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PubMed1997

Endoscopy information online: can endoscopists close the gap between what is known and what they do?

When do you go to the Internet and when do you go to online hosts for information about gastrointestinal endoscopy? This paper describes key concepts such as hosts, online databases such as MEDLINE and EMBASE, search engines, retrieval and query languages, and thesauri. The focus is on two specific thesaurus issues: the use (or absence of) complex hierarchical thesauri such as MEDLINE's Medical Subject Headings (MeSH) and EMBASE's EMTREE. This allows us to review briefly the great advantages of "term explosion" and automatic mapping of synonyms (and the absence of these facilities on the Internet). The introductory section ends with questions on what your information needs are - clinical information? Product information? Patient information? Research information? The main part of the article is concerned with what is available on the Internet and the host services that are available today and in the future. A light glance (perhaps more of a provocative preview) is cast at future developments relevant to information retrieval in the field of endoscopy. Conclusions include the following: - The Internet should be searched for: guidelines, training, and product information. - There is little published research available for free on the Internet. - For published research, search MEDLINE and EMBASE together, or DIMDI, STN or DataStar (in that order of preference). - Search EMBASE if you need the most recent endoscopy research. - Search EMBASE if you need the most recent drug information relevant in endoscopy - Search MEDLINE if you have no budget. - Search PubMed as the preferred (free) form of access to MEDLINE. - Distrust all Internet information.

Anti-Ulcer Agents↗
PubMed1996

Endoscopy databases: the Norwegian experience.

BACKGROUND AND STUDY AIMS: The implementation of endoscopy databases in Norway has been slow, and no commercial system has been successfully introduced. MATERIAL AND METHODS: To determine the current status in this area a questionnaire survey was conducted with replies received from 58 of the 67 hospitals to which the questionnaire was sent. RESULTS: Only 40% of the units had one or more personal computers available, but video endoscopes will soon be standard equipment at most Norwegian hospitals. For managing administrative data, a large majority of endoscopy units used a general-purpose hospital information system, but endoscopy data are dealt with manually in 72% of the units. The endoscopy report itself was produced manually in 93% of the units. When asked to rank various features of database systems according to their relative importance, the endoscopists stated that ease of use and simplification of routine chores were the most important aspects, while advanced storage and research features were less crucial. CONCLUSION: In Norwegian hospitals, the use of minimal endoscopic database systems that offer a high level of integration with existing hospital systems appears to be the most promising approach.

Database Management Systems↗
PubMed1991

Information requirements and sedation preferences of patients undergoing endoscopy of the upper gastrointestinal tract.

Patients' attitudes to sedation and their information needs before undergoing endoscopy were investigated using a questionnaire. One hundred and two patients completed the study; 32 had undergone endoscopy before. Sixty-six (94%) of the new patients and all follow-up patients knew why they were undergoing the procedure; 65 (93%) new and 28 (88%) follow-up patients understood how the procedure was carried out. Forty-one percent of the new and 25% of the follow-up patients wanted an information booklet about their disease and its management. Most patients chose to be sedated during the endoscopy. The proportion wishing to be sedated did not differ significantly between the new and follow-up patient groups. Sedation and information should be offered to all patients undergoing endoscopy.

Attitude to Health↗
PubMed1985

Endoscopy in basic research.

Gastroenterological endoscopy has stimulated research in a number of ways. New optical developments culminating in the glass fibre and the video endoscope, were necessary stages in the construction of highly sophisticated instruments. These advanced instruments made research possible and also stimulated it. Quite a few methods were made applicable to the gastrointestinal tract only with the aid of endoscopes. For this purpose, they first had to be carefully studied and then modified. Here, mention might be made of the taking of biopsies for histological work-up, X-ray procedures, diagnostic ultrasound, Doppler ultrasonography, operative endoscopy and laser beams. Developments have ensured that endoscopy did not remain restricted merely to its role as an optical diagnostic procedure capable only of visualizing the surfaces of internal organs. In numerous areas, operative endoscopy has now replaced the classical surgical procedure, and further developments may be expected in this field.

Biopsy↗
PubMed2000

Does open access endoscopy close the door to an adequately informed patient?

BACKGROUND: The use of open access endoscopy is increasing. Its effect on the adequacy of patient informed consent, procedure acceptance and the impact on subsequent communication/transfer of procedure results to the patient have not been evaluated. The aim of our study was to compare the extent of preknowledge of procedures and test explanation, patient medical complexity, information transfer and overall patient satisfaction between a patient group referred for outpatient open access endoscopy versus a patient group from a gastrointestinal (GI) subspecialty clinic. METHODS: Information was obtained from all patients presenting for outpatient upper and lower endoscopy by using a 1-page questionnaire. Patients from the two groups who had an outpatient upper/lower endoscopic procedure were contacted by phone after the procedure to obtain information with a standardized questionnaire. RESULTS: The open access patients reported receiving significantly less information to help them identify the procedure (p < 0.01) and less explanation concerning the nature of the procedure than the group of patients referred from the subspecialty clinic (p < 0.005). There was no difference between the two groups in satisfaction scores for examinations performed under conscious sedation. For flexible sigmoidoscopy without sedation, however, the GI clinic patient group were more satisfied with their procedure. The majority of patients, regardless of access, were more likely to receive endoscopic results from a gastroenterologist than the referring physician. Furthermore, the patients in the GI clinic group who underwent colonoscopy felt significantly better at follow-up. CONCLUSIONS: Patients undergoing open access procedures are less likely to be properly informed about their endoscopic procedure. Our results indicate that with open access endoscopy, a defined mechanism needs to be in place for communication of endoscopic results to the patient.

Adult↗
PubMed2002

Classification of Barrett's epithelium by magnifying endoscopy.

BACKGROUND: The specialized columnar epithelium of Barrett's esophagus can be detected by obtaining random or 4 quadrant biopsy specimens at conventional endoscopy. However, little is known about the fine mucosal structure of specialized columnar epithelium. METHODS: Thirty patients with Barrett's esophagus were studied by magnifying endoscopy. The fine mucosal pattern (pit pattern) of 67 regions in Barrett's mucosa was recorded and compared with methylene blue staining. Histologic, mucin immunohistologic, and cell proliferation analyses of biopsy specimens were performed in relation to the pit patterns determined by magnifying endoscopy. RESULTS: Pit pattern was classified into 5 types. Tubular and villous pit patterns were not only characteristics of both specialized columnar epithelium and methylene blue absorption, but also possessed an intestinal mucin phenotype with a high Ki-labeling index, whereas other pit patterns (dot and straight) did not have specialized columnar epithelium and were categorized as the gastric phenotype. The long oval pit pattern had an intermediate phenotype between gastric and intestinal. CONCLUSIONS: The classification of the superficial mucosal appearance of Barrett's epithelium by magnifying endoscopy reflects not only histologic features but also mucin phenotypes.

Aged↗
PubMed2001

A comparison of nasopharyngeal endoscopy and lateral cephalometric radiography in the diagnosis of nasopharyngeal airway obstruction.

Two auxiliary methods of diagnosing nasopharyngeal airway obstruction were compared. Cephalometric radiography and nasopharyngeal videoendoscopy were evaluated for efficacy in terms of reproducibility and validity. Thirty orthodontic patients (7 to 12 years of age) seeking otorhinolaryngologic treatment for mouth breathing, or mouth and nose breathing, had nasopharyngeal endoscopy and radiographic examinations performed on the same day. Two otorhinolaryngologists analyzed the results. Nasopharyngeal endoscopy was more reliable in identifying all the obstructive nasopharyngeal processes. Endoscopy obtained kappa index scores of almost perfect agreement for diagnosis of posterior nasal septum deviation, of substantial agreement for anterior nasal septum deviation and lower turbinate hypertrophy, and of moderate agreement for middle turbinate hypertrophy. Lateral cephalometric radiography obtained scores of perfect agreement for imaging hypertrophy of the middle turbinate, of almost perfect agreement for imaging hypertrophy of the posterior portion of the inferior turbinate, and of substantial agreement for imaging hypertrophy of the inferior turbinate. Radiographic diagnoses of hypertrophy of the middle and lower turbinates exhibited high sensitivity and low specificity when compared with diagnoses by nasopharyngeal endoscopy.

Cephalometry↗
PubMed2003

Endoscopy as minimal invasive routine treatment for sialolithiasis.

Endoscopy as a minimally invasive procedure with video-monitoring and documentation is demonstrated for diagnostics and therapy of sialolithiasis, which is the main indication for endoscopy in the area of the submandibular and parotid glands. Sialoendoscopy has become the routine procedure under ambulatory conditions. While on the one hand endoscopy is a diagnostic method especially in the case of radiolucent calculi, on the other hand it can be used as a therapeutic option for calculi removal in the same session. Endoscopy is also of high value in the diagnosis and treatment of other salivary gland diseases. In our experience, this procedure has an extremely low complication rate and is less stressful for the patient than other methods.

Adolescent↗
PubMed1998

Gastric contents in children presenting for upper endoscopy.

UNLABELLED: Previous studies of gastric contents in children presenting for surgery specifically excluded those with gastrointestinal disorders. Because these children often need sedation or anesthesia for procedures such as upper endoscopy, it is important to determine the gastric fluid volume and pH in this group to better characterize their risk of aspiration. We therefore analyzed the gastric fluid volume and pH of children with a variety of gastrointestinal symptoms presenting for upper endoscopy. After obtaining institutional review board approval, the stomach contents of 248 children (aged 2 mo to 18 yr) presenting for upper endoscopy were prospectively measured under direct endoscopic vision. Children were fasted for both solids and liquids for at least 6 h (<6 mo) or 8 h (>6 mo). Gastric fluid pH was measured using pH paper. Children received either deep sedation or general anesthesia and were grouped according to their presenting diagnosis. Results were analyzed by using analysis of variance, Kruskal-Wallis, and correlation (P value < 0.05). The mean gastric fluid volume was 0.35 +/- 0.45 mL/kg (range 0-3.14 mL/kg), and the mean gastric fluid pH was 1.37 +/- 1.6 (range 1-7). Of the children, 33% had gastric fluid volumes >0.4 mL/kg, 87% had gastric fluid pH <2.5, and 30% had gastric fluid volume >0.4 mL/kg and pH <2.5. Children with the presenting complaint of abdominal pain had the largest gastric fluid volumes. These data are not appreciably different from historical controls (healthy children fasted for an equivalent period of time who did not have gastrointestinal symptoms). IMPLICATIONS: When fasted for at least 6-8 h, children with a history of gastrointestinal symptoms presenting for upper endoscopy did not have gastric contents with increased volume and acidity compared with previously published groups of children without gastric symptoms who were fasted the same length of time. These results do not support the argument that children with gastrointestinal symptoms pose an increased anesthetic risk for aspiration.

Adolescent↗
PubMed1984

Endoscopy of the partitioned stomach.

Fiberoptic endoscopy is an important diagnostic modality for evaluation of the patient with upper gastrointestinal (GI) tract symptoms following gastric bypass and gastroplasty. During a 3-year period, 182 patients underwent gastric partitioning procedures and 22 patients (12%) developed upper GI symptoms requiring endoscopic evaluation. Eight patients had undergone Mason vertical banded gastroplasty, 12 patients had undergone Gomez gastroplasty, and two patients had undergone Roux-en-Y gastric bypass. In four of five patients with abdominal pain, gastritis of the proximal pouch was observed. Of the two patients with symptoms of obstruction of the proximal gastric outlet, one patient was found to have a cherry pit occluding the channel. Intraoperative endoscopy was performed in one patient who developed upper GI bleeding after Roux-en-Y gastric bypass, the pylorus was scarred and stenotic and multiple superficial ulcerations were seen in the excluded distal stomach. In eight patients with symptoms suggestive of channel stenosis, four were found to have a stenotic channel and underwent endoscopic dilation of the channel. Upper GI endoscopy was performed in eight patients with Gomez gastroplasty to confirm suspected dilatation of the channel between the upper and lower gastric pouches. Upper GI contrast studies did not estimate accurately the diameter of the channel as determined during endoscopy. No complications were observed following any of the endoscopic procedures. As the collective experience with gastric partitioning procedures increases, the need for endoscopic examinations of the upper GI tract will also increase. Endoscopists should be familiar with the altered gastric anatomy and with the spectrum of upper GI lesions that develop following these operations.

Constriction, Pathologic↗
PubMed1992

Office endoscopy.

Increasing numbers of physicians are considering office endoscopy. Planning for office endoscopy should include the nursing personnel who will be staffing the unit. This article introduces readers to office endoscopy and addresses issues involved in establishing an office-based endoscopy center.

Endoscopes↗
PubMedDate not supplied

Midazolam-induced sedation for upper gastrointestinal endoscopy: assessment of endoscopist and patient satisfaction.

Upper gastrointestinal endoscopy can be performed without intravenous sedation but the evidence suggests most patients and endoscopists prefer some form of premedication. Intravenous diazepam or midazolam are used by the majority of endoscopists in the United States, though it is not common practice in Turkey where this study was conducted. This study aimed to evaluate the efficacy and safety of midazolam in performing upper gastrointestinal endoscopy. A total of 352 patients undergoing upper gastrointestinal endoscopy were sedated with midazolam given as a bolus injection over 5 seconds. Ages of the patients ranged between 16 and 79 years (average: 41.6 +/- 12.7 years). The course of endoscopy, anterograde memory, degree of cooperation, degree of sedation, side effects, and acceptability of further intervention were evaluated by a questionnaire given to the patients and endoscopists.

Adolescent↗
PubMed1986

Gastrointestinal endoscopy in octagenarians.

Seventy-five patients, 80-90 years old, each having approximately three associated diseases, underwent a total of 104 gastrointestinal endoscopies. Of these, 73 were upper (29 emergencies) and 31 lower endoscopies (21 were rigid sigmoidoscopies). There were two very mild short-lived complications; vomiting and bleeding. We found 16 gastric ulcers, 16 duodenal or pyloric ulcers, and 11 cases of esophagitis. Bleeding duodenal (8) or gastric (4) ulcers and polyps or malignant tumors (7) were seen less often. In 34 of 68 lesions the endoscopic and x-ray findings were the same. In the other 34 there were 10 endoscopic failures to identify colonic diverticula, hiatus hernia, and gastroesophageal reflux that were seen radiologically. In 24 patients, diagnoses were not made radiologically, but were recognized at endoscopy. The safety and accuracy of endoscopy in the old and sick does not differ from that in younger patients.

Aged↗
PubMed1996

Presence of family member during upper endoscopy. What do patients and escorts think?

We evaluated what effect an escort present during upper endoscopy had on the attitude and anxiety level of patients and on the escorts. The study consisted of 206 patients (ages 15-85, 47% male) and their escorts. Both patients and escorts were interviewed before the procedure. Escorts were then randomly divided into two groups-on-the-spot escorts, who present throughout the procedure, as opposed to waiting-room escorts. Both groups were reinterviewed following the procedure. Before the procedure, 80% of the patients understood the nature of endoscopy. Thirteen percent believed the procedure to be dangerous, and only 33% were totally worry-free. Fifty percent preferred to be escorted during the procedure, while 17% refused. Following the procedure, 89% of the patients who were escorted in the endoscopy room expressed satisfaction. Fifty-two percent of the patients found the procedure to be mild, with a higher proportion among escorted patients. Among the escorts, 63% felt that their close presence had lessened their own fears and anxiety regarding the procedure, and 72% believed their presence to have been supportive to the patient. Having an escort present throughout endoscopy appears to be a promising approach.

Adolescent↗
PubMed2002

Sedation with intranasal midazolam in adults undergoing upper gastrointestinal endoscopy.

The use of intranasal (IN) midazolam in adults for sedation in upper gastrointestinal endoscopy has been evaluated in a controlled clinical study. Eighty-one patients with a mean age of 37.02 +/- 12.50 years who underwent upper gastrointestinal endoscopy for various reasons were included in the study. Three groups were formed according to the sedation regimen. In the first group (n = 30), patients received IN midazolam. In the second group (n = 28) intravenous (IV) midazolam was given for sedation, and the third group of patients (n = 23) received placebo before the procedures. Patients were monitored (using a pulse oximeter with an interval of 5 minutes until the 45th minute after the procedure) for arterial oxygen saturation, heart rate, systolic and diastolic arterial blood pressure, and respiratory rate. Efficacy of sedation, amnesia, side effects, and patients' preferences were evaluated. Superior results regarding the efficacy of sedation has been documented with the use of IV midazolam (p < 0.001), and this was the preferred route for drug application according to the patients' answers (p < 0.01). However, regarding amnesia, IN midazolam was found to be almost equally effective as IV midazolam (p < 0.05); moreover, IN route of drug application caused significantly fewer side effects than did the IV form (p < 0.001 ). Intranasal application of midazolam for gastrointestinal endoscopy appeared to be an interesting alternative to the IV route, the usage of which might be limited because of its potentially serious side effects. In contrast to the IV application of midazolam, the IN route may not even necessitate the monitoring of the patient during upper gastrointestinal endoscopy.

Administration, Intranasal↗
PubMed2003

Videocapsule endoscopy renders obscure gastrointestinal bleeding no longer obscure.

INTRODUCTION: Hemorrhage arising from inaccessible areas of the gastrointestinal tract has long been an enigma in gastroenterology. The advent of the Given M2A videocapsule endoscope now permits direct visualization of small bowel mucosa. The purpose of this study is to compare the diagnostic yield of the Given M2A videocapsule endoscope to conventional push enteroscopy. METHODS: Twenty consecutively referred patients (9 men aged 54.8 +/- 21.7 years, 11 women aged 65.6 +/- 16.6 years) who had previously had 1.6 +/- 0.8 EGDs, 1.6 +/- 0.8 colonoscopies, at least 1 normal small bowel radiographic study, and who had received 6.2 +/- 3.9 units of blood were studied. Patients underwent videocapsule endoscopy and subsequently push enteroscopy within 1 week. The endoscopist was blinded to the results of the videocapsule study. RESULTS: Videocapsule endoscopy determined the source of bleeding in 12/20 (60%) of patients versus 15% for push enteroscopy (McNemara chi2, P = 0.02). Videocapsule endoscopy found a source of bleeding in 9/13 patients in whom enteroscopy was negative. Three patients had surgical resections for vascular ectasias (2) and a hamartoma (1) based on the videocapsule endoscopy results. CONCLUSION: The Given M2A videocapsule endoscope has superior diagnostic utility for the evaluation of gastrointestinal bleeding when compared with standard push enteroscopy. The Given M2A videocapsule endoscope can be used to direct appropriate therapy in addition to avoiding the use of unnecessary conventional endoscopic and radiologic procedures.

Aged↗
PubMed1982

Bacteremia in children following upper gastrointestinal endoscopy or colonoscopy.

Fifty children undergoing upper gastrointestinal endoscopy and 25 undergoing colonoscopy were studied prospectively with aerobic and anaerobic blood cultures for the development of bacteremia. Twenty-six of the endoscopies and all the colonoscopies were done under general anesthesia. Cultures were obtained before, at 5 min, and at 30 min after the procedure. Only a single positive blood culture was obtained in an upper endoscopy patient. All cultures from the colonoscopy patients were negative. Biopsy or polypectomy were not important variables in the development of bacteremia. It is concluded that the risk of bacteremia in children following upper endoscopy or colonoscopy is minimal and should not be considered a contraindication to their performance.

Adolescent↗
PubMed1994

Contribution of endoscopy to early diagnosis of hypertrophic pyloric stenosis.

The diagnostic accuracy of ultrasonography and gastrointestinal endoscopy was compared in 63 infants who were operated on for infantile hypertrophic pyloric stenosis. Endoscopy was far more accurate than ultrasonography, the diagnosis being made in 97 and 81% of the cases, respectively. The difference between the techniques was even more obvious in the younger patients and in those with a short history of vomiting. The ability to detect coexistent or other causes of vomiting with endoscopy appeared advantageous. The endoscopic procedure is easily done without general anesthesia and was without complications in our series. We recommend endoscopy as an important tool in very young patients with few clinical signs other than vomiting, allowing for appropriate treatment without delay.

Endoscopy↗