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Iwagami H, Seta T, Nakano S, Wakita M, Konishi T, Matsumoto H, Nakatani Y, Akamatsu T, Urai S, Uenoyama Y, Yamashita Y, Nakayama T. Association between antispasmodics and detection of lesions by screening esophagogastroduodenoscopy. JGH OPEN 2022; 6:792-798. [PMID: 36406644 PMCID: PMC9667398 DOI: 10.1002/jgh3.12828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/08/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022]
Abstract
Background and Aim Whether administration of antispasmodics as a component of premedication contributes to detection of lesions by screening esophagogastroduodenoscopy (EGDS) remains unclear. Our primary aim was to investigate this possibility. Methods The cohort in this retrospective study comprised consecutive asymptomatic individuals who had undergone screening EGDS as part of a health check‐up at the Japanese Red Cross Wakayama Medical Center from October 2015 to September 2020. The investigated lesions comprised esophageal squamous cell carcinoma or adenocarcinoma, gastric adenoma or adenocarcinoma, and duodenal adenoma or adenocarcinoma. Results Targeted lesions were detected in 72 of 31 484 participants (0.23%), 18 260 and 13 224 of whom had received and not received pre‐procedure antispasmodics, respectively. The rates of detection of lesions in these groups were 0.21% (38/18260) and 0.26% (34/13224), respectively (P = 0.40). Multivariate logistic regression analysis showed no association between administration of antispasmodics and rates of detection of targeted lesions [P = 0.24, Odds ratio (95% CI): 1.46 (0.78–2.75)]. Conclusions Antispasmodics, which were administered to more than half of the study cohort, did not improve the rate of detection of targeted lesions.
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Affiliation(s)
- Hiroyoshi Iwagami
- Department of Gastroenterology and Hepatology Japanese Red Cross Wakayama Medical Center Wakayama Japan
- Department of Health Informatics Graduate School of Medicine & School of Public Health, Kyoto University Kyoto Japan
| | - Takeshi Seta
- Department of Gastroenterology and Hepatology Japanese Red Cross Wakayama Medical Center Wakayama Japan
- Department of Health Informatics Graduate School of Medicine & School of Public Health, Kyoto University Kyoto Japan
| | - Shogo Nakano
- Department of Gastroenterology and Hepatology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Midori Wakita
- Department of Gastroenterology and Hepatology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Takafumi Konishi
- Department of Gastroenterology and Hepatology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Hisakazu Matsumoto
- Department of Gastroenterology and Hepatology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Yasuki Nakatani
- Department of Gastroenterology and Hepatology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Takuji Akamatsu
- Department of Gastroenterology and Hepatology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Shunji Urai
- Department of Gastroenterology and Hepatology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Yoshito Uenoyama
- Department of Gastroenterology and Hepatology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Yukitaka Yamashita
- Department of Gastroenterology and Hepatology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Takeo Nakayama
- Department of Health Informatics Graduate School of Medicine & School of Public Health, Kyoto University Kyoto Japan
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Can YouTube videos concerning the esophagogastroduodenoscopy experience be a reliable and satisfactory source of information for patient education in developing countries? A cross-sectional study from Turkey. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1036253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kim SY, Park JM, Cho HS, Cho YK, Choi MG. Assessment of Cimetropium Bromide Use for the Detection of Gastric Neoplasms During Esophagogastroduodenoscopy. JAMA Netw Open 2022; 5:e223827. [PMID: 35319761 PMCID: PMC8943631 DOI: 10.1001/jamanetworkopen.2022.3827] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
IMPORTANCE Esophagogastroduodenoscopy (EGD) is a common procedure used to examine upper gastrointestinal diseases. Although cimetropium bromide and other antispasmodic agents are commonly administered as premedication to inhibit peristalsis during EGD examination, there are few data regarding the benefits of cimetropium bromide for the detection of gastric neoplasms. OBJECTIVE To investigate the association between the use of cimetropium bromide as premedication and gastric neoplasm detection rates during EGD examination. DESIGN, SETTING, AND PARTICIPANTS This propensity score-matched retrospective cohort study included 67 683 participants who received EGD screening at the Health Promotion Center of Seoul St. Mary's Hospital, The Catholic University of Korea, from January 2, 2010, to June 30, 2017. Data were analyzed from April 1 to December 30, 2021. EXPOSURES Participants were divided into 2 groups: those who received cimetropium bromide before EGD examination (intervention group) and those who did not (control group). MAIN OUTCOMES AND MEASURES Gastric neoplasm detection rates. RESULTS Among 67 683 participants, the mean (SD) age was 48.6 (10.8) years, and 36 517 participants (54.0%) were male; all participants were Asian (a racially homogenous population). Of those, 28 280 participants (41.8%; mean [SD] age, 50.3 [10.6] years; 57.8% male) received cimetropium bromide, and 39 403 participants (58.2%; mean [SD] age, 47.4 [10.8] years; 51.2% male) did not. Propensity score matching based on confounding variables yielded 41 670 matched participants (20 835 pairs). Detected lesions included 52 dysplasias (0.12%), 40 early cancers (0.10%), 7 advanced cancers (0.02%), and 3 lymphomas (0.01%). Gastric neoplasm detection rates were significantly higher in the intervention group (63 participants [0.30%]) vs the control group (39 participants [0.19%]; P = .02). A significant difference in the combined detection rate of dysplasia and early gastric cancer was found between those in the intervention group (57 participants [0.27%]) vs the control group (35 participants [0.17%]; P = .02). For small gastric lesions (<1 cm), those who received cimetropium bromide had higher detection rates (24 participants [0.12%]) than those who did not (11 participants [0.05%]; P = .03). Lesions in the gastric body were detected significantly more often in the intervention group (34 participants [0.16%]) vs the control group (15 participants [0.07%]; P = .007). In multivariate analyses involving all 67 683 participants, the use of cimetropium bromide was more likely to detect gastric neoplasms compared with nonuse (odds ratio, 1.42; 95% CI, 1.04-1.95; P = .03). CONCLUSIONS AND RELEVANCE In this study, the use of cimetropium bromide as premedication was significantly associated with increased gastric neoplasm detection rates during EGD screening, and lesions in the gastric body were detected more frequently among those who received cimetropium bromide compared with those who did not. These findings suggest that cimetropium bromide may be considered as premedication before EGD examination among individuals with no contraindications.
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Affiliation(s)
- Sang Yoon Kim
- Department of Internal Medicine, Myoungji Hospital, Hanyang University College of Medicine, Goyang-si, Gyeonggi-do, Republic of Korea
- Graduate School, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Myung Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
- Catholic Photomedicine Research Institute, Seoul, Republic of Korea
| | - Hyun Sun Cho
- Department of Health Promotion Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yu Kyung Cho
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Myung-Gyu Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
- Catholic Photomedicine Research Institute, Seoul, Republic of Korea
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Anikhindi SA, Kumar A, Uedo N, Singla V, Anikhindi A, Sharma P, Bansal N, Ranjan P, Kumar M, Sachdeva M, Khare S, Arora A. Pre-Endoscopy Drink of Simethicone and N-Acetylcysteine Significantly Improves Visualization in Upper Gastrointestinal Endoscopy. JOURNAL OF DIGESTIVE ENDOSCOPY 2021. [DOI: 10.1055/s-0041-1726225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Abstract
Introduction With the advancements in diagnostic and therapeutic upper gastrointestinal endoscopy (UGIE), clear mucosal visualization is essential to ensure optimal outcomes. Though routinely followed in Japan and Korea, pre-endoscopic preparation is seldom used in India. We evaluated the efficacy of a pre-endoscopic drink of N-acetylcysteine (NAC) and simethicone in improving mucosal visibility during UGIE.
Patients and Methods This study was a retrospective, investigator blind study with a case–control study design. Cases included patients who received a pre-endoscopy drink of NAC and simethicone in 100 mL water administered 10 to 30 minutes prior to UGIE. Controls only had mandatory fasting for 6 to 8 hours prior to UGIE. Propensity score matching was done to ensure comparability between the groups. Digital images were taken at six standard landmarks during UGIE and stored. A blinded investigator subsequently analyzed the images and rated the mucosal visibility on a 3-point scale. The difference in the mean mucosal visibility between the cases and controls was compared.
Results Mean mucosal visibility during UGIE was significantly better using NAC with simethicone as compared with no preparation at esophagus (1.14 [0.37] vs. 1.47 [0.62], p < 0.05), gastric fundus (1.10 [0.30] vs. 1.55 [0.64], p < 0.05), gastric body (1.22 [0.50] vs. 1.62 [0.73], p < 0.05), gastric antrum (1.13 [0.37] vs. 1.47 [0.62], p < 0.05), and duodenal bulb (1.13 [0.34] vs. 1.33 [0.56], p < 0.05). In distal duodenum, though visibility improved with NAC with simethicone, the difference was insignificant. There were no adverse events related to the pre-endoscopy drink.
Conclusion A pre-endoscopy drink of NAC with simethicone can significantly improve mucosal visibility during UGIE. It is safe, cheap, easily available and maybe considered for routine utilization for ensuring optimal endoscopic outcomes.
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Affiliation(s)
- Shrihari Anil Anikhindi
- Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Ashish Kumar
- Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Vikas Singla
- Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Praveen Sharma
- Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Naresh Bansal
- Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Piyush Ranjan
- Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Mandhir Kumar
- Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Munish Sachdeva
- Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Shivam Khare
- Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Anil Arora
- Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
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Feasibility and Safely of Oral Rehydration Therapy before Upper Gastrointestinal Endoscopic Submucosal Dissection. Gastroenterol Res Pract 2020; 2020:4372503. [PMID: 32831825 PMCID: PMC7428898 DOI: 10.1155/2020/4372503] [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: 06/04/2020] [Revised: 07/15/2020] [Accepted: 07/27/2020] [Indexed: 11/30/2022] Open
Abstract
Methods We used alginade water (125 mL, Nestle Co., Kobe, Japan) for PORT. Alginade water is a flavored sports drink, which is palatable and promotes wound healing due to a high concentration of alginate. We conducted a single-center single-arm prospective feasibility study of PORT in 244 patients who underwent upper gastrointestinal ESD. The group wherein PORT was administered up to two hours before ESD (n = 120) was compared with the historical control group (non-PORT group, n = 120). We investigated the total fluid intake, hematocrit change, complications due to PORT, complications during ESD, ESD procedure time, and length of hospital stay in each group. Results The average fluid intake in the PORT group was 462.6 mL. No complications were observed due to PORT and ESD, and significant differences in the ESD procedure time or hospital stay was not noted. Conclusion PORT up to two hours before upper gastrointestinal ESD is feasible.
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García García de Paredes A, Mateos Muñoz B, Albillos A. [Gastrointestinal endoscopy in patients of advanced age]. Rev Esp Geriatr Gerontol 2018; 53:293-298. [PMID: 29598971 DOI: 10.1016/j.regg.2018.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 02/06/2018] [Accepted: 02/09/2018] [Indexed: 11/17/2022]
Abstract
The dramatic increase in life expectancy is leading to a significant increase in the use of gastrointestinal endoscopy in the elderly. Taking into account these demographic changes, the use of gastrointestinal endoscopy in this age group is of great importance. Although these procedures are generally safe and well tolerated even in very elderly patients, the onset of physiological changes associated with aging and the increased prevalence of cardiovascular and pulmonary comorbidities raise the risk of sedation related complications in these patients. Age alone is not a contraindication for performing any endoscopic procedure. However, elderly patients have their own peculiarities that require a detailed review of the characteristics, risks and benefits of endoscopic procedures in this specific context.
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Affiliation(s)
- Ana García García de Paredes
- Departamento de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España.
| | - Beatriz Mateos Muñoz
- Departamento de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
| | - Agustín Albillos
- Departamento de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
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Kohan L, Salajegheh R, Hamill-Ruth RJ, Yerra S, Butz J. A review and survey of policies utilized for interventional pain procedures: a need for consensus. J Pain Res 2017; 10:625-634. [PMID: 28360531 PMCID: PMC5364016 DOI: 10.2147/jpr.s126851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Other than the newly published anticoagulation guidelines, there are currently few recommendations to assist pain medicine physicians in determining the safety parameters to follow when performing interventional pain procedures. Little information exists regarding policies for oral intake, cumulative steroid dose limits, driving restrictions with and without sedation, and routine medication use for interventional procedures. Methods A 16-question survey was developed on common policies currently in use for interventional pain procedures. The questionnaire was distributed through the American Society of Regional Anesthesia and Pain Medicine and American Academy of Pain Medicine. We sought to statistically analyze the range of policies being used by pain medicine physicians and to determine if there are any commonly accepted standards. Results A total of 337 physicians out of 4037 members responded to our survey with a response rate of 8.4%. A total of 82% of these respondents used a sedative agent while performing an interventional pain procedure. The majority of respondents required drivers after procedures, except after trigger points. A total of 47% indicated that they have an nil per os (NPO) policy for procedures without sedation. A total of 98% reported that they had an anticoagulation policy before an interventional procedure. A total of 17% indicated that the interval between steroid doses was <2 weeks, while 53% indicated that they waited 2–4 weeks between steroid doses. Conclusion Our study has clearly demonstrated a wide variation in the current practice among physicians regarding sedation, NPO status, steroid administration, and the need for designated drivers. There was much higher endorsement of policies regarding anticoagulation. There is an obvious need for evidence-based guidelines for these aspects of interventional pain care to improve patient safety and minimize the risk of adverse events.
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Affiliation(s)
- Lynn Kohan
- Department of Anesthesiology, University of Virginia, Charlottesville, VA
| | - Reza Salajegheh
- Department of Anesthesiology, University of Virginia, Charlottesville, VA
| | | | - Sandeep Yerra
- Department of Anesthesiology, University of Virginia, Charlottesville, VA
| | - John Butz
- West River Anesthesiology Consultants, Rapid City, SD, USA
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Randomized Controlled Study Comparing Use of Propofol Plus Fentanyl versus Midazolam Plus Fentanyl as Sedation in Diagnostic Endoscopy in Patients with Advanced Liver Disease. Int J Hepatol 2017; 2017:8462756. [PMID: 29312786 PMCID: PMC5634622 DOI: 10.1155/2017/8462756] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 08/08/2017] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES We aimed to investigate the safety and efficacy of propofol plus fentanyl versus midazolam plus fentanyl as sedative for patients with advanced liver disease presented for gastrointestinal endoscopy. METHODS A total of 100 patients with liver cirrhosis referred for upper endoscopy were enrolled and divided equally in two groups, midazolam plus fentanyl group and propofol plus fentanyl group. All patients were subjected to history taking, estimation of level of sedation, endoscopist rating, and hemodynamic parameters including oxygen saturation, heart rate, mean arterial pressure, incidence of side effect as (bradycardia, hypotension, hypoxia, nausea and vomiting, cough, shivering, or diplopia), time needed for complete recovery, and time needed for discharge. RESULTS There was no statistical significant difference between the studied groups regarding age, sex, weight, Child-Pugh classification score, type and duration of endoscopic intervention, time needed for complete recovery, or time needed for discharge. Complication rates were similar in both groups except for mean arterial blood pressure which was significantly lower in group of patients receiving propofol and fentanyl (P = 0.001). CONCLUSION The use of either propofol or midazolam in combination to fentanyl is effective in sedation of patients with advanced liver diseases presented for upper GIT endoscope. The trial is registered with ClinicalTrials.gov Identifier: NCT03063866.
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Abstract
Since its introduction, cholangioscopy has been used diagnostically and therapeutically. The working channel size has increased, permitting direct visualization for tissue sampling and to guide application of lithotripsy for difficult stones. Cholangioscopy utilizes endoscope and catheter-based systems. The application of slim gastroscopes for direct cholangioscopy provides better image resolution than conventional systems. Cholangioscopy has proven effective in the management of large biliary stones and for the diagnosis and exclusion of biliary tumors. Commercially available cholangioscopes are fiberoptic; those with digital video technology remain in a prototype development phase. This review covers available cholangioscope technologies, indications, technique, efficacy, and complications.
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Affiliation(s)
- Brian C Brauer
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, 1635 Aurora Court, Mailstop F-735, Room 2.031, Aurora, CO 80045, USA.
| | - Raj J Shah
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, 1635 Aurora Court, Mailstop F-735, Room 2.031, Aurora, CO 80045, USA
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Christian K, Hudson M, Goldberg E. Upper endoscopy in liver disease. Clin Liver Dis (Hoboken) 2014; 4:116-119. [PMID: 30992936 PMCID: PMC6448749 DOI: 10.1002/cld.436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 09/04/2014] [Accepted: 10/05/2014] [Indexed: 02/04/2023] Open
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Clinical safety of endoscopic submucosal dissection compared with surgery in elderly patients with early gastric cancer: a propensity-matched analysis. Gastrointest Endosc 2014; 80:599-609. [PMID: 24973177 DOI: 10.1016/j.gie.2014.04.042] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 04/21/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Little is known about the clinical and oncologic outcomes of endoscopic submucosal dissection (ESD) compared with surgery in elderly patients with early gastric cancer (EGC). OBJECTIVE To evaluate the clinical and oncologic outcomes of ESD compared with surgery in elderly patients with EGC of an expanded indication. DESIGN Retrospective study with propensity-matched analysis. SETTING University-affiliated tertiary-care hospital, Seoul, South Korea. PATIENTS A total of 518 patients 70 years of age or older with initial-onset EGC. INTERVENTIONS ESD and surgery. MAIN OUTCOME MEASUREMENTS Clinical outcomes, disease-free survival, and overall survival. RESULTS In a propensity-matched analysis of 132 pairs, the length of hospital stay of the ESD group was shorter than that of the surgery group (median [interquartile range], 4 [3-4] vs 9 [7-11] days; P < .001). Intensive care unit admission occurred in the surgery group only (7 patients [5.3%]). Two surgery-related deaths occurred in the surgery group (1 splenic artery bleeding and 1 anastomosis site leakage). During follow-up, metachronous lesions developed more often in the ESD group than in the surgery group (12 vs 2 lesions, P = .004). All recurred lesions were successfully treated endoscopically except for 3 patients who refused additional treatment. Overall survival did not differ between the 2 groups (P = .280). LIMITATIONS Nonrandomized, retrospective study. CONCLUSIONS ESD is a safe procedure in elderly patients with EGC. Although the risk of metachronous lesions is higher in patients who undergo ESD than in those who undergo surgery, overall survival did not differ between the patients who undergo ESD and surgery.
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Kuwatani M, Kawakami H, Hayashi T, Eto K, Yamato H, Onodera M, Naruse H, Oba K. Effect of antispasmodic drugs on endoscopic ultrasound/endoscopic ultrasound-guided fine-needle aspiration: A multicenter randomized controlled trial. Endosc Ultrasound 2014; 3:167-73. [PMID: 25184123 PMCID: PMC4145477 DOI: 10.4103/2303-9027.138788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 07/13/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Antispasmodic drugs (ADs) have been used to reduce examination time or improve the quality of gastrointestinal endoscopy, although the practice is controversial. No evidence about the efficacy of AD for endoscopic ultrasonography/EUS-guided fine-needle aspiration (EUS/EUS-FNA) is available. This study was aimed to evaluate the efficacy of AD in EUS/EUS-FNA. PATIENTS AND METHODS A total of 400 patients with pancreaticobiliary, peripancreatic, or peribiliary disease or disorder undergoing EUS/EUS-FNA were prospectively and evenly randomized to undergo EUS/EUS-FNA with AD (w-AD) or without AD (w/o-AD). The primary endpoint was total EUS/EUS-FNA examination time. The secondary endpoints were visual analogue scale (VAS) scores of endoscopists (patient body motion, gastrointestinal peristalsis, and accomplishment of the purpose) and patients (pain, discomfort, and willingness to undergo re-examination), vital sign changes, adverse events, and sedative dose. RESULTS Two hundred patients in the w-AD group and 197 patients in the w/o-AD group were ultimately analyzed. The total examination time was similar between the groups (2299 ± 937 vs. 2259 ± 1019 s). The difference in total examination time from w/o-AD group to w-AD group was -40 s (95% confidence interval, -234-153 s), which was within the noninferiority margin. No statistical differences were observed in endoscopist and patient VAS scores, changes in vital signs, adverse events, or total sedative dose other than fentanyl between the groups. CONCLUSION EUS/EUS-FNA can be effectively and safely performed w/o-AD. Further, randomized controlled trials on EUS/EUS-FNA in various disease entities may be required to confirm the results of this study (UMIN000008047).
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Affiliation(s)
- Masaki Kuwatani
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Hiroshi Kawakami
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Tsuyoshi Hayashi
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Kazunori Eto
- Department of Gastroenterology, Tomakomai City Hospital, Tomakomai 053-8567, Japan
| | - Hiroaki Yamato
- Department of Gastroenterology and Hepatology, Hakodate Municipal Hospital, Hakodate, 041-8680, Japan
| | - Manabu Onodera
- Department of Gastroenterology, Abashiri-Kosei General Hospital, Abashiri 093-0076, Japan
| | - Hirohito Naruse
- Department of Gastroenterology and Hepatology, Hakodate Municipal Hospital, Hakodate, 041-8680, Japan
| | - Koji Oba
- Translational Research and Clinical Trial Center, Hokkaido University Hospital, Sapporo 060-8648, Japan
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Koeppe AT, Lubini M, Bonadeo NM, Moraes I, Fornari F. Comfort, safety and quality of upper gastrointestinal endoscopy after 2 hours fasting: a randomized controlled trial. BMC Gastroenterol 2013; 13:158. [PMID: 24209639 PMCID: PMC4225862 DOI: 10.1186/1471-230x-13-158] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 11/05/2013] [Indexed: 12/13/2022] Open
Abstract
Background Upper gastrointestinal endoscopy has been performed after fasting 8 or more hours, which can be harmful to the patients. We assessed comfort, safety and quality of endoscopy under moderate sedation after 2 hours fasting for clear liquids. Methods In this clinical trial, patients referred for elective endoscopy were randomly assigned to a fasting period of 8 hours (F8) or a shorter fasting (F2), in which 200 ml of clear liquids were ingested 2 hours before the procedure. Endoscopists blinded to patients fasting status carried out the endoscopies. Comfort was rated by the patients, whereas safety and quality were determined by the endoscopists. Results Ninety-eight patients were studied (aging 48.5 ± 16.5 years, 60% women): 50 patients (51%) in F2 and 48 in F8. Comfort was higher in F2 than F8 in regard to anxiety (8% vs. 25%; P = 0.029), general discomfort (18% vs. 42%; P = 0.010), hunger (44% vs. 67%; P = 0.024), and weakness (22% vs. 42%; P = 0.034). Regurgitation of gastric contents into the esophagus after endoscopic intubation did not differ between F2 and F8 (26% vs. 19%; P = 0.471). There was no case of pulmonary aspiration. Gastric mucosal visibility was normal in most patients either in F2 or F8 (96% vs. 98%; P = 0.999). Conclusions Elective upper GI endoscopy after 2 hours fasting for clear liquids was more comfortable and equally safe compared to conventional fasting. This preparation might be cautiously applied for patients in regular clinical conditions referred for elective endoscopy. Trial registration SAMMPRIS ClinicalTrial.gov number, NCT01492296
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Affiliation(s)
| | | | | | | | - Fernando Fornari
- Programa de Pós-Graduação: Ciências em Gastroenterologia e Hepatologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre-RS, Brazil.
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Chandrasekhara V, Early DS, Acosta RD, Chathadi KV, Decker GA, Evans JA, Fanelli RD, Fisher DA, Foley KQ, Fonkalsrud L, Hwang JH, Jue T, Khashab MA, Lightdale JR, Muthusamy VR, Pasha SF, Saltzman JR, Sharaf R, Shergill AK, Cash BD. Modifications in endoscopic practice for the elderly. Gastrointest Endosc 2013; 78:1-7. [PMID: 23664042 DOI: 10.1016/j.gie.2013.04.161] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 04/03/2013] [Indexed: 12/12/2022]
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15
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Tokioka S, Umegaki E, Murano M, Takeuchi N, Takeuchi T, Kawakami K, Yoda Y, Kojima Y, Higuchi K. Utility and problems of endoscopic submucosal dissection for early gastric cancer in elderly patients. J Gastroenterol Hepatol 2012; 27 Suppl 3:63-9. [PMID: 22486874 DOI: 10.1111/j.1440-1746.2012.07075.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIM Endoscopic submucosal dissection (ESD) is reported to be a safe and reliable procedure for the elderly, but these reports could have already had a bias at the time ESD was performed. However, the reports have not clearly stated the criteria of indications. In the present study, we retrospectively elucidated the usefulness and problems of ESD for early gastric cancer in elderly patients (≥ 65 years) in comparison with non-elderly patients. METHODS The subjects were selected from 412 consecutive patients with early gastric cancer (515 lesions) for which ESD was performed between June 2002 and February 2010. The following were used for analysis between groups: pre- and postoperative performance status (PS) of subjects, prevalence rates of pre-existing comorbidities, characteristics of lesions, treatment outcomes, durations of hospitalization, operating times, incidence rates of complications and durations of hospitalization, and postoperative hemorrhage rates, and duration of hospitalization in patients with anticoagulant therapy. RESULTS Of the lesions in the elderly, four patients (1.0%) were elderly with a PS of 3. The PS increased to six patients (1.6%) after the procedure. None of the non-elderly had a PS of 3 before or after the procedure. The ratio of patients with a pre-existing comorbidity was higher in the elderly than in the non-elderly. There were no differences between the two groups in the characteristics of the lesions, their duration of hospitalization, their operating times, or the incidence rates of complications. However, the elderly with perforations had a significantly longer hospitalization than the comparable non-elderly. The percentage of the patients taking anticoagulant drugs was significantly higher among the elderly. Of the patients on anticoagulant therapy, the duration of hospitalization tended to be longer in the elderly but no significant difference was found. None of the non-elderly with postoperative hemorrhage had received anticoagulant therapy. In the elderly with postoperative hemorrhage, 15.8% of the lesions were in those who had received anticoagulant therapy, indicating a significantly higher percentage of such lesions in the elderly group. CONCLUSION We conclude that ESD is useful in elderly patients because there is a similar risk as for the non-elderly if the approach is individualized, and the following are taken into consideration when making the final decision of performing ESD in an elderly patient: patients should have a PS of 0, 1, or 2; determine whether or not anticoagulant therapy can be discontinued and whether or not treatment can be performed reliably without complications.
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Affiliation(s)
- Satoshi Tokioka
- Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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16
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Appalaneni V, Fanelli RD, Sharaf RN, Anderson MA, Banerjee S, Ben-Menachem T, Decker GA, Fisher L, Fukami N, Harrison ME, Strohmeyer L, Friis C, Ikenberry SO, Jain R, Jue TL, Khan KM, Krinsky ML, Malpas PM, Maple JT, Dominitz JA. The role of endoscopy in patients with anorectal disorders. Gastrointest Endosc 2010; 72:1117-23. [PMID: 21111864 DOI: 10.1016/j.gie.2010.04.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 04/14/2010] [Indexed: 02/08/2023]
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17
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Nguyen VX, Le Nguyen VT, Nguyen CC. Appropriate use of endoscopy in the diagnosis and treatment of gastrointestinal diseases: up-to-date indications for primary care providers. Int J Gen Med 2010; 3:345-57. [PMID: 21116340 PMCID: PMC2990396 DOI: 10.2147/ijgm.s14555] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The field of endoscopy has revolutionized the diagnosis and treatment of gastrointestinal (GI) diseases in recent years. Besides the ‘traditional’ endoscopic procedures (esophagogastroduodenoscopy, colonoscopy, flexible sigmoidoscopy, and endoscopic retrograde cholangiopancreatography), advances in imaging technology (endoscopic ultrasonography, wireless capsule endoscopy, and double balloon enteroscopy) have allowed GI specialists to detect and manage disorders throughout the digestive system. This article reviews various endoscopic procedures and provides up-to-date endoscopic indications based on the recommendations of American Society for Gastrointestinal Endoscopy and American Cancer Society for primary care providers in order to achieve high-quality and cost-effective care.
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Affiliation(s)
- Vien X Nguyen
- Department of Gastroenterology, Mayo Clinic, Scottsdale, AZ, USA
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18
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Nayar DS, Guthrie WG, Goodman A, Lee Y, Feuerman M, Scheinberg L, Gress FG. Comparison of propofol deep sedation versus moderate sedation during endosonography. Dig Dis Sci 2010; 55:2537-44. [PMID: 20635148 DOI: 10.1007/s10620-010-1308-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Accepted: 06/14/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND The purposes of this study are: (1) to prospectively evaluate clinically relevant outcomes including sedation-related complications for endoscopic ultrasound (EUS) procedures performed with the use of propofol deep sedation administered by monitored anesthesia care (MAC), and (2) to compare these results with a historical case-control cohort of EUS procedures performed using moderate sedation provided by the gastrointestinal (GI) endoscopist. MATERIALS AND METHODS Patients referred for EUS between January 1, 2001 and December 31, 2002 were enrolled. Complication rates for EUS using MAC sedation were observed and also compared with a historical case-control cohort of EUS patients who received meperidine/midazolam for moderate sedation, administered by the GI endoscopist. Logistic regression analysis was used to isolate possible predictors of complications. RESULTS A total of 1,000 patients underwent EUS with propofol sedation during the period from January 1, 2001 through December 31, 2002 (mean age 64 years, 53% female). The distribution of EUS indications based on the primary area of interest was: 170 gastroduodenal, 92 anorectal, 508 pancreaticohepatobiliary, 183 esophageal, and 47 mediastinal. The primary endpoint of the study was development of sedation-related complications occurring during a performed procedure. A total of six patients experienced complications: duodenal perforation (one), hypotension (one), aspiration pneumonia (one), and apnea requiring endotracheal intubation (three). The complication rate with propofol was 0.60%, compared with 1% for the historical case-control (meperidine/midazolam moderate sedation) group. CONCLUSIONS There does not appear to be a significant difference between complication rates for propofol deep sedation with MAC and meperidine/midazolam administered for moderate sedation.
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Affiliation(s)
- D S Nayar
- Gastroenterology Associates of Central Jersey, Edison, NJ, USA
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19
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Umegaki E, Abe S, Tokioka S, Takeuchi N, Takeuchi T, Yoda Y, Murano M, Higuchi K. Risk management for gastrointestinal endoscopy in elderly patients: questionnaire for patients undergoing gastrointestinal endoscopy. J Clin Biochem Nutr 2009; 46:73-80. [PMID: 20104268 PMCID: PMC2803136 DOI: 10.3164/jcbn.09-56] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 08/08/2009] [Indexed: 12/24/2022] Open
Abstract
More elderly patients now undergo gastrointestinal endoscopy following recent advances in endoscopic techniques. In this study, we conducted a high-risk survey of endoscopies in Japan, using a questionnaire administered prior to upper gastrointestinal tract endoscopy (UGITE), and identified anticholinergic agents and glucagon preparations as high-risk premedication. We also evaluated the cardiovascular effects of anticholinergic agents and glucagon through measurements of plasma levels of human atrial natriuretic peptide (hANP) and human brain natriuretic peptide (hBNP). The subjects were 1480 patients who underwent UGITE. Nurses administered a pre-endoscopy questionnaire, questioning subjects regarding heart disease, hypertension, glaucoma, and urinary difficulties as risk factors for anticholinergic agents, and Diabetes mellitus as a risk factor for glucagon preparations. Evaluation of subjects divided into under 65 and over 65 age groups revealed that in subjects aged 65 and over, risk factors for anticholinergic agents were significantly more high than those for glucagon. Analysis of the cardiovascular effects of anticholinergic agents and glucagon, in the elderly patients showed that hANP levels were significantly higher following administration of anticholinergic agents, but the change was not significant for glucagon premedication. Taking a detailed history before UGITE with the aid of a questionnaire at the same time as informed consent is obtained, is extremely useful in terms of risk management and selection of the appropriate premedication.
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Affiliation(s)
- Eiji Umegaki
- Second Department of Internal Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki-shi, Osaka 569-8686, Japan
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20
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Underwood D, Makar RR, Gidwani AL, Najfi SM, Neilly P, Gilliland R. A prospective randomized single blind trial of Fleet phosphate enema versus glycerin suppositories as preparation for flexible sigmoidoscopy. Ir J Med Sci 2009; 179:113-8. [PMID: 19655226 DOI: 10.1007/s11845-009-0403-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2008] [Accepted: 07/01/2009] [Indexed: 01/13/2023]
Abstract
AIM This study compared the efficacy and patient acceptability of two methods of bowel preparation for flexible sigmoidoscopy. METHODS Patients attending for outpatient flexible sigmoidoscopy were prospectively randomized to receive one Fleet ready-to-use enema or 2 x 4 g glycerin suppositories, 2 h preprocedure. Patient and endoscopist questionnaires were used to compare the outcomes. RESULTS From November 2000 to August 2001, 203 (male = 95; female = 108) patients were randomized. Patient data available for 163 patients (enema = 93; suppository = 70) revealed: ease of use (enema = 52; suppository = 25; P < 0.02, Fisher's exact); assistance required (enema = 19; suppository = 3; P < 0.005, Fisher's exact); grade of effectiveness (enema = 83; suppository = 44; P < 0.0001, Fisher's exact), and whether patients wished to try another preparation in future (enema = 16; suppository = 24; P = 0.016, Fisher's exact). Endoscopist data available for 151 patients (enema = 76; suppository = 75) revealed: average depth of insertion (enema = 53.6 +/- 11.6 cm; suppository 46.3 +/- 13.7 cm; P < 0.001, Student's t test); acceptable (excellent + good) quality of preparation [enema = 60 (78.9%); suppository = 34 (45.3%); P < 0.0001, Fisher's exact]. CONCLUSION Bowel preparation for flexible sigmoidoscopy using a single Fleet enema is acceptable to patients and more effective than glycerin suppositories.
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Affiliation(s)
- D Underwood
- Department of Surgery, Altnagelvin Area Hospital, Glenshane Road, Londonderry BT47 6SB, Northern Ireland, UK
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21
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Di Leo A, Busetti R, Pusiol T, Piscioli F, Franceschetti I, Ricci F. Intestinal obstruction associated with chronic peritonitis caused by Sphingomonas paucimobilis. Clin J Gastroenterol 2009; 2:178-182. [PMID: 26192291 DOI: 10.1007/s12328-009-0066-z] [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] [Received: 09/30/2008] [Accepted: 01/23/2009] [Indexed: 11/25/2022]
Abstract
We describe a very rare case of chronic peritonitis with secondary adhesive intestinal obstruction caused by Sphingomonas paucimobilis in a healthy 28-year-old Chinese man. This bacillus has not been described as a cause of spontaneous peritonitis in healthy people. It was an asymptomatic, generalized, and slow-growing peritonitis causing peritoneal adherens and at the end intestinal occlusion that needed surgical adhesiolysis.
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Affiliation(s)
- Alberto Di Leo
- Operative Unit of Surgery, APSS of Trento, Arco Hospital, Via Capitelli 50/52, 38062, Arco (TN), Italy.
| | - Rosanna Busetti
- Laboratory of Clinical Pathology, APSS of Trento, Arco Hospital, Arco (TN), Italy
| | - Teresa Pusiol
- Operative Unit of Pathology, APSS of Trento, Rovereto Hospital, Rovereto (TN), Italy
| | - Francesco Piscioli
- Operative Unit of Pathology, APSS of Trento, Rovereto Hospital, Rovereto (TN), Italy
| | - Ilaria Franceschetti
- Operative Unit of Pathology, APSS of Trento, Rovereto Hospital, Rovereto (TN), Italy
| | - Francesco Ricci
- Operative Unit of Surgery, APSS of Trento, Arco Hospital, Via Capitelli 50/52, 38062, Arco (TN), Italy
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Ritz E. Nephrology Potpourri. Clin J Am Soc Nephrol 2008. [DOI: 10.2215/cjn.03500708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Acute phosphate nephropathy is an accepted complication of the use of phosphate preparations in patients about to undergo colonoscopy. Age, renal failure, and the ongoing use of medications, such as angiotensin-converting enzyme inhibitors and/or angiotensin-receptor blockers, are now recognized as risk factors for the development of phosphate nephropathy. The presence of any of these risk factors necessitates careful attention to avoiding excessive dehydration in the process of bowel cleansing. In so doing, the likelihood of acute phosphate nephropathy occurring can be lessened.
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Affiliation(s)
- Domenic A Sica
- Section of Clinical Pharmacology and Hypertension, Division of Nephrology, MCV Station, Virginia Commonwealth University, Richmond, Virginia 23298, USA
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Affiliation(s)
- Daniel E Carl
- Department of Medicine, Division of Nephrology, Box 980160, MCV Station, Virginia Commonwealth University, Richmond, Virginia 23298-0160, USA.
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25
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Lubarsky DA, Candiotti K, Harris E. Understanding modes of moderate sedation during gastrointestinal procedures: a current review of the literature. J Clin Anesth 2007; 19:397-404. [PMID: 17869995 DOI: 10.1016/j.jclinane.2006.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2006] [Revised: 11/08/2006] [Accepted: 11/09/2006] [Indexed: 12/26/2022]
Abstract
Recommendations for routine screening for colorectal cancer with colonoscopy are likely to substantially increase the demand for provision of sedation for these procedures. Because of this burgeoning caseload and associated economic constraints, it is unlikely that anesthesiologists will be available for all such procedures, particularly those involving average-risk patients. Thus, sedative agents that can be safely administered by nonanesthesiologists, appropriately trained in monitoring and managing the patient's airway, are desperately needed. New concepts in sedation for colonoscopy include enhanced mechanisms for drug delivery such as patient-controlled sedation/analgesia and target-controlled infusion, along with the development of new drugs such as a modified cyclodextrin-based formulation of propofol and fospropofol disodium (Aquavan Injection), a water-soluble prodrug of propofol.
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Affiliation(s)
- David A Lubarsky
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL 33136, USA.
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Cohen LB, Delegge MH, Aisenberg J, Brill JV, Inadomi JM, Kochman ML, Piorkowski JD. AGA Institute review of endoscopic sedation. Gastroenterology 2007; 133:675-701. [PMID: 17681185 DOI: 10.1053/j.gastro.2007.06.002] [Citation(s) in RCA: 309] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2007] [Indexed: 12/13/2022]
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Wruble L, Demicco M, Medoff J, Safdi A, Bernstein J, Dalke D, Rose M, Karlstadt RG, Ettinger N, Zhang B. Residue-free sodium phosphate tablets (OsmoPrep) versus Visicol for colon cleansing: a randomized, investigator-blinded trial. Gastrointest Endosc 2007; 65:660-70. [PMID: 17173912 DOI: 10.1016/j.gie.2006.07.047] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Accepted: 07/27/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND The bowel purgative Visicol contains microcrystalline cellulose (MCC) residue, which may impair full visibility during a colonoscopy. An MCC residue-free sodium phosphate (RF-NaP; OsmoPrep) tablet was developed. OBJECTIVE To investigate appropriate RF-NaP dosing. DESIGN Phase 2, randomized, investigator-blinded study. SETTING Six research centers in the United States. PATIENTS AND INTERVENTIONS Patients undergoing a colonoscopy received Visicol (n = 34) or 1 of 6 RF-NaP regimens administered as either split (S) dosing (the evening before and the day of colonoscopy) or evening-only (E) dosing. Dosing regimens for RF-NaP were 40 tablets S, 3 every 15 minutes (n = 33); 40 tablets S, 4 every 15 minutes (n = 34); 32 tablets E, 4 every 15 minutes (n = 34); 32 tablets S, 4 every 15 minutes (n = 36); 28 tablets E, 4 every 15 minutes (n = 34); 28 tablets S, 4 every 15 minutes (n = 34). Visicol was administered as 40 tablets S, 3 every 15 minutes. MAIN OUTCOME MEASURE Overall colon cleansing (OCC) was assessed by a physician questionnaire (4-point scale, based on colonic contents). An OCC rating of "excellent" or "good" was considered a response. Safety measures were also monitored. RESULTS Split dosing with RF-NaP was associated with high OCC and achieved response rates of 90%, 97%, and 100% for 28, 32, and 40 tablets, respectively, compared with 86% for Visicol. In addition, RF-NaP evening-only regimen response rates were 90% (32 tablets) and 72% (28 tablets). Transient shifts in electrolyte levels were reduced, and GI adverse events were less common with lower RF-NaP dose regimens. CONCLUSIONS Administration of RF-NaP retains the benefits of a tablet purgative but eliminates MCC issues. Split dosing and 32-tablet evening-only dosing of RF-NaP tablets were efficacious and well tolerated, and split dosing of RF-NaP tablets is recommended.
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Greenwald DA. Peri-procedure pharmacotherapy, preparation, and infection control. Gastrointest Endosc Clin N Am 2007; 17:29-40, vi. [PMID: 17397774 DOI: 10.1016/j.giec.2006.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Minimizing endoscopic complications includes attention to the details about each patient's current medical condition before they undergo an invasive procedure. This article focuses on critical issues about proper preparation for endoscopic procedures and examines potential modifications to a patient's medical regimen near the time of an endoscopic procedure, highlighting recently published standards and guidelines. This article also reviews important issues related to infection control in endoscopy.
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Affiliation(s)
- David A Greenwald
- Division of Gastroenterology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA.
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30
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Shaoul R, Higaze H, Lavy A. Evaluation of topical pharyngeal anaesthesia by benzocaine lozenge for upper endoscopy. Aliment Pharmacol Ther 2006; 24:687-94. [PMID: 16907901 DOI: 10.1111/j.1365-2036.2006.03023.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND Among the randomized controlled trials evaluating the effect of pharyngeal anaesthesia only some suggest benefit. Spray is irritating for some people and leaves bitter taste in the throat. We hypothesized that delivering the local anaesthetic as a sucking lozenge would benefit the patients in terms of decreasing anxiety and will improve procedure performance and patient tolerance. AIM To determine whether benzocaine/tyrothricin sucking lozenges with conscious sedation is superior to conscious sedation alone, with respect to procedure performance and tolerance in patients undergoing upper endoscopy. METHODS One hundred and seventy-four adult patients undergoing upper endoscopy with conscious sedation completed the study. They were randomized to receive sucking lozenge containing benzocaine or placebo before the procedure. Patients were asked to rate prestudy anxiety, tolerance for topical pharyngeal anaesthesia, comfort during endoscopy, degree of difficulty of intubation, postprocedure throat discomfort and willingness to undergo subsequent examinations using a 10-cm visual analogue scale. Endoscopists were asked to estimate the ease of oesophageal intubation and procedure performance. RESULTS No significant statistical differences regarding all the points studied were found between the groups. CONCLUSIONS Topical pharyngeal anaesthesia with benzocaine/tyrothricin lozenges with conscious sedation has no advantages over conscious sedation alone in patients undergoing upper endoscopy.
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Affiliation(s)
- R Shaoul
- Department of Pediatrics, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel.
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Qureshi WA, Zuckerman MJ, Adler DG, Davila RE, Egan JV, Gan SI, Lichtenstein DR, Rajan E, Shen B, Fanelli RD, Van Guilder T, Baron TH. ASGE guideline: modifications in endoscopic practice for the elderly. Gastrointest Endosc 2006; 63:566-9. [PMID: 16564853 DOI: 10.1016/j.gie.2006.02.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Waqar A Qureshi
- American Society for Gastrointestinal Endoscopy, 1520 Kensington Road, Ste. 202, Oak Brook, IL 60523, USA
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Abstract
Adequate colonic cleansing is essential for accurate and safe colonic procedures. Common preparations for cleansing include diet in combination with a cathartic agent, gut lavage, and phosphate preparations. The diet used with a cathartic consists of clear liquids or is designed to leave a minimal colonic fecal residue with laxatives. Gut lavage solutions wash out the colon in a safe and effective manner. Phosphate preparations offer an attractive alternative due to smaller volumes required for ingestion; however, electrolyte disturbances can occur. This review discusses the development and clinical experience with various colon cleansing regimens and efforts to improve the tolerability and safety of preparation for colonoscopy, virtual colonoscopy, colon surgery, barium enema, and flexible sigmoidoscopy.
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Affiliation(s)
- Andrew R Brown
- Department of Medicine, Division of Gastroenterology, University of South Alabama, Knollwood Pavillion, 5600 Girby Road, Mobile, AL 36693, USA
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Huang R, Eisen GM. Efficacy, safety, and limitations in current practice of sedation and analgesia. Gastrointest Endosc Clin N Am 2004; 14:269-88. [PMID: 15121143 DOI: 10.1016/j.giec.2004.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The ease and availability of endoscopy as a diagnostic and therapeutic modality for gastrointestinal disorders has greatly increased the number of procedures performed in the United States. One of the main factors in achieving a flawless procedure is the use of sedation and analgesia in endoscopy. This article examines the efficacy, safety, and limitations inherent in the current practice of sedation and analgesia.
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Affiliation(s)
- Robert Huang
- Vanderbilt University Medical Center, 2201 West End Avenue, Nashville, TN 37235, USA
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Kusuma V. Driving after sedated endoscopic procedures. Gastrointest Endosc 2003; 58:816-7; author reply 817. [PMID: 14997915 DOI: 10.1016/s0016-5107(03)01997-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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