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C J Gostout

Publications and source records attributed to C J Gostout.

At least 19 recordsLinked to original sources
PubMed1992

Acute gastrointestinal bleeding. Experience of a specialized management team.

The initial experience of a specialized management team organized to provide expedient care for all acute major gastrointestinal bleeding in protocolized fashion at a large referral center is presented. Of the 417 patients, 56% developed bleeding while hospitalized. Upper gastrointestinal bleeding accounted for 82%. The five most common etiologies included gastric ulcers (83 patients), duodenal ulcers (67 patients), erosions (41 patients), varices (35 patients), and diverticulosis (29 patients). Nonsteroidal anti-inflammatory drugs were implicated in 53% of gastroduodenal ulcers. The incidence of nonbleeding visible vessels was 42% in gastric and 54% in duodenal ulcers. The rates of rebleeding were 24% (20 patients) in gastric ulcers and 28% (19 patients) in duodenal ulcers. Predictive factors for rebleeding included copious bright red blood, active arterial streaming, spurting, or a densely adherent clot. The rebleeding rate for esophagogastric varices was 57%. The mortality rate overall was 6% (27 patients), with rates varying from 3% (five patients) for gastroduodenal ulcers to 40% (14 patients) for esophagogastric varices. The morbidity rate for the entire patient population was 18% (77 patients), dominated by myocardial events (34 patients). The average length of hospitalization for gastroduodenal ulcers was 5 days, for diverticulosis 8 days, and for varices 10 days. The major efforts of a specialized Gastrointestinal Bleeding Team would be best directed at both reducing the morbidity associated with acute bleeding and reducing the overall cost of care.

Adolescent↗
PubMed1992

The clinical and endoscopic spectrum of the watermelon stomach.

The watermelon stomach is an uncommon but treatable cause of chronic gastrointestinal bleeding. We report our experience with the clinical and endoscopic features of 45 consecutive patients treated by endoscopic Nd:YAG laser coagulation. The prototypic patient was a woman (71%) with an average age of 73 years (range of 53-89 years) who presented with occult (89%) transfusion-dependent (62%) gastrointestinal bleeding over a median period of 2 years (range of 1 month to > 20 years). Autoimmune connective tissue disorders were present in 28 patients (62%), especially Raynaud's phenomena (31%) and sclerodactyly (20%). Atrophic gastritis occurred in 19 of 19 (100%) patients, with hypergastrinemia in 25 (76%) of 33 patients tested. Antral endoscopic appearances included raised or flat stripes of ectatic vascular tissue (89%) or diffusely scattered lesions (11%). Proximal gastric involvement was present in 12 patients (27%), typically in the presence of a diaphragmatic hernia. Endoscopic laser therapy after a median of one treatment (range of 1-4) resulted in complete resolution of visible disease in four patients (13%) and resolution of > 90% in 24 patients (80%). Hemoglobin levels normalized in 87% of patients over a median follow-up period of 2 years (range of 1 month to 6 years) with no major complications. Blood transfusions were not necessary after laser therapy in 86% of 28 initially transfusion-dependent patients. The characteristic clinical, laboratory, and endoscopic features allow for a confident diagnosis that can lead to successful endoscopic treatment.

Aged↗
PubMed1992

Portal hypertensive intestinal vasculopathy: a review of the clinical, endoscopic, and histopathologic features.

Over the past decade, awareness of the association between portal hypertension and changes in the intestinal circulation has increased. Most of the observations have been made by endoscopic examination and biopsy of the mucosa. The fundamental pathologic change is a vasculopathy. Portal hypertensive intestinal vasculopathy (PHIV) most often involves the stomach (gastropathy) and can be a common source of bleeding. The significance of small bowel involvement (enteropathy) is unknown. Colon involvement (colopathy) has been associated with bleeding, and mimics inflammatory bowel disease. The reliability of endoscopic appearances and histologic examination in establishing the diagnosis is questionable. Recent observations of other diagnostic modalities and associated physiologic alterations and treatment options are discussed. Further prospective evaluations that use uniform terminology for endoscopic and histologic descriptions are needed to establish criteria for accurate diagnosis and assessment of response to treatment.

Humans↗
PubMed1992

Role of endoscopic retrograde cholangiopancreatography after orthotopic liver transplantation.

We reviewed the records of 20 liver transplant patients who underwent 28 procedures [endoscopic retrograde cholangiopancreatography (ERCP)] to rule out biliary obstruction, treat bile leaks, dilate and/or stent strictures, or remove stones and debris. Three patients (two with abnormal T-tube cholangiograms and one with hyperbilirubinemia) underwent ERCP to rule out obstruction. Therapeutic ERCP (sphincterotomy with balloon dilatation or stone extraction) was successful in 16 of 17 patients, including seven of nine in whom there was resolution of bile leaks without the use of stents or surgery. Mild pancreatitis occurring in one patient was the only complication experienced that was related to ERCP. We conclude that ERCP is a safe and important modality in the medical management of biliary tract complications after orthotopic liver transplantation.

Adult↗
PubMed1990

Gastrointestinal laser endoscopy--future horizons.

The laser, especially the neodymium:yttrium-aluminum-garnet device, has been a dominant influence on the development of gastrointestinal therapeutic endoscopy. More than 2,000 such procedures were performed in the first 5 years of experience with laser endoscopy at the Mayo Clinic. The major areas for future development are (1) the control of acute and chronic gastrointestinal bleeding, (2) the palliation of malignant gastrointestinal neoplasms, and (3) the management of benign and malignant obstructive lesions of the biliary tract. Refinements in laser devices, delivery systems, and techniques such as photodynamic therapy will be needed to achieve more selective tissue destruction. Improvements in the new adjunctive endoscopic methods of electronic (video) endoscopy and ultrasonography may enhance evolving laser applications by more accurately identifying diseased tissues and guiding their destruction.

Endoscopy↗
PubMed1990

Congestive gastropathy and other upper endoscopic findings in 81 consecutive patients undergoing orthotopic liver transplantation.

Pretransplant endoscopic findings in 81 consecutive patients with nonalcoholic liver disease were examined to determine the spectrum of abnormalities encountered, with particular attention to mucosal changes consistent with congestive gastropathy. Abnormalities were observed in 75 patients (93%). Twenty-three patients (28%) had findings suggestive of congestive gastropathy: petechiae, focal and diffuse intense erythema, with or without erosions, edematous mucosa with a fine white reticulated or mosaic pattern, and cherry red spots resembling vascular malformations. Congestive gastropathy was the second most common abnormality identified after esophageal varices (66 patients, 81%). Other abnormalities included gastric varices in 13 patients (16%), esophagitis in seven (9%), gastric ulcers in six (7%), duodenal ulcer in 11 (14%), postsclerotherapy esophageal ulceration in 10 (12%), and a postsclerotherapy symptomatic esophageal stricture in one. The prevalence of congestive gastropathy has provided a stimulus for our prospective evaluation of gastric mucosal disease before and after liver transplantation or portosystemic shunt.

Chronic Disease↗
PubMed1989

Endoscopic laser therapy for watermelon stomach.

Thirteen patients (9 women, 4 men) with anemia from acute and chronic gastrointestinal bleeding were found to have antral vascular disease consistent with watermelon stomach. The median age was 73 yr, with a range of 54-88 yr. Eight of the patients were transfusion-dependent, requiring a median of 5.5 U within the 12 mo before treatment. All were treated with endoscopic neodymium:yttrium-aluminum-garnet laser coagulation. Endoscopic and hematologic improvement were evident in 12 patients available for follow-up after a median period of 6 mo. There was a median increase of 4 g/dl in hemoglobin concentration; thus, the need for transfusion was eliminated. No major complications were encountered. Laser coagulation for watermelon stomach appears to be safe and efficacious and may be a therapeutic alternative for this disorder.

Aged↗
PubMed1988

Cholangiopancreatography, sphincterotomy, and common duct stone removal via Roux-en-Y limb enteroscopy.

An enteroscopic method that uses a pediatric colonoscope provides an alternative approach to the diagnostic and management problems arising in the setting of a Roux-en-Y limb hepaticojejunostomy or biliary diversion. Three patients with Roux-en-Y limb reconstructions who experienced recurrent cholangitis, recurrent pancreatitis, or choledocholithiasis in whom the technique was used are presented. The technique, which uses colonoscopic principles, is discussed along with the combined use of percutaneous transhepatic assistance. Enteroscopy of a Roux-en-Y limb is technically feasible and expands the diagnostic and management approach to biliary and pancreatic disease involving this postoperative anatomic condition.

Adult↗
PubMed1988

Acute gastrointestinal bleeding--a common problem revisited.

Acute gastrointestinal bleeding, a common problem, becomes a serious situation in the 15% of afflicted patients in whom the bleeding does not stop spontaneously. The typical high-risk patient is elderly, has multisystem disease, has a hemorrhagic episode during hospitalization for other disorders, or is an outpatient with severe bleeding of short duration and symptoms of volume depletion. Endoscopy can be performed to identify the active site of hemorrhage and is associated with an overall diagnostic accuracy that exceeds 90% in patients with upper gastrointestinal bleeding. The rate and character of observed bleeding have substantial predictive value for continued bleeding. The mortality among high-risk patients with bleeding in either the upper or the lower gastrointestinal tract ranges from 17 to 44%. Therefore, an organized aggressive approach to management of acute gastrointestinal bleeding is necessary.

Acute Disease↗
PubMed1988

Mucosal vascular malformations of the gastrointestinal tract: clinical observations and results of endoscopic neodymium: yttrium-aluminum-garnet laser therapy.

Ninety-three consecutive patients with transfusion-dependent gastrointestinal bleeding from vascular malformations (VMs) underwent systematic assessment in our gastrointestinal laser suite with extended upper gastrointestinal endoscopy and colonoscopy. Of these patients, 83 had angiodysplasia and 10 had the Osler-Weber-Rendu (OWR) syndrome. The median age in each of these groups was 70 and 63 years, respectively. Cardiovascular disease, especially valvular disease, was common. A poor correlation existed between the results of endoscopically identified VMs and visceral angiography in patients with angiodysplasia. A combination of upper and lower gastrointestinal VMs was found in 11% of patients with angiodysplasia and 60% of those with the OWR syndrome. All identified VMs were completely obliterated by photocoagulation with use of a neodymium:yttrium-aluminum-garnet (Nd:YAG) laser. Bleeding was successfully controlled in 9 patients with the OWR syndrome and in 72 patients with angiodysplasia (range of follow-up, 1 to 39 months). In 243 laser treatments, 3 perforations and 5 episodes of delayed bleeding occurred. This experience demonstrates that extended upper endoscopy is useful in identifying VMs and that gastrointestinal bleeding from VMs can be safely and successfully controlled with use of endoscopic Nd:YAG laser therapy.

Aged↗
PubMed1987

Endoscopic laser palliation of malignant dysphagia: a prospective study.

We prospectively studied the short-term and long-term efficacy and safety of endoscopic laser treatment in 25 patients with dysphagia from advanced esophageal cancer. Malignant stenoses were recanalized in all patients, and the ability to swallow was improved in about 80%. Results were best in patients with adenocarcinomas and in those who reported a good appetite. A single laser treatment provided adequate palliation in more than half the patients until the time of death. In those patients in whom stenosis recurred, re-treatment was necessary a median of 3.2 months after the initial laser treatment. No laser-related mortality or major morbidity occurred. We conclude that endoscopic laser therapy seems to be a feasible method of palliating malignant dysphagia.

Adenocarcinoma↗
PubMed1986

Laser therapy for severe radiation-induced rectal bleeding.

Four patients with chronic hematochezia and transfusion-dependent anemia from postradiation rectal vascular lesions were successfully managed by endoscopic laser coagulation. In all four patients, symptomatic, hematologic, and endoscopic improvement was evident. Laser therapy for severe radiation-induced rectal bleeding seems to be safe and efficacious and should be considered before surgical intervention.

Aged↗
PubMed1985

Hemosuccus pancreaticus. An unusual cause of upper gastrointestinal bleeding.

Two cases of hemosuccus pancreaticus as the source of upper gastrointestinal bleeding of unknown cause are presented. The literature on this rare cause of gastrointestinal blood loss is reviewed. Also, the influences of time-course and clinical appearance on the diagnosis of this problem are described.

Aneurysm↗
PubMedDate not supplied

Prospective comparison of contact with noncontact Nd:Yag laser therapy for palliation of esophageal carcinoma.

Twenty patients with dysphagia due to inoperable esophageal cancer were randomized to receive either contact or noncontact endoscopic laser treatment. Treatment groups were similar with respect to age, dysphagia score, and tumor dimensions. The median number of initial treatment sessions was two in both groups, and the median treatment times per session were 23 min (range, 12 to 55 min) in the contact group and 19 min (range, 5 to 28 min) in the noncontact group. Median dysphagia scores were also similar in both groups 1 month after laser treatment, and no difference was apparent in the duration of palliation. There were no patient complications attributable to laser therapy, but damage to the laser wave guide occurred in three contact sessions and two noncontact sessions. These data suggest no advantage for the contact method of endoscopic Nd:YAG laser palliation of esophageal carcinoma with respect to number of treatment sessions, relief of dysphagia, or occurrence of complications.

Adenocarcinoma↗
PubMedDate not supplied

Endoscopic gastric vagotomy: a feasibility study using laser in dogs.

The aim of this study was to explore the feasibility of an endoscopic approach to gastric vagotomy using the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser in dogs. Based on gross and histologic measurements, target zones for endoscopic vagotomy were defined with reference to mucosal side landmarks. Target zones containing the unbranched segments of the major intramural vagal branches were linear and symmetrically located anterior and posterior to the midline of the lesser curvature extending from the level of the esophagogastric junction to the proximal antral border. Because of minimal variability between dogs, this zone could be accessed endoscopically and reliably injured. Unfortunately, it was necessary to produce a nearly full thickness burn to interrupt the deep intramural vagal branches. Despite efforts to control dosimetry, delayed perforations occurred in three of four dogs. We conclude that endoscopic gastric vagotomy using the Nd:YAG laser is not feasible in the dog model because of difficulty controlling the depth of thermal injury. An endoscopic approach to vagotomy remains conceptually appealing because of the predictable location of and accessibility to a target zone.

Animals↗
PubMedDate not supplied

Congestive gastroenteropathy--an extension of nonvariceal upper gastrointestinal bleeding in portal hypertension.

Three cirrhotic patients with acute and chronic gastrointestinal blood loss are described. All had extensive gastric mucosal changes on endoscopy consistent with congestive gastropathy and also had extensive duodenal and jejunal changes consisting of multiple friable punctate areas of erythema. Two patients had esophageal varices from which bleeding could not be documented. The mucosal abnormalities seen in the small intestine of all three patients were similar to those within the stomach and are thought to represent an extension of congestive gastropathy and to be contributing to the blood loss. We propose that the term "congestive gastropathy" be replaced by a more comprehensive term, "congestive gastroenteropathy." The cause of these mucosal abnormalities remains unclear. Attempts at endoscopic therapy of these extensive abnormalities should be avoided until a greater understanding of the underlying pathophysiology is reached.

Aged↗