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At least 937 records · Page 52Linked to original sources
PubMed1991

Diagnostic emergency endoscopy in upper gastrointestinal bleeding--do we have any decision aids for patient selection?

The benefit of emergency endoscopy and therapeutic policies based on certain stigmata of bleeding has recently been demonstrated in patients with peptic ulcer hemorrhage. Applying a simple method of computer-aided diagnosis to a set of prospective data (n = 571) we investigated the question as to whether information on the history (28 variables) and clinical examination (8 variables) could be used to predict ulcer bleeding or certain stigmata of bleeding, with a view to deciding when to perform an emergency endoscopy in patients with upper gastrointestinal bleeding. The patients were assigned to either a high-risk group (probability greater than 0.50 for ulcer bleeding, arterial bleeding, etc.) or a low-risk group (p less than 0.50), and the prediction was compared with the actual findings at endoscopy. The results were disappointing, with an overall accuracy of 71% for the prediction of bleeding peptic ulcer and 71% for the prediction of a bleeding or non-bleeding visible vessel. Despite a relative risk of 2.8 for "bleeding ulcer" and 2.5 for "visible vessel" in the high-risk group, only 72% of all "bleeding ulcer" patients, and 69% of the "visible vessel" patients could be identified by the model. These results indicate that neither a bleeding ulcer nor stigmata of bleeding can be reliably predicted by the patient's history and clinical examination. Emergency endoscopy should therefore be performed in all patients with gastrointestinal bleeding.

Diagnosis, Computer-Assisted↗
PubMedDate not supplied

Flumazenil used for reversal of midazolam-induced sedation in endoscopy outpatients.

A double-blind, placebo-controlled randomized clinical study was performed in 69 outpatients scheduled for endoscopy and sedated with midazolam to assess the efficacy, safety, and usefulness of flumazenil in reversing the effects of midazolam-induced sedation. Midazolam was administered intravenously before endoscopy up to a maximum dose of 15 mg. After endoscopy either flumazenil or placebo was injected. Vital signs and psychomotoric tests were assessed before injection of midazolam, before injection of flumazenil or placebo, and 5, 15, 30, 60, 240, and 360 min afterward. Thirty-six patients received flumazenil, 33 placebo. All parameters returned to pre-sedation levels within 5 min in all patients in the flumazenil group, with significant differences as compared with placebo after 5, 15, 30, and 60 min. Flumazenil was well tolerated. No rebound sedation was observed. Flumazenil is a safe and effective benzodiazepine antagonist. The combination of midazolam with flumazenil makes it possible to reduce the recovery period and is useful in outpatient endoscopy.

Adult↗
PubMed1989

[Digestive endoscopy in the diagnosis of upper gastrointestinal hemorrhage. A retrospective study of 340 cases].

After a short examination of data in the literature, the paper presents a retrospective analysis of 340 patients who underwent endoscopic examination for upper gastrointestinal haemorrhage. Among them, 123 underwent emergency and 112 elective endoscopy. A source of active or recent bleeding was identified in 87.5% of the cases. Emergency endoscopy showed a clearcut diagnostic superiority over elective endoscopy, and endoscopy as a whole was more efficient than conventional radiology. The most commonly observed bleeding lesions were found in the duodenum and stomach followed by oesophageal varices. The value of an early endoscopic approach to the diagnosis and treatment of upper gastrointestinal haemorrhage is confirmed.

Adolescent↗
PubMed1989

Arterial oxygen saturation in sedated patients undergoing gastrointestinal endoscopy and a review of pulse oximetry.

The pulse oximeter is a widely used noninvasive monitor which provides a continuous reading of arterial oxygen saturation. We sought to determine if patients with cardiopulmonary disease were at higher risk of oxygen unsaturation than controls during gastrointestinal endoscopy. Patients presenting for upper gastrointestinal endoscopy and/or colonoscopy were placed into one of two groups: A. control population:patients with no history of cardiac and/or pulmonary disease (N = 11); B. test population:patients with a history of cardiac and/or pulmonary disease (N = 39). The procedure was performed by one of 14 equally experienced physicians. The Nellcor N-100 Pulse Oximeter and D-25 finger probe were used to monitor arterial oxygen saturation which was recorded at five minute intervals from commencement of intravenous sedation analgesia to 15 minutes post-procedure. In both groups, the oxygen saturation fell to statistically significant. A: 98.3% to 90.2%; B: 97.7% to 89.5%. However, the amount of unsaturation which occurred in Group B was not statistically different from Group A. Therefore, history of prior cardiac and/or pulmonary disease does not increase the degree of unsaturation from that occurring in patients with no such history. In addition, the effects of age, procedure, duration, I.V. sedation, and individual tolerance on oxygen unsaturation were studied by regression analysis and analysis of variance (ANOVA). Only the upper GI endoscopy patients showed a dependence of oxygen unsaturation upon one of the variables, specifically patient tolerance. It is concluded that patients at risk for hypoxemia during endoscopy or colonoscopy cannot be determined prior to the initiation of the procedure, and it is recommended that all of these patients be given supplemental oxygen as well as monitored with a pulse oximeter.

Endoscopy↗
PubMedDate not supplied

Diagnostic accuracy of endoscopy with brushing cytology and biopsy in upper gastrointestinal lesions.

Because of the high rate of diagnostic error with routine barium X-ray studies in detection of upper gastroesophageal lesions, a prospective investigation was undertaken to evaluate endoscopy together with brushing cytology and biopsy. Ninety-nine patients with recurrent upper gastrointestinal symptoms were examined during a two year period. Thirty-seven patients had cancer and 62 had benign ulcers as diagnosed by cytology and histopathology. All patients with diagnosis of carcinoma were correctly diagnosed by a combination of the above studies as proven by subsequent surgical exploration of all 37 patients. In the benign group, 23 patients were confirmed by exploratory laparotomy and 16 patients by following up for at least 2 years with upper GI series and/or endoscopy. The highest degree of accuracy in the diagnosis of cancer was achieved by cytology alone (92% of cases) and lowest by barium study of upper gastrointestinal tract (84% of cases). Although the accuracy of endoscopy in detecting cancer of the upper gastrointestinal tract was 86 per cent, 15 per cent of benign ulcers were falsely called neoplastic by this technique. It is concluded that endoscopy with brushing cytology and biopsy is an effective diagnostic tool in distinguishing benign lesions from malignant neoplasms and can be performed with little risk to the patient.

Biopsy↗
PubMed1989

Upper gastrointestinal endoscopy in infants and children.

Fibreoptic endoscopy is a highly efficient diagnostic tool which is now being increasingly used in pediatric age group also. However, certain special considerations like the use of special instruments, use of general anesthesia in younger children and various indications of diagnostic and therapeutic endoscopy need to be clearly emphasized. Over a period of 24 months, 132 children underwent upper gastrointestinal endoscopic examination in our section. Diagnostic endoscopy was carried out on 102 occasions and therapeutic on 162 occasions. Most of the children below 3 years of age required general anesthesia for the procedure. Children above 3 years of age could be managed by intravenous diazepam and pentazocine. The commonest cause of upper gastrointestinal bleed in children was variceal (60.6%) followed by erosive gastritis (27.2%). In children with recurrent abdominal pain no underlying cause was detected at endoscopy. Injection sclerotherapy was found to be a safe and effective mean for control of variceal bleed and most of the foreign bodies ingested by children and still lying proximal to 2nd part of duodenum could be successfully retrieved endoscopically.

Child↗
PubMed1989

Detection of early gastric cancer in an aggressive endoscopy unit.

Early Gastric Cancer (EGC) is defined as tumor invasion limited to the mucosa and submucosa, irrespective of regional lymph node involvement. These patients have five-year survival rates in excess of 90 per cent. Although frequently seen in Japan, the detection of ECG remains uncommon in the United States. Twenty-two patients with EGC over a 15-year period were reviewed. EGC was identified in 0.5 per cent (1/207) of all gastric cancers before the widespread use of endoscopy (1972-1979) in our institution and in 16.5 per cent (21/127) of such patients after endoscopy began to replace barium contrast studies (1980-1987). Radiographic studies were performed initially in 14 out of 22 patients with EGC, and in ten patients were reported as normal. Endoscopy was used to make the diagnosis of EGC in 21 of 22 patients. Nineteen of the 22 patients are currently alive and free of disease (86%) with a mean follow-up of 3.4 years (range 6 months to 12 years). Our experience has paralleled that of the Japanese in that, with the adoption of fiberoptic endoscopy as the first-line diagnostic modality in patients with GI complaints, the detection of EGC has significantly increased.

Adult↗
PubMed1979

[Emergency endoscopy].

The possibilities and advantages of the emergency endoscopy of the upper intestinal tract are emphasized. With the help of 475 own examinations from 1971 to 1973 and from 1973 to June 1977 the improvement of the diagnostic gain by instruments with prograde optics is proved. Ulcerous diseases of the stomach and the duodenum are found as most frequent cause of haemorrhage which appear in the oesophagus or in the oesophagogastric transition. With 20% the number of the multiple findings was significantly high, the proof of which is to be regarded as an essential advantage of the emergency endoscopy. But at the same time they also emphasize the necessity not to be satisfied with the proof of a source of haemorrhage. The coloscopic emergency endoscopy is more difficult. Endoscopico-therapeutic possiblities increase the importance of the emergency endoscopy.

Colonic Diseases↗
PubMed1986

[Significance of emergency endoscopy in severe upper gastrointestinal hemorrhage].

312 of a total of 543 emergency endoscopies were carried out in patients with severe haemorrhage of the upper gastrointestinal tract. This was defined as a haemorrhage of such severity that at least 2 of the following 3 criteria were present: a shock index greater than 1, an erythrocyte count of less than 3 million/mm3, and a transfusion requirement of three or more 500 ml bags of blood. The source of the bleeding was exactly located in 247 endoscopies, and accurate diagnoses were established in 94.4% of the cases examined. The most frequent source of bleeding was oesophageal varices, followed by duodenal ulcers. In 20.2% of these cases, further sources of potential haemorrhage were found in the upper gastrointestinal tract. Endoscopic diagnosis resulted in immediate, specific therapy in 286 cases. Treatment was given within the first 24 hours in every case. 24.7% of our patients had to undergo laparotomy immediately after endoscopy. 30.4% were given H2 receptor inhibitors, and 35.6% underwent endoscopic haemostasis. The mortality rate in these patients was 29.5%. These results indicate that emergency endoscopy is an important aid to decision-making in cases of severe haemorrhage of the upper gastrointestinal tract.

Acute Disease↗
PubMed1986

Surgical endoscopy training in a university program.

Recent directives from the American Board of Surgery requires that applicants become familiar with a variety of endoscopic procedures. The purpose of this report is to review the VA Medical Center's two and a half year experience following the establishment of a surgical endoscopy unit. During the first year, July 1982-June 1983, 212 procedures were performed. These included 64 Colonoscopies (C), 98 Gastroscopies (G), 42 Flexible Sigmoidoscopies (S) and 8 Choledochoscopies (CD). The following year 564 procedures were performed (C-201, G-269, S-86, CD-8). Over the last 6 months 210 procedures were performed (C-98, G-86, S-22, CD-4). Senior surgical residents in their fourth or fifth year of training spent 4 months in the endoscopy service as part of their surgical oncology rotation. Technical and diagnostic competency was achieved in 2 to 4 months. This review indicates that the volume of cases, currently averaging 45 per month, is adequate to train surgical residents and support an independent endoscopy service. The establishment of the unit has also been associated with the development of screening programs for colon and esophageal cancers as well as broader applications of some of the newer indications of fiberoptic endoscopy. Future plans include introduction of variceal sclerotherapy and ERCP.

Endoscopy↗
PubMed1979

[Endoscopy of the esophagus, stomach and duodenal bulb].

The authors report on the position of the endoscopy of oesophagus, stomach and duodenal bulb within the diagnostic endoscopy. The therapeutic endoscopy including polypectomy remains widely not taken into consideration. They particularly deal with the endoscopic-bioptic diagnosis of the stenoses of the oesophagus, the gastric ulcers and the early carcinoma of the stomach. It is referred to the importance of the endoscopy for the diagnostics of varicose veins of the oesophagus and of duodenal ulcers. For the clinician references to the clinical elaboration of the endoscopic and bioptic findings are given.

Digestive System Diseases↗
PubMed1978

Clinical value of gastrointestinal fiberoptic endoscopy.

This review describes the contribution of fiberoptic endoscopy and its associated ancillary procedures to the improved diagnosis of some common gastrointestinal disorders. The diagnostic approach to esophagitis and carcinoma of the esophagus and stomach is outlined. Swallowed foreign bodies that do not pass out of the stomach can be removed with relative ease by endoscopic ancillary procedures. The role of endoscopy in duodenal ulcer disease and the effects on morbidity and mortality of the vigorous diagnostic approach in upper gastrointestinal hemorrhage are discussed. Endoscopy is invaluable for assessing the condition of the stomach postoperatively. Colonoscopic polypectomy has lent support to the "poly-cancer" hypothesis. The role of colonoscopy in the evaluation of inflammatory bowel disease must still be delineated. Endoscopic retrograde cholangiopancreatography is of value in the investigation of obstructive jaundice and pancreatic disease. In the former, noninvasive techniques of ultrasonography and computerized tomography scanning complemented by fine-needle transhepatic cholangiography will probably be the preferred methods of investigation. The impact of the contribution of fiberoptic endoscopy on health care will be maintained only if the physician has been properly trained in its use and has an understanding of the different diseases.

Biliary Tract Diseases↗
PubMedDate not supplied

[Esophagogastroduodenal endoscopy in diagnosis in tropical areas. Apropos of 3000 studies performed in adults].

The authors report on the results gained from 3000 peroral endoscopies (10% as urgent cases) carried out in adults at the Dakar General Hospital within a period of 30 months. They emphasize the low cost of such an exam, and they underline: a) the young age of examined patients b) the number of examinations on out-patients, demonstrating that oesogastroduodenoscopy is now well accepted by Africans. Digestive hemorrhages are mainly caused by duodenal ulcers, oesophageal varices, hemorrhagic gastritis. A new pathology is raising up: volontary ingestion of caustic pro ducts. The most frequent lesions observed are duodenal ulcers, oesophagic and gastric cancers, gastritis. The interest of endoscopic control of healing of cancers is confirmed. Revealing of oesophageal varices often take place before an hepatopathy is discovered. Therapeutic endoscopy and monitoring endoscopy should be developed. Through improved technics, diagnostic endoscopy has been efficient.

Adolescent↗
PubMed1982

A prospective reappraisal of emergency endoscopy in patients with portal hypertension.

In a prospective study of emergency endoscopy in patients with portal hypertension and oesophageal varices referred to King's College Hospital with acute upper gastrointestinal bleeding, initial endoscopic examination on 90 separate consecutive hospital admissions carried out within 24 h of clinical haemorrhage showed active variceal bleeding in only 21 (23.3%) cases. Coexisting upper gastrointestinal lesions were present in 38.8% of examinations, but active bleeding from these sites was seen in only five cases (5.6%). Of the 64 cases in which no active bleeding was seen at initial endoscopy, 39 (60.9%) rebled during that admission, and repeat endoscopy in 27 of these, carried out within 1 h of this episode, revealed active variceal haemorrhage in 20 (74.1%) cases. These results indicate that variceal haemorrhage is intermittent, and, although bleeding may often stop spontaneously, a high proportion of patients subsequently rebleed, and this is invariably from varices rather than from coexisting upper gastrointestinal lesions. In addition, these findings confirm the importance of emergency endoscopy in making the correct decision about acute management.

Emergencies↗
PubMed1995

[The value of diagnostic and interventional endoscopy in acute, non-varicose, upper gastrointestinal hemorrhage].

There is a broad consensus about the benefits of emergency endoscopy in the diagnosis and treatment of acute upper gastrointestinal bleeding. The Wels General Hospital is a large teaching hospital where all emergency endoscopies are performed by the staff of the First Department of Internal Medicine. The reports of 11,078 esophagogastro-duodenoscopies performed between November 1987 and February 1993 were scrutinized by the authors and 980 cases identified where a clinical diagnosis of suspected upper gastrointestinal hemorrhage had been made. All together 156 patients showed signs of active or recent bleeding on endoscopy (Forrest Ia, Ib, IIa) and were selected as database for this analysis. We identified 64 patients with duodenal ulcers, 43 patients with gastric ulcers and 15 patients with Mallory-Weiss-tears. Erosions, anastomotic ulcers, cancer and so called rare causes (Dieulafoy ulcers, mesenchymal tumors Hemobilia) were identified in 34 patients. Therapeutic endoscopy was performed in 69 patients (44.2%). For hemostatic therapy we used the injection method with epinephrine. 34 patients underwent surgical therapy (13 cases underwent emergency surgery). 10 of 156 patients 10 (6.4%) died secondary to their acute nonvariceal upper gastrointestinal hemorrhage.

Adult↗
PubMed1993

[Open access upper endoscopy. Can the practice be improved?].

150 patients who were referred to the open access endoscopical unit in a county hospital for upper gastrointestinal examination were evaluated. The aim was to answer the following questions: How often is this upper GI-endoscopy of value for medical treatment of the patient, and is "open access endoscopy" a practical system? In order to obtain a more reliable diagnosis it is necessary to examine the patient without delay, and thereby avoid the masking effect of H-2 blockers and omeprazole. More attention to anamnestic risk factors would improve case selection. In many cases it is possible to rely on X-ray examination, and thus reduce the burden on the endoscopy unit and allow for instant endoscopy service.

Adult↗
PubMedDate not supplied

Knot tying at flexible endoscopy.

Four new knotting techniques were developed for use at flexible endoscopy: (1) half hitches tied with knot-pusher, (2) thread-locking device, (3) self-tightening slip-knot, and (4) externally releasable knot. Remoteness from site of action, access through small-diameter orifice, and difficulty in applying lateral traction to tighten knots are problems met in knot tying at endoscopy. All four knotting techniques were studied in experiments on postmortem human stomachs and used for radio-telemetry studies and anti-reflux operations in survival studies in dogs using endoscopic sewing techniques. Half hitches tied at endoscopy with a knot-pusher were also used in human studies to treat esophageal reflux and secure pH radio-telemetry capsules for long-term measurements. Externally releasable knots were used to secure nasogastric tubes to the stomach of five patients for long-term nutrition. Knot tying is feasible at flexible endoscopy by a variety of new techniques. Endoscopically tied knots can be as secure as surgically hand-tied knots and have been used successfully in man.

Animals↗
PubMed1994

Are referring physicians satisfied with endoscopy reports?

To assess the opinions of referring physicians on the contents of endoscopy reports, 150 consecutive endoscopy reports were accompanied by a questionnaire. Of these, 102 reports were returned: response was 68%. Almost half of the reports were considered not fully satisfactory. However, endoscopy reports may be improved by including information such as indication, therapy plan and follow-up plan on a more regular basis, and add clarity whether findings may account for complaints of the patient. To tailor endoscopy reports to the needs of individual referring physicians, more explicit information of referring physicians is required. If endoscopists are responsible for the information they provide to the referrer, it is also their task to facilitate the explicit formulation of preferences by the referrer.

Attitude of Health Personnel↗