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PubMed1999

Digestive endoscopy: relevance of negative findings.

In patients with digestive complaints, endoscopy is the gold standard and is often the primary exploration. Positive findings in upper gastrointestinal endoscopy occur in 30 to 40% in relation to a benign or malignant structural disease. Negative findings occur therefore in 60 to 70% of cases: dyspepsia and/or reflux are functional diseases. Colonoscopy aims essentially at screening of colorectal cancer. Digestive cancer is very rare under 50 years, and most cases detected with symptoms are advanced; asymptomatic early and curable cancer is detected in screening. A negative finding at endoscopy is reliable in the hands of an experienced endoscopist controlling the risk of false negative and false positive findings. A reliable negative endoscopy is beneficial for the quality of life when it relieves anxiousness of the patient. It may be cost effective if drugs and consultations are decreased. Overuse of negative endoscopy is not so much through large indications, that in repetition of negative procedures. The relevance of negative endoscopy in screening for cancer in the upper and lower digestive tract, is whether is should be repeated. There is tendency to increased intervals in surveillance protocols. In the very near future the first role of endoscopy in the primary diagnosis could be challenged by concurrent techniques. Future progress is based upon a Quality Assurance program for quality, experience of the operator a control of the cost and a research programme on tolerance with a trend to reduced sedation.

Cost-Benefit Analysis↗
PubMed2001

[Diagnostic benefit of gastrointestinal endoscopy in infants under one year of age--a two-year survey].

INTRODUCTION: Gastrointestinal endoscopy in children is a well-established procedure. We reviewed our experience of endoscopy in infants below one year of age to evaluate indications, endoscopic findings, histology, and complications. MATERIAL AND METHODS: Twenty-eight infants were studied over a two-year period. Of these, 18 underwent upper endoscopy, six recto/sigmoidoscopy or colonoscopy, and four both procedures. RESULTS: The most common indication (10/22) for upper endoscopy was vomiting and suspicion of gastrooesophageal reflux disease. In these infants, 24-hour continuous monitoring of the oesophageal pH followed the procedure. Indications for lower endoscopy were rectal bleeding (n = 6) and intractable diarrhoea (n = 4). There were no complications to anaesthesia, endoscopy, or biopsy. Overall, there were endoscopic abnormalities in 82% and histological abnormalities in 75% of the infants. The diagnostic findings included rare disorders, such as eosinophilic gastroenteritis, microvillous inclusion disease, and chylomicron retention disease. Diagnosis of these diseases requires gastrointestinal biopsy. DISCUSSION: Gastrointestinal endoscopy is a safe procedure, which is a valuable part of the diagnostic work-up in a selected group of infants with long-lasting or severe gastrointestinal symptoms.

Colonoscopy↗
PubMed2001

Sedation for gastrointestinal endoscopy. Analysis of tolerance and complications.

OBJECTIVE: To analyse tolerance and complications in patients undergoing a gastrointestinal endoscopy. PATIENTS AND METHODS: One hundred forty three patients were prospectively studied: 44.8% underwent a diagnostic upper endoscopy; 13.3%, a therapeutic upper endoscopy; 37%, a diagnostic colonoscopy and 4.9%, a therapeutic colonoscopy. Midazolam or midazolam combined with meperidine were used. Tolerance, level of sedation and complications were studied. Chis quare and ratio comparison tests were used for the statistical analysis. P-values less than 0.05 were considered as statistically significant. RESULTS: In the diagnostic upper endoscopy group, tolerance was better with midazolam plus meperidine vs midazolam only (83.8% and 59.3% respectively); p < 0.05. In the therapeutic upper endoscopy group, tolerance was also better when both drugs were combined; p < 0.05. In the diagnostic and therapeutic colonoscopy groups, tolerance was good in 63.5% and 85.7% of patients, respectively. Men had better tolerance for upper endoscopy; p < 0.05. Tolerance was worse in patients under 40 years of age for upper endoscopy; p < 0.05. Mild desaturation occur in 27.3% of patients, being more severe in therapeutic procedures; p < 0.05. CONCLUSIONS: Tolerance was good in a high percentage of patients, and better in men and in patients older than 40 years of age. The main problem is desaturation, that increases in therapeutic procedures.

Adolescent↗
PubMed2002

[A developmental history of endoscopy].

The real development of endoscopy began from modern times, though people have attempted to observed cavities of human body for advancing their knowledge of diseases for a long time. Generally, the development of endoscopy can be divided into the following stages: the stage of rigid - tube system, semiflexible instruments, fiberoptic endoscopy, endoscopic ultrasonography and electronic endoscopy etc. Now, endoscopy is not only used in diagnosis, but also in therapy. The development of endoscopy started quite late in China. However, due to the great efforts made by the endoscopic physicians and some experts, the clinical applications and operations of endoscopy have been upgraded to the international level, and the manufacture engineers of medical instruments have also made contributions to the endoscopic development of China.

China↗
PubMed2004

Wireless capsule endoscopy in Chinese patients with suspected small bowel diseases.

OBJECTIVE: To evaluate the use of wireless capsule endoscopy in Chinese patients. DESIGN: Retrospective analysis. SETTING: University teaching hospital, Hong Kong. PATIENTS: Twenty-eight patients who had undergone wireless capsule endoscopy between December 2002 and December 2003. MAIN OUTCOME MEASURES: Diagnoses according to findings of capsule endoscopy and complications from the procedure. RESULTS: The mean age of the 28 patients (15 men and 13 women) was 60.0 (standard deviation, 18.3) years. The indications for capsule endoscopy were obscure gastro-intestinal bleeding (n=16), unexplained iron-deficiency anaemia (n=9), and recurrent abdominal pain (n=3). Half of the patients had abnormal endoscopy findings that may account for their presenting symptoms. The most common abnormality was angioectasia of the small bowel. Small bowel ulcers and erosions were also noted in three patients with obscure bleeding. In contrast, none of the patients with recurrent abdominal pain had abnormal capsule endoscopy. No complications arose from the procedure. CONCLUSIONS: Wireless capsule endoscopy is a safe and useful mode of investigation for the diagnosis of obscure gastro-intestinal bleeding in Chinese patients.

Abdominal Pain↗
PubMed2002

[Endoscopy in the diagnosis of chronic hepatitis C--diagnosis and therapy depending on the phase of diseases progression and liver regeneration].

The GI endoscopy can be divided into upper GI tract endoscopy (esophago-, gastro-, entero-, fistulo- and cholangioscopy) and lower GI tract endoscopy (recto-, sigmoido-, colonoscopy) from practical point of view and the characteristic of used equipment. A lot of therapeutic methods for GI tract is associated with each of these procedures. GI tract endoscopy doesn't play significant part in diagnosis of acute and chronic C hepatitis. Significance of endoscopy procedures decidedly increases in the case of progressive liver fibrosis and liver cirrhosis associated with HCV infection., where changes in GI tract are observed to 87% patients. These changes can be divided into: 1) not associated with portal hypertension, 2) these ones caused by portal hypertension. The most observed changes not associated with portal hypertension involve: reflux esophagitis, esophageal candidiasis; different variants of gastritis, gastric and duodenal ulcer. To the changes connected with portal hypertension, which are possible for endoscopy assessment, belongs esophageal and gastric varices, portal gastro-, entero-, colopathy, and gastric antral vascular ectasiae (GAVE). However to-day endoscopy has got not only diagnostic significance but also enables: estimation of pharmacotherapy efficiency, the primary and secondary prophylaxis of bleedings from GI varices as well as therapy of GI bleeding in this group of patients.

Endoscopy, Digestive System↗
PubMedDate not supplied

[Sensitivity and specificity of endoscopy for the detection of velocardiofacial syndrome].

INTRODUCTION: Velo-cardio-facial syndrome (VCFS) (also known as DiGeorge sequence, and 22q11.2 deletion syndrome among other labels) is now recognized as the most common syndrome associated with cleft palate and velopharyngeal insufficiency. 22q11.2 deletion syndrome has been associated with medially positioned internal carotid arteries. This anomaly may be associated with posterior pharyngeal pulsations seen on endoscopy. The purpose of this paper is to study the diagnostic efficacy of the endoscopy for the detection of patients with 22q11.2 deletion syndrome, using as gold standard test the fluorescence in situ hybridization (FISH) test. MATERIAL AND METHODS: Twenty nine patients with submucous cleft palate, velopharyngeal insufficiency, and 22q11.2 deletion as demonstrated by FISH were studied. Also, 29 patients with submucous cleft palate, and without abnormalities in the FISH procedure, were studied as controls. All patients from both groups underwent endoscopy. A double-blind procedure was utilized whereby all videonasopharyngoscopies were independently revised by the two examiners. RESULTS: Twenty five patients with VCFS demonstrated posterior pharyngeal pulsations seen on endoscopy (sensitivity of 86%). In contrast, none of the patients from the control group showed posterior pulsations (specificity of 100%). Positive predictive value was 100%, and negative predictive value was 87%. CONCLUSIONS: Endoscopy seems to be a safe and reliable procedure for evaluating patients with 22q11.2 deletion syndrome. The observations of posterior pharyngeal wall pulsations on endoscopy should alert clinicians to the diagnosis of 22q11.2 deletion, and also, can be useful for preventing the risk of damage to the carotid arteries during velopharyngeal surgery. This indicates another important role of endoscopy in the preoperative assessment of children for palatopharyngoplasty.

Abnormalities, Multiple↗
PubMed2004

Result of wireless capsule endoscopy in patients with suspected small bowel disease: the first series from Thailand.

BACKGROUND AND AIMS: Capsule endoscopy (CE) is a promising diagnostic tool for patients with obscure gastrointestinal bleeding. Only a few papers have reported data from Asian countries. This retrospective study aimed to demonstrate result of capsule endoscopy in patients with suspected small bowel disease as the first series from Thailand. METHOD: Twenty-one patients who underwent wireless capsule endoscopy between July 2003 and June 2004 at King Chulalongkorn Memorial Hospital were retrospectively reviewed in the present study. The indications for capsule endoscopy were overt obscure gastro-intestinal bleeding (n= 12), occult obscure gastro-intestinal bleeding (n=5), chronic recurrent abdominal pain (n=3) and chronic diarrhea (n=1). Diagnoses according to findings of capsule endoscopy were classifield into definite, suspicious and negative finding. RESULTS: The mean age of the 21 patients (10 men and 11 women) was 46 (standard deviation, 18.57) years. Of those 17 obscure gastrointestinal bleeding patients, there were positive findings in 11 from 17 patients (65%). Four patients (24%), 3 with tumor and another with AVM, were classified as definite results. Seven patients (41%), 6 with angioectasia and another with a small ulcer, were classified as suspicious because there was no demonstrated active bleeding lesion and no other clinical supportive evidence. Of these 3 patients with recurrent abdominal pain, one patient (33%) with terminal ileum lymphoid hyperplasia was classified as definite result because of clinical improvement after treatment of the lesion. Another case of chronic diarrhea yielded a negative result. CONCLUSION: Wireless capsule endoscopy is a safe and useful mode of investigation for the diagnosis of obscure gastrointestinal bleeding in Thailand. There is not so much difference in capsule endoscopy results between Western and Asian series.

Abdominal Pain↗
PubMed2005

[Wireless capsule endoscopy and its role in gastroenterology: our results and a review of the literature].

INTRODUCTION: Since its recent introduction, capsule endoscopy has revolutionized the diagnostics of diseases of the small bowel. The number of studies on the use of this method is constantly increasing. Along with this, our knowledge about the usability and diagnostic power of capsule endoscopy is growing and the indications for this technique are getting progressively more accurate. AIMS: To study the usability of capsule endoscopy in suspected Crohn's disease, in gastrointestinal bleeding of small bowel origin, and in undetermined abdominal complains. METHOD: Capsule endoscopy was performed in 20, previously examined, carefully selected patients. RESULTS: Positive findings were recorded in all patients with gastrointestinal bleeding and in 3/4 of patients with suspected Crohn's disease. However, in patients with indeterminate abdominal complains, the capsule endoscopy proved to be inefficient. CONCLUSION: In the study below, based on their own experience, the authors try to provide an overall picture of capsule endoscopy by reviewing contemporary medical literature. The usability of the capsule endoscopy in suspected Crohn's disease and gastrointestinal bleeding of small bowel origin is suggested by the results of the study.

Adolescent↗
PubMed1991

Efficacy and outcome of an open access endoscopy service.

In a retrospective questionnaire-study, we have attempted to elucidate how open access endoscopy influences management of dyspeptic patients, with special focus on young patients (less than 40 year), since the proportion of examinations with findings not requiring medical treatment are consistently reported higher in this age group. During a one-year period, 436 patients referred for open access endoscopy and their general practitioners completed questionnaires giving details of medical treatment, consultation rate for dyspepsia and global assessment before and 6-18 months after the endoscopy. Relevant changes in medical treatment (stopped in patients with no or minor abnormalities or started in patients with major abnormalities) was found for 27% of the patients, irrespective of age group. The result of the endoscopy provided reassurance for 70% of the patients with no or minor abnormalities. Reassurance was coupled with a lower consultation rate and with fewer symptoms. Altogether, 83% of the young patients with no or minor abnormalities had a positive outcome of the endoscopy. As the endoscopy service introduced relevant and lasting prescription habits and reduced consultation rates at general practitioners, also for younger dyspeptic patients with no or minor abnormalities, the strategy generally proposed of a trial with H2-receptor antagonists before considering referral for endoscopy should be subjected to formal clinical trial evaluating all relevant levels of efficacy.

Adolescent↗
PubMed1991

Same-day upper and lower inpatient endoscopy: a trend for the future.

Performance of same-day upper and lower endoscopy has many potential advantages, as it may reduce costs, shorten hospital stay, and expedite patient care, but its feasibility, efficacy, and potential have not been carefully defined. We report here our experience with a group of 87 patients who underwent same-day upper and lower endoscopy (174 procedures) over a 2-yr period at a tertiary care VA Hospital, compared with an alternate-day upper and lower endoscopy group of 50 patients (100 procedures) over the same time period. Most patients were elderly males. Common indications for endoscopy were occult or overt gastrointestinal bleeding, previous or concomitant history of pertinent pathology (i.e., polyps, ulcers), abdominal pain, diarrhea, or other symptoms, abnormal radiological studies, and iron deficiency anemia. Both groups required similar amounts of intravenous sedation. There were no complications in either group. In both groups, common positive findings were inflammation (i.e., colitis, esophagitis), benign neoplasms, diverticulae, peptic ulcer, and cancer. In both groups, only 2-6% had negative upper and lower endoscopy, whereas either one procedure was negative in 25% and 18% of cases, respectively. We conclude that the practice of same-day inpatient upper and lower endoscopy is feasible, has excellent diagnostic yield, even in the elderly, and carries no increased risks. When indicated, the practice of same-day upper and lower endoscopy should be encouraged.

Adult↗
PubMed1988

Arterial oxygen saturation during upper gastrointestinal endoscopy: influence of sedation and operator experience.

In order to compare the effects of Diazemuls and midazolam on arterial oxygen saturation during upper gastrointestinal endoscopy, 120 patients were randomly allocated to receive Diazemuls, midazolam, or normal saline. Endoscopy was performed by one consultant or one of four residents. Arterial oxygen saturation was monitored continuously during endoscopy by means of a Biox III pulse oximeter and ear probe. Oxygen saturation fell during endoscopy in all three groups, but no significant differences between the groups were detected at any stage of the procedure. When all groups were combined, there was significantly less desaturation when the consultant performed the endoscopy, and he was also significantly faster in carrying out endoscopy than the residents in each group. When an inexperienced resident was compared with one with at least 6 months of experience, there were significant differences in degree of desaturation, lowest value during endoscopy and tolerance score. It is suggested that the patient at risk of hypoxemia should, if possible, be endoscoped by an experienced endoscopist.

Clinical Competence↗
PubMed1983

[Comparative study of x-ray and endoscopy in the detection of polyps and cancer of the large bowel with office computer].

A comparative study of X-ray and endoscopy in the detection of polyp and cancer of the large bowel was done with the use of office computer, and following result was obtained. False positive and negative rate of X-ray in the detection of polyp was 31.5% and 16.3% respectively when X-ray preceded endoscopy. False negative rate of X-ray and endoscopic diagnosis was 40.8% and 28.6% respectively in the detection of polyp, when endoscopy preceded X-ray. But the possibility that the false negative of endoscopy might be the false positive of X-ray was not excluded in many cases. The false positive and negative rate of X-ray diagnosis was 21.0% and 7.0% respectively in the detection of cancer when X-ray preceded endoscopy. The false negative rate of X-ray diagnosis was 2.8% in the detection of cancer when endoscopy preceded X-ray. It was emphasized that X-ray should be preceded by endoscopy in the detection of polyp and cancer of the large bowel in order to reduce the false positive and negative rate of X-ray diagnosis to the minimum.

Cecal Neoplasms↗
PubMed1993

Computer programs in gastrointestinal endoscopy: issues, problems, and solutions.

For 10 years, a computerized gastrointestinal endoscopy database was promoted as necessary and desirable. At least 2 endoscopy societies, the American Society for Gastrointestinal Endoscopy (ASGE) and the World Society for Gastrointestinal Endoscopy (OMED), devoted considerable effort to develop appropriate terminology and structure. Numerous vendors and individuals developed software conforming, to various degrees, with the ASGE and OMED recommendations, and hundreds of institutions in the United States and an equal number worldwide have computerized their endoscopy paperwork. Dozens of articles and several large multicenter research efforts signal the usefulness of the database concept. Although desired, and apparently needed, endoscopy databases have not, however, caught the attention of a majority of physicians who could benefit from them--probably because of perceived difficulty with user interface. Whereas the keyboard has succeeded in virtually every other discipline, it is an enigma why there is so much anathema to this ubiquitous device among the majority of the medical community. Attempts at alternate input modalities, such as voice, resulted in several commercially available report-writers; however, the original database concept is insignificant in these current products. The international experience with this subject is reviewed with an optimistic prediction that a satisfactory doctor-computer interface will be developed, perhaps with totally new technology, and that continued interest, use, and development of an endoscopy database is justified.

Endoscopy, Gastrointestinal↗
PubMed1996

[Pulse-oximetry monitoring during endoscopy of the upper digestive tract and chronic obstructive lung disease].

BACKGROUND: During upper digestive endoscopy arterial desaturations occur which may favour cardiopulmonary complications; therefore, monitoring and oxygen administration to risk patients is recommended. The aim of this study was to evaluate desaturations occurring during endoscopy and whether there are differences between patients with or without prior obstructive respiratory pathology. METHODS: A total of 119 consecutive patients undergoing upper digestive endoscopy were studied. The clinical history and simple spirometry were obtained before endoscopy; during endoscopy, a continuous monitoring of oxygen saturation and heart rate with pulse oximetry. RESULTS: Forty-six patients (38.7%) had oxygen saturations lower than 90% (Group I). Patients were significantly older and FEV-1, FVC, FEF 25-75, and FEV-1/FVC significantly lower among patients in Group I than among the 73 patients (61.3%) with no oxygen desaturation (Group II). A Tiffenau index lower than 70% was not a good predictor for oxygen desaturation during endoscopy. CONCLUSIONS: Pulse-oximetry monitoring during upper digestive endoscopy is recommended and particularly in patients with obstructive respiratory conditions and/or advanced age.

Adolescent↗
PubMed1998

Can the urea breath test for H.pylori replace endoscopy for the assessment of dyspepsia in primary care?

AIMS: The urea breath test may have value in the initial assessment of dyspepsia in primary care. This pilot study tracks patient and general practitioner behaviour which cannot be predicted with modelling studies. METHODS: The urea breath test was made available over a period of 18 months. The test was requested when general practitioners would normally have used a trial of medication or referred for endoscopy. Patients with a positive urea breath test had early endoscopy before treatment. Patients with a negative urea breath test were treated according to symptom response. A follow-up questionnaire was given 6-24 months after the urea breath test. RESULTS: Urea breath tests were requested on 249 patients; clinical notes and follow-up interview data were available for 207 patients (83%). The urea breath test was positive for 89 patients (43%); 70 were referred for endoscopy and peptic ulcer disease was found in 33 (47%). The urea breath test was negative for 118 patients; 14 were follow-up tests after previous H.pylori treatment. For the 104 patients with dyspepsia, a negative test and no previous treatment, 42% had 1 or more previous investigations for dyspepsia and 66% had dyspepsia symptoms for more than one year. During follow-up, 21 patients had endoscopy. Dyspepsia symptom scores were significantly lower at follow-up (p < 0.01). Using a global assessment, 66% had fewer symptoms, 22% same and 12% had more symptoms. The symptom improvement was greater if the duration of symptoms was less than one year (p < 0.05). Medication use did not change significantly. Twelve patients were dissatisfied with management; most of these would have preferred endoscopy. CONCLUSIONS: A negative urea breath test appears to have some reassurance value. The use of the urea breath test as initial assessment for dyspespia may prevent the need for some endoscopy. Further controlled studies of breath testing compared with early endoscopy are required.

Adult↗
PubMed1998

[Experiences with a theloresectoscope compared with conventional teat endoscopy in diagnosis and therapy of covered teat lesions].

In 30 dairy-cows, suffering from a covered teat lesion near the papillar duct and, as a result, from milk flow hindrance, two different methods of minimal invasive endoscopy for diagnosis and therapy were performed. In 15 patients (group I) the endoscope was inserted through the papillar duct and additionally through an artificial approach in the teat wall. Avulsions of mucosa could be visualized and resected with special instruments. In further 15 patients (group II) a new Theloresectoscope (teat-endoscope, combined with integrated radiosurgery-unit) was used for performance of endoscopy via papillar duct and lateral endoscopy. Mucosal avulsions were removed under visualization by means of radiosurgery without inserting an additional instrument through the papillar duct. Afterwards, after application of antibiotic drugs intramammarily, a natural teat canal insert (NIT) was administered in the papillar ducts of the 30 treated teats for seven days to keep the teat canal calm and wide. After three days the NIT was replaced and antibiosis refreshed. Eight days after endoscopy the temporary cessation of milking was canceled and the quarters were milked by machine. In two probands out of group I and three cows out of group II six weeks after first intervention lateral endoscopy was performed again for documentation of the healing process. In all 30 cases six weeks after resection of mucosal avulsions inquiries about the milking-quality were made by phoning the owners of patients. In 29 cows, still existing on the farms after six weeks, the milking comfort was considered as being good or, in few cases, satisfactory by the owners. Somatic cell count showed good results, though eight probands in group I and nine cows in group II presented positive results in the California-Mastitis-Test. Comparing the two different endoscopic techniques used in this study, both methods appeared of same value concerning diagnosis of aberrations in bovine teat by means of endoscopy via teat canal. Differences were found in handling of instruments performing endoscopy with lateral, artificial approach: the novel Theloresectoscope is by far more useful in endoscopic surgery, because the surgical intervention can be performed by a single person, whereas using the conventional instruments in most cases a second person as an assistant for operation is required.

Animals↗
PubMed2003

Office-based lower airway endoscopy in pediatric patients.

BACKGROUND: Office-based evaluation of the lower airway in adults with only topical anesthetics has been well documented. This study was performed to assess the feasibility of performing office-based lower airway endoscopy in a pediatric population. DESIGN: One hundred five consecutive pediatric patients requiring flexible laryngoscopy were studied. All received only a topical anesthetic-decongestant applied nasally. After flexible laryngoscopy, the endoscope was passed below the vocal folds to visualize the subglottis, trachea, and carina. All evaluations were videotaped for later review. SETTING: Academic pediatric otolaryngology practice. MAIN OUTCOME MEASURES: All 105 patients were studied for complications and agreement between office endoscopy and operative endoscopy when necessary (performed in 20 patients). A subset of 24 consecutive patients were studied for ease of performing the lower airway evaluation, rated on a 3-point scale: 1, unable to perform; 2, performed with some difficulty; and 3, performed without difficulty. The ability to view the subglottis, trachea, and carina were also rated on a 3-point scale. RESULTS: There were no complications for any of the procedures. Office endoscopy correlated with operative endoscopy in all cases. In the subset of 24 patients, the mean score for ease of endoscopy was 2.83. The mean scores for visualizing the lower airway were 2.91 for the subglottis, 2.80 for the trachea, and 2.24 for the carina. CONCLUSION: With the use of only topical anesthesia, flexible endoscopy of the lower airway in children can be performed in the office setting and can be used effectively to evaluate abnormalities of the lower airway.

Chi-Square Distribution↗