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Results for “Endoscopy, Digestive System”

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PubMed1980

Sedation for upper gastro-intestinal endoscopy. A comparison of oral temazepam and i.v. diazepam.

Temazepam 20 mg orally was compared with titrated doses of i.v. diazepam as sedation for elective upper gastro-intestinal endoscopy. The mean time from taking oral temazepam to endoscopy was 66 min, and from i.v. diazepam to endoscopy was 10 min. The endoscopists found that the sedation achieved was the same in both groups and allowed adequate examination of the upper alimentary tract. The oral presentation, avoiding the pain of injection and the possible shorter duration of action, made oral temazepam preferable to i.v. diazepam.

Administration, Oral↗

PubMed1982

Biopsy appearances easily mistaken for malignancy in gastrointestinal endoscopy.

A series of 10 cases is described which were characterized by the occurrence, in gastrointestinal endoscopic biopsies, of benign lesions which bore a close resemblance to malignancy. In three cases an erroneous diagnosis of carcinoma was made and major resections were performed unnecessarily. The lesions fall into two histological types, one of which is seen only in gastric biopsies and the other at any level of the gastrointestinal tract. The histopathology of these lesions is described in detail.

Adult↗

PubMed1991

Endoscopic nasobiliary catheter drainage in biliary and pancreatic disease.

Nasobiliary catheter drainage was first introduced a decade ago. It provides drainage of the biliary system and facilitates interventional procedures of the biliary and pancreatic system, both for therapy and research purposes. The present review addresses the designs of nasobiliary catheters, the technique of insertion, and indications for drainage, with special emphasis on the management of bile duct stones and associated complications. Its potential application in biliary research is discussed further. Certain caveats in the performance of nasobiliary drainage are also included. All of these emphasize the need for this technique to be included in therapeutic endoscopy training.

Biliary Tract Diseases↗

PubMed2003

Endoscopic drainage of pancreatic fluid collections and pancreatic necrosis.

PFCs are heterogeneous, with different underlying pathology and pathophysiology. Each type of PFC is amenable to drainage, although not in every patient. Collections with only a fluid component that have either apposition to the gastric or duodenal wall demonstrated by CT or communication with the main pancreatic duct demonstrated by pancreatography can be drained endoscopically using transmural or transpapillary approaches, respectively. Collections containing significant amounts of solid debris that are treated endoscopically require placement of an irrigation system to evacuate solid debris. Endoscopists considering endoscopic therapy of a pancreatic collection must identify the type of collection being drained and exclude masqueraders of PFCs such as cystic neoplasms. EUS-guided drainage, if available, may decrease the complications of bleeding and perforation during transmural entry of PFCs. Refinement in endoscopic techniques to improve the safety and studies comparing the efficacy of endoscopic therapy with that of other drainage methods are needed.

Drainage↗

PubMed1996

[Duodenal ulcer: clinical significance of adaptation defects in the system of neurohumoral regulation].

Radioimmunoassay was used to determine prostaglandin (PGE-2) and cyclic nucleotides (cAMP and cGMP) concentrations in the serum before, 1 and 2 hours after standard test breakfast (5066 kJ) in 65 patients with duodenal ulcer. Basal hyperproduction of prostaglandins and cyclic nucleotides were interpreted as an adaptation-compensatory mechanism. The unbalance of their aftermeal reactions persistent even in ulcer healing may belong to factors of the disease progression.

Adaptation, Biological↗

PubMed1989

Midazolam versus diazepam for combined esophogastroduodenoscopy and colonoscopy.

This study compares the effects of two different benzodiazepines used for conscious sedation during combined upper gastrointestinal endoscopy (EGD) and colonoscopy. Subjects were assessed for their degree of analgesia and amnesia for the procedure, prior experience with endoscopy, and willingness to undergo another similar procedure should such be necessary. The patients were randomized single blind to receive either midazolam or diazepam for their preprocedure sedation. The amount of preprocedure sedation utilized was determined by titration of the dose to achieve slurring of speech. Prior to receiving either agent, the subjects were shown a standard card containing pictures of 10 common objects, were asked to name and remember them, and were told they would be "quizzed" (at 30 min and 24 hr) after being sedated for their recollection as to the objects pictured on the card. Each subject filled out a questionnaire addressing their perceived discomfort during the endoscopic procedure and their memory of the procedure 24 hr after the procedure. Sixty-three percent of the midazolam-sedated subjects reported total amnesia for their colonoscopy vs 20% of diazepam-sedated patients (P less than 0.001). Fifty-three percent of midazolam-sedated patients reported total amnesia of their upper gastrointestinal endoscopy vs only 23% of diazepam-sedated subjects (P less than 0.05). The midazolam-sedated subjects reported experiencing less pain with both upper gastrointestinal endoscopy (P less than 0.05) and colonoscopy (P less than 0.001) than did the diazepam-sedated group. Most importantly, the midazolam group was more willing to undergo another similar endoscopic procedure should they be asked to do so by their physician (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2003

Diagnostic tests for gastroesophageal reflux disease.

A range of tests is available to the physician pursuing the diagnosis of gastroesophageal reflux disease (GERD). Many times, these studies are unnecessary because the history is sufficiently revealing to identify the presence of troubling reflux disease. 1 However, this may not be the case and the clinician must decide which tests to choose to arrive at a diagnosis in a reliable, timely, and cost-effective manner (Table 1). Furthermore, the various esophageal tests need to be selected carefully depending upon the information desired. For example, identifying the presence of gastroesophageal reflux disease is different from proving that the patient's symptoms are caused by reflux episodes. Additionally, defining that acid reflux exists may not be enough. To tailor appropriate medical or surgical therapy requires knowing whether complications of GERD are present as well as possible mechanisms by which abnormal GER occurs. A thorough and well-devised investigation strategy requires knowledge of testing procedures ranging from radiology and pathology to physiology and endoscopy. An informed background in these areas allows the clinician and investigator to address not only the presence of reflux and its correlation to patient symptoms but also the severity of esophageal injury and even the mechanisms by which the damage is done. By using the available tests judiciously, one can increase the opportunity of making a correct diagnosis of GERD and simultaneously limit the potential inconveniences or cost to the patient.

Animals↗

PubMed1991

Plasma shock wave lithotripsy of gallstones in vitro. Animal experiments and clinical application.

It is sometimes very difficult to extract a huge impacted stone through the T-tube fistulous tract by conventional techniques with choledochoscope. To simplify the procedure, a lithotriptor PSW-G type using plasma shock wave to disintegrate the stone was designed. The efficacy to fragmentate stone was investigated both in vitro and in vivo. Stones can be shattered into pieces less than 3 mm in diameter in about 30 times of spark with lower energy ranging from 1.7-3.4 kV and 1-3 J. Animal experiments were carried out to prove the safety of the lithotriptor. There was neither interference with the cardiovascular and respiratory systems nor obvious damage to the adjacent tissue where plasma shock wave applied to break stones. Six patients with retained calculi impacted both in extra- and intra-hepatic duct were successfully treated by plasma shock wave lithotripsy. It appears very useful in dealing with a huge impacted stone in the biliary tract.

Animals↗

PubMedDate not supplied

[Reparative processes in peptic ulcer (clinico-morphologic study)].

475 patients with stomach ulcer (1984-1993) were studied using various methods: endoscopical, immunological, biochemical, bacteriological and morphological. Morphology of exacerbation and type of reparative processes in normal scarring and torpid course of disease are presented. Under adequate regeneration there is an activation of immune system, first that of T-cell compartment. Torpid course is characterized by a grave regeneration disturbance and depression of the immune system. The interpretation of the so-called "red scar" is given: it reflects different stages of the epithelial regeneration, however in 4.8% of duodenal ulcers and in 11.2% of stomach ulcers it masks a torpid course. Helicobacter pylori has no influence on the reparative processes. Adequately chosen therapy improves and accelerates ulcer scarring.

Adult↗

PubMed1994

Indications and contraindications for upper gastrointestinal endoscopy.

Upper endoscopy is currently one of the most frequently performed procedures. The most common indications for diagnostic EGD include dyspepsia unresponsive to medical therapy or associated with systemic signs, dysphagia or odynophagia, persistent gastroesophageal reflux symptoms, occult gastrointestinal bleeding, and surveillance for malignancy. These guidelines, however, are largely based on consensus opinion, and few controlled trials have evaluated the effect of endoscopy on patient outcome, medical expenditures, and management. It appears that the benefits of therapeutic upper endoscopy for such conditions as acute gastrointestinal bleeding, foreign-body removal, and stricture dilatation are more well defined. Future studies should be directed at the most cost-effective and beneficial management strategies for many of these common conditions.

Contraindications↗

PubMed1992

[Fiber endoscopy in the extraction of foreign bodies from the gastrointestinal tract].

23 patients that they swallowed foreign bodies, were treated. There were 16 male and 7 female, between 3 and 85 years old; 6 children and 17 adults. Of all, 7 were psychiatric patients. 15 foreign bodies were removed by upper digestive fiberendoscopy and 2, by procto/colonoscopy, without early nor late complications. 8 foreign bodies were eliminated spontaneously through the rectum/anus. Fiberendoscopy is an excellent method for treatment in these clinical problems.

Adolescent↗

PubMed1995

Portal hypertension: review of data and influence on management.

It is evident that endoscopic ultrasonography could have a great clinical role in the selection of the best treatment for the individual patient because it allows the simultaneous visualization of a large part of the portal venous system and its collaterals. It has not been shown that the same kind of treatment is suitable for every patient with portal hypertension, and failure of a particular treatment may be attributable to an incorrect selection of patients. Further perspective studies with EUS in patients with portal hypertension are thus necessary in order to clearly state the cost-benefit of this technique in the management of these subjects.

Endoscopy, Digestive System↗

PubMed2004

ERCP and MRCP in the differentiation of pancreatic tumors.

The introduction of endoscopic retrograde cholangiopancreatography (ERCP) in the early 1970s provided gastroenterologists with a number of diagnostic as well as therapeutic possibilities for examining biliopancreatic systems. In the meantime, magnetic resonance cholangiopancreatography presents a non-invasive alternative to diagnostic ECRP providing the advantage of a lower rate of possible complications. This article addresses the two methods presently available for differentiating pancreatic tumors. The objective of this article is to describe the advantages and disadvantages as well as the possibilities inherent in both methods.

Adenoma, Islet Cell↗

PubMed2005

[Particular features of clinical and morphological manifestations of the atrophic process in the mucous coat of the stomach in case of absence and presence of infection with Helicobacter pylori (first stage)].

A clinical and endoscopic examination and morphological study of gastrobiopsies were conducted in 62 patients with Helicobacter (H.) pylori-negative and -positive chronic atrophic gastritis (CAG) to study the manifestations of the atrophic process in the mucous coat of the stomach (MCS) and stages of its progression in terms of pre-cancerous changes (second stage). The MCS atrophy is characterized by considerable frequency of concomitant endocrinopathies, connective tissue dysplasia, systemic lesions of the mucous coats of the gastrointestinal tract, as well as morphologically diverse disorders of proliferation and differentiation. Thus, the MCS atrophy appears as a result of homeostasis dysregulation at various levels. CAG being a particular manifestation of the atrophy phenomenon characterized by polyetiology and complexity of pathogenesis cannot be reduced to one causal factor (HP), and therefore it deserves special attention and needs further study.

Adolescent↗

PubMed2002

Percutaneous transhepatic small-caliber choledochoscopic lithotomy: a safe and effective technique for percutaneous transhepatic common bile duct exploration in high-risk elderly patients.

PURPOSE: Endoscopic bile duct clearance is now the treatment of first choice for bile duct stones, particularly in elderly or high-risk patients. The purpose of this study was to objectively assess the safety, efficiency, and ease of use of percutaneous transhepatic choledochoscopy, using a small-caliber choledochoscope with a facilitated insertion technique, in high-risk elderly patients with choledocholithiasis. METHODS: Sixty-five consecutive patients with common bile duct stones scheduled for percutaneous transhepatic choledochoscopic lithotomy were studied prospectively. Choledochoscopy was carried out with a simplified introducer system, using a 2.8-mm choledochoscope with electrohydraulic lithotripsy. RESULTS: The common bile duct was successfully accessed and the stones removed in all 65 patients. The average time for the entire procedure was 45 min. There were no serious procedure-related complications. CONCLUSIONS: Percutaneous transhepatic choledochoscopic lithotomy, using electrohydraulic lithotripsy, is an attractive alternative for patients with common bile duct stones when surgery or retrograde methods are not suitable.

Age Factors↗

PubMed2004

Recurrent Dieulafoy's disease with surgical management: diagnosis by endoscopic ultrasonography.

Dieulafoy's disease is an uncommon but potentially significant cause of gastrointestinal bleeding caused by a large-caliber arterial vessel in the submucosa, which causes erosion and debilitation of the surrounding mucosa and may lead to massive gastrointestinal bleeding. Since endoscopy may prove insufficient, echoendoscopy may help in the diagnosis of this condition. Echoendoscopy may also help improve endoscopic management using mechanical techniques (hemoclips or band ligation) or a combination of thermal techniques and injection sclerotherapy, since this allows an accurate localization of the submucosal vessel. We present a case illustrating this approach by endoscopic ultrasonography, and describe the morphological substrate of this condition.

Adult↗

PubMed2003

The effect of duodenogastric reflux on Helicobacter pylori presence and gastric histopathologic changes.

BACKGROUND/AIMS: In this study, we investigated the presence of Helicobacter pylori infection and gastric histological changes in unoperated patients with and without duodenogastric reflux. METHODS: Twenty-two women and 15 men, mean age of 51.17 years, who had duodenogastric reflux during endoscopy were included. Thirty-seven age-and gender-matched patients without duodenogastric reflux served as controls. The Helicobacter pylori infection was detected by histology. The Helicobacter pylori density and gastric histology according to the modified Sydney system were evaluated with specimens from antrum, corpus and fundus. RESULTS: The presence of Helicobacter pylori, Helicobacter pylori density, chronic inflammation score, lymphoid follicles, atrophy, and intestinal metaplasia were similar in patients with and without duodenogastric reflux (p>0.05). Acute inflammation was found to be lower in the antrum (p<0.05) in the duodenogastric reflux-positive group. CONCLUSION: Duodenogastric reflux does not affect the presence of Helicobacter pylori and gastric histopathologic changes.

Atrophy↗

PubMedDate not supplied

Gastroesophageal reflux disease: clinical manifestations.

Gastroesophageal reflux disease (GERD) is generally a lifelong illness that affects many people, but its significance is often underestimated. Chronic abnormal gastric reflux results in erosive esophagitis in up to 60% of patients with GERD. Esophageal stricture, Barrett's esophagus, and esophageal adenocarcinoma are the most serious complications of GERD. Although heartburn and acid regurgitation are the most common complaints, extraesophageal symptoms such as noncardiac chest pain, laryngitis, coughing, and wheezing can be manifestations of GERD. Unfortunately, the severity of symptoms is not a reliable indicator of the severity of erosive esophagitis. Endoscopy is the preferred method to diagnose and grade erosive esophagitis, and various classification systems are used to grade disease severity. The Los Angeles Classification is a valid and widely accepted system to evaluate the severity of erosive esophagitis. The immediate goals of treatment are to provide effective symptomatic relief and to achieve healing in patients with esophageal damage. The treatment regimen often begins by prescribing a therapy to reduce gastric acid secretion. A proton pump inhibitor is the preferred agent for many patients. Because GERD is a chronic, relapsing disease, long-term maintenance therapy is usually necessary to relieve symptoms, prevent complications, and improve the quality of life in patients with GERD.

Anti-Ulcer Agents↗