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At least 1,477 records · Page 82Linked to original sources
PubMed1995

Prediction of complications following unintentional caustic ingestion in children. Is endoscopy always necessary?

The records of 115 children hospitalized following caustic ingestion over an 18.5-year period from 1976 to 1994 were reviewed. The relationship between types of product ingested, signs and symptoms, degree of esophageal injury and complications was analyzed. All complications were the result of strong alkali ingestion (sensitivity = 1.0). Among the 102 incident patients, 36.8% of lye ingestions resulted in complications, whereas only 2.7% (one) of automatic dishwasher detergent (ADD) ingestions caused any complications (p < 0.01). Endoscopy 6 h to 4 days after injury was accurate in predicting or identifying complications in all types of strong alkali ingestions. In lye ingestions, endoscopy was not superior to the test, "one or more signs or symptoms" in predicting complications (predictivity = 1.0). Endoscopy is recommended to establish or confirm a prognosis, or to identify acute respiratory complications, in symptomatic ingestions of lye or ammonia water, in children with respiratory symptoms, and in rare cases of severe symptoms following ADD or strong acid ingestion. It is suggested that children who are non-symptomatic following unintentional ingestions are not at risk of complications and do not need endoscopic examination.

Adolescent↗
PubMed1979

Upper gastrointestinal endoscopy: its effects on patient management.

Out of 95 patients referred for upper gastrointestinal endoscopy after a barium-meal examination, 44 underwent a change in management. Some changes were minor but in 12 patients a decision on surgery was required. Seven of these patients were among a group of 13 for whom the referring consultant would have recommended laparotomy had endoscopy not been available, while the other five were subjected to an unplanned laparotomy. These findings support the practice of performing endoscopy on patients whose symptoms are not fully explained by barium-meal examination, especially patients aged over 45. In such cases the procedure also seems to be cost-effective.

Adult↗
PubMed1983

Scoring system to improve cost effectiveness of open access endoscopy.

The introduction of an open access general practitioner endoscopy service may result in many unnecessary examinations being performed. In an attempt to prevent this, 235 patients attending for endoscopy were interviewed and the results analysed to determine which factors best discriminated between those with major disease (ulcers, cancers, oesophageal strictures; n = 48) and those without (n = 187). The six characteristics which best discriminated between the two groups were increasing age, history of vomiting, male sex, smoking, and a past history of peptic ulcer or hiatus hernia. With the use of these six features a scoring system was devised, designed to give an indication of the likelihood of finding such disease in an individual patient. This was assessed prospectively in a further 356 patients. The results showed that by utilising this scoring system it would be possible to reduce the number of examinations performed by 30% yet still detect 98% of serious disease. If confirmed in further prospective studies, this scoring system (or a modification) could more accurately assess individual priority for endoscopy and enable optimum use to be made of limited resources.

Age Factors↗
PubMed2004

Accuracy of staging in early oesophageal cancer using high resolution endoscopy and high resolution endosonography: a comparative, prospective, and blinded trial.

BACKGROUND AND AIMS: The increasing use of endoscopic resection for curative treatment of early oesophageal cancers requires accurate staging before therapy. In a prospective blinded trial, we compared staging of early oesophageal carcinoma using high resolution endoscopy (HR-E) with staging using high resolution endosonography (HR-EUS). PATIENTS AND METHODS: A total of 100 patients (89 men, 11 women; mean age 63.9 (10.8) years (range 31-91)) with a suspicion of early oesophageal adenocarcinoma (n = 81) or squamous cell carcinoma (n = 19) were enrolled in the study. After endoscopic staging with high resolution video endoscopy by two experienced endoscopists, HR-EUS was performed by an experienced endosonographer who was blinded to the endoscopic assessment. Results of the staging examinations were correlated with the histology of the resected tumours. RESULTS: Overall rates for accuracy of the endoscopic and endosonographic staging were 83.4% and 79.6%, respectively. Sensitivity for mucosal tumours (n = 68) was more than 90% (EUS 91.2%, endoscopy 94.1%) while sensitivity for submucosal tumours (n = 25) was lower, at 48% for EUS and 56% for endoscopic staging. A combination of the two techniques increased the sensitivity for submucosal tumours to 60%. Submucosal tumours in the tubular oesophagus were significantly better staged with HR-EUS than submucosal tumours close to the oesophagogastric junction (10/11 v 2/14; p<0.001). Tumours infiltrating the second and third submucosal layers were also more correctly diagnosed than tumours with slight infiltration of the first submucosal layer (sm1). CONCLUSIONS: The overall diagnostic accuracy of both HR-E and HR-EUS with a 20 MHz miniprobe in early oesophageal cancer was high (approximately 80%), with no significant differences between the two techniques. HR-E and HR-EUS provide a high level of diagnostic accuracy for mucosal tumours and submucosal tumours located in the tubular part of the oesophagus. With submucosal tumours located at the oesophagogastric junction or with infiltration of the first third of the submucosa however, the diagnostic accuracy of both techniques is not yet satisfactory.

Adenocarcinoma↗
PubMed1981

Endoscopy and gastric cancer.

In an attempt to assess the impact of upper gastrointestinal endoscopy on the outcome of patients with gastric cancer, we have studied 483 patients with gastric cancer from three centres with differing endoscopic practice. The introduction of an open access general practitioners endoscopy service led to a 10-fold increase in the number of endoscopies being performed per head of population, but there was no demonstrable effect on prognosis or on the duration of symptoms before diagnosis. There was no increase in the proportion of early gastric cancer diagnosed.

Gastroscopy↗
PubMed1988

Does measurement of yield pressure at the cardia during endoscopy provide information on the function of the lower oesophageal sphincter mechanism?

We describe a technique for measuring the yield pressure at the cardia during upper gastrointestinal endoscopy. The test was applied to 47 patients with macroscopic oesophagitis and nine patients with achalasia. Controls were 123 patients from the routine endoscopy list in whom no abnormality was found and 21 healthy volunteers. Yield pressure was similar in both control groups, but was significantly higher in achalasia (p less than 0.001) and lower in oesophagitis (p less than 0.001). Yield pressures fell dramatically after pneumatic dilatation in the achalasia patients. The test was reproducible and yield pressure was not affected by age, sex, weight, or sedation. Measurement of yield pressure during endoscopy provides information which may reflect the function of the whole antireflux mechanism, and not just the lower oesophageal sphincter.

Adolescent↗
PubMed1999

A blind comparison of the effectiveness of endoscopic ultrasonography and endoscopy in staging early gastric cancer.

BACKGROUND/AIMS: Endoscopic ultrasonography is expected to be useful for invasion depth staging of early gastric cancer. A prospective blind study of the staging characteristics of endoscopy and endoscopic ultrasonography for early gastric cancer was performed. METHODS: Findings of endoscopy and endoscopic ultrasonography using a 20 MHz thin ultrasound probe were independently reviewed and the results of 52 early gastric cancer lesions analysed. RESULTS: The overall accuracy rates in invasion depth staging of early gastric cancer were 63% for endoscopy and 71% for endoscopic ultrasonography. No statistically significant differences were observed in overall accuracy. Endoscopic ultrasonography tended to overstage, and lesions that were classified as mucosal cancer by endoscopic ultrasonography were very likely (95%) to be limited to the mucosa on histological examination. All 16 lesions staged as mucosal cancer independently but coincidentally by both methods were histologically limited to the mucosa. CONCLUSIONS: Endoscopic ultrasonography is expected to compensate for the understaging of lesions with submucosal invasion that are endoscopically staged as mucosal cancer.

Adult↗
PubMed1982

Removal of embolised catheters using flexible endoscopy forceps.

Five cases are described in which embolised catheters were removed percutaneously from the right side of the heart. Flexible endoscopy biopsy forceps were used in four cases and achieved removal in two: in the two other cases the catheter lay in a position which could not be reached by the biopsy forceps mouth, and retrieval was made with a helical wire basket after dislodgment of the proximal end of the catheter. In a fifth case a catheter fragment was removed from the pulmonary artery with endoscopy grasping forceps. Flexible endoscopy forceps provide a very firm grip and with a Teflon sleeve they can be negotiated around curves. They have limited manoeuvrability but W-shape "grasping" forceps have a large mouth, which helps to overcome this limitation.

Adolescent↗
PubMed1985

Esophageal varices: correlation of left gastric venography and endoscopy in patients with portal hypertension.

Selective left gastric venography was performed via percutaneous transheptic catheterization in 100 patients with portal hypertension to study hemodynamics and left gastric collaterals. Flow was hepatofugal in 81 patients, while 63 had varices supplied by the left gastric vein; azygos/hemiazygos collaterals were seen in 27 patients, gastrorenal shunts in 18, and other collaterals in 58. In 79 cases, enlarged, tortuous veins arising from thin parallel vessels at the esophagogastric junction on venography corresponded with varices on endoscopy in both size and course. Venography failed to show small varices which were seen endoscopically, whereas endoscopy often interpreted non-tortuous veins as varices. Using endoscopy as a reference, the sensitivity of venography for varices was 76%, specificity 100%, and accuracy 78%. There was a significant correlation between venographic demonstration of varices and previous hematemesis. Left gastric venography is necessary prior to embolization of varices and is also useful in their diagnosis as well as study of hemodynamics and assessment of bleeding risk.

Esophageal and Gastric Varices↗
PubMed1987

Peptic ulcer and gastric carcinoma: diagnosis with biphasic radiography compared with fiberoptic endoscopy.

The diagnostic value of biphasic radiographic examination of the stomach and duodenum was compared with that of fiberoptic endoscopy in a prospective, blinded study of 385 patients with dyspepsia. This investigation was directed at gastric malignancies and peptic ulcers. Methodologically there is no absolute standard for a study of this kind because histologic examination is useful for detection of cancer but inadequate for ulcers. As an alternative, kappa indexes and the sensitivity and specificity, as derived by Hui and Walter, were calculated and compared. For the detection of gastric carcinoma, radiographic and endoscopic findings had almost perfect agreement beyond chance. For gastric ulcers, radiography and endoscopy had substantial agreement, which became perfect if small ulcers (less than 5 mm) were excluded. For duodenal ulcers, radiography had a lower sensitivity than endoscopy; this disagreement disappeared if small ulcers were excluded. Both methods have equal merit; choice of the initial diagnostic procedure will therefore depend on cost, discomfort to the patient, and risk of complications.

Female↗
PubMed1999

5-Aminolevulinic acid-induced fluorescence endoscopy for the detection of lower urinary tract tumors.

The use of a photodynamic fluorescence marker for diagnosis of tumors is an intriguing concept to improve the thoroughness of surgical tumor resection. Complete surgical resection of multifocal bladder tumors and flat lesions such as carcinoma in situ is known to be difficult, and thus a source of recurrences. We report on the recent experience with the intravesical application of the photosensitizer prodrug 5-aminolevulinic acid (5-ALA), which is a nontoxic physiological heme substrate. Initial results from fluorescence diagnosis using krypton laser light, and recent results with a modified incoherent light source constantly showed a 25% increase in urothelial tumor detection in comparison to white light endoscopy. Due to the high sensitivity, the number of biopsies could be decreased constantly in comparison to routine random biopsies taken under white light endoscopy. The results show about 25-30% of cases with fluorescent lesions which are histologically benign. 5-ALA is a promising tool for the diagnosis of bladder cancer. The outcome of the admission study for 5-ALA in urology in Germany is positive, and is being continued by prospective multicenter clinical studies to prove the hypothesis of reduction of tumor recurrence with this method. 5-ALA-based fluorescence endoscopy is strongly recommended for further clinical testing.

Administration, Intravesical↗
PubMed2004

Minimal change esophagitis: prospective comparison of endoscopic and histological markers between patients with non-erosive reflux disease and normal controls using magnifying endoscopy.

INTRODUCTION: More than half the patients with gastroesophageal reflux disease (GERD) show no endoscopic abnormality or minimal change esophagitis (non-erosive reflux disease, NERD). We investigated the value of endoscopic and histological markers for the prediction of NERD before and after treatment with 20 mg esomeprazole. METHODS: Between July and October 2002, consecutive patients presenting for upper endoscopy were stratified into GERD and non-reflux patients (control group) with the help of a questionnaire. The endoscopist was blind to the presence of reflux symptoms. Using magnifying endoscopes minimal change esophagitis was defined by the presence of vascular injection or vascular spots above the Z-line, villous mucosal surface and islands of squamous cell epithelium below the Z-line. Targeted and random biopsies were taken below and above the Z-line. Patients with endoscopically visible classical signs of esophagitis (Los Angeles A-D) or histologically proven Barrett's esophagus were not further investigated in the study (drop out). The esophageal specimens were histologically evaluated for erosions, infiltration with leukocytes, hyperplasia of basal cells and length of papillae. Patients with NERD were treated with 20 mg esomeprazole/day for 4 weeks and reevaluated by endoscopy as described before. RESULTS: 39 patients with heartburn and 39 patients without reflux symptoms (controls) were finally included in the analysis (per protocol). Patients with NERD significantly (p = 0.005) more often showed endoscopic signs of minimal change esophagitis (27/39) than the control group (8/39). An increased length of papillae (14/39 versus 2/39; p = 0.005) and basal cell hyperplasia (17/39 versus 4/39; p = 0.009) were significantly more common in the heartburn group. After treatment with esomeprazole, no significant endoscopic or histological differences between the NERD and control group could be observed. CONCLUSIONS: Minimal change esophagitis can be seen with high resolution magnifying endoscopy. By combining endoscopic and histological markers NERD can be predicted with a sensitivity of 62% and a specificity of 74%. Treatment with esomeprazole for 4 weeks reverses the slight alterations to normal.

Anti-Ulcer Agents↗
PubMed1998

Routine hospital admission for patients undergoing upper aerodigestive tract endoscopy is unwarranted.

Although upper aerodigestive tract endoscopy is commonly performed, the need for hospital admission remains controversial. A retrospective review of endoscopy performed between January 1, 1993, and June 30, 1995, identified 201 patients who underwent 371 procedures. Complications occurred in 34 of 371 (9.2%) procedures in 26 of 201 (12.9%) patients. Of these, 11 of 371 (3.0%) were major (requiring admission for management) and 23 of 371 (6.2%) were minor. For multiple concurrent procedures, the overall complication rate was 19.3% (22/114); 5.3% (6/114) were major and 14.0% (16/114) were minor. All 8 patients (100%) who went on to have major complications and 24 of the 26 (92.3%) who went on to have any complication were successfully identified prior to discharge; 2 required postdischarge outpatient management of urinary retention. Five statistically significant risk factors for complication were identified: preexisting cardiac conditions, American Society of Anesthesiologists rating, airway class rating, anesthesia type, and number of endoscopic procedures performed. A comparison of various approaches to hospital admission demonstrated that selective admission based on clinical judgment was superior to routine admission of all patients. In conclusion, we recommend that upper tract endoscopy be performed on an ambulatory basis because 1) the complication rate is low, 2) complications requiring inpatient management are identifiable in the immediate postoperative period, and 3) of the approaches to hospital admission examined, it was the most economical.

Adult↗
PubMed1997

Emergency endoscopy in patients with portal hypertension having upper gastrointestinal bleeding.

During the last 4 years, 147 patients suffering from portal hypertension with acute upper gastrointestinal bleeding were subjected to emergency endoscopy soon after they were resuscitated. Seventeen (11.5%) patients were referred to us with a clinical diagnosis other than portal hypertension. The causes of bleeding as seen during endoscopy were: oesophageal varices (n = 130; 88%), gastric varices (n = 11), gastric ulcer (n = 2) portal hypertensive gastropathy (n = 2) and erosive gastritis and duodenal ulcer in one patient each. All patient bleeding from oesophageal varices except one underwent emergency endoscopic sclerotherapy. One hundred and twenty-one (94%) stopped bleeding immediately. Rebleeding was seen in 11% and was effectively controlled by a second session of sclerotherapy in all but one patient. Twenty (14%) patients died. It is concluded that emergency endoscopy has a definite role in the management of patients with portal hypertension complicated by gastrointestinal bleeding.

Adolescent↗
PubMed2004

The diagnostic value of endoscopy and Helicobacter pylori tests for peptic ulcer patients in late post-treatment setting.

BACKGROUND: Guidelines for management of peptic ulcer patients after the treatment are largely directed to detection of H. pylori infection using only non-invasive tests. We compared the diagnostic value of non-invasive and endoscopy based H. pylori tests in a late post-treatment setting. METHODS: Altogether 34 patients with dyspeptic complaints were referred for gastroscopy 5 years after the treatment of peptic ulcer using a one-week triple therapy scheme. The endoscopic and histologic findings were evaluated according to the Sydney classification. Bacteriological, PCR and cytological investigations and 13C-UBT tests were performed. RESULTS: Seventeen patients were defined H. pylori positive by 13C-UBT test, PCR and histological examination. On endoscopy, peptic ulcer persisted in 4 H. pylori positive cases. Among the 6 cases with erosions of the gastric mucosa, only two patients were H. pylori positive. Mucosal atrophy and intestinal metaplasia were revealed both in the H. pylori positive and H. pylori negative cases. Bacteriological examination revealed three clarithromycin resistant H. pylori strains. Cytology failed to prove validity for diagnosing H. pylori in a post-treatment setting. CONCLUSIONS: In a late post-treatment setting, patients with dyspepsia should not be monitored only by non-invasive investigation methods; it is also justified to use the classical histological evaluation of H. pylori colonisation, PCR and bacteriology as they have shown good concordance with 13C-UBT. Moreover, endoscopy and histological investigation of a gastric biopsy have proved to be the methods with an additional diagnostic value, providing the physician with information about inflammatory, atrophic and metaplastic lesions of the stomach in dyspeptic H. pylori positive and negative patients. Bacteriological methods are suggested for detecting the putative antimicrobial resistance of H. pylori, aimed at successful eradication of infection in persistent peptic ulcer cases.

Bacteriological Techniques↗
PubMed2003

Stroke risk in anticoagulated patients with atrial fibrillation undergoing endoscopy.

OBJECTIVE: To determine the risk of stroke in anticoagulated patients with atrial fibrillation (AF) when anticoagulation is adjusted for bronchoscopy, gastroscopy, or colonoscopy, and to identify factors that could modify this risk. METHODS: The authors reviewed patients with AF undergoing endoscopies between 1995 and 2001, with specific analysis of patients with AF in whom anticoagulation was adjusted for the procedures. The authors calculated the stroke rate within 30 days of the procedures. RESULTS: Twelve strokes occurred in 987 patients undergoing 1,137 procedures (1.06%/procedure). The risk ranged from 0.31% for patients with nonvalvular AF undergoing routine procedures to 2.93% for complex patients undergoing endoscopies combined with other procedures or with comorbid illnesses. Patients with stroke were more likely to be complex (7/12 vs 219/975, p = 0.04); to be older than 80 years (6/12 vs 187/975, p = 0.017); to have a history of stroke (7/12 vs 194/975, p = 0.004), hypertension (10/12 vs 508/975, p = 0.04), or hyperlipidemia (9/12 vs 334/975, p = 0.005); or to have a family history of vascular disease (10/12 vs 502/975, p = 0.039). CONCLUSIONS: The risk of stroke in patients with AF whose anticoagulation is adjusted for endoscopies is low, but almost tenfold higher in patients with complex clinical situations. Age, history of stroke, hypertension, hyperlipidemia, and family history of vascular disease may increase the risk of stroke.

Age Factors↗
PubMed1998

Comparison of three-dimensional virtual endoscopy with bronchoscopy in patients with oesophageal carcinoma infiltrating the tracheobronchial tree.

Virtual endoscopy (VE) is a technique for performing simulated bronchoscopy using helical CT data of the tracheobronchial tree. In order to evaluate a virtual three-dimensional (3D) endoluminal procedure for the tracheobronchial tree, comparison was made between bronchoscopy, axial CT images and minimal intensity projections (MIP). 21 patients were referred for helical CT because of oesophageal carcinoma shown by bronchoscopy to infiltrate into the trachea or bronchi. Axial CT images obtained on a helical scanner were transferred to a Sparc20 workstation. VE was compared with the axial CT images and the MIP concerning additional information on the location and degree of stenosis gained after 3D reconstruction of the inner surface of the tracheobronchial tree. The accuracy of this VE system was compared with bronchoscopy. Follow-up was performed in two patients to evaluate the tracheobronchial system after stent implantation. All stenoses were identified by VE with no statistically significant difference in detection of location or grading of the stenosis to real time bronchoscopy. Passage of subtotal stenosis was only possible with VE. VE is suitable for following up stent implantation. Submucosal lesions of the tracheobronchial tree could not be detected by VE. There was no statistically significant difference regarding the location of the stenoses between VE, axial CT slices, MIP and bronchoscopy. The VE showed only a statistically significant difference with regard to the degree of stenosis which was underrated on axial CT slices and MIPs. Pitfalls including mucus plugs and wall defects due to the wrong threshold value were a limitation of VE. VE is presently too time-consuming to use in every patient with an infiltrating tumour into the tracheobronchial tree. In conclusion, while VE cannot replace endoscopy of the tracheobronchial tree or the oesophagus, it is an accurate and non-invasive method for identifying endoluminal tumours, grading stenoses and visualizing the tracheobronchial tree beyond stenoses in a small number of patients who are not amenable to endoscopy.

Aged↗
PubMed1996

Validation of Pouch Size Measurement Following the Swedish Adjustable Gastric Banding Using Endoscopy, MRI and Barium Swallow.

BACKGROUND: Pouch volume appears to be of major importance for subsequent weight loss following any gastric restriction type of surgery for morbid obesity. In order to be able to evaluate pouch volume following Swedish Adjustable Gastric Banding (SAGB), an endoscopic pouch volume classification system was designed in which pouch volume is classified in five categories. The aim of this study was to validate the endoscopic classification system using MRI and barium swallow as reference methods for pouch volume measurement. METHODS: Twenty patients (13 women and seven men) were operated for obesity with SAGB. They were investigated a mean of 3 years (6 weeks-5.5 years) after surgery and had at that time lost a mean of 60 (12-112) kg. During the same afternoon they sequentially underwent endoscopy, MRI and barium swallow with an empty stomach. RESULTS: The mean pouch volume measured with MRI was 70 ml (0-1 80 ml) and with barium swallow was 72 ml (0-1 95 ml). In 17/20 patients the volume as measured by MRI and barium swallow was in the same volume category as with endoscopy. The correlation measured according to Pearson was significant between endoscopy on one hand and MRV barium swallow both independently and together (p < 0.001). CONCLUSION: Based on these results we are confident in using our endoscopic classification system for postoperative follow-up of pouch volume.

Journal Article↗