Search PubMed⌕ Search

Biomedical subjects

Gerard A Isenberg

Publications and source records attributed to Gerard A Isenberg.

11 recordsLinked to original sources
PubMed2003

Virtual colonoscopy.

Explore the source record for details and available documents.

Colonography, Computed Tomographic↗
PubMed2003

Prospective evaluation of 4-mm diameter endoscopes for esophagoscopy in sedated and unsedated patients.

BACKGROUND: Unsedated esophagoscopy with small-diameter endoscopes is generally well tolerated but of limited sensitivity for the diagnosis of esophageal mucosal disease. This study evaluated the sensitivity of esophagoscopy performed with new 4-mm diameter prototype battery-powered and video endoscopes. Patient tolerance for an unsedated examination with the 4-mm endoscopes was assessed and the performance characteristics of the battery-powered and video 4-mm endoscopes were compared. METHODS: Patients referred for EGD were recruited to undergo an additional examination with a 4-mm endoscope. A prototype 60-cm long, 4-mm diameter battery-powered fiberoptic esophagoscope was used in the first 24 patients and a prototype 60-cm long, 4-mm diameter video esophagoscope in the next 27 patients. Examiners who were unaware of patient history and procedure indications recorded esophageal findings, ease of intubation, optical quality (5-point visual scale), and time for examination of the esophagus and then recorded esophageal findings after the standard EGD. RESULTS: The sensitivity, specificity, and accuracy for identification of Barrett's esophagus was 100%; overall sensitivity, accuracy, and specificity for detecting esophageal lesions were, respectively, 91%, 98%, and 99%. Patient tolerance (assessed by symptom scores for choking, pain, and discomfort) and acceptability of unsedated esophagoscopy with the 4-mm diameter instruments were significantly better than in a historical group of patients examined with a 3-mm diameter endoscope. The optical quality of video endoscope was rated as superior to that of battery-powered endoscope, and esophageal examination was performed significantly quicker with the video versus the battery-powered endoscope (68 vs. 137 seconds; p = 0.001). CONCLUSIONS: Unsedated esophagoscopy with 4-mm diameter endoscopes may be an alternative to EGD for screening for Barrett's esophagus. Given the current state of endoscopic technology, a minimum diameter of 4 mm is required for satisfactory esophageal imaging.

Barrett Esophagus↗
PubMed2003

Clinical utility of intraductal US for evaluation of choledocholithiasis.

BACKGROUND: Intraductal US can improve the diagnostic accuracy of cholangiography performed under C-arm fluoroscopy in patients with suspected choledocholithiasis. This study aimed to determine the clinical utility of intraductal US for patient management. METHODS: Patients with suspected choledocholithiasis undergoing ERCP with a C-arm fluoroscope at two tertiary academic medical centers were enrolled. After initial cholangiography, findings and decisions concerning the need for further interventions were recorded. Intraductal US (20 MHz) was then selectively performed in patients with equivocal cholangiography or those without cholangiographic evidence of bile duct stones. Intraductal US was also performed after endoscopic sphincterotomy and stone extraction to confirm bile duct clearance. RESULTS: Fifty-two patients (28 men, 24 women) were enrolled and intraductal US was selectively performed in 35 (64%). Of the 21 patients with normal cholangiography, 8 (38%) had stones or sludge by intraductal US. Endoscopic sphincterotomy was performed as a direct result of intraductal US in these 8 and the findings were confirmed in 7. In the 14 patients in whom cholangiography demonstrated small (<5 mm) or round filling defects, intraductal US concurred in 9 and found air bubble/no stone in 5. Sphincterotomy was avoided in these 5 patients. Overall, intraductal US led to a change in clinical management in 13 of 35 patients (37%) in whom it was performed. CONCLUSIONS: Selective use of intraductal US affects the clinical management of a large proportion of patients who undergo C-arm fluoroscopy-guided ERCP for suspected bile duct stones.

Adult↗
PubMed2003

Criteria for the diagnosis of dysplasia by endoscopic optical coherence tomography.

BACKGROUND: Endoscopic optical coherence tomography provides images of the GI mucosa and submucosa in microscopic detail. It is unknown whether endoscopic optical coherence tomography can reliably detect dysplasia. Colon polyps were used as a model to determine whether dysplasia in GI tissue has characteristic optical coherence tomography imaging features. METHODS: Endoscopic optical coherence tomography images of colon polyps and normal colon tissue were obtained at colonoscopy. In real time, endoscopists compared tissue organization and light scattering for polyps and normal mucosa with endoscopic optical coherence tomography. Imaged polyps were removed and evaluated histopathologically. Organization and light scattering, as assessed by endoscopic optical coherence tomography at colonoscopy, were compared for adenomas versus hyperplastic polyps. A computer program also quantified and compared the degree of light scattering for hyperplastic polyps and adenomas. RESULTS: A total of 44 polyps were imaged in 24 patients (30 adenomas, 14 hyperplastic polyps). Endoscopic optical coherence tomography images of adenomas had significantly less structure (p = 0.0005) and scattered light to a lesser degree than hyperplastic polyps (p = 0.0007). Hyperplastic polyps were significantly closer in organization (p = 0.0003) and light scattering (p = 0.0006) to normal mucosa as compared with adenomas. By digital image analysis, the light-scattering property of hyperplastic polyps was closer to normal mucosa compared with adenomas (14.86 vs. 45.81; p = 0.0001). CONCLUSIONS: Real-time endoscopic optical coherence tomography imaging differentiated adenomas, hyperplastic polyps, and normal colon tissue. By using the colon adenoma as a model, the endoscopic optical coherence tomography characteristics of dysplasia are loss of tissue organization and reduced light scattering.

Adenoma↗
PubMed2002

Endoscopic retrograde cholangiopancreatography in children and adolescents.

OBJECTIVES: Endoscopic retrograde cholangiopancreatography (ERCP) is becoming a more frequently used diagnostic and therapeutic tool in children. We sought to determine the indications, feasibility, safety, and effect on patient management of ERCP in pediatric patients of varying age. METHODS: All ERCPs performed during a 4-year period in patients aged 18 years or less at an academic hospital were retrospectively reviewed. The indications, type of anesthesia administered, type of duodenoscope used, diagnostic findings, therapeutic interventions, complication rate, and effect on management were compared between children (age 0-12 years) and adolescents (age 13-18 years). RESULTS: A total of 53 procedures were performed in 43 patients whose median age was 13.5 years. ERCP was successful in 50 of 53 cases (94%) with a complication rate of 6%. Endoscopic therapy was provided in 24 of 53 cases (45%). Compared with adolescents (n = 28), children (n = 25) were more likely to receive general anesthesia (96% vs. 29%; P < 0.001) and undergo ERCP with a pediatric duodenoscope (0% vs. 40%). ERCP affected management in 73% of cases, equally in both groups. CONCLUSION: ERCP is a successful and safe diagnostic and therapeutic modality in a variety of pancreatobiliary disorders that directly affects management in children of all ages.

Adolescent↗