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At least 361 records · Page 20Linked to original sources
PubMedDate not supplied

Malpractice claims in gastrointestinal endoscopy: analysis of an insurance industry data base.

We investigated 610 endoscopy-associated and 486 gastroenterology-associated malpractice claim files of the Physicians Insurers Association of America data-sharing project. We determined the relative malpractice claim risk for each of the major types of endoscopic procedures by comparing claim frequencies with Medicare performance frequencies. Relative malpractice risks were 1.0 for sigmoidoscopy, 1.2 for esophagogastroduodenoscopy, 1.6 for endoscopic retrograde cholangiopancreatography, and 1.7 for colonoscopy. "Improper performance" was alleged in 54% of claims and "diagnosis error" in 24% of claims. Of 121 claim files alleging a diagnostic error, 74 (61%) pertained to missed malignancies, of which 69% were colorectal. Of 147 claims alleging iatrogenic injury, 140 (95%) involved perforation or similar direct injury to the gastrointestinal tract. Problems with consent were alleged in 44% of 158 endoscopy-related claim files alleging additional associated issues.

Databases, Factual↗
PubMedDate not supplied

Clinical application of an ultra-thin pancreatoscope using a sequential video converter.

The main pancreatic duct was studied endoscopically by inserting an ultra-thin pancreatoscope into the normal papilla of Vater. Recently, we developed a new pancreatoscope system and improved the image, the durability, and the ease of use. A special video converter was connected to the head of the pancreatoscope. The sequential electronic endoscope images were observed on a TV monitor. We performed examinations with this new system in 52 cases (8 with pancreatic cancer, 19 with chronic pancreatitis and 25 normal cases). We studied the brightness, color and quality of the images on 35-mm film and on videotape. As a result, it has become clear that the images obtained with this system are much better than those obtained by the conventional method. Although further improvement in the ability to angulate the endoscope is necessary, this new pancreatoscope system should help diagnose diseases of the pancreas.

Chronic Disease↗
PubMed1994

Combined laparoscopic-endoscopic gastrostomy.

Since the first report of successful percutaneous endoscopic gastrostomy placement by Gauderer and Ponsky in 1981 [Surg. Gynecol. Obstet. 152: 83-85], many modifications of the original technique have been published. Each reports easier and safer placement of the gastrostomy tube, but all have the same inherent flaw: Access to the gastric lumen is accomplished by a blind needle puncture of the anterior abdominal wall. A new technique, utilizing a newly available microendoscope (Origin Medsystems), is described. Using the microendoscope, direct visualization of the stomach and left upper quadrant of the abdomen allows safer access to the gastric lumen for subsequent tube placement without the need for additional incisions or punctures. The procedure can still be performed with local infiltrative anesthesia and systemic intravenous sedation.

Abdomen↗
PubMed1981

Acupuncture analgesia for upper gastrointestinal endoscopy: a Lagos experience.

Acupuncture analgesia was employed as a therapeutic modality for upper gastro-intestinal tract (G.I.T) endoscopy in 18 adult Nigerians. The overall success rate was 88.2%. This correlates with the finding with conventional chemical analgesia (such as topical analgesia, diazepam and /or pethidine injection) without the added complications. The main advantage of acupuncture analgesia in G.I.T. endoscopy is the ease of cricopharyngeal sphincter intubation.

Acupuncture Therapy↗
PubMed2000

Endoscopic ultrasound.

Endoscopic ultrasound was introduced in the early 1980s. Today, endoscopic ultrasound remains the most accurate modality for local staging of gastrointestinal cancers but the emphasis is now on what findings will impact patient care. At the same time, a new era of interventional endoscopic ultrasound that might also be called image-directed therapies is emerging. The future looks bright for the further application of endoscopic ultrasound in gastrointestinal endoscopy. This article provides the current status and a glimpse into the future of endoscopic ultrasound.

Digestive System↗
PubMed2003

Endoscopic ablation of distal tracheal lesions using Nd:YAG contact laser.

Surgical lasers are an excellent tool for the treatment of airway lesions. Distal tracheal lesions offer a greater challenge in that they are less accessible to laser treatment relative to upper airway lesions yet retain the propensity to cause complete airway obstruction. The ideal treatment modality for the endoscopic ablation of distal tracheal lesions provides secure airway protection, excellent visualization of the lesion in question, and delivery of a safe and effective method of treatment. We have found that the use of a contact Nd:YAG fiberoptic delivery system through a rigid bronchoscope has performed very well in meeting these criteria.

Bronchoscopes↗
PubMed1978

Premedication for upper gastrointestinal endoscopy: a comparative study of flunitrazepam, diazepam and neuroleptanalgesia.

Flunitrazepam or diazepam with atropine and a combination of phenoperidine, droperidol and cyclizine (neuroleptanalgesia) were compared as premedication in three groups of 25 patients undergoing routine upper gastrointestinal endoscopy. Drug doses were titrated carefully against response and all three regimes were found to be similar in terms of safety, patient co-operation, relaxation and speed of recovery. Neuroleptanalgesia however produced a statistically significant rise in endtidal pCO2 and systolic blood pressure. The benzodiazepines, and in particular flunitrazepam, produced a significantly greater amnesia for the procedure, patients given these drugs being more willing to undergo repeat endoscopy.

Anti-Anxiety Agents↗
PubMed1995

Endoscopic intracorporeal laser lithotripsy of difficult common bile duct stones with a stone-recognition pulsed dye laser system.

BACKGROUND: Endoscopic retrograde intracorporeal lithotripsy with a stone recognition laser system seems to be a promising alternative in patients with difficult bile duct stones. METHOD: Sixteen patients with bile duct stones not suitable for endoscopic standard procedures underwent intracorporeal laser lithotripsy during a 3-month period. An average of 6800 (120 to 25000) discharges were applied with a power setting of 100 mJ. Inserting the laser fiber into a radiopaque marked catheter or into a balloon catheter guaranteed a successful location on the stone surface in 70% of all discharges. The automatic feedback/cut-off at the fiber is not in contact with the stone surface. RESULTS: Fragmentation was achieved in all cases. Complete bile duct clearance was reached in 14/16 cases. In two cases, remaining fragments passed spontaneously through the papilla as controlled by ERCP. Minor complications were noted in two patients (hemobilia, cholangitis). Complete recovery was achieved in both patients with conservative management. CONCLUSIONS: For a selected group of patients with difficult common bile duct stones, intracorporeal laser lithotripsy with a stone recognition laser system was found to be a highly effective and safe technique.

Aged↗
PubMed1990

Arterial oxygen saturation during upper gastrointestinal endoscopy: the effects of a midazolam/pethidine combination.

This study was performed to assess the severity and duration of hypoxia during and after prolonged upper gastrointestinal endoscopy. Twenty patients were studied using a non-invasive pulse oximeter. Significant reductions in oxygen saturation were noted during endoscopy and remained below the preexamination level during the one hour period after the examination. This study indicates that pulse oximetry is a useful monitor for detection of hypoxia during and after endoscopy.

Adult↗
PubMed1991

Intraluminal radiation therapy per endoprosthesis: a case study.

Palliation of cholangeocarcinomas has been achieved by radiation delivered to the bile duct via endoprothesis. This case study supports and extends the works of others by describing the endoscopic techniques involved in the implantation of iridium seeds within a nasobiliary catheter. The case presented demonstrates endoscopic radiation treatment with no systemic radiation effects in a patient whose life extension was 19 months.

Adenocarcinoma↗
PubMed1996

Are patients who undergo open-access endoscopy more anxious about their procedures than patients referred from the GI clinic?

OBJECTIVES: Our academic hospital center operates an open access endoscopy service that allows referring physicians to directly schedule patients for outpatient esophagogastroduodenoscopy and colonoscopy without having them first seen in the GI clinic. Although patients from the GI clinic have an opportunity to meet the endoscopist and discuss their procedures directly beforehand, patients who are scheduled to undergo endoscopy through our open access service receive only a brief telephone call from a GI fellow or nurse that is made to screen for contraindications to the procedure and to give instructions. Our objective was to find out whether patients who used our open access service were more anxious about their procedures than those referred from the GI clinic. METHODS: On arrival to our endoscopy center, consecutive patients from the open access service (n = 142) and the GI clinic (n = 85) completed a questionnaire that included three measures of anxiety. After completion of the endoscopic procedure, the attending endoscopist rated patient cooperation. Patients also completed a phone questionnaire on the day after their procedures assessing their experience with endoscopy. RESULTS: We found no difference between patients from the open access service and those from the GI clinic in any of the measures of preprocedure anxiety, in scores measuring cooperation during procedures, or in patient ratings of their experience with endoscopy as assessed on the day after procedures. CONCLUSIONS: Patients who used our open access service were no more anxious about their procedures or less cooperative during them than patients first seen in the GI clinic. In both groups, procedure-related anxiety was decreased in patients who had previously undergone endoscopy.

Adolescent↗