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PubMed2006

Limited impact on endoscopy demand from a primary care based 'test and treat' dyspepsia management strategy: the results of a randomised controlled trial.

BACKGROUND: Helicobacter pylori testing has been suggested as an alternative to endoscopy for young patients with dyspepsia. Secondary care studies have suggested that demand for endoscopy among this group could be reduced by up to 74%. However, the effect of H. pylori testing in the primary care setting, where the majority of dyspepsia is managed, is unclear. AIM: To determine the effects of providing a H. pylori serology service for GPs upon demand for open access endoscopy. DESIGN OF STUDY: A prospective randomised controlled trial. SETTING: Forty-seven general practices in Gloucestershire. METHOD: General practices were stratified by endoscopy referral rate and randomised into two groups. The intervention group was provided with access to H. pylori serology testing and encouraged to use it in place of endoscopy for patients aged under 55 years with dyspepsia. Endpoints were referral for endoscopy and serology use. RESULTS: There was a significant reduction in referrals for endoscopy in the intervention group compared to the control group: 18.8% (95% confidence interval = 5.0 to 30.6%; P = 0.009). CONCLUSIONS: Providing GPs with H. pylori serology testing reduced demand for open access endoscopy, but by less than previous studies had predicted.

Adult↗
PubMed2006

Changes in pulse oximetry levels and factors affecting oxygen saturation during routine upper gastrointestinal endoscopy with or without sedation.

BACKGROUND/AIMS: We aimed to investigate whether endoscopy or midazolam as premedication causes oxygen desaturation and to determine factors which may affect the occurrence of oxygen desaturation. METHODS: Totally 200 patients with various indications (103 men and 97 women), who presented to the Endoscopy Unit of Dicle University Hospital for upper gastrointestinal endoscopy examination, were included in the study. Anamnesis and anthropometric values of the patients were taken. Preoperative oxygen saturation, hemoglobin levels and heart rate per minute were recorded. Patients with initial oxygen saturation levels <90% were excluded. Patients were divided into two groups. The first group included 100 patients who underwent endoscopic examination without sedation and the second group included 100 patients who underwent endoscopic examination with sedation [midazolam (2-5 mg)]. At the end of endoscopy, intravenous flumazenil (0.2 mg) was administered to the premedication patients. Patients were monitored for oxygen saturation and heart rate starting before the sedation and oropharynx anesthesia and lasting until 1 min after the end of the procedure. During the endoscopic examination, minimum oxygen saturation and maximum heart rate values were recorded. The duration of the oxygen saturation <90% was recorded throughout the procedure and the relation of this time with the total time of the endoscopic examination was evaluated. RESULTS: The mean age of the 200 patients included in the study was 45 and 44 years for Group 1 and Group 2, respectively. No differences were found between the two groups in terms of body mass index, smoking, hemoglobin and basal maximum pulse rate, duration of endoscopy, minimum basal oxygen saturation, duration of hypoxia and time to hypoxia. No relation was determined between oxygen desaturation and gender, duration of the endoscopy, basal pulse rate or hemoglobin level. It was found that smoking made significant contributions to the oxygen desaturation. CONCLUSION: Midazolam premedication for upper gastrointestinal system endoscopy is a reliable procedure and does not contribute an additional risk in individuals without serious comorbidities. Smoking habits should be taken into account in endoscopy patients.

Adult↗
PubMed1989

The impact of video endoscopy on surgical training.

The impact of video endoscopy on surgical resident training was assessed by an analysis of 1531 endoscopic procedures (1057 video endoscopy and 474 fiberoptic endoscopy) and a standardized questionnaire response of surgical staff and residents. Video endoscopy provided advantages in the following areas: 1) Technical. Superior quality of image with a significantly greater resolution. 2) Procedural. Multiple simultaneous viewers for teaching and increased coordination for therapeutic maneuvers. 3) Educational. "Freeze frame" capability for real time teaching; video taping for subsequent consultation, review, or teaching conference, video tape evaluation at preoperative conferences, and archive of video tape for teaching file. 4) Documentation. For use review and quality assurance or for patient education. 5) Research. Investigation of video image enhancement techniques. 6) Physical comfort. Relief of many causes of strain and fatigue and elimination of potential danger to the endoscopist in certain therapeutic maneuvers. Residents learned video and fiberoptic endoscopy equally well, requiring only 3 to 5 procedures to learn each type of system. Experience in this teaching program indicates a decided advantage to incorporating video endoscopy into surgical residency training. After more than 1000 video endoscopy procedures, the novelty has worn off but enthusiasm persists; the video system is now a workhorse that provides greater technical capabilities and broader educational horizons while returning endoscopy to the realm of surgical education.

Digestive System Surgical Procedures↗
PubMed1994

[Digestive echo-endoscopy].

Since its introduction into clinical practice in 1980, echo-endoscopy has greatly contributed to improving our capacity to image the digestive tract and now plays a major role in management of digestive tract diseases. Echo-endoscopy is a second intention technique reserved for further investigation of lesions previously identified by endoscopy or other imaging techniques. All five layers of the wall and surroundings of the accessible structures (oesophagus, stomach, duodenum, rectum and colon) can be visualized. Evaluation of locoregional extension of cancer invasion is one of the predominant indications. For example, since the prognosis of tumours of the oesophagus are directly related to parietal and lymph node extension, echo-endoscopy would be indicated to precisely determine the tumoural stage and thus help in adapting therapeutic management. Today, it is generally accepted that echo-endoscopy is superior to computed tomography for staging tumours of the oesophagus and the cardia. For gastric and duodenal adenocarcinomas, the performance of echo-endoscopy is similar and can identify more readily superficial lesions accessible for photocoagulation. For adenocarcinoma of the rectum, echo-endoscopy can be used to identify the tumoural stage and local extension and thus help in therapeutic decision making. Other classical indications include the evaluation of submucosal tumefaction and biliopancreatic disorders (biliary lithiasis, pancreatitis, tumours). Thus for certain well-defined indications, echo-endoscopy is now the highest performing imaging technique currently available for lesions of the digestive tract. Operator experience is however a limiting factor, emphasizing the need for clinical training.

Digestive System Diseases↗
PubMed2003

Approach to treatment of dyspepsia in primary care: a randomized trial comparing "test-and-treat" with prompt endoscopy.

BACKGROUND: The value of the "test-and-treat" strategy in the approach to dyspepsia has been evaluated only in a few secondary care studies. Most patients with dyspepsia, however, are treated by their primary care physician. This study evaluated the test-and-treat strategy in primary care. METHODS: Patients consulting their general practitioners for dyspepsia were randomized to either direct open-access endoscopy with Helicobacter pylori testing or a test-and-treat strategy by H pylori serology. In the 12-month follow-up period, any additional treatment or referral for investigations was left at the discretion of the general practitioner. At the end of the study, data were collected concerning the number of endoscopies, changes in symptom severity and quality of life, patient satisfaction, and the use of medical resources. RESULTS: Two hundred seventy patients were enrolled (129 who received endoscopy and 141 in the test-and-treat group). The prevalence of H pylori infection was 38.3% and 37.2% in the test-and-treat and endoscopy groups, respectively. In the test-and-treat group, 46 patients (33%) were referred for endoscopy during follow-up. Improvement in symptom severity, quality of life, and patient satisfaction was comparable in both groups. Patients in the test-and-treat group paid more dyspepsia-related visits to their general practitioner (P =.005). Patients in the endoscopy group were more often prescribed proton pump inhibitors (P =.007), whereas patients in the test-and-treat group were more often prescribed prokinetic drugs (P =.005). CONCLUSIONS: The test-and-treat strategy proved to be as effective and safe as prompt endoscopy. Only a minority of patients were referred for endoscopy after the test-and-treat approach.

Adult↗
PubMed2005

The annual yield of diagnostic endoscopy of the lower digestive tract.

BACKGROUND: Endoscopy of the colon and rectum has become a standard diagnostic procedure. No data are presented in the literature on the annual yield or on morbidity patterns. A large, cross-sectional, single-center study was done in order to detect the annual yield of endoscopy of the colon and rectum. METHODS: All consecutive endoscopies performed over an 11-year period were included. All files from a random year were taken in order to collect data on the indication for the endoscopy. A standardized endoscopy report was used. RESULTS: Over the 11-year period, 11,550 consecutive endoscopies of the lower digestive tract were performed. Seven hundred and fourteen procedures were excluded because they were done as a direct follow-up after the index procedure. The majority of endoscopies were scheduled as colonoscopy. The most common endoscopic diagnoses made each year remained constant in number. Cancer was diagnosed in 4-6% of cases, inflammation in 9-15%, polyps in 9-16%, and diverticular disease in 21-37%. The percentage of women undergoing the procedure each year ranged from 54% to 59%, that of men from 41% to 46%. CONCLUSION: From this study it can be concluded that the annual yield of endoscopy of the lower digestive tract remains rather constant. No major changes in morbidity are noted.

Journal Article↗
PubMed1997

Endoscopic ultrasonography and endoscopy for staging depth of invasion in early gastric cancer: a pilot study.

BACKGROUND: We compared the accuracy of endoscopic ultrasonography (EUS) for staging depth of invasion of early gastric cancer with that of conventional endoscopy. PATIENTS AND METHODS: We assessed the depth of invasion of 108 lesions (104 patients) using EUS with a thin 20 MHz probe and compared the results with those of conventional endoscopy and of histologic examination of endoscopically or surgically resected specimens. RESULTS: The overall accuracy rates for staging depth of invasion for conventional endoscopy and EUS were 72.2% and 64.8%, respectively. Lesions that were classified as limited to the mucosa on both conventional endoscopy and EUS were very likely (92.2%) to be limited to the mucosa on histologic examination. The rates for understaging and overstaging were 16.7% and 11.1%, respectively, for conventional endoscopy; and 7.4% and 24.1%, respectively, for EUS. The highest rate for understaging based on conventional endoscopy occurred for lesions in the gastric body (including cardia, 23.9%). CONCLUSIONS: EUS appears to be useful in combination with conventional endoscopy for staging depth of invasion of early gastric cancer. In particular, the two techniques in tandem may accurately predict that a lesion is limited to the mucosa, and EUS may be useful to overcome the potential for understaging by conventional endoscopy, particularly in the gastric body.

Adult↗
PubMed1997

The diagnostic yield of lower endoscopy plus biopsy in nonbloody diarrhea.

BACKGROUND: Patients presenting with diarrhea frequently undergo lower endoscopy plus biopsy as part of their diagnostic evaluation. The diagnostic yield of this approach has not been systematically evaluated. METHODS: To evaluate the diagnostic yield of endoscopy and biopsy in the investigation of nonbloody diarrhea, we performed a retrospective analysis using the endoscopy unit database of a tertiary care university hospital over a 3-year period. The database was searched for cases in which colonoscopy was performed for the single indication of diarrhea. The endoscopic findings and initial biopsy reports were extracted from a chart review, and each clinician was interviewed for the patient's current clinical diagnosis. The clinical diagnoses were compared with the endoscopy and biopsy results to determine whether the tests had contributed to making the clinical diagnoses. RESULTS: Three hundred six patients were identified. One hundred one were excluded for standardized predefined exclusion criteria, leaving 205 evaluable patients, of whom 77 had flexible sigmoidoscopy and 128 had colonoscopy. Eighteen percent had specific clinical diagnoses facilitated by endoscopy and/or biopsy. Endoscopy and biopsy results were normal in 74% of cases. In 8% of the cases either the endoscopy or biopsy findings were inconsistent with the final clinical diagnoses. CONCLUSIONS: Endoscopy and biopsy are important diagnostic tools in the evaluation of patients with nonbloody diarrhea, leading to a specific diagnosis in nearly one fifth of cases.

Adult↗
PubMed2007

Attendance at surveillance endoscopy of patients with adenoma or colorectal cancer.

OBJECTIVE: Surveillance of patients treated for adenoma or colorectal cancer (CRC) is intended to reduce the incidence of CRC. Responsibility for the adherence to surveillance advice is often left to the patients and family physician. It is not known whether this type of passive policy affects the efficacy of surveillance. The aim of this study was to determine the yield of surveillance without active invitation to follow-up endoscopy. MATERIAL AND METHODS: The study comprised a cohort follow-up of patients under 75 years of age with adenomas or CRC at index endoscopy in the period 1997-99. Adherence and intervals of follow-up endoscopy were determined up to December 2004. RESULTS: During the inclusion period 2946 patients underwent lower endoscopy. In total, 393 patients were newly diagnosed with colorectal polyps (n=280) or CRC (n=113). Polyps were classified as adenomas in 167/280 (61%) patients. Forty-five (27%) of the adenoma patients underwent surveillance endoscopy within the guideline interval, 63 (38%) underwent delayed endoscopy, and 59 (35%) did not have any follow-up at all. CRC was diagnosed in 113 patients. Thirty-six patients who died during the first year or were diagnosed with metastases were excluded from the analysis. Twenty-three (30%) of the remaining 77 patients underwent endoscopic surveillance according to the guidelines, 40 (52%) had delayed surveillance endoscopy, and 14/77 (18%) did not undergo surveillance endoscopy at all. CONCLUSIONS: In surveillance for colorectal neoplasia, active follow-up invitation is important. Given the low follow-up rate in our series, passive follow-up policies may lead to under-performance of surveillance programs. An active and controlled follow-up is advisable.

Adenocarcinoma↗
PubMed1998

Correlating fibreoptic nasotracheal endoscopy performance and psychomotor aptitude.

We have investigated the correlation between the scores attained on computerized psychometric tests, measuring psychomotor and information processing aptitudes, and learning fibreoptic endoscopy with the videoendoscope. Sixteen anaesthetic trainees performed two adaptive tracking tasks (ADTRACK 2 and ADTRACK 3) and one information management task (MAZE) from the MICROPAT testing system. They then embarked on a standardized fibreoptic training programme during which they performed 15 supervised fibreoptic nasotracheal intubations on anaesthetized oral surgery patients. There was a significant correlation between the means of the 15 endoscopy times and both ADTRACK 2 (r = -0.599, P = 0.014) and ADTRACK 3 (r = -0.589, P = 0.016) scores. The correlation between the means of the 15 endoscopy times and MAZE scores was not significant. The ratios of the mean endoscopy time for the last seven endoscopies to the mean endoscopy time for the first seven endoscopies were not significantly correlated with ADTRACK 2, ADTRACK 3 or MAZE scores. Psychomotor abilities appeared to be determinants of trainees' initial proficiency in endoscopy, but did not appear to be determinants of trainees' rates of progress during early fibreoptic training.

Anesthesiology↗
PubMed2004

Empirical treatment followed by a test-and-treat strategy is more cost-effective in comparison with prompt endoscopy or radiography in patients with dyspeptic symptoms: a randomized trial in a primary care setting.

OBJECTIVE: Management of patients with dyspepsia remains controversial. No consensus has yet been reached concerning diagnostic and medical strategies. We conducted a randomized trial to assess the effectiveness of three management strategies for patients with uninvestigated persistent dyspeptic symptoms. METHODS: A total of 199 patients presenting in primary care with dyspeptic symptoms (age 18-65 years, no alarming symptoms) were randomized to either empirical treatment with omeprazole and, in the case of symptomatic relapse, serological Helicobacter pylori infection testing plus eradication therapy (treat-and-test group), prompt upper gastrointestinal endoscopy (endoscopy group) or prompt upper gastrointestinal radiography (radiography group) followed by directed medical treatment. Symptoms, patients' satisfaction and use of resources were recorded during 6 months of follow-up. RESULTS: Sixty-nine patients were assigned to the treat-and-test group, 64 to the radiography group and 66 to the endoscopy group. The median age was 44 years; 104 patients were male and 37% were H.pylori infected. A total of 170 patients (85%) returned the 6 months questionnaire. The numbers of patients with complete symptom relief in the treat-and-test group, endoscopy group and radiography group were 21, 16 and 15, respectively, at 3 months (P = 0.59), and 23, 13 and 12, respectively, at 6 months (P = 0.05). Twenty-two patients in the treat-and-test group underwent endoscopy or radiography. Two patients in the endoscopy group and four patients in the radiography group underwent more than one diagnostic test. The average medical cost per patient for the treat-and-test group was euro 276, for the endoscopy group euro 426 and for the radiography group euro 321, respectively. CONCLUSION: Empirical treatment followed by a test-and-eradicate strategy resulted in fewer diagnostic tests, more symptom relief and lower medical costs compared with prompt upper gastrointestinal radiography or endoscopy in the management of uninvestigated patients with persistent dyspeptic symptoms.

Adult↗
PubMed1994

Comparison of magnetic resonance imaging and endoscopy in distinguishing the type and severity of inflammatory bowel disease.

Twenty consecutive patients with first-time presentation of suspected inflammatory bowel disease underwent both endoscopy with biopsy and magnetic resonance imaging (MRI) within a 3-day period; the relative abilities of endoscopy and MRI to distinguish ulcerative colitis (UC) from Crohn's disease (CD) and to determine the severity of the disease process were compared. In 18 of 20 patients, a diagnosis of UC or CD could be made on histological specimens. MRI correctly diagnosed 17 of these 18 patients using T1-weighted fat-suppressed spin echo and gadolinium enhancement. Endoscopy correctly diagnosed 15 patients. Overall, MRI was not significantly better (p > 0.05) than endoscopy in distinguishing UC from CD. MRI correctly graded the severity of inflammatory changes in 13 of 20 patients, and endoscopy did so in 11 of 20. MRI and endoscopy findings were within one grade of histology findings in seven patients each. No significant difference (p > 0.05) was found between MRI and endoscopy in the ability to estimate the severity of the disease (as determined from biopsies). Bowel wall thickness measured on MR images demonstrated good correlation with percentage of contrast enhancement: r = 0.61; p = 0.003. In sum, magnetic resonance imaging was shown to be comparable with endoscopy in differentiating UC from CD and in gauging the severity of disease. Transmural assessment, sagittal imaging, and the lack of invasiveness were attractive features of MRI.

Adult↗
PubMed1998

The effectiveness of early endoscopy for upper gastrointestinal hemorrhage: a community-based analysis.

OBJECTIVES: The effectiveness of upper endoscopy in unselected patients with upper gastrointestinal hemorrhage has not been well studied. This study was undertaken to identify factors associated with the performance of early endoscopy (ie, within 1 day of hospitalization) and, after adjusting for these factors, to determine associations between early endoscopy and in-hospital mortality, length of stay, and performance of surgery. METHODS: Subjects in this observational cohort study were 3,801 consecutive admissions with upper gastrointestinal hemorrhage to 30 hospitals in a large metropolitan region. Demographic and clinical data were abstracted from hospital records. A multivariable model based on factors that potentially could relate to the decision to perform endoscopy was developed to determine the propensity (0 to 100%) for early endoscopy in each patient. RESULTS: Early endoscopy was performed in 2,240 patients (59%), and although it was not associated with mortality after adjusting for severity of illness among all patients, it was associated with a higher risk of death for patients in the lowest propensity group. Early endoscopy was associated with a lower likelihood of upper gastrointestinal surgery in all patients and in the two highest propensity groups and with a shorter length of stay in the entire cohort and in all subgroups. CONCLUSIONS: In the absence of specific contraindications, early endoscopy should be considered because of associated reductions in length of stay and surgical intervention. Further studies are needed to identify subgroups in whom the procedure may be associated with adverse effects on survival.

Adult↗
PubMed2004

Cost-effectiveness and long-term impact of Helicobacter pylori 'test and treat' service in reducing open access endoscopy referrals.

INTRODUCTION: We have shown that the introduction of a carbon urea breath test (13C-UBT) service for Helicobacter pylori screening and eradication is effective in reducing the rate of open access endoscopy referrals in patients aged < 40 years in the short term. This has been substantiated by several randomized controlled trials comparing a 'test and treat' strategy with early endoscopy in these patients. However, the long-term impact of such a strategy is not established. OBJECTIVE: To ascertain the influence of 13C-UBT services on open access endoscopy referral rates in dyspeptic patients under the age of 40 years over a period of 5 years. METHODS: Retrospective analysis of open access endoscopy referral rates between August 1990 and July 2000. Cost minimization analysis was performed with a Decision Analysis Model using Treeage Data 3.5. RESULTS: The total number of open access referrals for endoscopy during 1990-1995 was between 765 and 1325 per year. The proportion of endoscopies performed in patients < 40 years ranged between 33.4% and 34.6%. The total number of endoscopy referrals during 1995-2000 after the introduction of the 13C-UBT services was between 1178 and 1321 per year. However, there was a sustained reduction in the proportion of patients aged < 40 years, ranging between 23.2% and 26.2% (Chi2 = 153.9, degrees of freedom = 9, P < 0.0001) during this period. CONCLUSIONS: The H. pylori screening and treatment strategy using the 13C-UBT service results in a sustained reduction of the number of endoscopy referrals and is cost effective in dyspeptic patients under the age of 40 years, enabling better utilization of available resources.

Adult↗
PubMed2004

Helicobacter pylori test and eradicate versus prompt endoscopy for management of dyspeptic patients: 6.7 year follow up of a randomised trial.

BACKGROUND: Dyspepsia is a chronic disease with significant impact on the use of health care resources. A management strategy based on Helicobacter pylori testing has been recommended but the long term effect is unknown. AIM: To investigate the long term effect of a test and treat strategy compared with prompt endoscopy for management of dyspeptic patients in primary care. PATIENTS: A total of 500 patients presenting in primary care with dyspepsia were randomised to management by H pylori testing plus eradication therapy (n = 250) or by endoscopy (n = 250). Results of 12 month follow up have previously been presented. METHODS: Symptoms, quality of life, and patient satisfaction were recorded during a three month period, a median 6.7 years after randomisation (range 6.1-7.3 years). Number of endoscopies, antisecretory medication, H pylori treatments, and hospital visits were recorded from health care databases for the entire follow up period. RESULTS: Median age was 45 years; 28% were H pylori infected. Use of resources was registered in all 500 patients (3084 person years) of whom 312 completed diaries. We found no difference in symptoms between the two groups. Median proportion of days without symptoms was 0.52 (interquartile range 0.10-0.88) in the test and eradicate group versus 0.64 (0.14-0.90) in the prompt endoscopy group (p = 0.27) (mean difference 0.05 (95% confidence interval (CI) -0.03 to 0.14)). Compared with the prompt endoscopy group, the test and eradicate group underwent fewer endoscopies (mean difference 0.62 endoscopies/person (95% CI 0.38-0.86)) and used less antisecretory medication (mean difference 102 defined daily doses/person (95% CI -1 to 205)). CONCLUSION: On a long term basis, a H pylori test and eradicate strategy is as efficient as prompt endoscopy for management of dyspeptic patients in primary care and reduces the use of endoscopy and antisecretory medication.

Adolescent↗
PubMed1995

Serology for Helicobacter pylori compared with symptom questionnaires in screening before direct access endoscopy.

This prospective study aimed to compare serology for Helicobacter pylori with two, symptom questionnaires in screening patients before direct access endoscopy. Methods were compared in terms of the number of endoscopies saved and pathology missed in 315 patients referred to a gastroenterology unit by 65 local GPs. The serology used was based on an acid glycine extract of H pylori. One in-house questionnaire was based on the Glasgow dyspepsia (GLADYS) system and the other questionnaire was that reported by Holdstock et al. A cut off point of 6.3 U/ml for H pylori serology was selected for screening patients (97% sensitive and 75% specific). Serology was combined with a history of NSAID usage in determining who should have endoscopy. For the in-house questionnaire, a cut off score of more than 8 out of a possible maximum of 18 was chosen, after prior evaluation in 118 patients referred for direct access endoscopy (the sensitivity for detection of peptic ulcer was 88%, specificity 61%). A cut off score of more than 412 was used for the Holdstock questionnaire. In patients under 45 years, serology detected more peptic ulcers than the in-house questionnaire and the Holdstock questionnaire (27/28 v 24/28, NS and v 20/28, p < 0.05 respectively). The Holdstock questionnaire saved significantly more endoscopies than the other two methods (76/149 v 57/149 for the in-house questionnaire, p = 0.05 and 59/149 for serology, p = 0.05). In all age groups combined, serology was significantly better than the in-house and Holdstock questionnaires at detecting peptic ulcers and gastric cancer (61/63, 52/63, p<0.02, and 50/63, p<0.01 respectively). But serology saved significantly fewer endoscopies (89/315, 135/315, p<0.005, and 119/315, p<0.05 respectively). Serology was inferior to the Holdstock questionnaire at detecting severe oesophagitis. It is concluded that serology is the method of choice in screening before direct access upper gastrointestinal endoscopy in those under 45 years. It best combines a high sensitivity for peptic ulcer disease with a large reduction in unnecessary negative endoscopies.

Adolescent↗
PubMed1980

X-ray examination and/or endoscopy in the diagnosis of gastroduodenal ulcer and cancer.

The diagnostic value of barium meal and endoscopy for the diagnosis of gastric ulcer and cancer was studied in 173 unselected patients with upper abdominal dyspepsia. The predictive value of both positive and negative results was higher for endoscopy than for barium meal. This was also found in earlier studies comprising hospitalized patients, with a consequent higher prevalence of disease, but this study shows that the superiority of endoscopy is maintained in a low-prevalence outpatient population. The diagnostic efficiency of both endoscopy and X-ray was independent of the order of examination. Knowledge of the result of the first examination thus did not improve the efficiency of the second one. Parallel use of endoscopy and barium meal results in a maximum of diagnostic yield but requires the highcost of double examination and supplementary examinations in cases of discrepancy between the two results. Routine use of barium meal with selective use of endoscopy in X-ray-positive cases requires a smaller number of examinations but results in the loss of an unacceptable number of diagnoses. When both costs and diagnostic yield are considered, endoscopy seems to be the examination of choice, with X-ray examination reserved for exceptional cases when endoscopy for one reason or another cannot be carried out. Hospital facilities should be planned with the aim of developing endoscopic services capable of taking over the traditional leading role of X-ray examination in the gastroduodenal field.

Adolescent↗
PubMedDate not supplied

[Virtual endoscopy of the nasal cavity and the paranasal sinuses with computerized tomography. Anatomical study].

INTRODUCTION: Virtual endoscopy is a new 3D technique which permits to depict the inner surface of anatomic cavities. We report our experience in the study of the nasal cavity and paranasal sinuses. MATERIAL AND METHODS: CT examinations of the maxillofacial region were obtained using 1.5 or 3.0 mm slices, 1.5 or 3.0 mm table feed, 120 kV, 140 mA, 2 s scan time, standard and high resolution algorithms for bony structures and a field of view of 14-16 cm. The images were transferred on a workstation and processed with the Navigator virtual endoscopy software (General Electric). A threshold value ranging -300 to -550 UH was applied. RESULTS: We report a series of virtual images of the nasal cavity which includes rhinopharynx vault, torius tubarius, choanae, turbinates, tubal orifice and osteomeatal complex. Moreover, images of frontal sinus and tear duct, of polyps and fracture of maxillary sinus are also presented. 3D virtual endoscopy provides a clear visualization of the anatomic structures of the nasal cavity and sinuses. The images are similar to those of conventional endoscopy. Moreover virtual endoscopy visualizes the paranasal sinuses, which are not accessible at conventional endoscopy. The main limitations of this new technique are the arbitrary choice of the threshold value and the homogenization of different tissue densities, which reduces the contrast resolution. CONCLUSIONS: Virtual endoscopy can presently be considered a complementary technique of the standard axial and coronal CT examination. It provides an effective demonstration of the anatomy of these structures and shows areas which are difficult to visualize with conventional endoscopy. This technique could be of help in didactical activity; its clinical application has to be verified.

Humans↗