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PubMed1989

Large colonic neoplasms missed by endoscopy.

Endoscopy is commonly accepted as the gold standard in the evaluation of neoplastic colonic disease. The procedure is used to confirm or exclude lesions detected on barium enemas, with the assumption that the endoscopist was successful in reaching the appropriate segment of the colon. We collected 18 cases, all with proved colonic neoplasm 2-8 cm in diameter that were detected by barium enema but overlooked on initial endoscopy. All of the lesions were relatively flat with little intraluminal protuberance. Histologic examination showed malignant foci in six of 11 tumors that were resected. In two of the other seven patients, unresected lesions progressed to advanced carcinomas. This experience suggests that a repeat barium enema is indicated when endoscopy fails to detect a colonic tumor suspected on barium enema examination.

Barium Sulfate↗
PubMedDate not supplied

[Rigid telescopy and contact endoscopy in the diagnosis and surgery of Reinke's oedema--clinical and histological assessment].

We focussed our attention on the use of both rigid telescopy and contact endoscopy in order to assess their effectiveness in the diagnosis and surgery of Reinke's oedema. Changes were observed in a sample of 40 patients, suffering from different stages of Reinke's oedema, who had undergone microlaryngoscopies. For the first time during our laryngological praxis, we discussed a number of parameters that appeared to be significant in the monitoring and detailed evaluation of this vocal fold disease. With contact endoscopy, during the early stages of the disease, the cells and nuclei of normal squamous layered epithelium continued to display uniform morphological features. The appearance of epithelial changes helps to distinguish between different stages of Reinke's oedema, which can be associated with severe inflammation or keratinisation. With latter-stage oedemas, the following was observed: various changes in the blood vessels of the glottis, which when viewed through the endoscope have an unusual "loop-like" or "branching" appearance, as well as elongated and varicose blood vessels, and the build-up of erythrocytes inside atypical capillaries. Both endoscope techniques are non-invasive and very appropriate for precisely diagnosing Reinke's oedema within a relatively short period of time. Rigid telescopy has the advantage of enabling the systematic observation of many details in the large area of both vocal fold mucosae, particularly when access to the larynx is difficult. This enables dynamic monitoring and immediate pathology consultations inside the operating theatre. The special contribution of contact endoscopy is that, both in vivo and in situ, it allows a detailed scanning and mapping to be performed of all cell changes and ofvascularisation throughout the entire mucosa surface. Video-assisted telescopy does not permit a completely first-rate surgical resection of Reinke's oedema, because of unsatisfactory control or insufficient stability of the instrument during the operation using the one-handed method.

Humans↗
PubMed2005

Sinonasal endoscopy reporting format: emphasis on chronic rhinosinusitis.

The role of nasal endoscopy has been well characterized in terms of diagnosis and treatment, the methods of performing the endoscopy, and the findings that can be visualized within the nasal cavities. The reporting format of such findings has not been the subject of such detailed popularity. A structured format would create a common language between otolaryngologists, potentially facilitating outcomes assessment and/or research by providing an objective tool for recording findings. More so, professional associations might use a structured format for government or billing negotiations and justifications. The following sinonasal endoscopy reporting format represents a synthesis of clinical experience from three rhinologists in attempting to document endoscopic findings in the nose and sinuses. Our primary objective was limited to establishing a standardized format that will be suitable for objective outcomes assessment and communication between endoscopic sinus surgeons. It is also hoped that this reporting format can be correlated with patients' subjective quality of life outcomes.

Chronic Disease↗
PubMed1986

Microscopic appearance of the esophageal mucosa in a consecutive series of patients submitted to upper endoscopy. Correlation with gastroesophageal reflux symptoms and macroscopic findings.

The histologic finding of basal-layer hyperplasia and papillosis as consequences of gastroesophageal reflux still constitute an area of controversy. Consequently, a prospective study of symptoms and endoscopy and biopsy interpretation was undertaken in 200 patients consecutively submitted to upper endoscopy, whereof 12 were excluded. Complete agreement among all three variables was found in half of the patients and harmony between two of the variables in one fourth. In the last fourth the outcome was positive in one variable only, equally distributed among the symptoms, endoscopy, and histology. It is concluded that histology is of considerable value in gastroesophageal reflux disease.

Esophagoscopy↗
PubMed1997

The efficacy of a pectin-based raft-forming anti-reflux agent in endoscopy-negative reflux disease.

BACKGROUND: Patients with heartburn as their main complaint but normal oesophageal mucosa at endoscopy are classified as having endoscopy-negative gastro-oesophageal reflux disease (GORD). They have mainly postprandial reflux and low total acid exposure and could possibly be managed with a non-systemic drug. In such patients we examined the effect of a pectin-based raft-forming anti-reflux agent (Aflurax (Idoflux)) on the severity of heartburn. METHODS: Patients with heartburn but with normal/erythematous oesophageal mucosa (n = 65) were randomized to double-blind treatment with two 1200-mg tablets of Aflurax or two placebo tablets four times daily for 4 weeks. The main outcome measure was heartburn severity on day 15 and day 29. RESULTS: The number of patients scoring heartburn severity on day 15 as none, mild, moderate, and severe were 6, 14, 8, and 3, respectively, with Aflurax versus 2, 6, 13, and 11 with placebo (P < 0.05). No further treatment effect was found on day 29. CONCLUSION: Aflurax reduces heartburn in patients with endoscopy-negative GORD.

Adult↗
PubMedDate not supplied

Test and treat Helicobacter pylori before endoscopy.

BACKGROUND: Helicobacter pylori may have major implications for patients' wellbeing and future health. If a patient is found to be H. pylori positive it is important that the infection is eradicated because of the risk of associated peptic ulcers and gastric cancers. There are, however, great demands on NHS gastroenterology and endoscopy services and following the introduction of recent guidelines for dyspepsia some of these issues may be addressed. The literature suggests that a strategy of test and treat before endoscopy referral will benefit patients and be cost-effective. CONCLUSION: There is evidence that, over a period of time, it is more prudent to test and treat H. pylori first and then review the patient's condition before endoscopy is performed (if no other symptoms are identified).

Algorithms↗
PubMed1998

[Geometric modeling and virtual endoscopy of the laryngo-tracheal lumen from computerized tomography images: initial applications to laryngo-tracheal pathology in the child].

Endoscopy is an essential stage in the management of laryngo-tracheal disorders in the infant, but remains a difficult procedure. CT scanning is used to confirm the abnormality and to estimate the degree to which the airway is compromised. The authors describe virtual endoscopy of the larynx and trachea based on a mathematical model, itself constructed from CT images. This work is based on a methodology developed at the Hôpital de la Timone for modelling the aorta. By applying this methodology to the study of laryngo-tracheal disorders, it is possible to establish the relevant pre-treatment measurements (length, diameter, degree of narrowing). This preliminary study has been carried out in 8 cases, in parallel with their clinical treatment. It has allowed us to single out the 3 typical examples which are presented in detail, and to show the advantages of this new approach: immediate and precise measurements, presentation which it is not possible to achieve with conventional techniques of 3-dimensional imaging, and demonstration of the degree of encroachment of the externe stenoses. When taken as part of the management of the patient, this technique complements the findings of real endoscopy, or replaces them, thus reducing the costs of hospital admission and the risks inherent in this procedure.

Adolescent↗
PubMed1996

Virtual endoscopy of the head and neck. Diagnosis using three-dimensional visualization and virtual representation.

BACKGROUND: 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. METHODS: 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. CONCLUSIONS: In the future we will fly through data instead of inserting endoscopic instruments for gastrointestinal endoscopic diagnosis.

Computer Simulation↗
PubMed1999

Fibreoptic bronchoscopy in sedated infants facilitated by an airway endoscopy mask.

Fibreoptic bronchoscopy (FB) is frequently associated with a decline in PaO2, whose degree and duration can be substantial especially in infants. The effect of a face mask, which allows the administration of 100% oxygen and continuous positive airway pressure during FB, on the incidence and severity of hypoxaemia was studied in thirty-one consecutive infants. Sedation was provided by intravenous propofol titrated to allow patient comfort. A transient fall in SpO2 <95% was recorded in 6/31 patients during endoscopy of the upper airway (lasting 1.6+/-1.1 min) and in 11/31 patients during endoscopy of the lower airways (lasting 1.4+/-1.1 min). Capillary blood gas analysis before and after endoscopy of the lower airways demonstrated an increase in the PCO2 6.4+/-1.3 to 7.3+/-1.4 kPa (49+/-10 to 56+/-11 mmHg). The risk of hypoxaemia in sedated infants breathing spontaneously is low when 100% oxygen and continuous positive airway pressure are administered during FB

Blood Pressure↗
PubMed1979

[Emergency endoscopy in acute upper gastrointestinal hemorrhage: Does the effectiveness justify the effort?].

On the basis of a common care of patients with acute upper gastrointestinal haemorrhage by internists, surgeons, and anaesthetists lasting several years advantages and disadvantages of emergency endoscopy are analysed from the standpoint of effectivity. High diagnostic ability, help in the decision concerning operative or conservative activity, the influence of the operative-tactic approach and the furthering influence on the close cooperation of the specialities are to be emphasized. Criteria of effectivity, such as mortality rates, duration of the stay in the hospital and frequency of relapsing haemorrhages underlie many factors of influence. They express results of therapy, to which emergency endoscopy may at present contribute only limitedly. The basic decision to medical activity -- active striving for a rapid, exact diagnosis or waiting when the diagnosis is uncertain -- does not inessentially influence the standpoint in the controversy about the emergency endoscopy.

Acute Disease↗
PubMed2001

The role of upper gastrointestinal endoscopy in the diagnosis and treatment of caustic ingestion, esophageal strictures, and achalasia in children.

The practice of upper gastrointestinal endoscopy in children continues to evolve. Therapeutic endoscopic procedures are now routinely performed in children. Patient preparation, sedation, and instrumentation have improved, allowing therapeutic endoscopy to be performed for a wide variety of conditions. This article focuses on the role of endoscopy in the diagnosis and care of caustic ingestion, balloon dilation of esophageal strictures, and new developments in the treatment of achalasia in children.

Adolescent↗
PubMed1975

The value of endoscopy and biopsy in the diagnosis of gastric carcinoma.

The value of endoscopy and biopsy in the diagnosis of gastric carcinoma has been examined. Out of a total of 550 patients, gastric carcinoma was suspected in 101. Endoscopy and biopsy provided a firm diagnosis in 43 of the 44 cases of gastric carcinoma present, and effectively excluded gastric carcinoma in 48 cases. We recommend endoscopy and biopsy as valuable diagnostic procedures in the investigation of patients suspected of having gastric carcinoma. Used together they can eliminate the necessity for diagnostic laparotomy.

Biopsy↗
PubMed2001

Helicobacter pylori: prevalence, clinical and endoscopic findings in children who underwnet upper endoscopy for abdominal ailments.

A total of 97 children aged 1 month to 16 years (mean 6.6 years) had upper endoscopies performed in Paediatric Institute, Kuala Lumpur Hospital between January 1997 and December 1999 for various gastrointestinal symptoms. Of these 70 children were tested for Helicobacter pylori. The four most common indications for upper endoscopy were recurrent abdominal pain, upper gastrointestinal bleeding, epigastric pain and vomiting. The overall prevalence of this infection in this heterogenous group of symptomatic children was 10% (7/70). This study shows that H.pylori positivity in a routine endoscopy population is low and does not appear to be associated with specific symptoms.

Abdomen↗
PubMed2002

Virtual endoscopy: a promising new technology.

Growing evidence shows that early detection of cancer can substantially reduce mortality, necessitating screening programs that encourage patient compliance. Radiology is already established as a screening tool, as in mammography for breast cancer and ultrasonography for congenital anomalies. Advanced processing of helical computed tomographic data sets permits three-dimensional and virtual endoscopic models. Such models are noninvasive and require minimal patient preparation, making them ideal for screening. Virtual endoscopy has been used to evaluate the colon, bronchi, stomach, blood vessels, bladder, kidney, larynx, and paranasal sinuses. The most promising role for virtual endoscopy is in screening patients for colorectal cancer. The technique has also been used to evaluate the tracheobronchial tree for bronchogenic carcinoma. Three-dimensional and virtual endoscopy can screen, diagnose, evaluate and assist determination of surgical approach, and provide surveillance of certain malignancies.

Bronchoscopy↗
PubMed2002

Continuous evaluation of patient satisfaction in endoscopy centres.

BACKGROUND: A randomized sample of 14,000 men and women, aged 55-64 years, resident in the City of Oslo and Telemark County, were drawn from the population registry to be offered a flexible sigmoidoscopy (FS) screening examination. A questionnaire was designed to modify routines and evaluate patient satisfaction. METHODS: Consecutive participants (4956) were given a questionnaire immediately after the FS to be filled in and returned by mail on the following day. Participants were asked questions about service, practical issues, and the level of pain during the FS and post-examination discomfort. They were also encouraged to give their comments in free text. RESULTS: Questionnaire replies were received from 4574 (92%) out of 4956 participants. The vast majority reported to have experienced no (70%) or slight (21%) pain during the examination. Women reported pain and post-examination discomfort more often than men. Pain was also associated with age of the patient and length of bowel examined, but not with total examination time. The proportion of painless examinations varied between endoscopists from 62% to 81%. For all endoscopists collectively, this improved during the study period, irrespective of past experience, but trainees seemed to adopt the score of their masters. CONCLUSIONS: The study demonstrated that the use of feedback information in an endoscopy screening unit may be useful in improving standards, including the performance of endoscopists. It is possible that the introduction of similar feedback systems in routine endoscopy laboratories may in the long run improve the reputation of gastrointestinal endoscopy.

Ambulatory Care Facilities↗
PubMed1992

Yield of upper endoscopy in the evaluation of asymptomatic patients with Hemoccult-positive stool after a negative colonoscopy.

The yield of upper endoscopy in asymptomatic patients with positive fecal occult blood test (FOBT) and a negative colonoscopy was evaluated prospectively in 70 consecutive patients. Significant pathology was diagnosed in 19 patients (27%), eight patients with ulcers, five with arteriovenous malformations, three with esophageal or gastric varices, two with multiple erosions, and two with biopsy-proven Barrett's esophagus. Thirteen patients had iron deficiency anemia and demonstrated a 38% prevalence of significant pathology. Fifteen patients on nonsteroidal anti-inflammatory agents had a 30% prevalence of significant pathology. No statistically significant difference was noted between subgroups. In conclusion, asymptomatic patients without a colonic source to explain a positive FOBT often have significant lesions, on upper endoscopy. Iron deficiency anemia did not have an impact on pathology. Because treatment and follow-up plans were altered in many of the cases in which significant pathology was demonstrated, we conclude that upper endoscopy should be seriously considered for all asymptomatic patients with occult gastrointestinal bleeding and a negative colonoscopic examination.

Adult↗
PubMed1992

Evaluation of perilymphatic fistulas by middle ear endoscopy.

Transtympanic endoscopy provides a unique opportunity to view the undisturbed contents of the middle ear. Fiberoptic and rigid endoscopes have been used for thorough examination of the middle ear without the need for local anesthetics or surgical trauma. Endoscopy is now routinely used in the evaluation of a perilymphatic fistula and the patient is awake during an intermittent forceful Valsalva maneuver. Oval and round windows in both ears of five cats were studied endoscopically to evaluate surgically created fistulas. Excellent visualization of the defect was obtained in all instances. Endoscopy is a useful office technique for the evaluation of perilymphatic fistula. It reduces the need for surgical exploration and provides a satisfactory examination of the middle ear. Obliteration of the window niche can even be performed through the myringotomy using autologous blood.

Adult↗
PubMed1992

[Bronchial endoscopy. Technical aspects in adults].

The author analyses all the practical aspects of bronchial endoscopy: the choice of equipment amongst equipment available from the makers for flexible and rigid endoscopes; the place of the most recent developments such as video-endoscopy; the upkeep of the equipment and specific problems linked to disinfection. Then the examination techniques of endoscopy are described from the admission of the patient and the anaesthesia to the completion of the report. Finally side effects and possible complications are reviewed. A protocol is specified.

Adult↗