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At least 433 records · Page 24Linked to original sources
PubMed1988

Use of propofol for sedation during gastrointestinal endoscopies.

This study investigated the suitability of propofol as a sole agent for continuous sedation in 100 unpremedicated patients during gastrointestinal endoscopy. The propofol was given very slowly (average 62.7 seconds) in order to prevent apnoea during induction, and the dose adjusted according to age (68% of patients were older than 50 years) and ASA grade (32% were ASA grade 3 or 4). There was no correlation under these circumstances between the observed haemodynamic variations and the age or ASA grade of the patients. The infusion rate during maintenance was also adjusted for age, and for the type of endoscopy. The mean rate was 4.3 mg/kg/hour. Recovery was rapid and of excellent quality; 77 patients were awake within 10 minutes and 99 reported total amnesia.

Adult↗
PubMedDate not supplied

Laser lithotripsy of difficult bile duct stones by means of a rhodamine-6G laser and an integrated automatic stone-tissue detection system.

This report describes the initial clinical implementation of a new laser lithotripter system capable of effective fragmentation of common bile duct stones with a high degree of safety provided by an integrated stone-tissue detection system. This system automatically terminates laser pulse transmission if tissue contact is sensed. Eighteen patients with giant or impacted common bile duct stones refractory to standard treatment techniques were treated via the endoscopic retrograde route using a rhodamine-6G dye laser with an integrated stone-tissue detection system. In the event of tissue contact, the stone-tissue detection system cuts off the laser pulse after 190 ns (after transmission of 5% to 8% of the total pulse energy). Nine patients were treated under cholangioscopic control, and nine patients were treated blindly under fluoroscopic control using only standard duodenoscopes with either a 6F standard endoscopic retrograde cholangiopancreatography catheter (4 patients), a 6.8F balloon catheter (3 patients), or a laser lithotriptor basket (2 patients). Laser-induced fragmentation was achieved in all 18 patients (100%). Sixteen of 18 patients (89%) became completely stone-free after completion of the treatment, including additional intracorporeal shock wave lithotripsy in five patients. The only major complications occurred in one fully anticoagulated patient with a prosthetic heart valve who developed significant hemobilia and transient cholangitis but recovered after conservative treatment. Laser lithotripsy using the rhodamine-6G dye laser plus stone-tissue detection system appears safe and effective and allows "blind" fragmentation of difficult common bile duct stones to be performed under radiologic control.

Adult↗
PubMedDate not supplied

The impact of endoscopic technology on gastrointestinal pathology.

Since its introduction in the 1950s, fiberoptic endoscopy has dramatically altered the scope and practice of gastrointestinal (GI) pathology. Whereas examination by rigid instruments was generally restricted to the proximal digestive foregut and distal 25 cm of the large bowel, fiberoptic endoscopy extended these limits considerably, which resulted in a greater volume of biopsies submitted to the pathology laboratory. Furthermore, this technique is associated with a lesser degree of patient discomfort and a lower risk of complications compared to rigid or semiflexible endoscopy. In established endoscopy units, flexible endoscopy is performed increasingly with the videoscope rather than the fiberscope. With the added advantage of direct visualization, flexible endoscopy has eclipsed barium radiology as the premier investigative modality for GI diseases. Although upper GI endoscopy and colonoscopy account for the majority of biopsy material, there are other flexible endoscopic techniques, including endoscopic retrograde cholangiopancreatography and enterostomy. Flexible endoscopy has not only impacted the diagnosis of important disease entities (eg, reflux esophagitis, H. pylori gastritis, celiac disease and GI polyps and neoplasia), but it has also become a key component of surveillance protocols for dysplasia in Barrett's esophagus and idiopathic inflammatory bowel disease. Predicting major trends that may emerge from (GI flexible endoscopy in the future is somewhat difficult, but promising new avenues of investigation include increased use of endoluminal ultrasound and trans-bowel fine needle aspiration. Biopsy material will be submitted with more frequency for genetic molecular studies such as tumor development and progression and identification of infections agents; the priorities for handling biopsy material may have to be re-examined. Gastrointestinal (GI) biopsies constitute a substantial proportion of the surgical pathology load in most tertiary care medical centers. Based on topographic site of origin, the GI tract is the single largest component of the biopsy service in this institution. This relates in part to the high frequency of patients' complaints referable to the digestive tract and is also a result of the advances in GI endoscopy that have led to more widespread application of this technique. To gain a better appreciation of the impact of the changes in endoscopic techniques on gastrointestinal pathology, it is pertinent to examine the historical perspective from which the technology arose.

Digestive System↗
PubMed1999

Endoscopic urease sensor system for detecting Helicobacter pylori on gastric mucosa.

BACKGROUND: It is now accepted that the curing of Helicobacter pylori infection will result in healing of chronic active gastritis and will change the natural history of gastroduodenal ulcer disease. Both endoscopic observation and evaluation of H. pylori status of the stomach are necessary for diagnosis and treatment of such patients. We carried out a clinical evaluation of an endoscopic tube type urease sensor system for the detection of H. pylori on the gastric mucosa. The differential output of two pH-sensitive field effect transistors at the tip of the endoscopic tube reflects the pH change in a urea solution depending on the existence of urease. METHODS: In vitro experiments and clinical evaluation of the system were performed. Fifty-one patients who were suspected to have a gastroduodenal disorder were examined for H. pylori infection with this system, using the combination of histologic and bacteriologic examinations and rapid urease test as the references. RESULTS: Clinical sensitivity and specificity of this system were 26 of 28 (92.9%) and 22 of 23 (95.7%), respectively. A measurement at 1 site is completed in about 1 minute. Repetition of the procedure provides multi-site measurements. CONCLUSIONS: The present system makes possible quick on-site detection of H. pylori under endoscopic observation, with satisfactory sensitivity and specificity.

Adult↗
PubMed1997

Fatal diffuse invasive gastrointestinal candidiasis masking as ileus after bone marrow transplantation.

High-dose cytotoxic chemotherapy has increased the incidence of candidal infections that make neutropenic patients very sick and may kill them. We report fatal invasive candidiasis involving the entire alimentary tract after autologous bone marrow transplantation in a young woman with breast cancer. Illustrated are the significance of fungal infections in this patient population, the potential for Candida albicans to invade the entire gastrointestinal tract, and the potential role of endoscopy in the early diagnosis of these often catastrophic infections. We also suggest that diffuse, invasive candidiasis should be considered in the differential diagnosis of ileus in the immunocompromised patient.

Adult↗
PubMed2006

A novel endoscopic approach to brachytherapy in the management of Hilar cholangiocarcinoma.

OBJECTIVES: Traditionally, biliary brachytherapy sources are placed percutaneously via transhepatic drains or endoscopically via nasobiliary tubes (NBT). Another ERCP is needed for stent replacement after NBT removal. The aim of this study was to determine the feasibility and safety of endoscopic transpapillary insertion of irradiation sources through 10-Fr stents. METHODS: Medical records of Mayo Clinic Rochester patients undergoing biliary brachytherapy for hilar cholangiocarcinoma (CCA) were reviewed. Patients were part of a treatment protocol with curative intent including external beam radiation therapy (4,500 cGy), radiation sensitization (5-FU), and low dose rate (LDR) brachytherapy (<3,000 cGy) followed by liver transplantation. The 10-Fr biliary stent placed across the malignant biliary stricture was directly cannulated using a radiopaque (192)Ir embedded ribbon within a 300-cm long, 5.1-Fr plastic sheath. After withdrawal of the endoscope, the external end of the brachytherapy catheter was rerouted transnasally and secured. Each patient was hospitalized in a shielded room up to 24 h after which the brachytherapy catheter was removed by hand. RESULTS: Between 1999 and 2004, 32 patients underwent biliary brachytherapy via endoscopically placed 10-Fr plastic stents (mean age 50.6 yr, 69% PSC, bilateral brachytherapy catheters 28.1%). The technical complication observed was immediate brachytherapy catheter displacement (7 of 32, 22%) managed by prompt brachytherapy catheter repositioning. CONCLUSION: LDR biliary brachytherapy administration via endoscopically placed biliary stents is technically feasible and appears reasonably safe in select patients with unresectable perihilar CCA. Unlike NBTs, stents can potentially be placed in bilateral ductal systems to accommodate dual brachytherapy catheters when indicated.

Bile Duct Neoplasms↗
PubMed2004

Enhanced magnification endoscopy in the upper gastrointestinal tract.

In diseases such as Barrett's esophagus and celiac disease, the mucosal abnormality is patchy or irregular, highlighting the need for targeted biopsies. Enhanced magnification endoscopy is an effective, readily available method that can be used to assist in target biopsies and endoscopic diagnosis leading to an endoscopic classification system. The technique is not difficult and adds only an additional 5 to 10 minutes to a standard endoscopic procedure;however, most endoscopists never receive instruction in magnification endoscopy during their training. The value of this technique is still being explored, but the improvement in diagnostic accuracy will have an impact on decreasing morbidity and mortality without a large increase in cost. Increased use of this technique will aid in the diagnosis of celiac disease and simplify the classification system for Barrett's esophagus. Using enhanced magnification endoscopy at multiple centers in studies will help to determine the intra- and inter-observer variability, define the endoscopic criteria for dysplasia and early neoplastic changes, and standardize the visualized mucosal patterns more clearly.

Acetic Acid↗
PubMed1997

The Omega-Project--a comparison of two diagnostic strategies for risk- and cost-oriented management of dyspepsia.

OBJECTIVES: In dyspepsia few data are available from the primary care setting on how selective, risk-factor-oriented endoscopy compares with mandatory endoscopy in the diagnostic outcome and in direct and secondary costs. We studied this in a two-armed multicentre trial (omega-project) with primary care physicians. MATERIAL AND METHODS: Patients were enrolled and treated by primary care physicians and referred to a gastroenterologist for upper gastrointestinal endoscopy (UGE). Patients were enrolled in the study if they had had epigastric complaints for more than 1 month and no obvious signs or history of organic disease. In the first arm of the study endoscopy was mandatory, in the second selective, i.e. according to a predefined risk profile. Patients enrolled were treated with prokinetic drugs for 2 months. A further indication for endoscopy was non-response to treatment (reduction of the initial symptoms score by less than two-thirds) in the study with selective endoscopy and relapse within the 2-month follow-up period in both studies. The direct costs from number of consultations with the primary care physician, UGEs, number of prescriptions per patient and also absenteeism in days per week were carefully registered in both groups. RESULTS: All 172 patients of the mandatory endoscopy study and 203/656 patients enrolled in the selective endoscopy study had an UGE (125 at admission, 78 in the follow-up period). Patients were treated for 4 weeks (cisapride or domperidone) and thereafter followed for 8 weeks, at the end of the observation period the response rates were 80% and 79%, respectively. The prevalence of gastric cancers was similar in both groups (> 1%) but extrapolation from the data collected with compulsory endoscopy suggests that two-fifths of the anticipated peptic lesions remained undetected by following the selective strategy. The cost analysis revealed a 31% cost reduction with the selective strategy--in the Swiss cost system--through a reduction in the number of endoscopies by 67%. CONCLUSION: Selective UGE is cheaper and appears not to compromise the response to prokinetics; however, its diagnostic power is less than with mandatory UGE.

Adult↗
PubMed1996

Upper gastrointestinal endoscopic and histologic findings before and after vertical banded gastroplasty.

BACKGROUND: A total of 30 consecutive morbidly obese patients, six males and 24 females, who underwent vertical banded gastroplasty (VBG) between January 1992 and December 1994 and were followed up by endoscopy and biopsy were included in this study with the aim to determine the short- and mid-term complications and to investigate alterations in esophageal, gastric, and duodenal mucosa after surgery. METHODS: All patients underwent endoscopy before operation. Postoperatively, 28 patients were reendoscoped at 6 months, 26 at 12 months, and 22 at 18 months. Biopsies were taken from the lower part of esophagus, just below the esophagogastric junction (vertical part of the partitioned stomach), corpus, antrum, and duodenal bulb. RESULTS: Before operation 5 patients (16.6%) had a hiatus hernia and four of them (13.3%) had esophagitis. Endoscopic gastritis was diagnosed in nine patients (30%) and endoscopic duodenitis in two (6. 6%). Histologically, in 15 patients (50%) esophagitis was recognized; in 24 patients (80%) corpus gastritis; in 27 patients (90%) antral gastritis; and in 23 (76.6%) duodenitis. Helicobacter pylori was found in 20 (66.6%) patients. Postoperatively, three patients developed a mild stoma stenosis and were treated only by passing the endoscope 6 months after operation; one patient, with a severe stoma stenosis, was treated by Eder-Puestow dilatations and surgery. Gastric ulcer was found in two patients 6 and 12 months after surgery. One patient developed an endostomach channel because of staple line dehiscence 18 months after VBG. An increasing incidence of esophagitis and gastritis of the vertical part of the stomach was found at 6 and 12 months. Endoscopic and histologic gastritis of the corpus and antrum, as well as endoscopic and histologic duodenitis decreased gradually after surgery. CONCLUSIONS: Our findings suggest that postoperative complications of VBG can be diagnosed by endoscopy, and some of them can easily be managed. Vertical banded gastroplasty causes not only no harm to the esophageal, gastric, and duodenal mucosa but also influences them favorably.

Adult↗
PubMed1998

High-resolution cross-sectional imaging of the gastrointestinal tract using optical coherence tomography: preliminary results.

BACKGROUND: Optical coherence tomography (OCT) is a novel technique for noninvasive cross-sectional imaging with high spatial resolution (10 to 20 microm). OCT is similar to B-mode ultrasound except that it uses infrared light rather than ultrasound. We studied OCT imaging of the gastrointestinal (GI) tract in vitro to analyze the potential of this technique for endoscopic applications. METHODS: Human gastrointestinal tissues harvested from surgical resection and autopsy specimens were used. Specimens were imaged within 5 hours of resection or snap frozen in liquid nitrogen. After imaging, OCT scan locations were carefully marked using dye microinjections, fixed, and prepared for routine histologic processing. OCT images were then compared and correlated with the histologic sections. RESULTS: OCT images demonstrated clear delineation of the mucosa and submucosa in most specimens. Furthermore, microscopic structures such as crypts, blood vessels, or esophageal glands in the submucosa and lymphatic nodules were observed. CONCLUSIONS: The resolution of OCT images of GI wall is sufficient to delineate the microscopic structure of the mucosa and submucosa. Potentially, OCT would allow in vivo imaging at endoscopy of the microstructure of the mucosa and submucosa. This would be particularly useful in the detection and staging of small lesions such as early stage cancers.

Anatomy, Cross-Sectional↗
PubMed2000

[Resident physician training in the digestive system. The point of view of the residents].

AIM: To evaluate various aspects of current training of Spanish residents in gastroenterology. METHOD: An anonymous postal questionnaire was sent to fourth-year resident physicians in Spanish hospitals with accredited gastroenterology residency programs. RESULTS: Forty residents in the fourth year (53% offered positions), four from the second year and one from the first year (20 men, 25 women) answered the survey. Mean age was 29.7 years (26-42 years). Fifty-one percent of the departments did not have ultrasonography facilities apart from those in the radiology department. Endoscopic retrograde cholangiopancreatography (ERCP) was available in all the departments but in 55% of these, residents did not receive training in this technique. Forty-one percent of residents did not know the objectives of the various training periods. Eighty-four percent evaluated the pressure of clinical work as "intense" or "very intense" with 67% reporting that it disturbed their training "seriously" or "very seriously" and 71% that it disturbed their personal lives. Supervision in ultrasonography, endoscopy and clinical work were mainly evaluated as "good" or "very good". Supervision was rated lower in outpatient departments and while on duty. Forty-two percent of residents rated the supervision of the personal tutor as "average". Seventy-six percent were "fairly" or "very interested" in the introduction of "areas of specific training". CONCLUSIONS: The quality of residents' training in general and of gastroenterology training in particular is high. There are, however, several aspects which could be improved.

Adult↗
PubMed1998

Gastro-oesophageal reflux disease.

New approaches to the grading of reflux oesophagitis and the definition of reflux disease have been proposed which should improve the precision of descriptions of this common problem. Endoscopy and 24-hour pH monitoring studies, though of great value, have significant limitations for assessment of reflux disease. Only about one third of reflux disease patients have oesophageal mucosal erosion or ulceration. Analysis of symptoms is probably the most useful method for diagnosis. Further research is needed into the best strategies for maximising the potential of symptom analysis. In the pathogenesis of reflux disease, Helicobacter pylori infection is not a major factor but the interaction of H. pylori gastritis and eradication therapy are important areas of great current interest. Troublesome reflux disease arises primarily from abnormally frequent gastro-oesophageal reflux, though heightened oesophageal mucosal sensitivity and defective oesophageal clearance play a role in some patients. Transient lower oesophageal sphincter relaxation appears to be the most important mechanism of reflux. This distinctive, swallow-independent type of lower oesophageal sphincter relaxation has a complex triggering system, apparently located in the brain stem. Medical and surgical treatments of reflux disease are now well characterised and have improved very substantially over recent years. Drugs that inhibit the occurrence of transient lower oesophageal sphincter relaxation are an intriguing possible future therapy.

Antacids↗
PubMed1994

[Conservative and interventional therapy of chronic pancreatitis].

In chronic pancreatitis high-dose enzyme therapy is only indicated if an insufficiency of the exocrine gland exists. For pain conventional analgesics such as Paracetamol, Metamizol or Tramadol are indicated. In case of pancreolithiasis, ESWL is the method of choice. This treatment should be combined with papillotomy of the pancreatic sphincter to achieve a good access to the duct system. If strictures are seen during ERCP, balloon dilatation and consecutive implantation of a plastic prosthesis are necessary to permit regular flow of pancreatic juice. Stent-clogging is the main problem of drainage-procedures. Regular exchange of the stent is mandatory. Pseudocysts should be drained via the papilla if there is a connection between the cyst and the duct system. All others should be drained endoscopically, by puncturing the cyst through the gastric or duodenal wall, or percutaneously. Surgical procedures should be delayed whenever possible, since surgical treatment is invasive (e.g. Whipple's operation) and the long-term prognosis is poor.

Calculi↗
PubMed1996

[Management of caustic esophagitis in adults].

The experience of surgical management of caustic ingestion in adults started a quarter of a century ago in the Paris Poisons Centre. It was found that, inasmuch as certain cases of massive ingestion require major emergency surgery, the patient must be received by a competent surgical unit, associated with an Intensive Care Unit with permanent availability of gastrointestinal and tracheobronchial fibroscopy. The assistance of an ENT surgeon can be precious, and a psychiatrist is often necessary. The Saint Louis Hospital visceral surgery unit in Paris has developed a specialized on-call system. Its current experience concerns approximately one thousand patients. Comparison with other French or European experiences at the time of preparation of this report, presented to the 97th French Surgery Congress in 1990, allows the definition of a consensual management.

Adult↗
PubMed1979

[Indications and value of gastrointestinal biopsy].

Concerning the stomach biopsy without optical control has only historical importance, concerning the small intestine it serves for the recognition of diffuse changes--particularly for the the differential diagnosis of the malabsorption and in the large intestine for the diagnosis and course control of inflammation. The aimed biopsy is a constituent of every endoscopy investigation, with the exception of completely normal or fully clear pathological findings. Without an aimed biopsy the diagnosis of the early cancer in ulcers, "polyps" and "ulcer scars" is not possible. Its gain depends on the number of biopsy particles; only the positive findings are proving.

Biopsy↗
PubMed1992

[Cost of fibroscopy in gastroduodenal ulcer].

The assessment of mean cost of upper GI endoscopy is of critical importance if one wants to perform pharmacoeconomic studies, especially in peptic ulcer disease (PUD). The aim of this work was to calculate such costs, based on an inquiry conducted in December 1991 in a representative sampling of 94 French gastroenterologists (GEs) (i.e. 4.3% of the whole population). Thirty-nine percent of GEs work in their office; 25% work in private and 26% in public hospitals. GEs performed 70 +/- 5 (mean +/- SEM) upper GI endoscopies per month. Fifty-nine % are performed to investigate epigastric pain; PUD was found in nearly one patient out of four. Fifteen % of the endoscopies were performed for follow-up of PUD. Upper GI endoscopy modalities varied greatly according to whether performed in GEs' office, private or public hospital. The proportion of investigations performed with biopsies was 66, 71 and 50%, respectively. Neuroleptanalgesia (or general anesthesia), was performed in 8, 49 and 4% of cases, respectively, and a 24-hour hospitalization was required in 0, 7 and 2% of cases, respectively. Sources of expenditure were evaluated according to the current fares of the French Health Care System (for GEs' office and private hospitals) and to real costs (for public hospitals). Taking into account the differences in place and modalities of realization, mean cost of upper GI endoscopy was evaluated at 1,084 FF. This cost could be used in future cost or cost/effectiveness studies of diagnostic or therapeutic strategies.

Duodenal Ulcer↗