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Incidence and evaluation of Laryngopharyngeal (LP) pathology noted during routine Esophagogstroduodenoscopy (EGD) in a rural population
CLINICAL ENDOSCOPIC PRACTICE 113
115
RETROSPECTIVE ANALYSIS OF IATROGENIC MALLORYWEISS TEARS OCCURRING DURING UPPER GASTROINTESTINAL ENDOSCOPY. M. Lee, O. A l v a r e z , M. Lindner, B. Maz~oum, J. M u n o z , V. Patel, F. Rablto, J. B a r n e s . T h e University of T e x a s
DO Wig NEED T O USE ANTIBIOTIC P R O P H Y L A X I S IN BONE MARROW TRANSPLANT PATIENTS WHO UNDERGO GASTROINTESTINAL ENDOSCOPY? W . J . Leland, C.D. Lind; Department o f Medicine, Vanderbi|t University, Nashville, TN 37232 Antibiotic prophylaxis in patients u n d e r g o i n g endoscopy within the first 100 days of bone m a r r o w t r a n s p l a n t is controversial. In one study, a high incidence (19%) of bacteremia following E G D in this clinical setting (Am J of M e d 89:135,1990) suggests a need for antibiotic prophylaxis, while a second study (Dig Dis Sci 38:71;1993) failed to confirm this high incidence of bacteremia. AIM: To determine the prevalence of clinically significant bacteremia after endoscopic procedures in patients within 100 days of bone m a r r o w transplantation. METHODS: The c h a r t s of patients undergoing endoscopic procedures were retrospectively reviewed. New fevers greater t h a n 101F, hypotension, or bacteremia within 48 hours as defined by positive blood cultures were recorded. In addition the use of antibiotics on the day of endoscopy was assessed. RESULTS: The charts of 63 patients receiving bone m a r r o w transIflant and endoscopy between July 1987 a n d April 1994 were reviewed. A total of 89 procedures in 84 endoscopic sessions were performed. In 50 sessions (32 EGD/20 Colon) patients were on systemic intravenous antibiotics, in 14 sessions (9 EGD/7 Colon) patients were on daily oral antibiotics, in 5 sessions (4 EGD/1 Colon) patients were on twice weekly prophylaxis with TMP/Sulfa, a n d in 15 sessions (14 EGD/2 Colon) patients were on no antibiotics. No patient in any group had documented baeteremia or hypotension. Three patients receiving antibiotics experienced new fevers. No source for the fevers was found. CONCLUSION: Although the n u m b e r of patients off antibiotics is small, this study would suggest prophylactic antibiotics is not needed in patients undergoing endoscopy within 100 days of bone m a r r o w transplant.
Health Science Center, San Antonio, Recent studies report that
TX. iatrogenic M a l l o r y - W e i s s tears (MWT) d u r i n g u p p e r endoscopy are rare and h a v e a benign course. PURPOSE: To determine the incidence and natural history of iatrogenic MWT. METHODS: W e h a v e retrospectively reviewed ii cases of MWT identified from the records of 2061 c a s e of upper endoscopy performed at our institution during an 18-month period (July 1993-December 1994). RESULTS: T h e s e Ii patients included 6 m a l e s a n d 5 f e m a l e s w i t h a m e a n a g e of 51 years. All Ii patients underwent esophagogastroduodenoscopy. Six patients (55%) were noted to have retching during the procedure. Hiatus hernias were noted in three patients (27%). Bleeding stopped spontaneously without intervention in all ii cases. N o n e of these patients required blood transfusion o r hospitalization. All patients recovered without any further intervention. CONCLUSIONS: T a t r o g e n l c M a l l o r y - W e i s s t e a r s are rare (incidence = 0.5%) and generally h a v e a
benign course, and they tend to occur in patients who have experienced excessive retching during endoscopy.
7114
t116
INCIDENCE AND EVALUATION OF LARYNGOPHARYNGEAL (LP) P A T H O L O G Y NOTED DURING ROUTINE ESOPHAGOGASTRODUODENOSCOPY (EGD) I N A R U R A L P O P U L A T I O N , Richard S. Lee, Neuse Gastroenterology, P.A. Johnston Memorial Hospital, Smithfield, North Carolina
EFFECT OF SODIUM PHOSPHATE COLON PREP ON SERUM PHOSPHATE AND CALCIUM IN PATIENTS WITH NORMAL RENAL FUNCTION. D Lieberman, K Flora, J Ghormley. Portland VAMC, Portland OR.
PURPOSE: LP pathology may be visualized upon withdrawal of the endoscopy during routine EGD. Risk factors for upper gastrointestinal (G1) and upper aerodigesfive (AE) diseases often coexist. In many cases, diseases of the upper AE trac~ are very treatable, making their early diagnosis important. This study notes the incidence of pathology of ~rhe taryngopharynx noted during routine EGD in a rural population. METHODS: 449 patients were evaluated prospectively during a 17 month period. The LP anatomy was visualized and inspected upon withdrawal of the endoscope at the completion of routine EGD. Patients with abnormalities were referred for complete head and neck examination. RESULTS: During routine EGD, pathology was noted in the laryngopharynx in 16 of 449 patients. The patients had an age range of 1890 years. There were 186 males (41.5%) and 263 females (58.5%). Pathologic findings noted included I4 patients with vocal cord (VC) polyps and 2 patients with carcinoma of the free vocal cords. There were no complications. Only 43 of the 449 patients (9.6%) were unable to tolerate the maneuver. CONCLUSIONS: Abnormal LP findings were noted in 16 of 449 patients (3.6%) during routine EGD. Visualization and inspection of the laryngopharynx after routine EGD is a safe maneuver; it is well-tolerated and no complications were noted secondary to its performance. Since it was performed at the end of the EGD, it did not interfere with evaluation of the GI tract. LP anatomy should be emphasized in GI training, since risk factors for both GI and LP disease are often coexistent. LP evaluation should be considered during EGD since it is well-tolerated and can add significantly to the information gained during routine EGD.
324
GASTROINTESTINAL ENDOSCOPY
Sodium phosphate (NAP) is widely used as a co/on preparation for patients undergoing colonosocopy. Several studies have suggested that changes in serum phosphate (P) and calcium (Ca)may be observed after using Nap. Prior studies have not stratified patients with normal renal function to determine if they experience significant electrolyte alterations with Nap. The purpose o f this pilot study was to determine if there are significant changes in sertml P and/or Ca after NaP colon preparation in patients with normal renal function. Patients scheduled for elective colonoscopy had a panel of electrolytes obtained during a clinic visit. Patients were excluded if serum creatinine was greater than 1.5mg/dl. Patients took 1.5 ounces of Nap with 1.5 ounces of water at 7:00 PM and 6:00 AM before the colonoscopy. Upon arrival at the hospital at 7:30 AM, a second electrolyte panel was obtained, sBgN~t~in 32 patients are shown: Baselin~ After NaP Phosphate 3.1 (2.0-4.2) 6.8 (3.4-9.4)* Calcium 9.2 (7.8-11.0) 8.6 (7.5-9.5)* Creatinine 1.0 (0.8-1.4) (* baseline vs post Nap, p< 0.001, paired t-test) Patients with normal renal function experienced a significant increase in serum P. 9 of 32 patients (28%) had a serum P of greater than 8.0 following NaP. Serum Ca decreased modestly in most patients - only two patients had a decrease to less than 8.0 mg/dl. In conclusion, serum phosphate may rise significantly after NaP, even in patients with normal renal function. These data suggest than NaP should be used cautiously, especially if there is possible impairment of renal fimction.
VOLUME 41, NO. 4, 1995
115
RETROSPECTIVE ANALYSIS OF IATROGENIC MALLORYWEISS TEARS OCCURRING DURING UPPER GASTROINTESTINAL ENDOSCOPY. M. Lee, O. A l v a r e z , M. Lindner, B. Maz~oum, J. M u n o z , V. Patel, F. Rablto, J. B a r n e s . T h e University of T e x a s
DO Wig NEED T O USE ANTIBIOTIC P R O P H Y L A X I S IN BONE MARROW TRANSPLANT PATIENTS WHO UNDERGO GASTROINTESTINAL ENDOSCOPY? W . J . Leland, C.D. Lind; Department o f Medicine, Vanderbi|t University, Nashville, TN 37232 Antibiotic prophylaxis in patients u n d e r g o i n g endoscopy within the first 100 days of bone m a r r o w t r a n s p l a n t is controversial. In one study, a high incidence (19%) of bacteremia following E G D in this clinical setting (Am J of M e d 89:135,1990) suggests a need for antibiotic prophylaxis, while a second study (Dig Dis Sci 38:71;1993) failed to confirm this high incidence of bacteremia. AIM: To determine the prevalence of clinically significant bacteremia after endoscopic procedures in patients within 100 days of bone m a r r o w transplantation. METHODS: The c h a r t s of patients undergoing endoscopic procedures were retrospectively reviewed. New fevers greater t h a n 101F, hypotension, or bacteremia within 48 hours as defined by positive blood cultures were recorded. In addition the use of antibiotics on the day of endoscopy was assessed. RESULTS: The charts of 63 patients receiving bone m a r r o w transIflant and endoscopy between July 1987 a n d April 1994 were reviewed. A total of 89 procedures in 84 endoscopic sessions were performed. In 50 sessions (32 EGD/20 Colon) patients were on systemic intravenous antibiotics, in 14 sessions (9 EGD/7 Colon) patients were on daily oral antibiotics, in 5 sessions (4 EGD/1 Colon) patients were on twice weekly prophylaxis with TMP/Sulfa, a n d in 15 sessions (14 EGD/2 Colon) patients were on no antibiotics. No patient in any group had documented baeteremia or hypotension. Three patients receiving antibiotics experienced new fevers. No source for the fevers was found. CONCLUSION: Although the n u m b e r of patients off antibiotics is small, this study would suggest prophylactic antibiotics is not needed in patients undergoing endoscopy within 100 days of bone m a r r o w transplant.
Health Science Center, San Antonio, Recent studies report that
TX. iatrogenic M a l l o r y - W e i s s tears (MWT) d u r i n g u p p e r endoscopy are rare and h a v e a benign course. PURPOSE: To determine the incidence and natural history of iatrogenic MWT. METHODS: W e h a v e retrospectively reviewed ii cases of MWT identified from the records of 2061 c a s e of upper endoscopy performed at our institution during an 18-month period (July 1993-December 1994). RESULTS: T h e s e Ii patients included 6 m a l e s a n d 5 f e m a l e s w i t h a m e a n a g e of 51 years. All Ii patients underwent esophagogastroduodenoscopy. Six patients (55%) were noted to have retching during the procedure. Hiatus hernias were noted in three patients (27%). Bleeding stopped spontaneously without intervention in all ii cases. N o n e of these patients required blood transfusion o r hospitalization. All patients recovered without any further intervention. CONCLUSIONS: T a t r o g e n l c M a l l o r y - W e i s s t e a r s are rare (incidence = 0.5%) and generally h a v e a
benign course, and they tend to occur in patients who have experienced excessive retching during endoscopy.
7114
t116
INCIDENCE AND EVALUATION OF LARYNGOPHARYNGEAL (LP) P A T H O L O G Y NOTED DURING ROUTINE ESOPHAGOGASTRODUODENOSCOPY (EGD) I N A R U R A L P O P U L A T I O N , Richard S. Lee, Neuse Gastroenterology, P.A. Johnston Memorial Hospital, Smithfield, North Carolina
EFFECT OF SODIUM PHOSPHATE COLON PREP ON SERUM PHOSPHATE AND CALCIUM IN PATIENTS WITH NORMAL RENAL FUNCTION. D Lieberman, K Flora, J Ghormley. Portland VAMC, Portland OR.
PURPOSE: LP pathology may be visualized upon withdrawal of the endoscopy during routine EGD. Risk factors for upper gastrointestinal (G1) and upper aerodigesfive (AE) diseases often coexist. In many cases, diseases of the upper AE trac~ are very treatable, making their early diagnosis important. This study notes the incidence of pathology of ~rhe taryngopharynx noted during routine EGD in a rural population. METHODS: 449 patients were evaluated prospectively during a 17 month period. The LP anatomy was visualized and inspected upon withdrawal of the endoscope at the completion of routine EGD. Patients with abnormalities were referred for complete head and neck examination. RESULTS: During routine EGD, pathology was noted in the laryngopharynx in 16 of 449 patients. The patients had an age range of 1890 years. There were 186 males (41.5%) and 263 females (58.5%). Pathologic findings noted included I4 patients with vocal cord (VC) polyps and 2 patients with carcinoma of the free vocal cords. There were no complications. Only 43 of the 449 patients (9.6%) were unable to tolerate the maneuver. CONCLUSIONS: Abnormal LP findings were noted in 16 of 449 patients (3.6%) during routine EGD. Visualization and inspection of the laryngopharynx after routine EGD is a safe maneuver; it is well-tolerated and no complications were noted secondary to its performance. Since it was performed at the end of the EGD, it did not interfere with evaluation of the GI tract. LP anatomy should be emphasized in GI training, since risk factors for both GI and LP disease are often coexistent. LP evaluation should be considered during EGD since it is well-tolerated and can add significantly to the information gained during routine EGD.
324
GASTROINTESTINAL ENDOSCOPY
Sodium phosphate (NAP) is widely used as a co/on preparation for patients undergoing colonosocopy. Several studies have suggested that changes in serum phosphate (P) and calcium (Ca)may be observed after using Nap. Prior studies have not stratified patients with normal renal function to determine if they experience significant electrolyte alterations with Nap. The purpose o f this pilot study was to determine if there are significant changes in sertml P and/or Ca after NaP colon preparation in patients with normal renal function. Patients scheduled for elective colonoscopy had a panel of electrolytes obtained during a clinic visit. Patients were excluded if serum creatinine was greater than 1.5mg/dl. Patients took 1.5 ounces of Nap with 1.5 ounces of water at 7:00 PM and 6:00 AM before the colonoscopy. Upon arrival at the hospital at 7:30 AM, a second electrolyte panel was obtained, sBgN~t~in 32 patients are shown: Baselin~ After NaP Phosphate 3.1 (2.0-4.2) 6.8 (3.4-9.4)* Calcium 9.2 (7.8-11.0) 8.6 (7.5-9.5)* Creatinine 1.0 (0.8-1.4) (* baseline vs post Nap, p< 0.001, paired t-test) Patients with normal renal function experienced a significant increase in serum P. 9 of 32 patients (28%) had a serum P of greater than 8.0 following NaP. Serum Ca decreased modestly in most patients - only two patients had a decrease to less than 8.0 mg/dl. In conclusion, serum phosphate may rise significantly after NaP, even in patients with normal renal function. These data suggest than NaP should be used cautiously, especially if there is possible impairment of renal fimction.
VOLUME 41, NO. 4, 1995