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PubMed1978

Clinical value of gastrointestinal fiberoptic endoscopy.

This review describes the contribution of fiberoptic endoscopy and its associated ancillary procedures to the improved diagnosis of some common gastrointestinal disorders. The diagnostic approach to esophagitis and carcinoma of the esophagus and stomach is outlined. Swallowed foreign bodies that do not pass out of the stomach can be removed with relative ease by endoscopic ancillary procedures. The role of endoscopy in duodenal ulcer disease and the effects on morbidity and mortality of the vigorous diagnostic approach in upper gastrointestinal hemorrhage are discussed. Endoscopy is invaluable for assessing the condition of the stomach postoperatively. Colonoscopic polypectomy has lent support to the "poly-cancer" hypothesis. The role of colonoscopy in the evaluation of inflammatory bowel disease must still be delineated. Endoscopic retrograde cholangiopancreatography is of value in the investigation of obstructive jaundice and pancreatic disease. In the former, noninvasive techniques of ultrasonography and computerized tomography scanning complemented by fine-needle transhepatic cholangiography will probably be the preferred methods of investigation. The impact of the contribution of fiberoptic endoscopy on health care will be maintained only if the physician has been properly trained in its use and has an understanding of the different diseases.

Biliary Tract Diseases↗

PubMed1976

[Endoscopy, a hobby for specialists--or more?].

In the years between 1958 and 1970, diagnostic endoscopy made decisive advances. In this period, the ground was prepared for operative endoscopy. This applies not only to the technical, but also to the psychological aspects. The fact that formerly hidden structures could now be directly inspected and ""grasped'', spurned the endoscopist to intensive activity. Polypectomy, papillotomy with the removal of gallstones and, increasingly, photocoagulation for the arrest of bleeding, have made in many cases classical surgical operations superfluous. In close cooperation and rapport with the surgeons, the indications for, but also the limitations of, the new procedure are being established. In addition to the more practical aspects, modern endoscopy has also created a bridge to better understanding of biochemical processes in the gastrointestinal tract. The possibility of being able to investigate the effects of newly discovered, analysed and synthesized gastrointestinal hormones has been considerably improved. Endoscopy, formerly considered, more or less, a hobby for a few specialists, has become a sort of intermediary system which is capable of providing excellent diagnostic information, of making possible elegant therapeutic measures and of producing new biochemical information. In this creative function, it is surpassed by virtually no other method. A pre-condition for this development was, however, that the endoscopist was not content to remain merely an observer of interesting views, but was, rather, an active physician, to whom the advantages to the patient of early detection of disease and suitable therapeutic measures were equally important as the useful information obtained on biochemical relationships.

Cholelithiasis↗

PubMedDate not supplied

[Exerience with 3000 endoscopies of the upper digestive tract].

A study is presented of over 3,000 upper gastrointestinal endoscopies over a 4 year period. The principal findings were: 1.282 normal 42,73%), 349 gastric ulcers (11,63%), 314 duodenal ulcers (10,47%), and 208 gastric cancers (6,90%). Endoscopy is an important method for the study of upper gastrointestinal tract diseases. Specially for nonconclusive X-ray study, locating the site of a hemorrhage, differentiating between a benign and a malignant lesion, recommending continuation of medical treatment or surgery, and indicating the zone of surgical resection. The routine use for endoscopy should be insisted upon in patients with vague chronic symptoms to increase the diagnosis of incipient lesions. We have obtained more advantages with endoscopy than with X-rays. However, both methods are complementary and give a more certain diagnosis of digestive diseases. It is a method that when done by experts is innocuous and free of complications. Although the cost of the fibroscope instruments is high, the invaluable services they render to gastroenterology more than compensate their cost.

Esophageal Diseases↗

PubMed1975

Correlation between hysterosalpingography and pelvic endoscopy for the evaluation of tubal factor.

In this study of 132 infertile couples, findings with hysterosalpingography (HSG) were compared with those observed at subsequent culdoscopy or laparoscopy. Both procedures correctly revealed normal tubes in 29% of the subjects and identical abnormalities in 24%. A complete agreement between the two procedures was thus observed in 53% of women. Hysterosalpingography showed 5% false positive and 14% false negative findings. In the remaining cases the type of anomaly revealed by HSG was different from that found at laparoscopy. Peritubal adhesion was the pathologic process most commonly missed by HSG and diagnosed subsequently by endoscopy. Pelvic endoscopy also revealed endometriosis and other pelvic disease in a high proportion of women, whereas HSG exclusively detected all intrauterine lesions. Similar pregnancy rates resulted when HSG and endoscopy revealed normal organs. The significance of these findings is discussed.

Adult↗

PubMed1977

Diagnostic value of nasopharyngeal endoscopy for the early recognition of tumours.

It is reported on own experiences gathered with the endoscopy of the nasopharyngeal space by means of an angular optic according to Hopkins (70 degrees). The nasopharyngeal endoscopy is indicated for an early diagnosis of malignant tumour growth and clears up a clinically uncertain nasopharyngeal picture. In addition to the generally known examination methods, the endoscopy of the nasopharynx enables a direct local finding.

Endoscopy↗

PubMed1977

[Prognosis of acute upper gastrointestinal bleeding before and after the introduction of emergency endoscopy (author's transl)].

A total of 416 patients had been admitted to hospital for acute upper gastrointestinal bleeding, about half of them before the introduction of endoscopy. There was a highly significant decrease in total mortality rate by 18 percent since the introduction of endoscopy. The reason for this is probably largely the much higher number of correct identification or localisation of bleeding points by endoscopy (98 percent) when compared with conventional radiological examination.

Adult↗

PubMed1979

Open-access endoscopy service for general practitioners.

An open-access general-practitioner referral service for endoscopy of the upper gastrointestinal tract was established in a district general hospital, and the impact of the service over three years was assessed. The reason for referral, duration of symptoms, and amount of disease detected were the same in patients referred by general practitioners and those attending from hospital outpatient departments. Despite a steady increase in the number of patients referred for endoscopy, the number of barium-meal examinations performed did not correspondingly decrease. The number of ulcers and cancers detected in each six-month period of the study did not increase, and the combined overall pick-up rate for these two conditions fell from 25% to 13%. All general practitioners in the area were sent questionnaires. Most thought that clinic referral had been reduced and patient management helped as a result of the introduction of the service. While the value of negative endoscopic findings cannot be assessed, there is little objective evidence of benefit. Hence the large increase in numbers of endoscopies performed as a result of the introduction of the service cannot be justified.

Diagnostic Services↗

PubMed1978

[Gastroenterological endoscopy--fascination and obligation (author's transl)].

The development of fiber endoscopy has made possible routine endoscopic bioptic examination of the upper (including the duodenum) and lower digestive tract (with the terminal ileum). Biopsy material can be obtained in the necessary quantities with forceps or a loop. In many centers endoscopy is already the basic method for the diagnosis of diseases of the upper digestive tract. A similar tendency is also becoming apparent in colo-ileoscopy. The increase in the frequency of endoscopic investigations is accompanied by a decrease in the number of complications. The increasing importance and dissemination of gastrointestinal fiber endoscopy demands greater and better training facilities and adequate control of qualifications together with an integrated cooperation with the pathologists.

Biopsy↗

PubMed1977

[Emergency endoscopy: its application in the department of medicine of a city hospital (author's transl)].

In about 90% of cases of active gastrointestinal hemorrage, sources and nature of bleeding can be identified exactly by means of emergency endoscopy. With time passing from the beginning of hemorrhage, diagnosis established by endoscopy is getting less precise. The most common cases of bleeding are peptic lesions, either esophageal, gastric, or duodenal; the most common site of hemorrhage is the stomach. Different potential points bleeding at the same time have to be take in account. A case report of Mallory-Weiss syndrome (13 episodes of hemorrhage) illustrated the method's value in establishing diagnosis of acute gastrointestinal bleeding. Special applications of emergency endoscopy in mental patients are described.

Emergencies↗

PubMed1978

[Methods and possibilities of surgical endoscopy].

In a number of diseases, operative or therapeutic endoscopy permits an effective therapy without the necessity to open up the abdominal wall and the digestive organs themselves. Included here are the removal of foreign bodies, haemostasis, papillotomy with concrement dislodgement, polypectomy and the obliteration of the excretory pancreas. The evaluation of the achieved results and the examination of operative endoscopy in respect of its clinical value cooperation with the pathologisz should not be neglected. The refined endoscopic methods and the highly developed technology can only be applied successfully, when it is possible to get enough skillful endoscopists and to prevent an everyman's endoscopy by which the new methods could be brought into discredit.

Cholelithiasis↗

PubMed1979

[Value of endoscopy in the diagnosis of upper digestive tract hemorrhage].

In 11 years experience (67-78) we studied the importance of endoscopy in HDA. Were carried out 8300 esophagogastroduodenal endoscopies of which 2837 were HDA. The main reasons to follow these studies were: 1) Diagnostic of the HDA location; 2) Diagnostic of type of injury; 3) Injury intensity. Referring to the findings 30% were duodenal ulcer; 27% hemorrhagic gastritis; 17% gastric ulcer and 10% were due to VE. From the remaining 10% the most frequent were the esophagitis and gastric cancer. It is most important to show that aspiring added to alcohol in the most common cause of hemorrhagic gastritis. We have to point out that in 42 endoscopies performed in Intensive Care Service 10 of them were due to non-digestive causes. Through this method of diagnosis the Endoscopist has an important role to play in defining the prognosis and conduct to be followed.

Alcoholic Beverages↗

PubMed1979

[Therapeutic endoscopy in the gastrointestinal tract].

In selected chapters of the therapeutic endoscopy we tried to represent secure knowledge, actual tendencies and partly future prognoses. Hereby completeness cannot be expected. However, it became clear that numerous physical principles became useful for the therapy with the endoscope. Chemical techniques, such as the litholysis of gall-stones are only at present used in our field. With all scepticism against the own field of interest one may say that the operative therapeutic endoscopy, as it is seen at the instance of the classification of polyps, has led to an improvement of the diagnostics, Its advantages in the therapeutic field are based on the fact that it substitutes larger operations. In the polypectomy- the intervention, avoiding laparotomy and colotomy, is reduced on the minimum given by the size of the polyp. The risk of endoscopic operations is small, compared with the alternative surgical interventions. Shortening of the duration of the disease and hospitalisation leads to lower expenses. Methods, such as the endoscopic haemostypsis or the obliteration of the pancreatic duct, need further detailed examinations. There is no doubt that the modern endoscopy has a strong technical fascination for many young physicians. It gets the greatest value in the hands of a clinically experienced physician.

Cholelithiasis↗

PubMed1978

Cardiovascular responses to upper gastrointestinal endoscopy.

Continuous Holter monitoring and serial blood pressure recordings were obtained during upper gastrointestinal endoscopy on 51 unselected patients, 18 with cardiovascular disease. Sedation with intravenous diazepam produced a small but significant fall (P is less than .001) in blood pressure, heart rate and rate-pressure product. During endoscopy, the blood pressure rose only to base line levels but the heart rate and rate-pressure product went significantly higher (P is less than .001). Nine subjects (fice with pre-existing cardiovascular disease, four normal) exhibited electrocardiographic changes, including supraventricular arrhythmias, ventricular ectopy and significant ST segment depression. None of the patients had bradycardia or significant vagal symptomatology. The difference in incidence of abnormalities between the normal patients (4/33) and those with cardiovascular disease (5/18) was not statistically significant (P = 0.3). Endoscopy can be safely performed even in patients with cardiovascular diseasebut attention to the reduction of cardiac stress would further increase its safety.

Adolescent↗

PubMed1977

Vascular endoscopy: useful tool or interesting toy.

A prospective protocol was designed to evaluate the efficacy and practically of intraluminal endoscopy in vascular reconstructive procedures. The choledochoscope and the arthroscope which utilize the Hopkins Optical System, as well as other available fiberoptic endoscopy units, were evaluated in 91 vascular reconstructions, including 42 carotid endarterectomies, 24 femoral artery reconstructions, 13 popliteal artery anastomoses, seven aortic and iliac procedures, one renal reconstruction, and one tibial reconstruction. In three cases the internal surface of an occluded limb of an aortic graft was examined endoscopically following thrombectomy. The optical resolution of the Hopkins Optical System was superior to the fiberoptic units. Vascular endoscopy required 5 minutes or less in 53 cases, between 5 to 10 minutes in 29 cases, and more than 10 minutes in nine. There were no infections. The single complication was a 1 cm linear tear in the intima of an internal artery. Positive findings were noted in 60 endoscopic studies, for an incidence of 66%. These consisted of intimal shreds in 47, elevated or irregular intimal flaps in 25, clot in five, and stenosis in three. In 26 cases the endoscopic findings were considered to be significant enough to possibly affect the ultimate outcome of the reconstruction.

Carotid Arteries↗

PubMed1977

[Gastrointestinal endoscopy in surgical patients (author's transl)].

Gastrointestinal endoscopy with flexible glass fiber instruments is of increasing importance in surgery. Preoperative endoscopic examinations bring good progress in planning the operative procedure, especially concerning proximal selective vagotomy, pancreas surgery and reoperations on the large intestine. By applying postoperative endosocopic controls mucosal alterations can earlier be detected in the area concerned than by radiological methods; this has to be emphasized especially in view of patients operated upon for cancer. Emergency endoscopy in massive gastrointestinal bleeding is one of the outstanding tasks. Under certain circumstances risky abdominal operations can be avoided by therapeutic endoscopy.

Biliary Tract Diseases↗

PubMed1976

Disinfection procedures of fiberscopes in endoscopy departments.

Disinfection of fibre endoscopes was examined in 5 endoscopy departments during endoscopy sessions. On the endoscopes, especially in the instrument channels, Pseudomonas aeruginosa and Proteus species could be regularly found, in some cases also Enterobacter cloacae and Candida albicans. With the results of disinfection experiments, proposals are made to reduce the infection risk due to insufficiently disinfected instruments in endoscopy departments.

Bacteriological Techniques↗

PubMed1979

Upper gastrointestinal endoscopy: its effects on patient management.

Out of 95 patients referred for upper gastrointestinal endoscopy after a barium-meal examination, 44 underwent a change in management. Some changes were minor but in 12 patients a decision on surgery was required. Seven of these patients were among a group of 13 for whom the referring consultant would have recommended laparotomy had endoscopy not been available, while the other five were subjected to an unplanned laparotomy. These findings support the practice of performing endoscopy on patients whose symptoms are not fully explained by barium-meal examination, especially patients aged over 45. In such cases the procedure also seems to be cost-effective.

Adult↗

PubMed1979

[Emergency endoscopy in acute upper gastrointestinal hemorrhage: Does the effectiveness justify the effort?].

On the basis of a common care of patients with acute upper gastrointestinal haemorrhage by internists, surgeons, and anaesthetists lasting several years advantages and disadvantages of emergency endoscopy are analysed from the standpoint of effectivity. High diagnostic ability, help in the decision concerning operative or conservative activity, the influence of the operative-tactic approach and the furthering influence on the close cooperation of the specialities are to be emphasized. Criteria of effectivity, such as mortality rates, duration of the stay in the hospital and frequency of relapsing haemorrhages underlie many factors of influence. They express results of therapy, to which emergency endoscopy may at present contribute only limitedly. The basic decision to medical activity -- active striving for a rapid, exact diagnosis or waiting when the diagnosis is uncertain -- does not inessentially influence the standpoint in the controversy about the emergency endoscopy.

Acute Disease↗