Yield of Upper Endoscopy in the Evaluation of Asymptomatic Patients with Hemoccult-Positive Stool after a Negative Colonoscopy

The yield of upper endoscopy in asymptomatic patients with positive fecal occult blood test (FOBT) and a negative colonoscopy was evaluated prospectively in 70 consecutive patients. Significant pathology was diagnosed in 19 patients (27%), eight patients with ulcers, five with arteriovenous malformations, three with esophageal or gastric varices, two with multiple erosions, and two with biopsy-proven Barrett's esophagus. Thirteen patients had iron deficiency anemia and demonstrated a 38% prevalence of significant pathology. Fifteen patients on nonsteroidal anti-inflammatory agents had a 30% prevalence of significant pathology. No statistically significant difference was noted between subgroups. In conclusion, asymptomatic patients without a colonic source to explain a positive FOBT often have significant lesions, on upper endoscopy. Iron deficiency anemia did not have an impact on pathology. Because treatment and follow-up plans were altered in many of the cases in which significant pathology was demonstrated, we conclude that upper endoscopy should be seriously considered for all asymptomatic patients with occult gastrointestinal bleeding and a negative colonoscopic examination.     

PEG ileus

Summary A case of small bowel obstruction due to a lodged percutaneous endoscopic gastrostomy tube inner bumper is described. Most probably inner bumper lodgement in the terminal ileum is related to its size. Laparotomy was required to remove the bumper and relieve the obstruction. We suggest that all percutaneous endoscopic gastrostomy bumpers be retrieved endoscopically when the PEG tube is removed or replaced unless a collapsible inner bumper is used.     

High-resolution chromoendoscopy for classifying colonic polyps: a multicenter study

BACKGROUND: Chromoendoscopy may reliably separate adenomatous from nonadenomatous polyps. The aim of this multicenter trial was to determine the accuracy of high-resolution chromoendoscopy for the determination of colonic polyp histology. METHODS: This multicenter trial included 4 academic centers and a primary care practice. In 299 patients referred for routine colonoscopy or sigmoidoscopy, 520 polyps 10 mm in size were sprayed with indigo carmine dye. Using a high-resolution endoscope, the endoscopist predicted the histology of each polyp based on its surface characteristics. Hyperplastic polyps had a "pitted" surface pattern of orderly arranged "dots" that resembled surrounding normal mucosa. Adenomatous polyps had at least one surface "groove" or "sulcus." Each polyp was subsequently resected for histopathologic evaluation. RESULTS: The resected polyps were comprised by 193 adenomas (37%), 225 hyperplastic polyps (43%), and 102 "other" types (20%). Forty polyps (7.7%) could not be classified by high resolution chromoendoscopy with indigo carmine dye. For the remaining polyps, the sensitivity, specificity, and negative predictive value of indigo carmine dye staining for adenomatous polyps were, respectively, 82%, 82%, and 88%. The results were consistent among the academic centers and the primary care practice. CONCLUSIONS: High-resolution chromoendoscopy with indigo carmine dye demonstrates morphologic detail of diminutive colorectal polyps that can reliably be used to separate adenomatous from nonadenomatous polyps.     

Promoting Arab and Israeli cooperation: peacebuilding through health initiatives

This article describes a positive experience in building Arab and Israeli cooperation through health initiatives. Over the past 10 years Israeli, Jordanian, and Palestinian health professionals have worked together through the Canada International Scientific Exchange Program (CISEPO). In the initial project, nearly 17,000 Arab and Israeli newborn babies were tested for early detection of hearing loss, an important health issue for the region. The network has grown to address additional needs, including mother-child health, nutrition, infectious diseases, and youth health. Our guiding model emphasises two goals: project-specific outcomes in health improvement, and broader effects on cross-border cooperation. Lessons learned from this experience and the model provide direction for ways that health professionals can contribute to peacebuilding.     

Cardiovascular complications after GI endoscopy: occurrence and risks in a large hospital system

BACKGROUND: There is limited information concerning the risks for, and occurrence of, cardiovascular complications because of GI endoscopy. Published data are based on questionnaire surveys, which have a potential for bias. Moreover, available studies pertain exclusively to out-patients. METHODS: In-patients and day-stay patients who incurred charges for endoscopy with endoscopic procedure coding from 1999 through 2001 were identified from a financial database for all 9 hospitals in a large health care system. From these patients, those considered "at risk" for cardiovascular complications were selected based on charges for cardioactive medications, cardiac enzyme determinations, or intensive care services on the day of or the day after endoscopy. Medical records were reviewed for 25% of these patients, selected at random, noting demographics, history, and a modified Goldman score in patients with cardiovascular complications (defined as arrhythmia, chest pain or anginal equivalent, hypotension or myocardial infarction occurring within 24 hours after endoscopy). Identical information was obtained from a random sample of 0.5% of the chart records for all patients undergoing endoscopy. RESULTS: Patients who underwent endoscopy were not reliably identified for one hospital. This hospital was omitted from the calculation of the extrapolated rate of complication occurrence, but patients identified through chart review as having or not having a complication after endoscopy were included in the risk analysis. The extrapolated rate of occurrence of cardiovascular complications was 308: 95% CI [197, 457] per 100,000 procedures. Independent risk factors were: male gender, modified Goldman score, and use of propofol. CONCLUSIONS: In this study of patients undergoing hospital-based GI endoscopy, the risk of procedure-related cardiovascular complications was 2 to 70 times higher than previously reported. This finding may be ascribed to differences in the populations sampled and to a case-finding method that minimized reporting and ascertainment biases.     

Monte Carlo calculations of AAPM Task Group Report No. 43 dosimetry parameters for the (125)I I-Seed AgX100 source model

PurposeThe purpose of this study was to determine the dosimetric parameters of the AgX100, a new ¹²⁵I brachytherapy seed model, using Monte Carlo (MC) simulations according to the protocol specified by the updated American Association of Physicists in Medicine Task Group No. 43 Report (TG-43U1) and compare these parameters with those of the established brachytherapy ¹²⁵I seed models 6711 and I25.S06.Methods and MaterialsIndependent verification of the new seed geometry was performed using high-resolution digital radiography and scanning electron microscopy. MCNPX v.2.5 MC simulations of the AgX100 seed were performed to derive its TG-43U1 parameters, the dose rate constant, the radial dose function, and the two- and one-dimensional anisotropy functions in liquid water. A dosimetric error propagation analysis was also performed to include uncertainty because of seed manufacturing tolerances and physics parameters.ResultsThe MC-calculated dose rate constant for the AgX100 seed was 0.943 cGy·h^?1·U^?1 ± 2.6% (k = 1) based on the air kerma strength for a simulated point detector. Tabulated results of the radial dose function for line and point source approximations and the two-dimensional anisotropy function are also reported.ConclusionsThe MC-predicted dose distribution of the AgX100 seed was found to be comparable with that of the model 6711 seed but much different from the dose distribution of the model I25.S06 seeds. However, at shallow distances, there were some dosimetric differences between the AgX100 and 6711 seed, which warrant separate TG-43U1 parameters for use in clinical treatment planning systems.