Heterotopic gastric mucosa

Posted on November 16th, 2016 in Rectal Cancer | No Comments »

Heterotopic gastric mucosa of the proximal esophagus (HGMPE), also referred to as “inlet patch” or “cervical inlet patch”, is a salmon colored patch that is usually located just distal to the upper esophageal sphincter. HGMPE is uncommon with endoscopic studies reporting a prevalence ranging from less than one percent to 18%. Most HGMPE are asymptomatic and are detected incidentally during endoscopy for evaluations of other gastrointestinal complaints. Most consider HGMPE as clinically irrelevant entity. The clinical significance of HGMPE is mainly acid related or neoplastic transformation. The reported prevalence of laryngopharyngeal reflux symptoms varies from less than 20% to as high as 73.1%. However, most of these symptoms are mild. Clinically significant acid related complications such as bleeding, ulcerations, structure and fistulization have been reported. Although rare, dysplastic changes and malignancies in association with HGMPE have also been reported. Associations with Barrett’s esophagus have also been reported but the findings so far have been conflicting. There are still many areas that are unknown or not well understood and these include the natural history of HGMPE, risk factors for complications, role of Helicobacter pylori infection and factors associated with malignant transformations. Follow-up may need to be considered for patients with complications of HGMPE and surveillance if biopsies show intestinal metaplasia or dysplastic changes. Despite the overall low incidence of clinically relevant manifestations reported in the literature, HGMPE is a clinically significant entity but further researches are required to better understand its clinical significance.

Haemorrhoids Banding better than Haemorrhoid Artery Ligation

Posted on November 16th, 2016 in Rectal Cancer | No Comments »

Haemorrhoidal Artery Ligation Versus Rubber Band Ligation for the Management of Symptomatic Second-Degree and Third-Degree Haemorrhoids (HubBLe): A Multicentre, Open-Label, Randomised Controlled Trial

Brown SR, Tiernan JP, Watson AJ, et al; HubBLe Study team
Lancet. 2016;388:356-364

Summary

How does hemorrhoidal artery ligation (HAL) compare with rubber band ligation (RBL) for managing symptomatic second- and third-degree hemorrhoids? Brown and colleagues performed a multicenter, randomized controlled trial comparing 185 patients undergoing HAL with 187 patients undergoing RBL. After 1 year, 49% of patients in the RBL group had hemorrhoid recurrence versus 30% in the HAL group. In the first week, pain scores were significantly lower in the RBL group (P=.001), but this difference disappeared after 3 weeks. At 21 days, patient-reported perceived health benefits were similar in the two groups. A cost-utility analysis revealed that the costs were significantly lower in the RBL group.

Viewpoint

Although surgical excision has been a common treatment for hemorrhoids, this carefully performed study compared two newer treatment options: Doppler-guided HAL and RBL. Hemorrhoid recurrence rates were lower and initial pain was higher with HAL than with RBL. The mean total cost per patient was substantially less with RBL, and patient satisfaction with either procedure was about the same. These two alternative treatments to surgical excision have similar outcomes and patient satisfaction scores. RBL could be an attractive option if patients understand and accept the need for a repeat banding procedure.

Future endoscopes….

Posted on August 1st, 2015 in Rectal Cancer | No Comments »

Neoguide (Intuitive Surgical)

This innovative device is a computer-assisted colonoscope comprising 16 articulated segments. Position sensors located at the distal tip and externally at the base of device provide real-time three-dimensional mapping of the leading tip of the endoscope. Articulation of the shaft is based on the tip sensor during insertion, enabling automatic shape control of the shaft to decrease looping and patient discomfort during the procedure. The platform allows the colonoscopist to have accurate images of the tip position, endoscope shaft configuration and luminal views.[19]

It has been shown to reduce looping and lateral force transmission compared with a conventional colonoscope, and feasibility studies have shown successful caecal intubation in 10 patients.[20] Further human studies are warranted in order to improve the platform and to establish its potential for NOTES.

(A) Aer-O-Scope; (B) Invendoscope SC40; (C) Invendoscope SC40 components and the propulsion mechanism. A is the hand-held device that performs all the endoscopic and software functions. B is the driving unit with eight wheels that moves the endoscope in and out of the colon. C is the inverted sleeve, enabling the endoscope to grow or shrink at the tip. D is the inner endoscope sheath. E is the inner layer of the inverted sleeve, when driven forward, unfolds here and becomes part of the outer layer, which then stays in position. There is hence no relative movement, and minimal forces are exerted on the colonic wall. F is the working channel. G is electrohydraulic deflection of the endoscope tip, which can move 180° in any direction. H is the high-resolution camera with three light-emitting diodes. (D) Endotics single-use probe (E-worm). (E) Method of locomotion: (i) adhesion of proximal clamper; (ii) elongation and adhesion of distal clamper; (iii) release of proximal clapper and E-worm shortening. (F) ColonoSight. (G) ColonoSight. The force generated by insufflating the sleeve propels the tip of the colonoscope forward in the direction of the green arrows.

Endotics Colonoscopy System (Era Endoscopy S.R.L)

The Endotics System is a novel robotic self-propelling device. It is a disposable flexible probe with a steerable tip 7.5 mm in diameter (E-worm), able to adapt its shape to configure the colon. The head of the E-worm contains a light source, camera, water and air channels. A workstation enables the operator to steer the E-worm 180° in every direction using a hand-held device.

The device moves in a unique manner comparable to a worm using proximal and distal clampers sited within the E-worm. Using vacuum and mechanical grasping, the proximal clamper adheres to the colonic mucosa, the central probe body is manually elongated and the distal clamper automatically adheres to the mucosa. The proximal clamper is released and the central body of the probe contracts. The proximal clamper adheres to the mucosa followed by the distal clamp being released for the cycle to repeat itself.

In vitro experiments and a prospective, open-label clinical trial showed forces exerted by the E-worm were 90% lower and the procedure more tolerable than conventional colonoscopy with improved diagnostic accuracy.[27]

Sightline Colonosight (Stryker Gi)

This system consists of EndoSight, a colonoscope with integrated LED located at the distal tip. It is covered by a compressed disposable multilumen sheath (ColonoSleeve) acting as a proactive barrier eliminating the need for disinfection.

The device is powered by an electro-pneumatic unit that generates a pulling forward force at the distal tip, thereby reducing the ‘pushing’ force required to insert the device. This mechanism delivers 0.5 kg of effective force at the distal tip.[28]

A multicentre trial showed a 90% caecal intubation rate in a mean time of 11.2±6.5 min[29] Biopsies were taken in some of the procedures and no complications noted after a fortnight,[28,29] showing promising potential of this device over standard colonoscopy.

Endoscopy – Future scopes

Posted on August 1st, 2015 in Rectal Cancer | No Comments »

1. Third Eye Retroscope (Avantis Medical)
This catheter-mounted video chip has been used to improve diagnostic yield of colonoscopy, particularly in hard-to-reach areas.

The device passes through the working channel of a standard colonoscope. As it emerges from the endoscope, the pre-shaped catheter automatically turns 180° into the ‘J-position’ to face the distal end of the endoscope and locks into place (figure 1). This allows the colonoscopist simultaneous forward and retroflexed views of the colon on withdrawal of the endoscope.

Click to zoom
1. Third Eye Retroscope.
It has shown to significantly improve polyp detection rates in both animal model and human studies. The Third Eye Retroscope Randomised Clinical Evaluation (TERRACE) study also showed a significantly improved adenoma detection rate in diagnostic and surveillance colonoscopy.

2. Peerscope System (Peermedical Ltd)

This consists of a main control unit and PeerScope CS colonoscope with a wide-angle lens, allowing a high-resolution field of view of up to 330°. The PeerScope model H is an advance on the legally marketed model B with improvements in video resolution and software. Bench-top and usability tests show this model is safe and effective and human trials are promising.

3. Therapeutic Endoscopes

Endoscopic mucosal resection is widely performed; emerging techniques such as endoscopic submucosal dissection (ESD) and per-oral endoscopic myotomy are also gaining popularity.

There are a number of challenges posed by the flexible endoscope for ELS and NOTES. These include a lack of stability, triangulation of instruments for adequate tissue manipulation and inadequate force transmission to perform accurate microsurgery. This in turn has prompted a wave of new endoscopes to be developed (figure 2).

Multitasking platforms: (A) EndoSamurai; (B) ANUBISCOPE; (C) R-scope; (D) TransPort.

From Medscape
I like the name..Endosamurai

Start dates for Gastroscopy and Colonoscopy lists

Posted on January 3rd, 2015 in Rectal Cancer | No Comments »

Coburg Endoscopy – Jan 20 Tuesday fornightly

Western Gastroenterology – Thursday Jan 15 morning(monthly),  Jan 21 Wed afternoon fortnightly

John Fawkner Private Hospital – Monday mornings weekly(except on public holidays)

Western Private – Wed afternoon monthly

For more information – see www.melbournesurgery.com

Tortous colon

Posted on March 30th, 2014 in Colonoscopy | No Comments »

Sometimes the colonoscope cannot reach the caecum if the large bowel is too long and loopy. A CT colonography is usually performed to visualize the rest of the colon. (Rarely the colon is so long – that the radiological contrast needed is too dilute to visualize the whole colon)

Coeliac disease – importance of doing routine duodenal biopsy vs costs

Posted on March 11th, 2014 in Diagnosis, Gastroscopy | No Comments »

Recent study shows that over 10 percent of new cases can be missed on routine gastroscopy

PLOS ONE 2014

Histologic examination of the duodenum is the gold standard for diagnosing CD. However routine biopsy of the duodenum is expensive. An Australian study [18] assessed the cost-effectiveness of random small bowel biopsy in patients presenting with iron deficiency. Four new cases of CD were found from 253 biopsies taken (2% prevalence) ($72.15/biopsy), equating to $4563.49 per new case. This figure could be reduced to $2435 when only those less than 60 years of age were tested. No case of CD would be missed in their experience by the lower age threshold, although our study results suggest 28% of the adult CD cases would have been missed using that age cut-off. The cost of CD antibody testing in this study  was only $25.00 per sample, significantly cheaper than the cost of biopsy assessment.

 

 

 

Mitcham Private Hospital Endoscopy fees

Posted on March 11th, 2014 in Bowel preparation, Endoscopy Centre Charges | No Comments »

Please enquire directly at 9210 3140

Item number is 30473 for a gastroscopy;  32090 for a colonoscopy and 32135 if also for a banding of haemorrhoids

 

John Fawkner Private Hospital Endoscopy Fees

Posted on March 11th, 2014 in Bowel preparation, Endoscopy Centre Charges | No Comments »

For patients with private health insurance – the health fund normally pays for the costs : please check directly with the health fund. Item number is 30473 for a gastroscopy and 32090 for a colonoscopy

For patients who are uninsured , the fees are:

Gastroscopy – $471

Colonoscopy – $700

Anaesthetist – usually gapcover

 

Western Gastroenterology Fees

Posted on March 11th, 2014 in Bowel preparation, Endoscopy Centre Charges | No Comments »

GASTROSCOPY

 

UN-INSURED PATIENT                                                                $180

(Working patient)

 

 

DISADVANTAGED PATIENT                                                      $140

(HCC/Invalid Pension/single Parent/Carers Pension)

 

 

AGED PENSION                                                                                      $ 90

(Patient over 65 years of age)

 

 

COLONOSCOPY

 

UN-INSURED PATIENT                                                                $250

(Working patient)

 

 

DISADVANTAGED PATIENT                                                      $180

(HCC/Invalid Pension/single Parent/Carers Pension)

 

 

AGED PENSION                                                                                      $120

(Patient over 65 years of age)

 

 

GASTROSCOPY AND COLONOSCOPY

 

UN-INSURED PATIENT                                                                $340

(Working patient)

 

 

DISADVANTAGED PATIENT                                                      $240

(HCC/Invalid Pension/single Parent/Carers Pension)

 

 

AGED PENSION                                                                                      $170

(Patient over 65 years of age)

 

 

FEES FOR CONSUMABLES PER PATIENT ADMISSION

EFFECTIVE MARCH 2013

The prices quoted on booking are for a basic gastroscopy, colonoscopy and flexible sigmoidoscopy. Abnormalities found may require additional equipment to achieve an outcome. The following is a list of special equipment that may be needed during your procedure and will be added to your account, if it is required during your procedure.

SNARE AND POLYP TRAP

A snare is a wire loop that will cut off a polyp and allow an electrical current through to stop bleeding. The polyp trap collects the polyp.

$100.00

HOT BIOPSY AND POLYP TRAP

This allows current through the biopsy forceps in order to coagulate (stop) bleeding areas, when taking a sample from, or removing a polyp

$100.00

HAEMORRHOID BANDING/SKIN TAG

Elastic bands are placed around haemorrhoids to cut them off

$120.00

HAEMORRHOID INJECTION

Haemorrhoids are injected with a drug that causes them to harden, shrink and disappear

$120.00

ROTATABLE CLIPPING DEVICE

This is a clip which is fixed into place to stop a bleeding vessel in case of large bleeds, or to prevent a potential bleed

$ 145.00

ENDOSCOPIC MARKER WITH NEEDLE INJECTION

If there is a tumour that requires surgical removal, it needs to be marked with a dye (tattoo), so that the Surgeon can see where it is during an operation

$120.00

SPIDER NET

The net is used to sweep up large polyps, or to retrieve the pillcam capsule

$100.00

 

These are additional costs for uninsured patients only

Western Gastroenterology Services

30 Eleanor Street, Footscray Vic 3011

Phone: 03 9318 3399 Fax: 03 9317 3182

ABN64983054642