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Roelandt P, Haesaerts R, Demedts I, Bisschops R. Implementation of the Aldrete score reduces recovery time after non-anesthesiologist-administered procedural sedation in gastrointestinal endoscopy. Endosc Int Open 2022; 10:E1544-E1547. [PMID: 36531676 PMCID: PMC9754857 DOI: 10.1055/a-1964-7458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/12/2022] [Indexed: 12/23/2022] Open
Abstract
Background and study aims Procedural sedation and analgesia (PSA) by trained non-anesthesiologist physicians and/or nurses is often performed during endoscopic procedures. Discharge from the recovery area after monitored observation is frequently based on fixed time parameters or subjective clinical assessment. In this study, the effect of implementation of the Aldrete score on recovery time after procedural sedation was analyzed in a real-life setting. Patients and methods A prospective observational study of patients undergoing procedural sedation and analgesia during gastroscopy, colonoscopy or endoscopic ultrasound was performed. All procedures were randomly included to represent a real-life situation with different endoscopists, recovery nurses, endoscopy systems and indications. After a first observation period, all endoscopy nurses were trained to implement the Aldrete score when discharging patients, followed by a second observation period. Results During the first observation period, the average time spent in the recovery area was 59 ± 22 minutes after procedural sedation. After implementation of the Aldrete score, the recovery time decreased significantly to 47 ± 25 minutes ( P < 0.01) with identical doses of procedural sedation and analgesia. The decrease in time was between 19 % and 35 % for the different endoscopic procedures. Conclusions Implementation of the Aldrete score after procedural sedation and analgesia significantly reduces the time spent in the recovery area. The score can be used to safely implement a discharge policy that provides more efficient and standardized management for an endoscopy service.
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Affiliation(s)
- Philip Roelandt
- Department of Gastroenterology and Hepatology, UZ Leuven, Leuven, Belgium,Translational Research in Gastrointestinal Diseases (TARGID), Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
| | - Rico Haesaerts
- Department of Gastroenterology and Hepatology, UZ Leuven, Leuven, Belgium
| | - Ingrid Demedts
- Department of Gastroenterology and Hepatology, UZ Leuven, Leuven, Belgium,Translational Research in Gastrointestinal Diseases (TARGID), Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, UZ Leuven, Leuven, Belgium,Translational Research in Gastrointestinal Diseases (TARGID), Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
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Gubbiotti A, Spadaccini M, Badalamenti M, Hassan C, Repici A. Key factors for improving adenoma detection rate. Expert Rev Gastroenterol Hepatol 2022; 16:819-833. [PMID: 36151898 DOI: 10.1080/17474124.2022.2128761] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Colonoscopy is a fundamental tool in colorectal cancer (CRC) prevention. Nevertheless, one-fourth of colorectal neoplasms are still missed during colonoscopy, potentially being the main reason for post-colonoscopy colorectal cancer (PCCRC). Adenoma detection rate (ADR) is currently known as the best quality indicator correlating with PCCRC incidence. AREAS COVERED We performed a literature review in order to summarize evidences investigating key factors affecting ADR: endoscopists education and training, patient management, endoscopic techniques, improved navigation (exposition defect), and enhanced lesions recognition (vision defect) were considered. EXPERT OPINION 'Traditional' factors, such as split dose bowel preparation, adequate withdrawal time, and right colon second view, held a significant impact on ADR. Several devices and technologies have been developed to promote high-quality colonoscopy, however artificial intelligence may be considered the most promising tool for ADR improvement, provided that endoscopists education and recording are guaranteed.
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Affiliation(s)
- Alessandro Gubbiotti
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Italy
| | - Marco Spadaccini
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Italy
| | - Matteo Badalamenti
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Italy
| | - Cesare Hassan
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Italy
| | - Alessandro Repici
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Italy
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Camargo MG, Moreira MM, Magro DO, Santos JOM, Ayrizono MDLS. VOLUMETRIC CAPNOGRAPHY FOR RESPIRATORY MONITORING OF PATIENTS DURING ROUTINE COLONOSCOPY WITH ROOM-AIR AND CARBON DIOXIDE INSUFFLATION. ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:383-389. [PMID: 36102436 DOI: 10.1590/s0004-2803.202203000-69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Capnography and carbon dioxide (CO2) insufflation during gastrointestinal endoscopy under sedation are associated with safety and comfort improvements, respectively. Capnography can provide early detection of apnea and hypoxemia, whereas CO2 insufflation causes lower periprocedural discomfort. This is the first study to report the application of volumetric capnography in colonoscopy. OBJECTIVE This study aimed to evaluate the use of volumetric capnography with room air (RA) and CO2 insufflation during routine colonoscopy. METHODS In this prospective cohort study, 101 patients who underwent routine colonoscopy under sedation with volumetric capnography monitoring were included. Insufflation with RA was used to distend the intestinal lumen in group 1 (n=51), while group 2 (n=50) used CO2 insufflation. The primary endpoints were episodes of hypoxia, alveolar hypoventilation, and end-tidal CO2 (EtCO2). The secondary endpoints were tidal volume per minute, consumption of sedation medications, and post-procedure pain using the Gloucester modified pain scale. RESULTS The number of episodes of hypoxia (SpO2<90%) was similar between the groups: four episodes in Group 1 and two episodes in Group 2. The duration of hypoxia was significantly longer in group 2 (P=0.02). Hypoalveolar ventilation (EtCO2) occurred more frequently in Group 2 than in Group 1 (27 vs 18 episodes, P=0.05). Regarding EtCO2, Group 2 showed higher values in cecal evaluation (28.94±4.68 mmHg vs 26.65±6.12 mmHg, P=0.04). Regarding tidal volume per minute, Group 2 had significantly lower values at the cecal interval compared to Group 1 (2027.53±2818.89 vs 970.88±1840.25 L/min, P=0.009). No episodes of hypercapnia (EtCO2 > 60 mmHg) occurred during the study. There was no difference in the consumption of sedation medications between the groups. Immediately after colonoscopy, Group 2 reported significantly less pain than Group 1 (P=0.05). CONCLUSION In our study, volumetric capnography during colonoscopy was feasible and effective for monitoring ventilatory parameters and detecting respiratory complications. CO2 insufflation was safe and associated with less pain immediately after colonoscopy.
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Affiliation(s)
- Michel Gardere Camargo
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Gastrocentro, Campinas, SP, Brasil
| | - Marcos Mello Moreira
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Clínica Médica, Disciplina de Pneumologia, Campinas, SP, Brasil
| | - Daniéla Oliveira Magro
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Gastrocentro, Campinas, SP, Brasil
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Gündüz F, Kani HT, Chang S, Akdeniz E, Eren F, Yılmaz Y, Alahdab YÖ. Effect of carbon dioxide versus room air insufflation on post-colonoscopic pain: A prospective, randomized, controlled study. TURKISH JOURNAL OF GASTROENTEROLOGY 2020; 31:676-680. [PMID: 33169704 DOI: 10.5152/tjg.2020.20596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS Room air (RA) and carbon dioxide (CO2) are widely used to insufflate the colon to examine the mucosa in colonoscopy. Pain, discomfort, and bloating can be seen during and after colonoscopy secondary to bowel distention. This study aimed to investigate the effect of CO2 on post-procedure pain sensation (PPPS) in comparison with RA. MATERIALS AND METHODS Patients were randomly assigned to the RA and CO2 insufflation groups in a 1:1 ratio. The visual analog scale (VAS) was used to measure the pain before and after the colonoscopy. VAS score of 0 was accepted as the absence of pain and above 0 was accepted as the presence of pain. The primary outcome was to investigate the effect of CO2 insufflation on PPPS. Secondary outcomes were to investigate the other contributing factors affecting PPPS and the effect of CO2 on PPPS in patients with inflammatory bowel disease (IBD). RESULTS A total of 204 patients were enrolled in the study. No significant difference in PPPS was seen between the 2 groups at any point in time after the colonoscopy. Furthermore, there was no significant difference in pain sensation between the CO2 and RA groups in patients with IBD. When we investigated the other contributing factors to pain sensation, body-mass index (BMI) was found to be significant at 30 minutes and BMI and colonoscopy time were found to be significant at 6 hours afterwards. CONCLUSION We found no favorable effect of CO2 insufflation on PPPS in colonoscopy, including in patients with IBD.
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Affiliation(s)
- Feyza Gündüz
- Department of Gastroenterology, Marmara University School of Medicine, İstanbul, Turkey;Marmara University, Institute of Gastroenterology, İstanbul, Turkey
| | - Haluk Tarık Kani
- Department of Gastroenterology, Marmara University School of Medicine, İstanbul, Turkey
| | - Shannon Chang
- Division of Gastroenterology, Inflammatory Bowel Disease Center, New York University Langone Health, New York, New York
| | - Esra Akdeniz
- Department of Medical Education, Marmara University, School of Medicine, İstanbul, Turkey
| | - Fatih Eren
- Marmara University Institute of Gastroenterology, İstanbul, Turkey; Department of Medical Biology, Marmara University School of Medicine, İstanbul, Turkey
| | - Yusuf Yılmaz
- Department of Gastroenterology, Marmara University School of Medicine, İstanbul, Turkey;Marmara University, Institute of Gastroenterology, İstanbul, Turkey
| | - Yeşim Özen Alahdab
- Department of Gastroenterology, Marmara University School of Medicine, İstanbul, Turkey;Marmara University, Institute of Gastroenterology, İstanbul, Turkey
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Kaiser-Júnior RL, DE-Quadros LG, Flamini-Júnior M, Faria MAG, Campo JCO, DE-Oliveira VL, Zotarelli-Filho IJ. NEW BOWEL PREPARATION TECHNIQUE FOR COLONOSCOPY: CLINICAL TRIAL COMPARING AQUANET AND MANNITOL. ACTA ACUST UNITED AC 2018; 31:e1393. [PMID: 30133685 PMCID: PMC6097177 DOI: 10.1590/0102-672020180001e1393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/28/2018] [Indexed: 01/15/2023]
Abstract
Background: Fifty-five percent of Americans aged 50-65 are submitted to colonoscopy. For
over 65-year, this number increases to 64%. In Brazil, it is forecast that
the population submitted to colonoscopy will grow, even though inadequate
preparation is still a major problem. Aim: To analyze the quality of a new intestinal preparation technique, Aquanet
EC-2000®, compared to oral Mannitol solution. Methods: This prospective longitudinal study enrolled 200 patients with indication for
colonoscopy. The sample was randomly allocated to two groups of 100; one
group received Aquanet EC-2000® to prepare for colonoscopy and
the other Mannitol solution. The Boston scale was used to analyze the
results. Results: As expected both preparations produced similar results with the bowel
cleansing of the different regions of the colon being classified as Boston
scale 3 (excellent) in most patients (p>0.05). Conclusion: The results of bowel preparation using Aquanet EC-2000® were
similar to using Mannitol solution.
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Affiliation(s)
- Roberto Luiz Kaiser-Júnior
- Kaiser Clinic and Hospital, Endoscopy and Colonoscopy, São José do Rio Preto, SP.,Hospital Beneficência Portuguesa, Colonoscopy, São José do Rio Preto, SP
| | - Luiz Gustavo DE-Quadros
- Kaiser Clinic and Hospital, Endoscopy and Colonoscopy, São José do Rio Preto, SP.,Hospital Beneficência Portuguesa, Colonoscopy, São José do Rio Preto, SP.,Faculty of Medicine of the ABC, Endoscopy, Santo André, SP
| | - Mário Flamini-Júnior
- Kaiser Clinic and Hospital, Endoscopy and Colonoscopy, São José do Rio Preto, SP.,Hospital Beneficência Portuguesa, Colonoscopy, São José do Rio Preto, SP
| | - Mikaell Alexandre Gouvea Faria
- Kaiser Clinic and Hospital, Endoscopy and Colonoscopy, São José do Rio Preto, SP.,Hospital Beneficência Portuguesa, Colonoscopy, São José do Rio Preto, SP.,Faculty of Medicine, Unilago, Colonoscopy, São José do Rio Preto, SP, Brasil
| | | | | | - Idiberto José Zotarelli-Filho
- Kaiser Clinic and Hospital, Endoscopy and Colonoscopy, São José do Rio Preto, SP.,Hospital Beneficência Portuguesa, Colonoscopy, São José do Rio Preto, SP
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