Gastrointestinal Endoscopic Examination Research Articles

Value of upper gastrointestinal endoscopic examination of head and neck cancer patients

Between January 1995 and March 1999, we performed the upper gastrointestinal endoscopic examinations on 287 patients with head and neck cancers and detected 23 cases (8%) of esophageal cancer and 8 cases (2.8%) of gastric cancer, showing how frequently esophageal cancer occurs in head and neck cancer. The esophageal cancer involved the oral cavity in 8 cases (9.5%), the oropharynx in 3 cases (8.6%), the hypopharynx in 10 cases (19.6%), and the larynx in 2 cases (2%). Esophageal cancer occurred most frequently in hypopharyngeal cancer, particularly the pyriform sinus type and the postcricoid type. We conclude that upper gastrointestinal endoscopic examination, including Lugol staining, is necessary in head and neck cancer patients.

生石灰誤飲による食道潰よう，喉頭浮腫例

Calcium oxide is commonly used as a desiccant for food in Japan. Calcium oxide, reacting with water, changes into calcium hydroxide and releases heat. Calcium hydroxide is a strong alkaline and seriously damages mucosa and skin together with heat. We report a rare case of a corrosive injury of the esophagus and larynx caused by calcium oxide. A 67-year-old male accidentally swallowed calcium oxide, mistaking it for a cookie. After 6 hours, he complained of dyspnea and dysphagia. An upper gastrointestinal endoscopic examination revealed an ulcer of the upper esophagus and edema of the pharynx and larynx. He underwent a tracheostomy and was treated with prednisolon, aluminum hydroxide and magnesium hydroxide and recovered with no complications.

System for Fast Measurements of in Vivo Fluorescence Spectra of the Gastrointestinal Tract at Multiple Excitation Wavelengths

We describe a nitrogen dye laser—optical multichannel analyzer (OMA) system capable of quickly measuring tissue autofluorescence spectra in vivo at multiple excitation wavelengths. Sample spectra were acquired successfully from patients undergoing gastrointestinal (GI) endoscopic examination.

Clinical applications of technetium Tc 99m hexamethyl propylene amine oxime leukocyte scan in children with inflammatory bowel disease.

Labeled leukocyte imaging is a helpful diagnostic tool in the detection of inflammation and sepsis. The technetium Tc 99m hexamethyl propylene amine oxime (99mTc HMPAO)-labeled leukocyte scan has been found to be more sensitive than the Indium-111 labeled leukocyte scan in detecting inflammatory bowel disease, with reported sensitivities of 95% to 100%. Experience with the 99mTc HMPAO-labeled leukocyte scan was examined and its clinical applications evaluated in the immediate treatment of patients with inflammatory bowel disease. A retrospective chart review was undertaken that included pediatric patients who underwent 99mTc HMPAO-labeled leukocyte scan at the James Whitcomb Riley Hospital for Children. The disease activity of patients with inflammatory bowel disease was assessed. The leukocyte scan was performed according to the manufacturer's specifications, and images were obtained 30 minutes and 2 hours after administration of the radiopharmaceutical. During the period of July 1996 through November 1997, 41 scans were performed in 35 patients. Twenty-nine patients had histologically proven inflammatory bowel disease: 24 with Crohn's disease, 4 with ulcerative colitis, and 1 with indeterminate colitis. Active inflammatory bowel disease was suspected in 24 patients when the leukocyte scan was performed. Twenty of the 24 patients (83% sensitivity) had abnormal findings in leukocyte scans that prompted more aggressive management in 15 (75%). Six of the 15 who were receiving maximum medical therapy underwent surgical resection of severely affected bowel segments, and medical treatment was intensified in the other 9. The remaining 5 patients were receiving optimal medical therapy, instituted at their recent visit, and did not require further medication adjustments. Four of the 24 patients with active inflammatory bowel disease had normal leukocyte scans (17% false-negative rate), 3 of whom were receiving corticosteroid therapy at the time the scans were performed. All of the 11 patients in whom inflammatory bowel disease was in remission and 6 patients who did not have inflammatory bowel disease had normal findings in leukocyte scans (100% specificity). Although a tissue diagnosis is still recommended, obtained during upper and lower gastrointestinal endoscopic examinations, and contrast radiography of the small bowel for the initial work-up of patients with suspected inflammatory bowel disease, the 99mTc HMPAO-labeled leukocyte scan is a safe and useful diagnostic adjunct for subsequent evaluation of patients known to have inflammatory bowel disease. The results of 99mTc HMPAO-labeled leukocyte scans directly influenced treatment of 75% of the study patients with active inflammatory bowel disease, which included the decision to refer patients for surgical intervention.

Overuse or underuse of endoscopy? The optimal indications

The quality and costs of health care depend on the appropriate indications for medical procedures. Although upper gastrointestinal endoscopy is safe and effective, the increasing number of patients referred for this procedure leads to high cost and in some countries an overload on endoscopic resources. Health care insurers, public and private, look for a reduction in the number of upper gastrointestinal endoscopic examinations and a reduction in coding. Patients and endoscopists fear that restricted use might lead to a decrease in the quality of health care provided to the general population of western Europe.

Abnormal Iodine-131 Uptake in the Mediastinum Caused by Achalasia

A 50-year-old woman who had had surgery 4 years earlier for papillary carcinoma of the thyroid received 30 mCi 1-131 for ablation. Follow-up 1-131 imaging showed successful thyroid gland ablation; however, persistent activity was present in the mediastinum corresponding to the esophageal projection. The patient had been experiencing dysphagia for approximately 10 years. Esophageal scintigraphy showed delayed transit time. A contrast esophagogram showed a rat tail deformity with narrowing most marked at the gastroesophageal junction and dilatation of the entire esophagus. Although endoscopic examination demonstrated nonperistaltic contractions, an upper gastrointestinal endoscopic examination was normal. Because these findings suggested achalasia, we concluded that the abnormal I-131 uotake was caused by achalasia.

The effect of ciprofloxacin in the prevention of bacterial infection in patients with cirrhosis after upper gastrointestinal bleeding

Objectives: Cirrhotic patients with upper gastrointestinal bleeding are prone to bacterial infection. The aim of this study was to investigate the efficacy of prophylactic intestinal decontamination with oral ciprofloxacin for the prevention of bacterial infections in cirrhotic patients with upper gastrointestinal bleeding. Methods: A total of 120 cirrhotic patients with acute upper gastrointestinal bleeding were enrolled. Sixty patients received ciprofloxacin 500 mg twice daily given orally or through nasogastric tube immediately after upper gastrointestinal endoscopic examination; drug administration continued for 7 days. The remaining 60 patients, who received placebo, served as controls. Results: The incidence of proven bacterial infection in the ciprofloxacin-treated group was significantly lower than that of placebo group (10% vs 45%, p < 0.001). The incidences of bacteremia, spontaneous bacterial peritonitis, and urinary tract infection in the ciprofloxacin-treated group were significantly lower than those in the placebo group (0% vs 23%, 3.3% vs 13%, and 5% vs 18%, respectively; p < 0.05, respectively). Multivariate logistic regression analysis showed that a lack of prophylactic treatment with ciprofloxacin and severity of cirrhosis were the independent significant predictors for cirrhotic patients with acute gastrointestinal bleeding with infection. Conclusions: Prophylactic intestinal decontamination with oral ciprofloxacin is effective in the prevention of bacterial infections in patients with cirrhosis who were suffering from acute upper gastrointestinal hemorrhage.

The Effect of Ciprofloxacin in the Prevention of Bacterial Infection in Patients With Cirrhosis After Upper Gastrointestinal Bleeding

Cirrhotic patients with upper gastrointestinal bleeding are prone to bacterial infection. The aim of this study was to investigate the efficacy of prophylactic intestinal decontamination with oral ciprofloxacin for the prevention of bacterial infections in cirrhotic patients with upper gastrointestinal bleeding. A total of 120 cirrhotic patients with acute upper gastrointestinal bleeding were enrolled. Sixty patients received ciprofloxacin 500 mg twice daily given orally or through nasogastric tube immediately after upper gastrointestinal endoscopic examination; drug administration continued for 7 days. The remaining 60 patients, who received placebo, served as controls. The incidence of proven bacterial infection in the ciprofloxacin-treated group was significantly lower than that of placebo group (10% vs 45%, p < 0.001). The incidences of bacteremia, spontaneous bacterial peritonitis, and urinary tract infection in the ciprofloxacin-treated group were significantly lower than those in the placebo group (0% vs 23%, 3.3% vs 13%, and 5% vs 18%, respectively; p < 0.05, respectively). Multivariate logistic regression analysis showed that a lack of prophylactic treatment with ciprofloxacin and severity of cirrhosis were the independent significant predictors for cirrhotic patients with acute gastrointestinal bleeding with infection. Prophylactic intestinal decontamination with oral ciprofloxacin is effective in the prevention of bacterial infections in patients with cirrhosis who were suffering from acute upper gastrointestinal hemorrhage.

Acute gastric mucosal lesions (AGML) caused by Helicobacter, pylori (H. pylori) infection after endoscopy

AGML occasionally develop after upper gastrointestinal endoscopic examination. We report about the diagnosis of endoscopic infection with H. pylori and character of the strains in respect of gene. Patient and Methods: We studied six patients (5 males and 1 female, mean 43.8 yrs, range 27-61). The patients underwent endoscopy for screening for gastric disease at other hospital and were normal endoscopically. On day 5 or 6, they complained of epigastric pain and nausea. They visited our hospital and endoscopy was repeated. AGML were seen in the antrum. To detect H. pylori infection, biopsy specimens of the mucosa of the gastric antrum and body were taken for culture, rapid urease test and light microscopic examination. Serum IgG anti-/-/, pylori antibody was measured by ELISA for exclusion of previous infection. PCR method of cag A and vac A gene was performed with regard to the gene of H. pylori. Results: In all cases, H. pylori was detected by culture and Giemsa staining, whereas rapid urease test were negative. Serum IgG antibody was negative in all cases at first visit. All strains had both cag A and vac A gene. Four of six patients were treated without eradication therapy and AGML was healed within 14 days. In three of these four cases, H. pylori was not detected by culture and histological examination. In only one patient, a small number of H. pylori was detected histologically. The patient relapsed AGML after 3 months without a trigger. His blood group was group O and Lewis b+ which was repotted associated with attachment H. pylori to gastric mucosa. Conclusion: 1).H. pylori infection through endoscopy was responsible for postendoscopic AGML. 2). Rapid urease test was negative. 3). Stains which may cause AGML possess cag A. 4). In one of 4 cases, chronic infection was established. These finding suggest that the genetic factor of host and stain contribute to the pathogenicity and resistance to H. pylori infection.

A CASE OF COLLISION TUMOR WITH ESOPHAGEAL SQUAMOUS CELL CARCINOMA AND GASTRIC SIGNETRING CELL CARCINOMA AT THE CARDIA

A 62-year-old man was seen at the hospital because of dysphagia. Upper gastrointestinal series and endoscopic examination showed a type 2 lesion at the cardia and a Borrmann type 5 lesion in the stomach. Biopsy specimens demonstrated squamous cell carcinoma and signet ring cell carcinoma, respectively. A collision tumor was strongly suspected. The resected material showed the type 2 lesion measuring 6.0×5.0cm and the Borrmann type 5 lesion measuring 8.5×5.5cm which located close to each other at the cardia. Histologically, the esophageal squamous cell carcinoma and the gastric signet ring cell carcinoma were separated only by a thin fibrous tissue, and there was no histological transition between two lesions. With respect to metastatic sites, only one component from each tumor was seen.

Use of conscious sedation for lower and upper gastrointestinal endoscopic examinations in children, adolescents, and young adults: a twelve-year review

Background: Over the past decade, many pediatric endoscopists have replaced general anesthesia with conscious sedation. Sedation is commonly used to minimize discomfort. Methods: To evaluate the safety and efficacy of conscious sedation we reviewed 2711 reports of lower and upper gastrointestinal endoscopic examinations performed in 2026 patients between July 1981 and December 1992. Results: Intravenous sedation was accomplished using meperidine and diazepam (914 examinations, 35%) or meperidine and midazolam (1427 examinations, 55%). Single agents were used for 83 examinations (3%), and 96 examinations (3.5%) were performed with the patient under general anesthesia. In the lower endoscopy group sedated intravenously (n = 713), the cecum was reached in 82% of examinations. The procedure could not be completed in 17 cases in which patients were uncooperative despite sedation. In the upper endoscopy group sedated intravenously (N = 1653), all but 91 endoscopies were completed to the descending duodenum. Esophagoscopy had been planned in 76% of these procedures. Minor complications occurred in 7 patients (0.3%). This included two episodes of significant oxygen desaturation that responded to oxygen administration and narcotic reversal. A major complication occurred in 1 patient (0.04%) who had a gastric perforation during esophageal dilation over a defective guide wire. There were no deaths, episodes of cardiorespiratory arrest, or pulmonary aspirations in our series. The combined major and minor complication rate was 0.3%. Conclusions: Intravenous conscious sedation is safe and effective in children undergoing endoscopic examination of the gastrointestinal tract. Selected patients will require general anesthesia. (Gastrointest Endosc 1997;45:375-80.)

Excess costs from gastrointestinal disease associated with nonsteroidal anti-inflammatory drugs.

To quantify medical care costs for the diagnosis and treatment of gastrointestinal disorders attributable to use of nonsteroidal anti-inflammatory drugs (NSAIDs) other than aspirin in elderly persons. Retrospective cohort study of 75,350 Tennessee Medicaid enrollees at least 65 years of age. The cohort was classified by baseline NSAID use as nonusers (no use preceding 1988), occasional users (< 75% of days) or regular users (> or = 75% of days). For the follow-up year (1989), we calculated annual rates of utilization of and Medicare/Medicaid payments for: medical care for NSAID-associated gastrointestinal disorders; hospitalizations/emergency department visits for peptic ulcers, gastritis/duodenitis, and gastrointestinal bleeding; outpatient upper and lower gastrointestinal tract radiologic and endoscopic examinations; and histamine2 (H2)-receptor antagonist, sucralfate, and antacid prescriptions. Rates were adjusted for demographic characteristics and baseline health care utilization. Among nonusers of NSAIDs, the adjusted mean annual payment for all types of medical care for study gastrointestinal disorders was $134. This increased to $180 among occasional users, an excess of $46 (p < .001); and to $244 among regular users, an excess of $111 (p < .001, comparison with both nonusers and occasional users). Cohort members with any baseline year NSAID use had an adjusted mean annual payment of $191, $57 (p < .001) higher than that for nonusers. In both users and nonusers of NSAIDs, medications and inpatient care accounted for the largest component of costs. Among regular NSAID users, excess payments increased with baseline NSAID dose: $56, $120, and $157 for less than 1, 1 to 2, and more than 2 standard units per day, respectively (p < .01, linear trend). Nonsteroidal anti-inflammatory drug (NSAID) use in elderly patients was associated with substantial excess costs and utilization of medical care for gastrointestinal disorders.

Primary malignant melanoma (clear cell sarcoma) of bone: Report of a case arising in the ulna

To the authors' knowledge, there has been no previous report of primary malignant melanoma of bone. A 33-year-old woman presented with a tumorous lesion in the olecranon of the right ulna. The histologic diagnosis was malignant melanoma with close similarity to clear cell sarcoma. To exclude the possibility of malignant melanoma metastatic to the bone, clinical investigations including gallium 67-citrate scintigraphy, brain, chest, and abdominal computed tomography, and upper and lower gastrointestinal endoscopic examinations were performed. Conventional histopathologic, immunohistochemical, and electron microscopic studies were also performed. Clinical investigations showed no lesion suggestive of a primary melanoma other than that in the right ulna. Histologically, the tumor was comprised of polygonal or fusiform cells with clear or granular cytoplasm and vesicular nuclei containing one or two prominent nucleoli. The features were similar to those of clear cell sarcoma (malignant melanoma of soft parts). Fontana preparations and immunohistochemical staining for S-100 protein and HMB-45 (melanoma specific antigen) also revealed that the tumor cells had the characteristics of malignant melanoma. The patient has remained alive and well for more than 5 years after the initial treatment. The clinicopathologic findings in this case strongly suggested that the lesion was a primary malignant melanoma of bone. Therefore, this is the first report to indicate that malignant melanoma and related diseases can occur even in bone tissue.

Misoprostol Dosage in the Prevention of Nonsteroidal Anti-inflammatory Drug-Induced Gastric and Duodenal Ulcers: A Comparison of Three Regimens

To compare the effectiveness and tolerability of three misoprostol dosing regimens for the prevention of gastric and duodenal ulcers associated with long-term nonsteroidal anti-inflammatory drug (NSAID) therapy. A multicenter, 12-week, randomized, double-blind, placebo-controlled, parallel, four-limb study. Eligibility criteria included upper gastrointestinal symptoms during NSAID therapy and no endoscopic evidence of gastric or duodenal ulcers. A total of 1623 patients was enrolled; 1197 of these met major accession and regimen-compliance criteria and completed the trial. These 1197 patients composed the evaluable group. Patients were randomly assigned to one of four regimens: placebo four times daily; 200 micrograms of misoprostol twice daily and placebo twice daily; 200 micrograms of misoprostol three times daily and placebo once daily; and 200 micrograms of misoprostol four times daily. Upper gastrointestinal endoscopic examinations for ulcers were done after 4, 8, and 12 weeks of therapy. Tolerability and safety of the regimens were assessed by adverse-event monitoring. In the placebo group, the incidence of gastric ulcers was 15.7% and the incidence of duodenal ulcers was 7.5%. The incidence of gastric ulcers was significantly lower in the groups receiving misoprostol twice daily (8.1%; difference, 7.6% [95% CI, 2.7% to 12.5%]; P = 0.002), three times daily (3.9%; difference, 11.8% [CI, 7.4% to 16.3%]; P < 0.001), and four times daily (4%; difference, 11.7% [CI, 6.7% to 16.8%]; P < 0.001) compared with placebo. The gastric ulcer rate was significantly higher in patients receiving misoprostol twice daily compared with those receiving misoprostol three times daily (difference, 4.2% [95% CI, 0.7% to 7.7%]; P = 0.02). A significant (P = 0.02) misoprostol dose-response effect was noted in the prevention of gastric ulcers. The incidence of duodenal ulcers was significantly lower in the groups receiving misoprostol twice daily (2.6%; difference, 4.9% [CI, 1.5% to 8.2%]; P = 0.004), three times daily (3.3%; difference, 4.2% [CI, 0.6% to 7.7%]; P = 0.019), and four times daily (1.4%; difference, 6.1% [CI, 2.6% to 9.6%]; P = 0.007) compared with placebo. No significant difference was detected between patients receiving misoprostol twice daily and those receiving misoprostol three times daily, and no dose-response effect was noted with duodenal ulcers. The incidence of withdrawals for adverse events was significantly lower in the groups receiving misoprostol twice daily (12%) and three times daily (12%) than in the group receiving it four times daily (20%). The incidence of gastrointestinal adverse events was significantly higher in the group receiving misoprostol four times daily (74%) than in the placebo group (62%). Misoprostol, 200 micrograms twice or three times daily, offers substantial protection against gastric and duodenal ulcers in patients receiving long-term NSAID therapy. These dosages were better tolerated than the currently approved regimen of 200 micrograms four times daily.

A CASE OF PEPTICULCERS IN A PULLED-UP GASTRICTUBE 5 YEARS AFTER OPERATION FOR AN ESOPHAGEAL CANCER

A 71-year-old man was seen at the hospital because of epigastralgia after a 5-year uneventful postoperative course. In 1986 the patient was diagnosed as having a lu esophageal cancer and underwent total resection of the intrathoracic esophagus with esophageal replacement via the retrosternal route by means of a gastric tube and pyloroplasty. This time an upper gastrointestinal series and endoscopic examination revealed two A2 stage peptic ulcers on the anterior wall and posterior wall of the lower part of the gastric tube respectively. He had not have any habitual use of non-steroidal anti-inflammatory drugs. The Gastogram of the gastric tube showed the rapid empty pattern. The serum gastrin value was high. The good acidity of the gastric tube was revealed by the acid analysis, 24 hours gastric tube pH-monitor and the endoscopic Congo-Reddye test. The gastric mucosal prostaglandin E2 value was high. Although H2-blocker was not effective, there was a clinical and endoscopical improvement with H+-inhibitor. We presum that in this csase, the peptic ulcers in a gastric tube were caused by losing the balance of the offense and deffense factors due to an incerse of the offense factor.

Breath hydrogen excretion after oral administration of xylose to cats

ABSTRACTMaximum breath hydrogen excretion after the oral administration of xylose to 11 healthy cats ranged from 0.13 ml/hour to 0.47 ml/hour, with a mean of 0.18 ml/hour. After oral administration of xylose, breath hydrogen excretion in five cats with chronic diarrhoea and, or, vomiting was significantly different (P&lt;0.001) compared with healthy cats. Increased breath hydrogen excretion occurred before xylose was given and at all measurement times after its administration to the sick cats (P&lt;0.05), indicating carbohydrate malassimilation. In four sick cats, large increases in breath hydrogen excretion occurred, with maximum values ranging from 1.21 to 1.56 ml/hour, but in one cat the maximum value was only 0.28 ml/hour. Plasma xylose concentrations in cats with chronic diarrhoea and, or, vomiting were not significantly different from healthy cats (P&gt;0.05) and thus did not demonstrate carbohydrate malassimilation. A hiatus hernia was seen on radiographic views of the thorax and abdomen of one cat with chronic vomiting. Inflammatory bowel disease was found in three of the five sick cats after upper gastrointestinal endoscopic examination and mucosal biopsy. Clostridium species were isolated in increased numbers from the cats with chronic diarrhoea and, or, vomiting (P&lt;0.005), after quantitative bacterial culture of small intestinal fluid specimens obtained endoscopically. Clostridium species were isolated from all five cats with chronic diarrhoea and, or, vomiting but from only one of eight healthy cats. However, whether a specific bacterial pathogen caused the increased breath hydrogen excretion found in these cats could not be determined from this study.

頭頚部癌患者における上部消化管スクリーングの重要性について 特に食道内視鏡検査の有用性について

頭頚部癌患者における上部消化管スクリーングの重要性について 特に食道内視鏡検査の有用性について

A CASE REPORT OF THE PRIMARY EARLY SMALL DUODENAL BULB CANCER SHOWING AN ELEVATED LESION WITH CENTRAL DEPRESSION

A 70-year-old man was seen at the hospital because of epigastralgia. He was diagnosed as intestinal obstruction on his abdominal plain film and was admitted for further examination. A small elevated lesion on the anterior wall of the duodenal bulb was recognised by gastrointestinal endoscopic examination and the pathological specimen showed adenocarcinoma. Gastrectomy with partial resection of the duodenum was performed under a diagnosis of primary early duodenal bulb cancer. A 4.0×3.0mm elevated lesion with central depression was found at the anterior portion of the duodenal bulb on the macroscopical finding. Postoperative histopathological findings disclosed a well differentiated adenocarcinoma with submucosal invasion. This is the smallest case and fourth case showing an elevated lesion with central depression in the Japanese literature. An exact gastrointestinal endscopic examination is rutinely required for the finding of early duodenal bulb cancer.

巨大なⅠ型早期胃癌の1例

A 76-year-old woman was admitted to our hospital complaints of epigastralgia. Upper gastrointestinal series and endoscopic examinations identified a giant nodular tumor with rough surface extending from anterior wall to greater curvature of the antrum. By using ultrasonography, it was revealed that the serosal side of the proper muscle layer was well preserved and unaffected by the tumor, although the mucosal side of the proper muscle layer was involved. The tumor was diagnosed to be advanced gastric cancer of type I. A subtotal gastrectomy was performed. Pathological findings revealed a well differentiated adenocarcinoma limited within the mucosal layer.

A CASE OF DOUBLE CANCER OF THE STOMACH AND LARYNX WITH THE SIGN OF LESER-TRÉLAT

A 73-year-old man was admitted to the hospital because of upper abdominal discomfort and hoarseness on May 21 1993, when the seborrheic keratosis, rapidly increasing with itchin, were seen on his trunk. An upper gastrointestinal series and endoscopic examination showed so called 3'type gastric cancer on the posterior wall at the upper corpus. Biopsy revealed signet ring cell carcinoma. A swollen and reddish vocal cord was diagnosed as laryngeal cancer by laryngendoscopic examination. Cytology revealed squamous cell carcinoma. So, this patient was diagnosed as double cancer of the stomach and larynx with the sign of Leser-Trelat. Total gastrectomy, splenectomy and distal pancreatectomy were performed for the gastric cacner. Radiotherapy for the laryngeal cancer was done after the operation. The sign of Leser-Trelat is one of the dermatedoromes. Especially, this paraneoplastic syndrome is most frequently associated with adenocarcinoma of the gastrointestinal tract. Malignant diseases with the sign of Leser-Trelat are discussed in this report with 73 cases in Japan.