Original Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Apr 7, 2013; 19(13): 2037-2043
Published online Apr 7, 2013. doi: 10.3748/wjg.v19.i13.2037
Efficacy of cap-assisted endoscopy for routine examining the ampulla of Vater
Young Rak Choi, Joung-Ho Han, Young Shim Cho, Hye-Suk Han, Hee Bok Chae, Seon Mee Park, Sei Jin Youn
Young Rak Choi, Joung-Ho Han, Young Shim Cho, Hye-Suk Han, Hee Bok Chae, Seon Mee Park, Sei Jin Youn, Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju 361-711, South Korea
Author contributions: Choi YR and Han JH designed, conceptualized the study and performed the procedures; Youn SJ, Park SM provided clinical advice, assessed the results from the picture archiving, communication system images and video recordings; Han HS, Cho YS, Chae HB were involved in final editing and writing of the manuscript.
Supported by Grant of the Korea Healthcare Technology R and D Project, Ministry of Health and Welfare, South Korea, No. A100054
Correspondence to: Joung-Ho Han, MD, Department of Internal Medicine, College of Medicine, Chungbuk National University, 410 SungBong-Ro Heungdeok-Gu, Cheongju-Si ChungBuk, Cheongju 361-711, South Korea. joungho@cbnu.ac.kr
Telephone: +82-43-2696802 Fax: +82-43-2733252
Received: September 28, 2012
Revised: October 30, 2012
Accepted: November 6, 2012
Published online: April 7, 2013
Abstract

AIM: To determine the efficacy of a cap-assisted endoscopy (CAE) to completely visualize the ampulla of Vater (AV) in patients failed by conventional endoscopy.

METHODS: A prospective study was conducted on 120 patients > 20 years of ages who visited the Health Promotion Center of Chungbuk National University Hospital for conscious sedation esophagogastroduodenoscopy (EGD) as a screening test from July to October, 2011. First, forward-viewing endoscopy was performed with reasonable effort using a push and pull method. We considered complete visualization of the AV when we could observe the entire AV including the orifice clearly, and reported the observation as complete or incomplete (partial or not found at all). Second, in cases of complete failure of the observation, an additional AV examination was conducted by attaching a short cap (D-201-10704, Olympus Medical Systems, Tokyo, Japan) to the tip of a forward-viewing endoscope. Third, if the second method failed, we replaced the short cap with a long cap (MH-593, Olympus Medical Systems) and performed a re-examination of the AV.

RESULTS: Conventional endoscopy achieved complete visualization of the AV in 97 of the 120 patients (80.8%) but was not achieved in 23 patients (19.2%). Age (mean ± SD) and gender [male (%)] were not significantly different between the complete observation and the incomplete observation groups. Additional short CAE was performed in patients in whom we could not completely visualize the AV. This group included 13 patients (10.9%) with partial observation of the AV and 10 (8.3%) in which the AV was not found. Short CAE permitted a complete observation of the AV in 21 of the 23 patients (91.3%). Patients in whom visualization of the AV failed with short CAE had satisfactory outcomes by replacing the short cap with a long cap. The additional time for CAE took an average of 141 ± 88 s. There were no complications and no significant mucosal trauma.

CONCLUSION: CAE is safe to use as a salvage method to achieve complete visualization of the AV when a regular EGD examination fails.

Keywords: Ampulla of Vater, Conventional endoscopy, Cap-assisted endoscopy, Screening test, Complete observation