Current Impact on Credit Scores Medical bills don’t affect your credit score if paid on time. But if left unpaid and sent to collections, they can affect your score, though recent changes have reduced the risk. As of now, medical collections under $500, paid collections and collections less than a year old are not reported on credit reports. So only large, older unpaid medical debts will…
Introduction Sedation is regularly used to facilitate the performance of endoscopic procedures. Sedation practices have noticeably changed over the past decade, with a shift from no or moderate sedation to monitored anesthesia care (MAC) for gastrointestinal (GI) endoscopy. Sedation during an endoscopic procedure helps in two ways; first, by decreasing procedural pain, thereby making the patient more comfortable, and second, by decreasing any untimely patient movements,…
Introduction The therapeutic basis of all electrosurgery is the use of high frequency, alternating electric current to produce heating in living cells. The heating can be manipulated to achieve a desired tissue effect such as cutting, tissue ablation, desiccation, or a combination of these. Electrical energy to produce heating and tissue effects has been a part of endoscopy since the early 1970s. Common indications include biliary…
Endoscopic Biopsy Biopsy Techniques Pinch Biopsy Forceps The most common pinch biopsy forceps used worldwide fits through a 2.8-mm biopsy channel ( Fig. 5.1 ). In general, mucosal samples vary from 4 to 8 mm in size. A smaller-sized forcep that fits through a 2.2 mm biopsy channel is used in infants and young children. Pediatric gastroenterologists generally use narrow-bore instruments for routine diagnostic biopsies if the child…
Introduction The field of gastrointestinal (GI) endoscopy has expanded dramatically as new procedures, instruments, and accessories have been introduced into the medical community; more than 20 million GI endoscopies are performed annually in the United States. Although GI endoscopes are used as a diagnostic and therapeutic tool for a broad spectrum of GI disorders, more health care–associated infectious outbreaks and patient exposures have been linked to…
Endoscopes are flexible instruments combining fiber-optics (for illumination) and charge-coupled devices (for imaging) that are used in medicine to visualize the interior of otherwise inaccessible sites, such as the lumen of hollow organs. Endoscopes are used to examine the gastrointestinal (GI) tract, the bronchial system, the ureters and other body cavities. They have numerous uses in non-medical settings as well and are central to the modern…
Introduction The safe and efficient performance of gastrointestinal (GI) endoscopy has the following requirements: A properly trained endoscopist with appropriate privileges to perform specific GI endoscopic procedures Properly trained nursing and ancillary personnel Operational, well-maintained equipment Adequately designed and equipped space for patient preparation, performance of procedures, and patient recovery Cleaning areas for reprocessing endoscopes and accessories Trained personnel and appropriate equipment to perform cardiopulmonary resuscitation…
Introduction The role of the physician is to observe, detect anatomic abnormalities or disease, and conceive ways and means by which discovered deficiencies in function can be corrected or ameliorated. To extend the physical examination to areas hidden from external view, such as within body orifices, presents a problem of safe and effective access. In insatiable attempts to accomplish these goals, there is no human orifice…
15.1 Introduction Endoscopic eradication therapy (EET), either using endoscopic resection (ER) or radiofrequency ablation (RFA), cryoablation, or a combination of resection and ablation, aims not only to completely eliminate Barrett’s esophagus (BE) dysplasia and early neoplasia but also a complete eradication of intestinal metaplasia (CEIM) . EET is mostly applied in patients with high-grade dysplasia (HGD) and intramucosal cancer (IMC) and increasingly in patients with BE…
14.1 Introduction Barrett’s esophagus (BE) is an acquired condition in which a metaplastic columnar epithelium replaces the stratified squamous epithelium that normally lines the distal esophagus . Metaplasia commonly is a consequence of chronic inflammation, and intestinal metaplasia results from chronic reflux esophagitis caused by the gastroesophageal reflux of acid, bile, and other hazardous substances . Approximately 5% of adult population in the United States is…
13.1 Introduction Earlier chapters in this book describe how ablative therapies have essentially replaced surgery for the management of Barrett’s esophagus (BE) with high-grade dysplasia (HGD). However, resectional therapies, performed either with flexible endoscopy or surgery, are still required for managing this disease either as an adjunct to ablation or for definitive therapy. This chapter describes the indications for using resectional therapies in the management of…
12.1 Introduction Endoscopic cryospray ablation or cryotherapy is a unique method of ablation that offers physicians a versatile choice in the treatment of Barrett’s and early esophageal cancer. The concept of endoscopic cryospray ablation began in the late 1990s with the development of two delivery platforms using liquid nitrogen (LN) and carbon dioxide (CO 2 ). Both methods share some unique characteristics compared to other ablation…
11.1 Introduction Barrett’s esophagus (BE) occurs when an abnormal, intestinal-type epithelium called “specialized intestinal metaplasia” replaces the stratified squamous epithelium that normally lines the distal esophagus. The condition develops as a consequence of chronic gastroesophageal reflux disease and predisposes to the development of adenocarcinoma of the esophagus . Traditionally, high-grade dysplasia (HGD) and intramucosal carcinoma (IMC) arising from BE were treated with esophagectomy, while nondysplastic BE…
10.1 Introduction A general outline of this chapter includes a brief background followed by historical trends of endoscopic ablation (with the exception of radiofrequency ablation and cryospray ablation, which are covered in chapter 11, chapter 12 : Radiofrequency Ablation and Cryospray Ablation) for nondysplastic Barrett’s esophagus (BE), BE with low-grade dysplasia (LGD), and BE with high-grade dysplasia (HGD)/intramucosal esophageal adenocarcinoma (EA). Finally, therapeutic options for endoscopic…
9.1 Introduction Barrett’s esophagus (BE) is associated with the risk of development of esophageal adenocarcinoma. Current surveillance according to the Seattle protocol includes white light endoscopy (WLE) with the collection of random four-quadrant biopsy specimens over every 1–2 cm of the columnar-lined esophagus. The aim of such surveillance is detection of neoplasia, ideally at an (endoscopically) curable stage. This state-of-the-art approach is labor intensive and prone…
8.1 Introduction Optical coherence tomography (OCT) is an optical analog of ultrasound imaging that was invented in the early 1990s . OCT fills a resolution gap between confocal laser endomicroscopy (CLE) and ultrasound, affording the capability of visualizing architectural microscopic morphology at a resolution of approximately 10 µm and to a depth of several millimeters (mm). OCT is also advantageous in that it provides cross-sectional images…
7.1 Introduction The incidence of adenocarcinoma of the esophagus is increasing more rapidly than any other type of carcinoma in the United States . Almost 100% of cases occur in patients with Barrett’s esophagus (BE) , a benign condition in which metaplastic columnar epithelium replaces the normal squamous epithelium of the esophagus. Although the prognosis of patients diagnosed with adenocarcinoma is poor, the chances of successful…
6.1 Overview Five decades after the British surgeon Norman Barrett first described the condition that bears his name, the true incidence of Barrett’s esophagus (BE) in the general population and the risk of progression to cancer continue to be areas of uncertainty, debate, and controversy . While the pathologic definition of BE has evolved over time, our current screening and surveillance recommendations are based in large…
5.1 Introduction In 1950, Norman Barrett wrote the paper entitled “Chronic peptic ulcer of the oesophagus and ‘oesophagitis’” where he described a case in which a portion of the stomach was noted to be within the chest . It was later determined by Allison and Johnstone in a detailed description of seven cases that what Barrett had described was actually a columnar-lined esophageal segment. They also…
4.1 Introduction Barrett’s esophagus (BE) is the premalignant lesion for esophageal adenocarcinoma (EAC): a malignancy with a very poor prognosis. The progression of BE from benign columnar-lined epithelium (CLE) to adenocarcinoma often occurs through a series of dysplastic stages termed low-grade dysplasia (LGD) and high-grade dysplasia (HGD). Recent evidence suggests a benefit for treating patients with dysplasia in order to prevent progression to adenocarcinoma. However, this…