ABSTRACT
Dyspepsia has a high prevalence in the general population with significant health care costs. It remains one of the most common indications for upper endoscopy. This article reviews the role of endoscopy in the management of dyspepsia. In addition, this article reviews the published series of endoscopic findings in subjects with dyspepsia and evidence of the effectiveness of endoscopy in dyspepsia management. This article concludes with directions in endoscopic research and development for dyspepsia.
Subject(s)
Dyspepsia , Endoscopy, Gastrointestinal , Outcome Assessment, Health Care , Dyspepsia/diagnosis , Dyspepsia/therapy , HumansABSTRACT
The authors investigated the incidence of unplanned work absence the day following outpatient colonoscopy and examined factors associated with missing work. A total of 250 patients were studied. Patient demographic information, the length of the procedure, time of day the exam was performed, and the amount and type of sedation medication used was obtained at the time of the procedure. The incidence and reasons for missing work were elicited via a phone survey 7 days postprocedure. Ten patients (4%) had an unplanned work absence the day after their colonoscopy. No complications were noted. Feeling sleepy and weak or abdominal pain and bloating were the most common reasons for missing work. In univariate analyses, patients with an unplanned work absence were more likely to be younger (p = 0.009), and female (p = 0.02) compared with patients who returned to work. No statistically significant differences were found with regard to the amount of sedation medication used, the length of the procedure, or whether the procedure was performed in the morning or afternoon. Unplanned work absence is low following outpatient colonoscopy in a community-based practice. Female gender and younger age are associated with a higher likelihood of missing work. Postprocedure work absence may have a greater economic impact than procedure-related complications.
Subject(s)
Absenteeism , Colonoscopy , Adolescent , Adult , Age Factors , Aged , Ambulatory Care Facilities , Colonoscopy/adverse effects , Female , Humans , Male , Middle Aged , Minnesota , Postoperative Period , Prospective Studies , Sex FactorsABSTRACT
Annular pancreas divisum is a rare congenital variant of pancreatic anatomy which may cause symptoms of gastric outlet obstruction and recurrent pancreatitis. It is diagnosed by endoscopic retrograde pancreatography. We present two cases of this condition and review the literature.
Subject(s)
Pancreatic Ducts/abnormalities , Abdominal Pain/etiology , Adult , Cholangiopancreatography, Endoscopic Retrograde , Chronic Disease , Female , Humans , Pancreas/embryology , Pancreatic Ducts/diagnostic imaging , Pancreatitis/etiology , Recurrence , Tomography, X-Ray ComputedABSTRACT
The tremendous growth in the use of gastrointestinal endoscopy has necessarily produced complications of the procedures. In general, overall reported complication rates for diagnostic endoscopy are extremely low (0.13%-0.24%) reflecting these procedures' overall safety. However, many of these reports are likely to underestimate the true complication rate. Therapeutic procedures have substantially higher complication rates, the most frequent of which is perforation. Esophageal dilation, achalasia pneumatic dilation, and esophageal endoprosthesis placement carry the highest risk of perforation, 0.25%, 3.3%, and 7% to 15%, respectively. The outcomes research movement will revolutionize the future practice of endoscopy. Practice guidelines for endoscopy will not be determined by expert panels, but will be established empirically by outcomes research. Accurate complication rates will be determined from studies with complete and timely collection of intervention, confounding factors, and outcome. Finally, risk factors will be established by studies of appropriate design and power.
