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PubMed1994

The role of upper gastrointestinal endoscopy in foreign body removal.

Upper gastrointestinal foreign bodies can be difficult to manage. Patient population, consultant expertise, and equipment availability play an important role in the decision to use rigid versus flexible endoscopes or radiologic methods. The various foreign bodies, clinical signs and symptoms, and treatment approaches are reviewed in this article.

Digestive System↗
PubMedDate not supplied

Foreign bodies in the aerodigestive tract--a clinical study of cases in the coastal belt of South India.

PURPOSE: To investigate the cases of foreign body in the aerodigestive tract and to elucidate the characteristic problems in India. DESIGN AND SETTING: Three hundred patients presenting with a history of either aspirating or swallowing a foreign body were analyzed in a tertiary care center. Data were collected by retrospective chart review and statistically analyzed. RESULTS: Of the 300 patients studied, 90% (270 cases) did have a retained foreign body, with 233 (86.2%) cases found in the pharyngoesophagus and 37 (13.7%) cases in the tracheobronchial tree. With foreign bodies in the tracheobronchial passages, the most common sign and symptom were rhonchi (50%) and dyspnea (67%), respectively; in pharyngoesophagus, the most common symptom and sign were dysphagia (64%) and odynophagia (45%), respectively. The most common foreign body found was fish bone in 39% (106 cases) and the most common site of lodgment was the cervical esophagus 50.5% (136 cases). Rigid endoscopy with forceps removal under general anesthesia was the main treatment modality. Thirty-three (12.2%) cases had complications secondary to retained foreign body. CONCLUSION: Foreign bodies in the aerodigestive tract continue to be a common problem affecting adults and children alike. Rigid endoscopies with forceps removal under general anesthesia are the preferred management modality. From their experience, the authors recommend that no foreign body in the upper aerodigestive tract should be left alone with the hope that it will come out spontaneously. Delay in diagnosis and management can lead to life-threatening complications.

Adult↗
PubMed1992

[The importance of the diagnostic imaging of malignant gastrointestinal tumors for radiotherapy].

The importance of diagnostic imaging in malignant gastrointestinal tumors has moved from the primary diagnosis towards staging and follow-up studies. An accurate staging by diagnostic radiology is the cornerstone in planning radiation therapy. Especially in estimating the T- and N-stage as well as the primary diagnosis in esophagus-, gastric and rectal cancer endoscopy with endoscopic ultrasound is the method of choice. When planning radiation therapy barium studies of the esophagus and contrast enema of the colon are important. Only in the case of gastric lymphoma an upper gastrointestinal series is necessary. In the case of suspected recurrent rectal cancer CT-guided biopsy distinguishes between tumor recurrence and reactive fibrosis.

Biopsy↗
PubMed2003

Hair relaxers: a benign caustic ingestion?

BACKGROUND: Despite federally legislated safety regulations, caustic ingestions remain a significant problem in the pediatric population. The current standard of care for caustic ingestion includes upper gastrointestinal endoscopy in most cases. Hair relaxers are a common caustic ingestion at our institution, yet few data have been published describing the clinical or endoscopic outcome. We explored the relative frequency of hair relaxer ingestion, the incidence of associated upper gastrointestinal injury, and the adverse clinical sequelae resulting from these ingestions. METHODS: Consecutive caustic ingestions admitted to our institution between January 1990 and January 2001 were identified. The data were collected through retrospective physician chart review, were analyzed, and were pooled with the existing literature to evaluate for the presence of esophageal injury. RESULTS: 96 charts were reviewed, 29 (30%) of which were hair relaxer ingestions that underwent esophagogastroduodenoscopy; these ingestions served as our study cohort. The median age of the cohort was 14.0 months and patients were evenly divided in gender. The most common symptoms at presentation were drooling and emesis. At endoscopy, lip and oropharyngeal mucosa were most commonly affected. While six patients (20.7%) had Grade I esophageal mucosal injury and five patients (17.2%) had Grade I gastric mucosal injury, none had greater than Grade I mucosal damage. No adverse clinical events were identified. When our data were combined with all previously published cohort data, the findings were similar and no adverse clinical outcomes were reported. CONCLUSIONS: Hair relaxer is the most common childhood caustic ingestion presenting to our large metropolitan tertiary care center. Symptoms are common at presentation. However, despite the high pH of these products, no clinically significant esophageal or gastric mucosal injuries and no long-term sequelae were identified.

Burns, Chemical↗
PubMedDate not supplied

Status evaluation: endoscopic ultrasonography. American Society for Gastroenterology Endoscopy. Technology Assessment Committee.

Endoscopic ultrasound is a new technology that improves the local staging of esophageal, gastric, and rectal carcinomas. In addition, EUS may provide useful information which will affect management in individual patients with subepithelial masses (e.g., varices, leiomyomas) and pancreatic diseases. Other imaging studies such as transcutaneous ultrasonography and CT are still necessary to detect distant metastatic disease. At present, EUS may be best reserved for use by individuals who have sufficient patient materials to provide broad experience with the technique. Physicians at centers where large numbers of patients with gastrointestinal cancer are evaluated may find this technology most useful. Even in patients with malignancy, however, studies are needed to show that the improved local staging by EUS will translate into changes in patient management and improved outcome.

Digestive System↗
PubMed1990

Predictive value of visible lesions (cheeks, lips, oropharynx) in suspected caustic ingestion: may endoscopy reasonably be omitted in completely negative pediatric patients?

The relationship between absence or presence of grossly visible lesions in the cheeks, lips, and oropharynx (C.L.O. burns) and the incidence, site, and degree of visceral burns was evaluated in all children referred to our hospital for a suspected caustic ingestion during a 10-year period. All children underwent eso-gastro-duodenoscopy within 24 hours. Of the 156 children, 96 (61.6%) showed no visible signs of contact with the caustic substance; however, in 36/96 (37.5%), endoscopy revealed burns in one or more visceral sites. Eight of 36 children (22.2%) sustained potentially dangerous lesions (second to third degree). Sixty of 156 children (38.4%) showed visible lesions; in 30/60 (50%), endoscopy revealed other burns in one or more visceral sites. Fourteen of 30 patients (46.6%) sustained potentially dangerous lesions (second to third degree). A total of 50 esophageal burns have been recorded: first degree (E1), 32; second degree (E2), 12; third degree (E3), 6. Two of 12 patients with E2 lesions and 6/6 with E3 lesions developed esophageal stenosis. One patient in this latter group died because of complications related to a tracheostomy. A total of 31 gastric burns have been recorded: G1 (22), G2 (6), G3 (3). One gastric perforation was observed in the G3 group, whereas the remaining two lesions healed with residual asymptomatic scarring. Minimal scarring was observed in two of six patients with G2 burns. A total of eight lesions have been recorded in the larynx [L1 (3), L3 (1)] and in the duodenum [D1 (2), D2 (2)].(ABSTRACT TRUNCATED AT 250 WORDS)

Burns, Chemical↗
PubMed2001

Is esophagogastroduodenoscopy necessary in all caustic ingestions?

BACKGROUND: It is unclear whether symptoms alone can identify patients with caustic ingestion who will benefit from esophagogastroduodenoscopy (EGD). The published data are contradictory. The purpose of the current study was to determine the relationship between initial symptoms and EGD findings in patients with caustic ingestion. METHODS: Chart review of all caustic ingestions who underwent EGD during a 4-year period (December 1993 through November 1997). RESULTS: Twenty-eight patients (15 girls; mean age, 2.7 years (range, 0.92-13.33) underwent EGD after caustic ingestion. Fourteen percent (4/28) of patients were asymptomatic, and findings on endoscopy were normal. Another 57% (16/28) had normal endoscopic findings, although all were symptomatic. Twenty-nine percent (8/28) of patients had esophageal injury on EGD, and all were symptomatic. Esophageal injury was graded as 1 (mucosal erythema), 2 (superficial burns; noncircumferential) or 3 (deep burns; circumferential). The injury was grade 1 in three of eight patients and grade 2 in two; all had one symptom each. Grade 3 injury was found in three of eight patients: two had two symptoms (drooling and vomiting, drooling and stridor), and one had one symptom (dysphagia). All patients with grade 3 injury subsequently underwent esophageal dilations. Follow-up information was secured for two of the three patients with grade 1 injury and both patients with grade 2 injury at 34.3 months (range, 24-50) after the ingestion, and all were asymptomatic. Of the 20 patients with absence of esophageal mucosal damage, follow-up data were available for 15 patients at 37.2 months (range, 7-63) after the event and all were well. CONCLUSIONS: All patients with clinically significant injury (grades 2 and 3) were symptomatic at initial assessment. No single symptom or combination of symptoms could identify all patients with esophageal injury. All asymptomatic patients had normal findings on endoscopic examinations. Esophagogastroduodenoscopy seems unnecessary in asymptomatic patients with alleged caustic ingestion. A larger, prospective study would be necessary to unequivocally answer this clinically important question.

Adolescent↗
PubMed2006

[Endoscopic endoprosthesis insertion in the treatment of digestive diseases].

Over the last few years the use of endoscopically placed endoprostheses for benign and malignant digestive diseases has considerably developed. The endoscopic placement of prostheses is usually well tolerated by patients; it does not require anaesthesia and it is a relatively low-risk procedure. New self-expandable metallic prostheses allow to treat even very tight stenoses; they do not usually require dilatation, therefore reducing the risks involved in dilatation procedure. This study presents a review of experience with prostheses placement in digestive diseases. Indications, limits and complications will be discussed according to data reported in the international literature.

Cholangitis, Sclerosing↗
PubMed1990

[Therapeutic endoscopy in diseases of the digestive system].

A study of 374 patients with ulcer disease, chronic gastroduodenitis and esophagitis allowed to distinguish three clinico-endoscopic syndromes (erosive-ulcerative, irritated pylorus, regurgitating syndromes). Therapeutic endoscopic manipulations were carried out: transesophageal block of the vagal nerve, pricking of the ulcer with trimecaine, solkoseryl, oxyferriscorbone, trental and laser treatment. The results were favourable.

Digestive System Diseases↗
PubMed1992

[Echo-endoscopy of the digestive system].

Endoscopic ultrasonography of the gastrointestinal tract allows a precise ultrasound study of the accessible gastrointestinal walls (oesophagus, stomach, duodenum, rectum) and, through these walls, of the adjacent organs (lymph nodes, posterior mediastinum, pancreas, extrahepatic biliary ducts and perirectal region). This method is better than computerized tomography to evaluate the local and regional extension of oesophageal and cardial carcinomas producing little or no stenosis and of gastric and rectum carcinomas and lymphomas. It is the examination of choice to detect a perianastomotic recurrence of these cancers and to evaluate submucosal tumors of the gastrointestinal tract. This method, with no morbidity, is better than computerized tomography or ultrasonography in the aetiological diagnosis of obstacles in the biliary tract and in the diagnosis and pretherapeutic assessment of pancreatic cancer or endocrine tumors.

Digestive System↗