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PubMed1984

Double-contrast barium meal and upper gastrointestinal endoscopy. A comparative study.

One hundred randomly selected inpatients were examined with both double-contrast barium meal and endoscopy in a blinded prospective fashion. All studies were done by staff personnel, with equal clinical information available to both the radiologist and endoscopist. The final diagnosis was made by a review committee of participating radiologists and endoscopists. Endoscopy was more sensitive (92% versus 54%, p less than 0.001) and specific (100% versus 91%, p less than 0.05) than the double-contrast barium meal. Both procedures significantly affected the clinical outcome of the patient, the effect of endoscopy being significantly greater than that of the double-contrast barium meal. Although errors with the barium study related predominantly to an inability to show subtle lesions, poor patient cooperation and perceptual and technical failures were additional significant factors. Endoscopy is recommended for certain groups of patients.

Adult↗
PubMed1999

Virtual endoscopy using surface rendering and perspective volume rendering.

Noninvasive virtual endoscopy is a new method of diagnosis using computer processing of 3-D image data sets (such as CT or MRI scans). Conventionally, two methods have been used in virtual endoscopy. One is 3-D surface rendering method. 3-D surface of human organs can be explored in real time by using this method, but surface rendering algorithm has disadvantages such as the low quality of visualized image and the loss of the volume data. The other is perspective volume rendering method. The power of perspective volume rendering is that the intrinsic 3-D richness of the volume data is preserved. However, there are the difficulty in planning flight-path and the disability of real time flight for a computationally intense procedure. This paper presents virtual endoscopy using both surface and perspective volume rendering. By combining each merits of two methods, a user can not only process virtual endoscopy interactively in real time but also view lossless and high-resolution image using the flight path defined by surface rendering. As a result, the use of common fly-paths removes the burden to define a flight-path in conventional perspective rendering method. Also 3-D object is explored in real time and viewed as lossless and detail cine sequences.

Aged↗
PubMed1999

Impact of nonsurgical, invasive endoscopy of the diagnosis and therapy of gastrointestinal diseases.

In the last 2 decades, endoscopy has become the most reliable means of diagnosing gut disorders. With the aid of magnifying endoscopy and staining methods, gastrointestinal cancers and malignant diseases can be detected in the early stages. Endoscopic ultrasonography is currently indicated for staging digestive cancers, assessing submucosal tumors, and diagnosing biliary and pancreatic diseases. During the past decade, endoscopy evolved from a solely diagnostic tool to a therapeutic modality. Endoscopic heater probes, bipolar electrocoagulation, and laser therapy are all of effective for achieving immediate hemostasis and preventing rebleeding in actively bleeding lesions. Various ligation methods and endoscopic injection sclerotherapy safely achieve high rates of hemostasis. Endoscopic mucosal resection allows curative treatment of gastrointestinal cancer in the mucosal layer, and removal of precancerous lesions. Endoscopic balloon dilators have been developed for dilating gut stenoses. Various endoprostheses are used for palliation of malignant stenoses. Endoscopic sphincterotomy, balloon dilation, lithotripsy, and endoprosthesis placement are alternatives for biliary tract and pancreatic disease therapy. Endoscopic photodynamic therapy is useful in palliation of esophageal cancer or in ablation of dysplastic lesions in Barrett's esophagus. With advances in modern biotechnology, endoscopy continues to show value in treating or preventing diseases, with less discomfort and lower cost than other methods.

Endoscopy, Gastrointestinal↗
PubMed2000

Paediatric airway endoscopy.

OBJECTIVES: To review all paediatric endoscopies performed in a tertiary referral unit over a three-year period. METHODS OF STUDY: Retrospective analysis of case-notes of all paediatric endoscopies performed between May 1993 and June 1996. RESULTS: 333 paediatric airway endoscopies were performed on 146 children, of which 52% were GP referrals and the remainder secondary referrals. 70% were diagnostic endoscopies, 30% therapeutic procedures, with the commonest indication being stridor and respiratory distress (82%). Routine chest radiographs, lateral neck X-rays, and barium swallows were unhelpful in the management of the commoner upper-airway conditions. The commonest findings were laryngomalacia (44%) and subglottic stenosis (22%) and 17% of all cases had multiple airway abnormalities. Tracheotomy was performed on 18.4%, laryngotracheoplasty on 7.5%, and laryngotracheal reconstruction on 2.5%. There were no major complications in this series. CONCLUSIONS: All children with airway symptoms should have a thorough rigid-endoscopic evaluation of their upper and lower airways. Radiology has a limited role in the diagnosis of the more common airway pathologies. These patients need to be assessed and managed in regional centres.

Adolescent↗
PubMed2000

Planned second look endoscopy in patients with bleeding duodenal or gastric ulcers.

INTRODUCTION: Preliminary studies have suggested a beneficial effect of second look endoscopy in patients with bleeding peptic ulcers. METHODOLOGY: We have performed a retrospective survey of seventy patients with bleeding peptic ulcers admitted to our unit in the period 1 September 1996-31 March 1998. Planned second look endoscopy and repeated sclerotherapy were standard care. The effects were evaluated by comparing the expected number of rebleeders with actual rebleeders. At the same time we assessed predicting factors for rebleeding. RESULTS: Fifteen of the admitted seventy patients were found to rebleed after initial sclerotherapy. The overall success rate of endoscopic therapy was 63/70 patients (90%). Six patients (9%) had to undergo surgery to obtain haemostasis, and one patient died suddenly after the second endoscopic sclerotherapy. Perforation was seen in two patients (3%) and the total mortality (30 days) was 4% (three patients). The most important factor predicting rebleeding was the occurrence of active bleeding at the initial endoscopy. CONCLUSION: From the literature we could expect that twenty to twenty-five patients would rebleed, comparing this with the findings of the present study suggests a beneficial effect on rebleeding rate of patients treated with planned second look endoscopy. Future controlled trails should verify this hypothesis.

Adult↗
PubMed1975

Fiberoptic endoscopy in the head and neck region.

The potential use of fiberoptic endoscopy in the head and neck region was evaluated by the comparison with the findings we obtained from indirect, mirror endoscopy. Fiberoptic endoscopy confirmed our clinical staging and diagnosis in 39 percent, changed our diagnosis in 41 percent, and changed our clinical staging in 20 percent of this series of patients. These findings indicate that fiberoptic endoscopy is a valuable aid for clinical staging; in some instances it may be used in preference to indirect, mirror examination; frequently, it may enable one to avoid a direct laryngoscopy. The procedure is safe, well tolerated, and may be performed on an outpatient basis. With this instrument, routine examination of the head and neck in suitable patients may lead to improved clinical evaluations.

Adolescent↗
PubMed2000

[Gastrointestinal endoscopy in children].

BACKGROUND: Abdominal pain and other gastrointestinal symptoms in children may be, but are not always due to disease. Endoscopy in general anaesthesia may be necessary in children with long-term symptoms from the gastrointestinal tract. MATERIAL AND METHODS: We present a retrospective study of all children under the age of 15 who underwent endoscopy at the Central Hospital in Akershus (SIA) in the period 1993-98. 254 gastro-, 123 colono- and 43 sigmoideoscopies were performed. A conclusive diagnosis was made following endoscopy. There were few complications to the endoscopies. RESULTS AND INTERPRETATION: Our results indicate a higher incidence of inflammatory bowel disease than in similar studies, but with the same relative rates. Celiac disease occurs at a rate similar to the Swedish epidemic in the 1980s.

Abdominal Pain↗
PubMed1975

The value of biliary endoscopy.

The value of biliary endoscopy was determined in 100 consecutive patients undergoing choledochotomy. Using a compact, rigid, right-angled choledochoscope with a rod-lens optical system the biliary tract was inspected for residual stomes following conventional exploration. Completion operative cholangiography and postoperative T-tube cholangiography were performed in all patients. Of 52 patients undergoing primary choledocholithotomy, the duct was cleared of all calculi in 51. A small residual stone was found by postoperative cholangiography in one patient. Exploration revealed no calculi in the ducts of the remaining 30 patients. Biliary endoscopy was of benefit to the surgeon in the majority of patients. In 17 patients, calculi missed by standard exploration were detected; in five of these, the calculi could be retrieved only under endoscopic control. In 11 patients, interpretation of operative cholangiograms was aided, while in three the endoscopic findings clarified operative strategy. The use of biliary endoscopy did not increase the postoperative morbidity or mortality rates beyond those oridinarily encountered in choledocholithotomy. Current experience indicates that the new choledhchoscope overcomes limitations of previous endoscopes and should serve as the definitive diagnostic tool for operative biliary endoscopy. The addition of this technique to the armamentarium of the biliary surgeon will play a significant role in overcoming the age-old problem of the retained common duct stone.

Aged↗
PubMed2000

[Digestive endoscopy in children].

Also in the pediatric population the digestive endoscopy became, at this point, a very good diagnostic and operative technique largement used. The endoscopy can explore the upper gastrointestinal tract (esophagus, stomach, duodenum and jejunum) and can investigate the colon and the terminal ileum regarding the lower gastrointestinal tract. Principally, the operative endoscopy concerns emostasis of gastrointestinal bleeding, polipectomy, extraction of foreign bodies, and intestinal dilatations. The patients population submitted to this investigation by now is very wide thanks to the modernization of the instruments and at specialization of gastroenterologist pediatricians: range from newborn, to childhood, adolescence and young adults. The gastroenterologist pediatricians specialization associated to a routine use of amnemonic drugs (benzodiazepine) reduced at the minimum the invasivity of endoscopy; this technique can be considered a good safe procedure and free of important physical and psychic side effects for the young patient.

Child↗
PubMed2001

Prevalence of Helicobacter pylori in Northern Jordan. Endoscopy based study.

OBJECTIVE: Helicobacter pylori infection is considered the most common infection worldwide and is associated with many other disorders. The aim of this study is to determine the prevalence of this infection among patients undergoing endoscopy in Northern Jordan. METHODS: Between November 1998 and September 2000, all patients referred from the Gastro-esophageal Clinic to the Endoscopy Unit at Princess Basma Teaching Hospital, Irbid, Northern Jordan were enrolled in this prospective study. For each patient clinical and epidemiological data was collected and endoscopy was performed. At least 3 antral biopsies were obtained from each patient, and these were examined histologically for the presence of gastritis and stained for Helicobacter pylori using modified Giemsa stain. RESULTS: A total of 197 consecutive patients (113 females) with a mean age of 40.2 years (range 15-91 years) were studied. Abdominal pain was the highest presenting symptom. Gastritis 91% and esophagitis 42% were the most frequent endoscopic findings. Gastritis was documented histologically in 183 (93%) of patients. Helicobacter pylori was found in 161 patients (82%), with all of these having histological gastritis. The 11 patients with gastric ulcer, compared to the 51 out of the 59 (86%) patients with duodenal ulcer, showed Helicobacter pylori in their biopsies. CONCLUSION: The prevalence of Helicobacter pylori infection in patients subjected to an upper gastrointestinal endoscopy in Jordan is high. This study confirms that Helicobacter pylori is significantly associated with gastritis and peptic ulcer. Further studies are needed to determine the types of Helicobacter pylori strains present in Jordan.

Adolescent↗
PubMed2002

[Indigo carmine contrast staining in combination with high resolution electronic endoscopy].

INTRODUCTION: Chromoendoscopy is an old endoscopic technique which has a renascence in the era of high resolution electronic endoscopy. Indigo carmine, this deep blue stain is not absorbed by gastrointestinal epithelium. It pools in crevices and valleys and highlights small lesions and defines irregularities in mucosal architecture. METHOD: The indigo carmine dye contrast method was introduced in author's endoscopic laboratory in 1994 and high resolution (400 k.pixels) endoscopy in 1997. 0.1-0.5% indigo carmine solution was administered to the gastric, duodenal or colonic mucosa through the biopsy channel of the endoscope. The author found the dye method gave dramatic accentuation of abnormalities of mucosal architecture (i.e. small irregularities, ulcer scars, extent of small tumours, polyps) and was suitable to evaluate villous atrophy in the duodenum. RESULTS: Using indigo carmine and high resolution electronic endoscopy it was possible to diagnose 3 times more gastric adenomas than was in the past. In the colon it was studied the surface appearance of colonic crypts and was able to discriminate between hyperplastic polyps which had a tipical "pit" pattern ("dots") and adenomatous polyps, which had a "groove" or "sulci" pattern. After histological examination the diagnostic accuracy was proved 59/64 in adenomatous and 18/23 in hyperplastic polyps. CONCLUSION: One should improve minute endoscopical observation and it is believed the administration of indigo carmine dye and high resolution endoscopy are suitable method for that.

Adult↗
PubMed2002

14 day endoscopy study comparing risedronate and alendronate in postmenopausal women stratified by Helicobacter pylori status.

OBJECTIVE: Bisphosphonates are effective treatment for osteoporosis but have been associated with gastrointestinal (GI) mucosal injury. This study compared the incidence of gastric ulcers after treatment with risedronate, a pyridinyl bisphosphonate, or alendronate, a primary amino bisphosphonate, in healthy postmenopausal women stratified by Helicobacter pylori status. METHODS: Subjects were randomized to receive risedronate 5 mg (n = 318) or alendronate 10 mg (n = 317) daily for 14 days. Endoscopy and evaluator-blind assessments of the esophageal, gastric, and duodenal mucosa were performed at baseline and on Days 8 and 15. RESULTS: Overall, gastric ulcers > or = 3 mm were observed in 18 (6.0%) of 300 evaluable subjects in the risedronate group and 36 (12.1%) of 297 in the alendronate group during treatment (p = 0.013). On Day 8, the incidences of gastric ulcers in the risedronate and alendronate groups were 3.6% and 6.6%, respectively (p = 0.133), and on Day 15, they were 3.3% and 8.7% (p = 0.008). The incidence of gastric ulcers was not affected by H. pylori status. Mean gastric endoscopy scores at Days 8 and 15 were significantly lower in the risedronate group than in the alendronate group (p < 0.001). Mean esophageal and duodenal endoscopy scores were similar in the 2 groups at Days 8 and 15. When the treatment groups were combined, gastric endoscopy scores were significantly higher among H. pylori negative than H. pylori positive subjects at Days 8 and 15 (p < 0.05). Upper GI adverse events were reported by 18 (5.7%) subjects in the risedronate group (19 events) and 28 (8.8%) subjects in the alendronate group (32 events). Symptoms did not predict the presence of mucosal damage. CONCLUSION: Risedronate was associated with a significantly lower incidence of gastric ulcers than alendronate. H. pylori infection did not increase the incidence of bisphosphonate related gastric ulcers. The findings from this 14 day study in healthy volunteers support the hypothesis that bisphosphonates may differ from one another in their potential to produce upper GI mucosal damage.

Aged↗
PubMed2003

[Undiagnosed celiac disease in adults unmasked by endoscopy].

BACKGROUND: Celiac disease may be present in many patterns other than the classical manifestations of diarrhea and malabsorption. The prevalence of celiac disease is greater than usually reported as mild cases are often undiagnosed. Diagnosing celiac disease may have major health significance. AIMS: The aim of our study was to determine the prevalence of celiac disease in adults appearing for endoscopy with abdominal pain, in an open access setting. METHODS: Two hundred and seventy consecutive, non-selected adult patients undergoing upper endoscopy for abdominal pain were included in the study. Three biopsies were routinely taken from the second part of the duodenum. In those cases with flattened villi on histology, antiendomysial antibody (AEA) was tested. RESULTS: The prevalence of celiac disease among Israeli patients undergoing endoscopy for abdominal pain was high (1:23), greater than its highest reported prevalence in general populations (1:200-300). CONCLUSIONS: Routine small bowel biopsies should be considered in patients undergoing upper endoscopy for otherwise unexplained pain.

Abdominal Pain↗
PubMedDate not supplied

[Prognostic value of the finding of blood/clots in the stomach at the emergency upper endoscopy].

INTRODUCTION: In the setting of upper endoscopy after upper gastrointestinal bleeding (UGIB), the presence of blood or clots in the gastric lumen precluding the complete mucosal examination is a frequent finding. AIMS: To define the prognostic value of this endoscopic finding and the need of a follow-up endoscopy. METHODS: Retrospective study of 100 consecutive patients with UGIB and the endoscopic finding of blood in the stomach (Group A) and 100 at the same conditions but without this endoscopic finding (Group B). In both groups we compared the bleeding lesions and the presence of clinic, laboratorial and endoscopic signs of severity. RESULTS: Gastric and duodenal ulcers were the bleeding lesions more frequently identified in both groups. Lesions related to portal hypertension were more frequent in the first than in the second one. There was also a significant association with other endoscopic signs of severe haemorrhage and with the clinical signs of bad prognosis. In the follow-up endoscopy we found new lesions in 46% of the patients in the first group and only in 15% of the second one. CONCLUSIONS: The endoscopic finding of blood or clots in the stomach should be considered as a bad prognostic sign and lead to a second endoscopy.

Adult↗
PubMed2003

The prevalence of coeliac disease at endoscopy units in Romania: routine biopsies during gastroscopy are mandatory (a multicentre study).

UNLABELLED: The incidence and prevalence of coeliac disease vary internationally. In Eastern Europe little is known about the prevalence of coeliac disease. THE AIM: of this study was to evaluate the prevalence and the clinical features of coeliac disease in adults biopsied during upper endoscopy in Romania. This is the first incidence study of the coeliac disease in Romania. METHODS: The study was initiated by the Romanian Society of Digestive Endoscopy for the period 1 January 2002 - 31 May 2002. It was carried out in 9 Academic Centres in Romania, which ensured an even geographical distribution and therefore significant statistical results at a national level. The study included 2436 patients according to following criteria: age over 16 years, with no known history of coeliac disease, visiting the participating upper endoscopy units or patients with documented coeliac disease presenting for follow-up check or recurrence of clinical symptoms. At least two bioptic samples were obtained from the distal duodenum, as distally as possible, which were submitted to histopathological examination and scored according to the modified UEGW Marsh criteria (2001). A database was set up to include all the patients with data regarding sex, age, urban or rural background, full clinical diagnosis, clinical symptoms, history of the coeliac disease. RESULTS: Of the 2436 patients studied, 54 (2.22%) were diagnosed with coeliac disease. Their demographic features: 48.15% men, 51.85% women, 68.52% living in urban areas, 31.48% in rural ones, mean age 42 +/-17.0 years. The most frequent reasons for performing upper digestive endoscopy were: dyspeptic syndrome - 15.93%, anemia - 24.07%, and chronic diarrhoea - 22.22%. The most frequently recorded clinical manifestations were: chronic diarrhoea in 46.3%, asthenia in 29.63%, anemia in 24.07%, aphthae in 24.07%. Histopathological results according to Marsh classification were: Marsh III- 64.81 %, Marsh II-35.19%. CONCLUSIONS: The prevalence of the coeliac disease in Romania is 2.22%: its sex distribution is fairly equal, the age distribution includes two peaks, at 30-40 and 50-60 years respectively, and patients from urban areas predominate. The most frequent (over 50% of the cases) histological type was M III. The most common clinical symptoms were diarrhoea, asthenia, anemia, aphthae, while the most frequent associated diseases were diabetes mellitus and Duhring-Brocq dermatiti

Adult↗
PubMed2003

Upper gastrointestinal endoscopy in children - an experience at a paediatric gastroenterology unit.

Upper gastrointestinal endoscopy has changed the management of upper gastrointestinal problems in children. The aim of this communication is to share our experience with 153 cases on whom upper gastrointestinal endoscopy was done over a period of 24 months at a paediatric gastroenterology unit of a tertiary care hospital of Dhaka, Bangladesh. Children who attended the department with various gastrointestinal problems are the subjects of this paper. Intravenous midazolam and 10% pharyngeal xylocain were used in majority of cases for sedating the children. The ages of the children were between 15 months to 15 years (9.41+/- 3.22 years). The positive diagnostic yield was 92 out of 153 cases (60.1%). The major indication for doing endoscopy in the present series was recurrent abdominal pain (51.6%), followed by upper gastrointestinal bleeding (28.8%). Combining histopathological findings and CLO/rapid urease tests the overall positive yield of recurrent abdominal pain was 45 out of 79 (57%). The sources of upper gastrointestinal bleeding could be identified in 79.5% cases. Esophageal varices indicating portal hypertension were found in 62.5% children who were endoscoped for unexplained splenomegaly with or without ascitis. Endoscopy has become a safe and valuable procedure in the management of upper gastrointestinal problems in children and gastric antral biopsy has increased the positive diagnostic yield of recurrent abdominal pain in the studied children.

Adolescent↗
PubMed2003

[Surgical treatment of small intestinal diseases, causing hemorrhage, and diagnosed with capsule endoscopy].

The wireless video capsule endoscopy is a new, painless, non-invasive technique for imaging the small bowel. It can be used to visualise the entire small bowel in selected patients where bleeding source cannot be verified by conventional diagnostic methods. Authors operated on three patients between November 2002 and March 2003, after intestinal bleeding source was detected by capsule endoscopy. The conventional diagnostic techniques could not provide correct diagnosis. The first patient, a 63-year-old man underwent right hemicolectomy one year earlier because of to colonic cancer. The source of bleeding was local recurrence penetrating into small bowel. The second patient, a 56-year-old woman underwent small bowel resection because of Meckel diverticulitis more than 30 years ago. By capsule endoscopy an ulcer was detected in the anastomosis. In the third case--a 60-year-old woman--an ulcerated leiomyoma was found in the first jejunal loop, next to the duodeno-jejunal flexure. In all the three patients resection was performed. The postoperative periods were uneventful. All patients are free of symptoms since the procedure. Capsule endoscopy was able to localise the source of intestinal bleeding, when conventional diagnostic methods were ineffective.

Endoscopy, Gastrointestinal↗
PubMedDate not supplied

[Comparison between an upper airway obstruction score and airway endoscopy to detect airway injury associated with endotracheal intubation in children].

OBJECTIVE: To compare an upper airway obstruction score vs. airway endoscopy to detect moderate or severe airway injury associated with endotracheal intubation in children. METHODS: Prospective study. Airway endoscopy and clinical evaluation were performed after extubation. Airway injuries identified on endoscopy or according to the upper airway obstruction score were classified as minor, moderate or severe. The obstruction score was assessed in terms of sensitivity, specificity, positive and negative predictive values and likelihood ratio to detect moderate or severe injuries. RESULTS: Among 215 patient, endoscopy was normal in 10.2%. Minor lesions were diagnosed in 54.9% of the patients, followed by moderate (24.2%) and severe (10.7%) lesions. In 163 patients with upper airway obstruction, the score classified injuries as minor in 23.3%, moderate in 41.4% and severe in 11.2%. A score > or = 4 had a sensitivity of 73.3% (95% CI: 67.4-79.2) to detect moderate or severe injuries and a specificity of 58.6% (95% CI: 52.0-65.2) to exclude patients without moderate or severe lesions. The positive predictive value of a score > or = 4 was 48.7% (95% CI: 42.0-55.4). In patients with a score < or = 3 the chance of not presenting moderate or severe injuries was 80.4% (95% CI: 75.1-85.7). The probability of a patient with moderate or severe injuries to present a score > or = 4 was 73.3% compared to patients without those injuries (41.4%) (1.8 fold higher). CONCLUSIONS: The score reliably ruled out moderate or severe airway injury in patients with minor upper airway distress. On the other hand, scores > or = 4 presented a low specificity. Clinical evaluation can be useful to rule out patients with minor airway injuries.

Airway Obstruction↗