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At least 19 recordsLinked to original sources
PubMed1998

Transnasal gastroscopy compared to conventional gastroscopy: a randomized study of feasibility, safety, and tolerance.

BACKGROUND AND STUDY AIMS: Gastroscopy is often an unpleasant procedure for the patient. Sedation improves the tolerance, but it causes inconvenience both for patients and for endoscopy units. The aim of the present study was to compare the feasibility, safety, and tolerance of transnasal gastroscopy using a thin endoscope with conventional oral gastroscopy. PATIENTS AND METHODS: One hundred eighty-one consecutive outpatients referred for diagnostic gastroscopy were randomized to undergo transnasal or oral conventional gastroscopy. The tolerance (discomfort, retching, throat pain, and desire for sedation in any further procedures) and examination difficulty (intubation, examination, aspiration, and visibility) were assessed by the patients and the endoscopists, respectively, using visual analogue scales and a questionnaire. RESULTS: Endoscope insertion failed in six patients (four transnasal, two conventional). The tolerance was significantly better with transnasal gastroscopy in comparison to conventional oral gastroscopy. Only 3% of patients undergoing transnasal gastroscopy desired sedation in any further examinations, compared to 15% in the conventional oral gastroscopy group (P = 0.01). The examination time was longer in the transnasal group (5 min 25 sec +/- 1 min 46 sec vs. 3 min 22 sec +/- 1 min 9 sec, P < 0.001). Visualization capability and aspiration using the thin endoscope were considered more difficult by the endoscopists. CONCLUSIONS: Nasal introduction of thin endoscopes is better tolerated by patients than conventional gastroscopy, minimizing the need for sedation. However, technical improvements in thin endoscopes (a wider working channel, increased length and better image quality) would increase their usefulness.

Adolescent↗
PubMed1994

What happens to patients following open access gastroscopy? An outcome study from general practice.

BACKGROUND: Open access gastroscopy allows general practitioners to request a gastroscopy without prior referral to a specialist. The effect of open access gastroscopy upon patient management is poorly explored. Most studies have been hospital based and have focused on diagnostic yields and on means of tightening requests to reduce inefficient use. A user evaluation can only be made by measuring outcomes in primary care. AIM: A study was undertaken to determine the impact of open access gastroscopy in general practice and in particular, the value of a normal result. METHOD: All general practices in South Tees District Health Authority were asked to participate. Any of their patients who had had open access gastroscopy in the year prior to July 1990 were identified from the hospital computer and their general practitioner notes examined. Patient management during the year prior to the open access gastroscopy was compared with the year after. The main outcome measures were: detection rate and grade of lesion, change in graded score of prescribed drugs, consultation rate for dyspepsia and non-dyspepsia problems, and further hospital referral and investigations. Outcomes among those with normal and abnormal gastroscopy results were compared. RESULTS: The study sample comprised 715 patients, 36% of whom had a normal gastroscopy result, 34% a major abnormality and 26% a minor abnormality (4% of patients had miscellaneous diagnoses). It was found that 39% of all patients, and 60% of those with normal findings on open access gastroscopy had their drug treatment stopped or reduced in grade after the investigation. Of those with a major endoscopic abnormality 58% increased their treatment score. Consultations for dyspepsia in the year before and after gastroscopy fell by 57% overall among those with a normal gastroscopy result, by 37% among those with a minor finding and by 33% in those with a major finding. There was a 21% fall in consultations for all reasons among those with a normal gastroscopy result but those with a minor abnormality had a 23% increase in non-dyspepsia consultations. Of all patients 19% were referred to hospital subsequently. CONCLUSION: Open access gastroscopy has a major effect upon patient management in general practice, and a normal endoscopy result has an important an impact as an abnormal one. Open access gastroscopy is associated with a rationalization of drug therapy, reduced consultations and a low hospital referral rate.

Dyspepsia↗
PubMed1993

[Acceptance, side-effects and reactive ability after medicamentous anxiolysis with midazolam. A prospective study with 519 gastroscopy and 506 colonoscopy patients].

In a prospective study 519 patients had gastroscopy (393 with and 126 without midazolam-premedication) and 506 patients had colonoscopy (377 with and 129 without midazolam-premedication) to evaluate acceptance, adverse reactions and reactivity after midazolam-premedication in outpatients immediately and 24 hours later by standard telephone interview. Patients could choose whether they would have midazolam or not. Normally 2 mg midazolam for gastroscopy and 4 mg for colonoscopy were given intravenously directly before endoscopy. 71.5% of gastroscopy and 75.3% of colonoscopy patients who received midazolam afterwards accepted endoscopy only with premedication. 27.7% of our gastroscopy and 14.1% of the colonoscopy patients who than received midazolam were beforehand unable to decide about premedication by themselves. 27.5% of the gastroscopy and 13.8% of the colonoscopy group were persuaded to have midazolam by the doctor examining. 12.7% of our gastroscopy- and 27.1% of our colonoscopy-patients who wished to have midazolam were persuaded to withdraw from it. There were no cardio-pulmonal complications but fatigue was found in 35.4% of the gastroscopy Patients with and 11.9% of those without premedication; colonoscopy patients: 50.4% with and 34.9% without premedication. The incidence of headache was: gastroscopy patients: 6.4% vs. 4%; colonoscopy patients: 11.1% vs. 10.9%. Dizziness: gastroscopy patients: 6.4% vs. 3.2%; colonoscopy patients: 7.6% vs. 7%. Nausea and vomiting were rare (0 to 5%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2000

[Analysis of indications and diagnosis of the gastroscopies requested by primary care physicians].

OBJECTIVES: To analyse the pathology diagnosed on the basis of the gastroscopies requested from a primary care centre (PCC). Assessment and treatment of Helicobacter pylori (HP) infection. DESIGN: Retrospective and descriptive. SETTING: Urban PCC. PATIENTS: Those over 14 who had a gastroscopy for a diagnostic purpose, requested by their primary care doctor during 1997. MEASUREMENTS: Review of clinical records and gastroscopy reports analysing: personal data, reasons for request, prior treatment, diagnoses, treatment to eradicate HP, later referral to the digestion specialist and waiting-time for the gastroscopy. RESULTS: 206 gastroscopies were performed, 139 for epigastralgia (67%) and 73 for heartburn (35%). 161 patients (78%) had had previous treatment, with alkalines used in 94 cases (45%). The most common diagnoses were: 54 normal (26%), 60 hiatus hernias (30%), 43 oesophagitis (21%), 18 duodenal ulcers (9%) and 4 gastric ulcers (2%). The Helicobacter pylori study was positive in 67 cases, with triple treatment (amoxycillin, clarithromycin and omeprazole) to eradicate it given for 7 days in 36 cases (54%). Referral to the specialist of 3% of the patients. Waiting-time for the performance of the gastroscopy: 60 days (SD: 35). CONCLUSIONS: Gastroscopy is a diagnostic method habitually used in our PCC. The pathology diagnosed is mainly treated in primary care. Given the current controversy about actions at determined clinical entities, standardisation of criteria used by professionals at different care levels is very important. This standardisation should affect the indications of the examinations, and the treatment and follow-up of the pathologies. The reduction in waiting-time for a gastroscopy could possibly modify the prescription and duration of the prior treatment.

Amoxicillin↗
PubMed2000

Does gastroscopy induce myocardial ischemia in patients with coronary heart disease?

BACKGROUND AND STUDY AIMS: Gastroscopy has been reported to be dangerous for unstable patients with coronary heart disease (CHD). The aims of this study were to find out whether endoscopy is equally liable to cause myocardial ischemia in stable CHD patients, and whether this can be predicted prior to endoscopy, and to find out the frequency of abnormal findings in patients for whom a secondary prophylaxis with acetylsalicylic acid (ASA) is indicated. PATIENTS AND METHODS: Electrocardiograph recording using a Holter monitor was performed during gastroscopy in 71 patients with stable CHD, to check for silent ischemia. To predict potential ischemia during gastroscopy, the Holter monitoring ECG was applied prior to a treadmill test, and withdrawn after gastroscopy 16-22 hours later. RESULTS: During gastroscopy, 30 patients (42%) had silent ischemia, but only 1 patient (1%) became symptomatic. Ischemia was dependent on heart-rate (median heart rate with ischemia 124 beats/min, without 104 beats/min). Abnormal findings on gastroscopy were found in 53 patients (75%). They implied a potential bleeding risk in 30 patients (42%) and prevented the indication for ASA in 6 of them (8%). CONCLUSIONS: Gastroscopy is potentially a harmful procedure for CHD patients, but the incidence of ischemic periods may be reduced by conscious sedation and, if the patient is receiving beta-blocking agent therapy, by applying this medication prior to gastroscopy.

Adult↗
PubMedDate not supplied

Uncensored open access gastroscopy--limited resources--unlimited demand.

In the first 3 yr of an uncensored open access gastroscopy service in a County Hospital, 891 patients attended for first gastroscopy. The data on these patients is presented and compared with a randomly selected group who attended for gastroscopy in the yr prior to the establishment of the service having come to the normal Consultant clinics. In the open access group the gastroscopy examination was normal in 29 per cent (32 per cent comparator group), 31 per cent had major abnormalities (33 per cent comparator group) and 40 per cent had minor abnormalities (35 per cent comparator group). Delay time from referral to endoscopy was 37 days for open access patients (45 days comparator group). Only 6 per cent of open access patients were brought back to O.P.D. (47 per cent comparator group) and 72 per cent of open access patients returned directly to their family doctor (28 per cent comparator group). A comparison of the Clonmel findings with British centres reporting their results shows a broadly similar picture. It is concluded that almost 1,300 unnecessary clinic visits were avoided by the provision of the open access service, some reduction in delay time to gastroscopy was achieved, the family doctor maintained control of patient management in the great majority of patients, the pattern of referral was not inappropriate and compared very well with the comparator group. Over the 3 yr there was a large increase in the number of gastroscopies performed which caused resource difficulties. It is recommended that adequate planning of these requirements should be carried out before an open access service is started. At least 1 additional dedicated gastroscopy only endoscopy service per week would be required.

Gastroscopy↗
PubMed1998

A prospective study of the management of the young Helicobacter pylori negative dyspeptic patient--can gastroscopies be saved in clinical practice?

BACKGROUND: Helicobacter pylori status has been suggested as a means of selecting young dyspeptic patients for gastroscopy as patients who are H. pylori negative and do not exhibit alarm symptoms or ingest non-steroidal anti-inflammatory medication have a low risk of serious organic disease. AIM: To determine if young patients with ulcer-like dyspepsia and found to be H. pylori negative on non-invasive testing could be reassured by this knowledge and not proceed to gastroscopy. PATIENTS: One hundred and sixty-one consecutive attendees aged 45 years or less with a presenting complaint of epigastric pain or discomfort were prospectively recruited from open access gastroscopy referrals and gastroenterology clinics. METHODS: Patients who were H. pylori negative on 13-carbon urea breath test were reassured of the likelihood of a normal gastroscopy, given lifestyle advice and also advised to take symptomatic therapy as required. Patients were reviewed at 6 weeks, 3 months and 6 months when symptoms and quality of life were reassessed. Patients proceeded to gastroscopy if at any review their dyspepsia score stayed the same or worsened. RESULTS: Fifty-five H. pylori negative patients were recruited (30 male, mean age 31 years), two patients did not attend subsequent review. Thirty-two (58%) came to gastroscopy. Endoscopic diagnoses included 25 which were normal, three with gastro-oesophageal reflux disease, three with peptic ulcer disease and one with gastric erosions. Dyspepsia and quality of life scores showed significant improvement over 6 months. CONCLUSIONS: This management strategy resulted in a 42% reduction in gastroscopies in H. pylori negative patients. Whilst the majority of patients endoscoped had normal findings, seven patients (22%) had pathology. Overall there were significant improvements in dyspepsia and quality of life at 6 month follow-up.

Adult↗
PubMed1995

Reasons for variations in the use of open access gastroscopy by general practitioners.

This study aimed to investigate the wide variation between general practitioners (GPs) in their use of open access gastroscopy by assessing (i) their partnership share, workload, and the aggregated practice request rate; (ii) correlations with their professional and practice characteristics; and (iii) a comparison with referral rates to medicine, surgery, and all specialties. All 145 GPs and their practice managers were sent a questionnaire and hospital held data on all requests for open access gastroscopy over one year were reviewed. During the year, the 145 GPs made 1210 requests for open access gastroscopy, varying from one to 44 per GP. There were 987,880 practice consultations altogether, an average of 22,451 per practice or 7127 per whole time practitioner. Requests for open access gastroscopy formed 2.4% of all referrals, an average of one per 1000 consultations, or eight per GP. Of a total of 49,123 referrals to all specialties (371 per GP) 4218 (8.5%) were to medicine, and 6444 to surgery (13.1%). The following factors did not correlate with requests: vocational training, a concurrent hospital post, length of service, or receipt of the deprivation allowance by the practice. When the open access gastroscopy referral rate was aggregated for each practice the variation between practices was narrowed to essentially twofold. Requests for open access gastroscopy form a small proportion of all referrals (2.4%). Aggregated practice request rates are relatively uniform compared with the wide variation between individual GPs, suggesting a disproportionate gastroenterology workload between partners. The open access gastroscopy service does not seem to be subject to misuse from most GPs if a variation in practice usage is used as a measure.

Family Practice↗
PubMed1993

[Music during gastroscopy].

As part of a project "Music therapy in internal medicine" we investigated 32 consecutive patients undergoing gastroscopy for various reasons. Patients were randomly assigned to two groups, regardless of sex, age or underlying disease. One group listened to music during gastroscopy, while the other did not. The choice of the type of music within the corresponding group was made with the patient and a trained music therapist in a short discussion prior to gastroscopy. The hormones ACTH and cortisol, as well as the catecholamines adrenalin and noradrenaline, were measured in both groups with three blood samples taken before, directly after and one hour after gastroscopy. Parallel measurements included blood pressure and pulse rate as well as questions about the patients' feelings during gastroscopy. The study showed the rise in the plasma levels of the stress hormones ACTH and cortisol to be significantly lower under the influence of music. The subjective feelings of the patients concerning "fear in general" and "fear about gastroscopy" paralleled these findings. Conversely, the plasma adrenalin and noradrenaline levels before and after gastroscopy were virtually unchanged in both groups, as were pulse rate and blood pressure. This study shows the influence of music on human biochemical parameters when used in the setting of a diagnostic procedure.

Adrenocorticotropic Hormone↗
PubMed1997

Usefulness of anti-Helicobacter pylori and anti-CagA antibodies in the selection of patients for gastroscopy.

OBJECTIVES: Screening of dyspeptic patients with serological tests for Helicobacter pylori before open-access gastroscopy has been suggested to be worthwhile. CagA-positive H. pylori strains may be associated with major pathology more often than CagA-negative strains. The usefulness of anti-H. pylori and anti-CagA antibodies in screening for gastroscopy was evaluated in unselected dyspeptic patients. METHODS: Four hundred consecutive, unselected dyspeptic patients (mean age, 56.8 yr) in primary care were investigated with gastroscopy, ultrasonography of the upper abdomen, laboratory tests (including serological tests for H. pylori and CagA), and other examinations if needed. The patients were followed for 1 yr. RESULTS: Results of serological tests were positive for H. pylori in 56.2% of patients, of whom 64.4% also had results positive for CagA. Use of H. pylori and CagA serology-based screening combined with a history of nonsteroidal anti-inflammatory drug use would have detected only 80 and 70% of the major pathologies (peptic ulcer, moderate or severe esophagitis, celiac disease, or malignancy), respectively, in these patients. Gastroscopy would have been avoided in 30 and 41%, respectively, if only patients who had positive results on serological tests or who were nonsteroidal anti-inflammatory drug users would have been referred. In patients younger than 45 yr of age (n = 87), 60-74% of gastroscopies would have been avoided, but 50-60% of major pathologies would have been missed, by using the screening strategy studied. One of the nine malignancies (all in patients >45 yr of age) was H. pylori-negative, and two were CagA-negative. CONCLUSIONS: Anti-CagA antibodies do not offer advantages compared with anti-H. pylori antibodies in screening patients for gastroscopy. A remarkable share of major pathologies are missed by both of these screening methods. Therefore, the results of these screening tests are not recommended as selective criteria for gastroscopy.

Adolescent↗
PubMed2001

The effect of videotaped or written information on Chinese gastroscopy patients' clinical outcomes.

The researchers compared videotaped information with specific written information on Chinese out-patients' post-gastroscopy anxiety and satisfaction levels. We randomly allocated 30 out-patients having scheduled gastroscopy to receive videotaped or detailed written information, and assessed the effect of the information on patients' post-gastroscopy BP, pulse and self-reported anxiety and satisfaction levels. Patients receiving videotaped information had better post-gastroscopy outcomes on all measures, but the results were not statistically significant. BP and Pulse rates increased after the intervention within each group but the changes were statistically significant in the group receiving detailed written information only. A-state scores decreased in both groups after the intervention but these changes were not statistically significant. Education and age significantly influenced post-gastroscopy state anxiety scores. The researchers conclude that information may have little effect on Chinese gastroscopy patients' outcomes, irrespective of the method of providing it. Education and age may influence patients' reports of anxiety.

Adult↗
PubMedDate not supplied

[The value of gastroscopy in patients with radiological diagnosis of stomach diseases].

Eighty-seven records of patients with a radiologic diagnosis of benign ulcer, cancer or non-specific gastric changes and with a final diagnosis confirmed by biopsy, surgery or follow-up were analyzed to find out whether gastroscopy was useful. In patients with radiologic diagnosis of benign ulcer, gastroscopy was useful in 87% of the cases. When radiology suspected gastric cancer, gastroscopy established the diagnosis in two thirds of the cases. When the radiologist considered a diagnosis as certain his accuracy and specificity were comparable with those of the endoscopist. In such cases endoscopy is only confirmatory. In 7 patients with a radiologic diagnosis of non-specific gastric changes gastroscopy established diagnosis in 6. We concluded that gastroscopy is useful for the patient with a diagnosis of benign ulcer, non-specific gastric changes, or suspicion of gastric cancer. When diagnosis of gastric cancer is established by radiology, gastroscopy is not useful.

Adolescent↗
PubMed1998

Can we improve the uptake of gastroscopy in the population at risk for gastric cancer? The effect of home letter information.

The poor outlook for gastric cancer in Britain is largely due to late diagnosis. Earlier diagnosis will require both easy access to endoscopy and increased public awareness of dyspeptic symptoms. We used information by personal letter to encourage reporting of potentially significant symptoms in patients over 40 years of age. The aim of this study was to measure the acceptability and effect on gastroscopy rates of home letter information. Patients over 40 registered with 12 general practices were used in the study (practice population 80,000). Patients over 40 from another nine practices (practice population 46,500) acted as controls. A letter encouraging consultation for new dyspeptic symptoms was sent to all study subjects. Gastroscopy rates were compared in both study and control populations. Questionnaires on symptoms were sent to 500 study subjects. The principal outcome measure was the gastroscopy rate in people over 40 in both populations, before and during the intervention. The gastroscopy rate was 23% higher in the study than in the control population during the study (3.32 vs. 2.7%, P = 0.00016, chi 2 = 14.25). Gastroscopy uptake increased by 85% from 1991/2 to 1993/4 in the study group and by 34% in the control group (chi 2 = 14.02, P = 0.00018). Thirty-one per cent of questionnaire respondents had dyspeptic symptoms; only 3% had 'significant' symptoms of between 2 and 52 weeks duration. Home letters are an acceptable and efficient method of increasing gastroscopy uptake in dyspeptic patients over 40.

Adult↗
PubMed1999

Arterial oxygen desaturation during endoscopic ultrasonography combined with gastroscopy: a safety evaluation in out-patients.

BACKGROUND AND STUDY AIMS: Data concerning potential clinically relevant arterial oxygen desaturation (SaO2 <90.0 %) during endoscopic ultrasonography (EUS) combined with a prior conventional gastroscopy are not available, but are nevertheless important in view of the increasing numbers of examinations and relevant safety standards. We therefore continuously measured SaO2 before and during the periods of gastroscopy and subsequent EUS in order to answer the question of whether EUS has additional effects on arterial oxygen desaturation. A secondary aim of the study was to define patients with particular risks for decreased SaO2. PATIENTS AND METHODS: SaO2 was continuously monitored in 96 outpatients before and during the endoscopic procedures. After sedation with midazolam, an exploratory gastroscopy was performed, followed by endoscopic ultrasonography. RESULTS: In all patients undergoing gastroscopy followed by EUS (n = 96), SaO2 values significantly decreased from 96.5 +/- 2.6 % to 92.4 +/- 4.7 % (P < 0.0001). Analysis of the time-related SaO2 courses showed that the minimal SaO2 was reached after 7.5 minutes. The SaO2 curves in patients with desaturation (n = 29) were similar to those in patients who had no desaturation, except for a significantly lower nadir (88.6 +/- 5.3 %, P< 0.0001). The SaO2 time courses in all patients showed no further decrease or a second minimum during the EUS period, as might have been expected with the insertion of a second instrument. Baseline (pre-procedure) and minimal SaO2 were significantly correlated (T(s): 0.604, P<0.038). Quantitative analysis yielded the lowest significant percentage of desaturation, with baseline SaO2 equal to or above 97.5 % (6.3 %, P< 0.038). CONCLUSIONS: EUS following an exploratory gastroscopy under mild sedation causes no additional reduction in SaO2. Patients with an initial arterial oxygen saturation equal to or above 97.5 % may have a low probability of desaturation during the combined procedure after sedation with one single midazolam dose, and are therefore unlikely to need further monitoring after an initial assessment. Patients below this limit, however, should be continuously monitored, due to the increasing probability of desaturation below this limit.

Adult↗