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

Overview

---

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.

More on [ Endoscopy ]

Surgical Endoscopy

News and Notices
Thu, 10 Dec 2009 15:17:29 -0000
News and Notices Content Type Journal ArticleCategory News and noticesDOI 10.1007/s00464-009-0821-8 Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
Laparoscopic splenectomy for severe blunt trauma: initial experience of ten consecutive cases with a fast hemostatic technique
Thu, 10 Dec 2009 00:12:28 -0000
Abstract Background  Minor splenic injuries from blunt trauma can be treated conservatively, whereas high-grade injuries commonly associated with multiple trauma require surgical treatment and usually removal of the organ. Although splenectomy is nowadays routinely performed laparoscopically for the treatment of hematological pathologies, in an emergency the operational procedure is performed through conventional laparotomy worldwide, advocating the need for hemostasis. Progress in surgical skill and new developments in equipment allow us to treat also patients affected by severe splenic blunt trauma minimally invasively. Methods  In this study we analyzed 12 patients who consecutively came under our observation during a 2-year period and, being affected by severe spleen injury from blunt trauma requiring surgery, underwent emergency laparoscopy. All of them had Injury Severity Score (ISS) ≥ 20 with Glasgow Coma Score (GCS) ≥ 10. Laparoscopic splenectomy was performed in ten of the cases utilizing a quick hemostatic technique. In one case bleeding was controlled without removal of the organ and in another case laparoscopy revealed that the supposed hemoperitoneum and splenic rupture were in fact the rupture of a giant splenic cyst. Results  The median operative time to reach hemostasis was 17 min (13–125 min) and the median overall operative time was 120 min (55–210 min). All operations were performed fully laparoscopically. Neither mortality nor morbidity related to abdominal problems was observed. Median postoperative stay was 4 days (3–11 days). Conclusion  Laparoscopic approach to splenic blunt trauma requiring surgery is a safe and effective procedure. The described technique allows laparoscopic splenectomy to be performed in an emergency, with much the same hemostatic efficacy as the open technique, but with much better outcome for the patient. Content Type Journal ArticleDOI 10.1007/s00464-009-0768-9Authors Andrea Carobbi, “Campo di Marte” Hospital Department of General Surgery Via Barbantini 1 Lucca 55100 ItalyFrancesco Romagnani, “Campo di Marte” Hospital Department of General Surgery Via Barbantini 1 Lucca 55100 ItalyGiacomo Antonelli, “Campo di Marte” Hospital Department of General Surgery Via Barbantini 1 Lucca 55100 ItalyManlio Bianchini, “Campo di Marte” Hospital Department of General Surgery Via Barbantini 1 Lucca 55100 Italy Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
Ischemic conditioning shows a time-dependant influence on the fate of the gastric conduit after minimally invasive esophagectomy
Thu, 10 Dec 2009 00:12:28 -0000
Abstract Background  Minimally invasive esophagectomy (MIO) is now established as a valid alternative to open surgery for the management of esophagogastric cancers. However, a high incidence of ischemia-related gastric conduit failure (ICF) is observed, which is detrimental to any potential benefits of this approach. Methods  Since April 2004, MIO has been the procedure of choice for esophagogastric resection in the authors’ unit. Data relating to the surgical technique were collected, with a focus on ischemic conditioning by laparoscopic ligation of the left gastric artery (LIC) 2 weeks or 5 days before resection. Results  A total of 97 patients underwent a planned MIO. Four in-patient deaths (4.1%) occurred, none of which were conduit related, and overall, 20 patients experienced ICF (20.6%). In four patients, ICF was recognized and dealt with at the initial surgery. The remaining 16 patients experienced this complication postoperatively, with 9 (9.3%) of them requiring further surgery. Of the 97 patients, 55 did not undergo ischemic conditioning, and conduit failure was observed in 11 (20%). Thirty-five patients had LIC at 2 weeks, and 2 (5.7%) experienced ICF. All seven patients (100%) who had LIC at 5 days experienced ICF. Timing of ischemic conditioning (p < 0.0001) had a definite impact on the conduit failure rate, and the benefit of ischemic conditioning at 2 weeks compared with no conditioning neared significance (p = 0.07). Conclusions  Ischemic failure of the gastric conduit significantly impairs recovery after MIO. Ischemic conditioning 2 weeks before surgery may reduce this complication and allow the benefits of this approach to be realized. Content Type Journal ArticleDOI 10.1007/s00464-009-0739-1Authors Darmarajah Veeramootoo, Royal Devon and Exeter NHS Foundation Trust, Royal Devon and Exeter Foundation Hospital Department of Thoracic and Upper GI Surgery Exeter EX2 5DW UKAngela C. Shore, Peninsula NIHR Clinical Research Facility and Peninsula Medical School Exeter UKBeverley Shields, Peninsula NIHR Clinical Research Facility and Peninsula Medical School Exeter UKRakesh Krishnadas, Royal Devon and Exeter NHS Foundation Trust, Royal Devon and Exeter Foundation Hospital Department of Thoracic and Upper GI Surgery Exeter EX2 5DW UKMartin Cooper, Royal Devon and Exeter NHS Foundation Trust, Royal Devon and Exeter Foundation Hospital Department of Thoracic and Upper GI Surgery Exeter EX2 5DW UKRichard G. Berrisford, Royal Devon and Exeter NHS Foundation Trust, Royal Devon and Exeter Foundation Hospital Department of Thoracic and Upper GI Surgery Exeter EX2 5DW UKShahjehan A. Wajed, Royal Devon and Exeter NHS Foundation Trust, Royal Devon and Exeter Foundation Hospital Department of Thoracic and Upper GI Surgery Exeter EX2 5DW UK Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
When does testing for GERD become cost effective in an integrated health network?
Thu, 10 Dec 2009 00:12:27 -0000
Abstract Background  Gastroesophageal reflux (GERD) is the most common gastrointestinal disorder, affecting as many as 14% of the US population. Rising rates of esophageal adenocarcinoma are seen in this population, and chronic proton pump inhibitor (PPI) use does not normalize cancer risk. It has also been demonstrated that up to one-third of patients on PPI therapy did not actually have GERD and could be taken off the medication. These facts form the basis for a quality-assurance study of care provided to patients in an integrated health care network who were on high-dose, long-term PPI therapy. Methods  A cost–benefit analysis of patients who were on double-dose PPI therapy for more than 6 months was performed. Pharmacy, facility, physician reimbursement, and radiologic data from a cohort who were both primary-care patients and insured in our system were utilized. Results  Two hundred and twenty-four patients were prescribed a double dose of this medication for over 6 months. Utilizing a 4.5% discount rate, our break-even analysis showed that Bravo testing [with esophagogastroduodenoscopy (EGD)] needed to identify those patients who could be taken off PPI therapy paid for itself in 33 months. Bravo + EGD + manometry testing needed to screen for other possible pathologies paid for itself in 38 months. Bravo + barium swallow + EGD testing to screen patients for possible esophageal adenocarcinoma paid for itself in 42 months. Bravo + barium swallow + manometry + EGD testing paid for itself in 47 months. Conclusions  Significant savings can be realized through early use of upper endoscopy, Bravo testing, barium swallow, and manometry to identify patients that are taking double-dose PPIs unnecessarily based on presumptive diagnosis of GERD. This early testing also has the potential to diagnose a variety of other clinically important pathologic conditions more readily. Content Type Journal ArticleDOI 10.1007/s00464-009-0754-2Authors Anoop Raman, Tufts University School of Medicine Boston MA USAJoel Sternbach, Tufts University School of Medicine Boston MA USAAzeesat Babajide, Tufts University School of Medicine Boston MA USAKetan Sheth, Harvard Medical School Department of Surgery, Cambridge Health Alliance 1493 Cambridge Street Cambridge MA 02139 USASteven D. Schwaitzberg, Harvard Medical School Department of Surgery, Cambridge Health Alliance 1493 Cambridge Street Cambridge MA 02139 USA Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
Dietetic-led management of patients undergoing laparoscopic gastric banding: early results
Thu, 10 Dec 2009 00:12:27 -0000
Abstract Background  Optimal results of bariatric surgery are achieved when it is performed within a multidisciplinary team. Within this team, the dietician plays a key role before and after surgery in patient education and behaviour change. With long-term follow-up, the number of patients per surgeon increases exponentially. This study evaluated the outcomes of a dietician-only led management program for patients who underwent laparoscopic gastric banding in our unit. Methods  Between April 2003 and November 2007, 1,335 patients underwent laparoscopic gastric banding in two hospitals by the same surgical team. Weight loss outcomes were compared for patients in a dietician-led management program against a surgeon/nurse specialist follow-up program with more frequent patient visits. For the dietician-led group, a standard protocol of six postoperative visits and two to three fluoroscopic adjustments was developed from referral until 2 years after surgery. Results  There were 316 patients followed up in a dietician-led program. They were compared with the remaining patients who were followed up in a surgeon/ nurse specialist led program. The mean preoperative weight and body mass index (BMI) for the dietetic-led subset was significantly higher (weight: 147.4 ± 30.2; BMI: 52.8 ± 8.9) compared with the remaining group (weight: 113.8 ± 18.7; BMI: 41.6 ± 5.2; p < 0.001: Mann–Whitney test). Percent BMI loss was initially lower in the dietician-led group, but this difference disappeared at the end of 24 months (p = 0.056). Conclusions  A patient management program led by specialist dieticians is an effective way to manage large numbers of patients after laparoscopic gastric banding while maintaining comparable weight loss to surgeon/nurse-led series. Content Type Journal ArticleDOI 10.1007/s00464-009-0758-yAuthors Rishi Singhal, Heart of England NHS Foundation Trust Upper GI Unit and Minimally Invasive Unit Birmingham UKMark Kitchen, Heart of England NHS Foundation Trust Upper GI Unit and Minimally Invasive Unit Birmingham UKSue Bridgwater, Heart of England NHS Foundation Trust Upper GI Unit and Minimally Invasive Unit Birmingham UKPaul Super, Heart of England NHS Foundation Trust Upper GI Unit and Minimally Invasive Unit Birmingham UK Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
Surveillance and treatment for second primary cancer in the gastric tube after radical esophagectomy
Thu, 10 Dec 2009 00:12:26 -0000
Abstract Background  Recent improvement in the survival of patients after esophagectomy for esophageal cancer has led to increasing occurrence of second primary cancer in the pulled-up stomach as gastric tube cancer (GTC). However, a treatment strategy for GTC including surveillance has not been established. The aims of this study are to clarify the incidence and clinicopathological characteristics of GTC and to assess the treatment results of endoscopic resection. Methods  Twenty-five patients with 29 GTC lesions treated between 1989 and 2007 were analyzed retrospectively. Results  The median interval between esophagectomy and GTC detection was 86 months, and the 10-year cumulative incidence rate of GTC was 8.6%. Of 18 asymptomatic GTCs, 17 lesions (94.4%) were detected by periodic endoscopy and 15 (88.2%) of them were treated endoscopically. Of all 29 GTCs, endoscopic submucosal dissection (ESD) was performed in 10 GTCs with a completely curative resection rate of 90%, which was significantly higher than that of 7 GTCs treated with endoscopic mucosal resection (EMR) (14.3%, P = 0.004). In these 17 GTCs, no cancer recurrence developed during a median follow-up period of 24 months, and the 3-year survival rate was 80.8%. Conclusions  For patients after esophagectomy with gastric pull-up, long-term follow-up including periodic endoscopy is necessary to detect a potentially curable GTC. ESD is a feasible and safe procedure for GTC, with oncologically favorable features. Content Type Journal ArticleDOI 10.1007/s00464-009-0766-yAuthors Takeo Bamba, Niigata University Graduate School of Medical and Dental Sciences Division of Digestive and General Surgery 1-757 Asahimachi-dori, Chuou-ku Niigata City 951-8510 JapanShin-ichi Kosugi, Niigata University Graduate School of Medical and Dental Sciences Division of Digestive and General Surgery 1-757 Asahimachi-dori, Chuou-ku Niigata City 951-8510 JapanManabu Takeuchi, Niigata University Medical and Dental Hospital Department of Endoscopy Niigata City JapanMasaaki Kobayashi, Niigata University Medical and Dental Hospital Department of Endoscopy Niigata City JapanTatsuo Kanda, Niigata University Graduate School of Medical and Dental Sciences Division of Digestive and General Surgery 1-757 Asahimachi-dori, Chuou-ku Niigata City 951-8510 JapanAtsushi Matsuki, Niigata University Graduate School of Medical and Dental Sciences Division of Digestive and General Surgery 1-757 Asahimachi-dori, Chuou-ku Niigata City 951-8510 JapanKatsuyoshi Hatakeyama, Niigata University Graduate School of Medical and Dental Sciences Division of Digestive and General Surgery 1-757 Asahimachi-dori, Chuou-ku Niigata City 951-8510 Japan Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Subscribe to Endoscopic RSS feed