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PubMed2003

Small-bowel endoscopy.

This review of the literature on endoscopy of the small bowel focuses on published reports, and does not include abstracts. The literature was reviewed for the period September 2001 to September 2002. MEDLINE was searched under the topics of "small-bowel endoscopy", "small bowel", "enteroscopy", "obscure bleeding", and "wireless endoscopy", and a hand search was also carried out of the major gastroenterology journals, along with a review of the tables of contents of all journals that could be identified as being related to gastroenterology or gastrointestinal endoscopy. Sonde small-bowel enteroscopy is no longer an option, and has been rightfully retired as an investigation tool for the small bowel. There is still a place for further evaluation of push enteroscopy, as evidenced by the 11 papers published since the last review of small-bowel endoscopy in 2002. In the field of intraoperative enteroscopy, only one series and a handful of case reports have appeared. By contrast, wireless capsule endoscopy of the small bowel has captured the imagination of gastroenterologists throughout the world. Up to 2003, there have not been many published papers concerning this new diagnostic modality, since patients with obscure gastrointestinal bleeding or suspected small-bowel disease are relatively scarce. Large numbers of abstracts concerning capsule endoscopy have been submitted for presentation at major gastroenterology and gastrointestinal endoscopy meetings over the past 2 years, and the enthusiasm for this new technique of small-bowel imaging has increased with reports of its successful application.

Adult↗
PubMed2005

Is early endoscopy in the emergency room beneficial in patients with bleeding peptic ulcer? A "fortuitously controlled" study.

BACKGROUND AND STUDY AIMS: In previous randomized trials, early endoscopy improved the outcome in patients with bleeding peptic ulcer, though most of these studies defined "early" as endoscopy performed within 24 hours after admission. Using the length of hospital stay as the primary criterion for the clinical outcome, we compared the results of endoscopy done immediately after admission (early endoscopy in the emergency room, EEE) with endoscopy postponed to a time within the first 24 hours after hospitalization, but still during normal working hours ("delayed" endoscopy in the endoscopy unit, DEU). PATIENTS AND METHODS: We conducted a retrospective analysis of data from 81 consecutive patients with bleeding peptic ulcer admitted in 1997 and 1998 (age range 16 - 90 years). Of these 81 patients, 38 underwent DEU (the standard therapy at the hospital) and 43 underwent EEE. Patients in the two groups were comparable with regard to admission criteria, were equally distributed with respect to their risk of adverse outcome (assessed using the Baylor bleeding score and the Rockall score), and differed only in the treatment they received. Endoscopic hemostasis was performed whenever possible in all patients with Forrest types I, IIa, and IIb ulcer bleeding. RESULTS: We found similar rates in the two groups for recurrent bleeding (16 % in DEU patients vs. 14 % in EEE patients), persistent bleeding (8 % in DEU patients vs. none in EEE patients), medical complications (21 % in DEU patients vs. 26 % in EEE patients), the need for surgery (8 % in DEU patients vs. 9 % in EEE patients), and the length of hospital stay (5.1 days for DEU patients vs. 5.9 days for EEE patients). None of the differences between the two groups in these parameters were statistically significant. None of the patients died. CONCLUSIONS: Early endoscopy in an emergency room did not improve the clinical outcome in our 81 consecutive patients with bleeding peptic ulcer.

Adolescent↗
PubMed2006

Routine coagulation screening in children undergoing gastrointestinal endoscopy does not predict those at risk of bleeding.

BACKGROUND AND STUDY AIMS: Routine coagulation screening prior to gastrointestinal endoscopy is performed in many centres in the UK, despite the lack of any evidence to support the practice. The aim of this study was to assess the benefits of routine pre-endoscopy coagulation screening in children and to assess how widespread this practice is in the UK. PATIENTS AND METHODS: We performed a retrospective analysis of the case notes of 250 consecutive patients who had undergone routine coagulation screening prior to endoscopy and biopsy, in accordance with our unit's protocol, looking for evidence of abnormal results or episodes of bleeding. We also performed a telephone survey of the protocols for coagulation screening at other paediatric units in the UK which are known to perform gastrointestinal endoscopy on a routine basis. RESULTS: According to our hospital's laboratory reference ranges, 16.8 % of the children who underwent endoscopy and biopsy had abnormal clotting. This was neither clinically significant nor associated with an increased bleeding risk in any patient. Of the 23 UK paediatric gastroenterology centres surveyed, including our own, five (21.7 %) perform routine coagulation screening before endoscopy. CONCLUSIONS: This study suggests that, although it is a relatively common practice, routine coagulation screening is not indicated in children who are undergoing gastrointestinal endoscopy and biopsy, and that it does not predict those at risk of significant bleeding. We would therefore suggest that if pre-endoscopy screening is to be performed, it should be reserved for those who are potentially at high risk of bleeding.

Blood Coagulation Disorders↗
PubMed2000

Waiting lines in the endoscopy unit.

BACKGROUND: The efficient management of the endoscopy unit involves issues of scheduling. The aim of this study was to assess efficient use of an endoscopy unit and its relationship to patient waiting. METHODS: Formulas of queueing theory are applied to patient scheduling in endoscopy. The M/M/n queueing model assumes exponential (Markovian) distributions underlying both patient arrival and endoscopy times with n as the number of endoscopists, while the D/M/n model assumes a constant (deterministic) patient arrival rate. RESULTS: As the use of the facility increases, so does the probability that patients will have to wait. It is impossible for an endoscopy facility to have a 100% rate of use without patients being forced to wait. Any increase in the use rate of an endoscopy unit results in a concomitant increase in waiting times. A facility with multiple endoscopists can reduce waiting probability at a higher rate of facility use. A table is included that physicians and administrators can use as a guide to estimate the use rate and waiting characteristics of different types of endoscopy facilities. CONCLUSIONS: Endoscopy units must find a balance between patient waiting and underuse of their resources. Endoscopists will occasionally find themselves idle at the benefit of providing patients with tolerable waiting times. It needs to be explained to patients that even under the best of circumstances some waiting cannot be prevented.

Appointments and Schedules↗
PubMed2002

Nasal endoscopy and the definition and diagnosis of chronic rhinosinusitis.

OBJECTIVES: Although endoscopy has been shown by a few authors to be a valuable tool for the diagnosis of chronic rhinosinusitis, its true role in the evaluation of the patient with chronic rhinosinusitis has not been elucidated. The current definition of chronic rhinosinusitis is a symptom-based definition, and objective testing such as endoscopy or computed tomography (CT) is not included. However, the current treatment paradigm for chronic rhinosinusitis is dependent on the definition for diagnosis. Patients are treated with 4 weeks of antibiotics and decongestant/antihistamines/steroids based on the definition. This study aims to evaluate in a prospective fashion the place of endoscopy in the diagnosis of chronic rhinosinusitis. STUDY DESIGN: A group of 78 patients meeting the definition of chronic rhinosinusitis were subjected to same-day endoscopy and CT scanning. RESULTS: Seventeen (22%) of 78 patients had positive endoscopic and CT results. There were 20 (26%) of 78 patients with negative endoscopic and positive CT results. Six (8%) patients had positive endoscopic and negative CT results, and 35 (45%) had negative endoscopic and negative CT results. Overall, 37 (47%) patients had positive CT results, and 41 (53%) patients had negative CT results. Endoscopy showing the presence of purulence, nasal polyps, or watery congested mucosa correlated well with CT results. Negative endoscopy correlated with CT results in 65% of patients. CONCLUSION: The use of endoscopy to corroborate the diagnosis in nonpolypoid or nonpurulent rhinosinusitis in previously unoperated patients is questioned. Patients who meet the subjective definition of chronic rhinosinusitis should have a high degree of sensitivity and specificity with endoscopy or CT. The fact this is not the case questions the accuracy of the definition and the treatment paradigm. SIGNIFICANCE: According to this study, positive endoscopic results correlated well with CT, and negative endoscopic results correlated in 71% of patients with negative CT results.

Adolescent↗
PubMed2006

Capsule endoscopy retention: is it a complication?

BACKGROUND: Capsule endoscopy has been found superior to barium x-rays and push enteroscopy in the investigation of obscure gastrointestinal bleeding and in the evaluation of suspected Crohn's disease. Currently, small bowel obstruction and strictures are considered by many physicians to be a contraindication to capsule endoscopy for fear of capsule retention or impaction. The goal of this study was to reassess this conventional wisdom that capsule endoscopy is contraindicated in small bowel obstruction and to determine the safety and efficacy of capsule endoscopy in the evaluation of patients with suspected stricture or small bowel obstruction. STUDY: A retrospective chart review was performed using a database of 568 capsule endoscopy cases performed between August 2001 and November 2003. Cases of suspected small bowel obstruction were selected and reviewed. RESULTS: Nineteen cases were identified in which capsule endoscopy was used in the setting of suspected small bowel obstruction. The diagnosis of suspected small bowel obstruction was based on symptoms alone in 8 cases and on symptoms plus abnormal radiographs in the remaining 11 cases. Capsule endoscopy made a definitive diagnosis in 5 of the 19 cases (26%): 2 Crohn's strictures, 1 radiation induced stricture, 1 nonsteroidal anti-inflammatory drug induced stricture, and 1 MALT lymphoma. The capsule was retained proximal to a stricture in 4 cases, in which the obstructing lesions were electively resected without complications. There was no case in which administration of the capsule led to an acute small bowel obstruction. CONCLUSIONS: Capsule endoscopy can be safely used to help identify the etiology and site of a small bowel obstruction. Retention of the capsule may indicate the presence of a lesion requiring surgery, but small bowel obstruction or strictures are not in themselves contraindications to the procedure. It is understood, however, that retention may lead to surgery in a patient who otherwise may have been treated medically without surgery for the same illness (eg, Crohn's disease and nonsteroidal anti-inflammatory drug enteropathy).

Adult↗
PubMed1995

A prospective study of screening upper gastrointestinal (GI) endoscopy prior to and after bone marrow transplantation (BMT).

BACKGROUND: Upper gastrointestinal (GI) endoscopic abnormalities are common in symptomatic bone marrow transplant (BMT) recipients but the incidence of occult gastrointestinal disease in these patients is unknown. AIMS: To examine the role of screening upper GI endoscopy before and after BMT. METHODS: Endoscopy was performed routinely on allogeneic (n = 24) and autologous (n = 17) BMT patients before transplant and at 30 and 120 days after transplant. RESULTS: Twenty-one of 41 patients (51%) had an endoscopic abnormality on one or more occasions which necessitated a change in treatment. These abnormalities were present in ten of 41 (24%) pre-transplant endoscopies, ten of 32 (31%) endoscopies at day 30 after BMT, and in seven of 22 (32%) day 120 endoscopies. Abnormalities included mucosal erosions or ulcers n = 22 endoscopies), infections (n = 5) or previously undiagnosed GI graft-versus-host disease (n = 3). Mucosal erosions or ulcers were present in eight of 28 endoscopies despite regular anti ulcer drug therapy. CONCLUSIONS: Screening upper GI endoscopy before and after BMT is generally safe and detects a high yield of significant GI abnormalities. However, it remains to be demonstrated that treatment of these lesions will improve the clinical outcome in BMT recipients without GI symptoms.

Adult↗
PubMed1998

The one-stop dyspepsia clinic--an alternative to open-access endoscopy for patients with dyspepsia.

The most sensitive investigative tool for the upper gastrointestinal tract is endoscopy, and many gastroenterologists offer an open-access endoscopy service to general practitioners. However, for patients with dyspepsia, endoscopy is not always the most appropriate initial investigation, and the one-stop dyspepsia clinic allows for different approaches. We have audited, over one year, the management and outcomes of patients attending a one-stop dyspepsia clinic. All patients seen in the clinic were included, and for those not endoscoped the notes were reviewed one year after the end of the study to check for reattendances and diagnoses originally missed. Patients' and general practitioners' views of the service were assessed by questionnaire. 485 patients were seen, of whom 301 (62%) were endoscoped at first attendance. In 66 patients (14%), endoscopy was deemed inappropriate and only one of these returned subsequently for endoscopy. 118 patients (24%) were symptom-free when seen in the clinic and were asked to telephone for an appointment if and when symptoms recurred; half of these returned and were endoscoped. Oesophagitis and duodenal ulcer were significantly more common in this 'telephone endoscopy' group than in those endoscoped straight from the clinic. Overall, 25% of patients referred were not endoscoped. Important additional diagnoses were made from the clinic consultation. General practitioners and patients valued the system, in particular the telephone endoscopy service. 84% of general practitioners said they would prefer the one-stop dyspepsia clinic to open-access endoscopy.

Diagnosis, Differential↗
PubMed2003

Nurse endoscopy in a district general hospital.

INTRODUCTION: This study describes the first full year of independent practice by a newly appointed nurse endoscopist in a district general hospital. PATIENTS AND METHODS: Patients underwent either 'one stop' flexible sigmoidoscopy and barium enema or flexible sigmoidoscopy alone. Barium enema results, video photography, clinical follow-up, and histology were used to validate the results of the flexible sigmoidoscopy. One stop clinic: 161 endoscopies were performed, with 104 female patients (65%), and a mean age of 64 years. There was one failed endoscopy due to poor bowel preparation. Abnormalities were identified in 84% of endoscopies. Flexible sigmoidoscopy detected abnormalities not seen on the barium enema in 28 cases, all of which were polyps (18%). Barium enema identified one abnormality within reach of the flexible sigmoidoscope not identified at endoscopy (small polyp in sigmoid; 1%). Elective flexible sigmoidoscopy list: 121 endoscopies were performed, with 65 female patients (54%), and a mean age of 59 years. There were two failed endoscopy procedures, both attributed to poor bowel preparation. Two-thirds of patients had an abnormality on investigation. There were no complications in either group of patients. CONCLUSIONS: The nurse-led endoscopy service has been successfully initiated with a high completion rate for flexible sigmoidoscopies. All significant conditions were identified with 99% sensitivity. Nurse endoscopy is a safe, useful and practical procedure in the setting of this district general hospital.

Adult↗
PubMed2000

MR virtual endoscopy of the upper urinary tract.

OBJECTIVE: We investigated the feasibility of applying surface-rendered virtual endoscopy to the visualization of the upper urinary tract by processing unenhanced MR urography data sets. SUBJECTS AND METHODS: Twenty-six patients, having neoplastic lesions (n = 9), calculi (n = 8), pelviureteric junction stenoses (n = 4), postoperative fibrotic strictures (n = 3), and extrinsic compressions of the ureter (n = 2), underwent unenhanced MR urography. Virtual endoscopy of the upper urinary tract was obtained using a thresholding technique and surface-rendering MR urography data sets. RESULTS: Virtual endoscopy of the renal pelvis and calices was feasible in all cases on the side of the urinary obstruction. Virtual endoscopy of the ureter was obtained for a diameter of at least larger than 5 mm. The nondilated side could be partially explored in 11 cases (43%). The mean virtual endoscopy threshold required for the visualization of the urinary tract was 157.36-159.94. The mean time for virtual endoscopy was 13.8 min. Endoluminal masses were found in three (12%) of 26 cases on the renal pelvis (corresponding to neoplastic lesions), and occlusions, in 23 (88%) of 26 on the pelviureteric junction and ureter (neoplastic lesions and other abnormalities). CONCLUSION: Virtual endoscopy of MR urography data sets is feasible in patients with urinary tract dilatation. Virtual endoscopy displays the renal pelvis, calices, and ureter and, moreover, can show endoluminal changes caused by abnormalities.

Diagnostic Techniques, Urological↗
PubMed1986

The clinical benefit of routine upper gastrointestinal endoscopy.

In a prospective study including 1526 consecutive endoscopies, attempts were made to characterize the benefit of upper gastrointestinal endoscopy. Before endoscopy judgements were made about the most likely diagnosis and treatment and about the degree of suspicion of upper gastrointestinal malignancy. After endoscopy the same types of judgement were made again. The study showed that about half of the endoscopies disclosed clinically significant abnormalities. Furthermore, about every third endoscopy led to unpredicted diagnostic and diagnostic and therapeutic consequences. The benefit was comparably small in patients below the age of 40 years and particularly great in patients above the age of 65, in patients submitted to endoscopy because of barium meal pathology or general suspicion of malignancy, and in patients with upper gastrointestinal bleeding. In general, the present study supports the widespread use of upper gastrointestinal endoscopy in clinical practice.

Adolescent↗
PubMed1992

Gastrointestinal endoscopy: an accurate and safe primary diagnostic and therapeutic modality.

OBJECTIVE: To review the place of gastrointestinal endoscopy in the management of upper and lower gastrointestinal disorders. DATA SOURCES: We reviewed articles on endoscopy reported over two decades. A Medline search complementing our experience and knowledge of the literature was used to identify the articles. STUDY SELECTION: Papers were selected which focused on indications, comparison with radiology, including clinical outcome measures, and complications. One hundred papers, including those from radiology journals, were reviewed. DATA EXTRACTION: Results of studies are referenced as appropriate. DATA SYNTHESIS AND CONCLUSIONS: Endoscopy allows direct visualisation of the mucosa of the upper gastrointestinal tract, colon and terminal ileum. Subtleties of colour change, vascular pattern abnormalities and scarring are easily detected at endoscopy and are often of diagnostic importance. Endoscopy also provides access for tissue biopsy and allows a wide variety of therapeutic interventions. Traditionally barium studies have been the first step in the evaluation of many gastrointestinal symptoms and still retain cost advantages over endoscopy. However, endoscopy is frequently more sensitive and specific than barium studies. Costs associated with incorrect diagnoses may undermine the apparent cost benefits of barium studies. Advances in endoscopic design have allowed wider therapeutic options and increased safety. Gastrointestinal endoscopy should now be the first line of investigation where diagnostic precision is required or where therapeutic intervention is likely.

Barium Sulfate↗
PubMed2001

Fluorescence endoscopy with 5-aminolevulinic acid reduces early recurrence rate in superficial bladder cancer.

PURPOSE: Several investigators have demonstrated an approximately 20% higher tumor detection rate by 5-aminolevulinic acid (ALA) fluorescence endoscopy compared to standard white light cystoscopy, and suggested a reduction in tumor recurrences when fluorescence endoscopy was performed as standard procedure during transurethral resection. We test this hypothesis. MATERIALS AND METHODS: In a prospective randomized multicenter study 102 patients underwent transurethral resection of bladder tumor(s) either with white light or ALA fluorescence assisted endoscopy. A second look transurethral resection with ALA fluorescence endoscopy was performed 6 weeks after the initial operation. RESULTS: At second look transurethral resection tumor was detected in 20 of 51 patients (39%) in the white light group and in 8 of 51 (16%) in the ALA fluorescence endoscopy group. This difference was statistically significant (p = 0.005). CONCLUSIONS: ALA fluorescence endoscopy is an innocuous and inexpensive diagnostic procedure that significantly improves bladder tumor detection rates compared to standard white light endoscopy. In our controlled study ALA fluorescence endoscopy reduced the residual tumor detection rate at second look transurethral resection by 59%.

Adult↗
PubMed2002

[Complexity index and analysis of digestive endoscopies at a university hospital].

BACKGROUND: In Spain neither the cost of digestive endoscopies nor the complexity index (CI) have been objectively estimated. Consequently, the profitability of an endoscopy unit cannot be evaluated. OBJECTIVES: 1: To classify endoscopies according to the time taken to accomplish them in order to estimate the CI and determine the relative value unit (RVU). 2: To evaluate the cost of each examination in order to determine the profitability of endoscopy as a diagnostic and therapeutic tool. 3: To measure unnecessary delays in examinations and to determine whether there are differences in the time an examination takes according to the endoscopist's experience and the patient's age or sex. MATERIAL AND METHODS: The cost per hour of an endoscopy room was estimated by dividing the cost per year of employees, equipment, maintenance and the hospital's general costs between the hours of work per year of the endoscopy team. The time taken to perform endoscopies was estimated and the result was used to calculate the RVI, the CI and the cost of 500 consecutive endoscopies. RESULTS: The annual cost amounted to 349,617.69 E. Staffing costs represented 65.5%, of which 56.3% were direct costs. Gastroscopy was taken as the RVU (cost = 27.52 E). Anoscopy was the simplest procedure (RVU = 0.61, cost = 15.08 E) and colonoscopy plus polypectomy was the most complex procedure (RVU = 4.41, cost = 74.28 E). The greater the experience of the member of staff performing the procedure, the less time it took (p < 0.01). CONCLUSION: CI was lowest for anoscopy (URV = 0.61) and highest for total colonoscopy plus polypectomy (URV = 4.41). Cost and exploration time depended on the endoscopist's experience. Staff represented the highest percentage of cost.

Costs and Cost Analysis↗
PubMed2003

[Capsule endoscopy in small bowel diagnostics].

INTRODUCTION: Capsule endoscopy allows for the first time total and painless imaging of the entire small bowel. The main indication for capsule endoscopy is obscure gastrointestinal bleeding which not explained by upper gastrointestinal endoscopy, colonoscopy and small bowel radiology. Capsule endoscopy has also the capacity to detect tiny small bowel manifestations of other pathologic conditions such as Crohns's disease. METHOD AND AIMS: The GivenM2A wireless capsule endoscopy system for investigation of the whole small bowel was developed in the late 1990s. The small size swallowable capsule contains a miniature video camera, four light sources, two batteries and a radiotransmitter. This paper describes the capsule endoscopy examination method and summerizes the initial achievements from two medical centres, the Petz Aladár County and Teaching Hospital and from the Malmö University Hospital. RESULTS: 42 patients were included of whom 37 patients with obscure gastrointestinal bleeding. Pathological small bowel findings were detected in 62% of the all cases, and the source of bleeding was identified by the M2A capsule in 56.7% of the chronic bleeders. The diagnostic sensitivity of the capsule endoscopy in obscure gastrointestinal bleedings was superior both to that of push enteroscopy, 19%, and enterography, 6.7%. The capsule endoscopy was well tolerated and accepted by the patients. CONCLUSIONS: This new diagnostic method is promising mainly for detection of a small bowel source of obscure bleedings. The availability of the method in major gastroenterological centers is strongly recommended.

Adolescent↗
PubMed2004

Capsule endoscopy and push enteroscopy in the diagnosis of obscure gastrointestinal bleeding.

BACKGROUND: In obscure gastrointestinal (GI) bleeding, it is often difficult to detect the bleeding sites located in the small bowel with conventional radiological, scintigraphic or angiographic techniques. Push enteroscopy and capsule endoscopy are currently considered to be the most effective diagnostic procedures. The aim of this study was to compare the detection rates between capsule endoscopy and push enteroscopy. METHODS: From May 2002 through January 2003, we prospectively examined by capsule endoscopy 39 patients with suspected small bowel diseases, in particular GI bleeding of unknown origin in Renji Hospital. Among them, 32 complained of obscure recurrent GI bleeding. Between January 1993 and October 1996, we used push enteroscopy on 36 patients who suffered from unexplained GI bleeding. All patients had prior normal results on gastroscopy, colonoscopy, small bowel barium radiography, scintigraphy and/or angiography. RESULTS: M2A capsule endoscopy disclosed abnormal small bowel findings in 26 (82%) out of 32 patients. Twenty-one of them had significant pathological findings explaining their clinical disorders. Diagnostic yield was therefore 66% (21 of 32 patients). Definite bleeding sites diagnosed by capsule endoscopy in 21 patients included angiodysplasia (8), inflammatory small-bowel (5), small-bowel polyps (4), gastrointestinal stromal tumour (2), carcinoid tumour and lipoma (1), and hemorrhagic gastritis (1). Push enteroscopy detected the definite sources of bleeding in 9 (25%) of the 36 patients. Patients with definite bleeding sources included angiodysplasias (2), leiomyosarcoma (2), leiomyoma (1), lymphoma (1), Crohn's disease (1), small-bowel polyps (1) and adenocarcinoma of ampulla (1). Suspected bleeding sources were shown by push enteroscopy in two additional patients (6%), and in other five patients (16%) by capsule endoscopy. CONCLUSIONS: The present study of patients with obscure GI bleeding showed that capsule endoscopy significantly superior to push enteroscopy in detecting GI bleeding (P < 0.001). Capsule endoscopy is safe and painless, and should become the initial diagnostic choice for patients with obscure GI bleeding.

Adolescent↗
PubMedDate not supplied

Role of nasal endoscopy in patients undergoing endoscopic sinus surgery.

BACKGROUND: The goal of this study was to determine the role of nasal endoscopy in patients undergoing endoscopic sinus surgery and to examine the correlation between nasal endoscopy and pre- and postoperative computed tomography (CT) grade, symptom scores, and the patients' asthma status. METHODS: A retrospective analysis of prospectively collected data from 254 consecutive patients treated with endoscopic sinus surgery was performed from 1999 to 2002. There were 131 men and 123 women, with a mean age of 48 years. All patients had at least 1-year follow-up. All patients received preoperative CT scans, which were graded as per Lund-MacKay, completed the sinonasal outcome test 20 questionnaires, and underwent endoscopic nasal examination at both the preoperative and 1-year postoperative visits. The correlation between the endoscopy score, CT grade, and sinonasal outcome test 20 findings was calculated. RESULTS: Nasal endoscopy indicated a statistically significant correlation with preoperative CT grade in this patient population. There was no correlation between endoscopic findings and patient symptom scores. Nasal endoscopy in patients with asthma (n = 47) did not correlate with either CT grade or patient symptom scores. In patients without asthma (n = 207), nasal endoscopy correlated with CT grade but not with symptom scores. CONCLUSION: Nasal endoscopy findings do not correlate with symptom scores in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis. Nasal endoscopy findings correlated with CT grade in patients without asthma, but no such correlation was found in patients with asthma.

Adolescent↗
PubMed2004

Routine preoperative upper endoscopy for laparoscopic gastric bypass: is it necessary?

Upper endoscopy is often performed in patients undergoing bariatric procedures. Various pathologies may be found during upper endoscopy that may change treatment plans for these patients. This study tested the hypothesis that routine use of upper endoscopy is necessary before laparoscopic gastric bypass. All patients in a 6-month period who underwent laparoscopic gastric bypass for the treatment of morbid obesity were reviewed. Demographic data, body mass index (BMI), operative reports, upper endoscopies, and Helicobacter pylori results were reviewed. Documentation of polyps, ulcerations, and hiatal hernias were noted. Hiatal hernias were further classified as small (3.5 to 4.0 cm), medium (4.0 to 4.5 cm), and large (>4.5 cm). All patients (N = 102) had preoperative upper endoscopy. There were 87 female and 15 male patients. BMI ranged from 38.2 to 63.2 (mean, 48.2) and weight ranged from 93 to 232 kg (mean, 133 kg). Hiatal hernia incidences were small, 36.3 per cent; medium, 27.5 per cent; and large, 26.5 per cent. All of these hernias were verified and repaired at time of surgery. Distal esophagitis was noted in 24 per cent of patients. Other pathology (gastric polyps, duodenitis, Schatzki ring) was observed in 5 per cent of patients. Overall, 91 per cent of patients had some type of pathology seen on upper endoscopy. Of the patients tested, 20 per cent were positive for H. pylori and were medically treated. Routine use of preoperative upper endoscopy revealed significant pathology in many patients before laparoscopic gastric bypass. The pathology found modified treatment in many cases. Bariatric surgeons should adopt the routine use of preoperative upper endoscopy during the workup for bariatric surgery.

Adult↗