Endoscopy
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Randomized Controlled Trial Clinical Trial
Evaluation of a virtual endoscopy simulator for training in gastrointestinal endoscopy.
Skills in gastrointestinal endoscopy mainly depend on experience and practice. Training on endoscopy simulators may decrease the time needed to reach competency in endoscopy. The purpose of the study was to determine whether the GI-Mentor, a virtual reality endoscopy simulator, can distinguish between beginners and experts in endoscopy and to assess whether training improves the performance of beginners. ⋯ This virtual endoscopy simulator is capable of identifying differences between beginners and experts in gastrointestinal endoscopy. A 3-week training improves the performance of beginners significantly. This quite fast improvement in endoscopic skills certainly cannot be seen in clinical practice; no conclusions can be made about the impact of virtual simulator training on real-life endoscopy, and this must be evaluated.
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Comparative Study
Evaluation of endoscopic retrograde cholangiopancreatography under conscious sedation and general anesthesia.
In adults, general anesthesia is usually only provided during endoscopic retrograde cholangiopancreatography (ERCP) when prior attempts using conscious sedation have failed. It was hypothesized that in our hospital, other factors might be associated with general anesthesia for ERCP. The aim of this study was therefore to assess the indications for ERCP under general anesthesia, and to evaluate the underlying diseases, type, and efficacy of ERCP under general anesthesia in comparison with conscious sedation. ⋯ The frequent use of general anesthesia for ERCP at our institution is related to the underlying diseases, which are frequently treated with complex and painful ERCP procedures. The efficacy of ERCP with general anesthesia supports a continued preference for general anesthesia rather than conscious sedation when complex and painful interventional ERCP procedures are planned.
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Real-time digital video transmission (rtDVT) at an acceptable quality through networks has been possible for several years. This technique can be used for telemedical applications, such as tele-endoscopy. The hypotheses of the present study were that the quality of real-time DVT depends on the technical equipment used, and that the resulting image quality influences the usability of the system for diagnostic purposes. ⋯ rtDVT using MPEG2 [4 : 2 : 2] compression and a bandwidth of 40 Mb/s did not effectively differ from the original video images in routine tele-endoscopy. The qualitative requirements in diagnostic video endoscopy, however, are obviously much higher than previously assumed, since experienced endoscopists detected a loss of image quality and a reduction in diagnostic usability with any reduction in the technical specification. Modern methods of data compression, broadband networks and a network protocol with good quality-of-service guarantees are therefore prerequisites for diagnostic rtDVT.
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Benzocaine is used routinely for topical pharyngeal anesthesia prior to upper endoscopy, to improve patient tolerance. A potentially fatal, although often unrecognized, complication of benzocaine use is methemoglobinemia. ⋯ This case serves as an important reminder to physicians, especially endoscopists, about this serious side effect. Furthermore, we question the need for topical anesthesia for upper endoscopy in sedated patients.