Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “ENDOSCOPY”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 181 records · Page 10Linked to original sources
PubMed1996

[Micro-endoscopy, minimal access endoscopy--an overview of current status and future possibilities].

Based on technical and clinical application research a new generation of so-called micro-endoscopes was developed, with a wide range of indications in gynaecology as well. The innovative potential of these new endoscopes is, however, still to be considered against the background of the risks of erroneous findings at laparoscopical and hysteroscopical diagnosis, so that here too, clear indications will have to be worked out.

Female↗
PubMed1999

Use of open access in GI endoscopy at an academic medical center.

BACKGROUND: Open access endoscopy systems (those in which endoscopy is performed without prior gastroenterology consultation) are becoming more common in the current cost-conscious environment. The aim of this study was to compare appropriateness and yield of endoscopy for patients referred for open access endoscopy with those for patients who had prior contact with a gastroenterologist. We also evaluated patients' preference for undergoing open access endoscopy as opposed to having prior consultation with a gastroenterologist and compared preparedness for endoscopic procedures between the two groups. METHODS: The cases of all outpatients referred for upper endoscopy and colonoscopy were assessed prospectively over a 5-month period. American Society for Gastrointestinal Endoscopy (ASGE) guidelines for indications for gastrointestinal endoscopy were used to determine appropriateness of referrals. Significant pathologic findings were rated independently by two investigators using defined criteria. Patients' opinions regarding preparedness for endoscopy and referral preference were measured by means of questionnaires administered before endoscopy. RESULTS: Eighty-six percent of endoscopies after consultation with gastroenterologists were performed for accepted indications compared with 65% of open access procedures (p < 0.01). Significant pathologic findings were present in 40% of the former group compared with 28% of those undergoing open access endoscopy (p < 0.01). Significant pathologic findings were found in 37% of endoscopies performed for indications listed in the ASGE guidelines compared with 20% for unlisted indications (p < 0.01). Forty percent of patients referred for open access endoscopy would have preferred prior consultation with a gastroenterologist. CONCLUSION: Patients initially seen by a gastroenterologist are more likely to undergo endoscopy for accepted indications, and the yield of endoscopy is higher than among patients referred through an open access system. The system of open access endoscopy as currently practiced may have to be reassessed.

Academic Medical Centers↗
PubMed1999

Endoscopy for Helicobacter pylori sero-negative young dyspeptic patients: an economic evaluation based on a randomized trial.

BACKGROUND: A policy of withholding endoscopy in Helicobacter pylori sero-negative dyspeptic patients without sinister symptoms saves up to 36% of endoscopies. However, it is unclear whether the net cost of applying this policy outweighs that of conventional management. AIM: To determine the direct (healthcare) and indirect (productivity) costs of applying a strategy of endoscopy versus no endoscopy in H. pylori sero-negative young dyspeptics in the UK. METHOD: The direct and indirect incremental costs for both strategies were calculated amongst 154 H. pylori seronegative subjects randomized to have an endoscopy or no endoscopy before subsequent management by their general practitioners. The cost per patient of each strategy was calculated using reference values in our clinical setting and sensitivity analysis was used to test different scenarios. RESULTS: The total direct cost rose for the endoscopy group (mean Pound Sterling 103, 95% CI 78 to 127) but did not change for the non-endoscopy group (mean Pound Sterling 6, 95% CI -32 to 44). On average, direct (healthcare) costs for patients in the endoscopy group rose by Pound Sterling 96 (95% CI 51 to 142) more than those for non-endoscopy patients. Indirect (productivity) cost fell for the non-endoscopy group (mean -Pound Sterling 40, 95% CI -220 to 140) compared to a rise for the endoscopy group (mean Pound Sterling 180, 95% CI -60 to 420) (difference not significant). The total cost (including direct and indirect costs) fell for the non-endoscopy group (mean -Pound Sterling 34, 95% CI -228 to 160) but rose for the endoscopy group (mean Pound Sterling 283, 95% CI 32 to 533)--an incremental cost of Pound Sterling 317 (95% CI 0 to 634). For all assumptions in the sensitivity analysis, the mean cost in the endoscopy group was at least Pound Sterling 200 higher than in the non-endoscopy group. CONCLUSIONS: It is less expensive to manage H. pylori-negative dyspeptic patients aged under 45 without sinister symptoms by withholding endoscopy.

Absenteeism↗
PubMed2002

Unsedated transnasal endoscopy accurately detects Barrett's metaplasia and dysplasia.

BACKGROUND: Unsedated transnasal upper endoscopy has a diagnostic yield comparable with that of sedated conventional upper endoscopy. The ability of transnasal upper endoscopy to detect Barrett's metaplasia or dysplastic change has not been systematically evaluated. The aim of this study was to assess the feasibility of transnasal upper endoscopy for surveillance of patients with Barrett's esophagus and to evaluate its histopathologic yield for Barrett's metaplasia and dysplasia. METHODS: Thirty-two patients with Barrett's esophagus were evaluated with conventional upper endoscopy and transnasal upper endoscopy. An effort was made to recruit patients known to have dysplasia. Quadrantic biopsy specimens were taken with standard (conventional upper endoscopy) and pediatric (transnasal upper endoscopy) biopsy forceps at procedures performed at least 1 week apart. Two blinded pathologists evaluated the specimens. RESULTS: Transnasal upper endoscopy detected Barrett's metaplasia histopathologically in 31 of 32 patients. Level of agreement for presence of dysplasia in biopsy specimens obtained between conventional upper endoscopy and transnasal upper endoscopy was excellent (k = 0.79). Interobserver agreement for dysplasia in specimens obtained by conventional upper endoscopy (k = 0.61) and by transnasal upper endoscopy (k = 0.61) were similar. Intraobserver agreement between conventional upper endoscopy and transnasal upper endoscopy biopsy specimens for dysplasia by pathologist 1 (k = 0.73) and pathologist 2 (k = 0.75) were also similar. No significant adverse effects were noted. CONCLUSIONS: Transnasal upper endoscopy is feasible and accurate for identification and histopathologic confirmation of Barrett's metaplasia with a histopathologic yield for dysplasia comparable with conventional upper endoscopy.

Adult↗
PubMed2003

Cost-saving approach to patients on long-term anticoagulation who need endoscopy: a decision analysis.

OBJECTIVES: The management strategies used when patients requiring long-term anticoagulation need endoscopic procedures vary considerably. Two commonly used approaches are a "heparin window" strategy in the inpatient setting and, more recently, a "switch to low molecular weight heparin (LMWH)" strategy for elective procedures. The aim of this study was to determine whether an initial diagnostic endoscopy (visualization only) is a cost-effective strategy in these patients. METHODS: Decision analysis was performed for two scenarios using probability estimates from our retrospective study. Scenario 1: Patients with any (urgent and elective) indication for endoscopy while on anticoagulation. A decision tree was made outlining two strategies: 1) a diagnostic endoscopy on full anticoagulation followed by therapeutic endoscopy if needed using standard practice; and 2) standard approach. Scenario 2: Patients requiring elective endoscopy. Here, the decision tree outlined three strategies: 1) initial diagnostic endoscopy on full anticoagulation followed by a therapeutic endoscopy if needed using a "heparin window"; 2) initial diagnostic endoscopy followed by therapeutic endoscopy if needed using "switch to LMWH" strategy; and 3) "direct switch to LMWH strategy." RESULTS: Initial diagnostic endoscopy is the preferred strategy when patients requiring anticoagulation need endoscopy. In scenario 1 (all patients), the diagnostic endoscopy approach will reduce need for hospital stay and save $85,006 per 100 patients when a therapeutic impact is not predictable before endoscopy. Similarly, in scenario 2, an initial diagnostic endoscopy followed by switch to LMWH strategy is the most cost saving. CONCLUSIONS: In anticoagulated patients, an initial diagnostic endoscopy approach on anticoagulation is the most cost-saving strategy, when a direct therapeutic impact is not predictable.

Anticoagulants↗