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Background With an overall incidence of 3.5%, pancreatitis is the most frequent complication of endoscopic retrograde cholangiopancreatography ( ERCP). Periprocedural hydration may prevent post- ERCP pancreatitis by maintaining pancreatic microperfusion, thereby inhibiting the pancreatic inflammatory response. However, the evidence for periprocedural hydration as a preventive measure is unclear. Aim To conduct a systematic review to assess the evidence regarding periprocedural hydration as a preventive measure for post- ERCP pancreatitis. Methods We searched PubMed and EMBASE databases and adhered to the PRISMA guidelines. We included studies addressing periprocedural hydration as a preventive measure to reduce frequency and severity of post- ERCP pancreatitis. Study quality was assessed by using the MINORS and Cochrane Collaboration's tool. Results Six studies with a total of 1102 patients were included. Two randomised controlled trials reported a decreased incidence of post- ERCP pancreatitis after hydration: 0% vs. 17% ( P = 0.016) and 5.3% vs. 22.7% ( P = 0.002). A third trial and two case-controls studies did not report significant differences. Two retrospective studies found that patients with mild post- ERCP pancreatitis had received significantly more fluids during (mean 940 mL vs. 810 mL; P = 0.031) or after ERCP (median 2834 mL vs. 2044 mL; P < 0.02) compared to patients with moderate/severe disease. Adverse events of periprocedural hydration were not reported in any of the included studies. The different methodologies of the included studies precluded a formal data synthesis. Conclusions There is some evidence to suggest that hydration affords protection against post- ERCP pancreatitis, but study heterogeneity precludes firm conclusions. Adequately powered randomised trials are needed to evaluate the preventive effect of periprocedural hydration. [ABSTRACT FROM AUTHOR]

Background Treatment of achalasia is complicated by symptom recurrence and a significant risk for severe complications. Endoscopic myotomy was developed in the search for a highly efficacious treatment with lower risks. Since its introduction in 2010, several centers have adopted the technique and published excellent short-term results of open label series. Randomized trials with long-term endpoint comparing per-oral endoscopic myotomy ( POEM) with the established treatments such as balloon dilation and surgical myotomy are now warranted, before POEM can be regarded as the routine clinical care for achalasia patients. Purpose This review describes the development, technical aspects, efficacy, and complications of POEM. [ABSTRACT FROM AUTHOR]

Aim The study assessed the impact on anorectal function of endoscopic mucosal resection ( EMR) and transanal endoscopic microsurgery ( TEM) of large rectal adenomas. Method Patients with a large (≥ 3 cm) rectal adenoma undergoing EMR or TEM were included. Self-reported faecal incontinence was assessed using the Colorectal Functional Outcome ( COREFO) questionnaire and the Wexner Incontinence Grading Scale. Anorectal manometry was performed before and at 6 months after treatment to measure anal resting ( ARP) and squeeze pressure ( SP), squeeze endurance ( SE), the rectoanal inhibitory reflex ( RAIR), rectal volumetry of first sensation ( FS), first urge ( FU), maximum tolerable volume ( MTV) and rectal compliance ( RC). Results Twenty-four patients were included in the study, of whom 11 underwent EMR and 13 underwent TEM. The mean adenoma size was 51 ± 19 mm and the median distance from the anal verge was 3 cm (interquartile range 1-10 cm). Follow-up data were available from 20 patients; one patient had died and three had undergone total mesorectal excision. Incontinence for liquid stool and Wexner score decreased significantly after treatment. In contrast, none of the measured parameters of anorectal motility ( ARP, SP, SE, RAIR, RC) and perception ( FS, FU, MTV) was affected by adenoma resection. No differences were found in baseline and follow-up incontinence and functional parameters between intervention groups, except for postprocedural ARP, which was lower after TEM than after EMR. Conclusion Continence in patients with a large rectal adenoma improved after EMR or TEM, probably due to decreased rectal mucus production. Anal sphincter pressure, rectoanal reflexes, rectal sensation and compliance were not affected by adenoma resection. [ABSTRACT FROM AUTHOR]

Aim A recent systematic review indicated that dysplasia present before restorative proctocolectomy is a predictor of subsequent dysplasia in the pouch. This prospective study was carried out to assess the prevalence of dysplasia in the ileal pouch in patients having RPC for ulcerative colitis with co-existing dysplasia in the operation specimen. Method Eligible patients were invited for a surveillance endoscopy. The afferent and blind efferent ileal loop, ileoanal pouch and rectal cuff were examined by standard endoscopy using a dye-spray technique with methylene blue. Mucosal abnormalities were biopsied and random biopsies were taken from the afferent and blind ileal loop, pouch and rectal cuff. Results Fourty-four patients (25 male, mean 49 years) underwent pouch endoscopy at a mean interval from RPC of 8.6 years. Dysplasia was detected in two (4.5%) patients. In one, low-grade dysplasia was found in the rectal cuff and in the other low-grade dysplasia was detected in random biopsies from the pouch and the efferent ileal loop. Conclusion This prospective pouch-endoscopy study detected dysplasia in < 5% of patients over nearly 10 years. The benefit of routine surveillance for dysplasia in the pouch is uncertain, as the significance of low-grade dysplasia in the pouch is not clear. [ABSTRACT FROM AUTHOR]

Aim Large (> 2 cm) rectal adenomas are currently treated by transanal endoscopic microsurgery (TEM) or piecemeal endoscopic mucosal resection (EMR). The potential lower morbidity of EMR becomes irrelevant if it is less effective. We aimed to compare the safety and effectiveness of EMR and TEM for large rectal adenomas. Method Data from patients undergoing TEM or EMR for a rectal adenoma > 2 cm in eight hospitals were retrospectively collected. Patient- and procedure-related characteristics, complications and recurrences were recorded. As EMR may require several attempts to achieve complete resection, e arly (after a single intervention) and late (permitting re-treatment for residual adenoma within 6 months) recurrence rates were determined. Results Two hundred and ninety-two (292) patients (49% male; mean age 67 years) were included; 219 were treated by TEM and 73 by EMR. Adenomas treated by EMR were smaller (median 30 vs 40 mm; P = 0.007). Perioperative complication rates were 2% for TEM and 6% for EMR ( P = 0.171). Postoperative complications occurred in 24% of TEM patients and in 13% of EMR patients ( P = 0.038). Median hospitalization after TEM was 3 days vs 0 days after EMR ( P < 0.001). Median follow-up was 12.6 months (0-47 months); Early recurrence rates were 10.2% in TEM patients and 31.0% in EMR patients ( P < 0.001); late recurrence rates were 9.6% and 13.8%, respectively ( P = 0.386). Conclusion After a single intervention, EMR of large rectal adenomas seems less effective, but safer than TEM. When allowing re-treatment of residual adenoma within 6 months, EMR and TEM seem equally effective. A prospective randomized comparison seems to be necessary. [ABSTRACT FROM AUTHOR]

Chronic pelvic sepsis after ileoanal or coloanal anastomosis precludes ileostomy closure and, even if closure is ultimately possible, function of the neorectum is badly affected. Early closure of the anastomotic leak might prevent chronic pelvic sepsis and its adverse sequelae. In our experience of early closure in a consecutive group of six patients with a leaking low anastomosis (five with ileoanal pouch anastomosis and one after a low anterior resection), we were able to achieve anastomotic closure in five by means of initial endosponge therapy followed either by early suture (four patients) or endoscopic clip repair (one patient). Early minimally invasive closure of low anastomotic leaks is therefore possible provided that the para-anastomotic cavity is drained well prior to closure and the anastomosis is defunctioned. [ABSTRACT FROM AUTHOR]

Aliment Pharmacol Ther 31, 548–552 Background Confocal laser endomicroscopy (CLE) is rapidly emerging as a valuable tool for gastrointestinal endoscopic imaging. Fluorescent contrast agents are used to optimize imaging with CLE, and intravenous fluorescein is the most widely used contrast agent. Fluorescein is FDA-cleared for diagnostic angiography of the retina. For these indications, the safety profile of fluorescein has been well-documented; however, to date, fluorescein is not cleared for use with CLE. Aims To estimate the rate of serious and total adverse events attributable to intravenous fluorescein when used for gastrointestinal CLE. Methods We performed a cross sectional survey of 16 International Academic Medical Centres with active research protocols in CLE that involved intravenous fluorescein. Centres using i.v. fluorescein for CLE who were actively monitored for adverse events were included. Results Sixteen centres performed 2272 gastrointestinal CLE procedures. The most common dose of contrast agent was 2.5–5 mL of 10% sodium fluorescein. No serious adverse events were reported. Mild adverse events occurred in 1.4% of individuals, including nausea/vomiting, transient hypotension without shock, injection site erythema, diffuse rash and mild epigastric pain. The limitation is that only immediate post procedure events were actively monitored. Conclusions Use of intravenous fluorescein for gastrointestinal CLE appears to be safe with few acute complications. [ABSTRACT FROM AUTHOR]

Background Colonoscopic detection and removal of neoplasia from the colorectum prevent the development of colorectal cancer. Sporadic adenomas and neoplasia associated with ulcerative colitis are frequently missed during colonoscopy, as a result of which, interval cancers might develop. Aim To review new developments in colonoscopic imaging concerning the detection of neoplasia. Methods Medical databases were searched for relevant publications, dealing with advanced endoscopic imaging techniques during colonoscopy. Results Pancolonic chromoendoscopy has shown to increase the detection of sporadic adenomas and ulcerative colitis associated neoplasia, at the expense of longer examination times. As chromoendoscopy is labour intensive and time-consuming, its widespread use has been hampered. Narrow band imaging is a novel endoscopic imaging technique, which enhances mucosal and vascular details. Recent studies indicate that narrow band imaging has a high yield for neoplasia; however, no improvement compared to standard colonoscopy has been demonstrated. Autofluorescence imaging is another new technique for which blue endoscopic light is used to induce mucosal autofluorescence. So far, preliminary results have shown promising results of autofluorescence imaging for neoplasia detection. Conclusion Whether chromoendoscopy or novel advanced imaging techniques will change current colonoscopic practice depends on results of future studies comparing these different colonoscopic techniques. [ABSTRACT FROM AUTHOR]

Background Over the last decades, gastrointestinal endoscopy has transformed from serving purely diagnostic purposes to therapeutic applications. One recent major progress is taking the endoscope beyond the gastrointestinal lumen into the peritoneal cavity for diagnostic and therapeutic procedures. The first step towards Natural Orifice Translumenal Endoscopic Surgery (NOTES) was translumenal endoscopic debridement of pancreatic necrosis. Aim To overview current status of endoscopic debridement of organized pancreatic necrosis. Finally, we take a short look into the potential future of translumenal endoscopic procedures. Methods Medical databases were searched for relevant publications, dealing with endoscopic debridement of pancreatic necrosis and NOTES. Results All current published studies concerning endoscopic debridement of organized pancreatic necrosis were retrospectivally performed and relatively small (largest n = 25). Succes rates varies from 80–93% and complication rates from 7–20%. There was no procedure related mortality reported. Published NOTES experiments showed feasibilty of a variety of transgastric, transcolonic and transvaginal procedures in the porcine model. Conclusion Endoscopic debridement seems to be an effective and relatively safe minimally invasive therapy in patients with symptomatic organized pancreatic necrosis and is the first step towards NOTES. Further comparative studies need to define its definitive role in the management of these patients. [ABSTRACT FROM AUTHOR]

Investigates the delivery of beclomethasone to the distal part of the small bowel for oral sustained release formations. Examination of the recovery of beclomethasone in ileostomy effluent; Similarity of gastrointestinal passage characteristics in treatment; Delivery of oral formulations in amount of steroid drugs.

Rationale, Aims and Objectives: Timely communication is important to ensure high-quality health care. To facilitate this, the Gastro Intestinal Oncology Center Amsterdam (GIOCA) stipulated to dispatch medical reports on the day of the patient's visit. However, with the increasing number of patients, administrative processes at GIOCA were under pressure, and this standard was not met for the majority of patients. The aim and objective of this study was to dispatch 90% of medical reports on the day of the patient's visit by improving the logistic process., Methods: To assess the main causes for a prolonged dispatch time and to design improvements actions, the roadmap offered by Lean Six Sigma (LSS) was used, consisting of five phases: Define, Measure, Analyze, Improve and Control (DMAIC roadmap)., Results: Initially, 12.3% of the reports were dispatched on the day of the patient's visit. Three causes for a prolonged dispatch time were identified: (1) determining which doctors involved with treatment would compose the report; (2) the reports composed by a senior resident had to be reviewed by a medical specialist; and (3) a medical specialist had to authorize the administration to dispatch the reports. To circumvent these causes, a digital form was implemented in the electronic medical record that could be completed during the multidisciplinary team meeting. After implementation, 90.6% of the reports were dispatched on the day of the visit., Conclusion: The dispatch time of reports sent from hospital to primary care can be significantly reduced using Lean Six Sigma, improving the communication between hospital and primary care., (© 2016 John Wiley & Sons, Ltd.)