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RESEARCH MONTH Tamar Meszaros PGY-3 July 24, 2006 Preparing for the Month Find a mentor Attending Fellow Find a Project Topic Case Research Project Formulate a Question Literature Search Develop a Protocol IRB Approval QUESTION

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research month

RESEARCH MONTH

Tamar Meszaros

PGY-3

July 24, 2006

preparing for the month
Preparing for the Month
  • Find a mentor
    • Attending
    • Fellow
  • Find a Project
    • Topic
    • Case
research project
Research Project
  • Formulate a Question
  • Literature Search
  • Develop a Protocol
  • IRB Approval
question
QUESTION

Is Video Capsule Endoscopy a reasonable alternative to EGD in the detection of esophageal varices in the cirrhotic patient?

relevant q
Relevant Q
  • Attractive alternative to EGD
    • Less risks
      • Coagulopathy
      • Encephalopathy with sedation
    • More comfortable
    • Few contraindications
  • To date, there is no published study showing it’s efficacy in the detection of esophageal varices.
esopahgeal capsule endoscopy
Esopahgeal Capsule Endoscopy
  • Prospective multicenter, international study
  • 66 of 106 patients had + esophageal findings
  • ECE identified esophageal abnormalities in 61 (sensitivity, 92%; specificity, 95%).
  • The per-protocol sensitivity, specificity, PPV, and NPV of ECE for Barrett esophagus were 97%, 99%, 97%, and 99%, respectively
  • Esophagitis 89%, 99%, 97%, and 94%,
  • ECE was preferred over EGD by all patients
  • No adverse events related to ECE.

Journal of Clinical Gastroenterology. A Prospective Study of the Diagnostic Accuracy of

PillCam ESO Esophageal Capsule Endoscopy Versus Conventional Upper Endoscopy

in Patients With Chronic Gastroesophageal Reflux Diseases August 2005; 39(7): 572-578

vce in small bowel dz
VCE in small bowel dz
  • Review articles from Israel & Netherlands
    • Wireless capsule video endoscopy: three years of experience
    • Video capsule endoscopy: procedure, indications and diagnostic yield.
    • More sensitive diagnostic tool than enteroscopy, CT and SBFT for small bowel disease.
alternatives
Alternatives
  • Some alternatives have been studied
    • Transnasal endoluminal ultrasound.
    • Compared transnasal endoscopy to EGD.
    • Concluded it to be a safe and good alternative.
    • Study was small.
    • No follow up studies to date.

Saelan K. et al. Unsedated Transnasal Endoscopy: a New Technique for Accurately Detecting and Grading Esophageal Varices in Cirrhotic atients. The American Journal of Gastroenterology Sept 2002; 97: 2246-2249

background varices in the cirrhotic
Background:Varices in the Cirrhotic
  • 2/3 of patients will develop varices.
  • Prevalence as high as eighty to ninety percent reported in newer studies.
  • The mortality rate after the first episode of bleeding is twenty to thirty five percent.

Dennis M Jensen. Endoscopic Screening for Varices in cirrhosis: findings, implications and Outcomes. Gastroenterology 2002;122:1620-1630.

methods materials
Methods/Materials
  • A randomized selection of cirrhotic patients from Dr. Lewis’ liver clinic.
  • Both pill endoscopy and EGD will be performed on the same day
  • Pill endoscopy will be performed first, followed by EGD.
  • Dr. Bull Henry to interpret the pill endoscopy
  • Both Dr. Bull-Henry and Dr. Lewis will be blinded to results of the other clinician’s procedure as well as the patient’s history.
methods materials13
Methods/Materials
  • Northern Italian System
  • Dr. Bull-Henry will describe the varices
    • there is no established grading system for varices seen by pill endoscopy at this time.
  • Correlation to the EGD results determined in order to evaluate the pill’s efficacy in variceal detection.
  • Ultimate Goal
    • conduct a larger study if the results are statistically significant.
reality check
Reality Check!!
  • Insurance would not cover both pill endoscopy and EGD.
  • Back to the drawing board!!
patient selection
Patient Selection
  • Patients with known cirrhotic liver dz
  • EGD performed by Dr. Lewis within the last 6 months
  • Pill endoscopy results to be read by Dr. Bull-Henry
slide17
Dr. Lewis did not receive the 20 free pills as promised!
  • Working with Maria Bertagnolli on finding funding!
slide19
Prospective Study
    • Dr. Charabaty
    • VCE in the Crohn’s patient
  • Case Report
    • WHC
    • Pancreatitis and PPI
citations
CITATIONS
  • Dennis M Jensen. Endoscopic Screening for Varices in cirrhosis: findings, implications and Outcomes. Gastroenterology 2002;122:1620-1630.
  • Saelan K. et al. Unsedated Transnasal Endoscopy: a New Technique for Accurately Detecting and Grading Esophageal Varices in Cirrhotic Patients. The American Journal of Gastroenterology Sept 2002; 97: 2246-2249.
  • Rami Eliakim. Wireless capsule video endoscopy: three years of experience. World J Gastroenterology 2004; 10(9): 1238-1239.
  • S.A.C. van Tuyl et al. Video capsule endoscopy: procedure, indications and diagnostic yield. The Netherlands Journal of Medicine July 2004; 62(7):225-228.
  • Gastroenterology & Hepatology. Technology Insight: current status of video capsule endoscopy. 2006 Mar;3(3):158-64
  • Journal of Clinical Gastroenterology. A Prospective Study of the Diagnostic Accuracy of PillCam ESO Esophageal Capsule Endoscopy Versus Conventional Upper Endoscopy in Patients With Chronic Gastroesophageal Reflux Diseases August 2005; 39(7): 572-578.