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Gastrointestinal Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Gareth Davies, Chris Black, Keeley Fairbrass
Also known as gastroscopy or oesophagogastroduodenoscopy (OGD), this is the most commonly used investigation for upper GI symptoms. It is often performed without sedation, using lignocaine to numb the throat. If sedation is used, the most common agent is intravenous (IV) benzodiazepine; the main side effect is respiratory depression. A slim gastroscope can be introduced transnasally. This is easier to tolerate but has reduced diagnostic and therapeutic ability.
Gastrostomy
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Alejandra M. Casar Berazaluce, Aaron P. Garrison, Todd A. Ponsky
The gastroscope is inserted and the stomach insufflated. The stoma should be away from the ribcage. Under- or overinsufflation should be avoided to minimize the possibility of accidentally piercing the transverse colon. Insufflation of the small intestine tends to push the transverse colon in front of the stomach and should be avoided.
Upper Gastrointestinal Surgery
Published in Gozie Offiah, Arnold Hill, RCSI Handbook of Clinical Surgery for Finals, 2019
Diagnosis and investigation➢ Diagnosis usually by gastroscopy and biopsy Barium meal may be required if gastroscopy contraindicated.➢ Staging investigations include CT TAP to assess for distant metastases and local lymphadenopathy.Endoluminal ultrasound to assess for local disease.Diagnostic laparoscopy (for patients considered for potential resection) to exclude small volume peritoneal metastases.
Diagnostic yield for video capsule endoscopy in gastrointestinal graft- versus -host disease: a systematic review and metaanalysis
Published in Scandinavian Journal of Gastroenterology, 2023
Jonas Varkey, Viktor Jonsson, Eva Hessman, Thomas De Lange, Per Hedenström, Mihai Oltean
Furthermore, the frequency of incomplete examinations was at an average of 12% ranging from 5–26%. The data was retrieved from four studies consisting of totally 237 examinations [26–28,30] which is acceptable according to European recommendation [33]. Overall, the retention rate seems to have declined globally over the past two decades [34] it still occurs at varying frequencies, depending on the indications, ranging from 2% in gastrointestinal bleeding [35] to 8–13% in Crohn’s disease [36,37]. However, these patients do not seem to have an elevated risk of retention if other complicating factors are not present. Therefore, the use of VCE in this patient cohort appeared safe since no serious adverse events were detected. The use of patency capsule is therefore not necessary if additional risk factors are not present. Several strategies such as administering propulsive agents prior to the procedure or placing the capsule directly in the duodenum with the help of a gastroscope may increase the completion rate by shortening the time spent in the stomach and saving battery time for the examination of the small and large intestine. Similarly, the use of Simethicone and bowel preparation would likely play a role in improving the visualization of the small bowel [38] but these agents seem to have been used in less than half of the patients.
Endoscopic resection of large subepithelial esophageal lesions via submucosal tunneling endoscopic resection and endoscopic submucosal dissection: a single-center, retrospective cohort study
Published in Scandinavian Journal of Gastroenterology, 2022
Bin Yang, Huazhong Han, Jianhong Shen, Pinxiang Lu, Fei Jiang
According to pathological reports, all tumors were measured in two dimensions: with the maximal longitudinal length and maximal transverse diameter. The operation speed was calculated as the ratio of the tumor area to the procedure time (tumor area = π×T/2 × L/2, T = maximum transverse diameter, L = maximum longitudinal length) [10]. Complete resection was achieved when entire tumors and surrounding tissue were resected in a single piece with negative vertical and lateral margins. The time from inserting the gastroscope to the withdrawal of the resected tumor was defined as the operation time. Perforation was considered to have occurred if there was visualization of any extra gastrointestinal structure during the procedure. The length of postoperative hospital stay was calculated as the time interval from the date of surgery to discharge from the hospital.
Percutaneous Endoscopic Necrosectomy (PEN) Combined with Percutaneous Catheter Drainage (PCD) and Irrigation for the Treatment of Clinically Relevant Pancreatic Fistula after Pancreatoduodenectomy
Published in Journal of Investigative Surgery, 2020
Jian Lin, Biqing Ni, Guozhong Liu
Bartoli et al. succeeded in treating patients who suffered from grade B pancreatic fistula after PD by using endoscopic double-pigtail stents for drainage [29]. Futagawa Y et al. treated POPF and postoperative peripancreatic fluid collection with endoscopic ultrasound guided transgastric drainage (EUS-GD), and had high technical and clinical success rates [30]. These useful methods transgastric approach had some advantages compared with our combination therapy method: First, the procedure did not need repeated section of the abdominal wall. Second, the procedure had no extracorporeal facilities such as drainage tube and pack, and improved the quality of patients' life. Third, in cases when the puncture route for PCD is difficult to establish, the transgastric approach is feasible and safe [30]. However, the transgastric approach for the treatment of patients suffering from CR-POPF after PD may have some potential complications. The gastroscope manipulation may injure the stomach itself and the poorly healing gastrojejunostomy anastomosis, then aggravate the gastrojejunostomy anastomosis fistula. The gas injection during the gastroscope manipulation may induce air embolism. After the drainage established, the gastric contents and gastric acid may regurgitate into the area of the collection, which may exacerbate the infection and cause erosion of the structure around the anastomosis. Furthermore, the gastroscope manipulation was restricted by the distance from the gastric wall to the collection to reduce the risk of free perforation.