David Fleischer

Evaluation of submucosal upper gastrointestinal tract lesions by endoscopic ultrasound

The proper diagnosis of submucosal upper gastrointestinal tract mass lesions by endoscopy or barium study is difficult. Differentiation between submucosal tumors, vascular structures, and extrinsic organs is often impossible. We performed endoscopic ultrasound examination of 91 patients with upper gastrointestinal submucosal mass lesions. Endoscopic ultrasound was accurate in determining the site of origin in 48 of 50 cases where pathology or angiography comparison was available. Leiomyoma, lipoma, varices, and carcinoma had characteristic ultrasonographic findings. Endoscopic ultrasound is a useful procedure in the evaluation of upper gastrointestinal submucosal mass lesions.

Colonoscopy with a VideoEndoscope: preliminary experience.

A prototype VideoEndoscope was tested that does not have an optical fiber bundle. This was replaced by a sensing device in the instruments distal tip that transmits an image to a video processor for display on a television monitor. The television image was excellent, and the instrument system and its concept in general were thought to be acceptable for diagnostic and therapeutic colonoscopy. The instrument has unique advantages with regard to documentation, demonstration, and review of endoscopic findings.

Incidence of bacteremia with elective upper gastrointestinal endoscopic laser therapy

The incidence of bacteremia associated with endoscopy varies widely for different endoscopic procedures. This study prospectively evaluates the incidence of bacteremia in patients undergoing elective endoscopic laser therapy for two diseases of the upper gastrointestinal tract. In five patients (eight treatment sessions) with arteriovenous malformations, no bacteremia developed. In 15 patients (26 treatment sessions) with esophagogastric carcinoma, bacteremia developed at some time during the procedure in six (40%). However, bacteremia appeared to be associated with the endoscopic insertion through the tumor rather than the laser treatment per se. These findings lead us to conclude that for patients undergoing endoscopy and laser therapy for esophagogastric malignancy, but not for those being treated for arteriovenous malformations, antibiotic prophylaxis to prevent endocarditis may be indicated.

Endoscopic laser therapy for gastrointestinal neoplasms.

Neoplasms of the esophagus, stomach, duodenum, ampulla, colon, and rectum have been treated with endoscopic laser therapy. For the most part, the therapy has been palliative, although curative treatment has sometimes been achieved. Considerations involved in management of cancers of the GI tract by the laser are discussed and future options envisioned.