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At least 577 records · Page 32Linked to original sources
PubMed2005

Transanal endoscopic microsurgery: a systematic review.

PURPOSE: The aim of this study was to systematically review the evidence relating to the safety and efficacy of transanal endoscopic microsurgery, a relatively new technique used to locally excise rectal tumors, compared with existing techniques such as anterior resections and abdominoperineal resections or local excisions. METHODS: We conducted a systematic review of comparative studies and case series of transanal endoscopic microsurgery from 1980 to August 2002. RESULTS: Three comparative studies (including one randomized, controlled trial) and 55 case series were included. The first area of study was the safety and efficacy of adenomas. In the randomized, controlled trial, no difference could be detected in the rate of early complications between transanal endoscopic microsurgery (10.3 percent) and direct local excision (17 percent) (relative risk, 0.61; 95 percent confidence interval, 0.29-1.29). Transanal endoscopic microsurgery resulted in less local recurrence (6/98; 6 percent) than direct local excision (20/90; 22 percent) (relative risk, 0.28; 95 percent confidence interval, 0.12-0.66). The 6 percent rate of local recurrence for transanal endoscopic microsurgery in this trial is consistent with the rates found in case series of transanal endoscopic microsurgery (median, 5 percent). The second area of study was the safety and efficacy of carcinomas. In the randomized, controlled trial, no difference could be detected in the rate of complications between transanal endoscopic microsurgery and direct local excision (relative risk for overall early complication rates, 0.56; 95 percent confidence interval, 0.22-1.42). No differences in survival or local recurrence rate between transanal endoscopic microsurgery and anterior resection could be detected in either the randomized, controlled trial (hazard ratio,1.02 for survival) or the nonrandomized, comparative study. There were 2 of 25 (8 percent) transanal endoscopic microsurgery recurrences in the randomized, controlled trial, but no figures were given for recurrence after anterior resection. In the case series, the median local recurrence rate for transanal endoscopic microsurgery was 8.4 percent, ranging from 0 percent to 50 percent. The third comparison was cost of the procedures. Transanal endoscopic microsurgery had both a lower recurrence rate and a lower cost than local excision or anterior resection for adenomas. Although the effectiveness of transanal endoscopic microsurgery could not be established for carcinomas, costs were lower than those for either anterior resection or abdominoperineal resection. CONCLUSIONS: The evidence regarding transanal endoscopic microsurgery is very limited, being largely based on a single relatively small randomized, controlled trial. However, transanal endoscopic microsurgery does appear to result in fewer recurrences than those with direct local excision in adenomas and thus may be a useful procedure for several small niches of patient types--e.g., for large benign lesions of the middle to upper third of the rectum, for T1 low-risk rectal cancers, and for palliative, not curative, use in more advanced tumors.

Anal Canal↗
PubMed2004

Development and validation of a new, simplified endoscopic activity score for Crohn's disease: the SES-CD.

BACKGROUND: Healing of mucosal lesions appears to offer significant benefit and is an important end point in clinical trials of treatment for Crohn's disease. The only validated endoscopic activity score at present is the Crohn's Disease Endoscopic Index of Severity, which is complicated and time consuming and, hence, is unsuitable for routine use. The aim of this study was to develop and to prospectively validate a simpler endoscopic score of disease activity, the Simple Endoscopic Score for Crohn's Disease. METHODS: Selected endoscopic parameters (ulcer size, ulcerated and affected surfaces, stenosis) were scored from 0 to 3. Reproducibility for scoring of these parameters was evaluated through 71 examinations in which the endoscopist was paired with an observer. The simplest score (Simple Endoscopic Score for Crohn's Disease) that was highly correlated with both the Crohn's Disease Endoscopic Index of Severity and Crohn's Disease Activity Index was derived for 70 patients and then was prospectively validated in 121 different patients with Crohn's disease. RESULTS: The interobserver agreement for all selected endoscopic variables was excellent (kappa coefficient 0.791-1.000). Based on multiple linear regression, the Simple Endoscopic Score for Crohn's Disease resulted in the sum of the scores for ulcer size, ulcerated surface, affected surface, and luminal narrowing. In the validation phase of the study, a strong correlation was demonstrated for the Simple Endoscopic Score for Crohn's Disease with Crohn's Disease Endoscopic Index of Severity (r = 0.920). In addition, the Simple Endoscopic Score for Crohn's Disease was correlated to clinical parameters and serum C-reactive protein level. CONCLUSIONS: Simple Endoscopic Score for Crohn's Disease is a simple, reproducible, and easy-to-use endoscopic scoring system for Crohn's disease.

Adult↗
PubMed1998

Endoscopic injection of botulinum toxin for biliary sphincter of Oddi dysfunction.

BACKGROUND AND STUDY AIMS: Endoscopic sphincterotomy is not without risks, and is also ineffective in about half of patients with type III sphincter of Oddi dysfunction (SOD), i.e. those without clinical evidence of biliary obstruction (normal liver tests, normal bile duct diameter, and regular drainage time at endoscopic retrograde cholangiography). The present study therefore investigated the efficacy and safety of endoscopic botulinum toxin (BTX) injection into the papilla of Vater, and analyzed whether the symptomatic response to BTX injection might be a predictor of outcome for endoscopic sphincterotomy. PATIENTS AND METHODS: Twenty-two patients who had undergone cholecystectomy and had manometrically confirmed type III SOD were enrolled during a three-year study period. All patients received treatment with an endoscopic single-shot injection of 100 mouse units of BTX into the papilla of Vater. Initial symptomatic responses were analyzed six weeks later. If the BTX injection had been ineffective, or if biliary symptoms recurred after initial benefit during the follow-up period, endoscopic manometry and endoscopic sphincterotomy were performed. All patients then received further prospective clinical follow-up examinations. RESULTS: With the exception of one patient with mild pancreatitis (4.5%), no side effects were observed after endoscopic BTX injection. Six weeks after BTX injection, 12 SOD patients (55%) were symptom-free, but ten patients (45%) were not. However five of these ten SOD patients who did not experience symptomatic benefit from BTX injection had normal basal sphincter of Oddi pressures (< 40 mmHg) at this time, and none of these five patients was free of complaints after subsequent endoscopic sphincterotomy. Two of the remaining five patients with sustained sphincter hypertension after BTX injection benefitted from endoscopic sphincterotomy. Eleven of the 12 SOD patients who had initially responded to BTX injection developed recurrent symptoms after a median period of six months. Manometry revealed sphincter hypertension in all 11 cases, and all patients became free of complaints again after endoscopic sphincterotomy during a median follow-up of a further 15 months. Overall, 11 of the 12 patients who responded to BTX injection, versus two of the ten patients who did not gain pain relief after BTX injection, later benefitted from endoscopic sphincterotomy (p < 0.01). CONCLUSIONS: Endoscopic injection of botulinum toxin into the papilla of Vater is a safe procedure and provides short-term relief of symptoms in half of patients with type III SOD. Our results also indicate that the clinical response to BTX injection can predict whether SOD patients will gain long-term benefit from endoscopic sphincterotomy.

Adult↗
PubMed2006

Endoscopic microneurosurgery: usefulness and cost-effectiveness in the consecutive experience of 210 patients.

OBJECTIVE: Indications, usefulness, and cost-effectiveness of the endoscope in routine microneurosurgery are not clear. To delineate such aspects, we assessed our experience of endoscopic application and additional cost to use an endoscope. METHODS: Endoscopes were used in 210 patients with cranial base and cisternal pathological features in the previous 7 years. Lesions were located in the extradural cranial base in 78 patients and in the cistern in 132 patients. Rigid lens endoscopes 2.7 to 4 mm in width, 11 to 20 cm in length, and 0 to 70 degrees in angle were used. RESULTS: Endoscopes were used for primary or a significant part of the surgery in 64% of the extradural cranial base procedures. Although endoscopes were used only for visual assistance in 82% of cisternal pathological features, significant benefit was noted in 9% and was not different from cranial base lesions. Eleven patients may have had complications if the endoscope had not been used, and 10 procedures would have been impossible without endoscopic use. Therefore, the number of patients need to treat to experience significant benefits by endoscope was 10. Endoscopic equipment costs an additional 326 US dollars per patient and, hence, significant benefit was the equivalent of 3260 US dollars. No permanent complications resulted from the use of the endoscope. CONCLUSION: The endoscope can be applied safely in routine microsurgery with specific equipment and has proven useful in 1 of 10 patients. To perform more effective procedures using endoscopes, we need to develop specially designed instruments usable through a narrow corridor and in an angled field.

Cisterna Magna↗
PubMed2004

Reprocessing endoscopes: United States perspective.

Endoscopes are used frequently for the diagnosis and therapy of medical disorders. For example, greater than 10000000 gastrointestinal endoscopic procedures are performed each year in the United States. Failure to employ appropriate cleaning and disinfection/sterilization of endoscopes has been responsible for multiple nosocomial outbreaks and serious, sometimes life-threatening, infections. Flexible endoscopes, by virtue of the site of use, have a high bioburden of microorganisms after use. The bioburden found on flexible gastrointestinal endoscopes following use has ranged from 10(5) to 10(10)CFU/ml, with the highest levels being found in the suction channels. Cleaning dramatically reduces the bioburden on endoscopes. Several investigators have shown a mean log(10) reduction factor of 4 (99.99%) in the microbial contaminants with cleaning alone. Cleaning should be done promptly following each use of an endoscope to prevent drying of secretions, allow removal of organic material, and decrease the number of microbial pathogens. Because the endoscope comes into intimate contact with mucous membranes, high-level disinfection is the reprocessing standard after each patient use. High-level disinfection refers to the use of a disinfectant (e.g., FDA-cleared chemical sterilant or high-level disinfectant) that inactivates all microorganisms (i.e., bacteria, viruses, fungi, mycobacteria) but not high levels of bacterial spores. The disinfection process requires immersion of the endoscope in the high-level disinfectant and ensuring all channels are perfused for the approved contact time (e.g., for ortho-phthaladehyde this is 12 min in the US). Following disinfection, the endoscope and channels are rinsed with sterile water, filtered water, or tapwater. The channels are then flushed with alcohol and dried using forced air. The endoscope should be stored in a manner that prevents recontamination. A protocol that describes the meticulous manual cleaning process, the appropriate training and evaluation of the reprocessing personnel, and a quality assurance program for endoscopes should be adopted and enforced by each unit performing endoscopic reprocessing.

Bronchoscopes↗
PubMed2006

Endoscopic balloon sphincter dilation (sphincteroplasty) versus sphincterotomy for common bile duct stones.

BACKGROUND: Endoscopic balloon dilation was introduced as an alternative to endoscopic sphincterotomy to preserve the sphincter of Oddi and avoid undesirable effects due to an incompetent sphincter. Endoscopic balloon dilation has been largely abandoned by USA endoscopists due to increased risks of pancreatitis noted in one multicentre trial, but is still practiced in parts of Asia and Europe. OBJECTIVES: To assess the beneficial and harmful effects of endoscopic balloon dilation versus endoscopic sphincterotomy in the management of common bile duct stones. SEARCH STRATEGY: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, and EMBASE until January 2004. We hand searched Gastrointestinal Endoscopy (1983-2002), read through bibliographies of all included randomised clinical trials, and contacted all primary authors regarding missed randomised trials. SELECTION CRITERIA: Randomised clinical trials comparing endoscopic balloon dilation versus endoscopic sphincterotomy in removal of common bile duct stones irrespective of publication status, language, or blinding. DATA COLLECTION AND ANALYSIS: Data collection was done by two independent authors for decisions on study inclusion, data abstraction, and quality assessment. When there was a non-resolvable discrepancy, the third author made the final decision. Analysis was run with RevMan Analysis. MAIN RESULTS: Fifteen randomised trials met our inclusion criteria (1768 participants). Less than half of the trials reported adequate methods of randomisation and only two trials used blinded outcome assessment. Endoscopic balloon dilation is statistically less successful for stone removal (relative risk (RR) 0.90, 95% confidence interval (CI) 0.84 to 0.97), requires higher rates of mechanical lithotripsy (RR 1.34, 95% CI 1.08 to 1.66), and carries a higher risk of pancreatitis (RR 1.96, 95% CI 1.34 to 2.89). Conversely, endoscopic balloon dilation has statistically significant lower rates of bleeding. When a fixed-effect model is applied endoscopic balloon dilation leads to significantly less short-term infection and long-term infection. There was no statistically significant difference with regards to mortality, perforation, or total short-term complications. AUTHORS' CONCLUSIONS: Endoscopic balloon dilation is slightly less successful than endoscopic sphincterotomy in stone extraction and more risky regarding pancreatitis. However, endoscopic balloon dilation seems to have a clinical role in patients who have coagulopathy, who are at risk for infection, and possibly in those who are older.

Catheterization↗
PubMed2004

Bacteriologic testing of endoscopes after high-level disinfection.

BACKGROUND: There are no definitive data available concerning microbiologic safety of prolonged endoscope storage after reprocessing and disinfection. This study evaluated the durability of high-level disinfection of endoscopes stored in a dust-proof cabinet for 5 days. METHODS: Three different types of endoscopes (upper endoscopes, duodenoscopes, colonoscopes) were tested. After completion of the endoscopic procedure, endoscopes were subjected to an initial decontamination, followed by manual cleaning with the endoscope immersed in detergent. The endoscopes then were placed in an automatic reprocessor that provides high-level disinfection. They then were stored by hanging in a dust-proof cabinet. Bacteriologic samples were obtained from the surface of the endoscopes, the openings for the piston valves, and the accessory channel daily for 5 days, and by flush-through (combined with brushing) from the accessory channels after 5 days of storage. Samples were cultured for all types of aerobic and anaerobic bacteria, including bacterial spores, and for Candida species. RESULTS: For all assays, all endoscopes were bacteria-free immediately after high-level disinfection. Only 4 assays (of 135) were positive during the subsequent 5-day assessment (skin bacteria cultured from endoscope surfaces). All flush-through samples were sterile. CONCLUSIONS: When endoscope reprocessing guidelines are strictly observed and endoscopes are stored in appropriate cabinets for up to 5 days, reprocessing before use may not be necessary.

Disinfection↗
PubMed2002

Flexible endoscope-assisted endonasal transsphenoidal surgery for pituitary tumors.

We have performed rigid endoscope-assisted endonasal transsphenoidal microsurgeries for pituitary tumors in 230 patients. Recently, we further introduced the use of a flexible endoscope to inspect the tumor bed and suprasellar structures more extensively. We report our experience with the flexible endoscope in endonasal transsphenoidal surgery for pituitary tumors. The endoscopes were used to complement the microscope in visualization. The flexible endoscopes were used in 34 recent cases with suprasellar and/or lateral tumor extension. During or after removal of the main tumor bulk, the flexible endoscope together with a rigid endoscope was used to inspect the tumor cavity, especially at the blind spot of the microscope. Despite limited resolving power, in all the 34 cases the flexible endoscope was a highly efficient tool permitting extensive visualization of almost the whole surgical area, even in narrow surgical fields and spaces not visible with an operating microscope or a rigid endoscope, and allowing continuous change of viewing angle. The residual tumor situated laterally or in the suprasellar areas that could not be reached and was impossible to remove by a rigid endoscope could be dissected and extirpated under a flexible endoscope using grasping forceps in 5 patients with pituitary adenoma and all the craniopharyngioma cases. The flexible endoscope may be more efficient in the lateral and suprasellar areas than the rigid endoscope in compensating for the narrow surgical field in endonasal pituitary surgery, despite its limited resolving power. Surgeons should make the best use of the advantages of each instrument.

Adenoma↗
PubMed2005

Randomized trial of endoscopic versus open vein harvest for coronary artery bypass grafting: six-month patency rates.

OBJECTIVE: We sought to compare the 6-month angiographic patency rates of greater saphenous veins removed during coronary artery bypass grafting with the endoscopic vein harvest or open vein harvest techniques. METHODS: Two hundred patients undergoing nonemergency on-pump coronary artery bypass grafting were prospectively randomized to either endoscopic vein harvest or open vein harvest. Follow-up angiography of all vein grafts was scheduled at 6 months. Graft patency and disease grades were assigned independently by 2 interventional cardiologists. Leg wound healing was evaluated at discharge, 1 month, and 6 months for evidence of complications. RESULTS: There were 3 conversions from endoscopic vein harvest to open vein harvest because of vein factors. Leg wound complications were significantly lower in the endoscopic vein harvest group (7.4% vs 19.4%, P = .014). On multivariable analysis, endoscopic vein harvest emerged as the only factor affecting wound complications (odds ratio, 0.33). Three deaths (2 perioperative and 1 late) occurred in the endoscopic vein harvest group that were unrelated to vein graft closure. Twenty-four and 29 patients in the endoscopic vein harvest and open vein harvest cohorts, respectively, refused the follow-up 6-month angiography. Therefore a total of 144 angiograms (73 endoscopic vein harvests and 71 open vein harvests) and 336 vein grafts (166 endoscopic vein harvests and 170 open vein harvests) were available for analysis. The overall occlusion rates at 6 months were 21.7% for endoscopic vein harvest and 17.6% for open vein harvest. Additionally, there was evidence of significant disease (>50% stenosis) in 10.2% and 12.4% of endoscopic vein harvest and open vein harvest grafts, respectively. By means of ordinal hierarchic logistic regression, endoscopic vein harvest was not found to be a risk factor for vein graft occlusion or disease (odds ratio, 1.15). Significant predictors were congestive heart failure (odds ratio, 2.87), graft to the diagonal artery territory (odds ratio, 1.76), larger vein conduit size (odds ratio, 1.32), and graft flow (odds ratio, 0.90). CONCLUSION: Endoscopic vein harvest reduces leg wound complications compared with open vein harvest without compromising the 6-month patency rate. The overall patency rate depends on target and vein-related variables and patient characteristics rather than the method of vein harvesting.

Aged↗
PubMedDate not supplied

Endoscopic ligation of esophageal varices compared with injection sclerotherapy: a prospective randomized trial.

Fifty cirrhotic patients with esophageal varices underwent endoscopic treatment in a prospective randomized trial carried out to compare variceal ligation with injection sclerotherapy, with respect to safety, efficacy, and complications in the initial session. Twenty-five patients each were treated using endoscopic variceal ligation or endoscopic injection sclerotherapy in the initial session and then only endoscopic injection sclerotherapy for all following sessions. Ligations numbered 4.1 at the initial session. The total number of sessions of endoscopic injection sclerotherapy was 4.0 +/- 1.3 in the endoscopic injection sclerotherapy group compared with 3.6 +/- 1.4 in the endoscopic variceal ligation group. The total volume of the sclerosant used by the end of all the sessions was 23.9 +/- 10.3 ml in the endoscopic variceal ligation group and 39.0 +/- 11.5 ml in the endoscopic injection sclerotherapy group (p < 0.0001). In all patients, complete eradication of the varices was achieved, and at 7 to 15 months follow-up no evidence of recurrence was seen. Adverse effects such as pyrexia, chest pain, and pleural effusion after the initial session were significantly lower in the endoscopic variceal ligation group (p < 0.05), and total bilirubin, serum creatinine, lactate dehydrogenase, and urinary beta 2-microglobulin were significantly increased and PaO2 decreased after endoscopic injection sclerotherapy (p < 0.05). This study shows that endoscopic variceal ligation significantly decreased the adverse effects associated with endoscopic injection sclerotherapy in the initial session, and it is recommended as an alternative to sclerotherapy.

Aged↗
PubMed1998

Endoscopic versus open carpal tunnel release: a cost-effectiveness analysis.

Endoscopic carpal tunnel release is a controversial procedure used in the treatment of carpal tunnel syndrome. Although endoscopic carpal tunnel release is associated with less incisional pain and faster recovery time than the open carpal tunnel release, opponents of endoscopic carpal tunnel release suggest that its benefits are outweighed by its higher complication rates from median nerve transection and transient numbness of the fingers. Because of the huge economic and social impact of carpal tunnel syndrome in this country, we performed a cost-effectiveness analysis comparing endoscopic carpal tunnel release and open carpal tunnel release using guidelines established by the Panel on Cost-Effectiveness in Health and Medicine of the U.S. Public Health Service. A decision analytic model was used to measure differences in cost and effectiveness--expressed as quality-adjusted life-years (QALYs)--between endoscopic carpal tunnel release and open carpal tunnel release. The societal perspective was chosen, and probabilities for various outcomes for the two procedures were obtained from published randomized-controlled trials. Cost data were derived from the Medicare Resource-Based Relative Value Units published in the Federal Register. QALYs were obtained from two groups of health care providers using a utility-assessment questionnaire. Using probabilities for various outcomes from the two published randomized-controlled trials comparing endoscopic carpal tunnel release and open carpal tunnel release, we constructed a decision tree to derive both the cost and the QALYs for the two procedures. The incremental cost difference between endoscopic carpal tunnel release and open carpal tunnel release was $46, using Medicare cost and probabilities of various outcomes derived from a study by Brown et al. in 1993. We calculated QALYs for five age groups--25, 35, 45, 55, 65--assuming a life expectancy of 75 years. The marginal effectiveness (QALY of endoscopic carpal tunnel release minus QALY of open carpal tunnel release) ranged from 0.235 QALY for the 25-year-old age group to 0.066 QALY for the 65-year-old age group, giving a cost-effectiveness ratio of $195/QALY and $693/QALY, respectively. When compared with other accepted medical interventions such as breast cancer screening ($4836/QALY) and exercise to prevent coronary heart disease ($13,508/QALY), endoscopic carpal tunnel release seems to be cost-effective. However, our sensitivity analysis indicated that the cost-effectiveness ratio was very sensitive to a major complication such as median nerve injury. For endoscopic carpal tunnel release to be a cost-effective procedure, the incidence of median nerve injury must be one percentage point less for endoscopic carpal tunnel release than for open carpal tunnel release. Based on the data from the randomized-controlled trials, endoscopic carpal tunnel release seems to be a cost-effective procedure; however, before it can be recommended, greater emphasis must be given to the training of surgeons in this new technique, so that major complications such as median nerve injuries can be avoided. In addition, future studies must better define the actual incidence of nerve injuries for both endoscopic carpal tunnel release and open carpal tunnel release in the community setting.

Adult↗
PubMed2005

Endoscopic management of pediatric brain tumors.

OBJECT: Primary endoscopic procedures for children with intraventricular brain tumors include endoscopic tumor biopsy and endoscopic tumor removal. The simultaneous treatment of hydrocephalus with endoscopic third ventriculostomy (ETV) or endoscopic septostomy increases the appeal of a minimally invasive endoscopic approach. METHODS: Eighty-five patients who underwent endoscopic management of an intraventricular brain tumor were identified from a prospective database. Of these patients, 26 were younger than 21 years of age at the time of diagnosis. The surgical technique, its success rate, and patient outcome were assessed. Illustrative cases are used in this study to detail the procedure of endoscopic tumor biopsy and resection. Endoscopic tumor procedures were successful in 96% of cases (23 of 24 endoscopic tumor biopsy samples and both endoscopic tumor removals). Fourteen simultaneous procedures were performed to treat hydrocephalus successfully. There was no recognized morbidity from the surgical procedures. CONCLUSIONS: Endoscopic surgery in children with intraventricular brain tumors is an effective and safe method for sampling of the lesion and, in select cases, its resection. This minimally invasive technique should be considered in situations in which the patient might thereby avoid a more conventional procedure, given the high rate of success and low morbidity associated with endoscopic management.

Adolescent↗
PubMed1994

Liquid disinfecting and sterilizing reprocessors used for flexible endoscopes.

In this issue, we evaluate three liquid disinfecting flexible endoscope reprocessors that can be used with a user-supplied liquid chemical germicide (LCG), primarily for high-level disinfection (HLD). Applying most of the same criteria and test methods, we also evaluated a fourth unit, presented separately, that is marketed as a liquid sterilizing reprocessor and must be used with manufacturer-supplied, single-use containers of LCG. Although the sterilizing unit can be used for rigid endoscopes, surgical instruments, and endoscopic accessories, we evaluated its application to the reprocessing of only flexible endoscopes. Our ratings are based on the following: (1) basic performance, such as compatibility with several different types of endoscopes and LCGs, inclusion of all essential reprocessing phases, and exposure of all endoscope surfaces to the LCG and rinse water; (2) safety, such as ensuring that essential reprocessing phases cannot be skipped or omitted, that personnel exposure to LCG vapors is minimized, and that the reprocessor is unlikely to contaminate the endoscope during reprocessing; and (3) human factors design, such as ease of use and installation. We did not perform microbiological testing to confirm HLD or sterilization by any of the evaluated reprocessors because, with a suitably clean endoscope that is in good condition, no evidence indicates that the LCGs used would not be effective on the surfaces that they contact; also, the results would be unique to the two flexible endoscopes that we used for our testing. We rated all four reprocessors Conditionally Acceptable. The units are Acceptable on the condition that users understand that they cannot be used to process the elevator cable channel of side-viewing duodenoscopes; additional conditions apply only to the liquid disinfecting units. However, if the conditions are met, all four units reduce the likelihood of using a contaminated endoscope on a patient and reduce personnel exposure to the LCG. Selection of a unit will be based on the needs and preferences of the individual healthcare facility. Our ratings also assume that these units will be used according to the manufacturers' instructions and the endoscope's operator's manual. Note that, although the evaluated liquid disinfecting units provide detergent-flushing, post-detergent water-rinse, and post-detergent water-rinse-removal phases, manual cleaning of endoscopes before automatic reprocessing is essential, regardless of which reprocessor is used.(ABSTRACT TRUNCATED AT 400 WORDS)

Consumer Behavior↗
PubMed2005

[The outcome of endoscopic treatment in bile duct injury after cholecystectomy].

BACKGROUND/AIMS: Bile duct injury is the most serious complication of cholecystectomy. The aim of this study was to evaluate the outcome of endoscopic treatment in bile duct injury after cholecystectomy. METHODS: We reviewed the results of endoscopic treatments in the patients diagnosed as bile duct injury after cholecystectomy on cholangiographic examinations, retrospectively. Endoscopic treatment included insertion of nasobiliary drainage catheter or plastic stent after endoscopic sphicterotomy. RESULTS: A total of twenty-two patients (9 male, 13 female; median age of 59 years) with bile duct injury were included. Endoscopic treatment was successfully performed in 12 of 13 patients with bile leak only. In patients with both bile leak and stricture, endoscopic treatment was successful in 2 of 3 patients. In 6 patients with complete obstruction of bile duct, endoscopic treatment failed and surgical approach was needed. In our series, transpapillary endoscopic treatment was not successful when proximal bile duct above the injured site was not visualized by endoscopic retrograde cholangiopancreatography (ERCP) and surgery was performed in all cases. Overall success rate of endoscopic treatment in 22 patients with bile duct injury was 64% (14/22). There was no complication associated with endoscopic treatment. CONCLUSIONS: ERCP is useful for the treatment of bile leakage after cholecystectomy and can be used for the treatment prior to surgery. Surgical intervention is needed in case of endoscopic treatment failure.

Adult↗
PubMed2002

Endoscopic stapling technique for the treatment of Zenker diverticulum vs standard open-neck technique: a direct comparison and charge analysis.

BACKGROUND: Presently, the 2 most widely used methods for the treatment of Zenker diverticulum are endoscopic stapling of the common party wall between the diverticulum sac and the esophagus and the standard open-neck technique involving diverticulectomy and cricopharyngeal myotomy. OBJECTIVE: To perform an analysis of the hospital charges to determine the economic efficiency of each technique based on our experience at the Mt Sinai Medical Center, New York, NY. METHODS: A retrospective analysis of 16 patients diagnosed as having Zenker diverticulum was conducted. Eight randomly chosen patients underwent endoscopic stapling with an EndoGIA 35-mm endoscopic stapler (Ethicon Inc, Somerville, NJ), and 8 randomly chosen patients underwent a standard open approach with diverticulectomy. Medical records were reviewed to determine operative time, length of hospital stay, time to oral intake, and postoperative complications. A charge analysis of the operative and postoperative fees was also performed. Statistical analysis between the 2 groups was conducted using analysis of variance and the paired t test. RESULTS: The mean +/- SD operative time for the endoscopic stapling technique was 25.5 +/- 15.78 minutes, which was significantly less (P<.001) than that for the open procedure, 87.6 +/- 35.10 minutes. The mean operative charges were roughly equivalent at US$ 5178 for the endoscopic procedure and US$ 5113 for the open procedure. The endoscopic procedure, while shorter in operative time, had the added expense of specialized equipment, specifically the EndoGIA endoscopic stapler. The mean +/- SD length of hospital stay for the endoscopic procedure was significantly shorter (P<.001) at 1.3 +/- 0.59 days vs 5.2 +/- 1.03 days for the open procedure. The inpatient hospital charges for the endoscopic group was also significantly less (P<.001) at a mean of US$ 3589 per stay vs US$ 11,439 for the open group. The mean +/- SD time to oral intake was significantly shorter (<.001) at a mean of US$ 3589 per stay vs US$ 11,439 for the open group. The mean +/- SD time to oral intake was significantly shorter (P<.001) in the endoscopic group at 0.8 +/- 0.26 days vs 5.1 +/- 1.25 days for the open group. There were no major complications in either group, and all patients experienced resolution of preoperative symptoms. CONCLUSIONS: Compared with the standard open technique, the endoscopic stapling technique for the treatment of Zenker diverticulum results in a statistically significant shorter operative time, hospital stay, and time to resume oral feedings. While the charges of the operative procedures were roughly equivalent, the total hospital charges were significantly less for the patients treated endoscopically.

Aged↗
PubMed1999

Usefulness of endoscopic aspiration mucosectomy as compared with strip biopsy for the treatment of gastric mucosal cancer.

BACKGROUND: Several techniques are available for the endoscopic treatment of gastric intramucosal cancers, but their advantages and disadvantages have not been adequately evaluated. We compared the therapeutic usefulness of endoscopic aspiration mucosectomy with that of strip biopsy. METHODS: Between May 1995 and May 1997, we performed strip biopsy (May 1995 through February 1996) or endoscopic aspiration mucosectomy (March 1996 through May 1997) in a consecutive series of patients with intestinal-type intramucosal cancer. Parameters of assessment included the following: size of removed specimens, en bloc resection rate, time required for resection, duration of hospitalization, and complications. RESULTS: Forty-nine patients with gastric intramucosal cancers underwent endoscopic aspiration mucosectomy and 44 underwent strip biopsy. The two groups were similar with respect to age, gender, and lesion macroscopic appearance, size, and site. The mean longest diameter of the resected specimens was significantly greater with endoscopic aspiration mucosectomy (20.3 +/- 3.4 mm) than with strip biopsy (15. 8 +/- 4.4 mm) (p < 0.001). The rate of en bloc resection (resection of an entire lesion in one procedure) was significantly higher with endoscopic aspiration mucosectomy (61.2%, 30 of 49) than with strip biopsy (36.4%, 16 of 44) (p < 0.05). The number of specimens obtained by piecemeal resection was slightly, but not significantly, higher with strip biopsy (2.4 +/- 1.7) than with endoscopic aspiration mucosectomy (2.0 +/- 1.7). The time required for treatment was similar for each procedure. The duration of hospitalization was significantly shorter with endoscopic aspiration mucosectomy (12.8 +/- 5.3 days) than with strip biopsy (15.9 +/- 74 days) (p < 0.05). As for complications, the rate of bleeding was 20. 5% (9 of 44) with strip biopsy and 10.2% (5 of 49) with endoscopic aspiration mucosectomy; bleeding was controlled in all cases by treatment with a heater probe. CONCLUSIONS: Endoscopic resection of large gastric intramucosal tumors is easier with endoscopic aspiration mucosectomy compared with strip biopsy. Endoscopic aspiration mucosectomy is a useful procedure for en bloc resection.

Adenocarcinoma↗
PubMed1999

Open versus endoscopic carpal tunnel release: a decision analysis.

The endoscopic technique for the surgical treatment of carpal tunnel syndrome was developed to decrease postoperative morbidity and accelerate a patient's return to normal activities and work. We used the methods of decision analysis to compare the total cost of the open versus the endoscopic technique. We adopted a societal perspective and included estimates of the costs of medical procedures and complications, as well as lost wages. Our base case analysis showed that the 2 techniques have similar total costs, given the assumptions of our model. The endoscopic approach is more costly if the complication rate of endoscopic surgery exceeds 6.2% (base case estimate, 5.0%). The endoscopic technique is more costly if the risk of career ending injury exceeds 0.001 (base case estimate, 0.0004) and if the average work absence following a complication exceeds 15.5 months (base case estimate, 12 months). In addition, the endoscopic technique is more costly if the difference between the 2 techniques in mean time to return to work is less than 21 days (base case estimate, 26 days). These findings have different implications for recipients and non-recipients of workers' compensation. If endoscopically treated patients return to work an average of 42 days faster than patients treated with the open technique (24 days vs 66 days), as was documented for non-recipients of workers' compensation in one large study, the endoscopic strategy would be less costly ($5,599 for endoscopic release vs $7,340 for open surgery). If endoscopically treated patients return to work an average of just 10 days sooner (103 days vs 113 days), however, as was documented for workers' compensation recipients in the same study, the open technique would be less costly ($11,353 for open release vs $11,959 for the endoscopic technique). The relative costs are not sensitive to the direct medical costs of complications. These findings allow prediction of the costs of endoscopic and open surgery under a range of assumptions concerning key parameters. The analyses also emphasize the need for more precise data on risks and costs of surgical treatments for carpal tunnel syndrome.

Carpal Tunnel Syndrome↗
PubMed2005

Endoscopic surgery of the anterior skull base.

OBJECTIVES/HYPOTHESIS: Traditional surgical approaches to the anterior skull base often involve craniotomy, facial incisions, disruption of skeletal framework, tracheotomy, and an extended hospital stay. As experience with endoscopic sinus surgery has grown, the techniques and equipment have been found to be adaptable to treatment of lesions of the anterior and central skull base. A minimally invasive endoscopic approach theoretically offers the advantages of avoiding facial incisions, osteotomies, and tracheotomy; surgery should be less painful, recovery quicker, and hospital stays should be shorter. The study attempted to assess endoscopic approaches to the anterior and central skull base for its ability to achieve those goals. STUDY DESIGN: Retrospective review of 72 cases performed at a single institution from November 1996 to July 2003. A subgroup of 15 patients who underwent endoscopic approach to their pituitary tumors was compared with a similar group of 15 patients who underwent traditional open trans-sphenoidal surgery for their pituitary tumors. METHODS: Patient records were analyzed and information tabulated for age, sex, disease, location of lesion, operative time, use of image-guided surgical systems, blood loss, length of intensive care unit stay, duration of operative pain, length of postoperative hospitalization, complications, and completeness of resection. RESULTS: Of the cases, 86.1% were performed exclusively endoscopically, and 13.9% used a combination of endoscopic and open techniques. An image-guided surgical system was used in 83% of cases. Hospital length of stay was 2.3 days for the exclusively endoscopic group as opposed to 8 days for the combined group. With the patients with pituitary tumors, operative times were similar between the two groups (255.13 vs. 245.73 min), blood loss was less in the endoscopic group (125.33 vs. 243.33 mL), pain duration was shorter in the endoscopic group (10 of 15 patients pain free on postoperative day 1 vs. 2 of 15 patients pain free in the open group), and intensive care unit stay and hospital length of stay were both shorter in the endoscopic group. Complication rates and completeness of resection was similar in both groups, although the open group had a higher rate of complications related to the approach to the sella. CONCLUSION: The study demonstrated the safety and efficacy of judicious endoscopic approaches to anterior skull base lesions. An outcomes assessment in pituitary surgery demonstrates advantages of an endoscopic approach in appropriate cases.

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