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C J Gostout

Publications and source records attributed to C J Gostout.

At least 19 recordsLinked to original sources
PubMed1996

Endoscopic decompression for acute colonic pseudo-obstruction.

BACKGROUND: Acute colonic pseudo-obstruction is often treated by colonoscopic decompression. Efficacy, safety, and outcome of endoscopic decompression was assessed. METHODS: Colonoscopic decompressions from 1988 to 1994 were reviewed. Resolution without further endoscopic intervention was defined as clinical success. RESULTS: Acute colonic pseudo-obstruction was diagnosed in 50 patients. Thirty-three cases followed surgery or trauma and 17 developed during severe medical illness. Orthopedic joint surgery was most common. Nineteen of 50 patients (38%) had severe underlying medical disease. Forty-one patients (82%) had one colonoscopic decompression with clinical success in 39 (95%). Nine patients (18%) required multiple (2 to 4) colonoscopic decompressions with clinical success in 5 (56%). A decompression tube positioned in the right colon (57%) and in the transverse colon (33%) had similar clinical success. In 8 procedures a decompression tube was not placed, with poor clinical success (25%). The overall clinical success of colonoscopic decompression was 88% (44 of 50). An endoscopic perforation occurred in 1 patient (2%). Overall hospital mortality was 30%. CONCLUSIONS: Colonoscopic decompression is effective and safe for acute colonic pseudo-obstruction that does not respond to conservative therapy. Most patients will respond to one colonoscopic decompression with decompression tube placement. Complete colonoscopy and cecal tube placement is unnecessary.

Acute Disease↗
PubMed1996

Development of hyperplastic polyps following laser therapy for watermelon stomach.

BACKGROUND: Our goal was to evaluate the long-term sequelae of repeated thermal injury to the gastric mucosa of patients undergoing laser therapy for watermelon stomach. METHODS: A retrospective review of all patients who underwent endoscopic laser therapy for watermelon stomach from 1987 to 1994 was performed to identify patients with antral polyps following laser photoablation therapy. Statistical analysis was performed using the paired t test. RESULTS: Antral hyperplastic polyps as large as 4 cm developed in 4 of 60 patients (7%) and were associated with recurrent anemia in 3. All patients had received significantly more laser thermal energy during the course of therapy for their watermelon stomach. Conventional polypectomy was used to remove the polyps. CONCLUSIONS: Repeated thermal injury to the antral mucosa in patients with the watermelon stomach may result in the development of hyperplastic polyps. These may be large, may contribute to significant blood loss with anemia, and are amenable to conventional polypectomy.

Adult↗
PubMed1996

Endoscopic treatment of ampullary adenomas in familial adenomatous polyposis.

Duodenal adenomas, usually considered premalignant, are found in < or = 100% of patients with familial adenomatous polyposis (FAP). Endoscopic screening is accepted, but the optimal treatment is unclear. Our objective was to assess endoscopic treatment of the upper gastrointestinal tract in patients with FAP. We reviewed the clinical records of 393 FAP patients in detail. Six patients had ampullary cancers. Sixty-nine had periampullary adenomas, none of whom developed malignancy during follow-up. Several endoscopic approaches were used, leading to various outcomes. (a) Follow-up with ampullary biopsy was the only method in 18 patients, with macroscopic improvement in one, unchanged condition in 11, and enlargement of adenomas in six. (b) Thermal ablation was used in 19 patients, with resolution in 10, improvement in seven unchanged condition in one, and one recurrence. (c) Yearly push enteroscopy, duodenoscopy, and ampullary biopsies were conducted in 11 of the 19 patients treated first with thermal ablation. Positive biopsies resulted in endoscopic retrograde cholangiopancreatography (ERCP), prophylactic sphincterotomy, and ablation with reexamination every 2-6 months. Follow-up of the patients treated with this last and favored strategy showed that five experienced resolution of symptoms, five had macroscopic improvement, and one had macroscopic as well as histologic progression. We conclude that patients with FAP should have periampullary surveillance, including duodenoscopy and biopsies from the time of diagnosis. Periampullary adenomas can be eradicated endoscopically. It is not clear whether ablation of adenomas or periodic biopsy is the ideal treatment.

Adenoma↗
PubMed1996

The risk of withdrawing chronic anticoagulation because of acute GI bleeding.

OBJECTIVE: We sought evidence for thromboembolic sequelae after the transient withdrawal of chronic anti-coagulation because of acute GI bleeding. METHODS: Our Gastrointestinal Bleeding Team endoscopic database was reviewed over a 5-yr period to identify patients who underwent a transient withdrawal from chronic anticoagulation as a result of acute GI bleeding. Long term follow-up records were available for all study patients and were carefully scrutinized for any symptomatic thromboembolic events. RESULTS: Twenty-seven patients were included in the study, of which 17 (63%) were on chronic anticoagulation for prosthetic heart valves. Chronic anticoagulation was withheld for a median period of 3 days (range = 2-7 days) for patients with prosthetic heart valves and 7 days (range = 2-15 days) for patients on chronic anticoagulation for other indications. Over a median follow-up period of 8 months (range = 1-54 months), one patient developed documented lower extremity thromboembolism. CONCLUSIONS: We conclude that symptomatic thromboembolism can occur after the transient withdrawal of chronic anticoagulation for acute GI bleeding but that it does not occur frequently.

Acute Disease↗
PubMed1996

Sonde enteroscopy. Technique, depth of insertion, and yield of lesions.

Sonde enteroscopy provides the only opportunity to directly view the contents and mucosa of potentially the entire small intestine. Although the instrumentation and technique are less than ideal, sonde enteroscopy can be a useful adjunct to the evaluation of small intestinal disease. A comprehensive review of this labor-intensive procedure from patient selection to its outcome is provided in this article.

Diagnosis, Differential↗
PubMed1995

Infrared video imaging of subsurface vessels: a feasibility study for the endoscopic management of gastrointestinal bleeding.

The feasibility of infrared video imaging of subsurface vessels in the stomach was investigated both experimentally and in more detail using computer simulations of light propagation. Infrared video imaging was first attempted in several experimental situations. Images of a human arm illuminated with infrared light (wavelength > 700 nm) revealed subcutaneous venous structures not revealed by visible light (wavelength of 500 to 600 nm). An infrared-sensitive video endoscope was used to view both a human arm and normal stomach wall. Infrared illumination within the stomach enhanced only the larger subsurface vessels. Infrared transillumination of a rat skin flap window chamber allowed video recording of images during injection of an absorbing dye, indocyanine green, into the blood volume and showed that indocyanine green can enhance the contrast in infrared images of small vessels. Computer simulations of vessels of varying depths and sizes indicated successful detection was possible by infrared imaging. Computer simulations demonstrated that the shadow caused by an imaged subsurface vessel has two characteristics: (1) the central loss of reflectance, which indicates the size of the vessel, and (2) the full-width half-maximum of the reflectance loss, which indicates the depth of the vessel. The simulations further suggested that images of small vessels can be dramatically enhanced (68-fold) by indocyanine green, which attenuates the transmittance of scattered light from behind the vessels to the surface for observation. On the other hand, indocyanine green enhances the contrast of large vessels to a lesser degree (2.6-fold). The ultimate goal is to develop an endoscopic video imaging system capable of capturing reflected light from the stomach wall.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

Bleeding from the endoscopically-identified Dieulafoy lesion of the proximal small intestine and colon.

OBJECTIVES: Our goal was to assess the incidence of the endoscopically-identified small intestinal and colonic Dieulafoy-like lesions in our GI bleeding population and to characterize the clinical and endoscopic features and response to endoscopic therapy. METHODS: Patients with GI bleeding from Dieulafoy lesions were identified from our Bleeding Team and GI laser data bases from August 1984 to September 1993. Clinical and endoscopic information contained within the data bases and from each patient's medical record were retrospectively reviewed. Diagnostic criteria that had been used to endoscopically diagnose a Dieulafoy lesion were arterial bleeding or nonbleeding visible vessel stigmata, all without ulceration or erosion. RESULTS: Nine patients (three male; six female; median age, 70 yr; range, 16-94) were identified from a population of 3059 patients. Symptoms included: melena (2); hematochezia (7); and unstable hemodynamics (3). The mean hemoglobin was 8.4 +/- 2.2 g/dl. There was no significant nonsteroidal antiinflammatory drug or alcohol use. Four patients had small bowel and five patients had colonic Dieulafoy's lesions. Specific sites were: distal duodenum (3); jejunum (1); cecum (1); hepatic flexure (3); and transverse colon (1). The diagnosis was made at initial endoscopy in seven patients, after two endoscopies in one patient, and after four in another patient. Active bleeding was encountered in seven patients (three small bowel; four colon). Endoscopic therapy was successful. Two patients rebled, one from the same site (small bowel) 1 yr later. Both were successfully retreated. There were no complications or deaths. CONCLUSIONS: The endoscopic Dieulafoy lesion of the small bowel and colon is infrequently encountered. The diagnosis is most often made during active bleeding. The endoscopic diagnosis requires an aggressive approach, including repeated endoscopy. Endoscopic therapy of proximal small intestinal and colonic Dieulafoy lesions is safe, effective, and should be performed.

Adolescent↗
PubMed1995

The black esophagus.

A dark-pigmented (black) esophagus is a rare observation during the course of upper endoscopy. The differential diagnosis of a black esophagus includes acute necrotizing esophagitis, exogenous dye ingestion, lye ingestion, malignant melanoma, melanosis, and pseudomelanosis esophagi. Many of these conditions are suggested by the history and associated endoscopic findings. In most patients, a biopsy is needed to establish a definitive diagnosis and explanation for the black-appearing esophagus. We describe a patient with a black esophagus encountered during routine endoscopy. The clinical, endoscopic, and histopathological features of this unusual finding are presented, along with a review of the literature.

Aged↗