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At least 1,387 records · Page 77Linked to original sources
PubMed1993

Open access endoscopy: a large-scale analysis of its use in dyspeptic patients.

We examined 2,253 consecutive dyspeptic patients referred to our endoscopy service by general practitioners ("open" group) and hospital clinicians ("clinic" group) to study the prevalence of the various endoscopic findings according to patient age and the route of endoscopic referral. The results obtained are representative of that specific population. Normal endoscopic findings progressively lessened as patients' age increased, and the overall rate was as low as 26.5% in the open and 30.3% in the clinic groups. Erosive prepyloric changes and duodenitis were the most frequently noted abnormalities in patients < 40 years of age (16.9% and 20.1%, respectively, in the open and 11.6% and 14.2% in the clinic groups). Chronic gastritis was prevalent in patients > 60 years of age. Duodenal ulcer decreased from 9.7% (open) and 18% (clinic) in patients < 40 to 2% and 1.1% in patients > 60. No malignancy was found in patients < 40, while only approximately 1% of those < 60 had neoplasms. All our endoscopic findings, both in the open and the clinic groups, were not significantly different. No significant differences in symptoms were observed among patients with different endoscopic findings. We conclude that (a) endoscopy is really useful only in a small group of patients < 40 years of age; (b) individual symptoms alone have a poorly discriminant diagnostic power; and (c) restriction of open access endoscopy is not justified.

Adolescent↗
PubMed1996

Appropriateness of referrals for open-access endoscopy. How do physicians in different medical specialties do?

BACKGROUND: Open-access endoscopy allows nongastroenterologist physicians the opportunity to directly schedule elective common endoscopic procedures for their patients without having them first examined in the gastrointestinal clinic. There are few data as to whether nongastroenterologist physicians in the United States schedule patients for appropriate indications. OBJECTIVES: To examine our practice to see whether patients undergoing open-access endoscopy were scheduled for appropriate indications and to see whether there were differences among physicians in various medical specialties. METHODS: We prospectively tracked 310 consecutive patients scheduled for open-access esophagogastroduodenoscopy (EGD) and colonoscopy by nongastroenterologist physicians over a 9-month period in our academic practice setting to determine whether the indications for performing the procedures were appropriate. The American Society for Gastrointestinal Endoscopy criteria (revised in 1992) were used as the standard for comparison. RESULTS: Primary care physicians (family practitioners and general internists) did a superior job of scheduling patients for appropriate indications for EGD and colonoscopy than did non-primary care physicians (internal medicine subspecialists and surgeons): 97.0% vs 81.3% for EGD (P = .04) and 84.9% vs 66.7% for colonoscopy (P = .02), respectively., CONCLUSIONS: Primary care physicians were significantly more likely to schedule patients for open-access EGD and colonoscopy for appropriate indications than were non-primary care physicians. The frequency of inappropriate indications for colonoscopy referrals was greater than for EGD. The reasons for the differences among primary care physicians, surgeons, and internal medicine subspecialists require further exploration.

Adolescent↗
PubMed1996

[Patient's opinion following an upper digestive endoscopy in ambulatory care. Results of a national survey (II)].

OBJECTIVES: The aim of the study was to evaluate patient satisfaction after esophagogastroscopy performed in ambulatory care and to correlate it with conditions of usual practice. METHODS: Study was proposed to the French gastroenterologists. During a week, 2 questionnaires were filled out for each esophagogastroscopy performed in ambulatory care: one recorded conditions of examination and one was independently filled out by the patient one day after endoscopy. RESULTS: Seven hundred and thirty nine gastroenterologists and 4,585 patients participated in the study. Among the patients, 3,758 (82%) filled out the questionnaire. Sedation was performed in 36.6% of cases. Subsequent endoscopy would be accepted by 79.3% of patients in the same conditions. Acceptance was significantly better with use of sedation and use of propofol. Without sedation, independent factors associated with a better acceptance were: male gender, absence of habitual benzodiazepine medication, endoscopy performed in private practice or private hospitals, smaller size of endoscope. CONCLUSION: This study underlines factors associated with a good acceptance of esophagogastroscopy without sedation and could help to improve decision-making regarding use of sedation.

Adult↗
PubMed1996

Virtual endoscopy: diagnosis using 3-D visualization and virtual representation.

Although flexible endoscopy is only 25 years old, a new technology may soon be used to provide the same view of internal organs without inserting an instrument. This is virtual endoscopy. By acquiring patient-specific high-resolution digital images with a helical CT scan or MRI, individual organs can be graphically isolated or "segmented" into fully interactive 3-D reconstructions on a computer monitor. Applying sophisticated flight-tracking programs from military pilots, the organs can be "flown through," giving a view identical to endoscopy. In the future we will fly through data instead of inserting endoscopic instruments for gastrointestinal endoscopic diagnosis.

Endoscopes↗
PubMed1977

Vascular endoscopy: useful tool or interesting toy.

A prospective protocol was designed to evaluate the efficacy and practically of intraluminal endoscopy in vascular reconstructive procedures. The choledochoscope and the arthroscope which utilize the Hopkins Optical System, as well as other available fiberoptic endoscopy units, were evaluated in 91 vascular reconstructions, including 42 carotid endarterectomies, 24 femoral artery reconstructions, 13 popliteal artery anastomoses, seven aortic and iliac procedures, one renal reconstruction, and one tibial reconstruction. In three cases the internal surface of an occluded limb of an aortic graft was examined endoscopically following thrombectomy. The optical resolution of the Hopkins Optical System was superior to the fiberoptic units. Vascular endoscopy required 5 minutes or less in 53 cases, between 5 to 10 minutes in 29 cases, and more than 10 minutes in nine. There were no infections. The single complication was a 1 cm linear tear in the intima of an internal artery. Positive findings were noted in 60 endoscopic studies, for an incidence of 66%. These consisted of intimal shreds in 47, elevated or irregular intimal flaps in 25, clot in five, and stenosis in three. In 26 cases the endoscopic findings were considered to be significant enough to possibly affect the ultimate outcome of the reconstruction.

Carotid Arteries↗
PubMed1977

[Gastrointestinal endoscopy in surgical patients (author's transl)].

Gastrointestinal endoscopy with flexible glass fiber instruments is of increasing importance in surgery. Preoperative endoscopic examinations bring good progress in planning the operative procedure, especially concerning proximal selective vagotomy, pancreas surgery and reoperations on the large intestine. By applying postoperative endosocopic controls mucosal alterations can earlier be detected in the area concerned than by radiological methods; this has to be emphasized especially in view of patients operated upon for cancer. Emergency endoscopy in massive gastrointestinal bleeding is one of the outstanding tasks. Under certain circumstances risky abdominal operations can be avoided by therapeutic endoscopy.

Biliary Tract Diseases↗
PubMed1997

Appropriateness of upper gastrointestinal endoscopy: comparison of American and Swiss criteria.

OBJECTIVE: Examine the reproducibility of the RAND method for developing criteria for the appropriateness of medical procedures. DESIGN: Comparison of two sets of explicit criteria for appropriateness of upper gastrointestinal (UGI) endoscopy, developed by separate expert panels from two countries. SETTING: United States, Switzerland. STUDY PARTICIPANTS: National experts from different medical specialties involved in the referral or application of UGI endoscopy. INTERVENTIONS: Each panel was presented with about 500 clinical scenarios (indications) that were rated on a nine-point scale as to the appropriateness of performing UGI endoscopy for a patient with that clinical presentation. MAIN OUTCOME MEASURES: (1) distribution of appropriateness ratings and intrapanel agreement categories between the two panels, (2) between-panel agreement of assigning appropriateness for comparable indications and, (3) percentage of indications with major between-panel differences. RESULTS: Ratings for 2/3 of indications could be compared. The Swiss panel showed higher intrapanel agreement (54.6% versus 46.2%, P = 0.002). Seventy-eight per cent of comparable indications were assigned to identical categories of appropriateness by both panels (kappa = 0.76, P < 0.001). For 93% of the 376 comparable indications, there were no major interpanel differences. CONCLUSION: Separate expert panels in different countries, using a standardized methodology, produce criteria for appropriateness of medical procedures that are similar. Given the resources being invested throughout the world in developing criteria and guidelines, international collaboration in seeking optimal use of limited health care resources should be intensified.

Endoscopy, Gastrointestinal↗
PubMed1997

Open access fundholding endoscopy in the private sector.

We conducted a comparative study of 150 patients referred for endoscopy to an NHS hospital and 150 patients referred to an open access scheme in the private sector for fundholding GPs. The concept of consultoscopy, whereby a consultant gastroenterologist gives an opinion at the same visit as the endoscopy is performed, is introduced. Results showed a similar number of normal studies (about 40%) were performed in each group, although the number of examinations showing serious pathology was significantly higher in the fundholding group (p < 0.01). Patients seen in the fundholding scheme had less sedation, required fewer outpatient appointments, and the GPs were given more advice on further management than those seen in the non-fundholding group. We conclude that open access endoscopy in the private sector is a workable option and may result in work being transferred from NHS hospitals to the private sector unless NHS hospitals review their working practices. The concept of consultoscopy is a useful development on traditional open access systems.

Adolescent↗
PubMed1997

Disease progression in gastro-oesophageal reflux disease as determined by repeat oesophageal pH monitoring and endoscopy 3 to 4.5 years after diagnosis.

OBJECTIVES: Reflux oesophagitis may progress to complications such as Barrett's mucosa and stricture formation. However, few studies have assessed long-term disease progression in oesophagitis patients and fewer still have considered disease progression in the significant proportion of gastro-oesophageal reflux disease (GORD) patients who do not have oesophagitis at diagnosis. The aim of this study was to reassess GORD patients 3 to 4 years after initial diagnosis and determine whether or not disease progression had occurred. METHODS: Prospective follow-up of 101 GORD patients at least 32 months after initial assessment with oesophageal pH monitoring and upper gastrointestinal endoscopy. Patients were invited to complete a symptomatic questionnaire and undergo repeat investigation with the same techniques. RESULTS: Seventy-seven (76%) patients responded (mean follow-up period 39 months, range 32-54 months) of whom 28 initially had oesophagitis (group A), 17 had normal endoscopy but abnormal pH monitoring (group B) and 32 had normal investigations but typical reflux symptoms (group C). At the time of follow-up, 57 (74%) patients either had frequent heartburn or were taking daily acid suppression therapy. Fifty-two (68%) responders had at least one repeat investigation: 44 (57%) had repeat pH monitoring; 43 (56%) had repeat endoscopy. Three (11% of the 28 responders) group A patients had developed Barrett's mucosa, 4 (24% of responders) group B patients had developed oesophagitis and 10 (31% of responders) group C patients had developed abnormal pH monitoring (4), oesophagitis (4) or both (2). CONCLUSION: Three-quarters of GORD patients still have troublesome symptoms at least 3 years after diagnosis and a significant proportion show endoscopic progression of the condition's severity.

Adult↗
PubMedDate not supplied

The impact of direct access endoscopy, Helicobacter pylori near patient testing and acid suppressants on the management of dyspepsia in general practice.

Direct access endoscopy services, Helicobacter pylori infection and more effective acid suppression therapy have influenced the management of dyspepsia in the past decade. Three hundred and ten GPs in south London were surveyed via postal questionnaire to determine the impact of these factors on the management of dyspepsia in general practice. Ninety-one per cent of GPs prescribed simple antacids as initial treatment for simple dyspepsia and referred only if symptoms did not improve. When acid suppressants were used, 41% used H2 antagonists compared with 11% for proton pump inhibitors (p = 0.0001). Risk factors for underlying malignancy were the most frequent reason for hospital referral at first consultation. Long outpatient waiting times result in about 90% of GPs choosing direct access endoscopy as the route of referral for all patients with dyspepsia, while only 36% would refer patients with sinister symptoms to direct access endoscopy if waiting times were similar to that of outpatients. H. pylori near patient testing did not seem to influence the management of dyspepsia in general practice.

Antacids↗
PubMed1998

[Effectiveness of differential diagnosis of benign and malignant ulcers at endoscopy].

AIM: Assessment of efficacy of differential diagnosis between benign and malignant lesions in gastric mucosa by means of endoscopy. MATERIALS AND METHODS: Morphological verdicts upon investigation of operative specimens were compared to findings at preoperative duodenofibrogastroscopy with spot biopsy in 326 patients operated for gastric ulcer. The number of discrepancies between the endoscopic and morphological diagnoses enabled estimation of endoscopy + biopsy efficiency in identification of the ulcer malignancy. RESULTS: The number of diagnostic errors made on malignant or benign nature of ulcer at endoscopic and biopsy investigations is rather big, i.e. at least 12% for both false negative and false positive hypophyses. The overall diagnostic efficacy of endoscopy in detection of the disease lies within 65-80%. CONCLUSION: Reliability of endoscopic identification including biopsy of malignant nature of gastric ulcers is not very high. Real sensitivity of this method in detection of ulcers undergoing malignant transformation reaches 76-78%.

Adolescent↗
PubMed1998

Endoscopy in the treatment of benign biliary strictures.

BACKGROUND/AIMS: Operative endoscopy is now the method of choice for treating numerous biliary tree diseases. In the treatment of benign strictures of the biliary tree, endoscopy serves as an alternative to surgical interventions. We evaluated the efficacy of endoscopic biliary stents in the treatment of benign biliary strictures. PATIENTS: Fifty-three consecutive patients with benign strictures of the biliary tree underwent endoscopic placement of one or more 10-12 Fr endoprostheses. Thirty-nine patients (73.6%) had iatrogenic strictures and 14 had inflammatory strictures (in 8 patients due to gallstones and in 6, chronic pancreatitis). Of the 53 patients, 20 (37.7%) had strictures classified as Bismuth type I, 23 (43.3%) Bismuth type II, 7 (13.2%) Bismuth type III and 3 (5.7%) Bismuth type IV. RESULTS: None of the patients died during the study period; three patients (5.6%) had immediate endoscopy-related complications treated conservatively. Late complications developed in 47.1% of the patients: 11.3% had cholangitis amenable to medical therapy, 5.6% had dislodged endoprostheses and 30.2% had obstructed endoprostheses. The reason why blocked stents accounted for most of the long-term complications in this series was that endoprostheses were not changed electively: they were changed only when clinical and laboratory signs indicated obstruction. Follow-up (6-84 months) in 42 of the 56 patients. 20 after stent removal, showed that 71.4% had an excellent outcome, 14.3% good results and 14.3% needed surgery. CONCLUSION: In benign biliary stricture endoscopic stenting is the first approach, providing definitive treatment or preparing patients for surgery.

Cholestasis↗
PubMed1998

Appropriate use of the day care unit for rigid endoscopy of the upper aerodigestive tract.

There is increasing pressure for more day surgery to be undertaken in the health service. In this retrospective study of 325 rigid upper aerodigestive tract endoscopies performed in the Day Care Unit of The Royal National Throat Nose and Ear Hospital, London, there were no post-discharge complications and only four patients required admission, none were, in our opinion, the direct result of day case rigid endoscopy. In our unit, the day case rate for microlaryngeal surgery is 44.8%, showing that rates significantly higher than published national rates of 17.1% (1993/1994) are achievable. We conclude that day case microlaryngeal surgery and diagnostic rigid endoscopy of the upper aerodigestive tract is safe if performed by suitably qualified staff in dedicated specialist units with patients selected according to existing day case criteria.

Adolescent↗
PubMed1998

[Virtual endoscopy with a volumetric reconstruction technic: the technical aspects].

OBJECTIVE: We analyze the peculiar technical features of virtual endoscopy obtained with volume rendering. MATERIAL AND METHODS: Our preliminary experience is based on virtual endoscopy images from volumetric data acquired with spiral CT (Siemens, Somatom Plus 4) using acquisition protocols standardized for different anatomic areas. Images are reformatted at the CT console, to obtain 1 mm thick contiguous slices, and transferred in DICOM format to an O2 workstation (Silicon Graphics, Mountain View CA, USA) with processor speed of 180 Mhz, 256 Mbyte RAM memory and 4.1 Gbyte hard disk. The software is Vitrea 1.0 (Vital Images, Fairfield, Iowa), running on a Unix platform. Image output is obtained through the Ethernet network to a Macintosh computer and a thermic printer (Kodak 8600 XLS). RESULTS: Diagnostic quality images were obtained in all the cases. Fly-through in the airways allowed correct evaluation of the main bronchi and of the origin of segmentary bronchi. In the vascular district, both carotid strictures and abdominal aortic aneurysms were depicted, with the same accuracy as with conventional reconstruction techniques. In the colon studies, polypoid lesions were correctly depicted in all the cases, with good correlation with endoscopic and double-contrast barium enema findings. In a case of lipoma of the ascending colon, virtual endoscopy allowed to study the colon both cranially and caudally to the lesion. The simultaneous evaluation of axial CT images permitted to characterize the lesion correctly on the basis of its density values. DISCUSSION: The peculiar feature of volume rendering is the use of the whole information inside the imaging volume to reconstruct three-dimensional images; no threshold values are used and no data are lost as opposite to conventional image reconstruction techniques. The different anatomic structures are visualized modifying the reciprocal opacities, showing the structures of no interest as translucent. The modulation of different opacities is obtained modifying the shape of the opacity curve, either using pre-set curves or in a completely independent way. Other technical features of volume rendering are the perspective evaluation of the objects, color and lighting. In conclusion, volume rendering is a promising technique to elaborate three-dimensional images, offering very realistic endoscopic views. At present, the main limitation is represented by the need of powerful and high-cost workstations.

Aged↗
PubMed1998

[Comparison of endoscopy, radiology and scintigraphy with Tc-99m-exametazine labeled leukocytes and In-111 labeled human polyclonal immunoglobulin G in the diagnosis of inflammatory bowel disease].

BACKGROUND: The 99mTc-exametazine labelled leukocytes (99mTc-WBC) scintigraphy is an established method for the inflammatory bowel disease (IBD) diagnosis, but the labelled procedure is a large and laborious process. The 111In-labelled human polyclonal immunoglobulin G (111In-IgG) can be an alternative in the non invasive IBD diagnosis. PATIENTS AND METHODS: Thirty-four patients routinely referred for investigation of IBD were studied. The 99mTc-WBC and 111In-IgG were simultaneously injected and images were obtained at 30 min, 3 and 24 h post-injection. The diagnostic was established by histology of endoscopy and/or surgery samples. Images were blindly evaluated by two experienced observers who only knew of the clinical suspicion of IBD. IBD was confirmed in 27 patients (17 with Crohn's disease [CD] and 10 with ulcerative colitis [UC]). RESULTS: Sensitivity, specificity and accuracy were 88.5, 100 and 90.3% respectively for endoscopy, 73.7, 75 and 73.9% for radiology, 59.3, 85.7 and 64.7% for 111In-IgG scan and 96.3, 85.7 and 94.1% for 99mTc-WBC scan. In the diagnosis of CD involvement of small bowel, the 99mTc-WBC scan identified 9/11 patients with confirmed disease, whereas the 111In-IgG scan diagnosed only four of them. In the evaluation of colonic disease, the 99mTc-WBC scan correctly diagnosed 21/22 confirmed patients, being the 111In-IgG scan positive in 13 of them. As far as disease extension concerned, the 99mTc-WBC demonstrated a statistically significance rather number of disease segments than endoscopy, radiology and 111In-IgG scan. CONCLUSIONS: The 99mTc-WBC was an effective method in the diagnosis of suspected IBD patients, both in the evaluation of small bowel disease and colonic disease, with slightly best results for colonic disease, whereas the 111In-IgG scan seems to have no utility neither in diagnosis nor in extension evaluation of IBD.

Adolescent↗
PubMed1998

Cytologic examination of exfoliative specimens obtained during endoscopy for diagnosis of gastrointestinal tract disease in dogs and cats.

OBJECTIVE: To determine whether cytologic examination of exfoliative specimens obtained during endoscopy was as useful as histologic examination of mucosal biopsy specimens for the diagnosis of gastrointestinal tract disease in dogs and cats and to compare the diagnostic accuracy of 2 techniques (brush or touch) in preparing specimens for cytologic examination. DESIGN: Prospective case series. ANIMALS: 85 dogs and 23 cats. PROCEDURE: Specimens for cytologic and histologic examination were obtained during routine endoscopic examination of the stomach, small intestine, and colon. A diagnosis was made on the basis of cytologic findings (graded objectively) and compared with the diagnosis on the basis of histologic findings. RESULTS: The diagnostic accuracy of cytologic examination was high for all 3 organs. Sensitivities, specificities, and predictive values of positive and negative results were > 90% in most instances. The diagnostic accuracy of the brush technique was equal or superior to that of the touch technique for 84% of specimens. The brush technique was most useful in detecting cellular infiltrates in the lamina propria, whereas the touch technique was more likely to detect acute mucosal inflammation. Percentages of false-positive (3.2%) and false-negative (6.9%) cytologic interpretations were low. CLINICAL IMPLICATIONS: Endoscopy is safe and requires little time to procure specimens for cytologic examination, which can be obtained concurrently with mucosal biopsy specimens. Cytologic examination of exfoliative specimens obtained during endoscopy is a useful and reliable adjunct to histologic examination of biopsy specimens in the diagnosis of gastrointestinal tract disease in dogs and cats.

Animals↗
PubMed1998

[The combined use of intraoperative video endoscopy and contact microvascular dopplerography in the surgery of cerebral aneurysms].

The article describes results of an anatomo-clinical investigation using video-endoscopy and contact microvascular dopplerography in surgery of cerebral aneurysms. The endoscopic anatomy of cisterns of the cerebral base was studied in 36 corpses of adult humans. More than 200 video-endoscopic operative interventions were performed on sectional material. Video-endoscopy in combination with contact microvascular dopplerography was conducted in the clinic on 20 patients with aneurysms of the brain. Main advantages of endoscopy used in combination with microvascular dopplerography during clipping the aneurysm are formulated. Complex using the two methods described gives less volume of the access and traumaticity of the intervention but not less radical effect. It is a valuable and highly informative method which optimizes performing the operation and has less amount of postoperative complications.

Adult↗
PubMed2005

Detection of labyrinthine fistulas in human temporal bone by virtual endoscopy and density threshold variation on computed tomographic scan.

OBJECTIVE: To assess the sensitivity of the routine computed tomographic (CT) scan of the temporal bone coupled to a virtual endoscopy, with density threshold variation, in detecting small fistulas in human temporal bone specimens. DESIGN: Single-blind, before-after trial. SETTING: This study was carried out in a research laboratory in collaboration with a radiology department. PATIENTS: Five human adult temporal bone specimens were included. INTERVENTIONS: The fistulas were created with calibrated burrs (0.3, 0.5, and 0.8 mm) in the 3 semicircular canals and in the promontory of 3 temporal bones. Two other temporal bones served as controls. All bones underwent CT scan (1-mm section thickness) before and after dissection. Three-dimensional images were obtained from CT scan native axial views at different density reconstruction thresholds. The virtual endoscope was placed in the middle ear cavity looking to the inner ear wall. The threshold at which a bony defect appeared on virtual endoscopic images (opening threshold in Hounsfield units [H]) was noted for each location. MAIN OUTCOME MEASURES: Opening thresholds before and after dissection. RESULTS: On standard axial views, fistulas smaller than 0.5 mm were not visualized. By virtual endoscopy, all fistulas could be visualized. The opening threshold decreased after fistula creation in the semicircular canals (1244 +/- 50.5 H [n = 36] vs 778 +/- 52.4 H [n = 34]; P<.001; 1-way analysis of variance and Dunnett multiple comparisons posttest) and in the promontory (1541 +/- 37.8 H [n = 12] vs 1334 +/- 35.1 H [n = 8]; P<.001). The opening thresholds in the control specimens remained unchanged after dissection. CONCLUSION: Virtual endoscopy with variation of reconstruction threshold allows the detection of small labyrinthine fistulas with diameters of 0.3 mm or smaller.

Adult↗