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At least 1,261 records · Page 70Linked to original sources
PubMed2003

Diagnosing small bowel Crohn's disease with wireless capsule endoscopy.

BACKGROUND: The small bowel is the most commonly affected site of Crohn's disease (CD) although it may involve any part of the gastrointestinal tract. The current methodologies for examining the small bowel are x ray and endoscopy. AIMS: To evaluate, for the first time, the effectiveness of wireless capsule endoscopy in patients with suspected CD of the small bowel undetected by conventional modalities, and to determine the diagnostic yield of the M2A Given Capsule. PATIENTS: Seventeen patients (eight males, mean age 40 (15) years) with suspected CD fulfilled study entry criteria: nine had iron deficiency anaemia (mean haemoglobin 10.5 (SD 1.8) g%), eight had abdominal pain, seven had diarrhoea, and three had weight loss. Small bowel x ray and upper and lower gastrointestinal endoscopic findings were normal. Mean duration of symptoms before diagnosis was 6.3 (SD 2.2) years. METHODS: Each subject swallowed an M2A Given Capsule containing a miniature video camera, batteries, a transmitter, and an antenna. Recording time was approximately eight hours. The capsule was excreted naturally in the patient's bowel movement, and the data it contained were retrieved and interpreted the next day. RESULTS: Of the 17 study participants, 12 (70.6%, six males, mean age 34.5 (12) years) were diagnosed as having CD of the small bowel according to the findings of the M2A Given Capsule. CONCLUSIONS: Wireless capsule endoscopy diagnosed CD of the small bowel (diagnostic yield of 71%). It was demonstrated as being an effective modality for diagnosing patients with suspected CD undetected by conventional diagnostic methodologies.

Adult↗
PubMed1994

Possible role of Helicobacter pylori serology in reducing endoscopy workload.

We validated a commercial enzyme-linked immunosorbent assay (ELISA), Helico-G, in diagnosing H. pylori in 129 patients (mean age 50 years, range 15-86). We analysed the results of endoscopy against serology to see whether there was a possibility of adopting the strategy of not endoscoping dyspeptic subjects under the age of 45. H. pylori infection was considered present if either histology and/or culture were positive. The ELISA had a sensitivity of 88%, specificity of 72%, positive predictive value of 85%, negative predictive value of 77% and accuracy of 82% in detecting H. pylori. In a subgroup of 52 subjects aged 45 or less (mean age 35 years, range 15-45), 17 out of 25 patients with positive endoscopic findings were H. pylori seropositive while 16 out of 27 patients had normal endoscopic findings. Eighteen out of the 52 patients (35%) were H. pylori seronegative and normal endoscopically except for five patients (10%) who had mild to moderate oesophagitis and two who had non-erosive gastritis (4%). All patients with duodenal ulcer disease (7) were seropositive giving predictive values of positive and negative serology for a diagnosis of duodenal ulcer disease as 28% and 100%, respectively. Therefore adopting a strategy of endoscoping subjects under the age of 45 only if they were H. pylori seropositive would have saved 35% of endoscopies in this age group but missed oesophagitis in 10%. Negative serology would tend to exclude duodenal ulcer disease while positive serology discriminates poorly for it. Serology may be a useful adjunct in screening to reduce endoscopy workload provided that patients with gastro-oesophageal reflux symptoms are excluded.

Aged↗
PubMed1996

Comparison of the utilization of endoscopy units in selected teaching hospitals across Canada.

There is no information on the number of endoscopic procedures performed at major teaching hospitals across Canada. The directors of endoscopy units at eight teaching hospitals from Halifax to Vancouver volunteered demographic information on the unit at their location. There was a very wide range of endoscopic utilization, with approximately comparable rates of out-patient versus in-patient procedures and of gastroscopies versus colonoscopies, but there was no obvious linking of the ratios of in-patients:out-patients versus total number of designated gastrointestinal beds or total number of hospital beds. Thus, the appropriateness of endoscopic procedures needs to be based on standards of practice and accepted indications. The number of endoscopies performed per endoscopy unit support staff varied widely (from 323.7 to 1065.3 per year), and it would be interesting to learn whether this represents an opportunity for cost-saving in some units.

Canada↗
PubMed2002

Motion - All patients with GERD should be offered once in a lifetime endoscopy: arguments against the motion.

The evidence for the recommendation that patients with gastroesophageal reflux disease (GERD) be offered once in a lifetime endoscopy is weak and is not supported by any clinical trials. GERD is a very prevalent condition, yet only 10% of patients with GERD have Barrett's esophagus (BE). Esophageal adenocarcinoma (EAC) is a rare condition and is uncommon even among patients with BE. A decision analysis found that surveillance of BE patients is performed because of inflated estimates of the rate of progression from BE to EAC. Dysplasia more often regresses to more benign histological findings than to cancer, and transient dysplasia can also lead to a high rate of unnecessary endoscopy. Even though practice guidelines about endoscopic surveillance have been published, there is no consensus among gastroenterologists about appropriate protocols, and many physicians are more aggressive than the guidelines. It has not been proved that surveillance saves lives, in part because BE rarely leads to death from EAC. The favourable results from some specialized centres may not be widely applicable. The recommendation for 'once in a lifetime' endoscopy for GERD patients is premature.

Endoscopy, Digestive System↗
PubMed2002

The cost of an upper gastroduodenal endoscopy: an activity-based approach.

The cost of medical procedures is often unknown, but is nevertheless crucial for setting reimbursement and health care policies. The cost of an upper gastroduodenal endoscopy was investigated in ambulatory adults in a large academic hospital in the province of Quebec, from the perspective of the hospital. An activity-based costing methodology was used to break down the procedure into a number of priory tasks, to which resources used at the department level (labour, equipment, materials) were allocated. The direct cost of performing an endoscopy ranged from $62 for an unsedated, unbiopsied patient to $89 for a sedated, biopsied patient. Not included in this amount were separate reimbursement fees of $15 for biopsy analysis and the $50 professional fee for the performing physician, which are charged directly to the Ministry of Health. Incorporating overall, general hospital fixed overhead costs raises the cost of the procedure substantially, by $41, as does the use of nonreusable biopsy forceps, which adds about $63 to the total cost of the procedure. Given the high proportion of overall, hospital-wide, overhead costs in the total cost of the procedure, allocation methods of these overhead costs in current hospital accounting systems should be improved to obtain a more precise estimate of the full cost of upper gastroduodenal endoscopy.

Costs and Cost Analysis↗
PubMed2000

Virtual endoscopy for planning endoscopic third ventriculostomy procedures.

Virtual endoscopy was used to plan 10 endoscopic third ventriculostomy procedures in 9 patients suffering from occlusive hydrocephalus due to idiopathic aqueductal stenosis and tumors. The patients were 4 children (4-14 years, mean age: 9 years) and 5 adults (21-38 years, mean age: 29 years). The aim of the study was to preoperatively evaluate the individual intraventricular and vascular endoscopic anatomy at the floor of the third ventricle based on virtual endoscopic images. The virtual views were correlated with the real endoscopic images, intraoperatively obtained by a standard ventriculoscope (Wolf, Knittlingen, Germany) during endoscopic third ventriculostomy procedures. Contrast-medium-enhanced MR images (3D-MPRAGE; Siemens, Germany) were semiautomatically segmented with a surface-rendering technique ('Navigator' software; General Electric Medical, Buc, France) to produce the virtual endoluminal views. The virtual endoscopic images were comparable with the real intraoperative endoscopic view in 8 of 9 patients. Virtual endoscopy can display the position of the basilar artery, the posterior cerebral arteries and the posterior communicating arteries in their relationship to the mammillary bodies and the clivus. Preoperative virtual endoscopy planning can intraoperatively assist the neurosurgeon to find a safe location for third ventriculostomy.

Adolescent↗
PubMed2002

Appropriateness of diagnostic digestive endoscopy.

The indications of diagnostic endoscopy--upper gastrointestinal endoscopy or colonoscopy--in the exploration of the digestive tract are classified as appropriate or inappropriate with regard to criteria established in guidelines supported by national scientific societies and by insurance companies. This applies to the exploration of symptomatic patients and to screening protocols for malignant lesions. Functional or nonstructural diseases being more frequent than structural diseases, negative findings in endoscopy are common. However this reassures the patient and should not be considered as overuse. On the other hand excess in the repetition of negative endoscopic procedures during surveillance raises ethical problems, increased costs, and may be considered as unethical.

Endoscopy, Gastrointestinal↗
PubMed2003

Perception of gastrointestinal endoscopy by patients and examiners with and without background music.

BACKGROUND/AIMS: Several studies have reported improved patient comfort with music in the preoperative setting, however music has seldom been assessed during gastrointestinal endoscopy. We aimed to assess how background music may influence the perception of patients and examiners involved in endoscopic examinations. METHODS: 301 patients (128 females, 173 males; mean age 59 years) were included in the study (EGD and colonoscopy) in a prospective fashion. 90 EGD and 61 colonoscopies were performed with music (50.17%) and 102 EGD and 48 colonoscopies without music (49.83%). Patients, nurses and endoscopists completed a questionnaire. RESULTS: No significant differences in demographic data were found between the patients examined with or without music. Tolerance to the examination, pain sensation and perception of the endoscopy room ambiance were similar in both groups. The majority of patients (83.4%) expressed a preference for music during any future endoscopic examination and none perceived the music as disturbing. During the 151 examinations, music was considered unpleasant in 14 examinations by the physicians (9.3%) and in 11 examinations by the nurses (7.3%). CONCLUSIONS: Music has little influence on patients' experience of gastrointestinal endoscopy. Nevertheless, the majority of patients felt music to be helpful and expressed a preference for music during any future examination. This positive attitude to music of patients is in contrast with the assessment of some endoscopists and nurses.

Anxiety↗
PubMed1990

The office diagnosis of nasal and sinus disorders using rigid nasal endoscopy.

Functional nasal endoscopic surgery has become increasingly popular because of the development of fiberoptic ridge nasal endoscopes. These same nasal endoscopes play an important role in the office diagnosis of nasal and sinus disorders. While not all physicians or medical institutions can afford the cost of nasal endoscopes for nasal sinus surgery, the cost of an office examination set is reasonable and the patient benefits are great. One hundred and fifty consecutive patients with nasal and/or sinus complaints and normal anterior rhinoscopic nasal speculum and posterior rhinoscopic nasopharyngeal examinations were each examined with rigid fiberoptic nasal endoscopy by two physicians to confirm each findings. Nasal endoscopy revealed fifty-eight (38.7%) patients with nasal pathology who had not been seen with traditional anterior and posterior rhinoscopic examination. The pathology found included obstructed natural maxillary sinus ostia and several pathologic disorders in the middle meatus, such as polyps and "synechiae". Many of these patients had seen several physicians and exhibited frustrating longstanding symptoms, some of which included postnasal catarrh, postnasal drainage, headache, facial pain, "sinus", pressure, and congestion. Nasal endoscopy can find nasal and sinus pathology that might easily be missed with routine speculum and nasopharyngeal examination. For patients with unexplained nasal sinus symptoms, the general otolaryngologist might consider rigid nasal endoscopic office examination as part of the routine office examination.

Ambulatory Care↗
PubMedDate not supplied

The effect of supplemental oxygen in sedated and unsedated patients undergoing upper gastrointestinal endoscopy.

A total of 212 patients undergoing elective upper gastrointestinal endoscopy were prospectively studied. They were randomly assigned to one of four treatment groups: (I) sedation with no supplemental oxygen; (II) no sedation and no oxygen supplementation; (III) sedation and supplemental oxygen; and (IV) no sedation but supplemental oxygen. Oxygen desaturation occurred in all the groups except group IV and was worsened by sedation. Supplemental oxygen corrected the desaturation in the sedated patients and minimized the associated haemodynamic changes. The duration of the endoscopy procedure was shortest in patients who were sedated and given supplemental oxygen. It can be concluded that during conscious sedation for upper gastro-intestinal endoscopy, supplemental oxygen should be given and continued during the postendoscopy period to prevent oxygen desaturation.

Adult↗
PubMed2006

Exogenous endoscopy-related infections, pseudo-infections, and toxic reactions: clinical and economic burden.

OBJECTIVES: The objective of this study was to analyze the characteristics and costs of exogenous endoscopy-related infections, pseudo-infections, and toxic reactions in the US. METHODS: A systematic review of the scientific literature published between 1966 and 2005 was conducted in Medline. Data collection was based on a prospective protocol developed by the authors. RESULTS: The literature review included 70 outbreaks described in 64 scientific articles. Bronchoscopy accounted for half of all reported outbreaks. Inadequate decontamination practices were the leading cause of contamination; equipment malfunction became the second leading cause of contamination during the period 1990-2004. More than 91% of the infections identified could be prevented by health care providers if quality control systems are improved and implemented. The available economic information concerning exogenous endoscope related events is very limited. A model for the analysis of the economic burden of exogenous endoscopy-related events is proposed. CONCLUSIONS: Proper decontamination practices, the use of protective sheaths, and the improvement of surveillance systems could reduce the clinical and economic burdens associated with exogenous endoscopy-related events.

Cross Infection↗
PubMed2001

Nasopharyngeal endoscopy adds to reliability of clinical diagnosis of infectious mononucleosis.

Frequently, the clinical picture in the oropharynx alone does not lend itself to a reliable differentiation between acute pharyngotonsillitis in infectious mononucleosis and a streptococcal inflammation. Such a differentiation, however, is essential for the indication of antibiotic therapy. Therefore, it was the aim of the present study to investigate whether or not endoscopic verification of larger-than-normal lymphatic tissue with fibrinous membranes in the nasopharynx would enhance the reliability of diagnosis. Fifty hospitalized patients exhibiting the clinical picture of acute pharyngotonsillitis were examined for the following parameters: nasopharyngeal endoscopy, determination of glutamine-oxaloacetic transaminase (GOT), glutamine-pyruvic transaminase (GPT), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), leucocytes and haemogram, antibodies to viral capsid antigen (VCA)-IgM, Epstein-Barr virus nuclear antigen (EBNA), and cytomegalovirus (CMV). In 24 patients with acute tonsillitis/peritonsillar abscess, and in 26 patients with infectious mononucleosis, the total leucocyte count in the blood and the blood/erythrocyte sedimentation rate were comparable. Atypical lymphocytes or absolute lymphocytosis were not seen in acute tonsillitis, but were found in 88.5 per cent of patients with infectious mononucleosis. Elevated transaminase levels were noted in 77 (GOT) and 88.5 per cent (GPT) of patients with infectious mononucleosis, and in acute tonsillitis in 4.2 (GOT) and 12.5 per cent (GPT) of patients. The CRP was higher than normal in 91.7 per cent of patients with acute tonsillitis, and in 57.7 of patients with infectious mononucleosis. In none of the patients with acute tonsillitis was lymphatic tissue with fibrinous membranes seen in the nasopharyngeal cavity. In contrast, nasopharyngeal endoscopy in infectious mononucleosis was positive in 24 out of 26 patients. Hence, the sensitivity was 92.3 per cent, the specificity 100 per cent, and the prediction value for a positive test turned out to be 1. Endoscopy of the nasopharngeal cavity employed as a simple and supplementary procedure adds to the reliability of diagnosis of infectious mononucleosis.

Adolescent↗
PubMedDate not supplied

Endoscopy plays an important preoperative role in bariatric surgery.

BACKGROUND: The role of upper endoscopy (EGD) in obese patients prior to bariatric surgery is controversial. The aim of this study was to evaluate the diagnostic yield and cost of routine EGD before bariatric surgery. METHODS: The medical records of consecutive obese patients who underwent EGD prior to bariatric surgery between May 2000 and September 2002 were reviewed. Two experienced endoscopists reviewed all EGD reports, and findings were divided into 4 groups based on predetermined criteria: group 0 (normal study), group 1 (abnormal findings that neither changed the surgical approach nor postponed surgery), group 2 (abnormal findings that changed the surgical approach or postponed surgery), and group 3 (results that were an absolute contraindication to surgery). Clinically important findings included lesions in groups 2 and 3. The cost of EGD (430.72 US dollars) was estimated using the endoscopist fee under Medicare reimbursement. RESULTS: During the 28-month study period, 195 patients were evaluated by EGD prior to bariatric surgery. One or more lesions were identified in 89.7% of patients, with 61.5% having a clinically important finding. The prevalence of endoscopic findings using the classification system above was as follows: group 0 (10.3%), group 1 (28.2%), group 2 (61.5%), and group 3 (0.0%). Overall, the most common lesions identified were hiatal hernia (40.0%), gastritis (28.7%), esophagitis (9.2%), gastric ulcer (3.6%), Barrett's esophagus (3.1%), and esophageal ulcer (3.1%). The cost of performing routine endoscopy on all patients prior to bariatric surgery was 699.92 US dollars per clinically important lesion detected. CONCLUSIONS: Routine upper endoscopy before bariatric surgery has a high diagnostic yield and has a low cost per clinically important lesion detected.

Adult↗
PubMed2006

Preoperative work-up in asymptomatic patients undergoing Roux-en-Y gastric bypass: is endoscopy mandatory?

BACKGROUND: We aimed to determine before Roux-en-Y gastric bypass (RYGBP) in asymptomatic morbidly obese patients: 1) the prevalence of abnormal findings at upper gastrointestinal (UGI) endoscopy; 2) Helicobacter pylori (HP) status; 3) clinical consequences of these findings; and 4) associated costs. METHODS: We retrospectively reviewed 468 consecutive patients, excluded those with UGI symptoms, drug intake or previous UGI endoscopy/surgery, and analyzed findings in the 319 remaining patients (68%). RESULTS: There were abnormal findings in 147 patients (46%), including 54 hiatal hernias and 146 parietal (i.e. mucosal or submucosal) lesions. The most significant were 7 ulcers and 2 gastric polyposis. HP was detected (using CLO-test) in 124 patients (39%). Histopathological examination of biopsies was abnormal in 109/161 patients (68%), and disclosed mainly chronic gastritis (n=98). Abnormal findings were more frequent in HP-positive compared to HP-negative patients (94 vs 51%, P<0.001). Findings had clinical implications in only 4% of patients: delayed surgery (7 ulcers), prophylactic gastrectomy (2 gastric polyposis), unnecessary work-up (3 irrelevant/false-positive diagnoses), and inclusion in a screening program (1 Barrett's esophagus). Mean cost of complete UGI work-up was 389 euro/patient. CONCLUSION: Asymptomatic morbidly obese patients frequently harbour UGI lesions warranting UGI work-up before RYGBP. However, routine endoscopy presents drawbacks. We propose a less invasive strategy which reduces costs and limits false-positive results and the subsequent investigations that they require. In our series, it would have missed two gastric polyposis only, for which no formal recommendation has yet been issued. This strategy could be a valuable alternative to routine UGI endoscopy before RYGBP in asymptomatic patients.

Adult↗
PubMed1992

Vascular endoscopy for intravascular surgery--an experimental study.

A combination of endoscope and high-pressure saline irrigation system was tested in the occlusion of experimental aneurysms, and angioplasty and fibrinolysis of vascular occlusive lesions in canine femoral arteries. Endoscopy provided detailed information about the aneurysmal orifice and lumen and aided balloon placement and detachment. Endoscopy visualized the dynamic changes accompanying thrombolysis and the fine intimal injury due to angioplasty invisible on angiography. Vascular endoscopy is valuable for pre-, intra-, and postoperative evaluation of intravascular interventions.

Angiography↗
PubMed1995

H. Joachim Burhenne Lecture. Common areas of interest between interventional biliary radiology and endoscopy.

Therapeutic biliary endoscopy is a more recent subspecialty than interventional biliary radiology, and much has been learned from the pioneering work of interventional radiologists. The areas of interest to biliary radiologists and biliary endoscopists are largely identical. The common bile duct can be approached either by the antegrade percutaneous transhepatic approach or by the retrograde endoscopic transpapillary route. In most cases, endoscopy is the treatment of choice because of its lower risk. A new era in therapeutic endoscopy began with the invention of endoscopic papillotomy in 1973 by Classen and Demling in Germany [1] and Kawai et al. in Japan [2]. This technique made access to the hepatobiliary and pancreatic ductal systems possible, and endoscopic papillotomy has replaced choledochotomy for the treatment of bile duct stones in many centers. Endoscopic or radiologic treatment can entirely replace surgical management. The radiologic approach is advantageous via the endoscopic route when a patient has residual stones in a T tube or intrahepatic stones that lie proximal to a stricture. For patients who have had abdominal surgery and in whom access to the papilla is sometimes impossible because of a long afferent jejunal loop, radiologic therapy is suitable. They also can be treated by the rendezvous approach, whereby the radiologist feeds a guidewire through the papilla into the duodenum and the endoscopist then accesses the bile duct in a retrograde fashion. Calculous disease and ductal stenoses are the main indications for endoscopic therapy; these and other conditions of the biliary tract will be discussed here.

Biliary Tract Diseases↗
PubMedDate not supplied

[Making a diagnosis of different lesions of vocal fold mucosa by contact endoscopy--the first usage in our clinical practice].

During laryngomicroscopy, the superficial layers of vocal fold epithelium can be examined in vivo and in situ by contact endoscopy. Methylene blue is applied initially to stain the epihelial cells of the vocal folds. When in contact with mucosal tissue, this endoscope provides 60 and 150 times magnification and clear visualization of cellular patterns of the superficial epithelial layers. For the first time in our laryngological clinical practice, we confirmed a number of previosly established parametars such as regularity and arrangement of the epithelium, nucleus contour, and nucleus-cytoplasm ratio, what all enable recognition and easy evaluation of different clinical conditions such as chronic laryngitis, Reinke's edema, papiloma dysplasia or vocal fold carcinoma. The advantage of contact endoscopy in vivo and in situ allows for detailed scan and mapping of all cell changes of the whole mucosa surface. All these features definitely classify the contact endoscopy into additional diagnostic methods in laryngology.

Endoscopy↗
PubMedDate not supplied

The role of endoscopy in the management of nasal neoplasia.

Fiberoptic endoscopy has made a notable impact in rhinology over the last decade, mainly in the diagnosis and treatment of paranasal sinus inflammatory disease. The aim of this article is to review, discuss, and illustrate the role of endoscopy in the management of nasal neoplasia. We have reviewed our own experience and illustrate this with four cases. We discuss the role of endoscopy in the diagnosis, biopsy, resection, posttherapeutic surveillance, and palliation of these tumors.

Biopsy↗