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PubMedDate not supplied

Oxygen saturation post-gastroscopy and post-colonoscopy.

A standard of care for providing pulse oximetry monitoring for patients receiving conscious sedation during and after endoscopy has not been established. This study sought to clarify whether desaturation occurs after gastroscopy and colonoscopy and what characteristics are predictive of desaturation that does occur. The convenience sample consisted of 475 adult participants receiving meperidine and/or midazolam in a hospital-based outpatient setting. A baseline oxygen saturation level was obtained before the procedure. Assessment of the oxygen saturation continued in the recovery room for 1 hour, with readings recorded every 10 minutes. A saturation of 90% or less was used as the indicator to resume oxygen therapy. Data revealed that oxygen desaturation in the recovery phase is influenced by the preprocedure baseline oxygen saturation level, smoking history, and age. The incidence of oxygen desaturation was 24% in the recovery phase, with the majority of decreases occurring within the first 10 minutes.

Colonoscopy↗
PubMed1977

Transient megacolon after gastroscopy.

A 38-year-old man who developed abdominal distention and pain following fiberoptic gastroscopy is described. The patient had had an upper gastrointestinal roentgenographic series earlier, and the dilatation of the colon was thought to be due to entrapment of air in the proximal colon secondary to inspissated barium in the descending colon. Premedication with meperidine hydrochloride and atropine also may have been contributory. A saline enema relieved the patient's symptoms and a barium enema examination later showed a normal colon.

Adult↗
PubMed2003

Open-access gastroscopy is associated with improved outcomes in gastric cancer.

OBJECTIVE: To examine whether patients with gastric cancer diagnosed via open-access gastroscopy (OAG) differ in their outcomes compared with patients referred conventionally to outpatient clinics or as acute emergencies. DESIGN AND SETTING: Prospective observational study in the gastroenterology and surgical units of a large district general hospital. PARTICIPANTS: One hundred consecutive patients with gastric adenocarcinoma. MAIN OUTCOME MEASURES: Data were collected prospectively and subdivided into two groups according to whether the patients were referred via the open-access route or the conventional route. RESULTS: Diagnostic delay from onset of symptoms was shorter for patients referred via OAG compared with those referred conventionally. Stages of disease were significantly earlier in patients referred via OAG compared with patients referred conventionally. Potentially curative resection was significantly more likely following OAG than after conventional referral. Cumulative five-year survival for patients referred via OAG was 30% compared with 12% after conventional outpatient referral and 13% after acute referral. Multivariate analysis revealed three factors to be associated with survival: stage of disease, distant metastases and referral via the open-access route. CONCLUSIONS: Gastric cancers presenting at OAG were diagnosed at an earlier stage than cancers diagnosed after conventional referral. This led to a higher proportion of potentially curative resections and better five-year survival.

Adenocarcinoma↗
PubMed2005

An audit of informed consent in gastroscopy: investigation of a hospital's informed consent procedure in endoscopy by assessing current practice.

OBJECTIVE: To investigate, by assessing current practice, whether a UK general hospital's informed consent procedure in endoscopy was implemented for all patients, because informed consent is central to the proper conduct of endoscopic procedures. METHODS: A retrospective study of patients' medical notes, in which information written on the UK National Health Service (NHS) consent form and on a departmental leaflet on the gastroscopy procedure completed by the patient was assessed. Sampling began from 9 October 2003 until 100 patients were recorded. For each patient's record, a data collection sheet was completed. RESULTS: Of the 67 patient records assessed (33 were unavailable), all contained the NHS consent form with signatures from the practitioner and patient. The departmental leaflet was present for only 31 patients, and of these, 20 had a signature from the patient and one leaflet had a signature from the practitioner. The multiple choice test was completed for 28 of the 31 departmental leaflets and full marks were awarded for 17 of 28. Although 11 patients answered one or more questions incorrectly, a discussion of the correct answers was only found in two records. CONCLUSION: To achieve improved performance, a training/induction programme should explain the informed consent procedure and its importance. This should be supported by 'booster' training sessions to avoid the emergence of bad practice. These sessions should take advantage of evidence-based medicine via feedback from audits and discussions of litigation cases. Departmental leaflets and NHS consent forms should also be provided in other languages.

England↗
PubMed1978

Oesophageal disease revealed by endoscopy in 1,000 patients referred primarily for gastroscopy.

Of 1000 patients referred primarily for gastroscopy, almost 18% had endoscopic signs of clinically important oesophageal disease. Erosive oesophagitis, a disease that is notoriously difficult to diagnose on X-ray, was demonstrated in alsmot 10% and oesophageal varices in 3.6% of the patients. It is concluded that a thorough examination of the oesophagus should be included in every routine upper gastrointestinal endoscopy.

Diverticulum, Esophageal↗
PubMed1982

Midazolam and diazepam for gastroscopy.

Midazolam 0.1 mg/kg was compared with diazepam 0.15 mg/kg intravenously in patients undergoing gastroscopy. The patients receiving midazolam were more sedated at the end of the procedure. The mean discharge times from the clinic for diazepam and midazolam patients were 85 and 102 minutes, respectively. The principal differences between the two drugs were that midazolam had a faster rate of onset, was virtually free from venous complications, provided much better amnesia (90% compared with 50%), and although the recovery time was longer with midazolam, the rate of recovery during the period of observation was faster. Neither drug caused any significant cardiorespiratory depression.

Adult↗
PubMed1986

Benzodiazepine antagonist Ro 15-1788. Antagonism of diazepam sedation in outpatients undergoing gastroscopy.

In a double-blind, randomised trial the efficacy and safety of Ro 15-1788, a new benzodiazepine antagonist, was assessed in forty adults undergoing gastroscopy under diazepam sedation. Criteria of efficacy were the degree of sedation and anterograde amnesia. There was a significantly faster recovery of the patients after the injection of 0.6-1.0 mg of Ro 15-1788 than after placebo. Patients were awake shortly after Ro 15-1788, but remained drowsy or asleep after placebo administration. There were no side effects of note.

Adolescent↗
PubMed2006

Virtual gastroscopy: initial attempt in North American patients.

BACKGROUND: Virtual endoscopy (VE) is a new evolving technology that describes the 3-D reconstruction of medical image scans to create a visualization similar to that produced by fiber-optic and video endoscopy. The present study was carried out to establish the feasibility of this technique in the upper gastrointestinal tract. METHODS: Ten patients who underwent upper endoscopy for different clinical reasons and who were found to have a normal or near normal examination underwent a spiral computed tomography scan of the lower chest and abdomen. A 3-D image was reconstructed using the Freeflight software. RESULTS: The anatomy of the stomach including the lumen, the cardia, the pylorus, gastric folds and the incisura angularis were well-visualized. It was not possible to visualize the esophagus by VE because the lumen was unable to be kept patent long enough to provide accurate imaging. CONCLUSIONS: The present preliminary study has demonstrated the feasibility of performing virtual gastroscopy. Further development in this area is needed before any routine clinical application.

Adult↗
PubMed1977

Bacteraemia following oesophageal dilatation and oesophago-gastroscopy.

Significant, but asymptomatic, bacteraemia after oesophageal dilatation with Hurst's bougies for oesophageal stricture or spasm was detected in six of 11 patients. No bacteraemia was identified in ten volunteers without oesophageal pathology, who underwent passage of the same dilators. After oesophago-gastroscopy significant bacteraemia was identified in one of ten patients examined. The predominant bacterial isolates were streptococci ("Streptococcus viridans" and non-haemolytic Streptococcus sp.). All the strains were sensitive in vitro to penicillin, amplicillin and cephalosporins. Any of these antibiotics are considered suitable for prophylactic use prior to performing oesophageal dilatation and upper gastrointestinal endoscopy in "at risk" patients. The risk of bacteraemia is much lower after endoscopy than oesophageal dilatation for stricture or oesophageal spasm. Mucosal trauma is concluded as the site of entry of pharyngeal commensals leading to bacteraemia; and the incidence of bacteraemia appears related to the degree of trauma to the oesophagus.

Adult↗
PubMed1999

Comparative study of intestinal metaplasia and mucin staining at the cardia and esophagogastric junction in 225 symptomatic patients presenting for diagnostic open-access gastroscopy.

OBJECTIVE: Adenocarcinoma around the esophagogastric junction (EGJ) is increasing in incidence, and is frequently associated with areas of macroscopic or microscopic intestinal metaplasia (IM). The aim of this study was to define the incidence and type of metaplastic changes in the cardia and at the EGJ in symptomatic patients in whom there was no endoscopic columnar segment. METHODS: Patients attending for open-access gastroscopy had three sets of endoscopic biopsies taken at 3-cm intervals, from cardia, EGJ, and distal esophagus. Hematoxylin and eosin, Alcian blue/PAS (AB/PAS), and high-iron diamine/Alcian blue (AB/HID) were used to define and characterize IM. RESULTS: Of 225 patients, eight (4%) had carcinoma, eight (4%) had conventional long-segment Barrett's esophagus, 15 (7%) showed endoscopic short-segment Barrett's change, with no endoscopic Barrett's in 194 (86.2%). Of the latter, 34 (17.5%) had IM at the EGJ, and nine (4.6%) had IM at the cardia on hematoxylin and eosin. Acid mucin stains were positive at the EGJ in 135 (69.6%) and at the cardia in 75 (38.7%). Metaplasia at the EGJ was associated with sulphomucins (p < 0.0001) and involved the surface glandular epithelium (p < 0.0001) more frequently than the cardia. Metaplasia was not related to reflux symptoms, hiatus hernia, or endoscopic esophageal inflammation. Ninety percent of those with IM detectable by hematoxylin and eosin were taking acid suppression, compared with 72.8% overall. CONCLUSIONS: Intestinal metaplasia is very common at the esophagogastric junction and gastric cardia, with marked differences in incidence and characteristics of mucin staining between the two sites. The relationship of intestinal metaplasia to the development of carcinoma is yet to be determined.

Adolescent↗
PubMed1997

Open access gastroscopy: second survey of current practice in the United Kingdom.

In June 1990 a survey of members of the endoscopy section of the British Society of Gastroenterology showed that 47% of respondents were offering some form of open access gastroscopy (OAG). Only 10% offered true (non-censored) OAG. The survey was repeated in June 1994. The overall provision of OAG had risen to 74%, most of whom were offering true OAG. Censored OAG is still widely practised and characterised by referral letters to a consultant in contrast with the use of referral forms (p < 0.001). Referral forms are being increasingly used and are an effective way of capturing important data such as the patients' symptoms (100%), previous treatment (87%), non-steroidal anti-inflammatory drug or aspirin use (78%), suspected diagnosis (74%), and other medical conditions (72%). Forms were used to establish clinical responsibility with the general practitioner in 64% of units. Standardised referral and reporting forms were used by 27% of respondents. A perceived inability to cope with the expected workload was still the most commonly cited reason for not being able to offer OAG. Although 20% of units with a single handed endoscopist were able to offer OAG, this compared with 68% of units with two or more endoscopists (p < 0.001). Only three units indicated that an OAG service had had to be withdrawn, but a further 12 consultants (nine units) were now offering an age restricted service because of excessive workload. Two thirds of the respondents not offering OAG were hoping to do so in the near future. True OAG has increased from 10% to 41% in four years.

Gastroscopy↗
PubMed1997

Experimental pain in the stomach: a model based on electrical stimulation guided by gastroscopy.

BACKGROUND: Abdominal pain is often variable in intensity and difficult to characterise due to its referred pain pattern. Clinical pain is furthermore confounded by various emotional and cognitive factors. AIMS: To develop and apply an experimental model to induce localised gastric pain. SUBJECTS: Twelve healthy male volunteers. METHODS: Stimulating electrodes were mounted on a biopsy forceps and electric stimuli were delivered during gastroscopy. Single, five repeated, and continuous stimuli were given at four locations in the stomach. Pain detection thresholds and pain intensities were assessed together with localisation of the referred pain area. RESULTS: Pain detection thresholds were higher in the prepyloric region compared with those obtained at the lesser and greater curvature. Increasing stimulus intensity resulted in augmented pain perception and repeated stimuli elicited pain at a lower stimulus intensity than single stimuli. Continuous stimuli evoked constant (33%), increasing (33%), or decreasing (33%) pain. The localisation of referred pain varied considerably in the subjects. CONCLUSIONS: The model seems relevant to study basic pain mechanisms elicited by localised stimuli in the stomach. The experimental data support the premise that a gastric focus should always be suspected in patients referred with different kinds of abdominal pain.

Abdominal Pain↗
PubMed2000

Atrophic gastritis and Helicobacter pylori infection in outpatients referred for gastroscopy.

BACKGROUND: Atrophic gastritis has been shown to be one of the long term sequelae of Helicobacter pylori infection. AIMS: To determine the prevalence of atrophic gastritis in outpatients, to study the accuracy of serological methods for revealing atrophy, and to define the association of H pylori infection with atrophic gastritis in these patients. PATIENTS/METHODS: A total of 207 consecutive outpatients referred for gastroscopy were included. Biopsy specimens from the antrum and corpus were assessed histologically according to the Sydney system. Serum samples were studied for H pylori IgG and IgA antibodies by enzyme immunoassay, CagA antibodies by immunoblot, pepsinogen I by an immunoenzymometric assay, gastrin by radioimmunoassay, and parietal cell antibodies by indirect immunofluorescence. RESULTS: Histological examination revealed atrophic gastritis in 52 (25%) of 207 patients. H pylori and CagA antibodies were strongly associated with atrophic antral gastritis but poorly associated with atrophic corpus gastritis. Low serum pepsinogen I was the most sensitive and specific indicator of moderate and severe atrophic corpus gastritis. All six patients with moderate atrophic corpus gastritis had H pylori infection but eight of 10 patients with severe atrophic corpus had increased parietal cell antibodies and nine had no signs of H pylori infection. CONCLUSIONS: Atrophic antral gastritis was strongly associated with CagA positive H pylori infection. Severe atrophic corpus gastritis was not determined by H pylori tests but low serum pepsinogen I, high gastrin, and parietal cell antibodies may be valuable in detecting these changes.

Adult↗
PubMed1990

Gastroscopy in a West African rural mission hospital.

The results of 1075 fibreoptic gastroscopies performed in the Northwest Province of Cameroon are presented. Three hundred and fifty-three examinations showed pyloroduodenal ulcer disease, 111 showed macroscopic gastritis, and 37 had gastric carcinoma. Sixteen other diagnosis were made, with a positive finding in 620 cases. The benefits of the 'high-technology' gastroscope in a low technology setting are discussed. Included are examinations of a series of 46 patients with haematemesis and/or melaena, and 43 who had previous gastric surgery.

Adolescent↗
PubMed1988

Prevalence of Campylobacter pylori in an unselected Swedish population of patients referred for gastroscopy.

A survey of the prevalence of Campylobacter pylori in an unselected series of 117 patients referred for gastroscopy showed that 49.6% of the patients were infected. In 87% of infected patients both the antrum and the body of the stomach were involved. Duodenal infection occurred in only 9% of 102 studied patients. C. pylori could usually be demonstrated in mucosa showing signs of active chronic inflammation, whereas it was rarely found in histologically normal mucosa. The acridine orange staining method for demonstration of bacilli correlated well with bacteriology; identical results were obtained in 92.8% of the samples.

Adolescent↗
PubMed1989

Continuous measurement of gastric blood flow by laser-Doppler flowmetry during gastroscopy.

Endoscopic laser-Doppler flowmetry (LDF) of gastric blood flow (GBF) was performed simultaneously with intragastric manometry to detect a possible correlation between GBF and luminal pressure during gastroscopy. By increasing luminal air pressure from 10 to 20 cm H2O a significant reduction in GBF was observed. Regional differences in GBF were also demonstrated. Variations in luminal air pressure have a significant influence on GBF as measured by LDF, and therefore intragastric manometry and standardization of intraluminal air pressure is necessary in endoscopic LDF measurements.

Adult↗
PubMed1981

Gastrointestinal blood loss, gastroscopy and coagulation factors in normal volunteers during administration of acetylsalicylic acid and fluproquazone.

The influence of one week's treatment of fluproquazone, 300 mg daily, and acetylsalicylic acid (Aspirin, Bayer), 3000 mg daily, on the gastro-intestinal tract and coagulation factors was compared in a randomized cross-over study in 12 healthy male volunteers. Gastroscopy revealed two acute erosions after fluproquazone in one subject, whereas 11 of the 12 subjects showed a total of about 80 erosions, petechiae or diffuse bleeding after aspirin. Median faecal blood loss, as assessed by means of 51Cr tagging and measurement of bulk radioactivity in a whole-body counter, were significantly (p less than 0.01) raised, from 1.8 (range 0-6.5) ml during the preceding control week to 6.0 (range 1.9-10.5) ml after treatment with aspirin. No significant difference was recorded between control and treatment weeks with fluproquazone. Mean bleeding time was significantly increased by 40% with aspirin, whereas no statistically significant change was observed with fluproquazone. The prostaglandin synthesis was not significantly influenced by fluproquazone but was almost completely suppressed by aspirin. Coagulation factor II-VII-X decreased slightly, but remained within the normal range with both drugs. This study demonstrated a markedly smaller effect of fluproquazone compared with aspirin on the gastro-intestinal tract and on haemostatic factors.

Adolescent↗
PubMed1975

[Complete gastric erosions--a relatively frequent gastroscopy finding].

While by means of the semiflexible Wolf-Schnidler-gastroscope no complete erosions had been seen, they were found in 12.7% in 615 gastroscopies, carried out with glass fibre endoscopes. In nearly 80% of the patients the erosions, appearing in most cases in a larger number, were localised in the antrum ventriculi. As the most frequent concomitant disease the gastroduodenal ulcer was found. Roentgenologically in no case the diagnosis erosion was made. As to the soft tissues defects of the epithelium could rarely be ascertained, however, more frequently a foveolar pseudohyperplasia as the morphological substrate of the marginal wall. Chronic-atrophic changes of the mucous membrane in the environment of the erosions were by far more frequently to be proved than superficial gastritides or normal findings on the mucous membrane of the stomach.

Chronic Disease↗