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PubMed2004

[Acute hemorrhage of the upper part of the gastrointestinal tract--survey of emergency endoscopy of the upper gastrointestinal tract at our facility].

INTRODUCTION: Acute upper gastrointestinal tract bleeding is a cause of significant morbidity and mortality and is a reason for urgent endoscopy. Besides an age and associated diseases, prognosis of patients influence also localisation and type of bleeding. The aim of our retrospective analysis was to discover causes of bleeding into upper GI tract and its characteristics over a 4 year period. METHODOLOGY: A survey of urgent upper GI tract endoscopies in the Clinic of Internal Medicine in Motol in Prague because of an acute GI tract bleeding (hematemesis or melena) was done. Found ulcers were assessed using Forrest classification. Moreover, number and causes of recurrences of bleeding were also assessed. RESULTS: Within years 1998-2001 an urgent upper GI endoscopy because of bleeding (hematemesis or melena) was done in the Clinic of Internal Medicine in Prague in Motol in 1639 patients of an average age 62.2. 56% were men (average age 59) and 44% were women (average age 65.3). An endoscopy finding without pathology was present in 21.4%. The most frequent sources of bleeding were ulcers in duodenal bulb (20%), stomach ulcers (18.2%), and hemorrhagic gastropathy (16.5%) and varices (10.3%). Results of the Forrest classification in the ulcerative disease of stomach and duodenum were as follows: Forrest Ia 9.5%, Ib 24%, IIa 14.6%, IIb 18.7%, IIc 22.9%, III 10.3%. Recurrent bleeding was identified in 8.4% of patients, thereof bleeding from esophageal varices experienced 2.9% of patients (average age 45.8), bleeding from ulcers in bulbus 2.7% (Forrest Ib, IIa a IIb) of patients of an average age 62.6, and bleeding from ulcers in stomach 2.1% (Forrest Ia, IIa a Ib) of patients of an average age 62.5. Causes of recurrent bleeding were in one case bleeding from Barrett's oesophageal ulcer and in one case bleeding from ulcer in diaphragmatic hernia. Within 48 hours recurrent bleeding appeared in 65% of patients. CONCLUSION: Urgent endoscopy in gastrointestinal tract bleeding is an essential part of a complex medical care. It is highly reliable in identifying cause of bleeding, it enables to start treatment immediately and to consider prognosis of a patient.

Acute Disease↗
PubMedDate not supplied

How subjective is nasal endoscopy? A study of interrater agreement using the Lund and Mackay scoring system.

BACKGROUND: Scoring systems exist to standardize the recording of nasal endoscopy findings. The extent to which two surgeons will agree on the findings of nasal endoscopy in adults currently is unknown, although a study in children showed high rates of agreement between two observers. We studied the interobserver agreement of adult nasal endoscopy scored with the system proposed by Lund and Mackay. METHOD: A consecutive series of otolaryngology patients attending with a variety of nasal complaints were recruited. All were examined with a 0 degrees 4-mm endoscope by two surgeons on the same clinic visit. Each independently recorded their findings using the Lund and Mackay scoring system. Neither surgeon was aware of the other's findings. RESULTS: Thirty patients were studied (16 women and 14 men). Because the endoscopic findings were recorded separately for each side of the nose, each surgeon made 60 observations. Interrater agreement was calculated as Cohen's kappa, and suggested moderate agreement for edema (kappa = 0.45), good agreement for crusting (kappa = 0.62), and very good agreement for polyp (kappa = 0.93) and discharge (kappa = 0.84). CONCLUSION: Two independent observers agree on the findings of nasal endoscopy in a high proportion of cases. Nasal endoscopy is a reliable tool, especially when a scoring system such as that of Lund and Mackay is used.

Endoscopy↗
PubMedDate not supplied

The role of endoscopy in inflammatory bowel disease.

Endoscopy is an essential tool for diagnosis, management and prognostic evaluation of inflammatory bowel disease. However dyscomfort, potential risks and costs associated to endoscopic examinations should contribute to the narrowing of indications to those cases in which the result of endoscopy is essential to determine a variation in the management strategy. Ileocolonoscopy performed by an expert endoscopist allows accurate diagnosis of Crohn's disease or ulcerative colitis in up to almost 90% of cases. Colonoscopy has a prognostic role during a severe flare of disease (the occurrence of severe endoscopic lesions have a negative prognostic value with significantly higher risk not to respond to medical treatment) both in ulcerative colitis and in Crohn's disease; moreover in Crohn's disease the evaluation of recurrent lesions at anastomosis after curative surgery has a strong prognostic role (endoscopic recurrence closely correlates with clinical/surgical recurrence) and preliminary data suggest that mucosal healing assessed with endoscopy after biologic treatments could be associated with a better prognosis. Finally colonoscopy is essential for cancer surveillance during the long-term follow-up. Furthermore there are new endoscopic techniques under evaluation in inflammatory bowel disease, like wireless capsule endoscopy or double balloon enteroscopy for the imaging of small bowel, or endoscopic ultrasound for evaluation of strictures or of perianal disease. Finally some operative techniques like balloon dilation could possibly be employed more frequently in the future in the management of Crohn's disease. Future perspectives in endoscopy for IBD are chromoendoscopy and newer endoscopic imaging techniques, possibly leading to an "in-vivo histology".

Endoscopy, Digestive System↗
PubMedDate not supplied

Objective assessment of gastrointestinal endoscopy skills using a virtual reality simulator.

BACKGROUND: This study was carried out to validate the role of virtual reality computer simulation as a method of assessment of psychomotor skills in gastrointestinal endoscopy. We aimed to investigate whether the GI Mentor II computer system (Simbionix Ltd.) was able to differentiate between subjects with different experience with GI endoscopy. METHODS: Twenty-eight subjects were included in the study. They were divided into 3 groups according to their experience with GI endoscopy: experienced [group 1, performed > 200 endoscopic procedures, (n = 8)] residents [group 2, performed < 50 endoscopic procedures, (n = 10)] and medical students [group 3, never performed GI endoscopy, (n = 10)]. All participants received identical pretest instruction on the simulator. Assessment of endoscopic skills was performed during a simulated colonoscopy and was based on parameters measured by the computer system: time, percentage of mucosa surface examined, efficiency of screening, time with a clear view, excessive local pressure, pain, time with pain, loop formation, and total time with a loop. RESULTS: Significant differences in performance existed between surgeons in the 3 groups. Experienced surgeons demonstrated best performance parameters, followed by the residents and the medical students. Significant differences in time (Kruskal-Wallis test, P < 0.001), percentage of mucosa surface examined (P = 0.001), efficiency of screening (P = 0.001), time with a clear view (P = 0.001), pain experienced (P = 0.004), time with pain (P = 0.012), loop formation (P < 0.001), time with a loop (P < 0.001), and excessive local pressure (P = 0.001) were demonstrated. Significant differences existed between group 1 and 2 and 1 and 3 (Mann-Whitney test, P < 0.05). Differences between groups 2 and 3 did not reach statistical significance (P > 0.05). CONCLUSIONS: The VR simulator was able to differentiate between subjects with different endoscopic experience. This indicates that the GI Mentor measures skills relevant for gastrointestinal endoscopy and can be used in training programs as an assessment tool.

Computer Simulation↗
PubMed2005

[Abnormal gastrointestinal findings in patients with coronary disease revealed by endoscopy before cardiac surgery].

OBJECTIVES: To assess incidence of different abnormal gastrointestinal changes revealed by endoscopy before cardiac surgery in different female and male age groups and to establish criteria for carrying out preventive endoscopy in patients with coronary disease. MATERIAL AND METHODS: Retrospective analysis was performed on 3847 patients (63.2% and 36.8% of male and female patients, respectively; mean age 61.9+/-11.9) who underwent fiberoptic esophagogastroduodenoscopy (FEGDS) before cardiac surgery under extracorporeal circulation at Kaunas University of Medicine Hospital in 2000-2003. Study population was divided into two groups: group I consisted of 2348 (61%) patients whose endoscopy revealed active bleeding from mucous membranes of gastrointestinal tract (bleeding gastric or duodenal ulcer) or any other abnormal findings indicating bleeding potential (gastric and duodenal erosion or ulcer); group II comprised 1499 (39%) patients whose endoscopy revealed no abnormal changes or the revealed ones (scars, hiatal hernia, etc.) that cannot cause bleeding. RESULTS: No statistically significant differences were established in male and female percentage both generally and individually in groups (63.2% and 36.8% in all population studied; 61% and 39%, 64.6% and 35.4% in group I and group II, respectively). Further data analysis showed that FEGDS revealed changes requiring pre-surgical treatment in even 62.4% of male patients; meanwhile the similar changes were diagnosed in 58.7% of female patients. Incidence analysis of abnormal changes in terms of patient age established that even 31.1% of the group I population were patients aged 61-70, and 26.5%--patients aged 51-60. It should also be noted that these age groups were represented in the most ample manner in all population studied--31.7% (1209 patients) and 26.5% (1012 patients), respectively. The highest incidence of bleeding potential changes in male patients was found in the 51-60 year-old group (30.7% (462 patients)) and 61-70 year-old group (29% (436 patients)); in female patients, the highest incidence was observed in the 61-70 year-old group (35.2% (290 patients)) and 71-80 year-old group (25.6% (211 patients) (p<0.05). Data analysis showed that just 20.1% and 10.9% of male and female patients respectively were diagnosed with the changes mentioned in the age groups of up to 50 year-old. The study established that only 14.5% of FEGDS carried out revealed no abnormal changes in the upper gastrointestinal tract. CONCLUSION: Abnormal gastrointestinal changes indicating bleeding potential were established with significantly higher incidence in male compared with female patients. Gastrointestinal endoscopy before cardiac surgery under extracorporeal circulation should be carried out in 50-70 year-old male patients and 60-80 year-old female patients, while carrying out of the same examination in the younger and older patients is subject to additional indications. Only 14.5% of fiberoptic esophagogastroduodenoscopies carried out revealed no abnormal changes in the upper gastrointestinal tract.

Age Factors↗
PubMed1992

Value of the history and stool occult blood test in selection of patients for upper endoscopy in Zimbabwe.

Patients with abdominal pain and no definite diagnosis referred for endoscopy were studied to define discriminating features in the history, and the value of a stool occult blood test, in predicting the presence of upper gastrointestinal disease. Endoscopy was performed in 116 patients; pathology was seen in 32 (duodenal ulcer 17, gastric carcinoma 4, gastric ulcer 3, miscellaneous 8) and no pathology was seen in 84 patients. Features that predicted upper gastrointestinal pathology were, in descending order of rank: a positive pointing sign, a positive stool Fecult test, a history of vomiting, loss of weight, and alcohol intake. Using these discriminating features together it was possible to correctly predict 95% of patients with abnormal endoscopy and 82% of patients with a normal endoscopy. The history and the stool occult blood test are useful predictors of the presence of upper gastrointestinal pathology and may aid rational selection of patients for endoscopy.

Endoscopy, Gastrointestinal↗
PubMed2006

Computerisation of endoscopy reports using standard reports and text blocks.

BACKGROUND: The widespread use of gastrointestinal endoscopy for diagnosis and treatment requires effective, standardised report systems. This need is further increased by the limited storage of images, and by the need for structured databases for surveillance and epidemiology. We therefore aimed for a report system which would be quick, easy to learn, and suitable for use in busy daily practice. METHODS: Endobase III is an endoscopy information system offering three different ways of report writing, i.e. standard reports, text blocks and Minimal Standard Terminology (MST). A working group of two university and four general hospitals worked as a reference group for the development of standard reports and text blocks. Guidelines from various gastrointestinal endoscopy societies were followed to compose the reports. RESULTS: Standard reports were based on a list of distinct diagnoses; text blocks were based on anatomic landmarks and individual procedures. As such, 316 standard reports were developed for upper and lower gastrointestinal endoscopy, and endoscopic retrograde cholangiopancreatography (ERCP). In this way selecting one diagnosis produces a complete report. A total of 1571 different text blocks were additionally developed for each part of the gastrointestinal tract and for procedures during endoscopy. This module allowed generation of a full report on the combination of text blocks. Reports could be composed and printed within two minutes for 90% of cases. CONCLUSION: Standard reports and text blocks are a quick, user-friendly way of report writing accepted and used by a number of gastroenterologists in the Netherlands.

Databases, Factual↗
PubMed2006

Effect of systematic psychological preparation using visual illustration prior to gastrointestinal endoscopy on the anxiety of both pediatric patients and parents.

BACKGROUND: Anxiety, a psychological response to stress, can affect a child undergoing medical procedures, and their family members. The purpose of the present study was to evaluate the benefit of detailed systematic information using a set of real photograph-based technical illustrations provided to both parents and patients before performing endoscopy on the level of anxiety. MATERIAL AND METHOD: All children eligible for gastrointestinal endoscopy were consecutively enrolled from December 2003 to May 2004. Before and after providing systematic psychological preparation, the parents and patients older than five years of age were asked to score their anxiety on the procedures using visual analogue scale (VAS). RESULTS: There were fifty-four patients enrolled during the study period Of these, twenty-five children were older than five years of age. The most common indication of gastrointestinal endoscopy was lower gastrointestinal bleeding. The esophagogastroduodenoscopy, colonoscopy, and both upper and lower endoscopies were performed in 50%, 37%, and 13% of the cases, respectively. The mean and standard deviation of VAS on anxiety of the parents (n = 54) before and after providing systematic information were 3.89 +/- 3.45 and 1.90 +/- 2.46, respectively (p < 0.001). These values on anxiety of the children older than 5 years of age before and after providing systematic information were 4.38 +/- 3.72 and 3.36 +/- 3.69, respectively (p = 0.143). There was no statistically significant impact of types ofp rocedure, level of education, family s income, age of children, and birth order on the level of anxiety. CONCLUSION: The preparatory intervention using systematic visual illustration of the technical procedures in children undergoing gastrointestinal endoscopy could significantly reduce the parents' anxiety.

Adult↗
PubMed2006

[The contribution of capsule endoscopy to the diagnosis of small-bowel tumors in cases of obscure overt gastrointestinal bleeding].

BACKGROUND: The source of obscure bleeding is usually located in the small bowel. The use of capsule endoscopy (CE) has changed the management of these patients. GOALS: To review our experience with the diagnosis of small bowel tumors by CE in patients with obscure overt gastrointestinal bleeding. METHODS: Retrospective analysis of CE examinations performed consecutively in two university-affiliated hospitals. RESULTS: Among 156 patients who underwent CE examination (including 58 patients with obscure overt bleeding), five patients, all of whom presented with melena, were diagnosed as having a small bowel tumor. Three tumors were found in one patient (two ileal carcinoids and one ileal benign stromal tumor). A jejunal benign stromal tumor was diagnosed in two other patients by push enteroscopy. One of these was missed by a subsequent capsule endoscopy examination, and in the other, only active bleeding was detected by prior capsule endoscopy. In two patients, three small tumors were detected, beyond the reach of push enteroscopy, but surgical confirmation was not available. No tumors were found among patients in whom the indication for CE examination was not obscure overt bleeding. CONCLUSIONS: The possibility of finding a small bowel tumor emphasizes the role of capsule endoscopy in patients with obscure overt gastrointestinal bleeding. Push enteroscopy should be performed when capsule endoscopy yields negative or only suspicious findings.

Aged↗
PubMed2006

[Upper gastrointestinal endoscopy in neonates--experience of pediatric gastroenterology unit].

UNLABELLED: The aim of our study was to assess the frequency of the different lesions occurring as well as to precise indications of upper gastrointestinal endoscopy in neonates. METHOD: We have achieved a retrospective study about 128 neonatal gastrointestinal endoscopies. Three groups were constituted according to macroscopic findings: Group I: normal aspect (n=11); Group II: isolated esophagitis (n=19); Group III: esogastritis or gastroduodenitis or esogastroduodenitis (n=92). RESULTS: The neonates undergoing endoscopy for malaise were more frequent in group I than in group II and III, respectively 36.5% versus 15.8% and 9.8% (P = 0.04). Digestive hemorrhage (hematemesis and/or melena) was more frequent in group III than in group II and I, respectively 90.2% versus 78.9% and 63.6% (P = 0.03). Digestive hemorrhage was in our study the main indication of upper gastrointestinal endoscopy in neonates (85.9%) which showed a macroscopic lesion in 93.5% of cases. CONCLUSION: Hematemesis and suspicion of esophagitis are good indications for upper gastrointestinal endoscopy in neonates.

Age Factors↗
PubMed1991

Development of a surgical endoscopy database for quality assurance.

In view of the current incorporation of gastrointestinal endoscopy within surgical residency programs and therefore increased performance of these procedures by surgeons, it is appropriate to devise an effective database which allows retrieval of pertinent information for quality assurance (QA) and utilization review (UR) programs. During the development of two complete surgical endoscopy teaching programs, the QA process has been extensively analyzed for the minimal essential information required to perform QA in compliance with regulations of JCAHO and other reviewing authorities. Over the previous five years this information has been gathered on 3098 patients and incorporated into a database which allows for review of the medical record and the endoscopy unit record for QA and UR. Although the data were entered into a computerized database program for ease of data retrieval and analysis, this information can be complied by the "stubby pencil" method in paper files or log books. The QA process is integrated as part of the general surgery QA, not under a separate endoscopy committee. Results demonstrate that the minimal essential data for the medical record included: patient identification data, endoscopist, procedure, additional procedures, medications, indications, preoperative diagnosis, description of procedure, findings, tissue obtained, complications, final diagnosis, and discharge planning. The endoscopy unit record contained: patient identification, endoscopist, procedure, tissue obtained, and suite complications. From these data elements, complete QA was performed and included: completeness of documentation, appropriate indications, complications, endoscopic versus pathologic diagnosis, and unsuccessful procedures. Utilization review included: number of normal procedures, benefits of screening and surveillance procedures, and appropriateness of preoperative evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)

Databases, Factual↗
PubMed1990

Upper gastrointestinal endoscopy in children.

The purpose of this paper is to study the use of upper gastrointestinal (Gl) fiberoptic endoscopy in children. Two hundred consecutive patients referred to one of the authors were reviewed. The indications for performing upper gastrointestinal endoscopy in these 200 patients were: (1) recurrent abdominal pain (46.5%), (2) persistent vomiting (14.5%), (3) haematemesis (14.5%), (4) acute abdominal pain (13%) and (5) other indications such as foreign body removal, failure to thrive and unexplained chest pain (11.5%). The endoscopy was performed with the Olympus P3 or Olympus XP-10 gastroscopes. The sedation used was a combination of intravenous pethidine (2mg/kg) and diazepam (0.5 mg/kg). Among the patients with recurrent abdominal pain, upper Gl endoscopy showed duodenal ulcer in 7 patients (7.5%), duodenitis in 4 (4.3%), oesophagitis in 4 (4.3%) and gastric ulcer in 2 (2.2%). The rest of the patients were normal (81.7%). With regard to persistent vomiting, 37.9% of the patients showed gastroesophageal reflux and 6.9% had a hiatus hernia. Of 29 patients examined endoscopically for upper Gl bleeding, no focus of bleeding was identified in 27.6%. The remaining 72.4% were bleeding from acute gastric erosion (27.6%), oesophagitis (17.2%), oesophageal varices (13.8%), duodenal ulcer (10.3%) and Mallory-Weiss tear (3.5%). The Majority of the patients with acute abdominal pain were normal endoscopically (61.5%). The two common abnormal findings were acute gastritis (27.0%) and acute duodenitis (11.5%). No major complications were encountered during the procedure in these 200 patients. It was concluded that upper Gl endoscopy is useful for defining upper Gl mucosal pathology. The procedure can be performed safely in children under sedation.

Child↗
PubMed1989

[Outlook for the development of emergency endoscopy].

According to the object of emergency endoscopy, the author discusses the advances achieved in some fields of medicine owing to introduction of the methods of diagnostic and therapeutic endoscopy into practice. He fixes special attention on the fact that the use of modern methods of emergency endoscopy may reduce sharply the mortality and the incidence of complications in the most commonly encountered diseases and affections. Methods of therapeutic surgical endoscopy allow some patients to be spared the traditional surgical interventions. The main prospects of the development of emergency endoscopy are linked with the organization of its service.

Emergencies↗
PubMed1988

[Evaluating endoscopy].

Endoscopy is a safe technique with a sensitivity and specificity superior to those of conventional diagnostic procedures, which it has consequently replaced. In doing so, it has also altered many diagnostic and therapeutic concepts. Moreover, endoscopy has positively influenced the previously unaffected course of certain diseases, e.g. upper G. I. bleeding. Endoscopy benefits both the patient and the physician. Although no complete cost-benefit analysis is available, preliminary reports have been favourable. These aspects indicate that endoscopy is highly valuable in a clinical setting. It must be pointed out, however, that endoscopy as a whole has not yet been fully analyzed in any single given clinical study.

Diagnosis, Differential↗
PubMed1988

Evaluation of endoscopy training in a general surgery residency.

To evaluate the gastrointestinal endoscopy training program, a survey of the 33 former chief residents, who finished our program in 1981-1986, was conducted. All 33 graduates responded; 22 graduates are general surgeons, 11 completed or are completing training in a surgical specialty. Eighteen of the 22 general surgeons routinely perform endoscopy in their practice. Graduates in cities with a population greater than 250,000 are as likely to perform endoscopy as the surgeons who live in smaller communities. Ninety one per cent consider endoscopy training to have been an important part of their surgical training. Based on this assessment, endoscopy training is an important part of a general-surgery residency.

Colonoscopy↗
PubMed1984

[Progress and focal points discussed at the Japanese Committee on Pediatric Endoscopy].

Recent advances of pediatric endoscopy were discussed. Progresses of technique and improvements of instrument have made it possible to scope safely resulting in the increase of pediatric endoscopies. Gastric endoscopy has become useful to find the peptic ulcer of the stomach in the newborn babies who showed hematemesis. ERCP has been done successfully in the newborn babies making it possible to differentiate congenital biliary atresia from infantile hepatitis. Colonofiberscopy has become reliable and useful procedure to search the source of rectal bleeding but still had some problems to be resolved. General anesthesia has been widely used at the performance of pediatric endoscopy. In some institutes, local anesthesia has been recommended in the patients over 8 years old. In 1983, 1161 pediatric endoscopies were performed in 24 institutes, which were twofold of those performed in 1978. Number of these cases is not enough for the training of pediatric endoscopist. Urgent theme is to establish the system for the education of "true" pediatric endoscopist.

Anesthesia↗
PubMed1983

Diagnostic yield of endoscopy in upper gastrointestinal bleeding.

On a total of 934 fibreoptic oesophagogastroduodenoscopies, performed between September, 1978 and September 1981, 122 patients presented with symptoms of upper gastrointestinal bleeding of less than two weeks duration. The most frequent findings were peptic ulcer (40.9%), oesophageal varices (16.4%) and mucosal lesions (7.4% as an isolated finding and a further 16.4% associated with peptic ulcer or varices). Negative endoscopies comprised 24.6% of all 122 patients, but in 19 in whom the bleeding episode preceded the endoscopy by not more than 48 hours, there were none. In 105 patients whose history of haematemesis and/or melaena was not recent, endoscopy was negative in 30%, but in patients without such history in 50%. Haematemesis and melaena are important symptoms and add weight to the indication for endoscopy. The earlier the endoscopy can be done, the greater is the diagnostic yield.

Adult↗
PubMed1984

Intraoperative fiberoptic endoscopy.

Conventional endoscopy is an indispensable tool in the diagnosis and management of many patients with gastrointestinal disease. Intraoperative use of the fiberoptic endoscope permits direct visualization of the mucosal surface, eliminating the need for enterotomy in many cases. Over a 4.5-year period, 32 patients underwent gastrointestinal endoscopy during laparotomy for a wide variety of surgical problems. In 15 cases, obscure or unknown sites of upper and lower gastrointestinal bleeding were localized. Replacement of percutaneously placed biliary drainage tubes was facilitated in four cases. In three patients artifactual lesions suggested by gastrointestinal (GI) contrast studies were excluded with intraoperative endoscopy at the time of exploratory laparotomy, and in four cases, retained foreign bodies were recovered easily without the need for enterotomy. In six additional patients intraoperative endoscopy was used to localize nonpalpable colon polyps or to determine the extent of mucosal ulceration. The average time for an intraoperative fiberoptic endoscopic examination was 20 minutes. No complications resulted from this technique. In summary, intraoperative fiberoptic endoscopy is of definite value in assessing selected patients with difficult GI surgical problems encountered during laparotomy. This technique enhances the surgeon's ability to identify and treat inaccessible and occult GI lesions.

Adult↗