RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,



THESIS SYNOPSIS

TOPIC

ENDOSCOPIC EVALUATION OF ESOPHAGEAL DISEASES

DR. NARASIMHA MURTHY.MP.

Post Graduate Student in M.S GENRAL SURGERY.

Dept. of Surgery,

VIMS, Bellary.

GUIDE

Dr. KASA SOMASEKHAR.

Professor

Department of surgery,

VIMS, Bellary

Place: Bellary

Date: 16- 11-2009

From,

DR. NARASIMHA MURTHY.MP.

Post Graduate Student in M.S GENRAL SURGERY.

Dept. of Surgery,

VIMS, Bellary.

To,

The Principal,

Vijayanagar Institute of Medical Sciences,

Bellary.

THROUGH PROPER CHANNEL

Respected sir,

Subject: Acceptance of registration and forwarding of dissertation topic,

In accordance with the above cited subject, I the undersigned studying Post Graduate Course in M.S. General surgery have been allotted the dissertation topic “ENDOSCOPIC EVALUATION OF ESOPHAGEAL DISEASES AT VIMS BELLARY.”, under the guidance of Dr. KASA SOMASEKHAR, Professor, Department of surgery, VIMS, Bellary.

I request you to kindly forward the dissertation topic in the prescribed form to the University for Approval.

Thanking you,

Yours faithfully,

DR.NARASIMHAMURTHY.MP.

Signature of the guide

Dr. KASA SOMASEKHAR.

Professor

Department of surgery,

VIMS, Bellary.

Place: Bellary

Date: 16- 11-2009

From

Professor & Head of the Department,

Department of surgery,

VIMS, Bellary.

To

The Registrar,

Rajiv Gandhi University of Health Sciences,

Bangalore.

THROUGH PROPER CHANNEL

Respected sir,

As per the regulations of the University for registration of Dissertation topic, the following Post Graduate in M.S. in General Surgery has been allotted the dissertation topic as follows, by the Official Registration Committee of all qualified and eligible guides of the Department of surgery.

|NAME |TOPIC |GUIDE |

|DR.Narasimha murthy.M.P |“ENDOSCOPIC EVALUATION OF ESOPHAGEAL |Dr. KASA SOMASEKHAR |

|Post Graduate Student in |DISEASES AT VIMS BELLARY.”, |Professor |

|M.S GENERAL SURGERY. | |Department of surgery, |

|Dept. of Surgery, | |VIMS, Bellary. |

|VIMS, Bellary. | | |

Therefore, I kindly request you to communicate the acceptance of the dissertation topic allotted to the PG student at an early date.

Thanking you,

Yours faithfully,

Signature of the guide

DR.VIDHYADHAR.A.KINHAL

Dr. KASA SOMASEKHAR Professor & Head of the Department,

Professor Department of Surgery, VIMS, Bellary

Department of surgery,

VIMS, Bellary.

.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE.

ANNEXURE—II

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

|1. |NAME OF THE CANDIDATE AND ADDRESS (in block letters) |DR.NARASIMHA MURTHY.MP. |

| | |POST GRADUATE STUDENT IN M.S GENRAL SURGERY. |

| | |DEPARTMENT OF SURGERY, VIMS,BELLARY. |

|2. |NAME OF THE INSTITUTION |VIJAYANAGAR INSTITUTE OF MEDICAL SCIENCES, BELLARY |

|3. |COURSE OF STUDY AND SUBJECT |MS in GENERAL SURGERY |

|4. |DATE OF ADMISSION TO THE COURSE |17-04-2009 |

|5. |TITLE OF THE TOPIC: “ENDOSCOPIC EVALUATION OF ESOPHAGEAL DISEASES AT VIMS BELLARY.” |

| 6. |BRIEF RESUME OF THE INTENDED WORK: |

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| |6.1 NEED FOR THE STUDY: |

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| |Many of the esophageal diseases present with number of symptoms which are either specific or nonspecific like dysphagia, retrosternal |

| |burning, haemetemesis , regurgitation of food, etc and with atypical symptoms like chest pain, back pain, cough, loss of appetite, loss of |

| |weight and sometimes altogether asymptomatic. |

| |Diagnosis of esophageal diseases by only clinical examination is not enough and hence there is need for investigating the esophageal |

| |diseases. |

| |Investigations like plain x-ray chest, contrast studies like barium study, CT thorax etc are also not informative in many diseases. Direct |

| |viewing of esophagus through endoscopes, especially newly available less traumatic flexible scopes has revolutionised the investigation |

| |modality of esophageal diseases. |

| |Endoscopic study of esophagus can diagnose many diseases just by visualization itself/confirm the disease by biopsy/can be complementary to |

| |contrast x-ray/CT scan study /monometric studies and can rule out the non esophageal diseaseslike coronary artery diseases,pleuritis |

| |etc.Hence the need for endoscopic evaluation of esophageal diseases. |

| |Though flexible video endoscope facility was available in our institution for long time, a proper study in this regard has not been done |

| |sofar. Our studyof “ENDOSCOPIC EVALUATION OF ESOPHAGEAL DISEASES AT VIMS BELLARY’’may give insight into |

| |- The load of various esophageal diseases in and around Bellary with respect to age, sex ,socioeconomic status, occupation etc. |

| |- Pattern of presentation of esophageal diseases. |

| |- Amount of endoscopic therapeutic work load needed in our hospital. |

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| |6.2 REVIEW OF LITERATURE: |

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| |Upper gastrointestinal endoscopy had its beginning in 1881 when Karl Stoerk, an Austrian Laryngologist, examined the entire length of the |

| |oesophagus with a rigid tube.At about same time Johan von Mikalicz Radecki, a polished surgeon constructed a gastroscope with an angle of 30|

| |degree at the junction of the distal and proximal two thirds of a hollow tube. Over the next 50 years, Chevalier Jackson perfected in |

| |developing rigid bronchoesophagoscopy.(1) |

| |A new era for endoscopy began in 1932 when the gastroscope designed by Rudolf Schirdler and manufactured by George Wolf in Berlin was |

| |introduced.In the early 1950s an intragastric camera was manufactured in Japan. This gastrocamera consisted of a flexible tube with a lens |

| |incorporated in the tip.(2) |

| |By 1970 an endoscope was perfected that permitted complete inspection of oesophagus, stomach and duodenum, incorporated in the most recently|

| |developed instruments are channels for air insufflations, lens washing and introduction of biopsy forceps or cytology brushes. (3) |

| |Endoscopy is necessary for the investigation of most oesophageal conditions. It is required to view the inside of the oesophagus and |

| |oesophagogastric junction, to obtain a biopsy or cytology specimen, for the removal of foreign bodies and to dilate strictures.[4] |

| |The American society of gastrointestinal endoscopy(ASGE)have guidelines regarding the upper G I endoscopy. Upper GI endoscopy is more |

| |accurate than radiology in detecting inflammations, ulcers or tumours of the UGI tract. A variety of instruments can also be passed through |

| |the endoscope that allows many abnormalities to be treated directly with little or no discomfort.[5] |

| |The evaluation of esophageal motility disorders often begins with endoscopy. Many diagnoses can be made with endoscopy alone, although some|

| |require manometry or barium x-ray study for confirmation[6] |

| |Endoscopy is, currently, the initial investigation of choice for the investigation of gastroesophageal reflux disease (GERD) in clinical |

| |practice and clinical research. Erosion severity is predictive of a patient’s response to therapy and of the likelihood of relapse after |

| |therapy. It is, therefore, important to grade the severity of erosive reflux esophagitis, particularly in the context of clinical trials.[7]|

| |The diagnostic yield of esophagogastroduodenoscopy, esophageal manometry and Bernstein testing was assessed in 100 consecutive patients |

| |being evaluated for non cardiac chest pain. Results indicate that endoscopy can identify a significant number of patients with acid-peptic |

| |disease who present with non-cardiac chest pain, that would not have been otherwise diagnosed by esophageal monometry or Bernstein testing |

| |alone or in combination(8) |

| |Early detection of esophageal carcinoma improves patients survival and may lead to cure with better quality of life by much less invasive |

| |endoscopic treatment than esophagectomy. Lugol chromoendoscopy(LC), iodine mucosal staining by spraying lugol solution, is known to improve |

| |the endoscopic visualization of esophageal squamous dysplasia and carcinoma.(9) |

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| |6.3 OBJECTIVES OF THE STUDY: |

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| |To study incidence of various esophageal diseases with respect to |

| |age, sex, occupation, socioeconomic status etc in our hospital. |

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| |To study the pattern of presentation of various esophageal diseases. |

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| |To study the need for different therapeutic procedures that can be done endoscopically in our hospital. |

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|7. |MATERIALS AND METHODS |

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| |SOURCE OF DATA: |

| |Patients under going upper GI endoscopy both on In patient department and Out patient department basis in VIMS Bellary are include in our |

| |study by applying the following inclusion and exclusion criteria. The study will be conducted during the period from December 2009 to May |

| |2011. |

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| |INCLUSION CRITERIA FOR THE STUDY: |

| |Patients Undergoing Endoscopy for Specific and Nonspecific symptoms like Retrosternal burning, Dysphagia, Haematemisis, Loss of Appetite |

| |etc in our unit of Surgery Department. |

| |Patients with atypical symptoms like chest pain, Back pain, cough, loss of weight etc referred from other departments. |

| |Both sexes will be included. |

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| |EXCLUSION CRITERIA : |

| |Patients with diagnosed esophageal disease on follow up. |

| |Patients with co morbid diseases like severe IHD, Cervical spondylosis, Trismus etc. |

| |Patients with age less than 10 years due to nonavailability of anesthesia facility at our Endoscopy unit. |

| |Patients with active and severe haemetemisis |

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| |7.2 METHOD OF COLLECTION OF DATA (including sampling procedure, if any): |

| |. Data will be collected from a specially designed Performa case recording Performa (CRF) pertaining to patient’s particulars, |

| |proper history, clinical examinations, investigations, diagnosis & surgical procedures. It is then subjected to statistical analysis with |

| |the help of biostatistician of our institute. All the surgical procedures & medical management and investigations will be conducted under |

| |direct guidance and supervision of our guide. Before start of our study a written/informed consent will be obtained in local vernacular in |

| |each patient. |

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| |7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO DESCRIBE |

| |BRIEFLY. |

| |Yes It includes |

| |Upper GI Endoscopy |

| |Biopsy ( wherever Required) |

| |Barium Swallow ( wherever Required) |

| |Chest x-ray, USG Abdomen, CT Scan thorax and abdomen. |

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| |Among the above mentioned investigations UGI Endoscopy will be the principle procedure. |

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| |7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM ETHICAL COMMITTEE OF YOUR INSTITUTION IN CASE OF 7.3 |

| |Yes. Clearance has been obtained from Ethical Clearances Committee, VIMS, Bellary. |

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| |LIST OF REFERENCES: |

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| |HenningN,BerryL.H.Historyof gastrointestinal endoscopy.Gastrointestinal panendoscopy,1st Ed.Spring field:Charles C.Thomas;1974:5-23. |

| |MorrisseyJ.Y,TanakaY,ThorsenW.B.Gastrointestinal endoscopy.1968;15:197-200. |

| |Bockus.Upper gastrointestinal endoscopy.Gastroenterology,4th Ed.Philadelphia:W.B.Saunders Company;1985.564-580. |

| |Bailey and love’s Short practice of surgery 25th edition:chapter59:pp1012, |

| |Editors-N.S.Williams ,Christoper J.K.Bulstrode and P.Ronan O |

| |Connell. |

| |5. guidelines. |

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| |6. susan E.McCormick,M.D.and RichardA.Kozarek,M.D. |

| |GIMotility online(2006)doi:10.1038/gimo29 |

| |Published16May2006. |

| |D.Armstrong |

| |Division of Gastroenterology,McMaster university medical |

| |centre,Ontario,Canada. |

| |D.Armstrong:armstro@fhs.csu.mcmaster.ca |

| |8. Utility Of Upper endoscopy in the evaluation of non cardiac chest pain |

| |Gastro intestinal endoscopy,volume 37,issue1,pages 22-26 |

| |p.Hsia,k.Maher,J.lewis,E.Cattau jr. ,D.Fleisher,S.Benjamin |

| |9. NoriyaUedo;Hiroyasu lishi; Masaharu Tatsuta |

|8. |Source:GastrointestinalEndoscopy Vol:57,No:5,April, 2003 |

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|9. |SIGNATURE OF THE CANDIDATE: | |

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| | |(DR.NARASIMHAMURTHY.MP.) |

|10. |REMARKS OF THE GUIDE: |Recommended and forwarded for the needful |

|11. |NAME AND DESIGNATION OF | |

| |(in block letters) | |

| |11.1 GUIDE | |

| | |Dr. KASA SOMASEKHAR |

| | |PROFESSOR |

| | |DEPARTMENT OF SURGERY, |

| | |VIMS, BELLARY. |

| |11.2 SIGNATURE | |

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| |11.3 CO.GUIDE (if any) | |

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| |11.4 SIGNATURE | |

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| |11.5 HEAD OF THE DEPARTMENT: |DR. VIDHYADHAR.A.KINHAL. |

| | |PROF. & HEAD OF THE DEPARTMENT, |

| | |DEPARTMENT OF SURGERY, |

| | |VIMS, BELLARY. |

| |11.6 SIGNATURE | |

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|12. |12.1 REMARKS OF THE CHAIRMAN & PRINCIPAL | |

| |12.2 SIGNATURE | |

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