Tag Archives: endoscopy

Inter-observer variability on the value of endoscopic images for the documentation of upper gastrointestinal endoscopy – our center experience

Ioana Natalia Bernatchi1, Septimiu Voidazan2, Madalina Ioana Petrut1, Gabriella Gabos1, Madalin Balasescu3, Carmen Nicolau1

1. Gastroenterology Department, Lotus Image Medical Center, Târgu Mureş, Romania
2. Department of Epidemiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Intensive Care Unit, Mureș County Clinical Hospital, Targu Mures, Romania

DOI: 10.2478/amma-2023-0015

Objective: Endoscopy is an essential and invaluable diagnostic tool in the arsenal of every gastroenterologist. ESGE presented additional guidelines for standardized image documentation in upper and lower gastrointestinal endoscopy. Clinical disagreement is a common challenge in most, if not all, fields of medicine. Settling disagreements is important so as to find ways to minimize it. Clinical disagreement in gastroscopy may be demonstrated by studying the observer variability.
Methods: We retrospectively recruited 120 random patients that underwent conventional upper gastrointestinal endoscopy between 2021-2022 in our Department of Gastroenterology, all of them performed by one endoscopist. As part of the study, all video-endoscopic recordings were stored using one internal server. In order to study interobserver variability, four physicians (endoscopists and gastroenterologist specialists) were invited to complete the questionnaire.
Results: The interobserver variability in our study ranged from moderate to very good in the assessment of the esophagus, with the highest degree of agreement in response to questions concerning characteristic findings such as normal mucosa, esophagitis Class A Los Angeles, hiatal hernia for the esophagus endoscopic evaluation, benign ulcer niche in gastric antrum, normal gastric corpus mucosa, intestinal metaplasia and angiodysplasia in gastric corpus. The question on atrophic mucosa in the first and second part of the duodenum was the most difficult to agree upon.
Conclusion: The present study found that the variability between observers in the assessment of images obtained from patients that underwent conventional upper gastrointestinal endoscopy in our center was acceptably good.

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Comparative study of Clinical Characteristics in Patients with Mild and Severe Reflux Esophagitis

Melania Macarie1, Simona Maria Bataga1, Monica Pantea1, Razvan Opaschi1, Simona Mocan2, Ioan Macarie3

1. Department of Gastroenterology. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Department of Pathology, Targu Mures County Clinical Emergency Hospital, Romania
3. Department of Internal Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2020-0002

Objective: This study aims to determine the correlation between risk factors and erosive esophagitis development. Methods: We conducted a retrospective observational study on a consecutive series of 19.672 patients who underwent upper gastrointestinal endoscopy between 01.01.2011-31.12.2017. A total of 3005 patients, diagnosed with erosive esophagitis, were included in the present study and stratified according to Los Angeles classification. Results: During the studied period we found 3005 patients with erosive esophagitis, sex ratio male to female was 1.3/1, the most common forms of esophagitis being grade A and B: 74.54% patients with esophagitis grade A, 14.80% patients with grade B; 5.29% patients were with grade C and 5.35% patients with esophagitis grade D. In severe esophagitis the male predominance was more prevalent (249 males, 71 female), with a sex ratio 3.50/1. The correlation of male gender with severe esophagitis was highly statistically significant (p < 0.0001, OR 2.97; 95% CI 2.25-3.91). Hiatal hernia was diagnosed in 1171 patients, the presence of large hiatal hernias, being an important predictor, with statistical significance (p < 0.0001, OR 3.41; 95% CI 2.22-5.21), for severe esophagitis development. Incidence of Helicobacter pylori infection was 11.51%, in the entire study group, with no statistical significant difference between patients with mild or severe esophagitis (12.02% vs 7.18%). Conclusion: Erosive esophagitis is a frequent disease, the most common forms being grade A and B. Male gender and the presence of hiatal hernia are the most important risk factors for erosive esophagitis development, in our study group.

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Tips and Tricks to Manage Vascular Risks Using the Transnasal Endoscopic Approach to Pituitary Adenomas

Chinezu Rareș1,2*, Berhouma Moncef3, Jacquesson Timothée3, Raverot Gerard4,5,6, Jouanneau Emmanuel3,5,6

1 University of Medicine and Pharmacy Tirgu Mures, Tirgu Mures, Romania
2 Clinic of Neurosurgery, County Clinical Emergency Hospital Tirgu Mures, Romania
3 Service de neurochirurgie B, Unité de chirurgie de la base du crâne. Groupement hospitalier Est, Hospices civils de Lyon, Bron, France
4 Fédération d’endocrinologie du pôle Est, Aile A1, Groupement hospitalier Est, Hospices civils de Lyon, France
5 Université Claude-Bernard, Lyon-1, Lyon, France
6 Inserm U1028, CNRS UMR 5292, Centre de neurosciences de Lyon, France

DOI: 10.1515/amma-2015-0100

Objective: The purely transnasal endoscopic approach has taken in the last decade a paramount importance in the treatment of pituitary adenomas, but some authors have been linked it to an increase in vascular complications. The aim of this paper is to provide a stepwise description of the vascular risks and steps required to avoid them.
Method: We present the minimal invasive technique used by the senior author in over 900 transnasal purely endoscopic approaches focusing on the relevant vascular landmarks, preoperative and operative steps taken in order to avoid vascular injury and the management of vascular injury from a multitude of sources.
Conclusion: Endoscopy has brought a wider field of view, with numerous vascular structures well inside the operating field. This represents control but also higher risk. Solid knowledge of the skull base anatomy and proper preoperative imaging coupled with an experienced surgeon can greatly reduce the vascular risks associated with surgery.

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The Detection of Premalignant and Malignant Gastric Lesions by Conventional Endoscopy in a General Population Sample

Boeriu Alina1, Dobru Daniela1, Pascarenco Ofelia2, Mocan Simona3

1 Department of Gastroenterology, University of Medicine and Pharmacy Targu Mures
2 Department of Gastroenterology, Targu Mures County Hospital
3 Department of Pathology, Targu Mures County Emergency Hospital

Background and Aims: The identification of patients with premalignant lesions and endoscopic surveillance could improve the early detection of gastric cancer, with better therapy and prognosis. We performed conventional endoscopy with biopsies to identify the incidence rates of premalignant and malignant gastric lesions and the risk of patients for this pathology.
Methods: A total of 1651 patients were investigated with conventional endoscopy. We took biopsies from 1493 patients. Biopsy specimens were analyzed for gastric inflammation, atrophy, intestinal metaplasia, dysplasia and neoplasia.
Results: We demonstrated that major symptoms had a sensitivity of 95.2%, and a specificity of 54.5% for the detection of gastric neoplasia, with a sensitivity of 61.6% and a specificity of 57.2% for the detection of premalignant lesions. We showed the risk of patients over 45 years, with major or minor symptoms, for premalignant and malignant gastric lesions (p < 0.001; RR = 3.34; 95%CI: 2.41–4.61). We emphasized the importance of histological evaluation by biopsies of entire gastric mucosa in case of polyps, ulcers, gastric atrophy detection or remnant stomach, for the evaluation of premalignant lesions (p < 0.,05). We showed that the prevalence of premalignant lesions increased with age and the presence of Hp infection. We demonstrated the risk of the inflammation in the gastric body for premalignant lesions.
Conclusions: The patient’s symptoms were not predictive of endoscopic and histologic findings. Not only symptoms, but also the age, the presence of Helicobacter pylori infection, the histological detection of the extent and location of gastric inflammation and premalignant lesions define the risk for the dyspeptic patients.

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The Usefulness of White Light Endoscopy, Narrow Band Imaging, and Magnification for the Optimization of Diagnosis in Barrett’s Esophagus

Boeriu Alina1*, Brusnic Olga1, Onișor Danusia1, Pascarenco Ofelia1, Boeriu C2, Dobru Daniela1

1 Department of Gastroenterology, University of Medicine and Pharmacy Tirgu Mures, Romania
2 University of Medicine and Pharmacy Tirgu Mures, Tirgu Mures County Emergency Hospital, Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0002

The diagnosis of dysplasia and early neoplasia in Barrett’s esophagus by conventional endoscopy is based on a four- quadrant random biopsies protocol that is prone to sampling errors. Novel endoscopic techniques have been developed to enhance the detection of premalignant and malignant lesions by real time assessment of microvasculare architecture and mucosal structure. Chromoendoscopy with magnification has improved the visualization of lesions, but the dye application impairs a clear evaluation of vascular network. Narrow band imaging endoscopy enhances vascular imaging by using narrow bandwidth lights, with penetration to superficial mucosal structures. Different classification systems of mucosal and vascular patterns have been developed to improve the diagnostic accuracy of non-dysplastic and dysplastic BE, as well as of early esophageal cancer. This article is focused on both the clinical benefits and controversies surrounding conventional and advanced endoscopic methods used for screening and surveillance of patients with Barrett’s esophagus. Current evidence shows that the adoption of new technology in routine practice requires a high level of performance as well as the standardization of various classification systems.

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