Tu1475 How Much Does Cap-Fitted Gastroscopy Improve the Examination of the Duodenal Ampulla?

BackgroundA frontal-view endoscope with a transparent cap attached is used to reach and treat difficult lesions in the gastrointestinal (GI) tract. The advantages of cap-fitted endoscopy are enhanced visualization and targeting of lesions by adding a tactile dimension to conventional endoscopy. We conducted a prospective trial to investigate the usefulness of cap-fitted endoscopy for examining the duodenal ampulla.MethodsFrom October to November 2010, consecutive patients undergoing routine endoscopic checkups were prospectively included in our study. Routine upper endoscopy was performed by one endoscopist (Han). If the ampulla was visualized suboptimally or not found on conventional endoscopy, it was re-examined using an endoscope with short and long caps (disposable distal attachment 201-10704, MH-463). The caps were placed so that 4 or 12 mm, respectively, extended beyond the tip of the gastroscope. All examinations were reviewed by two endoscopists. We reported visualization of the ampulla as four groups: I, complete observation; II, partial observation with a visible orifice; III, partial observation without a visible orifice; IV, not found.ResultThirty-seven patients were enrolled in this study. On conventional upper endoscopy, a completed view of the ampulla was seen in 54% (group I, 20 of 37), whereas nothing was seen in 11% (group IV, 4 of 37). Groups II to IV were re-examined using a short cap, and a complete view of the ampulla was achieved in 88% (15/17). A complete view was achieved in the remainder (2/17) with a long cap. The use of a cap-fitted endoscope permitted adequate examination of the ampulla in 17 patients for whom conventional endoscopy failed (100%). No complications occurred.ConclusionThe use of a frontal-view endoscope with an attached transparent cap enables adequate and reliable visualization of the ampulla. This technique potentially allows for a more complete diagnostic examination of the upper gastrointestinal tract without the need for a lateral duodenoscope. BackgroundA frontal-view endoscope with a transparent cap attached is used to reach and treat difficult lesions in the gastrointestinal (GI) tract. The advantages of cap-fitted endoscopy are enhanced visualization and targeting of lesions by adding a tactile dimension to conventional endoscopy. We conducted a prospective trial to investigate the usefulness of cap-fitted endoscopy for examining the duodenal ampulla. A frontal-view endoscope with a transparent cap attached is used to reach and treat difficult lesions in the gastrointestinal (GI) tract. The advantages of cap-fitted endoscopy are enhanced visualization and targeting of lesions by adding a tactile dimension to conventional endoscopy. We conducted a prospective trial to investigate the usefulness of cap-fitted endoscopy for examining the duodenal ampulla. MethodsFrom October to November 2010, consecutive patients undergoing routine endoscopic checkups were prospectively included in our study. Routine upper endoscopy was performed by one endoscopist (Han). If the ampulla was visualized suboptimally or not found on conventional endoscopy, it was re-examined using an endoscope with short and long caps (disposable distal attachment 201-10704, MH-463). The caps were placed so that 4 or 12 mm, respectively, extended beyond the tip of the gastroscope. All examinations were reviewed by two endoscopists. We reported visualization of the ampulla as four groups: I, complete observation; II, partial observation with a visible orifice; III, partial observation without a visible orifice; IV, not found. From October to November 2010, consecutive patients undergoing routine endoscopic checkups were prospectively included in our study. Routine upper endoscopy was performed by one endoscopist (Han). If the ampulla was visualized suboptimally or not found on conventional endoscopy, it was re-examined using an endoscope with short and long caps (disposable distal attachment 201-10704, MH-463). The caps were placed so that 4 or 12 mm, respectively, extended beyond the tip of the gastroscope. All examinations were reviewed by two endoscopists. We reported visualization of the ampulla as four groups: I, complete observation; II, partial observation with a visible orifice; III, partial observation without a visible orifice; IV, not found. ResultThirty-seven patients were enrolled in this study. On conventional upper endoscopy, a completed view of the ampulla was seen in 54% (group I, 20 of 37), whereas nothing was seen in 11% (group IV, 4 of 37). Groups II to IV were re-examined using a short cap, and a complete view of the ampulla was achieved in 88% (15/17). A complete view was achieved in the remainder (2/17) with a long cap. The use of a cap-fitted endoscope permitted adequate examination of the ampulla in 17 patients for whom conventional endoscopy failed (100%). No complications occurred. Thirty-seven patients were enrolled in this study. On conventional upper endoscopy, a completed view of the ampulla was seen in 54% (group I, 20 of 37), whereas nothing was seen in 11% (group IV, 4 of 37). Groups II to IV were re-examined using a short cap, and a complete view of the ampulla was achieved in 88% (15/17). A complete view was achieved in the remainder (2/17) with a long cap. The use of a cap-fitted endoscope permitted adequate examination of the ampulla in 17 patients for whom conventional endoscopy failed (100%). No complications occurred. ConclusionThe use of a frontal-view endoscope with an attached transparent cap enables adequate and reliable visualization of the ampulla. This technique potentially allows for a more complete diagnostic examination of the upper gastrointestinal tract without the need for a lateral duodenoscope. The use of a frontal-view endoscope with an attached transparent cap enables adequate and reliable visualization of the ampulla. This technique potentially allows for a more complete diagnostic examination of the upper gastrointestinal tract without the need for a lateral duodenoscope.