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We prefer emergency-endoscopy in case of acute hemorrhage of the upper gastro-intestinal-tract, in case of perforation no endoscopy. Within the last two years 122 patients were treated by endoscopy and more than half of them must be treated by operation.
AIM: Written consent is not advised in France because it is thought it may alter the patient's trust in his/her doctor. Our aim was to elaborate a consent form for gastrointestinal endoscopy and to assess the patient's opinion concerning the written consent process. METHODS: Seven health professionals and seven patients or users elaborated a consent form and a list of 24 questions about the written consent process. The consent form, accompanied with an information form, was given to the patients before endoscopy. For a period of 9 consecutive days, all patients undergoing gastrointestinal endoscopy were asked to fill out the questionnaire at the end of the procedure. RESULTS: One hundred and forty-three patients participated in the survey. Twenty-eight were unable to read the form. One hundred patients filled out the form. Sixty-six percent of the patients were satisfied with the written consent process. Only 10% considered that the written consent process altered their trust in their doctor. Ninety-eight percent of the patients were satisfied with the consent form and 97% felt it was clear and comprehensible. Eighty percent of the patient felt it was reassuring. CONCLUSIONS: Written consent does not alter the patient's trust in his/her doctor. The majority of the patients understood the written consent process and agreed with it. Almost all patients were satisfied with the consent form we elaborated, suggesting that its use could be generalized.
OBJECTIVE: To evaluate normal and bony anatomy of nasal cavity and paranasal sinus on the spiral CT virtual endoscopy(VE) and coronal scanning image. METHOD: After patients were scanned on axial or coronal position by spiral CT, data were transferred to workstation. Structures such as ostium-meatal complex(OMC) were viewed by navigator software when threshold was changing. RESULT: Turbinates, meatus and ostium-meatal complex were better viewed by virtual endoscopy compared with by coronal scanning image. To some extent, bony anatomy was clearer. CONCLUSION: Virtual endoscopy is of value in realizing characteristics of nasal cavity and paranasal sinus anatomy.
OBJECTIVE: To further understand the advantage of radiofrequency treatment of hemangioma of nasal cavity under nasal endoscopy. METHOD: Fifteen cases with hemangioma of nasal cavity were treated with radiofrequency under nasal endoscopy. RESULT: The hemangioma of fifteen cases could be removed completely. The complication was absent. None of them recurred in six months to four years following up. CONCLUSION: This method has many advantages such as clear operation visual field, less hemorrhage and postoperative pain, no facial scar. The radiofrequency under endoscopy is valuable in treatment for hemangioma of nasal cavity.
OBJECTIVE: to explore some new techniques of postoperative cholelith endoscopy via the fistula. METHODS: Netting, washing, clamping, pushing, and electrohydraulic techniques were used in 260 cases of postoperative cholelith endoscopy via the fistula and the clinical data were analyzed retrospectively. RESULTS: The stones in 257 cases (98.8%) were removed completely in an average of 2.7 times. Three patients were operated on again because of biliary stricture and huge stones. CONCLUSION: The application of some new techniques in postoperative cholelith endoscopy via the fistula favors the complete removal of stones.
Immunodepressed subjects appear to present as a common adverse event the infections complication of paranasal sinuses which can lead to an unfavourable clinical evolution spreading the infection to encephalic and endo-orbital tissues. The patients described by the authors present a common clinical history of neoplastic disorders concerning the haemopoietic tissue with an indication for bone marrow transplantation. These patients also demonstrated clinical-radiological evidence of rhino-sinusal impairment with specific maxillary sinus involvement. The clinical condition obliged us to reach a final diagnosis of the origin of rhino-sinusal involvement which clearly appeared by performing imaging diagnostic examinations in order to rapidly establish the correct therapy. The resolution of the rhino-sinus complication allows these patients to follow on the treatment for their own initial pathology. In fact, in order to resume the treatment against haemoblastic disorders, an essential step is to approach the paranasal sinus affection. Endoscopy, in the cases reported, permitted us to obtain a correct diagnosis and to develop a correct antimicrobic therapy, achieving the drainage of the maxillary sinus as well. Endoscopy achieved the same results as radical surgery of the maxillary sinus by the Caldwell-Luc approach, proving less aggressive and reducing operative timing, postoperative recovery timing and intra and post operative haemorrhagic complications. Moreover, endoscopy characteristics present a specific validity in patients with severe general conditions, which are described in the examined group, reducing time for diagnosis and therapy resulting specific to solve the rhino-sinus complication and also particularly important in order to interfere less with the delicate medical therapy for the primary pathology by the sample examined.
AIM: To determine the diagnostic accuracy of upper gastrointestinal endoscopy in a selected group of patients with HIV infection, who had severe symptoms unresponsive to empirical treatment. METHOD: We reviewed all patients with HIV infection, who had undergone upper gastrointestinal endoscopy at Auckland Hospital. Specific diagnoses were based on the endoscopic appearances and on the histological and microbiological examination of endoscopic biopsies taken from the oesophagus, stomach and duodenum. RESULTS: A definitive diagnosis was reached in 16 of the 21 patients endoscoped, of whom 13 had a good clinical response to treatment. The median survival was three months. The most common diagnosis was oesophageal candidiasis seen in six patients, all of whom responded to treatment with a median survival of six months. Invasive cytomegalovirus gastrointestinal disease was seen in three patients, none of whom had positive blood cultures for cytomegalovirus. All responded to intravenous ganciclovir. Three patients with severe diarrhoea had opportunistic infection of the small bowel. All three had advanced AIDS with a median survival of less than one month. CONCLUSION: Upper gastrointestinal endoscopy has a high diagnostic yield in patients with HIV infection with oesophageal symptoms which fail to respond to antifungal therapy, or with severe weight loss and diarrhoea and it should be considered in these patients because excellent palliation may be possible.
OBJECTIVE: To use virtual endoscopy to obtain detailed three-dimensional images of bone, soft tissue and paranasal sinus damage as well as images of adjacent unaffected areas for optimum surgical planning. METHODS: A spiral CT scanner was used to examine 46 cases of facial bone fractures, maxillary cysts, obstructive sleep apnea syndrome (OSAS) and maxillary bone tumours. Data were input into a navigator workstation to create images similar to those displayed by a fiberoptic endoscope. Various 3-D images were obtained when probe sites were changed. RESULTS: Virtual endoscopy can clearly display the anatomic structure of the paranasal sinuses, nasopharyngeal cavity and upper respiratory tract, revealing damage to the sinus wall caused by a bone tumor or fracture. In addition, the technique can be used to indicate volume changes of the upper respiratory tract in OSAS patients. These results were similar to those obtained through actual operations. CONCLUSIONS: Virtual endoscopy is a new method which produces very clear images. It is reliable to provide detailed information for optimal operative planning.
BACKGROUND: The purpose of this study was to evaluate the clinical presentations and features of upper gastrointestinal (UGI) endoscopy and the role of Helicobacter pylori in children with UGI bleeding. METHODS: A retrospective review was done of the medical records of 112 infants and children who presented with UGI bleeding. They underwent UGI endoscopy in the Taipei Veterans General Hospital, Taiwan between July 1996 and December 2000. Patients with hematemesis caused by swallowing caustic agents or foreign bodies were excluded. RESULTS: There were 112 patients involved in this study. Clinical manifestations included hematemesis (77 cases, 68.8%), tarry stool (37 cases, 33%) and hematochezia (9 cases, 8%). Fifty-three patients (47.3%) had underlying diseases, including neuromuscular deficits (17), hepatobiliary disease (17), renal insufficiency (8), Henoch-Schonlein purpura (HSP) (3), and cow milk allergy (3). Another 34 patients had a preceding acute febrile illness history. The endoscopic appearances included esophageal varices (10.7%), esophagitis or esophageal ulcers (30.4%), superficial gastric mucosal lesions (SGML) (44.6%), gastric ulcers (9.8%), duodenal ulcers (DU) (15.2%), and hemorrhagic erosive duodenitis (2.7%). Eleven cases (9.8%) showed negative findings. There were 13 (11.6%) patients receiving endoscopic hemostatic therapy. The rate of positive results in rapid urease tests in the patients without underlying diseases was 54.8%, which was significantly higher than that of the patients with underlying diseases (17.1%), while Helicobacter pylori was closely related to primary DU. CONCLUSIONS: In children with UGI bleeding, UGI endoscopy provides an accurate diagnostic tool and also provides therapeutic intervention when needed. SGML was the most common endoscopic finding. About 30% of the infants and children with UGI bleeding had history of acute febrile illness. Half of the children had underlying diseases. Helicobacter pylori plays a role in a subgroup of children with UGI bleeding, particularly in children with primary DU.
The role of pelvic endoscopy in diagnosing uterine abnormalities, considering material of 1170 patients, is presented in this paper. It has been documented that pelviscopy together with hysterosalpingography play basic role in determining type of uterine abnormality. In 20 cases pelvic endoscopy enabled verification of the primary diagnosis set by hysterosalpingography. Pelvic endoscopy is a method by choice in the diagnostics of the Rokitansky-Küster-Hauser syndrome.
Over the period of 25 years, 1080 pelvic endoscopy in infertile women were performed, with special attention payed to the pathology of Fallopian tubes. Pelvic endoscopy was performed after previous HSG. During the pelvic endoscopy, the state of the uterus, ovaries and uterine tubes were evaluated, with much attention paid to the condition of the abdominal ostium of the uterine tube, symptoms of active and chronic inflammation, endometriosis, the authors also tried to diagnose the extension and character of pelvic-salpingian adhesions. Confrontation of the results enabled diagnosis in 111 (41.7%) women, out of 266, with patient Fallopian tubes the organic factors which impaired conception or made conception impossible. In the group of 814 women with tubal impotency in 15 (1.8%) cases extratubal factor was found, subserosal myoma in uterine horn, cyst, adhesions, while Fallopian tube itself was patent and unchanged. Organic factors of Fallopian tube disorder were determined. In 360 (44.2%) patients, out of 814, with tubal impotency pathological status was found (active salpingitis, tuberculosis, endometriosis) which required establishing of a necessary treatment and cancelling the surgical treatment.
UNLABELLED: Mortality and morbidity conferences (M & MC) are designed to establish a collegial analysis of all complications in order to define their cause, assess avoidability and propose corrective measures aimed at preventing recurrence of the same kind of complications. AIM: The aim of this study was to report the results of a quality improvement program focused on the complications of gastrointestinal endoscopy in a hospital endoscopy unit. METHODS: From 1/7/1999 to 30/6/2001, the complications of gastrointestinal endoscopic procedures were systematically and prospectively recorded and then retrospectively analysed during monthly M & MC. RESULTS: Eleven thousand seven hundred forty-four procedures were performed and 79 complications (0.7%) were recorded and analyzed. Seventy percent of the complications occurred during therapeutic procedures. Thirty-four percent of complications were due to an error: 22 attributed to the endoscopists, 4 to the nurses and 1 to the material. Thirteen percent of the complications were considered avoidable and 24% probably avoidable. The rate of avoidable complications was 0.07% for diagnostic procedures and 1.4% for therapeutic procedures (P<0.001). Avoidable complications affected mainly endoscopic gastrostomy procedures (48%) and ERCP (24%). The analysis of 15 complications enabled seven corrective measures which concerned 52% of avoidable complications. CONCLUSION: Systematic prospective recording of complications and careful exhaustive retrospective analysis during M & MC are efficient and complementary tools for continuous quality improvement programs in gastrointestinal endoscopy.
This review is presenting the "capsule endoscopy", a developing method for visualizing the gut and especially its "dark" areas, the small intestine. It is presented its description, and the evaluation of its present indications. The capsule endoscopy is good for identifying bleeding of unknown origin, tumors and inflammatory lesions of small bowel. Capsule endoscopy seems to be an expanding method for investigating the gut.
Meckel's diverticulum is an embryonic derivative of the omphalomesenteric duct and the most commonly encountered congenital anomaly of the gastrointestinal tract. Its incidence records about 2%. Among them, only 5% are symptomatic with complications-bleeding, intestinal obstruction, inflammation, and perforation. In particular, bleeding is a common complication and has always been caused by an ulceration of the ileal mucosa adjacent to the acid-producing ectopic mucosa in a Meckel's diverticulum. Wireless capsule endoscopy is a new method enabling non-invasive diagnostic endoscopy of the entire small intestine. We experienced a case of Meckel's diverticulum detected by wireless capsule endoscopy in a 34 year-old man who presented with chronic obscure gastrointestinal bleeding.
INTRODUCTION: To study the utility of upper gastrointestinal endoscopy with biopsy in the evaluation of children with clinically-significant recurrent abdominal pain. METHODS: Over a three-month period, children with three or more episodes of upper abdominal pain that was severe enough to impair their normal activity and required medical attention were included in the study. After complete history, physical examination and basic investigations, upper gastrointestinal endoscopy with biopsy was performed in all patients. RESULTS: Thirty-eight children were enrolled. Their average age was 10.5 years and 21 were female. Organic causes were identified in 44.7 percent of the cases, with Helicobacter pylori gastritis being the most common diagnosis (28.9 percent). No specific dyspeptic symptom was significantly associated with either organic cause of recurrent abdominal pain or Helicobacter pylori infection. Antral nodularity was the only endoscopic finding significantly associated with Helicobacter pylori infection (sensitivity 63.4 percent, specificity 85.2 percent). All patients improved after specific therapy was instituted. CONCLUSION: The organic causes of recurrent abdominal pain in children have been increasingly identified in our hospital, a tertiary care centre in Northern Thailand. One of the most common causes found in this study was Helicobacter pylori infection. Upper endoscopy was very helpful in identifying the underlying pathology.
BACKGROUND: Aneurysms complicated by enteric fistulae are uniformly fatal clinical conditions and therefore should be placed high on the list of possible diagnoses in any patient with aneurysmal disease and gastrointestinal bleeding. A number of different diagnostic techniques have been proposed, but most of them are usually of little help or even misleading. METHODOLOGY: Between May 2000 and April 2002, endoscopy was performed in 290 consecutive patients with upper gastrointestinal bleeding. We retrospectively evaluated that endoscopy may provide an important diagnostic clue in aneurysm-enteric fistulae. RESULTS: Three patients with gastrointestinal bleeding presented with aneurysmal disease complicated by duodenal fistula formation. Two patients presented with aortoduodenal fistula, and the last one hepatic artery aneurysm with duodenal fistula formation. In all of our cases, endoscopic findings were suggestive and helpful for the preoperative diagnosis. CONCLUSIONS: Considering that prompt aggressive surgical intervention is mandatory for survival and more than 90% of aneurysmal disease with duodenal fistula formation should be within range of the endoscopists, aggressive and thorough endoscopy with a high index of clinical suspicion seems to be the most important diagnostic test in these difficult cases.
Knowledge of oxygen saturation and the timing of nursing interventions were studied for their relationship to positive patient outcomes in a group of patients receiving intravenous conscious sedation during endoscopy. The convenience sample consisted of 38 patients receiving midazolam or a combination of midazolam/fentanyl during esophagogastroduodenoscopy or colonoscopy in a hospital-based endoscopy unit. Data collection included monitoring oxygen saturation levels, physiological parameters, and skin color. Baseline arterial oxygen saturation was obtained and monitored continuously throughout the procedure and during the recovery period. During the procedures, the nurse was aware of the oxygen saturation levels for half of the subjects. For the other subjects, the nurse was informed only when the oxygen saturation dropped below 85%. Data revealed a clinically significant relationship between knowledge of oxygen saturation and the timing of nursing interventions in effecting positive patient outcomes during endoscopic procedures. The results of this pilot study contributed to the development of standards of care for monitoring oxygen saturation in an endoscopy unit. The timeliness of nursing interventions was enhanced by the use of pulse oximetry, thereby producing positive patient outcomes and improving the quality of care for the endoscopic patient receiving conscious sedation.
Wireless capsule endoscopy is a new diagnostic technique used especially for investigating the entire small bowel. Recent studies have demonstrated its superior ability to detect and evaluate small bowel lesions compared to other radiological examinations. Performing video capsule endoscopy is regarded as contraindicated when an intestinal occlusion is documented. We present a case of hidden intestinal bleeding which underwent wireless capsule endoscopy and was treated successfully despite documented ileal stenosis.