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Xu W, Xia G, Li L, Cao G, Yan X, Dong L, Zhu Y. Evaluation of a novel disposable endoscope for retroflexed endoscopic rubber band ligation of internal hemorrhoids: a randomized pilot study. Postgrad Med J 2024; 100:407-413. [PMID: 38330500 DOI: 10.1093/postmj/qgae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/11/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE Retroflexed endoscopic rubber band ligation (ERBL) for treating Grade II and III internal hemorrhoids using disposable endoscopes has not been previously assessed. We therefore compared the safety and effectiveness of ERBL for internal hemorrhoids using novel disposable endoscopes versus traditional reusable endoscopes. METHODS This prospective randomized controlled trial involved 42 patients who underwent ERBL for Grade II and III internal hemorrhoids using either a disposable endoscope (n = 21) or a reusable endoscope (n = 21). Safety was assessed by the incidence of equipment failure, device-related adverse events, and in-procedure stability of vital signs. Effectiveness was assessed by the postoperative therapeutic effect, feasibility of retroflexed ERBL, and incidence of complications. RESULTS In terms of safety, no life-threatening events, equipment failure, or device-related adverse effects occurred during the procedures in either group. The rate of diastolic blood pressure stability was significantly different between the two groups (P = .049), but the rates of systolic blood pressure and heart rate stability were similar. In terms of effectiveness, the therapeutic effects on postoperative Day 30 were similar in both groups. Image clarity and endoscopic flexibility in the disposable endoscope group were mildly inferior to those in the reusable endoscope group, but without statistical significance. Matching between the endoscope and ligating device was 100% in both groups. The incidence of complications on postoperative Days 1 and 10 was not significantly different between the two groups. CONCLUSION Compared with reusable endoscopes, disposable endoscopes are equally safe, feasible, and reliable in ERBL for internal hemorrhoids.
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Affiliation(s)
- Wen Xu
- Department of Gastroenterology, Southern Medical University, Shenzhen Hospital, Shenzhen, Guangdong 518000, China
| | - Guili Xia
- Department of Gastroenterology, Southern Medical University, Shenzhen Hospital, Shenzhen, Guangdong 518000, China
| | - Laihe Li
- Department of Gastroenterology, Southern Medical University, Shenzhen Hospital, Shenzhen, Guangdong 518000, China
| | - Ge Cao
- HuiZhou Xzing Technology Co., Ltd., Huizhou, Guangdong 516000, China
| | - Xianhuan Yan
- HuiZhou Xzing Technology Co., Ltd., Huizhou, Guangdong 516000, China
| | - Ling Dong
- Department of Gastroenterology, Southern Medical University, Shenzhen Hospital, Shenzhen, Guangdong 518000, China
| | - Ying Zhu
- Department of Gastroenterology, Southern Medical University, Shenzhen Hospital, Shenzhen, Guangdong 518000, China
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Ikebuchi Y, Matsumoto K, Ueda N, Yamashita T, Kurumi H, Onoyama T, Takeda Y, Yoshida A, Kawaguchi K, Yashima K, Fujiwara K, Imamoto R, Noma H, Ueki M, Isomoto H. Efficacy and Safety of a Novel Mouthpiece for Esophagogastroduodenoscopy: A Multi-Center, Randomized Study. Diagnostics (Basel) 2021; 11:diagnostics11030538. [PMID: 33802944 PMCID: PMC8002750 DOI: 10.3390/diagnostics11030538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/04/2021] [Accepted: 03/15/2021] [Indexed: 12/24/2022] Open
Abstract
This randomized trial aimed to compare the safety and efficacy of the GAGLESS mouthpiece for esophagogastroduodenoscopy (EGD) with that of the conventional mouthpiece. In all, 90 participants were divided into the GAGLESS mouthpiece and conventional mouthpiece groups. The primary endpoint was the severity of pain using the visual analog scale (VAS), and secondary endpoints were examination time, past history of endoscopy, success of the procedure, systolic (SBP) and diastolic (DBP) blood pressure, oxygen saturation, pulse rate before and after EGD, and adverse events. Endoscopy was completed in all cases, and no complications were observed. VAS, when passing the scope through the pharynx, was 2.5 ± 2.4 and 2.0 ± 1.9 cm (p = 0.24) in the conventional and GAGLESS groups, respectively, and that, throughout the examination, was 2.5 ± 2.4 and 1.7 ± 1.5 cm (p = 0.06), respectively. The difference in blood pressure between the GAGLESS and conventional groups was not significant for SBP (p = 0.08) and significant for DBP (p = 0.03). The post-EGD difference in DBP was significantly lower in the GAGLESS group than in the conventional group. The results indicate that GAGLESS mouthpieces had a lower VAS during endoscopy than the conventional mouthpieces, and the changes in blood pressure were smaller with the GAGLESS mouthpiece.
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Affiliation(s)
- Yuichiro Ikebuchi
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori 683-8504, Japan; (T.Y.); (H.K.); (T.O.); (Y.T.); (A.Y.); (K.K.); (K.Y.)
- Correspondence: (Y.I.); (K.M.)
| | - Kazuya Matsumoto
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori 683-8504, Japan; (T.Y.); (H.K.); (T.O.); (Y.T.); (A.Y.); (K.K.); (K.Y.)
- Irisawa Medical Clinic, Shimane 690-0025, Japan;
- Correspondence: (Y.I.); (K.M.)
| | - Naoki Ueda
- Irisawa Medical Clinic, Shimane 690-0025, Japan;
- Department of Gastroenterology, Yasugi Municipal Hospital, Shimane 692-0404, Japan; (R.I.); (H.I.)
| | - Taro Yamashita
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori 683-8504, Japan; (T.Y.); (H.K.); (T.O.); (Y.T.); (A.Y.); (K.K.); (K.Y.)
| | - Hiroki Kurumi
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori 683-8504, Japan; (T.Y.); (H.K.); (T.O.); (Y.T.); (A.Y.); (K.K.); (K.Y.)
| | - Takumi Onoyama
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori 683-8504, Japan; (T.Y.); (H.K.); (T.O.); (Y.T.); (A.Y.); (K.K.); (K.Y.)
| | - Yohei Takeda
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori 683-8504, Japan; (T.Y.); (H.K.); (T.O.); (Y.T.); (A.Y.); (K.K.); (K.Y.)
| | - Akira Yoshida
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori 683-8504, Japan; (T.Y.); (H.K.); (T.O.); (Y.T.); (A.Y.); (K.K.); (K.Y.)
| | - Koichiro Kawaguchi
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori 683-8504, Japan; (T.Y.); (H.K.); (T.O.); (Y.T.); (A.Y.); (K.K.); (K.Y.)
| | - Kazuo Yashima
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori 683-8504, Japan; (T.Y.); (H.K.); (T.O.); (Y.T.); (A.Y.); (K.K.); (K.Y.)
| | - Kazunori Fujiwara
- Department of Otolaryngology, Head and Neck Surgery, Division of Medicine of Sensory and Motor Organs, Faculty of Medicine, Tottori University, Tottori 683-8504, Japan;
| | - Ryu Imamoto
- Department of Gastroenterology, Yasugi Municipal Hospital, Shimane 692-0404, Japan; (R.I.); (H.I.)
| | - Hisashi Noma
- The Institute of Statistical Mathematics, Tokyo 190-8562, Japan;
| | - Masaru Ueki
- Advanced Medicine, Innovation and Clinical Research Center, Tottori University Hospital, Tottori 683-8504, Japan;
| | - Hajime Isomoto
- Department of Gastroenterology, Yasugi Municipal Hospital, Shimane 692-0404, Japan; (R.I.); (H.I.)
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Introduction of Transnasal Endoscopy to a Scottish District General Hospital. Gastroenterol Nurs 2021; 44:E24-E28. [PMID: 33795625 DOI: 10.1097/sga.0000000000000589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/13/2021] [Indexed: 10/21/2022] Open
Abstract
Esophagogastroduodenoscopy can be uncomfortable and distressing with many patients opting for conscious sedation over topical local anesthetic spray. Transnasal endoscopy is an alternative and we sought to assess how easily it could be introduced to a district general hospital and how acceptable patients found it. Selected patients requiring diagnostic endoscopy were offered transnasal endoscopy with topical nasal anesthetic by clinicians new to transnasal endoscopy but competent at esophagogastroduodenoscopy. Postal feedback questionnaires were used to assess comfort, distress, recollection of periprocedural consultation, and overall experience (visual analog scale 1-10). A total of 213 transnasal endoscopy procedures were undertaken with 207 completed successfully (97.2%). Two patients (0.9%) had self-limiting epistaxis and no patient required admission. One hundred (47%) questionnaires were returned including 98 from those with completed transnasal endoscopy. Thirty-three (33%) had previous esophagogastroduodenoscopy and 28 (85%) reported a preference for transnasal endoscopy. Fifty-eight patients (59%) found transnasal endoscopy comfortable (visual analog scale >6) with 17 reporting discomfort (visual analog scale <5). Seventeen patients found the procedure distressing (visual analog scale >6) but 70 (73%) did not (visual analog scale <5). Eighty-four patients (85.7%) had clear recollection of their procedure (visual analog scale >6) and overall satisfaction was reported as good (visual analog scale >6) by 94.7%. Transnasal endoscopy can be adopted by clinicians competent with conventional esophagogastroduodenoscopy with expectation of high procedure completion rate and low complication rate. Our patients reported high levels of satisfaction with few reporting distress. Perhaps as a consequence, most patients had a clear recollection of their procedure.
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Sogabe M, Okahisa T, Fukuya A, Kagemoto K, Okada Y, Adachi Y, Kurihara T, Nii T, Teramae S, Tanaka H, Tomonari T, Okamoto K, Miyamoto H, Nakasono M, Takayama T. Effects of audio and visual distraction on patients' vital signs and tolerance during esophagogastroduodenoscopy: a randomized controlled trial. BMC Gastroenterol 2020; 20:122. [PMID: 32316918 PMCID: PMC7175521 DOI: 10.1186/s12876-020-01274-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 04/13/2020] [Indexed: 12/27/2022] Open
Abstract
Background Esophagogastroduodenoscopy (EGD) provides an indispensable and unambiguous inspection allowing the discovery upper gastrointestinal lesions. However, many patients are anxious about undergoing EGD. Few studies have investigated the influence on patients’ vital signs and tolerance during EGD using subjective and objective assessments. This study was a prospective randomized controlled study that investigated the influence of audio and visual distraction on EGD. Methods We randomly divided 289 subjects who underwent EGD into 4 groups (control group, audio group, visual group, combination group) and examined their vital signs, heart rate variability (HRV), psychological items, and acceptance of distraction. Results Pulse rate (PR) at post-distraction and post-EGD in the 3 distraction groups were significantly lower than those of control group (p < 0.001 and p < 0.01, respectively). Blood pressure (BP) during and post-EGD was significantly higher than that at pre-EGD in control group (p < 0.05), but no significant elevation of BP was observed during the latter half of EGD and post-EGD in the 3 distraction groups. BP at post-distraction improved significantly compared to pre-distraction in the 3 distraction groups (p < 0.05). There was a significant difference in the low-frequency (LF) power/ high-frequency (HF) power at post-distraction and post-EGD among the 4 groups (p < 0.001 and p < 0.001, respectively). The LF power/HF power at post-distraction and post-EGD in the 3 distraction groups was significantly lower than that in control group (p < 0.05). Several items of profile of mood states (POMS) and the impression of EGD at post-distraction improved significantly compared to those at pre-distraction among the 3 distraction groups (p < 0.05). Visual analog scale (VAS) of willingness for the next use of distraction in the 3 distraction groups was excellent because VAS was more than 70. Conclusions Distractions effectively improved psychological factors, vital signs and some of HRV at pre and post-EGD. Distractions may suppress BP elevation during the latter half of EGD and lead to stability of HRV on EGD. Trial registration This prospective trial was registered in the University Hospital Medical Information Network (UMIN) Clinical Trials Registry as UMIN000029637. Registered on 20 October 2017.
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Affiliation(s)
- Masahiro Sogabe
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima city, Tokushima, 770-8503, Japan. .,Department of Internal Medicine, Shikoku Central Hospital of the Mutual aid Association of Public School teachers, Shikokuchuo, Japan.
| | - Toshiya Okahisa
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima city, Tokushima, 770-8503, Japan.,Department of Internal Medicine, Shikoku Central Hospital of the Mutual aid Association of Public School teachers, Shikokuchuo, Japan
| | - Akira Fukuya
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima city, Tokushima, 770-8503, Japan
| | - Kaizo Kagemoto
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima city, Tokushima, 770-8503, Japan
| | - Yasuyuki Okada
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima city, Tokushima, 770-8503, Japan
| | - Yuka Adachi
- Department of Internal Medicine, Shikoku Central Hospital of the Mutual aid Association of Public School teachers, Shikokuchuo, Japan
| | - Takeshi Kurihara
- Department of Internal Medicine, Shikoku Central Hospital of the Mutual aid Association of Public School teachers, Shikokuchuo, Japan
| | - Toru Nii
- Department of Internal Medicine, Shikoku Central Hospital of the Mutual aid Association of Public School teachers, Shikokuchuo, Japan
| | - Satoshi Teramae
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima city, Tokushima, 770-8503, Japan
| | - Hironori Tanaka
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima city, Tokushima, 770-8503, Japan
| | - Tetsu Tomonari
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima city, Tokushima, 770-8503, Japan
| | - Koichi Okamoto
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima city, Tokushima, 770-8503, Japan
| | - Hiroshi Miyamoto
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima city, Tokushima, 770-8503, Japan
| | - Masahiko Nakasono
- Department of Internal Medicine, Tsurugi Municipal Handa Hospital, Tsurugi, Japan
| | - Tetsuji Takayama
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima city, Tokushima, 770-8503, Japan
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Wellenstein DJ, Honings J, Schutte HW, Herruer JM, van den Hoogen FJA, Marres HAM, Takes RP, van den Broek GB. Cost analysis of office-based transnasal esophagoscopy. Eur Arch Otorhinolaryngol 2019; 276:1457-1463. [PMID: 30806806 PMCID: PMC6458968 DOI: 10.1007/s00405-019-05357-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/20/2019] [Indexed: 12/23/2022]
Abstract
Purpose Although office-based transnasal esophagoscopy has been investigated extensively, a cost analysis is still lacking. We performed a cost analysis combined with feasibility study for two diagnostic processes: patients with globus pharyngeus and/or dysphagia, and hypopharyngeal carcinoma. Methods Prospective cohort study. Results Forty-one procedures were performed, of which 35 were fully completed. The procedure was well tolerated with mild complaints such as nasal or pharyngeal pain and burping. Four complications occurred: two minor epistaxis and two vasovagal reactions. In patients with globus pharyngeus and/or dysphagia, transnasal esophagoscopy resulted in a cost saving of €94.43 (p 0.026) per procedure, compared to our regular diagnostic process. In patients with suspicion of hypopharyngeal carcinoma, cost savings were €831.41 (p 0.000) per case. Conclusions Cost analysis showed that office-based transnasal esophagoscopy can provide significant cost savings for the current standard of care. Furthermore, this procedure resulted in good patient acceptability and few complications.
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Affiliation(s)
- David J Wellenstein
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands.
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Henrieke W Schutte
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Jasmijn M Herruer
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Henri A M Marres
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
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Comparative Assessment of Patient Preferences and Tolerability in Barrett Esophagus Screening: Results From a Randomized Trial. J Clin Gastroenterol 2018; 52:880-884. [PMID: 29369237 PMCID: PMC6056346 DOI: 10.1097/mcg.0000000000000991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
GOALS To determine patient preference for the Barrett esophagus (BE) screening techniques. BACKGROUND Sedated esophagogastroduodenoscopy (sEGD) and unsedated transnasal endoscopy (uTNE) are both potential techniques for BE screening. However, systematic assessment of patient preference for these 2 techniques is lacking. As part of a comparative effectiveness randomized trial of BE screening modalities, we measured short-term patient preferences for the following approaches: in-clinic uTNE (huTNE), mobile-based uTNE (muTNE), and sEGD using a novel assessment instrument. STUDY Consenting community patients without known BE were randomly assigned to receive huTNE, muTNE, or sEGD, followed by a telephone administered preference and tolerability assessment instrument 24 hours after study procedures. Patient preference was measured by the waiting trade-off method. RESULTS In total, 201 patients completed screening with huTNE (n=71), muTNE (n=71), or sEGD (n=59), and a telephone interview. Patients' preferences for sEGD and uTNE using the waiting trade-off method were comparable (P=0.51). Although tolerability scores were superior for sEGD (P<0.001) compared with uTNE, scores for uTNE examinations were acceptable. CONCLUSIONS Patient preference is comparable between sEGD and uTNE for diagnostic examinations conducted in an endoscopy suite or in a mobile setting. Given acceptable tolerability, uTNE may be a viable alternative to sEGD for BE screening.
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Wellenstein DJ, Schutte HW, Marres HAM, Honings J, Belafsky PC, Postma GN, Takes RP, van den Broek GB. Office-based procedures for diagnosis and treatment of esophageal pathology. Head Neck 2017; 39:1910-1919. [DOI: 10.1002/hed.24819] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- David J. Wellenstein
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Henrieke W. Schutte
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Henri A. M. Marres
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Peter C. Belafsky
- Center for Voice and Swallowing; Department of Otolaryngology and Head and Neck Surgery, University of California, Davis School of Medicine; Sacramento California
| | - Gregory N. Postma
- Department of Otolaryngology; Medical College of Georgia at Augusta University; Augusta Georgia
| | - Robert P. Takes
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Guido B. van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
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Ortiz V, Sáez-González E, Blé M, Díaz-Jaime FC, Vinaixa C, Garrigues V. Effects of high-resolution esophageal manometry on oxygen saturation and hemodynamic function. Dis Esophagus 2017; 30:1-4. [PMID: 27859989 DOI: 10.1111/dote.12523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The effect of high-resolution esophageal manometry (HRM) on oxygen saturation (SaO2) and hemodynamic function has not been previously evaluated. This was a prospective study of consecutive patients referred for HRM. Demographic and clinical data were collected on all patients. The study variables included SaO2, heart rate (HR) and blood pressure (BP). SaO2 and HR were measured at baseline, during intubation, during and 5 min after HRM. BP was measured at baseline, during and after HRM. 158 (56% women) patients with a mean age of 56 (SD 15) years were included. Thirty-five (22%) were obese and 55 (35%) were overweight. Eighteen (12%) patients had a history of respiratory disease and 27 (17%) were smokers. Intubation was difficult in 22%. Exploration tolerance was poor in 17% or very poor in 6%. The average duration of the test was 9.9 (SD 2.8) minutes. Sixty-four (47%) and 59 (37%) patients had SaO2 below 95% during intubation and during HRM, respectively. Three patients had SaO2 ≤90%. Sixty-nine (44%) patients had tachycardia during intubation and 8 (5%) during HRM. The appearance of desaturation (SaO2 <95%) during intubation was associated with a lower basal SaO2; desaturation during HRM and 5 minutes after HRM was associated with a higher age, a higher BMI and a lower basal SaO2. HRM decreases SaO2 and increases heart rate primarily during the insertion of the probe, as part of the standard stress response and therefore HMR can be considered a safe procedure. However, in older and overweight patients, respiratory parameters should be monitored.
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Affiliation(s)
- Vicente Ortiz
- Digestive Functional Disorders Unit, Gastroenterology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Esteban Sáez-González
- Digestive Functional Disorders Unit, Gastroenterology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Michel Blé
- Digestive Functional Disorders Unit, Gastroenterology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Francia Carolina Díaz-Jaime
- Digestive Functional Disorders Unit, Gastroenterology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Carmen Vinaixa
- Digestive Functional Disorders Unit, Gastroenterology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Vicente Garrigues
- Digestive Functional Disorders Unit, Gastroenterology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Department of Medicine, Universitat de Valencia, Valencia, Spain
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Murakami K, Kataoka H, Hayano J, Fukuta H, Mori Y, Nishiwaki H, Mizoshita T, Tanaka M, Okamoto Y, Shimura T, Hirata Y, Mizushima T, Ebi M, Joh T. Autonomic nervous responses in colorectal polypectomy: Randomized controlled trial comparing air and carbon dioxide insufflation. Dig Endosc 2016; 28:203-9. [PMID: 26584960 DOI: 10.1111/den.12577] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/05/2015] [Accepted: 11/16/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Carbon dioxide (CO2) insufflation devices are commonly used for endoscopic examination and treatment. In this prospective randomized controlled trial (RCT), we compared patient acceptance, cardiovascular tolerance,and autonomic nervous responses between patients receiving air insufflation and CO2 insufflation. METHODS We initially enrolled 170 patients and, of these, 158 patients in total were analyzed (air group, 83; CO2 group, 75). Autonomic nervous responses were evaluated by analysis of heart rate variability (HRV). Primary end point was superiority in the effects of CO2 insufflation on the autonomic nervous system by HRV analysis. RESULTS Visual analog scale disclosed significantly less abdominal pain and abdominal fullness with CO2. Percentage heart rate change rate at 1 h and 4 h after the procedure was also significantly lower in the CO2 group than in the air group (1 h after: P < 0.01, 4 h after: P < 0.05). Comparison based on age showed that % heart rate change was significantly lower in the younger CO2 patients (just after colonoscopy and 1 h after: P < 0.01, 4 h after: P < 0.05), but this difference was not apparent in an older group of patients. CONCLUSIONS This is the first RCT showing that colorectal polypectomy using CO2 insufflation significantly decreases abdominal pain and abdominal fullness common in such patients with lowered stress to the autonomous nervous system. The effects using CO2 insufflation on the sympathetic nervous system also seemed to be more prominent among younger patients.
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Affiliation(s)
| | | | | | - Hidekatsu Fukuta
- Department of Cardio-Renal Medicine and Hypertension; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | | | | | | | | | | | | | | | | | | | - Takashi Joh
- Departments of Gastroenterology and Metabolism
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10
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Sami SS, Subramanian V, Ortiz-Fernández-Sordo J, Saeed A, Singh S, Guha IN, Iyer PG, Ragunath K. Performance characteristics of unsedated ultrathin video endoscopy in the assessment of the upper GI tract: systematic review and meta-analysis. Gastrointest Endosc 2015; 82:782-92. [PMID: 26371850 DOI: 10.1016/j.gie.2015.07.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 07/07/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIMS Reports on the performance of unsedated ultrathin endoscopy via the transnasal (uTNE) and transoral (uTOE) routes are conflicting. We aimed to estimate the technical success rate, patient preference, and acceptability of uTNE and uTOE alone and in comparison with conventional EGD (cEGD; with or without sedation). METHODS A systematic review and meta-analysis was performed on all primary studies reporting the outcomes of interest. Electronic databases (Cochrane library, MEDLINE, EMBASE) were searched on February 1, 2014. RESULTS Thirty-four studies met the inclusion criteria with 6659 patients in total. The pooled technical success rate was 94.0% for uTNE (95% confidence interval [CI], 91.6-95.8; 30 studies) and 97.8% for uTOE (95% CI, 95.6-98.9; 16 studies). The difference in proportion of success for uTNE compared with cEGD was -2.0% (95% CI, -4.0 to -1.0; 18 studies), but that difference was not significant when uTNE < 5.9 mm in diameter was used (-1.0%; 95% CI, -3.0 to .0; 9 studies). There was no significant difference in success rate between uTOE and cEGD (.0%; 95% CI, -1.0 to 2.0; 10 studies). The pooled difference in proportion of patients who preferred uTNE over cEGD was 63.0% (95% CI, 49.0-76.0; 10 studies), whereas preference for uTOE versus cEGD was not significantly different (38.0%; 95% CI, -4.0 to 80.0; 2 studies). Acceptability was high for both uTNE (85.2%; 95% CI, 79.1-89.9; 16 studies) and uTOE (88.7%; 95% CI, 82.4-92.9; 10 studies). CONCLUSIONS Technical success rate for uTNE < 5.9 mm is equivalent to cEGD. uTNE has high patient acceptability, with better patient preference, and therefore could be a useful alternative to cEGD for screening purposes. uTOE had a similar technical success rate but an equivocal preference to cEGD.
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Affiliation(s)
- Sarmed S Sami
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Venkataraman Subramanian
- Molecular Gastroenterology, Institute of Biomedical and Clinical Sciences, University of Leeds, and Center for Digestive Diseases, St James University Hospital, Leeds, UK
| | - Jacobo Ortiz-Fernández-Sordo
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Alhussain Saeed
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Siddharth Singh
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Indra N Guha
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Prasad G Iyer
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Krish Ragunath
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
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A pilot study assessing tolerance safety and feasibility of diagnostic transnasal esophagogastroduodenoscopy using an improved larger caliber endoscope and an adapted topical anesthesia. Surg Endosc 2014; 29:3002-9. [DOI: 10.1007/s00464-014-4025-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 12/02/2014] [Indexed: 01/03/2023]
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12
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Ono S, Niimi K, Fujishiro M, Takahashi Y, Sakaguchi Y, Nakayama C, Minatsuki C, Matsuda R, Hirayama-Asada I, Tsuji Y, Mochizuki S, Kodashima S, Yamamichi N, Ozeki A, Matsumoto L, Ohike Y, Yamazaki T, Koike K. Evaluation of preferable insertion routes for esophagogastroduodenoscopy using ultrathin endoscopes. World J Gastroenterol 2014; 20:5045-5050. [PMID: 24803817 PMCID: PMC4009539 DOI: 10.3748/wjg.v20.i17.5045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 11/16/2013] [Accepted: 01/20/2014] [Indexed: 02/07/2023] Open
Abstract
AIM: To evaluate the discomfort associated with esophagogastroduodenoscopy (EGD) using an ultrathin endoscope through different insertion routes.
METHODS: This study (January 2012-March 2013) included 1971 consecutive patients [male/female (M/F), 1158/813, 57.5 ± 11.9 years] who visited a single institute for annual health checkups. Transnasal EGD was performed in 1394 patients and transoral EGD in 577. EGD-associated discomfort was assessed using a visual analog scale score (VAS score: 0-10).
RESULTS: Multivariate analysis revealed gender (M vs F: 4.02 ± 2.15 vs 5.06 ± 2.43) as the only independent predictor of the VAS score in 180 patients who underwent EGD for the first time; whereas it revealed gender (M vs F 3.60 ± 2.20 vs 4.84 ± 2.37), operator, age group (A: < 39 years; B: 40-49 years; C: 50-59 years; D: 60-69 years; E: > 70 years; A/B/C/D/E: 4.99 ± 2.32/4.34 ± 2.49/4.19 ± 2.31/3.99 ± 2.27/3.63 ± 2.31), and type of insertion as independent predictors in the remaining patients. Subanalysis for gender, age group, and insertion route revealed that the VAS score decreased with age regardless of gender and insertion route, was high in female patients regardless of age and insertion route, and was low in males aged over 60 years who underwent transoral insertion.
CONCLUSION: Although comprehensive analysis revealed that the insertion route may not be an independent predictor of the VAS score, transoral insertion may reduce EGD-associated discomfort in elderly patients.
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Goetze O, Schmitt J, Spliethoff K, Theurl I, Weiss G, Swinkels DW, Tjalsma H, Maggiorini M, Krayenbühl P, Rau M, Fruehauf H, Wojtal KA, Müllhaupt B, Fried M, Gassmann M, Lutz T, Geier A. Adaptation of iron transport and metabolism to acute high-altitude hypoxia in mountaineers. Hepatology 2013; 58:2153-62. [PMID: 23787477 DOI: 10.1002/hep.26581] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 06/06/2013] [Indexed: 12/19/2022]
Abstract
UNLABELLED Human iron homeostasis is regulated by intestinal iron transport, hepatic hepcidin release, and signals from pathways that consume or supply iron. The aim of this study was to characterize the adaptation of iron homeostasis under hypoxia in mountaineers at the levels of (1) hepatic hepcidin release, (2) intestinal iron transport, and (3) systemic inflammatory and erythropoietic responses. Twenty-five healthy mountaineers were studied. Blood samples and duodenal biopsies were taken at baseline of 446 m as well as on day 2 (MG2) and 4 (MG4) after rapid ascent to 4559 m. Divalent metal-ion transporter 1 (DMT-1), ferroportin 1 (FP-1) messenger RNA (mRNA), and protein expression were analyzed in biopsy specimens by quantitative reverse-transcription polymerase chain reaction (RT-PCR) and immunohistochemistry. Serum hepcidin levels were analyzed by mass spectrometry. Serum iron, ferritin, transferrin, interleukin (IL)-6, and C-reactive protein (CRP) were quantified by standard techniques. Serum erythropoietin and growth differentiation factor 15 (GDF15) levels were measured by enzyme-linked immunosorbent assay (ELISA). Under hypoxia, erythropoietin peaked at MG2 (P < 0.001) paralleled by increased GDF15 on MG2 (P < 0.001). Serum iron and ferritin levels declined rapidly on MG2 and MG4 (P < 0.001). Duodenal DMT-1 and FP-1 mRNA expression increased up to 10-fold from baseline on MG2 and MG4 (P < 0.001). Plasma CRP increased on MG2 and MG4, while IL-6 only increased on MG2 (P < 0.001). Serum hepcidin levels decreased at high altitude on MG2 and MG4 (P < 0.001). CONCLUSION This study in healthy volunteers showed that under hypoxemic conditions hepcidin is repressed and duodenal iron transport is rapidly up-regulated. These changes may increase dietary iron uptake and allow release of stored iron to ensure a sufficient iron supply for hypoxia-induced compensatory erythropoiesis.
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Affiliation(s)
- Oliver Goetze
- Division of Gastroenterology & Hepatology, University Hospital Zurich, Switzerland; Division of Hepatology, Department of Medicine II, University Hospital Würzburg, Germany
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Kataoka H, Mizuno K, Hayashi N, Tanaka M, Nishiwaki H, Ebi M, Mizoshita T, Mori Y, Kubota E, Tanida S, Kamiya T, Joh T. Diagnostic utility of small-caliber and conventional endoscopes for gastric cancer and analysis of endoscopic false-negative gastric cancers. World J Gastrointest Endosc 2013; 5:440-445. [PMID: 24044043 PMCID: PMC3773856 DOI: 10.4253/wjge.v5.i9.440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 05/28/2013] [Accepted: 07/19/2013] [Indexed: 02/05/2023] Open
Abstract
AIM: To analyze the diagnostic utility of a small-caliber endoscope (SC-E) and clinicopathological features of false-negative gastric cancers (FN-GCs).
METHODS: A total of 21638 esophagogastroduodenoscopy (EGD) gastric cancer (GC) screening examinations were analyzed. Secondary endoscopic examinations (n = 3352) were excluded because most secondary examinations tended to be included in the conventional endoscopy (C-E) group. Detection rates of GCs and FN-GCs were compared between SC-E and C-E groups. FN-GC was defined as GC performed with EGD within the past 3 years without GC detection. Macroscopic types, histopathological characteristics and locations of FN-GCs were compared with firstly found-gastric cancers (FF-GCs) in detail.
RESULTS: SC-E cases (n = 6657) and C-E cases (n = 11644), a total of 18301 cases, were analyzed. GCs were detected in 16 (0.24%) SC-E cases and 40 C-E (0.34%) cases (P = 0.23) and there were 4 FN-GCs (0.06%) in SC-E and 13 (0.11%) in C-E (P = 0.27), with no significant difference. FN-GCs/GCs ratio between SC-E and C-E groups was not significantly different (P = 0.75). The comparison of endoscopic macroscopic types of FN-GCs tended to be a less advanced type (P = 0.02). Histopathologically, 70.6% of FN-GCs were differentiated and 29.4% undifferentiated type. On the other hand, 43.0% of FF-GCs were differentiated and 53.8% undifferentiated type, so FN-GCs tended to be more differentiated type (P = 0.048).
CONCLUSION: The diagnostic utility of SC-E for the detection of GCs and FN-GCs was not inferior to that of C-E. Careful observation for superficially depressed type lesions in the upper lesser curvature region is needed to decrease FN-GCs.
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Lee YN, Moon JH, Choi HJ, Kim DC, Chung JH, Lee TH, Cha SW, Cho YD, Park SH, Kim SJ. Direct biliary drainage using transnasal endoscopy for patients with severe-to-moderate acute cholangitis. J Gastroenterol Hepatol 2013; 28:739-43. [PMID: 23278442 DOI: 10.1111/jgh.12105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2012] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIM Endoscopic biliary drainage (BD) is an effective palliative treatment for acute cholangitis. Transnasal endoscopy (TNE) using an ultraslim endoscope can be less stressful and has limited hemodynamic effects compared with endoscopic retrograde cholangiography using a conventional duodenoscope. Here, we evaluate the clinical usefulness of direct BD by TNE in critically ill patients with acute cholangitis who had undergone endoscopic sphincterotomy (ES) previously. METHODS Twenty-three patients with severe-to-moderate acute cholangitis who had undergone ES previously were enrolled prospectively. BD was achieved by TNE, using an ultraslim upper endoscope with a 5-Fr nasobiliary drainage catheter and/or a plastic stent. The technical and clinical success, as well as the safety, of the procedure were investigated. RESULTS A total of 23 patients were enrolled, including 17 with bile duct stones. The severity of the cholangitis was severe in nine (39.1%) and moderate in 14 patients (60.9%). The technical success rate was 95.7% (22/23). Nasobiliary drainage was performed in 15 patients, a plastic stent was placed in three, and both treatments were used in four patients. In three patients, direct BD by TNE was achieved in the intensive care unit without fluoroscopy. Direct cholangioscopy for distal common bile duct was performed in nine patients (40.9%), and three patients underwent immediate stone extraction under endoscopic visualization. Clinical improvement was achieved in 20/23 (87.0%) of patients. No significant procedure-related complications occurred. CONCLUSION Direct BD by TNE may be useful in critically ill patients with severe-to-moderate acute cholangitis who had undergone ES previously.
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Affiliation(s)
- Yun Nah Lee
- Digestive Disease Center, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon, Seoul, Korea
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Matsunaga T, Hashimoto S, Okamoto T, Harima S, Tanabe R, Nishikawa J, Sakaida I. Effect of capsule placement with transnasal endoscopy. Dig Endosc 2013; 25:156-9. [PMID: 23368535 DOI: 10.1111/j.1443-1661.2012.01346.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM One of the prohibiting factors in achieving complete small bowel capsule endoscopy is slow gastric transit of the capsule. The present study retrospectively investigated the success rate of, and the time required for, transnasal endoscope-assisted capsule placement to assess its clinical utility. METHODS In 24 of 27 patients who underwent capsule placement assisted by a transnasal endoscope, the capsule was successfully transported to and released in the duodenum (capsule placement group). For each patient in the capsule placement group, three age- and sex-matched patients who underwent conventional capsule endoscopy were assigned as controls (n=72). Gastric transit time, small bowel transit time, and rate of capsule arrival at the cecum within 8h were compared between the two patient groups. RESULTS Among the 27 patients in whom capsule placement was carried out, the capsule was successfully placed in the duodenum in 24 patients (88.9% success rate). In the capsule placement group, gastric transit time was significantly shorter (10.5 vs 46.2min, P=0.0021), small bowel transit time was significantly longer (354.7 vs 301.3min, P=0.0134), and completion rate (capsule arrival at the cecum within 8h) was significantly higher (83.3 vs 61.1%, P=0.0455) than in the control group. There were no procedural accidents associated with capsule placement. CONCLUSION Transnasal endoscope-assisted capsule placement appears to be a safe and reliable procedure, achieving complete small bowel capsule endoscopy, and is considered clinically useful.
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Affiliation(s)
- Takaharu Matsunaga
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
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