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Sidhu R, Turnbull D, Haboubi H, Leeds JS, Healey C, Hebbar S, Collins P, Jones W, Peerally MF, Brogden S, Neilson LJ, Nayar M, Gath J, Foulkes G, Trudgill NJ, Penman I. British Society of Gastroenterology guidelines on sedation in gastrointestinal endoscopy. Gut 2024; 73:219-245. [PMID: 37816587 PMCID: PMC10850688 DOI: 10.1136/gutjnl-2023-330396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/06/2023] [Indexed: 10/12/2023]
Abstract
Over 2.5 million gastrointestinal endoscopic procedures are carried out in the United Kingdom (UK) every year. Procedures are carried out with local anaesthetic r with sedation. Sedation is commonly used for gastrointestinal endoscopy, but the type and amount of sedation administered is influenced by the complexity and nature of the procedure and patient factors. The elective and emergency nature of endoscopy procedures and local resources also have a significant impact on the delivery of sedation. In the UK, the vast majority of sedated procedures are carried out using benzodiazepines, with or without opiates, whereas deeper sedation using propofol or general anaesthetic requires the involvement of an anaesthetic team. Patients undergoing gastrointestinal endoscopy need to have good understanding of the options for sedation, including the option for no sedation and alternatives, balancing the intended aims of the procedure and reducing the risk of complications. These guidelines were commissioned by the British Society of Gastroenterology (BSG) Endoscopy Committee with input from major stakeholders, to provide a detailed update, incorporating recent advances in sedation for gastrointestinal endoscopy.This guideline covers aspects from pre-assessment of the elective 'well' patient to patients with significant comorbidity requiring emergency procedures. Types of sedation are discussed, procedure and room requirements and the recovery period, providing guidance to enhance safety and minimise complications. These guidelines are intended to inform practising clinicians and all staff involved in the delivery of gastrointestinal endoscopy with an expectation that this guideline will be revised in 5-years' time.
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Affiliation(s)
- Reena Sidhu
- Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - David Turnbull
- Department of Anaesthetics, Royal Hallamshire Hospital, Sheffield, UK
| | - Hasan Haboubi
- Department of Gastroenterology, University Hospital Llandough, Llandough, South Glamorgan, UK
- Institute of Life Sciences, Swansea University, Swansea, UK
| | - John S Leeds
- Hepato-Pancreato-Biliary Unit, Freeman Hospital, Newcastle upon Tyne, UK
- Newcastle University Population Health Sciences Institute, Newcastle upon Tyne, UK
| | - Chris Healey
- Airedale NHS Foundation Trust, Keighley, West Yorkshire, UK
| | - Srisha Hebbar
- Department of Gastroenterology, University Hospital of North Midlands, Stoke-on-Trent, Staffordshire, UK
| | - Paul Collins
- Department of Gastroenterology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Wendy Jones
- Specialist Pharmacist Breastfeeding and Medication, Portsmouth, UK
| | - Mohammad Farhad Peerally
- Digestive Diseases Unit, Kettering General Hospital; Kettering, Kettering, Northamptonshire, UK
- Department of Population Health Sciences, College of Life Science, University of Leicester, Leicester, UK
| | - Sara Brogden
- Department of Gastroenterology, University College London, UK, London, London, UK
| | - Laura J Neilson
- Department of Gastroenterology, South Tyneside District Hospital, South Shields, Tyne and Wear, UK
| | - Manu Nayar
- Hepato-Pancreato-Biliary Unit, Freeman Hospital, Newcastle upon Tyne, UK
- Newcastle University Population Health Sciences Institute, Newcastle upon Tyne, UK
| | - Jacqui Gath
- Patient Representative on Guideline Development Group and member of Independent Cancer Patients' Voice, Sheffield, UK
| | - Graham Foulkes
- Patient Representative on Guideline Development Group, Manchester, UK
| | - Nigel J Trudgill
- Department of Gastroenterology, Sandwell General Hospital, West Bromwich, UK
| | - Ian Penman
- Centre for Liver and Digestive Disorders, Royal Infirmary Edinburgh, Edinburgh, Midlothian, UK
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Liang R, Kaliyaperumal K, Ng WK, Tsao SKK, Vu CKF. Motorised spiral enteroscopy: pilot experience from a tertiary care centre in Singapore. Singapore Med J 2023; 64:758-762. [PMID: 35849882 PMCID: PMC10775294 DOI: 10.11622/smedj.2022096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/27/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Raymond Liang
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore
| | | | - Wee Khoon Ng
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore
| | | | - Charles Kien Fong Vu
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore
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Oka P, Ray M, Sidhu R. Small Bowel Bleeding: Clinical Diagnosis and Management in the Elderly. Expert Rev Gastroenterol Hepatol 2023:1-8. [PMID: 37184832 DOI: 10.1080/17474124.2023.2214726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
INTRODUCTION With the global increase in life expectancy, there is an increase in gastrointestinal presentations in the elderly. Small bowel bleeding (SBB) is a cause of significant morbidity in the elderly requiring multiple hospital visits, investigations and potentially expensive therapy. AREAS COVERED In this review we will outline the different modalities which are used for the diagnosis and management of SBB. We will also discuss the common causes of SBB in the elderly. EXPERT OPINION SBB in elderly has a significant impact on the quality of life of the elderly. Larger randomized studies in the elderly are urgently required to help guide clinicians on the best and most cost-effective treatment algorithm in this challenging cohort.
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Affiliation(s)
- Priya Oka
- Department of Gastroenterology, University of Sheffield, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, Royal Hallamshire Hospital, Sheffield, UK
| | - Meghna Ray
- Department of Gastroenterology, University of Sheffield, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, Royal Hallamshire Hospital, Sheffield, UK
| | - Reena Sidhu
- Department of Gastroenterology, University of Sheffield, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, Royal Hallamshire Hospital, Sheffield, UK
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Trebbi M, Casadei C, Dari S, Buzzi A, Brancaccio ML, Feletti V, Mussetto A. Outcomes of Double Balloon-Enteroscopy in Elderly vs. Adult Patients: A Retrospective 16-Year Single-Centre Study. Diagnostics (Basel) 2023; 13:diagnostics13061112. [PMID: 36980420 PMCID: PMC10047120 DOI: 10.3390/diagnostics13061112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/13/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Abstract
Background and Aim: Double-balloon enteroscopy (DBE) is a well-established procedure for direct visualisation of the entire small bowel mucosa, and, in contrast with other imaging techniques, allows to perform biopsies and therapeutic interventions. The aim of this study was to evaluate the indications, diagnostic yield, therapeutic yield, and complications of DBE in a cohort of consecutive patients according to patients’ age. Methods: We conducted a retrospective study of consecutive patients who underwent DBE in our endoscopy unit between January 2006 and December 2021. Results: A total of 387 consecutive patients who underwent 460 DBE procedures were included. Mean age of the patients was 63 years. The overall diagnostic yield was 67.6%; vascular lesions were the predominant endoscopic findings (31.5%), followed by polyps or neoplastic masses (17.6%). Older patients (≥65 years) showed statistically higher rates of clinically relevant findings than adult patients (18–65 years) (p = 0.001). Crohn’s disease and polyps or neoplastic masses were more frequent in the younger group (p = 0.009 and p = 0.066, respectively), while vascular lesions and non-specific inflammation were the most common findings in the older group (p < 0.001 and p < 0.001, respectively). The therapeutic intervention rate was 31.7%. Rates of endoscopic treatment were significantly higher in the older group (p < 0.001). Total complications occurred in five procedures (1.1%). Conclusion: In clinical practice, DBE is an efficient diagnostic and therapeutic tool with a high safety profile, particularly in the elderly population.
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Elli L, Scaramella L, Tontini GE, Topa M, Conte D, Sidhu R, Rondonotti E, Penagini R, Vecchi M. Clinical impact of videocapsule and double balloon enteroscopy on small bowel bleeding: Results from a large monocentric cohort in the last 19 years. Dig Liver Dis 2022; 54:251-257. [PMID: 34373230 DOI: 10.1016/j.dld.2021.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/27/2021] [Accepted: 07/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Suspected small bowel bleeding (SSBB) is the main indication for videocapsule endoscopy (VCE) and double balloon enteroscopy (DBE). We assessed the impact of both modalities in a large cohort of SSBB patients in a European tertiary center. METHODS We retrospectively evaluated consecutive patients with SSBB undergoing VCE and/or DBE from March 2001 to July 2020. Demographic/clinical parameters, anticoagulant therapies, technical characteristics and adverse events were collected, as well as diagnostic yield (DY), VCE-DBE concordance, hemoglobin (Hb) values before and after DBE, and complications. RESULTS 807 VCEs and 407 DBEs were performed in 751 patients. The DY was significantly higher in DBE compared with VCE (68.8% vs 57.7%), with the highest (75%) yield for overt active SB bleeding. The agreement between VCE and DBE was generally suboptimal (k = 0.059). This improved in cases where both procedures were done within 1-5 days of the other (k = 0.323). Post-procedural Hb values were significantly higher. In patients treated with direct oral anticoagulants (DOACs), there were no differences in DY, complications or Hb values compared with non-DOAC patients. CONCLUSION VCE and DBE play a pivotal role in the diagnostic and therapeutic approach to SSBB, having a high clinical impact even in patients treated with DOACs.
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Affiliation(s)
- Luca Elli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20131, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Lucia Scaramella
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20131, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Gian Eugenio Tontini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20131, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Matilde Topa
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20131, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Dario Conte
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20131, Italy
| | | | | | - Roberto Penagini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20131, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20131, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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