Colonoscopy capacity in Tennessee: potential response to an increased demand for colorectal cancer screening.

To determine the potential colonoscopy capacity in Tennessee, a questionnaire was sent to the 162 members of the American College of Gastroenterology in Tennessee. Fifty-three (32.7 percent) were returned.

A randomized, double-blind, phase 3 study of fospropofol disodium for sedation during colonoscopy.

Goals: This double-blind, multicenter study evaluated the safety and efficacy of intravenous fospropofol (6.5 mg/kg vs. 2 mg/kg) for moderate sedation in patients undergoing colonoscopy.

Detection of tissue injury after extracorporeal shockwave lithotripsy of gallstones.

We evaluated seven patients undergoing gallstone lithotripsy for evidence of hepatic or renal trauma after each of 10 lithotripsy treatments. Postlithotripsy magnetic resonance imaging (MRI) and sonography showed no evidence of hepatic or renal injury as compared with baseline studies. Four treatments resulted in sonographic evidence of gaseous hepatic microbubbles (analogous to "the bends") due to cavitation effects of the shockwaves.

Limited benefit of atropine as premedication for colonoscopy.

A prospective double-blind trial was performed comparing atropine (0.5 mg) by slow intravenous administration to placebo as premedication for colonoscopy, to assess the possible beneficial effects of this vagolytic agent on the performance and safety of the procedure. A total of 77 patients was randomly assigned to receive atropine (38 patients) or placebo (39 patients) before colonoscopy in conjunction with our standard initial medications for conscious sedation (meperidine, 0.

Diltiazem therapy for symptoms associated with nutcracker esophagus.

Unlabelled: A randomized double-blind, cross-over prospective trial in 22 patients was designed to evaluate possible effect of an oral calcium channel blocker, diltiazem, on symptoms of chest pain and/or dysphagia in patients with nutcracker esophagus. We studied 22 consecutive patients referred to an esophageal diagnostic center for evaluation of noncardiac chest pain or dysphagia having high amplitude esophageal contractions, 14 of whom completed the study. Diltiazem (60-90 mg qid) was compared with placebo, each being administered for 8 wk.

Utility of upper endoscopy in the evaluation of noncardiac chest pain.

The diagnostic yield of esophagogastroduodenoscopy, esophageal manometry, and Bernstein testing was assessed in 100 consecutive patients being evaluated for non-cardiac chest pain. Manometric studies revealed the nutcracker esophagus in 21 patients; non-specific esophageal motility disorders in 19 patients; a hypertensive lower esophageal sphincter in 4 patients; diffuse esophageal spasm in 2 patients; and normal motility in 54 patients. Endoscopy was normal in 38 patients; but revealed grades II to IV esophagitis in 24 patients; gastritis and/or duodenitis in 18 patients; a sliding hiatal hernia without evidence of esophagitis in 14 patients; and gastric or duodenal ulcers in 6 patients.

Abnormal cardiac sensitivity in patients with chest pain and normal coronary arteries.

The causes of chest pain in patients found to have angiographically normal coronary arteries during cardiac catheterization remain controversial. Cardiac sensitivity to catheter manipulation, pacing at various stimulus intensities and intracoronary injection of contrast medium was examined in several groups of patients who underwent cardiac catheterization. Right heart (especially right ventricular) catheter manipulation and pacing and intracoronary contrast medium provoked chest pain typical of that previously experienced in 29 (81%) of 36 patients with chest pain and angiographically normal coronary arteries and 15 (46%) of 33 symptomatic patients with hypertrophic cardiomyopathy.

Cavitation effects during lithotripsy. Part II. Clinical observations.

Cavitation effects during biliary lithotripsy can produce sonographically visible microbubbles. The relationship between microbubble formation and clinical outcome of gallstone lithotripsy performed with a commercial lithotriptor was studied in 50 treatments in 29 patients. Microbubble formation in bile was a useful predictor of successful stone fragmentation in 31 of 34 treatments.

Intraesophageal balloon distention versus drug provocation in the evaluation of noncardiac chest pain.

Intraesophageal balloon distention (IEBD) has been advocated as an effective provocative test for the evaluation of chest pain and dysphagia. The normal esophageal response to intraesophageal balloon distention is to generate a sustained contraction proximal to the balloon while showing a distinctive absence of activity distal to the balloon. We evaluated intraesophageal balloon distention in 62 patients with noncardiac chest pain and compared the diagnostic results to those obtained by using a combination of acid infusion, edrophonium (80 micrograms/kg iv) and bethanechol (80 micrograms/kg sq).

A prospective study of the prevalence of colonic neoplasms in asymptomatic patients with an age-related risk.

This study was designed to determine the prevalence of colorectal neoplasia in healthy, asymptomatic adults with an age-related risk for colorectal neoplasia. Ninety patients were studied with air contrast barium enema and colonoscopy. The study population included 61 males and 21 females, with an age range of 51-82 yr (65 +/- 2 yr).

Relationship between stone motion, targeting, and fragmentation during experimental biliary lithotripsy.

In vitro experiments in an anthropomorphic phantom were performed to clarify the relationship between stone motion, targeting, and fragmentation. Stone motion was minimized by pinning the stone against the dependent wall of a mock gallbladder cavity during shock wave treatment. Fragmentation was most effective (probably due to increased cavitation effects) when the shock wave traversed fluid at the point of its impact with a stone.

Coronary flow reserve, esophageal motility, and chest pain in patients with angiographically normal coronary arteries.

Purpose And Methods: To ascertain the relative prevalence of abnormalities of coronary flow reserve and esophageal function in patients with chest pain despite angiographically normal coronary arteries, 87 patients underwent invasive study of coronary flow reserve and, during the same week, esophageal testing.

Results: Sixty-three of the 87 patients (72%) demonstrated abnormalities of coronary flow reserve, as evidenced by an increase in coronary resistance during the stress of rapid atrial pacing after administration of ergonovine 0.15 mg intravenously (1.

Intraesophageal balloon distention in the manometric evaluation of chest pain.

Drug provocation is routinely used during esophageal manometry in the evaluation of chest pain of presumed esophageal origin. As significant side effects have been associated with the use of drugs in provocation, and these provocative tests are inadequately sensitive to exclude esophageal etiology as the cause of chest pain, alternative provocative tests have been sought. Intraesophageal balloon distention (IEBD) has recently been reintroduced as a method of pain provocation in the manometric evaluation of chest pain.

Manometric responses to balloon distention in patients with nonobstructive dysphagia.

The manometric responses to graded intraesophageal balloon distention were studied in 30 patients with symptoms of intermittent dysphagia but without evidence of structural narrowing on barium swallow or endoscopy, or both. These studies were compared with those performed in 10 normal volunteers. Using a manometric catheter with a balloon of reproducible dimension, balloon distention produced a sustained pressure proximal to the distended esophageal balloon in 28 of 30 (93%) patients and 9 of 10 (90%) normal volunteers.

Prospective evaluation of high-dose bethanechol in investigation of esophageal chest pain.

We compared the value of bethanechol 80 micrograms/kg subcutaneously, acid infusion with a 0.1 normal hydrochloric acid, and edrophonium 80 micrograms/kg intravenously as provocative agents to reproduce chest pain and manometric alterations in 72 patients with noncardiac chest pain. No patient developed typical chest pain and manometric alteration with acid infusion, while five (6.

A marked guide wire facilitates esophageal dilatation.

Esophageal dilatation by endoscopists is a commonly performed procedure. The introduction of tapered polyvinyl dilators by Savary has made the procedure even more popular. In the United States, esophageal dilatation with guide wires has been traditionally performed with fluoroscopy.

Pulmonary disease in progressive systemic sclerosis. A complication of gastroesophageal reflux and occult aspiration?

Thirteen patients with progressive systemic sclerosis were studied to evaluate the possible role of gastroesophageal reflux as a contributing pathogenic factor in the pulmonary disease of the patients. The evaluation of all patients included fiberoptic esophagogastroduodenoscopy with biopsies of the esophagus, otolaryngologic evaluation, technetium Tc 99m sulfur colloid aspiration scan, pulmonary function testing, including the diffusing capacity for carbon monoxide (DLCO) test, and 24-hour intraesophageal pH monitoring with probes placed 5 and 15 cm above the lower esophageal sphincter. Eleven patients had microscopic and macroscopic evidence of proximal esophagitis, 12 patients had laryngeal changes suggestive of aspiration, and 12 patients had abnormal DLCO values.

Development of a laser balloon for the treatment of gastrointestinal obstruction.

This work describes the initial results using a laser balloon in a canine model in an attempt to deliver the energy in a circumferential pattern. A balloon catheter, 2 cm long and 3 mm in diameter, was developed. Using a standard cw 100 watt Nd:YAG laser, a 600 micron fiber was tapered to 200 microns and passed through the proximal end of the balloon.

Hyperplastic colonic polyps as a marker for adenomatous colonic polyps.

Hyperplastic colonic polyps are generally regarded as being of little or no clinical consequence. Recently, however, hyperplastic polyps have been found to share numerous functional similarities with colorectal carcinoma. To determine whether the presence of an isolated left-sided colonic hyperplastic (metaplastic) polyp could serve as a marker for more proximal synchronous adenomatous colonic polyps, we retrospectively analyzed all consecutive colonoscopic polypectomies performed over an 18-month period at two medical centers.

Use of endoscopic ultrasound in patients with esophageal motility disorders.

New technology has combined the endoscope with ultrasound in an effort to enhance the visualization of the gastrointestinal tract. With a modified standard endoscope that has an ultrasound transducer built into the tip, high frequency ultrasonic beams can be targeted in close proximity to existing lesions. This results in better quality resolution which enhances the evaluation of the targeted lesion.

The role of endoscopic retrograde cholangiopancreatography injection training sessions for the gastroenterology nurse and associate.

Pancreatitis is a recognized serious complication of endoscopic retrograde cholangiopancreatography (ERCP). The pressure with which contrast media are injected may be a risk factor for developing pancreatitis. We, therefore, designed a study to determine if there were differences in pressures generated by experienced and inexperienced gastroenterology nurses and how much training would be required to instruct individuals to inject to a specific pressure.