Endoscopy means looking inside and refers to looking inside the human body for medical reasons.

Overview

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It is a minimally invasive diagnostic medical procedure used to evaluate the interior surfaces of an organ by inserting a small scope in the body, often but not necessarily through a natural body opening. Through the scope, one is able to see lesions.

An instrument may not only provide an image but also enable taking small biopsies and retrieve foreign objects. Endoscopy is the vehicle for minimally invasive surgery.

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Surgical Endoscopy (Online First™)

The burden of endoscopic retrograde cholangiopancreatography (ERCP) performed with the patient under conscious sedation
Thu, 02 Feb 2012 18:07:54 -0000
Abstract Background  Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure that proves burdensome to patients. Nevertheless, very little data are available on patient tolerance of this procedure that may improve practice guidelines and could aid in decreasing the burden of ERCP. This study therefore investigated the burden of ERCP performed with the patient under conscious sedation. Methods  Consecutive patients receiving ERCP under conscious sedation between November 2007 and December 2008 at the University Medical Center Utrecht and Erasmus MC Rotterdam (The Netherlands) were asked to participate in this study. The patients completed questionnaires on demographics, medical history, burden of ERCP (mental health, discomfort, and pain), symptoms and the EuroQol-5D (EQ-5D), including the EQ-VAS (lower EQ-5D scores and higher EQ-VAS scores represent a better quality of life). The paired t-test, the Kruskal–Wallis test, Pearson correlation, and logistic regression were used to evaluate the results. Results  The questionnaire was returned by 149 (54%) of 276 eligible patients, 139 of whom completed the entire questionnaire (54% males; mean age, 60 ± 14 years). Throat ache (p < 0.001) was the only symptom higher than baseline value 1 day after the ERCP. On day 1, about one-tenth of the patients experienced moderate to severe mental health problems, which were associated with a higher EQ-5D score before ERCP (p = 0.01). Slightly fewer than half of the patients experienced pain and discomfort during and immediately after ERCP. More discomfort was experienced by patients who underwent therapeutic ERCP (p < 0.05) and those with a higher EQ-5D score (p < 0.001) or lower VAS (p < 0.01). Pain was associated with younger age (p < 0.01), higher EQ-5D score (p < 0.001), and lower VAS (p < 0.01). Conclusion  One-third to one-half of patients experience pain and discomfort during and immediately after ERCP when it is performed with conscious sedation for the patient. Other sedation strategies, such as the use of general anesthesia or propofol, may well reduce the burden of ERCP, particularly for patients with a higher EQ-5D score, younger age, or therapeutic ERCP treatment. However, randomized trials are warranted. Content Type Journal ArticlePages 1-7DOI 10.1007/s00464-012-2162-2Authors S. M. Jeurnink, Department of Gastroenterology and Hepatology, University Medical Center, P.O. Box 85500, 3508 GA Utrecht, The NetherlandsE. W. Steyerberg, Department of Public Health, Erasmus MC/University Medical Center, Rotterdam, The NetherlandsE. J. Kuipers, Department of Gastroenterology and Hepatology, Erasmus MC/University Medical Center, Rotterdam, The NetherlandsP. D. Siersema, Department of Gastroenterology and Hepatology, University Medical Center, P.O. Box 85500, 3508 GA Utrecht, The Netherlands Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
The use of novel hemostatic sealant (Tisseel®) in laparoscopic myomectomy: a case–control study
Thu, 02 Feb 2012 18:07:53 -0000
Abstract Background  This is the first case–control study on the use of a fibrin sealant (Tisseel®) on uterine suture during laparoscopic myomectomy (LM), with the primary endpoint to evaluate the intraoperative bleeding and postoperative blood loss. In addition, we evaluated the time required to achieve hemostasis using Tisseel® and how much it can influence operative time. Methods  From December 2009 to January 2011, consecutive patients older than 18 years with symptomatic isolate intramural myoma with maximal diameter ≤6 cm and ≥4 cm and with a sonographically diagnosed free myometrium margin ≥0.5 cm were included in the study. We selected from our institute’s database a group of consecutive patients with homogeneous features of the study group, who underwent laparoscopic myomectomy without Tisseel® application. Results  Fifteen women with symptomatic myoma were enrolled in the study (group A). Regarding the control group (group B), we selected a homogenous group of 15 patients with the same preoperative characteristics of the study group. Mean operative time was 47.7 min and 62.1 min, for groups A and B respectively (p < 0.05). Mean time required to achieve complete haemostasis was 195.5 s in group A and 361.8 in control group B (p < 0.0001). Mean estimated blood loss was 111.3 mL and 230 mL in groups A and B, respectively (p < 0.05). Mean hemoglobin decrease was 1.36 g/dL and 2.04 g/dL in groups A and B, respectively (p < 0.05). Conclusions  The use of Tisseel® during LM may represent a valid alternative solution for obtaining hemostasis, reducing intra- and postoperative bleeding. Furthermore, it may help the surgeon to obtain a rapid healing of the injured surfaces, probably reducing the use of electrocoagulation and traumatisms. Content Type Journal ArticlePages 1-8DOI 10.1007/s00464-012-2154-2Authors Roberto Angioli, Department of Obstetrics and Gynecology, “Campus Bio Medico” University of Rome, Via Álvaro del Portillo, 200-00128 Rome, ItalyFrancesco Plotti, Department of Obstetrics and Gynecology, “Campus Bio Medico” University of Rome, Via Álvaro del Portillo, 200-00128 Rome, ItalyRoberto Ricciardi, Department of Obstetrics and Gynecology, “Campus Bio Medico” University of Rome, Via Álvaro del Portillo, 200-00128 Rome, ItalyCorrado Terranova, Department of Obstetrics and Gynecology, “Campus Bio Medico” University of Rome, Via Álvaro del Portillo, 200-00128 Rome, ItalyMarzio Angelo Zullo, Department of Obstetrics and Gynecology, “Campus Bio Medico” University of Rome, Via Álvaro del Portillo, 200-00128 Rome, ItalyPatrizio Damiani, Department of Obstetrics and Gynecology, “Campus Bio Medico” University of Rome, Via Álvaro del Portillo, 200-00128 Rome, ItalyRoberto Montera, Department of Obstetrics and Gynecology, “Campus Bio Medico” University of Rome, Via Álvaro del Portillo, 200-00128 Rome, ItalyFederica Guzzo, Department of Obstetrics and Gynecology, “Campus Bio Medico” University of Rome, Via Álvaro del Portillo, 200-00128 Rome, ItalyGiuseppe Scaletta, Department of Obstetrics and Gynecology, “Campus Bio Medico” University of Rome, Via Álvaro del Portillo, 200-00128 Rome, ItalyLudovico Muzii, Department of Obstetrics and Gynecology, “Campus Bio Medico” University of Rome, Via Álvaro del Portillo, 200-00128 Rome, Italy Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
Randomized controlled trial of laparoscopic gastric ischemic conditioning prior to minimally invasive esophagectomy, the LOGIC trial
Thu, 02 Feb 2012 18:07:53 -0000
Abstract Introduction  Minimally invasive esophagectomy (MIE) is a viable alternative to open resection for the management of esophagogastric cancer. However, the technique may relate to a higher incidence of ischemia-related gastric conduit complications. Laparoscopic ischemic conditioning (LIC) by ligating the left gastric vessels 2 weeks before MIE may have a protective role, possibly through an improvement of conduit perfusion. This project was designed to evaluate whether LIC influenced ultimate conduit perfusion. Methods  A randomized controlled trial was designed to compare MIE with LIC (L) against MIE without (N). The project began in May 2009 and was offered to consecutive patients with the objective of recruiting 22 in each arm. Sample size calculations were based on data from previous clinical series. The main outcome measure was perfusion recorded by validated laser Doppler fluximetry, at the fundus (F) and greater curve (G); performed at routine staging laparoscopy and every stage of an MIE. A perfusion coefficient measured as ratio at stage of MIE over baseline was used for statistical analysis. Results  Sixteen patients were recruited before an interim analysis of the trial data. At staging laparoscopy perfusion at F was higher than at G (p = 0.016). In the L cohort, an apparent rise in perfusion at G is observed post intervention (p = 0.176). At MIE, baseline perfusion is comparable for both arms; however, a significant drop is observed at both locations once the stomach is mobilized and exteriorized (p = 0.001). Once delivered at the neck, perfusion coefficient is approximately 38% of baseline levels. However, there was no discernible difference between the L (38.3 ± 12) and N (37.7 ± 16.8) cohorts (p = 0.798). Conclusions  LIC does not translate into an improved perfusion of the gastric conduit tip. The benefits reported from published clinical series suggest that the resistance of the conduit to ischemia occurs through alternative possibly microcellular mechanisms. Content Type Journal ArticlePages 1-8DOI 10.1007/s00464-011-2123-1Authors Darmarajah Veeramootoo, Department of Upper Gastro-Intestinal Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, EX2 5DW UKAngela C. Shore, Institute of Biomedical and Clinical Science, Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, UKShahjehan A. Wajed, Department of Upper Gastro-Intestinal Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, EX2 5DW UK Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
Endoscopic laser fragmentation and removal of a nonremovable metal esophageal stent for persistent dysphagia: a technical note
Thu, 02 Feb 2012 18:07:53 -0000
Abstract Background  Self-expanding metal stents are widely used in the palliation of esophageal diseases (Todd, N Engl J Med 344(22):1681–1687, 2001). The majority are inserted for end-stage malignancy and are not designed to be removed. Methods  We report the first recorded successful endoscopic removal of an “irremovable” stent by laser fragmentation after its placement became redundant. A 72-year-old man who had persistent dysphagia after esophageal stent insertion for Boerhaave’s syndrome had his stent removed by Nd-YAG laser fragmentation at staged endoscopies. Results  The stent was removed in its entirety and the patients’ symptoms resolved. Conclusions  We describe a successful technique for the removal of a nonretrievable stent using laser fracture and endoscopic retrieval. This method of stent removal has not been previously reported. Content Type Journal ArticleCategory TechniquePages 1-3DOI 10.1007/s00464-011-2111-5Authors Ross S. Coomber, Department of Upper GI Surgery, West Herts NHS Trust, Watford General Hospital, Vicarage Road, Watford, WD18 0HB UKPranav H. Patel, Department of Upper GI Surgery, West Herts NHS Trust, Watford General Hospital, Vicarage Road, Watford, WD18 0HB UKAnubhav Dhir, Department of Healths Clinical Advisor Scheme, Bupa Health Dialog, London, UKJeremy I. Livingstone, Department of Upper GI Surgery, West Herts NHS Trust, Watford General Hospital, Vicarage Road, Watford, WD18 0HB UK Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
The optimal strategy for proximal mesh fixation during laparoscopic ventral rectopexy for rectal prolapse: an ex vivo study
Thu, 02 Feb 2012 18:07:51 -0000
Abstract Background  Laparoscopic ventral rectopexy (LVR) is an established technique for the treatment of rectal prolapse. Several techniques and devices can be used for proximal mesh fixation on the sacral promontory during this procedure. The aim of this study was to compare the fixation strength of a recently introduced screw for mesh fixation on the promontory during LVR with two other frequently used techniques. Methods  An ex vivo experimental model using a porcine spinal column was designed to measure the strength of proximal mesh fixation. In a laparoscopic box trainer, a polypropylene mesh was anchored on the spinal column using three different fixation methods, i.e., the Protack 5-mm tacker device, Ethibond Excel 2-0 stitches, and the Karl Storz screw. Subsequently, increasing traction was applied to the mesh. This traction was applied at a standardized angle as determined by measuring the mean angle between the site of distal mesh fixation on the rectum and a line straight through the sacral promontory on 12 random dynamic MR scans of the pelvic floor after the LVR procedure. The applied force was measured at the moment that the fixation broke, using a calibrated electronic Newton meter. All fixation methods were tested ten times. Results  The mean angle, as measured on the MR scans, was 100°. The mean disruption force, which led to a break of the proximal mesh fixation, was 58 N for the three Protack tacks, 55 N for the two stitches, and 70 N for the new screw. The use of a screw therefore led to a significantly stronger fixation compared to the use of stitches (p ≤ 0.05). No significant difference was determined between the tacks and the screw fixation and between the tacks and the stitches fixation. Conclusion  The new screw for proximal mesh fixation during LVR procedures offers similar fixation strength when compared to tacks. The use of one screw for proximal mesh fixation is therefore a reasonable alternative to the use of several tacks or sutures. Content Type Journal ArticlePages 1-5DOI 10.1007/s00464-012-2161-3Authors Hendrik A. Formijne Jonkers, Department of Surgery, Meander Medical Centre, Amersfoort, The NetherlandsHarm J. van de Haar, Department of Surgery, Meander Medical Centre, Amersfoort, The NetherlandsWerner A. Draaisma, Department of Surgery, Meander Medical Centre, Amersfoort, The NetherlandsBen G. F. Heggelman, Department of Radiology, Meander Medical Centre, Amersfoort, The NetherlandsEsther C. J. Consten, Department of Surgery, Meander Medical Centre, Amersfoort, The NetherlandsIvo A. M. J. Broeders, Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
Comparable early changes in gastrointestinal hormones after sleeve gastrectomy and Roux-En-Y gastric bypass surgery for morbidly obese type 2 diabetic subjects
Thu, 02 Feb 2012 18:07:50 -0000
Abstract Background  Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGBP) are associated with similar type 2 diabetes mellitus (T2DM) resolution rates for morbidly obese subjects. However, the mechanisms underlying the resolution of T2DM after SG have not been clarified to date. This study aimed to compare the early changes in gastrointestinal hormones involved in insulin and glucagon secretion in morbidly obese T2DM subjects undergoing SG or RYGBP. Methods  This prospective study investigated 12 subjects with T2DM who had undergone SG (n = 6) or RYGBP (n = 6). Five body mass index (BMI)-matched obese non-diabetic subjects and five BMI-matched obese diabetic subjects served as control subjects. Glucose, insulin, glucagon, glucagon-like peptide 1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and GLP-2 were determined after a standardized mixed liquid meal before surgery and 6 weeks afterward. Results  After 6 weeks, five of the six subjects in each surgical group presented with T2DM remission, although the area under the curve (AUC)0–120 of glucose was greater than that of the non-diabetic control subjects (P < 0.01). Postsurgically, the indices of insulin and glucagon secretion were comparable between the two surgical groups. The AUC0–120 of GLP-1 (P < 0.05) and GLP-2 (P < 0.05) was significantly and comparably enlarged after SG and RYGB. The postsurgical GIP response was significantly associated with the glucagon response throughout the meal test (ρ = 0.747; P < 0.01). Conclusions  The data show that in a cohort of morbidly obese T2DM subjects, SG and RYGBP are associated with an early improvement in glucose tolerance, similar changes in insulin and glucagon secretion, and a similar GLP-1, GIP, and GLP-2 response to a standardized mixed liquid meal. Content Type Journal ArticlePages 1-9DOI 10.1007/s00464-012-2166-yAuthors Fabiola Romero, Endocrinology and Diabetes Department, Obesity Unit, Hospital Clinic Universitari, Villarroel 170, 08036 Barcelona, SpainJoana Nicolau, Endocrinology and Diabetes Department, Obesity Unit, Hospital Clinic Universitari, Villarroel 170, 08036 Barcelona, SpainLílliam Flores, Endocrinology and Diabetes Department, Obesity Unit, Hospital Clinic Universitari, Villarroel 170, 08036 Barcelona, SpainRoser Casamitjana, Endocrinology and Diabetes Department, Obesity Unit, Hospital Clinic Universitari, Villarroel 170, 08036 Barcelona, SpainAinitze Ibarzabal, Endocrinology and Diabetes Department, Obesity Unit, Hospital Clinic Universitari, Villarroel 170, 08036 Barcelona, SpainAntonio Lacy, Endocrinology and Diabetes Department, Obesity Unit, Hospital Clinic Universitari, Villarroel 170, 08036 Barcelona, SpainJosep Vidal, Endocrinology and Diabetes Department, Obesity Unit, Hospital Clinic Universitari, Villarroel 170, 08036 Barcelona, Spain Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

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