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At least 1,045 records · Page 58Linked to original sources
PubMed2002

[Assessment of anxiety levels in patients during diagnostic endoscopy].

Patients with increased pre-endoscopic anxiety take advantage of the use of conscious sedation. However, the habit of using premedication varies according to the type of endoscopic examination. Aims of this study were: to evaluate whether different endoscopic procedures may have different effects on patient anxiety; and whether anxiety affects patient tolerance. 163 consecutive outpatients undergoing endoscopy (75 gastroscopy, 51 colonoscopy and 37 bronchoscopy) were interviewed to evaluate pre-endoscopy anxiety, by using the Spielberger State-Trait Anxiety Inventory. After endoscopy, endoscopists rated patient cooperation on a 10-cm visual analogue scale. Females had state and trait anxiety levels higher than males (50.49 +/- 1.37 vs 45.07 +/- 1.20, p < 0.01; and 44.46 +/- 1.06 vs 38.48 +/- 1.01, p < 0.01). Anxiety levels were not related with the type of endoscopic procedure. A direct relationship was observed between state and trait anxiety (p < 0.001). Patient cooperation to endoscopy was inversely related with both trait (p < 0.05) and state anxiety (p < 0.01). In conclusion, gastroscopy, colonoscopy and bronchoscopy seem to induce similar pre-endoscopy anxiety levels. Therefore, the different frequency in the use of intravenous sedation between bronchial and gastrointestinal endoscopy does not seem justified.

Adolescent↗
PubMedDate not supplied

Laparoscopic splenectomy for variceal bleeding with non-cirrhotic portal vein thrombosis: a case report.

A 57-year-old man was referred to our hospital for treatment of refractory gastric bleeding from gastric varices secondary to portal vein thrombosis. The patient's liver function tests and coagulation profile were normal. The venous phase of the superior mesenteric arteriogram, on the other hand, showed superior mesenteric vein-portal vein occlusion with surrounding hepatopetal variceal collaterals. The venous phase of the splenic arteriogram additionally showed splenic vein occlusion and collateral vessels from the gastric and retroperitoneal regions flowing into a portal cavernous transformation. Gastroscopy confirmed that the patient had gastric varices in the cardia. We performed laparoscopic splenectomy to treat refractory gastric bleeding from varices and symptomatic hypersplenism. The postoperative course was uneventful; the patient's gastric varices were less prominent on follow-up gastroscopy and the hematologic profile returned to normal. Extrahepatic portal vein thrombosis is the leading cause of variceal hemorrhage in patients with healthy livers. There is a consensus in the literature that splenectomy alone is of minimal value in preventing variceal bleeding in portal vein thrombosis. Splenectomy is, however, indicated in cases in which the patient has hepatopetal collaterals from the mesenteric vein system and whose hemorrhagic gastric varices are related to splenic vein thrombosis as in our case.

Esophageal and Gastric Varices↗
PubMedDate not supplied

[Endoscopic treatment of gastric carcinoid. Report of a clinical case].

We report on a case of a gastric carcinoid of the sporadic type successfully treated by endoscopic electroresection. From January 1998 to October 2002, 1523 gastroscopies were performed in the Palermo University General Emergency Surgery and Organ Transplant Unit. In a 59-year-old man with a history of dyspepsia, a sessile polypoid gastric lesion was observed in the gastric corpus. Laboratory data were normal. The lesion was successfully treated by electroresection. Histological evaluation revealed an 8-mm-diameter well-differentiated neuroendocrine polypoid tumour infiltrating the muscularis mucosa. According to Rindi et al.'s classification, the polyp was a carcinoid of the sporadic type. A two-year follow-up consisting in gastroscopy every 6 months and evaluation of tumour markers and CT scans once a year has so far shown no recurrence. Surgical treatment is the therapy of choice for gastric carcinoids, but endoscopic resection may be a successful alternative in cases of carcinoids measuring less than 1 cm and presenting multricentric growth. Moreover, endoscopy can also be used in patents at high surgical risk.

Carcinoid Tumor↗
PubMed1991

Therapeutic activity, clinical and gastric tolerance of 20mg daily dose of droxicam in comparison with piroxicam in patients with degenerative joint disease.

The efficacy and safety of droxicam were compared with piroxicam in a pilot study in twenty patients with degenerative joint disease. After a one week washout period a baseline gastroscopy was carried out. Treatment during the following 4 weeks was randomised to droxicam or piroxicam. Safety and tolerance parameters were monitored at weekly intervals. Pain was evaluated with two visual analogue scales (VAS) (patient and investigator). Affected joints, articular index (AI), patient's status and a daily living activities questionnaire were also evaluated. Another gastroscopy was carried out at the end of the treatment period. Droxicam and piroxicam relieved all symptoms significantly without statistically significant clinical differences. Both groups showed no drug related side effects in the laboratory values. In the gastroscopic examinations two patients of the droxicam group and four of piroxicam group had minor gastric erosions after four weeks of treatment without any accompanying clinical symptoms.

Adult↗
PubMed2003

[Gastroduodenoscopy for screening of patients scheduled for oral anticoagulant therapy: incidence and age dependence for potentially bleeding pathologies].

UNLABELLED: This retrospective study was designed to shed light on the incidence and age-dependence of potentially bleeding pathologies in the upper gastrointestinal tract of asymptomatic patients scheduled for oral anticoagulant therapy. Gastroduodenoscopy was routinely performed during screening studies. The incidence of abnormalities was compared with gastroscopy findings of patients with epigastric symptoms. Only pathologies likely to bleed were considered. These included gastric ulcers, duodenal ulcers, esophageal varices, esophagitis, erosions, malformations and hemorrhages. RESULTS: 18.23% of the patients (n = 746) undergoing gastroscopy prior to scheduled oral anticoagulant therapy were found to present with abnormalities versus 18.44% of those with epigastric symptoms (n = 1,627). In the group scheduled for oral anticoagulant therapy, the rate of pathologies did not significantly increase with increasing age. CONCLUSIONS: The unexpectedly high incidence of potentially bleeding pathologies in asymptomatic patients scheduled for anti-coagulant therapy should prompt screening gastroduodenoscopies irrespective of the patients' age prior to instituting treatment.

Administration, Oral↗
PubMed2003

Malignancy risk of gastric ulcers: could it be higher than the expected values?

There are many reported methods in the literature for the discrimination between malignant and benign gastric ulcers by endoscopic evaluation, but unfortunately this could not be done in 20% of the cases. The sensitivity for diagnosis of malignant ulcers increases by multiple biopsies and endoscopies. In this study, solitary gastric ulcers which were detected at 1680 gastroscopies between January 2001 and June 2002 are evaluated. The ulcers which were on gastric mass, multiple little aphthous ulcers and ulcers with hemorrhagic erosions having a diameter less than 0.5 cm are excluded from the study. There were a total of 32 patients, 20 males and 10 females, having a median age of 54.8 years. In the initial biopsy, only nine patients had malignancy results. The 23 cases having benign results had medical treatment with proton pump inhibitors for four weeks. At the end of this period, they had their second gastroscopic evaluation. The ulcers of 14 patients did not heal and second round biopsies were per formed. Additionally four cases had malignant results following the second round biopsy. After 4 weeks the remaining 10 cases had their third round of gastroscopy which revealed that two patients still had the ulcer. A third round biopsy was done and one case had a malignancy result. A total of 14 malignancy cases was encountered, and nine of them was adenocarcinoma, four were signet cell carcinoma and one case was MALT lymphoma. 78% of the malignant cases were encountered at the proximal site of the incisura angularis, and in 64% of these malignant cases nodular lesions around the ulcer were encountered. The four ulcers out of eight which were settled at the smaller curvature site were malignant, and only one ulcer at cardia was also malignant. The main method for the discrimination of malign-benign ulcer is still biopsy. The follow up of the patients with repeated multiple biopsies may increase the sensitivity for diagnosis of malignancies in the solitary gastric ulcer.

Adenocarcinoma↗
PubMed2004

[The effect of Helicobacter pylori eradication on chronic use of acid-suppressant medication by patients in general practice; a randomised, double-blind study].

OBJECTIVE: To study the feasibility of tapering long-term acid-suppressant drugs (ASD) use in chronic dyspeptic patients in relation to Helicobacter pylori eradication. DESIGN: Prospective randomised double-blind study. METHOD: Patients from 54 general-practitioner practices in the Amsterdam area were studied in the period 1 April 1997 - 30 September 1999 after selection on the basis of their use of acid suppressants for a period of at least 8 weeks. After gastroscopy the patients with a peptic ulcer (PUD) and H. pylori were treated with eradication therapy and patients without an ulcer but with H. pylori were randomised for eradication or placebo treatment. After a gradual reduction of acid suppressants over a 3-week period following the intervention, the patients kept a diary for 24 weeks of the quantities of acid suppressants and antacids they used. RESULTS: Of the 1083 patients approached, 434 were prepared to undergo the gastroscopy. Data for the follow-up period were available for 186 of the 227 H. pylori-positive patients. Of them 61% stopped ASD use during follow-up. The mean daily ASD dosage per patient decreased by 85% from 1.85 to 0.27 units (p < 0.05), with minimal antacids use. Of the 75 patients with peptic-ulcer disease 86% stopped ASD use. In patients with functional dyspepsia no difference in ASD use was observed after successful H. pylori eradication or placebo. Patients with mild reflux disease (GERD) used more ASD after H. pylori eradication than after placebo (p < 0.05). CONCLUSION. After H. pylori eradication many patients with PUD stopped ADS use, while GERD patients used more ASD than after placebo. A gradual withdrawal of long-term ASD use, supported by antacids and on-demand use of low-dosage ASD, facilitated reduction of ASD use during 6 months.

Adolescent↗
PubMed2005

Patient acceptance of diagnostic laparoscopy.

PURPOSE: To assess patient acceptance of diagnostic conventional laparoscopy and minilaparoscopy under sedoanalgesia. MATERIALS AND METHODS: 120 consecutive patients undergoing diagnostic laparoscopy were enrolled prospectively in this study. Within the first week after diagnostic laparoscopy the patients were asked to answer a total of eight questions with regard to the acceptance of the procedure. RESULTS: The inconvenience of laparoscopy was assessed with a mean of 1.6 on a scale from 0 to 10 (0 = no inconvenience, 10 = very unpleasant). The discomfort in the two days following laparoscopy were graded with a mean of 2.1 on a scale from 0 to 10 (0 = no inconvenience, 10 = very unpleasant). There was no difference between conventional laparoscopy and minilaparoscopy. Only 10% of the patients described laparoscopy more inconvenient in comparison to diagnostic gastroscopy, whereas 29% of the patients assessed diagnostic gastroscopy more inconvenient. CONCLUSIONS: Diagnostic laparoscopy under sedoanalgesia is a very well tolerated procedure. There is no difference between conventional laparoscopy and minilaparoscopy.

Abdominal Pain↗
PubMed2006

[Expression of gastrin, somatostatin, PCNA and Fas-L in the mucosa of gastric antrum of children with chronic gastritis and duodenal ulcer].

OBJECTIVE: Since application of pediatric gastroscopy in the mid-nineteen nineties, there has been a trend that the prevalence rates of pediatric gastritis and duodenal ulcer (DU) are increasing. The diagnosed rate of pediatric gastritis has accounted for 85% - 95% of the total number of children who received gastroscopy, and the rate of DU accounted for 8% - 22%. Such a high rates of the diseases may influence the development of the children severely. However, the etiology and pathogenesis of pediatric chronic gastritis and DU have not been completely elucidated. The disordered gastrointestinal hormones play a crucial role in the pediatric chronic gastritis and DU. This study focused on the expression of gastrin (GAS), somatostatin (SS) in the mucosa of gastric antrum and PCNA and Fas-L in the sinus ventriculi and their possible roles in the pathogenesis of pediatric chronic gastritis and DU. METHOD: The sinus ventriculi mucosal samples of 83 cases were collected via gastroscopic biopsy from the hospital during the recent two years and the cases were divided into five groups: group A, chronic superficial gastritis, Helicobacter pylori (Hp)(+); group B, chronic superficial gastritis, Hp(-); group C, DU, Hp(+); Group D, DU, Hp(-); Group E, normal sinus ventriculi mucosa, Hp(-). Immunohistochemical staining (En Vision) was carried out for GAS, SS, PCNA and Fas-L, and positive cells of each slide were counted (x 400). Statistically significant differences among groups for continuous data were assessed with the software SPSS10.0. RESULTS: The expressions of GAS and SS in the groups A through E had no significant difference. The expression of PCNA in group A was significantly higher than that in group B (P < 0.05), and no significant differences were found among the other groups. There were no significant differences in expressions of Fas-L among the five groups. CONCLUSION: There seems to be an increasing tendency in the expressions of GAS and SS in children with chronic gastritis and duodenal ulcer. Hp infection promotes the multiplication of the sinus ventriculi mucosal epithelium cells in the pediatric chronic gastritis.

Adolescent↗
PubMed1991

Effect of acute ingestion of tobacco on gastric mucosa. An endoscopic study.

One hundred patients with non ulcer dyspepsia with history of chronic tobacco chewing were examined endoscopically to assess the effect of tobacco ingestion on the gastric mucosa. Gastric erosions were seen in 20 patients in the fasting state. The remaining 80 patients in whom gastroscopy did not reveal erosions were subjected to repeat gastroscopy after tobacco ingestion. In 40 patients, endoscopy was repeated 30 minutes after 200 mg of tobacco ingestion (Group I) and in another 40 patients endoscopy was repeated 1 hour after 400 mg of tobacco ingestion (Group II). Eleven patients (27.5%) in Group I and 19 (47.5%) in Group II developed gastric erosions. Erosions were observed mainly along the lesser curvature, and in the fundus and the body of stomach. Gastric pH, determined after tobacco ingestion, was 2.4 +/- 0.43 in patients with erosions and 3.0 +/- 0.67 in patients without erosions. It is concluded that tobacco ingestion produces dose-dependent damage to the gastric mucosa as seen on endoscopy. Hence, history of tobacco ingestion should always be asked for in patients with gastric erosions.

Gastric Acidity Determination↗
PubMed1990

[ECG Holter monitoring during endoscopic examination].

The aim of the study was an evaluation of ECG changes during endoscopy. In 57 hospitalized patients (34 female, 18 male, mean age 54) who had gastroscopy (n = 23), endoscopic retro-cholangiopancreatography (ERCP) (n = 17) or colonoscopy (n = 17) two hours before and two hours after the examination, an ECG monitoring by Holter method was done. The patients also filled a questionnaire to measure their level of anxiety. Arrhythmias and ST depression/elevation were seen in 37 (65%) patients during endoscopy. In 12% complex arrhythmias (III, IV A and IV B type Lown) were recorded. Complex arrhythmias and/or horizontal ST depression greater than 1 mm were observed more frequently (p less than 0.01) in the group of patients with clinically evident diseases of the cardiovascular system; this group was older than the group without cardiac symptoms. There was no correlation between ECG changes and the level of anxiety before the examination. During ERCP ECG changes were more complex than during colonoscopy (p less than 0.01) or gastroscopy (p less than 0.05).

Adult↗
PubMedDate not supplied

[Dieulafoy's lesion as a cause of massive gastrointestinal hemorrhage].

Dieulafoy's lesion also known as exulceration simplex with submucosal arterial malformation is a rare cause of massive upper gastrointestinal hemorrhage with high mortality. Surgery that has been considered as the preferred diagnostic and therapeutic option has been supplemented by endoscopy; gastroscopy may be a valid alternative for diagnosis and therapy. Between 1981 and 1988 we report 4 cases with massive upper gastrointestinal hemorrhage, haematemesis and hemodynamic decompensation consistent with Dieulafoy's lesion. In all patients emergency gastroscopy was performed, monopolar electrocoagulation was successfully applied in two patients. One patient died during surgery and another sixteen days after surgery from multiple organ failure. Rebleeding was seen in one of the coagulated patients, the site of bleeding was identified as Dieulafoy's lesion in three patients during the first endoscopy and was arterial spurting with normal surrounding gastric mucosa. All lesions were found in the upper third of the stomach. Diagnosis is not easy, especially when the bleeding is intermittent but once identified, endoscopic treatment should be attempted and if this fails surgery may be promptly performed with possible lowering of mortality.

Adult↗
PubMed1989

Endoscopy of vertical banded gastroplasty.

Vertical banded gastroplasty is the most common operation for morbid obesity. Postoperative gastroscopy was needed 91 times in 79 of 696 patients for 1) abdominal pain (23), 2) excess vomiting (22), 3) inadequate weight loss (14), 4) excess weight loss (13), 5) and a sudden increase in eating capacity (7). A normal appearance consisted of a clean gastric channel 6.8 +/- 1.4 SD cm long, with a rosette 46.6 +/- 2.1 cm from the incisors and, with insufflation, an 11 mm scope passed through this pseudopylorus snugly, but without difficulty. In Group 1, no problem was seen in the channel, and cholecystitis was found to be the cause. In Group 2, no problem was observed in ten (poor teeth and chewing), six experienced stasis or pill ulcerations, four had bezoars (fragmented or removed with basket), and two had intraluminal mesh. In Group 3, the scope floated through too large an outlet (greater than or equal to 13 mm) in eight, and no cause was seen in six (gorgers, sweets-eaters). In Group 4, tightness or stricture resolved with dilatations (Eder-Puestow; Savary; balloon dilators) in six, but seven required re-operation. In Group 5, the scope travelled through four breakdowns in the partition and three outlets were too large. Gastroscopy viewed problems accurately, indicated treatment and suggested modifications in gastroplasty technique.

Abdomen↗
PubMed1989

[X-ray fluorescent determination of iron, copper, zinc, bromine and rubidium in biopsies of the gastric mucosa].

A method of a combined use of fiber gastroscopy and x-ray fluorescent analysis was elaborated for a study of the chemical composition of the gastric mucosa. Fr, Cu, Zn, Br, and Rb concentrations were determined in gastric mucosa biopsy specimens obtained during fiber gastroscopy, using x-ray fluorescent analysis. The concentrations of trace elements in the gastric mucosa were determined in 13 healthy persons, in 23 patients with chronic mucosal atrophy, in 15--with gastric ulcer, and in 16--with polyps. Besides, the content of trace elements was determined in the tumorous tissue of 66 gastric cancer patients. The results of the investigation revealed a statistically significant rise of mean Fr concentrations on the ulcer edge, in polyps and tumorous tissue as compared to the unchanged mucosa. Polypous tissue differed from the normal gastric mucosa by a low level of Cu, the difference being statistically significant. A tendency to a decrease in Zn content as compared to the unchanged mucosa was noted in the edge of ulcerative defects. The method can be effectively used for intravital studies on Fr, Cu, Zn, Br, and Rb levels in the G. I. tract mucosa.

Biopsy↗
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

[Stomach cancer in patients under 40].

Fifty-one patients below the age of forty were treated for stomach carcinoma at the Surgical Hospital of Mainz University, between 1970 and 1986. They accounted for 5.2 per cent of all patients with stomach carcinoma. Diagnosis had been delayed under the following characteristic circumstances: The interval between onset of symptoms and diagnosis had been more than a year in 34 per cent of all cases. Fifty per cent of the patients had been originally hospitalised, following false suspicious diagnosis. Primary examination for gastro-intestinal passage produced falsely negative results in 43 per cent. The same falsely negative outcome was recorded from 24 per cent, following gastroscopy, and from twelve per cent, following gastroscopy combined with tissue sampling. The percentage of early stomach carcinomas was twice as high as that recorded from patients over forty. Undifferentiated carcinomas, on the other hand, were predominant in patients below forty, whereas adenocarcinomas were primarily recorded from patients over forty. Curative resection was successful in 55 per cent of the over-forties and 44 per cent of the under-forties. No-recurrence intervals were longer among the over-forties. However, five-year survival rates in Stages I, II, and III were better among the under-forties. Hence, the conclusion has been drawn from these findings that stomach carcinoma prognosis of patients below forty is better than that in higher age groups. This, however, is contradictory to other investigations reported in the literature.

Adult↗
PubMed1986

[Endoscopic intragastric detection of hydrogen].

The sensitivity of hydrogen (H2) breath-tests for testing small-intestinal bacterial overgrowth is limited by many factors. In this study H2 was tested directly with a selective electrochemical cell in a sample of stomach gas obtained during gastroscopy. This was possible in 100 of 109 cases. In patients with dyspeptic disorders (complaints of excess gas) H2 concentrations were significantly higher than in the group of patients without these complaints (p less than 0.001). In dyspepsia the stomach-test was significantly more often pathological than H2-breath-test with glucose (p = 0.01). There was no correlation between the results of both tests in 66 cases. Intragastral H2 may result from H2-reflux from the small bowel, because there was no difference in bacterial growth in gastric and duodenal juice and in gastric mucosa of patients with high and normal H2 concentrations in the stomach and because a motility disturbance of upper GI-tract (prolonged gastric emptying time) correlated well with H2-concentrations (p less than 0.05). PH of gastric contents, various ingested dietary substrates, smoking, endoscopic and histological diagnosis did not influence ig H2. Measurement of H2 during gastroscopy may give immediate evidence of small bowel motility-disorders.

Adult↗
PubMed1987

Dysplasia in gastric mucosa: prognostic significance.

Forty-seven patients having dysplasia in biopsies from the gastric mucosa were subjected to re-investigation. Twenty-three patients were alive at follow-up and 14 underwent gastroscopy with removal of random biopsies. The median duration of observation was 39 months, range 10-63 months. Regression of the dysplasia was found in all patients; in nine there was normal mucosa without dysplastic alterations in the control biopsies, mild dysplasia was still present in five of the patients. Our results suggest that the incidental finding of mild or moderate dysplasia does not, per se, indicate the necessity of further control, whereas severe dysplasia indicates repeat gastroscopies with biopsies, as such epithelial changes can occur together with gastric carcinoma.

Adult↗