Cap-assisted endoscopy increases ampulla of Vater visualization in high-risk patients

Periampullary adenocarcinoma is a major clinical problem in high-risk patients including FAP population. A recent modification for visualizing the ampulla of Vater (AV) involves attaching a cap to the tip of the forward-viewing endoscope. Our aim was to compare the rates of complete visualization of...

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Published in:BMC gastroenterology 2020-07, Vol.20 (1), p.214-214, Article 214
Main Authors: Silva, Leonardo Correa, Arruda, Rondinelle Martins, Botelho, Paula Fortuci Resende, Taveira, Leonardo Nogueira, Giardina, Kelly Menezio, de Oliveira, Marco Antonio, Dias, Julia, Oliveira, Cleyton Zanardo, Fava, Gilberto, Guimarães, Denise Peixoto
Format: Article
Language:English
Subjects:
Adenocarcinoma
Adolescent
Ampulla of Vater
Ampulla of Vater - diagnostic imaging
Ampullary adenoma
Ampullary carcinoma
Anesthesia
Biliary tract cancer
Cancer
Cap-assisted endoscopy
Care and treatment
Common Bile Duct Neoplasms - diagnostic imaging
Duodenal Neoplasms - diagnostic imaging
Endoscopes
Endoscopy
Endoscopy, Digestive System
Esophagogastroduodenoscopy
Fentanyl
Forward-viewing endoscopy
Gastroenterology
Humans
Midazolam
Patients
Propofol
Reproducibility of Results
Risk groups
Scopolamine
Sedatives
Software
Studies
Surveillance
Visualization
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cited_by cdi_FETCH-LOGICAL-c563t-7230a22faf6319a86544146725701f5da42bed254a758e0ec46d6ccbf457def93
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container_title BMC gastroenterology
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creator Silva, Leonardo Correa
Arruda, Rondinelle Martins
Botelho, Paula Fortuci Resende
Taveira, Leonardo Nogueira
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de Oliveira, Marco Antonio
Dias, Julia
Oliveira, Cleyton Zanardo
Fava, Gilberto
Guimarães, Denise Peixoto
description Periampullary adenocarcinoma is a major clinical problem in high-risk patients including FAP population. A recent modification for visualizing the ampulla of Vater (AV) involves attaching a cap to the tip of the forward-viewing endoscope. Our aim was to compare the rates of complete visualization of AV using this cap-assisted endoscopy (CAE) approach to standard forward-viewing endoscopy (FVE). We also determined: (i) the rates of complications and additional sedation; (ii) the mean time required for duodenal examination; and (iii) the reproducibility among endoscopists performing this procedure. We performed esophagogastroduodenoscopy for AV visualization in 102 > 18 years old using FVE followed by CAE. Video recordings were blinded and randomly selected for independent expert endoscopic evaluation. The complete visualization rate for AV was higher in CAE (97.0%) compared to FVE (51.0%) (p 
doi_str_mv 10.1186/s12876-020-01361-5
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A recent modification for visualizing the ampulla of Vater (AV) involves attaching a cap to the tip of the forward-viewing endoscope. Our aim was to compare the rates of complete visualization of AV using this cap-assisted endoscopy (CAE) approach to standard forward-viewing endoscopy (FVE). We also determined: (i) the rates of complications and additional sedation; (ii) the mean time required for duodenal examination; and (iii) the reproducibility among endoscopists performing this procedure. We performed esophagogastroduodenoscopy for AV visualization in 102 &gt; 18 years old using FVE followed by CAE. Video recordings were blinded and randomly selected for independent expert endoscopic evaluation. The complete visualization rate for AV was higher in CAE (97.0%) compared to FVE (51.0%) (p &lt;  0.001). The additional doses of fentanyl, midazolam, and propofol required for CAE were 0.05, 1.9 and 36.3 mg. in 0.9, 24.5, and 77.5% patients, respectively. The mean time of duodenal examination for AV visualization was lower on CAE compared to FVE (1.41 vs. 1.95 min, p &lt;  0.001). Scopolamine was used in 34 FVE and 24 CAE, with no association to AV complete visualization rates (p = 0.30 and p = 0.14). Three more ampullary adenomas were detected using CAE compared to FVE. Cap displacement occurred in one patient, and there was no observed adverse effect of the additional sedatives used. Kappa values for agreement between endoscopists ranged from 0.60 to 0.85. CAE is feasible, reproducible and safe, with a higher success rate for complete visualization compared to FVE. 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subjects Adenocarcinoma
Adolescent
Ampulla of Vater
Ampulla of Vater - diagnostic imaging
Ampullary adenoma
Ampullary carcinoma
Anesthesia
Biliary tract cancer
Cancer
Cap-assisted endoscopy
Care and treatment
Common Bile Duct Neoplasms - diagnostic imaging
Duodenal Neoplasms - diagnostic imaging
Endoscopes
Endoscopy
Endoscopy, Digestive System
Esophagogastroduodenoscopy
Fentanyl
Forward-viewing endoscopy
Gastroenterology
Humans
Midazolam
Patients
Propofol
Reproducibility of Results
Risk groups
Scopolamine
Sedatives
Software
Studies
Surveillance
Visualization
title Cap-assisted endoscopy increases ampulla of Vater visualization in high-risk patients
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