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In 1989 and 1992, HIV, HBV and HCV serosurveys were carried out among personnel and patients of an Italian Psychiatric Hospital. No HIV cases were found. Mean annual HBV seroconversion rate was 0.99% in patients and 4.4% in personnel; HCV rate was 0.42% among patients. Although the nosocomial risk of bloodborne infection was low, efforts should be made to minimize it.

The technique of perendoscopic manometry was used to study the motor patterns of the ileocecal junction and distal ileum. An expert endoscopist cannulated the distal ileum of 20 unsedated subjects in 260 ± 252 (mean ± SD) seconds, causing no discomfort beyond that of an ordinary colonoscopic examination. No sphincter-like motor activity was detected at the ileocecal junction, and four distinct motility patterns were identified in the distal ileum: (1) tone variations, (2) slow phasic contractions, (3) regular rapid phasic contractions, and (4) prolonged rapid phasic contractions. Previous appendectomy and insertion of the colonoscope into the distal ileum to position the manometric catheter did not affect the manometric recordings. Perendoscopic manometry of the distal ileum was compared with transileostomy manometry in 9 subjects. Perendoscopic and transileostomy manometric recordings showed the same motor patterns except for a longer occurrence of tone variations with perendoscopic manometry. In conclusion, this study shows that perendoscopic manometry of the distal ileum and ileocecal junction is feasible; recorded motor patterns are not affected. (Gastrointest Endosc 1994;40:685-91.)

Previous manometric studies of the ileocolonic junction were performed without assessing the precise spatial relationship between recording sensors and ileocolonic junction. In the present study, the motor activity of the ileocolonic junction was recorded using manometric sensors localized under direct colonoscopic control in 11 patients (4 men, 7 women; mean age, 55 years) referred for hematochezia with normal stool frequency. No medications were administered before and during endoscopy. A perfused catheter (OD 1.7 mm, with three side holes 4 mm apart and marked by evenly spaced black rings in the distal 6 cm) was passed through the biopsy channel of the endoscope and advanced through the ileocolonic junction and 6 cm into the ileum. The catheter was then withdrawn into the cecum by 1-cm steps, and motor activity was recorded for 4–6 minutes at each station. A single catheter taped to the endoscope continuously recorded cecal pressure. An ileocecal pressure gradient could not be identified in the majority of subjects; individual values ranged from −8 to +4 mm Hg, and gradients were maintained over the entire length of the ileum. In the distal ileum, tonic and phasic pressure waves were detected. Tonic variations were present for 70.1% of the recording time, either alone (44%) or together with phasic waves (56%). Phasic waves were present for 10.3% of the recording time and, according to their duration, were subdivided into those compatible with the rate of ileal slow waves and prolonged waves not compatible with the rate of ileal slow waves. Regular phasic waves could be either isolated or in clusters; prolonged waves were always isolated. A similar proportion of regular (27.9%) and prolonged (31.2%) phasic waves propagated aborally along the ileum or from ileum to cecum. Clusters presented an average of 8.7 ± 0.6 peaks/min, and 44% of them propagated aborally. The manometric characteristics did not vary between the segments 5-3 cm and 2-0 cm proximal to the ileocecal junction. In conclusion, a powerful ileocecal sphincter was not detected at the human ileocecal junction, and motor activity of the distal ileum was characterized by tonic changes and rapid phasic contractions.

Unsedated Transnasal Gastroscopy (T-EGD): Three Years Experience (2002-2004) in Operative Digestive Endoscopy Through Trans-Nasal Route Fausto Barberani, Alessandro Gigliozzi, Maurizio Giovannone, Mauro Tosoni, Sandro Boschetto T-EGD was first performed by Shaker in 1994 and proposed in Italy by Barberani with his own and innovative techniques, in 1998 (1,2). Our previous studies demonstrated that T-EGD is safer, better tolerated and cheaper than conventional one. There are only few records concerning T-EGD in operative endoscopy (PEG, Dilation on guide wire) when oral route is unavailable [3]. Aim of this study is to assess operative power of T-EGD in upper GI diseases. Material and Methods: 164 pts previously underwent to diagnostic unsedated T-EGD, were guided to a second T-EGD when endoscopic therapy was required. The procedures were performed according to Barberani’s technique: without topical anesthesia on left decubitus, evaluating both the naryx to choose the best way approaching middle or inferior meatus of the nose. Consent was obtained. A 6 mm Pentax video EG1840EG1870K with 2 mm operative channel was utilized. As additionals: injecting needle and snare Olympus and Deltamed, a 1.8 mm Deltamed Roth Net, a Boston CRE and Deltamed pneumatic dilator, a 1.8 mm Erbe Argon APC probe, Corpak-Peg16 Fr [4]. Results: We performed 164 therapies (age 23-91): 51 Injective therapy (42 PU, 6 achalasia, 3 varix); 9 esophageal dilation (6 benign stenosis, 3 malignant); 43 (5-25 mm) polipectomies (30 gastric, 12 esophageal, 1 duodenal); 23 Argon (12 angiodisplasya, 6 gastric fundic polyps, 1 GC, 4 Barrett esophagus); 16 prosthesis (15 PEG, 1 esoph prosth); 6 foreign bodies mobilization; 16 on the wire transnasal placing of nutritional naso duodenal tube. No complications were recorded. No changes in vital parameters. Conclusions: The large experience conducted in diagnostic T-EGD has leaded us to explore operative power of this technique thanks to the availability of hi-tech additionals:polyps’net recovery, decreasing volume, give this procedure sure and avoid accidental inhalation, guide wire inserted during T-EGD makes easy and safe pneumatic dilation of the esophagus, the APC fine probe treatments resulted definitively at the follow-up as well as the type of PEG and the injective therapy in bleeding and achalasyc pts, show safety, feasibility and tolerance of T-EGD not only in diagnostic procedure but also as possible tool for endoscopic therapy in selected patients. 1) Barberani F, et al. It. J. of Gastroent & Hepatol. 30 suppl 2; A 173, 1998. 2) Boschetto S, et al. Am. J. Gastroent. vol. 95, n 9; A132, 2000. 3) Dean R, et al. Gastroint. Endoscopy vol. 44 n.4: 422-4, 1996. 4) Barberani F, et al. Giorn. It. End. Dig. n 1, vol. 26: 9-17, 2003. T1328 In Vivo Full-Thickness Endoluminal Gastroplication Using Tissue Anchors in a Live Pig Model Jose G. De la Mora, Elizabeth Rajan, David Rea, Thomas C. Smyrk, Lori J. Herman, Jodie L. Deters, Mary A. Knipschield, Christopher J. Gostout Background: Long-term success of gastric wall apposition performed by flexible endoscopy is dependent on fold permanence. Prior work by our group demonstrated that only full-thickness folds with serosal apposition are durable. Aim: To study feasibility of different tissue anchors to create a full thickness inverted fold and the durability of each single fold plication. Material & Methods: Four 35-45 Kg female pigs were used. Under anesthesia a midline abdominal incision was performed. A 5-cm incision parallel to the greater curvature of the stomach was made. The posterior wall was exposed and longitudinal folds were created by indenting the wall from the serosal side (inverted fold) 1.5 cm in height and 5 cm long. Anchors were deployed to traverse the inverted gastric wall, including apposing serosal surfaces within the fold. Anchors were 1 cm apart with 3-4 of the same type used per fold. 4-6 folds were made in each pig. Four types of paired anchors joined with suture (prolene 2-0) were used: T-bar (T); polypropylene mesh pledget (TM); plastic star-shaped buttons (S) and a self-expanding nitinol basket (B). Suture (vicryl 2-0) for incision closure was used to control for tissue reaction. Follow-up endoscopy was done at 15, 30 and 60 days. Two pigs were sacrificed each at 30 and 60 days. Macroscopic description of the folds was done and samples of the folds sent for histology. Results: Day 15: all folds were still present endoscopically. Day 30: S and B folds were unchanged, TM folds were reduced in height, and T folds had flattened. Day 60: only S & B folds remained. Histologically, all B folds included the muscle layer (30 & 60 day specimens) and one developed serosal fusion (30-day specimen). Only one S fold included the muscle layer with serosal fusion at 60 days. Conclusions: The durability of endoluminally placed full thickness inverted folds remains a challenge. Serosal apposition remains requisite for fold permanence. The use of tissue anchors such as the S and B designs may help achieve greater durability for endoscopic gastric remodeling by tissue apposition.

Transnasal gastroscopy(T-EGD):the first preliminary experience in operative digestive endoscopy through trans-nasal route

Esophageal pH-metric measurements are performed to assess the clinical relevance of gastroesophageal reflux (GER). They could be particularly useful for evaluating patients with typical GER symptoms in the absence of endoscopic and histologic evidence of esophagitis and patients with atypical symptoms. It has been shown, however, that the occurrence of GER may vary over time, being more frequently detected postprandially [1] and during the daytime [2]; it is possible that in these patients GER episodes may show marked variability on different days, and this variability may affect the reproducibility of the pH-metric measurements and, therefore, diagnostic conclusions of the tests.

Background Recurrence and severity of Crohn's disease mucosal lesions after "curative" ileal resection is assessed at endoscopy. Intramural lesions can be detected as increased wall thickness at Small Intestine Contrast Ultrasonography (SICUS). Aims. To assess after ileal resection whether: 1) SICUS detects recurrence of Crohn's disease lesions, 2) the intestinal wall thickness measured at the level of ileo-colonic anastomosis predicts the severity of endoscopic lesions, 3) the extension of intramural lesions of the neo-terminal ileum is useful for grading severity of the recurrence, 4) the combined measures of wall thickness of the ileo-colonic anastomosis and of the extension of intramural lesions at level of the neo-terminal ileum may predict the endoscopic Rutgeerts score Methods Fifty eight Crohn's disease patients (M 37, age range 19-75 yrs) were prospectively submitted at 6-12 months intervals after surgery to endoscopy and SICUS for a total of 111 observations. Results Six months or more after surgery wall thickness of ileo-colonic anastomosis > 3.5 mm identified 100% of patients with endoscopic lesions (p < 0.0001). ROC curve analysis, combining wall thickness of ileo-colonic anastomosis and the extension of intramural lesions of neo-terminal ileum, discriminated (0.95) patients with, from those without, endoscopic lesions. Performing two multiple logistic regression analyses only wall thickness of ileo-colonic anastomosis and extension of neo-terminal ileum intramural lesions were significantly associated with absence or presence of endoscopic lesions. An ordinal polychotomus logistic model, considering all investigated variables, confirmed that only SICUS variables were associated with endoscopic grading of severity. Conclusions In patients submitted to ileal resection for Crohn's disease non-invasive Small Intestine Contrast Ultrasonography 1) by assessing thickness of ileo-colonic anastomosis accurately detects initial, minimal Crohn's disease recurrence, and 2) by assessing both thickness of ileo-colonic anastomosis and extension of intramural lesions of neo-terminal ileum grades the severity of the post-surgical recurrence.