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At least 217 records · Page 12Linked to original sources
PubMed2005

[Video-capsule endoscopy in children with unexplained symptoms of the small intestine].

Video-capsule endoscopy was used in 4 children with unexplained symptoms of the small intestine. Each patient swallowed a capsule of 11 by 27 mm, which contained a camera that takes 2 images per second (in children aged less than 8 years, the capsule was placed in the duodenum under sedation). In a 3-year-old girl with rectal bleeding following partial resection of the colon and small intestine, ulcers were seen proximal to the ileorectal anastomosis. In a 14-year-old boy with Crohn's disease and an abnormal growth curve, multiple stenoses of the small intestine were seen. In an 8-year-old boy with rectal bleeding, a solitary polypoid mass was seen that, upon operation, appeared to be the result of a partially invaginated Meckel's diverticulum. In a 17-year-old boy with weight loss, rectal bleeding and colitis, abnormalities were seen that were consistent with Crohn's disease. Patients were treated based on the endoscopic results and subsequently recovered. Video-capsule endoscopy is non-invasive and painless and provides better images of the small intestine than a standard endoscopic and radiological examination.

Adolescent↗
PubMedDate not supplied

Transnasal endoscopic approach to expose the medial rectus from the annulus of Zinn to the penetration of Tenon's capsule.

Conventional strabismus surgery employs a conjunctival incision to gain access to Tenon's space where a wide variety of procedures are routinely performed on the tendon and anterior aspect of the extraocular muscles. Recently, transnasal endoscopic surgical techniques have gained acceptance as effective means of decompressing the medial wall and floor of the orbit in patients with thyroid-related orbitopathy. The orbital surface of the medial rectus and inferior rectus are exposed from the annulus of Zinn to a position close to where the muscles penetrate Tenon's capsule. In theory, this technique also provides the exposure necessary to locate and retrieve a "lost" medial rectus when the usual sub-Tenon's approach fails to recover the muscle. Cadaver studies demonstrate the feasibility of exposure and suture placement in the stump of a lost medial rectus with passage of the suture through Tenon's capsule to transmit the force of the muscle to the globe, provided that the lost muscle is retrieved before severe contracture develops.

Endoscopy↗
PubMed1999

Are endoscopic biopsies of small bowel as good as suction biopsies for diagnosis of enteropathy?

BACKGROUND: Endoscopy is increasingly used in paediatric practice for diagnosis of enteropathy, although the quality of grasp forceps-obtained biopsy specimens required for reliable diagnosis has been questioned in comparison with suction capsule biopsy specimens. This study prospectively compared the diagnostic suitability of grasp forceps biopsy versus suction biopsy in the same patient during the same procedure. METHODS: A double-port paediatric suction biopsy capsule was front-loaded onto an endoscope and directed to the fourth part duodenum-proximal jejunum for biopsy sampling. Subsequently, three grasp biopsy specimens were taken from the same region. All biopsies were coded, photographed, and measured for area, using computed morphometry. A single blinded histopathologist assessed sample adequacy for diagnosis. Twenty-nine patients were enrolled (age range, 8-185 months). RESULTS: On three occasions the suction capsule failed to fire, and on four occasions only one sample was obtained. Three grasp biopsy specimens were obtained on each occasion by endoscopy, and the first two were used for comparison with suction biopsy samples. Median total area of individual biopsy samples obtained by the two procedures was not different (21.3 vs. 22.5 mm2; P = 0.027). Muscularis mucosae was obtained more commonly with grasp biopsies (P<0.001), and no difference was observed for the presence of three or more villus-crypt units, degree of haemorrhage, or optimal orientation. Two suction biopsy procedures and one grasp biopsy procedure were inadequate for diagnosis. CONCLUSIONS: Endoscopic grasp biopsies are perfectly adequate for the assessment of small intestinal histology. In addition, endoscopy affords advantage in diagnosis of other upper gastrointestinal disease with avoidance of radiologic screening involved with the suction capsule technique.

Adolescent↗
PubMed1987

Evaluation of the ulcerogenic effect of potassium chloride by endoscopy and fecal blood loss.

In a blinded-observer crossover study, 16 volunteers ingested equimolar doses of three different potassium chloride preparations and placebo for nine days in a random order. The irritating effect on the mucosa was evaluated by means of upper gastrointestinal endoscopy and fecal blood loss, measured by reference to the amount of radioactivity in three 24-hour samples after previous injection of 51Cr-tagged autologous red cells. The microencapsulated KCl capsule preparation induced three ulcers, but the total endoscopic group score was not significantly higher than the score with placebo. The total endoscopic group score for the wax-matrix formulation was significantly higher than the score for placebo (P less than .05) and for a new microencapsulated KCl tablet preparation containing a potent disintegrant (P less than .10). We did not find any significant differences in mean fecal blood loss during the four different treatments. A correlation between endoscopic score and fecal blood loss was found in the placebo group (r = .54) and the microencapsulated KCl capsule preparation (r = .56) group.

Adult↗
PubMed1988

YAG laser treatment of early carcinoma of the prostate.

We describe our initial experience of a method which develops the role of endoscopic surgery in the treatment of early prostatic carcinoma. An "extended" transurethral resection of the prostate (TURP) under ultrasound control reduces the prostatic tissue to a thin residual capsule suitable for subsequent transmural coagulation by endoscopic YAG laser. Twenty patients with early disease were entered into the pilot study. Three were excluded after staging (2 T0a and 1 with positive nodes on pelvioscopy-T2 N1 M0); 17 received a full course of treatment. Mean follow-up was 6 months (range 1-14). Two early patients with excessive residual tissue had initially positive biopsies and underwent second treatments with subsequently negative biopsies. Two patients continue to have positive biopsies and the rest are negative. No tumour has progressed and complications have been minimal. One patient experienced reduced frequency of erections and 1 required bladder neck incision for symptomatic bladder neck stenosis at routine follow-up endoscopy. There were no other effects on either potency or continence.

Adult↗
PubMedDate not supplied

The role of endoscopy in inflammatory bowel disease.

Endoscopy is an essential tool for diagnosis, management and prognostic evaluation of inflammatory bowel disease. However dyscomfort, potential risks and costs associated to endoscopic examinations should contribute to the narrowing of indications to those cases in which the result of endoscopy is essential to determine a variation in the management strategy. Ileocolonoscopy performed by an expert endoscopist allows accurate diagnosis of Crohn's disease or ulcerative colitis in up to almost 90% of cases. Colonoscopy has a prognostic role during a severe flare of disease (the occurrence of severe endoscopic lesions have a negative prognostic value with significantly higher risk not to respond to medical treatment) both in ulcerative colitis and in Crohn's disease; moreover in Crohn's disease the evaluation of recurrent lesions at anastomosis after curative surgery has a strong prognostic role (endoscopic recurrence closely correlates with clinical/surgical recurrence) and preliminary data suggest that mucosal healing assessed with endoscopy after biologic treatments could be associated with a better prognosis. Finally colonoscopy is essential for cancer surveillance during the long-term follow-up. Furthermore there are new endoscopic techniques under evaluation in inflammatory bowel disease, like wireless capsule endoscopy or double balloon enteroscopy for the imaging of small bowel, or endoscopic ultrasound for evaluation of strictures or of perianal disease. Finally some operative techniques like balloon dilation could possibly be employed more frequently in the future in the management of Crohn's disease. Future perspectives in endoscopy for IBD are chromoendoscopy and newer endoscopic imaging techniques, possibly leading to an "in-vivo histology".

Endoscopy, Digestive System↗
PubMed1980

Endoscopic small bowel biopsy in children with a modified multipurpose biopsy tube.

Small bowel biopsy is a difficult procedure in infants and children, and the authors describe a new technique. The Quinton multipurpose suction biopsy instrument is incorporated into an Olympus GIF-P2 fiberoptic endoscope to allow positioning of the biopsy capsule under direct visual control. Fourteen children, 2 months to 4 years of age, have been biopsied, and tissue was successfully obtained in 20 of 21 procedures. Nine of 21 endoscopic examinations of duodenal mucosa were abnormal and gave additional diagnostic information.

Biopsy↗
PubMed2001

Virtual endoscopic evaluation of labyrinthine fistulae resulting from cholesteatoma.

OBJECTIVES/HYPOTHESIS: Fistulae of the otic capsule occur in approximately 10% of cholesteatoma cases. Preoperative imaging of this complication is valuable in limiting intraoperative morbidity. Three-dimensional virtual endoscopic imaging provides a new method for analysis of conventional computed tomography (CT) imaging data. The purpose of the study was to examine the feasibility and efficacy of this technique in detecting labyrinthine fistulae caused by cholesteatoma. STUDY DESIGN: Retrospective case study. METHODS: Fifteen patients with surgically confirmed lateral semicircular canal fistula and preoperative CT scan were included. Scans meeting inclusion criteria were imported into a software program for production of virtual endoscopic images. Dehiscent and normal lateral semicircular canals were navigated while varying threshold values for surrounding bone. Changes in threshold values produce the effect of thickening or thinning the bone enveloping the semicircular canal. Threshold parameters that produced easy circumnavigation ("open") and intact inner surface of the lateral canal ("closed") were recorded. RESULTS: The fistula group demonstrated a significantly lower "closed" threshold level and, consequently, a greater range of navigation between "open" and "closed" thresholds. Intrasubject absolute differences in threshold values between normal and abnormal ears appeared to be the most accurate method for detecting a fistula. The suggested imaging parameters displayed an overall sensitivity for fistula detection of 67% with a specificity of 93%. CONCLUSIONS: The three-dimensional virtual endoscopic algorithm shows promise as a method for confirmation of otic capsule dehiscences. Sensitivity for detection is suboptimal but can be improved by alterations in image acquisition parameters.

Adolescent↗
PubMedDate not supplied

[Critical assessment of indications for arthroscopic lateral release and medial tightening of the knee joint].

UNLABELLED: Based on the results of a retrospective study of 50 patients with mild lateral tracking and lateral compression of the patella (32 patients) and recurrent patellofemoral dislocation (18 patients), we present the technique, the results, the complications and the indications for the endoscopic lateral retinacular release and medial drawing tight of the capsule. The average age of the patients was 28.8 years (range: 10-53). At time of follow-up (m = 51 months) the patients were examined clinically as well as radiologically. The results were scored according to a score by Crosby and Insall. 73% of the patients with mild lateral tracking and lateral compression (lateral release) were satisfied with the operative results (visual analogue scale), as well as 66.6% of the patients with recurrent patellofemoral dislocation (lateral release and medial drawing tight of the capsule). Only 40% of the patients with patellofemoral arthritis (lateral release) reported about an improvement of this procedure. The score showed significantly good results but didn't raise the differences in between the groups of different indications. 28% of the patients showed an abnormal lateral tracking of the patella in active motion, the passive patella-glide-test (Hughston) raised a patella-hypermobility to the lateral side in 36% of the cases and to the medial side in 76%. X-rays of both knees showed an increased lateral patellofemoral angle of 10.8 degrees and an increased sulcus angle of 144 degrees. There was no progression in osteoarthritis in the operated side of the patellofemoral joint found. Complications revealed in a high number of hemarthrosis right after the operation, in 2 cases an open revision was necessary. CLINICAL RELEVANCE: According to our results patients with patella compression syndrome without patellofemoral arthritis and patients with recurrent luxation or subluxation of the patella are good candidates for endoscopic lateral release and eventually medial drawing tight of the capsule. In a young population the endoscopic lateral release is a relatively simple surgical procedure making an open technique in failed cases possible.

Adolescent↗
PubMed2006

Day-to-day variability in acid reflux patterns using the BRAVO pH monitoring system.

BACKGROUND & GOALS: The wireless pH monitoring system such as the BRAVO pH system is a significant advancement in the evaluation of patients with gastroesophageal reflux because of its potentially better tolerability and the ability to record data over a 48-hour period. The aim of our study was to evaluate safety, performance, tolerability, and day-to-day variability in acid reflux patterns using the BRAVO pH system. METHODS: A total of 90 consecutive patients (48 men and 42 women) with persistent reflux symptoms underwent BRAVO pH capsule placement from October 2002 to August 2003 at a tertiary care hospital. The BRAVO pH capsule was deployed 6 cm proximal to the squamocolumnar junction under endoscopic guidance. The pH recordings over 48 hours were obtained after uploading data to a computer from the pager-like device that recorded pH signals from the BRAVO pH capsule. RESULTS: Successful pH data over 48 hours was obtained in 90% of patients. Nearly two thirds of patients experienced a variety of symptoms ranging from a foreign body sensation to chest discomfort or pain. Four patients had severe chest pain, 3 of whom required endoscopic removal of the BRAVO pH capsule. In 74.4% of patients, number of reflux events as well as time (%) pH<4 correlated from the first 24-hour period to the second 24-hour period. However, in 28% of patients, no predictable pattern of (%) time pH<4 in the supine position was reproduced from one 24-hour period to the next 24-hour period. CONCLUSIONS: The BRAVO pH system appears a safe and effective method of recording esophageal acid exposure. It is an acceptable alternative for patients who are unwilling or unable to tolerate nasopharyngeal catheter-based pH studies, and it has a potential advantage of the 2-day recording period.

Adolescent↗
PubMed2002

Wireless capsule endoscopy -- beyond the frontiers of flexible gastrointestinal endoscopy.

Wireless capsule endoscopy is currently the outstanding technical innovation in diagnostic gastrointestinal endoscopy. Especially for small bowel diseases this new technique offers several potential advantages compared to traditional diagnostic tools. Capsule endoscopy is a painless procedure that can be performed as an ambulatory endoscopic examination. First experimental studies proved the good tolerance of the capsule endoscopy and the possibility of a complete visual investigation of the small bowel. Clinical studies demonstrated possible fields of application: Obscure chronic or intermittent gastrointestinal blood loss and inflammatory bowel disease. The major risk of the procedure - intestinal obstruction by the capsule - may hinder its use in the diagnosis of polyps or tumors in the small bowel. In the next years it will be exciting to see whether capsule endoscopy will finally reach the clinical significance we expect at the moment. Possibly, the diagnostic algorithm for obscure gastrointestinal bleeding has to be changed in the future due to the abandonment of less effective procedures.

Endoscopy, Gastrointestinal↗
PubMed2005

Small Bowel Bleeding.

The management of patients with small bowel bleeding remains a diagnostic and therapeutic challenge. In most gastrointestinal bleeding episodes, the source of hemorrhage is localized to either the upper gastrointestinal tract or colon; however, in about 5% of cases, upper endoscopy and colonoscopy are nondiagnostic, and the small intestine is the site of bleeding. Patients with suspected small bowel source of bleeding may present with either occult blood loss or recurrent overt gastrointestinal hemorrhage requiring frequent blood transfusions and hospitalizations. Knowing the etiology and site of hemorrhage is essential prior to initiating appropriate therapy. The most common causes of small bowel bleeding are vascular ectasia, tumors, ulcerative diseases, and Meckel's diverticula. For patients with severe obscure bleeding, push enteroscopy with a 220- to 250-cm enteroscope is strongly recommended. This procedure provides not only a thorough examination for diagnosis, but also allows for biopsy, tattooing, and hemostasis of lesions. If enteroscopy is nondiagnostic, capsule endoscopy is recommended. A diagnostic capsule endoscopy will direct appropriate medical, endoscopic, or surgical intervention, depending on whether the lesion is single or multiple, and whether the patient is a surgical candidate for intraoperative enteroscopy. Intraoperative enteroscopy should be strongly considered in patients with recurrent bleeding and a nondiagnostic evaluation. Laparoscopy and intraoperative enteroscopy is highly recommended in young patients (< 50 years of age) because there is an increased frequency of small bowel tumors and Meckel's diverticulum which are amenable to surgical therapy.

Journal Article↗
PubMed2005

Complications, limitations, and failures of capsule endoscopy: a review of 733 cases.

BACKGROUND: Although a variety of technical and clinical problems of capsule endoscopy have been reported, their incidence and clinical importance are unknown. The objective was to evaluate the incidence and the type of such events. METHODS: This was a retrospective analysis of 733 consecutive examinations at 4 large referral centers. The main outcome measurements were that the problems were classified as "technical," i.e., related to the functioning of the equipment, and "clinical," i.e., related to patient characteristics. For each type of event, the causes and the impact on the ability to reach a diagnosis were examined. RESULTS: A total of 183 problems were recorded in 174 patients (23.7%): one problem occurred in 165 patients, two in 9 patients. In 8.46% of patients, technical limitations or failures, or clinical complications prevented or hampered diagnosis. Technical problems (e.g., gaps in the recordings, short duration of capsule batteries, failure of downloading) occurred in the early phase of capsule use in 8.6% of examinations and prevented or hampered diagnosis in 2.9%. Clinical problems (difficulty/inability to swallow the capsule, incomplete small-bowel examination) occurred in 16.4% of examinations and hampered or prevented diagnosis in 6.4%. Capsule retention that required surgical or endoscopic retrieval occurred in 1.9% of cases. CONCLUSIONS: Technical problems were rare and hampered or prevented the diagnosis in a very small number of cases. The majority of clinical failures were related to an incomplete small-bowel examination.

Adolescent↗
PubMed2004

Duodenal versus jejunal biopsies in suspected celiac disease.

BACKGROUND AND STUDY AIMS: In the past, small-bowel biopsies for diagnosis of celiac disease were taken from the jejunum with a suction capsule, but nowadays most physicians take endoscopic biopsies from the distal duodenum. To validate that practice we compared the diagnostic yield of endoscopic duodenal biopsies with that of endoscopic jejunal biopsies. In addition, we describe a method of orienting biopsy specimens optimally. PATIENTS AND METHODS: Upper endoscopy was performed with a colonoscope. Four jejunal and four duodenal biopsies were taken and oriented immediately thereafter. The pathologist rated the orientation as poor, adequate, or good, and histopathological results were expressed according to the Marsh classification. Jejunal and duodenal biopsy results were compared. RESULTS: 146 patients were included. Jejunal biopsies were taken in 142 patients, and Marsh I-II lesions were found in 56 and Marsh III lesions in 15 patients. In three patients duodenal biopsies were normal while jejunal biopsies showed Marsh I-II lesions. No discrepancies were found in patients with Marsh III lesions. Orientation was good in all biopsies. CONCLUSION: Duodenal biopsies are sufficient to diagnose full-blown celiac disease (Marsh III), but Marsh I-II lesions may be missed in some cases.

Adult↗