RESEARCH  MONTH Tamar Meszaros PGY-3 July 24, 2006
Preparing for the Month <ul><li>Find a mentor </li></ul><ul><ul><li>Attending </li></ul></ul><ul><ul><li>Fellow </li></ul>...
Research Project <ul><li>Formulate a Question </li></ul><ul><li>Literature Search </li></ul><ul><li>Develop a Protocol </l...
QUESTION <ul><li>Is Video Capsule Endoscopy a reasonable alternative to EGD in the detection of esophageal varices in the ...
The PillCam ESO Capsule Endoscope
 
Relevant Q <ul><li>Attractive alternative to EGD  </li></ul><ul><ul><li>Less risks  </li></ul></ul><ul><ul><ul><li>Coagulo...
Esopahgeal Capsule Endoscopy <ul><li>Prospective multicenter, international study  </li></ul><ul><li>66 of 106 patients ha...
VCE in small bowel dz <ul><li>Review articles from Israel & Netherlands </li></ul><ul><ul><li>Wireless capsule video endos...
Alternatives <ul><li>Some alternatives have been studied </li></ul><ul><ul><li>Transnasal endoluminal ultrasound.  </li></...
Background: Varices in the Cirrhotic <ul><li>2/3 of patients will develop varices. </li></ul><ul><li>Prevalence as high as...
Methods/Materials <ul><li>A randomized selection of cirrhotic patients from Dr. Lewis’ liver clinic. </li></ul><ul><li>Bot...
Methods/Materials <ul><li>Northern Italian System  </li></ul><ul><li>Dr. Bull-Henry will describe the varices </li></ul><u...
Reality Check!! <ul><li>Insurance would not cover both pill endoscopy and EGD.  </li></ul><ul><li>Back to the drawing boar...
Patient Selection <ul><li>Patients with known cirrhotic liver dz </li></ul><ul><li>EGD performed by Dr. Lewis within the l...
New Snag!!
<ul><li>Dr. Lewis did not receive the 20 free pills as promised! </li></ul><ul><li>Working with Maria Bertagnolli on findi...
In the meantime……..
<ul><li>Prospective Study </li></ul><ul><ul><li>Dr. Charabaty </li></ul></ul><ul><ul><li>VCE in the Crohn’s patient </li><...
CITATIONS <ul><li>Dennis M Jensen.  Endoscopic Screening for Varices in cirrhosis: findings, implications and Outcomes.  G...
 
 
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RESEARCH MONTH

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RESEARCH MONTH

  1. 1. RESEARCH MONTH Tamar Meszaros PGY-3 July 24, 2006
  2. 2. Preparing for the Month <ul><li>Find a mentor </li></ul><ul><ul><li>Attending </li></ul></ul><ul><ul><li>Fellow </li></ul></ul><ul><li>Find a Project </li></ul><ul><ul><li>Topic </li></ul></ul><ul><ul><li>Case </li></ul></ul>
  3. 3. Research Project <ul><li>Formulate a Question </li></ul><ul><li>Literature Search </li></ul><ul><li>Develop a Protocol </li></ul><ul><li>IRB Approval </li></ul>
  4. 4. QUESTION <ul><li>Is Video Capsule Endoscopy a reasonable alternative to EGD in the detection of esophageal varices in the cirrhotic patient? </li></ul>
  5. 5. The PillCam ESO Capsule Endoscope
  6. 7. Relevant Q <ul><li>Attractive alternative to EGD </li></ul><ul><ul><li>Less risks </li></ul></ul><ul><ul><ul><li>Coagulopathy </li></ul></ul></ul><ul><ul><ul><li>Encephalopathy with sedation </li></ul></ul></ul><ul><ul><li>More comfortable </li></ul></ul><ul><ul><li>Few contraindications </li></ul></ul><ul><li>To date, there is no published study showing it’s efficacy in the detection of esophageal varices. </li></ul>
  7. 8. Esopahgeal Capsule Endoscopy <ul><li>Prospective multicenter, international study </li></ul><ul><li>66 of 106 patients had + esophageal findings </li></ul><ul><li>ECE identified esophageal abnormalities in 61 (sensitivity, 92%; specificity, 95%). </li></ul><ul><li>The per-protocol sensitivity, specificity, PPV, and NPV of ECE for Barrett esophagus were 97%, 99%, 97%, and 99%, respectively </li></ul><ul><li>Esophagitis 89%, 99%, 97%, and 94%, </li></ul><ul><li>ECE was preferred over EGD by all patients </li></ul><ul><li>No adverse events related to ECE. </li></ul>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
  8. 9. VCE in small bowel dz <ul><li>Review articles from Israel & Netherlands </li></ul><ul><ul><li>Wireless capsule video endoscopy: three years of experience </li></ul></ul><ul><ul><li>Video capsule endoscopy: procedure, indications and diagnostic yield. </li></ul></ul><ul><ul><li>More sensitive diagnostic tool than enteroscopy, CT and SBFT for small bowel disease. </li></ul></ul>
  9. 10. Alternatives <ul><li>Some alternatives have been studied </li></ul><ul><ul><li>Transnasal endoluminal ultrasound. </li></ul></ul><ul><ul><li>Compared transnasal endoscopy to EGD. </li></ul></ul><ul><ul><li>Concluded it to be a safe and good alternative. </li></ul></ul><ul><ul><li>Study was small. </li></ul></ul><ul><ul><li>No follow up studies to date. </li></ul></ul><ul><li>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 </li></ul>
  10. 11. Background: Varices in the Cirrhotic <ul><li>2/3 of patients will develop varices. </li></ul><ul><li>Prevalence as high as eighty to ninety percent reported in newer studies. </li></ul><ul><li>The mortality rate after the first episode of bleeding is twenty to thirty five percent. </li></ul><ul><li>Dennis M Jensen. Endoscopic Screening for Varices in cirrhosis: findings, implications and Outcomes. Gastroenterology 2002;122:1620-1630. </li></ul>
  11. 12. Methods/Materials <ul><li>A randomized selection of cirrhotic patients from Dr. Lewis’ liver clinic. </li></ul><ul><li>Both pill endoscopy and EGD will be performed on the same day </li></ul><ul><li>Pill endoscopy will be performed first, followed by EGD. </li></ul><ul><li>Dr. Bull Henry to interpret the pill endoscopy </li></ul><ul><li>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. </li></ul>
  12. 13. Methods/Materials <ul><li>Northern Italian System </li></ul><ul><li>Dr. Bull-Henry will describe the varices </li></ul><ul><ul><li>there is no established grading system for varices seen by pill endoscopy at this time. </li></ul></ul><ul><li>Correlation to the EGD results determined in order to evaluate the pill’s efficacy in variceal detection. </li></ul><ul><li>Ultimate Goal </li></ul><ul><ul><li>conduct a larger study if the results are statistically significant. </li></ul></ul>
  13. 14. Reality Check!! <ul><li>Insurance would not cover both pill endoscopy and EGD. </li></ul><ul><li>Back to the drawing board!! </li></ul>
  14. 15. Patient Selection <ul><li>Patients with known cirrhotic liver dz </li></ul><ul><li>EGD performed by Dr. Lewis within the last 6 months </li></ul><ul><li>Pill endoscopy results to be read by Dr. Bull-Henry </li></ul>
  15. 16. New Snag!!
  16. 17. <ul><li>Dr. Lewis did not receive the 20 free pills as promised! </li></ul><ul><li>Working with Maria Bertagnolli on finding funding! </li></ul>
  17. 18. In the meantime……..
  18. 19. <ul><li>Prospective Study </li></ul><ul><ul><li>Dr. Charabaty </li></ul></ul><ul><ul><li>VCE in the Crohn’s patient </li></ul></ul><ul><li>Case Report </li></ul><ul><ul><li>WHC </li></ul></ul><ul><ul><li>Pancreatitis and PPI </li></ul></ul>
  19. 20. CITATIONS <ul><li>Dennis M Jensen. Endoscopic Screening for Varices in cirrhosis: findings, implications and Outcomes. Gastroenterology 2002;122:1620-1630. </li></ul><ul><li>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. </li></ul><ul><li>Rami Eliakim. Wireless capsule video endoscopy: three years of experience. World J Gastroenterology 2004; 10(9): 1238-1239. </li></ul><ul><li>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. </li></ul><ul><li>Gastroenterology & Hepatology. Technology Insight: current status of video capsule endoscopy . 2006 Mar;3(3):158-64 </li></ul><ul><li>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. </li></ul>

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