Faculty Bibliography

BACKGROUND: Adequate colon preparation is essential for the quality and accuracy of colonoscopy and has a significant influence on related costs. The aim of this study was to assess the efficacy and safety of a novel attachable colon-cleaning device used during colonoscopies in porcine colon. METHODS: The ClearPath device consists of a multilumen extruded tube with channels for water irrigation and evacuation designed to allow the break up and removal of stool remnants during colonoscopy. Seven female domestic swine underwent several series of experiments in which partial bowel preparation followed by a sedated colonoscopy using the new device was performed. RESULTS: Between February 2008 and October 2008, a total of 57 colonoscopic procedures were conducted. The device enabled rapid cleaning of the partially prepared porcine colon with no immediate or delayed adverse consequences. CONCLUSIONS: Use of the ClearPath device was found to be a simple, reliable, and safe method for intraprocedural cleaning of partly prepared porcine colon. These experiments support a potential role for ClearPath in cleaning the colon in unprepared or poorly prepared human patients

INTRODUCTION: This study was designed to compare symptomatic outcomes following cholecystectomy in patients with biliary dyskinesia. MATERIALS AND METHODS: From 1999 to 2006 at New York University Medical Center, 197 adults underwent hepatobiliary scintigraphy with cholecystokinin administration to evaluate gallbladder ejection fraction (GBEF). Biliary dyskinesia was demonstrated in 120 patients based on decreased GBEF of </=35%. Forty-four patients underwent cholecystectomy, and data from chart review and telephone questionnaires were available for 42 patients. Patients reported symptomatic improvement whether gallstones were present (25/27, 92.6%) or absent (13/15, 86.7%) prior to cholecystectomy (p = 0.90). The most common pathologic findings were chronic cholecystitis and cholesterolosis, regardless of the presence of gallstones. Additional data from 101 of the 120 patients with decreased GBEF demonstrated 74/101 (73.2%) patients were diagnosed with gastroesophageal reflux disease (GERD), and 59/101 (58.4%) patients were diagnosed with gastritis. RESULTS: The results of this study suggest that biliary dyskinesia should be considered as part of the spectrum of symptomatic gallbladder disease that can be successfully treated with cholecystectomy and that biliary dyskinesia is associated with GERD and gastritis

This article focuses on potential complications of standard upper and lower endoscopic procedures. Adverse events associated with endoscopic retrograde cholangiopancreatography, EUS, and certain advanced therapeutic techniques such as mucosal resection are not covered. Rather, the article focuses on the recognition of preprocedure risk factors for various complications and the diagnosis and management for procedure-related adverse events.

Training in colonoscopy occurs in the traditional mentoring method, wherein trainees are exposed to procedures under the guidance of an experienced teacher. This teaching experience is unstructured and dictated by the random admission of patients rather than a consistent exposure to fundamental medical problems in an organized programmatic fashion. Evidence shows that a higher incidence of complications is observed in procedures performed by trainees in comparison to experienced endoscopists. Colonoscopy simulator training is without the involvement of patient risk and might lead to improved quality of patient care without any additional risk. Virtual reality simulators provide the ability of feedback of patient discomfort and could increase the awareness of trainees causing discomfort. This increased vigilance could potentially lead to a decreased rate of colon perforation. Training on ex-vivo simulators may lead to better performance of interventional procedures, such as polypectomy and endoscopic mucosal resection, with the possibility of decreasing the incidence of intraoperative and postoperative bleeding. Data shows that with the use of structured simulator training with ample feedback from tutors, fellows advance faster to more proficient skill levels. Reaching a more advanced level of expertise by simulator training in the early phase of training could potentially lead to increased patient comfort and thus less requirement of sedation, which has been shown to decrease the rate of unexpected cardiopulmonary events. However, clinical evidence of simulator training in colonoscopy in reducing procedure-related complications is currently not available and subject to further investigation. Given the low rate of complications associated with colonoscopy, studies to provide this evidence may be difficult to conduct