Upper gastrointestinal endoscopy in children

The purpose of this paper is to study the use of upper gastrointestinal (Gl) fiberoptic endoscopy in children. Two hundred consecutive patients referred to one of the authors were reviewed. The indications for performing upper gastrointestinal endoscopy in these 200 patients were: (1) recurrent abdominal pain (46.5%), (2) persistent vomiting (14.5%), (3) haematemesis (14.5%), (4) acute abdominal pain (13%) and (5) other indications such as foreign body removal, failure to thrive and unexplained chest pain (11.5%). The endoscopy was performed with the Olympus P3 or Olympus XP-10 gastroscopes. The sedation used was a combination of intravenous pethidine (2mg/kg) and diazepam (0.5 mg/kg). Among the patients with recurrent abdominal pain, upper Gl endoscopy showed duodenal ulcer in 7 patients (7.5%), duodenitis in 4 (4.3%), oesophagitis in 4 (4.3%) and gastric ulcer in 2 (2.2%). The rest of the patients were normal (81.7%). With regard to persistent vomiting, 37.9% of the patients showed gastroesophageal reflux and 6.9% had a hiatus hernia. Of 29 patients examined endoscopically for upper Gl bleeding, no focus of bleeding was identified in 27.6%. The remaining 72.4% were bleeding from acute gastric erosion (27.6%), oesophagitis (17.2%), oesophageal varices (13.8%), duodenal ulcer (10.3%) and Mallory-Weiss tear (3.5%). The Majority of the patients with acute abdominal pain were normal endoscopically (61.5%). The two common abnormal findings were acute gastritis (27.0%) and acute duodenitis (11.5%). No major complications were encountered during the procedure in these 200 patients. It was concluded that upper Gl endoscopy is useful for defining upper Gl mucosal pathology. The procedure can be performed safely in children under sedation.     

消化内镜规范化教学的临床实践

消化内镜诊疗技术在当今消化内科疾病诊治中具有非常重要的作用。通过实施规范化、制度化的内镜培训教学实践，提高了内镜教学水平，研究生能掌握常用的消化内镜诊疗技术，为他们以后的工作打下了良好的基础。     

Upper gastrointestinal endoscopy in children - an experience at a paediatric gastroenterology unit

Upper gastrointestinal endoscopy has changed the management of upper gastrointestinal problems in children. The aim of this communication is to share our experience with 153 cases on whom upper gastrointestinal endoscopy was done over a period of 24 months at a paediatric gastroenterology unit of a tertiary care hospital of Dhaka, Bangladesh. Children who attended the department with various gastrointestinal problems are the subjects of this paper. Intravenous midazolam and 10% pharyngeal xylocain were used in majority of cases for sedating the children. The ages of the children were between 15 months to 15 years (9.41+/- 3.22 years). The positive diagnostic yield was 92 out of 153 cases (60.1%). The major indication for doing endoscopy in the present series was recurrent abdominal pain (51.6%), followed by upper gastrointestinal bleeding (28.8%). Combining histopathological findings and CLO/rapid urease tests the overall positive yield of recurrent abdominal pain was 45 out of 79 (57%). The sources of upper gastrointestinal bleeding could be identified in 79.5% cases. Esophageal varices indicating portal hypertension were found in 62.5% children who were endoscoped for unexplained splenomegaly with or without ascitis. Endoscopy has become a safe and valuable procedure in the management of upper gastrointestinal problems in children and gastric antral biopsy has increased the positive diagnostic yield of recurrent abdominal pain in the studied children.     

Upper gastrointestinal endoscopy findings in Nigerians: a review of 170 cases in Lagos

BACKGROUND: The advent of flexible endoscopy has made it possible to visualise the mucosa of virtually the entire intestine. This service is yet to be widely available in Nigeria. Existing reports on indications and findings at endoscopies are sometimes conflicting, with some recent reports suggesting a changing pattern of gastrointestinal diseases. OBJECTIVE: The study set out to evaluate the indications, endoscopic findings and their frequencies as well as any adverse outcome from the endoscopic examinations. METHODOLOGY: This was a retrospective study in which we reviewed the endoscopy records of the first one hundred and seventy patients that underwent upper gastrointestinal endoscopy at the Lagos State University Teaching Hospital. The patients' bio data, indications and findings during endoscopic examinations as well as any adverse outcome were documented. Data obtained were analysed using SPSS version 11. RESULTS: The majority of the patients were in the middle to elderly age with a peak in the 5th decade. The commonest indications for upper gastrointestinal endoscopy were; Dyspepsia, upper gastrointestinal haemorrhage, previously diagnosed peptic ulcer unresponsive to treatment and retrosternal discomfort or pain. Endoscopic request for variceal screening were uncommon. The commonest endoscopic findings were; features of gastroesophageal reflux disease, followed by gastroduodenitis (non-ulcer mucosal lesions in stomach and duodenum) and peptic ulcer disease. In 14 patients the endoscopy examination revealed normal findings. CONCLUSION: The role of endoscopy in the diagnosis and management of gastrointestinal disorders cannot be overemphasised. It is hereby recommended that provision of endoscopic facilities and training of necessary personnel be encouraged by all relevant agencies so that the services can be accessible and affordable by all who require it in view of its importance in patient management.     

Advances in gastrointestinal endoscopy

Endoscopy has a rapidly expanding role in diagnosis and management of gastrointestinal disease.     

临床路径带教在胃肠外科护理实习教学中的应用

目的探讨临床路径带教在护理实习教学中的应用效果。方法将80名专科护理学生随机分为对照组和实验组。对照组采用传统方法带教,实验组采用临床路径带教,比较两组护生在出科综合考试成绩和对带教的满意度等方面的差异。结果实验组均明显优于对照组（P〈0．05）,差异有统计学意义。结论临床路径带教可显著提高护理实习教学质量。     

Total gastrointestinal endoscopy in the management of Peutz-Jeghers syndrome.

Peutz-Jeghers syndrome was diagnosed in a 51-year-old woman presenting with iron deficiency anaemia. Upper gastrointestinal endoscopy and colonoscopy revealed several hamartomatous polyps in the stomach, duodenum and colon, which were removed. At a combined surgical-endoscopic procedure, 42 hamartomatous polyps were removed from the small intestine by snare polypectomy. This enteroscopic procedure reduces symptoms, may protect against future intestinal obstructive episodes and their associated surgery, and may reduce the risk of developing gastrointestinal malignancy.     

Salmonella typhimurium. Transmission by fiberoptic upper gastrointestinal endoscopy.

During a four-month period, Salmonella typhimurium developed in seven persons within five days of fiberoptic upper gastrointestinal (GI) endoscopy. A retrospective cohort study confirmed the association between S typhimurium infection and fiberoptic upper GI endoscopy. Salmonella typhimurium was cultured from the endoscopic equipment and the accessory suction equipment. The Salmonella isolated from the endoscopic and accessory suction equipment was identical to that recovered from the seven patients with salmonellosis by serotype, antimicrobial susceptibility pattern, and bacteriophage lysis pattern. Salmonella transmission was attributed to inadequate disinfection of the endoscope and accessory equipment between procedures. The original source of the contamination was not discovered.     

Pulse oximetry monitoring during non-sedated upper gastrointestinal endoscopy.

Fifty consecutive patients judged fit for non-sedated upper gastrointestinal endoscopy were monitored by pulse oximetry before, during and after the procedure. Transient hypoxia developed during intubation in five subjects (10%) but treatment was not required nor was the test halted. Only one patient with pre-existing respiratory problems became hypoxaemic to the extent that oxygen had to be given and the procedure halted. The chance of hypoxia was unrelated to age, sex, smoking, anxiety, or the duration of intubation. Routine pulse oximetry is not necessary for non-sedated gastroscopy but oximetry monitoring may be important in selected cases.     

Outcome and benefits of upper gastrointestinal endoscopy in the elderly.

Presenting symptoms, physical findings and treatment were reviewed in 70 patients over 65 years old who underwent oesophago-gastro-duodenoscopy in the Royal Victoria Hospital, Belfast, during an 18-month period. Most frequent indications for the procedure were epigastric pain, retrosternal pain or haematemesis. Physical signs were present in only 54%. Abnormal endoscopic findings were detected in 97%. The majority of patients responded to subsequent treatment. It was not possible to identify clinical features associated with major gastrointestinal pathology, which aided selection of those subgroups of elderly patients who would most benefit from endoscopy.     

Upper gastrointestinal haemorrhage-a review of 100 cases.

The case records of the last 100 consecutive patients with upper gastrointestinal tract bleeding admitted to the adult section of the Mater Misericordiae Hospital have been analysed with attention to presentation, investigations, aetiology, management and mortality. The period of these admissions was almost three years-from May, 1971, to June, 1974.