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L Aabakken

Publications and source records attributed to L Aabakken.

At least 37 records · Page 2Linked to original sources
PubMed1999

Standardized terminology in endoscopic ultrasound.

Standardized terminology is a prerequisite for meaningful collaboration and communication. This issue has been addressed for regular gastrointestinal endoscopy, through the OMED terminology and minimal standard terminology (MST) for endoscopic reporting. However, no similar initiative was taken for endoscopic ultrasound, although the need for a specific reporting language may be even greater for ultrasound investigations. This report describes the process and results of 'The International Working Group for Minimal Standard Terminology in Gastrointestinal Endosonography'. The resulting 'Minimal standard terminology in gastrointestinal endosonography' is presently available in a 1.0 version, and will now be subjected to clinical testing to further improve the selection and definition of core terms. It is reasonable to expect a fusion of this Endoscopic ultrasound (EUS) terminology with the general endoscopy MST terminology in the near future, to supply software developers with a joint standardized terminology.

Endosonography↗
PubMed1999

Cost-efficacy of endoscopic ultrasonography with fine-needle aspiration vs. mediastinotomy in patients with lung cancer and suspected mediastinal adenopathy.

BACKGROUND AND STUDY AIMS: The use of endoscopic ultrasonography (EUS) guidance for fine-needle aspiration (FNA) of mediastinal lymph nodes has become an important aid in the staging of bronchogenic carcinoma. In many cases, it may be an alternative to mediastinoscopy/mediastinotomy (MED), but the cost-effectiveness of the two techniques has not been compared. The aim of this study was to apply a decision-analysis model to compare the cost-effectiveness of EUS and MED in the preoperative staging of patients with non-small-cell lung cancer. PATIENTS AND METHODS: A decision-analysis model was designed, taking as entry criteria lung cancer and abnormal mediastinal lymph nodes verified by computerized tomography (CT). Performance characteristics of MED and EUS were retrieved from the published literature, as were life expectancy data. Direct actual costs of the relevant procedures were retrieved from the billing system of our hospital. RESULTS: The cost per year of expected survival is US$ 1.729 with the EUS strategy, and US$ 2.411 with the MED strategy. The advantage conferred by EUS remains even when the negative predictive value of EUS is as low as 0.22. CONCLUSION: Because of its low cost and high yield, EUS-guided FNA is a cost-effective aid assessing mediastinal lymphadenopathy.

Biopsy, Needle↗
PubMed1999

Small-bowel side-effects of non-steroidal anti-inflammatory drugs.

The hitherto small number of reports of toxic effects of non-steroidal anti-inflammatory drugs (NSAIDs) to the small bowel may reflect primarily a lack of diagnostic tools. In fact, a host of small bowel manifestations have now been documented, ranging from strictures causing dramatic small-bowel obstruction and severe bleeding to low-grade NSAID 'enteropathy', a syndrome comprising increased intestinal permeability, low-grade inflammation with blood and protein loss. The enteropathy, although not dramatic, may add to existing complications, for example in rheumatic patients, and contribute to iron-deficiency anaemia or hypoalbuminaemia. Enteroscopy can be used to detect erosive or haemorrhagic lesions in a small number of patients, but, in general, functional methods are applied to detect the NSAID enteropathy. Permeability markers and white and red blood cell labelling have been successfully applied, and recently, calprotectin faecal shedding has been shown to detect early inflammatory changes in the gut. We still have insufficient knowledge about the pathogenic mechanism, but prostaglandin synthesis inhibition may be less vital than in the gastroduodenal mucosa, and local luminal aggressors may play a role. Apart from stopping or reducing the dose of the NSAID, we so far have few therapeutic alternatives for NSAID enteropathy. However, the ongoing research has brought us important new insight, and helped bring this prevalent problem in focus.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1999

Endoscopic ultrasound guided fine needle aspiration biopsy: a large single centre experience.

BACKGROUND: Endoscopic ultrasound guided fine needle aspiration biopsy (EUS-FNA) is a recent innovation in the evaluation of gastrointestinal and pulmonary malignancies. AIMS: To review the experience with EUS-FNA of a large single centre. METHODS: 333 consecutive patients underwent EUS-FNA. Follow up data were available on 327 lesions in 317 patients, including 160 lymph nodes, 144 pancreatic lesions, 15 extraintestinal masses, and eight intramural tumours. RESULTS: A primary diagnosis of malignancy was obtained by EUS-FNA in 62% of patients with clinically suspicious lesions. The overall accuracy of EUS-FNA for the diagnosis of malignancy was 86%, with sensitivity of 84% and specificity of 96%. With respect to lesion types, the sensitivity, specificity, and accuracy were 85%, 100%, and 89% for lymph nodes; 82%, 100%, and 85% for pancreatic lesions; 88%, 100%, and 90% for perirectal masses; and 50%, 25%, and 38% for intramural lesions, respectively. Compared with size and sonographic criteria, EUS-FNA in the evaluation of lymph nodes provided superior accuracy and specificity, without compromising sensitivity. Inadequate specimens were obtained from only six patients, including 3/5 with stromal tumors. Only one complication occurred. CONCLUSIONS: EUS-FNA is safe and can readily obtain tissue specimens adequate for cytopathological diagnoses. Compared with size and sonographic criteria, it is a superior modality for the detection of nodal metastases. While providing accurate diagnosis of pancreatic and perirectal malignancies, results suggest the technique is less useful for intramural lesions.

Adolescent↗
PubMed1999

Clinical symptoms, endoscopic findings and histologic features of gastroduodenal non-steroidal anti-inflammatory drugs lesions.

Gastrointestinal side effects of non-steroidal anti-inflammatory drugs are among the most prevalent iatrogenic gastrointestinal problems, due to the prevalence of problems, but even more because of the large and increasing population that is exposed. Dyspeptic complaints are prevalent, and cause discontinuation of the drug in 10% of patients. These symptoms fail, however, to correlate with endoscopic findings, and cannot be used to monitor patients for serious adverse events. The interventional measures include dose reduction, administration with food, concomitant use of antiacids or antisecretory drugs. Sometimes, changing the drug can help. Non-steroidal anti-inflammatory gastropathy comprises petechiae, haemorrhagic erosions and mucosal erythema. Such lesions are prevalent even in short term studies, but the clinical significance is uncertain, since an extrapolation to serious adverse events has not been documented. Histologically, a "chemical gastritis" has been described, but others fail to distinguish convincingly between Helicobacter pylori- and non-steroidal anti-inflammatory drug-induced inflammatory changes. Frank ulcerations are present in 20% of all long term users, with an even distribution between stomach and duodenum. Multiple ulceration in the antrum and prepyloric area are typical, but non-steroidal anti-inflammatory drug ulcer may be indistinguishable from Helicobacter pylori ulcers and gastric cancers. Thus, even in the context of non-steroidal anti-inflammatory drug exposure, the possibility of malignancy must be ruled out by serial biopsies until complete healing.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1998

Prospective assessment of the ability of endoscopic ultrasound to diagnose, exclude, or establish the severity of chronic pancreatitis found by endoscopic retrograde cholangiopancreatography.

BACKGROUND: Our aim was to verify endoscopic ultrasound (EUS) accuracy to diagnose, rule out, and establish the severity of chronic pancreatitis found by endoscopic retrograde cholangiopancreatography (ERCP). METHODS: Patients undergoing ERCP for unexplained abdominal pain and/or suspected chronic pancreatitis underwent EUS. EUS was performed by experienced operators who were aware of the history but blinded to ERCP results. Chronic pancreatitis was defined using the Cambridge classification: 0 to 1 = "normal," 2 to 4 = "all chronic pancreatitis," 3 to 4 = "moderate to severe chronic pancreatitis." The number of EUS criteria required to obtain sensitivity, specificity, positive and negative predictive values > or = 85% was determined. EUS criteria for chronic pancreatitis are hyperechoic foci, hyperechoic strands, lobularity, hyperechoic duct, irregular duct, visible side-branches, ductal dilation, calcification, and cysts. RESULTS: One hundred twenty-six patients underwent EUS and ERCP. EUS was highly sensitive and specific (> 85%) depending on the number of criteria present. Chronic pancreatitis is likely (PPV > 85%) when more than two criteria (for "all chronic pancreatitis") and more than six criteria (for "moderate to severe chronic pancreatitis") are present. "Moderate to severe chronic pancreatitis" is unlikely (NPV > 85%) when fewer than three criteria are present. Independent predictors of chronic pancreatitis were "calcification" (p = 0.000001), history of alcohol abuse (p = 0.002), and the total number of EUS criteria (p = 0.008). CONCLUSIONS: EUS can accurately diagnose, rule out, and establish the severity of chronic pancreatitis found by ERCP.

Adult↗
PubMed1998

Endoscopic pancreaticobiliary procedures in patients with a Billroth II resection: a 10-year follow-up study.

BACKGROUND: Previous gastrectomy may present technical difficulties for the endoscopist, but the problem appears to be decreasing. AIM: To assess endoscopic retrograde cholangiopancreatography and endoscopic papillotomy in Billroth II patients compared to similar material acquired 10 years ago. MATERIAL AND METHODS: We compared a five-year series of patients submitted to Billroth II to a similar series at our two hospitals obtained 10 years ago. The techniques applied were mostly unchanged, although stent-assisted needle knife papillotomy was successfully introduced during the last year. RESULTS: Endoscopic retrograde cholangiopancreatography was successful in 123 out of 138 patients (89%), requiring a total of 206 procedures to complete diagnostic and therapeutic goals. Endoscopic papillotomy was successful in 81 out of 87 cases (93%). Additional procedures were performed in 40 of the patients. Two duodenal perforations occurred. Compared to ten years ago, total numbers were almost unchanged, but the proportion of patients with a therapeutic indication increased from 34% to 63%. CONCLUSION: There is still need for the special endoscopic retrograde cholangiopancreatography competence that Billroth II anatomy requires, and the special techniques described here should be available in at least some referral endoscopy centres.

Adult↗
PubMed1997

Development and evaluation of written patient information for endoscopic procedures.

BACKGROUND AND STUDY AIMS: In the process of revising our written patient information, we wanted to incorporate some patient feedback into the text, and to compare the new brochures with the old one in terms of procedure-related anxiety and general patient satisfaction. PATIENTS AND METHODS: A total of 136 patients were asked about their present sources of information and issues they would like more information on. New brochures were developed for upper endoscopy, colonoscopy, and endoscopic retrograde cholangiopancreatography (ERCP), and 235 consecutive patients were then randomized to receive either the new brochures or the old one. Before the endoscopy procedure, the patients' sources of information, level of anxiety (on a five-point Likert scale) and general satisfaction with the written information was assessed. In addition, 89 patients completed a similar questionnaire after completing the endoscopic procedure, recording their degree of anxiety and discomfort during the procedure, and the appropriateness of the written information they had received. RESULTS: The written brochure was regarded as providing important information by 79% of the patients, while only 31% felt they had received important information from their referring doctor. The general level of anxiety was 2.0 (slightly anxious) with both brochures, with a mean score of 2.1 and 1.9 for the old brochure and the new one, respectively (P = 0.04). Previous endoscopy, male sex and high age were associated with a lower anxiety score. The post-endoscopy response indicated that the patients had received a realistic description of the procedure. The new brochures were rated as "excellent" or "very good" by 87% of the respondents. CONCLUSIONS: We have developed a new set of information brochures which appear to serve the purpose of providing adequate information, without causing patients undue anxiety.

Anxiety↗
PubMed1997

Sphincter of Oddi dysfunction is associated with chronic pancreatitis.

OBJECTIVES: Chronic pancreatitis can be caused by ductal obstruction resulting from cicatricial papillary stenosis, but sphincter of Oddi motility studies have been inconclusive in patients with established chronic pancreatitis. We sought to determine whether there is an association between papillary sphincter dysfunction and changes of early chronic pancreatitis. METHODS: Consecutive patients who underwent sphincter of Oddi manometry to investigate unexplained upper abdominal pain (n = 104) were assessed for evidence of chronic pancreatitis by pancreatic ductography, endoscopic ultrasound, and pancreatic fluid bicarbonate concentration. RESULTS: Sphincter of Oddi dysfunction patients were four times more likely (odds ratio = 4.6) to have evidence of chronic pancreatitis than were those without sphincter dysfunction (p = 0.01). Of 68 patients with sphincter of Oddi dysfunction, 20 (29%) had structural evidence of chronic pancreatitis. Twenty of 23 (87%) patients with chronic pancreatitis had sphincter of Oddi dysfunction. CONCLUSIONS: Sphincter of Oddi dysfunction is associated with changes of chronic pancreatitis in patients with unexplained pancreaticobiliary pain. Longitudinal follow-up is required to confirm these preliminary findings.

Adult↗
PubMed1996

[Diagnosis and treatment of gastrointestinal hemorrhage].

The handling of gastrointestinal bleeding was discussed at a national expert symposium in February 1995. Internists are in charge of therapeutic endoscopy of upper gastrointestinal bleeding at the majority of Norwegian hospitals, but close collaboration with the surgeon on call is vital. The need for intensive care and monitoring may have been underestimated, since decompensation of co-existing diseases is a more frequent cause of death than the haemorrhage itself. Endoscopic treatment is the primary choice in all parts of the gut where endoscopy is possible, but surgery must be considered for patients who rebleed. Injection of sclerosering agents is the most prevalent mode of treatment for oesophageal varices and ulcers, but thermal probes and rubber band ligation are probably equally effective in experienced hands. Major lower bowel haemorrhage can render colonoscopy impossible, and emergency resections may be warranted, but preferably after angiography or peroperative endoscopic localisation of the area of bleeding.

Acute Disease↗
PubMed1996

[Administrative handling of gastrointestinal hemorrhage in Norway].

Rapid and adequate endoscopic treatment is a vital part of the initial handling of gastrointestinal haemorrhage. A national survey was carried out to study the logistics of the initial handling of these patients. Replies were received from 97% of the hospitals, each of which received an average of 11 patients per month with haematemesis/melena or rectal bleeding. Patients with haematemesis or melena were admitted primarily to medical departments or intensive care units, while patients with haematochezia were admitted most often to the surgical department. 47% of the hospitals performed emergency endoscopy as a routine on patients with red haematemesis, but even in this group of patients, endoscopy was postponed until the first working day in some instances, provided that the patient's condition was stable. The majority of emergency flexible endoscopies are performed by internists, but most hospitals describe close inter-departmental cooperation in the handling of these patients. The situation was deemed satisfactory at 91% of the hospitals.

Emergency Service, Hospital↗
PubMed1996

Gastrointestinal tolerability of lornoxicam compared to that of naproxen in healthy male volunteers.

BACKGROUND AND AIM: Gastrointestinal effects are common adverse effects associated with nonsteroidal anti-inflammatory drugs (NSAIDs). Lornoxicam is a new nonsteroidal anti-inflammatory drug and its gastroduodenal tolerability was compared to that of naproxen in a randomized, double-blind, crossover study. METHODS: Eighteen healthy male volunteers received lornoxicam 8 mg b.d. or naproxen 500 mg b.d. administered orally over two 7-day dosing periods. Upper endoscopy was performed by two independent investigators at the beginning and end of each dosing regimen. RESULTS: Lornoxicam 8 mg b.d. caused significantly less mucosal injury than naproxen 500 mg b.d. in the stomach/duodenal bulb, as well as in the mid/distal duodenum. CONCLUSION: These findings may have favourable implications for lornoxicam in the clinical setting, if this dose provides optimal control of arthritic pain.

Adolescent↗
PubMed1996

Endoscopy databases: the Norwegian experience.

BACKGROUND AND STUDY AIMS: The implementation of endoscopy databases in Norway has been slow, and no commercial system has been successfully introduced. MATERIAL AND METHODS: To determine the current status in this area a questionnaire survey was conducted with replies received from 58 of the 67 hospitals to which the questionnaire was sent. RESULTS: Only 40% of the units had one or more personal computers available, but video endoscopes will soon be standard equipment at most Norwegian hospitals. For managing administrative data, a large majority of endoscopy units used a general-purpose hospital information system, but endoscopy data are dealt with manually in 72% of the units. The endoscopy report itself was produced manually in 93% of the units. When asked to rank various features of database systems according to their relative importance, the endoscopists stated that ease of use and simplification of routine chores were the most important aspects, while advanced storage and research features were less crucial. CONCLUSION: In Norwegian hospitals, the use of minimal endoscopic database systems that offer a high level of integration with existing hospital systems appears to be the most promising approach.

Database Management Systems↗