Bernard M. Schuman

Complications of fiberoptic endoscopy.

This review summarizes the complications of fiberoptic peroral endoscopy, endoscopic retrograde cholangiopancreatography and colonoscopy gleaned from reports of extensive endoscopic surveys. Unique individual experiences are also included. Means whereby complications can be prevented or remedied are noted.

Duodenal Polyps: Diagnosis and Management

Forty-five polyps were encountered at duodenoscopy between 1973 and 1978. Upper gastrointestinal x-rays were helpful in 25 patients, 13 of whom had duodenal polyps and 12 duodenal deformity or mass lesions. Polyps in 23 patients were larger than 1 cm in size. Biopsies were done in 38 patients; in 19 there was only normal duodenal mucosa or chronic inflammation. Eight adenomatous polyps, six villous adenomas, two Brunners gland hyperplasia, two lipomas, and one carcinoid tumor were found. Surgery was performed in eight patients and endoscopic polypectomy in four. We conclude that 1) small duodenal polyps are frequently missed on upper gastrointestinal x-rays, but these are submucosal polyps of little significance; 2) in general, polyps cannot be differentiated endoscopically into tissue categories, but villous adenomas show some characteristic features which allow a dependable endoscopic diagnosis; 3) a villous adenoma warrants excision because of the high incidence of malignancy; and 4) pedunculated duodenal polyps can be removed safely with endoscopic snare excision.

The management of esophageal complications of epidermolysis bullosa

Two cases of esophageal obstruction occurring with epidermolysis bullosa of the dystrophic type are presented. The mode of definitive therapy, retrograde dilation in one and colonic transplant in the other, was determined by considerations of pathology, age and nutritional state.

Lymphocytic colitis. A definable clinical and histological diagnosis.

We reviewed colorectal biopsies and clinical records from 36 patients with chronic watery diarrhea who had been diagnosed as having microscopic colitis and compared their histologic features with the more detailed and precise criteria for lymphocytic colitis. Published pathologic criteria for lymphocytic colitis were applied to the biopsies and compared. Focal or diffuse nature of the lymphoid infiltrate were noted separately. The focal lymphoid infiltrate was related to lymphoid aggregates in the lamina propria of the mucosa. Eighteen cases had focal lymphoid cell infiltration, and 16 of them had associated diverticula, polyps, or both. Eighteen cases had diffuse lymphoid cell infiltration, and six of them had diverticula or polyps. Results indicate that focal cellular infiltration strongly predicts associated diverticula or polyps. The group with no diverticula or polyps most closely conformed to histologic criteria for lymphocytic colitis (Kruskal-WallisP<0.02). We conclude that lymphocytic colitis comprises a well-defined group of cases within the large and less-defined group of microscopic colitis.

Continuous electrocardiographic monitoring during colonoscopy

Sixty-three patients had continuous electrocardiographic monitoring before, during, and after colonoscopy. Of these, 37 (59%) patients had no significant electrocardiographic abnormalities during the procedure. However, 29 patients developed new or exaggerated electrocardiographic abnormalities. Seventeen (27%) patients had previously recognized heart disease, and the frequency of arrhythmias in these patients (64.7%) was greater than in the others (32.6%). More serious arrhythmias also tended to occur in patients with heart disease.

Endoscopic diverticulectomy in the sigmoid colon

A 43-year-old woman was seen in December 1973 for left lower quadrant abdominal pain. A barium enema demonstrated several diverticula of the sigmoid colon. Because of persistent symptoms, colonoscopy was done as an outpatient and several sessile polyps were observed. A biopsy was taken and the histological diagnosis was adenoma. Because of the possibility that multiple polypectomy might be necessary, hospital admission was advised. Cotonoscopy was carried out to the splenic flexure. In the proximal to midsigmoid, several projections were identified which were considered to be submucosal rather than mucosal and appeared to vary in prominence with the distension and contractility of the bowel. Two of these lesions were biopsied and a third, which was the larger one, was removed in toto by snare electrocoagulation (Fig. 1). There was no evidence of bleeding or excessive electrocoagulation at the time. Diverticula were also identified.

Endoscopic injection therapy for nonvariceal upper gastrointestinal hemorrhage—Is it too good to be true?

Endoscopic injection of esophageal varices has assumed the major role in the management of variceal hemorrhage. It is remarkable and a little puzzling that so few of the many endoscopists experienced with endoscopic injection sclerotherapy have branched out to inject bleeding ulcers, Mallory-Weiss tears, or telangiectasias. Perhaps the high percentage of rebleeding seen after sclerotherapy of esophageal varices has discouraged endoscopists from venturing beyond the esophagus with their needle catheters. It goes without saying that those who have a

Carcinoma of the gastric remnant in a U.S. population

100,000.00 commitment to a laser unit are reluctant (if not embarassed) to abandon it for a system that costs less than

The gastroscopic yield from the negative upper gastrointestinal series

100.00. More likely for the majority of endoscopists, the popular bipolar electrocoagulator and heat probe have served their operators well and there is no obvious basis to make a switch to a relatively untried method. Injection therapy, however, is not a brand new procedure but has been practiced in one form or another since the mid 1970s. Asaki, whose work was reviewed by Hajiro, l achieved initial hemostasis by means of absolute alcohol injections in virtually 100% of patients, only 10% of whom rebled. This work has been duplicated by Sugawa et al./ who injected absolute alcohol into four sites surrounding the bleeding vessel and obtained permanent hemostasis in 88% of their 33 patients without complications. Two years ago in this journal Hirao et al. described their technique of injecting a solution of hypertonic saline-epinephrine into the base of a bleeding vessel, with permanent hemostasis occurring in 93.7% of 158 patients. In their last 128 patients they injected the ulcer base prophylactically 24 to 48 hours later, and only one of those patients required emergency surgery. In this issue of Gastrointestinal Endoscopy, Leung and Chung treated 37 patients with bleeding ulcers by injecting 0.5 ml of 1 to 10,000 epinephrine alone into multiple sites around the bleeding vessel and into the bleeding point itself. As much as 10 ml was injected to control spurting vessels. They achieved initial hemostasis in every patient, but five patients rebled 4 hours to 4 days later. One of these patients stopped bleeding spontaneously, and in one bleeding was again controlled by repeat epinephrine injection. The other three patients successfully underwent surgery. Two died of unrelated causes after the bleeding was controlled. Although not a controlled study, Leung and

Colonoscopy in inflammatory bowel disease

Ninety-three consecutive patients who had a partial gastrectomy for peptic ulcer disease underwent endoscopy. Adenocarcinoma was found in four patients, adenomatous polyps in seven, and epithelial atypia in three. Gastroscopic screening every 10 years after surgery is recommended to identify those patients who should undergo regular surveillance because of findings of premalignant change.