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Research paper thumbnail of Short Duration versus 14-day Antibiotic Treatment in Acute Cholangitis due to Bile Duct Stone: A randomized study

BaCKGROUND and Aims: The optimum duration of antibiotic therapy in common bile duct stone associa... more BaCKGROUND and Aims: The optimum duration of antibiotic therapy in common bile duct stone associated cholangitis is not well established. We aimed to assess the efficacy and safety of short antibiotic therapy in acute cholangitis associated with common bile duct stone. Methods: Eighteen (9 mild cholangitis and 9 moderate cholangitis) were recruited in group A (antibiotic cessation when fever subsided for 72 hours) and 16 (mild cholangitis and 8 moderate cholangitis) were recruited in group B (a full 2 weeks of antibiotic therapy). Both groups were evaluated and compared in term of the recurrence rate, duration of fever, abdominal pain, hospital stay and complications. The duration of antibiotic therapy in group A and in patients with or without bacteremia were evaluated and compared. Results: No recurrence occured in group A and 1 recurrence occured in group B (p = 0.485). Clinical outcomes were similar between the 2 groups. The fever duration was similar between mild and moderate c...

Research paper thumbnail of Prospective Controlled Randomized Study of Large-Balloon-Dilatation versus Mechanical Lithotripsy for Large Bile Duct Stone

Journal of Hepatology and Gastrointestinal disorders

Jo u r n a l o f Hepat o lo g y a nd Ga s tr o in te st inal D is o r d e rs

Research paper thumbnail of Abstract Near-Focus Versus Normal-Focus Narrow Band Imaging Colonoscopy in Diagnosis of ColorectalPolyps Based on Combined NICE and WASP Classification in Routine Colonoscopy: A Randomized Controlled Trial

Near-focus versus Normal-focus Narrow Band Imaging Colonoscopy in Diagnosis of Colorectal Polyps ... more Near-focus versus Normal-focus Narrow Band Imaging Colonoscopy in Diagnosis of Colorectal Polyps based on Combined NICE and WASP Classification in routine colonoscopy: a Randomized Controlled TrialNisa Netinatsunton1, Natcha Cheewasereechon1Tanawat Pattarapuntakul1, Jaksin Sottisuporn1, Kanet Kanjanapradit2, Bancha Ovartlarnporn1Background: NICE (NBI International Colorectal Endoscopic) and WASP (Workgroup on Serrated Polyps and Polyposis) classification were developed for optical diagnosis of adenoma and sessile serrated polyps, respectively. Near focus NBI with NICE combined with WASP criteria for optical diagnosis of colonic polyps has not been assessed formerly. Aims: To compare the accuracy of near focus NBI (group A) with normal focus NBI (group B) in real time optical diagnosis of colorectal polyps using combined NICE and WASP criteria.Methods: 118 out of 362 patients with 227 polyps were recruited. 62 patients with 130 polyps (3 lost polyps) were assigned to group A and 56 p...

Research paper thumbnail of Su1065 NEAR-FOCUS VERSUS NORMAL-FOCUS NARROW BAND IMAGING COLONOSCOPY IN DIAGNOSIS OF COLORECTAL POLYPS BASED ON COMBINED NICE AND WASP CLASSIFICATION: A RANDOMIZED CONTROLLED TRIAL

Gastrointestinal Endoscopy

Research paper thumbnail of Re-bleeding and its predictors after capsule endoscopy in patients with obscure gastrointestinal bleeding in long-term follow-up

BMC Gastroenterology

Background Capsule endoscopy (CE) is the preferred diagnostic test of choice in the investigation... more Background Capsule endoscopy (CE) is the preferred diagnostic test of choice in the investigation of obscure gastrointestinal bleeding (OGIB). Although, a conservative strategy is recommended in the short-term, for cases with a negative result from CE, the impact of CE on long-term re-bleeding still remains unclear. Hence, the aim of this study was to determine the long-term re-bleeding rate along with predictors after CE in patients with OGIB. Methods We retrospectively reviewed 216 patients with OGIB, whom had received a CE examination, so as to investigate the cause of obscure GI bleeding; between July 2008 and March 2018. The patient’s characteristics, medication use, CE finding, treatments strategy, re-bleeding episodes and follow-up information were collected from the institutional electronic medical chart and CE database. Re-bleeding free survival was evaluated using Kaplan-Meier curves with log rank test, whilst predictors associated with the re-bleeding episodes were analyz...

Research paper thumbnail of Su1195 ENDOSCOPIC ULTRASOUND-GUIDED BILIARY DRAINAGE VS. ERCP IN INOPERABLE MALIGNANT HIGH-GRADE DISTAL BILE DUCT OBSTRUCTION: PROSPECTIVE RANDOMIZED CONTROLLED STUDY: A PRELIMINARY ANALYSIS

Gastrointestinal Endoscopy

Research paper thumbnail of Su1400 LONG-TERM RE-BLEEDING AND ITS PREDICTORS AFTER CAPSULE ENDOSCOPY IN PATIENTS WITH OBSCURE GASTROINTESTINAL BLEEDING

Gastrointestinal Endoscopy

Research paper thumbnail of Prospective randomized trial of EUS-assisted ERCP without fluoroscopy versus ERCP in common bile duct stones

Gastrointestinal Endoscopy

Research paper thumbnail of Tu1675 Interobserver and Intraobserver Variation in the Diagnosis of Minimal Change Esophagitis by High Definition and I-SCAN Upper Endoscopy

Data Revues 00165107 V75i4ss S0016510712016069, May 17, 2012

Research paper thumbnail of Efficacy of Propofol With Midazolam and Meperidine Versus Midazolam and Meperidine for ERCP by Endoscopists with Variable Experience

Journal of Gastroenterology and Hepatology Research, Jun 21, 2014

Research paper thumbnail of Su1663 An Open-Labeled, Randomized Controlled Trial Comparing Between Short Duration and Standard 14 Days Antibiotic Treatments for Acute Cholangitis in Patients With Common Bile Duct Stone After Successful Endoscopic Biliary Drainage. a Preliminary Report

Gastrointestinal Endoscopy, 2014

On each line: pCLE image representative of a query video (framed image on the left), followed by ... more On each line: pCLE image representative of a query video (framed image on the left), followed by 3 pCLE images representative of the 3 atlas videos which have been automatically recognized by the Smart Atlas software as the most visually similar to the query video. Each pCLE video is annotated with final diagnosis.

Research paper thumbnail of Tu1675 Interobserver and Intraobserver Variation in the Diagnosis of Minimal Change Esophagitis by High Definition and I-SCAN Upper Endoscopy

Gastrointestinal Endoscopy, 2012

Research paper thumbnail of Su1318 Efficacy and Safety Profiles of Sedation With Propofol Combined With Intravenous Midazolam and Pethidine Versus Intravenous Midazolam and Pethidine Administered by Trained Nurses for Ambulatory Endoscopic Retrograde Cholangiopancreatography (ERCP)

Gastrointestinal Endoscopy, 2012

Research paper thumbnail of Comparing cost-effectiveness between endoscopic ultrasound and endoscopic retrograde cholangiopancreatography in diagnosis of common bile duct stone in patients with predefined risks: A study from a developing country

Endoscopic Ultrasound, 2016

Research paper thumbnail of i-Scan detection of minimal change esophagitis in dyspeptic patients with or without Gastroesophageal Reflux disease

BMC Gastroenterology, 2016

The association of minimal change esophagitis (MCE) with GERD is controversial. i-Scan endoscopy ... more The association of minimal change esophagitis (MCE) with GERD is controversial. i-Scan endoscopy (SE) provides high resolution and modulation of images that may improve minimal change lesion (MCL) detection. We aimed to assess the efficacy of SE in detecting MCL in dyspeptic patients with GERD compared with patients without GERD by GerdQ or by endoscopy with 24-h pH monitoring (PHM) and in normal volunteers. This is a cohort study conducted at a tertiary center. All dyspeptic patients were prospectively recruited. All patients completed a validated Thai version of GerdQ and then underwent endoscopy. Forty normal volunteers as a control group were recruited for endoscopy. The distal esophagus was examined by high definition endoscopy and SE sequentially. All had PHM done. GERD was diagnosed by Los Angeles classification A-D and/or by a positive PHM. MCE was diagnosed when MCL or combination of MCL was present. Of 174 patients, 144 completed the study protocol. After the exclusion of 6 patients, 138 remained for analysis. Overlapping GERD symptoms were found in 44.2 % and 26.8 % had confirmed GERD. Group A was comprised of 61 patients with a positive GerdQ and 77 patients in group B had a negative GerdQ. Twenty-four in group A, 28 in group B and 7 in the control group had MCE that was not significantly different. MCE in GERD was significantly higher (51.45 %) than in non-GERD (32.7 %) (p = 0.047) and in the control group (20.58 %) (p = 0.007). The sensitivity, specificity, positive predictive value, and negative predictive value of SE were 51.35 %, 67.33 %, 36.54 % and 79.06 %, respectively. In dyspeptic patients, SE detected more MCE in GERD than in non-GERD patients and in the control group. ClinicalTrials.gov number NCT01742377.

Research paper thumbnail of The Value of Carlsson-Dent Questionnaire in Diagnosis of Gastroesophageal Reflux Disease in Area With Low Prevalence of Gastroesophageal Reflux Disease

Journal of Neurogastroenterology and Motility, 2011

Symptom-based diagnosis for gastroesophageal reflux disease (GERD) has been accepted in the popul... more Symptom-based diagnosis for gastroesophageal reflux disease (GERD) has been accepted in the population with high prevalence. Carlsson-Dent questionnaire (CDQ) is a standardized symptom-based diagnosis tool for GERD. The value of this tool in the population with low prevalence is unknown. The aim of this study was to determine CDQ performance for diagnosis of GERD in Thai population with low prevalence versus endoscopy or 24 hour pH monitoring.

Research paper thumbnail of Su1653 A Prospective Randomized Trial Comparing EUS Guided ERCP Without Fluoroscopy With Standard ERCP in Common Bile Duct Stone Removal: a Preliminary Report

Gastrointestinal Endoscopy, 2014

Research paper thumbnail of Su1663 An Open-Labeled, Randomized Controlled Trial Comparing Between Short Duration and Standard 14 Days Antibiotic Treatments for Acute Cholangitis in Patients With Common Bile Duct Stone After Successful Endoscopic Biliary Drainage. a Preliminary Report

Gastrointestinal Endoscopy, 2014

Research paper thumbnail of Su1318 Efficacy and Safety Profiles of Sedation With Propofol Combined With Intravenous Midazolam and Pethidine Versus Intravenous Midazolam and Pethidine Administered by Trained Nurses for Ambulatory Endoscopic Retrograde Cholangiopancreatography (ERCP)

Gastrointestinal Endoscopy, 2012

Introduction: The detection of early cancer during gastroscopy in the western world is poor. UK s... more Introduction: The detection of early cancer during gastroscopy in the western world is poor. UK studies have demonstrated up to a 15% miss rate during diagnostic gastroscopy for early neoplasia. Early gastric cancer has a vastly superior survival rate and may be amenable to endoscopic resection. Diagnostic gastroscopy provides a unique opportunity to diagnose early gastric neoplasia, whatever the indication; however intraluminal mucus and saliva can obscure mucosal visualisation and potential detection of these early lesions. Aim: The aim of this study was to investigate whether the use of a premedication solution containing the mucolytic agent N-acetylcysteine and the surfactant simethicone improves mucosal visualisation within an unselected UK diagnostic gastroscopy service. Methods: 75 consecutive patients were recruited from a single (SJ) endoscopist's diagnostic gastroscopy list. These were randomised into 3 treatment groups. 1: Standard control -clear fluids only for 6 hours, NBM for 2 hours. 2: Placebo control -standard control ϩ 100ml sterile water (given 20-30 minutes prior to gastroscopy). 3: Solution -standard control ϩ 100ml investigated solution (20-30 minutes prior). The endoscopist was blinded to patient preparation. Inadequate mucosal visualisation was measured by assessing fluid/mucus during gastroscopy that could not be suctioned and required flushing with water. The volume of flush, the site at which it was used and the total procedure time were recorded. Results: All 3 groups showed no statistical difference for age, gender ratio, procedure priority or indication. The mean volume of flush required to obtain clear mucosa was significantly less in the solution group (12.1ml (3.5-20.7)) compared to the standard control group (54.2ml (39.2-69.2), pϽ0.00003) and the placebo control group (61.0ml (44.6-77.4), pϽ0.00001). This significant difference was identified across all sites recorded in the upper GI tract, bar the OGJ where very little stubborn mucus was identified in all 3 groups.61% of the solution group required no flushing at all, significantly more than the standard control group (13%, pϽ0.002) and the placebo control group (9%, pϽ0.0005). Mean overall procedure time was less in the solution group (8.5min (7.1-9.9)) compared with the standard control group (10.4min (8.5-12.3), pϽ0.075) and the placebo control group (10.5min (9.3-11.7), pϽ0.028). When patients on Barrett's surveillance are excluded this difference is more significant. Solution (7.2min (6.2-8.2)) v standard control (8.8min (7.3-10.1), pϽ0.041) v placebo control (10.2min (8.6-11.8), pϽ0.0031).Discussion: Premedication with NAC and simethicone is a low cost and well-tolerated method of dramatically improving visibility and procedure time during diagnostic gastroscopy. This simple intervention may improve detection of early gastric cancer.

Research paper thumbnail of Tu1675 Interobserver and Intraobserver Variation in the Diagnosis of Minimal Change Esophagitis by High Definition and I-SCAN Upper Endoscopy

Gastrointestinal Endoscopy, 2012

Research paper thumbnail of Short Duration versus 14-day Antibiotic Treatment in Acute Cholangitis due to Bile Duct Stone: A randomized study

BaCKGROUND and Aims: The optimum duration of antibiotic therapy in common bile duct stone associa... more BaCKGROUND and Aims: The optimum duration of antibiotic therapy in common bile duct stone associated cholangitis is not well established. We aimed to assess the efficacy and safety of short antibiotic therapy in acute cholangitis associated with common bile duct stone. Methods: Eighteen (9 mild cholangitis and 9 moderate cholangitis) were recruited in group A (antibiotic cessation when fever subsided for 72 hours) and 16 (mild cholangitis and 8 moderate cholangitis) were recruited in group B (a full 2 weeks of antibiotic therapy). Both groups were evaluated and compared in term of the recurrence rate, duration of fever, abdominal pain, hospital stay and complications. The duration of antibiotic therapy in group A and in patients with or without bacteremia were evaluated and compared. Results: No recurrence occured in group A and 1 recurrence occured in group B (p = 0.485). Clinical outcomes were similar between the 2 groups. The fever duration was similar between mild and moderate c...

Research paper thumbnail of Prospective Controlled Randomized Study of Large-Balloon-Dilatation versus Mechanical Lithotripsy for Large Bile Duct Stone

Journal of Hepatology and Gastrointestinal disorders

Jo u r n a l o f Hepat o lo g y a nd Ga s tr o in te st inal D is o r d e rs

Research paper thumbnail of Abstract Near-Focus Versus Normal-Focus Narrow Band Imaging Colonoscopy in Diagnosis of ColorectalPolyps Based on Combined NICE and WASP Classification in Routine Colonoscopy: A Randomized Controlled Trial

Near-focus versus Normal-focus Narrow Band Imaging Colonoscopy in Diagnosis of Colorectal Polyps ... more Near-focus versus Normal-focus Narrow Band Imaging Colonoscopy in Diagnosis of Colorectal Polyps based on Combined NICE and WASP Classification in routine colonoscopy: a Randomized Controlled TrialNisa Netinatsunton1, Natcha Cheewasereechon1Tanawat Pattarapuntakul1, Jaksin Sottisuporn1, Kanet Kanjanapradit2, Bancha Ovartlarnporn1Background: NICE (NBI International Colorectal Endoscopic) and WASP (Workgroup on Serrated Polyps and Polyposis) classification were developed for optical diagnosis of adenoma and sessile serrated polyps, respectively. Near focus NBI with NICE combined with WASP criteria for optical diagnosis of colonic polyps has not been assessed formerly. Aims: To compare the accuracy of near focus NBI (group A) with normal focus NBI (group B) in real time optical diagnosis of colorectal polyps using combined NICE and WASP criteria.Methods: 118 out of 362 patients with 227 polyps were recruited. 62 patients with 130 polyps (3 lost polyps) were assigned to group A and 56 p...

Research paper thumbnail of Su1065 NEAR-FOCUS VERSUS NORMAL-FOCUS NARROW BAND IMAGING COLONOSCOPY IN DIAGNOSIS OF COLORECTAL POLYPS BASED ON COMBINED NICE AND WASP CLASSIFICATION: A RANDOMIZED CONTROLLED TRIAL

Gastrointestinal Endoscopy

Research paper thumbnail of Re-bleeding and its predictors after capsule endoscopy in patients with obscure gastrointestinal bleeding in long-term follow-up

BMC Gastroenterology

Background Capsule endoscopy (CE) is the preferred diagnostic test of choice in the investigation... more Background Capsule endoscopy (CE) is the preferred diagnostic test of choice in the investigation of obscure gastrointestinal bleeding (OGIB). Although, a conservative strategy is recommended in the short-term, for cases with a negative result from CE, the impact of CE on long-term re-bleeding still remains unclear. Hence, the aim of this study was to determine the long-term re-bleeding rate along with predictors after CE in patients with OGIB. Methods We retrospectively reviewed 216 patients with OGIB, whom had received a CE examination, so as to investigate the cause of obscure GI bleeding; between July 2008 and March 2018. The patient’s characteristics, medication use, CE finding, treatments strategy, re-bleeding episodes and follow-up information were collected from the institutional electronic medical chart and CE database. Re-bleeding free survival was evaluated using Kaplan-Meier curves with log rank test, whilst predictors associated with the re-bleeding episodes were analyz...

Research paper thumbnail of Su1195 ENDOSCOPIC ULTRASOUND-GUIDED BILIARY DRAINAGE VS. ERCP IN INOPERABLE MALIGNANT HIGH-GRADE DISTAL BILE DUCT OBSTRUCTION: PROSPECTIVE RANDOMIZED CONTROLLED STUDY: A PRELIMINARY ANALYSIS

Gastrointestinal Endoscopy

Research paper thumbnail of Su1400 LONG-TERM RE-BLEEDING AND ITS PREDICTORS AFTER CAPSULE ENDOSCOPY IN PATIENTS WITH OBSCURE GASTROINTESTINAL BLEEDING

Gastrointestinal Endoscopy

Research paper thumbnail of Prospective randomized trial of EUS-assisted ERCP without fluoroscopy versus ERCP in common bile duct stones

Gastrointestinal Endoscopy

Research paper thumbnail of Tu1675 Interobserver and Intraobserver Variation in the Diagnosis of Minimal Change Esophagitis by High Definition and I-SCAN Upper Endoscopy

Data Revues 00165107 V75i4ss S0016510712016069, May 17, 2012

Research paper thumbnail of Efficacy of Propofol With Midazolam and Meperidine Versus Midazolam and Meperidine for ERCP by Endoscopists with Variable Experience

Journal of Gastroenterology and Hepatology Research, Jun 21, 2014

Research paper thumbnail of Su1663 An Open-Labeled, Randomized Controlled Trial Comparing Between Short Duration and Standard 14 Days Antibiotic Treatments for Acute Cholangitis in Patients With Common Bile Duct Stone After Successful Endoscopic Biliary Drainage. a Preliminary Report

Gastrointestinal Endoscopy, 2014

On each line: pCLE image representative of a query video (framed image on the left), followed by ... more On each line: pCLE image representative of a query video (framed image on the left), followed by 3 pCLE images representative of the 3 atlas videos which have been automatically recognized by the Smart Atlas software as the most visually similar to the query video. Each pCLE video is annotated with final diagnosis.

Research paper thumbnail of Tu1675 Interobserver and Intraobserver Variation in the Diagnosis of Minimal Change Esophagitis by High Definition and I-SCAN Upper Endoscopy

Gastrointestinal Endoscopy, 2012

Research paper thumbnail of Su1318 Efficacy and Safety Profiles of Sedation With Propofol Combined With Intravenous Midazolam and Pethidine Versus Intravenous Midazolam and Pethidine Administered by Trained Nurses for Ambulatory Endoscopic Retrograde Cholangiopancreatography (ERCP)

Gastrointestinal Endoscopy, 2012

Research paper thumbnail of Comparing cost-effectiveness between endoscopic ultrasound and endoscopic retrograde cholangiopancreatography in diagnosis of common bile duct stone in patients with predefined risks: A study from a developing country

Endoscopic Ultrasound, 2016

Research paper thumbnail of i-Scan detection of minimal change esophagitis in dyspeptic patients with or without Gastroesophageal Reflux disease

BMC Gastroenterology, 2016

The association of minimal change esophagitis (MCE) with GERD is controversial. i-Scan endoscopy ... more The association of minimal change esophagitis (MCE) with GERD is controversial. i-Scan endoscopy (SE) provides high resolution and modulation of images that may improve minimal change lesion (MCL) detection. We aimed to assess the efficacy of SE in detecting MCL in dyspeptic patients with GERD compared with patients without GERD by GerdQ or by endoscopy with 24-h pH monitoring (PHM) and in normal volunteers. This is a cohort study conducted at a tertiary center. All dyspeptic patients were prospectively recruited. All patients completed a validated Thai version of GerdQ and then underwent endoscopy. Forty normal volunteers as a control group were recruited for endoscopy. The distal esophagus was examined by high definition endoscopy and SE sequentially. All had PHM done. GERD was diagnosed by Los Angeles classification A-D and/or by a positive PHM. MCE was diagnosed when MCL or combination of MCL was present. Of 174 patients, 144 completed the study protocol. After the exclusion of 6 patients, 138 remained for analysis. Overlapping GERD symptoms were found in 44.2 % and 26.8 % had confirmed GERD. Group A was comprised of 61 patients with a positive GerdQ and 77 patients in group B had a negative GerdQ. Twenty-four in group A, 28 in group B and 7 in the control group had MCE that was not significantly different. MCE in GERD was significantly higher (51.45 %) than in non-GERD (32.7 %) (p = 0.047) and in the control group (20.58 %) (p = 0.007). The sensitivity, specificity, positive predictive value, and negative predictive value of SE were 51.35 %, 67.33 %, 36.54 % and 79.06 %, respectively. In dyspeptic patients, SE detected more MCE in GERD than in non-GERD patients and in the control group. ClinicalTrials.gov number NCT01742377.

Research paper thumbnail of The Value of Carlsson-Dent Questionnaire in Diagnosis of Gastroesophageal Reflux Disease in Area With Low Prevalence of Gastroesophageal Reflux Disease

Journal of Neurogastroenterology and Motility, 2011

Symptom-based diagnosis for gastroesophageal reflux disease (GERD) has been accepted in the popul... more Symptom-based diagnosis for gastroesophageal reflux disease (GERD) has been accepted in the population with high prevalence. Carlsson-Dent questionnaire (CDQ) is a standardized symptom-based diagnosis tool for GERD. The value of this tool in the population with low prevalence is unknown. The aim of this study was to determine CDQ performance for diagnosis of GERD in Thai population with low prevalence versus endoscopy or 24 hour pH monitoring.

Research paper thumbnail of Su1653 A Prospective Randomized Trial Comparing EUS Guided ERCP Without Fluoroscopy With Standard ERCP in Common Bile Duct Stone Removal: a Preliminary Report

Gastrointestinal Endoscopy, 2014

Research paper thumbnail of Su1663 An Open-Labeled, Randomized Controlled Trial Comparing Between Short Duration and Standard 14 Days Antibiotic Treatments for Acute Cholangitis in Patients With Common Bile Duct Stone After Successful Endoscopic Biliary Drainage. a Preliminary Report

Gastrointestinal Endoscopy, 2014

Research paper thumbnail of Su1318 Efficacy and Safety Profiles of Sedation With Propofol Combined With Intravenous Midazolam and Pethidine Versus Intravenous Midazolam and Pethidine Administered by Trained Nurses for Ambulatory Endoscopic Retrograde Cholangiopancreatography (ERCP)

Gastrointestinal Endoscopy, 2012

Introduction: The detection of early cancer during gastroscopy in the western world is poor. UK s... more Introduction: The detection of early cancer during gastroscopy in the western world is poor. UK studies have demonstrated up to a 15% miss rate during diagnostic gastroscopy for early neoplasia. Early gastric cancer has a vastly superior survival rate and may be amenable to endoscopic resection. Diagnostic gastroscopy provides a unique opportunity to diagnose early gastric neoplasia, whatever the indication; however intraluminal mucus and saliva can obscure mucosal visualisation and potential detection of these early lesions. Aim: The aim of this study was to investigate whether the use of a premedication solution containing the mucolytic agent N-acetylcysteine and the surfactant simethicone improves mucosal visualisation within an unselected UK diagnostic gastroscopy service. Methods: 75 consecutive patients were recruited from a single (SJ) endoscopist's diagnostic gastroscopy list. These were randomised into 3 treatment groups. 1: Standard control -clear fluids only for 6 hours, NBM for 2 hours. 2: Placebo control -standard control ϩ 100ml sterile water (given 20-30 minutes prior to gastroscopy). 3: Solution -standard control ϩ 100ml investigated solution (20-30 minutes prior). The endoscopist was blinded to patient preparation. Inadequate mucosal visualisation was measured by assessing fluid/mucus during gastroscopy that could not be suctioned and required flushing with water. The volume of flush, the site at which it was used and the total procedure time were recorded. Results: All 3 groups showed no statistical difference for age, gender ratio, procedure priority or indication. The mean volume of flush required to obtain clear mucosa was significantly less in the solution group (12.1ml (3.5-20.7)) compared to the standard control group (54.2ml (39.2-69.2), pϽ0.00003) and the placebo control group (61.0ml (44.6-77.4), pϽ0.00001). This significant difference was identified across all sites recorded in the upper GI tract, bar the OGJ where very little stubborn mucus was identified in all 3 groups.61% of the solution group required no flushing at all, significantly more than the standard control group (13%, pϽ0.002) and the placebo control group (9%, pϽ0.0005). Mean overall procedure time was less in the solution group (8.5min (7.1-9.9)) compared with the standard control group (10.4min (8.5-12.3), pϽ0.075) and the placebo control group (10.5min (9.3-11.7), pϽ0.028). When patients on Barrett's surveillance are excluded this difference is more significant. Solution (7.2min (6.2-8.2)) v standard control (8.8min (7.3-10.1), pϽ0.041) v placebo control (10.2min (8.6-11.8), pϽ0.0031).Discussion: Premedication with NAC and simethicone is a low cost and well-tolerated method of dramatically improving visibility and procedure time during diagnostic gastroscopy. This simple intervention may improve detection of early gastric cancer.

Research paper thumbnail of Tu1675 Interobserver and Intraobserver Variation in the Diagnosis of Minimal Change Esophagitis by High Definition and I-SCAN Upper Endoscopy

Gastrointestinal Endoscopy, 2012