Diagnosis and treatment using endoscopy

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Percutaneous endoscopic gastrostomy feeding has continued to gain popularity with a 12-fold increase in its use in the United Kingdom in the past 4 years. There is now a large body of literature detailing the outcome and complications of percutaneous endoscopic gastronomy feeding. A recent randomized controlled study comparing percutaneous endoscopic gastrostomy feeding with nasogastric feeding in patients requiring long-term nutritional support indicates that percutaneous endoscopic gastrostomy feeding is superior in improving nutritional status and is better tolerated. Portal hypertensive gastropathy is being increasingly recognized as a cause of upper gastrointestinal hemorrhage. Recent studies have highlighted the role of variceal sclerotherapy and the anatomic pattern of the blood supply to the stomach as factors that promote the development of portal hypertensive gastropathy. β-Blockers decrease the incidence of bleeding from portal hypertensive gastropathy and should be used in most patients both prophylactically and after variceal sclerotherapy. Further evidence has accumulated indicating that endoscopic injection of ulcers with visible vessels decreases the risk of rebleeding. Endoscopic therapy is also beneficial for the treatment of Dieulafoy's lesions. A steady flow of publications continues to point to endosonography as a powerful tool in the diagnosis and staging of upper gastrointestinal malignancy, and for the detection of residual tumor tissue after therapy.

Current Opinion in Gastroenterology 1993, 9:917-921

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