BACKGROUND:Prokinetics are a class of pharmacological drugs designed to improve gastrointestinal (GI) motility, either regionally or across the whole gut. Each drug has its merits and drawbacks, and based on current evidence as high-quality studies are limited, we have no clear recommendation on one class or other. However, there remains a large unmet need for both regionally selective and/or globally acting prokinetic drugs that work primarily intraluminally and are safe and without systemic side effects.PURPOSE:Here, we describe the strengths and weaknesses of six classes of prokinetic drugs, including their pharmacokinetic properties, efficacy, safety and tolerability and potential indications.

Background: Currently small bowel enteroscopy (SBE) is limited by loss of vector forces and curling of scope within the stomach. Attempts to overcome these limitations have led to widespread application of capsule endoscopy (CE), development of double-balloon enteroscopy (DBE), and use of conventional overtubes. CE is limited by inability to undertake endotherapy. DBE requires a significant capital expenditure. Conventional overtubes prove difficult to get through the pylorus and have been associated with inadvertent strip mucosectomy and even procedural pancreatitis from damage to the papilla.

Purpose: A small proportion of Colonscopy procedures are unsuccessful due to failure to reach the cecum. This unique new shape lock device was evaluated as to its ability to facilitate passage of the colonoscope to the cecum. Methods: 16 Pts undergoing colonoscopy were enrolled. 63%were male and 27%had a previous colonoscopy in which cecal intubation failed. The Shape Lock overtube was preloaded over the colonoscope and intubation was carried out in the usual fashion. After advancing the colonoscope to 100 cm or the splenic flexure, the scope position was reduced as much as possible to remove any sigmoid loops and then the 70 cm long Shape Lock device was advanced over the scope. This device has a unique design which converts the device from a flexible shape to a fixed shape. Once the scope is shortened as much as possible the Shape Lock device is fixed in a rigid configuration to allow advancement of the scope without reforming a sigmoid loop. Fluoroscopy was used to visualize the manouvres employed and to track the position of this new device Results: Three different colonoscopy techniques were observed. 1) The Shape Lock fixed the sigmoid in place to enable advancement of the scope tip forward after standard shortening manouvres. 2) The Shape Lock device in its flexible state was shortened along with the scope and then advanced forward before locking into the rigid configuration. 3) The scope was shortened and simultaneously the Shape Lock was advanced in a coordinated fashion. Cecal intubation was achieved in all patients without any mucosal trauma or other adverse effect associated with the use of the device. Conclusions: The new and unique Shape Lock technology is much simpler than a conventional overtube with the ability to be advanced, held in position, or withdrawn in a flexible or rigid configuration. This feature allowed for cecal intubation in previously failed colonoscopies.

Summary form only given. Standard clinical diagnosis of oral cancer rely almost exclusively on the visual examination of tissue followed by pathological determinations of tissue biopsies collected from suspected lesions in the oral cavity and upper digestive-tract. The search for more accurate and less invasive method for rapid screening of epithelial tissue and early detection of malignant tissue transformation has significant appeal. Ideally, a method that maintains the existing visualization approach but utilizing a more sensitive imaging capability, while simultaneously adding a quantitative aspect for non-invasive assessment of tissue, could prove to be an extremely powerful technique for early detection of epithelial neoplasia. We investigated the potential for combination of fluorescence spectroscopy and optical coherence tomography (OCT) imaging as a means to detect neoplastic changes in oral cavity tissues. Our goal was to demonstrate that the combined imaging modalities would improve our ability to detect early-stage neoplastic lesions that are not identifiable grossly non-invasively

Chronic intestinal pseudo-obstruction (CIPO) is a rare gastro-intestinal motor disorder that causes a lot of suffering in those affected.Most patients are in need of continuous treatment with analgesics, often opiates, and nutritional support.However, little is known about perceived quality of life in patients with CIPO.We have therefore assessed self-reported symptoms, functional status, and health-related quality of life (HRQL) in 40 patients with CIPO and compared this to corresponding data from healthy controls and patients with other gastrointestinal diseases.-s-Methods: We used four validated questionnaires: the Gastrointestinal Symptom Rating Scale (GSRS), the Sickness Impact Profile (SIP), the Swedish Health-Related Quality of Life Questionnaire (SWED-QUAL) and the Psychological General Well-being Index (PGWB).The diagnosis of pseudo-obstruction was based on the presence of a typical history, abnormal small bowel manometry.and abnormal full thickness biopsy of the bowel or radiological dilatation of the bowel.All adult patients (18 years or older) with CIPO in the Stockholm area were asked to participate in the study.--,)Results: The average score on PGWB was 85 in patients with CIPO.The corresponding values for controls was 103.Patients with CWO had significantly higher scores on GSRS but similar scores on PGWB compared to patients with other gastrointestinal diseases.We found significant correlations between