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Biomedical subjects

Jonathan A Leighton

Publications and source records attributed to Jonathan A Leighton.

At least 37 records · Page 2Linked to original sources
PubMed2005

ASGE guideline: the role of endoscopy in the diagnosis, staging, and management of colorectal cancer.

This is one of a series of statements discussing the utilization of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy prepared this text. In preparing this guideline, a MEDLINE literature search was performed, and additional references were obtained from the bibliographies of the identified articles and from recommendations of experts. When little or no data exist from well-designed prospective trials, emphasis is given to results from large series and reports from recognized experts. Guidelines for appropriate utilization of endoscopy are based on a critical review of the available data and expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement and revision needed to clarify aspects of this statement and revision may be necessary as new data appear. Clinical consideration may justify a course of action at variance to the recommendations.

Biopsy, Needle↗
PubMed2005

ASGE guideline: the management of low-molecular-weight heparin and nonaspirin antiplatelet agents for endoscopic procedures.

This is one of a series of statements discussing the utilization of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy prepared this text. In preparing this guideline, a MEDLINE literature search was performed, and additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When little or no data exist from well-designed prospective trials, emphasis is given to results from large series and reports from recognized experts. Guidelines for appropriate use of endoscopy are based on a critical review of the available data and expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data appear. Clinical consideration may justify a course of action at variance to these recommendations.

Clinical Trials as Topic↗
PubMed2005

ASGE guideline: complications of EUS.

This is one of a series of statements discussing the utilization of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy prepared this text. In preparing this guideline, a MEDLINE literature search was performed, and additional references were obtained from the bibliographies of the identified articles and from recommendations of experts. When little or no data exist from well-designed prospective trials, emphasis is given to results from large series and reports from recognized experts. Guidelines for appropriate utilization of endoscopy are based on a critical review of the available data and expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement and revision needed to clarify aspects of this statement and revision may be necessary as new data appear. Clinical consideration may justify a course of action at variance to the recommendations.

Autonomic Nerve Block↗
PubMed2005

A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding.

OBJECTIVES: Due to its superior ability to examine the entire small bowel mucosa, capsule endoscopy (CE) has broadened the diagnostic evaluation of patients with obscure gastrointestinal bleeding (OGIB). Published studies have revealed a numerically superior performance of CE in determining a source of OGIB compared with other modalities, but due to small sample sizes, the overall magnitude of benefit is unknown. Additionally, the types of lesions more likely to be found by CE versus alternate modalities are also unknown. The aim of this study was to evaluate the yield of small bowel findings with CE in patients with OGIB compared to other modalities using meta-analysis. METHODS: We performed a recursive literature search of prospective studies comparing the yield of CE to other modalities in patients with OGIB. Data on yield and types of lesions identified among various modalities were extracted, pooled, and analyzed. Incremental yield (IY) (yield of CE-yield of comparative modality) and 95% confidence intervals (95% CI) of CE over comparative modalities were calculated. RESULTS: A total of 14 studies (n = 396) compared the yield of CE with push enteroscopy for OGIB. The yield for CE and push enteroscopy was 63% and 28%, respectively (IY = 35%, p < 0.00001, 95% CI = 26-43%) and for clinically significant findings (n = 376) was 56% and 26%, respectively (IY = 30%, p < 0.00001, 95% CI = 21-38%). Three studies (n = 88) compared the yield of CE to small bowel barium radiography. The yield for CE and small bowel barium radiography for any finding was 67% and 8%, respectively (IY = 59%, p < 0.00001, 95% CI = 48-70%) and for clinically significant findings was 42% and 6%, respectively (IY = 36%, p < 0.00001, 95% CI = 25-48%). Number needed to test (NNT) to yield one additional clinically significant finding with CE over either modality was 3 (95% CI = 2-4). One study each compared the yield of significant findings on CE to intraoperative enteroscopy (n = 42, IY = 0%, p= 1.0, 95% CI =-16% to 16%), computed tomography enteroclysis (n = 8, IY = 38%, p= 0.08, 95% CI =-4% to 79%), mesenteric angiogram (n = 17, IY =-6%, p= 0.73, 95% CI =-39% to 28%), and small bowel magnetic resonance imaging (n = 14, IY = 36%, p= 0.007, 95% CI = 10-62%). Ten of the 14 trials comparing CE with push enteroscopy classified the types of lesions found on examination. CE had a 36% yield for vascular lesions versus 20% for push enteroscopy, with an IY of 16% (p < 0.00001, 95% CI = 9-23%). Inflammatory lesions were also found more often in CE (11%) than in push enteroscopy (2%), with an IY of 9% (p= 0.0001, 95% CI = 5-13%). There was no significant difference in the yield of tumors or "other" findings between CE and push enteroscopy. CONCLUSIONS: CE is superior to push enteroscopy and small bowel barium radiography for diagnosing clinically significant small bowel pathology in patients with OGIB. In study populations, the IY of CE over push enteroscopy and small bowel barium radiography for clinically significant findings is >or=30% with an NNT of 3, primarily due to visualization of additional vascular and inflammatory lesions by CE.

Barium Sulfate↗
PubMed2005

Yield of repeat wireless video capsule endoscopy in patients with obscure gastrointestinal bleeding.

PURPOSE: Capsule endoscopy (CE) has been shown to have a high diagnostic yield in patients with obscure gastrointestinal bleeding (OGIB). It is not known if repeating CE improves diagnostic yield or changes patient management when the initial CE is negative or nondiagnostic. The aims of this study are (1) to understand the reasons for repeat CE, (2) to determine the diagnostic yield of repeat CE, and (3) to establish if findings on repeat CE resulted in a change in patient management. METHODS: Between August 2001 and October 2003, we performed 391 capsule studies. Of these, 24 were repeat studies in patients with OGIB. We retrospectively reviewed the charts of these 24 patients. RESULTS: The reasons for repeat CE were: recurrent gastrointestinal bleeding (13), limited visualization on first exam due to poor prep or blood (10), complication (1) (capsule impaction at cricopharyngeus). Eighteen of 24 (75%) repeat capsule studies revealed additional findings (7 arteriovenous malformations, 2 gastropathy, 2 erosions, 2 masses, 1 ulcer, 2 red spots, 1 linear streak, 1 erythema). These findings led to changes in patient management in 15 of the 24 (62.5%) cases. CONCLUSIONS: Indications for repeat CE most commonly include recurrent gastrointestinal bleeding and limited visualization on initial study. Repeat CE results in a high yield of new findings that lead to changes in patient management. Repeat CE should be considered in patients with persistent OGIB when the initial study is negative or inconclusive.

Aged↗
PubMed2005

Safety of wireless capsule endoscopy in patients with implantable cardiac defibrillators.

OBJECTIVES: Wireless video capsule endoscopy (CE) is a new technology that allows visualization of the entire small intestinal mucosa. It is indicated for the evaluation of obscure gastrointestinal bleeding (OGIB) and other disorders of the small intestine. Studies to date suggest that CE is safe and associated with few adverse events. A concern, which has not been studied, is the potential effect of CE on implanted cardiac devices such as implantable cardiac defibrillators (ICD) and other electromedical devices. We previously found CE to be safe in patients with cardiac pacemakers. The primary aim of this study was to evaluate the safety of CE in patients with ICDs who were being evaluated for OGIB. In addition, a secondary aim of the study was to determine whether ICDs had any effect on the images captured by CE. METHODS: Patients referred for the evaluation of OGIB and who also had an ICD were enrolled into the study after informed consent. Five consecutive patients (four females and one male; mean age: 72 yr; range: 60-81 yr) with ICDs were studied. All patients had transvenous endocardial ICDs located in the chest. Prior to CE, patients had a baseline electrocardiogram (ECG) and ICD interrogation. Thereafter, CE was performed in a hospital setting with telemetry monitoring performed simultaneously. A post-procedure ICD interrogation was carried out to evaluate changes in programmed parameters. A cardiologist and ICD nurse specialist together reviewed both the telemetry monitor and the post-procedure ICD interrogation on each patient. When CE studies were reviewed, observations pertaining to technical difficulties and interference with video imaging were documented. RESULTS: No arrhythmia or other adverse cardiac events were noted during capsule transmission. No interference by the ICD on the CE video images was seen. CONCLUSIONS: CE was performed safely in these five patients with ICDs, and was not associated with any adverse cardiac events. ICDs also do not appear to interfere with video capsule imaging.

Aged↗
PubMed2004

Safety of capsule endoscopy in patients with pacemakers.

BACKGROUND: Capsule endoscopy, a new technology, allows visualization of the entire small intestinal mucosa. The main indication for capsule endoscopy at present is the evaluation of GI bleeding of obscure origin. Studies to date suggest that capsule endoscopy is safe and is associated with few adverse events. One concern, which has not been studied, is the potential effect of the capsule on cardiac pacemakers and other electromedical devices. The primary aims of this study were to evaluate the safety of capsule endoscopy in patients with cardiac pacemakers who are being evaluated for GI bleeding of obscure origin and to determine whether pacemakers have any effect on the images captured by the capsule endoscope. METHODS: Patients with cardiac pacemakers referred for evaluation of GI bleeding of obscure origin were entered into the study. Before the procedure, an electrocardiogram was obtained, and pacemaker functions were checked. Capsule endoscopy was performed in a hospital setting to allow closer monitoring, instead of the outpatient clinic, which is our routine. Cardiac rhythm was assessed simultaneously during capsule endoscopy with a Holter monitor. Post-procedure pacemaker function was again checked for any disturbance. When the capsule endoscopy studies were reviewed, observations were made with particular reference to technical difficulty or interference with imaging. OBSERVATIONS: Five consecutive patients (4 men, 1 woman; mean age, 73 years, range 56-92 years) with cardiac pacemakers were studied. In all patients, the indication for capsule endoscopy was GI bleeding of obscure origin. A cardiologist and pacemaker nurse specialist reviewed the Holter monitor recordings and evaluated pacemaker function after the procedure for each patient. No arrhythmia or other adverse cardiac event was noted during capsule transmission. No pacemaker-induced interference on the capsule endoscopy images was observed. CONCLUSIONS: Capsule endoscopy appears to be safe in patients with cardiac pacemakers and does not appear to be associated with any significant adverse cardiac event. Pacemakers do not interfere with capsule imaging.

Aged↗
PubMed2004

Strategies to address increased demand for colonoscopy: Guidelines in an open endoscopy practice.

BACKGROUND AND AIMS: Since Medicare approval for reimbursement of screening colonoscopies, the number of colonoscopy requests has increased. Physician resources have often been inadequate to meet the demand. We sought to reduce the demand for colonoscopy in an open endoscopy system by using a guideline-based triage system to eliminate inappropriate procedures and to align the timing of surveillance colonoscopies with recommendations made by national organizations. METHODS: This was a cohort study with primary care outpatients. From October 2002 to February 2003, 498 consecutive patients on a waiting list of 2400 awaiting colonoscopy for all indications were triaged and are the focus of the study. Selection of patients for appropriate colonoscopy was based on consensus guidelines developed for institutional use by using established published guidelines for appropriate colonoscopy indications. RESULTS: Of the 498 consecutive patients triaged, 139 (28%) were deemed inappropriate. The most common reason was inappropriate referral for surveillance of colorectal polyps. The percentage of inappropriate referrals by the 3 largest referring specialties (internal medicine, family medicine, and gastroenterology) combined was also 28% with no statistically significant differences between specialties. CONCLUSIONS: Most referrals for colonoscopy in an open-access endoscopy system were appropriate, although about 1 in 4 were not. Use of triage and further education of physicians regarding colonoscopy may optimize colonoscopy utilization.

Cohort Studies↗
PubMed2004

Diaphragm disease after use of nonsteroidal anti-inflammatory agents: first report of diagnosis with capsule endoscopy.

Diaphragm disease of the small intestine is part of the spectrum of diseases associated with injury to the gastrointestinal tract induced by nonsteroidal anti-inflammatory drugs. Standard endoscopy or contrast studies of the small intestine rarely identify these lesions. The diagnosis usually is established at the time of surgery. We report the case of a 72-year-old woman with obscure gastrointestinal bleeding and intermittent obstruction of the small intestine who had had multiple hospitalizations and extensive testing. The patient had been treated with nonsteroidal anti-inflammatory drugs for osteoarthritis. A radiograph of the small intestine with barium contrast revealed no abnormalities, so capsule endoscopy was performed. Capsule endoscopy showed multiple small intestinal strictures beyond which the capsule could not pass. After the patient experienced continued symptoms suggestive of intermittent partial obstruction of the small intestine, computed tomography showed the capsule within a dilated loop of intestine adjacent to a stricture. After 9 days of conservative medical therapy and worsening symptoms, the patient required an exploratory laparotomy. The capsule was located in a 12-cm segment of intestine with 4 diaphragm-like lesions. Pathologic study found submucosal lesions with features identical to those of neuromuscular and vascular hamartoma (eg, mature, reactive tissue elements of smooth muscle, dense fibrous tissue, and nerve tissue bundles with scattered ganglion cells and vessels). No manifestations of Crohn disease were evident. This case represents the first diagnosis with capsule endoscopy of diaphragm disease of the small intestine with pathologic features of neuromuscular and vascular hamartoma.

Aged↗
PubMed2004

The diagnostic yield of stool pathogen studies during relapses of inflammatory bowel disease.

GOALS: We sought to determine the yield of stool analysis for bacterial culture, ova and parasites, and Clostridium difficile toxin in suspected relapses of inflammatory bowel disease (IBD). BACKGROUND: The diagnostic yield of such stool studies has not been examined recently in the United States. STUDY: The medical records of consecutive IBD patients who underwent stool testing for relapses at our institution between July 1, 2000, and November 25, 2001, were abstracted for demographics, stool test results, recent antibiotic exposure, and hospitalization. RESULTS: Fifty-four patients were evaluated during 62 relapses with 99 stool samples. Twelve stool tests were positive. C. difficile accounted for the majority of positive tests (10/12). Of these, 9 (90%) were associated with antibiotic use in the prior month versus 10 (22%) in the C. difficile-negative group (P < 0.001). Hospitalization, prednisone use, or sulfasalazine use did not differ significantly with C. difficile status. Eight C. difficile-positive patients improved clinically with targeted antibiotic therapy. Two bacterial cultures (4%) were positive for Campylobacter jejuni and Plesiomonas shigelloides. CONCLUSION: Stool studies yielded a pathogen, mainly C. difficile, in 20% of the relapsing IBD patients. Antibiotic use was significantly associated with a positive C. difficile toxin. Toxin-positive patients improved clinically with targeted antibiotics.

Adult↗
PubMed2003

Small bowel: preliminary comparison of capsule endoscopy with barium study and CT.

PURPOSE: To retrospectively compare capsule endoscopic (CE) findings with findings at barium studies or computed tomography (CT) in patients without evidence of small-bowel stricture at barium examination. MATERIALS AND METHODS: Fifty-two patients underwent CE, and the majority (43 of 52) did so for obscure gastrointestinal bleeding. Forty-two (81%) of 52 patients underwent 36 small-bowel follow-through examinations; four, enteroclysis; and 19, contrast material-enhanced CT of the abdomen and pelvis within 6 months of CE (either before or after CE). Imaging results were retrospectively reviewed and compared with CE, standard endoscopic, and surgical results. Findings of any examinations between CE and imaging that were discrepant were retrospectively reviewed by a radiologist not blinded to CE results. Proportion of positive findings at CE was compared with proportion of positive findings at barium studies and CT in the same patients. Statistical significance was calculated with McNemar chi2 statistic. RESULTS: Barium examination findings were positive in one (3%) of 40 patients; CE findings were positive in 22 (55%) (P <.001). CT demonstrated small-bowel findings in four (21%) of 19 patients, but CE demonstrated findings in 12 (63%) of 19 patients (P =.02). The most common CE finding, angioectasia (n = 11), was not detected at any imaging study. More ulcers (n = 8) were detected with CE than with barium study (one of eight) and CT (three of six). At CE, three of five surgically confirmed masses (carcinoid, intussusception, lymphangioma) were identified, but two jejunal tumors were not detected in a patient with poor bowel preparation. At barium study, no masses (zero of five) were detected; at CT, one of four masses was detected. CONCLUSION: In patients without a small-bowel stricture at barium study, more small-bowel disease was found at CE when findings were retrospectively compared with barium examination and CT findings.

Adult↗