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PubMed1996

Endoscopy databases: the Norwegian experience.

BACKGROUND AND STUDY AIMS: The implementation of endoscopy databases in Norway has been slow, and no commercial system has been successfully introduced. MATERIAL AND METHODS: To determine the current status in this area a questionnaire survey was conducted with replies received from 58 of the 67 hospitals to which the questionnaire was sent. RESULTS: Only 40% of the units had one or more personal computers available, but video endoscopes will soon be standard equipment at most Norwegian hospitals. For managing administrative data, a large majority of endoscopy units used a general-purpose hospital information system, but endoscopy data are dealt with manually in 72% of the units. The endoscopy report itself was produced manually in 93% of the units. When asked to rank various features of database systems according to their relative importance, the endoscopists stated that ease of use and simplification of routine chores were the most important aspects, while advanced storage and research features were less crucial. CONCLUSION: In Norwegian hospitals, the use of minimal endoscopic database systems that offer a high level of integration with existing hospital systems appears to be the most promising approach.

Database Management Systems↗
PubMedDate not supplied

Complication in endoscopy.

Explore the source record for details and available documents.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1991

The SADE system: an endoscopic database manager.

The development of the SADE database manager was commenced in 1985 since no commercially available systems were suited for the needs of a large endoscopy unit. Over a period of five years, this database was programmed, revised and enhanced through the joint efforts of gastroenterologists and programmers, the SADE system being implemented for daily use on 1 January 1989. The patient administration and medical record modules are fully implemented and functional, while the statistical module has only recently been finished. The present features of the system are described, and the limitations discussed. Instant report generation and direct access to previous medical data are the most immediate benefits of the system. The initial intention to have structured anamnestic data had to be modified to suit the need for flexibility and ease of free text input by the users.

Computer Systems↗
PubMed1991

SADE database for endoscopic procedures: aspects of clinical use.

The time aspects of daily use of a clinical database system in an endoscopy department were studied. The SADE database system for endoscopic procedures was introduced for daily use at Ullevål Hospital on 1 January 1989. The average weekly programme of the endoscopy unit includes 57 gastroduodenoscopies, 23 colonoscopies and 12 ERCP/EPTs. During three consecutive weeks of the study the mean physician input time was 4 min 17 sec per patient (range 57 sec to 15 min), individual variation depending mainly on the extent of the report. Assistants spent a mean time of 4 min 23 sec for each patient. Thus, a total of 8 min 40 sec was spent for every patient seen. Endoscopic units should analyze their routines and needs before introducing an electronic data base manager.

Database Management Systems↗
PubMed1990

Endoscopic examination for fistula.

In 15 postoperative fistula cases, we performed endoscopic examination (fistuloscopy) and studied the clinical significance. The inside of the fistula was easily observed after irrigation with physiological saline. The drain was extubated in 6 cases in which cavities without abscesses were recognized. In a case of pancreatic fistula, the fistula was temporarily closed using fibrin glue. Re-operation was performed in a case in which recurrence of cancer was recognized by biopsy. On the other hand, in 9 cases in which cavities with abscesses were recognized, foreign bodies, such as suture threads, which were sources of infections were removed. Moreover, the drain was removed to the effective site, and the fistula then irrigated repeatedly. Consequently, with the exception of a death due to cancer and a case complicated by osteomyelitis, the fistula was closed in all cases. Fistuloscopy is a safe and easy technique. In addition, the method, which is less stressful for the patient, is considered to be effective for the examination and treatment of fistulas.

Adult↗
PubMed2001

Prospective evaluation of balloon-sheathed catheter US system.

BACKGROUND: Catheter US probes must rely on luminal water to create images because they do not incorporate a water-filled balloon such as that used with a designated echoendoscope. The purpose of this study is to determine the effectiveness and safety of a balloon sheath for the US catheter system. METHODS: Catheter EUS was performed on 50 patients by using a 2.3 mm 12 MHz or 20 MHz catheter probe. Catheter EUS was used in 47 cases, and a newly developed water-filled balloon sheath was used in 41 cases. Both devices were used in 39 cases. Procedure time, depth of ultrasound penetration, and a subjective assessment of image quality and ease of use were recorded, along with TMN stage as applicable. Catheter EUS findings were confirmed with a standard radial scanning echoendoscopy (S-EUS) in 18 cases. RESULTS: Catheter probe EUS (C-EUS) and catheter probe plus balloon (CB-EUS) imaging was obtained of 25 esophageal, 8 gastric, 4 rectal, 1 biliary, and 1 duodenal lesion. Time required for the ultrasound portion of the examination was identical with C-EUS and CB-EUS. Depth of penetration increased with CB-EUS with both the 12 MHz and 20 MHz probes (p < 0.05). Subjective assessment of image clarity improved when CB-EUS was used in the esophagus. C-EUS failed to identify 2 esophageal cancers and 2 sets of paraesophageal lymph nodes, and understaged 1 esophageal cancer. The remaining 14 cancers were staged identically by both modalities. The catheter probes with and without the balloon sheath were easy to use, even in markedly narrow esophageal strictures. CB-EUS did not significantly improve resolution in the stomach or rectum. S-EUS confirmed findings of CB-EUS in all 18 cases in which both instruments were used. There were no procedure-related complications. CONCLUSIONS: For esophageal lesions, CB-EUS improves images compared with C-EUS, and enhances depth of penetration without prolonging or encumbering the examination. CB-EUS offers no advantage over C-EUS in organs other than the esophagus. S-EUS, when possible, remains the preferred imaging modality for esophageal cancers because of the ability to image the celiac axis and other deep structures.

Catheterization↗
PubMed2001

EUS with EUS-guided fine-needle aspiration as the first endoscopic test for the evaluation of obstructive jaundice.

BACKGROUND: This study assesses the cost savings associated with using endoscopic ultrasound (EUS) before endoscopic retrograde cholangiopancreatography (ERCP) for evaluating patients with suspected obstructive jaundice. METHODS: One hundred forty-seven patients with obstructive jaundice of unknown or possibly neoplastic origin had EUS as their first endoscopic procedure. With knowledge of the final diagnosis and actual management for each patient, their probable evaluation and outcomes and their additional costs were reassessed assuming that ERCP would have been performed as the first endoscopic procedure. Also calculated were the additional costs incurred if EUS were unavailable for use after ERCP and had to be replaced by computed tomography or other procedures. RESULTS: The final diagnoses in these patients included malignancies (65%), choledocholithiasis or cholecystitis (18%), "medical jaundice" (11%), and miscellaneous benign conditions (6%). Fifty-four percent had EUS-guided fine-needle aspiration but only 53% required ERCP after EUS. An EUS-first approach saved an estimated $1007 to $1313/patient, but the cost was $2200 more if EUS was unavailable for use after ERCP. Significant savings persisted through sensitivity analysis. CONCLUSIONS: Performing EUS with EUS-guided fine-needle aspiration as the first endoscopic procedure in patients suspected to have obstructive jaundice can obviate the need for about 50% of ERCPs, helps direct subsequent therapeutic ERCP, and can substantially reduce costs in these patients.

Adult↗
PubMed1994

Endosonography--is it sound for the masses?

Endoscopic ultrasound (EUS), a relatively new addition to the endoscopist's diagnostic armamentarium, provides detailed images of the gut wall layers and surrounding organs. Endosonography is highly accurate in the staging of gastrointestinal neoplasms and may provide information that is invaluable in treatment planning, such as evidence of unresectability. EUS also has particular utility in the evaluation of submucosal lesions of the gastrointestinal tract and the preoperative localization of States, Olympus and Pentax manufacture two different endosonography systems, each with unique advantages and disadvantages. Recently, EUS-directed biopsy has enhanced the diagnostic potential of the procedure. With the recent approval of CPT codes and reimbursement values, interest in the procedure is likely to expand. Adequate training in EUS is essential for the successful performance of the procedure; a period of proctored training with an experienced endosonographer is recommended.

Digestive System Diseases↗
PubMed1999

Isolated deficient alpha6beta4 integrin expression in the gut associated with intractable diarrhea.

BACKGROUND: An infant born with pyloric atresia had development of intractable diarrhea and was found to have total epithelial detachment of gastric and small and large bowel mucosa. She had no skin abnormalities. Parental consanguinity and pyloric atresia in a sibling who died without autopsy suggest an inherited origin for this disorder. The purpose of this study was to examine defects in intestinal and skin cell adhesion. METHODS: Histologic, immunohistochemical, and ultrastructural characteristics of the skin and gut of the patient were compared with that of normal control subjects. Distribution of adhesion molecules was determined. RESULTS: Immunofluorescent analysis of the digestive mucosa showed alpha6beta4 integrin expression deficiency at the epithelial cell-lamina propria junction. Ultrastructural examination of the digestive mucosa revealed a complete epithelial detachment with a cleavage plane lying between the lamina densa and the basal pole of the enterocytes. Consistent with the absence of skin blistering, integrin alpha6beta4 was expressed at the dermal-epidermal junction. Electron micrographs of skin biopsy specimens showed the presence of normal hemidesmosomes and the absence of dermal-epidermal dysadhesion. CONCLUSION: It was postulated that this patient had protracted diarrhea related to epithelial detachment of the digestive mucosa as a consequence of a deficiency of an integrin alpha6beta4 isoform specific to the gut.

Antigens, Surface↗
PubMed2002

Push enteroscopy in a UK district general hospital: experience of 51 cases over 2 years.

OBJECTIVES: To determine the number of patients referred for enteroscopy in a district general hospital (DGH), the indication, enteroscopic +/- histological diagnosis, and to compare findings with other series from tertiary referral centres or outside the UK. DESIGN: Retrospective case series over a 2-year period. RESULTS: In the 2-year period, 52 patients were referred for enteroscopy. All except one underwent enteroscopy. The mean age of the patients was 60 years (range 31-84 years). The main indications for enteroscopy were obscure gastrointestinal haemorrhage in 31 (61%) patients (19 with acute and 12 with chronic bleeding) and 7 (14%) patients with arteriovenous malformations (AVMs) on initial oesophagogastroduodenoscopy (OGD). Other indications included clinical deterioration in known coeliac disease in four (8%) patients and abnormal small-bowel follow-through in five (10%) patients. More than half (51%) of the enteroscopies were reported as abnormal, but 10 (38%) had pathology in the stomach or first part of the duodenum (D1) not diagnosed on initial OGD. Diagnoses of two T-cell lymphomas and one of pre-lymphomatous monoclonal T-cell proliferation were made in the refractory coeliac disease group. CONCLUSIONS: Indications (obscure gastrointestinal bleeding), most frequent findings (small-bowel AVMs), and 'missed' lesions within reach of a gastroscope (20%) were in keeping with other series. Enteroscopy is a useful tool in investigating patients with refractory coeliac disease. Its value in investigating patients with abnormal small-bowel radiology was not confirmed. The current need for push enteroscopy in a DGH is small (approximately 1 per 8000 population per year), but it would take only small changes in referral practice to escalate. Criteria for enteroscopy should be developed and refined with improving knowledge of the diagnostic yield for each indication and clinical outcome.

Endoscopy, Digestive System↗
PubMed2005

Push enteroscopy alters management in a majority of patients with obscure gastrointestinal bleeding.

INTRODUCTION: Although enteroscopy has been increasingly used to investigate occult or obscure bleeding, little is known about its impact on patient management. The aim of the present paper was to evaluate both the diagnostic yield and the impact of push enteroscopy on the management of patients referred to a tertiary Australian institution. METHODS: Data were collected prospectively in all patients undergoing push enteroscopy at Royal Adelaide Hospital. Fifty-five patients were investigated for obscure gastrointestinal (GI) bleeding (25 women, mean age 65.6 years), the cause of which remained unknown despite previous gastroscopy and colonoscopy. The patients were divided into two groups: occult-obscure (anemia without macroscopic blood loss) and overt-obscure (macroscopic bleeding). Findings at enteroscopy, therapeutic procedures, and complications were recorded. Patients were followed to establish the impact of the procedure on subsequent management and clinical outcome. RESULTS: Enteroscopy demonstrated a potential site of bleeding in 38 patients (69%), and 38% of lesions found were within the reach of the gastroscope. The most common lesions were small intestinal angiodysplasia. Seventy-five percent of patients with positive findings had alterations to their management. After subsequent treatment, 62% were no longer anemic and there was a significant reduction in rebleeding (P < 0.05) and transfusion requirements (P < 0.05) compared to patients with negative findings. The procedure was well tolerated and complications were rare. CONCLUSION: Enteroscopy has a positive impact on patient management and clinical outcome in a majority of patients with obscure gastrointestinal bleeding.

Adult↗
PubMed1995

Endoscopic US of the gastrointestinal tract with endoscopic, radiographic, and pathologic correlation.

Endoscopic ultrasonography (US) makes it possible to evaluate the layers of the wall of the gastrointestinal tract, as well as surrounding structures. The authors have used endoscopic US to evaluate the gastrointestinal tract in 160 patients. In the esophagus, endoscopic US is useful in staging esophageal carcinoma, planning radiation therapy ports, and locating and characterizing esophageal masses. Endoscopic US of the esophagus is also used to identify varices and evaluate the results of therapy. Applications of endoscopic US in the stomach include staging of gastric carcinoma, localization and characterization of nonmucosal gastric masses, detection and evaluation of gastric varices, and evaluation of gastric lymphoma. In the pancreas, endoscopic US is used for detecting pancreatic masses; staging pancreatic, distal common bile duct, and ampullary carcinoma; and evaluation biliary tract obstruction. Applications of endoscopic US in the rectum include localization and characterization of nonmucosal lesions and local staging of rectal carcinoma.

Digestive System Diseases↗
PubMedDate not supplied

[Endoscopic treatment of gastrointestinal fistulas with biological fibrin glue].

OBJECTIVE: We summarize our experience of endoscopic treatment of gastrointestinal fistulas with fibrin glue. PATIENTS AND METHOD: We retrospectively reviewed the outcome of 30 patients with gastrointestinal fistulas (9 internal and 21 external) refractory to standard conservative treatment for at least 10 days. Once the fistula was endoscopically located, 4 to 8 ml of reconstituted fibrin glue (Tissucol 2.0) at 37 degrees C was injected through a Duplocath catheter on a weekly basis. RESULTS: The mean age was 59 years (32-87) and 63% were men. A total of 21.9% of the patients had high output fistulas. We were able to find all fistular orifices what were located close to the surgical anastomosis. Healing time was 17 days (4-90); 2.8 sessions were required per patient (1-5) but only 2.3 sessions were required in responders. Complete sealing of fistulas was achieved in 75%; (80% in low-output, 25% in high-output and 55.5% in internal fistulas). The frequency of fistula recurrence was 3.3%. No complications related to the sealing procedure were found. Overall mortality was 10%, but only 6.6% was related to persistence of the fistula. CONCLUSIONS: Endoscopic treatment of fistulas with biological glue has a high success rate in sealing without complications, helping to speed up the healing process and reduce costs, particularly in low-output enterocutaneous fistulas.

Adult↗
PubMed2003

Gastrostomy tube insertion into intestinal-cutaneous tract fistulas is a new technique to improve fistula control.

BACKGROUND: The management of gastrointestinal-cutaneous fistulas may be complicated by the difficulty in obtaining adequate control of the fistula tract. This study describes a new method to obtain better fistula control utilizing a semi-rigid stent in the form of a gastrostomy tube. METHODS: Consecutive patients with intestinal-cutaneous fistulas of at least 3 weeks duration and treated by the new technique were analyzed. The technique involved the insertion of a guide wire into the fistula tract from the luminal side using an endoscope, snaring the wire with a Dormia basket inserted into the fistula tract from the cutaneous side and then exteriorized. The gastrostomy tube was then pulled with the guide wire from the lumen along the fistula tract and out through the skin. RESULTS: Five patients had had fistulas for a median duration of 42 (range 26-140) days before insertion of the gastrostomy tube. The gastrostomy tube was replaced with a smaller diameter tube in 4 of the patients (range 1-3 changes). The patients were discharged from the hospital at a median of 14 (range 12-23) days after the tube insertion but with the tube in situ. The median time from the insertion of the tube to its removal was 42 (range 32-108) days. CONCLUSIONS: Gastrostomy tube insertion using minimally invasive techniques may improve fistula control enabling patients to be discharged home sooner than otherwise and improve the rate of healing.

Adult↗