John F. Morrissey

Psychological preparation for an endoscopic examination

An intricate and controlled investigation shows that pre-endoscopic instruction can lessen the requirement for ataraxic medication and can reduce the patients reaction to the procedure.

Colonoscopy in radiation colitis

Colonoscopy in 13 patients with stenosis or hemorrhage after radiation therapy is correlated with clinical and radiographic features. The authors found colonoscopy helpful in delineating the diagnosis and in guiding treatment.

Brush cytology in the diagnosis of upper gastrointestinal malignancy

In a review of 196 cases of malignant neoplasms of the esophagus and stomach, endoscopically guided brush cytology at the initial examination appreciably improved diagnostic accuracy of esophageal lesions. However, cytology may have been superfluous when routinely applied to the evaluation of lesions intrinsic to the stomach. In these cases, when biopsy is negative while radiography or endoscopic appearance is that of mailgnancy, then brush cytology is recommended as an adjunct to repeated endoscopy.

Colonic Complications After Renal Transplantation

Three of 112 patients who underwent renal transplantation during a 6-year period, developed abdominal pain, fever, and bloody diarrhea during the immediate postoperative period. Radiological, pathological, and endoscopic appearance was compatible with ischemic disease of the colon. The survival of these 3 patients was thought to be due to the early recognition of the colonic complications, with prompt treatment by colonic resection in 1 patient and vigorous supportive measures in 2 cases.

Clinical Approach to Diagnostic Endoscopy in Patients with Upper Gastrointestinal Bleeding

The physician faced with a patient with a history of gastrointestinal bleeding must decide at the time that the patient is admitted to the hospital whether the patient can be evaluated by the routine scheduling of diagnostic procedures or if an emergent approach to the problem is indicated. If the patient has bled within 48 hr and if any of the findings shown in Table 1 are present, then an emergent approach is indicated. Emergent endoscopy performed within 24 hr of hospital admission must weigh its timing against the severity of the bleeding, recognizing the advantage of performing procedures during the day when the endoscopist and ancillary personnel are at their best. The emergent approach should increase the accuracy of endoscopic diagnosis by performing the procedure while stigmata of bleeding are present, before tube artifacts are introduced, and before superficial lesions have healed. The information provided should assure that medical or surgical therapy is most appropriately determined by the cause of bleeding.

THE USE OF THE GASTROCAMERA FOR THE DIAGNOSIS OF GASTRIC ULCER.

Summary A study comparing the frequency with which the type V Japanese gastrocamera, the barium meal X-ray and the gastroscope diagnosed benign gastric ulcer in 159 patients has been described. Sixty-two ulcers were found in the study. Forty-one or 66% were seen on X-ray; 36 or 58% were located at gastroscopy, and 46 or 74% were photographed by the gastrocamera. Gastrocamera photography is an accurate, well tolerated, and safe endoscopic technique which can assume a major role in the diagnosis and management of patients with gastric ulcers. The routine use of intragastric photography with the gastrocamera should improve rather than replace the older techniques of gastroscopy and barium meal X-ray.

Early endoscopy for major gastrointestinal bleeding —It should be done

At 3 am the sleepy gastroenterologist or fellow in training arrives at the hospital to perform emergency endoscopy. The patient is intoxicated and uncooperative. After extraordinary doses of premedication, bleeding fingers and a bitten instrument, the endoscope is finally passed into the stomach. The view is promptly occluded by blood and clots and the procedure must be terminated. Alternatively a MalloryWeiss tear, gastric ulcer, gastritis or duodenal ulcer is tentatively or definitively identified. In the rare situation, usually in the patient with clinically apparent liver disease and ascites, bleeding esophageal varices will be visualized. Does emergency endoscopy affect therapy, morbidity or mortality? Does haste make waste? Dr. John Morrissey is Professor of Medicine, Vice Chairman of the Department of Medicine and Chief of the Division of Gastroenterology at the University of Wisconsin. He is also President of the American Society for Gastrointestinal Endoscopy. Dr. Charles Winans is Associate Professor of Medicine in the Section of Gastroenterology at the University of Chicago and a member of the Editorial Board of the American Journal of Digestive Diseases. Dr. Morrissey and Dr. Winans present opposing viewpoints on the value of emergency endoscopy. ALLEN L. GINSBERG, MD

Use of an external suction-irrigation device in endoscopy.

A simple and inexpensive external suction-irrigation device, which attaches to the biopsy port of endoscopes, is used to rapidly infuse and aspirate large volumes of fluid. By bypassing the umbilical cord, this system avoids blockage of the instrument while permitting intermittent injections of water and aspirations of luminal contents. It may be operated with one hand. Use of the device as described saves considerable time during many examinations and avoids postponement of other examinations.

Antacids in Peptic Ulcer Disease: State of the Art, G. Bianchi Porro, C.T. Richardson (Eds.). Cortina International Verona and Raven Press, New York (1988), 115,

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“The traditional ulcer diet may be on its way out.” So began another panel discussion on ulcer moderated by Dr. Zollinger two years ago in this Journal (June 1969, page 160). The statement is even truer today, and there are other shifts in emphasis. The diagnosis of gastric ulcer is more sophisticated, the use of the various medications is more discriminating, and malignancy is less likely to escape detection.