The development of fibre-optic endoscopy revolutionized the ability to investigate the gastrointestinal tract. Flexible endoscopes often have a diameter of less than 1 cm, with a control head and a flexible shaft with a manoeuvrable tip. The head is connected to a light source and can transmit images to a video image screen.
All endoscopes have multiple small lumens allowing transmission of air and water and for suction. The suction channel can also be used for the passage of interventional devices, for example biopsy forceps. The ability to transmit air (insufflation) allows the endoscopist to inflate the lumen to obtain optimal views. The water channel provides a means of washing mucosal surfaces, and suction maybe used to remove pools of fluid within the gastrointestinal tract, thus ensuring that all mucosal surfaces are inspected.
Diagnostic indications include the investigation of gastro-esophageal reflux (diagnostic investigation or surveillance endoscopy of Barrett's esophagus).
Therapeutic procedures that can be undertaken include mucosal biopsy, stent insertion for strictures, and dilatation of strictures.
Patient preparation
Informed consent is required, and patients are fasted for 4-6 hours prior to the procedure. Although most patients do not require sedation, the choice is offered and discussed. Sedation involves the use of a short-acting benzodiazepine which provides a sedative and amnesic effect. Monitoringis required (pulse oximetry) with sedation due to the risk of respiratory depression. Antibiotic prophylaxis is administered to patients with heart valve disease to prevent bacterial endocarditis.
Procedure
A mouthguard is used. The endoscope is introduced into the pharynx, then the oesophagus. Patients may retch during this procedure. The endoscope is progressively introduced to inspect the oesophagus, stomach and proximal small bowel (duodenum).
Complications
The overall complication rate is approximately 1 per 1000 with a mortality rate of approximately 1 per 25000. Complications include bleeding, perforation and respiratory arrest (a complication of sedation).
Post procedure care
Patients are monitored in a recovery area until safe for discharge.
What is acid reflux relief?
In medically oriented terms, antonyms of the word relief include pain, distress or damage. That links its meaning to both subjective and objective aspects. Subjective, denoting sensations experienced by the sufferer such as pain and objective, meaning physical findings detected by specialists which are either functional distress or organic damage. Actually relief is related to control measures and it quantitatively signifies removal of an unpleasant existence or reduction of its magnitude. The definition of relief, therefore encompasses alleviation of pain, relaxation of distress and healing of damage. Acid reflux on the other hand has two sides; the subjective side (symptoms) which reflects the symptom of heartburn and the objective side (signs) that reflects the functional and/or organic signs of esophageal changes. Acid reflux relief is therefore a broad term that covers all the measures used to control symptoms and signs of acid reflux disease. Normally, the lower esophageal sphincter remains closed except during swallowing. This prevents the passage of food and acid from the stomach into the esophagus. If the lower esophageal sphincter becomes weakened or relaxed, stomach acid may back up into the esophagus. Frequent acid reflux can irritate and inflame the lining of the esophagus, causing symptoms and signs of acid reflux. A better understanding of relief would thus entail knowledge of some aspects of normal structure and function, so that changes in the disease and its control could be easily considered. Actually acid reflux relief involves both preventive and curative measures, and in addition to treatment; orientation with the causes, symptoms and complications of acid reflux are essential for proper management. Acid reflux relief includes: dietary changes,lifestyle modifications, specific medications and surgical operations.Basic knowledge of the underlying causes and progression of acid reflux and answering frequently asked questions about its relief; add to the depth of understanding.
Saturday, May 3, 2008
Endoscopic investigation of gastro-esophageal reflux
Posted by SSS at 3:01 PM