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Nabi Z, Basha J, Darisetty S, Reddy DN. Per-oral endoscopic septotomy in a pacemaker-dependent patient with Zenker's diverticulum using a novel bipolar device. Indian J Gastroenterol 2024:10.1007/s12664-024-01658-3. [PMID: 39126600 DOI: 10.1007/s12664-024-01658-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Affiliation(s)
- Zaheer Nabi
- Asian Institute of Gastroenterology, Hyderabad, 500 082, India.
| | - Jahangeer Basha
- Asian Institute of Gastroenterology, Hyderabad, 500 082, India
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Walayat S, Stadmeyer P, Hameed A, Sarfaraz M, Estrada P, Benson M, Soni A, Pfau P, Hayes P, Kile B, Cruz T, Gopal D. Sedation reversal trends at outpatient ambulatory endoscopic center vs in-hospital ambulatory procedure center using a triage protocol. World J Gastrointest Endosc 2024; 16:413-423. [PMID: 39072249 PMCID: PMC11271719 DOI: 10.4253/wjge.v16.i7.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/22/2024] [Accepted: 06/19/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND Routine outpatient endoscopy is performed across a variety of outpatient settings. A known risk of performing endoscopy under moderate sedation is the potential for over-sedation, requiring the use of reversal agents. More needs to be reported on rates of reversal across different outpatient settings. Our academic tertiary care center utilizes a triage tool that directs higher-risk patients to the in-hospital ambulatory procedure center (APC) for their procedure. Here, we report data on outpatient sedation reversal rates for endoscopy performed at an in-hospital APC vs at a free-standing ambulatory endoscopy digestive health center (AEC-DHC) following risk stratification with a triage tool. AIM To observe the effect of risk stratification using a triage tool on patient outcomes, primarily sedation reversal events. METHODS We observed all outpatient endoscopy procedures performed at AEC-DHC and APC from April 2013 to September 2019. Procedures were stratified to their respective sites using a triage tool. We evaluated each procedure for which sedation reversal with flumazenil and naloxone was recorded. Demographics and characteristics recorded include patient age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, procedure type, and reason for sedation reversal. RESULTS There were 97366 endoscopic procedures performed at AEC-DHC and 22494 at the APC during the study period. Of these, 17 patients at AEC-DHC and 9 at the APC underwent sedation reversals (0.017% vs 0.04%; P = 0.06). Demographics recorded for those requiring reversal at AEC-DHC vs APC included mean age (53.5 ± 21 vs 60.4 ± 17.42 years; P = 0.23), ASA class (1.66 ± 0.48 vs 2.22 ± 0.83; P = 0.20), BMI (27.7 ± 6.7 kg/m2 vs 23.7 ± 4.03 kg/m2; P = 0.06), and female gender (64.7% vs 22%; P = 0.04). The mean doses of sedative agents and reversal drugs used at AEC-DHC vs APC were midazolam (5.9 ± 1.7 mg vs 8.9 ± 3.5 mg; P = 0.01), fentanyl (147.1 ± 49.9 μg vs 188.9 ± 74.1 μg; P = 0.10), flumazenil (0.3 ± 0.18 μg vs 0.17 ± 0.17 μg; P = 0.13) and naloxone (0.32 ± 0.10 mg vs 0.28 ± 0.12 mg; P = 0.35). Procedures at AEC-DHC requiring sedation reversal included colonoscopies (n = 6), esophagogastroduodenoscopy (EGD) (n = 9) and EGD/colonoscopies (n = 2), whereas APC procedures included EGDs (n = 2), EGD with gastrostomy tube placement (n = 1), endoscopic retrograde cholangiopancreatography (n = 2) and endoscopic ultrasound's (n = 4). The indications for sedation reversal at AEC-DHC included hypoxia (n = 13; 76%), excessive somnolence (n = 3; 18%), and hypotension (n = 1; 6%), whereas, at APC, these included hypoxia (n = 7; 78%) and hypotension (n = 2; 22%). No sedation-related deaths or long-term post-sedation reversal adverse outcomes occurred at either site. CONCLUSION Our study highlights the effectiveness of a triage tool used at our tertiary care hospital for risk stratification in minimizing sedation reversal events during outpatient endoscopy procedures. Using a triage tool for risk stratification, low rates of sedation reversal can be achieved in the ambulatory settings for EGD and colonoscopy.
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Affiliation(s)
- Saqib Walayat
- Department of Gastroenterology, University of Illinois, Peoria, IL 61605, United States
| | - Peter Stadmeyer
- Department of Gastroenterology, University of Wisconsin, Madison, WI 53792, United States
| | - Azfar Hameed
- Department of Internal Medicine, Texas Health Denton, Denton, TX 76201, United States
| | - Minahil Sarfaraz
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore 042, Pakistan
| | - Paul Estrada
- Department of Gastroenterology, Texas Tech University Health Services Center, El Paso, TX 79911, United States
| | - Mark Benson
- Department of Gastroenterology and Hepatology, University of Wisconsin, Madison, WI 53705, United States
| | - Anurag Soni
- Department of Gastroenterology and Hepatology, University of Wisconsin, Madison, WI 53705, United States
| | - Patrick Pfau
- Department of Gastroenterology and Hepatology, University of Wisconsin, Madison, WI 53705, United States
| | - Paul Hayes
- Finance Business Partners UW Health, University of Wisconsin, Madison, WI 53792, United States
| | - Brittney Kile
- UW Health Digestive Health Center Endoscopy, University of Wisconsin, Madison, WI 53792, United States
| | - Toni Cruz
- UW Health Digestive Health Center Endoscopy, University of Wisconsin, Madison, WI 53792, United States
| | - Deepak Gopal
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin Hospitals and Clinics, Madison, WI 53705, United States
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Jena A, Jain S, Sundaram S, Singh AK, Chandnani S, Rathi P. Electrosurgical unit in GI endoscopy: the proper settings for practice. Expert Rev Gastroenterol Hepatol 2023; 17:825-835. [PMID: 37497836 DOI: 10.1080/17474124.2023.2242243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 06/14/2023] [Accepted: 07/26/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION Electrosurgical unit (ESU) is integral to the endoscopy unit. The proper knowledge of the Mode with setting is essential for good therapeutic outcomes and the safety of the patients. AREAS COVERED ESU generates high-frequency electric current, which could perform cutting and coagulation for various therapeutic interventions. We review the proper settings for common endoscopic interventions like hemostasis, polypectomy, sphincterotomy, and advanced procedures like endoscopic ultrasound-guided cysto-gastrostomy, bile duct drainage, and endoscopic Ampullectomy. We review the various waveforms of ESU in practice in endoscopy, including special conditions like patients with pacemakers. EXPERT OPINION Knowledge of the waveforms' duty cycle and crest factor is necessary. A high-duty cycle and lower crest factor lead to a good cutting effect on the tissue. Endocut is the most commonly used Mode in ESU in endoscopic practices like sphincterotomy and polypectomy. Endocut I mode (effect 1-2, duration 3, interval 3) is used for endoscopic sphincterotomy, while Forced Coag mode (Effect 2, 60 W) controls post-sphincterotomy bleeding. Endocut Q mode (Effect 2-3, duration 1, interval 3) is used for cutting the polyp, while Forced Coag mode (Effect 2, 60 W) is used before cutting for pre-coagulation of the stalk.
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Affiliation(s)
- Anuraag Jena
- Department of Gastroenterology, BYL Nair Hospital and Topiwala National Medical College, Mumbai, India
| | - Shubham Jain
- Department of Gastroenterology, BYL Nair Hospital and Topiwala National Medical College, Mumbai, India
| | - Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, India
| | - Anupam Kumar Singh
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Chandnani
- Department of Gastroenterology, BYL Nair Hospital and Topiwala National Medical College, Mumbai, India
| | - Pravin Rathi
- Department of Gastroenterology, BYL Nair Hospital and Topiwala National Medical College, Mumbai, India
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Marín-Gabriel JC, Romito R, Guarner-Argente C, Santiago-García J, Rodríguez-Sánchez J, Toyonaga T. Use of electrosurgical units in the endoscopic resection of gastrointestinal tumors. GASTROENTEROLOGIA Y HEPATOLOGIA 2019; 42:512-523. [PMID: 31326105 DOI: 10.1016/j.gastrohep.2019.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/31/2019] [Accepted: 04/05/2019] [Indexed: 12/18/2022]
Abstract
Electrosurgical units (ESUs) are indispensable devices in our endoscopy units. However, many endoscopists are not well-trained on their use and their physical bases are usually not properly studied or understood. In addition, comparative data concerning the settings that may be applied in different circumstances are scarce in the medical literature. Given that it is important to be aware of their strengths and risks, we conducted a review of the available information and research on this topic.
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Affiliation(s)
- José C Marín-Gabriel
- Department of Gastroenterology, Endoscopy Unit, High Risk GI Cancer Clinic, Research Institute, 12 de Octubre (i+12), "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain.
| | - Raffaella Romito
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Institut de Reçerca - IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Guarner-Argente
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Institut de Reçerca - IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Santiago-García
- Department of Gastroenterology, Endoscopy Unit, "Puerta de Hierro-Majadahonda" University Hospital, Autonomous University of Madrid (UAM), Majadahonda (Madrid), Spain
| | - Joaquín Rodríguez-Sánchez
- Department of Gastroenterology, Endoscopy Unit, Hospital Universitario de Ciudad Real, Ciudad Real, Spain
| | - Takashi Toyonaga
- Department of Endoscopy, Kobe University Hospital, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Japan
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