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PubMed1992

Open access endoscopy--a nationwide survey of current practice.

In a postal survey of 450 members of the Endoscopy Section of the British Society of Gastroenterology carried out during 1990, 47% of respondants stated that they were offering some form of open access endoscopy. Virtually all of these were offering open access gastroscopy, but one in three were also performing open access flexible sigmoidoscopy. Those units that offered open access endoscopy had significantly more endoscopists sharing the workload, including a greater number of clinical assistants. Only 10% of those who replied, however, were offering 'true' open access endoscopy, the remainder used some form of 'censoring'. There were also important differences in consultants' attitudes to the investigation and management of patients referred with dyspepsia, which may account for the patchy availability of the service. Some 71% of those who did not offer open access endoscopy cited an inability to cope with numbers as their main reason for not doing so. Support for these concerns is gained from the finding that 52% of those that offered the service have had a waiting list exceeding six weeks at some time. Nevertheless, open access endoscopy is becoming more widely available with a large increase in participating units during the past 12 months.

Attitude of Health Personnel↗
PubMed1994

Improving information given to patients before endoscopy: a regional audit.

To improve the information given to patients before endoscopy an audit was performed in 16 of 18 endoscopy units in Northern region. Details of current endoscopy information leaflets provided by the 16 respondents were discussed by nurses and consultants from the participating units, and a standard, including 12 separate items, was agreed. Each unit was provided with a comparison of its current leaflet with the standard, which highlighted areas for potential improvement. Six months later the participating units were again asked to provide details of the information; 13 replied, 11 of which had produced new leaflets and two which were in the process of doing so. In the initial survey only 35% (range 8-67%) of the items in the standard were included in the leaflets. Particular omissions were an indication of risks of procedures (three units), notification of follow up procedures (two), details for obtaining the results of the endoscopy (five), advice for people with diabetes (two) and providing a contact number for the endoscopy unit (four). In the repeat audit all 11 units had made changes to their leaflets and, overall, 80% of the items were included. Through this simple audit the range of information given to patients attending for endoscopy in the region has improved.

Data Collection↗
PubMed1995

Occupational asthma due to glutaraldehyde and formaldehyde in endoscopy and x ray departments.

BACKGROUND: Glutaraldehyde is the best disinfectant for fibreoptic endoscopes. It is also used in the processing of x ray films. A number of studies have reported eye, nose, and respiratory symptoms in exposed workers. Three individual case reports of occupational asthma in endoscopy workers and a radiographer have also been published. We describe a further seven cases of occupational asthma due to glutaraldehyde in endoscopy and x ray departments, together with exposure levels measured during the challenge tests and in 19 endoscopy and x ray departments in the region. METHODS: Eight workers were referred for investigation of suspected occupational asthma following direct or indirect exposure to glutaraldehyde at work. They were investigated by serial measurements of peak expiratory flow (PEF) and specific bronchial provocation tests. Glutaraldehyde levels were measured using personal and static short and longer term air samples during the challenge tests and in 13 endoscopy units and six x ray darkrooms in the region where concern about glutaraldehyde exposure had been expressed. Three of the workers investigated with occupational asthma came from departments where glutaraldehyde air measurements had been made; the others came from other hospitals or departments. RESULTS: The diagnosis of occupational asthma was confirmed in seven workers, all of whom had PEF records suggestive of occupational asthma and positive specific bronchial challenge tests to glutaraldehyde. Bronchial provocation testing was negative in one worker who was no longer exposed and who had a less clearcut history of occupational asthma. Three workers also had a positive specific bronchial challenge to formaldehyde. The mean level of glutaraldehyde in air during the challenge tests was 0.068 mg/m3, about one tenth of the short term occupational exposure standard of 0.7 mg/m3. The levels obtained in the challenge chamber were similar to those measured in 13 endoscopy suites and six x ray darkrooms where median short term levels were 0.16 mg/m3 during decantation in endoscopy suites and < 0.009 mg/m3 in darkrooms. CONCLUSIONS: Glutaraldehyde can cause occupational asthma. The exposure levels measured in the workplace suggest that sensitisation may occur at levels below the current occupational exposure standard.

Adult↗
PubMed2000

Emergency endoscopy.

The need for emergency endoscopy is a matter of debate. The time interval for emergency procedures remains to be defined. Most authors propose a time span of 24 h as emergency time, while some define a period of 72 h (especially in acute pancreatitis). Several studies have shown a possible benefit for a select group of patients. Four main indications are established for emergency endoscopy: acute gastrointestinal bleeding (variceal and nonvariceal), acute biliary pancreatitis and acute cholangitis. In the case of upper gastrointestinal bleeding, emergency endoscopy enables exact diagnosis and appropriate therapy, and provides important prognostic information. There is some evidence that emergent endoscopic injection therapy improves clinical outcome and reduces mortality in patients with acute ulcer bleeding. Patients do not benefit if endoscopy is performed only as a diagnostic procedure. Controversial results were published recently for emergency endoscopy in acute biliary pancreatitis. There is good evidence that emergency endoscopic retrograde cholangiopancreatography is helpful in patients with severe pancreatitis and stone impaction if performed within the first 24 h after onset of symptoms. However, emergency endoscopic retrograde cholangiopancreatography is not beneficial for patients with mild pancreatitis if performed later than 72 h (or 24 h) after onset of symptoms. There is a limited number of well established evidence-based indications for emergency endoscopy. Some other indications are still a matter of debate, and controversial opinions have been published.

Acute Disease↗
PubMed2004

Wireless capsule endoscopy for obscure gastrointestinal bleeding: a single-centre, one-year experience.

BACKGROUND: Wireless capsule endoscopy (CE) is increasingly being used in the investigation of obscure gastrointestinal (GI) bleeding, but some studies have found that many of the bleeding lesions recognized by this technique are within the reach of conventional endoscopy. METHODS: The results of CE performed in the authors' centre in a 12 month period for obscure GI bleeding were retrospectively reviewed. RESULTS: Of the 46 patients with obscure GI bleeding, CE found a definite or probable cause in 19 (41%) and a possible cause in another 10 (22%), with an overall diagnostic yield of 63%. One of these lesions was found to be within reach of conventional gastroscopy, two were within reach of push enteroscopy, four were within reach of colonoscopy and one was within reach of retrograde enteroscopy through a stoma. The percentage of patients with a bleeding source within reach of routine endoscopy but missed during pre-CE endoscopy was significantly higher for those patients having endoscopy only in the community (30% [eight of 27]) versus in the authors' centre (0% [zero of 19]). CONCLUSIONS: CE was valuable for diagnosing bleeding lesions not only within the small bowel, but also in the stomach and colon. However, "second-look" endoscopy may be considered before ordering CE for obscure GI bleeding when local expertise is available.

Adult↗
PubMed1998

Muscular strain and fatigue among urologists during transurethral resections using direct and monitor endoscopy.

OBJECTIVES: The aims of the study were to analyze muscular strain and fatigue of urologists during the performance of transurethral resections using direct and video endoscopy and to reduce the muscular effort by an ergonomic arrangement of the operation equipment. METHODS: The study was performed before, during and after the introduction of a video-guided resection method. Muscular strain and fatigue were studied by means of surface electromyograms derived from various shoulder and back muscles of surgeons. RESULTS: During direct endoscopy, muscular strain was found to be significantly higher for the shoulder muscles than during monitor endoscopy. The occurrence of muscular fatigue was established for at least one of the muscles under test in all operations during the application of direct endoscopy. A routine use of the video method was facilitated by arranging the operation equipment according to ergonomic principles. This results in a reduction in muscular fatigue, in particular for the trapezius muscle. For this muscle the number of operations accompanied with fatigue was lowered from about 80% before redesign to about 42% after redesign. CONCLUSION: Muscular strain and fatigue of urologists occurring during transurethral resections is reduced by applying video endoscopy instead of using direct endoscopy. The routine use of the video method requires an ergonomic arrangement of the operation equipment.

Adult↗
PubMed2004

Role of endoscopy in the management of chronic rhinosinusitis.

Endoscopy has multiple uses in both the medical and surgical management of chronic rhinosinusitis (CRS). This article reviews applications of endoscopy in preoperative evaluation and postoperative management of CRS. Before operation, nasal endoscopy is the standard for tissue sampling, evaluation of the mucosa, identifying structural alterations, and staging of allergic fungal sinusitis. As part of the surgical procedure, endoscopy may be used to minimize the time needed for postoperative debridement. Applications of endoscopy in in-office medical management of CRS include culturing the sinuses for fungus or bacteria, inserting a cannula for the delivery of drug therapy, and various minor manipulations following a surgical procedure. Perhaps the most important role for endoscopy in patients with CRS is in medical management, particularly in cases involving eosinophilic inflammation. Angled telescopes are important for visualizing areas often overlooked in sinuses that may otherwise appear to be normal, ie, the depths of the maxillary, frontal, or sphenoid sinus. Further use and research are likely to elicit more uses for this important technology.

Chronic Disease↗
PubMed2000

Response to open access endoscopy findings by general practitioners guidelines need education for implementation.

General practitioners may gain valuable information from the use of open access endoscopy. The benefit to the individual patient depends on the interpretation of the endoscopy findings and the subsequent action. The aim of the study was to determine GPs response to open access endoscopy findings of three conditions with possible malignant complications: Barrett's oesophagus, gastric ulcer and colonic adenomatous polyps. The study took place at Ninewells Hospital, Dundee. Using the endoscopy unit's records for the year, 1 January 1995 to 31 December 1995, all patients having had an open access upper gastro-intestinal endoscopy or sigmoidoscopy were identified. Case-notes were reviewed of patients who had Barrett's oesophagus, gastric ulcer or colonic polyps diagnosed. During the year, 1158 upper gastro-intestinal endoscopies and 293 sigmoidoscopies were performed by the open access service. The referral rates for the conditions were as follows: Barrett's oesophagus 56%; Gastric ulcers 56%; Adenomatous polyps 88%; Non adenomatous polyps 12.5%. The provision of guidelines does not ensure a high referral rate, education is a vital partner.

Adenomatous Polyps↗
PubMed2003

The utility of flexible endoscopy during advanced laparoscopy.

Advanced laparoscopic techniques have continued to grow in prevalence for the treatment of gastrointestinal surgical conditions. The field of flexible endoscopy has also continued to increase the boundaries of its capabilities with the advent of purely flexible endoscopic techniques, such as in the treatment of gastrointestinal reflux disease. This article illustrates how flexible endoscopy can be used in combination with laparoscopy in a diverse number of operations in the human foregut and hindgut, such as reflux operations, esophageal myotomies, gastric resections, peptic ulcer operations, colon resections, and pancreatic pseudocyst operations. These examples of the utility of flexible endoscopy during laparoscopy show the marriage of these two disciplines. To be able to adequately use flexible endoscopy during laparoscopy, the surgeon will need to be skilled in flexible endoscopy, and the best way to maintain those skills is to use the flexible endoscopy in one's daily practice.

Endoscopy, Gastrointestinal↗
PubMed2005

Impairment state of cognitive performance and the affecting factors in outpatients following gastrointestinal endoscopy after single-dose diazepam.

Diazepam is commonly used as premedicant for endoscopic procedures. Wide interindividual differences have been observed in the residual cognitive effects of the drug after gastrointestinal endoscopy. Our aim was to clarify the major factors, including pharmacokinetic factors, contributing to this wide variation in residual cognitive effect after gastrointestinal endoscopy in the study. Sixty-one outpatients undergoing gastrointestinal endoscopy participated in the study. Cognitive effects were evaluated in the diazepam group (n=52) by the digit symbol substitution test (DSST) twice before and 30 min after an intravenous administration of 5 mg diazepam; in the intervening time gastrointestinal endoscopy was performed. Plasma concentrations of diazepam were determined by HPLC. The control group (n=9) was tested by DSST in the same manner. The cognitive effects according to the change in DSST score was significantly decline in the diazepam group compared with the control group (by 0.2 versus -4.6; P=0.014). This prospective study confirmed that cognition was significantly impaired after gastrointestinal endoscopy by premedication to subjects with 5 mg diazepam. There were very wide variations in change in DSST score. However we could not identify the independent variables that best predicted DSST score difference in a multiple regression analysis for age, plasma albumin level, and plasma diazepam concentration 30 min after intravenous administration. We should pay attention to patients' individual states in cognitive performance following gastrointestinal endoscopy after single-dose diazepam.

Adult↗
PubMed2003

Clinical utility, safety and tolerability of capsule endoscopy in urban Southeast Asian population.

AIM: Capsule endoscopy has demonstrated its clinical utility in the evaluation of small bowel pathology in several Western studies. In this prospective study, we aimed to determine the clinical utility, safety and tolerability of capsule endoscopy in the evaluation of suspected small bowel disease in an urban Southeast Asian population. METHODS: We used the given (M2A) capsule endoscopy system in 16 consecutive patients with suspected small bowel pathology. In 9 patients the indication was obscure gastrointestinal bleeding, while in 6 patients it was to determine the extent of small bowel involvement in Crohn's disease. One patient underwent capsule endoscopy for evaluation of chronic abdominal pain. Patient's tolerability to the procedure was evaluated by standardized questionnaires and all patients were reviewed at one week to ensure that the capsule had been excreted without any adverse events. RESULTS: Abnormal findings were present in 8 patients (50%). The cause of obscure gastrointestinal bleeding was determined in 5 out of 9 patients. Findings included 2 cases of angiodysplasia, 2 cases of jejunal ulcers and 1 case of both angiodysplasia and jejunal ulcer. One patient had small bowel erosions and foci of erythema of doubtful significance. Ileal lesions were diagnosed in 2 out of 6 patients with Crohn's disease. Capsule endoscopy was well tolerated by all patients. One patient with Crohn's disease had a complication of capsule retention due to terminal ileum stricture. The capsule eventually passed out spontaneously after 1 month. CONCLUSION: Our study, which represented the first Asian series, further confirms the diagnostic utility, safety and tolerability of wireless capsule endoscopy.

Adult↗
PubMed2005

Reliability of the Spanish version of a brief questionnaire on patient satisfaction with gastrointestinal endoscopy.

BACKGROUND: There has not been a validated questionnaire available in Spanish to evaluate patient satisfaction with gastrointestinal endoscopy. Our aim was to evaluate the external validity and internal consistency of the Spanish version of a questionnaire on patient satisfaction with gastrointestinal endoscopy elaborated by the American Society for Gastrointestinal Endoscopy. DESIGN: Prospective questionnaire validation study. PATIENTS AND METHODS: A total of 485 consecutive patients referred to two different hospitals for endoscopy were interviewed by telephone. Internal consistency was studied using Cronbach's alfa test and corrected item-total correlations (CITC). External validity was determined using a mailed questionnaire completed by 185 patients-correlations between telephone and postal responses were calculated, as well as the correlation with the total score obtained. RESULTS: Cronbach's alfa was 0.82 and mean CITC was 0.59. Weighted kappa values for the same questionnaire items performed by telephone or mail varied between 0.51 and 0.81. Total score correlation was 0.78. Internal consistency and external validity were not affected by differences in the administration of the questionnaire (mail or by telephone), different interviewers, type of endoscopy, or source of patients. CONCLUSIONS: The Spanish version of the ASGE questionnaire on satisfaction with endoscopy is valid, reliable, and reproducible.

Endoscopy, Gastrointestinal↗
PubMed2006

Cardiorespiratory compromise under conscious sedation during upper gastrointestinal endoscopy.

OBJECTIVE: To compare the cardiorespiratory effects of benzodiazepine and midazolam used for sedation in patients undergoing upper gastrointestinal endoscopy with cardiorespiratory changes in the non-sedated patients. STUDY DESIGN: Comparative, randomized, single blind study. Duration and Setting: Department of Medicine at Government Medical College and Hospital, Chandigarh, India, from January to July 2000. PATIENTS AND METHODS: A total of 252 adult patients without previous cardiorespiratory co-morbidity, undergoing upper gastrointestinal endoscopy were recruited. They were randomly allocated in to group I (placebo with saline administration), group II (diazepam administered) and group III (midazolam administered). The pulse rate, blood pressure, ECG and peripheral oxygen saturation (SpO2) was noted at baseline, after pre-medication, during endoscopy and postendoscopy. Statistical analysis was done by paired t-test, Chi-square test and ANOVA as applicable. RESULTS: There was no difference in baseline record of the three groups. Significant fall in SpO2 was noted in all the groups, more marked in the sedated one during endoscopy. Tachycardia developed in all the three groups and settled within 5 minutes of endoscopy. Blood pressure remained more stable in the sedated group. ECG changes included atrial and ventricular premature contraction in all the three groups. CONCLUSION: Endoscopy is a safe procedure where cardiorespiratory complication are minimized in non-sedated patients when appropriately selected.

Adult↗
PubMed1998

Prevalence of Helicobacter pylori antibodies in endoscopy personnel and non-medical volunteers of Karachi.

Prevalence of Helicobacter pylori (Hp) is high in developing countries. As endoscopy personnel are at greater risk of exposure to gastric secretions, they are apparently at higher risk of acquiring this infection. The aim of this study was to determine prevalence of Hp antibodies in endoscopy staff and compare it with non-medical volunteers and assess any additional risk of occupational exposure to Hp in the former group. Thirty-three subjects working in endoscopy suites of different hospitals of Karachi and 33 non-medical volunteers were investigated for the prevalence of Hp antibodies by using a commercially available rapid qualitative test (FlexPack HP; Abbott). The two groups were comparable in mean age, sex and social class. Twenty-six of 33 (79%) of the endoscopy personnel and 19/33 (58%) of the non-medical volunteers were positive for Hp serology (p = 0.06 R.R 1.37). Among the endoscopy personnel 13/14 (93%) of endoscopy assistants were positive and this subgroup had a significantly higher prevalence of Hp antibodies as compared to the control group (p = 0.019). No correlation could be found between the positive serology and symptoms of dyspepsia.

Adult↗
PubMed1999

Endoscopy of the middle ear through the eustachian tube: anatomic possibilities and limitations.

HYPOTHESIS: This anatomic study was designed to provide otosurgeons with a detailed description of the technique of transtubal middle ear endoscopy and anatomic landmarks facilitating orientation. To establish the role of transtubal endoscopy, its anatomical potentials and limitations were studied. BACKGROUND: Transtubal endoscopy has recently been described as an atraumatic tool for exploring the tympanic cavity. From the nasopharynx, a thin, flexible endoscope is advanced into the middle ear through the Eustachian tube. After the endoscope has been placed, it offers an anteroposterior view of the tympanic structures. METHODS: Temporal bone blocks and whole skulls of recently deceased persons were examined to define the average range of view obtained by transtubal endoscopy. Key structures in each region of the tympanic cavity were chosen for inspection, and positive identifications were noted. RESULTS: With a 0.8-mm, flexible, steerable scope, most mesotympanic structures (stapes suprastructure, incudostapedial joint, tympanic chord, and inner surface of the eardrum) were clearly defined. Areas of the posterior wall that were not accessible with the otomicroscope (lateral tympanic sinus, tympanic sinus, and facial recess) were also seen. Unlike with transtympanic endoscopy, the epitympanum (incudomalleal joint and malleus neck) was also evaluable. The stapes footplate was not seen well and the round window niche was unable to be inspected in the anteroposterior view inherent in the technique. Technical factors (poor illumination and small image size) and the unfamiliar anteroposterior view made orientation in the middle ear difficult. CONCLUSION: Transtubal middle ear endoscopy is a suitable method for exploring the tympanic cavity without traumatizing the eardrum.

Ear, Middle↗
PubMed2000

Virtual endoscopy of the middle and inner ear with spiral computed tomography.

OBJECTIVE: To evaluate the inner anatomy of the auditory apparatus by means of virtual endoscopy of spiral computed tomography (CT) data sets. BACKGROUND: Virtual endoscopy permits simulation of the fiberoptic endoscopy perspective by processing CT or magnetic resonance images. METHODS: Seven formalin-fixed specimens of human mastoid were scanned with spiral CT with the following protocol: beam collimation 1 mm, pitch ratio 1, reconstruction spacing 0.2 to 0.5 mm, field of view 90 mm. For the generation of endoscopic views of the auditory spaces, the axial images were processed with Navigator software 2.0 running on UltraSparc I workstation. RESULTS: Virtual endoscopy allowed the demonstration of the external auditory canal, the head and handle of the malleus, the stapes and incudostapedial articulation, the corpus, the long process of the incus with its lenticular process and the short limb, the malleoincudal articulation, the rounded promontory, the round and oval windows, and Prussak's space. From inside the basal turn of the cochlea, virtual endoscopy showed the orifices of the fenestrae cochlea and vestibuli, the origin of the lateral and the anterior semicircular canals, and the basal turn of cochlea. The optimal perspectives that allowed demonstration of the anatomical details of the middle and inner ear are described. CONCLUSION: Virtual endoscopy allows the generation of inner views of the auditory spaces. This new method of image processing can be proposed as an integrative tool of spiral CT imaging.

Culture Techniques↗
PubMed2002

Endoscopy in primary care--a survey of current practice.

BACKGROUND: Long waiting lists in district general hospitals and savings from fundholding led to the setting up of a number of endoscopy units in primary care. Concerns have been expressed over safety, supervision and cost effectiveness. Increasingly, general practitioners (GPs) are being encouraged to become specialists and offer intermediate care. Endoscopy is frequently cited as an example of intermediate care that could be offered by primary care specialists. This is the first survey of such a service. AIM: To examine whether endoscopy in primary care can be considered to be a safe procedure. DESIGN OF STUDY: A questionnaire-based survey. SETTING: Twenty-eight general practice units performing endoscopy in primary care. METHOD: Units performing endoscopy in primary care were identified using the Primary Care Society of Gastroenterology (PCSG) database and following an appeal in the GP press. A postal questionnaire was sent to each unit covering its history, throughput, and case-mix, experience of endoscopists, supervision, audit and CME, equipment, waiting times and complication rates. RESULTS: Of the 28 units identified, 27 (96%) replied to the questionnaire, 13 units provided both upper and lower bowel examination, six oesophago-gastro-duodenoscopy (OGD) only, and eight lower bowel only. Units had been openfor an average of five years (range = 2 to 18 years), and 41 doctors and 68 nurse assistants provided the service. The average experience of endoscopists was 16 years (range = 6 to 25 years), and 36,455 procedures had been performed by the time of the survey (24,195 OGD and 12,260 lower bowel examinations). Ninety-six per cent of the units undertook audit. Urgent waiting times were 1.2 weeks and routine 3.4 weeks (range = 1.0 to 6.0). The annual throughput of 22 units in the past year was 8,478 procedures (4506 OGD, 3,972 lower bowel examinations). Out of 24,195 OGDs there were three reported complications (one perforation of pharyngeal pouch, treated conservatively, one chest pain after over-insufflation, and one slow recovery after intravenous sedation); there was no mortality. Out of 12,260 lower bowel procedures there was one perforated caecal carcinoma after flexible sigmoidoscopy (died), three perforations at colonoscopy and seven other minor complications. CONCLUSIONS: Endoscopy in primary care appears to be a safe procedure. This good safety record is probably attributable to careful case selection and minimal use of intravenous sedation.

Clinical Competence↗
PubMed2002

Is repeat endoscopy necessary after percutaneous endoscopic gastrostomy?

Percutaneous endoscopic gastrostomy (PEG), a safe and effective procedure, is an alternative to open gastrostomy. There are two techniques of placing PEG tubes. One technique consists of a pull-string Ponsky-Gauderer type gastrostomy and the other a push-over-wire Sachs-Vine type gastrostomy. After the gastrostomy tube is positioned, a repeat endoscopy is performed to determine optimal placement of the PEG tube. The purpose of this study was to determine the necessity of a repeat endoscopy to determine the optimal positioning of the PEG tube. Charts of 132 patients who underwent a PEG procedure between July 1, 1994 and September 30, 1996 were reviewed. Specifically, we assessed whether the endoscopist changed the position of the bumper during repeat endoscopy after PEG placement. PEG was performed successfully in 125 of 132 adult patients. Of 125 patients, the endoscope was reintroduced after PEG in 110 patients. A minor adjustment was defined as repositioning of the bumper by < or = 1.0 cm and a major adjustment as > 1.0 cm. The endoscopist made no adjustment in initial placement of the gastrostomy tube bumpers in 102 of 110 patients (93%). A minor adjustment was made in 5 patients (4%), and a major adjustment was made in 3 patients (3%). Therefore, in 102 of 110 patients (93%), initial placement of the gastrostomy tube bumpers was felt to be adequate, and repeat endoscopy was not necessary. Thus, repeat endoscopy is not routinely required to assess the proper positioning of the internal bumper. Repeat endoscopy should be at the discretion of the endoscopist if there is suspicion of improper positioning of the bumper along the gastric mucosa.

Aged↗