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At least 1,531 records · Page 85Linked to original sources
PubMed1981

[Gastroesophageal reflux: importance of endoscopy in surgical indications and postoperative control].

Endoscopy constitutes an important investigation in the presence of a gastro-oesophageal reflux. The primary intention is to exclude the possibility of an organic pathology, for example cancer, which has not been demonstrated by other investigative procedures. Accordingly it must provide a detailed exploration of the whole superior digestive tract, from the mouth to the duodenum. Secondly, endoscopy must establish the consequence of the reflux on the mucosa of the lower oesophagus both by a macroscopic and a detailed microscopic description. Peptic lesions are classified according to 4 degrees of severity. The difficulty in evaluating the very early lesions (1st degree) and the advanced stages (4th degree) necessitates systematic biopsies of the lesions. The erythroplasic type of carcinoma in situ can present the same endoscopic changes as a 1st degree peptic lesion, whereas the exclusion of an adenocarcinoma constitutes the major preoccupation at the time of endoscopy of a 4th degree oesophagitis.

Adenocarcinoma↗
PubMed1981

The safety of combined endoscopy, biopsy and dilation in esophageal strictures.

The evaluation and management of esophageal strictures ordinarily involves the three procedures of endoscopy, biopsy, and dilation at different times. The safety of performing these procedures in a single sitting was evaluated. The study included 48 patients (ages 44-85) with radiographically confirmed esophageal strictures located in the upper third (3/48), middle third (18/48), and lower third (27/48) of the esophagus. The strictures were determined to be due to peptic esophagitis of varying severity (28/48) or carcinoma (20/48). Dilation immediately followed endoscopy and biopsy with an average of three mercury-weighted dilators passed at this sitting. The size and type of dilators were determined clinically by the endoscopic estimation of esophageal lumen diameter. Anesthesia included topical Cetacaine and intravenous diazepam (5-15 mg.). All patients experienced symptomatic improvement immediately following the procedures. No complications were encountered. These data indicate that endoscopy, biopsy and dilation of esophageal strictures may safely be performed in a single sitting. Other advantages may include shortened hospital stay, earlier diagnosis and relief of symptoms and increased cost effectiveness.

Adult↗
PubMed1994

Causes of upper gastrointestinal bleeding in Thai patients: review of 5,000 upper gastrointestinal endoscopy.

Upper gastrointestinal endoscopies were performed in 5,000 patients who presented with upper gastrointestinal hemorrhage during a period of 20 years (between January 1973 and December 1992). The causes of bleeding were: peptic ulcer (G.U. & D.U.) in 51.24 per cent; acute mucosal lesion in 31.61 per cent; variceal bleeding in 8.20 per cent; Mallory-Weiss tears in 4.54 per cent; cancerous bleeding in 1.66 per cent; gastric polyps in 0.28 per cent and normal endoscopy in 2.46 per cent. The patients ages ranged from 12 to 91 years old and male to female ratio was 3.3: 1. The lesions found were 61.28 per cent in the stomach, 20.78 per cent in the duodenum and 15.48 per cent in the esophagus. The causes of bleeding could be detected in 97.54 per cent by endoscopy. No significant complications were encountered in the examinations. It was concluded that panendoscopy is a safe and useful procedure and should be done routinely as the primary diagnostic approach in the diagnosis of upper gastrointestinal bleeding.

Adolescent↗
PubMedDate not supplied

[Extracorporeal lithotripsy and endoscopy in the treatment of pancreatic lithiasis].

The decompression of the pancreatic duct with the extraction of stones by endoscopy is now recognized as an effective method for the treatment of some forms of chronic pancreatitis. The limits of this methodology are strictly linked to the morphology of the pancreatic duct and/or to the size, morphology and number of stones. The association of endoscopy with the ESWL often allows to overcome these limits. A case of lithiasis of the Wirsung in a patient affected by C.P. successfully treated associating endoscopy to ESWL is reported.

Adult↗
PubMed1994

[Diagnostic value of upper endoscopy in achalasia of the esophagus].

Thirty one patients with achalasia of the oesophagus as diagnosed by manometry between 1978 and 1991 at Aarhus Municipal Hospital (Arhus Kommunehospital) constituted the study group. All had had at least one upper endoscopy prior to oesophageal manometry. At the last endoscopy before manometry the endoscopist had no suspicion of achalasia in 48.4% of the cases. It is concluded, that in patients with dysphagia where an organic cause is excluded by upper endoscopy, oesophageal manometry should be carried out.

Adult↗
PubMed1997

Comparison of radionuclide labelled test meals versus endoscopy in the preoperative assessment of the gastric outlet patency.

A series of 39 patients with peptic ulcer disease is investigated with respect to gastric outlet obstruction. Two diagnostic tools are compared, namely endoscopy and evaluation of radionuclide meal emptying. Endoscopic obstruction was qualified as non passage of a 14 mm gastroscope. Gastric emptying reduction was considered clinically relevant when half emptying times exceeded 60 minutes for solids and 12 minutes for liquids. Comparison of both techniques of radionuclide meal emptying with endoscopy showed a poor correlation (accuracy 15/28), especially when liquid gastric emptying versus endoscopy was concerned.

Adolescent↗
PubMed1998

[Eradication of Helicobacter pylori by triple therapy in ulcerous patients: the role of endoscopy and antibiotic sensitivity].

BACKGROUND: A protocol was conducted to evaluate the compliance and results of Helicobacter pylori infection treatment in patients with ulcer disease. To know the metronidazole, clarithromycin and amoxicillin activities of Helicobacter pylori strains from such patients. PATIENTS AND METHODS: 35 patients with ulcer disease (27 duodenal ulcer and 8 gastric ulcer) were studied. Diagnosis of Helicobacter pylori infection was performed by urease test and culture of mucosal gastric samples from patients undergoing endoscopy. The patients received the following treatment during 7 days: omeprazole (20 mg bid), clarithromycin (500 mg bid) and amoxicillin (1 g bid), OCA x 7. Susceptibility was determined by E-test system on Wilkins-Chalgren blood agar and read after 5 days. RESULTS: 22/24 patients who had completed the protocol design eradicated Helicobacter pylori (91.7%), 11 patients (31.4%) refused second endoscopy to verify control of eradication. After treatment 10 patients presented with pyrosis "de novo" (28%). The overall metronidazol, claritromycin and amoxicillin resistance rate was 50%, 1.5% and 0% respectively. CONCLUSIONS: OCA x 7 treatment obtains a eradication rate higher than 90% in our patients with ulcer disease, despite smoking habit, but with a significative number of patients presenting pyrosis after treatment. We recommend a non-endoscopy method to verify eradication rate, because of its poor acceptance. 3. Metronidazol resistance rate is high in our series but clarithromycin susceptibility is maintained.

Adult↗
PubMed2006

Efficacy and safety of upper endoscopy procedures during pregnancy.

The risks of performing endoscopy become more complex when the patient is pregnant. The endoscopist has to consider all the factors that affect the health of both the patient and the fetus. Although pregnant patients are generally healthy, they may have changes in blood pressure and volume status as well as alterations in tolerance of anesthesia and luminal distention. Maternal complications will impact the health of the fetus. In addition, the fetus can be directly affected by procedural medications, mechanical factors, and therapeutic interventions. The endoscopist must be able to minimize the risks to the fetus and provide the pregnant patient with a safe and comfortable procedure. This review focuses on the risks of upper endoscopy as they relate to the health of a pregnant woman and the fetus.

Electrocoagulation↗
PubMed2006

Evolution of endoscopy simulators and their application.

Significant advances already have been made in the use of simulators for teaching and training in GI endoscopy. Indeed, during the past decade the evolution and improvement of these devices is readily apparent with each passing year. Doubtless, these advances have led to the increased availability and popularity of simulator-based hands-on workshops. Simulator-based skills assessment remains a relatively undeveloped field, awaiting increased realism and the development and validation of proper tests. Still, static models, ex vivo artificial models, ex vivo animal models, and computer simulators collectively represent a substantial and powerful tool for education and training in GI endoscopy. It is easy to foresee a day when hands-on training using simulators will be readily available outside the gastroenterology fellowship setting. With the progression of technology and the continuous introduction of new devices and procedures will come a parallel, compelling need for hands-on, simulator-based experience with all such new tools and techniques.

Animals↗
PubMedDate not supplied

Magnification endoscopy as a reliable tool for the early diagnosis of rejection in living related small bowel transplants: a case report.

The purpose was to determine whether magnification endoscopy (ME) accurately diagnosed rejection in living related small bowel transplants (LRSBTx) during initial morphological adaptation of segmental intestinal grafts. The small bowel recipient was a 44-year-old woman with short gut syndrome following multiple bowel surgeries for familial adenomatous polyposis. ME was enhanced by chromoendoscopy staining. Bowel mucosa was washed with acetic acid and stained with methylene blue for optimal visualization of mucosal villi and to improve the diagnostic yield of biopsies. The recipient underwent surveillance ME with biopsy 16 times through the ileostomy in the first 9 months following transplantation. The recipient developed diarrhea in the postoperative course, which led to the suspicion of rejection. ME findings of patchy villus blunting were consistent with biopsy samples that showed mild acute cellular rejection. Episodes of rejection were treated with high-dose immunosuppressants and steroids. Reversal of rejection was monitored by follow-up ME, which showed increased length of villi and normalization of morphology. Biopsy confirmed these findings. The first endoscopy, at 5 days posttransplant, showed no evidence of intestinal ischemia. LRSBTx involves early morphological adaptation of the recipient small bowel mucosa, characterized by an increased length of villi. ME is a reliable technique to follow adaptation and detect early rejection. The superior imaging of small bowel mucosa created by ME chromoendoscopy enables early diagnosis and delivery of more prompt antirejection therapy to prevent progression of rejection. ME also confirmed that segmental LRSBTx caused minimal ischemic injury to the recipient.

Adenomatous Polyposis Coli↗
PubMed2000

Patterns of endoscopy use in the United States.

BACKGROUND & AIMS: The aim of this study was to use a large national endoscopic database to determine why routine endoscopy is performed in diverse practice settings. METHODS: A computerized endoscopic report generator was developed and disseminated to gastrointestinal (GI) specialists in diverse practice settings. After reports were generated, a data file was transmitted electronically to a central databank, where data were merged from multiple sites for analysis. RESULTS: From April 1, 1997, to October 28, 1998, 276 physicians in 31 practice sites in 21 states provided 18,444 esophagogastroduodenoscopy (EGD) reports, 20,748 colonoscopy reports, and 9767 flexible sigmoidoscopy reports to the central databank. EGD was most commonly performed to evaluate dyspepsia and/or abdominal pain (23.7%), dysphagia (20%), symptoms of gastroesophageal reflux without dysphagia (17%), and suspected upper GI bleeding (16.3%). Colonoscopy was most often performed for surveillance of prior neoplasia (24%) and evaluation of hematochezia (19%) or positive fecal occult blood test (15%). Flexible sigmoidoscopy was most commonly performed for routine screening (40%) and evaluation of hematochezia (22%). There were significant differences between academic and nonacademic sites. CONCLUSIONS: The endoscopic database can be an important resource for future research in endoscopy by documenting current practice patterns and changes in practice over time.

Colonoscopy↗
PubMed1997

Management of esophageal perforations after therapeutic upper gastrointestinal endoscopy.

BACKGROUND: Esophageal perforation is one of the most dreaded complications in therapeutic gastrointestinal endoscopy. We assessed the frequency of esophageal perforation after endoscopic procedures in a highly specialized endoscopy unit and compared clinical outcomes in patients undergoing either surgical or conservative management. METHODS: From January 1985 to June 1996, 1011 instrumental endoscopic procedures (dilatation and bougienage) were performed in our department. The computerized complication database was searched to identify all patients with esophageal perforation during this same period, and their records were reviewed. RESULTS: Seventeen esophageal perforations (1.7%) occurred in the course of 1011 procedures. Four perforations resulted from balloon dilatation, and 13 were secondary to bougienage. Six patients were managed surgically (35%), all of them recovering uneventfully. Eleven patients were managed conservatively, mainly because they were unfit for surgery. Survival rate in this group was 82%; only two patients died, both of whom had underlying malignant disease. CONCLUSIONS: The current concept in management of esophageal perforations comprises surgical as well as medical treatment. In well-selected cases, non-operative treatment can be considered with favorable results.

Aged↗
PubMed2004

[Training simulators in digestive endoscopy].

Advanced techniques, optimal patient care, and quality management are currently important topics in clinical medicine. The increasing numbers of minimally invasive procedures being carried out in gastroenterology and surgery, and the effects of the learning curve on complication rates with various procedures, have given rise a recently debate on training standards. Public awareness and increasing legal pressure to show and document competence have further contributed to the importance of training in interventional medicine. Although evidence-based medicine is rapidly becoming the gold standard for treatment modalities, responsibility for education-including the theoretical background, as well as acquiring and refining manual skills in gastrointestinal endoscopy--is still a matter for the individual physician. Practical skills are routinely acquired by practicing on patients, initially under the supervision of a senior endoscopist. The development of new endoscopy simulators has brought out the debate whether training in basic manual skills is better obtained outside the patient. This paper presents an overview of the training simulators currently available and issues associated with them.

Animals↗
PubMed1993

Objective evaluation of endoscopy skills during training.

OBJECTIVE: To evaluate the number of supervised gastrointestinal endoscopic procedures required to achieve initial competency using a simple objective grading system. DESIGN: Prospective, cross-sectional study. SETTING: A gastroenterology and surgical training program at a large, university-affiliated county hospital. PARTICIPANTS: Seven gastroenterology fellows and five fourth-year surgery residents. INTERVENTIONS: Trainees were graded postprocedure using a microcomputer program. Grading criteria for esophagogastroduodenoscopy included entering the esophagus (esophageal intubation), traversing the pylorus into the duodenum, and recognizing whether the upper gastrointestinal tract was abnormal. Criteria for colonoscopy were traversing the splenic flexure, intubating the cecum, and recognizing whether the colon was abnormal. RESULTS: When presented with a case mix representative of practice, esophageal intubation did not reach 90% until more than 100 procedures had been done. Cecal intubation remained at only 84% after 100 procedures. CONCLUSIONS: More than 100 supervised upper gastrointestinal endoscopies or colonoscopies are necessary to achieve technical competence in gastrointestinal endoscopy.

Clinical Competence↗
PubMed1998

The role of second-look nasal endoscopy after pediatric functional endoscopic sinus surgery.

OBJECTIVE: To determine if second-look nasal endoscopy (SLE) improves clinical outcome after pediatric functional endoscopic sinus surgery (FESS). DESIGN: A retrospective review was performed for all patients who had undergone FESS between January 1993 and December 1994. The patients were divided into 2 groups: those who underwent SLE 2 to 3 weeks after FESS (n=94) and those who did not undergo SLE after FESS (n=53). Patients with a history of cystic fibrosis, bone marrow transplantation, or isolated sphenoidal sinus disease were excluded from the study. SETTING: Pediatric tertiary care hospital. PATIENTS: All patients had a diagnosis of chronic rhinosinusitis, had failed medical therapy, and had subsequently undergone FESS. MAIN OUTCOME MEASURES: The need for revision sinus surgery was used as the definition for poor clinical outcome, indicating that sinus disease recurred or was persistent. The number of patients requiring revision sinus surgery in each group was compared. RESULTS: Revision surgery was performed in 20 of the 94 patients who underwent SLE after FESS. Revision surgery was performed in 10 of the 53 patients who did not undergo SLE after FESS. Six patients in the "no-second-look group" underwent follow-up nasal endoscopy at some time after the initial FESS. There was no significant difference in terms of clinical outcome between the 2 groups. CONCLUSIONS: The rate of revision sinus surgery was comparable in those patients who underwent SLE after FESS and those who did not. The usefulness and application of SLE need to be considered carefully.

Child↗
PubMed1999

Two-port endoscopy of the middle ear: endoscopic anatomy.

OBJECTIVES: To shed light on the endoscopic anatomy of the middle ear seen on 2-port endoscopy and to describe potential clinical applications. DESIGN: Anatomical structures were visualized by transmeatal or transtympanic rigid scopes of different angles and by a flexible scope in the eustachian tube. This arrangement ensured reciprocal guidance of the scopes and provided access to regions not seen otherwise. SETTING: The Department of Anatomy 1, University of Vienna, Vienna, Austria. MATERIALS: Forty tympanic cavities obtained from cadaver skulls without prior fixation were examined. Specimens did not show any abnormalities and were chosen without regard to age or sex. RESULTS: Depending on the angle of view, rigid transmeatal or transtympanic endoscopes provided a full view of the entire tympanic cavity except for the epitympanum, access to which was barred by the incudomallear joint, the mallear folds, and the tympanic chord, but the epitympanum was well visualized through the flexible, steerable, transtubal scope. CONCLUSIONS: Two-port endoscopy of the middle ear offers a full view of all structures in the tympanic cavity. The atraumatic transtubal approach to the tympanic cavity enhances the safety of transmeatal interventions and facilitates postoperative follow-up.

Cadaver↗
PubMed1985

The role of endoscopy in evaluating patients with head and neck cancer. A multi-institutional prospective study.

In a prospective multi-institutional study of 384 patients undergoing endoscopy, an 8.9% incidence of second primary neoplasms was discovered simultaneously in the lung (3.3%), esophagus (1.8%), and other head and neck sites (3.6%). The endoscopy was the only source of detection of these tumors in 58% of cases. A trend indicates that flexible fiberoptic bronchoscopy was more effective than rigid bronchoscopy in discovering lung tumors (7.5% vs 2.3%). Nevertheless, the chest roentgenogram remains an important tool in the diagnosis of second primary lesions in the lung. Panendoscopy is safe, takes little time, and can add invaluable information concerning therapy in patients with head and neck cancers.

Bronchoscopy↗
PubMed1979

Salmonella typhimurium. Transmission by fiberoptic upper gastrointestinal endoscopy.

During a four-month period, Salmonella typhimurium developed in seven persons within five days of fiberoptic upper gastrointestinal (GI) endoscopy. A retrospective cohort study confirmed the association between S typhimurium infection and fiberoptic upper GI endoscopy. Salmonella typhimurium was cultured from the endoscopic equipment and the accessory suction equipment. The Salmonella isolated from the endoscopic and accessory suction equipment was identical to that recovered from the seven patients with salmonellosis by serotype, antimicrobial susceptibility pattern, and bacteriophage lysis pattern. Salmonella transmission was attributed to inadequate disinfection of the endoscope and accessory equipment between procedures. The original source of the contamination was not discovered.

Aged↗