Gastric Foreign Bodies
John F. Pohl, Christopher Jolley, Daniel Gelfond in Pediatric Gastroenterology, 2014
Endoscopy is typically performed with a flexible upper endoscope. Due to the increased airway compliance in younger patients and risk of obstruction, tracheal intubation is typically performed during the procedure. Retrieval devices include retrieval forceps, retrieval nets, polypectomy snares, polyp graspers, retrieval baskets, magnetic probes, banding caps, and sutures (Table 16.1, 16.2). If the patient is large enough, the use of an overtube will help to protect the airway, facilitate multiple passages for removal of several objects or piecemeal removal of a bezoar, and protect the GI tract during removal of sharp or long objects. Currently, there are no pediatric-sized overtubes. Protecting the mucosa from further injury during the removal of a sharp item can also be performed with the use of a latex hood or friction fit adaptor.
Endoscopic screening for upper gastrointestinal malignancy
David Westaby, Martin Lombard in Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
Another study of laser-induced fluorescence for the detection of adenocarcinoma in Barrett’s oesophagus adopted a different approach [29]. Patients with adenocarcinoma were pre-treated with an intravenous photosensitizer and measurements performed immediately after resection of the oesophagus. Measurements were also taken during endoscopy in five patients to assess how applicable the technique was for clinical use. Fluorescence was excited using the nitrogen pumped dye laser connected to a 600-pm optical fibre. This fibre was used to collect light emitted from the tissue and connected to a charged coupled device camera; the fluorescence spectrum from 450 nm to 750 nm was analysed. A tumour demarcation function was established in the form of a fluorescence ratio: the quotient of porphyrins fluorescence at 630 nm divided by autofluorescence at 500 nm. Normal oesophageal mucosa had a fluorescence ratio of 0.1 ± 0.058, gastric mucosa 0.16 ± 0.073, Barretts oesophagus 0.205 ±0.17, severe dysplasia 0.79 ± 0.54 and adenocarcinoma 0.78 ± 0.56. Thus, this technique can characterize different histological changes in the oesophagus, which were not macroscopically evident. The problem which might occur in very early lesions was that uptake of a photosensitizer may not be homogeneous (Fig. 5.15). Our experience with 5-aminolaevulinic acid indicates that the uptake is high in preneoplastic lesions, but that there is such variability that more specific discriminators are necessary [30].
Endoscopic Biopsy Demonstrating High-Grade Dysplasia in Barrett’s Esophagus
Savio George Barreto, Shailesh V. Shrikhande in Dilemmas in Abdominal Surgery, 2020
To manage the risk of recurrence (noted in case reports and some large case series), ongoing surveillance is required following ablation. The timing of this follow-up is essentially guided by expert opinion. There are a few long-term outcome studies available and the risk of recurrence of Barrett’s esophagus with high-grade dysplasia or T1a cancer is unknown, especially beyond five years. At the present time, expert consensus recommends follow-up for life. Initial endoscopy at three monthly intervals is standard, but with time this can almost certainly be lengthened. The author currently arranges endoscopy six monthly after the first year, and then yearly from five years. However, there is little evidence to support this protocol, or any protocol that advocates more frequent or less frequent endoscopy.
Factors associated with the efficacy and safety of endoscopic dilatation of symptomatic strictures in Crohn’s disease: a retrospective cohort study
Published in Scandinavian Journal of Gastroenterology, 2023
Pierre Dandoy, Edouard Louis, Pierrette Gast, Maxime Poncin, Laurence Seidel, Jean-Philippe Loly
EBDs were performed during colonoscopy under conscious sedation in an ambulatory setting. All endoscopic procedures were performed by the three gastroenterologists specialized in therapeutic endoscopy in our department. These EBD procedures were wire-guided. We used one brand of balloons: CRE Wireguided Boston Scientific balloons of 12–15, 15–18 and 18–20 mm diameter, with the following dilatation sizes: 12–13, 5–15–16–16, 5–18–20 mm. Choice of balloon size and duration of inflation was at the discretion of the endoscopist. Regarding the insufflation pressure, it could vary according to the caliber of the balloon used, for the same diameter (e.g., a 15 mm dilatation caliber can be obtained by using a 12–15 balloon with a maximum insufflation pressure, or with a 15–18 mm balloon with a minimum pressure), this variable was therefore not studied.
Angiography and transcatheter arterial embolization for non-variceal gastrointestinal bleeding
Published in Scandinavian Journal of Gastroenterology, 2020
Hai-Yang Lai, Ke-Tong Wu, Yang Liu, Zhao-Fei Zeng, Bo Zhang
Gastrointestinal bleeding can be caused by a variety of pathologies and they differ in onset, location, risk and clinical presentation. Emergency resuscitation should be preferred to any investigations for patients with active gastrointestinal bleeding who are unstable [1,27]. Upper endoscopy and colonoscopy are still the mainstay for the diagnosis and treatment of gastrointestinal bleeding. However, there are several limitations of endoscopy in a setting of acute gastrointestinal bleeding, including inadequate bowel preparation, the influence of large blood clots and fecal content, as well as risks associated with sedation and perforation. Therefore, the definite or potential source of bleeding can be obscured by these limitations, resulting in a high rate of non-diagnostic endoscopic examinations. In our study, 76 of the 158 patients underwent endoscopic examination before angiography, and bleeding was confirmed in 40 patients (52.6%). Among them, endoscopic hemostasis was performed but failed in 26 patients, and endoscopic hemostasis was difficult to perform in the other 14 patients due to vascular malformation, intestinal mass and intestinal diffuse bleeding. The remaining 82 patients did not undergo endoscopic examination before angiography, the causes of which included poor gastrointestinal preparation for massive bleeding, hemorrhagic shock, lack of cooperation with the endoscopic examination, and bleeding caused by gastrointestinal tumors.
The rare Ogilvie’s Syndrome in pregnancy. How to manage? A case report and literature review
Published in Journal of Obstetrics and Gynaecology, 2022
Vittorio Bresadola, Pier Paolo Brollo, Michele Graziano, Carlo Biddau, Tommaso Occhiali, Lorenza Driul
When medical therapy is not effective, and in the absence of clinical-instrumental suspicion of colonic perforation, a detensive endoscopy is indicated. In some medical centres, given its low risk of adverse effects, endoscopy is considered even prior to medical therapy with parasympathomimetic prokinetics. In fact, some studies have reported greater effectiveness, both after primary treatment, and after secondary procedure, as well as reporting a similar risk of perforation (Tsirline et al. 2012; Peker et al. 2017). An important consideration to keep in mind is that endoscopy can be hindered by abundant faecal stagnation, exposing the patient to an increased risk of worsening the dilated bowel and therefore to possible iatrogenic perforation. The procedure is codified in the 2020 ASGE guidelines (Naveed et al. 2020).
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