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At least 883 records · Page 49Linked to original sources
PubMed2003

Flexible endoscopy simulators.

Training in flexible endoscopy is becoming increasingly complex. In an effort to improve the efficiency of endoscopic education, physicians are turning to simulation technology to provide a platform for training away from the endoscopy suite. The concept of medical simulation is not new, but the recent addition of powerful computer-generated virtual reality simulation has revolutionized the field. These compact computers are now able to generate a simulated environment that not only mimics the movement of the endoscope, but also recreates the sounds of the endoscopy suite, the feel of the movement of the scope, the reaction of intestinal tissue, and the response of a patient experiencing discomfort. Within this life-like simulated environment, a wide variety of diagnostic and therapeutic endoscopic procedures can be performed. This article reviews the history of flexible endoscopy simulators and details the most advanced models currently available. The literature supporting the use of these simulators is also presented, and issues involving the incorporation of simulation technology into endoscopic education and credentialing are discussed.

Animals↗
PubMed2006

The future of teaching surgical endoscopy.

Gastrointestinal surgery, with its emphasis on endoscopy, has renewed interest in teaching surgical endoscopy. The field is rapidly evolving, with innovative techniques emanating from the laboratory to the operating room and endoscopy suite. To ensure that surgeons spearhead the field of endoscopic surgery, a new strategy for teaching surgical endoscopy to residents and practicing surgeons must be developed.

Education, Medical, Graduate↗
PubMed2005

Usefulness of post-mortem ophthalmological endoscopy during forensic autopsy: a case report.

Post-mortem intraocular findings in two autopsy cases with traumatic intracranial haemorrhage were obtained using an ophthalmological endoscope. The endoscopy results clearly revealed the presence of intraocular haemorrhages and papilledema caused by intracranial haemorrhage. Post-mortem ophthalmological endoscopy offers several benefits. First, post-mortem intraocular findings can be directly observed in corpses with post-mortem clouding of the cornea. Secondly, the endoscopy only requires a 0.9 mm incision in the sclera and does not require the removal of the eye from the corpse, a procedure that should be avoided for ethical and cosmetic reasons. Thus, post-mortem opthalmological endoscopy is a useful method for obtaining intraocular findings in autopsies.

Aged↗
PubMed1984

Problems in localization of bleeding sites and the incidence of varicose rupture in emergency endoscopy.

An investigation was made for problems involved in identification of bleeding sites and the incidences of bleeding from esophageal and gastric varices in emergency endoscopy within 24 hr after overt gastrointestinal bleeding. Varices or ulcers are not always the source of bleeding, and endoscopic examinations should be performed early after the onset of bleeding to make correct identification of the bleeding site. For such purposes, aspiration using endoscopy, washing under direct observation using a teflon tube and changing of body posture were found effective. During the 6 years from 1977, bleeding from the esophageal or gastric varices was detected in 4 cases out of 30 cases of esophageal or gastric varices which had undergone emergency endoscopy for overt bleeding. After June, 1979, when hemostatic measure using pure ethanol was applied actively, bleeding from esophageal or gastric varices was observed in 4 cases (2.5%) out of 160 cases. Results of the present emergency endoscopy revealed that the incidence of rupture of varices was not so high as had been expected conventionally.

Emergencies↗
PubMed1997

Contact endoscopy of the nasal mucosa.

The possibility of contact endoscopy in the nasal mucosa, using a contact microlaryngoscope is examined. With contact endoscopy it has been possible to visualize in vivo and in situ (60x, 150x) the superficial cell layers of the nasal epithelium, previously stained with methylene blue. Normal mucosa and cases with pathology (chronic rhinitis, nasal polyposis, inverted papilloma, mucormicosis and carcinoma) were assessed with contact endoscopy (50 patients). Squamous epithelium, ciliated epithelium, glandular ostia, mucus secretions, microvascular networks, inflammatory cell infiltrates, tissue inclusions, nuclear abnormalities, and fungal hyphae have been made visible. The potential of contact endoscopy in the nose, the alterations required in the contact endoscope and the intense interdisciplinary work needed are discussed. Evaluation and differentiation of stages of chronic mucosal diseases, nasal polyposis, environmental pathology, allergy, mucocilliary diseases, pharmacotherapy, are some of the entities that will benefit from this technique.

Adolescent↗
PubMed1990

Therapeutic upper gastrointestinal endoscopy. Past, present, and future.

Therapeutic procedures in upper gastrointestinal endoscopy are usually performed with the patient under sedation, and there is a clear advantage with video endoscopy. The endoscopy assistant needs full training on the appropriate and safe use of equipment and accessories. Complications of procedures should be detected early and managed appropriately. Indications, results, and perspectives of endoscopic procedures are reviewed for the following situations: gastrointestinal bleeding, caustic injury, foreign bodies, advanced and superficial cancer, dysplasia, reflux esophagitis, motility disorders, and nutritional assistance. Consolidation of current methods and systematic evaluation of the results of therapeutic endoscopy are important tasks for the near future.

Duodenal Diseases↗
PubMed1993

Sedation and monitoring in gastrointestinal endoscopy.

The use of sedation and monitoring in gastrointestinal endoscopy is still open for debate. In The Netherlands, generally, no systemic sedation is used for relatively simple procedures like diagnostic upper GI endoscopy and sigmoidoscopy. In most centres, for more time-consuming and burdensome endoscopies like colonoscopy, ERCP, sclerotherapy and therapeutic procedures, some form of sedation is applied. In a survey among a number of University Hospitals in The Netherlands it was shown that the sedatives mostly used are midazolam and diazepam. In more complex endoscopies these sedatives are often combined with narcotics like pethidine, morphine, fentanyl or thalamonal. Equipment to monitor the effect of these compounds on respiratory or cardiovascular function is not routinely available. However, there is a tendency towards the use of monitoring equipment and more specific to the use of pulse oximetry. Endpoints of conscious sedation are anxiolysis, amnesia and cooperation; it should not lead to ptosis, dysarthria and drowsiness. Features of drugs for conscious sedation should include these aforementioned points as well as a defined dose-effect relationship and a broad therapeutic window. Furthermore, they should be water soluble and give rapid recovery. Signs of oversedation are hypotension, bradycardia and respiratory depression. Competitive antagonists to the receptor, like flumazenil, can reverse overdosage of benzodiazepine sedatives. The sedative of choice at this moment is midazolam. When a benzodiazepine is combined with a narcotic, the narcotic should be given first and the dosage of the sedative adjusted.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Well-being and gastrointestinal symptoms among patients referred to endoscopy owing to suspected duodenal ulcer.

BACKGROUND: Few studies have evaluated quality of of life (QoL) in patients with upper gastrointestinal diseases, and there is a lack of validated measures for use in gastroenterology. METHODS: The applicability and relevance of self-administered questionnaires such as the Psychological General Well-Being (PGWB) index and the Gastrointestinal Symptoms referred to endoscopy because of suspected duodenal ulcer were evaluated. RESULTS: In total, 1526 patients with suspected duodenal ulcer were screened for inclusion in a clinical study. On the basis of medical history and endoscopy, 1424 patients who completed the questionnaire before endoscopy were classified in five diagnostic groups: oesophagitis, gastric ulcer, duodenal ulcer, negative endoscopy, and gastritis duodenitis. Irrespective of diagnosis, all patient groups reported a considerable decrease in their general well-being (mean score, 85, compared with 105 in healthy populations) with no significant differences between the groups. The results of the GSRS, however, showed statistically significant differences between the groups in dimensions depicting Abdominal pain, Reflux, Indigestion, and Diarrhoea Syndrome. CONCLUSIONS: The results of the study showed that, irrespective of endoscopic findings, patients complaining of upper gastrointestinal symptoms have a low degree of general well-being. The symptoms profiles in the different diagnostic groups vary considerably.

Duodenal Ulcer↗
PubMed1998

Intraoperative endoscopy in the management of patients with colorectal disease.

Preoperative colonoscopy is recommended in the evaluation of patients with lower gastrointestinal malignancies. The purpose of this study was to investigate the indications and impact on patient management in patients undergoing intraoperative endoscopy. This is a retrospective review of patient charts from February 1972 to July 1994 of 69 intraoperative endoscopic procedures performed in 54 patients during 54 operative sessions. The results of intraoperative endoscopy affected patient management in 29 of the 54 operative sessions (54%). This included 9 cases (17%) in which the planned surgical procedure was altered. There were no complications related to the endoscopies and 99% were completed successfully. Intraoperative endoscopy can provide important information that can alter the surgical management of patients with colorectal disease. This technique should be considered when intraoperative palpation fails to identify synchronous lesions identified on preoperative studies or in cases where the preoperative study is suboptimal.

Adult↗
PubMed2004

Wireless capsule video endoscopy: three years of experience.

AIM: To review and summarize the current literature regarding M2A wireless capsule endoscopy. METHODS: Peer reviewed publications regarding the use of capsule endoscopy as well as our personal experience were reviewed. RESULTS: Review of the literature clearly showed that capsule endoscopy was superior to enteroscopy, small bowel follow through and computerized tomography in patients with obscure gastrointestinal bleeding, iron deficiency anemia, or suspected Crohn's disease. It was very sensitive for the diagnosis of small bowel tumors and for surveillance of small bowel pathology in patients with Gardner syndrome or familial adenomatous polyposis syndrome. Its role in celiac disease and in patients with known Crohn's disease was currently being investigated. CONCLUSION: Capsule video endoscopy is a superior and more sensitive diagnostic tool than barium follow through, enteroscopy and entero-CT in establishing the diagnosis of many small bowel pathologies.

Contraindications↗
PubMed2004

Capsule endoscopy in diagnosis of small bowel Crohn's disease.

AIM: To evaluate the effectiveness of wireless capsule endoscopy in patients with suspected Crohn's disease (CD) of the small bowel undetected by conventional modalities, and to determine the diagnostic yield of M2A Given Capsule. METHODS: From May 2002 to April 2003, we prospectively examined 20 patients with suspected CD by capsule endoscopy. The patients had the following features: abdominal pain, weight loss, positive fecal occult blood test, iron deficiency anaemia, diarrhoea and fever. All the patients had normal results in small bowel series (SBS) and in upper and lower gastrointestinal endoscopy before they were examined. Mean duration of symptoms before diagnosis was 6.5 years. RESULTS: Of the 20 patients, 13 (65%) were diagnosed as CD of the small bowel according to the findings of M2A Given Capsule. The findings detected by the capsule were mucosal erosions (2 patients), aphthas (5 patients), nodularity (1 patient), large ulcers (2 patients), and ulcerated stenosis (3 patients). The distribution of the lesions was mainly in the distal part of the small bowel, and the mild degree of lesions was 54%. CONCLUSION: Wireless capsule endoscopy is effective in diagnosing patients with suspected CD undetected by conventional diagnostic methods. It can be used to detect early lesions in the small bowel of patients with CD.

Adolescent↗
PubMed2005

Effect of oral erythromycin on gastric and small bowel transit time of capsule endoscopy.

AIM: To determine the effect of oral erythromycin on gastric and small bowel transit time of capsule endoscopy. METHODS: Consecutive patients who underwent capsule endoscopy during the 16-mo study period were either given 250 mg oral erythromycin, 1 h prior to swallowing the capsule endoscope or nothing. The gastric and small bowel transit time, and the small bowel image quality were compared. RESULTS: Twenty-four patients received oral erythromycin whereas 14 patients were not given any prokinetic agent. Patients who received erythromycin had a significantly lower gastric transit time than control (16 min vs 70 min, P = 0.005), whereas the small bowel transit time was comparable between the two groups (227 min vs 183 min, P = 0.18). Incomplete small bowel examination was found in three patients of the control group and in one patient of the erythromycin group. There was no significant difference in the overall quality of small bowel images between the two groups. A marked reduction in gastric transit time was noted in two patients who had repeat capsule endoscopy after oral erythromycin. CONCLUSION: Use of oral erythromycin significantly reduces the gastric transit time of capsule endoscopy.

Body Mass Index↗
PubMed2006

Intraoperative endoscopy in obstructive hypopharyngeal carcinoma.

AIM: To demonstrate the necessity of intraoperative endoscopy in the diagnosis of secondary primary tumors of the upper digestive tract in patients with obstructive hypopharyngeal carcinoma. METHODS: Thirty-one patients with hypopharyngeal squamous cell carcinoma had been operated, with radical intent, at our Institution in the period between 1978 and 2004. Due to obstructive tumor mass, in 7 (22.6%) patients, preoperative endoscopic evaluation of the esophagus and stomach could not be performed. In those patients, intraoperative endoscopy, made through an incision in the cervical esophagus, was standard diagnostic method for examination of the esophagus and stomach. RESULTS: We found synchronous foregut carcinomas in 3 patients (9.7%). In two patients, synchronous carcinomas had been detected during preoperative endoscopic evaluation, and in one (with obstructive carcinoma) using intraoperative endoscopy. In this case, preoperative barium swallow and CT scan did not reveal the existence of second primary tumor within esophagus, despite the fact that small, but T2 carcinoma, was present. CONCLUSION: It is reasonable to use intraoperative endoscopy as a selective screening test in patients with obstructive hypopharyngeal carcinoma.

Adult↗
PubMed2006

Usefulness of duodenal biopsy during routine upper gastrointestinal endoscopy for diagnosis of celiac disease.

AIM: To describe the trend in duodenal biopsy performance during routine upper gastrointestinal endoscopy in an adult Spanish population, and to analyze its value for the diagnosis of celiac disease in clinical practice. METHODS: A 15 year-trend (1990 to 2004) in duodenal biopsy performed when undertaking upper gastrointestinal endoscopy was studied. We analysed the prevalence of celiac disease in the overall group, and in the subgroups with anaemia and/or chronic diarrhoea. RESULTS: Duodenal biopsy was performed in 1033 of 13 678 upper gastrointestinal endoscopies (7.6%); an increase in the use of such was observed over the study period (1.9% in 1990-1994, 5% in 1995-1999 and 12.8% in 2000-2004). Celiac disease was diagnosed in 22 patients (2.2%), this being more frequent in women than in men (3% and 1% respectively). Fourteen out of 514 (2.7%) patients with anaemia, 12 out of 141 (8.5%) with chronic diarrhoea and 8 out of 42 (19%) with anaemia plus chronic diarrhoea had celiac disease. A classical clinical presentation was observed in 55% of the cases, 23% of the patients had associated dermatitis herpetiformis and 64% presented anaemia; 9% were diagnosed by familial screening and 5% by cryptogenetic hypertransaminasaemia. CONCLUSION: Duodenal biopsy undertaken during routine upper gastrointestinal endoscopy in adults, has been gradually incorporated into clinical practice, and is a useful tool for the diagnosis of celiac disease in high risk groups such as those with anaemia and/or chronic diarrhoea.

Adult↗
PubMed2006

[Clinical value of capsule endoscopy in obscure gastrointestinal bleeding].

OBJECTIVE: To investigate clinical diagnostic value of capsule endoscopy in obscure gastrointestinal bleeding. METHODS: Capsule endoscopy were performed in 90 patients with obscure gastrointestinal bleeding, which was defined as negative finding by gastroscopy and colonoscopy in our hospital. RESULT: In 90 patients, 2 of them accepted second examination. Eighty-seven of 92 (94.57%) patients accepted of capsule endoscopy successfully including 21 of 25 (84.0%) in group of acute massive bleeding and 66 of 67 (98.51%) in recurrent melena (P <0.05). In above patients, 74 of 87 (85.06%) had positive findings and the false negative rate was 17.24%. The detectable rate in acute massive bleeding and recurrent melena was 80.95% and 86.36%, respectively (P >0.05), and the false negative rate of that was 23.81% and 15.15%, respectively (P >0.05). CONCLUSION: Capsule endoscopy can be performed safely and well-toleratedly for visualizing the small bowel in patients with obscure gastrointestinal bleeding, which induces a highly detectable rate compared with other methods for detecting obscure gastrointestinal bleeding.

Adolescent↗
PubMed2005

[Practical training in gastrointestinal endoscopy].

In this paper, we describe a practical approach to the gastrointestinal endoscopy. We comment on the basic clinical education, endoscopy training with static models, basic courses with animals, as well as a reference to audiovisual media as books, journals, videotapes and CDs. Also we deal with the computer simulation. We describe the strategies for the interventional endoscopy training, as well as the education in the future developments. At the end, we introduce a structured training in gastrointestinal endoscopy.

Endoscopy, Gastrointestinal↗
PubMed1986

"Open-access" endoscopy for general practitioners. Experience of a private gastrointestinal clinic.

Previous authors have questioned the value of an "open-access" upper gastrointestinal endoscopy service, its increased usage and its low useful diagnostic yield. We have analysed the results of 8270 consecutive endoscopies that were performed in one private outpatient gastrointestinal clinic from 1977 to 1984. Of these, 1409 endoscopies were performed as part of an open-access service for referring doctors. The remainder were performed after referral for a gastrointestinal consultation. No deaths or major complications occurred in either group. A steady increase in referrals to both groups was noted over the years, with an increasing proportion of normal results. A positive endoscopic finding was found significantly more frequently in the open-access group (61%) compared with those patients that were referred for a gastrointestinal consultation (52.6%). Individual endoscopists varied significantly in their tendency to report mucosal inflammatory lesions. We believe that outpatient open-access endoscopy that is performed by experienced clinicians with trained staff and appropriate facilities is a safe and acceptable alternative to barium meal examinations.

Ambulatory Care Facilities↗
PubMed2003

Initial experience with capsule endoscopy at a major referral hospital.

OBJECTIVES: To determine the utility of capsule endoscopy in patients referred for investigation of suspected disease of the small intestine. DESIGN AND SETTING: Single centre, prospective, cohort study from 4 July 2001 to 8 September 2002. PATIENTS: Sixty consecutive patients who underwent capsule endoscopy for investigation of suspected disease of the small intestine. MAIN OUTCOME MEASURES: Abnormal findings at capsule endoscopy. RESULTS: Examination of the entire small bowel was achieved in 46/60 patients (77%). Thirty-two of 47 patients (68%) referred with obscure gastrointestinal bleeding had positive findings. Seven of nine patients (78%) referred for investigation of suspected Crohn's disease had small bowel erosions or ulcers consistent with Crohn's disease. The capsule was not passed in one patient. CONCLUSION: Capsule endoscopy is a novel, minimally invasive and useful tool for the investigation of the small intestine.

Capsules↗