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Biomedical subjects

D E Fleischer

Publications and source records attributed to D E Fleischer.

At least 19 recordsLinked to original sources
PubMed2006

The yield of capsule endoscopy in patients with abdominal pain or diarrhea.

BACKGROUND AND STUDY AIMS: Capsule endoscopy, proven effective for evaluation of obscure gastrointestinal bleeding and suspected Crohn's disease, is increasingly used to investigate other small-intestine disorders, but its yield for other indications is not well known. We sought to evaluate its yield and findings for abdominal pain or diarrhea. PATIENTS AND METHODS: Medical records of patients with abdominal pain or diarrhea (> 6 weeks' duration) who underwent capsule endoscopy between August 2001 and June 2004 were retrospectively reviewed for demographic data, indications, findings, diagnoses, complications, and radiologic studies. All patients had previous endoscopic or radiologic examinations (colonoscopy, enteroscopy, upper endoscopy, small-bowel series, computed tomography enterography, or computed tomography) demonstrating no abnormalities sufficient for diagnosis. RESULTS: 64 patients (26 men; 38 women; mean age, 43 years; age range, 19 - 83 years) who met study criteria had 68 capsule endoscopy studies. Indications were abdominal pain (35 patients), diarrhea (14), or both (15). Complete small-bowel visualization with identification of the cecum was achieved in 81 %; yield of positive findings was 9 % (6 patients). By indications, the yield was 6 % for abdominal pain, 14 % for diarrhea, and 13 % for both. Diagnoses included Crohn's disease (3), enteropathy induced by nonsteroidal anti-inflammatory drugs (2), and submucosal tumor (1). Capsule retention occurred in two patients, requiring surgical removal. CONCLUSIONS: Capsule endoscopy had a low yield for evaluation of abdominal pain or diarrhea and cannot be recommended as a first-line test without further study. Nonetheless, it facilitated diagnosis in 9 % of patients with negative endoscopic and radiologic examinations.

Abdominal Pain↗
PubMed2005

Impaction and fracture of a video capsule in the small bowel requiring laparotomy for removal of the capsule fragments.

Capsule endoscopy has become an important diagnostic tool because of its high sensitivity and specificity for evaluation of the small-bowel mucosa. It is usually a safe procedure. The main complication has been retention of the video capsule in patients with unsuspected obstructive small-bowel disease. We describe a case of a 76-year-old man who underwent capsule endoscopy for the investigation of chronic abdominal pain. The patient returned several months after the procedure with recurrence of his symptoms. Investigations at that time showed that the capsule had been retained in a section of the distal ileum which showed stricture formation and that it had broken up into fragments. This is the first reported case of a fractured video capsule.

Abdominal Pain↗
PubMed2004

Nonvariceal upper gastrointestinal bleeding.

Although the incidence of nonvariceal upper gastrointestinal bleeding (NVUGIB) may be decreasing, the case fatality associated with it remains unchanged. What do the most recent studies tell us about medical and endoscopic therapy? Erythromycin is a potentially useful adjunct to endoscopy, and further data are needed to establish its role in the management of patients with NVUGIB. The use of proton-pump inhibitors in addition to combination endoscopic therapy appears to reduce the rebleeding rate consistently across different studies; the route of administration, dosage, and duration of treatment require further definition. Although two controlled studies suggest improved outcomes with clot removal and endoscopic therapy, the exact role of endoscopic treatment in the setting of overlying clots remains controversial. Hemoclips have not been found, in general, to be superior to the available endoscopic techniques. Currently, other hemostatic techniques such as injection and thermocoagulation - and in particular, combination therapy using both methods - are preferable. No major "breakthrough" endoscopic treatment has emerged. Newer endoscopic therapies such as cryotherapy are interesting, but have not had widespread application. Endoscopic suturing techniques, as used in the treatment of esophageal reflux and obesity, have not been adapted to the management of gastrointestinal bleeding.

Clinical Trials as Topic↗
PubMed2004

Prevalence of gastric precancerous lesions in Ardabil, a high incidence province for gastric adenocarcinoma in the northwest of Iran.

BACKGROUND/AIMS: Ardabil Province, in northwestern Iran, has the highest rate of gastric (predominantly cardia) adenocarcinoma in Iran. This study aimed to investigate the feasibility of endoscopic screening and to look for associated Helicobacter pylori infection and gastric precancerous lesions. METHODS: One thousand one hundred and five adult volunteers, residents of Ardabil and Meshkinshahr, districts, 40 years old and above were selected and invited by a simple random household canvass in rural and urban locations. Informed consents were obtained and upper gastrointestinal video endoscopy was performed to biopsy all visible lesions and standard sites in the antrum, corpus, and cardia. RESULTS: One thousand and eleven of the invited individuals agreed to participate, including 494 men and 517 women, with a mean (SD) age of 53.32 (10.39) years. Endoscopy was well tolerated by all subjects; 96.7% of antral and 80.7% of cardia mucosal biopsies were satisfactory. The urease test or histology for H pylori was positive in at least 89.2% of subjects. Histological evidence of mucosal atrophy was seen in 39.3% of antral and 21.9% of cardia samples. Chronic gastritis with or without activity, reactive atypia of glandular epithelium, intestinal metaplasia, dysplasia, and cancer were found in 95.1%, 38.0%, 8.7%, 0.2%, and 0.3% of antral and 85.3%, 22.9%, 3.8%, 0.3%, and 0.1% of cardiac biopsies, respectively. CONCLUSION: Endoscopic screening for upper gastrointestinal diseases was feasible and well tolerated in Ardabil, Iran. Most subjects showed H pylori infection. Atrophic gastritis, reactive atypia, and intestinal metaplasia were common in antrum, corpus, and cardia subsites.

Adenocarcinoma↗
PubMed2002

Nonvariceal upper gastrointestinal bleeding.

Nonvariceal upper gastrointestinal bleeding (NVUGIB) remains an important cause of morbidity and mortality. The etiological role and the relative risk of nonsteroidal anti-inflammatory drugs (NSAIDs) in association with other clinical factors are the focus of several papers published in the last year. Data from studies that evaluate the interaction of NSAIDs with Helicobacter pylori suggest that there is a clear role for eradication in aspirin-related bleeding. Although the benefit of H. pylori eradication in nonaspirin NSAID-related bleeding is being debated, they should both be eliminated given their relative contribution to the causation of peptic ulcer hemorrhage. The search for reliable and accurate tools to predict outcomes after NVUGIB continues. Recent important contributions in this area of research are the use of a clinical prediction guide to identify patients who are likely to require endoscopic intervention, and the use of Doppler ultrasound examination of the ulcer base to predict rebleeding. The role of antisecretory therapy in the setting of acute NVUGIB has been revisited in two meta-analyses and one randomized, placebo-controlled trial of omeprazole as an adjunct to endoscopic intervention. Until more definitive data are available, it appears that the effect of acid-decreasing medications is more important when endoscopic therapy is not provided than when effective endoscopic intervention is instituted. With regard to therapeutic endoscopy for upper gastrointestinal bleeding, the few randomized trials that have been published in full form in the last year focus on the use of mechanical methods of hemostasis for peptic ulcer bleeding and other etiologies such as Mallory-Weiss tears and Dieulafoy lesions.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2000

Patterns of endoscopy use in the United States.

BACKGROUND & AIMS: The aim of this study was to use a large national endoscopic database to determine why routine endoscopy is performed in diverse practice settings. METHODS: A computerized endoscopic report generator was developed and disseminated to gastrointestinal (GI) specialists in diverse practice settings. After reports were generated, a data file was transmitted electronically to a central databank, where data were merged from multiple sites for analysis. RESULTS: From April 1, 1997, to October 28, 1998, 276 physicians in 31 practice sites in 21 states provided 18,444 esophagogastroduodenoscopy (EGD) reports, 20,748 colonoscopy reports, and 9767 flexible sigmoidoscopy reports to the central databank. EGD was most commonly performed to evaluate dyspepsia and/or abdominal pain (23.7%), dysphagia (20%), symptoms of gastroesophageal reflux without dysphagia (17%), and suspected upper GI bleeding (16.3%). Colonoscopy was most often performed for surveillance of prior neoplasia (24%) and evaluation of hematochezia (19%) or positive fecal occult blood test (15%). Flexible sigmoidoscopy was most commonly performed for routine screening (40%) and evaluation of hematochezia (22%). There were significant differences between academic and nonacademic sites. CONCLUSIONS: The endoscopic database can be an important resource for future research in endoscopy by documenting current practice patterns and changes in practice over time.

Colonoscopy↗
PubMed2000

Current status of endoscopic therapy for ulcer bleeding.

This article provides an overview of the therapeutic endoscopic modalities available for the treatment of peptic ulcer bleeding. The benefits of endoscopic haemostasis have been fully demonstrated by three meta-analyses, which included most of the controlled trials published until 1992. In this review, an emphasis is placed on randomized, prospective comparative trials published during the past 20 years. Using an evidence-based medicine approach, the results of meta-analyses are translated into efficacy measures known as relative and absolute risk reductions, and number needed to treat. Single-modality treatments with injection agents such as epinephrine, sclerosants and thrombogenic substances, or with thermal therapies, are efficacious and comparable. Combination therapy involving injection and thermal techniques may offer an advantage over single-method therapy. The differences in the results between clinical trials and routine clinical practice, and among the various randomized studies, are probably related to operators' experience and variations in technique rather than to inconsistency of endoscopic haemostasis.

Acute Disease↗
PubMed2000

Colonic neoplasia in patients with nonspecific GI symptoms.

BACKGROUND: The purpose of this study was to determine the prevalence rate of colonic polyps or masses 1 cm or greater in diameter in patients with nonspecific abdominal symptoms, from diverse practice settings, using a national endoscopic database. METHODS: Consecutive patients undergoing colonoscopy were included based on procedure indication. Endoscopic data were generated with a computer database at each practice site, transmitted to a central data bank and merged with data from multiple sites for analysis. Group 1 patients had nonspecific abdominal symptoms, which were defined as pain, constipation and diarrhea. Group 2 patients had a positive fecal occult blood test. Group 3 patients were asymptomatic, undergoing screening colonoscopy. Serious colon pathology was defined as a polyp or mass greater than 9 mm in size. RESULTS: Data were collected from 31 practice sites in 21 states during a period of 18 months. Of the 20,745 colonoscopy examinations, 9.2% were performed to evaluate patients with nonspecific abdominal symptoms, excluding other indications. Among patients with nonspecific symptoms 7.27% had polyp(s) 1 cm or greater in diameter compared with 17.05% of patients with positive fecal occult blood test (odds ratio 2.12: CI [1.73, 2.60]; p < 0.001). Patients with nonspecific symptoms had similar rates of large polyps as asymptomatic patients (7.27% vs. 6.45%, p = 0.32). Multivariate analysis identified several independent variables including increasing age, male gender and practice site at a Veterans Affairs Medical Center. CONCLUSIONS: In diverse, practice-based settings, patients with nonspecific abdominal symptoms who are referred for colonoscopy do not have a higher risk of serious colonic pathology than asymptomatic patients.

Abdominal Pain↗
PubMed1999

Prospective analysis of complications 30 days after outpatient colonoscopy.

BACKGROUND: Our objective was to (1) determine whether more complications are reported by patients 30 days after outpatient colonoscopy than are discussed at our monthly morbidity and mortality conferences, (2) identify complications resulting in visits to the emergency department or physician's office or leading to hospitalization, and (3) assess which factors put patients at highest risk. A secondary goal was to determine the rate of work lost after outpatient colonoscopy. METHODS: Trained interviewers performed standardized telephone interviews of consecutive outpatients undergoing colonoscopy at Georgetown University Hospital over a 1-year period. RESULTS: One thousand one hundred ninety-six patients were contacted 30 days after outpatient colonoscopy and participated in our study. Twenty patients had complications that required a visit to an emergency department or physician. Ninety percent of these cases (18) were detected at 30 days, but 15% (3) were discussed at morbidity and mortality conferences. All seven complications that necessitated hospitalization were identified at 30 days, but only two were discussed at our morbidity and mortality conference. The most common complications reported by patients were abdominal discomfort (5.4%) and rectal bleeding (2.1%). CONCLUSION: More complications are detected by means of contacting patients 30 days after outpatient colonoscopy than are discussed at our morbidity and mortality conferences.

Abdominal Pain↗
PubMed1999

Ulcers and nonvariceal bleeding.

This review of nonvariceal upper gastrointestinal bleeding concentrates mainly on peptic ulcer bleeding, and is based on papers published during the last two years. While the focus is on outcome prediction models and therapeutic interventions, brief reference is also made to certain epidemiological aspects, pathological and animal studies, and risk factors for bleeding peptic ulcer.

Duodenal Ulcer↗
PubMed1999

Prospective analysis of complications 30 days after outpatient upper endoscopy.

OBJECTIVE: The aim of this study was to compare complication rates reported by patients 30 days after outpatient upper endoscopy with those discussed at our monthly morbidity and mortality conference. We also intended to establish which complications were reported most frequently 30 days after upper endoscopy, and which patients or procedures involved the highest risk. METHODS: Trained interviewers performed standardized telephone interviews on consecutive outpatients undergoing upper endoscopy over a 1-yr period. Patients were queried regarding potential events related to their upper endoscopy in the 30 days subsequent, including symptoms, emergency room (ER) and/or physician visits, and hospitalizations. The indications, findings, and therapies were reviewed from endoscopic reports. RESULTS: A total of 473 patients were contacted 30 days after outpatient upper endoscopy and agreed to participate in our study. The most common complications reported by patients at 30 days were sore throat (9.5%) and abdominal discomfort (5.3%). Twelve patients (2.5%) required an ER/physician visit and five patients (1.1%) required hospitalization. The minority of both ER/physician visits (16.7%) and hospitalizations (40%) were discussed at our monthly morbidity and mortality conferences. CONCLUSIONS: More complications were reported by patients 30 days after outpatient upper endoscopy than were discussed at our monthly morbidity and mortality conferences. The most frequent complications reported by patients were sore throat and abdominal pain. The minority of ER/physician visits and hospitalizations were discussed at our morbidity and mortality conferences.

Abdominal Pain↗
PubMed1999

The esophacoil stent for malignant esophageal obstruction.

Esophageal cancer is the seventh most common cause of cancer-related deaths in men in the United States. For a disease in which 60% of patients are incurable at presentation, palliative therapy is the main treatment option. Palliative measures include surgery, radiation therapy, chemotherapy, photodynamic therapy, endoscopic dilation, endoscopic ablation, and the use of endoscopic prostheses. This article reviews the characteristics, technique, efficacy, and complications of the Esophacoil stent for malignant esophageal strictures.

Biocompatible Materials↗
PubMed1998

Mucosal iodine staining improves endoscopic visualization of squamous dysplasia and squamous cell carcinoma of the esophagus in Linxian, China.

BACKGROUND: In previous studies in the high risk population of Linxian, China, the majority of foci of high grade (moderate and severe) squamous dysplasia (HGD) and invasive squamous carcinoma (CA) of the esophagus were associated with endoscopically visible lesions that could be targeted for biopsy, but some foci of HGD were missed by routine endoscopic examination. This study examined whether spraying the mucosa with Lugol's iodine solution, which stains normal epithelium brown but leaves dysplasia and carcinoma unstained, could improve endoscopic detection and delineation of these lesions. METHODS: Two hundred twenty-five Linxian adults with balloon cytologic evidence of dysplasia or carcinoma underwent endoscopy. All visible lesions were described and photographed before and after staining with 1.2% Lugol's iodine solution. Biopsies were taken from all lesions visible before staining, from all unstained lesions (USLs) after applying the stain, and from representative control areas of stained mucosa. RESULTS: Two hundred fifty-three USLs and 255 control sites were biopsied. No complications occurred. Ninety-four biopsy sites contained HGD and 20 contained CA. Before staining, the sensitivity of visible lesions for identifying HGD or CA was 62%, and the specificity was 79%. After staining, the sensitivity of USLs for identifying HGD or CA was 96%, and the specificity was 63%. Eighty-eight percent of the HGD and CA lesions were larger or more clearly defined after staining. The diagnostic lesions in 17 of 31 patients with moderate dysplasia (55%), 8 of 35 patients with severe dysplasia (23%), and none of the 19 patients with invasive carcinoma (0%) were identified only after staining. CONCLUSIONS: Mucosal iodine staining improved endoscopic detection and delineation of HGD and CA in these patients. This simple technique is highly sensitive for identifying these precursor and invasive squamous lesions, and it should be used whenever optimal visualization of squamous mucosal abnormalities is required.

Adult↗