Endoscopic polypectomy for pacemaker patients: is it safe?

Endo-anesthesia: a primer

Gastrointestinal (GI) endoscopy has witnessed a Cambrian explosion of techniques, indications, and expanding target populations. GI endoscopy encompasses traditional domains that include preventive measures, palliation, as alternative therapies in patients with prohibitive risks of more invasive procedures, and indicated primary treatments. But, it has expanded to include therapeutic and diagnostic interventional endosonography, luminal endoscopic resection, third space endotherapy, endohepatology, and endobariatrics. The lines between surgery and endoscopy are blurred on many occasions within this paradigm. Moreover, patients with high degrees of co-morbidity and complex physiology require more nuanced peri-endoscopic management. The rising demand for endoscopy services has resulted in the development of endoscopy referral centers that offer these invasive procedures as directly booked referrals for regional and rural patients. This further necessitates specialized programs to ensure appropriate evaluation, risk stratification, and optimization for safe sedation and general anesthesia if needed. This landscape is conducive to the organic evolution of endo-anesthesia to meet the needs of these focused and evolving practices. In this primer, we delineate important aspects of endo-anesthesia care and provide relevant clinical and logistical considerations pertaining to the breadth of procedures.

Evaluation of the safety of MRI scans in patients undergoing dual-chamber pacemaker implantation

The safety of magnetic resonance imaging (MRI) scans in patients undergoing dual-chamber pacemaker (Medtronic's EnRhythm MRI SureScan IPG (implantable pulse generator) and CapSureFix MRI pacing electrodes) implantation were evaluated. A total of 86 patients undergoing this pacemaker implantation who were admitted to Huanggang Hospital from June 2006 to March 2017 were continuously selected. On average 6.8±2.3 months after the implantation, the first MRI scan was conducted. The mean scan time was 2.2±0.9 and mean duration was 45.6±12.3 min; mean follow-up visit period was 40.5±15.6 months, and after follow-up, all the abnormal symptoms of patients and pacemaker abnormalities after scans were recorded. Causes of receiving MRI scans included neurological diseases (27%), spinal diseases (14%), cancers (26%), joint injuries (25%) and visceral systems (8%). A total of 12 cases (14.0%) showed significant discomfort symptoms, 10 cases (11.6%) showed pacemaker abnormalities, and the incidence rate was 25.6%. Multivariate logistic regression analysis showed that the basic types of cardiovascular diseases, dependence on pacemakers, duration of education, pacing threshold, impedance and MRI scan time were related to the occurrence of adverse scan results (p<0.05). In conclusion, MRI scans show that MRI-compatible dual-chamber pacemaker was relatively safe.