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Sample records for gastrointestinal endoscopy asge

  1. Gastrointestinal endoscopy in pregnancy

    PubMed Central

    Savas, Nurten

    2014-01-01

    Gastrointestinal endoscopy has a major diagnostic and therapeutic role in most gastrointestinal disorders; however, limited information is available about clinical efficacy and safety in pregnant patients. The major risks of endoscopy during pregnancy include potential harm to the fetus because of hypoxia, premature labor, trauma and teratogenesis. In some cases, endoscopic procedures may be postponed until after delivery. When emergency or urgent indications are present, endoscopic procedures may be considered with some precautions. United States Food and Drug Administration category B drugs may be used in low doses. Endoscopic procedures during pregnancy may include upper gastrointestinal endoscopy, percutaneous endoscopic gastrostomy, sigmoidoscopy, colonoscopy, enteroscopy of the small bowel or video capsule endoscopy, endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography. All gastrointestinal endoscopic procedures in pregnant patients should be performed in hospitals by expert endoscopists and an obstetrician should be informed about all endoscopic procedures. The endoscopy and flexible sigmoidoscopy may be safe for the fetus and pregnant patient, and may be performed during pregnancy when strong indications are present. Colonoscopy for pregnant patients may be considered for strong indications during the second trimester. Although therapeutic endoscopic retrograde cholangiopancreatography may be considered during pregnancy, this procedure should be performed only for strong indications and attempts should be made to minimize radiation exposure. PMID:25386072

  2. [Gastrointestinal endoscopy and infection].

    PubMed

    Boudabbous, Mona; Amouri, Ali; Mnif, Leila; Tahri, Nabil

    2010-09-01

    During a gastrointestinal endoscopy, the device crosses natural cavities with always commensal bacterial flora, sometimes pathogenic flora. In all cases, the device is contaminated after the exam. The lack of effective disinfection exposes to the risks of transmission of germs. The infectious risk depends on the patient, the endoscopic procedure as well as on the technique of disinfection. The bacteraemia is usually not clinically significant. The endoscopic transmission of the germs from a patient to another one is very rare and is mostly due to a defect of disinfection. The procedures for disinfecting equipment should be known, established and controlled. PMID:20430569

  3. ASGE Bariatric Endoscopy Task Force systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting endoscopic bariatric therapies.

    PubMed

    Abu Dayyeh, Barham K; Kumar, Nitin; Edmundowicz, Steven A; Jonnalagadda, Sreenivasa; Larsen, Michael; Sullivan, Shelby; Thompson, Christopher C; Banerjee, Subhas

    2015-09-01

    The increasing global burden of obesity and its associated comorbidities has created an urgent need for additional treatment options to fight this pandemic. Endoscopic bariatric therapies (EBTs) provide an effective and minimally invasive treatment approach to obesity that would increase treatment options beyond surgery, medications, and lifestyle measures. This systematic review and meta-analysis were performed by the American Society for Gastrointestinal Endoscopy (ASGE) Bariatric Endoscopy Task Force comprising experts in the subject area and the ASGE Technology Committee Chair to specifically assess whether acceptable performance thresholds outlined by an ASGE Preservation and Incorporation of Valuable endoscopic Innovations (PIVI) document for clinical adoption of available EBTs have been met. After conducting a comprehensive search of several English-language databases, we performed direct meta-analyses by using random-effects models to assess whether the Orbera intragastric balloon (IGB) (Apollo Endosurgery, Austin, Tex) and the EndoBarrier duodenal-jejunal bypass sleeve (DJBS) (GI Dynamics, Lexington, Mass) have met the PIVI thresholds. The meta-analyses results indicate that the Orbera IGB meets the PIVI thresholds for both primary and nonprimary bridge obesity therapy. Based on a meta-analysis of 17 studies including 1683 patients, the percentage of excess weight loss (%EWL) with the Orbera IGB at 12 months was 25.44% (95% confidence interval [CI], 21.47%-29.41%) (random model) with a mean difference in %EWL over controls of 26.9% (95% CI, 15.66%-38.24%; P ? .01) in 3 randomized, controlled trials. Furthermore, the pooled percentage of total body weight loss (% TBWL) after Orbera IGB implantation was 12.3% (95% CI, 7.9%–16.73%), 13.16% (95% CI, 12.37%–13.95%), and 11.27% (95% CI, 8.17%–14.36%) at 3, 6, and 12 months after implantation, respectively, thus exceeding the PIVI threshold of 5% TBWL for nonprimary (bridge) obesity therapy. With the data available, the DJBS liner does appear to meet the %EWL PIVI threshold at 12 months, resulting in 35% EWL (95% CI, 24%-46%) but does not meet the 15% EWL over control required by the PIVI. We await review of the pivotal trial data on the efficacy and safety of this device. Data are insufficient to evaluate PIVI thresholds for any other EBT at this time. Both evaluated EBTs had ?5% incidence of serious adverse events as set by the PIVI document to indicate acceptable safety profiles. Our task force consequently recognizes the Orbera IGB for meeting the PIVI criteria for the management of obesity. As additional data from the other EBTs become available, we will update our recommendations accordingly. PMID:26232362

  4. Clinical Endoscopy as One of Leading Journals in Gastrointestinal Endoscopy

    PubMed Central

    Kwon, Kwang An; Choi, Il Ju; Ryu, Ji Kon; Kim, Eun Young

    2015-01-01

    Clinical Endoscopy (CE) is an official open access journal published bimonthly by the Korean Society of Gastrointestinal Endoscopy (KSGE, http://www.gie.or.kr) and is listed on PMC, PubMed and SCOPUS. The KSGE was established on August 14, 1976, and the journal of the KSGE was published in Korean for the first time in November 1981. The journal was then titled the "Korean Journal of Gastrointestinal Endoscopy" and was published in Korean untill the July 2011 issue. The journal was published in English from the September 2011 issue under the official title of CE. In this review, the past and present of CE are discussed and future perspectives are introduced. In addition, the efforts to progress to a "first come, first served journal" in the field of gastrointestinal endoscopy and to be indexed in Science Citation Index will be described. PMID:26240805

  5. Endoscopy for Nonvariceal Upper Gastrointestinal Bleeding

    PubMed Central

    Kim, Ki Bae; Youn, Sei Jin

    2014-01-01

    Endoscopy for acute nonvariceal upper gastrointestinal bleeding plays an important role in primary diagnosis and management, particularly with respect to identification of high-risk stigmata lesions and to providing endoscopic hemostasis to reduce the risk of rebleeding and mortality. Early endoscopy, defined as endoscopy within the first 24 hours after presentation, improves patient outcome and reduces the length of hospitalization when compared with delayed endoscopy. Various endoscopic hemostatic methods are available, including injection therapy, mechanical therapy, and thermal coagulation. Either single treatment with mechanical or thermal therapy or a treatment that combines more than one type of therapy are effective and safe for peptic ulcer bleeding. Newly developed methods, such as Hemospray powder and over-the-scope clips, may provide additional options. Appropriate decisions and specific treatment are needed depending upon the conditions. PMID:25133117

  6. Utilisation of magnets to enhance gastrointestinal endoscopy.

    PubMed

    Rahman, Imdadur; Patel, Praful; Boger, Philip; Thomson, Mike; Afzal, Nadeem Ahmad

    2015-12-25

    Methods to assess, access and treat pathology within the gastrointestinal tract continue to evolve with video endoscopy replacing radiology as the gold standard. Whilst endoscope technology develops further with the advent of newer higher resolution chips, an array of adjuncts has been developed to enhance endoscopy in other ways; most notable is the use of magnets. Magnets are utilised in many areas, ranging from endoscopic training, lesion resection, aiding manoeuvrability of capsule endoscopes, to assisting in easy placement of tubes for nutritional feeding. Some of these are still at an experimental stage, whilst others are being increasingly incorporated in our everyday practice. PMID:26722611

  7. Utilisation of magnets to enhance gastrointestinal endoscopy

    PubMed Central

    Rahman, Imdadur; Patel, Praful; Boger, Philip; Thomson, Mike; Afzal, Nadeem Ahmad

    2015-01-01

    Methods to assess, access and treat pathology within the gastrointestinal tract continue to evolve with video endoscopy replacing radiology as the gold standard. Whilst endoscope technology develops further with the advent of newer higher resolution chips, an array of adjuncts has been developed to enhance endoscopy in other ways; most notable is the use of magnets. Magnets are utilised in many areas, ranging from endoscopic training, lesion resection, aiding manoeuvrability of capsule endoscopes, to assisting in easy placement of tubes for nutritional feeding. Some of these are still at an experimental stage, whilst others are being increasingly incorporated in our everyday practice. PMID:26722611

  8. Efficiency of upper gastrointestinal endoscopy in pediatric surgical practice.

    PubMed

    Temiz, Abdulkerim

    2015-11-01

    After the introduction of flexible fiber optic endoscopy to pediatric gastroenterology in the 1970s, upper gastrointestinal (UGI) endoscopy can be performed for the diagnosis and treatment of all age groups of children. We review indications, contraindications, preparation of patients for the procedure, and details of diagnostic and therapeutic UGI endoscopy used in pediatric surgery. We also discuss potential complications of endoscopy. PMID:26566483

  9. Efficiency of upper gastrointestinal endoscopy in pediatric surgical practice

    PubMed Central

    Temiz, Abdulkerim

    2015-01-01

    After the introduction of flexible fiber optic endoscopy to pediatric gastroenterology in the 1970s, upper gastrointestinal (UGI) endoscopy can be performed for the diagnosis and treatment of all age groups of children. We review indications, contraindications, preparation of patients for the procedure, and details of diagnostic and therapeutic UGI endoscopy used in pediatric surgery. We also discuss potential complications of endoscopy. PMID:26566483

  10. Guidelines for Safety in the Gastrointestinal Endoscopy Unit

    PubMed Central

    Calderwood, Audrey H.; Chapman, Frank J.; Cohen, Jonathan; Cohen, Lawrence B.; Collins, James; Day, Lukejohn W.; Early, Dayna S.

    2014-01-01

    EXECUTIVE SUMMARY Historically, safety in the gastrointestinal (GI) endoscopy unit has focused on infection control, particularly around the reprocessing of endoscopes. Two highly publicized outbreaks where the transmission of infectious agents were related to GI endoscopy have highlighted the need to address potential gaps along the endoscopy care continuum that could impact patient safety. PMID:24485393

  11. Inhaled sevoflurane for lower gastrointestinal endoscopy with possible propofol anaphylaxis

    PubMed Central

    Ye, Ling; Liu, Yun-Fei; Zhu, Tao

    2014-01-01

    Sedation with propofol is widely used for the outpatient examination. Although anaphylaxis to propofol is rare, there were some reports of anaphylaxis following propofol administration. We present a case of female patient under sedation for lower gastrointestinal endoscopy with possible propofol anaphylaxis. Then sevoflurane was successfully used for the examination and the following surgery. We discussed the possible feasibility of sevoflurane for the examination of lower gastrointestinal endoscopy. Propofol is widely used for the sedation of outpatient with lower gastrointestinal endoscopy. But it may cause some allergic reaction. Inhaled sevoflurane may provide a satisfactory and safe alternative for adult outpatients’ endoscopy. PMID:25419408

  12. Time to endoscopy and outcomes in upper gastrointestinal bleeding

    PubMed Central

    Sarin, Nitin; Monga, Neerav; Adams, Paul C

    2009-01-01

    BACKGROUND Upper gastrointestinal bleeding (UGIB) is a common problem associated with significant morbidity and mortality. Previous studies show that immediate endoscopies do not affect outcomes in patients; however, endoscopic interventions have evolved. The present retrospective review of endoscopies performed at a large teaching hospital assessed the timing of endoscopy with respect to the morbidity and mortality of UGIB. METHODS Diagnostic billing codes were used to assess all inpatients of gastroenterologists at the University Hospital of the London Health Sciences Centre, London, Ontario, from July 2004 to June 2006, using a centralized data recording system. Time to endoscopy (within 6 h, 6 h to 24 h and beyond 24 h) were compared for the outcomes of mortality, need for surgery and transfusion requirements. RESULTS From July 2004 to June 2006, there were 502 upper endoscopies performed for the indication of suspected UGIB and 375 for overt acute nonvariceal UGIB. Approximately 10% of cases revealed variceal bleeding. When comparing endoscopy within 6 h with endoscopy at 6 h to 24 h, there were no significant differences in mortality, need for surgery (OR 3.6 and 2.8, respectively, compared with endoscopy beyond 24 h) or transfusion requirements. Even when assessing the group that received endoscopic hemostasis, time to endoscopy was not associated with better outcomes. Multivariate analysis did not demonstrate any advantages for early endoscopy (less than 6 h) compared with endoscopy within 24 h. CONCLUSIONS Most patients with acute gastrointestinal bleeding can be effectively managed with endoscopy within 24 h. PMID:19623332

  13. Sedation-related complications in gastrointestinal endoscopy

    PubMed Central

    Amornyotin, Somchai

    2013-01-01

    Sedation practices for gastrointestinal endoscopic (GIE) procedures vary widely in different countries depending on health system regulations and local circumstances. 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-related complications in gastrointestinal endoscopy, once occurred, can lead to significant morbidity and occasional mortality in patients. The risk factors of these complications include the type, dose and mode of administration of sedative agents, as well as the patient’s age and underlying medical diseases. Complications attributed to moderate and deep sedation levels are more often associated with cardiovascular and respiratory systems. However, sedation-related complications during GIE procedures are commonly transient and of a mild degree. The risk for these complications while providing any level of sedation is greatest when caring for patients already medically compromised. Significant unwanted complications can generally be prevented by careful pre-procedure assessment and preparation, appropriate monitoring and support, as well as post-procedure management. Additionally, physicians must be prepared to manage these complications. This article will review sedation-related complications during moderate and deep sedation for GIE procedures and also address their appropriate management. PMID:24255744

  14. Wireless capsule endoscopy: Perspectives beyond gastrointestinal bleeding

    PubMed Central

    Redondo-Cerezo, Eduardo; Sánchez-Capilla, Antonio Damián; De La Torre-Rubio, Paloma; De Teresa, Javier

    2014-01-01

    Wireless capsule endoscopy (CE) is a technology developed for the endoscopic exploration of the small bowel. The first capsule model was approved by the Food and Drug Administration in 2001, and its first and essential indication was occult gastrointestinal (GI) bleeding. Over subsequent years, this technology has been refined to provide superior resolution, increased battery life, and capabilities to view different parts of the GI tract. Indeed, cases for which CE proved useful have increased significantly over the last few years, with new indications for the small bowel and technical improvements that have expanded its use to other parts of the GI tract, including the esophagus and colon. The main challenges in the development of CE are new devices with the ability to provide therapy, air inflation for a better vision of the small bowel, biopsy sampling systems attached to the capsule and the possibility to guide and move the capsule with an external motion control. In this article we review the current and new indications of CE, and the evolving technological changes shaping this technology, which has a promising potential in the coming future of gastroenterology. PMID:25400450

  15. Therapeutic upper gastrointestinal tract endoscopy in Paediatric Gastroenterology

    PubMed Central

    Rahman, Imdadur; Patel, Praful; Boger, Philip; Rasheed, Shahnawaz; Thomson, Mike; Afzal, Nadeem Ahmad

    2015-01-01

    Since the first report of use of endoscopy in children in the 1970s, there has seen an exponential growth in published experience and innovation in the field. In this review article we focus on modern age therapeutic endoscopy practice, explaining use of traditional as well as new and innovative techniques, for diagnosis and treatment of diseases in the paediatric upper gastrointestinal tract. PMID:25789087

  16. A design of hardware haptic interface for gastrointestinal endoscopy simulation.

    PubMed

    Gu, Yunjin; Lee, Doo Yong

    2011-01-01

    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

  17. Computer vision and augmented reality in gastrointestinal endoscopy.

    PubMed

    Mahmud, Nadim; Cohen, Jonah; Tsourides, Kleovoulos; Berzin, Tyler M

    2015-08-01

    Augmented reality (AR) is an environment-enhancing technology, widely applied in the computer sciences, which has only recently begun to permeate the medical field. Gastrointestinal endoscopy-which relies on the integration of high-definition video data with pathologic correlates-requires endoscopists to assimilate and process a tremendous amount of data in real time. We believe that AR is well positioned to provide computer-guided assistance with a wide variety of endoscopic applications, beginning with polyp detection. In this article, we review the principles of AR, describe its potential integration into an endoscopy set-up, and envisage a series of novel uses. With close collaboration between physicians and computer scientists, AR promises to contribute significant improvements to the field of endoscopy. PMID:26133175

  18. Computer vision and augmented reality in gastrointestinal endoscopy

    PubMed Central

    Mahmud, Nadim; Cohen, Jonah; Tsourides, Kleovoulos; Berzin, Tyler M.

    2015-01-01

    Augmented reality (AR) is an environment-enhancing technology, widely applied in the computer sciences, which has only recently begun to permeate the medical field. Gastrointestinal endoscopy—which relies on the integration of high-definition video data with pathologic correlates—requires endoscopists to assimilate and process a tremendous amount of data in real time. We believe that AR is well positioned to provide computer-guided assistance with a wide variety of endoscopic applications, beginning with polyp detection. In this article, we review the principles of AR, describe its potential integration into an endoscopy set-up, and envisage a series of novel uses. With close collaboration between physicians and computer scientists, AR promises to contribute significant improvements to the field of endoscopy. PMID:26133175

  19. Sedation Practice Outside the Operating Room for Pediatric Gastrointestinal Endoscopy.

    PubMed

    Isik, Ishak A; Iyilikci, Leyla; Ozturk, Yesim; Adiyaman, Esma

    2015-11-01

    Medical records of the 575 children who underwent gastrointestinal endoscopy outside the operating room were investigated retrospectively. The most frequently used combinations were propofol-midazolam-fentanyl in 83.2% of the procedures and propofol-midazolam in 13.8% of the procedures. 24 (3.4%) of 703 procedures had complications due to sedation anesthesia; 11 had hypoxia and 8 had pain in the injection area. Sedation anesthesia practice provided by an anesthesiologist outside the operating room enables gastrointestional endoscopic procedures to be carried out more safely. PMID:26615354

  20. Introduction to Starting Upper Gastrointestinal Endoscopy: Proper Insertion, Complete Observation, and Appropriate Photographing

    PubMed Central

    2015-01-01

    Diagnostic upper gastrointestinal endoscopy is the most basic of endoscopy procedures and is the technique that trainee doctors first learn. Mastering the basics of endoscopy is very important because when this process is imprecise or performed incorrectly, it can severely affect a patient's health or life. Although there are several guidelines and studies that consider these basics, there are still no standard recommendations for endoscopy in Korea. In this review, basic points, including proper endoscope insertion, precise observation without blind spots, and appropriate photographing, for upper gastrointestinal endoscopy will be discussed. PMID:26240799

  1. Non-anesthesiologist administration of propofol for gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates Guideline - Updated June 2015.

    PubMed

    Dumonceau, Jean-Marc; Riphaus, Andrea; Schreiber, Florian; Vilmann, Peter; Beilenhoff, Ulrike; Aparicio, Jose R; Vargo, John J; Manolaraki, Maria; Wientjes, Caroline; Rácz, István; Hassan, Cesare; Paspatis, Gregorios

    2015-12-01

    This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA). It addresses the administration of propofol by non-anesthesiologists for gastrointestinal (GI) endoscopy. Main Recommendations 1 We recommend that the type of endoscopic procedure and the patient's American Society of Anesthesiologists (ASA) physical status, age, body mass index, Mallampati's classification, and risk factors for obstructive sleep apnea (OSA) be assessed before each procedure with non-anesthesiologist administration of propofol (NAAP) (strong recommendation, moderate quality evidence). 2 We suggest primary involvement of an anesthesiologist in patients of ASA class ??3, with a Mallampati's class ??3 or other conditions that put them at risk of airway obstruction (e.?g. pharyngolaryngeal tumors), in patients who chronically receive significant amounts of narcotic analgesics, or in cases where a long-lasting procedure is anticipated (weak recommendation, low quality evidence). 3 We suggest consideration of capnographic monitoring during NAAP in specific situations including high risk patients, intended deep sedation, and long procedures (weak recommendation, high quality evidence). 4 We suggest propofol monotherapy except in particular situations (weak recommendation, high quality evidence). 5 We recommend administering propofol through intermittent bolus infusion or perfusor systems, including target-controlled infusion (TCI), and consideration of patient-controlled sedation (PCS) in particular situations (strong recommendation, high quality evidence). 6 We suggest that patients listen to self-selected music during upper and lower GI endoscopy procedures (weak recommendation, moderate quality evidence). 7 We do not suggest using pharyngeal anesthesia during propofol sedation for upper GI endoscopy (weak recommendation, moderate quality evidence). 8 We suggest using the post-anesthetic discharge scoring system (PADSS) to determine when patient recovery is sufficient to allow discharge (weak recommendation, low quality evidence). 9 Minimum discharge criteria should be fulfilled before discharging a patient. We recommend that patients who have received combined regimens, and all patients of ASA class >?2, should upon discharge be accompanied by a responsible person and refrain for 24 hours from driving, drinking alcohol, operating heavy machinery, or engaging in legally binding decisions. Advice should be provided verbally and in written form to the patient, including a 24-hour contact phone number (strong recommendation, low quality evidence). 10 For patients of ASA classes 1?-?2 who have received low dose propofol monotherapy, a 6-hour limit is suggested (weak recommendation, low quality evidence). PMID:26561915

  2. Nonvariceal Upper Gastrointestinal Bleeding: Timing of Endoscopy and Ways to Improve Endoscopic Visualization.

    PubMed

    Khamaysi, Iyad; Gralnek, Ian M

    2015-07-01

    Upper gastrointestinal (UGI) endoscopy is the cornerstone of diagnosis and management of patients presenting with acute UGI bleeding. Once hemodynamically resuscitated, early endoscopy (performed within 24 hours of patient presentation) ensures accurate identification of the bleeding source, facilitates risk stratification based on endoscopic stigmata, and allows endotherapy to be delivered where indicated. Moreover, the preendoscopy use of a prokinetic agent (eg, i.v. erythromycin), especially in patients with a suspected high probability of having blood or clots in the stomach before undergoing endoscopy, may result in improved endoscopic visualization, a higher diagnostic yield, and less need for repeat endoscopy. PMID:26142030

  3. Highlights from the 52nd Seminar of the Korean Society of Gastrointestinal Endoscopy

    PubMed Central

    Kim, Eun Young; Choi, Il Ju; Kwon, Kwang An; Ryu, Ji Kon

    2015-01-01

    In this July issue of Clinical Endoscopy, state-of-the-art articles selected from the lectures delivered during the 52nd Seminar of the Korean Society of Gastrointestinal Endoscopy (KSGE) on March 29, 2015 are covered, focusing on highlighted educational contents relevant to either diagnostic or therapeutic gastrointestinal (GI) endoscopy. Our society, the KSGE, has continued to host this opportunity for annual seminars twice a year over the last 26 years and it has become a large-scale prestigious seminar accommodating over 4,000 participants. Definitely, the KSGE seminar is considered as one of the premier state-of-the-art seminars dealing with GI endoscopy, appealing to both the beginner and advanced experts. Lectures, live demonstrations, hands-on courses, as well as an editor school, which was an important consensus meeting on how to upgrade our society journal, Clinical Endoscopy, to a Science Citation Index (Expanded) designation were included in this seminar. The 52nd KSGE seminar consisted of more than 20 sessions, including special lectures, concurrent sessions for GI endoscopy nurses, and sessions exploring new technologies. This is a very special omnibus article to highlight the core contents divided into four sessions: upper GI tract, lower GI tract, pancreatobiliary system, and other specialized sessions. PMID:26240798

  4. Studying and Incorporating Efficiency into Gastrointestinal Endoscopy Centers

    PubMed Central

    Day, Lukejohn W.; Belson, David

    2015-01-01

    Efficiency is defined as the use of resources in such a way as to maximize the production of goods and services. Improving efficiency has been the focus of management in many industries; however, it has not been until recently that incorporating efficiency models into healthcare has occurred. In particular, the study and development of improvement projects aimed at enhancing efficiency in GI have been growing rapidly in recent years. This focus on improving efficiency in GI has been spurred by the dramatic rise in the demand for endoscopic procedures as well as the rising number of insured patients requiring GI care coupled at the same time with limited resources in terms of staffing and space in endoscopy centers. This paper will critically review the history of efficiency in endoscopy centers, first by looking at other healthcare industries that have extensively studied and improved efficiency in their fields, examine a number of proposed efficiency metrics and benchmarks in endoscopy centers, and finally discuss opportunities where endoscopy centers could improve their efficiency. PMID:26101525

  5. Capsule Endoscopy in the Assessment of Obscure Gastrointestinal Bleeding: An Economic Analysis

    PubMed Central

    Palimaka, S; Blackhouse, Gord; Goeree, Ron

    2015-01-01

    Background Small-bowel capsule endoscopy is a tool used to visualize the small bowel to identify the location of bleeds in obscure gastrointestinal bleeding (OGIB). Capsule endoscopy is currently funded in Ontario in cases where there has been a failure to identify a source of bleeding via conventional diagnostic procedures. In Ontario, capsule endoscopy is a diagnostic option for patients whose findings on esophagogastroduodenoscopy, colonoscopy, and push enteroscopy have been negative (i.e., the source of bleeding was not found). Objectives This economic analysis aims to estimate the budget impact of different rates of capsule endoscopy use as a complement to push enteroscopy procedures in patients aged 18 years and older. Data Sources Population-based administrative databases for Ontario were used to identify patients receiving push enteroscopy and small-bowel capsule endoscopy in the fiscal years 2008 to 2012. Review Methods A systematic literature search was performed to identify economic evaluations of capsule endoscopy for the investigation of OGIB. Studies were assessed for their methodological quality and their applicability to the Ontarian setting. An original budget impact analysis was performed using data from Ontarian administrative sources and published literature. The budget impact was estimated for different levels of use of capsule endoscopy as a complement to push enteroscopy due to the uncertain clinical utility of the capsule based on current clinical evidence. The analysis was conducted from the provincial public payer perspective. Results With varying rates of capsule endoscopy use, the budgetary impact spans from savings of $510,000,1 when no (0%) push enteroscopy procedures are complemented with capsule endoscopy, to $2,036,000, when all (100%) push enteroscopy procedures are complemented with capsule endoscopy. A scenario where 50% of push enteroscopy procedures are complemented with capsule endoscopy (expected use based on expert opinion) would result in additional expenditure of about $763,000. Limitations In the literature on OGIB, estimates of rebleeding rates after endoscopic procedures or spontaneous cessation rates are unreliable, with a lack of data. Rough estimates from expert consultation can provide an indication of expected additional use of capsule endoscopy; however, a wide range of capsule uses was explored. Conclusions The budgetary impact in the first year in Ontario of capsule endoscopy use to complement push enteroscopy procedures ranges from $510,000 in savings to an additional expenditure of $2,036,000 (at 0% and 100% push enteroscopy procedures complemented, respectively). The expected scenario of 50% of push enteroscopy procedures likely to benefit from the use of capsule endoscopy, based on expert opinion, would result in additional expenditures of $763,000 in the first year. PMID:26355732

  6. [Videocapsule endoscopy used for diagnosis of Henoch-Schönlein purpura with gastrointestinal complications].

    PubMed

    Sivayogajeyam, Sivakaran; Christensen, Kent Dencker

    2013-09-16

    Henoch-Schönlein purpura (HSP) is primarily a childhood disease and is less common in adults where the incidence varies from 3.4 to 14.3 cases per million. We describe a case of adult HSP and discuss the role of videocapsule endoscopy, which is a non-invasive and safe method to evaluate the typical mucosa changes in especially small bowel. Medical doctors should be aware of HSP in adults and pay attention to the fact that in an unusual presentation with gastrointestinal manifestation videocapsule endoscopy may play a safe diagnostic role. PMID:24044543

  7. The European Society of Gastrointestinal Endoscopy Quality Improvement Initiative: developing performance measures.

    PubMed

    Rutter, Matthew D; Senore, Carlo; Bisschops, Raf; Domagk, Dirk; Valori, Roland; Kaminski, Michal F; Spada, Cristiano; Bretthauer, Michael; Bennett, Cathy; Bellisario, Cristina; Minozzi, Silvia; Hassan, Cesare; Rees, Colin; Dinis-Ribeiro, Mário; Hucl, Tomas; Ponchon, Thierry; Aabakken, Lars; Fockens, Paul

    2016-01-01

    The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) have a vision to create a thriving community of endoscopy services across Europe, collaborating with each other to provide high quality, safe, accurate, patient-centered and accessible endoscopic care. Whilst the boundaries of what can be achieved by advanced endoscopy are continually expanding, we believe that one of the most fundamental steps to achieving our goal is to raise the quality of everyday endoscopy. The development of robust, consensus- and evidence-based key performance measures is the first step in this vision.ESGE and UEG have identified quality of endoscopy as a major priority. This paper explains the rationale behind the ESGE Quality Improvement Initiative and describes the processes that were followed. We recommend that all units develop mechanisms for audit and feedback of endoscopist and service performance using the ESGE performance measures that will be published in future issues of this journal over the next year. We urge all endoscopists and endoscopy services to prioritize quality and to ensure that these performance measures are implemented and monitored at a local level, so that we can provide the highest possible care for our patients. PMID:26662057

  8. Role of endoscopy in management of gastrointestinal complications of portal hypertension

    PubMed Central

    Luigiano, Carmelo; Iabichino, Giuseppe; Judica, Antonino; Virgilio, Clara; Peta, Valentina; Abenavoli, Ludovico

    2015-01-01

    The management of patients with gastrointestinal complications of portal hypertension is often complex and challenging. The endoscopy plays an important role in the management of these patients. The role of endoscopy is both diagnostic and interventional and in the last years the techniques have undergone a rapid expansion with the advent of different and novel endoscopic modalities, with consequent improvement of investigation and treatment of these patients. The choice of best therapeutic strategy depends on many factors: baseline disease, patient’s clinical performance and the timing when it is done if in emergency or a prophylactic approaches. In this review we evaluate the endoscopic management of patients with the gastrointestinal complications of portal hypertension. PMID:25610530

  9. Review on sedation for gastrointestinal tract endoscopy in children by non-anesthesiologists

    PubMed Central

    Orel, Rok; Brecelj, Jernej; Dias, Jorge Amil; Romano, Claudio; Barros, Fernanda; Thomson, Mike; Vandenplas, Yvan

    2015-01-01

    AIM: To present evidence and formulate recommendations for sedation in pediatric gastrointestinal (GI) endoscopy by non-anesthesiologists. METHODS: The databases MEDLINE, Cochrane and EMBASE were searched for the following keywords “endoscopy, GI”, “endoscopy, digestive system” AND “sedation”, “conscious sedation”, “moderate sedation”, “deep sedation” and “hypnotics and sedatives” for publications in English restricted to the pediatric age. We searched additional information published between January 2011 and January 2014. Searches for (upper) GI endoscopy sedation in pediatrics and sedation guidelines by non-anesthesiologists for the adult population were performed. RESULTS: From the available studies three sedation protocols are highlighted. Propofol, which seems to offer the best balance between efficacy and safety is rarely used by non-anesthesiologists mainly because of legal restrictions. Ketamine and a combination of a benzodiazepine and an opioid are more frequently used. Data regarding other sedatives, anesthetics and adjuvant medications used for pediatric GI endoscopy are also presented. CONCLUSION: General anesthesia by a multidisciplinary team led by an anesthesiologist is preferred. The creation of sedation teams led by non-anesthesiologists and a careful selection of anesthetic drugs may offer an alternative, but should be in line with national legislation and institutional regulations. PMID:26240691

  10. Endoscopy and antiplatelet agents. European Society of Gastrointestinal Endoscopy (ESGE) Guideline.

    PubMed

    Boustière, C; Veitch, A; Vanbiervliet, G; Bulois, P; Deprez, P; Laquiere, A; Laugier, R; Lesur, G; Mosler, P; Nalet, B; Napoleon, B; Rembacken, B; Ajzenberg, N; Collet, J P; Baron, T; Dumonceau, J-M

    2011-05-01

    With the increasing use of antiplatelet agents (APA), their management during the periendoscopic period has become a more common and more difficult problem. The increase in use is due to the availability of new drugs and the widespread use of drug-eluting coronary stents. Acute coronary syndromes can occur when APA therapy is withheld for noncardiovascular interventions. Guidelines about APA management during the periendoscopic period are traditionally based on assessments of the procedure-related risk of bleeding and the risk of thrombosis if APA are stopped. New data allow better assessment of these risks, of the necessary duration of APA discontinuation before endoscopy, of the use of alternative procedures (mostly for endoscopic retrograde cholangiopancreatography [ERCP]), and of endoscopic methods that can be used to prevent bleeding (following colonic polypectomy). This guideline makes graded, evidence-based, recommendations for the management of APA for all currently performed endoscopic procedures. A short summary and two tables are included for quick reference. PMID:21547880

  11. Our results of lower gastrointestinal endoscopy: evaluation of 700 patients

    PubMed Central

    Özsoy, Mustafa; Celep, Bahad?r; Ersen, Ogun; Özkececi, Taner; Bal, Ahmet; Y?lmaz, Sezgin; Ar?kan, Yüksel

    2014-01-01

    Objective: Although radiological imaging modalities like barium enema and computed tomography provide some clues, endoscopic methods still maintain superiority in assessment and differential diagnosis of large intestinal symptoms and complaints that require biopsy. We aimed to present the results of colonoscopic procedures performed in our general surgery clinic in detail. Material and Methods: Seven hundred patients who presented to Afyon Kocatepe University, Faculty of Medicine, Department of General Surgery Endoscopy Unit between January 2011 and July 2012 with an indication for colonoscopy were retrospectively evaluated. Results: Out of the 700 patients enrolled in the study 356 (50.8%) were male while 344 patients (49.2%) were female. The mean age of the patients was found to be 49 years. Within the group of 700 patients who underwent colonoscopic examinations, the terminal ileum and cecum have been reached on the first attempt in 432 patients (61.7%) and colonoscopic success has been achieved. Results of colonoscopies performed on 700 patients in our clinic revealed malignancy in 42 (6%) patients, and all of these patients were treated surgically in our clinic. Mortality was not observed in this series. Procedure-related bleeding and perforation developed in 6 patients. One patient developed respiratory arrest due to sedation and patient was responsive to resuscitation. The complication rate in our series was 1%. Conclusion: In the study where we revised our own clinical experience, we found that our success rate was lower than the literature, and our complication rate was higher. The main reasons are accepted as our colonoscopy unit’s being young and the low patient volume. PMID:25931898

  12. Capsule Endoscopy in the Assessment of Obscure Gastrointestinal Bleeding: An Evidence-Based Analysis

    PubMed Central

    2015-01-01

    Background Obscure gastrointestinal bleeding (OGIB) is defined as persistent or recurrent bleeding associated with negative findings on upper and lower gastrointestinal (GI) endoscopic evaluations. The diagnosis and management of patients with OGIB is particularly challenging because of the length and complex loops of the small intestine. Capsule endoscopy (CE) is 1 diagnostic modality that is used to determine the etiology of bleeding. Objectives The objective of this analysis was to review the diagnostic accuracy, safety, and impact on health outcomes of CE in patients with OGIB in comparison with other diagnostic modalities. Data Sources A literature search was performed using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid Embase, the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database, for studies published between 2007 and 2013. Review Methods Data on diagnostic accuracy, safety, and impact on health outcomes were abstracted from included studies. Quality of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results The search yielded 1,189 citations, and 24 studies were included. Eight studies reported diagnostic accuracy comparing CE with other diagnostic modalities. Capsule endoscopy has a higher sensitivity and lower specificity than magnetic resonance enteroclysis, computed tomography, and push enteroscopy. Capsule endoscopy has a good safety profile with few adverse events, although comparative safety data with other diagnostic modalities are limited. Capsule endoscopy is associated with no difference in patient health-related outcomes such as rebleeding or follow-up treatment compared with push enteroscopy, small-bowel follow-through, and angiography. Limitations There was significant heterogeneity in estimates of diagnostic accuracy, which prohibited a statistical summary of findings. The analysis was also limited by the fact that there is no established reference standard to which the diagnostic accuracy of CE can be compared. Conclusions There is very-low-quality evidence that CE has a higher sensitivity but a lower specificity than other diagnostic modalities. Capsule endoscopy has few adverse events, with capsule retention being the most serious complication. Capsule endoscopy is perceived by patients as less painful and less burdensome compared with other modalities. There is low-quality evidence that patients who undergo CE have similar rates of rebleeding, further therapeutic interventions, and hospitalization compared with other diagnostic modalities. PMID:26357529

  13. INTEGRATED OPTICAL TOOLS FOR MINIMALLY INVASIVE DIAGNOSIS AND TREATMENT AT GASTROINTESTINAL ENDOSCOPY

    PubMed Central

    Rodriguez-Diaz, Eladio; Bigio, Irving J.; Singh, Satish K.

    2010-01-01

    Over the past two decades, the bulk of gastrointestinal (GI) endoscopic procedures has shifted away from diagnostic and therapeutic interventions for symptomatic disease toward cancer prevention in asymptomatic patients. This shift has resulted largely from a decrease in the incidence of peptic ulcer disease in the era of antisecretory medications coupled with emerging evidence for the efficacy of endoscopic detection and eradication of dysplasia, a histopathological biomarker widely accepted as a precursor to cancer. This shift has been accompanied by a drive toward minimally-invasive, in situ optical diagnostic technologies that help assess the mucosa for cellular changes that relate to dysplasia. Two competing but complementary approaches have been pursued. The first approach is based on broad-view targeting of “areas of interest” or “red flags.” These broad-view technologies include standard white light endoscopy (WLE), high-definition endoscopy (HD), and “electronic” chromoendoscopy (narrow-band-type imaging). The second approach is based on multiple small area or point-source (meso/micro) measurements, which can be either machine (spectroscopy) or human-interpreted (endomicroscopy, magnification endoscopy), much as histopatholgy slides are. In this paper we present our experience with the development and testing of a set of familiar but “smarter” standard tissue-sampling tools that can be routinely employed during screening/surveillance endoscopy. These tools have been designed to incorporate fiberoptic probes that can mediate spectroscopy or endomicroscopy. We demonstrate the value of such tools by assessing their preliminary performance from several ongoing clinical studies. Our results have shown promise for a new generation of integrated optical tools for a variety of screening/surveillance applications during GI endoscopy. Integrated devices should prove invaluable for dysplasia surveillance strategies that currently result in large numbers of benign biopsies, which are of little clinical consequence, including screening for colorectal polyps and surveillance of “flat” dysplasia such as Barrett’s esophagus and chronic colitis due to inflammatory bowel diseases. PMID:21152112

  14. Urgent double balloon endoscopy provides higher yields than non-urgent double balloon endoscopy in overt obscure gastrointestinal bleeding

    PubMed Central

    Aniwan, Satimai; Viriyautsahakul, Vichai; Rerknimitr, Rungsun; Angsuwatcharakon, Phonthep; Kongkam, Pradermchai; Treeprasertsuk, Sombat; Kullavanijaya, Pinit

    2014-01-01

    Background and study aims: In overt obscure gastrointestinal bleeding (OV), double balloon endoscopy (DBE) is recommended as one of the most important investigations as it can provide both diagnosis and treatment. However, there is no set standard on the timing of DBE in OV. The aim of this study was to compare the diagnostic and therapeutic yields between urgent and non-urgent DBE in patients with OV. Patients and methods: Between January 2006 and February 2013, 120 patients with OV who underwent DBE were retrospectively reviewed. An urgent DBE was defined as DBE performed within 72?h from the last visible gastrointestinal bleeding (n?=?74) whereas a non-urgent DBE was defined as DBE performed after 72?h (n?=?46). Diagnostic yields, therapeutic impact and clinical outcomes were evaluated. Results: Diagnostic yield in urgent DBE was significantly higher than that in non-urgent DBE (70?% versus 30?%; P?

  15. Applying LED in full-field optical coherence tomography for gastrointestinal endoscopy

    NASA Astrophysics Data System (ADS)

    Yang, Bor-Wen; Wang, Yu-Yen; Juan, Yu-Shan; Hsu, Sheng-Jie

    2015-08-01

    Optical coherence tomography (OCT) has become an important medical imaging technology due to its non-invasiveness and high resolution. Full-field optical coherence tomography (FF-OCT) is a scanning scheme especially suitable for en face imaging as it employs a CMOS/CCD device for parallel pixels processing. FF-OCT can also be applied to high-speed endoscopic imaging. Applying cylindrical scanning and a right-angle prism, we successfully obtained a 360° tomography of the inner wall of an intestinal cavity through an FF-OCT system with an LED source. The 10-?m scale resolution enables the early detection of gastrointestinal lesions, which can increase detection rates for esophageal, stomach, or vaginal cancer. All devices used in this system can be integrated by MOEMS technology to contribute to the studies of gastrointestinal medicine and advanced endoscopy technology.

  16. International Digestive Endoscopy Network 2014: Turnpike to the Future

    PubMed Central

    Kim, Eun Young; Kwon, Kwang An; Choi, Il Ju; Ryu, Ji Kon

    2014-01-01

    Social networks are useful in the study of relationships between individuals or entire populations, and the ties through which any given social unit connects. Those represent the convergence of the various social contacts of that unit. Consequently, the term "social networking service" (SNS) became extremely familiar. Similar to familiar SNSs, International Digestive Endoscopy Network (IDEN) 2014 was based on an international network composed of an impressive 2-day scientific program dealing with a variety of topics for gastrointestinal (GI) diseases, which connects physicians and researchers from all over the world. The scientific programs included live endoscopic demonstrations and provided cutting-edge information and practice tips as well as the latest advances concerning upper GI, lower GI, and pancreatobiliary endoscopy. IDEN 2014 featured American Society for Gastrointestinal Endoscopy-Korean Society of Gastrointestinal Endoscopy (ASGE-KSGE)-joint sessions prepared through cooperation between ASGE and KSGE. Furthermore, IDEN 2014 provided a special program for young scientists called the 'Asian Young Endoscopist Award Forum' to foster networks, with many young endoscopists from Asian countries taking an active interest and participation. PMID:25324994

  17. Re-bleeding events in patients with obscure gastrointestinal bleeding after negative capsule endoscopy

    PubMed Central

    Magalhães-Costa, Pedro; Bispo, Miguel; Santos, Sofia; Couto, Gilberto; Matos, Leopoldo; Chagas, Cristina

    2015-01-01

    AIM: To investigate long-term re-bleeding events after a negative capsule endoscopy in patients with obscure gastrointestinal bleeding (OGIB) and the risk factors associated with the procedure. METHODS: Patients referred to Hospital Egas Moniz (Lisboa, Portugal) between January 2006 and October 2012 with OGIB and a negative capsule endoscopy were retrospectively analyzed. The following study variables were included: demographic data, comorbidities, bleeding-related drug use, hemoglobin level, indication for capsule endoscopy, post procedure details, work-up and follow-up. Re-bleeding rates and associated factors were assessed using a Cox proportional hazard analysis. The Kaplan-Meier method was used to estimate the cumulative incidence of re-bleeding at 1, 3 and 5 years, and the differences between factors were evaluated. RESULTS: The study population consisted of 640 patients referred for OGIB investigation. Wireless capsule endoscopy was deemed negative in 113 patients (17.7%). A total of 64.6% of the population was female, and the median age was 69 years. The median follow-up was forty-eight months (interquartile range 24-60). Re-bleeding occurred in 27.4% of the cases. The median time to re-bleeding was fifteen months (interquartile range 2-33). In 22.6% (n = 7) of the population, small-bowel angiodysplasia was identified as the culprit lesion. A univariate analysis showed that age > 65 years old, chronic kidney disease, aortic stenosis, anticoagulant use and overt OGIB were risk factors for re-bleeding; however, on a multivariate analysis, there were no risk factors for re-bleeding. The cumulative risk of re-bleeding at 1, 3 and 5 years of follow-up was 12.9%, 25.6% and 31.5%, respectively. Patients who presented with overt OGIB tended to re-bleed sooner (median time for re-bleeding: 8.5 mo vs 22 mo). CONCLUSION: Patients with OGIB despite a negative capsule endoscopy have a significant re-bleeding risk; therefore, these patients require an extended follow-up strategy. PMID:25901220

  18. Deep sedation during gastrointestinal endoscopy: Propofol-fentanyl and midazolam-fentanyl regimens

    PubMed Central

    Lera dos Santos, Marcos Eduardo; Maluf-Filho, Fauze; Chaves, Dalton Marques; Matuguma, Sergio Eiji; Ide, Edson; Luz, Gustavo de Oliveira; de Souza, Thiago Ferreira; Pessorrusso, Fernanda C Simões; de Moura, Eduardo Guimarães Hourneaux; Sakai, Paulo

    2013-01-01

    AIM: To compare deep sedation with propofol-fentanyl and midazolam-fentanyl regimens during upper gastrointestinal endoscopy. METHODS: After obtaining approval of the research ethics committee and informed consent, 200 patients were evaluated and referred for upper gastrointestinal endoscopy. Patients were randomized to receive propofol-fentanyl or midazolam-fentanyl (n = 100/group). We assessed the level of sedation using the observer’s assessment of alertness/sedation (OAA/S) score and bispectral index (BIS). We evaluated patient and physician satisfaction, as well as the recovery time and complication rates. The statistical analysis was performed using SPSS statistical software and included the Mann-Whitney test, ?2 test, measurement of analysis of variance, and the ? statistic. RESULTS: The times to induction of sedation, recovery, and discharge were shorter in the propofol-fentanyl group than the midazolam-fentanyl group. According to the OAA/S score, deep sedation events occurred in 25% of the propofol-fentanyl group and 11% of the midazolam-fentanyl group (P = 0.014). Additionally, deep sedation events occurred in 19% of the propofol-fentanyl group and 7% of the midazolam-fentanyl group according to the BIS scale (P = 0.039). There was good concordance between the OAA/S score and BIS for both groups (? = 0.71 and ? = 0.63, respectively). Oxygen supplementation was required in 42% of the propofol-fentanyl group and 26% of the midazolam-fentanyl group (P = 0.025). The mean time to recovery was 28.82 and 44.13 min in the propofol-fentanyl and midazolam-fentanyl groups, respectively (P < 0.001). There were no severe complications in either group. Although patients were equally satisfied with both drug combinations, physicians were more satisfied with the propofol-fentanyl combination. CONCLUSION: Deep sedation occurred with propofol-fentanyl and midazolam-fentanyl, but was more frequent in the former. Recovery was faster in the propofol-fentanyl group. PMID:23801836

  19. Appropriate use of endoscopy in the diagnosis and treatment of gastrointestinal diseases: up-to-date indications for primary care providers

    PubMed Central

    Nguyen, Vien X; Le Nguyen, Vi Thuy; Nguyen, Cuong C

    2010-01-01

    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. PMID:21116340

  20. Technical skills and training of upper gastrointestinal endoscopy for new beginners

    PubMed Central

    Lee, Seung-Hwa; Park, Young-Kyu; Cho, Sung-Min; Kang, Joon-Koo; Lee, Duck-Joo

    2015-01-01

    The incidence of gastric cancer remains high in South Korea. Upper gastrointestinal (GI) endoscopy, i.e., esophagogastroduodenoscopy (EGD), has a higher diagnostic specificity and sensitivity than the upper GI series. Additionally, EGD has the ability to biopsy, through taking a tissue of the pathologic lesion. Successful training of EGD procedural skills require a few important things to be learned and remembered, including the posture of an examinee (e.g., left lateral decubitus and supine) and examiner (e.g., one-man standing method vs one-man sitting method), basic skills (e.g., tip deflection, push forward and pull back, and air suction and infusion), advanced skills (e.g., paradoxical movement, J-turn, and U-turn), and intubation techniques along the upper GI tract (e.g., oral cavity, pharynx, larynx including vocal cord, upper and middle and lower esophagus, gastroesophageal junction, gastric fundus, body, and antrum, duodenal bulb, and descending part of duodenum). In the current review, despite several limitations, we explained the intubation method of EGD for beginners. We hope this will be helpful to beginners who wish to learn the procedure. PMID:25624710

  1. New lidocaine lozenge as topical anesthesia compared to lidocaine viscous oral solution before upper gastrointestinal endoscopy

    PubMed Central

    Mogensen, Stine; Treldal, Charlotte; Feldager, Erik; Pulis, Sylvia; Jacobsen, Jette; Andersen, Ove; Rasmussen, Mette

    2012-01-01

    Objective To evaluate the effect and acceptance of a new lidocaine lozenge compared with a lidocaine viscous oral solution as a pharyngeal anesthetic before upper gastrointestinal endoscopy (UGE), a diagnostic procedure commonly performed worldwide during which many patients experience severe discomfort mostly because of the gag reflex. Participants The single-blinded, randomized, controlled study involved 110 adult patients undergoing diagnostic UGE at the Department of Gastroenterology, Hvidovre University Hospital, Denmark. Methods The patients were randomized to receive either 100 mg lidocaine as a lozenge or 5 mL lidocaine viscous oral solution 2%. Intravenous midazolam was administered if needed. The effect of a lidocaine lozenge in reducing patient discomfort, including the gag reflex, during UGE compared with a lidocaine oral solution was assessed. Results Questionnaires from the patients showed that the gag reflex was acceptable for 64% in the lozenge group compared with 33% in the oral solution group (P = 0.0072). UGE was evaluated as acceptable by 69% in the lozenge group compared with 39% in the oral solution group (P = 0.0092). The taste was evaluated as good by 78% in the lozenge group (P < 0.0001), and 82% found the lozenge to have good texture (P < 0.0001). Conclusion The lozenge reduced the gag reflex, diminished patients’ discomfort during UGE, and was evaluated as having a good taste and texture. The lozenge improved patients’ acceptance of UGE. PMID:22915898

  2. Risk of transmission of carbapenem-resistant Enterobacteriaceae and related “superbugs” during gastrointestinal endoscopy

    PubMed Central

    Muscarella, Lawrence F

    2014-01-01

    To evaluate the risk of transmission of carbapenem-resistant Enterobacteriaceae (CRE) and their related superbugs during gastrointestinal (GI) endoscopy. Reports of outbreaks linked to GI endoscopes contaminated with different types of infectious agents, including CRE and their related superbugs, were reviewed. Published during the past 30 years, both prior to and since CRE’s emergence, these reports were obtained by searching the peer-reviewed medical literature (via the United States National Library of Medicine’s “MEDLINE” database); the Food and Drug Administration’s Manufacturer and User Facility Device Experience database, or “MAUDE”; and the Internet (via Google’s search engine). This review focused on an outbreak of CRE in 2013 following the GI endoscopic procedure known as endoscopic retrograde cholangiopancreatography, or ERCP, performed at “Hospital X” located in the suburbs of Chicago (IL; United States). Part of the largest outbreak of CRE in United States history, the infection and colonization of 10 and 28 of this hospital’s patients, respectively, received considerable media attention and was also investigated by the Centers for Disease Control and Prevention (CDC), which published a report about this outbreak in Morbidity and Mortality Weekly Report (MMWR), in 2014. This report, along with the results of an independent inspection of Hospital X’s infection control practices following this CRE outbreak, were also reviewed. While this article focuses primarily on the prevention of transmissions of CRE and their related superbugs in the GI endoscopic setting, some of its discussion and recommendations may also apply to other healthcare settings, to other types of flexible endoscopes, and to other types of transmissible infectious agents. This review found that GI endoscopy is an important risk factor for the transmission of CRE and their related superbugs, having been recently associated with patient morbidity and mortality following ERCP. The CDC reported in MMWR that the type of GI endoscope, known as an ERCP endoscope, that Hospital X used to perform ERCP in 2013 on the 38 patients who became infected or colonized with CRE might be particularly challenging to clean and disinfect, because of the complexity of its physical design. If performed in strict accordance with the endoscope manufacturer’s labeling, supplemented as needed with professional organizations’ published guidelines, however, current practices for reprocessing GI endoscopes, which include high-level disinfection, are reportedly adequate for the prevention of transmission of CRE and their related superbugs. Several recommendations are provided to prevent CRE transmissions in the healthcare setting. CRE transmissions are not limited to contaminated GI endoscopes and also have been linked to other reusable flexible endoscopic instrumentation, including bronchoscopes and cystoscopes. In conclusion, contaminated GI endoscopes, particularly those used during ERCP, have been causally linked to outbreaks of CRE and their related superbugs, with associated patient morbidity and mortality. Thorough reprocessing of these complex reusable instruments is necessary to prevent disease transmission and ensure patient safety during GI endoscopy. Enhanced training and monitoring of reprocessing staffers to verify the proper cleaning and brushing of GI endoscopes, especially the area around, behind and near the forceps elevator located at the distal end of the ERCP endoscope, are recommended. If the ERCP endoscope features a narrow and exposed channel that houses a wire connecting the GI endoscope’s control head to this forceps elevator, then this channel’s complete reprocessing, including its flushing with a detergent using a procedure validated for effectiveness, is also emphasized. PMID:25324917

  3. Image Quality Analysis of Various Gastrointestinal Endoscopes: Why Image Quality Is a Prerequisite for Proper Diagnostic and Therapeutic Endoscopy

    PubMed Central

    Ko, Weon Jin; An, Pyeong; Ko, Kwang Hyun; Hahm, Ki Baik; Hong, Sung Pyo

    2015-01-01

    Arising from human curiosity in terms of the desire to look within the human body, endoscopy has undergone significant advances in modern medicine. Direct visualization of the gastrointestinal (GI) tract by traditional endoscopy was first introduced over 50 years ago, after which fairly rapid advancement from rigid esophagogastric scopes to flexible scopes and high definition videoscopes has occurred. In an effort towards early detection of precancerous lesions in the GI tract, several high-technology imaging scopes have been developed, including narrow band imaging, autofocus imaging, magnified endoscopy, and confocal microendoscopy. However, these modern developments have resulted in fundamental imaging technology being skewed towards red-green-blue and this technology has obscured the advantages of other endoscope techniques. In this review article, we have described the importance of image quality analysis using a survey to consider the diversity of endoscope system selection in order to better achieve diagnostic and therapeutic goals. The ultimate aims can be achieved through the adoption of modern endoscopy systems that obtain high image quality. PMID:26473119

  4. Image Quality Analysis of Various Gastrointestinal Endoscopes: Why Image Quality Is a Prerequisite for Proper Diagnostic and Therapeutic Endoscopy.

    PubMed

    Ko, Weon Jin; An, Pyeong; Ko, Kwang Hyun; Hahm, Ki Baik; Hong, Sung Pyo; Cho, Joo Young

    2015-09-01

    Arising from human curiosity in terms of the desire to look within the human body, endoscopy has undergone significant advances in modern medicine. Direct visualization of the gastrointestinal (GI) tract by traditional endoscopy was first introduced over 50 years ago, after which fairly rapid advancement from rigid esophagogastric scopes to flexible scopes and high definition videoscopes has occurred. In an effort towards early detection of precancerous lesions in the GI tract, several high-technology imaging scopes have been developed, including narrow band imaging, autofocus imaging, magnified endoscopy, and confocal microendoscopy. However, these modern developments have resulted in fundamental imaging technology being skewed towards red-green-blue and this technology has obscured the advantages of other endoscope techniques. In this review article, we have described the importance of image quality analysis using a survey to consider the diversity of endoscope system selection in order to better achieve diagnostic and therapeutic goals. The ultimate aims can be achieved through the adoption of modern endoscopy systems that obtain high image quality. PMID:26473119

  5. Randomized controlled trial comparing outcomes of video capsule endoscopy with push enteroscopy in obscure gastrointestinal bleeding

    PubMed Central

    Segarajasingam, Dev S; Hanley, Stephen C; Barkun, Alan N; Waschke, Kevin A; Burtin, Pascal; Parent, Josée; Mayrand, Serge; Fallone, Carlo A; Jobin, Gilles; Seidman, Ernest G; Martel, Myriam

    2015-01-01

    BACKGROUND: Optimal management of obscure gastrointestinal bleeding (OGIB) remains unclear. OBJECTIVE: To evaluate diagnostic yields and downstream clinical outcomes comparing video capsule endoscopy (VCE) with push enteroscopy (PE). METHODS: Patients with OGIB and negative esophagogastroduodenoscopies and colonoscopies were randomly assigned to VCE or PE and followed for 12 months. End points included diagnostic yield, acute or chronic bleeding, health resource utilization and crossovers. RESULTS: Data from 79 patients were analyzed (VCE n=40; PE n=39; 82.3% overt OGIB). VCE had greater diagnostic yield (72.5% versus 48.7%; P<0.05), especially in the distal small bowel (58% versus 13%; P<0.01). More VCE-identified lesions were rated possible or certain causes of bleeding (79.3% versus 35.0%; P<0.05). During follow-up, there were no differences in the rates of ongoing bleeding (acute [40.0% versus 38.5%; P not significant], chronic [32.5% versus 45.6%; P not significant]), nor in health resource utilization. Fewer VCE-first patients crossed over due to ongoing bleeding (22.5% versus 48.7%; P<0.05). CONCLUSIONS: A VCE-first approach had a significant diagnostic advantage over PE-first in patients with OGIB, especially with regard to detecting small bowel lesions, affecting clinical certainty and subsequent further small bowel investigations, with no subsequent differences in bleeding or resource utilization outcomes in follow-up. These findings question the clinical relevance of many of the discovered endoscopic lesions or the ability to treat most of these effectively over time. Improved prognostication of both patient characteristics and endoscopic lesion appearance with regard to bleeding behaviour, coupled with the impact of therapeutic deep enteroscopy, is now required using adapted, high-quality study methodologies. PMID:25803018

  6. Intraductal biliopancreatic imaging: European Society of Gastrointestinal Endoscopy (ESGE) technology review.

    PubMed

    Tringali, Andrea; Lemmers, Arnaud; Meves, Volker; Terheggen, Grischa; Pohl, Jürgen; Manfredi, Guido; Häfner, Michael; Costamagna, Guido; Devière, Jacques; Neuhaus, Horst; Caillol, Fabrice; Giovannini, Marc; Hassan, Cesare; Dumonceau, Jean-Marc

    2015-08-01

    This technology review expresses the current view of the European Society of Gastrointestinal Endoscopy (ESGE) on the available techniques for intraductal biliopancreatic imaging. The three cholangioscopy techniques are described: the "dual-operator" and " single-operator" mother-baby approaches using dedicated instruments, and the "direct" technique using currently available ultrathin gastroscopes. The mother-baby method is standardized and reproducible, while direct cholangioscopy is technically demanding and its safety requires further evaluation. As well as direct visualization of the bile ducts, cholangioscopy has the further advantage of allowing targeted biopsy. Image quality is still suboptimal for single-operator cholangioscopy, while the other techniques have achieved adequately detailed imaging. The costs of mother-baby cholangioscopy are high and its application in clinical practice should be restricted to selected cases (i.e. indeterminate biliary strictures/intraluminal lesions, difficult biliary stones) and to the setting of tertiary care centers. Peroral pancreatoscopy may find an indication in situations where other imaging modalities (mainly EUS) are inconclusive (i.e. delineation of main duct intraductal papillary mucinous neoplasia extension, sampling of indeterminate main pancreatic duct strictures). Intraductal ultrasonography (IDUS) has a poorer performance than EUS in the staging of pancreatic malignancies and can increase the risk of pancreatitis. A promising indication for IDUS could be the evaluation of indeterminate biliary strictures and ampullary tumors. Probe-based confocal laser endomicroscopy (pCLE) of the bile ducts is a difficult and expensive technique. Appropriate training needs to be established, since interpretation of images is challenging. pCLE can be an important diagnostic tool in the setting of indeterminate biliary strictures. PMID:26147492

  7. The pre- and postprocedure assessment of patients undergoing sedation for gastrointestinal endoscopy.

    PubMed

    Mitty, Roger D; Wild, Daniel M

    2008-10-01

    A thorough and efficient pre-procedure evaluation of the patient's readiness to undergo sedation for endoscopy is essential. This evaluation will allow the formulation of an appropriate sedation plan for the patient, resulting in a safe and effective examination. The post procedure assessment of the patient confirms readiness for discharge and allows for appropriate patient education and follow-up planning. PMID:18922403

  8. Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline.

    PubMed

    Spada, Cristiano; Stoker, Jaap; Alarcon, Onofre; Barbaro, Federico; Bellini, Davide; Bretthauer, Michael; De Haan, Margriet C; Dumonceau, Jean-Marc; Ferlitsch, Monika; Halligan, Steve; Helbren, Emma; Hellstrom, Mikael; Kuipers, Ernst J; Lefere, Philippe; Mang, Thomas; Neri, Emanuele; Petruzziello, Lucio; Plumb, Andrew; Regge, Daniele; Taylor, Stuart A; Hassan, Cesare; Laghi, Andrea

    2014-10-01

    This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). It addresses the clinical indications for the use of computed tomographic colonography (CTC). A targeted literature search was performed to evaluate the evidence supporting the use of CTC. 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 1 ESGE/ESGAR recommend computed tomographic colonography (CTC) as the radiological examination of choice for the diagnosis of colorectal neoplasia. ESGE/ESGAR do not recommend barium enema in this setting (strong recommendation, high quality evidence). 2 ESGE/ESGAR recommend CTC, preferably the same or next day, if colonoscopy is incomplete. Delay of CTC should be considered following endoscopic resection. In the case of obstructing colorectal cancer, preoperative contrast-enhanced CTC may also allow location or staging of malignant lesions (strong recommendation, moderate quality evidence). 3 When endoscopy is contraindicated or not possible, ESGE/ESGAR recommend CTC as an acceptable and equally sensitive alternative for patients with symptoms suggestive of colorectal cancer (strong recommendation, high quality evidence). 4 ESGE/ESGAR recommend referral for endoscopic polypectomy in patients with at least one polyp ?? ?6? mm in diameter detected at CTC. CTC surveillance may be clinically considered if patients do not undergo polypectomy (strong recommendation, moderate quality evidence). 5 ESGE/ESGAR do not recommend CTC as a primary test for population screening or in individuals with a positive first-degree family history of colorectal cancer (CRC). However, it may be proposed as a CRC screening test on an individual basis providing the screenee is adequately informed about test characteristics, benefits, and risks (weak recommendation, moderate quality evidence). PMID:25268304

  9. Volumetric photoacoustic endoscopy of upper gastrointestinal tract: ultrasonic transducer technology development

    NASA Astrophysics Data System (ADS)

    Yang, Joon-Mo; Favazza, Christopher; Chen, Ruimin; Maslov, Konstantin; Cai, Xin; Zhou, Qifa; Shung, K. Kirk; Wang, Lihong V.

    2011-03-01

    We have successfully implemented a focused ultrasonic transducer for photoacoustic endoscopy. The photoacoustic endoscopic probe's ultrasound transducer determines the lateral resolution of the system. By using a focused ultrasonic transducer, we significantly improved the endoscope's spatial resolution and signal-to-noise ratio. This paper describes the technical details of the ultrasonic transducer incorporated into the photoacoustic endoscopic probe and the experimental results from which the transducer's resolution is quantified and the image improvement is validated.

  10. Capturing and stitching images with a large viewing angle and low distortion properties for upper gastrointestinal endoscopy

    NASA Astrophysics Data System (ADS)

    Liu, Ya-Cheng; Chung, Chien-Kai; Lai, Jyun-Yi; Chang, Han-Chao; Hsu, Feng-Yi

    2013-06-01

    Upper gastrointestinal endoscopies are primarily performed to observe the pathologies of the esophagus, stomach, and duodenum. However, when an endoscope is pushed into the esophagus or stomach by the physician, the organs behave similar to a balloon being gradually inflated. Consequently, their shapes and depth-of-field of images change continually, preventing thorough examination of the inflammation or anabrosis position, which delays the curing period. In this study, a 2.9-mm image-capturing module and a convoluted mechanism was incorporated into the tube like a standard 10- mm upper gastrointestinal endoscope. The scale-invariant feature transform (SIFT) algorithm was adopted to implement disease feature extraction on a koala doll. Following feature extraction, the smoothly varying affine stitching (SVAS) method was employed to resolve stitching distortion problems. Subsequently, the real-time splice software developed in this study was embedded in an upper gastrointestinal endoscope to obtain a panoramic view of stomach inflammation in the captured images. The results showed that the 2.9-mm image-capturing module can provide approximately 50 verified images in one spin cycle, a viewing angle of 120° can be attained, and less than 10% distortion can be achieved in each image. Therefore, these methods can solve the problems encountered when using a standard 10-mm upper gastrointestinal endoscope with a single camera, such as image distortion, and partial inflammation displays. The results also showed that the SIFT algorithm provides the highest correct matching rate, and the SVAS method can be employed to resolve the parallax problems caused by stitching together images of different flat surfaces.

  11. ASGE Technology Committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps.

    PubMed

    Abu Dayyeh, Barham K; Thosani, Nirav; Konda, Vani; Wallace, Michael B; Rex, Douglas K; Chauhan, Shailendra S; Hwang, Joo Ha; Komanduri, Sri; Manfredi, Michael; Maple, John T; Murad, Faris M; Siddiqui, Uzma D; Banerjee, Subhas

    2015-03-01

    In vivo real-time assessment of the histology of diminutive (?5 mm) colorectal polyps detected at colonoscopy can be achieved by means of an "optical biopsy" by using currently available endoscopic technologies. This systematic review and meta-analysis was performed by the American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee to specifically assess whether acceptable performance thresholds outlined by an ASGE Preservation and Incorporation of Valuable endoscopic Innovations (PIVI) document for clinical adoption of these technologies have been met. We conducted direct meta-analyses calculating the pooled negative predictive value (NPV) for narrow-band imaging (NBI), i-SCAN, and Fujinon Intelligent Color Enhancement (FICE)-assisted optical biopsy for predicting adenomatous polyp histology of small/diminutive colorectal polyps. We also calculated the pooled percentage agreement with histopathology when assigning postpolypectomy surveillance intervals based on combining real-time optical biopsy of colorectal polyps 5 mm or smaller with histopathologic assessment of polyps larger than 5 mm. Random-effects meta-analysis models were used. Statistical heterogeneity was evaluated by means of I(2) statistics. Our meta-analyses indicate that optical biopsy with NBI, exceeds the NPV threshold for adenomatous polyp histology, supporting a "diagnose-and-leave" strategy for diminutive predicted nonneoplastic polyps in the rectosigmoid colon. The pooled NPV of NBI for adenomatous polyp histology by using the random-effects model was 91% (95% confidence interval [CI], 88-94). This finding was associated with a high degree of heterogeneity (I(2) = 89%). Subgroup analysis indicated that the pooled NPV was greater than 90% for academic medical centers (91.8%; 95% CI, 89-94), for experts (93%; 95% CI, 91-96), and when the optical biopsy assessment was made with high confidence (93%; 95% CI, 90-96). Our meta-analyses also indicate that the agreement in assignment of postpolypectomy surveillance intervals based on optical biopsy with NBI of diminutive colorectal polyps is 90% or greater in academic settings (91%; 95% CI, 86-95), with experienced endoscopists (92%; 95% CI, 88-96) and when optical biopsy assessments are made with high confidence (91%; 95% CI, 88-95). Our systematic review and meta-analysis confirms that the thresholds established by the ASGE PIVI for real-time endoscopic assessment of the histology of diminutive polyps have been met, at least with NBI optical biopsy, with endoscopists who are expert in using this advanced imaging technology and when assessments are made with high confidence. PMID:25597420

  12. Negative capsule endoscopy in patients with obscure gastrointestinal bleeding reliable: Recurrence of bleeding on long-term follow-up

    PubMed Central

    Riccioni, Maria Elena; Urgesi, Riccardo; Cianci, Rossella; Rizzo, Gianluca; D’Angelo, Luca; Marmo, Riccardo; Costamagna, Guido

    2013-01-01

    AIM: To assess the rate of recurrent bleeding of the small bowel in patients with obscure bleeding already undergone capsule endoscopy (CE) with negative results. METHODS: We reviewed the medical records related to 696 consecutive CE performed from December 2002 to January 2011, focusing our attention on patients with recurrence of obscure bleeding and negative CE. Evaluating the patient follow-up, we analyzed the recurrence rate of obscure bleeding in patient with a negative CE. Actuarial rates of rebleeding during follow-up were calculated, and factors associated with rebleeding were assessed through an univariate and multivariate analysis. A P value of less than 0.05 was regarded as statistically significant. The sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of negative CE were calculated. RESULTS: Two hundred and seven out of 696 (29.7%) CE studies resulted negative in patient with obscure/overt gastrointestinal bleeding. Overall, 489 CE (70.2%) were positive studies. The median follow-up was 24 mo (range 12-36 mo). During follow-up, recurrence of obscure bleeding was observed only in 34 out of 207 negative CE patients (16.4%); 26 out of 34 with obscure overt bleeding and 8 out of 34 with obscure occult bleeding. The younger age (< 65 years) and the onset of bleeding such as melena are independent risk factors of rebleeding after a negative CE (OR = 2.6703, 95%CI: 1.1651-6.1202, P = 0.0203; OR 4.7718, 95%CI: 1.9739-11.5350, P = 0.0005). The rebleeding rate (CE+ vs CE-) was 16.4% vs 45.1% (?2 test, P = 0.00001). The sensitivity, specificity, and PPV and NPV were 93.8%, 100%, 100%, 80.1%, respectively. CONCLUSION: Patients with obscure gastrointestinal bleeding and negative CE had a significantly lower rebleeding rate, and further invasive investigations can be deferred. PMID:23901227

  13. Virtual gastrointestinal colonoscopy in combination with large bowel endoscopy: clinical application.

    PubMed

    He, Qing; Rao, Ting; Guan, Yong-Song

    2014-10-14

    Although colorectal cancer (CRC) has no longer been the leading cancer killer worldwide for years with the exponential development in computed tomography (CT) or magnetic resonance imaging, and positron emission tomography/CT as well as virtual colonoscopy for early detection, the CRC related mortality is still high. The objective of CRC screening is to reduce the burden of CRC and thereby the morbidity and mortality rates of the disease. It is believed that this goal can be achieved by regularly screening the average-risk population, enabling the detection of cancer at early, curable stages, and polyps before they become cancerous. Large-scale screening with multimodality imaging approaches plays an important role in reaching that goal to detect polyps, Crohn's disease, ulcerative colitis and CRC in early stage. This article reviews kinds of presentative imaging procedures for various screening options and updates detecting, staging and re-staging of CRC patients for determining the optimal therapeutic method and forecasting the risk of CRC recurrence and the overall prognosis. The combination use of virtual colonoscopy and conventional endoscopy, advantages and limitations of these modalities are also discussed. PMID:25320519

  14. Virtual gastrointestinal colonoscopy in combination with large bowel endoscopy: Clinical application

    PubMed Central

    He, Qing; Rao, Ting; Guan, Yong-Song

    2014-01-01

    Although colorectal cancer (CRC) has no longer been the leading cancer killer worldwide for years with the exponential development in computed tomography (CT) or magnetic resonance imaging, and positron emission tomography/CT as well as virtual colonoscopy for early detection, the CRC related mortality is still high. The objective of CRC screening is to reduce the burden of CRC and thereby the morbidity and mortality rates of the disease. It is believed that this goal can be achieved by regularly screening the average-risk population, enabling the detection of cancer at early, curable stages, and polyps before they become cancerous. Large-scale screening with multimodality imaging approaches plays an important role in reaching that goal to detect polyps, Crohn’s disease, ulcerative colitis and CRC in early stage. This article reviews kinds of presentative imaging procedures for various screening options and updates detecting, staging and re-staging of CRC patients for determining the optimal therapeutic method and forecasting the risk of CRC recurrence and the overall prognosis. The combination use of virtual colonoscopy and conventional endoscopy, advantages and limitations of these modalities are also discussed. PMID:25320519

  15. Bupivacaine Lozenge Compared with Lidocaine Spray as Topical Pharyngeal Anesthetic before Unsedated Upper Gastrointestinal Endoscopy: A Randomized, Controlled Trial

    PubMed Central

    Salale, Nesrin; Treldal, Charlotte; Mogensen, Stine; Rasmussen, Mette; Petersen, Janne; Andersen, Ove; Jacobsen, Jette

    2014-01-01

    Unsedated upper gastrointestinal endoscopy (UGE) can induce patient discomfort, mainly due to a strong gag reflex. The aim was to assess the effect of a bupivacaine lozenge as topical pharyngeal anesthetic compared with standard treatment with a lidocaine spray before UGE. Ninety-nine adult outpatients undergoing unsedated diagnostic UGE were randomized to receive either a bupivacaine lozenge (L-group, n = 51) or lidocaine spray (S-group, n = 42). Primary objective was assessment of patient discomfort including acceptance of the gag reflex during UGE. The L-group assessed the discomfort significantly lower on a visual analog scale compared with the S-group (P = 0.02). There was also a significant difference in the four-point scale assessment of the gag reflex (P = 0.03). It was evaluated as acceptable by 49% in the L-group compared with 31% in the S-group. A bupivacaine lozenge compared with a lidocaine spray proved to be a superior option as topical pharyngeal anesthetic before an UGE. PMID:25374463

  16. Comprehensive management of full-thickness luminal defects: The next frontier of gastrointestinal endoscopy

    PubMed Central

    Winder, Joshua S; Pauli, Eric M

    2015-01-01

    Full thickness gastrointestinal defects such as perforations, leaks, and fistulae are a relatively common result of many of the endoscopic and surgical procedures performed in modern health care. As the number of these procedures increases, so too will the number of resultant defects. Historically, these were all treated by open surgical means with the associated morbidity and mortality. With the recent advent of advanced endoscopic techniques, these defects can be treated definitively while avoiding an open surgical procedure. Here we explore the various techniques and tools that are currently available for the treatment of gastrointestinal defects including through the scope clips, endoscopic suturing devices, over the scope clips, sealants, endoluminal stents, endoscopic suction devices, and fistula plugs. As fistulae represent the most recalcitrant of defects, we focus this editorial on a multimodal approach of treatment. This includes optimization of nutrition, treatment of infection, ablation of tracts, removal of foreign bodies, and treatment of distal obstructions. We believe that by addressing all of these factors at the time of attempted closure, the patient is optimized and has the best chance at long-term closure. However, even with all of these factors addressed, failure does occur and in those cases, endoscopic therapies may still play a role in that they allow the patient to avoid a definitive surgical therapy for a time while nutrition is optimized, and infections are addressed. PMID:26191340

  17. The Value of U/S to Determine Priority for Upper Gastrointestinal Endoscopy in Emergency Room.

    PubMed

    Ali Hussein, Abd Elrazek M; Mahfouz, Hamdy; Elazeem, Khaled Abd; Fakhry, Mohamed; Elrazek, Emad Abd; Foad, Mahmoud; Alboraie, Mohamed; Ragab, Aly; Baghdady, Shazly; Bilasy, Shymaa E; Salama, Khaled; Masseih, Ramy Abdel; Amer, Mohamed Omar; Hassaneen, Sayed; Bhagavathula, Akshaya Srikanth; Elnour, Asim Ahmed; Al Nuaimi, Saif K; Shehab, Abdulla

    2015-12-01

    In countries endemic for liver and GIT diseases, frequent emergency department (ED) patients contribute to a disproportionate number of visits consuming substantial amount of medical resources. One of the most frequent ED visits is patients who present with hypovolemic shock, abdominal pain, or confusion with or without signs of upper gastrointestinal bleeding (UGIB). The use of conventional two-dimensional ultrasound (2D-U/S) may provide immediate and useful information on the presence of esophageal varices, gastrointestinal tumors, and other GIT abnormalities.The current study investigated the feasibility of using (2D-U/S) to predict the source of UGIB in ED and to determine patients' priority for UGE.Between February 2003 and March 2013, we retrospectively reviewed the profiles of 38,551 Egyptian patients, aged 2 to 75 years old, who presented with a history of GI/liver diseases and no alcohol consumption. We assessed the value of 2D-U/S technology in predicting the source of UGIB.Of 38,551 patients presenting to ED, 900 patients (2.3%), 534 male (59.3%) and 366 female (40.7%) developed UGIB. Analyzing results obtained from U/S examinations by data mining for emergent UGE were patients with liver cirrhosis (LC), splenomegaly, and ascites (42.6% incidence of UGIB), followed by LC and splenomegaly (14.6%), LC only (9.4%), and was only 0.5% who had no morbidity finding by 2D-U/S.Ultrasonographic instrumentation increases the feasibility of predictive emergency medicine. The area has recently not only gained a fresh impulse, but also a new set of complex problems that needs to be addressed in the emergency medicine setting according to each priority. PMID:26656368

  18. The Cost-Effectiveness Analysis of Video Capsule Endoscopy Compared to Other Strategies to Manage Acute Upper Gastrointestinal Hemorrhage in the Emergency Department

    PubMed Central

    Meltzer, Andrew C.; Ward, Michael J.; Gralnek, Ian M.; Pines, Jesse M.

    2014-01-01

    Study objective Acute upper gastrointestinal (GI) hemorrhage is a common presentation in hospital-based emergency departments (EDs). A novel diagnostic approach is to use video capsule endoscopy to directly visualize the upper GI tract and identify bleeding. Our objective was to evaluate and compare the relative costs and benefits of video capsule endoscopy compared to other strategies in low to moderate risk ED patients with acute upper GI hemorrhage. Methods We constructed a model using standard decision analysis software to examine the cost-effectiveness of four available strategies for a base-case patient who presents to the ED with either mild or moderate risk scenarios (by Glasgow-Blatchford Score) for requiring invasive hemostatic intervention (i.e., endoscopic, surgical, etc.) The four available diagnostic strategies were (1) direct imaging with video capsule endoscopy performed in the ED, (2) risk stratification using the Glasgow-Blatchford score, (3) nasogastric tube placement and, finally, (4) an admit-all strategy. Results In the low-risk scenario, video capsule endoscopy was preferred strategy (cost $5,691, 14.69 QALYs) and more cost effective than the remaining strategies including nasogastric tube strategy (cost $8,159, 14.69 QALYs), risk stratification strategy (cost $10,695, 14.69 QALYs) and admit-all strategy (cost $22,766, 14.68 QALYs). In the moderate risk scenario, video capsule endoscopy continued to be preferred strategy (cost $9,190, 14.56 QALYs) compared to nasogastric tube (cost $9,487, 14.58 QALYs, ICER $15,891) and more cost effective than admit-all strategy (cost, $22,584, 14.54 QALYs.) Conclusion Video capsule endoscopy may be cost-effective for low and moderate risk patients presenting to the ED with acute upper GI hemorrhage. PMID:24961149

  19. Efficacy and Safety of Low Dose Ketamine and Midazolam Combination for Diagnostic Upper Gastrointestinal Endoscopy in Children

    PubMed Central

    Cakir, Murat

    2015-01-01

    Purpose We aimed to analyze the effectiveness and safety of low-dose midazolam and ketamine combination for upper gastrointestinal endoscopy (UGIE) in children. Methods The study included the children (n=425, 10.78±3.81 years) who underwent UGIE for diagnostic purpose during 1 year period. All children were sedated with low dose midazolam (0.1 mg/kg) and ketamine (0.5 mg/kg) intravenously. Effectiveness of the sedation and complications during the procedure and recovery period were recorded. Results Endoscopic procedure was successfully completed in 414 patients (97.4%; 95% confidence interval, 95.8-98.9). Mean±standard deviation (SD) duration of procedure was 6.36±1.64 minutes (median, 6.0 minutes; range, 4-12 minutes). Minor complications occurred during the procedure in 39.2% of the patients. The most common complication was increased oral secretion (33.1%). No major complications were observed in any patient. Age and Ramsay sedation scores of patients with complications during the procedure were lower than the others (9.49±4.05 years vs. 11.61±3.43 years, p=0.002 and 2.10±1.46 vs. 4.37±1.16, p=0.001). Mean recovery time was 22 minutes (range, 10-90 minutes; mean±SD, 25±12.32 minutes). Minor complications developed during recovery in 60.1% of the patients. The most common complication was transient double vision (n=127, 30.7%). Emergence reaction was observed in 5 patients (1.2%). Conclusion The procedure was completed with high level of success without any major complication in our study. Combination of low-dose midazolam and ketamine is a suitable sedation protocol for pediatric endoscopists in UGIE. PMID:26473135

  20. Proton pump inhibitors therapy vs H2 receptor antagonists therapy for upper gastrointestinal bleeding after endoscopy: A meta-analysis

    PubMed Central

    Zhang, Ying-Shi; Li, Qing; He, Bo-Sai; Liu, Ran; Li, Zuo-Jing

    2015-01-01

    AIM: To compare the therapeutic effects of proton pump inhibitors vs H2 receptor antagonists for upper gastrointestinal bleeding in patients after successful endoscopy. METHODS: We searched the Cochrane library, MEDLINE, EMBASE and PubMed for randomized controlled trials until July 2014 for this study. The risk of bias was evaluated by the Cochrane Collaboration’s tool and all of the studies had acceptable quality. The main outcomes included mortality, re-bleeding, received surgery rate, blood transfusion units and hospital stay time. These outcomes were estimated using odds ratios (OR) and mean difference with 95% confidence interval (CI). RevMan 5.3.3 software and Stata 12.0 software were used for data analyses. RESULTS: Ten randomized controlled trials involving 1283 patients were included in this review; 678 subjects were in the proton pump inhibitors (PPI) group and the remaining 605 subjects were in the H2 receptor antagonists (H2RA) group. The meta-analysis results revealed that after successful endoscopic therapy, compared with H2RA, PPI therapy had statistically significantly decreased the recurrent bleeding rate (OR = 0.36; 95%CI: 0.25-0.51) and receiving surgery rate (OR = 0.29; 95%CI: 0.09-0.96). There were no statistically significant differences in mortality (OR = 0.46; 95%CI: 0.17-1.23). However, significant heterogeneity was present in both the numbers of patients requiring blood transfusion after treatment [weighted mean difference (WMD), -0.70 unit; 95%CI: -1.64 - 0.25] and the time that patients remained hospitalized [WMD, -0.77 d; 95%CI: -1.87 - 0.34]. The Begg’s test (P = 0.283) and Egger’s test (P = 0.339) demonstrated that there was no publication bias in our meta-analysis. CONCLUSION: In patients with upper gastrointestinal bleeding after successful endoscopic therapy, compared with H2RA, PPI may be a more effective therapy. PMID:26034370

  1. Obscure gastrointestinal bleeding: diagnostic performance of 64-section multiphase CT enterography and CT angiography compared with capsule endoscopy

    PubMed Central

    He, B; Gong, S; Fan, J; Qian, J; Huang, S; Cui, L; Ji, Y

    2014-01-01

    Objective: To compare the diagnostic capabilities between capsule endoscopy (CE) and multislice CT (MSCT) enterography in combination with MSCT angiography for assessment of obscure gastrointestinal bleeding (OGIB). Methods: A total of 127 patients with OGIB were looked at in this study. 82 patients (aged 42.7?±?19.1 years; 34 males) were assigned to receive MSCT diagnosis and 67 patients to (aged 53.9?±?16.2 years; 28 males) receive CE diagnosis. Among them, 22 patients (aged 54.1?±?19.1 years; 12 males) received both examinations. Oral isotonic mannitol and intramuscular injection of anisodamine were performed; non-ionic contrast (iopromide, 370?mg?I?ml?1) was intravenously administered; and then multiphase scanning was conducted at arterial, small intestinal and portal venous phases in MSCT. The results were compared with findings of reference standards including double balloon enteroscopy, digital subtraction angiography, intraoperative pathological examination and/or clinical diagnosis. Results: Administration of anisodamine markedly increased the satisfaction rate of bowel filling (94.67% vs 28.57%; p??0.05). Among the 22 cases in whom both examinations were conducted, CE showed no significantly different diagnostic capability compared with MSCT (p?=?0.4597). Conclusion: Both CE and MSCT are safe and effective diagnostic methods for OGIB. Advances in knowledge: CE is preferred for overt bleeding or patients aged younger than 40 years. The combined use of CE and MSCT is recommended in OGIB diagnosis. PMID:25248830

  2. Fluorescence multi-scale endoscopy and its applications in the study and diagnosis of gastro-intestinal diseases: set-up design and software implementation

    NASA Astrophysics Data System (ADS)

    Gómez-García, Pablo Aurelio; Arranz, Alicia; Fresno, Manuel; Desco, Manuel; Mahmood, Umar; Vaquero, Juan José; Ripoll, Jorge

    2015-06-01

    Endoscopy is frequently used in the diagnosis of several gastro-intestinal pathologies as Crohn disease, ulcerative colitis or colorectal cancer. It has great potential as a non-invasive screening technique capable of detecting suspicious alterations in the intestinal mucosa, such as inflammatory processes. However, these early lesions usually cannot be detected with conventional endoscopes, due to lack of cellular detail and the absence of specific markers. Due to this lack of specificity, the development of new endoscopy technologies, which are able to show microscopic changes in the mucosa structure, are necessary. We here present a confocal endomicroscope, which in combination with a wide field fluorescence endoscope offers fast and specific macroscopic information through the use of activatable probes and a detailed analysis at cellular level of the possible altered tissue areas. This multi-modal and multi-scale imaging module, compatible with commercial endoscopes, combines near-infrared fluorescence (NIRF) measurements (enabling specific imaging of markers of disease and prognosis) and confocal endomicroscopy making use of a fiber bundle, providing a cellular level resolution. The system will be used in animal models exhibiting gastro-intestinal diseases in order to analyze the use of potential diagnostic markers in colorectal cancer. In this work, we present in detail the set-up design and the software implementation in order to obtain simultaneous RGB/NIRF measurements and short confocal scanning times.

  3. Detection of malignant lesions in vivo in the upper gastrointestinal tract using image-guided Raman endoscopy

    NASA Astrophysics Data System (ADS)

    Bergholt, Mads Sylvest; Zheng, Wei; Lin, Kan; Ho, Khek Yu; Yeoh, Khay Guan; Teh, Ming; So, Jimmy Bok Yan; Huang, Zhiwei

    2012-01-01

    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.

  4. ASGS: an alternative splicing graph web service.

    PubMed

    Bollina, Durgaprasad; Lee, Bernett T K; Tan, Tin Wee; Ranganathan, Shoba

    2006-07-01

    Alternative transcript diversity manifests itself a prime cause of complexity in higher eukaryotes. The Alternative Splicing Graph Server (ASGS) is a web service facilitating the systematic study of alternatively spliced genes of higher eukaryotes by generating splicing graphs for the compact visual representation of transcript diversity from a single gene. Taking a set of transcripts in General Feature Format as input, ASGS identifies distinct reference and variable exons, generates a transcript splicing graph, an exon summary, splicing events classification and a single line graph to facilitate experimental analysis. This freely available web service can be accessed at http://asgs.biolinfo.org. PMID:16845045

  5. Current status of core and advanced adult gastrointestinal endoscopy training in Canada: Survey of existing accredited programs

    PubMed Central

    Xiong, Xin; Barkun, Alan N; Waschke, Kevin; Martel, Myriam

    2013-01-01

    OBJECTIVE: To determine the current status of core and advanced adult gastroenterology training in Canada. METHODS: A survey consisting of 20 questions pertaining to core and advanced endoscopy training was circulated to 14 accredited adult gastroenterology residency program directors. For continuous variables, median and range were analyzed; for categorical variables, percentage and associated 95% CIs were analyzed. RESULTS: All 14 programs responded to the survey. The median number of core trainees was six (range four to 16). The median (range) procedural volumes for gastroscopy, colonoscopy, percutaneous endoscopic gastrostomy and sigmoidoscopy, respectively, were 400 (150 to 1000), 325 (200 to 1500), 15 (zero to 250) and 60 (25 to 300). Eleven of 13 (84.6%) programs used endoscopy simulators in their curriculum. Eight of 14 programs (57%) provided a structured advanced endoscopy training fellowship. The majority (88%) offered training of combined endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography. The median number of positions offered yearly for advanced endoscopy fellowship was one (range one to three). The median (range) procedural volumes for ERCP, endoscopic ultrasonography and endoscopic mucosal resection, respectively, were 325 (200 to 750), 250 (80 to 400) and 20 (10 to 63). None of the current programs offered training in endoscopic submucosal dissection or natural orifice transluminal endoscopic surgery. CONCLUSION: Most accredited adult Canadian gastroenterology programs met the minimal procedural requirements recommended by the Canadian Association of Gastroenterology during core training. However, a more heterogeneous experience has been observed for advanced training. Additional studies would be required to validate and standardize evaluation tools used during gastroenterology curricula. PMID:23712301

  6. Quality Metrics in Endoscopy

    PubMed Central

    Gurudu, Suryakanth R.

    2013-01-01

    Endoscopy has evolved in the past 4 decades to become an important tool in the diagnosis and management of many digestive diseases. Greater focus on endoscopic quality has highlighted the need to ensure competency among endoscopists. A joint task force of the American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy has proposed several quality metrics to establish competence and help define areas of continuous quality improvement. These metrics represent quality in endoscopy pertinent to pre-, intra-, and postprocedural periods. Quality in endoscopy is a dynamic and multidimensional process that requires continuous monitoring of several indicators and benchmarking with local and national standards. Institutions and practices should have a process in place for credentialing endoscopists and for the assessment of competence regarding individual endoscopic procedures. PMID:24711767

  7. Upper Gastrointestinal Symptoms Predictive of Candida Esophagitis and Erosive Esophagitis in HIV and Non-HIV Patients: An Endoscopy-Based Cross-Sectional Study of 6011 Patients.

    PubMed

    Takahashi, Yuta; Nagata, Naoyoshi; Shimbo, Takuro; Nishijima, Takeshi; Watanabe, Koji; Aoki, Tomonori; Sekine, Katsunori; Okubo, Hidetaka; Watanabe, Kazuhiro; Sakurai, Toshiyuki; Yokoi, Chizu; Mimori, Akio; Oka, Shinichi; Uemura, Naomi; Akiyama, Junichi

    2015-11-01

    Upper gastrointestinal (GI) symptoms are common in both HIV and non-HIV-infected patients, but the difference of GI symptom severity between 2 groups remains unknown. Candida esophagitis and erosive esophagitis, 2 major types of esophagitis, are seen in both HIV and non-HIV-infected patients, but differences in GI symptoms that are predictive of esophagitis between 2 groups remain unknown. We aimed to determine whether GI symptoms differ between HIV-infected and non-HIV-infected patients, and identify specific symptoms of candida esophagitis and erosive esophagitis between 2 groups.We prospectively enrolled 6011 patients (HIV, 430; non-HIV, 5581) who underwent endoscopy and completed questionnaires. Nine upper GI symptoms (epigastric pain, heartburn, acid regurgitation, hunger cramps, nausea, early satiety, belching, dysphagia, and odynophagia) were evaluated using a 7-point Likert scale. Associations between esophagitis and symptoms were analyzed by the multivariate logistic regression model adjusted for age, sex, and proton pump inhibitors.Endoscopy revealed GI-organic diseases in 33.4% (2010/6.011) of patients. The prevalence of candida esophagitis and erosive esophagitis was 11.2% and 12.1% in HIV-infected patients, respectively, whereas it was 2.9% and 10.7 % in non-HIV-infected patients, respectively. After excluding GI-organic diseases, HIV-infected patients had significantly (P?endoscopy-based study showed that HIV-infected patients have greater GI symptom scores compared with non-HIV-infected patients even after excluding GI-organic diseases. None of the upper GI symptoms predict candida esophagitis in HIV-infected patients, but dysphagia and odynophagia predict candida esophagitis in non-HIV-infected patients. Heartburn and acid regurgitation predict erosive esophagitis in both patient groups. PMID:26632738

  8. ASGS: an alternative splicing graph web service

    PubMed Central

    Bollina, Durgaprasad; Lee, Bernett T. K.; Tan, Tin Wee; Ranganathan, Shoba

    2006-01-01

    Alternative transcript diversity manifests itself a prime cause of complexity in higher eukaryotes. The Alternative Splicing Graph Server (ASGS) is a web service facilitating the systematic study of alternatively spliced genes of higher eukaryotes by generating splicing graphs for the compact visual representation of transcript diversity from a single gene. Taking a set of transcripts in General Feature Format as input, ASGS identifies distinct reference and variable exons, generates a transcript splicing graph, an exon summary, splicing events classification and a single line graph to facilitate experimental analysis. This freely available web service can be accessed at . PMID:16845045

  9. Editorial on the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) guideline on clinical indications for CT colonography in the colorectal cancer diagnosis.

    PubMed

    Laghi, Andrea; Neri, Emanuele; Regge, Daniele

    2015-11-01

    European Society of Gastrointestinal Endoscopy (ESGE)-European Society of Gastrointestinal and Abdominal Radiology (ESGAR) guideline was generated jointly by a team of researchers, including gastrointestinal radiologists and endoscopists, and represents the first full collaborative effort between the two specialties after years of turf battles involving CT colonography (CTC) and colonoscopy (CS). This guideline has a main educational purpose and it represents the attempt to find a consensus about the use of CTC in clinical practice based on the best current available evidence. Thus, it should not be considered as rules for establishing a legal standard of care. Main recommendations include the use of CTC as the radiological examination of choice for the diagnosis of colorectal neoplasia, the use of CTC in the case of incomplete CS, and the possible use of CTC as an acceptable and equally sensitive alternative for patients with symptoms suggestive of colorectal cancer (CRC), when CS is contraindicated or not possible. ESGE-ESGAR guideline does not recommend CTC for population screening, but considers that CTC may be proposed as a CRC screening test on an individual basis (opportunistic screening) provided the screenee is adequately informed about test characteristics, benefits and risks. With regard to patient management, referral for endoscopic polypectomy in patients with at least one polyp ?6 mm in diameter detected at CTC is recommended, considering surveillance only in case polyp removal is not possible. Knowledge about CTC is in continuous evolution and this means that a revision might be necessary in the future as new data appear. PMID:25863970

  10. Functional imaging and endoscopy

    PubMed Central

    Zhang, Jian-Guo; Liu, Hai-Feng

    2011-01-01

    The emergence of endoscopy for the diagnosis of gastrointestinal diseases and the treatment of gastrointestinal diseases has brought great changes. The mere observation of anatomy with the imaging mode using modern endoscopy has played a significant role in this regard. However, increasing numbers of endoscopies have exposed additional deficiencies and defects such as anatomically similar diseases. Endoscopy can be used to examine lesions that are difficult to identify and diagnose. Early disease detection requires that substantive changes in biological function should be observed, but in the absence of marked morphological changes, endoscopic detection and diagnosis are difficult. Disease detection requires not only anatomic but also functional imaging to achieve a comprehensive interpretation and understanding. Therefore, we must ask if endoscopic examination can be integrated with both anatomic imaging and functional imaging. In recent years, as molecular biology and medical imaging technology have further developed, more functional imaging methods have emerged. This paper is a review of the literature related to endoscopic optical imaging methods in the hopes of initiating integration of functional imaging and anatomical imaging to yield a new and more effective type of endoscopy. PMID:22090783

  11. Biophotonic endoscopy: a review of clinical research techniques for optical imaging and sensing of early gastrointestinal cancer

    PubMed Central

    Coda, Sergio; Siersema, Peter D.; Stamp, Gordon W. H.; Thillainayagam, Andrew V.

    2015-01-01

    Detection, characterization, and staging constitute the fundamental elements in the endoscopic diagnosis of gastrointestinal diseases, but histology still remains the diagnostic gold standard. New developments in endoscopic techniques may challenge histopathology in the near future. An ideal endoscopic technique should combine a wide-field, “red flag” screening technique with an optical contrast or microscopy method for characterization and staging, all simultaneously available during the procedure. In theory, biophotonic advances have the potential to unite these elements to allow in vivo “optical biopsy.” These techniques may ultimately offer the potential to increase the rates of detection of high risk lesions and the ability to target biopsies and resections, and so reduce the need for biopsy, costs, and uncertainty for patients. However, their utility and sensitivity in clinical practice must be evaluated against those of conventional histopathology. This review describes some of the most recent applications of biophotonics in endoscopic optical imaging and metrology, along with their fundamental principles and the clinical experience that has been acquired in their deployment as tools for the endoscopist. Particular emphasis has been placed on translational label-free optical techniques, such as fluorescence spectroscopy, fluorescence lifetime imaging microscopy (FLIM), two-photon and multi-photon microscopy, second harmonic generation (SHG) and third harmonic generation (THG) imaging, optical coherence tomography (OCT), diffuse reflectance, Raman spectroscopy, and molecular imaging. PMID:26528489

  12. Biophotonic endoscopy: a review of clinical research techniques for optical imaging and sensing of early gastrointestinal cancer.

    PubMed

    Coda, Sergio; Siersema, Peter D; Stamp, Gordon W H; Thillainayagam, Andrew V

    2015-10-01

    Detection, characterization, and staging constitute the fundamental elements in the endoscopic diagnosis of gastrointestinal diseases, but histology still remains the diagnostic gold standard. New developments in endoscopic techniques may challenge histopathology in the near future. An ideal endoscopic technique should combine a wide-field, "red flag" screening technique with an optical contrast or microscopy method for characterization and staging, all simultaneously available during the procedure. In theory, biophotonic advances have the potential to unite these elements to allow in vivo "optical biopsy." These techniques may ultimately offer the potential to increase the rates of detection of high risk lesions and the ability to target biopsies and resections, and so reduce the need for biopsy, costs, and uncertainty for patients. However, their utility and sensitivity in clinical practice must be evaluated against those of conventional histopathology. This review describes some of the most recent applications of biophotonics in endoscopic optical imaging and metrology, along with their fundamental principles and the clinical experience that has been acquired in their deployment as tools for the endoscopist. Particular emphasis has been placed on translational label-free optical techniques, such as fluorescence spectroscopy, fluorescence lifetime imaging microscopy (FLIM), two-photon and multi-photon microscopy, second harmonic generation (SHG) and third harmonic generation (THG) imaging, optical coherence tomography (OCT), diffuse reflectance, Raman spectroscopy, and molecular imaging. PMID:26528489

  13. Short message service (SMS) can enhance compliance and reduce cancellations in a sedation gastrointestinal endoscopy center: a prospective randomized controlled trial.

    PubMed

    Deng, Xiaoqian; Wang, Yuting; Zhu, Tao; Zhang, WeiYi; Yin, Yan; Ye, Ling

    2015-01-01

    Many outpatients who inadequately prepared for the procedure were cancelled on the day of the examination for various reasons. The aim of study was to investigate whether short message service (SMS) can improve patients' compliance and reduce cancellation rates. Outpatients scheduled for sedation gastrointestinal endoscopy were randomly assigned to mobile phone SMS group or control group. Patients in the control group received a leaflet on preparation instructions, while patients in the SMS group received SMS reminders after making an appointment. A total of 1786 patients were analyzed. There was a significant reduction in the rate of cancellations for patients in the SMS group (4.8%) compared with patients in the control group (8.0%) (P<0.001). Patients in the SMS group were 40% less likely to be cancelled by medical staff than patients in the control group. The compliance score of the two groups based on demographic and clinic characteristic distribution showed that for both male and female patients, the compliance score was higher in the SMS group than that in the control group (P=0.023, P<0.001, respectively). Additionally, the compliance score was also significantly higher in the SMS group among patients who were under 50 years old, less than an undergraduate education level, experiencing their first time for procedure, or whose procedures were gastroscopy, waiting time was between 4 and 15 days, and schedules were in morning (P?0.032). SMS reminders can be considered a complement to conventional preparation instructions, which could help improve the compliance of outpatients and reduce the rate of cancellations. PMID:25476268

  14. Clinical applications of small bowel capsule endoscopy

    PubMed Central

    Kopylov, Uri; Seidman, Ernest G

    2013-01-01

    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. PMID:23983481

  15. Nasal endoscopy

    MedlinePLUS

    Nasal endoscopy is a test to view the inside of the nose and sinus to check for problems. ... You may have a nasal endoscopy to figure out what is causing problems in your nose and sinuses. During the procedure, your provider may: Look at the ...

  16. American Society for Gastrointestinal Endoscopy

    MedlinePLUS

    ... EDUCATION EndoFest Digestive Disease Week Online Learning Center STAR Certificate Programs Maintenance of Certification (MOC) Course Calendar ... DC Early Bird Rate Ends January 28! EMR STAR Certificate Program—Lower GI February 27-28, 2016, ...

  17. Training and Assessment in Pediatric Endoscopy.

    PubMed

    Walsh, Catharine M

    2016-01-01

    A key aspect of pediatric gastroenterology practice is the ability to perform endoscopy procedures safely, effectively, and efficiently. Similar to adult endoscopy, performance of pediatric endoscopy requires the acquisition of related technical, cognitive, and integrative competencies to effectively diagnose and manage gastrointestinal disorders in children. However, the distinctive requirements of pediatric patients and their families and the differential spectrum of disease highlight the need for a pediatric-specific training curriculum and assessment framework to ensure endoscopic procedures are performed safely and successfully in children. This review outlines the current state of evidence as it pertains to pediatric endoscopy training and assessment. PMID:26616894

  18. CASS—CFEL-ASG software suite

    NASA Astrophysics Data System (ADS)

    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

    2012-10-01

    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) [6]. 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 summary Program title: CASS Catalogue identifier: AEMP_v1_0 Program summary URL: http://cpc.cs.qub.ac.uk/summaries/AEMP_v1_0.html Program obtainable from: CPC Program Library, Queen's University, Belfast, N. Ireland Licensing provisions: GNU General Public Licence, version 3 No. of lines in distributed program, including test data, etc.: 167073 No. of bytes in distributed program, including test data, etc.: 1065056 Distribution format: tar.gz Programming language: C++. Computer: Intel x86-64. Operating system: GNU/Linux (for information about restrictions see outlook). RAM: >8 GB Classification: 2.3, 3, 15, 16.4. External routines: Qt-Framework[1], SOAP[2], (optional HDF5[3], VIGRA[4], ROOT[5], QWT[6]) Nature of problem: Analysis and visualisation of scientific data acquired at Free-Electron-Lasers Solution 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 program Additional comments: An updated extensive documentation of CASS is available at [7]. Running time: Depending on the data size and complexity of analysis algorithms. References: [1] http://qt.nokia.com [2] http://www.cs.fsu.edu/~engelen/soap.html [3] http://www.hdfgroup.org/HDF5/ [4] http://hci.iwr.uni-heidelberg.de/vigra/ [5] http://root.cern.ch [6] http://qwt.sourceforge.net/ [7] http://www.mpi-hd.mpg.de/personalhomes/gitasg/cass

  19. Photometric stereo endoscopy

    PubMed Central

    Parot, Vicente; Lim, Daryl; González, Germán; Traverso, Giovanni; Nishioka, Norman S.; Vakoc, Benjamin J.

    2013-01-01

    Abstract. While color video endoscopy has enabled wide-field examination of the gastrointestinal tract, it often misses or incorrectly classifies lesions. Many of these missed lesions exhibit characteristic three-dimensional surface topographies. An endoscopic system that adds topographical measurements to conventional color imagery could therefore increase lesion detection and improve classification accuracy. We introduce photometric stereo endoscopy (PSE), a technique which allows high spatial frequency components of surface topography to be acquired simultaneously with conventional two-dimensional color imagery. We implement this technique in an endoscopic form factor and demonstrate that it can acquire the topography of small features with complex geometries and heterogeneous optical properties. PSE imaging of ex vivo human gastrointestinal tissue shows that surface topography measurements enable differentiation of abnormal shapes from surrounding normal tissue. Together, these results confirm that the topographical measurements can be obtained with relatively simple hardware in an endoscopic form factor, and suggest the potential of PSE to improve lesion detection and classification in gastrointestinal imaging. PMID:23864015

  20. Upper Gastrointestinal Hemorrhage—Diagnosis and Management

    PubMed Central

    Midgley, Robert C.; Cantor, David

    1977-01-01

    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. PMID:335664

  1. Setting up the Pediatric Endoscopy Unit.

    PubMed

    Lerner, Diana G; Pall, Harpreet

    2016-01-01

    As pediatric gastrointestinal endoscopy continues to develop and evolve, pediatric gastroenterologists are more frequently called on to develop and direct a pediatric endoscopy unit. Lack of published literature and focused training in fellowship can render decision making about design, capacity, operation, equipment purchasing, and staffing challenging. To help guide management decisions, we distributed a short survey to 18 pediatric gastroenterology centers throughout the United States and Canada. This article provides practical guidance by summarizing available expert opinions on the topic of setting up a pediatric endoscopy unit. PMID:26616893

  2. Capsule endoscopy

    MedlinePLUS

    ... cameras, a light bulb, a battery, and a radio transmitter. It is about the size of a ... the way through the digestive (gastrointestinal) tract. The radio transmitter sends the photos to a recorder the ...

  3. Use of the Complete Rockall Score and the Forrest Classification to Assess Outcome in Patients with Non-variceal Upper Gastrointestinal Bleeding Subject to After-hours Endoscopy: A Retrospective Cohort Study

    PubMed Central

    Giese, A; Grunwald, C; Zieren, J; Büchner, NJ; Henning, BF

    2014-01-01

    Objectives: To evaluate the usefulness of the Forrest classification and the complete Rockall score with customary cut-off values for assessing the risk of adverse events in patients with upper gastrointestinal bleeding (UGI-B) subject to after-hours emergency oesophago-gastro-duodenoscopy (E-EGD) within six hours after admission. Methods: The medical records of patients with non-variceal UGI-B proven by after-hours endoscopy were analysed. For 'high risk' situations (Forrest stage Ia–IIb/complete Rockall score > 2), univariate analysis was conducted to evaluate odds ratio for reaching the study endpoints (30-day and one-year mortality, re-bleeding, hospital stay ? 3 days). Results: During the study period (75 months), 86 cases (85 patients) met the inclusion criteria. Patients 'age was 66.36 ± 14.38 years; 60.5% were male. Mean duration of hospital stay was 15.21 ± 19.24 days. Mortality rate was 16.7% (30 days) and 32.9% (one year); 14% of patients re-bled. Univariate analysis of post-endoscopic Rockall score ? 2 showed an odds ratio of 6.09 for death within 30 days (p = 0.04). No other significant correlations were found. Conclusion: In patients with UGI-B subject to after-hours endoscopy, a 'high-risk' Rockall score permits an estimation of the risk of death within 30 days but not of re-bleeding. A 'high-risk ' Forrest score is not significantly associated with the study endpoints. PMID:25303191

  4. Understanding Capsule Endoscopy

    MedlinePLUS

    ... Education Videos Questions to Ask Your MD Endoscopy Unit Recognition Program Screen4coloncancer.org About Colonoscopy Facts About Common Colon Cancer Screening Tests PATIENTS Understanding Capsule Endoscopy What is Capsule Endoscopy? ...

  5. The AIMS65 Score Is a Useful Predictor of Mortality in Patients with Nonvariceal Upper Gastrointestinal Bleeding: Urgent Endoscopy in Patients with High AIMS65 Scores

    PubMed Central

    Park, Sun Wook; Song, Young Wook; Tak, Dae Hyun; Ahn, Byung Moo; Kang, Sun Hyung; Moon, Hee Seok; Sung, Jae Kyu; Jeong, Hyun Yong

    2015-01-01

    Background/Aims: To validate the AIMS65 score for predicting mortality of patients with nonvariceal upper gastrointestinal bleeding and to evaluate the effectiveness of urgent (<8 hours) endoscopic procedures in patients with high AIMS65 scores. Methods: This was a 5-year single-center, retrospective study. Nonvariceal, upper gastrointestinal bleeding was assessed by using the AIM65 and Rockall scores. Scores for mortality were assessed by calculating the area under the receiver-operating characteristic curve (AUROC). Patients with high AIMS65 scores (?2) were allocated to either the urgent or non-urgent endoscopic procedure group. In-hospital mortality, success of endoscopic procedure, recurrence of bleeding, admission period, and dose of transfusion were compared between groups. Results: A total of 634 patients were analyzed. The AIMS65 score successfully predicted mortality (AUROC=0.943; 95% confidence interval [CI], 0.876 to 0.99) and was superior to the Rockall score (AUROC=0.856; 95% CI, 0.743 to 0.969) in predicting mortality. The group with high AIMS65 score included 200 patients. The urgent endoscopic procedure group had reduced hospitalization periods (p<0.05) Conclusions: AIMS65 score may be useful in predicting mortality in patients with nonvariceal upper gastrointestinal bleeding. Urgent endoscopic procedures in patients with high scores may be related to reduced hospitalization periods. PMID:26668799

  6. The future of wireless capsule endoscopy

    PubMed Central

    Swain, Paul

    2008-01-01

    We outline probable and possible developments with wireless capsule endoscopy. It seems likely that capsule endoscopy will become increasingly effective in diagnostic gastrointestinal endoscopy. This will be attractive to patients especially for cancer or varices detection because capsule endoscopy is painless and is likely to have a higher take up rate compared to conventional colonoscopy and gastroscopy. Double imager capsules with increased frame rates have been used to image the esophagus for Barrett’s and esophageal varices. The image quality is not bad but needs to be improved if it is to become a realistic substitute for flexible upper and lower gastrointestinal endoscopy. An increase in the frame rate, angle of view, depth of field, image numbers, duration of the procedure and improvements in illumination seem likely. Colonic, esophageal and gastric capsules will improve in quality, eroding the supremacy of flexible endoscopy, and become embedded into screening programs. Therapeutic capsules will emerge with brushing, cytology, fluid aspiration, biopsy and drug delivery capabilities. Electrocautery may also become possible. Diagnostic capsules will integrate physiological measurements with imaging and optical biopsy, and immunologic cancer recognition. Remote control movement will improve with the use of magnets and/or electrostimulation and perhaps electromechanical methods. External wireless commands will influence capsule diagnosis and therapy and will increasingly entail the use of real-time imaging. However, it should be noted that speculations about the future of technology in any detail are almost always wrong. PMID:18636658

  7. Easy to swallow: detection of an extramural jejunal GIST by video capsule endoscopy.

    PubMed

    Kauser, Ricky; Kazemi, Ali; Farah, Katie; Morrissey, Suzanne

    2015-01-01

    We report a case of a 57-year-old woman with an obscure gastrointestinal bleed who was found to have an extramural gastrointestinal stromal tumour (GIST), detected by capsule endoscopy, and confirmed by laparoscopically-assisted enteroscopy and resection. Currently, major modalities used for detection of GISTs include double-balloon enteroscopy, capsule endoscopy and CT. Endoscopic measures, including capsule endoscopy, are limited in their ability to detect GISTs with extramural growth, as these typically do not demonstrate obvious luminal abnormalities. This case report illustrates a case in which an extraluminal GIST causing recurrent gastrointestinal bleeding presented as an ulcer, as seen on capsule endoscopy. PMID:26459493

  8. Asymptomatic Gallstones (AsGS) - To Treat or Not to?

    PubMed

    Behari, Anu; Kapoor, V K

    2012-02-01

    With ready availability of abdominal ultrasound, asymptomatic gallstones (AsGS) are being diagnosed with increasing frequency. Management decisions need to take into account the natural history of AsGS as well as the risks of cholecystectomy. Long-term follow up studies from the West have consistently shown that only a small minority of asymptomatic gallstones lead to development of symptoms or complications. Some sub-groups of patients (eg those with chronic hemolytic syndromes) have been shown to be at a higher risk of developing symptoms and complications and prophylactic cholecystectomy has been advised for them. Clear division of patients into low or high risk categories is still far from ideal and better identification of risk factors and risk stratification is needed. Overall, both open and laparoscopic cholecystectomy, are generally safe procedures. However, the incidence of bile duct injury (with all its serious consequences) continues to be higher with laparoscopic cholecystectomy and this should receive due consideration before offering prophylactic cholecystectomy to an asymptomatic patient who is not expected to receive any clinical benefit from it. Gallbladder cancer is rare in most of the developed world and prophylactic cholecystectomy has generally not been recommended to prevent development of GBC. Considering the wide geographical/ethnic variation in incidence of GBC across the world and the strong association of GBC with gallstones, it may not be prudent to extrapolate the results of studies of natural history of AsGS from one part of the world to another. Since northern India has one of the highest incidences of GBC in the world, it is imperative to have data on natural history of AsGS in patients from this area to allow formulation of precise guidelines for management of AsGs. PMID:23372301

  9. Respiratory distress during endoscopy--report of an unusual case.

    PubMed

    Narendranathan, M; Kalam, A

    1987-09-01

    A 30 year old man developed severe respiratory distress during upper gastrointestinal endoscopy. He had a short oesophagus and part of the stomach was intrathoracic. Air-insufflation during endoscopy caused distension of the stomach inside the chest leading to respiratory distress. When part of the stomach is intrathoracic, the endoscopist should be cautious and the possibility of respiratory embarrassment kept in mind during air-insufflation. PMID:3444807

  10. Asg1 is a stress-inducible gene which increases stomatal resistance in salt stressed potato

    PubMed Central

    Batelli, Giorgia; Massarelli, Immacolata; Van Oosten, Michael; Nurcato, Roberta; Vannini, Candida; Raimondi, Giampaolo; Leone, Antonella; Zhu, Jian-Kang; Maggio, Albino; Grillo, Stefania

    2013-01-01

    The identification of critical components in plant salt stress adaptation has greatly benefitted, in the last two decades, from fundamental discoveries in Arabidopsis and close model systems. Nevertheless, this approach has also highlighted a non-complete overlap between stress tolerance mechanisms in Arabidopsis and agricultural crops. Within a long-running research program aimed at identifying salt stress genetic determinants in potato by functional screening in Escherichia coli, we isolated Asg1, a stress-related gene with an unknown function. Asg1 is induced by salt stress in both potato and Arabidopsis and by abscisic acid in Arabidopsis. Asg1 is actively transcribed in all plant tissues. Furthermore, Asg1 promoter analysis confirmed its ubiquitous expression, which was remarkable in pollen, a plant tissue that undergoes drastic dehydration/hydration processes. Fusion of Asg1 with green fluorescent protein showed that the encoded protein is localized close to the plasma membrane with a non-continuous pattern of distribution. In addition, Arabidopsis knockout asg1 mutants were insensitive to both NaCl and sugar hyperosmotic environments during seed germination. Transgenic potato plants over-expressing the Asg1 gene revealed a stomatal hypersensitivity to NaCl stress which, however, did not result in a significantly improved tuber yield in stress conditions. Altogether, these data suggest that Asg1 might interfere with components of the stress signaling pathway by promoting stomatal closure and participating in stress adaptation. PMID:22854180

  11. Therapeutic ERCP

    MedlinePLUS

    ... order form. ASGE - The Source for Colonoscopy and Endoscopy IMPORTANT REMINDER: The preceding information is intended only ... Contact Us Copyright © 2015 American Society for Gastrointestinal Endoscopy 3300 Woodcreek Dr. • Downers Grove, IL 60515

  12. Quantitative measurements in capsule endoscopy.

    PubMed

    Keuchel, M; Kurniawan, N; Baltes, P; Bandorski, D; Koulaouzidis, A

    2015-10-01

    This review summarizes several approaches for quantitative measurement in capsule endoscopy. Video capsule endoscopy (VCE) typically provides wireless imaging of small bowel. Currently, a variety of quantitative measurements are implemented in commercially available hardware/software. The majority is proprietary and hence undisclosed algorithms. Measurement of amount of luminal contamination allows calculating scores from whole VCE studies. Other scores express the severity of small bowel lesions in Crohn?s disease or the degree of villous atrophy in celiac disease. Image processing with numerous algorithms of textural and color feature extraction is further in the research focuses for automated image analysis. These tools aim to select single images with relevant lesions as blood, ulcers, polyps and tumors or to omit images showing only luminal contamination. Analysis of motility pattern, size measurement and determination of capsule localization are additional topics. Non-visual wireless capsules transmitting data acquired with specific sensors from the gastrointestinal (GI) tract are available for clinical routine. This includes pH measurement in the esophagus for the diagnosis of acid gastro-esophageal reflux. A wireless motility capsule provides GI motility analysis on the basis of pH, pressure, and temperature measurement. Electromagnetically tracking of another motility capsule allows visualization of motility. However, measurement of substances by GI capsules is of great interest but still at an early stage of development. PMID:26299419

  13. Gastrointestinal hemorrhage: evaluation with MDCT.

    PubMed

    Soto, Jorge A; Park, Seong Ho; Fletcher, Joel G; Fidler, Jeff L

    2015-06-01

    Gastrointestinal (GI) bleeding is a common medical problem, with high associated morbidity and mortality. The clinical presentation of gastrointestinal hemorrhage varies with the location of the bleeding source, the intensity of the bleed, and the presence of comorbidities that affect the ability to tolerate blood loss. Conventional endoscopic examinations are usually the initial diagnostic tests in patients presenting with overt gastrointestinal hemorrhage. However, implementation of upper tract endoscopy and colonoscopy in the emergency setting can be challenging due to inconsistent availability of the service and difficulties in achieving adequate colonic cleansing in emergent situations. Thus, imaging tests are often relied upon to establish the location and the cause of bleeding, either for initial diagnosis or after non-revealing upper and lower tract endoscopies ("obscure" bleeding). This article discusses the imaging evaluation of patients with gastrointestinal bleeding and reviews the imaging appearance of the most common causes, taking into account the two most relevant clinical presentations: overt bleeding and obscure bleeding. PMID:25637128

  14. Management of gastrointestinal hemorrhage.

    PubMed Central

    Hilsden, R. J.; Shaffer, E. A.

    1995-01-01

    Acute gastrointestinal hemorrhage is a common problem that requires prompt recognition and management to prevent serious morbidity and mortality. Management goals are stabilization of the patient with vigorous fluid resuscitation followed by investigation and definitive treatment of the bleeding source. Endoscopy is often the initial diagnostic test and allows therapeutic measures to be performed at the same time. Images Figure 1 Figure 2 PMID:8563510

  15. Contribution of endoscopy to early diagnosis of hypertrophic pyloric stenosis.

    PubMed

    De Backer, A; Bové, T; Vandenplas, Y; Peeters, S; Deconinck, P

    1994-01-01

    The diagnostic accuracy of ultrasonography and gastrointestinal endoscopy was compared in 63 infants who were operated on for infantile hypertrophic pyloric stenosis. Endoscopy was far more accurate than ultrasonography, the diagnosis being made in 97 and 81% of the cases, respectively. The difference between the techniques was even more obvious in the younger patients and in those with a short history of vomiting. The ability to detect coexistent or other causes of vomiting with endoscopy appeared advantageous. The endoscopic procedure is easily done without general anesthesia and was without complications in our series. We recommend endoscopy as an important tool in very young patients with few clinical signs other than vomiting, allowing for appropriate treatment without delay. PMID:8126622

  16. Sedation for Your Endoscopy

    MedlinePLUS

    ... blood” such as Coumadin, Lovenox, Heparin, and Plavix yes | no Any type of medicine that is used for diabetes ( ... the past? yes | no Are you allergic to any medicines? yes | no If you had an endoscopy before, were ...

  17. The Myxococcus xanthus asgA gene encodes a novel signal transduction protein required for multicellular development.

    PubMed Central

    Plamann, L; Li, Y; Cantwell, B; Mayor, J

    1995-01-01

    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

  18. Endoscopic Evaluation of Swallowing (Endoscopy)

    MedlinePLUS

    ... Language and Swallowing / Swallowing Endoscopic Evaluation of Swallowing (Endoscopy) Do you have problems swallowing? You may have ... test done. Some names you might hear are: Endoscopy Endoscopic Evaluation of swallowing FEES (Fiberoptic Endoscopic Evaluation ...

  19. Towards CARS Endoscopy Franois Lgar*

    E-print Network

    Xie, Xiaoliang Sunney

    Towards CARS Endoscopy François Légaré* Center for Nanoscale Systems and Department of Chemistry provide a proof-of-principle demonstration of CARS endoscopy. The design utilizes a single mode optical characteristics at intensities needed for endoscopy. CARS endoscopic images are recorded by collecting the epi-CARS

  20. Lower Gastrointestinal Bleeding in Children.

    PubMed

    Sahn, Benjamin; Bitton, Samuel

    2016-01-01

    This article provides an overview of the evaluation and management of lower gastrointestinal bleeding (LGIB) in children. The common etiologies at different ages are reviewed. Conditions with endoscopic importance for diagnosis or therapy include solitary rectal ulcer syndrome, polyps, vascular lesions, and colonic inflammation and ulceration. Diagnostic modalities for identifying causes of LGIB in children include endoscopy and colonoscopy, cross-sectional and nuclear medicine imaging, video capsule endoscopy, and enteroscopy. Pre-endoscopic preparation and decision-making unique to pediatrics is highlighted. The authors conclude with a summary of current and emerging therapeutic hemostatic techniques that can be used in pediatric patients. PMID:26616898

  1. Recent advances in photoacoustic endoscopy

    PubMed Central

    Yoon, Tae-Jong; Cho, Young-Seok

    2013-01-01

    Imaging based on photoacoustic effect relies on illuminating with short light pulses absorbed by tissue absorbers, resulting in thermoelastic expansion, giving rise to ultrasonic waves. The ultrasonic waves are then detected by detectors placed around the sample. Photoacoustic endoscopy (PAE) is one of four major implementations of photoacoustic tomography that have been developed recently. The prototype PAE was based on scanning mirror system that deflected both the light and the ultrasound. A recently developed mini-probe was further miniaturized, and enabled simultaneous photoacoustic and ultrasound imaging. This PAE-endoscopic ultrasound (EUS) system can offer high-resolution vasculature information in the gastrointestinal (GI) tract and display differences between optical and mechanical contrast compared with single-mode EUS. However, PAE for endoscopic GI imaging is still at the preclinical stage. In this commentary, we describe the technological improvements in PAE for possible clinical application in endoscopic GI imaging. In addition, we discuss the technical details of the ultrasonic transducer incorporated into the photoacoustic endoscopic probe. PMID:24255745

  2. Capsule endoscopy: Current practice and future directions

    PubMed Central

    Hale, Melissa F; Sidhu, Reena; McAlindon, Mark E

    2014-01-01

    Capsule endoscopy (CE) has transformed investigation of the small bowel providing a non-invasive, well tolerated means of accurately visualising the distal duodenum, jejunum and ileum. Since the introduction of small bowel CE thirteen years ago a high volume of literature on indications, diagnostic yields and safety profile has been presented. Inclusion in national and international guidelines has placed small bowel capsule endoscopy at the forefront of investigation into suspected diseases of the small bowel. Most commonly, small bowel CE is used in patients with suspected bleeding or to identify evidence of active Crohn’s disease (CD) (in patients with or without a prior history of CD). Typically, CE is undertaken after upper and lower gastrointestinal flexible endoscopy has failed to identify a diagnosis. Small bowel radiology or a patency capsule test should be considered prior to CE in those at high risk of strictures (such as patients known to have CD or presenting with obstructive symptoms) to reduce the risk of capsule retention. CE also has a role in patients with coeliac disease, suspected small bowel tumours and other small bowel disorders. Since the advent of small bowel CE, dedicated oesophageal and colon capsule endoscopes have expanded the fields of application to include the investigation of upper and lower gastrointestinal disorders. Oesophageal CE may be used to diagnose oesophagitis, Barrett’s oesophagus and varices but reliability in identifying gastroduodenal pathology is unknown and it does not have biopsy capability. Colon CE provides an alternative to conventional colonoscopy for symptomatic patients, while a possible role in colorectal cancer screening is a fascinating prospect. Current research is already addressing the possibility of controlling capsule movement and developing capsules which allow tissue sampling and the administration of therapy. PMID:24976712

  3. Endoscopy in screening for digestive cancer.

    PubMed

    Lambert, René

    2012-12-16

    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. PMID:23293721

  4. Confocal laser endomicroscopy for gastrointestinal diseases.

    PubMed

    Kiesslich, Ralf; Goetz, Martin; Neurath, Markus F

    2008-07-01

    Confocal laser endomicroscopy enables in vivo microscopy of the mucosal layer of the gastrointestinal tract with subcellular resolution during ongoing endoscopy. Endomicroscopy opens the door to immediate tissue and vessel analysis. Different types of diseases can be diagnosed with optical surface and subsurface analysis. Analysis of the in vivo microarchitecture can be used for targeting biopsies to relevant areas, and subsurface imaging can unmask microscopic diseases or bacterial infection. Molecular imaging is becoming feasible, which will enable new indications in gastrointestinal endoscopy. This article reviews the current and rapidly expanding clinical data on endomicroscopy and gives a look into future research. PMID:18674696

  5. A Review of Current Disinfectants for Gastrointestinal Endoscopic Reprocessing

    PubMed Central

    Park, Sanghoon; Koo, Ja Seol; Park, Jeong Bae; Lim, Yun Jeong; Hong, Su Jin; Kim, Sang-Woo; Chun, Hoon Jai

    2013-01-01

    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. PMID:23964330

  6. UC Survey Register 2014 ASG Updated 09 March 2015 Survey Register 2014

    E-print Network

    Hickman, Mark

    UC ­ Survey Register 2014 ­ ASG ­ Updated 09 March 2015 Survey Register 2014 Date/ Month Unit / Owner /sponsor Survey Description Details Freq. Links to output Feb Satisfaction Survey Cancelled for 2014, replaced by U-Count survey Annual na 25 May to 27 June UC Hamish

  7. The Past, Present, and Future of Image-Enhanced Endoscopy

    PubMed Central

    Jang, Jae-Young

    2015-01-01

    Despite the remarkable progress recently made to enhance the resolution of white-light endoscopy, detection, and diagnosis of premalignant lesions, such as adenomas and subtle early-stage cancers, remains a great challenge. As for example, although chromoendoscopy, such as endoscopy using indigo carmine, is useful for the early diagnosis of subtle lesions, the technique presents various disadvantages ranging from the time required for spray application of the dye and suctioning of excess dye to the increased difficulty in identifying lesions in the presence of severe inflammation and obstruction of visual field due to the pooling of solution in depressed-type lesions. To overcome these diagnostic problems associated with chromoendoscopy, research has focused on the development of endoscopes based on new optical technologies. Several types of image-enhanced endoscopy methods have recently been presented. In particular, image-enhanced endoscopy has emerged as a new paradigm for the diagnosis of gastrointestinal disorders. Image-enhanced endoscopes provide high-contrast images of lesions by means of optical or electronic technologies, including the contrast enhancement of the mucosal surface and of blood vessels. Chromoendoscopy, narrow-band imaging, i-SCAN, and flexible spectral imaging color enhancement are representative examples of image-enhanced endoscopy discussed in this paper. PMID:26668791

  8. The Past, Present, and Future of Image-Enhanced Endoscopy.

    PubMed

    Jang, Jae-Young

    2015-11-01

    Despite the remarkable progress recently made to enhance the resolution of white-light endoscopy, detection, and diagnosis of premalignant lesions, such as adenomas and subtle early-stage cancers, remains a great challenge. As for example, although chromoendoscopy, such as endoscopy using indigo carmine, is useful for the early diagnosis of subtle lesions, the technique presents various disadvantages ranging from the time required for spray application of the dye and suctioning of excess dye to the increased difficulty in identifying lesions in the presence of severe inflammation and obstruction of visual field due to the pooling of solution in depressed-type lesions. To overcome these diagnostic problems associated with chromoendoscopy, research has focused on the development of endoscopes based on new optical technologies. Several types of image-enhanced endoscopy methods have recently been presented. In particular, image-enhanced endoscopy has emerged as a new paradigm for the diagnosis of gastrointestinal disorders. Image-enhanced endoscopes provide high-contrast images of lesions by means of optical or electronic technologies, including the contrast enhancement of the mucosal surface and of blood vessels. Chromoendoscopy, narrow-band imaging, i-SCAN, and flexible spectral imaging color enhancement are representative examples of image-enhanced endoscopy discussed in this paper. PMID:26668791

  9. Role of Clinical Endoscopy in Emphasizing Endoscope Disinfection

    PubMed Central

    Ryu, Ji Kon; Kim, Eun Young; Kwon, Kwang An; Choi, Il Ju

    2015-01-01

    Based on the unexpected Middle East respiratory syndrome (MERS) outbreak in Korea, it was established that the virus can spread easily, MERS exposure in hospitals carries an extreme risk for infection as well as mortality, and the sharing of information was essential for infection control. Although the incidence of exogenous infections related to contaminated endoscopes is very low, the majority of published outbreaks have been caused by various shortcomings in reprocessing procedures, including insufficient training or awareness. Ever since the inauguration of "Clinical Endoscopy" as an English-language journal of the Korean Society of Gastrointestinal Endoscopy in 2011, it has published several articles on disinfection of the endoscope and its accessories. Many Science Citation Index journals have also emphasized high-level disinfection of the gastrointestinal endoscope. Many papers have been produced specifically, since the outbreak of carbapenem-resistant Enterobacteriaceae in 2013. The recent review papers concluded that quality control is the most important issue among all the aspects of procedural care, including the efficiency of the gastrointestinal endoscopy unit and reprocessing room. Thorough reprocessing of endoscopes using high-level disinfection and sterilization methods may be essential for reducing the risk of infection. PMID:26473114

  10. Role of Clinical Endoscopy in Emphasizing Endoscope Disinfection.

    PubMed

    Ryu, Ji Kon; Kim, Eun Young; Kwon, Kwang An; Choi, Il Ju; Hahm, Ki Baik

    2015-09-01

    Based on the unexpected Middle East respiratory syndrome (MERS) outbreak in Korea, it was established that the virus can spread easily, MERS exposure in hospitals carries an extreme risk for infection as well as mortality, and the sharing of information was essential for infection control. Although the incidence of exogenous infections related to contaminated endoscopes is very low, the majority of published outbreaks have been caused by various shortcomings in reprocessing procedures, including insufficient training or awareness. Ever since the inauguration of "Clinical Endoscopy" as an English-language journal of the Korean Society of Gastrointestinal Endoscopy in 2011, it has published several articles on disinfection of the endoscope and its accessories. Many Science Citation Index journals have also emphasized high-level disinfection of the gastrointestinal endoscope. Many papers have been produced specifically, since the outbreak of carbapenem-resistant Enterobacteriaceae in 2013. The recent review papers concluded that quality control is the most important issue among all the aspects of procedural care, including the efficiency of the gastrointestinal endoscopy unit and reprocessing room. Thorough reprocessing of endoscopes using high-level disinfection and sterilization methods may be essential for reducing the risk of infection. PMID:26473114

  11. Colon capsule endoscopy.

    PubMed

    Spada, Cristiano; Hassan, Cesare; Costamagna, Guido

    2015-04-01

    Colon capsule endoscopy (CCE) is a minimally invasive technique specifically designed to explore the colon without sedation and air insufflation. CCE may overcome some of the limitations of colonoscopy. Second-generation CCE (CCE-2) was proved accurate in detecting colonic neoplastic lesions when used in average-risk individuals. The evidence to date supports the use of CCE-2 in cases of colonoscopy failure, in patients unwilling to undergo colonoscopy, and when colonoscopy is contraindicated. Other potential applications, such as colorectal cancer screening or diagnostic surveillance of inflammatory bowel disease, require clarification. PMID:25839692

  12. Can Gastrointestinal Carcinoid Tumors Be Found Early?

    MedlinePLUS

    ... may also be found when parts of the gastrointestinal system are removed to treat other diseases. For example, a person with stomach pain or bleeding may have a test called an upper endoscopy to look for an ... Tumors? Causes, Risk Factors, and Prevention Early ...

  13. Electronic imaging in endoscopy.

    PubMed

    Berci, G; Paz-Partlow, M

    1988-01-01

    Endoscopy evolved from a hollow tube view of visually restricted areas into an expansive, distal representation of the anatomy. Rod lens telescopes, improved coherent imaging bundles, superior light sources, and other optical advances enhanced endoscopic observations. Yet complicated endoscopic procedures remained visible to the endoscopist alone, relegating assistance and consultation to verbal description of sophisticated visual observation. Instrumentational advances alone did not promote three crucial elements: participation, cooperation and documentation. The importance of these elements has increased with the need for coordinated assistance in complex operative endoscopic manipulations, as well as in a visual record for improved documentation and consultation. New imaging technologies are supplanting the unwieldy, often daunting equipment once required for photodocumentation. The charged couple device (CCD) 2/3 and 1/2 in. "chip" video camera miniaturization provides nearly weightless TV coobservation. Distal chip placement has created the "video endoscope". Combined with the 8 mm tape format, the chip has created a lightweight, single unit camera, monitor, and recorder. A recent advantage, magnetic disc recording, permits still video storage of up to 25 images. An electronic printer produces a hard color copy (4 x 5), which is inserted in the chart before the patient leaves the endoscopy room. The cost of the equipment can be shared in multidisciplinary institutions. PMID:3071869

  14. GASTROINTESTINAL EOSINOPHILIA

    PubMed Central

    Zuo, Li; Rothenberg, Marc E.

    2007-01-01

    SYNOPSIS Gastrointestinal eosinophilia, as a broad term for abnormal eosinophil accumulation in the GI tract, involves many different disease identities. These diseases include primary eosinophil associated gastrointestinal diseases, gastrointestinal eosinophilia in HES and all gastrointestinal eosinophilic states associated with known causes. Each of these diseases has its unique features but there is no absolute boundary between them. All three groups of GI eosinophila are described in this chapter although the focus is on primary gastrointestinal eosinophilia, i.e. EGID. PMID:17868858

  15. Small bowel involvement documented by capsule endoscopy in Churg-Strauss syndrome

    PubMed Central

    Beye, Birane; Lesur, Gilles; Claude, Pierre; Martzolf, Lionel; Kieffer, Pierre; Sondag, Daniel

    2015-01-01

    Churg-Strauss syndrome is a small and medium vessel vasculitis and is also known as allergic granulomatous angiitis. Gastrointestinal involvement is common in patients with Churg-Strauss syndrome (20-50%). The most common symptoms are abdominal pain, diarrhoea and occasionally gastrointestinal bleeding and perforation. We present a case of Churg-Strauss syndrome with small bowel lesions documented by video capsule endoscopy. PMID:26664542

  16. Measuring Quality in Pediatric Endoscopy.

    PubMed

    Lightdale, Jenifer R

    2016-01-01

    Measuring quality in endoscopy includes the assessment of appropriateness of a procedure and the skill with which it is performed. High-quality pediatric endoscopy is safe and efficient, used effectively to make proper diagnoses, is useful for excluding other diagnoses, minimizes adverse events, and is accompanied by appropriate documentation from beginning through end of the procedure. There are no standard quality metrics for pediatric endoscopy, but proposed candidates are both process and outcomes oriented. Both are likely to be used in the near future to increase transparency about patient outcomes, as well as to influence payments for the procedure. PMID:26616896

  17. Swallowable Wireless Capsule Endoscopy: Progress and Technical Challenges

    PubMed Central

    Pan, Guobing; Wang, Litong

    2012-01-01

    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. PMID:22253621

  18. Management of iatrogenic colorectal perforation: From surgery to endoscopy

    PubMed Central

    Cai, Shi-Lun; Chen, Tao; Yao, Li-Qing; Zhong, Yun-Shi

    2015-01-01

    Iatrogenic colon perforation is one the most pernicious complications for patients undergoing endoscopic screening or therapy. It is a serious but rare complication of colonoscopy. However, with the expansion of the indications for endoscopic therapies for gastrointestinal diseases, the frequency of colorectal perforation has increased. The management of iatrogenic colorectal perforation is still a challenge for many endoscopists. The methods for treating this complication vary, including conservative treatment, surgical treatment, laparoscopy and endoscopy. In this review, we highlight the etiology, recognition and treatment of colorectal iatrogenic perforation. Specifically, we shed light on the endoscopic management of this rare complication. PMID:26191347

  19. Upper Endoscopy for Gastroesophageal Reflux Disease

    MedlinePLUS

    Annals of Internal Medicine Summaries for Patients Upper Endoscopy for Gastroesophageal Re?ux Disease The full report is titled “Upper Endoscopy for Gastroesophageal Re?ux Disease: Best Practice Advice From ...

  20. Early endoscopy in systemic sclerosis without gastrointestinal symptoms.

    PubMed

    Thonhofer, Rene; Siegel, Cornelia; Trummer, Markus; Graninger, Winfried

    2012-01-01

    Investigation into the upper GI-tract of patients suffering from systemic sclerosis [SSc] and mixed connective tissue disease [MCTD] without symptoms of GI-tract involvement early in the course of the disease to diagnose inflammatory and motility disorders. We retrospectively analysed patients with SSc and MCTD who underwent oesophago-gastro-duodenoscopy [OGD] within a year of the first diagnosis. Patients with a Rodnan skin score above 5, proton pump inhibitors and treatment regimes potentially harmful to the mucosa of the upper GI-tract were excluded. Mucosal damage of the oesophagus was classified according to the Los Angeles Classification. Oesophageal dysmotility was assessed during OGD and confirmed by video cineradiography. A total of thirteen patients with SSc and six with MCTD fulfilled the inclusion criteria. OGD revealed reflux-oesophagitis in 77%, dysmotility of the distal oesophagus in 85%, gastritis in 92% [31% erosive gastritis] and Helicobacter pylori positivity in 38% of our patients suffering from SSc. Patients with MCTD showed features of reflux-oesophagitis, dysmotility of the distal oesophagus, gastritis and dysmotility of the stomach in 0.6%. In all thirteen patients with SSc, significant pathology of the upper GI-tract was found. The results of this study might indicate that OGD should be performed early in patients diagnosed with SSc, even if they do not report typical symptoms. An early diagnose of GI involvement might be followed by an effective therapy and therefore subsequently may improve the prognosis. PMID:20711592

  1. Blood detection in wireless capsule endoscopy using expectation maximization clustering

    NASA Astrophysics Data System (ADS)

    Hwang, Sae; Oh, JungHwan; Cox, Jay; Tang, Shou Jiang; Tibbals, Harry F.

    2006-03-01

    Wireless Capsule Endoscopy (WCE) is a relatively new technology (FDA approved in 2002) allowing doctors to view most of the small intestine. Other endoscopies such as colonoscopy, upper gastrointestinal endoscopy, push enteroscopy, and intraoperative enteroscopy could be used to visualize up to the stomach, duodenum, colon, and terminal ileum, but there existed no method to view most of the small intestine without surgery. With the miniaturization of wireless and camera technologies came the ability to view the entire gestational track with little effort. A tiny disposable video capsule is swallowed, transmitting two images per second to a small data receiver worn by the patient on a belt. During an approximately 8-hour course, over 55,000 images are recorded to a worn device and then downloaded to a computer for later examination. Typically, a medical clinician spends more than two hours to analyze a WCE video. Research has been attempted to automatically find abnormal regions (especially bleeding) to reduce the time needed to analyze the videos. The manufacturers also provide the software tool to detect the bleeding called Suspected Blood Indicator (SBI), but its accuracy is not high enough to replace human examination. It was reported that the sensitivity and the specificity of SBI were about 72% and 85%, respectively. To address this problem, we propose a technique to detect the bleeding regions automatically utilizing the Expectation Maximization (EM) clustering algorithm. Our experimental results indicate that the proposed bleeding detection method achieves 92% and 98% of sensitivity and specificity, respectively.

  2. Capsule endoscopy: Present status and future expectation

    PubMed Central

    Goenka, Mahesh K; Majumder, Shounak; Goenka, Usha

    2014-01-01

    Video capsule endoscopy (CE) since its introduction 13 years back, has revolutionized our approach to small intestinal diseases. Obscure gastrointestinal bleed (OGIB) continues to be the most important indication for CE with a high sensitivity, specificity as well as positive and negative predictive values. It is best performed during ongoing bleed or immediately thereafter. Overt OGIB has a higher diagnostic yield than occult OGIB. However, even in iron deficiency anemia, CE is emerging as important investigation after initial negative work up. In suspected Crohn’s disease (CD), CE has been shown superior to traditional imaging and endoscopic technique and should be considered after a negative ileocolonoscopy. Although CE has also been used for evaluating established CD, a high capsule retention rate precludes its use ahead of cross-sectional imaging. Celiac disease, particularly where gastro-duodenoscopy cannot be performed or is normal, can also be investigated by CE. Small bowel tumor, hereditary polyposis syndrome, and non-steroidal anti-inflammatory drugs induced intestinal damage are other indications for CE. Capsule retention is the only significant adverse outcome of CE and occurs mostly in presence of intestinal obstruction. This can be prevented by use of Patency capsule prior to CE examination. Presence of cardiac pacemaker and intracardiac devices continue to be relative contraindications for CE, though data do not suggest interference of CE with these devices. Major limitations of CE today include failure to control its movement from outside, inability of CE to acquire tissue for diagnosis, and lack of therapeutic help. With ongoing interesting and exciting developments taking place in these areas, these issues would be solved in all probability in near future. CE has the potential to become one of the most important tools in diagnostic and possibly in the therapeutic field of gastrointestinal disorder. PMID:25110430

  3. Capsule endoscopy: Present status and future expectation.

    PubMed

    Goenka, Mahesh K; Majumder, Shounak; Goenka, Usha

    2014-08-01

    Video capsule endoscopy (CE) since its introduction 13 years back, has revolutionized our approach to small intestinal diseases. Obscure gastrointestinal bleed (OGIB) continues to be the most important indication for CE with a high sensitivity, specificity as well as positive and negative predictive values. It is best performed during ongoing bleed or immediately thereafter. Overt OGIB has a higher diagnostic yield than occult OGIB. However, even in iron deficiency anemia, CE is emerging as important investigation after initial negative work up. In suspected Crohn's disease (CD), CE has been shown superior to traditional imaging and endoscopic technique and should be considered after a negative ileocolonoscopy. Although CE has also been used for evaluating established CD, a high capsule retention rate precludes its use ahead of cross-sectional imaging. Celiac disease, particularly where gastro-duodenoscopy cannot be performed or is normal, can also be investigated by CE. Small bowel tumor, hereditary polyposis syndrome, and non-steroidal anti-inflammatory drugs induced intestinal damage are other indications for CE. Capsule retention is the only significant adverse outcome of CE and occurs mostly in presence of intestinal obstruction. This can be prevented by use of Patency capsule prior to CE examination. Presence of cardiac pacemaker and intracardiac devices continue to be relative contraindications for CE, though data do not suggest interference of CE with these devices. Major limitations of CE today include failure to control its movement from outside, inability of CE to acquire tissue for diagnosis, and lack of therapeutic help. With ongoing interesting and exciting developments taking place in these areas, these issues would be solved in all probability in near future. CE has the potential to become one of the most important tools in diagnostic and possibly in the therapeutic field of gastrointestinal disorder. PMID:25110430

  4. What we have learned and what to expect from capsule endoscopy

    PubMed Central

    Adler, Samuel N; Bjarnason, Ingvar

    2012-01-01

    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

  5. Guidelines for Video Capsule Endoscopy: Emphasis on Crohn's Disease

    PubMed Central

    Park, Soo-Kyung; Kim, Kyeong Ok; Park, Cheol Hee; Lee, Wan-Sik; Jang, Byung Ik; Jeen, Yoon Tae; Choi, Myung-Gyu; Kim, Hyun Jung

    2015-01-01

    Video capsule endoscopy (VCE) is an ingestible video camera that transmits high-quality images of the small intestinal mucosa. This makes the small intestine more readily accessible to physicians investigating the presence of small bowel disorders, such as Crohn's disease (CD). Although VCE is frequently performed in Korea, there are no evidence-based guidelines on the appropriate use of VCE in the diagnosis of CD. To provide accurate information and suggest correct testing approaches for small bowel diseases, the Korean Gut Image Study Group, part of the Korean Society of Gastrointestinal Endoscopy, developed guidelines on VCE. Teams were set up to develop guidelines on VCE. Four areas were selected: diagnosis of obscure gastrointestinal bleeding, small bowel preparation for VCE, diagnosis of CD, and diagnosis of small bowel tumors. Three key questions were selected regarding the role of VCE in CD. In preparing these guidelines, a systematic literature search, evaluation, selection, and meta-analysis were performed. After writing a draft of the guidelines, the opinions of various experts were solicited before producing the final document. These guidelines are expected to play a role in the diagnosis of CD. They will need to be updated as new data and evidence become available. PMID:25844340

  6. Gastrointestinal pacing.

    PubMed

    Eagon, J C; Soper, N J

    1993-12-01

    Gastrointestinal pacing has been used to alter motor function and is effective in animal models in modulating gastric emptying, intestinal transit, and absorption. Application of gastrointestinal pacing to disorders of the human stomach and small bowel is an attractive treatment option that may some day become a clinical reality. Several technical problems must be overcome before further clinical testing can proceed. PMID:8248832

  7. Ingestible wireless capsules for enhanced diagnostic inspection of gastrointestinal tract

    NASA Astrophysics Data System (ADS)

    Rasouli, Mahdi; Kencana, Andy Prima; Huynh, Van An; Ting, Eng Kiat; Lai, Joshua Chong Yue; Wong, Kai Juan; Tan, Su Lim; Phee, Soo Jay

    2011-03-01

    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.

  8. Embolization for gastrointestinal hemorrhages.

    PubMed

    Krämer, S C; Görich, J; Rilinger, N; Siech, M; Aschoff, A J; Vogel, J; Brambs, H J

    2000-01-01

    Retrospective evaluation of interventional embolization therapy in the treatment of gastrointestinal hemorrhage over a long-term observation period from 1989 to 1997. Included in the study were 35 patients (age range 18-89 years) with gastrointestinal bleeding (GI) referred for radiological intervention either primarily or following unsuccessful endoscopy or surgery. Sources of GI bleeding included gastric and duodenal ulcers (n = 7), diverticula (n = 3), erosion of the intestinal wall secondary to malignancy (n = 6), vascular malformations (n = 4), and hemorrhoids (n = 2), as well as from postoperative (n = 6), posttraumatic (n = 2), postinflammatory (n = 4) or unknown (n = 1) causes. Ethibloc (12 cases) or metal coils (14 cases) were predominantly used as embolisates. In addition, combinations of tissue adhesive and gelfoam particles and of coils and Ethibloc were used (six cases). Finally, polyvinyl alcohol particles, a coated stent, and an arterial wire dissection were utilized in one case each. Bleeding was stopped completely in 29 of 35 cases (83%). In one case (3%) the source of bleeding was recognized but the corresponding vessel could not be catheterized. In five other cases (14%) there was partial success with reduced, though still persistent, bleeding. The rate of complications was 14%, including four instances of intestinal ischemia with fatal outcome in the first years, and, later, one partial infarction of the spleen without serious consequences. Gastrointestinal hemorrhage can be controlled in a high percentage of patients, including the seriously ill and those who had previously undergone surgery, with the use of minimally invasive interventional techniques. The availability of minicoils instead of fluid embolization agents has reduced the risk of serious complications. PMID:10823636

  9. Strongyloides stercoralis hyperinfection: an unusual cause of gastrointestinal bleeding.

    PubMed

    Rios, Juliana Trazzi; Franco, Matheus Cavalcante; Martins, Bruno da Costa; Baba, Elisa Ryoka; Safatle-Ribeiro, Adriana Vaz; Sakai, Paulo; Retes, Felipe Alves; Maluf-Filho, Fauze

    2015-08-01

    SummaryStrongyloidiasis is a parasitic disease that may progress to a disseminated form, called hyperinfection syndrome, in patients with immunosuppression. The hyperinfection syndrome is caused by the wide multiplication and migration of infective larvae, with characteristic gastrointestinal and/or pulmonary involvement. This disease may pose a diagnostic challenge, as it presents with nonspecific findings on endoscopy. PMID:26466210

  10. Model of the Availability of Satellite Navigational Systems Asg-Eupos and Dgps Services in Poland

    NASA Astrophysics Data System (ADS)

    Oszczak, Bartlomiej; Kowalik, Dorota

    In paper there is presented model of availability, continuity and reliability od navigational sat-telite systems. To examine model we used new realtime DGPS NAWGIS and KODGIS services from polish system ASG-EUPOS. These services were tested relative to availability, continuity, reliability, accuracy and integrity, and further their comparison was based on achieved results and observations. It is possible to use this model for each existing navigational sattelite system. Achieved results are satisfactory, the accuracy of measurement is included in requested limits, but the services do not meet the requirements for applications in marine and naval navigation in operations which require high accuracy of determinations of the position and high availability factor.

  11. Clinical utility, safety and tolerability of capsule endoscopy in urban Southeast Asian population

    PubMed Central

    Ang, Tiing-Leong; Fock, Kwong-Ming; Ng, Tay-Meng; Teo, Eng-Kiong; Tan, Yi-Lyn

    2003-01-01

    AIM: Capsule endoscopy has demonstrated its clinical utility in the evaluation of small bowel pathology in several Western studies. In this prospective study, we aimed to determine the clinical utility, safety and tolerability of capsule endoscopy in the evaluation of suspected small bowel disease in an urban Southeast Asian population. METHODS: We used the given (M2A) capsule endoscopy system in 16 consecutive patients with suspected small bowel pathology. In 9 patients the indication was obscure gastrointestinal bleeding, while in 6 patients it was to determine the extent of small bowel involvement in Crohn’s disease. One patient underwent capsule endoscopy for evaluation of chronic abdominal pain. Patient’s tolerability to the procedure was evaluated by standardized questionnaires and all patients were reviewed at one week to ensure that the capsule had been excreted without any adverse events. RESULTS: Abnormal findings were present in 8 patients (50%). The cause of obscure gastrointestinal bleeding was determined in 5 out of 9 patients. Findings included 2 cases of angiodysplasia, 2 cases of jejunal ulcers and 1 case of both angiodysplasia and jejunal ulcer. One patient had small bowel erosions and foci of erythema of doubtful significance. Ileal lesions were diagnosed in 2 out of 6 patients with Crohn’s disease. Capsule endoscopy was well tolerated by all patients. One patient with Crohn’s disease had a complication of capsule retention due to terminal ileum stricture. The capsule eventually passed out spontaneously after 1 month. CONCLUSION: Our study, which represented the first Asian series, further confirms the diagnostic utility, safety and tolerability of wireless capsule endoscopy. PMID:14562399

  12. Hyperemesis gravidarum: a case of starvation and altered sensorium gestosis (ASG).

    PubMed

    Erick, Miriam

    2014-05-01

    Of the problems that complicate child-bearing, hyperemesis gravidarum (HG), or severe nausea and vomiting of pregnancy (NVP), is likely one of the most painful with unrelenting retching and vomiting that can lead to measurable injuries such as Mallory-Weiss Syndrome and esophageal rupture, and/or subtle maternal cognitive impairments related to starvation and dehydration. Recognized hallmarks of HG include dehydration, ketonuria, weight loss over 5%, and electrolyte abnormalities not attributable to other causes. Historically providers regarded the hyperemetic as a difficult to treat patient with potentially underlying psychological problems. Sick patients who experience pain and suffering present challenges to care, not excepting NVP. Ill patients can be demanding and agitated. Agitation can be one of the early signs of delirium or altered mental status (AMS). AMS can include previously diagnosed psychiatric conditions as well as new onset of Wernicke's encephalopathy, deliria, insomnia, hallucinations and autoscopy, resulting from various etiologies including and not limited to medications, pain including pain from hunger, vomiting and retching, constipation, dehydration, altered electrolytes, hypoglycemia, malnutrition and sleep deprivation. AMS may have a subtle waxing and waning trajectory, making the condition difficult to diagnosis in early stages. What have not been well elucidated in AMS are subjective images and/or experiences. Whether all AMS experiences are similar is unknown. We believe there may be a transient alteration of cognitive status or "altered sensorium gestosis" (ASG), attributed to the direct insults of hyperemesis gravidarum which will be discussed herein. How prevalent ASG might be is unknown and needs further investigation. PMID:24613734

  13. Endoscopy of the middle ear

    NASA Astrophysics Data System (ADS)

    Pankratov, Michail M.; Poe, Dennis S.; Gadre, Arun K.; Rebeiz, Elie E.

    1992-08-01

    Transtympanic endoscopy provides a unique opportunity to view, undisturbed, the contents of the middle ear. Flexible and rigid endoscopes with diameters of 2 mm and smaller are now available with adequate resolution to perform exploration of the middle ear. Endoscopes can be introduced through a myringotomy or an existing perforation in the tympanic membrane to examine the middle ear in the office setting, thus reducing the need for exploratory surgery.

  14. Endoscopic Evaluation of Upper and Lower Gastro-Intestinal Bleeding

    PubMed Central

    Ray-Offor, Emeka; Elenwo, Solomon N

    2015-01-01

    Introduction: A myriad of pathologies lead to gastro-intestinal bleeding (GIB). The common clinical presentations are hematemesis, melena, and hematochezia. Endoscopy aids localization and treatment of these lesions. Aims: The aim was to study the differential diagnosis of GIB emphasizing the role of endoscopy in diagnosis and treatment of GIB. Patients and Methods: A prospective study of patients with GIB referred to the Endoscopy unit of two health facilities in Port Harcourt Nigeria from February 2012 to August 2014. The variables studied included: Demographics, clinical presentation, risk score, endoscopic findings, therapeutic procedure, and outcome. Data were collated and analyzed using SPSS version 20 software. Results: A total of 159 upper and lower gastro-intestinal (GI) endoscopies were performed during the study period with 59 cases of GI bleeding. There were 50 males and 9 females with an age range of 13–86 years (mean age 52.4 ± 20.6 years). The primary presentations were hematochezia, hematemesis, and melena in 44 (75%), 9 (15%), and 6 (10%) cases, respectively. Hemorrhoids were the leading cause of lower GIB seen in 15 cases (41%). The majority of pathologies in upper GIB were seen in the stomach (39%): Gastritis and benign gastric ulcer. Injection sclerotherapy was successfully performed in the hemorrhoids and a case of gastric varices. The mortality recorded was 0%. Conclusion: Endoscopy is vital in the diagnosis and treatment of GIB. Gastritis and Haemorrhoid are the most common causes of upper and lower GI bleeding respectively, in our environment PMID:26425062

  15. Advances in Urinary Tract Endoscopy.

    PubMed

    Berent, Allyson C

    2016-01-01

    The use of endoscopy in veterinary medicine has become the mainstay of diagnosis and treatment in the subspecialty of small animal urology over the past decade. This subspecialty is termed endourology. With the common incidence of urinary tract obstructions, stones disease, renal disease, and urothelial malignancies, combined with the recognized invasiveness and morbidity associated with traditional surgical techniques, the use of endoscopic-assisted alternatives using interventional endoscopic techniques has become appealing to both owners and clinicians. This article provides a brief overview of some of the most common urologic procedures being performed in veterinary medicine. PMID:26440205

  16. Optoacoustic endoscopy with curved scanning.

    PubMed

    He, Hailong; Buehler, Andreas; Ntziachristos, Vasilis

    2015-10-15

    The optoacoustic (photoacoustic) technique has been shown to resolve anatomical, functional, and molecular features at depths that go beyond the reach of epi-illumination optical microscopy, offering new opportunities for endoscopic imaging. In this Letter, we investigate the merits of optoacoustic endoscopy implemented by translating a sound detector in linear or curved geometries. The linear and curved detection geometries are achieved by employing an intravascular ultrasound transducer within a plastic guide shaped to a line or a curve. This concept could be used together with optical endoscopes to yield hybrid optical and optoacoustic imaging. PMID:26469590

  17. Transcription factors Asg1p and Hal9p regulate pH homeostasis in Candida glabrata

    PubMed Central

    Wu, Jing; Chen, Xiulai; Cai, Lijun; Tang, Lei; Liu, Liming

    2015-01-01

    Candida glabrata is an important microorganism used in commercial fermentation to produce pyruvate, but very little is known about its mechanisms for surviving acid stress in culture. In this study, it was shown that transcription factors Asg1p and Hal9p play essential roles in C. glabrata in the tolerance of acid stress, as the deletion of CgASG1 or CgHAL9 resulted in the inability to survive in an acidic environment. Cgasg1? and Cghal9? mutant strains are unable to maintain pH homeostasis, as evidenced by a decrease in intracellular pH and an increase in reactive oxygen species production, which results in metabolic disorders. The results showed that intracellular acidification was partly due to the diminished activity of the plasma membrane proton pump, CgPma1p. In addition, transcriptome sequencing revealed that Cgasg1? and Cghal9? mutant strains displayed a variety of changes in gene expression under acidic conditions, including genes in the MAPK signaling pathway, plasma membrane, or cell wall organization, trehalose accumulation, and the RIM101 signaling pathway. Lastly, quantitative reverse-transcribed PCR and cellular localization showed that CgAsg1p and CgHal9p played independent roles in response to acid stress. PMID:26347728

  18. Comparative Analysis of Satellite Measurements Calculation Results Using the Postprocessing Services: Asg-Eupos (Poland), Apps (USA) and CSRS (Canada)

    NASA Astrophysics Data System (ADS)

    Mika, Monika; Kudach, Jakub

    2014-06-01

    The publication has a cognitive research character. It presents a comparative analysis of free Internet services in Poland and abroad, used to adjust the data obtained using satellite measurement techniques. The main aim of this work is to describe and compare free tools for satellite data processing and to examine them for possible use in the surveying works in Poland. Among the many European and global services three of them dedicated to satellite measurements were selected: ASG-EUPOS (Poland), APPS (USA) and CSRS (Canada). The publication contains the results of calculations using these systems. Calculations were based on RINEX files obtained via postprocessing service (ASG-EUPOS network) POZGEO D for 12 reference stations in the South Poland. In order to examine differences in results between the ASG-EUPOS, APPS and CSRS the transformation points coordinate to a single coordinate system ETRF 2000 (in force in Poland) was made. Studies have shown the possibility of the calculation in Poland (in postprocessing mode) using the analyzed applications with global coverage.

  19. Assessment of regional ionosphere model supporting precise positioning for ASG-EUPOS network

    NASA Astrophysics Data System (ADS)

    Krypiak-Gregorczyk, Anna; Wielgosz, Pawel; Jarmo?owski, Wojciech

    2015-04-01

    Since 2008 the Head Office of Geodesy and Cartography in Poland operates a dense active GNSS network - ASG-EUPOS - consisting of over 100 stations. Currently over 60 stations are equipped with GPS+GLONASS receivers, including almost 30 stations with Galileo capability. This greatly improves IPP coverage over Poland and neighboring areas and offers excellent opportunity of providing high resolution and accurate ionosphere model for positioning purposes. In this paper we show performance assessment of a multi-GNSS ionospheric TEC model derived from precise carrier phase GNSS data. The model is based on processing of 170 GNSS stations located in Poland and neighboring countries. In the first step, carrier phase biases are estimated for each satellite arc. In the second step, theses biases are used together with multi-frequency, multi-GNSS carrier phase observations to calculate TEC at IPP locations. Then, the least squares collocation method is applied to provide vertical TEC grid - the TEC model. The TEC grid is used to calculate ionospheric delay corrections. The corrections are then verified by comparison to double differences ionospheric residual derived from GNSS data at selected test baselines. Our results show that the multi-GNSS regional ionospheric TEC model is capable of providing ionospheric corrections that may satisfy precise GNSS positioning requirements.

  20. Capsule endoscopy in the small bowel Crohn's disease.

    PubMed

    Argüelles-Arias, Federico; Rodríguez-Oballe, Juan; Duarte-Chang, Calixto; Castro-Laria, Luisa; García-Montes, Josefa María; Caunedo-Álvarez, Angel; Herrerías-Gutiérrez, Juan Manuel

    2014-01-01

    CD is a chronic inflammatory disorder associated to mucosal and transmural inflammation of the bowel wall. It is well known that CD can affect the entire gastrointestinal. Therefore, ileocolonoscopy and biopsies of the terminal ileum as well as of each colonic segment to look for microscopic evidence of CD are the first-line procedures to establish the diagnosis. However, it has been observed that up to 30% of the patients have only small bowel involvement. Evaluation of the small bowel has been made with radiological procedures, barium radiography, and abdominal computed tomography or by ileocolonoscopy or enteroscopy, but they have many recognized limitations. CE is undoubtedly a very useful diagnostic tool proposed to observe small-bowel lesions undetectable by conventional endoscopy or radiologic studies. We review different studies that have been published reporting the use of CE in suspected and evaluation of the extension or the recurrence in CD and also its use in pediatric population and its complications. PMID:24741374

  1. A review of drug delivery systems for capsule endoscopy.

    PubMed

    Munoz, Fredy; Alici, Gursel; Li, Weihua

    2014-05-01

    The development of a highly controllable drug delivery system (DDS) for capsule endoscopy has become an important field of research due to its promising applications in therapeutic treatment of diseases in the gastrointestinal (GI) tract and drug absorption studies. Several factors need to be considered to establish the minimum requirements for a functional DDS. Environmental factors of the GI tract and also pharmaceutical factors can help determine the requirements to be met by a DDS in an endoscopic capsule. In order to minimize the influence of such factors on the performance of an effective DDS, at least two mechanisms should be incorporated into a capsule endoscope: an anchoring mechanism to control the capsule position and a drug release mechanism to control variables such as the drug release rate, number of doses and amount of drug released. The implementation of such remotely actuated mechanisms is challenging due to several constraints, including the limited space available in a swallowable capsule endoscope and the delicate and complex environment within the GI tract. This paper presents a comprehensive overview of existing DDS. A comparison of such DDS for capsule endoscopy based on the minimum DDS requirements is presented and future work is also discussed. PMID:24384373

  2. Recent advancement of therapeutic endoscopy in the esophageal benign diseases

    PubMed Central

    Bechara, Robert; Inoue, Haruhiro

    2015-01-01

    Over the past 30 years, the field of endoscopy has witnessed several advances. With the advent of endoscopic mucosal resection, removal of large mucosal lesions have become possible. Thereafter, endoscopic submucosal resection was refined, permitting en bloc removal of large superficial neoplasms. Such techniques have facilitated the development of antireflux mucosectomy, a promising novel treatment for gastroesophageal reflux. The introduction and use of over the scope clips has allowed for endoscopic closure of defects in the gastrointestinal tract, which were traditionally treated with surgical intervention. With the development of per-oral endoscopic myotomy (POEM), the treatment of achalasia and spastic disorders of the esophagus have been revolutionized. From the submucosal tunnelling technique developed for POEM, Per oral endoscopic tumor resection of subepithelial tumors was made possible. Simultaneously, advances in biotechnology have expanded esophageal stenting capabilities with the introduction of fully covered metal and plastic stents, as well as biodegradable stents. Once deemed a primarily diagnostic tool, endoscopy has quickly transcended to a minimally invasive intervention and therapeutic tool. These techniques are reviewed with regards to their application to benign disease of the esophagus. PMID:25992187

  3. Wireless capsule endoscopy: from diagnostic devices to multipurpose robotic systems.

    PubMed

    Moglia, Andrea; Menciassi, Arianna; Schurr, Marc Oliver; Dario, Paolo

    2007-04-01

    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

  4. Gastrointestinal cancer

    SciTech Connect

    Levin, B.

    1988-01-01

    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.

  5. Endoscopy

    MedlinePLUS

    ... It uses an instrument called an endoscope, or scope for short. Scopes have a tiny camera attached to a long, ... or opening to see inside an organ. Sometimes scopes are used for surgery, such as for removing ...

  6. Time trends of upper gastrointestinal diseases in Nigeria

    PubMed Central

    Nwokediuko, Sylvester Chuks; Ijoma, Uchenna; Obienu, Olive; Picardo, Neri

    2012-01-01

    Background The changing epidemiology of a disease often provides valuable insight into possible etiopathogenic mechanisms. There have been significant changes over the last several decades in disease manifestations of the foregut in Western Europe, North America and Asia. This time trend analysis was carried out to determine if any changes have occurred in the prevalence of diseases of the upper gastrointestinal tract in Nigeria. Method Records of patients who underwent upper gastrointestinal endoscopy during two time periods (1995 to 1999 and 2006 to 2010) in Enugu, South-East Nigeria were analyzed with regard to biodata of patients, indications for upper gastrointestinal endoscopy and endoscopic findings. Results During the two time periods, 1,365 patients had upper gastrointestinal endoscopy (575 patients in the period 1995-1999 and 790 in the period 2006-2010). Dyspepsia was the commonest indication for upper gastrointestinal endoscopy for both periods (81.9% and 72.9%, respectively; p= 0.9052). Heartburn and dysphagia were more frequent during the second time period (p<0.0001). Duodenal ulcer was more common in the first time period (p<0.0001), while esophagitis, gastric ulcer and bile reflux were significantly more common in the second period (p<0.0001, p=0.0007 and p=0.0019, respectively). Conclusion Over the 15-year period, the prevalence of duodenal ulcer has declined while that of gastric ulcer has increased. There has also been an increase in the prevalence of gastroesophageal reflux disease. Putative explanations for this trend may include widespread availability and use of very potent acid suppressant drugs, increasing use of non steroidal anti-inflammatory drugs, change towards western diet and increasing obesity. PMID:24713802

  7. Endoscopy of the lacrimal system

    PubMed Central

    Mullner, K.; Bodner, E.; Mannor, G.

    1999-01-01

    BACKGROUND/AIM—Until recently, diagnosis of disorders of the lacrimal system has depended on digital dacryocystography and on clinical examinations such as the fluorescein dye test, lacrimal probing, and irrigation. The lacrimal system and its mucous membranes can now be viewed directly with a lacrimal endoscope. While the first endoscopes were rigid and limited by poor picture quality in axial illuminations, the new generation of endoscopes are a great leap forward for new diagnostic and therapeutic approaches.?METHODS—132 patients ranging in age from 8 months to 73 years with nasolacrimal obstruction were referred to the lacrimal department. Diagnostic lacrimal imaging utilising various small calibre endoscopes less than 0.5 mm in external diameter was performed. The endoscopes are coupled to specially designed lacrimal probes as well as a CCD camera and a video recorder. The imaging was performed during standard lacrimal probing and irrigation in an outpatient clinic setting in 120 of 132 patients?RESULTS—All patients reported the pain of endoscopy as being similar to that of standard lacrimal probing and irrigation. No adverse effects such as bleeding or lacrimal perforation were noted. Endoscopic manipulation was not too difficult and the picture quality, depth of focus, and illumination were satisfactory in all cases. The most common site of stenosis was the nasolacrimal duct (59 patients), followed by the lacrimal sac (39 patients) and the canaliculi (34 patients). In 25 patients, partial obstruction, rather than complete stenosis, was visualised as a narrow lumen, which widened during irrigation. In 14 of 28 patients, obstruction was due to canalicular submucosal folds and was removed with laser. In addition, the colour and consistency of the lining mucosa correlated with type of obstruction. Normal mucosa is smooth and light pink in colour. Inflammatory changes manifest as thickened and reddish grey mucosa. More complete stenosis is shown as fibrotic plaques with grey white inelastic membranes.?CONCLUSION—Lacrimal endoscopy is a new, non-invasive method used to view directly and localise obstructions precisely. It allows differentiation between inflammatory, partial, and complete stenosis. Endoscopy enables one to choose the appropriate surgical therapy for patients. Patients tolerated the procedure well without any adverse reactions or effects. While it may not replace standard probing and irrigation, this technique is an extremely useful adjunct in determining the proper surgical modality, ease, and tolerance of the endoscopic manipulation by patients, and obtaining sharp and clear images of the nasolacrimal outflow system anatomy and pathology. Differentiation of various types of obstruction by precise location and severity can be achieved.?? PMID:10413700

  8. The role of magnetic assisted capsule endoscopy (MACE) to aid visualisation in the upper GI tract.

    PubMed

    Rahman, Imdadur; Afzal, Nadeem Ahmad; Patel, Praful

    2015-10-01

    Examination of the upper gastrointestinal tract by a standard endoscope is often thought as a daunting experience to many who have undertaken or are about to undergo the procedure. The overall perceived size of the gastroscope, unpleasantness of stimulation of the gag reflex and the need often for sedation is discouraging to many. A method to visualise the upper gastrointestinal mucosa which negates the need for sedation, the associated expensive decontamination costs and the possibility of having a community based examination would be particularly welcoming to this endoscopy field. Since the first swallow of a capsule endoscope by a human volunteer in 1999, their usage for examining the small bowel has exponentially grown to that of over a million patients worldwide. More recently, innovation in this field have shown plausibility for its use to visualise the upper gastrointestinal tract, with the integration of magnets within the capsule the most promising method. PMID:25934086

  9. Acute upper gastrointestinal bleeding (UGIB) - initial evaluation and management.

    PubMed

    Khamaysi, Iyad; Gralnek, Ian M

    2013-10-01

    Acute upper gastrointestinal bleeding (UGIB) is the most common reason that the 'on-call' gastroenterologist is consulted. Despite the diagnostic and therapeutic capabilities of upper endoscopy, there is still significant associated morbidity and mortality in patients experiencing acute UGIB, thus this is a true GI emergency. Acute UGIB is divided into non-variceal and variceal causes. The most common type of acute UGIB is 'non-variceal' and includes diagnoses such as peptic ulcer (gastric and duodenal), gastroduodenal erosions, Mallory-Weiss tears, erosive oesophagitis, arterio-venous malformations, Dieulafoy's lesion, and upper GI tract tumours and malignancies. This article focuses exclusively on initial management strategies for acute upper GI bleeding. We discuss up to date and evidence-based strategies for patient risk stratification, initial patient management prior to endoscopy, potential causes of UGIB, role of proton pump inhibitors, prokinetic agents, prophylactic antibiotics, vasoactive pharmacotherapies, and timing of endoscopy. PMID:24160923

  10. Angiography in gastrointestinal bleeding in children

    SciTech Connect

    Meyerovitz, M.F.; Fellows, K.E.

    1984-10-01

    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%).

  11. The role of a computed tomography-based image registered navigation system for natural orifice transluminal endoscopic surgery: a comparative study in a

    E-print Network

    to- mography) image registered navigation system in identifying safe gastrointestinal access sitesThe role of a computed tomography-based image registered navigation system for natural orifice- trointestinal Endoscopy (ASGE)/Society of Ameri- can Gastrointestinal and Endoscopic Surgeons (SAGES) [11], one

  12. Emerging Issues and Future Developments in Capsule Endoscopy

    PubMed Central

    Slawinski, Piotr R.; Obstein, Keith L.; Valdastri, Pietro

    2015-01-01

    Capsule endoscopy (CE) has transformed from a research venture into a widely used clinical tool and the primary means for diagnosing small bowel pathology. These orally administered capsules traverse passively through the gastrointestinal tract via peristalsis and are used in the esophagus, stomach, small bowel, and colon. The primary focus of CE research in recent years has been enabling active CE manipulation and extension of the technology to therapeutic functionality; thus, widening the scope of the procedure. This review outlines clinical standards of the technology as well as recent advances in CE research. Clinical capsule applications are discussed with respect to each portion of the gastrointestinal tract. Promising research efforts are presented with an emphasis on enabling active capsule locomotion. The presented studies suggest, in particular, that the most viable solution for active capsule manipulation is actuation of a capsule via exterior permanent magnet held by a robot. Developing capsule procedures adhering to current healthcare standards, such as enabling a tool channel or irrigation in a therapeutic device, is a vital phase in the adaptation of CE in the clinical setting. PMID:26028956

  13. Upper non-variceal gastrointestinal bleeding - review the effectiveness of endoscopic hemostasis methods

    PubMed Central

    Szura, Miros?aw; Pasternak, Artur

    2015-01-01

    Upper non-variceal gastrointestinal bleeding is a condition that requires immediate medical intervention and has a high associated mortality rate (exceeding 10%). The vast majority of upper gastrointestinal bleeding cases are due to peptic ulcers. Helicobacter pylori infection, non-steroidal anti-inflammatory drugs and aspirin are the main risk factors for peptic ulcer disease. Endoscopic therapy has generally been recommended as the first-line treatment for upper gastrointestinal bleeding as it has been shown to reduce recurrent bleeding, the need for surgery and mortality. Early endoscopy (within 24 h of hospital admission) has a greater impact than delayed endoscopy on the length of hospital stay and requirement for blood transfusion. This paper aims to review and compare the efficacy of the types of endoscopic hemostasis most commonly used to control non-variceal gastrointestinal bleeding by pooling data from the literature. PMID:26421105

  14. Upper non-variceal gastrointestinal bleeding - review the effectiveness of endoscopic hemostasis methods.

    PubMed

    Szura, Miros?aw; Pasternak, Artur

    2015-09-25

    Upper non-variceal gastrointestinal bleeding is a condition that requires immediate medical intervention and has a high associated mortality rate (exceeding 10%). The vast majority of upper gastrointestinal bleeding cases are due to peptic ulcers. Helicobacter pylori infection, non-steroidal anti-inflammatory drugs and aspirin are the main risk factors for peptic ulcer disease. Endoscopic therapy has generally been recommended as the first-line treatment for upper gastrointestinal bleeding as it has been shown to reduce recurrent bleeding, the need for surgery and mortality. Early endoscopy (within 24 h of hospital admission) has a greater impact than delayed endoscopy on the length of hospital stay and requirement for blood transfusion. This paper aims to review and compare the efficacy of the types of endoscopic hemostasis most commonly used to control non-variceal gastrointestinal bleeding by pooling data from the literature. PMID:26421105

  15. Endoscopy - Multiple Languages: MedlinePlus

    MedlinePLUS

    ... XYZ List of All Topics All Endoscopy - Multiple Languages To use the sharing features on this page, please enable JavaScript. Arabic (???????) French (français) Japanese (???) Korean (???) Russian (???????) Somali (af Soomaali) Spanish (español) ...

  16. Infrared luminescence in Bi-doped Ge-S and As-Ge-S chalcogenide glasses and fibers

    E-print Network

    Plotnichenko, V G; Sokolov, V O; Sukhanov, M V; Velmuzhov, A P; Churbanov, M F; Dianov, E M

    2014-01-01

    Experimental and theoretical studies of spectral properties of chalcogenide Ge-S and As-Ge-S glasses and fibers are performed. A broad infrared (IR) luminescence band which covers the 1.2-2.3~$\\mu$m range with a lifetime about 6~$\\mu$s is discovered. Similar luminescence is also present in optical fibers drawn from these glasses. Arsenic addition to Ge-S glass significantly enhances both its resistance to crystallization and the intensity of the luminescence. Computer modeling of Bi-related centers shows that interstitial Bi$^+$ ions adjacent to negatively charged S vacancies are most likely responsible for the IR luminescence.

  17. Geometric Endoscopy and Mirror Symmetry

    E-print Network

    Edward Frenkel; Edward Witten

    2008-04-05

    The geometric Langlands correspondence has been interpreted as the mirror symmetry of the Hitchin fibrations for two dual reductive groups. This mirror symmetry, in turn, reduces to T-duality on the generic Hitchin fibers, which are smooth tori. In this paper we study what happens when the Hitchin fibers on the B-model side develop orbifold singularities. These singularities correspond to local systems with finite groups of automorphisms. In the classical Langlands Program local systems of this type are called endoscopic. They play an important role in the theory of automorphic representations, in particular, in the stabilization of the trace formula. Our goal is to use the mirror symmetry of the Hitchin fibrations to expose the special role played by these local systems in the geometric theory. The study of the categories of A-branes on the dual Hitchin fibers allows us to uncover some interesting phenomena associated with the endoscopy in the geometric Langlands correspondence. We then follow our predictions back to the classical theory of automorphic functions. This enables us to test and confirm them. The geometry we use is similar to that which is exploited in recent work by B.-C. Ngo, a fact which could be significant for understanding the trace formula.

  18. Intravenous midazolam sedation in pediatric diagnostic upper digestive endoscopy. A prospective study in a general hospital.

    PubMed

    Verhage, Jan; Mulder, Chris J J; Willekens, Frans L A

    2003-12-01

    The positive role of benzodiazepines (Midazolam) in conscious sedation in pediatric patients is widely known. However, problems concerning the role of sedation in diagnostic upper endoscopy are a matter for debate as little is known about dosage and timing. We prospectively evaluated the efficacy, safety and optimal intravenous sedation dosage of midazolam in 257 consecutive patients, aged 2 months to 18 years old, who underwent upper endoscopy of the gastrointestinal tract. The initial midazolam dosage was 0.2 mg/kg Bw (Body weight) i.v. for 1 minute and, if necessary, another 0.1 mg/kg Bw was administered 5 minutes later. If sedation was sufficient, the procedure would be started 4-5 minutes later; if not, another 0.1 - 0.2 mg/kg Bw would be administered. All procedures were performed by a pediatrician together with a gastroenterologist. No serious complications occurred in any of the procedures. Oxygen saturation (OS) was maintained at over 90%, if necessary with blowby oxygen. Flumazenil was administered to 7 children (OS < 90%). Endoscopy could not be completed in 1 child. All endoscopies were completed within 10 minutes. No unexpected hospital admissions were necessary. The mean midazolam dosage was 0.4 mg/kg Bw in patients up to 6 years, for the over 6 years-olds the mean dosage was decreased to 0,2 mg/kg Bw. Particular attention was paid to the importance of informing patients before the procedure. Endoscopic diagnostic procedures can be performed safely and effectively in children with intravenous sedation in a well equipped pediatric endoscopy unit. PMID:14726970

  19. Wide-field endoscopic fluorescence imaging for gastrointestinal tumor detection with glucose analogue

    NASA Astrophysics Data System (ADS)

    He, Yun; Qu, Yawei; Bai, Jing; Liu, Haifeng

    2014-05-01

    The lack of functional information and targeted imaging in conventional white-light endoscopy leads to a high miss-rate of gastrointestinal tumor. The combination of near-infrared fluorescence imaging and endoscopy presents a promising approach. Here we introduce a new endoscopy method employing a home-made flexible wide-field epi-fluorescence endoscope, that can be inserted through the biopsy channel of a gastrointestinal endoscope, with the glucose analogue 2- DeoxyGlucosone as the near-infrared fluorescent probe. System characterization indicates a good sensitivity and linearity over a large field of view. Its capability of tumor identification and location is demonstrated with in-vivo imaging of xenografted tumor model.

  20. Severe upper gastrointestinal bleeding in extraluminal diverticula in the third part of the duodenum.

    PubMed

    Wilhelmsen, Michael; Andersen, Johnny Fredsbo; Lauritsen, Morten Laksafoss

    2014-01-01

    The successful management of upper gastrointestinal (GI) bleeding requires identification of the source of bleeding and when this is achieved the bleeding can often be treated endoscopically. However, the identification of the bleeding can be challenging due to the location of the bleeding or technical aspects. Therefore it might be necessary to use other measures than endoscopy such as CT angiography. Duodenal diverticula is a rare cause of upper GI bleeding and can be challenging to diagnose as they often require specialised endoscopy procedures such as endoscopy with a side-viewing scope. This case describes the first successful management of this rare condition with an upper GI endoscopy with a colonoscope and afterwards intravascular coiling. PMID:24825552

  1. System for clinical photometric stereo endoscopy

    NASA Astrophysics Data System (ADS)

    Durr, Nicholas J.; González, Germán.; Lim, Daryl; Traverso, Giovanni; Nishioka, Norman S.; Vakoc, Benjamin J.; Parot, Vicente

    2014-02-01

    Photometric stereo endoscopy is a technique that captures information about the high-spatial-frequency topography of the field of view simultaneously with a conventional color image. Here we describe a system that will enable photometric stereo endoscopy to be clinically evaluated in the large intestine of human patients. The clinical photometric stereo endoscopy system consists of a commercial gastroscope, a commercial video processor, an image capturing and processing unit, custom synchronization electronics, white light LEDs, a set of four fibers with diffusing tips, and an alignment cap. The custom pieces that come into contact with the patient are composed of biocompatible materials that can be sterilized before use. The components can then be assembled in the endoscopy suite before use. The resulting endoscope has the same outer diameter as a conventional colonoscope (14 mm), plugs into a commercial video processor, captures topography and color images at 15 Hz, and displays the conventional color image to the gastroenterologist in real-time. We show that this system can capture a color and topographical video in a tubular colon phantom, demonstrating robustness to complex geometries and motion. The reported system is suitable for in vivo evaluation of photometric stereo endoscopy in the human large intestine.

  2. Massive upper gastrointestinal bleeding originating from a fourth-stage duodenal diverticulum: a case report and review of the literature

    PubMed Central

    Rioux, Louis; Groseilliers, Sylvain Des; Fortin, Michel; Mutch, David O.

    1996-01-01

    Duodenal diverticulum is well-known pathologic entity. Most such diverticula are asymptomatic and located on the second stage of the duodenum. The diagnosis is most often established by endoscopy or upper gastrointestinal radiography. Hemorrhage has been described but is an infrequent complication. We report on a patient who presented with massive upper gastrointestinal bleeding, originating from a fourth-stage duodenal diverticulum. The diagnosis was made with a combination of arteriography and scanning with technetium 99-labelled red cells. Diverticulectomy was performed with a successful outcome. This report underlines the diagnostic limits of fiberoptic endoscopy for hemorrhagic lesions located past the third stage of the duodenum. PMID:8956821

  3. Endoscopy services and training: a national survey of general surgeons

    PubMed Central

    Skubleny, Daniel; Switzer, Noah; Karmali, Shahzeer; de Gara, Christopher

    2015-01-01

    Background Delivering high-quality endoscopy services depends largely on the competence of endoscopists. General surgery residency training in endoscopy and the associated quality of endoscopy services being delivered by general surgeons have been the subject of considerable controversy. In conjunction with the Canadian Association of General Surgeons (CAGS) executive board, we formulated a survey to evaluate the general state of endoscopy practice and training among general surgeons in Canada. Methods The study was designed as a cross-sectional survey. General surgeons who are members of CAGS were selected to participate in the study and were emailed a link to the online questionnaire regarding the importance of endoscopy. They were asked to compare their training to resident training today. Results Sixty-nine surveys were completed. The majority of general surgeons (95.7%) indicated that endoscopy was an important skill to possess, and more than 85.5% used endoscopy in their own practices. However, nearly half (46.4%) felt that general surgery endoscopy training in Canada is currently inadequate to produce competent endoscopists. The main qualitative themes emerging from the survey were the inadequacy of current postgraduate endoscopy training (37.5%) and the absence of standardization in training (25.0%). Conclusion Endoscopy is considered integral to academic and community general surgeons’ practices; however, the adequacy of training seems to be questioned. Postgraduate training in endoscopy needs to be formalized and standardized, with a greater emphasis placed on teaching endoscopy. PMID:26384148

  4. A robust real-time abnormal region detection framework from capsule endoscopy images

    NASA Astrophysics Data System (ADS)

    Cheng, Yanfen; Liu, Xu; Li, Huiping

    2009-02-01

    In this paper we present a novel method to detect abnormal regions from capsule endoscopy images. Wireless Capsule Endoscopy (WCE) is a recent technology where a capsule with an embedded camera is swallowed by the patient to visualize the gastrointestinal tract. One challenge is one procedure of diagnosis will send out over 50,000 images, making physicians' reviewing process expensive. Physicians' reviewing process involves in identifying images containing abnormal regions (tumor, bleeding, etc) from this large number of image sequence. In this paper we construct a novel framework for robust and real-time abnormal region detection from large amount of capsule endoscopy images. The detected potential abnormal regions can be labeled out automatically to let physicians review further, therefore, reduce the overall reviewing process. In this paper we construct an abnormal region detection framework with the following advantages: 1) Trainable. Users can define and label any type of abnormal region they want to find; The abnormal regions, such as tumor, bleeding, etc., can be pre-defined and labeled using the graphical user interface tool we provided. 2) Efficient. Due to the large number of image data, the detection speed is very important. Our system can detect very efficiently at different scales due to the integral image features we used; 3) Robust. After feature selection we use a cascade of classifiers to further enforce the detection accuracy.

  5. Zoonotic Ancylostoma ceylanicum Infection Detected by Endoscopy

    PubMed Central

    Ngui, Romano; Lim, Yvonne A. L.; Ismail, Wan Hafiz Wan; Lim, Kie Nyok; Mahmud, Rohela

    2014-01-01

    We report a case of Ancylostoma ceylanicum infection detected by endoscopy. It was diagnosed and confirmed using polymerase chain reaction (PCR) and DNA sequencing. The patient is a 58-year-old Malaysian woman who lives in a rural area, where uncontrolled populations of stray and semidomesticated dogs live in close proximity with humans. PMID:24891471

  6. Effectiveness comparison of endoscopic methods of non-varicose upper gastrointestinal bleeding treatment

    PubMed Central

    Kujawski, Krzysztof; Stasiak, Magdalena; St?pie?, Mariusz

    2010-01-01

    Introduction In every case of upper gastrointestinal bleeding suspicion, an endoscopic examination ought to be performed as a matter of urgency. Finding active bleeding, a visible non-bleeding vessel or a lesion with an adherent clot should be followed by application of an available method of endoscopic therapy. The aim of the study was to compare the effectiveness of various endoscopic treatment techniques such as epinephrine injections, coagulation methods and mechanical methods in the treatment of non-varicose upper gastrointestinal bleeding. Material and methods Sixty cases of non-varicose upper gastrointestinal bleeding were analysed in terms of the effectiveness of the above-mentioned procedures used in monotherapy or in combination therapy comprising epinephrine injections and clips application. The choice of the applied procedure depended on morphological features and location of the bleeding source, the patient's general condition, as well as technical equipment and manual skills of the endoscopy staff. Results The study confirmed the effectiveness of endoscopic treatment of non-varicose upper gastrointestinal bleeding applying the above-mentioned methods. In most patients, this treatment enabled traumatic surgical intervention to be avoided; it was required in only 3 (5%) out of 60 patients with confirmed upper gastrointestinal bleeding. With the first endoscopy, haemostasis was achieved in 47 cases (78.3%) and the second endoscopy, performed due to bleeding recurrence, was successful in the remaining 10 cases (16.7%). Conclusions In non-varicose upper gastrointestinal bleeding, urgent diagnostic and therapeutic endoscopy should be the first-line management. If the lesion that is the source of bleeding is possible to localize, the endoscopic techniques should be applied. Among the endoscopic procedures used in monotherapy, clips appeared to be the most effective, their effectiveness being comparable to combination therapy. In bleeding from extensive lesions, coagulation methods are considered to be the most efficacious. PMID:22371806

  7. A modular and programmable development platform for capsule endoscopy system.

    PubMed

    Khan, Tareq Hasan; Shrestha, Ravi; Wahid, Khan A

    2014-06-01

    The state-of-the-art capsule endoscopy (CE) technology offers painless examination for the patients and the ability to examine the interior of the gastrointestinal tract by a noninvasive procedure for the gastroenterologists. In this work, a modular and flexible CE development system platform consisting of a miniature field programmable gate array (FPGA) based electronic capsule, a microcontroller based portable data recorder unit and computer software is designed and developed. Due to the flexible and reprogrammable nature of the system, various image processing and compression algorithms can be tested in the design without requiring any hardware change. The designed capsule prototype supports various imaging modes including white light imaging (WLI) and narrow band imaging (NBI), and communicates with the data recorder in full duplex fashion, which enables configuring the image size and imaging mode in real time during examination. A low complexity image compressor based on a novel color-space is implemented inside the capsule to reduce the amount of RF transmission data. The data recorder contains graphical LCD for real time image viewing and SD cards for storing image data. Data can be uploaded to a computer or Smartphone by SD card, USB interface or by wireless Bluetooth link. Computer software is developed that decompresses and reconstructs images. The fabricated capsule PCBs have a diameter of 16 mm. An ex-vivo animal testing has also been conducted to validate the results. PMID:24859846

  8. Audit of endoscopic surveillance biopsy specimens in HIV positive patients with gastrointestinal symptoms.

    PubMed Central

    Lim, S G; Lipman, M C; Squire, S; Pillay, D; Gillespie, S; Sankey, E A; Dhillon, A P; Johnson, M A; Lee, C A; Pounder, R E

    1993-01-01

    An audit of upper gastrointestinal endoscopy in HIV infected patients with gastrointestinal symptoms assessed the frequency of disease detected by endoscopy and routine laboratory analysis of surveillance biopsy specimens. Sixty nine consecutive endoscopies were performed in 59 HIV infected patients. Endoscopic biopsy specimens were taken from the lower oesophagus, gastric antrum, and third part of the duodenum for virology, histopathology, parasitology, bacteriology, and mycobacterial culture. Endoscopic appearances detected disease in 25/59 (42.4%) patients (oesophageal candida, 14; oesophageal ulcer, 3; Kaposi's sarcoma, 4; others, 4), but only 4/43 (9.3%) specimens showed evidence of disease in the absence of endoscopic abnormality. Virology for cytomegalovirus (detection of early antigenic fluorescent foci and culture) was positive in 6/59 (10.2%) patients, but parasitology and mycobacterial culture were negative in all cases. Histopathology was abnormal in 11/52 (21%) oesophageal biopsy specimens, 13/47 (28%) gastric biopsy specimens, and 4/65 (6%) duodenal biopsy specimens. Abnormal findings were found predominantly in those with advanced HIV disease (CDC Stage IV) (21/33 patients (64%)) compared with those with early HIV disease (CDC Stage II) (5/26 (19%)). In conclusion, upper gastrointestinal endoscopy detects macroscopic disease in AIDS patients and those with low CD4 counts, but routine surveillance biopsy specimens of apparently normal bowel in early HIV disease (or where CD4 counts are greater than 0.2 x 10(9)/1) are of little value. PMID:8244115

  9. Recent Update on Microbiological Monitoring of Gastrointestinal Endoscopes after High-Level Disinfection

    PubMed Central

    Shin, Suk Pyo

    2015-01-01

    Endoscopy-related infections are important contributors to nosocomial infections. Endoscope reprocessing according to standard guidelines ensures high-level disinfection and prevents endoscopy-related infections. Microbiological surveillance may help in monitoring the effectiveness of gastrointestinal endoscope disinfection. The process involves microbial cultures and non-culture methods such as bioburden assays, adenosine triphosphate (ATP) bioluminescence, and quantitative polymerase chain reactions (PCRs). Surveillance culturing to monitor endoscopes after reprocessing has been recommended by a majority of organizations. Bioburden assays, ATP bioluminescence, and quantitative PCRs provide rapid and reliable measures. Each institution will have to try to establish its own surveillance guidelines. PMID:26473118

  10. Recent Update on Microbiological Monitoring of Gastrointestinal Endoscopes after High-Level Disinfection.

    PubMed

    Shin, Suk Pyo; Kim, Won Hee

    2015-09-01

    Endoscopy-related infections are important contributors to nosocomial infections. Endoscope reprocessing according to standard guidelines ensures high-level disinfection and prevents endoscopy-related infections. Microbiological surveillance may help in monitoring the effectiveness of gastrointestinal endoscope disinfection. The process involves microbial cultures and non-culture methods such as bioburden assays, adenosine triphosphate (ATP) bioluminescence, and quantitative polymerase chain reactions (PCRs). Surveillance culturing to monitor endoscopes after reprocessing has been recommended by a majority of organizations. Bioburden assays, ATP bioluminescence, and quantitative PCRs provide rapid and reliable measures. Each institution will have to try to establish its own surveillance guidelines. PMID:26473118

  11. Zinc and gastrointestinal disease

    PubMed Central

    Skrovanek, Sonja; DiGuilio, Katherine; Bailey, Robert; Huntington, William; Urbas, Ryan; Mayilvaganan, Barani; Mercogliano, Giancarlo; Mullin, James M

    2014-01-01

    This review is a current summary of the role that both zinc deficiency and zinc supplementation can play in the etiology and therapy of a wide range of gastrointestinal diseases. The recent literature describing zinc action on gastrointestinal epithelial tight junctions and epithelial barrier function is described. Zinc enhancement of gastrointestinal epithelial barrier function may figure prominently in its potential therapeutic action in several gastrointestinal diseases. PMID:25400994

  12. Gastrointestinal Kaposi’s sarcoma: Case report and review of the literature

    PubMed Central

    Lee, Ann Joo; Brenner, Lacie; Mourad, Bashar; Monteiro, Carmela; Vega, Kenneth J; Munoz, Juan Carlos

    2015-01-01

    Kaposi’s sarcoma (KS) of the gastrointestinal tract is not an uncommon disease among individuals with acquired immunodeficiency syndrome (AIDS). The majority is asymptomatic, and for this reason, gastrointestinal KS (GI-KS) remains undiagnosed. With continued tumor growth, considerable variation in clinical presentation occurs including abdominal pain, nausea, vomiting, iron deficiency anemia (either chronic or frank gastrointestinal bleeding), and rarely mechanical obstruction alone or combined with bowel perforation. Endoscopy with biopsy allows for histological and immunohistochemical testing to confirm the diagnosis of GI-KS among those with clinical symptoms. In previous studies, dual treatment with highly active antiretroviral therapy and systemic chemotherapy have been associated with improved morbidity and mortality in individuals with visceral KS. Therefore, investigators have suggested performing screening endoscopies in select patients for early detection and treatment to improve outcome. In this review, we describe a 44 years old man with AIDS and cutaneous KS who presented for evaluation of postprandial abdominal pain, vomiting, and weight loss. On upper endoscopy, an extensive, infiltrative, circumferential, reddish mass involving the entire body and antrum of the stomach was seen. Histologic examination later revealed spindle cell proliferation, and confirmatory immunohistochemical testing revealed human herpes virus 8 latent nuclear antigen expression consistent with a diagnosis of gastric KS. Following this, we present a comprehensive review of literature on KS with emphasis on gastrointestinal tract involvement and management. PMID:26261737

  13. Double-clad fiber coupler for endoscopy.

    PubMed

    Lemire-Renaud, Simon; Rivard, Maxime; Strupler, Mathias; Morneau, Dominic; Verpillat, Frédéric; Daxhelet, Xavier; Godbout, Nicolas; Boudoux, Caroline

    2010-05-10

    We present a double-clad fiber coupler (DCFC) for use in endoscopy to reduce speckle contrast, increase signal collection and depth of field. The DCFC is made by fusing and tapering two all silica double-clad fiber (DCF) and allows achromatic transmission of >95% of core illumination (1265nm - 1325nm) as well as collection of >42% of inner cladding diffuse light. Its potential for endoscopy is demonstrated in a spectrally encoded imaging setup which shows speckle reduction by a factor 5, increased signal collection by a factor 9 and enhanced depth of field by 1.8 times. Separation by the DCFC of single- and multi-mode signals allows combining low-speckle reflectance images (25.5 fps) with interferometrically measured depth profiles (post-processed) for of small three-dimensional (3D) features through an all-fiber low loss instrument. PMID:20588826

  14. Indications for Detection, Completion, and Retention Rates of Small Bowel Capsule Endoscopy Based on the 10-Year Data from the Korean Capsule Endoscopy Registry

    PubMed Central

    Lim, Yun Jeong; Jeen, Yoon Tae; Lim, Chi Yeon; Cheung, Dae Young; Cheon, Jae Hee; Ye, Byong Duk; Song, Hyun Joo; Kim, Jin Su; Do, Jae Hyuk; Lee, Kwang Jae; Shim, Ki-Nam; Chang, Dong Kyung; Park, Cheol Hee; Jang, Byung Ik; Moon, Jeong Seop; Chun, Hoon Jai; Choi, Myung-Gyu; Kim, Jin Oh

    2015-01-01

    Background/Aims Capsule endoscopy (CE) is widely used. However, CE has limitations including incomplete examination, inadequate bowel preparation, and retention. The aim of this study was to estimate the indications for and detection, completion, and retention rates of small intestine CE based on the 10-year data from the Korean Capsule Endoscopy Registry. Methods Twenty-four hospitals participated in this study. Clinical information, such as reasons for CE, method and quality of bowel preparation, and incomplete examination and capsule retention rates, was collected and analyzed. Results A total of 2,914 CEs were registered. The most common reason for CE was obscure gastrointestinal bleeding (59%). Significant lesions were detected in 66% of cases. Positive CE diagnosis occurred in 63% of cases. The preparation method did not significantly affect the quality of bowel preparation for CE. The overall incomplete rate was 33%, and was high in the elderly and those with poor bowel preparation. Capsule retention was 3% and high in patients with small bowel tumors and Crohn's disease and in children under 10 years of age. Conclusions CE is a valuable technique; while the overall detection rate is high, incompletion and retention rates are also relatively high. CE should be carefully considered in the elderly and children less than 10 years of age, as well as in patients with small bowel tumors and Crohn's disease. PMID:26473123

  15. Endogenous and exogenous fluorescence of gastrointestinal tumors: initial clinical observations

    NASA Astrophysics Data System (ADS)

    Borisova, Ekaterina; Plamenova, Lilia; Keremedchiev, Momchil; Vladimirov, Borislav; Avramov, Latchezar

    2013-03-01

    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.

  16. Endoscopy in Canada: Proceedings of the National Roundtable.

    PubMed

    Switzer, Noah; Dixon, Elijah; Tinmouth, Jill; Bradley, Nori; Vassiliou, Melina; Schwaitzberg, Steve; Gomes, Tony; Ellsmere, James; de Gara, Chris

    2015-01-01

    This 2014 roundtable discussion, hosted by the Canadian Association of General Surgeons, brought together general surgeons and gastroenterologists with expertise in endoscopy from across Canada to discuss the state of endoscopy in Canada. The focus of the roundtable was the evaluation of the competence of general surgeons at endoscopy, reviewing quality assurance parameters for high-quality endoscopy, measuring and assessing surgical resident preparedness for endoscopy practice, evaluating credentialing programs for the endosuite and predicting the future of endoscopic services in Canada. The roundtable noted several important observations. There exist inadequacies in both resident training and the assessment of competency in endoscopy. From these observations, several collaborative recommendations were then stated. These included the need for a formal and standardized system of both accreditation and training endoscopists. PMID:25886520

  17. High-level disinfection of gastrointestinal endoscope reprocessing

    PubMed Central

    Chiu, King-Wah; Lu, Lung-Sheng; Chiou, Shue-Shian

    2015-01-01

    High level disinfection (HLD) of the gastrointestinal (GI) endoscope is not simply a slogan, but rather is a form of experimental monitoring-based medicine. By definition, GI endoscopy is a semicritical medical device. Hence, such medical devices require major quality assurance for disinfection. And because many of these items are temperature sensitive, low-temperature chemical methods, such as liquid chemical germicide, must be used rather than steam sterilization. In summarizing guidelines for infection prevention and control for GI endoscopy, there are three important steps that must be highlighted: manual washing, HLD with automated endoscope reprocessor, and drying. Strict adherence to current guidelines is required because compared to any other medical device, the GI endoscope is associated with more outbreaks linked to inadequate cleaning or disinfecting during HLD. Both experimental evaluation on the surveillance bacterial cultures and in-use clinical results have shown that, the monitoring of the stringent processes to prevent and control infection is an essential component of the broader strategy to ensure the delivery of safe endoscopy services, because endoscope reprocessing is a multistep procedure involving numerous factors that can interfere with its efficacy. Based on our years of experience in the surveillance of culture monitoring of endoscopic reprocessing, we aim in this study to carefully describe what details require attention in the GI endoscopy disinfection and to share our experience so that patients can be provided with high quality and safe medical practices. Quality management encompasses all aspects of pre- and post-procedural care including the efficiency of the endoscopy unit and reprocessing area, as well as the endoscopic procedure itself. PMID:25699232

  18. Management of Upper Gastrointestinal Bleeding in Children: Variceal and Nonvariceal.

    PubMed

    Lirio, Richard A

    2016-01-01

    Upper gastrointestinal (UGI) bleeding is generally defined as bleeding proximal to the ligament of Treitz, which leads to hematemesis. There are several causes of UGI bleeding necessitating a detailed history to rule out comorbid conditions, medications, and possible exposures. In addition, the severity, timing, duration, and volume of the bleeding are important details to note for management purposes. Despite the source of the bleeding, acid suppression with a proton-pump inhibitor has been shown to be effective in minimizing rebleeding. Endoscopy remains the interventional modality of choice for both nonvariceal and variceal bleeds because it can be diagnostic and therapeutic. PMID:26616897

  19. Diagnostic value of endoscopic ultrasonography for gastrointestinal leiomyoma

    PubMed Central

    Xu, Guo-Qiang; Zhang, Bing-Ling; Li, You-Ming; Chen, Li-Hua; Ji, Feng; Chen, Wei-Xing; Cai, Shu-Ping

    2003-01-01

    AIM: To investigate the clinical pathologic features of gastrointestinal leiomyoma and the diagnostic value of endoscopic ultrasonography (EUS) on gastrointestinal leiomyoma. METHODS: A total of 106 patients with gastrointestinal leiomyoma diagnosed with EUS were studied. The location, size and layer origin of gastric and esophageal leiomyomas were analyzed and compared. The histological diagnosis of the resected specimens by endoscopy or surgery in some patients was compared with their results of EUS. RESULTS: The majority of esophageal leiomyomas were located in the middle and lower part of the esophagus and their size was smaller than 1.0 cm, and 62.1% of esophageal leiomyomas originated from the muscularis mucosae. Most of the gastric leiomyomas were located in the body and fundus of the stomach with a size of 1-2 cm. Almost all gastric leiomyomas (94.2%) originated from the muscularis propria. The postoperative histological results of 54 patients treated by endoscopic resection or surgical excision were completely consistent with the preoperative diagnosis of EUS, and the diagnostic specificity of EUS to gastrointestinal leiomyoma was 94.7%. CONCLUSION: The size and layer origin of esophageal leiomyomas are different from that of gastric leiomyomas. Being safe and accurate, EUS is the best method not only for gastrointestinal leiomyoma diagnosis but also for the follow-up of patients. PMID:12970912

  20. Endoscopic management of gastrointestinal perforations, leaks and fistulas

    PubMed Central

    Rogalski, Pawel; Daniluk, Jaroslaw; Baniukiewicz, Andrzej; Wroblewski, Eugeniusz; Dabrowski, Andrzej

    2015-01-01

    Gastrointestinal perforations, leaks and fistulas may be serious and life-threatening. The increasing number of endoscopic procedures with a high risk of perforation and the increasing incidence of leakage associated with bariatric operations call for a minimally invasive treatment for these complications. The therapeutic approach can vary greatly depending on the size, location, and timing of gastrointestinal wall defect recognition. Some asymptomatic patients can be treated conservatively, while patients with septic symptoms or cardio-pulmonary insufficiency may require intensive care and urgent surgical treatment. However, most gastrointestinal wall defects can be satisfactorily treated by endoscopy. Although the initial endoscopic closure rates of chronic fistulas is very high, the long-term results of these treatments remain a clinical problem. The efficacy of endoscopic therapy depends on several factors and the best mode of treatment will depend on a precise localization of the site, the extent of the leak and the endoscopic appearance of the lesion. Many endoscopic tools for effective closure of gastrointestinal wall defects are currently available. In this review, we summarized the basic principles of the management of acute iatrogenic perforations, as well as of postoperative leaks and chronic fistulas of the gastrointestinal tract. We also described the effectiveness of various endoscopic methods based on current research and our experience. PMID:26457014

  1. Gastrointestinal morbidity in obesity.

    PubMed

    Acosta, Andres; Camilleri, Michael

    2014-04-01

    Obesity is a complex disease that results from increased energy intake and decreased energy expenditure. The gastrointestinal system plays a key role in the pathogenesis of obesity and facilitates caloric imbalance. Changes in gastrointestinal hormones and the inhibition of mechanisms that curtail caloric intake result in weight gain. It is not clear if the gastrointestinal role in obesity is a cause or an effect of this disease. Obesity is often associated with type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Obesity is also associated with gastrointestinal disorders, which are more frequent and present earlier than T2DM and CVD. Diseases such as gastroesophageal reflux disease (GERD), cholelithiasis, or nonalcoholic steatohepatitis are directly related to body weight and abdominal adiposity. Our objective is to assess the role of each gastrointestinal organ in obesity and the gastrointestinal morbidity resulting in those organs from the effects of obesity. PMID:24602085

  2. Pancreatic Gastrointestinal Stromal Tumor after Upper Gastrointestinal Hemorrhage and Performance of Whipple Procedure: A Case Report and Literature Review

    PubMed Central

    Aziret, Mehmet; Çetinkünar, Süleyman; Akta?, Elife; ?rkörücü, Oktay; Bali, ?lhan; Erdem, Hasan

    2015-01-01

    Patient: Male, 56 Final Diagnosis: Pancreatic GIST Symptoms: Abdominal pain Medication: None Clinical Procedure: Whipple procedure Specialty: Surgery Objective: Rare disease Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal system. These types of tumors originate from any part of the tract as well as from the intestine, colon, omentum, mesentery or retroperitoneum. GIST is a rare tumor compared to other types of tumors, accounting for less than 1% of all gastrointestinal tumors. Case Report: A 56-year-old male patient was hospitalized due to an upper gastrointestinal hemorrhage and the start of abdominal pain on the same day. In the upper gastrointestinal endoscopy that was performed, a solitary mass was found in the second section of the duodenum and a blood vessel (Forrest type 2a) was seen. The extent and location of the mass was detected by abdominal tomography. After hemodynamic recovery, a Whipple procedure was performed without any complications. A subsequent histopathological examination detected a c-kit-positive (CD117) pancreatic GIST with high mitotic index. Conclusions: The most effective treatment method for GISTs is surgical resection. In patients with a head of pancreatic GIST, the Whipple procedure can be used more safely and effectively. PMID:26237079

  3. Continuing challenges in the diagnosis and management of obscure gastrointestinal bleeding

    PubMed Central

    Baptista, Veronica; Marya, Neil; Singh, Anupam; Rupawala, Abbas; Gondal, Bilal; Cave, David

    2014-01-01

    The diagnosis and management of obscure gastrointestinal bleeding (OGIB) have changed dramatically since the introduction of video capsule endoscopy (VCE) followed by deep enteroscopy and other imaging technologies in the last decade. Significant advances have been made, yet there remains room for improvement in our diagnostic yield and treatment capabilities for recurrent OGIB. In this review, we will summarize the latest technologies for the diagnosis of OGIB, limitations of VCE, technological enhancement in VCE, and different management options for OGIB. PMID:25400996

  4. Uncommon gastrointestinal bleeding during targeted therapy for advanced renal cell carcinoma: A report of four cases

    PubMed Central

    FUJIHARA, SHINTARO; MORI, HIROHITO; KOBARA, HIDEKI; NISHIYAMA, NORIKO; AYAKI, MAKI; OHATA, RYO; UEDA, NOBUFUMI; SUGIMOTO, MIKIO; KAKEHI, YOSHIYUKI; MASAKI, TSUTOMU

    2015-01-01

    Clinically available targeted agents to treat advanced renal cell carcinoma (RCC) include sunitinib, sorafenib and temsirolimus. Sorafenib and sunitinib have been associated with bleeding in selected trials, but clinical and endoscopic characteristics of gastrointestinal bleeding are not well described. Herein, we report four cases of advanced RCC in which endoscopic hemostasis effectively resolved high-grade, life-threatening gastrointestinal bleeding that occurred during targeted therapy. Although stomatitis and mucositis have occurred during targeted therapies, life-threatening gastrointestinal bleeding is less common. In these four patients, the origins of gastrointestinal bleeding were identified, and complete endoscopic hemostasis was achieved. Endoscopies revealed variable characteristics including angiodysplasia, multiple gastric ulcers and oozing bleeding of the normal mucosa. Although the most effective diagnostic and treatment strategies are disputed, endoscopic examinations are best performed before starting targeted therapies. Additionally, these patients should be monitored even for rare life-threatening events. PMID:26722259

  5. Eosinophilic Gastroenteritis: Review of a Rare and Treatable Disease of the Gastrointestinal Tract

    PubMed Central

    Mori, Amit; Enweluzo, Chijioke; Grier, David; Badireddy, Madhu

    2013-01-01

    Eosinophilic gastroenteritis is a rare disease of the gastrointestinal tract characterized by crampy abdominal pain, nausea, vomiting, diarrhea, gastrointestinal bleeding, and weight loss associated with peripheral eosinophilia leading to eosinophilic infiltrates in stomach and intestine, usually in a patient with a prior history of atopy. In this article, we describe our encounter with a 59-year-old female presenting with severe abdominal pain, nausea, vomiting, and weight loss with an extensive evaluation including an upper endoscopy with biopsies resulting in a diagnosis of eosinophilic gastroenteritis. The patient was eventually treated with oral prednisone for three weeks with complete resolution of her symptoms. PMID:23904840

  6. Boerhaave's syndrome presenting as an upper gastrointestinal bleed

    PubMed Central

    Lee, William; Siau, Keith; Singh, Gurjit

    2013-01-01

    A 64-year-old man without any significant medical history presented to accident and emergency department with haematemesis and melaena, quite similar to an upper gastrointestinal bleed. However, the unexplained left-sided neck pain with a history of overnight vomiting prompted further imaging. Air was visible in the soft tissues on a lateral X-ray of the neck, which led to a CT scan and this showed a proximal-mid oesophageal rupture. The patient was stabilised and transferred to a cardiothoracic unit for observation. An inpatient endoscopy did not detect a perforation and the patient was discharged 5?days later without any further complications. This case report highlights how a high oesophageal rupture can mimic an upper gastrointestinal bleed and also the need for further imaging when there is an incongruent history, so that appropriate care is provided to minimise mortality. PMID:24293537

  7. Registered nurse-administered sedation for gastrointestinal endoscopic procedure

    PubMed Central

    Amornyotin, Somchai

    2015-01-01

    The rising use of nonanesthesiologist-administered sedation for gastrointestinal endoscopy has clinical significances. Most endoscopic patients require some forms of sedation and/or anesthesia. The goals of this sedation are to guard the patient’s safety, minimize physical discomfort, to control behavior and to diminish psychological responses. Generally, moderate sedation for these procedures has been offered by the non-anesthesiologist by using benzodiazepines and/or opioids. Anesthesiologists and non-anesthesiologist personnel will need to work together for these challenges and for safety of the patients. The sedation training courses including clinical skills and knowledge are necessary for the registered nurses to facilitate the patient safety and the successful procedure. However, appropriate patient selection and preparation, adequate monitoring and regular training will ensure that the use of nurse-administered sedation is a feasible and safe technique for gastrointestinal endoscopic procedures. PMID:26191341

  8. [Drug-eluting stent in gastrointestinal disease].

    PubMed

    Lee, Don Haeng

    2007-05-01

    Gastrointestinal (GI) cancers cause obstruction of the GI tract including biliary tree. In advanced GI cancer, endoscopic stent insertion is the treatment of choice. However, the current stent allows only mechanical palliation of obstructed GI tract and has no anti-tumor effect. The primary role of a drug eluting stent (DES) in gastrointestinal malignancy is that it decreases the tumor re-growth and sustains the stent patency. This might not be as impressive as the effect of a vascular DES which decreases the incidence of restenosis and thus increases the survival rate of the patient. However, in terms of improving the quality of life of the patient, maintaining the stent patency is one of the most important task of GI doctors. With an advanced technology in stent production, Korea would be able to play an active role in the field of DES especially with more advanced anti-tumor effect. Moreover, advances in this type of drug delivery system will enable the development of local treatment of GI malignancy using endoscopy. PMID:17525517

  9. Pharmacological Treatment in Upper Gastrointestinal Bleeding.

    PubMed

    Lam, Kelvin L Y; Wong, John C T; Lau, James Y W

    2015-12-01

    Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency. Bleeding peptic ulcers account for the majority of causes in patients presenting with AUGIB, whereas variceal bleeding in cirrhotic patients represents a more severe form of bleeding. Endoscopic therapy is the mainstay of treatment in patients with active bleeding, as it achieves hemostasis and improves patient outcomes. Pharmacotherapy is an important adjunct to endoscopic hemostasis. In the management of patients with bleeding peptic ulcers, acid suppression after endoscopic hemostasis reduces rates of further bleeding and interventions. In patients with stable hemodynamics awaiting endoscopy, acid suppression starts ulcer healing and downstages stigmata of bleeding, thereby reducing the need for endoscopic therapy. In managing patients with variceal bleeding, early administration of vasoactive drugs lowers splanchnic blood flow, promotes hemostasis, and makes subsequent endoscopic treatment easier. The use of vasoactive agents and antibiotics have both been shown to reduce mortality. In this review article, strategies of acid suppression therapy for peptic ulcer bleeds, vasoactive agents, and antibiotics for variceal bleeding, together with recent evidence on the use of tranexamic acid in gastrointestinal bleeding, are discussed. PMID:26310578

  10. Electronic Endoscopy in Endoscopic Mucosal Resection (EMR) of Gastric Cancer

    PubMed Central

    Misaka, Ryouichi; Yamada, Michiru; Midorikawa, Shouko; Sanji, Tetuya; Shinohara, Satoshi; Morita, Shigefumi; Handa, Yutaka; Ohno, Hiroyuki; Saitou, Yasuhiko; Yosida, Hajime; Takase, Masahisa; Saitou, Toshihiko

    1995-01-01

    The role in which electronic endoscopy plays is important in EMR. It is useful in diagnosis and treatment of gastric cancer from a clinical viewpoint. EMR with use of electronic endoscopy allows better coordination between the operator and assistants, and thus improves the results further. PMID:18493367

  11. VIVENDI -A Virtual Ventricle Endoscopy System for Virtual Medicine?

    E-print Network

    Bartz, Dirk

    -processing stage and the virtual endoscopy of the ventric- ular system (Figure 1). Medicine Computer ScienceVIVENDI - A Virtual Ventricle Endoscopy System for Virtual Medicine? Dirk Bartz1 and Martin Skalej2-Seyler-Str. 3 D72076 T¨ubingen, Germany Abstract. Virtual Medicine is an emerging and challenging field

  12. BOUNDS ON RF COOPERATIVE LOCALIZATION FOR VIDEO CAPSULE ENDOSCOPY

    E-print Network

    Pahlavan, Kaveh

    BOUNDS ON RF COOPERATIVE LOCALIZATION FOR VIDEO CAPSULE ENDOSCOPY by Yunxing Ye A Dissertation video capsule endoscopy has been in use for over a decade and it uses radio frequency (RF) signals to transmit approximately fifty five thousands clear pictures of inside the GI tract to the body

  13. Intraoperative salvage endoscopy performed during orthotopic liver transplantation due to esophageal bleeding

    PubMed Central

    Kozie?, S?awomir; Patkowski, Waldemar; Gr?t, Micha?; Wróblewski, Tadeusz; Krawczyk, Marek

    2015-01-01

    Introduction Liver transplantation (LTx) is a widely accepted method of treatment for end stage liver diseases. There are many reports on the management of gastrointestinal bleeding (GIB) after LTx, however the number of studies concerning salvage endoscopic procedures during LTx are scarce. Aim We present our material of intraoperative endoscopic procedures due to GIB during LTx. Material and methods During this period there were 4 females and 1 male at the mean age of 52.2 (35–65) years who underwent LTx and 1 patient had Re-LTx. All patients were Child-Pugh group C and mean MELD score was 17.75. Esophageal and/or gastric varices were present before surgery in all patients but only 1 female patient didn't experience GIB prior to LTx. Variables such as operating time, cold ischemic time, blood loss, blood transfusion, PLT count, international normalized ratio, albumin levels were similar in all patients thus making it statistically insignificant as the cause of GIB. Results In all cases a single IOE was necessary and bleeding from ruptured varices succumbed to endoscopic ligation. In 2 patients besides trials of ligating the varix, histoacryl was put in use which proved success. In both these last female patients the endoscopic physician had to insert a Danis stent. A follow up endoscopy was performed on the 7–10 POD. Conclusions Intra-operative endoscopy performed during LTx does not interrupt surgery. Performed as soon as possible results in less future endoscopic interventions due to GIB. Intraoperative endoscopy may be considered as a salvage procedure and should be performed in the shortest possible time.

  14. Endoscopy training in Canadian general surgery residency programs

    PubMed Central

    Bradley, Nori L.; Bazzerelli, Amy; Lim, Jenny; Ying, Valerie Wu Chao; Steigerwald, Sarah; Strickland, Matt

    2015-01-01

    Summary Currently, general surgeons provide about 50% of endoscopy services across Canada and an even greater proportion outside large urban centres. It is essential that endoscopy remain a core component of general surgery practice and a core competency of general surgery residency training. The Canadian Association of General Surgeons Residents Committee supports the position that quality endoscopy training for all Canadian general surgery residents is in the best interest of the Canadian public. However, the means by which quality endoscopy training is achieved has not been defined at a national level. Endoscopy training in Canadian general surgery residency programs requires standardization across the country and improved measurement to ensure that competency and basic credentialing requirements are met. PMID:26011848

  15. Small bowel capsule endoscopy: Where are we after almost 15 years of use?

    PubMed Central

    Van de Bruaene, Cedric; De Looze, Danny; Hindryckx, Pieter

    2015-01-01

    The development of capsule endoscopy (CE) in 2001 has given gastroenterologists the opportunity to investigate the small bowel in a non-invasive way. CE is most commonly performed for obscure gastrointestinal bleeding, but other indications include diagnosis or follow-up of Crohn’s disease, suspicion of a small bowel tumor, diagnosis and surveillance of hereditary polyposis syndromes, Nonsteroidal anti-inflammatory drug-induced small bowel lesions and celiac disease. Almost fifteen years have passed since the release of the small bowel capsule. The purpose of this review is to offer the reader a brief but complete overview on small bowel CE anno 2014, including the technical and procedural aspects, the possible complications and the most important indications. We will end with some future perspectives of CE. PMID:25610531

  16. Global-constrained hidden Markov model applied on wireless capsule endoscopy video segmentation

    NASA Astrophysics Data System (ADS)

    Wan, Yiwen; Duraisamy, Prakash; Alam, Mohammad S.; Buckles, Bill

    2012-06-01

    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.

  17. Texture and color based image segmentation and pathology detection in capsule endoscopy videos.

    PubMed

    Szczypi?ski, Piotr; Klepaczko, Artur; Pazurek, Marek; Daniel, Piotr

    2014-01-01

    This paper presents an in-depth study of several approaches to exploratory analysis of wireless capsule endoscopy images (WCE). It is demonstrated that versatile texture and color based descriptors of image regions corresponding to various anomalies of the gastrointestinal tract allows their accurate detection of pathologies in a sequence of WCE frames. Moreover, through classification of single pixels described by texture features of their neighborhood, the images can be segmented into homogeneous areas well matched to the image content. For both, detection and segmentation tasks the same procedure is applied which consists of features calculation, relevant feature subset selection and classification stages. This general three-stage framework is realized using various recognition strategies. In particular, the performance of the developed Vector Supported Convex Hull classification algorithm is compared against Support Vector Machines run in configuration with two different feature selection methods. PMID:23164524

  18. Application of wireless power transmission systems in wireless capsule endoscopy: an overview.

    PubMed

    Basar, Md Rubel; Ahmad, Mohd Yazed; Cho, Jongman; Ibrahim, Fatimah

    2014-01-01

    Wireless capsule endoscopy (WCE) is a promising technology for direct diagnosis of the entire small bowel to detect lethal diseases, including cancer and obscure gastrointestinal bleeding (OGIB). To improve the quality of diagnosis, some vital specifications of WCE such as image resolution, frame rate and working time need to be improved. Additionally, future multi-functioning robotic capsule endoscopy (RCE) units may utilize advanced features such as active system control over capsule motion, drug delivery systems, semi-surgical tools and biopsy. However, the inclusion of the above advanced features demands additional power that make conventional power source methods impractical. In this regards, wireless power transmission (WPT) system has received attention among researchers to overcome this problem. Systematic reviews on techniques of using WPT for WCE are limited, especially when involving the recent technological advancements. This paper aims to fill that gap by providing a systematic review with emphasis on the aspects related to the amount of transmitted power, the power transmission efficiency, the system stability and patient safety. It is noted that, thus far the development of WPT system for this WCE application is still in initial stage and there is room for improvements, especially involving system efficiency, stability, and the patient safety aspects. PMID:24949645

  19. Application of Wireless Power Transmission Systems in Wireless Capsule Endoscopy: An Overview

    PubMed Central

    Basar, Md Rubel; Ahmad, Mohd Yazed; Cho, Jongman; Ibrahim, Fatimah

    2014-01-01

    Wireless capsule endoscopy (WCE) is a promising technology for direct diagnosis of the entire small bowel to detect lethal diseases, including cancer and obscure gastrointestinal bleeding (OGIB). To improve the quality of diagnosis, some vital specifications of WCE such as image resolution, frame rate and working time need to be improved. Additionally, future multi-functioning robotic capsule endoscopy (RCE) units may utilize advanced features such as active system control over capsule motion, drug delivery systems, semi-surgical tools and biopsy. However, the inclusion of the above advanced features demands additional power that make conventional power source methods impractical. In this regards, wireless power transmission (WPT) system has received attention among researchers to overcome this problem. Systematic reviews on techniques of using WPT for WCE are limited, especially when involving the recent technological advancements. This paper aims to fill that gap by providing a systematic review with emphasis on the aspects related to the amount of transmitted power, the power transmission efficiency, the system stability and patient safety. It is noted that, thus far the development of WPT system for this WCE application is still in initial stage and there is room for improvements, especially involving system efficiency, stability, and the patient safety aspects. PMID:24949645

  20. Targeted detection of murine colonic dysplasia in vivo with flexible multispectral scanning fiber endoscopy.

    PubMed

    Miller, Sharon J; Lee, Cameron M; Joshi, Bishnu P; Gaustad, Adam; Seibel, Eric J; Wang, Thomas D

    2012-02-01

    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. PMID:22463021

  1. Diagnostic techniques in chronic sinusitis: endoscopy, sinusomanometry.

    PubMed

    Bertrand, B; Collet, S; Betsch, C; Rombaux, P; Eloy, P

    1997-01-01

    The first endoscope was conceived as early as 1806. Since then successive technical advances led endoscopy of the nose and paranasal sinuses to a routine procedure. From the rediscovery of the rigid telescopes by Hopkins in the fifties, progress has stemmed essentially from the quality of the more powerful cold lights and the improvement in the light output of the fiber optics. Exam procedures of the nose and sinuses are conducted under general as well as local anesthesia, and are commonly combined with concomitant diagnostic procedures: measure of the mucociliary clearance with indicators, biopsies, smear sampling for bacterial and fungal examinations, and sinusomanometry which can help to estimate the patency of the maxillary ostium and of the nasofrontal duct. Sinus endoscopy has been widely used to correlate efficiency of other diagnostic techniques such as plain X-rays, CT scanners, A and B mode ultrasonography. A similar work should be done for MRI. Endoscopic exploration is the key to the management of chronic pathology as it brings precise information on the quality of the naso-sinus mucosa, the presence of secretions and, combined with sinusomanometry, the functional state of the ostia or ducts. PMID:9444374

  2. Pillcam ESO® is more accurate than clinical scoring systems in risk stratifying emergency room patients with acute upper gastrointestinal bleeding

    PubMed Central

    Shalomov, Albert; Hussain, Syed A.; Kim, Sang H.; Cortes, Rafael; Gray, Sondra; Judeh, Hani; Pollack, Simcha; Rubin, Moshe

    2013-01-01

    Background: Upper gastrointestinal bleeding (UGIB) accounts for 400,000 hospital admissions in the US each year. Despite advances, mortality rates remain high and are estimated to be 5–10%. Early therapeutic endoscopy is widely recommended as a means of reducing morbidity and mortality. The Rockall and Blatchford scores are clinical scoring systems devised to assist in risk stratifying patients with UGIB. In a prior study we found that rapid live bedside video capsule endoscopy (VCE) utilizing Pillcam ESO® correctly identified patients with high-risk stigmata of bleeding seen on upper endoscopy. In this study, we compare the accuracy of the Rockall and Blatchford scores with Pillcam ESO® in predicting high-risk endoscopic stigmata. Methods: Pre-endoscopy Blatchford and Rockall scores were calculated for 25 patients (14 males, 11 females) presenting to the emergency room with acute UGIB. The average patient was 66 years of age. A total of 24 out of 25 patients underwent upper endoscopy within 24 hours. One patient did not undergo endoscopy due to clinical instability. The timing of endoscopy was based on clinical parameters in 12 patients, and on live view VCE with Pillcam ESO® in the other 13 patients. Positive VCE was defined as red blood, clot or coffee grounds. Mean Rockall and Blatchford scores for all 24 patients were compared to determine potential differences between high- and low-risk patients. Rockall and Blatchford scores were also compared with VCE findings. Results: Of 24 patients, 13 had high-risk stigmata on upper endoscopy. The mean Rockall and Blatchford scores were 3 and 13, respectively. In the 11 patients without stigmata, the mean Rockall and Blatchford scores were 2 and 11, respectively. There was no statistically significant difference between the Blatchford scores of the two groups (95% confidence interval [CI] ?5.1 to 1.3; p = 0.22). There was no statistically significant difference between the Rockall scores of the two groups (95% CI ?2.3 to 0.3; p = 0.11). In the subgroup of 12 patients who underwent VCE prior to endoscopy, 8/12 had positive findings, which were all confirmed at endoscopy. All 4 patients with negative VCE had no high-risk stigmata at endoscopy. Conclusion: In emergency room patients with acute UGIB, neither the Rockall nor the Blatchford scores were able to differentiate high- and low-risk patients identified at endoscopy. Live view VCE, however, was accurate in predicting high-risk endoscopic stigmata, and may be better suited as a risk stratification tool. Additional studies with a larger cohort will be required to validate these findings. PMID:23634183

  3. How much helpful is the capsule endoscopy for the diagnosis of small bowel lesions?

    PubMed Central

    Ersoy, Osman; Sivri, Bulent; Arslan, Serap; Batman, Figen; Bayraktar, Yusuf

    2006-01-01

    AIM: To assess the practically usefulness and diagnostic yield of this new method in a group of patients with suspected small bowel lesions. METHODS: Capsule endoscopic (CE) examination by using M2A capsule endoscope TM (Given Imaging, Yoqneam, Israel) was performed in thirty nine patients (26 males, 13 females) with suspected small intestinal lesions. The composing of the patients was as follows: obscure gastrointestinal bleeding in twenty three patients, known Crohn’s disease in 6 patients, in whom CE was used to evaluate the severity and extension of the diseases, chronic diarrhea in 8 patients, abdominal pain in one patient and malignancy in one patient with unknown origin. RESULTS: In two patients CE failed. Different abnormalities were revealed in 26 patients overall. Detection rate of abnormalities was highest among patients with obscure gastrointestinal bleeding and the source of bleeding was demonstrated in 17 of 23 patients with obscure bleeding (73.9%). Entero-Behcet was diagnosed in two patients by CE as a source of obscure gastrointestinal bleeding. In 6 patients with known Crohn's disease, CE revealed better evaluation of the disease extension. In 3 of 8 (37.5%) patients with chronic diarrhea; CE revealed some mucosal abnormalities as the cause of chronic diarrhea. In a patient with unexplained abdominal pain and in a cancer patient with unknown origin, CE examination was normal. CONCLUSION: In our relatively small series, we found that capsule endoscopy is a useful diagnostic tool particularly in diagnosis of obscure gastrointestinal bleeding, chronic diarrhea and in estimating the extension of Crohn’s disease. PMID:16804980

  4. Room-temperature electroluminescence from germanium in an Al(0.3)Ga(0.7)As/Ge heterojunction light-emitting diode by ?-valley transport.

    PubMed

    Cho, Seongjae; Park, Byung-Gook; Yang, Changjae; Cheung, Stanley; Yoon, Euijoon; Kamins, Theodore I; Yoo, S J Ben; Harris, James S

    2012-07-01

    Group-IV materials for monolithic integration with silicon optoelectronic systems are being extensively studied. As a part of efforts, light emission from germanium has been pursued with the objective of evolving germanium into an efficient light source for optical communication systems. In this study, we demonstrate room-temperature electroluminescence from germanium in an Al(0.3)Ga(0.7)As/Ge heterojunction light-emitting diode without any complicated manipulation for alternating material properties of germanium. Electroluminescence peaks were observed near 1550 nm and the energy around this wavelength corresponds to that emitted from direct recombination at the ?-valley of germanium. PMID:22772186

  5. Recent Advances in Image-enhanced Endoscopy

    PubMed Central

    Cho, Won Young; Lee, Don Haeng

    2011-01-01

    The desire to better recognized such malignancies, which may be difficult to distinguish from inflammation or trauma, has accelerated the development of endoscopy with new optical technologies. Narrow-band imaging is a novel endoscopic technique that may enhance the accuracy of diagnosis using narrow-bandwidth filters in a red-green-blue sequential illumination system. Autofluorescence imaging is based on the detection of natural tissue fluorescence emitted by endogenous molecules. I-scan technology using a digital filter that modifies normal images through software functions, is the newly developed image-enhanced endoscopic technology from PENTAX. Flexible spectral imaging color enhancement enhances the visualization of mucosal structure and microcirculation by the selection of spectral transmittance with a dedicated wavelength. Confocal laser endomicroscopy images were collected with an argon beam with a scanning depth of 0 (epithelium) to 250 µm (lamina propria) and analyzed using the reflected light. PMID:22741116

  6. Micro-Optics In Holographic Endoscopy

    NASA Astrophysics Data System (ADS)

    von Bally, G.; Dirksen, D.; Zou, Y.; Kraetzig, E.

    1989-10-01

    The combination of holographic metrology with endoscopic imaging allows the development of a new class of minute instruments for high-resolving, non-contactive, non-destructive intra-cavity measurements. New developments in micro-optics give main impulses to actual progress in holographic endoscopy: - Assembled gradient-index rod lenses are used for small submillimeter needle diameter rigid endoscopic instruments. - The use of (single-mode) optical fibers offers easy handling and flexibility. Especially, new single-mode imaging fiber bundles show improved performance data (high lateral resolution) at very small diameters. - The use of electro-optical crystals opens the possibility of developing a minute holographic storage device for an easy-to-handle, small holographic endoscopic camera system for in-situ recording, reconstruction and erasure with fast repetition rate.

  7. [Principles of hygiene in ENT endoscopy].

    PubMed

    Kramer, A; Kohnen, W; Israel, S; Ryll S, S; Hübner, N-O; Luckhaupt, H; Hosemann, W

    2015-03-01

    This article gives a report on principles of reprocessing of rigid and flexible endoscopes used in ENT units including structural and spatial requirements based on the general and also ENT-specific risks of infection associated with diagnostic and therapeutic endoscopy. The underlying legal principles as well as recommendations from scientific societies will be exemplified in order to give the otorhinolaryngologist a practical guidance.Preliminary results of a nation-wide survey on infection control standards based on data of 29 ENT practices in Germany reveal actual deficits of varying degree concerning infection control management including reprocessing of endoscopes. The presented review aims to give support to the establishment of a structured infection control management program including the evaluation of results by means of a prospective surveillance. PMID:25860491

  8. Miniature Grating for Spectrally-Encoded Endoscopy

    PubMed Central

    Kang, Dongkyun; Martinez, Ramses V.; Whitesides, George M.

    2013-01-01

    Spectrally-encoded endoscopy (SEE) is an ultraminiature endoscopy technology that acquires high-definition images of internal organs through a sub-mm endoscopic probe. In SEE, a grating at the tip of the imaging optics diffracts the broadband light into multiple beams, where each beam with a distinctive wavelength is illuminated on a unique transverse location of the tissue. By encoding one transverse coordinate with the wavelength, SEE can image a line of the tissue at a time without using any beam scanning devices. This feature of the SEE technology allows the SEE probe to be miniaturized to sub-mm dimensions. While previous studies have shown that SEE has the potential to be utilized for various clinical imaging applications, the translation of SEE for medicine has been hampered by challenges in fabricating the miniature grating inherent to SEE probes. This paper describes a new fabrication method for SEE probes. The new method uses a soft lithographic approach to pattern a high-aspect-ratio grating at the tip of the miniature imaging optics. Using this technique, we have constructed a 500-?m-diameter SEE probe. The miniature grating at the tip of the probe had a measured diffraction efficiency of 75%. The new SEE probe was used to image a human finger and formalin fixed mouse embryos, demonstrating the capability of this device to visualize key anatomic features of tissues with high image contrast. In addition to providing high quality imaging SEE optics, the soft lithography method allows cost-effective and reliable fabrication of these miniature endoscopes, which will facilitate the clinical translation of SEE technology. PMID:23503940

  9. The Value of Endoscopy in a Wildlife Raptor Service.

    PubMed

    Desmarchelier, Marion R; Ferrell, Shannon T

    2015-09-01

    Although endoscopy is part of the basic standard of care in most avian practices, many wildlife rehabilitation centers do not have access to the equipment or do not use it on a regular basis. Endoscopic equipment is easily available at a lower cost on the used market or can be acquired through donations from local human hospitals. Several medical conditions encountered in wild raptors have an improved prognosis if they are diagnosed or treated early with the aid of endoscopy. In many cases, endoscopy provides a noninvasive alternative to exploratory surgery, saving cost and time and decreasing postoperative pain. PMID:26094021

  10. Nasal endoscopy: new tools and technology for accurate assessment.

    PubMed

    Bliss, Morgan; Muntz, Harlan

    2015-01-01

    In this chapter the technique of nasal endoscopy is discussed. Standardized reporting of nasal endoscopy findings is essential in order to allow communication between different surgeons, speech therapists and endoscopists. Representative videos are provided for the normal examination, for coronal and sagittal velopharyngeal closure patterns, as well as for other anatomical variants of interest. Recommendations for tailoring surgical therapy based on the nasopharyngeal closure pattern are given, although the experience of the surgeon is an important factor for success of any surgical procedure for velopharyngeal insufficiency. Limitations and new frontiers of the technique of nasal endoscopy are also outlined. PMID:25733228

  11. Diagnostic Modalities for Inflammatory Bowel Disease: Serologic Markers and Endoscopy.

    PubMed

    Clark, Clarence; Turner, Jacquelyn

    2015-12-01

    The evaluation, diagnosis, and monitoring of inflammatory bowel disease (IBD) has improved significantly over the past few decades. However, differentiation and management of the subtypes of IBD (Crohn's disease, ulcerative colitis, and indeterminate colitis) can still be challenging. The evolution of serologic markers has improved our understanding of the pathogenesis and natural history of IBD. In addition, advancements in endoscopy and endoscopic scoring systems have improved the accuracy of diagnosis and the efficacy of surveillance of IBD patients. This article reviews the recent literature on serologic markers, endoscopy, and endoscopy scoring systems. PMID:26596918

  12. Gastrointestinal Malignancies Faculty

    Cancer.gov

    Mission Statement The Gastrointestinal Malignancies Faculty (GMF) facilitates interactions among basic, epidemiological, translational, and clinical researchers promoting a community of investigators working together for the prevention, diagnosis, and cur

  13. Gastrointestinal Steering Committee

    Cancer.gov

    The Gastrointestinal Steering Committee evaluates and prioritizes concepts for phase 3 and large phase 2 therapeutic clinical trials to be conducted in the NCI National Clinical Trials Network (NCTN).

  14. Gastrointestinal Malignancies Faculty

    Cancer.gov

    1) Promote collaborative interactions among NCI basic, epidemiological, translational, and clinical investigators who conduct research in gastrointestinal malignancies; and 2) Facilitate the development of new prevention, diagnosis, and treatment options

  15. ASGE: Find a Doctor

    MedlinePLUS

    ... State, Zip Code, or Country. Last Name Country Select A Country Afghanistan Aland Islands Albania Algeria American ... and Futuna Western Sahara Yemen Zambia Zimbabwe State Select A State City Postal Code Search by Distance ...

  16. A typical presentation of a rare cause of obscure gastrointestinal bleeding

    PubMed Central

    Reuter, Stefan; Bettenworth, Dominik; Mees, Sören Torge; Neumann, Jörg; Beyna, Torsten; Domschke, Wolfram; Wessling, Johannes; Ullerich, Hansjörg

    2011-01-01

    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

  17. ROC curves and video analysis optimization in intestinal capsule endoscopy

    E-print Network

    Kuncheva, Ludmila I.

    ROC curves and video analysis optimization in intestinal capsule endoscopy Fernando Vilarin~o a by a highly qualified professional. Time episodes corre- sponding to intestinal contractions, which reserved. Keywords: ROC curves; Classification; Classifiers ensemble; Detection of intestinal contractions

  18. Colon capsule endoscopy: Advantages, limitations and expectations. Which novelties?

    PubMed Central

    Riccioni, Maria Elena; Urgesi, Riccardo; Cianci, Rossella; Bizzotto, Alessandra; Spada, Cristiano; Costamagna, Guido

    2012-01-01

    Since the first reports almost ten years ago, wireless capsule endoscopy has gained new fields of application. Colon capsule endoscopy represents a new diagnostic technology for colonic exploration. Clinical trials have shown that colon capsule endoscopy is feasible, accurate and safe in patients suffering from colonic diseases and might be a valid alternative to conventional colonoscopy in selected cases such as patients refusing conventional colonoscopy or with contraindications to colonoscopy or when colonoscopy is incomplete. Despite the enthusiasm surrounding this new technique, few clinical and randomized controlled trials are to be found in the current literature, leading to heterogeneous or controversial results. Upcoming studies are needed to prove the substantial utility of colon capsule endoscopy for colon cancer screening, especially in a low prevalence of disease population, and for other indications such as inflammatory bowel disease. Possible perspectives are critically analysed and reported in this paper. PMID:22523610

  19. Integrated optical tools for minimally invasive diagnosis and treatment at gastrointestinal endoscopy

    E-print Network

    Bigio, Irving J.

    Department of Biomedical Engineering, Boston University, Boston, MA, USA a r t i c l e i n f o Keywords, with minimal invasion and in real-time. Clearly, there is the potential for the reduction of overall procedure costs, patient distress, and risks as a consequence of biopsying and processing only diseased tissue

  20. Application and limitations of endoscopy in anthropological and archaeological research.

    PubMed

    Beckett, Ronald G

    2015-06-01

    The use of endoscopy in anthropological and archaeological research was been well documented in the literature. This article explores the varied settings in which endoscopy is beneficial in gathering visual data for interpretation related to cultural remains and artifacts. Endoscopic data may be used to assist in the pursuit of answering such bioanthropological questions as sex, age at death, presence of paleopathologies, dental conditions, and cultural practices. Endoscopy is often used to guide and document biopsy procedures as well as the retrieval of artifacts from within poorly accessible locations such as body cavities, coffins, or tombs. In addition, endoscopic data is used to examine such archaeological features as tomb structure and design. A contrast between the medical and anthropological approach is described. Endoscopic research is enhanced when applied in conjunction with additional varied imaging modalities. While invasive, endoscopy is a nondestructive methodological approach. As with all methods, endoscopy has application and interpretational limitations, which can be described as limitations resulting from instrumentation, and those arising from personnel less familiar with the various approaches to endoscopy in both field and laboratory settings. PMID:25998646

  1. Genetics Home Reference: Gastrointestinal stromal tumor

    MedlinePLUS

    ... gastrointestinal stromal tumor? gastrointestinal stromal neoplasm gastrointestinal stromal sarcoma GIST For more information about naming genetic conditions, see the Genetics Home Reference Condition Naming ...

  2. Asbestos and gastrointestinal cancer

    SciTech Connect

    Morgan, R.W.; Foliart, D.E.; Wong, O.

    1985-07-01

    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.

  3. Gastrointestinal bleeding from Dieulafoy’s lesion: Clinical presentation, endoscopic findings, and endoscopic therapy

    PubMed Central

    Nojkov, Borko; Cappell, Mitchell S

    2015-01-01

    Although relatively uncommon, Dieulafoy’s lesion is an important cause of acute gastrointestinal bleeding due to the frequent difficulty in its diagnosis; its tendency to cause severe, life-threatening, recurrent gastrointestinal bleeding; and its amenability to life-saving endoscopic therapy. Unlike normal vessels of the gastrointestinal tract which become progressively smaller in caliber peripherally, Dieulafoy’s lesions maintain a large caliber despite their peripheral, submucosal, location within gastrointestinal wall. Dieulafoy’s lesions typically present with severe, active, gastrointestinal bleeding, without prior symptoms; often cause hemodynamic instability and often require transfusion of multiple units of packed erythrocytes. About 75% of lesions are located in the stomach, with a marked proclivity of lesions within 6 cm of the gastroesophageal junction along the gastric lesser curve, but lesions can also occur in the duodenum and esophagus. Lesions in the jejunoileum or colorectum have been increasingly reported. Endoscopy is the first diagnostic test, but has only a 70% diagnostic yield because the lesions are frequently small and inconspicuous. Lesions typically appear at endoscopy as pigmented protuberances from exposed vessel stumps, with minimal surrounding erosion and no ulceration (visible vessel sans ulcer). Endoscopic therapy, including clips, sclerotherapy, argon plasma coagulation, thermocoagulation, or electrocoagulation, is the recommended initial therapy, with primary hemostasis achieved in nearly 90% of cases. Dual endoscopic therapy of epinephrine injection followed by ablative or mechanical therapy appears to be effective. Although banding is reportedly highly successful, it entails a small risk of gastrointestinal perforation from banding deep mural tissue. Therapeutic alternatives after failed endoscopic therapy include repeat endoscopic therapy, angiography, or surgical wedge resection. The mortality has declined from about 30% during the 1970’s to 9%-13% currently with the advent of aggressive endoscopic therapy. PMID:25901208

  4. Is endoscopic resection of gastric gastrointestinal stromal tumors safe?

    PubMed

    Waterman, Alyson L; Grobmyer, Stephen R; Cance, William G; Hochwald, Steven N

    2008-12-01

    Gastric gastrointestinal stromal tumors (GIST) commonly present as an incidental finding on upper gastrointestinal endoscopy. Advances in endoscopic technology have allowed some to perform attempted excision of these lesions endoscopically. The oncologic implications of such an approach remain unclear. A-74-year-old man initially presented with an incidental finding of a 1.6 x 1.8-cm c-kit-positive gastrointestinal stromal tumor with low mitotic activity in the gastric fundus. The patient underwent an attempted endoscopic resection of this mass resulting in incomplete excision and gastric perforation. There was immediate conversion to a celiotomy and the patient underwent partial gastrectomy; there was no evidence of metastatic GIST. Three years later, the patient was noted to have an asymptomatic large pelvic mass (4 x 7 cm) on CT scan and was referred for evaluation. Subsequent surgical exploration revealed a single mass adherent to the pelvic sidewall that was resected. Subsequent pathology demonstrated a c-kit-positive GIST consistent with metastatic disease. Eighteen months later, the patient remains free of disease. Complications from endoscopic resection of gastric GIST may be associated with peritoneal dissemination of disease. This should be considered when formulating a strategy for management of gastric GIST. Complete transperitoneal excision (either open or laparoscopic) with clear margins and without tumor rupture remains the gold standard for management of gastric GIST. PMID:19097534

  5. Management of early asymptomatic gastrointestinal stromal tumors of the stomach

    PubMed Central

    Scherübl, Hans; Faiss, Siegbert; Knoefel, Wolfram-Trudo; Wardelmann, Eva

    2014-01-01

    Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the digestive tract. Approximately two thirds of clinically manifest tumors occur in the stomach, nearly one third in the small bowel, and the rest in the colorectal region with a few cases in the esophagus. GIST originate within the smooth muscle layer in the wall of the tubular gastrointestinal tract and grow mostly toward the serosa, far less often toward the mucosa. In the latter case, ulceration may develop and can cause gastrointestinal bleeding as the cardinal symptom. However, most GIST of the stomach are asymptomatic. They are increasingly detected incidentally as small intramural or submucosal tumors during endoscopy and particularly during endoscopic ultrasound. Epidemiological and molecular genetic findings suggest that early asymptomatic GIST of the stomach (< 1 cm) show self-limiting tumorigenesis. Thus, early (< 1 cm) asymptomatic gastric GIST (synonym: micro-GIST) are found in 20%-30% of the elderly. The mostly elderly people with early gastric GIST have an excellent GIST-specific prognosis. Patients with early GIST of the stomach can therefore be managed by endoscopic surveillance. PMID:25031785

  6. [Serious gastrointestinal effects of nonsteroidal anti-inflammatory drugs (NSAIDS) in a prospective study in Morocco].

    PubMed

    Benkirane, Raja; El Kihal, Latifa; Nabil, Safae; Benchekroun-Belabbés, Abdellatif; El Feydi, Abdellah Essaid; Soulaymani, Rachida

    2005-01-01

    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

  7. What Are Gastrointestinal Stromal Tumors?

    MedlinePLUS

    ... the digestive system. The gastrointestinal system The gastrointestinal (GI) system (or digestive system) processes food for energy ... bloodstream. This is the longest section of the GI tract, measuring more than 20 feet. The small ...

  8. Benefit of Preoperative Flexible Endoscopy for Patients Undergoing Weight-Reduction Surgery in Saudi Arabia

    PubMed Central

    Al Akwaa, Ahmad M.; Alsalman, Ahmad

    2008-01-01

    Background: Little information is available to demonstrate the importance of flexible endoscopic examination of the upper gastrointestinal tract in obese patients prior to the weight-reduction surgery. In spite of the controversies, there are more evidences to support the value of preoperative endoscopy. In this study, we aimed to evaluate the benefit of preoperative endoscopy in morbidly obese patients who have planned to undergo bariatric surgery. Materials and Methods: The medical records of morbidly obese patients who were admitted to our hospital from November 2004 to January 2007 and underwent flexible esophagogastroduodenoscopy (EGD) prior to the weight-reduction surgery were reviewed. The endoscopic findings and demographic data were recorded and analyzed. Results: Sixty-five patients underwent EGD preoperatively. The mean age was 34.6 years (range: 18–52 years), their mean BMI was 57 (range: 35–92) with a maximum weight of 280 kg. Majority were females (64%). Endoscopic findings included gastritis in 44 patients (67.7%), hiatus hernia in 8 (12%), gastric erosions in 7 (10.7%), reflux esophagitis in 4 (6%) and normal EGD findings in 15 patients (23%). There was no significant increase in reflux esophagitis in this group of patients. Sixty percent of the patients had comorbid medical conditions with diabetes mellitus being the most common. Conclusion: These data suggest that it might be necessary to perform preoperative EGD in patients undergoing bariatric surgery, although it possibly will not alter the surgical intervention. Prospectively conducted studies with larger number of patients are required to further explore the need of EGD in this subset of patients. PMID:19568487

  9. Magnifying endoscopy in upper gastroenterology for assessing lesions before completing endoscopic removal

    PubMed Central

    Chai, Ning-Li; Ling-Hu, En-Qiang; Morita, Yoshinori; Obata, Daisuke; Toyonaga, Takashi; Azuma, Takeshi; Wu, Ben-Yan

    2012-01-01

    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. PMID:22493543

  10. Seismic Endoscopy: Design of New Instruments

    NASA Astrophysics Data System (ADS)

    Conil, F.; Nicollin, F.; Gibert, D.

    2003-04-01

    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.

  11. Review of musculoskeletal injuries and prevention in the endoscopy practitioner.

    PubMed

    Harvin, Glenn

    2014-08-01

    Practitioners of endoscopy often experience musculoskeletal pain and injury (most often in the back, neck, shoulders, hands, wrists, and thumbs) that are associated with the minute and repetitive strain that is placed on these areas during endoscopic procedures. This review of the current documentation of endoscopy-related pain and injuries among practitioners finds that such problems are widespread and specific in kind as well as strongly correlated with high procedure volume and procedure duration. Research on the nature and impact of cumulative trauma and overuse syndromes in other professions such as dentistry, pianists, production labor, and athletics is brought to bear on the work of the endoscopist. A more thorough understanding of the nature and prevalence of work-related pain and injury sustained by endoscopists should inform further development of ergonomic practices and equipment design. This article reviews current recommendations for ergonomic design in the endoscopy procedure space and finds that reported compliance with those recommendations is quite low. Strategies for the management of the risk of musculoskeletal injuries related to the practice of endoscopy include compliance with currently recommended ergonomic practices, education of trainees in ergonomic technique when practicing endoscopy, and research toward the modification and development of more ergonomic endoscopes and procedure spaces. PMID:24798940

  12. Ambience in the endoscopy room has little effect on patients.

    PubMed

    Stermer, E; Levy, N; Beny, A; Meisels, R; Tamir, A

    1998-06-01

    With hopes of alleviating discomfort and improving the tolerance of patients undergoing endoscopy, we have assessed the influence of various background conditions in the endoscopy room. Two hundred twenty-one candidates for upper endoscopy were randomly allocated to four groups, each with one of the following conditions in the endoscopy room: background music and conversation related to the patient's complaints (n=50); background music and conversation unrelated to the patient (n=53); background music only, with the staff maintaining silence (n=49); and complete silence (n=47). Before endoscopy patients answered a 26-item questionnaire that included an evaluation of their degree of anxiety before the examination. Conscious sedation was induced by using 3 mg midazolam. After complete recovery from sedation, patients answered another set of questions. Patients in all four groups felt quite comfortable with the atmosphere in which gastroscopy was performed. Neither music, conversation, nor silence had a great effect on patients as far as improving tolerance or diminishing anxiety. Therefore, endoscopists and nurses may have a free hand in choosing the prevailing conditions during the examination. This conclusion may be valid for both patients and the staff involved in other invasive procedures performed under light sedation. PMID:9649005

  13. Gastrointestinal Bleeding in Athletes.

    ERIC Educational Resources Information Center

    Eichner, Edward R.

    1989-01-01

    Describes the scope and importance of gastrointestinal bleeding in runners and other athletes, discussing causes, sites, and implications of exercise-related bleeding. Practical tips to mitigate the problem, potentially more troublesome in women because of lower iron stores, are presented (e.g., gradual conditioning and avoidance of prerace…

  14. Apollo gastrointestinal analysis

    NASA Technical Reports Server (NTRS)

    Nichols, B. L.; Huang, C. T. L.

    1975-01-01

    Fecal bile acid patterns for the Apollo 17 flight were studied to determine the cause of diarrhea on the mission. The fecal sterol analysis gave no indication of an infectious diarrhea, or specific, or nonspecific etiology occurring during the entire flight. It is assumed that the gastrointestinal problems encountered are the consequences of altered physiology, perhaps secondary to physical or emotional stress of flight.

  15. Pediatric functional gastrointestinal disorders

    Technology Transfer Automated Retrieval System (TEKTRAN)

    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, irrita...

  16. A report of three cases of exophytic gastrointestinal stromal tumor detected by transabdominal ultrasound.

    PubMed

    Sugihara, Takaaki; Koda, Masahiko; Tanimura, Takashi; Yoshida, Manabu; Murawaki, Yoshikazu

    2016-01-01

    Gastrointestinal stromal tumors (GISTs) are the most common submucosal tumors of the stomach. GISTs are often detected by esophagogastroduodenal endoscopy (EGD). However, the exophytic GIST type is relatively rare and difficult to detect by EGD. Most exophytic GISTs found are large and symptomatic. We present three cases with exophytic GISTs less than 5 cm in diameter detected by transabdominal ultrasound (TUS). All patients were asymptomatic and TUS revealed hypoechoic solid masses 2-3 cm in diameter between the stomach and left lobe of the liver. In contrast, no tumor in the stomach was detected by esophagogastroduodenal endoscopy. Endoscopic ultrasound and enhanced CT showed gastric tumors protruding outward. All three cases underwent partial gastrectomy, and the excised tumor was diagnosed as low-grade GIST. In conclusion, TUS can be a starting point for diagnosing exophytic GISTs of the stomach. PMID:26703175

  17. Management of variceal and nonvariceal upper gastrointestinal bleeding in patients with cirrhosis

    PubMed Central

    Ribeiro, Suzane

    2014-01-01

    Acute upper gastrointestinal haemorrhage remains the most common medical emergency managed by gastroenterologists. Causes of upper gastrointestinal bleeding (UGIB) in patients with liver cirrhosis can be grouped into two categories: the first includes lesions that arise by virtue of portal hypertension, namely gastroesophageal varices and portal hypertensive gastropathy; and the second includes lesions seen in the general population (peptic ulcer, erosive gastritis, reflux esophagitis, Mallory–Weiss syndrome, tumors, etc.). Emergency upper gastrointestinal endoscopy is the standard procedure recommended for both diagnosis and treatment of UGIB. The endoscopic treatment of choice for esophageal variceal bleeding is band ligation of varices. Bleeding from gastric varices is treated by injection with cyanoacrylate. Treatment with vasoactive drugs as well as antibiotic treatment is started before or at the same time as endoscopy. Bleeding from portal hypertensive gastropathy is less frequent, usually chronic and treatment options include ?-blocker therapy, injection therapy and interventional radiology. The standard of care of UGIB in patients with cirrhosis includes careful resuscitation, preferably in an intensive care setting, medical and endoscopic therapy, early consideration for placement of transjugular intrahepatic portosystemic shunt and, sometimes, surgical therapy or hepatic transplant. PMID:25177367

  18. Upper gastrointestinal bleeding: gallstone-induced auto-sphincterotomy.

    PubMed

    Kalipershad, Sujala; Chung, Kin Tong; Jehangir, Ernest

    2012-01-01

    A 67-year-old gentleman with no significant medical history of note presented with sudden onset of epigastric pain, coffee ground vomiting and passing black tarry stool. A series of investigations including blood tests, ultrasound scan, CT abdomen and pelvis with contrast and endoscopy failed to reveal any site of active bleeding. The mystery remained and the patient continued to have upper gastrointestinal bleeding. A second CT abdomen and pelvis with contrast was carried out and showed evidence of contrast extravasation into the duodenum (figure 3). An exploratory laparotomy showed no obvious site of haemorrhage and a loop jejunostomy was performed. The diagnosis of gallstone-induced auto-sphincterotomy was only made, using gastroscope via jejunostomy, when a big gallstone was found in the third part of the duodenum and the papilla was ruptured (figure 5). PMID:22914239

  19. Upper gastrointestinal bleeding: gallstone-induced auto-sphincterotomy

    PubMed Central

    Kalipershad, Sujala; Chung, Kin Tong; Jehangir, Ernest

    2012-01-01

    A 67-year-old gentleman with no significant medical history of note presented with sudden onset of epigastric pain, coffee ground vomiting and passing black tarry stool. A series of investigations including blood tests, ultrasound scan, CT abdomen and pelvis with contrast and endoscopy failed to reveal any site of active bleeding. The mystery remained and the patient continued to have upper gastrointestinal bleeding. A second CT abdomen and pelvis with contrast was carried out and showed evidence of contrast extravasation into the duodenum (figure 3). An exploratory laparotomy showed no obvious site of haemorrhage and a loop jejunostomy was performed. The diagnosis of gallstone-induced auto-sphincterotomy was only made, using gastroscope via jejunostomy, when a big gallstone was found in the third part of the duodenum and the papilla was ruptured (figure 5). PMID:22914239

  20. Eosinophilic Gastroenteritis Due to Rhus Ingestion Presenting with Gastrointestinal Hemorrhage

    PubMed Central

    Choi, Wonsuk; Choi, Chan; Cho, Kyuman; Park, Chang-Hwan; Kim, Hyun-Soo; Choi, Sung-Kyu; Rew, Jong-Sun

    2015-01-01

    Rhus-related illnesses in Korea are mostly caused by ingestion of parts of the Rhus tree. Contact dermatitis occurrence after ingestion of Rhus-related food is very common in Korea. However, Rhus-related gastrointestinal disease is very rare. Herein, we present a case of eosinophilic gastroenteritis caused by Rhus ingestion. A 75-year-old woman was admitted with hematemesis and hematochezia after Rhus extract ingestion. Routine laboratory tests revealed leukocytosis without eosinophilia. Endoscopy showed friable and granular mucosal changes with touch bleeding in the second portion of the duodenum. Abdominal computed tomography revealed edematous wall thickening of the duodenum and proximal jejunal loops. Patch testing with Rhus extracts showed a strong positive reaction, suggesting Rhus as the allergen. Her symptoms improved after avoidance of the allergen. PMID:25844348

  1. Endoscopy in neutropenic and/or thrombocytopenic patients

    PubMed Central

    Tong, Michelle C; Tadros, Micheal; Vaziri, Haleh

    2015-01-01

    AIM: To evaluate the safety of endoscopic procedures in neutropenic and/or thrombocytopenic cancer patients. METHODS: We performed a literature search for English language studies in which patients with neutropenia and/or thrombocytopenia underwent endoscopy. Studies were included if endoscopic procedures were used as part of the evaluation of neutropenic and/or thrombocytopenic patients, yielding 13 studies. Two studies in which endoscopy was not a primary evaluation tool were excluded. Eleven relevant studies were identified by two independent reviewers on PubMed, Scopus, and Ovid databases. RESULTS: Most of the studies had high diagnostic yield with relatively low complication rates. Therapeutic endoscopic interventions were performed in more than half the studies, including high-risk procedures, such as sclerotherapy. Platelet transfusion was given if counts were less than 50000/mm3 in four studies and less than 10000/mm3 in one study. Other thrombocytopenic precautions included withholding of biopsy if platelet count was less than 30000/mm3 in one study and less than 20000/mm3 in another study. Two of the ten studies which examined thrombocytopenic patient populations reported bleeding complications related to endoscopy, none of which caused major morbidity or mortality. All febrile neutropenic patients received prophylactic broad-spectrum antibiotics in the studies reviewed. Regarding afebrile neutropenic patients, prophylactic antibiotics were given if absolute neutrophil count was less than 1000/mm3 in one study, if the patient was undergoing colonoscopy and had a high inflammatory condition without clear definition of significance in another study, and if the patient was in an aplastic phase in a third study. Endoscopy was also withheld in one study for severe pancytopenia. CONCLUSION: Endoscopy can be safely performed in patients with thrombocytopenia/neutropenia. Prophylactic platelet transfusion and/or antibiotic administration prior to endoscopy may be considered in some cases and should be individualized. PMID:26674926

  2. Evaluation of Fujinon intelligent chromo endoscopy-assisted capsule endoscopy in patients with obscure gastroenterology bleeding

    PubMed Central

    Gupta, Tarun; Ibrahim, Mostafa; Deviere, Jacques; Gossum, André Van

    2011-01-01

    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. PMID:22147964

  3. Emerging role of fecal microbiota therapy in the treatment of gastrointestinal and extra-gastrointestinal diseases.

    PubMed

    Konturek, P C; Haziri, D; Brzozowski, T; Hess, T; Heyman, S; Kwiecien, S; Konturek, S J; Koziel, J

    2015-08-01

    In the recent decade our understanding of the role of the human gut microbiome has been revolutionized by advances in development of molecular methods. Approximately, up to 100 trillion (10(14)) microorganisms per human body colonize the intestinal tract making an additional acquired organ that provides many vital functions to the host. A healthy gut microbiome can be defined by the presence of the various classes of microbes that enhance metabolism, resistance to infection and inflammation, prevention against cancer and autoimmunity and that positively influence so called braingut axis. Diet represents one of the most important driving forces that besides environmental and genetic factors, can define and influence the microbial composition of the gut. Aging process due to different changes in gut physiology (i.e. gastric hypochlorhydria, motility disorders, use of drugs, degenerative changes in enteric nervous system) has a profound effect on the composition, diversity and functional features of gut microbiota. A perturbed aged gut microbiome has been associated with the increasing number of gastrointestinal (e.g. Clostridium difficile infection - CDI) and non-gastrointestinal diseases (metabolic syndrome, diabetes mellitus, fatty liver disease, atherosclerosis etc.). Fecal microbiota transplantation (FMT) is a highly effective method in the treatment of refractory CDI. FMT is the term used when stool is taken from a healthy individual and instilled during endoscopy (colonoscopy or enteroscopy) into a gut of the sick person to cure certain disease. FMT represents an effective therapy in patient with recurrent CDI and the effectiveness of FMT in the prevention of CDI recurrence had reached approx. 90%. There is also an increasing evidence that the manipulation of gut microbiota by FMT represents a promising therapeutic method in patients with inflammatory bowel disease and irritable bowel syndrome. There is also an increased interest in the role of FMT for the treatment of metabolic syndrome and obesity which collectively present the greatest health challenge in the developed world nowadays. Targeting of gut microbiota by FMT represents an exciting new frontier in the prevention and management of gastrointestinal and non-gastrointestinal diseases that awaits further studies in preclinical and clinical settings. PMID:26348073

  4. [Microbiota and gastrointestinal diseases].

    PubMed

    Polanco Allué, I

    2015-12-01

    The bacterial colonisation is established immediately after birth, through direct contact with maternal microbiota, and may be influenced during lactation. There is emerging evidence indicating that quantitative and qualitative changes on gut microbiota contribute to alterations in the mucosal activation of the immune system, leading to intra- or extra-intestinal diseases. A balance between pathogenic and beneficial microbiota throughout childhood and adolescence is important to gastrointestinal health, including protection against pathogens, inhibition of pathogens, nutrient processing (synthesis of vitamin K), stimulation of angiogenesis, and regulation of host fat storage. Probiotics can promote an intentional modulation of intestinal microbiota favouring the health of the host. A review is presented on the modulation of intestinal microbiota on prevention, and adjuvant treatment of some paediatric gastrointestinal diseases. PMID:26534880

  5. Gastrointestinal parasite infestation.

    PubMed

    Abd El Bagi, Mohamed E; Sammak, Bassam M; Mohamed, Abdulrahman E; Al Karawi, Mohamed A; Al Shahed, Mona; Al Thagafi, Mohamed A

    2004-03-01

    Twenty-five percent of the world's population could be suffering parasitic infestation. Highest prevalence is in underdeveloped agricultural and rural areas in the tropical and subtropical regions. In some areas incidence may reach 90% of the population. In contrast, some major economic projects intended to promote local development have, paradoxically, caused parasitic proliferation, e.g. bilharziasis in Egypt and Sudan and Chagas disease in Brazil. The commonest cosmopolitan gastrointestinal parasite is Entamoeba histolytica. Some intestinal parasite are endemic in temperate climates, e.g. Entrobius vermicularis. The AIDS epidemic has increased the prevalence and severity of parasitic disease, particularly Strongyloides stercolaris. Tropical parasites are seen in Western people who travel to tropical countries. Radiology has acquired a major role in diagnosis and management of gastrointestinal parasite infestations and their complications. PMID:14749961

  6. Isolated Splenic Vein Thrombosis: 8-Year-Old Boy with Massive Upper Gastrointestinal Bleeding and Hypersplenism.

    PubMed

    Kiani, Mohammad Ali; Forouzan, Arash; Masoumi, Kambiz; Mazdaee, Behnaz; Bahadoram, Mohammad; Kianifar, Hamid Reza; Ravari, Hassan

    2015-01-01

    We present an 8-year-old boy who was referred to our center with the complaint of upper gastrointestinal bleeding and was diagnosed with hypersplenism and progressive esophageal varices. Performing a computerized tomography (CT) scan, we discovered a suspicious finding in the venography phase in favor of thrombosis in the splenic vein. Once complementary examinations were done and due to recurrent bleeding and band ligation failure, the patient underwent splenectomy. And during the one-year follow-up obvious improvement of the esophageal varices was observed in endoscopy. PMID:26345989

  7. Isolated Splenic Vein Thrombosis: 8-Year-Old Boy with Massive Upper Gastrointestinal Bleeding and Hypersplenism

    PubMed Central

    Kiani, Mohammad Ali; Forouzan, Arash; Masoumi, Kambiz; Mazdaee, Behnaz; Bahadoram, Mohammad; Kianifar, Hamid Reza; Ravari, Hassan

    2015-01-01

    We present an 8-year-old boy who was referred to our center with the complaint of upper gastrointestinal bleeding and was diagnosed with hypersplenism and progressive esophageal varices. Performing a computerized tomography (CT) scan, we discovered a suspicious finding in the venography phase in favor of thrombosis in the splenic vein. Once complementary examinations were done and due to recurrent bleeding and band ligation failure, the patient underwent splenectomy. And during the one-year follow-up obvious improvement of the esophageal varices was observed in endoscopy. PMID:26345989

  8. ONE-AGAINST-ONE CLASSIFICATION FOR ZOOM-ENDOSCOPY IMAGES

    E-print Network

    Uhl, Andreas

    - proaches in this research area. 1 Introduction Recent statistics of the American Cancer Society reveal endoscopy, colon cancer Abstract In this paper, we present a novel approach for the classifi- cation of zoom that colorectal cancer is the third most common cancer in men and women and the second most common cause of US

  9. DESIGN AND CONTROL OF A SIMPLIFIED STEWART PLATFORM FOR ENDOSCOPY

    E-print Network

    Wendlandt, Jeff

    the development of a workspace con- troller for a newly designed platform. The platform is designed to manipulate-driven manipulator originally designed for minimally invasive surgery. Simulation as well as ex- perimental results the full motion of the Stewart platform. The device is originally designed as a manipulator for endoscopy

  10. Automatic Classification of Digestive Organs in Wireless Capsule Endoscopy Videos

    E-print Network

    Lee, Jeongkyu

    Automatic Classification of Digestive Organs in Wireless Capsule Endoscopy Videos Jeongkyu Lee1. University of North Texas Denton, TX 76203 {jhoh,xyuan}@cse.unt.edu 3 Division of Digestive Diseases UTSW the assessment time, it is critical to develop a technique to automatically discriminate digestive organs

  11. Quantitative ENT endoscopy: the future in the new millennium

    NASA Astrophysics Data System (ADS)

    Mueller, Andreas; Schubert, Mario

    1999-06-01

    In Otorhinolaryngology the endoscopic appraisal of luminal dimensions of the nose, the throat, the larynx and the trachea is a daily problem. Those concerned with endoscopy know, that endoscopes distort dimensions of examined anatomical structures. To draw conclusions on luminal dimensions from the endoscopic pictures additional measuring devices are required. We developed a new method of measuring luminal dimensions in rigid or flexible endoscopy. For this a laser beam directed radially marks the anatomical lumen of interest in the videoendoscopic vision. The laser ring becomes deformed according to the form of the cavity explored. By keeping the distance defined between the laser ring and the top of the endoscope, the endoscopic video image can be measured. A piece of software developed by us calculates from the pictures the cross sectional area as well as the extension of benign or malign stenosis of the cavity explored. The result of the endoscopic measuring procedure can be visualized 3D on a PC-monitor. We are going to demonstrate the result of our clinical experience in different otorhinolaryngological diseases with the new endoscopic measuring kit in comparison to standard endoscopy. A further perspective is the endoscopic measuring kit in comparison to standard endoscopy. A further perspective is the endoscopic assisted manufacturing (EAM) of anatomical adapted stents, tubes and cannules.

  12. Overview LS ABV K Three perspectives on endoscopy

    E-print Network

    Nevins, Monica

    Overview LS ABV K Three perspectives on endoscopy Paul Mezo Carleton University #12;Overview LS ABV;Overview LS ABV K The three perspectives by abbreviation LS ? ? ABV ? K #12;Overview LS ABV K Character endoscopic group given by s Sad · s : WR LH · Spectral transfer: s = H s H (s, ) #12;Overview LS ABV K

  13. Protein C deficiency related obscure gastrointestinal bleeding treated by enteroscopy and anticoagulant therapy.

    PubMed

    Hsu, Wei-Fan; Tsang, Yuk-Ming; Teng, Chung-Jen; Chung, Chen-Shuan

    2015-01-21

    Obscure gastrointestinal bleeding is an uncommonly encountered and difficult-to-treat clinical problem in gastroenterology, but advancements in endoscopic and radiologic imaging modalities allow for greater accuracy in diagnosing obscure gastrointestinal bleeding. Ectopic varices account for less than 5% of all variceal bleeding cases, and jejunal variceal bleeding due to extrahepatic portal hypertension is rare. We present a 47-year-old man suffering from obscure gastrointestinal bleeding. Computed tomography of the abdomen revealed multiple vascular tufts around the proximal jejunum but no evidence of cirrhosis, and a visible hypodense filling defect suggestive of thrombus was visible in the superior mesenteric vein. Enteroscopy revealed several serpiginous varices in the proximal jejunum. Serologic data disclosed protein C deficiency (33.6%). The patient was successfully treated by therapeutic balloon-assisted enteroscopy and long-term anticoagulant therapy, which is normally contraindicated in patients with gastrointestinal bleeding. Diagnostic modalities for obscure gastrointestinal bleeding, such as capsule endoscopy, computed tomography enterography, magnetic resonance enterography, and enteroscopy, were also reviewed in this article. PMID:25624741

  14. Protein C deficiency related obscure gastrointestinal bleeding treated by enteroscopy and anticoagulant therapy

    PubMed Central

    Hsu, Wei-Fan; Tsang, Yuk-Ming; Teng, Chung-Jen; Chung, Chen-Shuan

    2015-01-01

    Obscure gastrointestinal bleeding is an uncommonly encountered and difficult-to-treat clinical problem in gastroenterology, but advancements in endoscopic and radiologic imaging modalities allow for greater accuracy in diagnosing obscure gastrointestinal bleeding. Ectopic varices account for less than 5% of all variceal bleeding cases, and jejunal variceal bleeding due to extrahepatic portal hypertension is rare. We present a 47-year-old man suffering from obscure gastrointestinal bleeding. Computed tomography of the abdomen revealed multiple vascular tufts around the proximal jejunum but no evidence of cirrhosis, and a visible hypodense filling defect suggestive of thrombus was visible in the superior mesenteric vein. Enteroscopy revealed several serpiginous varices in the proximal jejunum. Serologic data disclosed protein C deficiency (33.6%). The patient was successfully treated by therapeutic balloon-assisted enteroscopy and long-term anticoagulant therapy, which is normally contraindicated in patients with gastrointestinal bleeding. Diagnostic modalities for obscure gastrointestinal bleeding, such as capsule endoscopy, computed tomography enterography, magnetic resonance enterography, and enteroscopy, were also reviewed in this article. PMID:25624741

  15. Comparison of Capsule Endoscopy Findings to Subsequent Double Balloon Enteroscopy: A Dual Center Experience

    PubMed Central

    Kalra, Amandeep S.; Walker, Andrew J.; Benson, Mark E.; Soni, Anurag; Guda, Nalini M.; Misha, Mehak; Gopal, Deepak V.

    2015-01-01

    Background. There has been a growing use of both capsule endoscopy (CE) and double balloon enteroscopy (DBE) to diagnose and treat patients with obscure gastrointestinal blood loss and suspected small bowel pathology. Aim. To compare and correlate sequential CE and DBE findings in a large series of patients at two tertiary level hospitals in Wisconsin. Methods. An IRB approved retrospective study of patients who underwent sequential CE and DBE, at two separate tertiary care academic centers from May 2007 to December 2011, was performed. Results. 116 patients were included in the study. The mean age ± SD was 66.6 ± 13.2 years. There were 56% males and 43.9% females. Measure of agreement between prior capsule and DBE findings was performed using kappa statistics, which gave kappa value of 0.396 with P < 0.001. Also contingency coefficient was calculated and was found to be 0.732 (P < 0.001). Conclusions. Our study showed good overall agreement between DBE and CE. Findings of angioectasia had maximum agreement of 69%. PMID:26420979

  16. A video wireless capsule endoscopy system powered wirelessly: design, analysis and experiment

    NASA Astrophysics Data System (ADS)

    Pan, Guobing; Xin, Wenhui; Yan, Guozheng; Chen, Jiaoliao

    2011-06-01

    Wireless capsule endoscopy (WCE), as a relatively new technology, has brought about a revolution in the diagnosis of gastrointestinal (GI) tract diseases. However, the existing WCE systems are not widely applied in clinic because of the low frame rate and low image resolution. A video WCE system based on a wireless power supply is developed in this paper. This WCE system consists of a video capsule endoscope (CE), a wireless power transmission device, a receiving box and an image processing station. Powered wirelessly, the video CE has the abilities of imaging the GI tract and transmitting the images wirelessly at a frame rate of 30 frames per second (f/s). A mathematical prototype was built to analyze the power transmission system, and some experiments were performed to test the capability of energy transferring. The results showed that the wireless electric power supply system had the ability to transfer more than 136 mW power, which was enough for the working of a video CE. In in vitro experiments, the video CE produced clear images of the small intestine of a pig with the resolution of 320 × 240, and transmitted NTSC format video outside the body. Because of the wireless power supply, the video WCE system with high frame rate and high resolution becomes feasible, and provides a novel solution for the diagnosis of the GI tract in clinic.

  17. A clinically viable capsule endoscopy video analysis platform for automatic bleeding detection

    NASA Astrophysics Data System (ADS)

    Yi, Steven; Jiao, Heng; Xie, Jean; Mui, Peter; Leighton, Jonathan A.; Pasha, Shabana; Rentz, Lauri; Abedi, Mahmood

    2013-02-01

    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.

  18. Comparative assessment of feature extraction methods for visual odometry in wireless capsule endoscopy.

    PubMed

    Spyrou, Evaggelos; Iakovidis, Dimitris K; Niafas, Stavros; Koulaouzidis, Anastasios

    2015-10-01

    Wireless capsule endoscopy (WCE) enables the non-invasive examination of the gastrointestinal (GI) tract by a swallowable device equipped with a miniature camera. Accurate localization of the capsule in the GI tract enables accurate localization of abnormalities for medical interventions such as biopsy and polyp resection; therefore, the optimization of the localization outcome is important. Current approaches to endoscopic capsule localization are mainly based on external sensors and transit time estimations. Recently, we demonstrated the feasibility of capsule localization based-entirely-on visual features, without the use of external sensors. This technique relies on a motion estimation algorithm that enables measurements of the distance and the rotation of the capsule from the acquired video frames. Towards the determination of an optimal visual feature extraction technique for capsule motion estimation, an extensive comparative assessment of several state-of-the-art techniques, using a publicly available dataset, is presented. The results show that the minimization of the localization error is possible at the cost of computational efficiency. A localization error of approximately one order of magnitude higher than the minimal one can be considered as compromise for the use of current computationally efficient feature extraction techniques. PMID:26073184

  19. Early Diagnosis of Colonic Anastomotic Leak With Peritoneal Endoscopy

    PubMed Central

    Gaarden, Morten; Mortensen, Frank Viborg

    2015-01-01

    Background and Objectives: At present, we do not have a reliable method for the early diagnosis of colorectal anastomotic leakage (AL). We tested peritoneal flexible endoscopy through a port placed in the abdominal wall in the early postoperative course, as a new diagnostic method for detection of this complication and evaluated the suggested method for safety, feasibility, and accuracy. Methods: Ten swine were randomized into 2 groups: group A, colorectal anastomosis without leakage; and group B, colorectal anastomosis with leakage. A button gastrostomy feeding tube was inserted percutaneously into the peritoneal cavity. Colorectal anastomosis (with or without defect) was created 48 hours after the first operation. The swine were examined by peritoneal flexible endoscopy 8 and 24 hours after the colonic operation, by a consultant surgeon who was blinded to both the presence and the allocated location of the of the anastomotic defect. Results: None of the animals showed signs of illness 48 hours after the intraperitoneal gastrostomy tube placement. More than half of the anastomosis circumference was identified in 60 and 10% of the animals at endoscopy 8 and 24 hours, respectively, after the anastomosis was created. Excessive adhesion formation was observed in all animals, irrespective of AL. The sensitivity and specificity of endoscopy in detecting peritonitis 24 hours after AL were both 60%. Conclusions: Peritoneal endoscopy is a safe and simple procedure. Visualization of the peritoneal cavity in the early postoperative course was limited due to adhesion formation. Further studies are needed to clarify the accuracy of the procedure and to address additional methodological concerns. PMID:26273185

  20. Fibre-Optic Endoscopy In Clinical Practice

    NASA Astrophysics Data System (ADS)

    Jourdan, Martin H.

    1985-08-01

    Man's curiosity has led him to seek methods of investigating the inner workings of the human body, but it is only recently that it has become possible to properly visualise the inner cavities of the human frame. Physiologists such as William Beaumont have occasionally had the opportunity to see the function of the gastrointestinal tract, in this case the gastric fistula of Alexis St Martin who was injured following an accidental firearm explosion. Rigid instruments, down which lights are shone, can be used to visualise the respiratory passages, the gullet, the rectum, and the bladder, and in the past artists were employed to record what was seen. Such instruments are still in use, although light from a powerful source is now conducted down the instrument using a fibreoptic bundle. The first semi-flexible instrument which could be inserted into the stomach and used to visualise its walls was developed by Schindler and Wolf in Germany in 1932. The optics consisted of a series of convex-lenses, transmitting an image back to the eye, but again the view obtained was limited and since its optics were side viewing, the gullet could not be viewed. The advent of fibre-optics revolutionised the situation, and the first fibrescope conducting the image up a fibreoptic bundle was a side-viewing instrument, developed by Hirschowitz, Curtiss, Peters and Pollard by 1958, and used for viewing the stomach. Since those pioneering days, the development of fibrescopes for viewing every potential cavity in the human body has proceeded in leaps and bounds.

  1. Comparison of the diagnostic yield and outcomes between standard 8 h capsule endoscopy and the new 12 h capsule endoscopy for investigating small bowel pathology

    PubMed Central

    Rahman, Merajur; Akerman, Stuart; DeVito, Bethany; Miller, Larry; Akerman, Meredith; Sultan, Keith

    2015-01-01

    AIM: To evaluate the completion rate and diagnostic yield of the PillCam SB2-ex in comparison to the PillCam SB2. METHODS: Two hundred cases using the 8-h PillCam SB2 were retrospectively compared to 200 cases using the 12 h PillCam SB2-ex at a tertiary academic center. Endoscopically placed capsules were excluded from the study. Demographic information, indications for capsule endoscopy, capsule type, study length, completion of exam, clinically significant findings, timestamp of most distant finding, and significant findings beyond 8 h were recorded. RESULTS: The 8 and 12 h capsule groups were well matched respectively for both age (70.90 ± 14.19 vs 71.93 ± 13.80, P = 0.46) and gender (45.5% vs 48% male, P = 0.69). The most common indications for the procedure in both groups were anemia and obscure gastrointestinal bleeding. PillCam SB2-ex had a significantly higher completion rate than PillCam SB2 (88% vs 79.5%, P = 0.03). Overall, the diagnostic yield was greater for the 8 h capsule (48.5% for SB2 vs 35% for SB2-ex, P = 0.01). In 4/70 (5.7%) of abnormal SB2-ex exams the clinically significant finding was noted in the small bowel beyond the 8 h mark. CONCLUSION: In our study, we found the PillCam SB2-ex to have a significantly increased completion rate, though without any improvement in diagnostic yield compared to the PillCam SB2. PMID:25987777

  2. Rare case of upper gastrointestinal bleeding in achalasia.

    PubMed

    Zhang, Wei-Wei; Xie, Xiang-Jun; Geng, Chang-Xin; Zhan, Shu-Hui

    2015-03-16

    Achalasia is a prototypic esophageal motility disorder with complications including aspiration-pneumonia, esophagitis, esophageal-tracheal fistula, spontaneous rupture of the esophagus, and squamous cell carcinoma. However, achalasia is rarely associated with esophageal stones and ulcer formation that lead to upper gastrointestinal bleeding. Here, we report the case of a 61-year-old woman who was admitted to our department after vomiting blood for six hours. Physical examination revealed that the patient had severe anemia and mild palpitation in the upper abdomen. CT revealed lower esophageal dilatation and esophageal wall thickening, and an emergency upper endoscopy showed that the esophagus was substantially expanded by a dark round stone, with multiple ulcers on the esophageal wall and a slit in the cardiac mucosa with a large clot attached. The patient's history included ingestion of 1 kg hawthorn three days prior. The acute upper gastrointestinal bleeding was caused by Mallory-Weiss syndrome associated with achalasia and an esophageal stone. For patients with achalasia, preventing excessive ingestion of tannins is crucial to avoid complications such as bleeding and rupture. PMID:25789307

  3. Giant esophageal gastrointestinal stromal tumor: report of a case.

    PubMed

    Nakano, Akira; Akutsu, Yasunori; Shuto, Kiyohiko; Uesato, Masaya; Kono, Tsuguaki; Hoshino, Isamu; Akanuma, Naoki; Maruyama, Tetsuro; Isozaki, Yuka; Matsubara, Hisahiro

    2015-02-01

    Gastrointestinal stromal tumors (GISTs) rarely arise in the esophagus, where carcinoma is the most common malignant neoplasm and leiomyoma is the most common benign tumor. Because of their rarity, the clinical course and treatment of esophageal GISTs are poorly understood. These lesions are generally thought to carry a poor prognosis, making the differential diagnosis of other common mesenchymal neoplasms essential, for both prognostic and therapeutic reasons. We report a case of successfully resected giant esophageal GIST, thought to be the largest resected GIST reported in Japan. The patient was a 65-year-old woman, in whom upper gastrointestinal endoscopy found a 180-mm submucosal tumor in the lower thoracic esophagus, extending just below the aortic arch. We diagnosed esophageal GIST, and the patient underwent middle and lower esophagectomy via left thoracotomy, followed by gastric tube reconstruction. The tumor was resected completely. Histopathological and immunohistochemical staining confirmed that the tumor was a high-risk lesion, and treatment with imatinib was initiated. Computed tomography showed liver metastasis 5 months later, but the patient is doing well 24 months after surgery. PMID:24890800

  4. Prospective study of acute gastrointestinal bleeding attributable to anti-inflammatory drug ingestion in the Yorkshire region of the United Kingdom

    PubMed Central

    Lim, C; Heatley, R

    2005-01-01

    Objective: To assess the general use of all non-steroidal anti-inflammatory drugs (NSAID) and their relation to upper gastrointestinal bleeding in view of National Institute for Clinical Excellence guidelines published in July 2001 in the UK. Methods: Cross sectional study on all patients who were referred for endoscopy for suspected upper gastrointestinal bleeding in six hospitals in Yorkshire region of the UK. Results: One hundred and sixty three patients presented for endoscopy for suspected upper gastrointestinal bleeding, 43 patients were taking at least one ulcerogenic drug, and 120 were not. The mean age difference between these two groups was eight years (p<0.01). The absolute difference between the proportion of patients with peptic ulcer disease/erosion (PUD) in NSAID with/without aspirin group and no ulcerogenic drug group was 31% (p = 0.02). The difference between the proportion of PUD in cyclo-oxygenase 2 with/without aspirin group and no ulcerogenic drug group was 30% (p = 0.1). The overall 30 days mortality rate was 14.1%. Conclusions: Elderly patients are being inappropriately prescribed conventional NSAIDs. NSAIDs with or without aspirin use are still associated with a significant risk of upper gastrointestinal bleeding in the era of cyclo-oxygenase 2 selective agents. Substitution with cyclo-oxygenase 2 selective NSAIDs is not without risk of upper gastrointestinal bleeding. PMID:15811890

  5. The gastrointestinal endocrine system

    PubMed Central

    Track, Norman S.

    1980-01-01

    Gastrointestinal endocrinology is the study of the hormonal regulation of digestion. A number of characterized polypeptide hormones have been localized in specific gastroenteropancreatic endocrine cells. The fact that some of these hormones are also found in nerve and brain cells has given rise to the concept of a gut-brain axis. The functional capacities of these endocrine cells are determined by their anatomic location; the luminal exposure of gastroenteric endocrine cells represents an additional avenue for stimulation and release that is not open to pancreatic endocrine cells. Gastroenteropancreatic hormones regulate carbohydrate metabolism, gastric acid secretion, pancreatic exocrine and gallbladder function, gastrointestinal motility and blood flow. These important regulatory hormones may in turn be controlled by a series of gastroduodenal releasing hormones. Diabetes mellitus is the most important metabolic disorder related to a gastroenteropancreatic hormone imbalance. Most tumours producing these hormones are of pancreatic origin and produce a number of hormones; insulinomas and gastrinomas are detected readily because of the serious metabolic distrubances they cause. Other instances of altered circulating concentrations of these hormones result from rather than cause the disease. The challenge of future study is to determine if postprandial changes in the plasma concentrations of these hormones are sufficient or necessary, or both, for the control of digestion. PMID:6989456

  6. Volumetric sub-surface imaging using spectrally encoded endoscopy.

    PubMed

    Yelin, D; Bouma, B E; Tearney, G J

    2008-02-01

    Endoscopic imaging below tissue surfaces and through turbid media may provide improved diagnostic capabilities and visibility in surgical settings. Spectrally encoded endoscopy (SEE) is a recently developed method that utilizes a single optical fiber, miniature optics and a diffractive grating for high-speed imaging through small diameter, flexible endoscopic probes. SEE has also been shown to provide three-dimensional topological imaging capabilities. In this paper, we have configured SEE to additionally image beneath tissue surfaces, by increasing the system's sensitivity and acquiring the complex spectral density for each spectrally resolved point on the sample. In order to demonstrate the capability of SEE to obtain subsurface information, we have utilized the system to image a resolution target through intralipid solution, and conduct volumetric imaging of a mouse embryo and excised human middle-ear ossicles. Our results demonstrate that real-time subsurface imaging is possible with this miniature endoscopy technique. PMID:18542254

  7. Gastrointestinal hormones regulating appetite

    PubMed Central

    Chaudhri, Owais; Small, Caroline; Bloom, Steve

    2006-01-01

    The role of gastrointestinal hormones in the regulation of appetite is reviewed. The gastrointestinal tract is the largest endocrine organ in the body. Gut hormones function to optimize the process of digestion and absorption of nutrients by the gut. In this capacity, their local effects on gastrointestinal motility and secretion have been well characterized. By altering the rate at which nutrients are delivered to compartments of the alimentary canal, the control of food intake arguably constitutes another point at which intervention may promote efficient digestion and nutrient uptake. In recent decades, gut hormones have come to occupy a central place in the complex neuroendocrine interactions that underlie the regulation of energy balance. Many gut peptides have been shown to influence energy intake. The most well studied in this regard are cholecystokinin (CCK), pancreatic polypeptide, peptide YY, glucagon-like peptide-1 (GLP-1), oxyntomodulin and ghrelin. With the exception of ghrelin, these hormones act to increase satiety and decrease food intake. The mechanisms by which gut hormones modify feeding are the subject of ongoing investigation. Local effects such as the inhibition of gastric emptying might contribute to the decrease in energy intake. Activation of mechanoreceptors as a result of gastric distension may inhibit further food intake via neural reflex arcs. Circulating gut hormones have also been shown to act directly on neurons in hypothalamic and brainstem centres of appetite control. The median eminence and area postrema are characterized by a deficiency of the blood–brain barrier. Some investigators argue that this renders neighbouring structures, such as the arcuate nucleus of the hypothalamus and the nucleus of the tractus solitarius in the brainstem, susceptible to influence by circulating factors. Extensive reciprocal connections exist between these areas and the hypothalamic paraventricular nucleus and other energy-regulating centres of the central nervous system. In this way, hormonal signals from the gut may be translated into the subjective sensation of satiety. Moreover, the importance of the brain–gut axis in the control of food intake is reflected in the dual role exhibited by many gut peptides as both hormones and neurotransmitters. Peptides such as CCK and GLP-1 are expressed in neurons projecting both into and out of areas of the central nervous system critical to energy balance. The global increase in the incidence of obesity and the associated burden of morbidity has imparted greater urgency to understanding the processes of appetite control. Appetite regulation offers an integrated model of a brain–gut axis comprising both endocrine and neurological systems. As physiological mediators of satiety, gut hormones offer an attractive therapeutic target in the treatment of obesity. PMID:16815798

  8. Gastrointestinal safety of NSAIDs and over-the-counter analgesics.

    PubMed

    Bjarnason, I

    2013-01-01

    Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used. It is well recognised that they may adversely cause damage throughout the gastrointestinal tract and aggravate pre-existing disease. Their side effects on the upper gastrointestinal tract can be assessed by various means; each study type has different clinical connotations. Short-term use (less than 14 days) demonstrates dose-dependent damage of prescribed NSAIDs; the damage is proportional to the acidity of the drugs and not seen with Cyclooxygenase-2 (COX-2) selective inhibitors that have a pKa over 7.0. There have not been any serious outcomes, such as bleeding or perforation in these studies, and Helicobacter pylori (HP) plays no role in this damage. Long-term (3 months or more) endoscopy studies in patients show ulcer rates from 15%-35% with the various NSAIDs, but serious outcomes are exceedingly rare. Epidemiological studies show an association between NSAID intake and serious events. Ibuprofen is consistently at the lower end of toxicity rankings, whereas ketorolac and azapropazone are the worst. The risk of bleeding is increased with advancing age, presence of HP, previous history of bleeding, anticoagulant use, etc. The mega-trials show that COX-2 selective agents halve the bleeding episodes, but NSAID-induced gastric bleeding is very rare usually, less than 1 in 200 subjects taking them for a year. Seventy percent of patients develop NSAID-enteropathy, which is associated with intestinal blood and protein loss and rarely strictures. Over-the-counter (OTC) use of ibuprofen and diclofenac is associated with symptomatic gastrointestinal side effects comparable with placebo. Ibuprofen is shown to be remarkably well tolerated at OTC doses in a number of studies. There are recent studies to suggest that OTC NSAIDs should be taken on a fasting stomach, not with food as commonly advocated. PMID:23163547

  9. Risk factors for complications associated with upper gastrointestinal foreign bodies

    PubMed Central

    Hong, Kyong Hee; Kim, Yoon Jae; Kim, Jae Hak; Chun, Song Wook; Kim, Hee Man; Cho, Jae Hee

    2015-01-01

    AIM: To investigate predictive risk factors associated with complications in the endoscopic removal of foreign bodies from the upper gastrointestinal tract. METHODS: We retrospectively reviewed the medical records of 194 patients with a diagnosis of foreign body impaction in the upper gastrointestinal tract, confirmed by endoscopy, at two university hospital in South Korea. Patient demographic data, including age, gender, intention to ingestion, symptoms at admission, and comorbidities, were collected. Clinical features of the foreign bodies, such as type, size, sharpness of edges, number, and location, were analyzed. Endoscopic data those were analyzed included duration of foreign body impaction, duration of endoscopic performance, endoscopic device, days of hospitalization, complication rate, 30-d mortality rate, and the number of operations related to foreign body removal. RESULTS: The types of upper gastrointestinal foreign bodies included fish bones, drugs, shells, meat, metal, and animal bones. The locations of impacted foreign bodies were the upper esophagus (57.2%), mid esophagus (28.4%), stomach (10.8%), and lower esophagus (3.6%). The median size of the foreign bodies was 26.2 ± 16.7 mm. Among 194 patients, endoscopic removal was achieved in 189, and complications developed in 51 patients (26.9%). Significant complications associated with foreign body impaction and removal included deep lacerations with minor bleeding (n = 31, 16%), ulcer (n = 11, 5.7%), perforation (n = 3, 1.5%), and abscess (n = 1, 0.5%). Four patients underwent operations because of incomplete endoscopic foreign body extraction. In multivariate analyses, risk factors for endoscopic complications and failure were sharpness (HR = 2.48, 95%CI: 1.07-5.72; P = 0.034) and a greater than 12-h duration of impaction (HR = 2.42, 95%CI: 1.12-5.25, P = 0.025). CONCLUSION: In cases of longer than 12 h since foreign body ingestion or sharp-pointed objects, rapid endoscopic intervention should be provided in patients with ingested foreign bodies. PMID:26185385

  10. Small-bowel capsule endoscopy: A ten-point contemporary review

    PubMed Central

    Koulaouzidis, Anastasios; Rondonotti, Emanuele; Karargyris, Alexandros

    2013-01-01

    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

  11. Dynamic Distortion Correction for Endoscopy Systems with Exchangeable Optics

    NASA Astrophysics Data System (ADS)

    Stehle, Thomas; Hennes, Michael; Gross, Sebastian; Behrens, Alexander; Wulff, Jonas; Aach, Til

    Endoscopic images are strongly affected by lens distortion caused by the use of wide angle lenses. In case of endoscopy systems with exchangeable optics, e.g. in bladder endoscopy or sinus endoscopy, the camera sensor and the optics do not form a rigid system but they can be shifted and rotated with respect to each other during an examination. This flexibility has a major impact on the location of the distortion centre as it is moved along with the optics. In this paper, we describe an algorithm for the dynamic correction of lens distortion in cystoscopy which is based on a one time calibration. For the compensation, we combine a conventional static method for distortion correction with an algorithm to detect the position and the orientation of the elliptic field of view. This enables us to estimate the position of the distortion centre according to the relative movement of camera and optics. Therewith, a distortion correction for arbitrary rotation angles and shifts becomes possible without performing static calibrations for every possible combination of shifts and angles beforehand.

  12. Opinion: How to manage subepithelial lesions of the upper gastrointestinal tract?

    PubMed Central

    Franco, Matheus Cavalcante; Schulz, Ricardo Teles; Maluf-Filho, Fauze

    2015-01-01

    Subepithelial lesions (SELs) in the upper gastrointestinal (GI) tract are relatively frequent findings in patients undergoing an upper GI endoscopy. These tumors, which are located below the epithelium and out of reach of conventional biopsy forceps, may pose a diagnostic challenge for the gastroenterologist, especially when SELs are indeterminate after endoscopy and endoscopic ultrasound (EUS). The decision to proceed with further investigation should take into consideration the size, location in the GI tract, and EUS features of SELs. Gastrointestinal stromal tumor (GIST) is an example of an SEL that has a well-recognized malignant potential. Unfortunately, EUS is not able to absolutely differentiate GISTs from other benign hypoechoic lesions from the fourth layer, such as leiomyomas. Therefore, EUS-guided fine needle aspiration (EUS-FNA) is an important tool for correct diagnosis of SELs. However, small lesions (size < 2 cm) have a poor diagnostic yield with EUS-FNA. Moreover, studies with EUS-core biopsy needles did not report higher rates of histologic and diagnostic yields when compared with EUS-FNA. The limited diagnostic yield of EUS-FNA and EUS-core biopsies of SELs has led to the development of more invasive endoscopic techniques for tissue acquisition. There are initial studies showing good results for tissue biopsy or resection of SELs with endoscopic submucosal dissection, suck-ligate-unroof-biopsy, and submucosal tunneling endoscopic resection. PMID:26675266

  13. Evaluation of technetium-99m DTPA for localization of site of acute upper gastrointestinal bleeding

    SciTech Connect

    Abdel-Dayem, H.M.; Mahajan, K.K.; Ericsson, S.; Nawaz, K.; Owunwanne, A.; Kouris, K.; Higazy, E.; Awdeh, M.

    1986-11-01

    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.

  14. Obesity and Gastrointestinal Diseases

    PubMed Central

    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

    2013-01-01

    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

  15. Fucosylation and gastrointestinal cancer

    PubMed Central

    Moriwaki, Kenta; Miyoshi, Eiji

    2010-01-01

    Fucose (6-deoxy-L-galactose) is a monosaccharide that is found on glycoproteins and glycolipids in verte-brates, invertebrates, plants, and bacteria. Fucosylation, which comprises the transfer of a fucose residue to oligosaccharides and proteins, is regulated by many kinds of molecules, including fucosyltransferases, GDP-fucose synthetic enzymes, and GDP-fucose transporter(s). Dramatic changes in the expression of fucosylated oligosaccharides have been observed in cancer and inflammation. Thus, monoclonal antibodies and lectins recognizing cancer-associated fucosylated oligosaccharides have been clinically used as tumor markers for the last few decades. Recent advanced glycomic approaches allow us to identify novel fucosylation-related tumor markers. Moreover, a growing body of evidence supports the functional significance of fucosylation at various pathophysiological steps of carcinogenesis and tumor progression. This review highlights the biological and medical significance of fucosylation in gastrointestinal cancer. PMID:21160988

  16. Adherence to guidelines: A national audit of the management of acute upper gastrointestinal bleeding. The REASON registry

    PubMed Central

    Lu, Yidan; Barkun, Alan N; Martel, Myriam

    2014-01-01

    OBJECTIVES: To assess process of care in nonvariceal upper gastrointestinal bleeding (NVUGIB) using a national cohort, and to identify predictors of adherence to ‘best practice’ standards. METHODS: Consecutive charts of patients hospitalized for acute upper gastrointestinal bleeding across 21 Canadian hospitals were reviewed. Data regarding initial presentation, endoscopic management and outcomes were collected. Results were compared with ‘best practice’ using established guidelines on NVUGIB. Adherence was quantified and independent predictors were evaluated using multivariable analysis. RESULTS: Overall, 2020 patients (89.4% NVUGIB, variceal in 10.6%) were included (mean [± SD] age 66.3±16.4 years; 38.4% female). Endoscopy was performed in 1612 patients: 1533 with NVUGIB had endoscopic lesions (63.1% ulcers; high-risk stigmata in 47.8%). Early endoscopy was performed in 65.6% and an assistant was present in 83.5%. Only 64.5% of patients with high-risk stigmata received endoscopic hemostasis; 9.8% of patients exhibiting low-risk stigmata also did. Intravenous proton pump inhibitor was administered after endoscopic hemostasis in 95.7%. Rebleeding and mortality rates were 10.5% and 9.4%, respectively. Multivariable analysis revealed that low American Society of Anesthesiologists score patients had fewer assistants present during endoscopy (OR 0.63 [95% CI 0.48 to 0.83), a hemoglobin level <70 g/L predicted inappropriate high-dose intravenous proton pump inhibitor use in patients with low-risk stigmata, and endoscopies performed during regular hours were associated with longer delays from presentation (OR 0.33 [95% CI 0.24 to 0.47]). CONCLUSION: There was variability between the process of care and ‘best practice’ in NVUGIB. Certain patient and situational characteristics may influence guideline adherence. Dissemination initiatives must identify and focus on such considerations to improve quality of care. PMID:25314356

  17. Wireless Insufflation for Wireless Capsule Endoscopy Byron Smith

    E-print Network

    of the gastrointestinal (GI) tract can be attributed to the clear view that such techniques provide of the intestinal-platform. Success of the system is determined by its ability to provide a level of insufflation that is necessary

  18. Epigenetic mechanisms and gastrointestinal development

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This review considers the hypothesis that nutrition during infancy affects developmental epigenetics in the gut, causing metabolic imprinting of gastrointestinal (GI) structure and function. Fundamentals of epigenetic gene regulation are reviewed, with an emphasis on the epigenetic mechanism of DNA ...

  19. The Gastrointestinal Microbiome

    PubMed Central

    Engen, Phillip A.; Green, Stefan J.; Voigt, Robin M.; Forsyth, Christopher B.; Keshavarzian, Ali

    2015-01-01

    The excessive use of alcohol is a global problem causing many adverse pathological health effects and a significant financial health care burden. This review addresses the effect of alcohol consumption on the microbiota in the gastrointestinal tract (GIT). Although data are limited in humans, studies highlight the importance of changes in the intestinal microbiota in alcohol-related disorders. Alcohol-induced changes in the GIT microbiota composition and metabolic function may contribute to the well-established link between alcohol-induced oxidative stress, intestinal hyperpermeability to luminal bacterial products, and the subsequent development of alcoholic liver disease (ALD), as well as other diseases. In addition, clinical and preclinical data suggest that alcohol-related disorders are associated with quantitative and qualitative dysbiotic changes in the intestinal microbiota and may be associated with increased GIT inflammation, intestinal hyperpermeability resulting in endotoxemia, systemic inflammation, and tissue damage/organ pathologies including ALD. Thus, gut-directed interventions, such as probiotic and synbiotic modulation of the intestinal microbiota, should be considered and evaluated for prevention and treatment of alcohol-associated pathologies. PMID:26695747

  20. Alternative Agents to Prevent Fogging in Head and Neck Endoscopy

    PubMed Central

    Piromchai, Patorn; Kasemsiri, Pornthep; Thanaviratananich, Sanguansak

    2011-01-01

    Background: The essential factor for diagnosis and treatment of diseases in head and neck endoscopy is the visibility of the image. An anti-fogging agent can reduce this problem by minimizing surface tension to prevent the condensation of water in the form of small droplets on a surface. There is no report on the use of hibiscrub® or baby shampoo to reduce fogging in the literature. The objective of this study was to compare the efficacy between commercial anti-fogging agent, hibiscrub® and baby shampoo to reduce fogging for the use in head and neck endoscopy. Methods: The study was conducted at the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University in August 2010. Commercial anti-fogging agent, baby shampoo and hibiscrub® were applied on rigid endoscope lens before putting them into a mist generator. The images were taken at baseline, 15 seconds, 30 seconds and 1 minute. The images’ identifiers were removed before they were sent to two evaluators. A visual analogue scale (VAS) was used to rate the image quality from 0 to 10. Results: The difference in mean VAS score between anti-fogging agent, baby shampoo and hibiscrub® versus no agent were 5.46, 4.45 and 2.1 respectively. The commercial anti-fogging agent and baby shampoo had most protective benefit and performed significantly better than no agent (P = 0.05). Conclusions: Baby shampoo is an effective agent to prevent fogging during head and neck endoscopy and compares favourably with commercial anti-fogging agent. PMID:24179399

  1. Training the endoscopy trainer: From general principles to specific concepts

    PubMed Central

    Coderre, Sylvain; Anderson, John; Rostom, Alaa; McLaughlin, Kevin

    2010-01-01

    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. PMID:21165376

  2. Photoacoustic endoscopy probe using a coherent fibre optic bundle

    NASA Astrophysics Data System (ADS)

    Ansari, R.; Zhang, E.; Mathews, S.; Desjardins, A. E.; Beard, P. C.

    2015-07-01

    There is considerable interest in the development of photoacoustic endoscopy probes (PAE) for applications in foetal medicine, interventional surgery and gastroenterology. However, most previous PAE probes employ a combination of mechanical scanning and piezoelectric transducers at the distal end which can be technically complex and pose challenges in achieving the required level of miniaturisation and acoustic performance. To overcome these limitations, we present two novel all-optical forward-viewing endoscopic probes that use coherent fibre bundles to address a Fabry-Perot polymer film ultrasound sensor.

  3. State of the art in advanced endoscopic imaging for the detection and evaluation of dysplasia and early cancer of the gastrointestinal tract

    PubMed Central

    Coda, Sergio; Thillainayagam, Andrew V

    2014-01-01

    Ideally, endoscopists should be able to detect, characterize, and confirm the nature of a lesion at the bedside, minimizing uncertainties and targeting biopsies and resections only where necessary. However, under conventional white-light inspection – at present, the sole established technique available to most of humanity – premalignant conditions and early cancers can frequently escape detection. In recent years, a range of innovative techniques have entered the endoscopic arena due to their ability to enhance the contrast of diseased tissue regions beyond what is inherently possible with standard white-light endoscopy equipment. The aim of this review is to provide an overview of the state-of-the-art advanced endoscopic imaging techniques available for clinical use that are impacting the way precancerous and neoplastic lesions of the gastrointestinal tract are currently detected and characterized at endoscopy. The basic instrumentation and the physics behind each method, followed by the most influential clinical experience, are described. High-definition endoscopy, with or without optical magnification, has contributed to higher detection rates compared with white-light endoscopy alone and has now replaced ordinary equipment in daily practice. Contrast-enhancement techniques, whether dye-based or computed, have been combined with white-light endoscopy to further improve its accuracy, but histology is still required to clarify the diagnosis. Optical microscopy techniques such as confocal laser endomicroscopy and endocytoscopy enable in vivo histology during endoscopy; however, although of invaluable assistance for tissue characterization, they have not yet made transition between research and clinical use. It is still unknown which approach or combination of techniques offers the best potential. The optimal method will entail the ability to survey wide areas of tissue in concert with the ability to obtain the degree of detailed information provided by microscopic techniques. In this respect, the challenging combination of autofluorescence imaging and confocal endomicroscopy seems promising, and further research is awaited. PMID:24868168

  4. Second-Look Endoscopy after Gastric Endoscopic Submucosal Dissection for Reducing Delayed Postoperative Bleeding

    PubMed Central

    Park, Chan Hyuk; Park, Jun Chul; Lee, Hyuk; Shin, Sung Kwan; Lee, Sang Kil; Lee, Yong Chan

    2015-01-01

    Background/Aims This stuy evaluated the role of a second-look endoscopy after gastric endoscopic submucosal dissection in patients without signs of bleeding. Methods Between March 2011 and March 2012, 407 patients with gastric neoplasms who underwent endoscopic submucosal dissection for 445 lesions were retrospectively reviewed. After the patients had undergone endoscopic submucosal dissection, they were allocated to two groups (with or without second-look endoscopy) according to the following endoscopy. The postoperative bleeding risk of the lesions was not considered when allocating the patients. Results The delayed postoperative bleeding rates did not differ between the two groups (with vs without second-look endoscopy, 3.0% vs 2.1%; p=0.546). However, a tumor in the upper-third of the stomach (odds ratio [OR], 5.353; 95% confidence interval [CI], 1.075 to 26.650) and specimen size greater than 40 mm (OR, 4.794; 95% CI, 1.307 to 17.588) were both independent risk factors for delayed postoperative bleeding. Additionally, second-look endoscopy was not related to reduced delayed postoperative bleeding. However, delayed postoperative bleeding in the patients who did not undergo a second-look endoscopy occurred significantly earlier than that in patients who underwent a second-look endoscopy (4.5 and 14.0 days, respectively, p=0.022). Conclusions A routine second-look endoscopy after gastric endoscopic submucosal dissection is not necessary for all patients. PMID:25170062

  5. 21 CFR 876.1725 - Gastrointestinal motility monitoring system.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...2010-04-01 false Gastrointestinal motility monitoring system. 876.1725... § 876.1725 Gastrointestinal motility monitoring system. (a) Identification. A gastrointestinal motility monitoring system is a...

  6. 21 CFR 876.1725 - Gastrointestinal motility monitoring system.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...2013-04-01 false Gastrointestinal motility monitoring system. 876.1725... § 876.1725 Gastrointestinal motility monitoring system. (a) Identification. A gastrointestinal motility monitoring system is a...

  7. 21 CFR 876.1725 - Gastrointestinal motility monitoring system.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...2011-04-01 false Gastrointestinal motility monitoring system. 876.1725... § 876.1725 Gastrointestinal motility monitoring system. (a) Identification. A gastrointestinal motility monitoring system is a...

  8. 21 CFR 876.1725 - Gastrointestinal motility monitoring system.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...2012-04-01 false Gastrointestinal motility monitoring system. 876.1725... § 876.1725 Gastrointestinal motility monitoring system. (a) Identification. A gastrointestinal motility monitoring system is a...

  9. 21 CFR 876.1725 - Gastrointestinal motility monitoring system.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...2014-04-01 false Gastrointestinal motility monitoring system. 876.1725... § 876.1725 Gastrointestinal motility monitoring system. (a) Identification. A gastrointestinal motility monitoring system is a...

  10. Prevalence and Outcome of Upper Gastrointestinal Bleeding Post-coronary Artery Bypass Graft

    PubMed Central

    Aljarallah, Badr; Wong, Winnie; Modry, Dennis; Fedorak, Richard

    2008-01-01

    Background: Upper gastrointestinal bleeding (UGIB), a potentially fatal occurrence, can sometimes follow coronary artery bypass graft (CABG) surgery. However, little has been published about its prevalence, risk factors, and outcomes. Aim: This study aimed to determine the rate, etiologies, predisposing factors, and outcomes of UGIB following CABG. Method: The authors conducted a retrospective chart review of all UGIBs which followed CABGs performed at the University of Alberta Hospital from January 1, 1998 to December 31, 2002. Results: During the study period, 4,502 CABGs were performed at the UAH. Eighteen patients (0.4%) had a documented major UGIB (defined as evidence of melena, red or coffee-grounds emesis, blood per NG tube, or a decrease of Hgb by > 20 g/l and requiring a confirmation by endoscopy or radiological study). Two of these 18 patients (11%) had a past history of peptic ulcer disease, and one of these patients had had previous UGIB. Three patients (17%) had been taking proton pump inhibitors (PPI) before the UGIB occurred. At the time of UGIB, PPIs were prescribed for 16 patients (89%), and the PPIs achieved effective hemostasis as a single agent for 10 (62.5%). Of the 18 patients, 16 (89%) underwent upper GI endoscopy. Bleeding was found to be due to duodenal ulceration in 9 (56%), esophagitis in 4 (22%) and gastritis in 6 cases (33%); fifty percent of these patients had multiple sites of bleeding. Endoscopic therapeutic intervention was needed by 6 patients (37.5%), and successful hemostasis was achieved for 5 of these patients (83%). One patient had a recurrence of bleeding and required surgery. One patient underwent surgery as the primary hemostatic therapy after a diagnostic endoscopy. The overall surgical rate was 11.1% for this patient cohort. In this cohort, three patients died, two from multi-organ failure, and the third, a surgically managed patient, had a cardiac arrest 72 hours post-surgery. The number of complication increased as both cardiopulmonary bypass and cross clamp time increased. There were no endoscopy-related complications. Conclusions: UGI bleeding following CABGs is relatively infrequent, occurring at a rate of 0.4% in this study. Upper gastrointestinal bleeding post-CABG is most frequently related to a duodenal ulcer, though 50% of the patients had multiple bleeding sites. prolonged bypass and cross clamp time associated with more complications. PMID:21475474

  11. Role and timing of endoscopy in acute biliary pancreatitis

    PubMed Central

    Anderloni, Andrea; Repici, Alessandro

    2015-01-01

    The role and timing of endoscopy in the setting of acute biliary pancreatitis (ABP) is still being debated. Despite numerous randomized trials have been published, there is an obvious lack of consensus on the indications and timing of endoscopic retrograde cholangiopancreatography (ERCP) in ABP in meta-analyses and nationwide guidelines. The present editorial has been written to clarify the role of endoscopy in ABP. In clinical practice the decision to perform an ERCP is often based on biochemical and radiological criteria despite they already have been shown to be unreliable predictors of common bile duct stone presence. Endoscopic ultrasonography (EUS) is not currently a worldwide standard diagnostic procedure early in the course of acute biliary pancreatitis, but it has been shown to be accurate, safe and cost effective in diagnosing biliary obstructions compared with magnetic resonance cholangiopancreatography and ERCP and therefore in preventing unnecessary ERCP and its related complications. Early EUS in ABP allows, if appropriate, immediate endoscopic treatment and significant spare of unnecessary operative procedures thus reducing possible related complications. PMID:26527465

  12. Flexor Digitorum Accessorius Longus: Importance of Posterior Ankle Endoscopy

    PubMed Central

    Batista, Jorge Pablo; del Vecchio, Jorge Javier; Golanó, Pau; Vega, Jordi

    2015-01-01

    Endoscopy for the posterior region of the ankle through two portals is becoming more widespread for the treatment of a large number of conditions which used to be treated with open surgery years ago. The tendon of the flexor hallucis longus (FHL) travels along an osteofibrous tunnel between the posterolateral and posteromedial tubercles of the talus. Chronic inflammation of this tendon may lead to painful stenosing tenosynovitis. The aim of this report is to describe two cases depicting an accessory tendon which is an anatomical variation of the flexor hallucis longus in patients with posterior friction syndrome due to posterior ankle impingement and associated with a posteromedial osteochondral lesion of the talus. The anatomical variation (FDAL) described was a finding during an endoscopy of the posterior region of the ankle, and we have spared it by sectioning the superior flexor retinaculum only. The accessory flexor digitorum longus is an anatomical variation and should be taken into account when performing an arthroscopy of the posterior region of the ankle. We recommend this treatment on this type of injury although we admit this does not make a definite conclusion. PMID:26060592

  13. [Upper digestive tract endoscopy in rural Africa: Togo].

    PubMed

    Djibril, M A; M'Ba, K B; Kaaga, Y L; Bagny, A; Edou, K A; Redah, D; Agbetra, A

    2009-02-01

    The purpose of this report was to describe the profile of esogastroduodenal disease diagnosed by upper digestive tract endoscopy (UDTE) in a rural area of Togo. This prospective study combines data collected during two two-week screening campaigns carried out in the Kara region. Patients were informed of the presence of the endoscopy team by means of a bulletin on a rural radio station. All male and female patients 15 years or older were included. A total of 220 UDTE procedure reports were recorded and analyzed including 107 men and 113 women with a mean age of 37.7 years (range: 15-84 years). Disease was detected in 72 procedures mainly in the 21 to 41 year age group (47.2 %) with a higher proportion of men than women: 38% versus 27% respectively. The most frequent indications for UDTE were epigastralgia (47.7 %) including 39% of procedures leading to the discovery of disease and diffuse abdominal pain (21.8 %). The procedure was carried out for follow-up purposes in 19.1% of cases. The most common lesions were peptic ulcer (34.2%), inflammatory disease including esophagitis, gastritis, and bulboduodenitis (32.4%), gastroduodenal bile reflux (9.3%), pylorobulbar stenosis (5.5%), tumoral disease (3.7%), and esophageal varicosities (3.7%). This study based on UDTE diagnostic procedures provided insight into the profile of esogastroduodenal disease in rural Africa. These screening campaigns required special organization using appropriate equipment and personnel. PMID:19499733

  14. Gastrointestinal Amyloidosis Presenting with Multiple Episodes of Gastrointestinal Bleeding

    SciTech Connect

    Kim, Sang Hyeon Kang, Eun Ju; Park, Jee Won; Jo, Jung Hyun; Kim, Soo Jin; Cho, Jin Han; Kang, Myong Jin; Park, Byeong Ho

    2009-05-15

    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.

  15. A Case of an Upper Gastrointestinal Bleeding Due to a Ruptured Dissection of a Right Aortic Arch

    SciTech Connect

    Born, Christine; Forster, Andreas; Rock, Clemens; Pfeifer, Klaus-Juergen; Rieger, Johannes; Reiser, Maximilian

    2003-09-15

    We report a case of severe upper gastrointestinal hemorrhage with a rare underlying cause. The patient was unconscious when he was admitted to the hospital. No chest radiogram was performed. Routine diagnostic measures, including endoscopy, failed to reveal the origin of the bleeding, which was believed to originate from the esophagus secondary to a peptic ulcer or varices. Exploratory laparotomy added no further information, but contrast-enhanced multislice computed tomography (MSCT) of the chest showed dextroposition of the widened aortic arch with a ruptured type-B dissection and a consecutive aorto-esophageal fistula (AEF). The patient died on the day of admission. Noninvasive MSCT angiography gives rapid diagnostic information on patients with occult upper gastrointestinal bleeding and should be considered before more invasive conventional angiography or surgery.

  16. Epigenetic Biomarkers for the Early Detection of Gastrointestinal Cancer

    PubMed Central

    Chen, Hui-Mi; Fang, Jing-Yua

    2014-01-01

    Background Gastric cancer and colorectal cancer, the two most frequent cancers within the gastrointestinal tract, account for a large proportion of human malignancies worldwide. The initiation and progression of gastrointestinal cancer (GIC) is controlled by both genetic and epigenetic events. Epigenetic alterations, including changes in DNA methylation, specific histone modifications, chromatin remodeling and noncoding RNA-mediated gene silencing, are potentially reversible and heritable. Summary In this article, we summarize the current advances in epigenetic biomarkers as potential substrates for GIC detection. The combined screening of a panel of methylated genes, hyperacetylated histones, microRNAs or other noncoding RNAs is currently under evaluation to improve sensitivity. Key Message Current studies concentrated on the development of cost-effective epigenetic diagnostic biomarkers for GIC based on noninvasive blood or stool samples. The combined blood or stool test with a relatively high sensitivity could be a cost-effective screening tool for the detection of patients with asymptomatic cancers who could therefore choose whether or not to go for further examinations, such as endoscopy or colonoscopy. Practical Implications A better understanding of epigenetic mechanisms has not only offered new insights into a deeper understanding of the underlying mechanisms of carcinogenesis, but has also allowed identification of clinically relevant putative biomarkers for the early detection, disease monitoring, prognosis and risk assessment of GIC. In particular, noninvasive biomarkers in serum or fecal samples for the detection of GIC could have potential for better compliance and can be incorporated into routine clinical practice in the foreseeable future, pending their validation in large-scale prospective trials.

  17. Targeted therapy in gastrointestinal malignancies

    PubMed Central

    Chhatrala, Ravi; Thanavala, Yasmin; Iyer, Renuka

    2014-01-01

    Increased understanding of cancer pathogenesis has identified several pathways that serve as potential targets for novel targeted agents in development. The selection of targeted cancer therapy based on biomarkers has instigated a new era of personalized medicine and changed the way we practice oncology. Many targeted agents are approved for treatment of gastrointestinal malignancies most targeting tumor angiogenesis, and many more are in different phases of development. Here we briefly summarize nine different targeted agents that are approved currently in the U.S. and several other agents currently being studied in various gastrointestinal cancers. PMID:24737952

  18. Motion management in gastrointestinal cancers

    PubMed Central

    Abbas, Hassan; Chang, Bryan

    2014-01-01

    The presence of tumor and organ motions complicates the planning and delivery of radiotherapy for gastrointestinal cancers. Without proper accounting of the movements, target volume could be under-dosed and the nearby normal critical organs could be over-dosed. This situation is further exacerbated by the close proximity of abdominal tumors to many normal organs at risk (OARs). A number of strategies have been developed to deal with tumor and organ motions in radiotherapy. This article presents a review of the techniques used in the evaluation, quantification, and management of tumor and organ motions for radiotherapy of gastrointestinal cancers. PMID:24982771

  19. Review of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography using several endoscopic methods in patients with surgically altered gastrointestinal anatomy

    PubMed Central

    Shimatani, Masaaki; Takaoka, Makoto; Tokuhara, Mitsuo; Miyoshi, Hideaki; Ikeura, Tsukasa; Okazaki, Kazuichi

    2015-01-01

    The endoscopic approach for biliary diseases in patients with surgically altered gastrointestinal anatomy (SAGA) had been generally deemed impractical. However, it was radically made feasible by the introduction of double balloon endoscopy (DBE) that was originally developed for diagnosis and treatments for small-bowel diseases. Followed by the subsequent development of single-balloon endoscopy (SBE) and spiral endoscopy (SE), interventions using several endoscopes for biliary disease in patients with SAGA widely gained an acceptance as a new modality. Many studies have been made on this new technique. Yet, some problems are to be solved. For instance, the mutual unavailability among devices due to different working lengths and channels, and unestablished standardization of procedural techniques can be raised. Additionally, in an attempt to standardize endoscopic procedures, it is important to evaluate biliary cannulating methods by case with existence of papilla or not. A full comprehension of the features of respective scope types is also required. However there are not many papers written as a review. In our manuscript, we would like to evaluate and make a review of the present status of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography applying DBE, SBE and SE for biliary diseases in patients with SAGA for establishment of these modalities as a new technology and further improvement of the scopes and devices. PMID:26078830

  20. Gastric Glomus Tumor: A Rare Cause of Upper Gastrointestinal Bleeding

    PubMed Central

    Handa, Yoshinori; Kano, Mikihiro; Kaneko, Mayumi; Hirabayashi, Naoki

    2015-01-01

    A 24-year-old woman was referred to our department because of melena. These symptoms combined with severe anemia prompted us to perform an emergency upper endoscopy, which showed bleeding from an ulcerated 30?mm submucosal tumor in the gastric antrum. A computed tomography scan revealed a homogeneously enhanced mass, and endoscopic ultrasonography identified a well-demarcated mass in the third and fourth layers of the gastric wall. Because analysis of the possible medical causes remained inconclusive and the risk of rebleeding, laparoscopy-assisted gastric wedge resection was performed after administration of 10 units of red cell concentrate. Histological and immunohistological analysis revealed the tumor to be a gastric glomus tumor. Gastric submucosal tumors remain challenging to diagnose preoperatively as they show a variety of radiologic and clinicopathologic features and are associated with the risk of bleeding upon biopsy, as is indicated in the guidelines for gastric submucosal tumors. Gastric glomus tumors characteristically present with exsanguinating gastrointestinal hemorrhaging that often requires blood transfusion. Additionally, gastric submucosal tumors typically occur in elderly patients; however, this case involved a young patient who was 24 years old. Here, we describe this case in order to identify features that may aid in early differentiation of gastric submucosal tumors. PMID:26697255

  1. Upper gastrointestinal bleed associated with cholinesterase inhibitor use.

    PubMed

    Kok, Khoon-Sheng; Loke, Yoon; Southgate, Jo

    2015-01-01

    An 86-year-old man was admitted with a 3-day history of melaena and syncope. He was haemodynamically compromised and anaemic on presentation. His only medical history was mild Alzheimer's disease diagnosed 6?months prior. For this, he was on donepezil, a cholinesterase inhibitor (ChEI), with a recent dose increase 3?months earlier. After fluid resuscitation with packed red cells, an endoscopy was performed, which showed an acute duodenal ulcer. This was treated with a high-dose proton pump inhibitor. The patient recovered well and was discharged on donepezil with the addition of a gastro-protective proton pump inhibitor. In view of other absent risk factors of upper gastrointestinal haemorrhage, donepezil was the likely causative agent. ChEIs are associated with frequent side effects and increased hospitalisation due to central and peripheral increase in acetylcholine. With this case report, we review the literature of side effects related to ChEIs, where the mechanisms of action, complications and appropriate management are discussed. PMID:26420698

  2. Diagnosis and therapy of non-variceal upper gastrointestinal bleeding

    PubMed Central

    Biecker, Erwin

    2015-01-01

    Non-variceal upper gastrointestinal bleeding (UGIB) is defined as bleeding proximal to the ligament of Treitz in the absence of oesophageal, gastric or duodenal varices. The clinical presentation varies according to the intensity of bleeding from occult bleeding to melena or haematemesis and haemorrhagic shock. Causes of UGIB are peptic ulcers, Mallory-Weiss lesions, erosive gastritis, reflux oesophagitis, Dieulafoy lesions or angiodysplasia. After admission to the hospital a structured approach to the patient with acute UGIB that includes haemodynamic resuscitation and stabilization as well as pre-endoscopic risk stratification has to be done. Endoscopy offers not only the localisation of the bleeding site but also a variety of therapeutic measures like injection therapy, thermocoagulation or endoclips. Endoscopic therapy is facilitated by acid suppression with proton pump inhibitor (PPI) therapy. These drugs are highly effective but the best route of application (oral vs intravenous) and the adequate dosage are still subjects of discussion. Patients with ulcer disease are tested for Helicobacter pylori and eradication therapy should be given if it is present. Non-steroidal anti-inflammatory drugs have to be discontinued if possible. If discontinuation is not possible, cyclooxygenase-2 inhibitors in combination with PPI have the lowest bleeding risk but the incidence of cardiovascular events is increased. PMID:26558151

  3. Electromechanical performance of piezoelectric scanning mirrors for medical endoscopy

    PubMed Central

    Gilchrist, Kristin H.; Dausch, David E.; Grego, Sonia

    2012-01-01

    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. PMID:22773894

  4. Electromechanical performance of piezoelectric scanning mirrors for medical endoscopy.

    PubMed

    Gilchrist, Kristin H; Dausch, David E; Grego, Sonia

    2012-05-01

    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. PMID:22773894

  5. Nasal endoscopy and CT study of Pharaonic and Roman mummies.

    PubMed

    Gaafar, H; Abdel-Monem, M H; Elsheikh, S

    1999-03-01

    In ancient Egypt mummifications were first carried out around 3000 BC. The visceral organs (lungs, stomach, liver and bowel) were removed from the body, cleansed, desiccated and placed in four canopic jars. The brain was removed from the body but was not preserved. Exactly how removal of the brain was accomplished is not clear. This study investigated the route of brain removal during mummification. Nasal endoscopy was carried out on 20 Pharaonic and Roman mummies. CT examination was performed on 2 mummy heads. In all mummies a communication between the cranial and nasal cavities was found passing through the posterior ethmoids and cribriform plates. The cranial cavity was empty. Our results demonstrate that brain removal during mummification was performed endonasally by trained personnel with a good knowledge of anatomy, using special instruments capable of creating a clean-cut endonasal craniotomy. PMID:10320087

  6. Portable wireless power transmission system for video capsule endoscopy.

    PubMed

    Zhiwei, Jia; Guozheng, Yan; Bingquan, Zhu

    2014-10-01

    Wireless power transmission is considered a practical way of overcoming the power shortage of wireless capsule endoscopy (VCE). However, most patients cannot tolerate the long hours of lying in a fixed transmitting coil during diagnosis. To develop a portable wireless power transmission system for VCE, a compact transmitting coil and a portable inverter circuit driven by rechargeable batteries are proposed. The couple coils, optimized considering the stability and safety conditions, are 28 turns of transmitting coil and six strands of receiving coil. The driven circuit is designed according to the portable principle. Experiments show that the integrated system could continuously supply power to a dual-head VCE for more than 8 h at a frame rate of 30 frames per second with resolution of 320 × 240. The portable VCE exhibits potential for clinical applications, but requires further improvement and tests. PMID:25082182

  7. Single Nanowire Probe for Single Cell Endoscopy and Sensing

    NASA Astrophysics Data System (ADS)

    Yan, Ruoxue

    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

  8. Role of virtual reality simulation in endoscopy training.

    PubMed

    Harpham-Lockyer, Louis; Laskaratos, Faidon-Marios; Berlingieri, Pasquale; Epstein, Owen

    2015-12-10

    Recent advancements in virtual reality graphics and models have allowed virtual reality simulators to be incorporated into a variety of endoscopic training programmes. Use of virtual reality simulators in training programmes is thought to improve skill acquisition amongst trainees which is reflected in improved patient comfort and safety. Several studies have already been carried out to ascertain the impact that usage of virtual reality simulators may have upon trainee learning curves and how this may translate to patient comfort. This article reviews the available literature in this area of medical education which is particularly relevant to all parties involved in endoscopy training and curriculum development. Assessment of the available evidence for an optimal exposure time with virtual reality simulators and the long-term benefits of their use are also discussed. PMID:26675895

  9. Role of virtual reality simulation in endoscopy training

    PubMed Central

    Harpham-Lockyer, Louis; Laskaratos, Faidon-Marios; Berlingieri, Pasquale; Epstein, Owen

    2015-01-01

    Recent advancements in virtual reality graphics and models have allowed virtual reality simulators to be incorporated into a variety of endoscopic training programmes. Use of virtual reality simulators in training programmes is thought to improve skill acquisition amongst trainees which is reflected in improved patient comfort and safety. Several studies have already been carried out to ascertain the impact that usage of virtual reality simulators may have upon trainee learning curves and how this may translate to patient comfort. This article reviews the available literature in this area of medical education which is particularly relevant to all parties involved in endoscopy training and curriculum development. Assessment of the available evidence for an optimal exposure time with virtual reality simulators and the long-term benefits of their use are also discussed. PMID:26675895

  10. Capsule endoscopy of the future: What's on the horizon?

    PubMed

    Slawinski, Piotr R; Obstein, Keith L; Valdastri, Pietro

    2015-10-01

    Capsule endoscopes have evolved from passively moving diagnostic devices to actively moving systems with potential therapeutic capability. In this review, we will discuss the state of the art, define the current shortcomings of capsule endoscopy, and address research areas that aim to overcome said shortcomings. Developments in capsule mobility schemes are emphasized in this text, with magnetic actuation being the most promising endeavor. Research groups are working to integrate sensor data and fuse it with robotic control to outperform today's standard invasive procedures, but in a less intrusive manner. With recent advances in areas such as mobility, drug delivery, and therapeutics, we foresee a translation of interventional capsule technology from the bench-top to the clinical setting within the next 10 years. PMID:26457013

  11. Therapeutic Decision-Making in Endoscopically Unmanageable Nonvariceal Upper Gastrointestinal Hemorrhage

    SciTech Connect

    Defreyne, Luc; Schrijver, Ignace De; Decruyenaere, Johan; Maele, Georges Van; Ceelen, Wim; Looze, Danny De; Vanlangenhove, Peter

    2008-09-15

    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.

  12. Emergency Department Evaluation And Management Of Patients With Upper Gastrointestinal Bleeding.

    PubMed

    DeLaney, Matthew; Greene, Christopher James; Hess, Jamie; Sachs, Carolyn

    2015-04-01

    Upper gastrointestinal bleeding results from a variety of conditions that may vary in severity from merely bothersome to imminently life-threatening. While stabilization is standard for nearly all causes of bleeding, identifying whether the bleed is from variceal or nonvariceal sources is critical. Testing and treatments such as nasogastric lavage, antibiotics, somatostatin analogues, proton pump inhibitors, and emergent endoscopy may benefit some patients, depending upon the bleeding source and other clinical factors; however, some therapies that are routinely used have very little evidence demonstrating effectiveness. This issue reviews the most recent evidence regarding appropriate testing, risk stratification, and indications for gastroenterology consult in the emergency department in order to treat these patients appropriately. PMID:26291048

  13. Gastric Metastasis of Hepatocellular Carcinoma With Gastrointestinal Bleeding After Liver Transplant: A Case Report.

    PubMed

    Li, L; Zhang, W H; Meng, F P; Ma, X M; Shen, L J; Jin, B; Li, H W; Han, J; Zhou, G D; Liu, S H

    2015-10-01

    Gastrointestinal (GI) metastasis of hepatocellular carcinoma is very rare. This is the first report of post-transplantation gastric metastasis. A 43-year-old man with a history of hepatitis B-related hepatocellular carcinoma (HCC) in the right anterior segment of the liver received an orthotopic liver transplant. Three months after the transplantation, pulmonary metastasis was found by chest computed tomography, and he received 1 course of gamma knife treatment. He complained of melena with anemia 17 months post liver transplantation. Abdominal CT scan showed new occupying lesions in the liver and a mass in the stomach and around the spleen with embolus in the splenic vein. Endoscopy revealed a large irregular cauliflower-like mass in fundus with ulceration and bleeding on the surface. He received symptomatic treatment, but died of cancer-related bleeding 4 months later. GI bleeding may due to gastric metastasis after liver transplantation. PMID:26518968

  14. An obscure cause of gastrointestinal bleeding: Renal cell carcinoma metastasis to the small bowel

    PubMed Central

    Gorski, Robyn L.; Jalil, Salah Abdel; Razick, Manver; Jalil, Ala' Abdel

    2015-01-01

    Renal cell carcinoma metastasis to the small intestine is a rare condition. It usually results in gastrointestinal bleeding and it could happen many years after the diagnosis with renal cell cancer. Treatment includes surgery as well as targeted agents such as tyrosine kinases. We report here the case of an 82-year-old man with a past medical history of high-grade renal cell carcinoma and right nephrectomy 6 years earlier, who presented with recurrent episodes of syncope and black stools. He underwent esophagogastroduodenoscopy (EGD) and colonoscopy without evident source of bleeding. Video capsule endoscopy (VCE) showed three bleeding lesions in the jejunum and ileum. Push enteroscopy revealed a proximal jejunum bleeding mass that was suspicious for malignancy. Histopathology demonstrated poorly differentiated carcinoma. Given the patient’s history of high-grade renal cell carcinoma, and similarity of histologic changes to the old renal cell cancer specimen, metastatic renal cell carcinoma was felt to be the responsible etiology. PMID:26348395

  15. Success of Minimally Invasive Transumbilical Single-Incision Laparoscopic Surgery (T-SILS) Plus Double-Balloon Endoscopy (DBE) for Pediatric Intestinal Angiodysplasia: A Case Report.

    PubMed

    Mori, Koichiro; Koike, Yuhki; Inoue, Mikihiro; Ohtake, Kohei; Tanaka, Koji; Uchida, Keichi; Mohri, Yasuhiko; Kusunoki, Masato

    2015-05-01

    We describe here a child with angiodysplasia of the small intestine, diagnosed by double-balloon endoscopy (DBE), who was treated with transumbilical single-incision laparoscopic surgery (T-SILS). A 9-year-old boy presented to another hospital with intermittent fresh melena of a duration of 5 months and 4 days. Anoscopy and gastric mucosal membrane scintigraphy were unsuccessful diagnostically, and he was referred to our hospital for further examination and treatment. Under general anesthesia, we performed DBE by an anal route, with the ileum assessed for a distance of about 150 cm from the ileocecal valve. Although no bleeding lesion was found in the colon, a flat elevated venous lake approximately 20 mm in size was observed 20 cm from the ileocecal valve, suggesting angiodysplasia of the small intestine. A tattoo was made under DBE, and wedge resection by T-SILS was performed 1 month later under general anesthesia. The excised specimen appeared as a flat, elevated venous lake approximately 20 mm in size. Histopathologic analysis revealed several dilated and distorted veins within the submucosa of the small intestine. The patient was diagnosed with angiodysplasia of the small intestine. His postoperative course was uneventful, and he remained free of recurrent gastrointestinal bleeding 18 months after the operation. This is the first case report showing the diagnosis, localization, and tattooing of an obscure gastrointestinal bleeding lesion of the small intestine by preoperative DBE and removal of the lesion by subsequent T-SILS in children. PMID:26011216

  16. The natural history of occult or angiodysplastic gastrointestinal bleeding in von Willebrand disease.

    PubMed

    Makris, M; Federici, A B; Mannucci, P M; Bolton-Maggs, P H B; Yee, T T; Abshire, T; Berntorp, E

    2015-05-01

    Recurrent gastrointestinal bleeding is one of the most challenging complications encountered in the management of patients with von Willebrand disease (VWD). The commonest cause is angiodysplasia, but often no cause is identified due to the difficulty in making the diagnosis. The optimal treatment to prevent recurrences remains unknown. We performed a retrospective study of VWD patients with occult or angiodysplastic bleeding within the setting of the von Willebrand Disease Prophylaxis Network (VWD PN) to describe diagnostic and treatment strategies. Centres participating in the VWD PN recruited subjects under their care with a history of congenital VWD and gastrointestinal (GI) bleeding due to angiodysplasia, or cases in which the cause was not identified despite investigation. Patients with acquired von Willebrand syndrome or those for whom the GI bleeding was due to another cause were excluded. Forty-eight patients from 18 centres in 10 countries were recruited. Seven individuals had a family history of GI bleeding and all VWD types except 2N were represented. Angiodysplasia was confirmed in 38%, with video capsule endoscopy and GI tract endoscopies being the most common methods of making the diagnosis. Recurrent GI bleeding in VWD is associated with significant morbidity and required hospital admission on up to 30 occasions. Patients were treated with multiple pharmacological agents with prophylactic von Willebrand factor concentrate being the most efficient in preventing recurrence of the GI bleeding. The diagnosis and treatment of recurrent GI bleeding in congenital VWD remains challenging and is associated with significant morbidity. Prophylactic treatment with von Willebrand factor concentrate was the most effective method of preventing recurrent bleeding but its efficacy remains to be confirmed in a prospective study. PMID:25381842

  17. Validation of administrative data sources for endoscopy utilization in colorectal cancer diagnosis

    PubMed Central

    2012-01-01

    Background Validation of administrative data is important to assess potential sources of bias in outcome evaluation and to prevent dissemination of misleading or inaccurate information. The purpose of the study was to determine the completeness and accuracy of endoscopy data in several administrative data sources in the year prior to colorectal cancer diagnosis as part of a larger project focused on evaluating the quality of pre-diagnostic care. Methods Primary and secondary data sources for endoscopy were collected from the Alberta Cancer Registry, cancer medical charts and three different administrative data sources. 1672 randomly sampled patients diagnosed with invasive colorectal cancer in years 2000–2005 in Alberta, Canada were included. A retrospective validation study of administrative data for endoscopy in the year prior to colorectal cancer diagnosis was conducted. A gold standard dataset was created by combining all the datasets. Number and percent identified, agreement and percent unique to a given data source were calculated and compared across each dataset and to the gold standard with respect to identifying all patients who underwent endoscopy and all endoscopies received by those patients. Results The combined administrative data and physician billing data identified as high or higher percentage of patients who had one or more endoscopy (84% and 78%, respectively) and total endoscopy procedures (89% and 81%, respectively) than the chart review (78% for both). Conclusions Endoscopy data has a high level of completeness and accuracy in physician billing data alone. Combined with hospital in/outpatient data it is more complete than chart review alone. PMID:23062117

  18. Gastrointestinal lesions associated with spondyloarthropathies

    PubMed Central

    Orlando, Ambrogio; Renna, Sara; Perricone, Giovanni; Cottone, Mario

    2009-01-01

    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. PMID:19468992

  19. Vasculitides of the gastrointestinal tract.

    PubMed

    Ahn, Eric; Luk, Adriana; Chetty, Runjan; Butany, Jagdish

    2009-05-01

    Systemic vasculitis is often not considered as a possible diagnosis by clinicians because of its low prevalence compared with other more common diseases. Vasculitis can affect any end organ, and it is therefore often missed early on in disease progression. Gastrointestinal (GI) manifestations of vasculitis are considered rare and the presentation is often nonspecific. However, if there is significant involvement of the major vessels of the gastrointestinal system, life-threatening sequelae, including perforation and bowel ischemia, may occur. This makes early and immediate management crucial to improve long-term morbidity and mortality. Diagnosis of various GI vasculitides often relies on correlation of clinical manifestations with pathology and additional investigations. This paper reviews the various vasculitides that affect the GI tract, including systemic lupus erythematosus, mixed connective tissue disease, Henoch Schönlein purpura, polyarteritis nodosa, Churg-Strauss syndrome, Wegener's granulomatosis, microscopic polyangiitis, enterocolic lymphocytic phlebitis, and Behcet's disease. Segmental arterial mediolysis, mistakenly believed to be a vasculitis, is also discussed. PMID:19891302

  20. Lanthanum-Induced Gastrointestinal Histiocytosis

    PubMed Central

    Araya, Hiwot; Longacre, Teri A.; Pasricha, Pankaj J.

    2015-01-01

    A patient with end-stage renal disease (ESRD) on hemodialysis presented with fever, anorexia, and nausea shortly after starting oral lanthanum carbonate for phosphate control. Gastric and duodenal biopsies demonstrated diffuse histiocytosis with intracellular aggregates of basophilic foreign material. Transmission electron microscopy, an underutilized diagnostic test, revealed the nature of the aggregates as heavy metal particles, consistent with lanthanum. Symptoms and histiocytosis improved after discontinuation of lanthanum. Lanthanum may be an underdiagnosed cause of gastrointestinal histiocytosis. PMID:26157959

  1. Role of wireless capsule endoscopy in the follow-up of inflammatory bowel disease

    PubMed Central

    Mitselos, Ioannis V; Christodoulou, Dimitrios K; Katsanos, Konstantinos H; Tsianos, Epameinondas V

    2015-01-01

    The introduction of wireless capsule endoscopy in 2000 has revolutionized our ability to visualize parts of the small bowel mucosa classically unreached by the conventional endoscope, and since the recent introduction of colon capsule endoscopy, a promising alternative method has been available for the evaluation of large bowel mucosa. The advantages of wireless capsule endoscopy include its non-invasive character and its ability to visualize proximal and distal parts of the intestine, while important disadvantages include the procedure’s inability of tissue sampling and significant incompletion rate. Its greatest limitation is the prohibited use in cases of known or suspected stenosis of the intestinal lumen due to high risk of retention. Wireless capsule endoscopy plays an important role in the early recognition of recurrence, on Crohn’s disease patients who have undergone ileocolonic resection for the treatment of Crohn’s disease complications, and in patients’ management and therapeutic strategy planning, before obvious clinical and laboratory relapse. Although capsule endoscopy cannot replace traditional endoscopy, it offers valuable information on the evaluation of intestinal disease and has a significant impact on disease reclassification of patients with a previous diagnosis of ulcerative colitis or inflammatory bowel disease unclassified/indeterminate colitis. Moreover, it may serve as an effective alternative where colonoscopy is contraindicated and in cases with incomplete colonoscopy studies. The use of patency capsule maximizes safety and is advocated in cases of suspected small or large bowel stenosis. PMID:26078832

  2. Value of screening endoscopy in evaluation of esophageal, gastric and colon cancers

    PubMed Central

    Ro, Tae H; Mathew, Michelle A; Misra, Subhasis

    2015-01-01

    Esophageal, gastric, and colorectal cancers are deadly diseases that continue to plague our world today. The value of screening endoscopy in evaluating these types of cancers is a critical area of discussion due to a potential reduction in morbidity and mortality. This article describes how to identify a good screening test and explains what are important criteria in the field of screening endoscopy. Furthermore, the current status and progress of screening endoscopy for esophageal, gastric, and colorectal cancer will be evaluated and discussed. Mass screening programs have not been implemented for esophageal and gastric carcinomas in those with average or low risk populations. However, studies of high-risk populations have found value and a cost-benefit in conducting screening endoscopy. Colorectal cancer, on the other hand, has had mass screening programs in place for many years due to the clear evidence of improved outcomes. As the role of endoscopy as a screening tool has continued to develop, newer technology and techniques have emerged to improve its utility. Many new image enhancement techniques and computer processing programs have shown promise and may have a significant role in the future of endoscopic screening. These developments are paving the way for improving the diagnostic and therapeutic capability of endoscopy in the field of gastroenterology. PMID:26361416

  3. Value of screening endoscopy in evaluation of esophageal, gastric and colon cancers.

    PubMed

    Ro, Tae H; Mathew, Michelle A; Misra, Subhasis

    2015-09-01

    Esophageal, gastric, and colorectal cancers are deadly diseases that continue to plague our world today. The value of screening endoscopy in evaluating these types of cancers is a critical area of discussion due to a potential reduction in morbidity and mortality. This article describes how to identify a good screening test and explains what are important criteria in the field of screening endoscopy. Furthermore, the current status and progress of screening endoscopy for esophageal, gastric, and colorectal cancer will be evaluated and discussed. Mass screening programs have not been implemented for esophageal and gastric carcinomas in those with average or low risk populations. However, studies of high-risk populations have found value and a cost-benefit in conducting screening endoscopy. Colorectal cancer, on the other hand, has had mass screening programs in place for many years due to the clear evidence of improved outcomes. As the role of endoscopy as a screening tool has continued to develop, newer technology and techniques have emerged to improve its utility. Many new image enhancement techniques and computer processing programs have shown promise and may have a significant role in the future of endoscopic screening. These developments are paving the way for improving the diagnostic and therapeutic capability of endoscopy in the field of gastroenterology. PMID:26361416

  4. Gastrointestinal manifestations of Behcet's disease.

    PubMed

    Bayraktar, Y; Ozaslan, E; Van Thiel, D H

    2000-03-01

    Behcet's disease (BD) is a multisystem, chronic, relapsing vasculitis of unknown origin that affects nearly all organs and systems. While recurrent oral ulcerations are a "sine qua non" of BD, the frequency of extra-oral parts of the gastrointestinal involvement varies widely in different countries. The most frequent extra-oral sites of gastrointestinal involvement are the ileocecal region and the colon. The liver (except with Budd-Chiari syndrome), pancreas, and spleen are rarely involved. The symptoms associated with these extra-oral manifestations of BD are abdominal pain, nausea, vomiting, diarrhea with or without blood, and constipation. The lesions typically are resistant to medical treatment and frequently recur with surgical treatment. We review the literature regarding the gastrointestinal and hepatobiliary systems in BD. Also, we present a patient who had BD complicated with radiologically-proven hepatic veins involvement (Budd-Chiari syndrome) and complete occlusion of hepatic portion of inferior vena cava and who had a good response to colchicine and penicillin treatment. PMID:10730919

  5. Diet and upper gastrointestinal malignancies.

    PubMed

    Abnet, Christian C; Corley, Douglas A; Freedman, Neal D; Kamangar, Farin

    2015-05-01

    Diet is believed to modulate cancer risk and this relationship has been widely studied in the gastrointestinal tract. Observational epidemiologic studies have provided most of the evidence about the effects of diet on cancer risk because clinical trials to determine nutritional exposures are often impossible, impractical, or unaffordable. Although a few foods or nutrients are thought to protect against specific types of cancer, it seems clear that the strength and even direction of dietary associations (increasing or decreasing risk) is organ-site- and even histology-specific, along the gastrointestinal tract. Although some hypotheses are supported by a substantial body of observational data (drinking hot maté [an infusion of the herb Ilex Paraguarensis] contributes to esophageal cancer), there are not much data to support others. We discuss some highly touted hypotheses and draw interim conclusions about what is known and what could be done to improve the level of evidence. The complex nature of diet and its associations can be productively investigated with disease-specific studies. However, public health recommendations for normal-risk individuals regarding diet and gastrointestinal cancer should probably emphasize the importance of eating for overall health rather than eating specific foods to reduce risk for specific cancers. PMID:25680671

  6. Interpretability of the PedsQL gastrointestinal symptoms scales and gastrointestinal worry scales in pediatric patients with functional and organic gastrointestinal diseases

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The present study investigates the clinical interpretability of the Pediatric Quality of Life Inventor (PedsQL) Gastrointestinal Symptoms Scales and Worry Scales in pediatric patients with functional gastrointestinal disorders or organic gastrointestinal diseases in comparison with healthy controls....

  7. A Novel Easy-to-Use Prediction Scheme for Upper Gastrointestinal Bleeding

    PubMed Central

    Hoffmann, Vera; Neubauer, Henrik; Heinzler, Julia; Smarczyk, Anna; Hellmich, Martin; Bowe, Andrea; Kuetting, Fabian; Demir, Muenevver; Pelc, Agnes; Schulte, Sigrid; Toex, Ullrich; Nierhoff, Dirk; Steffen, Hans-Michael

    2015-01-01

    Abstract Acute upper gastrointestinal bleeding (UGIB) is the leading indication for emergency endoscopy. Scoring schemes have been developed for immediate risk stratification. However, most of these scores include endoscopic findings and are based on data from patients with nonvariceal bleeding. The aim of our study was to design a pre-endoscopic score for acute UGIB—including variceal bleeding—in order to identify high-risk patients requiring urgent clinical management. The scoring system was developed using a data set consisting of 586 patients with acute UGIB. These patients were identified from the emergency department as well as all inpatient services at the University Hospital of Cologne within a 2-year period (01/2007–12/2008). Further data from a cohort of 322 patients who presented to our endoscopy unit with acute UGIB in 2009 served for external/temporal validation. Clinical, laboratory, and endoscopic parameters, as well as further data on medical history and medication were retrospectively collected from the electronic clinical documentation system. A multivariable logistic regression was fitted to the development set to obtain a risk score using recurrent bleeding, need for intervention (angiography, surgery), or death within 30 days as a composite endpoint. Finally, the obtained risk score was evaluated on the validation set. Only C-reactive protein, white blood cells, alanine-aminotransferase, thrombocytes, creatinine, and hemoglobin were identified as significant predictors for the composite endpoint. Based on the regression coefficients of these variables, an easy-to-use point scoring scheme (C-WATCH) was derived to estimate the risk of complications from 3% to 86% with an area under the curve (AUC) of 0.723 in the development set and 0.704 in the validation set. In the validation set, no patient in the identified low-risk group (0–1 points), but 38.7% of patients in the high-risk group (? 2 points) reached the composite endpoint. Our easy-to-use scoring scheme is able to distinguish high-risk patients requiring urgent endoscopy, from low-risk cases who are suitable candidates for outpatient management or in whom endoscopy may be postponed. Based on our findings, a prospective validation of the C-WATCH score in different patient populations outside the university hospital setting seems warranted. PMID:26402828

  8. Video capsule endoscopy: Perspectives of a revolutionary technique

    PubMed Central

    Bouchard, Simon; Ibrahim, Mostafa; Van Gossum, Andre

    2014-01-01

    Video capsule endoscopy (VCE) was launched in 2000 and has revolutionized direct endoscopic imaging of the gut. VCE is now a first-line procedure for exploring the small bowel in cases of obscure digestive bleeding and is also indicated in some patients with Crohn’s disease, celiac disease, and polyposis syndrome. A video capsule has also been designed for visualizing the esophagus in order to detect Barrett’s esophagus or esophageal varices. Different capsules are now available and differ with regard to dimensions, image acquisition rate, battery life, field of view, and possible optical enhancements. More recently, the use of VCE has been extended to exploring the colon. Within the last 5 years, tremendous developments have been made toward increasing the capabilities of the colon capsule. Although colon capsule cannot be proposed as a first-line colorectal cancer screening procedure, colon capsule may be used in patients with incomplete colonoscopy or in patients who are unwilling to undergo colonoscopy. In the near future, new technological developments will improve the diagnostic yield of VCE and broaden its therapeutic capabilities. PMID:25516644

  9. Imaging efficacy of a targeted imaging agent for fluorescence endoscopy

    NASA Astrophysics Data System (ADS)

    Healey, A. J.; Bendiksen, R.; Attramadal, T.; Bjerke, R.; Waagene, S.; Hvoslef, A. M.; Johannesen, E.

    2008-02-01

    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.

  10. Engineering Micromechanical Systems for the Next Generation Wireless Capsule Endoscopy

    PubMed Central

    Woods, Stephen; Constandinou, Timothy

    2015-01-01

    Wireless capsule endoscopy (WCE) enables the detection and diagnosis of inflammatory bowel diseases such as Crohn's disease and ulcerative colitis. However treatment of these pathologies can only be achieved through conventional means. This paper describes the next generation WCE with increased functionality to enable targeted drug delivery in the small intestinal tract. A prototype microrobot fabricated in Nylon 6 is presented which is capable of resisting peristaltic pressure through the deployment of an integrated holding mechanism and delivering targeted therapy. The holding action is achieved by extending an “anchor” spanning a 60.4?mm circumference, for an 11.0?mm diameter WCE. This function is achieved by a mechanism that occupies only 347.0?mm3 volume, including mechanics and actuator. A micropositioning mechanism is described which utilises a single micromotor to radially position and then deploy a needle 1.5?mm outside the microrobot's body to deliver a 1?mL dose of medication to a targeted site. An analysis of the mechanics required to drive the holding mechanism is presented and an overview of microactuators and the state of the art in WCE is discussed. It is envisaged that this novel functionality will empower the next generation of WCE to help diagnose and treat pathologies of the GI tract. PMID:26258143

  11. Capsule endoscopy in pediatrics: A 10-years journey

    PubMed Central

    Oliva, Salvatore; Cohen, Stanley A; Di Nardo, Giovanni; Gualdi, Gianfranco; Cucchiara, Salvatore; Casciani, Emanuele

    2014-01-01

    Video capsule endoscopy (CE) for evaluation the esophagus (ECE), small bowel (SBCE) and the colon (CCE) is particularly useful in pediatrics, because this imaging modality does not require ionizing radiation, deep sedation or general anesthesia. The risk of capsule retention appears to be dependent on indication rather than age and parallels the adult experience by indication, making SBCE a relatively safe procedure with a significant diagnostic yield. The newest indication, assessment of mucosal change, greatly enhances and expands its potential benefit. The diagnostic role of CE extends beyond the SB. The use of ECE also may enhance our knowledge of esophageal disease and assist patient care. Colon CCE is a novel minimally invasive and painless endoscopic technique allowing exploration of the colon without need for sedation, rectal intubation and gas insufflation. The limited data on ECE and CCE in pediatrics does not yet allow the same conclusions regarding efficacy; however, both appear to provide safe methods to assess and monitor mucosal change in their respective areas with little discomfort. Moreover, although experience has been limited, the patency capsule may help lessen the potential of capsule retention; and newly researched protocols for bowel cleaning may further enhance CE’s diagnostic yield. However, further research is needed to optimize the use of the various CE procedures in pediatric populations. PMID:25469028

  12. Classification of colon polyps in NBI endoscopy using vascularization features

    NASA Astrophysics Data System (ADS)

    Stehle, Thomas; Auer, Roland; Gross, Sebastian; Behrens, Alexander; Wulff, Jonas; Aach, Til; Winograd, Ron; Trautwein, Christian; Tischendorf, Jens

    2009-02-01

    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%.

  13. Towards active capsular endoscopy: preliminary results on a legged platform.

    PubMed

    Menciassi, Arianna; Stefanini, Cesare; Orlandi, Giovanni; Quirini, Marco; Dario, Paolo

    2006-01-01

    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

  14. Autoimmune disorders: gastrointestinal manifestations and endoscopic findings.

    PubMed

    Schneider, Alison; Merikhi, Afkhamossadat; Frank, Barbara B

    2006-01-01

    The gastrointestinal tract can be involved in many autoimmune disorders, and women are affected more than men in most of the disease processes discussed. As this article outlines, gastrointestinal manifestations can be either part of the clinical presentation or complications of treatment. Depending on the disease process and the severity of symptoms, gastrointestinal evaluation and treatment can have an important role in the management of these diseases. PMID:16546029

  15. Fluorescence spectroscopy of gastrointestinal tumors: in vitro studies and in vivo clinical applications

    NASA Astrophysics Data System (ADS)

    Angelova, L.; Borisova, E.; Zhelyazkova, Al.; Keremedchiev, M.; Vladimirov, B.; Avramov, L.

    2013-11-01

    The limitations of standard endoscopy for detection and evaluation of cancerous changes in the gastrointestinal tract (GIT) are significant challenges 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 levels of clinical applicability and diagnostic success. Fluorescence imaging has been one of the most promising technologies in this area. The technique is very topical with its practical application in intra-operative, image-guided resection of tumors, because it permits minimal surgery intervention and friendly therapeutic conditions. The investigations presented here are based on in vitro measurements of excitation-emission matrices (EEM) for GIT neoplasia and in vivo measurements in the frames of initial clinical trial for tumor fluorescence spectra detection, applied for introduction of spectroscopic diagnostic system for optical biopsy of GIT tumors in the daily clinical practice of the University Hospital "Queen Jiovanna - ISUL"- Sofia. Autofluorescence and exogenous fluorescence signals are detected from normal mucosa, inflammation, dysphasia and carcinoma and main spectral features are evaluated. The systems and methods developed for diagnosis and monitoring could open new dimensions in diagnostic and real-time tumor resection. This will make the entire procedure more personal, patient friendly and effective and will help for further understanding of the tumor nature.

  16. Role of hemostatic powders in the endoscopic management of gastrointestinal bleeding

    PubMed Central

    Bustamante-Balén, Marco; Plumé, Gema

    2014-01-01

    Acute gastrointestinal bleeding (AGIB) is a prevalent condition with significant influence on healthcare costs. Endoscopy is essential for the management of AGIB with a pivotal role in diagnosis, risk stratification and management. Recently, hemostatic powders have been added to our endoscopic armamentarium to treat gastrointestinal (GI) bleeding. These substances are intended to control active bleeding by delivering a powdered product over the bleeding site that forms a solid matrix with a tamponade function. Local activation of platelet aggregation and coagulation cascade may be also boosted. There are currently three powders commercially available: hemostatic agent TC-325 (Hemospray®), EndoClot™ polysaccharide hemostatic system, and Ankaferd Bloodstopper®. Although the available evidence is based on short series of cases and there is no randomized controlled trial yet, these powders seem to be effective in controlling GI bleeding from a variety of origins with a very favorable side effects profile. They can be used either as a primary therapy or a second-line treatment, and they seem to be especially indicated in cases of cancer-related bleeding and lesions with difficult access. In this review, we will comment on the mechanism of action, efficacy, safety and technical challenges of the use of powders in several clinical scenarios and we will try to define the main current indications of use and propose new lines of research in this area. PMID:25133029

  17. Review of Pure Endoscopic Full-Thickness Resection of the Upper Gastrointestinal Tract

    PubMed Central

    Mori, Hirohito; Kobara, Hideki; Nishiyama, Noriko; Fujihara, Shintaro; Masaki, Tsutomu

    2015-01-01

    Natural-orifice transluminal endoscopic surgery (NOTES) using flexible endoscopy has attracted attention as a minimally invasive surgical method that does not cause an operative wound on the body surface. However, minimizing the number of devices involved in endoscopic, compared to laparoscopic, surgeries has remained a challenge, causing endoscopic surgeries to gradually be phased out of use. If a flexible endoscopic full-thickness suturing device and a counter-traction device were developed to expand the surgical field for gastrointestinal-tract collapse, then endoscopic full-thickness resection using NOTES, which is seen as an extension of endoscopic submucosal dissection for full-thickness excision of tumors involving the gastrointestinal-tract wall, might become an extremely minimally invasive surgical method that could be used to resect only full-thickness lesions approached by the shortest distance via the mouth. It is expected that gastroenterological endoscopists will use this surgery if device development is advanced. This extremely minimally invasive surgery would have an immeasurable impact with regard to mitigating the burden on patients and reducing healthcare costs. Development of a new surgical method using a multipurpose flexible endoscope is therefore considered a socially urgent issue. PMID:26343069

  18. Cerenkov Luminescence Endoscopy: Improved Molecular Sensitivity with ??-Emitting Radiotracers

    PubMed Central

    Carpenter, Colin M.; Ma, Xiaowei; Liu, Hongguang; Sun, Conroy; Pratx, Guillem; Wang, Jing; Gambhir, Sanjiv S.; Xing, Lei; Cheng, Zhen

    2015-01-01

    Cerenkov luminescence endoscopy (CLE) is an optical technique that captures the Cerenkov photons emitted from highly energetic moving charged particles (?+ or ??) and can be used to monitor the distribution of many clinically available radioactive probes. A main limitation of CLE is its limited sensitivity to small concentrations of radiotracer, especially when used with a light guide. We investigated the improvement in the sensitivity of CLE brought about by using a ?? radiotracer that improved Cerenkov signal due to both higher ?-particle energy and lower ? noise in the imaging optics because of the lack of positron annihilation. Methods The signal-to-noise ratio (SNR) of 90Y was compared with that of 18F in both phantoms and small-animal tumor models. Sensitivity and noise characteristics were demonstrated using vials of activity both at the surface and beneath 1 cm of tissue. Rodent U87MG glioma xenograft models were imaged with radiotracers bound to arginine-glycine-aspartate (RGD) peptides to determine the SNR. Results ? noise from 18F was demonstrated by both an observed blurring across the field of view and a more pronounced fall-off with distance. A decreased ? background and increased energy of the ? particles resulted in a 207-fold improvement in the sensitivity of 90Y compared with 18F in phantoms. 90Y-bound RGD peptide produced a higher tumor-to-background SNR than 18F in a mouse model. Conclusion The use of 90Y for Cerenkov endoscopic imaging enabled superior results compared with an 18F radiotracer. PMID:25300598

  19. Cholangiocarcinoma and malignant bile duct obstruction: A review of last decades advances in therapeutic endoscopy

    PubMed Central

    Bertani, Helga; Frazzoni, Marzio; Mangiafico, Santi; Caruso, Angelo; Manno, Mauro; Mirante, Vincenzo Giorgio; Pigò, Flavia; Barbera, Carmelo; Manta, Raffaele; Conigliaro, Rita

    2015-01-01

    In the last decades many advances have been achieved in endoscopy, in the diagnosis and therapy of cholangiocarcinoma, however blood test, magnetic resonance imaging, computed tomography scan may fail to detect neoplastic disease at early stage, thus the diagnosis of cholangiocarcinoma is achieved usually at unresectable stage. In the last decades the role of endoscopy has moved from a diagnostic role to an invaluable therapeutic tool for patients affected by malignant bile duct obstruction. One of the major issues for cholangiocarcinoma is bile ducts occlusion, leading to jaundice, cholangitis and hepatic failure. Currently, endoscopy has a key role in the work up of cholangiocarcinoma, both in patients amenable to surgical intervention as well as in those unfit for surgery or not amenable to immediate surgical curative resection owing to locally advanced or advanced disease, with palliative intention. Endoscopy allows successful biliary drainage and stenting in more than 90% of patients with malignant bile duct obstruction, and allows rapid reduction of jaundice decreasing the risk of biliary sepsis. When biliary drainage and stenting cannot be achieved with endoscopy alone, endoscopic ultrasound-guided biliary drainage represents an effective alternative method affording successful biliary drainage in more than 80% of cases. The purpose of this review is to focus on the currently available endoscopic management options in patients with cholangiocarcinoma. PMID:26078827

  20. What's New in Gastrointestinal Stromal Tumor Research and Treatment?

    MedlinePLUS

    ... Topic Additional resources for gastrointestinal stromal tumor What’s new in gastrointestinal stromal tumor research and treatment? There ... GIST) Talking With Your Doctor After Treatment What`s New in Gastrointestinal Stromal Tumor (GIST) Research? Other Resources ...

  1. Gastrointestinal citrate absorption in nephrolithiasis

    NASA Technical Reports Server (NTRS)

    Fegan, J.; Khan, R.; Poindexter, J.; Pak, C. Y.

    1992-01-01

    Gastrointestinal absorption of citrate was measured in stone patients with idiopathic hypocitraturia to determine if citrate malabsorption could account for low urinary citrate. Citrate absorption was measured directly from recovery of orally administered potassium citrate (40 mEq.) in the intestinal lavage fluid, using an intestinal washout technique. In 7 stone patients citrate absorption, serum citrate levels, peak citrate concentration in serum and area under the curve were not significantly different from those of 7 normal subjects. Citrate absorption was rapid and efficient in both groups, with 96 to 98% absorbed within 3 hours. The absorption of citrate was less efficient from a tablet preparation of potassium citrate than from a liquid preparation, probably due to a delayed release of citrate from wax matrix. However, citrate absorption from solid potassium citrate was still high at 91%, compared to 98% for a liquid preparation. Thus, hypocitraturia is unlikely to be due to an impaired gastrointestinal absorption of citrate in stone patients without overt bowel disease.

  2. Gastrointestinal Behçet's disease: a review.

    PubMed

    Skef, Wasseem; Hamilton, Matthew J; Arayssi, Thurayya

    2015-04-01

    Behçet's disease (BD) is an idiopathic, chronic, relapsing, multi-systemic vasculitis characterized by recurrent oral and genital aphthous ulcers, ocular disease and skin lesions. Prevalence of BD is highest in countries along the ancient silk road from the Mediterranean basin to East Asia. By comparison, the prevalence in North American and Northern European countries is low. Gastrointestinal manifestations of Behçet's disease are of particular importance as they are associated with significant morbidity and mortality. Although ileocecal involvement is most commonly described, BD may involve any segment of the intestinal tract as well as the various organs within the gastrointestinal system. Diagnosis is based on clinical criteria - there are no pathognomonic laboratory tests. Methods for monitoring disease activity on therapy are available but imperfect. Evidence-based treatment strategies are lacking. Different classes of medications have been successfully used for the treatment of intestinal BD which include 5-aminosalicylic acid, corticosteroids, immunomodulators, and anti-tumor necrosis factor alpha monoclonal antibody therapy. Like inflammatory bowel disease, surgery is reserved for those who are resistant to medical therapy. A subset of patients have a poor disease course. Accurate methods to detect these patients and the optimal strategy for their treatment are not known at this time. PMID:25852265

  3. Gastrointestinal Behçet's disease: A review

    PubMed Central

    Skef, Wasseem; Hamilton, Matthew J; Arayssi, Thurayya

    2015-01-01

    Behçet’s disease (BD) is an idiopathic, chronic, relapsing, multi-systemic vasculitis characterized by recurrent oral and genital aphthous ulcers, ocular disease and skin lesions. Prevalence of BD is highest in countries along the ancient silk road from the Mediterranean basin to East Asia. By comparison, the prevalence in North American and Northern European countries is low. Gastrointestinal manifestations of Behçet’s disease are of particular importance as they are associated with significant morbidity and mortality. Although ileocecal involvement is most commonly described, BD may involve any segment of the intestinal tract as well as the various organs within the gastrointestinal system. Diagnosis is based on clinical criteria - there are no pathognomonic laboratory tests. Methods for monitoring disease activity on therapy are available but imperfect. Evidence-based treatment strategies are lacking. Different classes of medications have been successfully used for the treatment of intestinal BD which include 5-aminosalicylic acid, corticosteroids, immunomodulators, and anti-tumor necrosis factor alpha monoclonal antibody therapy. Like inflammatory bowel disease, surgery is reserved for those who are resistant to medical therapy. A subset of patients have a poor disease course. Accurate methods to detect these patients and the optimal strategy for their treatment are not known at this time. PMID:25852265

  4. Vasculitis and the gastrointestinal tract.

    PubMed

    Geboes, K; Dalle, I

    2002-01-01

    Vasculitis, defined as a non-infectious inflammatory disorder of blood vessels, can affect vessels of any type in any organ. The gastrointestinal (GI) tract may thus also be involved. In systemic disorders as mixed connective tissue disease (MCTD) and systemic lupus erythematodes (SLE), patients may present with symptoms of gastrointestinal disfunction such as motility disorders, caused by alterations in the connective tissue. True vasculitis however also occurs in the GI tract. Severe, occlusive damage often leads to ischemia that may result in ulceration and perforation. Non-occlusive vascular disease may lead to vascular leakage resulting in oedema and haemorrhage. Those patients often present with diarrhoea or symptoms of bleeding. GI involvement is frequent in Henoch-Schönlein purpura and also often noted in polyarteritis nodosa (PAN), microscopic polyangiitis, Wegener's syndrome and Churg-Strauss syndrome. Furthermore, GI vasculitis has also been described in giant cell arteritis, Takayasu's disease, Buerger's disease and leucocytoclastic vasculitides as essential mixed cryoglubulinemia, lupus vasculitis, rheumatoid disease, MCTD, drug-induced vasculitis and Behçet's disease. The diagnosis and classification of vasculitis relies upon a combination of clinical, serological, haematological, radiological and histological findings. Establishing a precise diagnosis can be difficult but is important because treatment and prognosis can be highly variable. PMID:12619427

  5. The Nervous System and Gastrointestinal Function

    ERIC Educational Resources Information Center

    Altaf, Muhammad A.; Sood, Manu R.

    2008-01-01

    The enteric nervous system is an integrative brain with collection of neurons in the gastrointestinal tract which is capable of functioning independently of the central nervous system (CNS). The enteric nervous system modulates motility, secretions, microcirculation, immune and inflammatory responses of the gastrointestinal tract. Dysphagia,…

  6. Diagnostic and therapeutic role of endoscopy in gastroenteropancreatic neuroendocrine neoplasms.

    PubMed

    Attili, Fabia; Capurso, Gabriele; Vanella, Giuseppe; Fuccio, Lorenzo; Delle Fave, Gianfranco; Costamagna, Guido; Larghi, Alberto

    2014-01-01

    Gastroenteropancreatic neuroendocrine neoplasms have substantially increased over the last decades. Because of the indolent clinical course of the disease even in advance stages and the rise in the incidental diagnosis of small asymptomatic lesions, the prevalence of gastroenteropancreatic neuroendocrine neoplasms is higher than that of pancreatic, gastric and oesophageal adenocarcinomas, making them the second most prevalent cancer type of the gastrointestinal tract. This increase in the overall prevalence of gastroenteropancreatic neuroendocrine neoplasms has been paralleled by a growth in the importance of the endoscopist in the care of these patients, who usually require a multidisciplinary approach. In this manuscript the diagnostic and therapeutic role of endoscopic for gastroenteropancreatic neuroendocrine neoplasms will be reviewed. PMID:23731843

  7. Colon Capsule Endoscopy for the Detection of Colorectal Polyps: An Economic Analysis

    PubMed Central

    Palimaka, Stefan; Blackhouse, Gord; Goeree, Ron

    2015-01-01

    Background Colorectal cancer is a leading cause of mortality and morbidity in Ontario. Most cases of colorectal cancer are preventable through early diagnosis and the removal of precancerous polyps. Colon capsule endoscopy is a non-invasive test for detecting colorectal polyps. Objectives The objectives of this analysis were to evaluate the cost-effectiveness and the impact on the Ontario health budget of implementing colon capsule endoscopy for detecting advanced colorectal polyps among adult patients who have been referred for computed tomographic (CT) colonography. Methods We performed an original cost-effectiveness analysis to assess the additional cost of CT colonography and colon capsule endoscopy resulting from misdiagnoses. We generated diagnostic accuracy data from a clinical evidence-based analysis (reported separately), and we developed a deterministic Markov model to estimate the additional long-term costs and life-years lost due to false-negative results. We then also performed a budget impact analysis using data from Ontario administrative sources. One-year costs were estimated for CT colonography and colon capsule endoscopy (replacing all CT colonography procedures, and replacing only those CT colonography procedures in patients with an incomplete colonoscopy within the previous year). We conducted this analysis from the payer perspective. Results Using the point estimates of diagnostic accuracy from the head-to-head study between colon capsule endoscopy and CT colonography, we found the additional cost of false-positive results for colon capsule endoscopy to be $0.41 per patient, while additional false-negatives for the CT colonography arm generated an added cost of $116 per patient, with 0.0096 life-years lost per patient due to cancer. This results in an additional cost of $26,750 per life-year gained for colon capsule endoscopy compared with CT colonography. The total 1-year cost to replace all CT colonography procedures with colon capsule endoscopy in Ontario is about $2.72 million; replacing only those CT colonography procedures in patients with an incomplete colonoscopy in the previous year would cost about $740,600 in the first year. Limitations The difference in accuracy between colon capsule endoscopy and CT colonography was not statistically significant for the detection of advanced adenomas (? 10 mm in diameter), according to the head-to-head clinical study from which the diagnostic accuracy was taken. This leads to uncertainty in the economic analysis, with results highly sensitive to changes in diagnostic accuracy. Conclusions The cost-effectiveness of colon capsule endoscopy for use in patients referred for CT colonography is $26,750 per life-year, assuming an increased sensitivity of colon capsule endoscopy. Replacement of CT colonography with colon capsule endoscopy is associated with moderate costs to the health care system. PMID:26366240

  8. Virtual endoscopy-a new assessment tool in difficult airway management.

    PubMed

    Ahmad, I; Millhoff, B; John, M; Andi, K; Oakley, R

    2015-09-01

    Preemptive mapping of the airway is a useful adjunct to conventional clinical assessments when airway management planning for patients with complex head and neck pathology. Nasendoscopy is frequently used for this purpose but is also invasive and poorly tolerated in a subset of patients and, even in expert hands, may not allow complete visualization of the glottis and subglottic structures. We present a novel tool for difficult airway management planning in the form of virtual endoscopy by applying free online OsiriX software to head and neck computed tomographic scans to generate a "fly-through" airway reconstruction. To highlight how well virtual endoscopy correlates to conventional fibreoscopy, we compare both of these assessment tools in 3 patients with glottic, subglottic, and multilevel airway pathologies. Virtual endoscopy represents a unique, noninvasive, safe, and accurate airway assessment and educational resource, which warrants further exploration. PMID:26229015

  9. Cooperative laparoscopic endoscopic and hybrid laparoscopic surgery for upper gastrointestinal tumors: Current status

    PubMed Central

    Ntourakis, Dimitrios; Mavrogenis, Georgios

    2015-01-01

    AIM: To investigate the cooperative laparoscopic and endoscopic techniques used for the resection of upper gastrointestinal tumors. METHODS: A systematic research of the literature was performed in PubMed for English and French language articles about laparoscopic and endoscopic cooperative, combined, hybrid and rendezvous techniques. Only original studies using these techniques for the resection of early gastric cancer, benign tumors and gastrointestinal stromal tumors of the stomach and the duodenum were included. By excluding case series of less than 10 patients, 25 studies were identified. The study design, number of cases, tumor pathology size and location, the operative technique name, the endoscopy team and surgical team role, operative time, type of closure of visceral wall defect, blood loss, complications and length of hospital stay of these studies were evaluated. Additionally all cooperative techniques found were classified and are presented in a systematic approach. RESULTS: The studies identified were case series and retrospective cohort studies. A total of 706 patients were operated on with a cooperative technique. The tumors resected were only gastrointestinal stromal tumors (GIST) in 4 studies, GIST and various benign submucosal tumors in 22 studies, early gastric cancer (pT1a and pT1b) in 6 studies and early duodenal cancer in 1 study. There was important heterogeneity between the studies. The operative techniques identified were: laparoscopic assisted endoscopic resection, endoscopic assisted wedge resection, endoscopic assisted transgastric and intragastric surgery, laparoscopic endoscopic cooperative surgery (LECS), laparoscopic assisted endoscopic full thickness resection (LAEFR), clean non exposure technique and non-exposed endoscopic wall-inversion surgery (NEWS). Each technique is illustrated with the roles of the endoscopic and laparoscopic teams; the indications, characteristics and short term results are described. CONCLUSION: Along with the traditional cooperative techniques, new procedures like LECS, LAEFR and NEWS hold great promise for the future of minimally invasive oncologic procedures. PMID:26604655

  10. Role of Endoscopy in Diagnosis and Management of Pediatric Eosinophilic Esophagitis.

    PubMed

    Muir, Amanda B; Merves, Jamie; Liacouras, Chris A

    2016-01-01

    Eosinophilic esophagitis (EoE) is a chronic allergic (immune-mediated) disease that leads to esophageal dysfunction and feeding disorders in children. Foods, and possibly environmental triggers, cause an inflammatory response in the esophagus, leading to esophageal inflammation, eosinophilic infiltration, and esophageal dysmotility, which may progress to dysphagia, food impaction, and esophageal stricture. Endoscopy with biopsy and histologic evaluation is currently the only method to diagnose EoE. Once diagnosed with EoE, children undergo follow-up endoscopy after therapy initiation and adjustments to ensure remission. Furthermore, children with food impactions or strictures may require endoscopic intervention such as foreign body removal and/or esophageal dilation. PMID:26616904

  11. Antimicrobial Peptides in Gastrointestinal Inflammation

    PubMed Central

    Jäger, Simon; Stange, Eduard F.; Wehkamp, Jan

    2010-01-01

    Acute and chronic inflammations of mucosal surfaces are complex events in which the effector mechanisms of innate and adaptive immune systems interact with pathogenic and commensal bacteria. The role of constitutive and inducible antimicrobial peptides in intestinal inflammation has been investigated thoroughly over the recent years, and their involvement in various disease states is expanded ever more. Especially in the intestines, a critical balance between luminal bacteria and the antimicrobial peptides is essential, and a breakdown in barrier function by impaired production of defensins is already implicated in Crohn's disease. In this paper, we focus on the role of antimicrobial peptides in inflammatory processes along the gastrointestinal tract, while considering the resident and pathogenic flora encountered at the specific sites. The role of antimicrobial peptides in the primary events of inflammatory bowel diseases receives special attention. PMID:21151692

  12. Microbial biofilms and gastrointestinal diseases

    PubMed Central

    von Rosenvinge, Erik C.; O’May, Graeme A.; Macfarlane, Sandra; Macfarlane, George T.; Shirtliff, Mark E.

    2014-01-01

    The majority of bacteria live not planktonically, but as residents of sessile biofilm communities. Such populations have been defined as ‘matrix-enclosed microbial accretions, which adhere to both biological and nonbiological surfaces’. Bacterial formation of biofilm is implicated in many chronic disease states. Growth in this mode promotes survival by increasing community recalcitrance to clearance by host immune effectors and therapeutic antimicrobials. The human gastrointestinal (GI) tract encompasses a plethora of nutritional and physicochemical environments, many of which are ideal for biofilm formation and survival. However, little is known of the nature, function, and clinical relevance of these communities. This review summarizes current knowledge of the composition and association with health and disease of biofilm communities in the GI tract. PMID:23620117

  13. Visceral Pain and Gastrointestinal Microbiome

    PubMed Central

    Chichlowski, Maciej; Rudolph, Colin

    2015-01-01

    A complex set of interactions between the microbiome, gut and brain modulate responses to visceral pain. These interactions occur at the level of the gastrointestinal mucosa, and via local neural, endocrine or immune activity; as well as by the production of factors transported through the circulatory system, like bacterial metabolites or hormones. Various psychological, infectious and other stressors can disrupt this harmonious relationship and alter both the microbiome and visceral pain responses. There are critical sensitive periods that can impact visceral pain responses in adulthood. In this review we provide a brief background of the intestinal microbiome and emerging concepts of the bidirectional interactions between the microbiome, gut and brain. We also discuss recent work in animal models, and human clinical trials using prebiotics and probiotics that alter the microbiome with resultant alterations in visceral pain responses. PMID:25829337

  14. Automatic detection of informative frames from wireless capsule endoscopy images.

    PubMed

    Bashar, M K; Kitasaka, T; Suenaga, Y; Mekada, Y; Mori, K

    2010-06-01

    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 frames that are highly contaminated by turbid fluids, faecal materials and/or residual foods. These materials and fluids are presented in a wide range of colors, from brown to yellow, and/or have bubble-like texture patterns. The detection scheme therefore consists of two steps: isolating (Step-1) highly contaminated non-bubbled (HCN) frames and (Step-2) significantly bubbled (SB) frames. Two color representations, viz., local color moments in Ohta space and the HSV color histogram, are attempted to characterize HCN frames, which are isolated by a support vector machine (SVM) classifier in Step-1. The rest of the frames go to Step-2, where a Gauss Laguerre transform (GLT) based multiresolution texture feature is used to characterize the bubble structures in WCE frames. GLT uses Laguerre Gauss circular harmonic functions (LG-CHFs) to decompose WCE images into multiresolution components. An automatic method of segmentation was designed to extract bubbled regions from grayscale versions of the color images based on the local absolute energies of their CHF responses. The final informative frames were detected by using a threshold on the segmented regions. An automatic procedure for selecting features based on analyzing the consistency of the energy-contrast map is also proposed. Three experiments, two of which use 14,841 and 37,100 frames from three videos and the rest uses 66,582 frames from six videos, were conducted for justifying the proposed method. The two combinations of the proposed color and texture features showed excellent average detection accuracies (86.42% and 84.45%) with the final experiment, when compared with the same color features followed by conventional Gabor-based (78.18% and 76.29%) and discrete wavelet-based (65.43% and 63.83%) texture features. Although intra-video training-testing cases are typical choices for supervised classification in Step-1, combining a suitable number of training sets using a subset of the input videos was shown to be possible. This mixing not only reduced computation costs but also produced better detection accuracies by minimizing visual-selection errors, especially when processing large numbers of WCE videos. PMID:20137998

  15. Endoprobe: A system for radionuclide-guided endoscopy

    SciTech Connect

    Raylman, Raymond R.; Srinivasan, Amarnath

    2004-12-01

    Methods to guide the surgical treatment of cancer utilizing handheld beta-sensitive probes in conjunction with tumor-avid radiopharmaceuticals [such as {sup 18}F-fluorodeoxyglucose (FDG)] have previously been developed. These technologies could also potentially be used to assist in minimally invasive techniques for the diagnosis of cancer. The goal of this project is to develop and test a system for performing radionuclide-guided endoscopies. This system (called Endoprobe) has four major subsystems: beta detector, position tracker, endoscope, and user interface. The beta detection unit utilizes two miniaturized solid state detectors to preferentially detect beta particles. The position tracking system allows real-time monitoring of the unit's location. The beta detector and position tracking system's receiver are mounted on the tip of an endoscope. Information from the beta detector and tracking system, in addition to the video signal from the endoscope, are combined and presented to the user via a computer interface. The system was tested in a simulated search for radiotracer-avid areas of esophageal cancer. The search for esophageal cancer was chosen because this type of cancer is often diagnosed with endoscopic procedures and has been reported to have good affinity for FDG. Accumulations of FDG in the normal organs of the abdomen were simulated by an anthropomorphic torso phantom filled with the appropriate amounts of radioactivity. A 1.5-mm-thick gelatin film containing FDG was used to simulate radiotracer uptake in the lining of normal esophagus. Esophageal lesions (both benign and malignant) were simulated by thin disks of gelatin (diameters=3.5-12 mm) containing appropriate concentrations of FDG embedded in the gelatin film simulating normal esophagus. Endoprobe facilitated visual identification and examination of the simulated lesions. The position tracking system permitted the location of the Endoprobe tip to be monitored and plotted in real time on a previously acquired positron emission tomography-computed tomography (PET-CT) image of the phantom. The detection system successfully acquired estimates of the beta flux emitted from areas chosen by the user. Indeed, Endoprobe was able to assist in distinguishing simulated FDG-avid areas as small as 3.5 mm in diameter from normal esophagus (p value <0.025). In addition to FDG, Endoprobe can be used with other positron or electron-emitting radionuclides such as {sup 11}C or {sup 131}I. The next phase of this project will focus on modification of the prototype to make it more suitable for clinical use.

  16. Solitary fibrous tumor of the greater omentum, mimicking gastrointestinal stromal tumor of the small intestine: a case report.

    PubMed

    Urabe, Masayuki; Yamagata, Yukinori; Aikou, Susumu; Mori, Kazuhiko; Yamashita, Hiroharu; Nomura, Sachiyo; Shibahara, Junji; Fukayama, Masashi; Seto, Yasuyuki

    2015-05-01

    Solitary fibrous tumor (SFT) is one of the mesenchymal tumors, which rarely arises in the abdominal space. We report a very rare case of abdominal SFT, mimicking another mesenchymal tumor. A 52-year-old Japanese man was referred to our hospital for further evaluation and treatment of gallbladder polyp. Contrast-enhanced computed tomography (CT) showed an enhanced nodule within the gallbladder, and incidentally, also showed a well-circumscribed mass adjacent to the small intestine. The mass was depicted as slightly high density in plain CT, and with contrast-enhancement, the mass was partially stained in early phase and the stained area spread heterogeneously in delayed phase. Magnetic resonance imaging showed that the abdominal mass was depicted as slightly high intensity on T2-weighted imaging and low intensity on T1-weighted imaging. With double-balloon endoscopy and capsule endoscopy, we did not find any tumor inside the small intestine. These visual findings lead us to diagnose it as gastrointestinal stromal tumor of the small intestine with extraluminal growth. We planned to resect both the gallbladder polyp and the intraperitoneal tumor at the same time for pathologic diagnosis and treatment. When the operation was performed, we found a milk-white lobulated tumor on the greater omentum and the tumor was entirely resected. Microscopically, the gallbladder polyp was diagnosed as tubular adenoma, and the omental tumor was diagnosed as SFT. It is important to bear in mind that omental SFTs sometimes mimic other mesenchymal tumors and should be included in the differential diagnosis of abdominal tumor not revealed by endoscopy. PMID:26011203

  17. Rare gastrointestinal lymphomas: The endoscopic investigation

    PubMed Central

    Vetro, Calogero; Bonanno, Giacomo; Giulietti, Giorgio; Romano, Alessandra; Conticello, Concetta; Chiarenza, Annalisa; Spina, Paolo; Coppolino, Francesco; Cunsolo, Rosario; Raimondo, Francesco Di

    2015-01-01

    Gastrointestinal lymphomas represent up to 10% of gastrointestinal malignancies and about one third of non-Hodgkin lymphomas. The most prominent histologies are mucosa-associated lymphoid tissue lymphoma and diffuse large B-cell lymphoma. However, the gastrointestinal tract can be the site of rarer lymphoma subtypes as a primary or secondary localization. Due to their rarity and the multifaceted histology, an endoscopic classification has not been validated yet. This review aims to analyze the endoscopic presentation of rare gastrointestinal lymphomas from disease diagnosis to follow-up, according to the involved site and lymphoma subtype. Existing, new and emerging endoscopic technologies have been examined. In particular, we investigated the diagnostic, prognostic and follow-up endoscopic features of T-cell and natural killer lymphomas, lymphomatous polyposis and mantle cell lymphoma, follicular lymphoma, plasma cell related disease, gastrointestinal lymphomas in immunodeficiency and Hodgkin’s lymphoma of the gastrointestinal tract. Contrarily to more frequent gastrointestinal lymphomas, data about rare lymphomas are mostly extracted from case series and case reports. Due to the data paucity, a synergism between gastroenterologists and hematologists is required in order to better manage the disease. Indeed, clinical and prognostic features are different from nodal and extranodal or the bone marrow (in case of plasma cell disease) counterpart. Therefore, the approach should be based on the knowledge of the peculiar behavior and natural history of disease. PMID:26265987

  18. Different roles of capsule endoscopy and double-balloon enteroscopy in obscure small intestinal diseases

    PubMed Central

    Zhang, Zhi-Hong; Qiu, Chun-Hua; Li, Yi

    2015-01-01

    AIM: To compare the roles of capsule endoscopy (CE) and double-balloon enteroscopy (DBE) in the diagnosis of obscure small bowel diseases. METHODS: From June 2009 to December 2014, 88 patients were included in this study; the patients had undergone gastroscopy, colonoscopy, radiological small intestinal barium meal, abdominal computed tomography or magnetic resonance imaging scan and mesenteric angiography, but their diagnoses were still unclear. The patients with gastrointestinal obstructions, fistulas, strictures, or cardiac pacemakers, as well as pregnant women, and individuals who could not accept the capsule-retention or capsule-removal surgery were excluded. Patients with heart, lung and other vital organ failure diseases were also excluded. Everyone involved in this study had undergone CE and DBE. The results were divided into: (1) the definite diagnosis (the diagnosis was confirmed at least by one of the biopsy, surgery, pathology or the drug treatment effects with follow-up for at least 3 mo); (2) the possible diagnosis (a possible diagnosis was suggested by CE or DBE, but not confirmed by the biopsy, surgery or follow-up drug treatment effects); and (3) the unclear diagnosis (no exact causes were provided by CE and DBE for the disease). The detection rate and the diagnostic yield of the two methods were compared. The difference in the etiologies between CE and DBE was estimated, and the different possible etiologies caused by the age groups were also investigated. RESULTS: CE exhibited a better trend than DBE for diagnosing scattered small ulcers (P = 0.242, Fisher’s test), and small vascular malformations (?2 = 1.810, P = 0.179, Pearson ?2 test), but with no significant differences, possible due to few cases. However, DBE was better than CE for larger tumors (P = 0.018, Fisher’s test) and for diverticular lesions with bleeding ulcers (P = 0.005, Fisher’s test). All three hemangioma cases diagnosed by DBE in this study (including sponge hemangioma, venous hemangioma, and hemangioma with hamartoma lesions) were all confirmed by biopsy. Two parasite cases were found by CE, but were negative by DBE. This study revealed no obvious differences in the detection rates (DR) of CE (60.0%, 53/88) and DBE (59.1%, 52/88). However, the etiological diagnostic yield (DY) difference was apparent. The CE diagnostic yield was 42.0% (37/88), and the DBE diagnostic yield was 51.1% (45/88). Furthermore, there were differences among the age groups (?2 = 22.146, P = 0.008, Kruskal Wallis Test). Small intestinal cancer (5/6 cases), vascular malformations (22/29 cases), and active bleeding (3/4 cases) appeared more commonly in the patients over 50 years old, but diverticula with bleeding ulcers were usually found in the 15-25-year group (4/7cases). The over-25-year group accounted for the stromal tumors (10/12 cases). CONCLUSION: CE and DBE each have their own advantages and disadvantages. The appropriate choice depends on the patient’s age, tolerance, and clinical manifestations. Sometimes CE followed by DBE is necessary. PMID:26109818

  19. Evaluation of nasogastric tubes to enable differentiation between upper and lower gastrointestinal bleeding in unselected patients with melena.

    PubMed

    Kessel, Boris; Olsha, Oded; Younis, Aurwa; Daskal, Yaakov; Granovsky, Emil; Alfici, Ricardo

    2016-02-01

    Gastrointestinal (GI) bleeding is a common surgical problem. The aim of this study was to evaluate how insertion of the nasogastric tube may enable differentiation between upper and lower GI bleeding in patients with melena. A retrospective study involving patients admitted to our surgery division with a melena was carried out between the years 2010 and 2012. A total of 386 patients were included in the study. Of these, 279 (72.2%) patients had negative nasogastric aspirate. The sensitivity of examination of nasogastric aspirate to establish the upper GI as the source of bleeding was only 28% and the negative predictive value of a negative nasogastric aspirate was less than 1%. Most patients who initially presented with melena and were found to have upper GI bleeding had a negative nasogastric aspirate. Insertion of a nasogastric tube does not affect the clinical decision to perform upper endoscopy and should not be routinely carried out. PMID:25747792

  20. Importance of Heparin Provocation and SPECT/CT in Detecting Obscure Gastrointestinal Bleeding on 99mTc-RBC Scintigraphy

    PubMed Central

    Haghighatafshar, Mahdi; Gheisari, Farshid; Ghaedian, Tahereh

    2015-01-01

    Abstract We presented a pediatric case with a history of intermittent melena for 3 years because of angiodyplasia of small intestine. The results of frequent upper gastrointestinal endoscopies and colonoscopies as well as both 99mTc-red blood cell (RBC) and Meckel's scintigraphies for several times were negative in detection of bleeding site. However, 99mTc-RBC scintigraphy with single-photon emission computed tomography (SPECT)/computed tomography (CT) after heparin augmentation detected a site of bleeding in the distal ileum which later was confirmed during surgery with final diagnosis of angiodysplasia. It could be stated that heparin provocation of bleeding before 99mTc-RBC scintigraphy accompanied by fused SPECT/CT images should be kept in mind for management of intestinal bleeding especially in difficult cases. PMID:26313771

  1. Immunohistochemical features of the gastrointestinal tract tumors

    PubMed Central

    Wong, Hannah H.

    2012-01-01

    Gastrointestinal tract tumors include a wide variety of vastly different tumors and on a whole are one of the most common malignancies in western countries. These tumors often present at late stages as distant metastases which are then biopsied and may be difficult to differentiate without the aid of immunohistochemical stains. With the exception of pancreatic and biliary tumors where there are no distinct immunohistochemical patterns, most gastrointestinal tumors can be differentiated by their unique immunohistochemical profile. As the size of biopsies decrease, the role of immunohistochemical stains will become even more important in determining the origin and differentiation of gastrointestinal tract tumors. PMID:22943017

  2. Accuracy of faecal occult blood test and Helicobacter pylori stool antigen test for detection of upper gastrointestinal lesions

    PubMed Central

    Lee, Yi-Chia; Chiu, Han-Mo; Chiang, Tsung-Hsien; Yen, Amy Ming-Fang; Chiu, Sherry Yueh-Hsia; Chen, Sam Li-Sheng; Fann, Jean Ching-Yuan; Yeh, Yen-Po; Liao, Chao-Sheng; Hu, Tsung-Hui; Tu, Chia-Hung; Tseng, Ping-Huei; Chen, Chien-Chuan; Chen, Mei-Jyh; Liou, Jyh-Ming; Liao, Wei-Chih; Lai, Yo-Ping; Wang, Chen-Ping; Ko, Jenq-Yuh; Wang, Hsiu-Po; Chiang, Hung; Lin, Jaw-Town; Chen, Hsiu-Hsi; Wu, Ming-Shiang

    2013-01-01

    Objective Highly sensitive guaiac-based faecal occult blood (Hemoccult SENSA) and Helicobacter pylori stool antigen testing might help detect upper gastrointestinal lesions when appended to a colorectal cancer screening programme with faecal immunochemical testing. We evaluated the diagnostic accuracies of two stool tests in detecting upper gastrointestinal lesions. Design Cross-sectional design. Setting Hospital-based and community-based screening settings. Participants A hospital-based deviation cohort of 3172 participants to evaluate test performance and a community-based validation cohort of 3621 to verify the findings. Interventions Three types of stool tests with bidirectional endoscopy as the reference standard. Outcomes Sensitivity, specificity and positive and negative likelihood ratios. Results For detecting upper gastrointestinal lesions in cases with negative immunochemical tests, the sensitivity, specificity, and positive and negative likelihood ratios of the guaiac-based and H pylori antigen tests were 16.3% (95% CI 13.3% to 19.8%), 90.1% (88.9% to 91.2%), 1.64 (1.31 to 2.07), and 0.93 (0.89 to 0.97), respectively, and 52.5% (48.1% to 56.9%), 80.6% (79.0% to 82.1%), 2.71 (2.41 to 3.04) and 0.59 (0.54 to 0.65), respectively. For detecting upper gastrointestinal lesions in cases with normal colonoscopy, the results of the guaiac-based and H pylori antigen tests were 17.9% (14.8% to 21.5%), 90.1% (88.9% to 91.2%), 1.81 (1.45 to 2.26) and 0.91 (0.87 to 0.95), respectively, and 53.1% (48.6% to 57.4%), 80.7% (79.1% to 82.2%), 2.75 (2.45 to 3.08) and 0.58 (0.53 to 0.64), respectively. Within the community, positive predictive values of the immunochemical and H pylori antigen tests were 36.0% (26.0% to 46.0%) and 31.9% (28.3% to 35.5%), respectively, for detecting lower and upper gastrointestinal lesions, which were similar to expected values. Conclusions The H pylori stool antigen test is more accurate than the guaiac-based test in the screening of upper gastrointestinal lesions in a population with high prevalence of H pylori infection and upper gastrointestinal lesions. It is applicable to add the H pylori antigen test to the immunochemical test for pan detection. Trial registration NCT01341197 (ClinicalTrial.gov). PMID:24176798

  3. Wireless powered capsule endoscopy for colon diagnosis and treatment.

    PubMed

    Chen, Wenwen; Yan, Guozheng; He, Shu; Ke, Quan; Wang, Zhiwu; Liu, Hua; Jiang, Pingping

    2013-11-01

    This paper presents a wireless power transfer system integrated with an active locomotion and biopsy module in an endoscopic capsule for colon inspection. The capsule, which can move automatically, is designed for non-invasive biopsy and visual inspection of the intestine. To supply enough power for multiple functions and ensure safety for the human body, the efficiency of the current power transmission system needs to be improved. To take full advantage of the volume in the capsule body, a novel structure of receiving coils wound on a multi-core of MnZn ferrite hollow cylinder was used; with this new core, the efficiency increased to more than 7.98%. Up to 1.4 W of dc power can be delivered to the capsule as it travels along the gastrointestinal tract. Three micro motors were integrated for pumping, anchoring, locomotion and biopsy. A user interface and RF communication enables the operator to drive the capsule in an intuitive manner. To gauge the efficacy of the wireless power supply in a simulated real-world application, the biopsy and locomotion capabilities of the device were successfully tested in a slippery, soft tube and gut environment in vitro. PMID:24149981

  4. Clinical Outcome of Acute Upper Gastrointestinal Hemorrhage among Patients Admitted to a Government Hospital in Egypt

    PubMed Central

    Gado, Ahmed S.; Ebeid, Basel A.; Abdelmohsen, Aida M.; Axon, Anthony T.

    2012-01-01

    Background/Aim: Acute upper gastrointestinal hemorrhage (AUGIH) is a life-threatening emergency that results in high morbidity and mortality. The mortality rate varies between 4% and 14%. The aim of the study was to determine the clinical outcome of AUGIH among patients admitted to a government hospital in Egypt. Patients and Methods: This was a cross-sectional hospital-based study performed in 1000 patients presenting with AUGIH over a 7-year period between January 2004 and January 2011. Results: One thousand patients were analyzed. Fifty-four percent were male. Mean age was 52 ± 17 years. Eighty-eight percent were emergency admissions and 12% were inpatients at the time of bleeding. At presentation 68% had major comorbidity and 50% had liver disease. Seven hundred and twenty-four patients (72%) underwent endoscopy. Bleeding varices accounted for 31% of AUGIH and peptic ulcer 28%. Two hundred and thirty-two patients had endoscopically diagnosed bleeding varices or peptic ulcer with a visible vessel or active bleeding. These received endoscopic therapy. Initial hemostasis was achieved in 207 (89%). Thirteen patients (6%) had therapy at a subsequent endoscopy for further bleeding. Surgery was performed on 9 patients (0.9%) with AUGIH. Complications were reported in 70 patients (7%) mainly liver failure (4%). Six hundred and eighty-four patients (68%) were discharged improved, 162 (16%) left hospital without a diagnosis and 4 (0.4%) were referred to another facility. The overall mortality was 15%. Mortality was 24% in patients ?60 years, 37% among inpatients, and 21% in those who had a major comorbidity. Mortality was 22% in patients who had liver disease and 9% in variceal bleeding. Conclusion: The most common cause of AUGIH was variceal in origin. Endoscopic therapy was successful in most cases. Mortality after AUGIH was particularly high among elderly patients, inpatients, and patients who had a major comorbidity, liver disease, and variceal bleeding. PMID:22249090

  5. Analysis of bias voltage dependent spectral response in Ga{sub 0.51}In{sub 0.49}P/Ga{sub 0.99}In{sub 0.01}As/Ge triple junction solar cell

    SciTech Connect

    Sogabe, Tomah Ogura, Akio; Okada, Yoshitaka

    2014-02-21

    Spectral response measurement plays great role in characterizing solar cell device because it directly reflects the efficiency by which the device converts the sunlight into an electrical current. Based on the spectral response results, the short circuit current of each subcell can be quantitatively determined. Although spectral response dependence on wavelength, i.e., the well-known external quantum efficiency (EQE), has been widely used in characterizing multijunction solar cell and has been well interpreted, detailed analysis of spectral response dependence on bias voltage (SR ?V{sub bias}) has not been reported so far. In this work, we have performed experimental and numerical studies on the SR??V{sub bias} for Ga{sub 0.51}In{sub 0.49}P/Ga{sub 0.99}In{sub 0.01}As/Ge triple junction solar cell. Phenomenological description was given to clarify the mechanism of operation matching point variation in SR??V{sub bias} measurements. The profile of SR?V{sub bias} curve was explained in detail by solving the coupled two-diode current-voltage characteristic transcend formula for each subcell.

  6. ORIGINAL ARTICLE: Clinical Endoscopy Does cancer risk affect health-related quality of life in patients

    E-print Network

    Hastie, Trevor

    ORIGINAL ARTICLE: Clinical Endoscopy Does cancer risk affect health-related quality of life. Goldstein, MD, MS Stanford and Palo Alto, California, USA Background: Health-related quality of life-state utility values, quality of life in reflux and dyspepsia (QOLRAD), and Medical Outcomes Survey short form

  7. Technology insight: confocal laser endoscopy for in vivo diagnosis of colorectal cancer.

    PubMed

    Kiesslich, Ralf; Goetz, Martin; Vieth, Michael; Galle, Peter R; Neurath, Markus F

    2007-08-01

    Recent studies on a novel technology, denoted confocal laser endomicroscopy (CLE), have altered thinking about the possibilities of endoscopy in the diagnosis and treatment of colorectal cancer. CLE is a new endoscopic tool that allows in vivo histology at subcellular resolution during ongoing endoscopy, and permits subsurface imaging of normal and neoplastic human mucosa. This new technique has unequivocal major implications for the diagnosis and clinical management of patients scheduled for screening or surveillance colonoscopy for colorectal cancer. For instance, CLE allows immediate diagnosis of colonic neoplasias, and the detection of neoplastic cells helps to target endoscopic intervention to relevant areas. Furthermore, the combination of chromoendoscopy with CLE significantly decreases the number of biopsies required for cancer surveillance in patients with ulcerative colitis, but provides a fourfold higher diagnostic yield compared with white-light endoscopy used with random biopsies. Taken together, CLE has led colorectal cancer endoscopy into a new era. CLE can no longer be regarded as just another endoscopic technique, but emerges as a crucial novel imaging technique for in vivo diagnosis of colorectal cancer. PMID:17657253

  8. Efficacy of Conversational Hypnosis and Propofol in Reducing Adverse Effects of Endoscopy

    PubMed Central

    Izanloo, Azra; Fathi, Mehdi; Izanloo, Sara; Vosooghinia, Hassan; Hashemian, Alireza; Sadrzadeh, Sayyed Majid; Ghaffarzadehgan, Kamran

    2015-01-01

    Background: As pain and nausea is usually associated with endoscopy procedure, its management is important to alleviate patients’ anxious in this regard. Objectives: The present study aimed to examine the effectiveness of conversational hypnosis in reducing anxiety and endoscopy-related complications as well as its role in increasing the satisfaction of patients exposed to endoscopic procedures. Patients and Methods: The participants of upper GI endoscopy procedure were randomly assigned to an experiment group (with conversational hypnosis intervention, n = 93) and a control group (n = 47). The participants’ hemodynamic indexes (HR, blood pressure, pulse oximetry), anxiety, satisfaction level, and complications resulted from the procedure were monitored and included in the self-administered questionnaire. Results: The results indicated that the participants in experiment group had a significant reduction of anxiety in the posttest. The adverse side effects such as vomiting, nausea, and hiccups in the experimental group was less than the control group, though this difference was not significant (P = 0.54). Conclusions: The results suggested that conversational hypnosis technique could reduce anxiety as well as the sedation process in invasive procedures such as endoscopy. PMID:26587402

  9. The role of contact endoscopy in screening for premalignant laryngeal lesions: a study of 141 patients.

    PubMed

    Klan?nik, Marisa; Glun?i?, Ivo; Cikojevi?, Draško

    2014-01-01

    At their earliest stage, pathologic lesions of the laryngeal epithelium are macroscopically invisible. Ideally, these lesions should be detected before their clinical manifestations appear so that prompt management can be initiated. However, most diagnostic modalities are unable to detect early premalignant lesions. We conducted a retrospective study of the use of contact endoscopy in analyzing the vocal fold mucosal epithelium in adults who had been operated on at our hospital under general anesthesia for various nonlaryngeal diseases. After we identified 71 such patients who were smokers, we chose an almost equal number of nonsmokers (n = 70) for comparison purposes. In all, our study population was made up of 141 patients--51 men and 90 women, aged 21 to 78 years (mean: 52). All patients had normal findings on preoperative laryngeal endoscopy. Our goal was to determine if the routine use of this diagnostic modality is justified in selected cases. Contact endoscopy identified dysplastic vocal fold lesions in 4 patients and chronic laryngitis in 3; all 7 of these patients were smokers. Since early laryngeal lesions are not macroscopically evident, early detection of these changes by other means is associated with a better prognosis and easier management. Our study demonstrates that the use of contact endoscopy during general anesthesia as a standard diagnostic method in long-time cigarette smokers is fully justified. PMID:24817233

  10. IEEE TRANSACTIONS ON MEDICAL IMAGING ---FINAL MANUSCRIPT 20040117 1 Interactive Virtual Endoscopy in Coronary Arteries

    E-print Network

    Wahle, Andreas

    in Coronary Arteries based on Multi­Modality Fusion Andreas Wahle, # Senior Member, IEEE, Mark E. Olszewski­independent virtual endoscopy in human coronary arteries is presented in this pa­ per. It incorporates previously results in a three­ or four­dimensional (3­D/4­D) model of a coronary artery, specifically of its lumen

  11. Technical tip: percutaneous bone shaving and ulcer endoscopy to manage abnormal pressure point of the sole.

    PubMed

    Lui, T H

    2014-12-01

    Abnormal plantar pressure can follow post-traumatic foot deformity, Charcot neuroarthropathy and partial foot amputations. Surgery is indicated if the condition does not improve with orthotic treatment. We describe the techniques of percutaneous shaving of the plantar bone prominence and ulcer endoscopy to manage abnormal pressure points under the sole of the foot. PMID:25241265

  12. Abnormal Image Detection in Endoscopy Videos Using a Filter Bank and Local Binary Patterns

    PubMed Central

    Nawarathna, Ruwan; Oh, JungHwan; Muthukudage, Jayantha; Tavanapong, Wallapak; Wong, Johnny; de Groen, Piet C.; Tang, Shou Jiang

    2014-01-01

    Finding mucosal abnormalities (e.g., erythema, blood, ulcer, erosion, and polyp) is one of the most essential tasks during endoscopy video review. Since these abnormalities typically appear in a small number of frames (around 5% of the total frame number), automated detection of frames with an abnormality can save physician’s time significantly. In this paper, we propose a new multi-texture analysis method that effectively discerns images showing mucosal abnormalities from the ones without any abnormality since most abnormalities in endoscopy images have textures that are clearly distinguishable from normal textures using an advanced image texture analysis method. The method uses a “texton histogram” of an image block as features. The histogram captures the distribution of different “textons” representing various textures in an endoscopy image. The textons are representative response vectors of an application of a combination of Leung and Malik (LM) filter bank (i.e., a set of image filters) and a set of Local Binary Patterns on the image. Our experimental results indicate that the proposed method achieves 92% recall and 91.8% specificity on wireless capsule endoscopy (WCE) images and 91% recall and 90.8% specificity on colonoscopy images. PMID:25132723

  13. Correlation of Narrow Band Imaging Endoscopy and Histopathology in the Diagnosis of Nonerosive Reflux Disease

    PubMed Central

    Arul, P; Vinoth, B; Alexander, Thomas; Phansalkar, Manjiri; Padhi, Somanath

    2015-01-01

    Background /Aim: Narrow band imaging (NBI) is a novel, innovative high-resolution endoscopic technique, which utilizes spectral narrow band filter for the visualization of mucosal patterns and microvasculature. Nonerosive reflux disease (NERD) is a type of gastroesophageal reflux disease (GERD) and it is characterized by reflux symptoms without mucosal breaks on white light endoscopy (WLE). Biopsies from distal esophagus of GERD patients show group of histologic features such as basal cell hyperplasia, elongation of lamina propria papillae, and inflammatory cells. The present study was undertaken to evaluate diagnostic utility of NBI endoscopy and biopsy study in NERD patients and also to correlate NBI endoscopy findings with histologic features of GERD. Patients and Methods: A total of 71 cases of NERD having symptom score more than 10 and those not having erosion on WLE were recruited prospectively and underwent NBI endoscopic examination. Two mucosal biopsies were taken at 3 cm above the squamocolumnar junction. Results: Histologic features of GERD were seen in 50 (70.4%) out of 71 cases. No significant correlation between NBI endoscopic findings with histologic features of GERD was found. Conclusion: The present study showed that histopathologic evaluation of distal esophageal mucosa has promising diagnostic value over NBI endoscopy in NERD patients. Use of newly introduced NBI technique requires tremendous familiarity for the detection of the cases of NERD, which show histologic features of GERD. PMID:26458862

  14. Quality Indicators for Colonoscopy Procedures: A Prospective Multicentre Method for Endoscopy Units

    PubMed Central

    Coriat, Romain; Lecler, Augustin; Lamarque, Dominique; Deyra, Jacques; Roche, Hervé; Nizou, Catherine; Berretta, Olivier; Mesnard, Bruno; Bouygues, Martin; Soupison, Alain; Monnin, Jean-Luc; Podevin, Philippe; Cassaz, Carole; Sautereau, Denis; Prat, Frédéric; Chaussade, Stanislas

    2012-01-01

    Background and Aims Healthcare professionals are required to conduct quality control of endoscopy procedures, and yet there is no standardised method for assessing quality. The topic of the present study was to validate the applicability of the procedure in daily practice, giving physicians the ability to define areas for continuous quality improvement. Methods In ten endoscopy units in France, 200 patients per centre undergoing colonoscopy were enrolled in the study. An evaluation was carried out based on a prospectively developed checklist of 10 quality-control indicators including five dependent upon and five independent of the colonoscopy procedure. Results Of the 2000 procedures, 30% were done at general hospitals, 20% at university hospitals, and 50% in private practices. The colonoscopies were carried out for a valid indication for 95.9% (range 92.5–100). Colon preparation was insufficient in 3.7% (range 1–10.5). Colonoscopies were successful in 95.3% (range 81–99). Adenoma detection rate was 0.31 (range 0.17–0.45) in successful colonoscopies. Conclusion This tool for evaluating the quality of colonoscopy procedures in healthcare units is based on standard endoscopy and patient criteria. It is an easy and feasible procedure giving the ability to detect suboptimal practice and differences between endoscopy-units. It will enable individual units to assess the quality of their colonoscopy techniques. PMID:22509267

  15. Flumazenil used for reversal of midazolam-induced sedation in endoscopy outpatients.

    PubMed

    Bartelsman, J F; Sars, P R; Tytgat, G N

    1990-01-01

    A double-blind, placebo-controlled randomized clinical study was performed in 69 outpatients scheduled for endoscopy and sedated with midazolam to assess the efficacy, safety, and usefulness of flumazenil in reversing the effects of midazolam-induced sedation. Midazolam was administered intravenously before endoscopy up to a maximum dose of 15 mg. After endoscopy either flumazenil or placebo was injected. Vital signs and psychomotoric tests were assessed before injection of midazolam, before injection of flumazenil or placebo, and 5, 15, 30, 60, 240, and 360 min afterward. Thirty-six patients received flumazenil, 33 placebo. All parameters returned to pre-sedation levels within 5 min in all patients in the flumazenil group, with significant differences as compared with placebo after 5, 15, 30, and 60 min. Flumazenil was well tolerated. No rebound sedation was observed. Flumazenil is a safe and effective benzodiazepine antagonist. The combination of midazolam with flumazenil makes it possible to reduce the recovery period and is useful in outpatient endoscopy. PMID:2112500

  16. Abnormal Image Detection in Endoscopy Videos Using a Filter Bank and Local Binary Patterns.

    PubMed

    Nawarathna, Ruwan; Oh, JungHwan; Muthukudage, Jayantha; Tavanapong, Wallapak; Wong, Johnny; de Groen, Piet C; Tang, Shou Jiang

    2014-11-20

    Finding mucosal abnormalities (e.g., erythema, blood, ulcer, erosion, and polyp) is one of the most essential tasks during endoscopy video review. Since these abnormalities typically appear in a small number of frames (around 5% of the total frame number), automated detection of frames with an abnormality can save physician's time significantly. In this paper, we propose a new multi-texture analysis method that effectively discerns images showing mucosal abnormalities from the ones without any abnormality since most abnormalities in endoscopy images have textures that are clearly distinguishable from normal textures using an advanced image texture analysis method. The method uses a "texton histogram" of an image block as features. The histogram captures the distribution of different "textons" representing various textures in an endoscopy image. The textons are representative response vectors of an application of a combination of Leung and Malik (LM) filter bank (i.e., a set of image filters) and a set of Local Binary Patterns on the image. Our experimental results indicate that the proposed method achieves 92% recall and 91.8% specificity on wireless capsule endoscopy (WCE) images and 91% recall and 90.8% specificity on colonoscopy images. PMID:25132723

  17. Unusual foreign bodies of upper gastrointestinal tract.

    PubMed

    Nijhawan, S; Rai, R R; Agarwal, S; Vijayvergiya, R

    1995-01-01

    We report management of unusual foreign bodies of upper gastrointestinal tract, namely beer bottle cap, raisins and pistachu, mango peel, betelnut and plum seed at a university hospital in Northern India. PMID:8854958

  18. 2011 Update in Gastrointestinal Cancer Therapeutics

    PubMed Central

    Sahai, Vaibhav; Nimeiri, Halla

    2012-01-01

    ABSTRACT This discussion highlights key investigational findings of existing cytotoxic and novel biological therapeutics, combination regimens, and predictive and prognostic biomarkers in the field of gastrointestinal oncology during the past year. PMID:23077682

  19. Society of American Gastrointestinal Endoscopic Surgeons

    MedlinePLUS

    ... Opportunities Exhibit Opportunities Sponsorship Opportunities Login ‹ › Welcome to SAGES The mission of the Society of American Gastrointestinal ... endoscopic surgery. ???? ???? ?????? ???? ???? ???? SAGES Tweets Tweets by @SAGES_Updates Recent Videos Web ...

  20. Drugs Approved for Gastrointestinal Stromal Tumors

    Cancer.gov

    This page lists cancer drugs approved by the Food and Drug Administration (FDA) for gastrointestinal stromal tumors (GIST). The list includes generic names and brand names. The drug names link to NCI's Cancer Drug Information summaries.

  1. A 100-year perspective on gastrointestinal motility.

    PubMed

    Szurszewski, J H

    1998-03-01

    This contribution to the centennial commemorative issue of the American Journal of Physiology: Gastrointestinal and Liver Physiology identifies some of the important studies of spontaneous electrical and motor activity in the gastrointestinal tract published in the Journal between 1898 and 1996. Emphasis is given to the contributions made by Walter B. Cannon, Walter C. Alvarez, Emil Bozler, C. Ladd Prosser, and James Christensen. PMID:9565541

  2. Recent Advances in Gastrointestinal Stent Development

    PubMed Central

    Park, Jin-Seok; Jeong, Seok

    2015-01-01

    Endoscopic stenting is increasingly being used in the management of gastrointestinal luminal obstruction, and has become the current treatment of choice for the palliation of blockage caused by malignant or benign growths. A variety of stents have been developed to enhance the efficacy of the procedure, and improvements are ongoing. In this article, we review the history of, and recent advances in, gastrointestinal stenting. We describe the rationale behind the design as well as the resulting outcome for each stent type. PMID:26064820

  3. Blood-based Biomarkers at Large Bowel Endoscopy and Prediction of Future Malignancies

    PubMed Central

    Kring, Thomas S.; Piper, Thomas B.; Jørgensen, Lars N.; Olsen, Jesper; Rahr, Hans B.; Nielsen, Knud T.; Laurberg, Søren; Davis, Gerard; Dowell, Barry; Johansen, Julia S.; Christensen, Ib J.; Brünner, Nils; Nielsen, Hans J.

    2015-01-01

    Soluble cancer-related protein biomarker levels may be increased in subjects without findings at large bowel endoscopy performed due to symptoms associated with colorectal cancer. The present study focused on a possible association between increased biomarker levels in such subjects and subsequent development of malignant diseases. In a major study of 4,990 subjects undergoing large bowel endoscopy, 691 were without pathology and comorbidity. Plasma levels of TIMP-1, CEA, CA19-9, and YKL-40 were determined in samples collected just before endoscopy and compared with subsequent development of a malignant disease within a period of 7–8 years. The upper 90% limits of the reference levels of every single protein were used to differentiate between normal and increased levels. The levels were separated into three groups: 0, none of the biomarkers increased; 1, one biomarker increased; 2, two or more biomarkers increased. A total of 43 subjects developed a primary malignant disease in the observation period. Univariatly, increase of all four biomarkers was significantly associated with subsequent development of a malignant disease. A multivariate analysis showed that increased biomarker levels were associated with subsequent development of a malignant disease (P = 0.002). The cumulative risk of developing malignant disease within the first 5 years after endoscopy was group 0, 3.3%; group 1, 5.8%; group 2, 7.8%. It is concluded that increased levels of plasma TIMP-1, CEA, CA19-9, and serum YKL-40 at large bowel endoscopy without findings may be associated with an increased risk of developing a subsequent malignant disease. PMID:26526637

  4. Detection of Mucosal Recurrent Nasopharyngeal Carcinomas After Radiotherapy With Narrow-Band Imaging Endoscopy

    SciTech Connect

    Wang, Wen-Hung; Lin, Yen-Chun; Chen, Wen-Cheng; Chen, Miao-Fen; Chen, Chih-Cheng; Lee, Kam-Fai

    2012-07-15

    Purpose: This study evaluated the feasibility of screening mucosal recurrent nasopharyngeal carcinoma with narrow-band imaging (NBI) endoscopy. Methods and Materials: One hundred and six patients were enrolled. All patients underwent conventional white-light (WL) endoscopic examination of the nasopharynx followed by NBI endoscopy. Biopsies were performed if recurrence was suspected. Results: We identified 32 suspected lesions by endoscopy in WL and/or NBI mode. Scattered brown spots (BS) were identified in 22 patients, and 4 of the 22 who had negative MRI findings were histopathologically confirmed to be neoplasias that were successfully removed via endoscopy. A comparison of the visualization in NBI closer view corresponded to histopathological findings in 22 BS, and the prevalence rates of neoplasias in tail signs, round signs, and irregularities signs were 0% (0/6), 0% (0/7), and 44.4% (4/9), respectively (p = 0.048). The sensitivity, specificity, and diagnostic capability were 37.5%, 92.9% and 0.652 for WL, 87.5%, 74.5% and 0.810 for NBI, and 87.5%, 87.8%, and 0.876 for NBI closer view, respectively. NBI closer view was effective in increasing specificity compared with NBI alone (87.8% vs. 74.5%, p < 0.05), and in increasing sensitivity and diagnostic capability compared to WL alone (87.5% vs. 37.5%, p < 0.05; 0.876 vs. 0.652, p = 0.0001). Conclusions: Although NBI in endoscopy can improve sensitivity of mucosal recurrent nasopharyngeal neoplasias, false-positive (nonneoplasia BS) results may be obtained in areas with nonspecific inflammatory changes due to postradiation effects. NBI closer view not only can offer a timely, convenient, and highly reliable assessment of mucosal recurrent nasopharyngeal carcinoma, it can also make endoscopic removal possible.

  5. Gastrointestinal Bleeding Secondary to Calciphylaxis.

    PubMed

    Gupta, Nancy; Haq, Khwaja F; Mahajan, Sugandhi; Nagpal, Prashant; Doshi, Bijal

    2015-01-01

    BACKGROUND Calciphylaxis is associated with a high mortality that approaches 80%. The diagnosis is usually made when obvious skin lesions (painful violaceous mottling of the skin) are present. However, visceral involvement is rare. We present a case of calciphylaxis leading to lower gastrointestinal (GI) bleeding and rectal ulceration of the GI mucosa. CASE REPORT A 66-year-old woman with past medical history of diabetes mellitus, hypertension, end-stage renal disease (ESRD), recently diagnosed ovarian cancer, and on hemodialysis (HD) presented with painful black necrotic eschar on both legs. The radiograph of the legs demonstrated extensive calcification of the lower extremity arteries. The hospital course was complicated with lower GI bleeding. A CT scan of the abdomen revealed severe circumferential calcification of the abdominal aorta, celiac artery, and superior and inferior mesenteric arteries and their branches. Colonoscopy revealed severe rectal necrosis. She was deemed to be a poor surgical candidate due to comorbidities and presence of extensive vascular calcifications. Recurrent episodes of profuse GI bleeding were managed conservatively with blood transfusion as needed. Following her diagnosis of calciphylaxis, supplementation with vitamin D and calcium containing phosphate binders was stopped. She was started on daily hemodialysis with low calcium dialysate bath as well as intravenous sodium thiosulphate. The clinical condition of the patient deteriorated. The patient died secondary to multiorgan failure. CONCLUSIONS Calciphylaxis leading to intestinal ischemia/perforation should be considered in the differential diagnosis in ESRD on HD presenting with abdominal pain or GI bleeding. PMID:26572938

  6. Lumen detection for capsule endoscopy Xenophon Zabulis, Antonis A. Argyros and Dimitris P. Tsakiris

    E-print Network

    Zabulis, Xenophon

    endoscopic capsules within the gastrointestinal (GI) tract. These cues consist of the detection and tracking of the gastrointestinal (GI) tract, utilizing a microcamera mounted on one of its tips (see Fig. 1). The duration behaviour to be implemented by the navigation system of the capsule would be to strive to follow the lumen

  7. Gastrointestinal Bleeding Secondary to Calciphylaxis

    PubMed Central

    Gupta, Nancy; Haq, Khwaja F.; Mahajan, Sugandhi; Nagpal, Prashant; Doshi, Bijal

    2015-01-01

    Patient: Female, 66 Final Diagnosis: Calciphylaxis Symptoms: Gastrointesinal haemorrhage Medication: None Clinical Procedure: Hemodialysis • blood transfusions Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: Calciphylaxis is associated with a high mortality that approaches 80%. The diagnosis is usually made when obvious skin lesions (painful violaceous mottling of the skin) are present. However, visceral involvement is rare. We present a case of calciphylaxis leading to lower gastrointestinal (GI) bleeding and rectal ulceration of the GI mucosa. Case Report: A 66-year-old woman with past medical history of diabetes mellitus, hypertension, end-stage renal disease (ESRD), recently diagnosed ovarian cancer, and on hemodialysis (HD) presented with painful black necrotic eschar on both legs. The radiograph of the legs demonstrated extensive calcification of the lower extremity arteries. The hospital course was complicated with lower GI bleeding. A CT scan of the abdomen revealed severe circumferential calcification of the abdominal aorta, celiac artery, and superior and inferior mesenteric arteries and their branches. Colonoscopy revealed severe rectal necrosis. She was deemed to be a poor surgical candidate due to comorbidities and presence of extensive vascular calcifications. Recurrent episodes of profuse GI bleeding were managed conservatively with blood transfusion as needed. Following her diagnosis of calciphylaxis, supplementation with vitamin D and calcium containing phosphate binders was stopped. She was started on daily hemodialysis with low calcium dialysate bath as well as intravenous sodium thiosulphate. The clinical condition of the patient deteriorated. The patient died secondary to multiorgan failure. Conclusions: Calciphylaxis leading to intestinal ischemia/perforation should be considered in the differential diagnosis in ESRD on HD presenting with abdominal pain or GI bleeding. PMID:26572938

  8. Upper gastrointestinal issues in athletes.

    PubMed

    Waterman, Jason J; Kapur, Rahul

    2012-01-01

    Gastrointestinal (GI) complaints are common among athletes with rates in the range of 30% to 70%. Both the intensity of sport and the type of sporting activity have been shown to be contributing factors in the development of GI symptoms. Three important factors have been postulated as contributing to the pathophysiology of GI complaints in athletes: mechanical forces, altered GI blood flow, and neuroendocrine changes. As a result of those factors, gastroesophageal reflux disease (GERD), nausea, vomiting, gastritis, peptic ulcers, GI bleeding, or exercise-related transient abdominal pain (ETAP) may develop. GERD may be treated with changes in eating habits, lifestyle modifications, and training modifications. Nausea and vomiting may respond to simple training modifications, including no solid food 3 hours prior to an athletic event. Mechanical trauma, decreased splanchnic blood flow during exercise, and non-steroidal anti-inflammatory drugs (NSAID) contribute to gastritis, GI bleeding, and ulcer formation in athletes. Acid suppression with proton-pump inhibitors may be useful in athletes with persistence of any of the above symptoms. ETAP is a common, poorly-understood, self-limited acute abdominal pain which is difficult to treat. ETAP incidence increases in athletes beginning a new exercise program or increasing the intensity of their current exercise program. ETAP may respond to changes in breathing patterns or may resolve simply with continued training. Evaluation of the athlete with upper GI symptoms requires a thorough history, a detailed training log, a focused physical examination aimed at ruling out potentially serious causes of symptoms, and follow-up laboratory testing based on concerning physical examination findings. PMID:22410703

  9. 21 CFR 876.1300 - Ingestible telemetric gastrointestinal capsule imaging system.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...Ingestible telemetric gastrointestinal capsule imaging system. 876.1300...Ingestible telemetric gastrointestinal capsule imaging system. (a) Identification...ingestible telemetric gastrointestinal capsule imaging system is...

  10. 21 CFR 876.1300 - Ingestible telemetric gastrointestinal capsule imaging system.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...Ingestible telemetric gastrointestinal capsule imaging system. 876.1300...Ingestible telemetric gastrointestinal capsule imaging system. (a) Identification...ingestible telemetric gastrointestinal capsule imaging system is...

  11. 21 CFR 876.1300 - Ingestible telemetric gastrointestinal capsule imaging system.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...Ingestible telemetric gastrointestinal capsule imaging system. 876.1300...Ingestible telemetric gastrointestinal capsule imaging system. (a) Identification...ingestible telemetric gastrointestinal capsule imaging system is...

  12. 21 CFR 876.1300 - Ingestible telemetric gastrointestinal capsule imaging system.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...Ingestible telemetric gastrointestinal capsule imaging system. 876.1300...Ingestible telemetric gastrointestinal capsule imaging system. (a) Identification...ingestible telemetric gastrointestinal capsule imaging system is...

  13. 21 CFR 876.1300 - Ingestible telemetric gastrointestinal capsule imaging system.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...Ingestible telemetric gastrointestinal capsule imaging system. 876.1300...Ingestible telemetric gastrointestinal capsule imaging system. (a) Identification...ingestible telemetric gastrointestinal capsule imaging system is...

  14. Colon Capsule Endoscopy for the Detection of Colorectal Polyps: An Evidence-Based Analysis

    PubMed Central

    2015-01-01

    Background Colorectal cancer, a leading cause of mortality and morbidity in Ontario, can be prevented through early diagnosis and removal of precancerous polyps. Colon capsule endoscopy is a relatively new, minimally invasive test for detecting colorectal polyps. Objective The objectives of this analysis were to evaluate the diagnostic accuracy and safety of colon capsule endoscopy for the detection of colorectal polyps among adult patients with signs or symptoms of colorectal cancer or with increased risk of colorectal cancer, and to compare colon capsule endoscopy with alternative procedures. Review Methods A literature search was performed using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid EMBASE, the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database, for studies published between 2006 and 2014. Data on diagnostic accuracy and safety were abstracted from included studies. Quality of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results The search yielded 2,189 citations. Five studies, all of which evaluated PillCam COLON 2 (PCC2), met the inclusion criteria. The per-patient sensitivity and specificity for detecting colorectal polyps were meta-analyzed. Colon capsule endoscopy, using PCC2, had a pooled sensitivity and specificity of 87% (95% confidence interval [CI] 77%–93%) and 76% (95% CI 60%–87%), respectively, for the detection of a colorectal polyp at least 6 mm in size (GRADE: very low). PCC2 had a pooled sensitivity and specificity of 89% (95% CI 77%–95%) and 91% (95% CI 86%–95%), respectively, for the detection of a colorectal polyp at least 10 mm in size (GRADE: low). One study directly compared PCC2 with computed tomographic (CT) colonography and found no statistically significant difference in accuracy (GRADE: low). Few adverse events were reported with PCC2; 3.9% of patients (95% CI 2.4%–6.5%) experienced adverse effects related to bowel preparation. Capsule retention was the most serious adverse event and occurred in 0.8% of patients (95% CI 0.2%–2.4%) (GRADE: very low). Conclusions In adult patients with signs, symptoms, or increased risk of colorectal cancer, there is low-quality evidence that colon capsule endoscopy using the PCC2 device has good sensitivity and specificity for detecting colorectal polyps. Low-quality evidence does not show a difference in accuracy between colon capsule endoscopy and CT colonography. There is very low-quality evidence that PCC2 has a good safety profile with few adverse events; capsule retention is the most serious complication. PMID:26366239

  15. Clinical and psychosocial variables associated with behavioral intentions to undergo surveillance endoscopy

    PubMed Central

    2014-01-01

    Background Many patients with Barrett’s esophagus do not adhere to guideline-recommended endoscopic surveillance. Among patient factors related to cancer prevention behaviors, patients’ stated behavioral intention is a strong predictor of behavior performance. Little is known about the patient factors associated with having a strong behavioral intention to pursue surveillance endoscopy. This study explores the association of clinical and psychosocial variables and behavioral intention to pursue surveillance endoscopy among patients with Barrett’s Esophagus and no or low-grade dysplasia. Methods Potential subjects were screened using electronic medical records of a regional Veterans Affairs Medical Center and a pathologically confirmed Barrett’s esophagus registry. Eligible participants were recruited by a mailer or phone call and completed a questionnaire to measure six distinct psychosocial factors, their behavioral intention to undergo surveillance endoscopy, and various demographic and clinical variables. Univariate and multivariate linear regression identified the relation of behavioral intention with each of six psychosocial variables. Results One-hundred and one subjects consented and returned surveys. The analytical sample for this study consists of the 94% of surveys with complete responses to the behavior intention items. Three of the six psychosocial domains were statistically significant predictors of intention in both univariate and adjusted univariate analysis (salience/coherence ??=?0.59, 95% CI?=?0.45-0.76, P <0.01; self-efficacy ??=?0.30, 95% CI?=?0.10-0.51, P <0.01; and social influence ??=?0.20, 95% CI?=?0.08-0.33, P <0.01). In a multivariate analysis only salience/coherence (??=?0.65, 95% CI?=?0.42-0.88, P <0.01) remained statistically significant predictor of intention. Conclusion This study established the validity of a scale to measure psychosocial variables associated with behavioral intentions to undergo surveillance endoscopy. Results demonstrate the importance of assessing self-efficacy, social influences, and bottom-line belief in the value of surveillance endoscopy when evaluating a patient’s likelihood of completing surveillance endoscopy. PMID:24916457

  16. Occupational asthma due to glutaraldehyde and formaldehyde in endoscopy and x ray departments.

    PubMed Central

    Gannon, P. F.; Bright, P.; Campbell, M.; O'Hickey, S. P.; Burge, P. S.

    1995-01-01

    BACKGROUND--Glutaraldehyde is the best disinfectant for fibreoptic endoscopes. It is also used in the processing of x ray films. A number of studies have reported eye, nose, and respiratory symptoms in exposed workers. Three individual case reports of occupational asthma in endoscopy workers and a radiographer have also been published. We describe a further seven cases of occupational asthma due to glutaraldehyde in endoscopy and x ray departments, together with exposure levels measured during the challenge tests and in 19 endoscopy and x ray departments in the region. METHODS--Eight workers were referred for investigation of suspected occupational asthma following direct or indirect exposure to glutaraldehyde at work. They were investigated by serial measurements of peak expiratory flow (PEF) and specific bronchial provocation tests. Glutaraldehyde levels were measured using personal and static short and longer term air samples during the challenge tests and in 13 endoscopy units and six x ray darkrooms in the region where concern about glutaraldehyde exposure had been expressed. Three of the workers investigated with occupational asthma came from departments where glutaraldehyde air measurements had been made; the others came from other hospitals or departments. RESULTS--The diagnosis of occupational asthma was confirmed in seven workers, all of whom had PEF records suggestive of occupational asthma and positive specific bronchial challenge tests to glutaraldehyde. Bronchial provocation testing was negative in one worker who was no longer exposed and who had a less clearcut history of occupational asthma. Three workers also had a positive specific bronchial challenge to formaldehyde. The mean level of glutaraldehyde in air during the challenge tests was 0.068 mg/m3, about one tenth of the short term occupational exposure standard of 0.7 mg/m3. The levels obtained in the challenge chamber were similar to those measured in 13 endoscopy suites and six x ray darkrooms where median short term levels were 0.16 mg/m3 during decantation in endoscopy suites and < 0.009 mg/m3 in darkrooms. CONCLUSIONS--Glutaraldehyde can cause occupational asthma. The exposure levels measured in the workplace suggest that sensitisation may occur at levels below the current occupational exposure standard. PMID:7701454

  17. An autocorrelator-interferometer used to determine the pulse width of a pulsed laser used in two-photon endoscopy

    E-print Network

    Baksh, Nicholas A. (Nicholas Anwar)

    2005-01-01

    An autocorrelator-inferometer was designed to correctly assess the pulse width of pulse laser used in two photon endoscopy. The path length of the light was altered using a retro-reflecting corner cube attached to a 6880 ...

  18. What's Next for Gastrointestinal Disorders: No Needles?

    PubMed

    Urbanska, Aleksandra M; Karagiannis, Emmanouil D; Au, Andrew S; Dai, Si Yuan; Mozafari, Masoud; Prakash, Satya

    2016-01-10

    A myriad of pathologies affect the gastrointestinal tract, citing this affected area as a significant target for therapeutic intervention. One group of therapeutic agents, antisense and oligonucleotides and small interfering RNAs, offer a promising platform for treating a wide variety of diseases ranging from cancer to auto-immune diseases. Current delivery methods are carried out either systemically or locally into diseased areas, both of which involve needles. The challenge in orally administering this type of treatment lies in the complications that arise due to the vast environmental extremes found within the gastrointestinal tract, owing to the fact that, as the drug travels down the gastrointestinal tract, it is subjected to pH changes and interactions with bacteria and a variety of digestive and protective enzymes including proteases, DNAses, and RNAses. Overcoming these challenges to allow the practical application of these drugs is a priority that has invoked a multitude of research in the chemical, biological, and material sciences. In this review, we will address common gastrointestinal pathologies, the barriers to oral-based therapies and antisense-interfering technologies, the approaches that have already been applied for their delivery, and the current status of antisense drug therapy clinical trials for gastrointestinal-related disorders. PMID:26646543

  19. Validation of the Rockall scoring system for outcomes from non-variceal upper gastrointestinal bleeding in a Canadian setting

    PubMed Central

    Enns, Robert A; Gagnon, Yves M; Barkun, Alan N; Armstrong, David; Gregor, Jamie C; Fedorak, Richard N; Group, RUGBE Investigators

    2006-01-01

    AIM: To validate the Rockall scoring system for predicting outcomes of rebleeding, and the need for a surgical procedure and death. METHODS: We used data extracted from the Registry of Upper Gastrointestinal Bleeding and Endoscopy including information of 1869 patients with non-variceal upper gastrointestinal bleeding treated in Canadian hospitals. Risk scores were calculated and used to classify patients based on outcomes. For each outcome, we used ?2 goodness-of-fit tests to assess the degree of calibration, and built receiver operating characteristic curves and calculated the area under the curve (AUC) to evaluate the discriminative ability of the scoring system. RESULTS: For rebleeding, the ?2 goodness-of-fit test indicated an acceptable fit for the model [?2 (8) = 12.83, P = 0.12]. For surgical procedures [?2 (8) = 5.3, P = 0.73] and death [?2 (8) = 3.78, P = 0.88], the tests showed solid correspondence between observed proportions and predicted probabilities. The AUC was 0.59 (95% CI: 0.55-0.62) for the outcome of rebleeding and 0.60 (95% CI: 0.54-0.67) for surgical procedures, representing a poor discriminative ability of the scoring system. For the outcome of death, the AUC was 0.73 (95% CI: 0.69-0.78), indicating an acceptable discriminative ability. CONCLUSION: The Rockall scoring system provides an acceptable tool to predict death, but performs poorly for endpoints of rebleeding and surgical procedures. PMID:17203520

  20. Safety and efficacy of nasogastric intubation for gastrointestinal bleeding after myocardial infarction: an analysis of 125 patients at two tertiary cardiac referral hospitals.

    PubMed

    Cappell, Mitchell S

    2005-11-01

    Our purpose was to analyze risks versus benefits of nasogastric (NG) intubation for gastrointestinal (GI) bleeding performed soon after myocardial infarction (MI). While NG intubation and aspiration is relatively safe, clinically beneficial, and routinely performed in the general population for recent GI bleeding, its safety after MI is unstudied and unknown. In addition to the usual complications of NG tubes, patients status post-MI may be particularly susceptible to myocardial ischemia or cardiac arrhythmias from anxiety or discomfort during intubation. We studied NG intubation within 30 days of MI in 125 patients at two hospitals from 1986 through 2001. Indications for NG intubation included melena in 55 patients; fecal occult blood with an acute hematocrit decline, severe anemia, or sudden hypotension in 37; hematemesis in 18; bright red blood per rectum in 8; and dark red blood per rectum in 7. The intubation was performed on average 5.3 +/- 7.2 (SD) days after MI. NG aspiration revealed bright red blood in 38 patients, "coffee grounds"-appearing blood in 45, and clear (or bilious) fluid in 42. Among 114 of the patients undergoing esophagogastroduodenoscopy (EGD), EGD revealed the cause of bleeding in 79 (95%) of 83 patients with a grossly bloody NG aspirate versus 12 (39%) of 31 patients with a clear aspirate (P < 0.0001, OR = 31.3, OR CI = 9.4-103.1). Among 85 patients undergoing EGD within 16 hr of NG intubation, stigmata of recent hemorrhage were present in 28 (42%) of 66 with a bloody NG aspirate versus 3 (16%) of 19 with a clear aspirate (P = 0.06, OR = 3.93). Among 35 patients undergoing lower GI endoscopy, lower endoscopy revealed the cause of bleeding in 14 (56%) of 25 patients with a clear NG aspirate versus 1 (10%) of 10 patients with a grossly bloody aspirate (P < 0.04, OR = 11.46, OR CI = 1.55-78.3). The two NG tube complications (epistaxis during intubation and gastric erosions from NG suctioning) were neither cardiac nor major (requiring blood transfusions). This study suggests that short-term NG intubation is relatively safe and may be beneficial and indicated for acute GI bleeding after recent MI. Aside from improving visualization at EGD, the potential benefits include providing a rational basis for the timing of endoscopy (urgent versus semielective), for prioritizing the order of endoscopy (EGD versus colonoscopy), and for avoiding or deferring endoscopy in low-yield situations (e.g., colonoscopy when the NG aspirate is bloody). These benefits may be particularly relevant in patients after recent MI due to their increased endoscopic risks. PMID:16240216

  1. Gastric carcinoid tumor--incidental finding on endoscopy prior to bariatric surgery.

    PubMed

    Moretto, Myriam; Mottin, Cláudio Corá; Padoin, Alexandre Vontobel; Júnior, Sidnei Pacheco; Barrios, Carlos

    2008-06-01

    A 32-year-old female patient with morbid obesity (body mass index 44.4) was submitted to upper digestive endoscopy performed routinely as a preoperative procedure in bariatric surgery. The examination identified multiple small polypoid lesions in the upper portion of the gastric body, some with small ulcerations. Anatomo-pathological findings were compatible with carcinoid tumor of the stomach. The patient was submitted to extended subtotal gastrectomy with loco-regional lymphadenectomy. Upper digestive endoscopy is performed routinely in some services for bariatric surgery, but its value has been questioned by some authors. In this case, endoscopic examination was of great importance, being responsible for a change in the surgical procedure. We did not find any report in the literature of a carcinoid tumor of the stomach in morbidly obese patients. PMID:18320290

  2. Bayesian network modelling of upper gastrointestinal bleeding

    NASA Astrophysics Data System (ADS)

    Aisha, Nazziwa; Shohaimi, Shamarina; Adam, Mohd Bakri

    2013-09-01

    Bayesian networks are graphical probabilistic models that represent causal and other relationships between domain variables. In the context of medical decision making, these models have been explored to help in medical diagnosis and prognosis. In this paper, we discuss the Bayesian network formalism in building medical support systems and we learn a tree augmented naive Bayes Network (TAN) from gastrointestinal bleeding data. The accuracy of the TAN in classifying the source of gastrointestinal bleeding into upper or lower source is obtained. The TAN achieves a high classification accuracy of 86% and an area under curve of 92%. A sensitivity analysis of the model shows relatively high levels of entropy reduction for color of the stool, history of gastrointestinal bleeding, consistency and the ratio of blood urea nitrogen to creatinine. The TAN facilitates the identification of the source of GIB and requires further validation.

  3. The Chronic Gastrointestinal Manifestations of Chagas Disease

    PubMed Central

    Matsuda, Nilce Mitiko; Miller, Steven M.; Evora, Paulo R. Barbosa

    2009-01-01

    Chagas disease is an infectious disease caused by the protozoan Trypanosoma cruzi. The disease mainly affects the nervous system, digestive system and heart. The objective of this review is to revise the literature and summarize the main chronic gastrointestinal manifestations of Chagas disease. The chronic gastrointestinal manifestations of Chagas disease are mainly a result of enteric nervous system impairment caused by T. cruzi infection. The anatomical locations most commonly described to be affected by Chagas disease are salivary glands, esophagus, lower esophageal sphincter, stomach, small intestine, colon, gallbladder and biliary tree. Chagas disease has also been studied in association with Helicobacter pylori infection, interstitial cells of Cajal and the incidence of gastrointestinal cancer. PMID:20037711

  4. Gastrointestinal abnormalities and involvement in systemic mastocytosis.

    PubMed

    Jensen, R T

    2000-06-01

    Recent studies have shown that involvement of the gastrointestinal tract is much more frequent than originally reported in patients with systemic mastocytosis. Seventy percent to 80% of patients with systemic mastocytosis are found to have gastrointestinal symptoms when a careful history is taken, and abnormalities in the gastrointestinal tract are frequently detected by endoscopic studies, functional studies of absorption, and barium studies. Because of the rarity of the disease, there are few prospective studies of gastrointestinal involvement, so the actual frequency of upper and lower gastrointestinal lesions is unknown. Furthermore, there have been no studies correlating endoscopic abnormalities of the lower gastrointestinal tract with the presence or absence of diarrhea, which is a frequent symptom (mean, 43% [range 14%-100%]). A review of gastric acid studies reveals that a proportion of patients develop gastric acid hypersecretion because of the hyperhistaminemia, which can result in ulcer disease that in turn can cause dyspeptic pain, small intestinal mucosal damage, and malabsorption. In some patients gastric acid hypersecretion in the range seen in Zollinger-Ellison syndrome can develop. A number of studies suggest that the prevalence of peptic ulcer disease has been underestimated in these patients and is certainly higher than the general population. The exact physiologic basis for the diarrhea or nondyspeptic abdominal pain remains largely unknown in these patients. Whereas some studies suggest small intestinal mucosal abnormalities are responsible for most cases of malabsorption not associated with gastric acid hypersecretion, this supposition also remains unproven. Hepatomegaly, portal hypertension, splenomegaly, and ascites occur frequently in patients with systemic mastocytosis, especially those with category II through IV disease. Whereas the histology of the liver and spleen and alterations in hepatic function studies have been well studied, the pathogenesis of each of these abnormalities has not been well studied, and almost all the information comes from a few well-studied case reports. PMID:10909042

  5. Multiple Gastrointestinal Complications of Crack Cocaine Abuse

    PubMed Central

    Carlin, Neal; Nguyen, Nhat; DePasquale, Joseph R.

    2014-01-01

    Cocaine and its alkaloid free base “crack-cocaine” have long since been substances of abuse. Drug abuse of cocaine via oral, inhalation, intravenous, and intranasal intake has famously been associated with a number of medical complications. Intestinal ischemia and perforation remain the most common manifestations of cocaine associated gastrointestinal disease and have historically been associated with oral intake of cocaine. Here we find a rare case of two relatively uncommon gastrointestinal complications of hemorrhage and pancreatitis presenting within a single admission in a chronic crack cocaine abuser. PMID:24839446

  6. Upper Gastrointestinal Cancer and Reflux Disease

    PubMed Central

    2013-01-01

    There is a growing evidence that gastroesophageal reflux disease is related to several upper gastrointestinal cancers, mainly the esophageal adenocarcinoma and a certain type of gastric cardia adenocarcinoma. Currently, the incidence of gastroesophageal reflux disease is rapidly increasing in Korea. Therefore, there is a possibility of such increasing cancerous incidents, similar to the western worlds. In this article, the relationship between gastroesophageal reflux disease and several upper gastrointestinal cancers, the components of refluxate which has possible causal relationship with carcinogenesis, and the clinical implications of such relationship in the management of gastroesophageal reflux disease patients are discussed through the review of literature. PMID:23844321

  7. [Perioperative nutrition support for gastrointestinal surgery].

    PubMed

    Wu, Guohao

    2015-07-01

    Patients with gastrointestinal disease usually suffer from malnutrition, which is associated with poorer outcome, including longer length of stay, poorer wound healing, more infectious complications, reduced quality of life and higher mortality. Thus, acknowledgement of nutritional risk and nutritional risk factors are mandatory for nutritional therapy, to reduce risk of adverse complications and to improve clinical outcome. This article addresses and updates recent advances in clinical nutrition regarding gastrointestinal disease surgery and physiological considerations, essential for planning relevant nutritional therapy throughout the treatment course. PMID:26211762

  8. Lower Gastrointestinal Bleeding in Chronic Hemodialysis Patients

    PubMed Central

    Saeed, Fahad; Agrawal, Nikhil; Greenberg, Eugene; Holley, Jean L.

    2011-01-01

    Gastrointestinal (GI) bleeding is more common in patients with chronic kidney disease and is associated with higher mortality than in the general population. Blood losses in this patient population can be quite severe at times and it is important to differentiate anemia of chronic diseases from anemia due to GI bleeding. We review the literature on common causes of lower gastrointestinal bleeding (LGI) in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. We suggest an approach to diagnosis and management of this problem. PMID:22007297

  9. Progress in digestive endoscopy: Flexible Spectral Imaging Colour Enhancement (FICE)-technical review

    PubMed Central

    Negreanu, L; Preda, CM; Ionescu, D; Ferechide, D

    2015-01-01

    Background. A substantial advance in digestive endoscopy that has been made during the last decade is represented by digital chromoendoscopy, which was developed as a quicker and sometimes better alternative to the gold standard of dye spraying. Fujifilm developed a virtual coloration technique called Flexible spectral Imaging Color Enhancement (FICE). FICE provides a better detection of lesions of “minimal” esophagitis, of dysplasia in Barrett’s esophagus and of squamous cell esophageal cancer. The use of FICE resulted in an improvement in the visualization of the early gastric cancer, being less invasive, and time consuming than the classic dye methods. Current evidence does not support FICE for screening purposes in colon cancer but it definitely improves characterization of colonic lesions. Its use in inflammatory bowel disease is still controversial and in video capsule endoscopy is considered a substantial progress. Conclusions. The use of FICE endoscopy in routine clinical practice can increase the diagnostic yield and can provide a better characterization of lesions. Future studies to validate its use, the good choice of channels, and the “perfect indications” and to provide common definitions and classifications are necessary. PMID:26664462

  10. Preoperative endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors, including magnifying endoscopy

    PubMed Central

    Tsuji, Shigetsugu; Doyama, Hisashi; Tsuji, Kunihiro; Tsuyama, Sho; Tominaga, Kei; Yoshida, Naohiro; Takemura, Kenichi; Yamada, Shinya; Niwa, Hideki; Katayanagi, Kazuyoshi; Kurumaya, Hiroshi; Okada, Toshihide

    2015-01-01

    Superficial non-ampullary duodenal epithelial tumor (SNADET) is defined as a sporadic tumor that is confined to the mucosa or submucosa that does not arise from Vater’s papilla, and it includes adenoma and adenocarcinoma. Recent developments in endoscopic technology, such as high-resolution endoscopy and image-enhanced endoscopy, may increase the chances of detecting SNADET lesions. However, because SNADET is rare, little is known about its preoperative endoscopic diagnosis. The use of endoscopic resection for SNADET, which has no risk of metastasis, is increasing, but the incidence of complications, such as perforation, is significantly higher than in any other part of the digestive tract. A preoperative diagnosis is required to distinguish between lesions that should be followed up and those that require treatment. Retrospective studies have revealed certain endoscopic findings that suggest malignancy. In recent years, several new imaging modalities have been developed and explored for real-time diagnosis of these lesion types. Establishing an endoscopic diagnostic tool to differentiate between adenoma and adenocarcinoma in SNADET lesions is required to select the most appropriate treatment. This review describes the current state of knowledge about preoperative endoscopic diagnosis of SNADETs, such as duodenal adenoma and duodenal adenocarcinoma. Newer endoscopic techniques, including magnifying endoscopy, may help to guide these diagnostics, but their additional advantages remain unclear, and further studies are required to clarify these issues. PMID:26557007

  11. Efficiency of bowel preparation for capsule endoscopy examination: A meta-analysis

    PubMed Central

    Niv, Yaron

    2008-01-01

    Good preparation before endoscopic procedures is essential for successful visualization. The small bowel is difficult to evaluate because of its length and complex configuration. A meta-analysis was conducted of studies comparing small bowel visualization by capsule endoscopy with and without preparation. Medical data bases were searched for all studies investigating the preparation for capsule endoscopy of the small bowel up to July 31, 2007. Studies that scored bowel cleanness and measured gastric and small bowel transit time and rate of cecum visualization were included. The primary endpoint was the quality of bowel visualization. The secondary endpoints were transit times and proportion of examinations that demonstrated the cecum, with and without preparation. Meta-analysis was performed with StatDirect Statistical software, version 2.6.1 (http://statsdirect.com). Eight studies met the inclusion criteria. Bowel visualization was scored as “good” in 78% of the examinations performed with preparation and 49% performed without (P < 0.0001). There were no significant differences in transit times or in the proportion of examinations that demonstrated the cecum with and without preparation. Capsule endoscopy preparation improves the quality of small bowel visualization, but has no effect on transit times, or demonstration of the cecum. PMID:18322940

  12. Multiphoton gradient index endoscopy for evaluation of diseased human prostatic tissue ex vivo

    PubMed Central

    Huland, David M.; Jain, Manu; Ouzounov, Dimitre G.; Robinson, Brian D.; Harya, Diana S.; Shevchuk, Maria M.; Singhal, Paras; Xu, Chris; Tewari, Ashutosh K.

    2014-01-01

    Abstract. Multiphoton microscopy can instantly visualize cellular details in unstained tissues. Multiphoton probes with clinical potential have been developed. This study evaluates the suitability of multiphoton gradient index (GRIN) endoscopy as a diagnostic tool for prostatic tissue. A portable and compact multiphoton endoscope based on a 1-mm diameter, 8-cm length GRIN lens system probe was used. Fresh ex vivo samples were obtained from 14 radical prostatectomy patients and benign and malignant areas were imaged and correlated with subsequent H&E sections. Multiphoton GRIN endoscopy images of unfixed and unprocessed prostate tissue at a subcellular resolution are presented. We note several differences and identifying features of benign versus low-grade versus high-grade tumors and are able to identify periprostatic tissues such as adipocytes, periprostatic nerves, and blood vessels. Multiphoton GRIN endoscopy can be used to identify both benign and malignant lesions in ex vivo human prostate tissue and may be a valuable diagnostic tool for real-time visualization of suspicious areas of the prostate. PMID:25415446

  13. Calculus detection calibration among dental hygiene faculty members utilizing dental endoscopy: a pilot study.

    PubMed

    Partido, Brian B; Jones, Archie A; English, Dana L; Nguyen, Carol A; Jacks, Mary E

    2015-02-01

    Dental and dental hygiene faculty members often do not provide consistent instruction in the clinical environment, especially in tasks requiring clinical judgment. From previous efforts to calibrate faculty members in calculus detection using typodonts, researchers have suggested using human subjects and emerging technology to improve consistency in clinical instruction. The purpose of this pilot study was to determine if a dental endoscopy-assisted training program would improve intra- and interrater reliability of dental hygiene faculty members in calculus detection. Training included an ODU 11/12 explorer, typodonts, and dental endoscopy. A convenience sample of six participants was recruited from the dental hygiene faculty at a California community college, and a two-group randomized experimental design was utilized. Intra- and interrater reliability was measured before and after calibration training. Pretest and posttest Kappa averages of all participants were compared using repeated measures (split-plot) ANOVA to determine the effectiveness of the calibration training on intra- and interrater reliability. The results showed that both kinds of reliability significantly improved for all participants and the training group improved significantly in interrater reliability from pretest to posttest. Calibration training was beneficial to these dental hygiene faculty members, especially those beginning with less than full agreement. This study suggests that calculus detection calibration training utilizing dental endoscopy can effectively improve interrater reliability of dental and dental hygiene clinical educators. Future studies should include human subjects, involve more participants at multiple locations, and determine whether improved rater reliability can be sustained over time. PMID:25640616

  14. Epistaxis in end stage liver disease masquerading as severe upper gastrointestinal hemorrhage

    PubMed Central

    Camus, Marine; Jensen, Dennis M; Matthews, Jason D; Ohning, Gordon V; Kovacs, Thomas O; Jutabha, Rome; Ghassemi, Kevin A; Machicado, Gustavo A; Dulai, Gareth S

    2014-01-01

    AIM: To describe the prevalence, diagnosis, treatment, and outcomes of end stage liver disease (ESLD) patients with severe epistaxis thought to be severe upper gastrointestinal hemorrhage (UGIH). METHODS: This observational single center study included all consecutive patients with ESLD and epistaxis identified from consecutive subjects hospitalized with suspected UGIH and prospectively enrolled in our databases of severe UGIH between 1998 and 2011. RESULTS: A total of 1249 patients were registered for severe UGIH in the data basis, 461 (36.9%) were cirrhotics. Epistaxis rather than UGIH was the bleeding source in 20 patients. All patients had severe coagulopathy. Epistaxis was initially controlled in all cases. Fifteen (75%) subjects required posterior nasal packing and 2 (10%) embolization in addition to correction of coagulopathy. Five (25%) patients died in the hospital, 12 (60%) received orthotopic liver transplantation (OLT), and 3 (15%) were discharged without OLT. The mortality rate was 63% in patients without OLT. CONCLUSION: Severe epistaxis in patients with ESLD is (1) a diagnosis of exclusion that requires upper endoscopy to exclude severe UGIH; and (2) associated with a high mortality rate in patients not receiving OLT. PMID:25320538

  15. Transcatheter embolization as the new reference standard for endoscopically unmanageable upper gastrointestinal bleeding.

    PubMed

    Loffroy, Romaric; Estivalet, Louis; Cherblanc, Violaine; Sottier, Damien; Guiu, Boris; Cercueil, Jean-Pierre; Krausé, Denis

    2012-10-27

    Acute nonvariceal upper gastrointestinal bleeding (UGIB) is a major medical emergency problem associated with significant morbidity and mortality. Endoscopy is considered the first method of choice to detect and treat UGIB. Endoscopic therapy usually achieves primary hemostasis, but 10%-30% of these patients have repeat bleeding. In patients in whom hemostasis is not achieved with endoscopic techniques, treatment with transcatheter angiographic embolization (TAE) or surgery is needed. Surgical intervention is usually an expeditious and gratifying endeavor, but it can be associated with high operative mortality rates. A large number of studies support the use of TAE as salvage therapy as an alternative to surgery. However, few studies have compared the results of TAE with that of emergency surgery in terms of efficiency, the frequency of repeat bleeding, and complications. Recently, Ang et al retrospectively compared the outcome of TAE and surgery as salvage therapy of UGIB after failed endoscopic treatment. There were no significant differences in 30 d mortality, complication rates and length of stay although higher rebleeding rates were observed after TAE compared with surgery. In this commentary, we discuss the advantages and drawbacks of these two therapeutic strategies for UGIB. We also attempt to define the exact role of TAE for acute nonvariceal UGIB. PMID:23467300

  16. Laboratory test variables useful for distinguishing upper from lower gastrointestinal bleeding

    PubMed Central

    Tomizawa, Minoru; Shinozaki, Fuminobu; Hasegawa, Rumiko; Shirai, Yoshinori; Motoyoshi, Yasufumi; Sugiyama, Takao; Yamamoto, Shigenori; Ishige, Naoki

    2015-01-01

    AIM: To distinguish upper from lower gastrointestinal (GI) bleeding. METHODS: Patient records between April 2011 and March 2014 were analyzed retrospectively (3296 upper endoscopy, and 1520 colonoscopy). Seventy-six patients had upper GI bleeding (Upper group) and 65 had lower GI bleeding (Lower group). Variables were compared between the groups using one-way analysis of variance. Logistic regression was performed to identify variables significantly associated with the diagnosis of upper vs lower GI bleeding. Receiver-operator characteristic (ROC) analysis was performed to determine the threshold value that could distinguish upper from lower GI bleeding. RESULTS: Hemoglobin (P = 0.023), total protein (P = 0.0002), and lactate dehydrogenase (P = 0.009) were significantly lower in the Upper group than in the Lower group. Blood urea nitrogen (BUN) was higher in the Upper group than in the Lower group (P = 0.0065). Logistic regression analysis revealed that BUN was most strongly associated with the diagnosis of upper vs lower GI bleeding. ROC analysis revealed a threshold BUN value of 21.0 mg/dL, with a specificity of 93.0%. CONCLUSION: The threshold BUN value for distinguishing upper from lower GI bleeding was 21.0 mg/dL. PMID:26034359

  17. Patient characteristics with high or low blood urea nitrogen in upper gastrointestinal bleeding

    PubMed Central

    Tomizawa, Minoru; Shinozaki, Fuminobu; Hasegawa, Rumiko; Shirai, Yoshinori; Motoyoshi, Yasufumi; Sugiyama, Takao; Yamamoto, Shigenori; Ishige, Naoki

    2015-01-01

    AIM: To examine characteristics of patients with blood urea nitrogen (BUN) levels higher and lower than the normal limit. METHODS: Patient records between April 2011 and March 2014 were analyzed retrospectively. During this time, 3296 patients underwent upper endoscopy. In total, 50 male (69.2 ± 13.2 years) and 26 female (72.3 ± 10.2 years) patients were assessed. Patients were divided into two groups based on BUN levels: higher than the normal limit (21.0 mg/dL) (H) and lower than the normal limit (L). One-way analysis of variance was performed to reveal differences in the variables between the H and L groups. Fisher’s exact test was used to compare the percentage of patients with gastric ulcer or gastric cancer in the H and L groups. RESULTS: White blood cell count was higher in the H group than in the L group (P = 0.0047). Hemoglobin level was lower in the H group than in the L group (P = 0.0307). Glycated hemoglobin was higher in the H group than in the L group (P = 0.0264). The percentage of patients with gastric ulcer was higher in the H group (P = 0.0002). The H group contained no patients with gastric cancer. CONCLUSION: Patients with BUN ? 21 mg/dL might have more severe upper gastrointestinal bleeding. PMID:26139996

  18. Consensus on Control of Risky Nonvariceal Upper Gastrointestinal Bleeding in Taiwan with National Health Insurance

    PubMed Central

    Sheu, Bor-Shyang; Wu, Chun-Ying; Wu, Ming-Shiang; Chiu, Cheng-Tang; Hsu, Ping-I; Cheng, Hsiu-Chi; Wang, Hsiu-Po; Lin, Jaw-Town

    2014-01-01

    Background and Aims. To compose upper gastrointestinal bleeding (UGIB) consensus from a nationwide scale to improve the control of UGIB, especially for the high-risk comorbidity group. Methods. The steering committee defined the consensus scope to cover preendoscopy, endoscopy, postendoscopy, and overview from Taiwan National Health Insurance Research Database (NHIRD) assessments for UGIB. The expert group comprised thirty-two Taiwan experts of UGIB to conduct the consensus conference by a modified Delphi process through two separate iterations to modify the draft statements and to vote anonymously to reach consensus with an agreement ?80% for each statement and to set the recommendation grade. Results. The consensus included 17 statements to highlight that patients with comorbidities, including liver cirrhosis, end-stage renal disease, probable chronic obstructive pulmonary disease, and diabetes, are at high risk of peptic ulcer bleeding and rebleeding. Special considerations are recommended for such risky patients, including raising hematocrit to 30% in uremia or acute myocardial infarction, aggressive acid secretory control in high Rockall scores, monitoring delayed rebleeding in uremia or cirrhosis, considering cycloxygenase-2 inhibitors plus PPI for pain control, and early resumption of antiplatelets plus PPI in coronary artery disease or stroke. Conclusions. The consensus comprises recommendations to improve care of UGIB, especially for high-risk comorbidities. PMID:25197649

  19. Do We Know What Causes Gastrointestinal Carcinoid Tumors?

    MedlinePLUS

    ... Topic Can gastrointestinal carcinoid tumors be prevented? Do we know what causes gastrointestinal carcinoid tumors? Researchers have ... our genes, which control how our cells function. We look like our parents because they are the ...

  20. What Are the Key Statistics about Gastrointestinal Carcinoid Tumors?

    MedlinePLUS

    ... the risk factors for gastrointestinal carcinoid tumors? What are the key statistics about gastrointestinal carcinoid tumors? Although ... tract (the stomach, intestine, appendix, colon, or rectum) are diagnosed each year in the United States. These ...

  1. What's New in Gastrointestinal Carcinoid Tumors Research and Treatment?

    MedlinePLUS

    ... Topic Additional resources for gastrointestinal carcinoid tumors What’s new in gastrointestinal carcinoid tumor research and treatment? There ... for the causes of , ways to prevent , and new approaches to diagnose and treat GI carcinoid tumors. ...

  2. Lower Gastrointestinal (GI) Tract X-Ray (Radiography)

    MedlinePLUS

    ... Physician Resources Professions Site Index A-Z X-ray (Radiography) - Lower GI Tract Lower gastrointestinal tract radiography ... Tract Radiography? What is Lower GI Tract X-ray Radiography (Barium Enema)? Lower gastrointestinal (GI) tract radiography, ...

  3. Effect of pronase as mucolytic agent on imaging quality of magnifying endoscopy

    PubMed Central

    Kim, Gwang Ha; Cho, Yu Kyung; Cha, Jae Myung; Lee, Sun-Young; Chung, Il-Kwun

    2015-01-01

    AIM: To investigate the efficacy of premedication with pronase, a proteolytic enzyme, in improving image quality during magnifying endoscopy. METHODS: The study was of a blinded, randomized, prospective design. Patients were assigned to groups administered oral premedication of either pronase and simethicone (Group A) or simethicone alone (Group B). First, the gastric mucosal visibility grade (1-4) was determined during conventional endoscopy, and then a magnifying endoscopic examination was conducted. The quality of images obtained by magnifying endoscopy at the stomach and the esophagus was scored from 1 to 3, with a lower score indicating better visibility. The endoscopist used water flushes as needed to obtain satisfactory magnifying endoscopic views. The main study outcomes were the visibility scores during magnifying endoscopy and the number of water flushes. RESULTS: A total of 144 patients were enrolled, and data from 143 patients (M:F = 90:53, mean age 57.5 years) were analyzed. The visibility score was significantly higher in the stomach following premedication with pronase (73% with a score of 1 in Group A vs 49% in Group B, P < 0.05), but there was no difference in the esophagus visibility scores (67% with a score of 1 in Group A vs 58% in Group B). Fewer water flushes [mean 0.7 ± 0.9 times (range: 0-3 times) in Group A vs 1.9 ± 1.5 times (range: 0-6 times) in Group B, P < 0.05] in the pronase premedication group did not affect the endoscopic procedure times [mean 766 s (range: 647-866 s) for Group A vs 760 s (range: 678-854 s) for Group B, P = 0.88]. The total gastric mucosal visibility score was also lower in Group A (4.9 ± 1.5 vs 8.3 ± 1.8 in Group B, P < 0.01). CONCLUSION: The addition of pronase to simethicone premedication resulted in clearer images during magnifying endoscopy and reduced the need for water flushes. PMID:25741158

  4. Magnifying narrow-band imaging endoscopy is superior in diagnosis of early gastric cancer

    PubMed Central

    Yu, Hang; Yang, Ai-Ming; Lu, Xing-Hua; Zhou, Wei-Xun; Yao, Fang; Fei, Gui-Jun; Guo, Tao; Yao, Li-Qing; He, Li-Ping; Wang, Bang-Mao

    2015-01-01

    AIM: To evaluate the diagnostic effectiveness of white light endoscopy, magnifying endoscopy (ME), and magnifying narrow-band imaging endoscopy (ME-NBI) in detecting early gastric cancer (EGC). METHODS: From March 2010 to June 2012, a total of 3616 patients received screening for gastric cancer by magnifying endoscopy. There were 3675 focal gastric lesions detected using conventional high definition white light endoscopy (HD-WLE) in four different referential hospitals that were recruited for further investigation using ME and ME-NBI. The images obtained from HD-WLE, ME, and ME-NBI were reviewed by four experienced endoscopists to evaluate their diagnostic effectiveness for EGC. The diagnosis of cancerous and non-cancerous lesions was conducted by evaluating the microvascular and microsurface patterns using the VS classification system. The final endoscopic diagnosis of each lesion was determined by consultation when a disagreement occurred. We used histopathological results as the gold standard for the diagnosis of EGC. RESULTS: Among the 3675 lesions found, 1508 were validated by pathological findings as chronic gastritis, 1279 as chronic gastritis with intestinal metaplasia, 631 as low-grade neoplasia, and 257 as EGC. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of HD-WLE for the diagnosis of EGC were 71.2%, 99.1%, 85.5%, 97.9% and 97.1%, respectively. The results of ME for diagnosing EGC were 81.3%, 98.8%, 83.3%, 98.6% and 97.6%, respectively. The results of ME-NBI for the diagnosis of EGC were 87.2%, 98.6%, 82.1%, 99.0% and 97.8%, respectively. The diagnostic sensitivity and accuracy of paired ME and ME-NBI were significantly better than those of HD-WLE (P < 0.05). CONCLUSION: HD-WLE has a relatively high accuracy for diagnosing EGC and is an effective screening tool. Further investigations of ME and ME-NBI are required to achieve superior accuracy. PMID:26290643

  5. Sleep, immunity and inflammation in gastrointestinal disorders.

    PubMed

    Ali, Tauseef; Choe, James; Awab, Ahmed; Wagener, Theodore L; Orr, William C

    2013-12-28

    Sleep disorders have become a global issue, and discovering their causes and consequences are the focus of many research endeavors. An estimated 70 million Americans suffer from some form of sleep disorder. Certain sleep disorders have been shown to cause neurocognitive impairment such as decreased cognitive ability, slower response times and performance detriments. Recent research suggests that individuals with sleep abnormalities are also at greater risk of serious adverse health, economic consequences, and most importantly increased all-cause mortality. Several research studies support the associations among sleep, immune function and inflammation. Here, we review the current research linking sleep, immune function, and gastrointestinal diseases and discuss the interdependent relationship between sleep and these gastrointestinal disorders. Different physiologic processes including immune system and inflammatory cytokines help regulate the sleep. The inflammatory cytokines such as tumor necrosis factor, interleukin-1 (IL-1), and IL-6 have been shown to be a significant contributor of sleep disturbances. On the other hand, sleep disturbances such as sleep deprivation have been shown to up regulate these inflammatory cytokines. Alterations in these cytokine levels have been demonstrated in certain gastrointestinal diseases such as inflammatory bowel disease, gastro-esophageal reflux, liver disorders and colorectal cancer. In turn, abnormal sleep brought on by these diseases is shown to contribute to the severity of these same gastrointestinal diseases. Knowledge of these relationships will allow gastroenterologists a great opportunity to enhance the care of their patients. PMID:24409051

  6. Sleep, immunity and inflammation in gastrointestinal disorders

    PubMed Central

    Ali, Tauseef; Choe, James; Awab, Ahmed; Wagener, Theodore L; Orr, William C

    2013-01-01

    Sleep disorders have become a global issue, and discovering their causes and consequences are the focus of many research endeavors. An estimated 70 million Americans suffer from some form of sleep disorder. Certain sleep disorders have been shown to cause neurocognitive impairment such as decreased cognitive ability, slower response times and performance detriments. Recent research suggests that individuals with sleep abnormalities are also at greater risk of serious adverse health, economic consequences, and most importantly increased all-cause mortality. Several research studies support the associations among sleep, immune function and inflammation. Here, we review the current research linking sleep, immune function, and gastrointestinal diseases and discuss the interdependent relationship between sleep and these gastrointestinal disorders. Different physiologic processes including immune system and inflammatory cytokines help regulate the sleep. The inflammatory cytokines such as tumor necrosis factor, interleukin-1 (IL-1), and IL-6 have been shown to be a significant contributor of sleep disturbances. On the other hand, sleep disturbances such as sleep deprivation have been shown to up regulate these inflammatory cytokines. Alterations in these cytokine levels have been demonstrated in certain gastrointestinal diseases such as inflammatory bowel disease, gastro-esophageal reflux, liver disorders and colorectal cancer. In turn, abnormal sleep brought on by these diseases is shown to contribute to the severity of these same gastrointestinal diseases. Knowledge of these relationships will allow gastroenterologists a great opportunity to enhance the care of their patients. PMID:24409051

  7. Hydrogen Sulfide Signaling in the Gastrointestinal Tract

    PubMed Central

    2014-01-01

    Abstract Significance: The current literature regarding the effects of the gaseous signal molecule hydrogen sulfide (H2S) in the gastrointestinal system is reviewed. Bacterial, host and pharmaceutical-derived H2S are all considered and presented according to the physiological or pathophysiological effects of the gaseous signal molecule. These subjects include the toxicology of intestinal H2S with emphasis on bacterial-derived H2S, especially from sulfate-reducing bacteria, the role of endogenous and exogenous H2S in intestinal inflammation, and the roles of H2S in gastrointestinal motility, secretion and nociception. Recent Advances: While its pro- and anti-inflammatory, smooth muscle relaxant, prosecretory, and pro- and antinociceptive actions continue to remain the major effects of H2S in this system; recent findings have expanded the potential molecular targets for H2S in the gastrointestinal tract. Critical Issues: Numerous discrepancies remain in the literature, and definitive molecular targets in this system have not been supported by the use of competitive antagonism. Future Directions: Future work will hopefully resolve discrepancies in the literature and identify molecular targets and mechanisms of action for H2S. It is clear from the current literature that the long-appreciated relationship between H2S and the gastrointestinal tract continues to be strong as we endeavor to unravel its mysteries. Antioxid. Redox Signal. 20, 818–830. PMID:23582008

  8. Eastern Canadian Gastrointestinal Cancer Consensus Conference 2014

    PubMed Central

    Tsvetkova, E.; Sud, S.; Aucoin, N.; Biagi, J.; Burkes, R.; Samson, B.; Brule, S.; Cripps, C.; Colwell, B.; Falkson, C.; Dorreen, M.; Goel, R.; Halwani, F.; Maroun, J.; Michaud, N.; Tehfe, M.; Thirlwell, M.; Vickers, M.; Asmis, T.

    2015-01-01

    The annual Eastern Canadian Colorectal Cancer Consensus Conference was held in Montreal, Quebec, 23–25 October 2014. Expert radiation, medical, and surgical oncologists and pathologists involved in the management of patients with gastrointestinal malignancies participated in presentations and discussions resulting in consensus statements on such hot topics as management of neuroendocrine tumours, advanced and metastatic pancreatic cancer, and metastatic colorectal cancer. PMID:26300681

  9. Catastrophic gastrointestinal complication of systemic immunosuppression.

    PubMed

    Smith, Lyn Alexandra; Gangopadhyay, Mitali; Gaya, Daniel R

    2015-02-28

    We present a case of acute upper gastrointestinal haemorrhage in a patient with systemic vasculitis immunosuppressed on cyclophosphamide and prednisolone. The patient presented with a diffuse haemorrhagic oesophagitis and a non-specific duodenitis. Biopsies taken from the oesophagus and duodenum demonstrated infection with herpes simplex virus (HSV) and cytomegalovirus (CMV) respectively. Viral infection of the upper gastrointestinal tract is a recognised complication of immunosuppression and HSV is one of the most common pathogens. CMV on the other hand most commonly causes a colitis or less commonly oesophagitis. CMV enteritis is rare as is the synchronous infection with two viral agents in an immunocompromised patient having being described in a few case series only. Viral infection of the gastrointestinal tract in immunocompromised patients should be treated with systemic anti-viral medication and consideration to withdrawal of the immunosuppressive therapy if possible and appropriate. The authors highlight the need for a high suspicion of viral infection in immunosuppressed patients presenting with upper gastrointestinal bleeding. PMID:25741165

  10. Gastrointestinal Disorders in Children with Neurodevelopmental Disabilities

    ERIC Educational Resources Information Center

    Sullivan, Peter B.

    2008-01-01

    Children with neurodevelopmental disabilities such as cerebral palsy (CP), spina bifida, or inborn errors of metabolism frequently have associated gastrointestinal problems. These include oral motor dysfunction leading to feeding difficulties, risk of aspiration, prolonged feeding times, and malnutrition with its attendant physical compromise.…

  11. Original Article Gastrointestinal Stem Cells and Cancer--

    E-print Network

    Dove, William

    Original Article Gastrointestinal Stem Cells and Cancer-- Bridging the Molecular Gap S.J. Leedham Cancer is believed to be a disease involving stem cells. The digestive tract has a very high cancer in both the mouse and human has shown that crypts are clonal units and mutated stem cells may develop

  12. Gastrointestinal manifestations of mixed connective tissue disease.

    PubMed

    Marshall, J B; Kretschmar, J M; Gerhardt, D C; Winship, D H; Winn, D; Treadwell, E L; Sharp, G C

    1990-05-01

    We examined the gastrointestinal tract abnormalities in 61 patients with mixed connective tissue disease. The first 34 were part of a prospective longitudinal study that included manometric and radiographic evaluation of the esophagus. Heartburn (48%) and dysphagia (38%) were by far the most common gastrointestinal symptoms. Seventeen percent of patients undergoing manometry had distal esophageal aperistalsis, and 43% low-amplitude peristalsis (less than 30 mmHg). Studies in 10 patients before and after treatment suggested that esophageal dysfunction in mixed connective tissue disease may be responsive to corticosteroids. Upper esophageal sphincter hypotension was also common. One patient had marked upper esophageal sphincter hypotension and recurrent aspiration, which resolved with corticosteroid therapy. Findings on radiographic studies of the stomach and small bowel in 54 patients and barium enemas in 16 patients were reviewed. Our series included one case each of malabsorption, colonic and small bowel perforations due to vasculitis, chronic active hepatitis, and acute pancreatitis. In conclusion, any area of the gastrointestinal tract may be affected by mixed connective tissue disease, although the esophagus is the most common location. The gastrointestinal aspects of mixed connective tissue disease overlap with those of progressive systemic sclerosis, polymyositis, and systemic lupus erythematosus. PMID:2323516

  13. Costs and quality of life associated with acute upper gastrointestinal bleeding in the UK: cohort analysis of patients in a cluster randomised trial

    PubMed Central

    Campbell, H E; Stokes, E A; Bargo, D; Logan, R F; Mora, A; Hodge, R; Gray, A; James, M W; Stanley, A J; Everett, S M; Bailey, A A; Dallal, H; Greenaway, J; Dyer, C; Llewelyn, C; Walsh, T S; Travis, S P L; Murphy, M F; Jairath, V

    2015-01-01

    Objectives Data on costs associated with acute upper gastrointestinal bleeding (AUGIB) are scarce. We provide estimates of UK healthcare costs, indirect costs and health-related quality of life (HRQoL) for patients presenting to hospital with AUGIB. Setting Six UK university hospitals with >20 AUGIB admissions per month, >400 adult beds, 24?h endoscopy, and on-site access to intensive care and surgery. Participants 936 patients aged ?18?years, admitted with AUGIB, and enrolled between August 2012 and March 2013 in the TRIGGER trial of AUGIB comparing restrictive versus liberal red blood cell (RBC) transfusion thresholds. Primary and secondary outcome measures Healthcare resource use during hospitalisation and postdischarge up to 28? days, unpaid informal care, time away from paid employment and HRQoL using the EuroQol EQ-5D at 28? days were measured prospectively. National unit costs were used to value resource use. Initial in-hospital treatment costs were upscaled to a UK level. Results Mean initial in-hospital costs were £2458 (SE=£216) per patient. Inpatient bed days, endoscopy and RBC transfusions were key cost drivers. Postdischarge healthcare costs were £391 (£44) per patient. One-third of patients received unpaid informal care and the quarter in paid employment required time away from work. Mean HRQoL for survivors was 0.74. Annual initial inhospital treatment cost for all AUGIB cases in the UK was estimated to be £155.5 million, with exploratory analyses of the incremental costs of treating hospitalised patients developing AUGIB generating figures of between £143 million and £168 million. Conclusions AUGIB is a large burden for UK hospitals with inpatient stay, endoscopy and RBC transfusions as the main cost drivers. It is anticipated that this work will enable quantification of the impact of cost reduction strategies in AUGIB and will inform economic analyses of novel or existing interventions for AUGIB. Trial registration number ISRCTN85757829 and NCT02105532. PMID:25926146

  14. Identification of gastrin-secreting cells and cholecystokinin-secreting cells in the gastrointestinal tract of the human fetus and adult man.

    PubMed

    Dubois, P M; Paulin, C; Chayvialle, J A

    1976-12-10

    Gastrin- and cholecystokinin (C.C.K.)-containing cells were detected by using anti-gastrin and anti-C.C.K. sera in the gastrointestinal tract of human fetuses and premature infants and in the stomach and duodenum of adult man obtained by biopsy from eight patients with normal gastro-duodenal endoscopy. The specificity of immunocytological reactions was ascertained by studying the inhibition of the reaction by gastrin, C.C.K., secretin, somatostatin, glucagon, insulin, serotonin, histamin, caerulein and octapeptide of C.C.K. In adult man, the gastrin cells are located only in the antrum and juxtapyloric region; C.C.K. was detected in the duodenum. In the human fetus, the first gastrin cells are seen in the antrum at 14 weeks of age and in the duodenum as early as 10 weeks; the C.C.K. cells are seen in the small intestine at 10 weeks of age. PMID:793724

  15. Importance of Heparin Provocation and SPECT/CT in Detecting Obscure Gastrointestinal Bleeding on 99mTc-RBC Scintigraphy: A Case Report.

    PubMed

    Haghighatafshar, Mahdi; Gheisari, Farshid; Ghaedian, Tahereh

    2015-08-01

    We presented a pediatric case with a history of intermittent melena for 3 years because of angiodyplasia of small intestine. The results of frequent upper gastrointestinal endoscopies and colonoscopies as well as both Tc-red blood cell (RBC) and Meckel's scintigraphies for several times were negative in detection of bleeding site. However, Tc-RBC scintigraphy with single-photon emission computed tomography (SPECT)/computed tomography (CT) after heparin augmentation detected a site of bleeding in the distal ileum which later was confirmed during surgery with final diagnosis of angiodysplasia.It could be stated that heparin provocation of bleeding before Tc-RBC scintigraphy accompanied by fused SPECT/CT images should be kept in mind for management of intestinal bleeding especially in difficult cases. PMID:26313771

  16. Massive Upper Gastrointestinal Bleeding from a Splenic Artery Pseudoaneurysm Caused by a Penetrating Gastric Ulcer: Case Report and Review of Literature

    PubMed Central

    Sawicki, Marcin; Marlicz, Wojciech; Czapla, Norbert; ?okaj, Marek; Skoczylas, Micha? M.; Donotek, Maciej; Ko?aczyk, Katarzyna

    2015-01-01

    Summary Background Splenic artery aneurysm and pseudoaneurysm are rare pathologies. True aneurysms are usually asymptomatic. Aneurysm rupture occurring in 2–3% of cases results in bleeding into the lesser sack, peritoneal space or adjacent organs typically presenting as abdominal pain and hemodynamic instability. In contrast, pseudoaneurysms are nearly always symptomatic carrying a high risk of rupture of 37–47% and mortality rate of 90% if untreated. Therefore, prompt diagnosis and treatment are essential in the management of patients with splenic artery pseudoaneurysm. Typical causes include pancreatitis and trauma. Rarely, the rupture of a pseudoaneurysm presents as upper gastrointestinal (UGI) bleeding. Among causes, peptic ulcer is the casuistic one. Case Report This report describes a very rare case of recurrent UGI bleeding from a splenic artery pseudoaneurysm caused by a penetrating gastric ulcer. After negative results of endoscopy and ultrasound, the diagnosis was established in CT angiography. The successful treatment consisted of surgical ligation of the bleeding vessel and suture of the ulcer with preservation of the spleen and pancreas, which is rarely tried in such situations. Conclusions The most important factor in identifying a ruptured splenic artery pseudoaneurysm as a source of GI bleeding is considering the diagnosis. UGI hemorrhage from splenic artery pseudoaneurysm can have a relapsing course providing false negative results of endoscopy and ultrasound if performed between episodes of active bleeding. In such cases, immediate CT angiography is useful in establishing diagnosis and in application of proper therapy before possible recurrence. PMID:26309450

  17. Extremely unusual case of gastrointestinal trichobezoar

    PubMed Central

    Jatal, Sopan N; Jamadar, Nawab P; Jadhav, Bhagwat; Siddiqui, Saleha; Ingle, Sachin B

    2015-01-01

    Trichobezoars (hair ball) are usually located in the stomach, but may extend through the pylorus into the duodenum and small bowel (Rapunzel syndrome). Rapunzel syndrome remains uncommon; with fewer than 40 cases reported. To the best of our knowledge, this case may be the first well-documented case with a length of 75 cm. They are almost always associated with trichotillomania and trichophagia or other psychiatric disorders. In the literature several treatment options are proposed, including removal by conventional laparotomy, laparoscopy and endoscopy. Herein, we are reporting an interesting case of an 18-year mentally retarded girl with history of trichotillomania and trichophagia who presented to our emergency department with a history of central abdominal pain associated with vomiting and constipation for five days. An examination showed a trichobezoar requiring emergent surgical intervention, and indicating the need for psychiatric treatment. The trichobezoar was treated successfully by laparoscopy. PMID:25984522

  18. Wireless Insufflation of the Gastrointestinal Tract

    PubMed Central

    Battaglia, Santina; Smith, Byron F.; Ciuti, Gastone; Gerding, Jason; Menciassi, Arianna; Obstein, Keith L.; Valdastri, Pietro; Webster, Robert J.

    2013-01-01

    Despite clear patient experience advantages, low specificity rates have thus far prevented swallowable capsule endoscopes from replacing traditional endoscopy for diagnosis of colon disease. One explanation for this is that capsule endoscopes lack the ability to provide insufflation, which traditional endoscopes use to distend the intestine for a clear view of the internal wall. To provide a means of insufflation from a wireless capsule platform, in this paper we use biocompatible effervescent chemical reactions to convert liquids and powders carried onboard a capsule into gas. We experimentally evaluate the quantity of gas needed to enhance capsule visualization and locomotion, and determine how much gas can be generated from a given volume of reactants. These experiments motivate the design of a wireless insufflation capsule, which is evaluated in ex vivo experiments. These experiments illustrate the feasibility of enhancing visualization and locomotion of endoscopic capsules through wireless insufflation. PMID:23212312

  19. Polyethylene glycol plus an oral sulfate solution as a bowel cleansing regimen for colon capsule endoscopy: a prospective, single-arm study in healthy volunteers

    PubMed Central

    Peled, Ravit

    2015-01-01

    Objectives: As with colonoscopy, adequate bowel cleansing is essential prior to colon capsule endoscopy (CCE). Because CCE requires that the capsule traverse the entire gastrointestinal tract during the examination, laxative ‘boosters’ are used. The objective of this prospective, single-center, single-arm study was to evaluate the safety of a bowel preparation consisting of polyethylene glycol (PEG) plus an oral sulfate solution. Methods: Subjects were healthy volunteers aged 50–75 years old with normal baseline serum chemistry. The bowel preparation consisted of 4 Senna tablets, 4 liters of PEG (split dose), 10 mg metoclopramide, 2 oral sulfate solution boosters (6 oz. and 3 oz.), and 10 mg bisacodyl. Serum chemistry was performed at baseline, following PEG intake, 24 hours after bisacodyl administration, and at 7 days post procedure (in subjects with abnormal 24 hour results). The primary endpoints were the percentage of subjects with a clinically significant change in serum chemistry at the last test and the adverse event (AE) rate. Results: A total of 25 subjects were enrolled. The serum chemistry was normal in all subjects at the final evaluation. One subject showed a slight elevation in creatinine (1.08 mg/dl 7 days post procedure from 0.84 mg/dl at baseline), deemed not clinically significant. Another subject had a transient elevation in serum creatinine (from 1.01 mg/dl at baseline to 1.45 mg/dl at 24 hours after the bowel preparation); values returned to near baseline at 7 days post procedure (1.06 mg/dl). There were no serious AEs, three moderate AEs related to the bowel preparation (nausea, headache, elevated creatinine) and two mild unrelated AEs (chills, abdominal cramping). Conclusions: A bowel cleansing regimen of PEG plus an oral sulfate solution can be used in healthy volunteers. These data provide support for the continued study of this regimen in future CCE clinical trials and in medical practice. PMID:26327914

  20. Characterizing variability in in vivo Raman spectra of different anatomical locations in the upper gastrointestinal tract toward cancer detection

    NASA Astrophysics Data System (ADS)

    Bergholt, Mads Sylvest; Zheng, Wei; Lin, Kan; Ho, Khek Yu; Teh, Ming; Yeoh, Khay Guan; So, Jimmy Bok Yan; Huang, Zhiwei

    2011-03-01

    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 was utilized for real-time in vivo tissue Raman measurements of normal esophageal (distal, middle, and proximal), gastric (antrum, body, and cardia) as well as cancerous esophagous and gastric tissues from 107 patients who underwent endoscopic examinations. The non-negativity-constrained least squares minimization coupled with a reference database of Raman active biochemicals (i.e., actin, histones, collagen, DNA, and triolein) was employed for semiquantitative biomolecular modeling of tissue constituents in the upper GI. A total of 1189 in vivo Raman spectra were acquired from different locations in the upper GI. The Raman spectra among the distal, middle, and proximal sites of the esophagus showed no significant interanatomical variability. The interanatomical variability of Raman spectra among normal gastric tissue (antrum, body, and cardia) was subtle compared to cancerous tissue transformation, whereas biomolecular modeling revealed significant differences between the two organs, particularly in the gastroesophageal junction associated with proteins, DNA, and lipids. Cancerous tissues can be identified across interanatomical regions with accuracies of 89.3% [sensitivity of 92.6% (162/175) specificity of 88.6% (665/751)], and of 94.7% [sensitivity of 90.9% (30/33) specificity of 93.9% (216/230)] in the gastric and esophagus, respectively, using partial least squares-discriminant analysis together with the leave-one tissue site-out, cross validation. This work demonstrates that Raman endoscopy technique has promising clinical potential for real-time, in vivo diagnosis and detection of malignancies in the upper GI at the molecular level.

  1. Value of biopsy and brush cytology in the diagnosis of gastric cancer. Shanghai Gastrointestinal Endoscopy Cooperative Group, People's Republic of China.

    PubMed Central

    1982-01-01

    This report presents the diagnostic value of brush cytology in gastric cancer. Gastric biopsies and brush cytology were performed in 155 patients with gastric cancer and 48 with benign gastric disease. The positive rate for biopsy and brush cytology in cancer patients (including 11 cases of early gastric cancer) was 74.2% and 76.8% respectively. The positive rate of biopsy with concomitant brush cytology was 87.7, which was superior to that of biopsy or brush cytology alone (p less than 0.01). In 29 cases of gastric cancer involving the cardiac region. 20 were biopsy positive (69%) and 22 were brush cytology positive (75.9%). Biopsy with brush cytology was positive in 27 cases (93.1%) and gave better results than biopsy alone (p less than 0.01). The positive rate of biopsy with concomitant brush cytology in Borrmann type I, II, and III lesions (89.7%) was significantly higher than in Borrmann type IV lesions (50%). In the 48 patients with benign gastric lesion, biopsy and brush cytology each provided two false positives. The study shows that the combination of biopsy and brush cytology increases diagnostic accuracy for gastric cancer. PMID:7106623

  2. Scheduled out-patient endoscopy and lack of compliance in a minority serving tertiary institution

    PubMed Central

    Jackson, Danielle S.; Egbuonnu, Nneka; Umunakwe, Chukwuma; Fullum, Terrence M.; Ford, Debra H.; Anders, Kyle B.; McDonald-Pinkett, Shelly; Smoot, Duane T.; Laiyemo, Adeyinka O.

    2011-01-01

    Background Lack of adherence to appointments wastes resources and portends a poorer outcome for patients. We sought to determine if the type of scheduled endoscopic procedures affect compliance. Methods We reviewed the final endoscopy schedule from January 2010 to August 2010 in an inner city teaching hospital that serves a predominantly African American population. The final schedule only includes patients who did not cancel, reschedule or notify the facility of their inability to adhere to their care plan up to 24 hours prior to their procedures. All patients had face to face consultation with gastroenterologists or surgeons prior to scheduling. We identified patients who did not show up for their procedures. We used Poisson regression models to calculate Relative Risks (RR) and 95% Confidence Intervals (CI). Results Of 2,183 patients who were scheduled for outpatient endoscopy, 400 (18.3%) patients were scheduled for Esophago-gastro-duodenoscopy (EGD), 1,335 (61.2%) for colonoscopy and 448 (20.5%) for both EGD and colonoscopy. The rate of non compliance was 17.5%, 22.8% and 22.1%, respectively. When compared to those scheduled for only EGD, patients scheduled for colonoscopy alone (RR = 1.47; 95%CI: 1.13-1.92) and patients scheduled for both EGD and colonoscopy (RR = 1.36; 95%CI: 1.01-1.84) were less likely to show up for their procedures. Conclusions Our study suggests a high rate of non-compliance with scheduled out-patient endoscopy, particularly for colonoscopy. Since this may be a contributing factor to colorectal cancer disparities, increased community outreach on colorectal cancer education is needed and may help to reduce non compliance. PMID:22197978

  3. What is the current role of endoscopy in primary sclerosing cholangitis?

    PubMed Central

    Tharian, Benjamin; George, Nayana Elizabeth; Tham, Tony Chiew Keong

    2015-01-01

    Endoscopy has important roles in the management of primary sclerosing cholangitis (PSC), ranging from narrowing down the differential diagnoses, screening for complications, determining prognosis and therapy. While the need for a diagnostic endoscopic retrograde cholangiopancreatography (ERCP) may be obviated by a positive magnetic resonance cholangiopancreatography (MRCP), a negative MRCP does not exclude PSC and may therefore necessitate an ERCP, which is traditionally regarded as the gold standard. In this editorial we have not covered the endoscopic management of inflammatory bowel disease in the context of PSC nor of endoscopic surveillance and treatment of portal hypertension complicating PSC. PMID:26265986

  4. Evaluative survey-questionnaire exploring the perceptions and experiences of endoscopy and sterile service staff.

    PubMed

    Cobbold, A

    2013-12-01

    There is considerable research surrounding professionalization and the barriers that emerging allied health professions may face. In order to develop any emerging profession, the move to voluntary registration and academic qualification will substantially pave the way towards raising the profile and professional recognition with a regulatory governing body. The aim of this evaluative survey-questionnaire was to explore the attitudes and experiences of endoscopy and sterile service staff in their current job roles and to identify any perceived barriers during the proposed transition to professionalization. This article concludes by highlighting the positive and negative aspects of current job roles in relation to job satisfaction, staff retention and career progression opportunities. PMID:24404705

  5. Stereotactic laser surgery for deep-seated brain tumors by open-system endoscopy.

    PubMed

    Otsuki, T; Yoshimoto, T; Jokura, H; Katakura, R

    1990-01-01

    A new approach for stereotactic laser surgery of deep-seated brain tumors using open-system endoscopy, i.e. employing a stereotactic guiding tube and fine endoscopes, is described. Accurate resection of intraaxial brain lesions with efficient hemostasis was achieved by CO2 and Nd:Yag laser irradiation under computed tomographic and magnetic resonance image guidance. Stereotactic endoscopic laser surgery is a promising new method for the treatment of deep-seated brain pathologies for which biopsy or irradiation had previously been the only treatment of choice. PMID:2080357

  6. A novel broadband Raman endoscopy for in vivo diagnosis of intestinal metaplasia in the stomach

    NASA Astrophysics Data System (ADS)

    Lin, Kan; Bergholt, Mads S.; Wang, Jianfeng; Zheng, Wei; Xu, Hongzhi; Ren, Jian-lin; Ho, Khek Yu; Teh, Ming; Yeoh, Khay Guan; Huang, Zhiwei

    2015-03-01

    We report a novel simultaneous fingerprint (FP) and high-wavenumber (HW) fiber-optic Raman spectroscopy developed for in vivo diagnosis of intestinal metaplasia (IM) in the stomach under wide-field endoscopic imaging. The FP/HW Raman endoscopy technique was performed to differentiate IM from normal tissues with sensitivity of 89% and specificity of 83%. This study shows the great potential of the FP/HW Raman endoscopic technique for early diagnosis of non-neoplastic gastric disease in vivo during routine endoscopic examination.

  7. Fabry-Perot micro-structured polymer optical fibre sensors for opto-acoustic endoscopy

    NASA Astrophysics Data System (ADS)

    Broadway, Christian; Gallego, Daniel; Woyessa, Getinet; Pospori, Andreas; Carpintero, Guillermo; Bang, Ole; Sugden, Kate; Lamela, Horacio

    2015-06-01

    Opto-Acoustic Endoscopy (OAE) requires sensors with a high sensitivity and small physical dimensions in order to facilitate integration into an endoscope of less than 1mm in diameter. We present fibre Bragg grating (FBG) and Fabry- Perot intrinsic fibre sensors for ultrasound detection. We present a structure profile characterisation setup to analyse tune the fibre sensors in preparation for ultrasonic detection. We evaluate the suitability of the different structures and grating parameters for ultrasonic sensing. By analysing the prepared gratings, we enable the optimisation of the profile and a simplification of the detection regime for an optimal interferometric OAE configuration.

  8. Gastrointestinal Stromal Tumor – An Evolving Concept

    PubMed Central

    Tornillo, Luigi

    2014-01-01

    Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal tumors of the gastrointestinal tract. The discovery that these tumors, formerly thought of smooth muscle origin, are indeed better characterized by specific activating mutation in genes coding for the receptor tyrosine kinases (RTKs) CKIT and PDGFRA and that these mutations are strongly predictive for the response to targeted therapy with RTK inhibitors has made GISTs the typical example of the integration of basic molecular knowledge in the daily clinical activity. The information on the mutational status of these tumors is essential to predict (and subsequently to plan) the therapy. As resistant cases are frequently wild type, other possible oncogenic events, defining other “entities,” have been discovered (e.g., succinil dehydrogenase mutation/dysregulation, insuline growth factor expression, and mutations in the RAS-RAF-MAPK pathway). The classification of disease must nowadays rely on the integration of the clinico-morphological characteristics with the molecular data. PMID:25593916

  9. Current status of familial gastrointestinal polyposis syndromes

    PubMed Central

    Jung, Ioan; Gurzu, Simona; Turdean, Gligore Sabin

    2015-01-01

    Because of the rarity of familial gastrointestinal cancer-predisposing syndromes, their exploration in literature is not extensive. In this review, an update of the clinicopathological and molecular criteria of gastrointestinal familial polyposis syndromes with potential malignant transformation is performed. In addition, a guide for screening and surveillance was synthesized and a distribution of gene mutations according to the specific syndromes and geographic distribution was included. The following inherited polyposes syndromes were analyzed: familial adenomatous polyposis, the hamartomatous familial polyposes (Juvenile polyposis, Peutz-Jeghers syndrome, Cowden syndrome, Bannayan-Riley-Ruvalcaba syndrome, hereditary mixed polyposis syndrome, Gorlin syndrome, Birt-Hogg-Dube syndrome, neurofibromatosis type?I?and multiple endocrine neoplasia syndrome 2B), Li-Fraumeni syndrome, and MUTYH-associated adenomatous polyposis. For proper medical care, subspecialization of gastroenterologists, pathologists, and genticists in the field of familial diseases should be introduced in the medical curriculum. PMID:26600934

  10. Current status of familial gastrointestinal polyposis syndromes.

    PubMed

    Jung, Ioan; Gurzu, Simona; Turdean, Gligore Sabin

    2015-11-15

    Because of the rarity of familial gastrointestinal cancer-predisposing syndromes, their exploration in literature is not extensive. In this review, an update of the clinicopathological and molecular criteria of gastrointestinal familial polyposis syndromes with potential malignant transformation is performed. In addition, a guide for screening and surveillance was synthesized and a distribution of gene mutations according to the specific syndromes and geographic distribution was included. The following inherited polyposes syndromes were analyzed: familial adenomatous polyposis, the hamartomatous familial polyposes (Juvenile polyposis, Peutz-Jeghers syndrome, Cowden syndrome, Bannayan-Riley-Ruvalcaba syndrome, hereditary mixed polyposis syndrome, Gorlin syndrome, Birt-Hogg-Dube syndrome, neurofibromatosis type?I?and multiple endocrine neoplasia syndrome 2B), Li-Fraumeni syndrome, and MUTYH-associated adenomatous polyposis. For proper medical care, subspecialization of gastroenterologists, pathologists, and genticists in the field of familial diseases should be introduced in the medical curriculum. PMID:26600934

  11. Gastrointestinal motility revisited: The wireless motility capsule

    PubMed Central

    Farmer, Adam D; Scott, S Mark

    2013-01-01

    Introduction The wireless motility capsule (WMC) is a novel ambulatory technology that concurrently measures intraluminal pH, temperature, and pressure as it traverses the gastrointestinal tract. Objectives We aim to provide a concise summary of the WMC, detailing the procedure for its administration and the parameters it records. We also review the evidence that has validated the WMC against other methods currently regarded as ‘gold standard’. Conclusions The WMC offers a number of advantages over and above current techniques, especially with respect to patient tolerability, safety, and standardization. The WMC represents a considerable enhancement of the researchers’ and clinicians’ investigatory armamentarium. If this technology becomes widely adopted, coupled with international consensus upon the interpretation of physiological data derived therein, it may herald a new and exciting era in gastrointestinal physiology. PMID:24917991

  12. Hypnotherapy for functional gastrointestinal disorders: a review.

    PubMed

    Miller, Vivien; Whorwell, Peter J

    2009-07-01

    Patients with functional gastrointestinal disorders, such as irritable bowel syndrome, functional dyspepsia, and noncardiac chest pain, can suffer from a range of severe symptoms that often substantially erode quality of life. Unfortunately, these conditions are notoriously difficult to treat, with many patients failing to improve despite being prescribed a wide variety of conventional medications. As a consequence, the potential benefits of hypnotherapy have been explored with evidence that this approach not only relieves symptoms but also appears to restore many of the putative psychological and physiological abnormalities associated with these conditions toward normal. These observations suggest that this form of treatment has considerable potential in aiding the management of functional gastrointestinal disorders and should be integrated into the ongoing medical care that these patients are receiving. PMID:19459089

  13. [Nonsteroidal antirheumatic agents and the gastrointestinal system].

    PubMed

    Jaji?, I

    1990-01-01

    The antiinflammatory drugs are broadly used also in the treatment of inflammatory and degenerative rheumatic diseases relating to the treatment of extraarticular rheumatism. It has been held that they have an effect in rheumatic diseases even by means of the inhibition of prostaglandins synthesis. Later it was evidented that all drugs coming from that group cause a numerous side-effects particularly in gastrointestinal system, usually relating to those caming a strong inhibition of prostaglandin synthesis. Some of them cause a selective inhibition of prostaglandin synthesis especially in stomach and kidneys. The appearance of side-effects in gastrointestinal system with patients taking these drugs for a longer period of time could be prevented by a careful choice of their usage. It has been evidented that misoprostol strongly effect the prevention of stomach lesions and duodenum enabling so the usage of non-steroidal antiinflammatory drugs over a longer period of time. PMID:2135454

  14. Immunity to gastrointestinal nematodes: mechanisms and myths

    PubMed Central

    Grencis, Richard K; Humphreys, Neil E; Bancroft, Allison J

    2014-01-01

    Immune responses to gastrointestinal nematodes have been studied extensively for over 80 years and intensively investigated over the last 30–40 years. The use of laboratory models has led to the discovery of new mechanisms of protective immunity and made major contributions to our fundamental understanding of both innate and adaptive responses. In addition to host protection, it is clear that immunoregulatory processes are common in infected individuals and resistance often operates alongside modulation of immunity. This review aims to discuss the recent discoveries in both host protection and immunoregulation against gastrointestinal nematodes, placing the data in context of the specific life cycles imposed by the different parasites studied and the future challenges of considering the mucosal/immune axis to encompass host, parasite, and microbiome in its widest sense. PMID:24942690

  15. Gastrointestinal motility disorders in inflammatory bowel diseases

    PubMed Central

    Bassotti, Gabrio; Antonelli, Elisabetta; Villanacci, Vincenzo; Salemme, Marianna; Coppola, Manuela; Annese, Vito

    2014-01-01

    The relationship between motility and inflammatory gastrointestinal disorders is at the same time complex and intriguing since these conditions might share some genetic, environmental, immunological and microbial predisposing factors. In addition, significant symptom overlapping may occur, muddling the waters within the clinical context. Although on one hand this represents a challenge for the clinician for a potential under- or over-treatment and diagnostic delay, on the other hand it possibly represents an opportunity for the researcher to better disclose the intimate relationship between chronic (often low-grade) inflammation, motor disorders and deranged sensory function. The best example is probably represented by Crohn’s disease and ulcerative colitis. In fact, a number of gastrointestinal motor disorders have been described in association with these diseases, disorders which span from the esophagus to the anorectum, and which will be extensively covered in this review. It is conceivable that at least part of this derangement is strictly related to inflammatory cytokine trafficking and neuromuscular changes; however, given the high prevalence of functional gastrointestinal disorders in the general population, this overlap might also be serendipitous. However, it is worth noting that literature data on this topic are relatively scarce, sometimes quite outdated, and mostly focused on the interplay between irritable bowel syndrome and inflammatory bowel disease. Nevertheless, both researchers and clinicians must be aware that symptoms related to gastrointestinal motility disorders may be highly prevalent in both active and inactive inflammatory bowel disease, correlate with greater psychological comorbidity and poorer quality of life, and may negatively influence the therapeutic approaches. PMID:24415856

  16. Electrosurgery in the Gastrointestinal Suite: Knowledge Is Power.

    PubMed

    Nelson, Geri; Morris, Marcia L

    2015-01-01

    Electrosurgery allows both cutting and coagulation of tissue and is an essential tool for therapeutic endoscopy. Electrosurgery is also the most commonly used and misunderstood technology by all surgical and medical disciplines. In other words, everyone uses it, but few understand it! The aims of this article are to (1) present a useful review of the fundamentals of electrosurgery technology; (2) relate the fundamentals to commonly performed flexible endoscopy procedures; and (3) provide a review of the safe application of grounding pads, careful management of accessories, and special patient safety considerations. PMID:26626032

  17. Imatinib treatment for gastrointestinal stromal tumour (GIST)

    PubMed Central

    Lopes, Lisandro F; Bacchi, Carlos E

    2010-01-01

    Abstract Gastrointestinal stromal tumour (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. GISTs are believed to originate from intersticial cells of Cajal (the pacemaker cells of the gastrointestinal tract) or related stem cells, and are characterized by KIT or platelet-derived growth factor receptor alpha (PDGFRA) activating mutations. The use of imatinib has revolutionized the management of GIST and altered its natural history, substantially improving survival time and delaying disease progression in many patients. The success of imatinib in controlling advanced GIST led to interest in the neoadjuvant and adjuvant use of the drug. The neoadjuvant (preoperative) use of imatinib is recommended to facilitate resection and avoid mutilating surgery by decreasing tumour size, and adjuvant therapy is indicated for patients at high risk of recurrence. The molecular characterization (genotyping) of GISTs has become an essential part of the routine management of the disease as KIT and PDGFRA mutation status predicts the likelihood of achieving response to imatinib. However, the vast majority of patients who initially responded to imatinib will develop tumour progression (secondary resistance). Secondary resistance is often related to secondary KIT or PDGFRA mutations that interfere with drug binding. Multiple novel tyrosine kinase inhibitors may be potentially useful for the treatment of imatinib-resistant GISTs as they interfere with KIT and PDGFRA receptors or with the downstream-signalling proteins. PMID:19968734

  18. JC virus existence in Chinese gastrointestinal carcinomas

    PubMed Central

    WANG, JIAN-PING; WANG, ZUO-ZHOU; ZHENG, YU-SHUANG; XIA, PU; YANG, XIANG-HONG; LIU, YUN-PENG; TAKANO, YASUO; ZHENG, HUA-CHUAN

    2012-01-01

    The John Cunningham virus (JCV) infects a large proportion of the population worldwide and may cause progressive multifocal leukoencephalopathy upon immunodeficiency. Recent reports provided evidence of its oncogenetic role in malignancies. In this study, JCV was examined by targeting T antigen, viral protein and agnoprotein in paraffin-embedded or frozen gastrointestinal carcinomas and paired non-neoplastic mucosa (NNM) samples by nested-PCR followed by Southern blot analysis. In addition, the expression of JCV T antigen, ki-67, caspase-3, p53, Rb and ?-catenin was studied by immunohistochemistry on tissue microarrays. The positive rate of JCV T antigen was higher in paraffin-embedded gastrointestinal carcinomas compared to adjacent NNM by nested-PCR followed by Southern blot analysis (36.9 vs. 16.9%, P<0.05), while there was no difference in other viral oncogenes regardless of whether they were paraffin-embedded or frozen samples. Immunohistochemically, T antigen was detectable in 9.6% (13/135) of carcinoma cases, which was higher than its positive rate in NNM (0.8%, 1/126, P<0.01). However, the genomic JCV DNA existence or its T antigen expression was not correlated with age, gender, tumor size, histological types, lymph node metastasis, expression of ki-67, caspase-3, p53, Rb and ?-catenin of gastric carcinomas (P>0.05). In conlusion, JCV T antigen may be involved in gastrointestinal carcinogenesis as an oncogene in China. PMID:22783394

  19. Particle Radiation Therapy for Gastrointestinal Malignancies

    PubMed Central

    Meyer, Jeffrey J.; Willett, Christopher G.

    2007-01-01

    Treatment-related toxicity is common in the radiotherapeutic management of cancers of the gastrointestinal tract. These toxicities can diminish treatment efficacy by necessitating treatment breaks, limiting the radiation dose that can be delivered, and hindering concomitant use of chemotherapy and targeted drug agents. Many efforts have focused on widening the gap between the likelihood of tumor control and the likelihood of toxicities associated with radiation. Use of particles that exhibit a Bragg peak phenomenon in their interactions with tissue, such as protons, heavier ions like carbon ions, and pions, is one means of concentrating radiation dose in tumors and away from normal tissues. Neutron beams have also been used in the treatment of gastrointestinal cancers in an effort to take advantage of their potent biologic effects. This report reviews basic particle radiation physics and biology, as well as the clinical experience with protons, heavier ions, pions, and neutrons in the treatment of various gastrointestinal malignancies. Potential future directions in clinical research with particle therapy are discussed. PMID:19360149

  20. Abstract. Video-endoscopy (Figure 1), a mode of minimally invasive surgery, has proven to be significantly less invasive to the

    E-print Network

    Wang, Yuan-Fang

    Abstract. Video-endoscopy (Figure 1), a mode of minimally invasive surgery, has proven video-endoscopy, and in training the surgeons to master this new mode of operation. Our research in the emerging minimally invasive surgery [2,3]. There has been a revolution in medical surgery in recent years

  1. A case of acquired laryngomalacia in an infant, with endoscopy before and after establishing the diagnosis for the first time.

    PubMed

    Gazzaz, Malak Jamal; El-Hakim, Hamdy

    2015-01-01

    A 12-week-old infant girl born at 27?weeks gestation, with multiple comorbidities, was referred to the paediatric otolaryngology team due to stridor and feeding difficulties. Initial airway endoscopy was performed, showing no abnormal findings. The infant underwent frequent hospitalisations for recurrent cyanotic spells. Despite initial laryngoscopy and bronchoscopy not showing abnormalities, a repeat endoscopy demonstrated laryngomalacia, significant enough to require a supraglottoplasty. This is the first report to confirm, with video evidence, that some cases of laryngomalacia are acquired rather than congenital, even in infancy. PMID:26628452

  2. An atypically localized gastrointestinal stromal tumor: a case report of pancreas gastrointestinal stromal tumor

    PubMed Central

    Serin, Kür?at Rahmi; Keskin, Metin; Güllüo?lu, Mine; Emre, Ali

    2013-01-01

    Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. They can arise from any part of the tract as well as the omentum, mesentery or retroperitoneum. In this study, we present a case of a GIST originating from an extraordinary site, the pancreas. Evaluation of 30-year-old man with complaints of abdominal distension revealed a cystic, distal pancreatic lesion 13 cm in diameter. There were no intra-abdominal or distant organ metastases. The patient was operated with a diagnosis of cystic pancreas tumor, distal pancreatectomy and splenectomy was performed. The lesion was diagnosed as gastrointestinal stromal tumor upon histopathological examination. He was discharged on the sixth postoperative day without any complications and is being followed up for 21 months without systemic or local recurrence. Extragastrointestinal GISTs are reported rarely. To our knowledge, only one pancreatic GIST has been reported previously in the English literature. PMID:25931843

  3. In vivo early diagnosis of gastric dysplasia using narrow-band image-guided Raman endoscopy

    NASA Astrophysics Data System (ADS)

    Huang, Zhiwei; Bergholt, Mads Sylvest; Zheng, Wei; Lin, Kan; Ho, Khek Yu; Teh, Ming; Yeoh, Khay Guan

    2010-05-01

    We first report on the implementation of a novel narrow-band image-guided Raman endoscopy technique for in vivo diagnosis of gastric dysplasia. High-quality in vivo Raman spectra can be acquired from normal and dysplastic gastric mucosal tissue within 0.5 sec under narrow-band image (NBI) guidance at gastroscopy. Significant differences are observed in in vivo Raman spectra between normal (n=54) and dysplastic (n=18) gastric tissue from 30 gastric patients, particularly in the spectral ranges of 825 to 950, 1000 to 1100, 1250 to 1500, and 1600 to 1800 cm-1, which primarily contain signals related to proteins, nucleic acids, and lipids. The multivariate analysis [i.e., principal components analysis (PCA) and linear discriminant analysis (LDA)], together with the leave-one tissue site-out, cross validation on in vivo gastric Raman spectra yields a diagnostic sensitivity of 94.4% (17/18) and specificity of 96.3% (52/54) for distinction of gastric dysplastic tissue. This study suggests that narrowband image-guided Raman endoscopy associated with PCA-LDA diagnostic algorithms has potential for the noninvasive, in vivo early diagnosis and detection of gastric precancer during clinical gastroscopic examination.

  4. Image enhancement of surface micro-structure on mucosa for polarimetric endoscopy

    NASA Astrophysics Data System (ADS)

    Kanamori, Katsuhiro

    2015-03-01

    This paper describes a novel image processing method for endoscopy that enhances the appearance of microstructures on mucosa. The new technique employs two pairs of parallel- and crossed-nicols polarimetric images, from which an averaged subtracted polarization image (AVSPI) is calculated. Experiments were first executed using a manual experimental setup with ring-type lighting, two rotating polarizers and a color camera. A new objective evaluation method that uses texture analysis (GLCM) was developed and applied to evaluation of the enhanced microstructure images. Experiments using excised porcine stomach tissue showed better results than with conventional color intensity image processing. Next, an online rigid-type polarimetric endoscope system using a polarized ring-shaped LED and a special three-CCD color polarimetric camera was developed. The two types of equipment described above are quite different as to extinction ratio values, but show similarly enhanced image quality. Our results show that polarimetric endoscopy is not only effective but also practical for hardware implementation.

  5. A 3D endoscopy reconstruction as a saliency map for analysis of polyp shapes

    NASA Astrophysics Data System (ADS)

    Ruano, Josue; Martínez, Fabio; Gómez, Martín.; Romero, Eduardo

    2015-01-01

    A first diagnosis of colorectal cancer is performed by examination of polyp shape and appearance during an endoscopy routine procedure. However, the video-endoscopy is highly noisy because exacerbated physiological conditions like increased motility or secretion may limit the visual analysis of lesions. In this work a 3D reconstruction of the digestive tract is proposed, facilitating the polyp shape evaluation by highlighting its surface geometry and allowing an analysis from different perspectives. The method starts by a spatio-temporal map, constructed to group the different regions of the tract by their similar dynamic patterns during the sequence. Then, such map was convolved with a second derivative of a Gaussian kernel that emulates the camera distortion and allows to highlight the polyp surface. The position initialization in each frame of the kernel was computed from expert manual delineation and propagated along the sequence based on. Results show reliable reconstructions, with a salient 3D polyp structure that can then be better observed.

  6. Discrimination between normal and cancerous cells by gap-FRAP: feasibility in endoscopy

    NASA Astrophysics Data System (ADS)

    Stines, Jean-Rene; Dumas, Dominique; Blondel, Walter; Didelon, Jacques; Guillemin, Francois

    2004-09-01

    Several reports show that cancerous cells are linked to early decrease in gap-junction number and functionality diminution. This precancerous phenomenon may be accessed by different fluorescence techniques and particularly by gap-FRAP technique (gap-junction fluorescence recovery after photobleaching). Measurements at cell or tissue scale allowed by this method lead to consider its potential interest in endoscopic technics applied to early cancer detection. Experiments were performed on HT-29 (human colon adenocarcinoma), MCF-7 (human breast cancer cell) and CCD-1137Sk (human Fibroblasts) in the presence of 5.6CFDA. Dye was bleached by laser light (488nm) during few seconds depending on the region of interest (one or fewer cells). Fluorescence recovery kinetic after photobleaching was measured by imaging and spectral analysis with a confocal laser scanning microscope as reference technique. Then, a microspectrofluorimeter was used in order to evaluate the faisability on a fiber optics based system offering measurement condition close to the tissue clinical endoscopy conditions.Preliminary results obtained on the various cells lines show significant differences in kinetics for normal and cancerous cells. We have shown that CCD-1137Sk line cells possess functional communicating junctions, contrary to the carcinogenic HT-29 and MCF-7 cells. Results obtained by microspectrofluorimetry are related to confocal microscopes ones confirming the feasibility in endoscopy.

  7. Integrated micro-endoscopy system for simultaneous fluorescence and optical-resolution photoacoustic imaging

    NASA Astrophysics Data System (ADS)

    Shao, Peng; Shi, Wei; Hajireza, Parsin; Zemp, Roger J.

    2012-07-01

    We present a new integrated micro-endoscopy system combining label-free, fiber-based, real-time C-scan optical-resolution photoacoustic microscopy (F-OR-PAM) and a high-resolution fluorescence micro-endoscopy system for visualizing fluorescently labeled cellular components and optically absorbing microvasculature simultaneously. With a diode-pumped 532-nm fiber laser, the F-OR-PAM sub-system is able to reach a resolution of ~7 ?m. The fluorescence subsystem, which does not require any mechanical scanning, consists of a 447.5-nm-centered diode laser as the light source, an objective lens, and a CCD camera. Proflavine is used as the fluorescent contrast agent by topical application. The scanning laser and the diode laser light source share the same light path within an optical fiber bundle containing 30,000 individual single-mode fibers. The absorption of proflavine at 532 nm is low, which mitigates absorption bleaching of the contrast agent by the photoacoustic excitation source. We demonstrate imaging in live murine models. The system is able to provide cellular morphology with cellular resolution co-registered with the structural information given by F-OR-PAM. Therefore, the system has the potential to serve as a virtual biopsy technique, helping visualize angiogenesis and the effects of anti-cancer drugs on both cells and the microcirculation, as well as aid in the study of other diseases.

  8. Colon capsule endoscopy: What we know and what we would like to know.

    PubMed

    Spada, Cristiano; Barbaro, Federico; Andrisani, Gianluca; Minelli Grazioli, Leonardo; Hassan, Cesare; Costamagna, Isabella; Campanale, Mariachiara; Costamagna, Guido

    2014-12-01

    Colonoscopy is usually perceived as an invasive and potentially painful procedure, being also affected by a small, but definite, risk of major complications (cardiopulmonary complications, perforation, hemorrhage) and even mortality. To improve both acceptability and safety, PillCam Colon Capsule Endoscopy (CCE) (Given Imaging Ltd, Yoqneam, Israel) has been developed. CCE represents a non-invasive technique that is able to explore the colon without sedation and air insufflation. The Second Generation of Colon Capsule Endoscopy (PillCam Colon 2) (CCE-2) was proven to be an accurate tool to detect colonic neoplastic lesions when used in average risk individuals. To date, the evidence supports the use of CCE-2 in case of colonoscopy failure, in patients unwilling to perform colonoscopy and when colonoscopy is contraindicated. Other potential applications, such as colorectal cancer screening or diagnostic surveillance of inflammatory bowel disease need to be clarified. In this paper, the current "state of the art", potential application of CCE and future needs are evaluated. PMID:25493007

  9. Colon capsule endoscopy: What we know and what we would like to know

    PubMed Central

    Spada, Cristiano; Barbaro, Federico; Andrisani, Gianluca; Minelli Grazioli, Leonardo; Hassan, Cesare; Costamagna, Isabella; Campanale, Mariachiara; Costamagna, Guido

    2014-01-01

    Colonoscopy is usually perceived as an invasive and potentially painful procedure, being also affected by a small, but definite, risk of major complications (cardiopulmonary complications, perforation, hemorrhage) and even mortality. To improve both acceptability and safety, PillCam Colon Capsule Endoscopy (CCE) (Given Imaging Ltd, Yoqneam, Israel) has been developed. CCE represents a non-invasive technique that is able to explore the colon without sedation and air insufflation. The Second Generation of Colon Capsule Endoscopy (PillCam Colon 2) (CCE-2) was proven to be an accurate tool to detect colonic neoplastic lesions when used in average risk individuals. To date, the evidence supports the use of CCE-2 in case of colonoscopy failure, in patients unwilling to perform colonoscopy and when colonoscopy is contraindicated. Other potential applications, such as colorectal cancer screening or diagnostic surveillance of inflammatory bowel disease need to be clarified. In this paper, the current “state of the art”, potential application of CCE and future needs are evaluated. PMID:25493007

  10. Roles and Regulation of Gastrointestinal Eosinophils in Immunity and Disease

    PubMed Central

    Jung, YunJae; Rothenberg, Marc E.

    2014-01-01

    Eosinophils have been considered to be destructive end-stage effector cells that have a role in parasitic infections and allergy reactions by the release of their granule-derived cytotoxic proteins. However, an increasing number of experimental observations indicate that eosinophils also are multifunctional leukocytes involved in diverse inflammatory and physiologic immune responses. Under homeostatic conditions, eosinophils are particularly abundant in the lamina propria of the gastrointestinal tract where their involvement in various biological processes within the gastrointestinal tract has been posited. In this review, we summarize the molecular steps involved in eosinophil development and describe eosinophil trafficking to the gastrointestinal tract. We synthesize the current findings on the phenotypic and functional properties of gastrointestinal eosinophils and the accumulating evidence that they have a contributory role in gastrointestinal disorders, with a focus on primary eosinophilic gastrointestinal disorders. Finally, we discuss the potential role of eosinophils as modulators of the intestinal immune system. PMID:25049430

  11. Laser endoscopy.

    PubMed

    McElvein, R B

    1981-11-01

    A carbon dioxide laser operating in the invisible infrared range (10.6 mu) generates a beam of energy that is almost completely absorbed by biological tissue with release of intense heat and rapid destruction. A laser attached to a rigid bronchoscope has been used in 18 patients ranging in age from 21 to 62 years to treat a variety of causes of airway obstruction. These include tracheal stenosis and granulation tissue (6 patients), adenoma (1), web (2), and carcinoma (9). The results were good in 15 and poor in 3 patients. However, all patients had an improved airway after laser treatment with the best results occurring in patients with benign, inflammatory disease. The advantages of the laser are a lack of bleeding, minimal edema after treatment, and minimal scar formation. The disadvantages are the expense of the machine, and the need for general anesthesia and direct visualization of the lesion. PMID:6796011

  12. Confocal endoscopy

    NASA Astrophysics Data System (ADS)

    Karadaglic, Dejan; Juskaitis, Rimas; Wilson, Tony

    2003-07-01

    We describe a simple modification to a rigid endoscope so as to provide both high quality conventional endoscopic as well as and confocal endoscopic images of reasonably accessible regions of the body in real time. The systems are based around either host lenslet-array tandem scanning microscope together with laser illumination or a structured illumination approach together with a conventional incoherent illumination source. Images taken in fluorescence are presented using this combined conventional and confocal endoscope.

  13. Management of Severe Gastrointestinal Tuberculosis with Injectable Antituberculous Drugs

    PubMed Central

    Goldani, Luciano Z.; Spessatto, Camila O.; Nunes, Daltro L.; Oliveira, Juliana G.; Takamatu, Eliziane; Cerski, Carlos T.; Goldani, Helena A. S.

    2015-01-01

    Abdominal tuberculosis (TB) is generally responsive to medical treatment, and early diagnosis and management can prevent unnecessary surgical intervention. However, intravenous therapy is needed for severe forms of tuberculosis with extensive gastrointestinal involvement. The authors report an immunocompetent patient with gastrointestinal TB who was successfully managed with a combination of surgical intervention and anti-TB medications, and discuss the importance of injectable anti-TB medications in the management of severe gastrointestinal TB. The present case report provides a model for assessment and intervention in severe forms of gastrointestinal TB. PMID:26543395

  14. Bleeding Jejunal GIST: An uncommon cause of Gastrointestinal Bleeding.

    PubMed

    Mohanaraj, T; Hanif, H; Zainal, A A

    2015-02-01

    Gastrointestinal stromal tumours (GIST) are rare gastrointestinal tumours and are one of the causes of obscure gastrointestinal bleeding. We report a case of massive gastrointestinal bleeding secondary to bleeding jejunal GIST in a 43 years old gentleman. Endoscopic intervention failed to identify the source of bleeding and CT Angiography (CTA) showed a jejunal mass and patient underwent laparotomy and resection of the bleeding jejunal GIST. This article highlights the rare cause of the massive GI bleeding and also emphasise the role of CTA in obscure GI bleeding. PMID:26032526

  15. Polyarteritis nodosa presenting as massive upper gastrointestinal hemorrhage.

    PubMed

    Perez, R A; Silver, D; Banerjee, B

    2000-01-01

    We report the first case of massive upper gastrointestinal hemorrhage as the initial presentation of polyarteritis nodosa (PAN), which is an uncommon form of systemic necrotizing vasculitis that may involve many organ systems and could affect any age group. Abdominal pain is the most common sign of gastrointestinal involvement. Gastrointestinal bleeding occurs less frequently in approximately 6% of cases. Reported cases of gastrointestinal hemorrhage have been in the form of coffee ground emesis, melena, or hematochezia. Such bleeding complications have resulted from ischemic ulceration or perforation of the small or large intestine. However, we are unaware of previous reports showing massive hematemesis to be the initial presentation of PAN. PMID:10854517

  16. Gastrointestinal imaging-practical magnetic resonance imaging approach

    PubMed Central

    Liu, Baodong; Ramalho, Miguel; AlObaidy, Mamdoh; Busireddy, Kiran K; Altun, Ersan; Kalubowila, Janaka; Semelka, Richard C

    2014-01-01

    Over the past two decades, advances in cross-sectional imaging such as computed tomography and magnetic resonance imaging (MRI) have dramatically changed the concept of gastrointestinal imaging. MR is playing an increasing role in the evaluation of gastrointestinal disorders. MRI combines the advantages of excellent soft-tissue contrast, noninvasiveness, functional information and lack of ionizing radiation. Furthermore, recent developments of MRI have led to improved spatial and temporal resolution as well as decreased motion artifacts. In this article we describe the technical aspects of gastrointestinal MRI and present a practical approach for a well-known spectrum of gastrointestinal disease processes. PMID:25170393

  17. Gastrointestinal motility in space motion sickness

    NASA Technical Reports Server (NTRS)

    Thornton, William E.; Linder, Barry J.; Moore, Thomas P.; Pool, Sam L.

    1987-01-01

    Gastrointestinal symptoms in space motion sickness (SMS) are significantly different from those in ordinary motion sickness (MS). Recording and tabulation of sounds was the only technique that could be used as a measure of motility during spaceflight operations. There were 17 subjects, six unaffected by SMS, who made ambulatory recordings preflight and inflight. With one exception, all those affected had sharply reduced sounds, while those unaffected had increases or moderate reductions. The mechanism of vomiting in SMS appears to be secondary to this ileus, in contrast to vomiting in ordinary MS, where the emesis center is thought to be directly triggered by the vestibular system.

  18. Systemic Therapies for Advanced Gastrointestinal Carcinoid Tumors.

    PubMed

    Mulvey, Claire K; Bergsland, Emily K

    2016-02-01

    Well-differentiated gastrointestinal neuroendocrine tumors (GINETs) tend to be slow growing, but treatment of advanced disease remains a challenge. Somatostatin analogues (SSAs) are considered standard therapy for carcinoid syndrome. SSAs delay tumor progression in advanced well-differentiated gastroenteropancreatic NETs. Cytotoxic chemotherapy and interferon play a limited role in the treatment of nonpancreatic GINETs. There is no standard approach to treatment of patients with disease progression. Identification of systemic agents with antitumor activity in advanced disease remains an unmet medical need. Enrollment to clinical trials is encouraged; potential therapeutic targets include the vascular endothelial growth factor and mammalian target of rapamycin signaling pathways. PMID:26614369

  19. Gastrointestinal metastases from extra-abdominal tumors.

    PubMed

    Telerman, A; Gerard, B; Van den Heule, B; Bleiberg, H

    1985-05-01

    Over a period of 4 years, metastatic lesions to the gastrointestinal tract were analysed in postmortem and clinical series. Melanoma, breast and lung cancers were the most common primary lesions. The topography of parietal involvement shows that all patients evidenced tumor involvement of the submucosa, but not all of them revealed invasion of the mucosa and serosa, suggesting a hematogenous route of dissemination. Although almost all cases had widespread disease at the time of referral for diagnosis, patients who were submitted to surgery had a median survival of 8 months (range 1-48). In selected cases, surgery offers good palliation and may permit resumption of otherwise active chemotherapeutic treatments. PMID:4006875

  20. [The Most Common Acute Gastrointestinal Infections].

    PubMed

    Greuter, Thomas; Magdeburg, Bernhard

    2015-10-14

    Acute gastrointestinal infections and diarrhea with vomiting as its main presentation are a frequently encountered entity in an outpatient setting. Due to a mostly self-limiting disease course a diagnostic work-up is often futile. Viral infections caused by Noro- or Rotavirus are most frequent, while bacterial infections are second line due to high hygienic standards in developed countries. In an inpatient setting and after a precedent antibiotic treatment one should think of clostridium difficile. Traveler’s diarrhea represents a special case, with most of the cases caused by enterovirulent E. coli. In this mini review we describe the most important pathogens in detail. PMID:26463905

  1. IEEE TRANSACTIONS ON MEDICAL IMAGING --FINAL MANUSCRIPT 2004-0117 1 Interactive Virtual Endoscopy in Coronary Arteries

    E-print Network

    Wahle, Andreas

    in Coronary Arteries based on Multi-Modality Fusion Andreas Wahle, Senior Member, IEEE, Mark E. Olszewski-independent virtual endoscopy in human coronary arteries is presented in this pa- per. It incorporates previously results in a three- or four-dimensional (3-D/4-D) model of a coronary artery, specifically of its lumen

  2. Identification of obstructive sites and patterns in obstructive sleep apnoea syndrome by sleep endoscopy in 614 patients.

    PubMed

    Salamanca, F; Costantini, F; Bianchi, A; Amaina, T; Colombo, E; Zibordi, F

    2013-08-01

    The aim of this study was to analyze and report sites and patterns of obstruction observed during sleep endoscopy in a large group of patients and suggest consequent therapeutic prescriptions. 614 consecutive patients who approached the Centre for Diagnosis and Treatment of Respiratory Sleep Disorders underwent sleep endoscopy. We used propofol to induce sleep, monitoring the value of bispectral index to evaluate the depth of sedation. For each patient, we recorded obstruction sites,obstruction patterns and the effects of the mandibular pull-up manoeuvre on both obstruction and snoring. We ascertained that, in almost all patients, the noise of snoring was generated at the oropharyngeal level. The obstruction at the oropharyngeal level, either in isolation or in combination with other structures, is far more common. The mandibular pull-up manoeuvre was effective in reducing or resolving the obstruction in a large number of patients, even though their AHI values were high. For those patients having an AHI over 15, we point out the various therapeutic indications gained from the sleep endoscopy examinations. Drug-induced (propofol) sleep endoscopy can be considered be a safe procedure, easily practicable, valid and reliable; we therefore consider it a fundamental clinical investigation that can be essential when choosing treatment. PMID:24043914

  3. Real-time depth-resolved fiber optic Raman endoscopy for in vivo diagnosis of gastric precancer

    NASA Astrophysics Data System (ADS)

    Bergholt, Mads S.; Zheng, Wei; Ho, Khek Yu; Yeoh, Khay Guan; Teh, Ming; So, Jimmy B. Y.; Huang, Zhiwei

    2014-03-01

    Raman spectroscopy represents a unique optical vibrational technique based on the fundamental premise of inelastic light scattering. Raman spectroscopy enables histopathological assessment at the biomolecular level. We have developed a fiber-optic depth-resolved near-infrared (NIR) Raman endoscopy technique integrated with on-line diagnostic algorithms for in vivo real-time epithelial diagnostics under multimodal wide-field imaging (i.e., white light reflectance (WLR), narrow-band imaging (NBI), autofluorescence imaging (AFI)) modalities. A selection of 450 patients who previously underwent Raman endoscopy (n=1900 spectra) was used to render diagnostic models for identifying gastric precancer (i.e., dysplasia) based on probabilistic partial least squares (PLS) - discriminant analysis (DA). The on-line Raman endoscopy technique was tested prospectively on (n=5) patients for real-time in vivo gastric epithelium tissue diagnosis. The fiber-optic confocal Raman endoscopic technique developed could prospectively identify gastric dysplasia in real-time with a sensitivity: 81.3% (61/75) and specificity 88.3% (188/213) on spectrum basis. On lesion basis, all dysplastic lesions were identified. This study successfully demonstrates for the first time the prospective real-time in vivo diagnosis of gastric precancer using depth-resolved Raman endoscopy.

  4. 3rd caesarium Computer Aided Medicine Bonn, Germany, November 12-13, 2001 Integration of Navigation, Optical and Virtual Endoscopy

    E-print Network

    Bartz, Dirk

    of Navigation, Optical and Virtual Endoscopy in Neurosurgery and Oral and Maxillofacial Surgery Dirk Bartz1 Hospital T¨ubingen 4Department of Oral and Maxillofacial Surgery, University Hospital T¨ubingen Email-operative navigation are already used in the departments of neurosurgery [5, 6] and oral and maxillofacial surgery [8

  5. Small-bowel mucosal injuries in low-dose aspirin users with obscure gastrointestinal bleeding

    PubMed Central

    Iwamoto, Junichi; Mizokami, Yuji; Saito, Yoshifumi; Shimokobe, Koichi; Honda, Akira; Ikegami, Tadashi; Matsuzaki, Yasushi

    2014-01-01

    AIM: To investigate the clinical differences between small intestinal injuries in low-dose aspirin (LDA) users and in non-steroidal anti-inflammatory drug (NSAID) users who were examined by capsule endoscopy (CE) for obscure gastrointestinal bleeding (OGIB). METHODS: A total of 181 patients who underwent CE for OGIB were included in this study. Based on clinical records, laboratory data such as hemoglobin levels, major symptoms, underlying diseases, the types and duration of LDA and NSAID use, and endoscopic characteristics of CE were reviewed. RESULTS: Out of a total of 45 cases of erosive lesions, 27 cases were taking LDA or NSAIDs (7 were on NSAIDs, 9 were on LDA alone, 9 were on LDA and thienopyridine, and 2 were on LDA and warfarin).The prevalence of ulcers or erosion during chronic use of LDA, LDA and the anti-platelet drug thienopyridine (clopidogrel or ticlopidine), and NSAIDs were 64.3%, 80.0%, and 75.0%, respectively. Erosive lesions were observed predominantly in chronic LDA users, while ulcerative lesions were detected mainly in NSAID users. However, concomitant use of thienopyridine such as clopidogrel with LDA increased the proportion of ulcers. The erosive lesions were located in the whole of the small intestine (jejunum and ileum), whereas ulcerative lesions were mainly observed in the ileum (P < 0.05). CONCLUSION: Our CE findings indicate that chronic LDA users and NSAID users show different types and locations of small-bowel mucosal injuries. The concomitant use of anti-platelet drugs with LDA tends to exacerbate the injuries from LDA-type to NSAID-type injuries. PMID:25278707

  6. Using an ‘action set’ for the management of acute upper gastrointestinal bleeding

    PubMed Central

    Murray, Charles; Hamilton, Mark; Epstein, Owen; Negus, Rupert; Peachey, Tim; Kaul, Arvind; O’Beirne, James

    2013-01-01

    Background: We studied the management of patients with acute upper gastrointestinal (GI) bleeding (AUGIB) at the Royal Free Hospital. The aim was to compare our performance with the national standard and determine ways of improving the delivery of care in accordance with the recently published ‘Scope for improvement’ report. Methods: We randomly selected patients who presented with haematemesis, melaena, or both, and had an oesophageogastroduodenoscopy (OGD) between April and October 2009. We developed local guidelines and presented our findings in various forums. We collaborated with the British Medical Journal’s Evidence Centre and Cerner Millennium electronic patient record system to create an electronic ‘Action Set’ for the management of patients presenting with AUGIB. We re-audited using the same standard and target. Results: With the action set, documentation of pre-OGD Rockall scores increased significantly (p ? 0.0001). The differences in the calculation and documentation of post-OGD full Rockall scores were also significant between the two audit loops (p = 0.007). Patients who inappropriately received proton-pump inhibitors (PPIs) before endoscopy were reduced from 73.8% to 33% (p = 0.02). Patients receiving PPIs after OGD were also reduced from 66% to 50% (p = 0.01). Discharges of patients whose full Rockall score was less than or equal to two increased from 40% to 100% (p = 0.43). Conclusion: The use of the Action Set improved calculation and documentation of risk scores and facilitated earlier hospital discharge for low-risk patients. Significant improvements were also seen in inappropriate use of PPIs. Actions sets can improve guideline adherence and can potentially promote cost-cutting and improve health economics. PMID:24179478

  7. A population based study of Helicobacter pylori infection in a European country: the San Marino Study. Relations with gastrointestinal diseases.

    PubMed Central

    Gasbarrini, G; Pretolani, S; Bonvicini, F; Gatto, M R; Tonelli, E; Mégraud, F; Mayo, K; Ghironzi, G; Giulianelli, G; Grassi, M

    1995-01-01

    Helicobacter pylori is present worldwide but few large population studies exist on the epidemiology of the infection. A random cross sectional study was performed of H pylori infection in the adult population of San Marino, a European country with high gastric cancer rate, to assess its prevalence and to evaluate its relations with gastrointestinal disease. In 2237 subjects (77% of the initial sample) H pylori IgG antibodies were detected with enzyme linked immunosorbent assay (ELISA) and immunoblotting. A questionnaire including questions about occupation, place of birth, and smoking was given to all subjects. Dyspepsia, peptic ulcer, and gastric cancer in the subjects, relatives, and partners as well as use of drug, dental treatment/prostheses, and gastrointestinal endoscopies, were evaluated by multivariate analysis. H pylori prevalence was of 51%, increased with age from 23% (20-29 years) to 68% (> or = 70 years), and was higher among manual workers. H pylori was independently associated with ulcer (OR = 1.63, 95% confidence intervals (CI) = 1.16 to 2.27), H2 antagonists (OR = 1.94, 95% CI = 1.21 to 3.10), and benzodiazepines (OR = 1.57, 95% CI = 1.02 to 2.42), dental prostheses (OR = 1.25, 95% CI = 1.05 to 1.49), gastroscopy in the past five years (OR = 1.50, 95% CI = 1.05 to 2.14), peptic ulcer in siblings (OR = 1.52, 95% CI = 1.09 to 2.12), gastric cancer in father (OR = 1.61, 95% CI = 1.02 to 2.52). The association of seropositivity with history of ulcer, gastric cancer in family, gastroscopy, and H2 antagonists suggests that H pylori is an epidemiological key factor in the pathogenesis of gastroduodenal diseases in this area. PMID:7615270

  8. Novel treatment options for perforations of the upper gastrointestinal tract: endoscopic vacuum therapy and over-the-scope clips.

    PubMed

    Mennigen, Rudolf; Senninger, Norbert; Laukoetter, Mike G

    2014-06-28

    Endoscopic management of leakages and perforations of the upper gastrointestinal tract has gained great importance as it avoids the morbidity and mortality of surgical intervention. In the past years, covered self-expanding metal stents were the mainstay of endoscopic therapy. However, two new techniques are now available that enlarge the possibilities of defect closure: endoscopic vacuum therapy (EVT), and over-the-scope clip (OTSC). EVT is performed by mounting a polyurethane sponge on a gastric tube and placing it into the leakage. Continuous suction is applied via the tube resulting in effective drainage of the cavity and the induction of wound healing, comparable to the application of vacuum therapy in cutaneous wounds. The system is changed every 3-5 d. The overall success rate of EVT in the literature ranges from 84% to 100%, with a mean of 90%; only few complications have been reported. OTSCs are loaded on a transparent cap which is mounted on the tip of a standard endoscope. By bringing the edges of the perforation into the cap, by suction or by dedicated devices, such as anchor or twin grasper, the OTSC can be placed to close the perforation. For acute endoscopy associated perforations, the mean success rate is 90% (range: 70%-100%). For other types of perforations (postoperative, other chronic leaks and fistulas) success rates are somewhat lower (68%, and 59%, respectively). Only few complications have been reported. Although first reports are promising, further studies are needed to define the exact role of EVT and OTSC in treatment algorithms of upper gastrointestinal perforations. PMID:24976714

  9. Evaluation of anesthesia management, feasibility and efficacy of peroral endoscopic myotomy (POEM) for achalasia performed in the endoscopy unit

    PubMed Central

    Yang, Dennis; Pannu, Davinderbir; Zhang, Qing; White, Jeffrey D.; Draganov, Peter V.

    2015-01-01

    Introduction: Data on anesthesia management and outcomes associated with peroral endoscopic myotomy (POEM) performed exclusively in the endoscopy unit are limited. In this prospective study, we evaluated the safety of anesthesia management, and the feasibility and efficacy of POEM performed exclusively in the endoscopy unit. Methods: A single-center prospective study of consecutive patients with achalasia treated with POEM in an endoscopy unit was performed. Safety of anesthesia management and POEM were determined by procedure-related adverse events. Feasibility was assessed by completion rate. Short-term efficacy was established by clinical success (Eckardt score ??3) and by comparing Eckardt and dysphagia scores before and after POEM. Results: Patients (n?=?52) underwent POEM under general anesthesia with endotracheal intubation and positive pressure ventilation. Aspiration was prevented by keeping patients on a clear liquid diet before the procedure without requiring a prior esophagogastroduodenoscopy for esophageal content clearance. POEM completion rate was 96?% (50/52 patients). There was no post-POEM bleeding. Postprocedure leak was observed in one patient (3?%). Four patients (7.7?%) experienced mucosal injury, three of them were treated uneventfully endoscopically and one required laparoscopic repair. Clinical success was achieved in 88?% of patients. There was a significant decrease in the mean Eckardt score (8.1 to 1.4) and dysphagia score (2.4 to 0.4) (P?endoscopy unit and aspiration can be prevented without requiring prior esophagogastroduodenoscopy for esophageal content clearance. Overall, POEM performed by a gastroenterologist in the endoscopy unit was feasible and effective for the treatment of achalasia. PMID:26357672

  10. 78 FR 6404 - Agency Information Collection (Survey of Chronic Gastrointestinal Illness in Persian Gulf...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-30

    ...Collection (Survey of Chronic Gastrointestinal Illness in Persian Gulf Veterans...Titles: a. Survey of Chronic Gastrointestinal Illness in Persian Gulf Veterans...determining whether chronic gastrointestinal illness in Persian Gulf...

  11. 77 FR 64597 - Proposed Information Collection (Survey of Chronic Gastrointestinal Illness in Persian Gulf...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-22

    ...Collection (Survey of Chronic Gastrointestinal Illness in Persian Gulf Veterans...10-2109b. c. Survey of Chronic Gastrointestinal Illness in Persian Gulf Veterans...determining whether chronic gastrointestinal illness in Persian Gulf...

  12. Botulinum Toxin and Gastrointestinal Tract Disorders

    PubMed Central

    Weiser, Kirsten; Kennedy, Abigail

    2008-01-01

    The history of botulinum toxin is fascinating. First recognized as the cause of botulism nearly 200 years ago, it was originally feared as a deadly poison. Over the last 30 years, however, botulinum toxin has been transformed into a readily available medication used to treat a variety of medical disorders. Interest in the use of botulinum toxin has been particularly strong for patients with spastic smooth muscle disorders of the gastrointestinal tract. Patients with achalasia, diffuse esophageal spasm, gastroparesis, sphincter of Oddi dysfunction, and anal fissures have all been treated with botulinum toxin injections, often with impressive results. However, not all patients respond to botulinum toxin therapy, and large randomized controlled trials are lacking for many conditions commonly treated with botulinum toxin. This paper reviews the history, microbiology, and pharmacology of botulinum toxin, discusses its mechanism of action, and then presents recent evidence from the literature regarding the use of botulinum toxin for the treatment of a variety of gastrointestinal tract disorders. PMID:21960915

  13. Acupuncture and regulation of gastrointestinal function

    PubMed Central

    Li, Hui; He, Tian; Xu, Qian; Li, Zhe; Liu, Yan; Li, Fang; Yang, Bo-Feng; Liu, Cun-Zhi

    2015-01-01

    In China, acupuncture has been considered an effective method for treating gastrointestinal (GI) dysfunction diseases for thousands of years. In fact, acupuncture has gained progressive acceptance from both practitioners and patients worldwide. However, the therapeutic effects and underlying mechanisms in treating GI dysfunction have not yet been established due to a lack of systematic and comprehensive review articles. Therefore, the aim of this review is to discuss the efficacy of acupuncture as a treatment for GI dysfunction and the associated underlying mechanisms. A search of PubMed was conducted for articles that were published over the past 10 years using the terms “acupuncture”, “gastrointestine”, and other relevant keywords. In the following review, we describe the effect and underlying mechanisms of acupuncture on GI function from the perspectives of GI motility, visceral sensitivity, the GI barrier, and the brain-gut axis. The dual regulatory effects of acupuncture may manifest by promoting gastric peristalsis in subjects with low initial gastric motility, and suppressing peristalsis in subjects with active initial motility. In addition, the regulation of acupuncture on gastric motility may be intensity-dependent. Our findings suggest that further studies are needed to investigate the effects and more systematic mechanisms in treating GI dysfunction, and to promote the application of acupuncture for the treatment of GI diseases. PMID:26217082

  14. Cutaneous manifestations of gastrointestinal disease: part II.

    PubMed

    Thrash, Breck; Patel, Mahir; Shah, Kejal R; Boland, C Richard; Menter, Alan

    2013-02-01

    The gastrointestinal (GI) and cutaneous organ systems are closely linked. In part I of this continuing medical education article, the intricacies of this relationship were explored as they pertained to hereditary polyposis disorders, hamartomatous disorders, and paraneoplastic disease. Part II focuses on the cutaneous system's links to inflammatory bowel disease and vascular disorders. An in-depth analysis of inflammatory bowel disease skin findings is provided to aid dermatologists in recognizing and facilitating early consultation and intervention by gastroenterologists. Cutaneous signs of inflammatory bowel disease include fissures and fistulae, erythema nodosum, pyoderma gangrenosum, pyostomatitis vegetans, oral aphthous ulcers, cutaneous polyarteritis nodosa, necrotizing vasculitis, and epidermolysis bullosa acquisita. Additional immune-mediated conditions, such as diverticulitis, bowel-associated dermatosis-arthritis syndrome, Henoch-Schönlein purpura, dermatitis herpetiformis, and Degos disease, in which the skin and GI system are mutually involved, will also be discussed. Genodermatoses common to both the GI tract and the skin include Hermansky-Pudlak syndrome, pseudoxanthoma elasticum, Ehlers-Danlos syndrome, hereditary hemorrhagic telangiectasia, and blue rubber bleb nevus syndrome. Kaposi sarcoma is a neoplastic disease with lesions involving both the skin and the gastrointestinal tract. Acrodermatitis enteropathica, a condition of zinc deficiency, likewise affects both the GI and dermatologic systems. These conditions are reviewed with updates on the genetic basis, diagnostic and screening modalities, and therapeutic options. Finally, GI complications associated with vascular disorders will also be discussed. PMID:23317981

  15. Toxic trace elements at gastrointestinal level.

    PubMed

    Vázquez, M; Calatayud, M; Jadán Piedra, C; Chiocchetti, G M; Vélez, D; Devesa, V

    2015-12-01

    Many trace elements are considered essential [iron (Fe), zinc (Zn), copper (Cu)], whereas others may be harmful [lead (Pb), cadmium (Cd), mercury (Hg), arsenic (As)], depending on their concentration and chemical form. In most cases, the diet is the main pathway by which they enter our organism. The presence of toxic trace elements in food has been known for a long time, and many of the food matrices that carry them have been identified. This has led to the appearance of legislation and recommendations concerning consumption. Given that the main route of exposure is oral, passage through the gastrointestinal tract plays a fundamental role in their entry into the organism, where they exert their toxic effect. Although the digestive system can be considered to be of crucial importance in their toxicity, in most cases we do not know the events that occur during the passage of these elements through the gastrointestinal tract and of ascertaining whether they may have some kind of toxic effect on it. The aim of this review is to summarize available information on this subject, concentrating on the toxic trace elements that are of greatest interest for organizations concerned with food safety and health: Pb, Cd, Hg and As. PMID:26482641

  16. Psychosocial aspects of the functional gastrointestinal disorders

    PubMed Central

    Drossman, D; Creed, F; Olden, K; Svedlund, J; Toner, B; Whitehead, W

    1999-01-01

    The functional gastrointestinal disorders (FGID) are the most frequent conditions seen in gastroenterology practice and comprise a major portion of primary care. Psychosocial factors are important in these disorders with regard to: (1) their effects on gut physiology; (2) their modulation of the symptom experience; (3) their influence on illness behavior; (4) their impact on outcome; and (5) the choice of the therapeutic approach. This paper provides a review and consensus of the existing literature by gastroenterologists, psychiatrists, psychologists, physiologists, and health services investigators. Evidence is provided to support the biopsychosocial model as a basis for understanding and treating these disorders, and epidemiological and clinical information on the relations of psychosocial factors to gut physiology, symptom presentation, health behavior, and outcome is offered. Features of motility, personality, abuse history, health concerns, and treatment-seeking differ between patients with FGID and healthy controls, but they are not specific to FGID. They occur in other patients with chronic medical conditions and/or psychiatric disorders. Review of treatment trials indicates clear support for psychotherapeutic treatments, especially in the long term, as well as some evidence for the benefit of antidepressants in FGID, even in the absence of improvements in mood.???Keywords: functional gastrointestinal disorders; psychologic assessment; psychiatric diagnosis; psychosocial factors; health-related quality of life; psychological treatment; psychopharmacological treatment; Rome II PMID:10457041

  17. Gastroesophageal reflux and congenital gastrointestinal malformations

    PubMed Central

    Marseglia, Lucia; Manti, Sara; D’Angelo, Gabriella; Gitto, Eloisa; Salpietro, Carmelo; Centorrino, Antonio; Scalfari, Gianfranco; Santoro, Giuseppe; Impellizzeri, Pietro; Romeo, Carmelo

    2015-01-01

    Although the outcome of newborns with surgical congenital diseases (e.g., diaphragmatic hernia; esophageal atresia; omphalocele; gastroschisis) has improved rapidly with recent advances in perinatal intensive care and surgery, infant survivors often require intensive treatment after birth, have prolonged hospitalizations, and, after discharge, may have long-term sequelae including gastro-intestinal comorbidities, above all, gastroesophageal reflux (GER). This condition involves the involuntary retrograde passage of gastric contents into the esophagus, with or without regurgitation or vomiting. It is a well-recognized condition, typical of infants, with an incidence of 85%, which usually resolves after physiological maturation of the lower esophageal sphincter and lengthening of the intra-abdominal esophagus, in the first few months after birth. Although the exact cause of abnormal esophageal function in congenital defects is not clearly understood, it has been hypothesized that common (increased intra-abdominal pressure after closure of the abdominal defect) and/or specific (e.g., motility disturbance of the upper gastrointestinal tract, damage of esophageal peristaltic pump) pathological mechanisms may play a role in the etiology of GER in patients with birth defects. Improvement of knowledge could positively impact the long-term prognosis of patients with surgical congenital diseases. The present manuscript provides a literature review focused on pathological and clinical characteristics of GER in patients who have undergone surgical treatment for congenital abdominal malformations. PMID:26229394

  18. 5-Hydroxytryptamine (serotonin) in the gastrointestinal tract

    PubMed Central

    Gershon, Michael D.

    2013-01-01

    Purpose of review Although the gut contains most of the body’s 5-hydroxytryptamine (5-HT), many of its most important functions have recently been discovered. This review summarizes and directs attention to this new burst of knowledge. Recent findings Enteroendocrine cells have classically been regarded as pressure sensors, which secrete 5-HT to initiate peristaltic reflexes; nevertheless, recent data obtained from studies of mice that selectively lack 5-HT either in enterochromaffin cells (deletion of tryptophan hydroxylase 1 knockout; TPH1KO) or neurons (TPH2KO) imply that neuronal 5-HT is more important for constitutive gastrointestinal transit than that of enteroendocrine cells. The enteric nervous system of TPH2KO mice, however, also lacks a full complement of neurons; therefore, it is not clear whether slow transit in TPH2KO animals is due to their neuronal deficiency or absence of serotonergic neurotransmission. Neuronal 5-HT promotes the growth/maintenance of the mucosa as well as neurogenesis. Enteroendocrine cell derived 5-HT is an essential component of the gastrointestinal inflammatory response; thus, deletion of the serotonin transporter increases, whereas TPH1KO decreases the severity of intestinal inflammation. Enteroendocrine cell derived 5-HT, moreover, is also a hormone, which inhibits osteoblast proliferation and promotes hepatic regeneration. Summary New studies show that enteric 5-HT is a polyfunctional signalling molecule, acting both in developing and mature animals as a neurotransmitter paracrine factor, endocrine hormone and growth factor. PMID:23222853

  19. Gastroesophageal reflux and congenital gastrointestinal malformations.

    PubMed

    Marseglia, Lucia; Manti, Sara; D'Angelo, Gabriella; Gitto, Eloisa; Salpietro, Carmelo; Centorrino, Antonio; Scalfari, Gianfranco; Santoro, Giuseppe; Impellizzeri, Pietro; Romeo, Carmelo

    2015-07-28

    Although the outcome of newborns with surgical congenital diseases (e.g., diaphragmatic hernia; esophageal atresia; omphalocele; gastroschisis) has improved rapidly with recent advances in perinatal intensive care and surgery, infant survivors often require intensive treatment after birth, have prolonged hospitalizations, and, after discharge, may have long-term sequelae including gastro-intestinal comorbidities, above all, gastroesophageal reflux (GER). This condition involves the involuntary retrograde passage of gastric contents into the esophagus, with or without regurgitation or vomiting. It is a well-recognized condition, typical of infants, with an incidence of 85%, which usually resolves after physiological maturation of the lower esophageal sphincter and lengthening of the intra-abdominal esophagus, in the first few months after birth. Although the exact cause of abnormal esophageal function in congenital defects is not clearly understood, it has been hypothesized that common (increased intra-abdominal pressure after closure of the abdominal defect) and/or specific (e.g., motility disturbance of the upper gastrointestinal tract, damage of esophageal peristaltic pump) pathological mechanisms may play a role in the etiology of GER in patients with birth defects. Improvement of knowledge could positively impact the long-term prognosis of patients with surgical congenital diseases. The present manuscript provides a literature review focused on pathological and clinical characteristics of GER in patients who have undergone surgical treatment for congenital abdominal malformations. PMID:26229394

  20. Dopamine receptors in human gastrointestinal mucosa

    SciTech Connect

    Hernandez, D.E.; Mason, G.A.; Walker, C.H.; Valenzuela, J.E.

    1987-12-21

    Dopamine is a putative enteric neurotransmitter that has been implicated in exocrine secretory and motility functions of the gastrointestinal tract of several mammalian species including man. This study was designed to determine the presence of dopamine binding sites in human gastric and duodenal mucosa and to describe certain biochemical characteristics of these enteric receptor sites. The binding assay was performed in triplicate with tissue homogenates obtained from healthy volunteers of both sexes using /sup 3/H-dopamine as a ligand. The extent of nonspecific binding was determined in the presence of a 100-fold excess of unlabeled dopamine. Scatchard analysis performed with increasing concentrations of /sup 3/H-dopamine (20-500 nM) revealed a single class of saturable dopamine binding sites in gastric and duodenal mucosa. The results of this report demonstrate the presence of specific dopamine receptors in human gastric and duodenal mucosa. These biochemical data suggest that molecular abnormalities of these receptor sites may be operative in the pathogenesis of important gastrointestinal disorders. 33 references, 2 figures.