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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. 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

  3. American Society for Gastrointestinal Endoscopy

    MedlinePLUS

    ... On Training Training and Core Curriculum GESAP VIII Self-Assessment Education Achievement Program ASGE Endorsed Activities Ambassador Program ... ASGE Leading Edge Endoscopic Learning Library GESAP VIII Self-Assessment Patient Education Brochures QR Codes poster Anatomical images ...

  4. Advances in upper gastrointestinal endoscopy

    PubMed Central

    Graham, David G.; Banks, Matthew R.

    2015-01-01

    The rapidly moving technological advances in gastrointestinal endoscopy have enhanced an endoscopists ability to diagnose and treat lesions within the gastrointestinal tract. The improvement in image quality created by the advent of high-definition and magnification endoscopy, alongside image enhancement, produces images of superb quality and detail that empower the endoscopist to identify important lesions that have previously been undetectable. Additionally, we are now seeing technologies emerge, such as optical coherence tomography and confocal laser endomicroscopy, that allow the endoscopist to visualize individual cells on a microscopic level and provide a real time, in vivo histological assessment. Within this article we discuss these technologies, as well as some of the results from their early use in clinical studies. PMID:26918137

  5. Gastrointestinal endoscopy: infection and disinfection.

    PubMed Central

    O'Connor, H J; Axon, A T

    1983-01-01

    The past decade has seen the development of an array of complex flexible fibreoptic instruments for gastrointestinal (GI) endoscopy, and an increasing use of these for diagnostic and therapeutic purposes. It has been recognised more recently that the use of contaminated endoscopic equipment can lead to serious and occasionally fatal infections. Infection with a wide variety of micro-organisms has been reported following oesophago-gastroduodenoscopy (OGD) and endoscopic retrograde cholangio-pancreatography (ERCP). PMID:6414894

  6. 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

  7. Colon capsule endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline.

    PubMed

    Spada, C; Hassan, C; Galmiche, J P; Neuhaus, H; Dumonceau, J M; Adler, S; Epstein, O; Gay, G; Pennazio, M; Rex, D K; Benamouzig, R; de Franchis, R; Delvaux, M; Devire, J; Eliakim, R; Fraser, C; Hagenmuller, F; Herrerias, J M; Keuchel, M; Macrae, F; Munoz-Navas, M; Ponchon, T; Quintero, E; Riccioni, M E; Rondonotti, E; Marmo, R; Sung, J J; Tajiri, H; Toth, E; Triantafyllou, K; Van Gossum, A; Costamagna, G

    2012-05-01

    PillCam colon capsule endoscopy (CCE) is an innovative noninvasive, and painless ingestible capsule technique that allows exploration of the colon without the need for sedation and gas insufflation. Although it is already available in European and other countries, the clinical indications for CCE as well as the reporting and work-up of detected findings have not yet been standardized. The aim of this evidence-based and consensus-based guideline, commissioned by the European Society of Gastrointestinal Endoscopy (ESGE) is to furnish healthcare providers with a comprehensive framework for potential implementation of this technique in a clinical setting. PMID:22389230

  8. [Sedation in upper gastrointestinal endoscopy].

    PubMed

    Adamsen, S

    1991-03-18

    Sedation in connection with oesophago-gastro-duodenoscopy is carried out in various ways. The investigation may be carried out with surface anaesthesia in the pharynx in well-informed and mentally stable patients but accept of renewed endoscopy is increased significantly when sedation is employed. Patients with an absolute requirement for sedation may be selected possibly employing a brief personality test. Employment of diazepam is extensively employed but diazepam interacts with cimetidin among other drugs, has a relatively long half-life and can cause secondary sedation. Midazolam has a more rapid effect, a briefer half-life, provides deeper sedation and results in more amnesia than diazepam. The oxygen tension decrease during endoscopy regardless of the sedative employed. Other sedatives, opioids, atropin or anaesthetics are not indicated under normal circumstances. Sedation can be abolished immediately after endoscopy with the bendzodiazepin-antagonist, flumazenil. PMID:2014564

  9. Gastrointestinal endoscopy in the pregnant woman

    PubMed Central

    Friedel, David; Stavropoulos, Stavros; Iqbal, Shahzad; Cappell, Mitchell S

    2014-01-01

    About 20000 gastrointestinal endoscopies are performed annually in America in pregnant women. Gastrointestinal endoscopy during pregnancy raises the critical issue of fetal safety in addition to patient safety. Endoscopic medications may be potentially abortifacient or teratogenic. Generally, Food and Drug Administration category B or C drugs should be used for endoscopy. Esophagogastroduodenoscopy (EGD) seems to be relatively safe for both mother and fetus based on two retrospective studies of 83 and 60 pregnant patients. The diagnostic yield is about 95% when EGD is performed for gastrointestinal bleeding. EGD indications during pregnancy include acute gastrointestinal bleeding, dysphagia > 1 wk, or endoscopic therapy. Therapeutic EGD is experimental due to scant data, but should be strongly considered for urgent indications such as active bleeding. One study of 48 sigmoidoscopies performed during pregnancy showed relatively favorable fetal outcomes, rare bad fetal outcomes, and bad outcomes linked to very sick mothers. Sigmoidoscopy should be strongly considered for strong indications, including significant acute lower gastrointestinal bleeding, chronic diarrhea, distal colonic stricture, suspected inflammatory bowel disease flare, and potential colonic malignancy. Data on colonoscopy during pregnancy are limited. One study of 20 pregnant patients showed rare poor fetal outcomes. Colonoscopy is generally experimental during pregnancy, but can be considered for strong indications: known colonic mass/stricture, active lower gastrointestinal bleeding, or colonoscopic therapy. Endoscopic retrograde cholangiopancreatography (ERCP) entails fetal risks from fetal radiation exposure. ERCP risks to mother and fetus appear to be acceptable when performed for ERCP therapy, as demonstrated by analysis of nearly 350 cases during pregnancy. Justifiable indications include symptomatic or complicated choledocholithiasis, manifested by jaundice, cholangitis, gallstone pancreatitis, or dilated choledochus. ERCP should be performed by an expert endoscopist, with informed consent about fetal radiation risks, minimizing fetal radiation exposure, and using an attending anesthesiologist. Endoscopy is likely most safe during the second trimester of pregnancy. PMID:24891928

  10. 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

  11. 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

  12. 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

  13. 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

  14. Flexible Gastrointestinal Endoscopy in Ferrets (Mustela putorius furo).

    PubMed

    Pignon, Charly; Huynh, Minh; Husnik, Roman; Jekl, Vladimir

    2015-09-01

    Gastrointestinal disease is a common complaint in ferrets (Mustela putorius furo). Their relatively simple and short gastrointestinal tract makes them good candidates for flexible endoscopy. However, apart from a few references in biomedical research articles, there is little information on the use of flexible endoscopy in ferrets. This review describes patient preparation, equipment, and select gastrointestinal endoscopy techniques in ferrets, including esophagoscopy, gastroscopy, duodenoscopy, percutaneous endoscopic gastrostomy, jejunoileoscopy, colonoscopy, and biopsy. PMID:26335999

  15. 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

  16. Propofol alternatives in gastrointestinal endoscopy anesthesia

    PubMed Central

    Goudra, Basavana Gouda; Singh, Preet Mohinder

    2014-01-01

    Although propofol has been the backbone for sedation in gastrointestinal endoscopy, both anesthesiologists and endoscopists are faced with situations where an alternative is needed. Recent national shortages forced many physicians to explore these options. A midazolam and fentanyl combination is the mainstay in this area. However, there are other options. The aim of this review is to explore these options. The future would be, invariably, to move away from propofol. The reason is not in any way related to the drawbacks of propofol as a sedative. The mandate that requires an anesthesia provider to administer propofol has been a setback in many countries. New sedative drugs like Remimazolam might fill this void in the future. In the meantime, it is important to keep an open eye to the existing alternatives. PMID:25422614

  17. 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 patients 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

  18. Optimizing early upper gastrointestinal cancer detection at endoscopy.

    PubMed

    Veitch, Andrew M; Uedo, Noriya; Yao, Kenshi; East, James E

    2015-11-01

    Survival rates for upper gastrointestinal cancers are poor and oesophageal cancer incidence is increasing. Upper gastrointestinal cancer is also often missed during examinations; a predicament that has not yet been sufficiently addressed. Improvements in the detection of premalignant lesions, early oesophageal and gastric cancers will enable organ-preserving endoscopic therapy, potentially reducing the number of advanced upper gastrointestinal cancers and resulting in improved prognosis. Japan is a world leader in high-quality diagnostic upper gastrointestinal endoscopy and the clinical routine in this country differs substantially from Western practice. In this Perspectives article, we review lessons learnt from Japanese gastroscopy technique, training and screening for risk stratification. We suggest a key performance indicator for upper gastrointestinal endoscopy with a minimum total procedure time of 8 min, and examine how quality assurance concepts in bowel cancer screening in the UK could be applied to upper gastrointestinal endoscopy and improve clinical practice. PMID:26260369

  19. Wireless capsule endoscopy: perspectives beyond gastrointestinal bleeding.

    PubMed

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

    2014-11-14

    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

  20. Wireless capsule endoscopy: Perspectives beyond gastrointestinal bleeding

    PubMed Central

    Redondo-Cerezo, Eduardo; Snchez-Capilla, Antonio Damin; 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

  1. Requirements and standards facilitating quality improvement for reporting systems in gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement.

    PubMed

    Bretthauer, Michael; Aabakken, Lars; Dekker, Evelien; Kaminski, Michal F; Rösch, Thomas; Hultcrantz, Rolf; Suchanek, Stepan; Jover, Rodrigo; Kuipers, Ernst J; Bisschops, Raf; Spada, Cristiano; Valori, Roland; Domagk, Dirk; Rees, Colin; Rutter, Matthew D

    2016-03-01

    To develop standards for high quality in gastrointestinal (GI) endoscopy, the European Society of Gastrointestinal Endoscopy (ESGE) has established the ESGE Quality Improvement Committee. A prerequisite for quality assurance and improvement for all GI endoscopy procedures is state-of-the-art integrated digital reporting systems for standardized documentation of the procedures. The current paper describes the ESGE's viewpoints on the requirements for high-quality endoscopy reporting systems in GI endoscopy. Recommendations 1 Endoscopy reporting systems must be electronic. 2 Endoscopy reporting systems should be integrated into hospitals' patient record systems. 3 Endoscopy reporting systems should include patient identifiers to facilitate data linkage to other data sources. 4 Endoscopy reporting systems shall restrict the use of free-text entry to a minimum, and be based mainly on structured data entry. 5 Separate entry of data for quality or research purposes is discouraged. Automatic data transfer for quality and research purposes must be facilitated. 6 Double entry of data by the endoscopist or associate personnel is discouraged. Available data from outside sources (administrative or medical) must be made available automatically. 7 Endoscopy reporting systems shall facilitate the inclusion of information on histopathology of detected lesions, patient satisfaction, adverse events, and surveillance recommendations. 8 Endoscopy reporting systems must facilitate easy data retrieval at any time in a universally compatible format. 9 Endoscopy reporting systems must include data fields for key performance indicators as defined by quality improvement committees. 10 Endoscopy reporting systems must facilitate changes in indicators and data entry fields as required by professional organizations. PMID:26841269

  2. 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

  3. 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

  4. Holes in gastric mucosa in upper gastrointestinal endoscopy.

    PubMed

    Effenberger, Maria; Steinle, Hartmut; Offner, Felix A; Vogel, Wolfgang; Millonig, Gunda

    2014-06-01

    Gastritis cystica profunda (GCP) is a rare disease that shows multiple cystic gastric glands dispersed within the submucosa of the stomach. GCP occurs most commonly in patients who have undergone previous gastric surgery and presents as subepithelial tumor or a polypoid lesion. Here, we report the case of GCP in a 79-year-old patient who had undergone Billroth II gastric resection. During upper gastrointestinal endoscopy multiple lesions like tiny holes in the mucosa were observed. Endoscopic ultrasound showed cystic structures in the gastric submucosa. Biopsies finally proved the dispersed mucosal glands in the submucosa, which are pathognomonic for GCP. So far, in all published cases, GCP presented as polypoid lesions with no mucosal damage in upper gastrointestinal endoscopy. It is for the first time that GCP has been diagnosed with cystic lesions connected to the gastric lumen with a porus in each of the cysts. PMID:24743500

  5. Optical Coherence Tomography for Gastrointestinal Endoscopy

    NASA Astrophysics Data System (ADS)

    Kang, Wei; Qi, Xin; Wang, Hui; Rollins, Andrew M.

    Researchers have long been exploring OCT as a diagnostic tool for the early epithelial dysplastic changes in the gastrointestinal tract. One reason is that the subsurface microscopic changes are within the depth-penetrating and detail-resolving capability of OCT. However, endoscopically imaging a large lumen (i.e. esophagus and colon) has been challenging. In this chapter, the key technologies to overcome the obstacles are introduced: 1) Rapid imaging acquisition based on spectral-domain OCT technology; 2) Miniature scanning probe and balloon-based catheter for volumetric imaging; and 3) Image reconstruction and computer-aided diagnosis algorithms. Animal and clinical studies based on these technologies will be presented.

  6. Summary of guidelines for infection prevention and control for flexible gastrointestinal endoscopy

    PubMed Central

    Hookey, Lawrence; Armstrong, David; Enns, Rob; Matlow, Anne; Singh, Harminder; Love, Jonathan

    2013-01-01

    BACKGROUND: High-quality processes to ensure infection prevention and control in the delivery of safe endoscopy services are essential. In 2010, the Public Health Agency of Canada and the Canadian Association of Gastroenterology (CAG) developed a Canadian guideline for the reprocessing of flexible gastrointestinal endoscopy equipment. METHODS: The CAG Endoscopy Committee carefully reviewed the 2010 guidelines and prepared an executive summary. RESULTS: Key elements relevant to infection prevention and control for flexible gastrointestinal endoscopy were highlighted for each of the recommendations included in the 2010 document. The 2010 guidelines consist of seven sections, including administrative recommendations, as well as recommendations for endoscopy and endoscopy decontamination equipment, reprocessing endoscopes and accessories, endoscopy unit design, quality management, outbreak investigation and management, and classic and variant Creutzfeldt-Jakob Disease. DISCUSSION: The recommendations for infection prevention and control for flexible gastrointestinal endoscopy are intended for all individuals with responsibility for endoscopes in all settings where endoscopy is performed. PMID:23781518

  7. Transmission of Infection by Flexible Gastrointestinal Endoscopy and Bronchoscopy

    PubMed Central

    Peters, Frans T. M.; van der Mei, Henny C.; Degener, John E.

    2013-01-01

    SUMMARY Flexible endoscopy is a widely used diagnostic and therapeutic procedure. Contaminated endoscopes are the medical devices frequently associated with outbreaks of health care-associated infections. Accurate reprocessing of flexible endoscopes involves cleaning and high-level disinfection followed by rinsing and drying before storage. Most contemporary flexible endoscopes cannot be heat sterilized and are designed with multiple channels, which are difficult to clean and disinfect. The ability of bacteria to form biofilms on the inner channel surfaces can contribute to failure of the decontamination process. Implementation of microbiological surveillance of endoscope reprocessing is appropriate to detect early colonization and biofilm formation in the endoscope and to prevent contamination and infection in patients after endoscopic procedures. This review presents an overview of the infections and cross-contaminations related to flexible gastrointestinal endoscopy and bronchoscopy and illustrates the impact of biofilm on endoscope reprocessing and postendoscopic infection. PMID:23554415

  8. Capsule Endoscopy in the Evaluation of Obscure Gastrointestinal Bleeding

    PubMed Central

    Li, Feng; Leighton, Jonathan A.

    2007-01-01

    Historically, the evaluation of patients with obscure gastrointestinal bleeding (OGIB) has been often suboptimal, due to the limited ability to adequately image the small bowel. However, over the past several years, significant improvements have been made in small-bowel imaging techniques, both endoscopically and radiologically. Since the introduction of capsule endoscopy (CE) in particular, the diagnostic and therapeutic approaches to OGIB have improved significantly. Capsule-based technology has enabled a more rapid and accurate diagnosis of many small-bowel disorders. Capsule endoscopy is safe and well tolerated. Many prospective comparative studies have shown that the diagnostic yield of CE is superior compared to other endoscopic and radiologic modalities. Numerous other studies have also shown that CE leads to a significant change in management and improved outcomes. PMID:21960786

  9. 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

  10. Use of water jet instruments in gastrointestinal endoscopy

    PubMed Central

    Nakano, Toru; Sato, Chiaki; Sakurai, Tadashi; Kamei, Takashi; Nakagawa, Atsuhiro; Ohuchi, Noriaki

    2016-01-01

    In recent years, water jet instruments have been used in the field of gastrointestinal endoscopy, mainly in two clinical situations: Investigation and treatment under endoscopic view. Injecting water jet into the gastrointestinal lumen is helpful for maintaining a clear endoscopic view, washing away blood or mucous in the lumen or on the surface of the tip of the endoscope. This contributes to reducing time and discomfort of examination. Water jet technology is an alternative method for dissecting soft tissue; this method does not harm the small vessels or cause mechanical or thermal damage. However, its use in clinical settings has been limited to the transmucosal injection of water into the submucosal layer that elevates the mucosa to prepare for endoscopic mucosal resection or endoscopic submucosal dissection, instead of tissue dissection, which may occur because of the continuous water jet. A preclinical study has been conducted using a pulsed water jet system as an alternative method for submucosal dissection by reducing intraoperative water consumption and maintenance of dissection capability. This review introduces recent studies pertaining to using a water jet in gastrointestinal endoscopy and discusses future prospects. PMID:26862362

  11. Use of water jet instruments in gastrointestinal endoscopy.

    PubMed

    Nakano, Toru; Sato, Chiaki; Sakurai, Tadashi; Kamei, Takashi; Nakagawa, Atsuhiro; Ohuchi, Noriaki

    2016-02-10

    In recent years, water jet instruments have been used in the field of gastrointestinal endoscopy, mainly in two clinical situations: Investigation and treatment under endoscopic view. Injecting water jet into the gastrointestinal lumen is helpful for maintaining a clear endoscopic view, washing away blood or mucous in the lumen or on the surface of the tip of the endoscope. This contributes to reducing time and discomfort of examination. Water jet technology is an alternative method for dissecting soft tissue; this method does not harm the small vessels or cause mechanical or thermal damage. However, its use in clinical settings has been limited to the transmucosal injection of water into the submucosal layer that elevates the mucosa to prepare for endoscopic mucosal resection or endoscopic submucosal dissection, instead of tissue dissection, which may occur because of the continuous water jet. A preclinical study has been conducted using a pulsed water jet system as an alternative method for submucosal dissection by reducing intraoperative water consumption and maintenance of dissection capability. This review introduces recent studies pertaining to using a water jet in gastrointestinal endoscopy and discusses future prospects. PMID:26862362

  12. Outcome and benefits of upper gastrointestinal endoscopy in the elderly.

    PubMed

    Brown, D C; Collins, J S; Love, A H

    1989-10-01

    Presenting symptoms, physical findings and treatment were reviewed in 70 patients over 65 years old who underwent oesophago-gastro-duodenoscopy in the Royal Victoria Hospital, Belfast, during an 18-month period. Most frequent indications for the procedure were epigastric pain, retrosternal pain or haematemesis. Physical signs were present in only 54%. Abnormal endoscopic findings were detected in 97%. The majority of patients responded to subsequent treatment. It was not possible to identify clinical features associated with major gastrointestinal pathology, which aided selection of those subgroups of elderly patients who would most benefit from endoscopy. PMID:2603271

  13. Sedation in gastrointestinal endoscopy: Where are we at in 2014?

    PubMed Central

    Ferreira, Alexandre Oliveira; Cravo, Marília

    2015-01-01

    Gastrointestinal endoscopies are invasive and unpleasant procedures that are increasingly being used worldwide. The importance of high quality procedures (especially in colorectal cancer screening), the increasing patient awareness and the expectation of painless examination, increase the need for procedural sedation. The best single sedation agent for endoscopy is propofol which, due to its’ pharmacokinetic/dynamic profile allows for a higher patient satisfaction and procedural quality and lower induction and recovery times, while maintaining the safety of traditional sedation. Propofol is an anesthetic agent when used in higher doses than those needed for endoscopy. Because of this important feature it may lead to cardiovascular and respiratory depression and, ultimately, to cardiac arrest and death. Fueled by this argument, concern over the safety of its administration by personnel without general anesthesia training has arisen. Propofol usage seems to be increasing but it’s still underused. It is a safe alternative for simple endoscopic procedures in low risk patients even if administered by non-anesthesiologists. Evidence on propofol safety in complex procedures and high risk patients is less robust and in these cases, the presence of an anesthetist should be considered. We review the existing evidence on the topic and evaluate the regional differences on sedation practices. PMID:25685266

  14. EVALUATION OF UPPER GASTROINTESTINAL ENDOSCOPY IN PATIENTS UNDERGOING BARIATRIC SURGERY

    PubMed Central

    ASSEF, Maurício Saab; MELO, Tiago Torres; ARAKI, Osvaldo; MARIONI, Fábio

    2015-01-01

    Background: Obesity has become epidemic, and is associated with greater morbidity and mortality. Treatment is multidisciplinary. Surgical treatment is a consistent resource in severe obesity. The indication of preoperative upper gastrointestinal endoscopy in asymptomatic patients is controversial; however, most studies recommend its implementation in all patients. Aim: To analyze endoscopic performance in patients who were in preoperative for bariatric surgery and compare them with control group. Method: A series of 35 obese patients in preoperative period for bariatric surgery compared with a control group of 30 patients submitted to upper endoscopy. There were analyzed clinical and endoscopic data. Results: The mean age of the group of patients was 43.54 years. Most individuals in the group of patients were female with median BMI of 47.26kg/m2and in control group 24.21 kg/m2. The majority of patients were asymptomatic. Upper endoscopy was altered in 81.25% of asymptomatic patients. Endoscopic findings in the patient group were 57.1% resulting from peptic ulcer disease and 34.3% associated with GERD. The analysis of endoscopic findings in patients showed no significant difference in relation of the control group. The prevalence of H. pylori infection was 60% in patients. Conclusion: It is recommended that the upper endoscopy should be made in all patients in the preoperative bariatric surgery period, although the degree of obesity is not related to a greater number of endoscopic findings. Obese patients do not have more endoscopic findings that non-obese individuals. PMID:26537272

  15. Learning models for endoscopic ultrasonography in gastrointestinal endoscopy

    PubMed Central

    Kim, Gwang Ha; Bang, Sung Jo; Hwang, Joo Ha

    2015-01-01

    Endoscopic ultrasonography (EUS) has become a useful diagnostic and therapeutic modality in gastrointestinal endoscopy. However, EUS requires additional training since it requires simultaneous endoscopic manipulation and ultrasonographic interpretation. Obtaining adequate EUS training can be challenging since EUS is highly operator-dependent and training on actual patients can be associated with an increased risk of complications including inaccurate diagnosis. Therefore, several models have been developed to help facilitate training of EUS. The models currently available for EUS training include computer-based simulators, phantoms, ex vivo models, and live animal models. Although each model has its own merits and limitations, the value of these different models is rather complementary than competitive. However, there is a lack of objective data regarding the efficacy of each model with recommendations on the use of various training models based on expert opinion only. Therefore, objective studies evaluating the efficacy of various EUS training models on technical and clinical outcomes are still needed. PMID:25954091

  16. Appropriateness of indication and diagnostic yield of colonoscopy: First report based on the 2000 guidelines of the American Society for Gastrointestinal Endoscopy

    PubMed Central

    Siddique, Iqbal; Mohan, Krishna; Hasan, Fuad; Memon, Anjum; Patty, Istvan; Al-Nakib, Basil

    2005-01-01

    AIM: To assess the appropriateness of referrals and to determine the diagnostic yield of colonoscopy according to the 2000 guidelines of the American Society for Gastrointestinal Endoscopy (ASGE). METHODS: A total of 736 consecutive patients (415 males, 321 females; mean age 43.616.6 years) undergoing colonoscopy during October 2001-March 2002 were prospectively enrolled in the study. The 2000 ASGE guidelines were used to assess the appropriateness of the indications for the procedure. Diagnostic yield was defined as the ratio between significant findings detected on colonoscopy and the total number of procedures performed for that indication. RESULTS: The large majority (64%) of patients had colonoscopy for an indication that was considered generally indicated, it was generally not indicated for 20%, and it was not listed for 16% in the guidelines. The diagnostic yield of colonoscopy was highest for the generally indicated (38%) followed by not listed (13%) and generally not indicated (5%) categories. In the multivariable analysis, the diagnostic yield was independently associated with the appropriateness of indication that was generally indicated (odds ratio=12.3) and referrals by gastroenterologist (odds ratio =1.9). CONCLUSION: There is a high likelihood of inappropriate referrals for colonoscopy in an open-access endoscopy system. The diagnostic yield of the procedure is dependent on the appropriateness of indication and referring physicians specialty. Certain indications not listed in the guidelines have an intermediate diagnostic yield and further studies are required to evaluate whether they should be included in future revisions of the ASGE guidelines. PMID:16437607

  17. 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; Rcz, Istvn; 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

  18. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline.

    PubMed

    Gralnek, Ian M; Dumonceau, Jean-Marc; Kuipers, Ernst J; Lanas, Angel; Sanders, David S; Kurien, Matthew; Rotondano, Gianluca; Hucl, Tomas; Dinis-Ribeiro, Mario; Marmo, Riccardo; Racz, Istvan; Arezzo, Alberto; Hoffmann, Ralf-Thorsten; Lesur, Gilles; de Franchis, Roberto; Aabakken, Lars; Veitch, Andrew; Radaelli, Franco; Salgueiro, Paulo; Cardoso, Ricardo; Maia, Lus; Zullo, Angelo; Cipolletta, Livio; Hassan, Cesare

    2015-10-01

    This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH). Main Recommendations MR1. ESGE recommends immediate assessment of hemodynamic status in patients who present with acute upper gastrointestinal hemorrhage (UGIH), with prompt intravascular volume replacement initially using crystalloid fluids if hemodynamic instability exists (strong recommendation, moderate quality evidence). MR2. ESGE recommends a restrictive red blood cell transfusion strategy that aims for a target hemoglobin between 7?g/dL and 9?g/dL. A higher target hemoglobin should be considered in patients with significant co-morbidity (e.?g., ischemic cardiovascular disease) (strong recommendation, moderate quality evidence). MR3. ESGE recommends the use of the Glasgow-Blatchford Score (GBS) for pre-endoscopy risk stratification. Outpatients determined to be at very low risk, based upon a GBS score of 0?-?1, do not require early endoscopy nor hospital admission. Discharged patients should be informed of the risk of recurrent bleeding and be advised to maintain contact with the discharging hospital (strong recommendation, moderate quality evidence). MR4. ESGE recommends initiating high dose intravenous proton pump inhibitors (PPI), intravenous bolus followed by continuous infusion (80?mg then 8?mg/hour), in patients presenting with acute UGIH awaiting upper endoscopy. However, PPI infusion should not delay the performance of early endoscopy (strong recommendation, high quality evidence). MR5. ESGE does not recommend the routine use of nasogastric or orogastric aspiration/lavage in patients presenting with acute UGIH (strong recommendation, moderate quality evidence). MR6. ESGE recommends intravenous erythromycin (single dose, 250?mg given 30?-?120 minutes prior to upper gastrointestinal [GI] endoscopy) in patients with clinically severe or ongoing active UGIH. In selected patients, pre-endoscopic infusion of erythromycin significantly improves endoscopic visualization, reduces the need for second-look endoscopy, decreases the number of units of blood transfused, and reduces duration of hospital stay (strong recommendation, high quality evidence). MR7. Following hemodynamic resuscitation, ESGE recommends early (??24 hours) upper GI endoscopy. Very early (endoscopy may be considered in patients with high risk clinical features, namely: hemodynamic instability (tachycardia, hypotension) that persists despite ongoing attempts at volume resuscitation; in-hospital bloody emesis/nasogastric aspirate; or contraindication to the interruption of anticoagulation (strong recommendation, moderate quality evidence). MR8. ESGE recommends that peptic ulcers with spurting or oozing bleeding (Forrest classification Ia and Ib, respectively) or with a nonbleeding visible vessel (Forrest classification IIa) receive endoscopic hemostasis because these lesions are at high risk for persistent bleeding or rebleeding (strong recommendation, high quality evidence). MR9. ESGE recommends that peptic ulcers with an adherent clot (Forrest classification IIb) be considered for endoscopic clot removal. Once the clot is removed, any identified underlying active bleeding (Forrest classification Ia or Ib) or nonbleeding visible vessel (Forrest classification IIa) should receive endoscopic hemostasis (weak recommendation, moderate quality evidence). MR10. In patients with peptic ulcers having a flat pigmented spot (Forrest classification IIc) or clean base (Forrest classification III), ESGE does not recommend endoscopic hemostasis as these stigmata present a low risk of recurrent bleeding. In selected clinical settings, these patients may be discharged to home on standard PPI therapy, e.?g., oral PPI once-daily (strong recommendation, moderate quality evidence). MR11. ESGE recommends that epinephrine injection therapy not be used as endoscopic monotherapy. If used, it should be combined with a second endoscopic hemostasis modality (strong recommendation, high quality evidence). MR12. ESGE recommends PPI therapy for patients who receive endoscopic hemostasis and for patients with adherent clot not receiving endoscopic hemostasis. PPI therapy should be high dose and administered as an intravenous bolus followed by continuous infusion (80?mg then 8?mg/hour) for 72 hours post endoscopy (strong recommendation, high quality evidence). MR13. ESGE does not recommend routine second-look endoscopy as part of the management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH). However, in patients with clinical evidence of rebleeding following successful initial endoscopic hemostasis, ESGE recommends repeat upper endoscopy with hemostasis if indicated. In the case of failure of this second attempt at hemostasis, transcatheter angiographic embolization (TAE) or surgery should be considered (strong recommendation, high quality evidence). MR14. In patients with NVUGIH secondary to peptic ulcer, ESGE recommends investigating for the presence of Helicobacter pylori in the acute setting with initiation of appropriate antibiotic therapy when H. pylori is detected. Re-testing for H. pylori should be performed in those patients with a negative test in the acute setting. Documentation of successful H. pylori eradication is recommended (strong recommendation, high quality evidence). MR15. In patients receiving low dose aspirin for secondary cardiovascular prophylaxis who develop peptic ulcer bleeding, ESGE recommends aspirin be resumed immediately following index endoscopy if the risk of rebleeding is low (e.?g., FIIc, FIII). In patients with high risk peptic ulcer (FIa, FIb, FIIa, FIIb), early reintroduction of aspirin by day 3 after index endoscopy is recommended, provided that adequate hemostasis has been established (strong recommendation, moderate quality evidence). PMID:26417980

  19. 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

  20. ASGE: Find a Doctor

    MedlinePLUS

    ... On Training Training and Core Curriculum GESAP VIII Self-Assessment Education Achievement Program ASGE Endorsed Activities Ambassador Program ... ASGE Leading Edge Endoscopic Learning Library GESAP VIII Self-Assessment Patient Education Brochures QR Codes poster Anatomical images ...

  1. Highlights from the 50th Seminar of the Korean Society of Gastrointestinal Endoscopy

    PubMed Central

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

    2014-01-01

    The July issue of Clinical Endoscopy deals with selected articles covering the state-of-the-art lectures delivered during the 50th seminar of the Korean Society of Gastrointestinal Endoscopy (KSGE) on March 30, 2014, highlighting educational contents pertaining to either diagnostic or therapeutic gastrointestinal (GI) endoscopy, which contain fundamental and essential points in GI endoscopy. KSGE is very proud of its seminar, which has been presented twice a year for the last 25 years, and hosted more than 3,500 participants at the current meeting. KSGE seminar is positioned as one of premier state-of-the-art seminars for endoscopy, covering topics for novice endoscopists and advanced experts, as well as diagnostic and therapeutic endoscopy. The 50th KSGE seminar consists of more than 20 sessions, including a single special lecture, concurrent sessions for GI endoscopy nurses, and sessions exploring new technologies. Nine articles were selected from these prestigious lectures, and invited for publication in this special issue. This introductory review, prepared by the editors of Clinical Endoscopy, highlights core contents divided into four sessions: upper GI tract, lower GI tract, pancreatobiliary system, and other specialized topic sessions, including live demonstrations and hands-on courses. PMID:25133113

  2. 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

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

    PubMed

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

    2015-07-01

    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

  5. Highlights of the 48th Seminar of Korean Society of Gastrointestinal Endoscopy

    PubMed Central

    Kwon, Kwang An; Choi, Il Ju; Kim, Eun Young; Dong, Seok Ho

    2013-01-01

    This special May issue of Clinical Endoscopy discusses the tutorial contents dealing with either the diagnostic or therapeutic gastrointestinal (GI) endoscopy that contain very fundamental and essential points in this filed. The seminar of Korean Society of Gastrointestinal Endoscopy (KSGE) had positioned as one of prime educational seminars covering the very beginner to advanced experts of GI endoscopy. Besides of four rooms allocated for each lecture, two additional rooms were open for either live demonstration or hands-on course, covering totally 20 sessions including one special lecture. Among these prestigious lectures, 12 lectures were selected for the current review articles in this special issue of Clinical Endoscopy journal. Basic course for beginner to advanced tips to expert were all covered in this seminar. This introductory review prepared by four associated editors of Clinical Endoscopy contained core contents divided into four sessions-upper gut, lower gut, pancreaticobiliary, and specialized topic session part-to enhance understandings not covered by enlisted review articles in this issue. PMID:23767027

  6. Current status of advanced gastrointestinal endoscopy training fellowships in the United States

    PubMed Central

    Heller, Stephen J; Tokar, Jeffrey L

    2011-01-01

    Rapid growth in the field of advanced gastrointestinal endoscopy has led to an increase in specialized therapeutic endoscopy fellowships. The cornerstones of these programs are training in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound. These procedures are more complex and challenging to master than routine colonoscopy and upper endoscopy, and in the case of ERCP, higher risk. The concentration of the educational experience in the hands of relatively fewer trainees with specialized interest in advanced endoscopy has resulted in providing a focused cohort of graduating fellows with higher case volumes in training, which likely enhances diagnostic and therapeutic success and safer performance of these procedures. Endoscopic simulators, although not currently in widespread use, have the potential to improve advanced procedural training without jeopardizing patient safety. PMID:23745073

  7. 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

  8. Current issues in endoscope reprocessing and infection control during gastrointestinal endoscopy

    PubMed Central

    Nelson, Douglas B; Muscarella, Lawrence F

    2006-01-01

    The purpose of this article is to review the evidence regarding transmission of infection during gastrointestinal endoscopy, factors important in endoscope reprocessing and infection control, areas to focus on to improve compliance, and recent developments and advances in the field. PMID:16810740

  9. Application of robotics in gastrointestinal endoscopy: A review.

    PubMed

    Yeung, Baldwin Po Man; Chiu, Philip Wai Yan

    2016-02-01

    Multiple robotic flexible endoscope platforms have been developed based on cross specialty collaboration between engineers and medical doctors. However, significant number of these platforms have been developed for the natural orifice transluminal endoscopic surgery paradigm. Increasing amount of evidence suggest the focus of development should be placed on advanced endolumenal procedures such as endoscopic submucosal dissection instead. A thorough literature analysis was performed to assess the current status of robotic flexible endoscopic platforms designed for advanced endolumenal procedures. Current efforts are mainly focused on robotic locomotion and robotic instrument control. In the future, advances in actuation and servoing technology, optical analysis, augmented reality and wireless power transmission technology will no doubt further advance the field of robotic endoscopy. Globally, health systems have become increasingly budget conscious; widespread acceptance of robotic endoscopy will depend on careful design to ensure its delivery of a cost effective service. PMID:26855540

  10. Application of robotics in gastrointestinal endoscopy: A review

    PubMed Central

    Yeung, Baldwin Po Man; Chiu, Philip Wai Yan

    2016-01-01

    Multiple robotic flexible endoscope platforms have been developed based on cross specialty collaboration between engineers and medical doctors. However, significant number of these platforms have been developed for the natural orifice transluminal endoscopic surgery paradigm. Increasing amount of evidence suggest the focus of development should be placed on advanced endolumenal procedures such as endoscopic submucosal dissection instead. A thorough literature analysis was performed to assess the current status of robotic flexible endoscopic platforms designed for advanced endolumenal procedures. Current efforts are mainly focused on robotic locomotion and robotic instrument control. In the future, advances in actuation and servoing technology, optical analysis, augmented reality and wireless power transmission technology will no doubt further advance the field of robotic endoscopy. Globally, health systems have become increasingly budget conscious; widespread acceptance of robotic endoscopy will depend on careful design to ensure its delivery of a cost effective service. PMID:26855540

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

    PubMed Central

    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

    2015-01-01

    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:26966520

  12. 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, Mrio; 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

  13. Unsedated versus sedated gastrointestinal endoscopy: a questionnaire investigation in Wuhan, central China.

    PubMed

    Wang, Hong-ling; Ye, Fen; Liao, Wen-fei; Xia, Bing; Zheng, Guo-rong

    2013-12-01

    National data show that in China mainland unsedated gastrointestinal (GI) endoscopy has been applied in most hospitals for clinical examination, while sedated GI endoscopy is only performed in some hospitals. The purpose of this study was to compare sedated versus unsedated GI endoscopy regarding cost, safety, degree of comfort, tolerance level and overall satisfaction of patients over a 6-month period investigation. From March to September 2011, a questionnaire survey was performed on 1800 patients and 30 physicians at Zhongnan Hospital of Wuhan University and Wuhan General Hospital of Guangzhou Military Command. The patients fell into two groups according to their own decisions: the unsedated group (n=1000) and the sedated group (n=800). After examination, the patients and the physicians were required to fill in a questionnaire form. All the data were analyzed statistically. The results showed that the main factors the patients took for consideration between sedated and unsedated procedures included economy, comfort and safety. The income levels between the sedated and unsedated groups showed significant difference (P<0.01). Most patients in the unsedated group had lower income and were covered by less medical insurance. The tolerance rate was 92.4% vs. 65.5% between the sedated and unsedated group, respectively. 95.5% patients in the sedated group and 72.1% patients in the unsedated group chose the same endoscopy procedure for repeat examination. The survey data from endoscopists suggested the sedated procedure was more comfortable but less safe than the unsedated procedure (P<0.01). In China, unsedated GI endoscopy is now widely accepted by the majority of patients due to low cost and safety. Compared to unsedated GI endoscopy, sedated GI endoscopy is less painful, but more expensive and less safe. With the rapid improvement of people's living standard and the reliability of sedation technology, we expect sedated GI endoscopy will be gradually accepted by more patients. PMID:24337848

  14. Gastric volvulus following diagnostic upper gastrointestinal endoscopy: a rare complication

    PubMed Central

    Karthikeyan, Vilvapathy Senguttuvan; Sistla, Sarath Chandra; Ram, Duvuru; Rajkumar, Nagarajan

    2014-01-01

    Esophagogastroduodenoscopy (EGD) is a commonly used, safe diagnostic modality for evaluation of epigastric pain and rarely its major complications include perforation, haemorrhage, dysrhythmias and death. Gastric volvulus has been reported to complicate percutaneous endoscopic gastrostomy but its occurrence after diagnostic EGD has not yet been reported in literature. The successful management relies on prompt diagnosis and gastric untwisting, decompression and gastropexy or gastrectomy in full thickness necrosis of the stomach wall. A 38-year-old woman presented with epigastric pain and EGD showed pangastritis. Immediately after EGD she developed increased severity of pain, vomiting and abdominal distension. Emergency laparotomy carried out for peritoneal signs revealed eventration of left hemidiaphragm with the stomach twisted anticlockwise in the longitudinal axis. After gastric decompression and untwisting of volvulus, anterior gastropexy and gastrostomy was carried out. Hence, we report this rare complication of diagnostic endoscopy and review the existing literature on the management. PMID:24515235

  15. Gastric volvulus following diagnostic upper gastrointestinal endoscopy: a rare complication.

    PubMed

    Karthikeyan, Vilvapathy Senguttuvan; Sistla, Sarath Chandra; Ram, Duvuru; Rajkumar, Nagarajan

    2014-01-01

    Esophagogastroduodenoscopy (EGD) is a commonly used, safe diagnostic modality for evaluation of epigastric pain and rarely its major complications include perforation, haemorrhage, dysrhythmias and death. Gastric volvulus has been reported to complicate percutaneous endoscopic gastrostomy but its occurrence after diagnostic EGD has not yet been reported in literature. The successful management relies on prompt diagnosis and gastric untwisting, decompression and gastropexy or gastrectomy in full thickness necrosis of the stomach wall. A 38-year-old woman presented with epigastric pain and EGD showed pangastritis. Immediately after EGD she developed increased severity of pain, vomiting and abdominal distension. Emergency laparotomy carried out for peritoneal signs revealed eventration of left hemidiaphragm with the stomach twisted anticlockwise in the longitudinal axis. After gastric decompression and untwisting of volvulus, anterior gastropexy and gastrostomy was carried out. Hence, we report this rare complication of diagnostic endoscopy and review the existing literature on the management. PMID:24515235

  16. [Management of new oral anticoagulants in gastrointestinal bleeding and endoscopy].

    PubMed

    del Molino, Fátima; Gonzalez, Isabel; Saperas, Esteve

    2015-10-01

    New oral direct anticoagulants agents are alternatives to warfarin for long-term anticoagulation in a growing number of patients that require long-term anticoagulation for atrial fibrillation, deep venous thrombosis and pulmonary embolism. These new agents with predictable pharmacokinetic and pharmacodynamics profiles offer a favorable global safety profile, but increased gastrointestinal bleeding compared to the vitamin K antagonists. Many gastroenterologists are unfamiliar and may be wary of these newer drugs, since Clinical experience is limited and no specific antidote is available to reverse their anticoagulant effect. In this article the risk of these new agents and, how to manage these agents in both the presence of acute gastrointestinal bleeding and in patients undergoing endoscopic procedures is reviewed. PMID:25908223

  17. Narrow-band imaging with magnifying endoscopy for the evaluation of gastrointestinal lesions.

    PubMed

    Boeriu, Alina; Boeriu, Cristian; Drasovean, Silvia; Pascarenco, Ofelia; Mocan, Simona; Stoian, Mircea; Dobru, Daniela

    2015-02-16

    Narrow band imaging (NBI) endoscopy is an optical image enhancing technology that allows a detailed inspection of vascular and mucosal patterns, providing the ability to predict histology during real-time endoscopy. By combining NBI with magnification endoscopy (NBI-ME), the accurate assessment of lesions in the gastrointestinal tract can be achieved, as well as the early detection of neoplasia by emphasizing neovascularization. Promising results of the method in the diagnosis of premalignant and malignant lesions of gastrointestinal tract have been reported in clinical studies. The usefulness of NBI-ME as an adjunct to endoscopic therapy in clinical practice, the potential to improve diagnostic accuracy, surveillance strategies and cost-saving strategies based on this method are summarized in this review. Various classification systems of mucosal and vascular patterns used to differentiate preneoplastic and neoplastic lesions have been reviewed. We concluded that the clinical applicability of NBI-ME has increased, but standardization of endoscopic criteria and classification systems, validation in randomized multicenter trials and training programs to improve the diagnostic performance are all needed before the widespread acceptance of the method in routine practice. However, published data regarding the usefulness of NBI endoscopy are relevant in order to recommend the method as a reliable tool in diagnostic and therapy, even for less experienced endoscopists. PMID:25685267

  18. Narrow-band imaging with magnifying endoscopy for the evaluation of gastrointestinal lesions

    PubMed Central

    Boeriu, Alina; Boeriu, Cristian; Drasovean, Silvia; Pascarenco, Ofelia; Mocan, Simona; Stoian, Mircea; Dobru, Daniela

    2015-01-01

    Narrow band imaging (NBI) endoscopy is an optical image enhancing technology that allows a detailed inspection of vascular and mucosal patterns, providing the ability to predict histology during real-time endoscopy. By combining NBI with magnification endoscopy (NBI-ME), the accurate assessment of lesions in the gastrointestinal tract can be achieved, as well as the early detection of neoplasia by emphasizing neovascularization. Promising results of the method in the diagnosis of premalignant and malignant lesions of gastrointestinal tract have been reported in clinical studies. The usefulness of NBI-ME as an adjunct to endoscopic therapy in clinical practice, the potential to improve diagnostic accuracy, surveillance strategies and cost-saving strategies based on this method are summarized in this review. Various classification systems of mucosal and vascular patterns used to differentiate preneoplastic and neoplastic lesions have been reviewed. We concluded that the clinical applicability of NBI-ME has increased, but standardization of endoscopic criteria and classification systems, validation in randomized multicenter trials and training programs to improve the diagnostic performance are all needed before the widespread acceptance of the method in routine practice. However, published data regarding the usefulness of NBI endoscopy are relevant in order to recommend the method as a reliable tool in diagnostic and therapy, even for less experienced endoscopists. PMID:25685267

  19. 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

  20. 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

  1. Usefulness of duodenal biopsy during routine upper gastrointestinal endoscopy for diagnosis of celiac disease

    PubMed Central

    Riestra, S; Domnguez, F; Fernndez-Ruiz, E; Garca-Riesco, E; Nieto, R; Fernndez, E; Rodrigo, L

    2006-01-01

    AIM: To describe the trend in duodenal biopsy performance during routine upper gastrointestinal endoscopy in an adult Spanish population, and to analyze its value for the diagnosis of celiac disease in clinical practice. METHODS: A 15 year-trend (1990 to 2004) in duo-denal biopsy performed when undertaking upper gastrointestinal endoscopy was studied. We analysed the prevalence of celiac disease in the overall group, and in the subgroups with anaemia and/or chronic diarrhoea. RESULTS: Duodenal biopsy was performed in 1033 of 13?678 upper gastrointestinal endoscopies (7.6%); an increase in the use of such was observed over the study period (1.9% in 1990-1994, 5% in 1995-1999 and 12.8% in 2000-2004). Celiac disease was diagnosed in 22 patients (2.2%), this being more frequent in women than in men (3% and 1% respectively). Fourteen out of 514 (2.7%) patients with anaemia, 12 out of 141 (8.5%) with chronic diarrhoea and 8 out of 42 (19%) with anaemia plus chronic diarrhoea had celiac disease. A classical clinical presentation was observed in 55% of the cases, 23% of the patients had associated dermatitis herpetiformis and 64% presented anaemia; 9% were diagnosed by familial screening and 5% by cryptogenetic hypertransaminasaemia. CONCLUSION: Duodenal biopsy undertaken during routine upper gastrointestinal endoscopy in adults, has been gradually incorporated into clinical practice, and is a useful tool for the diagnosis of celiac disease in high risk groups such as those with anaemia and/or chronic diarrhoea. PMID:16937500

  2. Glossopharyngeal Nerve Block versus Lidocaine Spray to Improve Tolerance in Upper Gastrointestinal Endoscopy

    PubMed Central

    Ortega Ramrez, Moiss; Linares Segovia, Benigno; Garca Cuevas, Marco Antonio; Snchez Romero, Jorge Luis; Botello Buenrostro, Illich; Amador Licona, Norma; Guzar Mendoza, Juan Manuel; Guerrero Romero, Jess Francisco; Vzquez Zrate, Vctor Manuel

    2013-01-01

    Aim of the Study. To compare the effect of glossopharyngeal nerve block with topical anesthesia on the tolerance of patients to upper gastrointestinal endoscopy. Methods. We performed a clinical trial in one hundred patients undergoing upper gastrointestinal endoscopy. Subjects were randomly assigned to one of the following two groups: (1) treatment with bilateral glossopharyngeal nerve block (GFNB) and intravenous midazolam or (2) treatment with topical anesthetic (TASS) and intravenous midazolam. We evaluated sedation, tolerance to the procedure, hemodynamic stability, and adverse symptoms. Results. We studied 46 men and 54 women, from 17 to 78 years of age. The procedure was reported without discomfort in 48 patients (88%) in the GFNB group and 32 (64%) in the TAAS group; 6 patients (12%) in GFNB group and 18 (36%) in TAAS group reported the procedure as little discomfort (?2 = 3.95, P = 0.04). There was no difference in frequency of nausea (4% in both groups) and retching, 4% versus 8% for GFNB and TASS group, respectively (P = 0.55). Conclusions. The use of glossopharyngeal nerve block provides greater comfort and tolerance to the patient undergoing upper gastrointestinal endoscopy. It also reduces the need for sedation. PMID:23533386

  3. Glossopharyngeal Nerve Block versus Lidocaine Spray to Improve Tolerance in Upper Gastrointestinal Endoscopy.

    PubMed

    Ortega Ramrez, Moiss; Linares Segovia, Benigno; Garca Cuevas, Marco Antonio; Snchez Romero, Jorge Luis; Botello Buenrostro, Illich; Amador Licona, Norma; Guzar Mendoza, Juan Manuel; Guerrero Romero, Jess Francisco; Vzquez Zrate, Vctor Manuel

    2013-01-01

    Aim of the Study. To compare the effect of glossopharyngeal nerve block with topical anesthesia on the tolerance of patients to upper gastrointestinal endoscopy. Methods. We performed a clinical trial in one hundred patients undergoing upper gastrointestinal endoscopy. Subjects were randomly assigned to one of the following two groups: (1) treatment with bilateral glossopharyngeal nerve block (GFNB) and intravenous midazolam or (2) treatment with topical anesthetic (TASS) and intravenous midazolam. We evaluated sedation, tolerance to the procedure, hemodynamic stability, and adverse symptoms. Results. We studied 46 men and 54 women, from 17 to 78 years of age. The procedure was reported without discomfort in 48 patients (88%) in the GFNB group and 32 (64%) in the TAAS group; 6 patients (12%) in GFNB group and 18 (36%) in TAAS group reported the procedure as little discomfort (? (2) = 3.95, P = 0.04). There was no difference in frequency of nausea (4% in both groups) and retching, 4% versus 8% for GFNB and TASS group, respectively (P = 0.55). Conclusions. The use of glossopharyngeal nerve block provides greater comfort and tolerance to the patient undergoing upper gastrointestinal endoscopy. It also reduces the need for sedation. PMID:23533386

  4. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.

    PubMed

    Pennazio, Marco; Spada, Cristiano; Eliakim, Rami; Keuchel, Martin; May, Andrea; Mulder, Chris J; Rondonotti, Emanuele; Adler, Samuel N; Albert, Joerg; Baltes, Peter; Barbaro, Federico; Cellier, Christophe; Charton, Jean Pierre; Delvaux, Michel; Despott, Edward J; Domagk, Dirk; Klein, Amir; McAlindon, Mark; Rosa, Bruno; Rowse, Georgina; Sanders, David S; Saurin, Jean Christophe; Sidhu, Reena; Dumonceau, Jean-Marc; Hassan, Cesare; Gralnek, Ian M

    2015-04-01

    This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). The Guideline was also reviewed and endorsed by the British Society of Gastroenterology (BSG). It addresses the roles of small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders. Main recommendations 1 ESGE recommends small-bowel video capsule endoscopy as the first-line investigation in patients with obscure gastrointestinal bleeding (strong recommendation, moderate quality evidence). 2 In patients with overt obscure gastrointestinal bleeding, ESGE recommends performing small-bowel capsule endoscopy as soon as possible after the bleeding episode, optimally within 14 days, in order to maximize the diagnostic yield (strong recommendation, moderate quality evidence). 3 ESGE does not recommend the routine performance of second-look endoscopy prior to small-bowel capsule endoscopy; however whether to perform second-look endoscopy before capsule endoscopy in patients with obscure gastrointestinal bleeding or iron-deficiency anaemia should be decided on a case-by-case basis (strong recommendation, low quality evidence). 4 In patients with positive findings at small-bowel capsule endoscopy, ESGE recommends device-assisted enteroscopy to confirm and possibly treat lesions identified by capsule endoscopy (strong recommendation, high quality evidence). 5 ESGE recommends ileocolonoscopy as the first endoscopic examination for investigating patients with suspected Crohn's disease (strong recommendation, high quality evidence). In patients with suspected Crohn's disease and negative ileocolonoscopy findings, ESGE recommends small-bowel capsule endoscopy as the initial diagnostic modality for investigating the small bowel, in the absence of obstructive symptoms or known stenosis (strong recommendation, moderate quality evidence).ESGE does not recommend routine small-bowel imaging or the use of the PillCam patency capsule prior to capsule endoscopy in these patients (strong recommendation, low quality evidence). In the presence of obstructive symptoms or known stenosis, ESGE recommends that dedicated small bowel cross-sectional imaging modalities such as magnetic resonance enterography/enteroclysis or computed tomography enterography/enteroclysis should be used first (strong recommendation, low quality evidence). 6 In patients with established Crohn's disease, based on ileocolonoscopy findings, ESGE recommends dedicated cross-sectional imaging for small-bowel evaluation since this has the potential to assess extent and location of any Crohn's disease lesions, to identify strictures, and to assess for extraluminal disease (strong recommendation, low quality evidence). In patients with unremarkable or nondiagnostic findings from such cross-sectional imaging of the small bowel, ESGE recommends small-bowel capsule endoscopy as a subsequent investigation, if deemed to influence patient management (strong recommendation, low quality evidence). When capsule endoscopy is indicated, ESGE recommends use of the PillCam patency capsule to confirm functional patency of the small bowel (strong recommendation, low quality evidence). 7 ESGE strongly recommends against the use of small-bowel capsule endoscopy for suspected coeliac disease but suggests that capsule endoscopy could be used in patients unwilling or unable to undergo conventional endoscopy (strong recommendation, low quality evidence). PMID:25826168

  5. Cardiac Arrests in Patients Undergoing Gastrointestinal Endoscopy: A Retrospective Analysis of 73,029 Procedures

    PubMed Central

    Goudra, Basavana; Nuzat, Ahmad; Singh, Preet M.; Gouda, Gowri B.; Carlin, Augustus; Manjunath, Amit K.

    2015-01-01

    Background/Aims: Airway difficulties leading to cardiac arrest are frequently encountered during propofol sedation in patients undergoing gastrointestinal (GI) endoscopy. With a noticeable increase in the use of propofol for endoscopic sedation, we decided to examine the incidence and outcome of cardiac arrests in patients undergoing gastrointestinal (GI) endoscopy with sedation. Patients and Methods: In this retrospective study, cardiac arrest data obtained from the clinical quality improvement and local registry over 5 years was analyzed. The information of patients who sustained cardiac arrest attributable to sedation was studied in detail. Analysis included comparison of cardiac arrests due to all causes until discharge (or death) versus the cardiac arrests and death occurring during the procedure and in the recovery area. Results: The incidence of cardiac arrest and death (all causes, until discharge) was 6.07 and 4.28 per 10,000 in patients sedated with propofol, compared with nonpropofol-based sedation (0.67 and 0.44). The incidence of cardiac arrest during and immediately after the procedure (recovery area) for all endoscopies was 3.92 per 10,000; of which, 72% were airway management related. About 90.0% of all peri-procedural cardiac arrests occurred in patients who received propofol. Conclusions: The incidence of cardiac arrest and death is about 10 times higher in patients receiving propofol-based sedation compared with those receiving midazolamfentanyl sedation. More than two thirds of these events occur during EGD and ERCP. PMID:26655137

  6. 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?

  7. 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 Barretts esophagus and chronic colitis due to inflammatory bowel diseases. PMID:21152112

  8. 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

  9. Integration of a standard gastrointestinal endoscopy terminology in the UMLS Metathesaurus.

    PubMed

    Tringali, Michele; Hole, William T; Srinivasan, Suresh

    2002-01-01

    MST(c), a standard terminology for gastrointestinal endoscopy reporting, was integrated in the January 2002 UMLS Metathesaurus in order to ease the practical interoperability of clinical data repositories in gastroenterology. The integration required full specification of names, resolution of discrepancies between English, French and Italian versions of MST, appropriate categorization with UMLS Semantic Types and MST-level Class attributes, assignment of explicit intra-table (and some useful inter-table) relationships mainly at concept level but also at the source level in order to retain and fully represent the original explicit and implicit MST organization. Main results, problems encountered and future plans are discussed. PMID:12463935

  10. 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

  11. 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-μm 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.

  12. Pediatric Patient and Parental Anxiety and Impressions Related to Initial Gastrointestinal Endoscopy: A Japanese Multicenter Questionnaire Study

    PubMed Central

    Hagiwara, Shin-ichiro; Nakayama, Yoshiko; Tagawa, Manabu; Arai, Katsuhiro; Ishige, Takashi; Murakoshi, Takatsugu; Sekine, Hiroko; Abukawa, Daiki; Yamada, Hiroyuki; Inoue, Mikihiro; Saito, Takeshi; Kudo, Takahiro; Seki, Yoshitaka

    2015-01-01

    Objective. To assess anxiety among pediatric patients and their parents related to initial gastrointestinal endoscopy. Methods. Patients aged <19 years undergoing initial gastrointestinal (GI) endoscopy and their parents were invited to complete a self-administered questionnaire related to endoscopy in 13 institutions in Japan. Results. The subjects were 128 children, aged 1 month to 17 years. Forty-eight patients (37.5%) underwent esophagogastroduodenoscopy (EGD), 32 (25%) underwent colonoscopy (CS), 39 (30.5%) underwent both EGD and CS, 3 (2.3%) underwent balloon enteroscopy (BE), 3 (2.3%) underwent capsule endoscopy (CE), and 3 (2.3%) underwent CE and other endoscopic procedures. In the preendoscopy questionnaire, the most common concerns of the patients and parents before undergoing the procedure were Pain (45% of the patients underwent EGD or BE via the oral approach, and 52% of the patients underwent CS or BE via the anal approach) and Procedural accidents related to the endoscopy (63% of parents). In the postendoscopy questionnaire, the most common difficulty that patients and parents actually experienced before and after undergoing the procedure was Hunger. Conclusion. A preparatory intervention including an explanation regarding specific concerns before initial GI endoscopy, which this study revealed, could reduce anxiety experienced by both pediatric patients and parents. PMID:26417474

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

    PubMed Central

    Magalhes-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

  14. Modeling the costs and benefits of capnography monitoring during procedural sedation for gastrointestinal endoscopy

    PubMed Central

    Saunders, Rhodri; Erslon, Mary; Vargo, John

    2016-01-01

    Background and study aims: The addition of capnography to procedural sedation/analgesia (PSA) guidelines has been controversial due to limited evidence of clinical utility in moderate PSA and cost concerns. Patients and methods: A comprehensive model of PSA during gastrointestinal endoscopy was developed to capture adverse events (AEs), guideline interventions, outcomes, and costs. Randomized, controlled trials and large-scale studies were used to inform the model. The model compared outcomes using pulse oximetry alone with pulse oximetry plus capnography. Pulse oximetry was assumed at no cost, whereas capnography cost USD 4,000 per monitor. AE costs were obtained from literature review and Premier database analysis. The model population (n = 8,000) had mean characteristics of age 55.5 years, body mass index 26.2 kg/m2, and 45.3 % male. Results: The addition of capnography resulted in a 27.2 % and 18.0 % reduction in the proportion of patients experiencing an AE during deep and moderate PSA, respectively. Sensitivity analyses demonstrated significant reductions in apnea and desaturation with capnography. The median (95 % credible interval) number needed to treat to avoid any adverse event was 8 (2; 72) for deep and 6 (−59; 92) for moderate. Reduced AEs resulted in cost savings that accounted for the additional upfront purchase cost. Capnography was estimated to reduce the cost per procedure by USD 85 (deep) or USD 35 (moderate). Conclusions: Capnography is estimated to be cost-effective if not cost saving during PSA for gastrointestinal endoscopy. Savings were driven by improved patient safety, suggesting that capnography may have an important role in the safe provision of PSA. PMID:27004254

  15. The Role of Capsule Endoscopy in Patients with Obscure Gastrointestinal Bleeding

    PubMed Central

    Min, Yang Won; Chang, Dong Kyung

    2016-01-01

    Obscure gastrointestinal bleeding (OGIB) accounts for 5% of all gastrointestinal (GI) bleeding cases and is often caused by small bowel lesions. Capsule endoscopy (CE), which allows non-invasive visualization of the small bowel mucosa, has revolutionized the evaluation of OGIB. CE is preferred by both patients and physicians mainly because of its non-invasiveness, and is widely used as the first-line diagnostic modality for OGIB. The diagnostic yield of CE in OGIB has been reported to be in the range of 32% to 83%. Although no direct comparison has been made, a meta-analysis showed similar diagnostic yields between CE and double-balloon enteroscopy (DBE) for OGIB. However, CE could enhance the yield of subsequent DBE and serve as a guide for optimizing the insertion route for DBE. Even after negative CE, selected patients could benefit from second-look CE for OGIB. In terms of outcomes, a favorable clinical impact after CE has been reported in several studies. However, observations indicate that CE might not influence clinical outcomes directly, but rather play a role in selecting patients with OGIB who are likely to benefit from subsequent evaluation and intervention. PMID:26855918

  16. H. pylori May Not Be Associated with Iron Deficiency Anemia in Patients with Normal Gastrointestinal Tract Endoscopy Results

    PubMed Central

    Saler, Tayyibe; Ke?kek, ?akir zgr; K?rk, Sibel; Ahbab, Sleyman; Orto?lu, Glay

    2014-01-01

    Background. The aim of this study was to investigate the association between iron deficiency anemia and H. pylori in patients with normal gastrointestinal tract endoscopy results. Materials and Methods. A total of 117 male patients with normal gastrointestinal tract endoscopy results were included in this retrospective study. The study and control groups included 69 and 48 patients with and without iron deficiency anemia, respectively. The prevalence of H. pylori, the number of RBCs, and the levels of HGB, HTC, MCV, iron, and ferritin were calculated and compared. Results. There was no statistically significant difference found between the groups according to the prevalence of H. pylori (65.2% versus 64.6%, P = 0.896). Additionally, the levels of RBCs, HGB, HTC, MCV, iron, and ferritin in the patients in the study group were lower than those in the control group (P < 0.05). Finally, there was no association between iron deficiency anemia and H. pylori (OR 1.02, Cl 95% 0.472.22, and P = 0.943). Conclusion. H. pylori is not associated with iron deficiency anemia in male patients with normal gastrointestinal tract endoscopy results. PMID:25610466

  17. 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

  18. Roles of Capsule Endoscopy and Single-Balloon Enteroscopy in Diagnosing Unexplained Gastrointestinal Bleeding

    PubMed Central

    Ooka, Shohei; Kobayashi, Kiyonori; Kawagishi, Kana; Kodo, Masaru; Yokoyama, Kaoru; Sada, Miwa; Tanabe, Satoshi; Koizumi, Wasaburo

    2016-01-01

    Background/Aims: The diagnostic algorithms used for selecting patients with obscure gastrointestinal bleeding (OGIB) for capsule endoscopy (CE) or balloon-assisted enteroscopy (BE) vary among facilities. We aimed to demonstrate the appropriate selection criteria of CE and single balloon-assisted enteroscopy (SBE) for patients with OGIB according to their conditions, by retrospectively comparing the diagnostic performances of CE and BE for detecting the source of the OGIB. Methods: We investigated 194 patients who underwent CE and/or BE. The rate of positive findings, details of the findings, accidental symptoms, and hemostasis methods were examined and analyzed. Results: CE and SBE were performed in 103 and 91 patients, respectively, and 26 patients underwent both examinations. The rate of positive findings was significantly higher with SBE (73.6%) than with CE (47.5%, p<0.01). The rate of positive findings was higher in overt bleeding cases than in occult bleeding cases for both BE and SBE. Among the overt bleeding cases, the rate was significantly higher in ongoing bleeding cases than in previous bleeding cases. Conclusions: Both CE and SBE are useful to diagnose OGIB. For overt bleeding cases and ongoing bleeding cases, SBE may be more appropriate than CE because endoscopic diagnosis and treatment can be completed simultaneously. PMID:26855925

  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. Is image-enhanced endoscopy useful for the diagnosis and treatment of gastrointestinal tumor?

    PubMed

    Kim, Kyoung Oh; Ku, Yang Suh

    2013-05-01

    Since the introduction of endoscopic submucosal dissection method for the treatment of early gastric cancer, endoscopic treatment of early gastric cancer has increased exponentially. Accordingly, early diagnosis of cancerous or precancerous lesion has become one of the most important missions for endoscopists. The desire to improve diagnostic capability of white light endoscopy led to the development of new imaging techniques called "image enhanced endoscopy." The usefulness of these image enhanced endoscopy has not been proven yet, although there are several studies reporting diagnostic superiority of these new imaging methods over white light endoscopy. Among these new imaging modalities, narrow band image (NBI) with magnification endoscopy has been most widely used and studied. This manuscript will be focused on the NBI with magnification endoscopy. PMID:23767035

  1. 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

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

    PubMed

    Muscarella, Lawrence F

    2014-10-16

    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. Sedation in gastrointestinal endoscopy: a prospective study comparing nonanesthesiologist-administered propofol and monitored anesthesia care

    PubMed Central

    de Paulo, Gustavo Andrade; Martins, Fernanda P.B.; Macedo, Erika P.; Gonalves, Manoel Ernesto P.; Mouro, Carlos Alberto; Ferrari, Angelo P.

    2015-01-01

    Introduction: Adequate sedation is one of the cornerstones of good quality gastrointestinal endoscopy (GIE). Propofol sedation has increased significantly but there has been much debate over whether it can be administered by endoscopists. The aim of this prospective trial was to compare nonanesthesiologist-administered propofol (NAAP) and monitored anesthesia care (MAC). Methods: A total of 2000 outpatients undergoing GIE at Hospital Albert Einstein (So Paulo, Brazil), a tertiary-care private hospital, were divided into two matched groups: NAAP (n?=?1000) and MAC (n?=?1000). In NAAP, propofol doses were determined by the endoscopist. A second physician stayed in the room during the entire procedure, according to local regulations. In MAC, the anesthesiologist administered propofol. Results: In total, 1427 patients (71.3?%) were ASA (American Society of Anesthesiologists) class I and 573 were ASA class II. In NAAP, patients received more propofol?+?fentanyl (61.1?% vs. 50.5?%; P?

  5. The role of capsule endoscopy in etiological diagnosis and management of obscure gastrointestinal bleeding

    PubMed Central

    Ingle, Meghraj; Pandav, Nilesh; Parikh, Pathik; Patel, Jignesh; Phadke, Aniruddha; Sawant, Prabha

    2016-01-01

    Background/Aims To investigate the various etiologies, yields, and effects of capsule endoscopy (CE) on management and complications, along with follow up of patients with obscure gastrointestinal (GI) bleeding. Methods The study group of patients included those having obscure, overt, or occult GI bleeding. The findings were categorized as (A) obvious/definitive, (B) equivocal, or (C) negative. Any significant alteration in patient management post CE in the form of drug or surgical intervention was noted. Results Total patients included in the study were 68 (48 males and 20 females). The ratio of male:female was 2.4:1. The age ranged between 16 years to 77 years. Mean age for males was 62±14 years, for females 58±16 years. The total yield of CE with definitive lesions was in 44/68 (65.0%) of patients. In descending order (A) angiodysplasia 16/68 (23.53%), (B) Crohn's disease 10/68 (14.70%), (C) non-steroidal anti-inflammatory drug enteropathy 8/68 (11.76%), (D) small bowel ulcers 4/68 (5.88%), (E) jejunal and ileal polyps 2/68 (2.94%), (F) intestinal lymphangiectasis 2/68 (2.94%), and (G) ileal hemangiomas 2/68 (2.94%) were followed. Equivocal findings 12/68 (17.65%) and negative study 12/68 (17.65%) was found. Complications in the form of capsule retention in the distal ileum were noted in 2/68 (2.94%) subjects. Statistically, there was a higher probability of finding the etiology if the CE was done during an episode of bleeding. Conclusions CE plays an important role in diagnosing etiologies of obscure GI bleeding. Its role in influencing the management outcome is vital. PMID:26884737

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

    PubMed

    Tringali, Andrea; Lemmers, Arnaud; Meves, Volker; Terheggen, Grischa; Pohl, Jrgen; Manfredi, Guido; Hfner, Michael; Costamagna, Guido; Devire, 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 Yearly Prevalence of Findings in Endoscopy of the Lower Part of the Gastrointestinal Tract

    PubMed Central

    Loffeld, R. J. L. F.; Liberov, B.; Dekkers, P. E. P.

    2012-01-01

    Introduction. Endoscopy of the colon and rectum is increasingly used. Aim of the Study. All consecutive endoscopies of the colon and rectum were studied in order to assess the yearly prevalence of significant endoscopic diagnoses. Methods. All consecutive endoscopies of the colon and rectum were included. Endoscopies were done with endoscopes of Olympus. Significant endoscopic diagnoses were defined as colorectal cancer, polyps, diverticuli, large sessile polyps, and inflammatory bowel disease. Results. In 20 years a total of 24431 endoscopies were done. The yearly number of sigmoidoscopies was mean 96, range of 42370. The number of colonoscopies was mean 1126, range of 6431912. The number of colonoscopies significantly increased. The number of colonoscopies on request of an internist or gastroenterologist showed a slow but steady increase. Successful caecal intubation rose from 70% to 92% in 2011. Since 1996 there is a steep increase in the percentage of procedures with abnormalities. The number of cancer and polyps increased in twenty years. No great changes were seen in inflammatory bowel disease. Conclusion. Colonoscopy is a procedure with a high diagnostic yield. The number of patients with tumours rose in twenty years. PMID:23326676

  8. Recommendations for standards of sedation and patient monitoring during gastrointestinal endoscopy.

    PubMed Central

    Bell, G D; McCloy, R F; Charlton, J E; Campbell, D; Dent, N A; Gear, M W; Logan, R F; Swan, C H

    1991-01-01

    (1) Safety and monitoring should be part of a quality assurance programme for endoscopy units. (2) Resuscitation equipment and drugs must be available in the endoscopy and recovery areas. (3) Staff of all grades and disciplines should be familiar with resuscitation methods and undergo periodic retraining. (4) Equipment and drugs necessary for the maintenance of airway, breathing, and circulation should be present in the endoscopy unit and recovery area (if outside the unit) and checked regularly. (5) A qualified nurse, trained in endoscopic techniques and adequately trained in resuscitation techniques, should monitor the patient's condition during procedures. (6) Before endoscopy, adverse risk factors should be identified. This may be aided by the use of a check list. (7) The dosage of all drugs should be kept to the minimum necessary. There is evidence that benzodiazepine/opioid mixtures are hazardous. (8) Specific antagonists for benzodiazepines and opioids exist and should be available in the event of emergency. (9) A cannula should be placed in a vein during endoscopy on 'at risk' patients. (10) Oxygen enriched air should be given to 'at risk' patients undergoing endoscopic procedures. (11) The endoscopist should ensure the well being and clinical observation of the patient undergoing endoscopy in conjunction with another individual. This individual should be a qualified nurse trained in endoscopic techniques or another medically qualified practitioner. (12) Monitoring techniques such as pulse oximetry are recommended. (13) Clinical monitoring of the patient must be continued into the recovery area. (14) Records of management and outcome should be collected and will provide data for appropriate audit. PMID:1855692

  9. Intravenous midazolam: a study of the degree of oxygen desaturation occurring during upper gastrointestinal endoscopy.

    PubMed Central

    Bell, G D; Reeve, P A; Moshiri, M; Morden, A; Coady, T; Stapleton, P J; Logan, R F

    1987-01-01

    Intravenous midazolam (mean dose of 6.3 mg) was given to 100 consecutive patients coming to endoscopy. All patients had an ear oximeter attached throughout the procedure to record continuously their levels of oxygen saturation. Eighty-five of the 100 patients had pre-endoscopy respiratory function tests measured, and 82 wore an induction plethysmograph vest to get a continuous qualitative estimate of respiratory rate and excursion throughout the procedure. Following intravenous midazolam a reduction in respiratory excursion was observed in 80% of patients. The initial baseline oxygen saturation of 95.4% fell 3.3% (P less than 0.0005) following intravenous midazolam to 92.1%. During the endoscopic procedure there was a further 3.1% decrease in oxygen saturation to 89.0% (P less than 0.0005) and in 7% the level fell to below 80%. Age, sex, dose of midazolam given and pre-endoscopy respiratory function tests failed to identify those patients at risk of hypoxia during the endoscopy. PMID:3606930

  10. 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

  11. Performing forward-viewing endoscopy at time of pancreaticobiliary EUS and ERCP may detect additional upper gastrointestinal lesions

    PubMed Central

    Thomas, Ashby; Vamadevan, Arunan S; Slattery, Eoin; Sejpal, Divyesh V; Trindade, Arvind J

    2016-01-01

    Background and study aims: It is unknown whether significant incidental upper gastrointestinal lesions are missed when using non-forward-viewing endoscopes without completing a forward-viewing exam in linear endoscopic ultrasound (EUS) or endoscopic retrograde cholangiopancreatography (ERCP) exams. We evaluated whether significant upper GI lesions are missed during EUS and ERCP when upper endoscopy is not performed routinely with a gastroscope. Patients and methods: A retrospective analysis was performed in which an EGD with a forward-viewing gastroscope was performed after using a non-forward-viewing endoscope (linear echoendoscope, duodenoscope, or both) during a single procedure. Upper gastrointestinal tract findings were recorded separately for each procedure. Significant lesions found with a forward-viewing gastroscope were defined as findings that led to a change in the patient’s medication regimen, additional endoscopic surveillance/interventions, or the need for other imaging studies. Results: A total of 168 patients were evaluated. In 83 patients, a linear echoendoscope was used, in 52 patients a duodenoscope was used, and in 33 patients both devices were used. Clinically significant additional lesions diagnosed with a gastroscope but missed by a non-forward-viewing endoscope were found in 30 /168 patients (18 %). EGD after linear EUS resulted in additional lesion findings in 17 /83 patients (20.5 %, χ2 = 13.385, P = 0.00025). EGD after use of a duodenoscope resulted in additional lesions findings in 10 /52 patients (19.2 %, χ2 = 9.987, P = 0.00157). EGD after the use of both a linear echoendoscope and a duodenoscope resulted in additional lesions findings in 3/33 patients (9 %, χ2 = 3.219, P = 0.07). Conclusion: Non forward-viewing endoscopes miss a significant amount of incidental upper gastrointestinal lesions during pancreaticobiliary endoscopy. Performing an EGD with a gastroscope at the time of linear EUS or ERCP can lead to increased yield of upper gastrointestinal lesions. PMID:26878048

  12. 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.

  13. Esophageal polyps in pediatric patients undergoing routine diagnostic upper gastrointestinal endoscopy: a multicenter study.

    PubMed

    Septer, S; Cuffari, C; Attard, T M

    2014-01-01

    Esophageal polyps are uncommon findings in pediatric patients, and reports have been limited to case reports. Esophageal polyps have been previously ascribed to esophagitis secondary to gastroesophageal reflux, medications, infections and recurrent vomiting. They have been associated with underlying conditions such as hiatal hernia, Barrett's esophagus, eosinophilic esophagitis and Crohn's disease. Presenting complaints of children with esophageal polyps have included vomiting, dysphagia, hematemesis and abdominal pain. The aim of this paper is to characterize the incidence, clinical presentation and progression, histologic subtypes and associated mucosal abnormalities in children with esophageal polyps. A retrospective multicenter study was performed at four institutions identifying diagnosis of esophageal polyps in pediatric patients (<21 years). Information was obtained from patient charts, endoscopy reports and histopathology reports. Specimens and slides were examined by experienced pediatric pathologists for all included cases. Esophageal polyps were identified in 13 patients (9 M) from 9438 esophagogastroduodenoscopies (0.14%). Mean age of subjects was 9.2 years. Vomiting was the most common indication for endoscopy. Polyp location was at the gastroesophageal junction in 7 of the 13 cases. Most polyps were inflammatory (n = 7). Esophagitis was noted in 69% of those with esophageal polyps. Repeat endoscopies in six patients at a mean interval of 8 months noted persistence of polyps in all six patients. This paper is the first to characterize esophageal polyps in pediatrics. These polyps are rare in children and often are associated with esophagitis. Presenting complaints seem to vary by age. Polyps did not consistently change with either time or acid suppression. The optimal management strategy has yet to be defined and likely depends on the underlying pathophysiologic process. PMID:23551692

  14. Recurrent Lower Gastrointestinal Bleeding: Ileal GIST Diagnosed by Video Capsule EndoscopyA Case Report and Literature Review

    PubMed Central

    Lamsen, Marie; Coron, Roger; Deliana, Danila; Rangraj, Madhu; Jesmajian, Stephen

    2013-01-01

    Introduction. Gastrointestinal stromal tumor (GIST) in the ileum is an extremely rare cause of recurrent lower gastrointestinal bleeding (GIB). Case Report. An 89-year-old man was admitted with melana. He had extensive PMH of CAD post-CABG/AICD, AAA repair, chronic anemia, myelodysplastic syndrome, lung cancer after resection, and recurrent GIB. Prior EGDs, colonoscopies, and upper device-assisted enteroscopy showed duodenal ulcer, A-V malformation s/p cauterization, and angioectasia. On admission, Hb was 6.0?g/dL. An endoscopic capsule study showed an ulcerated tumor in the ileum. CT showed no distant metastasis. The lesion was resected successfully and confirmed as a high-grade GIST. The patient was discharged with no further bleeding. Discussion. Early diagnosis for patients with ileal GIST is often challenging. Video capsule endoscopy and double balloon enteroscopy could be useful diagnostic tools. Surgical removal is the first line for a resectable GIST. Imatinib has become the standard therapy. Conclusion. This is a unique case of an ileal GIST in a patient with recurrent GIB which was diagnosed by video capsule. Complicated medical comorbidities often lead to a significant delay in diagnosis. Therefore, we recommend that if GIB does not resolve after appropriate treatments for known causes, the alternative diagnosis for occult GIB must be considered, including malignancy such as GIST. PMID:24027646

  15. Provision of gastrointestinal endoscopy and related services for a district general hospital. Working Party of the Clinical Services Committee of the British Society of Gastroenterology.

    PubMed Central

    1991-01-01

    (1) The number of endoscopic examinations performed is rising. Epidemiological data and the workload of well developed units show that annual requirements per head of population are approaching: Upper gastrointestinal 1 in 100 Flexible sigmoidoscopy 1 in 500 Colonoscopy 1 in 500 ERCP 1 in 2000 (2) Open access endoscopy to general practitioners is desirable and increasingly sought. For a district general hospital serving a population of 250,000, this workload entails about 3500 procedures annually, performed during 10 half day routine sessions plus emergency work. (3) High standards of training and experience are needed by all staff, who must work in purpose built accommodation designed to promote efficient and safe practice. (4) The endoscopy unit should be adjacent to day care facilities and near the x ray department. There should be easy access to wards. (5) An endoscopy unit needs at least two endoscopy rooms; a fully ventilated cleaning/disinfection area; rooms for patient reception, preparation, and recovery; and accommodation for administration, storage, and staff amenities. (6) The service should be consultant based. At least 10 clinical sessions are required, made up of six or more consultant sessions and two to four clinical assistant, hospital practitioner, or staff specialist sessions. Each consultant should be expected to commit at least two sessions weekly to endoscopy. Extra consultant sessions may be needed to provide an efficient service. (7) A specially trained nursing sister (grade G or H) and five other endoscopy nurses are needed to care for the patients; their work may be supplemented by care assistants. (8) A new post of endoscopy department assistant (analogous to an operating department assistant) is proposed to maintain and prepare instruments, and to give technical assistance during procedures. (9) A full time secretary should be employed. Records, appointments, and audit should be computer based. (10) ERCP needs the collaboration of an interventional radiologist working with high quality x ray equipment in a specially prepared radiology screening room. This facility may need to serve more than one hospital. (11) A gastrointestinal measurement laboratory can conveniently be combined with the endoscopy unit. In some hospitals one or more gastrointestinal measurement technicians may staff this laboratory. (12) An endoscopy unit is a service department analogous to a radiology department. It needs an annual budget. PMID:1991644

  16. Efficacy and implications of a 48-h cutoff for video capsule endoscopy application in overt obscure gastrointestinal bleeding

    PubMed Central

    Kim, Seung Han; Keum, Bora; Chun, Hoon Jai; Yoo, In Kyung; Lee, Jae Min; Lee, Jong Soo; Nam, Seung Joo; Choi, Hyuk Soon; Kim, Eun Sun; Seo, Yeon Seok; Jeen, Yoon Tae; Lee, Hong Sik; Um, Soon Ho; Kim, Chang Duck

    2015-01-01

    Background and study aims: Early video capsule endoscopy (VCE) may provide a high diagnostic yield and improve clinical outcomes in patients with overt obscure gastrointestinal bleeding (OGIB); however, there is no practical recommendation for the ideal timing of VCE application in overt OGIB. Therefore, this study investigated the diagnostic yield and efficacy of VCE to assess overt OGIB with respect to the timing of application. Patients and methods: We retrospectively enrolled patients who had undergone VCE for overt OGIB between April 2004 and February 2014?at a tertiary referral academic center. We included hemodynamically stable patients who underwent VCE for overt OGIB after negative bidirectional endoscopy. We analyzed the diagnostic yield of VCE, therapeutic intervention rate, and length of hospital stay. Results: A total of 94 patients underwent VCE to assess overt OGIB. The diagnostic yields in the groups that underwent VCE ?48?h from the last overt OGIB were 66.7?% and 40.6?%, respectively (P?=?0.019). Therapeutic intervention was performed in 26.7?% and 9.4?% of patients in the ?48-h groups, respectively (P?=?0.028). The mean lengths of hospital stay in the ?48-h groups were 5 days (95?% confidence interval [CI], 4.8??7.7) and 7 days (95?%CI, 6.9??10.1), respectively (P?=?0.039). Conclusions: Performing VCE within 2 days from the last overt OGIB results in a higher diagnostic yield, higher therapeutic intervention rate, and shorter hospital stay. Therefore, VCE application with a 48-h cutoff could improve the outcome of patients with overt OGIB. PMID:26357679

  17. Degree of concordance between single balloon enteroscopy and capsule endoscopy for obscure gastrointestinal bleeding after an initial positive capsule endoscopy finding

    PubMed Central

    Shiani, Ashok; Nieves, Javier; Lipka, Seth; Patel, Brijesh; Kumar, Ambuj; Brady, Patrick

    2016-01-01

    Introduction: In patients with obscure gastrointestinal bleeding (OBGIB) capsule endoscopy (CE) is the initial diagnostic procedure of choice. Often patients undergo single balloon enteroscopy (SBE) with both diagnostic and therapeutic intention after CE. Although SBE offers a therapeutic benefit, long procedure times, complexity, and invasiveness are drawbacks. We aimed to evaluate the diagnostic correlation between these two modalities after an initial positive CE finding. Methods: We performed a retrospective review of 418 patients who underwent CE at our institution from January 2010 to May 2014. A total of 95 patients were analyzed after selecting patients that underwent SBE originally after a positive CE result for the evaluation for OGIB. Agreement beyond chance was evaluated using the ? coefficient. A p value less than 5% was considered statistically significant. Results: The mean age of our population was 65.8 12.2 and it was female predominant: 57/95 (60%). The most frequent positive findings were vascular lesions found on SBE in 31.6% and on CE in 41.1%. There was a strong agreement when identifying active bleeding and clots [?=0.97; 95% confidence interval (CI) 0.921.03; p ? 0.0001], and a moderate agreement when diagnosing vascular lesions (0.41; 95% CI 0.210.61; p ? 0.0001). There was fair agreement for ulcers (0.26; 95% CI 0.070.59; p = 0.005). There was a low correlation between masses, polyps, and others. Conclusion: CE still remains the initial test of choice in evaluating stable patients with OBGIB since it has strong-to-fair concordance for the major small bowel findings. However, in cases of severe overt small bowel bleeding, balloon-assisted enteroscopy can be considered the initial procedure of choice since it is therapeutic as well as diagnostic and this approach avoids delays in treatment. Further research should focus on methods to improve interpretation of CE and enhance the ability to evaluate the entire small bowel with SBE. PMID:26770263

  18. 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

  19. 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

  20. Comparison of magnetic resonance enterography, capsule endoscopy and gastrointestinal radiography of children with small bowel Crohns disease

    PubMed Central

    LAI, CAN; ZHOU, HAI-CHUN; MA, MING; ZHANG, HONG-XI; JIA, XUAN

    2013-01-01

    The aim of this study was to compare magnetic resonance enterography (MRE) findings with those of video capsule endoscopy (VCE) or conventional gastrointestinal radiography (CGR) in pediatric patients with small bowel Crohns disease. A total of 55 cases of small bowel Crohns disease that were diagnosed through clinical, laboratory, surgical and histopathological findings were reviewed. Prior to the examination, children suspected of having other types of diseases of the small intestinal were identified. The pulse sequences included coronal T2-true-fast imaging with steady-state precession (TrueFISP) images, navigation axial and coronal T1-weighted images, T2-weighted fat-suppressed images and coronal fat-suppressed three-dimensional gradient-echo images, immediately followed by contrast-enhanced axial and coronal T1-weighted fat-suppressed images. Findings from MRE were compared with those of VCE (n=39) and CGR (n=37). MRE results exhibited a number of features characteristic to small bowel Crohns disease, including wall thickening, mesenteric fibrofatty changes and mesenteric vasculature changes. VCE, MRE and CGR demonstrated sensitivities of 94.6, 85.7 and 71.1% with specificities of 72.7, 70 and 40%; accuracies of 89.6, 82.2 and 61.1%; positive predictive values of 92.1, 90.9 and 59.6%; and negative predictive values of 80, 58.3 and 40%, respectively. VCE depicted mucosal pathologies missed by MRE in three patients. MRE revealed 83 extraenteric findings in 55 patients and CGR was able to show the dynamic evolution of the gastrointestinal function. MRE is a simple, safe, non-invasive and effective method for evaluating small bowel Crohns disease. VCE allows visualization and readily characterizes subtle mucosal lesions missed by MRE, whereas MRE yields additional mural, perienteric and extraenteric information. However, oral barium CGR utilizes radiation, which is not suitable for repeated use in children. PMID:23935731

  1. 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; DAngelo, 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

  2. 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

  3. Complimentary Imaging Modalities for Investigating Obscure Gastrointestinal Bleeding: Capsule Endoscopy, Double-Balloon Enteroscopy, and Computed Tomographic Enterography

    PubMed Central

    Chu, Ye; Wu, Sheng; Qian, Yuting; Wang, Qi; Li, Juanjuan; Tang, Yanping; Bai, Tingting; Wang, Lifu

    2016-01-01

    Objectives. The complimentary value of computed tomographic enterography (CTE) and double-balloon enteroscopy (DBE) combined with capsule endoscopy (CE) was evaluated in the diagnosis of obscure gastrointestinal bleeding (OGIB). Methods. Patients who received CE examinations at Ruijin Hospital between July 2007 and July 2014 with the indication of OGIB were identified, and those who also underwent DBE and/or CTE were included. Their clinical information was retrieved, and results from each test were compared with findings from the other two examinations. Results. The overall diagnostic yield of CE was comparable with DBE (73.9% versus 60.9%) but was significantly higher than the yield of CTE (87% versus 25%, p < 0.001). The diagnostic yield of angiodysplasia at CE was significantly higher than CTE (73% versus 8%, p < 0.001) and DBE (39.1% versus 17.4%, p = 0.013), while no significant difference was found between the three approaches for small bowel tumors. DBE and CTE identified small bowel diseases undetected or undetermined by CE. Conversely, CE improved diagnosis in the cases with negative CTE and DBE, and findings at initial CE directed further diagnosis made by DBE. Conclusions. Combination of the three diagnostic platforms provides complementary value in the diagnosis of OGIB. PMID:26858753

  4. [The role of endoscopy in the therapy for perforations and leakages of the gastrointestinal tract].

    PubMed

    Feisthammel, J; Jonas, S; Mssner, J; Hoffmeister, A

    2013-06-01

    Perforations and leakages of hollow organs of the gastrointestinal tract can occur spontaneously among other causes. They can also develop as complications of an endoscopic intervention or after surgical construction of an anastomosis. For the patient, these situations usually are serious and life-threatening. Standard therapy has always been - and most of the time still is - major surgery. These procedures usually are technically difficult and their mortality and morbidity are not satisfactory due to, among others, the occurrence of local infections. Thus, various endoscopic techniques as therapy for perforations and leakages have been developed over the last years. These include above all the endoscopic placement of clip systems and stents and the relatively new vacuum drainage systems. In case of perforations and leakages of the bile duct and the rectum especially, these minimal invasive techniques are widely used, also increasingly in lesions of the esophagus. However, these new, endoscopic procedures suffer from a lack of evidence. This paper highlights the possibilities and limitations of endoscopic options in therapy for perforations and leakages of organs of the gastrointestinal tract. PMID:22562158

  5. 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

  6. 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

  7. Capsule endoscopy in the diagnosis of an exophytic gastrointestinal stromal tumor in the small intestine of a young adult woman: A case report

    PubMed Central

    XU, XIAOLING; CAO, ZHENGLONG; ZHU, HAIHANG

    2016-01-01

    Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors that mainly arise in the gastrointestinal tract. They are usually asymptomatic and are incidentally discovered during endoscopy or surgery. Diagnosis is confirmed by histological examination of the specimen. This is the case report of an asymptomatic GIST of the small intestine diagnosed by wireless capsule endoscopy. The tumor was initially suspected to be a leiomyoma, as GISTs in young adults are rare and are mainly discovered incidentally during colorectal cancer screening. The patient was a 35-year-old woman with occult gastrointestinal bleeding, with a normal medical history. An endoscopic assessment of the upper and lower GI tract (gastroscopy and colonoscopy) was performed, but did not reveal any abnormalities. Subsequently, an exophytic tumor initially suspected as leiomyoma or external pressure was detected in the small intestine by capsule endoscopy. A computed tomography scan was suggestive of a soft tissue tumor arising from the small intestine. A surgical specimen was obtained and the immunohistochemical examination revealed that the tumor was positive for CD117 and discovered on GIST-1 markers, while the markers of carcinoma, melanoma and lymphoma were negative, which was consistent with a diagnosis of a low-risk GIST with a mitotic count of <5/50 high-power fields. In this study, we aimed to present in detail the capsule endoscopic and radiological characteristics, as well as the findings of the histological examination of the surgical specimen. In conclusion, when occult blood is detected in the stool, even when gastroscopy and colonoscopy reveal no abnormal findings, small intestinal lesions should be suspected. Exophytic small intestinal GISTs, although rare, particularly in younger patients, they should be considered by physicians in the differential diagnosis of obscure GI bleeding of unknown origin, in order to reduce morbidity and mortality. Capsule endoscopy may be considered to be the first choice as a diagnostic tool for obscure GI bleeding.

  8. 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, 10.783.81 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). Meanstandard deviation (SD) duration of procedure was 6.361.64 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 (9.494.05 years vs. 11.613.43 years, p=0.002 and 2.101.46 vs. 4.371.16, p=0.001). Mean recovery time was 22 minutes (range, 10-90 minutes; meanSD, 2512.32 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

  9. 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

  10. Outcomes of acute upper gastrointestinal bleeding in relation to timing of endoscopy and the experience of endoscopist: a tertiary center experience

    PubMed Central

    Mohammed, Noor; Rehman, Amer; Swinscoe, Mark Thomas; Mundre, Pradeep; Rembacken, Bjorn

    2016-01-01

    Introduction: Patients with gastrointestinal bleeding admitted out of hours or at the weekends may have an excess mortality rate. The literature reports around this are conflicting. Aims and methods: We aimed to analyze the outcomes of emergency endoscopies performed out of hours and over the weekends in our center. We retrospectively analyzed data from April 2008 to June 2012. Results: A total of 507 ‘high risk’ emergency gastroscopies were carried out over the study period for various indications. Patients who died within 30 days of the index procedure [22 % (114 /510)] had a significantly higher Rockall score (7.6 vs. 6.0, P < 0.0001), a higher American Society of Anesthesiologists (ASA) status (3.5 vs. 2.7, P < 0.001), and a lower systolic blood pressure (BP) at the time of the examination (94.8 vs 103, P = 0.025). These patients were significantly older (77.7 vs. 67.5 years, P = 0.006), and required more blood transfusion (5.9 versus 3.8 units). Emergency out-of-hours endoscopy was not associated with an increased risk of death [relative risk (RR) 1.09, 95 % confidence interval (CI) 1.12 – 1.95]. Whether the examination was carried out by a senior specialist registrar (senior trainee) or a consultant made no difference to the survival of the patient (RR 0.98, CI 0.77 – 1.32). Conclusion: Higher pre-endoscopy Rockall score and ASA status contributed significantly to the 30-day mortality following upper gastrointestinal bleeding, whereas lower BP tended towards significance. Outcomes did not vary with the time of the endoscopy nor was there any difference between a consultant and a senior specialist registrar led service. PMID:27004244

  11. 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

  12. 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

  13. Cleaning and disinfection of equipment for gastrointestinal endoscopy. Report of a Working Party of the British Society of Gastroenterology Endoscopy Committee.

    PubMed

    1998-04-01

    Two per cent glutaraldehyde is the most commonly used disinfectant in endoscopy units within the UK. Unfortunately adverse reactions to glutaraldehyde are common among endoscopy personnel and the Health and Safety Commission has recommended substantial reductions in atmospheric levels of glutaraldehyde in order to comply with the Control of Substances Hazardous to Health Regulations, 1994. The Working Party addressed ways of eliminating or minimising exposure to glutaraldehyde in endoscopy units by reviewing alternative disinfectants and the use of automated washer/disinfectors. Alternatives to glutaraldehyde must be at least as microbicidal as glutaraldehyde, non-irritating and compatible with endoscope components and decontamination equipment. Peracetic acid is a highly effective disinfectant and may be a suitable alternative to glutaraldehyde. Peracetic acid has a vinegary-like odour and is claimed to be less irritating than glutaraldehyde. Experience with this agent remains relatively limited and the Working Party recommends that peracetic acid should be used in sealed or exhaust ventilated facilities until further experience is obtained. It is considerably more expensive than glutaraldehyde, is less stable and large volumes have to be stored. It causes cosmetic (but not functional) damage to endoscopes and is not compatible with some washer/ disinfectors. Chlorine dioxide is a powerful oxidising agent and highly effective as a disinfectant. Once activated it must be stored in sealed containers with little head space. Fumes cause irritation and sealed or exhaust ventilated facilities are necessary. The agent may damage some metallic and polymer components of endoscopes and automated washer/disinfectors and compatibility should be established with equipment manufacturers before the agent is used. Other disinfectants such as peroxygen compounds and quaternary ammonium derivatives are less suitable because of unsatisfactory mycobactericidal and/or virucidal activity, or incompatibility with endoscopes and automated washer/disinfectors. Alcohol is effective but, on prolonged contact, is damaging to lens cements. It is also flammable and therefore unsuitable for use in large quantities in automated systems. Superoxidised water (Sterilox) is an electrochemical solution (anolyte) containing a mixture of radicals with strong oxidising properties. It is highly microbicidal when freshly generated, provided items are thoroughly clean and strict generation criteria are met--that is, current, pH, redox potential. It seems to be safe for users and provided field trials substantiate laboratory efficacy tests, and the agent is non-damaging, it too may become an alternative to glutaraldehyde. When 2% glutaraldehyde is used for manual and automated disinfection, 10 minutes' immersion is recommended for endoscopes before the session and between patients. This will destroy vegetative bacteria and viruses (including hepatitis B virus (HBV) and HIV). A five minute contact period is recommended for 0.35% peracetic acid and for chlorine dioxide (1100 ppm av ClO2), but if immersed for 10 minutes sporicidal activity will also be achieved. At the end of each session 20 minutes' immersion in glutaraldehyde or five minutes in peracetic acid or chlorine dioxide is recommended. Microbiological studies show that 20 minutes of exposure to 2% glutaraldehyde destroys most organisms, including Mycobacterium tuberculosis. The Working Party concludes therefore that immersion of the endoscope in 2% glutaraldehyde for 20 minutes is sufficient for endoscopy involving patients with AIDS and other immunodeficiency states or pulmonary tuberculosis. Similarly, 20 minutes' immersion is recommended at the start of the list and between cases for endoscopic retrograde cholangiopancreatography (ERCP) when high level disinfection is required. Cleaning and disinfection of endoscopes should be undertaken by trained staff in a dedicated room. Thorough cleaning with detergent PMID:9616326

  14. 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)

    Gmez-Garca, Pablo Aurelio; Arranz, Alicia; Fresno, Manuel; Desco, Manuel; Mahmood, Umar; Vaquero, Juan Jos; 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.

  15. 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.

  16. Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines.

    PubMed

    Veitch, Andrew M; Vanbiervliet, Geoffroy; Gershlick, Anthony H; Boustiere, Christian; Baglin, Trevor P; Smith, Lesley-Ann; Radaelli, Franco; Knight, Evelyn; Gralnek, Ian M; Hassan, Cesare; Dumonceau, Jean-Marc

    2016-04-01

    The risk of endoscopy in patients on antithrombotics depends on the risks of procedural haemorrhage vs. thrombosis due to discontinuation of therapy. P2Y12 receptor antagonists (clopidogrel, prasugrel, ticagrelor): For low-risk endoscopic procedures we recommend continuing P2Y12 receptor antagonists as single or dual antiplatelet therapy (low quality evidence, strong recommendation);For high-risk endoscopic procedures in patients at low thrombotic risk, we recommend discontinuing P2Y12 receptor antagonists five days before the procedure (moderate quality evidence, strong recommendation). In patients on dual antiplatelet therapy, we suggest continuing aspirin (low quality evidence, weak recommendation).For high-risk endoscopic procedures in patients at high thrombotic risk, we recommend continuing aspirin and liaising with a cardiologist about the risk/benefit of discontinuation of P2Y12 receptor antagonists (high quality evidence, strong recommendation). Warfarin: The advice for warfarin is fundamentally unchanged from BSG 2008 guidance. Direct Oral Anticoagulants (DOAC): For low-risk endoscopic procedures we suggest omitting the morning dose of DOAC on the day of the procedure (very low quality evidence, weak recommendation). For high-risk endoscopic procedures, we recommend that the last dose of DOAC be taken ≥ 48 hours before the procedure (very low quality evidence, strong recommendation). For patients on dabigatran with CrCl (or estimated glomerular filtration rate, eGFR) of 30 - 50 mL/min we recommend that the last dose of DOAC be taken 72 hours before the procedure (very low quality evidence, strong recommendation). In any patient with rapidly deteriorating renal function a haematologist should be consulted (low quality evidence, strong recommendation). PMID:26890676

  17. Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

    PubMed Central

    Veitch, Andrew M; Vanbiervliet, Geoffroy; Gershlick, Anthony H; Boustiere, Christian; Baglin, Trevor P; Smith, Lesley-Ann; Radaelli, Franco; Knight, Evelyn; Gralnek, Ian M; Hassan, Cesare; Dumonceau, Jean-Marc

    2016-01-01

    The risk of endoscopy in patients on antithrombotics depends on the risks of procedural haemorrhage versus thrombosis due to discontinuation of therapy. P2Y12 receptor antagonists (clopidogrel, prasugrel, ticagrelor) For low-risk endoscopic procedures we recommend continuing P2Y12 receptor antagonists as single or dual antiplatelet therapy (low quality evidence, strong recommendation); For high-risk endoscopic procedures in patients at low thrombotic risk, we recommend discontinuing P2Y12 receptor antagonists five days before the procedure (moderate quality evidence, strong recommendation). In patients on dual antiplatelet therapy, we suggest continuing aspirin (low quality evidence, weak recommendation). For high-risk endoscopic procedures in patients at high thrombotic risk, we recommend continuing aspirin and liaising with a cardiologist about the risk/benefit of discontinuation of P2Y12 receptor antagonists (high quality evidence, strong recommendation). Warfarin The advice for warfarin is fundamentally unchanged from British Society of Gastroenterology (BSG) 2008 guidance. Direct Oral Anticoagulants (DOAC) For low-risk endoscopic procedures we suggest omitting the morning dose of DOAC on the day of the procedure (very low quality evidence, weak recommendation); For high-risk endoscopic procedures, we recommend that the last dose of DOAC be taken ≥48 h before the procedure (very low quality evidence, strong recommendation). For patients on dabigatran with CrCl (or estimated glomerular filtration rate, eGFR) of 30–50 mL/min we recommend that the last dose of DOAC be taken 72 h before the procedure (very low quality evidence, strong recommendation). In any patient with rapidly deteriorating renal function a haematologist should be consulted (low quality evidence, strong recommendation). PMID:26873868

  18. Outcome of non-variceal acute upper gastrointestinal bleeding in relation to the time of endoscopy and the experience of the endoscopist: A two-year survey

    PubMed Central

    Parente, Fabrizio; Anderloni, Andrea; Bargiggia, Stefano; Imbesi, Venerina; Trabucchi, Emilio; Baratti, Cinzia; Gallus, Silvano; Porro, Gabriele Bianchi

    2005-01-01

    AIM: To prospectively assess the impact of time of endoscopy and endoscopists experience on the outcome of non-variceal acute upper gastrointestinal (GI) bleeding patients in a large teaching hospital. METHODS: All patients admitted for non-variceal acute upper GI bleeding for over a 2-year period were potentially eligible for this study. They were managed by a team of seven endoscopists on 24-h call whose experience was categorized into two levels (high and low) according to the number of endoscopic hemostatic procedures undertaken before the study. Endoscopic treatment was standardized according to Forrest classification of lesions as well as the subsequent medical therapy. Time of endoscopy was subdivided into two time periods: routine (8 a.m.-5 p.m.) and on-call (5 p.m.-8 a.m.). For each category of experience and time periods rebleeding rate, transfusion requirement, need for surgery, length of hospital stay and mortality we compared. Multivariate analysis was used to discriminate the impact of different variables on the outcomes that were considered. RESULTS: Study population consisted of 272 patients (mean age 67.3 years) with endoscopic stigmata of hemorrhage. The patients were equally distributed among the endoscopists, whereas only 19% of procedures were done out of working hours. Rockall score and Forrest classification at admission did not differ between time periods and degree of experience. Univariate analysis showed that higher endoscopists experience was associated with significant reduction in rebleeding rate (14% vs 37%), transfusion requirements (1.80.6 vs 3.01.7 units) as well as surgery (4% vs 10%), but not associated with the length of hospital stay nor mortality. By contrast, outcomes did not significantly differ between the two time periods of endoscopy. On multivariate analysis, endoscopists experience was independently associated with rebleeding rate and transfusion requirements. Odds ratios for low experienced endoscopist were 4.47 for rebleeding and 6.90 for need of transfusion after the endoscopy. CONCLUSION: Endoscopists experience is an important independent prognostic factor for non-variceal acute upper GI bleeding. Urgent endoscopy should be undertaken preferentially by a skilled endoscopist as less expert staff tends to underestimate some risk lesions with a negative influence on hemostasis. PMID:16437658

  19. 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

  20. 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

  1. 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

  2. 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 ?6mm 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

  3. 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

  4. New Evidence on the Impact of Antithrombotics in Patients Submitted to Small Bowel Capsule Endoscopy for the Evaluation of Obscure Gastrointestinal Bleeding

    PubMed Central

    Rosa, Bruno; Moreira, Maria Joo; Cotter, Jos

    2014-01-01

    Objectives. Small bowel capsule endoscopy (SBCE) plays a decisive role in the obscure gastrointestinal bleeding (OGIB) diagnosis. Antithrombotics may increase bleeding risk in patients with preexistent lesions or through direct mucosal aggression. We aimed to correlate antithrombotics usage with lesions with bleeding potential found in SBCE. Methods. Retrospective single-center study including 274 consecutive SBCE performed over 7 years for OGIB. The lesions were classified as P0 (no bleeding potential), P1 (uncertain bleeding potential: erosions), and P2 (high bleeding potential: angioectasias, ulcers, and tumors). We assessed antiplatelet and anticoagulant drug use during the 60 days preceding SBCE. Results. One-third of the patients were under antithrombotic therapy. The diagnostic yield of SBCE for P2 lesions was 30.0%. Angioectasias (20.4%) were the most frequently observed lesions. There was a significant correlation between anticoagulant drug use and a higher incidence of P2 lesions in the small bowel (43.2% versus 26.5%; OR = 2.11, P = 0.026). We found no significant correlation between antiplatelets and lesions with bleeding potential in SBCE. Conclusions. Small bowel lesions with high bleeding potential were more frequently detected when the patient was on anticoagulant drugs, resulting in a twofold risk. Antiplatelet drugs were not associated with small bowel lesions. PMID:25431588

  5. Understanding Capsule Endoscopy

    MedlinePLUS

    ... On Training Training and Core Curriculum GESAP VIII Self-Assessment Education Achievement Program ASGE Endorsed Activities Ambassador Program ... ASGE Leading Edge Endoscopic Learning Library GESAP VIII Self-Assessment Patient Education Brochures QR Codes poster Anatomical images ...

  6. 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

  7. 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

  8. 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

  9. 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 ...

  10. 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, Crohns 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

  11. Clinical applications of small bowel capsule endoscopy.

    PubMed

    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

  12. Sketch of International Digestive Endoscopy Network 2012 Meeting: Overview

    PubMed Central

    2012-01-01

    International Digestive Endoscopy Network (IDEN) is an international meeting covering scientific subjects of diverse topics about upper gastrointestinal (GI) endoscopy, colonoscopy, endoscopic ultrasonography, and PB endoscopy. IDEN is organized by Korean Society of Gastrointestinal Endoscopy and the Korean Gastrointestinal Endoscopy Research Foundation, and took its first step in 2011 in Seoul, Korea. IDEN inaugurated a new era of diagnostic and therapeutic GI endoscopy. IDEN 2012 was designed to offer participants from all over the world with opportunities to share up-to-date knowledge about basic and clinical aspects of GI endoscopy and to engage in in-depth discussion with worldwide well-known experts. During the 2 days of meeting, there were 62 invited lectures, 28 case-based discussions, 20 video lectures, and 6 breakfast with the experts. There were a total of 598 participants registered from 12 countries, including Asian countries, Europe, and USA as well as Korea. PMID:22977804

  13. 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

  14. Highlights of International Digestive Endoscopy Network 2013

    PubMed Central

    Kwon, Kwang An; Choi, Il Ju; Kim, Eun Young; Dong, Seok Ho

    2013-01-01

    Rapid advances in the technology of gastrointestinal endoscopy as well as the evolution of science have made it necessary for us to continue update in either various endoscopic techniques or state of art lectures relevant to endoscopy. International Digestive Endoscopy Network (IDEN) 2013 was held in conjunction with Korea-Japan Joint Symposium on Gastrointestinal Endoscopy (KJSGE) during June 8 to 9, 2013 at Seoul, Korea. Two days of impressive scientific program dealt with a wide variety of basic concerns from upper gastrointestine (GI), lower GI, pancreaticobiliary endoscopy to advanced knowledge including endoscopic submucosal dissection forum. IDEN seems to be an excellent opportunity to exchange advanced information of the latest issues on endoscopy with experts from around the world. In this special issue of Clinical Endoscopy, we prepared state of art review articles from contributing authors and the current highlights will skillfully deal with very hot spots of each KJSGE, upper GI, lower GI, and pancreaticobiliary sessions by associated editors of Clinical Endoscopy. PMID:24143297

  15. [Therapeutic endoscopy in pediatrics].

    PubMed

    Méndez-Nieto, Carlos; Ramírez-Mayans, Jaime; Montijo-Barrios, Erica; Cervantes-Bustamante, Roberto; Zárate-Mondragón, Flora

    2005-07-01

    Gastrointestinal endoscopy is a procedure that appeared at the end of the seventies and beginning of the eighties in adult patients. With time, however, the instruments have become more sophisticated and have been adapted for use in children; with this the procedure has become at present not only an important diagnostic arm but also an indispensable therapeutic procedure in much pediatric pathology. The purpose of this article is to show any physician who treats children the main therapeutic advantages and indications of this procedure. PMID:17469419

  16. Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED)

    PubMed Central

    Dinis-Ribeiro, M.; Areia, M.; de Vries, A. C.; Marcos-Pinto, R.; Monteiro-Soares, M.; O'Connor, A.; Pereira, C.; Pimentel-Nunes, P.; Correia, R.; Ensari, A.; Dumonceau, J. M.; Machado, J. C.; Macedo, G.; Malfertheiner, P.; Matysiak-Budnik, T.; Megraud, F.; Miki, K.; O'Morain, C.; Peek, R. M.; Ponchon, T.; Ristimaki, A.; Rembacken, B.; Carneiro, F.; Kuipers, E. J.

    2012-01-01

    Atrophic gastritis, intestinal metaplasia, and epithelial dysplasia of the stomach are common and are associated with an increased risk for gastric cancer. In the absence of guidelines, there is wide disparity in the management of patients with these premalignant conditions. The European Society of Gastrointestinal Endoscopy (ESGE), the European Helicobacter Study Group (EHSG), the European Society of Pathology (ESP) and the Sociedade Portuguesa de Endoscopia Digestiva (SPED) have therefore combined efforts to develop evidence-based guidelines on the management of patients with precancerous conditions and lesions of the stomach (termed MAPS). A multidisciplinary group of 63 experts from 24 countries developed these recommendations by means of repeat online voting and a meeting in June 2011 in Porto, Portugal. The recommendations emphasize the increased cancer risk in patients with gastric atrophy and metaplasia, and the need for adequate staging in the case of high grade dysplasia, and they focus on treatment and surveillance indications and methods. PMID:22198778

  17. LC phase bias investigation of ASG-EUPOS stations

    NASA Astrophysics Data System (ADS)

    Araszkiewicz, Andrzej; Szafranek, Karolina

    2013-12-01

    Monitoring of permanent stations that make up the reference frame is an integral part of the geodesists work. Selection of reference stations is based on analysis of parameters characterizing them (hardware, coordinates' stability, mounting, location). In this paper, we took into account phase residual as an indicator of unmodelled signal. Phase residuals were computed based on ASG-EUPOS and EPN observation processing. The results show the connection between the method of mounting the antenna and the residuals. We have reviewed multipath effect at ASG-EUPOS stations, and chosen those which are characterized by the highest value of phase residual. The results show that LC phase residual is a good factor to characterize site's solutions' reliability. For majority of sites RMS values were less than 10 mm. Modulations associated with multipath effect were observed for few ASG-EUPOS sites only. Phase residuals are distributed specifically for sites, which antennas are mounted on pillars (more common for EPN sites). For majority of analysed sites phase residual distribution was similar for different days and did not depend directly on atmosphere condition. Monitorowanie permanentnych stacji GPS/GNSS, ktre tworz? uk?ad wsp?rz?dnych stanowi integraln? cz??? pracy geodetw. Wybr takich stacji bazuje na analizie parametrw, ktre charakteryzuj? jej jako?? (mi.in. sprz?t, stabilno?? wsp?rz?dnych, lokalizacja i monta? anteny). W przedstawionej pracy przeanalizowano jeden z nich - odchy?ki obserwacji fazowych. Warto?ci tych r?nic obliczono dla stacji EPN oraz ASG-EUPOS z rozwi?za? dobowych. Dla wi?kszo?ci z analizowanych stacji ?rednia kwadratowa otrzymanych odchy?ek nie przekracza?a 10 mm. Warto?? ta oraz sam rozk?ad odchy?ek nie zmienia? si? znacz?co przy r?nych warunkach atmosfery. Na podstawie otrzymanych odchy?ek fazowych przeanalizowano wp?yw wielotorowo?ci na tych stacjach. Modulacje warto?ci odchy?ek na niskich k?tach elewacji, ktrych jednym ze ?rde? jest efekt wielotorowo?ci otr zymano zaledwie na kilku stacjach ASG-EUPOS. Taka sytuacja mia?a miejsce g?wnie dla stacji, ktrych anteny zamontowane s? na s?upach. Wyniki pokaza?y, ?e podej?cie wykorzystuj?ce analiz? odchy?ek liniowej kombinacji obserwacji fazowych jest dobr? metod? do oceny pracy stacji.

  18. Guidelines for sedation in gastroenterological endoscopy.

    PubMed

    Obara, Katsutoshi; Haruma, Ken; Irisawa, Atsushi; Kaise, Mitsuru; Gotoda, Takuji; Sugiyama, Masanori; Tanabe, Satoshi; Horiuchi, Akira; Fujita, Naotaka; Ozaki, Makoto; Yoshida, Masahiro; Matsui, Toshiyuki; Ichinose, Masao; Kaminishi, Michio

    2015-05-01

    Recently, the need for sedation in gastrointestinal endoscopy has been increasing. However, the National Health Insurance Drug Price list in Japan does not include any drug specifically used for the sedation. Although benzodiazepines are the main medication, their use in cases of gastrointestinal endoscopy has not been approved. This has led the Japan Gastrointestinal Endoscopy Society to develop the first set of guidelines for sedation in gastrointestinal endoscopy on the basis of evidence-based medicine in collaboration with the Japanese Society for Anesthesiologists. The present guidelines comprise 14 statements, five of which were judged to be valid on the highest evidence level and three on the second highest level. The guidelines are not intended to strongly recommend the use of sedation for gastrointestinal endoscopy, but rather to indicate the policy as to the choice of appropriate procedures when such sedation is deemed necessary. In clinical practice, the final decision as to the use of sedation should be made by physicians considering patient willingness and physical condition. PMID:25677012

  19. 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 ...

  20. An unexpectedly difficult intubation following repeated endoscopy.

    PubMed

    Fitzwilliams, B; Volikas, I

    2004-04-01

    A 67-year-old man required an urgent laparotomy for a bleeding gastric ulcer. He had undergone three upper gastrointestinal endoscopies over five days since admission to hospital. Tracheal intubation was unexpectedly difficult due to marked supraglottic oedema as well as unfavourable upper airway anatomy. A fibreoptic intubation through a laryngeal mask airway was performed with difficulty. The management of this case of difficult intubation following repeated endoscopy is presented. PMID:15957728

  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. 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

  3. 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

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

    PubMed

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

    2012-12-15

    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

  5. ASG2 is a farnesylated DWD protein that acts as ABA negative regulator in Arabidopsis.

    PubMed

    Dutilleul, Christelle; Ribeiro, Iliana; Blanc, Nathalie; Nezames, Cynthia D; Deng, Xing Wang; Zglobicki, Piotr; Palacio Barrera, Ana María; Atehortùa, Lucia; Courtois, Martine; Labas, Valérie; Giglioli-Guivarc'h, Nathalie; Ducos, Eric

    2016-01-01

    The tagging-via-substrate approach designed for the capture of mammal prenylated proteins was adapted to Arabidopsis cell culture. In this way, proteins are in vivo tagged with an azide-modified farnesyl moiety and captured thanks to biotin alkyne Click-iT® chemistry with further streptavidin-affinity chromatography. Mass spectrometry analyses identified four small GTPases and ASG2 (ALTERED SEED GERMINATION 2), a protein previously associated to the seed germination gene network. ASG2 is a conserved protein in plants and displays a unique feature that associates WD40 domains and tetratricopeptide repeats. Additionally, we show that ASG2 has a C-terminal CaaX-box that is farnesylated in vitro. Protoplast transfections using CaaX prenyltransferase mutants show that farnesylation provokes ASG2 nucleus exclusion. Moreover, ASG2 interacts with DDB1 (DAMAGE DNA BINDING protein 1), and the subcellular localization of this complex depends on ASG2 farnesylation status. Finally, germination and root elongation experiments reveal that asg2 and the farnesyltransferase mutant era1 (ENHANCED RESPONSE TO ABSCISIC ACID (ABA) 1) behave in similar manners when exposed to ABA or salt stress. To our knowledge, ASG2 is the first farnesylated DWD (DDB1 binding WD40) protein related to ABA response in Arabidopsis that may be linked to era1 phenotypes. PMID:26147561

  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 Barretts 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. Evidence from Multiple Species that Spider Silk Glue Component ASG2 is a Spidroin.

    PubMed

    Collin, Matthew A; Clarke, Thomas H; Ayoub, Nadia A; Hayashi, Cheryl Y

    2016-01-01

    Spiders in the superfamily Araneoidea produce viscous glue from aggregate silk glands. Aggregate glue coats prey-capture threads and hampers the escape of prey from webs, thereby increasing the foraging success of spiders. cDNAs for Aggregate Spider Glue 1 (ASG1) and 2 (ASG2) have been previously described from the golden orb-weaver, Nephila clavipes, and Western black widow, Latrodectus hesperus. To further investigate aggregate glues, we assembled ASG1 and ASG2 from genomic target capture libraries constructed from three species of cob-web weavers and three species of orb-web weavers, all araneoids. We show that ASG1 is unlikely to be a glue, but rather is part of a widespread arthropod gene family, the peritrophic matrix proteins. For ASG2, we demonstrate its remarkable architectural and sequence similarities to spider silk fibroins, indicating that ASG2 is a member of the spidroin gene family. Thus, spidroins have diversified into glues in addition to task-specific, high performance fibers. PMID:26875681

  8. Evidence from Multiple Species that Spider Silk Glue Component ASG2 is a Spidroin

    PubMed Central

    Collin, Matthew A.; Clarke, Thomas H.; Ayoub, Nadia A.; Hayashi, Cheryl Y.

    2016-01-01

    Spiders in the superfamily Araneoidea produce viscous glue from aggregate silk glands. Aggregate glue coats prey-capture threads and hampers the escape of prey from webs, thereby increasing the foraging success of spiders. cDNAs for Aggregate Spider Glue 1 (ASG1) and 2 (ASG2) have been previously described from the golden orb-weaver, Nephila clavipes, and Western black widow, Latrodectus hesperus. To further investigate aggregate glues, we assembled ASG1 and ASG2 from genomic target capture libraries constructed from three species of cob-web weavers and three species of orb-web weavers, all araneoids. We show that ASG1 is unlikely to be a glue, but rather is part of a widespread arthropod gene family, the peritrophic matrix proteins. For ASG2, we demonstrate its remarkable architectural and sequence similarities to spider silk fibroins, indicating that ASG2 is a member of the spidroin gene family. Thus, spidroins have diversified into glues in addition to task-specific, high performance fibers. PMID:26875681

  9. Evidence that asgB encodes a DNA-binding protein essential for growth and development of Myxococcus xanthus.

    PubMed Central

    Plamann, L; Davis, J M; Cantwell, B; Mayor, J

    1994-01-01

    The asg mutants of Myxococcus xanthus are defective in production of extracellular A-signal, which serves as a cell density signal for fruiting-body development. The DNA sequence of asgB, one of the three asg genes, was determined. The deduced amino acid sequence of AsgB contains a DNA-binding helix-turn-helix motif near the C terminus. This putative helix-turn-helix is highly similar to the helix-turn-helix in region 4.2 of major sigma factors, which is the region that recognizes and interacts with -35 sequences of promoters. We propose that AsgB is a transcription factor that binds to DNA sequences similar to the -35 hexamer, TTGACA. Analyses of asgB RNA levels and expression of an asgB-lacZ translational fusion indicate that expression of asgB remains fairly constant during the transition from growth into early development. The mutation within the asgB480 allele was identified as an A-to-G transition that results in a threonine-to-alanine substitution in the predicted protein product. Attempts to replace the wild-type copy of asgB with a null allele failed, indicating that asgB may be essential for growth. Images PMID:8144470

  10. A Review of Locomotion Systems for Capsule Endoscopy.

    PubMed

    Liu, Lejie; Towfighian, Shahrzad; Hila, Amine

    2015-01-01

    Wireless capsule endoscopy for gastrointestinal (GI) tract is a modern technology that has the potential to replace conventional endoscopy techniques. Capsule endoscopy is a pill-shaped device embedded with a camera, a coin battery, and a data transfer. Without a locomotion system, this capsule endoscopy can only passively travel inside the GI tract via natural peristalsis, thus causing several disadvantages such as inability to control and stop, and risk of capsule retention. Therefore, a locomotion system needs to be added to optimize the current capsule endoscopy. This review summarizes the state-of-the-art locomotion methods along with the desired locomotion features such as size, speed, power, and temperature and compares the properties of different methods. In addition, properties and motility mechanisms of the GI tract are described. The main purpose of this review is to understand the features of GI tract and diverse locomotion methods in order to create a future capsule endoscopy compatible with GI tract properties. PMID:26292162

  11. Capsule endoscopy: The road ahead

    PubMed Central

    Singeap, Ana-Maria; Stanciu, Carol; Trifan, Anca

    2016-01-01

    Since its introduction into clinical practice 15 years ago, capsule endoscopy (CE) has become the first-line investigation procedure in some small bowel pathologies, and more recently, dedicated esophageal and colon CE have expanded the fields of application to include the upper and lower gastrointestinal disorders. During this time, CE has become increasingly popular among gastroenterologists, with more than 2 million capsule examinations performed worldwide, and nearly 3000 PubMed-listed studies on its different aspects published. This huge interest in CE may be explained by its non-invasive nature, patient comfort, safety, and access to anatomical regions unattainable via conventional endoscopy. However, CE has several limitations which impede its wider clinical applications, including the lack of therapeutic capabilities, inability to obtain biopsies and control its locomotion. Several research groups are currently working to overcome these limitations, while novel devices able to control capsule movement, obtain high quality images, insufflate the gut lumen, perform chromoendoscopy, biopsy of suspect lesions, or even deliver targeted drugs directly to specific sites are under development. Overlooking current limitations, especially as some of them have already been successfully surmounted, and based on the tremendous progress in technology, it is expected that, by the end of next 15 years, CE able to perform both diagnostic and therapeutic procedures will remain the major form of digestive endoscopy. This review summarizes the literature that prognosticates about the future developments of CE. PMID:26755883

  12. Capsule endoscopy: Future horizons

    PubMed Central

    Fireman, Zvi

    2010-01-01

    Capsule endoscopy (CE) was launched at the beginning of this millennium and has since become a well established methodology for evaluating the entire small bowel for manifold pathologies. CE far exceeded early expectations by providing a tool for establishing the correct diagnosis for elusive gastrointestinal (GI) conditions such as obscure GI bleeding, Crohns disease, polyposis syndrome and others. Contemporary CE, like radiology, gives results that can only be read, unlike conventional endoscopic procedures which enable concomitant biopsy when indicated. This is one of the major limitations of the technique. The ideal CE should improve the quality of the image and have a faster frame rate than the currently available one. There should be a therapeutic capsule capable of performing a biopsy, aspirating fluid, delivering drugs as well as measuring the motility of the small bowel wall. Another major leap forward would be the capability of remote control of the capsules movement in order to navigate it to reach designated anatomical areas for carrying out a variety of therapeutic options. Technology for improving the capability of the future generation capsule is almost within grasp and it would not be surprising to witness the realization of these giant steps within the coming decade. PMID:21160761

  13. 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

  14. Capsule endoscopy in patients refusing conventional endoscopy

    PubMed Central

    Romero-Vázquez, Javier; Argüelles-Arias, Federico; García-Montes, Josefa Maria; Caunedo-Álvarez, Ángel; Pellicer-Bautista, Francisco Javier; Herrerías-Gutiérrez, Juan Manuel

    2014-01-01

    Capsule endoscopy is nowadays the diagnostic technique of choice in the study of small bowel pathologies, allowing the non-invasive study of the entire mucosa. This has led, together with new technical advances, to the creation of two new models (PillCam ESO and PillCam Colon) for the study of esophageal and colonic diseases. These two new capsules offer an interesting alternative to conventional endoscopy in the study of the upper and lower digestive tracts, because traditional endoscopy is often unpleasant and uncomfortable for the patient, can be painful, often requires moderate or deep sedation and is not without complications (hemorrhage, perforation, etc.). PillCam Colon is particularly important for its usefulness in the diagnosis of colonic polyps, and is a potentially useful tool in cases of incomplete colonoscopy or in colorectal cancer screening, even more when most patients are reluctant to undergo screening programs due to the said disadvantages of conventional colonoscopy. This article discusses the advantages of capsule endoscopy over conventional endoscopy, its current application possibilities and indications in routine clinical practice. In the various sections of the work, we assess the application of endoscopic capsule in different sections of the digestive tract (esophagus, stomach, and colon) and finally the potential role of panendoscopy with PillCam Colon. PMID:24966612

  15. Capsule endoscopy in patients refusing conventional endoscopy.

    PubMed

    Romero-Vzquez, Javier; Argelles-Arias, Federico; Garca-Montes, Josefa Maria; Caunedo-lvarez, ngel; Pellicer-Bautista, Francisco Javier; Herreras-Gutirrez, Juan Manuel

    2014-06-21

    Capsule endoscopy is nowadays the diagnostic technique of choice in the study of small bowel pathologies, allowing the non-invasive study of the entire mucosa. This has led, together with new technical advances, to the creation of two new models (PillCam ESO and PillCam Colon) for the study of esophageal and colonic diseases. These two new capsules offer an interesting alternative to conventional endoscopy in the study of the upper and lower digestive tracts, because traditional endoscopy is often unpleasant and uncomfortable for the patient, can be painful, often requires moderate or deep sedation and is not without complications (hemorrhage, perforation, etc.). PillCam Colon is particularly important for its usefulness in the diagnosis of colonic polyps, and is a potentially useful tool in cases of incomplete colonoscopy or in colorectal cancer screening, even more when most patients are reluctant to undergo screening programs due to the said disadvantages of conventional colonoscopy. This article discusses the advantages of capsule endoscopy over conventional endoscopy, its current application possibilities and indications in routine clinical practice. In the various sections of the work, we assess the application of endoscopic capsule in different sections of the digestive tract (esophagus, stomach, and colon) and finally the potential role of panendoscopy with PillCam Colon. PMID:24966612

  16. Endoscopy in Amphibians.

    PubMed

    Chai, Norin

    2015-09-01

    Despite advances in exotic animal endoscopy, descriptions involving amphibians are scarce. Amphibian endoscopy shares some similarities with reptiles, especially in lizards. Selected procedures are discussed, including stomatoscopy, gastroscopy, coelioscopy, and biopsy of coelomic organs and lesions. This short overview provides the practitioner with pragmatic advice on how to conduct safe and effective endoscopic examinations in amphibians. PMID:26094022

  17. Aldehyde disinfectants and health in endoscopy unit

    PubMed Central

    Cowan, R E; Manning, A P; Ayliffe, G A J; Axon, A T R; Causton, J S; Cripps, N F; Hall, R; Hanson, P J V; Harrison, J; Leicester, R J; Neumann, C; Wicks, J

    1993-01-01

    Summary of main recommendations (1) Glutaraldehyde, used in most endoscopy units in the United Kingdom for the disinfection of flexible gastrointestinal endoscopes, is a toxic substance being an irritant and a sensitiser; symptoms associated with glutaraldehyde exposure are common among staff working in endoscopy units. (2) The Control of Substances Hazardous to Health Regulations 1988 (COSHH) obliges the employer to make a systematic assessment of risk to staff of exposure to glutaraldehyde and institute measures to deal effectively with exposure. (3) At present glutaraldehyde remains the first line agent for the disinfection of flexible gastrointestinal endoscopes. Other agents are being developed; a standard means of assessment for flexible endoscope disinfectants should be devised. (4) Equipment and accessories that are heat stable should be sterilised by autoclaving; disposable accessories should be used wherever possible. (5) Flexible gastrointestinal endoscopes should be disinfected within automated washer/disinfectors; trays, bowls or buckets for this purpose are unacceptable. (6) Local exhaust ventilation must be used to control glutaraldehyde vapour. Extracted air may be discharged direct to the atmosphere or passed over special absorbent filters and recirculated. Such control measures must be regularly tested and records retained. (7) Endoscope cleaning and disinfection should be carried out in a room dedicated to the purpose, equipped with control measures to maintain the concentration of glutaraldehyde vapour at a level certainly below the current occupational exposure standard of 0·2 ppm and preferably below the commonly used working limit of 0·1 ppm. Sites other than the endoscopy unit where endoscopy is regularly performed, such as the radiology department, should have their own fully equipped cleaning and disinfection room. (8) COSHH limits the use of personal protective equipment to those situations where other measures cannot adequately control exposure. Such equipment includes nitrile rubber gloves, apron, chemical grade eye protection, and respiratory protective equipment for organic vapours. (9) Monitoring of atmospheric levels of glutaraldehyde should be performed by a competent person such as an occupational hygienist; the currently preferred method of sampling uses a filtration technique, the commercially available meters being less reliable. (10) Health surveillance of staff is mandatory; occupational health records must be retained for 30 years. (11) Endoscopy staff must be informed of the risks of exposure to glutaraldehyde and trained in safe methods of its control. Only staff who have completed such an education and training programme should be allowed to disinfect endoscopes. (12) The unsafe use of glutaraldehyde has significant health and legal consequences; the safe use of glutaraldehyde may have revenue consequences that contribute significantly to the cost of gastrointestinal endoscopy. PMID:8244157

  18. Overview of technical solutions and assessment of clinical usefulness of capsule endoscopy.

    PubMed

    Koprowski, Robert

    2015-01-01

    The paper presents an overview of endoscopic capsules with particular emphasis on technical aspects. It indicates common problems in capsule endoscopy such as: (1) limited wireless communication (2) the use of capsule endoscopy in the case of partial patency of the gastrointestinal tract, (3) limited imaging area, (4) external capsule control limitations. It also presents the prospects of capsule endoscopy, the most recent technical solutions for biopsy and the mobility of the capsule in the gastrointestinal tract. The paper shows the possibilities of increasing clinical usefulness of capsule endoscopy resulting from technological limitations. Attention has also been paid to the current role of capsule endoscopy in screening tests and the limitations of its effectiveness. The paper includes the author's recommendations concerning the direction of further research and the possibility of enhancing the scope of capsule endoscopy. PMID:26626725

  19. New aspects of modern endoscopy

    PubMed Central

    Rey, Johannes Wilhelm; Kiesslich, Ralf; Hoffman, Arthur

    2014-01-01

    The prognosis for patients with malignancies of the gastrointestinal-tract is strictly dependent on early detection of premalignant and malignant lesions. However, small, flat or depressed neoplastic lesions remain difficult to detect with these technologies thereby limiting their value for polyp and cancer screening. At the same time computer and chip technologies have undergone major technological changes which have greatly improved endoscopic diagnostic investigation. New imaging modalities and techniques are very notable aspects of modern endoscopy. Chromoendoscopy or filter-aided colonoscopy (virtual chromoendoscopy) with high definition endoscopes is able to enhance the detection and characterization of lesions. Finally, confocal laser endomicroscopy provides histological confirmation of the presence of neoplastic changes. The developing techniques around colonoscopy such as the retro-viewing colonoscope, the balloon-colonoscope or the 330-degrees-viewing colonoscope try to enhance the efficacy by reducing the adenoma miss rate in right-sided, non-polypoid lesions. Colon capsule endoscopy is limited to identifying cancer and not necessarily small adenomas. Preliminary attempts have been made to introduce this technique in clinical routine. PMID:25132916

  20. Unusual cause of upper gastrointestinal bleeding

    PubMed Central

    Wardi, Joram; Langer, Peter; Shimonov, Mordechai

    2013-01-01

    We report a case of recurrent severe upper gastrointestinal bleeding where the bleeding source was difficult to find during recurrent hospitalizations. Eventually videocapsule endoscopy was the modality that finally diagnosed an ulcerated lipoma within an area of intussuscepted jejunum. Segmental resection of small bowel was performed and no further bleeding episodes have occurred. Our case illustrates the value of capsule endoscopy and the rare potential of lipomas to cause serious gastrointestinal bleeding. PMID:24964424

  1. The ambulatory endoscopy center (AEC): what it can do for your gastroenterology practice.

    PubMed

    Frakes, James T

    2006-10-01

    Endoscopy accounts for most of the gastroenterologist's professional time and revenue. The thoughtful gastroenterologist in practice must understand the potential sites of service for endoscopy, including either the hospital endoscopy unit or an ambulatory endoscopy center (whether an office endoscopy suite or a licensed, certified, and accredited ambulatory surgery center). Out-of-hospital endoscopy centers have advantages for patients, including convenience, efficiency, economy, and more pleasant surroundings than the hospital. Payers appreciate improved access and reduced costs. For gastrointestinal practices, ambulatory endoscopy centers, particularly ambulatory surgery centers, provide significant advantages, including enhanced reimbursement and cost management, control, efficiency and convenience, quality control, opportunities for clinical research, and marketing and competitive strengths. PMID:17098615

  2. Famous endoscopy quotes.

    PubMed

    Cappell, Mitchell S

    2012-01-01

    These quotations, whether humorous or serious, provide insight into how gastroenterology nurses, gastroenterologists, and endoscopists feel about themselves as professionals, how other healthcare professionals perceive them, and their image in popular culture. Recognition of these aspects of gastroenterology nursing, gastroenterology, and endoscopy are important for self-improvement, correcting public misperceptions, and appreciating how patient misperceptions about gastroenterology nurses and gastroenterologists and patient attitudes toward endoscopy may present barriers that gastroenterology professionals must overcome to improve patient care. These quotations also fulfill a need for witticisms during dry endoscopy lectures! PMID:22472673

  3. ASGE guidelines result in cost-saving in the management of choledocholithiasis

    PubMed Central

    Singhvi, Gaurav; Ampara, Rajiv; Baum, Joel; Gumaste, Vivek

    2016-01-01

    Background The goal of this study was to determine whether utilization of the ASGE guidelines for the evaluation of bile duct stones (BDS) would result in fewer imaging studies and in turn lead to a lower healthcare expenditure. Methods This was a retrospective study set in an urban Teaching Hospital. Patients undergoing evaluation for BDS and who had their gallbladders in situ were included in the study. Data with regard to age, sex, clinical history, pain level, vital signs and laboratory studies as well as diagnostic tests performed were extracted from the hospital’s electronic medical record. The ASGE guidelines were applied retrospectively to each patient in the study group and the group was divided into two cohorts: one that followed the ASGE guidelines and one which did not. Patients in the two cohorts were further stratified into high-, intermediate-, and low-risk categories. Results Thirty-eight patients met the criteria and were included in the study. Of the 38 patients, 22 were managed as per the ASGE guidelines and 16 were not. Twenty-seven patients were categorized as high-risk (14 following the correct algorithm, 13 not) and 11 as intermediate-risk (8 following, 3 not). There were no low-risk patients. Twelve of the 27 patients in the high-risk group had stones (56%) while 6 of 11 (55%) had stones in the intermediate-risk group. Fourteen computed tomography scans and 12 magnetic resonance cholangiopancreatographies were deemed inappropriate resulting in unnecessary increased expenditure of $ 22,236. Conclusion The application of ASGE guidelines can minimize redundant investigations and effect cost saving but need to be refined to produce a better yield. PMID:26752953

  4. 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 ...

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

    PubMed

    De Backer, A; Bov, 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

  6. 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

  7. Endoscopic Evaluation of Swallowing (Endoscopy)

    MedlinePLUS

    ... the Public / Speech, Language and Swallowing / Swallowing Endoscopic Evaluation of Swallowing (Endoscopy) Do you have problems swallowing? ... Some names you might hear are: Endoscopy Endoscopic Evaluation of swallowing FEES (Fiberoptic Endoscopic Evaluation of Swallowing) ...

  8. Remote transmission of live endoscopy over the Internet: Report from the 87th Congress of the Japan Gastroenterological Endoscopy Society.

    PubMed

    Shimizu, Shuji; Ohtsuka, Takao; Takahata, Shunichi; Nagai, Eishi; Nakashima, Naoki; Tanaka, Masao

    2016-01-01

    Live demonstration of endoscopy is one of the most attractive and useful methods for education and is often organized locally in hospitals. However, problems have been apparent in terms of cost, preparation, and potential risks to patients. Our aim was to evaluate a new approach to live endoscopy whereby remote hospitals are connected by the Internet for live endoscopic demonstrations. Live endoscopy was transmitted to the Congress of the Japan Gastroenterological Endoscopic Society by 13 domestic and international hospitals. Patients with upper and lower gastrointestinal diseases and with pancreatobiliary disorders were the subjects of a live demonstration. Questionnaires were distributed to the audience and were sent to the demonstrators. Questions concerned the quality of transmitted images and sound, cost, preparations, programs, preference of style, and adverse events. Of the audience, 91.2% (249/273) answered favorably regarding the transmitted image quality and 93.8% (259/276) regarding the sound quality. All demonstrators answered favorably regarding image quality and 93% (13/14) regarding sound quality. Preparations were completed without any outsourcing at 11 sites (79%) and were evaluated as 'very easy' or 'easy' at all but one site (92.3%). Preparation cost was judged as 'very cheap' or 'cheap' at 12 sites (86%). Live endoscopy connecting multiple international centers was satisfactory in image and sound quality for both audience and demonstrators, with easy and inexpensive preparation. The remote transmission of live endoscopy from demonstrators' own hospitals was preferred to the conventional style of locally organized live endoscopy. PMID:26110485

  9. 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

  10. Endoscopy in screening for digestive cancer.

    PubMed

    Lambert, Ren

    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

  11. 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 Crohns 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, Barretts 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

  12. Endoscopy in sharks.

    PubMed

    Murray, Michael J

    2010-05-01

    The importance of the shark species as ambassadors for the ocean ecosystems within public aquariums, and an ever increasing understanding of their importance as keystone species in those ecosystems, has resulted in more and more opportunities for the veterinary profession to interact with these charismatic fish. Although still in its infancy in aquatic medicine, endoscopy has the potential to be a valuable tool in the management of captive and free-ranging sharks. When contemplating an endoscopic procedure in a shark, the clinician must consider the unique anatomy of the species, the nature of the immobilization planned, and the performance of the procedure itself. Endoscopy should be considered as an adjunct procedure in the clinical management of captive sharks, and may have an important role in the scientific monitoring of free-ranging shark populations. PMID:20381779

  13. 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

  14. [Use of spasmolytic agent otilonium bromide (spasmomen) in digestive endoscopy: a prospective study in 63 patients].

    PubMed

    Gmez, N A; Len, C J; Gutirrez, J

    1997-01-01

    Otilonium bromide is a calcium antagonist with a direct myolytic effect, that is indicated in spastic conditions and functional dyskinesias of the gastroenteric apparatus (irritable bowel syndrome) and as a premedication for gastrointestinal endoscopic procedures. The present study assessed otilonium bromide 40 mg PO the night before and 40 mg PO the morning in 49 upper and 14 lower flexible endoscopies in 63 patients, to determine the presence or absence of peristalsis and relaxation of the pylorus. No side effects were observed due to the medication. In 46 (93.8%) upper endoscopies marked relaxation of the gastrointestinal tract and also pylorus relaxation were observed. In 13 (92.8%) lower endoscopies, marked relaxation of the colonic tract was also seen. All patients tolerated well the endoscopies. Otilonium bromide was useful as premedication in order to enable upper and lower endoscopic explorations, because of its spasmolytic effect. PMID:9412140

  15. 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

  16. 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

  17. Hypereosinophilic Syndrome (HES)

    MedlinePLUS

    ... Cincinnati Center for Eosinophilic Disorders CCFA- Crohn’s and Colitis Foundation of America CDF- Celiac Disease Foundation Childrens ... North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) American Society for Gastrointestinal Endoscopy (ASGE) National ...

  18. EoE (Eosinophilic Esophagitis)

    MedlinePLUS

    ... Cincinnati Center for Eosinophilic Disorders CCFA- Crohn’s and Colitis Foundation of America CDF- Celiac Disease Foundation Childrens ... North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) American Society for Gastrointestinal Endoscopy (ASGE) National ...

  19. 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

  20. Canadian Association of Gastroenterology consensus guidelines on safety and quality indicators in endoscopy

    PubMed Central

    Armstrong, David; Barkun, Alan; Bridges, Ron; Carter, Rose; de Gara, Chris; Dub, Catherine; Enns, Robert; Hollingworth, Roger; MacIntosh, Donald; Borgaonkar, Mark; Forget, Sylviane; Leontiadis, Grigorios; Meddings, Jonathan; Cotton, Peter; Kuipers, Ernst J; Valori, Roland

    2012-01-01

    BACKGROUND: Increasing use of gastrointestinal endoscopy, particularly for colorectal cancer screening, and increasing emphasis on health care quality, highlight the need for clearly defined, evidence-based processes to support quality improvement in endoscopy. OBJECTIVE: To identify processes and indicators of quality and safety relevant to high-quality endoscopy service delivery. METHODS: A multidisciplinary group of 35 voting participants developed recommendation statements and performance indicators. Systematic literature searches generated 50 initial statements that were revised iteratively following a modified Delphi approach using a web-based evaluation and voting tool. Statement development and evidence evaluation followed the AGREE (Appraisal of Guidelines, REsearch and Evaluation) and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) guidelines. At the consensus conference, participants voted anonymously on all statements using a 6-point scale. Subsequent web-based voting evaluated recommendations for specific, individual quality indicators, safety indicators and mandatory endoscopy reporting fields. Consensus was defined a priori as agreement by 80% of participants. RESULTS: Consensus was reached on 23 recommendation statements addressing the following: ethics (statement 1: agreement 100%), facility standards and policies (statements 2 to 9: 90% to 100%), quality assurance (statements 10 to 13: 94% to 100%), training, education, competency and privileges (statements 14 to 19: 97% to 100%), endoscopy reporting standards (statements 20 and 21: 97% to 100%) and patient perceptions (statements 22 and 23: 100%). Additionally, 18 quality indicators (agreement 83% to 100%), 20 safety indicators (agreement 77% to 100%) and 23 recommended endoscopy-reporting elements (agreement 91% to 100%) were identified. DISCUSSION: The consensus process identified a clear need for high-quality clinical and outcomes research to support quality improvement in the delivery of endoscopy services. CONCLUSIONS: The guidelines support quality improvement in endoscopy by providing explicit recommendations on systematic monitoring, assessment and modification of endoscopy service delivery to yield benefits for all patients affected by the practice of gastrointestinal endoscopy. PMID:22308578

  1. 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

  2. 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

  3. 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

  4. Capsule endoscopy in neoplastic diseases

    PubMed Central

    Pennazio, Marco; Rondonotti, Emanuele; de Franchis, Roberto

    2008-01-01

    Until recently, diagnosis and management of small-bowel tumors were delayed by the difficulty of access to the small bowel and the poor diagnostic capabilities of the available diagnostic techniques. An array of new methods has recently been developed, increasing the possibility of detecting these tumors at an earlier stage. Capsule endoscopy (CE) appears to be an ideal tool to recognize the presence of neoplastic lesions along this organ, since it is non-invasive and enables the entire small bowel to be visualized. High-quality images of the small-bowel mucosa may be captured and small and flat lesions recognized, without exposure to radiation. Recent studies on a large population of patients undergoing CE have reported small-bowel tumor frequency only slightly above that reported in previous surgical series (range, 1.6%-2.4%) and have also confirmed that the main clinical indication to CE in patients with small-bowel tumors is obscure gastrointestinal (GI) bleeding. The majority of tumors identified by CE are malignant; many were unsuspected and not found by other methods. However, it remains difficult to identify pathology and tumor type based on the lesions endoscopic appearance. Despite its limitations, CE provides crucial information leading in most cases to changes in subsequent patient management. Whether the use of CE in combination with other new diagnostic (MRI or multidetector CT enterography) and therapeutic (Push-and-pull enteroscopy) techniques will lead to earlier diagnosis and treatment of these neoplasms, ultimately resulting in a survival advantage and in cost savings, remains to be determined through carefully-designed studies. PMID:18785274

  5. Evaluation and outcomes of patients with obscure gastrointestinal bleeding

    PubMed Central

    Santhakumar, Cositha; Liu, Ken

    2014-01-01

    Obscure gastrointestinal bleeding (OGIB) is defined as recurrent or persistent bleeding or presence of iron deficiency anaemia after evaluation with a negative bidirectional endoscopy. OGIB accounts for 5% of gastrointestinal bleeding and presents a diagnostic challenge. Current modalities available for the investigation of OGIB include capsule endoscopy, balloon assisted enteroscopy, spiral enteroscopy and computed tomography enterography. These modalities overcome the limitations of previous techniques. Following a negative bidirectional endoscopy, capsule endoscopy and double balloon enteroscopy remain the cornerstone of investigation in OGIB given their high diagnostic yield. Long-term outcome data in patients with OGIB is limited, but is most promising for capsule endoscopy. This article reviews the current literature and provides an overview of the clinical evaluation of patients with OGIB, available diagnostic and therapeutic modalities and long-term clinical outcomes. PMID:25400992

  6. Screening for Precancerous Lesions of Upper Gastrointestinal Tract: From the Endoscopists' Viewpoint

    PubMed Central

    Chung, Chen-Shuan; Wang, Hsiu-Po

    2013-01-01

    Upper gastrointestinal tract cancers are one of the most important leading causes of cancer death worldwide. Diagnosis at late stages always brings about poor outcome of these malignancies. The early detection of precancerous or early cancerous lesions of gastrointestinal tract is therefore of utmost importance to improve the overall outcome and maintain a good quality of life of patients. The desire of endoscopists to visualize the invisibles under conventional white-light endoscopy has accelerated the advancements in endoscopy technologies. Nowadays, image-enhanced endoscopy which utilizes optical- or dye-based contrasting techniques has been widely applied in endoscopic screening program of gastrointestinal tract malignancies. These contrasting endoscopic technologies not only improve the visualization of early foci missed by conventional endoscopy, but also gain the insight of histopathology and tumor invasiveness, that is so-called optical biopsy. Here, we will review the application of advanced endoscopy technique in screening program of upper gastrointestinal tract cancers. PMID:23573079

  7. Lasers in digestive endoscopy

    NASA Astrophysics Data System (ADS)

    Brunetaud, Jean Marc; Maunoury, Vincent; Cochelard, Dominique

    1997-01-01

    Lasers were introduced in digestive endoscopy to stop active gastroduodenal hemorrhages. Their use spread progressively to the treatment of chronic hemorrhages from vascular malformations and sessile tumors. Laser face competition from other endoscopic techniques such as electrocoagulation, injection techniques, dilation, stents, and brachytherapy. Many series have reported the efficacy of lasers in digestive endoscopy used for their thermal or photochemical effects. However, they were gradually abandoned for the treatment of hemorrhages because of competition from nonlaser techniques. Lasers are still used for ablation of sessile tumors, but their true impact is difficult to evaluate. Modern methods of technology assessment did not allow gastroenterologists to clearly define the place of lasers among surgery, radio-chemotherapy, and other endoscopic techniques, and data on the daily use of lasers are not available. Therefore, the conclusion can only be subjective. The best current application of thermal lasers appears to be in the treatment of rectosigmoid villous adenomas in elderly patients. Small superficial rectal cancers may also become a good subject due to the impact of endoscopic ultrasonography. Early lesions with multifocal or diffuse disease such as early esophageal cancers could be the most promising subject of application for photodynamic therapy in the future.

  8. 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

  9. [Learning gastroenterologic endoscopy].

    PubMed

    Koelsch, K A

    1976-11-01

    1. Knowledge of the gastroenterological endoscopy and biopsy is necessary at all levels of medical education. 2. Knowledge of students: possible methods, diagnostic effectiveness, stress of the patients. Knowledge of the candidates for specialisation: indications, contraindications, possibilities of the method also in reference to the individual case. Persons interested in the subspecialisation gastro-enterology: theory, possibilities and limits, technical performance. Experienced endoscopists: regular refreshment and supplementation of knowledge and skill in highly specialised endoscopic centres. 3. Tested teaching methods are lecture, report, study of atlants and text-books, demonstrations of diapositives in connection with schematic figures, seminars with diapositives, film demonstrations, work at the patient under supervision of the tutor and use of a demonstration device as well as endoscopic demonstration by means of colour television. The centre is, however, the individual examination of the patient. 4. Knowledge of the subspecialist: History of endoscopy, knowledge of instruments, optics and endoscopic perspective, physical fundaments about light and photography, human macro- and microscopic anatomy, care of instruments and desinfection. Indications, contraindications, possibilities and limits of the method, emergency and intensive medicine, writing of the findings. PMID:1020386

  10. 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

  11. Antenna calibration models in height determinations in ASG-EUPOS' POZGEO-D service - a case study

    NASA Astrophysics Data System (ADS)

    Dawidowicz, Karol

    2012-12-01

    GNSS observations in a network of permanent stations are a complex systems which offer both post-processing and corrections sent in real-time. In Poland such a system, known as the Polish Active Geodetic Network (ASG-EUPOS), has been in operation since June 2008. The GNSS development forces also continuous modernization of ASG-EUPOS (e.g.: GPS/GLONASS receivers mounting, ASG+ project) which aims to improve the accuracy of position determination. One of the factors limiting the accuracy (especially the vertical component) is antenna phase center variations (PCV) problem. PCV problem is resolved using the antenna calibration process. As a result, antenna phase center corrections models (PCC) are created. So far three methods have been developed to determine GNSS antenna PCV. For this reason and because of some problems in introducing of absolute models at present we can speak of three models of receiver antennas PCV (so called: relative, absolute converted and absolute). The aim of this paper was to study the height differences caused by using different calibration models in GNSS observation processing done in the ASG-EUPOS POZGEO-D service. The analysis was done using 3 days of GNSS data, collected with four different receivers and antennas, divided by one hour observation sessions. The results of the calculations show that switching between PCV models may have a visible effect on height determination, particularly in high accuracy applications.

  12. Three-dimensional nonlinear optical endoscopy.

    PubMed

    Fu, Ling; Jain, Ankur; Cranfield, Charles; Xie, Huikai; Gu, Min

    2007-01-01

    The development of miniaturized nonlinear optical microscopy or endoscopy is essential to complement the current imaging modalities for diagnosis and monitoring of cancers. We report on a nonlinear optical endoscope based on a double-clad photonic crystal fiber and a two-dimensional (2-D) microelectromechanical system mirror, enabling the three-dimensional (3-D) nonlinear optical imaging through in vitro gastrointestinal tract tissue and human breast cancer tissue with a penetration depth of approximately 100 mum and axial resolution of 10 mum. The 3-D high-resolution and high-sensitive imaging ability of the nonlinear optical endoscope facilitates the visualization of 3-D morphologic and cell nuclei arrangement within tissue, and therefore will be important for histopathologic interpretation without the need of tissue excision. PMID:17867789

  13. [Possibilities of energy augmentation of pellets shot from ASG replicas and gunshot wounds].

    PubMed

    Golema, Wojciech; Jurek, Tomasz; Thannhäuser, Agata; Kawecki, Jerzy; Trnka, Jakub

    2011-01-01

    In this paper, the authors review the types of air soft gun replicas depending on the type of drive and ammunition, showing the possibilities of altering the M4A1 rifle replica's technical parameters and the effect of such modifications on initial energy of the projectile. A PJ4 CQB NAVY replica's inner barrel, spring, motor and cylinder kit were replaced. Subsequently, the muzzle velocity was determined and compared to the initial muzzle velocity. This example showed that amateur modifications can greatly increase the initial energy of the pellet. The authors suggest that especially in terms of determining the exposure to direct danger of death or grave detriment to health, the manufacturer's data about pellet energy should not be taken without question, but one should strive for an individual assessment of the ASG replica constituting the evidence. PMID:22715674

  14. Extra-Articular Endoscopy.

    PubMed

    Doral, Mahmut N; Huri, Gazi; Bohacek, Ivan; Turhan, Egemen; Bojanic, Ivan

    2016-03-01

    With the advent of endoscopy in the last 2 decades, a number of procedures, and modifications to them, have been developed and have advanced exponentially. The list of indications was extended over time because of several reasons: better understanding of the pathophysiology, better diagnostics, and advances in endoscopic technology. In this review article, we summarize the most frequently performed extra-articular endoscopic procedures on the extremities. As there are several methods, some have been described briefly, whereas others have been described in greater detail, such as suprascapular nerve entrapment syndrome and Achilles tendon disorders, as they present our area of interest and subspecialty domain. Recent advances in the treatment of versatile pathologic entities have been described, together with new methods, which currently lack sufficient clinical data but still represent promising techniques for the future. PMID:26752776

  15. Malpractice claims for endoscopy

    PubMed Central

    Hernandez, Lyndon V; Klyve, Dominic; Regenbogen, Scott E

    2013-01-01

    AIM: To summarize the magnitude and time trends of endoscopy-related claims and to compare total malpractice indemnity according to specialty and procedure. METHODS: We obtained data from a comprehensive database of closed claims from a trade association of professional liability insurance carriers, representing over 60% of practicing United States physicians. Total payments by procedure and year were calculated, and were adjusted for inflation (using the Consumer Price Index) to 2008 dollars. Time series analysis was performed to assess changes in the total value of claims for each type of procedure over time. RESULTS: There were 1901 endoscopy-related closed claims against all providers from 1985 to 2008. The specialties include: internal medicine (n = 766), gastroenterology (n = 562), general surgery (n = 231), general and family practice (n = 101), colorectal surgery (n = 87), other specialties (n = 132), and unknown (n = 22). Colonoscopy represented the highest frequencies of closed claims (n = 788) and the highest total indemnities ($54 093 000). In terms of mean claims payment, endoscopic retrograde cholangiopancreatography (ERCP) ranked the highest ($374??794) per claim. Internists had the highest number of total claims (n = 766) and total claim payment ($70??730??101). Only total claim payments for colonoscopy and ERCP seem to have increased over time. Indeed, there was an average increase of 15.5% per year for colonoscopy and 21.9% per year for ERCP after adjusting for inflation. CONCLUSION: There appear to be differences in malpractice coverage costs among specialties and the type of endoscopic procedure. There is also evidence for secular trend in total claim payments, with colonoscopy and ERCP costs rising yearly even after adjusting for inflation. PMID:23596540

  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. Role of endoscopy in the bariatric surgery of patients

    PubMed Central

    De Palma, Giovanni D; Forestieri, Pietro

    2014-01-01

    Obesity is an increasingly serious health problem in nearly all Western countries. It represents an important risk factor for several gastrointestinal diseases, such as gastroesophageal reflux disease, erosive esophagitis, hiatal hernia, Barrett’s esophagus, esophageal adenocarcinoma, Helicobacter pylori infection, colorectal polyps and cancer, non-alcoholic fatty liver disease, cirrhosis, and hepatocellular carcinoma. Surgery is the most effective treatment to date, resulting in sustainable and significant weight loss, along with the resolution of metabolic comorbidities in up to 80% of cases. Many of these conditions can be clinically relevant and have a significant impact on patients undergoing bariatric surgery. There is evidence that the chosen procedure might be changed if specific pathological upper gastrointestinal findings, such as large hiatal hernia or Barrett’s esophagus, are detected preoperatively. The value of a routine endoscopy before bariatric surgery in asymptomatic patients (screening esophagogastroduodenoscopy) remains controversial. The common indications for endoscopy in the postoperative bariatric patient include the evaluation of symptoms, the management of complications, and the evaluation of weight loss failure. It is of critical importance for the endoscopist to be familiar with the postoperative anatomy and to work in close collaboration with bariatric surgery colleagues in order to maximize the outcome and safety of endoscopy in this setting. The purpose of this article is to review the role of the endoscopist in a multidisciplinary obesity center as it pertains to the preoperative and postoperative management of bariatric surgery patients. PMID:24976715

  18. 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

  19. Preoperative diagnosis of cavernous hemangioma presenting with melena using wireless capsule endoscopy of the small intestine

    PubMed Central

    Akazawa, Yu; Hiramatsu, Katsushi; Nosaka, Takuto; Saito, Yasushi; Ozaki, Yoshihiko; Takahashi, Kazuto; Naito, Tatsushi; Ofuji, Kazuya; Matsuda, Hidetaka; Ohtani, Masahiro; Nemoto, Tomoyuki; Suto, Hiroyuki; Yamaguchi, Akio; Imamura, Yoshiaki; Nakamoto, Yasunari

    2016-01-01

    Background and study aims: Primary neoplasms of the small intestine are relatively rare in all age groups, accounting for about 5 % of all gastrointestinal tumors 1. Cavernous hemangiomas of the small intestine are also rare, can cause gastrointestinal bleeding, and are extremely difficult to diagnose preoperatively 2. We present a patient who presented with melena and iron deficiency anemia, for whom wireless capsule endoscopy and single-balloon enteroscopy facilitated the diagnosis of cavernous hemangioma. PMID:27004239

  20. Capsule Endoscopy for Portal Hypertensive Enteropathy

    PubMed Central

    2016-01-01

    Portal hypertensive enteropathy (PHE) is a mucosal abnormality of the small bowel that is observed in patients with portal hypertension (PH) and can lead to gastrointestinal bleeding and anemia. The pathogenesis is still not completely understood. The introduction of new endoscopic methods, including capsule endoscopy (CE) or balloon-assisted enteroscopy, has increased the detection of these abnormalities. CE can also serve as a road map for deciding subsequent interventions and evaluating the treatment effect. The prevalence of PHE is reportedly 40–70% in patients with PH. Endoscopic findings can be roughly divided into vascular and nonvascular lesions such as inflammatory-like lesions. Traditionally, PHE-associated factors include large esophageal varices, portal hypertensive gastropathy or colopathy, Child-Turcotte-Pugh class B or C, a history of variceal treatment, and acute gastrointestinal bleeding. More recently, on using scoring systems, a high computed tomography or transient elastography score was reportedly PHE-related factors. However, the prevalence of PHE and its related associated factors remain controversial. The management of PHE has not yet been standardized. It should be individualized according to each patient's situation, the availability of therapy, and each institutional expertise. PMID:26819613

  1. 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

  2. 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

  3. Diagnosis of gastrointestinal bleeding: A practical guide for clinicians

    PubMed Central

    Kim, Bong Sik Matthew; Li, Bob T; Engel, Alexander; Samra, Jaswinder S; Clarke, Stephen; Norton, Ian D; Li, Angela E

    2014-01-01

    Gastrointestinal bleeding is a common problem encountered in the emergency department and in the primary care setting. Acute or overt gastrointestinal bleeding is visible in the form of hematemesis, melena or hematochezia. Chronic or occult gastrointestinal bleeding is not apparent to the patient and usually presents as positive fecal occult blood or iron deficiency anemia. Obscure gastrointestinal bleeding is recurrent bleeding when the source remains unidentified after upper endoscopy and colonoscopic evaluation and is usually from the small intestine. Accurate clinical diagnosis is crucial and guides definitive investigations and interventions. This review summarizes the overall diagnostic approach to gastrointestinal bleeding and provides a practical guide for clinicians. PMID:25400991

  4. 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.

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

    PubMed

    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

  6. 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. Cgasg1Δ and Cghal9Δ 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 Cgasg1Δ and Cghal9Δ 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

  7. 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.

  8. Small bowel capsule endoscopy in 2007: Indications, risks and limitations

    PubMed Central

    Rondonotti, Emanuele; Villa, Federica; Mulder, Chris JJ; Jacobs, Maarten AJM; de Franchis, Roberto

    2007-01-01

    Capsule endoscopy has revoluzionized the study of the small bowel by providing a reliable method to evaluate, endoscopically, the entire small bowel. In the last six years several papers have been published exploring the possible role of this examination in different clinical conditions. At the present time capsule endoscopy is generally recommended as a third examination, after negative bidirectional endoscopy, in patients with obscure gastrointestinal bleeding. A growing body of evidence suggests also an important role for this examination in other clinical conditions such as Crohns disease, celiac disease, small bowel polyposis syndromes or small bowel tumors. The main complication of this examination is the retention of the device at the site of a previously unknown small bowel stricture. However there are also some other open issues mainly due to technical limitations of this tool (which is not driven from remote control, is unable to take biopsies, to insufflate air, to suck fluids or debris and sometimes to correctly size and locate lesions).The recently developed double balloon enteroscope, owing to its capability to explore a large part of the small bowel and to take targeted biopsies, although being invasive and time consuming, can overcome some limitations of capsule endoscopy. At the present time, in the majority of clinical conditions (i.e. obscure GI bleeding), the winning strategy seems to be to couple these two techniques to explore the small bowel in a painless, safe and complete way (with capsule endoscopy) and to define and treat the lesions identified (with double balloon enteroscopy). PMID:18069752

  9. Operative endoscopy of the airway.

    PubMed

    Walters, Dustin M; Wood, Douglas E

    2016-03-01

    Airway endoscopy has long been an important and useful tool in the management of thoracic diseases. As thoracic specialists have gained experience with both flexible and rigid bronchoscopic techniques, the technology has continued to evolve so that bronchoscopy is currently the foundation for diagnosis and treatment of many thoracic ailments. Airway endoscopy plays a significant role in the biopsy of tumors within the airways, mediastinum, and lung parenchyma. Endoscopic methods have been developed to treat benign and malignant airway stenoses and tracheomalacia. And more recently, techniques have been conceived to treat end-stage emphysema and prolonged air leaks in select patients. This review describes the abundant uses of airway endoscopy, as well as technical considerations and limitations of the current technologies. PMID:26981263

  10. Operative endoscopy of the airway

    PubMed Central

    Walters, Dustin M.

    2016-01-01

    Airway endoscopy has long been an important and useful tool in the management of thoracic diseases. As thoracic specialists have gained experience with both flexible and rigid bronchoscopic techniques, the technology has continued to evolve so that bronchoscopy is currently the foundation for diagnosis and treatment of many thoracic ailments. Airway endoscopy plays a significant role in the biopsy of tumors within the airways, mediastinum, and lung parenchyma. Endoscopic methods have been developed to treat benign and malignant airway stenoses and tracheomalacia. And more recently, techniques have been conceived to treat end-stage emphysema and prolonged air leaks in select patients. This review describes the abundant uses of airway endoscopy, as well as technical considerations and limitations of the current technologies. PMID:26981263

  11. 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 ...

  12. 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

  13. Efforts to increase image quality during endoscopy: The role of pronase

    PubMed Central

    Kim, Gwang Ha; Cho, Yu Kyung; Cha, Jae Myung; Lee, Sun-Young; Chung, Il-Kwun

    2016-01-01

    Clear visualization of the gastrointestinal mucosal surface is essential for thorough endoscopy. An unobstructed assessment can reduce the need for additional time-consuming manipulations such as frequent washing and suction, which tend to prolong total procedure time. However, mucus, foam, and bubbles often hinder clear visibility during endoscopy. Premedication with pronase, a compound of mixed proteolytic enzymes, has been studied in order to improve mucosal visibility during endoscopy. Although its effects differ according to the location in the stomach, premedication with pronase 10 to 20 min before endoscopy significantly improves mucosal visibility without affecting the accuracy of Helicobacter pylori identification. The effects of pronase as premedication also extend to chromoendoscopy, narrow-band imaging, magnifying endoscopy, and endoscopic ultrasonography. In addition, endoscopic flushing with pronase during endoscopy may improve the quantity and the quality of a biopsy to some degree. Although improved mucosal visibility does not necessarily improve clinical outcomes, premedication with pronase may be helpful for increasing the detection rate of early cancers. PMID:26981178

  14. A stubborn anemia caused by ectopic pancreas bleeding in the jejunum revealed by capsule endoscopy

    PubMed Central

    Wang, Qun-Ying; Yang, Xiao-Yun

    2015-01-01

    Ectopic pancreas is extremely rare in clinical setting. Meanwhile, a stubborn anemia without obvious dark bloody stool due to ectopic pancreas diagnosed by capsule endoscopy has not been reported. We reported a case of an ectopic pancreas inducing obscure gastrointestinal bleeding in a 70-year-old woman presenting as stubborn anemia, which was diagnosed by capsule endoscopy. The patient recovered well after resection the lesion. Diagnosis of ectopic pancreas is extremely difficult with conventional techniques. Endoscopists should pay more attention to the ectopic pancreas as a rare differential consideration for occult intestinal bleeding. PMID:26682148

  15. Long-Term Outcomes and Prognostic Factors for Patients with Endoscopy-Negative Iron Deficiency

    PubMed Central

    Soon, Anny; Cohen, Benjamin L.; Groessl, Erik J.

    2016-01-01

    Background and Aim Iron deficiency anemia (IDA) is a common problem among the elderly, and often no cause is identified after routine upper endoscopy and colonoscopy exams. The purpose of this study was to determine the long-term outcomes and predictors of gastrointestinal pathology and death in patients with endoscopy-negative IDA. Methods This was a retrospective review of consecutive endoscopy negative-IDA patients during 2002–2004 at the VA San Diego Healthcare System. Results Mean age was 69.3 years (range 42–93), and included 105 men and nine women. Mean length of follow-up was 65.1 months. IDA resolved in 56 patients. None of these patients developed evidence of any clinically significant gastrointestinal pathology. The remaining 58 patients had persistent anemia (n = 47) or recurrent anemia (n = 11). Only 2/47 patients with persistent anemia were found to have clinically significant but benign gastrointestinal pathology during follow-up. In contrast, 6/11 patients with recurrent anemia were subsequently found to have gastrointestinal pathology. Deaths during follow-up occurred in 7 (12.5 %) patients with resolved anemia, compared with 20 (34.5 %) patients with recurrent or persistent anemia (p = 0.006). Significant independent predictors of death included persistent or recurrent anemia, anti-platelet or anticoagulant use, and congestive heart failure. Conclusions Patients with iron deficiency anemia and negative upper endoscopy and colonoscopy often have a favorable outcome, especially if the anemia resolves with treatment. In patients with recurrent anemia a malignancy within reach of standard endoscopy and colonoscopy are possible, and repeating these procedures is warranted before consideration of further investigations. PMID:22945477

  16. 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.

  17. 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 Crohns 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

  18. 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

  19. Electropermanent magnetic anchoring for surgery and endoscopy.

    PubMed

    Tugwell, Josef; Brennan, Philip; O'Shea, Conor; O'Donoghue, Kilian; Power, Timothy; O'Shea, Michael; Griffiths, James; Cahill, Ronan; Cantillon-Murphy, Padraig

    2015-03-01

    The use of magnets for anchoring of instrumentation in minimally invasive surgery and endoscopy has become of increased interest in recent years. Permanent magnets have significant advantages over electromagnets for these applications; larger anchoring and retraction force for comparable size and volume without the need for any external power supply. However, permanent magnets represent a potential hazard in the operating field where inadvertent attraction to surgical instrumentation is often undesirable. The current work proposes an interesting hybrid approach which marries the high forces of permanent magnets with the control of electromagnetic technology including the ability to turn the magnet OFF when necessary. This is achieved through the use of an electropermanent magnet, which is designed for surgical retraction across the abdominal and gastric walls. Our electropermanent magnet, which is hand-held and does not require continuous power, is designed with a center lumen which may be used for trocar or needle insertion. The device in this application has been demonstrated successfully in the porcine model where coupling between an intraluminal ring magnet and our electropermanent magnet facilitated guided insertion of an 18 Fr Tuohy needle for guidewire placement. Subsequent investigations have demonstrated the ability to control the coupling distance of the system alleviating shortcomings with current methods of magnetic coupling due to variation in transabdominal wall thicknesses. With further refinement, the magnet may find application in the anchoring of endoscopic and surgical instrumentation for minimally invasive interventions in the gastrointestinal tract. PMID:25361499

  20. 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 Crohns 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

  1. 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

  2. Application and Efficacy of Super-Magnifying Endoscopy for the Lower Intestinal Tract.

    PubMed

    Hosoe, Naoki; Ogata, Haruhiko

    2016-01-01

    Endoscopy plays a significant role in the diagnosis, management, and surveillance of colorectal cancer (CRC) and inflammatory bowel diseases (IBDs). Moreover, magnifying endoscopy and image-enhanced endoscopy has a crucial role in the clinical setting. Recently, a super-magnifying endoscope has been developed, and two devices, confocal laser endomicroscopy (CLE) and an endocytoscopy system (ECS), which allow in vivo microscopic inspection of the microstructural mucosal features of the gastrointestinal tract, are currently available. Studies on the use of ECS in CRC were reported by a Japanese group. Additionally, a few studies on the use of ECS in IBD have been reported. CLE has been shown to be reliable in assessing the activity of the disease in IBDs in both ulcerative colitis and Crohn's disease. Various published studies evaluated the use of CLE during colonoscopy to distinguish colorectal polyp pathology and neoplasia. However, these studies are heterogeneous, and further evidence is necessary to confirm the efficacy of CLE. PMID:26855922

  3. Application and Efficacy of Super-Magnifying Endoscopy for the Lower Intestinal Tract

    PubMed Central

    Hosoe, Naoki; Ogata, Haruhiko

    2016-01-01

    Endoscopy plays a significant role in the diagnosis, management, and surveillance of colorectal cancer (CRC) and inflammatory bowel diseases (IBDs). Moreover, magnifying endoscopy and image-enhanced endoscopy has a crucial role in the clinical setting. Recently, a super-magnifying endoscope has been developed, and two devices, confocal laser endomicroscopy (CLE) and an endocytoscopy system (ECS), which allow in vivo microscopic inspection of the microstructural mucosal features of the gastrointestinal tract, are currently available. Studies on the use of ECS in CRC were reported by a Japanese group. Additionally, a few studies on the use of ECS in IBD have been reported. CLE has been shown to be reliable in assessing the activity of the disease in IBDs in both ulcerative colitis and Crohn’s disease. Various published studies evaluated the use of CLE during colonoscopy to distinguish colorectal polyp pathology and neoplasia. However, these studies are heterogeneous, and further evidence is necessary to confirm the efficacy of CLE. PMID:26855922

  4. [Heterotopic gastric mucosa of the gastrointestinal tract].

    PubMed

    Schmidt, G; Brsch, G; Wegener, M

    1985-10-01

    Islets of heterotopic gastric mucosa can occur in the whole alimentary tract as well as in the gallbladder, the extrahepatic bile ducts and the pancreatic tissue. In most cases they have incidentally been discovered in autopsies and surgical specimens. Ectopic gastric mucosa is known to cause gastrointestinal bleeding in Meckel's diverticulum and duplications of the intestine, and, in exceptional cases may show a malignant transformation. In endoscopy of the gastrointestinal tract ectopic gastric epithelium can often be conjectured from certain morphological phenomena. In this paper we review pathogenesis, localization, clinical significance as well as diagnostic and therapeutic aspects of heterotopic gastric mucosa. PMID:4082686

  5. 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.

  6. Embolization for gastrointestinal hemorrhages.

    PubMed

    Krmer, S C; Grich, 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

  7. 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

  8. 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

  9. Role of upper endoscopy in diagnosing opportunistic infections in human immunodeficiency virus-infected patients

    PubMed Central

    Werneck-Silva, Ana Luiza; Prado, Ivete Bedin

    2009-01-01

    Highly active antiretroviral therapy (HAART) has dramatically decreased opportunistic infections (OIs) in human immunodeficiency virus (HIV)-infected patients. However, gastrointestinal disease continues to account for a high proportion of presenting symptoms in these patients. Gastrointestinal symptoms in treated patients who respond to therapy are more likely to the result of drug-induced complications than OI. Endoscopic evaluation of the gastrointestinal tract remains a cornerstone of diagnosis, especially in patients with advanced immunodeficiency, who are at risk for OI. The peripheral blood CD4 lymphocyte count helps to predict the risk of an OI, with the highest risk seen in HIV-infected patients with low CD4 count (< 200 cells/mm3). This review provides an update of the role of endoscopy in diagnosing OI in the upper gastrointestinal tract in HIV-infected patients in the era of HAART. PMID:19266596

  10. Informative-frame filtering in endoscopy videos

    NASA Astrophysics Data System (ADS)

    An, Yong Hwan; Hwang, Sae; Oh, JungHwan; Lee, JeongKyu; Tavanapong, Wallapak; de Groen, Piet C.; Wong, Johnny

    2005-04-01

    Advances in video technology are being incorporated into today"s healthcare practice. For example, colonoscopy is an important screening tool for colorectal cancer. Colonoscopy allows for the inspection of the entire colon and provides the ability to perform a number of therapeutic operations during a single procedure. During a colonoscopic procedure, a tiny video camera at the tip of the endoscope generates a video signal of the internal mucosa of the colon. The video data are displayed on a monitor for real-time analysis by the endoscopist. Other endoscopic procedures include upper gastrointestinal endoscopy, enteroscopy, bronchoscopy, cystoscopy, and laparoscopy. However, a significant number of out-of-focus frames are included in this type of videos since current endoscopes are equipped with a single, wide-angle lens that cannot be focused. The out-of-focus frames do not hold any useful information. To reduce the burdens of the further processes such as computer-aided image processing or human expert"s examinations, these frames need to be removed. We call an out-of-focus frame as non-informative frame and an in-focus frame as informative frame. We propose a new technique to classify the video frames into two classes, informative and non-informative frames using a combination of Discrete Fourier Transform (DFT), Texture Analysis, and K-Means Clustering. The proposed technique can evaluate the frames without any reference image, and does not need any predefined threshold value. Our experimental studies indicate that it achieves over 96% of four different performance metrics (i.e. precision, sensitivity, specificity, and accuracy).

  11. 78 FR 24463 - In the Matter of the Review of the Designation of the Abu Sayyaf Group (ASG) (and Other Aliases...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-25

    ... From the Federal Register Online via the Government Publishing Office ] DEPARTMENT OF STATE In the Matter of the Review of the Designation of the Abu Sayyaf Group (ASG) (and Other Aliases) as a Foreign... published in the Federal Register. Dated: April 17, 2013. John F. Kerry, Secretary of State, U.S....

  12. 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 ...

  13. Endoscopy

    MedlinePLUS

    ... AJ, Kavoussi LR, Novick AC, et al, eds. Campbell-Walsh Urology . 10th ed. Philadelphia, PA: Elsevier Saunders; ... of arthroscopy. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics . 12th ed. Philadelphia, PA: Elsevier Mosby; ...

  14. An Unsusual Case of Lower Gastrointestinal Bleeding.

    PubMed

    Guru, Pramod Kumar; Iyer, Vivek N

    2016-01-01

    BACKGROUND Amyloidosis is a multisystem disease, and can present with multitude of nonspecific symptoms. Gastrointestinal amyloidosis is common, and gastrointestinal (GI) bleeding in these patients has a wide differential diagnosis. The present case features the distinctive endoscopic finding of submucosal hematoma as a clue to immunoglobin light chain (AL) amyloid involvement of the gastrointestinal tract. CASE REPORT An 81-year-old woman with AL amyloidosis was transferred to the intensive care unit (ICU) for evaluation of GI bleeding. Prior to the bleeding episode, the patient had undergone paracentesis for management of her ascites related to restrictive cardiomyopathy. Initial evaluation was negative for any intra-abdominal catastrophe related to her recent paracentesis. Upper gastrointestinal endoscopy was negative for any source of bleeding. However, colonoscopy showed a ruptured submucosal hematoma, which is a rare but classical finding in patients with amyloidosis. The patient was managed conservatively and did not have any further episodes of bleeding in the hospital. She unfortunately died due to her primary illness 6 weeks after discharge from the hospital. CONCLUSIONS The finding of submucosal hematoma on endoscopy is a rare but sentinel sign for amyloidosis involvement in the GI tract. PMID:26979633

  15. Capsule Endoscopy in Patients with Implantable Electromedical Devices is Safe

    PubMed Central

    Harris, Lucinda A.; Hansel, Stephanie L.; Rajan, Elizabeth; Srivathsan, Komandoor; Rea, Robert; Crowell, Michael D.; Fleischer, David E.; Pasha, Shabana F.; Gurudu, Suryakanth R.; Heigh, Russell I.; Shiff, Arthur D.; Post, Janice K.; Leighton, Jonathan A.

    2013-01-01

    Background and Study Aims. The presence of an implantable electromechanical cardiac device (IED) has long been considered a relative contraindication to the performance of video capsule endoscopy (CE). The primary aim of this study was to evaluate the safety of CE in patients with IEDs. A secondary purpose was to determine whether IEDs have any impact on images captured by CE. Patients and Methods. A retrospective chart review of all patients who had a capsule endoscopy at Mayo Clinic in Scottsdale, AZ, USA, or Rochester, MN, USA, (January 2002 to June 2010) was performed to identify CE studies done on patients with IEDs. One hundred and eighteen capsule studies performed in 108 patients with IEDs were identified and reviewed for demographic data, method of preparation, and study data. Results. The most common indications for CE were obscure gastrointestinal bleeding (77%), anemia (14%), abdominal pain (5%), celiac disease (2%), diarrhea (1%), and Crohn's disease (1%). Postprocedure assessments did not reveal any detectable alteration on the function of the IED. One patient with an ICD had a 25-minute loss of capsule imaging due to recorder defect. Two patients with LVADs had interference with capsule image acquisition. Conclusions. CE did not interfere with IED function, including PM, ICD, and/or LVAD and thus appears safe. Additionally, PM and ICD do not appear to interfere with image acquisition but LVAD may interfere with capsule images and require that capsule leads be positioned as far away as possible from the IED to assure reliable image acquisition. PMID:23710168

  16. 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

  17. Five years experience with capsule endoscopy in a single center

    PubMed Central

    Kav, Taylan; Bayraktar, Yusuf

    2009-01-01

    Capsule endoscopy (CE) is a novel technology that facilitates highly effective and noninvasive imaging of the small bowel. Although its efficacy in the evaluation of obscure gastrointestinal bleeding (OGIB) has been proven in several trials, data on uses of CE in different small bowel diseases are rapidly accumulating in the literature, and it has been found to be superior to alternative diagnostic tools in a range of such diseases. Based on literature evidence, CE is recommended as a first-line investigation for OGIB after negative bi-directional endoscopy. CE has gained an important role in the diagnosis and follow-up of Crohns disease and celiac disease and in the surveillance of small bowel tumors and polyps in selected patients. Capsule retention is the major complication, with a frequency of 1%-2%. The purpose of this review was to discuss the procedure, indications, contraindications and adverse effects associated with CE. We also review and share our five-year experience with CE in various small bowel diseases. The recently developed balloon-assisted enteroscopies have both diagnostic and therapeutic capability. At the present time, CE and balloon-assisted enteroscopies are complementary techniques in the diagnosis and management of small bowel diseases. PMID:19399924

  18. The development and application of wireless capsule endoscopy.

    PubMed

    Glukhovsky, A; Jacob, H

    2004-06-01

    The introduction of the Video Capsule Endoscope (VCE) by Given Imaging Ltd. (Yoqneam, Israel) in 2001, and its subsequent approval by the FDA as a first line tool in the detection of abnormalities of the small bowel, is indicative of the rapid acceptance of capsule endoscopy by the practicing gastroenterological community. An extensive clinical trials program consistently revealed a high diagnostic yield of the VCE when compared to other diagnostic modalities of the small intestine. The capsule endoscope contains a miniature color video camera, illumination sources, lens, transmitter/controller, antenna, and a power source. It is small enough to easily swallow (11 x 26 mm), and it is propelled through the gastrointestinal (GI) tract by peristalsis. Its development was enabled by a series of technological breakthroughs that occurred at the close of the 20th century. The VCE is one of the most exciting examples of the recent trend for minimally invasive autonomous medical tools in diagnostic, monitoring, and therapeutic applications. Expanding applications of the VCE to additional parts of the GI tract, adding physiological sensors, and--in the more remote future--addition of therapeutic capabilities will likely occur as this new branch of endoscopy develops. PMID:17520603

  19. Endoscopy of the lacrimal system

    PubMed Central

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

    1999-01-01

    BACKGROUND/AIMUntil 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.?METHODS132 patients ranging in age from 8months to 73years with nasolacrimal obstruction were referred to the lacrimal department. Diagnostic lacrimal imaging utilising various small calibre endoscopes less than 0.5mm 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 120of 132patients?RESULTSAll 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 (59patients), followed by the lacrimal sac (39patients) and the canaliculi (34patients). In 25patients, partial obstruction, rather than complete stenosis, was visualised as a narrow lumen, which widened during irrigation. In 14of 28patients, 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.?CONCLUSIONLacrimal 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

  20. 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 1386 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

  1. The present status of endoscopy.

    PubMed

    Poindexter, B D; Vasconez, L O

    1998-12-01

    Introduced to the field of plastic surgery in the early 1990s, surgical endoscopy has expanded rapidly with applications across the broad range of plastic surgery. Although basic principles and concepts have remained the same, there have been advances in both instrumentation and surgical ingenuity, allowing these broader applications. The numerous applications of the endoscope were reviewed and evaluated. Although some applications such as the endoscopic forehead lift and transaxillary endoscopic augmentation seem to have received general acceptance and are used across a broad spectrum of plastic surgery practices, others such as endoscopic muscle harvest have not gained such widespread acceptance. Also, there are areas such as endoscopic microvascular surgery that await advances in technology and instrumentation. PMID:9869146

  2. Challenges and Future of Wireless Capsule Endoscopy

    PubMed Central

    Saurin, Jean-Christophe; Beneche, Nicolas; Chambon, Christine; Pioche, Mathieu

    2016-01-01

    In 2015, capsule endoscopy was introduced as the main investigation method for small bowel mucosal diseases, and its role in colonic diseases has been gradually revealed. Future challenges for capsule endoscopy, besides improvements of image quality and visualization of each part of the small bowel and colonic mucosa, include the development of gastric capsules, the capacity to perform histological examination of the mucosa, and maybe in the future, some capsule endoscopy-driven therapeutics. The aim of this review was to evaluate the clinical demands and feasibility of achieving the aforementioned objectives. PMID:26855920

  3. Implementation of an endoscopy safety checklist

    PubMed Central

    Matharoo, M; Thomas-Gibson, S; Haycock, A; Sevdalis, N

    2014-01-01

    Patient safety and quality improvement are increasingly prioritised across all areas of healthcare. Errors in endoscopy are common but often inconsequential and therefore go uncorrected. A series of minor errors, however, may culminate in a significant adverse event. This is unsurprising given the rising volume and complexity of cases coupled with shift working patterns. There is a growing body of evidence to suggest that surgical safety checklists can prevent errors and thus positively impact on patient morbidity and mortality. Consequently, surgical checklists are mandatory for all procedures. Many UK hospitals are mandating the use of similar checklists for endoscopy. There is no guidance on how best to implement endoscopy checklists nor any measure of their usefulness in endoscopy. This article outlines lessons learnt from innovating service delivery in our unit. PMID:25285191

  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. Wireless Capsule Endoscopy Detects Meckel's Diverticulum in a Child with Unexplained Intestinal Blood Loss

    PubMed Central

    Xinias, I.; Mavroudi, A.; Fotoulaki, M.; Tsikopoulos, G.; Kalampakas, A.; Imvrios, G.

    2012-01-01

    Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal (GI) tract, affecting about 2% of the population. Most cases of Meckel's diverticula are asymptomatic. The diagnosis of symptomatic MD is often difficult to make. We report the case of an 8-year-old boy who presented with GI bleeding due to MD. The diagnostic difficulties after an initial negative endoscopic evaluation and the diagnostic value of the various endoscopic procedures are discussed. The patient had suffered from bright red stools for 20 h before hospital admission. GI scintigraphy with 99mTc-Na-pertechnetate was negative for heterotopic gastric tissue in the small bowel area. Colonoscopy performed in order to exclude Crohn's disease was also negative. He was placed on ranitidine at a dose of 6 mg/kg body weight twice daily. The patient remained asymptomatic over a period of 6 months before he was readmitted due to macroscopic rectal bleeding. Upper endoscopy and colonoscopy used to investigate the source of bleeding showed normal macroscopic findings. Radiolabeling of blood constituents with 99mTc on delayed imaging showed radionucleotide concentration in the ascending and transverse colon suggestive of a lesion in the ileocecal area. Further investigation with the use of wireless capsule endoscopy revealed a MD. Wireless capsule endoscopy may thus be indicated for patients with GI blood loss when other diagnostic methods, such as upper and lower endoscopy and colonoscopy, have failed to identify the source of bleeding. PMID:23139657

  6. Report of video-capsule endoscopy disruption producing episodic small bowel obstruction after prolonged retention

    PubMed Central

    Royall, Nelson A.; Fiscina, Creighton D.

    2014-01-01

    INTRODUCTION Wireless video-capsule endoscopy is a procedure which provides direct visualization of the gastrointestinal tract, particularly the jejunum and ileum. Capsule retention is the main risk associated with capsule endoscopy, occurring at a significantly elevated incidence in patients with known or suspected Crohn's disease. PRESENTATION OF CASE A case of a prolonged retained capsule with subsequent fragmentation producing a multicentric complete small bowel obstruction in a 39 year old male patient who had undergone wireless video capsule-endoscopy approximately three years prior. Management required surgical resection of the strictured jejunum and removal of retained capsule fragments under fluoroscopic guidance. DISCUSSION Although capsule endoscopy is capable of diagnosis, evaluation, and monitoring inflammatory bowel disease, understanding the elevated risk for capsule retention is important in this population. Specifically, prolonged capsule retention appears to increase the risk of capsule disruption, and likely the potential for intestinal perforation. CONCLUSION Patients should therefore be carefully selected for monitoring based upon treatment compliance and offered early endoscopic or surgical intervention in the setting of questionable compliance due to the risk for capsule disruption and subsequent intestinal perforation. PMID:25460458

  7. 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

  8. Usefulness of wireless capsule endoscopy for detecting inflammatory bowel disease in children presenting with arthropathy.

    PubMed

    Taddio, Andrea; Simonini, Gabriele; Lionetti, Paolo; Lepore, Loredana; Martelossi, Stefano; Ventura, Alessandro; Cimaz, Rolando

    2011-10-01

    Inflammatory bowel disease (IBD) is a cause of chronic intestinal inflammation in children. In a subset of patients affected by IBD, arthropathy may be the leading presenting sign. In the past years, remarkable advances in gastrointestinal endoscopy techniques have been achieved; recently, the development of capsule endoscopy (CE) provided a non-invasive method for the complete endoscopic evaluation, including small bowel assessment. We report three children suffering from IBD but presenting with articular complaints in whom CE was a useful tool for detecting gut inflammation. Patients were investigated with the wireless CE: PillCam SB2 (Given Imaging, Yoqneam, Israel) capsule, the second-generation capsule, was used in our paediatric patients. Three patients were initially evaluated for arthropathy. Enteropathic arthritis was suspected for gastrointestinal symptoms and/or persistence of inflammatory markers elevation. In one of these children, conventional endoscopy was refused by parents, while in the other two children, CE was proposed as first-line diagnostic tool. In all patients, CE revealed to be safe and provided information that led to diagnosis. Paediatric rheumatologists should consider CE as a valid, non-invasive tool, eventually first level diagnostic approach in order to evaluate the presence of IBD in children presenting with chronic articular complaints. PMID:21643650

  9. Gastrointestinal Kaposi's sarcoma: Case report and review of the literature.

    PubMed

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

    2015-08-01

    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

  10. Gastrointestinal involvement in systemic mastocytosis.

    PubMed Central

    Ammann, R W; Vetter, D; Deyhle, P; Tschen, H; Sulser, H; Schmid, M

    1976-01-01

    Four consecutive patients with systemic mastocytosis were studied. One patient had a malabsorption syndrome with only minor histological changes of the intestinal mucosa. Another patient with ulcer diathesis had a gastric secretory pattern resembling Zollinger-Ellison syndrome. Serum gastrin and histamine levels were consistently normal in all patients. Endoscopy of stomach and colon disclosed urticaria-like papulae either spontaneously or after topical provocation in all patients. No increase of mast cells was found in multiple mucosal biopsies. A markedly increased gastric tissue content of histamine was found, however, in the three patients studied. The findings suggest that urticaria-like lesions associated with a high tissue content of histamine may be more important that hyperhistaminaemia in causing the various gastrointestinal symptoms. PMID:1261881

  11. Current Status and Research into Overcoming Limitations of Capsule Endoscopy.

    PubMed

    Kwack, Won Gun; Lim, Yun Jeong

    2016-01-01

    Endoscopic investigation has a critical role in the diagnosis and treatment of gastrointestinal (GI) diseases. Since 2001, capsule endoscopy (CE) has been available for small-bowel exploration and is under continuous development. During the past decade, CE has achieved impressive improvements in areas such as miniaturization, resolution, and battery life. As a result, CE is currently a first-line tool for the investigation of the small bowel in obscure gastrointestinal bleeding and is a useful alternative to wired enteroscopy. Nevertheless, CE still has several limitations, such as incomplete examination and limited diagnostic and therapeutic capabilities. To resolve these problems, many groups have suggested several models (e.g., controlled CO2 insufflation system, magnetic navigation system, mobile robotic platform, tagging and biopsy equipment, and targeted drug-delivery system), which are in development. In the near future, new technological advances will improve the capabilities of CE and broaden its spectrum of applications not only for the small bowel but also for the colon, stomach, and esophagus. The purpose of this review is to introduce the current status of CE and to review the ongoing development of solutions to address its limitations. PMID:26855917

  12. Current Status and Research into Overcoming Limitations of Capsule Endoscopy

    PubMed Central

    Kwack, Won Gun; Lim, Yun Jeong

    2016-01-01

    Endoscopic investigation has a critical role in the diagnosis and treatment of gastrointestinal (GI) diseases. Since 2001, capsule endoscopy (CE) has been available for small-bowel exploration and is under continuous development. During the past decade, CE has achieved impressive improvements in areas such as miniaturization, resolution, and battery life. As a result, CE is currently a first-line tool for the investigation of the small bowel in obscure gastrointestinal bleeding and is a useful alternative to wired enteroscopy. Nevertheless, CE still has several limitations, such as incomplete examination and limited diagnostic and therapeutic capabilities. To resolve these problems, many groups have suggested several models (e.g., controlled CO2 insufflation system, magnetic navigation system, mobile robotic platform, tagging and biopsy equipment, and targeted drug-delivery system), which are in development. In the near future, new technological advances will improve the capabilities of CE and broaden its spectrum of applications not only for the small bowel but also for the colon, stomach, and esophagus. The purpose of this review is to introduce the current status of CE and to review the ongoing development of solutions to address its limitations. PMID:26855917

  13. 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

  14. 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

  15. Advanced gastrointestinal endoscopic imaging for inflammatory bowel diseases

    PubMed Central

    Tontini, Gian Eugenio; Rath, Timo; Neumann, Helmut

    2016-01-01

    Gastrointestinal luminal endoscopy is of paramount importance for diagnosis, monitoring and dysplasia surveillance in patients with both, Crohn’s disease and ulcerative colitis. Moreover, with the recent recognition that mucosal healing is directly linked to the clinical outcome of patients with inflammatory bowel disorders, a growing demand exists for the precise, timely and detailed endoscopic assessment of superficial mucosal layer. Further, the novel field of molecular imaging has tremendously expanded the clinical utility and applications of modern endoscopy, now encompassing not only diagnosis, surveillance, and treatment but also the prediction of individual therapeutic responses. Within this review, we describe how novel endoscopic approaches and advanced endoscopic imaging methods such as high definition and high magnification endoscopy, dye-based and dye-less chromoendoscopy, confocal laser endomicroscopy, endocytoscopy and molecular imaging now allow for the precise and ultrastructural assessment of mucosal inflammation and describe the potential of these techniques for dysplasia detection. PMID:26811662

  16. Advanced gastrointestinal endoscopic imaging for inflammatory bowel diseases.

    PubMed

    Tontini, Gian Eugenio; Rath, Timo; Neumann, Helmut

    2016-01-21

    Gastrointestinal luminal endoscopy is of paramount importance for diagnosis, monitoring and dysplasia surveillance in patients with both, Crohn's disease and ulcerative colitis. Moreover, with the recent recognition that mucosal healing is directly linked to the clinical outcome of patients with inflammatory bowel disorders, a growing demand exists for the precise, timely and detailed endoscopic assessment of superficial mucosal layer. Further, the novel field of molecular imaging has tremendously expanded the clinical utility and applications of modern endoscopy, now encompassing not only diagnosis, surveillance, and treatment but also the prediction of individual therapeutic responses. Within this review, we describe how novel endoscopic approaches and advanced endoscopic imaging methods such as high definition and high magnification endoscopy, dye-based and dye-less chromoendoscopy, confocal laser endomicroscopy, endocytoscopy and molecular imaging now allow for the precise and ultrastructural assessment of mucosal inflammation and describe the potential of these techniques for dysplasia detection. PMID:26811662

  17. Preoperative diagnosis of obscure gastrointestinal bleeding due to a GIST of the jejunum: a case report

    PubMed Central

    Kotoulas, Dimitrios; Aloizos, Stavros; Kolovou, Aikaterini; Salemis, Nikolaos S; Kantounakis, Ioannis

    2009-01-01

    Gastrointestinal stromal tumours are rare mesenchymal neoplasms affecting the digestive tract or nearby structures within the abdomen. We present a case of a 66-year-old female patient who presented with obscure anemia due to gastrointestinal bleeding and underwent exploratory laparotomy during which a large gastrointestinal stromal tumour of the small intestine was discovered. Examining the preoperative results of video capsule endoscopy, computed tomography, and angiography and comparing them with the operative findings we discuss which of these investigations plays the most important role in the detection and localization of gastrointestinal stromal tumours. A sort review of the literature is also conducted on these rare mesenchymal tumours. PMID:19918463

  18. [Enteric-coated aspirin does not reduce the risk of gastrointestinal side effects.

    PubMed

    Haastrup, Peter; Jarbl, Dorte Ejg

    2014-04-28

    Enteric-coated aspirin has been developed in order to decrease the risk of gastrointestinal side effects. When reviewing the existing literature on the effects of the coating on the incidence of gastrointestinal side effects we find that enteric-coated aspirin causes significantly less minor gastrointestinal lesions compared to plain aspirin evaluated by endoscopy after short-term treatment, but there seems to be no effect of enteric-coating on the incidence of dyspepsia or gastrointestinal bleeding of clinical relevance. In conclusion enteric-coated aspirin is not superior to plain aspirin. PMID:25096559

  19. Optical Molecular Imaging in the Gastrointestinal Tract

    PubMed Central

    Carns, Jennifer; Keahey, Pelham; Quang, Timothy; Anandasabapathy, Sharmila; Richards-Kortum, Rebecca

    2013-01-01

    Recent developments in optical molecular imaging allow for real-time identification of morphological and biochemical changes in tissue associated with gastrointestinal neoplasia. This review summarizes widefield and high resolution imaging modalities currently in pre-clinical and clinical evaluation for the detection of colorectal cancer and esophageal cancer. Widefield techniques discussed include high definition white light endoscopy, narrow band imaging, autofluoresence imaging, and chromoendoscopy; high resolution techniques discussed include probe-based confocal laser endomicroscopy, high-resolution microendoscopy, and optical coherence tomography. Finally, new approaches to enhance image contrast using vital dyes and molecular-specific targeted contrast agents are evaluated. PMID:23735112

  20. 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.

  1. Ruling in or out a source of gastrointestinal bleeding

    PubMed Central

    2014-01-01

    Background and aims The search for a source of gastrointestinal bleeding is associated with two distinct approaches of trying to rule in a specific diagnosis or rule out any potential source of bleeding. The study aim was to understand the conceptual differences underlying the two searches. Methods The performance of endoscopy as diagnostic test is analyzed in terms of Bayes formula. Results The performance of gastrointestinal endoscopy to rule in a suspected lesion is mostly influenced by its underlying specificity. Because the specificity of endoscopy is less likely to be affected by procedural exigencies, the demands on pre-procedural prep and general quality can be more relaxed. In contradistinction, the performance of endoscopy to rule out a suspected bleeding site is mostly influenced by its sensitivity, which can easily be compromised by suboptimal procedural conditions. Conclusions Paradoxically, the more urgent, focused, and important search (to rule in a bleeding site), carries less stringent criteria for its execution than the more general and aimless search (to rule out a bleeding site) that frequently ends up just empty handed. PMID:25436110

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

    PubMed Central

    Szura, Mirosław; 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

  3. Transthoracic endoscopy for upper thoracic chemical sympathectomy.

    PubMed

    Bardaxoglou, E; Reigner, B; Enon, B; Tolstuchow, N; Lescali, F; Peret, M; Chevalier, J M

    1992-07-01

    Beginning in April 1989, we have performed eight upper thoracic chemical sympathectomies by transthoracic endoscopy. The indications were occlusive arterial disease in four patients and Raynaud's syndrome and palmar hyperhidrosis in two patients each. Transthoracic endoscopy was performed under general anesthesia, through the third costal interspace on the anterior mid-clavicular line. Five ml of phenol were injected into the parietal pleura covering the three proximal thoracic ganglia. The duration of thoracic drainage was 24 hours. The postoperative course was uneventful except for one case of subcutaneous emphysema and transient Horner's syndrome in three instances. There were no initial failures. Because of its simplicity and the short hospitalization period, chemical sympathectomy by transthoracic endoscopy constitutes a valuable alternative to conventional surgery. This technique is, however, limited in the case of antecedent pleuropulmonary disorders. PMID:1390030

  4. Exotic mammal diagnostic endoscopy and endosurgery.

    PubMed

    Divers, Stephen J

    2010-05-01

    Despite the extensive use of endoscopy in avian and domestic animal practice, inclusion of exotic mammals (rabbits, rodents, ferrets, and so forth) in the endoscopist's case load is a much more recent phenomenon. Initially used as a means for the detailed evaluation of the oral cavity, rigid endoscopy has also become invaluable for the evaluation of the nasal cavity, urogenital tract, and increasingly for laparoscopic procedures. This article summarizes the most common procedures used by the author for first opinion and referral cases, and introduces some of the recent developments that are expected to become the standard of care in exotic animal practice in the future. PMID:20381776

  5. Capsule endoscopy in clinical practice: concise up-to-date overview

    PubMed Central

    Koulaouzidis, Anastasios; Douglas, Sarah

    2009-01-01

    Until recently, the small bowel was considered a no mans land as the imaging modalities available for its investigation were laborious, invasive, costly, or involve significant radiation exposure. Wireless capsule endoscopy (WCE) has changed the field dramatically, over the last eight years. The established indications for small bowel WCE are obscure gastrointestinal bleed/anemia, Crohns disease, hereditary polyposis syndromes, and to a lesser extent, evaluation of side effects of nonsteroidal anti-inflammatory medications and coeliac disease. We herein present an overview of the capsule examination, which seems to be a quickly improving area. PMID:21694834

  6. Endoscopic management of mucosal lesions in the gastrointestinal tract.

    PubMed

    Chen, Wei-Chung; Wallace, Michael B

    2016-04-01

    With the increasing role of endoscopy in patient evaluation, more mucosal lesions, including gastric, duodenal and colonic polyps, are encountered during routine examinations. It is imperative for gastroenterologists to become familiar with the endoscopic management of these various gastrointestinal lesions. In this article, various resection techniques will be discussed, including hot/cold forceps polypectomy, hot/cold snare polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection. The article will also discuss the evidence regarding the efficacy and safety of these techniques and the future direction of endoscopic management of mucosal lesions in the gastrointestinal tract. PMID:26581857

  7. A Cause of Mortal Massive Upper Gastrointestinal Bleeding: Aortoesophageal Fistula

    PubMed Central

    Akin, Mete; Yalcinkaya, Tolga; Alkan, Erhan; Arslan, Gokhan; Tuna, Yasar; Yildirim, Bulent

    2016-01-01

    Introduction: Aortoesophageal fistula is an uncommon but mortal cause of massive upper gastrointestinal bleeding. The most common causes are thoracic aortic aneurisym, foreign body reaction, malignancy and postoperative complication. It can be seen in different pattern on upper gastrointestinal endoscopy. There are surgical, endoscopic and interventional radiological treatment options, however, definitive treatment is surgical intervention. Diagnosis and treatment desicion should be made quickly because of rapid and mortal course. Case report: In this article, a case of aortoesophageal fistula was presented that resulted in mortality as a result of massive bleeding. PMID:26980940

  8. 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

  9. 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

  10. 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. French (français) Japanese (日本語) Korean (한국어) Russian (Русский) Somali ( ...

  11. The Use of Channel-Purge Storage for Gastrointestinal Endoscopes Reduces Microbial Contamination.

    PubMed

    Saliou, Philippe; Cholet, Franck; Jézéquel, Julien; Robaszkiewicz, Michel; Le Bars, Hervé; Baron, Raoul

    2015-09-01

    Storage cabinets for heat-sensitive endoscopes (SCHEs) are designed to store gastrointestinal (GI) endoscopes in a clean, dry and well-ventilated cupboard to prevent microbiological proliferation. The use of SCHEs in a GI endoscopy unit has significally reduced the rate of contaminated endoscopes (13.0% vs 45.0%, P<.001). PMID:26036960

  12. 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

  13. 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.

  14. The Usefulness of Capsule Endoscopy for Small Bowel Tumors.

    PubMed

    Cheung, Dae Young; Kim, Jin Su; Shim, Ki-Nam; Choi, Myung-Gyu

    2016-01-01

    Video capsule endoscopy (VCE) has expanded the range of endoscopic examination of the small bowel. The clinical application of VCE is mainly for obscure gastrointestinal bleeding (OGIB) and small bowel tumor is one of the clinically significant diagnoses of VCE, often requiring subsequent invasive interventions. Small bowel tumors are detected with a frequency of around 4% with VCE in indications of OGIB, iron deficiency anemia, unexplained abdominal pain, and others. Protruding mass with bleeding, mucosal disruption, irregular surface, discolored area, and white villi are suggested as the VCE findings of small bowel tumor. Device assisted enteroscopy (DAE), computed tomography enteroclysis/enterography and magnetic resonance enteroclysis/enterography also have clinical value in small bowel examination and tumor detection, and they can be used with VCE, sequentially or complementarily. Familial adenomatous polyposis, Peutz-Jeghers syndrome, melanoma, lymphoma, and neuroendocrine tumor with hepatic metastasis are the high risk groups for small bowel tumors, and surveillance programs for small bowel tumors are needed. VCE and radiological imaging have value in screening, and in selected cases, DAE can provide more accurate diagnosis and endoscopic treatment. This review describes the usefulness and clinical impact of VCE on small bowel tumors. PMID:26855919

  15. 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 16mm. An ex-vivo animal testing has also been conducted to validate the results. PMID:24859846

  16. The Usefulness of Capsule Endoscopy for Small Bowel Tumors

    PubMed Central

    Cheung, Dae Young; Kim, Jin Su; Shim, Ki-Nam; Choi, Myung-Gyu

    2016-01-01

    Video capsule endoscopy (VCE) has expanded the range of endoscopic examination of the small bowel. The clinical application of VCE is mainly for obscure gastrointestinal bleeding (OGIB) and small bowel tumor is one of the clinically significant diagnoses of VCE, often requiring subsequent invasive interventions. Small bowel tumors are detected with a frequency of around 4% with VCE in indications of OGIB, iron deficiency anemia, unexplained abdominal pain, and others. Protruding mass with bleeding, mucosal disruption, irregular surface, discolored area, and white villi are suggested as the VCE findings of small bowel tumor. Device assisted enteroscopy (DAE), computed tomography enteroclysis/enterography and magnetic resonance enteroclysis/enterography also have clinical value in small bowel examination and tumor detection, and they can be used with VCE, sequentially or complementarily. Familial adenomatous polyposis, Peutz-Jeghers syndrome, melanoma, lymphoma, and neuroendocrine tumor with hepatic metastasis are the high risk groups for small bowel tumors, and surveillance programs for small bowel tumors are needed. VCE and radiological imaging have value in screening, and in selected cases, DAE can provide more accurate diagnosis and endoscopic treatment. This review describes the usefulness and clinical impact of VCE on small bowel tumors. PMID:26855919

  17. Current status and future perspectives of capsule endoscopy

    PubMed Central

    Song, Hyun Joo

    2016-01-01

    Small bowel capsule endoscopy (CE) was first introduced 15 years ago, and a large amount of literature has since been produced, focused on its indication, diagnostic yields, and safety. Guidelines that have made CE the primary diagnostic tool for small bowel disease have been created. Since its initial use in the small bowel, CE has been used for the esophagus, stomach, and colon. The primary indications for small bowel CE are obscure gastrointestinal bleeding, unexplained iron deficiency anemia, suspected Crohn's disease, small bowel tumors, nonsteroidal anti-inflammatory drug enteropathy, portal hypertensive enteropathy, celiac disease, etc. Colon CE provides an alternative to conventional colonoscopy, with possible use in colorectal cancer screening. Guidelines for optimal bowel preparation of CE have been suggested. The main challenges in CE are the development of new devices with the ability to provide therapy, air inflation for better visualization of the small bowel, biopsy sampling systems attached to the capsule, and the possibility of guiding and moving the capsule by an external motion controller. We review the current status and future directions of CE, and address all aspects of clinical practice, including the role of CE and long-term clinical outcomes. PMID:26884731

  18. A comparison of diazepam and midazolam as endoscopy premedication assessing changes in ventilation and oxygen saturation.

    PubMed Central

    Bell, G D; Morden, A; Coady, T; Lee, J; Logan, R F

    1988-01-01

    1. One hundred and two consecutive patients undergoing upper gastrointestinal endoscopy were randomised to be sedated with either intravenous diazepam (Diazemuls-Kabi Vitrum) or intravenous midazolam (Hypnovel-Roche). It was assumed that midazolam was likely to be approximately twice as potent as diazepam on the basis of previous work. 2. All patients had an ear oximeter attached throughout the procedure to record continuously their level of oxygen saturation. 3. All 102 patients had pre-endoscopy respiratory function tests measured and 100 wore an induction plethysmograph vest to allow continuous estimation of respiratory rate and excursion. The plethysmograph was calibrated using a pneumotachygraph, so baseline, post-injection and post-endoscopy minute volumes could be estimated. 4. The age, sex ratio and pre-endoscopy respiratory function tests of the 51 patients given intravenous diazepam in a mean dose (s.d.) of 11.5 (5.8) mg over a mean of 3.4 (0.9) min) were similar to that of the 51 patients sedated with intravenous midazolam (mean dose 6.0 (2.8) mg over 3.3 (0.9) min. 5. Both drugs significantly reduced minute volume (P less than 0.001) and oxygen saturation (P less than 0.001). Midazolam appeared to produce slightly greater hypoxaemia with 57% having falls in oxygen saturation of greater than 2.5% compared with only 35% given an equivalent dose of diazepam. 6. Ventilation was still less than baseline when re-checked some minutes after removal of the gastroscope. The speed of recovery appeared faster after diazepam sedation which is in contrast to its longer pharmacological half-life.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3061425

  19. Double-clad fiber coupler for endoscopy.

    PubMed

    Lemire-Renaud, Simon; Rivard, Maxime; Strupler, Mathias; Morneau, Dominic; Verpillat, Frdric; 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

  20. A new approach to blue rubber bleb nevus syndrome: the role of capsule endoscopy and intra-operative enteroscopy.

    PubMed

    Kopácová, Marcela; Tachecí, Ilja; Koudelka, Jaroslav; Králová, Miroslava; Rejchrt, Stanislav; Bures, Jan

    2007-07-01

    Blue rubber bleb nevus syndrome (BRBNS) is a rare vascular malformation disorder with cutaneous and visceral lesions frequently associated with serious, even fatal bleeding and anemia. The syndrome is considered to be autosomaly predominantly inherited. Intra-operative enteroscopy (IOE) is the best method of identification of all lesions (particularly the small ones, less than 3 mm) and treatment by endoscopic electro-coagulation or surgical excision. Capsule wireless endoscopy is optimal for screening before the IOE and for monitoring the effect of therapy (in patients with BRBNS). We report two cases of BRBNS. Anemia, gastrointestinal bleeding, gastrointestinal malformations and multifocal venous malformations of the skin were present in both of our cases. Gastrointestinal lesions were identified by gastroscopy, colonoscopy and capsule endoscopy. The multiple venous malformations were treated partly by endoscopic electro-coagulation (lesions up to 4 mm in diameter) and by wedge resection. Both of our patients were 12-year-old girls at the time of operation. In the first patient 31 venous malformations of the small bowel were coagulated, two were resected by the surgeon. In the second patient 20 lesions were coagulated endoscopically and another 31 nevi were resected during an 8 h procedure. The first girl is doing fine 4 years after the procedure, the second was allowed home 2 weeks after the procedure in excellent condition. IOE is a unique method of small bowel investigation and concurrently provides a solution for pathological findings. Capsule endoscopy is a feasible non-invasive screening procedure. We believe that a radical eliminatory approach by means of combined surgery and IOE is indicated for the BRBNS to prevent ongoing gastrointestinal bleeding. PMID:17205297

  1. Treatment and prevention of gastrointestinal bleeding in patients receiving antiplatelet therapy

    PubMed Central

    Yasuda, Hiroshi; Matsuo, Yasumasa; Sato, Yoshinori; Ozawa, Sun-ichiro; Ishigooka, Shinya; Yamashita, Masaki; Yamamoto, Hiroyuki; Itoh, Fumio

    2015-01-01

    Antiplatelet therapy is the standard of care for the secondary prevention of acute coronary syndrome and ischemic stroke, especially after coronary intervention. However, this therapy is associated with bleeding complications such as gastrointestinal bleeding, which is one of the most common life-threatening complications. Early endoscopy is recommended for most patients with acute upper gastrointestinal bleeding. After successful endoscopic hemostasis, immediate resumption of antiplatelet therapy with proton-pump inhibitors (PPIs) is recommended to prevent further ischemic events. PPI prophylaxis during antiplatelet therapy reduces the risk of upper gastrointestinal bleeding. The potential negative metabolic interaction between PPIs and clopidogrel is still unclear. PMID:25685721

  2. Wireless capsule endoscopy for the detection of small bowel diseases in HIV-1-infected patients

    PubMed Central

    2009-01-01

    Background and Aims In HIV-infected patients, manifestations of the disease are common in the gastrointestinal tract. The objective of our study was to evaluate the diagnostic yield of the Given Video Capsule System (Given Imaging, Yoqneam, Israel) in these patients. Methods After exclusion of GI-tract stenosis by anamnestic exploration, 49 patients were included into the study. Stratification: Group A (n = 19): HIV-positive, CD4 cell count < 200/?l, gastrointestinal symptoms present. Group B: HIV-positive, CD4 < 200/?l, without gastrointestinal symptoms (n = 19 Group) C: healthy volunteers (n = 11). Results In group A there was a total of 30 pathological findings, 15 of which with therapeutic implications. In group B, there was a total of 22 pathological findings, 5 relevant for therapy. In group C there was a total of 13 pathological findings, 3 with therapeutic relevance. In 89% (group A) vs. 26% (group B), pathological findings were detected distal the ligament of Treitz (p = 0.001). All capsules were recovered without complications after 12 to 96 h from the stool. Conclusion Wireless capsule endoscopy of the small intestine should be considered for HIV-infected patients with marked immunosuppression and gastrointestinal symptoms. PMID:19541574

  3. Aspects of computer vision in surgical endoscopy

    NASA Astrophysics Data System (ADS)

    Rodin, Vincent; Ayache, Alain; Berreni, N.

    1993-09-01

    This work is related to a project of medical robotics applied to surgical endoscopy, led in collaboration with Doctor Berreni from the Saint Roch nursing-home in Perpignan, France). After taking what Doctor Berreni advises, two aspects of endoscopic color image processing have been brought out: (1) The help to the diagnosis by the automatic detection of the sick areas after a learning phase. (2) The 3D reconstruction of the analyzed cavity by using a zoom.

  4. 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

  5. Endoscopy in Canada: Proceedings of the National Roundtable

    PubMed Central

    Switzer, Noah; Dixon, Elijah; Tinmouth, Jill; Bradley, Nori; Vassiliou, Melina; Schwaitzberg, Steve; Gomes, Anthony; 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

  6. Randomised trial of endoscopy with testing for Helicobacter pylori compared with non-invasive H pylori testing alone in the management of dyspepsia

    PubMed Central

    McColl, K E L; Murray, L S; Gillen, D; Walker, A; Wirz, A; Fletcher, J; Mowat, C; Henry, E; Kelman, A; Dickson, A

    2002-01-01

    Objective To compare the efficacy of non-invasive testing for Helicobacter pylori with that of endoscopy (plus H pylori testing) in the management of patients referred for endoscopic investigation of upper gastrointestinal symptoms. Design Randomised controlled trial with follow up at 12 months. Setting Hospital gastroenterology unit. Participants 708 patients aged under 55 referred for endoscopic investigation of dyspepsia, randomised to non-invasive breath test for H pylori or endoscopy plus H pylori testing. Main outcome measure Glasgow dyspepsia severity score at one year. Use of medical resources, patient oriented outcomes, and safety were also assessed. Results In 586 patients followed up at 12 months the mean change in dyspepsia score was 4.8 in the non-invasive H pylori test group and 4.6 in the endoscopy group (95% confidence interval for difference 0.7 to 0.5, P=0.69). Only 8.2% of patients followed up who were randomised to breath test alone were referred for subsequent endoscopy. The use of non-endoscopic resources was similar in the two groups. Reassurance value, concern about missed pathology, overall patient satisfaction, and quality of life were similar in the two groups. The patients found the non-invasive breath test procedure less uncomfortable and distressing than endoscopy with or without sedation. No potentially serious pathology requiring treatment other than eradication of H pylori was missed. Conclusion In this patient group, non-invasive testing for H pylori is as effective and safe as endoscopy and less uncomfortable and distressing for the patient. Non-invasive H pylori testing should be the preferred mode of investigation. What is already known on this topicEndoscopy is a commonly used investigation for upper gastrointestinal symptoms, but its effectiveness has been questionedNon-invasive testing for Helicobacter pylori has been shown to predict endoscopic diagnosis in patients with dyspepsiaWhat this study addsIn patients less than 55 years of age with uncomplicated dyspepsia, non-invasive testing for H pylori is as effective and as safe as endoscopyNon-invasive H pylori testing is as reassuring to the patient as endoscopy and is less uncomfortable and distressing PMID:11976239

  7. 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

  8. Faecal markers of gastrointestinal inflammation.

    PubMed

    Sherwood, Roy A

    2012-11-01

    Gastrointestinal (GI) symptoms including abdominal pain, bloating and diarrhoea are a relatively common reason for consulting a physician. They may be due to inflammatory bowel disease (inflammatory bowel disease; Crohn's disease, ulcerative colitis and indeterminate colitis), malignancy (colorectal cancer), infectious colitis or irritable bowel syndrome (IBS). Differentiation between these involves the use of clinical, radiological, endoscopic and serological techniques, which are invasive or involve exposure to radiation. Serological markers include C-reactive protein, erythrocyte sedimentation rate and antibodies (perinuclear antineutrophil cytoplasm antibody and anti-Saccharomyces cerevisiae antibody). Faecal markers that can aid in distinguishing inflammatory disorders from non-inflammatory conditions are non-invasive and generally acceptable to the patient. As IBS accounts for up to 50% of cases presenting to the GI clinic and is a diagnosis of exclusion (Rome III criteria), any test that can reliably distinguish IBS from organic disease could speed diagnosis and reduce endoscopy waiting times. Faecal calprotectin, lactoferrin, M2-PK and S100A12 will be reviewed. PMID:22813730

  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. Compact endoscopic fluorescence detection system for gastrointestinal cancers

    NASA Astrophysics Data System (ADS)

    Nadeau, Valerie; Padgett, Miles J.; Hewett, Jacqueline; Sibbett, Wilson; Hamdan, Khaled; Mohammed, Sami; Tait, Iain; Cushieri, Alfred

    2001-04-01

    We describe a compact endoscopic imaging system for the detection of gastro-intestinal cancers. This system is designed to image ALA-induced PpIX fluorescence and allows the clinician to perform fluorescence endoscopy and white light endoscopy simultaneously. The system comprises a filtered mercury arclamp for illumination and fluorescence excitation, a dual camera system coupled to an endoscope for detection and a desktop PC for processing and display of images. The result is a real-time colour image onto which fluorescence information is superimposed. Preliminary in vivo results indicate an increased fluorescence level within cancers in comparison with normal tissue. In addition, the system allows point spectroscopy to be carried out by the insertion of an optical fibre probe down the biopsy channel of the endoscope.

  11. What Are Gastrointestinal Stromal Tumors?

    MedlinePLUS

    ... key statistics about gastrointestinal stromal tumors? What are gastrointestinal stromal tumors? Cancer starts when cells in the ... system, also known as the digestive system. The gastrointestinal system The gastrointestinal (GI) system (or digestive system) ...

  12. 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

  13. [Stress lesions in the upper gastrointestinal tract].

    PubMed

    Jaschinski, U

    2012-07-01

    Clinically relevant bleeding in the upper gastrointestinal tract due to stress lesions is a rare event; however, the related mortality may be as high as 13% (van Leerdam, Best Pract Res Clin Gastroenterol 2008; 22:209-224). Most often affected are patients in the intensive care unit (ICU) with impaired perfusion as the protective pathways are critically dependent on a near normal blood flow. Minimal mucosal lesions with a tiny hemorrhage can escalate to severe bleeding as the coagulation potential in the presence of an acidic pH is clearly decreased. Mechanical ventilation and coagulopathy are recognized risk factors and these patients should receive an acid suppressing therapy. Proton pump inhibitors (PPI) and histamine type 2 receptor antagonists (H(2)RA) are equal in their ability to prevent stress-related bleeding. However, the side effects of PPI can cause severe morbidity and therefore H(2)RAs may be the drug of choice for prophylaxis. Endoscopy is recommended as a diagnostic and therapeutic tool for patients with active bleeding. Treatment with PPI in this scenario (before and after endoscopy) may reduce complications by leading to premature hemostasis and reduced recurrence of bleeding. PMID:22782130

  14. Factors associated with incomplete small bowel capsule endoscopy studies

    PubMed Central

    Lee, Mitchell M; Jacques, Andrew; Lam, Eric; Kwok, Ricky; Lakzadeh, Pardis; Sandhar, Ajit; Segal, Brandon; Svarta, Sigrid; Law, Joanna; Enns, Robert

    2010-01-01

    AIM: To identify patient risk factors associated with incomplete small bowel capsule endoscopy (CE) studies. METHODS: Data from all CE procedures performed at St. Pauls Hospital in Vancouver, British Columbia, Canada, between December 2001 and June 2008 were collected and analyzed on a retrospective basis. Data collection for complete and incomplete CE study groups included patient demographics as well as a number of potential risk factors for incomplete CE including indication for the procedure, hospitalization, diabetes mellitus with or without end organ damage, limitations in mobility, renal insufficiency, past history of bowel obstruction, abdominal surgery, abdominal radiation therapy and opiate use. Risk factors were analyzed using a univariable and multivariable logistic regression model. RESULTS: From a total of 535 CE procedures performed, 158 were incomplete (29.5%). The univariable analysis showed that CE procedures performed for overt gastrointestinal bleeding (P = 0.002), and for patients with a prior history of abdominal surgery (P = 0.023) or bowel obstruction (P = 0.023) were significantly associated with incomplete CE studies. Patients on opiate medications (P = 0.094) as well as hospitalized patients (P = 0.054) were not statistically significant, but did show a trend towards incomplete CE. The multivariable analysis showed that independent risk factors for an incomplete CE procedure include prior history of bowel obstruction [odds ratios (OR) 2.77, P = 0.02, 95% confidence intervals (CI): 1.17-6.56] and procedures performed for gastrointestinal bleeding (Occult OR 2.04, P = 0.037, 95% CI: 1.04-4.02 and Overt OR 2.69, P = 0.002, 95% CI: 1.44-5.05). Patients with a prior history of abdominal surgery (OR 1.46, P = 0.068, 95% CI: 0.97-2.19), those taking opiate medications (OR 1.54, P = 0.15, 95% CI: 0.86-2.76) and hospitalized patients (OR 1.82, P = 0.124, 95% CI: 0.85-3.93) showed a trend towards statistical significance. CONCLUSION: We have identified a number of risk factors for incomplete CE procedures that can be used to risk-stratify patients and guide interventions to improve completion rates. PMID:21072896

  15. Gastrointestinal Kaposis 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

    Kaposis 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

  16. Endoscopic submucosal dissection for gastrointestinal neoplasms

    PubMed Central

    Kakushima, Naomi; Fujishiro, Mitsuhiro

    2008-01-01

    Endoscopic submucosal dissection (ESD) is an advanced technique of therapeutic endoscopy for superficial gastrointestinal neoplasms. Three steps characterize it: injecting fluid into the submucosa to elevate the lesion, cutting the surrounding mucosa of the lesion, and dissecting the submucosa beneath the lesion. The ESD technique has rapidly permeated in Japan for treatment of early gastric cancer, due to its excellent results of en-bloc resection compared to endoscopic mucosal resection (EMR). Although there is still room for improvement to lessen its technical difficulty, ESD has recently been applied to esophageal and colorectal neoplasms. Favorable short-term results have been reported, but the application of ESD should be well considered by three aspects: (1) the possibility of nodal metastases of the lesion, (2) technical difficulty such as location, ulceration and operators skill, and (3) organ characteristics. PMID:18494043

  17. 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.

  18. Computed tomography angiography in patients with active gastrointestinal bleeding*

    PubMed Central

    Reis, Fatima Regina Silva; Cardia, Patricia Prando; D'Ippolito, Giuseppe

    2015-01-01

    Gastrointestinal bleeding represents a common medical emergency, with considerable morbidity and mortality rates, and a prompt diagnosis is essential for a better prognosis. In such a context, endoscopy is the main diagnostic tool; however, in cases where the gastrointestinal hemorrhage is massive, the exact bleeding site might go undetected. In addition, a trained professional is not always present to perform the procedure. In an emergency setting, optical colonoscopy presents limitations connected with the absence of bowel preparation, so most of the small bowel cannot be assessed. Scintigraphy cannot accurately demonstrate the anatomic location of the bleeding and is not available at emergency settings. The use of capsule endoscopy is inappropriate in the acute setting, particularly in the emergency department at night, and is a highly expensive method. Digital angiography, despite its high sensitivity, is invasive, presents catheterization-related risks, in addition to its low availability at emergency settings. On the other hand, computed tomography angiography is fast, widely available and minimally invasive, emerging as a promising method in the diagnostic algorithm of these patients, being capable of determining the location and cause of bleeding with high accuracy. Based on a critical literature review and on their own experience, the authors propose a computed tomography angiography protocol to assess the patient with gastrointestinal bleeding. PMID:26811556

  19. 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

  20. Detection of neoplastic gastric lesions using capsule endoscopy: pilot study.

    PubMed

    Jun, Byoung Yeon; Lim, Chul-Hyun; Lee, Wook Hyun; Kim, Jin Su; Park, Jae Myung; Lee, In Seok; Kim, Sang Woo; Choi, Myung-Gyu

    2013-01-01

    Objectives. Capsule endoscopy is relatively noninvasive method and its use extends from the small bowel to the esophagus and colon. The aim of this study was to evaluate the feasibility and acceptability of capsule endoscopy for neoplastic gastric lesions. Methods. Capsule endoscopy (Pillcam ESO) was performed within 48 hours of esophagogastroduodenoscopy for eight patients who were diagnosed with gastric cancers, the size of which were less than 4?cm and who presented written consent. Patients changed position in a specified designed sequence every 30 seconds after capsule ingestion. Position change was repeated with ingestion of an effervescent agent. The rate of detection of intragastric lesions, observation of normal gastric anatomy and patient satisfaction between capsule endoscopy and esophagogastroduodenoscopy were compared. Results. Capsule endoscopy found four out of eight gastric lesions. The gastroesophageal junction was observed in seven of the eight cases, pyloric ring in five of the eight cases, and gastric angle in four of the eight cases. The patient satisfaction assessment questionnaire rated capsule endoscopy significantly higher than upper endoscopy in all categories. Conclusions. Capsule endoscopy was less effective than esophagogastroduodenoscopy and showed limited value in this feasibility study. PMID:23762039

  1. Evaluation of friction enhancement through soft polymer micro-patterns in active capsule endoscopy

    NASA Astrophysics Data System (ADS)

    Buselli, Elisa; Pensabene, Virginia; Castrataro, Piero; Valdastri, Pietro; Menciassi, Arianna; Dario, Paolo

    2010-10-01

    Capsule endoscopy is an emerging field in medical technology. Despite very promising innovations, some critical issues are yet to be addressed, such as the management and possible exploitation of the friction in the gastrointestinal environment in order to control capsule locomotion more actively. This paper presents the fabrication and testing of bio-inspired polymeric micro-patterns, which are arrays of cylindrical pillars fabricated via soft lithography. The aim of the work is to develop structures that enhance the grip between an artificial device and the intestinal tissue, without injuring the mucosa. In fact, the patterns are intended to be mounted on microfabricated legs of a capsule robot that is able to move actively in the gastrointestinal tract, thus improving the robot's traction ability. The effect of micro-patterned surfaces on the leg-slipping behaviour on colon walls was investigated by considering both different pillar dimensions and the influence of tissue morphology. Several in vitro tests on biological samples demonstrated that micro-patterns of pillars made from a soft polymer with an aspect ratio close to 1 enhanced friction by 41.7% with regard to flat surfaces. This work presents preliminary modelling of the friction and adhesion forces in the gastrointestinal environment and some design guidelines for endoscopic devices.

  2. 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

  3. Eosinophilic esophagitis prevalence in an adult population undergoing upper endoscopy in southeastern Mexico.

    PubMed

    De la Cruz-Patio, E; Ruz Jurez, I; Meixueiro Daza, A; Grube Pagola, P; Roesch-Dietlen, F; Remes-Troche, J M

    2015-01-01

    Eosinophilic esophagitis (EoE) prevalence fluctuates according to the population studied and varies from 0.4% in an open population to 6.5% in subjects with esophageal symptoms. Even though this entity has been described in North American and European populations, it is still considered an 'unusual' condition in Latin America. The study aimed to determine EoE prevalence in patients undergoing elective endoscopy in a tertiary referral center in southeastern Mexico. Consecutive patients were evaluated that had been referred to the Medical and Biological Research Institute, Veracruz, Mexico, for upper endoscopy due to gastrointestinal symptoms. Demographic variables and symptoms were analyzed in all the cases. Eight mucosal biopsies of the esophagus (four proximal and four distal) were obtained and were reviewed by a blinded pathologist. Histological diagnosis was established when the mean eosinophil count at a large magnification was ?15. A total of 235 subjects (137 women, 51.16 years) were evaluated, and EoE prevalence was 1.7% (4/235 95% confidence interval 0.2-3.6%). In all four cases, pH test were normal. Among patients with histological diagnosis of EoE, a greater number of patients with a past history of asthma (50% vs. 19.3%, P = 0.04) and a tendency for a greater frequency of dysphagia (50% vs. 25%, P = 0.10). There were no differences in the endoscopic findings (rings, grooves, plaques, or stricture) when compared with the patients presenting with erosive esophagitis. EoE prevalence among patients undergoing upper endoscopy from southeastern Mexico was 1.7%, which can be regarded as intermediate to low. PMID:24835543

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

    PubMed Central

    Kozie?, S?awomir; Patkowski, Waldemar; Gr?t, Micha?; Wrblewski, 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 (3565) 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 710 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. PMID:26649098

  5. Upper gastrointestinal bleeding in cirrhosis: clinical and endoscopic correlations.

    PubMed Central

    Ters, J; Bordas, J M; Bru, C; Diaz, F; Bruguera, M; Rodes, J

    1976-01-01

    The clinical data of 180 episodes of upper gastrointestinal bleeding in 168 patients with cirrhosis of the liver are examined. The source of bleeding had been determined by early endoscopy in all cases. In men under the age of 50 years, and without symptoms of liver failure, bleeding was due to ruptured gastro-oesophageal varices in 84% of cases. Severe liver failure was associated with acute lesions of gastric mucosa in many cases. No presumptive diagnosis of the source of haemorrhage could be based on the examination of other clinical data (presence of ascites, mode of presentation and pattern of bleeding, history of ulcer disease, alcoholism, and previous medication. PMID:1083824

  6. 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

  7. 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

  8. 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

  9. A Review of Machine-Vision-Based Analysis of Wireless Capsule Endoscopy Video

    PubMed Central

    Chen, Yingju; Lee, Jeongkyu

    2012-01-01

    Wireless capsule endoscopy (WCE) enables a physician to diagnose a patient's digestive system without surgical procedures. However, it takes 1-2 hours for a gastroenterologist to examine the video. To speed up the review process, a number of analysis techniques based on machine vision have been proposed by computer science researchers. In order to train a machine to understand the semantics of an image, the image contents need to be translated into numerical form first. The numerical form of the image is known as image abstraction. The process of selecting relevant image features is often determined by the modality of medical images and the nature of the diagnoses. For example, there are radiographic projection-based images (e.g., X-rays and PET scans), tomography-based images (e.g., MRT and CT scans), and photography-based images (e.g., endoscopy, dermatology, and microscopic histology). Each modality imposes unique image-dependent restrictions for automatic and medically meaningful image abstraction processes. In this paper, we review the current development of machine-vision-based analysis of WCE video, focusing on the research that identifies specific gastrointestinal (GI) pathology and methods of shot boundary detection. PMID:23197930

  10. [Design of extracorporeal apparatus of capsule endoscopy based on ARM+FPGA].

    PubMed

    Wang, Shenghua; Zhang, Sijie; Wang, Yue; Wang, Zhenxing

    2011-10-01

    Considering that the patients would bear the annoyance of fixed posture for long time when they are examined with gastrointestinal wireless endoscopy, even though portable devices have been developed, the treatments still depend on PC so much, we proposed an embedded solution based on ARM + FPGA. It used embedded ARM9 S3C2440 as processor core, collected images from digestive tract through capsule endoscopy which can be swallowed down there, and wirelessly transferred these images to the receiving system, then used video decoder chip SAA7114H for analog of NTSC video image decode. And under FPGA's logic controlling, effective digital video signal was transferred to S3C2440 for further treatment. Finally within the embedded Linux environment, we programmed the visual user interfaces using the QT/Embedded, realizing the offline record of the real-time video images of digestive tract portable and preferences. It can make patients move more freely and even without PC when examining. In addition, the method greatly improves the efficiency of the doctor, and is more intelligent and with more humane nature. PMID:22097259

  11. A case of primary jejunal cancer diagnosed by preoperative small intestinal endoscopy.

    PubMed

    Nabeshima, Kazuhito; Machimura, Takao; Wasada, Mitsuru; Takayasu, Hiroyuki; Ogoshi, Kyoji; Makuuchi, Hiroyasu

    2008-04-01

    The patient was a 37-year-old female. She was brought to our hospital by ambulance with nausea and vomiting. Abdominal ultra sound and abdominal enhanced CT scan showed a tumor in left side of the abdominal aorta 6 cm in size, and it showed an expanded stomach and duodenum. Upper gastrointestinal series revealed an apple core sign in upper jejunum near the Treitz' ligament. Small intestinal endoscopy (XSIF-240 endoscope, Olympus Inc.) revealed stenosis related to an epithelially protruding lesion with an irregular surface in the jejunum on the anal side of the horizontal duodenal peduncle. Biopsy suggested a well-differentiated adenocarcinoma. Scintigraphy showed hot spot in left middle abdomen. Under a diagnosis of primary jejunum cancer, Partial resection of the jejunum and partial resection of the transverse colon was performed. Histopathologically, the tumor was well differentiated adenocarcinoma exposed serosal surface. Postoperatively, the stage was evaluated as III (T3, N1, M0). Preoperative diagnosis to use small intestinal endoscopy was effectiveness. We report a patient with primary jejunum cancer in whom a definitive diagnosis was made before surgery. PMID:21318964

  12. Beyond white light endoscopy--the prospect for endoscopic optical biopsy.

    PubMed

    Fulljames, C; Stone, N; Bennett, D; Barr, H

    1999-11-01

    The most important factor in the successful treatment of cancer is early detection. This will be more likely to facilitate eradication of abnormal cells prior to systemic invasion. White light endoscopy has been an essential tool in medical diagnosis for a number of years. Direct endoscopic inspection of gastrointestinal organs has revolutionised diagnostic techniques, improving the targeting of biopsies of macroscopic morphological abnormalities. Recent technological developments are threatening a further revolution enabling the instantaneous and non-invasive diagnosis of microscopic tissue abnormalities in vivo. This is made possible by improving the level of information that can be obtained from the tissue. As well as the two-dimensional surface morphology image, which the traditional endoscope can view, new techniques enable structure at depth, i.e., the third-dimension, to be imaged in high resolution. Other advances enable the detection of biochemical changes in tissue that precede any changes in morphology, thus enabling earlier diagnosis of tissue abnormalities. This review details recent advances that have the greatest potential, for use in partnership with endoscopy, for the diagnosis of malignancy and pre-malignancy. PMID:10730562

  13. Gastric carcinoma originating from the heterotopic submucosal gastric gland treated by laparoscopy and endoscopy cooperative surgery

    PubMed Central

    Imamura, Taisuke; Komatsu, Shuhei; Ichikawa, Daisuke; Kobayashi, Hiroki; Miyamae, Mahito; Hirajima, Shoji; Kawaguchi, Tsutomu; Kubota, Takeshi; Kosuga, Toshiyuki; Okamoto, Kazuma; Konishi, Hirotaka; Shiozaki, Atsushi; Fujiwara, Hitoshi; Ogiso, Kiyoshi; Yagi, Nobuaki; Yanagisawa, Akio; Ando, Takashi; Otsuji, Eigo

    2015-01-01

    Gastric carcinoma is derived from epithelial cells in the gastric mucosa. We reported an extremely rare case of submucosal gastric carcinoma originating from the heterotopic submucosal gastric gland (HSG) that was safely diagnosed by laparoscopy and endoscopy cooperative surgery (LECS). A 66-year-old man underwent gastrointestinal endoscopy, which detected a submucosal tumor (SMT) of 1.5 cm in diameter on the lesser-anterior wall of the upper gastric body. The tumor could not be diagnosed histologically, even by endoscopic ultrasound-guided fine-needle aspiration biopsy. Local resection by LECS was performed to confirm a diagnosis. Pathologically, the tumor was an intra-submucosal well differentiated adenocarcinoma invading 5000 μm into the submucosal layer. The resected tumor had negative lateral and vertical margins. Based on the Japanese treatment guidelines, additional laparoscopic proximal gastrectomy was curatively performed. LECS is a less invasive and safer approach for the diagnosis of SMT, even in submucosal gastric carcinoma originating from the HSG. PMID:26306144

  14. 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

  15. 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

  16. 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

  17. 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.

  18. Does magnetically assisted capsule endoscopy improve small bowel capsule endoscopy completion rate? A randomised controlled trial

    PubMed Central

    Hale, Melissa F.; Drew, Kaye; Sidhu, Reena; McAlindon, Mark E.

    2016-01-01

    Background and study aims: Delayed gastric emptying is a significant factor in incomplete small bowel capsule examinations. Gastric transit could be hastened by external magnetic control of the capsule. We studied the feasibility of this approach to improve capsule endoscopy completion rates. Patients and methods: Prospective, single-center, randomized controlled trial involving 122 patients attending for small bowel capsule endoscopy using MiroCam Navi. Patients were randomized to either the control group (mobilisation for 30 minutes after capsule ingestion, followed by intramuscular metoclopramide 10 mg if the capsule failed to enter the small bowel) or the intervention group (1000 mL of water prior to capsule ingestion, followed by positional change and magnetic steering). Outcome measures were capsule endoscopy completion rate, gastric clarity and distention, relationship of body habitus to capsule endoscopy completion rate (CECR), and patient comfort scores. Results: 122 patients were recruited (61 each to the control and intervention groups: mean age 49 years [range 21 – 85], 61 females). There was no significant difference in CECR between the two groups (P = 0.39). Time to first pyloric image was significantly shorter in the intervention group (P = 0.03) but there was no difference in gastric transit times (P = 0.12), suggesting that magnetic control hastens capsular transit to the gastric antrum but does not influence duodenal passage. Gastric clarity and distention were significantly better in the intervention group (P < 0.0001 and P < 0.0001 respectively). Conclusions: Magnetic steering of a small bowel capsule is unable to overcome pyloric contractions to enhance gastric emptying and improve capsule endoscope completion rate. Excellent mucosal visualisation within the gastric cavity suggests this technique could be harnessed for capsule examination of the stomach. PMID:26878053

  19. 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

  20. Removal of a sewing needle penetrating the wall of the third portion of the duodenum by double-balloon endoscopy.

    PubMed

    Shishido, Takayoshi; Oka, Shiro; Tanaka, Shinji; Aoyama, Taiki; Watari, Ikue; Imagawa, Hiroki; Yoshida, Shigeto; Hiyama, Toru; Chayama, Kazuaki

    2012-02-01

    We describe successful removal a sewing needle penetrating the wall of the third portion of the duodenum by means of double-balloon endoscopy (DBE). The patient was a 47-year-old woman who accidentally swallowed a sewing needle and was admitted to our hospital. Abdominal radiography and abdominal computed tomography revealed a metallic object in the third portion of the duodenum. DBE performed by the antegrade approach, revealed that the sewing needle had penetrated the duodenal wall. The sewing needle was retrieved with biopsy forceps and pulled out together with the endoscope through the flexible overtube that remained positioned in the duodenum. There was no injury to the patient's esophagus or gastrointestinal wall. Our experience in this case suggests that sharp foreign bodies in the gastrointestinal tract can be safely removed by means of DBE. PMID:26181881

  1. Optimal Bowel Preparation for Video Capsule Endoscopy.

    PubMed

    Song, Hyun Joo; Moon, Jeong Seop; Shim, Ki-Nam

    2016-01-01

    During video capsule endoscopy (VCE), several factors, such as air bubbles, food material in the small bowel, and delayed gastric and small bowel transit time, influence diagnostic yield, small bowel visualization quality, and cecal completion rate. Therefore, bowel preparation before VCE is as essential as bowel preparation before colonoscopy. To date, there have been many comparative studies, consensus, and guidelines regarding different kinds of bowel cleansing agents in bowel preparation for small bowel VCE. Presently, polyethylene glycol- (PEG-) based regimens are given primary recommendation. Sodium picosulphate-based regimens are secondarily recommended, as their cleansing efficacy is less than that of PEG-based regimens. Sodium phosphate as well as complementary simethicone and prokinetics use are considered. In this paper, we reviewed previous studies regarding bowel preparation for small bowel VCE and suggested optimal bowel preparation of VCE. PMID:26880894

  2. Optimal Bowel Preparation for Video Capsule Endoscopy

    PubMed Central

    Song, Hyun Joo; Moon, Jeong Seop; Shim, Ki-Nam

    2016-01-01

    During video capsule endoscopy (VCE), several factors, such as air bubbles, food material in the small bowel, and delayed gastric and small bowel transit time, influence diagnostic yield, small bowel visualization quality, and cecal completion rate. Therefore, bowel preparation before VCE is as essential as bowel preparation before colonoscopy. To date, there have been many comparative studies, consensus, and guidelines regarding different kinds of bowel cleansing agents in bowel preparation for small bowel VCE. Presently, polyethylene glycol- (PEG-) based regimens are given primary recommendation. Sodium picosulphate-based regimens are secondarily recommended, as their cleansing efficacy is less than that of PEG-based regimens. Sodium phosphate as well as complementary simethicone and prokinetics use are considered. In this paper, we reviewed previous studies regarding bowel preparation for small bowel VCE and suggested optimal bowel preparation of VCE. PMID:26880894

  3. Gastrointestinal Morbidity in Obesity

    PubMed Central

    Acosta, Andres; Camilleri, Michael

    2014-01-01

    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 diseases (CVD). Obesity is also associated with gastrointestinal disorders, which are more frequent and present earlier than T2DM and CVD. Diseases such as gastro-esophageal reflux disease, cholelithiasis or non-alcoholic 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 effects of obesity. PMID:24602085

  4. 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

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

    PubMed Central

    Aziret, Mehmet; etinknar, Sleyman; Akta?, Elife; ?rkrc, 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

  6. Gastrointestinal nuclear imaging

    SciTech Connect

    Not Available

    1988-01-01

    This book contains paper grouped under the headings of: salivary scintigraphy, abscess detection with radionuclides; pediatric gastroenterology; liver spleen, and miscellaneous GI studies: gastrointestinal.

  7. 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

  8. 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

  9. Endoscopy simulators: lessons from the aviation and automobile industries.

    PubMed

    Cohen, Jonathan; Nuckolls, Lance; Mourant, Ronald R

    2006-07-01

    Individuals who are interested in using technology to promote education and quality assurance in endoscopy may turn to aviation and driver's test simulation for guidance. Of course the forces driving the innovation and the regulation governing these fields are entirely different from the ones faced in endoscopy. However, some of the general principles of how simulators can enhance training and how their strengths can be put to optimal use are quite pertinent to those individuals interested in the ongoing evolution of endoscopy simulation. PMID:16876714

  10. 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

  11. Advanced imaging and visualization in gastrointestinal disorders

    PubMed Central

    Gilja, Odd Helge; Hatlebakk, Jan G; degaard, Svein; Berstad, Arnold; Viola, Ivan; Giertsen, Christopher; Hausken, Trygve; Gregersen, Hans

    2007-01-01

    Advanced medical imaging and visualization has a strong impact on research and clinical decision making in gastroenterology. The aim of this paper is to show how imaging and visualization can disclose structural and functional abnormalities of the gastrointestinal (GI) tract. Imaging methods such as ultrasonography, magnetic resonance imaging (MRI), endoscopy, endosonography, and elastography will be outlined and visualization with Virtual Reality and haptic methods. Ultrasonography is a versatile method that can be used to evaluate antral contractility, gastric emptying, transpyloric flow, gastric configuration, intragastric distribution of meals, gastric accommodation and strain measurement of the gastric wall. Advanced methods for endoscopic ultrasound, three-dimensional (3D) ultrasound, and tissue Doppler (Strain Rate Imaging) provide detailed information of the GI tract. Food hypersensitivity reactions including gastrointestinal reactions due to food allergy can be visualized by ultrasonography and MRI. Development of multi-parametric and multi-modal imaging may increase diagnostic benefits and facilitate fusion of diagnostic and therapeutic imaging in the future. PMID:17457973

  12. 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

  13. 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 patients 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

  14. 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

  15. Endoscopic repair of post-surgical gastrointestinal complications.

    PubMed

    Manta, Raffaele; Magno, Luca; Conigliaro, Rita; Caruso, Angelo; Bertani, Helga; Manno, Mauro; Zullo, Angelo; Frazzoni, Marzio; Bassotti, Gabrio; Galloro, Giuseppe

    2013-11-01

    Complications following gastrointestinal surgery may require re-intervention, can lead to prolonged hospitalization, and significantly increase health costs. Some complications, such as anastomotic leakage, fistula, and stricture require a multidisciplinary approach. Therapeutic endoscopy may play a pivotal role in these conditions, allowing minimally invasive treatment. Different endoscopic approaches, including fibrin glue injection, endoclips, self-expanding stents, and endoscopic vacuum-assisted devices have been introduced for both anastomotic leakage and fistula treatment. Similarly endoscopic treatments, such as endoscopic dilation, incisional therapy, and self-expanding stents have been used for anastomotic strictures. All these techniques can be safely performed by skilled endoscopists, and may achieve a high technical success rate in both the upper and lower gastrointestinal tract. Here we will review the endoscopic management of post-surgical complications; these techniques should be considered as first-line approach in selected patients, allowing to avoid re-operation, reduce hospital stay, and decrease costs. PMID:23623147

  16. Massive gastrointestinal hemorrhage secondary to typhoid colitis: A case report and literature review

    PubMed Central

    De Mel, Sanjay; Wong, Reuben K.

    2015-01-01

    We present a case of massive lower gastrointestinal hemorrhage secondary to Salmonella enterica subtype Typhi (S. Typhi) colitis, in a 29 year-old female treated for S. Typhi bacteremia. One week post-treatment, she unexpectedly developed a large volume of rectal bleeding. Endoscopy showed colonic ulcers and ileitis, but no endoscopic hemostasis was required. Treatment was supportive with transfusions and a prolonged course of antimicrobials, with the bleeding stopping spontaneously. This case illustrates the phenomenon of delayed lower gastrointestinal hemorrhage, as a rare complication of S. Typhi infection.

  17. Preoperative diagnosis of obscure gastrointestinal bleeding due to a GIST of the jejunum: a case report

    PubMed Central

    2009-01-01

    Gastrointestinal stromal tumours (GISTs) are rare mesenchymal neoplasms affecting the digestive tract or nearby structures within the abdomen. We present a case of a 66-year-old female patient who presented with obscure anemia due to gastrointestinal bleeding and underwent exploratory laparotomy during which a large GIST of the small intestine was discovered. Examining the preoperative results of video capsule endoscopy, computed tomography, and angiography and comparing them with the operative findings we discuss which of these investigations plays the most important role in the detection and localization of GIST. A sort review of the literature is also conducted on these rare mesenchymal tumours. PMID:20062725

  18. 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

  19. Rapid Access Real-Time device and Rapid Access software: new tools in the armamentarium of capsule endoscopy.

    PubMed

    Spada, Cristiano; Riccioni, Maria Elena; Costamagna, Guido

    2007-07-01

    Small bowel capsule endoscopy represents a significant advance in the investigation of the small bowel, allowing direct visualization of this section of the gastrointestinal system. More recently, new video capsules have been released, specifically designed to investigate the esophagus and the colon. In June 2006, Given Imaging Ltd received marketing clearance from the US FDA for the Rapid Access Real-Time (RT) and Rapid Access software. The Rapid Access RT is a handheld device that enables real-time viewing during capsule endoscopy procedures. To date, the clinical benefits of this device are unknown as studies on the Rapid Access RT system have not yet been published. However, it appears that the Rapid Access RT system may reduce the examination and reading time, and may impact significantly in cases where it is important to know the precise localization of the capsule (during PillCam ESO ingestion procedures, PillCam Colon examinations or when delayed gastric transit is suspected) or in case of severe gastrointestinal bleeding (when a therapeutic procedure is required urgently). PMID:17605677

  20. MULTIPHOTON IMAGING CAN BE USED FOR MICROSCOPIC EXAMINATION OF INTACT HUMAN GASTROINTESTINAL MUCOSA EX VIVO

    PubMed Central

    Rogart, Jason N.; Nagata, Jun; Loeser, Caroline S.; Roorda, Robert D.; Aslanian, Harry; Robert, Marie E.; Zipfel, Warren R.; Nathanson, Michael H.

    2008-01-01

    Background & Aims The ability to observe cellular and subcellular detail during routine endoscopy is a major goal in the development of new endoscopic imaging techniques. Multiphoton microscopy, which relies on nonlinear infared optical processes, has the potential to identify cellular details by excitation of endogenous fluorescent molecules. We examined the feasibility of using multiphoton microscopy to characterize mucosal histology in the human gastrointestinal tract. Methods A multiphoton microscope was used to determine the optimal excitation wavelength for examination of gastrointestinal mucosa. Fresh, unfixed, and unstained biopsy specimens obtained during routine endoscopy in human subjects were then examined by confocal microscopy and multiphoton microscopy. Multiphoton images also were compared to standard H&E images obtained from paired biopsy specimens. A prototype miniaturized multiphoton probe was used to examine intact rat colon. Results Peak multiphoton autofluorescence intensity was detected in mucosa excited at 735 nm. Multiphoton microscopic examination of unstained biopsy specimens revealed improved cellular detail relative to either unstained or stained specimens examined by confocal imaging. Resolution of structures such as epithelial nuclei, goblet cells, and interstitial fibers and cells was comparable to what was obtained using standard H&E histology. Similar findings were observed when using a prototype miniaturized multiphoton probe. Conclusions Multiphoton microscopy can be used to examine gastrointestinal mucosa at the cellular level, without the need for fluorescent dyes. The construction of a multiphoton endomicroscope could therefore provide a practical means of performing virtual biopsies during the course of routine endoscopy, with advantages over currently available endomicroscopy technologies. PMID:18065276

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

    PubMed

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

    2012-04-16

    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

  2. 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

  3. The Gastrointestinal Tumor Microenvironment

    PubMed Central

    Quante, Michael; Varga, Julia; Wang, Timothy C.; Greten, Florian R.

    2013-01-01

    Over the past decade, the microenvironment of gastrointestinal tumors has gained increasing attention because it is required for tumor initiation, progression, and metastasis. The tumor microenvironment has many components and has been recognized as one of the major hallmarks of epithelial cancers. Although therapeutic strategies for gastrointestinal cancer have previously focused on the epithelial cell compartment, there is increasing interest in reagents that alter the microenvironment, based on reported interactions among gastrointestinal epithelial, stromal, and immune cells during gastrointestinal carcinogenesis. We review the different cellular components of the gastrointestinal tumor microenvironment and their functions in carcinogenesis, and discuss how improving our understanding of the complex stromal network could lead to new therapeutic strategies. PMID:23583733

  4. Tacrolimus-Induced Intestinal Angioedema: Diagnosis by Capsule Endoscopy

    PubMed Central

    Zvidi, I.; Gal, E.; Rachamimov, R.; Niv, Y.

    2007-01-01

    Small intestinal angioedema has been reported with angiotensin converting enzyme inhibitors therapy, but not in implanted patients treated with tacrolimus. We present a kidney transplanted patient, hospitalized with severe diarrhea, diagnosed with tacrolimus-induced intestinal angioedema with abdominal computerized tomography and capsule endoscopy. To the best of our knowledge this is the first described case of tacrolimus-induced small bowel angioedema diagnosed with capsule endoscopy. PMID:20376210

  5. Effect of longer battery life on small bowel capsule endoscopy

    PubMed Central

    Ou, George; Shahidi, Neal; Galorport, Cherry; Takach, Oliver; Lee, Terry; Enns, Robert

    2015-01-01

    AIM: To determine if longer battery life improves capsule endoscopy (CE) completion rates. METHODS: A retrospective study was performed at a tertiary, university-affiliated hospital in Vancouver, Canada. Patients who underwent CE with either PillCam SB2 or SB2U between 01/2010 and 12/2013 were considered for inclusion. SB2 and SB2U share identical physical dimensions but differ in their battery lives (8 h vs 12 h). Exclusion criteria included history of gastric or small bowel surgery, endoscopic placement of CE, interrupted view of major landmarks due to technical difficulty or significant amount of debris, and repeat CE using same system. Basic demographics, comorbidities, medications, baseline bowel habits, and previous surgeries were reviewed. Timing of major landmarks in CE were recorded, and used to calculate gastric transit time, small bowel transit time, and total recording time. A complete CE study was defined as visualization of cecum. Transit times and completion rates were compared. RESULTS: Four hundred and eight patients, including 208 (51.0%) males, were included for analysis. The mean age was 55.5 19.3 years. The most common indication for CE was gastrointestinal bleeding (n = 254, 62.3%), followed by inflammatory bowel disease (n = 86, 21.1%). There was no difference in gastric transit times (group difference 0.90, 95%CI: 0.72-1.13, P = 0.352) and small bowel transit times (group difference 1.07, 95%CI: 0.95-1.19, P = 0.261) between SB2U and SB2, but total recording time was about 14% longer in the SB2U group (95%CI: 10%-18%, P < 0.001) and there was a corresponding trend toward higher completion rate (88.2% vs 93.2%, OR = 1.78, 95%CI 0.88-3.63, P = 0.111). There was no statistically significant difference in the rates of positive findings (OR = 0.98, 95%CI: 0.64-1.51, P = 0.918). CONCLUSION: Extending the operating time of CE may be a simple method to improve completion rate although it does not affect the rate of positive findings. PMID:25759536

  6. Management by the intensivist of gastrointestinal bleeding in adults and children

    PubMed Central

    2012-01-01

    Intensivists are regularly confronted with the question of gastrointestinal bleeding. To date, the latest international recommendations regarding prevention and treatment for gastrointestinal bleeding lack a specific approach to the critically ill patients. We present recommendations for management by the intensivist of gastrointestinal bleeding in adults and children, developed with the GRADE system by an experts group of the French-Language Society of Intensive Care (Société de Réanimation de Langue Française (SRLF), with the participation of the French Language Group of Paediatric Intensive Care and Emergencies (GFRUP), the French Society of Emergency Medicine (SFMU), the French Society of Gastroenterology (SNFGE), and the French Society of Digestive Endoscopy (SFED). The recommendations cover five fields of application: management of gastrointestinal bleeding before endoscopic diagnosis, treatment of upper gastrointestinal bleeding unrelated to portal hypertension, treatment of upper gastrointestinal bleeding related to portal hypertension, management of presumed lower gastrointestinal bleeding, and prevention of upper gastrointestinal bleeding in intensive care. PMID:23140348

  7. Modern treatment of gastric gastrointestinal stromal tumors.

    PubMed

    Roggin, Kevin K; Posner, Mitchell C

    2012-12-14

    Gastrointestinal stromal tumors (GIST) are rare mesenchymal smooth muscle sarcomas that can arise anywhere within the gastrointestinal tract. Sporadic mutations within the tyrosine kinase receptors of the interstitial cells of Cajal have been identified as the key molecular step in GIST carcinogenesis. Although many patients are asymptomatic, the most common associated symptoms include: abdominal pain, dyspepsia, gastric outlet obstruction, and anorexia. Rarely, GIST can perforate causing life-threatening hemoperitoneum. Most are ultimately diagnosed on cross-sectional imaging studies (i.e., computed tomography and/or magnetic resonance imaging in combination with upper endoscopy. Endoscopic ultrasonographic localization of these tumors within the smooth muscle layer and acquisition of neoplastic spindle cells harboring mutations in the c-KIT gene is pathognomonic. Curative treatment requires a complete gross resection of the tumor. Both open and minimally invasive operations have been shown to reduce recurrence rates and improve long-term survival. While there is considerable debate over whether GIST can be benign neoplasms, we believe that all GIST have malignant potential, but vary in their propensity to recur after resection and metastasize to distant organ sites. Prognostic factors include location, size (i.e., > 5 cm), grade (> 5-10 mitoses per 50 high power fields and specific mutational events that are still being defined. Adjuvant therapy with tyrosine kinase inhibitors, such as imatinib mesylate, has been shown to reduce the risk of recurrence after one year of therapy. Treatment of locally-advanced or borderline resectable gastric GIST with neoadjuvant imatinib has been shown to induce regression in a minority of patients and stabilization in the majority of cases. This treatment strategy potentially reduces the need for more extensive surgical resections and increases the number of patients eligible for curative therapy. The modern surgical treatment of gastric GIST combines the novel use of targeted therapy and aggressive minimally invasive surgical procedures to provide effective treatment for this lethal, but rare gastrointestinal malignancy. PMID:23239909

  8. 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

  9. Interventional Endoscopy Database for Pancreatico-biliary, Gastrointestinal and Esophageal Disorders

    ClinicalTrials.gov

    2015-06-01

    Ampullary Cancer; Duodenal Cancer; Bile Duct Cancer; Bile Duct Disorders; Gallstones; Obstructive Jaundice; Pancreatic Disorders (Noncancerous); Colorectal Cancer; Esophageal Cancer; Barrett's Esophagus; Gastric Malignancies; Pancreatic Cancer; Pediatric Gastroenterology; Cholangiocarcinoma; Pancreatic Pseudocysts; Acute and Chronic Pancreatitis; Recurrent Pancreatitis; Cholangitis; Bile Leak; Biliary Strictures; Pancreatic Divisum; Biliary and Pancreatic Stones; Choledocholithiasis

  10. Upper Gastrointestinal Dieulafoy's Lesions and Endoscopie Treatment: First Report from a Mexican Centre

    PubMed Central

    Lpez-Arce, Gustavo; Zepeda-Gmez, Sergio; Chvez-Tapia, Norberto C.; Garcia-Osogobio, Sandra; Franco-Guzmn, Ada M.; Ramirez-Luna, Miguel A.

    2008-01-01

    The aim was to evaluate the initial success, rebleeding rate, need for emergent surgery, and mortality rates of patients with Dieulafoy's lesion (DL) and endoscopic treatment (ET). Patients with DL from a tertiary center were included. We included 20 patients with follow-up of 90 (60-550) days. The lesser curvature was the most common localization. Initial success, rebleeding, and emergent surgery requirement were observed in 90%, 10%, and 15%, respectively. No objective variables were related with response to ET. In conclusion, ET is secure and useful in patients with DL and it must be considered as the first-line treatment modality. PMID:21180518

  11. A UWB wireless capsule endoscopy device.

    PubMed

    Thotahewa, Kasun M S; Redoute, Jean-Michel; Yuce, Mehmet Rasit

    2014-01-01

    Wireless capsule endoscopy (WCE) presents many advantages over traditional wired endoscopic methods. The performance of WCE devices can be improved using high-frequency communication systems such as Impulse Radio-Ultra-Wideband (IR-UWB) to enable a high data rate transmission with low-power consumption. This paper presents the hardware implementation and experimental evaluation of a WCE device that uses IR-UWB signals in the frequency range of 3.5 GHz to 4.5 GHz to transmit image data from inside the body to a receiver placed outside the body. Key components of the IR-UWB transmitter, such as the narrow pulse generator and up-conversion based RF section are described in detail. This design employs a narrowband receiver in the WCE device to receive a control signal externally in order to control and improve the data transmission from the device in the body. The design and performance of a wideband implantable antenna that operates in the aforementioned frequency range is also described. The operation of the WCE device is demonstrated through a proof-of-concept experiment using meat. PMID:25571601

  12. Endoscopy water source: tap or sterile water?

    PubMed

    Puterbaugh, M; Barde, C; Van Enk, R

    1997-01-01

    The purpose of this study was to determine whether the endoscopic water source holds potential for transmission of pathogens. Phase I of the study used tap water and clean water bottles; Phase II used sterile water and steam-sterilized water bottles. In both phases, a control bottle filled with water from the appropriate source was set up. Cultures were taken from both the controls and endoscopy water sources before the day's procedures were started and at the end of the day. Each phase contained 100 to 106 sets of samples. Many of the tap water samples were positive for normal flora found in city water sources. No clinically significant complications were identified during either phase of the study. The use of tap water and clean water bottles was found to carry no greater risk than using sterile water and sterile bottles. The practice of using tap water will result in significant cost savings. Further study will be needed to look at the integrity of the endoscope and water bottle design in preventing transmission of pathogens. PMID:9460351

  13. Automated polyp detection in colon capsule endoscopy.

    PubMed

    Mamonov, Alexander V; Figueiredo, Isabel N; Figueiredo, Pedro N; Tsai, Yen-Hsi Richard

    2014-07-01

    Colorectal polyps are important precursors to colon cancer, a major health problem. Colon capsule endoscopy is a safe and minimally invasive examination procedure, in which the images of the intestine are obtained via digital cameras on board of a small capsule ingested by a patient. The video sequence is then analyzed for the presence of polyps. We propose an algorithm that relieves the labor of a human operator analyzing the frames in the video sequence. The algorithm acts as a binary classifier, which labels the frame as either containing polyps or not, based on the geometrical analysis and the texture content of the frame.We assume that the polyps are characterized as protrusions that are mostly round in shape. Thus, a best fit ball radius is used as a decision parameter of the classifier. We present a statistical performance evaluation of our approach on a data set containing over 18 900 frames from the endoscopic video sequences of five adult patients. The algorithm achieves 47% sensitivity per frame and 81% sensitivity per polyp at a specificity level of 90%. On average, with a video sequence length of 3747 frames, only 367 false positive frames need to be inspected by an operator. PMID:24710829

  14. [Clinical practice using colon capsule endoscopy].

    PubMed

    Kakugawa, Yasuo; Matsumoto, Minori; Saito, Yutaka

    2014-01-01

    PillCam COLON capsule endoscopy(CCE) (Given Imaging Ltd., Yoqneam, Israel) is one of the most recent diagnostic technologies designed to explore the colorectum. The first generation of CCE was released onto the market in 2006, and the second generation (PillCam COLON 2 : CCE-2), with increased sensitivity, was released in 2009. The CCE-2 has 2 imagers with a much wider angle of view that has been increased to 172 degrees per imager, allowing nearly 360 degrees coverage of the colon by two. The most unique feature of the CCE-2 is its adaptive frame rate (AFR). This new technology allows the CCE-2 to capture 35 images per second when in motion and 4 images per second when virtually stationary. The per-patient CCE-2 sensitivity for detecting polyps > or = 6 mm has been reported as 84%-91%. These recent advancements in this modality might offer physicians the option to screen for colorectal lesions noninvasively. PMID:24597367

  15. Distance optical sensor for quantitative endoscopy.

    PubMed

    Lucesoli, Agnese; Criante, Luigino; Farabollini, Bruno; Bonifazi, Floriano; Simoni, Francesco; Rozzi, Tullio

    2008-01-01

    We present a novel optical sensor able to measure the distance between the tip of an endoscopic probe and the anatomical object under examination. In medical endoscopy, knowledge of the real distance from the endoscope to the anatomical wall provides the actual dimensions and areas of the anatomical objects. Currently, endoscopic examination is limited to a direct and qualitative observation of anatomical cavities. The major obstacle to quantitative imaging is the inability to calibrate the acquired images because of the magnification system. However, the possibility of monitoring the actual size of anatomical objects is a powerful tool both in research and in clinical investigation. To solve this problem in a satisfactory way we study and realize an absolute distance sensor based on fiber optic low-coherence interferometry (FOLCI). Until now the sensor has been tested on pig trachea, simulating the real humidity and temperature (37 degrees C) conditions. It showed high sensitivity, providing correct and repeatable distance measurements on biological samples even in case of very low reflected power (down to 2 to 3 nW), with an error lower than 0.1 mm. PMID:18315349

  16. Gastrointestinal Parasitic Infections

    PubMed Central

    Embil, Juan A.; Embil, John M.

    1988-01-01

    This article surveys the most important gastrointestinal parasites that affect humans. The modes of acquisition, pathology, epidemiology, diagnosis, and treatment are all briefly examined. Gastrointestinal parasites have become increasingly important in the differential diagnosis of gastrointestinal disease, as a result of a number of circumstances. These circumstances include: increasing travel to developing countries; increased numbers, for one reason or another, of immunocompromised individuals; increased consumption of raw or partially cooked ethnic delicacies; more crowding in day-care centres; increased immigration from developing countries; and an endemic pocket of individuals with certain unhygienic or unsanitary practices. PMID:21253148

  17. In the workup of patients with obscure gastrointestinal bleed, does 64-slice MDCT have a role?

    PubMed Central

    Kulkarni, Chinmay; Moorthy, Srikanth; Sreekumar, KP; Rajeshkannan, R; Nazar, PK; Sandya, CJ; Sivasubramanian, S; Ramchandran, PV

    2012-01-01

    Purpose: The purpose was to prospectively determine the sensitivity of 64-slice MDCT in detecting and diagnosing the cause of obscure gastrointestinal bleed (OGIB). Materials and Methods: Our study included 50 patients (male 30, female 20) in the age range of 382 years (average age: 58.52 years) who were referred to our radiology department as part of their workup for clinically evident gastrointestinal (GI) bleed or as part of workup for anemia (with and without positive fecal occult blood test). All patients underwent conventional upper endoscopy and colonoscopy before undergoing CT scan. Following a noncontrast scan, all patients underwent triple-phase contrast CT scan using a 64-slice CT scan system. The diagnostic performance of 64-slice MDCT was compared to the results of capsule endoscopy, 99m-technetium-labeled red blood cell scintigraphy (99mTc-RBC scintigraphy), digital subtraction angiography, and surgery whenever available. Results: CT scan showed positive findings in 32 of 50 patients. The sensitivity, specificity, positive predictive value, and negative predictive values of MDCT for detection of bleed were 72.2%, 42.8%, 81.2%, and 44.4%, respectively. Capsule endoscopy was done in 15 patients and was positive in 10 patients; it had a sensitivity of 71.4%. Eleven patients had undergone 99mTc-RBC scintigraphy prior to CT scan, and the result was positive in seven patients (sensitivity 70%). Digital subtraction angiography was performed in only eight patients and among them all except one patient showed findings consistent with the lesions detected on MDCT. Conclusion: MDCT is a sensitive and noninvasive tool that allows rapid detection and localization of OGIB. It can be used as the first-line investigation in patients with negative endoscopy and colonoscopy studies. MDCT and capsule endoscopy have complementary roles in the evaluation of OGIB. PMID:22623816

  18. Management of lower gastrointestinal bleeding in older adults.

    PubMed

    Triadafilopoulos, George

    2012-09-01

    Lower gastrointestinal bleeding, acute overt, occult or obscure in nature, causes significant morbidity and mortality in older adults. As the elderly population is expected to increase in the future, healthcare costs and the clinical burden of lower gastrointestinal bleeding will rise. Lower gastrointestinal bleeding, by definition, originates from a site distal to the ligament of Treitz and is usually suspected when patients present with haematochezia, or maroon stools per rectum. A thorough history is paramount in guiding the diagnostic steps and management but is frequently inadequate in elderly, poorly communicating, nursing home patients. The causes of lower gastrointestinal bleeding in older adults may be anatomic, vascular, inflammatory, neoplastic or iatrogenic. Comorbidity from cardiopulmonary disease, renal disease, diabetes or underlying cancer, all prevalent in older adults, may affect the incidence, severity, morbidity and mortality of lower gastrointestinal bleeding in the elderly. The use of multiple medications, particularly non-steroidal anti-inflammatory, antiplatelet and anticoagulant agents, needs to be always considered in elderly patients with lower gastrointestinal bleeding and anaemia. CT imaging and early colonoscopy are useful in determining the site of bleeding and allowing haemostasis. If unsuccessful, angiographic intervention and surgery need to be considered. Videocapsule endoscopy is useful in cases where the small bowel is suspected as the source, and its results guide the performance of double- or single-balloon enteroscopy. Optimal care should involve a coordinated effort among the primary physician, endoscopist, interventional radiologist and surgeon in order to improve prognosis and subsequent management and reduce morbidity, mortality, length of stay and overall healthcare costs. PMID:23018607

  19. 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

  20. 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

  1. Epifluorescence light collection for multiphoton microscopic endoscopy

    NASA Astrophysics Data System (ADS)

    Brown, Christopher M.; Rivera, David R.; Xu, Chris; Webb, Watt W.

    2011-03-01

    Multiphoton microscopic endoscopy (MPM-E) is a promising medical in vivo diagnostic imaging technique because it captures intrinsic fluorescence and second harmonic generation signals to reveal anatomical and histological information about disease states in tissue. However, maximizing light collection from multiphoton endoscopes remains a challenge: weak nonlinear emissions from endogenous structures, miniature optics, large imaging depths, and light scattering in tissue all hamper light collection. The quantity of light that may be collected using a dual-clad fiber system from scattering phantoms that mimic the properties of the in vivo environment is measured. In this experiment, 800nm excitation light from a Ti:Sapphire laser is dispersion compensated and focused through a SM800 optical fiber and lens system into the tissue phantom. Emission light from the phantom passes through the lens system, reflects off the dichroic and is then collected by a second optical fiber actuated by a micromanipulator. The lateral position of the collection fiber varies, measuring the distribution of emitted light 2000?m on either side of the focal point reimaged to the object plane. This spatial collection measurement is performed at depths up to 200?m from the phantom surface. The tissue phantoms are composed of a 15.8 ?M fluorescein solution mixed with microspheres, approximating the scattering properties of human bladder and dermis tissue. Results show that commercially available dual-clad optical fibers collect more than 47% of the total emission returning to the object plane from both phantoms. Based on these results, initial MPM-E devices will image the surface of epithelial tissues.

  2. Mycobiota in gastrointestinal diseases.

    PubMed

    Mukherjee, Pranab K; Sendid, Boualem; Hoarau, Gautier; Colombel, Jean-Frdric; Poulain, Daniel; Ghannoum, Mahmoud A

    2015-02-01

    New insights gained through the use of state-of-the-art technologies, including next-generation sequencing, are starting to reveal that the association between the gastrointestinal tract and the resident mycobiota (fungal community) is complex and multifaceted, in which fungi are active participants influencing health and disease. Characterizing the human mycobiome (the fungi and their genome) in healthy individuals showed that the gastrointestinal tract contains 66 fungal genera and 184 fungal species, with Candida as the dominant fungal genera. Although fungi have been associated with a number of gastrointestinal diseases, characterization of the mycobiome has mainly been focused on patients with IBD and graft-versus-host disease. In this Review, we summarize the findings from studies investigating the relationship between the gut mycobiota and gastrointestinal diseases, which indicate that fungi contribute to the aggravation of the inflammatory response, leading to increased disease severity. A model explaining the mechanisms underlying the role of the mycobiota in gastrointestinal diseases is also presented. Our understanding of the contribution of the mycobiota to health and disease is still in its infancy and leaves a number of questions to be addressed. Answering these questions might lead to novel approaches to prevent and/or manage acute as well as chronic gastrointestinal disease. PMID:25385227

  3. Review of Musculoskeletal Injuries and Prevention in the Endoscopy Practitioner

    PubMed Central

    2014-01-01

    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

  4. 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

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

    PubMed Central

    Reuter, Stefan; Bettenworth, Dominik; Mees, Sren Torge; Neumann, Jrg; Beyna, Torsten; Domschke, Wolfram; Wessling, Johannes; Ullerich, Hansjrg

    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

  6. On-the-fly detection of images with gastritis aspects in magnetically guided capsule endoscopy

    NASA Astrophysics Data System (ADS)

    Mewes, P. W.; Neumann, D.; Juloski, A. L.; Angelopoulou, E.; Hornegger, J.

    2011-03-01

    Capsule Endoscopy (CE) was introduced in 2000 and has since become an established diagnostic procedure for the small bowel, colon and esophagus. For the CE examination the patient swallows the capsule, which then travels through the gastrointestinal tract under the influence of the peristaltic movements. CE is not indicated for stomach examination, as the capsule movements can not be controlled from the outside and the entire surface of the stomach can not be reliably covered. Magnetically-guided capsule endoscopy (MGCE) was introduced in 2010. For the MGCE procedure the stomach is filled with water and the capsule is navigated from the outside using an external magnetic field. During the examination the operator can control the motion of the capsule in order to obtain a sufficient number of stomach-surface images with diagnostic value. The quality of the examination depends on the skill of the operator and his ability to detect aspects of interest in real time. We present a novel computer-assisted diagnostic-procedure (CADP) algorithm for indicating gastritis pathologies in the stomach during the examination. Our algorithm is based on pre-processing methods and feature vectors that are suitably chosen for the challenges of the MGCE imaging (suspended particles, bubbles, lighting). An image is classified using an ada-boost trained classifier. For the classifier training, a number of possible features were investigated. Statistical evaluation was conducted to identify relevant features with discriminative potential. The proposed algorithm was tested on 12 video sequences stemming from 6 volunteers. A mean detection rate of 91.17% was achieved during leave-one out cross-validation.

  7. Role of endoscopy, cross-sectional imaging and biomarkers in Crohn's disease monitoring.

    PubMed

    Benitez, Jose-Manuel; Meuwis, Marie-Alice; Reenaers, Catherine; Van Kemseke, Catherine; Meunier, Paul; Louis, Edouard

    2013-12-01

    Crohn's disease is characterised by recurrent and/or chronic inflammation of the gastrointestinal tract leading to cumulative intestinal tissue damage. Treatment tailoring to try to prevent this tissue damage as well as achieve optimal benefit/risk ratio over the whole disease course is becoming an important aspect of Crohn's disease management. For decades, clinical symptoms have been the main trigger for diagnostic procedures and treatment strategy adaptations. However, the correlation between symptoms and intestinal lesions is only weak. Furthermore, preliminary evidence suggests that a state of remission beyond the simple control of clinical symptoms, and including mucosal healing, may be associated with better disease outcome. Therefore monitoring the disease through the use of endoscopy and cross-sectional imaging is proposed. However, the degree of mucosal or bowel wall healing that needs to be reached to improve disease outcome has not been appropriately studied. Furthermore, owing to their invasive nature and cost, endoscopy and cross-sectional imaging are not optimal tools for the patients or the payers. The use of biomarkers as surrogate markers of intestinal and systemic inflammation might help. Two biomarkers have been most broadly assessed in Crohn's disease: C-reactive protein and faecal calprotectin. These markers correlate significantly with endoscopic lesions, with the risk of relapse and with response to therapy. They could be used to help make decisions about diagnostic procedures and treatment. In particular, with the use of appropriate threshold values, they could determine the need for endoscopic or medical imaging procedures to confirm the disease activity state. PMID:24203056

  8. Gastrointestinal intubations: nursing considerations.

    PubMed

    Short, N M

    1989-01-01

    This article describes 10 special therapeutic tubes utilized in gastroenterology. The discussion includes a description of each tube; categories are developed by anatomical site as well as the number of lumens in each tube. Several tubes are not discussed due to previous development in the literature or specialty purposes limited to diagnostics: esophageal manometry, Levin, Salem sump, gastrostomy tubes, bougies, dilators, the Dreiling tube and the Rubin-Quinton tube. Many of the tubes discussed are often utilized in the inpatient setting on a ward and may not be as familiar to the gastroenterology nurse or associate in an endoscopy suite. PMID:2487810

  9. Service user and carer participation in an endoscopy nursing programme.

    PubMed

    Martin, Daphne; Hoy, Leontia; N Hoy, Karl

    This article reports an initiative to improve students' insight into service user and carer experience of endoscopy, particularly those with severe disability, such as spinal cord injury. This insight has the potential to improve the information provided and level of person-centred care in an endoscopy service. It was evident in the feedback from the classroom encounter that the teaching and learning strategy had a positive outcome, which will allow us to integrate the approach into future curriculum development and delivery, bringing the lived experience from the service user and carer perspective into the classroom. Students engaged in discussion and used their reflective skills to develop sensitivity to those with physical disability and complex needs requiring endoscopy procedures. PMID:24121848

  10. 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

  11. [Virtual CT endoscopy "Cruising Eye View": development and clinical applications].

    PubMed

    Hayashi, H; Kobayashi, H; Kumazaki, T; Goto, Y

    1996-02-01

    We have developed a virtual CT endoscopy, designated as "Cruising Eye View (CEV)", which have generated from spiral volumetric CT data and reconstracted using a new three-dimensional image reconstruction technique. Using this new method, we have reconstructed the inner image of patients with aortic dissection (2 cases) and arteriosclerosis obliterance (3 cases). The view point and view direction could be set arbitrarily in the vessel, so that the site, configuration, and/or degree of the intravascular abnormalities were recognized at first glance. Virtual CT endoscopy with CEV method is a promising, non-invasive strategy for archiving the inner image of diverse aorto-arterial pathologies. PMID:8725340

  12. 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.

  13. Impact of cytomegalovirus gastrointestinal disease on the clinical outcomes in patients with gastrointestinal graft-versus-host disease in the era of preemptive therapy.

    PubMed

    Cho, Byung-Sik; Yahng, Seung-Ah; Kim, Jung-Ho; Yoon, Jae-Ho; Shin, Seung-Hwan; Lee, Sung-Eun; Choi, Su-Mi; Lee, Dong-Gun; Eom, Ki-Seong; Park, Gyeongsin; Kim, Yoo-Jin; Kim, Hee-Je; Lee, Seok; Min, Chang-Ki; Cho, Seok-Goo; Kim, Dong-Wook; Lee, Jong-Wook; Min, Woo-Sung; Park, Chong-Won

    2013-04-01

    Cytomegalovirus gastrointestinal (CMV-GI) disease in GI graft-versus-host disease (GI-GVHD) has not been properly evaluated in the era of preemptive therapy for CMV infection. We investigated 103 patients with GI-GVHD who underwent endoscopic biopsies with immunohistochemical staining for CMV. All recipients and/or donors were seropositive for CMV and monitored with a strategy of preemptive therapy based on real-time quantitative polymerase chain reaction. Twenty-six patients (25 %) developed CMV-GI disease, especially in HLA-mismatched transplants (P = 0.023) and with initial gut involvement of GVHD (P = 0.009). The CMV-GI diseases were diagnosed at follow-up endoscopies (n = 10, 39 %), comprising 19 % of 52 patients who underwent follow-up endoscopies, as well as initial endoscopies (n = 16, 61 %), comprising 16 % of all GI-GVHD patients. In seven cases, either at initial (n = 5) or follow-up endoscopies (n = 2), CMV-GI disease was diagnosed in the absence of histopathologic evidence for GI-GVHD. Notably, only 11 patients (42 %) had prior CMV DNAemia before the diagnosis of CMV-GI disease, while 12 (46 %) and three (12 %) had concurrent and no CMV DNAemia, respectively. Sixty-five percent of CMV-GI disease was resolved by additional antiviral therapies, but CMV-GI disease (P = 0.032) as well as severity of GVHD (P = 0.001) negatively affected GVHD-specific survival. In conclusion, our data demonstrate that CMV-GI disease was a cause of initial or persistent GI manifestations after the initiation of therapy in a considerable proportion of GI-GVHD. These suggest the necessity of novel strategies to reduce CMV-GI disease as well as an effort to confirm CMV with repeated endoscopies. PMID:23180439

  14. Gastrointestinal Stent Update

    PubMed Central

    2010-01-01

    The use of self-expanding metallic stents in the upper gastrointestinal tract, placed under radiologic imaging or endoscopic guidance, is the current treatment of choice for the palliation of malignant gastrointestinal outlet obstructions. Advances in metallic stent design and delivery systems have progressed to the stage where this treatment is now considered a minimally invasive therapy. Metallic stent placement will broaden further into the field of nonsurgical therapy for the gastrointestinal tract. To date, metallic stents placed in the esophagus, gastric outlet, colorectum, and bile ducts are not intended to be curative, but rather to provide a palliative treatment for obstructions. The evolution of metallic stent technology will render such procedures not only palliative but also therapeutic, by enabling local drug delivery, and the use of biodegradable materials will reduce procedure-related complications. PMID:21103290

  15. Gastrointestinal bleeding from Dieulafoys lesion: Clinical presentation, endoscopic findings, and endoscopic therapy

    PubMed Central

    Nojkov, Borko; Cappell, Mitchell S

    2015-01-01

    Although relatively uncommon, Dieulafoys 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, Dieulafoys lesions maintain a large caliber despite their peripheral, submucosal, location within gastrointestinal wall. Dieulafoys 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 1970s to 9%-13% currently with the advent of aggressive endoscopic therapy. PMID:25901208

  16. Duodenum identification mechanism for capsule endoscopy.

    PubMed

    Woo, Sang Hyo; Mohy-Ud-Din, Zia; Cho, Jin Ho

    2011-04-01

    The aim of this study is to implement a duodenum identification mechanism for capsule endoscopes because commercially available capsule endoscopes sometimes present a false negative diagnosis of the duodenum. One reason for the false negative diagnosis is that the duodenum is the fastest moving part within the gastrointestinal tract and the current frame rate of the capsule is not fast enough. When the capsule can automatically identify that it is in the duodenum, the frame rate of the capsule can be temporarily increased to reduce the possibility of a false negative diagnosis. This study proposes a mechanism to identify the duodenum using capacitive proximity sensors that can distinguish the surrounding tissue and transmit data using RF communication. The implemented capsule (D11 mm L22 mm) was smaller than the commercially available capsule endoscopes, and power consumption was as low as 0.642 mW. Preexperiments were conducted to select an appropriate electrode width in order to increase the signal-to-noise ratio (SNR), and in vitro experiments were conducted to verify whether the implemented capsule could identify the duodenum within 3 s. The experiment showed that the identification rate of duodenum was 93% when the velocity of the capsule was less than 1 cm/s. PMID:21134813

  17. 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

  18. Effective treatment of gastrointestinal bleeding with thalidomide - Chances and limitations

    PubMed Central

    Bauditz, Juergen

    2016-01-01

    For more than 50 years bleeding from gastrointestinal angiodysplasias has been treated by hormonal therapy with estrogens and progesterons. After a randomized study finally demonstrated that hormones have no effect on bleeding events and transfusion requirements, therapy has switched to endoscopic coagulation. However, angiodysplasias tend to recur over months to years and endoscopy often has to be repeated for long time periods. Thalidomide, which caused severe deformities in newborn children in the 1960s, is now increasingly used after it was shown to suppress tumor necrosis factor alpha, inhibit angiogenesis and to be also effective for treatment of multiple myeloma. In 2011 thalidomide was proven to be highly effective for treatment of bleeding from gastrointestinal angiodysplasias in a randomized study. Further evidence by uncontrolled studies exists that thalidomide is also useful for treatment of bleeding in hereditary hemorrhagic telangiectasia. In spite of this data, endoscopic therapy remains the treatment of choice in many hospitals, as thalidomide is still notorious for its teratogenicity. However, patients with gastrointestinal bleeding related to angiodysplasias are generally at an age in which women have no child-bearing potential. Teratogenicity is therefore no issue for these elderly patients. Other side-effects of thalidomide like neurotoxicity may limit treatment options but can be monitored safely. PMID:27003992

  19. Effective treatment of gastrointestinal bleeding with thalidomide - Chances and limitations.

    PubMed

    Bauditz, Juergen

    2016-03-21

    For more than 50 years bleeding from gastrointestinal angiodysplasias has been treated by hormonal therapy with estrogens and progesterons. After a randomized study finally demonstrated that hormones have no effect on bleeding events and transfusion requirements, therapy has switched to endoscopic coagulation. However, angiodysplasias tend to recur over months to years and endoscopy often has to be repeated for long time periods. Thalidomide, which caused severe deformities in newborn children in the 1960s, is now increasingly used after it was shown to suppress tumor necrosis factor alpha, inhibit angiogenesis and to be also effective for treatment of multiple myeloma. In 2011 thalidomide was proven to be highly effective for treatment of bleeding from gastrointestinal angiodysplasias in a randomized study. Further evidence by uncontrolled studies exists that thalidomide is also useful for treatment of bleeding in hereditary hemorrhagic telangiectasia. In spite of this data, endoscopic therapy remains the treatment of choice in many hospitals, as thalidomide is still notorious for its teratogenicity. However, patients with gastrointestinal bleeding related to angiodysplasias are generally at an age in which women have no child-bearing potential. Teratogenicity is therefore no issue for these elderly patients. Other side-effects of thalidomide like neurotoxicity may limit treatment options but can be monitored safely. PMID:27003992

  20. Endoscopy and endosurgery of the chelonian reproductive tract.

    PubMed

    Innis, Charles J

    2010-05-01

    The development of endosurgical techniques for chelonians has reduced the need for more invasive approaches such as plastron osteotomy. Surgical access and manipulation of much of the coelomic viscera of chelonians can be accomplished using endoscopy. Endoscopic methods may be used to perform many chelonian reproductive surgical procedures, including oophorectomy, salpingotomy, salpingectomy, gender identification, and removal of ectopic eggs. PMID:20381775

  1. A Quantitative Analysis of Published Skull Base Endoscopy Literature.

    PubMed

    Hardesty, Douglas A; Ponce, Francisco A; Little, Andrew S; Nakaji, Peter

    2016-02-01

    Objectives Skull base endoscopy allows for minimal access approaches to the sinonasal contents and cranial base. Advances in endoscopic technique and applications have been published rapidly in recent decades. Setting We utilized an Internet-based scholarly database (Web of Science, Thomson Reuters) to query broad-based phrases regarding skull base endoscopy literature. Participants All skull base endoscopy publications. Main Outcome Measures Standard bibliometrics outcomes. Results We identified 4,082 relevant skull base endoscopy English-language articles published between 1973 and 2014. The 50 top-cited publications (n = 51, due to articles with equal citation counts) ranged in citation count from 397 to 88. Most of the articles were clinical case series or technique descriptions. Most (96% [49/51])were published in journals specific to either neurosurgery or otolaryngology. Conclusions A relatively small number of institutions and individuals have published a large amount of the literature. Most of the publications consisted of case series and technical advances, with a lack of randomized trials. PMID:26949585

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

    PubMed

    Benkirane, Raja; El Kihal, Latifa; Nabil, Safae; Benchekroun-Belabbs, 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

  3. Fulminant gastrointestinal graft-versus-host disease concomitant with cytomegalovirus infection: Case report and literature review

    PubMed Central

    Okubo, Hidetaka; Nagata, Naoyoshi; Uemura, Naomi

    2013-01-01

    Here, we report a case of fulminant gastrointestinal graft-versus-host disease (GI-GVHD) with cytomegalovirus (CMV) infection in 44-year-old woman. Despite the difficulties associated with the treatment of GI-GVHD and GI-CMV disease, the mucosal findings and the clinical course showed marked improvements during long-term clinical observation. The endoscopic findings were remarkable, with diffuse sloughing mucosa in the stomach and highly active inflammation and deep discrete ulcers throughout the colon. Changes in the CMV quantitative polymerase chain reaction results were correlated with the endoscopic mucosal findings and were useful for assessing the efficacy of the treatment. Although a definite diagnosis of GI-GVHD is generally made by endoscopy with biopsy, the gross appearance of this disease can vary depending on the endoscopy. In this paper, we also conduct a literature review of patients with GI-GVHD. PMID:23382644

  4. 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

  5. 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

  6. 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...

  7. 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.

  8. 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.

  9. Single Cavernous Hemangioma of the Small Bowel Diagnosed by Using Capsule Endoscopy in a Child with Chronic Iron-Deficiency Anemia

    PubMed Central

    Bae, Soo Jin; Hwang, Geol; Kang, Hyun Sik; Song, Hyun Joo; Chang, Weon Young; Maeng, Young Hee

    2015-01-01

    Cavernous hemangiomas of the gastrointestinal tract are extremely rare. In particular, the diagnosis of small bowel hemangiomas is very difficult in children. A 13-year-old boy presented at the outpatient clinic with dizziness and fatigue. The patient was previously diagnosed with iron-deficiency anemia at 3 years of age and had been treated with iron supplements continuously and pure red cell transfusion intermittently. Laboratory tests indicated that the patient currently had iron-deficiency anemia. There was no evidence of gross bleeding, such as hematemesis or bloody stool. Laboratory findings indicated no bleeding tendency. Gastroduodenoscopy and colonoscopy results were negative. To obtain a definitive diagnosis, the patient underwent capsule endoscopy. A purplish stalked mass was found in the jejunum, and the mass was excised successfully. We report of a 13-year-old boy who presented with severe and recurrent iron-deficiency anemia caused by a cavernous hemangioma in the small bowel without symptoms of gastrointestinal bleeding. PMID:26240811

  10. Effect of small bowel preparation with simethicone on capsule endoscopy*

    PubMed Central

    Fang, You-hong; Chen, Chun-xiao; Zhang, Bing-ling

    2009-01-01

    Background: Capsule endoscopy is a novel non-invasive method for visualization of the entire small bowel. The diagnostic yield of capsule endoscopy depends on the quality of visualization of the small bowel mucosa and its complete passage through the small bowel. To date, there is no standardized protocol for bowel preparation before capsule endoscopy. The addition of simethicone in the bowel preparation for the purpose of reducing air bubbles in the intestinal lumen had only been studied by a few investigators. Methods: Sixty-four participants were randomly divided into two groups to receive a bowel preparation of polyethylene glycol (PEG) solution (Group 1) and both PEG solution and simethicone (Group 2). The PEG solution and simethicone were taken the night before and 20 min prior to capsule endoscopy, respectively. Frames taken in the small intestine were examined and scored for luminal bubbles by two professional capsule endoscopists. Gastric emptying time and small bowel transit time were also recorded. Results: Simethicone significantly reduced luminal bubbles both in the proximal and distal small intestines. The mean time proportions with slight bubbles in the proximal and distal intestines in Group 2 were 97.1% and 99.0%, respectively, compared with 67.2% (P<0.001) and 68.8% (P<0.001) in Group 1. Simethicone had no effect on mean gastric emptying time, 32.08 min in Group 2 compared with 30.88 min in Group 1 (P=0.868), but it did increase mean small intestinal transit time from 227.28 to 281.84 min (P=0.003). Conclusion: Bowel preparation with both PEG and simethicone significantly reduced bubbles in the intestinal lumen and improved the visualization of the small bowel by capsule endoscopy without any side effects observed. PMID:19198022

  11. 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

  12. Factors associated with attendance to scheduled outpatient endoscopy

    PubMed Central

    Laiyemo, Adeyinka O.; Williams, Carla D.; Burnside, Clinton; Moghadam, Sepideh; Sanasi-Bhola, Kamla D.; Kwagyan, John; Brim, Hassan; Ashktorab, Hassan; Scott, Victor F.; Smoot, Duane T.

    2015-01-01

    Background Non-attendance of 42% has been reported for outpatient colonoscopy among persons with low socioeconomic status (SES) in an open access system in the United States. Objectives To evaluate attendance to outpatient endoscopy among populations with low SES after in-person consultations with endoscopists prior to scheduling. Methods Retrospectively, we reviewed the endoscopy schedule from September 2009 to August 2010 in an inner city teaching hospital in Washington DC. We identified patients who came for their procedures. We defined non-attendance as when patients did not notify the facility up to 24 hours prior to their scheduled procedures and did not show up . Results A total of 3,304 patients were scheduled for outpatient endoscopy (mean age 55.2 years; 59.5% females). Only 36 (1.1%) patients were uninsured. 716 (21.7%) patients did not show up for their procedures. There were no differences in attendance by age, sex and race. Patients seen in a private endoscopist's office (OR=1.47; 95%CI: 1.07–2.04) were more likely to attend when compared to patients seen in trainees’ continuity clinic. Married patients (OR=1.40; 95%CI: 1.11–1.78) were also more likely to attend. Conversely, Medicaid and uninsured patients were less likely to attend. Restricting our analysis to patients scheduled for only colonoscopy yielded similar results except that patients who were 50 years and older were more likely to attend. Conclusions Our study suggests improved attendance to endoscopy when populations with lower SES undergo prior consultation with an endoscopist. There is a potential to further improve attendance to out-patient endoscopy by directly involving the social support of the patients. PMID:25180285

  13. Endoscopy in patients with diarrhea during treatment with vascular endothelial growth factor receptor tyrosine kinase inhibitors: Is the cause in the mucosa?

    PubMed

    Boers-Sonderen, Marye J; Mulder, Sasja F; Nagtegaal, Iris D; Derikx, Lauranne A A P; Wanten, Geert J A; Mulders, Peter F A; van der Graaf, Winette T A; Hoentjen, Frank; van Herpen, Carla M L

    2016-04-01

    Background Diarrhea is a frequently occurring adverse event during treatment with vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR TKIs) and is mostly accompanied by abdominal cramps, flatulence and pyrosis. These complaints impair quality of life and lead to dose reductions and treatment interruptions. It is hypothesized that the diarrhea might be due to ischemia in bowel mucosa or inflammation, but the exact underlying pathophysiological mechanism of the diarrhea is still unknown. We aimed at exploring the mechanism for diarrhea in these patients by thorough endoscopic and histological assessment. Materials and methods Endoscopies of the upper and lower gastrointestinal (GI) tract in 10 patients with metastatic renal cell carcinoma (mRCC) who developed diarrhea during treatment with VEGFR TKIs were performed. Results Ten patients were included. The results showed endoscopically normal mucosa in the lower GI tract in seven patients without signs of ischemic colitis or inflammation. Gastroduodenoscopy revealed gastro-esophageal reflux disease, bulbitis and/or duodenitis with ulcers in eight patients. In three selected patients with bulbitis/duodenitis additional video capsule endoscopy was performed but revealed no additional intestinal abnormalities. Conclusion We observed frequent mucosal abnormalities in the upper GI tract in VEGFR TKI-treated mRCC patients with diarrhea. Although these abnormalities provide insufficient explanation for the occurrence of diarrhea, we suggest to perform routine upper GI endoscopy in VEGFR TKI-treated patients with GI complaints. PMID:26959411

  14. Video summarization based tele-endoscopy: a service to efficiently manage visual data generated during wireless capsule endoscopy procedure.

    PubMed

    Mehmood, Irfan; Sajjad, Muhammad; Baik, Sung Wook

    2014-09-01

    Wireless capsule endoscopy (WCE) has great advantages over traditional endoscopy because it is portable and easy to use. More importantly, WCE combined with mobile computing ensures rapid transmission of diagnostic data to hospitals and enables off-site senior gastroenterologists to offer timely decision making support. However, during this WCE process, video data are produced in huge amounts, but only a limited amount of data is actually useful for diagnosis. The sharing and analysis of this video data becomes a challenging task due the constraints such as limited memory, energy, and communication capability. In order to facilitate efficient WCE data collection and browsing tasks, we present a video summarization-based tele-endoscopy service that estimates the semantically relevant video frames from the perspective of gastroenterologists. For this purpose, image moments, curvature, and multi-scale contrast are computed and are fused to obtain the saliency map of each frame. This saliency map is used to select keyframes. The proposed tele-endoscopy service selects keyframes based on their relevance to the disease diagnosis. This ensures the sending of diagnostically relevant frames to the gastroenterologist instead of sending all the data, thus saving transmission costs and bandwidth. The proposed framework also saves storage costs as well as the precious time of doctors in browsing patient's information. The qualitative and quantitative results are encouraging and show that the proposed service provides video keyframes to the gastroenterologists without discarding important information. PMID:25037715

  15. Feasibility of full-spectrum endoscopy: Korea’s first full-spectrum endoscopy colonoscopic trial

    PubMed Central

    Song, Jeong-Yeop; Cho, Youn Hee; Kim, Mi A; Kim, Jeong-Ae; Lee, Chun Tek; Lee, Moon Sung

    2016-01-01

    AIM: To evaluate the full-spectrum endoscopy (FUSE) colonoscopy system as the first report on the utility thereof in a Korean population. METHODS: We explored the efficacy of the FUSE colonoscopy in a retrospective, single-center feasibility study performed between February 1 and July 20, 2015. A total of 262 subjects (age range: 22-80) underwent the FUSE colonoscopy for colorectal cancer screening, polyp surveillance, or diagnostic evaluation. The cecal intubation success rate, the polyp detection rate (PDR), the adenoma detection rate (ADR), and the diverticulum detection rate (DDR), were calculated. Also, the success rates of therapeutic interventions were evaluated with biopsy confirmation. RESULTS: All patients completed the study and the success rates of cecal and terminal ileal intubation were 100% with the FUSE colonoscope; we found 313 polyps in 142 patients and 173 adenomas in 95. The overall PDR, ADR and DDR were 54.2%, 36.3%, and 25.2%, respectively, and were higher in males, and increased with age. The endoscopists and nurses involved considered that the full-spectrum colonoscope improved navigation and orientation within the colon. No colonoscopy was aborted because of colonoscope malfunction. CONCLUSION: The FUSE colonoscopy yielded a higher PDR, ADR, DDR than did traditional colonoscopy, without therapeutic failure or complications, showing feasible, effective, and safe in this first Korean trial. PMID:26937150

  16. Duodenal gastrointestinal stromal tumor: From clinicopathological features to surgical outcomes.

    PubMed

    Marano, L; Boccardi, V; Marrelli, D; Roviello, F

    2015-07-01

    Duodenal gastrointestinal tumors represent an extremely rare subset of stromal tumors arising from interstitial cells of Cajal. In the last 30 years the comprehension of the pathophysiology and natural history of this previously misunderstood clinical entity, in association with developments in endoscopy, imaging technology, and immunohistochemistry has resulted in novel diagnostic and treatment approaches. This is a comprehensive review of the current data of the literature on the various aspects of the diagnosis and treatment of these tumors. The duodenum is the less commonly involved site for these tumors in the digestive tract. Endoscopy and computed tomography can usually establish the diagnosis, confirmed by immunohistochemical staining and occasionally molecular genetic analysis. Endoscopic ultrasound with fine needle aspiration has been recently found to be the gold diagnostic standard with high sensitivity and specificity rates, diagnosing GIST in up to 80% of patients. Due to the complex anatomy of the pancreatico-duodenal region optimal therapeutic strategy of duodenal GISTs are challenging. Nevertheless surgical resection with microscopically clear resection margins seems to be the only potentially curative treatment for non-metastatic primary GISTs of the duodenum. Imatinib mesylate plays a key role in the management of GISTs both as neoadjuvant therapy and in patients with recurrent and metastatic disease. Meanwhile, the advances in the comprehension of the pathophysiology and natural history of this previously misunderstood clinical entity as well as the treatment of these tumors may render feasible, in the near future, the advent of newer and more effective treatment options. PMID:25956211

  17. 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

  18. Acute gastrointestinal haemorrhage: the role of the radiologist.

    PubMed

    Kerr, S F; Puppala, S

    2011-05-01

    Acute gastrointestinal (GI) haemorrhage is a frequent and potentially life threatening medical presentation, the management of which depends on more than one speciality. Upper GI haemorrhage is often treated by endoscopic methods, failing which radiological intervention or surgery are the alternative methods of treatment. Radiology is crucial both in the diagnosis and treatment of lower GI haemorrhage, where the role of endoscopy is limited by poor visibility. CT angiography is now the first line investigation of choice and catheter angiography is used as a prelude to intervention. Interventional radiological techniques for treatment include embolisation for both upper and lower GI arterial haemorrhage and transjugular intrahepatic portosystemic shunting for upper GI variceal haemorrhage refractory to endoscopic treatment. PMID:21398684

  19. Current application of confocal endomicroscopy in gastrointestinal disorders.

    PubMed

    Nguyen, Nam Q; Leong, Rupert W L

    2008-10-01

    Confocal endomicroscopy (CEM) is a recent advancement in imaging technology that incorporates a confocal laser microscope into the tip of a flexible endoscope. The 1000-fold magnification and high resolution allows for real time in vivo histology or "virtual biopsies" of the gastrointestinal tract mucosa. CEM has the capability to instantaneously diagnose intra-epithelial neoplasia during endoscopy, alone or in combination with a "red-flag" technique, such as chromoendoscopy. Therefore, there is clinical utility in the surveillance or diagnosis of Barrett's esophagus, gastric intestinal metaplasia and cancer, longstanding ulcerative colitis, and colonic neoplasia. Furthermore, CEM also appears to be useful in the evaluation of coeliac disease, microscopic colitis, and in diagnosing Helicobacter pylori chronic gastritis. This review examines the current available data on the utility of this new technology in clinical gastroenterology and its potential impact in the future. PMID:18761561

  20. 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

  1. [Gastroduodenal invagination and upper gastrointestinal hemorrhage secondary to gastric lipoma].

    PubMed

    Ortiz de Solrzapo Aurusa, F J; Yarritu Viilanueva, C; Ruiz Adrados, E; Obelar Bernal, L; Acebo Garca, M; Alvarez Rabanal, R; Viguri Daz, A

    1997-01-01

    A patient with a history of epigastric abdominal pain and occasional vomiting is presented. During the study of an upper gastrointestinal hemorrhage, gastroduodenal invagination secondary to a gastric lipoma of 5.5 cm in diameter was diagnosed. Upper digestive endoscopy and gastroduodenal study were not diagnostic. Echography detected a duodenal mass suspect of invagination. CAT diagnosed the lipomatous nature of the tumor. Surgery confirmed gastroduodenal invagination with a gastric lipoma with ulceration in the mucosa which covered the same. Enucleation of the tumor was performed. Histologic study established the diagnosis of gastric lipoma. The post operative period was uneventful. A review of the clinical, diagnostic and therapeutic aspects of this rare disease is reported. PMID:9296846

  2. 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.

  3. [Evaluation of the gastrotoxicity of anti-inflammatory drugs: contribution of general registries of digestive endoscopy].

    PubMed

    Le Jeunne, C L; La Batide Alanore, S; Hugues, F C; Barbier, J P

    1994-01-01

    The evaluation of the rate of gastroduodenal toxicity of anti inflammatory drugs is a difficult problem. We tried to analyse that question by studying the general endoscopic registers of the Gastro-Enterologic department of the hospital. This retrospective study concerns 2,945 endoscopies performed during the year 1988 and 1992 randomly chosen among the last 5 years. 992 results show injuries suggestive of non steroidal anti inflammatory drugs (NSAID) toxicity, however only in 65 cases the potential role of an anti inflammatory drug is mentioned: 36 men and 29 women, mean age: 50.6 +/- 19.6 years. Concerning the drugs, only the pharmacological classes they belong to are mentioned except for Aspirin. Acetyl salicylate acid 7 cases, NSAIDS 36 and Steroids 22. In the drug group 63% of injuries are located to the stomach (ulcers 13%, gastritis 50%), 37% to the duodenum (19% ulcers, 18% duodenitis). Compared to the groups with the same kind of injuries, but without any mention of drugs, there are no statistical difference in the proportion of ulcers. Aging and sex are not influent in our results on the genesis of drug induced ulcers. These results must be discussed because a lot of datas are missing in the registers and so the number of patients taking drugs is probably underestimated. This means that unless a prospective study is held with someone enquiring for all the risk factors, the study of the general endoscopic registers is not a good way to estimate gastrointestinal damages due to drugs. PMID:7855757

  4. 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

  5. New vision in video capsule endoscopy: current status and future directions.

    PubMed

    Fisher, Laurel R; Hasler, William L

    2012-07-01

    Now, more than 10 years after the approval of video capsule endoscopy (VCE), the technology has become an essential component in the management of several clinical conditions. Currently, two capsules are approved in the USA for visualizing the small bowel mucosa, one capsule is authorized for oesophageal assessment and several others are in use or under evaluation worldwide. New investigations have focused on optical improvements, advances in intestinal cleansing and risk reduction strategies to optimize VCE methodologies in clinical care. Established indications diagnosed using VCE include unexplained gastrointestinal bleeding, small bowel Crohn's disease (in adults and children >10 years old), localization of small bowel tumours and a broad range of miscellaneous abnormalities. Investigations are ongoing to determine the utility of VCE in colon cancer screening, assessment of oesophageal disorders and diagnosis of coeliac disease. Active research is in progress into ways to improve the efficacy of VCE recording interpretation, prolong imaging time and further enhance optics and imaging methods. To expand the potential utility of VCE, novel devices that can manoeuvre within or insufflate the gut lumen, tag or biopsy suspect lesions, or target drug delivery to specific sites are in development. To facilitate these advances, consortia have been organized to promote innovative VCE technologies. PMID:22565098

  6. GISentinel: a software platform for automatic ulcer detection on capsule endoscopy videos

    NASA Astrophysics Data System (ADS)

    Yi, Steven; Jiao, Heng; Meng, Fan; Leighton, Jonathon A.; Shabana, Pasha; Rentz, Lauri

    2014-03-01

    In this paper, we present a novel and clinically valuable software platform for automatic ulcer detection on gastrointestinal (GI) tract from Capsule Endoscopy (CE) videos. Typical CE videos take about 8 hours. They have to be reviewed manually by physicians to detect and locate diseases such as ulcers and bleedings. The process is time consuming. Moreover, because of the long-time manual review, it is easy to lead to miss-finding. Working with our collaborators, we were focusing on developing a software platform called GISentinel, which can fully automated GI tract ulcer detection and classification. This software includes 3 parts: the frequency based Log-Gabor filter regions of interest (ROI) extraction, the unique feature selection and validation method (e.g. illumination invariant feature, color independent features, and symmetrical texture features), and the cascade SVM classification for handling "ulcer vs. non-ulcer" cases. After the experiments, this SW gave descent results. In frame-wise, the ulcer detection rate is 69.65% (319/458). In instance-wise, the ulcer detection rate is 82.35%(28/34).The false alarm rate is 16.43% (34/207). This work is a part of our innovative 2D/3D based GI tract disease detection software platform. The final goal of this SW is to find and classification of major GI tract diseases intelligently, such as bleeding, ulcer, and polyp from the CE videos. This paper will mainly describe the automatic ulcer detection functional module.

  7. 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

  8. 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

  9. Gastrointestinal stromal tumor

    PubMed Central

    Yue, Changjun

    2012-01-01

    Gastrointestinal stromal tumor has received a lot of attention over the last 10 years due to its unique biologic behavior, clinicopathological features, molecular mechanisms, and treatment implications. GIST is the most common mesenchymal neoplasm in the gastrointestinal tract and has emerged from a poorly understood and treatment resistant neoplasm to a well-defined tumor entity since the discovery of particular molecular abnormalities, KIT and PDGFRA gene mutations. The understanding of GIST biology at the molecular level promised the development of novel treatment modalities. Diagnosis of GIST depends on the integrity of histology, immunohistochemistry and molecular analysis. The risk assessment of the tumor behavior relies heavily on pathological evaluation and significantly impacts clinical management. In this review, historic review, epidemiology, pathogenesis and genetics, diagnosis, role of molecular analysis, prognostic factor and treatment strategies have been discussed. PMID:22943011

  10. Blindness following gastrointestinal haemorrhage.

    PubMed

    Mofredj, A; Curan, D; d'Arondel, C; Laribi, K; Coutarel, P; Cassaz, C; Devergie, B; Cadranel, J F

    2000-12-01

    Loss of vision is a rare but well known complication of distant and recurrent haemorrhage. It shares a poor prognosis, with only 10-14% of cases likely to make a complete recovery. Visual symptoms, due to ischaemic anterior optic neuropathy, vary from blurred vision to complete loss of vision in one or both eyes. The pathogenesis of such ischaemia remains unclear. Gastrointestinal bleeding seems to be the leading cause of loss of vision secondary to haemorrhage. However, complete and permanent blindness following gastrointestinal bleeding has rarely been reported. We report the case of a 51 -year-old woman who complained of complete blindness following blood loss, secondary to peptic ulcer, and discuss the pathogenesis of such a complication. PMID:11192325

  11. [Microbiota and gastrointestinal diseases].

    PubMed

    Polanco Allu, 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

  12. 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

  13. Orexins and gastrointestinal functions.

    PubMed

    Baccari, M C

    2010-03-01

    Orexin A (OXA) and orexin B (OXB) are recently discovered neuropeptides that appear to play a role in various distinct functions such as arousal and the sleep-wake cycle as well as on appetite and regulation of feeding and energy homeostasis. Orexins were first described as neuropeptides expressed by a specific population of neurons in the lateral hypothalamic area, a region classically implicated in feeding behaviour. Orexin neurons project to numerous brain regions, where orexin receptors have been shown to be widely distributed: both OXA and OXB act through two subtypes of receptors (OX1R and OX2R) that belong to the G protein-coupled superfamily of receptors. Growing evidence indicates that orexins act in the central nervous system also to regulate gastrointestinal functions: animal studies have indeed demonstrated that centrally-injected orexins or endogenously released orexins in the brain stimulates gastric secretion and influence gastrointestinal motility. The subsequent identification of orexins and their receptors in the enteric nervous system (including the myenteric and the submucosal plexuses) as well as in mucosa and smooth muscles has suggested that these neuropeptides may also play a local action. In this view, emerging studies indicate that orexins also exert region-specific contractile or relaxant effects on isolated gut preparations. The aim of the proposed review is to summarize both centrally- and peripherally-mediated actions of orexins on gastrointestinal functions and to discuss the related physiological role on the basis of the most recent findings. PMID:20353399

  14. 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

  15. Is Surveillance Endoscopy Necessary after Colectomy in Ulcerative Colitis?

    PubMed Central

    Shuno, Yasutaka; Hata, Keisuke; Sunami, Eiji; Shinozaki, Masaru; Kawai, Kazushige; Kojima, Tetsu; Tsurita, Giichiro; Hiyoshi, Masaya; Tsuno, Nelson H.; Kitayama, Joji; Nagawa, Hirokazu

    2011-01-01

    The role of surveillance endoscopic followup in colectomized patients with long standing total colitis is controversial. Here, we aimed to clarify its usefulness for the early detection of dysplasia and cancer in this group of patients. Ninety-seven colectomised UC patients followedup by surveillance endoscopy were retrospectively investigated by reviewing the pathological reports. Patients had received either subtotal colectomy and ileo-rectal anastomosis (IRA) or total proctocolectomy and ileal anal anastomosis (IPAA). Definite dysplasia was diagnosed in 4 patients, who had received IRA; among them, 2 were carcinoma with submucosal invasion, and one was a high-grade dysplasia. Postoperative surveillance endoscopy is useful for the detection of early cancer in the remaining colonic mucosa of UC patients, and those receiving IRA, in which rectal mucosa is left intact, would be good candidates. However, its effectiveness for patients receiving IPAA, in which the rectal mucosa is resected, needs further investigation. PMID:21991515

  16. Small bowel tumors detected and missed during capsule endoscopy: Single center experience

    PubMed Central

    Zagorowicz, Edyta S; Pietrzak, Anna M; Wronska, Ewa; Pachlewski, Jacek; Rutkowski, Piotr; Kraszewska, Ewa; Regula, Jaroslaw

    2013-01-01

    AIM: To characterize small bowel (SB) tumors detected by capsule endoscopy (CE), and identify missed tumors. METHODS: The study included 145 consecutive patients in whom 150 CEs were performed. Following CE, the medical records of the study population were reviewed. Results of double- or single-balloon enteroscopy performed after CE and the results of surgery in all patients operated on were retrieved. The patients were contacted through telephone interviews or postal mail. In addition, the national cancer registry and the polish clinical gastrointestinal stromal tumor (GIST) Registry were searched to identify missed neoplasms. RESULTS: Indications for CE included overt and occult obscure gastrointestinal bleeding (n = 81, 53.7%), anemia (n = 19, 12.7%), malabsorption (n = 18, 12%), abnormal CB follow through (n = 9, 6%), abdominal pain (n = 7, 5%), celiac disease (n = 5, 3%), neuroendocrine tumor (n = 3, 2%), Crohns disease (n = 2, < 2%), Peutz-Jeghers syndrome (n = 2, < 2%), other polyposes (n = 2, < 2%), and diarrhea (n = 2, < 2%). The capsule reached the colon in 115 (76.6%) examinations. In 150 investigations, CE identified 15 SB tumors (10%), 14 of which were operated on or treated endoscopically. Malignancies included metastatic melanoma (n = 1), adenocarcinoma (n = 2), and GIST (n = 3). Benign neoplasms included dysplastic Peutz-Jeghers polyps (n = 4). Non-neoplastic masses included venous malformation (n = 1), inflammatory tumors (n = 2), and a mass of unknown histology (n = 1). During the follow-up period, three additional SB tumors were found (2 GISTs and one mesenteric tumor of undefined nature). The National Cancer Registry and Polish Clinical GIST Registry revealed no additional SB neoplasms in the post-examination period (follow-up: range 4.2-102.5 mo, median 39 mo). The sensitivity of CE for tumor detection was 83.3%, and the negative predictive value was 97.6%. The specificity and positive predictive value were both 100%. CONCLUSION: Neoplasms may be missed by CE, especially in the proximal SB. In overt obscure gastrointestinal bleeding, complementary endoscopic and/or radiologic diagnostic tests are indicated. PMID:24379629

  17. 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

  18. A large-sized phytobezoar located on the rare site of the gastrointestinal tract.

    PubMed

    Yang, Jee Eun; Ahn, Ji Yong; Kim, Gi Ae; Kim, Ga Hee; Yoon, Da Lim; Jeon, Sung Jin; Jung, Hwoon-Yong; Kim, Jin-Ho

    2013-07-01

    Bezoars are concretions of undigested material and are most often observed in the stomach. They can occur at any site in the gastrointestinal tract; however, duodenal localization is very rare. We report the case of a 71-year-old male who had undergone subtotal gastrectomy with gastroduodenostomy and experienced severe epigastric discomfort, abdominal pain, and vomiting for a few days. An approximately 78 cm-sized mass was found on an abdominal computed tomography scan. On following endoscopy, a large bezoar was revealed in the duodenum and was removed using an endoscopic removal technique, assisted by a large amount of Coca-Cola infusion. PMID:23964339

  19. [Gastroesophageal reflux disease in children: the role of endoscopy].

    PubMed

    Shcherbakov, P L; Zablodski?, A N

    2014-01-01

    The article deals with the problem of modern diagnosis of gastroesophageal reflux disease in children with the use of modern techniques used in endoscopy. This article provides an analysis of the current literature on the efficacy of diagnosis of various manifestations of gastroesophageal reflux disease in children of different ages. The data on the benefits of the various diagnostic techniques and endoscopic techniques. Article illyustrirovavana endofotografiyami original authors. PMID:25518460

  20. Role of capsule endoscopy in inflammatory bowel disease

    PubMed Central

    Kopylov, Uri; Seidman, Ernest G

    2014-01-01

    Videocapsule endoscopy (VCE) has revolutionized our ability to visualize the small bowel mucosa. This modality is a valuable tool for the diagnosis of obscure small bowel Crohns disease (CD), and can also be used for monitoring of disease activity in patients with established small-bowel CD, detection of complications such as obscure bleeding and neoplasms, evaluation of response to anti-inflammatory treatment and postoperative recurrence following small bowel resection. VCE could also be an important tool in the management of patients with unclassified inflammatory bowel disease, potentially resulting in reclassification of these patients as having CD. Reports on postoperative monitoring and evaluation of patients with ileal pouch-anal anastomosis who have developed pouchitis have recenty been published. Monitoring of colonic inflammatory activity in patients with ulcerative colitis using the recently developed colonic capsule has also been reported. Capsule endoscopy is associated with an excellent safety profile. Although retention risk is increased in patients with small bowel CD, this risk can be significanty decreased by a routine utilization of a dissolvable patency capsule preceding the ingestion of the diagnostic capsule. This paper contains an overview of the current and future clinical applications of capsule endoscopy in inflammatory bowel disease. PMID:24574792

  1. Role of capsule endoscopy in inflammatory bowel disease.

    PubMed

    Kopylov, Uri; Seidman, Ernest G

    2014-02-01

    Videocapsule endoscopy (VCE) has revolutionized our ability to visualize the small bowel mucosa. This modality is a valuable tool for the diagnosis of obscure small bowel Crohn's disease (CD), and can also be used for monitoring of disease activity in patients with established small-bowel CD, detection of complications such as obscure bleeding and neoplasms, evaluation of response to anti-inflammatory treatment and postoperative recurrence following small bowel resection. VCE could also be an important tool in the management of patients with unclassified inflammatory bowel disease, potentially resulting in reclassification of these patients as having CD. Reports on postoperative monitoring and evaluation of patients with ileal pouch-anal anastomosis who have developed pouchitis have recenty been published. Monitoring of colonic inflammatory activity in patients with ulcerative colitis using the recently developed colonic capsule has also been reported. Capsule endoscopy is associated with an excellent safety profile. Although retention risk is increased in patients with small bowel CD, this risk can be significanty decreased by a routine utilization of a dissolvable patency capsule preceding the ingestion of the diagnostic capsule. This paper contains an overview of the current and future clinical applications of capsule endoscopy in inflammatory bowel disease. PMID:24574792

  2. Gesture analysis and immersive visualization for virtual endoscopy

    NASA Astrophysics Data System (ADS)

    Englmeier, Karl-Hans; Siebert, Markus; Bruening, Roland; Scheidler, Juergen; Reiser, Maximilian

    2001-05-01

    To improve diagnosis and therapy planning with additional information in an easy to use and fast way a virtual endoscopy system was developed. From a technical viewpoint, virtual endoscopy can be generated using image sequencies acquired with CT or MRI. It requires appropriate software for image processing and endoluminal visualization and hardware capabilities for immersive virtual reality. This includes that firstly the intuitive user interaction is supported by data gloves, position tracking systems and stereo display devices. Secondly the virtual environment requires real time visualization supported by high end graphic engines to enable the continuous operation and interaction. To enable the endoluminal view, the precise segmentation of the inner lumina like tracheobronchial tree, inner ear or vessels is necessary. In addition to this pathological findings must be defined. We use automatic segmentation techniques like volume growing as well as semiautomatic techniques like deformable models in a virtual environment. After that the surfaces of the segmented volume are reconstructed. This is the basis for our multidimensional display system which visualizes volumes, surfaces and computation results simultaneously. Our developed method of virtual endoscopy enables the interactive, immersive and endoluminal inspection of complex anatomical structures. It is based on intensive image processing like 3D-segmentation and a so called hybrid technique which displays all the information by volume and surface rendering. The system was applied on virtual bronchoscopy, colonoscopy, angioscopy as well as endoluminal representation of the inner ear.

  3. 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

  4. Gastrointestinal motility disorders and acupuncture.

    PubMed

    Yin, Jieyun; Chen, Jiande D Z

    2010-10-28

    During the last decades, numerous studies have been performed to investigate the effects and mechanisms of acupuncture or electroacupuncture (EA) on gastrointestinal motility and patients with functional gastrointestinal diseases. A PubMed search was performed on this topic and all available studies published in English have been reviewed and evaluated. This review is organized based on the gastrointestinal organ (from the esophagus to the colon), components of gastrointestinal motility and the functional diseases related to specific motility disorders. It was found that the effects of acupuncture or EA on gastrointestinal motility were fairly consistent and the major acupuncture points used in these studies were ST36 and PC6. Gastric motility has been mostly studied, whereas much less information is available on the effect of EA on small and large intestinal motility or related disorders. A number of clinical studies have been published, investigating the therapeutic effects of EA on a number of functional gastrointestinal diseases, such as gastroesophageal reflux, functional dyspepsia and irritable bowel syndrome. However, the findings of these clinical studies were inconclusive. In summary, acupuncture or EA is able to alter gastrointestinal motility functions and improve gastrointestinal motility disorders. However, more studies are needed to establish the therapeutic roles of EA in treating functional gastrointestinal diseases. PMID:20363196

  5. Nutrition and gastrointestinal disorders.

    PubMed

    Lin, S K; Lambert, J R; Wahlqvist, M L

    1992-03-01

    The gastrointestinal tract, including the liver and pancreas, is a complex system whose function is to process a wide range of nutrient and other products enabling their absorption as well as detoxification and excretion. During the process, food is converted into energy and into other substances that are used by cells throughout the entire body. Many diseases can affect the various organs of the gastrointestinal (GI) system and diet plays a relatively minor role in the onset of such GI diseases. Recently it has become clear that glutamine, a 'non-essential' amino acid, is important in the maintenance of intestinal mucosal metabolism, structure and function. Dietary fibre has complicated properties including trophic effects on intestinal mucosa, volatile fatty acid production, alteration of bacterial flora and faecal bacterial mass and change in faecal bile acids. Gastrointestinal disease many result from deficiency or excess of specific nutrients in normal individuals. In allergic or susceptible subjects, diseases such as food allergy, disaccharidase intolerance and gluten sensitive enteropathy may occur with intake of normal daily requirements. In genetically susceptible individuals, specific nutrients have been linked, based on epidemiological studies and animal experimentation, to carcinoma of the stomach (high starch, high nitrate foods and smoked meats) and colon (low fibre, high fat, low vitamin A). A recent Australian multi-centre polyp prevention project has recruited subjects with adenomatous polyps cleared at colonoscopy. Subjects were randomised to receive high fibre, low fat, b -carotene or a combination of these and compared to an unchanged control group at 2-yearly follow up colonoscopy. Low fat and high fibre were not protective against polyp development; however, b -carotene ingestion was associated with an increased risk. Duodenal ulcer disease is multifactorial with gastric acid and H. pylori induced gastroduodenitis playing important aetiological roles. Protection is afforded to individuals with a higher unsaturated fatty acid and lower refined sugar intakes. Treatment of gastrointestinal disease may require dietary modifications or, if the gut is not functioning adequately, nutritional support via the parenteral route. In subjects with inflammatory bowel disease and short gut syndrome replacement of specific nutrients may be required particularly calcium, magnesium, zinc, iron, and vitamins B12, folate, D and A. Controversy still exists as to the role of parenteral and enteral nutrition as primary therapy for inflammatory bowel disease. PMID:24323003

  6. Lower Gastrointestinal Hemorrhage.

    PubMed

    Qayed, Emad; Dagar, Gaurav; Nanchal, Rahul S

    2016-04-01

    Lower gastrointestinal bleeding (LGIB) is a frequent reason for hospitalization especially in the elderly. Patients with LGIB are frequently admitted to the intensive care unit and may require transfusion of packed red blood cells and other blood products especially in the setting of coagulopathy. Colonoscopy is often performed to localize the source of bleeding and to provide therapeutic measures. LGIB may present as an acute life-threatening event or as a chronic insidious condition manifesting as iron deficiency anemia and positivity for fecal occult blood. This article discusses the presentation, diagnosis, and management of LGIB with a focus on conditions that present with acute blood loss. PMID:27016165

  7. Assessment of gastrointestinal involvement.

    PubMed

    Clements, P J; Becvar, R; Drosos, A A; Ghattas, L; Gabrielli, A

    2003-01-01

    The purpose of this paper is to identify a list of clinical, laboratory and instrumental tools suitable to assess the presence of gastrointestinal involvement in SSc patients to be included in clinical investigational studies. The pertinent literature was reviewed to select those variables which have been demonstrated to be valid, reliable and feasible. A minimal core set of variables has been identified to be used in clinical investigation for the assessment of esophagus, stomach, small intestine, colon and anorectum involvement in scleroderma patients. PMID:12889216

  8. Magnetically controllable gastrointestinal steering of video capsules.

    PubMed

    Carpi, Federico; Kastelein, Nathan; Talcott, Michael; Pappone, Carlo

    2011-02-01

    Wireless capsule endoscopy (WCE) allows for comfortable video explorations of the gastrointestinal (GI) tract, with special indication for the small bowel. In the other segments of the GI tract also accessible to probe gastroscopy and colonscopy, WCE still exhibits poorer diagnostic efficacy. Its main drawback is the impossibility of controlling the capsule movement, which is randomly driven by peristalsis and gravity. To solve this problem, magnetic maneuvering has recently become a thrust research area. Here, we report the first demonstration of accurate robotic steering and noninvasive 3-D localization of a magnetically enabled sample of the most common video capsule (PillCam, Given Imaging Ltd, Israel) within each of the main regions of the GI tract (esophagus, stomach, small bowel, and colon) in vivo, in a domestic pig model. Moreover, we demonstrate how this is readily achievable with a robotic magnetic navigation system (Niobe, Stereotaxis, Inc, USA) already used for cardiovascular clinical procedures. The capsule was freely and safely moved with omnidirectional steering accuracy of 1, and was tracked in real time through fluoroscopic imaging, which also allowed for 3-D localization with an error of 1 mm. The accuracy of steering and localization enabled by the Stereotaxis system and its clinical accessibility world wide may allow for immediate and broad usage in this new application. This anticipates magnetically steerable WCE as a near-term reality. The instrumentation should be used with the next generations of video capsules, intrinsically magnetic and capable of real-time optical-image visualization, which are expected to reach the market soon. PMID:20952324

  9. Pancreatic Aetiology for Massive Upper Gastrointestinal Haemorrhage in Pregnancy

    PubMed Central

    Zaborowski, Alexandra; Walsh, Siun M.; Ravi, Narayanasamy; Reynolds, John V.

    2016-01-01

    We present herein what we believe is the first reported case of massive upper gastrointestinal bleeding in pregnancy due to a pancreatic neuroendocrine tumour causing left sided portal hypertension. A 37-year-old 27-week pregnant female presented with massive haematemesis and melaena requiring transfusion of 10 units of red cell concentrate. Gastric varices were evident at endoscopy. An MRI revealed a large mass infiltrating the pancreatic tail and spleen with massive upper abdominal varix formation secondary to splenic vein invasion. A caesarean section was performed, followed by a radical en bloc partial pancreatectomy and splenectomy with resection of the fundus of the stomach and ligation of gastric and splenic varices. Her postoperative course was uncomplicated. Histology revealed a well differentiated grade 2 neuroendocrine tumour with final staging of T4N0. This case highlights an infrequently encountered cause of massive gastrointestinal bleeding. Diagnosis and management of pancreatic neuroendocrine tumours, due to their rarity and variable clinical presentation, can be challenging particularly in the setting of pregnancy where the wellbeing of a second patient must also be considered. A multidisciplinary approach with input from obstetricians and general surgeons is required when deciding optimum management, while also taking into account the patient's preferences.

  10. [A modified monopolar electrocoagulation probe for endoscopic treatment of gastrointestinal hemorrhage].

    PubMed

    Reimold, W V

    1991-06-01

    A modified monopolar electrocoagulation probe for endoscopic treatment of gastrointestinal bleedings in special situations is described. The tip of the active electrode may be moved foreward or drawn back into a teflon catheter. Thereby, blood clots are removed from the tip of the probe. The device is easy to use, reliable in emergency endoscopies and can be employed with conventional high-frequency diathermy instruments. The probe is inexpensive. 49 patients with active gastrointestinal bleedings according to Forrest Ib were treated. In 40/49 patients permanent hemostasis could be achieved. In 4/49 patients recurrent bleedings were controlled after repeated electro-coagulation. 4/49 patients needed elective operation, one patient emergency operation. Complications by application of the described monopolar electrocoagulation probe did not occur. The area of necrosis according to electrocoagulation was small. PMID:1926958

  11. In Vivo Endoscopic Imaging of Ancylostomiasis-Induced Gastrointestinal Bleeding: Clinical and Biological Profiles

    PubMed Central

    Barakat, Maha; Ibrahim, Naglaa; Nasr, Ahmed

    2012-01-01

    Little data are available regarding the association of ancylostomiasis with overt gastrointestinal bleeding. This 6-year retrospective study describes the clinical and biological profiles of unexpectedly identified ancylostomiasis in a 4-month-old baby and four adults; they presented with melena and were referred for urgent diagnostic gastrointestinal endoscopy, which confirmed numerous small intestine injuries with surrounding blood pools caused by Ancylostoma duodenale worms. Gastric erosions were also encountered in one patient. Uniquely, worm biological activities were recorded live in vivo, including mucosal invasion through a vigorous, rapid piercing process, repeated bloodsucking habits, and gut appearance during the stages of feeding, digestion, and excretion in male and female worms. In conclusion, ancylostomiasis-induced melena may occur in all ages from infants to the elderly. Worm bloodfeeding occurs after quick mucosal piercing, with blood loss being aggravated by a repeated feeding behavior. After treatment is started, bleeding stops rapidly in response to anthelmintic therapy. PMID:22869629

  12. Osteoporosis in Gastrointestinal Diseases.

    PubMed

    Krela-Kaźmierczak, Iwona; Szymczak, Aleksandra; Łykowska-Szuber, Liliana; Eder, Piotr; Linke, Krzysztof

    2016-01-01

    Secondary osteoporosis occurs as an isolated pathology or co-exists with types I and II osteoporosis. The gastroenterologist may come across osteoporosis or osteopenia in a patient with a gastrointestinal disease. This is often a young patient in whom investigations should be carried out and appropriate treatment initiated, aimed at preventing bone fractures and the formation of the best peak bone mass. Osteoporosis occurs in patients with the following conditions: Crohn's disease, ulcerative colitis, celiac disease, post gastrectomy patients, patients with short bowel syndrome, chronic hepatitis and cirrhosis, treated with steroids (steroid-induced osteoporosis) and patients using proton pump inhibitors chronically (state of achlorhydria). It is therefore necessary to approve a list of risk factors of secondary osteoporosis, the presence of which would be an indication for screening for osteoporosis, including a DXA study and the development of a separate algorithm for the therapeutic management of secondary osteoporosis accompanying gastrointestinal diseases, especially in premenopausal young women and young men, because there are currently no registered drugs with proven antifracture activity for this group of patients. PMID:26935513

  13. 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

  14. Endoscopic Findings and Clinical Outcomes in Ventricular Assist Device Recipients with Gastrointestinal Bleeding

    PubMed Central

    Elmunzer, B. Joseph; Padhya, Kunjali T.; Lewis, Jason J.; Rangnekar, Amol S.; Saini, Sameer D.; Eswaran, Shanti L.; Scheiman, James M.; Pagani, Francis D.; Haft, Jonathan W.; Waljee, Akbar K.

    2015-01-01

    Background Gastrointestinal bleeding (GIB) is an important clinical problem in recipients of ventricular assist devices (VAD), although data pertaining to the endoscopic evaluation and management of this complication are limited in the medical literature. Aims We sought to identify the most common endoscopic findings in VAD recipients with GIB, and to better define the diagnostic and therapeutic utility of endosopy for this patient population. Methods Twenty-six subjects with VAD and overt GIB were retrospectively identified. Clinical and endoscopic data were abstracted for each subject on to standardized forms in duplicate and independent fashion. Raw data and descriptive statistics were reported. Results Non-peptic vascular lesions were the most common cause of GIB. A definitive cause of bleeding was identified by endoscopy in almost 60% of subjects. Endoscopic hemostasis was achieved in 14/15 patients in whom bleeding did not stop spontaneously. Rebleeding occurred in 50% of subjects and was successfully retreated or stopped spontaneously in all cases. Colonoscopy did not establish a definitive diagnosis or deliver hemostatic therapy in any case. Conclusions Vascular malformations account for the overwhelming majority of bleeding lesions in VAD patients with GIB. Endoscopy seems to be a safe and effective tool for diagnosing, risk stratifying, and treating this patient population, although multiple endoscopies may be necessary before therapeutic success, and the incidence of rebleeding is high. A prospective multi-center registry is necessary to establish evidence-based management algorithms for VAD recipients with GIB. PMID:21792619

  15. 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

  16. 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 bloodbrain 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 braingut 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 braingut 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

  17. [Artificial nutrition in gastrointestinal diseases].

    PubMed

    Hamvas, Jzsef

    2014-12-21

    The association between nutrition and intestinal function is based on facts. The main function of the gut is to digest and absorb nutrients in order to maintain life. Consequently, chronic gastrointestinal diseases commonly result in malnutrition and increased morbidity and mortality. Chronic malnutrition impairs digestive and absorptive function. Parenteral and enteral nutritions are effective therapeutic modalities in several diseases. In cases of gastrointestinal malfunctions, nutrition has a direct therapeutic role. The benefit of nutrition therapy is similar to medical treatment in patients with pancreatitis, Crohn disease, hepatic failure, and in those with gastrointestinal fistulas. Nutrition has both supportive and therapeutic roles in the management of chronic gastrointestinal diseases. With the development of modern techniques of nutritional support, the morbidity and mortality associated with chronic gastrointestinal diseases can be reduced. PMID:25497153

  18. Spectral imaging using forward-viewing spectrally encoded endoscopy

    PubMed Central

    Zeidan, Adel; Yelin, Dvir

    2016-01-01

    Spectrally encoded endoscopy (SEE) enables miniature, small-diameter endoscopic probes for minimally invasive imaging; however, using the broadband spectrum to encode space makes color and spectral imaging nontrivial and challenging. By careful registration and analysis of image data acquired by a prototype of a forward-viewing dual channel spectrally encoded rigid probe, we demonstrate spectral and color imaging within a narrow cylindrical lumen. Spectral imaging of calibration cylindrical test targets and an ex-vivo blood vessel demonstrates high-resolution spatial-spectral imaging with short (10 μs/line) exposure times. PMID:26977348

  19. Spectral imaging using forward-viewing spectrally encoded endoscopy.

    PubMed

    Zeidan, Adel; Yelin, Dvir

    2016-02-01

    Spectrally encoded endoscopy (SEE) enables miniature, small-diameter endoscopic probes for minimally invasive imaging; however, using the broadband spectrum to encode space makes color and spectral imaging nontrivial and challenging. By careful registration and analysis of image data acquired by a prototype of a forward-viewing dual channel spectrally encoded rigid probe, we demonstrate spectral and color imaging within a narrow cylindrical lumen. Spectral imaging of calibration cylindrical test targets and an ex-vivo blood vessel demonstrates high-resolution spatial-spectral imaging with short (10 μs/line) exposure times. PMID:26977348

  20. Colon capsule endoscopy: Current status and future directions

    PubMed Central

    Tal, Andrea O; Vermehren, Johannes; Albert, Jrg G

    2014-01-01

    Colon capsule endoscopy (CCE; PillCam Colon; Given Imaging; Yoqneam, Israel) is a minimally invasive wireless technique for the visualization of the colon. With the recent introduction of the second generation colon capsule the diagnostic accuracy of CCE for polyp detection has significantly improved and preliminary data suggest it may be useful to monitor mucosal inflammation in patients with inflammatory bowel disease. Limitations include the inability to take biopsies and the procedural costs. However, given the potentially higher acceptance within an average risk colorectal cancer (CRC) screening population, its usefulness as a screening tool with regard to CRC prevention should be further evaluated. PMID:25469027

  1. Colon capsule endoscopy: current status and future directions.

    PubMed

    Tal, Andrea O; Vermehren, Johannes; Albert, Jrg G

    2014-11-28

    Colon capsule endoscopy (CCE; PillCam Colon; Given Imaging; Yoqneam, Israel) is a minimally invasive wireless technique for the visualization of the colon. With the recent introduction of the second generation colon capsule the diagnostic accuracy of CCE for polyp detection has significantly improved and preliminary data suggest it may be useful to monitor mucosal inflammation in patients with inflammatory bowel disease. Limitations include the inability to take biopsies and the procedural costs. However, given the potentially higher acceptance within an average risk colorectal cancer (CRC) screening population, its usefulness as a screening tool with regard to CRC prevention should be further evaluated. PMID:25469027

  2. Automatic small bowel tumor diagnosis by using multi-scale wavelet-based analysis in wireless capsule endoscopy images

    PubMed Central

    2012-01-01

    Background Wireless capsule endoscopy has been introduced as an innovative, non-invasive diagnostic technique for evaluation of the gastrointestinal tract, reaching places where conventional endoscopy is unable to. However, the output of this technique is an 8 hours video, whose analysis by the expert physician is very time consuming. Thus, a computer assisted diagnosis tool to help the physicians to evaluate CE exams faster and more accurately is an important technical challenge and an excellent economical opportunity. Method The set of features proposed in this paper to code textural information is based on statistical modeling of second order textural measures extracted from co-occurrence matrices. To cope with both joint and marginal non-Gaussianity of second order textural measures, higher order moments are used. These statistical moments are taken from the two-dimensional color-scale feature space, where two different scales are considered. Second and higher order moments of textural measures are computed from the co-occurrence matrices computed from images synthesized by the inverse wavelet transform of the wavelet transform containing only the selected scales for the three color channels. The dimensionality of the data is reduced by using Principal Component Analysis. Results The proposed textural features are then used as the input of a classifier based on artificial neural networks. Classification performances of 93.1% specificity and 93.9% sensitivity are achieved on real data. These promising results open the path towards a deeper study regarding the applicability of this algorithm in computer aided diagnosis systems to assist physicians in their clinical practice. PMID:22236465

  3. 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

  4. Implantable functional gastrointestinal neurostimulation.

    PubMed

    Jurkov, A S; Arriagada, A; Mintchev, M P

    2009-01-01

    Neural Gastrointestinal Electrical Stimulation (NGES) is a new microprocessor-based method for invoking gastric or colonic contractions by generating multi-channel, high energy, high frequency waveforms. It has been shown that when applied to the lower stomach, NGES offers the possibility for enhancing propulsive peristalsis for the treatment of gastric motor dysfunctions, or for producing retrograde peristalsis for the treatment of obesity. When applied to the colon, NGES can be utilized either for propulsive control in severe constipation or for invoked retrograde contractility. This paper briefly discusses the implementation of an implantable neurostimulator and summarizes the performance of the NGES technique in acute tests on experimental animals and humans, and in chronic tests on animals. These experimental tests indicate that NGES is successful in accelerating gastric emptying of both liquids and solids, and in producing strong, externally-controlled, retrograde contractions. PMID:19963851

  5. Mosapride in gastrointestinal disorders.

    PubMed

    Curran, Monique P; Robinson, Dean M

    2008-01-01

    Mosapride was effective in improving overall symptoms in patients with gastrointestinal disorders, including chronic gastritis, gastro-oesophageal reflux disease and functional dyspepsia. Mosapride was more effective than teprenone in improving gastric stasis symptoms and gastric pain after 2 weeks of therapy (p < 0.001) in an open-label trial in 1042 patients with functional dyspepsia. Mosapride was as effective as famotidine and itopride, but more effective than tandospirone, in improving overall or individual symptoms of functional dyspepsia in randomized trials. However, in one randomized, double-blind trial in patients with mild to severe disease, the improvement in overall symptoms of functional dyspepsia did not differ significantly between mosapride or placebo treatment. Mosapride was well tolerated, with diarrhoea/loose stools, dry mouth, malaise and headache being reported in <5% of patients. PMID:18457463

  6. 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

  7. Massive lower gastrointestinal bleeding due to 'Dieulafoy's vascular malformation' of the jejunum: case report.

    PubMed Central

    Goins, W. A.; Chatman, D. M.; Kaviani, M. J.

    1995-01-01

    Dieulafoy reported three cases of massive gastric hemorrhage due to a dilated submucosal artery in 1898, and since then, more than 100 cases of this gastric vascular malformation have been reported in the literature. These same pathologic lesions are even a rarer occurrence in the small bowel. This article reports a 38-year-old hypotensive male who presented to the hospital after an acute onset of massive lower gastrointestinal hemorrhage; superior mesenteric angiography demonstrated an actively bleeding lesion in a proximal jejunal branch. Intraoperative small bowel endoscopy via an enterotomy demonstrated a 4 mm bleeding submucosal lesion 30 cm distal to the ligament of Treitz. A literature review revealed six other cases of Dieulafoy's vascular malformation that occurred in the small bowel, with the lesions located in the proximal jejunum between 15 cm and 45 cm distal to the ligament of Treitz. The cause of these lesions is unknown. This case demonstrates the importance of preoperative angiography and intraoperative endoscopy when massive lower gastrointestinal hemorrhage is suspected to be from a small bowel source. Images Figure 1 Figure 2 Figure 3 PMID:7473854

  8. 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

  9. Capsule endoscopy compared with conventional colonoscopy for detection of colorectal neoplasms

    PubMed Central

    Sieg, Andreas

    2011-01-01

    Colon capsule endoscopy (CCE) may be a means to overcome the low adherence to colorectal cancer screening. The device is an ingestible capsule with a video camera at both ends that can take photographs as it progresses through the gastrointestinal tract. PillCam colon (PCC1) may be used for structural evaluation of the large bowel following an adequate cleaning procedure. PCC1 measures 11 mm 31 mm and has dual cameras that enable the device to acquire video images from both ends with a wide coverage area, automatic light control and a frame rate of four frames per second. The system includes a sensor array and data recorder connected to the patient during the procedure. The recorded data are downloaded to the Given Imaging Rapid workstation for review of the colon video. The second generation of PillCam Colon (PCC2) is similar to PCC1 and incorporates new developments. The angle of view has been increased to 172 degrees. It has an adaptive frame rate, alternating from 35 frames per second while in motion to 4 images when virtually stationary. The new RAPID software now includes a simple graphic interface tool for polyp size estimation. The procedure of bowel cleansing until capsule ingestion is similar to that used for traditional colonoscopy. However it is more rigorous as the bowel cleanliness for capsule colonoscopy has to be excellent or at least good to result in an adequate sensitivity of the method. Briefly, it consists of 3.5-4 L of split dose polyethylene glycol. Oral NaP boosters are administered after 1-2 h if the capsule has entered the small bowel. Sodium phosphate (NaP) seems to be a necessary adjunct to the regimen because the total transit time is doubled without NaP. The cleansing level was considered to be good to excellent in 72%-88% in studies with PCC1. The sensitivity for significant polyps (> 6 mm or more than 3 polyps >3 mm) ranged from 63%-88% with specificities between 64%-94%. PCC2 showed an improved sensitivity of 89% and a specificity of 76%. CCE seems to be a safe and effective method of visualizing the colonic mucosa through colon fluids without the need for sedation or insufflation of air. The sensitivity of CCE to detect polyps, advanced adenomas and cancer is lower compared to optical colonoscopy but improvements will be made in the near future. With an increased recording duration, even a panenteric examination of the whole gastrointestinal tract may be possible. PMID:21772938

  10. Capsule endoscopy compared with conventional colonoscopy for detection of colorectal neoplasms.

    PubMed

    Sieg, Andreas

    2011-05-16

    Colon capsule endoscopy (CCE) may be a means to overcome the low adherence to colorectal cancer screening. The device is an ingestible capsule with a video camera at both ends that can take photographs as it progresses through the gastrointestinal tract. PillCam colon (PCC1) may be used for structural evaluation of the large bowel following an adequate cleaning procedure. PCC1 measures 11 mm 31 mm and has dual cameras that enable the device to acquire video images from both ends with a wide coverage area, automatic light control and a frame rate of four frames per second. The system includes a sensor array and data recorder connected to the patient during the procedure. The recorded data are downloaded to the Given Imaging Rapid workstation for review of the colon video. The second generation of PillCam Colon (PCC2) is similar to PCC1 and incorporates new developments. The angle of view has been increased to 172 degrees. It has an adaptive frame rate, alternating from 35 frames per second while in motion to 4 images when virtually stationary. The new RAPID() software now includes a simple graphic interface tool for polyp size estimation. The procedure of bowel cleansing until capsule ingestion is similar to that used for traditional colonoscopy. However it is more rigorous as the bowel cleanliness for capsule colonoscopy has to be excellent or at least good to result in an adequate sensitivity of the method. Briefly, it consists of 3.5-4 L of split dose polyethylene glycol. Oral NaP boosters are administered after 1-2 h if the capsule has entered the small bowel. Sodium phosphate (NaP) seems to be a necessary adjunct to the regimen because the total transit time is doubled without NaP. The cleansing level was considered to be good to excellent in 72%-88% in studies with PCC1. The sensitivity for significant polyps (> 6 mm or more than 3 polyps >3 mm) ranged from 63%-88% with specificities between 64%-94%. PCC2 showed an improved sensitivity of 89% and a specificity of 76%. CCE seems to be a safe and effective method of visualizing the colonic mucosa through colon fluids without the need for sedation or insufflation of air. The sensitivity of CCE to detect polyps, advanced adenomas and cancer is lower compared to optical colonoscopy but improvements will be made in the near future. With an increased recording duration, even a panenteric examination of the whole gastrointestinal tract may be possible. PMID:21772938

  11. [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

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

    PubMed

    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

  14. Diagnostic Accuracy of the Initial Endoscopy for Ampullary Tumors

    PubMed Central

    Lee, Hee Seung; Jang, Jong Soon; Lee, Seungho; Yeon, Myeong Ho; Kim, Ki Bae; Park, Jae Geun; Lee, Joo Young; Kim, Mi Jin; Han, Joung-Ho; Sung, Rohyun

    2015-01-01

    Background/Aims Ampullary tumors come in a wide variety of malignant forms. We evaluated the diagnostic accuracy of endoscopy for ampullary tumors, and analyzed the causes of misdiagnosis. Methods We compared endoscopic imaging and biopsy results to final diagnoses. Types of endoscope, numbers of biopsy specimens taken, and final diagnoses were evaluated as possible factors influencing diagnostic accuracy. Results Final diagnoses were 19 adenocarcinomas, 18 normal or papillitis, 11 adenomas, two adenomyomas, one paraganglioma, and one neuroendocrine tumor. The diagnostic accuracy of endoscopic imaging or the initial biopsy was identical (67.3%). At least one test was concordant with the final diagnosis in all except two cases. Compared with the final diagnosis, endoscopic imaging tended to show more advanced tumors, whereas the initial biopsy revealed less advanced lesions. The diagnostic accuracy of the initial biopsy was influenced by the type of endoscope used and the final diagnosis, but not by the number of biopsies taken. Conclusions Endoscopy has limited accuracy in the diagnosis of ampullary tumors. However, most cases with concordant endoscopic imaging and biopsy results are identical to the final diagnosis. Therefore, in cases where both of these tests disagree, re-evaluation with a side-viewing endoscope after resolution of papillitis is required. PMID:26064825

  15. 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

  16. Role and timing of endoscopy in acute biliary pancreatitis.

    PubMed

    Anderloni, Andrea; Repici, Alessandro

    2015-10-28

    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

  17. Bowel preparation regimens for colon capsule endoscopy: a review

    PubMed Central

    Nigar, Sofia; Paleti, Vani; Lane, Devin; Duddempudi, Sushil

    2014-01-01

    Colon capsule endoscopy (CCE) is being actively evaluated as an emerging complementary or alternative procedure for evaluation of the colon. The yield of CCE is significantly dependent on the quality of bowel preparation. In addition to achieving a stool-free colon the bowel preparation protocols need to decrease bubble effect and aid propulsion of the capsule. An extensive English literature search was done using PubMed with search terms of colon capsule endoscopy, PillCam and bowel preparation. Full-length articles which met the criteria were included for review. A total of 12 studies including 1149 patients were reviewed. There was significant variability in the type of bowel preparation regimens. Large-volume (34 liters) polyethylene glycol (PEG) was the most widely used laxative. Lower volumes of PEG showed comparable results but larger studies are needed to determine efficacy. Sodium phosphate was used as an effective booster in most studies. Magnesium citrate and ascorbic acid are emerging as promising boosters to replace sodium phosphate when it is contraindicated. The potential benefit of prokinetics needs further evaluation. Over the past decade there has been significant improvement in the bowel preparation regimens for CCE. Further experience and studies are likely to standardize the bowel preparation regimens before CCE is adopted into routine clinical practice. PMID:24790642

  18. Bowel preparation regimens for colon capsule endoscopy: a review.

    PubMed

    Singhal, Shashideep; Nigar, Sofia; Paleti, Vani; Lane, Devin; Duddempudi, Sushil

    2014-05-01

    Colon capsule endoscopy (CCE) is being actively evaluated as an emerging complementary or alternative procedure for evaluation of the colon. The yield of CCE is significantly dependent on the quality of bowel preparation. In addition to achieving a stool-free colon the bowel preparation protocols need to decrease bubble effect and aid propulsion of the capsule. An extensive English literature search was done using PubMed with search terms of colon capsule endoscopy, PillCam and bowel preparation. Full-length articles which met the criteria were included for review. A total of 12 studies including 1149 patients were reviewed. There was significant variability in the type of bowel preparation regimens. Large-volume (3-4 liters) polyethylene glycol (PEG) was the most widely used laxative. Lower volumes of PEG showed comparable results but larger studies are needed to determine efficacy. Sodium phosphate was used as an effective booster in most studies. Magnesium citrate and ascorbic acid are emerging as promising boosters to replace sodium phosphate when it is contraindicated. The potential benefit of prokinetics needs further evaluation. Over the past decade there has been significant improvement in the bowel preparation regimens for CCE. Further experience and studies are likely to standardize the bowel preparation regimens before CCE is adopted into routine clinical practice. PMID:24790642

  19. A Comparison of Gastrointestinal Toxicities between Intensity-Modulated Radiotherapy and Three-Dimensional Conformal Radiotherapy for Pancreatic Cancer

    PubMed Central

    Lee, Kyong Joo; Yoon, Hong In; Chung, Moon Jae; Park, Jeong Youp; Bang, Seungmin; Park, Seung-woo; Seong, Jin Sil; Song, Si Young

    2016-01-01

    Background/Aims Concurrent chemoradiotherapy (CCRT) is considered the treatment option for locally advanced pancreatic cancer, but accompanying gastrointestinal toxicities are the most common complication. With the introduction of three-dimensional conformal radiotherapy (3-D CRT) and intensity-modulated radiotherapy (IMRT), CCRT-related adverse events are expected to diminish. Here, we evaluated the benefits of radiation modalities by comparing gastrointestinal toxicities between 3-D CRT and IMRT. Methods Patients who received CCRT between July 2010 and June 2012 in Severance Hospital, Yonsei University College of Medicine, were enrolled prospectively. The patients underwent upper endoscopy before and 1 month after CCRT. Results A total of 84 patients were enrolled during the study period. The radiotherapy modalities delivered included 3D-CRT (n=40) and IMRT (n=44). The median follow-up period from the start of CCRT was 10.6 months (range, 3.8 to 29.9 months). The symptoms of dyspepsia, nausea/vomiting, and diarrhea did not differ between the groups. Upper endoscopy revealed significantly more gastroduodenal ulcers in the 3-D CRT group (p=0.003). The modality of radiotherapy (3D-CRT; odds ratio [OR], 11.67; p=0.011) and tumor location (body of pancreas; OR, 11.06; p=0.009) were risk factors for gastrointestinal toxicities. Conclusions IMRT is associated with significantly fewer gastroduodenal injuries among patients treated with CCRT for pancreatic cancer. PMID:26470767

  20. Gastric emptying scan after distal subtotal gastrectomy: Differences between Billroth I and II and predicting the presence of food residue at endoscopy

    PubMed Central

    Chong, Ari; Ha, Jung-Min; Kim, Sungsoo

    2015-01-01

    Purpose: We investigated whether gastric emptying scans (GESs) showed different emptying patterns between patients after different types of laparoscopic distal subtotal gastrectomies. We also investigated whether the presence of food residue via endoscopy can be predicted by GESs. Materials and Methods: We retrospectively enrolled patients who had GESs within postoperative week 1 after a Billroth I or Billroth II operation. Diabetic patients were excluded. GESs were done with a solid test meal. Percent emptying at each scan time was analyzed. The presence of food residue in the stomach and gastrointestinal symptoms at the outpatient clinic were also analyzed. Results: In total, 46 patients were enrolled (Billroth I: Billroth II = 21:25). Sixteen patients underwent a second GES (postoperative 3-6 months). Both groups showed delayed gastric emptying at the postoperative 1 week scan, but group I showed much slower emptying. However, this difference disappeared by the second scan. Based on endoscopies conducted 6 months after the operation, 73.2% of patients had significant amounts of food residue, which hindered an accurate evaluation. The proportion of patients with food residues did not differ between the groups. Receiver Operating Characteristic (ROC) curve analysis revealed that a cut-off value of ? 30% emptying at 100 min and 120 min in postoperative 3-6 month scans was both highly sensitive and specific for predicting the presence of food residue (90.91% and 75% for 100 min and 91.67% and 75% for 120 min, respectively). Conclusions: GESs within a week after distal subtotal gastrectomy show slower emptying of Billroth I than II. At a ? 30% emptying threshold, a GES can predict subtotal gastrectomy patients who might have a significant amount of food residue in their stomach even after following typical fasting instructions to prepare endoscopy. PMID:26885000

  1. A Retrospective Evaluation of the Utility of Capsule Endoscopy and Double-Balloon Endoscopy in Crohn's Disease

    PubMed Central

    Nakamura, Masanao; Hirooka, Yoshiki; Watanabe, Osamu; Yamamura, Takeshi; Funasaka, Kohei; Ohno, Eizaburo; Kawashima, Hiroki; Miyahara, Ryoji

    2016-01-01

    Background. Although the usefulness of capsule endoscopy (CE) and double-balloon endoscopy (DBE) for the evaluation of Crohn's disease (CD) is established, their capabilities in the differential diagnosis of small bowel stenosis have not been sufficiently addressed. The present study therefore aimed to retrospectively determine the types of patients for whom CE and DBE would confer the most benefit. Patients and Methods. We retrospectively reviewed data from 185 patients with established CD. A change of treatment based on CE or DBE results or successful DBE balloon dilation was defined as clinically useful indication. We then analyzed the factors significantly related to useful and poor indications. Results. CE results were assessed as useful indications in 28 (45%) of 62 patients. Multivariate analysis demonstrated that positive CRP and low IOIBD score are factors significantly related to a useful indication. DBE results were recognized as useful indications in 118 (77%) of 153 patients. Multivariate analysis indicated small bowel stenosis and abdominal pain as factors significantly associated with useful indications. All patients with a poor indication on CE had small bowel stenosis. Conclusions. CE was most useful for patients in clinical remission with positive CRP and without stenosis, whereas DBE was useful for patients with symptoms of stenosis. PMID:26843856

  2. 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 ...

  3. The chicken gastrointestinal microbiome.

    PubMed

    Oakley, Brian B; Lillehoj, Hyun S; Kogut, Michael H; Kim, Woo K; Maurer, John J; Pedroso, Adriana; Lee, Margie D; Collett, Stephen R; Johnson, Timothy J; Cox, Nelson A

    2014-11-01

    The domestic chicken is a common model organism for human biological research and of course also forms the basis of a global protein industry. Recent methodological advances have spurred the recognition of microbiomes as complex communities with important influences on the health and disease status of the host. In this minireview, we provide an overview of the current state of knowledge of the chicken gastrointestinal microbiome focusing on spatial and temporal variability, the presence and importance of human pathogens, the influence of the microbiota on the immune system, and the importance of the microbiome for poultry nutrition. Review and meta-analysis of public data showed cecal communities dominated by Firmicutes and Bacteroides at the phylum level, while at finer levels of taxonomic resolution, a phylogenetically diverse assemblage of microorganisms appears to have similar metabolic functions that provide important benefits to the host as inferred from metagenomic data. This observation of functional redundancy may have important implications for management of the microbiome. We foresee advances in strategies to improve gut health in commercial operations through management of the intestinal microbiota as an alternative to in-feed subtherapeutic antibiotics, improvements in pre- and probiotics, improved management of polymicrobial poultry diseases, and better control of human pathogens via colonization reduction or competitive exclusion strategies. PMID:25263745

  4. Immunotherapy for Gastrointestinal Malignancies

    PubMed Central

    Toomey, Paul G.; Vohra, Nasreen A.; Ghansah, Tomar; Sarnaik, Amod A.; Pilon-Thomas, Shari A.

    2016-01-01

    Background Gastrointestinal (GI) cancers are the most common human tumors encountered worldwide. The majority of GI cancers are unresectable at the time of diagnosis, and in the subset of patients undergoing resection, few are cured. There is only a modest improvement in survival with the addition of modalities such as chemotherapy and radiation therapy. Due to an increasing global cancer burden, it is imperative to integrate alternative strategies to improve outcomes. It is well known that cancers possess diverse strategies to evade immune detection and destruction. This has led to the incorporation of various immunotherapeutic strategies, which enable reprogramming of the immune system to allow effective recognition and killing of GI tumors. Methods A review was conducted of the results of published clinical trials employing immunotherapy for esophageal, gastroesophageal, gastric, hepatocellular, pancreatic, and colorectal cancers. Results Monoclonal antibody therapy has come to the forefront in the past decade for the treatment of colorectal cancer. Immunotherapeutic successes in solid cancers such as melanoma and prostate cancer have led to the active investigation of immunotherapy for GI malignancies, with some promising results. Conclusions To date, monoclonal antibody therapy is the only immunotherapy approved by the US Food and Drug Administration for GI cancers. Initial trials validating new immunotherapeutic approaches, including vaccination-based and adoptive cell therapy strategies, for GI malignancies have demonstrated safety and the induction of antitumor immune responses. Therefore, immunotherapy is at the forefront of neoadjuvant as well as adjuvant therapies for the treatment and eradication of GI malignancies. PMID:23302905

  5. 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

  6. Feline gastrointestinal microbiota.

    PubMed

    Minamoto, Yasushi; Hooda, Seema; Swanson, Kelly S; Suchodolski, Jan S

    2012-06-01

    The close relationship between gastrointestinal (GI) microbiota and its host has an impact on the health status of an animal that reaches beyond the GI tract. A balanced microbiome stimulates the immune system, aids in the competitive exclusion of transient pathogens and provides nutritional benefits to the host. With recent rapid advances in high-throughput sequencing technology, molecular approaches have become the routinely used tools for ecological studies of the feline microbiome, and have revealed a highly diverse and complex intestinal ecosystem in the feline GI tract. The major bacterial groups are similar to those found in other mammals, with Firmicutes, Bacteroidetes, Actinobacteria and Proteobacteria constituting more than 99% of intestinal microbiota. Several nutritional studies have demonstrated that the feline microbiota can be modulated by the amount of soluble fibers (i.e., prebiotics) and macronutrients (i.e., protein content) in the diet. Initial clinical studies have suggested the presence of a dysbiosis in feline inflammatory bowel disease (IBD). Recently, metagenomic approaches have attempted to characterize the microbial gene pool. However, more studies are needed to describe the phylogenetic and functional changes in the intestinal microbiome in disease states and in response to environmental and dietary modulations. This paper reviews recent studies cataloging the microbial phylotypes in the GI tract of cats. PMID:22853923

  7. Role of small bowel capsule endoscopy in the diagnosis and management of iron deficiency anemia in elderly: a comprehensive review of the current literature.

    PubMed

    Muhammad, Adnan; Vidyarthi, Gitanjali; Brady, Patrick

    2014-07-14

    Iron deficiency anemia (IDA) is common and often under recognized problem in the elderly. It may be the result of multiple factors including a bleeding lesion in the gastrointestinal tract. Twenty percent of elderly patients with IDA have a negative upper and lower endoscopy and two-thirds of these have a lesion in the small bowel (SB). Capsule endoscopy (CE) provides direct visualization of entire SB mucosa, which was not possible before. It is superior to push enteroscopy, enteroclysis and barium radiography for diagnosing clinically significant SB pathology resulting in IDA. Angioectasia is one of the commonest lesions seen on the CE in elderly with IDA. The diagnostic yield of CE for IDA progressively increases with advancing age, and is highest among patients over 85 years of age. Balloon assisted enteroscopy is used to treat the lesions seen on CE. CE has some limitations mainly lack of therapeutic capability, inability to provide precise location of the lesion and false positive results. Overall CE is a very safe and effective procedure for the evaluation of IDA in elderly. PMID:25024599

  8. Role of small bowel capsule endoscopy in the diagnosis and management of iron deficiency anemia in elderly: A comprehensive review of the current literature

    PubMed Central

    Muhammad, Adnan; Vidyarthi, Gitanjali; Brady, Patrick

    2014-01-01

    Iron deficiency anemia (IDA) is common and often under recognized problem in the elderly. It may be the result of multiple factors including a bleeding lesion in the gastrointestinal tract. Twenty percent of elderly patients with IDA have a negative upper and lower endoscopy and two-thirds of these have a lesion in the small bowel (SB). Capsule endoscopy (CE) provides direct visualization of entire SB mucosa, which was not possible before. It is superior to push enteroscopy, enteroclysis and barium radiography for diagnosing clinically significant SB pathology resulting in IDA. Angioectasia is one of the commonest lesions seen on the CE in elderly with IDA. The diagnostic yield of CE for IDA progressively increases with advancing age, and is highest among patients over 85 years of age. Balloon assisted enteroscopy is used to treat the lesions seen on CE. CE has some limitations mainly lack of therapeutic capability, inability to provide precise location of the lesion and false positive results. Overall CE is a very safe and effective procedure for the evaluation of IDA in elderly. PMID:25024599

  9. 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

  10. Development of a fluorescence video endoscopy imaging system for the early detection of cancer in the gastrointestinal tract

    NASA Astrophysics Data System (ADS)

    Zeng, Haishan; Weiss, Alan; MacAulay, Calum E.; MacKinnon, Nick; Cline, Richard W.; Dawson, Remy

    1997-06-01

    The utility of autofluorescence imaging for the early detection of lung cancer has been previously demonstrated. The aim of this work is to extend the use of real time autofluorescence imaging to the early detection of cancer of the esophagus, stomach, and colon. A prototype fluorescence imaging system was developed which produces real time video images of tissue autofluorescence. The system consist of a filtered blue light source, two intensified CCD cameras, a fiber optic endoscope, and a computer based control center. The system produces a real time pseudo color display based on images acquired from two fluorescence bands. These bands were selected based on in vivo fluorescence spectroscopic studies. The generated pseudo image clearly delineates the abnormal tissue areas for biopsy. Early cancer sties missed under conventional white light examination became visible under fluorescence imaging. A further development allows the fluorescence imaging system to be used in an alternate fashion. The system captures a fluorescence image in the green and a reflectance image in the red-near IR. Different spectral information was exploited in the two imaging modes.

  11. 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

  12. Intravital microscopy of subpleural alveoli via transthoracic endoscopy.

    PubMed

    Schwenninger, David; Runck, Hanna; Schumann, Stefan; Haberstroh, Jörg; Meissner, Sven; Koch, Edmund; Guttmann, Josef

    2011-04-01

    Transfer of too high mechanical energy from the ventilator to the lung's alveolar tissue is the main cause for ventilator-induced lung injury (VILI). To investigate the effects of cyclic energy transfer to the alveoli, we introduce a new method of transthoracic endoscopy that provides morphological as well as functional information about alveolar geometry and mechanics. We evaluate the new endoscopic method to continuously record images of focused subpleural alveoli. The method is evaluated by using finite element modeling techniques and by direct observation of subpleural alveoli both in isolated rat lungs as well as in intact animals (rats). The results confirm the overall low invasiveness of the endoscopic method insofar as the mechanical influences on the recorded alveoli are only marginal. It is, hence, a suited method for intravital microscopy in the rat model as well as in larger animals. PMID:21529071

  13. 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

  14. 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

  15. Video endoscopy: removal of retained sewing needles from the duodenum.

    PubMed

    Gajbhiye, Ashok S; Gajbhiye, Raj N; Tirupude, Bhupesh H; Bajaj, Prasang P; Gupta, Tarush H

    2013-06-01

    We report an interesting case of a 21-year-old unmarried girl who swallowed six sewing needles. Her complaints were pain in the epigastrium, associated with nausea and vomiting. On examination, there was mild tenderness in the epigastrium. X-ray of the abdomen and endoscopy confirmed the presence of six needles in the duodenum, with tips lodged in the duodenal wall. Psychiatric opinion was sought which was normal. Under video endoscope (Pentax 2.8, EG 27708) guidance with Captura biopsy forceps without spikes (Cook DBF-2.4-160-S), six sewing needles were removed successfully from the duodenum through the endoscope channel without any complications. However, a video endoscopic removal of the retained six needles from duodenum is probably being reported for the first time. PMID:24426531

  16. 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

  17. Quality assurance of endoscopy in colorectal cancer screening.

    PubMed

    Valori, Roland; Sint Nicolaas, Jerome; de Jonge, Vincent

    2010-08-01

    This chapter explores the concept of quality assurance of colorectal cancer screening. It argues that effective quality assurance is critical to ensure that the benefits of screening outweigh the harms. The three key steps of quality assurance, definition of standards, measurement of standards and enforcement of standards, are explained. Quality is viewed from the perspective of the patient and illustrated by following the path of patients accessing endoscopy within screening services. The chapter discusses the pros and cons of programmatic versus non-programmatic screening and argues that quality assurance of screening can and should benefit symptomatic services. Finally, the chapter emphasises the importance of a culture of excellence underpinned by continuous quality improvement and effective service leadership. PMID:20833349

  18. Principles of infection prevention and reprocessing in ENT endoscopy

    PubMed Central

    Kramer, Axel; Kohnen, Wolfgang; Israel, Susanne; Ryll, Sylvia; Hübner, Nils-Olaf; Luckhaupt, Horst; Hosemann, Werner

    2015-01-01

    This article gives an overview on the principles of reprocessing of rigid and flexible endoscopes used in ENT units including structural and spatial requirements based on general and 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 a practical guidance to the otorhinolaryngologist. Preliminary results of a small nation-wide survey on infection control standards based on data of 29 ENT practices in Germany reveal current 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:26770284

  19. 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

  20. 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

  1. Intravital microscopy of subpleural alveoli via transthoracic endoscopy

    NASA Astrophysics Data System (ADS)

    Schwenninger, David; Runck, Hanna; Schumann, Stefan; Haberstroh, Jrg; Meissner, Sven; Koch, Edmund; Guttmann, Josef

    2011-04-01

    Transfer of too high mechanical energy from the ventilator to the lung's alveolar tissue is the main cause for ventilator-induced lung injury (VILI). To investigate the effects of cyclic energy transfer to the alveoli, we introduce a new method of transthoracic endoscopy that provides morphological as well as functional information about alveolar geometry and mechanics. We evaluate the new endoscopic method to continuously record images of focused subpleural alveoli. The method is evaluated by using finite element modeling techniques and by direct observation of subpleural alveoli both in isolated rat lungs as well as in intact animals (rats). The results confirm the overall low invasiveness of the endoscopic method insofar as the mechanical influences on the recorded alveoli are only marginal. It is, hence, a suited method for intravital microscopy in the rat model as well as in larger animals.

  2. Childhood functional gastrointestinal disorders.

    PubMed

    Rasquin-Weber, A; Hyman, P E; Cucchiara, S; Fleisher, D R; Hyams, J S; Milla, P J; Staiano, A

    1999-09-01

    This is the first attempt at defining criteria for functional gastrointestinal disorders (FGIDs) in infancy, childhood, and adolescence. The decision-making process was as for adults and consisted of arriving at consensus, based on clinical experience. This paper is intended to be a quick reference. The classification system selected differs from the one used in the adult population in that it is organized according to main complaints instead of being organ-targeted. Because the child is still developing, some disorders such as toddler's diarrhea (or functional diarrhea) are linked to certain physiologic stages; others may result from behavioral responses to sphincter function acquisition such as fecal retention; others will only be recognizable after the child is cognitively mature enough to report the symptoms (e.g., dyspepsia). Infant regurgitation, rumination, and cyclic vomiting constitute the vomiting disorders. Abdominal pain disorders are classified as: functional dyspepsia, irritable bowel syndrome (IBS), functional abdominal pain, abdominal migraine, and aerophagia. Disorders of defecation include: infant dyschezia, functional constipation, functional fecal retention, and functional non-retentive fecal soiling. Some disorders, such as IBS and dyspepsia and functional abdominal pain, are exact replications of the adult criteria because there are enough data to confirm that they represent specific and similar disorders in pediatrics. Other disorders not included in the pediatric classification, such as functional biliary disorders, do occur in children; however, existing data are insufficient to warrant including them at the present time. For these disorders, it is suggested that, for the time being, clinicians refer to the criteria established for the adult population. PMID:10457047

  3. Primary gastrointestinal lymphoma

    PubMed Central

    Aledavood, Amir; Nasiri, Mohammad Reza Ghavam; Memar, Bahram; Shahidsales, Soodabeh; Raziee, Hamid Reza; Ghafarzadegan, Kamran; Mohtashami, Samira

    2012-01-01

    Background: Extranodal lymphoma may arise anywhere outside lymph nodes mostly in the gastrointestinal (GI) tract as non-Hodgkin's disease. We reviewed the clinicopathological features and treatment results of patients with primary GI lymphoma. Materials and Methods: A total number of 30 cases with primary GI lymphoma were included in this study. Patients referred to the Radiation Oncology Department of Omid Hospital (Mashhad, Iran) during a 5-year period (2006-11). Clinical, paraclinical, and radiological data was collected from medical records of the patients. Results: Out of the 30 patients with primary GI lymphoma in the study, 12 were female (40%) and 18 were male (60%) (male to female ratio: 3/2). B symptoms were present in 27 patients (90%). Antidiuretic hormone (LDH) levels were elevated in 9 patients (32.1%). The most common primary site was stomach in 14 cases (46.7%). Other common sites included small intestine and colon each in 8 patients (26.7%). All patients had histopathologically proven non-Hodgkin's lymphoma. The most common histologic subtype was diffuse large B-cell lymphoma (DLBL) in 16 patients (53.3%). In addition, 28 patients (93.3%) received chemotherapy with cyclophosphamide, vincristine, doxorubicin, prednisolone (CHOP regimen). The median course of chemotherapy was 6 cources. Moreover, 8 patients (26.7%) received radiotherapy with cobalt 60. The median follow-up time was 26 months. The overall 5-year survival rate was 53% and the median survival time was 60 months. Conclusion: Primary GI lymphoma is commonly seen in stomach and small intestine and mostly is DLBCL or mucosa-associated lymphoid tissue (MALT) lymphoma. PMID:23626617

  4. Capsule endoscopy in patients with cardiac pacemakers, implantable cardioverter defibrillators and left heart assist devices

    PubMed Central

    Bandorski, Dirk; Hltgen, Reinhard; Stunder, Dominik; Keuchel, Martin

    2014-01-01

    According to the recommendations of the US Food and Drug Administration and manufacturers, capsule endoscopy should not be used in patients carrying implanted cardiac devices. For this review we considered studies indexed (until 30.06.2013) in Medline [keywords: capsule endoscopy, small bowel endoscopy, cardiac pacemaker, implantable cardioverter defibrillator, interference, left heart assist device], technical information from Given Imaging and one own publication (not listed in Medline). Several in vitro and in vivo studies included patients with implanted cardiac devices who underwent capsule endoscopy. No clinically relevant interference was noticed. Initial reports on interference with a simulating device were not reproduced. Furthermore technical data of PillCam (Given Imaging) demonstrate that the maximum transmission power is below the permitted limits for cardiac devices. Hence, impairment of cardiac pacemaker, defibrillator or left ventricular heart assist device function by capsule endoscopy is not expected. However, wireless telemetry can cause dysfunction of capsule endoscopy recording. Application of capsule endoscopy is feasible and safe in patients with implanted cardiac devices such as pacemakers, cardioverter defibrillators, and left heart assist devices. Development of new technologies warrants future re-evaluation. PMID:24714370

  5. Capsule endoscopy in patients with cardiac pacemakers, implantable cardioverter defibrillators and left heart assist devices.

    PubMed

    Bandorski, Dirk; Hltgen, Reinhard; Stunder, Dominik; Keuchel, Martin

    2014-01-01

    According to the recommendations of the US Food and Drug Administration and manufacturers, capsule endoscopy should not be used in patients carrying implanted cardiac devices. For this review we considered studies indexed (until 30.06.2013) in Medline [keywords: capsule endoscopy, small bowel endoscopy, cardiac pacemaker, implantable cardioverter defibrillator, interference, left heart assist device], technical information from Given Imaging and one own publication (not listed in Medline). Several in vitro and in vivo studies included patients with implanted cardiac devices who underwent capsule endoscopy. No clinically relevant interference was noticed. Initial reports on interference with a simulating device were not reproduced. Furthermore technical data of PillCam (Given Imaging) demonstrate that the maximum transmission power is below the permitted limits for cardiac devices. Hence, impairment of cardiac pacemaker, defibrillator or left ventricular heart assist device function by capsule endoscopy is not expected. However, wireless telemetry can cause dysfunction of capsule endoscopy recording. Application of capsule endoscopy is feasible and safe in patients with implanted cardiac devices such as pacemakers, cardioverter defibrillators, and left heart assist devices. Development of new technologies warrants future re-evaluation. PMID:24714370

  6. Clinical Experience with the PillCam Patency Capsule prior to Video Capsule Endoscopy: A Real-World Experience.

    PubMed

    Römmele, C; Brueckner, J; Messmann, H; Gölder, S K

    2016-01-01

    Background. In patients with known or suspected risk factors for gastrointestinal stenosis, the PillCam patency capsule (PC) is given before a video capsule endoscopy (VCE) in order to minimize the risk of capsule retention (CR). CR is considered unlikely upon excretion of the PC within 30 hours, excretion in an undamaged state after 30 hours, or radiological projection to the colon. Methods. We performed a retrospective analysis of 38 patients with risk factors for CR, who received a PC from 02/2013 to 04/2015 at Klinikum Augsburg. Results. Sixteen of our 38 patients observed a natural excretion after a mean time of 34 hours past ingestion. However, only 8 patients observed excretion within 30 hours, as recommended by the company. In 20 patients passage of the PC into the colon was shown via RFID-scan or radiological imaging (after 33 and 45 hours, resp.). Only 2 patients showed a pathologic PC result. In consequence, 32 patients received the VCE; no CR was observed. Conclusion. Our data indicates that a VCE could safely be performed even if the PC excretion time is longer than 30 hours and the excreted PC was not screened for damage. PMID:26880902

  7. Detection of small bowel tumor based on multi-scale curvelet analysis and fractal technology in capsule endoscopy.

    PubMed

    Liu, Gang; Yan, Guozheng; Kuang, Shuai; Wang, Yongbing

    2016-03-01

    Wireless capsule endoscopy (WCE) has been a revolutionary technique to noninvasively inspect gastrointestinal (GI) tract diseases, especially small bowel tumor. However, it is a tedious task for physicians to examine captured images. To develop a computer-aid diagnosis tool for relieving the huge burden of physicians, the intestinal video data from 89 clinical patients with the indications of potential tumors was analyzed. Out of the 89 patients, 15(16.8%) were diagnosed with small bowel tumor. A novel set of textural features that integrate multi-scale curvelet and fractal technology were proposed to distinguish normal images from tumor images. The second order textural descriptors as well as higher order moments between different color channels were computed from images synthesized by the inverse curvelet transform of the selected scales. Then, a classification approach based on support vector machine (SVM) and genetic algorithm (GA) was further employed to select the optimal feature set and classify the real small bowel images. Extensive comparison experiments validate that the proposed automatic diagnosis scheme achieves a promising tumor classification performance of 97.8% sensitivity and 96.7% specificity in the selected images from our clinical data. PMID:26829705

  8. Clinical Efficacy of Various Diagnostic Tests for Small Bowel Tumors and Clinical Features of Tumors Missed by Capsule Endoscopy

    PubMed Central

    Han, Jung Wan; Hong, Sung Noh; Jang, Hyun Joo; Jeon, Seong Ran; Cha, Jae Myung; Park, Soo Jung; Byeon, Jung Sik; Ko, Bong Min; Kim, Eun Ran; Choi, Hwang; Chang, Dong Kyung

    2015-01-01

    Background. We aimed to evaluate the efficacy of various diagnostic tools such as computerized tomography (CT), small bowel follow-through (SBFT), and capsule endoscopy (CE) in diagnosing small bowel tumors (SBTs). Additionally, we aimed to evaluate the clinical features of SBTs missed by CE. Methods. We retrospectively studied 79 patients with histologically proven SBT. Clinical data were analyzed with particular attention to the efficacy of CT, SBFT, and CE in detecting SBT preoperatively. We also analyzed the clinical features of SBTs missed by CE. Results. The most common symptoms of SBT were bleeding (43%) and abdominal pain (13.9%). Diagnostic yields were as follows: CT detected 55.8% of proven SBTs; SBFT, 46.1%; and CE, 83.3%. The sensitivity for detecting SBTs was 40.4% for CT, 43.9% for SBFT, and 79.6% for CE. Two patients with nondiagnostic but suspicious findings on CE and seven patients with negative findings on CE were eventually found to have SBT. These nine patients were eventually diagnosed with gastrointestinal stromal tumor (4), small polyps (3), inflammatory fibroid polyp (1), and adenocarcinoma (1). These tumors were located in the proximal jejunum (5), middle jejunum (1), distal jejunum (1), and proximal ileum (1). Conclusion. CE is more efficacious than CT or SBFT for detecting SBTs. However, significant tumors may go undetected with CE, particularly when located in the proximal jejunum. PMID:26229529

  9. Automatic detection of small bowel tumors in capsule endoscopy based on color curvelet covariance statistical texture descriptors.

    PubMed

    Barbosa, Daniel J C; Ramos, Jaime; Correia, Jos Higino; Lima, Carlos S

    2009-01-01

    Traditional endoscopic methods do not allow the visualization of the entire Gastrointestinal (GI) tract. Wireless Capsule Endoscopy (CE) is a diagnostic procedure that overcomes this limitation of the traditional endoscopic methods. The CE video frames possess rich information about the condition of the stomach and intestine mucosa, encoded as color and texture patterns. It is known for a long time that human perception of texture is based in a multi-scale analysis of patterns, which can be modeled by multi-resolution approaches. Furthermore, modeling the covariance of textural descriptors has been successfully used in classification of colonoscopy videos. Therefore, in the present paper it is proposed a frame classification scheme based on statistical textural descriptors taken from the Discrete Curvelet Transform (DCT) domain, a recent multi-resolution mathematical tool. The DCT is based on an anisotropic notion of scale and high directional sensitivity in multiple directions, being therefore suited to characterization of complex patterns as texture. The covariance of texture descriptors taken at a given detail level, in different angles, is used as classification feature, in a scheme designated as Color Curvelet Covariance. The classification step is performed by a multilayer perceptron neural network. The proposed method has been applied in real data taken from several capsule endoscopic exams and reaches 97.2% of sensitivity and 97.4% specificity. These promising results support the feasibility of the proposed method. PMID:19964706

  10. 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.

  11. [Gastrointestinal stromal tumors: conceptual evolution].

    PubMed

    Fonseca, Ismael B; Spitale, Luis S; Gramtica, Luis; Cejas, Hugo; Piccinni, Daniel J; Ghirardi, Graciela

    2006-01-01

    Gastrointestinal stromal tumors (GISTs) constitute the largest category of primary nonepithelial neoplasms of the stomach and small bowel. They represent about 1-2% from all neoplasms of the digestive tract. They occur most commonly in the stomach and small bowel, but small series of comparable tumors have also been reported in all the other parts of the tubular gastrointestinal tract, including esophagus, colon, rectum and anus. They can also involve omentum, mesentery, uterus, retroperitoneum, mesocolon and soft tissues. Originally recognized in 1960 by Martin et. al. as a distinctive type of stromal neoplasm of the bowel, they were subsequently reported by Stout, who introduced the term leiomyoblastoma. Because of difficulties in accurately predicting the biologic behavior of these tumors, the term "smooth muscle tumor of uncertain malignant potential" (SMTUMP) has been introduced for borderline tumors. In 1983, Mazur and Clark coined the term gastrointestinal stromal tumor and suggested that these neoplasms might arise from the myenteric nervous system. Some studies have reported evidence of neuronal cell differentiation in a proportion of GISTs and the term "gastrointestinal autonomic nerve tumor (GANT) has been introduced. Kindblom et al are providing cogent arguments to suggest that GISTs show differentiation toward interstitial Cajal cells (pacemaker cells of the gastrointestinal tract). Inmunohistochemically the GISTs often reveal inmunoreactivity for vimentin. CD34 and CD 117. The aim of this paper is to perform and analysis of the historic evolution and conceptual of the GISTs. PMID:17639807

  12. 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.

  13. 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.

  14. Ankaferd Blood Stopper for controlling gastrointestinal bleeding due to distinct benign lesions refractory to conventional antihemorrhagic measures

    PubMed Central

    Kurt, Mevlut; Onal, Ibrahim Koral; Akdogan, Meral; Kekilli, Murat; Arhan, Mehmet; Sayilir, Abdurrahim; Oztas, Erkin; Haznedaroglu, Ibrahim Celalettin

    2010-01-01

    OBJECTIVE: To assess the hemostatic efficacy of the Ankaferd Blood Stopper (ABS, Ankaferd Health Products Ltd, Turkey) hemostatic agent for controlling gastrointestinal bleeding associated with various benign lesions refractory to conventional antihemorrhagic measures. METHODS: The records of all patients who underwent upper and lower endoscopy procedures at the Turkiye Yuksek Ihtisas Teaching and Research Hospital (Ankara, Turkey) between April 2008 and June 2009 were reviewed. Patients in whom ABS was used as a primary or adjuvant hemostatic agent were included in the study. Rates of bleeding control and postprocedural complications were documented. RESULTS: Hemostasis with no immediate complications was achieved in all patients within seconds of endoscopic application of ABS. CONCLUSIONS: ABS may have a role as a primary treatment or as an adjuvant to conventional modalities used to control gastrointestinal bleeding. Prospective controlled studies are needed to help establish its efficacy and, perhaps, offer a comparison with conventional hemostatic interventions. PMID:20559581

  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. Malakoplakia of the gastrointestinal tract.

    PubMed Central

    McClure, J.

    1981-01-01

    The clinical and pathological features of 3 cases of colonic malakoplakia are documented thereby bringing to 34 the total of recorded cases of malakoplakia involving the gastrointestinal tract. This is therefore the most common site of involvement outside the urogenital tract. A comprehensive review of the world literature on gastrointestinal malakoplakia has been made and the characteristic features of the condition have been delineated. There was a bimodal age incidence with a small cluster of cases occurring in childhood and associated with significant additional systemic disease. In the adult cases the average age was 57 years with a slight excess of males. The most commonly involved part of the gastrointestinal tract was the colon and colonic carcinoma was the most common associated disease. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 PMID:7267514

  17. Anthrax of the Gastrointestinal Tract

    PubMed Central

    Sirisanthana, Thira

    2002-01-01

    When swallowed, anthrax spores may cause lesions from the oral cavity to the cecum. Gastrointestinal anthrax is greatly underreported in rural disease-endemic areas of the world. The apparent paucity of this form of anthrax reflects the lack of facilities able to make the diagnosis in these areas. The spectrum of disease, ranging from subclinical infection to death, has not been fully recognized. In some community-based studies, cases of gastrointestinal anthrax outnumbered those of cutaneous anthrax. The oropharyngeal variant, in particular, is unfamiliar to most physicians. The clinical features of oropharyngeal anthrax include fever and toxemia, inflammatory lesion(s) in the oral cavity or oropharynx, enlargement of cervical lymph nodes associated with edema of the soft tissue of the cervical area, and a high case-fatality rate. Awareness of gastrointestinal anthrax in a differential diagnosis remains important in anthrax-endemic areas but now also in settings of possible bioterrorism. PMID:12095428

  18. Anthrax of the gastrointestinal tract.

    PubMed

    Sirisanthana, Thira; Brown, Arthur E

    2002-07-01

    When swallowed, anthrax spores may cause lesions from the oral cavity to the cecum. Gastrointestinal anthrax is greatly underreported in rural disease-endemic areas of the world. The apparent paucity of this form of anthrax reflects the lack of facilities able to make the diagnosis in these areas. The spectrum of disease, ranging from subclinical infection to death, has not been fully recognized. In some community-based studies, cases of gastrointestinal anthrax outnumbered those of cutaneous anthrax. The oropharyngeal variant, in particular, is unfamiliar to most physicians. The clinical features of oropharyngeal anthrax include fever and toxemia, inflammatory lesion(s) in the oral cavity or oropharynx, enlargement of cervical lymph nodes associated with edema of the soft tissue of the cervical area, and a high case-fatality rate. Awareness of gastrointestinal anthrax in a differential diagnosis remains important in anthrax-endemic areas but now also in settings of possible bioterrorism. PMID:12095428

  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. Helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphoma: magnifying endoscopy findings.

    PubMed

    Law, T T; Tong, Daniel; Wong, Sam W H; Chan, S Y; Law, Simon

    2015-04-01

    Gastric mucosa-associated lymphoid tissue lymphoma is uncommon and most patients have an indolent clinical course. The clinical presentation and endoscopic findings can be subtle and diagnosis can be missed on white light endoscopy. Magnifying endoscopy may help identify the abnormal microstructural and microvascular patterns, and target biopsies can be performed. We describe herein the case of a 64-year-old woman with Helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphoma diagnosed by screening magnification endoscopy. Helicobacter pylori-eradication therapy was given and she received biological therapy. She is in clinical remission after treatment. The use of magnification endoscopy in gastric mucosa-associated lymphoid tissue lymphoma and its management are reviewed. PMID:25904569