phenylephrine-hydrochloride and Esophageal-and-Gastric-Varices

To clarify the usefulness of transnasal esophagogastroduodenoscope (N-EGD) with all flexible imaging color enhancement (FICE) patterns (0-9) for the diagnosis of esophageal varices (EV).. A total of 50 patients with EV were examined during the same period by N-EGD without sedation and by peroral endoscopy (O-EGD) with sedation. The visibility of treatment scars, microvessels, recurrent EV and red color sign (RCS) were measured. Visibility was evaluated by five blinded observers (poor-good: 0-10), and the effect of both endoscopic examinations on the cardiorespiratory function of the patients was measured.. The image scores for O-EGD and N-EGD with ordinary mode and N-EGD with FICE were 7.3 ± 1.2, 6.1 ± 1.0 and 6.9 ± 1.0 for treatment scars; 7.2 ± 1.4, 6.2 ± 1.2 and 7.3 ± 1.0 for microvessels; 7.2 ± 1.2, 6.1 ± 1.0 and 7.1 ± 1.0 for recurrent EV and 7.2 ± 1.3, 6.1 ± 1.3, and 7.2 ± 1.2 for RCS, respectively (intraclass correlation coefficients > 0.6). When FICE patterns 2, 6 and 9 were used, visibility was much improved. Ten minutes after insertion, the double product values in the N-EGD with the FICE group were significantly better (P < 0.05).. N-EGD with FICE is very useful for the diagnosis of EV and can improve the visibility of N-EGD on each lesion to the same level as that of O-EGD. N-EGD with FICE does not require sedation and may reduce the risk of hepatic encephalopathy.

Topics: Adult; Aged; Aged, 80 and over; Color; Conscious Sedation; Endoscopy, Digestive System; Esophageal and Gastric Varices; Female; Hepatic Encephalopathy; Humans; Image Enhancement; Liver Cirrhosis; Male; Middle Aged; Mouth; Nose; Single-Blind Method; Young Adult

Screening in selected high risk populations for Barrett's oesophagus (BO) and oesophageal varices (OVs) has been proposed, but there are obstacles with conventional oesophagogastroduodenoscopy (C-OGD), including patient acceptability. Portable and disposable office-based transnasal endoscopy (TNE) is a feasible and accurate alternative to C-OGD that may have use in primary and secondary care. This article outlines a qualitative analysis of patient experiences of TNE and C-OGD in order to gain an insight into an acceptable delivery of an endoscopic screening service.. Purposeful sampling identified 23 participants who then underwent semi-structured interviews to determine their experiences of both procedures. Thematic analysis was conducted to derive meaning from their lived experiences.. A secondary care endoscopy unit, clinic room and interview room.. Patients referred for BO or OV surveillance and for endoscopy to investigate dyspepsia underwent unsedated TNE using the EG Scan II device followed by C-OGD with or without sedation (patient choice), as part of a clinical trial.. The themes that arose from our analysis were: inclusivity in one's own healthcare, comfort level and convenience, validity of the procedure and application to a screening population and a sense of altruism and reciprocity. Positive aspects of TNE included participant empowerment, reduced discomfort and avoidance of conscious sedation. Participants felt that if TNE screening was of proven efficacy it would be welcomed, though views on use in a community setting were mixed.. Most patients preferred TNE to unsedated C-OGD and the reasons they gave featured strongly in the emerging themes. Preferences between TNE and sedated C-OGD were more subtle, with equivalent comfort scores but merits and drawbacks of both being discussed. This information identifies opportunities and challenges in establishing an endoscopic screening service.

Topics: Aged; Aged, 80 and over; Barrett Esophagus; Disposable Equipment; Endoscopy, Digestive System; Esophageal and Gastric Varices; Female; Humans; Interviews as Topic; Male; Mass Screening; Middle Aged; Natural Orifice Endoscopic Surgery; Nose; Patient Acceptance of Health Care; Qualitative Research

Topics: Adult; Balloon Occlusion; Esophageal and Gastric Varices; Hematemesis; Humans; Male; Necrosis; Nose; Pressure

Topics: Child; Drug Administration Routes; Endoscopy, Digestive System; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Hematemesis; Humans; Nose; Sclerotherapy; Treatment Outcome

Topics: Adult; Aged; Endoscopy; Esophageal and Gastric Varices; Esophagoscopy; Female; Fiber Optic Technology; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Intubation, Gastrointestinal; Liver Cirrhosis; Male; Middle Aged; Nose; Recurrence