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At least 1,207 records · Page 67Linked to original sources
PubMed1993

Benign biliary strictures. Surgery or endoscopy?

OBJECTIVE: This study compared the results of surgery and endoscopy for benign biliary strictures in one institution, over the same period of time and with the same outcome definitions. SUMMARY BACKGROUND DATA: Surgery is considered the treatment of choice, offering more than 80% long-term success. Endoscopic stenting has been reported to yield similar results and might be a useful alternative. METHODS: In this nonrandomized retrospective study, 101 patients with benign biliary strictures were included. Thirty-five patients were treated surgically and 66 by endoscopic stenting. Patient characteristics, initial trauma, previous repairs, and level of obstruction were comparable in both groups. Surgical therapy consisted of constructing a biliary-digestive anastomosis in normal ductal tissue. Endoscopic therapy consisted of placement of endoprostheses, with trimonthly elective exchange for a 1-year period. RESULTS: Mean length of follow-up was 50 +/- 3.8 and 42 +/- 4.2 months for surgery and endoscopy, respectively. Early complications occurred more frequently in the surgically treated group (p < 0.03). Late complications during therapy, occurred only in the endoscopically treated group. In 46 patients, the endoprostheses were eventually removed. Recurrent stricturing occurred in 17% in both surgical and endoscopic patients. CONCLUSIONS: Surgery and endoscopy for benign biliary strictures have similar long-term success rates. Indications for surgery are complete transections, failed previous repairs, and failures of endoscopic therapy. All other patients are candidates for endoscopic stenting as the initial treatment.

Adult↗
PubMed1991

Infection control practices in gastrointestinal endoscopy in the United States: a national survey.

OBJECTIVE: To ascertain current infection control practices, endoscope cleaning procedures, perceived risks of infection, and implementation of universal precautions in gastrointestinal endoscopy units in the United States. DESIGN: National mailed survey of gastroenterology nurses and associates conducted anonymously in March 1988. SETTING: Completed surveys were received from all 50 states and Puerto Rico and from all practice settings. The most common practice setting was private/community hospitals (66%). PARTICIPANTS: Of the 4,952 survey forms mailed to all members and to interested nonmembers of the Society of Gastrointestinal Nurses and Associates, 2, 158 (44%) were returned and 2,030 (41%) were completed and evaluable. Of the respondents, 1,487 (73%) were registered nurses. RESULTS: Sixty-seven percent (n = 1,358) of the respondents routinely used an enzymatic cleaner as a step in the instrument decontamination process; 93% (n = 1,879) chemically disinfected instruments after each case; and 88% (n = 1,779) disinfected endoscopes with an aqueous glutaraldehyde product. Respondents reported that they and a significantly smaller proportion of physicians (p less than .001) employed barrier precautions for all endoscopic cases involving possible contact with blood/body fluids of patients known (66% versus 57%, respectively) and not known (12% versus 8%, respectively) to have a bloodborne infection. Endoscopy-related infections, usually bacterial, were reported to have occurred at their institutions by 6% (n = 116) of respondents. CONCLUSIONS: We conclude that cleaning, disinfection, and sterilization procedures for gastrointestinal endoscopic instruments vary, that appropriate protective apparel is not always worn, and that some practices may lead to preventable endoscopy-related infection in patients.

Disinfection↗
PubMed1994

Staffing levels in endoscopy units.

Staffing the endoscopy area has become increasingly complex. Growth in procedure volumes, changes in technology, and the application of endoscopy in the diagnosis and treatment of disease contribute to the complexities. The manager must deal with these changes, maintain costs, and still provide adequate staffing to ensure patient safety and quality care. The purpose of this article is to present the results of a laboratory manager survey conducted in 1990. Of 51 laboratory managers who responded, those who rated their laboratories to be adequately staffed averaged 4.2 hr per procedure. The survey results may be useful to laboratory managers seeking to calculate staff needs in a typical endoscopy area.

Data Collection↗
PubMedDate not supplied

Needle safety in an endoscopy unit.

Personnel in GI Endoscopy units are at higher risk than health care workers in general for exposure to Hepatitis B and Human Immunodeficiency Virus. Occupational Safety and Health Administration Standards require personal protective equipment including gloves, goggles, masks, water-impervious gowns, shoe covers, sharps containers, and biohazardous waste containers to be readily available. Special hazards in endoscopy make staff compliance both essential and challenging. Contaminated needle sticks are a common occupational injury in this setting, and one GI unit has developed several safeguards to increase staff's protection. These safeguards include inserting all intravenous lines in the safest, most accessible site: the right forearm; hanging IV fluids on all patients whose procedures are done in the radiology suite; and employing the needle recapping system that is cost-effective and easy to use in the endoscopy setting.

Endoscopy↗
PubMedDate not supplied

Recovery time and safe discharge of endoscopy patients after conscious sedation.

The aim of this study was to identify the best method for determining when to safely discharge the endoscopy patient; specifically, it was designed to determine whether the patient's risk factors, intraoperative occurrences, and/or medications used during endoscopy should be used to determine the minimum length of stay postconscious sedation or whether a general policy can be used, as is currently practiced at many institutions. Preoperative, intraoperative, and postoperative data were collected on a convenience sample of 405 adult ambulatory outpatients undergoing upper endoscopy and/or colonoscopy. Subjects were also interviewed by phone within 48 hours of discharge to assess postdischarge complications and their duration. Age predicted length of time in recovery, but only 2% of the variation in recovery time was predicted by the study variables. Intraprocedure occurrences predicted postprocedure occurrence. The implications of these and other findings are discussed in relation to nursing practice and future research.

Adult↗
PubMedDate not supplied

Defensible documentation using the endoscopy pathway.

Complete, defensible documentation in a busy endoscopy unit can be elusive. Quick turnaround time, impatient physicians, and add-on and emergent cases all contribute to chaotic days. The endoscopy pathway provides a guided path for succinct documentation by the healthcare worker. A scoring system is initiated on admission. Assessment parameters clearly define scores for vital signs, level of consciousness, abdominal status, pain, safety, and mobility. Scores can be scanned quickly and compared by the nurse to identify significant changes in each patient. Documentation is timely, communicative, and complete. The endoscopy pathway is illustrated by a case study. It reflects patients' progress throughout their stay in the GI unit from admission to discharge. The implementation process of this innovative chart form is presented.

Critical Pathways↗
PubMedDate not supplied

Detecting a small bowel tumor via wireless capsule endoscopy: a clinical case study.

Tumors of the small intestine account for fewer than 5% of gastrointestinal neoplasms. Approximately 20% of small bowel neoplasms are gastrointestinal stromal cell tumors, a spectrum of mesenchymal tumors of the gastrointestinal tract that range from benign to highly malignant. Diagnosis of gastrointestinal stromal cell tumors is usually incidental, given their rarity and the limitations of traditional endoscopy and radiology studies in visualizing the small intestine. The advent of wireless capsule endoscopy has improved the definitive diagnosis of small bowel disorders. This article outlines the course of diagnosis and treatment for a patient who presented to our hospital with severe anemia and demonstrates the role of capsule endoscopy in identifying the causes of obscure gastrointestinal bleeding.

Abdominal Pain↗
PubMed1995

Double contrast upper gastrointestinal barium examination with biopsy versus endoscopy with biopsy in dyspeptic patients.

RATIONALE AND OBJECTIVES: The financial restrictions of the managed care environment require reconsideration of the barium upper gastrointestinal examination as a diagnostic tool for gastritis patients. However, a greater sensitivity and specificity for gastritis is needed. A prospective study was performed comparing barium examinations with gastric biopsies to endoscopy with biopsy. METHODS: Forty adult patients underwent upper gastrointestinal barium examination with gastric biopsies obtained under fluoroscopy through a nasogastric tube. Twenty-seven patients gave consent for subsequent endoscopy with biopsy. Both sets of biopsies were compared, as were the interpretations of the radiographs and visual appearances. RESULTS: For barium examinations with gastric biopsies, sensitivity for gastritis was 94% and specificity was 100%, using endoscopic biopsies as the gold standard. CONCLUSIONS: In addition to endoscopy with biopsy, the upper gastrointestinal barium examination with biopsy is another option of sufficient sensitivity and specificity for consideration by clinicians in their workup of patients with gastritis.

Adult↗
PubMed1983

Effect of atropine and upper gastrointestinal endoscopy on serum gastrin.

To determine if atropine alone, gastric distension alone, or atropine plus gastric distension affected serum gastrin levels, we obtained serum gastrins on 45 consecutive patients who were randomized into two groups. Group 1 (27 patients) was premedicated with meperidine alone, 1.5 mg/kg I.M. Group 2 received atropine 0.6 mg I.M. in addition to meperidine. Blood samples were drawn: 1) before premedication, 2) 30 minutes after premedication, and 3) immediately after endoscopy. We found: 1) no statistical difference between mean basal gastrin levels for groups 1 and 2, 2) no change in basal serum gastrin levels after premedications in either group, and 3) that endoscopy caused no significant increase in mean serum gastrin levels. We conclude that endoscopy does not lead to a significant elevation of basal serum gastrin in patients premedicated with meperidine or meperidine and atropine.

Atropine↗
PubMed1988

Biphasic radiologic examination and endoscopy of the upper gastrointestinal tract. A comparative study.

In this prospective, blind study we compare the diagnostic results of endoscopy with a biphasic radiologic examination with drug-induced hypotony in gastric malignancy, peptic ulcer, and reflux esophagitis. Two hundred fourteen patients underwent both examinations within a week. Both disciplines detected seven malignant tumors. Twenty-three peptic ulcers were found by both; in addition, each diagnosed another ulcer. Fourteen ulcer scars were diagnosed by both; endoscopy demonstrated 10 additional scars and radiology 1. The radiologic examination detected 7 of the 37 cases of endoscopically diagnosed cases of mild reflux esophagitis, 4 of the 7 moderate cases, and 7 of 8 severe ones. A state-of-the-art radiologic examination represents an adequate initial examination in the dyspeptic patient. If the complaints suggest reflux esophagitis, the clinician has to choose between treatment and endoscopy.

Adult↗
PubMed1991

Arterial oxygen saturation, blood pressure, and pulse rate during upper gastrointestinal endoscopy--influence of sedation and age.

We studied the effect of sedation by I.V. meperidine on blood pressure, pulse rate, and arterial oxygen saturation during upper gastrointestinal endoscopy. Meperidine increased the tolerance of the patients and attenuated the endoscopy-induced rise in blood pressure and pulse rate. Arterial oxygen saturation was transiently depressed in the first few minutes of the endoscopic procedure even without sedation, and meperidine administration did not aggravate this oxygen desaturation. Therefore, meperidine may be a favorable sedative for upper gastrointestinal endoscopy because its treatment increases the tolerance of patients and decreases cardiac oxygen demand without decreasing arterial oxygen saturation.

Age Factors↗
PubMed1997

Diagnostic and therapeutic endoscopy through the gastrostomy site.

We report a successful diagnostic and therapeutic endoscopy through the gastrostomy site in two patients in whom conventional antegrade upper endoscopy was not possible. In one, the endoscopic and histologic diagnosis of a completely obstructing malignant lesion in the upper esophagus was possible by retrograde intubation using a bronchoscope. In the other, the gastrostomy site was used to gain access and assist in the placement of a jejunostomy tube. We describe a technique to help circumvent the lack of air insufflation with the bronchoscope. Both endoscopies were carried out without the need for drugs for conscious sedation. This percutaneous route, through a gastrostomy site, in the technique described by us uses a readily available endoscope in any hospital setting, does not need conscious sedation, and does not need dilation of the stoma site, allowing access to the gastrointestinal tract for diagnostic and therapeutic purposes.

Aged↗
PubMed1997

Yield of routine endoscopy beyond the duodenal bulb.

The authors determined the clinical yield, endoscopic time, and patient tolerance of routine upper endoscopy beyond the duodenal bulb. From May through October 1994, all patients undergoing routine esophagogastroduodenoscopy (EGD) were recruited for study. Each procedure was timed from start to finish by the endoscopy nurse, and, in addition, the time of the postbulbar examination was recorded. The endoscopy nurse assessed the patient's comfort level when the endoscope was advanced into the duodenal bulb and again at the postbulbar region. A total of 250 EGDs were performed. There were 152 males and 98 females, with a mean age of 57.1 (range, 23-91) years. Indications for the procedure were as follows: gastroesophageal reflux disease symptoms 82, epigastric pain 64, dysphagia 46, Barrett's surveillance 25, anemia 23, other research study 16, and other 61. The mean time for the procedure was 11 min and 54 s, whereas the mean time for the postbulbar examination was 46.6 s. Patients tolerated endoscope insertion well both before and during examination of the postbulbar duodenum. The only postbulbar finding that affected clinical management was a postbulbar ulcer in a patient without other ulcers who was positive for Helicobacter pylori. Although routine endoscopic examination beyond the duodenal bulb involves minimal time and is well tolerated by patients, the yield of pathologic findings is low (3.6%) and the yield of findings that alter clinical management even lower (0.4%). In patients without prior GI surgery undergoing routine EGD for indications other than suspected small bowel pathology or active upper GI bleeding, examination of the postbulbar duodenum can be considered an elective part of the procedure.

Adult↗
PubMed2000

What predictive parameters best indicate the need for emergent gastrointestinal endoscopy after foreign body ingestion?

Our aim was to determine what parameters may be used to indicate an emergent endoscopy after foreign body (FB) ingestion and to ascertain how often FBs are found endoscopically. Demographic data, gastroesophageal antecedents, clinical and endoscopic data, and complications were obtained. We examined 122 patients endoscopically. The onset of symptoms was immediate after FB ingestion in 93% of patients. Dysphagia was the most frequent symptom (66%), with the pharynx the most frequent location of impaction (71%). Endoscopy confirmed the presence of FBs in 52% of patients. Extraction was performed in 78%. The immediate onset of symptoms, dysphagia, and the absence of pharynx localization of impaction were predictive indicators of a positive FB finding (p < 0.05), with diagnostic sensitivity of 86% and specificity of 63%. Upper endoscopy should be performed in all patients with FB ingestion, even though no FB was found in 48%.

Deglutition Disorders↗
PubMed2002

Acute pancreatitis after gastrointestinal endoscopy.

Acute pancreatitis is a well-recognized complication of endoscopic retrograde cholangiopancreatography but is not considered to be a complication associated with other endoscopic procedures. We present a case of acute pancreatitis that occurred after uneventful upper and lower gastrointestinal endoscopy. The temporal relationship of the endoscopic procedures and development of acute pancreatitis suggests a causal relation. Furthermore, the patient had none of the usual etiologic factors associated with pancreatitis, i.e., alcoholism, cholelithiasis, hypertriglyceridemia, hypercalcemia, or use of a drug associated with pancreatitis. The causal mechanism of acute pancreatitis is uncertain but might potentially involve local trauma to the pancreas during a procedure or release of as yet undefined inflammatory mediators. In summary, three previous reports of clinical pancreatitis associated with endoscopy, in addition to the current case, suggests that acute pancreatitis should be considered as a rare complication of routine upper endoscopy or colonoscopy.

Acute Disease↗
PubMed2002

Endoscopy for anterior pelvis fixation.

The objectives of this study are to describe the anatomic findings relative to anterior pelvic endoscopy, determine the potential use of endoscopy for reduction and fixation of fractures of the anterior pelvic ring, and report two illustrative cases performed using this method. Using the windows described, endoscopy permits placement of plates and screws on top of the symphysis pubis, reduction of internally displaced fragments, and performance of percutaneous procedures that do not harm anatomic structures.

Adolescent↗
PubMed1993

Efficacy of diazepam and meperidine in ambulatory pediatric patients undergoing endoscopy: a randomized, double-blind trial.

Medications are routinely administered to children prior to upper gastrointestinal endoscopy procedures. We evaluated the efficacy and safety of four dosage regimens: meperidine 2 mg/kg (M); low-dose meperidine 1 mg/kg and diazepam 0.1 mg/kg (M low+D); high-dose meperidine 2 mg/kg and diazepam 0.1 mg/kg (M high+D); and, diazepam 0.1 mg/kg (D) in a randomized, double-blind trial in 71 pediatric patients (ages 1 to 19 years). Cooperation, emotional state, and sedation were rated. The frequency of negative behavior demonstration (i.e., crying, gagging, flailing, nervous behavior) indicating ineffective or inadequate sedation was recorded before, during, and after the procedure. Vital signs and oxygen saturation were noted. Significant differences were observed in the efficacy of the various sedation regimens. Overall, the physicians and nurses rated M most effective in children < 11 years. In these children, M high + D and D were rated least effective by the nurses, whereas physicians felt that D was least effective. In the older children, M, M low + D, and M high + D were rated similarly effective by physicians and nurses, and D was rated least effective. In both age groups, the lowest incidence of negative behaviors during the endoscopy procedure occurred in patients who received M. Combinations of D and M + D resulted in an increased incidence of negative behaviors; thus, M may be the preferred sedation regimen in children undergoing endoscopy. The addition of diazepam to meperidine may be detrimental in terms of eliciting negative behaviors.

Adult↗
PubMed1999

Head and neck computed tomography virtual endoscopy: evaluation of a new imaging technique.

OBJECTIVE: To evaluate a new radiographic imaging technique: computed tomography virtual endoscopy (CTVE) for head and neck tumors. STUDY DESIGN: Twenty-one patients presenting with head and neck masses who underwent axial computed tomography (CT) scan with contrast were evaluated by CTVE. Comparisons were made with video-recorded images and operative records to evaluate the potential utility of this new imaging technique. METHODS: Twenty-one patients with aerodigestive head and neck tumors were evaluated by CTVE. One patient had a nasal cylindrical cell papilloma; the remainder, squamous cell carcinomas distributed throughout the upper aerodigestive tract. Patients underwent complete head and neck examination, flexible laryngoscopy, axial CT with contrast, CTVE, and in most cases, operative endoscopy. Available clinical and radiographic evaluations were compared and correlated to CTVE findings. RESULTS: CTVE accurately demonstrated abnormalities caused by intraluminal tumor, but where there was apposition of normal tissue against tumor, inaccurate depictions of surface contour occurred. Contour resolution was limited, and mucosal irregularity could not be defined. There was very good overall correlation between virtual images, flexible laryngoscopic findings, rigid endoscopy, and operative evaluation in cases where oncological resections were performed. CTVE appears to be most accurate in evaluation of subglottic and nasopharyngeal anatomy in our series of patients. CONCLUSION: CTVE is a new radiographic technique that provides surface-contour details. The technique is undergoing rapid technical evolution, and although the image quality is limited in situations where there is apposition of tissue folds, there are a number of potential applications for this new imaging technique.

Aged↗