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Sedation and analgesia in Gastrointestinal endoscopy: What’s new?

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World Journal of Gastroenterology 2010年第20期16卷 2451-2457页

作者： Lorella Fanti Pier Alberto Testoni Division of Gastroenterology and Gastrointestinal endoscopy Vita-Salute San Raffaele UniversityScientific Institute San Raffaele20132 MilanItaly

Various types of sedation and analgesia technique have been used during Gastrointestinal endoscopy procedures.The best methods for analgesia and sedation during Gastrointestinal endoscopy are still debated.Providing an adequate regimen of sedation/analgesia might be considered an art,influencing several aspects of endoscopic procedures: the quality of the examination,the patient’s cooperation and the patient’s and physician’s satisfaction with the sedation.The properties of a model sedative agent for endoscopy would include rapid onset and offset of action,analgesic and anxiolytic effects,ease of titration to desired level of sedation,rapid recovery and an excellent safety prof ile.Therefore there is an impulse for development of new approaches to endoscopic sedation.This article provides an update on the methods of sedation today available and future directions in endoscopic sedation.

关键词： Gastrointestinal endoscopy Analgesia Sedation Propofol

Unsedated versus Sedated Gastrointestinal endoscopy:A Questionnaire Investigation in Wuhan,Central China

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2013年第6期33卷 857-861页

作者：王红玲叶芬廖雯斐夏冰郑国荣 Department of Gastroenterology the Research Center for Clinical Study of Intestinal & Colorectal Diseases of Hubei ProvinceZhongnan Hospital of Wuhan University Department of Gastroenterology Wuhan General HospitalGuangzhou Military Command of China PLA

National data show that in China mainland unsedated gastrointestinal （GI） endoscopy has been applied in most hospitals for clinical examination, while sedated GI endoscopy is only performed in some hospitals. The purpose of this study was to compare sedated versus unsedated GI endoscopy regarding cost, safety, degree of comfort, tolerance level and overall satisfaction of patients over a 6-month period investigation. From March to September 2011, a questionnaire survey was performed on 1800 patients and 30 physicians at Zhongnan Hospital of Wuhan University and Wuhan General Hospital of Guangzhou Military Command. The patients fell into two groups according to their own de- cisions： the unsedated group （n=1000） and the sedated group （n=800）. After examination, the patients and the physicians were required to fill in a questionnaire form. All the data were analyzed statistically. The results showed that the main factors the patients took for consideration between sedated and unse- dated procedures included economy, comfort and safety. The income levels between the sedated and unsedated groups showed significant difference （P〈0.01）. Most patients in the unsedated group had lower income and were covered by less medical insurance. The tolerance rate was 92.4% vs. 65.5% be- tween the sedated and unsedated group, respectively. 95.5% patients in the sedated group and 72.1% pa- tients in the unsedated group chose the same endoscopy procedure for repeat examination. The survey data from endoscopists suggested the sedated procedure was more comfortable but less safe than the unsedated procedure （P〈0.01 ）. In China, unsedated GI endoscopy is now widely accepted by the major- ity of patients due to low cost and safety. Compared to unsedated GI endoscopy, sedated GI endoscopy is less painful, but more expensive and less safe. With the rapid improvement of people＇s living stan- dard and the reliability of sedation technology, we expect sedated GI endoscopy will be gradually ac- cepted by more patients.

关键词： Gastrointestinal endoscopy sedated unsedated comparative study

Clinical course of subepithelial lesions detected on upper Gastrointestinal endoscopy

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World Journal of Gastroenterology 2010年第4期16卷 439-444页

作者： Yeun Jung Lim Hee Jung Son Jong-Soo Lee Young Hye Byun Hyun Joo Suh Pool Lyul Rhee Jae J Kim Jong Chul Rhee Center for Health Promotion Department of MedicineSamsung Medical CenterSungkyunkwan University School of Medicine50Irwon-dongGangnam-guSeoul 135-710South Korea Division of Gastroenterology Department of MedicineSamsung Medical CenterSungkyunkwan University School of Medicine50Irwon-dongGangnam-guSeoul 135-710South Korea

AIM:To evaluate the natural history of subepithelial lesions.METHODS:We reviewed the medical records of 104 159 patients who underwent upper Gastrointestinal endoscopy at the Center for Health Promotion of Samsung Medical Center between 1996 and 2003.Subepithelial lesions were detected in 795 patients(0.76%);252 patients were followed using upper Gastrointestinal endoscopy for 82.5 ± 29.2 mo(range,12-160 mo;median,84 mo;1st quartile,60 mo;3rd quartile,105 mo).The median interval of follow-up endoscopy was 12 mo(range,6-105 mo;1st quartile,12 mo;3rd quartile,24 mo).RESULTS:The mean patient age was 53 years(range,22-80 years),and the male-to-female ratio was 2.36:1(177/75).The lesion size at initial measurement averaged 8.9 mm(range,2-25 mm;median,8 mm;1st quartile,5 mm;3rd quartile,10 mm).Of the 252 lesions,244(96.8%) were unchanged and 8(3.2%) were significantly increased in size(from 12.9 ± 6.0 to 21.2 ± 12.2 mm) after a mean interval of 59.1 ± 27.5 mo(range,12-86 mo).Surgical resection of lesions was performed when the lesions were ≥ 3 cm in diameter.Two lesions were diagnosed as gastrointestinal stromal tumors with an intermediate or high risk of malignancy and one lesion was classified as a schwannoma.CONCLUSION:Most small subepithelial lesions do not change as shown by endoscopic examination,and regular follow-up with endoscopy may be considered in small,subepithelial lesions,especially lesions < 1 cm in size.

关键词： Subepithelial tumor Ultrasonography gastrointestinal diseases Gastrointestinal endoscopy Time factors

Evolving role of artificial intelligence in Gastrointestinal endoscopy

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World Journal of Gastroenterology 2020年第46期26卷 7287-7298页

作者： Gulshan Parasher Morgan Wong Manmeet Rawat Division of Gastroenterology and Hepatology Department of Internal MedicineUniversity of New Mexico School of MedicineAlbuquerqueNM 87131United States

Artificial intelligence(AI)is a combination of different technologies that enable machines to sense,comprehend,and learn with human-like levels of intelligence.AI technology will eventually enhance human capability,provide machines genuine autonomy,and reduce errors,and increase productivity and efficiency.AI seems promising,and the field is full of invention,novel applications;however,the limitation of machine learning suggests a cautious optimism as the right strategy.AI is also becoming incorporated into medicine to improve patient care by speeding up processes and achieving greater accuracy for optimal patient care.AI using deep learning technology has been used to identify,differentiate catalog images in several medical fields including Gastrointestinal endoscopy.The Gastrointestinal endoscopy field involves endoscopic diagnoses and prognostication of various digestive diseases using image analysis with the help of various gastrointestinal endoscopic device systems.AI-based endoscopic systems can reliably detect and provide crucial information on gastrointestinal pathology based on their training and validation.These systems can make gastroenterology practice easier,faster,more reliable,and reduce inter-observer variability in the coming years.However,the thought that these systems will replace human decision making replace gastrointestinal endoscopists does not seem plausible in the near future.In this review,we discuss AI and associated various technological terminologies,evolving role in Gastrointestinal endoscopy,and future possibilities.

关键词： Artificial intelligence Gastrointestinal endoscopy Machine learning Endoscopic diagnosis Gastric cancer gastrointestinal diseases

Artificial intelligence application in diagnostic Gastrointestinal endoscopy-Deus ex machina?

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World Journal of Gastroenterology 2021年第32期27卷 5351-5361页

作者： Fábio Pereira Correia Luís Carvalho Lourenço Department of Gastroenterology Hospital Prof.Dr Fernando FonsecaLisbon 2720-276Portugal

The close relationship of medicine with technology and the particular interest in this symbiosis in recent years has led to the development of several computed artificial intelligence(AI)systems aimed at various areas of medicine.A number of studies have demonstrated that those systems allow accurate diagnoses with histological precision,thus facilitating decision-making by clinicians in real time.In the field of gastroenterology,AI has been applied in the diagnosis of pathologies of the entire digestive tract and their attached glands,and are increasingly accepted for the detection of colorectal polyps and confirming their histological classification.Studies have shown high accuracy,sensitivity,and specificity in relation to expert endoscopists,and mainly in relation to those with less experience.Other applications that are increasingly studied and with very promising results are the investigation of dysplasia in patients with Barrett's esophagus and the endoscopic and histological assessment of colon inflammation in patients with ulcerative colitis.In some cases AI is thus better than or at least equal to human abilities.However,additional studies are needed to reinforce the existing data,and mainly to determine the applicability of this technology in other indications.This review summarizes the state of the art of AI in gastroenterological pathology.

关键词： Artificial intelligence Computer-aided diagnosis Deep learning Gastrointestinal endoscopy Colorectal polyps Dysplasia

Safety of Gastrointestinal endoscopy in patients with acute coronary syndrome and concomitant gastrointestinal bleeding

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World Journal of Clinical Cases 2021年第5期9卷 1048-1057页

作者： Ahmed A Elkafrawy Mohamed Ahmed Mohammad Alomari Ahmed Elkaryoni Kevin F Kennedy Wendell KClarkston Donald R Campbell Digestive Disease and Surgery Institute Cleveland Clinic FoundationClevelandOH 44195United States Internal Medicine University of Missouri Kansas City School of MedicineKansas CityMO 64108United States Department of Gastroenterology and Hepatology Cleveland Clinic FloridaWestonFL 33331United States Division of Cardiovascular Medicine Loyola University Medical Center and Stritch School of MedicineMaywoodIL 60153United States Mid America Heart Institute Saint Luke's Health SystemKansas CityMO 64111United States Department of Gastroenterology Saint Luke's Hospital/University of Missouri Kansas CityKansas CityMO 64111United States

BACKGROUND gastrointestinal bleeding(GIB)is a major concern in patients hospitalized with acute coronary syndrome(ACS)due to the common use of both antiplatelet medications and anticoagulants.Studies evaluating the safety of Gastrointestinal endoscopy(GIE)in ACS patients with GIB are limited by their relatively small size,and the focus has generally been on upper GIB and esophago-gastroduodenoscopy(EGD)only.AIM To evaluate the safety profile and the hospitalization outcomes of undergoing GIE in patients with ACS and concomitant GIB using the national database for hospitalized patients in the United States.METHODS The Nationwide Inpatient Sample database was queried to identify patients hospitalized with ACS and GIB during the same admission between 2005 and 2014.The International Classification of Diseases Code,9th Revision Clinical Modification was utilized for patient identification.Patients were further classified into two groups based on undergoing endoscopic procedures(EGD,small intestinal endoscopy,colonoscopy,or flexible sigmoidoscopy).Both groups were compared regarding demographic information,outcomes,and comorbidities.Multivariate analysis was conducted to identify factors associated with mortality and prolonged length of stay.Chi-square test was used to compare categorical variables,while Student’s t-test was used to compare continuous variables.All analyses were performed using SAS 9.4(Cary,NC,United States).RESULTS A total of 35612318 patients with ACS were identified between January 2005 and December 2014.269483(0.75%)of the patients diagnosed with ACS developed concomitant GIB during the same admission.At least one endoscopic procedure was performed in 68%of the patients admitted with both ACS and GIB.Patients who underwent GIE during the index hospitalization with ACS and GIB had lower mortality(3.8%)compared to the group not undergoing endoscopy(8.6%,Pendoscopy(mea

关键词： Gastrointestinal endoscopy gastrointestinal bleeding Acute coronary syndrome Safety Outcomes Mortality

Computer vision and augmented reality in Gastrointestinal endoscopy

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Gastroenterology Report 2015年第3期3卷 179-184页

作者： Nadim Mahmud Jonah Cohen Kleovoulos Tsourides Tyler M.Berzin Department of Internal Medicine Brigham and Women’s HospitalHarvard Medical SchoolBoston MAUSA The Center for Advanced endoscopy Beth Israel Deaconess Medical CenterHarvard Medical SchoolBoston MAUSA Brain and Cognitive Sciences Massachusetts Institute of TechnologyBoston MAUSA

Augmented reality(AR)is an environment-enhancing technology,widely applied in the computer sciences,which has only recently begun to permeate the medical field.Gastrointestinal endoscopy—which relies on the integration of highdefinition video data with pathologic correlates—requires endoscopists to assimilate and process a tremendous amount of data in real time.We believe that AR is well positioned to provide computer-guided assistance with a wide variety of endoscopic applications,beginning with polyp detection.In this article,we review the principles of AR,describe its potential integration into an endoscopy set-up,and envisage a series of novel uses.With close collaboration between physicians and computer scientists,AR promises to contribute significant improvements to the field of endoscopy.

关键词： augmented reality Gastrointestinal endoscopy colonoscopy computer vision

Virtual reality tools for training in Gastrointestinal endoscopy:A systematic review

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Artificial Intelligence in Gastrointestinal endoscopy 2024年第2期5卷 41-54页

作者： Tuấn Quang Dương Jonathan Soldera Department of Acute Medicine University of South WalesCardiff CF371DLUnited Kingdom Department of Acute Medicine and Gastroenterology University of South WalesCardiff CF371DLUnited Kingdom

BACKGROUND Virtual reality(VR)has emerged as an innovative technology in endoscopy training,providing a simulated environment that closely resembles real-life scenarios and offering trainees a valuable platform to acquire and enhance their endoscopic skills.This systematic review will critically evaluate the effectiveness and feasibility of VR-based training compared to traditional methods.AIM To evaluate the effectiveness and feasibility of VR-based training compared to traditional methods.By examining the current state of the field,this review seeks to identify gaps,challenges,and opportunities for further research and implementation of VR in endoscopic training.METHODS The study is a systematic review,following the guidelines for reporting systematic reviews set out by the PRISMA statement.A comprehensive search command was designed and implemented and run in September 2023 to identify relevant studies available,from electronic databases such as PubMed,Scopus,Cochrane,and Google Scholar.The results were systematically reviewed.RESULTS Sixteen articles were included in the final analysis.The total number of participants was 523.Five studies focused on both upper endoscopy and colonoscopy training,two on upper endoscopy training only,eight on colonoscopy training only,and one on sigmoidoscopy training only.gastrointestinal Mentor virtual endoscopy simulator was commonly used.Fifteen reported positive results,indicating that VR-based training was feasible and acceptable for endoscopy learners.VR technology helped the trainees enhance their skills in manipulating the endoscope,reducing the procedure time or increasing the technical accuracy,in VR scenarios and real patients.Some studies show that the patient discomfort level decreased significantly.However,some studies show there were no significant differences in patient discomfort and pain scores between VR group and other groups.CONCLUSION VR training is effective for endoscopy training.There are several well-designed randomized controlled trials with large sam

关键词： Virtual reality Gastrointestinal endoscopy Systematic review Virtual reality training Simulation

Gastrointestinal endoscopy in cirrhotic patient:Issues on the table

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World Journal of Gastrointestinal endoscopy 2021年第7期13卷 210-220页

作者： Giuseppe Grassi Ilaria Lenci Alessandro Signorello Martina Milana Leonardo Baiocchi Hepatology Unit University of Tor VergataRome 00100Italy

Patients with liver cirrhosis are fragile and present specific clinical hallmarks.When undergoing to gastrointestinal(GI)endoscopy,these subjects require an individual pre evaluation,taking into account:Level of haemostasis impairment,the individual risk of infection,the impact of sedation on hepatic encephalopathy and other factors.The overall assessment of liver function,employing common scoring systems,should be also assessed in the preprocedural phase.Beside some common general problems,regarding GI endoscopy in cirrhotic subjects,also specific issues are present for some frequent indications or procedures.For instance,despite an increased incidence of adenomas in cirrhosis,colon cancer screening remains suboptimal in subjects with this disease.Several studies in fact demonstrated liver cirrhosis as a negative factor for an adequate colon cleansing before colonoscopy.On the other hand,also the routine assessment of gastroesophageal varices during upper GI endoscopy presents some concern,since important inter-observer variability or incomplete description of endoscopic findings has been reported in some studies.In this review we discussed in details the most relevant issues that may be considered while performing general GI endoscopic practice,in patient with cirrhosis.For most of these issues there are no guidelines or clear indications.Moreover until now,few studies focused on these aspects.We believe that targeting these issues with corrective measures may be helpful to develop a tailored endoscopic approach for cirrhosis,in the future.

关键词： Gastrointestinal endoscopy Cirrhosis Sedation Infection Gastroesophageal varices Colonoscopy Bowel cleansing Liver transplantation