Gastrointestinal endoscopy: (first of two parts)

Article Abstract:

Gastrointestinal endoscopy is a method of directly visualizing the digestive tract with a fiberoptic instrument to perform diagnostic and surgical procedures. The cost of the procedure and objections to its possible overuse have led professional groups to develop a series of position papers related to these matters. This report presents detailed recommendations concerning the appropriate and most cost-effective applications of gastrointestinal endoscopy of the upper digestive tract (excluding the large intestine). A table lists the appropriate indications for the technique. Most patients now undergo endoscopy without first undergoing barium X-ray studies (in which the patient swallows a barium meal and the gastrointestinal tract is then X-rayed). Physicians can often refer patients directly for the endoscopic procedure without first obtaining the consultation of a gastroenterologist. Dyspepsia (painful digestion) is the most common reason for endoscopy referral in the authors' clinic. All patients with these symptoms should be carefully screened, and a few weeks of drug treatment should be tried before endoscopy in most cases. The elderly and the immunocompromised should be evaluated with endoscopy soon after the onset of symptoms. Gastrointestinal endoscopy is discussed with regard to several conditions: persistent nausea and vomiting, difficulty or pain on swallowing, chest pain without signs of heart disease, and after the ingestion of caustic substances. The technique is used for small-bowel biopsies, after surgery for obesity, for diagnosing ulcers or malignancy, for controlling bleeding from a peptic ulcer, for performing sclerotherapy of esophageal varices (injecting hardening agents into tortuous, dilated blood vessels in the esophagus), for examining the small intestine, for dilating the esophagus, for creating an entryway directly into the stomach through the abdominal wall for feeding patients (percutaneous gastrostomy), for placing stents (hollow tubes) to allow the esophagus to remain open when malignancy is present, and for the removal of foreign bodies from the esophagus or stomach. (Consumer Summary produced by Reliance Medical Information, Inc.)

Standards, Medical examination, Gastrointestinal system, Gastroscopy, American Society for Gastrointestinal Endoscopy

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Gastrointestinal endoscopy

Article Abstract:

A discussion of the indications for and value of gastrointestinal endoscopy (use of a fiberoptic tube and magnifying lens to diagnose and treat disease of the digestive tract) begun in the October 17, 1991 issue of The New England Journal of Medicine is concluded. Fibersigmoidoscopy (examination of the latter part of the colon with the endoscope) is most often used to screen asymptomatic people for colon cancer. While screening at three- to five-year intervals is recommended for all persons over the age of 40 by the American Cancer Society and the National Cancer Institute, it has not been conclusively shown that mortality is reduced by this approach. One reason may be that the assumption that adenomatous polyps (benign growths) in the sigmoid colon herald cancer of the colon farther up has been questioned: in one study, 27 percent of patients with colon cancer did not have adenomas visible with the fibersigmoidoscope. Colonoscopy (examining the entire colon) is difficult, can be hazardous, and is undoubtedly overused. In many cases where pain is the reason for the diagnostic procedure, fibersigmoidoscopy plus a barium enema is sufficient. The cost-effectiveness of repeat examinations for polyp removal is discussed briefly. Guidelines exist for the management of malignant polyps and of incurable colon cancer. A discussion is presented of the social and economic issues surrounding the question of screening patients at risk for colon cancer. Other topics discussed include endoscopic retrograde cholangiopancreatography (using the endoscope to examine the bile ducts) to diagnose biliary obstruction. When acute pancreatitis (inflammation of the pancreas) is suspected to be due to gallstones, endoscopy is useful. Endoscopic cholangiopancreatography is also recommended to detect and treat stones of the common bile duct and certain obstructions of the bile ducts. The ultrasonic endoscope, which contains an ultrasound transducer, and the videoendoscope, which allows transmission of the image at the viewing/surgical field to a television screen, are new, valuable developments in endoscopy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Endoscopy

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One commensal bacterial molecule: All we need for health?

Article Abstract:

Mazmanian et al. introduced Bacteroides fragilis, a ubiquitous gram-negative anaerobe abundant in the mammalian gastrointestinal tract, into germfree mice to study how the immune system responds to an immunodominant bacterial polysaccharide (Psac) during colonization. The immune response invoked by PSac involved recognition by and activation of antigen-presenting dendritic cells.

United States, Risk factors, Gram-negative bacterial infections, Dendritic cells

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