Jerome D. Waye

The role of colonoscopy in the differential diagnosis of inflammatory bowel disease

Definitive colonoscopic criteria have been developed for the differential diagnosis of ulcerative and granulomatous colitis. Colonoscopy should not be performed in all patients with inflammatory bowel disease but may be quite useful in certain situations, such as strictures, filling defects seen on barium enema, and in preoperative evaluation.

Esophageal motility and symptoms after endoscopic injection sclerotherapy.

Endoscopic injection sclerotherapy is known to cause a variety of motility abnormalities, but the correlation between these changes and symptomatology has not been clearly defined. To assess the effects of endoscopic sclerosis of varices on esophageal function and symptoms, we prospectively studied esophageal motility in 25 patients undergoing sclerotherapy (group I). Thirteen patients underwent studies before and after sclerosis, and 12 patients were studied after completion of therapy. Acid clearance was studied in five patients (group I). Twenty-four of the 25 patients (group I) completed a course of sclerosis without the development of persistent dysphagia. We found that endoscopic sclerotherapy did not significantly alter the velocity of peristalsis or lower esophageal sphincter pressure, amplitude of contraction, or the duration of contraction. Acid clearance was diminished in three of five patients. Four patients who developed an esophageal stricture following sclerotherapy were studied manometrically (group II). Three of these four patients had a manometric pattern characterized by repetitive, nonperistaltic contractions, and all four patients experienced dysphagia which was relieved by bougienage. We conclude that esophageal motility is generally well preserved following endoscopic injection sclerotherapy and does not result in a long-lasting disturbance of swallowing. Dysphagia and disordered esophageal motility do occur after sclerotherapy when a sufficient fibrotic response has resulted in an esophageal stricture.

Diazepam versus midazolam (versed) in outpatient colonoscopy: a double-blind randomized study

Midazolam is a new parenteral benzodiazepine premedication for endoscopy. Consecutive patients were randomized to receive either intravenous midazolam or diazepam as premedication for outpatient total colonoscopy by one endoscopist. Fifty-five patients received diazepam (0.15 mg/kg) and 50 received midazolam (0.07 mg/kg). Both patient and endoscopist were blind to the study drug used. The two groups were similar with respect to age, sex, and indication for colonoscopy. Patients were rated by the endoscopist for degree of cooperation, sedation, and pain during examination. There was significantly more oversedation in the midazolam group than in the diazepam group (p less than 0.05). Immediate procedure recall was less in midazolam patients (p less than 0.005), but on repeat interview the next day there was no difference between the two groups concerning recall of the endoscopy. There was no significant difference between the two groups in the incidence of arm pain. We conclude that in a clinical setting, midazolam does not appear to offer any significant advantage over diazepam, except for cost. Midazolam carries an increased risk of oversedation when it is administered on a milligram per kilogram basis and should instead be titrated individually.

Colonoscopic Diagnosis of Inflammatory Bowel Disease

The indications and limitations of colonoscopy in the diagnosis of inflammatory bowel disease are well defined. The endoscopic examination is usually easily performed and well tolerated by the patient, but, since endoscopic examination of the colon is an invasive procedure (and potentially dangerous), colonoscopy should only be performed in those patients in whom the indication is clear and the benefits identifiable. Colonoscopy may provide valuable information in the diagnosis and may help outline the course of therapy in patients with inflammatory bowel disease.

Colitis, cancer, and colonoscopy.

Colonoscopy has added a new dimension to the diagnosis of colonic diseases. In the field of inflammatory bowel disease, colonscopy is indicated only when certain specific problems arise. Patients with acute colitis and those who are too sick to withstand cleansing enemas should not undergo colonoscopy. A major use of the colonoscope is in the detection of carcinoma in the colitic colon either in the form of colonic strictures or filling defects discovered by barium enema x-ray, or in the long-term surveillance of patients with universal ulcerative colitis. Criteria are listed to assist in the colonoscopic differential diagnosis between ulcerative and granulomatous colitis. By using different criteria than the radiographer, and with the help of biopsy specimens, a high degree of accuracy in proper diagnosis can be achieved.

The continent ileostomy: diagnosis and treatment of problems by means of operative fiberoptic endoscopy

About 1 in 10 patients with internal pouch ileostomies may develop incontinence. Of 4 incontinent patients in this study, operative endoscopy has restored continence in 2 and has markedly improved symptoms in a third. Foreign bodies retained within the ileostomy pouch may be successfully removed endoscopically. All patients with an incontinent Kock ileostomy pouch should be endoscoped for adequate assessment and treatment.

A technique for emergency upper gastrointestinal endoscopy in adults using a small caliber endoscope (GIF-P2)

The small caliber peroral endoscope (GIF-P2) was efficient and safe in the detection of lesions in a series of 69 patients with acute upper gastrointestinal hemorrhage. The authors describe a technique of examination that they have found appropriate to this problem.

Endoscopic nonoperative gastric polypectomy

SummaryA gastric polypectomy was performed using the same technic with flexible fiberoptic instruments that has been successful in the removal of colonic polyps. The patient was a poor surgical operative risk and had obstructive symptoms from a prepyloric adenomatous polyp which prolapsed into the duodenal bulb. The polypectomy was performed with ease, and no complications were encountered. The entire polyp was retrieved for pathologic examination. On follow-up examination one month later a small healed stump was all that remained at the site of the previous gastric polyp.

Retrograde amnesia effects of intravenous diazepam in endoscopy patients

The presence of a retrograde amnesia, when caused by medications given prior to a medical procedure, can pose the medicolegal question of informed consent. This study investigated the retrograde amnesic effects of intravenous diazepam administered prior to gastrointestinal endoscopy. No significant retrograde amnesia was found in case subjects when compared with controls.

Diagnostic retrospective in pancreaticobiliary imaging: ultrasound and ERCP.

Seventy-three patients underwent both endoscopic retrograde cholangiopancreatography (ERCP) and ultrasound examinations over a 2 1/4-year period. The results of both examinations are compared and evaluated. Ultrasound was found to be more sensitive for gallbladder disease and also was able to reveal abnormalities outside of the pancreaticobiliary system. ERCP was best for ductal abnormalities because dilatation was unnecessary for visualization by this method.