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 541 records · Page 30Linked to original sources

PubMed1999

Gastrointestinal toxicity of non-steroidal anti-inflammatory drugs: the effect of nimesulide compared with naproxen on the human gastrointestinal tract.

This overview includes theories and evaluation of non-steroidal anti-inflammatory drug (NSAID)-induced gastrointestinal toxicity. Factors in damage include microvascular aspects, neutrophil recruitment, mucosal prostaglandins, gastrointestinal secretions and bacteria. We have proposed an extensive simplified framework that includes an important local initiating effect which may involve NSAID accumulation, interaction with surface phospholipids, events that alter cellular ATP, and local/systemic effects of cyclooxygenase (COX) inhibition. COX-2-selective drugs are desirable not only because they spare COX-1 and so avoid gastrointestinal toxicity, but also because COX-2-selective agents are only weakly acidic and therefore avoid substantial accumulation in the gastric mucosa. Short-term endoscopy studies of NSAIDs are important initially to evaluate human gastroduodenal tolerability. They show that injury increases with the amount of NSAIDs even though the lowest therapeutic doses inhibit gastric COX almost completely, and that the more-acidic NSAIDs tend to cause greater gastric damage. Long-term endoscopy studies involve NSAID ingestion for at least 3 months. A main question is the extent to which the ulcers seen cause symptoms, substantial bleeding and/or perforation. Measurement of serious outcomes is thought by many to be the best assessment of gastrointestinal safety, but studies find marked variations even with the same drug. Damage to the small intestine by NSAIDs is even more frequent than to the upper gastrointestinal tract, but is difficult to evaluate. Conventional acidic NSAIDs increase the permeability of human small intestine, probably by a non-prostaglandin mechanism, but nimesulide does not do so, possibly because of its very weak acidity.

Animals↗

PubMed1984

Diagnosis and management of ingested foreign bodies: a ten-year experience.

Ingested gastrointestinal foreign bodies may be managed by observation, endoscopy, and/or surgical intervention. We retrospectively reviewed 87 consecutive cases of foreign body ingestion. In 49 patients the ingested foreign body had passed beyond the gastroesophageal junction, and these cases form the basis of this study. Of the 49 patients, 19 (38.7%) required surgical intervention for removal of the swallowed object. Nearly 75% of these patients had swallowed objects that were more than 6.5 cm in length. Of 30 adults, more than 50% required surgery for removal of the foreign body. However, fewer than 16% of children who had swallowed and retained foreign bodies required surgery for ultimate cure. Based on these findings, guidelines are presented for the management of foreign body ingestion.

Adolescent↗

PubMed1999

Treatment strategy for mucin-producing intrahepatic cholangiocarcinoma: value of percutaneous transhepatic biliary drainage and cholangioscopy.

Intrahepatic cholangiocarcinomas that secrete macroscopically excessive mucin into the biliary system are rare, and few of the previously reported cases have achieved a curative resection. We defined these tumors as "mucin-producing intrahepatic cholangiocarcinomas" and clarify the optimal preoperative and surgical management for them. Eleven patients with mucin-producing intrahepatic cholangiocarcinomas underwent surgical resection in our department. The clinical, radiologic, surgical, and pathologic findings were studied. The clinical presentation of the 11 patients included repeated abdominal pain, jaundice, and fever. Conventional cholangiographies, such as percutaneous transhepatic cholangiography or endoscopic retrograde cholangiography, could not offer precise information about tumor location and extension because of abundant mucin in the biliary system. Using percutaneous transhepatic biliary drainage (PTBD) and percutaneous transhepatic cholangioscopy (PTCS), we were able to drain the mucin and determine precisely the cancer extension into intrahepatic segmental bile ducts. Based on these findings, various types of liver resection with or without extrahepatic bile duct resection were planned, and 10 patients obtained curative resection. The cumulative 5-year survival rate after curative resection was 78%. In patients with mucin-producing intrahepatic cholangiocarcinoma, PTBD and PTCS are important for evaluating the cancer extension. Rational surgery based on accurate preoperative diagnosis improved the prognosis of patients with this disease.

Adult↗

PubMed2002

Nutritional support via percutaneous endoscopic gastrostomy in children with cardiac disease experiencing difficulties with feeding.

Adequate nutrition is crucial to the management of children and infants with cardiac disease. Difficulties with feeding are extremely common, and maintaining an adequate caloric intake, in order to achieve sustained growth, is often not possible without nutritional support. We retrospectively reviewed our experience between 1995 and 1999 in treating 37 children with cardiac disease who underwent percutaneous endoscopic construction of a gastrostomy to augment nutritional needs. We stratified the patients into those with cyanotic heart disease, when saturations of oxygen were less than 95%; those with non-cyanotic heart disease with saturations greater than 95%, and those with minor cardiac disease associated with a systemic disorder. Each group was compared to control children matched for age, sex, and diagnosis. We evaluated, the variation in standard deviation score for body weight over a median period of follow-up of 295 days. Improvements in the standard deviation score for body weight occurred in each of the groups, whereas children in the control groups demonstrated a decrease in standard deviation score for body weight. The median change of the score for body weight was significantly higher in patients managed with gastrostomy compared to controls. We conclude that supplementation using a gastrostomy tube allows the safe delivery of the caloric intake needed to support malnourished children with cardiac disease.

Body Weight↗

PubMed1998

Peroral pancreatoscopy for the diagnosis of pancreatic diseases.

The efficacy associated with peroral pancreatoscopy to diagnose and differentiate pancreatic diseases is herein reviewed and clarified, and problems with this modality are discussed. Three types of pancreatoscopes are presently available: (a) a thin fiberscope with a diameter of 3.3 or 4.5 mm, which has an angulation system and a forceps channel; (b) an ultrathin pancreatoscope with a diameter of 0.75 or 0.8 mm, which can be inserted via an ordinary endoscopic retrograde cholangiopancreatography (ERCP) cannula without endoscopic sphincterotomy; and (c) an ultrathin pancreatoscope combined with a catheter that has an outer diameter of 1.67 mm. Peroral pancreatoscopy facilitates the detection of small lesions of the duct in malignancy or chronic pancreatitis. In particular, it is quite useful in differentiating pancreatic cancer from chronic pancreatitis in cases with local stenosis or elevated lesions of the main pancreatic duct. Among patients with a mucus-producing tumor of the pancreas, pancreatoscopy is also very useful, especially in determining lesion extent. Despite some unresolved problems, we predict that pancreatoscopy will retain a limited or specific and definite role in diagnostic and therapeutic endoscopy for pancreatic diseases.

Endoscopy, Digestive System↗

PubMed2026

The Role of Artificial Intelligence Combined With Digital Cholangioscopy for Indeterminant and Malignant Biliary Strictures: A Systematic Review and Meta-analysis.

BACKGROUND: Current endoscopic retrograde cholangiopancreatography (ERCP) and cholangioscopic-based diagnostic sampling for indeterminant biliary strictures remain suboptimal. Artificial intelligence (AI)-based algorithms by means of computer vision in machine learning have been applied to cholangioscopy in an effort to improve diagnostic yield. The aim of this study was to perform a systematic review and meta-analysis to evaluate the diagnostic performance of AI-based diagnostic performance of AI-associated cholangioscopic diagnosis of indeterminant or malignant biliary strictures. METHODS: Individualized searches were developed in accordance with PRISMA and MOOSE guidelines, and meta-analysis according to Cochrane Diagnostic Test Accuracy working group methodology. A bivariate model was used to compute pooled sensitivity and specificity, likelihood ratio, diagnostic odds ratio, and summary receiver operating characteristics curve (SROC). RESULTS: Five studies (n=675 lesions; a total of 2,685,674 cholangioscopic images) were included. All but one study analyzed a deep learning AI-based system using a convoluted neural network (CNN) with an average image processing speed of 30 to 60 frames per second. The pooled sensitivity and specificity were 95% (95% CI: 85-98) and 88% (95% CI: 76-94), with a diagnostic accuracy (SROC) of 97% (95% CI: 95-98). Sensitivity analysis of CNN studies (4 studies, 538 patients) demonstrated a pooled sensitivity, specificity, and accuracy (SROC) of 95% (95% CI: 82-99), 88% (95% CI: 72-95), and 97% (95% CI: 95-98), respectively. CONCLUSIONS: Artificial intelligence-based machine learning of cholangioscopy images appears to be a promising modality for the diagnosis of indeterminant and malignant biliary strictures.

Humans↗

PubMed2000

Induction of P-glycoprotein by rifampin increases intestinal secretion of talinolol in human beings: a new type of drug/drug interaction.

BACKGROUND: P-Glycoprotein is an efflux pump in many epithelial cells with excretory function. It has been demonstrated that rifampin (INN, rifampicin) induces P-glycoprotein, particularly in the gut wall. We therefore hypothesized that rifampin affects pharmacokinetics of the P-glycoprotein substrate talinolol, a beta1-blocker without appreciable metabolic disposition but intense intestinal secretion in human beings. METHODS: Pharmacokinetics of talinolol (a single dose of 30 mg administered intravenously or 100 mg administered orally for 7 days) and duodenal expression of the MDR1 gene product P-glycoprotein as assessed by reverse transcriptase-polymerase chain reaction of the MDR1-messenger ribonucleic acid, by immunohistochemistry and Western blot analysis were analyzed before and after coadministration of rifampin (600 mg per day for 9 days) in 8 male healthy volunteers (age 22 to 26 years). RESULTS: During rifampin treatment, the areas under the curve of intravenous and oral talinolol were significantly lower (21% and 35%; P < .05). Treatment with rifampin resulted in a significantly increased expression of duodenal P-glycoprotein content 4.2-fold (2.9, 6.51) (Western blot) and messenger RNA was increased in six of the eight volunteers. P-Glycoprotein expression in biopsy specimens of gut mucosa correlated significantly with the systemic clearance of intravenous talinolol (rs = 0.74; P < .001). CONCLUSIONS: Rifampin induces P-glycoprotein-mediated excretion of talinolol predominantly in the gut wall. Moreover, clearance of talinolol from the blood into the lumen of the gastrointestinal tract may be predicted by the individual intestinal P-glycoprotein expression. Thus we describe a new type of steady-state drug interaction affecting compounds that are subject to transport rather than metabolism.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

PubMed1995

Guideline for the management of ingested foreign bodies. American Society for Gastrointestinal Endoscopy.

This guideline is intended to aid the endoscopist in the management of adult patients with possible foreign object ingestion and/or food bolus impaction. A literature search was performed on the Medline using Medlars II, the National Library of Medicine's National Interactive Retrieval Service. This search generated 181 citations. References chosen for review were English-language citations from the gastroenterology, otolarygology, general surgical, and radiological literature. As little or no data exist from well-designed prospective trials, emphasis was given to results from large series, and reports from recognized experts. In preparing this guideline several drafts were distributed to the members of the ASGE Standards of Practice Committee, to the practice committees of the AGA, ACG, and SAGES, and to national experts on this subject for critical review. A final draft was then reviewed by the ASGE Governing Board. The final guideline reflects the input from this review process.

Digestive System↗

PubMed1995

Serum anti-Helicobacter pylori antibodies and gastritis.

We investigated the relationship between the severity of Helicobacter pylori-associated gastritis and serum anti-H. pylori antibodies. A total of 158 consecutive patients underwent upper gastroduodenal endoscopy. At the time of endoscopy, three biopsy specimens were taken from the antrum and the body of the stomach for culture of H. pylori, CLO test, and histology. Specimens with a negative rapid urease test and no organisms found by culture were judged to be H. pylori-negative. The GAP test used for the antibody measurement is a kit designed to measure serum IgG, IgA, and IgM antibodies. The severity of gastritis was classified according to the Sydney System. The sensitivity and specificity of the IgG antibody measurement kit was 98.3 and 71.4%, respectively. The sensitivity and specificity of the IgM antibody measurement kit was 14.3 and 60.8%, respectively. The sensitivity and specificity of the IgA antibody measurement kit was 45.1 and 100%, respectively. Serum anti-H. pylori IgG antibody titers were correlated significantly with the severity of inflammation in both the antrum and body. Significant associations were found between serum anti-H. pylori IgG and IgA antibody titers and the development of atrophic gastritis. These results suggest that measurement of serum anti-H. pylori antibody titers is useful in the diagnosis of H. pylori infection and severity of gastritis.

Antibodies, Anti-Idiotypic↗

PubMed1995

[Variety of pancreatic lesions observed in von Hippel-Lindau disease. Apropos of 8 cases].

Von Hippel-Lindau's disease is a rare genetic disease, with an autosomal dominant mode of inheritance, characterised by the development of several tumours, such as haemangioblastoma of the central nervous system and retina, renal cysts or carcinoma and pheochromocytoma. Several pancreatic lesions, mainly represented by multiple cysts, are also encountered. We report here 8 cases of pancreatic involvement in patients affected with von Hippel-Lindau's disease. It consisted of multiple cysts (3 cases), serous cystadenoma (2 cases), endocrine tumour (1 case), haemangioblastoma (1 case) and ductal adenocarcinoma (1 case). Diagnosis of a rare lesion of the pancreas (multiple cysts, serous cystadenoma or vascularized tumour) in a young patient may lead to search the other lesions of von Hippel-Lindau's disease and to undergo a familial inquiry in order to propose a multidisciplinary approach for patients affected by the disease.

Adenocarcinoma↗

PubMed2005

Pediatric endoscopy: new information from the PEDS-CORI project.

The PEDS-CORI (Pediatric Endoscopy Database System-Clinical Outcomes Research Initiative) was created in December 1999 to develop and maintain a database of pediatric endoscopy procedures and to promote scientific inquiry into the need, efficacy, costs, and outcomes of pediatric endoscopy. The PEDS-CORI database was queried to determine the type, frequency, indication, and findings of all procedures. Of the 27,710 now in the database, 62% were esophagogastroduodenoscopies (EGDs), 24% were colonoscopies, 7.5% were flexible sigmoidoscopies, 1.5% were endoscopic retrograde cholangiopancreatographies, and 5% were other procedures. The male-to-female ratio was approximately 1:1. Eighty-three percent were outpatients, 12% were inpatients, and 5% were not recorded. Forty percent of patients were aged from 5 to 10 years. EGD is 2.5 times as common as colonoscopy. Most procedures are performed on children aged from 5 to 10 years. PEDS-CORI is a powerful tool that can be used to determine the patterns of use in pediatric endoscopy.

Adolescent↗

PubMed2006

Evaluation of modified crystal violet chromoendoscopy procedure using new mucosal pit pattern classification for detection of Barrett's dysplastic lesions.

BACKGROUND: Pit pattern diagnosis is important for endoscopic detection of dysplastic Barrett's lesions, though using magnification endoscopy can be difficult and laborious. We investigated the usefulness of a modified crystal violet chromoendoscopy procedure and utilised a new pit pattern classification for diagnosis of dysplastic Barrett's lesions. METHODS: A total of 1,030 patients suspected of having a columnar lined oesophagus were examined, of whom 816 demonstrated a crystal violet-stained columnar lined oesophagus. The early group of patients underwent 0.05% crystal violet chromoendoscopy, while the later group was examined using 0.03% crystal violet with 3.0% acetate. A targeted biopsy of the columnar lined oesophagus was performed using crystal violet staining after making a diagnosis of closed or open type pit pattern with a newly proposed system of classification. The relationship between type of pit pattern and histologically identified dysplastic Barrett's lesions was evaluated. RESULTS: Dysplastic Barrett's lesions were identified in biopsy samples with an open type pit pattern with a sensitivity of 96.0%. Further, Barrett's mucosa with the intestinal predominant mucin phenotype was closely associated with the open type pit pattern (sensitivity 81.9%, specificity 95.6%). CONCLUSIONS: The new pit pattern classification for diagnosis of Barrett's mucosa was found to be useful for identification of cases with dysplastic lesions and possible malignant potential using a crystal violet chromoendoscopic procedure.

Acetates↗

PubMed1997

Carcinoma of the common bile duct with superficial spread to the intrahepatic segmental bile ducts: a case report.

A 54-year-old woman presented with jaundice. Percutaneous transhepatic biliary drainage, cholangiography via a percutaneous transhepatic biliary, drainage catheter, and percutaneous transhepatic cholangioscopy were performed to alleviate the jaundice and to evaluate her biliary system. A diffuse-type tumor was detected in the common bile duct. The tumor had spread superficially up to the right anterior segmental duct and the left hepatic duct and involved the caudate branches. Curative surgery, which included a right anterior segmentectomy, total caudate lobectomy, and pylorus-preserving pancreatoduodenectomy, was performed. The histopathologic diagnosis was moderately differentiated tubular adenocarcinoma originating at the common bile duct. The extent of the superficial spread of the tumor corresponded to our preoperative determination. Her postoperative recovery was uneventful. In this case report, we discuss the accurate preoperative diagnosis and rational surgical treatment of bile duct carcinoma with superficial spread.

Adenocarcinoma↗

PubMed1995

Endoscopic stenting for palliation of malignant biliary obstruction. A review of progress in the last 15 years.

Since the late 1970s, endoscopic biliary stenting has become a standard palliative treatment for obstructive jaundice due to malignancies of the pancreas and the hepatobiliary system. Despite the high initial success rate in achieving biliary drainage, endoscopic stenting therapy has been limited by the clogging of biliary stents, usually after four to five months, due to formation of adherent bacterial biofilm and accumulation of biliary sludge. Various methods for the prevention of bacterial adhesion and prolongation of stent patency have been investigated, including prophylactic antimicrobial agents and bile salts, new stent materials, and new stent designs. Recently, the introduction of self-expandable metal stents has significantly improved the duration of stent patency but the cost is considerably higher. Each method has its own merits as well as specific problems. This article reviews the pathogenesis of biofilm formation on the biliary stents and the latest status of research in avoiding stent occlusion.

Biliary Tract↗

PubMed2002

Premedication, preparation, and surveillance.

The vigorous debate over whom to sedate, when to sedate, and how to sedate shows no sign of running out of steam. There is a general consensus that patients should be more involved in the decision-making process for the sedation "menu". A move away from the take-it-or-leave-it attitude of all or nothing to an "à la carte" choice is to be encouraged. A new textbook and several further guidelines have appeared. The particular problems associated with sedating the elderly are briefly presented. The pros and cons of using local pharyngeal anaesthesia are discussed. Enthusiasm for the use of intravenous propofol is gathering momentum, despite continuing worries about its safety in the hands of the nonanaesthetist. For many endoscopists, the combination of a benzodiazepine plus (or minus) an opioid with which they are most familiar is still the best compromise in terms of efficacy, cost, and safety. Fatal drug-induced cardiopulmonary complications continue to occur, despite a general trend toward using smaller doses of sedation than we did 5 - 10 years ago. Monitoring techniques that are at present considered as research tools may one day become commonplace. These include: the use of an electroencephalography parameter known as bispectral analysis; transcutaneous CO(2) measurement; and a modified continuous capnographic waveform trace to monitor ventilatory effort. Bispectral analysis may be of use in monitoring central nervous system depression and helping to distinguish between conscious sedation and deep sedation. If the measurement of CO(2) levels, either transcutaneously or in breath samples, was as easy and inexpensive as measuring SpO(2) with a pulse oximeter, then undoubtedly such technology would enhance the early detection of sedative-induced hypoventilation and apnoea. Further evidence regarding droperidol's possible role in conscious sedation is presented. Pain during colonoscopy remains a problem, and the possible role for intraluminal injection of peppermint oil, as well as the value of variable-stiffness colonoscopes, in reducing the need for intravenous sedation is discussed. Case reports of hyponatraemic encephalopathy and hypocalcaemic tetany as complications of oral bowel preparation are presented, as is the challenge associated with adequate bowel preparation in diabetic patients.

Administration, Topical↗

PubMed1999

Miniscopes.

Various miniscopes are available for cholangioscopy and pancreatoscopy, differing in the size of the external diameter and the instrumentation channel, the angulation system and the optical performance. For the per-oral route, the devices are inserted through a carrier duodenoscope. Ultra-thin instruments can be introduced into the biliopancreatic tract without the need for endoscopic sphincterotomy. Larger and steerable miniscopes are required for target biopsies and the approach to proximal lesions. Percutaneous cholangioscopy is more invasive and should be restricted to cases with a difficult anatomy or intrahepatic biliary disease. These techniques can be useful for the diagnosis of lesions that cannot be differentiated by indirect imaging methods. However, further studies are needed to evaluate their impact on clinical outcome. Controlled trials indicate that cholangioscopic lithotripsy is an effective and rapid alternative to other therapeutic methods for difficult bile duct stones. Mini-endoscopy is restricted to specific centres because of the high costs of the instruments, limited indications and the need for special endoscopic expertise.

Bile Duct Neoplasms↗

PubMed1994

[Endoscopy in the intensive care unit].

The present study retrospectively evaluates all endoscopies performed on a medical intensive care unit during the period from 1986 to 1992. During these seven years, 415 endoscopies were performed of which 77.8% were done as an upper gastrointestinal endoscopy. The most frequent findings consisted in esophagitis (23.6%), ulcers of the stomach or duodenum (20.2%), esophageal varices (10.1%) and erosive-hemorrhagic gastritis (9.6%). More than 2/3 of all endoscopies were performed because of an gastrointestinal bleeding with upper bleeding being three times more frequent than lower bleeding. The endoscopy was able to identify the cause and site of bleeding with certainty or high probability in 92.8%. Esophagitis was the most frequent cause of bleeding (30.7%) followed by ulcers in the duodenum and stomach (25.6%), esophageal varices (14.8%) and erosive gastritis (13.7%). In more than 90% of patients with esophagitis a nasogastric tube had been administered during the two preceding days. Therefore, the tube is probably responsible for the esophagitis. The present data show that bleeding from esophageal lesions are about ten times more frequent in patients treated in an intensive care unit when compared to data published for the general group of patients with gastrointestinal bleeding. Considering the frequency of bleeding from esophagitis in intensive care patients, an administration of a nasogastric tube should be done only when mandatory.

Critical Care↗

PubMed2003

Can symptoms predict endoscopic findings in GERD?

BACKGROUND: It is difficult to decide which patients with reflux symptoms require endoscopy. The aim of this study was to develop a scoring system to predict esophageal findings at endoscopy. METHODS: A consecutive sample of 1011 adult patients scheduled for upper endoscopy were asked to complete a validated symptom questionnaire. The endoscopy reports were abstracted. Individual logistic regression models were developed to predict esophagitis, Barrett's esophagus (long and short segment) and esophageal stricture, including Schatzki's ring. RESULTS: Reflux esophagitis was independently associated with heartburn frequency (p<0.0001) but not severity or duration (p>0.05). Barrett's esophagus was associated with the duration of acid regurgitation (p<0.005) but not with frequency or severity (p>0.05). Strictures were associated with dysphagia severity (p<0.0001) and duration (p<0.0001) but not frequency (p>0.05). At a sensitivity of 80%, the models had a specificity of 49% for esophagitis, 57% for Barrett's esophagus, and 68% for strictures. At a specificity of 80%, the sensitivities were 51% for esophagitis, 62% for Barrett's esophagus and 71% for strictures. CONCLUSIONS: Endoscopic findings were associated with distinct attributes of reflux symptoms. Symptoms are only modestly predictive of findings at endoscopy.

Barrett Esophagus↗