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| 1 | Changes in efficiency and resource utilization after increasing experience with double balloon enteroscopy显示文摘AIM:To investigate changes in efficiency and resource utilization as a single endoscopist's experience increased with each subsequent 100 double balloon enteroscopy(DBE) procedures.METHODS:We reviewed consecutive DBE procedures performed by a single endoscopist at our center over 4 years.DBE was employed when the clinician deemed the procedure was needed for disease management.The approach(oral,anal or both) was chosen based on suspected location of the target lesion.All DBE was performed in a standard endoscopy room with a portable fluoroscopy unit.Fluoroscopy was used to aid in shortening the small intestine and reducing bowel loops.For oral DBE,measurements were taken from the incisors.For anal DBE,measurements were taken from the anal verge.Enteroscopy continued until the target lesion was reached,until the entire small intestine was examined,or until no further progress was deemed possible.The length of small intestine examined(cm),procedure duration(min),and fluoroscopy time(s) were analyzed for sequential groups of 100 DBE.Sub-groups of diagnostic and therapeutic procedures were analyzed using multivariable linear regression.RESULTS:802 consecutive DBE procedures were analyzed.For oral DBE,median [interquartile range(IQR)] length of small bowel examined was 230.8 cm(range:210-248 cm) and for anal DBE was 143.5 cm(range:100-180 cm).No significant increase in length examined was noted for either the oral or anal approach with advancing position in series.In terms of duration of procedure,the median(IQR) for oral DBE was 86 min(range:71-105 min) and for anal DBE was 81.3 min(range:67-105 min).When comparing by the position in series,there was a significant(P value < 0.001) decrease in procedure duration for both upper and lower procedures with increasing experience.Median(IQR) time of exposure to fluoroscopy for oral DBE was 190 s(114-275) compared to anal DBE which was 196.4 s(312-128).This represented a significant(P value < 0.001) decrease in the amount of fluoroscopy used with increasing position in series.For both oral and anal DBE,fluoroscopy time was reduced by greater than 50% over the course of 802 total procedures performed.Sub-group analysis was conducted on therapeutic and diagnostic groups.Out of 802 procedures,a total of 434 were considered therapeutic.Argon plasma coagulation was by far the most common therapeutic intervention performed.There was no evidence of a difference in length examined or fluoroscopy exposure among oral DBE for diagnostic and therapeutic procedures,P = 0.91 and P = 0.32 respectively.The median(IQR) for length was 235 cm(range:178-280 cm) for diagnostic vs 230 cm(range:180-275 cm) for therapeutic procedures;additionally,fluoroscopy time median(IQR) was 180 s(range:110-295 s) and 162 s(range:102-263 s) for no intervention and intervention.However,there was a significant difference in procedure duration among oral DBE(P < 0.001).The median(IQR) was 80 min(range:60-97 min) and 94 min(range:77-110 min) for diagnostic and therapeutic interventions respectively.CONCLUSION:For a single endoscopist,increased DBE experience with number of performed procedures is associated with increased efficiency and decreased resource utilization. | Neal C Patel William C Palmer Kanwar R Gill David Cangemi Nancy Diehl Mark E Stark | 2013 | World Journal of Gastrointestinal Endoscopy2013，5，3： | 2 |
| 2 | Biologic properties of mesenchymal stem cells derived from bone marrow and adipose tissue显示文摘 | Izadpanah R Trygg C Patel B | 2006 | J Cell Biochem2006，99，5： | 1 |
| 3 | Sex-specific effects of gestational and lactational coexposure to lead and cadmium on hepatic phase I and phase II xenobiotic/steroid-metabolizing enzymes and antioxidant status显示文摘 | Pillai P Patel R Pandya C | | 0，，06： | 1 |
| 4 | Effect of intravenous infusion of dexmedetomidine on perioperative haemodynamie changes and postoperative recovery:a study with entropy analysis 显示文摘 | PATEL C R ENGINEER S R SHAH B J | 2012 | Indian J Anaesth2012，56，6： | 1 |
| 5 | Solid phase grafting of Various monomers on hydroperoxidized polypropylene 显示文摘 | PATEL A C BRAHMBHATT R B RAO P V C | 2000 | Eur Polym J2000，36，： | 1 |
| 6 | Effect of intravenous infusion of dexmedetomidine on perioperative? haemodynamic changes and postoperative recovery: A study with entropy analysis 显示文摘 | Patel C R Engineer S R Shah B J | 2012 | Indian J Anaesth2012，56，6： | 1 |
| 7 | Experience of using DSP controller in power converter board design显示文摘 | PATEL R C SHAH V K | 2005 | IETE Technical Review2005，22，6： | 1 |
| 8 | Endothelial dysfunction is induced by proinflammatory oxidant hypochlorous acid 显示文摘 | Zhang C Patel R Eiserich JP | 2001 | Am J Physiol2001，281，4： | 1 |
| 9 | Ventilator associated pneumonia: evolving definitions and preventive strategies 显示文摘 | Mietto C Pinciroli R Patel N | 2013 | Respir Care2013，58，6： | 1 |
| 10 | Recent advances in solid-state fermentation 显示文摘 | Singhania R R Patel A k Soccol C R Pandey A | 2009 | Biochem Eng J2009，44，： | 1 |
| 11 | Stereoseleetive reduction of fl-keto esters by Geotrichum candidum 显示文摘 | Patel R N Banerjee A Mcnamee C G | 1992 | Enzyme Microb Technol1992，14，9： | 1 |
| 12 | Risks of intravitreous injection: a comprehensive review 显示文摘 | JAGER R D AIELLO L P PATEL S C | 2004 | Retina2004，24，5： | 1 |
| 13 | Imaging of the Complications of Peripherally Inserted Central Venous Catheters显示文摘 | Amerasekera S S Jones C M Patel R | 2009 | Clin Radiol2009，64，8： | 1 |
| 14 | The effect of dexme- detomidine continuous infusion as an adjuvant to general anesthesia on sevoflurane requirements: A study based on entropy analysis 显示文摘 | Patel C R Engineer S R Shah B J | 2013 | J Anaesthesiol Clin Pharmaeol2013，29，3： | 1 |
| 15 | Internal root re so rp tio n :are v ie w 显示文摘 | Patel S R icucci D Durak C | | J E n d o d0，36，7： | 1 |
| 16 | Endothelial cell infection and thrombosis in paralysis caused by equid herpesvirus-l:equine stroke 显示文摘 | Bridges C G Patel J R | 1996 | Archives of Virology1996，90，： | 1 |
| 17 | Postreceptor signal transduction mechanisms involved in octreotide-induced inhibition of angiogenesis显示文摘 | Patel P C Barrie R Hill N | 1994 | Surgery1994，166，： | 1 |
| 18 | Recent advances in solid state ferrnentation显示文摘 | Singhania R R Patel A K Soccol C R Pandey A | | 0，，01： | 1 |
| 19 | Cervical carotid artery dissection: current review of diagnosis and treatment 显示文摘 | Patel RR Adam R Maldjian C | 2012 | Cardiol Rev2012，20，： | 1 |
| 20 | Oil formation in groundnut with reference to quality显示文摘 | PATEL J S SESHADRI C R | 1935 | India Jour Agric Sci1935，5，： | 1 |
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