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Chen S, Zhou D, Ruan R, Yu J, Li Y, Liu Y, Wang S. A Novel Bipolar Polypectomy Snare Can Be an Alternative Choice for Endoscopic Resection. Front Med (Lausanne) 2021; 7:619844. [PMID: 33553214 PMCID: PMC7855578 DOI: 10.3389/fmed.2020.619844] [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: 10/21/2020] [Accepted: 12/15/2020] [Indexed: 12/24/2022] Open
Abstract
Objective: Endoscopic resection (ER) is more difficult and has a higher rate of complications, such as perforation and bleeding. The aim of this study was to evaluate the safety and feasibility of a bipolar polypectomy snare for ER. Methods: Initial ER procedures in live pigs were carried out. Then, a human feasibility study was performed in patients with colorectal polyps. Finally, the finite element method was used to evaluate the safety and effectiveness of the new bipolar snare. Results: In the live animal model, there were no significant differences in wound size and cutting time between monopolar and bipolar groups. The histological results (histological scores) of the two groups in porcine experiments were almost the same except that the incision flatness of bipolar group was better than that of the monopolar group. Incidence of bleeding and perforation was similar between the two groups in pigs' and patients' study. At last, the finite element model showed that the vertical thermal damage depth produced by bipolar snare system was approximately 71–76% of that produced by monopolar snare system at the same power. Conclusions: The novel bipolar snare is feasible in patients with colorectal polyps and can be an alternative choice for ERs.
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Affiliation(s)
- Shengsen Chen
- Department of Endoscopy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Danping Zhou
- Department of Endoscopy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Rongwei Ruan
- Department of Endoscopy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Jiangping Yu
- Department of Endoscopy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Yandong Li
- Department of Endoscopy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Yuanshun Liu
- Department of Endoscopy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Shi Wang
- Department of Endoscopy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
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Samuels JM, Overbey DM, Wikiel KJ, Jones TS, Robinson TN, Jones EL. Electromagnetic interference on cardiac pacemakers and implantable cardioverter defibrillators during endoscopy as reported to the US Federal Drug Administration. Surg Endosc 2020; 35:3796-3801. [PMID: 32804270 DOI: 10.1007/s00464-020-07872-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/05/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION More than 3 million patients have a cardiac implanted electronic device (CIED) such as a pacemaker or implanted cardioverter-defibrillator in the USA. These devices are susceptible to electromagnetic interference (EMI) leading to malfunction and injury. Radiofrequency energy, the most common modality for obtaining hemostasis during endoscopy, is the most common source of EMI. Few studies have evaluated the effect of endoscopic radiofrequency energy on CIEDs. We aim to characterize CIED dysfunction related to endoscopic procedures. We hypothesize that EMI from endoscopic energy can result in patient injury. METHODS We queried the Manufacturer and User Facility Device Experience (MAUDE) database for CIED dysfunction related to electrosurgical devices over a 10-year period (2009-2019). CIED dysfunction events were identified using seven problem codes (malfunction, electromagnetic interference, ambient noise, pacing problem, over-sensing, inappropriate shock, defibrillation). These were cross-referenced for the terms "cautery, electrocautery, endoscopy, esophagus, colonoscopy, colon, esophagoscopy, and esophagogastroduodenoscopy." Reports were individually reviewed to confirm and characterize CIED malfunction due to an endoscopic procedure. RESULTS A search for CIED dysfunction resulted in 43,759 reports. Three hundred and eleven reports (0.7%) were associated with electrocautery, and of these, 45 reports (14.5%) included endoscopy. Ten reports involving endoscopy (22%) specified upper (3, 7%) or lower (7, 16%) endoscopy while the remainder were non-specific. Twenty-six of reports involving endoscopy (58%) suffered injury because of CIED dysfunction: Of these, 17 (65%) received inappropriate shocks, 5 (19%) had pacing inhibition with bradycardia or asystole, 3 (12%) had CIED damage requiring explant and replacement, and 1 (4%) patient suffered ventricular tachycardia requiring hospital admission. CONCLUSION The use of energy during endoscopy can cause dysfunction of CIEDs. This most commonly results in inappropriate defibrillation, symptomatic bradycardia, and asystole. Patients with CIEDs undergoing endoscopy should undergo pre- and post-procedure device interrogation and re-programming to avoid patient injury.
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Affiliation(s)
- Jason M Samuels
- Department of Surgery, University of Colorado, Aurora, CO, USA
| | | | - Krzysztof J Wikiel
- Rocky Mountain Regional Veterans Affairs Medical Center, University of Colorado, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Teresa S Jones
- Rocky Mountain Regional Veterans Affairs Medical Center, University of Colorado, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Thomas N Robinson
- Rocky Mountain Regional Veterans Affairs Medical Center, University of Colorado, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Edward L Jones
- Rocky Mountain Regional Veterans Affairs Medical Center, University of Colorado, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA.
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Itoi T, Ryozawa S, Katanuma A, Okabe Y, Kato H, Horaguchi J, Tsuchiya T, Gotoda T, Fujita N, Yasuda K, Igarashi Y, Fujimoto K. Japan Gastroenterological Endoscopy Society guidelines for endoscopic papillary large balloon dilation. Dig Endosc 2018; 30:293-309. [PMID: 29411902 DOI: 10.1111/den.13029] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/29/2018] [Indexed: 02/08/2023]
Abstract
The Japan Gastroenterological Endoscopy Society has developed the 'EPLBD Clinical Practice Guidelines' as fundamental guidelines based on new scientific techniques. EPLBD is a treatment method that has recently become widely used for choledocolithiasis. The evidence level in this field is usually low, and in many instances, the recommendation grading has to be determined on the basis of expert consensus. At this point, the guidelines are divided into the following six sections according to the 'EST Clinical Practice Guidelines': (i) Indications, (ii) procedures, (iii) special cases, (iv) procedure-related adverse events, (v) treatment outcomes, and (vi) postoperative follow up observation.
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Affiliation(s)
- Takao Itoi
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Shomei Ryozawa
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Akio Katanuma
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Hironori Kato
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Jun Horaguchi
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Takuji Gotoda
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Naotaka Fujita
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Kenjiro Yasuda
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
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Ryozawa S, Itoi T, Katanuma A, Okabe Y, Kato H, Horaguchi J, Fujita N, Yasuda K, Tsuyuguchi T, Fujimoto K. Japan Gastroenterological Endoscopy Society guidelines for endoscopic sphincterotomy. Dig Endosc 2018; 30:149-173. [PMID: 29247546 DOI: 10.1111/den.13001] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/10/2017] [Indexed: 02/06/2023]
Abstract
The Japan Gastroenterological Endoscopy Society (JGES) has recently compiled guidelines for endoscopic sphincterotomy (EST) using evidence-based methods. Content regarding actual clinical practice, including detailed endoscopic procedures, instruments, device types and usage, has already been published by the JGES postgraduate education committee in May 2015 and, thus, in these guidelines we avoided duplicating such content as much as possible. The guidelines do not address pancreatic sphincterotomy, endoscopic papillary balloon dilation (EPBD), and endoscopic papillary large balloon dilation (EPLBD). The guidelines for EPLBD are planned to be developed separately. The evidence level in this field is often low and, in many instances, strong recommendation has to be determined on the basis of expert consensus. At this point in time, the guidelines are divided into six items including indications, techniques, specific cases, adverse events, outcomes, and postoperative follow up.
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Affiliation(s)
- Shomei Ryozawa
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Takao Itoi
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Akio Katanuma
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Hironari Kato
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Jun Horaguchi
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Naotaka Fujita
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Kenjiro Yasuda
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
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Li Y, Han Z, Sun Y, Li A, Zhang W, Li A, Liu S. Endoscopic polypectomy for pacemaker patients: is it safe? ANZ J Surg 2014; 85:834-7. [PMID: 24990118 DOI: 10.1111/ans.12747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Endoscopic polypectomy is believed to reduce the incidence of colorectal cancer, and it has become a standard practice for the removal of gastrointestinal polyps. However, for patients with implanted cardiac devices, endoscopic polypectomy is thought to be relatively contraindicated. Aside from two case reports from around 10 years ago, few studies have evaluated the safety of endoscopic polypectomy for this population. In this study, polypectomy was performed in 14 consecutive pacemaker patients to determine the safety of endoscopic polypectomy using high-frequency current in patients with implanted cardiac devices. METHODS Fourteen patients with gastrointestinal polyps and implanted cardiac devices were evaluated, and endoscopic polypectomy was performed. Continuous monitoring of heart rate, blood pressure, oxygen saturation and electrocardiographic tracing was conducted. A trained cardiologist was present during the procedures. At the end of the procedures, the cardiac devices were reinterrogated to check for any changes. RESULTS Our results showed that a total of 61 procedures in 14 patients were all successfully completed, and no abnormalities were identified during continuous monitoring. There were no statistically significant differences in the preoperation, intraoperation and postoperation data. None of the patients suffered any arrhythmias or functional disruption to their cardiac devices. CONCLUSIONS Endoscopic polypectomy using high-frequency current appears to be safe when performed in patients with pacemakers. However, larger multicentre studies are needed to confirm the safety of this procedure in this patient population.
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Affiliation(s)
- Yue Li
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zelong Han
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yaqing Sun
- Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Anbing Li
- Department of Applied Psychology, School of Psychology, South China Normal University, Guangzhou, China
| | - Wei Zhang
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Aimin Li
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Side Liu
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Rapsang AG, Bhattacharyya P. Pacemakers and implantable cardioverter defibrillators--general and anesthetic considerations. Braz J Anesthesiol 2014; 64:205-14. [PMID: 24907883 DOI: 10.1016/j.bjane.2013.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 02/28/2013] [Indexed: 11/28/2022] Open
Abstract
A pacemaking system consists of an impulse generator and lead or leads to carry the electrical impulse to the patient's heart. Pacemaker and implantable cardioverter defibrillator codes were made to describe the type of pacemaker or implantable cardioverter defibrillator implanted. Indications for pacing and implantable cardioverter defibrillator implantation were given by the American College of Cardiologists. Certain pacemakers have magnet-operated reed switches incorporated; however, magnet application can have serious adverse effects; hence, devices should be considered programmable unless known otherwise. When a device patient undergoes any procedure (with or without anesthesia), special precautions have to be observed including a focused history/physical examination, interrogation of pacemaker before and after the procedure, emergency drugs/temporary pacing and defibrillation, reprogramming of pacemaker and disabling certain pacemaker functions if required, monitoring of electrolyte and metabolic disturbance and avoiding certain drugs and equipments that can interfere with pacemaker function. If unanticipated device interactions are found, consider discontinuation of the procedure until the source of interference can be eliminated or managed and all corrective measures should be taken to ensure proper pacemaker function should be done. Post procedure, the cardiac rate and rhythm should be monitored continuously and emergency drugs and equipments should be kept ready and consultation with a cardiologist or a pacemaker-implantable cardioverter defibrillator service may be necessary.
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Affiliation(s)
- Amy G Rapsang
- Department of Anesthesiology & Intensive Care, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India.
| | - Prithwis Bhattacharyya
- Department of Anesthesiology & Intensive Care, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
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Rapsang AG, Bhattacharyya P. Marcapassos e cardioversores desfibriladores implantáveis – considerações gerais e anestésicas. Braz J Anesthesiol 2014; 64:205-14. [DOI: 10.1016/j.bjan.2013.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 02/28/2013] [Indexed: 11/24/2022] Open
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Corbett GD, Buttery PC, Pugh PJ, Cameron EAB. Endoscopy and implantable electronic devices. Frontline Gastroenterol 2012; 3:72-75. [PMID: 28839637 PMCID: PMC5517255 DOI: 10.1136/flgastro-2011-100010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Accepted: 01/10/2012] [Indexed: 02/04/2023] Open
Abstract
The increasing use of implantable electronic devices such as cardiac pacemakers and neurostimulators means that they are being increasingly encountered in endoscopy departments. The electromagnetic fields generated during electrosurgery and with magnetic imaging systems have the potential to interfere with such devices. The authors present a case that highlights some of the steps necessary for minimising risk, review the evidence and summarise the currently available guidance.
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Affiliation(s)
- G D Corbett
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - P C Buttery
- Department of Neurology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - P J Pugh
- Department of Cardiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - E A B Cameron
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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SHIBATA H, YANO M, OKAHISA T, OKAMURA S, MUGURUMA N, ITO S. Effects of High‐frequency Current on Pacemakers during Endoscopic Gastric Surgery: Experimental Study. Dig Endosc 2007. [DOI: 10.1111/j.1443-1661.1999.tb00213.x] [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] [Indexed: 02/23/2023]
Affiliation(s)
- Hil‐oshi SHIBATA
- *Second Department of Internal Medicine, School of Medicine, The University of Tokushima, Tokushima, Japan
| | - Mituyasii YANO
- **Gastroenterology Division of Internal Medicine, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Toshiya OKAHISA
- *Second Department of Internal Medicine, School of Medicine, The University of Tokushima, Tokushima, Japan
| | - Seisuke OKAMURA
- *Second Department of Internal Medicine, School of Medicine, The University of Tokushima, Tokushima, Japan
| | - Naoki MUGURUMA
- *Second Department of Internal Medicine, School of Medicine, The University of Tokushima, Tokushima, Japan
| | - Susumu ITO
- *Second Department of Internal Medicine, School of Medicine, The University of Tokushima, Tokushima, Japan
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Petersen BT. Reducing Risk During Endoscopy in Patients with Implanted Electronic Devices. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2007. [DOI: 10.1016/j.tgie.2007.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Petersen BT, Hussain N, Marine JE, Trohman RG, Carpenter S, Chuttani R, Croffie J, Disario J, Chotiprasidhi P, Liu J, Somogyi L. Endoscopy in patients with implanted electronic devices. Gastrointest Endosc 2007; 65:561-8. [PMID: 17383453 DOI: 10.1016/j.gie.2006.09.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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