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PubMed2005

[Examination of patients with dyspepsia in areas with a low prevalence of Helicobacter pylori infection].

Examination of patients with dyspepsia is quantitatively a major task in gastroenterology. Several strategies have been used. In recent years the "test and treat strategy" has gained wide acceptance, because it is easy and without discomfort to the patient. The primary step in this strategy is a 13C-urea breath test for Helicobacter pylori. If the test is positive, the Helicobacter pylori must be eradicated. Only patients with alarm symptoms or refractory symptoms are offered gastroscopy. This strategy has been found useful in clinical trials performed in areas with a high prevalence of Helicobacter pylori infection. To examine whether these results are valid in clinical practice in a low-prevalence country, we performed a one-year retrospective study of our modified strategy of 666 patients, in which gastroscopy is offered to patients who test negative--an "open access test and scope strategy". In all, 576 patients were referred and examined according to the strategy; 90 patients, of whom 43 had alarm symptoms, were referred erronously. We performed 322 breath tests, of which 66 were positive--49 in patients without alarm symptoms. Of the latter, 39 were improved by Helicobacter pylori eradication therapy. These were the patients who really benefitted from the strategy. Of the 230 patients with a negative breath test, 197 agreed to have a gastroscopy done, and 31 cases of oesophagitis and 3 idiopathic ulcers were found. It is concluded that the strategy is advantageous but complicated in an open-access setting.

Adolescent↗

PubMed1991

[Stomach ulcers in the horse--clinical and gastroscopic findings in 12 horses (1989-1990)].

Twelve horses with clinical symptoms of a gastric disorder were studied by gastroscopy. Symptoms of gastric disorders were periprandial colic, bruxism, ructus and reflux. Preliminary to gastroscopy the horses were fasted for 24 h. Access to water was not restricted. The gastroscopy could be conducted easily using a fiberscope 2.5 m in length and 11 mm in outer diameter. While ulcers were present in the squamous fundus of all horses only one horse showed ulceration of the glandular fundus. Solitary ulcers near the margo plicatus were found in horses with mild clinical symptoms. In contrast, diffuse gastroesophageal ulceration was accompanied by severe clinical symptoms. Four horses were affected by an acute gastroesophageal ulceration with gastric reflux and subsequent aspiration pneumonia. Two of those horses suffered from acute gastric ulceration 3-4 days following laparatomy. All horses were treated with cimetidine (5 mg/kg bwt/q.i.d.) until clinical symptoms ceased.

Animals↗

PubMed1990

[Does an information booklet on gastrointestinal endoscopy reduce anxiety for these examinations? Results of a randomized study with 379 patients].

A randomized controlled trial was performed between June and December 1989 in 379 outpatients to evaluate whether a patient information booklet is able to reduce anxiety levels before gastroscopy or colonoscopy. Anxiety levels were measured by a Visual Analogue Scale (VAS) in all patients entering the office. Half of the patients received the information booklet about the endoscopic investigations and half did not. VAS was measured again directly before endoscopy in each patient. All patient groups were comparable. The median anxiety level of gastroscopy patients before and after reading the information booklet was 5.3 (2.5-10) and 4.9 (0.8-10), and for colonoscopy patients 6.0 (2.5-10) vs 5.0 (0.7-10). So not much difference concerning the anxiety level before and after reading the patient information booklet was found. Thus better than an information booklet, for every patient an individualized technique of the endoscopist may reduce patient anxiety before gastroscopy or colonoscopy.

Adolescent↗

PubMed1990

A study to assess the efficacy of chemoprophylaxis in the prevention of endoscopy-related bacteraemia in patients aged 60 and over.

Five hundred and fifteen patients aged 60 and over (mean age 74.7; 278 men and 237 women) underwent routine endoscopic procedures (gastroscopy, bronchoscopy and cystoscopy). Alternate patients were given antibiotics before the procedure, as currently recommended, and blood was taken for culture from all patients within five minutes of completion of the procedure. Of 74 patients who underwent bronchoscopy, only one culture, from one of 37 controls was positive. Of 262 who underwent gastroscopy, cultures were negative in the 130 who received antibiotics but positive in 13 of the 132 controls (9.8 per cent p less than 0.001). Cystoscopy was performed in 179; one culture was positive in the 88 given antibiotics (1.1 per cent) compared to 25 in the 91 controls (27.5 per cent; p less than 0.001). Bacteraemia rates appear to be low following bronchoscopy (less than 5 per cent) but higher with gastroscopy (10 per cent) and cystoscopy (28 per cent). Chemoprophylaxis was effective in reducing these rates in this patient group.

Aged↗

PubMed1977

[Early carcinoma of the stomach from the endoscopic point of view].

3060 gastroscopies were performed during the period from 1971 until April 1976 and the diagnosis of gastric carcinoma, was made in 131 cases. From this series, 25 carcinomas fulfilled the criteria of an "early gastric cancer" after examination of the resection specimen. The percentage of early gastric cancer is 0.82% of all gastroscopies and 19% of all gastric carcinomas detected by endoscopy, in our patient series. It is confirmed by this data, that the prognostically favorable early gastric cancer does not occur so rarely in our area, when adequate diagnostic possibilities are available. In this context, greatest importance is attributed to gastroscopy, combined with biopsy.

Adult↗

PubMed1989

[Current aspects of the diagnosis and surgical treatment of reflux esophagitis].

For a period of 18 months (1986-1987) a total of 2595 fiber gastroscopies have been performed for different reasons. Reflux esophagitis (RE) was visualized in 436 of the patients undergone fiber gastroscopy (16.8 per cent), histologically verified in 64. The esophageal lesions in 11 patients were severe--III I and degree, according to the endoscopic classification of Plüoke, 1 of them having ulcer and 2 stricture of the esophagus. All 11 patients were operated. Nine had fundoplasty performed by Nissen's technique, associated in 5 with proximal selective vagotomy and in 1 with gastric resection for simultaneous occurrence of RE and duodenal ulcer. Resection of esophagus with esophagogastric anastomosis was performed in the two patients with esophageal stricture. On control examination after 3 and 6 months 5 of the patients having undergone fundoplasty reported mild dysphagia. Control fiber gastroscopy with biopsy showed significant decrease, even complete disappearance of the esophageal lesions and healing of the duodenal ulcer. One patient who had esophageal resection suffered restenosis, prompting bougienage with satisfactory result. Problems related to the diagnosis, indications for operation and operative tactics in severe forms of RE are discussed.

Esophagitis, Peptic↗

PubMed1986

[Relations between stomach polyps and stomach cancer--results of follow-up after endoscopic polypectomy].

We report on 468 polypectomies on 303 patients in 23,260 gastroscopies. In 230 endoscopic follow-up controls on 129 patients 4 carcinomas are found, and that once after a hyperplastic polyp and thrice after hyperplasiogenic polyps. In comparison to our routine gastroscopies the number of the carcinomas is distinctly lower in the control of polyps, so that the hyperplasiogenic polyps in our gastroscopies do not represent a particular risk group for a carcinoma of the stomach. After polypectomy should be controlled: adenimas, polyps with severe dysplasias, hyperplasiogenic polyposes and stomachs in which polyps remained.

Cell Transformation, Neoplastic↗

PubMed1983

Familial amyloidosis with polyneuropathy: roentgenological and gastroscopic appearance of gastrointestinal involvement.

Forty-three patients suffering from familial amyloidosis with polyneuropathy were examined by means of barium meal, barium follow through, barium enema, cholecystogram, and gastroscopy. The findings were reviewed with respect to the presence of steatorrhea and impaired d-xylose absorption. Seven patients had gastric stasis (without gross anatomical changes) on barium meal examination and seven others on the gastroscopy. Gastroscopy revealed that another five patients had inactive peristalsis of the antrum-pylorus. Only one patient had slow transit of barium on follow through. The transit time of barium did not correlate with increased fecal fat output or decreased d-xylose absorption. Barium enema and cholecystogram were normal. The main radiological and gastroscopic finding in familial amyloidosis with polyneuropathy was reduced gastric motility.

Adult↗

PubMed1980

[Early gastric carcinoma detection by endoscopy and biopsy; clinical experiences (author's transl)].

This report presents the clinical features of 15 cases of early gastric cancer detected amont altogether 144 gastric cancers diagnosed with the aid of gastroscopy and directed biopsy in a series of 2953 patients. Since the clinical and laboratory data of the patients with early gastric cancer do not provide satisfactory diagnostic evidence, careful X-ray examination must be carried out in all cases with long-standing symptoms relating to the upper part of the abdomen, especially in patients over 40 years old. Gastroscopy is essential in the clarification of any suspected pathological signs indicated by the radiologists and, furthermore, in all cases in which no radiological diagnosis was reached to account for the patient's symptoms. During gastroscopy multiple biopsy specimens should be taken from all lesions which may mask any type of the early cancers. The importance of regular endoscopic examination of high-risk persons for gastric cancer is emphasized.

Adult↗

PubMed1997

Helicobacter pylori infection after partial gastrectomy for peptic ulcer and its role in relapsing disease.

OBJECTIVE: To elucidate the role of Helicobacter pylori in relapsing disease after partial gastrectomy for peptic ulcer. DESIGN: Retrospective study of gastroscopies between January 1985 and February 1988. SETTING: Department of Surgery, Helsinki University Central Hospital, Finland. PARTICIPANTS: One hundred and fifty-five patients, who had undergone partial gastrectomy for peptic ulcer disease. MAIN OUTCOME MEASURES: Correlation between clinical and laboratory data, macroscopic findings at gastroscopy and histopathology. RESULTS: At gastroscopy 41 patients showed an ulcer at the site of anastomosis or in the gastric stump and two patients had a history of a previous ulcer recurrence. The median time interval between operation and relapse was 4 years. There was no correlation between ulcer recurrence, sex, age, ABO blood group or other diseases. Smokers and patients using non-steroidal anti-inflammatory drugs (NSAIDs) or alcohol had more relapses, but the difference was not significant. The recurrence rate was higher after Billroth II (BII; 34%) than after Roux-en-Y (14%; P = 0.03) or Billroth I (BI) reconstruction (24%). Giemsa staining demonstrated H. pylori in the gastric stump of 37% of the patients. H. pylori expression was related to age but unrelated to sex, ABO blood group, NSAID use, smoking or alcohol consumption. H. pylori positivity was more common (52%) after BI than after BII (28%; P = 0.04) or Roux-en-Y resection (40%). Recurrent ulcer was more often found in gastric remnants with normal mucosa (36%) than in those with H. pylori-positive gastritis (18%; P = 0.03) or H. pylori-negative gastritis (26%). CONCLUSION: It seems that H. pylori infection plays a minor role in the pathogenesis of ulcer recurrence after partial gastrectomy for peptic ulcer disease. Eradication of H. pylori of the remnant stomach is therefore presumably not effective in preventing ulcer recurrence.

Adult↗

PubMed1996

High seroprevalence of IgG against Helicobacter pylori among endoscopists in Taiwan.

A prospective survey to investigate the seroprevalence of IgG against Helicobacter pylori among endoscopists in Taiwan was conducted by analyzing blood samples of 70 study subjects and 64 nonendoscopist physicians with quantitative ELISA. Personal information and the practices of infection control related to gastroscopy examination were obtained by a self-administered questionnaire. Significant differences were detected in the IgG prevalence between study and control subjects (80.0% vs 51.6%; P < 0.05). The serum level of antibody in endoscopists (385.2 +/- 36.1 unit/ml) was significantly higher than that of nonedoscopists (211.8 +/- 33.0 unit/ml; P = 0.018). Endoscopists performing 30 or more sessions of gastroscopy per week had higher seroprevalence than those performing less than 30 sessions (90.9% vs 70.3%; P = 0.0126). In conclusion, endoscopists in Taiwan had a high prevalence of H. pylori infection. The cause might be related to the frequency of gastroscopies performed.

Adult↗

PubMed2004

Reliable detection of macrolide-resistant Helicobacter pylori via fluorescence in situ hybridization in formalin-fixed tissue.

Macrolide-resistant Helicobacter (H.) pylori represent an increasing therapeutic problem. Macrolide resistance is usually determined phenotypically in vitro with methods such as E-test or agar dilution test. A prerequisite for those tests, however, is bacterial culture that is not routinely set up in the course of gastroscopy. In contrast, formalin-fixed, paraffin-embedded biopsies are regularly available from patients who have undergone gastroscopy. In such biopsies macrolide-resistant H. pylori can be detected by the genotype-based technique of fluorescence in situ hybridization (FISH). Experience gained by this new method, however, is still extremely limited, especially in formalin-fixed tissue. Therefore, we retrospectively investigated formalin-fixed, paraffin-embedded biopsy specimens by FISH in 104 patients suffering from therapy-resistant H. pylori gastritis. To test the accuracy of FISH, we initially examined specimens from 53 patients for whom results of the E-test were available. Next we analyzed biopsies from another 51 patients that had been selected since phenotypical resistance testing had failed despite documented culturing attempts. In all 104 patients, H. pylori was detected by FISH and could thus be investigated for macrolide resistance. Overall, macrolide-resistant bacteria were found in 71 patients (68.3%). In 49 of 53 patients (92.4%), FISH and E-test returned identical results (no significant discordance according to McNemar's chi(2)-test). Taken together, our study demonstrates that FISH is a highly sensitive and reliable method for detecting macrolide-resistant H. pylori in formalin-fixed, paraffin-embedded biopsy specimens, which represents the routine method of processing tissue obtained upon gastroscopy.

Anti-Bacterial Agents↗

PubMed1996

A double-blind randomized trial of low-dose versus high-dose topical anaesthesia in unsedated upper gastrointestinal endoscopy.

BACKGROUND: Upper gastrointestinal endoscopy is frequently performed on unsedated subjects. Pharyngeal anaesthesia is thought to improve patient tolerance to the procedure but the optimum dose of anaesthesia is not known. The aim of this study was to assess the benefits of low-dose vs. high-dose topical anaesthesia in unsedated gastroscopy. METHODS: One hundred and fourteen subjects attending for diagnostic gastroscopy were studied. Patients were randomized to receive either 30 mg or 100 mg of topical pharyngeal lidocaine spray prior to endoscopy in a double-blind fashion. Subjects completed a questionnaire before and after endoscopy. RESULTS: A similar proportion of patients in each group required intravenous sedation because of discomfort or anxiety during the procedure (P = 0.48). The high-dose group experienced less discomfort during endoscope insertion (P = 0.002) and throughout the examination (P = 0.01). Overall satisfaction was almost identical in the two groups (P = 0.85) and a similar percentage of the high-dose and low-dose groups stated that they would request sedation prior to future endoscopy (37 vs. 44%; P = 0.48). Further analysis showed that apprehensive patients and younger patients reported relatively high levels of discomfort, and that female subjects were more likely to express a preference for sedation at any future gastroscopy. CONCLUSION: High-dose pharyngeal anaesthesia reduces patient discomfort during unsedated upper gastrointestinal endoscopy. However, patient tolerance is also influenced by clinical features, which might be useful in deciding which patients are suitable for this procedure.

Administration, Topical↗

PubMed1998

Using endoscopic procedures for AN-DRG (Australian National Diagnosis Related Groups) assignment: Australia leads the way.

The study reported in this article sought to develop Australian National Diagnosis Related Groups (AN-DRGs) using endoscopic procedures in Major Diagnostic Category (MDC) 6 (Digestive System) and MDC 7 (Hepatobiliary System and Pancreas) through statistical analysis of the Australian Casemix Clinical Committee's recommendations. Five ANOVA were undertaken on final recommendations for gastroscopy and colonoscopy in MDC 6. The Reduction in Variance (RIV) for the AN-DRGs in version 3 relative to version 2 increased by up to 14.6%, representing RIV of between 25.28% to 32.30%. For all ANOVAs, F > 100, alpha < .0001, Coefficient of Variation (CV) was generally lower in version 3 by between 0.4% to 22.9%, except for AN-DRGs for other gastroscopy for major gastro-intestinal disease, which increased by 8.7%. Two ANOVA for Endoscopic Retrograde Cholangio-pancreatography Procedures (ERCP) recommendations resulted in RIV of up to 18.67%, F > 100, alpha < .0001 and CV up to 0.8091. MDC 6, in AN-DRG versions 3 and 3.1, has 11 AN-DRGs following the surgical hierarchy involving gastroscopy and colonoscopy. Patients assigned will not have an operating room procedure; they will have a non-operating room procedure that is either a complex therapeutic or other (diagnostic or therapeutic) procedure. Similar AN-DRGs are in MDC 7 for ERCP. Version 3.1 has expanded the definition of Common Bile Duct Exploration (CDE) to include ERCP. There is no separate AN-DRG for laparoscopy cholecystectomy.

Analysis of Variance↗

PubMed1995

Prospective audit of upper gastrointestinal endoscopy in two regions of England: safety, staffing, and sedation methods.

A prospective audit of upper gastrointestinal endoscopy in 36 hospitals across two regions provided data from 14,149 gastroscopies of which 1113 procedures were therapeutic and 13,036 were diagnostic. Most patients received gastroscopy under intravenous sedation; midazolam was the preferred agent in the North West and diazepam was preferred in East Anglia. Mean doses of each agent used were 5.7 mg and 13.8 mg respectively, although there was a wide distribution of doses reported. Only half of the patients endoscoped had some form of intravenous access in situ and few were supplied with supplementary oxygen. The death rate from this study for diagnostic endoscopy was 1 in 2000 and the morbidity rate was 1 in 200; cardiorespiratory complications were the most prominent in this group and there was a strong relation between the lack of monitoring and use of high dose benzodiazepines and the occurrence of adverse outcomes. In particular there was a link between the use of local anaesthetic sprays and the development of pneumonia after gastroscopy (p < 0.001). Twenty perforations occurred out of a total of 774 dilatations of which eight patients died (death rate 1 in 100). A number of units were found to have staffing problems, to be lacking in basic facilities, and to have poor or virtually non-existent recovery areas. In addition, a number of junior endoscopists were performing endoscopy unsupervised and with minimal training.

Adult↗

PubMed2003

Esophageal foreign body causing direct aortic injury.

Foreign bodies in the esophagus are uncommon causes of esophageal perforation. Many nonperforating cases are successfully managed by flexible gastroscopy. However, complicated foreign bodies such as those that result in esophageal perforation and vascular injury are best managed surgically. Gastroscopy remains the primary method of diagnosis. A case of a 59-year-old woman who developed retrosternal and intrascapular pain, odynophagia and hematemesis after eating fish is reported. Flexible gastroscopy showed arterial bleeding from the midthoracic esophagus. Computed tomography scan localized a 3 cm fish bone perforating the esophagus with surrounding hematoma. An aortogram did not reveal an actively bleeding aortoesophageal fistula. The fish bone was surgically removed and the patient recovered with no postoperative complications. This case illustrates the importance of early consideration for surgical intervention when confronted with a brisk arterial bleed from the esophagus with suggestive history of foreign body ingestion.

Aorta↗

PubMed1990

Cumulative 10-year risk of symptomatic duodenal and gastric ulcer in patients with or without chronic gastritis. A clinical follow-up study of 454 outpatients.

The cumulative rate of symptomatic peptic ulcer (PU) was examined in a 10-year clinical follow-up study of 454 consecutive outpatients who had undergone diagnostic gastroscopy, from whom routine biopsy specimens were taken from the antral and corpus mucosa, and who were found to be ulcer-free before and at the time of this initial gastroscopy. During the follow-up period 34 (11%) of 321 patients who showed gastritis in the biopsy specimens at the initial gastroscopy had contracted symptomatic PU (18, 5, 7, and 4 cases of duodenal, pyloric, antral, and angular or corpus ulcer, respectively), which was verified by endoscopy. Only 1 (0.8%) of 133 patients with normal antral and corpus mucosa had contracted PU. It was calculated that the 10-year cumulative probability of PU was 10.6% (95% confidence interval (CI95), 7.2-14.0%) in the patients with gastritis, whereas this probability was only 0.8% (0-2.2%) in the patients who had normal antral and corpus mucosa in the initial specimens. The cumulative probability of PU was found to be highest, 27.3% (1.0-53.6%), in middle-aged men (41-60 years of age) who had chronic antral gastritis or chronic pangastritis (gastritis in both antrum and corpus). It is concluded that chronic gastritis precedes the appearance of PU and that the cumulative 10-year risk of PU is very low when both antral and corpus mucosa are normal but may be high if chronic gastritis is present.

Adult↗

PubMed1993

Metastatic involvement of the stomach secondary to lung carcinoma.

Blood-borne metastatic involvement of the stomach by cancer is a rare entity. According to the number of reports in the literature, the most common tumors that spread to the stomach through the blood stream are malignant melanoma, breast carcinoma and lung carcinoma. Recently, two cases of metastatic involvement of the stomach secondary to lung carcinoma were diagnosed by gastroscopy. The first patient was a 66-year-old man who had primary lung carcinoma with multiple bone and subcutaneous metastases. Gastroscopy showed multiple submucosal tumors with central umbilications in the fundus and in the upper body of the stomach. Pathologic examination revealed massive submucosal infiltration and conical shaped and scanty deep mucosal infiltration of undifferentiated small cell carcinoma suggestive of metastatic involvement. The second patient was a 68-year-old man who had primary lung carcinoma with brain metastasis. Gastroscopy showed a large fungating mass in the greater curvature side of the stomach. Pathologic examination revealed poorly differentiated squamous cell carcinoma. We report the two cases of metastatic gastric cancer from lung carcinoma with the literature review.

Aged↗