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Safety, Efficacy and High-Quality Standards of Gastrointestinal Endoscopy Procedures in Personalized Sedoanalgesia Managed by the Gastroenterologist: A Retrospective Study. J Pers Med 2022; 12:jpm12071171. [PMID: 35887668 PMCID: PMC9318151 DOI: 10.3390/jpm12071171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022] Open
Abstract
Performing GI endoscopy under sedoanalgesia improves the quality-indices of the examination, in particular for cecal intubation and adenoma detection rates during colonoscopy. The implementation of procedural sedoanalgesia in GI endoscopy is also strongly recommended by the guidelines of the major international scientific societies. Nevertheless, there are regional barriers that prevent the widespread adoption of this good practice. A retrospective monocentric analytic study was performed on a cohort of 529 patients who underwent EGDS/Colonoscopy in sedoanalgesia, with personalized dosage of Fentanyl and Midazolam. ASA class, age and weight were collected for each patient. The vital parameters were recorded during, pre- and post-procedure. The rates of cecal intubation and of procedure-related complications were entered. The VAS scale was used to evaluate the efficacy of sedoanalgesia, and the Aldrete score was used for patient discharge criteria. No clinically significant differences were found between vital signs pre- and post-procedure. Both anesthesia and endoscopic-related complications occurring were few and successfully managed. At the end of examination, both the mean Aldrete score (89.56), and the VAS score (<4 in 99.1%) were suitable for discharge. For the colonoscopies, the cumulative adenoma detection rate (25%) and the cecal intubation rate in the general group (98%) and in the colorectal cancer screening group (100%) were satisfying. Pain control management is an ethical and medical issue aimed at increasing both patient compliance and the quality of the procedures. The findings of this work underscore that in selected patients personalized sedoanalgesia in GI endoscopy can be safely managed by gastroenterologists.
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Galloro G, Musella M, Siciliano S, Berardi G, Vitiello A, Velotti N, Rizzello F, Gionchetti P, Calabrese C. New endoscopic capsule vs upper gastrointestinal endoscopy in preoperative work-up of obese candidate for bariatric surgery: Relevance of a pilot study in the COVID-19 era. Endosc Int Open 2022; 10:E183-E191. [PMID: 35178336 PMCID: PMC8847058 DOI: 10.1055/a-1723-3109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background and study aims Obesity represents a major health concern; bariatric surgery is the most effective treatment reducing and maintaining weight loss. The role of a routine esophagogastroduodenoscopy (EGD) prior bariatric surgery is still debated. Moreover, in this scenario of COVID-19 pandemic, EGD is even more questionable due to the procedural risk of viral transmission. A new model of video-endoscopic capsule (VEC) recently has been introduced as a good alternative to the EGD. The aim of this study was to determine if this new capsule is an adequate diagnostic alternative to EGD in the work-up of patients selected for bariatric surgery, particularly in the setting of COVID-19. Patients and methods From January to November 2020, 27 patients selected for bariatric surgery were enrolled in this pilot study to assess for noninferiority of VEC compared to EGD in detection of upper gastrointestinal disease. Results VEC had sensitivity, specificity, and positive and negative predictive values in identification of significant lesions of 91.3 %, 83.33 %, 98.01 %, and 51.57 %, respectively, compared with EGD as the standard criterion. The accuracy was 90.51 % (95 % CI, 73.75 %-98.18 %) and the chi-square statistic is 0.1153 ( P = 0.73). Conclusions Our report confirms the diagnostic noninferiority of VEC in preoperative work-up of patients selected for bariatric surgery, compared to EGD. This is very important, particularly during the COVID-19 pandemic, given the high risk of contamination with EGD. Larger multicenter studies are required to confirm our preliminary results.
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Affiliation(s)
- Giuseppe Galloro
- University of Naples Federico II – School of Medicine, Department of Clinical Medicine and Surgery – Surgical Endoscopy Unit, Naples, Italy
| | - Mario Musella
- University of Naples Federico II – School of Medicine, Department of Advanced Biomedical Sciences – Bariatric and Metabolic Surgery Unit, Naples, Italy
| | - Saverio Siciliano
- University of Naples Federico II – School of Medicine, Department of Clinical Medicine and Surgery – Surgical Endoscopy Unit, Naples, Italy
| | - Giovanna Berardi
- University of Naples Federico II – School of Medicine, Department of Advanced Biomedical Sciences – Bariatric and Metabolic Surgery Unit, Naples, Italy
| | - Antonio Vitiello
- University of Naples Federico II – School of Medicine, Department of Advanced Biomedical Sciences – Bariatric and Metabolic Surgery Unit, Naples, Italy
| | - Nunzio Velotti
- University of Naples Federico II – School of Medicine, Department of Advanced Biomedical Sciences – Bariatric and Metabolic Surgery Unit, Naples, Italy
| | - Fernando Rizzello
- University of Bologna Alma Mater – School of Medicine, Department of Medical and Surgical Sciences – Regional Referral Center for IBD, Bologna, Italy
| | - Paolo Gionchetti
- University of Bologna Alma Mater – School of Medicine, Department of Medical and Surgical Sciences – Regional Referral Center for IBD, Bologna, Italy
| | - Carlo Calabrese
- University of Bologna Alma Mater – School of Medicine, Department of Medical and Surgical Sciences – Regional Referral Center for IBD, Bologna, Italy
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Jayasena H, Abeynayake D, De Silva A, Niriella M, de Silva HJ. The use of personal protective equipment in endoscopy: what should the endoscopist wear during a pandemic? Expert Rev Gastroenterol Hepatol 2021; 15:1349-1359. [PMID: 34821190 DOI: 10.1080/17474124.2021.2011213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Endoscopists are at high risk of exposure and nosocomial transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus) when performing endoscopic procedures due to the highly aerosol generating nature of these procedures. At present, there is still no consensus among endoscopists with regards to the type of protective equipment to be worn by healthcare workers, when performing endoscopy during the coronavirus 2019 (COVID-19) pandemic. This review encompasses a summary of currently published guidelines related to the use of personal protective equipment (PPE) when performing endoscopic procedures during the COVID-19 pandemic. With increasing calls to rationalize the use of PPE due to shortages in global supply chains, the review offers a concise summary on the most appropriate and adequate use of PPE when performing endoscopy during the pandemic. It is expected that these adaptations in the use of PPE during the pandemic will help to improve standards of care and safety of healthcare workers.
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Affiliation(s)
- Hiruni Jayasena
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.,Department of Clinical Medicine, Faculty of Medicine, General Sir John Kotelawala Defence University, Rathmalana, Sri Lanka
| | | | - Arjuna De Silva
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Madunil Niriella
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - H Janaka de Silva
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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Chhibber A, Kharat A, Kneale D, Welch V, Bangpan M, Chaiyakunapruk N. Assessment of health equity consideration in masking/PPE policies to contain COVID-19 using PROGRESS-plus framework: a systematic review. BMC Public Health 2021; 21:1682. [PMID: 34525995 PMCID: PMC8443429 DOI: 10.1186/s12889-021-11688-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/29/2021] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION There is increasing evidence that COVID-19 has unmasked the true magnitude of health inequity worldwide. Policies and guidance for containing the infection and reducing the COVID-19 related deaths have proven to be effective, however the extent to which health inequity factors were considered in these policies is rather unknown. The aim of this study is to measure the extent to which COVID-19 related policies reflect equity considerations by focusing on the global policy landscape around wearing masks and personal protection equipment (PPE). METHODS A systematic search for published documents on COVID-19 and masks/PPE was conducted across six databases: PubMed, EMBASE, CINAHL, ERIC, ASSIA and Psycinfo. Reviews, policy documents, briefs related to COVID-19 and masks/PPE were included in the review. To assess the extent of incorporation of equity in the policy documents, a guidance framework known as 'PROGRESS-Plus': Place of residence, Race/ethnicity, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital, Plus (age, disability etc.) was utilized. RESULTS This review included 212 policy documents. Out of 212 policy documents, 190 policy documents (89.62%) included at least one PROGRESS-plus component. Most of the policy documents (n = 163, 85.79%) focused on "occupation" component of the PROGRESS-plus followed by personal characteristics associated with discrimination (n = 4;2.11%), place of residence (n = 2;1.05%) and education (n = 1;0.53%). Subgroup analysis revealed that most of the policy documents (n = 176, 83.01%) were focused on "workers" such as healthcare workers, mortuary workers, school workers, transportation workers, essential workers etc. Of the remaining policy documents, most were targeted towards whole population (n = 30; 14.15%). Contrary to "worker focused" policy documents, most of the 'whole population focused' policy documents didn't have a PROGRESS-plus equity component rendering them equity limiting for the society. CONCLUSION Our review highlights even if policies considered health inequity during the design/implementation, this consideration was often one dimensional in nature. In addition, population wide policies should be carefully designed and implemented after identifying relevant equity related barriers in order to produce better outcomes for the whole society.
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Affiliation(s)
| | - Aditi Kharat
- School of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Dylan Kneale
- The Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), UCL Social Research Institute, University College London, London, UK
| | - Vivian Welch
- Bruyere Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Mukdarut Bangpan
- The Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), UCL Social Research Institute, University College London, London, UK
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, University of Utah, Salt Lake City, UT, USA.
- School of Pharmacy, Monash University, Subang Jaya, Malaysia.
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Mariani A, Capurso G, Marasco G, Bertani H, Crinò SF, Magarotto A, Tringali A, Pasquale L, Arcidiacono PG, Zagari RM. Factors associated with risk of COVID-19 contagion for endoscopy healthcare workers: A survey from the Italian society of digestive endoscopy. Dig Liver Dis 2021; 53:534-539. [PMID: 33785281 PMCID: PMC7980179 DOI: 10.1016/j.dld.2021.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The present study was aimed to assess the risk of SARS-CoV-2 infection and associated factors among HCWs in endoscopy centers in Italy. METHODS All members of the Italian Society of Digestive Endoscopy (SIED) were invited to participate to a questionnaire-based survey during the first months of the COVID-19 outbreak in Italy. RESULTS 314/1306 (24%) SIED members accounting for 201/502 (40%) endoscopic centers completed the survey. Personal Protection Equipment (PPE) were available in most centers, but filtering face-piece masks (FFP2 or FFP3) and negative pressure room were not in 10.9 and 75.1%. Training courses on PPE use were provided in 57.2% of centers only; there was at least one positive HCW in 17.4% of centers globally, 107/3308 (3.2%) HCWs were diagnosed with COVID-19 with similar rates of physicians (2.9%), nurses (3.5%) and other health operators (3.5%). Involvement in a COVID-19 care team (OR: 4.96) and the lack of training courses for PPE, (OR: 2.65) were associated with increased risk. CONCLUSIONS The risk of COVID-19 among endoscopy HCWs was not negligible and was associated with work in a COVID-19 care team and lack of education on proper PPE use. These data deserve attention during the subsequent waves.
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Affiliation(s)
- Alberto Mariani
- Pancreatobiliary and EUS Unit, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita e Salute University of Milan, Via Olgettina 60, Milan 20132, Italy
| | - Gabriele Capurso
- Pancreatobiliary and EUS Unit, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita e Salute University of Milan, Via Olgettina 60, Milan 20132, Italy.
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Helga Bertani
- Gastroenterology and Endoscopy Unit, Azienda Ospedaliera-Universitaria Policlinico di Modena, Italy
| | - Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, Italy
| | - Andrea Magarotto
- Diagnostic and Therapeutic Endoscopy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Andrea Tringali
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy; Center for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Roma, Italy
| | - Luigi Pasquale
- Gastroenterology Unit, S. O. Frangipane Hospital of A. Irpino, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreatobiliary and EUS Unit, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita e Salute University of Milan, Via Olgettina 60, Milan 20132, Italy
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Zein AFMZ, Pribadi RR, Khasanah U, Bestari MB, Syam AF. Clinical Gastroenterology and Gastrointestinal Endoscopy Practices during the Coronavirus Disease 2019 Pandemic in Indonesia: An Online Nationwide Survey. Clin Endosc 2021; 54:348-355. [PMID: 33596636 PMCID: PMC8182243 DOI: 10.5946/ce.2020.216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/28/2020] [Accepted: 11/29/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND/AIMS The coronavirus disease 2019 (COVID-19) pandemic has necessitated modifications to allow the safe practice of clinical gastroenterology and gastrointestinal endoscopy. This study aimed to investigate the characteristics of clinical gastroenterology and gastrointestinal endoscopy practices during the COVID-19 pandemic in Indonesia. METHODS This cross-sectional study enrolled physician members of the Indonesian Society for Digestive Endoscopy. We used an online self-administered questionnaire disseminated via social media. The 32-item survey determined the baseline characteristics of the participants, characteristics of clinical gastroenterology and gastrointestinal endoscopy practices, involvement of the physicians in the management of COVID-19, and overall impact of the pandemic on practice. All collected data were analyzed using descriptive statistics. RESULTS The 200 participants in this study had a median age of 50 (34-76) years. Modifications in clinical gastroenterology practice were frequently reported in the outpatient (95.5%) and inpatient (100%) settings. All participants reported changes in the gastrointestinal endoscopy practice patterns. Of the participants, 86.0% were working in high-risk zones, and several of them reported inadequate protective personal equipment (34.0%). The median overall impact score of the pandemic on practice was 9 (2-10). CONCLUSION Physicians practicing clinical gastroenterology and gastrointestinal endoscopy in Indonesia work in high-risk settings. Modifications in clinical gastroenterology and gastrointestinal endoscopy practices are prevalent during the COVID-19 pandemic.
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Affiliation(s)
- Ahmad Fariz Malvi Zamzam Zein
- Department of Internal Medicine, Faculty of Medicine, Universitas Swadaya Gunung Jati-Waled General Hospital, Cirebon, Indonesia
| | - Rabbinu Rangga Pribadi
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Uswatun Khasanah
- Department of Biostatistics and Epidemiology, Faculty of Medicine, Universitas Swadaya Gunung Jati, Cirebon, Indonesia
| | - Muhammad Begawan Bestari
- Division of Gastroenterohepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran-Hasan Sadikin Hospital, Bandung, Indonesia
| | - Ari Fahrial Syam
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
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Abstract
INTRODUCTION Capsule endoscopy (CE) is an established modality in the diagnostic algorithm of small bowel (SB) pathology. Its use has expanded for investigation of upper and lower gastrointestinal diseases with similar prototypes. AREAS COVERED This review covers the role and recent advances of CE, as a non-invasive investigative tool. EXPERT OPINION The use of upper gastrointestinal CE is useful in patients who require surveillance for varices particularly in the current era of the COVID-19 pandemic. It has also shown high accuracy in the detection of upper gastrointestinal hemorrhage in patients presenting with a suspicion of hemorrhage. Findings on CE help to guide further management by device-assisted enteroscopy. The data on colon CE suggest comparable diagnostic accuracy to colonoscopy for polyp detection; however, more evidence is required in the high-risk group. Crohn's CE has become an integral part of the management of patients with Crohn's disease offering a comparative assessment tool post escalation of therapy. Artificial intelligence within CE has demonstrated similar if not better diagnostic yield compared to the human with a significantly shorter reading time. Artificial intelligence is likely to be in-built within CE reading platforms over the next few years minimizing reporting time and human error.
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Affiliation(s)
| | - Reena Sidhu
- Academic Department of Gastroenterology, Royal Hallamshire Hospital , Sheffield, UK
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Paccos JL, Lima IPD, Lima VRBD, Mukai NS. Ventilation mask adapted for endoscopy during the COVID-19 pandemic. Rev Assoc Med Bras (1992) 2020; 66Suppl 2:55-57. [PMID: 32965357 DOI: 10.1590/1806-9282.66.s2.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/11/2020] [Indexed: 11/22/2022] Open
Abstract
In the context of the COVID-19 pandemic, endoscopy services must adopt preventive measures to maintain proper functioning due to a high risk of disease contagion. Triage protocols before and after the procedure, personal protective equipment, and environmental contamination control are some of the endoscopy society's recommendations. However, the risk of infection may remain high due to poor control over the source of contamination.Using a combination of standardized supplies and accessories in a hospital, a ventilation mask adapted to be used in endoscopic procedures is proposed to reduce COVID-19 contamination.
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Affiliation(s)
- José Luiz Paccos
- . Médico do corpo clínico do Hospital Dr. Miguel Soeiro, Sorocaba, SP, Brasil
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