Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Endoscopes”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 703 records · Page 39Linked to original sources
PubMed1998

Contrast-enhanced endoscopic ultrasonography in gallbladder diseases.

BACKGROUND: The purpose of this study was to investigate the usefulness of contrast-enhanced endoscopic ultrasonography in gallbladder diseases. METHODS: Subjects were 38 patients including 12 with adenocarcinoma, 2 adenosquamous carcinoma, 6 cholesterol polyp, 10 cholecystitis, and 8 adenomyomatosis. After endoscopic ultrasonography, sonicated albumin was intravenously injected and the enhanced effect on images of these lesions was determined. For malignancies we compared diagnostic accuracy (T factor, TNM classification) of endoscopic ultrasonography and contrast-enhanced endoscopic ultrasonography. Vascularity as shown by contrast-enhanced endoscopic ultrasonography and angiograms was compared. RESULTS: Enhancement was observed in 11 patients with adenocarcinoma but not of those with adenosquamous carcinoma or cholesterol polyp. Angiography provided hypervascular images for all cases of adenocarcinoma, but all other lesions were hypovascular. In one case of adenocarcinoma, 3 cases of adenomyomatosis, and 8 cases of cholecystitis, there was a discrepancy between contrast-enhanced endoscopic ultrasonography images and angiograms with regard to vascularity. The accuracy of depth of tumor invasion for endoscopic ultrasonography was 78.6% (11 of 14) versus 92.9% (13 of 14) for contrast-enhanced endoscopic ultrasonography. CONCLUSION: Contrast-enhanced endoscopic ultrasonography is useful in the diagnosis of gallbladder lesions.

Adenocarcinoma↗
PubMed1994

Endoscopic treatment of major bleeding from advanced gastroduodenal malignant lesions.

OBJECTIVE: To summarize the results of endoscopic therapy for acute hemorrhage from gastroduodenal malignant lesions. DESIGN: The 3-year experience (1989 through 1991) of a specialized gastrointestinal (GI) bleeding team in the endoscopic treatment of acute upper GI bleeding from gastroduodenal malignant tumors was retrospectively reviewed. MATERIAL AND METHODS: Of 1,083 consecutive patients with acute major upper GI hemorrhage, 21 (1.9%) were found to have advanced tumors of the stomach and duodenum, 15 of whom received endoscopic therapy. In this study group of 15 patients, the tumors were gastric in 11 and duodenal in 4. Endoscopic treatment consisted of injection of epinephrine, heater probe coagulation, neodymium:yttrium-aluminum-garnet laser coagulation, or injection of sodium tetradecyl sulfate. RESULTS: Initial endoscopic hemostasis was achieved in 10 of the 15 patients (67%); however, bleeding recurred in 8 of 10 (80%), and all 5 in whom endoscopic hemostasis was not achieved continued to bleed. Mean transfusion requirements for the 30 days before and the 30 days after the first endoscopic treatment were 7.6 and 6.4 units of packed erythrocytes, respectively (P > 0.10). Five major procedure-related complications occurred, two of which were fatal. The median duration of survival after the first endoscopic treatment was 39 days (range, 1 to 1,414). CONCLUSION: In patients with major bleeding from advanced gastroduodenal malignant lesions, endoscopic therapy seems to provide limited benefit.

Acute Disease↗
PubMed2003

Comparison of revision rates following endoscopically versus nonendoscopically placed ventricular shunt catheters.

BACKGROUND: Endoscopic placement of ventriculoperitoneal (VP) shunt catheters in pediatric patients has been increasingly used in an attempt to minimize the unacceptably high rates of revision. Although this procedure carries an increased expense, there is currently no evidence to support an improved long-term outcome. This paper compares the rates of revision following ventricular catheter placement for shunted hydrocephalus with and without the use of endoscopy. METHODS: We retrospectively reviewed the records of all pediatric patients who had undergone shunt placement for hydrocephalus between April 1992 and February 1998. All shunts placed before March 1995 were performed without the endoscope; all subsequent shunts were placed endoscopically. The independent effect of endoscopic versus nonendoscopic shunt placement on subsequent shunt failure was analyzed via multivariate proportional hazards regression model. Multiple logistic regression analyses were used to determine the independent effect of endoscopic placement on subsequent etiology of failure (infection, proximal obstruction, distal malfunction) in the 511 failing shunts. RESULTS: There were 447 pediatric patients who underwent a total of 965 shunt placements or revisions. Six hundred and five (63%) catheters were placed with the use of the endoscope. Three hundred and sixty (37.3%) were placed without the use of the endoscope. Neuroendoscopy did not independently affect the risk of subsequent shunt failure [Hazard Ratio (95% Confidence Interval) = 1.08 (0.84-1.41)]. Endoscopic placement independently decreased the odds [Odds Ratio (95% Confidence Interval) = 0.56 (0.32-0.93)] of proximal obstruction, increased the odds of distal malfunction [1.52 (1.02-2.72)], and was not associated with infection [1.42 (0.78-2.61)]. CONCLUSIONS: Endoscopic assisted ventricular catheter placement decreased the odds of proximal obstruction but failed to improve overall shunt survival in this 6 year experience.

Cerebral Ventricles↗
PubMed1999

Worst-case soiling levels for patient-used flexible endoscopes before and after cleaning.

BACKGROUND: The soiling levels of patient-used narrow-lumened flexible endoscopes were assessed for bronchoscopes, duodenoscopes, and colonoscopes. The effect of cleaning on the soil composition and concentration was evaluated. DESIGN: Suction channels from 10 each of bronchoscopes, duodenoscopes used for endoscopic retrograde cholangiopancreatography, and colonoscopes were assessed immediately after patient use for the levels of bilirubin, hemoglobin, protein, sodium ion, carbohydrate, endotoxin, and viable bacteria. Another 10 suction channels of each type of endoscope were evaluated for the same components after routine cleaning but before processing by high-level disinfection or sterilization for subsequent clinical use. RESULTS: Recognizing that only soluble components could be quantified, the worst-case soil levels in the suction channels (the average surface area of these channels was 45.6 cm(2), 149.8 cm,(2) and 192.0 cm(2) for bronchoscopes, duodenoscopes, and colonoscopes, respectively) were protein 115 microg/cm(2), sodium ion 7.4 micromol/cm(2), hemoglobin 85 microg/cm(2), bilirubin 299 nmol/cm(2), carbohydrate 29.1 microg/cm(2), endotoxin 9852 endotoxin units/cm(2), and bacteria 7.1 (log(10)) colony-forming units (CFU)/cm(2). Colonoscopes had 4 to 5 times greater soiling on average compared with the other endoscope types. Routine cleaning reduced the levels of bilirubin to below the limits of detection for all endoscopes evaluated (limits of detection were <1 nmol/mL). After cleaning, residual hemoglobin was detectable in bronchoscopes only. After cleaning, the levels of protein, endotoxin, and sodium ion all were reduced fivefold to tenfold for all types of endoscopes. Carbohydrate was reduced to lower than the limit of detection for all endoscopes after cleaning, except the duodenoscopes. The average load of viable bacteria was reduced from 3 log(10) to 5 log(10) CFU/cm(2) (which represents 5.9-9.5 log(10) CFU/endoscope channel) after patient use to approximately 2 log(10) CFU/cm(2) (which represents 3.2-5.3 log(10) CFU/endoscope channel) after cleaning. CONCLUSIONS: These data demonstrated that cleaning effectively reduced or eliminated many components of soil, but a substantial amount of viable bacteria and protein remained. Hemoglobin levels in before samples indicated that blood was not present in high concentrations in the suction channels of the majority of flexible endoscope samples. Soil that mimics the worst-case composition from patient-used endoscopes would be ideal for simulated-use studies for such medical devices.

Bronchoscopes↗
PubMed1997

Endoscopic versus open subfascial division of incompetent perforating veins in the treatment of venous leg ulceration: a randomized trial.

PURPOSE: Subfascial division of incompetent perforating veins plays an important role in the surgical treatment of patients with venous ulceration of the lower leg. To minimize the high incidence of postoperative wound complications after open exploration, endoscopic approaches have recently been developed. We carried out a prospective, randomized comparison of open and endoscopic treatment of these patients that was aimed at ulcer healing and postoperative wound complications. METHODS: Patients with current venous ulceration on the medial side of the lower leg were randomly allocated to open exploration by the modified Linton approach or endoscopic exploration by use of a mediastinoscope. RESULTS: Thirty-nine patients were randomized, 19 to open exploration and 20 to endoscopic exploration. The incidence of wound infections after open exploration was 53%, compared with 0% in the endoscopic group (p < 0.001). Patients in the open group needed longer hospital stays (mean, 7 days; range, 3 to 39 days) than patients in the endoscopic group (mean, 4 days; range, 2 to 6 days; p = 0.001). Four months after operation, the ulcers of 17 patients (90%) in the open group and 17 patients (85%) in the endoscopic group had healed. During a mean follow-up of 21 months (range, 16 to 29 months), no recurrences were noticed in either group. CONCLUSIONS: Endoscopic division of incompetent perforating veins is equally as effective as open surgical exploration for the treatment of venous ulceration of the lower leg but leads to significantly fewer wound healing complications. Endoscopic division is therefore the preferred method.

Adult↗
PubMed2002

Endoscopic markers in adult coeliac disease.

BACKGROUND: Various endoscopic markers have been described in coeliac disease, particularly in the second part of the duodenum, with minor attention generally being paid to the duodenal bulb. AIMS: To evaluate, prospectively, the presence of all endoscopic markers in the bulb and the second part of the duodenum on a large series of patients submitted to endoscopy for duodenal biopsy. PATIENTS AND METHODS. A total of 367 consecutive patients, submitted to endoscopy with duodenal biopsy for various indications, were considered. Biopsies were graded as normal, with partial villous atrophy (mild, moderate, severe) or with subtotal villous atrophy. Endoscopic markers and corresponding locations evaluated were: micronodular pattern [bulb and descending duodenum], mosaic appearance (bulb and descending duodenum), scalloped folds (descending duodenum), reduced or absent folds (descending duodenum). RESULTS: In 78 patients, a diagnosis of untreated coeliac disease was made. Endoscopic markers were seen in 73/78 patients, with only a single sign present (bulb or descending duodenum) in 12 patients. In the remaining 289 patients, normal histology and normal endoscopic findings were observed, except in two patients with reduced folds. Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy regarding all endoscopic markers were 93.6%, 99.3%, 97.3%, 98.3% and 98.1%, respectively CONCLUSIONS: This study confirms the usefulness of endoscopic markers in detecting coeliac disease, underlining the importance of evaluating also abnormalities in the bulb and endoscopic single signs; although endoscopy may not detect all cases of coeliac disease, the recognition of endoscopic markers allows the selection for biopsy of unsuspected patients submitted to endoscopy for non-specific symptoms.

Adolescent↗
PubMed2002

Randomized trial of medical or endoscopic therapy to prevent recurrent ulcer hemorrhage in patients with adherent clots.

BACKGROUND & AIMS: Treatment of high-risk patients with nonbleeding adherent clots on ulcers is controversial. In a previous randomized trial, there was no benefit to endoscopic therapies compared with medical therapy for prevention of ulcer rebleeding. Our purpose was to test the hypothesis that patients treated with combination endoscopic therapy would have significantly lower rebleeding rates than those treated with medical therapy. METHODS: In this randomized, controlled trial, 32 high-risk patients with severe ulcer hemorrhage and nonbleeding adherent clots resistant to target irrigation were randomized to medical therapy or to combination endoscopic therapy (with epinephrine injection, shaving down the clot with cold guillotining, and bipolar coagulation on the underlying stigmata). Physicians blinded to the endoscopic therapy managed all patients. RESULTS: Patients were similar at study entry, except for older age in the medical group and lower platelet count in the endoscopic group. By hospital discharge, significantly more medically treated patients (6/17; 35.3%) than endoscopically treated patients (0/15; 0%) rebled (P = 0.011). There were no complications of endoscopic treatment. CONCLUSIONS: Combination endoscopic therapy of nonbleeding adherent clots significantly reduced early ulcer rebleeding rates in high-risk patients compared with medical therapy alone. This endoscopic treatment was safe.

Aged↗
PubMed2002

Endoscopic features of celiac disease in adults and their correlation with age, histological damage, and clinical form of the disease.

BACKGROUND AND STUDY AIMS: Although earlier studies have focused on endoscopic markers as predictors of celiac disease, there are still no certainties about the value of these markers. The aim of this study was to consider first, specific endoscopic features as predictors of specific histological damage; secondly, whether there is an association between the endoscopic features of celiac disease and the age of patients at the time of diagnosis; and thirdly, whether particular endoscopic features of celiac disease are associated with the clinical form of the disease. PATIENTS AND METHODS: We studied the endoscopic features of celiac disease in 144 consecutive adult patients (52 had the classical form of the disease, 64 the subclinical and 28 the silent form). The histopathological findings were expressed according to the Marsh classification. RESULTS: Slight/mild damage seen at endoscopy was associated with a Marsh II-IIIa grading (P < 0.005), while severe endoscopic damage was related to a Marsh IIIb-IIIc grading (P < 0.0005). Younger patients showed slighter damage at endoscopy (P < 0.001), while older patients showed more severe damage (P < 0.005). Finally, the classical form of celiac disease showed more severe damage at endoscopy, while the subclinical/silent forms of celiac disease showed slighter damage endoscopically (P < 0.001). CONCLUSIONS: This study showed that the endoscopic appearance of the duodenum may be predictive of histological damage grading. Moreover, we showed that in young patients with subclinical/silent celiac disease there is a greater probability of finding slight/mild endoscopic abnormalities associated with slight/mild histological damage.

Adolescent↗
PubMed2005

Utility of colour Doppler endoscopic ultrasound evaluation and guided therapy of submucosal tumours of the upper gastrointestinal tract.

BACKGROUND AND AIMS: Endoscopic ultrasound is considered the method of choice for evaluation of submucosal tumours. Endoscopic therapy of selected lesions represents a useful mini-invasive approach. The aim of this study was to assess the endoscopic management of submucosal tumours of the upper gastrointestinal tract (GIST), with emphasis on the use of colour and power Doppler endoscopic ultrasound. METHODS: The study included 35 consecutive patients referred to endoscopic ultrasound with submucosal tumours of the upper gastrointestinal tract. Colour and power Doppler imaging were performed with radial or linear instruments in all patients and allowed a better characterisation of the submucosal lesions. Histology was obtained in 22 patients and permitted a correct diagnosis, as well as confirmation or exclusion of malignancy. RESULTS: In 18 patients (51.4%) there was discrepancy between the suspected endoscopic diagnosis and the diagnosis made by endoscopic ultrasound. Most of the malignant GISTs had significant intratumoural vessels detected by colour or power Doppler EUS (5 out of 6 patients, 83.3%), as compared with the benign GISTs (2 out of 7 patients, 28.6%). Colour Doppler EUS was essential, both to diagnose and to direct therapy in vascular submucosal lesions (two haemangiomas). The same technique was useful to better characterise lipomas or cysts. CONCLUSIONS: Endoscopic ultrasound management of submucosal tumours was enhanced by the use of colour and power Doppler imaging. A precise management plan, supported by colour and power Doppler findings improved the diagnostic options and increased the feasibility and safety of endoscopic ultrasound guided therapeutic interventions.

Duodenal Neoplasms↗
PubMed2006

Endoscopic necrosectomy as primary therapy in the management of infected pancreatic necrosis.

BACKGROUND AND STUDY AIMS: Open pancreatic necrosectomy is the standard treatment for infected pancreatic necrosis but is associated with significant morbidity, mortality, and prolonged hospital stay. Percutaneous or endoscopic necrosectomy are alternative techniques. We evaluated the use of endoscopic necrosectomy for treatment of patients with necrosis that could be accessed through the posterior wall of the stomach. PATIENTS AND METHODS: We retrospectively analyzed the indication, patient status according to acute physiology and chronic health evaluation (APACHE) 2 severity score, and success of endoscopic necrosectomy as primary treatment, in selected patients with localized infected pancreatic necrosis, who presented between May 2002 and October 2004. After the necrosis cavity had been accessed, with the assistance of endoscopic ultrasound, a large orifice was created and necrotic debris was removed using endoscopic accessories under radiological control. Follow-up was clinical and radiological. RESULTS: 13 patients (nine men, four women, mean age 53 years), 11 with positive bacteriology, underwent attempted endoscopic necrosectomy. Median APACHE 2 score on presentation was 8 (range 1-18). Four patients needed intensive therapy unit care and one other patient required (nonventilatory) high-dependency unit care only. Necrosis was successfully treated endoscopically in 12 patients, requiring a mean of 4 endoscopic interventions (range 1-10); one patient required open surgery; two underwent additional percutaneous necrosectomy and one required laparoscopic drainage. Two patients died of complications unrelated to the procedure. The 11 survivors have a median (range) follow-up of 16 (6-38) months. CONCLUSION: Endoscopic necrosectomy is a safe method for treatment of infected pancreatic necrosis. Multiple procedures are usually needed. It may be combined with other methods of surgical intervention. Larger prospective studies will more precisely define its role.

Adult↗
PubMed2005

Comparing endoscopic systems on two simulated tasks.

Endoscopes are slender instruments for performing medical procedures through small incisions or natural body orifices. Three experiments examined the performance effects of various endoscope systems when naive participants executed tasks in a bladder-like environment. The systems involved a direct endoscope, requiring the user to look through a lens at the outer part of the endoscope, and a video endoscope that picks up the image via a camera attached to the endoscope and displays it on a video monitor. The results indicate that the participants performed the tasks better with video than with direct endoscopes, and showed more transfer of practice with video endoscopic surgery from a small to a large task environment than vice versa. The optimal position of the monitor with video endoscopic surgery appeared to involve a reasonable angle relative to the operating area (45 degrees was used). Performance was less at a greater angle (90 degrees), but also at a small angle (10 degrees). It did not matter whether the monitor was located left, right or above the operating area. As performance did not fully transfer to differently sized task environments, endoscopists should initially train with task environments of different, and especially small, sizes.

Adult↗
PubMed2003

Endoscopic therapeutic esophageal interventions: old, new, borrowed and . . . methylene blue?

PURPOSE OF REVIEW: Endoscopic interventions in the esophagus continue to evolve. This article reviews some of the notable advances over the past year in endoscopic therapy for the esophagus. RECENT FINDINGS: In 2002 several endoscopic therapies were reintroduced or modified. Ablative treatments, including Nd:YAG laser, photodynamic therapy, and thermal contact treatments have been shown to be effective for Barrett esophagus and some early esophageal cancers. The addition of endoscopic mucosal resection may improve these therapies. Endoscopic stenting remains the dominant endoscopic palliative modality for unresectable esophageal cancers, and modifications of this therapy have focused on reducing side effects and complications. Innovations in endoscopic treatments for strictures and bleeding esophageal varices have been proposed and may improve outcomes, although probably only marginally. Additional endoscopic antireflux procedures have been introduced, although the results of long-term studies still need to be published before their place in the treatment of gastroesophageal reflux disease can be determined. SUMMARY: Rather than heralding novel endoscopic therapeutics, 2002 was a year of retooling and refining existing techniques.

Journal Article↗
PubMed2003

Results of Caldwell-Luc after failed endoscopic middle meatus antrostomy in patients with chronic sinusitis.

OBJECTIVES/HYPOTHESIS: The Caldwell-Luc operation for treatment of medically refractory chronic maxillary sinusitis has largely been replaced by functional endoscopic sinus surgery. Despite this change, the Caldwell-Luc procedure still has well documented indications including treatment of both failed endoscopic middle meatus antrostomy and irreversible mucosal changes. The purpose of the study was to review the authors' experience and results of Caldwell-Luc procedure after failed endoscopic middle meatus antrostomy in patients clinically deemed to have irreversible mucosal changes. STUDY DESIGN: Retrospective review of preoperative and postoperative results of patients who underwent Caldwell-Luc procedure for refractory chronic maxillary sinusitis after failed endoscopic middle meatus antrostomy. METHODS: The preoperative and postoperative clinical course of patients treated with Caldwell-Luc procedure performed by a single surgeon between 1996 and 2001 were reviewed. Only patients with a history of chronic sinusitis after failed maximal medical therapy, no prior Caldwell-Luc procedure, prior endoscopic middle meatus antrostomy, and at least 6 months of follow-up were included. Outcome measurements including documented endoscopic examinations and the need for repeat surgery, and postoperative computed tomography scan results were evaluated to assess treatment success. RESULTS: The study involved 11 men and 26 women who underwent 50 Caldwell-Luc procedures. Caldwell-Luc procedure was performed bilaterally in 13 patients. The average number of prior endoscopic middle meatus antrostomies before Caldwell-Luc procedure was 2. Of all patients, 92% responded to surgical treatment as demonstrated by an endoscopic examination or computed tomography scan revealing a disease-free maxillary sinus. Repeat Caldwell-Luc procedure was required in 8.0% (n = 3) because of continued sinusitis. Two of the three cases with repeat Caldwell-Luc procedures demonstrated clinical improvement during follow-up. Average follow-up was 23.5 months. CONCLUSION: Caldwell-Luc procedure seems to be highly effective in the management of medically refractory chronic sinusitis after failed endoscopic middle meatus antrostomy. Caldwell-Luc procedure should remain in the otolaryngologist's surgical repertoire for these selected cases.

Chronic Disease↗
PubMed2002

Endoscope-assisted microsurgery for intracranial aneurysms.

OBJECTIVE: We discuss the role of the endoscope in the microsurgical treatment of intracranial aneurysms, analyzing its benefits, risks, and disadvantages. METHODS: This was a prospective study of 55 patients with 79 aneurysms, treated between July 1998 and June 2001, for whom the endoscope was used as an adjunct in the microsurgical treatment of their lesions. Seventy-one aneurysms were located in the anterior circulation, and eight were located in the posterior circulation. Thirty-seven patients presented with subarachnoid hemorrhage. Eighteen patients had unruptured aneurysms, of whom 5 presented with mass effect, 2 presented with transient ischemic attacks, and 11 were without symptoms. In all cases, the endoscope was used in addition to microsurgical dissection and clipping (sometimes before clipping, sometimes during clipping, and always after clipping), for observation of the neck anatomic features and perforators and verification of the optimal clip position. Intraoperative angiography was performed for all patients after aneurysm clipping. RESULTS: In the majority of cases, the endoscope was very useful for the assessment of regional anatomic features. It allowed better observation of anatomic features, compared with the microscope, for 26 aneurysms; in 15 cases, pertinent anatomic information could be obtained only with the endoscope. The duration of temporary clipping of the parent artery was significantly reduced for two patients. The clip was repositioned because of a residual neck or inclusion of the parent vessel during aneurysm clipping in six cases, and the clip position was readjusted because of compression of the optic nerve in one case. One patient experienced a small aneurysm rupture that was directly related to use of the endoscope, but this was easily controlled, with no sequelae. For many patients, the combination of the neuro-endoscope and the micro-Doppler probe made intraoperative angiography redundant. CONCLUSION: "Endoscope-assisted microsurgery" is a major advance in the microsurgical treatment of intracranial aneurysms; the endoscope allows better observation of regional anatomic features because of its magnification, illumination, and ability to "look around corners."

Adult↗
PubMed2004

The role of endoscopic treatment of vesicoureteral reflux: a 17-year experience.

PURPOSE: During the last 20 years endoscopic treatment of vesicoureteral reflux (VUR) has gained popularity in European countries. We performed a retrospective analysis of our 17-year experience with more than 1,000 patients treated to assess whether technique, indications or results of endoscopic treatment of VUR have changed over time. MATERIALS AND METHODS: From January 1986 to June 2002, 1,244 patients underwent endoscopic treatment for grades II to IV VUR. Polytetrafluoroethylene was injected as the bulking material in the first 14 cases, after 1989 bovine cross-linked collagen was used in 442 and since 1995 dextranomer/hyaluronic acid copolymer was used in 788. Urinary tract ultrasound was performed 1 and 6 months, and micturition cystourethrogram was done 3 and 12 months after endoscopic treatment. All patients included in the study completed a minimum 12-month followup. RESULTS: Endoscopic treatment was always performed in 1 day. Complications were observed in 0.5% of cases. After 1 or 2 injections the micturition cystourethrogram showed no significant VUR (absent or grade I) in 77% of cases. The success rate was 88%, 75% and 52% for grades II, III and IV VUR, respectively. With increasing experience not only primary VUR, but also secondary reflux was considered eligible for endoscopic treatment, and the number of grade IV VUR cases treated by endoscopy also increased. The presence of voiding dysfunction was identified as a limiting factor in the success of endoscopic treatment. CONCLUSIONS: The short hospital stay, acceptable success rate and absence of significant complications prompt us to consider endoscopic treatment as first choice treatment of VUR rather than long-term prophylaxis and open surgery. Even grade IV VUR and VUR in complex anatomical situations can be successfully treated by endoscopy. Patients with voiding dysfunction should be identified and adequately treated before any endoscopic attempt.

Adolescent↗
PubMed2006

Endoscopic resection of early gastric cancer: the Japanese perspective.

PURPOSE OF REVIEW: To examine recent advances in the techniques and technologies of endoscopic resection of early gastric cancer. RECENT FINDINGS: Endoscopic mucosal resection of early gastric cancer with no risk of lymph node metastasis has been a standard technique in Japan and is increasingly becoming accepted and regularly used in Western countries. Though this minimally invasive technique is a safe, convenient and efficacious method, it is insufficient for larger lesions. Difficulties in correctly assessing the depth of tumour invasion and increases in local recurrence by standard endoscopic mucosal resection have been reported in lesions larger than 15 mm. This is because such lesions are often resected piecemeal due to the technical limitation of standard endoscopic mucosal resection. New developments in endoscopic resection techniques to dissect the submucosa directly, called endoscopic submucosal dissection, allows resections of larger lesions en bloc. There are no limitations in resection size in endoscopic submucosal dissection, which is expected to replace surgery. This technique, however, still has higher complications rates than standard endoscopic mucosal resection and requires highly skilled endoscopists. SUMMARY: The techniques, indications, and pathological assessment methods of endoscopic resection of early gastric cancer are described so that proper treatment guidelines can be established and long-term outcome data can be assessed.

Adenocarcinoma↗
PubMed2005

Meta-analysis: endoscopic variceal ligation for primary prophylaxis of oesophageal variceal bleeding.

BACKGROUND: The treatment effects of primary prophylactic endoscopic variceal ligation are unclear. AIM: To compare the treatment effects of endoscopic variceal ligation and beta-blockers for primary prophylaxis of oesophageal variceal bleeding. In addition, a subgroup analysis was done with the purpose to delineate differences in the effects of intervention that were biologically based. METHODS: We performed a literature search for randomized controlled trials, which compared the treatment effects of endoscopic variceal ligation with beta-blockers for primary prophylaxis of oesophageal variceal bleeding. Of the 955 articles screened, eight randomized-controlled trials including 596 subjects (285 with endoscopic variceal ligation and 311 with beta-blockers) were analysed. Outcomes measures evaluated were first gastrointestinal bleed, first variceal bleed, all-cause deaths, bleed-related deaths and severe adverse events. The measure of association employed was relative risk; with heterogeneity and sensitivity analyses. RESULTS: Variceal obliteration was obtained in 261 (91.6%) patients and target beta-blockers therapy was achieved in 294 (94.5%) patients (P = 0.19). Endoscopic variceal ligation compared with beta-blockers significantly reduced rates of first gastrointestinal bleed by 31% (RR, 0.69; 95% CI: 0.49-0.96; P = 0.03; NNTB = 15) and first variceal bleed by 43% (RR, 0.57; 95% CI: 0.38-0.85; P = 0.0067; NNTB = 11). All-cause deaths and bleed-related deaths were unaffected (RR, 1.03; 95% CI: 0.79-1.36; P = 0.81 and RR, 0.84; 95% CI: 0.44-1.61; P = 0.60 respectively). Severe adverse events were significantly less in endoscopic variceal ligation compared with beta-blockers (RR, 0.34; 95% CI: 0.17-0.69; P = 0.0024; NNTB = 28). Sensitivity analysis of five trials published in peer review journals and four trials with high quality showed results similar to those seen in the primary analysis of all the eight trials, confirming stability of conclusions. Following variceal obliteration with endoscopic variceal ligation, oesophageal varices recurred in 83 (29.1%) patients. Seven (28.1%) patients bled with one fatal outcome. In subgroup analyses, endoscopic variceal ligation had significant advantage compared wtih beta-blockers in trials including < or =30% patients with alcoholic cirrhosis, >30% patients with Child Class C cirrhosis and >50% patients with large varices. CONCLUSIONS: In patients with cirrhosis with moderate to large varices and who have not bled, endoscopic varices ligation compared with beta-blockers significantly reduced bleeding episodes and severe adverse events, but had no effect on mortality.

Adrenergic beta-Antagonists↗
PubMed1997

Endoscopic management of acute calculous cholangitis.

Acute cholangitis is associated with significant morbidity and mortality. Endoscopic drainage procedures have been shown to be a safe and effective mode of treatment in acute cholangitis. As there is paucity of large series on endoscopic management of acute cholangitis, a study was performed to evaluate safety and efficiency of endoscopic biliary decompression in acute cholangitis. The study included 89 consecutive patients (mean age 55+/-15 years; range 35-70 years; 50 males) with acute cholangitis requiring biliary drainage. Main presenting features were upper abdominal pain (84%), fever with chills (90%) and jaundice (74%). Altered sensorium, hypotension, features of peritonitis and acute renal failure were present in 15, 11, 18 and 5%, respectively. Endoscopic procedures performed were endoscopic sphincterotomy (ES) with stone extraction (n=40); ES with endoscopic nasobiliary drainage (ENBD; n=30); ENBD without ES (n=8); and ES with stent placement (n=11). Of the 89 patients, 85 (95%) responded within 48-72 h. Endoscopic common duct clearance could be achieved in 58 of 78 (74%) patients, whereas in 11 patients undergoing stent placement, stone extraction was not attempted. Complications included post-sphincterotomy bleed (n=2), retroduodenal perforation (n=1) and acute pancreatitis (n=1) with an overall complication rate of 4.4%. All the complications were seen in patients undergoing ES with stone extraction. Mortality was 3.3%. In conclusion, endoscopic biliary drainage is a safe and effective mode of treatment for acute cholangitis. Endoscopic nasobiliary drainage or stent placement is safer than ES in acute cholangitis as an initial step.

Acute Disease↗