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PubMed1998

Histologic evaluation of endoscopic versus suction biopsies of small intestinal mucosae in children with and without celiac disease.

BACKGROUND: Concern over the adequacy of histologic diagnosis of endoscopic duodenal biopsies in children prompted this comparative study on the histologic quality of endoscopic versus capsule biopsies. We found this problem addressed in only six previous reports. METHODS: Blind examinations of the histologic sections of 48 duodenal biopsies obtained by gastrointestinal endoscopy in children aged 2-18 years were compared to 52 biopsies obtained by the small bowel suction method (from children aged 1-16 years). RESULTS: Although 87.5% of endoscopic biopsies and 94.2% of capsule biopsies were adequate for histologic diagnosis, fragmentation or squashing was seen in 83.3% of endoscopic biopsies and only in 25% of capsule biopsies. CONCLUSIONS: Biopsies obtained by suction are of better quality than those obtained by endoscopy. If endoscopy is preferred for technical reasons, the following conditions should be observed: the patients should be aged over 2 years, and a minimum of four biopsies should be obtained with forceps of a diameter greater than 2 mm. Adequate histologic criteria for diagnosis should include at least one full-thickness mucosal specimen more than 3 mm in length, vertically oriented, and not fragmented. In children under age 2, duodenal or jejunal capsule biopsies are preferred, since the specimens are usually larger and less fragmented. Endoscopy is technically more difficult in the very young patient.

Adolescent↗
PubMed1999

Are endoscopic biopsies of small bowel as good as suction biopsies for diagnosis of enteropathy?

BACKGROUND: Endoscopy is increasingly used in paediatric practice for diagnosis of enteropathy, although the quality of grasp forceps-obtained biopsy specimens required for reliable diagnosis has been questioned in comparison with suction capsule biopsy specimens. This study prospectively compared the diagnostic suitability of grasp forceps biopsy versus suction biopsy in the same patient during the same procedure. METHODS: A double-port paediatric suction biopsy capsule was front-loaded onto an endoscope and directed to the fourth part duodenum-proximal jejunum for biopsy sampling. Subsequently, three grasp biopsy specimens were taken from the same region. All biopsies were coded, photographed, and measured for area, using computed morphometry. A single blinded histopathologist assessed sample adequacy for diagnosis. Twenty-nine patients were enrolled (age range, 8-185 months). RESULTS: On three occasions the suction capsule failed to fire, and on four occasions only one sample was obtained. Three grasp biopsy specimens were obtained on each occasion by endoscopy, and the first two were used for comparison with suction biopsy samples. Median total area of individual biopsy samples obtained by the two procedures was not different (21.3 vs. 22.5 mm2; P = 0.027). Muscularis mucosae was obtained more commonly with grasp biopsies (P<0.001), and no difference was observed for the presence of three or more villus-crypt units, degree of haemorrhage, or optimal orientation. Two suction biopsy procedures and one grasp biopsy procedure were inadequate for diagnosis. CONCLUSIONS: Endoscopic grasp biopsies are perfectly adequate for the assessment of small intestinal histology. In addition, endoscopy affords advantage in diagnosis of other upper gastrointestinal disease with avoidance of radiologic screening involved with the suction capsule technique.

Adolescent↗
PubMed1992

Nizatidine versus placebo in active benign gastric ulcer disease: an eight-week, multicenter, randomized, double-blind comparison. The Nizatidine Benign Gastric Ulcer Disease Study Group.

STUDY OBJECTIVE: To determine if 150 mg nizatidine twice daily or 300 mg nizatidine at bedtime are similarly effective and to compare each dose with placebo in healing benign gastric ulcers and relieving peptic ulcer symptoms. METHODS: This study was a randomized, double-blind, placebo-controlled parallel comparison. The study was conducted at 74 gastroenterology and internal medicine clinics in the United States and Canada. Four hundred fifty-six patients with active benign gastric ulcer documented by endoscopy participated in the study. On the basis of a computer-generated randomization list, patients were assigned sequentially to receive either 150 mg nizatidine twice daily (n = 151), 300 mg nizatidine once daily at bedtime and identically appearing placebo capsules in the morning (n = 153), or placebo capsules twice daily (n = 152). Treatment lasted for 8 weeks unless healing was documented by endoscopy after 4 weeks. Antacid tablets (aluminum hydroxide, magnesium hydroxide, simethicone combination) were supplied for relief of symptoms. MEASUREMENTS AND MAIN RESULTS: Both doses of nizatidine significantly improved healing rates at 8 weeks compared with placebo. Daytime and nighttime symptom severity was improved by both nizatidine regimens at end point (p less than 0.015 versus placebo, two-tailed test). Antacid use was similar for all groups in the end point analysis. Patient well-being was significantly better in patients treated with nizatidine than in patients in the placebo group ((p less than 0.04, two-tailed test). No clinically significant differences in the incidence of adverse clinical or laboratory events were noted. CONCLUSION: Nizatidine, 300 mg at bedtime and 150 mg twice daily, resulted in greater healing of benign gastric ulcers than placebo treatment after 8 weeks. Relief of the symptoms of gastric ulcer was significantly better in the patients receiving nizatidine treatment versus placebo treatment.

Capsules↗
PubMed1999

Endoscopic suturing.

Suturing at flexible endoscopy might extend the range of less invasive surgical procedures that can be performed without incision. The development of sewing machines that can place single and multiple stitches in the gastrointestinal tract is outlined. Methods of tying knots and cutting thread at flexible endoscopy have also been developed. The results of some applications, including the treatment of gastro-oesophageal reflux disease, the closure of perforations, haemostasis, and the attachment of feeding tubes and radiotelemetry capsules to tissue using endoscopic suturing, are described.

Endoscopy, Digestive System↗
PubMed2004

Initial experience with wireless capsule enteroscopy in the diagnosis and management of inflammatory bowel disease.

BACKGROUND AND AIMS: Wireless capsule enteroscopy (WCE) offers the potential to directly visualize the entire small bowel and identify superficial lesions not detected by traditional endoscopy and radiography. The aim of this study is to assess the clinical utility of WCE in the evaluation of patients with known or suspected inflammatory bowel disease (IBD). METHODS: Fifty patients with ongoing symptoms underwent Given M2A endoscopic capsule examinations. Indications included: (1) evaluation for small-bowel involvement in patients with IBD with isolated colitis (n = 22), (2) determination of the extent of small-bowel disease in patients with Crohn's disease (CD; n = 20), and (3) workup of suspected IBD (n = 8). Outcome measures were classified as diagnostic when multiple ulcerations were present, suspicious when </=3 ulcerations were seen, and nonspecific or normal. RESULTS: WCE findings were diagnostic for CD in 20 patients and suspicious for small-bowel CD in 10 patients. Seventeen of 20 patients with diagnostic WCE findings improved with increased IBD-directed medical therapy, as did 7 of 10 patients with suspicious study results. WCE was normal or showed nonspecific findings in the remaining 20 patients. Notably, identification of small-bowel lesions in 5 patients with a previous history of isolated colitis resulted in a change in diagnosis to CD after confirmatory ileoscopy with biopsy. CONCLUSIONS: Results of this preliminary study suggest that WCE is a novel and potentially clinically useful method of directly visualizing and diagnosing small-bowel lesions in patients with IBD that can be missed by traditional endoscopic and radiological procedures.

Adolescent↗
PubMed1976

[Effective treatment of duodenal ulcer with cimetidine (author's transl)].

Twelve male duodenal ulcer in-patients received in a double-blind trial either the histamine H2-receptor antagonist cimetidine (4 X 200 mg/d p.o.) or placebo capsules. Ulcer sizes were assessed endoscopically before therapy followed by repeat endoscopy at weekly intervals. Duodenal ulcer healing was significantly more rapid in cimetidine-treated patients than in those receiving the placebo (chi2 test; P less than 0.0005). Plotting of log ulcer sizes (mm2) against time (days) resulted in regression lines the slopes of which indicated the respective half-time of ulcer healing: about 6 days on cimetidine therapy and about 20 days on placebo treatment. Gastric secretion of acid, protein, pepsin, and N-acetylneuraminic acid-containing glycoproteins was not altered by a 4-week course of daily cimetidine or placebo, nor pancreatic secretion of bicarbonate and enzymes. No statistically significant changes in laboratory findings (haemoglobin, white blood-cells, neutrophils, platelets, alkaline phosphatase, blood-urea, serum-creatinine, GOT, GPT) were associated with treatment.

Adolescent↗
PubMed1981

Tetracycline ulcers of the oesophagus, Endoscopy, histology and roentgenology in two cases, and review of the literature.

Two cases of tetracycline ulcers of the oesophagus are reported and compared with thirteen other cases from the literature. In most cases, the patients had taken their capsules with little or no fluid just before going to bed. Some hours later they developed retrosternal pain that was intensified by swallowing. Endoscopy showed sharply demarcated greyish-white areas of mucosal damage which represented layers of stratified squamous cells, separated by oedema, and a dense neutrophilic infiltration of the lamina propria and the muscularis mucosa. Roentgenology was unsuitable to detect the lesions. They healed without complications within one to six weeks. Prolonged retention of the capsules in the oesophagus is thought to cause the mucosal damage. Patients on oral tetracycline or doxycyline treatment should therefore be instructed to take their capsules with a meal or with copious water and not just before going to bed.

Aged↗
PubMed2005

[How endoscopy has changed in recent 60 years].

Sixty years ago only semi flexible instruments were used for the endoscopic examination of the gastrointestinal tract. They were developed by the German physician Rudolf Schindler together with George Wolf, the producer of medical instruments in 1932. They construct optical gastroscope with a system of lenses in the flexible distal end and with the rigid metallic proximal part. Those instruments were used in gastroscopy till the sixties when the era of fibroendoscopy with the use of glass fibre optic has started. In 1957 Basil Hirschowitz with his co-workers introduced a flexible gastroscope--a fibroscope. The next years brought improvement in the size of image, its brilliancy, possibility to control the distal end and a bioptic channels was added. Working length was elevated and since 1970 the instrument has been used as ezofago-gastro-duodenoscope. At the end of millennium a new technology was developed--videoendoscopy. Experience with the prototype of videoendoscope was published in 1984 (Sivak a Fleischer, Classen a Phillip). In the nineties of the previous century Paul Swain constructed the first prototype of wireless endoscopic capsule. A single chip camera with low electricity consumption was presented in 2000. Endoscopy has developed in recent years considerably and its progress will definitely continue.

Endoscopes, Gastrointestinal↗
PubMed1999

Ultrastructural study on adhesions in internal derangement of the temporomandibular joint.

PURPOSE: This study examined the ultrastructural characteristics of adhesions in the upper joint compartment of temporomandibular joint (TMJ). MATERIALS AND METHODS: Tissue biopsy specimens of adhesions were obtained during arthroscopic operation on 36 joints in 22 patients with internal derangement (ID). The biopsy specimens were examined by light and transmission electron microscopy. RESULTS: Adhesions were grossly divided into two types based on arthroscopic observation: 1) a band-like type, which connected the articular fossa and TMJ disc, and 2) a pseudowall-like type, which faced the synovial fluid and was lined by articular tissue. Two types of collagen arrangement were observed at the electron microscopic level: orderly arranged collagen bundles and randomly arranged collagen bundles. Orderly arranged collagen bundles were prominent in the band-like adhesions. In pseudowall-like adhesions, mainly the randomly arranged collagen bundles were seen. However, in some dense fiber parts, orderly arranged collagen bundles also were observed. In other pseudowall-like adhesions, only orderly arranged collagen bundles were seen. Elastic fibers were abundant in some pseudowall-like adhesions with randomly arranged collagen bundles. There were no elastic fibers in the band-like adhesions, some dense fiber parts of the pseudowall-like adhesion, pseudowall-like adhesions consisting of only orderly arranged collagen bundles, and in the synovial membrane. CONCLUSION: The different arrangement of collagen fibers and presence or absence of elastic fibers were observed in the two types of adhesions. These findings served to show that extracellular components correspond to a dysfunction involving an ID of TMJ.

Adult↗
PubMed1997

Cine-MR imaging of the shoulder.

PURPOSE: Shoulder lesions are usually examined with the joint in only one or two positions. We examined the shoulder with the joint in a variety of positions. We also assessed the application of cine-MR to the detection of instability and impingement. MATERIAL AND METHODS: The cine-MR examinations were performed in 30 patients and 15 healthy volunteers. We used an open 0.2 T system and a closed 1.0 T system. Spoiled gradient echo 2D T1-weighted images and turbo spin-echo T1- and T2-weighted images were obtained with a field of view of 180 mm. The examinations were videotaped and evaluated later. RESULTS: Normal variations of the glenohumeral joint were easy to recognize. Sub-luxations and luxations of the humeral head as well as rupture of the labrum were identified. It was also possible to identify the labrum with a signal change after arthroscopic refixation. And we were able to objectively assess distances between the osseous structures during dynamic movement. CONCLUSION: Unlike static MR, cine-MR would appear to be useful in visualizing the capsular ligament complex of the gleno-humeral joint in impingement and instability. It also provides information on dynamic changes and may thus prove to be an important tool for shoulder diagnostics. The method may provide an early diagnosis in the sub-acromial impingement syndrome.

Acromion↗
PubMed1980

The pathological anatomy of digital enucleation for benign prostatic hyperplasia and its application to endoscopic resection.

A detailed study of the macroscopic and microscopic anatomy of the prostate enlarged by benign hyperplasia and of the effects of enucleation is presented; based on this study in the cadaver, some aspects of endoscopic resection are described. The study and its findings are described in Part I and in Part II some aspects of endoscopic resection are dealt with as 3 questions: (1) Do technical considerations allow resection of the whole adenoma without encroachment on the shell? (2) Is it desirable and feasible to attempt the resection of the glandular tissue of the shell? (3) May resection impair continence even though injury has not been caused by the cutting loop? The discussion is concerned with 3 subjects: the morphology of the prostate, the prostatic capsule and the sphincter system.

Endoscopy↗
PubMed1990

Early diagnosis of esophageal cancer.

The doubling time of esophageal cancer, as measured by x-ray films, was studied retrospectively. The average doubling time of 19 lesions in 18 cases was 6.7 months, but in three cases the lesions doubled within a month. The developing time of depth of invasion in esophageal cancer in 19 lesions were: from mucosa to submucosa, 16 +/- 7.8 months; submucosa to advanced adventitia, 6.6 +/- 3.8 months; mucosa to advanced adventitia, 21.1 +/- 6.8 months. Lugol-staining endoscopy was effective in detecting not only lesions but also margin lines. Capsulated brushing cytology is also effective and the diagnostic rate was 94.5% in total, and 84.4% in superficial cancer. For early detection of esophageal cancer it is most desirable to have examinations once every six months and a combination of these three methods is recommended.

Esophageal Neoplasms↗
PubMed1994

Electronic endoscopy in perspective.

Electronic endoscopy, developed in 1983, enables the endoscopic image to be transmitted through electric signals that can be easily processed by computer. An electronic endoscope is composed of three vital parts, i.e., a charge-coupled device (CCD) that converts the image to electric signals, a video processor that converts analog electric signals to the digital and processes them to become video signals, and a television monitor. The introduction of electronic endoscopy has enabled computer management of endoscopic images, on one hand, and provided an opportunity for image processing and analysis, on the other. A digital image management system will further develop into a database of endoscopic images. Combined with the technologies of remote control and remote sensing, the introduction of CCD to endoscopy has made it possible to transform the endoscope, so that it could become a capsule. Future advances in the research of image processing and analysis will lead to the development of a system of automated endoscopic diagnosis.

Electronics, Medical↗
PubMedDate not supplied

[Effectiveness and safety of lansoprazole in the treatment of peptic ulcer].

BACKGROUND: Lansoprazole, a new proton pump inhibitor, is now available in Mexico. It has been tested elsewhere with excellent results. AIM: To study its safety and efficacy in Mexican patients. METHOD: 40 patients with gastric or duodenal ulcer larger than 0.5 cm, from 4 hospitals in central Mexico, were included. All were subjected to a complete medical history and upper GI endoscopy. symptoms (epigastric pain, heartburn, regurgitation, nausea, vomiting) were graded 1 to 4 according to severity. Lansoprazole (one 30 mg capsule/ day) was prescribed for 4 weeks in duodenal ulcer 8 weeks in gastric ulcer. Each patient was seen once a week at the office for compliance, symptom evaluation and side effects. A second endoscopy was performed at the end of the respective treatment period. Blood (CBC, chemistries) and urine tests were performed at the beginning and end of the study. RESULTS: 23 men and 17 women were included, Mean age: 53.8 yr. (19-95). 11 gastric ulcers and 29 duodenal ulcers. 27 measured 0.6-1.5 cm; 6 ulcers measured 1.6-2.5 cm; 6 ulcers were larger than 2.5 cm. 8 patients were bleeding at admission and 4 had multiple ulcers. 2 patients were lost to follow up. symptom grading: 18 patients had 10 points or less, 21 had more than 10 points, one bleeding patient was otherwise asymptomatic. After the first week of treatment, 42% were asymptomatic, after the 2nd. week, 75% were asymptomatic and 95% at the end of the study. The second endoscopy documented complete ulcer healing in 92% out of 37 remaining patients; further lansoprazole treatment healed 2 out of three unhealed ulcers. One patient underwent surgery for duodenal bulb stenosis. Side effects were reported by 2 patients. Treatment had to be discontinued in one patient because of headache. There was no effect of lansoprazole over the laboratory tests. CONCLUSIONS: Lansoprazole was effective for prompt symptom relief in most patients and was able to heal more than 90% of gastric and duodenal ulcers with minimal side effects.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2003

An endogastric capsule for measuring tumor markers in gastric juice: an evaluation of the safety and efficacy of a new diagnostic tool.

BACKGROUND: In gastric juice, high levels of the carcinoembryonic antigen (CEA) and the carbohydrate antigen 19-9 (CA 19-9) have been found to correlate with precancerous lesions and gastric cancer. So far, sampling of gastric juice has required upper endoscopy. In place of this invasive procedure, we investigated a new tool for the quantitation of tumor markers in gastric juice. MATERIALS AND METHODS: The study population consisted of healthy controls and consecutive subjects with suspected gastric cancer or dyspepsia/epigastric distress. Patients were asked to swallow a small gelatine capsule (14 mm in length and 5 mm in diameter) containing a pierced plastic cover and surrounding a piece of absorbent paper. The capsule was left in the gastric cavity for 60 min to allow saturation of the absorbent paper with gastric juice. A 45-50 cm length of nylon thread connected to the inner capsule was used to remove the device from the gastric cavity. After processing the absorbent paper for radioimmunoassay, CEA and CA 19-9 levels were correlated to the findings of upper endoscopy and biopsies of gastric mucosa or suspected lesions. RESULTS: The endogastric capsule did not cause any side-effects and 62 participants were fully compliant to the procedure. Assessable gastric juice samples were taken from 23 patients with gastric cancer, 15 patients with intestinal metaplasia or dysplasia, 12 patients with gastritis and 12 controls without gastric diseases. In the 12 samples of gastric juice from control patients, mean values of CEA and CA 19-9 were 1.1 +/- 0.9 ng/ml and 16 +/- 7.5 ng/ml, respectively. The mean levels of both markers were found to increase according to the severity of gastric lesions and in patients with cancer, mean CEA and CA 19-9 levels were 513 +/- 627 ng/ml and 545 +/- 510 ng/ml, respectively. Patients with precancerous lesions and cancer showed higher levels of CEA and CA 19-9 than patients with normal findings or gastritis (P <0.001). CONCLUSIONS: The endogastric capsule is a simple, non-invasive tool for the measurement of CEA and CA 19-9 levels in gastric juice. These values may discriminate between normal or minor pathologic changes and precancerous lesions or carcinomas. Further investigations are warranted, since this may represent a new method for gastric cancer screening.

Adolescent↗