Ming-Yao Su

Background: Caustic ingestion has gained increasing attention worldwide. However, the insight into whether to use esophagogastroduodenoscopy (EGD) or computed tomography (CT) for first-line investigation remains controversial. This study aimed to evaluate a diagnostic and management algorithm that combines EGD and CT for rapid triage. Methods: We established an algorithm for our hospital in 2013, aiming to maximize the benefits and minimize the limitations of EGD and CT. Then, we retrospectively analyzed the 163 enrolled patients treated between 2014 and 2019 and categorized them into 4 groups: A = 3 (1.8%): with perforation signs and directly confirmed by CT, B = 10 (6.1%): clinically suspected perforation but not initially proven by CT, C = 91 (55.8%): initial perforation less favored but with EGD grade ≥ 2b or GI/systemic complications, and D = 59 (36.2%): clinically stable with EGD grade ≤ 2a, according to initial signs/symptoms and EGD/CT grading. The morbidity and mortality of each group were analyzed. The predictive values of EGD and CT were examined by logistic regression analyses and receiver operating characteristic (ROC) curves. Results: The outcomes of such algorithm were reported. CT was imperative for patients with toxic signs and suspected perforation. For non-emergent operations, additional EGD was safe and helpful in identifying surgical necessity. For patients with an initially low perforation risk, EGD alone sufficiently determined admission necessity. Among inpatients, EGD provided excellent discrimination for predicting the risk for signs/symptoms’ deterioration. Routine additional CT was only beneficial for those with deteriorating signs/symptoms. Conclusions: According to the analyses, initial signs/symptoms help to choose EGD or CT as the first-line investigative tool in caustic patients. CT is necessary for seriously injured patients, but it cannot replace EGD for moderate/mild injuries. The severity stratification and patient categorization help to simplify complex scenarios, accelerate decision-making, and prevent unnecessary intervention/therapy. External validation in a larger sample size is further indicated for this algorithm.

Background: To evaluated the experiences of double balloon enteroscopy (DBE) for obscure gastrointestinal bleeding. Methods: From October 2003 to November 2009, a total of 124 patients with obscure gastrointestinal bleeding were investigated using DBE. A total of 142 procedures (84 per oral and 58 per rectal route) were performed by the same endoscopist. Results: The average insertion time was 71.4 (20–199) minutes per-orally; the average insertion time was 139.2 min for the first 5 procedures, 109.4 min for 6–10 procedures, 76.6 min for 11–15, 66.4 min for 16–20, 67.4 min for 21–25, 59 min for 26–30, 66 min for 31–35, 52 min for 36–40, 42.9 min for 41–45, 44.6 min for 46–50, 42.2 min for 51–55, 38.6 min for 56–60, 44.6 min for 61–65, 37.8 min for 66–70, 38.8 min for 71–75, 44.3 min for 76–80, and 36.6 min for 61–84 procedures; there was no statistical difference after the first ten procedures. The average insertion time was 92.1 (22–260) minutes per-rectally; the average insertion time was 159.6 min for the first 5 procedures, 98.4 min for 6–10 procedures, 86.6 min for 11–15, 76.4 min for 16–20, 82.4 min for 21–25, 75.0 min for 26–30, 78.2 min for 31–35, 72.4 min for 36–40, 68.2 min for 41–45, 66.9 min for 45–50, and 71.4 min for 51–58 procedures; there was no statistical difference after the first five procedures. For the different genders these was no statistically significant difference. There were no differences regarding the diagnostic yield between the previous factors. The overall diagnostic yield was 82.4%. Conclusion: DBE is a safe and effective means of diagnosing and managing patients with obscure gastrointestinal bleeding. However, because of its time-consuming, DBE has a learning curve to overcome before a physician can become an expert to achieve adequate insertion times with good diagnostic and therapeutic rates.

Background and Aim:  The technical performance of colonoscopy performed in deeply sedated patients differs from that performed without sedation or under minimal to moderate sedation. The aim of this study is to evaluate the factors affecting cecal intubation during colonoscopy performed under deep sedation.Methods:  A total of 5352 consecutive subjects who underwent a screening colonoscopy as part of a health check‐up between January 2008 and December 2008 at an academic hospital were reviewed. All endoscopies were performed with deep sedation using combination propofol or propofol alone. Data collected included characteristics of the patients (age, gender, body mass index, bowel habits, history of abdominal or pelvic surgery, quality of bowel preparation, and presence/absence of colonic diverticula) and characteristics of the colonoscopists (experience level, colonoscopy procedure volume, and instrument handling method). These factors were analyzed to evaluate their impact on cecal intubation rates.Results:  The crude cecal intubation rate was 98% and the adjusted cecal intubation rate was 98.3%. The mean cecal intubation time was 5.6 ± 3.2 min. Multivariate logistic regression analysis demonstrated that patient age greater than 60 years, constipation, poor colon preparation and a two‐person colonoscopy procedure were independently associated with lower cecal intubation rates.Conclusions:  Colonoscopy performed under deep sedation by experienced colonoscopists results in high cecal intubation rates. Among the significant patient‐related predictors influencing the cecal intubation, the quality of the bowel preparation was the only modifiable factor. When performed by experienced hands, the one‐person method was associated with higher cecal intubation rates than the two‐person method.