Esophagogastroduodenoscopy In Patients Research Articles

Özofagogastroduodenoskopi Yapılmış Çocuklarda Özofagus Patolojilerinin Değerlendirilmesi

Objective: Data concerning the prevalence of esophageal pathologies in children, and their relations with age and sex and symptoms, are limited. The purpose of this study was to investigate the prevalence, etiology and endoscopic and histopathological characteristics of esophageal pathologies in children. Material and Methods: Patients aged 1-17 and undergoing esophagogastroduodenoscopy in our unit between May 2009 and June 2015 were investigated retrospectively (n=3081). Patients’ ages, sex, symptoms and endoscopic findings were recorded from their medical files. At statistical analysis, the Independent Two Sample t test was used for normally distributed variables in two-group comparisons and the Mann-Whitney U test for non-normally distributed variables. The chi square test was used to compare categoric variables. results: Pathology was present in the esophagus of 335 patients (10.8%) (endoscopic in 205, histopathological in 12 and both endoscopic and histopathological in 118). Esophageal pathology was more common in patients aged over 10 (p<0.001, OR: 1.65, 95% CI: 1.31-2.08). A higher prevalence of pathology in the esophagus was determined in patients with reflux (89, 26.5%, p<0.001, OR: 7.58, 95% CI: 5.61-10.25) and dysphagia (10, 2.9%, p<0.001, OR: 7.01, %95 Cl: 3.00-16.35). Histopathological abnormality was determined in all patients with hiatal hernia (n=8), and histopathological abnormality was also more common with high-grade esophagitis determined endoscopically. conclusion: This study revealed the diagnostic importance of esophagogastroduodenoscopy in patients aged over 10 with reflux and dysphagia, and that histopathological anomalies are more common in the presence of hiatal hernia and high-grade esophagitis determined endoscopically.

Endoscopic Evaluation in Children With End-Stage Liver Disease-Associated Portal Hypertension Awaiting Liver Transplant.

Routine oesophago-gastro-duodenoscopy (OGD) pre-liver transplantation (LT) for evaluation and management of gastrointestinal (GI) pathology, in particular GI varices secondary to portal hypertension, is common practice in adult LT programmes. There is no universal consensus for this practice in children. We report our endoscopic experience in children with end-stage liver disease (ESLD) pre-LT. Retrospective audit of LT database and review of OGD findings of patients who had undergone endoscopy preceding LT. Of 69 patients with ESLD, 50 (72.4%) had pre-LT OGD, 37 of which were done electively, whereas the remaining 13 were event driven. Forty-eight (96%) patients who underwent OGD had abnormalities, in which 38 (76%) patients had varices and 23 (46%) had portal hypertensive gastropathy. Eleven (22%) patients required therapeutic intervention at initial OGD either with endoscopic variceal band ligation or endoscopic sclerotherapy. Compared with the group who underwent elective OGDs, the group who had event-driven OGDs had a significantly higher requirement for endoscopic intervention (P < 0.0001), occurrence of rebleeding (P < 0.029) and requirement for repeat OGDs (P = 0.014). There was no significant difference in terms of patient (P = 0.2746) or graft survival (P = 0.3192) between the 2 groups. The role of pre-LT OGDs in patients with ESLD associated with portal hypertension is possibly limited to control of bleeding during episodes of GI bleed, where the aim would be to stabilize the patient until eventual LT. Multicentre prospective studies are required to provide more evidence on the use of routine endoscopy for pre-LT assessment in children.

Acupuncture to improve tolerance of diagnostic esophagogastroduodenoscopy in patients without systemic sedation: results of a single-center, double-blinded, randomized controlled trial (DRKS00000164).

BackgroundSedation prior to esophagogastroduodenoscopy is widespread and increases patient comfort. However, it demands additional trained personnel, accounts for up to 40 % of total endoscopy costs and impedes rapid hospital discharge. Most patients lose at least one day of work. 98 % of all serious adverse events occurring during esophagogastroduodenoscopy are ascribed to sedation. Acupuncture is reported to be effective as a supportive intervention for gastrointestinal endoscopy, similar to conventional premedication. We investigated whether acupuncture during elective diagnostic esophagogastroduodenoscopy could increase the comfort of patients refusing systemic sedation.MethodsWe performed a single-center, double-blinded, placebo-controlled superiority trial to compare the success rates of elective diagnostic esophagogastroduodenoscopies using real and placebo acupuncture. All patients aged 18 years or older scheduled for elective, diagnostic esophagogastroduodenoscopy who refused systemic sedation were eligible; 354 patients were randomized. The primary endpoint measure was the rate of successful esophagogastroduodenoscopies. The intervention was real or placebo acupuncture before and during esophagogastroduodenoscopy. Successful esophagogastroduodenoscopy was based on a composite score of patient satisfaction with the procedure on a Likert scale as well as quality of examination, as assessed by the examiner.ResultsFrom February 2010 to July 2012, 678 patients were screened; 354 were included in the study. Baseline characteristics of the two groups showed a similar distribution in all but one parameter: more current smokers were allocated to the placebo group. The intention-to-treat analysis included 177 randomized patients in each group. Endoscopy could successfully be performed in 130 patients (73.5 %) in the real acupuncture group and 129 patients (72.9 %) in the placebo group. Willingness to repeat the procedure under the same conditions was 86.9 % in the real acupuncture group and 87.6 % in the placebo acupuncture group.ConclusionsEsophagogastroduodenoscopy without sedation is safe and can successfully be performed in two-thirds of patients. Patients planned for elective esophagogastroduodenoscopy without sedation do not benefit from acupuncture of the Sinarteria respondens (Rs) 24 Chengjiang middle line, Pericard (Pc) 6 Neiguan bilateral, or Dickdarm (IC) 4 Hegu bilateral, according to traditional Chinese medicine meridian theory.Trial registrationDRKS00000164. Registered on 10 December 2009.

Belching during gastroscopy and its association with gastroesophageal reflux disease.

Belching may result from transient lower esophageal sphincter relaxation; therefore, it has been proposed that belching may be a manifestation of gastroesophageal reflux disease (GERD). This study was conducted to investigate the frequency of belching during esophagogastroduodenoscopy (EGD) and its association with GERD. A retrospective review was performed on prospectively collected clinical and endoscopic data from 404 subjects who underwent EGD without sedation from December 2012 to May 2013 in a training hospital in Korea. All detectable belching events during endoscopy were counted. Frequency and severity of belching events were compared between the group with and without GERD using an ordinal logistic regression model. There were 145 GERD patients (26 erosive reflux disease and 119 nonerosive reflux disease [NERD]). In the multivariable analysis, GERD was significantly associated with a higher frequency of belching events (odds ratio = 6.59, P < 0.001). Central obesity, female, and younger age were also risk factors for frequent belching during EGD. Subgroup analyses were performed in subjects without erosive reflux disease (n = 378) and NERD (n = 293). NERD was also a predictive factor for frequent belching during EGD (odds ratio = 6.61, P < 0.001), and the frequency of belching was significantly correlated with GERD severity according to the Los Angeles classification (P < 0.05). Frequent belching during EGD was associated with GERD, including NERD. Future research should focus on its adjuvant role in the diagnosis of GERD/NERD and the necessity for applying differentiated endoscopy strategies for GERD patients, leading to less discomfort during EGD in patients at risk for intolerability.

Gastroesophageal and extraesophageal reflux symptoms: similarities and differences.

The association between extraesophageal reflux (EER) and symptoms of gastroesophageal reflux disease (GERD) is inadequately understood. We used the Comprehensive Reflux Symptom Scale (CReSS) to evaluate EER and reflux-symptom prevalence in gastroenterology and otolaryngology outpatients and symptom awareness among UK gastroenterologists. Cross-sectional cohort survey. Six hundred thirty-nine participants were surveyed: 103 controls, 359 patients undergoing esophagogastroduodenoscopy (EGD), and 177 otolaryngology clinic patients with throat symptoms. Participants completed the CReSS questionnaire. The study was undertaken in the Endoscopy Unit and the Department of Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle-upon-Tyne, United Kingdom. Registered members of the British Gastroenterology Society were asked to rate how frequently reflux patients might complain of each CReSS item. The median CReSS total in volunteers (4) was significantly lower (P < .002) than in ear, nose, and throat (ENT) patients (26) or EGD patients with (42) or without (32) esophageal inflammation. All items were scored as ≥1 by >15% of ENT patients and 28% of EGD patients. Three major, robust CReSS factors: esophageal, pharyngeal, and upper airway emerged. Of 259 gastroenterologists, >20% scored 8 of the 34 symptoms as never being reported by reflux patients. Endorsement of each EER CReSS item by 28% to 58% of patients with endoscopic evidence of GERD supports the Montreal consensus on an EER-GERD continuum. Gastroenterologists vary considerably in their appreciation of EER symptom relevance. The advantages of CReSS include standardized, comprehensive capture of patient experience; discriminant validity of ENT and GERD patients from volunteers; and discrete esophageal, pharyngeal, and upper airway subscales. 4.

Peptic ulcer disease in liver cirrhosis and chronic hepatitis: impact of portal hypertension

Objective. The pathophysiology of peptic ulcer disease (PUD) in liver cirrhosis (LC) and chronic hepatitis has not been established. The aim of this study was to assess the role of portal hypertension from PUD in patients with LC and chronic hepatitis. Materials and methods. We analyzed the medical records of 455 hepatic vein pressure gradient (HVPG) and esophagogastroduodenoscopy patients who had LC or chronic hepatitis in a single tertiary hospital. The association of PUD with LC and chronic hepatitis was assessed by univariate and multivariate analysis. Results. A total of 72 PUD cases were detected. PUD was associated with LC more than with chronic hepatitis (odds ratio [OR]: 4.13, p = 0.03). In the univariate analysis, taking an ulcerogenic medication was associated with PUD in patients with LC (OR: 4.34, p = 0.04) and smoking was associated with PUD in patients with chronic hepatitis (OR: 3.61, p = 0.04). In the multivariate analysis, taking an ulcerogenic medication was associated with PUD in patients with LC (OR: 2.93, p = 0.04). However, HVPG was not related to PUD in patients with LC or chronic hepatitis. Conclusion. According to the present study, patients with LC have a higher risk of PUD than those with chronic hepatitis. The risk factor was taking ulcerogenic medication. However, HVPG reflecting portal hypertension was not associated with PUD in LC or chronic hepatitis (Clinicaltrial number NCT01944878).

Is esophagogastroduodenoscopy before Roux-en-Y gastric bypass or sleeve gastrectomy mandatory?

BackgroundRoux-Y Gastric Bypass is a frequently used technique in bariatric surgery. Postoperative anatomy is altered by exclusion of the stomach, which makes this organ inaccessible for future esophagogastroduodenoscopy (EGD). The value of preoperative assessment of the stomach is unclear. Some institutions choose to investigate the future remnant stomach by EGD, others do not. Aim of the present study is to quantify the yield of preoperative EGD in our institution. MethodsPatients, planned for primary laparoscopic Roux-Y Gastric Bypass (LRYGB) or laparoscopic sleeve gastrectomy from December 2007 until August 2012, were screened by EGD in advance. Results of EGD and patient characteristics were retrospectively analyzed and categorized according to a classification system based on intervention needed. Results523 patients (122 male, 401 female, mean age 44.3 years, average BMI 46.6) underwent preoperative EGD. In 257 patients (48.9%) no abnormality was found (group A), 117 patients (17.2%) had abnormalities without treatment consequences (B1), 84 patients (of the 326 tested [comment #1, reviewer #1, 26.8%] were H. Pylori positive (B2), in 75 (14.3%) treatment with proton pump inhibitors was required (B3), 6 (1.1%) required follow up EGD before surgery (C). For1 patient (0.2%) the operation was canceled because preoperative EGD presented with Barrett’s esophagus with carcinoma (D). When all abnormalities were taken into account, baselines did show a significant difference for age, gender and reflux symptoms. ConclusionStandard preoperative assessment by EGD in patients who are planned for bariatric surgery is not indicated. The number needed to screen to find clinically significant abnormalities is high.

Endoscopy After Acute Myocardial Infarction

Upper gastrointestinal bleeding in the setting of acute myocardial infarction (MI) has substantial morbidity and mortality. Several studies have been performed on the safety of esophagogastroduodenoscopy (EGD) after MI; however, these studies vary in definitions and results. We evaluated the safety and effect of EGD in patients with acute MI in a tertiary center. A retrospective, single tertiary-care center study was undertaken of 87 patients who underwent EGD within 30 days of an acute MI between January 2001 and March 2012. Type of MI (ST segment elevation MI [STEMI] and non-ST segment elevation MI [NSTEMI]), peak troponin I, time from MI to EGD, Acute Physiology and Chronic Health Evaluation (APACHE) II score at EGD, cardiac catheterization before EGD, and medical complications within 24 hours of EGD were noted. Medical complications were defined as major complications (death, life-threatening arrhythmias) and minor complications (chest pain, abnormal vital signs, or minor arrhythmias). Eighty-seven patients underwent EGD within 30 days of having an MI. No major complications were observed. Minor complications occurred in 27 of 87 patients (31.0%), including mild hypotension, mild bradycardia, or increased chest pain. Patients with STEMI demonstrated statistically significant quicker endoscopy (P = 0.01) and were more likely to undergo cardiac catheterization in advance of EGD (P < 0.01) than those with NSTEMI. No statistically significant differences were noted for peak troponin I (P = 0.21), APACHE II score at EGD (P = 0.55), or minor complications (P = 0.08) among patients with STEMI versus NSTEMI. Cardiac catheterization before EGD did not seem to affect results. Patients with APACHE II scores >16 experienced more minor complications (P = 0.02). EGD appears relatively safe for the diagnosis and management of upper gastrointestinal bleeding in patients with acute MI.

Erythromycin decreases the time and improves the quality of EGD in patients with acute upper GI bleeding.

To evaluate the efficacy of erythromycin to decrease the time and improves the quality of EGD in patients with acute upper GI bleeding. The diagnostic and therapeutic value of esophagogastroduodenoscopy (EGD) in patients with upper GI bleeding is often limited by the presence of residual blood or clots. Infused erythromycin (3 mg/kg) before EGD, a potent gastro kinetic drug, might improve the quality of EGD in patients with upper GI bleeding and decrease the time of EGD and second- look EGD. In a prospective, randomized, double-blind controlled trial, 40 patients with acute upper gastrointestinal bleeding in Taleghani hospital, Tehran, Iran were studied. The patients were randomized into 2 groups: 1) nasogastric tube placement receiving placebo, and 2) intravenous erythromycin infusion (3mg/kg at 30 min) combined with nasogastric tube placement. The primary end point was endoscopic yield, as assessed by objective and subjective scoring systems and endoscopic duration. Secondary end points were the need for a second look, blood units transfused, and length of hospital stay and mortality. A clear stomach was found more often in the erythromycin group (100% vs. 25%; P < 0.001). Erythromycin shortened the endoscopic duration (14 vs. 32 minutes in the placebo group; P < 0.001) and reduced the need for second-look endoscopy (1 vs. 3; P < 0.001), admission duration (2 vs 5; P < 0.001) and reduced the blood units transfused (2 vs 4; P < 0.001). In patients with acute upper GI bleeding, infusion of erythromycin before endoscopy significantly decreases the time and improves the quality of EGD.

Candida esophagitis with fever alone in a patient with stroke

Background: Candida esophagitis is a rare disease, but its incidence is higher in patients with impaired immunity due to an underlying disease. Patients with candida esophagitis usually present with lower retrosternal pain or dysphagia, but they are sometimes asymptomatic. Several risk factors, including diabetes mellitus, malignancies, chronic obstructive pulmonary disease (COPD) and steroid therapy, have been shown to be associated with candida esophagitis. Candida esophagitis may mimic other disease processes and can thus be misdiagnosed.Case study: This study describes a case of candida esophagitis with fever alone in the patient with stroke. After a stroke attack, a 53-year-old man was hospitalized for rehabilitation. He had a fever unexpectedly, but the cause could not be found for 2 weeks. Esophagogastroduodenoscopy (EGD) was performed to find the cause of the fever and it was diagnosed as candida eosphagitis. Fever decreased respectively 4 days after anti-fungal therapy begun.Conclusion: Dysphagia, unexplained anaemia, loss of appetite and dyspepsia may require EGD to make a confirmative diagnosis. If unexplained fever is persistent without any of these symptoms, it is advisable to consider EGD in patients with stroke.

Obesity is Associated With High Risk Stigmata of Peptic Ulcer Disease

Obesity is a worsening epidemic in the United States (US). National Health and Nutrition Examination Survey (NHANES) data shows that one third of the US population is obese (BMI >30). Patients with obesity are at increased risk for a variety of GI conditions including GERD symptoms, erosive esophagitis, Barrett's esophagus, esophageal adenocarcinoma, gallstones, colonic adenomas, colon cancer, non-alcoholic fatty liver disease, and liver cirrhosis. Population studies suggest that obesity is a risk factor for peptic ulcer disease (PUD). The endoscopic appearance or stigmata of bleeding on initial esophagogastroduodenoscopy (EGD) predicts recurrent bleeding. AIM: To evaluate if obesity is a risk factor for high risk endoscopic stigmata of PUD. METHODS: This study was an IRB-approved protocol. 8050 EGD between 11/17/05 and 2/28/10 were reviewed for the finding of ulcer. Inclusion criteria: 1) Initial EGD with the finding of gastric or duodenal ulcer. Exclusion criteria: 1) malignant ulcer, 2) esophageal ulcer, and 3) incomplete documentation. Data collected: age, sex, BMI, ulcer stigmata, location, size, inpatient/outpatient status, NSAID and aspirin status, and H. pylori status. Ulcer appearance was documented by the Forrest classification. High risk stigmata: active spurting of blood (IA) or oozing blood (IB), a nonbleeding visible vessel or pigmented protuberance (IIA), and an adherent clot (IIB). Low risk stigmata: flat, pigmented spot (IIC), and clean-based ulcer (III). Statistical analysis: Chi square, logistic regression. RESULTS: 350 patients (mean age 64.8) with PUD were included. The mean BMI was 27.8. There were 95.7% males, 32.6% of the patients were obese (BMI >30), 30.3% were positive for H. pylori, and 68.9% were taking NSAIDS. 42% were inpatients and 58% were outpatients. Of all ulcers, the mean size was 8.6 mm, 58.0% were located in the stomach, 87.1% were low risk, and 12.9% were high risk. The distribution of stigmata by the Forrest classification: IA 2.9%(n=10), IB 2.6%(n=9), IIA 5.7%(n=20), IIB 1.7%(n=6), IIC 11.7%(n=41), and III 75.4%(n=264). High risk stigmata was not associated with age, sex, H. pylori status, or use of NSAIDS. However, it was significantly associated with BMI category (BMI ≥35: high risk stigmata 23.3%; BMI < 35: high risk stigmata 11.4% (p = 0.03)) and location (duodenum: high risk stigmata 17.7% vs. stomach: high risk stigmata 9.4% (p = 0.02)). Both BMI category (p=0.03) and PUD location (p=0.02) were significant independent predictors of high risk stigmata. CONCLUSION: A BMI ≥ 35 was associated with a significantly higher risk of stigmata on initial EGD in patients with PUD. A BMI≥ 35 may be helpful in risk stratification of patients with suspected PUD bleeding.

Upper Digestive Bleeding in Atrial Fibrillation: Evaluation of Gastroscopy Prior to Oral Anticoagulant Therapy (GOAT), Prospective, Randomized, Double Blind Study on a Community Population.

BackgroundThe aim of this study was to investigate the incidence of digestive hemorrhages in patients with non-valvular atrial fibrillation (NVAF), scheduled for oral anticoagulant therapy.MethodsWe conducted, over 24 months, a prospective, randomized, population-based observational study on consecutive patients with recurrent paroxysmal, persistent, or permanent NVAF, scheduled for oral anticoagulant therapy. The study initially included 268 patients with NVAF (162 males and 106 females) with a mean age of 74 years (range 42-86 years). Patients were split into two groups: those undergoing preventive Esophago-Gastro-Duodenoscopy (EGD) (Group A) and those who did not (Group B). All patients positive by EGD underwent medical treatment and subsequent 30-day endoscopic controls showed complete healing. The primary outcome of the study was to determine if previous EGD in patients with NVAF resulted in a low risk of bleeding during oral anticoagulant therapy. The two groups were comparable for most variables.ResultsSignificant differences were found between groups for the incidence of antiarrhythmic drugs and for early hemorrhage (P <0.001). The incidences of early hemorrhages were significantly different between the two groups with 12 in group B (12%) and 2 in group A (1.7%).ConclusionsPreventive EGD can identify hidden digestive diseases, which may increase the incidence of early hemorrhages.

Oesophagogastroduodenoscopy in patients with cirrhosis: Extending the range of detection beyond portal hypertension

Background Oesophagogastroduodenoscopy is currently recommended for the screening of varices in cirrhosis. In addition to the assessment of varices, oesophagogastroduodenoscopy can detect conditions that, while unrelated to portal hypertension, may require treatment. Aims We evaluated in a large cohort of cirrhotic patients the prevalence of upper digestive findings other than oesophagogastric varices, the associations between upper gastrointestinal findings, portal hypertension and features of cirrhosis, and the incidence of new lesions in the course of a surveillance program. Methods Analysis of the records of 611 consecutive cirrhotic patients undergoing oesophagogastroduodenoscopy for screening and surveillance. Results 232 patients (38%) presented endoscopic lesions not related to portal hypertension: peptic diseases ( n = 193), proliferative diseases ( n = 27) and vascular diseases ( n = 12). In the screening group, 127 patients (39.4%) had pathologic lesions. At multivariate analysis, an association was found between peptic diseases and the absence of portal hypertensive gastropathy (RR 3.3; 95% CI 2.2–4.8); vascular diseases were associated with endoscopic signs of portal hypertension ( p = 0.01). During surveillance, 9/55 patients (16.3%) in the group without previous pathologic findings developed new lesions. Conclusions Oesophagogastroduodenoscopy in patients with cirrhosis undergoing endoscopy for screening diagnosed pathologic lesions unrelated to portal hypertension requiring a change in management in 39.4% of asymptomatic subjects.

Meta-analysis of capsule endoscopy in patients diagnosed or suspected with esophageal varices

To review the literature on capsule endoscopy (CE) for detecting esophageal varices using conventional esophagogastroduodenoscopy (EGD) as the standard. A strict literature search of studies comparing the yield of CE and EGD in patients diagnosed or suspected as having esophageal varices was conducted by both computer search and manual search. Data were extracted to estimate the pooled diagnostic sensitivity and specificity. There were seven studies appropriate for meta-analysis in our study, involving 446 patients. The pooled sensitivity and specificity of CE for detecting esophageal varices were 85.8% and 80.5%, respectively. In subgroup analysis, the pooled sensitivity and specificity were 82.7% and 54.8% in screened patients, and 87.3% and 84.7% in the screened/patients under surveillance, respectively. CE appears to have acceptable sensitivity and specificity in detecting esophageal varices. However, data are insufficient to determine the accurate diagnostic value of CE in the screen/surveillance of patients alone.

Assessment of Pre-Gastroscopy Fasting Period Using Ultrasonography

Discomfort is frequent in patients undergoing esophagogastroduodenoscopy who are routinely recommended to abstain at least for 6 h from liquid or solid food prior to the procedure. We investigated the minimal period of time required for the stomach to clear fluids in order to define a safe minimal pre-endoscopy fasting period. Gastric emptying was sonographically assessed in 54 patients by measurement of the antrum surface area prior to, immediately after, and 30, 60, and 90 min after ingestion of 300 ml water and water containing 75 g glucose or apple juice. Esophagogastroduodenoscopy was performed subsequently. Ingestion of water required 1 h for complete clearance. Three hundred milliliters glucose solution and apple juice were cleared more slowly, 90 min after drinking. Ingestion of water or glucose solution prior to esophagogastroduodenoscopy in patients without a history of gastric emptying dysfunction is safe when observing a 90 min latency period and might prevent discomfort.

Benefit of preoperative flexible endoscopy for patients undergoing weight-reduction surgery in Saudi Arabia

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

Prevalence and Predictors of Esophageal Varices in Patients With Primary Biliary Cirrhosis

Esophageal varices and bleeding are among the most feared complications of primary biliary cirrhosis (PBC). We aimed to determine the prevalence of esophageal varices in patients with PBC, to evaluate noninvasive markers of esophageal varices in this population, and to validate the results in an independent set of patients. Data were collected on all patients with PBC seen for the first time at the University of Florida (study group) and at Case Western Reserve University hospitals (cross-validation group) during 7 consecutive years. Logistic regression analysis was used to identify independent predictors of esophageal varices. The best cut-off values were calculated based on receiver operating characteristic curves. The diagnostic accuracy of the independent predictors of esophageal varices identified in the study group were retested in the cross-validation group. Of 210 patients with PBC seen at the University of Florida, 113 had an endoscopy and 49.6% (56 of 113) were found to have esophageal varices. After excluding 22 patients with a history of variceal bleeding, data on 91 patients were analyzed. Thirty-four patients had esophageal varices (37%). Multivariate analysis revealed that a platelet count of less than 140,000 (odds ratio, 7.6; 95% confidence interval, 1.6-37) and a Mayo risk score of 4.5 or greater (odds ratio, 10.6; 95% confidence interval, 1.8-62) were independent predictors of esophageal varices. The diagnostic accuracy of these predictors was confirmed in an independent set of patients. Among patients with PBC, a platelet count of less than 140,000 and/or a Mayo risk score of 4.5 or greater appears to identify those patients more likely to benefit from a screening endoscopy.

Prospective randomized trial of transnasal versus peroral endoscopy using an ultrathin videoendoscope in unsedated patients

The aim of this study was to compare the acceptance and tolerance of transnasal and peroral esophagogastroduodenoscopy (EGD) using an ultrathin videoendoscope in unsedated patients. A total of 124 patients referred for diagnostic endoscopy were assigned randomly to have an unsedated transnasal EGD (n = 64) or peroral EGD (n = 60) with local anesthesia. An ultrathin videoendoscope with a diameter of 5.9 mm was used in this study. A questionnaire for tolerance was completed by the patient (a validated 0-10 scale where '0' represents no discomfort/well tolerated and '10' represents severe discomfort/poorly tolerated). Of the 64 transnasal EGD patients, 60 patients (94%) had a complete examination. Four transnasal EGD examinations failed for anatomical reasons; all four patients were successfully examined when switched to the peroral EGD. All 60 peroral EGD patients had a complete examination. Between the transnasal and peroral groups, there was a statistically significant difference in scores for discomfort during local anesthesia (1.5 +/- 0.2 vs 2.6 +/- 0.3, P = 0.003), discomfort during insertion (2.3 +/- 0.3 vs 4.3 +/- 0.3, P = 0.001), and overall tolerance during procedure (1.6 +/- 0.2 vs 3.8 +/- 0.2, P = 0.001). In all, 95% of transnasal EGD patients and 75% of peroral EGD patients (P = 0.002) were willing to undergo the same procedure in the future. Four patients in the transnasal EGD group experienced mild epistaxis. For unsedated endoscopy using an ultrathin videoendoscope, transnasal EGD is well tolerated and considerably reduces patient discomfort compared with peroral EGD.

The clinical significance of thickened gastric folds found on upper gastrointestinal series.

To assess the impact of upper endoscopy and biopsy on the outcome of patients with isolated thickened gastric folds found on barium upper gastrointestinal series (UGIS). A total of 8,325 consecutive UGIS reports were reviewed to identify 182 patients who were found to have isolated thickened gastric folds. Patients with other serious radiographic abnormalities were excluded. The 182 patients were studied by a systematic review of the esophagogastroduodenoscopy (EGD) findings, gastric biopsy results, and clinical outcome. The study included 96 men (52.7%) and 86 women (47.3%) who had isolated thickened gastric folds on the UGIS. Seventy-four patients underwent EGD; 108 patients did not. The two groups were similar in demographic and clinical features. The EGD results were normal, 18 (24.3%); thick gastric folds, 12 (16.2%); hiatal hernia, 12 (16.2%); erythema/inflammation, 11 (14.9%); erosions, 8 (10.8%); portal gastropathy, 3 (4.1%); and gastric ulcer, 1 (1.4%). Forty-eight of the 74 EGD patients had a gastric biopsy. The findings were chronic active gastritis, 39 (81.3%); and chronic gastritis, 5 (10.4%). Evidence for H. pylori infection was present in 91.7% of the gastric biopsies. Outcome (mean follow-up, 28.5 months) was assessed in 49 patients in the EGD group and in 55 patients in the non-EGD group. There were no cases of serious or new UGI problems in either group. Isolated thickened gastric folds found on UGIS are frequently associated with H. pylori infection. Performing endoscopy and biopsy did not appear to alter the outcome in these patients.

Enteroscopy for the initial evaluation of iron deficiency

Background: Occult gastrointestinal blood loss is generally investigated with colonoscopy and esophagogastroduodenoscopy in patients with iron-deficiency anemia. The aim of this study was to prospectively measure the additional diagnostic yield of examining the jejunum at the time of upper endoscopy in patients with iron-deficiency anemia. Methods: Asymptomatic patients with newly diagnosed iron-deficiency anemia who had no identifiable source of blood loss at colonoscopy underwent standard esophagogastroduodenoscopy with the Olympus SIF100L enteroscope followed by overtube-assisted enteroscopy. Upper tract and jejunal sources of blood loss were noted. Biopsy samples from the small bowel were taken when a bleeding lesion was not identified. Results: Thirty-one consecutive patients (13 men, mean age 71) with no gastrointestinal symptomatology were studied. Eleven patients (35%) had a bleeding source that required only esophagogastroduodenoscopy for identification; 8 patients (26%) had a source only in the jejunum; 2 patients (6%) (one with sprue) had a source in upper tract as well as jejunum. The enteroscopy was rated as causing minimal or mild discomfort in 25 of 31 patients (81%). Using Medicare reimbursement figures, a strategy of performing esophagogastroduodenoscopy first would have cost $656 per patient, whereas the strategy of performing esophagogastroduodenoscopy with enteroscopy as the initial test in all patients costs $467 per patient. Conclusions : Performance of push enteroscopy along with esophagogastroduodenoscopy increases the diagnostic yield from 41% to 67% when evaluating the upper gastrointestinal tract of asymptomatic patients with iron-deficiency anemia and, because of a lower cost, should be the preferred initial diagnostic test. (Gastrointest Endosc 1998:47:144-48)