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Screening pre-bariatric surgery patients for esophageal disease with esophageal capsule endoscopy

World Journal of Gastroenterology 2013年第37期19卷 6188-6192页

作者： Ashish Shah Erica Boettcher Marianne Fahmy Thomas Savides Santiago Horgan Garth R Jacobsen Bryan J Sandler Michael Sedrak Denise Kalmaz Department of Gastroenterology University of California San Diego Department of Minimally Invasive Surgery University of California San Diego

AIM:To determine if esophageal capsule endoscopy(ECE)is an adequate diagnostic alternative to esophagogastroduodenoscopy(EGD)in pre-bariatric surgery patients.METHODS:We conducted a prospective pilot study to assess the diagnostic accuracy of ECE(PillCam ESO2,Given Imaging)vs conventional EGD in pre-bariatric surgery patients.Patients who were scheduled for bariatric surgery and referred for pre-operative EGD were prospectively enrolled.All patients underwent ECE followed by standard EGD.Two experienced gastroenterologists blinded to the patient’s history and the findings of the EGD reviewed the ECE and documented their findings.The gold standard was the findings on EGD.RESULTS:Ten patients with an average body mass index of 50 kg/m2were enrolled and completed the study.ECE identified 11 of 14(79%)positive esophageal/gastroesophageal junction(GEJ)findings and 14of 17(82%)combined esophageal and gastric findings identified on EGD.Fisher’s exact test was used to compare the findings and no significant difference was found between ECE and EGD(P=0.64 for esophageal/GEJ and P=0.66 for combined esophageal and gastric findings respectively).Of the positive esophageal/GEJ findings,ECE failed to identify the following:hiatal hernia in two patients,mild esophagitis in two patients,and mild Schatzki ring in two patients.ECE was able to identify the entire esophagus in 100%,gastric cardia in0%,gastric body in 100%,gastric antrum in 70%,pylorus in 60%,and duodenum in 0%.CONCLUSION:There were no significant differences in the likelihood of identifying a positive finding using ECE compared with EGD in preoperative evaluation of bariatric patients.

关键词： Capsule endoscopy Bariatric Moderate sedation Esophagogastroduodenoscopy Esophageal capsule endoscopy

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Application of drug-induced sleep endoscopy in patients treated with upper airway stimulation therapy

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2017年第2期3卷 92-96页

作者： Adrian A.Ong Christopher M.Ayers Eric J.Kezirian B.Tucker Woodson Nico de Vries Shaun A.Nguyen M.Boyd Gillespie Department of Otolaryngology-Head and Neck Surgery Medical University of South CarolinaCharleston SC USA Department of Otolaryngology-Head and Neck Surgery Keck School of Medicine of USC Los AngelesCA USA Department of Otolaryngology Medical College of Wisconsin Milwaukee WI USA Department of Otorhinolaryngology-Head and Neck Surgery Saint Lucas Andreas HospitalAmsterdam The Netherlands Faculty of Medicine and Health Sciences University of Antwerp Edegem Belgium Department of Otolaryngology-Head and Neck Surgery University of Tennessee-Memphis USA

Objective:To determine the level of agreement among experienced operators of candidacy for upper airway stimulation (UAS) based on evaluation of drug-induced sleep endoscopy (DISE).Methods:The trial was designed as a single-blinded cross-sectional study.Four otolaryngologists with extensive DISE experience were given 63 video clips from the STAR trial video library.These videos were graded using the VOTE classification.Percentage agreement and Cohen's k (for inter-rater reliability) were calculated between pairs of reviewers,assessing palatal complete concentric collapse (CCC) and determining UAS eligibility.Subjects were also grouped based on collapse severity for each reviewer.Results:The reviewers had excellent (approximately 90％) agreement on findings at the level of the soft palate and tongue base.The inter-rater reliability for palatal CCC ranged from mod erate to substantial The agreement on determining the criteria for UAS implantation ranged from poor to moderate.All 4 upper airway structures as classified by the criteria of the VOTE were graded by all the reviewers as contributing to obstruction in a majority of subjects who were performed via application of DISE.Conclusion:Application of DISE remains a subjective examination,even among those experienced operators,therefore more studies need to be performed for evaluation of improvement in inter-rater reliability after implantation of training videos.

关键词： Drug-induced sleep endoscopy Drug-induced sedation endoscopy Upper airway stimulation Sleep-disordered breathing Obstructive sleep apnea Inter-rater reliability

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Efficacy and cost analysis of transrectal ultrasound-guided prostate biopsy under monitored anesthesia

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Asian Journal of Andrology 2011年第5期13卷 724-727页

作者： Sung Gu Kang Bum Sik Tae Sam Hong Min Young Hwii Ko Seok Ho Kang Jeong Gu Lee Je Jong Kim Jun Cheon Department of Urology Korea University School of Medicine Korea University Robotic Urologic Surgery Center Korea University Hospital Seoul 136-705 Korea Department of Anesthesiology and Pain Medicine Korea University School of Medicine Korea University Robotic Urologic Surgery Center Korea University Hospital Seou 136-705 Korea

sedation may result in reduction in pain during transrectal ultrasound （TRUS）-guided prostate biopsies. We aimed to evaluate the efficacy and safety of a combination of propofol and remifentanil infusion during TRUS-guided prostate biopsy and the related increases in health care costs. From January to September 2010, 100 men undergoing a transrectal prostate biopsy were randomized into two groups. In Group 1, 50 patients received a combined infusion of propofol and remifentanil; in Group 2, 50 patients received lidocaine jelly. After TRUS-guided biopsies were performed, pain and patient satisfaction were evaluated by a lO-point visual analog scale （VAS）, and a cost-related patient satisfaction questionnaire was completed by all patients. Patients were also asked whether they would be willing to undergo repeat biopsy by the same method. Patients in Group I showed a significantly lower VAS score than those in Group 2 （mean VAS score： 0.9± 1.1 versus 6.3±2.5; P〈0.001）. In addition, the patient satisfaction scale was significantly higher in Group 1 （P=0.002）. Although the overall cost was significantly higher in Group 1 （P=0.006）, patient satisfaction scales considering cost were also higher in this group （P=0.009）. A combination of propofol and remifentanil is a safe and effective way to decrease patient pain and increase patient satisfaction during TRUS-guided prostate biopsy. Although the costs were higher in the group that received sedation, as expected, the patients exhibited heightened satisfaction and willingness to repeat biopsies by the same method.

关键词： biopsy pain prostate sedation

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Endotics system vs colonoscopy for the detection of polyps

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World Journal of Gastroenterology 2010年第43期16卷 5452-5456页

作者： Emanuele Tumino Rodolfo Sacco Marco Bertini Michele Bertoni Giuseppe Parisi Alfonso Capria Operative Unit of Gastroenterology and Metabolic Diseases Department of Gastroenterology Pisa University Hospital Institute of Internal Medicine University of Foggia

AIM: To compare the endotics system (ES), a set of new medical equipment for diagnostic colonoscopy, with video-colonoscopy in the detection of polyps. METHODS: Patients with clinical or familial risk of colonic polyps/carcinomas were eligible for this study. After a standard colonic cleaning, detection of polyps by the ES and by video-colonoscopy was performed in each patient on the same day. In each single patient, the assessment of the presence of polyps was performed by two independent endoscopists, who were randomly assigned to evaluate, in a blind fashion, the presence of polyps either by ES or by standard colonoscopy. The frequency of successful procedures (i.e. reaching to the cecum), the time for endoscopy, and the need for sedation were recorded. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the ES were also calculated. RESULTS: A total of 71 patients (40 men, mean age51.9 ± 12.0 years) were enrolled. The cecum was reached in 81.6% of ES examinations and in 94.3% of colonoscopies (P = 0.03). The average time of endoscopy was 45.1 ± 18.5 and 23.7 ± 7.2 min for the ES and traditional colonoscopy, respectively (P sedation during ES examination, compared with 19.7% of patients undergoing colonoscopy (P sedation.

关键词： Colonoscopy Diagnosis Endotics system Polyps sedation

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Double balloon enteroscopy examinations in general anesthesia

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World Journal of Gastroenterology 2010年第27期16卷 3418-3422页

作者： Laszlo Zubek Lena Szabo Peter Laszlo Lakatos Janos Papp Janos Gal Gabor Elo Department of Anaesthesiology and Intensive Therapy Semmelweis University 2nd Department of Pediatrics Semmelweis University 1st Department of Medicine Semmelweis University

AIM:To demonstrate that the double balloon enteroscopy(DBE) can be safely performed in general anesthesia with intubation.METHODS:We performed a retrospective examination between August 2005 and November 2008 amongpatients receiving intubation narcosis due to DBE examination.The patients were grouped based on sex,age and physical status.Anesthesia records includedduration of anesthesia,quantity of medication usedand anesthesia-related complications.We determinedthe frequency of complications in the different groupsand their relation with the quantity of medication usedand the duration of anesthesia.RESULTS:We compiled data for 108 cases of general anesthesia with intubation.We did not observeany permanent anesthesia-related complications;themost frequent side effects of anesthesia were hypo-tension(30.55%),desaturation(21.29%),and apnea(17.59%).These complications were significantly more frequent among patients with multiple additional diseases [hypotension(23.1% vs 76.9%,P = 0.005),desaturation(12.3% vs 69.2%,P < 0.001) and apnea(7.7% vs 53.8%,P = 0.001)],however,their incidence was not proportional to the quantity of medication used or the duration of anesthesia.CONCLUSION:General anesthesia with intubation is definitely a viable option among DBE methods.It is highly recommended in patients with multiple additional diseases.

关键词： Double balloon enteroscopy General anesthesia Intubation sedation Patient autonomy

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Acute pancreatitis in pregnancy:An unresolved issue

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World Journal of Gastroenterology 2010年第16期16卷 2065-2066页

作者： Pankaj Jain Department of Gastroenterology Fortis Modi Hospital

Management of acute pancreatitis in pregnancy is based on expert opinion only,due to geographic and ethic variations.Nonbiliary causes should be sought as they are associated with worse outcomes.Alcohol as a cause of acute pancreatitis is not rare.Hemoconcentration as a marker of fluid def icit and severity should be predicted with caution and fluid resuscitation should be done carefully by closely monitoring the central venous pressure,cardiac and respiratory system.Hypercalcemia of hyperparathyroidism may be falsely lowered due to hypoalbuminemia or suppressed by magnesium tocolysis.

关键词： Acute pancreatitis Pregnancy sedation Nonbiliary cause

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Myths, fallacies and practical pearls in GI lab

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World Journal of Gastrointestinal Endoscopy 2014年第12期6卷 584-591页

作者： Pradeep Kumar Lowry Surgi Center Jeannette PA 15644United States

Many prevalent practices and guidelines related to Gastrointestinal endoscopy and procedural sedation are at odds with the widely available scientific-physiological and clinical outcome data. In many institutions, strict policy of pre-procedural extended fasting is still rigorously enforced, despite no evidence of increased incidence of aspiration after recent oral intake prior to sedation. Supplemental oxygen administration in the setting of GI procedural sedation has been increasingly adopted as reported in the medical journals, despite clear evidence that supplemental oxygen blunts the usefulness of pulse oximetry in timely detection of sedation induced hypoventilation, leading to increased number of adverse cardiopulmonary outcomes. Use of Propofol by Gastroenterologist-Nurse team is erroneously considered dangerous and often prohibited in various institutions, at the same time worldwide reports of remarkable safety and patient satisfaction continue to be published, dating back more than a decade. Of patient monitoring practices that have been advocated to be standard, many merely add cost, not value. Advances in the technology often are not incorporated in a timely manner in guidelines or clinical practices, e.g., Capsule endoscopy or electrocautery during GI procedures do not interfere with proper functioning of the current pacemakers or defibrillators. Orthopedic surgeons have continued to recommend prophylactic antibiotics for joint replacement patientsprior to GI procedures, without any evidence of need. These myths are explored for a succint review to prompt a change in clinical practices and institutional policies.

关键词： Endoscopy gastrointestinal Pulse oximetry Oxygen supplemental Propofol Conscious sedation Deep sedation Fasting preprocedural Standards of Care Clinical Practice Guidelines

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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 discharge.METHODS: 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 study.RESULTS: 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 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 symptoms.CONCLUSION: 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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Use of anesthesia on the rise in gastrointestinal endoscopy

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World Journal of Gastrointestinal Endoscopy 2013年第1期5卷 1-5页

作者： Basil Al-Awabdy C Mel Wilcox Division of Gastroenterology and Hepatology University of Alabama at BirminghamBirming-hamAL 35294United States

Conscious sedation has been the standard of care for many years for gastrointestinal endoscopic procedures. As procedures have become more complex and lengthy, additional medications became essential for adequate sedation. Often time's deep sedation is required for procedures such as endoscopic retrograde cholangiography which necessitates higher doses of narcotics and benzodiazepines or even use of other medications such as ketamine. Given its pharmacologic properties, pro-pofol was rapidly adopted worldwide to gastrointestinal endoscopy for complex procedures and more recently to routine upper and lower endoscopy. Many studies have shown superiority for both the physician and patient compared to standard sedation. Nevertheless, its use remains highly controversial. A number of studies worldwide show that propofol can be given safely by endoscopists or nurses when well trained. Despite this wealth of data, at many centers its use has been pro-hibited unless administered by anesthesiology. In this commentary, we review the use of anesthesia support for endoscopy in the United States based on recent data and its implications for gastroenterologists world-wide.

关键词： Propofol Ketamine Conscious sedation Deep sedation Anesthesiology Gastrointestinal endoscopy

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Sedated vs unsedated colonoscopy:A prospective study

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World Journal of Gastroenterology 2014年第17期20卷 5113-5118页

作者： Abdulrahman M Aljebreen Majid A Almadi Felix W Leung Gastroenterology Division King Khalid University HospitalKing Saud UniversityRiyadh 11461Saudi Arabia Gastroenterology Division McGill University Health Center McGill University MontrealQuebec H3G 1A4Canada Research and Medical Services Sepulveda Ambulatory Care CenterVeterans Affairs Greater Los Angeles Healthcare Systemand David Geffen School of Medicine at UCLALos AngelesCaliforniaCA 91343United States

AIM:To compare sedated to unsedated colonoscopy in terms of duration,pain and the patient’s willingness to repeat the procedure.METHODS:Consecutive patients who underwent colonoscopies over a 2-year period were invited to participate.All patients who were to undergo our endoscopy unit were offered sedation with standard intravenous sedatives and analgesics,or an unsedated colonoscopy was attempted.Demographic details were recorded.The patient anxiety level prior to the procedure,time to reach the cecum,total discharge time,patient and endoscopist pain assessments,satisfaction after the examination and the patient’s willingness to return for the same procedure in the future were recorded.RESULTS:Among the 403 observed patients,more males were observed in the unsedated group(66.2%vs 55.2%,P=0.04).Additionally,the unsedated group patients were less anxious prior to the procedure(5.1vs 6.0,P<0.01).The colonoscopy completion rates were comparable between the 2 groups(85.9%vs84.2%,P=0.66).The time to reach the cecum was also comparable(12.2 min vs 11.8 min);however,the total discharge times were shorter in the unsedated group(20.7 min vs 83.0 min,P<0.01).Moreover,the average patient pain score(3.4 vs 5.7,P<0.01)was lower in the sedated group,while the satisfaction score(8.8 vs 7.8,P<0.01)was significantly higher.There was no significant difference,however,between the groups in terms of willingness to repeat the procedure if another was required in the future(83.3%vs 77.3%,P=0.17).CONCLUSION:Unsedated colonoscopy is feasible in willing patients.The option saves the endoscopy units up to one hour per patient and does not affect the patient willingness to return to the same physician again for additional colonoscopies if a repeated procedure is needed.

关键词： sedation Colonoscopy Unsedated Screening Endoscopy

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