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PubMed1996

A model for calculating the hospital costs for pediatric endoscopy.

BACKGROUND: Hospitals increasingly need, besides effectiveness data, accurate and reliable cost data to allocate their resources as efficiently as possible. In this article, a framework to calculate the hospital costs of setting up a new activity is presented and applied to pediatric endoscopy. METHODS: The cost calculations were based on a detailed registration of labor time, materials, space, and equipment needed to perform endoscopy in pediatric patients in a tertiary care hospital, the University Hospital in Leuven, Belgium. RESULTS: The initial investment expenses amount to 70,000 ECU ($91,000 in U.S. money), assuming that the facilities of the adult endoscopy unit can be shared. The additional variable cost for each procedure, including labor time and materials, varies between 100 and about 170 ECU ($130 and $221 U.S.), depending on the type of endoscopy (upper or lower, diagnostic or therapeutic). These basic data can be used to calculate the total costs for pediatric endoscopy under alternative scenarios (e.g., varying total number of procedures). CONCLUSIONS: The costing exercise has given the hospital better insights into the working procedures (and hence costs) of pediatric endoscopy. Other organizations will be able to apply this framework in their setting, since all included cost components, as well as volumes and unit prices, are reported separately.

Anesthesia Department, Hospital↗

PubMed1999

A randomized trial of peroral versus transnasal unsedated endoscopy using an ultrathin videoendoscope.

BACKGROUND: Potential advantages of unsedated endoscopy include the prevention of side effects or morbidity related to the use of sedative drugs, less intensive patient monitoring, and less expense. We compared transnasal (T-EGD) with peroral (P-EGD) unsedated endoscopy by using an ultrathin video instrument with respect to patient tolerance and acceptance. METHOD: Patients were randomized to T-EGD or P-EGD. If the initial route of insertion failed, the patient was crossed over to the other route. If this also failed, the patient underwent endoscopy under conscious sedation with an ultrathin instrument. A questionnaire for tolerance was completed by the patient (a validated 0-10 scale where "0" represents none/well tolerated and "10" represents severe/poorly tolerated). RESULTS: Of 105 recruited patients, 60 consented to undergo unsedated endoscopy. There were 20 men and 11 women (mean age 45 years) in the P-EGD group and 15 men and 14 women (mean age 48 years) in the T-EGD group. Of 35 total P-EGD patients (4 were crossed over T-EGD patients), 34 (97%) completed an unsedated examination. Of 29 T-EGD patients, 25 (86%) had a complete examination. Three T-EGD examinations failed for anatomical reasons; all 3 patients when crossed over to the P-EGD route had a successful examination. One patient was unable to tolerate either route. Between the P-EGD and the T-EGD groups, pre-procedure anxiety (3.6 +/- 0.5 vs. 3.0 +/- 0.6), discomfort during insertion (2.1 +/- 0.5 vs 3.3 +/- 0.7), gagging (4.7 +/- 0.5 vs. 3.2 +/- 0. 6), and overall tolerance (2.4 +/- 0.5 vs. 3.8 +/- 0.7) were similar (p > 0.05). However, discomfort on insertion was significantly greater in the T-EGD versus the P-EGD group (4.4 +/- 0.6 vs. 2.7 +/- 0.5: p < 0. 05). Eighty-nine percent of P-EGD patients and 69% of T-EGD patients, p = 0.07, were willing to undergo unsedated endoscopy in the future. CONCLUSION: T-EGD patients experienced significantly more pain on insertion than did P-EGD patients. Otherwise, unsedated endoscopy by either the transnasal or the peroral route is generally well tolerated. In this study it was completed in 59 of 60 patients.

Adult↗

PubMedDate not supplied

Virtual endoscopy: development and evaluation using the Visible Human datasets.

Virtual endoscopy (VE) is a new method of diagnosis using computer processing of 3D image datasets (such as CT or MRI scans) to provide simulated visualizations of patient specific organs similar or equivalent to those produced by standard endoscopic procedures. Conventional endoscopy is invasive and often uncomfortable for patients. It sometimes has serious side effects such as perforation, infection and hemorrhage. VE visualization avoids these risks and can minimize difficulties and decrease morbidity when used before actual endoscopic procedures. In addition, there are many body regions not compatible with real endoscopy that can be explored with VE. Eventually, VE may replace many forms of real endoscopy. There remains a critical need to refine and validate VE visualizations for routine clinical use. We have used the Visible Human Dataset from the National Library of Medicine to develop and test these procedures and to evaluate their use in a variety of clinical applications. We have developed specific clinical protocols to compare virtual endoscopy with real endoscopy. We have developed informative and dynamic on-screen navigation guides to help the surgeon or physician interactively determine body orientation and precise anatomical localization while performing the VE procedures. Additionally, the adjunctive value of full 3D imaging (e.g. looking "outside" of the normal field of view) during the VE exam is being evaluated. Quantitative analyses of local geometric and densitometric properties obtained from the virtual procedures ("virtual biopsy") are being developed and compared with other direct measures. Preliminary results suggest that these virtual procedures can provide accurate, reproducible and clinically useful visualizations and measurements. These studies will help drive improvements in and lend credibility to VE procedures and simulations as routine clinical tools. VE holds significant promise for optimizing endoscopic diagnostic procedures, minimizing patient risk and morbidity, and reducing health care costs.

Anatomy, Cross-Sectional↗

PubMed1997

Submandibular gland duct endoscopy. Diagnostic value for salivary duct disorders in comparison to conventional radiography, sialography, and ultrasonography.

The purpose of this study is to evaluate the usefulness of endoscopy as a procedure for the diagnosis of submandibular gland duct disorders. Endoscopy of the submandibular glands was performed on 12 patients with symptoms of obstructive sialoadenitis to identify the cause of obstruction. The endoscopic findings were then compared to those of diagnostic procedures such as conventional radiography, sialography, and ultrasonography. Six normal subjects also underwent endoscopy to better understand the normal findings of the duct system. Endoscopy demonstrated salivary gland calculus in 5 of 12 patients, which was revealed as filling defects on sialograms and as strongly echogenic structures on ultrasonograms in 4 of the patients. Endoscopy revealed secretion plugs, secretion plaques, and/or stenosis, which could not be seen by any other diagnostic procedures in 5 patients, as the cause of recurrent swelling in all 7 patients not demonstrating sialolith. Abnormal findings of the duct wall such as vasodilatation, fibrosis, edema, or erythema were seen in four patients, three of whom exhibited dilatation of the duct system on sialograms. In four patients, a decreasing internal echo level of the gland was seen on ultrasonograms. Our initial results for submandibular gland duct endoscopy thus appear to be promising.

Adult↗

PubMedDate not supplied

Diagnosis of chronic rhinosinusitis in patients with cystic fibrosis: correlation between anamnesis, nasal endoscopy and computed tomography.

UNLABELLED: The sinonasal involvement is one of the most common manifestations in cystic fibrosis. Data show a high incidence of chronic rhinosinusitis in these patients. Although it has been found radiographic opacification of the sinus in more than 90% of cases, few are symptomatic. So that, it is difficult to recognize nasossinusal disease in patients with cystic fibrosis. Questionnaire, nasal endoscopy and CT-scan are very important methods in this approach. AIM: To evaluate the diagnosis of chronic rhinosinusitis in patients with cystic fibrosis by anamnesis, nasal endoscopy and CT-scan and compare those results. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: Evaluation of 34 patients--older than 6 years and with a confirmed diagnoses of cystic fibrosis--by anamnesis (questionnaire), nasal endoscopy (score Lund-Kennedy) and CT-scan (score Lund-Mackay). RESULTS: chronic rhinosinusitis was confirmed in: 20,58% of cases by the questionnaire, 73,52% of the cases by the nasal endoscopy and in 93,54% of the cases by the CT-scan. The results showed significant differences. The correlation between nasal endoscopy score (Lund-Kennedy score) and CT-scan score (Lund-Mackay score) was statistically significant. CONCLUSION: The diagnosis of chronic rhinosinusitis was statistically different between the three methods. It was higher in imaging analysis and lower in questionnaire. The nasal endoscopy is an excellent method to evaluate nasossinusal disease in cystic fibrosis.

Adolescent↗

PubMed2001

Nasal endoscopy in asthmatic children: assessment of rhinosinusitis and adenoiditis incidence, correlations with cytology and microbiology.

BACKGROUND: Upper respiratory airway diseases may induce a worsening of asthma. Sinusitis represents one of the most common chronic diseases. The association of asthma and sinusitis varies greatly in different studies, depending on diagnostic procedures. OBJECTIVE: The aims were: (i) to demonstrate that nasal endoscopy may be easily feasible in asthma at paediatric age; (ii) to evaluate the incidence of rhinosinusitis and adenoiditis in children with asthma by nasal endoscopy; (iii) to correlate inflammatory parameters such as cytology and microbiological cultures with nasal endoscopy findings. SUBJECTS AND METHODS: One hundred and forty-five asthmatic children were evaluated, 48 males and 97 females, with an average age of 7.27 years. Evaluated parameters were the incidence of rhinosinusal infections in asthmatic children, and the role of: (i) nasal endoscopy, (ii) nasal cytology, and (iii) nasal microbiology in their diagnoses. RESULTS: Nasal endoscopy was successfully performed on 128 patients. Twenty-six children had endoscopic rhinosinusitis alone, 10 had adenoiditis alone, and 35 showed endoscopic rhinosinusitis associated with adenoiditis. There were significant correlations between endoscopic rhinosinusitis and adenoiditis (P < 0.001), between clinical and endoscopic rhinosinusitis (P < 0.001), between endoscopic rhinosinusitis and adenoiditis and microbiology (P < 0.05 and P < 0.0001, respectively), and between microbiology and cytology (P < 0.05). CONCLUSION: This study shows that rhinosinusal infections are common in asthmatic children. Moreover, nasal endoscopy might represent a fruitful tool in the management of asthmatic children.

Adenoids↗

PubMed2002

Open access endoscopy in rural and remote Western Australia: does it work?

BACKGROUND: Access to diagnostic endoscopy is limited in rural and remote Western Australia. Published reports suggest open access referrals may result in over-servicing, this is reduced by adherence to the American Society for Gastrointestinal Endoscopy (ASGE) guidelines. The aim was to assess whether an outreach surgical service offering open access endoscopy to rural areas was being over utilized. METHODS: Prospective data collection from all patients undergoing upper and lower endoscopy procedures between January 1996 and June 2000 were included in the present study. Indications for referral between the general practitioners and the visiting surgeons were reviewed in patient records and assessed for compliance with the ASGE guidelines. The groups were analysed for appropriateness of referrals and frequency of positive pathology investigations. Records for all patients undergoing colonoscopy were reviewed to determine the reason and number of cancelled procedures. RESULTS: A total of 772 endoscopies were performed and 75% were booked as open access services. The referral rate for procedures was greater for general practitioners (583) compared to the visiting surgeons (189), the overall compliance rate for approved indications using the ASGE guidelines for both groups was 92%. There was no significant difference in pathology found between groups. CONCLUSION: The present study shows that an outreach rural surgical service programme in Western Australia offering open access endoscopy conforms to international guidelines and does not induce unnecessary procedures. Rural patients benefit from a personal cost savings and convenience. There is an associated reduction in government-assisted travel costs to larger centres as well as decreased waiting lists.

Colonoscopy↗

PubMed2002

A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel disease.

BACKGROUND & AIMS: This study was undertaken to prospectively compare the clinical outcomes of small bowel radiographs with the wireless capsule endoscopy. METHODS: Twenty-two patients were selected consecutively because of suspected small bowel disease. Two patients were excluded owing to ileal stenosis. Thus, the results of barium follow-through and the Given M2A wireless video capsule (Given Imaging Ltd., Yoqneam, Israel) endoscopy were compared in 20 patients (13 men; mean age, 52.5 yr; range, 29-78 yr). RESULTS: Barium follow-through was normal in 17 patients and showed ileal nodularity in 3 patients. Capsule endoscopy was normal in 3 patients and showed positive findings in the remaining 17 patients. The barium study was considered diagnostic in 4 (20%) patients. The capsule endoscopy was considered diagnostic in 9 (45%) patients, suspicious in 8 (40%) patients, and failed in 3 (15%) patients. For obscure gastrointestinal (GI) bleeding, the diagnostic potential of barium follow-through was much worse as compared with the capsule endoscopy (5% vs. 31%, P < 0.05). Capsule endoscopy was well tolerated and better accepted by patients when compared with the most recently performed endoscopic procedure. CONCLUSIONS: The video capsule endoscope was found to be superior to small bowel radiograph for evaluation of small bowel diseases. However, this novel wireless endoscope system needs further assessment because of limitations such as difficulties in interpretation of potentially nonspecific findings.

Adenomatous Polyposis Coli↗

PubMed2005

Helicobacter pylori "test and treat" or endoscopy for managing dyspepsia: an individual patient data meta-analysis.

BACKGROUND & AIMS: Helicobacter pylori "test and treat" has been recommended for the management of young dyspeptic patients without alarm symptoms, and trials have suggested that it is as effective as endoscopy. However, none of these trials have had sufficient sample size to confirm that "test and treat" costs less or to detect small differences in effect. A collaborative group has prospectively registered trials comparing prompt endoscopy with a "test and treat" approach, with the aim of performing an individual patient data meta-analysis of both effect and resource utilization data. METHODS: Researchers provided data for meta-analysis, pooling effects of interventions on individual dyspepsia symptoms. Standardized unit costs were applied to resource utilization, and net benefit was calculated at patient level. Effects, costs, and net benefit were then pooled at study level. RESULTS: Five trials were identified, containing 1924 patients (946 endoscopy [mean age, 40 years], 978 "test and treat" [mean age, 41 years]). The relative risk (RR) of remaining symptomatic after 1 year was reduced with endoscopy compared with "test and treat" (RR = 0.95; 95% confidence interval [CI]: 0.92-0.99). "Test and treat" cost 389 dollars less per patient (95% CI: 275-502 dollars). Using the net benefit approach, at no realistic level of willingness to pay per patient symptom-free did prompt endoscopy become cost-effective. CONCLUSIONS: Prompt endoscopy confers a small benefit in terms of cure of dyspepsia but costs more than "test and treat" and is not a cost-effective strategy for the initial management of dyspepsia.

Cost-Benefit Analysis↗

PubMed2001

Detection of gastric cancer by repeat endoscopy within a short time after negative examination.

BACKGROUND AND STUDY AIMS: Although a large number of patients are examined using endoscopy in order to identify gastric cancer, it is unclear how individuals should be managed after they are not diagnosed as having gastric cancer at the time of their initial examinations. This study was conducted to identify the group at high risk for gastric cancer who should be examined by repeat endoscopy within a short time after obtaining negative results. PATIENTS AND METHODS: The study involved 3672 patients who were not diagnosed as having gastric cancer by endoscopy in 1993, but underwent re-examination by gastroscopy between January 1994 and December 1996. RESULTS: Among these participants, 32 patients (0.9%) were diagnosed as having gastric cancer. The incidence of gastric cancer was 2.0% in participants aged 60 to 69 and 2.7% in those with marked atrophy of the gastric mucosa. Multivariate analysis showed that the odds ratios (OR) for patients aged 60 to 69 and those with marked atrophy of the gastric mucosa were 3.092 and 3.255 (P < 0.01), respectively. Gastric cancer was detected in 17.2 % of patients who were previously diagnosed as having gastric adenoma and in 2.2% of those who were previously diagnosed as having gastric ulcer. The ORs for participants with these gastric lesions detected by the initial examination were 49.417 and 5.259 (P < 0.01), respectively. CONCLUSIONS: Groups at high risk for gastric cancer were identified by the initial endoscopy, when two findings (gastric lesions, atrophy) and age were combined. We emphasize the importance of repeat endoscopic examination for patients who are aged 60 to 69 or have marked atrophy of gastric mucosa, even if no lesions are detected on initial endoscopy. If gastric adenoma or ulcer are detected, endoscopic examination should be likewise repeated or these lesions should be treated by endoscopy or by other means.

Adenocarcinoma↗

PubMed2004

Small-bowel endoscopy.

The role of small-bowel endoscopy in the management of small-bowel diseases is still evolving. During the last year, capsule endoscopy has developed from being an emerging method in gastroenterology to become a clinical reality, and it must now be considered critically. A number of peer-reviewed studies have been published that compare the method with push enteroscopy in patients with obscure gastrointestinal bleeding. In other studies, capsule endoscopy has been compared with traditional radiographic methods of examining the small bowel. The potential of capsule endoscopy for diagnosing small-bowel diseases has also been evaluated, particularly in patients with suspected Crohn's disease. Although this innovative diagnostic method has now entered clinical practice, it must be stressed that both push enteroscopy and intraoperative enteroscopy still have a precise and valid role in the management of patients with small-bowel diseases, as may be seen from several of the studies that are reviewed here. Capsule endoscopy will probably become a first-line tool for detecting abnormalities of the small bowel, and very probably this will entail redefining some diagnostic algorithms for diseases involving the small bowel. Nevertheless, further studies are required before today's clinical practice can be definitively modified, and these should make particular reference to the outcome in patients who undergo capsule endoscopy.

Adult↗

PubMed2004

Usefulness of magnifying endoscopy in the diagnosis of early gastric cancer.

BACKGROUND AND STUDY AIMS: We investigated the characteristic findings of early gastric cancer revealed by magnifying endoscopy, and clarified their relationship with histopathological features. PATIENTS AND METHODS: A total of 74 patients with early gastric cancer underwent magnifying endoscopy ( x 80) between March 2000 and December 2001. The endoscopic findings demonstrated 11 elevated-type carcinomas and 63 depressed-type, and histological examination showed 56 differentiated carcinomas and 18 undifferentiated carcinomas. The histopathological results were compared with findings from magnifying endoscopy regarding minute surface structure and microvessels. RESULTS: We were able to roughly classify the minute surface structure of early gastric cancer as shown by magnifying endoscopy into three patterns, as follows: (i). a small regular pattern of sulci and ridges; (ii). an irregular pattern of sulci and ridges; and (iii). a lack of visible structure. Abnormal microvessels observed in cancerous lesions were classified according to two patterns: irregular minute vessels and variation of vessel caliber. The small regular pattern of sulci and ridges was significantly more frequently observed in differentiated carcinoma (30/56, 53.6 %) than in undifferentiated carcinoma (2/18, 11.1 %). Lack of visible structure and irregular minute vessels were significantly more frequently observed in undifferentiated carcinoma (44.4 % and 77.7 %) than in differentiated carcinomas (5.4 % and 51.8 %). CONCLUSION: The minute surface structure and microvessels observed by magnifying endoscopy were related to histopathological findings. Magnifying endoscopy is valuable for predicting the histological nature in the diagnosis of early gastric cancer.

Adenocarcinoma↗

PubMed2004

Comparison of capsule endoscopy and magnetic resonance imaging for the detection of polyps of the small intestine in patients with familial adenomatous polyposis or with Peutz-Jeghers' syndrome.

BACKGROUND AND STUDY AIMS: We have conducted a study to compare the diagnostic yields of magnetic resonance imaging (MRI) and capsule endoscopy for the detection of small-bowel polyps in patients with inherited polyposis syndromes. PATIENTS AND METHODS: MRI was performed in 20 patients, with either Peutz-Jeghers' syndrome (PJS; n = 4) or familial adenomatous polyposis (FAP; n = 16), and capsule endoscopy was done the next day. The number, size, and location of polyps were analyzed. RESULTS: Overall, 448 polyps ranging from about 1 mm to 30 mm in size were detected in eight patients by capsule endoscopy, whereas with MRI only 24 polyps all bigger than 5 mm could be seen in the four PJS patients. CONCLUSIONS: Polyps bigger than 15 mm were detected similarly with capsule endoscopy and MRI, whereas smaller polyps were seen much more often with capsule endoscopy. Polyps smaller than 5 mm were exclusively seen with capsule endoscopy. However, location of the detected polyps and determination of their exact sizes was more accurate by MRI.

Adenomatous Polyposis Coli↗

PubMed2005

Structured terminology for capsule endoscopy: results of retrospective testing and validation in 766 small-bowel investigations.

BACKGROUND AND STUDY AIMS: Capsule endoscopy (CE) is an effective means of investigating the small bowel in patients with gastrointestinal diseases. Computerized reports are frequently used in endoscopy, and the Minimal Standard Terminology (MST) has been promoted by endoscopy societies as the official vocabulary for endoscopy. The aims of this study were to design a lexicon for CE reports based on the principles of the MST and to validate lists of terms for describing findings and reasons for performing a CE by cross-matching them with the results of CE procedures collected during ongoing clinical studies. MATERIALS AND METHODS: A consensus-based Capsule Endoscopy Structured Terminology (CEST) was developed by experts involved in CE studies. Lists of terms suitable for CE were designed for the various sections of an endoscopic report. They were then correlated with the corresponding MST lists for duodenal and intestinal endoscopy. The results of 766 CE procedures, collected in an electronic case record form (eCRF), were analyzed to provide lists of reasons for performing the procedures and of the findings. The eCRF provided only a limited number of items for each data field, along with free-text facilities. Only descriptions pertaining to the small bowel were analyzed. Lists of terms were then reviewed by two experts to group obvious synonyms. The accuracy of the CEST was defined beforehand as the capability to describe 90 % of entries. RESULTS: A total of 766 CE procedures were analyzed. The eCRF included 824 entries as reasons for the examination in 655 CEs (1.3 per procedure). These represented 122 different expressions. After grouping of synonyms, 28 expressions remained. Among them, 10 were matched with terms from the list of reasons for performing CE offered in the CEST. These were the most frequently used, accounting for 768 entries in this field (93.2 %). All eCRFs contained at least one description of findings. A total of 109 CE procedures were classified as normal (14.3 %). A total of 2624 entries for abnormal findings were recorded for 657 procedures (4.0 per procedure). In all, 213 different expressions were used to describe abnormal findings. After grouping of synonyms, 52 expressions remained. Among these, 27 were matched with terms from the list of findings in the CEST, covering 2403 entries (91.6 %). CONCLUSIONS: In this study, CEST terms were capable of describing more than 90 % of the reasons for performance and of the findings in an unselected set of CE procedures. CEST is therefore suitable for use as the standard lexicon for CE reports. Adopted as a standard, it could significantly improve the quality of the data collected and reported in CE studies.

Endoscopy, Gastrointestinal↗

PubMed2006

Use of anticoagulation during wireless capsule endoscopy for the investigation of recurrent obscure gastrointestinal bleeding.

Detecting the source of obscure gastrointestinal bleeding can be difficult. Capsule endoscopy is a promising diagnostic tool for investigating patients with this condition, although identifying the source of intermittent or low-grade bleeding remains a diagnostic challenge. We present case reports of two patients with obscure gastrointestinal bleeding, in whom the source of recurrent bleeding episodes was diagnosed by capsule endoscopy while they were on anticoagulation therapy. The first patient, an 81-year-old white woman, was on long-term oral anticoagulation because she had chronic atrial fibrillation. Capsule endoscopy demonstrated a bleeding tumor in the region of the terminal ileum. The second patient, a 59-year-old white man, underwent an initial capsule endoscopy, which was negative. After initiation of anticoagulation with heparin, a second capsule endoscopy procedure in this patient revealed several small bleeding lesions in the proximal small bowel. In both cases a gastrointestinal stromal tumor was identified as the bleeding source and was resected. These two cases demonstrate that provocation of bleeding during capsule endoscopy may increase its sensitivity.

Aged, 80 and over↗

PubMed1983

Bacteraemia with upper gastrointestinal endoscopy--a reappraisal.

To assess the risk of infective endocarditis for susceptible patients having upper gastrointestinal (GI) endoscopy, we have prospectively studied the incidence, level, duration and source of endoscopy-related bacteraemia and the microorganisms involved. Blood was drawn for aerobic and anaerobic culture and pour plate estimation from 50 patients undergoing upper GI endoscopy. Blood cultures were positive in two patients with the isolation of Streptococci and other oropharyngeal organisms during and 5 min after endoscopy. Pre-endoscopy salivary cultures in both patients grew Streptococci identical to those isolated from the blood; pour plates were negative. We conclude that though the risk of infective endocarditis after upper GI endoscopy is probably very low, the finding of a 4% incidence of transient low-level bacteraemia of oropharyngeal origin argues for antibiotic prophylaxis for susceptible patients.

Adolescent↗

PubMed2003

Systematic evaluation of complications related to endoscopy in a training setting: A prospective 30-day outcomes study.

BACKGROUND: The 30-day frequency of negative outcomes after outpatient endoscopy performed by gastroenterology fellows is unknown. METHODS: Questionnaires were mailed to 1000 consecutive patients 30 days after endoscopy to evaluate procedure-related negative outcomes (serious and minor adverse events) and patient satisfaction. Serious adverse events were defined as follows: oversedation requiring administration of a reversal agent, and those that resulted in a physician visit, emergency department visit, admission to the hospital, or death. Minor adverse events were defined as all problems other than serious adverse events that patients related to their endoscopic procedure. RESULTS: The 30-day frequency of negative outcomes in the 869 patients who responded was 14.3%, of which 0.6% were serious and 13.7% were minor adverse events. The frequency of negative outcomes was 17.1% for EGD, 15.0% for colonoscopy, 24.4% for combined EGD and colonoscopy, and 7.8% for flexible sigmoidoscopy. One hundred percent of the serious adverse events were known to us, but only 16.0% of minor adverse events (p < 0.001). Multiple logistic regression identified midazolam dose (OR for each 1 mg increase in dose 4.5; 95% CI [2.7, 7.3]; p < 0.001), treatment with warfarin (OR 3.0; 95% CI [1.4, 6.2]; p = 0.003), comorbid disease (OR 2.1; 95% CI [1.3, 3.4]; p = 0.001), endoscopy performed in July or August (OR 2.0; 95% CI [1.1,3.7]; p = 0.02), and age (OR for each 1 year increase in age 1.03; 95% CI [1.01, 1.05]; p = 0.01) as independent predictors of negative outcomes. There was a significant association between negative outcomes and decreased patient satisfaction, and patients who reported negative outcomes were less likely to agree to endoscopy in the future. CONCLUSIONS: Serious adverse events were rare after endoscopy performed by gastroenterology fellows. Contacting patients 30 days after outpatient endoscopy significantly improved the detection of negative outcomes. Although the majority of negative outcomes were minor, these adverse events were associated with decreased patient satisfaction.

Aged↗

PubMed1999

Serologic screening before endoscopy: the value of Helicobacter pylori serology, serum recognition of the CagA and VacA proteins, and serum pepsinogen I.

BACKGROUND: We wanted to assess the diagnostic value of pre-endoscopy screening by Helicobacter pylori serology, serum recognition of the CagA and VacA proteins, and serum pepsinogen I levels (sPGI) in patients up to 55 years of age with uncomplicated simple dyspepsia. METHODS: Consecutive dyspeptic patients referred for open-access endoscopy, excluding patients with alarm symptoms, recent intake of acid suppressants, or ingestion of non-steroidal anti-inflammatory drugs. H. pylori status was determined by histology and urease testing. H. pylori serologic status was determined with the enzyme-linked immunosorbent assay (ELISA) and Western blotting, serum recognition of CagA and VacA with Western blot, and sPGI levels by radioimmunoassay. RESULTS: One hundred and fifteen patients were studied (mean age, 40 years: range, 20-55 years), of whom 58 were H. pylori-positive in biopsy-based tests. Twenty-one patients (18%) had significant gastroduodenal lesions (erosions, ulcers, or cancer). The sensitivity (specificity) of the ELISA (optimized) and Western blot in determining H. pylori status was 94.8% (89.5%) and 100% (96.4%), respectively. Screening strategies based on the ELISA or Western blot for determining H. pylori serologic status would have detected 95% or 100% of significant lesions, respectively, and each 'saved' 47% of endoscopies for simple dyspepsia. Serum recognition of the CagA protein would have detected 95% of significant lesions and 'saved' 55% of endoscopies, whereas recognition of the VacA protein would have detected only 81% of the lesions. Screening by H. pylori serology plus a 'low' (<55 ng/ml) or 'high' sPGI (>125 ng/ml) would detect only 57% of significant lesions, although the only case of cancer was included in the hypopepsinogenaemic subgroup of just 11 patients. CONCLUSIONS: In patients with uncomplicated, simple dyspepsia up to 55 years of age, screening by H. pylori serology identified 95%-100% of patients with significant gastroduodenal lesions while potentially saving 46.9% of endoscopies. Serum recognition of the CagA protein identified 95% of lesions and would have saved an additional number of endoscopies (7.9%) compared with basic serology. Measurement of sPGI was of limited diagnostic value.

Adult↗