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Training of endoscopic ultrasonography (EUS) in Asia faces two major challenges: (i) the ever-increasing demand for skills to handle a growing range of interventional EUS procedures; and (ii) a continual shortage of EUS training programs. As the therapeutic application of EUS continues to expand, the need to train more new endosonographers and upgrade skills of existing ones has become more critical than ever before. A formal fellowship to acquire EUS knowledge and skills in an advanced endoscopy center has always been perceived as the best way of training novices, but such opportunities remain limited in most Asian countries. To keep up with the pace of development in EUS, more short-term EUS programs have been conducted across Asia in recent years. Such programs are generally intensive and may combine didactic lectures, live-case demonstrations, and hands-on training on phantoms, or live animal models for teaching. Although not as rigorous as conventional full-time EUS fellowships, such short-term programs are not necessarily inferior in quality. With courses offered from basic to advanced levels, and at regular intervals, busy practising endoscopists have the flexibility to attend the course that best matches their individual levels of experience, learn at their own pace and acquire EUS knowledge and skills over as many courses as desired. This open-ended progressive learning model is more agile than established fixed-term learning models and is expected to adapt better to future needs. [ABSTRACT FROM AUTHOR]

Drainage of obstructed bile duct and pancreatic duct under endoscopic ultrasonography (EUS) guidance has evolved into viable techniques suitable for patients with failed endoscopic retrograde cholangiopancreatography (ERCP) and/or altered surgical anatomy. One of the major advantages of EUS guidance is the possibility of multiple access points depending upon patient and ductal anatomy. Unlike ERCP, an approachable papilla is not a requisite for successful EUS-guided biliary or pancreatic ductal drainage. Moreover, as the access is away from the papilla, there is the possibility of reduced pancreatitis. A variety of procedures have become available for EUS-guided drainage, and it is important to develop standard terminology and procedural details. EUS-specific stents, including lumenapposing metal stents have recently become available, and are likely to impact the outcomes of these procedures. Available data show a high success rate and acceptable adverse event rate for EUS-guided biliary drainage. Success rate appears to be low for pancreatic duct drainage because of a variety of reasons. Outcomes of EUS-guided biliary drainage appear equivalent to percutaneous drainage and ERCP. EUS-guided gallbladder drainage appears promising for patients requiring gallbladder drainage but unfit for surgery. Further large controlled studies are needed to evaluate the exact role of these procedures. [ABSTRACT FROM AUTHOR]

The article presents research on the use of image-guided Raman endoscopy in gastroscopy. An evaluation of the clinical utility of the endoscopy for in vivo diagnosis of neoplastic lesions in the stomach done. An image-guided endoscopy system with 785 nanometer excitation has been developed to acquire in vivo gastric tissue. It concludes that the endoscopy procedure associated with ant colony optimization linear discriminant analysis diagnostic (ACO-LDA) algorithms has potential for the noninvasive diagnosis and detection of gastric neoplasia.

Closure of access site is one of the key issues that will determine the development of natural orifice transluminal endoscopic surgery. Our study was designed to compare the effectiveness of gastrotomy closure using endoloop and endoclip with hand-sewn closure as a control. Gastrotomy was carried out on 24 ex vivo porcine stomachs and the gastrotomies were randomized to be closed with either hand-sewn, endoloop or endoclip techniques. A 2 cm gastrotomy was created with a needle knife and sphincterotome and the defects closed thereafter. We measured the time to closure of gastrotomy and the pressure at which the closure leaked. Three endoloops were required for all the closures in the endoloop group. In the endoclip group, the mean (range) number of endoclips used was 10 (8-13). There was no difference in the median closure times between endoloop 28 (16-58) min and endoclip 30 (21-40) min; however, time for hand-sewn closure was much shorter (3-5 min). All stomachs were successfully distended with air without leak at the end of the procedure and none experienced fluid leak. The endoclip closure endured a significantly higher median (range) pressure of 72.5 mmHg (15-80 mmHg) before leaking compared to that of an endoloop 25 mmHg (15-37 mmHg) ( P < 0.001). The hand-sewn gastrotomy leaked at pressure of 95 mmHg (75-130 mmHg). The majority of air leaks were from the wound site. In the endoclip group, two leaks were noted at the clip bite site. In a bench-top model, endoclips seem to be better for gastrotomy closure because of their potential to endure relatively higher pressure without any prolongation of application time. Animal survival studies are needed to explore technical and wound-closure-related problems arising as a result of use of endoclips and endoloops for gastrotomy closure. [ABSTRACT FROM AUTHOR]

Aim: To determine the inter-observer agreement and validity of the LA Classification in scoring the severity of esophagitis in Asian patients. Methods: Video endoscopy clips were selected from 45 consecutive patients participating in reflux studies. The videos were viewed by endoscopists who then independently scored the presence, severity and distribution of esophagitis, including endoscopically suspected Barrett's esophagus (ESBE). Each video was discussed and a consensus on findings reached. Kappa (k) correlation was calculated to describe inter-observer agreement. Results: Thirty-five clips were scored (no esophagitis 20%, grade-A 54%, grade-B 23%, grade-C 3%, respectively and 10 clips were excluded for poor imaging). Excellent agreement was noted on the presence of esophagitis (mean k = 0.79, range 0.77–0.82). Fifteen patients (42%) had ESBE with a mean k of 0.48 (range 0.39–0.60). Inter-observer agreement on the LA grade was good (mean k = 0.58, range 0.55–0.63), whilst in agreement between endoscopists and consensus grading, the mean kappa rose to 0.77 (range 0.73–0.81). There was a trend of increasing agreement as viewings progressed, with superior kappa correlation after 16 cases. Evaluation of the extent of esophagitis showed good k values using the alternative approach of grouping by circumferential extent (mean k = 0.64, range 0.60–0.67) at the lower categories of severity. Conclusions: Scoring using the LA classification for esophagitis and the concurrence on the presence of ESBE showed moderate to strong agreement amongst Asian endoscopists. Our results also suggested that an alternative method of scoring esophagitis based on proportion of circumferential involvement was reliable. A learning effect was observed and reliable scoring was achieved after 16 patients. [ABSTRACT FROM AUTHOR]

Widespread epidemiological changes, rising prevalence and gradual shifts in patterns of disease manifestations: this is the changing face of gastroesophageal reflux disease (GERD) in Asia. Are we witnessing a disease in evolution or merely the result of increased and more accurate case reporting that comes with advancing diagnostic technology, better medical facilities and heightened awareness of the disease? Do the figures reported really reflect the actual scenario or is there more to it than meets the eye? In this article, we take you back in time to review relevant developments over the past decade or so. We will draw on findings from across Asia, take an in-depth look at prevailing trends and patterns and examine some of the most plausible explanations behind the dynamics of this epidemiological transition. [ABSTRACT FROM AUTHOR]

Gastroesophageal reflux disease (GERD) is less prevalent in Asia than in the West, but there is now evidence to suggest that its frequency is rapidly rising in Asia. The different prevalence rates reported in various Asian studies may represent different points in the ‘rising’ phase of GERD. The cause for the lower but increasing prevalence of GERD in Asia is not known, but genetics and to some extent environmental factors, may have initially protected Asians against GERD. However, with the recent globalization of economies, the associated lifestyle changes in many developing Asian countries may have tipped the balance in favor of the development of GERD. [ABSTRACT FROM AUTHOR]

Background: Little is known about the current status of endoscopic ultrasonography (EUS) training in the Asia–Pacific region. The aim of the present study was to assess EUS practice and training in the Asia–Pacific region and seek to identify areas where the development of EUS expertise could be further enhanced. Methods: A direct mail survey was sent out to 87 practising endosonographers in various parts of the Asia–Pacific region outside of Japan. They were asked to report on their prior training, utilization of EUS, and EUS training in their country. Results: The respondents ( n = 71) were mostly young (median age 40 years), male (97%), practising in academia (36.6%) or public hospitals (50.7%) and fairly experienced (median 5 years) in EUS practices; they had performed a median of 500 procedures in their career. Among them, 49.3% were self-taught. Only 22.5% and 21.1% had undergone formal overseas fellowship lasting ≥6 months, and local gastrointestinal fellowships of various durations, respectively. Fifty-six percent were currently involved in EUS teaching. Most (90%) thought that a formal EUS training fellowship is necessary for acquiring acceptable competence and there should be a minimum number (median 100) of supervised procedures performed and minimum amount of time (median 6 months) spent on training. Conclusions: Although EUS practitioners in the Asia–Pacific region were not behind their European or US counterparts in hands-on experience, the lack of formal EUS training programs and opportunities remains an area of concern. For the region to increase EUS utilization, the current shortage of training opportunities needs to be addressed. [ABSTRACT FROM AUTHOR]

The purpose of the present paper was to study previously obtained population-based data on the prevalence of reflux symptoms in a random sample of community adults in Singapore. This sample was re-investigated 5 years later to determine changes in the prevalence of reflux symptoms.In 1999, 237 (34%) of the original cohort of 696 persons who were interviewed in 1994, were re-interviewed using a validated Gastrointestinal Symptoms Questionnaire. The original cohort was a race-stratified random sample of residents in a Singaporean town. Reflux was defined as heartburn and/or acid regurgitation occurring at least once a month.Among the 237 respondents (aged 25–89 years; male : female, 49:51; Chinesen = 106, 45%; Malayn = 69, 29%; Indiann = 60, 25%), reflux was reported by 25 respondents, giving a prevalence of 10.5 ± 2.0%. This compared with the prevalence of 5.5 ± 1.5% (odds ratio[OR], 2.2; 95% confidence interval[CI]: 1.0–5.2;P = 0.05) among the same 237 respondents in the 1994 survey. Of the 25 subjects who reported reflux in the current survey, 22 (88.0%) did not complain of reflux symptoms in the 1994 survey. The ethnic-adjusted prevalence of reflux in 1999 was estimated to be 9.9 ± 1.9%. This was an increase above the prevalence in 1994 of 1.6 ± 1.0% (P = 0.051). The upward trend in the prevalence of reflux was not related to age, smoking, alcohol consumption, or increase in bodyweight.There is a rising trend of reflux symptoms frequency in the general population of Singapore over a 5-year period.© 2005 Blackwell Publishing Asia Pty Ltd [ABSTRACT FROM AUTHOR]