Mechanical displacement of the esophagus in patients undergoing left atrial ablation of atrial fibrillation.

Background: Left atrial (LA) ablation of atrial fibrillation (AF) may rarely be complicated by an atrio-esophageal fistula.

Objective: The purpose of this study was to determine the feasibility of mechanical displacement of the esophagus in patients undergoing LA ablation.

Methods: Twelve patients underwent mechanical displacement of the esophagus performed by an endoscopist during an LA ablation procedure under conscious sedation.

Atypical presentations of gastroesophageal reflux disease.

Gastroesophageal reflux disease typically manifests as heartburn and regurgitation, but it may also present with atypical or extraesophageal symptoms, including asthma, chronic cough, laryngitis, hoarseness, chronic sore throat, dental erosions, and noncardiac chest pain. Diagnosing atypical manifestations of gastroesophageal reflux disease is often a challenge because heartburn and regurgitation may be absent, making it difficult to prove a cause-and-effect relationship. Upper endoscopy and 24-hour pH monitoring are insensitive and not useful for many patients as initial diagnostic modalities for evaluation of atypical symptoms.

Esophageal Dilation / Dilators.

Esophageal dilation is the treatment of choice for most patients with esophageal dysphagia (functional and mechanical). Multiple forms of esophageal dilators are available. Mechanical dilators (guidewire/nonguidewire assisted) are the major forms of dilators used.

Review article: diagnosis and management of night-time reflux.

Symptoms of gastro-oesophageal reflux disease (GERD) range from mild to severe and, when they occur during night-time hours, can interfere with sleep patterns and reduce overall quality of life. The clinical presentation of GERD is characterized by oesophageal as well as supra-oesophageal symptoms, including otolaryngologic and pulmonary complications. However, GERD may be overlooked as the cause of a patient's supra-oesophageal symptoms because these complaints can occur in the absence of oesophageal symptoms or endoscopic changes.

Management of gastroesophageal reflux disease.

The primary treatment goals in patients with gastroesophageal reflux disease are relief of symptoms, prevention of symptom relapse, healing of erosive esophagitis, and prevention of complications of esophagitis. In patients with reflux esophagitis, treatment is directed at acid suppression through the use of lifestyle modifications (e.g.

Intrasphincteric botulinum toxin versus pneumatic balloon dilation for treatment of primary achalasia.

Goals: Despite a high success rate, pneumatic dilatation for achalasia is accompanied by a significant risk of esophageal perforation. Injection of botulinum toxin (botox) into the lower esophageal sphincter (LES) can lead to improvement in symptoms with reduced risk of complications. Direct comparisons of the two techniques are needed to define their role in clinical management.

The Stretta procedure for the treatment of GERD: 6 and 12 month follow-up of the U.S. open label trial.

Background: This multicenter prospective study investigated the longer-term (12 month) safety and efficacy of radiofrequency energy delivery for the treatment of GERD.

Methods: A prospective study was conducted of 118 patients with chronic heartburn and/or regurgitation who required antisecretory medication daily and had demonstrated pathologic esophageal acid exposure, a sliding hiatal hernia ( View Article and Find Full Text PDF

Endoscopic Treatment for Gastroesophageal Reflux Disease.

Gastroesophageal reflux disease is a common illness that requires continuous and potentially long-term therapy. Current therapies include long-term acid-reducing medications (most commonly proton pump inhibitors), laparoscopic and open antireflux surgery, and most recently, endoscopic therapies. For the majority of patients with symptomatic GERD, long-term acid-reduction medications are standard therapy.

Can endoscopic ultrasound or magnetic resonance cholangiopancreatography replace ERCP in patients with suspected biliary disease? A prospective trial and cost analysis.

Objectives: ERCP is the gold standard for pancreaticobiliary evaluation but is associated with complications. Less invasive diagnostic alternatives with similar capabilities may be cost-effective, particularly in situations involving low prevalence of disease. The aim of this study was to compare the performance of endoscopic ultrasound (EUS) with magnetic resonance cholangiopancreatography (MRCP) and ERCP in the same patients with suspected extrahepatic biliary disease.

Radiofrequency energy delivery to the gastroesophageal junction for the treatment of GERD.

Background: In this multi-center study, the feasibility, safety, and efficacy of radiofrequency (RF) energy delivery to the gastroesophageal junction (GEJ) for the treatment of gastroesophageal reflux disease (GERD) were investigated.

Methods: Forty-seven patients with classic symptoms of GERD (heartburn and/or regurgitation), a daily anti-secretory medication requirement, and at least partial symptom response to drugs were enrolled. All patients had pathologic esophageal acid exposure by 24-hour pH study, a 2 cm or smaller hiatal hernia, grade 2 or less esophagitis, and no significant dysmotility or dysphagia.

The accuracy of EUS and helical CT in the assessment of vascular invasion by peripapillary malignancy.

Background: The relative accuracy of helical CT and EUS for defining the local resectability of peripapillary malignancies is undefined.

Methods: Fifty-one patients with a peripapillary malignancy and no metastatic disease were prospectively evaluated with helical CT and EUS. Imaging results were compared with surgical staging, and a tumor was defined as resectable when there was no macroscopic or microscopic residual tumor.

Endoscopic ultrasound is highly accurate and directs management in patients with neuroendocrine tumors of the pancreas.

Unlabelled: Preoperative localization of pancreatic neuroendocrine tumors with traditional imaging fails in 40-60% of patients. Endoscopic ultrasound (EUS) is highly sensitive in the detection of these tumors. Previous reports included relatively few patients or required the collaboration of multiple centers.

Diagnosis and management of supra-esophageal complications of reflux disease.

Supra-esophageal reflux disease may be manifested in numerous ways, including reflux laryngitis, chronic cough, chronic sinusitis, and dental enamel loss. The mechanisms of pharyngeal and laryngeal reflux are not clearly defined, and standard reflux testing does not consistently demonstrate supra-esophageal reflux. The diagnosis is usually based on clinical suspicion when other causes of symptoms are not found and on the patient's response to empiric acid suppression.

Gastroesophageal reflux and laryngitis: a skeptic's view.

Gastroesophageal reflux disease (GERD) and laryngitis are common problems in the community. To prove a causal relationship between GERD and laryngitis, one must show the mechanism for acid-induced laryngitis, establish the frequency of association, have a gold standard for diagnosis of the condition, and show that treatment that reduces acid reduces laryngitis in double-blind, randomized, placebo-controlled trials. This article examines each of these components and finds that all are wanting as proof for reflux-induced laryngitis.

EUS compared with CT, magnetic resonance imaging, and angiography and the influence of biliary stenting on staging accuracy of ampullary neoplasms.

Background: Computerized tomography (CT), magnetic resonance imaging (MRI), and transabdominal ultrasound frequently fail to detect ampullary lesions. Endoscopic ultrasound (EUS) is a sensitive modality for detecting and staging ampullary tumors. Accurate staging may be affected by biliary stenting, which is frequently performed in these patients with obstructive jaundice.

Low- versus high-dose azithromycin triple therapy for Helicobacter pylori infection.

Background: We report a clinical trial which evaluated the effectiveness of triple therapy containing low- and high-dose azithromycin to treat Helicobacter pylori infection.

Methods: From March 1997 to March 1998, patients infected with H. pylori were assigned to receive either: Treatment 1: ranitidine bismuth citrate (RBC) (400 mg b.

Utility of a linear array ultrasound endoscope in the evaluation of suspected pancreatic disease.

Endoscopic ultrasonography (EUS) is currently being used to evaluate and stage pancreaticobiliary malignancies and neuroendocrine tumors, and to perform aspiration for cytologic diagnosis. There are currently two different commercially available EUS systems for clinical use. One system uses a mechanical radial sector scanner oriented in a plane perpendicular to the long axis of the endoscope, and the other uses an electronic convex scanner that is oriented in the long axis of the endoscope.

Screening for colorectal cancer.

Randomized, controlled trials have shown with certainty that screening for colorectal cancer reduces morbidity and is cost-effective. Factors that increase the risk of colorectal cancer include a personal or family history of adenomatous polyps or colorectal cancer, certain genetic syndromes and chronic inflammatory bowel disease.

Esophageal dilation.

Esophageal dilation, a technique developed four centuries ago, continues to be an important method of treating the symptom of dysphagia in patients with luminal narrowing of the esophagus. Dilation is safe, with < 0.5% chance of perforation and bleeding and a 0.

Pathophysiology and endoscopic/balloon treatment of esophageal motility disorders.

Diagnostic and therapeutic dilemmas associated with esophageal dysmotility syndromes continue to confront physicians managing these patient populations. Although modern manometric systems have allowed us to better define normal parameters of esophageal motility, with the exception of primary achalasia, the clinical relevance of many aberrant motor patterns remains unclear. The novel use of botulinum toxin in idiopathic achalasia stems from increased understanding of the pathogenesis of the disease.

Bismuth subsalicylate instead of metronidazole with lansoprazole and clarithromycin for Helicobacter pylori infection: a randomized trial.

Objective: We evaluated the efficacy of lansoprazole, clarithromycin, and metronidazole (LCM) administered twice daily for 7 days. Because there is growing concern about the development of metronidazole-resistant H. pylori (HP) strains, we also tested a novel regimen consisting of lansoprazole, clarithromycin, and bismuth subsalicylate (LCB).

Lansoprazole and ranitidine affect the accuracy of the 14C-urea breath test by a pH-dependent mechanism.

Objectives: To determine the effect of lansoprazole and high dose ranitidine on the accuracy of the 14C-urea breath test (UBT). Using intragastric pH recordings, we correlated the effect of these agents on the UBT with their potency of gastric acid suppression.

Methods: Patients with active Helicobacter pylori infection underwent a baseline UBT before receiving 14 days of lansoprazole (30 mg/day) or ranitidine (300 mg b.