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Unsedated ultrathin upper endoscopy is better than conventional endoscopy in routine outpatient gastroenterology practice:A randomized trial

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World Journal of Gastroenterology 2007年第6期13卷 906-911页

作者： lucio trevisani Viviana Cifalà Sergio Sartori Giuseppe Gilli Giancarlo Matarese Vincenzo Abbasciano Digestive Endoscopy Centre Department of Internal Medicine S. Anna Hospital Ferrara Italy Health Physics Department S. Anna Hospital Ferrara Italy

AIM： to compare the feasibility and patients＇ tolerance of esophagogastroduodenoscopy （EGD） using a thin endoscope with those of conventional oral EGD and to determine the optimal route of introduction of smallcaliber endoscopes. METHODS： One hundred and sixty outpatients referred for diagnostic EGD were randomly allocated to 3 groups： conventional （C）-EGD （9.8 mm in diameter）, transnasal （TN）-EGD and transoral （TO）-EGD （5.9 mm in diameter）. Pre-EGD anxiety was measured using a 100-mm visual analogue scale （VAS）. After EGD, patients and endoscopists completed a questionnaire on the pain, nausea, choking, overall discomfort, and quality of the examination either using VAS or answering some questions. The duration of EGD was timed. Blood oxygen saturation （SaO2） and heart rate （HR） were monitored during EGD. RESULTS： Twenty-one patients refused to participate in the study. The 3 groups were well-matched for age, gender, experience with EGD, and anxiety. EGD was completed in 91.1% （41/45）, 97.5% （40/41）, and 96.2% （51/53） of cases in TN-EGD, TO-EGD, and C-EGD groups, respectively. TN-EGD lasted longer （3.11 ± 1.60 min） than TO-EGD （2.25 ± 1.45 min） and C-EGD （2.49 ± 1.64 rain）（P 〈 0.05）. The overall tolerance was higher （P 〈 0.05） and the overall discomfort was lower （P 〈 0.05） in TN-EGD group than in C-EGD group. EGD was tolerated ＂better than expected＂ in 73.2% of patients in TN-EGD group and 55% and 39.2% of patients in TO-EGD and C-EGD groups, respectively （P 〈 0.05）. Endoscopy was tolerated ＂worst than expected＂ in 4.9% of patients in TN-EGD group and 17.5% and 23.5% of patients in TO- EGD and C-EGD groups, respectively （P 〈 0.05）. TN-EGD caused mild epistaxis in one case, The ability to insuffiate air, wash the lens, and suction of the thin endoscope were lower than those of conventional instrument （P 〈 0,001）, All biopsies performed were adequate for histological assessment. CONCLUSION： Diagnostic TN-EGD is better tolerated than C-EGD, Narrow-diameter end

关键词： Diagnotic esophagogastroduodenoscopy Endoscopy Gastroscopy

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Diagnostic accuracy of a rapid fecal test to confirm H pylori eradication after therapy: Prospective comparison with a laboratory stool test

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World Journal of Gastroenterology 2007年第33期13卷 4484-4488页

作者： lucio trevisani Viviana Cifalà Nadia Fusetti Giuseppe Gilli Paola Tombesi Marco Torchiaro Sergio Boccia Vincenzo Abbasciano Digestive Endoscopy Centre Medical Department S Anna Hospital Ferrara Italy Health Physics Department S Anna HospitalFerrara Italy

AIM: To investigate the clinical performances of rapidstool test (ImmunoCard STAT HpSA, Meridian DiagnosticInc.) in the evaluation of eradication therapy of H pyloriand to compare it with a well-known and validatedlaboratory stool test (Amplified IDEA Hp StAR, Dako).METHODS: Stool samples of 122 patients wereevaluated after eradication therapy of H pylori. H pyloristatus was assessed by 13C-urea breath test (UBT).Stool specimens were tested using either the rapidimmunoassay kit or the laboratory immunoassay ***: Forty-three patients were infected and 79non-infected. Sensitivity and specificity of ImmunoCardSTAT and Hp StAR were 58.14% and 76.4%, and97.47% and 98.73%, respectively (P > 0.05). Overallagreement between the two tests was 92.6% (113 of122 cases).CONCLUSION: ImmunoCard STAT seems to haverather low performances, and it cannot be regarded as areliable tool in the post-treatment setting. Also Hp StARcannot be recommended to confirm H pylori eradicationafter treatment.

关键词： Hpylori Diagnosis Feces

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Colonoscopy,pain and fears:Is it an indissoluble trinomial?

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World Journal of Gastrointestinal Endoscopy 2014年第6期6卷 227-233页

作者： lucio trevisani Angelo Zelante Sergio Sartori Digestive Endoscopy Unit Department of MedicineUniversity Hospital"S. Anna"44124 Cona(FE)Italy

Colonoscopy is the reference method in the secondary prevention,diagnosis and,in some cases,treatment of colorectal *** can often cause pain associated with embarrassment,anxiety,and physical and emotional *** intensity is influenced by a lot of factors,and there is a strict relationship among pain,pain perception,and *** methods can be used to break the trinomial colonoscopy,pain and *** is recommended by several *** no sedation is offered,the patient must accept a higher chance of unacceptable discomfort and the endoscopist a lower chance of completing the procedure because of patient *** non-pharmacologic methods such as acupuncture,music,and hydrocolonoscopy can be used as alternatives to pharmacologic ***,new endoscopic technologies such as variable-stiffness colonoscopes and ultrathin colonoscopes,or the use of carbon dioxide instead of air for colon insufflation,can reduce the pain caused by *** the future,technical improvements such as wireless capsules or robotic probes,will probably enable to overcome the present concept of colonoscopy,avoiding the use of traditional ***,at present the poor attention paid by endoscopists to the pain and discomfort caused by colonoscopy can not be *** are several methods to reduce pain and anxiety and to break the trinomial colonoscopy,pain and *** must use them.

关键词： Colonoscopy Pain Fear Anxiety Discomfort Conscious sedation

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Post-Anaesthetic Discharge Scoring System to assess patient recovery and discharge after colonoscopy

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World Journal of Gastrointestinal Endoscopy 2013年第10期5卷 502-507页

作者： lucio trevisani Viviana Cifalà Giuseppe Gilli Vincenzo Matarese Angelo Zelante Sergio Sartori Digestive Endoscopy Department of Medicine University Hospital "S. Anna" Modulo Dipartimentale di Endoscopia Di-gestiva Azienda Ospedaliero-Universitaria "Arcispedale S. Anna"

AIM: To investigate whether discharge scoring criteria are as safe as clinical criteria for discharge decision and allow for earlier ***: About 220 consecutive outpatients undergoing colonoscopy under sedation with Meperidine plus Midazolam were enrolled and assigned to 2 groups: in Control-group(110 subjects) discharge decision was based on the clinical assessment; in PADSS-group(110subjects) discharge decision was based on the modified Post-Anaesthetic Discharge Scoring System(PADSS).Measurements of the PADDS score were taken every20 min after colonoscopy, and patients were discharged after two consecutive PADSS scores ≥ 9. The investigator called each patient 24-48 h after discharge to administer a standardized questionnaire, to detect any delayed complications. Patients in which cecal intubation was not performed and those who were not found at follow-up phone call were excluded from the ***: Thirteen patients(7 in Control-group and6 in PADSS-group) were excluded from the study. Recovery from sedation was faster in PADSS-group than in Control-group(58.75 ± 18.67 min vs 95.14 ± 10.85min, respectively; P < 0.001). Recovery time resulted shorter than 60 min in 39 patients of PADSS-group(37.5%), and in no patient of Control-group(P < 0.001).At follow-up phone call, no patient declared any hospital re-admission because of problems related to colonoscopy and/or sedation. Mild delayed post-discharge symptoms occurred in 57 patients in Control-group(55.3%)and in 32 in PADSS-group(30.7%). The most common symptoms were drowsiness, weakness, abdominal distension, and headache. Only 3 subjects needed to take some drugs because of post-discharge ***: The Post-Anaesthetic Discharge Scoring System is as safe as the clinical assessment and allows for an earlier patient discharge after colonoscopy performed under sedation.

关键词： Colonoscopy Conscious sedation Patient discharge Recovery room Complications

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