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PubMed2003

Pro and cons of different designs of rigid endoscopes.

Experience with more than 200 neuroendoscopic procedures taught us the advantages and disadvantages of the different endoscope designs. Using an endoscope with a sheath with separate channels for the endoscope, the instruments as well as for rinsing and suction we found advantages in rinsing properties, handling, and preciseness of instrument steering. On the other hand an endoscope with a sheath with a singular channel for the endoscope itself, the instruments, rinsing, and suction the advantages were better in visualization of the instruments, more available instruments, and easier extraction of larger specimen. The knowledge of these advantages makes it possible to select the adequate endoscope regarding its design, especially in more complicated cases.

Brain Diseases↗
PubMed2005

Developing an animal model of massive ulcer bleeding for assessing endoscopic hemostatic devices.

BACKGROUND: Existing animal models of ulcerative bleeding are not suitable for endoscopic investigation. We describe a new porcine model of massive arterial bleeding in the stomach and its use for assessing a novel endoscopic suturing device. METHODS: Two animal models were investigated. In model 1, the short gastric artery (mean diameter 2 mm) was divided near its gastric end. A mucosal defect was created near the greater curve and the divided artery was brought into the lumen of the stomach through a submucosal tunnel. An inflatable plastic cuff was placed around the base of the artery. Cuff deflation led to massive bleeding. In model 2, the short gastric artery was carefully exposed along a segment of 2 cm on the side facing the stomach. It was then anchored to a small gastrostomy made at the posterior wall near the vessel. At endoscopy an ulcer-like lesion could be seen with a pulsatile vessel at the base and brisk bleeding could be started by cutting a hole in the artery using endoscissors. The pigs were heparinized by an intravenous bolus of 110-300 units per kilogram, in both models. A prototype suturing device, the Eagle Claw, was inserted using a gastroscope and the curved needle was driven around the bleeding artery. Extracorporeal knotting or intracorporeal ligation was done endoscopically. RESULTS: Pulsatile arterial bleeding was successfully created in four pigs using model 1, and in another four pigs using model 2. Model 2 was more reproducible and less time-consuming to create. Endoscopic suturing controlled arterial bleeding in five out of eight pigs with a single stitch and in another three pigs with an additional stitch. CONCLUSION: This animal model provides reproducible massive hemorrhage suitable for endoscopic studies. Control of gastric bleeding from large arteries by endoscopic suturing is possible.

Animals↗
PubMed1992

[Intubation aid by a rigid endoscope].

A method has been developed making it possible to look around intubation obstacles with the aid of rigid angular-lens systems. A glottis that is not or is only partly visible in direct laryngoscopy can be visualized endoscopically. The normal intubation technique is retained. A rigid endoscope is additionally introduced into the oropharynx, the glottis located endoscopically, and the endoscope secured to the laryngoscope in the position. The free hand can then be used to advance the tube through the glottis into the trachea under endoscopic control. This endoscopic method is intended to augment the physician's instrumental repertoire.

Endoscopes↗
PubMed1998

Effect of programmed endoscopic follow-up examinations on the rebleeding rate of gastric or duodenal peptic ulcers treated by injection therapy: a prospective, randomized controlled trial.

BACKGROUND AND STUDY AIMS: A second-look endoscopy is often performed to evaluate the efficacy of a prior injection therapy in patients with bleeding peptic gastric or duodenal ulcers. Although this strategy is widely established, it does not rely on unequivocal data from controlled studies. In a prospective, randomized, controlled multicenter trial we assessed the effect of programmed endoscopic follow-up examinations with eventual retreatment on the outcome of bleeding ulcers in these patients. PATIENTS AND METHODS: One hundred and five patients with gastric or duodenal peptic ulcers presenting with active (Forrest type I) or recent (Forrest type IIa and IIb) bleeding upon endoscopy within four hours after admission were included in the study. Emergency treatment consisted of the sequential injection of both epinephrine (1:10,000 v/v) and up to 2 ml of fibrin/thrombin around the ulcer base. Fifty-two patients were randomized to receive programmed endoscopic monitoring with eventual retreatment in cases of Forrest type I, IIa, or IIb ulcers beginning within 16-24 hours after the index bleed. Follow-up endoscopies were continued until the macroscopic appearance revealed a Forrest type IIc or III ulcer. Fifty-three patients in the control group were closely monitored, and only received a second endoscopy when there was clinical or biochemical evidence of recurrent bleeding. The groups did not differ with respect to age, sex, site and severity of bleeding. RESULTS: The numbers of patients with recurrent bleeding were similar whether they were endoscopically monitored or not (21% versus 17%, P=0.80 chi-squared test). In addition, there was no statistically significant difference between the two groups with respect to the number of blood units transfused, need for surgical intervention, hospital stay or number of deaths (Mann-Whitney U-test). Improving local ulcer stigmata was not related to a better outcome. CONCLUSIONS: Programmed endoscopic follow-up examinations with eventual retreatment in patients locally injected for an acute or recent hemorrhage from a gastric or duodenal ulcer did not influence their outcome when compared to patients receiving only a second endoscopic intervention upon evidence for recurrent hemorrhage. Scheduled control endoscopies cannot be recommended after an initial successful endoscopic treatment of peptic ulcer bleeding when selection of the patients for second-look endoscopy is directed by the Forrest criteria.

Aged↗
PubMed1998

Endoscopic hemostasis in exulceratio simplex-Dieulafoy's disease hemorrhage: a review of 25 cases.

BACKGROUND AND STUDY AIMS: Dieulafoy's disease is a rare cause of upper gastrointestinal tract hemorrhage. The aim of the study was to evaluate the efficacy of endoscopic hemostasis and to analyze the mortality of patients with hemorrhage due to Dieulafoy's disease. PATIENTS AND METHODS: The retrospective analysis included patients from our institution who had undergone urgent endoscopic examination of the upper digestive tract and hemostatic interventions in the period between January 1994 and December 1996. RESULTS: Twenty-five patients were examined (18 men and 7 women, average age 52.6, SD+/-15.3, range 25-78). In 20 patients endoscopic injection sclerotherapy was performed (diluted epinephrine 1:10,000 plus polidocanol 1%) and Nd:YAG laser photocoagulation in five patients. In all patients a total of 44 interventional endoscopies were carried out. Repeated endoscopic hemostasis did not prove successful in two patients (8%, 2 men), and they were treated operatively. During the postoperative period one patient died because of multiorgan failure. The total mortality rate of all patients in which endoscopic hemostasis was done was 16% (4/25). None of the 21 surviving patients had rebleeding on long-term follow-up (mean: 29.4 months). CONCLUSIONS: Endoscopic hemostasis is a major therapeutic advance in the management of Dieulafoy's disease hemorrhage. Interventional endoscopy has decreased the need for surgical management and significantly reduced mortality.

Adolescent↗
PubMed1998

Endoscopic ligation for non-esophageal variceal upper gastrointestinal hemorrhage.

BACKGROUND: Endoscopic ligation can be used for bleeding lesions in non-fibrotic tissue; however, only small numbers of patients with non-esophageal variceal upper gastrointestinal hemorrhage have been treated in this way. To evaluate the utility of the technique, we performed the procedure to treat hemorrhage not from esophageal varices during emergency endoscopy. PATIENTS AND METHODS: Bleeding was identified from gastric Dieulafoy's ulcers (n=4), duodenal ulcers (n=3), gastric angiodysplasia (n=2) and Mallory-Weiss tears (n=3). The bleeding points were aspirated and controlled by endoscopic ligation and complete hemostasis was achieved in all cases. RESULTS: Although these lesions were located in difficult areas where endoscopic injection therapy and clipping sometimes fail, endoscopic ligation was performed easily and effectively without complications. Six of the patients had severe underlying disease, including acute and chronic myelogenous leukemia, liver cirrhosis and chronic renal failure; none suffered deterioration in their general condition after endoscopic ligation. CONCLUSIONS: Our findings suggest that endoscopic ligation is an easy and effective method of treatment for patients with gastrointestinal hemorrhage not from esophageal varices, and is safe even in patients with poor general health.

Adult↗
PubMed1997

Diagnostic strategies for extrahepatic cholestasis of indefinite origin: endoscopic ultrasonography or retrograde cholangiography? Results of a prospective study.

BACKGROUND AND STUDY AIMS: Due to its lower morbidity, it has been suggested that endoscopic ultrasonography (EUS) might replace endoscopic retrograde cholangiography (ERC) in the management of extrahepatic cholestasis of unknown origin. The present study aimed to compare the diagnostic accuracy of EUS and ERC in the management of cholestasis of unknown origin, taking into account the patient's general status and the necessity of endoscopic therapy. PATIENTS AND METHODS: Sixty-eight patients with cholestasis of unknown origin were studied prospectively. EUS followed by ERC was carried out on a blinded basis by two endoscopists; diagnostic and therapeutic suggestions were made after either examination. During the ERC procedure and before withdrawing the tube, the endoscopist provided the final conclusions and carried out appropriate endoscopic treatment. RESULTS: A correct diagnosis was obtained with EUS and ERC in 94% and in 92% of cases, respectively (not significant). After EUS, diagnostic ERC was necessary for diagnosis and therapy in 24% and 58% of cases, respectively. After ERC, EUS was requested in 41% of cases. The higher the American Society of Anesthesiologists (ASA) grade, the less it was necessary to perform a complementary investigation. In ASA grade 1 patients, endoscopic therapy was suggested in 38% of cases after EUS and in 33% after ERC (not significant); in ASA grade 3 patients, it was suggested in 93% of cases. CONCLUSIONS: The diagnostic sensitivities of EUS and ERC are similar for extrahepatic cholestasis. ERC is first indicated in poor candidates for surgery, since endoscopic therapy is frequently required. In good candidates for surgery, EUS should be carried out first in order to stage a tumor or identify choledocholithiasis.

Adult↗
PubMed1997

Endoscopic management of Dieulafoy lesions of the stomach: a case study of 26 patients.

BACKGROUND AND STUDY AIMS: We studied the clinical features and therapeutic outcome in patients with a diagnosis of Dieulafoy lesion. PATIENTS AND METHODS: Twenty-six patients who had upper gastrointestinal bleeding from Dieulafoy lesions received endoscopic therapy. The clinical and endoscopic features, and the outcome of therapy, were analysed retrospectively. RESULTS: Hemostasis was attempted by hemoclipping in 18 patients, heater probe in six patients and ethanol injection in two patients. The initial therapy was successful in 22 (84.6%) cases. Hemostasis was achieved with additional endoscopic therapy in three cases (11,5%). Surgical treatment was needed only in one case, owing to uncontrolled bleeding. One patient died during the hospital stay from a cause unrelated to the Dieulafoy lesion. There were no side effects related to endoscopic therapy. None of these patients presented with rebleeding from Dieulafoy lesions over a mean long-term follow-up of 36 months. CONCLUSIONS: Bleeding from Dieulafoy lesions can be managed successfully by endoscopic methods, and these should be regarded as the first choice in their management. We emphasize the role of hemoclipping, a mechanical method, for the endoscopic treatment of these lesions.

Arteriovenous Malformations↗
PubMed1996

The Saeed Six-Shooter: a prospective study of a new endoscopic multiple rubber-band ligator for the treatment of varices.

BACKGROUND AND STUDY AIMS: Rubber-band ligation is superior to sclerotherapy, and is considered to be the endoscopic treatment of choice for bleeding varices. The single-shot mechanism of the ligation device generally used is inherently inefficient, and makes the procedure tedious. It also requires overtube placement, associated with discomfort and complications. This study describes the Saeed Six-Shooter, a multiple ligation device. PATIENTS AND METHODS: Twenty-seven consecutive patients with variceal bleeding were prospectively studied. After initial endoscopic ligation, subsequent sessions were every 7-10 days. The parameters studied were the ease of use, the ability to control active bleeding and eradicate varices, survival, and complications. RESULTS: Active bleeding was controlled in all seven (100%) patients. Esophageal varices were eradicated in 70% (3.2 +/- 1.2 sessions), and gastric varices in 88% of patients (2 +/- 1.2 sessions). Five patients re-bled, two from esophageal varices, two from gastric varices, and one from treatment-induced ulcer. There were four deaths, none due to exsanguination. A single complication, esophageal stricture, resolved with balloon dilation. Intubation was no more difficult with the endoscope loaded with the Six-Shooter than with the endoscope alone (P > 0.3). Six ligations were performed in 39% of cases within 60 seconds, and in 74% of cases within 90 seconds. For gastric varices, the device was effectively used with the endoscope retroflexed. CONCLUSIONS: The Saeed Six-Shooter is a safe and efficient instrument for the endoscopic ligation of varices, and has overcome the limitations of the single-shot ligator.

Adult↗
PubMed1994

A newly developed fine-caliber endoscope for peroral cholangiopancreatoscopy.

We have developed a new fine-caliber (2.09 mm outer diameter) endoscope for peroral cholangiopancreatoscopy. The endoscope contains one image transmission fiber, 12 light guide fibers (the transmitter of light from the light source) and a working channel (a lumen for the guide wire and rinsing). The working channel, whose bore is 0.72 mm, is located centrally within the endoscope. The endoscope can be introduced reliably into the bile and pancreatic ducts using the same techniques as those for endoscopic nasobiliary drainage through the instrumental channel of a duodenoscope for examination without pretreatment of the papilla of Vater. Two patients with lesions of the pancreatic duct and seven patients with lesions of the bile duct suspected or detected by endoscopic retrograde cholangiopancreatography (ERCP) were examined. Direct inspection of the biliopancreatic duct not only provided enough information to make a definite diagnosis, but also revealed lesions that were not detectable by ERCP or other examinations.

Adult↗
PubMed1989

Methods of disinfecting endoscopic material: results of an international survey.

A questionnaire on the methods of cleaning and disinfecting endoscopic equipment was mailed to 120 centers in Western Europe. Seventy-four questionnaires (61%) were returned. The centers were classified into three groups according to the number of endoscopic procedures performed per year. This survey has shown that precautions are more rigid in specialized centers than in units doing fewer than 1,500 endoscopic investigations a year. Complete disinfection is done by almost all the centers after ERCP in infected patients or in the case of HBsAg and HIV-positive patients, but only by 70% of centers after completion of endoscopies performed in patients with gastrointestinal hemorrhage and unknown immunological status. After endoscopic examination performed in presumably non-infected subjects, complete disinfection is not done in any center after gastroscopy, in 13% after colonoscopy and in 30% after ERCP. Continued education of endoscopic personnel and greater availability of adequate endoscopic equipment is mandatory for minimizing the risk of endoscopy-related infections.

Disinfection↗
PubMed1987

Color performance of video endoscopes: quantitative measurement of color reproduction.

We have conducted a study aimed at testing the color performance of video endoscopes in quantitative terms for the first time. The video endoscopes investigated were from Fuji, Olympus, Toshiba/Machida, and Welch-Allyn. The tests were carried out with an opto-electronic color analyser using standardized color charts and a neutral grey chart. Hue and chroma of the reproduced colors were measured. The Olympus video endoscope reproduces the hue very well, showing only slight color desaturation. The Fuji video endoscope had a yellowish tint, whereas the picture obtained with the WA video endoscope produced an inhomogeneous picture with a pronounced red/purplish cast at the top of the screen and almost neutral reproduction at the lower half. The Toshiba video endoscope was the only one with a color chip, and reproduced hue fairly well, but its colors were weakly saturated.

Color↗
PubMed1984

Electronic endoscopy of the gastrointestinal tract. Initial experience with a new type of endoscope that has no fiberoptic bundle for imaging.

We report on 31 endoscopic investigations using a new type of electronic endoscope which has no fiberoptic bundle for imaging. The device carries on its tip a light-sensitive CCD chip which functions as a TV camera. The signals received are transformed by a processor and displayed on a TV monitor. The upper digestive tract was inspected in 23 patients with the electronic endoscope and in the same session, a fiberoptic-endoscopic esophagogastroduodenoscopy was carried out on 16 of them. The information obtained using the 2 systems differed neither quantitatively nor qualitatively. Because of its external diameter, it was not possible to introduce the electronic endoscope past esophageal stenoses in 2 patients. Preliminary experience with 2 types of colonoscopes in 8 patients strongly indicates that these devices are equivalent, in respect of optical quality, to the fiberoptic endoscopes. The quality and color reproduction of the TV image of the upper and lower digestive tract are excellent. Electronic endoscopy offers great potential for consultation, training and documentation. The patients tolerated the procedure very well.

Adult↗
PubMed1999

[Computer assisted localization in endoscopic sinus surgery--state of the art? The Insta Trak system].

BACKGROUND: Image-guided surgery is increasingly acknowledged as useful technology also for endoscopic sinus surgery. For many years our department has been involved in the development and testing of devices for image-guided endoscopic sinus surgery. Since January 1997 we have been testing the "Insta Trak" System, which is based on electromagnetic tracking and was especially designed for use in endoscopic sinus surgery. METHODS: We tested practicability and accuracy of the system in a wide range of cases from standard sphenoethmoidectomies to tricky frontal sinus surgery, from endoscopic tumour surgery to endoscopic repair of CSF fistulas. System accuracy was assessed by means of visual landmarks which could be clearly identified endoscopically as well as via computer screen. Additionally we measured the time for setting up the system, total operating time and rating of the subjective surgeon's assessment of the system's usefulness in each particular case. RESULTS: We present the results according accuracy and practicability in 45 patients, who were operated on under computer-aided guidance. Our overall experience with the "Insta Trak" system was very positive. It was no longer the indeed promising, but still rather circumstantial and not always reliable technique we were used to. Operating the system was relatively easy and did not require excessive computer skills. We measured an average accuracy of 0.69 mm with a maximum deviation of 2 mm in a single test measurement. Incorrect use of the device, however, may significantly increase the possible weight of system errors. CONCLUSIONS: The system accuracy was high and "Insta Trak" proved to be practicable and efficient in daily clinical routine. Especially in complicated cases like revision surgery "Insta Trak" proved to be extremely helpful. Whether a system like "Insta Trak" will be definitely able to lower complication rates in FESS is still an open question. Certainly in the near future no such navigational device will become a substitute for the surgeon's understanding of anatomy. In our opinion and experience "Insta Trak" is a significant development in sinus surgery. However, one must be aware of the fact that it cannot be more than yet another and indeed helpful tool.

Endoscopes↗
PubMed1999

[Intravitreal endoscopic visualization of intraocular ganciclovir devices: improved long-term treatment of CMV retinitis].

BACKGROUND: The recent development of 20- and 19-gauge diameter endoscopes allows an excellent direct intravitreal visualization of intraocular morphology. A gradient index (GRIN) endoscope (Insight Instruments, Lake Mary, FL, USA), which combines a small diameter (0.89 mm, 20 gauge) and an exceptional optical resolution, can be used as a diagnostic tool for the assessment of the safety and vitreous interaction of sustained release intraocular devices which have been designed to deliver ganciclovir (Vitrasert) over a period of 8-12 months and were successively implanted in several eyes. PATIENTS AND METHODS: 78 eyes of 49 patients received 100 ganciclovir implants between November 1995 and July 1998. In six patients who received additional implants, the GRIN endoscope was used as an optical control of wound healing processes and Vitrasert positioning after implantation of prior devices (two-point suturing technique). RESULTS: In all of these six eyes, a clinical stabilization of the cytomegalovirus retinitis was noted. Endoscopic observation of the scleral 5-mm incision revealed no gaps after two-point suturing of the device. Only one of six eyes showed significant vitreous tractions around the Vitrasert. However, the struts of all pellets were completely covered by a fibrous membrane. Occasional fibrous plaques were noted on the surface of devices which presumably had been damaged by surgical manipulations. In one case, the endoscopic examination disclosed the suprachoroidal implantation of a device. In this eye, no signs of retinal toxicity or recurrence of CMV retinitis were observed. CONCLUSIONS: High resolution endoscopy of the vitreous cavity appears to be an effective method for the control of intraocular drug delivery devices. Basically, the repeated implantation of intraocular ganciclovir implants can be considered a safe method in the management of relapsing CMV retinitis. However, the endoscopic observation of fibrous membranes covering the struts suggest that the explanation of an intraocular device has the potential for various intraoperative complications (e.g. hemorrhages, traction, tears, retinal detachment). Therefore, we would recommend the additional implantation of further implants rather than a replacement.

Cytomegalovirus Retinitis↗
PubMed1983

[Stenosis endoscope. A new instrument for the diagnosis and therapy of stenoses in the gastrointestinal tract].

A new type of endoscope combines the advantages of the narrow-calibre paediatric endoscopes and the stable-shaft regular endoscopes. This is achieved by reduction of the distal diameter from 13 mm to 9,5 mm with a conical transition between both parts. These characteristics make the instrument particularly suitable for the diagnosis of gastrointestinal stenoses (stenosis endoscope). At the same time the stenosis endoscope dilates as well as a metal olive or a rubber bougie. Thus dilatation of gastrointestinal stenoses is now possible beyond the reach of instruments used as bougie or for dilatation until now. The stenosis endoscope opens new possibilities of therapeutic endoscopy.

Aged↗
PubMed2000

Endoscopic sphincterotomy for bile duct stones in patients 90 years of age and older.

BACKGROUND: Little information is available on the outcomes of endoscopic sphincterotomy for choledocholithiasis in patients of advanced age (>/=90 years). METHODS: Endoscopic sphincterotomy was performed for choledocholithiasis in 22 patients aged 90 years or more (group A) and 381 aged 70 to 89 years (group B). Clinical features and early outcomes of endoscopic sphincterotomy were compared between the two groups. In group A, long-term results for a mean follow-up period of 33 months were assessed. RESULTS: Group A patients had a higher incidence of symptoms, acute cholangitis and concomitant diseases, as well as larger and more numerous gallstones than did group B patients. Endoscopic sphincterotomy was technically successful in 100% of group A patients and 98% of group B patients. The rate of early complications was low in both groups: 5% in group A and 7% in group B. No deaths related to endoscopic retrograde cholangiopancreatography occurred in group A patients. Complete stone clearance was achieved in 86% of group A patients and 95% of group B patients. Group A required an emergency procedure, general anesthesia, multiple sessions, mechanical lithotripsy, and permanent biliary stent placement more frequently than group B. Late complications occurred in 5% of group A patients. CONCLUSION: Endoscopic sphincterotomy is safe and effective for the treatment of choledocholithiasis in patients 90 years of age or older. Biliary stent placement is a reasonable alternative treatment when stones prove to be difficult to extract.

Age Factors↗
PubMed2000

Bleeding Dieulafoy's lesions and the choice of endoscopic method: comparing the hemostatic efficacy of mechanical and injection methods.

BACKGROUND: Dieulafoy's lesion has unique endoscopic and histopathologic characteristics. This is a clinical trial of endoscopic therapy in 24 patients with Dieulafoy's lesions. METHODS: Patients were divided into 2 groups according to initial endoscopic treatment method. Data were analyzed with respect to clinical and endoscopic characteristics as well as outcomes. The 24 patients were evenly divided into mechanical (9 hemoclipping, 3 band ligation) and injection groups (12). RESULTS: The average number of therapeutic endoscopic sessions needed to achieve permanent hemostasis for the mechanical and injection groups were 1.17 and 1.67, respectively. Initial hemostasis was achieved in 91.7% of patients undergoing mechanical therapy and 75% of those undergoing injection therapy, with none in the former group needing subsequent surgery in comparison to 17% of the latter group. The rate of recurrent bleeding in the mechanical therapy group was significantly lower in comparison to the injection therapy group (8.3% versus 33.3%, p < 0. 05). CONCLUSIONS: Higher efficacy in terms of initial hemostasis and less recurrent bleeding was achieved by mechanical hemostatic therapy with hemoclip and band ligation compared with injection therapy. Endoscopic mechanical therapy is recommended as effective for bleeding Dieulafoy's lesions.

Adult↗