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PubMed1996

Computed tomography and granulocyte scintigraphy in active inflammatory bowel disease. Comparison with endoscopy and operative findings.

The accuracy of computed tomography (CT) and [99mTc]HMPAO granulocyte scintigraphy (GS) for detection of bowel localization, inflammatory activity, and complications in acute inflammatory bowel disease (IBD) was prospectively studied in 32 patients. Of each bowel segment, findings on CT and GS were scored by one blinded observer. Findings on operation or endoscopy served as the gold standard. In Crohn's disease (CD, 17 patients), CT detected bowel pathology (sensitivity 71%, specificity 98%), abscesses (sensitivity and specificity 100%), and fistulas (sensitivity 80%, specificity 100%). In CD, GS had a sensitive of 79% and a specificity of 98% for detection of inflammatory activity. The detection of complications with GS was poor. Segmental inflammatory activity correlated with endoscopy-operative findings for CT (r = 0/86, P < 0.0001) and GS (r = 0.86, P < 0.0001). In ulcerative colitis (UC, 15 patients), GS predicted proximal extension of bowel involvement better than CT. In CD, CT is Superior to GS for localization of both active and fibrostenotic bowel disease, and in detection of the abscesses and fistulas. In UC, GS showed proximal extension more accurately than CT.

Acute Disease↗
PubMed1988

Impact of biliary tract endoscopy on benign and malignant diseases.

In the last 15 years, the management of patients affected with obstructive jaundice has been greatly improved by the introduction into clinical practice of diagnostic and therapeutic biliary tract endoscopy. This method has provided better knowledge of the pathophysiology of diseases of the common bile duct (CBD), with enormous benefit for surgical decision making. Moreover, it has reduced morbidity and mortality in emergency patients as well as in high-risk patients with CBD stones. Even the incidence of retained stones has been reduced to almost 1%-2%. The impact of endoscopy on diseases of the biliary tract has been tremendous.

Biliary Tract Diseases↗
PubMed1991

Extracorporeal shock-wave lithotripsy and endoscopy: combined therapy for problematic bile duct stones.

Endoscopic treatment of bile duct stones is currently successful in 86% of patients. We prospectively studied the efficacy and complication rate of extracorporeal shock-wave lithotripsy (ESWL) of problematic bile duct stones combined with endoscopy. When stone removal was not possible, patients were subjected to ESWL. Fragmented stones were removed endoscopically. During 1 year, 220 patients presenting with choledocholithiasis were diagnosed and 188 were successfully treated endoscopically. In all, 3 subjects received alternative treatment and the remaining 29 (13%) constituted our study group; 19 (65%) were women and the mean age was 76.7 years. Overall, 22 (76%) were high-risk patients; 23 (79%) were jaundiced and 9 (31%) had cholangitis at admission. The most frequent indication for ESWL was stone size. Stone fragmentation was achieved in 80% of cases. Complications were mild and were managed conservatively. No patient died. Complete stone clearance was possible in 23 (80%) cases. The association of ESWL and endoscopy enhanced the success rate of endoscopic stone clearance from 86% to 96%. During the same period, open surgery was performed in 4 cases for residual common bile duct (CBD) stones and in 32 cases in association with simultaneous cholecystectomy.

Aged↗
PubMed1991

Surgical endoscopy during the Gulf War.

During Operation Desert Shield/Desert Storm, the 8th Evacuation Hospital (400 beds) evaluated the efficacy of endoscopy in the desert environment. Standard off-the-shelf fiber-optic endoscopes met the criteria of being rugged, versatile, portable, and easy to maintain. Over a 3-month period, 36 procedures (Esophagogastroduodenoscopy, 25; colonoscopy, 7; flexible sigmoidoscopy, 4) were performed in soldiers both in the garrison and in combat. Of these, 24 (67%) revealed normal findings; the remaining 33% demonstrated pathology (6 cases of peptic ulcers, 3 cases of esophageal ulcers, 2 cases of acute ulcerative colitis, and 1 case of proctitis). Two-thirds of the patients could immediately be returned to duty because they demonstrated either a normal examination or pathology that would resolve with medical management. Another 17% of the subjects were promptly air-evacuated out of the combat theater, and 17% were Iraqi prisoners of war in whom the proper medication was begun. Although no indication for surgical endoscopy was found that was unique to a combat theater, these procedures greatly enhanced the conservation of the fighting force, especially in determining which soldiers could be immediately returned for a combat mission.

Adult↗
PubMedDate not supplied

Therapeutic gastrointestinal endoscopy.

The safety, efficacy and utility of various therapeutic gastrointestinal (GI) endoscopic procedures performed on children (January 1992 to July 1995) at a tertiary referral centre in India were studied. A total of 1,030 sessions (upper GI 972 and lower GI 58) of therapeutic GI endoscopy were performed in 162 children (mean age 7.4 +/- 4 years; upper GI 115, lower GI 47). Various upper GI endoscopic procedures done were injection sclerotherapy (EIS), endoscopic variceal ligation (EVL), bougie dilatation of oesophageal strictures, balloon dilatations of oesophageal stricture/pyloric obstruction and retrieval of foreign bodies in 75%, 6%, 9%, 4% and 12% of children respectively. Therapy for bleeding from oesophageal varices constituted the major group (75%). Repeated EIS (sessions total--876, mean 8, range 5-15) performed on 86 children resulted in control of bleeding in all and eradication of oesophageal varices in 85% of cases. Minor complications (oesophageal ulcers and oesophageal strictures) due to EIS were observed in 9% of children. EVL (10 sessions in 7 children) was effective in controlling bleeding and substantial decrease of varices in all without any complication. Oesophageal dilation either by bougie (61 sessions in 10 children) or balloon (6 sessions in 3 children) were performed for benign strictures. Balloon dilatation of pyloric obstruction was successfully done in 2 children. Foreign bodies (retained or sharp) were retrieved from upper GI tract in 14 children. No complications were observed with stricture dilatation/foreign body retrieval. Therapeutic lower GI endoscopies were performed in 47 children (colonoscopic polypectomy in 92%, anal dilatation and piles banding in 4% each). One child with juvenile polyposis coli developed sigmoid colon performation following colonoscopic polypectomy which required surgical correction. We conclude that upper and lower GI endoscopic therapeutic procedures in children are highly effective and safe. The risk of major complication is very small in experienced hands and occasional minor complications, can be managed conservatively.

Adolescent↗
PubMedDate not supplied

Diagnostic upper GI endoscopy for hemetemesis in children: experience from a pediatric gastroenterology centre in north India.

Upper GI endoscopies were done in 236 children (upto 12 years of age) presenting with history of hemetemesis. Varices were the commonest lesions (in 39.41%) followed by esophagitis (23.73%). Gastritis, gastric ulcer, duodenal ulcer and oesophageal ulcers were identified in 7.20%, 1.27%, 0.42% and 0.42% cases respectively. Cause of bleeding could not be ascertained in 27.54% cases. No significant premedication or procedure related complications were observed. Upper GI endoscopy is thus a safe and useful mode of investigation in cases of hemetemesis in children.

Adolescent↗
PubMed1980

On the condition and activities of Jeddah Endoscopy Center.

Present condition and activities of Jeddah Endoscopy Center managed in cooperation with Saudian and Japanese doctors are reported. Total number of patients examined are 1,183 cases; 73% of which were subjected to endoscopy and 27% were to fluoroscopy. With respect to the stomach diseases, gastric cancer and ulcer were found in 16% and 14.7%, respectively. On the other hand, high incidences of severe atrophic gastritis and haemorrhagic or erosive gastritis accounted totally 64.7% of all stomach diseases were noted. Out of 264 cases of duodenal diseases, duodenal ulcer was diagnosed in number of 202 cases (76%). The ratio between gastric and duodenal ulcer was, therefore, approximately 1:6. It was further noted that most of patients with esophagus cancer were found in males having the local habit of taking green tobacco. From the results obtained, discussions were made on the statistical differences of gastrointestinal diseases between Saudi Arabia and Japan.

Adolescent↗
PubMed2003

Urgent bedside endoscopy for clinically significant upper gastrointestinal hemorrhage after admission to the intensive care unit.

OBJECTIVE: To investigate the sources of hemorrhage and use of endoscopic hemostasis in patients with clinically significant upper gastrointestinal (UGI) hemorrhage after admission to the intensive care unit (ICU). DESIGN AND SETTING: Prospective study, 123 beds of ICU in a 1,629-bed medical center. MEASUREMENTS AND RESULTS: Of the 9,512 consecutive admissions over a 2-year period 105 UGI hemorrhage patients underwent urgent bedside UGI endoscopy. We compared two groups of these patients, one receiving and the other not receiving endoscopic hemostasis. Ulcers with profusely bleeding stigmata occurred in 31 patients (29.5%), ulcers with clean bases or firmly adherent blood clots in 27 (25.7%), stress-related mucosal diseases in 23 (21.9%), esophageal varices in 5 (4.8%), malignancy in 4 (3.8%), and no detectable bleeding site in 15 (14.3%). Endoscopic hemostasis was attempted in 34 patients (32.4%). Primary hemostasis for them was achieved in 67.6% and the rebleeding rate was 30.4%. In-hospital mortality rate was 77.1% and death related to hemorrhage 6.2%. Length of ICU stay before endoscopic diagnosis was significantly shorter in those who underwent endoscopic hemostasis than those who did not (28.2+/-26.3 vs. 41.2+/-57.5 days). CONCLUSIONS: Endoscopic hemostasis may be more beneficial when the period between ICU admission and development of hemorrhage is shorter. Bleeders can be more readily identified and controlled endoscopically in such patients. A significant proportion of bleeding sites cannot be identified by UGI endoscopy. It may indicate higher risk of small bowel hemorrhage in these critically ill patients.

Adolescent↗
PubMed2001

Endoscopy, assisted percutaneous repair of the Achilles tendon ruptures: a cadaveric and clinical study.

Endoscopy-assisted percutaneous repair of Achilles tendon ruptures were investigated in a cadaveric and clinical study. Sixteen above-knee fresh amputation specimens in which different types of Achilles tendon ruptures were created were repaired percutaneously with the visualization of the tendon ends by endoscopy. Neither malalignment nor damage to the neurovascular structures was observed. Eleven patients were treated in this way. No reruptures, wound problems, or neurovascular injury were observed. All patients returned to daily activities 10-11 weeks after the repair. This technique seems to overcome certain problems of conservative, surgical, or percutaneous repair of the Achilles tendon ruptures.

Achilles Tendon↗
PubMed2004

Magnetic resonance angiography virtual endoscopy in the assessment of pulmonary veins before radiofrequency ablation procedures for atrial fibrillation.

Magnetic resonance angiography (MRA) is a safe and non-invasive imaging method that can readily depict the pulmonary veins (PV), whose imaging has acquired momentum with the advent of new techniques for radiofrequency ablation of atrial fibrillation (AF). We evaluated whether virtual endoscopy from 3D MRA images (MRA-VE) is feasible in studying the morphology of PV. Fifty patients with AF underwent pre-ablative MRA (1.5 T). Images were acquired with axial T-2 weighted and 3D-SPGR sequences after intravenous administration of Gd-DTPA and automatic triggering. Postprocessing was performed by an experienced radiologist with maximum intensity projection (MIP) and virtual endoscopy software (Navigator, GEMS). The venoatrial junction was visualized with MRA-VE in 49 of 50 patients (98.0%). Twenty-seven patients (55.1%) had two ostia on both sides, 13 patients (26.5%) had two ostia on the right and a single common ostium on the left, 5 patients (10.2%) had accessory PV and 4 patients (8.2%) had both an accessory right PV and a single common ostium on the left. Flythrough navigation showed the number and spatial disposition of second-order PV branches in 48 out of 49 patients (98.0%). MRA-VE is an excellent tool for at-a-glance visualization of ostia morphology, navigation of second-generation PV branches and easy endoluminal assessment of left atrial structures in pre-ablative imaging.

Adult↗
PubMed1999

Endoscopy of the femoral canal in revision arthroplasty of the hip.A new method for improving the operative technique and analysis of implant failure.

Femoral endoscopy using a special endoscope was performed in 28 revision arthroplasties with the aim of improving the operative technique and to analyze implant failure. Before clinical application, the method was used to analyze the implant bed in clinically and radiographically well-fixed prostheses in autopsy cases without implant failure. Initially, it was performed on 4 experimental implantations of newly designed revision devices into cadaver femurs to obtain additional information concerning the design rationale of implants and instruments for revision surgery. During revision surgery, the new endoscope showed that controlled removal of the cement and granulomatous tissue was possible while avoiding cortical windows or transfemoral approaches. Under visual control, preparation of the new implant bed was less hazardous and more efficient, resulting in good preservation of bone stock and reduced exposure to X-rays. Analysis of the implant bed in failed hip endoprostheses revealed cracks or fractures of the cement mantle in 21 of 23 cemented components. There were two different types of cracks: longitudinal and transverse, which were mostly connected and invisible to X-ray analysis. Cement defects, thin cement mantles, or the proximal border of the cement mantle were found to be places where cracks originated. Granulomatous tissue was noted to protrude into the cement fissures and cracks. In autopsy cases, cement cracks were also found in clinically asymptomatic and radiographically well-fixed prostheses. These cracks were observed to be mainly oriented in the longitudinal direction, similar to those seen in the revision cases. Early signs of debonding became obvious even without lesions in the cement mantle. In experimental implantations of newly designed stems, the efficacy of the different instruments and the fit of the implant could be evaluated by endoscopic control inside the intramedullary canal. Further, it was possible to directly visualize the shape and condition of the primary implant bed after removal of the implant. Femoral endoscopy improved the surgical technique in revision arthroplasty. In addition, it is a very useful tool for the analysis of the implant bed in clinical and autopsy cases as well as in experimental implantations.

Aged↗
PubMed2002

Virtual endoscopy imaging of the middle ear cavity and ossicles.

Ten cadaver temporal bone blocks were studied with high-resolution computed tomography (HRCT) in order to produce topographic images, which are more informative than ordinary CT slices. Virtual endoscopic images were produced with separate, commercially available software, paying attention to the middle ear cavity and ossicles. Four major viewing locations for virtual endoscopy (the ear canal, hypotympanum, attic and eustachian tube) developed images acceptably. The malleus and incus were visualized properly. Small structures such as the lenticular process and the stapes sometimes failed to have good imaging. The eustachian tube and attic virtual views, which are usually not receptive to ordinary endoscopy, gave proper visualization of middle ear structures. Even the smallest structure, the stapes, can produce a virtual image.Virtual endoscopic images, or topographic images, of the middle ear and ossicles contribute to the understanding of the anatomy of the middle ear, thus enhancing the chances for successful surgery.

Adult↗
PubMed2006

Clinical application of wireless capsule endoscopy in pediatric patients for suspected small bowel diseases.

Capsule endoscopy (CE) has been demonstrated to be safe and well tolerated in adults with suspicion of small intestinal diseases with negative results of gastroscopy and colonoscopy. However, its value in pediatric patients has not yet been well studied. This study aimed to evaluate the results and safety of CE in pediatric patients with suspicion of small bowel disorders. There were 16 consecutive children and adolescents (12 boys, 4 girls) and 15 adults (9 men, 6 women) referred to us for suspected small bowel diseases from August 2002 to September 2005. Among the pediatrics, six patients were less than 10 years old. Technique for capsule placement, gastric transit time, small bowel transit time, excretion time of capsule endoscopy, capsule findings, and complications were recorded. All 16 pediatric patients described that the capsule was easy to swallow except for three children. Finally we delivered the capsule under gastroscopy with overtube for these three children. No capsule retention occurred during our study. Median recording time was 7 h 44 min (range 6 h 51 min-9 h 11 min). Median gastric transit time was 83.5 min (range 4-296 min). Median small bowel transit time was 270 min (range 142-484 min). Median excretion time of capsule was 33.9 h (range 12-96 h). There was no significant difference in excretion time of capsule, gastric transit time and small bowel transit time between pediatric patients and adult patients (P > 0.05). CE was positive in 12 patients, including Crohn's disease (4), hemangioma (2), angiodysplasia (2), Meckel diverticulum (1), polyp (1), aphthous ulcer in ascending colon (1), and cobblestone appearance of ileal mucosa. CE has been performed safely in a small series of pediatric patients after ingestion or endoscopic placement of the capsule. The high yield of abnormal findings was comparable to those of adult patients.

Adolescent↗
PubMed2001

Gastric remnant carcinoma: reevaluation of screening endoscopy.

A 67-year-old male presented with complaints of chronic postprandial pain in the epigastric region. The patient had undergone a vagotomy, antrectomy, and loop gastrojejunostomy for peptic ulcer disease 25 years prior. Abdominal computed tomography (CT) revealed markedly thickened walls of the gastric remnant with infiltration of the adjacent fat planes. An esophagogastroscopy demonstrated erythematous, friable remnant mucosa. Gastric biopsies revealed invasive adenocarcinoma. At laparotomy a large tumor mass involving the gastric remnant and the antecolic loop gastrojejunostomy was identified. Further exploration revealed a firm nodule in the left lobe of the liver and several small nodules on the diaphragm and the lesser omentum. Biopsies confirmed metastatic adenocarcinoma at all sites. Curative resection was abandoned. Gastric remnant carcinoma (GRC) typically presents more than 20 years after resection for peptic ulcer disease and has a history of poor survival rates. With increased use of diagnostic endoscopy, GRC has been detected at earlier stages. Recent cohort studies demonstrate that GRC has similar survival rates after stage stratification when compared with primary proximal gastric carcinoma. The increased incidence of GRC in later decades (>20 years) after operation in conjunction with decreasing numbers of patients suggests that screening endoscopy should be considered on a 2- to 5-year basis in this population.

Adenocarcinoma↗
PubMed2001

Aortic graft in the jejunum without bleeding. A real surprise at endoscopy.

It is known that prosthetic infection, graft-duodenal fistula, and erosion are possible late complications after aortic reconstruction, and that all these reported complications are accompanied generally by variable bleeding with different presentations. We report the case of a 63-year-old man who underwent a diagnostic upper gastrointestinal endoscopy for investigation of nausea, anorexia, asthenia, fever, and mild leukocytosis. The patient's medical history included a gastric resection for ulcer, with Billroth II gastrojejunostomy reconstruction and implantation of a Dacron vascular graft for abdominal aortic aneurysm 20 years and 3 years earlier, respectively. Abdomen ultrasonography showed hypoechoic area around an aortic prosthesis. Endoscopy found a foreign body corresponding to the vascular graft at the jejunum. No signs of bleeding were recorded. The patient was hospitalized and submitted to surgery that involved extra-anatomic axillofemoral bypass, bowel resection with a gastrojejunum Roux anastomosis, and prosthesis removal.

Anastomosis, Roux-en-Y↗
PubMed2006

Use of alarm symptoms to select dyspeptics for endoscopy causes patients with curable esophagogastric cancer to be overlooked.

BACKGROUND: In August 2004, the United Kingdom Department of Health advisory body published dyspepsia referral guidelines for primary care practitioners. These guidelines advised empiric treatment with antisecretory medications and referral for endoscopy only in the presence of alarm symptoms. The current study aimed to evaluate the effect of these guidelines on the detection of esophagogastric cancer. METHODS: The study reviewed a prospectively compiled database of 4,018 subjects who underwent open access gastroscopy during the years 1990 to 1998. The main outcome measures for the study were cancer detection rates, International Union Against Cancer (UICC) stage, and survival. RESULTS: Gastroscopy identified esophagogastric carcinoma in 123 (3%) of the 4,018 subjects. Of these 123 patients, 104 (85%) with esophagogastric cancer had "alarm" symptoms (anemia, mass, dysphagia, weight loss, vomiting) and would have satisfied the referral criteria. The remaining 15% would not have been referred for initial endoscopic assessment because their symptoms were those of uncomplicated "benign" dyspepsia. The patients with "alarm" symptoms had a significantly more advanced tumor stage (metastatic disease in 47% vs 11%; p < 0.001), were less likely to undergo surgical resection (50% vs 95%; p < 0.001), and had a poorer survival (median, 11 vs 39 months; p = 0.01) than their counterparts without such symptoms. CONCLUSIONS: The use of alarm symptoms to select dyspeptics for endoscopy identifies patients with advanced and usually incurable esophagogastric cancer. Patients with early curable cancers often have only dyspeptic symptoms, and their diagnosis will be delayed until the symptoms of advanced cancer develop.

Adult↗
PubMed1999

Endoscopy during laparoscopy. Reduced postprocedural bowel distention with intraluminal CO2 insufflation.

BACKGROUND: Intraluminal endoscopy during laparoscopy can substitute for manual palpation in defining anatomy and pathology, but a potential problem is the persistent bowel distention associated with intraluminal air insufflation. METHODS: To compare the rates of intraluminal absorption, a 30-cm segment of small bowel with an intact vascular supply was insufflated with either air or CO2 during CO2 pneumoperitoneum. Intraluminal pressures and bowel circumferences were monitored after the insufflation was stopped. To study the metabolic and hemodynamic effects of CO2 endoscopy during laparoscopy, the small bowel was insufflated to an intraluminal pressure of 15 mmHg during CO2 pneumoperitoneum. Nitrogen pneumoperitoneum was used to differentiate the effects from intraluminal and peritoneal CO2 insufflation. RESULTS: The intraluminal pressures remained elevated and the bowel distended for the entire 3 h following bowel insufflation with air. Following intraluminal CO2 insufflation, both the intraluminal pressures and the bowel circumferences returned to preinsufflation values within 15 min. Intraluminal CO2 insufflation also led to systemic absorption of CO2 with significant metabolic and hemodynamic changes. These changes were effectively corrected by doubling minute ventilation. CONCLUSIONS: Intraluminal CO2 was absorbed faster than intraluminal air. Although decreased bowel distention is certainly of practical value, endotracheal intubation needs to be done to effectively ventilate the absorbed CO2.

Air↗
PubMed1999

Operative manometry and endoscopy during laparoscopic Heller myotomy. An initial experience.

BACKGROUND: We report our initial experience using operative esophageal manometry as an adjunct to endoscopy to determine the completeness of esophagogastric high-pressure zone (HPZ) obliteration during laparoscopic Heller myotomy. METHODS: Between July 1997 and October 1998, we performed laparoscopic Heller myotomies in 20 patients (eight male, 12 female; median age, 41 years). Mean duration of symptoms was 3.2 +/- 2.6 years (r = 0.5-11), and 45% of the patients had received prior dilation or toxin injection. A 16-channel esophageal manometry catheter was placed prior to anesthesia, with sites crossing the lower esophageal sphincter (LES). An endoscope was passed intraoperatively to localize the squamocolumnar junction, and the myotomy was performed. While the translucency was imaged in the area of the incision, we determined the adequacy of myotomy by visual assessment of LES and gastric cardia opening in response to endoscopic air insufflation. Manometry was then performed to detect any potential residual high pressure at the myotomized esophagogastric junction (EGJ). If it was found, the locus of persistent pressure was identified by probing along the myotomy, and residual muscle fibers were cut to yield a minimum pressure at the EGJ. RESULTS: A persistent HPZ was identified after the initial myotomy in 10 of 20 patients (50%). A Dor fundoplasty completed the operation. The mean operating time was 2.6 +/- 0.5 h (median, 2.5; r = 2-3.5 h), and the mean hospital stay was 1.6 +/- 1 days (median, 1, r = 1-5 days). The mean LES pressure was 2 +/- 3 mmHg immediately postmyotomy (p < 0.001 compared with preoperative value). Of 20 patients, only two have reported recurrence of dysphagia (10%). One had a recurrent HPZ on manometry, and one developed esophagitis, which resolved with omeprazole. CONCLUSIONS: Our initial experience suggests that operative esophageal manometry is a useful adjunct to upper endoscopy during laparoscopic Heller myotomy, quantitatively assuring obliteration of the nonrelaxing LES and HPZ.

Adolescent↗