The former editor of Gastrointestinal Endoscopy reflects on the history of endoscopy, which reveals much about the mechanisms whereby innovation occurred, and attempts to forecast the future. Endoscopic technological development in most industrialised countries will be determined largely by various combinations of many external factors together with the further development of virtual imaging
Sivak, M V
Background/Aim: Open access endoscopy (OAE) decreases the waiting time for patients and clinical burden to gastroenterologist; however, the appropriateness of referrals for endoscopy and thus the diagnostic yield of these endoscopies has become an important issue. The aim of this study was to determine the appropriateness of upper gastrointestinal (GI) endoscopy requests in an OAE system. Patients and Methods: A retrospective chart review of all consecutive patients who underwent an upper gastroscopy in the year 2008 was performed and was defined as appropriate or inappropriate according to the American Society for Gastrointestinal Endoscopy (ASGE) guidelines. Endoscopic findings were recorded and classified as positive or negative. Referrals were categorized as being from a gastroenterologist, internist, surgeon, primary care physicians or others, and on an inpatient or out-patient basis. Results: A total of 505 consecutive patients were included. The mean age was 45.3 (standard deviation 18.1), 259 (51%) of them were males. 31% of the referrals were thought to be inappropriate. Referrals from primary care physicians were inappropriate in 47% of patients while only 19.5% of gastroenterologists referrals were considered inappropriate. Nearly, 37.8% of the out-patient referrals were inappropriate compared to only 7.8% for inpatients. Abnormal findings were found in 78.5% and 78% of patients referred by gastroenterologists and surgeons respectively while in those referred by primary care physicians it was (49.7%). Inpatients referred for endoscopy had abnormal findings in (81.7%) while in out-patients it was (66.6%). The most common appropriate indications in order of frequency were "upper abdominal distress that persisted despite an appropriate trial of therapy "(78.9%),''persistent vomiting of unknown cause "(19.2%), upper GI bleeding or unexplained iron deficiency anemia (7.6%). The sensitivity and specificity of the ASGE guidelines in our study population was 70.3% and 35% respectively. Conclusion: A large proportion of patients referred for endoscopy through our open-access endoscopy unit are considered inappropriate, with significant differences among specialties. These results suggest that if proper education of practitioners was implemented, a better utilization would be expected. PMID:24045595
Aljebreen, Abdulrahman M; Alswat, Khalid; Almadi, Majid A
The academic gastrointestinal endoscopist is faced with many responsibilities. These include endoscopic teaching, clinical service responsibilities, development of new endoscopic therapies, and integration of the ever changing endoscopic technologies into contemporary clinical endoscopic practice. There exists in clinical gastrointestinal medicine and digestive endoscopy a great need for hypermedia-based instructional material. We are hopeful that our development of a hypermedia-based digestive endoscopy database and microcomputer endoscopy workstation will accelerate the acceptance of these formats into clinical endoscopic practice, teaching and research.
Werkman, R.F.; Abell, T.L.; Hahn, J.S.
Endoscopy is the primary diagnostic and therapeutic tool for upper gastrointestinal bleeding (UGIB). The performance of endoscopic therapy depends on findings of stigmata of recent hemorrhage (SRH). For peptic ulcer disease—the most common etiology of UGIB—endoscopic therapy is indicated for findings of major SRH, such as active bleeding, oozing, or the presence of a nonbleeding visible vessel, but not indicated
Mitchell S. Cappell
The diagnostic and therapeutic contribution of fiberoptic endoscopy to the advancement of the knowledge of gastrointestinal disease and to its proper management is already established. Technical refinements in the new instruments and extensive acceptance of the advantages of the method makes fiberendoscopy a procedure widely used throughout the world. Therefore, the appreciation of its potential risk of complications and hazards
Angelita Habr-Gama; Jerome D. Waye
INTRODUCTION: The importance of quality indicators has become increasingly recognized in gastrointestinal endoscopy. Patient safety requires the identification and monitoring of occurrences associated with harm or the potential for harm. The identification of relevant indicators of safety compromise is, therefore, a critical element that is key to the effective implementation of endoscopy quality improvement programs. OBJECTIVE: To identify key indicators of safety compromise in gastrointestinal endoscopy. METHODS: The Canadian Association of Gastroenterology Safety and Quality Indicators in Endoscopy Consensus Group was formed to address issues of quality in endoscopy. A subcommittee was formed to identify key safety indicators. A systematic literature review was undertaken, and articles pertinent to safety in endoscopy were identified and reviewed. All complications and measures used to document safety were recorded. From this, a preliminary list of 16 indicators was compiled and presented to the 35-person consensus group during a three-day meeting. A revised list of 20 items was subsequently put to the consensus group for vote for inclusion on the final list of safety indicators. Items were retained only if the consensus group highly agreed on their importance. RESULTS: A total of 19 indicators of safety compromise were retained and grouped into the three following categories: medication-related – the need for CPR, use of reversal agents, hypoxia, hypotension, hypertension, sedation doses in patients older than 70 years of age, allergic reactions and laryngospasm/bronchospasm; procedure-related early – perforation, immediate postpolypectomy bleeding, need for hospital admission or transfer to emergency department from the gastroenterology unit, instrument impaction, severe persistent abdominal pain requiring evaluation proven to not be perforation; and procedure-related delayed – death within 30 days of procedure, 14-day unplanned hospitalization, 14-day unplanned contact with a health provider, gastrointestinal bleeding within 14 days of procedure, infection or symptomatic metabolic complications. CONCLUSIONS: The 19 indicators of safety compromise in endoscopy, identified by a rigorous, evidence-based consensus process, provide clear outcomes to be recorded by all facilities as part of their continuing quality improvement programs.
Borgaonkar, Mark R; Hookey, Lawrence; Hollingworth, Roger; Kuipers, Ernst J; Forster, Alan; Armstrong, David; Barkun, Alan; Bridges, Ronald; Carter, Rose; de Gara, Chris; Dube, Catherine; Enns, Robert; MacIntosh, Donald; Forget, Sylviane; Leontiadis, Grigorios; Meddings, Jonathan; Cotton, Peter; Valori, Roland
Capsule endoscopy (CE) is a safe, non invasive diagnostic modality for the evaluation of small bowel lesions. Obscure gastrointestinal bleeding (OGIB) is one of the most important indications of capsule endoscopy. Capsule endoscopy has a very high diagnostic yield especially if the bleeding is ongoing. This technique appears to be superior to other techniques for the detection of suspected lesions and the source of bleeding. Capsule endoscopy has been shown to change the outcome in patients with obscure gastrointestinal (GI) bleed. PMID:17729404
Gupta, R; Reddy, Duvvuru Nageshwar
This article reviews the role of therapeutic endoscopy in the diagnosis and treatment of nonvariceal upper and lower gastrointestinal (GI) hemorrhage. The initial approach to patients with GI bleeding is reviewed. Endoscopic treatment of various stigmata of recent peptic ulcer hemorrhage is discussed in detail. Management of less common causes of nonvariceal bleeding, such as Dieulafoy's lesions, Mallory-Weiss tears, angiomas, and bleeding colonic diverticula is described. Recommendations for endoscopic techniques are based on the results of UCLA-CURE hemostasis studies. PMID:10836190
Savides, T J; Jensen, D M
Capsule endoscopy (CE) is considered as a noninvasive and reliable diagnostic tool of examining the entire small bowel. CE has been performed frequently at many medical centers in South Korea; however, there is no evidence-based CE guideline for adequate diagnostic approaches. To provide accurate information and suggest correct testing approaches for small bowel disease, the guideline on CE was developed by the Korean Gut Image Study Group, a part of the Korean Society of Gastrointestinal Endoscopy. Operation teams for developing the guideline were organized into four areas: obscure gastrointestinal bleeding, small bowel preparation, Crohn's disease, and small bowel tumor. A total of 20 key questions were selected. In preparing this guideline, MEDLINE, Cochrane library, KMbase, KISS, and KoreaMed literature searches were performed. After writing a draft of the guideline, opinions from various experts were reflected before approving the final document. The guideline should be regarded as recommendations only to gastroenterologists in providing care to their patients. These are not absolute rules and should not be construed as establishing a legal standard of care. Although further revision may be necessary as new data appear, this guideline is expected to play a role for adequate diagnostic approaches of various small bowel diseases.
Shim, Ki-Nam; Moon, Jeong Seop; Chang, Dong Kyung; Do, Jae Hyuk; Kim, Ji Hyun; Min, Byung Hoon; Jeon, Seong Ran; Choi, Myung-Gyu
Background and Study Aims: Skills in gastrointestinal endosco- py mainly depend on experience and practice. Training on endos- copy simulators may decrease the time needed to reach compe- tency in endoscopy. The purpose of the study was to determine whether the GI-Mentor, a virtual reality endoscopy simulator, can distinguish between beginners and experts in endoscopy and to assess whether training
A. Ferlitsch; P. Glauninger; A. Gupper; M. Schillinger; M. Haefner; A. Gangl; R. Schoefl
More elderly patients now undergo gastrointestinal endoscopy following recent advances in endoscopic techniques. In this study, we conducted a high-risk survey of endoscopies in Japan, using a questionnaire administered prior to upper gastrointestinal tract endoscopy (UGITE), and identified anticholinergic agents and glucagon preparations as high-risk premedication. We also evaluated the cardiovascular effects of anticholinergic agents and glucagon through measurements of plasma levels of human atrial natriuretic peptide (hANP) and human brain natriuretic peptide (hBNP). The subjects were 1480 patients who underwent UGITE. Nurses administered a pre-endoscopy questionnaire, questioning subjects regarding heart disease, hypertension, glaucoma, and urinary difficulties as risk factors for anticholinergic agents, and Diabetes mellitus as a risk factor for glucagon preparations. Evaluation of subjects divided into under 65 and over 65 age groups revealed that in subjects aged 65 and over, risk factors for anticholinergic agents were significantly more high than those for glucagon. Analysis of the cardiovascular effects of anticholinergic agents and glucagon, in the elderly patients showed that hANP levels were significantly higher following administration of anticholinergic agents, but the change was not significant for glucagon premedication. Taking a detailed history before UGITE with the aid of a questionnaire at the same time as informed consent is obtained, is extremely useful in terms of risk management and selection of the appropriate premedication.
Umegaki, Eiji; Abe, Shinya; Tokioka, Satoshi; Takeuchi, Nozomi; Takeuchi, Toshihisa; Yoda, Yukiko; Murano, Mitsuyuki; Higuchi, Kazuhide
The safe sedation of patients for diagnostic or therapeutic procedures requires a combination of properly trained physicians and suitable facilities. Additionally, appropriate selection and preparation of patients, suitable sedative technique, application of drugs, adequate monitoring, and proper recovery of patients is essential. The goal of procedural sedation is the safe and effective control of pain and anxiety as well as to provide an appropriate degree of memory loss or decreased awareness. Sedation practices for gastrointestinal endoscopy (GIE) vary widely. The majority of GIE patients are ambulatory cases. Most of this procedure requires a short time. So, short acting, rapid onset drugs with little adverse effects and improved safety profiles are commonly used. The present review focuses on commonly used regimens and monitoring practices in GIE sedation. This article is to discuss the decision making process used to determine appropriate pre-sedation assessment, monitoring, drug selection, dose of sedative agents, sedation endpoint and post-sedation care. It also reviews the current status of sedation and monitoring for GIE procedures in Thailand.
AIM: To determine the sedation practices and preferences of Nigerian endoscopists for routine diagnostic upper gastrointestinal endoscopy. METHODS: A structured questionnaire containing questions related to sedation practices and safety procedures was administered to Nigerian gastrointestinal endoscopists at the 2011 annual conference of the Society for Gastroenterology and Hepatology in Nigeria which was held at Ibadan, June 23-35, 2011. RESULTS: Of 35 endoscopists who responded, 17 (48.6%) used sedation for less than 25% of procedures, while 14 (40.0%) used sedation for more than 75% of upper gastrointestinal endoscopies. The majority of respondents (22/35 or 62.9%) had less than 5 years experience in gastrointestinal endoscopy. The sedative of choice was benzodiazepine alone in the majority of respondents (85.7%). Opioid use (alone or in combination with benzodiazepines) was reported by only 5 respondents (14.3%). None of the respondents had had any experience with propofol. Non-anaesthesiologist-directed sedation was practiced by 91.4% of endoscopists. Monitoring of oxygen saturation during sedation was practiced by only 57.1% of respondents. Over half of the respondents (18/35 or 51.4%) never used supplemental oxygen for diagnostic upper gastrointestinal endoscopy. CONCLUSION: Sedation for routine diagnostic upper gastrointestinal endoscopy in Nigeria is characterized by lack of guidelines, and differs markedly from that in developed countries.
Nwokediuko, Sylvester Chuks; Obienu, Olive
BACKGROUND: Pulmonary aspiration is a life-threatening complication of upper gastrointestinal endoscopy, the incidence of which has not been determined. Endoscopy-related aspiration has not been studied in procedures in which patients swallow a radiolabelled potential aspirate immediately before endoscopy and undergo nuclear scanning postprocedure. METHODS: A pilot study was conducted in which 200 MBq of non-absorbable technetium-99m phytate in 10 mL of water was administered orally to 50 patients who were about to undergo endoscopy. Gamma camera images were obtained to ensure that there had been no aspiration before endoscopy. After endoscopy, a repeat scan was performed. Fluid aspirated through the endoscope was also collected and analyzed for radioactivity using a hand-held radiation monitor. RESULTS: No evidence of pulmonary aspiration was found in any of the patients studied. The mean estimated percentage of the initially administered radioactivity aspirated through the endoscope was 2.66% (range 0% to 10.3%). CONCLUSION: The present pilot study confirms earlier observations that clinically significant aspiration in the context of upper gastrointestinal endoscopy is uncommon. The incidence of aspiration may, however, be different in acutely bleeding patients undergoing endoscopy. For logistic reasons, this group could not be studied.
Thomson, A; Tye-Din, J; Tonga, S; Scott, J; Mclaren, C; Pavli, P; Lomas, F
Gastrointestinal endoscopy simulations have been developed to train endoscopic procedures which require hundreds of practices to be competent in the skills. Even though realistic haptic feedback is important to provide realistic sensation to the user, most of previous simulations including commercialized simulation have mainly focused on providing realistic visual feedback. In this paper, we propose a novel design of portable haptic interface, which provides 2DOF force feedback, for the gastrointestinal endoscopy simulation. The haptic interface consists of translational and rotational force feedback mechanism which are completely decoupled, and gripping mechanism for controlling connection between the endoscope and the force feedback mechanism. PMID:21335788
Gu, Yunjin; Lee, Doo Yong
Introduction Gastrointestinal (GI) endoscopy is currently performed by different specialties. Information on GI endoscopy resources in Nigeria is limited. Training, cost, availability and maintenance of equipment are some unique challenges. Despite these challenges, the quality and completion rates are important. Methods Prospective audit of endoscopic procedures by an endoscopist in a Nigerian hospital over a 24 month period. Results One hundred and ninety endoscopic procedures were performed in 187 patients (109 male, 78 female) by a surgeon during this period. Mean age was 47.6 years (range 17 - 90 years). All patients were symptomatic. One hundred and twenty-two procedures (64.2%) were upper GI endoscopy, 52 (27.4%) colonoscopy and 16 (8.4%) sigmoidoscopy. Majority of endoscopies 182 (95.8%) were performed electively and only 7 (3.7%) were therapeutic. Upper GI endoscopy findings included 14 (11.5%) cases of peptic ulcer disease, 5 complicated by gastric outlet obstruction, and 21 (17.3%) cases of upper gastrointestinal cancer. Lower gastrointestinal endoscopy findings included 7 cases of polyps, 3 cases of colorectal cancer and 2 cases of diverticulosis. Commonest lesion on lower GI endoscopy was haemorrhoids (41.7%). Adjusted caecal intubation was 81.4% for colonoscopies performed. Overall adenoma detection rate for male and female patients were 18.2% and 5.3% respectively; in patients over 50 years these were 6.3% and 14.3%. Two complications, rupture of oesophageal varices, and respiratory arrest in bulbar palsy patient occurred. Conclusion An endoscopist can perform GI endoscopy effectively in developing countries like Nigeria but attention to equipment need and training is important.
Ismaila, Bashiru Omeiza; Misauno, Michael Ayedima
Diagnostic and therapeutic endoscopy can successfully be performed by applying moderate (conscious) sedation. Moderate sedation, using midazolam and an opioid, is the standard method of sedation, although propofol is increasingly being used in many countries because the satisfaction of endoscopists with propofol sedation is greater compared with their satisfaction with conventional sedation. Moreover, the use of propofol is currently preferred for the endoscopic sedation of patients with advanced liver disease due to its short biologic half-life and, consequently, its low risk of inducing hepatic encephalopathy. In the future, propofol could become the preferred sedation agent, especially for routine colonoscopy. Midazolam is the benzodiazepine of choice because of its shorter duration of action and better pharmacokinetic profile compared with diazepam. Among opioids, pethidine and fentanyl are the most popular. A number of other substances have been tested in several clinical trials with promising results. Among them, newer opioids, such as remifentanil, enable a faster recovery. The controversy regarding the administration of sedation by an endoscopist or an experienced nurse, as well as the optimal staffing of endoscopy units, continues to be a matter of discussion. Safe sedation in special clinical circumstances, such as in the cases of obese, pregnant, and elderly individuals, as well as patients with chronic lung, renal or liver disease, requires modification of the dose of the drugs used for sedation. In the great majority of patients, sedation under the supervision of a properly trained endoscopist remains the standard practice worldwide. In this review, an overview of the current knowledge concerning sedation during digestive endoscopy will be provided based on the data in the current literature. PMID:23382625
Triantafillidis, John K; Merikas, Emmanuel; Nikolakis, Dimitrios; Papalois, Apostolos E
Diagnostic and therapeutic endoscopy can successfully be performed by applying moderate (conscious) sedation. Moderate sedation, using midazolam and an opioid, is the standard method of sedation, although propofol is increasingly being used in many countries because the satisfaction of endoscopists with propofol sedation is greater compared with their satisfaction with conventional sedation. Moreover, the use of propofol is currently preferred for the endoscopic sedation of patients with advanced liver disease due to its short biologic half-life and, consequently, its low risk of inducing hepatic encephalopathy. In the future, propofol could become the preferred sedation agent, especially for routine colonoscopy. Midazolam is the benzodiazepine of choice because of its shorter duration of action and better pharmacokinetic profile compared with diazepam. Among opioids, pethidine and fentanyl are the most popular. A number of other substances have been tested in several clinical trials with promising results. Among them, newer opioids, such as remifentanil, enable a faster recovery. The controversy regarding the administration of sedation by an endoscopist or an experienced nurse, as well as the optimal staffing of endoscopy units, continues to be a matter of discussion. Safe sedation in special clinical circumstances, such as in the cases of obese, pregnant, and elderly individuals, as well as patients with chronic lung, renal or liver disease, requires modification of the dose of the drugs used for sedation. In the great majority of patients, sedation under the supervision of a properly trained endoscopist remains the standard practice worldwide. In this review, an overview of the current knowledge concerning sedation during digestive endoscopy will be provided based on the data in the current literature.
Triantafillidis, John K; Merikas, Emmanuel; Nikolakis, Dimitrios; Papalois, Apostolos E
OBJECTIVE:In December 1997, the American Society of Gastrointestinal Endoscopy (ASGE) issued guidelines regarding periendoscopic management of patients who take anticoagulants. They recommended that physicians substitute heparin for warfarin in their patients who have highly thrombotic conditions (e.g., a mechanical valve in the mitral position), and who will undergo high-risk procedures (e.g., polypectomy). The purpose of this study was to assess
Lauren B. Gerson; Brian F. Gage; Douglas K. Owens; George Triadafilopoulos
Conscious sedation has been the standard of care for many years for gastrointestinal endoscopic procedures. As procedures have become more complex and lengthy, additional medications became essential for adequate sedation. Often time’s deep sedation is required for procedures such as endoscopic retrograde cholangiography which necessitates higher doses of narcotics and benzodiazepines or even use of other medications such as ketamine. Given its pharmacologic properties, propofol was rapidly adopted worldwide to gastrointestinal endoscopy for complex procedures and more recently to routine upper and lower endoscopy. Many studies have shown superiority for both the physician and patient compared to standard sedation. Nevertheless, its use remains highly controversial. A number of studies worldwide show that propofol can be given safely by endoscopists or nurses when well trained. Despite this wealth of data, at many centers its use has been prohibited unless administered by anesthesiology. In this commentary, we review the use of anesthesia support for endoscopy in the United States based on recent data and its implications for gastroenterologists worldwide.
Al-Awabdy, Basil; Wilcox, C Mel
Conscious sedation has been the standard of care for many years for gastrointestinal endoscopic procedures. As procedures have become more complex and lengthy, additional medications became essential for adequate sedation. Often time's deep sedation is required for procedures such as endoscopic retrograde cholangiography which necessitates higher doses of narcotics and benzodiazepines or even use of other medications such as ketamine. Given its pharmacologic properties, propofol was rapidly adopted worldwide to gastrointestinal endoscopy for complex procedures and more recently to routine upper and lower endoscopy. Many studies have shown superiority for both the physician and patient compared to standard sedation. Nevertheless, its use remains highly controversial. A number of studies worldwide show that propofol can be given safely by endoscopists or nurses when well trained. Despite this wealth of data, at many centers its use has been prohibited unless administered by anesthesiology. In this commentary, we review the use of anesthesia support for endoscopy in the United States based on recent data and its implications for gastroenterologists worldwide. PMID:23330047
Al-Awabdy, Basil; Wilcox, C Mel
Practical relevance: Endoscopic examination of the feline gastrointestinal (GI) tract is a minimally invasive method for obtaining biopsy samples of the GI mucosa, which is often necessary for a diagnosis of chronic GI diseases. In addition endoscopy has several therapeutic indications including foreign body retrieval, oesophageal stricture dilation and placement of a percutaneous gastrostomy tube. Clinical challenges: Initially, practitioners must learn the subtle manipulations necessary to efficiently guide the endoscope through the GI tract to obtain biopsy samples of high diagnostic quality, and develop skills for implementing interventional procedures (eg, foreign body removal). Another challenge in mastering GI endoscopy is the ability to recognise normal from abnormal, which requires many years of practice and experience. Endoscopy is a diagnostic and interventional procedure that should be performed only in conjunction with a thorough history, physical examination, appropriate laboratory evaluation, and radiographic and/or ultrasonographic imaging. Audience: This review is intended to familiarize both the general and referral practitioner with GI endoscopy as a minimally invasive diagnostic and therapeutic intervention for the feline patient. Evidence base: The guidance contained within this article is based on a combination of the published literature, the authors' personal experience and the experience of colleagues. PMID:24152700
Neiger, Reto; Robertson, Elise; Stengel, Christiane
Background The purpose of the present study was to compare the use of a human and a computer-based technical skills assessment tool in\\u000a live and simulated gastrointestinal endoscopies performed by consultants and trainees.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Validated human-based Likert scales were used individually for generic and specific technical skills for two procedures. Two\\u000a observers assessed each procedure independently and blindly. Computer-based assessment tools were
Sudip K. Sarker; Tark Albrani; Atiquaz Zaman; Isis Kumar
Practical relevance: Feline gastrointestinal (GI) endoscopy is in high demand, particularly by cat owners already aware of the clinical benefits and availability of this procedure within the human healthcare system. This article will provide a basic introduction to GI flexible endoscopy, covering important aspects of endoscope selection, clinical indications, and basic techniques required to perform a thorough and diagnostically meaningful examination in the cat. Clinical challenges: Challenges associated with implementing endoscopy in GI tract investigations can include lack of appropriate/suitable-sized equipment to perform a thorough examination in the cat, insufficient operator training/understanding in how to 'drive the scope' through the GI tract, and/or lack of confidence in differentiating normal from abnormal. Audience: This article is intended to familiarize and motivate the feline practitioner to develop basic endoscopic skills. Clinical proficiency can only be obtained through use of appropriate equipment, formal training and hours of practice indistinguishing normal from abnormal. Evidence base: The guidance contained in this article is based on a combination of the published literature, the authors' personal experience and the experience of colleagues. PMID:24152699
Stengel, Christiane; Robertson, Elise; Neiger, Reto
Gastrointestinal endoscopy has become an important modality for the diagnosis and treatment of various gastrointestinal disorders. One of its major advantages is that it is minimally invasive and has an excellent safety record. Nevertheless, some complications do occur, and endoscopists are well aware and prepared to deal with the commonly recognized ones including bleeding, perforation, infection, and adverse effects from the sedative medications. Air embolism is a very rare endoscopic complication but possesses the potential to be severe and fatal. It can present with cardiopulmonary instability and neurologic symptoms. The diagnosis may be difficult because of its clinical presentation, which can overlap with sedation-related cardiopulmonary problems or neurologic symptoms possibly attributed to an ischemic or hemorrhagic central nervous system event. Increased awareness is essential for prompt recognition of the air embolism, which can allow potentially life-saving therapy to be provided. Therefore, we wanted to review the risk factors, the clinical presentation, and the therapy of an air embolism from the perspective of the practicing endoscopist. PMID:23951390
Donepudi, Suman; Chavalitdhamrong, Disaya; Pu, Liping; Draganov, Peter V
Background. We report our preliminary experience with the use of video capsule endoscopy (VCE) in 64 patients with obscure gastrointestinal bleeding (OGIB) and suspected small intestine disease. Methods. To be eligible for VCE, patients had to have undergone upper endoscopy, small bowel series, and colonscopy without discovering any source of bleeding. To find the best timing to perform VCE, the
Giampaolo Bresci; Giuseppe Parisi; Michele Bertoni; Emanuele Tumino; Alfonso Capria
Gastrointestinal stromal tumor (GIST) is a submucosal tumor which is most commonly found in the stomach and less commonly in small bowel. Small bowel GIST can be difficult to diagnose by conventional imaging and endoscopy techniques. We report a case of obscure GI bleeding due to a stromal tumor (GIST) of the jejunum diagnosed by video capsule endoscopy. PMID:18361032
Kurella, Ravi R; Ancha, Hanumantha R; Ancha, Hari B; Lightfoot, Stan A; Guild, Ralph T; Harty, Richard F
Background: Most of the sources of bleeding in patients with obscure gastrointestinal bleeding are located in the small bowel. Capsule endoscopy (CE) and dou- ble-balloon enteroscopy (DBE) are innovative modalities to examine the small intestine. This study evaluated the combined use of CE and DBE in patients with obscure gastrointestinal bleeding. Methods: From October 2005 to November 2006, ten patients
Tsung-Nan Lin; Ming-Yao Su; Chen-Ming Hsu; Wei-Pin Lin; Cheng-Tang Chiu; Pang-Chi Chen
Background Double-balloon endoscopy (DBE) utilizes both oral and anal routes. The proper selection of the initial route is important\\u000a for more rapid management of obscure gastrointestinal bleeding (OGIB). The aim of this retrospective study was to clarify\\u000a the accuracy of the transit time of video capsule endoscopy (VCE) to the lesion as a predictive indicator for the decision\\u000a on the initial
Masanao NakamuraNaoki; Naoki Ohmiya; Osamu Shirai; Hiroyuki Takenaka; Kenji Morishima; Ryoji Miyahara; Takafumi Ando; Osamu Watanabe; Hiroki Kawashima; Akihiro Itoh; Yoshiki Hirooka; Hidemi Goto
Background Although upper gastrointestinal (UGI) endoscopy is highly sensitive for the detection of esophago-gastroduodenal lesions, pain and discomfort during the procedure cause examinees to experience stress and anxiety. Moreover, there have been only a few studies on relief of pain and discomfort during UGI endoscopy through preparatory interventions. Therefore, the aim of this study was to investigate the relationship between a preparatory education program and the discomfort and retching experienced by examinees during endoscopy. Methods A total of 306 examinees who visited a health promotion center and underwent non-sedated endoscopy from May 13 to July 3, 2009 were included in this study. After they were assigned to experimental (n = 154) and control groups (n = 152), their discomfort and retching were measured with a visual analogue scale. The preparatory education program consisted of cognitive intervention, behavioral intervention and information. Results The preparatory education program relieved discomfort during endoscopy in male subjects, in subjects aged 60 and over, or in subjects with previous endoscopic experience with statistical significance (P < 0.05). It also relieved retching during endoscopy in subjects aged 60 and over with statistical significance (P = 0.023). Multiple logistic regression analysis showed that the preparatory education program significantly relieved the discomfort of examinees during endoscopy (P = 0.028). Conclusion We found that the preparatory education program used in this study could significantly relieve the discomfort caused by endoscopy, particularly in subjects aged 60 and over, or in male subjects with a high incidence of stomach cancer in Korea.
Lee, Ju-Yeon; Anhn, Min-Whon; Kim, Dae-Hyun; Kweon, Hyuk-Jung; Cho, Dong-Yung; Yoon, Hyung Moon
The present case illustrates a patient with obscure gastrointestinal bleeding which MiroCam capsule endoscopy showed erosions and ulcers from distal jejunum to ileum. Considering that ileal ulcers where closer to ileocecal valve, ileoscopy was repeated. Diagnosis with new biopsies was Crohn disease. Capsule endoscopy is an innovative technology, which let us have high resolution color pictures through gastrointestinal tract for more effective and diagnostic view of small bowel in a minimal invasive way. New guidelines in obscure GI bleeding agreed that initial diagnostic imaging of the small bowel should be performed using capsule endoscopy. Ballon assisted enteroscopy, angiography and laparoscopy should be used as a follow-up procedure for targeted endoscopic treatment or for obtaining histopathological diagnosis. PMID:20445729
Cedrón Cheng, Hugo; García Encinas, Carlos; de Los Ríos Senmache, Raúl; Huerta Mercado, Jorge; Cok García, Jaime
Several infection control practices and procedures crucial to the prevention of disease transmission in the health care setting are reviewed and discussed. Emphasis is placed on the importance of infection control to gastrointestinal endoscopy. Recommendations that minimize the risk of nosocomial infection during the preparation, handling, and administration of intravenous medications, particularly propofol, are provided. These recommendations include the labeling
Lawrence F Muscarella
In industrialized countries, surgicalgastroplasty is performed more and more frequently inpatients with morbid obesity. The aims of thisprospective study were to determine the incidence ofupper gastrointestinal lesions in obese patients and to assess theplace of digestive endoscopy in symptomatic patientsafter gastroplasty. A consecutive group of 159 obesepatients were studied before and after vertical banded gastroplasty. In the preoperative evaluation,reflux esophagitis
D. Verset; J.-J. Houben; F. Gay; J. Elcheroth; V. Bourgeois; A. Van Gossum
This is the second in a series of articles that review media reports investigating the risk of disease transmission associated with gastrointestinal flexible endoscopy. The first article in this series, "Commentary: Do Scopes Spread Sickness?'' was published in this journal in 1999 (Gastroenterology Nursing, 22(4), 179-180). PMID:15632761
Muscarella, Lawrence F
Patient evaluation and preparation is the first and mandatory step to ensure safety and quality of endoscopic procedures. This begins and ends with identifying the patient, procedure type, and indication. Every patient has the right to be fully informed about risks and benefits of what is to be performed on them, and the medical personnel should respect the decision made by the patients. Thoroughly performed history taking and physical examination will guide the endoscopists to better stratify risk and plan sedation. Special attention should be given to higher-risk patients with higher-risk condition undergoing higher-risk procedures. Making preparations to monitor the patients and being ready to handle emergency situations throughout the endoscopic procedure are sine qua non to warrant safe endoscopy.
Kang, Seong Hee
OBJECTIVE:The aim of this study was to determine the prevalence of duodenal villous atrophy (VA) among patients undergoing routine upper gastrointestinal (GI) endoscopy and the value of endoscopic markers for VA in selecting patients for duodenal biopsy.METHODS:One hundred and fifty adult patients with upper GI symptoms or iron-deficiency anemia had inspection and biopsy of the second part of the duodenum
William Dickey; Dermot Hughes
An 8-year-old male Shiba dog presented with chronic vomiting and diarrhea. Upper gastrointestinal endoscopy revealed severe enteritis and infection of the duodenal mucosa with Echinostoma hortense. We performed therapy for parasites and enteritis. The therapy was successful for deworming and temporarily improved the symptoms, but the dog died soon thereafter. To the authors' knowledge, this is the first case report of an antemortem diagnosis of E. hortense infection in a dog. PMID:23449463
Okanishi, Hiroki; Matsumoto, Jun; Nogami, Sadao; Kagawa, Yumiko; Watari, Toshihiro
Background\\/Aims: Only a few reports have examined informed consent for gastrointestinal endoscopy in Korea. The aim of this study was to evaluate the appropriateness of the informed consent procedure in Korea. Methods: A total of 209 patients who underwent endoscopy were asked to answer a self-administered structured questionnaire on the informed consent procedure for gastrointestinal endoscopy. Results: One hundred thirteen
Ji Hyun Song; Hwan Sik Yoon; Byung Hoon; Jun Min; Haeng Lee; Ho Kim; Dong Kyung Chang; Hee Jung Son; Poong Lyul Rhee; Jong Chul Rhee
Background Cardiopulmonary complications are common after endoscopy for upper gastrointestinal (UGI) hemorrhage in the intensive care unit (ICU) Objective To evaluate the practice and outcome of elective prophylactic endotracheal intubation prior to endoscopy for UGI hemorrhage in the ICU Design Retrospective, propensity matched case-control study Setting A 24-bed medical ICU in a tertiary center. Patients ICU patients who underwent endoscopy for UGI hemorrhage Main Outcome Measurements Cardiopulmonary complications, ICU and hospital length of stay and mortality. In a propensity analysis, patients who were intubated for airway protection prior to UGI endoscopy were matched by probability of intubation to controls not intubated prior to UGI endoscopy. Results Fifty-three out of 307 patients underwent elective prophylactic intubation prior to UGI endoscopy. Probability of intubation depended on APACHE III score (OR 1.4, 95%, CI 1.2 to 1.6), age (OR 0.97, 95%CI 0.95 to 0.09), presence of hematemesis (OR 1.9, 95%CI 0.8 to 5.1), prior lung disease (OR 2.1, 95%CI 0.8 to 4.9) and number of transfusions (OR 1.1 95%CI 1.0 to 1.1 per unit). Non-intubated matched controls were identified for all but 4 patients with active massive hematemesis who were excluded from matched analysis. Cumulative incidence of cardiopulmonary complications (53% vs 45%, p=0.414), ICU (median 2.2 days vs. 1.8 days, p=0.138) and hospital length of stay (6.9 vs. 5.9, p=0.785), and hospital mortality (14% vs. 20%, p=0.366) were similar. Conclusions Cardiopulmonary complications are frequent after endoscopy for acute UGI bleeding in ICU patients, and are largely unaffected by the practice of prophylactic intubation.
Rehman, Ahmer; Iscimen, Remzi; Yilmaz, Murat; Khan, Hasrat; Belsher, Jon; Gomez, Javier Fernandez; Hanson, Andrew C.; Afessa, Bekele; Baron, Todd H.; Gajic, Ognjen
Aim of the Study. To compare the effect of glossopharyngeal nerve block with topical anesthesia on the tolerance of patients to upper gastrointestinal endoscopy. Methods. We performed a clinical trial in one hundred patients undergoing upper gastrointestinal endoscopy. Subjects were randomly assigned to one of the following two groups: (1) treatment with bilateral glossopharyngeal nerve block (GFNB) and intravenous midazolam or (2) treatment with topical anesthetic (TASS) and intravenous midazolam. We evaluated sedation, tolerance to the procedure, hemodynamic stability, and adverse symptoms. Results. We studied 46 men and 54 women, from 17 to 78 years of age. The procedure was reported without discomfort in 48 patients (88%) in the GFNB group and 32 (64%) in the TAAS group; 6 patients (12%) in GFNB group and 18 (36%) in TAAS group reported the procedure as little discomfort (?2 = 3.95, P = 0.04). There was no difference in frequency of nausea (4% in both groups) and retching, 4% versus 8% for GFNB and TASS group, respectively (P = 0.55). Conclusions. The use of glossopharyngeal nerve block provides greater comfort and tolerance to the patient undergoing upper gastrointestinal endoscopy. It also reduces the need for sedation.
Ortega Ramirez, Moises; Linares Segovia, Benigno; Garcia Cuevas, Marco Antonio; Sanchez Romero, Jorge Luis; Botello Buenrostro, Illich; Amador Licona, Norma; Guizar Mendoza, Juan Manuel; Guerrero Romero, Jesus Francisco; Vazquez Zarate, Victor Manuel
BACKGROUND: Iron deficiency anaemia (IDA) due to occult gastrointestinal (GI) blood loss usually remains unnoticed until patient become symptomatic. There is sparse data in IDA patients without gastrointestinal symptoms. This study was designed to find out the frequency and predictors of endoscopic lesions in IDA without gastrointestinal symptoms. Cross-sectional study performed on a convenience sample of consecutive subjects. METHODS: Ninety
Shahid Majid; Mohammad Salih; Rozina Wasaya; Wasim Jafri
Hypoxemia is the most common adverse event that happened during gastrointestinal endoscopy. To estimate risk of hypoxemia prior to endoscopy, American Society of Anesthesiology (ASA) classification scores were used as a major predictive factor. But the accuracy of ASA scores for predicting hypoxemia incidence was doubted here, considering that the classification system ignores much information about general health status and fitness of patient that may contribute to hypoxemia. In this retrospective review of clinical data collected prospectively, the data on 4904 procedures were analyzed. The Pearson’s chi-square test or the Fisher exact test was employed to analyze variance of categorical factors. Continuous variables were statistically evaluated using t-tests or Analysis of variance (ANOVA). As a result, only 245 (5.0%) of the enrolled 4904 patients were found to present hypoxemia during endoscopy. Multivariable logistic regressions revealed that independent risk factors for hypoxemia include high BMI (BMI 30 versus 20, Odd ratio: 1.52, 95% CI: 1.13–2.05; P?=?0.0098), hypertension (Odd ratio: 2.28, 95% CI: 1.44–3.60; P?=?0.0004), diabetes (Odd ratio: 2.37, 95% CI: 1.30–4.34; P?=?0.005), gastrointestinal diseases (Odd ratio: 1.77, 95% CI: 1.21–2.60; P?=?0.0033), heart diseases (Odd ratio: 1.97, 95% CI: 1.06–3.68; P?=?0.0325) and the procedures that combined esophagogastroduodenoscopy (EGD) and colonoscopy (Odd ratio: 4.84, 95% CI: 1.61–15.51; P?=?0.0292; EGD as reference). It is noteworthy that ASA classification scores were not included as an independent predictive factor, and susceptibility of youth to hypoxemia during endoscopy was as high as old subjects. In conclusion, some certain pre-existing diseases of patients were newly identified as independent risk factors for hypoxemia during GI endoscopy. High ASA scores are a confounding predictive factor of pre-existing diseases. We thus recommend that youth (?18 yrs), obese patients and those patients with hypertension, diabetes, heart diseases, or GI diseases should be monitored closely during sedation endoscopy.
Yu, Changhong; Tian, Xia; Yang, Yi-Ran; Wang, Cheng; Pan, Yajuan
Background Upper and lower acute gastrointestinal bleeding (AGIB) is associated with high rates of mortality and morbidity. The latest\\u000a computerized tomography (CT) imaging techniques play an important role in the treatment of this pathology.\\u000a \\u000a \\u000a \\u000a Methods Twenty-nine patients with severe AGIB (11 upper, 18 lower), all hemodynamically stable, underwent endoscopy followed by a\\u000a multi-detector row CT (MDCT) scan. Endoscopic and MDCT accuracy for
Fabrizio M. Frattaroli; Emanuele Casciani; Domenico Spoletini; Elisabetta Polettini; Aldo Nunziale; Luca Bertini; Annarita Vestri; Gianfranco Gualdi; Giuseppe Pappalardo
1 A recent audit of upper gastrointestinal endoscopy carried out by the Royal College of Surgeons of England has shown that the majority of endoscopists use a bolus injection rather than a slow intravenous titration of benzodiazepine for intravenous sedation. In this study we have confirmed the theoretical premise that a reduced dose of midazolam is required when given as a bolus. A mean dose of 4.65 mg midazolam intravenously has been found to be effective and safe in sedating patients under 70 years (n = 552). The dose of midazolam needed is reduced in older patients: patients over 70 years (n = 236) needed a mean dose of 1.89 mg. 2 Topical pharyngeal anaesthesia was not required with these doses of midazolam, and it was our impression that the examination was equally well tolerated with a similar degree of anterograde amnesia as in the previous study. 3 Our data, together with the results of the audit, would suggest many endoscopists are employing unnecessarily large and at times potentially dangerous doses of intravenous sedation in elderly patients and that the vast majority of upper gastrointestinal endoscopies can be performed successfully, without topical pharyngeal anaesthesia, using a bolus injection techniquewith a reduced dosage of sedative agent.
Smith, M R; Bell, G D; Quine, M A; Spencer, G M; Morden, A E; Jones, J G
Peppermint oil has been shown to relax gastrointestinal smooth muscle. In this randomized, placebo-controlled study, an L-menthol preparation, NPO-11, was assessed for tolerability and pharmacokinetics (PK) during gastrointestinal endoscopy. Single doses of NPO-11, as high as 320 mg, were well tolerated. NPO-11 was rapidly absorbed, with peak concentrations reached within 1 h after administration. Approximately 70% of the administered L-menthol
N Hiki; M Kaminishi; T Hasunuma; M Nakamura; S Nomura; N Yahagi; H Tajiri; H Suzuki
Background/Aim: Erythromycin infusion before endoscopy in upper gastrointestinal bleeding (UGIB) has been hypothesized to aid in visualization and reduce the need for second-look endoscopy; however, the results have been controversial. To evaluate further, we performed a meta-analysis comparing the efficacy of erythromycin infusion before endoscopy in acute UGIB. Methods: Multiple databases were searched (March 2013). Only randomized controlled trials were included in the analysis. A meta-analysis for the effect of erythromycin or no erythromycin before endoscopy in UGIB were analyzed by calculating pooled estimates of primary (visualization of gastric mucosa and need for second endoscopy) and secondary (units of blood transfused, length of hospital stay, duration of the procedure) outcomes. Statistical analysis was performed using RevMan 5.1 (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration). Results: Six studies (N = 558) met the inclusion criteria. Erythromycin infusion before endoscopy in UGIB demonstrated a statistically significant improvement in visualization of the gastric mucosa [odds ratio (OR) 3.43; 95% confidence interval (CI): 1.81 to 6.50, P < 0.01] compared with no erythromycin. In addition, erythromycin infusion before endoscopy resulted in a statistically significant decrease in the need for a second endoscopy (OR 0.47; 95% CI: 0.26 to 0.83, P = 0.01), units of blood transfused (WMD - 0.41; 95% CI: -0.82 to -0.01, P = 0.04), and the duration of hospital stay (WMD - 1.51; 95% CI: -2.45 to -0.56, P < 0.01). Conclusions: Erythromycin infusion before endoscopy in patients with UGIB significantly improves visualization of gastric mucosa while decreasing the need for a second endoscopy, units of blood transfused, and duration of hospital stay. PMID:24045593
Theivanayagam, Shoba; Lim, Roxanne G; Cobell, William J; Gowda, Jayashree T; Matteson, Michelle L; Choudhary, Abhishek; Bechtold, Matthew L
AimThere is increasing evidence to suggest the presence of chronic inflammation in the gastrointestinal (GI) tract of cystic fibrosis (CF) patients. Some CF patients continue to have very severe GI symptoms despite conventional CF treatment. In our centre, these patients are managed in a CF gastroenterology clinic, jointly with a gastroenterologist. A number of them have required GI endoscopy and
H L Tan; N Shah; R Suri
Aims and Objectives: Continuous flow left ventricular assist devices (LVAD) have emerged as a reliable treatment option for heart failure. Because of bleeding secondary to anticoagulation, these patients present frequently for gastrointestinal (GI) endoscopy. The presently available literature on perioperative management of these patients is extremely limited and is primarily based upon theoretical principles. Materials and Methods: Perioperative records of patients with LVAD undergoing (GI) endoscopy between 2008 and 2012 were reviewed. Patient, device and procedure specific information was analyzed. Results: A total of 105 LVADs were implanted, and 68 procedures were performed in 39 patients. The most common indication was GI bleed (48/68), with yearly risk of 8.57% per patient. A total of 63 procedures were performed under deep sedation, with five procedures requiring general anesthesia. Intra-procedure hypotension was managed by fluids and (or) vasopressors/inotropes (phenylephrine, ephedrine or milrinone) guided by plethysmographic waveform, non-invasive blood pressure (NIBP) and LVADs pulsatility index (for HeartMate II)/flow pulsatility (for HeartWare). No patient required invasive monitoring and both NIBP and pulse oximeter could be reliably used for monitoring (and guided management) in all patients due to the presence of native heart's pulsatile output. Conclusion: In the presence of residual heart function, with optimal device settings, non-invasive hemodynamic monitoring can be reliably used in these patients while undergoing GI endoscopy under general anesthesia or monitored anesthesia care. Transient hypotensive episodes respond well to fluids/vasopressors without the need of increasing device speed that can be detrimental. PMID:24107691
Goudra, Basavana G; Singh, Preet Mohinder
AIM: To investigate whether the incidence of hiccups in patients undergoing esophagogastroduodenoscopy (EGD) or same-day bidirectional endoscopy (EGD and colonoscopy; BDE) with sedation is different from those without sedation in terms of quantity, duration and typical onset time. METHODS: Consecutive patients scheduled for elective EGD or same-day BDE at the gastrointestinal endoscopy unit or the health examination center were allocated to two groups: EGD without sedation (Group A) and BDE with sedation (Group B). The use of sedation was based on the patients’ request. Anesthesiologists participated in this study by administrating sedative drugs as usual. A single experienced gastroenterologist performed both the EGD and the colonoscopic examinations for all the patients. The incidence, duration and onset time of hiccups were measured in both groups. In addition, the association between clinical variables and hiccups were analyzed. RESULTS: A total of 435 patients were enrolled in the study. The incidences of hiccups in the patients with and without sedation were significantly different (20.5% and 5.1%, respectively). The use of sedation for patients undergoing endoscopy was still significantly associated with an increased risk of hiccups (adjusted odds ratio: 8.79, P < 0.001) after adjustment. The incidence of hiccups in males under sedation was high (67.4%). The sedated patients who received 2 mg midazolam developed hiccups more frequently compared to those receiving 1 mg midazolam (P = 0.0028). The patients with the diagnosis of gastroesophageal reflux disease (GERD) were prone to develop hiccups (P = 0.018). CONCLUSION: Male patients undergoing EGD or BDE with sedation are significantly more likely to suffer from hiccups compared to those without sedation. Midazolam was significantly associated with an increased risk of hiccups. Furthermore, patients with GERD are prone to develop hiccups.
Liu, Chien Cheng; Lu, Cheng Yuan; Changchien, Chih Fang; Liu, Ping Hsin; Perng, Daw Shyong
Background. The small intestine has been considered to be a highly difficult organ to visualize in imaging examinations due to its anatomical location compared with the stomach and the colon. In recent years, many imaging modalities have become available, such as CT enterography, MR enterography, capsule endoscopy (CE), and double-balloon endoscopy (DBE). Patients and Methods. DBE was performed in the postoperative intestines of 91 patients (128 DBE examinations) at Iwate Medical University between 2004 and 2010. There were 61 male and 30 female patients, and their mean age was 69.7 years (range: 30–80 years). Results. A total of 124 DBE examinations were performed with endoscope insertion into the reconstructed intestines. The endoscope reached the blind end in 115 of 124 examinations, (92.7%). There were 17 patients with obscure gastrointestinal bleeding in whom 30 DBE examinations were performed. The bleeding site was identified in 12 patients (70.6%). Nine patients underwent endoscopic treatment. Hemostasis was achieved in all patients. Conclusion. DBE is very useful modality for the assessment and application of endotherapy to areas of the small bowel which have been altered by surgery.
Endo, Masaki; Abiko, Yukito; Oana, Syuhei; Kudara, Norihiko; Kosaka, Takashi; Chiba, Toshimi; Takikawa, Yasuhiro; Suzuki, Kazuyuki; Sugai, Tamotsu
Objective: This study assessed the diagnostic yield of capsule endoscopy (CE) and its impact on patients with obscure gastrointestinal bleeding (OGIB). Subjects and Methods: Between May 2007 and May 2009, 63 patients with OGIB (overt bleeding: 25, and occult blood loss with chronic ferropenic anemia: 38) and normal upper and lower endoscopy were studied by CE. Demographic characteristics, prior diagnostic
Panagiotis Katsinelos; Grigoris Chatzimavroudis; Sotiris Terzoudis; Ioannis Patsis; Kostas Fasoulas; Taxiarchis Katsinelos; George Kokonis; Christos Zavos; Themistoklis Vasiliadis; Jannis Kountouras
Obscure gastrointestinal bleeding is defined as bleeding of unknown origin, that persists or recurs after negative conventional\\u000a barium contrast studies and upper and lower tract endoscopy. The causes of such a bleeding frequently arise in the small bowel,\\u000a and they are represented by mucosal vascular abnormalities, neoplasms and other conditions such as Crohn’s disease, Meckel’s\\u000a diverticulum, and vasculitis. Conventional barium
Antonella Filippone; Roberta Cianci; Angelo Milano; Sergio Valeriano; Veronica Di Mizio; Maria Luigia Storto
Background The management of patients with acute myocardial infarction (AMI) and upper gastrointestinal bleeding (UGIB) can present\\u000a a challenge. The utility of upper endoscopy (esophagogastroduodenoscopy, EGD) and endoscopic therapy must be weighed against\\u000a safety considerations. Aim To assess the utility and safety of EGD in patients with UGIB and AMI. Methods Using decision analysis, patients with UGIB and AMI were
Patrick Yachimski; Chin Hur
The field of endoscopy has revolutionized the diagnosis and treatment of gastrointestinal (GI) diseases in recent years. Besides the ‘traditional’ endoscopic procedures (esophagogastroduodenoscopy, colonoscopy, flexible sigmoidoscopy, and endoscopic retrograde cholangiopancreatography), advances in imaging technology (endoscopic ultrasonography, wireless capsule endoscopy, and double balloon enteroscopy) have allowed GI specialists to detect and manage disorders throughout the digestive system. This article reviews various endoscopic procedures and provides up-to-date endoscopic indications based on the recommendations of American Society for Gastrointestinal Endoscopy and American Cancer Society for primary care providers in order to achieve high-quality and cost-effective care.
Nguyen, Vien X; Le Nguyen, Vi Thuy; Nguyen, Cuong C
AIM: To investigate long-term outcome in obscure gastrointestinal bleeding (OGIB) after negative capsule endoscopy (CE) and identify risk factors for rebleeding. METHODS: A total of 113 consecutive patients underwent CE for OGIB from May 2003 to June 2010 at Seoul National University Hospital. Ninety-five patients (84.1%) with a subsequent follow-up after CE of at least 6 mo were enrolled in this study. Follow-up data were obtained from the patients’ medical records. The CE images were reviewed by two board-certified gastroenterologists and consensus diagnosis was used in all cases. The primary outcome measure was the detection of rebleeding after CE, and factors associated with rebleeding were evaluated using multivariate analysis. RESULTS: Of the 95 enrolled patients (median age 61 years, range 17-85 years), 62 patients (65.3%) were male. The median duration of follow-up was 23.7 mo (range 6.0-89.4 mo). Seventy-three patients (76.8%) underwent CE for obscure-overt bleeding. Complete examination of the small bowel was achieved in 77 cases (81.1%). Significant lesions were found in 38 patients (40.0%). The overall rebleeding rate was 28.4%. The rebleeding rate was higher in patients with positive CE (36.8%) than in those with negative CE (22.8%). However, there was no significant difference in cumulative rebleeding rates between the two groups (log rank test; P = 0.205). Anticoagulation after CE examination was an independent risk factor for rebleeding (hazard ratio, 5.019; 95%CI, 1.560-16.145; P = 0.007), regardless of CE results. CONCLUSION: Patients with OGIB and negative CE have a potential risk of rebleeding. Therefore, close observation is required and alternative modalities should be considered in suspicious cases.
Koh, Seong-Joon; Im, Jong Pil; Kim, Ji Won; Kim, Byeong Gwan; Lee, Kook Lae; Kim, Sang Gyun; Kim, Joo Sung; Jung, Hyun Chae
This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence.Main recommendations: The following recommendations for post-polypectomy endoscopic surveillance should be applied only after a high quality baseline colonoscopy with complete removal of all detected neoplastic lesions.1 In the low risk group (patients with 1 - 2 tubular adenomas < 10 mm with low grade dysplasia), the ESGE recommends participation in existing national screening programmes 10 years after the index colonoscopy. If no screening programme is available, repetition of colonoscopy 10 years after the index colonoscopy is recommended (strong recommendation, moderate quality evidence). 2 In the high risk group (patients with adenomas with villous histology or high grade dysplasia or ?10 mm in size, or ? 3 adenomas), the ESGE recommends surveillance colonoscopy 3 years after the index colonoscopy (strong recommendation, moderate quality evidence). Patients with 10 or more adenomas should be referred for genetic counselling (strong recommendation, moderate quality evidence). 3 In the high risk group, if no high risk adenomas are detected at the first surveillance examination, the ESGE suggests a 5-year interval before a second surveillance colonoscopy (weak recommendation, low quality evidence). If high risk adenomas are detected at first or subsequent surveillance examinations, a 3-year repetition of surveillance colonoscopy is recommended (strong recommendation, low quality evidence).4 The ESGE recommends that patients with serrated polyps < 10 mm in size with no dysplasia should be classified as low risk (weak recommendation, low quality evidence). The ESGE suggests that patients with large serrated polyps (? 10 mm) or those with dysplasia should be classified as high risk (weak recommendation, low quality evidence).5 The ESGE recommends that the endoscopist is responsible for providing a written recommendation for the post-polypectomy surveillance schedule (strong recommendation, low quality evidence). PMID:24030244
Hassan, Cesare; Quintero, Enrique; Dumonceau, Jean-Marc; Regula, Jaroslaw; Brandão, Catarina; Chaussade, Stanislas; Dekker, Evelien; Dinis-Ribeiro, Mario; Ferlitsch, Monika; Gimeno-García, Antonio; Hazewinkel, Yark; Jover, Rodrigo; Kalager, Mette; Loberg, Magnus; Pox, Christian; Rembacken, Bjorn; Lieberman, David
In 326 fibreoptic upper gastrointestinal (GI) endoscopies performed in Evangel Hospital (Jos, Nigeria), pathology was found in 210 patients, and of a major nature such as peptic ulcer disease or cancer in 129 of these. The three most useful features to predict the presence of major pathology were epigastric tenderness (the single most useful feature), loss of weight and epigastric pain of a burning nature. These features were selected by stepwise discriminant analysis, which also led to the conclusion that the presence of at least two of these three features is an even more powerful predictor of major pathology. PMID:7886842
Andrew, P J; Dixon, R A; Iya, D; Park, G T
OBJECTIVE:Etoricoxib is a selective cyclooxygenase inhibitor that in clinical studies has improved the signs and symptoms of osteoarthritis and rheumatoid arthritis and reduced the potential for GI injury. The incidence of endoscopically detected ulcers and of clinically important upper GI events (perforations, ulcers, and bleeding episodes) was compared in patients taking etoricoxib or nonselective nonsteroidal anti-inflammatory drugs (NSAIDs).METHODS:Upper GI endoscopy
Richard H. Hunt; Sean Harper; Douglas J. Watson; Chang Yu; Hui Quan; Michael Lee; Judith K. Evans; Bettina Oxenius
Hookworm infection is a relatively common cause of anemia in endemic areas. However, it is rarely encountered in Europe. In this report we describe the case of a 24-year old patient originating from an endemic area who was admitted due to severe anemia, with an Hct of 15.6% and eosinophilia (Eosinophils: 22.4%). While both esophagogastroduodenoscopy and colonoscopy were non-diagnostic, capsule endoscopy revealed a large number of hookworms infesting his small bowel and withdrawing blood. The patient was successfully treated with Albendazole. Capsule endoscopy was proven an important tool in diagnosing intestinal parasitosis. PMID:21173914
Christodoulou, Dimitrios K; Sigounas, Dimitrios E; Katsanos, Konstantinos H; Dimos, Georgios; Tsianos, Epameinondas V
A prospective design that included a survey tool, nursing care records, and telephone interview was used to determine postprocedural effects experienced by children and families following gastrointestinal endoscopy performed as a day procedure. One hundred twenty-one children attending a pediatric gastroenterology unit for endoscopy under general anesthesia participated in the study. Physical symptoms, day care/school attendance, behavioral issues, and economic factors in the 72 hours post procedure were identified. Over half the children (n = 69, 57%) experienced pain in the hospital post procedure. Pain was reported by 73 children (60%) at home on the day of the procedure, by 55 children (45%) on Day 1 post procedure, and by 37 children (31%) on Day 2 post procedure. The throat was the most common site of pain. Nausea or vomiting was experienced by 37 children (31%) at some time following their procedure but was not associated with procedure type, age, or fasting time. Over half the children (n = 53, 51%) who usually attended day care or school did not attend the day following their procedure. Twenty-four parents (40%) who would normally have worked on the day after the procedure did not attend employment. These findings have been used to improve the preprocedural information and discharge management of patients treated in a pediatric gastroenterology ambulatory setting. PMID:18156960
Melville, Diane; da Silva, Mary Soares; Young, Jeanine; McCann, Damhnat; Cleghorn, Geoffrey
We have developed novel photoacoustic endoscopy with a miniaturized imaging probe. A light guiding optical fiber, an ultrasonic sensor, and a mechanical scanning unit are integrated to enable circumferential sector scanning, which produces B-scan images. Biological tissues, including the gastrointestinal tract of a rat, have been imaged ex vivo or in situ.
Yang, Joon-Mo; Maslov, Konstantin; Yang, Hao-Chung; Zhou, Qifa; Shung, K. Kirk; Wang, Lihong V.
Introduction. Gastrointestinal stromal tumor (GIST) in the ileum is an extremely rare cause of recurrent lower gastrointestinal bleeding (GIB). Case Report. An 89-year-old man was admitted with melana. He had extensive PMH of CAD post-CABG/AICD, AAA repair, chronic anemia, myelodysplastic syndrome, lung cancer after resection, and recurrent GIB. Prior EGDs, colonoscopies, and upper device-assisted enteroscopy showed duodenal ulcer, A-V malformation s/p cauterization, and angioectasia. On admission, Hb was 6.0?g/dL. An endoscopic capsule study showed an ulcerated tumor in the ileum. CT showed no distant metastasis. The lesion was resected successfully and confirmed as a high-grade GIST. The patient was discharged with no further bleeding. Discussion. Early diagnosis for patients with ileal GIST is often challenging. Video capsule endoscopy and double balloon enteroscopy could be useful diagnostic tools. Surgical removal is the first line for a resectable GIST. Imatinib has become the standard therapy. Conclusion. This is a unique case of an ileal GIST in a patient with recurrent GIB which was diagnosed by video capsule. Complicated medical comorbidities often lead to a significant delay in diagnosis. Therefore, we recommend that if GIB does not resolve after appropriate treatments for known causes, the alternative diagnosis for occult GIB must be considered, including malignancy such as GIST.
Lamsen, Marie; Coron, Roger; Deliana, Danila; Rangraj, Madhu; Jesmajian, Stephen
BACKGROUND: The diagnostic yield of capsule endoscopy (CE) in the setting of iron deficiency anemia (IDA) without evidence of occult/overt bleeding has been questioned. Often, these patients have nongastrointestinal causes of iron deficiency but undergo CE to exclude a potential small bowel source. OBJECTIVE: To assess the diagnostic yield of CE, the characteristics predicting positive results, the presumed etiology of IDA in negative/normal CE and patient management after CE. METHODS: A retrospective review of 934 patients who underwent CE between December 2001 and February 2010 was conducted. All patients had undergone previous negative endoscopic examinations before CE. Patients with IDA but no evidence of overt/occult bleeding were separated into three categories based on CE findings: group A – positive; group B – negative/normal; and group C – incomplete/indeterminate. RESULTS: A total of 101 capsules in 97 patients were evaluated. Group A had 25 subjects with positive findings on CE, 18 of whom were managed supportively. Group B consisted of 69 subjects with negative/normal CE, 60 of whom were treated supportively. Group C consisted of three subjects with incomplete CE results. CONCLUSION: In patients with IDA without evidence of gastrointestinal bleeding, CE had a low diagnostic yield (25.7%), which increased to 45.5% after adjusting for low dietary iron intake and menorrhagia. However, CE did not alter management in most patients regardless of findings, and many of the lesions requiring intervention were within reach of standard endoscopes. No predictor of positive results was found. In this patient population, careful history taking and thorough endoscopy could improve CE utilization, although its value is still relatively limited.
Tong, Jessica; Svarta, Sigrid; Ou, George; Kwok, Ricky; Law, Joanna; Enns, Robert
Patients who present with upper gastrointestinal bleeding (UGIB) in the setting of acute myocardial infarction (AMI) may have\\u000a suffered an UGIB that subsequently led to an AMI or endured an AMI and subsequently suffered a UGIB as a consequence of anticoagulation.\\u000a We hypothesized that patients in the former group bled from more severe upper tract lesions. The aim of this
Sauyu Lin; Richard Konstance; James Jollis; Deborah A. Fisher
Pulmonary aspiration occurred in 16 out of 65 patients (24·6%) undergoing fibre-endoscopic examinations of the upper gastrointestinal tract under intravenous sedation, but it was rarely followed by serious complications. Aspiration was found to occur under sedation with diazepam alone, diazepam with atropine, and with chlormethiazole. The most important factors contributing to aspiration are the local pharyngeal anaesthesia and the mechanical interference of the fibrescope with laryngeal closure and swallowing. The patient is also at risk of aspiration after completion of the procedure and should remain recumbent until the local anaesthesia has worn off. Imagesp270-a
Prout, B. J.; Metreweli, C.
The aim of this study was to compare magnetic resonance enterography (MRE) findings with those of video capsule endoscopy (VCE) or conventional gastrointestinal radiography (CGR) in pediatric patients with small bowel Crohn’s disease. A total of 55 cases of small bowel Crohn’s disease that were diagnosed through clinical, laboratory, surgical and histopathological findings were reviewed. Prior to the examination, children suspected of having other types of diseases of the small intestinal were identified. The pulse sequences included coronal T2-true-fast imaging with steady-state precession (TrueFISP) images, navigation axial and coronal T1-weighted images, T2-weighted fat-suppressed images and coronal fat-suppressed three-dimensional gradient-echo images, immediately followed by contrast-enhanced axial and coronal T1-weighted fat-suppressed images. Findings from MRE were compared with those of VCE (n=39) and CGR (n=37). MRE results exhibited a number of features characteristic to small bowel Crohn’s disease, including wall thickening, mesenteric fibrofatty changes and mesenteric vasculature changes. VCE, MRE and CGR demonstrated sensitivities of 94.6, 85.7 and 71.1% with specificities of 72.7, 70 and 40%; accuracies of 89.6, 82.2 and 61.1%; positive predictive values of 92.1, 90.9 and 59.6%; and negative predictive values of 80, 58.3 and 40%, respectively. VCE depicted mucosal pathologies missed by MRE in three patients. MRE revealed 83 extraenteric findings in 55 patients and CGR was able to show the dynamic evolution of the gastrointestinal function. MRE is a simple, safe, non-invasive and effective method for evaluating small bowel Crohn’s disease. VCE allows visualization and readily characterizes subtle mucosal lesions missed by MRE, whereas MRE yields additional mural, perienteric and extraenteric information. However, oral barium CGR utilizes radiation, which is not suitable for repeated use in children.
LAI, CAN; ZHOU, HAI-CHUN; MA, MING; ZHANG, HONG-XI; JIA, XUAN
Perforations and leakages of hollow organs of the gastrointestinal tract can occur spontaneously among other causes. They can also develop as complications of an endoscopic intervention or after surgical construction of an anastomosis. For the patient, these situations usually are serious and life-threatening. Standard therapy has always been - and most of the time still is - major surgery. These procedures usually are technically difficult and their mortality and morbidity are not satisfactory due to, among others, the occurrence of local infections. Thus, various endoscopic techniques as therapy for perforations and leakages have been developed over the last years. These include above all the endoscopic placement of clip systems and stents and the relatively new vacuum drainage systems. In case of perforations and leakages of the bile duct and the rectum especially, these minimal invasive techniques are widely used, also increasingly in lesions of the esophagus. However, these new, endoscopic procedures suffer from a lack of evidence. This paper highlights the possibilities and limitations of endoscopic options in therapy for perforations and leakages of organs of the gastrointestinal tract. PMID:22562158
Feisthammel, J; Jonas, S; Mössner, J; Hoffmeister, A
A variety of agents are used as premedication for upper gastrointestinal endoscopy (U.G.E.). To our knowledge, no double blind studies have been performed to compare their value. In this study phenoperidine (2 mg i.v.) was compared with diazepam (t mg i.v.) in 200 consecutive patients undergoing elective U.G.E. The study was randomized and double blind in regard to both endoscopists and patients. All patients were given atropine (0.4 mg i.v.) and a throat spray with 2% amethocaine. Patients who needed supplemental medication were given diazepam and excluded from final analysis. A graded questionnaire was recorded by endoscopists and patients after U.G.E., and a further anonymous questionnaire was returned by patients four days later. Statistical analysis revealed that phenoperidine was superior at facilitating intubation and providing more relaxation as judged by the endoscopist. Patient questionnaires, four days after U.G.E., indicated less distress during intubation and examination with phenoperidine. Nausea, vomiting, amnesia and phlebitis were uncommon after either phenoperidine or diazepam. PMID:7047171
Werner, D; Ratnaike, R N; Lawson, M J; Barrie, J; Streeter, J; Read, T; Grant, A K
AIM: To evaluate the efficacy of retrograde observation of the esophagus, pharynx, larynx and lingual root. METHODS: With the beagle dog under anesthesia, the anterior wall of the stomach was fixed on the abdominal wall in a similar way to percutaneous endoscopic gastrostomy. The gastrointestinal scope was inserted via a 12 mm laparoscopic port for subsequent retrograde observation from stomach to the oral cavity. RESULTS: With this technique, direct observation of gastric cardia was possible without restriction. The cervical esophagus was dilated well, also allowing clear observation of the hypopharyngo-esophageal junction. If the tongue was manually pulled out forward, observation of the lingual root was possible. CONCLUSION: This procedure is easy and effective for pre-treatment evaluation of the feasibility of endoscopic resection in cases of superficial carcinoma of head and neck.
Honda, Michitaka; Hori, Yoshio; Shionoya, Yoshiki; Nakada, Akira; Sato, Toshihiko; Kobayashi, Takeshi; Shimada, Hidenori; Kida, Naoki; Nakamura, Tatsuo
Visual detection of tumors, especially during the early stages, is expected to be improved considerably by examining the fluorescence either of tumor-selective exogenous dyes such as protoporphyrin IX, induced by 5-aminolevulinic acid, or by analyzing the autofluorescent properties of healthy and neoplastic tissue. The present paper describes technical devices using light sources for fluorescence excitation, and sensitive detection systems such as intensified cameras and optical multichannel analyzers used for fiber-assisted point measurements. In the discussion of these systems, special consideration is given to their commercial availability and potential for endoscopic applications in the gastrointestinal tract. In this clinical discipline, the major interest lies in the ability to locate malignancies in the esophagus and colon. In recent years, there has been increasing clinical experience in this area, particularly in detecting adenocarcinoma in Barrett's esophagus and malignant alterations in the colon, such as in ulcerative colitis and polyps. Although several research groups have reported sensitivities and specificities for fluorescence gastroscopy of more than 80%, the potential benefits of the technique to patients need to be evaluated in further clinical studies. PMID:9689513
Stepp, H; Sroka, R; Baumgartner, R
Background/Aims In South Korea, health check-ups are readily accessible to the public. We aimed to compare the prevalence of upper gastrointestinal (GI) and lower GI diseases in Korean Americans and native Koreans to determine differences and risk factors. Methods In total, 1,942 subjects who visited Gangnam Severance Hospital from July 2008 to November 2010 for a health check-up were enrolled. Basic characteristics and laboratory data for the subjects were collected. Esophagogastroduodenoscopy and colonoscopy were performed. In total, 940 Korean Americans (group 1) and 1,002 native Koreans (group 2) were enrolled. Results The overall prevalence of GI diseases for each group (group 1 vs group 2) were as follows: reflux esophagitis (RE) (9.65% vs 7.9%), gastric ulcer (2.8% vs 3.4%), duodenal ulcer (2.3% vs 3.6%), gastric cancer (0.4% vs 0.3%), colorectal polyp (35.9% vs 35.6%), colorectal cancer (0.5% vs 0.5%), and hemorrhoids (29.4% vs 21.3%). The prevalence of hemorrhoids was significantly higher in group 1 than in group 2 (p=0.001). In the multivariable analysis of group 1, male sex, age over 50 years, hypercholesterolemia and hypertriglyceridemia predicted colorectal polyps. Male sex and high fasting glucose levels were associated with RE. Conclusions Our study showed that the prevalence of GI diseases (except hemorrhoids) in Korean Americans was similar to that observed in native Koreans. Therefore, the Korean guidelines for upper and lower screening endoscopy may be applicable to Korean Americans.
Baik, Su Jung; Kim, Kyung Hee; Oh, Cho Rong; Lee, Jung Hyun; Jo, Wan Jae; Kim, Hye Kyoung; Kim, Eun Young; Kim, Min Jung
Advances in endoscopy and anesthesia have enabled gastrointestinal endoscopy for children since 1960. Over the past decades, the number of endoscopies has increased rapidly. As specialized teams of pediatric gastroenterologists, pediatric intensive care physicians and pediatric endoscopy nurses are available in many medical centers, safe and effective procedures have been established. Therefore, diagnostic endoscopies in children are routine clinical procedures. The most frequently performed endoscopies are esophagogastroduodenoscopy (EGD), colonoscopy and endoscopic retrograde cholangiopancreaticography (ERCP). Therapeutic interventions include variceal bleeding ligation, foreign body retrieval and percutaneous endoscopic gastrostomy. New advances in pediatric endoscopy have led to more sensitive diagnostics of common pediatric gastrointestinal disorders, such as Crohn's disease, ulcerative colitis and celiac disease; likewise, new diseases, such as eosinophilic esophagitis, have been brought to light.Upcoming modalities, such as capsule endoscopy, double balloon enteroscopy and narrow band imaging, are being established and may contribute to diagnostics in pediatric gastroenterology in the future. PMID:23885793
Friedt, Michael; Welsch, Simon
n May of 2000, a short paper appeared in the jour- nal Nature describing a new form of gastrointestinal endoscopy that was performed with a miniaturized, swallowable camera that was able to transmit color, high-fidelity images of the gastrointestinal tract to a portable recording device.1 The article highlighted the ability of the device to image the entire small bowel, a
Jamie S. Barkin; Christopher J. Gostout
The Max Planck Advanced Study Group (ASG) at the Center for Free Electron Laser Science (CFEL) has created the CFEL-ASG Software Suite CASS to view, process and analyse multi-parameter experimental data acquired at Free Electron Lasers (FELs) using the CFEL-ASG Multi Purpose (CAMP) instrument Strüder et al. (2010) .The software is based on a modular design so that it can be adjusted to accommodate the needs of all the various experiments that are conducted with the CAMP instrument. In fact, this allows the use of the software in all experiments where multiple detectors are involved. One of the key aspects of CASS is that it can be used either ‘on-line’, using a live data stream from the free-electron laser facility’s data acquisition system to guide the experiment, and ‘off-line’, on data acquired from a previous experiment which has been saved to file.Program summaryProgram title: CASSCatalogue identifier: AEMP_v1_0Program summary URL: http://cpc.cs.qub.ac.uk/summaries/AEMP_v1_0.htmlProgram obtainable from: CPC Program Library, Queen’s University, Belfast, N. IrelandLicensing provisions: GNU General Public Licence, version 3No. of lines in distributed program, including test data, etc.: 167073No. of bytes in distributed program, including test data, etc.: 1065056Distribution format: tar.gzProgramming language: C++.Computer: Intel x86-64.Operating system: GNU/Linux (for information about restrictions see outlook).RAM: >8 GBClassification: 2.3, 3, 15, 16.4.External routines: Qt-Framework, SOAP, (optional HDF5, VIGRA, ROOT, QWT)Nature of problem: Analysis and visualisation of scientific data acquired at Free-Electron-LasersSolution method: Generalise data access and storage so that a variety of small programming pieces can be linked to form a complex analysis chain.Unusual features: Complex analysis chains can be built without recompiling the programAdditional comments: An updated extensive documentation of CASS is available at .Running time: Depending on the data size and complexity of analysis algorithms.References: http://qt.nokia.com http://www.cs.fsu.edu/~engelen/soap.html http://www.hdfgroup.org/HDF5/ http://hci.iwr.uni-heidelberg.de/vigra/ http://root.cern.ch http://qwt.sourceforge.net/ http://www.mpi-hd.mpg.de/personalhomes/gitasg/cass
Foucar, Lutz; Barty, Anton; Coppola, Nicola; Hartmann, Robert; Holl, Peter; Hoppe, Uwe; Kassemeyer, Stephan; Kimmel, Nils; Küpper, Jochen; Scholz, Mirko; Techert, Simone; White, Thomas A.; Strüder, Lothar; Ullrich, Joachim
Raman spectroscopy is a vibrational analytic technique sensitive to the changes in biomolecular composition and conformations occurring in tissue. With our most recent development of near-infrared (NIR) Raman endoscopy integrated with diagnostic algorithms, in vivo real-time Raman diagnostics has been realized under multimodal wide-field imaging (i.e., white- light reflectance (WLR), narrow-band imaging (NBI), autofluorescence imaging (AFI)) modalities. A selection of 177 patients who previously underwent Raman endoscopy (n=2510 spectra) was used to render two robust models based on partial least squares - discriminant analysis (PLS-DA) for esophageal and gastric cancer diagnosis. The Raman endoscopy technique was validated prospectively on 4 new gastric and esophageal patients for in vivo tissue diagnosis. The Raman endoscopic technique could identify esophageal cancer in vivo with a sensitivity of 88.9% (8/9) and specificity of 100.0% (11/11) and gastric cancers with a sensitivity of 77.8% (14/18) and specificity of 100.0% (13/13). This study realizes for the first time the image-guided Raman endoscopy for real-time in vivo diagnosis of malignancies in the esophagus and gastric at the biomolecular level.
Bergholt, Mads Sylvest; Zheng, Wei; Lin, Kan; Ho, Khek Yu; Yeoh, Khay Guan; Teh, Ming; So, Jimmy Bok Yan; Huang, Zhiwei
Abstract Objective. The use of nonanesthetist-administered propofol (NAAP) in GI endoscopy has long been controversial. In the setting of NAAP, acute situations can develop during endoscopy and thus training before starting with NAAPs is considered crucial. The aim was to evaluate a pilot study on crew resource management (CRM)-based training of teams of endoscopists and endoscopy nurses in NAAP in a full-scale hybrid simulation consisting of a full-scale human patient simulator and an endoscopy simulator. Our hypothesis was that the training would increase the self-efficacy of the participants. Material and methods. Four scenarios were created, each with typical side effects of propofol administration. All scenarios included the need for prompt decision-making and treatment. Colonoscopy, gastroscopy or endoscopic retrograde cholangiopancreatography (ERCP) cases were assigned to the course participants in coherence with their main clinical expertise in order to facilitate situated and contextualized training. Twenty-one participants (ten doctors and eleven nurses) completed a questionnaire on self-efficacy before and after the course. A questionnaire regarding the quality and yield of the course was also completed. Results. For all participants, the self-efficacy score was 26.0 (24.0-28.0; interquartile range) before training and 30.0 (27.0-30.5) after training (p = 0.0003). The ten doctors had a self-efficacy score before training of 26.5 (25.0-29.5) and 30.0 (29.0-33.0) after (p = 0.0078). The eleven nurses scored 24.0 (22.0-26.0) before and 28.0 (27.0-30.0) after training (p = 0.0098). Conclusions. Systematic target focused scenario-based training with hybrid simulation of NAAP in endoscopy resulted in increased self-efficacy in both nurses and physicians. PMID:24041148
Westfelt, Petter; Hedman, Leif; Axelsson Lindkvist, Mikael; Enochsson, Lars; Felländer-Tsai, Li; Schmidt, Peter Thelin
OBJECTIVE:Small bowel pathology can be diagnosed using enteroscopy (which has limitations) and by x-ray (which is not sensitive for flat lesions). For the first time ever, we used a new technique, wireless-capsule video endoscopy, to diagnose small bowel pathology. Our aim was to prove the effectiveness and safety of this technology.METHODS:We used the Given (M2A) system in 35 patients, aged
Eitan Scapa; Harold Jacob; Shlomo Lewkowicz; Michal Migdal; Daniel Gat; Arkady Gluckhovski; Nurit Gutmann; Zvi Fireman
Rapid advances in the technology of gastrointestinal endoscopy as well as the evolution of science have made it necessary for us to continue update in either various endoscopic techniques or state of art lectures relevant to endoscopy. International Digestive Endoscopy Network (IDEN) 2013 was held in conjunction with Korea-Japan Joint Symposium on Gastrointestinal Endoscopy (KJSGE) during June 8 to 9, 2013 at Seoul, Korea. Two days of impressive scientific program dealt with a wide variety of basic concerns from upper gastrointestine (GI), lower GI, pancreaticobiliary endoscopy to advanced knowledge including endoscopic submucosal dissection forum. IDEN seems to be an excellent opportunity to exchange advanced information of the latest issues on endoscopy with experts from around the world. In this special issue of Clinical Endoscopy, we prepared state of art review articles from contributing authors and the current highlights will skillfully deal with very hot spots of each KJSGE, upper GI, lower GI, and pancreaticobiliary sessions by associated editors of Clinical Endoscopy.
Kwon, Kwang An; Choi, Il Ju; Kim, Eun Young; Dong, Seok Ho
BACKGROUND: The optimal topical anesthesia regimen for unsedated transnasal endoscopy is unknown. The addition of a nasal decongestant, such as xylometazoline (X), to a topical anesthestic may improve patient comfort. OBJECTIVE: To determine the effectiveness of lidocaine (L) versus L plus X (LX) for anesthesia in unsedated transnasal endoscopy. METHODS: Consecutive participants of the Aklavik Helicobacter pylori project were prospectively randomly assigned to receive LX or L for unsedated transnasal 4.9 mm ultrathin endoscopy. The primary outcome was overall procedure discomfort on a validated 10-point visual analogue scale (1 = no discomfort, 10 = severe discomfort). Secondary outcomes included pain, endoscope insertion difficulty, gagging, adverse events and encounter times. Results were presented as mean ± SD, difference in mean, 95% CI. RESULTS: A total of 181 patients were randomly assigned to receive LX (n=94) and L (n=87). Baseline characteristics between the two groups were similar (mean age 40 years, 59% women). Overall, patient procedural discomfort with LX and L were 4.2±2.4 versus 3.9±2.1, respectively (0.29; 95% CI ?0.39 to 0.96). Transnasal insertion difficulty was significantly lower with LX than with L (2.4±2.1 versus 3.2±2.8, respectively [?0.80; 95% CI ?1.54 to ?0.06]). Compared with L, the use of LX was associated with significantly less time needed to apply anesthesia (2.4±1.8 min versus 3.5±2.2 min, respectively [?1.10; 95% CI ?1.71 min to ?0.50 min]) and less time for insertion (3.2±1.8 min versus 3.9±2.2 min, respectively [?0.70 min; 95% CI ?1.30 min to ?0.10 min]). Epistaxis was rare but occurred less frequently with LX (1.1%) than with L (4.6%) (P=0.19). CONCLUSIONS: LX did not improve patient comfort for transnasal endoscopy compared with L alone. However, LX was associated with less difficulty with endoscope transnasal insertion and reduced insertion time. Further studies on the optimal regimen and dosing of anesthesia are required.
Cheung, Justin; Goodman, Karen J; Bailey, Robert; Fedorak, Richard N; Morse, John; Millan, Mario; Guzowski, Tom; van Zanten, Sander Veldhuyzen
Recently, placement of self-expandable metallic stents has been used for the treatment of colorectal obstruction. As domestic awareness of colorectal cancer has increased, the number of colorectal stenting procedures performed has also increased. We aimed to provide evidence-based recommendations for colorectal stenting to aid gastroenterologists in making informed decisions regarding the management of patients who present with colorectal obstruction. The working group consisted of eight gastroenterologists who actively practice and conduct research in the field of colorectal stenting and are the members of the Stent Study Group of the Korean Society of Gastrointestinal Endoscopy. A literature search was conducted using the PubMed, Embase, KoreaMed, and the Cochrane Library databases to identify relevant articles published between January 2001 and June 2012. Based on the modified Delphi process, 10 recommendation statements regarding indications, usefulness, methodology and complications of colorectal stenting, and alternative treatments for malignant colorectal obstruction were determined. The contents will be widely distributed, and periodically revised to reflect the latest knowledge. These evidence-based recommendations for colorectal stenting will provide gastroenterologists and patients with appropriate and balanced information, and will improve the quality of care. PMID:23964332
Lee, Kwang Jae; Kim, Sang Woo; Kim, Tae Il; Lee, Jong-Hoon; Lee, Bo-In; Keum, Bora; Cheung, Dae Young; Yang, Chang Heon
Background and study aims Colon capsule endoscopy (CCE) was developed for the evaluation of colorectal pathology. In this study, our aim was to assess if a dual-camera analysis using CCE allows better evaluation of the whole gastrointestinal (GI) tract compared to a single-camera analysis. Patients and methods We included 21 patients (12 males, mean age 56.20 years) submitted for a CCE examination. After standard colon preparation, the colon capsule endoscope (PillCam Colon™) was swallowed after reinitiation from its “sleep” mode. Four physicians performed the analysis: two reviewed both video streams at the same time (dual-camera analysis); one analyzed images from one side of the device (“camera 1”); and the other reviewed the opposite side (“camera 2”). We compared numbers of findings from different parts of the entire GI tract and level of agreement among reviewers. Results A complete evaluation of the GI tract was possible in all patients. Dual-camera analysis provided 16% and 5% more findings compared to camera 1 and camera 2 analysis, respectively. Overall agreement was 62.7% (kappa = 0.44, 95% CI: 0.373–0.510). Esophageal (kappa = 0.611) and colorectal (kappa = 0.595) findings had a good level of agreement, while small bowel (kappa = 0.405) showed moderate agreement. Conclusion The use of dual-camera analysis with CCE for the evaluation of the GI tract is feasible and detects more abnormalities when compared with single-camera analysis.
Remes-Troche, Jose Maria; Jimenez-Garcia, Victoria Alejandra; Garcia-Montes, Josefa Maria; Hergueta-Delgado, Pedro; Roesch-Dietlen, Federico; Herrerias-Gutierrez, Juan Manuel
1. All patients undergoing gastrointestinal endoscopy must be considered 'at risk' for HIV and appropriate cleaning/disinfection measures taken for endoscopes and accessories. 2. Thorough manual cleaning with detergent, of the instrument and its channels is the most important part of the cleaning/disinfection procedure. Without this, blood, mucus and organic material will prevent adequate penetration of disinfectant for inactivation of bacteria and viruses. 3. Aldehyde preparations (2% activated glutaraldehyde and related products) are the recommended first line antibacterial and antiviral disinfectant. A four minute soak is recommended as sufficient for inactivation of vegetative bacteria and viruses (including HIV and HBV). 4. Quaternary ammonium detergents (8% Dettox for two minutes for bacterial disinfection), followed by exposure of the endoscope shaft and channels to ethyl alcohol (70% for four minutes for viral inactivation), is an acceptable second-line disinfectant routine where staff sensitisation prevents the use of an aldehyde disinfectant. 5. Accessories, including mouthguards and cleaning brushes, require similarly careful cleaning/disinfection, before and after each use. Disposable products (especially injection needles) may be used and appropriate items can be sterilised by autoclaving and kept in sterile packs. 6. Closed circuit endoscope washing machines have advantages in maintaining standards and avoiding staff sensitisation to disinfectants. Improved ventilation including exhaust extraction facilities may be required. 7. Endoscopy staff should receive HBV vaccination, wear gloves and appropriate protective garments, cover wounds or abrasions and avoid needlestick injuries (including spiked forceps, etc). 8. Known HIV-infected or AIDS patients are managed as immunosuppressed, and require protection from atypical mycobacteria/cryptosporidia etc, by one hour aldehyde disinfection of endoscopic equipment before and after the procedure. A dedicated instrument is not required. 9. Increased funding is necessary for capital purchases of GI endoscopic equipment, including extra and immersible endoscopes with additional accessories to allow for safe practice. 10. Greater numbers of trained GI assistants are needed to ensure that cleaning/disinfection recommendations and safety precautions are followed, both during routine lists and emergency endoscopic procedures. 11. These recommendations are based on expert interpretation of current data on infectivity and disinfection; they may require future modification.
This is one of a series of statements discussing the use of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE) prepared this text. In preparing this guideline, we performed a search of the medical literature by using PubMed. Additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. Guidelines for appropriate use of endoscopy are based on a critical review of the available data and expert consensus at the time the guidelines were drafted. Further controlled clinical studies may be needed to clarify aspects of this guideline. This guideline may be revised as necessary to account for changes in technology, new data, or other aspects of clinical practice. The recommendations are based on reviewed studies and are graded on the strength of the supporting evidence (Table 1).(1) The strength of individual recommendations is based both upon the aggregate evidence quality and an assessment of the anticipated benefits and harms. Weaker recommendations are indicated by phrases such as "we suggest," whereas stronger recommendations are typically stated as "we recommend." This guideline is intended to be an educational device to provide information that may assist endoscopists in providing care to patients. This guideline is not a rule and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment. Clinical decisions in any particular case involve a complex analysis of the patient's condition and available courses of action. Therefore, clinical considerations may lead an endoscopist to take a course of action that varies from these guidelines. PMID:20801285
Fisher, Laurel; Lee Krinsky, Mary; Anderson, Michelle A; Appalaneni, Vasundhara; Banerjee, Subhas; Ben-Menachem, Tamir; Cash, Brooks D; Decker, G Anton; Fanelli, Robert D; Friis, Cindy; Fukami, Norio; Harrison, M Edwyn; Ikenberry, Steven O; Jain, Rajeev; Jue, Terry; Khan, Khalid; Maple, John T; Strohmeyer, Laura; Sharaf, Ravi; Dominitz, Jason A
Capsule endoscopy is a new technology that, for the fi rst time, allows complete, non-invasive endoscopic imaging of the small bowel. The effi cacy of capsule endoscopy in the diagnosis of suspected small bowel diseases has been established. Important applications for surgeons include observations of obscure gastrointestinal bleeding and small bowel neoplasms.
Osman Ersoy; Bulent Sivri; Yusuf Bayraktar
Video capsule endoscopy has revolutionized our ability to visualize the entire small bowel mucosa. This modality is established as a valuable tool for the diagnosis of obscure gastrointestinal bleeding, Crohn’s disease, small bowel tumors, and other conditions involving the small bowel mucosa. This review includes an overview of the current and potential future clinical applications of small bowel video endoscopy.
Kopylov, Uri; Seidman, Ernest G
The asg mutants of Myxococcus xanthus are defective in production of extracellular A-signal, which serves as a cell density signal for fruiting-body development. The DNA sequence of asgB, one of the three asg genes, was determined. The deduced amino acid sequence of AsgB contains a DNA-binding helix-turn-helix motif near the C terminus. This putative helix-turn-helix is highly similar to the helix-turn-helix in region 4.2 of major sigma factors, which is the region that recognizes and interacts with -35 sequences of promoters. We propose that AsgB is a transcription factor that binds to DNA sequences similar to the -35 hexamer, TTGACA. Analyses of asgB RNA levels and expression of an asgB-lacZ translational fusion indicate that expression of asgB remains fairly constant during the transition from growth into early development. The mutation within the asgB480 allele was identified as an A-to-G transition that results in a threonine-to-alanine substitution in the predicted protein product. Attempts to replace the wild-type copy of asgB with a null allele failed, indicating that asgB may be essential for growth. PMID:8144470
Plamann, L; Davis, J M; Cantwell, B; Mayor, J
ASG-EUPOS is a Polish part of multifunctional EUropean POsitioning Stystem (EUPOS) that covers 16 Central European countries. EUPOS provides GPS correction data for real-time positioning and navigation as well as observation data for the post-processed positioning. ASG-EUPOS is an active reference network that provides a variety of services for geodesy, surveying and navigation. The separation between the reference stations is
P. Wielgosz; J. Paziewski
Despite widespread use of multiphoton fluorescence microscopy, development of endoscopes for nonlinear optical imaging has been stymied by the degradation of ultrashort excitation pulses that occurs within optical fiber as a result of the combined effects of group-velocity dispersion and self-phase modulation. We introduce microendoscopes (350-1000 ?m in diameter) based on gradient-index microlenses that effectively eliminate self-phase modulation within the endoscope. Laser-scanning multiphoton fluorescence endoscopy exhibits micrometer-scale resolution. We used multiphoton endoscopes to image fluorescently labeled neurons and dendrites.
Jung, Juergen C.; Schnitzer, Mark J.
The Myxococcus xanthus asgA gene is one of three known genes necessary for the production of extracellular A-signal, a cell density signal required early in fruiting body development. We determined the DNA sequence of asgA. The deduced 385-amino-acid sequence of AsgA was found to contain two domains: one homologous to the receiver domain of response regulators and the other homologous to the transmitter domain of histidine protein kinases. A kanamycin resistance (Kmr) gene was inserted at various positions within or near the asgA gene to determine the null phenotype. Those strains with the Kmr gene inserted upstream or downstream of asgA are able to form fruiting bodies, while strains containing the Kmr gene inserted within asgA fail to develop. The nature and location of the asgA476 mutation were determined. This mutation causes a leucine-to-proline substitution within a conserved stretch of hydrophobic residues in the N-terminal receiver domain. Cells containing the insertion within asgA and cells containing the asgA476 substitution have similar phenotypes with respect to development, colony color, and expression of an asg-dependent gene. An analysis of expression of a translational asgA-lacZ fusion confirms that asgA is expressed during growth and early development. Finally, we propose that AsgA functions within a signal transduction pathway that is required to sense starvation and to respond with the production of extracellular A-signal.
Plamann, L; Li, Y; Cantwell, B; Mayor, J
The Myxococcus xanthus asgA gene is one of three known genes necessary for the production of extracellular A-signal, a cell density signal required early in fruiting body development. We determined the DNA sequence of asgA. The deduced 385-amino-acid sequence of AsgA was found to contain two domains: one homologous to the receiver domain of response regulators and the other homologous to the transmitter domain of histidine protein kinases. A kanamycin resistance (Kmr) gene was inserted at various positions within or near the asgA gene to determine the null phenotype. Those strains with the Kmr gene inserted upstream or downstream of asgA are able to form fruiting bodies, while strains containing the Kmr gene inserted within asgA fail to develop. The nature and location of the asgA476 mutation were determined. This mutation causes a leucine-to-proline substitution within a conserved stretch of hydrophobic residues in the N-terminal receiver domain. Cells containing the insertion within asgA and cells containing the asgA476 substitution have similar phenotypes with respect to development, colony color, and expression of an asg-dependent gene. An analysis of expression of a translational asgA-lacZ fusion confirms that asgA is expressed during growth and early development. Finally, we propose that AsgA functions within a signal transduction pathway that is required to sense starvation and to respond with the production of extracellular A-signal. PMID:7721694
Plamann, L; Li, Y; Cantwell, B; Mayor, J
A capsule endoscope is a swallowable wireless miniature camera for getting images of the gastrointestinal (GI) mucosa. The\\u000a initial capsule endoscope model was developed by Given Imaging and approved in Western countries in 2001. Before the introduction\\u000a of capsule endoscopy (CE) and double-balloon endoscopy (DBE), there was no effective modality for the evaluation and management\\u000a of patients with obscure GI
Tetsuya Nakamura; Akira Terano
Capsule endoscopy (CE) enables remote diagnostic inspection of the gastrointestinal tract without sedation and with minimal discomfort. Initially intended for small-bowel endoscopy, modifications to the original capsule have since been introduced for imaging of the esophagus and the colon. This Review presents a research update on CE. Emphasis is placed on PillCam™ SB, PillCam™ ESO, and PillCam™ COLON (Given Imaging,
Arianna Menciassi; Paolo Dario; Alfred Cuschieri; Andrea Moglia
The current management of a patient with upper gastrointestinal hemorrhage involves three steps: initial correction of unstable hemodynamics, obtaining the specific diagnosis of the lesion responsible for gastrointestinal blood loss, and therapy directed at the specific bleeding lesion. The current approach to upper gastrointestinal hemorrhage is carrying out upper gastrointestinal endoscopy following stabilization of the patient. Although improved morbidity and mortality statistics have been slow to appear, the use of endoscopy permits appropriate therapy directed at the specific lesion. Specific therapeutic measures have been outlined for seven common causes of upper gastrointestinal hemorrhage. The advent of therapeutic endoscopy promises to bring further advances in therapy in the near future.
Midgley, Robert C.; Cantor, David
The Syrian hamster karyotype was established by use of known banding techniques with ASG and trypsin. Each pair of chromosomes was definitely identified on the basis of banding patterns. Differences in patterns between the two techniques were limited to resolution of fine bands in some chromosomes. Examination of 4-nitroquinoline-n-oxide transformed cells after use of the trypsin technique made possible accurate
N. C. Popescu; J. A. DiPaolo
Objective To compare the clinical effectiveness of doctors and nurses in undertaking upper and lower gastrointestinal endoscopy. Design Pragmatic trial with Zelen’s randomisation before consent to minimise distortion of existing practice. Setting 23 hospitals in the United Kingdom. In six hospitals, nurses undertook both upper and lower gastrointestinal endoscopy, yielding a total of 29 centres. Participants 67 doctors and 30 nurses. Of 4964 potentially eligible patients, we randomised 4128 (83%) and recruited 1888 (38%) from July 2002 to June 2003. Interventions Diagnostic upper gastrointestinal endoscopy and flexible sigmoidoscopy, undertaken with or without sedation, with the standard preparation, techniques, and protocols of participating hospitals. After referral for either procedure, patients were randomised between doctors and nurses. Main outcome measures Gastrointestinal symptom rating questionnaire (primary outcome), gastrointestinal endoscopy satisfaction questionnaire and state-trait anxiety inventory (all analysed by intention to treat); immediate and delayed complications; quality of examination and corresponding report; patients’ preferences for operator; and new diagnoses at one year (all analysed according to who carried out the procedure). Results There was no significant difference between groups in outcome at one day, one month, or one year after endoscopy, except that patients were more satisfied with nurses after one day. Nurses were also more thorough than doctors in examining the stomach and oesophagus. While quality of life scores were slightly better in patients the doctor group, this was not statistically significant. Conclusions Diagnostic endoscopy can be undertaken safely and effectively by nurses. Trial registration International standard RCT 82765705
Capsule endoscopy (CE) was launched at the beginning of this millennium and has since become a well established methodology for evaluating the entire small bowel for manifold pathologies. CE far exceeded early expectations by providing a tool for establishing the correct diagnosis for elusive gastrointestinal (GI) conditions such as obscure GI bleeding, Crohn’s disease, polyposis syndrome and others. Contemporary CE, like radiology, gives results that can only be read, unlike conventional endoscopic procedures which enable concomitant biopsy when indicated. This is one of the major limitations of the technique. The ideal CE should improve the quality of the image and have a faster frame rate than the currently available one. There should be a therapeutic capsule capable of performing a biopsy, aspirating fluid, delivering drugs as well as measuring the motility of the small bowel wall. Another major leap forward would be the capability of remote control of the capsule’s movement in order to navigate it to reach designated anatomical areas for carrying out a variety of therapeutic options. Technology for improving the capability of the future generation capsule is almost within grasp and it would not be surprising to witness the realization of these giant steps within the coming decade.
Acute gastrointestinal bleeding is an important medical emergency. Outcome and treatment are dependent upon the presence or absence of liver disease. The most important non-variceal cause is peptic ulcer. Prognosis is dependent upon the severity of bleeding, endoscopic findings and the presence of medical comorbidity. Endoscopy is undertaken only after resuscitation is optimized and is done to achieve an accurate
Acute gastrointestinal bleeding remains an important medical emergency. Outcome and treatment are dependent upon the presence or absence of liver disease. The most important non-variceal cause is peptic ulcer. Prognosis is dependant upon the severity of bleeding, endoscopic findings and the presence of medical comorbidity. Endoscopy is undertaken only after resuscitation is optimized and is done to achieve an accurate
Objectives: Our aim was to evaluate the structure and function of the upper gastrointestinal tract in a group of patients with autism who had gastrointestinal symptoms. Study design: Thirty-six children (age: 5.7 ± 2 years, mean ± SD) with autistic disorder underwent upper gastrointestinal endoscopy with biopsies, intestinal and pancreatic enzyme analyses, and bacterial and fungal cultures. The most frequent
Karoly Horvath; John C. Papadimitriou; Anna Rabsztyn; Cinthia Drachenberg; J. Tyson Tildon
The role of healthy volunteers (HV) in research covers a wide spectrum. In gastrointestinal research HV are often considered a control population. Endoscopy-based investigations are rare in terms of all studies performed in this field. The term ‘healthy’ must be questioned in some cases, as Helicobacter pylori-positive individuals are included as well. Problems arise from several fields, e.g. safety, financial
Gerhard Treiber; Peter Malfertheiner
Capsule endoscopy is an increasingly popular alternative to a tube-based endoscope used in diagnosing gastrointestinal diseases. It enables the inspection of areas that are not easily accessible using traditional endoscopy and reduces patient discomfort. In addition to transferring high-capacity demanding image data, the capsule's wireless interface must provide a wireless link that enables real-time positioning and tracking of the capsule.
S. Stoa; Raul Chavez-Santiago; Ilangko Balasingham
The advent of microchip video cameras has opened another technology to endoscopy of the gastrointestinal tract: video endoscopy. With direct video endoscopy, the microchip camera is mounted on the distal tip of the endoscope; with indirect video endoscopy, a miniature camera is coupled to the eyepiece of a standard fiberoptic endoscope. Both systems view the procedure on a monitor. The systems were "bench" tested in an electronics laboratory to objectively compare resolution, brightness (luminosity), and color intensity (chroma). Clinical comparison was performed in 619 patients. Both video endoscopy systems provided significant advantages over fiberoptic endoscopes in therapeutic procedures, teaching, and documentation. The direct video system provided the best overall video image; the indirect system had a slightly diminished resolution and luminosity in both the "bench" test and clinical evaluation. PMID:3569802
Satava, R M
Capsule endoscopy has revolutionised the management of digestive tract diseases by providing a new non-invasive way to view the entire small bowel mucosa directly. Obscure gastrointestinal bleeding is the primary and best validated indication to capsule endoscopy, which when used as first-line exploration is the most efficient strategy as regards diagnosis. In these patients, the technique is also helpful for
Background: The small bowel is the most commonly affected site of Crohn’s disease (CD) although it may involve any part of the gastrointestinal tract. The current methodologies for examining the small bowel are x ray and endoscopy.Aims: To evaluate, for the first time, the effectiveness of wireless capsule endoscopy in patients with suspected CD of the small bowel undetected by
Z Fireman; E Mahajna; E Broide; M Shapiro; L Fich; A Sternberg; Y Kopelman; E Scapa
Endoscopy accounts for most of the gastroenterologist's professional time and revenue. The thoughtful gastroenterologist in practice must understand the potential sites of service for endoscopy, including either the hospital endoscopy unit or an ambulatory endoscopy center (whether an office endoscopy suite or a licensed, certified, and accredited ambulatory surgery center). Out-of-hospital endoscopy centers have advantages for patients, including convenience, efficiency, economy, and more pleasant surroundings than the hospital. Payers appreciate improved access and reduced costs. For gastrointestinal practices, ambulatory endoscopy centers, particularly ambulatory surgery centers, provide significant advantages, including enhanced reimbursement and cost management, control, efficiency and convenience, quality control, opportunities for clinical research, and marketing and competitive strengths. PMID:17098615
Frakes, James T
Colonic diverticulosis is one of the most common causes of lower gastrointestinal bleeding. Endoscopy is not only a useful diagnostic tool for localizing the bleeding site, but also a therapeutic modality for its management. To date, haemostatic methods have included adrenaline injection, mechanical clipping, thermal and electrical coagulation or combinations of them. The results of all published data are herein reviewed.
Pilichos, Charalampos; Bobotis, Emmanouil
Endoscopy is an indispensible diagnostic and therapeutic instrument for gastrointestinal diseases. Endocytoscopy and confocal endomicroscopy are two types of ultra high magnification endoscopy techniques. Standard endoscopy allows for 50 × magnification, whereas endocytoscopy can magnify up to 1400 × and confocal endomicroscopy can magnify up to 1000 ×. These methods open the realm of real time microscopic evaluation of the GI tract, including cellular and subcellular structures. Confocal endomicroscopy has the additional advantage of being able to visualize subsurface structures. The use of high magnification endoscopy in conjunction with standard endoscopy allows for a real-time microscopic assessment of areas with macroscopic abnormalities, providing “virtual biopsies” with valuable information about cellular and subcellular changes. This can minimize the number of biopsies taken at the time of endoscopy. The use of this technology may assist in detecting pre-malignant or malignant changes at an earlier state, allowing for earlier intervention and treatment. High magnification endoscopy has shown promising results in clinical trials for Barrett’s esophagus, esophageal adenocarcinoma, esophageal squamous cell cancer, gastric cancer, celiac disease, colorectal cancer, and inflammatory bowel disease. As the use of high magnification endoscopy techniques increases, the clinical applications will increase as well. Of the two systems, only confocal endomicroscopy is currently commercially available. Like all new technologies there will be an initial learning curve before operators become proficient in obtaining high quality images and discerning abnormal from normal pathology. Validated criteria for the diagnosis of the various gastrointestinal diseases will need to be developed for each method. In this review, the basic principles of both modalities are discussed, along with their clinical applicability and limitations.
Arya, Aman V; Yan, Brian M
Small intestinal bleeding is difficult to detect and can be life-threatening. Capsule endoscopy (CE) is a new, minimally invasive diagnostic procedure designed to detect gastrointestinal (GI) bleeding. We report the successful management of idiopathic ileal varices by capsule endoscopy and laparoscopic surgery. Massive bleeding occurred suddenly with intermittent melena, and the patient was finally admitted to a local hospital in hypovolemic shock. Her condition was stabilized with conservative therapy but the site of bleeding was not defined by endoscopy, computed tomography, scintigraphy, or angiography. Thus, she was transferred to our hospital. On admission, CE revealed idiopathic ileal varices, so we performed laparoscopic partial ileal resection immediately. Follow-up CE has shown no evidence of recurrence in the 2 years since surgery. Idiopathic ileal varices are rare, difficult to diagnose, and often fatal. Capsule endoscopy is a minimally invasive diagnostic procedure that detects this disorder in time for laparoscopic surgery to be performed effectively and safely. PMID:21046511
Konishi, Hirotaka; Kikuchi, Shojiro; Miyashita, Atsushi; Ichikawa, Daisuke; Fujiwara, Hitoshi; Kubota, Takeshi; Ochiai, Toshiya; Kokuba, Yukihito; Yasukawa, Satoru; Yasukawa, Satoshi; Yanagisawa, Akio; Otsuji, Eigo
Capsule endoscopy (CE) has evolved in a few short years to become a first-line, noninvasive diagnostic technique for the small bowel. CE is now being utilized worldwide to assess patients for obscure gastrointestinal bleeding, possible Crohn's disease, celiac disease and small bowel tumors. The device is now used in tandem with balloon enteroscopy to direct therapeutic interventions. Alterations and improvements in CE have also led to the evaluation of both the esophagus and colon. It can be anticipated that in the near future pan CE of the entire GI tract will be performed, as well as possible tissue acquisition, drug delivery and therapeutic interventions. PMID:20678022
Lee, Noel M; Eisen, Glenn M
Bidirectional endoscopy (BE) is often used to assess patients for the reason of anemia or to screen asymptomatic population for malignancy. Limited clinical data favors to perform first the upper gastrointestinal system endoscopy, but its effect to the duration of colonoscopy is yet to be determined. The aim of this retrospective study is to evaluate the effect of upper gastrointestinal system endoscopy on the time to achieve cecal intubation during colonoscopy in patients undergoing BE. Patients of four endoscopists at similar experience levels were retrospectively identified and categorized into the upper gastrointestinal system endoscopy before colonoscopy group (group 1) or the colonoscopy only group (group 2). The demographics, clinical data and the time to achieve cecal intubation for each patient were analyzed. The mean time to achieve cecal intubation in the first group that included 319 cases was 8.4 ± 0.93 minutes and the mean time in the second group that included 1672 cases was 8.56 ± 1.16 minutes. There was no statistically significant difference between the groups. There was also no significant difference between the Group 1 and Group 2 when compared according to which of the four endoscopists performed the procedures. Performing the upper gastrointestinal system endoscopy prior to colonoscopy did not affect the time to achieve cecal intubation. Considering that performing the upper gastrointestinal system endoscopy prior to the colonoscopy is more advantageous in terms of patient comfort and analgesic requirement, beginning to BE with it seems more favorable.
Oner, Osman Zekai; Demirci, Rojbin Karakoyun; Gunduz, Umut R?za; Aslaner, Arif; Koc, Umit; Bulbuller, Nurullah
We present a simulation for endoscopie procedures. The anatomy of the patient is represented by 3D polyhedral models, computed from tomographic images. The simulation program can be used as a training system, or for prior simulation of complicated individual cases to reduce the error rate and to decide on the feasibility of biopsies. Additionally, we show how the system could
Bernhard Geiger; Ron Kikinis
The aim of this study is to describe the role of endoscopy in detection and treatment of neoplastic lesions of the digestive mucosa in asymptomatic persons. Esophageal squamous cell cancer occurs in relation to nutritional deficiency and alcohol or tobacco consumption. Esophageal adenocarcinoma develops in Barrett’s esophagus, and stomach cancer in chronic gastric atrophy with Helicobacter pylori infection. Colorectal cancer is favoured by a high intake in calories, excess weight, low physical activity. In opportunistic or individual screening endoscopy is the primary detection procedure offered to an asymptomatic individual. In organized or mass screening proposed by National Health Authorities to a population, endoscopy is performed only in persons found positive to a filter selection test. The indications of primary upper gastrointestinal endoscopy and colonoscopy in opportunistic screening are increasingly developing over the world. Organized screening trials are proposed in some regions of China at high risk for esophageal cancer; the selection test is cytology of a balloon or sponge scrapping; they are proposed in Japan for stomach cancer with photofluorography as a selection test; and in Europe, America and Japan; for colorectal cancer with the fecal occult blood test as a selection test. Organized screening trials in a country require an evaluation: the benefit of the intervention assessed by its impact on incidence and on the 5 year survival for the concerned tumor site; in addition a number of bias interfering with the evaluation have to be controlled. Drawbacks of screening are in the morbidity of the diagnostic and treatment procedures and in overdetection of none clinically relevant lesions. The strategy of endoscopic screening applies to early cancer and to benign adenomatous precursors of adenocarcinoma. Diagnostic endoscopy is conducted in 2 steps: at first detection of an abnormal area through changes in relief, in color or in the course of superficial capillaries; then characterization of the morphology of the lesion according to the Paris classification and prediction of the risk of malignancy and depth of invasion, with the help of chromoscopy, magnification and image processing with neutrophil bactericidal index or FICE. Then treatment decision offers 3 options according to histologic prediction: abstention, endoscopic resection, surgery. The rigorous quality control of endoscopy will reduce the miss rate of lesions and the occurrence of interval cancer.
A capsule endoscope is a swallowable wireless miniature camera for getting images of the gastrointestinal (GI) mucosa. The initial capsule endoscope model was developed by Given Imaging and approved in Western countries in 2001. Before the introduction of capsule endoscopy (CE) and double-balloon endoscopy (DBE), there was no effective modality for the evaluation and management of patients with obscure GI bleeding. Obscure GI bleeding is defined as bleeding of unknown origin that persists or recurs after a negative initial or primary endoscopy (colonoscopy or upper endoscopy) result. The first capsule endoscope model, which is now regarded as a first-line tool for the detection of abnormalities of the small bowel, was the PillCam SB. It was approved in Japan in April 2007. The main indication for use of the PillCam SB is obscure GI bleeding. Almost the only complication of CE is capsule retention, which is the capsule remaining in the digestive tract for a minimum of 2 weeks. A retained capsule can be retrieved by DBE. There are some limitations of CE in that it cannot be used to obtain a biopsy specimen or for endoscopic treatment. However, the combination of a PillCam SB and DBE seems to be the best strategy for management of obscure GI bleeding. Recently, several new types of capsule endoscope have been developed, such as Olympus CE for the small bowel, PillCam ESO for investigation of esophageal diseases, and PillCam COLON for detection of colonic neoplasias. In the near future, CE is expected to have a positive impact on many aspects of GI disease evaluation and management. PMID:18306982
Nakamura, Tetsuya; Terano, Akira
Wireless capsule endoscopy has become a common procedure for diagnostic inspection of gastrointestinal tract. This method offers a less-invasive alternative to traditional endoscopy and provides the opportunity for exploring inaccessible areas of the small intestine. Current capsule endoscopes, however, move by peristalsis and are not capable of detailed and on-demand inspection of desired locations. Here, we propose and develop two
Mahdi Rasouli; Andy Prima Kencana; Van An Huynh; E. Kiat; J. C. Y. Lai; L. S. J. Phee
Conventional endoscopy has reached a plateau in technical development, necessitating the exploration of bold new ideas in order to make further advances. One such idea is a self-navigating, independent, intelligent colonoscopic micro-robot. The design of a vehicle that can negotiate the difficult and hostile terrain of the colon is a complex task. Options include wheeled or tracked vehicles and pneumatically driven devices. The development of navigation and lesion recognition software to drive such a vehicle is also challenging. The various mathematical concepts involved in the development of such software are explored in this article. PMID:11030633
Goh, P; Krishnan, S M
Nonvariceal upper gastrointestinal bleeding is unique from variceal bleeding in terms of patient characteristics, management, rebleeding rates, and prognosis, and should be managed differently. The majority of nonvariceal upper gastrointestinal bleeds will not rebleed once treated successfully. The incidence is 80 to 90% of all upper gastrointestinal bleeds and the mortality is between 5 to 10%. The causes include nonacid-related ulceration from tumors, infections, inflammatory disease, Mallory-Weiss tears, erosions, esophagitis, dieulafoy lesions, angiodysplasias, gastric antral vascular ectasia, and portal hypertensive gastropathy. Rarer causes include hemobilia, hemosuccus pancreaticus, and aortoenteric fistulas. Hematemesis and melena are the key features of bleeding from the upper gastrointestinal tract, but fresh per rectal bleeding may be present in a rapidly bleeding lesion. Resuscitation and stabilization before endoscopy leads to improved outcomes. Fluid resuscitation is essential to avoid hypotension. Though widely practiced, there is currently insufficient evidence to show that routine red cell transfusion is beneficial. Coagulopathy requires correction, but the optimal international normalized ratio has not been determined yet. Risk stratification scores such as the Rockall and Glasgow-Blatchford scores are useful to predict rebleeding, mortality, and to determine the urgency of endoscopy. Evidence suggests that high-dose proton pump inhibitors (PPI) should be given as an infusion before endoscopy. If patients are intolerant of PPIs, histamine-2 receptor antagonists can be given, although their acid suppression is inferior. Endoscopic therapy includes thermal methods such as coaptive coagulation, argon plasma coagulation, and hemostatic clips. Four quadrant epinephrine injections combined with either thermal therapy or clipping reduces mortality. In hypoxic patients, endoscopy masks allow high-flow oxygen during upper gastrointestinal endoscopy. The risk of rebleeding reduces after 72 hours. In rebleeding, repeat endoscopy is useful and persistent failure of endoscopic therapy mandates either embolization or surgery. In this review, we analyze the management of nonvariceal upper gastrointestinal bleeding with evidence from the currently published clinical trials. PMID:21654147
The role of endoscopic retrograde cholangiopancreatography (ERCP) in the management of pancreatic diseases is continuing to evolve. This article reviews recent publications spanning a wide range of topics related to therapeutic pancreatic endoscopy: Over the last 12 months, several case series have added to the literature on the short-term and long-term effectiveness of endoscopic therapy of pseudocysts, pancreatic abscesses and fistulas. Identification of a communication between pancreatic duct and a pseudocyst has been suggested to predict response to percutaneous drainage. The importance of identifying pancreatic leaks in patients with severe pancreatitis has been stressed. In addition, endotherapy has been reported to be effective in patients with idiopathic chronic pancreatitis. Endoscopic removal of pancreatic stones after extracorporeal lithotripsy has been shown to result in long-term improvement in clinical outcomes in patients with chronic calcific pancreatitis. Other interesting publications addressed new techniques and tricks to achieve access to the difficult pancreatic duct. Finally, no review of pancreatic endotherapy would be complete without a reminder--as recently stated by a National Institutes of Health consensus panel--that there is considerable need for higher-quality and controlled trials in this and other areas of interventional endoscopy. PMID:12510226
Mergener, K; Kozarek, R A
BACKGROUND: Increasing use of gastrointestinal endoscopy, particularly for colorectal cancer screening, and increasing emphasis on health care quality, highlight the need for clearly defined, evidence-based processes to support quality improvement in endoscopy. OBJECTIVE: To identify processes and indicators of quality and safety relevant to high-quality endoscopy service delivery. METHODS: A multidisciplinary group of 35 voting participants developed recommendation statements and performance indicators. Systematic literature searches generated 50 initial statements that were revised iteratively following a modified Delphi approach using a web-based evaluation and voting tool. Statement development and evidence evaluation followed the AGREE (Appraisal of Guidelines, REsearch and Evaluation) and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) guidelines. At the consensus conference, participants voted anonymously on all statements using a 6-point scale. Subsequent web-based voting evaluated recommendations for specific, individual quality indicators, safety indicators and mandatory endoscopy reporting fields. Consensus was defined a priori as agreement by 80% of participants. RESULTS: Consensus was reached on 23 recommendation statements addressing the following: ethics (statement 1: agreement 100%), facility standards and policies (statements 2 to 9: 90% to 100%), quality assurance (statements 10 to 13: 94% to 100%), training, education, competency and privileges (statements 14 to 19: 97% to 100%), endoscopy reporting standards (statements 20 and 21: 97% to 100%) and patient perceptions (statements 22 and 23: 100%). Additionally, 18 quality indicators (agreement 83% to 100%), 20 safety indicators (agreement 77% to 100%) and 23 recommended endoscopy-reporting elements (agreement 91% to 100%) were identified. DISCUSSION: The consensus process identified a clear need for high-quality clinical and outcomes research to support quality improvement in the delivery of endoscopy services. CONCLUSIONS: The guidelines support quality improvement in endoscopy by providing explicit recommendations on systematic monitoring, assessment and modification of endoscopy service delivery to yield benefits for all patients affected by the practice of gastrointestinal endoscopy.
Armstrong, David; Barkun, Alan; Bridges, Ron; Carter, Rose; de Gara, Chris; Dube, Catherine; Enns, Robert; Hollingworth, Roger; MacIntosh, Donald; Borgaonkar, Mark; Forget, Sylviane; Leontiadis, Grigorios; Meddings, Jonathan; Cotton, Peter; Kuipers, Ernst J; Valori, Roland
Gastrointestinal bleeding in individuals with Turner syndrome is relatively rare and there have been only a handful of reported cases in the literature. Here, we present two patients with Turner syndrome who were evaluated for obscure gastrointestinal bleeding. Our first patient presented with iron deficiency anemia and the work-up for a possible gastrointestinal bleed was pertinent only for polyps and a non-bleeding vein in the colon seen on colonoscopy. Our second patient had a history of unexplained recurrent melena and iron deficiency anemia, with previously normal esophagogastroduodenoscopies, colonoscopies and a Meckel's diverticulum scan. Both patients were subsequently diagnosed with gastrointestinal vascular malformations via capsule endoscopy. PMID:23368930
Bang, Ji Young; Peter, Shajan
Upper gastrointestinal tract cancers are one of the most important leading causes of cancer death worldwide. Diagnosis at late stages always brings about poor outcome of these malignancies. The early detection of precancerous or early cancerous lesions of gastrointestinal tract is therefore of utmost importance to improve the overall outcome and maintain a good quality of life of patients. The desire of endoscopists to visualize the invisibles under conventional white-light endoscopy has accelerated the advancements in endoscopy technologies. Nowadays, image-enhanced endoscopy which utilizes optical- or dye-based contrasting techniques has been widely applied in endoscopic screening program of gastrointestinal tract malignancies. These contrasting endoscopic technologies not only improve the visualization of early foci missed by conventional endoscopy, but also gain the insight of histopathology and tumor invasiveness, that is so-called optical biopsy. Here, we will review the application of advanced endoscopy technique in screening program of upper gastrointestinal tract cancers.
Chung, Chen-Shuan; Wang, Hsiu-Po
AIM: To summarize the magnitude and time trends of endoscopy-related claims and to compare total malpractice indemnity according to specialty and procedure. METHODS: We obtained data from a comprehensive database of closed claims from a trade association of professional liability insurance carriers, representing over 60% of practicing United States physicians. Total payments by procedure and year were calculated, and were adjusted for inflation (using the Consumer Price Index) to 2008 dollars. Time series analysis was performed to assess changes in the total value of claims for each type of procedure over time. RESULTS: There were 1901 endoscopy-related closed claims against all providers from 1985 to 2008. The specialties include: internal medicine (n = 766), gastroenterology (n = 562), general surgery (n = 231), general and family practice (n = 101), colorectal surgery (n = 87), other specialties (n = 132), and unknown (n = 22). Colonoscopy represented the highest frequencies of closed claims (n = 788) and the highest total indemnities ($54 093 000). In terms of mean claims payment, endoscopic retrograde cholangiopancreatography (ERCP) ranked the highest ($374??794) per claim. Internists had the highest number of total claims (n = 766) and total claim payment ($70??730??101). Only total claim payments for colonoscopy and ERCP seem to have increased over time. Indeed, there was an average increase of 15.5% per year for colonoscopy and 21.9% per year for ERCP after adjusting for inflation. CONCLUSION: There appear to be differences in malpractice coverage costs among specialties and the type of endoscopic procedure. There is also evidence for secular trend in total claim payments, with colonoscopy and ERCP costs rising yearly even after adjusting for inflation.
Hernandez, Lyndon V; Klyve, Dominic; Regenbogen, Scott E
Gastrointestinal endoscopy is gaining popularity for diagnostic and therapeutic purposes. However, concerns over endoscope-related nosocomial infections are increasing, together with interest by the general public in safe and efficient endoscopy. For this reason, reprocessing the gastrointestinal endoscope is an important step for effective performance of endoscopy. Disinfectants are essential to the endoscope reprocessing procedure. Before selecting an appropriate disinfectant, their characteristics, limitations and means of use must be fully understood. Herein, we review the characteristics of several currently available disinfectants, including their uses, potency, advantages, and disadvantages. Most disinfectants can be used to reprocess gastrointestinal endoscopes if the manufacturer's guidelines are followed. The selection and use of a suitable disinfectant depends on the individual circumstances of each endoscopy suite.
Park, Sanghoon; Koo, Ja Seol; Park, Jeong Bae; Lim, Yun Jeong; Hong, Su Jin; Kim, Sang-Woo; Chun, Hoon Jai
Peptic ulcer disease is a common cause of gastrointestinal bleeding, independent of the patient's age. With advancing age, an increase of lower gastrointestinal bleeding (diverticula, angiodysplasia) has been observed. The administration of non-steroidal anti-inflammatory drugs and aspirin is an important risk factor for upper and lower gastrointestinal bleeding, thus in patients aged 65 years and more a concomitant therapy with proton pump inhibitors is recommended in order to prevent ulcer bleeding. Even in very old individuals endoscopy should be used for the diagnosis of gastrointestinal bleeding, providing the opportunity for definite endoscopic bleeding therapy. In elderly patients with comorbidities and recurrent bleeding after endoscopic therapy or continuous blood loss, surgery or transarterial embolisation should be considered in good time. PMID:23460102
Diagnostic as well as therapeutic endoscopy has a decisive role in management of early postoperative haemorrhage. Endoscopy combines easy access to the upper and lower gastrointestinal tract and application of an array of interventional tools. In near future, even the small bowel will be accessible for diagnostic and therapeutic measures due to the advent of double-balloon enteroscopy. Thus, the endoscopist increasingly replaces the surgeon for diagnosis and therapy of postsurgical bleeding. Published data on frequency and aetiology of postoperative haemorrhage are scarce and mainly casuistic. Sources of gastrointestinal bleeding associated with surgery may be: anastomotic ulcers, mucosal ischaemia, 'stress' ulcers, reflux-induced lesions, coagulopathies (e.g. in sepsis or after organ transplantation) and aortoenteric fistula after bypass surgery. The endoscopist will frequently identify the culprit lesion and guide further management of the patient (e.g. endoscopic approach, repeated surgery, interventional radiology). All accessible lesions in postoperative haemorrhage should primarily be treated by endoscopic means, except aortoenteric fistulas. There is even a place for repeated endoscopy in recurrent bleeding. In the face of lacking controlled data, the endoscopist often has to rely on his personal experience in the selection of therapeutic options. PMID:15494279
Mayer, Gerhard; Lingenfelser, Thomas; Ell, Christian
Advanced medical imaging and visualization has a strong impact on research and clinical decision making in gastroenterology. The aim of this paper is to show how imaging and visualization can disclose structural and functional abnormalities of the gastrointestinal (GI) tract. Imaging methods such as ultrasonography, magnetic resonance imaging (MRI), endoscopy, endosonography, and elastography will be outlined and visualization with Virtual
Odd Helge Gilja; Jan G Hatlebakk; Svein Ødegaard; Arnold Berstad; Ivan Viola; Christopher Giertsen; Trygve Hausken; Hans Gregersen
Wireless capsule endoscopy (WCE) allows for com- fortable video explorations of the gastrointestinal (GI) tract, with special indication for the small bowel. In the other segments of the GI tract also accessible to probe gastroscopy and colonscopy, WCE still exhibits poorer diagnostic efficacy. Its main drawback is the impossibility of controlling the capsule movement, which is randomly driven by peristalsis
Federico Carpi; Nathan Kastelein; Michael Talcott; Carlo Pappone
While the wireless endoscopic capsule examining human's large gastrointestinal (GI) cavity, such as stomach and large intestine, many interested spots are omitted by only one or two cameras due to its limited field of view. This paper proposes the new system architecture of the Micro-Ball for medical endoscopy application. Six cameras are embedded in the Micro-Ball for multiple fields of
Yingke Gu; Xiang Xie; Guolin Li; Tianjia Sun; Qiang Zhang; Ziqiang Wang; Zhihua Wang
Endoscopic evaluation of the presence or absenceof gastritis is often performed in lieu of biopsy andhistologic diagnosis. The purpose of our study was toassess the value of endoscopic examination as a diagnostic test for gastritis. Twoendoscopists prospectively assessed the antrum of 73patients undergoing upper gastrointestinal endoscopy andgraded, on a scale of 0-4 (0 = completely absent, 4 = definitely present),
Patricia A. Belair; David C. Metz; Douglas O. Faigel; Emma E. Furth
Wireless capsule endoscopy (WCE) offers a feasible noninvasive way to detect the whole gastrointestinal (GI) tract and revolutionizes the diagnosis technology. However, compared with wired endoscopies, the limited working time, the low frame rate, and the low image resolution limit the wider application. The progress of this new technology is reviewed in this paper, and the evolution tendencies are analyzed to be high image resolution, high frame rate, and long working time. Unfortunately, the power supply of capsule endoscope (CE) is the bottleneck. Wireless power transmission (WPT) is the promising solution to this problem, but is also the technical challenge. Active CE is another tendency and will be the next geneion of the WCE. Nevertheless, it will not come true shortly, unless the practical locomotion mechanism of the active CE in GI tract is achieved. The locomotion mechanism is the other technical challenge, besides the challenge of WPT. The progress about the WPT and the active capsule technology is reviewed.
Pan, Guobing; Wang, Litong
Ectopic pancreas is defined as pancreatic tissue found outside the usual anatomic location. It is often found incidentally at different sites in the gastrointestinal (GI) tract. The incidence of ectopic pancreatic tissue in autopsy series is 1% to 2%, with 70% of the ectopic lesions found in the stomach, duodenum and jejunum. Although it is usually a silent anomaly, an ectopic pancreas may become clinically evident when complicated by inflammation, bleeding, obstruction or malignant transformation. We report a case of ectopic pancreas located in the jejunum and presenting as an obscure GI bleeding, which was diagnosed by capsule endoscopy. PMID:22977800
Lee, Mi-Jeong; Chang, Jae Hyuck; Maeng, Il Ho; Park, Jin Young; Im, Yun Sun; Kim, Tae Ho; Han, Sok-Won; Lee, Do Sang
New technology and increased screening examinations continue to cause the demand for gastrointestinal endoscopic procedures to mushroom. Hospitals administered by the Department of Veterans Affairs, public health care facilities, and health maintenance organizations struggle to meet this demand because of limited resources for expansion of space or staff. For the past 3 yr, we have used a physician assistant in our endoscopy laboratory to assist with and perform endoscopic procedures. The benefits for our hospital include increased staff efficiency, improved housestaff education, and ability to perform an increased number of procedures with existing staff. PMID:1353660
Lieberman, D A; Ghormley, J M
Background Gastrointestinal illness may result from either an underlying structural abnormality (e.g. neoplastic obstruction), or a functional\\u000a disorder (e.g. motor diarrhea), or both (e.g. achalasia with squamous esophageal cancer).\\u000a \\u000a \\u000a \\u000a \\u000a Aims The purpose of this study was to highlight the potential value and role of endoscopy in the recognition and management of\\u000a patients with functional and motility disorders.\\u000a \\u000a \\u000a \\u000a \\u000a Methods We performed a literature review
Yael Kopelman; George Triadafilopoulos
In the recent study delta-aminolevulinic acid/Protoporphyrin IX (5-ALA/PpIX) is used as fluorescent marker for dysplasia and tumor detection in esophagus and stomach. The 5-ALA is administered per os six hours before measurements at dose 20mg/kg weight. High-power light-emitting diode at 405 nm is used as an excitation source. Special opto-mechanical device is built for LED to use the light guide of standard video-endoscopic system (Olimpus Corp.). Through endoscopic instrumental channel a fiber is applied to return information about fluorescence to microspectrometer (USB4000, OceanOptics Inc.). Very good correlation between fluorescence signals and histology examination of the lesions investigated is achieved.
Borisova, E.; Vladimirov, B.; Angelov, I.; Avramov, L.
Virtual endoscopy is a computer-generated simulation of fiberoptic endoscopy, and its application to the study of the middle\\u000a ear has been recently proposed. The need to represent the middle ear anatomy by means of virtual endoscopy arose from the\\u000a increased interest of otolarygologists in transtympanic endoscopy. In fact, this imaging method allows the visualization of\\u000a middle ear anatomy with high
E. Neri; D. Caramella; M. Panconi; S. Berrettini; S. Sellari Franceschini; F. Forli; C. Bartolozzi
Obscure gastrointestinal haemorrhage is defined the presence of overt or occult bleeding in the setting of a normal endoscopic examination of the upper and lower gastrointestinal tracts. While obscure bleeding is not common, the evaluation and management of these patients often incurs considerable expense. Potential options for small bowel evaluation include traditional radiographic studies, push enteroscopy, video capsule endoscopy, deep enteroscopy, tagged red blood cell scans, angiography, and enterography examinations with either computed tomography and/or magnetic resonance imaging. The decision regarding which modality to employ depends on the cost of the procedure, its effectiveness in rendering a diagnosis, and the potential for administration of therapy. This article will discuss determination of costs associated with technology for small bowel imaging, quality of life data associated with chronic GI haemorrhage, and available cost-effectiveness studies comparing the options for small bowel exploration. PMID:22704574
Gerson, Lauren B
Occult gastrointestinal bleeding is defined as gastrointestinal bleeding that is not visible to the patient or physician, resulting in either a positive fecal occult blood test, or iron deficiency anemia with or without a positive fecal occult blood test. A stepwise evaluation will identify the cause of bleeding in the majority of patients. Esophagogastroduodenoscopy (EGD) and colonoscopy will find the bleeding source in 48 to 71 percent of patients. In patients with recurrent bleeding, repeat EGD and colonoscopy may find missed lesions in 35 percent of those who had negative initial findings. If a cause is not found after EGD and colonoscopy have been performed, capsule endoscopy has a diagnostic yield of 61 to 74 percent. Deep enteroscopy reaches into the mid and distal small bowel to further investigate and treat lesions found during capsule endoscopy or computed tomographic enterography. Evaluation of a patient who has a positive fecal occult blood test without iron deficiency anemia should begin with colonoscopy; asymptomatic patients whose colonoscopic findings are negative do not require further study unless anemia develops. All men and postmenopausal women with iron deficiency anemia, and premenopausal women who have iron deficiency anemia that cannot be explained by heavy menses, should be evaluated for occult gastrointestinal bleeding. Physicians should not attribute a positive fecal occult blood test to low-dose aspirin or anticoagulant medications without further evaluation. PMID:23547576
Bull-Henry, Kathy; Al-Kawas, Firas H
Wireless capsule endoscopy (WCE) can be considered an example of disruptive technology since it represents an appealing alternative to traditional diagnostic techniques. This technology enables inspection of the digestive system without discomfort or need for sedation, thus preventing the risks of conventional endoscopy, and has the potential of encouraging patients to undergo gastrointestinal (GI) tract examinations. However, currently available clinical products are passive devices whose locomotion is driven by natural peristalsis, with the drawback of failing to capture the images of important GI tract regions, since the doctor is unable to control the capsule's motion and orientation. To address these limitations, many research groups are working to develop active locomotion devices that allow capsule endoscopy to be performed in a totally controlled manner. This would enable the doctor to steer the capsule towards interesting pathological areas and to accomplish medical tasks. This review presents a research update on WCE and describes the state of the art of the basic modules of current swallowable devices, together with a perspective on WCE potential for screening, diagnostic, and therapeutic endoscopic procedures. PMID:22273791
Ciuti, Gastone; Menciassi, Arianna; Dario, Paolo
The preparation for video capsule endoscopy (VCE) of the bowel suggested by manufacturers of capsule endoscopy systems consists only of a clear liquid diet and an 8-hour fast. While there is evidence for a benefit from bowel preparation for VCE, so far there is no domestic consensus on the preparation regimen in Korea. Therefore, we performed this study to recommend guidelines for bowel preparation before VCE. The guidelines on VCE were developed by the Korean Gut Image Study Group, part of the Korean Society of Gastrointestinal Endoscopy. Four key questions were selected. According to our guidelines, bowel preparation with polyethylene glycol (PEG) solution enhances small bowel visualization quality (SBVQ) and diagnostic yield (DY), but it has no effect on cecal completion rate (CR). Bowel preparation with 2 L of PEG solution is similar to that with 4 L of PEG in terms of the SBVQ, DY, and CR of VCE. Bowel preparation with fasting or PEG solution combined with simethicone enhances the SBVQ, but it does not affect the CR of VCE. Bowel preparation with prokinetics does not enhance the SBVQ, DY, or CR of VCE. PMID:23614124
Song, Hyun Joo; Moon, Jeong Seop; Do, Jae Hyuk; Cha, In Hye; Yang, Chang Hun; Choi, Myung-Gyu; Jeen, Yoon Tae; Kim, Hyun Jung
The preparation for video capsule endoscopy (VCE) of the bowel suggested by manufacturers of capsule endoscopy systems consists only of a clear liquid diet and an 8-hour fast. While there is evidence for a benefit from bowel preparation for VCE, so far there is no domestic consensus on the preparation regimen in Korea. Therefore, we performed this study to recommend guidelines for bowel preparation before VCE. The guidelines on VCE were developed by the Korean Gut Image Study Group, part of the Korean Society of Gastrointestinal Endoscopy. Four key questions were selected. According to our guidelines, bowel preparation with polyethylene glycol (PEG) solution enhances small bowel visualization quality (SBVQ) and diagnostic yield (DY), but it has no effect on cecal completion rate (CR). Bowel preparation with 2 L of PEG solution is similar to that with 4 L of PEG in terms of the SBVQ, DY, and CR of VCE. Bowel preparation with fasting or PEG solution combined with simethicone enhances the SBVQ, but it does not affect the CR of VCE. Bowel preparation with prokinetics does not enhance the SBVQ, DY, or CR of VCE.
Song, Hyun Joo; Do, Jae Hyuk; Cha, In Hye; Yang, Chang Hun; Choi, Myung-Gyu; Jeen, Yoon Tae; Kim, Hyun Jung
Background: The risk factors for perforation from colorectal endoscopy have been well studied, but little is known about clinical outcomes beyond the immediate event. Objective: To evaluate short- and long-term outcomes of iatrogenic colorectal perforation following colorectal endoscopy. Design: Retrospective review over 16 years at a single tertiary care institution. Main Outcome Measures: Treatment interventions, morbidity and mortality rates, hospital length of stay, stoma closure rate, and long-term complications. Results: Of 132,259 colorectal endoscopies, 26 patients (0.02%) had a perforation (54% males; mean age, 67 years). The rectosigmoid colon was the most common site of perforation (65%). Thirty-eight percent of the perforations were recognized at the time of procedure, 31% presented within 24 hours, and 31% presented beyond 24 hours. Operative repair was undertaken in 85% of the patients, and 15% were managed with inpatient hospital observation. Primary repair was performed in 68% (defunctioning stoma in 18%). Mean hospital length of stay was 10.1 days. The overall postoperative complications rate was 55%, and wound complications were noted in 45%. The 30-day mortality rate was 19%. No death was observed beyond the first month. American Society of Anesthesiologists physical status Classes 3 and 4 were associated with mortality (p = 0.004). Of 7 patients who received a stoma, only 2 patients (29%) had stoma reversal. Long-term complications included incisional hernia (10%) and small-bowel obstruction (5%). Conclusions: Perforation following colorectal endoscopy was uncommon in this study but was associated with significant morbidity and mortality. An increased risk of death was noted with higher American Society of Anesthesiologists physical status class.
Tam, Michael S; Abbas, Maher A
Acute lower gastrointestinal haemorrhage secondary to small bowel ascariasis is extremely rare. A high level of suspicion should be maintained when dealing with acute gastrointestinal haemorrhage in migrants and travellers. Small bowel examination is warranted when carefully repeated upper and lower endoscopies have failed to elicit the source of bleeding. Appropriate test selection is determined by the availability of local expertise. We present a case of acute lower gastrointestinal haemorrhage secondary to jejunal ascariasis and a literature search on lower gastrointestinal haemorrhage associated with jejunal infestation with Ascaris.
Daphne Dewi, Stephen; Sze Li, Siow
Capsule endoscopy was conceived by Gabriel Iddan and Paul Swain independently two decades ago. These applications include but are not limited to Crohn's disease of the small bowel, occult gastrointestinal bleeding, non steroidal anti inflammatory drug induced small bowel disease, carcinoid tumors of the small bowel, gastro intestinal stromal tumors of the small bowel and other disease affecting the small bowel. Capsule endoscopy has been compared to traditional small bowel series, computerized tomography studies and push enteroscopy. The diagnostic yield of capsule endoscopy has consistently been superior in the diagnosis of small bowel disease compared to the competing methods (small bowel series, computerized tomography, push enteroscopy) of diagnosis. For this reason capsule endoscopy has enjoyed a meteoric success. Image quality has been improved with increased number of pixels, automatic light exposure adaptation and wider angle of view. Further applications of capsule endoscopy of other areas of the digestive tract are being explored. The increased transmission rate of images per second has made capsule endoscopy of the esophagus a realistic possibility. Technological advances that include a double imager capsule with a nearly panoramic view of the colon and a variable frame rate adjusted to the movement of the capsule in the colon have made capsule endoscopy of the colon feasible. The diagnostic rate for the identification of patients with polyps equal to or larger than 6 mm is high. Future advances in technology and biotechnology will lead to further progress. Capsule endoscopy is following the successful modern trend in medicine that replaces invasive tests with less invasive methodology. PMID:23189215
Adler, Samuel N; Bjarnason, Ingvar
Capsule endoscopy (CE) has been increasingly used for diagnosing disease of the small bowel. It is an attractive technique for assessing celiac disease (CD) because it is noninvasive and provides a close and magnified view of the mucosa of the entire small bowel. The aim of this paper is to update the current data on the use of CE for diagnosing villous atrophy and complications of CD.
Akin, E.; Ersoy, O.
Pediatric endoscopy has evolved from a purely observational modality into one with the potential for many therapeutic applications.\\u000a Common therapeutic uses of endoscopy in children now include treatment of variceal bleeds and foreign body retrieval and newer\\u000a procedures such as endoluminal gastroplication and endoscopic pyloromyotomy. Continuing research in pediatric endoscopy will\\u000a allow pediatric gastroenterologists to perfect existing interventional endoscopic techniques
Steven Liu; Petar Mamula; Chris A. Liacouras
Background: Many patients with upper gastrointestinal (GI) bleeding have a benign outcome and could receive less intensive and costly care if accurately identified. We sought to determine whether early endoscopy performed shortly after admission in the emergency department could significantly reduce the health care use and costs of caring for patients with nonvariceal upper GI bleeding without adversely affecting the
John G. Lee; Samuel Turnipseed; Patrick S. Romano; Heather Vigil; Rahman Azari; Norman Melnikoff; Ronald Hsu; Douglas Kirk; Peter Sokolove; Joseph W. Leung
Background: Patient infection from contaminated gastrointestinal (GI) endoscopes can generally be attributed to failure to follow appropriate reprocessing guidelines. Recently, the Food and Drug Administration recommended a 45-minute exposure of GI endoscopes to 2.4% glutaraldehyde solutions heated to 25° C. Simultaneously, the American Society for Gastrointestinal Endoscopy (ASGE), the American Gastroenterological Association, and the Society of Gastroenterology Nurses and Associates
Raynard J. Cheung; Daisy Ortiz; Anthony J. DiMarino
We report herein a female infant in whom a heterotopic pancreas in the stomach caused gastrointestinal hemorrhage during the newborn period. Endoscopy was essential for ruling out other causes of hemorrhage and to follow the patient until the time of elective surgery at 6 months of age. Heterotopic pancreas should be borne in mind as a rare cause of gastrointestinal
Shigeru Ueno; Haruo Ishida; Akira Hayashi; Shoichiro Kamagata; Masahiko Morikawa
INTRODUCTIONPharmacotherapy for upper gastrointestinal bleeding has been difficult to evaluate because clinical end points are infrequent and affected by other factors.AIMSTo evaluate whether blood in the stomach at endoscopy reflected severity of bleeding, predicted clinical outcomes, and could be altered by therapeutic agents.METHODSWe studied 414 consecutive admissions with suspected upper gastrointestinal bleeding. Patients were randomised to receive lansoprazole 60 mg
G M Hawkey; A T Cole; A S McIntyre; R G Long; C J Hawkey
As a result of European unification, new regulations valid within the territory of the European Union (EU) have been negotiated and published. As in other medical fields, the Medical Device Directive (MDD) is the most important new regulation and also effects endoscopy. In a transition period until June 1998, the MDD will be transposed into national law by the member states of the EU. Compliance with the MDD and other European regulations is indicated by the CE mark affixed to the product. PMID:8565892
Wächter, M; Diekjobst, T
The future of endoscopy will be dictated by rapid technological advances in the development of light sources, optical fibers, and miniature scanners that will allow for images to be collected in multiple spectral regimes, with greater tissue penetration, and in three dimensions. These engineering breakthroughs will be integrated with novel molecular probes that are highly specific for unique proteins to target diseased tissues. Applications include early cancer detection by imaging molecular changes that occur before gross morphological abnormalities, personalized medicine by visualizing molecular targets specific to individual patients, and image guided therapy by localizing tumor margins and monitoring for recurrence.
Elahi, Sakib F.; Wang, Thomas D.
Bleeding in the digestive tract is one of the most common gastrointestinal (GI) tract diseases, as well as the complication\\u000a of some fatal diseases. Wireless capsule endoscopy (WCE), which is widely applied in the clinical field, allows physicians\\u000a to noninvasively examine the entire GI tract. However, it is very laborious and time-consuming to detect the huge amount of\\u000a WCE images,
Guo-bing Pan; Guo-zheng Yan; Xin-shuai Song; Xiang-ling Qiu
Wireless capsule endoscopy has become a common procedure for diagnostic inspection of gastrointestinal tract. This method offers a less-invasive alternative to traditional endoscopy by eliminating uncomfortable procedures of the traditional endoscopy. Moreover, it provides the opportunity for exploring inaccessible areas of the small intestine. Current capsule endoscopes, however, move by peristalsis and are not capable of detailed and on-demand inspection of desired locations. Here, we propose and develop two wireless endoscopes with maneuverable vision systems to enhance diagnosis of gastrointestinal disorders. The vision systems in these capsules are equipped with mechanical actuators to adjust the position of the camera. This may help to cover larger areas of the digestive tract and investigate desired locations. The preliminary experimental results showed that the developed platform could successfully communicate with the external control unit via human body and adjust the position of camera to limited degrees.
Rasouli, Mahdi; Kencana, Andy Prima; Huynh, Van An; Ting, Eng Kiat; Lai, Joshua Chong Yue; Wong, Kai Juan; Tan, Su Lim; Phee, Soo Jay
Advances in video technology are being incorporated into today"s healthcare practice. For example, colonoscopy is an important screening tool for colorectal cancer. Colonoscopy allows for the inspection of the entire colon and provides the ability to perform a number of therapeutic operations during a single procedure. During a colonoscopic procedure, a tiny video camera at the tip of the endoscope generates a video signal of the internal mucosa of the colon. The video data are displayed on a monitor for real-time analysis by the endoscopist. Other endoscopic procedures include upper gastrointestinal endoscopy, enteroscopy, bronchoscopy, cystoscopy, and laparoscopy. However, a significant number of out-of-focus frames are included in this type of videos since current endoscopes are equipped with a single, wide-angle lens that cannot be focused. The out-of-focus frames do not hold any useful information. To reduce the burdens of the further processes such as computer-aided image processing or human expert"s examinations, these frames need to be removed. We call an out-of-focus frame as non-informative frame and an in-focus frame as informative frame. We propose a new technique to classify the video frames into two classes, informative and non-informative frames using a combination of Discrete Fourier Transform (DFT), Texture Analysis, and K-Means Clustering. The proposed technique can evaluate the frames without any reference image, and does not need any predefined threshold value. Our experimental studies indicate that it achieves over 96% of four different performance metrics (i.e. precision, sensitivity, specificity, and accuracy).
An, Yong Hwan; Hwang, Sae; Oh, JungHwan; Lee, JeongKyu; Tavanapong, Wallapak; de Groen, Piet C.; Wong, Johnny
Ingestion of disk batteries may have serious complications such as esophageal burn, perforation, and tracheoesophageal fistula, particularly when the battery is caught in the esophagus. Proper placement of the tracheal tube is critical when tracheoesophageal fistula was occurred from esophageal impaction the battery. Endoscopy of upper gastrointestinal tract in infants and children is an important and effective tool for the diagnosis and treatment of foreign body ingestion. But upper gastrointestinal endoscopy in infant and children has very high risk of tracheal compression and airway compromise. We present a case of ventilatory compromise during insertion of the upper gastrointestinal endoscopy in 16-month-old child with tracheoesophageal fistula secondary to disk battery ingestion.
Kim, Kyung-Woo; Kim, Jung Won; Park, Jang Su; Choe, Won Joo; Kim, Kyung-Tae; Lee, Sangil
AIM: To evaluate the diagnostic value of endoscopy in patients with gastrointestinal graft-versus-host disease (GI GVHD). METHODS: We identified 8 patients with GI GVHD following allogeneic hematopoietic stem cell trans- plantation (HSCT). GVHD was defined histologically as the presence of gland apoptosis, not explained by other inflammatory or infectious etiologies. RESULTS: The symptoms of GI GVHD included anorexia, nausea, vomiting,
Chun-Fang Xu; Lan-Xiang Zhu; Xiao-Ming Xu; Wei-Chang Chen; De-Pei Wu
The efficacy of cimetidine in the prevention of gastrointestinal haemorrhage in a general intensive care unit was evaluated in 221 patients by a placebo controlled double blind randomised study. Criteria for bleeding were (i) haematemesis or gastric aspirate greater than 50 ml fresh blood, (ii) melaena or fresh blood per rectum with an upper source verified by endoscopy if the
A Groll; J B Simon; R D Wigle; K Taguchi; R J Todd; W T Depew
Gastrointestinal (GI) endoscopic procedure has become an essential modality for evaluation and treatment of GI diseases. Intravenous (IV) sedation and General Anesthesia (GA) have both been employed to minimize discomfort and provide amnesia. Both these procedures require, at the very least, monitoring of the level of consciousness, pulmonary ventilation, oxygenation and hemodynamics. Although GI endoscopy is considered safe, the procedure
Abdul Q Dar; Zahoor A Shah; Sheri Kashmir; Kazuki Sumiyama; Nishi Shinbashi; Shah Z. A. Anesthesia
Wireless capsule endoscopy is a medical procedure which has revolutionized endoscopy as it has enabled for the first time a painless inspection of the small intestine. The procedure was unveiled in 2000 and is based on a vitamin- size pill which captures images of the digestive tract while it is transported passively by peristalsis. The device consists of an image
Andrea Moglia; Arianna Menciassi; Paolo Dario
The use of a network of reference stations instead of a single reference station allows the modelling of some systematic errors in a region and allows a user to increase the distance between the rover receiver and reference stations. In some countries, GPS reference stations exist and GPS observations are available for users in real-time mode and in post-processing. Observations from several GPS reference stations in a regional network enable modelling spatially-correlated errors and their modelling on an epoch-by-epoch and satellite-by-satellite basis. As a result, observations of a virtual reference station can be created at a rover's approximate position and its observations can be used in the precise baseline positioning of the rover. This paper presents the performance of the static positioning of a rover station, its quality and reliability for two different baselines. Single-baseline and network static solutions are presented and compared. Network solutions are based on data from a virtual reference station (VRS) obtained by the Wasoft/Virtuall software. In both cases, the same strategy of ambiguity resolution was used. These approaches have been tested with the use of 24-hour GPS data from the Polish Active Geodetic Network (ASG-PL). The data from three reference stations with medium-range separation were used in the process of generating VRS data. GPS data of the rover station were divided into 20, 10 and 5-min. sessions with a sampling interval of 5 sec. Practical calculations and analyses of horizontal and vertical accuracy of coordinates clearly show the improvement of static positioning in terms of time observation span and ambiguity reliability.
In the recent past, the introduction of miniaturised image sensors with low power consumption, based on complementary metal oxide semiconductor (CMOS) technology, has allowed the realisation of an ingestible wireless capsule for the visualisation of the small intestine mucosa. The device has received approval from Food and Drug Administration and has gained momentum since it has been more successful than traditional techniques in the diagnosis of small intestine disorders. In 2004 an esophagus specific capsule was launched, while a solution for colon is still under development. However, present solutions suffer from several limitations: they move passively by exploiting peristalsis, are not able to stop intentionally for a prolonged diagnosis, they receive power from an internal battery with short length, and their usage is restricted to one organ, either small bowel or esophagus. However the steady progresses in many branches of engineering, including microelectromechanical systems (MEMS), are envisaged to affect the performances of capsular endoscopy. The near future foreshadows capsules able to pass actively through the whole gastrointestinal tract, to retrieve views from all organs and to perform drug delivery and tissue sampling. In the long term, the advent of robotics could lead to autonomous medical platforms, equipped with the most advanced solutions in terms of MEMS for therapy and diagnosis of the digestive tract. In this review, we discuss the state of the art of wireless capsule endoscopy (WCE): after a description on the current status, we present the most promising solutions. PMID:17160703
Moglia, Andrea; Menciassi, Arianna; Schurr, Marc Oliver; Dario, Paolo
Background and Study Aims. The presence of an implantable electromechanical cardiac device (IED) has long been considered a relative contraindication to the performance of video capsule endoscopy (CE). The primary aim of this study was to evaluate the safety of CE in patients with IEDs. A secondary purpose was to determine whether IEDs have any impact on images captured by CE. Patients and Methods. A retrospective chart review of all patients who had a capsule endoscopy at Mayo Clinic in Scottsdale, AZ, USA, or Rochester, MN, USA, (January 2002 to June 2010) was performed to identify CE studies done on patients with IEDs. One hundred and eighteen capsule studies performed in 108 patients with IEDs were identified and reviewed for demographic data, method of preparation, and study data. Results. The most common indications for CE were obscure gastrointestinal bleeding (77%), anemia (14%), abdominal pain (5%), celiac disease (2%), diarrhea (1%), and Crohn's disease (1%). Postprocedure assessments did not reveal any detectable alteration on the function of the IED. One patient with an ICD had a 25-minute loss of capsule imaging due to recorder defect. Two patients with LVADs had interference with capsule image acquisition. Conclusions. CE did not interfere with IED function, including PM, ICD, and/or LVAD and thus appears safe. Additionally, PM and ICD do not appear to interfere with image acquisition but LVAD may interfere with capsule images and require that capsule leads be positioned as far away as possible from the IED to assure reliable image acquisition.
Harris, Lucinda A.; Hansel, Stephanie L.; Rajan, Elizabeth; Srivathsan, Komandoor; Rea, Robert; Crowell, Michael D.; Fleischer, David E.; Pasha, Shabana F.; Gurudu, Suryakanth R.; Heigh, Russell I.; Shiff, Arthur D.; Post, Janice K.; Leighton, Jonathan A.
Background Familial adenomatous polyposis (FAP) is a hereditary disorder characterized by polyposis along the gastrointestinal tract. Information on adenoma status below the duodenum has previously been restricted due to its inaccessibility in vivo. Capsule Endoscopy (CE) may provide a useful adjunct in screening for polyposis in the small bowel in FAP patients. This study aims to evaluate the effectiveness of CE in the assessment of patients with FAP, compared to other imaging modalities for the detection of small bowel polyps. Method 20 consecutive patients with previously diagnosed FAP and duodenal polyps, presenting for routine surveillance of polyps at The Royal Melbourne Hospital were recruited. Each fasted patient initially underwent a magnetic resonance image (MRI) of the abdomen, and a barium small bowel follow-through study. Capsule Endoscopy was performed four weeks later on the fasted patient. An upper gastrointestinal side-viewing endoscopy was done one (1) to two (2) weeks after this. Endoscopists and investigators were blinded to results of other investigations and patient history. Results Within the stomach, upper gastrointestinal endoscopy found more polyps than other forms of imaging. SBFT and MRI generally performed poorly, identifying fewer polyps than both upper gastrointestinal and capsule endoscopy. CE was the only form of imaging that identified polyps in all segments of the small bowel as well as the only form of imaging able to provide multiple findings outside the stomach/duodenum. Conclusion CE provides important information on possible polyp development distal to the duodenum, which may lead to surgical intervention. The place of CE as an adjunct in surveillance of FAP for a specific subset needs consideration and confirmation in replication studies. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12608000616370
Accessing the bypassed portion of the stomach via conventional endoscopy is difficult following Roux-en-Y gastric bypass surgery. However, endoscopic examination of the stomach and small bowel is possible through percutaneous access into the bypassed stomach (BS) with a combined radiologic and endoscopic technique. We present a case of obscure overt gastrointestinal (GI) bleeding where the source of bleeding was thought to be from the BS. After conventional endoscopic methods failed to examine the BS, percutaneous endoscopy (PE) was used as an alternative to surgical exploration. PMID:18350638
Gill, Kanwar-Rs; McKinney, J-Mark; Stark, Mark-E; Bouras, Ernest-P
Obscure gastrointestinal bleeding (OGIB) is defined as bleeding from the gastrointestinal tract that persists or recurs after a negative initial evaluation using bidirectional endoscopy and radiologic imaging with small-bowel radiograph. The main challenges related to evaluation of OGIB include the high miss rate for lesions on initial evaluation with standard endoscopy and the limited capacity of older diagnostic modalities to effectively examine the small bowel. The introduction of capsule endoscopy, balloon-assisted enteroscopy, spiral enteroscopy, and computed tomography (CT) enterography have served to overcome the limitations of older diagnostic tests. Capsule endoscopy is currently recommended as the third test of choice in the evaluation of patients with OGIB, after a negative bidirectional endoscopy. Balloon-assisted enteroscopy is useful for both the diagnosis and endoscopic management of OGIB. CT enterography is superior to small-bowel radiograph for luminal and extraluminal small-bowel examination. These advances in small-bowel diagnostics and the capacity to successfully perform endoscopic therapeutics have largely replaced surgical procedures and resulted in a trend toward noninvasive evaluation and endoscopic management of OGIB.
Hara, Amy K.; Leighton, Jonathan A.
This book contains 33 selections. Some of the titles are: The natural history of colorectal cancer; opportunities for intervention; Radiotherapy for early rectal cancer; Intraoperative irradiation for gastrointestinal cancers; Hepatocellular carcinoma; clinical presentation, etiology, and prevention; and Current issues in the treatment of patients with gastric cancer.
Capsule endoscopy (CE) avoids the ionizing radiation, deep sedation, and general anesthesia required by other imaging modalities, making it particularly valuable in the evaluation of gastrointestinal disease in pediatric patients. In examining the use of CE in pediatric and adult patients through a review of the literature, it was observed that CE is most frequently indicated for the evaluation of Crohn's disease (CD) in pediatric patients and most frequently indicated for obscure gastrointestinal bleeding (OGIB) in adults, although OGIB is a more frequent indication than CD in pediatric patients younger than 8 years of age. Diagnostic accuracy has been good and comparable to that of magnetic resonance enterography, and capsule retention rates as well as other adverse events appear to be low in pediatric patients. Research is needed to explore broader indications and applications of CE in the diagnosis and monitoring of gastrointestinal disease. PMID:23983653
Cohen, Stanley A
Background: A modified Group Health Association of America-9 survey (mGHAA-9) was recently proposed for measurement of patient satisfaction with endoscopy. It is unknown whether the mGHAA-9 addresses the issues most important to this outcome. Methods: A 15-item survey of factors potentially important to patient satisfaction with endoscopy was developed, including the 6 core mGHAA-9 items. Respondents were asked to rank
Robert F. Yacavone; G. Richard Locke; Christopher J. Gostout; Todd H. Rockwood; Sarah Thieling; Alan R. Zinsmeister
Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal (GI) tract, affecting about 2% of the population. Most cases of Meckel's diverticula are asymptomatic. The diagnosis of symptomatic MD is often difficult to make. We report the case of an 8-year-old boy who presented with GI bleeding due to MD. The diagnostic difficulties after an initial negative endoscopic evaluation and the diagnostic value of the various endoscopic procedures are discussed. The patient had suffered from bright red stools for 20 h before hospital admission. GI scintigraphy with 99mTc-Na-pertechnetate was negative for heterotopic gastric tissue in the small bowel area. Colonoscopy performed in order to exclude Crohn's disease was also negative. He was placed on ranitidine at a dose of 6 mg/kg body weight twice daily. The patient remained asymptomatic over a period of 6 months before he was readmitted due to macroscopic rectal bleeding. Upper endoscopy and colonoscopy used to investigate the source of bleeding showed normal macroscopic findings. Radiolabeling of blood constituents with 99mTc on delayed imaging showed radionucleotide concentration in the ascending and transverse colon suggestive of a lesion in the ileocecal area. Further investigation with the use of wireless capsule endoscopy revealed a MD. Wireless capsule endoscopy may thus be indicated for patients with GI blood loss when other diagnostic methods, such as upper and lower endoscopy and colonoscopy, have failed to identify the source of bleeding.
Xinias, I.; Mavroudi, A.; Fotoulaki, M.; Tsikopoulos, G.; Kalampakas, A.; Imvrios, G.
Four consecutive patients with systemic mastocytosis were studied. One patient had a malabsorption syndrome with only minor histological changes of the intestinal mucosa. Another patient with ulcer diathesis had a gastric secretory pattern resembling Zollinger-Ellison syndrome. Serum gastrin and histamine levels were consistently normal in all patients. Endoscopy of stomach and colon disclosed urticaria-like papulae either spontaneously or after topical provocation in all patients. No increase of mast cells was found in multiple mucosal biopsies. A markedly increased gastric tissue content of histamine was found, however, in the three patients studied. The findings suggest that urticaria-like lesions associated with a high tissue content of histamine may be more important that hyperhistaminaemia in causing the various gastrointestinal symptoms.
Ammann, R W; Vetter, D; Deyhle, P; Tschen, H; Sulser, H; Schmid, M
Non-Hodgkin lymphomas affecting extranodal tissues can be primitive or secondary. The area most frequently involved is the gastrointestinal tract. MALT-type lymphomas are B-cell lymphomas characterized by small cells originating from the lymphoid tissue of the mucosa. The criteria for a correct diagnosis of extranodal lymphomas are morphological, but include immunophenotypic and immunogenotypic analysis. Gastrointestinal lymphomas consist of B-cell and T-cell lymphomas. B cell-lymphomas include: small cell B-lymphomas, large cell B-lymphomas, immunoproliferative small intestinal disease; multiple lymphomatous polyposis, follicular lymphomas, B-cell lymphomas centrocytic type. T-cell lymphomas include enteropathy-associated and non enteropathy-associated lymphomas. PMID:8539463
Baroni, C D
Background Radiomicrosphere therapy (RT) utilizing yttrium-90 (90Y) microspheres has been shown to be an effective regional treatment for primary and secondary hepatic malignancies. We sought to determine a large academic institution's experience regarding the extent and frequency of gastrointestinal complications. Methods Between 2004 and 2007, 27 patients underwent RT for primary or secondary hepatic malignancies. Charts were subsequently reviewed to determine the incidence and severity of GI ulceration. Results Three patients presented with gastrointestinal bleeding and underwent upper endoscopy. Review of the pretreatment angiograms showed normal vascular anatomy in one patient, sclerosed hepatic vasculature in a patient who had undergone prior chemoembolization in a second, and an aberrant left hepatic artery in a third. None had undergone prophylactic gastroduodenal artery embolization. Endoscopic findings included erythema, mucosal erosions, and large gastric ulcers. Microspheres were visible on endoscopic biopsy. In two patients, gastric ulcers were persistent at the time of repeat endoscopy 1–4 months later despite proton pump inhibitor therapy. One elderly patient who refused surgical intervention died from recurrent hemorrhage. Conclusion Gastrointestinal ulceration is a known yet rarely reported complication of 90Y microsphere embolization with potentially life-threatening consequences. Once diagnosed, refractory ulcers should be considered for aggressive surgical management.
South, Christopher D; Meyer, Marty M; Meis, Gregory; Kim, Edward Y; Thomas, Fred B; Rikabi, Ali A; Khabiri, Hooman; Bloomston, Mark
The origin, subtypes, physiology and pharmacology of botulinum toxin type A (BTX-A) have been discussed in other chapters.\\u000a In this chapter, some of the current applications of BTX in gastroenterology are discussed. BTX has been used for a large\\u000a number of gastrointestinal disorders, however, this chapter is confined to those conditions for which the best data are available\\u000a (achalasia, gastroparesis,
Shayan Irani; Frank K. Friedenberg
We report the case history of a 28-year-old homosexual man of Caucasian origin whose diagnosis of acquired immunodeficiency syndrome was established one year before admission on the basis of a positive human immunodeficiency virus serology and cutaneous Kaposi's sarcoma. Severe postprandial vomiting pointed to bowel obstruction in an emaciated, poor risk patient. Endoscopy revealed multifocal, violaceous tumours throughout the upper gastrointestinal tract which, eventually, obstructed the duodenum. Histology confirmed the putative diagnosis of gastrointestinal Kaposi's sarcoma, which responded well to monochemotherapy with vincristine. Significant clinical improvement and repeat endoscopy indicated tumour regression and resolution of bowel obstruction. PMID:7871860
Lingenfelser, T; Daiss, W; Overkamp, D; Weber, P
Background: The aim of this study was to analyze the learning curve for the GI Mentor II endoscope trainer and to determine whether psychomotor training can contribute to an improvement in the performance of virtual colonoscopy. Methods: To analyze the learning curve, 28 subjects were divided into three groups on the basis of their experience with gastrointestinal (GI) endoscopy: experienced
A. Eversbusch; T. P. Grantcharov
Background Gastrointestinal stromal tumors (GISTs) are relatively common mesenchymal tumors of the digestive tract characterized by c-KIT\\u000a mutations. This is a comprehensive review of the current data of the literature on the various aspects of the diagnosis and\\u000a treatment of these tumors.\\u000a \\u000a \\u000a \\u000a \\u000a Methods The stomach is the most commonly involved site for these tumors in the digestive tract. Computed tomography and endoscopy
Anastasios Machairas; Eva Karamitopoulou; Dimitrios Tsapralis; Theodore Karatzas; Nickolas Machairas; Evangelos P. Misiakos
Twenty-seven children aged 1 day to 16 years studied arteriographically for acute or chronic gastrointestinal bleeding were reviewed. Children with known esophageal varices and portal hypertension were excluded. Final diagnoses were made in 25 patients by means of surgery, endoscopy, biopsy, laboratory data, and clinical follow-up. Of these 25 cases, arteriography gave a correct diagnosis in 64% and was falsely negative in 36%. The common causes of bleeding in this study were gastric and duodenal ulcers, gastritis, vascular malformations, and typhlitis. Transcatheter therapy was attempted in six acute bleeders, with success in three (50%).
Meyerovitz, M.F.; Fellows, K.E.
With the widespread application of endoscopic submucosal dissection for the treatment of gastrointestinal neoplasms, accurate determination of the invasion depth prior to intervention has become an indispensable part of treatment planning. Narrow-band imaging (NBI) is a novel endoscopic technique that may enhance the accuracy of diagnosis. Magnifying endoscopy with NBI has been shown to be effective for determining invasion depth for intrapapillary capillary loop classification of esophageal cancer and microvascular pattern of stomach cancer. Such precise pre-treatment staging of early neoplastic lesions in the gastrointestinal tract warrants timely initiation of disease-tailored treatment and, ultimately, better quality of life and improved patient survival.
The recent advances in integrated circuit technology, wireless communication, and sensor technology have opened the door for development of miniature medical devices that can be used for enhanced monitoring and treatment of medical conditions. Wireless capsule endoscopy is one of such medical devices that has gained significant attention during the past few years. It is envisaged that future wireless capsule endoscopies replace traditional endoscopy procedures by providing advanced functionalities such as active locomotion, body fluid/tissue sampling, and drug delivery. Development of energy-efficient miniaturized actuation mechanisms is a key step toward achieving this goal. Here, we review some of the actuators that could be integrated into future wireless capsules and discuss the existing challenges.
Lin, Lin; Rasouli, Mahdi; Kencana, Andy Prima; Tan, Su Lim; Wong, Kai Juan; Ho, Khek Yu; Phee, Soo Jay
We prospectively evaluated 139 consecutive children presenting to the Sanjay Gandhi Postgraduate Institute of Medical Sciences (Lucknow, India) with gastrointestinal (GI) bleeding from January 1991 to November 1994. Our aims were to find out whether the causes of GI bleeding in a developing country differed from developed countries and how the application of newer diagnostic techniques would help in the diagnosis of GI bleeding. Barium studies, endoscopy, technetium-99m-labelled (erythrocytes and pertechnetate) scans, selective abdominal angiography using a digital subtraction technique and rectal endoscopic ultrasonography were performed. Upper GI bleeding (n = 75) was variceal in 71 (95%) children (extrahepatic portal venous obstruction in 65, cirrhosis in six) and non-variceal in four (5%) cases (Henoch-Schonlein purpura, idiopathic thrombocytopenic purpura, drug-induced gastric erosions and pseudoaneurysm of the gastroduodenal artery due to idiopathic chronic calcific pancreatitis). Causes of lower GI bleeding (n = 64) were colitis (27 cases; 42%), colorectal polyps (26 cases; 41%), enteric fever (n = 3), solitary rectal ulcer (n = 3), portal hypertensive colopathy (n = 2), colonic arteriovenous malformation (n = 1) and internal haemorrhoids (n = 1). One patient remained undiagnosed. Angiography performed in four children was diagnostic in two. In one child with massive lower GI bleeding from portal colopathy, the bleeding site (caecum) was localized by intra-operative colonoscopy, while in the other child with portal colopathy, rectal endoscopic ultrasonography was performed to substantiate the diagnosis. We conclude that the causes of upper GI bleeding in children in developing countries are different from those in developed countries (variceal bleeding due to extrahepatic portal venous obstruction is the most common cause, while peptic ulcer is rare). However, the spectrum of lower GI bleeding is similar to that of developed countries. Application of newer diagnostic techniques is helpful and safe in the identification of the cause of GI bleeding in children. PMID:8912124
Yachha, S K; Khanduri, A; Sharma, B C; Kumar, M
Gastrointestinal (GI) malignancies are notorious for frequently progressing to advanced stages even in the absence of serious symptoms, thus leading to delayed diagnoses and dismal prognoses. Secondary prevention of GI malignancies through early detection and treatment of cancer-precursor/premalignant lesions, therefore, is recognized as an effective cancer prevention strategy. In order to efficiently detect these lesions, systemic application of screening tests (surveillance) is needed. However, most of the currently used non-invasive screening tests for GI malignancies (for example, serum markers such as alpha-fetoprotein for hepatocellular carcinoma, and fecal occult blood test, for colon cancer) are only modestly effective necessitating the use of highly invasive endoscopy-based procedures, such as esophagogastroduodenoscopy and colonoscopy for screening purposes. Even for hepatocellular carcinoma where non-invasive imaging (ultrasonography) has become a standard screening tool, the need for repeated liver biopsies of suspicious liver nodules for histopathological confirmation can’t be avoided. The invasive nature and high-cost associated with these screening tools hinders implementation of GI cancer screening programs. Moreover, only a small fraction of general population is truly predisposed to developing GI malignancies, and indeed needs surveillance. To spare the average-risk individuals from superfluous invasive procedures and achieve an economically viable model of cancer prevention, it’s important to identify cohorts in general population that are at substantially high risk of developing GI malignancies (risk-stratification), and select suitable screening tests for surveillance in these cohorts. We herein provide a brief overview of such high-risk cohorts for different GI malignancies, and the screening strategies that have commonly been employed for surveillance purpose in them.
Tiwari, Ashish K; Laird-Fick, Heather S; Wali, Ramesh K; Roy, Hemant K
AIM: To evaluate the diagnostic value of endoscopy in patients with gastrointestinal graft-versus-host disease (GI GVHD). METHODS: We identified 8 patients with GI GVHD following allogeneic hematopoietic stem cell trans-plantation (HSCT). GVHD was defined histologically as the presence of gland apoptosis, not explained by other inflammatory or infectious etiologies. RESULTS: The symptoms of GI GVHD included anorexia, nausea, vomiting, watery diarrhea, abdominal pain, GI bleeding, etc. Upper endoscopic appearance varied from subtle mucosal edema, hyperemia, erythema to obvious erosion. Colonoscopic examination showed diffuse edema, hyperemia, patchy erosion, scattered ulcer, sloughing and active bleeding. Histological changes in GI GVHD included apoptosis of crypt epithelial cells, dropout of crypts, and lymphocytic infiltration in epithelium and lamina propria. The involvement of stomach and rectocolon varied from diffuse to focal. CONCLUSION: Endoscopy may play a significant role in early diagnosis of GI GVHD patients following allogeneic HSCT, and histologic examination of gastrointestinal biopsies is needed to confirm the final diagnosis.
Xu, Chun-Fang; Zhu, Lan-Xiang; Xu, Xiao-Ming; Chen, Wei-Chang; Wu, De-Pei
A case of primary small bowel adenocarcinoma is reported because of the rarity of this malignancy. Interestingly, the location of the tumour was in jejunum, instead of the most common site in duodenum. The clinical presentation was anemia, with positive fecal blood test, under antiaggregant platelet treatment for coronary heart disease, initially related to endoscopic evidence of erosive gastroduodenitis. The exacerbation of gastrointestinal bleeding during proton pump inhibitors therapy and the recurrence of abdominal pain caused careful investigation. The source of the obscure gastrointestinal bleeding had been achieved by wireless capsule endoscopy, because of not diagnostic findings of conventional upper endoscopy control, colonscopy, double contrast enteroclysis and selective arteriography. The primary definitive therapy was a radical resection of the jejunal neoplastic loop, important prognostic factor. PMID:17147051
Gastrointestinal vascular malformations are a rare cause of acute or chronic blood loss. Usually they are treated by endoscopic obliteration or surgical resection. When such a therapy is inapplicable, pharmacotherapy may be required. At the age of 15 years, our female patient suffered from transfusion dependent recurrent gastrointestinal haemorrhage due to multiple gastrointestinal vascular malformations. Gastroscopy, coloscopy and capsule endoscopy revealed numerous foci making both endoscopic obliteration and complete surgical resection impossible. Neither regular transfusions nor substitution with coagulation factors were helpful. However, subcutaneous octreotide resulted in immediate stop of bleeding. Initial treatment by daily subcutaneous injections was followed by monthly depot application. Over 3 years only 2 transfusions had to be given. The patient required thyroxin substitution, otherwise, no side effects occurred and the girl had a good quality of life. The authors conclude that octreotide is safe and effective in gastrointestinal angiodysplasias inaccessible to endoscopy or surgery.
Classen, Carl Friedrich; Haffner, Dieter; Hauenstein, Christina; Wolf, Ricarda; Kyank, Ulrike
Primary gastrointestinal lymphoma represents approximately 1% of all gastrointestinal neoplasms. Gastric involvement is more common than small or large intestine and carries a better prognosis. Abdominal pain and weight loss may be the only manifestations and may be present for months or years before the diagnosis is made. Perforation and obstruction occur infrequently. Multiple tumors constitute 8% of cases. Although barium studies and endoscopy reveal the lesion in a high percentage of cases, exploratory celiotomy is not infrequently required for diagnosis. Only one-third of lymphomas are confined to the bowel at laparotomy. Histologically one-third are reticulum cell sarcomas and the remainder lymphosarcoma or lymphocytic lymphoma. Five year survival overall was 38%. Curative resections yielded a survival of 60% regardless of site while palliative resections offered only a 17% chance of cure. As expected, survival was inversely proportional to extent of nodal spread. Postoperative radiotherapy is recommended for residual disease.
Contreary, K; Nance, F C; Becker, W F
Obscure gastrointestinal bleeding (OGIB) is one of the most challenging disorders faced by gastroenterologists because of its evasive nature and difficulty in identifying the exact source of bleeding. Recent technological advances such as video capsule endoscopy and small bowel deep enteroscopy have revolutionized the diagnosis and management of patients with OGIB. In this paper, we review the various diagnostic and therapeutic options available for the management of patients with OGIB.
Kochhar, Gursimran S.; Sanaka, Madhusudhan R.
ObjectiveTo compare the rates of clinically significant gastrointestinal bleeding and the number of blood units and endoscopies required for gastrointestinal hemorrhage between patients receiving or not receiving stress-ulcer prophylaxis.DesignHistorical observational study comparing two consecutive periods: with (phase 1) and without stress-ulcer prophylaxis (phase 2).Design and settingA 17-bed intensive care unit in a university teaching hospital.PatientsIn phase 1 there were 736
Christophe Faisy; Emmanuel Guerot; Jean-Luc Diehl; Eléonore Iftimovici; Jean-Yves Fagon
Complaints related to gastrointestinal gas are commonly encountered in clinical practice. Various therapies have been proposed, yet none has appeared to be extremely effective. A review of the literature revealed little hard evidence to support the use of simethicone, pancreatic enzymes, anticholinergic agents or antibiotics. Evidence supporting the use of prokinetic agents has been the strongest, and there may be a pathophysiologic basis for the use of these agents if the complaints are related to abnormal intestinal motility. The use of activated charcoal for adsorbing intestinal gas has been effective in healthy subjects but has not been properly investigated in patients with gas complaints. Dietary modification may be beneficial in certain cases. Additional controlled trials are necessary to clarify the issues in the treatment of this common problem. PMID:3058280
Fardy, J; Sullivan, S
Complaints related to gastrointestinal gas are commonly encountered in clinical practice. Various therapies have been proposed, yet none has appeared to be extremely effective. A review of the literature revealed little hard evidence to support the use of simethicone, pancreatic enzymes, anticholinergic agents or antibiotics. Evidence supporting the use of prokinetic agents has been the strongest, and there may be a pathophysiologic basis for the use of these agents if the complaints are related to abnormal intestinal motility. The use of activated charcoal for adsorbing intestinal gas has been effective in healthy subjects but has not been properly investigated in patients with gas complaints. Dietary modification may be beneficial in certain cases. Additional controlled trials are necessary to clarify the issues in the treatment of this common problem.
Fardy, J; Sullivan, S
We describe a structured and uniform resident experience in operative endoscopy and analyze the costs of implementing such a program at an urban academic medical center. The residency curriculum at Northwestern Memorial Hospital incorporates a five-part approach to endoscopy training: weekly endoscopy rounds, an annual animal laboratory for residents, an individual animal laboratory, supervision by skilled endoscopic surgeons, and a
Magdy Peter Milad; Stacy Tessler Lindau
Flexible endoscopy continues to advance encompassing treatment of a variety of diseases traditionally managed surgically. This review describes and evaluates many of these new endoscopic approaches with an eye toward the future. Gastroesophageal reflux disease is now treated with several endoscopic, non-operative techniques. A procedure using radiofrequency energy delivered by a peroral catheter with small needles inserted into the wall
Gary C. Vitale; Brian R. Davis; Tin C. Tran
The development of a computer-assisted diagnosis system in digestive endoscopy, relying on a reference endoscopical image database, requires that the diagnosis reasoning during the examination is understood. Two main and complementary approaches are described, one is guided by lesions detection, the other is guided by diagnosis hypothesis. The two approaches rely on medical knowledge of normal and pathological aspects of
J.-M. Cauvin; C. Le Guillou; B. Solaiman; M. Robaszkiewicz; H. Gouerou; C. Roux
In this paper, design of an autonomous microrobotic endoscopy system is presented. The proposed microrobotic endoscope is a vision-guided device, developed to facilitate navigation inside a human colon. The design of the entire system is divided into three areas viz. design of a microrobotic carrier, path planning and guidance, and an off-board control system. A microrobotic design based on pneumatic
Vijayan K. Asari; Sanjiv Kumar; Irwan M. Kassim
Video-Endoscopy has proven to be significantly less invasive to the patient. However, it also creates a more complex and difficult operating envi- ronment that requires the surgeon to operate through a video interface. Visual feedback control and image interpretation in this operating environment can be troublesome. Automated image analysis has tremendous potential in improv- ing the surgeon's visual feedback, resulting
Dan Koppel; Yuan-fang Wang; Hua Lee
BACKGROUND: Halitosis is a common human condition for which the exact pathophysiological mechanism is unclear. It has been attributed mainly to oral pathologies. Halitosis resulting from gastrointestinal disorders is considered to be extremely rare. However, halitosis has often been reported among the symptoms related to Helicobacter pylori infection and gastroesophageal reflux disease. OBJECTIVE: To retrospectively review the experience with children and young adults presenting with halitosis to a pediatric gastroenterology clinic. METHODS: A retrospective chart review of patients diagnosed with halitosis as a primary or secondary symptom was conducted. All endoscopies were performed by the same endoscopist. RESULTS: A total of 94 patients had halitosis, and of the 56 patients (59.6%) who were recently examined by a dental surgeon, pathology (eg, cavities) was found in only one (1.8%). Pathology was found in only six of 27 patients (28.7%) who were assessed by an otolaryngology surgeon. Gastrointestinal pathology was found to be very common, with halitosis present in 54 of the 94 (57.4%) patients. The pathology was noted regardless of dental or otolaryngological findings. Most pathologies, both macroscopically and microscopically, were noted in the stomach (60% non-H pylori related), followed by the duodenum and the esophagus. Fifty-two of 90 patients (57.8%) were offered a treatment based on their endoscopic findings. Of the 74 patients for whom halitosis improvement data were available, some improvement was noted in 24 patients (32.4%) and complete improvement was noted in 41 patients (55.4%). CONCLUSIONS: Gastrointestinal pathology was very common in patients with halitosis regardless of dental or otolaryngological findings, and most patients improved with treatment.
Kinberg, Sivan; Stein, Miki; Zion, Nataly; Shaoul, Ron
The Dieulafoy gastric malformation is a rare cause of upper gastrointestinal haemorrhage. When no obvious bleeding lesion is seen at laparotomy this diagnosis ought to be considered. Three such cases were identified and treated with simple underrunning of the lesion with no mortality and minimal morbidity. Follow-up endoscopy in each patient showed complete healing of the lesion.
Welch, M.; Hoare, E. M.
OBJECTIVE:Despite advances in diagnostic and therapeutic endoscopy, the mortality of patients with upper gastrointestinal bleeding (UGIB) has remained relatively constant. Inadequate early resuscitation is believed to be a major factor in the persistently high mortality rate in patients with UGIB. In order to evaluate the role of intensive resuscitation in the outcome of patients with UGIB, we conducted the following
Robin Baradarian; Susan Ramdhaney; Rajeev Chapalamadugu; Leor Skoczylas; Karen Wang; Svetlana Rivilis; Kristin Remus; Ira Mayer; Kadirawel Iswara; Scott Tenner
Numerous studies have addressed musculoskeletal disorders in the international working population. The literature indicates that injuries exist at astounding rates with significant economic impact. Attempts have been made by government, private industry, and special interest groups to address the issues related to the occurrence and prevention of musculoskeletal injuries. Because of the limited research on the gastrointestinal (GI) endoscopy nursing sector, this descriptive, correlational study explored the incidence of upper extremity injuries in GI endoscopy nurses and technicians in the United States. A total of 215 subjects were included in the study. Findings show that upper extremity injuries exist among nurses working in GI endoscopy. Twenty-two percent of respondents missed work for upper extremity injuries. The findings also show that the severity of disability is related to the type of work done, type of assistive aids available at work, and whether or not ergonomic or physiotherapy assessments were provided at the place of employment. In reference to rate of injury and the availability of ergonomics and physiotherapy assessments, those who had ergonomic assessments available to them had scores on the Disabilities of the Arm, Shoulder, and Hand (DASH) inventory (indicating upper extremity disability) that were significantly lower (DASH score, 9.96) than those who did not have the assessments available (DASH score, 14.66). The results suggest that there are a significant number of subjects who are disabled to varying degrees and the majority of these are employed in full-time jobs. PMID:24084131
Drysdale, Susan A
Quality assurance (QA) is a process that includes the systematic evaluation of a service, institution of improvements and ongoing evaluation to ensure that effective changes were made. QA is a fundamental component of any organized colorectal cancer screening program. However, it should play an equally important role in opportunistic screening. Establishing the processes and procedures for a comprehensive QA program can be a daunting proposition for an endoscopy unit. The present article describes the steps taken to establish a QA program at the Forzani & MacPhail Colon Cancer Screening Centre (Calgary, Alberta) – a colorectal cancer screening centre and nonhospital endoscopy unit that is dedicated to providing colorectal cancer screening-related colonoscopies. Lessons drawn from the authors’ experience may help others develop their own initiatives. The Global Rating Scale, a quality assessment and improvement tool developed for the gastrointestinal endoscopy services of the United Kingdom’s National Health Service, was used as the framework to develop the QA program. QA activities include monitoring the patient experience through surveys, creating endoscopist report cards on colonoscopy performance, tracking and evaluating adverse events and monitoring wait times.
Hilsden, Robert J; Rostom, Alaa; Dube, Catherine; Pontifex, Darlene; McGregor, S Elizabeth; Bridges, Ronald J
Gastric antral vascular ectasia (GAVE) has been recognized as one of the important causes of occult and obscure gastrointestinal bleeding. The diagnosis is typically made based on the characteristic endoscopic features, including longitudinal row of flat, reddish stripes radiating from the pylorus into the antrum that resemble the stripes on a watermelon. These appearances, however, can easily be misinterpreted as moderate to severe gastritis. Although it is believed that capsule endoscopy (CE) is not helpful for the study of the stomach with its large lumen, GAVE can be more likely to be detected at CE rather than conventional endoscopy. CE can be regarded as "physiologic" endoscopy, without the need for gastric inflation and subsequent compression of the vasculature. The blood flow of the ecstatic vessels may be diminished in an inflated stomach. Therefore, GAVE may be prominent in CE. We herein describe a case of active bleeding from GAVE detected by CE and would like to emphasize a possibility that CE can improve diagnostic yields for GAVE. PMID:23515703
Ohira, Tetsuya; Hokama, Akira; Kinjo, Nagisa; Nakamoto, Manabu; Kobashigawa, Chiharu; Kise, Yuya; Yamashiro, Satoshi; Kinjo, Fukunori; Kuniyoshi, Yukio; Fujita, Jiro
The endoscopic finding of a gastric polyp and the histopathologic report that follows may leave clinicians with questions that have not been addressed in formal guidelines: do all polyps need to be excised, or can they just be sampled for biopsy? If so, which ones and how many should be sampled? What follow-up evaluation is needed, if any? This review relies on the existing literature and our collective experience to provide practical answers to these questions. Fundic gland polyps, now the most frequent gastric polyps in Western countries because of widespread use of proton pump inhibitors, and hyperplastic polyps, the second most common polyps notable for their association with gastritis and their low but important potential for harboring dysplastic or neoplastic foci, are discussed in greater detail. Adenomas have had their name changed to raised intraepithelial neoplasia and are decreasing in parallel with Helicobacter pylori infection; however, they do retain their importance as harbingers of gastric cancer, particularly in East Asia. Gastrointestinal stromal tumors have low incidence and no known associations, but their malignant potential is high; early diagnosis and proper management are crucial. Although rare and benign, inflammatory fibroid polyps need to recognized, particularly by pathologists, to avoid misdiagnosis. Gastric neuroendocrine tumors (carcinoids) are important because of their association with either atrophic gastritis or the multiple endocrine neoplasia syndromes; those that do not arise in these backgrounds have high malignant potential and require aggressive management. The review concludes with some practical suggestions on how to approach gastric polyps detected at endoscopy. PMID:23583466
Shaib, Yasser H; Rugge, Massimo; Graham, David Y; Genta, Robert M
Virtual endoscopy uses CT data to display hollow viscera such as the stomach, duodenum and colon as if by real endoscopic observation. The results are independent of the operator skill because virtual endoscopy does not require direct manipulation of endoscopic equipment. The purpose of this study was to evaluate the utility of virtual endoscopy in small animals. Ten beagles were examined by conventional endoscopy and virtual endoscopy using multidetector CT. Virtual images were image-processed at a workstation designed for depicting virtual endoscopy using CT data. Virtual images were visually comparable with conventional endoscopic images, especially in the area of the angular incisure and pylorus. The advantages of virtual endoscopy are observation from any viewing angle, a reduced learning curve for diagnostic interpretation, quantification of lesion size in three dimensions and a potential for reducing anesthesia time. The disadvantages of virtual endoscopy are a lack of color recognition information, an inability to retrieve biopsy samples, limited visualization of the duodenum, artifacts from respiration/peristalsis motion and an inability to observe function. Based on our results, we suggest that conventional endoscopy is still superior to virtual endoscopy in dogs. However, as technology improves, virtual endoscopy may emerge as a suitable alternative or adjunctive diagnostic tool for certain digestive disorders in small animals. PMID:17691629
Yamada, Kazutaka; Morimoto, Manabu; Kishimoto, Miori; Wisner, Erik R
Epidemic Kaposi's sarcoma remains the most common cancer in patients with human immunodeficiency virus and is associated with significant morbidity and mortality in AIDS patients. Primary visceral Kaposi's sarcoma (Kaposi's sarcoma without cutaneous lesions) presenting with lower gastrointestinal bleeding (LGIB) has rarely been reported. Though Kaposi's sarcoma can occur anywhere in gastrointestinal tract, gastrointestinal symptoms are often non-specific such as chronic blood loss anaemia, vomiting, diarrhoea, intestinal obstruction. In these patients, severe gastrointestinal bleeding requiring repeated blood transfusions is extremely rare. Clinicians should be aware of gastrointestinal tract Kaposi's sarcoma since visceral Kaposi's sarcoma can present in the absence of cutaneous involvement. Endoscopy with biopsy is useful in the diagnosis for severe LGIB in patients with AIDS. Furthermore, gastrointestinal Kaposi's sarcoma should be considered in the differential diagnosis of GI bleeding. We report a case of primary colonic KS who presented with recurrent GI bleeding which was eventually diagnosed by sigmoidoscopy and confirmed pathologically. PMID:23970616
Ling, Jie; Coron, Roger; Basak, Prasanta; Jesmajian, Stephen
Background Knowledge of quality measures in endoscopy among trainees is unknown. Objective To assess knowledge of endoscopy-related quality indicators among U.S. trainees and determine whether it improves with a Web-based intervention. Design Randomized, controlled study. Setting Multicenter. Participants This study involved trainees identified from the American Society for Gastrointestinal Endoscopy membership database. Intervention Participants were invited to complete an 18-question online test. Respondents were randomized to receive a Web-based tutorial (intervention) or not. The test was readministered 6 weeks after randomization to determine the intervention’s impact. Main Outcome Measurements Baseline knowledge of endoscopy-related quality indicators and impact of the tutorial. Results A total of 347 of 1220 trainees (28%) completed the test; the mean percentage of correct responses was 55%. For screening colonoscopy, 44% knew the adenoma detection rate benchmark, 42% identified the cecal intubation rate goal, and 74% knew the recommended minimum withdrawal time. A total of 208 of 347 trainees (59%) completed the second test; baseline scores were similar for the tutorial (n = 106) and no tutorial (n = 102) groups (56.4% vs 56.9%, respectively). Scores improved after intervention for the tutorial group (65%, P = .003) but remained unchanged in the no tutorial group. On multivariate analysis, each additional year in training (odds ratio [OR] 2.3; 95% confidence interval [CI], 1.5–3.4), training at an academic institution (OR 2.6; 95% CI, 1.1–6.3), and receiving the tutorial (OR 3.2; 95% CI, 1.7–5.9) were associated with scores in the upper tertile. Limitations Low response rate. Conclusion Knowledge of endoscopy-related quality performance measures is low among trainees but can improve with a Web-based tutorial. Gastroenterology training programs may need to incorporate a formal didactic curriculum to supplement practice-based learning of quality standards in endoscopy. (Gastrointest Endosc 2012;76:100–6.)
Thompson, Jennifer S.; Lebwohl, Benjamin; Syngal, Sapna; Kastrinos, Fay
Existing technical conditions make it difficult for a single surgeon to simultaneously observe the endoscope and the observation field of the operating microscope. Video endoscopy is not adapted, because it respects neither the constraints of microsurgery (the surgeon has to stop observing the binoculars of the microscope to watch the video screen) nor the micromanipulations necessary for the specialties using micro endoscopy. A new device is described that closely joins endoscope and microscope. This coupling device allows the surgeon to permanently control and alternate the images according to his choice. The surgeon is able to observe in the binoculars the images transmitted by the endoscope and/or the operating microscope. This device respects the requirements of the microscope and, thanks to its optical capabilities, the endoscopic image is improved. The professions requiring double observation will improve their ability in diagnosis and therapy. PMID:7725222
Leon, C S; Leon, J A; Aron-Rosa, D
Although the field of outcomes research has received increased attention in recent years, there is still considerable uncertainty and confusion about what is “outcomes research”. The following editorial is designed to provide an overview on this topic, illustrate specific examples of outcomes research in clinical gastroenterology and endoscopy, and discuss its importance as a whole. In this article, we review the definition and specific goals of outcomes research. We outline the difference between traditional clinical research and outcomes research and discuss the benefits and limitations of outcomes research. We summarize the types of outcomes studies and methods utilized for outcomes assessment, and give specific examples of the impact of outcomes studies in the field of gastroenterology and endoscopy.
Gupta, Parantap; Buscaglia, Jonathan M
Multiphoton endoscopy can be applied for intra-corporeal imaging as well as to examine otherwise hard-to-access tissue areas like chronic wounds. Using high-NA (NA = 0.8) gradient-index (GRIN) lens-based endoscopes with a diameter of 1.4 mm and effective lengths of 7 mm and 20 mm, respectively, two-photon excitation of endogenous fluorophores and second-harmonic generation (SHG) is used for multimodal in vivo imaging of human skin. A further imaging modality is fluorescence lifetime imaging (FLIM) which allows functional imaging to investigate the healing mechanism of chronic wounds and the corresponding cell metabolism. We performed first in vivo measurements using FLIM endoscopy with the medically-certified multiphoton tomograph MPTflex® in combination with a computer-controlled motorized scan head and a GRIN-lens endoscope.
Weinigel, Martin; Breunig, Hans Georg; Fischer, Peter; Kellner-Höfer, Marcel; Bückle, Rainer; König, Karsten
Endoscopy units in 27 large teaching hospitals in Canada were surveyed to ascertain which solution was being used to soak endoscopic equipment. The purpose of this survey was to discover if staff in endoscopy units were experiencing side effects as a result of exposure to the soaking solutions. The type of solution used, the use of washing machines and the addition of ventilation are examined in relation to the side effects experienced. The results of the survey showed that five solutions were being used by GI units to soak and clean scopes. All five of the solutions contained some glutaraldehyde, and side effects were reported by staff using all five solutions. The use of washing machines and additional ventilation at some of the hospitals may have had an effect on the number of side effects experienced, but the results could not be used to determine their effect conclusively. PMID:1908703
Since its development, video capsule endoscopy (VCE) introduced a new area in the study of small bowel disease. We reviewed and discussed current issues from Korean capsule endoscopy multicenter studies. Main results are as follows: First, there was no significant difference in diagnostic yield according to the method of bowel preparation. Second, VCE represents a reliable and influential screening measure in patients with chronic unexplained abdominal pain and this technique could successfully alter the clinical course especially for patients with small bowel tumor. Third, the inter-observer variation in the expert group was lower than that in trainee group. Fourth, studies about the spontaneous capsule passage after retention showed 2.5% of retention rate and the size of lumen was an important factor of spontaneous passage. We need larger scale studies on the effect of bowel preparation methods on the diagnostic yield and further studies about the learning curve or unique capsule endoscopic findings for small intestinal diseases in Korean patients.
Kim, Kyeong Ok
Summary. During Operation Desert Shield\\/Desert Storm, the 8th Evacuation Hospital (400 beds) evaluated the efficacy of endoscopy\\u000a in the desert environment. Standard off-the-shelf fiber-optic endoscopes met the criteria of being rugged, versatile, portable,\\u000a and easy to maintain. Over a 3-month period, 36 procedures (Esophagogastroduodenoscopy, 25; colonoscopy, 7; flexible sigmoidoscopy,\\u000a 4) were performed in soldiers both in the garrison and in
Richard M. Satava
Management of endoscopic complications is a pertinent aspect of patient care that has received great attention in the past decade due to advancements and increases in complexity of therapeutic endoscopy. Working groups from various institutions such as American Society for Gastrointestinal Endoscopy (ASGE) and European Society of Gastrointestinal Endoscopy have devised detailed guidelines and management algorithms. Three main factors that contribute to endoscopic complications are patient, operator, and type of procedure. No one rule suits all;hence endoscopic complication management must be customized to individual patients. Comprehensive knowledge of patient, machine/device, and its interrelationship must be in place to manage endoscopic complications. PMID:23617664
Paramasivam, Rajesh Kumar; Angsuwatcharakon, Phonthep; Soontornmanokul, Tanassanee; Rerknimitr, Rungsun
To assess the patient with gastrointestinal problems, the airway, breathing and circulation should be checked. When considering a patient with gastrointestinal problems for anaesthesia, the history should be taken in particular considering the presence and nature of pain, other gastrointestinal symptoms (e.g. anorexia, dyspepsia, nausea, vomiting, haematemesis, melaena, diarrhoea, constipation), previous abdominal surgery and recent drug ingestion. Physical examination should
Capsule endoscopy (CE) offers state-of-the-art imaging of the small bowel. In Crohn’s disease its clinical role is still uncertain. This report analyses the usefulness of CE in patients with suspected Cronh’s disease, in patients with established Crohn’s disease (when assessing severity, occult gastrointestinal bleeding and/or as a guide to therapy), in patients with inflammatory bowel disease unclassified (IBDU), and in individuals with ulcerative colitis. The first item in this group is the most important although there is no strong evidence to establish the position of CE in the diagnostic workup. In patients with established Crohn’s disease, recently developed activity scores are promising tools for an accurate assessment of severity. As a guide to therapy, CE should be focused on patients with unexplained symptoms when other investigations are inconclusive. In postoperative Crohn’s Disease, international consensus recommended considering CE only if ileocolonoscopy is contraindicated or unsuccessful. In the case of IBDU, studies have shown a significant proportion of patients reclassified with Crohn’s disease. In this setting, CE could have a role determining small bowel involvement. The role of CE in ulcerative colitis is limited. Some authors advocate CE before colectomy for refractory cases in order to exclude Crohn’s disease. In summary, CE offers a new horizon in inflammatory bowel disease, and a better knowledge of mucosal abnormalities that could offer a paradigm shift: changing from symptom-based disease activity estimation to direct mucosal healing monitoring. Nevertheless, randomized controlled studies are still needed to provide stronger evidence in this setting.
Previous research has indicated that use of guidance systems during endoscopy can improve the performance and decrease the skill variation of physicians. Current guidance systems, however, rely on computationally intensive registration techniques or costly and error-prone electromagnetic (E/M) registration techniques, neither of which fit seamlessly into the clinical workflow. We have previously proposed a real-time image-based registration technique that addresses both of these problems. We now propose a system-level approach that incorporates this technique into a complete paradigm for real-time image-based guidance in order to provide a physician with continuously-updated navigational and guidance information. At the core of the system is a novel strategy for guidance of endoscopy. Additional elements such as global surface rendering, local cross-sectional views, and pertinent distances are also incorporated into the system to provide additional utility to the physician. Phantom results were generated using bronchoscopy performed on a rapid prototype model of a human tracheobronchial airway tree. The system has also been tested in ongoing live human tests. Thus far, ten such tests, focused on bronchoscopic intervention of pulmonary patients, have been run successfully.
Merritt, Scott A.; Rai, Lav; Gibbs, Jason D.; Yu, Kun-Chang; Higgins, William E.
During Operation Desert Shield/Desert Storm, the 8th Evacuation Hospital (400 beds) evaluated the efficacy of endoscopy in the desert environment. Standard off-the-shelf fiber-optic endoscopes met the criteria of being rugged, versatile, portable, and easy to maintain. Over a 3-month period, 36 procedures (Esophagogastroduodenoscopy, 25; colonoscopy, 7; flexible sigmoidoscopy, 4) were performed in soldiers both in the garrison and in combat. Of these, 24 (67%) revealed normal findings; the remaining 33% demonstrated pathology (6 cases of peptic ulcers, 3 cases of esophageal ulcers, 2 cases of acute ulcerative colitis, and 1 case of proctitis). Two-thirds of the patients could immediately be returned to duty because they demonstrated either a normal examination or pathology that would resolve with medical management. Another 17% of the subjects were promptly air-evacuated out of the combat theater, and 17% were Iraqi prisoners of war in whom the proper medication was begun. Although no indication for surgical endoscopy was found that was unique to a combat theater, these procedures greatly enhanced the conservation of the fighting force, especially in determining which soldiers could be immediately returned for a combat mission. PMID:1805402
Satava, R M
Hospital-acquired infection attributed to inadequate decontamination of gastrointestinal endoscopes prompted an in use evaluation of recommended procedures. Specimens were obtained from the internal channels of 123 endoscopes before, during and after decontamination by flushing with saline and brushing with a sterile brush, and examined for vegetative bacteria by broth and plate culture. Four endoscopy units were tested; the chemical disinfectants
A. K. Deva; K. Vickery; J. Zou; R. H. West; W. Selby; R. A. V. Benn; J. P. Harris; Y. E. Cossart
Raman spectroscopy is an optical vibrational technology capable of probing biomolecular changes of tissue associated with cancer transformation. This study aimed to characterize in vivo Raman spectroscopic properties of tissues belonging to different anatomical regions in the upper gastrointestinal (GI) tract and explore the implications for early detection of neoplastic lesions during clinical gastroscopy. A novel fiber-optic Raman endoscopy technique
Mads Sylvest Bergholt; Wei Zheng; Kan Lin; Khek Yu Ho; Ming Teh; Khay Guan Yeoh; Jimmy Bok Yan So; Zhiwei Huang
Acquisition of Helicobacter pylori occurs mainly in childhood. However, the mode of transmission remains unclear. To help elucidate this, 100 children attending for upper gastrointestinal endoscopy were investigated for the presence of H. pylori at various sites. H. pylori was detected in antral gastric biopsies by the rapid urease test (13 patients), culture (13 patients), histology (15 patients) and PCR
R. P. ALLAKER; K. A. YOUNG; J. M. HARDIE; P. DOMIZIO; N. J. MEADOWS
Capsule endoscopy is an emerging field in medical technology. Despite very promising innovations, some critical issues are yet to be addressed, such as the management and possible exploitation of the friction in the gastrointestinal environment in order to control capsule locomotion more actively. This paper presents the fabrication and testing of bio-inspired polymeric micro-patterns, which are arrays of cylindrical pillars fabricated via soft lithography. The aim of the work is to develop structures that enhance the grip between an artificial device and the intestinal tissue, without injuring the mucosa. In fact, the patterns are intended to be mounted on microfabricated legs of a capsule robot that is able to move actively in the gastrointestinal tract, thus improving the robot's traction ability. The effect of micro-patterned surfaces on the leg-slipping behaviour on colon walls was investigated by considering both different pillar dimensions and the influence of tissue morphology. Several in vitro tests on biological samples demonstrated that micro-patterns of pillars made from a soft polymer with an aspect ratio close to 1 enhanced friction by 41.7% with regard to flat surfaces. This work presents preliminary modelling of the friction and adhesion forces in the gastrointestinal environment and some design guidelines for endoscopic devices.
Buselli, Elisa; Pensabene, Virginia; Castrataro, Piero; Valdastri, Pietro; Menciassi, Arianna; Dario, Paolo
Some patients referred for esophagogastroduodenoscopy (EGD) to evaluate symptoms of dysphagia have normal endoscopies. How best to manage these patients is unclear. We reviewed our experience with empiric esophageal dilation in this setting. Over a five-year period, 40 consecutive patients with esophageal dysphagia and normal EGD underwent empiric esophageal dilation at the time of their endoscopy. Postdilation follow-up was available
John B. Marshall; Tabassum A. Chowdhury
This paper focuses on the particular aspect of image sensor data transmission under low power and small size conditions. The application is in wireless capsule endoscopy. Traditional image compression techniques are out of reach and a dedicated hard wired technique is developed. By taking advantage of the typical endoscopy images characteristics, it proposes a simple way to limit the bandwidth
D. Turgis; R. Puers
Objectives. Capsule endoscopy is relatively noninvasive method and its use extends from the small bowel to the esophagus and colon. The aim of this study was to evaluate the feasibility and acceptability of capsule endoscopy for neoplastic gastric lesions. Methods. Capsule endoscopy (Pillcam ESO) was performed within 48 hours of esophagogastroduodenoscopy for eight patients who were diagnosed with gastric cancers, the size of which were less than 4?cm and who presented written consent. Patients changed position in a specified designed sequence every 30 seconds after capsule ingestion. Position change was repeated with ingestion of an effervescent agent. The rate of detection of intragastric lesions, observation of normal gastric anatomy and patient satisfaction between capsule endoscopy and esophagogastroduodenoscopy were compared. Results. Capsule endoscopy found four out of eight gastric lesions. The gastroesophageal junction was observed in seven of the eight cases, pyloric ring in five of the eight cases, and gastric angle in four of the eight cases. The patient satisfaction assessment questionnaire rated capsule endoscopy significantly higher than upper endoscopy in all categories. Conclusions. Capsule endoscopy was less effective than esophagogastroduodenoscopy and showed limited value in this feasibility study.
Lee, Wook Hyun; Kim, Jin Su; Park, Jae Myung; Lee, In Seok; Kim, Sang Woo; Choi, Myung-Gyu
The limitations of standard endoscopy for detection and evaluation of cancerous changes in gastrointestinal tract (GIT) are significant challenge and initiate development of new diagnostic modalities. Therefore many spectral and optical techniques are applied recently into the clinical practice for obtaining qualitatively and quantitatively new data from gastrointestinal neoplasia with different level of clinical applicability and diagnostic success. One of the most promising approaches is fluorescence detection using naturally existing fluorescent molecules or added fluorescent markers. Deltaaminolevulinic acid / protoporphyrin IX is applied for exogenous fluorescent tumor detection in the upper part of gastrointestinal tract. The 5-ALA is administered per os six hours before measurements at dose 20mg/kg weight. Highpower light-emitting diode at 405 nm is used as a source and the excitation light is passed through the light-guide of standard video-endoscopic system to obtain 2-D visualization. Both kinds of spectra - autofluorescence signals and protoporphyrin IX signal are recorded and stored using a fiber-optic microspectrometer, as in endoscopy instrumental channel a fiber is applied to return information about fluorescence signals. In such way 1-D detection and 2-D visualization of the lesions' fluorescence are received. The results from in vivo detection show significant differentiation between normal and abnormal tissues in 1-D spectroscopic regime, but only moderate discrimination in 2-D imaging.
Borisova, Ekaterina; Plamenova, Lilia; Keremedchiev, Momchil; Vladimirov, Borislav; Avramov, Latchezar
Endoscopy offers several distinct advantages over the operating microscope during neuro-otologic surgery that make it an excellent adjunctive tool to the microscope or independent modality during cranial base surgery. The high magnification gives excellent definition of perforating blood vessels, cranial nerves, and neural structures, which in many cases is superior to that achieved with the microscope. Furthermore, the use of angled or flexible endoscopes allows one to look around corners and behind anatomic structures blocking the view seen via a 0 degree microscope. Endoscopy also has the theoretical advantage that a less invasive operative procedure is required, which should reduce the operative morbidity. Several notable disadvantages of endoscopy include the problems associated with blood soiling the endoscope, making visualization difficult or impossible, the lack of readily available instrumentation designed specifically for endoscopic neuro-otology, and the poor overview of the operative field. This last point is an important one because the endoscope is placed adjacent to the lesion and does not allow one to look backward to prevent [figure: see text] injury to structures next to the shaft of the telescope. Furthermore, the surgeon must be cognizant of potential thermal injury to structures caused by the heat generated by the light source. The present endoscopic technology limits the image that the surgeon sees to two dimensions, which results in certain unique problems when operating in a three-dimensional milieu. Because of this, there is a steep learning curve to acquire endoscopic dexterity and three-dimensional orientation. Finally, bimanual operation requires the use of an articulated endoscope holder or the commitment of the co-surgeon to hold the endoscope. One of the limitations of the operative microscope is that the angle of view is determined by the distance of the lens to the skull, retractor, or obstructing tissue, which is a function of the lens focal length; the longer the focal length, the narrower the viewing angle. During most microsurgical procedures, the focal distance varies between 200 and 400 mm. Using a previous analogy, if one looks through a door's keyhole at close range, nearly the entire room on the opposite side of the door can be seen, although nothing can be seen when the hole is viewed from a long distance. This is similar to what happens when using the endoscope with focal lengths ranging from 5 to 20 mm: a wider angle of view can be achieved. Based on their, experience the authors believe that endoscopes can be used safely during neuro-otologic surgery. As an adjunct to or substitution for the operative microscope, this modality does improve visualization of bony, neural, and vascular structures while minimizing cerebellar retraction. PMID:12391620
Wackym, Phillip A; King, Wesley A; Meyer, Glenn A; Poe, Dennis S
ObjectiveEtoricoxib is a selective cyclooxygenase inhibitor that in clinical studies has improved the signs and symptoms of osteoarthritis and rheumatoid arthritis and reduced the potential for GI injury. The incidence of endoscopically detected ulcers and of clinically important upper GI events (perforations, ulcers, and bleeding episodes) was compared in patients taking etoricoxib or nonselective nonsteroidal anti-inflammatory drugs (NSAIDs).
Richard H Hunt; Sean Harper; Douglas J Watson; Chang Yu; Hui Quan; Michael Lee; Judith K Evans; Bettina Oxenius
Accurate analysis of wireless capsule endoscopy (WCE) videos is vital but tedious. Automatic image analysis can expedite this task. Video segmentation of WCE into the four parts of the gastrointestinal tract is one way to assist a physician. The segmentation approach described in this paper integrates pattern recognition with statiscal analysis. Iniatially, a support vector machine is applied to classify video frames into four classes using a combination of multiple color and texture features as the feature vector. A Poisson cumulative distribution, for which the parameter depends on the length of segments, models a prior knowledge. A priori knowledge together with inter-frame difference serves as the global constraints driven by the underlying observation of each WCE video, which is fitted by Gaussian distribution to constrain the transition probability of hidden Markov model.Experimental results demonstrated effectiveness of the approach.
Wan, Yiwen; Duraisamy, Prakash; Alam, Mohammad S.; Buckles, Bill
Video capsule endoscopy (VCE) is a noninvasive method for examining the gastrointestinal tract which has been successful in small intestine studies. Recently, VCE has been attempted in the colon. However, the capsule often tumbles in the wider colonic lumen, resulting in missed regions. Self-stabilizing VCE is a novel method to visualize the colon without tumbling. The aim of the present study was to comparatively quantify the effect of stabilization of a commercially available nonmodified capsule endoscope (CE) MiroCam and its modified self-stabilizing version in acute canine experiments. Two customized MiroCam CEs were reduced in volume at the nonimaging back-end to allow the attachment of a self-expanding, biocompatible stabilizing device. Four mongrel dogs underwent laparotomy and exteriorization of a 15-cm segment of the proximal descending colon. A single CE, either self-stabilizing or nonmodified was inserted through an incision into the lumen of the colon followed by pharmacologically induced colonic peristalsis. The inserted capsule was propelled distally through the colon and expelled naturally through the anus. Novel signal processing method was developed to quantify the video stabilization based on camera tracking a predetermined target point (locale). The average locale trajectory, the average radius movement of the locale, and the maximum rate of change of the locale for sequential images were significantly lower for the stabilized capsules compared to the nonstabilized ones . The feasibility of self-stabilized capsule endoscopy has been demonstrated in acute canine experiments. PMID:21803680
Filip, Dobromir; Yadid-Pecht, Orly; Andrews, Christopher N; Mintchev, Martin P
Recently, image-enhanced endoscopy (IEE) has been used to diagnose gastrointestinal tumors. This method is a change from conventional white-light (WL) endoscopy without dyeing solution, requiring only the push of a button. In IEE, there are many advantages in diagnosis of neoplastic tumors, evaluation of invasion depth for cancerous lesions, and detection of neoplastic lesions. In narrow band imaging (NBI) systems (Olympus Medical Co., Tokyo, Japan), optical filters that allow narrow-band light to pass at wavelengths of 415 and 540 nm are used. Mucosal surface blood vessels are seen most clearly at 415 nm, which is the wavelength that corresponds to the hemoglobin absorption band, while vessels in the deep layer of the mucosa can be detected at 540 nm. Thus, NBI also can detect pit-like structures named surface pattern. The flexible spectral imaging color enhancement (FICE) system (Fujifilm Medical Co., Tokyo, Japan) is also an IEE but different to NBI. FICE depends on the use of spectral-estimation technology to reconstruct images at different wavelengths based on WL images. FICE can enhance vascular and surface patterns. The autofluorescence imaging (AFI) video endoscope system (Olympus Medical Co., Tokyo, Japan) is a new illumination method that uses the difference in intensity of autofluorescence between the normal area and neoplastic lesions. AFI light comprises a blue light for emitting and a green light for hemoglobin absorption. The aim of this review is to highlight the efficacy of IEE for diagnosis of colorectal tumors for endoscopic treatment.
Yoshida, Naohisa; Yagi, Nobuaki; Yanagisawa, Akio; Naito, Yuji
Wireless capsule endoscopy (WCE) enables a physician to diagnose a patient's digestive system without surgical procedures. However, it takes 1-2 hours for a gastroenterologist to examine the video. To speed up the review process, a number of analysis techniques based on machine vision have been proposed by computer science researchers. In order to train a machine to understand the semantics of an image, the image contents need to be translated into numerical form first. The numerical form of the image is known as image abstraction. The process of selecting relevant image features is often determined by the modality of medical images and the nature of the diagnoses. For example, there are radiographic projection-based images (e.g., X-rays and PET scans), tomography-based images (e.g., MRT and CT scans), and photography-based images (e.g., endoscopy, dermatology, and microscopic histology). Each modality imposes unique image-dependent restrictions for automatic and medically meaningful image abstraction processes. In this paper, we review the current development of machine-vision-based analysis of WCE video, focusing on the research that identifies specific gastrointestinal (GI) pathology and methods of shot boundary detection.
Chen, Yingju; Lee, Jeongkyu
Gastrointestinal cancers are heterogeneous and can overexpress several protein targets that can be imaged simultaneously on endoscopy using multiple molecular probes. We aim to demonstrate a multispectral scanning fiber endoscope for wide-field fluorescence detection of colonic dysplasia. Excitation at 440, 532, and 635 nm is delivered into a single spiral scanning fiber, and fluorescence is collected by a ring of light-collecting optical fibers placed around the instrument periphery. Specific-binding peptides are selected with phage display technology using the CPC;Apc mouse model of spontaneous colonic dysplasia. Validation of peptide specificity is performed on flow cytometry and in vivo endoscopy. The peptides KCCFPAQ, AKPGYLS, and LTTHYKL are selected and labeled with 7-diethylaminocoumarin-3-carboxylic acid (DEAC), 5-carboxytetramethylrhodamine (TAMRA), and CF633, respectively. Separate droplets of KCCFPAQ-DEAC, AKPGYLS-TAMRA, and LTTHYKL-CF633 are distinguished at concentrations of 100 and 1 ?M. Separate application of the fluorescent-labeled peptides demonstrate specific binding to colonic adenomas. The average target/background ratios are 1.71+/-0.19 and 1.67+/-0.12 for KCCFPAQ-DEAC and AKPGYLS-TAMRA, respectively. Administration of these two peptides together results in distinct binding patterns in the blue and green channels. Specific binding of two or more peptides can be distinguished in vivo using a novel multispectral endoscope to localize colonic dysplasia on real-time wide-field imaging.
Miller, Sharon J.; Lee, Cameron M.; Joshi, Bishnu P.; Gaustad, Adam; Seibel, Eric J.; Wang, Thomas D.
AIM: To investigate whether the small bowel transit time (SBTT) influences the diagnostic yield of capsule endoscopy (CE). METHODS: Six hundred and ninety-one consecutive CE procedures collected in a database were analyzed. SBTT and CE findings were recorded. A running mean for the SBTT was calculated and correlated to the diagnostic yield with a Spearman’s correlation test. Subgroup analyses were performed for the various indications for the procedure. RESULTS: There was a positive correlation between the diagnostic yield and SBTT (Spearman’s rho 0.58, P < 0.01). Positive correlations between diagnostic yield and SBTT were found for the indication obscure gastrointestinal bleeding (r = 0.54, P < 0.01), for polyposis and carcinoid combined (r = 0.56, P < 0.01) and for the other indications (r = 0.90, P <0.01), but not for suspected Crohn’s disease (r = -0.40). CONCLUSION: The diagnostic yield in small bowel capsule endoscopy is positively correlated with the small bowel transit time. This is true for all indications except for suspected Crohn’s disease.
Westerhof, Jessie; Koornstra, Jan J; Hoedemaker, Reinier A; Sluiter, Wim J; Kleibeuker, Jan H; Weersma, Rinse K
While the wireless endoscopic capsule examining human's large gastrointestinal (GI) cavity, such as stomach and large intestine, many interested spots are omitted by only one or two cameras due to its limited field of view. This paper proposes the new system architecture of the Micro-Ball for medical endoscopy application. Six cameras are embedded in the Micro-Ball for multiple fields of view, which can reduce endoscopic miss rate greatly. Based on this system architecture, a new working mode is proposed. The captured image data are saved in the Flash memory instead of being transmitted outside human body wirelessly. Only less than 6mJ is consumed when the Micro-Ball captures a frame of 480×480 image and writes the image data into the Flash memory. The endoscopic Micro-Ball can work in human's GI tract for 10 hours when the image frame rate is 2 fps. The Micro-Ball endoscopy system is verified on the FPGA-based demonstration system. PMID:21096705
Gu, Yingke; Xie, Xiang; Li, Guolin; Sun, Tianjia; Zhang, Qiang; Wang, Ziqiang; Wang, Zhihua
Any prognosis of gastrointestinal (GI) cancer is closely related to the stage of the disease at diagnosis. Endoscopic submucosal dissection (ESD) and en bloc endoscopic mucosal resection (EMR) have been performed as curative treatments for many early-stage GI lesions in recent years. The technologies have been widely accepted in many Asian countries because they are minimally invasive and supply thorough histopathologic evaluation of the specimens. However, before engaging in endoscopic therapy, an accurate diagnosis is a precondition to effecting the complete cure of the underlying malignancy or carcinoma in situ. For the past few years, many new types of endoscopic techniques, including magnifying endoscopy with narrow-band imaging (ME-NBI), have emerged in many countries because these methods provide a strong indication of early lesions and are very useful in determining treatment options before ESD or EMR. However, to date, there is no comparable classification equivalent to “Kudo’s Pit Pattern Classification in the colon”, for the upper GI, there is still no clear internationally accepted classification system of magnifying endoscopy. Therefore, in order to help unify some viewpoints, here we will review the defining optical imaging characteristics and the current representative classifications of microvascular and microsurface patterns in the upper GI tract under ME-NBI, describe the accurate relationship between them and the pathological diagnosis, and their clinical applications prior to ESD or en bloc EMR. We will also discuss assessing the differentiation and depth of invasion, defying the lateral spread of involvement and targeting biopsy in real time.
Chai, Ning-Li; Ling-Hu, En-Qiang; Morita, Yoshinori; Obata, Daisuke; Toyonaga, Takashi; Azuma, Takeshi; Wu, Ben-Yan
Wireless endoscopy is a new noninvasive diagnostic method that is able to visualize small bowel lesions. The instrument is small and carries a battery and microcamera that takes two photographs per second. It is indicated in cases of bleeding of unknown origin and for the diagnosis of inflammatory bowel disease, among other disorders. To date, it has mainly been used in adults. We believe that this instrument could play an important role in the pediatric age group since it is noninvasive and can be used to diagnose small bowel lesions, thus avoiding unnecessary diagnostic tests. We report the case of a girl with suspicion of Crohn's disease that was unconfirmed by conventional endoscopic techniques. The capsule showed small bowel lesions compatible with Crohn's disease. Corticosteroid treatment was initiated and the patient is now in clinical remission. PMID:14636525
Argüelles Arias, F; Argüelles Martín, F; Caunedo Alvarez, A; Rodríguez-Téllez, M; Herrerías Gutiérrez, J M
Wireless Capsule Endoscopy (WCE) is a relatively new technology (FDA approved in 2002) allowing doctors to view most of the small intestine. WCE transmits more than 50,000 video frames per examination and the visual inspection of the resulting video is a highly time-consuming task even for the experienced gastroenterologist. Typically, a medical clinician spends one or two hours to analyze a WCE video. To reduce the assessment time, it is critical to develop a technique to automatically discriminate digestive organs and shots each of which consists of the same or similar shots. In this paper a multi-level WCE video segmentation methodology is presented to reduce the examination time.
Hwang, Sae; Celebi, M. Emre
A thorough endoscopic visualization of the digestive mucosa is essential for reaching an accurate diagnosis and to treat the different lesions. Standard white light endoscopes permit a good mucosa examination but, nowadays, the introduction of powerful endoscopic instrumentations increased ability to analyze the finest details. By applying dyes and zoom-magnification endoscopy further architectural detail of the mucosa can be elucidated. New computed virtual chromoendoscopy have further enhanced optical capabilities for the evaluation of submucosal vascolar pattern. Recently, confocal endomicroscopy and endocytoscopy were proposed for the study of ultrastructural mucosa details. Because of the technological contents of powerful instrumentation, a good knowledge of implemented technologies is mandatory for the endoscopist, nowadays. Nevertheless, there is a big confusion about this topic. We will try to explain these technologies and to clarify this terminology.
Fluorescence images were recorded simultaneously with white light images to detect dyspasia or early malignancies during regular endoscopy of the upper gastrointestinal tract, after topical administration of 5-aminolaevulinic acid. Biopsies were taken at locations where fluorescence intensity were high compared with the mean fluorescence intensity of the image. Prompt and delayed fluorescence spectra of biopsies were subsequently recorded ex vivo, and normalized fluorescence intensities of Protoporphyrin IX derived from these spectra were compared with routine histology. In contrast to routine endoscopy, one early carcinoma and one signet-ring carcinoma were found in the stomach, and malignancies in a duodenal polyp. In addition, intestinal metaplasia could be visualized in the stomach of two patients, which had not been detected in biopsies taken prior to fluorescence endoscopy.
Sukowski, Uwe; Ebert, Bernd; Ortner, Marianne; Zumbusch, Katharina; Mueller, Karsten; Fleige, Barbara; Lochs, Herbert; Rinneberg, Herbert H.
A jejunal ectopic pancreas, where pancreatic tissue is found outside of the usual anatomical location, is a rare submucosal tumor that may cause obscure gastrointestinal (GI) bleeding. After initial negative endoscopic evaluation of the obscure GI bleeding, including colonoscopy and/or upper endoscopy, it is reasonable to proceed with further evaluation of the small bowel. Diagnostic options for the evaluation of the small bowel may include capsule endoscopy, push enteroscopy, or barium contrast small bowel studies. Here, we report a case of obscure GI bleeding caused by a jejunal ectopic pancreas, diagnosed through capsule endoscopy and barium contrast small bowel studies, which was treated successfully with single incision access laparoscopy. (Korean J Gastroenterol 2013;62:165-168). PMID:24077627
Choi, Woo Hyung; Chang, Hyoung Jin; Seung, Jee Hwan; Ko, Bong Suk; Kang, Sang Bum
AIM: To examine the predictive factors of capsule endoscopy (CE) completion rate (CECR) including the effect of inpatient and outpatient status. METHODS: We identified 355 consecutive patients who completed CE at Rush University Medical Center between March 2003 and October 2005. Subjects for CE had either nothing by mouth or clear liquids for the afternoon and evening of the day before the procedure. CE exams were reviewed by two physicians who were unaware of the study hypotheses. After retrospective analysis, 21 cases were excluded due to capsule malfunction, prior gastric surgery, endoscopic capsule placement or insufficient data. Of the remaining 334 exams [264 out-patient (OP), 70 in-patient (IP)], CE indications, findings, location of the patients [IP vs OP and intensive care unit (ICU) vs general medical floor (GMF)] and gastrointestinal transit times were analyzed. Statistical analysis was completed using SPSS version 17 (Chicago, IL). Chi-square, t test or fisher exact-tests were used as appropriate. Multivariate logistic regression analysis was used to identify variables associated with incomplete CE exams. RESULTS: The mean age for the entire study population was 54.7 years. Sixty-one percent of the study population was female, and gender was not different between IPs vs OPs (P = 0.07). The overall incomplete CECR was 14% in our study. Overt obscure gastrointestinal bleeding (OGB) was significantly more common for the IP CE (P = 0.0001), while abdominal pain and assessment of IBD were more frequent indications for the OP CE exams (P = 0.002 and P = 0.01, respectively). Occult OGB was the most common indication and arteriovenous malformations were the most common finding both in the IPs and OPs. The capsule did not enter the small bowel (SB) in 6/70 IPs and 8/264 OPs (P = 0.04). The capsule never reached the cecum in 31.4% (22/70) of IP vs 9.5% (25/ 264) of OP examinations (P < 0.001). The mean gastric transit time (GTT) was delayed in IPs compared to OPs, 98.5 ± 139.5 min vs 60.4 ± 92.6 min (P = 0.008). Minimal SB transit time was significantly prolonged in the IP compared to the OP setting [IP = 275.1 ± 111.6 min vs OP = 244.0 ± 104.3 min (P = 0.037)]. CECR was also significantly higher in the subgroup of patients with OGB who had OP vs IP exams (95% vs 80% respectively, P = 0.001). The proportion of patients with incomplete exams was higher in the ICU (n = 7/13, 54%) as compared to the GMF (n = 15/57, 26%) (P = 0.05). There was only a single permanent SB retention case which was secondary to a previously unknown SB stricture, and the remaining incomplete SB exams were due to slow transit. Medications which affect gastrointestinal system motility were tested both individually and also in aggregate in univariate analysis in hospitalized patients (ICU and GMF) and were not predictive of incomplete capsule passage (P > 0.05). Patient location (IP vs OP) and GTT were independent predictors of incomplete CE exams (P < 0.001 and P = 0.008, respectively). CONCLUSION: Incomplete CE is a multifactorial problem. Patient location and related factors such as severity of illness and sedentary status may contribute to incomplete exams.
Yazici, Cemal; Losurdo, John; Brown, Michael D; Oosterveen, Scott; Rahimi, Robert; Keshavarzian, Ali; Bozorgnia, Leila; Mutlu, Ece
Upper gastrointestinal bleeding is a life threatening condition in children. Common sources of upper gastrointestinal bleeding\\u000a in children include variceal hemorrhage (most commonly extra-hepatic portal venous obstruction in our settings) and mucosal\\u000a lesions (gastric erosions and ulcers secondary to drug intake). While most gastrointestinal bleeding may not be life threatening,\\u000a it is necessary to determine the source, degree and possible
Vidyut Bhatia; Rakesh Lodha
Endoscopy is an important diagnostic and therapeutic procedure that demands high levels of cognitive and technical skill to perform effectively. Surprisingly little is known about how endoscopy is best taught and training is often inadequate. The aims of this study were to explore the learning experiences of endoscopy trainees to improve our understanding of current training. Following the use of an initial focus group to generate appropriate themes semi-structured interviews were performed on 10 trainees to assess their learning experiences. Many different components of the learning experience were identified; one-to-one supervised performance forms the basis for teaching but is often sub-optimal; endoscopy learners experience anxiety and find re-adopting the role of novice difficult; motivation, clear explanation and feedback are crucial to learning; breaking down endoscopy training into segments is seen as valuable and as learners progress a gradual withdrawal of supervision is appreciated. Several of the issues contributing to a positive learning experience relate closely to published evidence and theory relating to skills teaching from other fields. A model identifying the key elements of endoscopy learning is proposed. Further work to apply and test the findings from this study should lead to improved endoscopy training. PMID:16973460
Thuraisingam, Adrian I; MacDonald, Janet; Shaw, Ian S
It is well documented that work with lasers poses a risk of ocular radiation damage. We specifically investigated the risk of intense backflash during laser treatment of gastrointestinal bleeding. Two well-characterized models of mucosal reflections are used to document flashback levels on several standard fiberoptic endoscopes. Both argon and neodymium-YAG laser sources are evaluated. Filter attachments that will provide adequate protection from the flashback hazard are also described. PMID:20212555
Gulacsik, C; Auth, D C; Silverstein, F E
Advances in interventional endoscopic technology and techniques are paving the way for the increased application of minimally\\u000a invasive methods to treat various upper gastrointestinal conditions, both benign and malignant. Through the description of\\u000a enteral stenting for palliation of malignant obstruction, expanded techniques of enteral feeding tube placement, mucosectomy\\u000a of early gastric cancer, and snare ampullectomy for benign ampullary lesions, this
Tonya Kaltenbach; Seth Crockett; George Triadafilopoulos
Background With the growing demand on endoscopy services, optimising practice efficiency has assumed increasing importance. Prior research\\u000a has identified practice changes, which increase the efficiency in endoscopy. In this study, the potential impact of these\\u000a practice changes on the current and projected future endoscopy waiting times at our institution was assessed.\\u000a \\u000a \\u000a \\u000a Methods The annual volume of endoscopic procedures performed at a major
G. C. Harewood; H. Ryan; F. Murray; S. Patchett
Aim of the present work was the development of a mechanic cell separation protocol for gastrointestinal biopsy analysis. Evaluation of the technique was performed on selected group of patients who underwent routine endoscopy. Routine gastrointestinal biopsies were obtained after informed consent. 23 gastric (6 healthy, 14 gastritis, 3 adenocarcinoma) and 15 colon samples (5 healthy, 7 colitis ulcerosa, 3 adenocarcinoma) were evaluated. The mechanic disruption of the biopsies was performed by Medimachine (DAKO, Denmark), a commercially available system using a 30 microns miner and a 30 microns mesh. The cell solution was centrifuged for 5 minutes by 250 g. The cells were fixed in paraformaldehide and stained by propidium iodide. The flow cytometry analysis was performed on a BD FacStar Plus flow cytometer. The DNA data were evaluated using the Winlist software. All of the preparations were appropriate for flow cytometric analysis. The coefficient of variation of the DNA histograms (n = 7) (CV mean +/- SD. 6.45% +/- 1.21) were acceptable for analysis. In the gastric biopsy samples aneuploidy was determined only in malignant cases. In four of the seven colitis ulcerosa samples and in one of the three adenocarcinoma aneploidy was found. The histologically healthy specimen were all diploid. Mechanic cell separation and disaggregation is a useful method for preparing fresh biopsy specimen for flow cytometry. PMID:10808730
Molnár, B; Kármán, J; Németh, A; Prónai, L; Zágoni, T; Tulassay, Z
Endoscopic evaluation of the presence or absence of gastritis is often performed in lieu of biopsy and histologic diagnosis. The purpose of our study was to assess the value of endoscopic examination as a diagnostic test for gastritis. Two endoscopists prospectively assessed the antrum of 73 patients undergoing upper gastrointestinal endoscopy and graded, on a scale of 0-4 (0 = completely absent, 4 = definitely present), the likelihood of gastritis. The following features were also assessed at the time of endoscopy: erythema, nodularity, erosion, edema, and friability. Two concomitant antral biopsies (3 cm from the pylorus on the greater curvature of the stomach) were performed regardless of the endoscopic impression. The histologic findings were graded independently on a scale of 0-3 by two pathologists who were not aware of the endoscopic findings. The following histologic features were graded: acute inflammation, chronic inflammation, lymphoid aggregates, intestinal metaplasia, and quantity of Helicobacter pylori organisms. Receiver operator characteristic analysis, a method derived from signal detection theory, assesses the trade-off of sensitivity and specificity over all cutoff points of a test and is considered the best method by which to compare tests and determine the diagnostic utility of a given test. Receiver operator characteristic analysis gave an area of 0.65 +/- 0.01 SE for endoscopy as a test for gastritis (0.5 = chance, 1 = perfect) as defined by the histologic presence of inflammation. Additionally, endoscopy as a test for the presence of histologically proven Helicobacter pylori gave an area of 0.55 +/- 0.01 SE. All endoscopically graded features treated as separate tests for gastritis and/or H. pylori gave areas of approximately 0.44-0.61, indicative of a poor test. While H. pylori was always associated with at least some degree of inflammation, linear regression analysis revealed no correlation among any of the histologic features or of any histologic feature with any endoscopic feature. We conclude that a tissue diagnosis is essential for the proper diagnosis of gastritis. PMID:9398799
Belair, P A; Metz, D C; Faigel, D O; Furth, E E
Complications following gastrointestinal surgery may require re-intervention, can lead to prolonged hospitalization, and significantly increase health costs. Some complications, such as anastomotic leakage, fistula, and stricture require a multidisciplinary approach. Therapeutic endoscopy may play a pivotal role in these conditions, allowing minimally invasive treatment. Different endoscopic approaches, including fibrin glue injection, endoclips, self-expanding stents, and endoscopic vacuum-assisted devices have been introduced for both anastomotic leakage and fistula treatment. Similarly endoscopic treatments, such as endoscopic dilation, incisional therapy, and self-expanding stents have been used for anastomotic strictures. All these techniques can be safely performed by skilled endoscopists, and may achieve a high technical success rate in both the upper and lower gastrointestinal tract. Here we will review the endoscopic management of post-surgical complications; these techniques should be considered as first-line approach in selected patients, allowing to avoid re-operation, reduce hospital stay, and decrease costs. PMID:23623147
Manta, Raffaele; Magno, Luca; Conigliaro, Rita; Caruso, Angelo; Bertani, Helga; Manno, Mauro; Zullo, Angelo; Frazzoni, Marzio; Bassotti, Gabrio; Galloro, Giuseppe
A 49-year-old woman presented with chronic abdominal discomfort, significant weight loss, and chronic intermittent diarrhea. She suddenly developed massive upper gastrointestinal bleeding and was referred for further treatment. Endoscopy indicated a large mass in the upper gastric body with antral and duodenal bulb involvement. Endosonography showed a large well-defined isoechoic gastric subepithelial mass with multiple intra-abdominal and peripancreatic lymphadenopathy, suspected to be malignant on the basis of fine needle aspiration cytology. The tumor was surgically removed, and histopathology showed typical characteristics of a neuroendocrine tumor. On the basis of immunohistochemical staining, somatostatinoma, a rare neuroendocrine tumor, was diagnosed. Gastrointestinal bleeding is a rare presentation and the stomach is an uncommon tumor location.
Aswakul, Pitulak; Deesomsak, Morakod; Pongpaibul, Ananya
A survey of 31 German hospitals (14 university hospitals with a special gastrointestinal service, 13 key hospitals with specialized GI units, mainly university teaching hospitals, and 4 smaller hospitals without specialization) showed that a service providing the usual gastrointestinal endoscopic procedures is available in all university and key hospitals. In the university hospitals, an average of 4,765 procedures per year are performed, in the key hospitals with specialized GI units 5,558, and in the smaller hospitals without specialization 2,935. Such special methods as ERCP, PTC and operative endoscopy are usually restricted to special clinics. The number of doctors and nursing staff is adequate at university hospitals and in specialized key hospitals. Smaller hospitals without specialization need more nursing staff. All hospitals need more rooms. The supply of instruments is sufficient at university and key hospitals, but more instruments are needed in general non-specialized hospitals. German endoscopic units are relatively well equipped with X-ray machines, but further X-ray equipment is still needed to achieve less dependence on centralized radiological departments. There is a distinct need for more waiting and recovery rooms. At the present time, there is no optimal endoscopic unit in Germany. Better and appropriate outfitting of the units, and an optimized floor-plan encompassing endoscopy rooms, rooms for preparation and after-care are needed--which is not practical in the case of existing hospitals, but must be considered when planning new hospitals. PMID:3948802
Seifert, E; Weismüller, J
This study was performed to determine if and for how long sucralfate (SU) binds selectively to sites of gastro-intestinal (GI) ulceration. Se-Su was prepared by sulfating sucrose with tracer Se-75 and precipitating it as the basic Al salt. All patients (pts) had endoscopy to confirm the presence of either: esophagitis (n=5), gastritis (GA) (n=5), gastric ulcers (GU) (n=5), duodenal ulcers
A. H. Maurer; L. C. Knight; M. Kollman; B. Krevsky; D. Pleet; F. DErcole; J. A. Siegel; R. S. Fisher; L. S. Malmud
Over the past decade, the microenvironment of gastrointestinal tumors has gained increasing attention because it is required for tumor initiation, progression, and metastasis. The tumor microenvironment has many components and has been recognized as one of the major hallmarks of epithelial cancers. Although therapeutic strategies for gastrointestinal cancer have previously focused on the epithelial cell compartment, there is increasing interest in reagents that alter the microenvironment, based on reported interactions among gastrointestinal epithelial, stromal, and immune cells during gastrointestinal carcinogenesis. We review the different cellular components of the gastrointestinal tumor microenvironment and their functions in carcinogenesis and discuss how improving our understanding of the complex stromal network could lead to new therapeutic strategies. PMID:23583733
Quante, Michael; Varga, Julia; Wang, Timothy C; Greten, Florian R
AIM: The fears and concerns are associated with gastroscopy (EGD) decrease patient compliance. Conscious sedation (CS) and non-pharmacological interventions have been proposed to reduce anxiety and allow better execution of EGD. The aim of this study was to assess whether CS, supplementary information with a videotape, or presence of a relative during the examination could improve the tolerance to EGD.
Lucio Trevisani; Sergio Sartori; Piergiorgio Gaudenzi; Giuseppe Gilli; Giancarlo Matarese; Sergio Gullini; Vincenzo Abbasciano
An acute upper gastrointestinal bleed (AUGIB) often represents a life-threatening event and is recognised universally as a common cause of emergency hospitalisation. Large observational studies have improved our understanding of the disease characteristics and its impact on mortality but despite significant advancement in endoscopic management, mortality remains high, particularly in elderly patients and those with multiple comorbidities. Skilled assessment, risk stratification and prompt resuscitation are essential parts of patient care, with endoscopy playing a key role in the definitive management. A successful outcome partly relies on the clinician's familiarity with current guidelines and recommendations, including the National Institute for Clinical Excellence guidelines published in 2012. Validated risk stratification scores, such as the Blatchford and Rockall score, facilitate early discharge of low-risk patients as well as help in identifying those needing early endoscopic intervention. Major advances in therapeutic endoscopy, including more recently, the development of non-toxic proprietary powders (Hemospray and EndoClot), have resulted in the development of effective treatments of bleeding lesions, reduction in rebleeding rates and the need for emergency surgery. The role of proton-pump inhibitor therapy prior to endoscopy and the level of optimum red cell transfusion in the setting of AUGIB remain fields that require further research. PMID:23924686
Hegade, Vinod S; Sood, Ruchit; Mohammed, Noor; Moreea, Sulleman
Gastrointestinal (GI) bleeding is a common clinical presentation increasing in an aging population, frequently requiring hospitalization and emergent intervention, with significant morbidity, mortality, and costs. It may manifest overtly as hematemesis, melena, or hematochezia, or as an asymptomatic occult bleed. Management typically involves an esophagogastroduodenoscopy or a colonoscopy; these in combination sometimes do not identify a source of bleeding, with the source remaining obscure. Further work up to identify an obscure source frequently requires radiologically detecting the leakage of an intravascular tracer (using tagged red blood cells or angiography) with brisk bleeding or in other cases CT enterography (CTE) to detect bowel wall changes consistent with a bleeding source. Recent advances including capsule endoscopy, CTE, and double-balloon endoscopy have helped to identify bleeding sources beyond the reach of conventional endoscopy. Clinical decision-making about their use is complex and evolving. Knowing their relative merits and weaknesses including yield, contraindications, complications, and cost is essential in coming up with an appropriate management plan. This review covers the rationale for clinical management of obscure sources of GI bleeding, mentioning the approach to and the yield of conventional methods, with an emphasis on the recent advances mentioned above. PMID:18581161
Singh, Vijay; Alexander, Jeffrey A
OBJECTIVE:The demand for endoscopic services is increasing rapidly. Of the several potential mechanisms to improve the supply of endoscopic procedures, improved efficiency in the endoscopy unit has received little attention.METHODS:We invited 20 experienced endoscopists to participate in an initial evaluation of endoscopy efficiency, in which they were observed performing procedures in their own unit. Procedure volume per unit time was
Saeed Zamir; Douglas K. Rex
Gastrointestinal stromal tumors (GIST) are rare mesenchymal smooth muscle sarcomas that can arise anywhere within the gastrointestinal tract. Sporadic mutations within the tyrosine kinase receptors of the interstitial cells of Cajal have been identified as the key molecular step in GIST carcinogenesis. Although many patients are asymptomatic, the most common associated symptoms include: abdominal pain, dyspepsia, gastric outlet obstruction, and anorexia. Rarely, GIST can perforate causing life-threatening hemoperitoneum. Most are ultimately diagnosed on cross-sectional imaging studies (i.e., computed tomography and/or magnetic resonance imaging in combination with upper endoscopy. Endoscopic ultrasonographic localization of these tumors within the smooth muscle layer and acquisition of neoplastic spindle cells harboring mutations in the c-KIT gene is pathognomonic. Curative treatment requires a complete gross resection of the tumor. Both open and minimally invasive operations have been shown to reduce recurrence rates and improve long-term survival. While there is considerable debate over whether GIST can be benign neoplasms, we believe that all GIST have malignant potential, but vary in their propensity to recur after resection and metastasize to distant organ sites. Prognostic factors include location, size (i.e., > 5 cm), grade (> 5-10 mitoses per 50 high power fields and specific mutational events that are still being defined. Adjuvant therapy with tyrosine kinase inhibitors, such as imatinib mesylate, has been shown to reduce the risk of recurrence after one year of therapy. Treatment of locally-advanced or borderline resectable gastric GIST with neoadjuvant imatinib has been shown to induce regression in a minority of patients and stabilization in the majority of cases. This treatment strategy potentially reduces the need for more extensive surgical resections and increases the number of patients eligible for curative therapy. The modern surgical treatment of gastric GIST combines the novel use of targeted therapy and aggressive minimally invasive surgical procedures to provide effective treatment for this lethal, but rare gastrointestinal malignancy. PMID:23239909
Roggin, Kevin K; Posner, Mitchell C
Heterotopic pancreas (HP) is pancreatic tissue found outside the usual anatomical location of the pancreas, typically in the upper gastrointestinal tract. Asymptomatic HP is considered a benign submucosal tumor (SMT) that can be followed without intervention. However, invasive surgery or endoscopic resection is often inappropriately applied in cases of HP due to the difficulty of preoperative diagnosis by endoscopic ultrasonography (EUS) and tissue sampling error. Therefore, it is very important to distinguish HP from neoplastic SMTs, such as gastrointestinal stromal tumor (GIST), preoperatively. Herein, we describe two asymptomatic gastric HP cases that were distinguished by endoscopic direct imaging (EDI) on submucosal endoscopy with a mucosal flap method (SEMF). In the two patients, EUS-guided fine needle aspiration (FNA) biopsy failed to accurately diagnose two SMTs, consistent with the suspicion of a GIST on EUS. Accordingly, we attempted to perform bloc biopsy using SEMF as a novel method for obtaining tissue samples for two indefinite SMTs. Direct endoscopic imaging via a dissected submucosal tunnel revealed a yellowish, multi-nodular mass identified as pancreatic tissue. Histopathology of the bloc biopsy confirmed the diagnosis of HP. Our findings indicate that the characteristic EDI findings of gastric HP may distinguish these lesions from neoplastic SMTs. Additional evaluations of this approach are warranted. PMID:24078995
Kobara, Hideki; Mori, Hirohito; Fujihara, Shintaro; Nishiyama, Noriko; Tsutsui, Kunihiko; Masaki, Tsutomu
Ingestible video capsules enable today non-invasive and comfortable gastrointestinal explorations. As such, capsule endoscopy is progressively emerging as an attractively simple wireless technology for optical investigations of the digestive tube and, in particular, as a useful complementary diagnostic tool with respect to traditional probe endoscopy. In spite of this, capsule endoscopes still show at present a major technical lack, capable of seriously limiting their clinical efficacy: their motion cannot be controlled by an external operator. In fact, the lack of a navigation control system makes their movements and orientations totally random, being exclusively driven by visceral peristalsis and gravity. In order to provide motion control properties, a technique based on the application of external magnetic fields, capable of manoeuvring a capsule previously equipped with a magnetic component, was recently proposed. This paper presents preliminary results of the first experimental implementation of this concept with a magnetic robotic system recently introduced in the clinical practice, although for different applications in the field of cardiology. The potentialities offered by this robotic system for magnetic controls of gastrointestinal capsules were preliminarily assessed in this work with manoeuvring tests of a video capsule inside a plastic replica of a human bust. Results showed the possibility of magnetically guiding the navigation of an endoscopic capsule within the considered experimental set-up, by advantageously using the reliable robotic navigation system already employed for clinical applications. Such an outcome encourages further investigations within more challenging experimental conditions. PMID:18786802
Carpi, Federico; Pappone, Carlo
We performed a randomized prospective trial to compare unsedated endoscopy via transnasal and transoral routes using a small-caliber\\u000a endoscope. Two hundred patients referred for diagnostic esophagogastroduodenoscopy (EGD) were randomly allocated to two groups:\\u000a those undergoing transnasal (TN) and transoral (TO) endoscopy. We examined the insertion rate, examination duration, nasal\\u000a pain, pharyngeal pain, number of occurrences of pharyngeal reflex, severity of
Hidetaka Watanabe; Naomi Watanabe; Rieko Ogura; Noriyuki Nishino; Yasuyuki Saifuku; Genyo Hitomi; Yutaka Okamoto; Keiichi Tominaga; Naoto Yoshitake; Michiko Yamagata; Masami Orui; Hideyuki Hiraishi
There are no validated training\\/accreditation guidelines for capsule endoscopy. We assessed the utility of a structured training\\u000a program on two experienced gastroenterologists and one endoscopy nurse. Validated studies were standardized for difficulty\\u000a in blocks of three. Trainees completed a standardized data sheet for each study reported (12 studies for the physicians, 22\\u000a studies for the nurse). After each block the
Aymer Postgate; Adam Haycock; Aine Fitzpatrick; Gill Schofield; Paul Bassett; Siwan Thomas-Gibson; Chris Fraser
This article surveys the most important gastrointestinal parasites that affect humans. The modes of acquisition, pathology, epidemiology, diagnosis, and treatment are all briefly examined. Gastrointestinal parasites have become increasingly important in the differential diagnosis of gastrointestinal disease, as a result of a number of circumstances. These circumstances include: increasing travel to developing countries; increased numbers, for one reason or another, of immunocompromised individuals; increased consumption of raw or partially cooked ethnic delicacies; more crowding in day-care centres; increased immigration from developing countries; and an endemic pocket of individuals with certain unhygienic or unsanitary practices.
Embil, Juan A.; Embil, John M.
In order to perform 3D images around shallow-depth boreholes, in conditions in the field and within reasonable times of data acquisitions, several instrumental developments have been performed. The first development concerns the design of a directional probe working in the 20-100 kHz frequency range; the idea is to create a tool composed of multiple elementary piezoelectric entities able to cover the whole space to explore; made of special polyurethane rigid foam with excellent attenuation performances, the prototypes are covered by flexible polyurethane electric resin. By multiplying the number of elementary receptors around the vertical axes and piling up each elementary sensor, a complete design of multi-azimuth and multi-offset has been concepted. In addition to this, a test site has been built in order to obtain a controlled medium at typical scales of interest for seismic endoscopy and dedicated to experiment near the conditions in the field. Various reflectors are placed in well known positions and filled in an homogeneous cement medium; the whole edifice (2.2 m in diameter and 8 metres in depth) also contains 4 PVC tubes to simulate boreholes. The second part of this instrumental developments concern the synthesis of input signals; indeed, many modern devices used in ultrasonic experiment have non linear output response outside their nominal range: this is especially true in geophysical acoustical experiments when high acoustical power is necessary to insonify deep geological targets. Thanks to the high speed electronic and computerised devices now available, it is possible to plug in experimental set-ups into non linear inversions algorithms like simulated annealing. First experiments showed the robustness of the method in case of non linear analogic architecture. Large wavelet families have or example been constructed thanks to the method and multiscale Non Destructive Testing Method have been performed as an efficient method to detect and characterise discontinuities or velocities variations of a material.
Conil, F.; Nicollin, F.; Gibert, D.
The correlation of gastrointestinal symptoms and infections in 186 consecutive patients with human immunodeficiency virus (HIV) infection undergoing diagnostic endoscopy (oesophagogastroduodenoscopy, n = 124; colonoscopy, n = 37; both, n = 25) was investigated. Biopsy and stool samples were examined for infective agents. Only weight loss (p = 0.003) and dysphagia (p = 0.027) were more common in patients at stage CDC IV compared with earlier stages. In three of 27 patients at stage II/III and in 93 of 159 patients at stage IV an infective agent was identified in stool or gastrointestinal biopsy specimen (p < 0.001). Cytomegalovirus (n = 35), Candida sp (n = 28), M avium complex (n = 10), and Cryptosporidium (eight) were the most frequent agents detected. At stage IV, diarrhoea was more frequent in infected compared with non-infected patients (p = 0.006); however, an infective agent was also found in 39 of 82 patients at stage IV without diarrhoea. The frequency of gastrointestinal symptoms was not consistently increased in patients harbouring specific infective agents compared with non-infected patients. Our findings indicate that the pathogenic relevance of a gastrointestinal infection in HIV infected patients has to be verified and indirectly support the existence of an HIV associated enteropathy.
Ullrich, R; Heise, W; Bergs, C; L'age, M; Riecken, E O; Zeitz, M
Intraductal endoscopy describes the use of an endoscope to directly visualize the biliary and pancreatic ducts. For many years, technological challenges have made performing these procedures difficult. The “mother-baby” system and other various miniscopes have been developed, but routine use has been hampered due to complex setup, scope fragility and the time consuming, technically demanding nature of the procedure. Recently, the SpyGlass peroral cholangiopancreatoscopy system has shown early success at providing diagnostic information and therapeutic options. The clinical utility of intraductal endoscopy is broad. It allows better differentiation between benign and malignant processes by allowing direct visualization and targeted sampling of tissue. Therapeutic interventions, such as electrohydraulic lithotripsy (EHL), laser lithotripsy, photodynamic therapy, and argon plasma coagulation (APC), may also be performed as part of intraductal endoscopy. Intraductal endoscopy significantly increases the diagnostic and therapeutic yield of standard endoscopic retrograde cholangiography (ERCP), and as technology progresses, it is likely that its utilization will only increase. In this review of intraductal endoscopy, we describe in detail the various endoscopic platforms and their diagnostic and clinical applications.
Judah, Joel R; Draganov, Peter V
For difficult cases in endoscopic sinus surgery, a careful planning of the intervention is necessary. Due to the reduced field of view during the intervention, the surgeons have less information about the surrounding structures in the working area compared to open surgery. Virtual endoscopy enables the visualization of the operating field and additional information, such as risk structures (e.g., optical nerve and skull base) and target structures to be removed (e.g., mucosal swelling). The Sinus Endoscopy system provides the functional range of a virtual endoscopic system with special focus on a realistic representation. Furthermore, by using direct volume rendering, we avoid time-consuming segmentation steps for the use of individual patient datasets. However, the image quality of the endoscopic view can be adjusted in a way that a standard computer with a modern standard graphics card achieves interactive frame rates with low CPU utilization. Thereby, characteristics of the endoscopic view are systematically used for the optimization of the volume rendering speed. The system design was based on a careful analysis of the endoscopic sinus surgery and the resulting needs for computer support. As a small standalone application it can be instantly used for surgical planning and patient education. First results of a clinical evaluation with ENT surgeons were employed to fine-tune the user interface, in particular to reduce the number of controls by using appropriate default values wherever possible. The system was used for preoperative planning in 102 cases, provides useful information for intervention planning (e.g., anatomic variations of the Rec. Frontalis), and closely resembles the intraoperative situation. PMID:18989001
Krüeger, Arno; Kubisch, Christoph; Straub, Gero; Preim, Bernhard
AIM: To investigate the potential benefit of Fujinon intelligent chromo endoscopy (FICE)-assisted small bowel capsule endoscopy (SBCE) for detection and characterization of small bowel lesions in patients with obscure gastroenterology bleeding (OGIB). METHODS: The SBCE examinations (Pillcam SB2, Given Imaging Ltd) were retrospectively analyzed by two GI fellows (observers) with and without FICE enhancement. Randomization was such that a fellow did not assess the same examination with and without FICE enhancement. The senior consultant described findings as P0, P1 and P2 lesions (non-pathological, intermediate bleed potential, high bleed potential), which were considered as reference findings. Main outcome measurements: Inter-observer correlation was calculated using kappa statistics. Sensitivity and specificity for P2 lesions was calculated for FICE and white light SBCE. RESULTS: In 60 patients, the intra-class kappa correlations between the observers and reference findings were 0.88 and 0.92 (P2), 0.61 and 0.79 (P1), for SBCE using FICE and white light, respectively. Overall 157 lesions were diagnosed using FICE as compared to 114 with white light SBCE (P = 0.15). For P2 lesions, the sensitivity was 94% vs 97% and specificity was 95% vs 96% for FICE and white light, respectively. Five (P2 lesions) out of 55 arterio-venous malformations could be better characterized by FICE as compared to white light SBCE. Significantly more P0 lesions were diagnosed when FICE was used as compared to white light (39 vs 8, P < 0.001). CONCLUSION: FICE was not better than white light for diagnosing and characterizing significant lesions on SBCE for OGIB. FICE detected significantly more non-pathological lesions. Nevertheless, some vascular lesions could be more accurately characterized with FICE as compared to white light SBCE.
Gupta, Tarun; Ibrahim, Mostafa; Deviere, Jacques; Gossum, Andre Van
A 52-year-old white woman had suffered from intermittent gastrointestinal (GI) bleeding for one year. Upper GI endoscopy, colonoscopy and peroral double-balloon enteroscopy (DBE) did not detect any bleeding source, suggesting obscure GI bleeding. However, in videocapsule endoscopy a jejunal ulceration without bleeding signs was suspected and this was endoscopically confirmed by another peroral DBE. After transfusion of packed red blood cells, the patient was discharged from our hospital in good general condition. Two weeks later she was readmitted because of another episode of acute bleeding. Multi-detector row computed tomography with 3D reconstruction was performed revealing a jejunal tumor causing lower gastrointestinal bleeding. The patient underwent exploratory laparotomy with partial jejunal resection and end-to-end jejunostomy for reconstruction. Histological examination of the specimen confirmed the diagnosis of a low risk gastrointestinal stromal tumor (GIST). Nine days after surgery the patient was discharged in good health. No signs of gastrointestinal rebleeding occurred in a follow-up of eight months. We herein describe the complex presentation and course of this patient with GIST and also review the current approach to treatment. PMID:21403816
Reuter, Stefan; Bettenworth, Dominik; Mees, Sören Torge; Neumann, Jörg; Beyna, Torsten; Domschke, Wolfram; Wessling, Johannes; Ullerich, Hansjörg
A 52-year-old white woman had suffered from intermittent gastrointestinal (GI) bleeding for one year. Upper GI endoscopy, colonoscopy and peroral double-balloon enteroscopy (DBE) did not detect any bleeding source, suggesting obscure GI bleeding. However, in videocapsule endoscopy a jejunal ulceration without bleeding signs was suspected and this was endoscopically confirmed by another peroral DBE. After transfusion of packed red blood cells, the patient was discharged from our hospital in good general condition. Two weeks later she was readmitted because of another episode of acute bleeding. Multi-detector row computed tomography with 3D reconstruction was performed revealing a jejunal tumor causing lower gastrointestinal bleeding. The patient underwent exploratory laparotomy with partial jejunal resection and end-to-end jejunostomy for reconstruction. Histological examination of the specimen confirmed the diagnosis of a low risk gastrointestinal stromal tumor (GIST). Nine days after surgery the patient was discharged in good health. No signs of gastrointestinal rebleeding occurred in a follow-up of eight months. We herein describe the complex presentation and course of this patient with GIST and also review the current approach to treatment.
Reuter, Stefan; Bettenworth, Dominik; Mees, Soren Torge; Neumann, Jorg; Beyna, Torsten; Domschke, Wolfram; Wessling, Johannes; Ullerich, Hansjorg
In a cooperation between the University Hospital Rotterdam (AZR) and HISCOM, HIS supplier, a multimedia information system for endoscopy (ENSIS) has been developed in a project funded by the Dutch Ministry of Health Care. An integral part of this project was an evaluation of costs and effects of this system. The system has been implemented on the gastroenterology department and the internal medicine ward in the AZR. The results indicate that the anatomical knowledge of requesting physicians improved with the system. Both the response time and availability of endoscopy images improved greatly. Because of the use of off-the-shelve technology (possible because of the relatively small resolution requirements of endoscopy images) ENSIS can be implemented at relatively low costs.
Enning, C. John W.; Siersema, P. D.; van Blankenstein, Mark; van Boven, Gert-Jan; van Gennip, Elisabeth M.
Capsule endoscopy has been shown to detect small bowel inflammatory changes better than any other imaging modality. Selection criteria have been optimized to increase the yield of capsule endoscopy in patients suspected to have Crohn’s disease. Capsule endoscopy allows for earlier diagnosis of Crohn’s disease of the small bowel and improved diagnosis of colitis in patients where it is unclear if they suffer from Crohn’s or ulcerative colitis. A test capsule is available to assess for small bowel strictures and thus avoid capsule retention. A common language has been developed and a new scoring index will be added to capsule software. It is envisioned that the manner in which we treat Crohn's disease in the future will change, based on earlier diagnosis and treatment aimed at mucosal healing rather than symptom improvement.
Lewis, Blair S
This article reports an initiative to improve students' insight into service user and carer experience of endoscopy, particularly those with severe disability, such as spinal cord injury. This insight has the potential to improve the information provided and level of person-centred care in an endoscopy service. It was evident in the feedback from the classroom encounter that the teaching and learning strategy had a positive outcome, which will allow us to integrate the approach into future curriculum development and delivery, bringing the lived experience from the service user and carer perspective into the classroom. Students engaged in discussion and used their reflective skills to develop sensitivity to those with physical disability and complex needs requiring endoscopy procedures. PMID:24121848
Martin, Daphne; Hoy, Leontia; N Hoy, Karl
A 55-year-old man was hospitalized for a neurologic and infectious workup after having hallucinations and productive cough for 2 days. During hospitalization, he experienced dark stools with an acute drop in hemoglobin. Upper endoscopy and colonoscopy were negative for an identifiable source of bleed. Capsule endoscopy was later done and subsequently an anteroposterior abdominal radiograph confirmed the presence of a retained capsule near the junction of the descending and distal transverse colon, likely contained within a colonic diverticulum. In the interim, the patient developed acute right-sided lumbar radiculopathy prompting emergent lumbar spine magnetic resonance imaging (MRI). During the scanning process, the retained capsule was seen and the test was immediately terminated without harm to the patient. Device retention is a complication unique to capsule endoscopy, occurring at a rate of 1% to 1.7%; retained devices are considered a danger and contraindication to MRI.
Liang, Jackson J.; DeJesus, Ramona S.
We present an ultrathin fiber-optic endoscopy probe for optical coherence tomography (OCT), which is made of a series of fused optical fibers instead of the conventional scheme based on an objective lens. The large-core fiber with a core diameter of 20 ?m was utilized for the probe, while a single-mode fiber of core diameter 8.2 ?m mainly delivered the OCT light. Those fibers were spliced with a bridge fiber of an intermediate core size. The guided light was stepwise converted to a beam of a large mode-field diameter to be radiated with a larger depth of focus. We obtained a 125 ?m thick all-fiber endoscopy probe with a side-viewing capability implemented by an angled fiber end. Successful OCT imaging was demonstrated with a swept-source OCT system and showed the practical applicability of our lens-free endoscopy probe. PMID:23938961
Moon, Sucbei; Piao, Zhonglie; Kim, Chang-Seok; Chen, Zhongping
Exposure to asbestos is among several factors cited as possible causes of esophageal, gastric and colorectal cancer. More than 45 published studies have presented mortality data on asbestos-exposed workers. For each cohort, the authors listed the observed and expected rates of deaths from types of gastrointestinal cancer based on the latest published follow-up. Summary standardized mortality ratios (SMRs) were then derived. Finally, summary SMRs were calculated for total gastrointestinal tract cancer for three occupational groups: asbestos factory workers, insulators/shipyard workers and asbestos miners. Statistically significant elevations in summary SMRs were found for esophageal, stomach and total gastrointestinal tract cancer in all asbestos-exposed workers. Esophageal cancer summary SMR remained significantly elevated when data were reanalyzed to include only those cohorts with death certificate diagnoses for cause of observed deaths. However, summary SMRs were not statistically significant for stomach and total gastrointestinal tract cancer after reanalysis. Summary SMRs by occupational group showed a significant elevation for total gastrointestinal cancer in insulators/shipyard workers. The elevation was not significant after reanalysis. 59 references, 5 tables.
Morgan, R.W.; Foliart, D.E.; Wong, O.
Functional gastrointestinal disorders continue to be a prevalent set of conditions faced by the healthcare team and have a significant emotional and economic impact. In this review, the authors highlight some of the common functional disorders seen in pediatric patients (functional dyspepsia, irritable bowel syndrome, functional abdominal pain) as well as one of the more intriguing (cyclic vomiting). The most recent Pediatric Rome Working Group has modified the definitions of functional gastrointestinal disorders. Current studies have used these categorizations to understand better the epidemiology, etiology, and treatment options for these disorders. As more data are available, children and their families will be offered a better understanding of the conditions and more effective treatments to overcome them. The importance of making an accurate diagnosis of a functional gastrointestinal disorder cannot be overemphasized.
McOmber, Mark A.; Shulman, Robert J.
The use of self-expanding metallic stents in the upper gastrointestinal tract, placed under radiologic imaging or endoscopic guidance, is the current treatment of choice for the palliation of malignant gastrointestinal outlet obstructions. Advances in metallic stent design and delivery systems have progressed to the stage where this treatment is now considered a minimally invasive therapy. Metallic stent placement will broaden further into the field of nonsurgical therapy for the gastrointestinal tract. To date, metallic stents placed in the esophagus, gastric outlet, colorectum, and bile ducts are not intended to be curative, but rather to provide a palliative treatment for obstructions. The evolution of metallic stent technology will render such procedures not only palliative but also therapeutic, by enabling local drug delivery, and the use of biodegradable materials will reduce procedure-related complications.
Gastrointestinal stromal sarcomas, formerly categorized as leiomyosarcomas of gastrointestinal origin, have a common pattern of intraperitoneal dissemination. Despite surgical resection with or without adjuvant systemic chemotherapy the vast majority of these patients succumb to intraperitoneal sarcomatosis and/or hepatic metastases. In an attempt to improve upon the morbidity and mortality associated with this disease we and several other centers have begun treating these patients with intraperitoneal chemotherapy. We have found that aggressive surgical resection with postoperative intraperitoneal chemotherapy has significantly lowered the peritoneal recurrence rate in patients with recurrent gastrointestinal stromal sarcomas as compared to those who have undergone surgical resection alone. However, this treatment approach has proven to be ineffective in preventing hepatic metastases, and thus has had little effect upon overall survival. With the treatment of primary rather than recurrent disease we hope to interrupt the disease process at an earlier stage further decreasing peritoneal recurrences and potentially improving survival. PMID:11094326
Eilber, F C; Rosen, G; Forscher, C; Nelson, S D; Dorey, F; Eilber, F R
The invention of wireless capsule endoscopy has opened new ways of diagnosing and treating diseases in the gastrointestinal tract. Current wireless capsules can perform simple operations such as imaging and data collection (like temperature, pressure, and pH) in the gastrointestinal tract. Researchers are now focusing on adding more sophisticated functions such as drug delivery, surgical clips/tags deployment, and tissue samples collection. The finite on-board power on these capsules is one of the factors that limits the functionalities of these wireless capsules. Thus multiple application-specific capsules would be needed to complete an endoscopic operation. This would give rise to a multi-capsule environment. Having a modular "plug-and-play" capsule design would facilitate doctors in configuring multiple application-specific capsules, e.g. tagging capsule, for use in the gastrointestinal tract. This multi-capsule environment also has the advantage of reducing power consumption through asymmetric multi-hop communication. PMID:19964181
Phee, S J; Ting, E K; Lin, L; Huynh, V A; Kencana, A P; Wong, K J; Tan, S L
Colorectal cancer is one of the leading causes of cancer-related death in the Western society, and the incidence is rising. Rare hereditary gastrointestinal polyposis syndromes that predispose to colorectal cancer have provided a model for the investigation of cancer initiation and progression in the general population. Many insights in the molecular genetic basis of cancer have emerged from the study of these syndromes. This review discusses the genetics and clinical manifestations of the three most common syndromes with gastrointestinal polyposis and an increased risk of colorectal cancer: familial adenomatous polyposis (FAP), juvenile polyposis (JP) and Peutz-Jeghers syndrome (PJS). PMID:17311531
Brosens, Lodewijk A A; van Hattem, W Arnout; Jansen, Marnix; de Leng, Wendy W J; Giardiello, Francis M; Offerhaus, G Johan A
In 1986, 292 patients were admitted to a joint medical-surgical gastrointestinal unit with upper gastrointestinal haemorrhage. Fourteen patients died (4.8%) a mortality considerably lower than recorded in most series. The low mortality may result from the use of a specialized gastrointestinal unit to which all patients with upper gastrointestinal haemorrhage are admitted and managed with strict protocols for resuscitation, transfusion and surgery.
Sanderson, J. D.; Taylor, R. F.; Pugh, S.; Vicary, F. R.
The case of an 81-year-old patient, initially presenting with gastrointestinal (GI) bleeding, including melena and hematemesis is reported. Endoscopy revealed an ulcerated mass of the stomach corpus with immunohistochemistry stains consistent with metastatic melanoma. The thorough physical and paraclinical examination did not reveal any lesions or nodules as a primary site of the disease. The literature concerning this rare presentation of melanoma is also reviewed. PMID:19454519
Kotteas, E A; Adamopoulos, A; Drogitis, P D; Zalonis, A; Giannopoulos, K V; Karapanagiotou, E M; Saif, M Wasif; Syrigos, K N
The purpose of this study was to evaluate the accuracy of multi-detector row helical CT (MDCT) for detection and localization\\u000a of acute upper and lower gastrointestinal (GI) hemorrhage or intraperitoneal bleeding. Thirty-six consecutive patients with\\u000a clinical signs of acute bleeding underwent biphasic (16- or 40-channel) MDCT. MDCT findings were correlated with endoscopy,\\u000a angiography or surgery. Among the 36 patients evaluated,
T. Jaeckle; G. Stuber; M. H. K. Hoffmann; M. Jeltsch; B. L. Schmitz; A. J. Aschoff
We report a case of somatostatinoma of the papilla of Vater with multiple gastrointestinal stromal tumors in a patient with\\u000a von Recklinghausen's disease (VRD). A 64-year-old woman who had had recurrent attacks of acute pancreatitis and cholangitis\\u000a was found, on gastroduodenal endoscopy, to have a tumor of the papilla of Vater and multiple submucosal tumors of the stomach\\u000a and duodenum.
Masanobu Usui; Shinsuke Matsuda; Hideaki Suzuki; Kazuki Hirata; Yoshifumi Ogura; Taizo Shiraishi
Background and study aims: The best anesthesia methods for analgesia and sedation during gastrointestinal endoscopy are still debated. The aim of this study was to compare the recovery time, clinical presentations, and satisfaction between target-controlled infusion (TCI) and manually controlled infusion (MCI) in same-day bidirectional endoscopy (esophagogastroduodenoscopy followed by colonoscopy).Patients and methods: A total of 220 patients with American Society of Anesthesiology physical status 1 or 2 were enrolled and randomized into the TCI or MCI groups. The clinical presentations, vasoactive drug demand, propofol consumption, and adverse events were recorded for both groups peri-procedurally. The concentrations of propofol in the plasma (Cp) and at the site of drug effect (Ce) by computerized simulation were also monitored in both groups. Finally, the satisfaction of patients, endoscopists, and nurse anesthetists was assessed by questionnaire after the examinations.Results: Compared with the MCI group, the TCI group had a faster recovery time (17.91 ± 7.72 minutes vs. 14.58 ± 8.55 minutes; P = 0.002), less moderate hypotension (7.37 ± 15.46 % vs. 1.82 ± 5.15 %; P < 0.001), and shorter period of bradypnea (13.81 ± 15.92 % vs. 9.18 ± 12.00 %; P = 0.013). In addition, the TCI group reduced the relative risk of moderate desaturation by 50 % compared with the MCI group (30.9 % vs. 15.5 %; 95 % confidence interval 1.191 - 3.360; P = 0.007).Conclusions: The study demonstrated that TCI of propofol combined with alfentanil was associated with a faster recovery time, and better hemodynamic and respiratory stability than MCI in same-day bidirectional endoscopy.Clinical trial registration: CGMH IRB Identifier 97-0969B. PMID:24165817
Chiang, Min-Hsien; Wu, Shao-Chun; You, Chia-Hsun; Wu, Keng-Liang; Chiu, Yi-Chun; Ma, Chao-Wei; Kao, Chin-Wei; Lin, Kun-Chen; Chen, Kuan-Hung; Wang, Peng-Chih; Chou, An-Kuo
Wireless capsule endoscopy (WCE) has been widely applied to diagnose diseases in human digestive tract due to its advantage that it can directly view the entire small intestine for the first time. However, many WCE images are rather dark, which challenge to analysis and diagnosis exerted by a clinician. To overcome this shortcoming so as to assist physicians, especially computer
Baopu Li; Max Q.-H. Meng
The capsule endoscopy (CE) has been widely used to diagnose the diseases in human digestive tract because of its great breakthrough that it can view the entire small bowel without invasiveness. However, a tough problem associated with this new technology is that too many images to be examined by eyes cause a huge burden to physicians, so it is very
Baopu Li; M. Q.-H. Meng
Wireless capsule endoscopy (WCE) is a new clinical technology permitting visualization of the small bowel, the most difficult segment of the digestive tract. The major drawback of this technology is the excessive amount of time required for video diagnosis. We therefore propose a method for generating smaller videos by detecting informative frames from original WCE videos. This method isolates useless
Takayuki Kitasaka; Yasuhito Suenaga; Yoshito Mekada; Kensaku Mori
At present, the application of Capsule endoscopy (CE) faces some extremely important issues, e.g., image quality and field of view, which causing difficulties for doctors to make an accurate diagnosis. It's a technical difficulty to acquire wide-angle internal intestinal image under the volume restrictions of CE. In this paper, a simple and practical design of CE lens aimed to clearer
Lilai Tang; Chao Hu; Kang Xie; Chang Cheng; Zhiyong Liu
This paper presents a method based on NLP to realize structuralization of digestive endoscopy reports. The method is taking advantage of existing NLP's processing technologies and introducing minimal standard terminology (MST) to transform a narrative gastroscopy report into the structuralization report based on MST, whose accuracy rate is 92.3%. PMID:19119655
Kong, Xiao-feng; Li, Ying; Li, Hao-min; Lu, Xu-dong
In the paper image compression algorithm suitable for wireless capsule endoscopy is proposed. In general, image compression is the best way to decrease the communication bandwidth and save the transmitting power. However due to power limitation and small size conditions traditional image compression techniques are not appropriate and dedicated ones are necessary. The proposed algorithm is based on integer version
P. Turcza; M. Duplaga
Virtual endoscopy was used to plan 10 endoscopic third ventriculostomy procedures in 9 patients suffering from occlusive hydrocephalus due to idiopathic aqueductal stenosis and tumors. The patients were 4 children (4–14 years, mean age: 9 years) and 5 adults (21–38 years, mean age: 29 years). The aim of the study was to preoperatively evaluate the individual intraventricular and vascular endoscopic
J. Burtscher; A. Dessl; R. Bale; W. Eisner; A. Auer; K. Twerdy; S. Felber
The place of somatostatin and its analogues in the management of gastrointestinal fistulae is reviewed, drawing attention to the difficulty of assessing treatments that influence spontaneous closure. Sixteen patients with gastric, small bowel, and pancreatic fistulae were randomized to receive octreotide injections (100 ?g t.i.d.) or placebo for 12 days. Spontaneous fistula closure occurred in 7 at a mean of
N. A. Scott; S. Finnegan; M. H. Irving
Wireless capsule endoscopy (WCE) is a revolutionary imaging technique that enables detailed inspection of the interior of the whole gastrointestinal tract in a non-invasive way. However, viewing WCE videos is a very time-consuming, and labor intensive task for physicians. In this paper, we propose an automatic method for bleeding detection in WCE images. A novel series of descriptors which combine color and spatial information is designed in a way that local and global features are also incorporated together. And a kernel based classification method using histogram intersection or chi-square is deployed to verify the performance of the proposed descriptors. Experiments demonstrate that the proposed kernel based scheme is very effective in detecting bleeding patterns of WCE images. PMID:22255862
Lv, Guolan; Yan, Guozheng; Wang, Zhiwu
In celiac disease (CD), the intestinal lesions can be patchy and partial villous atrophy may elude detection at standard endoscopy (SE). Narrow Band Imaging (NBI) system in combination with a magnifying endoscope (ME) is a simple tool able to obtain targeted biopsy specimens. The aim of the study was to assess the correlation between NBI-ME and histology in CD diagnosis and to compare diagnostic accuracy between NBI-ME and SE in detecting villous abnormalities in CD. Forty-four consecutive patients with suspected CD undergoing upper gastrointestinal endoscopy have been prospectively evaluated. Utilizing both SE and NBI-ME, observed surface patterns were compared with histological results obtained from biopsy specimens using the k-Cohen agreement coefficient. NBI-ME identified partial villous atrophy in 12 patients in whom SE was normal, with sensitivity, specificity, and accuracy of 100%, 92.6%, and 95%, respectively. The overall agreement between NBI-ME and histology was significantly higher when compared with SE and histology (kappa score: 0.90 versus 0.46; P = 0.001) in diagnosing CD. NBI-ME could help identify partial mucosal atrophy in the routine endoscopic practice, potentially reducing the need for blind biopsies. NBI-ME was superior to SE and can reliably predict in vivo the villous changes of CD.
De Luca, L.; Ricciardiello, L.; Rocchi, M. B. L.; Fabi, M. T.; Bianchi, M. L.; de Leone, A.; Fiori, S.; Baroncini, D.
In celiac disease (CD), the intestinal lesions can be patchy and partial villous atrophy may elude detection at standard endoscopy (SE). Narrow Band Imaging (NBI) system in combination with a magnifying endoscope (ME) is a simple tool able to obtain targeted biopsy specimens. The aim of the study was to assess the correlation between NBI-ME and histology in CD diagnosis and to compare diagnostic accuracy between NBI-ME and SE in detecting villous abnormalities in CD. Forty-four consecutive patients with suspected CD undergoing upper gastrointestinal endoscopy have been prospectively evaluated. Utilizing both SE and NBI-ME, observed surface patterns were compared with histological results obtained from biopsy specimens using the k-Cohen agreement coefficient. NBI-ME identified partial villous atrophy in 12 patients in whom SE was normal, with sensitivity, specificity, and accuracy of 100%, 92.6%, and 95%, respectively. The overall agreement between NBI-ME and histology was significantly higher when compared with SE and histology (kappa score: 0.90 versus 0.46; P = 0.001) in diagnosing CD. NBI-ME could help identify partial mucosal atrophy in the routine endoscopic practice, potentially reducing the need for blind biopsies. NBI-ME was superior to SE and can reliably predict in vivo the villous changes of CD. PMID:23983448
De Luca, L; Ricciardiello, L; Rocchi, M B L; Fabi, M T; Bianchi, M L; de Leone, A; Fiori, S; Baroncini, D
Gastrointestinal bleeding affects a substantial number of elderly people and is a frequent indication for hospitalization. Bleeding can originate from either the upper or lower gastrointestinal tract, and patients with gastrointestinal bleeding present with a range of symptoms. In the elderly, the nature, severity, and outcome of bleeding are influenced by the presence of medical comorbidities and the use of
Patrick S Yachimski; Lawrence S Friedman
Surgery has been the mainstay of therapy in patients with gastrointestinal perforations. This paradigm started to shift with the development of techniques for endoscopic closure of gastrointestinal perforations. A detailed review of the literature on this subject, along with a commentary on practical aspects in the management of patients with gastrointestinal leaks, is provided here.
Gottumukkala Subba Raju
Hereditary gastrointestinal polyposis syndromes can be divided into adenomatous and hamartomatous types. Familial adenomatous polyposis coli (FAPC) is the prototype adenomatous polyposis syndrome and is defined by the autosomal dominant transmission of multiple (more than 100) colorectal adenomas. Virtually all affected patients develop colorectal carcinoma if untreated. Adenomas may develop also in the stomach and small bowel in FAPC patients, but the incidence of carcinoma in these sites is low. A variety of extracolonic manifestations has been reported in FAPC, with the name Gardner's syndrome applied to kindreds with osteomas of the skull and mandible, multiple epidermal cysts, and other skin and soft-tissue lesions. In Turcot's syndrome, brain tumors are present. The distinction between Gardner's and Turcot's syndromes and classical FAPC has become blurred because of marked overlap between them; some authorities consider them to be varying manifestations of a single genetic defect. The hamartomatous polyposes include Peutz-Jeghers syndrome, familial juvenile polyposis, Cowden's disease, intestinal ganglioneuromatosis, and the Ruvalcaba-Myrhe-Smith syndrome. The incidence of gastrointestinal cancer in patients with Peutz-Jeghers syndrome and familial juvenile polyposis exceeds that in the normal population, but is relatively low. In Cowden's disease, the gastrointestinal tract may be the site of multiple hamartomas, but there is no associated increase in the incidence of gastrointestinal cancers; instead, there is an increased incidence of carcinoma of the breast and thyroid. Intestinal ganglioneuromatosis occurs in von Recklinghausen's disease, in association with multiple endocrine neoplasia, type 2b, or as an isolated abnormality. Patients with ganglioneuromatosis do not appear to have an increased risk of developing gastrointestinal cancer. Ruvalcaba-Myrhe-Smith syndrome comprises macrocephaly, mental deficiency, an unusual craniofacial appearance, hamartomatous intestinal polyposis, and pigmented macules on the penis. No increased risk of developing cancer has been identified in the few reported cases. PMID:3024515
Haggitt, R C; Reid, B J
In Morocco, the need for post-marketing surveillance of selective Cox2 inhibitors (coxibs) prompted a study to assess the serious gastrointestinal effects of NSAIDs and to compare gastrointestinal tolerance of conventional NSAIDs and coxibs. A prospective study was conducted from April 2001 through May 2002 among hospital-staff gastroenterologists in the public and private sector as well as emergency surgical units. Over this period, 123 patients were reported to have serious NSAID-related gastrointestinal effects, and 63% of them were admitted for bleeding or perforated ulcers. Endoscopy most often identified the lesion as a gastric ulcer (45%). Emergency rooms reported that aspirin was the most common causal agent and that NSAIDs accounted for 8.7% of bleeding and 9.3% of the perforated ulcers. Our findings indicate that men and youth are most vulnerable to serious gastrointestinal effects from these drugs. Several risk factors from the literature were confirmed in our population: history of gastrointestinal disorders and joint disease, occurrence within less than 1 month of beginning the drug; association of NSAIDs and aspirin, diabetes and hypertension. No conclusion could be drawn about the comparative gastrointestinal tolerance of conventional NSAIDs and coxibs, however, since the latter account for only 3% of the NSAID market. PMID:16061449
Benkirane, Raja; El Kihal, Latifa; Nabil, Safae; Benchekroun-Belabbés, Abdellatif; El Feydi, Abdellah Essaid; Soulaymani, Rachida
Here, we report a case of fulminant gastrointestinal graft-versus-host disease (GI-GVHD) with cytomegalovirus (CMV) infection in 44-year-old woman. Despite the difficulties associated with the treatment of GI-GVHD and GI-CMV disease, the mucosal findings and the clinical course showed marked improvements during long-term clinical observation. The endoscopic findings were remarkable, with diffuse sloughing mucosa in the stomach and highly active inflammation and deep discrete ulcers throughout the colon. Changes in the CMV quantitative polymerase chain reaction results were correlated with the endoscopic mucosal findings and were useful for assessing the efficacy of the treatment. Although a definite diagnosis of GI-GVHD is generally made by endoscopy with biopsy, the gross appearance of this disease can vary depending on the endoscopy. In this paper, we also conduct a literature review of patients with GI-GVHD.
Okubo, Hidetaka; Nagata, Naoyoshi; Uemura, Naomi
AIM: To improve the diagnosis of heterotopic pancreas by the use of contrast-enhanced computed tomography (CT) imaging and CT virtual endoscopy (CTVE). METHODS: A total of six patients with heterotopic pancreas, as confirmed by clinical pathology and immunohistochemistry in the Sixth Affiliated People’s Hospital of Shanghai Jiao Tong University, Shanghai, China, were included. Non-enhanced CT and enhanced CT scanning were performed, and the resulting images were reviewed and analyzed using three-dimensional post-processing software, including CTVE. RESULTS: Four males and two females were enrolled. Several heterotopic pancreas sites were involved; three occurred in the stomach, including the gastric antrum (n = 2) and lesser curvature (n = 1), and two were in the duodenal bulb. Only one case of heterotopic pancreas lesion occurred in the mesentery. Four cases had a solid yet soft tissue density that had a homogeneous pattern when viewed by enhanced CT. Additionally, their CT values were similar to that of the pancreas. The ducts of the heterotopic pancreas tissue, one of the characteristic CT features of heterotopic pancreas tissue, were detected in the CT images of two patients. CTVE images showed normal mucosa around the tissue, which is also an important indicator of a heterotopic pancreas. However, none of the CTVE images showed the typical signs of central dimpling or umbilication. CONCLUSION: CT, enhanced CT and CTVE techniques provide useful information about the location, growth pattern, vascularity, and condition of the gastrointestinal wall around heterotopic pancreatic tissue.
Wang, Dan; Wei, Xiao-Er; Yan, Lei; Zhang, Yu-Zhen; Li, Wen-Bin
Wireless Capsule Endoscopy (WCE), which allows clinicians to inspect the whole gastrointestinal tract (GI) noninvasively, has bloomed into one of the most efficient technologies to diagnose the bleeding in GI tract. However WCE generates large amount of images in one examination of a patient. It is hard for clinicians to leave continuous time to examine the full WCE images, and this is the main factor limiting the wider application of WCE in clinic. A novel intelligent bleeding detection based on Probabilistic Neural Network (PNN) is proposed in this paper. The features of bleeding region in WCE images distinguishing from non-bleeding region are extracted. A PNN classifier is built to recognize bleeding regions in WCE images. Finally the intelligent bleeding detection method is implemented through programming. The experiments show this method can correctly recognize the bleeding regions in WCE images and clearly mark them out. The sensitivity and specificity on image level are measured as 93.1% and 85.6% respectively. PMID:20703770
Pan, Guobing; Yan, Guozheng; Qiu, Xiangling; Cui, Jiehao
In a blinded-observer crossover study, 16 volunteers ingested equimolar doses of three different potassium chloride preparations and placebo for nine days in a random order. The irritating effect on the mucosa was evaluated by means of upper gastrointestinal endoscopy and fecal blood loss, measured by reference to the amount of radioactivity in three 24-hour samples after previous injection of 51Cr-tagged autologous red cells. The microencapsulated KCl capsule preparation induced three ulcers, but the total endoscopic group score was not significantly higher than the score with placebo. The total endoscopic group score for the wax-matrix formulation was significantly higher than the score for placebo (P less than .05) and for a new microencapsulated KCl tablet preparation containing a potent disintegrant (P less than .10). We did not find any significant differences in mean fecal blood loss during the four different treatments. A correlation between endoscopic score and fecal blood loss was found in the placebo group (r = .54) and the microencapsulated KCl capsule preparation (r = .56) group. PMID:3680575
Lech, Y; Hey, H; Jørgensen, F; Matzen, P; Ostergaard, O
Wireless Capsule Endoscopy (WCE) is a new colour imaging technology that enables close examination of the interior of the entire small intestine. Typically, the WCE operates for ~8 hours and captures ~40,000 useful images. The images are viewed as a video sequence, which generally takes a doctor over an hour to analyse. In order to activate certain key features of the software provided with the capsule, it is necessary to locate and annotate the boundaries between certain gastrointestinal (GI) tract regions (stomach, intestine and colon) in the footage. In this paper we propose a method of automatically discriminating stomach, intestine and colon tissue in order to significantly reduce the video assessment time. We use hue saturation chromaticity histograms which are compressed using a hybrid transform, incorporating the Discrete Cosine Transform (DCT) and Principal Component Analysis (PCA). The performance of two classifiers is compared: k-nearest neighbour (kNN) and Support Vector Classifier (SVC). After training the classifier, we applied a narrowing step algorithm to converge to the points in the video where the capsule firstly passes through the pylorus (the valve between the stomach and the intestine) and later the ileocaecal valve (IV, the valve between the intestine and colon). We present experimental results that demonstrate the effectiveness of this method.
Berens, Jeff; Mackiewicz, Michal; Bell, Duncan
In this paper, we present a novel and clinically valuable software platform for automatic bleeding detection on gastrointestinal (GI) tract from Capsule Endoscopy (CE) videos. Typical CE videos for GI tract run about 8 hours and are manually reviewed by physicians to locate diseases such as bleedings and polyps. As a result, the process is time consuming and is prone to disease miss-finding. While researchers have made efforts to automate this process, however, no clinically acceptable software is available on the marketplace today. Working with our collaborators, we have developed a clinically viable software platform called GISentinel for fully automated GI tract bleeding detection and classification. Major functional modules of the SW include: the innovative graph based NCut segmentation algorithm, the unique feature selection and validation method (e.g. illumination invariant features, color independent features, and symmetrical texture features), and the cascade SVM classification for handling various GI tract scenes (e.g. normal tissue, food particles, bubbles, fluid, and specular reflection). Initial evaluation results on the SW have shown zero bleeding instance miss-finding rate and 4.03% false alarm rate. This work is part of our innovative 2D/3D based GI tract disease detection software platform. While the overall SW framework is designed for intelligent finding and classification of major GI tract diseases such as bleeding, ulcer, and polyp from the CE videos, this paper will focus on the automatic bleeding detection functional module.
Yi, Steven; Jiao, Heng; Xie, Jean; Mui, Peter; Leighton, Jonathan A.; Pasha, Shabana; Rentz, Lauri; Abedi, Mahmood
Background/Aims In capsule endoscopy (CE), the capsule does not always reach the cecum within its battery life, which may reduce its diagnostic yield. We evaluated the effect of mosapride citrate, a 5-hydroxytryptamine-4 agonist that increases gastrointestinal motility, on CE completion. Methods In a retrospective study, we performed univariate and multivariate analyses for 232 CE procedures performed at our hospital. To identify factors that affect CE completion, the following data were systematically collected: gender, age, gastric transit time (GTT), nonsteroidal anti-inflammatory drug administration, previous abdominal surgery, hospitalization, use of a polyethylene glycol solution, use of mosapride citrate (10 mg), body mass index (BMI), and total recording time. Results The univariate analysis showed that oral mosapride citrate, GTT, and BMI were associated with improved CE completion. Multivariate analyses showed that oral mosapride citrate (odds ratio [OR], 1.99; 95% confidence interval [CI], 1.01 to 3.91) and GTT (OR, 2.34; 95% CI, 1.13 to 4.87) were significant factors for improving the CE completion. Oral mosapride citrate significantly shortened the GTT and small bowel transit time (SBTT). Conclusions Oral mosapride citrate reduced the GTT and SBTT during CE and improved the CE completion rate.
Ida, Yosuke; Hosoe, Naoki; Imaeda, Hiroyuki; Bessho, Rieko; Ichikawa, Riko; Naganuma, Makoto; Kanai, Takanori; Hibi, Toshifumi
Gastrointestinal (GI) bleeding is considered obscure when it persists or recurs after negative endoscopy. Small bowel lesions account for approximately 1-fourth of cases of obscure GI bleeding. These lack specific clinical symtoms and signs, and tend to be inaccessible to routine examinations. The management of patients with intermittent obscure GI bleeding poses both diagnostic and therapeutic challenges. The aim of this study was to report the importance of laparoscopy in diagnosing and treating small bowel lesions responsible for obscure bleeding in 5 patients with subacute presentations. Data were collected from 2 hospitals' in-patient records and a prospective database. All patients underwent laparoscopic exploration. After the identification of the diseased segments, laparoscopy-assisted segmental resection of the small bowel and enteroentorostomy were carried out in all cases. This approach enabled a successful minimally invasive treatment of the obscure GI bleeding. The overall procedure was safe and our results were satisfactory. PMID:20393334
Ertem, Metin; Ozben, Volkan; Ozveri, Emel; Yilmaz, Suleyman
Patients with persistent, recurrent, or intermittent bleeding from the gastrointestinal (GI) tract for which no definite cause has been identified by initial esophagogastroduodenoscopy, colonoscopy, or conventional radiologic evaluation are considered to have an obscure GI bleeding (OGIB). The diagnosis and management of patients with OGIB is challenging, often requiring extensive and expensive workups. The main objective is the identification of the etiology and site of bleeding, which should be as rapidly accomplished as possible, in order to establish the most appropriate therapy. The introduction of capsule endoscopy and double balloon enteroscopy and the recent improvements in CT and MRI techniques have revolutionized the approach to patients with OGIB, allowing the visualization of the entire GI tract, particularly the small bowel, until now considered as the "dark continent" . In this article we review and compare the radiologic and endoscopic examinations currently used in occult and OGIB, focusing on diagnostic patterns, pitfalls, strengths, weaknesses, and value in patients' management. PMID:21912990
Filippone, Antonella; Cianci, Roberta; Milano, Angelo; Pace, Erika; Neri, Matteo; Cotroneo, Antonio Raffaele
Gastrointestinal stromal tumours (GISTs) are mesenchymal neoplasms that arise in the gastrointestinal tract, usually in the stomach or the small intestine and rarely elsewhere in the abdomen. They can occur at any age, the median age being 60-65 years, and typically cause bleeding, anaemia, and pain. GISTs have variable malignant potential, ranging from small lesions with a benign behaviour to fatal sarcomas. Most tumours stain positively for the mast/stem cell growth factor receptor KIT and anoctamin 1 and harbour a kinase-activating mutation in either KIT or PDGFRA. Tumours without such mutations could have alterations in genes of the succinate dehydrogenase complex or in BRAF, or rarely RAS family genes. About 60% of patients are cured by surgery. Adjuvant treatment with imatinib is recommended for patients with a substantial risk of recurrence, if the tumour has an imatinib-sensitive mutation. Tyrosine kinase inhibitors substantially improve survival in advanced disease, but secondary drug resistance is common. PMID:23623056
Joensuu, Heikki; Hohenberger, Peter; Corless, Christopher L
Gastrointestinal stromal tumor has received a lot of attention over the last 10 years due to its unique biologic behavior, clinicopathological features, molecular mechanisms, and treatment implications. GIST is the most common mesenchymal neoplasm in the gastrointestinal tract and has emerged from a poorly understood and treatment resistant neoplasm to a well-defined tumor entity since the discovery of particular molecular abnormalities, KIT and PDGFRA gene mutations. The understanding of GIST biology at the molecular level promised the development of novel treatment modalities. Diagnosis of GIST depends on the integrity of histology, immunohistochemistry and molecular analysis. The risk assessment of the tumor behavior relies heavily on pathological evaluation and significantly impacts clinical management. In this review, historic review, epidemiology, pathogenesis and genetics, diagnosis, role of molecular analysis, prognostic factor and treatment strategies have been discussed.
Introduction. Glomus tumors (GTs) are benign neoplasm originating from the glomus body, commonly described in subungual region. The involvement abdominal is rare. Our aim is to describe a case of glomus tumor of the stomach that presented upper gastrointestinal bleeding. A 34-year-old woman was admitted with upper gastrointestinal bleeding and underwent an upper endoscopy that showed bleeding arising from an ulcerated lesion, treated by sclerosis therapy. A new endoscopy confirmed a submucosal lesion in upper portion of the stomach. During the laparotomy, a tumor at the upper anterior wall of gastric body was found and resected by a vertical gastrectomy. The pathological exam revealed hyperplastic smooth muscle fibers of the muscularis propria of the stomach wall, surrounded by hyaline stroma. The immunohistochemistry panel was positive for smooth muscle actin and type IV collagen, with low rate of mitosis studied by Ki-67 which allowed the final diagnosis of a gastric glomus tumor. Discussion. The majority of intraperitoneal glomus tumors occur in the stomach, and it is phenotypically similar to those localized in peripheral sites. Gastric GT generally is a benign tumor although it can be malignant and have the potential to metastasize. Conclusion. Even though gastric glomus tumor is rarely described, it should be considered as a possible cause of a major upper gastrointestinal bleeding.
Nascimento, Enzo Fabricio Ribeiro; Fonte, Fabio Piovezan; Mendonca, Roberta Lais; Nonose, Ronaldo; de Souza, Carlos Alberto Fonte; Martinez, Carlos Augusto Real
Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors characterized by a spindle morphology and expression of the\\u000a c-kit proto-oncogene. They occur primarily in the stomach and small intestine presenting with abdominal pain or bleeding,\\u000a but may be found incidentally. These tumors may behave malignantly by metastasizing, invading adjacent organs, or recurring\\u000a after resection. Tumor size more than 5 cm or more
Raquel E. Davila
\\u000a The fluoroquinolones have excellent in vitro activity against a variety of gastrointestinal pathogens including enteropathogenic\\u000a Escherichia coli, Salmonella spp., Shigella spp., Yersinia enterocolitica, Aeromonas hydrophila, Plesiomonas shigelloides,\\u000a and Helicobacter pylori [1-4]. The newer fluoroquinolones (trovafloxacin, gatifloxacin, gemifloxacin) are also active against many obligate anaerobes\\u000a [5, 6]. Coupled with favorable bioavailability after oral administration, and the ability to achieve high concentrations
Anthony W. Chow
Gastrointestinal stromal tumors (GISTs) have emerged from being poorly defined, treatment-resistant tumors to a well-recognized,\\u000a well-understood, and treatable tumor entity within only one decade. The understanding of GIST biology has made this tumor\\u000a a paradigm for molecularly targeted therapy in solid tumors and provides informative insights into the advantages and limitations\\u000a of so-called targeted therapeutics. Approximately 85% of GISTs harbor
Bernadette Liegl-Atzwanger; Jonathan A. Fletcher; Christopher D. M. Fletcher
Over the past 60 years, basic scientists, pathologists, and clinical investigators have studied gastrointestinal stromal tumors\\u000a (GISTs), with no major advances in patient care. Recent discoveries have led to an understanding of the biological role of\\u000a Kit in GISTs and the development of one of the most exciting examples of targeted therapy to date. The success of the Kit\\u000a tyrosine
Dejka M. Steinert; Jonathan Trent
Gastrointestinal stromal tumors (GIST) are generally found in the stomach or small intestine and less commonly in the colon or rectum. Complete surgical removal remains the best current therapy for GISTs. The treatment of advanced GIST patients is with imatinib, a selective tyrosine kinase inhibitor. In our series, 23 patients observed between 1994 and 2004 and affected by GIST were treated with complete negative margin resections (three cases by laparoscopy). PMID:16437933
Eccher, C; Famà, R; Berlanda, G; Silvestri, M; Prezzi, C
Background: Prolonged fasting may precipitate or exacerbate gastrointestinal complaints. The aim of this study was to evaluate the relation between Ramadan fasting and acute upper gastrointestinal bleeding (AUGIB), and to assess characteristics of those occurred in the holly month. Materials and Methods: Retrospective analysis was conducted for all patients, who underwent endoscopy for AUGIB in Ramadan (R) and the month before Ramadan (BR). Epidemiological, clinical and etiological characteristics and outcome of patients having AUGIB were compared between the two periods from 2001 to 2010. Results: Two hundred and ninety-one patients had endoscopy for AUGIB during the two periods study. There was an increasing trend in the overall number of patients in Ramadan period (n = 132, 45.4% versus n = 159, 54.6%), especially with duodenal ulcer (n = 48, 37.2% versus n = 81, 62.8%). The most frequent etiology was peptic ulcer but it was more observed in group R than in group BR (46.2% versus 57.9%, P = 0.04), especially duodenal ulcer (36.4% versus 50.3%, P = 0.01); this finding persisted in multivariable modeling (adjusted odds ratio: 1.67; 95% confidence interval, 1.03-2.69, P = 0.03). In contrast, there was a decreasing trend in rate of variceal bleeding from BR period (26.5%) to R period (18.9%; P = 0.11). Regarding the outcome, there were no significant differences between the two periods of the study: Recurrent bleeding (10.6% versus 7.5%, P = 0.36) and mortality rate (5.3% versus 4.4%, P = 0.7). Conclusion: The most frequent etiology of AUGIB was peptic ulcer during Ramadan. However, Ramadan fasting did not influence the outcome of the patients. Prophylactic measures should be taken for people with risk factors for peptic ulcer disease.
Amine, El Mekkaoui; Kaoutar, Saada; Ihssane, Mellouki; Adil, Ibrahimi; Dafr-Allah, Benajah
Double-balloon endoscopy (DBE) was developed as a new technique for visualization of and intervention in the entire small\\u000a intestine. In DBE, the intestinal walls are held apart by a balloon attached to the distal end of a soft overtube. DBE has\\u000a been reported worldwide to be very useful for not only diagnosis but also endoscopic therapy. Biopsy samples of small
Keijiro Sunada; Hironori Yamamoto
Since the late 1970s, there has been a dramatic shift of GI endoscopy services from the inpatient to the outpatient setting. Outpatient GI endoscopy has migrated from the hospital endoscopy unit to the office and then on to the EASC. This evolution has been brought about by many forces, including the drive for health care cost containment, a desire for enhanced service, cost pressure on physicians, and demands for quality assurance. Although there are advantages and disadvantages to each of the outpatient settings (see Tables 5 and 6), the EASC seems to offer the most value to patients, payers, and physician owners. That value is defined as good outcomes, excellent service, and reasonable cost. Those attributes of the EASC that are most important in guaranteeing this value are physician control, time efficiency, convenience, and adequate reimbursement. The endoscopic ambulatory surgery center seems to be the best environment for delivering endoscopic services. The office AEC can only approach the attractiveness of an EASC when restrictive certificate-of-need laws prevent the development of an EASC; when groups lack a critical number of endoscopists to support an EASC (at least three endoscopists with a potential procedure volume of 1200 to 1800 procedures per year ); when excess office capacity and personnel can be used for the office AEC; and, perhaps most importantly, when there is an ability to secure favorable contracts for facility payment from private health plans to the office endoscopy center. The evolution of EASCs over three decades has demonstrated many advantages to patients, physicians, and payers. Although further questions and challenges are inevitable, EASCs can adapt quickly and deliver value. The author believes the future is deservedly bright for such facilities. PMID:12180155
Frakes, James T
To assess the role of virtual endoscopy (VE) in the examination of intracisternal structures and of the inner ear, we studied\\u000a the anatomy of the labyrinth and internal auditory canal using the original CT slices and VE on the unaffected side in three\\u000a female and three male patients, age range 3–46 years, with contralateral retrocochlear hearing loss. We also examined
S. Boor; J. Maurer; W. Mann; P. Stoeter
We report a case of venous air embolism which occurred during intraoperative endoscopy in a five-year-old boy who had undergone Kasai procedure in his infancy. The child had a cardiac arrest during the procedure from which he could not be resuscitated. The awareness about this complication would allow rapid diagnosis, which is vital to provide specific treatment and prevent fatal outcome. PMID:23225935
Pujari, Vinayak S; Thomas, Mathews K; Bevinaguddaiah, Yatish; Anandaswamy, Tejesh C
Background and Objectives: Epistaxis is one of the common symptoms encountered in the Otorhinolaryngology department. Many times the cause for epistaxis is not found on anterior and posterior rhinoscopy. The present study was undertaken to assess the role of rigid nasal endoscope in the diagnosis and treatment of epistaxis, where normal anterior and posterior rhinoscopy did not reveal any specific finding. Methods: Fifty patients with epistaxis were studied using rigid nasal endoscope under local anaesthesia. Patients who were above 15 years with nasal bleeding and who were willing for rigid nasal endoscopy were included in the study. Patients less than 15 years were not included in the study because nasal endoscopy was difficult in them under local anaesthesia. Only those patients in whom, the cause for epistaxis could not be made out on anterior and posterior rhinoscopy were chosen for the study, this was done in order to remove the bias for nasal endoscopy. Results: The use of the nasal endoscope allowed diagnosis of bleeding points and treating them directly. Epistaxis was more in male patients especially in the 3rd and after the 5th decade. On endoscopic examination,the bleeding points were identified as coming from the crevices of the lateral nasal wall, posterior spur on the septum, posterior deviation of the septum with ulcer, congested polyps, enlarged and congested adenoids, scabs or crusts in the crevices of the lateral nasal wall and angiofibroma. Endoscope also helps in the treatment of epistaxis, which includes endoscopic selective nasal packing using gelfoam, endoscopic cautery or diathermy and endoscopic polypectomy. Other patients with adenoids, scabs and crusts and angiofibroma were managed on their merits. Interpretation and Conclusion: Nasal endoscopy helps not only in the localisation of the bleeding point but also in the treatment of those bleeding areas that are situated in the posterior and lateral part of the nose.
Kumar M.V., Vinay; Prasad K.U., Raghavendra; Gowda P.R., Belure; S.R., Manohar; P.K., Chennaveerappa
This is the second of three papers reinterpreting old theorems in endoscopy, or L-indistinghuishability, for real groups in terms of the canonical transfer factors of Langlands and Shelstad. The a priori de…nition of those factors provides an explicit geometric transfer theorem. The present paper introduces a parallel de…nition for spectral transfer factors. The author uses various simple properties of these
To improve diagnosis and therapy planning with additional information in an easy to use and fast way a virtual endoscopy system was developed. From a technical viewpoint, virtual endoscopy can be generated using image sequencies acquired with CT or MRI. It requires appropriate software for image processing and endoluminal visualization and hardware capabilities for immersive virtual reality. This includes that firstly the intuitive user interaction is supported by data gloves, position tracking systems and stereo display devices. Secondly the virtual environment requires real time visualization supported by high end graphic engines to enable the continuous operation and interaction. To enable the endoluminal view, the precise segmentation of the inner lumina like tracheobronchial tree, inner ear or vessels is necessary. In addition to this pathological findings must be defined. We use automatic segmentation techniques like volume growing as well as semiautomatic techniques like deformable models in a virtual environment. After that the surfaces of the segmented volume are reconstructed. This is the basis for our multidimensional display system which visualizes volumes, surfaces and computation results simultaneously. Our developed method of virtual endoscopy enables the interactive, immersive and endoluminal inspection of complex anatomical structures. It is based on intensive image processing like 3D-segmentation and a so called hybrid technique which displays all the information by volume and surface rendering. The system was applied on virtual bronchoscopy, colonoscopy, angioscopy as well as endoluminal representation of the inner ear.
Englmeier, Karl-Hans; Siebert, M.; Bruening, Roland; Scheidler, Juergen; Reiser, Maximilian
Bezoars are concretions of undigested material and are most often observed in the stomach. They can occur at any site in the gastrointestinal tract; however, duodenal localization is very rare. We report the case of a 71-year-old male who had undergone subtotal gastrectomy with gastroduodenostomy and experienced severe epigastric discomfort, abdominal pain, and vomiting for a few days. An approximately 7×8 cm-sized mass was found on an abdominal computed tomography scan. On following endoscopy, a large bezoar was revealed in the duodenum and was removed using an endoscopic removal technique, assisted by a large amount of Coca-Cola infusion.
Yang, Jee Eun; Kim, Gi Ae; Kim, Ga Hee; Yoon, Da Lim; Jeon, Sung Jin; Jung, Hwoon-Yong; Kim, Jin-Ho
The introduction of capsule endoscopy (CE) in clinical practice increased the interest for the study of the small-bowel. Consequently, in about 10 years, an impressive quantity of literature on indications, diagnostic yield (DY), safety profile and technical evolution of CE has been published as well as several reviews. At present time, there are 5 small-bowel capsule enteroscopy (SBCE) models in the worldwide market. Head-to-head trials have showed in the great majority of studies comparable results in terms of DY, image quality and completion rate. CE meta-analyses formed the basis of national/international guidelines; these guidelines place CE in a prime position for the diagnostic work-up of patients with obscure gastrointestinal bleeding, known and/or suspected Crohn’s disease and possible small-bowel neoplasia. A 2-L polyethylene glycol-based purge, administered the day before the procedure, is the most widely practiced preparation regimen. Whether this regimen can be further improved (i.e., by further decreasing its volume, changing the timing of administration, coupling it with prokinetics and/or other factors) or if it can really affect the DY, is still under discussion. Faecal calprotectin has been used in SBCE studies in two settings: in patients taking non-steroidal anti-inflammatory drugs, to evaluate the type and extent of mucosal damage and, more importantly from a clinical point of view, in patients with known or suspected Crohn’s disease for assessment of inflammation activity. Although there is still a lot of debate around the exact reasons of SBCE poor performance in various small-bowel segments, it is worth to remember that the capsule progress is non-steerable, hence more rapid in the proximal than in lower segments of the small-bowel. Capsule aspiration, a relatively unexpected complication, has been reported with increasing frequency. This is probably related with the increase in the mean age of patients undergoing CE. CE video review is a time-consuming procedure. Therefore, several attempts have been made to develop technical software features, in order to make CE video analysis easier and shorter (without jeopardizing its accuracy). Suspected Blood Indicator, QuickView and Fujinon Intelligent Chromo Endoscopy are some of the software tools that have been checked in various clinical studies to date.
Koulaouzidis, Anastasios; Rondonotti, Emanuele; Karargyris, Alexandros
The introduction of capsule endoscopy (CE) in clinical practice increased the interest for the study of the small-bowel. Consequently, in about 10 years, an impressive quantity of literature on indications, diagnostic yield (DY), safety profile and technical evolution of CE has been published as well as several reviews. At present time, there are 5 small-bowel capsule enteroscopy (SBCE) models in the worldwide market. Head-to-head trials have showed in the great majority of studies comparable results in terms of DY, image quality and completion rate. CE meta-analyses formed the basis of national/international guidelines; these guidelines place CE in a prime position for the diagnostic work-up of patients with obscure gastrointestinal bleeding, known and/or suspected Crohn's disease and possible small-bowel neoplasia. A 2-L polyethylene glycol-based purge, administered the day before the procedure, is the most widely practiced preparation regimen. Whether this regimen can be further improved (i.e., by further decreasing its volume, changing the timing of administration, coupling it with prokinetics and/or other factors) or if it can really affect the DY, is still under discussion. Faecal calprotectin has been used in SBCE studies in two settings: in patients taking non-steroidal anti-inflammatory drugs, to evaluate the type and extent of mucosal damage and, more importantly from a clinical point of view, in patients with known or suspected Crohn's disease for assessment of inflammation activity. Although there is still a lot of debate around the exact reasons of SBCE poor performance in various small-bowel segments, it is worth to remember that the capsule progress is non-steerable, hence more rapid in the proximal than in lower segments of the small-bowel. Capsule aspiration, a relatively unexpected complication, has been reported with increasing frequency. This is probably related with the increase in the mean age of patients undergoing CE. CE video review is a time-consuming procedure. Therefore, several attempts have been made to develop technical software features, in order to make CE video analysis easier and shorter (without jeopardizing its accuracy). Suspected Blood Indicator, QuickView and Fujinon Intelligent Chromo Endoscopy are some of the software tools that have been checked in various clinical studies to date. PMID:23840112
Koulaouzidis, Anastasios; Rondonotti, Emanuele; Karargyris, Alexandros
Kings County Hospital (KCH), and St. John's Episcopal Hospital (SJH) are inner-city hospitals in New York City serving predominantly minority populations. Staten Island University Hospital (SIUH) serves a predominantly middle-class Caucasian population. We examined H. pylori (HP) infection in patients undergoing upper endoscopy at these hospitals. Two gastric biopsies were obtained from each patient. One biopsy was examined by histology or the rapid urease test for the presence of HP. The other was subjected to analysis by PCR to detect HP DNA and to identify putative HP virulence factors. Of 200 subjects, 54% were African-American, 10% were Hispanic, and 36% were Caucasian. HP infection rates in African-American, Hispanic, and Caucasian patients were 43%, 20%, and 11%, respectively. Many of the African-American patients are recent immigrants from the Caribbean Islands. In these patients, an inverse relationship was observed between HP infection and the number of years living in the United States. Higher levels of HP infection were observed in patients with duodenitis and peptic ulcer disease. With respect to HP virulence factors, the vacA s1b and m1 alleles, as well as the iceA2 allele were the predominant alleles expressed in HP-positive samples obtained from African-Americans. The cagA gene was detected in 81% of HP-positive samples. However, CagA positivity was not related to any specific gastrointestinal disorder. Our findings indicate that among several ethnic groups served by three hospitals, African-American patients have the highest rate of HP infection. Moreover, in AfricanAmerican patients undergoing endoscopy: (1) HP infection was inversely related to the number of years the patients have been living in the USA; (2) HP infection rates were higher in patients diagnosed with duodenitis and peptic ulcer disease versus other disorders; (3) expression of the CagA gene was not associated with any specific gastroduodenal disorder; and (4) there was little allelic heterogeneity with respect to VacA and IceA subtypes. These findings suggest that inner-city African-Americans are more likely to be infected with HP and suffer from more serious gastroduodenal disorders than other ethnic groups. PMID:12141819
Straus, E W; Patel, H; Chang, J; Gupta, R M; Sottile, V; Scirica, J; Tarabay, G; Iyer, S; Samuel, S; Raffaniello, R D
The bacterial gastrointestinal infections cholera, salmonellosis, shigellosis, campylobacteriosis, and diarrheagenic Escherichia coli are prevalent in tropical regions. These diseases impose an immense cost and contribute significantly to childhood morbidity and mortality. Management is hampered by limited access to diagnostic facilities and by antimicrobial drug resistance. Rapid point-of-care assays aim to reduce treatment delay and encourage rational use of antimicrobial agents. Control through safe drinking water, good sanitation, and vaccination against typhoid and cholera in high-risk populations is recommended. Vaccines against other Shigella and diarrheagenic E coli infections are under development. PMID:22632648
Shakoor, Sadia; Zaidi, Anita K M; Hasan, Rumina
Irritable bowel syndrome occurs most frequently in young adults in response to emotional and other factors. The 20th century western epidemic of diverticular disease may be linked to low dietary fiber intake. Peptic ulceration is determined by genetic and environmental factors including tobacco and coffee. Aspirin specifically predisposes to gastric ulcer. The incidence of peptic ulcer is declining. Crohn's disease is increasing in frequency although the incidence of ulcerative colitis is fairly steady. Gastrointestinal cancer is closely related to dietary factors including ingested procarcinogens, excessive carbohydrate, fat and animal protein. There is potential for control of some intestinal cancers.
Smith, E. R.
Background We reviewed radiologic features of gastrointestinal stromal tumors (GISTs) and correlated them with clinical and pathologic\\u000a findings.\\u000a \\u000a \\u000a \\u000a Methods We investigated a series of 39 c-Kit–positive GISTs. Clinical and radiologic findings and management of these patients were\\u000a recorded.\\u000a \\u000a \\u000a \\u000a Results Twenty women and 19 men (mean age 64 years) had histologically proved GIST. Tumor locations were the small bowel (n = 20), stomach (n
A. Darnell; E. Dalmau; C. Pericay; E. Musulén; J. Martín; J. Puig; A. Malet; E. Saigí; M. Rey
Gastrointestinal complications of diabetes include gastroparesis, intestinal enteropathy (which can cause diarrhea, constipation, and fecal incontinence), and nonalcoholic fatty liver disease. Patients with gastroparesis may present with early satiety, nausea, vomiting, bloating, postprandial fullness, or upper abdominal pain. The diagnosis of diabetic gastroparesis is made when other causes are excluded and postprandial gastric stasis is confirmed by gastric emptying scintigraphy. Whenever possible, patients should discontinue medications that exacerbate gastric dysmotility; control blood glucose levels; increase the liquid content of their diet; eat smaller meals more often; discontinue the use of tobacco products; and reduce the intake of insoluble dietary fiber, foods high in fat, and alcohol. Prokinetic agents (e.g., metoclopramide, erythromycin) may be helpful in controlling symptoms of gastroparesis. Treatment of diabetes-related constipation and diarrhea is aimed at supportive measures and symptom control. Nonalcoholic fatty liver disease is common in persons who are obese and who have diabetes. In persons with diabetes who have elevated hepatic transaminase levels, it is important to search for other causes of liver disease, including hepatitis and hemochromatosis. Gradual weight loss, control of blood glucose levels, and use of medications (e.g., pioglitazone, metformin) may normalize hepatic transaminase levels, but the clinical benefit of aggressively treating nonalcoholic fatty liver disease is unknown. Controlling blood glucose levels is important for managing most gastrointestinal complications. PMID:18619079
Shakil, Amer; Church, Robert J; Rao, Shobha S
Wireless capsule endoscopy (WCE) allows for comfortable video explorations of the gastrointestinal (GI) tract, with special indication for the small bowel. In the other segments of the GI tract also accessible to probe gastroscopy and colonscopy, WCE still exhibits poorer diagnostic efficacy. Its main drawback is the impossibility of controlling the capsule movement, which is randomly driven by peristalsis and gravity. To solve this problem, magnetic maneuvering has recently become a thrust research area. Here, we report the first demonstration of accurate robotic steering and noninvasive 3-D localization of a magnetically enabled sample of the most common video capsule (PillCam, Given Imaging Ltd, Israel) within each of the main regions of the GI tract (esophagus, stomach, small bowel, and colon) in vivo, in a domestic pig model. Moreover, we demonstrate how this is readily achievable with a robotic magnetic navigation system (Niobe, Stereotaxis, Inc, USA) already used for cardiovascular clinical procedures. The capsule was freely and safely moved with omnidirectional steering accuracy of 1°, and was tracked in real time through fluoroscopic imaging, which also allowed for 3-D localization with an error of 1 mm. The accuracy of steering and localization enabled by the Stereotaxis system and its clinical accessibility world wide may allow for immediate and broad usage in this new application. This anticipates magnetically steerable WCE as a near-term reality. The instrumentation should be used with the next generations of video capsules, intrinsically magnetic and capable of real-time optical-image visualization, which are expected to reach the market soon. PMID:20952324
Carpi, Federico; Kastelein, Nathan; Talcott, Michael; Pappone, Carlo
Small bowel lipomas are rare gastrointestinal benign neoplasms, whose signs and symptoms are often obscure. When symptoms are clinically present, one of the most common is usually gastrointestinal (GI) bleeding. It is very difficult to make a precise preoperative diagnosis in the absence of evident signs. Definitive diagnosis can only be made through histopathological examination, after the surgical resection. We report a case of obscure and persistent GI bleeding in a 78-year-old woman. Through the combination of endoscopy and computed tomography (CT), it was possible to identify a small bowel lesion, being its direct cause. CT showed a certain fat component within the mass pinpointing the hypothesis of a lipoma. We then performed a laparoscopic resection of 21 cm of the middle jejunum, including the mass and an intussusception. The results of the subsequent histopathological examination of the resected specimen allowed us to conclude that the lesion was an intestinal lipoma. Surgical resection appears to be the most successful approach as good short- and long-term results are achieved. PMID:21691916
Ferrara, Francesco; Duburque, Clothilde; Quinchon, Jean-François; Gaudissart, Quentin
When using biopsy pathology in clinical pharmacology to assess drug efficacy in the gastrointestinal tract, a number of questions must be answered: Is the biopsy necessary or more effective than macroscopic views by endoscopy? Can we extract maximal information from the specimen? Are there surrogate serum or other markers that give an overall measure of disease and/or improvement? Indeed, clinicopathological correlation is of paramount importance. If biopsy is to be used, it is important to utilize appropriate scoring systems. Many grading systems use continuous spectra, which are ordinal categorical variables and therefore a grading system of assigned ‘numbers’ which cannot be used in processes that require continuous variables such as linear regression. The use of grading vs a ‘true’ score with real numbers must be carefully considered, the site and number of biopsies must be precisely chosen and interobserver reproducibility of results evaluated before undertaking drug trials. Immunocytochemistry and in situ hybridization, however, can provide quantifiable molecular information related to mechanisms of drug action. The biopsy is of significant value as it is a true in vivo assessment if the above caveats are taken into account. However, further work is needed to determine sound histological criteria to assess the efficacy of drugs for use in gastrointestinal disease.
Walker, Marjorie M
Acute upper gastrointestinal bleeding (UGIB) is a common reason for emergency hospitalisation. Early upper gastrointestinal endoscopy is the corner stone of management; the alternative option for achieving primary hemostasis is emergency surgery. The aim of this study was to analyse the frequency of UGIB in the last 10 years and to present our surgical results. We observed 5 955 bleeding patients (68.4 % male and 31.6 % female) with a mean age of 57.7 inverted question mark 15.8 years. The most frequent causes of bleeding were gastric and duodenal ulcers (61 %) followed by gastroduodenal erosions (15.4 %) and varicous veins (5.7 %). Indications for emergency surgery were massive UGIB or rebleeding after active endoscopic treatment. On operation, gastric and duodenal ulcers were responsible for massive UGIB in 86.4 % cases. Overall hospital mortality rate during 10 years was 13.2 % and depended on age and concomitant diseases. In total 5.9 % of operated patients were rebleeding. Those with rebleeding underwent a second operation and showed a statistically higher mortality rate (35.7 % vs 11.8 %) compared to those surgical patients without rebleeding; p < 0.001. The mortality rate after vagotomy and pyloroplasty was 13.2 % (14/106) and did not differ significantly from that after gastric resection (15.2 %; 9/59). PMID:11727185
Depolo, A; Dobrila-Dintinjana, R; Uravi, M; Grbas, H; Rubini, M
Video-capsule endoscopy has revolutionized the examination of small bowel mucosa. However, this modality is relatively young and its diagnostic yield is low. Herein, we discuss different approaches to improve examination’s diagnostic yield. There are strong data supporting some of them while there is speculation about the rest. As capsule endoscopy continues to evolve there is also a strong belief that technology will overcome at least some of the obstacles that hamper capsule endoscopy’s diagnostic yield sometime in the near future.
The role of operative endoscopy as opposed to surgery in the treatment of obstructive jaundice is in continuous positive evolution due to the rapid technical progress made in the use of this method. Of a total of 93 patients treated over the course of 3 years, some received surgical treatment alone, others endoscopic treatment alone, and a third group received endoscopic therapy followed by surgery. Various parameters were taken into consideration for the three groups studied: the pathological cause of jaundice, age, sex, success of the method used, early and late complications, hospital deaths. Results were then compared. PMID:2370956
Garbarini, A; Serenthà, U; Goi, M; Franchello, A; Orlando, E; Olivero, G; Sanfelici, G; Rozzio, G; Salto, C; Bosio, C
Endoscopy instruction has progressed a great deal in recent years, evolving from the age-old dictum of ‘see one, do one’ to the current skillful application of sound educational principles. Some of these educational principles are generic and applicable to the teaching of any content at all levels, while others are quite specific to technical skills training. The present review summarizes these important principles under the following headings: creating a learner-centred curriculum; delivering an achievable learning task; and moving from theory to practice. The present article challenges national gastroenterology organizations to embrace these concepts in structured, outcome-based educational programs.
Coderre, Sylvain; Anderson, John; Rostom, Alaa; McLaughlin, Kevin
Capsule endoscopy (CE) is a new modality to investigate the small bowel. Since it was invented in 1999, CE has been adopted in the algorithm of small bowel investigations worldwide. Reporting a CE video requires identification of landmarks and interpretation of pathology to formulate a management plan. There is established training infrastructure in place for most endoscopic procedures in Europe; however despite its wide use, there is a lack of structured training for CE. This paper focuses on the current available evidence and makes recommendations to standardise training in CE.
Sidhu, Reena; McAlindon, Mark E.; Davison, Carolyn; Panter, Simon; Humbla, Olaf; Keuchel, Martin
Capsule studies can be reviewed by varying rates and speeds; however, the presence of significant debris is frustrating to the reviewer much like the excessive stool that tends to hinder the progress of a colonoscopist. Numerous studies have been published in regards to the advantages of an ideal preparation in the setting of capsule endoscopy. This most recent study by Wei et al. is another study that has demonstrated that a colonic preparation, in this situation, combined with simethicone given just prior to the capsule study results in improved visibility of the mucosa. In theory, this will lead to an improved diagnostic ability to limit excessive reading duration. PMID:18184118
The traditional areas of interest in pediatric gastrointestinal radiology (gastroesophageal reflux, malrotation, necrotizing enterocolitis) were the source of many new and important studies in the past year. Information gleaned from correlative nonradiologic studies or from newer modalities provided the new focus of interest. The imaging and treatment of intussusception remains a topic in which literature is evolving. Pneumatic reduction is repeatedly being shown to be safe and effective. There have been a large number of studies addressing polysplenia, biliary atresia, and liver transplantation. Images of the anomalies associated with polysplenia were published in several sources. One paper reported better than previously described results of liver transplantation in the subset of patients with polysplenia and biliary atresia. PMID:1581126
Fernbach, S K
The prevalence of obesity in the Japanese population has been increasing dramatically in step with the Westernization of lifestyles and food ways. Our study demonstrated significant associations between obesity and a number of gastrointestinal disorders in a large sample population in Japan. We demonstrated that reflux esophagitis and hiatal hernia were strongly related to obesity (BMI > 25) in the Japanese. In particular, obesity with young male was a high risk for these diseases. On the other hand, it has been reported that obesity is also associated with Barrett's esophagus and colorectal adenoma; however, obesity was not a risk factor for these diseases in our study. The difference of ethnicity of our subjects may partly explain why we found no data to implicate obesity as a risk factor for Barrett's esophagus. Arterial sclerosis associated with advanced age and hyperglycemia was accompanied by an increased risk of colorectal adenoma. PMID:23781242
Fujimoto, Ai; Hoteya, Shu; Iizuka, Toshiro; Ogawa, Osamu; Mitani, Toshifumi; Kuroki, Yuichiro; Matsui, Akira; Nakamura, Masanori; Kikuchi, Daisuke; Yamashita, Satoshi; Furuhata, Tsukasa; Yamada, Akihiro; Nishida, Noriko; Arase, Koji; Hashimoto, Mitsuyo; Igarashi, Yoshinori; Kaise, Mitsuru
The tremendous increase in medical knowledge over the last decades and technical progress in medicine have caused further professional specialization. Numerous medical fields have evolved through the process of separation from the parent specialization and the traditional distinction between surgical and medical disciplines has been blurred. As a result of this development organ-specific interdisciplinary units have been formed and new partners have united, such as surgeons and gastroenterologists in the field of interventional endoscopy. The fading boundaries brought with them resistance and even resentment and called for a mutual regulation by the professional associations which took place 10 years ago. Nowadays, surgeons and gastroenterologists in Germany are trained in interventional endoscopy and are the foundation of endoscopic interdisciplinary teamwork in emergency care, diagnostics, therapy, complication management and palliative treatment. Technical innovations striving for a minimization of operative trauma like NOTES depend on the cooperation of both fields of expertise. The driving force behind these efforts should be the shared interest in further improvement of patient care at the highest level of individual expertise, patient-oriented process optimization and adequate use of resources. PMID:21153461
Kalff, J C; Schäfer, N
The article presents successful intubation experience in 54 patients. Laryngoscopy was performed with McGrath Series 5 laryngoscopy with a difficult airway blade ("Airway Medical") in 46 patients, and retromolar endoscope Bonfils ("Karl Storz") in 9 patients. Technical traits, resulting from the use video laryngoscopy and retromolar endoscope are discussed. It was shown that video laryngoscopy is a high-performance intubation technique, including difficult ones. The possibility of video laryngoscope conduction in case of significant difficulties with mouth opening (max incisors distance of 1.3 cm) and atlantoccipital immobility make this method a real support to fiber bronchoscope intubation. Retromolar orotracheal intubation with Bonfils stylet training is associated with difficulties in case of insufficient endoscopy skills. During intubation the rule should be used: "to enter prorsad, do everything vice versa". The use of videolaryngoscopy and retromolar intubation is a real support for standard laryngoscopy and fiberbronchoscopy during orotracheal intubation including difficult ones. Difficult intubation may result from mouth opening restriction, atlantoocciital immobility and orolaryngopharynx deformation because of edema and rigidity, for example after an osteotomy or tumors presence. Videolaryngoscopy master is easier than retromolar endoscopy, because videolaryngoscope construction, laryngoscopy technique and larynx structures visualization are similar to the classic MAC blades. PMID:24000653
Intravenous Tc-99m DTPA was evaluated in 34 patients with active upper gastrointestinal bleeding. Active bleeding was detected in 25 patients: nine in the stomach, 12 in the duodenum, and four from esophageal varices. No active bleeding was seen in nine patients (two gastric ulcers and seven duodenal ulcers). Results were correlated with endoscopic and/or surgical findings. All completely correlated except: 1) one case of esophageal varices in which there was disagreement on the site, 2) three cases of duodenal ulcers that were not bleeding on endoscopy but showed mild oozing on delayed images and 3) one case of gastric ulcer, in which no bleeding was detected in the Tc-99m DTPA study, but was found to be bleeding at surgery 24 hours later. The Tc-99m DTPA study is a reliable method for localization of upper gastrointestinal bleeding with an agreement ratio of 85%. This method also can be used safely for follow-up of patients with intermittent bleeding. It is less invasive than endoscopy, is easily repeatable, and has the same accuracy.
Abdel-Dayem, H.M.; Mahajan, K.K.; Ericsson, S.; Nawaz, K.; Owunwanne, A.; Kouris, K.; Higazy, E.; Awdeh, M.
A prospective study was conducted to determine the frequency of occurrence of Helicobacter pylori infection in outpatients presenting with upper gastro intestinal symptoms to Arba Minch Hospital over a one year period. Four hundred and forty four patient, 309 males and 135 females, underwent upper gastro intestinal fiberoptic endoscopy between March 1989 and April 1990. The age range was 14 to 75 years (mean = 35). All 444 patients were examined and tested for infection. Sixty per cent had abnormal endoscopy results. The major endoscopic findings were gastritis in 23% and peptic ulcer disease in 20% of the patients. To identify H. pylori infection, 2 biopsy specimens were taken from the greater curve of the gastric antral mucosa of all patients. The specimens were examined using the urease diagnostic test and Loeffler Methylene Blue stain. Infection was considered present when either of the tests were positive. Infection by H. pylori was found in 324 patients (73%). Among the 173 patients without endoscopic findings, 63% had infection. Of 271 patients with abnormal endoscopic findings, 79% were infected. The results of this study show that H. pylori infection is a common finding in patients with upper gastrointestinal symptoms in Ethiopia. There is a higher prevalence of infection among patients with endoscopic findings. Thus the management of patients with upper gastro-intestinal symptoms in Ethiopia should take H. pylori infection into consideration. PMID:1563364
Gastrointestinal bleeding can be obscure or occult (OGIB), the causes and diagnostic approach will be discussed in this editorial. The evaluation of OGIB consists on a judicious search of the cause of bleeding, which should be guided by the clinical history and physical findings. The standard approach to patients with OGIB is to directly evaluate the gastrointestinal tract by endoscopy, abdominal computed tomography, angiography, radionuclide scanning, capsule endoscopy. The source of OGIB can be identified in 85%-90%, no bleeding sites will be found in about 5%-10% of cases. Even if the bleedings originating from the small bowel are not frequent in clinical practice (7.6% of all digestive haemorrhages, in our casuistry), they are notoriously difficult to diagnose. In spite of progress, however, a number of OGIB still remain problematic to deal with at present in the clinical context due to both the difficulty in exactly identifying the site and nature of the underlying source and the difficulty in applying affective and durable diagnostic approaches so no single technique has emerged as the most efficient way to evaluate OGIB.
Peroxisome proliferator-activated receptor ? (PPAR?) is a nuclear receptor that is known to play a central role in lipid metabolism and insulin sensitivity as well as inflammation and cell proliferation. According to the results obtained from studies on several animal models of gastrointestinal inflammation, PPAR? has been implicated in the regulation of the immune response, particularly inflammation control, and has gained importance as a potential therapeutic target in the management of gastrointestinal inflammation. In the present paper, we present the current knowledge on the role of PPAR? ligands in the gastrointestinal tract.
Naito, Yuji; Takagi, Tomohisa; Yoshikawa, Toshikazu
Gastric cancer is the fourth common cancer and the second major cause of cancer death worldwide. Early detection of gastric cancer by endoscopy surveillance is actively investigated to improve patient survival, especially using the newly developed magnifying narrow-band imaging endoscopy in the stomach. However, meticulous examination of the aforementioned images is both time and experience demanding and interpretation could be variable among different doctors, which hindered its widespread application. In this study, we developed a new image analysis system by adopting local binary pattern and vector quantization to perform pattern comparison between known training abnormal images and testing images of magnifying narrow band endoscopy images in the stomach. Our preliminary results demonstrated promising potential for automatically labeled region of interest for endoscopy doctors to focus on abnormal lesions for subsequent targeted biopsy, with the rates of recall 0.46-1.00 and precision 0.39-0.87. PMID:24110716
Lee, Tsung-Chun; Lin, Yu-Huei; Uedo, Noriya; Wang, Hsiu-Po
Wireless Capsule Endoscopy (WCE) is an endoscopy technology that allows medical personnel to view the digestive tract non-invasively. Physicians can detect diseases such as blood-based abnormalities, polyps, ulcers and Crohn's disease. In previous papers we have proposed methodologies that deal with such abnormalities. In the current paper we are proposing a novel approach to visualize the digestive tract surface in
Alexandros Karargyris; Orestis Karargyris; Nikolaos G. Bourbakis
BackgroundRecommended procedure numbers for upper endoscopy (UE) and colonoscopy (C) are 35 and 50 for surgical residents, and 130 and 140 for gastroenterology fellows, respectively. The purpose of this study was to challenge the methods used to determine proficiency in flexible endoscopy.
Melina C. Vassiliou; Pepa A. Kaneva; Benjamin K. Poulose; Brian J. Dunkin; Jeffrey M. Marks; Riadh Sadik; Gideon Sroka; Mehran Anvari; Klaus Thaler; Gina L. Adrales; Jeffrey W. Hazey; Jenifer R. Lightdale; Vic Velanovich; Lee L. Swanstrom; John D. Mellinger; Gerald M. Fried
Background: Eliminating conscious sedation for diagnostic endoscopy may be advantageous for patient safety and cost containment. The aim of this study was to identify and validate independent predictors of a comfortable, technically adequate, unsedated diagnostic upper endoscopy in Canadian patients. Methods: Patients were consecutively enrolled in a prospective fashion. Data collected on an initial cohort of 268 patients included demographics,
Neena Abraham; Alan Barkun; Martin LaRocque; Carlo Fallone; Serge Mayrand; Vicky Baffis; Albert Cohen; Donald Daly; Habib Daoud; Lawrence Joseph
This study shows the local changes in intramedullary pressure during a new endoscopic technique for the medullary canal of the long bone. The procedure of intramedullary bone endoscopy (IBE) was performed on 4 tibial amputations. By slowly pushing the endoscope distally under visual control and endoscopic preparation of the medullary canal, a “neocavum” for endoscopy was created. During the procedure,
Michael Oberst; Alexander Bosse; Ulrich Holz
Although the concept of endoscopy has existed for centuries, a practical working neuro-endoscopic system did not emerge until last century, as a result of numerous contributions and refinements in optical technology, illumination sources, and instrumentation. Modern neuro-endoscopy would not be a flourishing field, as it is today, without the dedication, innovation, and implementation of emerging technology by key contributors including
Gabriel Zada; Charles Liu; Michael L. J. Apuzzo
Assessing the efficacy of famotidine and rebamipide in the treatment of gastric mucosal lesions in patients receiving long-term NSAID therapy (FORCE—famotidine or rebamipide in comparison by endoscopy)
Background Nonsteroidal anti-inflammatory drugs (NSAIDs) and Helicobacter pylori infection are major causes of gastric mucosal lesions.\\u000a In Japan, histamine-2 receptor antagonists are frequently prescribed, but the literature regarding their efficacy is limited.\\u000a In this study, we compare the effects of famotidine and rebamipide on NSAID-associated gastric mucosal lesions using upper\\u000a gastrointestinal endoscopy.\\u000a \\u000a \\u000a \\u000a Methods This study examined 112 patients taking NSAIDs for either
Jun-ichi Yamao; Eiryo Kikuchi; Masami Matsumoto; Masaki Nakayama; Tatsuichi Ann; Hideyuki Kojima; Akira Mitoro; Motoyuki Yoshida; Masaaki Yoshikawa; Hiroshi Yajima; Yoshizumi Miyauchi; Hiroshi Ono; Koichi Akiyama; Goro Sakurai; Yoshikazu Kinoshita; Ken Haruma; Yoshinori Takakura; Hiroshi Fukui
Reports about superior mesenteric vein thrombosis in childhood are very rare and have not been associated with gastrointestinal bleeding. We describe two cases of severe bleeding from the upper and lower gastrointestinal tract in children who had undergone complex abdominal surgery at considerable time before. The first child had a tracheoesophageal fistula, corrected by division, gastrostomy insertion, and repair of duodenal rupture. The child presented with severe bleeding from the gastrostomy site and was diagnosed with a thrombosis of the proximal superior mesenteric vein. The second child had a gastroschisis and duodenal atresia, and required duodenoplasty, gastrostomy insertion, hemicolectomy, and adhesiolysis. The child presented with intermittent severe lower gastrointestinal bleeding, resulting from collateral vessels at location of the surgical connections. He was diagnosed with a thrombosis of the superior mesenteric vein. In both children, the extensive previous surgery and anastomosis were considered the cause of the mesenteric thrombosis. CT angiography confirmed the diagnosis in both cases, in addition to characteristic findings on endoscopy. Paediatricians should suspect this condition in children with severe gastrointestinal bleeding, particularly in children with previous, complex abdominal surgery.
Fox, Anna L.; Jones, Matthew; Healey, Andrew; Auth, Marcus K. H.
BackgroundCapsule endoscopy is used to investigate the small bowel in patients with GI bleeding of obscure etiology. Capsule endoscopy was compared prospectively with push enteroscopy in 20 patients with GI hemorrhage.
Douglas G Adler; Mary Knipschield; Christopher Gostout
The goal of this short review is to summarize recent data on gastrointestinal changes with aging, focusing on gastrointestinal motility disorders, and mucosal variations. First of all, this review focused on gastrointestinal motility disorders with aging, even though an increased prevalence of several gastrointestinal motor disorders (i.e., dysphagia, dyspepsia, anorexia, and constipation) occurs in older people, aging per se appears
The link between thromboembolism and cancer has been recognized for over 100 years. Venous thromboembolism (VTE) is associated with considerable morbidity in patients with cancer, with emerging research also indicating a detrimental effect on survival. Investigations aimed at improving outcomes for patients with cancer have focused on the role of low molecular weight heparin in primary and secondary prevention of VTE and in improving patient survival. Important fundamental questions remain unanswered, however, and a significant line of research needs to be dedicated to investigating VTE in GI cancers. The effect of VTE on survival needs to be clarified, as does the role of anticoagulation in this patient population. Opportunities for additional research include investigating methods to identify patients at risk of developing VTE and developing new strategies and therapeutic interventions to reduce the morbidity and mortality associated with VTE. This review focuses on the current understanding of VTE related to gastrointestinal cancers and directions of interest in research specific to GI cancers and VTE. PMID:19259275
Tetzlaff, Eric D; Cheng, Jonathan D; Ajani, Jaffer A
Gastrointestinal tract perforations can occur for various causes such as peptic ulcer, inflammatory disease, blunt or penetrating trauma, iatrogenic factors, foreign body or a neoplasm that require an early recognition and, often, a surgical treatment.Ultrasonography could be useful as an initial diagnostic test to determine, in various cases the presence and, sometimes, the cause of the pneumoperitoneum.The main sonographic sign of perforation is free intraperitoneal air, resulting in an increased echogenicity of a peritoneal stripe associated with multiple reflection artifacts and characteristic comet-tail appearance.It is best detected using linear probes in the right upper quadrant between the anterior abdominal wall, in the prehepatic space.Direct sign of perforation may be detectable, particularly if they are associated with other sonographic abnormalities, called indirect signs, like thickened bowel loop and air bubbles in ascitic fluid or in a localized fluid collection, bowel or gallbladder thickened wall associated with decreased bowel motility or ileus.Neverthless, this exam has its own pitfalls. It is strongly operator-dependant; some machines have low-quality images that may not able to detect intraperitoneal free air; furthermore, some patients may be less cooperative to allow for scanning of different regions; sonography is also difficult in obese patients and with those having subcutaneous emphysema. Although CT has more accuracy in the detection of the site of perforation, ultrasound may be particularly useful also in patient groups where radiation burden should be limited notably children and pregnant women. PMID:23902744
Coppolino, Ff; Gatta, G; Di Grezia, G; Reginelli, A; Iacobellis, F; Vallone, G; Giganti, M; Genovese, Ea
. With advances in heart transplantation, a growing number of recipients are at risk of developing gastrointestinal disease.\\u000a We reviewed our experience with gastrointestinal disease in 92 patients undergoing 93 heart transplants. All had follow-up,\\u000a with the median time 4.8 years (range 0.5–9.6 years). During the period of the study we progressively adopted a policy of\\u000a low immunosuppression aiming toward
Xavier M. Mueller; Hendrick T. Tevaearai; Frank Stumpe; Michel Hurni; Patrick Ruchat; Adam P. Fischer; Charles Seydoux; Jean-Jacques Goy; Ludwig K. von Segesser
Gastrointestinal complications are common in patients undergoing various forms of cancer treatment, including chemotherapy, radiation therapy, and molecular-targeted therapies. Many of these complications are life-threatening and require prompt diagnosis and treatment. Complications of oncologic therapy can occur in the esophagus (esophagitis, strictures, bacterial, viral and fungal infections), upper gastrointestinal tract (mucositis, bleeding, nausea and vomiting), colon (diarrhea, graft–versus–host disease, colitis
Marta Davila; Robert S Bresalier
Incidence of tuberculosis has increased in the Netherlands in recent years, especially among immigrants. Nearly half of all patients with tuberculosis have extrapulmonary disease; in 5% of these patients it is localized in the gastrointestinal tract. Despite the low incidence of gastrointestinal tuberculosis we recently established this diagnosis in three of our patients, who demonstrated tuberculosis within the oesophagus, colon and pancreas, respectively. They were successfully treated, but only after a long diagnostic process. PMID:23739601
Schrauwen, Ruud; Richter, Clemens; Vrolijk, Jan Maarten
Sedation during invasive procedures provides appropriate humanitarian care as well as facilitating the completion of procedure. Although generally safe and effective, adverse effects may occur especially in patients with co-morbid diseases. In many cases, given its rapid onset and offset, propofol is chosen to provide sedation during various invasive procedures. We present a nine-year-old, 45 kg child with Duchenne muscular dystrophy (DMD) who presented for esophagogastroduodenoscopy (EGD). Given the egg allergy, which was a relative contraindication to the use of propofol, and the potential risk of malignant hyperthermia due to DMD, a combination of dexmedetomidine and ketamine was used for procedural sedation. Dexmedetomidine was administered as a loading dose of 1 ?g/kg along with a single bolus dose of ketamine (1 mg/kg). This was followed by a dexmedetomidine infusion at 0.5 ?g/kg/hour. The patient tolerated the procedure well and was discharged to home. Previous reports regarding the use of dexmedetomidine and ketamine for procedural sedation are reviewed and the potential efficacy of this combination is discussed.
Raman, Vidya; Yacob, Desale; Tobias, Joseph D
The utility of autofluorescence imaging for the early detection of lung cancer has been previously demonstrated. The aim of this work is to extend the use of real time autofluorescence imaging to the early detection of cancer of the esophagus, stomach, and colon. A prototype fluorescence imaging system was developed which produces real time video images of tissue autofluorescence. The system consist of a filtered blue light source, two intensified CCD cameras, a fiber optic endoscope, and a computer based control center. The system produces a real time pseudo color display based on images acquired from two fluorescence bands. These bands were selected based on in vivo fluorescence spectroscopic studies. The generated pseudo image clearly delineates the abnormal tissue areas for biopsy. Early cancer sties missed under conventional white light examination became visible under fluorescence imaging. A further development allows the fluorescence imaging system to be used in an alternate fashion. The system captures a fluorescence image in the green and a reflectance image in the red-near IR. Different spectral information was exploited in the two imaging modes.
Zeng, Haishan; Weiss, Alan; Macaulay, Calum E.; MacKinnon, Nick; Cline, Richard; Dawson, Remy
Background Simulators may improve the efficiency, safety, and quality of endoscopic training. However, no objective, reliable, and valid\\u000a tool exists to assess clinical endoscopic skills. Such a tool to measure the outcomes of educational strategies is a necessity.\\u000a This multicenter, multidisciplinary trial aimed to develop instruments for evaluating basic flexible endoscopic skills and\\u000a to demonstrate their reliability and validity.\\u000a \\u000a \\u000a \\u000a \\u000a Methods The Global
Melina C. Vassiliou; Pepa A. Kaneva; Benjamin K. Poulose; Brian J. Dunkin; Jeffrey M. Marks; Riadh Sadik; Gideon Sroka; Mehran Anvari; Klaus Thaler; Gina L. Adrales; Jeffrey W. Hazey; Jenifer R. Lightdale; Vic Velanovich; Lee L. Swanstrom; John D. Mellinger; Gerald M. Fried
In this paper, we presented a novel ray casting algorithm, which can escape time-consuming operation of truncating a floating-point number during resampling. By converting every sampled point into the vector sum of the vectors, which are comprised by the integer point and the floating-point vector point, and utilizing coherence between adjacent sampled points, we can completely escape the operation of truncating a floating-point number. Applied this algorithm, rendering speed can be improved obviously in ray casting algorithm with tri-linear interpolation. The algorithm is robust and can be easily combined with another fast ray casting algorithms to further speed up the rendering. Because this algorithm does not need additional memory consumption and other time-consuming preprocess, and moreover it does not degrade the image quality, it is very useful in the implementation of virtual endoscopy system.
Yuan, Feiniu; Zhou, Heqin; Zhao, He; Feng, Huanqing
The electromechanical performance of piezoelectric scanning mirrors for endoscopy imaging is presented. The devices are supported by a single actuating cantilever to achieve a high fill factor, the ratio of mirror area to the combined mirror and actuator area. The largest fill factor devices (74%) achieved 10° mechanical scan range at +/?10V with a 300 ?m long cantilever. The largest angular displacement of 30° mechanical scan range was obtained with a 500 ?m long cantilever device with a 63% fill factor driven at 40 Vpp. A systematic investigation of device performance (displacement and speed) as a function of fabrication and operational parameters including the stress balance in the cantilever revealed unexpectedly large displacements with lack of inversion at the coercive field. An interpretation of the results is presented based on piezoelectric film domain orientation and clamping with supporting piezoelectric film characterization measurements.
Gilchrist, Kristin H.; Dausch, David E.; Grego, Sonia
The ability to manipulate light in subwavelength photonic and plasmonic structures has shown great potentials in revolutionizing how information is generated, transformed and processed. Chemically synthesized nanowires, in particular, offers a unique toolbox not only for highly compact and integrated photonic modules and devices, including coherent and incoherent light sources, waveguides, photodetectors and photovoltaics, but also for new types of nanoscopic bio-probes for spot cargo delivery and in-situ single cell endoscopy and sensing. Such nanowire probes would enable us to carry out intracellular imaging and probing with high spatial resolution, monitor in-vivo biological processes within single living cells and greatly improve our fundamental understanding of cell functions, intracellular physiological processes, and cellular signal pathways. My work is aimed at developing a material and instrumental platform for such single nanowire probe. Successful optical integration of Ag nanowire plasmonic waveguides, which offers deep subwavelength mode confinement, and conventional photonic waveguides was demonstrated on a single nanowire level. The highest plasmonic-photonic coupling efficiency coupling was found at small coupling angles and low input frequencies. The frequency dependent propagation loss was observed in Ag nanowire and was confirmed by quantitative measurement and in agreement with theoretical expectations. Rational integration of dielectric and Ag nanowire waveguide components into hybrid optical-plasmonic routing devices has been demonstrated. This capability is essential for incorporating sub-100nm Ag nanowire waveguides into optical fiber based nanoprobes for single cell endoscopy. The nanoprobe system based on single nanowire waveguides was demonstrated by optically coupling semiconductor or metal nanowire with an optical fiber with tapered tip. This nanoprobe design requires minimal instrumentation which makes it cost efficient and readily adaptable to average bio-lab environment. These probes are mechanically robust and flexible and can withstand repeated bending and deformation without significant deterioration in optical performance, which offers an ideal instrumental platform for out subsequent effort of using these nanoprobes in chemical sensing as well as single cell endoscopy and spot delivery. Parameters affecting the coupling efficiency and output power of the nanoprobe were studied and chemical etched of single mode fiber with small cone angle was established to be optimized for highly effective optical nanoprobes. The versatility of the nanoprobe design was first tested by transforming the nanowire probe into a pH sensor with near-field photopolymerization of a copolymer containing pH sensitive dye on the tip of the nanowire. The pH-sensitive nanoprobe was able to report the pH difference in micro-droplets containing buffer solution with the excitation of light waveguided on the nanoprobe with internal calibration, fast response time and good photostability and reversibility. Such nanoprobe sensors are ideal for high definition spatial and temporal sensing of concentration profile, especially for the kinetic processes in single cell studies for which chemical probes of minute sizes and fast response are desired. The nanoprobe was then applied into spot cargo delivery and in-situ single cell endoscopy. It was demonstrated that nanowire-based optical probe can deliver payloads into the cell with a high spatiotemporal precision, guide and confine visible light into intracellular compartments selectively and detect optical signals from the subcellular regions with high spatial resolution. The nanoprobe was proven to be biocompatible and non-invasive. The effective optical coupling between the fiber optics and the nanowire enables highly localized excitation and detection, limiting the probe volume to the close proximity of the nanowire. None the less, this versatile technique does not rely on any expensive or bulky instrumentation, and relies only on micromanipulator and optical microscope th
Endoscopy is an important inspection device to detect cancers in the human body, but there exists the case of cancer that is hard to detect with only an optical device. Double inspection with optical and radio images is preferable for high accuracy diagnosis, and real time radio imaging is also promising for real time surgery with an endoscope. We have simulated, designed and fabricated a Si-based positron imaging probe for more accurate cancer detection in multi-modality endoscope systems. The fabricated Si-based detector with 2 mm diameter and 1 mm thickness was tested with gamma and positron sources, and also tested to detect cancers in a tumor bearing mouse. The direct positron imaging could have an advantage over gamma imaging in its high sensitivity and resolution.
Shimazoe, Kenji; Takahashi, Hiroyuki; Fujita, Kaoru; Mori, Hiroshi; Momose, Toshimitsu
The most common enteric viruses responsible for diarrhoea are rotavirus, enteric adenoviruses, caliciviruses including the Norwalk agent and astrovirus. These infections are usually mild to moderate in severity, self-limiting and of short duration and thus, specific antiviral therapy is not recommended. The standard management of these infections is restoration of fluid and electrolyte balance and then maintenance of hydration until the infection resolves. WHO oral rehydration therapy (ORT) was introduced about 30 years ago and has saved the lives of many infants and young children. During the last 10 years it has become evident that the efficacy of ORT can be increased by reducing the osmolality of the WHO oral rehydration solution (ORS) to produce a relatively hypotonic solution. Hypotonic ORS appears to be safe and effective in all forms of acute diarrhoea in childhood. Complex substrate ORS, which is also usually hypotonic, has been shown to have increased efficacy in cholera but not in other bacterial or viral diarrhoeas. Nevertheless, the scientific rationale for using rice or resistant starch as substrate in ORS is of physiological interest. Other treatments such as hyperimmune bovine colostrum, probiotics and antiviral agents are largely experimental and have not been introduced into routine clinical practice. Cytomegalovirus (CMV) infection of the gastrointestinal tract occurs mainly in the immunocompromised although it has been reported in immunocompetent individuals. CMV infects both the oesophagus and colon to produce oesophagitis, often with discrete ulcers, and colitis, respectively. Both conditions can be treated with ganciclovir or foscarnet. Failure to respond to monotherapy is an indication to use both agents concurrently. PMID:11444033
Farthing, M J
This is the first attempt at defining criteria for functional gastrointestinal disorders (FGIDs) in infancy, childhood, and adolescence. The decision-making process was as for adults and consisted of arriving at consensus, based on clinical experience. This paper is intended to be a quick reference. The classification system selected differs from the one used in the adult population in that it is organized according to main complaints instead of being organ-targeted. Because the child is still developing, some disorders such as toddler's diarrhea (or functional diarrhea) are linked to certain physiologic stages; others may result from behavioral responses to sphincter function acquisition such as fecal retention; others will only be recognizable after the child is cognitively mature enough to report the symptoms (e.g., dyspepsia). Infant regurgitation, rumination, and cyclic vomiting constitute the vomiting disorders. Abdominal pain disorders are classified as: functional dyspepsia, irritable bowel syndrome (IBS), functional abdominal pain, abdominal migraine, and aerophagia. Disorders of defecation include: infant dyschezia, functional constipation, functional fecal retention, and functional non-retentive fecal soiling. Some disorders, such as IBS and dyspepsia and functional abdominal pain, are exact replications of the adult criteria because there are enough data to confirm that they represent specific and similar disorders in pediatrics. Other disorders not included in the pediatric classification, such as functional biliary disorders, do occur in children; however, existing data are insufficient to warrant including them at the present time. For these disorders, it is suggested that, for the time being, clinicians refer to the criteria established for the adult population.???Keywords: infant vomiting; cyclic vomiting syndrome; functional dyspepsia in children; irritable bowel syndrome in children; functional abdominal pain in children; functional diarrhea in children; functional constipation in children; Rome II
Rasquin-Weber, A; Hyman, P; Cucchiara, S; Fleisher, D; Hyams, J; Milla, P; Staiano, A
Introduction Upper gastrointestinal bleeding is common in the adult population. Peptic ulcer disease is a common cause of gastrointestinal bleeding and is usually related to Helicobacter pylori (H. pylori) infection or nonsteroidal anti-inflammatory drugs. Patients with a large hiatal hernia are at risk for a Cameron ulcer, which has a different physiology and treatment options. Case Report A 64-year-old woman presented with multiple episodes of melena followed by a syncopal episode and coffee-ground emesis. Her past medical history was notable for GERD and a hiatal hernia diagnosed on esophagogastroduodenoscopy (EGD) in 2008; she denied any NSAID use. Her GERD had been well-controlled on esomeprazole, but she stopped taking this medication two months before her presentation due to a concern over long-term side effects. On presentation, her blood hemoglobin level was 9.8 g/dL, decreased from a baseline of 14 g/dL. She underwent EGD which confirmed a large hiatal hernia and showed a 1 cm ulcer with a visible vessel located along the diaphragmatic impression, consistent with a Cameron ulcer. The ulcer was treated with epinephrine injection and bipolar cautery. Gastric biopsies were obtained, which later retuned negative for H. pylori. A proton pump inhibitor was restarted and she recovered uneventfully. Repeat upper endoscopy two months later showed complete resolution of her Cameron's ulcer. After a discussion of therapeutic options, she was referred for fundoplication and surgical repair of her hiatal hernia. Discussion Cameron ulcers are a mechanical phenomenon, related to extrinsic compression of the diaphragm on the stomach in patients with large hiatal hernias. These lesions should be suspected during upper endoscopy in patients with large hiatal hernias as Cameron ulcers may be overlooked due to their location along the diaphragmatic impression. Although our patient's ulcer resolved after she was restarted on a proton pump inhibitor, surgical repair of the hiatal hernia (often performed in combination with a fundoplication) is a consideration in patients who fail to respond to standard therapy.
Stratton, Amy; Laczek, Jeffrey
The benefit of early endoscopy in the management of peptic ulcer bleeding remains controversial. In this study we looked at the role of early endoscopy in bleeding peptic ulcer patients with clear, "coffee grounds," or bloody nasogastric aspirate. A consecutive series of 325 patients with peptic ulcer bleeding were included (218 patients with clear aspirate, 77 patients with coffee-grounds aspirate, and 30 patients with bloody aspirate). They were randomized to receive early endoscopy (within 12 h of arrival at the emergency room) or delayed endoscopy (12 h after arrival at the emergency room). Early endoscopy did not benefit patients with clear or coffee-grounds aspirate. However, combined with endoscopic therapy, it did significantly benefit patients with bloody aspirate in reducing the need for blood transfusion (mean, 450 ml vs. 666 ml; p < 0.001) and hospital stay (mean, 4 vs. 14.5 days, p < 0.001). Early endoscopy and endoscopic therapy are not needed in bleeding peptic ulcer patients with clear or coffee-grounds nasogastric aspirate. However, early endoscopy and endoscopic therapy benefit patients with bloody nasogastric aspirate. PMID:8771420
Lin, H J; Wang, K; Perng, C L; Chua, R T; Lee, F Y; Lee, C H; Lee, S D
Amyloidosis is characterized by the extracellular deposition of amyloid protein in various organs. Gastrointestinal involvement in amyloidosis is common, but a diagnosis of amyloidosis is often delayed. Severe gastrointestinal hemorrhage in amyloidosis is rare but can be fatal in some cases. We experienced a case of a 49-year-old man who presented with recurrent massive hematochezia. Although embolization was performed eight times for bleeding from different sites of the small intestine, hematochezia did not cease. We report the case, with a review of the literature.
Kim, Sang Hyeon, E-mail: firstname.lastname@example.org; Kang, Eun Ju; Park, Jee Won; Jo, Jung Hyun [Dong-A University Hospital, Department of Diagnostic Radiology (Korea, Republic of); Kim, Soo Jin [College of Medicine, Dong-A University, Department of Pathology (Korea, Republic of); Cho, Jin Han; Kang, Myong Jin; Park, Byeong Ho [Dong-A University Hospital, Department of Diagnostic Radiology (Korea, Republic of)
Eagle's syndrome is often associated with elongated styloid process or ossified stylohyoid or stylomandibular ligament. Patients with this syndrome present with recurrent cervicofacial pain. Surgical removal of the elongated styloid process is a standard treatment and can be accomplished through either a transoral or extraoral approach. Both approaches have advantages and disadvantages, and the best surgical approach remains controversial. In our case, the elongated styloid process was removed by transoral approach assisted by endoscopy. Endoscopy provides clear surgical view thus lessen the chance of neurovascular injury and other intraoperative complications. Endoscopy-assisted transoral resection is an optional alternative surgical procedure for Eagle's syndrome.
SUMMARY Candida organisms commonly colonize the human gastrointestinal tract as a component of the resident microbiota. Their presence is generally benign. Recent studies, however, show that high level Candida colonization is associated with several diseases of the gastrointestinal tract. Further, results from animal models argue that Candida colonization delays healing of inflammatory lesions and that inflammation promotes colonization. These effects may create a vicious cycle in which low-level inflammation promotes fungal colonization and fungal colonization promotes further inflammation. Both inflammatory bowel disease and gastrointestinal Candida colonization are associated with elevated levels of the pro-inflammatory cytokine IL-17. Therefore, effects on IL-17 levels may underlie the ability of Candida colonization to enhance inflammation. Because Candida is a frequent colonizer, these effects have the potential to impact many people.
Kumamoto, Carol A.
Despite progress in the management of gastrointestinal malignancies, these diseases remain devastating maladies. Conventional treatment with chemotherapy and radiation is still only partially effective and highly toxic. In the era of increasing knowledge of the molecular biology of tumors and the interaction between the tumor and immune system, the development of targeted agents, including cancer vaccines, has emerged as a promising modality. In this paper, we discuss the principals of vaccine development, and we review most of the published trials on gastrointestinal cancer vaccines that have been conducted over the last decade. Many antigens and various treatment approaches have already been tested in colon, pancreatic, and other cancers. Some of these approaches have already shown some clinical benefit. In this paper, we discuss these different strategies and some of the future directions for targeting gastrointestinal malignancies with vaccines.
Rahma, Osama E.
The clinical and pathological features of 3 cases of colonic malakoplakia are documented thereby bringing to 34 the total of recorded cases of malakoplakia involving the gastrointestinal tract. This is therefore the most common site of involvement outside the urogenital tract. A comprehensive review of the world literature on gastrointestinal malakoplakia has been made and the characteristic features of the condition have been delineated. There was a bimodal age incidence with a small cluster of cases occurring in childhood and associated with significant additional systemic disease. In the adult cases the average age was 57 years with a slight excess of males. The most commonly involved part of the gastrointestinal tract was the colon and colonic carcinoma was the most common associated disease. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4
Gastrointestinal bleeding in elderly individuals is a frequent cause of consultation with a physician and of hospital admissions. Co-morbidity and greater medication use in this steadily growing patient group influence the clinical course and adversely affect outcome. Clinical presentation is often predictable and guides subsequent patient management. Due to a surprising lack of prospective controlled data in the area of gastrointestinal bleeding, the selection of diagnostic and therapeutic manoeuvres often depends more on local expertise and availability than on an algorithmic approach. Advances in endoscopic, medical, radiological and surgical treatment modalities offer promising new diagnostic and therapeutic tools, particularly in concerted applications. Outcome studies on the appropriate sequence and linking of these modalities are urgently needed. This chapter will address clinical presentation, aetiology, diagnosis and treatment of both upper and lower gastrointestinal bleeding in the elderly. PMID:11866487
Lingenfelser, T; Ell, C
The intestinal microbiota plays an important role in the development of post-natal gastrointestinal functions of the host. Recent advances in our capability to identify microbes and their function offer exciting opportunities to evaluate the complex cross talk between microbiota, intestinal barrier, immune system and the gut-brain axis. This review summarizes these interactions in the early colonization of gastrointestinal tract with a major focus on the role of intestinal microbiota in the pathogenesis of feeding intolerance in preterm newborn. The potential benefit of early probiotic supplementation opens new perspectives in case of altered intestinal colonization at birth as preventive and therapeutic agents. PMID:23433508
Di Mauro, Antonio; Neu, Josef; Riezzo, Giuseppe; Raimondi, Francesco; Martinelli, Domenico; Francavilla, Ruggiero; Indrio, Flavia
Introduction: Strategies for the diagnosis of tumors arising in the intestinal muscular wall are rap- idly evolving. Immunoreactivity for CD117 (KIT) usually supports the diagnosis of gastrointestinal stromal tumor (GIST), but a small subset of GISTs lacks KIT expression. In these cases the differential diagnosis of KIT-negative GIST versus one of their morphological mimics is diffi- cult and bears critical
Jens Kuhlgatz; Bjoern Sander; Mariola Monika Golas; Bastian Gunawan; Thorsten Schulze; Hans-Jürgen Schulten; Eva Wardelmann; László Füzesi
Abstract Abstract Abstract Abstract Abstract AIM: To determine the effect of oral erythromycin on gastric and small bowel transit time of capsule endoscopy. METHODS:Consecutive patients who underwent,capsule
Wai K Leung; Francis KL Chan; Sara SL Fung; Mei-Yin Wong; Joseph JY Sung
PurposeThe aim of this study was to assess the accuracy of multidetector computed tomography (MDCT), including virtual endoscopy (VE) for detection, precise localization, preoperative evaluation and staging of esophageal cancer (EC) by comparison with surgical and histopathological findings.
Omer Onba?; Atilla Eroglu; Mecit Kantarci; Pinar Polat; Fatih Alper; Nurettin Karaoglanoglu; Adnan Okur
In this study, the authors report the case of a 35-year-old man diagnosed preoperatively as having adenocarcinoma of the jejunum using a conventional endoscopy, usually used for the examination of the large intestine. PMID:18795691
Sakai, Yuji; Tsuyuguchi, Toshio; Ohara, Tadashi; Yukisawa, Seigo; Tsuchiya, Shin; Sugiyama, Harutoshi; Miyakhawa, Kaoru; Ohbu, Masamichi; Kato, Kazuki; Kimura, Michio; Kaiho, Takashi; Takeuchi, Osamu; Matsuzaki, Osamu; Miyazaki, Masaru; Yokosuka, Osamu
We report a case of a 12-year-old boy with heterotopic pancreas (HP) located in a Meckel's diverticulum (MD) and presenting as obscure gastrointestinal (GI) bleeding. Upper GI endoscopy and colonoscopy did not reveal the source of the bleeding, however, capsule endoscopy revealed a space-occupying lesion in the ileum. The patient developed massive bleeding and an emergency exploratory laparotomy was performed. A congested MD was discovered 100 cm from the ileocaecal valve using intra-operative endoscopy; the ulcerated tip of the diverticulum appeared to be the source of the bleeding. The MD and adjacent ileal segment were resected and an end-to-end anastomosis performed. Subsequent pathological examination revealed an ileal MD with HP tissue within the submucosa. The patient remains well, 12 months after the operation, with no evidence of recurrent bleeding. This case suggests that HP should be considered as one possible cause of obscure GI bleeding in children and capsule endoscopy is a valuable adjuvant tool in the diagnosis of HP in children. PMID:19589283
Xiao, W-D; Chen, W; Yang, H
The aim of this study was to evaluate gastrointestinal metastases from primary lung cancer confirmed by autopsy. We identified and examined patients with a diagnosis of primary lung cancer over 33 years. We also reviewed patients with gastrointestinal metastases including the stomach, small bowel, and large bowel. This study comprised 470 patients with lung cancer. We detected 56 (11.9%) cases with gastrointestinal metastases. There were 12 (30%) cases with gastrointestinal metastases among 40 cases with large cell carcinoma. The histological type of large cell carcinoma led to a significantly higher rate of gastrointestinal metastases compared with that of non-large cell carcinoma (P=0.004, odds ratio 3.524). Life threatening gastrointestinal metastases occurred in 12 cases and five occurred in large cell carcinoma. Gastrointestinal metastases from primary lung cancer may occur in the clinical course and result in life threatening gastrointestinal metastases, particularly if patients have the histological type of large cell carcinoma. PMID:17079136
Yoshimoto, Akihiro; Kasahara, Kazuo; Kawashima, Atsuhiro
The present invention relates to compositions and methods concerning isolated gastrointestinal stem cells. Particularly, the invention provides isolated gastrointestinal stem cells comprising a CD45 negative marker, a collagen IV negative marker, and that...
S. J. Henning
AIM: To analyze the effectiveness of the endoscopic therapy and to identify prognostic factors for recurrent bleeding. METHODS: Retrospective study of patients with gastrointestinal bleeding secondary to Dieulafoy’s lesion (DL) from 2005 to 2011. We analyzed the demographic characteristics of the patients, risk factors for gastrointestinal bleeding, endoscopic findings, characteristics of the endoscopic treatment, and the recurrence of bleeding. We included cases in which endoscopy described a lesion compatible with Dieulafoy. We excluded patients who had potentially bleeding lesions such as angiodysplasia in other areas or had undergone other gastrointestinal endoscopic procedures. RESULTS: Twenty-nine patients with DL were identified. Most of them were men with an average age of 71.5 years. Fifty-five percent of the patients received antiaggregatory or anticoagulant therapy. The most common location for DL was the stomach (51.7%). The main type of bleeding was oozing in 65.5% of cases. In 27.6% of cases, there was arterial (spurting) bleeding, and 6.9% of the patients presented with an adherent clot. A single endoscopic treatment was applied to nine patients (31%); eight of them with adrenaline and one with argon, while 69% of the patients received combined treatment. Six patients (20.7%) presented with recurrent bleeding at a median of 4 d after endoscopy (interquartile range = 97.75). Within these six patients, the new endoscopic treatment obtained a therapeutic success of 100%. The presence of arterial bleeding at endoscopy was associated with a higher recurrence rate for bleeding (50% vs 33.3% for other type of bleeding) [P = 0.024, odds ratio (OR) = 8.5, 95% CI = 1.13-63.87]. The use of combined endoscopic treatment prevented the recurrence of bleeding (10% vs 44.4% of single treatment) (P = 0.034, OR = 0.14, 95% CI = 0.19-0.99). CONCLUSION: Endoscopic treatment of DL is safe and effective. Adrenaline monotherapy and arterial (spurting) bleeding are associated with a high rate of bleeding recurrence.
Jamanca-Poma, Yuliana; Velasco-Guardado, Antonio; Pinero-Perez, Concepcion; Calderon-Begazo, Renzo; Umana-Mejia, Josue; Geijo-Martinez, Fernando; Rodriguez-Perez, Antonio
Prevention has a paramount role in reducing the incidence of corrosive ingestion especially in children, yet this goal is far from being reached in developing countries, where such injuries are largely unreported and their true prevalence simply cannot be extrapolated from random articles or personal experience. The specific pathophysiologic mechanisms are becoming better understood and may have a role in the future management and prevention of long-term consequences, such as esophageal strictures. Whereas the mainstay of diagnosis is considered upper gastrointestinal endoscopy, computed tomography and ultrasound are gaining a more significant role, especially in addressing the need for emergency surgery, whose morbidity and mortality remains high even in the best hands. The need to perform emergency surgery has a persistent long-term negative impact both on survival and functional outcome. Medical or endoscopic prevention of stricture is debatable, yet esophageal stents, absorbable or not, show promising data. Dilatation is the first therapeutic option for strictures and bougies should be considered especially for long, multiple and tortuous narrowing. It is crucial to avoid malnutrition, especially in developing countries where management strategies are influenced by malnutrition and poor clinical conditions. Late reconstructive surgery, mainly using colon transposition, offers the best results in referral centers, either in children or adults, but such a difficult surgical procedure is often unavailable in developing countries. Possible late development of esophageal cancer, though probably overemphasized, entails careful and long-term endoscopic screening.
Contini, Sandro; Scarpignato, Carmelo
Prevention has a paramount role in reducing the incidence of corrosive ingestion especially in children, yet this goal is far from being reached in developing countries, where such injuries are largely unreported and their true prevalence simply cannot be extrapolated from random articles or personal experience. The specific pathophysiologic mechanisms are becoming better understood and may have a role in the future management and prevention of long-term consequences, such as esophageal strictures. Whereas the mainstay of diagnosis is considered upper gastrointestinal endoscopy, computed tomography and ultrasound are gaining a more significant role, especially in addressing the need for emergency surgery, whose morbidity and mortality remains high even in the best hands. The need to perform emergency surgery has a persistent long-term negative impact both on survival and functional outcome. Medical or endoscopic prevention of stricture is debatable, yet esophageal stents, absorbable or not, show promising data. Dilatation is the first therapeutic option for strictures and bougies should be considered especially for long, multiple and tortuous narrowing. It is crucial to avoid malnutrition, especially in developing countries where management strategies are influenced by malnutrition and poor clinical conditions. Late reconstructive surgery, mainly using colon transposition, offers the best results in referral centers, either in children or adults, but such a difficult surgical procedure is often unavailable in developing countries. Possible late development of esophageal cancer, though probably overemphasized, entails careful and long-term endoscopic screening. PMID:23840136
Contini, Sandro; Scarpignato, Carmelo
Capsule endoscopy (CE) is considered to be a state-of-the-art imaging modality for digest tract diseases detection, especially for small intestine, which is unreachable by traditional endoscopy techniques. However, the large number of images produced by the procedure, about 60,000 images for each examination, cause a time consuming and attention intensive task for physicians, necessitating the development of computer aided detection
Baopu Li; M. Q.-H. Meng
To evaluate the endoscopic and histological changes in upper gastrointestinal tract of patients with chronic renal failure 50 patients and 50 controls were studied. Upper gastrointestinal endoscopy was done and 2 biopsies each were taken from oesophagus, corpus and antrum of the stomach and duodenum. Sections were stained with haematoxylin & eosin, Alcian blue--Periodic acid Schiff's (pH 2.5), and Loeffler's methylene blue stains. Oesophagus was endoscopically normal in most of the patients. Predominant histological finding was chronic oesophagitis which was significantly higher in patients than controls (47.1% Vs 26%; p<0.05). Significantly higher (p<0.001) number of patients had gastritis, oedema and pale mucosa on endoscopic examination of stomach. Predominant histological changes were mucosal oedema (82.35%), gastritis (23.5%) and increase in number of bi- and multinucleated parietal cells with vacuolation and fragmentation of the cytoplasm (29%). Prevalence of H. pylori was less in patients as controls (35.2% Vs 54%; p< 0.01). Endoscopic examination of duodenum mainly showed duodenitis, pale mucosa, oedema and nodularity. Brunner's gland hyperplasia (82.4%), duodenitis (70.6%) and gastric metaplasia (29.4%) were the main histological features. H. pylori was seen in 5.9% cases of gastric metaplasia in duodenum. Patients with CRF have significant upper gastrointestinal tract abnormalities which mainly occur due to metabolic changes in response to high urea concentration in gastric juice and are not related to H. pylori infection. PMID:16295460
Misra, Vatsala; Misra, S P; Shukla, S K; Jaiswal, Pramod Kumar; Agarwal, Ranjan; Tondon, Soniya
Gastrointestinal involvement is frequent in systemic sclerosis (SSc), occurring in 75 to 90% of patients with diffuse or limited cutaneous SSc. Although all regions of the gut may be affected, the esophagus is the most common gastrointestinal localization of this disease. If not diagnosed at an early stage, resulting complications may include esophagitis (leading to stenosis, strictures, and Barrett's esophagus) and increased risk of interstitial lung disease. Esophageal manometry is the most sensitive test for accurate diagnosis of motor dysfunction. Antisecretory agents (mainly proton-pump inhibitors) are effective for treating esophageal manifestations. Gastrointestinal involvement is reported in 50-88% of patients with SSc. It remains associated with a poor prognosis and leads to death in 6 to 12% of cases. Gastrointestinal impairment may lead to life-threatening complications, including severe dyspepsia, hemorrhage related to watermelon stomach (gastric antral vascular ectasia), malabsorption syndrome (related to bacterial overgrowth), and intestinal pseudo-obstruction. Treatment for the latter two remains difficult, although octreotide has proven to be effective in SSc patients. Small bowel manometry is useful for careful selection of SSc patients who will benefit from this treatment. Anorectal involvement is frequent in SSc patients (50-70%) and causes fecal incontinence and rectal prolapse. Other digestive manifestations, including liver impairment, are less common in SSc. PMID:17159722
Gastrointestinal (GI) motility is very frequently disturbed in Parkinson's disease (PD), manifesting chiefly as dysphagia, impaired gastric emptying and constipation. All these symptoms - constipation in particular – may precede the clinical diagnosis of PD for years. In the future, these symptoms might serve as useful early indicators in the premotor stage. Disturbed gastric emptying is an important factor in
Wolfgang H. Jost
International consensus meetings in Padova and Vienna have attempted to rationalise the grading and classification of gastrointestinal epithelial neoplasia (GEN). With its minor adjustments, the Vienna classification of GEN seeks to be more closely in tune with patient management and it is hoped that it is not seen as fiddling around with terms but as a genuine contribution to patient
M F Dixon
There are a myriad of dermatologic disorders asso- ciated with gastrointestinal (GI) diseases. This article covers the common dermatologic conditions that may be associated with underlying GI diseases and several uncommon conditions that the dermatologist should recognize as being associated with GI disor- ders. Table 1 presents an outline of the diseases that are covered. Inflammatory bowel diseases Inflammatory disorders
Erin E. Boh; Raed Mahmoud
Gastrointestinal bleeding in elderly individuals is a frequent cause of consultation with a physician and of hospital admissions. Co-morbidity and greater medication use in this steadily growing patient group influence the clinical course and adversely affect outcome. Clinical presentation is often predictable and guides subsequent patient management. Due to a surprising lack of prospective controlled data in the area of
Thomas Lingenfelser; Christian Ell
Colorectal cancer is a major cause of cancer death. A significant unmet clinical need exists in the area of screening for earlier and more accurate diagnosis and treatment. We have identified a fluorescence imaging agent targeted to an early stage molecular marker for colorectal cancer. The agent is administered intravenously and imaged in a far red imaging channel as an adjunct to white light endoscopy. There is experimental evidence of preclinical proof of mechanism for the agent. In order to assess potential clinical efficacy, imaging was performed with a prototype fluorescence endoscope system designed to produce clinically relevant images. A clinical laparoscope system was modified for fluorescence imaging. The system was optimised for sensitivity. Images were recorded at settings matching those expected with a clinical endoscope implementation (at video frame rate operation). The animal model was comprised of a HCT-15 xenograft tumour expressing the target at concentration levels expected in early stage colorectal cancer. Tumours were grown subcutaneously. The imaging agent was administered intravenously at a dose of 50nmol/kg body weight. The animals were killed 2 hours post administration and prepared for imaging. A 3-4mm diameter, 1.6mm thick slice of viable tumour was placed over the opened colon and imaged with the laparoscope system. A receiver operator characteristic analysis was applied to imaging results. An area under the curve of 0.98 and a sensitivity of 87% [73, 96] and specificity of 100% [93, 100] were obtained.
Healey, A. J.; Bendiksen, R.; Attramadal, T.; Bjerke, R.; Waagene, S.; Hvoslef, A. M.; Johannesen, E.
We present a method for patient-adaptive detection of bleeding region for a Capsule Endoscopy (CE) images. The CE system has 320x320 resolution and transmits 3 images per second to receiver during around 10-hour. We have developed a technique to detect the bleeding automatically utilizing color spectrum transformation (CST) method. However, because of irregular conditions like organ difference, patient difference and illumination condition, detection performance is not uniform. To solve this problem, the detection method in this paper include parameter compensation step which compensate irregular image condition using color balance index (CBI). We have investigated color balance through sequential 2 millions images. Based on this pre-experimental result, we defined ?CBI to represent deviate of color balance compared with standard small bowel color balance. The ?CBI feature value is extracted from each image and used in CST method as parameter compensation constant. After candidate pixels were detected using CST method, they were labeled and examined with a bleeding character. We tested our method with 4,800 images in 12 patient data set (9 abnormal, 3 normal). Our experimental results show the proposed method achieves (before patient adaptive method : 80.87% and 74.25%, after patient adaptive method : 94.87% and 96.12%) of sensitivity and specificity.
Jung, Yun Sub; Kim, Yong Ho; Lee, Dong Ha; Lee, Sang Ho; Song, Jeong Joo; Kim, Jong Hyo
The aim of this research is to propose a small intestine model for electrically propelled capsule endoscopy. The electrical stimulus can cause contraction of the small intestine and propel the capsule along the lumen. The proposed model considered the drag and friction from the small intestine using a thin walled model and Stokes' drag equation. Further, contraction force from the small intestine was modeled by using regression analysis. From the proposed model, the acceleration and velocity of various exterior shapes of capsule were calculated, and two exterior shapes of capsules were proposed based on the internal volume of the capsules. The proposed capsules were fabricated and animal experiments were conducted. One of the proposed capsules showed an average (SD) velocity in forward direction of 2.91 ± 0.99 mm/s and 2.23 ± 0.78 mm/s in the backward direction, which was 5.2 times faster than that obtained in previous research. The proposed model can predict locomotion of the capsule based on various exterior shapes of the capsule.
Interpretations by physicians of capsule endoscopy image sequences captured over periods of 7-8 hours usually require 45 to 120 minutes of extreme concentration. This paper describes a novel method to reduce diagnostic time by automatically controlling the display frame rate. Unlike existing techniques, this method displays original images with no skipping of frames. The sequence can be played at a high frame rate in stable regions to save time. Then, in regions with rough changes, the speed is decreased to more conveniently ascertain suspicious findings. To realize such a system, cue information about the disparity of consecutive frames, including color similarity and motion displacements is extracted. A decision tree utilizes these features to classify the states of the image acquisitions. For each classified state, the delay time between frames is calculated by parametric functions. A scheme selecting the optimal parameters set determined from assessments by physicians is deployed. Experiments involved clinical evaluations to investigate the effectiveness of this method compared to a standard-view using an existing system. Results from logged action based analysis show that compared with an existing system the proposed method reduced diagnostic time to around 32.5 ± minutes per full sequence while the number of abnormalities found was similar. As well, physicians needed less effort because of the systems efficient operability. The results of the evaluations should convince physicians that they can safely use this method and obtain reduced diagnostic times.
Vu, Hai; Echigo, Tomio; Sagawa, Ryusuke; Yagi, Keiko; Shiba, Masatsugu; Higuchi, Kazuhide; Arakawa, Tetsuo; Yagi, Yasushi
Objective To determine whether Medicare managed care penetration impacted the diffusion of endoscopy services (sigmoidoscopy, colonoscopy) among the fee-for-service (FFS) Medicare population during 2001–2006. Methods We model utilization rates for colonoscopy or sigmoidoscopy as impacted by both market supply and demand factors. We use spatial regression to perform ecological analysis of county-area utilization rates over two time intervals (2001–2003–2004–2006) following Medicare benefits expansion in 2001 to cover colonoscopy for persons of average risk. We examine each technology in separate cross-sectional regressions estimated over early and later periods to assess differential effects on diffusion over time. We discuss selection factors in managed care markets and how failure to control perfectly for market selection might impact our managed care spillover estimates. Results Areas with worse socioeconomic conditions have lower utilization rates, especially for colonoscopy. Holding constant statistically the socioeconomic factors, we find that managed care spillover effects onto FFS Medicare utilization rates are negative for colonoscopy and positive for sigmoidoscopy. The spatial lag estimates are conservative and interpreted as a lower bound on true effects. Our findings suggest that managed care presence fostered persistence of the older technology during a time when it was rapidly being replaced by the newer technology.
Subramanian, Sujha; Koschinsky, Julia; Frech, H.E.; Trantham, Laurel Clayton; Anselin, Luc
Gastroesophageal reflux disease (GERD) is a growing problem in the pediatric population and recent advances in diagnostics and therapeutics have improved their management, particularly the use of esophago-gastroduodenoscopy (EGD). Most of the current knowledge is derived from studies in adults; however there are distinct features between infant onset and adult onset GERD. Children are not just little adults and attention must be given to the stages of growth and development and how these stages impact the disease management. Although there is a lack of a gold standard test to diagnose GERD in children, EGD with biopsy is essential to assess the type and severity of tissue damage. To date, the role of endoscopy in adults and children has been to assess the extent of esophagitis and detect metaplastic changes complicating GERD; however the current knowledge points another role for the EGD with biopsy that is to rule out other potential causes of esophagitis in patients with GERD symptoms such as eosinophilic esophagitis. This review highlights special considerations about the role of EGD in the management of children with GERD.
Goldani, Helena AS; Nunes, Daltro LA; Ferreira, Cristina T
The evolution of colon cancer starts with colon polyps. There are two different types of colon polyps, namely hyperplasias and adenomas. Hyperplasias are benign polyps which are known not to evolve into cancer and, therefore, do not need to be removed. By contrast, adenomas have a strong tendency to become malignant. Therefore, they have to be removed immediately via polypectomy. For this reason, a method to differentiate reliably adenomas from hyperplasias during a preventive medical endoscopy of the colon (colonoscopy) is highly desirable. A recent study has shown that it is possible to distinguish both types of polyps visually by means of their vascularization. Adenomas exhibit a large amount of blood vessel capillaries on their surface whereas hyperplasias show only few of them. In this paper, we show the feasibility of computer-based classification of colon polyps using vascularization features. The proposed classification algorithm consists of several steps: For the critical part of vessel segmentation, we implemented and compared two segmentation algorithms. After a skeletonization of the detected blood vessel candidates, we used the results as seed points for the Fast Marching algorithm which is used to segment the whole vessel lumen. Subsequently, features are computed from this segmentation which are then used to classify the polyps. In leave-one-out tests on our polyp database (56 polyps), we achieve a correct classification rate of approximately 90%.
Stehle, Thomas; Auer, Roland; Gross, Sebastian; Behrens, Alexander; Wulff, Jonas; Aach, Til; Winograd, Ron; Trautwein, Christian; Tischendorf, Jens
Despite the increasing use of carbon dioxide for endoscopies during the last years, ambient air is still used. The amount of air depends on several factors such as examination time, presumable diameter of the endoscope channel and of course active use of air by the operator. Although endoscopic complications due to ambient air in the gastrointestinal (GI) tract are a rare observation and mostly described in the colon, we report five cases in the upper GI tract due to insufflating large amounts of air through the endoscopes. All 5 patients needed an emergency upper endoscopy for acute presumed upper GI bleeding. In two cases both esophageal variceal bleeding and ulcer bleeding were detected; the fifth case presented with a bleeding due to gastric cancer. Due to insufflation of inadequate amounts of air through the endoscope channel, all patients deteriorated in circulation and ventilation. Two rumenocenteses and consecutively three laparotomies had to be performed in three patients. In the other two, gastroscopies had to be stopped for an emergency computed tomography. All critical incidents were believed to be a consequence of a long-lasting examination with use of too much air. Therefore in emergency situations, endoscopies should be performed with either submersion, low air flow pumps or even better by the use of carbon dioxide.
Manser, Christine N.; Bauerfeind, Peter; Gubler, Christoph
This paper illustrates the problem of active locomotion in the gastrointestinal tract for endoscopic capsules. Authors analyze the problem of locomotion in unstructured, flexible and tubular environments and explain the reasons leading to the selection of a legged system. They present a theoretical simulation of legged capsule locomotion, which is used to define the optimal parameters for capsule design and gait selection. Finally, a legged capsule--about 3 cm3 in volume--is presented; it consists of 4 back legs whose actuation is achieved thanks to a miniaturized DC brushless motor. In vitro tests demonstrate good performance in terms of achievable speed (92 mm/min). PMID:17946504
Menciassi, Arianna; Stefanini, Cesare; Orlandi, Giovanni; Quirini, Marco; Dario, Paolo
'Submucosal tumors' represent a bulge underneath the mucosa of the gastrointestinal tract whose etiology cannot be determined by gastrointestinal endoscopy or barium studies. Because many of these lesions do not arise from the submucosa, these abnormalities have been recently referred to as subepithelial lesions. The aim of this review was to assess the value of EUS for the diagnosis and management of suspected subepithelial lesions. Endoscopic ultrasound (EUS) is currently considered the investigative procedure of choice when a subepithelial lesion has been detected. EUS can determine the intra- or extramural location of the lesion, can differentiate vascular, cystic and solid lesions, and can characterize the layer(s) of origin or ultrasound characteristics (size, borders, homogeneity, anechoic areas or echogenic foci). EUS cannot differentiate exactly between benign and malignant tumors, but it can guide fine needle aspiration (FNA) biopsy or histologic needle biopsies, thus providing samples for cytology or histological analysis. EUS also offers valuable information on the clinical management, and helps to decide whether a lesion should be consequently followed, removed by endoscopy or by surgery. The introduction of EUS and endoscopic submucosal resection (ESMR) clearly changed the management of small subepithelial lesions (less than 3 cm). A clinical decision algorithm was subsequently developed, taking into consideration the information offered by most of the reviews and case reports. However, further prospective studies will have to establish the value and indications of ESMR (used in association with EUS), for the treatment of subepithelial lesions, as compared to surgery and follow-up. PMID:14502323
S?ftoiu, Adrian; Vilmann, Peter; Ciurea, Tudorel
The purpose of this study was to identify endoscopic and clinical parameters influencing the decision-making in salvage of endoscopically unmanageable, nonvariceal upper gastrointestinal hemorrhage (UGIH) and to report the outcome of selected therapy. We retrospectively retrieved all cases of surgery and arteriography for arrest of endoscopically unmanageable UGIH. Only patients with overt bleeding on endoscopy within the previous 24 h were included. Patients with preceding nonendoscopic hemostatic interventions, portal hypertension, malignancy, and transpapillar bleeding were excluded. Potential clinical and endoscopic predictors of allocation to either surgery or arteriography were tested using statistical models. Outcome and survival were regressed on the choice of rescue and clinical variables. Forty-six arteriographed and 51 operated patients met the inclusion criteria. Univariate analysis revealed a higher number of patients with a coagulation disorder in the catheterization group (41.4%, versus 20.4% in the laparotomy group; p = 0.044). With multivariate analysis, the identification of a bleeding peptic ulcer at endoscopy significantly steered decision-making toward surgical rescue (OR = 5.2; p = 0.021). Taking into account reinterventions, hemostasis was achieved in nearly 90% of cases in both groups. Overall therapy failure (no survivors), rebleeding within 3 days (OR = 3.7; p = 0.042), and corticosteroid use (OR = 5.2; p = 0.017) had a significant negative impact on survival. The odds of dying were not different for embolotherapy or surgery. In conclusion, decision-making was endoscopy-based, with bleeding peptic ulcer significantly directing the choice of rescue toward surgery. Unsuccessful hemostasis and corticosteroid use, but not the choice of rescue, negatively affected outcome.
Defreyne, Luc, E-mail: Luc.Defreyne@UGent.b [Ghent University Hospital, Department of Interventional Radiology (Belgium); Schrijver, Ignace De [Clinique de Flandre, Flandre Imagerie (France); Decruyenaere, Johan [Ghent University Hospital, Department of Intensive Care (Belgium); Maele, Georges Van [Ghent University Hospital, Department of Medical Informatics and Statistics (Belgium); Ceelen, Wim [Ghent University Hospital, Department of Digestive Surgery (Belgium); Looze, Danny De [Ghent University Hospital, Department of Gastroenterology (Belgium); Vanlangenhove, Peter [Ghent University Hospital, Department of Interventional Radiology (Belgium)
AIM: To evaluate the effectiveness of our proposed bowel preparation method for colon capsule endoscopy. METHODS: A pilot, multicenter, randomized controlled trial compared our proposed “reduced volume method” (group A) with the “conventional volume method” (group B) preparation regimens. Group A did not drink polyethylene glycol electrolyte lavage solution (PEG-ELS) the day before the capsule procedure, while group B drank 2 L. During the procedure day, groups A and B drank 2 L and 1 L of PEG-ELS, respectively, and swallowed the colon capsule (PillCam COLON® capsule). Two hours later the first booster of 100 g magnesium citrate mixed with 900 mL water was administered to both groups, and the second booster was administered six hours post capsule ingestion as long as the capsule had not been excreted by that time. Capsule videos were reviewed for grading of cleansing level. RESULTS: Sixty-four subjects were enrolled, with results from 60 analyzed. Groups A and B included 31 and 29 subjects, respectively. Twenty-nine (94%) subjects in group A and 25 (86%) subjects in group B had adequate bowel preparation (ns). Twenty-two (71%) of the 31 subjects in group A excreted the capsule within its battery life compared to 16 (55%) of the 29 subjects in group B (ns). Of the remaining 22 subjects whose capsules were not excreted within the battery life, all of the capsules reached the left side colon before they stopped functioning. A single adverse event was reported in one subject who had mild symptoms of nausea and vomiting one hour after starting to drink PEG-ELS, due to ingesting the PEG-ELS faster than recommended. CONCLUSION: Our proposed reduced volume bowel preparation method for colon capsule without PEG-ELS during the days before the procedure was as effective as the conventional volume method.
Kakugawa, Yasuo; Saito, Yutaka; Saito, Shoichi; Watanabe, Kenji; Ohmiya, Naoki; Murano, Mitsuyuki; Oka, Shiro; Arakawa, Tetsuo; Goto, Hidemi; Higuchi, Kazuhide; Tanaka, Shinji; Ishikawa, Hideki; Tajiri, Hisao
A 17-year-old man was diagnosed as Peutz-Jeghers syndrome (PJS) because of pigmented lip and multiple gastrointestinal polyps. He had anemia and underwent polypectomy on the duodenum and colon. His maternal family members were patients with PJS. His mother used to be screened with endoscopy to remove large polyps. One and half years later, he underwent jejunal segmental resection due to intussusceptions. He underwent endoscopic polypectomy every 2 to 3 years. When he was 23 years old, high-grade dysplasia was found in colonic polyp and his mother underwent partial pancreatectomy due to intraductal papillary mucinous carcinoma. When he was 27 years old, diffuse gastric polyps on the greater curvature of corpus expanded and grew. Therefore, wide endoscopic polypectomy was done. Histological examination revealed focal intramucosal carcinoma and low-grade dysplasia in hamartomatous polyps. We report cases of cancers occurred in first-degree relatives with PJS.
Song, Sang Hee; Kim, Kun Woo; Kim, Won Hee; Kwon, Chang Il; Ko, Kwang Hyun; Hahm, Ki Baik; Park, Pil Won
Traditional medicine is widely practiced in tropical countries. Bottle gourd (Lagenaria siceraria) fruit juice is advocated as a part of complementary and alternative medicine. If the bottle gourd juice becomes bitter it is considered toxic. We report 15 patients, who developed toxicity due to drinking bitter bottle gourd juice. Patients presented with abdominal pain, vomiting, hematemesis, diarrhea and hypotension within 15 min to 6-h after ingestion of bottle gourd juice. Endoscopy showed esophagitis, gastric erosions, ulcers and duodenitis. Hypotension was treated with crystalloids and inotropic support. All patients recovered in 1-4 days. Endoscopically the lesions healed in 2 weeks. Bitter bottle gourd can cause gastrointestinal toxicity with hematemesis and hypotension. Supportive management is the treatment and all patients recover within 1 week. PMID:21986853
Puri, Rajesh; Sud, Randhir; Khaliq, Abdul; Kumar, Mandhir; Jain, Sanjay
OBJECTIVES Colonoscopy is associated with a decreased risk of colorectal cancer but may be more effective in reducing the risk of distal than proximal malignancies. To gain insight into the differences between proximal and distal colon endoscopic performance, we conducted a case-control study of advanced adenomas, the primary targets of colorectal endoscopy screening, and sessile serrated polyps (SSPs), newly recognized precursor lesions for a colorectal cancer subset that occurs most often in the proximal colon. METHODS The Group Health-based study population included: 213 advanced adenoma cases, 172 SSP cases, and 1,704 controls ages 50–79, who received an index colonoscopy from 1998–2007. All participants completed a structured questionnaire covering endoscopy history. Participants with polyps underwent a standard pathology review to confirm the diagnosis and reclassify a subset as advanced adenomas or SSPs. Logistic regression analyses were conducted to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between endoscopy and advanced adenomas and SSPs separately; site-specific analyses were completed. RESULTS Previous endoscopy was associated with decreased risk of advanced adenomas in both the rectum/distal colon (OR=0.38; 95% CI: 0.26–0.56) and proximal colon (OR=0.31; 95% CI: 0.19–0.52), but there was no statistically significant association between prior endoscopy and SSPs (OR=0.80; 95%CI: 0.56–1.13). CONCLUSIONS Our results support the hypothesis that the effect of endoscopy differs between advanced adenomas and SSPs. This may have implications for proximal colon cancer prevention and be due to the failure of endoscopy to detect/remove SSPs, or the hypothesized rapid development of SSPs.
Burnett-Hartman, Andrea N.; Newcomb, Polly A.; Phipps, Amanda I.; Passarelli, Michael N.; Grady, William M.; Upton, Melissa P.; Zhu, Lee-Ching; Potter, John D.
Gastrointestinal (GI) bleeding is a common clinical condition that is increasingly seen in an aging population and frequently requires hospitalization and intervention, with significant morbidity and mortality. Obscure GI bleeding (OGIB) is defined as loss of blood with no source identified after upper endoscopy and colonoscopy. Whether an obscure site of bleeding is clinically evident or silent, it constitutes a diagnostic and therapeutic challenge for the clinician. Gastroenterology and radiology provide the essential diagnostic tools used to evaluate suspected OGIB, each with its strengths and weaknesses. Small bowel series and conventional enteroclysis have a limited role in OGIB. Computed tomographic (CT) enterography and CT enteroclysis are noninvasive techniques with promising results in evaluation of small bowel disease and silent OGIB. CT angiography is a useful triaging tool for diagnosing or excluding active GI hemorrhage, localizing the site of bleeding, and guiding subsequent treatment. Tagged red blood cell scanning is the most sensitive technique for detection of active GI bleeding and allows imaging over a prolonged period, making it useful for detecting intermittent bleeding. Capsule endoscopy has emerged as an important tool for investigating OGIB, but it may soon have competition from double-balloon enteroscopy, a diagnostic technique that can also facilitate therapy. PMID:20083596
Graça, Bruno M; Freire, Paulo A; Brito, Jorge B; Ilharco, José M; Carvalheiro, Vitor M; Caseiro-Alves, Filipe
Subclinical gut inflammation has been described in up to two-thirds of patients with spondyloarthropathies (SpA). Arthritis represents an extra-intestinal manifestation of several gastrointestinal diseases, including inflammatory bowel disease (IBD), Whipple’s disease, Behcet’s disease, celiac disease, intestinal bypass surgery, parasitic infections of the gut and pseudomembranous colitis. Moreover about two-thirds of nonsteroidal anti-inflammatory drug users demonstrate intestinal inflammation. Arthritis may manifest as a peripheral or axial arthritis. The spondyloarthropathy family consists of the following entities: ankylosing spondylitis, undifferentiated spondyloarthritis, reactive arthritis, psoriatic arthritis, spondyloarthritis associated with IBD, juvenile onset spondyloarthritis. This topic reviews the major gastrointestinal manifestations that can occur in patients with SpA and in nonsteroidal anti-inflammatory drugs users.
Orlando, Ambrogio; Renna, Sara; Perricone, Giovanni; Cottone, Mario
Pharmacotherapy of gastrointestinal motor disorders is complicated by the large variety of drug targets and their interactions, the complex relation between contractile patterns and propulsion and the occurrence of regional and species differences. A number of drug classes are discussed: cholinergic agonists/antagonists, dopamine-antagonists, calcium-entry blockers and spasmolytics, serotonin-5-HT4-agonists, cholecystokinin-antagonists, motilin-agonists, 5-HT3-antagonists, opiate agonists, and laxatives. The number of drug classes is increasing rapidly allowing a more specific treatment for the large number of gastrointestinal disorders related to disturbed motility. An interesting new development is the search for compounds interfering with transmitters of the non-adrenergic non-cholinergic nerves of the enteric nervous system a.o. nitric oxide (NO). PMID:7991970
Schuurkes, J A
Systemic sclerosis is a chronic disorder of connective tissue that affects the gastrointestinal tract in more than 80% of\\u000a patients. Changes in neuromuscular function with progressive fibrosis of smooth muscle within the muscularis propria impair\\u000a normal motor function, which may secondarily alter transit and nutrient absorption. Esophageal manifestations with gastroesophageal\\u000a reflux and dysphagia are the most common visceral manifestation of
Robyn Domsic; Kenneth Fasanella; Klaus Bielefeldt