Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: An update 2018

Non-variceal upper gastrointestinal bleeding remains an important emergency condition, leading to significant morbidity and mortality. As endoscopic therapy is the 'gold standard' of management, treatment of these patients can be considered in three stages: pre-endoscopic treatment, endoscopic haemostasis and post-endoscopic management. Since publication of the Asia-Pacific consensus on non-variceal upper gastrointestinal bleeding (NVUGIB) 7 years ago, there have been significant advancements in the clinical management of patients in all three stages. These include pre-endoscopy risk stratification scores, blood and platelet transfusion, use of proton pump inhibitors; during endoscopy new haemostasis techniques (haemostatic powder spray and over-the-scope clips); and post-endoscopy management by second-look endoscopy and medication strategies. Emerging techniques, including capsule endoscopy and Doppler endoscopic probe in assessing adequacy of endoscopic therapy, and the pre-emptive use of angiographic embolisation, are attracting new attention. An emerging problem is the increasing use of dual antiplatelet agents and direct oral anticoagulants in patients with cardiac and cerebrovascular diseases. Guidelines on the discontinuation and then resumption of these agents in patients presenting with NVUGIB are very much needed. The Asia-Pacific Working Group examined recent evidence and recommends practical management guidelines in this updated consensus statement

Quantification of Airborne Elemental Carbon by Digital Imaging

Black carbon emitted from vehicles or industrial plants is a very common phenomenon observed by high school students. A cost effective and user friendly measurement protocol will greatly enhance school students' capability to investigate the black carbon pollutant in their ambient environments, and hence their awareness to environmental protection. This study shows the potential of applying digital imaging as an alternative method to measure airborne elemental carbon (EC). Aerosols were collected on filters and the blackness of the filters was digitalized into RGB values using an office scanner. It was found that maximum value of transformed R, G and B values (255-R, 255-G and 255-B, respectively), max {R',G',B'}, was power-law related with the EC loading of the filter (R2 = 0.85, n = 55). The power-law relationship between the max{R',G',B'} and EC loading could be applied as a cost effective and user friendly method to quantify EC by high school students. Using this method, the sampling flowrate and duration should be controlled so that the max{R',G',B'} of the filter samples lie in the optimal range between 40 and 170 to minimize the uncertainty. For samples within this range, the average percentage difference between the results of this method and the results from conventional thermal-optical method was found to be only 10.3%, which is close to common research grade instruments. Copyright © American Association for Aerosol Research

Motion compensation of tendon-sheath driven continuum manipulator for endoscopic surgery

10.1051/matecconf/20153204007MATEC Web of Conferences32400

Indetermination of indeterminate biliary strictures Response

Contains fulltext : 220098.pdf (Publisher’s version ) (Closed access

Digital single-operator peroral cholangioscopy-guided biopsy sampling versus ERCP-guided brushing for indeterminate biliary strictures: a prospective, randomized, multicenter trial (with video)

Contains fulltext : 220059.pdf (Publisher’s version ) (Closed access)BACKGROUND AND AIMS: Accurately diagnosing indeterminate biliary strictures is challenging but important for patient prognostication and further management. Biopsy sampling under direct cholangioscopic vision might be superior to standard ERCP techniques such as brushing or biopsy sampling. Our aim was to investigate whether digital single-operator cholangioscopy (DSOC) compared with standard ERCP workup improves the diagnostic yield in patients with indeterminate biliary strictures. METHODS: Patients with an indeterminate biliary stricture on the basis of MRCP were randomized to standard ERCP visualization with tissue brushing (control arm [CA]) or DSOC visualization and DSOC-guided biopsy sampling (study arm [SA]). This was a prospective, international, multicenter trial with a procedure-blinded pathologist. RESULTS: The first sample sensitivity of DSOC-guided biopsy samples was significantly higher than ERCP-guided brushing (SA 68.2% vs CA 21.4%, P < .01). The sensitivity of visualization (SA 95.5% vs CA 66.7%, P = .02) and overall accuracy (SA 87.1% vs CA 65.5%, P = .05) were significantly higher in the SA compared with the CA, whereas specificity, positive predictive value, and negative predictive value showed no significant difference. Adverse events were equally low in both arms. CONCLUSIONS: DSOC-guided biopsy sampling was shown to be safe and effective with a higher sensitivity compared with standard ERCP techniques in the visual and histopathologic diagnosis of indeterminate biliary strictures. (Clinical trial registration number: NCT03140007.)

Feasibility of full-thickness gastric resection using master and slave transluminal endoscopic robot and closure by overstitch: A preclinical study

10.1007/s00464-013-3149-3Surgical Endoscopy and Other Interventional Techniques281319-32