Time Of Esophagogastroduodenoscopy Research Articles

Comparison Of Data Obtained from Sedated versus Unsedated Wireless Telemetry Capsule Placement: Does Sedation Affect the Results of Ambulatory 48-Hour pH Testing?

The introduction of 48-hour wireless pH testing provides a novel technique of evaluating persons with suspected reflux disease. The wireless capsule can be placed in a sedated individual at the time of esophagogastroduodenoscopy (EGD) or in an unsedated individual at a time after the initial EGD, at the time of esophageal manometry or at the time of transnasal esophagoscopy. The effect that sedation has on the results of 48-hour wireless pH testing has not been evaluated. To evaluate the day to day variability and the effect of sedation on the results of 48-hour wireless pH testing. The charts of all patients at a tertiary swallowing center undergoing 48-hour wireless pH testing between June 1, 2003 and December 31, 2004 were retrospectively evaluated. Data concerning study indications, route of pH capsule placement, duration of pH recording, and test results were collected. Day to day variability was evaluated, and the results obtained from persons with sedated and unsedated pH capsule placement were compared. Two hundred and six studies were performed. The indications for the examination were gastroesophageal reflux disease (146/206), chronic cough (36/206), and laryngopharyngeal reflux (24/206). Sixty-two percent (128/206) of the studies were performed without sedation and 38% (78/206) with sedation. The overall reproducibility of the daily pH recordings (day 1 vs. day 2) was 77%. Although some trends were observed, there was no significant association between the use of sedation and any of the reflux parameters on pH testing (P > .05). The day to day reproducibility of 48-hour wireless pH testing was 77%. Intravenous sedation does not appear to have a significant effect on the results of 48-hour wireless pH testing.

Dysphagia without endoscopically evident disease: to dilate or not?

OBJECTIVES: It is not known whether patients with symptoms of dysphagia but normal upper endoscopy benefit from empiric esophageal dilation. The aim of this prospective study was to determine whether patients with solid food dysphagia and normal upper endoscopy have symptomatic benefit from empiric dilation using a through-the-scope balloon. METHODS: Patients who were seen for complaints of solid food dysphagia and who had normal endoscopic examinations at our institution from 1998 through 1999 were identified. Those patients who had agreed before sedation to participate in the study, if eligible, were randomized to either sham or balloon dilation using an 18-mm through-the-scope balloon at the time of esophagogastroduodenoscopy. All potentially eligible patients who had given provisional consent completed a dysphagia questionnaire and a 10-cm visual analog dysphagia scale before endoscopy. Follow-up questionnaires were completed on day 1 and at 3 months and 6 months after the procedure. The primary endpoint of the study was the patient’s self-assessment of difficulty swallowing, based on the questionnaires. RESULTS: A total of 83 patients met the study criteria and were randomized to balloon dilation (n = 43) or sham (n = 40). The two groups were comparable in age, sex, severity of baseline dysphagia, and use of antireflux medication. Improvement in dysphagia comparing sham to balloon on day 1 was 66% versus 67% ( p = 0.99); at 3 months it was 82% versus 76% ( p = 0.56); and at 6 months it was 84% versus 73% ( p = 0.38). There were no reported complications in either group. CONCLUSION: The data from this prospective randomized, controlled study do not support the practice of empiric dilation in patients with symptoms of dysphagia without an endoscopically evident cause of dysphagia.

Prevalence of clinically relevant bacteremia after upper gastrointestinal endoscopy in bone marrow transplant recipients

purpose: To determine the prevalence of clinically relevant bacteremia after upper endoscopy in patients undergoing bone marrow transplantation. patients and methods: We retrospectively reviewed the records of 151 patients who received an HLA-identical allogeneic bone marrow transplant (BMT) at the Seattle Veterans Affairs Medical Center between September 1983 and December 1988. Forty-seven patients who required esophago-gastroduodenoscopy (EGD) during their first 100 days after transplant were selected for evaluation. Clinically relevant bacteremia was defined as the development of hypotension, temperature greater than 38.5°C, and a positive blood culture occurring within 24 hours after endoscopy. The presence of acute graft-versus-host disease (GVHD) at the time of endoscopy and the use of prednisone prior to endoscopy were considered possible risk factors for the development of bacteremia. The proportion of subjects who became bacteremic were compared using Fisher's exact test. results: Within 24 hours following endoscopy, nine patients (19%) developed clinically evident bacteremia (hypotension, temperature greater than 38.5°C, and a positive blood culture). Eight of 14 patients receiving prednisone at the time of endoscopy developed bacteremia, compared to one of 33 not receiving prednisone (p <0.01). Nineteen patients had acute GVHD of at least grade 2 at the time of EGD, six of whom developed bacteremia. Although acute GVHD alone did not increase the risk of post-EGD bacteremia in patients not receiving prednisone (one of 21 versus zero of 12, p >0.9), the risk of bacteremia was particularly high in patients with acute GVHD treated with prednisone at the time of EGD (six of seven). conclusion: Allogeneic BMT recipients receiving prednisone for immunoprophylaxis after grafting or for treatment of acute GVHD are at high risk for clinically relevant bacteremia following EGD. Such patients are candidates for antibiotic prophylaxis prior to endoscopy.