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.     

Fiberoptic Endoscopy of the Gastrointestinal Tract in Infants and Children

Fiberoptic endoscopy of the upper gastrointestinal tract was performed on 53 patients without incident, ranging in age between two months and 18 years, of whom 35 were out patients at the time of examination. Of 27 patients with recurrent abdominal pain and normal upper gastrointestinal series, eight had abnormal findings at endoscopy: a duodenal ulcer in four, a gastric ulcer in two and duodenitis in two. Of 18 patients with hematemesis and/or melena, esophageal varices were demonstrated both by endoscopy and x-ray in two, gastric ulcer by endoscopy in three and x-ray in one, duodenal ulcer by endoscopy in three and by x-ray in two, esophagitis by endoscopy only in one patient, erosive gastritis by endoscopy in five and by x-ray in two and duodenitis by endoscopy in three and by x-ray in two. Of the remaining eight patients with abnormal x-rays findings and other symptomatology, endoscopy demonstrated foreign bodies in two (coins, esophagus and stomach), duodenitis in two, a gastric ulcer in one, a duodenal ulcer in one and normal examination in two. The data indicate that fiberoptic endoscopy significantly improves diagnostic accuracy in the evaluation of disorders of the upper gastrointestinal tract in children and is a safe and effective procedure in ambulatory pediatric patients.     

Fiberoptic colonoscopy: The fate of colonoscopic polypectomy sites

Summary Nine cases of colonoscopic polypectomy followed by colonic resection are reviewed. A properly performed colonoscopic polypectomy produces a mucosal defect resembling a superficial ulceration. Granulation tissue rapidly covers the area, and this, in turn, is eventually covered by normal colonic mucosal epithelium. Mural inflammation is mild and limited to the submucosa, and no demonstrable change occurs in the muscular layers.     

Abdominal Surgery Affects Small Bowel Transit Time and Completeness of Capsule Endoscopy

The aim of the study was to evaluate bowel dysmotility in patients with a history of abdominal surgery by measuring both gastric transit time and small bowel transit time during capsule endoscopy and assessing the completeness of the examination. The study included 26 patients who had undergone abdominal surgery (postoperative group) and 52 patients who had not (control group). The capsule reached the cecum in 50.0% of the postoperative group and 80.8% of the control group (P = 0.005). While there was no significant difference in gastric transit time between the two groups (P = 0.882), small bowel transit time was significantly longer in the postoperative group (338.3 ± 119.2 min) than in the control group (266.4 ± 110.8 min, P = 0.010). This is the first study to report that the small bowel transit time during capsule endoscopy is prolonged in patients who had a history of abdominal surgery, resulting in a lower frequency of complete examination.     

Meet EBE: The Development of an Evidence-Based Endoscopy Simulator

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Fiberoptic colonoscopy: Complications of colonoscopy and polypectomy

Summary Members of the American Society of Colon and Rectal Surgeons were polled regarding complications of colonoscopy and polypectomy. Sixty per cent of the members responded. One hundred sixty-two surgeons were found to be performing colonoscopy, and this paper presents the accumulated data on complications. A total of 20,139 colonoscopies were performed, with 12,746 diagnostic procedures and 7,393 polypectomies. The overall complication rate was 0,4 per cent with diagnostic colonoscopy and 1.8 per cent with polypectomy. Based upon these complications, guidelines in regard to history, preparation, and technique of colonoscopy and polypectomy are discussed.     

"Mother-Baby" Biliary Endoscopy: The University of Chicago Experience

Objectives : The "mother-baby" technique of peroral cholangioscopy is a relatively recent development in biliary endoscopy and permits direct visualization of the biliary tree. This paper presents the experience of one institution with this new technique. Methods : We used the Olympus mother-baby endoscopy system at the University of Chicago and at one of its affiliated hospitals to examine and treat selected lesions in the biliary tree that had eluded successful diagnosis or treatment by standard means. In addition, we used the baby endoscope alone through surgically created percutaneous tracts to treat selected patients with retained stones. Results : From July 1990 to June 1993, peroral cholangioscopy was performed 18 times in 12 patients at the University of Chicago and affiliated hospitals. The baby endoscope was successfully passed into the bile duct in 15 of 18 cases (83.3%). Additionally, the baby endoscope alone was used through a T-tube or cholecystostomy tract 10 times in six patients. Complications occurred in two patients and were minor; there were no fatalities. With refinement of technique, successful passage of the baby endoscope was accomplished in 100% of patients undergoing peroral cholangioscopy. Conclusions : Direct visualization of the biliary tree with the ability to sample (brush, biopsy) or treat (basket removal, electrohydraulic or laser lithotripsy) lesions significantly aided in the care of all patients in whom the baby endoscope was successfully passed by providing the correct diagnosis and, when appropriate, by allowing definitive treatment of lesions. The eventual role of this technique in the current cost-conscious climate is unclear, but at present it should be limited to selected referral centers.     

The Role of Endoscopy in Suspected Amebiasis

The diagnosis of amebic colitis can be difficult and confusing. The gross endoscopic appearance as well as the results of endoscopic biopsy can be extremely helpful in differentiating amebiasis from other forms of colitis. Clinical symptoms, laboratory studies, x-ray findings, cultures, and even serological studies may not be sufficient for making an accurate diagnosis. To illustrate the potential difficulties we are reporting three patients in whom the diagnosis of amebiasis was considered but in whom endoscopy was important for arriving at the correct diagnosis.     

The Clinical Utility of Wireless Capsule Endoscopy

Capsule endoscopy is a new method of assessing small bowel disease. Current literature has identified a role in obscure gastrointestinal bleeding and evidence for its use in patients with inflammatory bowel disease is increasing. Use in other settings such as surveillance of polyposis syndromes and assessment of patients with abdominal pain has been proposed. The available literature covering the clinical use of capsule endoscopy is reviewed and avenues of further study are suggested.     

Fiberoptic endoscopic examination of swallowing safety: A new procedure

A new procedure for assessing the pharyngeal stage of swallowing in patients with dysphagia is described. Called the fiberoptic endoscopic examination of swallowing safety (FEESS), it is being used to detect aspiration and to determine the safety of oral feeding in patients for whom the traditional videofluoroscopic evaluation may be difficult or impossible to perform. Patients for whom the FEESS procedure is indicated are identified and information obtainable via endoscopy is outlined.     

The Virtues of Transnasal Unsedated Upper Gastrointestinal Endoscopy

Clinical trials report

The Virtues of Transnasal Unsedated Upper Gastrointestinal Endoscopy