Bariatric endoscopy: Keep it simple and smart

AbstractAlthough not yet fully elucidated, the science behind the mechanisms of energy homeostasis has advanced significantly in recent decades. Current treatment paradigms, however, have not taken advantage of this evolving body of knowledge. The use of the scalpel to treat obesity is historically rooted in society's perception of obesity as the result of inadequate willpower—and not a “disease.” It is an individual's choice to eat excessively that leads to obesity and not a disease state to which the individual has fallen victim. Hence, to lose weight, the patient's anatomy must be surgically altered to either restrict nutrient intake or absorption. Endoscopic treatments have been modeled after this surgical paradigm. It is time for a new paradigm and the development of endoscopic treatments that apply our current understanding of the physiological mechanisms that control energy homeostasis. The author reviews the relevant aspects of the new science and offers a new treatment paradigm that is both simple and smart. A duodenal insert that slows the passage of ingesta through the proximal small bowel is described. The device triggers both early satiation and a continuing sense of fullness to assist in the reduction of caloric intake

Covid-19 pandemic impact on colonoscopy service and suggestions for managing recovery

Abstract Background and aim As the post-peak phase of the epidemic is approaching, there is an urgent need of an action plan to help resume endoscopy activity. To manage the Covid-19 pandemic-imposed backlog of postponed colonoscopy examinations, an efficient approach is needed. The practice of on-demand sedation with benzodiazepines and/or opiates will allow most patients to complete a water-aided examination with minimal or no sedation. Other methods reported to minimize patient discomfort during colonoscopy can be used, in addition to water-aided techniques. Unsedated or minimally sedated patients who do not require recovery or require a shorter one allow rapid turnaround. The practice obviates the need for assistance with deep sedation from anesthesiologists, who may be in short supply. Trainee education in water-aided colonoscopy has been demonstrated to confer benefits. This review provides some insights into the impact of Covid-19 on endoscopy services, challenges ahead, and possible solutions to help recovery of colonoscopy work and training

A multicenter, prospective study of a new fully covered expandable metal biliary stent for the palliative treatment of malignant bile duct obstruction

Background and Study Aims. Endoscopic placement of self-expanding metal stents (SEMSs) is indicated for palliation of inoperable malignant biliary obstruction. A fully covered biliary SEMS (WallFlex Biliary RX Boston Scientific, Natick, USA) was assessed for palliation of extrahepatic malignant biliary obstruction. Patients and Methods. 58 patients were included in this prospective, multicenter series conducted under an FDA-approved IDE. Main outcome measurements included (1) absence of stent occlusion within six months or until death, whichever occurred first and (2) technical success, need for reintervention, bilirubin levels, stent patency, time to stent occlusion, and adverse events. Results. Technical success was achieved in 98% (57/58), with demonstrated acute removability in two patients. Adequate clinical palliation until completion of followup was achievedin 98% (54/55) of evaluable patients, with 1 reintervention due to stent obstruction after 142 days. Mean total bilirubin decreased from 8.9 mg/dL to 1.2 mg/dL at 1 month. Device-related adverse events were limited and included 2 cases of cholecystitis. One stent migrated following radiation therapy. Conclusions. The WallFlex Biliary fully covered stent yielded technically successful placement with uncomplicated acute removal where required, appropriate reduction in bilirubin levels, and low rates of stent migration and occlusion. This SEMS allows successful palliation of malignant extrahepatic biliary obstruction

Spiral enteroscopy: prospective U.S. multicenter study in patients with small-bowel disorders

The performance characteristics of spiral enteroscopy have not been well-described

Olympus mechanical puncture echoendoscope

Le nouvel écho-endoscope Olympus à ponctions, mécanique radial, présente plusieurs caractéristiques originales. Il permet d'obtenir un champ de vision échographique de 250°, est équipé d'un érecteur pour ajuster l'angle de sortie de l'aiguille, et a un canal opérateur de 2,8 mm. De plus étant de technologie mécanique radiale sectorielle, est compatible avec le même processeur que l'écho-endoscope GF UM 20

Utilization of an overtube for placement of a lumen-apposing metal stent for removal of a capsule endoscope retained proximal to an ileal stricture

Video 1Narration of case and demonstration of overture-mediated lumen-apposing metal stent placement for removal of retained capsule endoscopy