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PubMed1978

Out-patient gastroscopy risks.

Complications in out-patient gastroscopy were evaluated retrospectively in 995 examinations performed in 625 patients. At the examination seven complications were registered in the gastroscopy record. Two complications: perforation of the stomach and cardiac arrhythmia, required hospitalisation. None of the complications was lethal. Inquiries to the referring general practitioners revealed 5 cases where the gastroscopy had led to consultations because of minor complaints after the examination. Considering all complaints as complications the frequency of complications in out-patient gastroscopy was 1.2%.

Adolescent↗
PubMed2004

Open-access gastroscopy in primary health-care offices to prevent peptic ulcer-related hospitalization and mortality.

BACKGROUND: Open-access gastroscopy performed by general practitioners is available at some primary care health centres in our Central Finland hospital referral area. The aim of the present study was to examine whether this practice influences peptic ulcer-related hospitalization and mortality. METHODS: Data on peptic ulcer-related hospitalization were obtained from discharge registries of the hospitals. Cause of death statistics were obtained from Statistics Finland Bureau. RESULTS: In 1996--2001, 896 inhabitants living in our hospital referral area were hospitalized owing to peptic ulcer. Of these, 265 (29.6%) had an ulcer related to the use of aspirin (ASA) or non-steroidal anti-inflammatory drugs (NSAIDs). Among the hospitalized patients, mortality was 11.6% (n = 104). In municipalities with or without an open-access gastroscopy service, the rates of hospitalization were 49.1 cases/100,000/year (95% CI 44.8-53.4) versus 77.5 cases/100,000/year (95% CI 72.0-83.0), and ulcer-related mortality 5.6 cases/100,000/year (95% CI 4.1-7.1) versus 9.4/100,000/year (95% CI 7.5-11.3). In municipalities without the service, inhabitants were older and their overall morbidity and mortality higher than in municipalities offering open-access gastroscopy. Of patients under 75 years of age (n = 582), 48 (8.2%) died, compared with 56 (17.8%, P < 0.001) of patients aged 75 years or older (n = 314). Age was the only independent risk factor for death (odds ratio (OR) 1.03 per year (95% CI 1.02-1.05)). Among patients with ASA-NSAID-related ulcer, open-access endoscopy was protective against ulcer-related death (OR 0.17 (95% CI 0.03-0.85)). CONCLUSIONS: Open-access gastroscopy in primary health-care offices significantly reduces ASA-NSAID-related ulcer mortality and may also reduce overall ulcer-related hospitalizations. The present results may, however, be biased by demographic factors. Age is a risk factor for death during ulcer-related hospitalization.

Age Factors↗
PubMed1990

Open access gastroscopy: too much to swallow?

OBJECTIVES: To ascertain the proportion of endoscopic examinations with normal findings in patients referred for gastroscopy through hospital medical staff or directly by their general practitioner and to assess the likely effect of targeting endoscopy in older patients. DESIGN: Retrospective audit of the gastroscopy practice of one consultant from 1986 to 1988 from information recorded on a standard form completed at the time of the examination, which contained details of patients, their endoscopic findings, and mode of referral (open access or clinic). SETTING: One district general hospital. PATIENTS: 1545 Consecutive patients from primary catchment area attending for their first gastroscopy; 454 were referred through the outpatient clinic or by hospital colleagues (clinic group) and 1091 were accepted for endoscopy solely on their general practitioner's clinical diagnosis (open access group). RESULTS: Similar numbers (about 40%) of examinations with normal findings were performed in each group, although in patients aged over 40 the proportion with normal findings was significantly higher in the clinic group (p less than 0.03). Endoscopic evidence of gastro-oesophageal reflux disease, peptic ulceration, and gastroduodenal inflammation was equally common in each group; upper gastrointestinal malignancy, however, was significantly more common in patients referred through hospital doctors (5%, 23/454 v 2%, 22/1091 respectively; p less than 0.005) (although many of these patients had already been extensively investigated). IMPLICATIONS: Open access gastroscopy does not increase the number of unnecessary examinations and should become more widely available. Targeting this service to patients aged over 40 would reduce the number of requests but increase the diagnostic yield.

Adolescent↗
PubMed2000

Detection of upper gastrointestinal cancer in patients taking antisecretory therapy prior to gastroscopy.

BACKGROUND: The incidence of early gastric cancer has not increased despite better access to endoscopic facilities for general practitioners. Many patients receive a course of symptomatic treatment while waiting for gastroscopy. AIMS: To ascertain the effect of antisecretory therapy on the diagnostic process and findings for patients with upper gastrointestinal cancer. METHODS: A consecutive case study survey of the primary care records of 133 patients who had died of upper gastrointestinal cancer during 1995-97 in the South Tees health district in the north-east of England (population 300 000). RESULTS: From the 133 patients identified, 116 had died from adenocarcinoma of the oesophagus (31) or stomach (85). Failure to reach the diagnosis of cancer at the index gastroscopy was associated with prior acid suppression therapy. Only one of 54 patients on no treatment or antacids alone was erroneously diagnosed as suffering from benign disease, whereas 22 of 62 patients treated with acid suppression were diagnosed as suffering from benign disease but at varying times later turned out to have adenocarcinoma. Twenty of 45 patients taking a proton pump inhibitor had a delayed diagnosis compared with two of 17 taking an H(2) receptor antagonist. The commonest lesion seen at index gastroscopy in those in whom the diagnosis was initially missed was gastric ulcer. Healing occurred in six patients taking a proton pump inhibitor, despite their later diagnosis of malignancy. CONCLUSIONS: The treatment of dyspeptic symptoms with acid suppression prior to gastroscopy masks and delays the detection of gastric and oesophageal adenocarcinoma on endoscopy in one third of patients.

Adenocarcinoma↗
PubMed2004

Patterns of use of flexible sigmoidoscopy, colonoscopy and gastroscopy: a population-based study in a Canadian province.

BACKGROUND & AIMS: Flexible sigmoidoscopy, colonoscopy and gastroscopy are important in the diagnosis and treatment of gastrointestinal (GI) diseases. Pressure on endoscopy resources is expected due to increased screening for GI cancers. The present study examined patterns of use of GI endoscopy in a Canadian province, Alberta, with universal health care insurance. METHODS: Data on physician payments from January 1, 1994 to March 31, 2002 were used to calculate age-sex adjusted rates and patterns of use. RESULTS: The gastroscopy rate increased by 17%, from 9.7 (95% CI 9.6 to 9.9) to 10.3 (95% CI 10.1 to 10.5). The colonoscopy rate increased by 105%, from 4.8 (95% CI 4.6 to 5.0) to 9.8 (95% CI 9.6 to 10.1). Flexible sigmoidoscopy rates declined by 10%, from 4.68 (95% CI 4.56 to 4.80) to 4.21 (95% CI 4.11 to 4.32). The increase in colonoscopy rates occurred in all age groups, whereas gastroscopy rates increased only in the older age groups. Regional variation in procedure rates was evident, but rural health regions did not have consistently lower rates than the large urban regions. A polypectomy was performed on 23.7% of male patients and 15.4% of female patients at time of colonoscopy. Rates of polypectomy for individual endoscopists ranged from 0% to 60%. CONCLUSIONS: There has been a marked increase in gastroscopy and colonoscopy rates, likely due to a broadening of indications rather than just increased use for cancer screening. Modest regional variation in rates exists, but there is no direct evidence of limited rural access to endoscopy. Reasonable polypectomy rates were seen but important variations between endoscopists exist.

Adult↗
PubMed1999

Cost-effectiveness of gastroscopy.

In a health economics perspective, no other decision area in gastroenterology has been more debated than the role of gastroscopy in dyspepsia. Cost-effectiveness analyses correlate costs with health outcomes. The cost-effectiveness of a diagnostic strategy must be compared to that of a competing strategy to produce useful information. This review examines the cost-effectiveness of gastroscopy in the management of dyspeptic patients, in particular in relation to the competing strategies of deferred referral guided by the outcome of either empirical antisecretory medication or of a non-invasive Helicobacter pylori test. Estimates of costs of gastroscopy differ widely. Cost estimates are usually much lower in European countries compared to the US. This is probably mainly due to differences in the calculations and in the payer perspective used. Cost-effectiveness analyses in dyspepsia management and the role of gastroscopy are difficult to interpret and impossible to compare due to a lack of uniformity in designing, measuring and reporting costs and health-care related outcome. Compared to empirical acid inhibition and to a test-and-scope strategy initial endoscopy is probably cost-effective--at least in Europe. Based on preliminary findings from clinical trials and from decision analyses a test-and-eradicate management strategy in young dyspeptic patients without warning symptoms seems to be cost-effective compared to early endoscopy. Implementing a test-and-eradicate strategy in primary care will probably save endoscopies without harmful effects. In view of the rapidly changing epidemiology of Helicobacter pylori infection in the Western world the long-term effects of such a policy should be monitored closely.

Cost-Benefit Analysis↗
PubMed2000

[Transnasal gastroscopy].

The use of transnasal endoscopy has not been reported earlier in Denmark. This study describes the preliminary experiences with transnasal gastroscopy using the Olympus XGIF-N200 prototype. Patients scheduled for diagnostic gastroscopy were examined transnasally. The patients answered questions regarding anxiety and discomfort, and the endoscopist commented on the quality of the procedure. Of sixty patients included, 56 (93%) were examined transnasally. Two patients did not have nasal passage and were examined orally, and two patients were examined with standard gastroscope because of technical difficulties. Sixty-eight percent of the procedures were unsedated, 55% of the patients did not experience gag-reflexes. The procedure was described by most patients as "slightly uncomfortable". Twenty-five percent had uncomplicated epistaxis. Pulse rate and saturation levels were stable. Transnasal gastroscopy seems to be well tolerated by the patients, as both subjective and objective criteria were better than those for conventional gastroscopy.

Gastroscopes↗
PubMed1999

[Clinical significance of post-operative follow-up gastroscopy for patients with gastric cancer: a report of 986 cases].

OBJECTIVE: To evaluate the clinical significance of postoperative follow-up gastroscopy in patients with gastric cancer. METHODS: Gastroscopy was performed in 986 patients with gastric cancer from 3 weeks to 21 years after operation. Each cases received gastroscopy 1 to 5 times in the follow-up period. RESULTS: Recurrent cancer was found in 75 cases, multiple primary malignant tumors in 4 cases and gastric stump cancer in 9 cases in the residual stomach. Functional disturbance of emptying after subtotal gastrectomy was found in 12 cases. Retention of gastric tube or silicon tube was found at the anastomotic stoma site in 9 cases. The other non-cancerous disorders included gastritis in 187 cases, residual non-absorbable sutures in 91 cases, metal staple in 4 cases, erosion in 51 cases, ulcer in 22 cases, polyposis in 38 cases and scar stenosis in 11 cases at anastomotic site. CONCLUSION: Routine postoperative gastroscopy check-up(s) is capable of early detecting cancer lesion and other non-cancer disorder in residual stomach. It helps increase survival rate and improve quality of life.

Adult↗
PubMed2002

Direct gastroscopy for detecting gastric cancer in the elderly.

OBJECTIVE: To evaluate the safety and effectiveness of direct gastroscopy for detecting gastric cancer. METHODS: Clinical screening by direct gastroscopy was performed for gastric cancer (GC) from September 1985 to July 1998. 3048 elderly people were screened. Their age ranged from 60 to 93 years, and 2034 of the 3084 were followed up. RESULTS: Ninety-two patients with gastric cancer were discovered by gastroscopy, representing 3.02% of the screened population. The rate of early gastric cancer (EGC) was 63.04% (58/92) of all gastric cancers detected. The rate was up to 79.59% (39/49) on follow-up, and was 74.14% (43/51) in asymptomatic patients with gastric cancer. The excision rate was 88.89% for patients with gastric cancer, and 100% for patients with early gastric cancer. The 5-year survival rate was 91.89% for patients with gastric cancer, and 96.30% for patients with early gastric cancer. CONCLUSION: Clinical screening and follow-up by direct gastroscopy in persons over 60 years of age are a safe and effective method for raising the 5-year survival and detection rate of gastric cancer, especially early gastric cancer.

Aged↗
PubMed1984

[Heart arrest in gastroscopy--report of 2 cases].

Two cases with cardiac arrest in the early phase of gastroscopy are presented. In a 83-years-old patient, the external cardiac reanimation was successful, but nevertheless the cardiac intensive therapy a 85-years-old woman died. The possible causes of cardiac complications of gastroscopy are discussed and consequences for premedication are proposed. This first communication about a fatal complication during gastroscopy in the GDR is reported to emphasize the potential rare but serious dangers of gastroscopy.

Aged↗
PubMed2006

Early gastric cancer: virtual gastroscopy.

Gastric cancer is one of the most common cancers and one of the most frequent causes of cancer-related deaths worldwide. Early detection and accurate preoperative staging of early gastric cancer (ECG) offers the best prognosis and is essential for planning optimal therapy such as endoscopic mucosal resection or gastric resection. Recent advances in computed tomographic technology and three-dimensional imaging software have enabled more accurate gastric imaging. Virtual gastroscopy (VG) is helpful in the detection and evaluation of EGC in the same way as gastroscopy. VG has a wider field of view than conventional gastroscopy, the angle of the virtual cancer can be adjusted omnidirectionally, and it has no blind point because retrospective reconstruction is available. Thus, VG is a promising method for evaluating gastric lesions despite its limitations. This report describes the clinical usefulness of VG with multidetector row computed tomography for EGC and axial computed tomography.

Early Diagnosis↗
PubMed2002

Is gastroscopy still a valid diagnostic tool in detecting gastric MALT lymphomas? A dilemma beyond the eye. Mucosa-associated lymphoid tissue.

BACKGROUND: Primary gastric lymphomas are distinct entities with an indolent clinical course and biologic behavior. They account for 2-8% of all gastric malignancies. We conducted this study to evaluate the role of gastroscopy as the principal diagnostic method in detecting gastric MALT lymphomas. METHODS: Sixty-three consecutive patients with gastric MALT lymphomas, who were evaluated and treated at our institution between January 1978 and December 1997, are retrospectively reviewed. There were 36 males and 27 females, with a mean age of 53 years (range 20-80 years). All patients underwent the standard diagnostic evaluation, including gastroscopy and biopsy. Patients were staged according to revised Musshof modification of the Ann Arbor classification system, whereas histological evaluation was made according to the Isaacson classification system for gastric MALT lymphomas. RESULTS: According to endoscopic findings, the antrum harbored the neoplasm in 31 patients (49%), the body in 38% (24 patients), and the fundus in 4% (3 patients), whereas in 5 patients (8%) the neoplasm occupied the entire stomach. The macroscopic appearance was not in most cases pathognomonic of the disease. Three macroscopic patterns were recognized at endoscopy: (a) the ulcerative in 51% (32 patients), (b) the polypoid in 33% (21 patients) and (c) the diffuse infiltrative in 16% (10 patients). The neoplasm was characterized as a benign disease in 24 patients (38%), with malignancy being suspected in 62% (39 patients). Endoscopy displayed a sensitivity of 61% in detecting malignancy; however, the sensitivity dropped to 27% when endoscopic diagnosis of non-Hodgkin's lymphoma was hypothesized. CONCLUSIONS: Although the impact of gastroscopy as a diagnostic tool in the patients of our study was of limited value, due to the nonspecific gross pattern of gastric MALT lymphomas, it should be maintained in the diagnostic intervention of the upper GI tract pathologies.

Adult↗
PubMed2006

Relative value of repeat gastric ulcer surveillance gastroscopy in diagnosing gastric cancer.

BACKGROUND: Gastric cancer can present with the endoscopic appearances of a benign gastric ulcer (GU). Opinion remains divided on the need for follow-up of patients diagnosed with GU, and the aim of this study was to examine the long-term outcomes of patients whose GU proved malignant on follow-up gastroscopy. METHODS: Between October 1, 1995, and September 30, 2003, 25,579 gastroscopies were performed in one unit. These identified 544 patients with apparently benign GU, of whom 277 (51%) underwent 334 elective follow-up endoscopies. Twelve of these patients (4.3%) were shown to have a malignant ulcer; their outcomes were compared to those of the 296 other patients diagnosed with gastric cancers in this time frame. RESULTS: The patients in the GU cancer group had earlier stage disease (stage I, 33% vs 6.4%; chi2 = 11.2; DF1; P = 0.001), and were more likely to undergo R0 gastrectomy (50% vs 30%; chi2 = 2.064; DF1; P = 0.151) and to survive long term (46% vs 16%; log-rank chi2, 5.79; DF1; P = 0.0162) than patients in the comparison cohort. CONCLUSION: Gastroscopic follow-up of 50 patients with an apparently benign GU will identify 1 patient with a malignancy destined to survive for 5 years following R0 gastrectomy. This justifies the diagnostic effort of repeat gastroscopy to ensure complete healing of GU.

Adenocarcinoma↗
PubMed1986

Use of gastroscopy in a community: a population-based study in Olmsted County, Minnesota.

We determined the use of gastroscopy in a defined population (Olmsted County, Minnesota) during the 3-year period 1978 through 1980. In slightly more than 271,000 person-years of observation, 418 residents underwent gastroscopy on 487 separate occasions. When age- and sex-adjusted to the structure of the US white population in 1980, the utilization rate was 215.9 per 100,000 person-years. With extrapolation of these data, approximately 500,000 gastroscopies would be expected to be performed in the United States each year.

Adult↗
PubMed2000

Cardiopulmonary complications during gastroscopy in patients with chronic respiratory failure undergoing long-term home oxygen therapy.

BACKGROUND AND STUDY AIMS: Gastric ulcer and hemorrhage are major complications in patients with chronic respiratory failure, but upper GI endoscopy tends to be avoided because of possible cardiopulmonary events. This study was designed to evaluate hypoxemia and subsequent cardiac complications during gastroscopic procedures in patients with chronic respiratory failure undergoing long-term home oxygen therapy (LHOT). PATIENTS AND METHODS: Gastroscopy was carried out in 10 patients undergoing LHOT and 10 age-matched control subjects without pulmonary diseases. Oxygen saturation and cardiac arrhythmias before and during gastroscopy were monitored. Patients were given 10 mg intramuscular scopolamine butylbromide and local anesthesia using 100-300 mg lidocaine gel 15 minutes before the procedure. Each patient continued to receive oxygen via a nasal cannula in the same dosage as their daily use. RESULTS: Decrease in oxygen saturation during endoscopic procedure was significantly greater in patients undergoing LHOT (from 95.9+/-0.9 to 93.4+/-1.7%) compared with control subjects (from 96.7+/-0.4 to 96.2+/-0.4%). There was a significant correlation between the degree of hypoxemia and the oxygen dosage required for their daily treatment in the patients (r = 0.727, P<0.02). CONCLUSIONS: These results indicate that the degree of respiratory failure influences the degree of decrease in oxygen saturation during gastroscopy. It is suggested that use of the nasal route for oxygen supply may be one of the major causes of the hypoxemia.

Aged↗
PubMed2004

[Rudolf Schindler (1888--1968)--"father" of gastroscopy].

Rudolf Schindler was born in Berlin and achieved his international reputation with the textbook "Lehrbuch und Atlas der Gastroskopie", written in Munich. This was the first book containing excellent endoscopic pictures. He was the first to report on more than four hundred gastroscopies performed without complications. 1928 to 1932, he developed the first semi-flexible gastroscope together with the technical designer Georg Wolf from Berlin. This became the lasting standard for about twenty-five years. In 1934, Schindler emigrated to Chicago after being released as a Nazi prisoner. In 1937, he was awarded the gold medal for his research on gastritis by the American Medical Association. He became the leading person among American gastroscopists for many years and, in 1941, the first president of the American Gastroscopic Club. After 1943 he moved to California to work and live. He also received awards from the American Societies for Gastroscopy and Gastrointestinal Endoscopy in 1953 and 1962. He spent his last years in Munich. His honorary titles of father, architect or super salesman of gastroscopy describe the spectrum of his personality. He was an endoscopist with outstanding technical and diagnostic skills and knew particularly how to deal with patients, how to develop endoscopes as well as being a highly qualified teacher, author and scientist. He also had many hobbies, in particular playing and conducting music perfectly.

Gastroscopes↗
PubMed2001

Factors associated with tolerance to, and discomfort with, unsedated diagnostic gastroscopy.

BACKGROUND: Identification of patients likely to experience high levels of discomfort during unsedated gastroscopy would be useful as these patients could be prospectively targeted for sedation. We prospectively assessed patient and endoscopic variables in subjects attending for endoscopy in order to identify factors associated with patients' experience of the unsedated examination. METHODS: We studied 508 patients attending for routine diagnostic gastroscopy. Clinical and endoscopic data were collected and patients completed a two-part questionnaire assessing their anxiety with, and experience of, the procedure. RESULTS: Thirty-nine subjects failed to complete the initial unsedated endoscopy. Failure to tolerate endoscopy was associated with younger age (P = 0.002) and examination with a standard-bore (> or = 9.0 mm) endoscope (P = 0.004). High levels of patient discomfort during the procedure were associated with younger age (P < 0.001), high levels of pre-endoscopic anxiety (P < 0.001), high levels of pre-endoscopic discomfort due to throat spray (P = 0.02) and examination with a standard-bore endoscope (P < 0.001). Preference for sedation during future examinations was related to female gender (P = 0.02), young age (P = 0.02), high levels of apprehension (P < 0.001), the examining doctor (P = 0.002) and use of a standard-bore endoscope (P < 0.001). CONCLUSIONS: Discrete clinical characteristics and endoscopic variables are associated with patients' experience of unsedated endoscopy. Further work might result in an algorithm for identifying patients who would benefit from sedation prior to gastroscopy.

Age Factors↗
PubMed2002

Integrating patient preferences in clinical trials: a pilot study of acupuncture versus midazolam for gastroscopy.

BACKGROUND AND OBJECTIVES: Patient preferences play an important role when choosing between different treatment options and may have an influence on outcome. We performed a study to investigate (1) to what extent patients make use of the offer to receive acupuncture as a pretreatment for gastroscopy, (2) whether this is perceived as being as effective as sedation, and (3) whether characteristics and outcomes differ between patients giving consent to random allocation and patients choosing their pretreatment. DESIGN: Partially randomized patient preference trial. Patients who gave consent to randomization were allocated randomly while patients who had a preference received the treatment of their choice. PATIENTS: One hundred and six (106) inpatients of a district hospital in southern Germany undergoing gastroscopy for diagnostic purposes. INTERVENTIONS: Pretreatment with a sedative (midazolam) or acupuncture. MAIN OUTCOME MEASURE: Patient's overall assessment on a visual analogue scale (VAS). RESULTS: Twenty-eight (28) patients (26%) agreed to be randomized, 21 (20%) chose acupuncture, 51 (47%) midazolam, and 8 (7%) did not want pretreatment. Patients receiving midazolam rated the examination as slightly less troublesome than those receiving acupuncture. Oxygen saturation, blood pressure, and heart rate were significantly lower in patients receiving midazolam. Characteristics and outcomes of randomized and nonrandomized patients did not differ significantly. CONCLUSIONS: Because of the low number of patients giving consent to random allocation conclusions on effectiveness are difficult to draw. The partially randomized patient preference design is recommended for use in future trials of acupuncture for gastroscopy. Such trials should be performed in an outpatient setting.

Acupuncture Therapy↗