Eugene A. Gelzayd

Fiberendoscopy: Removal of a retained sewing needle from the stomach

A sewing needle stuck in the prepyloric gastric wall was successfully removed by use of the duodenofiberscope.

Nonspecific duodenitis: A distinct clinical entity?

The clinical, radiologic, duodenoscopic, and pathologic findings in thirteen patients with nonspecific duodenitis are presented. The majority of patients had vague epigastric distress, duodenal bulb spasm, nodular or friable mucosa, and variable degrees of inflammatory cell infiltration of the lamina propria. Treatment is nonspecific with a favorable outlook expected. No clear relationship to duodenal ulcer could be determined. These observations are taken to support the contention that nonspecific duodenitis is probably a distinct clinical entity.

Hemorrhagic duodenitis: A significant cause of gastrointestinal bleeding

Hemorrhagic duodenitis, confirmed by endoscopy and target biopsy, accounted for 8% of acute upper gastrointestinal bleeders treated by these authors. The duodenoscopic and histologic features are described and should lead to more frequent recognition of this postulated entity.

Lymphadenopathy in celiac sprue, not necessarily a malignant disease.

A 47-year-old woman who was studied for other reasons proved to have abdominal lymphadenopathy, some nodes measuring up to 2 cm. The patient, through biopsy and other studies, was diagnosed with celiac sprue; however, on a gluten-free diet, abdominal computed tomography scans several months later showed marked reduction in the size of the mesenteric nodes.

The relative application of endoscopy and other diagnostic methods in achalasia

Clinical, radiologic, manometric, and endoscopic data were applied to distinguish achalasia in a group of 52 patients complaining of dysphagia or chest pain or both. Endoscopically, achalasia was characterized by a non-relaxing lower esophageal sphincter that would yield to gentle but firm forward thrust of the instrument. The finding of hiatal hernia or esophagitis was against a diagnosis of achalasia. Manometry was particularly helpful in achalasia patients with little or no esophageal dilation by radiography. Peroral endoscopy was found to add essential information leading to the correct diagnosis of patients with dysphagia or esophageal chest pain.

Correlation of manometric and endoscopic data from the esophagogastric area.

In 9 patients the inferior esophageal sphincter was identified manometrically and simultaneously by direct vision at endoscopy. It was related to the squamocolumnar junction which was identified visually. The average length of the sphincter was 1.6cm and it was proximal to the hiatus and squamocolumnar junction in all but 1 of the patients. The method described makes it possible to study the closing mechanism of the distal esophagus in vivo.