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PubMed2002

Gastric adenocarcinoma missed at endoscopy.

BACKGROUND AND PURPOSE: The diagnosis of gastric cancer is based on histological confirmation at endoscopy with the emphasis on early detection to improve prognosis. The aims of this study were to identify the proportion of patients with gastric adenocarcinoma in whom the diagnosis was missed at first endoscopy and the subsequent delay which occurred before the histological diagnosis was established. METHODS: Retrospective review of 137 consecutive patients with biopsy-proven gastric adenocarcinoma presenting to one surgical unit over a five-year period. RESULTS: Two patients with a biopsy diagnosis at laparotomy and 6 patients in whom case notes could not be traced were excluded from the study. Of the remaining 129 patients, the diagnosis of gastric adenocarcinoma was missed at first endoscopy in 18 (14%). The median delay to histological diagnosis in this subgroup of patients was 13 weeks (range 3-102). CONCLUSION: Delays in establishing the diagnosis of gastric adenocarcinoma following initial endoscopy occur in a number of patients. Greater suspicion and a more rigorous protocol for repeat endoscopy and biopsy must be implemented in order to reduce the number of missed diagnoses after initial endoscopy.

Adenocarcinoma↗
PubMed1992

Endoscopy for upper gastrointestinal bleeding at emergency unit.

From November 1, 1990 to January 31, 1991, 381 patients visited our emergency unit with the chief complaints of hematemesis (n = 153) and melena (n = 228). Of these patients, 298 (78.2%) received UGI endoscopy at the emergency unit, 29 (7.6%) received examination after they were admitted to wards, 3 (0.8%) received endoscopy at outpatient clinic and 51 (13.4%) did not have endoscopy. The percentages of endoscopic diagnoses in 330 patients who had UGI endoscopy were gastric ulcer (GU) 33.6%, duodenal ulcer (DU) 32.7%, esophageal varices (EV) 17.0%, and others 15.5%. Negative findings were noted in 3 cases and no definite bleeding source was found in 1 patient who had blood retention in stomach. The diagnostic rate of endoscopy was 98.8%. Of the 56 patients with EV, 45 (80.4%) had hematemesis; in contrast, 85 of the 108 DU patients (78.8%) complained of melena only. Of the 219 patients with bleeding GU/DU, 64 (29.2%) had endoscopic therapies and 7 (3.2%) needed operation. Sixty-four (29.2%) of them received UGI endoscopy within 6 hours after arrival. They had significantly higher frequency of stigmata of recent hemorrhage (SRH) and more endoscopic therapies than the remaining patients. The overall mortality rate in our patients was 6.0%; the mortality rate in patients with EV was much higher than that of the patients with GU/DU (19.6% vs. 1.8%, P less than 0.001). Of the 23 expired cases, only 11 died of hypovolemic shock. The remaining 12 patients died of deterioration or complications of their underlying diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

[The value of magnifying endoscopy combined with human telomerase reverse transcriptase in diagnosing precancerous gastric lesions].

OBJECTIVE: To explore the diagnostic value of magnifying endoscopy and human telomerase reverse transcriptase (hTERT) in identifying precancerous lesions of gastric mucosa. METHODS: 154 patients with upper digestive symptoms were included in the study. They were examined by the same senior doctor using magnifying endoscopy, and real-time diagnosis was made during the examination. Forceps biopsies were taken for pathological examination and were examined the expression of human telomerase reverse transcriptase mRNA (hTERT mRNA) by real-time quantitative PCR. The morphology of gastric pits under magnifying endoscopy was classified as follows: type A: round spot pits, type B: linear, type C: sparsely and thickly linear, typed D: patchy, and type E: villous. RESULTS: The divergence of intestinal metaplasia had significant differences implications among the gastric pit patterns from B to E under magnifying endoscopy (chi(2) = 17.58, P < 0.05). The more sever the intestinal metaplasia, the higher the pattern scale of the gastric pit (Pearson = 0.531, P < 0.05). The degree of dysplasia had a parallel relationship with the gastric pit patterns changed from C to E (chi(2) = 10.256, P < 0.05, Pearson = 0.549, P < 0.05). The expressions of hTERT mRNA of mucosa had significant differences among the gastric pit patterns B, C, D and E (F = 3.274, P < 0.05); If the expression of hTERT mRNA were taken as diagnostic criteria of gastric cancer, 65% of pit type E would be considered as gastric cancer which were otherwise negative by pathology. CONCLUSIONS: The micro-structural changes of gastric mucosa under magnifying endoscopy can reflect the severity of gastric disease, hTERT is a very important marker for diagnosis of gastric carcinoma. It is useful to predict the malignant change of gastric precancerous lesions in patients by following up high expression of hTERT mRNA combined with pit type E diagnosed by magnifying endoscopy.

Adolescent↗
PubMed1989

Intra-operative endoscopy. University of Minnesota experience.

This review of intraoperative endoscopies was undertaken to identify the accepted and the controversial indications, to report the results and complications, and to determine the impact the procedure had on the operation performed. This retrospective review identified 78 patients who had undergone 82 intraoperative endoscopic exams between 1981 and 1987. Sixty-nine patients underwent intraoperative colonoscopy (84%), six had upper enteroscopy (7%), and seven had total gut endoscopy (9%). Indications were as follows: the inability to fully colonoscope preoperatively (29%), Crohn's disease (19%), malignant polypectomy site (12%), gastrointestinal bleeding (12%), routine screening to rule out synchronous lesions (12%), non palpable colonic lesions (11%), and miscellaneous (4%). Intraoperative endoscopy was successful in 89 per cent of patients. The exams provided information that altered the planned operation in 27 per cent of cases. There were four complications that may have been related to the endoscopic exams. All resolved without the need for further surgery. It is concluded that intraoperative endoscopy can greatly influence the operation performed in a significant percentage of cases. The clear cut indications for its use at this time are location of malignant polypectomy sites, adhesions or tortuous colon that prevents complete preoperative colonoscopy, chronic gastrointestinal bleeding, and location of non palpable bowel lesions. Controversial indications that we feel will prove useful include Crohn's disease and acute gastrointestinal bleeding. Intraoperative endoscopy is best used as an adjunct to preoperative endoscopy and not as a substitute for it.

Colonic Diseases↗
PubMed1988

Value of a routine follow-up endoscopy program for the detection of recurrent colorectal carcinoma.

Four hundred fifty-two patients with surgically resected colon or rectal cancer were evaluated to determine the incidence of intraluminal recurrences and the utility of a routine endoscopy screening program for detecting such recurrences. At the time of analysis, recurrent disease was found in 86 of 380 colon cancer patients and 21 of 72 rectal cancer patients. Local recurrence, defined as tumor within 400 cm2 of the primary, was present in 38 of 86 colon, and 11 of 21 rectal cancer patients. Of those 49 local recurrences, 15 were intraluminal, 6 of which were initially detected by a follow-up endoscopy program. Time to diagnosis, stage of disease, and survival were similar for patients whose lesions were detected by routine endoscopy versus those found by other means. New primary (metachronous) lesions defined as an intraluminal lesion occurring at least 5 cm beyond the surgical anastomosis were identified in six colon cancer patients and no rectal cancer patients. Of these six lesions, four were discovered during routine endoscopy. Thus, a routine follow-up endoscopy program is an important tool for the detection of intraluminal recurrence of colon and rectal cancer in patients who have undergone curative resection. However, routine follow-up endoscopy should not be the sole method of follow-up, since the incidence of intraluminal recurrence is small, and may initially be detected by other means in the majority of cases.

Adenocarcinoma↗
PubMed1982

[Esophageal endoscopy and gastroesophageal reflux].

Authors expose the value of different tests performed in 166 patients diagnosed of gastroesophageal reflux (GER). In 24 patients, less than three months old, only radiological studies were performed. Another group of 142 patients had radiology, endoscopy and biopsy performed, with a total of 180 endoscopic procedures. From the results obtained patients were classified in four grades: Grade I, included 28 patients less than three months old, GER is due to the immaturity of antireflux system. Grade II, included 75 patients of all ages with radiology and/or positive scintigram, but endoscopy and biopsy within normal limits. Grade III, 46 patients, in whom endoscopy and biopsy revealed presence of edema, fibrinous exudates and other inflammatory changes. Grade IV, 17 patients, endoscopy revealed healing strictures or deep bleeding ulcers. Grades I, II and III should be treated with medical measures. Grade IV requires immediate surgical treatment. In 2.7% and 6.4% of grade II and grade III cases respectively, endoscopy revealed progressive disease and necessity of final surgical treatment. Authors believe that endoscopy and biopsy are not only valuable to detect complicating progression of disease, but are also an efficient method of grading and prognosis of GER disease.

Biopsy↗
PubMed1981

Endoscopy in the management of gastric ulcer disease.

The influence of endoscopy on the management of gastric ulcer disease during a three-year period was reviewed. A total of 265 endoscopies on 120 gastric ulcer patients were performed. 145 of these endoscopies were controls of ulcers primarily diagnosed as benign. At these controls 4 carcinomas were detected, all invasive. In all these cases the endoscopist had a suspicion of malignancy at the first endoscopy, although it was not verified histologically. This emphasizes the importance of the macroscopic appearance of the ulcer and of appropriately taken biopsies. All gastric cancers during the same period were reviewed, only 3.4% were classified as early. They were all diagnosed at the first endoscopy. There was a significant decrease in the number of operations on suspicion of malignancy compared with earlier periods when endoscopy was not a routine procedure.

Adult↗
PubMed2006

Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease.

BACKGROUND: Approximately 25% of adults experience heartburn, the cardinal feature of gastro-oesophageal reflux disease (GORD), at least monthly. The evaluation and treatment of patients with suspected GORD is associated with a substantial economic burden. Most patients are treated empirically (without specific diagnostic evaluation). They include a wide range of underlying oesophageal injury. The severity of oesophageal injury can only be established in those who have undergone upper endoscopy. Patients without visible damage to the oesophagus have been referred to as having endoscopy negative reflux disease (ENRD). The pathogenesis of ENRD as well as its response to treatment may differ from GORD with oesophagitis. OBJECTIVES: Summarise, quantify and compare the efficacy of the short-term use of proton pump inhibitors (PPI), H2-receptor antagonists (H2RA) and prokinetics in adults with GORD, treated empirically and in those with endoscopy negative reflux disease (ENRD). SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2005), MEDLINE (January 1966 to December 2005), EMBASE (January 1988 to December 2005). SELECTION CRITERIA: Randomised controlled trials focussing on symptomatic outcome after short-term treatment for GORD using proton pump inhibitors, H2-receptor antagonists or prokinetic agents. Studies were included provided that participants could be classified in the empirical treatment group (no endoscopy used in treatment allocation) or in the endoscopy negative reflux disease group (no endoscopic signs of erosive oesophagitis). DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. MAIN RESULTS: Thirty-one trials (9457 participants) were included: fifteen in the empirical treatment group, twelve in the ENRD group and four in both. In empirical treatment of GORD the relative risk (RR) for heartburn remission (the primary efficacy variable) in placebo-controlled trials for PPI was 0.37 (two trials, 95% confidence interval (CI) 0.32 to 0.44), for H2RAs 0.77 (two trials, 95% CI 0.60 to 0.99) and for prokinetics 0.86 (one trial, 95% CI 0.73 to 1.01). In a direct comparison PPIs were more effective than H2RAs (seven trials, RR 0.66, 95% CI 0.60 to 0.73) and prokinetics (two trials, RR 0.53, 95% CI 0.32 to 0.87). In treatment of ENRD, the RR for heartburn remission for PPI versus placebo was 0.69 (seven trials, 95% CI 0.62 to 0.78) and for H2RA versus placebo was 0.84 (two trials, 95% CI 0.74 to 0.95). The RR for PPI versus H2RA was 0.78 (three trials, 95% CI 0.62 to 0.97) and for PPI versus prokinetic 0.72 (one trial, 95% CI 0.56 to 0.92). AUTHORS' CONCLUSIONS: PPIs are more effective than H2RAs in relieving heartburn in patients with GORD who are treated empirically and in those with ENRD, although the magnitude of benefit is greater for those treated empirically.

Endoscopy, Digestive System↗
PubMed1986

An assessment of the value of triple endoscopy in the evaluation of head and neck cancer patients.

The purpose of this study was to evaluate the role of triple endoscopy in the routine diagnostic evaluation of head and neck cancer patients to (1) ascertain the accuracy and safety of this approach in identifying multiple neoplasms and (2) determine if such an approach is justifiable rather than relying on radiographic examinations coupled with the routine head and neck exam including indirect laryngoscopy. In this series, the incidence of second malignancies was found to be 11.3%, consistent with other reports in the medical literature. There were no complications noted as a result of triple endoscopy. There were no instances where the second malignancy was not diagnosed prior to triple endoscopy with either the physical exam or routine roentgenograms. There were no incidences where the treatment program of the primary tumor was altered by the information obtained at triple endoscopy. The results of this single institutional study suggest that triple endoscopy need not be a routine component of the diagnostic evaluation of every patient with head and neck cancer. However, every patient should probably have a thorough physical examination coupled with chest and esophageal roentgenograms to search for a simultaneous secondary neoplasm.

Bronchoscopy↗
PubMed2001

Virtual MRI endoscopy: detection of anomalies of the ventricular anatomy and its possible role as a presurgical planning tool for endoscopic third ventriculostomy.

BACKGROUND: Many anatomical anomalies have the potential to impair the efficacy of endoscopic third ventriculostomy (ETV) and increase the surgical morbidity. By virtual magnetic resonance imaging (MRI) endoscopy, the real endoscopic view into the ventricular system can be simulated. It was the objective of the present study to investigate if this simulation is sensitive enough to detect anatomical anomalies of the ventricular system. METHOD: In 18 hydrocephalic patients, first neuronavigationally guided ETV, then virtual MRI endoscopy were performed. This study design allowed for selection of a path for virtual MRI endoscopy, which was identical to that used during surgery, making the real and the virtual view on anatomical structures of the ventricular system highly comparable. It was investigated whether the intra-operatively identified anatomical anomalies could likewise be depicted on virtual MR endoscopic images. FINDINGS: Seven anatomical variants (not enlarged interventricular foramen n=2, atrophic corpus callosum and split fornical bodies n=1, narrow retroclival space n=1, prominent basilar tip n=1, opaque and thick/atypically declining third ventricular floor n=2) were encountered in 5 of the 18 patients during surgery. The five variants of the non-membraneous structures were identified by virtual MRI endoscopy (sensitivity 71%), whereas the anatomical variants of the third ventricular floor were missed. Both the normal as well as the variant third ventricular floor could not be visualised and appeared as a defect. Through this artefact, the anatomy of the major vessels in the interpeduncular cistern could be assessed. INTERPRETATION: The sensitivity of virtual MRI endoscopy for detection of anatomical variants of the ventricular system is low. Its potential usefulness as a presurgical planning tool inspite of this low sensitivity rate is discussed.

Adolescent↗
PubMed2002

[Surgical endoscopy for staging and the selection of procedure].

The outcome in the treatment of malignant tumors of the gastrointestinal tract can be improved in two ways: by early recognition, and possibly also by multimodal treatment concepts. Endoscopic methods are can serve two purposes: firstly, the diagnosis and recognition of early and flat lesions; here high resolution video-endoscopy, in some cases supplemented by magnification and chromo-endoscopy and other extended methods (e.g. autofluorescence), are likely to improve the diagnostic accuracy. Another purpose endoscopy and endoscopic ultrasound is to select patients suitable for local therapy of early cancers. In advanced tumors, endoscopy and especially endosonography are the standard methods for predicting the locoregional tumor stage, in order to select patients who may benefit from neoadjuvant treatment to select patients for curative treatment or palliation. The role of endoscopy and endosonography for the diagnosis and treatment of oesophageal, gastric and rectal carcinoma is discussed in the following review.

Adenocarcinoma↗
PubMed2006

The role of endoscopy in the allergist's office.

The introduction of nasal endoscopy has revolutionized the diagnosis and management of patients with sinonasal disorders. The brilliant illumination and magnification afforded by the nasal endoscopes has markedly enhanced the current knowledge of sinonasal anatomy and understanding of patterns of mucociliary clearance. Nasal endoscopy facilitates accurate diagnosis of sinonasal pathology and assessment of response to medical and surgical therapy by serial examination. Rigid telescopes also facilitate office-based procedures, including cultures of purulent secretions and biopsy of sinonasal masses. Indeed, nasal endoscopy forms the foundation of the surgical paradigm of functional endoscopic sinus surgery. In this review, the rationale, technique and current state of endoscopic applications of nasal endoscopy are described, with special focus on the role of endoscopy in the allergist's office.

Allergy and Immunology↗
PubMed1980

Limited value of early endoscopy in the management of acute upper gastrointestinal bleeding. Prospective controlled trial.

In an 11 month period, 95 patients with acute upper gastrointestinal hemorrhage underwent early fiberoptic endoscopy. Patients were randomized into two groups before endoscopy depending on whether the results of the procedure were revealed immediately or after 4 days. No attempt was made to influence the treatment or diagnostic plan. The groups were comparable with respect to historical features surrounding the bleeding episode and the anatomic site of hemorrhage. There were no significant differences in any aspect of patient management or outcome between groups. Important changes in diagnostic or treatment plan were made after learning the results of endoscopy in only 12% of the patients, half of whom were bleeding briskly at the time of endoscopy. It is concluded that the natural history of acute upper gastrointestinal hemorrhage (for example, the spontaneous cessation of bleeding) precludes endoscopy from having a significant effect on patient management.

Adolescent↗
PubMed2004

Observation of tongue papillae by video microscopy and contact endoscopy to investigate their correlation with taste function.

OBJECTIVES: Contact endoscopy is a technique used to obtain detailed images of living epithelium in the fields of gynecology, rhinology and laryngology. Video microscopy is useful for observation of the surface of tongue papillae. In the present study, we attempted to apply the contact endoscopy technique together with video microscopy to observe tongue papillae, and to study the correlation between the condition of fungiform papillae and taste function. METHODS: Ten subjects (3 men, 7 women) were divided into two groups based on the results of a taste examination by electrogustometry. We compared the shape and blood vessels of the papillae between normal taste and taste disorder groups. RESULTS: In the normal taste group, round shaped papillae and clear blood vessels were observed with both microscopy and contact endoscopy. In the taste disorder group, flat and irregular papillae were observed with microscopy. Blood vessel flow of the papillae was observed to be poor with contact endoscopy. CONCLUSION: These findings suggested that the images of microscopy and contact endoscopy were related to taste function, and both techniques were useful for evaluating taste function.

Adult↗
PubMed2006

Detection of abnormal lesions recorded by capsule endoscopy. A prospective study comparing endoscopist's and nurse's accuracy.

BACKGROUND AND STUDY AIM: Capsule endoscopy is a non-invasive technique for small bowel examination but its evaluation is time consuming. The aim of this study was to assess whether, following adequate training, an endoscopy nurse is capable of picking up all significant images without reducing the diagnostic accuracy of the procedure. PATIENTS AND METHODS: Between April 2003 and December 2004, a total of 41 consecutive capsule endoscopy studies were blindly reviewed by both an endoscopy nurse and an endoscopist. The two operators had to select all significant images independently and to complete a structured questionnaire. Thirty-nine capsule endoscopy examinations (two studies discharged for premature battery failure) were evaluated. The agreement between the two operators was calculated by kappa statistics (coefficient of agreement). RESULTS: Agreement was excellent for all kind of selected lesions (mean kappa>0.85); the agreement was complete (kappa=1) for site identification, active bleeding, stenosis and negative studies. The greater disagreement (kappa=0.77) was found in cases of subtle mucosal abnormalities (i.e. reduction of villi), which were over-estimated by the nurse. CONCLUSIONS: The preview recordings made by the nurse may increase the cost/effectiveness of the study, by considerably reducing the time needed for the endoscopist to make the final report (about 5-10 min), without compromising final diagnosis.

Capsule Endoscopy↗
PubMed2006

Efficiency of an endoscopy suite in a teaching hospital: delays, prolonged procedures, and hospital waiting times.

BACKGROUND: Increased demand for screening colonoscopy necessitates improved efficiency in endoscopy units, especially more efficient use of existing resources. The purpose of this study was to assess the efficiency of the endoscopy unit of a large tertiary care teaching hospital. OBJECTIVE: To assess the efficiency of the endoscopy unit in a large tertiary care teaching hospital. DESIGN: Prospective study from May 16 to September 5, 2003. SETTING: Endoscopy unit of a 650-bed acute care teaching hospital. PATIENTS: Inpatient and outpatient procedures. MAIN OUTCOME MEASUREMENTS: Time elapsed between endoscopic procedures; the duration of the procedures; procedure delays (>15 minutes between procedures) and the reasons for them. RESULTS: The research assistant observed 675 endoscopic procedures done for 625 patients (207 inpatients [33%]). The most common procedure was colonoscopy (42.1%), followed by EGD (36.0%). Overall, procedures for 193 (30.9%) of the 625 patients were delayed (>15 minutes between procedures), 70.5% (136/193) because the physician was not available to start the procedure. The time elapsed between procedures was longer than 30 minutes for 47 of the 193 delayed procedures (24.4%). The duration of procedures was prolonged for about 22% (130/593) of procedures. CONCLUSIONS: Physician unavailability contributed to considerable delays in endoscopic procedures. Strategies to reduce procedure delays could have a favorable impact on the volume of procedures performed in the unit, thereby improving the use of existing resources. We encourage other groups to assess the efficiency of their hospital-based endoscopy units.

Canada↗
PubMed2006

Sedation and analgesia for gastrointestinal endoscopy during pregnancy.

Endoscopy during pregnancy raises the unique issue of fetal safety. Endoscopic medications comprise a significant component of fetal risks from endoscopy. Before endoscopy, the gastroenterologist or anesthesiologist should evaluate the potential fetal risks of sedation and analgesia, identify any contraindications to endoscopy, stabilize the maternal medical status as necessary, and correct maternal hypoxia or hypotension. The mother should be informed about the potential teratogenic risks of endoscopic medications during pregnancy. Patients who receive sedation and analgesia should be monitored during endoscopy by continuous electrocardiography, continuous pulse oximetry, and intermittent sphygmomanometry, as well as by the pulse and respiratory rate. General principles of sedation and analgesia during pregnancy include use of the minimal effective dose, avoidance of unnecessary medications, and preferable use of Food and Drug Administration category B medications.

Analgesia↗
PubMed2006

Use of capsule endoscopy for established Crohn's disease.

There remains significant uncertainty regarding the role of capsule endoscopy in the setting of known inflammatory bowel disease (IBD). Capsule endoscopy should be considered for patients who have indeterminate colitis, who are failing medical therapy or who may require colectomy, who have truly unexplained symptoms based on standard endoscopy and radiography, and who have IBD and obscure bleeding. Although capsule endoscopy clearly detects small bowel pathology with greater sensitivity than other methods, the implications of these lesions are not fully understood. At this time, use of capsule endoscopy as a tool for the evaluation of mucosal healing or for prognostication of post-operative recurrence remains investigational.

Crohn Disease↗