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At least 919 records · Page 51Linked to original sources
PubMed2004

Evaluation of symptom presentation in dyspeptic patients referred for upper gastrointestinal endoscopy in Estonia.

AIM: To investigate the structure of dyspeptic symptoms and determine the association between dyspeptic symptoms and endoscopic findings in patients referred for upper gastrointestinal endoscopy by family physicians in a country with a high prevalence of Helicobacter pylori infection. METHODS: Consecutive outpatients (n=172; median 36 years, range 18-75; 85 male; 87 female) were referred to upper gastrointestinal endoscopy. Patient history was recorded prior to upper gastrointestinal endoscopy using the computer-aided Glasgow Diagnostic System for Dyspepsia (GLADYS). Family physicians used open access endoscopy with a short waiting list. Two biopsies, both from the antrum and the corpus, were taken for histological assessment. RESULTS: Out of the 172 patients studied, 81% (n=139) were H. pylori positive, 65% (n=112) were younger than 45 years. The incidence of peptic ulcer was 44% (n=75). Upper abdominal pain was the predominant complaint in 73% (n=126) of the patients, as well as the most frequent overall complaint. Hunger pain, night pain, periodical nature of symptoms, and history over 2 years were of independent value in differentiating between peptic ulcer and functional dyspepsia. The symptoms of gastroesophageal reflux disease and irritable bowel syndrome predominated in the minority of patients (11% and 5% respectively) but accompanied other complaints in almost 2/3 of the patients. In 32 out of 75 patients with peptic ulcer, the symptoms of irritable bowel syndrome and in 29 cases the presence of frequent heartburn and regurgitation were noted. CONCLUSIONS: Classical symptoms are valuable in predicting the diagnosis of peptic ulcer. Heartburn and acid regurgitation are present in both gastroesophageal reflux disease and peptic ulcer. Irritable bowel syndrome is common in patients with peptic ulcer.

Adolescent↗
PubMed2004

Appropriate utilisation of emergency upper gastrointestinal endoscopy in a tertiary referral centre.

A retrospective cross-sectional study was carried out in a tertiary referral centre to determine the appropriateness of usage of emergency upper gastrointestinal endoscopy (EUGIE) with reference to the guidelines set by the American Society of Gastrointestinal Endoscopy (ASGE). EUGIE was defined as early, non-elective endoscopy performed for in-patients within 48 hours of acute hospital admission. The median age of the 668 patients was 55 years (age range 12- 90), 31% of whom had a previous upper gastrointestinal endoscopy. Bleeding in the form of haematemesis, melaena or anaemia was the most common indication (40.7%) for EUGIE. Eighty one percent of the procedures were judged appropriate by the ASGE guidelines. There was a statistically significant relationship between appropriateness and significant diagnostic yield (P<0.05). Procedures performed for melaena, symptomatic anaemia and haemetemesis led to greater significant diagnostic yield (P<0.05) and there was no difference in the yield between working-hours and after-hours EUGIE.

Adolescent↗
PubMed2004

Value of early capsular endoscopy for severe gastrointestinal bleeding.

This case illustrates the importance of early capsule endoscopy in cases of severe rectal bleeding when initial diagnostic tests do not document the site of bleeding. Although this case occurred in a community hospital capable of performing capsule endoscopy, I practice at a city hospital that serves the poor and underserved and currently does not have capsule endoscopy capability. Over the years, we have seen several cases of severe rectal bleeding where the site of bleeding was never identified, despite multiple diagnostic procedures short of capsule endoscopy. Often times, the bleeding stops spontaneously or ends in emergency surgery where morbidity or mortality is increased. Physicians like myself need to be made aware of this relatively new diagnostic tool that provides added value to standard diagnostic tests for evaluating severe rectal bleeding of unknown etiology. Early identification of the site of rectal bleeding may curtail the need for multiple transfusions, resolve economical burden, and reduce morbidity and mortality associated with severe rectal bleeding.

Aged↗
PubMed2005

[Capsule endoscopy--a new method for the diagnosis of diseases of the small intestine].

BACKGROUND: Diseases of the small intestine are rare and often difficult to diagnose because of a lack of sensitive methods. A new technique called wireless capsule endoscopy has recently been developed; it allows visualisation of the entire small intestinal surface. MATERIAL AND METHODS: The patient swallows a capsule containing a small digital camera, a battery and a radio transmitter. The capsule takes 2 pictures per second during its passage through the intestines; pictures are transferred by radio signals that are detected by sensors on the abdominal skin, stored on a data recorder and later analysed on a PC. RESULTS: By the end of November 2003 we had performed 80 capsule endoscopies in 69 patients. All patients were referred because of suspected small bowel disease and had been through an extensive diagnostic workup before capsule endoscopy was performed. Most of them were referred because of obscure gastrointestinal bleeding or iron deficiency anaemia. Small bowel pathology was found in one third of the patients. INTERPRETATION: Capsule endoscopy seems to be a major improvement in the diagnosis of small intestinal diseases. It is a non-invasive and painless procedure.

Adult↗
PubMed2005

Crohn's disease diagnosed by wireless capsule endoscopy in adolescents with abdominal pain, protein-losing enteropathy, anemia and negative endoscopic and radiologic findings.

BACKGROUND: Approximately one-fourth of new Crohn's disease diagnoses are made in individuals under the age of 20 years, in whom proximal Crohn's disease tends to be more common. OBJECTIVES: To describe the role of wireless capsule endoscopy in diagnosing isolated small intestinal Crohn's disease in two adolescents. METHODS: Wireless capsule endoscopy was performed in two adolescents with severe protein-losing enteropathy and negative standard diagnostic workup. RESULTS: Wireless capsule endoscopy successfully diagnosed Crohn's disease with uncharacteristic presentations and negative radiographic and endoscopic findings in both patients. CONCLUSIONS: The non-invasiveness and ease in performance of capsule endoscopy on an ambulatory basis make this diagnostic modality especially advantageous for children.

Abdominal Pain↗
PubMed2005

Video capsule endoscopy in inflammatory bowel disease 2005.

PURPOSE OF REVIEW: Crohn's disease remains a clinical diagnosis based on a typical clinical history, physical examination, small bowel radiography, and ileocolonoscopy with biopsy. Wireless video capsule endoscopy allows direct visualization of the entire small bowel mucosa. This review analyzes recently reported studies assessing diagnostic yield, impact on management, and outcomes associated with this new procedure. Safety issues, particularly capsule retention, are also reviewed. RECENT FINDINGS: A number of recently published studies report 'diagnostic yields' for Crohn's disease from capsule endoscopy of over 70% in patients with negative, or inconclusive, findings on prior small bowel series and ileocolonoscopy. Capsule endoscopy is a more sensitive examination than traditional radiography, but the specificity and positive predictive values remain to be established. Most series report a positive influence on patient outcome based on capsule findings, but the specific details of management changes and specific outcomes are often not adequately described. Furthermore, 'mucosal breaks' are seen in 14% of normal volunteers, even in the absence of recent nonsteroidal antiinflammatory drugs. Capsule retention occurs in less than 1% of patients with suspected Crohn's, but retention rates of 4-6% are reported in patients with established Crohn's. SUMMARY: Capsule endoscopy is an effective tool in the diagnosis and follow-up of patients with Crohn's disease. Prospective comparative studies with adequate control groups and predefined clinical endpoints are necessary to determine the true role of this technology in Crohn's disease.

Endoscopy, Gastrointestinal↗
PubMedDate not supplied

[Diagnostic utility and clinical impact of capsule endoscopy in obscure gastrointestinal bleeding. Preliminary results].

INTRODUCTION: Obscure gastrointestinal bleeding (OGIB) represents from 5 to 10% of all episodes of gastrointestinal bleeding. The diagnosis is difficult to make because in most cases it originates in the small bowel. Radiological methods have low sensitivity and push enteroscopy does not allow for examination of the whole length of the small bowel. Capsule endoscopy is a recently introduced method which allows for the complete examination of the small bowel. Only a few studies have assessed its clinical impact. OBJECTIVE: To evaluate the diagnostic yield and the clinical impact of capsule endoscopy in patients with OGIB. METHOD: 28 patients were studied: 9 with iron deficiency anemia (32%), 14 with melena (50%) and 5 with melena and hematochezia (32%). They were 16 men and 12 women. Median values were: age 53 years (range 18-87), hemoglobin 7 g/dL (4-11), endoscopic and radiologic studies 4 (2-8), hospital admissions 3 (1-5) and transfused blood units 5 (0-52). RESULTS: Capsule endoscopy detected bleeding and nonbleeding lesions in 23 patients (82%). The diagnoses were: angiodysplasia in 10 patients (36%); ulcers in 7 (25%) and neoplasm in 6 (21%). In 12 patients (43%) findings motivated the performance of other diagnostic or therapeutic procedures: 8 patients were operated on (6 with neoplasm and 2 with stenotic ulcers); 3 received endoscopic treatment for angiodysplasia and ulcers; and one patient was submitted to ileoscopy with biopsy for Crohn's disease. There were no complications and good tolerance was observed. CONCLUSIONS: Capsule endoscopy had a diagnostic yield of 82% and a clinical impact of 43% in this highly selected group of patients with OGIB in whom no other endoscopic or radiologic procedures could lead to the diagnosis.

Adult↗
PubMedDate not supplied

[Ileal carcinoid tumor manifesting as gastrointestinal hemorrhage and diagnosed with capsule endoscopy: Case report].

OBJECTIVE: To present a case of carcinoid tumor of the small bowel that produced hemorrhage and was identified by capsule endoscopy before surgery. INTRODUCTION: Carcinoid tumors of the small bowel are difficult to diagnose since most of them are asymptomatic and endoscopic examination by standard methods is not possible. Therefore they are rarely detected before a surgical procedure. METHOD: A review of the literature is done. Emphasis in the importance of early diagnosis due to its invasive tendency is also made. RESULTS: Male patient who had 3 episodes of malena along three years before hospitalisation. During this period three upper gastrointestinal endoscopies (EGD), three colonoscopies, two small bowel scintigraphies, one mesenteric angiography and one CAT scan were done before a capsule endoscopy was performed. This procedure revealed a tumor 0.8 cm diameter in the ileum, which was surgically resected. The pathological examination revealed carcinoid tumor invading the serosa. CONCLUSIONS: The carcinoid tumor is highly infiltrating, therefore early diagnose is mandatory. Since the capsule endoscopy makes possible the complete examination of the small bowel, it should be indicated in patients with gastrointestinal hemorrhage in whom EGD and colonoscopy are negative.

Capsules↗
PubMed2005

[Capsule endoscopy].

Wireless capsule endoscopy is a new diagnostic tool in which a disposable video capsule is swallowed by the patient. This examination enables visualization of the small intestine that is not within the reach of conventional upper and lower endoscopy. The best indications include an obscure source of gastrointestinal bleeding, Crohn's disease, and small intestinal tumors. The disadvantage that biopsy cannot be performed is compensated for by employing double-balloon endoscopy. In particular, this examination can identify the origin of bleeding and diagnose the underlying disease, leading to prompt surgical treatment with better results. In future, capsule endoscopy will become a necessary examination for diagnosing digestive tract disease.

Endoscopes, Gastrointestinal↗
PubMed1992

[Monitoring and oxygen therapy during gastrointestinal endoscopy].

Gastroenterological Societies in Britain and USA have published recommendations for sedation, monitoring and oxygen therapy during gastrointestinal endoscopy. No scientific basis for the introduction of recommendations such as these is, however, present as it has not yet been proved that hypoxaemia is responsible for morbidity and mortality on gastrointestinal endoscopy. The pathogenesis of the development of myocardial ischaemia during gastrointestinal endoscopy is considered by many to be the simultaneous arterial hypoxaemia but recent investigations suggest that tachycardia is a more important factor. The scientific data available at present in this field is not conclusive. Introduction of recommendations for monitoring and oxygen therapy during gastrointestinal endoscopy in Denmark should be delayed until elucidation of the mechanisms involved has been undertaken.

Coronary Disease↗
PubMed2006

[Capsule endoscopy--the past, presence, and future].

Wireless capsule endoscopy is a safe non-invasive method for the examination of the small intestine and terminal oesophagus. Examination is well tolerated by most of the patients. Due to the possibility to assess mucosa of the small intestine in details, capsule endoscopy has the diagnostical yield higher than other available methods. It is effective namely for study of obscure bleeding, celiac disease and Crohn's disease. Capsule endoscopy is aimed at the longterm follow up of patients with Barrett's oesophagus, however, the costs are higher than using gastroscopy. Capsule retention represents the most serious and practically the only complication of the examination which frequently requires surgical treatment. The future of capsule endoscopy depends on the next development of the technology.

Capsules↗
PubMed2004

Upper gastrointestinal endoscopy: a review of 10,000 cases.

A total of 10,000 patients underwent upper gastrointestinal endosopy examination between August 1979 and October 1994 at Tikur Anbessa Hospital, Addis Ababa. The major indications were dyspepsia (59.4%), upper gastrointestinal bleeding (18%) and liver disease (10.8%). The other indications include dysphagia (2.2%), gastric outlet obstruction (2.1%), postoperative dyspeptic symptoms (1.9%), weight loss and/or anemia (1.4%), epigastric mass (0.6%) and odynophagia 0.2%. The mean age of the patients and their sex ratio was 36 years and 2:1, respectively. Twenty eight percent of the patients had normal findings. The commonest abnormal findings include duodenal ulcer (41%), esophageal varices (9%), acute gastritis (6%), duodenitis (3.4%), and reflux esophagitis (2.3%). Benign gastric ulcer was rare. The ratio of duodenal ulcer to gastric ulcer was 19.1%. Duodenal ulcer (45.6%), esophageal varices (15.6) and acute gastritis (5.7%) were found to be the commonest causes of upper gastrointestinal bleeding. The endoscopy or histology diagnosis of cancer in both the esophagus and stomach was 2.8% and 1.3%, respectively. The agreement between endoscopy and histology in the diagnosis of esophageal and gastric cancer was 80%. There was no major complication related to endoscopy or premeditation. Endoscopy is a fairly accurate and safe procedure and therefore should be available and applied widely for the diagnosis of upper gastrointestinal diseases in Ethiopia.

Adult↗
PubMed2006

Debate: endoscopy is unnecessary in the management of uncomplicated GERD.

The case of a 56-year-old man with recurrent retrosternal heartburn no longer relieved by antacids is discussed. Arguments for and against conducting endoscopy in this patient are presented. Initial therapy with a standard dose proton pump inhibitor, without endoscopy is the suggested treatment strategy. The main purpose of conducting an endoscopy in a patient with chronic gastrointestinal reflux is to detect the presence of Barrett's esophagus. However, data indicate that the presence of Barrett's esophagus is unrelated to symptoms and that it is not significantly associated with heartburn. Additionally, there is no certainty that survival is improved by the detection of Barrett's esophagus. Nonetheless, many clinical practice guidelines support conducting endoscopy in patients with GERD.

Barrett Esophagus↗
PubMed2006

[Magnifying endoscopy in upper gastrointestinal tract].

For the diagnosis of upper gastrointestinal (GI) lesions, magnification method is usually used in conjunction with chromoscopy, enabling the endoscopist to view subtle mucosal patterns in exquisite detail. Recently published datas have shown that magnifying endoscopy might be a valuable adjunct for the diagnosis, detection, and characterization of inflammatory and neoplastic lesions of the upper GI tract. It is also proven to be an useful surveillance protocol in identifying dysplastic epithelium or early cancer within a segment of Barrett's esophagus. Possible indications for magnifying endoscopy in upper GI tract include screening and surveillance of Barrett's esophagus, defining the extent of esophageal and gastric adenocarcinoma, detecting synchronous/metachronous gastric and esophageal cancers, diagnosing Helicobacter pylori infection, and recognizing minimal mucosal changes in gastroesophageal reflux disease. By grading the quality of evidence for the currently published trials, it is clear that the majority are case series, case reports, and/or observational studies without randomization, control, or blinding. Moreover, other evidence-based criteria such as independent, blind comparisons of magnifying endoscopy with a standard method which evaluates this technology in an appropriate spectrum of patients to whom the test may be applicable, and standardizing methodology would be crucial before magnifying endoscopy becomes a standard procedure in clinical practice. In the future, a uniform classification system for staining and magnifying patterns should be devised and observer agreement should be tested. Futher studies then could be performed based upon consistent, validated, and standardized terminologies and criteria.

Diagnosis, Differential↗
PubMed2006

[Identification of a Meckel's diverticulum bleeding by urgent capsule endoscopy].

A 10 year-old patient was admitted to our hospital due to severe gastrointestinal bleeding. His symptoms included hematochezia and fainting. Neither emergency upper endoscopy nor colonoscopy had identified the site of bleeding. During the colonoscopy they noticed that fresh blood entered the cecum from the ileum. An urgent capsule endoscopy was performed 8 hours after the patient admission. They placed the capsule with specific endoscopic technique into the proximal duodenum under general anesthesia. During 3,5 hours by the small bowel passage the capsule moved to the ileum and a focal bleeding lesion was detected at this site, suggesting the typical picture of bleeding Meckel's diverticulum. The patient was transfused by 1 unit of blood, with a minimum haemoglobin level 95 g/l. By surgery the ulcerated Meckel's diverticulum was identified and resected. Histopathology showed ectopic gastric mucosa. Surgical resection of the diverticulum resulted complete healing of this patient. The capsule endoscopy diagnosis was prompt, precise, and the all examinations were carried out within 24 hours. Involving urgent small bowel capsule endoscopy into the diagnostic workup of the obscure bleeding patient could considerably shorten the time to achieve a correct diagnosis and allowed the early institution of definitive treatment. By this one could spare a great number of costly alternative investigations with low diagnostic yield.

Child↗
PubMed2006

[Submucosal jejunal lymphangioma: an unusual case with obscure gastrointestinal bleeding in an adult, detected by video-capsule endoscopy and treated by laparoscopy].

A 54 year-old man, without any remarkable medical history, was examined for recurrent episodes of colicky abdominal pain, over a period of nine months, with positive faecal occult blood test. Three months earlier he had undergone an extensive evaluation for a single episode of melaena, including upper gastrointestinal endoscopy, colonoscopy to the caecum, enteroscopy and an abdominal ultrasound scan, that were negative. He was then submitted to the video capsule endoscopy (Given Imaging Ltd, Yoqneam, Israel) that revealed a polypoid white-yellowish lesion in the mid portion of the jejunum. The patient was admitted to our Department of Surgery in January 2005. During the operation, performed by laparoscopic video-assisted approach, the lesion, measuring 1.5x2 cm, was found at about 100 cm from the ligament of Treitz and was successfully excised. At histology, the final diagnosis was submucosal lymphangioma. The lymphangioma is a benign neoplastic lesion of the lymphatic system that usually is present in infancy and is found, in the majority of the patients, in the subcutaneous tissue outside the abdomen. The intrabdominal site accounts for less than 1% of the cases, and often occurs in the mesentery of the small bowel. Finding the lesion in the submucosa of the jejunum in an adult is very rare. The case here reported seems unusual to the Authors and worthy of publication because of the chronic, ambiguous clinical symptomatology, the occult digestive blood loss, and all the diagnostic examinations resulting negative, except for the video-capsule endoscopy. Moreover, the choice of the laparoscopic video-assisted technique, confirming the expected site of the lesion, with a ''minimal'' small bowel resection, made the postoperative course of the patient very short and uneventful. He is well and free of disease one year after the intervention. From a brief review of surgical literature, the case reported is the second one detected by the video capsule endoscopy and the fifth operated on by laparoscopy.

Capsule Endoscopy↗
PubMed1991

Upper gastrointestinal endoscopy in octogenarians.

A retrospective study of upper gastrointestinal endoscopy (GIE) in 217 octogenarians performed over a two-year period in a district general hospital was carried out. It showed that upper GIE in octogenarians is a safe and easy as in other age groups, and provides more useful information. Patients were referred mainly by the geriatricians for elective endoscopy, reflecting the growing recognition of the value of elective upper GIE in the very elderly. The incidence of peptic ulcer disease as a cause of upper GI bleeding was much less than previously reported. Thirty-nine patients with upper GI haemorrhage had an endoscopy within 24 hours. We believe that this helps to identify patients with a high risk of mortality and those who might benefit from early surgery. Eighty per cent of the patients had one or more associated diseases, but there were no complications from endoscopy. We would like to emphasise that there is no contraindication for upper GIE in very elderly patients.

Aged↗
PubMed1991

Monitoring of blood pressure and heart rate during routine endoscopy: a prospective, randomized, controlled study.

Six hundred and eighteen patients were randomized to have automated cardiovascular monitoring or clinical observation during routine endoscopy. Hemodynamic parameters were recorded at 3-min intervals before, during, and after the procedure. Upper gastrointestinal endoscopy resulted in an increased heart rate (HR), while colonoscopy caused a decreased blood pressure (BP) and HR. Hemodynamic aberrations occurred in 71% of monitored patients, including hypotension 6%, hypertension 30%, bradycardia 26%, and tachycardia 32%. Only one-third of the hypotensive episodes were recognized as aberrations, and therapeutic intervention did not improve outcome. No monitored or control patient had an adverse result. Certain hemodynamic changes were directly correlated with the baseline BP or HR and associated with the presence of coronary artery disease, particular medicines with cardiovascular effects and longer procedure duration. We conclude that automated monitoring during routine endoscopy unmasks frequent hemodynamic aberrations that are clinically insignificant. Routine monitoring during endoscopy does not improve outcome.

Aged↗