SEARCH · PubMed Health

Results for “Endoscopy, Digestive System”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 523 records · Page 29Linked to original sources

PubMed1989

Button battery ingestions.

Although ingestions of button batteries can have serious complications, the majority of these ingestions will be benign. Button batteries that lodge in the esophagus should be removed immediately by endoscopy. Other ingestions can be managed with observation at home unless symptoms develop. Weekly radiographic examinations should be done to follow the progression of the button battery in these patients. The expected threat of mercury toxicity has not materialized. Patients who ingest mercury-containing button batteries should undergo chelation therapy and monitoring of levels only if symptoms characteristic of mercury toxicity develop. Cathartics and water-soluble enemas, although not indicated for intact button batteries, may be useful in speeding transit of mercury if it is released into the bowel. Other metals present in button batteries appear to pose no health threat.

Algorithms↗

PubMedDate not supplied

Cowden syndrome: report of two cases and review of clinical presentation and management of a rare colorectal polyposis.

BACKGROUND/AIMS: Cowden syndrome (CS) is a rare and complex disease inherited through an autosomal dominant trait associated with germline mutations of the PTEN gene. OBJECTIVE: This article reports 2 female patients with classic features of the syndrome and reviews the current guidelines regarding diagnosis and surveillance. REVIEW: Although it exhibits variable clinical expressivity, the diagnosis is based on characteristic mucocutaneous alterations such as multiple facial trichilemmomas, oral mucosal papillomatosis, and acral and palmoplantar keratoses. These manifestations often precede systemic involvement. Extracutaneous lesions include fibrocystic disease of the breast, thyroid goiters or adenomas, multiple polyposis of the gastrointestinal tract, and ovarian cysts. Gastrointestinal polyps are usually asymptomatic, and the risk of gastrointestinal cancer is not greatly increased. Otherwise, an important feature of Cowden's disease is the greater risk of breast and thyroid cancer. CONCLUSIONS: Because of the potentially serious associations with internal malignancy, early and accurate diagnosis of CS is essential. For this reason, all patients must be screened for occult malignancies and undergo close surveillance throughout lifetime.

Adult↗

PubMed1992

Effect of somatostatin analog octreotide on human sphincter of Oddi.

The effect of the long-acting somatostatin analog octreotide on the sphincter of Oddi was investigated in seven subjects referred for endoscopic sphincter of Oddi manometry. Six patients had unexplained right upper quadrant pain and one had bile duct dilatation without evidence of fixed obstruction on endoscopic retrograde cholangiopancreatography. A triple-lumen low-compliance system was used to record the sphincter of Oddi basal pressure, phasic contraction frequency, amplitude, duration, and direction of wave propagation before and after intravenous administration of octreotide in a dose of 50 micrograms. After a mean latency period of 1 min, significant changes included increased basal pressure in all seven patients, increased frequency of wave contractions in six patients, and decreased wave amplitude in six patients. The median duration of wave contraction and wave propagation sequence were not significantly influenced. Thus, octreotide has a significant stimulatory affect on the sphincter of Oddi activity, which may impair biliary and pancreatic flow.

Adult↗

PubMed2003

Virtual reality applied to procedural testing: the next era.

OBJECTIVE: To establish the construct validity of a virtual reality-based upper gastrointestinal endoscopy simulator as a tool for the skills training of residents. SUMMARY BACKGROUND DATA: Previous studies have demonstrated the relevance of virtual reality training as an adjunct to traditional operating room learning for residents. The use of specific task trainers, which have the ability to objectively analyze and track user performance, has been shown to demonstrate improvements in performance over time. Using this off-line technology can lessen the financial and ethical concerns of using operative time to teach basic skills. METHODS: Thirty-five residents and fellows from General Surgery and Gastrointestinal Medicine were recruited for this study. Their performance on virtual reality upper endoscopy tasks was analyzed by computer. Assessments were made on parameters such as time needed to finish the examination, completeness of the examination, and number of wall collisions. Subjective experiences were queried through questionnaires. Users were grouped according to their prior level of experience performing endoscopy. RESULTS: Construct validation of this simulator was demonstrated. Performance on visualization and biopsy tasks varied directly with the subjects' prior experience level. Subjective responses indicated that novice and intermediate users felt the simulation to be a useful experience, and that they would use the equipment in their off time if it were available. CONCLUSIONS: Virtual reality simulation may be a useful adjunct to traditional operating room experiences. Construct validity testing demonstrates the efficacy of this device. Similar objective methods of skills evaluation may be useful as part of a residency skills curriculum and as a means of procedural skills testing.

Computer Simulation↗

PubMed2005

Endoscopic findings in a patient with Henoch-Schonlein purpura.

Henoch-Schonlein purpura (HSP) is a systemic vasculitis of the small vessels of the skin, joints, GI tract, and kidney. It preferentially affects children but may also occur in adults. We report a 60-year-old man with HSP who presented with colicky abdominal pain, bloody diarrhea, arthralgia, and skin rash. The gastrointestinal tract was viewed by upper endoscopy and colonoscopy. We found characteristic endoscopic findings in the stomach, cecum and sigmoid colon, the combination of which has rarely been demonstrated in one patient. Histologic examination of skin biopsy specimens revealed leukocytoclastic vasculitis with positive staining for IgA in the capillaries. Endoscopy appears to have substantial diagnostic utility in patients suspected of having HSP, especially when abdominal symptoms precede the cutaneous lesions.

Abdominal Pain↗

PubMed1996

Endoscopic management of biliary disease during pregnancy.

BACKGROUND: The transient but substantial alterations in the biliary system during pregnancy increase the risk of cholecystitis, choledocholithiasis, and pancreatitis. Traditionally, these disorders are managed conservatively or with operative cholecystectomy. Recent advances in fiber-optic technology allow endoscopy to be used as a safe, effective, and definitive treatment alternative for pancreaticobiliary disease in pregnancy. CASES: Three gravid women with cholelithiasis, acute cholecystitis, and/or gallstone pancreatitis were treated endoscopically with stone extraction and experienced rapid resolution of symptoms and successful pregnancy outcomes. CONCLUSION: Aggressive endoscopic intervention for biliary disorders in pregnancy appears to decrease morbidity, mortality, and costs. Endoscopy offers a safer, more effective treatment alternative to prolonged medical management and traditional surgical intervention during pregnancy. Because biliary abnormalities resolve rapidly in the postpartum period, it is unlikely these women will need subsequent treatment.

Adult↗

PubMed1992

[Economic analysis of maintenance treatment with ranitidine 150 mg in duodenal ulcer].

While it is well-established that ranitidine 150 mg/day is effective in preventing recurrence and complications of duodenal ulcer, the economic impact of maintenance therapy is unknown. Socio-economic data, allowing to calculate the costs and cost-effectiveness ratio of intermittent and maintenance therapy, were prospectively obtained from a therapeutic trial in 399 duodenal ulcer patients (Mignon et al, Gastroenterol Clin Biol 1990;14:732-8). Visits and endoscopy investigations, work days lost, duration of hospital stay and drug consumption were recorded in both placebo (n = 202) and ranitidine (n = 197) groups. Each source of expenditure was evaluated using current fares and sales prices, from the point of view of both the collectivity and the French Health Care System. The costs of ranitidine strategy were less than the costs of placebo strategy, for the collectivity (2,031 and 2,823 FF per patient for one year, respectively) as well as for the French Health Care System (1,541 and 2,426 FF per patient per year, respectively). In the ranitidine group, expenditures were principally due to the drug (71%) and endoscopy investigation (24%). In the placebo group, endoscopy and hospital stay accounted for 50 and 39% of the expenses, respectively. The latter were due to the occurrence of complications in the placebo group. Sensitivity analysis disclosed that the results were unsensitive to the variations in cost hypotheses of the main expenditure sources. Cost/effectiveness analysis defined as cost per patient successfully treated showed that the cost of a "ranitidine strategy" was 2-3 times less than a "placebo strategy". Maintenance therapy for duodenal ulcer with ranitidine 150 mg/day for one year is less expensive and more cost-effective than intermittent treatment.

Cost of Illness↗

PubMedDate not supplied

Long-term semi-quantitative follow-up of Helicobacter pylori associated gastritis.

Helicobacter pylori infection has been implicated with the development of gastric carcinoma and lymphoma. We studied the long-term effects of H. pylori infection on gastric mucosa. Ten patients with Helicobacter pylori infection underwent repeat endoscopy and antral biopsies 8 years later. Gastric mucosal features (polymorphs, monocytes, intestinal metaplasia, atrophy and lymphoid aggregates) were graded from mild to severe (0 to 3) based on the Sydney system of gastritis classification. At repeat biopsy, 1 patient was negative for H. pylori after eradication therapy. Two patients (20 per cent) had spontaneous disappearance of H. pylori. One of these had intestinal metaplasia which progressed to low grade dysplasia. Polymorphs decreased with eradication of H. pylori (P < 0.05). Lymphoid aggregates increased with continued H. pylori infection but decreased with eradication of H. pylori (P < 0.05). Monocytes, intestinal metaplasia and atrophy remained unchanged. Persistent H. pylori infection appears to increase lymphoid aggregates and may promote its evolution into gastric lymphoma while eradication of H. pylori may result in a reduction of polymorphs and lymphoid aggregates.

Adult↗

PubMed2004

In vivo observation of living cancer cells in the esophagus, stomach, and colon using catheter-type contact endoscope, "Endo-Cytoscopy system".

A catheter-type endomicroscope has been developed with a maximum magnifying power of 1100 times. Living cancer cells in the esophagus, stomach, and colon were successfully observed in high-resolution images. The "Endo-Cytoscopy system" (prototype,Olympus Optical, Co., Tokyo, Japan) is a catheter-based probe capable of passage through the accessory channel of the endoscope(GIF-1T, Olympus). Methylene blue solution was used for vital staining of the in vivo gastrointestinal mucosa. Living cells in both normal mucosa and malignant tissue were clearly demonstrated in luminal organs. In particular, the nucleus, cell body, and nucleolus were clearly demonstrated with high-quality images similar to those of conventional cytology. This novel technology has the potential to provide an in vivo histologic diagnosis via "optical biopsy" and virtual histology.

Catheterization↗

PubMed2006

Advances in the endoscopic management of patients with pancreatic and biliary malignancies.

Major advances in endoscopic techniques to diagnose and manage pancreatic biliary diseases have fundamentally changed the approach to these difficult clinical challenges. The diagnosis of benign and malignant pancreatic-biliary diseases is much more readily obtained through a combination of cross-sectional imaging and endoscopic procedures. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) are the most important endoscopic tools for imaging and accessing the pancreatic biliary system. The review summarizes the major imaging methods for providing a diagnosis of bile duct malignancy, including ERCP, transhepatic cholangiography (THC), and magnetic resonance cholangiopancreatography (MRCP). High quality image examples of cholangiocarcinoma are provided. EUS has provided a new imaging modality for the detection of pancreatic and biliary malignancy. EUS is particularly sensitive for the detection of early pancreatic malignancy. Furthermore, EUS excels at the guidance of fine needle aspiration of pancreatic lesions. Diagnostic tissue acquisition for cholangiocarcinoma remains an important challenge. The endoscopic therapy for pancreatic-biliary malignancy involves the use of stenting which relieves the biliary obstruction commonly seen in these patients.

Biliary Tract Neoplasms↗

PubMedDate not supplied

Videoendoscopic techniques for collection of multiple, serial intra-abdominal biopsy specimens in HIV-negative and HIV-positive pigtail macaques (Macaca nemestrina).

Tissue biopsy sampling by laparotomy is considered major surgery, which precludes serial sampling. This increases variability and requires a larger n value for pathogenesis studies. To address this problem, a study was conducted to develop and validate the feasibility of performing multiple, serial biopsy sampling by laparoscopy in pigtail macaques. Tissues were obtained laparoscopically from 2 HIV-negative and 2 HIV-positive (late postinoculation) macaques on days 0, 3, and 7, followed by necropsy on day 21. Anesthesia was induced with ketamine and atropine and maintained with isoflurane. Carbon dioxide pneumoperitoneum was maintained at 6 mm Hg. A triangulated threeport technique was used for insertion of pediatric (3.5-5.0 mm) laparoscopic instrumentation. Biopsies of kidney and spleen were obtained with a core-sampling biopsy needle, of small intestine and mesenteric lymph node with a pretied loop, and of liver with 3.5-5.0 mm biopsy forceps. Analgesics were administered for 24 h post operation, and animals were evaluated for postoperative complications. All monkeys maintained a good appetite. Mild postoperative pain was observed in one animal after the second surgery. There was no excessive bleeding or intestinal stenosis at biopsy sites. Skin infection, observed in 1/36 (2.8%) port sites, resolved with systemic antibiotics. Significant adhesions formed at 23/114 (20.2%) sites. Out of 34 samples evaluated for histopathology, 29 (85.3%) were satisfactory (minimal to mild tissue crushing). In situ hybridization results revealed few (4 of 29 samples tested) positive cells, which is consistent with the low level of HIV-2 virus found in cells late in the postinoculation period in pigtail macaques. The results of this study suggest that laparoscopic serial abdominal biopsy collection in healthy and immunocompromised pigtail macaques may be considered a minor procedure, and can be used to expedite serial tissue collection in survival studies.

Abdomen↗

PubMed2003

Motion--pancreatic endoscopy is useful for the pain of chronic pancreatitis: arguments for the motion.

Pain is the dominant clinical problem in patients with chronic pancreatitis. It can be due to pseudocysts, as well as strictures and stones in the pancreatic ducts. Most experts agree that obstruction could cause increased pressure within the main pancreatic duct or its branches, resulting in pain. Endoscopic therapy aims to alleviate pain by reducing the pressure within the ductal system and draining pseudocysts. Approaches vary according to the specific nature of the problem, and include transgastric, transduodenal and transpapillary stenting and drainage. Additional techniques for the removal of stones from the pancreatic duct include extracorporeal shockwave lithotripsy. Success rates for stone extraction and stenting of strictures are high in specialized centres that employ experienced endoscopists, but pain often recurs during long term follow-up. Complications include pancreatitis, bleeding, infection and perforation. In the case of pancreatic pseudocysts, percutaneous or even surgical drainage should be considered if septae or large amounts of debris are present within the lesion. This article describes the techniques, indications and results of endoscopic therapy of pancreatic lesions.

Calculi↗

PubMed1994

Peptic ulcer disease in children. Diagnosis, treatment, and the implication of Helicobacter pylori.

Peptic ulcers are a relatively infrequent occurrence in children. Ulcers in the stomach and duodenum are typically secondary to systemic illnesses or drugs in young children; secondary ulcers do not recur. In contrast, duodenal ulcers in older children and adolescents have a relapsing course that is increasingly recognized to be related to coexisting, chronic, active antral gastritis and Helicobacter pylori infection. Antihelicobacter therapy not only heals duodenal ulcers, but it alters the natural history by reducing the frequency of ulcer recurrences. Not all primary duodenal or gastric ulcers in the pediatric population, however, are related to H. pylori; their cause remains unknown. Treatment for these patients requires either antacids, H2 blockers, proton pump inhibitors, or ulcer coating agents for 6-8 weeks along with long-term maintenance therapy.

Acute Disease↗

PubMed1989

Low serum cobalamin levels in a population study of 70- and 75-year-old subjects. Gastrointestinal causes and hematological effects.

We examined causes and hematological consequences of low serum cobalamin (vitamin B12) concentration in two representative population samples of 70-year-old (N = 293) and 75-year-old subjects (N = 486). Subjects with values below 130 pmol/liter (4.8% and 5.6%, respectively) were investigated with Schilling test, upper gastrointestinal endoscopy, determination of serum gastrin and group I pepsinogens, and bone marrow examination. Gastrointestinal abnormalities of etiologic significance were found in 26 of the 32 examined subjects: atrophy of the gastric body mucosa (N = 16, with pernicious anemia in six), partial gastrectomy (N = 6), and intestinal malabsorption (N = 4). Megaloblastic hematopoiesis was found in 10 individuals, four of whom had macrocytic anemia. Our results indicate that low serum cobalamin concentration in the elderly is usually a consequence of disease rather than of high age per se and that gastric mucosal atrophy is a major etiologic factor.

Aged↗

PubMed2004

Initial experience with a new peroral electronic pancreatoscope with an accessory channel.

BACKGROUND: A peroral electronic pancreatoscope was previously developed to improve visualization of the pancreatic duct, but this instrument had no accessory channel. METHODS: A new peroral electronic pancreatoscope (2.6-mm external diameter) with an accessory channel (0.5 mm) was developed. Peroral pancreatoscopy or cholangioscopy was performed with this new instrument in 11 patients with various pancreatobiliary diseases. The clinical utility of the new peroral electronic pancreatoscope was assessed, and visualization with this new instrument was compared with that of the prototype. RESULTS: The resolution of the two instrument systems was nearly equal, with that provided by the new peroral electronic pancreatoscope being slightly better. The new peroral electronic pancreatoscope was inserted successfully into the pancreatic or bile duct in 9 of the 11 patients (82%). Observation of a predetermined target and juice collection with direct visualization was successful in 8 of the 9 patients (89%). CONCLUSIONS: The new peroral electronic pancreatoscope with an accessory channel was useful for clinical diagnosis of various pancreatobiliary diseases. Visualization is excellent. Pancreatic juice and other samples can be collected under direct visualization.

Aged↗

PubMed2002

Erythromycin intravenous bolus infusion in acute upper gastrointestinal bleeding: a randomized, controlled, double-blind trial.

BACKGROUND & AIMS: Emergency endoscopy may be difficult in upper gastrointestinal bleeding when blood obscures the visibility. Erythromycin, a motilin agonist, induces gastric emptying. We investigated whether an intravenous bolus infusion of erythromycin would improve the yield of endoscopy in these patients. METHODS: Patients admitted within 12 hours after hematemesis were randomly assigned to erythromycin (250 mg) or placebo, 20 minutes before endoscopy. The primary end point was endoscopic yield, as assessed by objective and subjective scoring systems and endoscopic duration. Secondary end points were the need for a second look, endoscopy-related complications, blood units transfused, and length of hospital stay. RESULTS: Fifty-one patients received erythromycin and 54 received placebo. A clear stomach was found more often in the erythromycin group (82% vs. 33%; P < 0.001). This difference remained significant in patients with cirrhosis. Erythromycin shortened the endoscopic duration (13.7 vs. 16.4 minutes in the placebo group; P = 0.036) and reduced the need for second-look endoscopy (6 vs. 17 cases; P = 0.018). Length of hospital stay and blood units transfused did not significantly differ between the 2 groups. No complications were noted. CONCLUSIONS: Erythromycin infusion before endoscopy in patients with recent hematemesis makes endoscopy shorter and easier, thereby reducing the need for a repeat procedure.

Adult↗

PubMed1999

Rheologic analysis of gastric mucosal hemodynamics in patients with cirrhosis.

BACKGROUND: Portal hypertensive gastropathy causes some gastric mucosal microcirculatory disorders in cirrhotic patients, but the nature of the rheologic dysfunction in the gastric microcirculation remains to be clarified. METHODS: To examine the rheologic properties of the gastric microcirculation, we subjected 112 cirrhotic patients and 51 control subjects to endoscopic laser Doppler flowmetry and measured multiple variables of flow, red blood cell volume, and velocity. Furthermore, based on these results, we analyzed the shear rate which reflects the status of the microcirculatory system. To validate the laser Doppler flowmetry, we derived the relationship between red blood cell volume and cross-sectional areas of submucosal collecting venules; near-infrared endoscopy was used to evaluate this relationship. RESULTS: Analysis of shear rate according to the severity of portal hypertensive gastropathy showed that the mucosa was exposed to strong hemokinetic stress in severe cases, characterized by a higher shear rate than in control subjects or in mild cases. Nitroglycerin, administered by intravenous infusion (1.0 microg/kg/min), reduced blood flow and restored shear rate to control levels in patients with severe portal hypertensive gastropathy. CONCLUSION: This rheologic study of the gastric mucosa suggests that a disorder of the shear rate control mechanism in the microcirculation is associated with severe portal hypertensive gastropathy.

Endoscopy, Digestive System↗

PubMed2002

[The use of laryngeal mask airway in esophagogastroduodenoscopy in children].

BACKGROUND: The use of laryngeal mask airway (LMA) for inducing and maintaining sedation during EGDS has never been reported in the literature but for a brief letter written by Gajraj in 1996. This study proposes the use of sevoflurane administered through LMA. METHODS: At the Pediatric Clinic of the University of Rome "La Sapienza" 80 children un-derwent EGDS. After premedication, immediate 8% sevoflurane and 60/40% N2O/O2 induction was delivered. Concentration of sevoflurane was reduced to 1% for maintaining general anesthesia. Heart rate (HR), systemic blood pressure (SBP), respiratory rate (RR), EtCO2 and SpO2 were not invasively monitored. Time for induction, time for emergence as well as complications, if any, were also evaluated. RESULTS: The monitored parameters did not show any significant changes. The time for loss of eyelash reflex and the time for end of induction were of 121+/-15 sec. 3.5+/-1.3 min respectively. The time for emergence was 3.4+/-1.8 min. Only minor complications were reported. CONCLUSIONS: The results obtained show that the use of LMA associated to sevoflurane as single inhaling agent can be a valid technique for EGDS in pediatric patients.

Anesthesia Recovery Period↗