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PubMed1991

Function of the minor duodenal papilla in humans as determined under duodenoscopy using indigo carmine dye and a pH sensor.

The function of the minor duodenal papilla in humans was studied by duodenoscopy using indigo carmine dye and a pH sensor. By this method it was possible to classify the function of the minor papilla into three types: Type I: pancreatic juice excretion without secretin administration; Type II: pancreatic juice excretion following secretin administration; Type III: no pancreatic juice excretion despite secretin administration. To determine the relative numbers of each type, the findings in 23 normal subjects were compared with those in 26 patients with benign papillary stenosis. In normal individuals, there were 11 Type I, 4 Type II and 8 Type III, while in patients with papillary stenosis we observed 20 Type I, 4 Type II and 2 Type III function, indicating that in patients with papillary stenosis, the incidence of Type I minor papilla was significantly high. From this it can be inferred that a minor papilla that does not excrete pancreatic juice spontaneously may begin such excretion, if pancreatic duct pressure persistently increases.

Adult↗
PubMed2001

Young dyspeptic patients: with a test-and-treat policy, are the benefits of decreased symptom severity and oesophago-gastric-duodenoscopy workload sustained?

OBJECTIVES: To examine the symptom severity and requirement for oesophago-gastro-duodenoscopy (OGD) in young dyspeptic patients 2 years after serological testing for Helicobacter pylori, and to compare the outcomes of seronegative patients with those of seropositive patients. DESIGN: Long-term follow-up study of 232 participants from our previous trial. METHODS: Telephone assessment of patients' symptom severity, scored using a previously validated questionnaire; return of patients for OGD determined using local patient administration system (PAS); and review of medical case notes. RESULTS: Dyspepsia symptom severity of both seronegative and seropositive patients remained reduced compared with initial scores at time of trial recruitment. Symptom severity of seropositive patients was significantly lower than that of seronegative patients (P< 0.001). Seventeen additional patients returned for OGD between six months and two years after the start of the serological study. As 61 of the original 232 study patients returned for OGD within the first six month follow-up period, a total of 78 individuals (34%) had OGD during the two years following the study. Thus, 66% of the original participants avoided OGD. CONCLUSIONS: This study of non-invasive testing for H. pylori in young dyspeptic patients has demonstrated an improvement in symptom severity and a substantial reduction in OGD workload over a 2-year period.

Adult↗
PubMed1976

Hyperamylasaemia after duodenoscopy and retrograde cholangiopancreatography.

The salivary and pancreatic isoamylases of serum were determined separately in 234 cases of duodenoscopy and retrograde cholangiopancreatography. Successful pancreatic opacification was associated with pathologically high pancreatic serum amylase activities in 60% of the cases. Extensive opacification was associated with large increases of pancreatic serum isoamylases, the maximal rise recorded was 40 times the initial value. In spite of these striking chemical events only two patients developed clinical acute pancreatitis. There were some variations in pancreatic opacification and in the elevation of pancreatic serum amylase which seemed to depend upon the particular contrast material used. A rise of the salivary serum isoamylases caused pathologically high total serum amylase activities in 7% of the cases. High levels of pancreatic serum isoamylase activity before the time of examination did not result in any different pattern of hyperamylasaemia.

Cholangiography↗
PubMed1980

Diagnosis of haemobilia by duodenoscopy.

A case of haemobilia due to liver abscess presenting as haematemesis and melaena is described. Duodenoscopy in the acute phase can distinguish haemobilia from other causes of upper gastrointestinal bleeding and is the first step towards accurate localization of the lesion by hepatic arteriography.

Duodenum↗
PubMed1991

Value of fibreoptic oesophago-gastro-duodenoscopy: experience with 4000 procedures at Kilimanjaro Christian Medical Centre, Moshi, Tanzania.

The paper presents the results of a retrospective study and the experiences with 4000 fibreoptic oesophago-gastro-duodenoscopies (EGD), which were performed at Kilimanjaro Christian Medical Centre (KCMC) between 1985 and 1989 in an open access service. Seventy per cent of all patients examined had abnormal findings with duodenal ulcer as the most frequent diagnosis (22%). Pyloric stenosis was seen in 6%, gastric ulcer in 5% and esophageal varices in 4% of all patients. High figures were found for carcinoma of the esophagus (4%) and malignancy of the stomach (5%). Gastritis was diagnosed in 11%. We consider fibreoptic EGD a cost effective and appropriate technology. Because of its high diagnostic yield, we advocate its use in certain centres in developing countries.

Adolescent↗
PubMed1976

Duodenal tuberculosis as seen by duodenoscopy.

A case of tuberculous stricture of the third part of the duodenum was detected by duodenoscopy. Endoscopic biopsy, however, failed to reveal the histological diagnosis. The possible role of endoscopic follow-up of tubercular strictures is indicated.

Adult↗
PubMed1976

[Deep duodenoscopy and endoscopic retrograde cholangiopancreaticography].

A survey is given on indications, results and complications of the deep duodenoscopy and endoscopic retrograde cholangiopancreaticography. The endoscopic retrograde pancreatography is indicated in the chronic forms of pancreatitis, in suspicion to cysts of the pancreas or tumours. Its results have a decisive influence on the indication to surgical procedure and on the planning of the intervention. The endoscopic retrograde cholangiography is of greatest practical significance for the differential diagnosis of the cholestatic icterus: non-obstructed bile ducts exclude an extrahepatic icterus and render a laparotomy useless. Furthermore, the endoscopic retrograde cholangiography is indicated when the demonstration of the duct is intravenously insufficient, when papillary or prepapillary narrowings are present and in the etiologically unclear syndrome of postcholecystectomy. The most dangerous complications of the endoscopic retrograde pancreatography are the acute pancreatitis and the infection of cysts. Cholangitides and septicaemias appear after the endoscopic retrograde cholangiography only in such cases when obstructions of the drainage are present.

Cholangiography↗
PubMed1975

[Pancreatic biologic reactions after Wirsung opacification under duodenoscopy. Preventive action of Frey's inhibitor (67 cases)].

After retrograde opacification of be pancreatic ducts by duodenoscopy, pancreatic biologic reactions have been studied, especially by amylasemia and lipasemia measures. These biologic reactions have been all the more frequent and intense as Wirsung's duct and its tributaries filling have been important. Frey's inhibitor had a proptious action on these biologic reactions; therefore, it may be used as a preventive treatment.

Amylases↗
PubMed1979

[The influence of a beta-adrenolytic premedication on cardiovascular parameters and plasma free fatty acids during esophago-gastro-duodenoscopy (author's transl)].

Three groups of patients with different premedications were examined for changes of blood pressure, heart rate, ECG and plasma free fatty acid levels during esophago-gastro-duodenoscopy: Group A was premedicated with Bunitrolol, group B was premedicated with Hyoscin-N-butyl-bromide and diazepam, group C was endoscopied without premedication. The pulse rate rose significantly less in group A than in groups A and C; the same phenomenon was observed with regard to the systolic blood pressure. Premature beats occurred in all 3 groups: 32 per cent of the patients in group A, 43 per cent in group B and 60 per cent in group C had at least occasional premature beats; an accumulation of premature beats however occurred significantly less frequently in group A than in groups B or C. A drop of the ST-part of the ECG occurred with about the same frequency in each group. An increase of the plasma free fatty acids, which was noted in groups B and C, could be observed in Group A. A pre-endoscopic medication of beta blocking agents could be a useful measure in patients with labile arterial hypertension, vegatative dysregulation and a hyperkinetic heart syndrome.

Adrenergic beta-Antagonists↗
PubMed1979

[Premedication of esophago-gastro-duodenoscopy with a neuroleptanalgesic drug and a tranquillizer--a controlled clinical study (author's transl)].

In a controlled double-blind randomized study Thalamonal and Valium were compared in 498 esophago-gastro-duodenoscopies. Both drugs were injected intravenously immediately before the procedure. Satisfactory sedation which made additional injection of the drug during the endoscopy superfluous could be achieved in 66% of the patients with Thalamonal and in 52% with Valium respectively. The difference between the two preparations is statistically significant (p less than 0,005). In 95 patients catamnestic studies were performed in order to evaluate second episodes of fatigue after the endoscopy. A good effect of the preparation during endoscopy and a lack of second attacks of sedation following discharge was observed only in 23% of the patients after Thalamonal and in 21% of the patients after Valium injection, respectively. Therfore a good premedication was achieved in only one fifth of the patients receiving one of the two drugs.

Diazepam↗
PubMed1979

[Deep duodenoscopy and ERCP].

The deep duodenoscopy serves for the endoscopico-bioptic clarification of radiologically unclear findings distally from the bulb (niches, sockets, stenoses) and of the positional relations between diverticulum and papilla. As a rule, it is connected with an endoscopic retrograde cholangiopancreaticography (ERCP). The endoscopic retrograde pancreaticography is indicated in relapsing chronic pancreatitis for proving or excluding of changes needing operation which are taken into consideration as partial factors of the relapsing course as well as in suspicion to a local pancreatitis complication and carcinoma of the pancreas. The endoscopic retrograde cholangiography is a decisive aid for the differentiation of the cholostatic icterus. It improves the diagnostics of complaints after operative interventions at the system of the biliary ducts, facilitates the diagnosis of the papillary stenosis and is indicated in insufficient conventional contrasting the biliary ducts. The complications (pancreatitis, cholangitis, cystic infection) have become rare with increasing experience. Contraindications are the florid pancreatitis and cholangitis.

Cholangiography↗
PubMed1978

[Examination of cardiovascular parameters and plasma free fatty acids during esophago-gastro-duodenoscopy (author's transl)].

53 patients were examined for changes of blood pressure, heart rate, ECG and plasma free fatty acids during esophago-gastro-duodenoscopy. In 23 cases there were premature contractions, occuring in small numbers only in most of the cases. Only in 5 cases there was an accumulation of premature contractions and in one case ventricular bigeminism occurred. The maximum of premature beats was observed when the primarily sitting patient was put into supine position. In 7 patients there was a lowering of the ST-segment in the ECG by at least 0.1 mV, mostly in patients who already had an abnormal ST-segment before endoscopy. The pulse rate went up by an average of 50.1 per cent, the systolic blood pressure by 14 and the diastolic blood pressure by 17 per cent. The increase of plasma free fatty acids in the total patient material was not statistically significant, but patients with a deterioration of ECG-findings endoscopy had a significantly higher increase of plasma free fatty acids. There was a tendency towards a positive correlation between the number of premature beats and the increase of plasma free fatty acids. It cannot be decided from our study whether the mobilization of free fatty acids is causing the above observed increase of premature beats or whether both phenomena are merely a result of sympathetic nervous stimulation. Gastric fiberoscopy may be applied to elderly patients with decreased cardiac function. The endoscopic procedure should not be started on the sitting patient but primarily in left supine position.

Adult↗
PubMed1997

[Neonatal esophago-gastro-duodenoscopy. Apropos of 123 examinations performed on 107 newborn infants].

UNLABELLED: Upper gastrointestinal endoscopy is frequently used in the neonatal period. The aim of this study was to assess the frequency of the different lesions occurring as well as to precise indications of upper gastrointestinal endoscopy in neonates. POPULATION AND METHODS: A retrospective study including 107 neonates referred between October 1986 and April 1995 has been achieved in the pediatric gastroenterology unit of the Lille University Hospital. Various factors were analysed: gestational age, sex, reasons for endoscopy and macroscopic lesions observed. Three groups were constituted according to macroscopic findings; group I: normal aspect (n = 22); group II: isolated esophagitis (n = 27); group III: esogastritis or gastroduodenitis or esogastroduodenitis (n = 38). Chi 2 test was performed for statistical analysis. RESULTS: Signs recalling esophagitis (cry during feeding) were more frequent in group II than in group III: 37% vs 13% (P < 0.03). The neonates undergoing endoscopy for life-threatening events were more frequent in group I than in group II or III, respectively: 59% vs 15% (P < 0.01) and 59% vs 8% (P < 10(-4). Upper gastrointestinal endoscopy led to a precise diagnosis in 80% of the neonates. However 95% of those examined for hematemesis presented macroscopic lesions. CONCLUSIONS: Hematemesis and suspicion of esophagitis are good indications for upper gastrointestinal endoscopy in neonatal period. In life-threatening events and suspicion of pyloric stenosis, upper gastrointestinal endoscopy is only complementary of more contributive other examinations.

Duodenoscopy↗
PubMed1991

Investigation of the effect of duodenoscopy on sphincter of Oddi manometry.

To investigate whether endoscopy affects sphincter of Oddi (SO) manometry, three patients who had undergone previous cholecystectomy and had a T-tube in situ for drainage were studied. Manometry was performed using a perfused triple lumen manometry catheter (diameter 1.7 mm), which was advanced into the SO lumen through the T-tube. SO motility, baseline pressure, common bile duct pressure and duodenal pressure were monitored before and during endoscopy while the tip of the endoscope was in the mouth, esophagus (upper third, precardial), stomach and duodenum. Endoscopy and even a moderate insufflation of air necessary to pass the pylorus and inspect the papilla of Vater did not affect the parameters mentioned. Thus, ERCP manometry is a reliable method for evaluation of SO motility which is not affected by endoscopy. Duodenal pressure is a stable parameter and suitable for serving as reference pressure.

Adult↗