in porcine models,and later 5gastric ESDs in 5 patients.The ESD was done following the method practiced at the National Cancer Center in Tokyo,Japan.Technical aspects,size,time and speed of ESD,as well as complications were registered.In patients,their clinical,endoscopic and histologic evolution was additionally added.RESULTS:Thirty en bloc ESDs were carried out in animal models.The mean±SD size of the pieces was of28.4±1.2 mm,and the time of ESD was 41.7±2.4min.The time of ESD in the first 15 procedures was 43.0±3.0 min whereas in the next 15 procedures,the time was 40.3±3.9 min,P=0.588.The speed in the first 15ESDs was 1.25±0.11 cm2/min vs 2.12±0.36 cm2/min in the remaining 15,P=0.028.There were no complications.In patients,5 lesions were resected en bloc.The size of the pieces was 25.2±5.1 mm and the time was85.0±25.6 min.Endoscopic and histological controls did not show evidence of residual neoplastic tissue.CONCLUSION:A sequential ESD training program of a unique endoscopist,based on the practice in porcine models,contributed to learning ESD for its subsequent application in humans,yielding good results in efficacy and safety.展开更多
AIM:To test a strategy for endoscopic submucosal dissection(ESD) training in animal models designed to overcome the initial learning curve.METHODS:ESD was attempted in ex vivo and in vivo pig models.Thirty ESD procedu...AIM:To test a strategy for endoscopic submucosal dissection(ESD) training in animal models designed to overcome the initial learning curve.METHODS:ESD was attempted in ex vivo and in vivo pig models.Thirty ESD procedures were attempted in the esophagus(n=9) or the stomach(n=21).The ex vivo model was used until initial competence was achieved.In the in vivo model,several ESD procedures were performed in up to 3 sessions.The following variables were analyzed:specimen size,complete and en bloc resection rate,time for circumferential incision,time for submucosal dissection,total ESD duration,and complications.RESULTS:Complete resection was achieved in 28 cases(en bloc 27);2 could not be completed(one perforation,one technical diff iculty).The mean ± SD time for circumferential incision was 36.2±16.8 min(range:8-87 min),and the mean±SD time for submucosal dissection was 45.1±35.7 min(range:9-196 min).The mean±SD size of the resected specimens was 45.2±17.8 mm.The mean±SD total resection time was signif icantly increased for the gastric cases performed in the f irst half of the study(n=13) than in the second half(n=8)(98.9±62.4 min vs 61.7±17.6 min,P=0.04),although the specimen size did not differ.CONCLUSION:Training in animal models could help endoscopists overcome the learning curve before starting ESD in humans.展开更多
基金Supported by Consejería de Educación,Cultura y Deportes,Gobierno de Canarias PI2002/138,the Instituto de Salud Carlos III C03/02
文摘AIM:To validate high definition endoscopes with Fujinon intelligent chromoendoscopy(FICE) in colonoscopy.METHODS:The image quality of normal white light endoscopy(WLE),that of the 10 available FICE filters and that of a gold standard(0.2% indigo carmine dye) were compared.RESULTS:FICE-filter 4 [red,green,and blue(RGB) wavelengths of 520,500,and 405 nm,respectively] provided the best images for evaluating the vascular pattern compared to white light.The mucosal surface was best assessed using filter 4.However,the views obtained were not rated significantly better than those observed with white light.The "gold standard",indigo carmine(IC) dye,was found to be superior to both white light and filter 4.Filter 6(RGB wavelengths of 580,520,and 460 nm,respectively) allowed for exploration of the IC-stained mucosa.When assessing mucosal polyps,both FICE with magnification,and magnification following dye spraying were superior to the same techniques without magnification and to white light imaging.In the presence of suboptimal bowel preparation,observation with the FICE mode was possible,and endoscopists considered it to be superior to observation with white light.CONCLUSION:FICE-filter 4 with magnification improves the image quality of the colonic vascular patterns obtained with WLE.
基金Supported by Department of GastroenterologyHospital de Clínicas+1 种基金MontevideoUruguay
文摘AIM:To assess whether the use of porcine models is useful for learning endoscopic submucosal dissection(ESD),thus contributing to its subsequent application in human patients.METHODS:This study/learning process was carried out in 3 phases:PhaseⅠ:Ex vivo animal;PhaseⅡ:In vivo animal;PhaseⅢ:Humans.One endoscopist performed 30 gastric ESDs in porcine models,and later 5gastric ESDs in 5 patients.The ESD was done following the method practiced at the National Cancer Center in Tokyo,Japan.Technical aspects,size,time and speed of ESD,as well as complications were registered.In patients,their clinical,endoscopic and histologic evolution was additionally added.RESULTS:Thirty en bloc ESDs were carried out in animal models.The mean±SD size of the pieces was of28.4±1.2 mm,and the time of ESD was 41.7±2.4min.The time of ESD in the first 15 procedures was 43.0±3.0 min whereas in the next 15 procedures,the time was 40.3±3.9 min,P=0.588.The speed in the first 15ESDs was 1.25±0.11 cm2/min vs 2.12±0.36 cm2/min in the remaining 15,P=0.028.There were no complications.In patients,5 lesions were resected en bloc.The size of the pieces was 25.2±5.1 mm and the time was85.0±25.6 min.Endoscopic and histological controls did not show evidence of residual neoplastic tissue.CONCLUSION:A sequential ESD training program of a unique endoscopist,based on the practice in porcine models,contributed to learning ESD for its subsequent application in humans,yielding good results in efficacy and safety.
基金Supported by (in part) A grant from Education, Culture and Sports Council, Government of the Canary Islands ("Consejería de Educación, Cultura y Deportes, Gobierno de Canarias") (PI2002/138)the Health Institute Carlos Ⅲ ("Instituto de Salud Carlos Ⅲ") (C03/02)
文摘AIM:To test a strategy for endoscopic submucosal dissection(ESD) training in animal models designed to overcome the initial learning curve.METHODS:ESD was attempted in ex vivo and in vivo pig models.Thirty ESD procedures were attempted in the esophagus(n=9) or the stomach(n=21).The ex vivo model was used until initial competence was achieved.In the in vivo model,several ESD procedures were performed in up to 3 sessions.The following variables were analyzed:specimen size,complete and en bloc resection rate,time for circumferential incision,time for submucosal dissection,total ESD duration,and complications.RESULTS:Complete resection was achieved in 28 cases(en bloc 27);2 could not be completed(one perforation,one technical diff iculty).The mean ± SD time for circumferential incision was 36.2±16.8 min(range:8-87 min),and the mean±SD time for submucosal dissection was 45.1±35.7 min(range:9-196 min).The mean±SD size of the resected specimens was 45.2±17.8 mm.The mean±SD total resection time was signif icantly increased for the gastric cases performed in the f irst half of the study(n=13) than in the second half(n=8)(98.9±62.4 min vs 61.7±17.6 min,P=0.04),although the specimen size did not differ.CONCLUSION:Training in animal models could help endoscopists overcome the learning curve before starting ESD in humans.
