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At least 19 recordsLinked to original sources

PubMed1992

[Contamination of endoscopes and endoscope washers by atypical mycobacteria].

Contamination of endoscopes and endoscope washers by atypical mycobacteria was studied. Large amounts of atypical mycobacteria were detected with high frequency inside endoscopes and endoscope washers. The species of atypical mycobacteria was Mycobacterium chelonae subsp. abscessus. Antibacterial-effects of glutaraldehyde against isolated atypical mycobacteria were checked. Sufficient antibacterial-effect was not obtained by 2% glutaraldehyde solution for endoscope sterilization. However, after frequent manual washing and brushing of endoscopes, by using 3% glutaraldehyde solution and 70% alcohol, all endoscopic instruments were completely decontaminated. We must pay attention to contamination of endoscopes and endoscope washer at least once a month.

Endoscopes↗

PubMed1991

Nosocomial infections from contaminated endoscopes: a flawed automated endoscope washer. An investigation using molecular epidemiology.

Approximately 1 year after purchase of one manufacturer's automated endoscope washing machine, we began to detect heavy contamination of upper gastrointestinal (UGI) endoscopes cultured after cleaning and disinfection in the washer. During the first 6 months of 1988, 77% of surveillance cultures (20-mL flush through the biopsy channel) were positive for gram-negative bacilli (median concentration, 10(5) cfu/mL), most frequently Pseudomonas aeruginosa serotype 10. During the first 19 months of use of the washer, nosocomial post-UGI endoscopy colonization or infections with P. aeruginosa increased 36%. Investigations show that endoscope contamination derives from a flaw in the design of the EW-10 washer: the detergent holding tank, inlet water hose, and air vents cannot be reliably disinfected and contain heavy biofilms that recontaminate the machine after it has been disinfected, as specified by the manufacturer, with glutaraldehyde. Only by rinsing machine-cleansed endoscopes with 70% alcohol followed by forced air drying has reliable disinfection been achieved. Since adaptation of terminal alcohol treatment and drying, post-UGI endoscopy colonization or infection by P. aeruginosa has declined threefold (p less than 0.001). Testing in other centers using the manufacturer's EW-10 or EW-20 washer has shown similar contamination. In three centers, including our own, postendoscopy infections by machine-associated type 10 P. aeruginosa have been confirmed by demonstrating concordance between isolates from contaminated machines or endoscopes and from infected patients by immunoblot of whole cell lysates and by pulsed-field electrophoresis of DraI endonuclease-digested genomic DNA. This problem reaffirms the vulnerability to microbial contamination of water-containing apparatus and equipment in patient care and points up the critical importance of engineering design to prevent contamination.

Cross Infection↗

PubMedDate not supplied

Randomized comparison of endoscopic microwave coagulation and endoscopic sclerosis in the treatment of bleeding peptic ulcers.

We conducted a prospective randomized trial to evaluate the effectiveness and safety of endoscopic microwave coagulation in comparison to endoscopic sclerosis in the treatment of peptic ulcer bleeding. Over 15 months 127 ulcer-bleeding patients with an actively bleeding vessel (N = 21), a non-bleeding vessel (N = 53), oozing hemorrhage (N = 25), or an adherent clot (N = 28) in the ulcer base were randomly assigned during endoscopy to receive treatment with endoscopic sclerosis or with microwave coagulation. There were no significant differences in effectiveness between endoscopic sclerosis and microwave coagulation in any of the assessed parameters: the percentage of patients with major recurrent hemorrhage (5 vs. 12), the percentage who needed emergency surgery (5 vs. 9), the mean (+/- SD) transfusion requirements (0.32 +/- 0.89 vs. 0.78 +/- 1.65), the mean number of hospital days (10.3 +/- 3.5 vs. 10.7 +/- 4.1), and the number of deaths due to bleeding (0 vs. 2) were similar in both groups. No case of perforation occurred in either group. The data suggest that microwave coagulation is as effective and safe as endoscopic sclerosis in the treatment of bleeding peptic ulcers.

Aged↗

PubMed1992

Endoscopic sclerotherapy as compared with endoscopic ligation for bleeding esophageal varices.

BACKGROUND: Endoscopic sclerotherapy is an accepted treatment for bleeding esophageal varices, but it is associated with substantial local and systemic complications. Endoscopic ligation, a new form of endoscopic treatment for bleeding varices, may be safer. We compared the effectiveness and safety of the two techniques. METHODS: In this randomized trial we compared endoscopic sclerotherapy and endoscopic ligation in 129 patients with cirrhosis who had proved bleeding from esophageal varices. Sixty-five patients were treated with sclerotherapy, and 64 with ligation. Initial treatment for acute bleeding was followed by elective retreatment to eradicate varices. The patients were followed for a mean of 10 months, during which we determined the incidence of complications and recurrences of bleeding, the number of treatments needed to eradicate varices, and survival. RESULTS: Active bleeding at the first treatment was controlled by sclerotherapy in 10 of 13 patients (77 percent) and by ligation in 12 of 14 patients (86 percent). Slightly more sclerotherapy-treated patients had recurrent hemorrhage during the study (48 percent vs. 36 percent for the ligation-treated patients, P = 0.072). The eradication of varices required a lower mean (+/- SD) number of treatments with ligation (4 +/- 2 vs. 5 +/- 2, P = 0.056) than with sclerotherapy. The mortality rate was significantly higher in the sclerotherapy group (45 percent vs. 28 percent, P = 0.041), as was the rate of complications (22 percent vs. 2 percent, P less than 0.001). The complications of sclerotherapy were predominantly esophageal strictures, pneumonias, and other infections. CONCLUSIONS: Patients with cirrhosis who have bleeding esophageal varices have fewer treatment-related complications and better survival rates when they are treated by esophageal ligation than when they are treated by sclerotherapy.

Esophageal and Gastric Varices↗

PubMed1991

Endoscopic removal of gastric lipoma: diagnostic value of endoscopic ultrasonography.

A 47-yr-old male with gastric lipoma is presented. X-ray and endoscopic examinations revealed a submucosal tumor on the posterior wall of the gastric antrum. Endoscopic ultrasonography demonstrated the hyperechoic mass in the submucosa without continuity to the muscularis propria, by which the lesion was diagnosed as lipoma. The lesion was successfully removed by endoscopic polypectomy without complications. The cross-sections of the removed specimens were quite consistent with the ultrasonographic findings. Endoscopic ultrasonography is valuable in assessing the exact extent of the tumor and in determining whether or not endoscopic polypectomy is called for.

Gastroscopy↗

PubMed1990

Granular cell tumor of the esophagus: endoscopic ultrasonographic demonstration and endoscopic removal.

A 35-yr-old Japanese man with a granular cell tumor of the esophagus that was removed by endoscopic polypectomy is presented. Radiography and endoscopy showed a 20 x 12 mm sessile protrusion in the distal esophagus. Endoscopic ultrasonography demonstrated the hypoechoic mass in the submucosa without continuity to the muscularis propria. The lesion was successfully treated by endoscopic polypectomy without complications. The cross-sections of the resected specimen were quite in agreement with the ultrasonographic findings. Endoscopic ultrasonography is valuable to assess the exact location and extent of the tumor, and to determine the indication for endoscopic polypectomy.

Adult↗

PubMed1990

Endoscopic retrograde cholangioscopy. An adjunct to endoscopic exploration of the common bile duct.

Choledochoscopy is an accepted technique in the operative exploration of the common bile duct, and is complimentary to operative cholangiography. Retrograde cholangiography can be achieved perorally in up to 97 per cent of patients and it is reasonable to assume that the use of complimentary cholangioscopy in such patients would help to improve the accuracy of bile duct examination just as it does when applied in the operative setting. We have had the opportunity to use a new technology in the endoscopic evaluation of the common bile duct. An endoscopic retrograde cholangioscopy (ERCP) is first performed and ductal anatomy outlined. When indicated, an endoscopic sphincterotomy is performed. If large stones are present they are removed with a balloon or basket. The standard side-viewing endoscope is then removed and replaced with the large channel, side-viewing scope. A "baby" scope is introduced through the "mother" scope and canulation of the common duct with the "baby" scope is performed. Biopsies and brushings of lesions may be obtained and numerous instruments are available for manipulation through the biopsy channel of the "baby" scope. The use of retrograde cholangioscopy as an adjunct to retrograde cholangiography should provide the same advantages that have been demonstrated with the use of operative choledochoscopy. Use of this instrument will allow the endoscopist to accurately identify questionable lesions seen on the cholangiogram, selectively canulate particular biliary radicals, biopsy lesions of the common duct, and perhaps intervene therapeutically in selected biliary tract lesions.

Cholangiopancreatography, Endoscopic Retrograde↗

PubMed1992

Endoscopic crescentic fold disease of the sigmoid colon: the clinical and histopathological spectrum of a distinctive endoscopic appearance.

In this paper we describe an endoscopic appearance of the sigmoid colon characterised by mucosal swelling, erythema and haemorrhage strictly localised to the crescentic mucosal folds. In a 5-year period these changes were seen in 34 (1.42%) of 2380 colonoscopies and fibreoptic sigmoidoscopies. The majority of patients were middle-aged or elderly. Diverticular disease was present in most (82%) but the abnormalities were confined to the crescentic mucosal folds with sparing of the diverticular orifices. The majority of patients presented with a history of bleeding per anum. Histologically there was a spectrum of changes varying from minor vascular congestion to florid active inflammatory disease with crypt architectural abnormalities mimicking ulcerative colitis, but rectal biopsies were invariably normal. Three patients later progressed to typical distal ulcerative colitis and two other patients presenting to us with endoscopic crescentic fold disease had a previous histologically documented history of distal ulcerative colitis. In three patients the histological features were of mucosal prolapse. About half the patients required some form of therapy to control their symptoms. Steroids and/or sulphasalazine were of value although two patients subsequently underwent sigmoid resection, one to control bleeding and the second for a diverticulosis-associated stricture. Whilst endoscopic crescentic fold disease represents a specific endoscopic appearance the clinical and histological features indicate a wide spectrum of disease.

Adult↗

PubMed1978

Endoscopic retrograde cholangiography (ERC) through artificial endoscopic choledocho-duodenal fistula.

A new endoscopic method for retrograde cholangiography in cases of unsuccessful cannulation of the papilla is described. In 1 patient with obstructive jaundice, severe diabetes and a previous history of biliary pain traditional ERC failed. An endoscopic artificial choledocho-duodenal fistula by means of a diathermic cutter (needle type) was performed at the lower end of the intramural portion of the common bile duct for retrograde cholangiography. X-ray showed an obstruction of the common bile duct due to a carcinoma of the head of the pancreas. Complications did not occur during the procedure and in the post-operative period. It is concluded that the described method may be helpful when traditional selective ERC fails, moreover it may permit an endoscopic choledocho-duodenostomy for choledocholithiasis in cases of unsuccessful endoscopic papillo-sphincterotomy.

Aged↗

PubMed1991

The endoscopic Doppler: its value in evaluating gastroduodenal ulcers after hemorrhage and as an instrument of control of endoscopic injection therapy.

In this prospective study of 80 patients with active bleeding from the gastrointestinal tract a Doppler ultrasonographic investigation of the gastroduodenal ulcers was performed, in addition to immediate endoscopic examination. Admitted to this study were ulcers with the stigmata of acute bleeding, such as a visible blood vessel in the ulcer floor, a blood clot, or a black base and Forrest III lesions. In 52 patients Doppler ultrasonography was able to document unequivocally a superficial blood vessel. Complete agreement of endoscopic and Doppler results was obtained in only 49% of the cases. When a blood vessel was positively identified, local injection of epinephrine and polidocanol was carried out. Thereupon, in the further course, the acoustic signal was shifted into deeper regions or disappeared entirely. In 8% of the cases initial sclerosing was followed by a rebleed, which was again treated by injection therapy. None of the patients died of their GI hemorrhage. Endoscopic Doppler ultrasonography is a new and effective procedure that enables objectification of the endoscopic findings. It identifies the indication for proceeding to operative endoscopy and can monitor the effectiveness of the latter.

Adult↗

PubMed1992

[Significance of the ulcer vessel in acute ulcer hemorrhage--value of local endoscopic therapy in combination with endoscopic Doppler ultrasound].

The acute ulcer hemorrhage is one of the most frequent diagnoses in Gastroenterology. In addition to the active hemorrhage the visible ulcer vessel, even if not bleeding at present, is one of the most important prognostic criteria. Numerous controlled studies have shown that with this sign recurrent hemorrhages will occur in up to 81%, resulting in emergency surgery in up to 56% with an associated mortality of up to 21%. By a meta-analysis we could show that prophylactic endoscopic therapy can significantly reduce both the rate of recurrent hemorrhage as well as emergency surgery. If the endoscopic doppler is used as well, as diagnostic as well as follow-up examination, the effectiveness of endoscopic treatment is greatly improved. The numbers we present show that active local endoscopic therapy should be undertaken in a visible ulcer vessel.

Arteries↗

PubMedDate not supplied

Endoscopic balloon dilation of esophageal strictures following surgical anastomoses, endoscopic variceal sclerotherapy, and corrosive ingestion.

Between 1987 and 1991, endoscopic balloon dilation was performed for esophageal strictures which developed after operation in 28 cases, after sclerotherapy in 9 cases, and after corrosive injury in 8 cases, for a total of 45 cases. The locations of stricture were upper third in 20 cases, mid-third in 2 cases, and lower third in 23 cases. The stricture appeared clinically 1 to 3 months after esophageal injury. Endoscopic follow-up interval was 1 week. A total of 136 dilations were done in these 45 patients with an average of 2.6 times/case (range, 1 to 8). The result of dilation was good in 9 cases, improved in 18 cases, slightly improved in 15 cases, with only 3 cases having no response. The follow-up period was 2 years on average (range, 0.5 to 4 years). The data suggest that endoscopic balloon dilation is a safe, effective, and easy method for the management of esophageal stricture caused by surgical anastomosis, sclerotherapy, and corrosive injury.

Anastomosis, Surgical↗

PubMed2026

Endoscopic submucosal dissection for locally recurrent gastric neoplasia following endoscopic resection: a systematic review and meta-analysis.

BACKGROUND AND AIMS: Endoscopic submucosal dissection (ESD) for locally recurrent gastric neoplasia following endoscopic resection (ER) is technically challenging because of scar-related submucosal fibrosis. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of salvage ESD in this setting. METHODS: Multiple databases were searched through December 2025 for studies reporting ESD outcomes for locally recurrent gastric lesions at or contiguous with a prior ER scar. Primary outcome was curative resection and need for surgery. Secondary outcomes were en bloc and R0 resection, local recurrence, delayed bleeding, and perforation. Meta-analyses were performed using a random effects model. Heterogeneity was assessed using I2. RESULTS: Seven studies (259 patients; 265 ESDs) were included. Across 5 studies and 243 ESDs, pooled curative resection rate was 69.7% (95% CI, 60.6-78.1; I2 = 38%), while 8.2% (95% CI, 3.3-14.6; I2 = 38.4%) required surgery. En bloc resection rate was 92.3% (95% CI, 79.1-99.7; I2 = 83.7%) across 6 studies, and pooled R0 resection rate was 87.5% (95% CI, 82.1-92.2; I2 = 0%) across 4 studies. Over a mean follow-up of 42 months, pooled local recurrence was 2.0% (95% CI, 0.0-9.7; I2 = 54.1%) across 6 studies. Delayed bleeding was 4.1% (95% CI, 0.8-9.0; I2 = 40.8%) and perforation was 4.1% (95% CI, 1.6-7.3; I2 = 0%). CONCLUSIONS: ESD for locally recurrent gastric neoplasia after ER achieves acceptable curative resection, high en bloc/R0 resection, and low local recurrence and morbidity. It is a viable organ-preserving option for appropriately selected patients, ideally performed at expert centers with close surveillance.

Humans↗

PubMed1991

[Disinfection of endoscopes in gastroenterology. Bacteriologic evaluation of the procedure employed in the endoscopic unit at the Mongi Slim Hospital of Tunisia].

An evaluation was made of the incidence of contamination of the endoscopes during gastroscopy and colonoscopy and of the efficacy of the disinfection procedure used in our digestive endoscopy unit. Serial bacteriological samples were made before and after the endoscopy session and also between patient procedures. These samples were taken on the endoscopes and their accessories and also on the walls, examination table, gloves and the uniforms of the staff. Over 60 p. cent of the samples were positive showing that the disinfection technique was not bacteriologicaly satisfactory. Most of the micro-organisms found were opportunists. Firm guidelines regarding adequate disinfection are important and regular micro-biological control of disinfection procedures must be performed.

Disinfection↗

PubMed1991

Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy in the management of suspected gallstone pancreatitis.

An approach to suspected gallstone pancreatitis based on endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) was adopted in 1976 and was followed in 29 patients. ERCP became the routine method of early biliary tract assessment when gallstone pancreatitis was suspected on clinical and biochemical grounds, and further management was based on ERCP findings. If calculi were detected in the common bile duct (13 cases) ES was performed; when calculi were confined to the gallbladder (12 cases) cholecystectomy was advised; and if no calculi were detected on ERCP (4 cases) investigations were continued. ERCP proved to be a reliable guide to management, while ES provided safe and effective symptomatic relief when choledocholithiasis was present, and prevented recurrence of pancreatitis even when the gallbladder remained in situ.

Acute Disease↗

PubMed1990

[Endoscopic study using a superthin endoscope in benign esophageal strictures].

To increase the diagnostic possibilities, the authors suggested a method of endoscopic examination of patients with esophageal strictures by means of a superthin PF-28 fibroscope produced by the Olympus firm (Japan), which was introduced along a string-guide. The examination was successful in 24 of 26 patients. Clinical observations have shown that esophagogastroscopy with a superthin endoscope makes it possible to recognize the exact length of the stenosed segment, detect the second zone of stenosis, and determine the condition of the mucous membrane of the esophago-gastric junction and the proximal part of the stomach.

Adult↗

PubMed1978

Radiation exposure in patients undergoing endoscopic retrograde cholangiopancreatography and endoscopic papillotomy.

Radiation exposure was studied in 327 patients undergoing endoscopic retrograde cholangiopancreatography, or endoscopic papillotomy taking into account fluoroscopy time and incident area exposure. The mean fluoroscopy time was 238 +/- 152 seconds and the incident area exposure 3,730 +/- 2,790 R X cm2. These results were compared with standard exposures in upper GI series and colon examinations as found in the literature.

Adult↗

PubMed1978

Descending sphincterotomy of the papilla of Vater through the T-drain under endoscopic view. Variants of endoscopic papillotomy (EPT).

An indwelling T-drain is a valuable access to the common bile duct if the conventional EPT fails in the case of choledocholithiasis. It is often easier to cannulate the duodenal papilla from the common bile duct than from the duodenum. A papillotome of the Erlangen type introduced through the T-drain into the papilla spontaneously has the correct cutting direction. The incision is controlled endoscopically. If a patient has undergone Billroth II operation, the particularly difficult cannulation and incision of the papilla is make much easier by the descending technique. Two variants of the endoscopically controlled descending electropapillotomy were successfully performed.

Aged↗