Endoscopy

Theory and Equipment. Many diseases of the human body can be identified by visual appearance. Tumors in the upper gastrointestinal (GI) tract, for example, possess a characteristic salmon pink color (3). The presence of such a color can be an indication of disease. Endoscopy is the medical imaging tool used to detect such colors in the inside of hoUow internal organs such as the rectum, urethra, urinary bladder, stomach, colon, etc. An endoscope is the instmment used to perform endoscopy. Endoscopic imaging involves the production of a tme color picture of the inside of the human body using lenses and either hoUow pipes, a fiber optic bundle, or a smaU CCD camera. AU three use a large field-of-view, sometimes referred to as a fish eye, lens to aUow a 180° field of view. 

The largest use of endoscopic techniques is in the examination of the gastrointestinal tract. Upper intestinal endoscopy is the examination of the esophagus, stomach, and proximal duodenum. Colonoscopy is the examination of the colon, large intestine, and in some cases the distal parts of the small intestine. Cholangiopancreatography is the examination of the biUary tree and pancreas. 

Glutaraldehyde (1,3-diformyl propane) is a powerful, cold disinfectant. It is used principally in aqueous solution as a biocide and chemical disinfectant. It has been widely used in the health services, e.g. in operating theatres, endoscopy units, dental units and X-ray film processing. 

Anon (1988) Cleaning and disinfection of equipment for gastt ointestinal flexible endoscopy interim recommendations of a Working Party of ttie British Society of Gastt oenterology. Gut, 29, 1134-1151. 

Tuberculosis is on the increase in developed countries such as the USA and UK furthermore, MAI may be associated with AIDS sufferers. Hospital-acquired opportunistic mycobacteria may cause disseminated infection and also lung infections, endocarditis and pericarditis. Transmission of mycobacterial infection by endoscopy is rare, despite a marked increase in the use of flexible fibreoptic endoscopes, but bronchoscopy is probably the greatest hazard for the transmission ofM tuberculosis and other mycobacteria. Thus, biocides used for bronchoscope disinfection must be ehosen carefully to ensure that such transmission does not occur. 

Wood, S.,et ah, Erythrosine is a potential photosensitizer for the photodynamic therapy of oral plaque biofihns, J. Antimicrob. Chemother., 57, 680, 2006. Hurlstone, D.P., et ah. Indigo carmine-assisted high-magnification chromoscopic colonoscopy for the detection and characterisation of intraepithelial neoplasia in ulcerative colitis a prospective evaluation. Endoscopy, 37,1186, 2005. 

Hummel T., Kiihnau D., Knecht M., Abolmaali N. and Huttenbrink K.B. (1999). The anatomy of the vomeronasal organ characterisation by means of nasal endoscopy and magnetic resonance imaging. Chem Senses 24, abs. 365. 

Antimicrobial prophylaxis if ascites/cirrhosis present preferably before endoscopy... 

More definitive diagnostic tests include endoscopy (via endoscope or Pillcam ESO capsule), 24-hour ambulatory pH monitoring, diagnostic proton pump inhibitor (PPI) administration, or esophageal manometry. 

Upper gastrointestinal endoscopy is the preferred diagnostic test for assessing the mucosa for esophagitis and Barrett s esophagus.1 It enables visualization and biopsy of the esophageal mucosa. Endoscopy should be considered upon initial presentation in any patient who presents with complicated symptoms and those at risk for Barrett s esophagus.1... 

The PPIs are superior to H2RAs in patients with moderate to severe GERD. This includes not only patients with erosive esophagitis or complicated symptoms (Barrett s esophagus or strictures), but also those with non-erosive reflux disease who have moderate to severe symptoms. Symptomatic relief is seen in approximately 83% of patients and healing rates at 8 weeks as judged by endoscopy are 78%.1... 

CV RRR, normal S, S2 no murmurs, rubs, or gallops Abdomen Soft, non-tender, non-distended (+) bowel sounds, (-) hepatosplenomegaly, heme (-) stool Endoscopy Diffuse erythema and several isolated erosions in the distal esophagus no evidence of ulceration, obstruction, or stricture... 

Patients presenting with atypical symptoms may require higher doses and longer treatment courses than patients with typical symptoms. These patients are best diagnosed with ambulatory pH testing or an empiric trial with a PPI.23 These tests can confirm reflux in patients who have persistent symptoms without evidence of mucosal damage by endoscopy.1 In patients presenting with non-cardiac chest pain, a short course (1 to 8 weeks) of omeprazole 20 mg twice daily has been advocated.23... 

Patients with Endoscopy-Negative Reflux Disease... 

Patients presenting with normal esophageal mucosa on endoscopy may undergo 24-hour ambulatory pH testing or a therapeutic trial with a PPI to further confirm the diagnosis of GERD. 

Endoscopic approaches are typically used and may include colonoscopy, proctosigmoidoscopy, or possibly upper GI endoscopy in patients with suspected CD. Endoscopy is useful for determining the disease distribution, pattern and depth of inflammation, and to obtain mucosal biopsy specimens. Supplemental information from imaging procedures, such as computed tomography (CT), abdominal x-ray, abdominal ultrasound, or intestinal barium studies may provide evidence of complications such as obstruction, abscess, perforation, or colonic dilation.3... 

Endoscopy with scrapings or biopsy and stained slides (iron hematoxylin or trichrome) may provide more definitive diagnosis of amebiasis. 

Endoscopy revealing whitish plaques with progression to superficial ulceration of the esophageal mucosa... 

CrCL Creatinine clearance Endo Endotracheal, endoscopy... 

Endoscopy A procedure used to evaluate the interior surfaces of an organ by inserting a small scope into the body through it, one can directly examine almost any part of the intestinal tract. Biopsies can be obtained, polyps removed, and clear images obtained. 

This type of modeling, as well as wide field FLIM [84-86] and endoscopy [72] have tremendous potential for clinical diagnosis. Although still at the preclinical stage, various groups have looked at the differences in fluorescence spectrum and decay profiles in breast cancer [87, 88], the gastrointestinal tract [89], and skin cancer [90, 91] (see also Chapter 4). 

Glanzmann, T., Ballini, J. P., van den Bergh, H. and Wagnieres, G. (1999). Time-resolved spectrofluorometer for clinical tissue characterization during endoscopy. Rev. Sci. Instrum. 70, 4067-77. 

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