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PubMed1999

[Preventive effect of postoperative disinfection of endoscope on bacterial adhesion to endoscope].

We took culture of throat swab from 77 subjects who were negative for infection of HBV, HCV, HIV and syphilis infection before and after endoscopy. Moreover, the existence of bacterium including Helicobacter pylori at overcoat of endoscopic instrument was investigated right after examination and after disinfection of endoscope. Povidoneiodine, 70% alcohol and 1% benzalkonium chloride was used as a disinfectant for endoscope, and it took less than 10 minutes to wash by hand to disinfection. alpha-haemolytic streptococci, Staphylococcus epidermids, Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Enterococcus faecalis, Candida, Pseudomonas aeruginosa and MRSA were cultured in throat swab. The rate of adhesion of bacterium especially such as Candida, K. pneumoniae and S. epidermids to endoscope was considerably high. 23 of 77 subjects had H. pylori infection, and the adhesion of H. pylori to endoscope was found to be 65.2% of the subjects. On the contrast, no bacterium was detected from the endoscopic instrument after careful disinfection. These findings stress the importance of postoperative disinfection of the endoscope to prevent the chance to acquire bacterial infection.

2-Propanol↗
PubMed1995

Endoscopic US of the gastrointestinal tract with endoscopic, radiographic, and pathologic correlation.

Endoscopic ultrasonography (US) makes it possible to evaluate the layers of the wall of the gastrointestinal tract, as well as surrounding structures. The authors have used endoscopic US to evaluate the gastrointestinal tract in 160 patients. In the esophagus, endoscopic US is useful in staging esophageal carcinoma, planning radiation therapy ports, and locating and characterizing esophageal masses. Endoscopic US of the esophagus is also used to identify varices and evaluate the results of therapy. Applications of endoscopic US in the stomach include staging of gastric carcinoma, localization and characterization of nonmucosal gastric masses, detection and evaluation of gastric varices, and evaluation of gastric lymphoma. In the pancreas, endoscopic US is used for detecting pancreatic masses; staging pancreatic, distal common bile duct, and ampullary carcinoma; and evaluation biliary tract obstruction. Applications of endoscopic US in the rectum include localization and characterization of nonmucosal lesions and local staging of rectal carcinoma.

Digestive System Diseases↗
PubMed2006

Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L5-S1 using a rigid working channel endoscope.

OBJECTIVE: Percutaneous endoscopic transforaminal discectomy is often used as a minimally invasive procedure for lumbar disc herniation. However, a transforaminal approach posts limitations at the L5-S1 level owing to anatomic constraints, such as a high iliac crest or small intervertebral foramen and especially for migrated large intracanalicular disc herniations. We discuss the procedure and clinical results of percutaneous endoscopic interlaminar discectomy using a rigid working channel endoscope at the L5-S1 level and the relevant surgical anatomy. METHODS: We performed percutaneous endoscopic discectomy through the interlaminar approach in 67 patients who satisfied our inclusion criteria during the period from March 2002 to November 2002. All procedures were performed under local anesthesia. Under fluoroscopic guidance, we performed discography using indigocarmine mixed with radio-opaque dye. The 6-mm working channel endoscope was then introduced into the epidural space. Herniated disc material was removed using forceps and laser under clear endoscopic visualization. We retrospectively evaluated the 65 cases with more than 1.5 years of follow-up. The patients were evaluated using the visual analogue scale (VAS) and the Oswestry Disability Index (ODI). RESULTS: VAS for leg pain (preoperative mean, 7.89; postoperative mean, 1.58) and ODI (preoperative mean, 57.43; postoperative mean, 11.52) showed statistically significant (P = 0.00) improvement in their values at the last follow-up examination compared with preoperative scores. Of the study group, 90.8% individuals showed favorable result. The mean hospital stay was 12 hours. The average time to return to work was 6.79 weeks. Complications included two cases of dural injury with cerebrospinal fluid leakage, nine cases of dysesthesia that were transient, and one case of recurrence. Two patients required conversion to open procedure at the initial operation. There was no evidence of infection in any patients. CONCLUSION: Percutaneous endoscopic interlaminar discectomy is a safe, effective, and minimally invasive procedure for the treatment of intracanalicular disc herniations at the L5-S1 level in properly selected cases, especially when the transforaminal approach is not possible because of anatomic constraints.

Adult↗
PubMed2003

[Minimal invasive treatment of early esophageal cancer and its precancerous lesion: endoscopic mucosal resection using transparent cap-fitted endoscope].

OBJECTIVE: To explore the effect of endoscopic esophageal mucosal resection using transparent cap-fitted endoscope to treat early esophageal cancer and severe hyperplasia, precancerous lesion of esophageal cancer. METHODS: Endoscopic esophageal mucosal resection were performed with transparent-cap technique on 29 cases of early esophageal cancer and 42 cases of severe hyperplasia, and the residual lesions were treated by Argon plasma coagulation (APC). All patients were followed up by endoscopic examination one month, 4 months, and 12 months after the therapy. RESULTS: (1) Local esophageal mucosa with the size of 21.8 mm +/- 1.02 mm x 18.2 mm +/- 1.02 mm on average was resected from 71 cases, with 88 lesions, using transparent cap-fitted endoscope. 1:1,000 saline-epinephrine at an average dose of 18 ml was injected submucosally for each lesion. (2) After the mucosectomy 5 cases had bleeding which was controlled successfully by compression, local injection of saline-epinephrine, and APC. None case suffered from perforation. Stenosis was found in 4 cases after mucosal resection, in three of which the extent of resected mucosa exceeded 3/4 of the esophageal circumference. Water-balloon dilator was used once a month for 3 - 4 times since one month after mucosal resection. All cases were cured. (3) The lesions of 58 cases (81.2%) were completely resected, and the remaining cases had residual lesions that were treated by APC. Three cases of early cancer and 2 cases of severe atypical hyperplasia were discovered endoscopically 4 months after resection and were cured by APC. (4) All cases survived without any discomfort after a follow-up of 4.6 months on average. CONCLUSION: Safe, simple, minimally invasive and effective on early esophageal cancer and precancerous lesion, endoscopic esophageal mucosal resection (EEMR) is promising clinically.

Adult↗
PubMedDate not supplied

Combined endoscopic trephination and endoscopic frontal sinusotomy for management of complex frontal sinus pathology.

BACKGROUND: The advances in endoscopic sinus surgery have revolutionized the management of frontal sinus disease. Despite the successes, the purely endoscopic approach has its limitations, especially in patients with alterations in anatomy caused by previous surgical intervention or complex frontal sinus pneumatization patterns. The purpose of this study was to evaluate the efficacy of combined endoscopic trephination and endoscopic frontal sinusotomy (the above and below approach) in the management of these difficult cases. METHODS: Chart review was performed on patients undergoing the combined approach from October 1999 to June 2004. Demographic data, symptomatology, comorbidity, previous surgery, and primary pathology were determined. Outcome was assessed based on subjective symptom relief and objective endoscopic patency. RESULTS: Twenty-two patients with a mean age of 49.2 years underwent the combined approach. The primary pathology included mucoceles (15 patients), frontal sinusitis (2 patients), inverted papilloma (2 patients), osteoma (1 patient), fibrous dysplasia (1 patient), and pneumocephalus (1 patient). A total of 25 above and below procedures (22 primary and 3 revision procedures) were performed to manage the pathology. Postoperatively, headaches resolved in 47%, improved in 35%, and remained unchanged in 18% of the patients. Orbital symptoms resolved in 63%, improved in 25%, and remained unchanged in 12% of the patients. Endoscopic patency of the frontal sinusotomy was confirmed in 19 of 22 cases (86%) at a mean follow-up of 16.2 months. CONCLUSION: Management of complex frontal sinus pathology may require adjunct approaches in conjunction to the standard endoscopic techniques. In this series, the above and below approach was used successfully in 22 patients. The combined approach may serve as an important adjunct for management of complex frontal sinus disease.

Adult↗
PubMed1997

Influence of direction of view, target-to-endoscope distance and manipulation angle on endoscopic knot tying.

INTRODUCTION: The aim of the study was to investigate the influence of (1) the direction of view of the endoscope, (2) the endoscope-to-task distance and (3) the manipulation angle between the instruments on intracorporeal endoscopic knotting. METHODS: Rigid endoscopes (0 degree, 30 degrees and 45 degrees) were introduced with the objective set at distances of 50, 75, 100, 125 and 150 mm from the task. Needle holders were inserted to make 30 degrees, 60 degrees and 90 degrees manipulation angles. The execution time and knot quality parameters of 2700 knots performed by ten surgeons were obtained. RESULTS: There was no significant difference in the execution time or parameters of knot quality with different endoscopes. The longest execution time (median 95 s, P < 0.0001) and the lowest performance quality score (20.61, P < 0.001) were observed at a distance of 50 mm when compared to other distances. A 60 degrees manipulation angle had a shorter execution time (median 71 s, P < 0.0001) and a higher performance quality score (26.84, P < 0.0001) than either 30 degrees or 90 degrees manipulation angles. CONCLUSION: The direction of view of the endoscope had no significant effect on intracorporeal knotting if the optical axis subtended the same angle with the task surface. The optimal ergonomic conditions include an endoscope-to-target distance of 75-150 mm and a manipulation angle of 60 degrees.

Endoscopy↗
PubMed2003

Endoscopic treatment of upper GI hemorrhage with a novel irrigating hood attached to the endoscope.

BACKGROUND: Despite advances in endoscopic treatment methods for upper GI hemorrhage, hemostasis is often difficult to achieve, particularly when the endoscopic view at the site of hemorrhage is poor because of the presence of mucus and blood. The investigators developed an end hood that facilitates endoscopic hemostatic procedures while simultaneously allowing irrigation of the bleeding site. The usefulness of this end hood for treatment of upper GI hemorrhage, excluding hemorrhage from varices, was evaluated. METHODS: The end-hood piece was fabricated by drilling a side hole in the cap portion of a conventional transparent hood. An irrigation tube then was glued to the exterior surface of the hole. The fabricated transparent hood was placed on the tip of an endoscope. With the hood piece in place, hemoclip placement and other endoscopic hemostatic procedures were performed in 15 patients with nonvariceal upper GI hemorrhage. RESULTS: Hemostasis was successfully achieved in all cases. In all cases of active hemorrhage, hemostatic treatment was enhanced by simultaneous irrigation beneath the hood. The median time required for the hemostatic procedure with the attached hood was 4.8 minutes. CONCLUSION: The end-hood irrigation device and technique facilitate endoscopic hemostatic treatment of nonvariceal upper GI hemorrhage.

Aged↗
PubMedDate not supplied

Complications of endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy: diagnosis, management and prevention.

Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy are carried out for a variety of billo-pancreatic diseases. These procedures were earlier performed at only a handful of tertiary centres in India. However, of late, they are being performed at several centres and even smaller clinics. Although, endoscopic sphincterotomy is one of the most commonly performed endoscopic procedure, there are no data on the number of procedures performed each year in India. It is estimated that in the USA alone more than 200,000 procedures are performed each year. The procedure has the dubious distinction of being considered as one of the most hazardous of all endoscopic procedures and is associated with a small but significant morbidity and mortality. The immediate complications of endoscopic sphincterotomy include pancreatitis, haemorrhage, perforation and cholangitis in addition to those associated with the use of sedation and anaesthesia. There are also reports of the long term adverse effects of the destruction of the sphincter of Oddi. There is also controversy as to what should be the minimum requirements for training and who should be allowed to perform these procedures.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1998

Intraductal papillary and mucinous tumors of the pancreas: accuracy of preoperative computed tomography, endoscopic retrograde pancreatography and endoscopic ultrasonography, and long-term outcome in a large surgical series.

BACKGROUND: Few data are available on the accuracy of preoperative imaging or on long-term outcome after surgery for intraductal papillary and mucinous tumors of the pancreas. The aims of this study were to assess the following: (1) the accuracy of preoperative computed tomography, endoscopic retrograde pancreatography, and endoscopic ultrasonography for determination of tumor invasion and pancreatic extension as compared with surgical findings; (2) the long-term outcome after surgery. METHODS: Forty-seven patients who underwent surgery between 1980 and 1995 for pathologically diagnosed intraductal papillary and mucinous tumors were included in this study. The findings of available computed tomography (n = 25), endoscopic retrograde pancreatography (n = 29), and endoscopic ultrasonography (n = 21) were reviewed by experienced clinicians blinded to pathologic diagnosis to assess tumor invasion and pancreatic extension. Pathologic specimens were reviewed by experienced pathologists. Postoperative follow-up data were analyzed. RESULTS: Histologic features of invasive carcinoma were found in 43% of patients, severe dysplasia in 21%, and mild or moderate dysplasia in 36%. The overall accuracy of computed tomography, endoscopic retrograde pancreatography, and endoscopic ultrasonography in distinguishing between invasive and noninvasive tumors were, respectively, 76%, 79%, and 76%. The overall 3-year disease-free survival rate was 63%, but it was 21% among patients with invasive carcinoma at surgery (p < 0.001). CONCLUSIONS: This study emphasizes the need for early surgical resection in patients with suspected intraductal papillary and mucinous tumors of the pancreas because of the high frequency of invasive carcinoma and the inadequacy of preoperative imaging for assessing malignancy.

Adenocarcinoma, Mucinous↗
PubMed2001

Utility of endoscopic ultrasonography in endoscopic drainage of pancreatic pseudocysts in selected patients.

OBJECTIVES: To determine the effect of endoscopic ultrasonography (EUS) on endoscopic drainage of pancreatic pseudocysts and to determine patency with fistula dilation and placement of multiple stents. PATIENTS AND METHODS: Between September 1995 and January 1999, 19 patients underwent endoscopic drainage of pancreatic pseudocysts, 17 of whom were assessed by EUS before drainage. Radial EUS scanning was used to detect an optimal site of apposition of pseudocyst and gut wall, free of intervening vessels. A fistula was created with a fistulatome, followed by balloon dilation of the fistula tract. Patency was maintained with multiple double pigtail stents. The primary goal of this retrospective study was to determine whether EUS affected the practice of endoscopic drainage of pancreatic pseudocysts. RESULTS: In 3 patients, drainage was not attempted based on EUS findings. In the other 13 patients (14 pseudocysts), creation of a fistula was successful on 13 occasions, and no immediate complications occurred. However, 1 patient subsequently developed sepsis that required surgery. All other patients were treated with balloon dilation, multiple stents, and antibiotics, with no septic complications. Of 14 pseudocysts (in 13 patients), 13 (93%) resolved. CONCLUSIONS: Results of EUS may alter management of patients considered for endoscopic drainage of pancreatic pseudocysts. Endoscopic ultrasonography was useful for selecting an optimal and safe drainage site. The combination of balloon dilation, multiple stents, and antibiotics appears to resolve pancreatic pseudocysts without septic complications.

Adult↗
PubMed2004

A prospective, randomized trial of endoscopic band ligation versus endoscopic hemoclip placement for bleeding gastric Dieulafoy's lesions.

BACKGROUND AND STUDY AIMS: Dieulafoy's lesion is a rare cause of massive gastrointestinal hemorrhage, most commonly in the proximal stomach. Mechanical endoscopic methods have recently become the standard therapeutic approach. However, there have been few studies comparing the efficacy of different mechanical endoscopic methods in treating gastric Dieulafoy's lesions. This study was therefore carried out to compare the hemostatic efficacy and safety of endoscopic band ligation (EBL) and endoscopic hemoclip placement (EHP) in the treatment of bleeding gastric Dieulafoy's lesions. PATIENTS AND METHODS: Between January 2002 and October 2003, 26 consecutive patients with bleeding gastric Dieulafoy's lesions were prospectively enrolled and were randomly assigned to undergo EBL (13 patients) or EHP (13 patients). Demographic characteristics, endoscopic variables, and outcome parameters, including rates of hemostasis and recurrent bleeding, were analyzed. RESULTS: One O-ring was applied in each case in the EBL group, and the median number of hemoclips applied was one (range one to four) in the EHP group. There were no significant differences between the groups with regard to age, sex, presence of shock, initial hemoglobin level, coagulopathy, concurrent diseases, location of the lesion, type of bleeding stigmata, blood transfusion requirements, or hospitalization periods. Primary hemostasis was achieved in all 26 patients. There was one case of recurrent bleeding in each group; secondary hemostasis was achieved with EBL in one of these patients and by endoscopic epinephrine injection in the other. There were no second episodes of recurrent bleeding, no procedure-related complications, no cases in which surgery was needed, and no bleeding-related deaths in either group. CONCLUSIONS: In this small study, no differences were detected in the efficacy or the safety of EBL vs. EHP in the management of bleeding gastric Dieulafoy's lesions.

Adult↗
PubMed2006

Development of advanced endoscopes for Natural Orifice Transluminal Endoscopic Surgery (NOTES).

Natural orifice transluminal endoscopic surgery (NOTES) is a hybrid procedure which uses flexible endoscopic technology to perform laparoscopic surgical procedures within the abdominal cavity. Initial reports of animal studies describe the use of standard endoluminal endoscopes to accomplish intra-abdominal surgeries. Current flexible scopes suffer from several deficiencies which make them unlikely to be able to be used for large scale human NOTES experiences. This review analyzes the deficiencies of current endoscopes, discusses the requirements of the ideal NOTES endoscope and reviews some of the possible "endoscopes of the future" that are being developed for the next generation of surgery. Discussion focuses on the "R" scope (Olympus, Tokyo, Japan) and the Transport and Cobra scopes (USGI Medical, San Capistrano, CA).

Endoscopes↗
PubMed1999

Endoscopic resection of colloid cysts: surgical considerations using the rigid endoscope.

OBJECTIVE: Colloid cysts of the third and lateral ventricles have traditionally been treated by transfrontal and transcallosal microsurgical resection or by stereotactic aspiration. Recently, rigid and flexible ventricular endoscopic techniques have been used to treat these lesions. Our study was undertaken to examine the efficacy of rigid endoscopy in the resection of colloid cysts. METHODS: Fifteen patients with a radiological diagnosis of colloid cysts were given the option of undergoing either endoscopic surgery or craniotomy. The average tumor size was 1.43 cm. Fourteen patients underwent planned endoscopic resections, and a craniotomy was performed initially in one patient. RESULTS: Entire tumor resection was achieved with the endoscope in 12 patients (86%). A craniotomy was required for two colloid cysts that could not be resected endoscopically. In total, complete radiographic resections were achieved in 14 patients (93%). There were no permanent complications, although postoperative deficits included short-term memory loss and hemiparesis, each in one patient. CONCLUSION: Rigid endoscopy affords good optical resolution, high magnification, and excellent illumination. Total or near total resection of colloid cysts should be the goal for all patients and can be achieved using the rigid endoscope, with little morbidity, shortened operative time, reduced length of stay, and resolution of symptoms. Although long-term follow-up is needed, we think that endoscopy should be considered as a primary treatment for most patients.

Adult↗
PubMed2007

Percutaneous endoscopic discectomy for extraforaminal lumbar disc herniations: extraforaminal targeted fragmentectomy technique using working channel endoscope.

STUDY DESIGN: A retrospective analysis of 41 patients operated for excision of soft lumbar extraforaminal disc herniation (EFDH) by percutaneous endoscopic extraforaminal approach under local anesthesia by a new technique. OBJECTIVES: To describe a new and safer percutaneous endoscopic technique for the removal of soft EFDH and report the results on the basis of a new objective criterion modified from Oswestry Disability Index (ODI). SUMMARY OF BACKGROUND DATA: EFDHs usually occur in older patients and present with atypical symptoms. Their diagnosis and treatment are still controversial, with various authors describing open midline or paraspinal approaches using the microscope with varying amounts of success. Percutaneous endoscopic techniques have traditionally been considered unsuitable for these herniations. METHODS: Forty-one patients with a soft EFDH were subjected to percutaneous endoscopic discectomy with the new technique. In our technique, the skin entry point is medial and the angle of approach steeper as compared with the earlier described endoscopic techniques. This might help in avoiding exiting root injury and increasing the efficacy of the procedure. The results were analyzed on the basis of percentage change in ODI as compared with preoperative values. RESULTS: Mean follow-up was 34.1 month. Mean VAS score for radicular pain improved from 8.6 to 1.9, and mean ODI improved from 66.3 to 11.5. Overall, 92% of patients experienced satisfactory outcome. Two patients had poor outcome due to the need for subsequent open surgery. CONCLUSION: Percutaneous endoscopic discectomy using the "extraforaminal targeted fragmentectomy" technique is an effective and safe procedure for the select group of patients with a soft EFDH.

Adult↗
PubMed1997

Prospective comparison of endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography in the detection of bile duct stones.

BACKGROUND: Conventional ultrasonography is used widely in the investigation of gallstone disease but is limited in the detection of bile duct stones due to poor visualization of the distal bile duct. Endoscopic retrograde cholangiopancreatography (ERCP) is currently the investigation of choice for suspected choledocholithiasis, but is not without morbidity. Endoscopic ultrasonography clearly visualizes the entire extrahepatic biliary tree and avoids the need for ERCP in many patients. METHODS: Some 50 patients with suspected duct stones underwent endoscopic ultrasonography followed by ERCP. All cholangiograms were performed or interpreted by a second doctor blinded to the results of endoscopic ultrasonography. RESULTS: Both tests were successful in 46 patients; both tests failed in two patients and ERCP alone failed in a further two. Duct stones were confirmed in 24 patients. Sensitivity (95 per cent confidence interval (c.i.)) of ERCP and endoscopic ultrasonography in identifying these stones was 79 (58-93) per cent and 88 (68-97) per cent respectively; specificity (95 per cent c.i.) was 92 (75-99) per cent and 96 (80-100) per cent. CONCLUSION: Endoscopic ultrasonography accurately identifies bile duct stones. It is recommended in all patients with a risk of duct stones but especially in those with a history of ERCP-induced pancreatitis, when other pathology is suspected, when ERCP has failed, when bile duct abnormalities are suspected during pregnancy and in patients with acute pancreatitis.

Adolescent↗
PubMed2006

Endoscopic band ligation of small gastric stromal tumors and follow-up by endoscopic ultrasonography.

BACKGROUND: Gastrointestinal stromal tumor (GIST) is a relatively common gastric submucosal tumor with potential for malignant transformation. The efficacy of a new method for resection of these tumors, endoscopic band ligation, was evaluated. METHODS: The study included 29 patients with small gastric stromal tumors arising in the gastric muscularis propria as determined by endoscopy, endoscopic ultrasonography (EUS), and deep endoscopic biopsies. A standard endoscope with a transparent cap attached to the tip was used. The cap was placed over the lesion, maximum sustained suction was applied, and an elastic band was released around the base. Beginning two weeks after banding, the lesions were observed endoscopically once per week until healing was complete. Thereafter, all patients underwent EUS every two to three months on schedule. RESULTS: The 28 GISTs sloughed completely. The mean time required for complete healing after band ligation was 4.8 weeks. One lesion did not slough because they were not completely ligated. The lesion was ligated for the second time and sloughed completely. Bleeding occurred in one patient three days after ligation because the lesion sloughed early. The bleeding was managed successfully with metallic clips. No perforation and other complications occurred. Followup ranged from 36 to 51 months, during which time only one recurrence was observed four months postoperatively. CONCLUSIONS: Endoscopic band ligation with systematic followup by EUS is an effective and safe treatment for small GISTs.

Adult↗