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PubMedDate not supplied

[Colorectal cancer screening: survey of endoscopy center's physicians in Lazio region].

The aim of the present work is to describe the characteristics of digestive endoscopy centers and the physicians that work there, with particular attention to their attitudes and practices in colorectal cancer screening. A questionnaire was sent to all 80 digestive endoscopy centers in the Lazio region, identified by the annual census of Italian Society of Digestive Endoscopy (Società Italiana di Endoscopia Digestiva, SIED). Seventy-one centers (89%), returned the questionnaire. Screening activity on average represents 14% of the centers' colonoscopy workload. Colonoscopy was considered to be a "very effective" screening test by 96% of physicians, the faecal occult blood test "very effective" by 20%, and flexosigmoidoscopy "very effective" by 11%. Ninety-seven percent (97%) of physicians reported recommending any test for screening: 80% colonoscopy, 61% faecal occult blood test, 14% double contrast barium enema and 11% flexosigmoidoscopy. Despite the fact that almost all physicians reported recommending screening, the centres are only marginally involved in screening practice. Endoscopy centers' physicians tend to have an aggressive strategy for colorectal cancer prevention and exclusive trust in colonoscopy; an attitude more consistent with a clinical-diagnostic approach than with real mass screening of a healthy population.

Adult↗
PubMedDate not supplied

[Intraoperative endoscopy in laparoscopic fundoplications].

BACKGROUND: Laparoscopic fundoplications are the standard surgical treatment of patients with gastroesophageal reflux disorder. Adequate technique is the most important outcome factor. There is no standardized method to evaluate the procedure itself. Intraoperative endoscopy is a method to evaluate laparoscopic fundoplications. MATERIAL AND METHODS: This was a retrospective observational study of patients undergoing laparoscopic fundoplications from July 1999 to June 2004, excluding open procedures and reoperations of previous failed laparoscopic fundoplications. Intraoperative endoscopy was performed during the dissection and suturing of the procedure to determine if correction of the technique is necessary. Number of changes were recorded and analyzed with Student's t-test. RESULTS: Three hundred patients were operated on, 23 were excluded (14 reoperations and nine conventional laparotomies). Of the 277 patients included, 178 were males and 99 females. Average age was 43.4 +/- 14 years (range: 12-85). There were 71 Toupet and 206 Nissen fundoplications. Intraoperative endoscopy determined correction of the technique in 77 patients with 1.69 +/- 0.96 changes; 68 rotated and/or angled fundoplications, one rotation with distended stomach, one redundant gastric fundus, and seven change in the type of fundoplication from Nissen to Toupet because of tightness (3.7 +/- 1.1 changes, p = 0.0001) to achieve adequate fundoplication. CONCLUSIONS: Intraoperative endoscopy confirms adequate technique and prevents inadequate laparoscopic fundoplications. Further studies will determine if routine use is justified to prevent postoperative complications and to improve outcome.

Adolescent↗
PubMed1990

Value of diagnostic upper endoscopy preceding percutaneous gastrostomy.

Percutaneous gastrostomies, placed endoscopically or radiographically, have supplanted their surgical counterparts in many institutions. Although there are few comparative data, a cost advantage is claimed for the radiographic method, as no endoscopy is required. We performed upper endoscopy on 201 patients prior to attempted percutaneous endoscopic gastrostomy (PEG). The medical records of these patients were reviewed. Data collected included endoscopic findings which precluded gastrostomy, necessitated conversion to jejunostomy, or led to changes in medical management. For a total of 73 patients (36%), findings at pregastrostomy endoscopy led to major changes in medical management, including 35 patients with severe reflux esophagitis, 29 patients with peptic ulcers, and two patients with gastric outlet obstruction. Appropriate treatment of such conditions may improve morbidity, mortality, and cost by reducing length of hospital stay. The authors recommend diagnostic upper endoscopy in patients undergoing percutaneous gastrostomy, regardless of placement method.

Digestive System Diseases↗
PubMed1991

Oesophageal changes in oral submucous fibrosis using fibreoptic endoscopy--a pilot study.

Thirty patients with oral submucous fibrosis (OSMF) underwent fibreoptic upper G.I. endoscopy and oesophageal biopsy from 20 cms to see if any correlation is found between visual and histological changes in OSMF and oesophageal mucosa. On endoscopy, the colour of oesophageal mucosa was normal in 28 and whitish pale in 2 cases. On endoscopy mucosa felt stiff and fibrotic in 19, leathery in 4, firm/gritty in 2 and normal in 5 cases. The biopsies were difficult to take in most cases yielding small tissue samples on repeated attempts. On histology most of the samples consisted of only a few layers of hyperplastic epithelium with lamina propria and submucosa being absent in all samples. Good correlation was found between the grade of OSMF and oesophageal changes seen on endoscopy.

Adolescent↗
PubMed1991

[Emergency endoscopy in the diagnosis and treatment of hemorrhage in the upper part of the gastrointestinal system].

The authors describe, based on an analysis of 2970 patients subjected to endoscopy, the advantages of urgent endoscopy performed within six hours after admission to the surgical department. They refute former statements that urgent endoscopy is endoscopy performed within 24 or 48 hours. They discuss the different approach of endoscopists to different types of haemorrhage and to the time factor and emphasize the prognostic considerations of the endoscopist.

Emergencies↗
PubMed1990

[Video-endoscopy and sonography--future developments].

Video Endoscopy and Video Sonography are new developments in the field of endoscopy. They will start a structural change of the common endoscopy unit. This article shall give an overview about new development ways and their consequences for the next years in the field of Video Endoscopy.

Endoscopes, Gastrointestinal↗
PubMed1990

The effect of preoperative endoscopy on recurrence and survival following surgery for colorectal carcinoma.

Numerous studies have elucidated the benefits of endoscopy before surgery for carcinoma of the colon and rectum. In patients with known colon cancer, the incidence of synchronous colon cancers is 1.5 to 7.6 per cent and synchronous colon polyps is 25 to 40 per cent. Standard barium contrast studies are inferior to endoscopic examination in detecting these synchronous lesions. Endoscopy has been shown to alter the planned surgical procedure in 11 to 13 per cent of patients with colorectal cancer. Nevertheless, some authors avoid preoperative endoscopy because of concern that neoplastic cells may be seeded throughout the colon during the examination. They fear that manipulation of the tumor may promote hematogenous or lymphatic spread. Our study seeks to demonstrate whether this concern is valid by comparing rates of local recurrence, distant metastases, and survival between patients who have undergone preoperative endoscopy with those who have not.

Adult↗
PubMed1989

[Comparison of endoscopy and the milk 99mTc-EHIDA test in assessing duodenogastric reflux].

Duodenogastric reflux was estimated in 101 patients with chronic gastritis by means of endoscopy and milk 99mTc-EHIDA test. 61 patients (60.4%) were deemed to be duodenogastric reflux positive by endoscopy, as compared to 40 patients (39.6%) by milk 99mTc-EHIDA test. These differences are statistically significant (P less than 0.005). The discrepancy arises largely from the error in endoscopic estimation of duodenogastric reflux. In a group of 58 patients who were mild to moderate reflux positive by endoscopy, the assessment made by the milk 99mTc-EHIDA test was reflux positive in only 33 (57%). In other words more than 40% of the endoscopically reflux positive patients did not show reflux with 99mTc activity in the stomach. Measurement of the ratio of 99mTc activity in gastric aspirates to the total 99mTc activity injected intravenously was carried out in 13 patients. A perfect correlation was found between the ratio and the grading of duodenogastric reflux estimated by the milk 99mTc-EHIDA test. This finding suggests that by using the milk 99mTc-EHIDA test, duodenogastric reflux may be monitored semiquantitatively without recourse to a nasogastric tube. Furthermore, 10 patients were evaluated twice by the milk 99mTc-EHIDA test at intervals ranging from 3-14 days. In 8 patients the results were identical. This indicates the good reproducibility of the test. This study demonstrates that milk 99mTc-EHIDA test is a more physiological and more accurate method of studying duodenal contents in the stomach, than endoscopy.

Adult↗
PubMed1987

Changes in arterial blood gases associated with gastrointestinal endoscopies.

Changes in arterial blood gases after gastrointestinal endoscopies were studied in 121 patients. The endoscopic procedure was performed either after the administration of fentanyl and diazepam (32 gastroscopies and 27 colonoscopies) or with no sedation (30 gastroscopies and 32 colonoscopies). A significant decrease in PaO2 (p less than 0.01-0.001) occurred in all groups of patients 2 min. after beginning the endoscopic procedure. The PaO2 values 60 min. after the endoscopy did not differ significantly from the preendoscopic levels. An increase in PaCO2 which was statistically (p less than 0.02-0.001) but not clinically significant was observed in the groups of endoscopies performed under sedation. It is concluded that the hypoxemia seen after gastrointestinal endoscopies is due to the procedures themselves and not to the sedation.

Aged↗
PubMed1988

Upper gastrointestinal endoscopy after cardiac transplantation.

Three hundred four patients have undergone cardiac transplantation at the University of Pittsburgh since 1980. Twenty patients have required 27 upper gastrointestinal (GI) endoscopic procedures. After heart transplantation the primary indications for endoscopy were epigastric pain (six patients with gastritis, one with multiple shallow gastric ulcers, and one with normal test results), mild upper GI bleeding (four patients with esophagitis, two with gastritis, and two with multiple shallow gastric ulcers), dysphagia and odynophagia (two patients with esophagitis), persistent nausea and vomiting (one with normal test results), lower GI bleeding (one with normal test results), and routine follow-up (one with normal test results). After heart-lung transplantation the primary indications for the endoscopy were massive upper GI bleeding (three patients with actively bleeding duodenal ulcers), dysphagia and odynophagia (one patient with esophagitis), mild upper GI bleeding (one patient with gastritis), and routine follow-up (one patient with normal test results). No complications resulted from endoscopy. The procedures were performed in the GI suite without cardiac monitoring. Prophylactic antibiotics were not routinely administered. No patient had a fungal infection of the upper GI tract--a finding attributed to the prophylactic use of nystatin in all patients. Opportunistic viral infections were identified histologically in six patients, including two patients with actively bleeding duodenal ulcers. The possibility of opportunistic viral infections in this immunosuppressed group required aggressive diagnostic techniques, including endoscopy and biopsy, which can be safely performed after cardiac transplantation.

Adult↗
PubMed1983

Vascular endoscopy for major vascular reconstruction: experimental and clinical studies.

A new technique of vascular endoscopy employing fiberoptic endoscope and balloon catheter was devised. Experimental and clinical studies showed excellent visual field and optical quality. Our technique of vascular endoscopy has several advantages. First, the size of the balloon is large enough to obtain satisfactory visual field and can be applied to the great vessels. Second, the endoscope can be advanced or withdrawn in the balloon catheter during balloon inflation. Third, the endoscope is never in contact with blood, so thrombus formation can be prevented and complete sterilization can be achieved. Fourth, no blood is lost during the procedure because the graft is snugly tightened to the hard portion of the catheter. Vascular endoscopy is useful to observe orifices of the major aortic branches, to distinguish atheromatous plaque from thrombus, and to identify unexpected intimal tears by vascular clamps, which cannot be achieved by operative angiography. It is particularly useful for identifying the exact site of the entry or reentry in dissecting aneurysm. Although our experience was limited to intraoperative use, vascular endoscopy can be an invaluable method to examine, diagnose, and treat the patient who requires aortic, caval, or other major vascular surgery.

Adult↗
PubMed1980

A comparison between upper gastro-intestinal endoscopy and barium meal examination in private practice.

In a series of approximately 1 300 oesophagogastroduodenoscopies performed between June 1972 and October 1978 there were 107 cases in which the upper gastro-intestinal endoscopy and barium meal had been performed within 14 days of one another (72% of these were performed within 7 days and 51,4% within 5 days). Comparison of the findings at endoscopy and barium meal examination in these 107 cases showed that endoscopy was diagnostically far superior. It was noted that, of 28 cases of oesophageal, gastric, duodenal and anastmotic ulcer and 12 cases of gastric and duodenal erosion diagnosed at endoscopy, only 14 ulcers and none of the erosions had been reported after barium examination. In addition, a large number of false-positive findings of gastric and duodenal ulcer had been reported after radiological examination.

Barium↗
PubMed1993

[Globus pharyngis: indications for flexible endoscopy?].

Flexible endoscopy of the upper gastrointestinal tract usually does not form part of the primary diagnostic evaluation of the globus syndrome. In order to find out the value of this investigation in the differential diagnosis of globus sensation, 51 globus patients were examined by flexible endoscopy of the upper gastrointestinal tract. Pathological findings requiring therapy were diagnosed in 70.6% of cases. The most frequent findings were reflux esophagitis (n = 24; 47%) and hiatal hernia (n = 25; 49%). In 16 cases (31.4%) these were accompanied by other pathological lesions. A total of 32 patients (62.7%) suffered from esophageal diseases as sole etiological factors of the globus syndrome, which allowed us to postulate a causative relationship in these cases. Flexible endoscopy, therefore, can contribute significantly to the differential diagnosis of the globus syndrome. The investigator should consider the potentially high diagnostic "yield" of flexible endoscopy for this indication, also.

Adult↗
PubMedDate not supplied

[Exerience with 3000 endoscopies of the upper digestive tract].

A study is presented of over 3,000 upper gastrointestinal endoscopies over a 4 year period. The principal findings were: 1.282 normal 42,73%), 349 gastric ulcers (11,63%), 314 duodenal ulcers (10,47%), and 208 gastric cancers (6,90%). Endoscopy is an important method for the study of upper gastrointestinal tract diseases. Specially for nonconclusive X-ray study, locating the site of a hemorrhage, differentiating between a benign and a malignant lesion, recommending continuation of medical treatment or surgery, and indicating the zone of surgical resection. The routine use for endoscopy should be insisted upon in patients with vague chronic symptoms to increase the diagnosis of incipient lesions. We have obtained more advantages with endoscopy than with X-rays. However, both methods are complementary and give a more certain diagnosis of digestive diseases. It is a method that when done by experts is innocuous and free of complications. Although the cost of the fibroscope instruments is high, the invaluable services they render to gastroenterology more than compensate their cost.

Esophageal Diseases↗
PubMed1993

Oesophageal diseases in Sudan, diagnosed by fibreoptic endoscopy.

Fibreoptic endoscopy was performed on 5,086 consecutive patients with upper gastrointestinal tract disease (UGITD) symptoms, at two endoscopy centres in Khartoum over five years. Oesophageal disease was diagnosed in 559 patients (11%) comprising (20.5%) of all the positive findings. In 46% of all the endoscopies no abnormality was detected. The commonest oesophageal disease was varices occurring in 186 patients (3.7%) of the 5,086 endoscopies with a mean age of 33.5 +/- 12 and a male/female ratio of 3.4:1. Hiatus hernia occurred in 124 patients (2.4%) with a male/female ratio of 1.6:1, oesophagitis in 115 patients (2.3%) with a male/female ratio of 2:1. Carcinoma of the oesophagus was diagnosed in 108 patients (2.1%), with a mean age of 56 +/- 14 years and a male/female ratio of 1.4:1. Achalasia of the oesophagus occurred in 20 patients (0.4%), Mallory Weiss syndrome in 4 patients (0.08%) and benign strictures in 2 patients (0.04%).

Adolescent↗
PubMed1996

Percutaneous endoscopic gastrostomy: evaluation of insertion by an endoscopy nurse practitioner.

OBJECTIVE: To evaluate the success rate and complications of percutaneous endoscopic gastrostomy (PEG) insertion performed with an endoscopy nurse practitioner, rather than a second doctor, carrying out percutaneous gastric puncture. DESIGN: A prospective evaluation of one nurse'e performance. SETTING: The endoscopy unit in a district general hospital. METHODS: An experienced endoscopy nurse, who had undergone a specific training course in PEG insertion, participated in PEG placement in 50 unselected patients over a one year period. The outcome and complications were compared with 50 PEGs inserted over the same period by medical personnel. A standard 'pull' technique was used to insert a 15Fr tube under sedation and local anaesthetic. RESULTS: The nurse was successful in PEG placement in all patients. Immediate complications from the procedure occurred in two cases in both the nurse-assisted and doctor-assisted groups. These were directly related to the gastric puncture in only one patient in each group; the others were respiratory complications related to the gastroscopy (resulting in the death of one patient). Thirty-day mortality was 8% in the nurse-assisted group and 12% following doctor-assisted PEG (mainly due to progression of the underlying condition). Outcome at 3 months was similar in the two groups, except for a slightly lower incidence of stomal infection in the nurse-assisted group. CONCLUSION: The participation of an endoscopy nurse practitioner in the gastric puncture for PEG insertion appeared to be safe and effective and offered advantages in terms of the efficient provision of a PEG placement service, increased continuity of care for the patients and an enhanced professional role for the nurse involved.

Adult↗
PubMed1997

Gastric ulcers at endoscopy: brush, biopsy, or both?

OBJECTIVES: All gastric ulcers discovered at endoscopy are potentially malignant. Concurrent use of both histological biopsy and cytological brushing has been advocated as a means of increasing the diagnostic yield for neoplasia at the time of initial endoscopy. The purpose of this analysis was to determine the impact of these diagnostic strategies on the cost-effectiveness of detecting malignancy in patients with a gastric ulcer. METHODS: The diagnostic performance of biopsy and brushings in detecting gastric malignancy was estimated from a meta-analysis of published reports. Nondiscounted direct costs were determined from patient resource consumer profiles from the perspective of a Canadian hospital. A decision tree was used to compare diagnostic strategies (biopsy alone, brushing alone, or biopsy and brushing) in a hypothetical cohort of patients found to have a gastric ulcer at endoscopy. Effectiveness was expressed as diagnostic days saved. RESULTS: No strategy achieved dominance. The brushing strategy was the most cost-effective, but its cost-effectiveness ratio was only slightly lower than that of biopsy. Cost differences between the biopsy and brushing strategies were small (less than $6 per case). Performing both biopsy and brushing slightly improved the true-positive rate but resulted in a doubling of the false-positive rate, which in turn led to unnecessary laparotomies. The impact of the high false-positive rate was also seen in the incremental cost of performing both brushings and biopsy ($168-$423 per case). CONCLUSIONS: For gastric ulcers discovered at endoscopy, the preferred strategy is to perform either cytological brushing or histological biopsy. The previously recommended strategy of performing both cytological brushing and histological biopsy should be reconsidered.

Biopsy↗
PubMed1997

[Evaluation by a randomized trial of the usefulness of endoscopy after treatment of a flare-up of non-severe esophagitis].

OBJECTIVES: The clinical usefulness of esophageal endoscopy at the end of a treatment of non-severe esophagitis due to gastro-esophageal reflux is unknown. The aim of this randomized trial was to compare two strategies for the management of non-severe esophagitis, one with endoscopy at the end of the initial treatment including a retreatment of persistent ulcerations (group 1) and one without final endoscopy (group 2). PATIENTS AND METHODS: Eligible patients had heartburn and endoscopically proved esophagitis, non-confluent or confluent erosions and must have been relieved of their heartburn after a 4 to 6 week treatment with H2 blockers or by proton pump inhibitor. When the ulcerations were healed in group 1 and immediately at the end of the initial treatment in group 2, a self-care treatment by sodium alginate was prescribed. A total of 369 patients were randomized, 178 in group 1, 191 in group 2. RESULTS: At 6 months, there was no difference in the percentage of patients with clinical and endoscopical success, 52% and 55% in group 1 versus 47% and 60% in group 2 respectively. In group 1, 29 patients (16%) needed another treatment than alginate versus 31 patients in group 2 (16%, NS). Among patients with endoscopy at 6 months, the percentage of patients with confluent erosions was 4% (5/140) and with non-confluent erosion 26% (37/140) in group 1 versus 6% (9/158) and 22% (34/158) in group 2 respectively (NS). The percentage of patients with at least one sick day related to reflux was 12% in group 1 versus 5% in group 2 (P = 0.03). There was no difference in pharmacy costs (331,40 vs 264,3 Francs). CONCLUSION: Endoscopic verification is not necessary in patients with non-severe esophagitis who have been clinically improved by an initial treatment by H2 blockers or proton pump inhibitor, even among patients with confluent esophageal erosions.

Adult↗