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PubMed2003

The significance of routine duodenal biopsies in pediatric patients undergoing upper intestinal endoscopy.

GOALS: To determine the significance of performing routine duodenal biopsies during upper intestinal endoscopy in a pediatric population and to evaluate their contribution to the overall diagnosis. BACKGROUND: Performing duodenal biopsy during every upper endoscopy regardless of the indication for endoscopy and the macroscopic findings, is a controversial topic. Advocates of performing routine biopsies argue that unexpected pathology such as villous atrophy, may have significant clinical implications. Opponents argue that the yield of performing a biopsy on an apparently normal mucosa is low. STUDY: Duodenal biopsies, routinely taken from 201 pediatric patients during upper endoscopy over a 26-month period were retrospectively reviewed. Duodenal biopsies taken during this period for suspected mucosal lesions were not included in the analysis. Indications for endoscopy included suspected peptic disease, gastroesophageal reflux, unexplained vomiting, abdominal pain, iron deficiency anemia and Crohn disease. RESULTS: Of the 201 sets of biopsies reviewed, 159 (79.1%) were normal, 7 had insufficient material for evaluation and 35 (17.4%) carried abnormalities that included: 10 Giardia lamblia (4.9%), 13 mild chronic inflammation (6.5%), and 8 increased intraepithelial lymphocytes (3.9%). Two biopsies showed mixed acute and chronic inflammation, 1 showed lymphatic dilatation and 1 had a mild mucosal lesion. The risk for microscopic pathology in the duodenum was higher when Helicobacter pylori was present in the gastric biopsy (25.98% vs. 12.16% P < 0.02). The negative predictive value of a normal appearing duodenal mucosa was 81.5%, implying that a normal appearing mucosa does not rule out pathology. No complications were encountered in our series. CONCLUSION: We suggest that the inclusion of routine duodenal biopsies as part of upper endoscopy in pediatric patients should be considered favorably. This practice may yield additional pathologic findings that otherwise could have been missed. It should be done regardless of the indication for endoscopy or the gross appearance of the mucosa. This practice does not increase the risk of the procedure.

Adolescent↗
PubMed2006

Alexithymia is associated with gastrointestinal symptoms, but does not predict endoscopy outcome in patients with gastrointestinal symptoms.

BACKGROUND: Alexithymia, where a person has difficulty in distinguishing between emotions and bodily sensations, is considered to be a character trait and a vulnerability factor for various psychosomatic disorders. Assessing alexithymia in patients with gastrointestinal (GI) symptoms before endoscopy might therefore be useful in selecting patients who are more prone to functional GI disorders. GOAL: To determine whether alexithymia might be a useful factor in predicting GI endoscopy outcomes. STUDY: Patients referred for endoscopy between February 2002 and February 2004 were enrolled. They were asked to report alexithymia on the Toronto Alexithymia Scale-20 2 weeks before endoscopy. Information about endoscopic diagnoses was obtained from medical files. RESULTS: A total of 1141 subjects was included (49% male), of whom 245 (21%) reported alexithymia. There was no difference in mean+/-SD alexithymia scores between patients with (51+/-12) and without (50+/-12) an endoscopic organic abnormality at GI endoscopy. When divided into subgroups, according to the most prominent finding at either upper or lower GI endoscopy, there was no association with alexithymia. Patients with alexithymia reported a worse sensation of GI symptoms during the last weeks before enrollment in the study (mean+/-SD symptom severity score: 42+/-34 vs. 34+/-30, respectively; P<0.01). CONCLUSIONS: Alexithymia is not associated with endoscopic findings, and has therefore no additive value in predicting endoscopy outcomes. Patients with alexithymia more often present with a higher number and more severe GI symptoms.

Affective Symptoms↗
PubMed2006

Guidelines for capsule endoscopy: diagnoses will be missed.

BACKGROUND: Capsule endoscopy represents a significant advance in the investigation of intestinal disease. National Institute of Health and Clinical Excellence, European Society of Gastrointestinal Endoscopy and American Society for Gastrointestinal Endoscopy guidelines support capsule endoscopy in obscure GI bleeding, Crohn's disease and the evaluation of non-steroidal anti-inflammatory drug side-effects, polyposis syndromes and coeliac disease. AIM: To determine whether the application of guidelines leads to missed diagnoses that would have been made if less stringent indications were adopted. METHODS: Retrospective analysis of 100 consecutive unselected capsule endoscopy examinations at Homerton Hospital, from October 2003 to November 2005. All referrals accepted following traditional investigations. Indications and findings were recorded. Comparison made as to whether diagnoses would have been missed if guidelines had been followed and capsule endoscopy not performed. RESULTS: Among the subjects 37 patients were children and 55 were male. Indications included recurrent bleeding and anaemia, assessment of Crohn's disease, 'others', i.e. assessment of coeliac disease, Peutz-Jehgers syndrome, Blue Rubber Bleb syndrome or non-specific abdominal pain. In patients with coeliac disease, widespread enteropathy was confirmed, with additional diagnoses of delayed gastric emptying and colitis. For those with abdominal pain findings included angiodysplasia, lymphoid hyperplasia and distal small bowel ulcers. CONCLUSIONS: Capsule endoscopy in patients with non-conventional indications yielded abnormal pathology, such as ulcers and inflammation. If published guidelines had been followed such diagnoses would have been missed.

Adult↗
PubMed2005

Human immunodeficiency virus and endoscopy: Experience of a general hospital in Singapore.

INTRODUCTION: As the human immunodeficiency virus (HIV) pandemic continues, demand on the endoscopic services will also increase. The aim of the present study was to characterize the characteristics and endoscopic findings of HIV-infected Asian patients. METHODS: Patients with HIV/AIDS who had endoscopy from January 1997 to September 2002 were identified and retrospectively reviewed. RESULTS: There were 125 patients (male, 111; mean age: 43.2 +/- 11 years; mean CD4 count 63 +/- 85/mm(3), range, 1-342/mm(3)) who underwent 181 procedures (upper gastrointestinal endoscopy [UGIE], n = 141; lower gastrointestinal endoscopy [LGIE], n = 40). The median time from diagnosis to endoscopy was 240 days (-660 to 4680 days). For UGIE the main findings were candidiasis, 23.1%; cytomegalovirus esophagitis/ulcers, 11.2%; duodenal ulcers, 8.4%; gastric ulcers, 7.0%; portal-hypertensive-related changes, 6.3%; idiopathic esophageal ulcers, 3.5%; herpes simplex esophagitis/ulcers, 3.5%; and tuberculosis, 2.1%. The CD4 counts were significantly lower in those with opportunistic infections (P = 0.004) but there was no difference between significant and non-significant findings (P = 0.191). For LGIE 35% had endoscopic colitis, 80% of which were non-specific. Significant findings were ileal tuberculosis, n = 3; colon cancer, n = 1; and colonic fistula, n = 1. Ten patients had undergone 16 procedures (UGIE, n = 13; LGIE, n = 3) prior to the diagnosis of HIV/AIDS. They were all male Chinese patients, with positive contact with commercial sex workers (CSW) and had lymphopenia at time of endoscopy. The median time from endoscopy to diagnosis was 180 days (range, 1-660 days). There were no significant differences in age (P = 0.512) and CD4 count at diagnosis (P = 0.066) between patients who had endoscopy before and after diagnosis of HIV/AIDS. Four procedures led to the suspicion of HIV. CONCLUSIONS: Endoscopic findings of symptomatic HIV Asian patients are comparable to those of the West. Universal precautions should always be exercised in all procedures to avoid transmission of disease.

AIDS-Related Opportunistic Infections↗
PubMed1998

Endoscopies in pediatric small intestinal transplant recipients: five years experience.

OBJECTIVE: Intestinal transplantation has become an option as a treatment for permanent intestinal failure. Endoscopy is an essential tool in assessing the intestinal allograft after intestinal transplantation. The aim of this study was to analyze our experience using endoscopy in intestinal transplant recipients. METHODS: This was a retrospective review of endoscopic and histological reports in 41 children who received an intestinal transplant between 1990 and 1995 at Children's Hospital of Pittsburgh. RESULTS: A total of 1273 endoscopies was performed of which 760 were ileoscopies via allograft ileostomy, 273 were upper endoscopies, and 240 were colonoscopies. One hundred four rejection episodes were documented histologically in 32 patients, 6 days to >4 yr after transplantation. Most episodes were mild and easily treated with increased immunosuppression; however, severe rejection with mucosal exfoliation was seen in nine patients. Rejection sometimes involved only part of the allograft. Endoscopic appearance alone without biopsies was sensitive enough to diagnose only 63% of the rejection episodes. Epstein-Barr and cytomegalovirus infections occurred in 11 and eight patients, respectively, and involved both native bowel and allograft in some. Complications of endoscopy were few: one perforation, three episodes of bleeding, and three episodes of transient respiratory compromise. CONCLUSIONS: Endoscopy is an essential tool in the postoperative assessment of intestinal transplant recipients. Frequent surveillance ileoscopies with biopsies should be performed after transplantation. If patients clinically deteriorate with fever, diarrhea, bacteremia, or gastrointestinal bleeding and a clear cause is not elucidated by ileoscopy, an upper endoscopy with biopsies is indicated.

Adolescent↗
PubMed2004

Controlled prospective evaluation of the diagnostic yield of a laryngopharyngeal screening examination during upper gastrointestinal endoscopy.

BACKGROUND AND AIMS: Examination of the laryngopharyngeal area is not always performed during routine upper gastrointestinal (UGI) endoscopies although older studies reported pathological findings in 0.9-3.5% of cases. The aim of our study was to prospectively evaluate the positive and negative predictive value of screening the laryngopharyngeal area during routine UGI endoscopy. METHODS: All patients undergoing elective UGI endoscopy between July 2000 and July 2001 were prospectively enrolled into the study. These patients underwent a careful structured examination of the laryngopharyngeal area, which was videotaped for later blinded review. If a pathological finding was suspected, patients were referred to the study otorhinolaryngologist for further evaluation. In all other cases the videotapes were reviewed by the otorhinolaryngologist, who was blinded to the endoscopic findings. RESULTS: During the study period, 1311 endoscopies were performed in 1209 patients; 1191 were fully evaluated. In 62 endoscopies a pathology in the laryngopharyngeal area was suspected. Forty two were examined by the study otorhinolaryngologist whereas in the remaining 19 only a review of the videotape was possible. In 26 patients pathology was confirmed, corresponding to a positive predictive value of 43% and a negative predictive value of 100%. In one patient (0.08%), an early cancer of the pharyngeal region was detected whereas all other findings were benign lesions. CONCLUSIONS: A screening examination of the laryngopharyngeal area should be part of every UGI endoscopy. A serious pathology such as an early cancer may be detected in approximately 1 in 1000 endoscopies.

Adolescent↗
PubMed2003

Upper gastrointestinal endoscopy performed by nurses: scope for the future?

BACKGROUND: Previous researchers have shown that non-medical endoscopists can perform lower gastrointestinal endoscopy as safely and effectively as medical staff. However, it is not known if upper gastrointestinal endoscopy performed by medical and non-medical endoscopists in clinical practice yields similar results in terms of performance, patient discomfort, and satisfaction. AIM: To determine differences in the yield of diagnosis for significant disease during upper gastrointestinal endoscopy performed by nurse and medical endoscopists and to measure patient discomfort, satisfaction, and attitudes towards future endoscopy. PATIENTS: This two part study included 3009 patients in a retrospective analysis and 480 in a prospective study. METHODS: The first part of the study assessed indications for endoscopy, diagnoses, and procedures performed by medical and nurse endoscopists. In a second prospective study, 480 patients were included to determine the association between endoscopist type and sedation, patient anxiety, discomfort, satisfaction, and attitudes towards future sedation. RESULTS: No patient refused endoscopy by either a nurse or medical endoscopist and there were no complications in either group. Nurses performed 1487 procedures and reported fewer endoscopies as "normal" than medical staff (p=0.006). Multivariate analysis showed that male sex, older age, inpatient status, dysphagia, and gastrointestinal bleeding, but not endoscopist type, were all associated with significant disease. In relation to discomfort and satisfaction, a similar proportion of patients received sedation in both groups (p=0.81). There were no differences in pre-procedure anxiety (p=0.61), discomfort during intubation (p=0.97), discomfort during examination (p=0.90), or post-procedure examination rating (p=0.79) in patients examined by medical or nurse endoscopists. CONCLUSION: Experienced nurses perform routine diagnostic gastroscopy safely in everyday clinical practice and with as little discomfort and as much patient satisfaction as medical staff.

Age Factors↗
PubMed2000

Survey of symptoms, respiratory function, and immunology and their relation to glutaraldehyde and other occupational exposures among endoscopy nursing staff.

OBJECTIVES: To find the nature and incidence of symptoms experienced by a large sample of hospital endoscopy nurses. To find whether nurses in endoscopy units develop asthma under current working conditions in endoscopy units. To obtain analytically reliable data on exposure concentrations of glutaraldehyde (GA) vapour in endoscopy units, and to relate them to individual hygiene and work practices. To characterise any exposure-response relations between airborne GA and the occurrence of work related symptoms (WRSs). Due to the growing concern about the perceived increase in WRSs among workers regularly exposed to biocides, all of whom work within a complex multiexposure environment, a cross sectional study was designed. METHODS: Current endoscopy nurses (n=348) from 59 endoscopy units within the United Kingdom and ex-employees (who had left their job for health reasons (n=18) were surveyed. Symptom questionnaires, end of session spirometry, peak flow diaries, skin prick tests (SPTs) to latex and common aeroallergens, and measurements of total immunoglobulin E (IgE) and IgE specific to GA and latex were performed. Exposure measurements included personal airborne biocide sampling for peak (during biocide changeover) and background (endoscopy room, excluding biocide changeover) concentrations. RESULTS: All 18 ex-employees and 91.4% of the current nurses were primarily exposed to GA, the rest were exposed to a succinaldehyde-formaldehyde (SF) composite. Work related contact dermatitis was reported by 44% of current workers exposed to GA, 56.7% of those exposed to SF composite, and 44.4% of ex-employees. The prevalence of WRSs of the eyes, nose, and lower respiratory tract in current workers exposed to GA was 13.5%, 19.8%, and 8.5% respectively and 50%, 61.1%, and 66.6% in the ex-employees. The mean percentage predicted forced expired volume in 1 second (ppFEV(1)) for ex-employees (93.82, 95% confidence interval (95% CI) 88.53 to 99.11) was significantly lower (p<0.01) than that of current workers exposed to GA (104.08, 95% CI 102.35 to 105.73). Occupational peak flow diaries completed by current workers with WRSs of the lower respiratory tract showed no evidence of bronchial asthma (<15% variation). Six per cent of the population had positive latex SPTs. Positive indications of one GA specific IgE and 4.1% latex specific IgE occurred. There was no conformity between the latex specific IgE and positive SPTs. Positive SPTs to latex were associated with WRSs of dermatitis and ocular WRSs, but no other WRSs. Exposures were above the current maximum exposure limit (MEL) of 0.2 mg/m(3) (0.05 ppm) in eight of the units investigated. A significant relation existed between peak GA concentrations and work related chronic bronchitis and nasal symptoms (after adjustment for types of local ventilation) but not to other WRSs. Peak GA concentrations were significantly higher in units that used both negative pressure room and decontaminating unit ventilation. CONCLUSION: This study documents a significant level of symptoms reported in the absence of objective evidence of the physiological changes associated with asthma. Ex-employees and current workers with WRSs warrant further study to elucidate the cause and mechanisms for their symptoms. Ventilation systems used for the extraction of aldehydes from the work area may be less effective than expected and due to poor design may even contribute to high peak exposures.

Air Pollutants, Occupational↗
PubMed1993

Open access endoscopy: is the lost outpatient clinic of value?

To test the value of an outpatient visit in patients with dyspepsia, 79 patients considered suitable for open access endoscopy by their general practitioners were instead seen in the medical outpatient clinic first. In 35 patients immediate endoscopy was seen as an inappropriate investigation and 23 of these were spared endoscopy. In 11 patients important extra diagnoses were made in the clinic which would have been delayed or missed had the patients been sent straight for open access endoscopy. Sixty-eight per cent of patients, when asked by questionnaire, said they preferred to be seen in the clinic first rather than come for open access endoscopy. These results lend support to the traditional medical clinic appointment followed by endoscopy if and when appropriate rather than the open access endoscopy system.

Adult↗
PubMed2005

Intravenous proton pump inhibitors before endoscopy in bleeding peptic ulcer with high-risk stigmata: a multicentre comparative study.

BACKGROUND: It is not clear if starting intravenous proton pump inhibitors (IV PPI) before endoscopic therapy provides additional benefit over starting it afterward in patients with high-risk ulcer stigmata of peptic ulcer disease. METHODS: All patients who received IV pantoprazole bolus and infusion and underwent endoscopy in six Canadian hospitals over 20 months were reviewed. Only patients with high-risk ulcer stigmata (arterial bleeding, oozing, nonbleeding visible vessel or adherent clot) were included. Patients receiving IV PPI before endoscopy (before group) were compared with those who received it after endoscopy (after group) with respect to endoscopic findings and, secondarily, to patient demographics and clinical outcomes. RESULTS: The demographics and baseline characteristics of the before group (n=57) and the after group (n=109) were similar. The before group was more likely to have had IV PPI started outside of daytime hours, and median time to endoscopy in patients admitted with upper gastrointestinal bleeding was 24 h (interquartile range 9.5 to 35) in the before group and 11.3 h (interquartile range 3.7 to 17.2) in the after group (P<0.0001). At the time of endoscopy, 33% of patients in the before group had actively bleeding lesions (Forrest 1a or 1b) compared with 54% in the after group (P=0.01), but there were no significant differences in rebleeding, surgical rates, intensive care unit admission or death between the groups. CONCLUSION: IV PPI infusions before endoscopy may lower the proportion of actively bleeding peptic ulcer lesions at endoscopy, but this finding does not appear to affect rates of rebleeding, surgery or death.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2003

Contact endoscopy for intraoperative parathyroid identification.

Experienced thyroid surgeons are often able to identify the parathyroid glands, but sometimes it is difficult to differentiate them from other contiguous tissues. Contact endoscopy was introduced in otolaryngology for the characterization of normal and pathological epithelia. Our objective was to analyze contact endoscopy as an auxiliary method for identification of the parathyroid glands during thyroid surgery. Five total thyroidectomies and 5 hemithyroidectomies were performed in September 2001. After surgical exposure, contact endoscopy was performed. A total of 15 peritracheal regions were studied. Superior and inferior parathyroid tissues were identified on the basis of color, size, and probable location. Contact endoscopy was performed before and after use of methylene blue stain. Contact endoscopy was also used in neighboring areas. We compared the visual impression to the contact endoscopy findings. Two structures were visually supposed to be the superior and inferior parathyroid glands in each case. From 30 visually supposed glands, 25 were confirmed by telescope. Of the other 5 structures initially supposed to be parathyroid tissue, 3 were adipose tissue and 2 were thyroid parenchyma. In the 5 cases in which the identification of one of the glands was not confirmed, an additional contact examination enabled us to further identify parathyroid glands in 3 cases in which structures were initially identified as adipose tissue. Contact endoscopy is an efficient auxiliary method for the identification of the parathyroid glands during thyroid surgery that poses little risk of morbidity to the patient.

Adipose Tissue↗
PubMed1994

Cochlear endoscopy with preservation of hearing in guinea pigs.

Advances in fiberoptic technology have revolutionized the way many disorders are treated by otolaryngologists. We have previously described our experiences with cochlear endoscopy during cochlear implantation. However, endoscopy of the functioning cochlea has not previously been reported. To test the hypothesis that endoscopy of the guinea pig cochlea is possible without catastrophic loss of auditory function, we subjected 20 ears of 10 Hartley-strain albino guinea pigs to limited endoscopy of the cochlea through the round window with evaluation of distortion product otoacoustic emissions and auditory brain stem responses. Insertion of the endoscope caused measurable changes in auditory brain stem response latency and amplitude. Distortion product otoacoustic emission amplitudes were reduced an average of 6 dB with greater loss close to the round window. Frequencies above 18 kHz, corresponding to the region of endoscopy, were not evaluated in this preliminary study and are suspected to have sustained more damage. Results demonstrate that endoscopy of the guinea pig cochlea is possible without major loss of the above physiologic measures in the regions tested. If endoscopy of the cochlea is to become a tool with clinical and basic science applications, refinements in techniques to avoid damage are necessary.

Animals↗
PubMedDate not supplied

Nasal endoscopy: its role in office diagnosis.

To clarify the role of nasal endoscopy in the diagnosis and treatment planning for patients with nasal or sinus complaints, 100 consecutive new patients were evaluated. Patients were excluded if their only complaint was obstruction and they had a septal deviation as the only clinical finding. Each patient underwent a thorough history and head and neck examination, including anterior rhinoscopy before and after decongestion, and the diagnosis and treatment plans were documented. Each then underwent nasal endoscopy, and the diagnosis and treatments were compared. The most common diagnoses after anterior rhinoscopy were allergic rhinitis (21), nonallergic rhinitis (12), chronic sinusitis with polyps (19) or without polyps (9), and nonsinus pain (13). Nasal endoscopy played a role in 11% of patients, although in no case did endoscopy change the diagnosis or treatment plan. Endoscopy allowed visualization past an enlarged turbinate or septal deviation in six patients, confirmed a suspected diagnosis in three by visualization of the middle meatus, and detected the site of a large choanal polyp in one. In one case, endoscopy identified a paradoxical turbinate on the side opposite the symptoms and radiological findings. Routine nasal endoscopy need not be part of the evaluation of all patients with nasal sinus disorders but is particularly valuable in confirming diagnoses, particularly in patients where anterior rhinoscopy is limited by anatomic obstruction.

Adult↗
PubMed1991

Patient attitudes to sedation for diagnostic upper endoscopy.

The presumed need for sedation in upper gastrointestinal endoscopy differs widely between countries and between endoscopists. Very little is known about patient attitudes and the factors that influence patient discomfort. We investigated all ambulatory patients scheduled for diagnostic upper GI endoscopy during a 4-month period (n = 1169) for their attitudes to sedation. One week before the examination they were asked whether they wanted sedation in addition to topical throat anesthesia. A brief description of the endoscopic procedure was given together with an explanation of presumed advantages and disadvantages of sedation. Only 399 patients (34.1%) wanted sedation. The two groups of patients were comparable as to age, gender, and previous experience of endoscopy. Of the 399 patients wanting sedative medication 54.2% were afraid of the diagnosis and 45.8% of the procedure. Male sex and young age were associated with a lower rate of preferring sedation. Patient discomfort during endoscopy was negatively correlated with age (r = -0.309; p = 0.000). Patients who had had more than one previous endoscopy had less discomfort than those without endoscopy experience (p = 0.0069). Men had less discomfort than women (p = 0.0014). The vast majority of our patients preferred 'a normal afternoon to endoscopy sedation'. Young women not previously endoscoped potentially benefit most from sedation.

Adult↗
PubMed2004

Complications of endoscopy of the upper gastrointestinal tract: a single-center experience.

OBJECTIVE: To evaluate prospectively the complications that occurred during consecutive endoscopies of the upper gastrointestinal tract. PATIENTS AND METHODS: We evaluated all endoscopies of the upper gastrointestinal tract (except endoscopic retrograde cholangiopancreatography and endosonography) performed at the Ambulatory Surgical Center at the Mayo Clinic in Jacksonville, Fla, between January 1999 and June 2002. A staff gastroenterologist with or without a trainee performed these procedures. Therapeutic procedures included esophageal band ligation, injection sclerotherapy, botulinum toxin injection, extended upper endoscopy, pneumatic balloon dilation, endoscopic mucosal resection, and endoscopic ablation using thermal laser, argon beam coagulator, or photodynamic therapy. All complications were tabulated prospectively as per mandatory state licensure reporting. RESULTS: Complications after diagnostic endoscopy of the upper gastrointestinal tract were related to anesthesia in 2 of the 12,841 patients. Perforations in 5 patients were associated with esophageal dilation (2), resection of duodenal lesions (2), or passage of a side-viewing instrument into the duodenum (1). No deaths occurred. CONCLUSIONS: Diagnostic endoscopy of the upper gastrointestinal tract is safe, with a complication rate of less than 1 per 5000 cases. Therapeutic endoscopy increases the risk of complications. Compared with complication rates published previously, our results from a single center indicate a favorable reduction in complications related to endoscopy of the upper gastrointestinal tract.

Aged↗
PubMed1993

Transmission of infection by gastrointestinal endoscopy and bronchoscopy.

OBJECTIVE: To review reports on the transmission of infections by flexible gastrointestinal endoscopy and bronchoscopy in order to determine common infecting microorganisms, circumstances of transmission, and methods of risk reduction. DATA SOURCES: Relevant English-language articles were identified through prominent review articles and a MEDLINE search (1966 to July 1992); additional references were selected from the bibliographies of identified articles. STUDY SELECTION: All selected articles related to transmission of infection by gastrointestinal endoscopy or bronchoscopy; 265 articles were reviewed in detail. DATA SYNTHESIS: Two hundred and eighty-one infections were transmitted by gastrointestinal endoscopy, and 96 were transmitted by gastrointestinal endoscopy, spectrum of these infections ranged from asymptomatic colonization to death. Salmonella species and Pseudomonas aeruginosa were repeatedly identified as the causative agents of infections transmitted by gastrointestinal endoscopy, and Mycobacterium tuberculosis, atypical mycobacteria, and P. aeruginosa were the most common causes of infections transmitted by bronchoscopy. One case of hepatitis B virus transmission via gastrointestinal endoscopy was documented. Major reasons for transmission were improper cleaning and disinfection procedures; the contamination of endoscopes by automatic washers; and an inability to decontaminate endoscopes, despite the use of standard disinfection techniques, because of their complex channel and valve systems. CONCLUSIONS: The most common agents of infection transmitted by endoscopy are Salmonella, Pseudomonas, and Mycobacterium species. To prevent endoscopic transmission of infections, recommended disinfection guidelines must be followed, the effectiveness of automatic washers must be carefully monitored, and improvements in endoscope design are needed to facilitate effective cleaning and disinfection.

Bronchoscopes↗
PubMed1976

[The importance of endoscopy in oncology].

The importance of the praetherapeutic histological manifestation of tumours is emphasized. In many cases for this purpose an endoscopy with biopsy is necessary. A particular role plays the endoscopy in urology, bronchology and gastroenterology. The endoscopy significantly developed by the introduction of fully flexible glass fibre endoscopes. This particular considers the gastroenterology. Several regions, such as the duodenum, the small intestine and the colon, were thus first accessible to endoscopic biopsy. Indications and possibilities of the individual endoscopic methods are mentioned. As to the question, who individually should perform the endoscopy, the opinion is expressed that every specialist should perform the endoscopy in his field. The performance of all endoscopic methods by one specialist, independent on the speciality, actually gives some technical advantages, which, however, do not compensate the disadvantages concerning a qualified total diagnostics of the diseases. During the last years by the removal of the polyps the endoscopy in an increasing stage also becomes a therapeutic method. At present the technical possibilities of endoscopy came to a certain close. By all means necessary is, however, the further distribution of the endoscopic methods which depends on the availability of adequate endoscopes.

Diagnosis, Differential↗
PubMedDate not supplied

Gastrointestinal endoscopy training in India.

A structured endoscopy training program with clear goals for proper teaching and evaluation serves to alleviate apprehensions in the minds of trainees regarding this crucial area. It also ensures that training is acquired not in isolation but in the setting of ongoing patient care, so that the emphasis is on how the procedure fits into the overall management plan for the patient. By specifying the details of the endoscopy unit set-up, the qualifications of the trainer and the number of procedures to be performed by the trainee, it is hoped that uniformity will be produced in the quality of training imparted, whether it be in a teaching or a non-teaching hospital. The end-product of such training, through the DM/MCh or the DNB stream, is a gastroenterologist who is also a certified endoscopist, capable of performing all standard diagnostic and therapeutic procedures. A further period of focused training for 1 to 2 years is required to achieve the level of competence expected of an advanced therapeutic endoscopist. There is little room for short-term training courses in endoscopy for the basic training of an endoscopist, although such courses are useful as CME activities, for the maintenance and renewal of skills of the trained endoscopist, as well as providing him with exposure to new and evolving therapeutic techniques. Efforts at improving and standardizing the training and practice of GI endoscopy in India are likely to remain exercises in futility without the active and dynamic involvement of all the leading professional societies in the country. The need of the hour is the establishment of technical committees for laying down standards in training and practice of GI endoscopy that should be voluntarily approved by all these societies so that they may then be implemented by the State medical councils and the MCI. A move in this direction from within the profession is far more appropriate and is also likely to find greater acceptance than such moves imposed from above, at the behest of judicial authorities. A system of hospital accreditation committees for large public and private sector hospitals offering endoscopy services, supervised by the accreditation committee of the State medical council, needs to be established. Clinics and nursing homes offering these services also need to be approved by the same committee after meeting standards similar to those laid down for larger hospitals. Mechanisms for audits of performance and outcome of endoscopic procedures as well as periodic participation in CME activities for maintenance of skills and expertise need to be established and linked to periodic renewal of credentials for practising GI endoscopy. Procedures for credentialing for new endoscopic techniques need to be established. The path ahead is long and arduous but we must tread it for it will only become more difficult if we procrastinate.

Clinical Competence↗