Enteroscopy:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1999
|
| Schriftenreihe: | Gastrointestinal endoscopy clinics of North America
9,1 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XII, 166 S. Ill., graph. Darst. |
Internformat
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| 490 | 1 | |a Gastrointestinal endoscopy clinics of North America |v 9,1 | |
| 650 | 2 | |a Endoscopie gastrointestinale - Méthode | |
| 650 | 2 | |a Estomac et intestinc, maladies - Diagnostic | |
| 650 | 2 | |a Intestin grêle | |
| 650 | 4 | |a Endoscopy, Gastrointestinal |x methods | |
| 650 | 4 | |a Gastrointestinal Diseases |x diagnosis | |
| 650 | 4 | |a Intestine, Small | |
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Datensatz im Suchindex
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| adam_text | ENTEROSCOPY
CONTENTS
Foreword xi
Charles J. Lightdale
Preface xiii
Masahiro Tada
The History of Enteroscopy 1
Blair S. Lewis
Enteroscopy was initially a technology with little application. The
small intestine was thought to be a rare site for any pathology and
the ability to look at the most proximal and distal ends, during
upper endoscopy and colonoscopy, was all that was needed in the
evaluation of most patients. The power to peer into the small bowel
has changed medical practice. This is especially true when dealing
with patients with unexplained gastrointestinal bleeding. Enteros¬
copy helped determine causes of bleeding in such cases, and helped
determine the most appropriate treatment algorithms.
Radiology Versus Endoscopy of the Small Bowel 13
Blair S. Lewis
Since the development of endoscopy, physicians have been com¬
paring radiographic studies with endoscopic examinations. Co¬
lonoscopy and upper endoscopy have largely replaced barium
enema and upper gastrointestinal series. Unfortunate]}, many
study protocols comparing colonoscopy with barium enema have
been retrospective and the radiologic examination is compared
with colonoscopy in a cohort group. The greatest difficulty with
interpreting results of these studies is the inclusion of clinically
GASTROINTESTINAL ENDOSCOPY
CLINICS OF NORTH AMERICA
VOLUME 9 • NUMBER 1 • JANUARY 1999 V
insignificant findings in the calculation of the diagnostic yield. For
example, in most studies barium enema is more successful than
colonoscopy in diagnosing diverticular disease, and inclusion of
this clinically insignificant entity increases the overall yield.
The Push Exam 29
John F. MacKenzie
Push enteroscopy has superseded sonde enteroscopy principally
because of its ability to provide therapy, as well as diagnosis. An
overtube limits gastric looping and allows deeper jejunal insertion.
A working channel allows therapeutic intervention. The technique
is increasingly used to the diagnosis and treatment of small intesti¬
nal disorders, particularly in obscure gastrointestinal bleeding. The
wider acceptance of push enteroscopy into routing practice re¬
quires further clinical effectiveness data.
The Sonde Exam 37
Rein Seensalu
Sonde type enteroscopy has made it possible to potentially exam¬
ine the entire depths of the small intestine. A relatively high diag¬
nostic yield has been obtained by the sonde method in patients
with obscure gastrointestinal bleeding. These features have made
sonde enteroscopy a clinically accepted method. However, sonde
type enteroscopy has also some disadvantages making it less then
a perfect endoscopy method. This article focuses on the technical
aspects of sonde enteroscpy, but also summarizes the indications
and the outcome of clinical studies.
Intraoperative Endoscopy 61
Jean Stephane Delmotte, Gerard Jean Gay,
Philippe H. Houcke, and Yvan Mesnard
Intraoperative endoscopy (IOE) is accepted as the ultimate diag¬
nostic procedure for the complete evaluation of small bowel. Until
recent years, operative endoscopy was the complement of sonde
enteroscopy. The difficulties of this long and fastidious type of
examination, for both the patient and the medical team are well
known. It provides incomplete exploration (detubing of certain
loops is too rapid), and renders impossible any diagnostic or thera¬
peutic procedure (biopsies, electrocoagulation). The indications of
IOE have diminished over recent years during the development
of push enteroscopy by upper or double way. Indeed, the latter
method makes it possible in a number of cases to obtain complete
exploration of the small bowel with biopsies and therapeutic proce¬
dures, or an exploration enabling screening for lesions in the first
jejunal loops of the lat ileal loops.
vi CONTENTS
Vascular Disorders of the Small Bowel 71
Darius Sorbi, Massimo Conio, and Christopher J. Gostout
Approximately 5% of all patients with gastrointestinal hemorrhage,
and up to 38% of subjects with iron deficiency anemia without
overt gastrointestinal bleeding, do not have a bleeding site identi¬
fied after routine evaluation by esophagogastroduodenoscopy and
colonoscopy. The source of bleeding in these subjects is often the
small intestine. Most vascular lesions of the small bowel present
as chronic gastrointestinal bleeding, which may severe in some
cases. Depending on the underlying disease, other systemic signs
and symptoms may be present. The diagnosis and often therapy
are heavily dependent upon endoscopic techniques, and in some
cases nonendoscopic methods.
Small Bowel Tumors and Polyposis Syndromes 93
Francesco P. Rossini, Mauro Risio, and Marco Pennazio
Tumors of the small bowel are uncommon and seldom suspected
on a clinical basis. Together with the relative inaccessibility of the
small bowel to endoscopic investigation, the rarity of these tumors
undoubtedly delays the diagnosis. Small bowel tumors may be an
interesting field of application for enterocscopy, which now can
be readily performed with dedicated enterocscopic evaluation in
patients with suspected small bowel neoplasia could improve prog¬
nosis and treatment. Enteroscopy may also play an important role
in the surveillance of inherited polyposis syndromes, as in other
precancerous condition of the small bowel. In Peutz Jeghers syn¬
drome it may reduce polyp induced complications and improve
planning for surgery; in familial adenomatous polyposis it may
contribute to preventing upper gastrointestinal tract cancer.
Enteroscopy in Small Intestinal Inflammatory Diseases 115
Gerard Jean Gay and Jean Stephane Delmotte
The development of new semilong enteroscopes, videopush entero
scope (VPE), has modified the diagnostic and therapeutic approach
to inflammatory intestinal diseases owing to the biopsy and thera¬
peutic capacities. In Crohn s Disease, VPE is useful in nonusual
clinical presentations: occult intestinal bleeding and in the treat¬
ment by dilatation of jejuna] and ileal strictures. In atrophic coeliac
disease (ACD) VPE is mandatory each time oesogastroduodenso
copy biopsies are noninformative in order to obtain pathologic
jejunal biopsis. In addition, in refractory ACD and in the case of
jejunal blood loss ACD, VPE is mandatory in the search for ulcera
tive jejunitis and lymphoma. The management of chronic diarrhea
of the adult, classic endoscopy remains the gold standard proce¬
dure and is carried out first but in patients with negative results,
VPE can proceed immediately. Good results can only be obtained
if VPE is performed by endoscopist who is highly interested in
this field of investigation.
CONTENTS vii
Nonsteroidal Anti Inflammatory Drug Enteropathy 125
A. John Morris
Although the upper gastrointestinal toxicity of non steroidal anti
inflammatory drugs( NSAID) is well documented, the appreciation
that NSAID damage extends beyond the duodenum is less well
recognized. Recent data suggests that clinically important ulcer
ation can be found in the small intestine, and may lead to complica¬
tions such as obscure bleeding, perforation, or obstruction. Enter
oscopy has identified the endoscopic and microscopic features of
this condition known as NSAID enteropathy. Information supplied
by enteroscopy has proven invaluable in managing patients with
suspected NSAID enteropathy. This article provides an update on
clinical features, endoscopic appearance, pathology, and outcome
of NSAID enteropathy.
The Role of Enteroscopy in Clinical Practice 135
C. Paul Swain
Enteroscopy does not yet carry the conviction that physicians are
used to with gastroscopy and colonoscopy. The examination is
never complete. The distance of small bowel examined in any
individual examination is unknown. Although some therapeutic
maneuvers are possible, the further the endoscope is into the small
bowel the more difficult it becomes to pass and control the instru¬
ments. There is more room for improvement in enteroscopy than in
almost any other area of gastrointestinal endoscopy. Nonetheless,
there have been real gains for patients with difficult gastrointestinal
bleeding and small bowel pathology with advances in diagnostic
and therapeutic ability with enteroscopes achieved by a combina¬
tion of relatively minor technologic changes and some clinical en¬
thusiasm.
Technical Advances and Experimental Devices
For Enteroscopy 145
Charles Alexander Mosse and C. Paul Swain
Enteroscopy remains the procedure in the gastrointestinal tract
that is most inaccessible to endoscopy, and technical limitations
severely impair the ability to advance and examine the small bowel
reliably or completely. Push type enteroscopy not only suffers limi¬
tations owing to looping in the stomach, but is intrinsically associ¬
ated with increasing loss of transmission of force to the tip and
consequent failure of advancement. Development is this area has
been slow, partly owing to the limited clinical need compared with
upper gastrointestinal endoscopy, and colonoscopy and conse¬
quent financial limitations imposed on further development. Practi¬
cal and useful technical advances have been made, especially in
push type as well as sonde type enteroscopy. These are reviewed
briefly and are covered in other articles elsewhere in this issue.
viii CONTENTS
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| title | Enteroscopy |
| title_auth | Enteroscopy |
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| title_full | Enteroscopy A. John Morris ..., guest ed. |
| title_fullStr | Enteroscopy A. John Morris ..., guest ed. |
| title_full_unstemmed | Enteroscopy A. John Morris ..., guest ed. |
| title_short | Enteroscopy |
| title_sort | enteroscopy |
| topic | Endoscopie gastrointestinale - Méthode Estomac et intestinc, maladies - Diagnostic Intestin grêle Endoscopy, Gastrointestinal methods Gastrointestinal Diseases diagnosis Intestine, Small Dünndarmkrankheit (DE-588)4196707-0 gnd Gastroenterologische Endoskopie (DE-588)4019404-8 gnd |
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