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The morphological development of the sheep and the goat is different and this difference is manifested from early post-natal life. The main characteristic of kid goat carcasses is their low adipose tissue, and this is considered detrimental to quality. In an attempt to determine the nutritional causes of this, a study was performed with kid goats of the Granadina breed and lambs of the Segureña breed. Six kid goats and six lambs were slaughtered at birth, while a further eight kids and eight lambs were fed a milk replacer to satiety until the 60th day of life and slaughtered on the 61st day. Dry matter (DM) and metabolizable energy (ME) intakes and apparent digestibility of energy were determined in four balance periods between 8 and 60 days of life. From the intakes of ME and comparative slaughter data it was possible to calculate energy retention (ER), heat loss (HL) and energy retained as protein (ERp) and as fat (ERf) for kids and lambs. Kid goats showed a similar apparent digestibility of energy to lambs but had lower DM and ME intakes per kg metabolic body weight (M0·75) than lambs. For kids and lambs respectively these values were: 0·93 and 0·94; 45·4 and 50·1 g/kg M0·75 per day; 937 and 1033 kJ/kg M0·75 per day. Mean values for ER, HL, ERp and ERf rates were: 263, 674, 131 and 132 kJ/kg M0·75 per day for kid goats and, 343, 690, 132 and 211 kJ/kg M0·75 per day for lambs. Together with the different intake, kid goats showed a lower rate of ER and overall, a lower rate of ERf than lambs.

Su1703 Endoscopic Report Card of a 10-Year Experience in 100 Patients With Walled-off Pancreatic Necrosis Ji Young Bang*, C. Mel Wilcox, John D. Christein, Muhammad Hasan, Pablo J. Arnoletti, Sebastian De La Fuente, Robert Hawes, Shyam Varadarajulu Center for Interventional Endoscopy, Florida Hospital, Orlando, FL; Gastroenterology-Hepatology, University of Alabama, Birmingham, AL; Surgery, Florida Hospital, Orlando, FL; Surgery, University of Alabama, Birmingham, AL Background: Given the high morbidity and procedure-related risks, endoscopic management of walled-off pancreatic necrosis (WOPN) remains a therapeutic challenge. Aim: To evaluate the clinical outcomes of 100 consecutive patients undergoing endoscopic management of WOPN over a 10-year period. Methods: This is a retrospective study of 100 patients (Median age 53 yrs, Male 63%) with WOPN treated endoscopically over 10 years from 2004-2013. During the initial period (20042009), pancreatitis was categorized using the 1992 Atlanta classification, access to WOPN was first attempted by conventional transmural drainage (CTD) with EUS being reserved only for failed cases and predominant treatment was by placement of transluminal stent and drainage catheters or necrosectomy. In the later period (2010-2013), pancreatitis was categorized using the (proposed) revised Atlanta classification, access was mainly under EUS-guidance and treatment approach was more HYBRID. The HYBRID approach involves endoscopic creation of multiple internal conduits for improved drainage of necrotic contents and multidisciplinary collaboration with interventional radiologists for percutaneous placement of largebore drainage catheters and pancreatic surgeons for minimally invasive percutaneous debridement. To track outcomes in relation to time, patients were divided into two groups: Group IZ2004-2009 vs. Group IIZ2010-2013. Main outcome measures: To compare clinical outcomes between two time periods (groups) and identify predictors of treatment success in patients undergoing endoscopic management of WOPN. Treatment success was defined as resolution of WOPN without the need for open surgical necrosectomy and discharge from the hospital with favorable clinical evolution. Results: There was no significant difference in pretreatment clinical parameters or WOPN characteristics between group I (NZ47) and group II (NZ53) patients. When compared to group I, patients in group II underwent more EUS-guided drainage (63.8 vs. 96.2%, p!0.001), received more HYBRID treatment (10.6 vs. 43.4%, p!0.001) and had higher treatment success (59.6% vs. 90.6%, p!0.001). On multivariate logistic regression analysis, undertaking treatment via HYBRID approach (OR 5.72, 95% CIZ 1.25-26.2; pZ0.025) was the only factor predictive of treatment success (Figure) when adjusted for the patient/disease characteristics, size/location of WOPN, access modality (EUS vs. CTD), enteral nutrition, number of endoscopic interventions and placement of transpapillary pancreatic duct stent. Conclusions: There has been an incremental improvement in the clinical outcomes of patients with WOPN managed by endoscopy over the past 10 years with a HYBRID multidisciplinary approach being the major determinant of treatment success.

To clarify the implication of pancreatic findings on transabdominal ultrasound and/or abdominal computed tomographic scan on outcomes of islet isolation and endocrine function after total pancreatectomy (TP) with islet autotransplantation (IAT).Retrospective review of islet isolations and graft functions in a cohort of patients with chronic pancreatitis who received TP with IAT from December 2007 to September 2009. Patients were categorized into the following 2 groups on the basis of their transabdominal ultrasound or computed tomographic findings before IAT: early group (normal or equivocal of Cambridge classification) and advanced group (mild to marked).A total of 12 patients (early group, n=6; advanced group, n=6) were included. Total islet yield per pancreas weight and per patient body weight in the early group was significantly higher compared with that in the advanced group (6989±659 vs 3567±615 islet equivalents per gram, P0.01; 8556±953 vs 3847±739 islet equivalents per kilogram, P0.01, respectively). Four patients (67%) in the early group became insulin-free, whereas 2 patients (33%) in the advanced group obtained insulin independence. However, both groups maintained islet graft function and similar glycated hemoglobin levels after transplantation.Excellent glycemic control was observed in both groups of patients who received TP with IAT, although the early group showed a significantly better outcome of islet isolation.

Dieulafoy lesions are a rare cause of gastrointestinal hemorrhage with a striking presentation because of rapid blood loss. Endoscopic therapy is usually successful at achieving primary hemostasis, but the best mode of endoscopic intervention is not clear, and outcomes relating to variables such as gender, medication, alcohol, and smoking are not known. We reviewed the clinical experience with Dieulafoy lesions at our institution, focusing on clinico-epidemiological features, management practices, and also survival. A retrospective and prospective cohort of patients with Dieulafoy lesions who underwent endoscopy from January 2004 through April 2009 were studied and detailed clinical data were abstracted and collected. We identified 63 patients with a Dieulafoy lesion. The majority were male with an average age 58 years. Hematemesis and melena were the most common presenting symptoms. Almost half the patients were on anticoagulation medication. Most of the Dieulafoy lesions occurred in the upper GI tract, and mostly in the stomach. Single-modality endoscopic therapy was used as frequently as combination therapy, and both were effective, as primary hemostasis was achieved in 92% of cases. There were 11 deaths overall; death due to Dieulafoy lesion exsanguination was attributed to three patients. Dieulafoy lesions occurred in younger patients than previously reported, and were more frequently diagnosed in males. Most DL lesions occurred in the upper GI tract. Primary hemostasis with endoscopic therapy was highly successful. Overall mortality was 17%, and associated with co-morbidities, and not with medical history, gender, age, or medication.

Overtube-assisted enteroscopy has expanded therapeutic options for the small bowel, but the effectiveness of spiral tip overtube-assisted endoscopy for retrograde small bowel evaluation is not known. This retrospective study reviewed the results of retrograde enteroscopy procedures among six consecutive patients. In these patients, cecal retroflexion was necessary to enter the terminal ileum when using an enteroscope, and 40 to 130 cm of the distal small bowel was intubated. The average procedure time was 52 minutes. The procedure was diagnostic in four patients, and successful endoscopic therapy was performed in three patients, including completion of a polypectomy at the ileocecal valve, resolution of a distal intestinal obstruction in a patient with cystic fibrosis, and a small bowel anastomotic stricture release. There were no procedure-related complications. Overtube-assisted enteroscopy with the spiral tip overtube allows for antegrade or retrograde evaluation of the small bowel. Pan-enteroscopy may become possible as the technique and equipment improve. The advantages of the different forms of overtube-assisted enteroscopy (spiral, single, and double balloon) need to be determined.

Endoscopic ultrasound (EUS)-guided biliary drainage (EUSBD) has been described as a viable alternative to percutaneous transhepatic cholangiography (PTC) in patients in whom ERCP has been unsuccessful. The purpose of our study was to assess the utility of EUSBD using a newly released, fully covered, self-expanding, biliary metal stent (SEMS) for palliation in patients with an obstructing malignant biliary stricture.We collected data on all patients who presented with obstructive jaundice and who underwent transduodenal EUSBD after a failed ERCP. Eight patients presented with biliary obstruction from inoperable pancreatic cancer or cholangiocarcinoma. Reasons for failed ERCP were duodenum stenosis, high-grade malignant stenosis of the common bile duct, periampullary tumor infiltration, failure to access the common bile duct, and periampullary diverticulum. EUS was used to access the common bile duct from the duodenum after which a guidewire was advanced upwards toward the liver hilum. The metal stent was then advanced into the biliary tree. Technical success was defined as correct stent deployment across the duodenum. Clinical success was defined as serum bilirubin level decreased by 50% or more within 2 weeks after the stent placement.Technical and clinical success was achieved in all eight patients. No stent malfunction or occlusion was observed. Complications included one case of duodenal perforation, which required surgery, and one case of self-limiting abdominal pain.EUSBD with a fully covered SEMS in whom ERCP is unsuccessful is effective for palliation of biliary obstruction. The limitations of our study are that we had a small number of patients and a limited follow-up time.

The main objective of pancreatic cyst fluid analysis is to differentiate mucin-producing or malignant cysts from other cysts which have a benign course. K-ras-2 point mutation and at least two mutations of allelic imbalance or loss of heterozygosity with good quality DNA has been suggested to predict mucinous cystic neoplasm (MCN). Elevated carcinogenic embryonic antigen (CEA) level in cyst fluid has also been shown to be predictive of mucinous or malignant cysts.Identify the clinical impact of DNA mutational analysis of pancreatic cyst fluid with its correlation to cyst fluid chemistry and histologic analysis.This retrospective analysis included all consecutive patients with pancreatic cysts who presented for evaluation by endoscopic ultrasound (EUS) with fine needle aspiration (FNA) over an 18 month period until November 2007.DNA analysis performed by Pathfinder TG (RedPath Integrated Pathology, Inc., Pittsburgh, PA, USA) and fluid CEA exceeding 192 ng/dL were used to suggest mucinous or malignant cysts. These parameters were compared to surgical histology or cytopathology of FNA specimens.Twenty-seven consecutive patients with cysts had samples submitted for DNA analysis which included 15 men and 12 women (mean age 62.8 and 61.3 years, respectively). In 20 patients, all parameters including cyst fluid, DNA analysis, and histology were available for comparison. Consistent findings were seen in 7/20 (35%) in which all parameters suggested negative benign findings. CEA level was elevated in 7 patients of which 4 had mucinous or malignant histology. In the remaining 13 patients with low CEA levels, 11 had negative histology. The sensitivity and specificity of CEA based on these results was 66% and 78.6% respectively. The positive predictive value (PPV) of CEA was 57% and the negative predictive value (NPV) was 84.6%. K-ras-2 mutation was detected in 3 patients, absent in 17 patients and falsely negative in 4 cases based on histology. The sensitivity and specificity were 33% and 92.6% respectively. The PPV was 66% and NPV was 76%. Detection of loss of heterozygosity mutations was noted in 7 patients, of which 4 were falsely positive. In the remaining 13 patients, 3 were falsely negative. The sensitivity and specificity were 50% and 71% respectively. The PPV was 42.9% and NPV was 76.9%. In a group of 6 patients with available surgical histology demonstrating mucin-producing or malignant cysts, fluid CEA level had a sensitivity of 66.7%. However, K-ras-2 and loss of heterozygosity mutational analysis had a much lower sensitivity at 33% and 50% respectively.Consistency in histology, CEA levels, and K-ras-2 and loss of heterozygosity mutations was seen in only 35% of cases, all of which were benign cysts. In the detection of malignant cysts, elevated CEA levels were more predictive of histology in comparison to K-ras-2 or loss of heterozygosity mutations. Additionally, false positivity of loss of heterozygosity mutations was noted to be considerably higher than K-ras-2 mutations or even fluid CEA levels. These findings suggest that DNA mutation analysis should not be used routinely but rather selectively in the evaluation of pancreatic cysts.

Background & Aims Acute pancreatitis is rare during pregnancy; limited data are available about maternal and fetal outcomes. We investigated the effects of acute pancreatitis during pregnancy on fetal outcome. Methods This retrospective cohort study, performed at a single academic center, included consecutive pregnant women who presented with (n = 96) or developed acute pancreatitis in the hospital (n = 7) in 2000–2006 (mean age, 26 y). Patient histories and clinical data were collected from medical records. Results Of the 96 patients with spontaneous pancreatitis, 4 had complications: 1 patient in the first trimester had acute peripancreatic fluid collection, and 3 patients in the third trimester developed disseminated vascular coagulation (DIC). None of these patients achieved term pregnancy, and 1 of the patients with DIC died. Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 23 patients with acute pancreatitis; post-ERCP pancreatitis was diagnosed in 4 patients (a total of 11 patients developed ERCP-associated pancreatitis). Term pregnancy was achieved in 73 patients (80.2%). Patients who developed pancreatitis in the first trimester had the lowest percentage of term pregnancy (60%) and highest risks of fetal loss (20%) and preterm delivery (16%). Of the patients with pancreatitis in the second and third trimesters, only one had fetal loss. Fetal malformations were not observed. Conclusions The majority of pregnant patients with acute pancreatitis did not have complications; most adverse fetal outcomes (fetal loss and preterm delivery) occurred during the first trimester. Acute pancreatitis, complicated by DIC, occurred most frequently in the third trimester and was associated with poor fetal and maternal outcomes.

Six growing female goats of the Granadina breed, aged 6 months, with weights ranging from 13.1 to 21.9 kg were used. Digestibility, nitrogen and energy balance measurements were made during two consecutive experiments with a diet of pelleted luzerne ( Medicago sativa ) hay, barley and sunflower cake, which was given at about maintenance level. Gas exchange was measured by open-circuit calorimetry. Fasting heat production (FHP) was also determined. By regression analysis of body energy retention (RE) on metabolizable energy (ME) intake, FHP and efficiency of utilization of ME for maintenance ( k m ) were found to be 320 kJ/kg BW 0.75 /d and 0.760, respectively. Energy requirement for maintenance (ME m ) was 421 kJ/kg BW 0.75 /d. It also was concluded that extrapolation of FHP values from sheep can lead to underestimation of energy requirements for maintenance of goats.

Background Endoscopic hemostasis is commonly practiced during GI endoscopy practice. We hypothesized that, because the choice of endoscopic intervention is influenced by many factors, for example personal experience, prior training, guidelines, etc., there would be differences in practice patterns among different groups of endoscopists. Objective To explore the potentially different practices for endoscopic hemostasis between the “East” (eight Asian countries) and the “West” (USA and Canada). Design Cross-sectional descriptive study (internet-based survey). Study subjects We administered a questionnaire survey to American Society of Gastrointestinal Endoscopy (ASGE) and Korean Society of Gastroenterology (KSGE) members (see: http://www4.utsouthwestern.edu/inetdemo/endoscopy/hemostasis.html, or supplementary paper for review online). Results Eastern ASGE members (n = 112) were more likely to complete this survey than ASGE members in the West (n = 180): 15.1 vs. 5.0%, P < 0.001. Choice of hemostatic method, regardless of primary or recurrent bleeding, varied significantly among Eastern and Western endoscopists. For example, for treatment of a gastric ulcer with a visible vessel, a vast majority (70%) of Western endoscopists preferred pre-injection followed by thermocoagulation whereas responses from the East were more diverse, with endoclip application ± pre-injection being the top choice (29%) (P < 0.001). Personal EGD volume and hospital bed numbers did not seem to be associated with hemostatic choices in either the East or the West. Conclusions Endoscopic hemostasis practice patterns for upper GI tract bleeding differed among Eastern and Western endoscopists, suggesting fundamental differences in practice habit determinants.

Sixteen adult castrated male goats of the Granadina breed, with initial live weights ranging from 26.0 to 33.3 kg were used in two experiments to determine their protein and energy requirements for maintenance. Digestibility, nitrogen and energy balance measurements were made during the experiments. Two diets, which were based on pelleted lucerne (Medicago sativa) hay alone or on this forage and barley, were individually given at about maintenance level once daily. Gas exchange was measured using open-circuit respiration chambers. Fasting heat production was also determined. By regression analysis endogenous urinary N and maintenance requirements for N were estimated to be 119 mg/kg body-weight (W)0.75 per d and 409 mg total N/kg W0.75 per d respectively. Fasting heat production was 324 kJ/kg W0.75. The energy requirement for maintenance was calculated by regression of energy balance on metabolizable energy (ME) intake and a value of 443 kJ/kg W0.75 per d was found. The overall efficiency of utilization of ME for maintenance was 0.73.

Roux-en-Y gastric bypass (RYGBP) is the most commonly performed bariatric operation in the USA. In the early postoperative stage, gastrointestinal (GI) bleeding is an infrequent but potentially serious complication that usually results from bleeding at the gastroje-junostomy staple-line. Observant management with transfusion for stable patients and surgical exploration for unstable patients is typically recommended for early GI bleeding. We hypothesized that use of endoclips, which do not cause thermal injury to the surrounding tissues (or anastomosis), may be preferable to thermal approaches which could cause tissue injury. We report 2 cases of early GI bleeding after RYGBP that were successfully managed with endoclip application to bleeding lesions. Emergent endoscopy was performed, and major stigmata such as active spurting vessel and adherent clot were noted at the gastrojejunostomy staple-lines. Endoscopic hemostasis using endoclips was readily applied to bleeding lesions at staple-lines. Primary hemostasis was achieved, and there was no recurrent bleeding or complication. We conclude that therapeutic endoscopy can be performed safely for early bleeding after RYGBP. In patients with early bleeding after RYGBP, use of endoclips is mechanistically preferable to other options.

Anticoagulation and antiplatelet medications may potentiate GI bleeding, and their use may lead to an increased need for a GI endoscopy. We hypothesized that there might be different practice patterns among international endoscopists.To explore the differences in management practices for patients who receive anticoagulation and antiplatelet medications from Eastern and Western endoscopists.International survey study.Academic medical centers and private clinics.Members of the American Society for Gastrointestinal Endoscopy (ASGE) in Eastern (Korea, Japan, China, India, Thailand, Singapore, Malaysia, and Philippines) and Western (United States and Canada) countries were invited to complete a Web-site-based questionnaire. In addition, the questionnaire was sent to university hospitals in South Korea and academic institutions in the United States.A survey was administered that contained detailed questions about the use of an endoscopy in patients on anticoagulation and antiplatelet medications.Different opinions and clinical practice patterns regarding the use of anticoagulation and antiplatelet medications by Eastern and Western endoscopists.A total of 105 Eastern and 106 Western endoscopists completed the survey. Western endoscopists experienced more instances of procedure-related bleeding (P = .003) and thromboembolism after withdrawal of medications (P = .016). Eastern endoscopists restarted medications later (1-3 days) than Western endoscopists after a biopsy (same day) (P.001). Eastern endoscopists withdrew aspirin for more than 7 days before a polypectomy and then restarted it 1 to 3 days after a polypectomy, whereas Western endoscopists performed a polypectomy without withdrawing aspirin (P.001). ASGE guidelines were followed less often by Eastern than by Western endoscopists (P.001).Low response rate, heterogeneity of the sample, and recall bias.The opinions and clinical practice patterns for the management of anticoagulation and antiplatelet medications differed significantly between Eastern and Western endoscopists. The lack of uniformity in practice patterns suggests that more data and better education are required in the area of GI endoscopy for patients on anticoagulation and antiplatelet medications, particularly given that individual patient characteristics may be associated with unique types of complications.

Background Long-term and permanent biliary stenting have been reported in many studies and are infrequently practiced in selected patients with irretrievable common bile duct stones and biliary strictures. Patients Here we report 3 new cases and review 7 other cases of de novo stent-stone complex formation after long-term biliary stent placement. Interventions De novo stent-stone complexes developed in 3 young patients after unintended long-term biliary stent placement of 4.5 to 11 years' duration. The stent-stone complexes were successfully removed during ERCP with electrohydrolic lithotripsy (EHL) in combination with choledochoscopy or extracorporeal shock wave lithotripsy (ESWL) with mechanical lithotripsy (ML). Results The de novo radiolucent stones formed around and above the stent in the proximal and end part of the stent. The stones were generally large with a diameter >2 to 3 cm. The stent-stone complex usually assumed a 1-sided dumbbell configuration inside the bile duct. The mean duration to clinical presentation after initial biliary stenting is 5.64 years (range 2-11 years). Conclusions It is important to keep in mind that a biliary stent can act as a nidus for new biliary stone formation around the stent after long-term placement. We recommend that the optimal endotherapy in this situation is ML for the free-floating complexes with short stents, and choledochoscopy with EHL or laser lithotripsy and ESWL for impacted complexes with longer stents.

BACKGROUND AND STUDY AIMS Many lesions found during push enteroscopy to evaluate obscure gastrointestinal bleeding are within the reach of standard endoscopes. The aim of this study was to determine whether the rate of proximal lesions varies in relation to the type of obscure bleeding that is present. PATIENTS AND METHODS A retrospective review of consecutive push enteroscopies carried out for obscure gastrointestinal bleeding between July 1996 and July 2000 was conducted. The patients were categorized into three groups: those with recurrent obscure/overt gastrointestinal bleeding; those with persistent obscure/overt gastrointestinal bleeding; and those with obscure/occult gastrointestinal bleeding. RESULTS A total of 63 patients (24 men, 39 women; mean age 69.8) were included. Push enteroscopy examinations were conducted for recurrent obscure/overt bleeding in 32 patients; for persistent obscure/overt bleeding in 12 patients; and for obscure/occult bleeding in 19 patients. The overall diagnostic yield of push enteroscopy was 47 % (15 of 32) in the group with recurrent obscure/overt bleeding; 66 % (eight of 12) in the group with persistent obscure/overt bleeding; and 63 % (12 of 19) in the group with obscure/occult bleeding. However, when lesions within the reach of standard esophagogastroduodenoscopy (EGD) were excluded, the yield of push enteroscopy was slightly higher in the group with recurrent obscure/overt bleeding (41 %) than in the groups with persistent obscure/overt bleeding (33 %) and obscure/occult bleeding (26 %). There were fewer lesions within the reach of EGD in the group with recurrent obscure/overt bleeding than in the groups with persistent obscure/overt bleeding (6 % vs. 33 %; P < 0.05) or obscure/occult bleeding (6 % vs. 37 %; P < 0.05). CONCLUSIONS Patients undergoing push enteroscopy for recurrent obscure/overt bleeding were significantly less likely to have lesions within the reach of EGD than patients with persistent obscure/overt bleeding or obscure/occult bleeding. Patients in the latter two groups would be able to undergo a repeat EGD examination before more intense evaluation with push enteroscopy or capsule endoscopy.

Eradication of Helicobacter pylori infection has had an impact on the treatment and recurrence rates of peptic ulcer disease and malignancies such as mucosa-associated lymphoid tissue lymphoma. Treatment options are cumbersome, expensive, and associated with side effects.Randomized, prospective, open-labeled equivalence trial with a parallel-group design to compare eradication rates of H pylori with a 1-day, 4-drug regimen with a 7-day, 3-drug regimen. A total of 160 patients with dyspepsia and a Glasgow Dyspepsia Severity Score of at least 3 had a urea breath test labeled with carbon 14. Patients who tested positive were randomized to 1 of the 2 study groups. The study was designed to test the therapeutic equivalence of 1-day and 7-day regimens based on the percentage of H pylori eradication in each group at 5 weeks.The 1-day treatment group (n = 80) had a slightly higher eradication percentage (95%) than the 7-day group (90%). The possible inferiority of the 1-day treatment relative to the 7-day treatment, a 15% difference in the number of patients whose infection was not eradicated at 5 weeks, was rejected (P.001; 90% confidence interval, 2.7%-11%). Both groups demonstrated a mean decrease of 7.5 points in the Glasgow Dyspepsia Severity Score. The 2 groups showed no significant differences in side effects. Patients whose treatment failed (4 in the 1-day treatment group and 7 in the 7-day treatment group) were re-treated for 10 days. One patient from the 7-day treatment group still tested positive after the second treatment.The 1-day treatment proved to be statistically similar to the 7-day treatment for the eradication of H pylori in patients with dyspepsia and a positive urea breath test. Further evaluation will be necessary to determine whether the 1-day regimen is adequate for patients with peptic ulcer disease, mucosa-associated lymphoid tissue lymphoma, or gastric adenocarcinoma.

Figure 2. Scatter plot of islet yield by ePFT result. Solid bar shows median and interquartile range.

measure differences in force application in humans and a colon model and gauge usability. Methods: Four endoscopists performed colonoscopy with CFM-4 in triplicate on a Kyoto-Kagaku case model with a redundant sigmoid and alpha loop configuration. In addition, two endoscopists performed 5 colonoscopies with CFM-4 were in human volunteers. Continuous force data were recorded and the following force parameters calculated: peak and average push, pull, clockwise and counter clockwise torque; average push, pull, clockwise and counter-clockwise torque rate; and exam time. Results: ANOVA of force parameters among endoscopists demonstrated a significant difference between the human and colon model. Peak clockwise (32.8 7.6 vs 8.3 12.4 N*cm, p! 0.001) and peak counter-clockwise torque (-30.1 6.1 vs -6.8 9.4 N*cm, p! 0.001) was greater in human than model colonoscopy. In addition, the average push rate (12.2 1.0 vs 8.7 1.9 N/s, p Z 0.003) and pull rate (-12.0 1.0 vs -9.1 1.9 N/s, p! 0.001) were higher for human when compared to model colonoscopy. Finally, exam time (754 359 vs 178 921s, p! 0.001) was significantly faster for model colonoscopy. There were no differences in peak or average push and pull force. All endoscopists had used both CFM-3 and CFM-4 and confirmed a marked improvement in ease of use and handling parameters. Conclusions: The CFM-4 device measured significant differences in force application patterns between a human and model colon. These differences were limited to reduced rotational force, slower force application rate and faster examination time in colon models when compared to a human colon. Further studies comparing model and human colonoscopy may facilitate development of more realistic colon training models and more precise operator technique assessment. Finally, the CFM-4 device design improved ease of use and effective force monitoring capability supporting its use in ongoing studies of force application.

Background: Colonoscopy is the preferred screening method for colorectal cancer (CRC) but may be incomplete in 4% to 25% of cases. CT colonography (CTC) is an adjunct to evaluate the colon after an incomplete colonoscopy (IC). No study has focused on same day CTC after an IC. Our primary aim was to determine the yield of same day CTC after IC. Methods: Our institution has the capability to perform same day CTC in patients with an incomplete colonoscopy. This was a retrospective review of all CTC done immediately following IC from January 2008 to December 2012. 198 CTC met inclusion criteria. Descriptive statistics were used. Results: Of 198 patients with IC and CTC 50 patients had 61 intracolonic findings. 23/50 (46%) were screening procedures, 1/50 (2%) high risk screening, 17/50 (34%) had a diagnostic colonoscopy and 9/50 (18%) surveillance colonoscopy. 10/50 patients had 12 findings on CTC on areas that were not reached by incomplete colonoscopy. 6 of these 10 patients had a follow up intervention: 2 had retrograde double balloon enteroscopy and 4 had colonoscopies. 3 findings correlated with CTC (1 ascending colon adenocarcinoma and 2 polyps) and 3 did not ( normal colonoscopy/DBE). 40 patients had 49 colonic findings on CTC on areas reached but not described during IC. 19/49 (39%) findings were not described during the initial colonoscopy. Only 6 of these 40 pts had a repeat colonoscopy. 9 findings did not correlate with subsequent complete colonoscopy. Only 1 CTC finding correlated with repeat colonoscopy. There were 30 colonic findings on CTC in areas that were reached and described during the incomplete colonoscopy. Nineteen were sigmoid diverticular strictures with no additional findings in the rest of the colon, 10 were diverticulosis of the sigmoid and 1 ascending colon adenocarcinoma with no synchronous lesions. Conclusions: Same day CTC can be of added value in patients with incomplete colonoscopy. Potential benefits include no need to repeat bowel cleansing and no extra day lost from work. Our data showed that correlation of findings by CTC in areas not visualized by incomplete colonoscopy was poor as 50% of patients had CTC abnormalities which did not correlate with a repeat colonoscopy. When CTC described an abnormality in an area already reached but not described during IC correlation was also poor as only one patient had correlation between CTC and repeat colonoscopy. When CTC reported the same findings described during IC correlation was 100%. More data on the efficacy and cost-effectiveness of same day CTC compared to repeating a colonoscopy or maybe performing a retrograde overtube assisted enteroscopy is needed to determine which effort is worthwhile.

[EN] Energy metaboclism of the Granadina kid goat and the Segureña lamb was analysed by an experiment on different feeding levels and comparative slaughter. The metabolizable energy (ME) intake, total energy retention, energy retained as protein and energy retained as fat were determined in both kinds of animal for their first 2 months of life. ME requirements for maintenance, ME efficiencies for energy retention and ME intake values at which protein retention and fat deposition begin to occur were estimated by the regression method. The estimated ME requirements for maintenance and ME efficiencies for energy retention were: 456 kJ per kg0.75 per day and 0.55 for kid goats, and 393 kJ per kg0.75 per day and 0.54 for lambs, respectively. Values of ME intake at which protein retention and fat deposition begin to occur were: 258 and 575 kJ per kg0.75 per day for kid goats, and 428 and 362 kJ per kg0.75 per day for lambs, respectively. According to the results obtained, it was deduced that kid goats compared with lambs show a higher ME requirement for maintenance together with a higher partial efficiency of ME utilization for protein retention and a lower partial efficiency of ME utilization for fat deposition., [ES] Por medio de un ensayo de alimentatioń bajo diferentes niveles de ingesta y método de los sacrificios comparados, se analizó el metabolismo energético del cabrito y cordero prerrumiante. Para estas dos clases de animales y para sus dos primeros meses de vida, se determinaron las tasas de ingesta de energía metabolizable, energía total retenida y energía retenida como proteína y grasa. A partir de estos valores y por el método de regresión, se estimaron las necesidades de energía metabolizable para mantenimiento, las eficiencias de Utilización de la energía metabolizable para la retención así como las ingestas energéticas a partir de las cuales comienza en estos animales, la retención de proteína y depósito de grasa. Los valores de necesidades de mantenimiento y eficiencias de utilización de la energía metabolizable para la retención, fueron: 465 kJ/kg0.75/día y 0.55 para el cabrito y, 393 kJ/kg0.75/día y 0.54 para el cordero, respectivamente. Los valores de ingesta energética a partir de los cuales comenzaba la retención de proteína y el depósito de grasa, se estimaron iguales a, 258 y 575 kJ/kg0.75/día para el cabrito y, 428 y 362 kJ/kg0.75día para el cordero, respectivamente. De acuerdo con los resultados obtenidos se deduce que el cabrito en comparacíon con el cordero, presenta unas necesidades energéticas para mantenimiento mayores, mostrando al mismo tiempo una mayor y menor eficiencia partial de utilización de una ingesta energética para la retencion de proteína y depósito de grasa, respectivamente., Financial support from CICYT (Project GAN-90-078 1) is acknowledge.