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PubMed1983

Upper gastrointestinal endoscopy in systemic vasculitis presenting as an acute abdomen.

Three cases of upper gastrointestinal vasculitis presenting as acute abdominal emergencies highlight an uncommon but often fatal presentation of systemic vasculitis. Although abdominal symptoms are common in such diseases, there may be a doubt during assessment of the patient as to whether the gastrointestinal tract is the prime target organ. Radiology is often negative during the acute illness. Endoscopy was important in documenting early and more advanced bleeding lesions of polyarteritis nodosa (PAN) and Henoch-Schoenlein disease, both conditions in which upper gastrointestinal lesions are rare. The gastric and duodenal vasculitic lesions demonstrated by endoscopy in such a clinical setting were confirmed histologically. Endoscopic assessment and early aggressive medical therapy contributed significantly towards the overall successful outcome. Gastroduodenoscopy has not been used either routinely or as an emergency investigation for the assessment of patients with vasculitis who present with acute abdominal pain. Involvement of the stomach and duodenum by vasculitis is therefore poorly appreciated, but remains a serious complication of vasculitic disease when the gastrointestinal tract is the prime target organ, and the information gained by endoscopy in a difficult clinical situation might alter the overall outcome of the disease.

Abdomen, Acute↗

PubMed1997

[New developments in endoscopy].

Beside the developments of new imaging modalities in endoscopy, efforts have been made to improve therapeutical possibilities of endoscopic interventions. In addition to the improvement or even development of new instruments for flexible and rigid endoscopy, the potentials of the new technique of argon-plasma-coagulation in ENT are only hardly discovered. This innovative method is based on high-frequency (HF) electric current for non contact tissue coagulation via ionized argon gas. It leads to a homogeneous coagulation and desiccation zone with a limited and controlled tissue penetration. In addition a multifunctional instrument is presented for the resection of tumors in the upper aero-digestive tract which is able to cut and coagulate tissue on an HF basis and is provided with a channel for suction and irrigation. Additional instruments are offered for the laser surgical resection of tumors through the microlaryngoscope. These instruments are equipped with a cable connection for HF current and are helpful for controlling and managing large bleeding tumor masses. The increasing significance of the flexible endoscopy in ENT surgery is being taken into consideration by the development of additional instruments to remove all kind of foreign bodies in the esophagus or tracheo bronchial system. Through the creation of new materials it is also possible to perform an endoscopic dilatation of esophageal or hypopharyngeal stenoses with a reduced risk of perforations.

Endoscopes↗

PubMed1981

[Micro-endoscopy of the uterine cervix (author's transl)].

Since 1978 micro-endoscopy of the uterine cervix was added to routine colposcopic and cytologic evaluation of the cervix for the purpose of early diagnosis of cancer. Especially, in cases of a typical transformation zones important diagnostic information about the malignity or benignity of the lesion can be obtained. Under colposcopic guidance a suspect point is vitally stained with Cresyl violet acetate 10% solution. Colposcopy is not only supplemented by micro-endoscopy, but colposcopy with the micro-endoscope. The new micro-endoscope gives a magnification of 130 times, a diameter of 5 mm, a length of 200 mm and in a fibre-optic light cable a light source of 280 volts with 150 watts/second from a Xenon Arc Lamp, focal depth of 0.8 mm, an internal visual field of 35 mm. In 356 micro-endoscopies 3.92% showed positive findings, 12.75% showed suspicious findings, 73.04% showed negative findings and 10.29% showed other findings such as necrotic cells, bleeding or were impossible to evaluated with the micro-endoscope.

Cervix Uteri↗

PubMed1999

Endoscopy of spinal cord and posterior fossa by a lumbar percutaneous approach: endoscopic anatomy in cadavers.

Endoscopy has a long history and is used extensively today following recent technical improvements. Endoscopy has been used in neurosurgery to examine ventricles, cisterns, and intra-arteries. In this study, we evaluated the possibility of endoscopic examination and treatment in the narrow confines of the subarachnoid space of the spine and the posterior fossa. Endoscopes with external diameters of 0.5, 1.4, and 2.2 mm were used. While the first two endoscopes had rigid tips, the 2.2-mm endoscope had a directable tip. Each endoscope was inserted percutaneously in the lumbar region in five cadavers and was advanced cranially into the posterior fossa under endoscopic monitoring. Arteries, veins and nerve roots upon the surface of the spinal cord could be distinguished readily with all endoscopes. All endoscopes could be inserted under direct observation, avoiding these vessels and nerve roots. Further rostral advancement of the endoscope permitted visualization of the upper spinal cord, cisterna magna at the foramen magnum, and the fourth ventricle. The lower aspect of the cerebellum, the foramen of Magendie, and the cerebral aqueduct could be observed from below. When the endoscope was advanced ventrolaterally, the vertebral artery and lower cranial nerves were observed. From this preliminary cadaver study, endoscopy via lumbar puncture appeared useful for inspection of structures surrounding the spinal cord and posterior fossa, and for some simple treatments.

Cadaver↗

PubMed1982

[Endoscopy of the nose as an aid in lacrimal duct surgery].

Endoscopy of the nose is a recently-adopted supplementary procedure for examining the tear drainage system. This examination is performed under local anesthesia with the patient on the operating table. We use a Hopkins endoscope with 30 degrees and 70 degrees deflections, diameter 2.7 mm and 4 mm. Endoscopy prior to dacryocystorhinostomy enables the examiner to judge whether the nasal cavity is large enough for an osteotomy. The orifice of the nasolacrimal duct is visible directly through the endoscope, so that the dye test can be rendered fairly objective. Endoscopy also enables the course of healing of the nasal ostium after surgery to be studied. We observed complications, such as granular tissue and synechiae developing between the posterior flap of the nasal mucosa, the middle turbinate and the nasal septum. Granulation tissue may be removed under endoscopic control. If an intubation of the lacrimal system is attempted, it may be easier to find the end of the steel probe exiting into the nose under endoscopic observation. If the inferior turbinate is impacted with the nasal floor, it may be impossible to find the probe under the inferior turbinate without endoscopic control. Finally, during lacrimal duct probing in infants, one can check whether the probe is correctly sited. Perforations created by probing can be recognized and avoided.

Dacryocystorhinostomy↗

PubMed1980

[Emergency endoscopy after operation of the upper gastro-intestinal tract: problems and risks (author's transl)].

Upper gastro-intestinal bleeding or other complications after operations on this tract can lead to grave additional risk for the patient, especially in the early postoperative phase. Because of its high degree of diagnostic accuracy, emergency endoscopy is in most cases of decisive importance in planning the type (conservative or surgical) and timing of any necessary treatment. Special investigative techniques as well as the early use of endoscopy in 97 patients achieved a high rate of success at a low risk to the patients. Indications, results and risks of emergency endoscopy of the upper gastro-intestinal tract in the late postoperative phase are similar to those for the non-operated patient.

Digestive System Surgical Procedures↗

PubMed2000

Bispectral index monitoring of sedation during endoscopy.

BACKGROUND: No objective measure of the level of sedation is universally accepted. However, bispectral index monitoring is currently used to objectively measure sedation levels in several clinical settings. This study compares the temporal relationship of bispectral index levels versus the Observer's Assessment of Alertness/Sedation (OAA/S) scale for sedation during endoscopy and proposes a functional bispectral index range for endoscopic procedures. METHODS: Fifty consecutive adults undergoing endoscopic retrograde cholangiopancreatography, colonoscopy, or esophagogastroduodenoscopy by a single endoscopist were studied. Intravenous sedation was achieved with diazepam and meperidine. Bispectral index levels (0 to 100) and OAA/S scores (1 to 5) were recorded every 3 minutes by a single trained observer. RESULTS: There were significant temporal correlations between bispectral index levels and OAA/S scores (r = 0.59, p < 0.0001). Bispectral index levels and OAA/S scores corresponded with the need for additional sedation as determined clinically by the endoscopist. An OAA/S score of 3 corresponded to a bispectral index level of 81.49 +/- 9.78. CONCLUSIONS: Bispectral index monitoring temporally correlates with the OAA/S scale and therefore provides an objective measure of sedation during endoscopy. This preliminary, observational study suggests that a bispectral index level near 82 corresponds with sufficient and functional sedation levels for endoscopy.

Adult↗

PubMed2000

Transnasal versus transoral endoscopy for the placement of nasoenteral feeding tubes in critically ill patients.

BACKGROUND: Nasoenteral feeding tube placement with the Seldinger technique using transoral endoscopy is a tedious procedure. This study compared the transoral approach with a new technique that uses a transnasal endoscope without the need for a mouth-to-nose wire transfer. METHODS: Critically ill patients requiring nasoenteral feeding tube placement were randomly assigned to the transoral technique using a standard upper endoscope (n = 80) or the transnasal method using a 5.3 mm fiberscope (n = 80). Procedure time, medication requirement, technical difficulty, patient tolerance, and radiologic tube position were assessed. RESULTS: The two groups were similar with regard to baseline medication, endoscopic findings, as well as overall technical difficulty and patient tolerance. The transnasal technique required less procedure time (median 8.0 versus 12.0 minutes, p < 0.001) and less relaxant medication (p = 0.029). Furthermore, it caused fewer circulatory (p = 0.040) and respiratory (p = 0.016) alterations regardless of the application of sedative or relaxant medication. The transnasal endoscope was inferior with respect to passage through the pylorus (p = 0.003) and duodenum (p = 0.020). These differences were significant in univariate hypothesis testing. Bonferroni correction for multiple testing of data removed the significance at p > 0.0031. Both techniques achieved similar rates of successful tube placement in the small bowel (86% versus 84%, p = 0.82). CONCLUSION: Transnasal endoscopy allows accurate placement of nasoenteral feeding tubes in critically ill patients and is superior to transoral endoscopy in terms of procedure time, medication requirement, and safety.

Adult↗

PubMed2001

Evaluation of topical pharyngeal anesthesia for upper endoscopy including factors associated with patient tolerance.

BACKGROUND: Topical pharyngeal anesthesia is generally used as a pretreatment for upper endoscopy. However its efficacy has not been established. METHODS: A randomized double-blind placebo-controlled study was undertaken. Subjects were 201 patients who underwent upper endoscopy and gave informed consent. Relative risks (RR) of patient discomfort were calculated for pharyngeal anesthesia, anxiety, and other potential confounding factors by using logistic regression analyses. RESULTS: The RR of patient discomfort on intubation was 0.56 for the anesthesia versus the placebo group (95% CI, 0.31-1.01). RR was higher in patients aged 39 or younger than in those 40 or over (RR = 2.22, 95% CI, 1.04-4.74). With subgroup analysis in those examinees less than 40 years old, the RR of patient discomfort was 0.21 for the topical anesthesia (95% CI, 0.04-0.99) versus the placebo group and 4.93 for patients undergoing upper endoscopy for the first time (95% CI, 1.13-21.60). In the first-time patients, the RR was lower in the topical anesthesia than in the placebo group (RR = 0.20; 95% CI, 0.04-0.93); it was higher in patients with a trait-anxiety score higher by 10 points than in those with a lower score (RR = 3.35, 95% CI, 1.01-11.15). With the Bonferroni correction for multiple testing of data, statistical significance is indicated by a CI of 97.5% in the subgroup analyses. CONCLUSIONS: Topical pharyngeal anesthesia appears to be effective in patients less than 40 years old and in those undergoing the procedure for the first time. A high trait-anxiety score could be a predictor of discomfort in first-time examinees.

Adult↗

PubMed2002

Propofol compared with general anesthesia for pediatric GI endoscopy: is propofol better?

BACKGROUND: The objective of this study was to compare the efficacy and safety of propofol and general anesthesia in children undergoing elective GI endoscopy. METHODS: The study design was prospective, randomized, and open label. Pediatric patients aged 2 to 21 years in whom elective GI endoscopy under general anesthesia was required were randomized to receive propofol or standard inhalational anesthesia. The parameters monitored in the 2 groups were (1) time until wake-up after completion of the procedure, and (2) total time for anesthesia and recovery. Adverse events during the procedures were noted with each agent. RESULTS: Fifty pediatric patients were recruited, 25 in each group. The mean (SD) time until wake-up in the propofol group was 29.92 (16.01) minutes and 18.52 (10.03) minutes in the anesthesia group, (p = 0.002). With stratification into 4 age groups, it was noted that the youngest children, those 2 to 5 years of age, took the longest to awaken with propofol compared with inhalational anesthesia, whereas in the other age groups the differences were not statistically significant. In contrast, the mean total time for anesthesia and recovery in the propofol group was 107.4 (30.14) minutes and 139 (7.61) minutes in the inhalational anesthesia group (p < 0.004). The total time for anesthesia and recovery was longest in the group 5 to 8 years of age who had inhalational anesthesia (p < 0.01). Changes in systolic and diastolic blood pressure occurred with equal frequency in both groups. Transient apnea was noted in 20% of patients receiving propofol. Restlessness and agitation occurred in 52% of patients receiving inhalational anesthesia compared with 8% in the propofol group (p = 0.001). CONCLUSIONS: Propofol, administered by an anesthesiologist, is an excellent and safe intravenous anesthetic agent for pediatric GI endoscopy.

Adolescent↗

PubMed2002

A new stereoscopic endoscopy system: accurate 3-dimensional measurement in vitro and in vivo with distortion-correction function.

BACKGROUND: The purpose of this study was to evaluate the accuracy and reproducibility of measurements obtained with a new 3-dimensional stereoscopic endoscopy system in vitro and in vivo. METHODS: The system includes an electronic stereoscopic endoscope and a personal computer. After correction of barrel distortion by an image-processing technique, 3-dimensional data are computed with triangulation. Initially, graph paper and models of gastric lesions, both elevated and depressed, were used as objects. For evaluating accuracy and reproducibility, the absolute error (/E/) and the coefficient of variation (CV) were calculated: /E/ = average value of absolute value (measured value minus sign true value)/true value. Then, the sizes of 50 gastric lesions were measured by 2 endoscopists, one experienced and the other inexperienced, and the findings were compared with measurements made radiographically. RESULTS: The maximum for /E/ and for the CV for the distance on the graph paper were, respectively, 5.6% and 7.0%. The /E/ and CV for the diameter and for the height of the elevated model were, respectively, 5.9% and 5.7% for the former and, respectively, 16.8% and 16.5% for the latter. The /E/ and CV for the area of the depressed model were, respectively, 9.0% and 1.6%. The correlation coefficients between the sizes of lesions measured by stereoscopic endoscopy and radiographically were 0.91: 99% CI [0.81, 1.00], and 0.98: 99% CI [0.85, 1.00], respectively, for the experienced and inexperienced endoscopists. CONCLUSIONS: The new stereoscopic endoscopy system is useful for measuring gastric lesion size in clinical practice.

Calibration↗

PubMed1986

Crohn's disease and ulcerative colitis. Evaluation with double-contrast barium examination and endoscopy.

Double-contrast barium examination of the colon can demonstrate the changes associated with inflammatory bowel disease more completely and specifically than the single-contrast barium study. However, endoscopy is slightly more sensitive than double-contrast examination for detection of disease. In general, between 18% and 20% of patients with Crohn's disease or ulcerative colitis may be expected to have normal radiographic findings but endoscopically detectable disease. However, most false-negative double-contrast colon studies are associated with mild or minimal findings at proctosigmoidoscopy. Although double-contrast radiography may be less sensitive than endoscopy in detection of inflammatory bowel disease, it has similar accuracy for classification and differentiation. Most studies indicate an accuracy of 95% to 98% in differentiating Crohn's disease and ulcerative colitis, due to the fact that morphologic changes detected by the double-contrast mucosal study rarely overlap in the two diseases. Double-contrast barium examination and endoscopy are complementary studies, and the use of both may provide valuable information for evaluation of patients with suspected inflammatory bowel disease.

Barium Sulfate↗

PubMed2003

Changes in prevalence of Helicobacter pylori infection in two groups of patients undergoing endoscopy and living in the same region in the Netherlands.

BACKGROUND: There are few data on the prevalence of Helicobacter pylori in different populations and no data on changes in time. A cross-sectional study was done in a large population of patients undergoing endoscopy in order to relate the presence of H. pylori to ethnic background and to detect changes in time. METHODS: All consecutive patients over a 10-year period were included and biopsy specimens from the gastric antrum were taken for detection of H. pylori. A large population of immigrants living in the Zaanstreek region was studied separately. RESULTS: In the 10-year period, 14,909 consecutive diagnostic upper GI endoscopies were done in 11,691 consecutive patients. Only the first endoscopy done in a patient was included. Of 11,691 patients available for evaluation, there were 5669 men and 6022 women (mean age 55 years, range 4-99). Of these, 3201 (27.4%) were H. pylori-positive and 4988 (42.7%) were H. pylori-negative. No biopsy specimens were available for the remaining 3501 (29.9%) patients. In the group under study, 1309 (11%) patients were immigrants. H. pylori was present significantly more often in men and in immigrants, where prevalence was 75% versus 33% (P < 0.0001). The prevalence of H. pylori showed a marked decrease in both populations during the period of study. Extrapolating trend lines into the future indicates a prevalence of H. pylori below 10% by the year 2009. Among immigrants, this will be reached in approximately 2027. CONCLUSION: This study shows differences in prevalence of H. pylori in different populations. We found a decreasing prevalence that can be explained by the lower acquisition rate of the infection. It is important to be aware of the differences in prevalence of H. pylori in a population composed of different ethnicities.

Adolescent↗

PubMed2004

Valid symptom reporting at upper endoscopy in a random sample of the Swedish adult general population: the Kalixanda study.

BACKGROUND: Upper oesophagogastroduodenoscopy is considered to be the gold standard for upper gastrointestinal disease assessment, but is currently seldom used in epidemiological studies. One concern is that the procedure may bias sampling among volunteers in a general adult population. The aim of this study was to explore whether the procedure affects symptom reporting. METHODS: A random sample of 3000 adults aged 20-81 years (mean age 50.4), from two Swedish municipalities (n=21,610) was surveyed using a validated postal questionnaire (the Abdominal Symptom Questionnaire) assessing gastrointestinal symptoms. A subsample of the responders was invited, in random order, to undergo an upper endoscopy and repeated symptom reporting using the same questionnaire, as well as a serology test for Helicobacter pylori. RESULTS: The response rate to the initial questionnaire was 74.2% and the participation rate for those eligible for the upper endoscopy was 73.3% (n = 1001, mean age 54.0 years, 48.8% male). No major social or symptom sampling error was encountered from the selection process, with the exception of an excess of symptom reporters among the youngest subjects. The prevalence of reflux symptoms, dyspeptic symptoms and irritable bowel symptoms was 40%, 37.6% and 29.6%, respectively, which is relatively high, but in no way extreme. CONCLUSIONS: The upper endoscopy survey strategy was successful. The response rate was high and there was no major selection bias of clinical relevance. The cohort selected for this study appears to be representative of the general Swedish adult population.

Adult↗

PubMed2006

Evaluation of sensitivity and inter- and intra-observer variability in the detection of intestinal metaplasia and dysplasia in Barrett's esophagus with enhanced magnification endoscopy.

OBJECTIVE: Magnification endoscopy with acetic acid or dye for diagnosis of Barrett's esophagus is presently undergoing clinical evaluation. Current studies report good accuracy in predicting specialized intestinal metaplasia. To date, however, there is no definitive information on the inter- and intra-observer variability of these methods applied to the diagnosis of normal and dysplastic Barrett's mucosa. MATERIAL AND METHODS: Sixty patients with endoscopically suspected Barrett's esophagus were investigated prospectively with the zoom endoscope after contrast enhancement of the mucosa with 1.5% acetic acid. Two hundred and twenty-three enlarged and histologically investigated areas of gastric, cardiac, normal and dysplastic Barrett's mucosa were photodocumented and in randomized sequence presented to 4 endoscopists in a blinded manner (2 with and 2 without experience of zoom endoscopy for evaluation). The reference for the first evaluation (A1) was standard endoscopic photographs of the respective, histologically confirmed mucosal entity. In a second evaluation (A2), the pictures were again interpreted by the same blinded investigators, but this time a modified pit-pattern classification as proposed by Sharma et al. was employed as the evaluation reference. RESULTS: The diagnostic sensitivity for specialized intestinal metaplasia and dysplasia in Barrett's esophagus calculated for the A1 evaluation ranged -- investigator dependently -- from 54.9% to 80.7% and for A2 from 42.2% to 81.5%. The inter- and intra-observer variability for the evaluation procedure A1 and A2 was high (all kappa values <0.4). In particular, the inexperienced investigators demonstrated high intra-observer variability and low sensitivity in comparison with the experienced investigators. CONCLUSIONS: The diagnosis of Barrett's mucosa using enhanced magnification endoscopy after acetic acid instillation is associated with a high level of interobserver variability. One reason is a frequent mismatch between cardiac mucosa and non-dysplastic Barrett's mucosa.

Adult↗

PubMed1980

Sedation for upper gastro-intestinal endoscopy. A comparison of oral temazepam and i.v. diazepam.

Temazepam 20 mg orally was compared with titrated doses of i.v. diazepam as sedation for elective upper gastro-intestinal endoscopy. The mean time from taking oral temazepam to endoscopy was 66 min, and from i.v. diazepam to endoscopy was 10 min. The endoscopists found that the sedation achieved was the same in both groups and allowed adequate examination of the upper alimentary tract. The oral presentation, avoiding the pain of injection and the possible shorter duration of action, made oral temazepam preferable to i.v. diazepam.

Administration, Oral↗

PubMed1984

Sedation for endoscopy: a comparison between diazepam, and diazepam plus pethidine with naloxone reversal.

The combination of diazepam plus pethidine, reversed with naloxone, was compared in a double-blind randomized study with diazepam alone in 100 patients undergoing endoscopy. Patients accepted both methods of sedation equally well. There was no significant difference in sedation after endoscopy, but the addition of pethidine produced a significant improvement in patient co-operation during the endoscopy (P less than 0.001).

Adolescent↗

PubMed1986

Contrasting presentation and findings between patients with rheumatic complaints taking nonsteroidal anti-inflammatory drugs and a general population referred for endoscopy.

One hundred and fifty patients with various rheumatic complaints who were taking nonsteroidal anti-inflammatory drugs (NSAIDs) and required upper gastrointestinal endoscopy were compared with 150 patients, matched for age and sex, who were also referred for gastroscopy but who did not have rheumatic complaints and were not taking these drugs. A comparison was made between the indications for endoscopy and the endoscopic findings in the two groups. Significant differences were found. Fewer patients with rheumatic complaints had normal findings, more had chronic gastric ulcer, duodenal ulcer, gastritis or mucosal erosions. Patients with rheumatic complaints were referred more frequently for anaemia and less frequently for dysphagia or abdominal symptoms. The increased severity of gastric morbidity in patients with rheumatism is probably due to damage caused by NSAIDs. The frequency and severity of upper gastrointestinal lesions in patients with rheumatic complaints taking NSAIDs cannot be estimated from the patient's complaint rate, anaemia rather than pain being the most frequent finding. Upper gastrointestinal tract endoscopy is required to make a definitive diagnosis. This has important implications for the licensing policies of regulatory authorities when considering the licensing of new nonsteroidal anti-inflammatory drugs.

Abdomen↗