Colonoscopy at King Hussein Medical Center; indications, effectiveness, safety and outcome

To find out the indications, effectiveness, safety and outcome of colonoscopy at King Hussein Medical Center. A retrospective analysis of the colonoscopy records for patients who underwent elective colonoscopy over a 7-year period [January 2000-October 2006] at King Hussein Medical Center in Amman, Jordan was done. Data collected included the number of the patients, age, gender, reason for doing the procedure, endoscopic findings, and any immediate complication. For all patients colonic preparation using Dulcolax [Biscodyl 5 mg tab] and Fortrans [Macrogol 4000-64 gm] or castor oil with normal saline and unistiffness endoscopes were used. Almost all colonoscopies were done with sedation using Mipiridine 25 mg and Midazolam 3 mg intravenously. A total of 3865 colonoscopies were included in the study, 42% percent of patients were aged less than 50 years. 89% of the colonoscopies were done for patients from physicians as outpatients and 11% for patients who were already in hospital. The number of endoscopies performed during the year 2006 per month was considerably higher [mean 65] than that done during the year 2000 [mean 30]. The main indications for colonoscopies were rectal bleeding [39%], constipation [17%], and diarrhea in 12%. In 3749 [97%] patients, the procedure was completed up to cecum. Normal colonoscopy was reported in 72.5% of patients. The most common abnormal findings were colonic cancer [29%], colonic polyps in 24% and inflammatory bowel disease in 16%. Other common findings were diverticulosis [13.4%], melanosis coli [2.4%], and vascular ectasias in 2.5%. Internal hemorrhoids was a coexistent finding in [n=30] those diagnosed as colonic cancer and [n=18] in those diagnosed as colonic polyps, but it was the only colonoscopic finding in 130 patients [12.2%]. Colonic polyps were also found as coexistent finding in 47 patients diagnosed as colonic cancer. Seven [0.018%] patients had a major complication related to the procedure in the form of colonic perforation [n=4], minor bleeding which did not necessitate blood transfusion [n=2], and stuck snare wire due to looping around a normal colonic mucosa that mandated removal by lapratomy [n=1]. Colonoscopy at King Hussein Medical Center, is safe and effective in establishing a definitive diagnosis, and rarely associated with major complications such as perforation or bleeding

Endoscopic findings in acute upper gastrointestinal hemorrhage at King Hussein Medical Center

To find out the diagnosis in patients presenting with acute upper gastrointestinal hemorrhage at King Hussein Medical Center. A total of 1118 cases of acute upper gastrointestinal hemorrhage patients aged over 16 years who underwent upper endoscopy over a six year-period at King Hussein Medical Center were studied. Most endoscopies were done within 24 hours from the occurrence of the gastrointestinal bleeding. Patients were divided into different age groups to compare the frequency of upper gastrointestinal hemorrhage between males and females in each group. The total number of patients was also divided into 2 subgroups: those below 50 years and above 50 years to compare the distribution of the endoscopic findings between young and older age groups. Upper gastrointestinal bleeding was more common in men at all age groups than that in women except in older patients [more than 70 years]. Eighty seven percent of the endoscopies were done for patients admitted to hospital through the emergency department, and 13% for patients who were already in hospital for some other reason. Sixty two percent of patients were aged over 50. The most common finding over all was duodenal ulcer [32%]. Normal endoscopy was reported in 21% of the cases. Other frequent sources of bleeding were stomach ulcers [18.5%], esophageal varices [5.2%], portal hypertensive gastropathy [0.6%]. Mallory-Weiss tears [3.3%], and gastric tumors [4.7%]. Gastric ulcers and malignancies were more common in older compared with younger age group [2 1.5%, 6.6% vs. 14%, 1.4% respectively]. Therapeutic endoscopic interventions were done in 17% of the patients; adrenaline injection for bleeding peptic ulcer in 16%. sclerotherapy for esophageal varices in 0.9% and banding in 0.1% patients. The frequency of acute upper gastrointestinal hemorrhage increases considerably with age. The most common finding for all age groups was duodenal ulcer. Malignancy was the most important finding in the older [> 50 years] age group

Endoscopic findings in upper gastrointestinal bleeding patients at Prince Hashem Hospital

To determine the frequency and underlying cases of upper endoscopic findings among patients with upper gastrointestinal bleeding who presented to Prince Hashem Hospital. This study was conducted between July 2002 and June 2003 involving 94 patients with upper gastrointestinal bleeding seen at Prince Hashem Hospital. Upper endoscopy was performed within 24 hours of presentation. Patients were inquired about current use of non-steroidal anti-inflammatory drugs. Data were analyzed with respect to patients' age, gender, and endoscopic findings. About two thirds of patients with upper gastrointestinal bleeding were males irrespective of the cause. Bleeding peptic ulcer disease was the commonnest cause [74%].with relation to the use of non-steroidal anti-inflammatory drugs, followed by bleeding esophagogastric varices [7.4%]. Malignant gastric tumours and Mallory-Weiss tears rated 6.4% and 4.3%, respectively. Normal upper endoscopy was found in 3.2% of all cases of upper gastrointestinal bleeding. Bleeding peptic ulcer disease remains the leading cause of upper gastrointestinal bleeding and mostly in males. There is a relation between upper gastrointestinal bleeding of peptic ulcer disease and the use of non-steroidal anti-inflammatory drugs and Aspirin. Further studies are needed to determine mortality rate and the frequency of patients who required surgery