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At least 253 records · Page 14Linked to original sources
PubMed2003

[Acute lower gastrointestinal hemorrhage. Diagnosis and management].

In most cases (80%), acute lower gastrointestinal bleeding stops spontaneously, but rebleeding is frequent (25%). The intensity and quality of the bleeding--hematochezia, melena, or occult bleeding--determines the diagnostic and therapeutic strategy (endoscopic evaluation of the upper and lower gastrointestinal tract, mesenteric angiography, scintigraphy, enteroscopy, capsule endoscopy) and its urgency. Acute lower gastrointestinal bleeding can mostly be treated conservatively or by endoscopic interventions (injection therapy, clip application, coagulation and ligation methods). Severe hemorrhage can render colonoscopy and the identification of the bleeding source technically difficult. Emergency operations are only indicated when patients with severe hemorrhage cannot be stabilized by interventional endoscopy or angiography with selective embolization.

Acute Disease↗
PubMed2000

Surgical and endoscopic treatment of pancreatic pseudocysts.

Not long ago surgery was the only way to treat pancreatic pseudocysts that would not resolve spontaneously. Nowadays minimally invasive methods are gaining popularity, such as percutaneous drainage, endoscopic cystogastrostomy or cystoduodenostomy, and endoscopic transpapillary drainage. The aim of this study was to evaluate these methods in comparison with conventional surgery for pancreatic pseudocysts. From March 1997 to July 2000 we treated at the 2nd Dep. of Surgery, Wrocław Medical University, 52 patients with pancreatic pseudocysts. 30 patients were treated surgically, 15 endoscopically, and 7 medically. For endoscopic treatment we chose patients with "mature" pseudocysts, with a distinct capsule on ultrasonography, adherent to the posterior wall of the stomach, clinically sterile, at least 5-15 cms in diameter. The endoscopic criterion was the appearance of the cyst bulging into the stomach. Surgical treatment was applicable for those patients who had no positive evidence of a direct contact of the pseudocyst and the stomach, those with cysts infected, multiple or filled with dense fluid. The observed complications (infection of the cyst and bleeding) are typically reported for the treatment of pancreatic pseudocysts. The single complication in the form of an inflammatory tumor of the pancreas was probably due to undiagnosed pancreatic necrosis. There was zero mortality in our group. In our opinion endoscopic cystogastrostomy with a double pigtail stent is a valuable alternative to conventional surgery and in selected cases can be the method of choice for the treatment of pancreatic pseudocysts. Conventional surgical methods of treatment still remain valid. They are often less hazardous as they allow full visual evaluation of the cyst and its neighbourhood (for the signs of necrosis). Surgical drainage provides secure anastomosis of the cyst with the GI tract and hemostasis, which may be vital in some cases.

Adult↗
PubMed1999

Endoscopic treatment of symptomatic septum pellucidum cysts: with some preliminary observations on the ultrastructure of the cyst wall: two technical case reports.

OBJECTIVE AND IMPORTANCE: We describe two patients with symptomatic septum pellucidum cysts managed by endoscopic fenestration. In each case, tissue from the cyst wall was studied to define the origin of the cyst wall and fluid. CLINICAL PRESENTATION: The patients, a 6-year-old boy and a 42-year-old man, each presented with headaches and a syncopal episode. Imaging studies demonstrated large septum pellucidum cysts with obstruction of the foramina of Monro. INTERVENTION: The patients underwent endoscopic transventricular cyst fenestration with a 4-mm steerable fiberscope. The fenestrations were created to allow communication with the right and left lateral ventricles. In one patient, adhesions between the cyst wall and the foramen of Monro were lysed with endoscopic monopolar cautery. Tissue from the cyst walls was removed for examination by electron microscopy. Postoperatively, the headaches and syncopal episodes resolved in both patients. CONCLUSION: Endoscopic fenestration of symptomatic septum pellucidum cysts produces immediate relief of the mass effect of the cyst and resolution of associated symptoms. Cannulation of the lateral ventricle before cyst fenestration prevents inadvertent injury to the fornices, thalamus, internal capsule, caudate nucleus, and septal and thalamostriate veins. The endoscopic approach allows the surgeon to ensure communication within the ventricular system, thus avoiding placement of a shunt. Preliminary ultrastructural analysis indicates that the cyst walls derive from the septum pellucidum rather than the choroid plexus or arachnoid. The cellular machinery necessary for fluid secretion was identified in some specimens.

Adult↗
PubMed2002

Future developments in endoscopic imaging.

Flexible gastrointestinal endoscopy was introduced more than 30 years ago; this chapter will try to look into its future. Developments are expected in five different categories. We will see better with the use of high-resolution magnification endoscopy as well as by using other light-tissue interactions (such as spectroscopy). We will also be able to look just below the surface with laser-scanning microscopy and optical coherence tomography with a resolution of 1 microm (in vivo histology). Computers will assist with the interpretation of what we see, and the availability of broadband networks all around the world will allow real-time consultation globally. Invisible areas of the gastrointestinal tract will be seen with the help of improved endoscopy capsules and virtual endoscopy. Finally, we will treat endoscopically, with the help of new instruments and accessories, more of the lesions that we see.

Endoscopes↗
PubMed2005

Patients with functional heartburn are more likely to report retrosternal discomfort during wireless pH monitoring.

BACKGROUND: Although the wireless Bravo pH system is effective, some patients experience retrosternal sensations possibly caused by esophageal sensitivity that may complicate clinical application. METHODS: Ambulatory pH of 40 consecutive patients with GERD who had erosive esophagitis or nonerosive reflux disease, were monitored for 2 days with the Bravo system. Results were stratified and compared on the basis of self-awareness of the intraesophageal capsule. RESULTS: Pathologic acid reflux was diagnosed in 20 patients and normal reflux was diagnosed in 20 patients. Seventeen patients (42.5%) reported retrosternal discomfort, and 12 of them (70.6%) had normal reflux. Patients with retrosternal discomfort were less likely to have moderate endoscopic esophagitis, i.e., Los Angeles classification grades B, C, and D endoscopic esophagitis (p = 0.006), and were less likely to have significantly elevated esophageal acid exposure (p = 0.0036) than those who did not perceive the discomfort. Reported discomfort was not associated with age, gender, or the presence of endoscopic esophagitis. CONCLUSIONS: The negative correlation between Bravo-capsule-induced retrosternal discomfort and esophageal-acid exposure indicates modified mechanical afferent nerve function after long-term acid stimulation. Capsule-induced retrosternal discomfort in the presence of normal acid exposure suggests functional heartburn.

Adult↗
PubMedDate not supplied

[Endoscopic treatment of early gastric cancer: from Endoscopic Mucosal Resection (EMR) to Endoscopic Submucosal Dissection (ESD)].

Surgery has been the traditional treatment for early gastric cancer, but it is known that the endoscopic treatment offers the same results with a lower mortality rate. The first endoscopic therapy used was the polypectomy in cases of pediculate tumors. However, in depressed or flat tumors, tissue-destructive methods are used together with sclerosant substances, laser or plasma argon; their disadvantage is that the procedure cannot be properly evaluated since the tissue is destroyed. On the other hand, the Endoscopic Mucous Resection (EMR) techniques, such as strip biopsy, the injecting and cutting technique, the transparent capsule or the varices ligation, does permit the evaluation of the results of the endoscopic treatment. Progresses in EMR are due to the use of the chromoscopy and the submucous injection of various substances (normal and hypertonic saline solution, hyaluronic acid, etc.). The problem of the EMR is local relapse, attributed to the resection in lesions fragments of more than 10 mm. To resolve this problem, the Endoscopic Submucous Dissection (ESD) has been developed, using the endoscopic scalpel or its modifications; such as the endoscopic scalpel with the isolated point (IT-Knife). The last ones require more operating time, better skills and have more complications. The efforts to make a better diagnosis and treatment of these lesions continue day by day, by using the magnification endoscopes, the endoscopes with multiple inflexions, etc.

Digestive System Surgical Procedures↗
PubMed1991

Impact of endoscopic duodenal biopsy on the detection of small intestinal villous atrophy.

Coeliac disease is underdiagnosed partly because of insufficient recognition of more subtle presentations and partly because of the relative difficulty of jejunal biopsy. We have compared new case detection of small intestinal villous atrophy in the 5 years following changing to endoscopic multiple biopsy with our preceding 9 year experience utilizing jejunal capsule suction biopsy. The detection rate for small intestinal disease doubled while the number of patients investigated by small bowel biopsy increased threefold. We recommend that endoscopic duodenal biopsy replace jejunal biopsy for routine diagnostic purposes.

Atrophy↗
PubMed2002

Recent advances in the endoscopic diagnosis and therapy of upper gastrointestinal, small intestinal, and colonic bleeding.

Endoscopy has become the first and primary diagnostic and therapeutic modality in the management of patients with severe gastrointestinal bleeding. Panendoscopy, push enteroscopy, and colonoscopy provide the diagnostic, prognostic, and therapeutic elements to improve patient outcomes and to reduce morbidity and mortality from severe GI hemorrhage. Recent improvements in endoscopic hemostatic techniques and in imaging modalities using wireless capsule endoscopy suggest that diagnostic and therapeutic endoscopy will be even more important in determining patient outcomes in the future.

Blood Vessels↗
PubMed2006

Results of videocapsule endoscopy in 250 patients with suspected small bowel pathology.

We aimed to assess technical feasibility, clinical applicability, and diagnostic yield of videocapsule endoscopy (VCE) in a large group of unselected patients. VCE was performed with the Given Imaging swallowable capsule. Findings were considered diagnostic if the observed finding could explain the symptomatology of the patient. Findings were considered suspicious if an observed finding failed to completely explain the patient's symptoms. We studied 250 patients. A definite diagnosis was made in 95 patients (38%). Suspicious findings were noted in 80 patients (32%). No diagnosis was obtained in 74 patients (30%). The yield of VCE was higher in patients with suspected Crohn's disease. Mean viewing time decreased significantly from 51 +/- 14 to 30 +/- 7 minutes after reviewing 50 procedures. VCE is an important diagnostic tool, but a definite diagnosis is established in only 38% of the patients. The highest diagnostic yield is obtained in patients with suspected Crohn's disease.

Adolescent↗
PubMed1997

Branch retinal artery occlusion by diathermy of a persistent hyaloid artery.

PURPOSE: To report branch retinal artery occlusion caused by diathermy of a persistent hyaloid artery. METHODS: Case report. A 21-year-old woman with unilateral tractional retinal detachment caused by contraction of the persistent primary vitreous underwent vitrectomy with endocoagulation of the primary hyaloid artery. RESULTS: Postoperatively, the patient had opacification of the neurosensory retina in the area of the inferotemporal branch retinal artery accompanied by a corresponding visual field defect. CONCLUSIONS: Diathermy of a persistent hyaloid artery may be complicated by the occlusion of a branch retinal artery. In similar cases, atypical branches of retinal arteries must be considered. Dissection of the anomaly from the posterior lens capsule should be performed without coagulation or perhaps endoscopically if visualization is obscured by a Mittendorf dot.

Adult↗
PubMedDate not supplied

A prospective comparative study of push and wireless-capsule enteroscopy in patients with obscure digestive bleeding.

OBJECTIVES: To prospectively compare the global and specific diagnostic yields of push and wireless videocapsule enteroscopy for small bowel lesions in patients with obscure digestive bleeding after esogastroduodenoscopy and colonoscopy. METHODS: The patients studied had unexplained chronic iron-deficient anemia or digestive blood loss after routine investigations. Small bowel investigation was performed first with the wireless-capsule (M2A, Given Imaging) and then with the push-enteroscope (Olympus SIF100). RESULTS: Twenty-one patients were included in the protocol (14 females and 7 males), whose mean age was 60 years (range: 18 to 81). All patients had iron-deficient anemia with occult bleeding (n = 16) or overt bleeding (n = 5). A digestive lesion was observed in 14 of 21 cases (66%). Lesions were: esophageal varices (n = 2), reflux esophagitis (n = 1), upper gastrointestinal tract ulcerations (n = 9), intestinal angioectasia (n = 4), ileal varices (n = 1), cecal angioectasia (n = 1) and tumor-like angioma in the jejunum (n = 1). These 19 lesions were discovered by both methods in 10 cases (52%), by push-enteroscopy only in 6 (31%) and by wireless-capsule endoscopy only in 3 (17%). The global diagnostic yield was therefore slightly but not significantly higher for push wireless-capsule enteroscopy (61 vs 52%; NS) and the specific diagnostic yield was similar (20%). Interobserver agreement on the wireless-capsule recordings reached 85% for detection of findings. CONCLUSIONS: In patients with obscure digestive bleeding, no significant difference in diagnostic yield was evidenced between push and wireless-capsule endoscopy. The main advantage of the latter method versus the former was the detection of distal lesions in the small bowel. Wireless-capsule enteroscopy is mandatory for patients with active unexplained bleeding and negative push-enteroscopy, or for defining the extension of a disease involving, for instance, the presence of angioectasia.

Adult↗
PubMedDate not supplied

Endoscopy: current state and future trends in tumor diagnosis.

Gastrointestinal endoscopy has been significantly improved during the last decade. Tumors of less than 5 mm in diameter can now be detected by using high-resolution videoendoscopes. Additional in vivo staining allows better delineation and more precise identification of the lateral spreading of lesions. Today the missing of cancers in early stage is mainly due to lack of screening programs rather than technical limitations. Endoscopic mucosal resection of superficial lesions is primarily a diagnostic procedure to determine the need for surgery. However, it may be curative when histology proves a complete resection. Swallowable endoscopy capsules provide access to the entire small bowel. The capsule takes 2 images/second and transmits them to a recorder. After passage of the small bowel the 50,000 recorded images are reviewed on a computer. The capsule should not be used in patients with suspected intestinal stenosis. Endoscopic ultrasound (EUS) is an established procedure for the T- and N-staging of gastrointestinal tumors. With an accuracy rate of around 90%, this method is helpful for the therapeutic decision e.g. indication for operation. EUS cannot distinguish benign from malignant changes, particularly in focal pancreatic lesions. However, this drawback can be reduced with EUS-guided fine-needle aspiration cytology of the primary lesion or an accessible lymph node. At 7.5-20 MHz the gastrointestinal wall is visualized in 5 and more layers allowing for detailed staging of T1 tumors. 3D-EUS resolution is described to be better than 100 microns. Optical coherence tomography (OCT) with a resolution of 10-20 microns demonstrates tissue micro-architecture. Structures only seen in histology before are visualized real-time in vivo during endoscopy. However, the infiltration depth is only 1 mm and the method is still in the clinical experimental stage. Confocal microscopy has been recently adapted for endoscopy. Images from the first clinical evaluations already show single cells and nuclei. Cellular characteristics become visible and endoscopy is on the way towards optical biopsy.

Endoscopy, Gastrointestinal↗
PubMed2006

Safety and tolerability of transoral Bravo capsule placement after transnasal manometry using a validated conversion factor.

OBJECTIVES: To prospectively calculate and validate a conversion factor in healthy volunteers that allows accurate nonsedated, transoral (TO) Bravo capsule placement after transnasal (TN) manometry, and to evaluate the ease and safety of nonendoscopic Bravo placement compared with endoscopic placement. METHODS: Part 1. Twenty-five healthy volunteers underwent sequential TN and TO esophageal manometry to measure the distance to the lower esophageal sphincter (LES). A TN to TO conversion factor was calculated from these measurements. Part 2. Twenty volunteers underwent TN manometry followed by unsedated TO Bravo capsule placement using the conversion factor calculated in part 1. TN endoscopy then measured the location of the Bravo capsule in relationship to the squamocolumnar junction (SCJ). Part 3. During an 18-month period, 370 consecutive patients referred for a Bravo procedure underwent nonendoscopic, unsedated TO placement (308 patients) or standard endoscopically assisted placement (62 patients). RESULTS: Part 1. All 25 volunteers completed TN and TO manometry; a conversion factor of 4 cm was calculated. Part 2. Using the calculated conversion factor of 4 cm, a Bravo capsule was deployed TO 5 cm above the proximal border of the LES. The mean +/- standard deviation (SD) TN endoscopic distance to the capsule was 6.0 cm (+/-0.3 cm) above the SCJ. Part 3. A total of 333 patients completed the entire study (90%). Analysis of 48-h pH measurements did not reveal any significant differences between the two groups. CONCLUSIONS: A reliable and valid conversion factor of 4 cm following TN manometry permits accurate TO placement of the Bravo capsule without endoscopy. TO, unsedated Bravo placement is safe, well tolerated, and may minimize costs and potential risks associated with endoscopy.

Adolescent↗
PubMed1994

[A case of resected gastric cancer in which cancer had apparently disappeared by preoperative administration of tegafur].

This paper reports a case of gastric carcinoma in which cancerous tissue was not found in the resected specimen, apparently due to preoperative tegafur administration. The patient was a 56-year-old woman who was diagnosed by initial endoscopic examination including endoscopic biopsy as having an advanced gastric cancer of Borrmann type 2. During the waiting period for operation, she was placed on oral administration of tegafur (Futrafur capsule) 600 mg 3 times a day for 31 days. The second endoscopic examination 14 days later showed reduction of both marginal elevation and central excavation of the lesion, and biopsy at this time was negative for carcinoma. Because of the initial definite diagnosis of cancer, a gastric resection was performed 31 days later, but no cancerous tissue was found in the resected specimen. This case was considered to be a carcinoma especially sensitive to tegafur.

Adenocarcinoma↗