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PubMed1979

[Fiber endoscopy and radiology in stomach ulcer, stomach neoplasms and hiatal hernia: questions, timing and value].

In 306 patients, fiberpanendoscopy and radiology were performed within a time interval of 7 days or less. In 196 cases, radiology was performed before endoscopy and in 110 cases after endoscopy. In cases with histologically unproven divergent findings, follow-up studies were performed. In the diagnosis of gastric ulcer and gastric cancer, endoscopy with biopsy was more accurate than radiology. In the diagnosis of hiatal hernia, radiology was more accurate. Important additional findings difficult or impossible to observe with endoscopy were present in 36% of the radiological examinations. Thus, the first examination should be endoscopy when ulcer or carcinoma is suspected. In patients with uncharacteristic epigastric symptoms, radiology should be performed first.

Duodenum↗

PubMed1994

[Endoscopy in the intensive care unit].

The present study retrospectively evaluates all endoscopies performed on a medical intensive care unit during the period from 1986 to 1992. During these seven years, 415 endoscopies were performed of which 77.8% were done as an upper gastrointestinal endoscopy. The most frequent findings consisted in esophagitis (23.6%), ulcers of the stomach or duodenum (20.2%), esophageal varices (10.1%) and erosive-hemorrhagic gastritis (9.6%). More than 2/3 of all endoscopies were performed because of an gastrointestinal bleeding with upper bleeding being three times more frequent than lower bleeding. The endoscopy was able to identify the cause and site of bleeding with certainty or high probability in 92.8%. Esophagitis was the most frequent cause of bleeding (30.7%) followed by ulcers in the duodenum and stomach (25.6%), esophageal varices (14.8%) and erosive gastritis (13.7%). In more than 90% of patients with esophagitis a nasogastric tube had been administered during the two preceding days. Therefore, the tube is probably responsible for the esophagitis. The present data show that bleeding from esophageal lesions are about ten times more frequent in patients treated in an intensive care unit when compared to data published for the general group of patients with gastrointestinal bleeding. Considering the frequency of bleeding from esophagitis in intensive care patients, an administration of a nasogastric tube should be done only when mandatory.

Critical Care↗

PubMed1993

Office endoscopy or an endoscopic ambulatory surgery center?

Gastroenterologists are examining alternatives that allow delivery of effective and efficient care. Office endoscopy once provided such opportunities. Time efficiency, control of practice outcomes, and enhanced patient relationships were powerful incentives to perform office endoscopy. However, newly imposed physician procedural fee reductions and heightened concerns about quality of care are strong negatives for performing quality office endoscopy. These issues necessitate consideration of an office-based endoscopic ambulatory surgery center (EASC), where licensure, peer review, and credentialing essentially guarantee a high level of quality in the provision of endoscopy. Furthermore, state-licensed and Medicare-certified EASCs offer the advantages of office endoscopy and allow collection of a facility fee to offset the costs of providing the service. This article details the advantages and risks of developing an office-based EASC.

Ambulatory Care↗

PubMed1993

[Upper gastrointestinal endoscopy. Assessment of activity during a 3-month period: clinical problems, diagnostic and therapeutic consequences].

All patients referred to upper gastrointestinal endoscopy, during a period of three months, were recorded prospectively. In connection with the endoscopy, the investigator completed a questionnaire, related to demographic data, results of endoscopy and therapeutic suggestions. Six weeks later the general practitioner received a second questionnaire concerning diagnostic and therapeutic consequences. At the same time the patient received a third questionnaire, concerning therapeutic and psychological consequences. In all, 200 endoscopies were performed; 147 diagnostic and 53 controls. Of the former, 65 were open access and 82 were admitted to a medical department. We found that the endoscopies were well founded. There was a great diagnostic yield and the patients, in general, followed the therapeutic aim. Furthermore we found a noticeable psychologic effect, independent of endoscopic findings.

Adult↗

PubMed1993

A study of the frequency of recovery of unexpected Giardia lamblia and Cryptosporidium from duodenal aspirates taken during routine upper endoscopy.

UNLABELLED: In this study, our objective was to determine whether the microscopic examination of duodenal aspirates recovered during routine upper endoscopy in unselected, immunocompetent patients, would disclose unsuspected Giardia lamblia or Cryptosporidium. DESIGN: Prospective, cross-sectional study to determine the prevalence of duodenal parasitosis. SETTING: Endoscopy unit in a university hospital. PATIENTS: One hundred and thirty-one unselected, immunocompetent patients undergoing upper endoscopy. MEASUREMENTS: Microscopic examination of duodenal aspirates, obtained during upper endoscopy. No pathogenic or commensal parasite was identified in any patient. CONCLUSIONS: No case of unsuspected parasitosis was found in the present study. On the basis of our findings, we do not recommend routine collection of duodenal aspirates during upper endoscopy.

Adult↗

PubMed1996

[Helicobacter pylori infection and basal levels of serum gastrins in patients with duodenal ulcer and subjects with normal endoscopy].

BACKGROUND: To study basal gastrin levels in duodenal ulcer patients and in those with normal endoscopy, according to Helicobacter pylori infection. METHODS: Eighty-four duodenal ulcer patients and 164 with normal endoscopy were studied. Biopsy specimens were taken from gastric antrum and body, and investigated for microbiology (Gram stain and culture) and histology (hematoxilin-eosin stain). Basal gastrin levels were measured (RIA). RESULTS: In duodenal ulcer patients the percentage of chronic gastritis was higher (p < 0.001) than in patients with normal endoscopy without H. pylori infection, and similar to patients infected by H. pylori. In patients with normal endoscopy (n = 164), those infected with H. pylori (n = 115) had higher (p = 0.02) gastrin levels (mean +/- SD) than non-infected (64 +/- 34 vs 51 +/- 14 pg/ml) and similar to duodenal ulcer patients (62 +/- 20 pg/ml). In the multiple regression model analysis H. pylori infection was the only variable which correlated with gastrin levels (regression coefficient 9.48 [SE = 4.59]; multiple correlation coefficient 0.22 [p = 0.008]). Additional variables (age, sex, duodenal ulcer) were not correlated with gastrin levels. Patients with chronic gastritis had higher gastrin levels (p < 0.01) than those with normal histologic mucosa. CONCLUSIONS: In patients with normal endoscopy, those infected with H. pylori had significantly higher basal gastrin levels than non-infected individuals, and similar to duodenal ulcer patients. Therefore, hypergastrinaemia seems to be associated with H. pylori infection, and is not a distinctive feature of duodenal ulcer disease.

Adolescent↗

PubMed1997

Open access endoscopy for hospitalized patients.

OBJECTIVES: Most requests for gastroenterology consultations for hospitalized patients are for endoscopic procedures. Open access endoscopy has been evaluated in several institutions for outpatients. Our aim was to evaluate an open access policy for hospitalized patients. METHODS: Since April of 1996, patients hospitalized in the Soroka Medical Center have been referred directly for upper endoscopy (esophagogastroduodenoscopy, EGD) and flexible sigmoidoscopy (FS). The numbers of procedures and consultation requests between July 1, 1996, and September 30, 1996, were compared with the corresponding months of 1995. A survey of physician satisfaction with the new open access system was conducted. RESULTS: The mean number of monthly consultations during the study period was 30.7 +/- 2.4, compared with 119.3 +/- 5.4 during the same months in 1995 (p = 0.006). Open access endoscopy was performed on 114 patients during the study period. Upper GI bleeding (n = 41) and abdominal pain (n = 33) were the most common indications for EGD. There were nine duodenal ulcers, five gastric ulcers, and eight gastric carcinomas. Sixteen patients (21%) had normal EGDs. The most common indications for FS were rectal bleeding (n = 24) and diarrhea (n = 13). Seven patients had colorectal cancer; 12 FSs were normal. In all, 286 EGDs and FSs were conducted in the study period compared with 253 in 1995 (not significant). All physicians expressed satisfaction with the new system and favored its continuation. CONCLUSIONS: The open access policy for hospitalized patients led to a considerable reduction in requests for consultations, with no significant increase in the number of endoscopies. The majority of patients referred directly for endoscopy had appropriate indications.

Adolescent↗

PubMed1998

Laparoscopy and lesser sac endoscopy in gastric carcinoma operability assessment.

The results of 502 laparoscopy and 200 lesser sac endoscopy applications in 502 patients with gastric carcinoma for operability assessment are studied. Laparoscopy demonstrated a 94.74 per cent sensitivity for diagnosis of peritoneal disseminations and liver metastases. However, laparoscopy failed to establish inoperability in any cases of carcinoma spread to areas not accessible to laparoscopic visualization. Of these latter cases, 95.74 per cent were caused by tumor spread to the lesser sac retroperitoneum. Thus, the resultant sensitivity of laparoscopy in gastric carcinoma inoperability diagnosis was only 42.35 per cent. Lesser sac endoscopy made it feasible to inspect all of the organs and tissues forming the lesser sac. Of 200 patients assessed by lesser sac endoscopy, invasion of gastric posterior wall serosa was found in 89, retroperitoneal tumor invasion in 97, and retroperitoneal metastases in 42. The sensitivity of gastric carcinoma inoperability diagnosis by lesser sac endoscopy was 93.44 per cent and in combination with laparoscopy, 96.7 per cent. Utilization of lesser sac endoscopy in patients with gastric carcinoma minimized the number of exploratory laparotomies 6.4 times in comparison with only laparoscopy use and was responsible for diminishing this number to 5 per cent of the total number of examined patients.

Adult↗

PubMedDate not supplied

Relative roles of computed tomography and endoscopy for determining the inferior extent of pyriform sinus carcinoma: correlative histopathologic study.

Ten laryngopharyngectomy specimens were dissected to determine the relative accuracy of computed tomography (CT) and endoscopy under anesthesia for evaluating the inferior extent of pyriform sinus carcinoma. Endoscopic examination failed to detect involvement of the pyriform sinus apex in one patient, and considerably underestimated disease at this level in two others; CT accurately predicted the status of the apex in these three and all other patients. Endoscopy underestimated the inferior extent of tumor in six patients; CT revealed the inferior limit relative to the esophageal verge more accurately in all six of these submucosal extensions. Endoscopy revealed one case of mucosal spread to the esophageal verge not demonstrated by CT. Endoscopy and CT were both correct in revealing the esophageal verge to be involved (one case) and free of disease (two cases). This study also confirmed a common tendency of pyriform fossa cancer to spread through thyrohyoid membrane adjacent to the course of superior laryngeal neurovascular bundle (six cases). High-resolution CT, in experienced hands, is a useful adjunct to endoscopy for detecting submucosal, inferior extension of pyriform sinus carcinoma. This information can influence the choice of the lower margin of resection and method of pharyngeal reconstruction.

Aged↗

PubMed1989

Safety of endoscopy in the immediate postoperative period following gastric anastomosis.

The safety of gastrointestinal endoscopy in the immediate postoperative period following partial gastrectomy was assessed in ten dogs. Endoscopy was performed preoperatively and at 1, 2, 3, and 7 days postoperatively. The mean pressures required to perform an adequate endoscopy varied from 17 to 20 mm Hg. Following partial gastrectomy, the abdominal wall was closed with a zipper to facilitate inspection of the gastric anastomosis. No leakage of air or intra-abdominal abscesses were seen following endoscopy. The results of this study suggest that endoscopy can be safely performed in the immediate postgastrectomy period.

Animals↗

PubMed2002

Abdominal compartment syndrome and intrahepatic portal venous gas: a possible complication of endoscopy.

OBJECTIVE: We report the first patient to developed abdominal compartment syndrome (ACS) with intrahepatic portal venous gas (IHPVG) and pneumatosis cystoides intestinalis following emergency upper gastrointestinal endoscopy. CASE PRESENTATION: A 53-year-old man underwent an emergency upper gastrointestinal endoscopy for suspicion of upper gastrointestinal bleeding. The patient developed intra-abdominal hypertension and ACS associated with IHPVG after the endoscopy. Although the patient developed severe shock following ACS, he was managed conservatively and successfully recovered. CONCLUSIONS: An emergency upper gastrointestinal endoscopy may be associated with intra-abdominal hypertension and ACS. Our report provides an additional case of a survivor who required no surgical intervention for ACS and IHPVG following endoscopy.

Abdomen↗

PubMed2004

Detection of reflux esophagitis on double-contrast esophagrams and endoscopy using the histologic findings as the gold standard.

The purpose of our study was to determine the accuracy of double-contrast barium studies and endoscopy for detecting reflux esophagitis, using the endoscopic biopsy findings as the gold standard. A review of radiology, endoscopy, and pathology files showed 37 patients with reflux symptoms who underwent double-contrast barium studies and endoscopy with biopsy specimens from the esophagus. The radiographic images were reviewed in a blinded fashion and correlated with the endoscopic and histologic findings to determine the radiographic and endoscopic accuracies for detecting reflux esophagitis, using the endoscopic biopsy specimens as the gold standard. Double-contrast barium studies and endoscopy had low but comparable accuracies for detecting reflux esophagitis, with sensitivities of 35% and 39%, specificities of 79% and 71%, positive predictive values of 73% and 69%, and negative predictive values of 42% and 41%, respectively. When mucosa granularity was evaluated as an individual sign of esophagitis on double-contrast studies, this finding had a sensitivity of 35%, a specificity of 93%, a positive predictive value of 89%, and a negative predictive value of 46% for detecting reflux esophagitis. Our experience suggests that double-contrast barium studies and endoscopy have limited ability to detect reflux esophagitis, in particular mild esophagitis, when using the histologic findings as the gold standard. When radiographic abnormalities are detected, however, mucosal granularity is the single best sign of reflux esophagitis on double-contrast studies.

Adult↗

PubMed2005

History of negative colorectal endoscopy and risk of rectosigmoid neoplasms at screening flexible sigmoidoscopy.

BACKGROUND AND AIMS: Screening sigmoidoscopy can reduce incidence of colorectal cancer and mortality. The optimal re-screening interval has not yet been defined. This study is aimed at estimating the risk of distal advanced adenomas (diameter >/=10 mm, villous component >20%, high-grade dysplasia) and cancer at screening flexible sigmoidoscopy in subjects aged 55-64 years who reported pre-screening negative colorectal endoscopy. PATIENTS: Eight thousands two hundred two subjects aged 55-64 years who underwent screening flexible sigmoidoscopy within the SCORE trial in Italy and who were able to report their previous history of colorectal endoscopy. RESULTS: Eight hundred eighty three of 8,202 subjects (10.8%) reported at least one prescreening negative endoscopy: among them, after 3-5 years, 6-10 years and >10 years intervals between last reported examination and screening endoscopy, the Absolute Risk of advanced adenomas was 1.5%, 0.9% and 0.9%; one cancer was detected (0.1%). Among the 7,319 subjects who did not report prescreening endoscopy the risks of advanced adenoma and cancer were 3.2% and 0.4%, respectively. Subjects with a previous colorectal examination had a 65% decreased risk of advanced adenomas (OR=0.35, 95%CI 0.18-0.66) and a 71% decreased risk of cancer (OR=0.29, 95%CI 0.04-1.12) as compared to those who did not. For subjects without family history of colorectal cancer the statistically significant decrease of the risk persisted up to ten years. The observed benefit seems not to apply to subjects with family history of colorectal cancer. CONCLUSIONS: Our results are consistent with the hypothesis that the interval between screening sigmoidoscopies could be safely expanded beyond 5 years for subjects without specific risk factors for colorectal cancer.

Adenoma, Villous↗

PubMed1999

Laparoscopic Heller's cardiomyotomy in achalasia. Is intraoperative endoscopy useful, and why?

BACKGROUND: Inappropriate length of the myotomy incision along the stomach, the most common technical fault during Heller's cardiomyotomy, is related to the difficulty of identifying the gastro-esophageal junction, in particular during laparoscopic surgery. The goal of this study was to evaluate the contribution of endoscopy to gastro-esophageal junction identification during laparoscopic Heller's cardiomyotomy. METHODS: In a group of 19 patients with intraoperative endoscopy with laparoscopic Heller's cardiomyotomy, surgical and endoscopic criteria for gastro-esophageal junction identification have been assessed. Then postoperative results of this group were compared with those of another group of 16 patients previously operated on without intraoperative endoscopy. RESULTS: Endoscopic and laparoscopic criteria for gastro-esophageal junction identification were discordant in 11 patients (11/19, 58%). The cardia was in all these cases at a more distal site with endoscopic criteria. Complications ascribable to suboptimal technique were more frequent in the group without intraoperative endoscopy (7/16 patients) than in the other group (2/19 patients). CONCLUSIONS: Endoscopy during laparoscopic Heller's cardiomyotomy is of great assistance in identifying the cardia, and thereby could improve surgical outcomes.

Cardia↗

PubMed2006

Tracheobronchial stenosis: role of virtual endoscopy in diagnosis and follow-up after therapy.

PURPOSE: This study was done to evaluate whether virtual endoscopy can be employed as a preliminary technique to shorten the time required for the subsequent endoscopic procedure and be proposed for treatment planning and, postoperatively, for evaluating response to treatment in patients with cancer or severe stenotic lesions. MATERIALS AND METHODS: From December 2004 to October 2005, 25 patients with suspected obstructive tracheobronchial stenosis were studied by contrast-enhanced computed tomography (CT) with multiplanar reconstruction (MPR) and virtual bronchoscopic navigation, after a preliminary clinical and conventional radiology assessment. RESULTS: Quality of the virtual endoscopy images was excellent in all cases. Out of the 25 patients, four were affected by benign lesions and 21 by malignant lesions. With regard to lesion site, virtual endoscopy proved to be as informative as real endoscopy. The virtual endoscope was able to cross severe stenoses with a residual lumen of 3 mm. Follow-up studies were performed in 15 patients treated with laser and cryotherapy. In all cases, evaluation of the degree of post-treatment stenosis was similar to that obtained with conventional endoscopy. CONCLUSIONS: Our study indicates that virtual bronchoscopy has a high diagnostic potential. The technique, with the integration of MPR images, can be proposed as a preliminary study to obtain accurate characterisation of stenoses, to shorten the time required for the subsequent endoscopic procedure and to plan the most appropriate treatment.

Aged↗

PubMed2007

Factors associated with myocardial infarction after emergency endoscopy for upper gastrointestinal bleeding in high-risk patients: a prospective observational study.

BACKGROUND: Because myocardial infarction (MI) after emergency endoscopy for upper gastrointestinal bleeding carries high mortality, we investigated factors associated with procedure-related MI in high-risk patients. METHODS: Consecutive patients with coronary artery disease or age-based risk for coronary artery disease (men, age >45 years; women, >55 years) who underwent emergency endoscopy were enrolled at a single ED. Demographic, laboratory, and outcome data were recorded. Patients fit 1 of 3 groups: MI before endoscopy (pre-panendoscopy [PES] MI), MI after endoscopy (post-PES MI), or non-MI. RESULTS: We enrolled 108 high-risk patients, including 5 (4.6%) with MI diagnosed preendoscopy. Five patients (4.6%) had MIs postendoscopy. Compared with non-MI patients, significantly more post-PES MI patients had heart disease (60.0% vs 12.2%; P = .021), lower systolic pressure on arrival (86.2 +/- 16.6 vs 128.0 +/- 27.2 mm Hg; P = .002), lower diastolic pressure on arrival (50.0 +/- 6.3 vs 69.5 +/- 15.8 mm Hg; P = .003), lower hemoglobin on arrival (6.7 +/- 1.1 vs 9.1 +/- 2.4 g/dL; P = .021), and more persistent shock status preendoscopy (80.0% vs 13.3%; P = .002). There was no significant difference in factors including duration of procedure and rates of recurrent bleeding, postprocedure complication, and mortality. CONCLUSIONS: Heart disease, lower blood pressure or hemoglobin level on arrival, and persistent shock before endoscopy are associated with increased risk for procedure-related MI.

Aged↗

PubMed2005

Economic evaluation of a randomized trial comparing Helicobacter pylori test-and-treat and prompt endoscopy strategies for managing dyspepsia in a primary-care setting.

BACKGROUND: In western European countries, most dyspeptic patients are initially managed by their general practitioners (GPs), who use a range of strategies to manage dyspepsia. We performed an economic analysis of a Helicobacter pylori test-and-treat strategy versus a prompt endoscopy approach in a primary care setting. METHODS: Data were used from the Strategy: Endoscopy versus Serology (SENSE) study, performed in The Netherlands from 1998 to 2001. Patients were randomized to a prompt endoscopy (n = 105) or test-and-treat (n = 118) group. Follow-up lasted 1 year. Adverse events were not recorded in the SENSE study. Health care costs were based on the total amount of dyspepsia-related drugs used, the number of dyspepsia-related GP visits, the number of diagnostic tests, and the number of dyspepsia-related referrals to specialists. The use of medical resources was calculated as standardized costs for 1999, recorded as euros. (On December 31, 1999, 1.00 Euro = 1.00 US dollar.) Quality of life was measured at inclusion and 1 year later, using the RAND-36 questionnaire. To calculate quality-adjusted life-years (QALYs), we transformed the individual scores of the RAND-36 into 1 overall score, the Health Utilities Index Mark 2, which introduced a limitation to the study. An incremental cost-effectiveness ratio (ICER) was calculated. The 95% confidence limits were calculated using a parametric bootstrap method with angular transformation. All cost data were analyzed from a third-party payer perspective. RESULTS: The total costs per patient were 511 Euros, with 0.037 QALY gained per patient, in the test-and-treat group, and 748 Euros, with 0.032 QALY gained per patient, in the endoscopy group (between groups, P < 0.001 and P = NS, respectively). The point estimate of the ICER indicated that the test-and-treat strategy yielded cost savings and QALYs gained. Parametric bootstrap confidence limits indicated cost savings per QALY gained in 75.7% of the bootstrap simulations. CONCLUSION: This analysis of data from the SENSE1026 study suggests that the H pylori test-and-treat strategy was more cost-effective than prompt endoscopy in the initial management of dyspepsia in general practice, from the perspective of a third-party payer.

Adult↗

PubMed2005

Lugol chromoendoscopy as a diagnostic tool in so-called endoscopy-negative GERD.

BACKGROUND: Esophageal mucosal breaks are found in less than half of patients with typical reflux symptom. Thus, endoscopy appears to be an insensitive test for GERD. Lugol chromoendoscopy has been used to detect early esophageal cancer, which is difficult to recognize by routine observation without dye staining. The aim of this study was to determine the efficacy of Lugol chromoendoscopy in the diagnosis of so-called endoscopy-negative GERD (ENRD). METHODS: The study was conducted with 61 patients (21 women; mean age of 59.8 years) with reflux symptoms and 42 controls (15 women; mean age, 65.0 years). In the absence of any esophageal mucosal abnormalities at conventional endoscopy, Lugol's iodine solution was sprayed onto the esophageal surface, followed by evaluation of the staining pattern. When Lugol-unstained streaks were observed at chromoendoscopy, biopsy specimens were obtained from unstained streaks and from adjacent stained mucosa. Histologic evaluation included basal cell hyperplasia, papillary length, and cellular infiltration. RESULTS: Twenty-two (36%) of 61 patients with reflux, and 4 (10%) of 42 controls had visible esophagitis by conventional endoscopy. Lugol chromoendoscopy was performed in the remaining 39 patients and 38 controls. The entire esophageal mucosa was uniformly stained dark brown in 20 patients with reflux and 37 controls. In the remaining 19 patients with reflux and in one control, several unstained streaks were observed in the distal esophagus (p < 0.0001). Histologically, Lugol-unstained mucosa showed a significantly thicker basal cell layer (30.9% +/- 7.6% vs. 12.3% +/- 4.5% of total epithelial thickness, mean +/- standard deviation [SD], p < 0.01) and longer papillae (57.9% +/- 12.6% vs. 38.1% +/- 12.6% of total epithelial thickness, mean [SD], p < 0.01) compared with stained mucosa. In addition, infiltration of lymphocytes in the epithelium was significantly increased in unstained mucosa than in stained mucosa (p < 0.01). CONCLUSIONS: Visible unstained streaks by Lugol chromoendoscopy seem to be indicative of mucosal injury, which was not detectable by conventional endoscopy. Lugol chromoendoscopy is simple and could be useful for the diagnosis of ENRD. This method could be appealing for the endoscopist as it is easy, safe, and can be performed at the same endoscopic session.

Aged↗