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PubMed1994

The upper gastrointestinal endoscopy report.

In summary, the endoscopy report is the permanent documentation and communication of the endoscopic procedure. The computerized endoscopy report system has, of necessity, improved our standardization of terminology and report content. Computerization of the endoscopy report has opened the door to easier auditing and quality review, as well as easier tracking and recall for research and teaching purposes. Nonetheless, the components of the endoscopy report have not changed. As with all communication, our goal should be clear, accurate, and concise expression.

Communication↗

PubMedDate not supplied

[Radiologic endoscopy of the biliary system in cholelithiasis].

Roentgenoendoscopic interventions combining diagnostic and therapeutic procedures were carried out in 320 patients with various pancreatobiliary diseases. Different combinations of therapeutic roentgenoendovascular interventions on the biliferous system are shown, which were used in 102 patients with clolelithiasis. These interventions were found a highly effective method for preoperative treatment and therapy of patients with cholelithiasis. Roentgenoendovascular interventions in cholelithiasis are conductive to optimization of surgical treatment.

Adult↗

PubMed1994

Common bile duct exploration: the place of laparoscopic choledochotomy.

Since laparoscopic cholecystectomy was introduced, the treatment of choledocholithiasis has been modified. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) has been performed selectively in elderly patients and in those with a strong suspicion of biliary duct stones (jaundice, demonstrated at ultrasound). Intraoperative discovery of common duct stones at cystic duct cholangiography signifies that they must be removed intraoperatively [or postoperatively by ERPC and endoscopic sphincterotomy (ES)]. As ES has a failure rate of 3-23%, laparoscopic common duct exploration emerges as the treatment of choice. Since November 1990, we have performed 59 laparoscopic common bile duct explorations. In our experience, the transcystic technique (18 patients) with choledochoscopy appears easier to perform than with fluoroscopy without choledochoscopy. Since, during our early experience, we encountered some difficulty with the transcystic technique, we elected to evaluate common duct exploration through a choledochotomy (41 patients). The main advantage of this technique is that it provides complete access to the ductal system without damage to the papilla. This procedure seems more difficult to perform than the transcystic technique and can be used when there are contraindications to the latter.

Adult↗

PubMed1997

Open access endoscopy for hospitalized patients.

OBJECTIVES: Most requests for gastroenterology consultations for hospitalized patients are for endoscopic procedures. Open access endoscopy has been evaluated in several institutions for outpatients. Our aim was to evaluate an open access policy for hospitalized patients. METHODS: Since April of 1996, patients hospitalized in the Soroka Medical Center have been referred directly for upper endoscopy (esophagogastroduodenoscopy, EGD) and flexible sigmoidoscopy (FS). The numbers of procedures and consultation requests between July 1, 1996, and September 30, 1996, were compared with the corresponding months of 1995. A survey of physician satisfaction with the new open access system was conducted. RESULTS: The mean number of monthly consultations during the study period was 30.7 +/- 2.4, compared with 119.3 +/- 5.4 during the same months in 1995 (p = 0.006). Open access endoscopy was performed on 114 patients during the study period. Upper GI bleeding (n = 41) and abdominal pain (n = 33) were the most common indications for EGD. There were nine duodenal ulcers, five gastric ulcers, and eight gastric carcinomas. Sixteen patients (21%) had normal EGDs. The most common indications for FS were rectal bleeding (n = 24) and diarrhea (n = 13). Seven patients had colorectal cancer; 12 FSs were normal. In all, 286 EGDs and FSs were conducted in the study period compared with 253 in 1995 (not significant). All physicians expressed satisfaction with the new system and favored its continuation. CONCLUSIONS: The open access policy for hospitalized patients led to a considerable reduction in requests for consultations, with no significant increase in the number of endoscopies. The majority of patients referred directly for endoscopy had appropriate indications.

Adolescent↗

PubMedDate not supplied

MR virtual endoscopy of the pancreaticobiliary tract: a feasible technique?

To evaluate the feasibility of magnetic resonance (MR) virtual endoscopy of the pancreaticobiliary tract by using MR cholangiopancreatography (MRCP) data sets as source images, we retrospectively reviewed MRCP data sets of 120 patients with Navigator software (GE/Medical Systems, Milwaukee, WI) that allowed display of inner views by surface rendering the internal wall of the bile ducts with simulated light and shadow.

Adolescent↗

PubMed1993

Carbon dioxide retention and oxygen desaturation during gastrointestinal endoscopy.

BACKGROUND: Pulse oximetry measures arterial oxygen saturation (SpO2), not hypoventilation, which is directly reflected by increases in carbon dioxide tension. METHODS: In the present study, transcutaneous carbon dioxide tension (PtcCO2) and SpO2 were measured during 101 endoscopic procedures selected for long duration or comorbid illnesses, and relationships between hypercapnia and hypoxemia were evaluated. Nasal oxygen was administered only for sustained desaturation (SpO2 < 90%). RESULTS: Mean peak increase in PtcCO2 was significantly higher in patients requiring oxygen for sustained desaturation (16.3 mm Hg; range, 4-52) than in patients breathing room air who had transient or no desaturation (10.2 mm Hg [range, 3-19] and 5.1 mm Hg [range, 0-15]). If nasal oxygen corrected desaturation, even transient recurrence of desaturation indicated worsening CO2 retention, which preceded respiratory arrest in one patient. Independent predictors of hypercapnia were fentanyl and midazolam doses, oxygen requirement, and dementia. CONCLUSIONS: Severe hypoventilation may occur during endoscopy, undetected by clinical observation or pulse oximetry, but only in sedated patients who require supplemental oxygen to maintain SpO2 above 90%. After oxygen supplementation corrects desaturation, recurrence of desaturation implies severe hypoventilation and warrants limitation of further sedation.

Adult↗

PubMed1999

The role of endoscopic findings for the diagnosis of Helicobacter pylori infection: evaluation in a country with high prevalence of atrophic gastritis.

BACKGROUND: This study examines endoscopic findings in the diagnosis of Helicobacter pylori (H. pylori) in the Japanese population. MATERIALS AND METHODS: The endoscopic findings (including gastric fold findings and degree of atrophy by the Kimura-Takemoto classification system), histologic severity of inflammation, and glandular atrophy were assessed according to the Sydney system in 642 patients (419 men; 223 women; mean age 43.5 years, range 13-86). H. pylori infection was evaluated by Giemsa staining and serum IgG antibodies. RESULTS: 391 of 642 patients (60.9%) were diagnosed as having endoscopic gastritis. Of the 391 patients with endoscopic gastritis, 318 (82.6%) had histologic gastritis and 310 (79.3%) had H. pylori infection. Of the 251 patients with endoscopically normal stomachs, 43 (17.1%) had histologic gastritis and 32 (12.7%) had H. pylori infection. Atrophic gastritis was the most prevalent finding (56.3%) among those with endoscopic gastritis. The prevalence of H. pylori infection in patients with atrophic gastritis (92.7%) and rugal hyperplastic gastritis (92.3%) was significantly higher than in those with other types of gastritis or with a normal stomach (12. 7%). A markedly high prevalence of H. pylori infection was found in subjects with tortuosity, hyperrugosity, and/or hyporugosity of the gastric folds. CONCLUSIONS: The accurate endoscopic assessment of gastritis according to the Sydney system along with gastric fold findings and the endoscopically identified extent of gastric atrophy are valuable indicators for determining H. pylori infection and histologic gastritis in the Japanese population.

Adolescent↗

PubMed1992

[Celioscopic cholecystectomy].

Laparoscopic cholecystectomy was born in 1987 and is now commonly performed, usually under general anaesthesia, and under the same technical conditions as conventional surgery. The operative procedure varies with the operators, but it is mandatory to evaluate the state of the bile duct by pre- or peroperative explorations. Compared with conventional surgery, the advantages of laparoscopic cholecystectomy are well known: the entire peritoneal cavity is explored; the lack of postoperative ileus makes it possible to resume normal feeding, and hence normal activity, after a short interruption; systemic and parietal complications are less frequent, but the biliary tract complication rate is higher, probably in relation to the operator's training. The indications were initially restrictive but now embrace the quasi-totality of gallstones, complicated or not, and in particular when the patient's general condition is fragile.

Cholecystectomy↗

PubMed1999

Prospective evaluation for upper gastrointestinal tract acute graft-versus-host disease after hematopoietic stem cell transplantation.

The incidence and clinical significance of upper gastrointestinal tract acute graft-versus-host disease (upper GI GVHD) were prospectively evaluated in 44 Japanese patients who underwent allogeneic (n = 26) or autologous (n = 18) stem cell transplantation. Endoscopic examination was routinely performed between days 20 and 50 post-transplant and when symptoms of upper GI and/or acute GVHD of other organs were present. The results were compared with the historical records of 49 allograft and 20 autograft recipients. The diagnosis of upper GI GVHD was confirmed by histologic findings of GVHD and persistent upper GI tract symptoms. The incidence of upper GI GVHD was 46% in the prospective allograft group, higher than in the retrospective group. Upper GI GVHD was not diagnosed in any autograft patients. Twelve of 19 patients with upper GI GVHD had skin GVHD, and two of the 12 had concurrent lower GI GVHD. Upper GI GVHD was successfully treated with steroids and did not progress to symptomatic lower GI GVHD. In addition, upper GI GVHD completely resolved without specific alteration in immunosuppressant therapy in six patients. No risk factors for upper GI GVHD could be identified. The presence of upper GI GVHD did not significantly affect early death rate, incidence of chronic GVHD, and overall survival. In conclusion, by the prospective evaluation of the upper GI tract by endoscopy we could accurately diagnose upper GI GVHD in half our allogeneic recipients. However, upper GI GVHD was successfully controlled with or without additional steroids in all cases and had little impact on transplant outcome.

Adolescent↗

PubMed2000

Endohyperthermia--experimental evaluation of a new therapeutic approach for treatment of biliary carcinoma.

BACKGROUND AND STUDY AIMS: To improve the prognosis of patients with unresectable, locally advanced bile duct carcinoma, new treatment strategies need to be evaluated. Hyperthermia has been successfully applied as part of multimodal therapy in esophageal and rectal carcinoma. We performed in-vitro and in-vivo experiments with a new intraluminal hyperthermia system in the biliary tract. METHODS: A radiofrequency system (13.56 MHz, Endoradiotherm XERT-200A; Olympus Optical Co., Tokyo, Japan) was used with a special intraluminal microelectrode (diameter 4.5 mm, length 40 mm) covered by a silicone balloon with cooling water and a large counter electrode for focusing the electromagnetic field around the electrode. The heating capacity of the endohyperthermia unit was examined in vitro in a muscle-equivalent phantom (agar 4 %), in isolated livers of pigs and cows, as well as in vivo in anesthetized sheep. Continuous thermometry was done with thermosensors at the applicator surface, and with multichannel thermocouple probes in the environment of the applicator. RESULTS: Endohyperthermia induced a homogeneous heating of the phantom and the isolated liver bile duct preparation to a temperature > or = 40 degrees C in an area at least 10 mm in depth. After placement of the applicator into the common bile duct of anesthetized sheep, endohyperthermia led to a consistent and repeatable heating of the surrounding tissue to 40.5 +/- 0.5 degrees C at 1 cm distance, and 39.9 +/- 0.7 degrees C at 2 cm distance. Blood pressure, heart rate, and systemic temperature did not change in vivo. Histological examination of the bile duct showed superficial mucosal necrosis (depth 100-200 microm), microvascular damage with petechiae, congestion and edema of the bile duct wall and adventitia after hyperthermia treatment in vivo. CONCLUSIONS: The intraluminal endohyperthermia system produces consistent and repeatable heating of the surrounding tissue. Since effective thermal power can reach a depth of up to 2 cm, tumors may also be heated adequately.

Animals↗

PubMed1992

[Technique of percutaneous drainage under ultrasound guidance for acute cholecystitis].

Gallbladder percutaneous drainage under ultrasound guidance could offer an interesting option compared to surgery in multi-systemic disease patients with acute cholecystitis and who are considered as high-risk patients towards anesthesia and surgery. The authors describe this technics which is an easy, quick and eventually repetitive procedure with no major complications.

Acute Disease↗

PubMed1994

Shape memory alloy catheter system for peroral pancreatoscopy using an ultrathin-caliber endoscope.

Two types of a shape memory alloy (SMA) catheter system with a mechanism for tip control and irrigation were evaluated in performing peroral pancreatoscopy (PPS) using an ultrathin-caliber endoscope. The selective cannulation of SMA catheters into the papilla was made possible in 18 of 19 patients with pancreatic diseases. Endoscopic sphincterotomy was necessary in six of seven patients with the two-directional catheter (2.6 mm) but in only one of 12 patients examined with the one-directional type (2.2 mm). In 17 of the 18 patients, the catheters were smoothly advanced to the desired positions in the main pancreatic duct, even to the distal pancreas, due to their controllable tip. PPS with adequate inspection of the ducts and lesions was successful in 16 of these 17 patients. Features of cancer (duct disruption, tumor infiltration) and chronic pancreatitis (smooth ductal surface, fine vascular network) could be distinguished. In this series, there were no obvious complications during or after the procedure. In our experience, the SMA catheter system is effective for PPS in patients with an intact papilla and without dilation of the main pancreatic duct. Further study will show the clinical benefits this technique may have in pancreatic diseases.

Alloys↗

PubMed1999

[Stent intubation for the airway stenosis under PCPS].

Placement of stents for the tracheal or carinal stenosis have a meaning of maintaining the airway. Failure of the stenting causes death. In cases of severe airway stenosis and low pulmonary function, the pulmonary support method should be performed instead of intubation and mechanical ventilation. Generally, PCPS (percutaneous cardio-pulmonary support system) is used as a pulmonary support. This method was very useful to place stents for airway stenosis. We concluded that PCPS was useful in emergency cases, and in cases of severe fixed type airway stenosis and low pulmonary function it had be on stand-by.

Cardiopulmonary Bypass↗

PubMed1993

Cystic duct anatomy: an endoscopic perspective.

Knowledge of the junction of the cystic and common hepatic duct is essential for endoscopic management of biliary tract disease. The cystic and common hepatic ducts were evaluated retrospectively in cholangiograms obtained for a variety of indications in 524 persons. The cysticohepatic junction was adequately visualized in 70%. Medial junctions were noted in 18% and a spiral configuration in 32%, both more common than reported. An 11% occurrence of parallel duct systems was less frequent than expected. In 10% of patients, the cystic duct entered the hepatic duct in the distal third of the extrahepatic biliary tree. The importance of understanding this anatomy is illustrated with selected cases of therapeutic biliary endoscopy and laparoscopic cholecystectomy complications. Suggestions are made for improving performance in this area.

Adult↗

PubMed1992

[Endoscopic ultrasonography of the upper digestive tract].

Endoscopic ultrasonography is a useful combination of endoscopy and abdominal ultrasonography. It visualized in detail the wall of the digestive tract and is thus indicated for the diagnosis of pathological processes of the wall and its close surroundings, in particular the differential diagnosis of tumours, assessment of their size and operability. The method has become available also under our conditions. The present paper deals with its technique and informative value.

Digestive System↗

PubMed1993

[Biliary lithotripsy using super fine cholangioscopy with the deviced bended sheath].

Percutaneous transhepatic cholangioscopy (PTCS) is an useful technique to evaluate or treat biliary diseases, although PTCS is an invasive method for the patients. We used 5 F or 7 F of super fine cholangioscopy to treat two cases of choledocholithiasis after surgery without dilatation of drainage tract. We developed different types of bended sheath for supplement of lack of angle system in this cholangioscope. Furthermore, by using bended sheath, cholangioscopic view improved, because saline was injected at the same time via the sheath. We emphasize that super fine cholangioscope with bended sheath is a safe and useful modality for evaluation of biliary disease.

Adult↗

PubMed1993

[How frequent is the diagnosis of GI metastasis in an endoscopic patient sample in general internal medicine clinics> Results of a questionnaire survey of 34 medical clinics].

With the aim of analysing the frequency of gastrointestinal (GI) metastases identified by endoscopic procedures, a survey was conducted by questionnaire, which was completed by 34 of 127 medical departments. Peritoneal carcinosis and direct tumor extension were disregarded. One GI metastasis (duodenum) was verified among 3477 upper GI tract endoscopies. Primary site was cutaneous melanoma. In another case metastatic origin is discussed (esophagus). Considering the average frequency of 102 upper GI tract endoscopies performed by the collaborating centers, one case of gastroduodenal metastasis could be expected every 17 (34) months in these institutions. 1634 examinations of the colon and rectum did not reveal any metastatic tumor growth. A longterm study is planned to provide further statistically reliable prevalence data.

Aged↗

PubMed1997

[Reparative characteristics of gastric and duodenal mucosa in ulcer].

Mucosal repair in the stomach and duodenum was assessed clinically and morphologically in various ulcer phases in 475 patients with gastroduodenal ulcer. It was found that poorly scarring ulcers are characterized by severe impairment of regeneration with epithelial proliferation prevailing over its differentiation. Participation of immune system, primarily T-cell component, in regeneration regulation is shown. Helicobacter pylori is not involved in repair. Superoxide dismutase activity in red cells and ulcer edges mucosa is prognostically significant indicating the disease phase, completeness of ulcer process.

Adult↗