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At least 55 records · Page 3Linked to original sources
PubMed2006

Video capsule endoscopy compared with standard endoscopy for the evaluation of small-bowel polyps in persons with familial adenomatous polyposis (with video).

BACKGROUND: Video capsule endoscopy (VCE) may be useful for surveillance of small-bowel polyps in patients with familial adenomatous polyposis (FAP). OBJECTIVE: To compare VCE to standard endoscopy for diagnosing small-bowel polyps in a defined segment of small bowel (proximal to a tattoo) and the entire examined small bowel. DESIGN: Prospective. SETTING: Single tertiary referral center. PATIENTS: Participants with FAP (n = 32). The majority were selected for their high number of proximal small-bowel polyps and prior endoscopic tattoo placement in the proximal small bowel. INTERVENTIONS: VCE (interpreted by 2 readers), push enteroscopy (PE), and lower endoscopy (LE) to count and measure small-bowel polyps. RESULTS: In the defined segment, VCE detected a median of 10.0 (interquartile range [IQR], 5.0-19.0) and 9.0 (IQR, 6.0-16.0) polyps for each reader compared with a median of 41.0 (IQR, 19.0-64.0) polyps on PE (P = .002). Agreement between the 2 methods was fair (kappa = 0.34, 0.36). Agreement between VCE and PE was poor to fair (kappa = 0.10, 0.22) for estimating the size of the largest polyp and poor (kappa = -0.20, -0.27) for detecting large polyps (> or =1 cm). In the entire examined small bowel, VCE diagnosed a median of 38.0 (IQR, 10.5-71.5) and 54.0 (IQR, 13.0-100.0) polyps for each reader compared with a median of 123.0 (IQR, 38.5-183.0) for combination endoscopy (PE and LE) (P < .001). Agreement between the 2 methods was fair to moderate (kappa = 0.21, 0.56). LIMITATIONS: Participants selected for high polyp burden, and results may not be applicable to all patients with FAP. CONCLUSIONS: VCE underestimates the number of small-bowel polyps in persons with FAP and does not reliably detect large polyps.

Adenomatous Polyposis Coli↗
PubMed2001

Autofluorescence endoscopy: feasibility of detection of GI neoplasms unapparent to white light endoscopy with an evolving technology.

BACKGROUND: Case studies are presented of fluorescence endoscopy in the upper and lower GI tract to illustrate the ability to detect early-stage lesions that were not observable with white light endoscopy or those in which the assessment of the stage or extension of the lesion were equivocal. METHODS: A new fluorescence imaging system was used in which blue light excites the naturally-occurring fluorescence of tissues (autofluorescence). The system produces real-time, false-color images that combine green and red fluorescence intensities. In general, abnormal lesions are seen to have an increase in the red-to-green fluorescence intensity compared with surrounding tissue. This system was evaluated in patients at 4 participating institutions, concurrently with standard white light endoscopy, with or without dye staining. RESULTS: Selected cases are presented in which fluorescence imaging identified specific lesions including focal high-grade dysplasia in Barrett's mucosa, signet ring carcinoma of the stomach, and flat adenoma in the colon. CONCLUSIONS: The capability of autofluorescence endoscopy to detect the presence and extent of occult malignant and premalignant GI lesions has been demonstrated. The future development and evaluation of this technology are discussed.

Adenocarcinoma↗
PubMed1994

Appropriate use of upper gastrointestinal endoscopy--a prospective audit. Steering Group of the Upper Gastrointestinal Endoscopy Audit Committee.

Work by this group has shown that there is a wide range of opinion as to patients' suitability for endoscopy. In a recent study, 1297 questionnaires were sent to a random selection of doctors, including 350 general physicians, 400 surgeons, 477 gastroenterologists, and 70 general practitioners. The respondent was asked to indicate whether or not he would refer the patient described by each case vignette for endoscopy. Depending on the indication, the positive referral rate varied from 4.5% to 99% overall, and from 4.5% to 63.8% for all those clinical situations that the working party felt to be inappropriate. A second study examined the appropriateness of 400 consecutive cases referred from four units within one health region; these cases were judged independently, and without conferring, by a panel of seven gastroenterologists. The same cases were rated by software that incorporated American opinion (the Rand criteria). Although only 45 (11%) of the cases were classed as inappropriate by the British panel, 120 cases (31%) assessed by the American software were rated inappropriate. These differences occurred largely because in the USA it is recommended that one month's antiulcer treatment be tried before considering endoscopy for dyspepsia and thus many referrals were seen as inappropriate by the American database. Of the 45 cases found to be inappropriate by the British doctors no important abnormality was found at endoscopy; whereas of 120 cases judged inappropriate by the Rand criteria, three duodenal and two gastric ulcers, and one gastric cancer were diagnosed at gastroscopy. This study attempts a quantitative assessment of inappropriate use and serves to encourage further work to define appropriateness.

Adult↗
PubMed2004

[Appropriateness of indications for upper gastrointestinal endoscopy in open-access endoscopy units].

INTRODUCTION: The indication for upper gastrointestinal endoscopy (UGE) by the general practitioner may significantly reduce the waiting time list for the exploration and accelerates the process of taking decisions in patients with upper gastrointestinal pathology. The objective of this study is to compare the appropriateness of indications for diagnostic UGE between general practitioners and gastroenterologists in open-access endoscopy units. PATIENTS AND METHODS: General practitioners were previously updated on the main indications, risks and benefits for UGE, and instructions for submitting patients to open-access units were given. The indications for UGE were analysed by means of the ASGE 1997 and EPAGE guidelines for the appropriate use of upper gastrointestinal endoscopy. RESULTS: There were no statistical differences between patients referred by general practitioners or gastroenterologists with respect to gender, age, indication of UGE or the presence of alarm symptoms. According to the ASGE guidelines overuse of UGE was observed in 25 (18.4%) of 136 patients submitted by general practitioners and in 32 (18.6%) of 172 patients submitted by gastroenterologists (NS). According to the EPAGE guidelines a non-appropriated UGE was present in 16 (11.8%) of patients referred by general practitioners and by 19 (11%) of patients submitted by gastroenterologists (NS). CONCLUSION: The level of appropriateness for UGE indication obtained by general practitioners is similar to that reached by gastroenterologists. This finding should be considered for the implementation of open-access endoscopy units in our country.

Adult↗
PubMed1999

A comparison of open access endoscopy and hospital-referred endoscopy in a district general hospital.

Open access endoscopy (OAE) is widely used in many hospitals. The aim of this study was to compare the upper gastrointestinal endoscopies referred to as "OGDs" performed under the OAE service and those referred from hospital outpatient clinics (HR) during the initial year in which an OAE service was provided in a district general hospital. A retrospective review of medical records from all patients undergoing OGD during the first year of OAE to identify the waiting time for OGD, the extent of pre-treatment at the time of OGD, the endoscopic findings and the number of endoscopies in which oesophageal or gastric neoplasia was detected. Follow-up endoscopies (n = 41) were excluded. Of 739 OGDs included, 384 (177 male; mean age 48.0 yrs.) were performed under the OAE service, 346 (149 male; mean age 50.7 yrs.) were referred from outpatient clinics and 9 could not be accurately classified. The waiting time was significantly lower in the OAE group compared to the HR group (24.5 v. 29.8 days, p<0.001). Pre-treatment at the time of OGD was significantly more frequent in the OAE group compared to the HR group (295 v. 186, p<0.001). Frequencies of the main endoscopic diagnoses did not differ significantly between the two groups. The OAE service provided faster access to OGD than the HR group and the endoscopic findings were similar in the two groups.

Endoscopy, Digestive System↗
PubMedDate not supplied

[Emergency endoscopy in children: experience of a digestive endoscopy department].

Many changes and advances have been achieved in the last years, so that emergency endoscopy has now a definite role also in the diagnosis and treatment of diseases in childhood. In order to determinate main indications to endoscopic examination, and which are the most useful diagnostic and therapeutic measures that should be performed, we examined the records of 202 patients (aged 1 day-14 years) undergone emergency endoscopy from June 1979 to January 1990. Patients were referred to endoscopy because of foreign bodies or caustic ingestion, hematemesis, and in one patient a suspected intussusception. We didn't record any complication. Our study shows that emergency endoscopy has a definite role also in pediatric age and gives a diagnostic and therapeutic gain in the management of many diseases.

Adolescent↗
PubMed2002

[Intramedullary bone endoscopy (IBE). First results of experimental intramedullary endoscopy of long bone].

INTRODUCTION: Intramedullary preparation and endoscopy of long bone is not mentioned in literature. We present our first results of experimental intramedullary endoscopy of long bone. METHODS: Experimental tests were performed at 4 corpse bones (twice tibia, twice femur). RESULTS: Intramedullary endoscopy and preparation was possible in all cases. A good view for inspection of the medullary canal was achieved by using the endoscope (Wolf GmbH, Germany). CONCLUSION: Endoscopic preparation and intramedullary endoscopy in the long bone ist possible. By using the endoscopic tools, a "neocavum" for endoscopic manipulation could easily be created.

Bone Marrow↗
PubMed1986

Endoscopy or radiography?--The patient's choice. Prospective comparative survey of patient acceptability of upper gastrointestinal endoscopy and radiography.

Patient acceptability of endoscopy and the double-contrast barium meal test was compared in a prospective randomized fashion. Ninety-six inpatients were interviewed with a standardized questionnaire within 24 hours of completion of double-contrast barium meal test and endoscopy, after recovery from administered sedation. Twenty-five percent of patients reported moderate to severe discomfort with each procedure. The levels of discomfort reported were similar for both procedures. The majority of patients would readily undergo a repeated procedure, if requested. There was a tendency (p less than 0.1) for patients to prefer endoscopy overall. No specific patient group that preferred one procedure over the other could be identified, although older patients (more than 55 years) showed a tendency to prefer endoscopy. The choice of one procedure over the other should no longer be based on the presumed superior acceptability of the double-contrast barium meal test.

Barium Sulfate↗
PubMed2005

The European panel on the appropriateness of gastrointestinal endoscopy guidelines colonoscopy in an open-access endoscopy unit: a prospective study.

BACKGROUND: The demand for gastrointestinal endoscopy is increasing in most developed countries, resulting in an important rise in overall costs and waiting lists for endoscopic procedures. Therefore, adherence to appropriate indications for these procedures is essential for the rational use of finite resources in an open-access system. AIM: To assess indications and appropriateness of colonoscopy according to the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) criteria. METHODS: From May to June 2004, all consecutive patients referred to our Unit for open-access colonoscopy were considered for inclusion in this prospective study. Appropriateness of each colonoscopy was established according to the EPAGE criteria. In order to evaluate whether appropriateness of use correlated with the diagnostic yield of colonoscopy, relevant endoscopic findings were also recorded. RESULTS: A total of 350 consecutive patients were included in the study. In 38 of them, the colonoscopy indication was not listed in the EPAGE guidelines and, consequently, they were not evaluated. In the remaining 312 patients, the indication for the procedure was considered inappropriate in 73 (23%) patients. Both referring doctor characteristics (specialty and health care setting) and patient data (age) correlated with appropriateness of endoscopy. The diagnostic yield was significantly higher for appropriate colonoscopies (42%) than in those judged inappropriate (21%) (P = 0.001). CONCLUSIONS: A noteworthy proportion of patients referred for colonoscopy to an open-access endoscopy unit are considered inappropriate because of their indication, with significant differences among specialties. These results suggest that implementation of validated guidelines for its appropriate use could improve this situation and, considering the correlation between appropriateness and diagnostic yield, even contribute to improve the prognosis of patients with colorectal diseases.

Adult↗
PubMed1998

Cleaning and disinfection of equipment for gastrointestinal endoscopy. Report of a Working Party of the British Society of Gastroenterology Endoscopy Committee.

Two per cent glutaraldehyde is the most commonly used disinfectant in endoscopy units within the UK. Unfortunately adverse reactions to glutaraldehyde are common among endoscopy personnel and the Health and Safety Commission has recommended substantial reductions in atmospheric levels of glutaraldehyde in order to comply with the Control of Substances Hazardous to Health Regulations, 1994. The Working Party addressed ways of eliminating or minimising exposure to glutaraldehyde in endoscopy units by reviewing alternative disinfectants and the use of automated washer/disinfectors. Alternatives to glutaraldehyde must be at least as microbicidal as glutaraldehyde, non-irritating and compatible with endoscope components and decontamination equipment. Peracetic acid is a highly effective disinfectant and may be a suitable alternative to glutaraldehyde. Peracetic acid has a vinegary-like odour and is claimed to be less irritating than glutaraldehyde. Experience with this agent remains relatively limited and the Working Party recommends that peracetic acid should be used in sealed or exhaust ventilated facilities until further experience is obtained. It is considerably more expensive than glutaraldehyde, is less stable and large volumes have to be stored. It causes cosmetic (but not functional) damage to endoscopes and is not compatible with some washer/ disinfectors. Chlorine dioxide is a powerful oxidising agent and highly effective as a disinfectant. Once activated it must be stored in sealed containers with little head space. Fumes cause irritation and sealed or exhaust ventilated facilities are necessary. The agent may damage some metallic and polymer components of endoscopes and automated washer/disinfectors and compatibility should be established with equipment manufacturers before the agent is used. Other disinfectants such as peroxygen compounds and quaternary ammonium derivatives are less suitable because of unsatisfactory mycobactericidal and/or virucidal activity, or incompatibility with endoscopes and automated washer/disinfectors. Alcohol is effective but, on prolonged contact, is damaging to lens cements. It is also flammable and therefore unsuitable for use in large quantities in automated systems. Superoxidised water (Sterilox) is an electrochemical solution (anolyte) containing a mixture of radicals with strong oxidising properties. It is highly microbicidal when freshly generated, provided items are thoroughly clean and strict generation criteria are met--that is, current, pH, redox potential. It seems to be safe for users and provided field trials substantiate laboratory efficacy tests, and the agent is non-damaging, it too may become an alternative to glutaraldehyde. When 2% glutaraldehyde is used for manual and automated disinfection, 10 minutes' immersion is recommended for endoscopes before the session and between patients. This will destroy vegetative bacteria and viruses (including hepatitis B virus (HBV) and HIV). A five minute contact period is recommended for 0.35% peracetic acid and for chlorine dioxide (1100 ppm av ClO2), but if immersed for 10 minutes sporicidal activity will also be achieved. At the end of each session 20 minutes' immersion in glutaraldehyde or five minutes in peracetic acid or chlorine dioxide is recommended. Microbiological studies show that 20 minutes of exposure to 2% glutaraldehyde destroys most organisms, including Mycobacterium tuberculosis. The Working Party concludes therefore that immersion of the endoscope in 2% glutaraldehyde for 20 minutes is sufficient for endoscopy involving patients with AIDS and other immunodeficiency states or pulmonary tuberculosis. Similarly, 20 minutes' immersion is recommended at the start of the list and between cases for endoscopic retrograde cholangiopancreatography (ERCP) when high level disinfection is required. Cleaning and disinfection of endoscopes should be undertaken by trained staff in a dedicated room. Thorough cleaning with detergent

Disinfectants↗
PubMed2006

The accuracy of PillCam ESO capsule endoscopy versus conventional upper endoscopy for the diagnosis of esophageal varices: a prospective three-center pilot study.

BACKGROUND AND STUDY AIMS: Variceal bleeding is a major complication of cirrhosis, and is associated with a 20 % mortality at 6 weeks. Current international guidelines recommend that patients with cirrhosis are screened by conventional upper endoscopy (esophagogastroduodenoscopy, EGD) in order to detect esophageal varices. The recently developed PillCam ESO esophageal capsule endoscope has been shown to be an accurate diagnostic tool in the investigation of patients with gastroesophageal reflux and Barrett's esophagus. We compared the PillCam ESO capsule endoscope with EGD for the detection of esophagogastric varices and portal hypertensive gastropathy in patients with cirrhosis. PATIENTS AND METHODS: A pilot trial was conducted at three sites. Patients with cirrhosis who were undergoing clinically indicated EGD for screening or surveillance for esophageal varices underwent a PillCam ESO study followed by an EGD within 48 hours. Capsule videos were assessed by an investigator who was blinded to the patient's medical history and EGD findings. RESULTS: A total of 23 of the 32 enrolled patients were found to have esophageal varices at both EGD and PillCam ESO endoscopy. In one patient PillCam ESO detected small varices that were not seen at EGD. The overall concordance between PillCam ESO and EGD was 96.9 % for the diagnosis of esophageal varices and 90.6 % for the diagnosis of portal hypertensive gastropathy. There were no adverse events related to PillCam ESO endoscopy. CONCLUSIONS: In a high-prevalence population, PillCam ESO may represent an accurate noninvasive alternative to EGD for the detection of esophageal varices and portal hypertensive gastropathy. A large-scale trial is underway to validate and expand these findings.

Endoscopes, Gastrointestinal↗
PubMed1983

Upper gastrointestinal fibreoptic endoscopy experience in the Sudan. Analysis of 2500 endoscopies.

The results of 2500 upper gastrointestinal fibreoptic endoscopies carried out at Soba University Hospital, Khartoum, between January, 1980, and June, 1982, were reviewed. 42% of the patients had no disorder visible on endoscopy, 9% had oesophageal varices, 0.7% gastric ulcer, 17% duodenal ulcer, and 2% pyloric obstruction. Duodenal ulcer was seen more commonly in men (male/female ratio 4.5/1) and in young people. Endoscopy is a feasible procedure in developing countries. It is more informative and cheaper than barium meal radiology.

Costs and Cost Analysis↗
PubMed2003

Capsule endoscopy in patients with suspected Crohn's disease and negative endoscopy.

BACKGROUND AND STUDY AIMS: The aim of the present study was to assess the value of capsule endoscopy in the diagnostic work-up of patients in whom there is a clinical suspicion of small bowel Crohn's disease that cannot be confirmed using traditional techniques. PATIENTS AND METHODS: A total of 21 patients (14 men, seven women; mean age 43 +/- 8 years) with a clinical and biochemical suspicion of Crohn's disease were included in the study. Conventional imaging work-up, including upper and lower endoscopy, as well as a small-bowel follow-through, was carried out in all of the patients. RESULTS: Pathological findings were not observed in 12 of the 21 patients (57 %). In the other nine patients (43 %), lesions supporting the diagnosis of Crohn's disease were seen. The most frequent findings were located in the distal ileum and included aphthae, lineal and serpiginous ulcers, and fissures. Four patients had lesions in the jejunum. One patient showed erosions in the distal duodenum, jejunum, and ileum. No adverse effects of the technique were observed in any of the patients. CONCLUSIONS: Capsule endoscopy is a valuable diagnostic tool in patients with suspected Crohn's disease that has not been confirmed using standard imaging techniques.

Adult↗
PubMed2003

Digestive endoscopy from rigid to fiber-optic instruments; the Polish contribution to the development of gastrointestinal endoscopy.

In 1987 on the occasion of the 50(th) anniversary of the British Society of Gastroenterology Sir Francis Avery-Jones (1) wrote (perhaps a little exaggerating) in his introductory remarks: "In 1937 the alimentary tract was invisible, impalpable and inaccessible-except the top and the bottom". Indeed, diagnostics in gastroenterology was very weak and uncertain at the beginning and even in the middle of the last century. Endoscopy and radiology, developing first apart and then together revolutionized the diagnostics and consequently the practice in gastroenterology. Endoscopy brought a new access to operative procedures alleviating the burden of open surgery as well. The method, apart from knowledge, needs personal skills and so new problems of postgraduate education and ethics appeared. Due to the enormous progress in science and in technology it has reached the present level of accuracy. Polish gastroenterology with its early achievements in gastric secretion (Leon Popielski, histamine), abdominal surgery (Ludwik Rydygier, first gastric resection), endoscopy (Jan Mikulicz-Radecki) and later research upon the neuro-hormonal brain-gut axis (Stanisław J. Konturek) tried to keep pace with the world-wide progress in this field. The Polish contributions to the growing knowledge and improving practice may be traced from the very beginning of the 20(th) century.

Digestive System Diseases↗
PubMed2006

Pretreatment endoscopy--pro & contra: is endoscopy needed before treatment in all patients with gastroesophageal reflux disease?

The role of endoscopy in reflux disease has changed from being primarily diagnostic to one of risk management. Objective studies of routine endoscopy have shown little change in outcomes after the examination. Screening and surveillance for Barrett's esophagus is still an unconfirmed strategy. In most developed countries, including western Europe and North America, middle-aged patients (over the age of 50) with gastroesophageal reflux disease would benefit more from colonoscopy than upper endoscopy.

Barrett Esophagus↗
PubMed1991

Diagnosis of gastric polypoid lesions by magnifying endoscopy and dye endoscopy.

From July 1989 to June 1990, a total of 19 patients with gastric polyps were studied by magnifying endoscopy and dye endoscopy. After pretreatment with pronase, both close and magnified pictures were observed before and after sprays of 0.2% indigo carmine. Polypectomy or multiple biopsies were done after endoscopic examinations. Of the 19 patients; 13 were classified as hyperplastic polyps and 6 as neoplastic polyps by histologic examination. Twelve of the 13 hyperplastic polyps showed regular sulciolar or sulciolar-mesh mucosal patterns after magnification, only 1 showed an irregular sulciolar-mesh pattern. All 6 neoplastic polyps showed irregular or destructive mucosal patterns. Hyperplastic polyps have a significantly higher rate of regular, fine gastric mucosal patterns. Contrast staining with indigo carmine did not significantly improve the observations. We conclude that magnifying endoscopy is useful in the diagnosis of gastric polyps; polyps with fine, regular gastric pits indicate a diagnosis of hyperplastic polyps, while irregular or destructive mucosal patterns suggest a high possibility of neoplastic polyps.

Coloring Agents↗
PubMed1998

[Colonic polyps considered unresectable by endoscopy. Removal by combinations of laparoscopy and endoscopy in 65 patients].

OBJECTIVE: To determine to what extent segmental colectomy could be avoided in patients with polyps though to be endoscopically unresectable by using combination laparoscopy and endoscopy. METHODS: Sixty-five patients referred for colonic polyps though to be unresectably by conventional endoscopy were studied. After analysis of the endoscopic findings, endoscopy was performed in a medicosurgical unit when possible, otherwise a surgical procedure was performed consisting of laparoscopy followed by colonoscopy. Therapeutic strategy depended on laparoscopic and endoscopic findings. RESULTS: Segmental colectomy was avoided in 44 patients (67.7%). Among them, 20 were treated by simple endoscopic polyp removal, 12 by laparoscopy-assisted colonoscopic polypectomy, 9 by laparoscopic wedge colonic resection and 3 by colotomy after colonic exteriorization and polyp resection. Laparoscopic or laparoscopy-assisted segmental colectomy was performed in 16. Segmental colectomy by laparotomy was necessary in 5. No complication occurred. CONCLUSION: Segmental colectomy for unresectable colonic polyps could be avoided in more than half of the patients using laparoscopy and colonoscopy combinations.

Adult↗
PubMed1976

Endoscopy - related bacteremia. Incidence of positive blood cultures after endoscopy of upper gastrointestinal tract.

A prospective study was undertaken to determine the frequency of bacteremia after endoscopy of the upper gastrointestinal tract. Three of 100 patients (3%) demonstrated positive blood cultures after the endoscopic procedure. Bacteriologic surveys disclosed that routine cleansing procedures of the endoscopy room and the endoscope itself frequently failed to achieve optimal sterile conditions. Particularly noteworthy was the growth of Enterobacter liquefaciens and Candida albicans on one occasion from the endoscope tip. We conclude that, although the incidence of postendoscopy positive blood cultures is low, a more vigorous approach to using clean equipment in clean surroundings is needed when dealing with a potentially susceptible host.

Candida↗