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PubMed1995

Upper gastrointestinal endoscopy.

Upper intestinal endoscopy is a well-accepted method for evaluation of the esophagus, stomach, and duodenum. The techniques are standardized and extremely safe. The therapeutic capability for control of gastrointestinal hemorrhage is a major advance in the treatment of gastrointestinal bleeding. Endoscopic ultrasound is useful in the staging of upper intestinal malignancies. Above all, the ability to directly visualize the mucosal lining, to obtain biopsies, and to remove polyps has made endoscopy a primary tool for investigation of upper gastrointestinal pathology.

Diagnosis, Differential↗
PubMed1996

[Evaluation of the effectiveness of screening for tumors of the digestive system].

Some features of digestive cancers encourage screening programs, even though no such program has been shown so far effective in reducing mortality rates. The visual inspection of the oral cavity and pharynx, with the addition of flexible endoscopy and, possibly, blue-toluidine staining, can be easily performed by specialists and dentists. The strong association with smoking habits and alcohol consumption favours the organization of screening programs but primary prevention maintains the highest priority. For cancer of the colon-rectum two different screening approaches are under close scrutiny: fecal occult blood testing, on an yearly basis, and once-in-a-life sigmoidoscopy at 55-60 years of age. Only one of five ongoing randomized prospective studies on occult blood testing has reported, so far, a significant reduction, around 33%, of mortality from colorectal cancer, with, however, a large burden of sigmoidoscopies.

Colorectal Neoplasms↗
PubMedDate not supplied

[The late examination results in children with pylorospasm and dyskinesia of the proximal sections of the small intestine].

The article analyses the late-term results of examination of 46 children with neurogenous dyskinesias of the gastrointestinal tract which were recognised in infancy for the first time. The author believes that the functional, motor-evacuation, and sphincter disorders of the proximal parts of the digestive tube lead to the development of organic noninfectious diseases of the gastroduodenal system.

Child↗
PubMed2000

Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease.

BACKGROUND: Heartburn affects 25% of the adult population on a monthly basis and represents the core symptom of gastro-oesophageal reflux disease (GORD). Treatment is readily available and puts a large demand on healthcare budgets. Research in the past has focused largely on the treatment of oesophagitis. A majority of GORD patients show no endoscopic abnormalities and in daily practice most patients are treated empirically. OBJECTIVES: Summarise, quantify and compare the efficacy of the short-term use of proton pump inhibitors (PPI), H2-receptor antagonists (H2RA) and prokinetics in the empirical treatment of GORD and the treatment of endoscopy negative reflux disease (ENRD). SEARCH STRATEGY: Electronic searches were performed of the Cochrane Controlled Trials Register, MEDLINE and EMBASE. Bibliographies were screened. SELECTION CRITERIA: Included were randomised controlled trials focussing on symptomatic outcome after short-term treatment for GORD using proton pump inhibitors, H2-receptor antagonists or prokinetic agents. Participants had to be classifiable in the empirical treatment group (no endoscopy used in treatment allocation) or in the endoscopy negative reflux disease group (no endoscopic signs of erosive oesophagitis). DATA COLLECTION AND ANALYSIS: Data from included trials were extracted by two reviewers independently. The impact of interventions was expressed as relative risks (RR) together with 95% confidence intervals (95% CI). Meta-analysis was only performed if there were sufficient trials of similar comparisons reporting the same outcomes. Relative risks were combined for binary outcomes. MAIN RESULTS: Twenty-one trials were included: eleven in the empirical treatment group, seven in the ENRD group and three in both. In empirical treatment of GORD the RR for heartburn remission in placebo-controlled trials for PPI was 0.35 (1 trial, 95% CI 0.26 to 0.46), for H2RAs 0.77 (2 trials, 95% CI 0.60 to 0.99) and for prokinetics 0.86 (1 trial, 95% CI 0.73 to 1.01). In direct comparison PPIs were significantly (p<0.05) more effective than H2RAs (3 trials, RR 0.67, 95% CI 0.57 to 0.80) and prokinetic's (2 trials, RR 0.53, 95% CI 0.32 to 0.87). In treatment of ENRD, RR for heartburn remission for PPI versus placebo was 0.68 (4 trials, 95% CI 0.53 to 0.88) and for H2RA versus placebo was 0.84 (2 trials, 95% CI 0.74 to 0.95). The RR for PPI versus H2RA was 0.69 (2 trials, 95% CI 0.39 to 1.20) and versus prokinetic 0.72 (1 trial, 95% CI 0.56 to 0.92). REVIEWER'S CONCLUSIONS: The findings in this review suggest that antisecretory drugs are effective in the empirical treatment of complaints likely to originate from GORD and in treatment of ENRD and furthermore that PPIs are superior to H2RAs in empirical treatment of typical GORD symptoms.

Endoscopy, Digestive System↗
PubMed2003

Endoscopic tumor diagnosis and treatment.

The abstracts from this year's Digestive Disease Week (DDW) show that endoscopic is consistently playing a prominent role in current gastroenterology. The topic of tumor diagnosis and treatment overlaps considerably with other review areas - e. g., endoscopic ultrasonography, endoscopic retrograde cholangiopancreatography (ERCP), and colonoscopy. This review therefore focuses on the following topics: enhanced imaging, endoscopic mucosal resection (EMR), and palliative stent therapy. Endoscopy with tissue sampling is increasingly becoming an integral part of transitional research, in collaboration with molecular biologists and geneticists, among others. This role is unlikely to be challenged by any of the rapidly improving pure imaging modalities, and may well become a core role for endoscopy in the years to come. Abstracts from this category are not included in this overview.

Clinical Trials as Topic↗
PubMed2006

Unsedated small-caliber upper endoscopy: an emerging diagnostic and therapeutic technology.

Although conventional esophagogastroduodenoscopy has become widespread in its applications and availability, it is constrained by the requirement for patient sedation. This requirement contributes to morbidity, time lost from work, and additional resource utilization in personnel and facilities. Small-caliber endoscopy is an emerging technology that enables transnasal evaluation of the upper gastrointestinal tract in a unsedated patient. This procedure can be performed in a wider range of settings, including the clinic setting where a dedicated conscious sedation suite is not available and can be incorporated into the office visit. The applications of small-caliber endoscopy include general diagnostic upper endoscopy, screening and surveillance of Barrett esophagus, and intraoperative diagnostics or postoperative evaluation of the upper gastrointestinal tract. Therapeutic applications include the placement of nasoduodenal feeding tubes, esophageal pH catheters, and impedance catheters. When used in the sedated patient, small-caliber endoscopy can also facilitate esophageal stricture dilation and transnasal placement of a percutaneous endoscopic gastrostomy tube. This review discusses the techniques, equipment, and applications of small-caliber endoscopy of the upper gastrointestinal tract.

Catheterization↗
PubMed2003

Upper gastrointestinal endoscopy in children - an experience at a paediatric gastroenterology unit.

Upper gastrointestinal endoscopy has changed the management of upper gastrointestinal problems in children. The aim of this communication is to share our experience with 153 cases on whom upper gastrointestinal endoscopy was done over a period of 24 months at a paediatric gastroenterology unit of a tertiary care hospital of Dhaka, Bangladesh. Children who attended the department with various gastrointestinal problems are the subjects of this paper. Intravenous midazolam and 10% pharyngeal xylocain were used in majority of cases for sedating the children. The ages of the children were between 15 months to 15 years (9.41+/- 3.22 years). The positive diagnostic yield was 92 out of 153 cases (60.1%). The major indication for doing endoscopy in the present series was recurrent abdominal pain (51.6%), followed by upper gastrointestinal bleeding (28.8%). Combining histopathological findings and CLO/rapid urease tests the overall positive yield of recurrent abdominal pain was 45 out of 79 (57%). The sources of upper gastrointestinal bleeding could be identified in 79.5% cases. Esophageal varices indicating portal hypertension were found in 62.5% children who were endoscoped for unexplained splenomegaly with or without ascitis. Endoscopy has become a safe and valuable procedure in the management of upper gastrointestinal problems in children and gastric antral biopsy has increased the positive diagnostic yield of recurrent abdominal pain in the studied children.

Adolescent↗
PubMed1999

The role of enteroscopy in clinical practice.

Enteroscopy does not yet carry the conviction that physicians are used to with gastroscopy and colonoscopy. The examination is never complete. The distance of small bowel examined in any individual examination is unknown. Although some therapeutic maneuvers are possible, the further the endoscope is into the small bowel the more difficult it becomes to pass and control the instruments. There is more room for improvement in enteroscopy than in almost any other area of gastrointestinal endoscopy. Nonetheless, there have been real gains for patients with difficult gastrointestinal bleeding and small bowel pathology with advances in diagnostic and therapeutic ability with enteroscopes achieved by a combination of relatively minor technologic changes and some clinical enthusiasm.

Biopsy↗
PubMed2001

[Endoscopy in the diagnosis of tumours of the digestive tract].

Methods of digestive endoscopy belong to the diagnostic standard of tumours of the digestive tract. The classical method is endoscopic examination of the upper and lower part of the tract which makes it possible to identify under visual control lesions which alter the character of the mucosal structure of hollow organs or lead to changes e.g. of the coloration of portions of the mucosa. From these sites samples can be taken to evaluate the character of the lesion and facilitate the differential diagnosis. Similarly examination of the pancreatobiliary system (ERCP) evaluates gross changes in the morphology of efferent systems. The objective is to find diagnostic methods which detect early stages of the disease, i.e. so-called minimal changes in the architectonics or biochemical structure at the level of the examined mucosa. These methods include endocopic sonography, supplemented by aimed biopsy. The examination makes it possible to visualize individual layers of the wall e.g. of the oesophagus, stomach or gut. An irregular pattern of the layers is the sign of a process which takes place inside the wall. New methods which make the diagnosis of mucosal lesions more accurate are endoscopic autofluorescence and optic coherent tomography (OCT). In particular OCT seems to be a promising contribution to the diagnosis of dysplasias and early tumourous changes of the oesophagus, stomach and gut.

Digestive System Neoplasms↗
PubMedDate not supplied

[Early endoscopic findings of the upper respiratory and digestive tract in patients undergoing translaryngeal intubation for more than 24 hours].

The large number of patients undergoing translaryngeal intubation justifies acquiring full knowledge of the complications that this invasive procedure may produce. The short-term problems that cause immediate complications (esophageal intubation, cuff rupture) are severe and do not escape notice. However, less immediate problems often pass undetected, although their presence may worsen the patient's outcome. Endoscopy allows the condition of the upper respiratory and digestive tract to be examined in order to detect and correct such problems. In this preliminary study, risk factors are analyzed and the lesions are described, classified, and quantified. Forty-seven adult patients were studied prospectively. In the first 24 to 48 hours of intubation, rigid endoscopy was performed under sedation using 0 degree and 30 degrees rigid endoscopes. The high rate of glottic edema (63.8%) was noteworthy because knowledge of this condition can be vital for preventing extubation failure.

Adolescent↗
PubMed2003

A prospective randomized comparison of unsedated ultrathin versus standard esophagogastroduodenoscopy in routine outpatient gastroenterology practice: does it work better through the nose?

BACKGROUND AND STUDY AIMS: In an outpatient gastroenterological practice setting, highly effective diagnostic procedures and patient satisfaction play an important role. Ultrathin endoscopy in unsedated patients has been shown to be more cost-effective and time-efficient in comparison with standard endoscopy. A prospective randomized study was carried out in unsedated patients to compare performance, feasibility, safety, and patient tolerance between ultrathin transnasal (UT), ultrathin oral (UO), and standard (SO) esophagogastroduodenoscopy (EGD). PATIENTS AND METHODS: A total of 200 of 600 eligible patients consented to participate in the study, and were randomly assigned to undergo UT, UO, or SO. Patients reported their tolerance of the procedure (anxiety, pain, gagging, and overall satisfaction; Likert scale 1-10), and the endoscopists reported the effectiveness of the procedure (handling, picture quality, and overall performance; Likert scale 1-10). Statistics were calculated using the Kruskal-Wallis test. RESULTS: After randomization, 65, 67, and 68 patients were allocated to the UT, UO, and SO groups, respectively. Failure to achieve complete EGD by the intended route occurred in 14 patients (22 %) in the UT group. Compared to the SO group, patients in the UT and UO groups rated anxiety before the procedure as being more intense - median score (10 % quantile estimate; 90 % quantile estimate): UT, 2.0 (1.0; 4.0); UO, 2.0 (1.0; 4.0); SO, 0.0 (0.0; 2.0); p < 0.0001), whereas SO patients experienced a higher level of anxiety during the procedure ( P < 0.0001). Pain during insertion of the endoscope was the least intense in the UO group: UT, 2.0 (1.0; 5.0); UO, 1.0 (1.0; 3.0); SO, 2.0 (1.0; 4.0); P < 0.001). Gagging during insertion was more pronounced in the UO group: UT, 2.0 (1.0; 4.0); UO, 3.0 (1.0; 7.0); SO, 2.0 (1.0; 5.0); P < 0.01). The patients' score for the overall assessment was better in the SO group ( P < 0.0001). The endoscopists' overall assessment for ultrathin EGD was poorer than for standard EGD: UT, 3.0 (2.0; 5.0); UO, 3.0 (2.0; 5.0); SO, 2.0 (1.0; 3.0); P < 0.0001). CONCLUSIONS: Ultrathin endoscopy through both the transnasal and oral routes has limited use in routine outpatient practice. Techniques for reducing pain and gagging may improve patient tolerance. Further technical improvements are needed to allow routine implementation.

Adult↗
PubMed1999

Safety and efficacy of esophagogastroduodenoscopy after myocardial infarction.

PURPOSE: To analyze the risks versus benefits of esophagogastroduodenoscopy performed soon after myocardial infarction. PATIENTS AND METHODS: We studied 200 patients who underwent endoscopy within 30 days after myocardial infarction with 200 controls matched for age, sex, and endoscopic indication who underwent endoscopy without a history of myocardial infarction within the prior 6 months. Odds ratios (OR) and 95% confidence intervals (CI) are reported. RESULTS: The indications for endoscopy included hematemesis in 88, melena in 43, fecal occult blood and anemia in 33, red blood per rectum in 13, abdominal pain in 13, and other indications in 10. Endoscopy was performed a mean (+/- SD) of 9.1 +/- 8.9 days after myocardial infarction, was diagnostic in 85% of all the patients, and was more frequently diagnostic when performed for hematemesis or melena than when performed for other indications (92% vs 71%, P <0.0003). Common diagnoses included duodenal ulcer, gastric ulcer, gastritis, and esophagitis. Fifteen post-myocardial infarction patients (7.5%) suffered endoscopic complications, including fatal ventricular tachycardia (n = 1), near respiratory arrest (n = 1), mild hypotension (n = 11), and moderate hypoxemia (n = 2), compared with three patients (1.5%) in the control group (OR = 5.3, CI = 1.5 to 19). Patients who had endoscopic complications after myocardial infarction had a significantly higher APACHE II score than those who did not (mean score of 17.3 +/- 5.8 vs 11.7 +/- 5.7, P <0.001). Endoscopic complications occurred in 21% (12 of 58) of post-myocardial infarction patients who were very ill (APACHE II score > or = 16) but in only 2% (3 of 142) of those whose condition was relatively stable (APACHE II score < or = 15, OR = 12; CI = 3.3 to 45). Hypotension before endoscopy and a high APACHE II score were independent risk factors for complications in post-myocardial infarction patients. CONCLUSIONS: Relatively stable patients with upper gastrointestinal bleeding and recent myocardial infarction can and should undergo esophagogastroduodenoscopy. Most endoscopic complications in these patients are cardiopulmonary, and they generally occur in very ill patients.

APACHE↗
PubMed2004

Valid symptom reporting at upper endoscopy in a random sample of the Swedish adult general population: the Kalixanda study.

BACKGROUND: Upper oesophagogastroduodenoscopy is considered to be the gold standard for upper gastrointestinal disease assessment, but is currently seldom used in epidemiological studies. One concern is that the procedure may bias sampling among volunteers in a general adult population. The aim of this study was to explore whether the procedure affects symptom reporting. METHODS: A random sample of 3000 adults aged 20-81 years (mean age 50.4), from two Swedish municipalities (n=21,610) was surveyed using a validated postal questionnaire (the Abdominal Symptom Questionnaire) assessing gastrointestinal symptoms. A subsample of the responders was invited, in random order, to undergo an upper endoscopy and repeated symptom reporting using the same questionnaire, as well as a serology test for Helicobacter pylori. RESULTS: The response rate to the initial questionnaire was 74.2% and the participation rate for those eligible for the upper endoscopy was 73.3% (n = 1001, mean age 54.0 years, 48.8% male). No major social or symptom sampling error was encountered from the selection process, with the exception of an excess of symptom reporters among the youngest subjects. The prevalence of reflux symptoms, dyspeptic symptoms and irritable bowel symptoms was 40%, 37.6% and 29.6%, respectively, which is relatively high, but in no way extreme. CONCLUSIONS: The upper endoscopy survey strategy was successful. The response rate was high and there was no major selection bias of clinical relevance. The cohort selected for this study appears to be representative of the general Swedish adult population.

Adult↗
PubMed1995

Endoscopic ultrasonography in the study of extramucosal swellings in the upper digestive tract.

The authors performed an echoendoscopic examination of 91 patients who, at a previous endoscopy, had presented extramucosal swellings in the upper digestive tract. On this occasion, the images were suggestive of a leiomyoma in 73 cases, a schwannoma in 3, an ectopic pancreas in 1, and a cyst of the gastric wall in 1. There was an extrinsic compression of the tract by an adjacent organ in three cases and by an adenopathy in two others. In six patients the authors were unable to make an echographic identification of the swellings noted upon endoscopy as they noted no echographic alteration. The echoendoscopic examination was considered normal. Given that most of these patients did not undergo surgery, the authors were only able to obtain a histological examination of surgically removed tissue in 11. The diagnosis was confirmed in eight cases. In one patient in which it proved impossible to pass the endoscope through the stenotic area, the histological examination did not confirm the echography: In two others, classified as leiomyomas, the histology showed leiomyosarcomas.

Digestive System Neoplasms↗
PubMed1999

[Advances in endoscopic therapies for cancers of the digestive tract].

Endoscopic therapies for the treatment of cancers of the digestive tract have been improved. Today, some early cancers can be curatively treated by endoscopy (endoscopic polypectomy, endoscopic mucosal resection, heatprobe method, etc.). In addition, endoscopic local injection chemotherapy is performed for some advanced cancers as an adjuvant therapy. Recent progress in endoscopic therapies for cancer is reviewed in this paper, including their historical background. Improvements in these endoscopic treatment methods are expected to provide increased advantages for the treatment of patients with cancer in the near future.

Colonic Polyps↗
PubMed2003

Incidental findings of thickening luminal gastrointestinal organs on computed tomography: an absolute indication for endoscopy.

OBJECTIVES: Incidental findings of thickened luminal GI organs (LGIO) on CT are not uncommon. However, the significance of these findings is unclear. Because of the lack of scientific data, there are no clinical guidelines for the evaluation of these radiologic abnormalities. Our objective was to determine whether endoscopic evaluation of these findings revealed significant abnormalities. METHODS: This study evaluated all incidental findings of thickened LGIO in a large medical center from October, 1997 to March, 1999 that were followed by endoscopic examinations. RESULTS: Ninety-six percent of patients with incidental findings of thickening of the sigmoid colon or rectum, 81% of patients with thickening of the distal esophagus, and 13% of patients with thickening of the cecum had significant abnormalities on further endoscopic work up. CONCLUSIONS: Although positive pathologic findings are less common in thickening of the cecum than in other LGIO, all of these incidental findings on CT warrant further endoscopic examination.

Adult↗