Improvement of atropine on esophagogastric junction observation during sedative esophagogastroduodenoscopy

Differences in clinicopathology and prognosis between gastroesophageal junctional and gastric non-cardiac neuroendocrine carcinomas: a retrospective comparison study of consecutive 56 cases from a single institution in China

Gastric neuroendocrine carcinoma (NEC), including mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN), is uncommon and differences in clinicopathological features and outcomes of NEC arising in various gastric regions remain elusive. We investigated 56 consecutive NECs identified among 3961 gastrectomies performed at our center between 2005 and 2021. We then compared clinicopathological characteristics and prognosis between gastroesophageal junctional (GEJ) NECs (N=39) and gastric non-cardiac NECs (N=17). No significant difference was found between the two groups in age, gender, tumor size, mixed non-neuroendocrine carcinoma component, MiNEN, NEC type, metastatic NEC component in lymph nodes, tumor infiltrating lymphocyte, lymph node metastasis, lymphovascular or perineural invasion, intestinal metaplasia in adjacent non-neoplastic mucosa, and expression of P53, PD-L1, TTF-1, HER2, and Ki-67. However, compared to gastric non-cardiac NECs, GEJ NECs displayed a significantly higher frequency of prevalence (2.79% versus 0.66%), pT3-T4 (92.3% versus 64.7%), advanced pathological stage (IIb-IV) (76.9% versus 47.1%), and a significantly lower 5-year overall survival rate (46.1% versus 73.1%) (P<0.05). The GEJ location was the only independent risk factor for overall survival. In stage-stratified comparisons, patients with stage II GEJ NEC demonstrated a significantly lower 5-year survival rate than those with gastric non-cardiac NEC at the same stage. Compared to non-NECs matched for age, gender, tumor location, and pathological summary stage, GEJ NEC was associated with significantly worse prognosis. In conclusion, GEJ NEC showed deeper invasion, more advanced pathological stages, and worse prognosis than gastric non-cardiac NEC. The findings provide pathologic evidence for individualized management strategies for patients with GEJ NEC. Future studies with larger samples are needed.

Comparison of effectiveness, cost and safety between moderate sedation and deep sedation under esophagogastroduodenoscopy in Chinese population: a quasi-experimental study

OBJECTIVE

Most endoscopists routinely perform moderate or deep sedation for esophagogastroduodenoscopy (EGD). Considering that there is no consensus on the optimal sedation depth and it varies from country to country, our study aims to compare the effectiveness, cost and safety of these two sedation methods in the Chinese population.

METHODS

This quasi-experimental study included a total of 556 eligible patients from July 2020 to June 2021, and they entered the moderate sedation group or deep sedation group based on their choices. Baseline information, scores of Patient Satisfaction with Sedation Instrument (PSSI) and Clinician Satisfaction with Sedation Instrument (CSSI), examination time, sedation time, recovery time, expenses before medicare reimbursement, hypoxaemia and hypotension were compared between the two groups. Propensity Score Matching (PSM) analysis was conducted to balance the confounding factors.

RESULTS

After PSM, 470 patients were involved in the analysis, with 235 for each group. The moderate sedation was clearly superior to the deep sedation group in terms of PSSI score (98.00 ± 0.94 vs. 97.29 ± 1.26), CSSI score (98.00 ± 0.78 vs. 97.67 ± 1.30), sedation time (11.90 ± 2.04 min vs. 13.21 ± 2.75 min), recovery time (25.40 ± 3.77 min vs. 28.0 ± 4.85 min), expenses (433.04 ± 0.00 Yuan vs. 789.85 ± 0.21 Yuan), with all p < .001. Examination time was not significantly different between the two groups (p = .124). In addition, the moderate sedation group had a lower occurrence rate of hypoxaemia (0.36% vs. 3.27%, p = .010) and hypotension (17.44% vs. 44.00%, p < .001) compared to the deep sedation group.

CONCLUSIONS

Moderate sedation presented better effectiveness and safety and lower cost, and thereby it should be recommended as a widely used sedation method in clinical practice in China. Trial registration: This trial was registered on http://www.chictr.org.cn/index.aspx (ChiCTR2000038050).

Association between sedation and small neoplasm detection during diagnostic esophagogastroduodenoscopy: a propensity score-matched retrospective study

BACKGROUND

Esophagogastroduodenoscopy (EGD) is fundamental for detecting upper gastrointestinal (GI) neoplasms. However, the impact of sedation on small neoplasm detection during EGD has not been evaluated. The aim of this study was to investigate whether EGD with sedation could improve small upper GI neoplasm detection.

METHODS

This propensity score-matched retrospective study analyzed the medical records of outpatients undergoing diagnostic EGD at a large tertiary center between January 2013 and December 2018. The primary outcome was the detection rate of small upper GI neoplasms (≤10 mm). The secondary outcomes were biopsy rate and small neoplasms in different anatomic subsites.

RESULTS

After propensity score matching, 20,052 patients undergoing diagnostic EGD with or without propofol sedation were identified. A higher detection rate of small upper GI neoplasms was observed in the sedation group (2.80% vs. 2.02%; p < .001). In particular, the detection rate of small cancers in the sedation group was 3-fold higher than that in the no-sedation group (0.16% vs. 0.05%; p = .023). Small neoplasms were more likely identified at the gastric antrum (1.60% vs. 1.09%; p = .002) and angulus (0.66% vs. 0.45%; p = .044) in the sedation group. In addition, endoscopists were more likely to take biopsies when performing sedated EGD (41.4% vs. 36.4%, p < .001), and a higher biopsy rate was associated with an increased detection rate of small neoplasms.

CONCLUSIONS

Sedation was significantly associated with a higher detection rate of small upper GI neoplasms and might be recommended for improving the quality of EGD.

Stimulating peristalsis improves esophagogastric junction observation during sedated esophagogastroduodenoscopy in children and adolescents

Background and study aims

Sedation impairs full visualization of the esophagogastric junction (EGJ) and Z line (the squamocolumnar junction) during esophagogastroduodenoscopy (EGD). The aim of this study was to determine whether induction of esophageal peristalsis could improve the ability to evaluate the Z line in children and adolescents.

Patients and methods

Study 1: Consecutive patients (10-15 years) undergoing EGD with propofol or midazolam sedation were enrolled. The proportion of Z line observed was compared between the two groups. Study 2: The effect of an air infusion near the EGJ following deflation of the stomach to induce esophageal peristalsis was investigated in the patients (15-18 years), undergoing EGD with propofol sedation. The proportion of Z line observed was compared between the stimulated group and control group.

Results

Study 1: 149 patients were evaluated; 87 received propofol (43 boys; average age 13.2 years (range, 10-15)) and 62 received midazolam (30 boys; average age 12.8 years (range, 10-15)). The proportion of the Z line visualized was low but was greater with propofol vs. midazolam sedation (36.8% vs 16.1%, P=0.0059). Study 2: 102 patients were evaluated; 62 had induction of peristalsis (34 boys; average age 16.2 years (range, 15-18)) and 40 controls (20 boys; average age 16.8 years (range, 15-18)). Complete visualization of the Z line achieved in 95% (59 of 62) following induction of peristalsis vs. 37.5% (15 of 40) of controls (P>0.001).

Conclusions

Induction of esophageal peristalsis greatly improved visualization of the Z line during sedated EGD in children and adolescents.