Rectal forceps biopsy procedure in cystic fibrosis: technical aspects and patients perspective for c

Patient safety and comfort with overall procedure No major complications (perforation, haemorrhage) were reported following NaCl 0.9% bowel preparation or jumbo biopsy forceps (allowing larger and more viable rectal specimens, 353 biopsies performed in total), thus making this a safe procedure. There was only one CF patient complaining about abdominal pain who was observed for 4h after the procedure, but had no other complications and recovered by then from such pain. We also report other minor complications that cannot be fully related to the sigmoidoscopy procedure, (see Discussion). Patients were asked by telephone to assess the rectal biopsy procedure by posing several questions targeting several aspects of patient assessment (Figure S1). The questions were divided into 3 broad categories (Additional file 2 : Questionnaire used for patients assessment of the rectal biopsy procedure): i) procedural pain/discomfort and sedation requirement (questions 1,2,3,5); ii) comparison with other clinical/diagnosis procedures (question 4); and iii) acceptance towards the possible introduction of this method as an outcome measure in clinical trials (question 7). In addition, there was also a question regarding preconceptual concerns or discomfort and pain associated a priori with this procedure (question 6). Data collected on patients (dis)comfort show that 57/75 (76%) of the interviewed individuals did not report high levels of discomfort, independently of sedation or age, but shows statistically significant differences (p = 0.032) regarding gender (Table 3 ): as there were more female patients saying that the overall rectal biopsy procedure is somewhat uncomfortable. Nevertheless, the majority of both female (32/41) and male (25/34) reported low levels of discomfort. Also, the great majority of the individuals inquired (78.7%) reported that this is a painless procedure, regardless of sedation, age or gender (Table 3 ). Only 2 individuals assessed the procedure as Very painful (data not shown). Moreover the vast majority of the individuals (88%, 66/75) accepted repeating this procedure for at least once more (18.7% for 1 more time; 12% for 2 more times; 4% for 3 more times; and 53.3% for 4 more times), while only a minority (12%, 9/75) do not wish to repeat it (Table 3 ), also independently of sedation, age and gender. Table 3. Evaluation of comfort, pain and future repetition of the rectal biopsy procedure assessed by patients by gender, age group and sedation (n = 75) When asked to indicate which steps of the procedure they considered as the least/most uncomfortable (Table 4 ), data shows that the monitoring was considered by the highest percentage (89.3%) as Not uncomfortable (76%) or Least uncomfortable (13.3%), followed by the biopsing (70.7%) and the bowel preparation (70.7%), and finally the sigmoidoscopy (66.7%). For the individuals being sedated, the sedation step was also well-tolerated, as much as the monitoring step (Table 4 ). enquiry http://www.biomedcentral.com/1471-230X/13/91





Unique gastroenterology procedure developed in adults shows promise in pediatrics





"Small intestinal enteroscopy in the pediatric population remains relatively unknown and underutilized," said Dr. Erdman, also a professor of Clinical Pediatrics at The Ohio State University College of Medicine. To shed light on the indications and possible benefits of DBE in children, physicians from Nationwide Children's reviewed the outcomes of DBE cases performed at the hospital during a two-year period. The physicians performed a total of 13 DBE procedures on 11 pediatric and adolescent patients. Prior to the DBE, all patients underwent a detailed diagnostic evaluation including laboratory testing and diagnostic radiologic imaging along with upper endoscopy, colonoscopy and capsule endoscopy (CE) tests. Abnormal small intestinal CE findings or continued small bowel disease symptoms without diagnosis by conventional methods were used as indications for DBE. Two of the patients underwent DBE for treatment of small intestinal polyps associated with Peutz-Jeghers Syndrome which dramatically improved their symptoms of abdominal pain and bleeding. Another patient's DBE was done to remove a bleeding small intestinal vascular malformation that had caused years of symptoms resolving chronic anemia. Two other patients had histories of bloody diarrhea, anorexia and weight loss; lower DBE provided evidence leading to the diagnosis of Crohn's disease when other medical techniques had been unsuccessful. DBE can be associated with abdominal discomfort following the procedure due to gaseous distention as was seen in five of the 13 procedures. Utilizing carbon dioxide rather than regular air to fill the intestine during this procedure has eliminated this issue. Noting the limitations of this study on a small number of patients from a single institution, Dr. Erdman says that DBE appears to hold promise for pediatrics. "Our experience suggests that DBE shows great potential in the diagnosis and management of pediatric small intestinal disease without undue risk," he said. Since completion of the original report, eight additional DBE procedures have been completed with similar positive outcomes. Although DBE shows great potential, Dr. go to website http://www.eurekalert.org/pub_releases/2010-09/nch-ugp092410.php





Noninvasive TIF procedure effective, safe in some patients with chronic, refractory GERD





The majority of patients indicated that daily bothersome heartburn (65% of evaluable participants) and regurgitation symptoms (86% of evaluable participants) had ceased at 12 months. Improvement to or normalization of esophageal acid exposure occurred in 53% of 19 evaluable patients who underwent pH testing at 12 months. The number of patients who reported dissatisfaction with their health decreased from 80% of cases before TIF to 15%. No intraoperative or postoperative complications were observed. Treatment failure and revision occurred in six patients, one for TIF and five for laparoscopic Nissen fundoplication. TIF is a noninvasive way of treating heartburn or regurgitation in patients without having to do surgery, researcher Peter G. Mavrelis, MD, Internal Medicine Associates in Merrillville, Ind., told Healio.com. This is a procedure we do on our own patients with heartburn thats not treated adequately with medication. We can take these patients we wouldve sent for surgery, and can do this operation ourselves as endoscopists to treat their regurgitation and heartburn so they can completely come off medications. Mavrelis said the researchers have since gathered 2-year data that further supports the conclusions reached from their 1-year data. They plan to present their additional findings in the coming year. Disclosure: Researchers Reginald C.W. Bell and Karim S. Trad serve as consultants for EndoGastric Solutions, which provided a small research grant for data collection. For more information: Mavrelis PG. sneak a peek at this site http://www.healio.com/gastroenterology/inflammatory-bowel-disease/news/online/%7B2F2F34DF-C888-4FD9-BFC7-6D59C5BA0736%7D/Noninvasive-TIF-procedure-effective-safe-in-some-patients-with-chronic-refractory-GERD