Applicability of the Barcelona scale to assess the quality of cleanliness of mucosa at esophagogastroduodenoscopy.

BACKGROUND AND OBJECTIVES: There are few scales with prospective validation for the assessment of the upper gastrointestinal mucosal cleanliness during an esophagogastroduodenoscopy (EGD). The aim of this study was to develop a valid and reproducible cleanliness scale for use during an EGD. METHODS: We developed a cleanliness scale (Barcelona scale) with a score (0-2 points) of five segments of the upper gastrointestinal tract with thorough cleaning techniques (esophagus, fundus, body, antrum, and duodenum). First, 125 photos (25 of each area) were assessed, and a score was assigned to each image by consensus among 7 experts endoscopists. Subsequently, 100 of the 125 images were selected and the inter- and intra-observer variability of 15 previously trained endoscopists was evaluated using the same images at two different times. RESULTS: In total, 1500 assessments were performed. In 1336/1500 observations (89%) there was agreement with the consensus score, with a mean kappa value of 0.83 (0.45-0.96). In the second evaluation, in 1330/1500 observations (89%) there was agreement with the consensus score, with a mean kappa value of 0.82 (0.45-0.93). The intra-observer variability was 0.89 (0.76-0.99). CONCLUSIONS: The Barcelona cleanliness scale is a valid measure and reproducible with minimal training. Its application in clinical practice is a significant step to standardize the quality of the EGD.

Methods for Gastrointestinal Endoscopy Quantification: A Focus on Hands and Fingers Kinematics.

Gastrointestinal endoscopy is a complex procedure requiring the mastery of several competencies and skills. This procedure is in increasing demand, but there exist important management and ethical issues regarding the training of new endoscopists. Nowadays, this requires the direct involvement of real patients and a high chance of the endoscopists themselves suffering from musculoskeletal conditions. Colonoscopy quantification can be useful for improving these two issues. This paper reviews the literature regarding efforts to quantify gastrointestinal procedures and focuses on the capture of hand and finger kinematics. Current technologies to support the capture of data from hand and finger movements are analyzed and tested, considering smart gloves and vision-based solutions. Manus VR Prime II and Stretch Sense MoCap reveal the main problems with smart gloves related to the adaptation of the gloves to different hand sizes and comfortability. Regarding vision-based solutions, Vero Vicon cameras show the main problem in gastrointestinal procedure scenarios: occlusion. In both cases, calibration and data interoperability are also key issues that limit possible applications. In conclusion, new advances are needed to quantify hand and finger kinematics in an appropriate way to support further developments.

360° video recording inside a GI endoscopy room: Technical feasibility and its potential use for the acquisition of gastrointestinal endoscopy skills. Pilot experience.

New advances in video processing, 3-dimensional designs, and augmented/virtual reality are exciting and evolving fields. These new tools can facilitate the learning phase of basic or advanced endoscopic procedures. Herein, we explain our initial experience, creating an immersive virtual reality (IVR) by using 360-degree recording videos from an interventional endoscopy room. Some common terms used around this technology, such as Augmented reality (AR), Virtual Reality (VR), Three hundred sixty videos, and Mixed Reality (MR), are discussed below. Three examples of VR 360 endoscopic room videos are included in this article.

Adverse events of EUS-guided FNA of pancreatic cystic and solid lesions by using the lexicon proposed in an ASGE workshop: a prospective and comparative study.

BACKGROUND AND AIMS: Pancreatic cysts and solid lesions are routinely examined by EUS-guided FNA (EUS-FNA). The aim of this study was to compare the incidence of adverse events (AEs) of this procedure by using the lexicon recommended by the American Society for Gastrointestinal Endoscopy (ASGE). METHODS: This was a prospective and comparative study of patients who underwent EUS-FNA in which a 22-gauge needle was used. In the pancreatic cystic lesions group (group I), complete fluid evacuation in a single needle pass was attempted, and ciprofloxacin was given during the procedure and for 3 days after. In the pancreatic solid lesions group (group II), the number of passes was determined by the on-site evaluation of the sample. AEs were defined and graded according to the lexicon recommended by the ASGE. Patients were followed for 48 hours, 1 week, and 1 month after the procedure. RESULTS: A total of 146 patients were included, 73 in group I and 73 in group II. Potential factors influencing the incidence of AEs (ie, access route for FNA) were similar in both groups. AEs occurred in 5 of 146 patients (3.4%; 95% confidence interval [CI], 1.3%-8%): 4 in group I (5.5%; 95% CI, 1.7%-13.7%) and 1 in group II (1.4%; 95% CI, -0.5% to 8.1%) (P = .03). Severity was mild in 1 of 5 patients (20%) and moderate in 3 of 5 patients (60%). One patient with a solid mass in the head of the pancreas had a duodenal perforation after EUS and died after surgery. All other AEs occurred in the first 48 hours and resolved with medical therapy. There were 3 incidents of transient hypoxia and self-limited abdominal pain in 1 and 2 patients, respectively. No patients were lost to follow-up. CONCLUSION: EUS-FNA of pancreatic cysts has an AEs rate similar to that of solid pancreatic masses, which is small enough to consider this procedure a safe and effective method for managing patients with both types of lesions. AEs occurred early after EUS-FNA, and patients should be closely followed during the first 2 days after the procedure.

Enhanced flat adenoma detection rate with high definition colonoscopy plus i-scan for average-risk colorectal cancer screening.

BACKGROUND AND AIM: The usefulness of high definition colonoscopy plus i-scan (HD+i-SCAN) for average-risk colorectal cancer screening has not been fully assessed. The detection rate of adenomas and other measurements such as the number of adenomas per colonoscopy and the flat adenoma detection rate have been recognized as markers of colonoscopy quality. The aim of the present study was to compare the diagnostic performance of an HD+i-SCAN with that of standard resolution white-light colonoscope. METHODS: This is a retrospective analysis of a prospectively collected screening colonoscopy database. A comparative analysis of the diagnostic yield of an HD+i-SCAN or standard resolution colonoscopy for average-risk colorectal screening was conducted. RESULTS: During the period of study, 155/163 (95.1%) patients met the inclusion criteria. The mean age was 56.9 years. Sixty of 155 (39%) colonoscopies were performed using a HD+i-SCAN. Adenoma-detection-rates during the withdrawal of the standard resolution versus HD+i-SCAN colonoscopies were 29.5% and 30% (p = n.s.). Adenoma/colonoscopy values for standard resolution versus HD+i-SCAN colonoscopies were 0.46 (SD = 0.9) and 0.72 (SD = 1.3) (p = n.s.). A greater number of flat adenomas were detected in the HD+i-SCAN group (6/60 versus 2/95) (p < .05). Likewise, serrated adenomas/polyps per colonoscopy were also higher in the HD+i-SCAN group. CONCLUSIONS: A HD+i-SCAN colonoscopy increases the flat adenoma detection rate and serrated adenomas/polyps per colonoscopy compared to a standard colonoscopy in average-risk screening population. HD+i-SCAN is a simple, available procedure that can be helpful, even for experienced providers. The performance of HD+i-SCAN and substantial prevalence of flat lesions in our average-risk screening cohort support its usefulness in improving the efficacy of screening colonoscopies.

Cardiorespiratory impact of transesophageal endoscopic mediastinoscopy compared with cervical mediastinoscopy: a randomized experimental study.

BACKGROUND: Transesophageal natural-orifice transluminal endoscopic surgery (NOTES) mediastinoscopy has been described as a feasible, less-invasive alternative to video-assisted mediastinoscopy (VAM). We aimed to investigate hemodynamic and respiratory effects during transesophageal NOTES mediastinoscopy compared with VAM. PATIENTS AND METHODS: This was a short-survival experiment in 20 female pigs randomized to NOTES (n = 10) or VAM (n = 10) mediastinoscopy. In the NOTES group, an endoscopist accessed the mediastinum through a 5-cm submucosal tunnel in the esophageal wall, and CO2 was used to create the pneumomediastinum. Conventional VAM was carried out by thoracic surgeons. A 30-minute systematic exploration of the mediastinum was then performed, including invasive monitoring for hemodynamic and respiratory data. Blood samples were drawn for gas analyses. RESULTS: All experiments except 2 in the NOTES group (one because of technical difficulties, the other because of thoracic lymphatic duct lesion) were completed as planned, and animals survived 24 hours. Also, 3 animals in the NOTES group presented a tension pneumothorax that was immediately recognized and percutaneously drained. VAM and NOTES animals showed similar pulmonary and systemic hemodynamic behavior during mediastinoscopy. Pulmonary gas exchange pattern was mildly impaired during the NOTES procedure, showing lower partial arterial oxygen pressure associated with higher airway pressures (more important in animals that presented with pneumothorax). CONCLUSIONS: NOTES mediastinoscopy induces minimal deleterious respiratory effects and hemodynamic changes similar to conventional cervical VAM and could be feasible when performed under strict hemodynamic and respiratory surveillance. Notably, serious complications caused by the injury of pleura are more frequent in NOTES, which mandates an improvement in technique and suitable equipment.

[Prevalence and epidemiology of Barrett's esophagus in the province of Barcelona]. / Prevalencia y características epidemiológicas del esófago de Barrett en la provincia de Barcelona.

INTRODUCTION: The prevalence of Barrett's esophagus (BE) varies from 0.45% to 2.2% in patients who undergo upper endoscopy and is >12% when the indication is for reflux symptoms. The prevalence has progressively increased in recent years but is unknown in the population of the province of Barcelona. OBJECTIVES: To determine the prevalence of BE and its epidemiological characteristics in our population. PATIENTS AND METHODS: We prospectively evaluated patients referred to the Endoscopy Unit of Hospital Clinic and Hospital General de Catalunya for an upper endoscopy. We excluded patients with known BE, prior upper endoscopy, esophagogastric surgery or refusal to participate in the study. Demographic data, alcohol intake, Helicobacter pylori infection and consumption of antisecretory agents were recorded, among other information. Participants completed a standardized questionnaire to assess the presence of gastroesophageal reflux disease (GERD) symptoms and their severity. RESULTS: Between July 2010 and July 2012, we included 200 patients (100 in each center). The mean age was 48.9 ± 15.6 years and the majority were women (n=120, 60%). Symptoms of GERD were present in 46 patients (23%) and some degree of esophagitis was present in 31 (15.5%). Infection by H. pylori was present in 29.7%. BE was found endoscopically in 14 (7%) patients, but was histologically confirmed in only 8 (4%). The only variable that correlated with the finding of BE was male sex. CONCLUSION: The prevalence of BE in our environment is similar to that reported in Western countries. The absence of reflux symptoms does not rule out the possibility of BE.

Comparative study of NOTES alone versus NOTES guided by a new image registration system for navigation in the mediastinum: a study in a porcine model.

BACKGROUND: Natural orifice transluminal endoscopic surgery (NOTES) mediastinoscopy (MED) through the esophagus has proved to be feasible in the animal model. However, injury of the adjacent pleura and pneumothorax has been reported as a frequent adverse event when using a blind access. OBJECTIVE: To assess the utility and safety of a CT-based image registration system (IRS) for navigation in the mediastinum. DESIGN: Prospective, randomized, controlled trial in 30 Yorkshire pigs. Thirty-minute MEDs were performed: 15 MEDs were performed with IRS guidance (MED-IRS), and 15 MEDs were performed with a blind access. SETTING: Animal research laboratory. INTERVENTIONS: In both groups, the mediastinum was accessed through a 10-cm submucosal tunnel in the esophageal wall. Timed exploration was performed with identification of 8 mediastinal structures. MAIN OUTCOME MEASUREMENTS: Technical feasibility, adverse events, and the number of mediastinal structures identified. RESULTS: Thirty animals weighing 31.5 ± 3.5 kg were included in this study. MED was not possible in 2 animals in the "MED with blind access" group but was possible in all MEDs performed with IRS. The mean number of identified organs was slightly higher in "with IRS-MED" (6.13 ± 1.3) than with MED with blind access (4.7 ± 2.3; P = .066). Moreover, the right atrium and vena cava were identified in more cases with IRS-MED than in MED with blind access (13 vs 3 and 15 vs 11, P = .000 and P = .03, respectively). There were 3 (23%) adverse events with IRS-MED and 4 (27%) with "MED with blind access" (P = not significant), with pneumothorax being the most frequent (2 and 3, respectively). LIMITATIONS: Nonsurvival animal study. CONCLUSIONS: This study demonstrates that the IRS system appears feasible in natural orifice transluminal endoscopic surgery MED and suggests that IRS guidance might be useful for selected procedures.

On-demand endoscopic CO2 insufflation with feedback pressure regulation during natural orifice transluminal endoscopic surgery (NOTES) peritoneoscopy induces minimal hemodynamic and respiratory changes.

BACKGROUND: Endoscopic insufflation has been associated with marked increase in intra-abdominal pressure (IAP) and hemodynamic and respiratory changes during transgastric surgery. OBJECTIVE: To investigate the hemodynamic and respiratory effects during intraperitoneal cavity exploration through 3 different natural orifice transluminal endoscopic surgery (NOTES) access locations compared with laparoscopy. DESIGN AND SETTING: Survival experiments using 40 female pigs randomized to transgastric, transcolonic, transvaginal, and laparoscopic peritoneoscopy. INTERVENTIONS: On-demand endoscopic insufflation of CO(2) with feedback pressure regulation was used in NOTES with a maximum pressure of 14 mm Hg. In the laparoscopy group, the IAP was maintained at 14 mm Hg. NOTES procedures were performed by an endoscopist (with the assistance of a gynecologist in the transvaginal group and a second endoscopist in the transgastric and transrectal groups) and laparoscopy by 2 surgeons. MAIN OUTCOME MEASUREMENTS: Invasive hemodynamic and respiratory data. Blood samples were drawn for gas analyses. RESULTS: All experiments except one in the transrectal group were completed. The IAP was significantly lower in all NOTES groups compared with the laparoscopy group. A significant increase in mean systemic arterial blood pressure was observed in the laparoscopy group at 15 and 30 minutes of intraperitoneal cavity exploration, but it remained unchanged during all NOTES procedures. An increase in airway pressures was observed at 15 and 30 minutes of peritoneoscopy in the animals undergoing laparoscopy, whereas those parameters remained unchanged in the NOTES groups. The laparoscopy group showed a significant impairment in pulmonary gas exchange (decrease in Pao(2), increase in Paco(2), and decrease in arterial pH) after 30 minutes of peritoneoscopy, whereas only a slight increase in Paco(2) was observed in the transrectal and transvaginal groups. LIMITATIONS: Healthy animal model. CONCLUSION: On-demand endoscopic insufflation of CO(2) with feedback pressure regulation can minimize the risk of hemodynamic and respiratory compromise caused by acute changes in IAP.

Gastric emptying is delayed in transgastric NOTES: a randomized study in swine.

AIM: The aim of this study was to evaluate the restoration of gastrointestinal motility after NOTES using capsule endoscopy (CE). MATERIALS AND METHODS: Twenty adult Yorkshire pigs were randomly assigned to four groups: transgastric NOTES (gNOTES), transrectal NOTES (rNOTES), transvaginal NOTES (vNOTES), and laparoscopy (LAP). At the end of a 30-min peritoneoscopy with identification of seven predetermined organs, an array of eight receivers and the recorder were attached to the abdominal wall. The CE was delivered into the antrum with the help of an endoscope and a polypectomy snare. Animals were kept alive for 14 d. RESULTS: Median time for surgery was longer in gNOTES (56 min, range 47-63) and vNOTES (54 min, range 44-79) than in LAP (32 min, range 32-33; P < 0.05 and P < 0.01) and in rNOTES (45.5 min, range 33-56) (P = ns). This increase was related to a larger incision and longer closure times. Images from the CE were successfully retrieved in 19 cases. The CE was retained in the stomach in all animals in gNOTES (459 min; range 360-600), but only in one animal in rNOTES and vNOTES and in none in the LAP group. Failure of passage of the CE beyond the stomach was associated with gNOTES and longer closure of the incision. Animals in the gNOTES group gained less weight than the others and this change was statistical significant when compared with vNOTES animals (1.7 kg, range -1.98 to 4.5 versus 8.4 kg, range 5.8 to 11.45; P < 0.01). CONCLUSION: Gastric emptying is delayed after gNOTES peritoneoscopy compared with rNOTES, vNOTES, and LAP and this effect is associated with less weight gain.

Inflammatory impact of NOTES peritoneoscopy is not different from that of laparoscopy: a randomized comparative study in a survival porcine model.

BACKGROUND: Inflammatory changes of different NOTES approaches remain unknown. The aim of this study was to compare the inflammatory effects of NOTES and laparoscopy. METHODS: Forty female pigs were assigned to transgastric, transrectal, and transvaginal NOTES and laparoscopic peritoneoscopy groups. Antiseptic technique was utilized for NOTES whereas laparoscopy was performed sterile. Intraperitoneal pressures were monitored and maintained below 15 mmH(2)O. Pneumoperitoneum was maintained with CO(2) in all groups. Pre- and postoperative blood samples of IL-6, Il-1ß, and TNFα, and peritoneal fluid collected at surgery were analyzed. Animals were followed daily for 14 days. At necropsy, peritoneal fluid was collected for cytokine analysis. RESULTS: Thirty-nine peritoneoscopies were successfully completed. The median procedure time was longer in the NOTES groups (57 min, range = 33-109) than in the laparoscopy group (33 min, range 32-36; P < 0.001); this was related to longer incision time and closure time. All 39 completed follow-up. Severe bleeding in the post-transrectal approach required early sacrifice of the remaining animal. Besides this, complications were similar among groups. At necropsy, adhesions were seen in four animals in the gastric group, five in the rectal group, two in the vaginal group, and two in the laparoscopic group (P = ns). There were no statistical differences in serum levels of TNFα among the groups. When serum TNFα values were expressed as the difference from the baseline, in the transvaginal group they were significantly lower than in the transrectal at 2 h [0.5 pg/ml (range = -14 to 59) vs. 60 pg/ml (range = -8 to 303); P = 0.041] and at 8 h [-5.5 pg/ml (range = -86 to 55] vs. 37 pg/ml (range = -30 to 62); P = 0.031]. The limitations of this study were that the analyses of IL-6 and Il-1ß were not possible because most of the samples were below detectable levels, it was an animal model, and the sample size was small. CONCLUSION: Inflammatory parameters are similar between NOTES and laparoscopic peritoneoscopy despite longer surgery time in the NOTES group. The vaginal route seems to reduce the inflammatory stress.

Infection during natural orifice transluminal endoscopic surgery peritoneoscopy: a randomized comparative study in a survival porcine model.

BACKGROUND: Infection in natural orifice transluminal endoscopic surgery (NOTES) remains controversial. OBJECTIVE: To estimate the frequency of infection during NOTES peritoneoscopy with different routes of access and to compare with laparoscopy. DESIGN: Prospective randomized controlled study (Canadian Classification type I). METHODS: Forty female pigs were randomly assigned to 3 NOTES (transgastric, transrectal, and transvaginal) and laparoscopic groups. Antiseptic technique was used for NOTES, whereas laparoscopy was performed in a sterile environment. Preoperative and postoperative intravenous antibiotics were administered. Closure of the transluminal access site was performed in all animals. Peritoneal fluid was collected for culture at the end of surgery and at necropsy at day 14. RESULTS: Thirty-nine peritoneoscopies were successfully completed. Necropsy confirmed complete healing of NOTES incisions, but 2 animals in the laparoscopy group had small abscesses in the abdominal incisions. There were no statistical differences in the presence of peritoneal adhesions. Positive culture results were seen in all groups at the end of the procedure and in all animals at necropsy, but this did not lead to clinical signs of gross infection. The most common organisms that colonized the peritoneum were gram-positive cocci and gram-negative bacilli from the normal swine gastrointestinal flora. LIMITATIONS: Animal model and small sample size. CONCLUSIONS: In these small series of animals and with the careful lavage and preparation used, NOTES appeared to be comparable to laparoscopy in terms of peritoneal contamination and clinical infection. Despite the adherence to a strict antiseptic protocol, peritoneal contamination occurs but does not lead to septic complications in the swine.

[Radiofrequency in the treatment of Barrett's esophagus]. / Radiofrecuencia en el tratamiento del esófago de Barrett.

Currently, there is ample evidence that endoscopic treatment of Barrett's esophagus (BE) and related neoplasms is safe and effective, suggesting that this approach should be preferred to esophagectomy in selected patients. Among new endoscopic tools, radiofrequency ablation is the latest to be developed. Due to its simplicity, effectiveness and safety, this technique may change the management of patients with BE since it appears to be effective not only in removing dysplasia but also in completely eradicating all Barrett's mucosa in most treated patients.

[Endoscopic treatment of pancreatic pseudocyst. Practical features]. / Tratamiento endoscópico del seudoquiste de páncreas: aspectos prácticos.

The initial treatment of most cases of pancreatic pseudocyst is endoscopic while surgery has been relegated to patients who cannot undergo this procedure for technical reasons, such as roux-en-Y roux reconstruction, or to those in whom other procedures have been unsuccessful. This change in the management of this entity is due to advances in therapeutic endoscopy (as a result of the development of guidelines, dilatation balloons, prostheses, safer techniques) as well as to better knowledge of the pathogenesis of pancreatic pseudocyst. The present study aims to describe endoscopic procedures for the drainage of pancreatic pseudocysts, particularly key technical features to ensure the maximum safety and effectiveness of this therapeutic technique.

[Epidemiology of inflammatory bowel disease in the elderly]. / Epidemiología de la enfermedad inflamatoria intestinal en el paciente de edad avanzada.

INTRODUCTION: Inflammatory bowel disease has classically been considered a disorder with onset in young people. However, between 5 and 15% of patients are diagnosed when aged more than 60 years old. Epidemiological studies comparing these two age groups are controversial and consequently new studies are required to define the characteristics in each group. OBJECTIVES: To determine the epidemiological characteristics specific to Crohn's disease and ulcerative colitis in the elderly and to compare these characteristics with the form of presentation in young people in Spain. METHOD: We performed a case-control, descriptive study. Patients with inflammatory bowel disease registered in the database of the Crohn-Colitis Unit were included. The patients were stratified in two groups according to age at symptom onset: the first group consisted of patients with onset at age 60 years or above and the second group was a control group consisting of patients aged less than 60 years old. The control group was composed of two patients for each case matched by sex and diagnosis. RESULTS: Thirty-three cases aged more than 60 years old (4.1%) were included, eight with Crohn's disease and 25 with ulcerative colitis. The control group included 66 patients (16 with Crohn's disease and 50 with ulcerative colitis). Statistically significant differences were observed between the two groups both in the form of presentation (tenesmus and occlusive symptoms were more frequent and abdominal pain was less frequent in the group aged more than 60 years than in the control group) and in treatment response (corticosteroid dependency and refractoriness and requirement for immunosuppressive treatment were more frequent in the elderly). CONCLUSION: The results of the present study suggest that there are epidemiological differences in inflammatory bowel disease among the elderly, notably a lower frequency of abdominal pain and a lower rate of refractoriness to steroid treatment.

Impact of endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration on the management of pancreatic cystic lesions.

BACKGROUND AND STUDY AIMS: Endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) are well-recognized techniques for the study of pancreatic cystic lesions (PCLs). However, little evidence exists on their impact on clinical care. The aim of this study is to determine how often EUS and EUS-FNA alter the diagnosis and management of patients with PCLs. PATIENTS AND METHODS: Eight physicians expert in pancreatic diseases were asked to report their diagnoses and management recommendations for 49 different PCLs. Clinical information was sequentially disclosed in a stepwise manner - progressively from clinical data plus computed tomography or MRI (level 1), to EUS (level 2) and EUS-FNA results including cytology, carcinoembryonic antigen, and amylase levels (level 3). RESULTS: EUS led to a change in the diagnosis and management in 30% [95% confidence interval (CI): 26-35%] and 19% (95% CI: 16-23%) of cases, respectively, usually to a more intensive approach (14%; 95% CI: 11-18%). EUS-FNA altered the diagnosis and management in an additional 39% (95% CI: 34-44%) and 21% (95% CI: 17-25%) of the evaluations, respectively. EUS-FNA also increased the consensus in the diagnosis among the specialists that ranged from fair with computed tomography/MRI (κ-index=0.32) to substantial with EUS-FNA (κ-index=0.43). CONCLUSION: EUS and EUS-FNA impact the diagnosis and management of patients with PCLs; therefore, both are necessary in the workup of these patients. EUS-FNA markedly improves the agreement between physicians in terms of diagnosis, but not management. This study highlights the need for more research and standardization in the field.

[Usefulness of endoscopic biopsy in Barrett's esophagus]. / Utilidad de la biopsia endoscópica en el esófago de Barrett.

BACKGROUND AND OBJECTIVE: Endoscopy with random biopsies is the standard technique for the diagnosis of Barrett's esophagus (BE). We studied the usefulness of endoscopic biopsies in the diagnosis and surveillance of patients with BE. PATIENTS: We reviewed all patients with BE controlled at the Hospital Clínic from February 2002 to March 2010. RESULTS: During the study period, 493 endoscopies were performed in 206 patients. We excluded 86 patients who had undergone one endoscopy only, hence the final sample consisted of 117 patients (mean age 61 [12] years, 73% men) with 407 endoscopies and a mean follow-up of 45 (38) months. Fifty-seven patients had a short-BE (49%), 28 a long-BE (24%) and 32 (27%) could not be inferred from the report. In 25 cases (21%), intestinal metaplasia (IM) was not detected at the endoscopic index. During follow-up, biopsies were negative for IM at some point in 45 patients (38.4%) and there was a change in the histologic grade in 100 cases (24.6%). The presence of a short-BE (43% in short-BE vs 7% in long-BE, P=.001) and few biopsies (3 [1.5] vs 6.2 [4.5]; P=.005) were associated with a higher frequency of negative biopsies for IM. CONCLUSION: Random endoscopic biopsies are not a good tool for diagnosis and surveillance of patients with BE.

Gastrotomy closure with a new tissue anchoring device: a porcine survival study.

AIM: To evaluate the feasibility, reproducibility and efficacy of a new tissue anchoring device in a porcine survival model. METHODS: Gastrotomies were performed using a needle-knife and balloon dilator in 10 female Yorkshire pigs weighing 30-35 kg. Gastric closure was attempted using a new tissue anchoring device. The tightness of the closure was confirmed by means of air insufflation and the ability to maintain gastric distension with stability in peritoneal pressure measured with a Veress needle. All animals were monitored daily for signs of peritonitis and sepsis over 14 d. During necropsy, the peritoneal cavity and the gastric access site were examined. RESULTS: Transgastric access, closure and 14 d survival was achieved in all pigs. The mean closure time was 18.1 ± 19.2 min and a mean of 2.1 ± 1 devices were used. Supplementary clips were necessary in 2 cases. The closure time was progressively reduced (24.8 ± 13.9 min in the first 5 pigs vs 11.4 ± 5.9 min in the last 5, P = NS). At necropsy, the gastric access site was correctly closed in all cases with all brace-bars present. One device was misplaced in the mesocolon. Minimal adhesions were observed in 3 pigs and signs of mild peritonitis and adhesions in one. CONCLUSIONS: The use of this new tissue anchoring device in porcine stomachs is feasible, reproducible and effective and requires a short learning curve.