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At least 307 records · Page 17Linked to original sources
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↗
PubMed2003

Safety of nonanesthetist sedation with propofol for outpatient colonoscopy and esophagogastroduodenoscopy.

BACKGROUND AND STUDY AIMS: In our endoscopy service, nonanesthetists administered propofol sedation has been used in more than 8000 procedures during the past 3 years. This study prospectively assessed the safety of propofol sedation in outpatient colonoscopy and esophagogastroduodenoscopy (EGD). PATIENTS AND METHODS: A total of 300 consecutive outpatients (mean age 53, range 14-94) were enrolled in the study (139 colonoscopies, 161 EGDs). After an initial dose of 0.5 mg/kg (ASA I-II and age </=70) or 0.25 mg/kg (ASA >III or age >70 years), propofol was titrated in 10 mg boluses to a steady state of sedation by the endoscopy nurse under the endoscopist's supervision. Colonoscopy patients also received 25 mg pethidine (meperidine) and 20 mg butylscopolamine, whereas EGDs were performed with propofol sedation alone, without topical pharyngeal anesthesia. In addition to standard monitoring with pulse oximetry and automated sphygmomanometry, patients were also observed with sidestream capnography or measurement of electrocardiographic impedance changes, providing real-time graphic assessment of respiratory activity. All patients were given oxygen 2 L/min by nasal cannula during the entire procedure. RESULTS: Mean dosages of 157 mg (range 70-340) and 180 mg (60-400) propofol were administered for colonoscopy and EGD procedures, respectively. No episodes of apnea occurred. The oxygen saturation fell below 90 % for short periods of time in 11 patients (3.7 %). Three patients required a temporary increase in oxygen delivery. No assisted ventilation was necessary. In 22 patients (7.3 %), the mean blood pressure temporarily decreased below 50 mmHg. Two patients received a 500-ml infusion of normal saline. CONCLUSIONS: Propofol can be safely administered for sedation during colonoscopy and esophagogastroduodenoscopy by nonanesthetists who are familiar with the pharmacological properties and use of this drug.

Adolescent↗
PubMed1998

Esophagogastroduodenoscopy performed by a family physician. A case series of 793 procedures.

BACKGROUND: Primary care physicians are performing an increasing number of gastrointestinal endoscopies. The purpose of this research is to present a large case series of diagnostic esophagogastroduodenoscopies (EGDs) performed by a family physician in a solo rural practice. METHODS: We present a retrospective chart review, including demographic characteristics, indications, endoscopic and pathologic findings, and complications for every EGD performed by a family physician over a 7-year period. RESULTS: Seven hundred ninety-three EGDs were performed on 602 patients (421 women, 181 men), with a mean age of 51.8 years. In 99% of procedures, the second portion of the duodenum was intubated. The most common indications for EGD were abdominal pain (60.5%), gastrointestinal bleeding (23.0%), dysphagia (11.6%), and heart-burn (10.7%). A total of 451 biopsies were obtained in 385 procedures, mostly from the distal esophagus (38%) or gastric antrum (37%). Common endoscopic diagnoses were gastritis (54%), esophagitis (25%), and normal study (15%). There were only two malignancies detected, one gastric lymphoma and one carcinoma metastatic to the stomach. One minor complication (0.13%) occurred, an immediate urticarial rash after intravenous meperidine. CONCLUSIONS: Experienced family physicians can safely and competently perform diagnostic EGD and provide this important service to their community.

Adolescent↗
PubMed2006

Value of preoperative upper endoscopy in patients undergoing laparoscopic gastric bypass.

BACKGROUND: Preoperative evaluation of patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGBP) has included esophagogastroduodenoscopy (EGD) with little data to substantiate its use. METHODS: A retrospective analysis was conducted of patients from Feb 04 to Mar 05 who underwent preoperative EGD and subsequently LRYGBP. RESULTS: 169 patients underwent EGD prior to surgery. Their mean age was 41.1 years (range 14-66), mean BMI 49.7 (range 35-78), and 82% were females. There were no complications from EGD. Significant findings in patients at EGD included gastric ulceration in 3 (2%), duodenal ulcer in 1 (0.7%), Barrett's esophagus in 2 (1.3%), and a GI stromal tumor (GIST) in 1 (0.7%). EGD revealed hiatal hernias in 56 (35.2%), esophagitis in 28 (17%), Schatzki's ring in 5 (3%), gastritis in 43 (27%), gastric polyps in 8 (5%), and duodenitis in 9 (6%). 53 patients (33.3%) had a negative EGD. Ulcer and severe gastritis, esophagitis, and duodenitis diagnosed preoperatively were treated medically before surgery. 9 hiatal hernias were repaired intraoperatively. The patient with the GIST underwent laparoscopic near-total gastrectomy and gastric bypass, while 1 patient with an antral polyp underwent laparoscopic partial gastrectomy in addition to the LRYGBP. CONCLUSION: EGD is essential for diagnosis of GI diseases including tumors, ulcers, and hiatal hernias that alter the medical and surgical management of patients undergoing gastric bypass.

Adolescent↗
PubMedDate not supplied

Mucolytic-antifoam solution for reduction of artifacts during endoscopic ultrasonography: a randomized controlled trial.

Gastric mucus and air bubbles are frequent sources of artifacts during endoscopic ultrasonography (EUS). To reduce these artifacts, we prepared a mucolytic-antifoam solution consisting of simethicone, acetylcysteine, and sodium bicarbonate and performed a prospective randomized and controlled trial comparing this solution (21 patients) to a placebo (22 patients) during EUS. Eight patients in the drug group received a perfect score for both mucolytic and antifoam effect compared with none in the placebo group (p less than 0.001). For overall rating, the drug group received a total of 10 excellents and 9 goods compared with 9 goods, 10 satisfactories, and 1 unacceptable in the placebo group (p less than 0.001). There were no complications associated with the solution. In conclusion, a mucolytic-antifoam solution improved endoscopic visualization and reduced artifacts during EUS study. Its routine use during EUS procedures is therefore recommended.

Acetylcysteine↗
PubMedDate not supplied

Percutaneous endoscopic gastrostomy in children with malignant disease.

The objective of the study was to assess both the possible complications of percutaneous endoscopic gastrostomy (PEG) in pediatric cancer patients and its effect on weight development. The medical records of 18 children with a median age of 2.5 years (range, 0.5-14.2 years) were reviewed. The diagnoses were leukemia, central nervous system tumors, solid tumors, and lymphoma. The indications for PEG were anticipated therapy-related nutritional problems and inadequate food intake, weight loss, swallowing problems in relation to paresis of the pharynx, and relapse of the disease. Ten children received a PEG at treatment start, and eight children received it at a median time of 3.4 months (range, 0.9-27.4 months) after treatment start. The median duration of having a PEG in place was 12.3 months (range, 1.2-24.0 months). At admission the median weight for age expressed as standard deviation (SD) was -0.11 (range, -2.78-2.68). There was a significant (p =.005) decrease in the median SD from admission until PEG installation. There was also a significant increase in the median SD from the start of PEG use until 1 (p =.04) and 2 (p =.039) months after start. The most common complications were episodes of inflammation of the PEG site, which were successfully treated with topically or orally administered antibiotics, and episodes of infection, which required intravenously administered antibiotics. Taking into consideration the medical condition of the children in the study group and the considerable length of time with a PEG in place, we believe that nutrition via PEG in children with cancer has several advantages and is rarely associated with other than minor complications.

Adolescent↗
PubMed2006

Dysphagia in stroke patients.

Swallowing musculature is asymmetrically represented in both motor cortices. Stroke affecting the hemisphere with the dominant swallowing projection results in dysphagia and clinical recovery has been correlated with compensatory changes in the previously non-dominant, unaffected hemisphere. This asymmetric bilaterality may explain why up to half of stroke patients are dysphagic and why many will regain a safe swallow over a comparatively short period. Despite this propensity for recovery, dysphagia carries a sevenfold increased risk of aspiration pneumonia and is an independent predictor of mortality. The identification, clinical course, pathophysiology, and treatment of dysphagia after stroke are discussed in this review.

Central Nervous System Diseases↗