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At least 19 recordsLinked to original sources

Duodenoscopy in the diagnosis of upper gastrointestinal disease.

Duodenoscopy was undertaken in 143 patients with upper gastrointestinal tract symptoms. There were no complications of the procedure. The duodenum was successfully entered in 98% of attempts, and in 90% of patients the examination was judged to be technically successful. When compared with radiological assessment, the findings at duodenoscopy significantly altered diagnosis and management in 21% of patients. The endoscopic appearance of the non-ulcerated duodenal mucosa could not be consistently correlated with changes found in biopsy tissue obtained under direct vision. Duodenoscopy is a valuable adjunct in the clinical assessment of upper gastrointestinal tract symptoms suspected to be due to pathological changes in the duodenum.

Biopsy

[Ultrasonic scanning and duodenoscopy in the diagnosis and treatment of obstructive jaundice].

In 186 patients with obstructive jaundice admitted to the clinic for diagnosis of its cause, the ultrasound scanning with duodenoscopy was employed. This permitted to establish the cause of jaundice in 84.9% of the patients and to choose proper therapeutic tactics at the shortest time after hospitalization. In 80% of the patients, an obstacle for bile outflow was liquidated by means of endoscopy. When it was not possible to established the cause of jaundice by the findings of ultrasound scanning and duodenoscopy, percutaneous transhepatic cholangiography was performed, which has proved to be successful in 5.9% of cases. Use of the given methods for diagnosis permitted to define the optimal therapeutic tactics in patients with obstructive jaundice, to reduce the lethality.

Acute Disease

Juxtapapillary choledochoduodenal fistula following choledochal exploration and diagnosed by early duodenoscopy.

In 86 patients who had undergone common-duct exploration at surgery for benign biliary disease, duodenoscopy was performed within 4 weeks after the operation. Choledochoduodenal fistula, apparently iatrogenic, was then found in eight patients (9.3%). All eight were among the 35 patients in whom a rigid probe had been passed to the duodenum, giving a fistula incidence of 23% in this group. Four of the eight patients consented to repeat duodenoscopy, which showed healing of fistula within a year in three cases. No patient with choledochoduodenal fistula experienced postoperative biliary symptoms.

Adult

A case of common bile duct ascariasis diagnosed by duodenoscopy.

A case of common bile duct ascariasis diagnosed by duodenoscopy is presented. At the admission, the patient, cholecystectomized for gallstones 13 years before, had been complaining of epigastric pain associated with post-prandial and nocturnal vomiting. Physical examination showed only slight tenderness in the epigastrium. Laboratory findings were within normal limits, with the exception of a moderate leukocytosis. Intravenous cholangiography showed the lack of visualization of the terminal common bile duct, but the flow of contrast medium was normal. Duodenoscopy, carried out without a specific clinical suspicion, revealed an ascaris lumbricoides inserted in the common bile duct and partially protruding from the papilla Vateri. The patient was treated by piperazine, intravenous fluids, antibiotics and a choleretic compound. After 24 hours an ascaris 33 cm long was excreted in the faeces and the patient became symptom-free. Some pathophysiological, clinical and epidemiological aspects of biliary ascariasis are discussed.

Aged

[Cardiac side-effects of oesophago-gastro-duodenoscopy in relation to premedication (author's transl)].

The electrocardiogram was monitored in 100 patients undergoing oesphago-gastro-duodenoscopy. Premedication differed: 25 patients each were given either (Group I) atropine 0.5 mg, hyoscine-N-butylbromide 20 mg, and diazepam 5 mg, or (Group II) hyoscine-N-butyl-bromide 20 mg and diazepam 5 mg, or (Group II) diazepam 5 mg and glucagon 0.2 mg, or (Group IV) only diazepam 5 mg intravenously. After injection of the parasympatholytic drugs (Groups I and II) there was a significantly higher heart rate duringthe entire length of the examination than in groups III and IV. Nine of the ten cases of ascending S-T depression were found in Groups I and II, while descending (ischaemic) S-T changes occurred equally frequently in patients of all four groups. Two of the three more serious arrhythmias were registered after atropine. Since parasympatholytic drugs fail to inhibit arrhythmias and ST-T changes, while accentuating the rise in heart rate, it is recommended that premedication for oesophago-gastro-duodenoscopy should not include such drugs.

Adolescent

Coeliac disease diagnosed by means of duodenoscopy and endoscopic duodenal biopsy.

Nineteen patients with suspected coeliac disease were examined by duodenoscopy and biopsy. In all patients a histopathology consistent with coeliac disease was demonstrated in endoscopic biopsies of the duodenal mucosa. On close-up view villous atrophy was seen in vivo. Fourteen patients were re-examined on a gluten-free diet. In 13 patients a restitution of the duodenal mucosa was shown. Duodenoscopy combined with biopsy seems to be a reliable method for the assessment of the mucosal change in coeliac disease.

Aged

[Heart rhythm during esophago-gastro-duodenoscopy].

The ECGs of 157 patients were registered continuously during the oesophago-gastro-duodenoscopy with a R-R intervall monitoring system. The behavior of frequencies and cardiac arrhythms of 53 patients with and 104 patients without heart diseases is reported. 32 patients were premedicated with 0,5 mg Atropin intravenously, 121 patients received intramuscular premedication. The influence of the vegetative nervous system is discussed in view of the heart actions during the diagnostic procedure. A clinically relevant danger for the heart and circulatory system caused by oesophago-gastro-duodenoscopy was not observed.

Arrhythmias, Cardiac

[The role of duodenoscopy in the diagnosis of duodenal diverticulosis].

The importance of duodenoscopy in the diagnosis of duodenal diverticula is illustrated by rich clinical material. It proved successful in 75.5% of patients. Retrograde choledochopancreatography is valuable in studying the relationship between the diverticulum of the descending part of the duodenum and the pancreatic and hepatic ducts.

Ampulla of Vater

Duodenoscopy and endoscopic retrograde choledochopancreatography: present position in relation to periampullary and pancreatic cancer.

Duodenoscopy and endoscopic retrograde choledochopancreatography represent a major advance in the diagnosis of periampullary and pancreatic lesions. Instruments, techniques and complications are reviewed. A combination of endoscopy and ERCP will yield diagnosis in a high proportion of patients suspected of pancreatic or ampullary carcinomata. Information is obtained which is not only of diagnostic value but is important in the surgical treatment of such patients.

Ampulla of Vater

Duodenoscopy and endoscopic pancreatography in patients with postive morphine prostigmine tests.

Twenty-three patients with abdominal pain and positive morphine prostigmine tests underwent duodenoscopy and endoscopic retrograde cholangiopancreatography (ERCP). Sixteen demonstrated marked or moderate ampullary stenosis. The pancreatic duct was dilated in three and stenotic in four. Ampullary stenosis was confirmed in all patients who subsequently underwent sphincteroplasty. Only six patients had pancreatitis demonstrated by appropriate laboratory studies or at surgery. Relief of pain after sphincteroplasty was complete in ten patients during follow-up.

Adolescent

Function of the minor duodenal papilla in humans as determined under duodenoscopy using indigo carmine dye and a pH sensor.

The function of the minor duodenal papilla in humans was studied by duodenoscopy using indigo carmine dye and a pH sensor. By this method it was possible to classify the function of the minor papilla into three types: Type I: pancreatic juice excretion without secretin administration; Type II: pancreatic juice excretion following secretin administration; Type III: no pancreatic juice excretion despite secretin administration. To determine the relative numbers of each type, the findings in 23 normal subjects were compared with those in 26 patients with benign papillary stenosis. In normal individuals, there were 11 Type I, 4 Type II and 8 Type III, while in patients with papillary stenosis we observed 20 Type I, 4 Type II and 2 Type III function, indicating that in patients with papillary stenosis, the incidence of Type I minor papilla was significantly high. From this it can be inferred that a minor papilla that does not excrete pancreatic juice spontaneously may begin such excretion, if pancreatic duct pressure persistently increases.

Adult

Hyperamylasaemia after duodenoscopy and retrograde cholangiopancreatography.

The salivary and pancreatic isoamylases of serum were determined separately in 234 cases of duodenoscopy and retrograde cholangiopancreatography. Successful pancreatic opacification was associated with pathologically high pancreatic serum amylase activities in 60% of the cases. Extensive opacification was associated with large increases of pancreatic serum isoamylases, the maximal rise recorded was 40 times the initial value. In spite of these striking chemical events only two patients developed clinical acute pancreatitis. There were some variations in pancreatic opacification and in the elevation of pancreatic serum amylase which seemed to depend upon the particular contrast material used. A rise of the salivary serum isoamylases caused pathologically high total serum amylase activities in 7% of the cases. High levels of pancreatic serum isoamylase activity before the time of examination did not result in any different pattern of hyperamylasaemia.

Cholangiography

Value of fibreoptic oesophago-gastro-duodenoscopy: experience with 4000 procedures at Kilimanjaro Christian Medical Centre, Moshi, Tanzania.

The paper presents the results of a retrospective study and the experiences with 4000 fibreoptic oesophago-gastro-duodenoscopies (EGD), which were performed at Kilimanjaro Christian Medical Centre (KCMC) between 1985 and 1989 in an open access service. Seventy per cent of all patients examined had abnormal findings with duodenal ulcer as the most frequent diagnosis (22%). Pyloric stenosis was seen in 6%, gastric ulcer in 5% and esophageal varices in 4% of all patients. High figures were found for carcinoma of the esophagus (4%) and malignancy of the stomach (5%). Gastritis was diagnosed in 11%. We consider fibreoptic EGD a cost effective and appropriate technology. Because of its high diagnostic yield, we advocate its use in certain centres in developing countries.

Adolescent

Duodenal tuberculosis as seen by duodenoscopy.

A case of tuberculous stricture of the third part of the duodenum was detected by duodenoscopy. Endoscopic biopsy, however, failed to reveal the histological diagnosis. The possible role of endoscopic follow-up of tubercular strictures is indicated.

Adult

[Deep duodenoscopy and endoscopic retrograde cholangiopancreaticography].

A survey is given on indications, results and complications of the deep duodenoscopy and endoscopic retrograde cholangiopancreaticography. The endoscopic retrograde pancreatography is indicated in the chronic forms of pancreatitis, in suspicion to cysts of the pancreas or tumours. Its results have a decisive influence on the indication to surgical procedure and on the planning of the intervention. The endoscopic retrograde cholangiography is of greatest practical significance for the differential diagnosis of the cholestatic icterus: non-obstructed bile ducts exclude an extrahepatic icterus and render a laparotomy useless. Furthermore, the endoscopic retrograde cholangiography is indicated when the demonstration of the duct is intravenously insufficient, when papillary or prepapillary narrowings are present and in the etiologically unclear syndrome of postcholecystectomy. The most dangerous complications of the endoscopic retrograde pancreatography are the acute pancreatitis and the infection of cysts. Cholangitides and septicaemias appear after the endoscopic retrograde cholangiography only in such cases when obstructions of the drainage are present.

Cholangiography

[Pancreatic biologic reactions after Wirsung opacification under duodenoscopy. Preventive action of Frey's inhibitor (67 cases)].

After retrograde opacification of be pancreatic ducts by duodenoscopy, pancreatic biologic reactions have been studied, especially by amylasemia and lipasemia measures. These biologic reactions have been all the more frequent and intense as Wirsung's duct and its tributaries filling have been important. Frey's inhibitor had a proptious action on these biologic reactions; therefore, it may be used as a preventive treatment.

Amylases

[The influence of a beta-adrenolytic premedication on cardiovascular parameters and plasma free fatty acids during esophago-gastro-duodenoscopy (author's transl)].

Three groups of patients with different premedications were examined for changes of blood pressure, heart rate, ECG and plasma free fatty acid levels during esophago-gastro-duodenoscopy: Group A was premedicated with Bunitrolol, group B was premedicated with Hyoscin-N-butyl-bromide and diazepam, group C was endoscopied without premedication. The pulse rate rose significantly less in group A than in groups A and C; the same phenomenon was observed with regard to the systolic blood pressure. Premature beats occurred in all 3 groups: 32 per cent of the patients in group A, 43 per cent in group B and 60 per cent in group C had at least occasional premature beats; an accumulation of premature beats however occurred significantly less frequently in group A than in groups B or C. A drop of the ST-part of the ECG occurred with about the same frequency in each group. An increase of the plasma free fatty acids, which was noted in groups B and C, could be observed in Group A. A pre-endoscopic medication of beta blocking agents could be a useful measure in patients with labile arterial hypertension, vegatative dysregulation and a hyperkinetic heart syndrome.

Adrenergic beta-Antagonists