Fiberoptic Endoscopy of the Gastrointestinal Tract in Infants and Children

Fiberoptic colonoscopy was performed on 15 patients between the ages of 1 1/2 years and 16 years. Ten patients were hospitalized and five were outpatients. Of 12 with frank or microscopic blood in stools, fiberoptic colonoscopy revealed single polyps in six patients, ulcerative colitis in two and negative results in four with prior nondiagnostic radiographic studies, colonoscopy revealed ulcerative colitis in one, granulomatous colitis in one and negative findings in one. Polypectomy through the colonoscope was accomplished in all six patients with polyps. Perforation of the sigmoid colon during polypectomy with the snare loop was the single complication encountered. Lower intestinal endoscopy should be selectively considered for diagnosis and therapy of unexplained bleeding or recurrent lower abdominal pain in children in whom proctosigmoidoscopic laboratory and radiographic examinations do not achieve a diagnosis.     

Endoscopy of the Upper Gastrointestinal Tract

Fiberendoscopy of the upper gastrointestinal tract recently has become a routine diagnostic procedure. This is due to its broad spectrum of applications and to its "reputation" of simplicity and innocuousness. The possible complications of fiberendoscopy, however, are similar to those of rigid endoscopy. Most of these complications can and must be avoided by strict adhesion to elementary precautions: adequate teaching and supervision of endoscopists in training; emphasis on all stages of the patient's preparation, psychological and pharmacological, each adopted to the individual patient and constant awareness of the possibility of complications.     

术中内镜在胃肠手术中的应用价值

目的：探讨术中内镜在胃肠手术中的应用价值。方法：对32例胃肠手术的患者进行了术中内镜检查，其中25例为剖腹探查，7例为术前明确诊断但术中找不到病灶或难以确定病灶的边缘者。结果：25例剖腹探查术患者24例通过术中内镜明确了诊断，分别为：胃底Dieulafoy病1例，胃溃疡1例，十二指肠平滑肌瘤3例，小肠平滑肉瘤2例，十二指肠水平部Dieulafoy病1例，十二指肠水平部平滑肌瘤2例，回肠淋巴瘤2例，小肠腺瘤性息肉2例，加肠末段溃疡2例，小肠海绵状血管瘤3例，小肠动静脉畸形4例，胰空肠吻合口出血1例。所有32例患者除1例小肠息肉和1例结肠息肉予内镜下高频电切除术、1例未找到病灶而未予特别处理外，其余28例患者均进行了病变切除。结论：应用术中内镜不仅极大地提高了病变的检出率，而且能对病变准确定位。术中内镜诊疗术是安全且有效的。     

Recent Advances in Light-Induced Fluorescence Endoscopy (LIFE) of the Gastrointestinal Tract

Abstract: Gastrointestinal (GI) cancer continues to be a significant malignant disease. It is well recognized that early detection of dysplastic changes prior to invasive growth may have a pronounced effect on the clinical efficacy of treatment and subsequent patient survival. Standard white-light endoscopic visualization of such early lesions is often difficult and many premalignant lesions remain undetected during routine screening procedures. Additionally, dysplastic lesions are usually not distinguished against surrounding normal tissue, and visible non-adenomatous lesions such as hyperplastic polyps are often indistinguishable from adenomatous polyps. However, recent developments in endoscopic technology have led to the development of more sensitive endoscopic screening methods. Fluorescence-based endoscopic imaging or spectroscopy of the gastrointestinal tract may offer a novel and alternative means of detecting and identifying premalignant and malignant lesions otherwise occult to conventional white-light endoscopy. The purpose of this review is to present a general overview of the current developments and possible clinical roles of light-induced fluorescence endoscopy (LIFE) as an adjunct to conventional diagnostic endoscopy for screening and surveillance for premaligant and malignant gastrointestinal lesions. (Dig Endosc 1999; 11: 108–118)     

Follicular Lymphoma with Extensive Gastrointestinal Tract Involvement: Follow-up by Capsule Endoscopy

Follicular lymphoma with gastrointestinal tract involvement is rare. We describe the case of a young woman with follicular lymphoma with multiple nodular lesions involving segments of the proximal jejunum and terminal ileum. The presenting symptom was chronic diarrhea. The diagnosis was made by endoscopy with histologic examination of the mucosal lesions of the proximal and distal small intestine, immunohistochemical staining, and molecular analysis. The initial spread and pattern of the small bowel involvement, as well as treatment response, were evaluated by videocapsule endoscopy. The application of molecular analysis along with immunophenotypic evaluation has made it possible to precisely diagnose follicular lymphoma. In the present case, the use of capsule endoscopy improved the evaluation of the extent of small bowel involvement prior to and following treatment.     

Opiates and the Gastrointestinal Tract

Opiate peptides, encephalins and endorphins, originally isolated from the brain, have been detected by the immunocytochemistry and radioimmunoassay in the digestive system and localized in the distinctive endocrine-paracrine cells of APUD series of the gastrointestinal mucosa and the nerve fibers of the myenteric plexus. The physiological role of endogenous opiates is unknown but the spectrum of biological action on the digestive system resembles that of morphine and related drugs. They strongly affect gastrointestinal motility such as gastric and intestinal contractions, gastric emptying, intestinal transit, biliary pressure and defecation. They also increase gastric secretory activity and raise gastric mucosal microcirculation without affecting gastrin release. They inhibit pancreatic bicarbonate and enzyme secretion probably via suppressing the release of intestinal hormones, secretin and cholecystokinin. The actions of opiates on the motility and secretion can be reversed by specific opiate receptor antagonists, e.g. naloxone, indicating that opiate receptors may be involved in these actions.     

Recent Advances in Gastrointestinal Endoscopy

Since 1970 considerable advances have been made in the field of fiber-optical endoscopy. One essential factor is that a greater variety and more efficient instruments became available. The development moved first in the direction of a more precise diagnosis and second in the direction of therapeutic or operative endoscopy.     

Methane and the Gastrointestinal Tract

Introduction

Several gases are produced through enteric fermentation in the intestinal tract. Carbon dioxide, hydrogen, hydrogen sulfide, and methane are thought to be the most common of these. Recent evidence suggests that methane may not be inert. In this review article, we summarize the findings with methane.

Methods

This is a review article discussing the various component gases in the gastrointestinal tract and their relevance to health and disease. Specific attention was paid to understanding methane.

Results

The majority of these gases are eliminated via flatus or absorbed into systemic circulation and expelled from the lungs. Excessive gas evacuation or retention causes gastrointestinal functional symptoms such as belching, flatulence, bloating, and pain. Between 30 and 62% of healthy subjects produce methane. Methane is produced exclusively through anaerobic fermentation of both endogenous and exogenous carbohydrates by enteric microflora in humans. Methane is not utilized by humans, and analysis of respiratory methane can serve as an indirect measure of methane production. Recent literature suggests that gases such as hydrogen sulfide and methane may have active effects on gut function. In the case of hydrogen sulfide, evidence demonstrates that this gaseous product may be produced by human eukaryotic cells. However, in the case of methane, there is increasing evidence that this gas has both physical and biological effects on gut function. It is now often associated with functional constipation and may have an active role here.

Conclusion

This review of the literature discusses the significance of enteric flora, the biogenesis of methane, and its clinical associations. Furthermore, we examine the evidence for an active role of methane in gastrointestinal motility and the potential applications to future therapeutics.     

The Place of Upper Gastrointestinal Tract Endoscopy Before and After Vertical Banded Gastroplasty for Morbid Obesity

In industrialized countries, surgicalgastroplasty is performed more and more frequently inpatients with morbid obesity. The aims of thisprospective study were to determine the incidence ofupper gastrointestinal lesions in obese patients and to assess theplace of digestive endoscopy in symptomatic patientsafter gastroplasty. A consecutive group of 159 obesepatients were studied before and after vertical banded gastroplasty. In the preoperative evaluation,reflux esophagitis and gastroduodenal lesions wereendoscopically observed in 31% and 37% of the patients,respectively. Interestingly, the majority of the obese patients with upper gastrointestinallesions were asymptomatic. In the postoperativefollow-up period, 55 of the 159 patients complained ofupper gastrointestinal symptoms such as vomiting (72%), esophageal reflux (17%), and epigastric pain(3%). Stenosis of the outlet of the gastric pouch wasdescribed in 40 of the 55 symptomatic patients.Esophagitis was observed in 60% of these patients.Endoscopic dilation using Savary bougies or TTS balloonwas successfully performed in all the patients withsymptomatic stenosis of the gastric outlet. Foodimpaction was endoscopically removed in four patients.Thus, we recommend performing an uppergastrointestinal endoscopy in obese patients who arecandidates for surgical gastroplasty because of the highincidence of upper gastrointestinal peptic lesions.Endoscopy is also helpful in patients with digestivedisorders occurring after gastroplasty in order todefine and to treat the lesions.