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At least 73 records · Page 4Linked to original sources
PubMed2002

Scorecard endoscopy: a pilot study to assess basic skills in trainees for upper gastrointestinal endoscopy.

BACKGROUND: The development of training models and structured training courses for endoscopic techniques provides practical experience. To assess individual performance and progress in this training we developed and tested a scorecard system. METHODS: Three test groups were compared: group 1, ten physicians without previous endoscopic experience; group 2, ten students, without endoscopic experience; group 3, a control group of experienced endoscopists. Groups 1 and 2 underwent 1 week of training with a theoretical introduction and practical demonstrations. They were assessed by the scorecard daily by an experienced tutor. The individual scores and learning curves of the two beginner groups were compared with those of the expert group using a biosimulation model was used. RESULTS: Each participant improved significantly during the 1-week course. Mean scores on the first day in groups 1-3 were, respectively, 26.7+/-10.7, 33.4+/-5.3, and 72.0+/-5.8, and on day 6 they were 62.2+/-6.6, 63.4+/-7.6, and 86.6+/-4.3. The difference between group 3 and the other two groups was significant but not that between groups 1 and 2. CONCLUSIONS: Training in endoscopy can be assessed using our training model and our scorecard protocol, which distinguishes between various levels of experience. In physicians beginning in the field of gastrointestinal endoscopy this approach could help to reduce risks to patients, shorten learning curves, and exclude unskilled individuals from further fruitless interventions.

Animals↗
PubMed2005

A survey of open-access endoscopy in primary health care centres: outcome of gastric carcinoma patients diagnosed by general practitioners compared with hospital-referred endoscopy.

BACKGROUND: We examined open-access endoscopy service based on general practitioner endoscopists. METHODS: We compared the survival of the gastric carcinoma patients originally diagnosed in health care centres by general practitioner endoscopists and hospital outpatient clinic by specialists. RESULTS: A total of 159 gastric carcinoma cases diagnosed during 1996-2000 were included in to the present study. Of them, 58% (N = 92) and 42% (N = 67) were detected by general practitioners and specialists, respectively. We observed no difference in the mean age of patients (71.3 years versus 71.4 years, p = 0.97) and stage of tumours [15% (N = 14) versus 21% localised tumours (N = 14, p = 0.30)] between cases diagnosed by general practitioners and specialists. The number of patients who underwent radical extirpation were 14% (N = 13) and 19% (N = 13, p = 0.38), respectively. After a minimum follow-up of 3.5 years, 29 patients (18%) were alive. The mean survival time of hospital-diagnosed carcinoma patients was longer (23.6 months versus 18.7 months, p = 0.23). Eight patients had undergone hospital-referred gastroscopy less than 3 years before cancer diagnosis. In multivariate analysis, radical extirpation of carcinoma (odds ratio 0.11, 95% confidence interval 0.04-0.28) predicted survival; whereas age (odds ratio 1.03 per year, 95% confidence interval 0.99-1.07 per year), female sex (odds ratio 1.785, 95% confidence interval 0.71-4.81) and the open-access endoscopy based on general practitioner endoscopists (odds ratio 1.48, 95% confidence interval 0.60-3.65) predicted neither survival nor carcinoma-related death. CONCLUSION: No significant difference was detected in the outcome of gastric cancer patients diagnosed in primary care centres by general practitioner endoscopists and in hospital outpatient clinic by specialists.

Aged↗
PubMed2005

Training with the compactEASIE biologic endoscopy simulator significantly improves hemostatic technical skill of gastroenterology fellows: a randomized controlled comparison with clinical endoscopy training alone.

BACKGROUND: The Erlangen Active Simulator for Interventional Endoscopy (EASIE) was introduced in 1997 for interventional endoscopy training. compactEASIE developed in 1998 is a modified, light-weight version of the original model. Objective evidence of the benefits of training with these models is limited. A randomized controlled study, therefore, was conducted to compare the effects of intensive 7-month, hands-on training in hemostatic techniques by using the compactEASIE model (in addition to clinical endoscopic training) vs. pure clinical training in endoscopic hemostatic methods. METHODS: Thirty-seven fellows in gastroenterology in New York City area training programs were enrolled. Baseline skills were assessed on the simulator for the following techniques: manual skills, injection and electrocoagulation, hemoclip application, and variceal ligation. Twenty-eight fellows were then randomized into two comparable groups. Those randomized to Group A received purely clinical training in endoscopic hemostatic techniques at their hospitals. Those in Group B, in addition, were trained by experienced tutors in 3 full-day hemostasis workshops over 7 months. Both groups underwent a final evaluation on the compactEASIE simulator conducted by their tutors and additional evaluators who were blinded to the method of training. Initial and final evaluation scores were compared for each group and between groups. Outcomes of actual clinical hemostatic procedures performed during the study period also were analyzed. RESULTS: Ten of 14 fellows randomized to Group A (standard training) and 13 of 14 in Group B (intensive training) returned for the final evaluation. For Group B, scores for all techniques were significantly improved. In Group A, a significant improvement was noted for variceal ligation alone. CONCLUSIONS: compactEASIE simulator training (3 sessions over 7 months), together with clinical endoscopic training resulted in objective improvement in the performance by fellows of all 4 endoscopic hemostatic techniques, whereas significant improvement was noted for variceal ligation alone for fellows who had standard clinical training. In clinical practice, fellows who had intensive simulator/clinical training had a significantly higher success rate and a nonsignificant reduction in the frequency of occurrence of complications.

Animals↗
PubMed1995

Antibiotic prophylaxis for gastrointestinal endoscopy. American Society for Gastrointestinal Endoscopy.

This is one of a series of statements discussing the practice of gastrointestinal endoscopy in common clinical situations. It is intended to aid endoscopists in determining the appropriate use of antibiotic prophylaxis for patients undergoing gastrointestinal endoscopic procedures. Guidelines for the appropriate practice of endoscopy are based on a critical review of the available data and expert consensus. Controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data appear. Clinical consideration may justify a course of action at variance from these recommendations. Recommendations on prophylaxis against infective endocarditis were developed in conjunction with the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease of the Council of Cardiovascular Disease in the Young of the American Heart Association.

Antibiotic Prophylaxis↗
PubMedDate not supplied

Mini doctors or advanced nurse practitioners?: Irish endoscopy nurses' perceptions regarding the development of advanced practice in endoscopy.

Advanced nurse practitioners are frequently perceived as "mini doctors," concerned more with the biomedical and technical aspects of healthcare than with the holistic, psychological elements. With an interest in advanced practice roles within the Irish context, a questionnaire designed to examine nurses' perceptions was administered to a convenience sample of 70 endoscopy nurses from six urban endoscopy departments. Findings indicate these nurses are generally positive in their attitudes, but they have concerns about the perceived increased vulnerability to litigation, exploitation, and fragmentation of their nursing role. On the basis of the findings of this study, a number of recommendations are made in relation to ensuring professional and educational support systems are in place for nurses as they develop their clinical practice.

Attitude of Health Personnel↗
PubMed2005

A prospective study of the diagnostic accuracy of PillCam ESO esophageal capsule endoscopy versus conventional upper endoscopy in patients with chronic gastroesophageal reflux diseases.

INTRODUCTION: Endoscopy is commonly performed to evaluate for suspected or established esophageal diseases including gastroesophageal reflux disease (GERD) and its complications. The newly developed PillCam ESO Esophageal Capsule offers an alternative approach to visualize the esophagus and to evaluate patients with suspected esophageal disease. AIM: Compare the accuracy (specificity, sensitivity, positive predictive value [PPV], and negative predictive value [NPV]) of esophageal capsule endoscopy (ECE) compared with esophagogastroduodenoscopy (EGD) in evaluating patients with GERD. METHODS: A multicenter pivotal trial was conducted at seven sites. The PillCam ESO esophageal capsule is similar to the standard capsule endoscope used for the small bowel but acquires video images from both ends of the device at 2 frames/second/end. A total of 106 patients (93 GERD; 13 Barrett) underwent ECE followed by EGD. ECE videos were evaluated by an investigator blinded to EGD findings. A blinded adjudication committee reviewed all discrepant findings between ECE and EGD. RESULTS: Sixty-six of 106 patients had positive esophageal findings, ECE identified esophageal abnormalities in 61 (sensitivity, 92%; specificity, 95%). The per-protocol sensitivity, specificity, PPV, and NPV of ECE for Barrett esophagus were 97%, 99%, 97%, and 99%, respectively, and for esophagitis 89%, 99%, 97%, and 94%, respectively. ECE was preferred over EGD by all patients. There were no adverse events related to ECE. CONCLUSIONS: ECE is a convenient and sensitive method for visualization of esophageal mucosal pathology and may provide an effective method to evaluate patients for esophageal disease.

Endoscopy, Gastrointestinal↗
PubMed2003

Magnification endoscopy, high resolution endoscopy, and chromoscopy; towards a better optical diagnosis.

In the past few years, optical magnification endoscopy and chromoscopy have gained renewed interest in the West as a means for the early detection of minute lesions in patients with Barrett's oesophagus and in patients referred for colonic cancer screening. In Barrett's oesophagus, the vast majority of data on the use of chromoscopy deals with the application of methylene blue. Conventional videoendoscopy in combination with methylene blue staining improves the detection of Barrett's mucosa. A correlation has been shown between variation and intensity of staining and histologically verified stages of dysplasia or cancer. Magnification endoscopy and chromoscopy improve the detection of colonic non-polypoid lesions associated with neoplasia and carcinoma. Pitt pattern analysis enables the distinction of non-neoplastic non-polypoid lesions (type I and II) from neoplastic type non-polypoid lesions (type III-V) with great accuracy. It is certain that "old fashioned" chromoscopy combined with advanced endoscopic technology carry a great diagnostic potential and should be further put to the test for use in daily clinical practice.

Barrett Esophagus↗
PubMed2005

Capsule endoscopy of the upper gastrointestinal tract -- the need for a second endoscopy.

BACKGROUND AND AIMS: Capsule endoscopy (CE) has been recognised as an important investigational tool in the diagnosis of gastrointestinal disease. Studies have shown that CE can identify lesions in the upper gastrointestinal tract as well as in the small intestine. However, contrary to conventional oesophagogastroscopy results, the role of CE findings in the diagnostic algorithm of disorders such as gastrointestinal bleeding has not been well understood. We evaluated the frequency of lesions identified in the oesophagus and the stomach as well as their significance. METHODS: We retrospectively evaluated patients who had undergone video CE over the last 2 years at our institution. Indication and findings in the oesophagus and the stomach were analysed and compared to previous oesophagogastroscopy findings. Patients in whom lesions were identified were followed up retrospectively for the significance of these findings. RESULTS: 95 patients were included in the analysis (47 males, 48 females, mean +/- SD age of 54.62 +/- 19.2 years). The commonest indication for CE was gastrointestinal bleeding (45%), the second commonest anaemia (28%). CE identified significant lesions in the stomach of 11/95 (11.57%) patients. These lesions had been overlooked in 9/95 (9%) of patients by conventional oesophagogastroscopy prior to CE examination (p value < 0.05). Eight of 95 (8%) patients had oesophageal abnormalities detected by CE. The diagnosis changed the treatment of 8/11 (82%) patients with significant lesions. CONCLUSIONS: CE has an undefined role in evaluating upper gastrointestinal lesions. Significant lesions missed at oesophagogastroscopy were identified during CE examination. This study underpins the importance of a second conventional endoscopy in the diagnostic algorithm.

Endoscopy, Gastrointestinal↗
PubMed1980

"Skinny" upper gastrointestinal endoscopy--the initial diagnostic tool: a prospective comparison of upper gastrointestinal endoscopy and radiology.

One hundred twenty-five patients were prospectively evaluated with upper gastrointestinal "skinny" endoscopy and radiology. Seventy-five patients underwent endoscopic examination before barium studies, whereas 50 patients underwent radiologic examination before endoscopy. If superficial mucosal erosions are eliminated, the areas of greatest disagreement occurred in the postoperative stomach, the deformed antrum, and the deformed duodenal bulb. We conclude that 1) a barium meal is not a prerequisite to a complete endoscopic examination by a trained endoscopist, 2) a barium meal following an adequate endoscopic examination usually adds little new information, and 3) "skinny" endoscopic examination can be utilized as the initial and usually the only diagnostic test in most patients with upper gastrointestinal symptoms.

Barium Sulfate↗
PubMed1997

Overuse of upper gastrointestinal endoscopy in a country with open-access endoscopy: a prospective study in primary care.

BACKGROUND: This prospective observational study was aimed at evaluating the appropriateness of use of upper gastrointestinal endoscopy (UGE) in primary care in a country with open access to and high availability of the procedure. METHODS: Outpatients were consecutively included in two clinical settings: Setting A (20 primary care physicians during 4 weeks) and B (university-based outpatient clinic during 3 weeks). In patients undergoing UGE, appropriateness of referral was judged by explicit Swiss criteria developed by the RAND/UCLA panel method. RESULTS: Patient visits (8135) were assessed. Six hundred eleven patients complained of upper gastrointestinal symptoms. Physicians decided to perform UGE in 63 of these patients. Twenty-five (40%) of the endoscopies were rated appropriate, 7 (11%) equivocal, and 31 (49%) inappropriate. Overuse of UGE occurred in 5.1% (setting A: 4.7%; setting B:6.5%; p = 0.39) of the patients who presented with upper gastrointestinal symptoms. The decision to perform UGE in previously untreated dyspeptic patients was the most common clinical situation resulting in overuse. CONCLUSIONS: Inappropriate use of UGE is high in Switzerland. However, to better reflect primary care decision making, overuse should be related not only to patients referred for a medical test, but also to the number of patients who complain of the symptoms that would be investigated by the procedure.

Adolescent↗
PubMed2000

[Lacrimal duct endoscopy with the rigid GRIN endoscopy].

BACKGROUND: Endoscopes play a more and more important role in visualizing and treating pathologies of the lacrimal drainage system. The present study analyzes the results obtained during endoscopy of the lacrimal ducts using a gradient-index (GRIN-) endoscope. PATIENTS AND METHODS: 44 patients, 18 to 87 years old (mean 59 years +/- 18.9), with chronic epiphora or symptoms of affection within the lacrimal ducts were examined using a rigid gradient-index (GRIN-) endoscope. Examination was performed ambulatory using drops for local anesthesia. RESULTS: All 44 patients showed pathologic conditions in the lacrimal drainage system. 2 patients had chronic changes. 25 patients had a relative stenosis (16 presaccal, 9 postcanalicular ones). 17 patients had a total stenosis (12 presaccal, 5 postcanalicular ones). 33 patients showed a single-sided pathology while 11 patients showed a bilateral one. The GRIN-endoscope could be used in all patients and gave excellent image quality of the pathologies. CONCLUSIONS: Endoscopy with a GRIN-endoscope can complement the ambulatory diagnostics and therapy of the lacrimal drainage system. In the patient group studied (n = 44), presaccal pathologies (n = 28) were twice more frequent than postcanalicular ones (n = 14). Further developments could enlarge the indications of the GRIN-endoscope.

Adolescent↗
PubMed2002

[Fluorescent endoscopy superior to white light endoscopy. Detecting cancers of the urinary bladder earlier].

5-aminolevulinic acid-induced fluorescence endoscopy (AFE) has enormously increased the effectiveness of early cancer detection. This was first shown for cancer of the bladder. After application of 5-aminolevulinic acid (5-ALA) endogenous protoporphyrin IX (PP IX) accumulates in tumor tissue. When such tissue is then irradiated with blue light, the neoplastic areas can be identified by red fluorescence and, in the case of the bladder, can be removed by transurethral resection (TUR) or laser coagulation in the same endoscopic session. The great advantage of this highly sensitive technique (95%) is to be seen in particular in the detection of flat urothelial neoplastic lesions--until recently a deficit in conventional white-light endoscopy. Initial investigations show that improved early detection and the reduction in the residual tumor rate lead to longer recurrence-free intervals.

Aminolevulinic Acid↗
PubMed1995

Technology assessment status evaluation: monitoring equipment for endoscopy. American Society for Gastrointestinal Endoscopy.

An understanding of the principles and limitations of monitoring devices is valuable for their appropriate use and interpretation. Reliable monitoring de available as an adjunct to skilled personnel to detect changes in patient condition during endoscopy. Combination units that provide pulse oximetry, automated sphygmomanometry and ECG monitoring appear to be the most convenient and cost effective products.

Blood Pressure Determination↗
PubMed2006

Video capsule endoscopy: clinical relevance of capsule endoscopy findings.

Video capsule endoscopy (VCE) is a novel diagnostic tool for noninvasively visualizing the lumen of the entire small intestine. It is especially useful in identifying the source of obscure small intestinal bleeding. However, VCE is not always optimal for localizing small bowel lesions. Several studies show VCE to be markedly superior to standard diagnostic techniques although the true clinical relevance of many of the capsule endoscopic findings remain unknown. We present two case reports of VCE findings that resulted in surgical intervention but were found to be benign lesions on definitive pathological examination. The actual clinical relevance of many of the lesions found on VCE thus remains to be demonstrated.

Aged↗
PubMed1991

Gastrointestinal endoscopy and general surgical practice. Surgical endoscopy versus surgeon endoscopists.

Endoscopic studies and treatment are a necessary and vital component of General Surgery practice. Since most of the concepts related to therapeutic endoscopy were conceived and developed in the context of surgical science, it is both appropriate and necessary that surgeons continue their involvement with this modality. Furthermore, within the evolution of surgical science, endoscopic tools will continue to be utilized.

Digestive System↗
PubMed1977

X-ray examination of endoscopy? A blind prospective study including barium meal, double contrast examiniation, and endoscopy of esophagus, stomach, and duodenum.

One hundred and one consecutive patients with upper abdominal dyspepsia were examined by conventional barium meal, double contrast examination, and endoscopy of the stomach and the duodenum in a blind prospective investigation. All the examiners were specially trained. Only small differences between the sensitivity and the specificity of the methods were found, but the clinical importance of the false positive and the false negative errors of the three methods of examination was not the same. The sensitivity of the ordinary X-ray examination was found to be sufficiently high for still recommending this method for primary screening. In case of posivite findings in the stomach, supplementary gastroscopy ought to be performed in order to increase the diagnostic specificity.

Adult↗
PubMed2004

[Hygiene in endoscopy in the clinic and practice, 2003: Results of infection hygiene survey on endoscopy services in Frankfurt am Main by the public health service].

UNLABELLED: Guidelines for reprocessing flexible endoscopes have been published in many countries. Compliance to the German guidelines, published in 2002 by the Commission on Hospital Hygiene and Infection Prevention on the Robert Koch Institute is mandatory in all endoscopic units, in hospitals as well as in private practices. Here, a survey of current reprocessing practices in an urban region in Germany is published, covering all hospitals and private practices in this region. MATERIAL AND METHODS: In summer 2003, all endoscopic units in Frankfurt/Main, Germany--15 hospitals and 23 private practices -- were visited by members of the public health service, using a checklist based on the recommendations of the German guideline. RESULTS: In these institutions, more than 70 000 endoscopic examinations per year are performed. 87 % (13 /15) of the hospitals and 43 % (10/23) of the practices, reported to conduct more than 1000 procedures per year. Great differences were found in hygienic quality comparing endoscopic units in hospitals and in private practices. In hospitals compliance with the guidelines was satisfactory. Main problems in the practices were: missing facilities for ultrasonic cleaning (74%) and sterilizing (43%), faults in reprocessing the bottle and tube for air/water-channel flushing (26%) which was filled in with water not sterilised (48%), storage of the endoscope with risk of recontamination (48%), missing routine-tests of the endoscopes after reprocessing (44%). Generally, hygienic conditions and procedures were worse in smaller units than in bigger ones. DISCUSSION: The data from Frankfurt hospitals are satisfactory. In private practices, however, especially in smaller ones, improvements are mandatory. Improvements should cover the quality of structure and process, i.e. specific education of the nurses, availability of ultrasonic cleaners and sterilizators and -- preferably -- automatic dishwashers, as well as implementation of a written protocol for hygiene in endoscopy, based on the German Guidelines.

Endoscopes↗