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At least 739 records · Page 41Linked to original sources
PubMed1990

Endoscopy in dyspeptic patients: is gastric mucosal biopsy useful?

Should dyspeptic patients coming to endoscopy with "normal" findings also be biopsied? To assess this, we studied the sensitivity and specificity of endoscopic examination compared with histology, microscopic evidence of Helicobacter pylori, CP-TEST, culture, and serum IgG and IgA antibody titers to H. pylori to determine whether endoscopy and antral biopsies really are useful. One hundred seven consecutive dyspeptic patients (mean age 43 yr) were entered. Four antral biopsies were taken routinely for evaluation by histology, microscopy, CP-TEST, and culture. Serum IgG and IgA antibody levels were measured in all patients. Of symptoms, postprandial bloating was statistically more common in H. pylori-positive than in negative patients. Endoscopy had the poorest sensitivity (37.1%) and specificity (53.3%). Patients with normal endoscopic appearances but histologically confirmed gastritis had significantly higher IgG and IgA titers than the patients normal by both endoscopy and histology and without evidence of H. pylori. This study has shown that endoscopy is unhelpful in dyspeptic patients if endoscopic biopsies are not routinely taken.

Adult↗
PubMed1989

[Endoscopy or trial treatment of patients with dyspepsia?].

The predictive value of dyspeptic symptoms is low. Upper GI endoscopy is the diagnostic gold standard, giving optimal basis for adequate drug treatment and may have a positive influence on the prognosis of non ulcer dyspepsia. Accordingly, endoscopy tends to be recommended at an early stage of chronic dyspepsia. Age above 40 years, pains relieved by food or antacids, night pains, smoking and male sex enhances the probability of an organic disease and thus the need for endoscopy. Trial treatment is recommended if the waiting period for endoscopy exceeds two weeks. Patients previously endoscoped may often be treated in accordance with earlier diagnosis and drug experience when relapsing. Drug choice when there is no firm diagnosis, should be determined by the symptom pattern. Two weeks of treatment failure necessitates endoscopy. Individual trial packages containing both the active drug and placebo could improve decision making in clinical practice.

Adult↗
PubMed1989

Cardiac response to upper gastrointestinal endoscopy.

In 54 subjects, cardiac function was investigated during upper gastrointestinal endoscopy with a Holter electrocardiorecorder. The heart rate of patients who were premedicated with an anticholinergic agent increased more than did that of patients who received no premedication. In the group who received no anticholinergic premedication, sinus tachycardia was evident during endoscopy, but the only clinically important change was in one patient who converted to atrial flutter from atrial fibrillation. The heart rate increased during endoscopy among patients undergoing the procedure for the first time, but it did not increase in the patients who had previously undergone endoscopy. These results show that endoscopy is a relatively safe examination from the view point of cardiac risk when performed without the administration of an anticholinergic agent, but that cardiac patients should be monitored carefully. The endoscopist should also take into consideration the psychological state of the examinees.

Adult↗
PubMed1983

Risk of hepatitis B virus infection following upper gastrointestinal endoscopy: a prospective study in an endemic area.

A prospective survey, comprising 623 consecutive upper gastrointestinal endoscopies (in 588 patients) was carried out simultaneously at two endoscopy centres of a Mediterranean country, without altering the routine procedures. Each patient was tested for HBsAg, and sera found to be HBsAg-positive were tested for HBeAg/antiHBe: 40/588 (7.1%) subjects were found to be HBsAg-positive and 6 of them were HBeAg-positive. Sera of the first 5 HBsAg-negative patients in whom the same endoscope and/or biopsy forceps were used after a HBsAg-positive subject, were tested for antiHBc to ascertain antecedent HBV immunity: 77/136 (56.6%) were found to be antiHBc-positive. Forty-eight out of the 59 individuals "at risk" lacking evidence of previous HBV infection were contacted 6 months after endoscopy: none reported symptoms of hepatitis; 40 of them had blood tests for HBsAg and antiHBc: none showed serum markers of HBV infection. It is therefore concluded that, in spite of the high number of HBsAg carriers among endoscopy candidates, the risk of HBV spread during upper G.I. endoscopy is very low, even in high prevalence areas.

Adult↗
PubMed1981

[Endoscopy by color television--a new technique? (author's transl)].

The routine endoscopic examination by color television is possible be new technical developments. For routine color television - endoscopy an efficient three-tube-camera should be used, directly attached to the endoscope. For demonstration purposes or to control technical proceedings in the field of operative endoscopy the one-tube-color television camera can be sufficient, even if there are difficulties also for the experienced examiner to read findings from the television screen. This difficulty do not exist with the three-tube-camera. The resolution power of the endoscope in comparison to the television picture of the endoscopic color television picture is not different. The resolution power is limited by the endoscopes. An enlargement of the endoscopic picture by changing the focus of the objective gives no improvement. We have excellent experiences with the routine color television-endoscopy during colonoscopy. With a three-tube-camera the total examination can be controlled while the one-tube-camera is only valid to insert the coloscope. The color television endoscopy enables to produce a large archive of endoscopic findings for teaching purposes without secondary cost and with a description during the active examination. Our experiences with routine endoscopy with color television proves that this technique is an improvement.

Colonoscopes↗
PubMed1980

Upper intestinal endoscopy induces hypoxemia in patients with obstructive pulmonary disease.

We studied the effects of fiberoptic upper intestinal endoscopy on blood oxygenation and cardiac rhythm in 13 patients. Six patients had normal pulmonary function or mild obstruction to air flow. None of these developed arterial oxygen desaturation during endoscopy. Seven patients had moderate to severe airflow obstruction. Six of these desaturated to less than 90%; the mean +/- SEM arterial oxygen tension changed from a baseline of 75 +/- 2 mm Hg to 54 +/- 2 mm Hg during endoscopy (P less than 0.01). Electrocardiographic changes during endoscopy occurred in 5 patients, 4 of whom had moderate to severe airflow obstruction. In 3 of these patients, the ECG changes were concurrent with desaturation. Patients with moderate to severe airflow obstruction frequently become hypoxemic and may develop cardiac arrhythmias during upper gastrointestinal endoscopy.

Airway Obstruction↗
PubMed1996

Diagnostic tests for Helicobacter pylori--can they help select patients for endoscopy?

AIM: Dyspepsia is a common symptom and some selection process for endoscopy is required. This study seeks to determine if noninvasive tests for Helicobacter pylori could be useful as a screening test to help select patients for endoscopy. METHODS: Consecutive patients attending for upper gastrointestinal endoscopy were interviewed prior to endoscopy and the endoscopic diagnoses was recorded. The presence of Helicobacter pylori infection was assessed by serology. Some patients also had a 13C urea breath test or rapid urease test (CLO test). RESULTS: 436 consecutive patients were evaluated. The endoscopy findings were normal in 44%, 29% had reflux oesophagitis, 18% had duodenal ulcer, duodenitis or gastric ulcer and 9% had other diagnoses. 54.8% of patients were positive for Helicobacter serology. Using either the CLO test or 13C urea breath test as the confirmatory test for the diagnosis of Helicobacter pylori, the sensitivity of the serology test was 96% and 91% respectively and the specificity was 66.6 and 82%. Patients with negative serology and no history of recent NSAID or aspirin use comprised 34% of the total with dyspepsia or reflux symptoms. There were no gastric or duodenal ulcers in this group. CONCLUSION: The serology test may have some potential or the initial evaluation of dyspepsia. These tests need to be prospectively evaluated in general practice.

Adolescent↗
PubMed2006

Logistical considerations for endoscopy simulators.

A variety of endoscopy simulators have been produced during the last several decades. Multiple factors have influenced the types of simulators that have been developed and the ongoing evolution of existing models. Realistic simulation is only one issue in providing simulation-based training in GI endoscopy. Details such as cost, technologic limitations, management and availability of training facilities, personnel, animal welfare and the procurement, handling, and disposal of animal parts are all major factors when considering the options available among existing endoscopy simulators. Table 1 summarizes the logistical factors for the different types of endoscopy simulator. These considerations clearly are of major importance in simulator design and development and in the conceptualization and organization of simulator-based curricula and courses.

Animals↗
PubMed2000

Assessment of the efficacy of endoscopy in pituitary adenoma resection.

OBJECTIVE: To obtain objective evidence that the use of endoscopy in the surgical management of pituitary tumors improves intraoperative visualization and significantly impacts operative outcomes. DESIGN: Case series of pituitary adenomas treated surgically by endoscope-assisted microscopic resection. SETTING: University-affiliated tertiary care medical center. PATIENTS: Consecutive sample of 9 patients referred for surgical management of pituitary adenoma. INTERVENTIONS: Each patient underwent transseptal transsphenoidal microscopic tumor resection. The procedure was modified by the use of intrasellar endoscopy as an adjunctive imaging modality. Following complete microscopic resection of tumor, rigid 0 degrees and 30 degrees 4.0-mm endoscopes were used to conduct a final survey of the sellar and parasellar spaces. Residual tumor fragments identified during this endoscopic examination were removed. OUTCOME MEASURES: Endoscopes were thought to have a significant impact on surgical therapy in cases where residual tumor that was not detected microscopically was identified and removed during endoscopic examination. Analysis of each case included correlation between intraoperative findings and retrospective review of dictated operative reports and intraoperative videotape. RESULTS: Three of the patients with macroadenoma (33% of total, 43% of macroadenoma cases) had tumor fragments that were only identified and removed endoscopically. CONCLUSIONS: Endoscopy provides distinct advantages over microscopy in imaging intrasellar and parasellar structures during pituitary tumor resection. These data support the numerous anecdotal accounts of the usefulness of pituitary endoscopy and are consistent with the small amount of objective evidence offered on the subject. Arch Otolaryngol Head Neck Surg. 2000;126:1487-1490

Adenoma↗
PubMed1992

Evaluation of routine upper digestive tract endoscopy before laparoscopic cholecystectomy.

Endoscopy of the upper digestive tract was performed in 376 patients with symptomatic gallstone disease before elective laparoscopic cholecystectomy. Abnormalities were found in 60 patients (16.0 per cent); these included peptic ulcer (n = 14), gastric erosions (n = 15) and oesophagitis (n = 11). Thirty patients were treated medically and two by endoscopic polypectomy. In four patients endoscopy led to cancellation of cholecystectomy; in two the complaints have persisted. Statistical analysis of 28 variables showed few significant differences in symptoms between patients with normal and those with abnormal appearances at endoscopy. It is concluded that routine endoscopy before laparoscopic cholecystectomy is neither clinically useful nor cost effective in patients with symptomatic gallstone disease. This conclusion is related exclusively to patients with typical gallstone symptoms according to the definition used in this department.

Adolescent↗
PubMedDate not supplied

III. New developments: 2. Virtual MR endoscopy in the central nervous system.

Recent advances in three-dimensional (3D) data acquisition and postprocessing technologies have been playing a important role in widening the potential applications of 3D display. The authors described new applications of a virtual endoscopic algorithm for 3D display of high resolution MR images: (a) intracranial intravascular virtual MR endoscopy using the 3D fast imaging with steady state precession (FISP) sequence, and (b) virtual MR endoscopy of the cerebrospinal fluid (CSF) spaces using the constructive interference in steady state (CISS) three-dimensional Fourier transform (3DFT) sequence. The virtual endoscopic images were displayed with use of a commercially available perspective volume-rendering algorithm. Our initial experience showed that virtual MR endoscopy can be performed to observe the intracranial arteries and CSF spaces from the viewpoints within themselves. Although the clinical use of the intracranial virtual MR endoscopy has not been established yet, the images obtained are very attractive and further investigations in this field will be expected.

Central Nervous System↗
PubMed2006

Combined breast ductal lavage and ductal endoscopy for the evaluation of the high-risk breast: a feasibility study.

BACKGROUND AND OBJECTIVES: Evaluation of the ductal epithelium of the breast at increased risk for breast cancer is needed to define the carcinogenic pathway, for risk assessment, and to improve selection of women for chemoprevention therapy. We studied the feasibility of combining breast ductal endoscopy with ductal lavage in the high-risk contralateral breast of women with ipsilateral breast cancer for the evaluation of high-risk ducts and acquisition of ductal epithelial cells for analysis. METHODS: Breast ducts were studied by ductal lavage and ductal endoscopy, and epithelial cell content studied cytologically and quantitatively. RESULTS: Twenty-five subjects and 44 ducts, including 22 (50.0%) which did not produce nipple aspirate fluid (NAF), were studied. Cellular atypia was present in five subjects. Ductal endoscopy was performed on 1 or more ducts in 24 subjects. Structural changes were noted in 63.6% of the ducts, most commonly fibrous stranding or bridging. Ductal sampling with endoscopic brush and coil sampling devices provided additional cellular samples of relatively pure ductal epithelial content (> or = 91% purity) in 8/11 subjects. CONCLUSIONS: Breast ductal endoscopy combined with ductal lavage represents a feasible approach for characterizing the ducts and ductal epithelium of the high-risk breast, especially in a research setting.

Adult↗
PubMed1981

National ASGE survey on upper gastrointestinal bleeding: complications of endoscopy.

Data about the risks of upper endoscopy in patients with upper gastrointestinal bleeding was gathered as part of a prospective national survey of the ASGE membership. Endoscopic complications occurred in 21 of 2320 endoscopies (0.9%). These included 12 major (perforation, aspiration, bleeding) and 9 minor (mucosal tear, medication reaction, transient cardiac or pulmonary episode) complications. There were 3 deaths attributable to major complications of the procedure. These fatalities all occurred in patients with severe major underlying illnesses. Although these results indicate a higher complication rate than earlier retrospective ASGE surveys on endoscopy, they are comparable to other available data about the risks of endoscopy in the specific group of patients with upper gastrointestinal bleeding.

Adult↗
PubMed1977

[Role of endoscopy in diagnosis and therapy (author's transl)].

Gastroenterologic endoscopy has developed into a perfect diagnostic tool. All sections of the gastrointestinal tract are accessible to visual inspection. The early diagnosis of gastrointestinal cancer has become a reality. The sources of acute bleeding can be located by emergency endoscopy. The combination of endoscopy with other procedures (biopsy, radiology, ultrasonics) has opened up further essentially diagnosis possibilities. Where changes occur in polyps, small particles are not representative. Polypectomy has advanced to total biopsy. Along with this, the step from diagnostic to curative endoscopy was taken. Further milestones in this direction are endoscopic papillotomy and endoscopic hemostasis and the prevention of bleeding by the use of laser light.

Acute Disease↗
PubMed1992

Gastrointestinal endoscopy in Henoch-Schönlein purpura.

Gastrointestinal (GI) endoscopy was performed in seven patients with Henoch-Schönlein purpura (HSP). In two patients there were no cutaneous lesions at the time of endoscopy, but inflammation of the duodenum, especially of the second part, led to suspicion of the disease. Upper GI endoscopy showed abnormalities in six of seven cases, and sigmoidoscopy in one of four cases. The changes were more marked in the second part of the duodenum rather than in the bulb or the stomach. The endoscopic findings included redness, swelling, petechiae or haemorrhage, erosions and ulceration of the mucosa. Histology of the mucosal biopsy specimens revealed non-specific inflammation with positive staining for IgA in the capillaries, but failed to show vasculitis. Upper GI endoscopy, including study of IgA, can be useful in the diagnosis of HSP. Colonoscopy is less helpful, especially if limited to the sigmoid colon.

Adolescent↗
PubMed2001

Brush cytology: an adjunct to diagnostic upper GI endoscopy.

Endoscopic brush cytology (EBC) was performed in antral and duodenal brushings of children subjected to upper GI endoscopy for the detection of H. pylori (Hp) and trophozoites of Giardia lamblia (Glt) in addition to routine endoscopic grasp biopsy (EGB). It was hospital based prospective study. EBC was performed in children subjected to upper GI endoscopy with a sheathed cytology brush. Mucosal brushings were collected from antrum, body of the stomach and second or third part of duodenum by gently rubbing the surface of the brush with the mucosal wall in all the directions, brush withdrawn and brushings performed on a glass slide. The smears were placed in 95% ethyl alcohol and later examined for Glt and Hp using Giemsa and Hematoxylin & Eosin stain. EGB was taken from antrum, body of the stomach and duodenum from sites other than those used for brushings. One hundred and seventy children between 1-13 years (median age = 5 years) were subjected to upper GI endoscopy for malabsorption (n = 94), recurrent abdominal pain (n = 49), failure to thrive (n = 16) and recurrent vomiting/regurgitation (n = 11) and EBC was performed in addition to routine EGB. Thirty five children (20.4%) were colonized by Hp, 14 (8.2%) were detected to have Glt and in 6 cases (3.5%) both Hp as well as Glt were detected. Out of 41 cases colonized by Hp, 24 cases (58.5%) were detected by EGB and 27 cases (65.8%) were detected by EBC. Out of 20 children in whom Glt were detected from their duodenum, the detection was by EBG in 12 cases (60%) and by EBC in as many as 19 cases (95%). Comparison of EGB and EBC suggested that detection rates with EBC were higher than EGB. Detection by EBC was significantly higher for Glt than Hp. There were no complications attributed to EBC and procedure time for endoscopy was not significantly prolonged. On the contrary, detection of Hp and particularly Glt in higher proportion of cases with the help of EBC was helpful in their appropriate management. Our results suggest that EBC is a safe and useful tool to enhance the value of diagnostic endoscopic procedure when used in combination with routine EGB.

Animals↗
PubMed2004

Virtual endoscopy of the nasopharynx in the evaluation of its normal anatomy and alterations due to lymphoid hyperplasia: preliminary report.

The purpose of this study was to evaluate the diagnostic usefulness of virtual endoscopy in establishing the anatomic appearance of nasopharynx, both normal and affected by lymphoid hyperplasia. Thirty-seven patients affected by chronic rhinosinusal and otomastoid pathology, all studied by rhinoscopy, were examined with multislice computed tomography (CT) and virtual endoscopy of the nasopharynx. Rhinoscopy showed a completely normal nasopharynx in 15 cases and a variable grade of lymphoid hypertrophy in 22 patients. A general agreement was observed between traditional and virtual endoscopy findings in both subgroups. The tasca of Luschka was detected in 13/15 of normal subjects and only in 3/22 patients. The Rosenmuller fossae appeared deeper in normal subjects and their symmetry could be considered an important criterion of normality. In all cases, a good evaluation of the tubaric ostium was obtained. Differentiation between hyperplasic lymphoid tissue and neoplasms is possible only in lymphoid hyperplasia characterized by median crest-like swelling with a narrow base. In most cases, differential diagnosis cannot be based only on morphological criteria of virtual endoscopy, but it should be evaluated considering the overall CT findings and clinical presentation.

Diagnosis, Differential↗
PubMed2004

An innovative method for the assessment of skills in lower gastrointestinal endoscopy.

BACKGROUND: Although virtual reality (VR) simulators can be used ability to objectively assess skills in endoscopy, the evaluation is solely quantitative. We have developed a novel method for the objective assessment of technical skills in lower gastrointestinal (GI) endoscopy that incorporates qualitative as well as quantitative measures. METHODS: We developed a virtual endoscopy suite by deconstructing the VR simulator to enable a more realistic and ergonomic placement of the monitor. Trainee endoscopists with varying levels of experience performed the case 4 task of the simulator. Ten essential components of endoscopic performance were rated on a five-point Likert scale (global score) by three independent observers. These observers viewed two videos (one showing scope handling and the other showing the monitor image), which were synchronized and played simultaneously. RESULTS: The study population comprised six experts (group 1, > 200 procedures), seven subjects with intermediate experience (group 2, 20-80 procedures), and seven novices (group 3, 1-10 procedures). The global score was found to discriminate the level of skills across all three groups (p < 0.001). There were significant differences between groups 1 and 2 (p = 0.003) and groups 2 and 3 (p = 0.004). There was a significant correlation between the global score and the percentage of red-out (without vision) as recorded by the simulator (correlation coefficients = -0.61, p = 0.004). CONCLUSION: This novel method for the assessment of technical skills in lower GI endoscopy has construct validity and high interrater reliability.

Clinical Competence↗