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Söderberg S, Nyhlin N, Moro A, Figaro C, Fransson E, Stefansdotter J, Schagerström M, Lindblad M, Ahlzén M, Zukovets O, Borell S, Johansson V, Axman M, Wendt A, Falck H, van Nieuwenhoven MA. Time and Motion at the Endoscopy Unit-A University Hospital Experience. Health Serv Res Manag Epidemiol 2023; 10:23333928231159808. [PMID: 36923210 PMCID: PMC10009022 DOI: 10.1177/23333928231159808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Background/aims An effective workflow at the endoscopy unit is important for optimal production. We conducted a time-and-motion study to identify the amount of time that patients spend during the different steps of a regular endoscopy procedure and compared propofol with midazolam sedation. Methods Data from 376 patients were prospectively collected. Durations of the different procedure steps were measured. Correlations between recovery times, age, and dose of sedative were calculated. Multiple regression analysis was performed to evaluate how various factors affect recovery time. Results The use of midazolam resulted in significantly shorter procedure duration for gastroscopy (5.1 vs 8.3 min), shorter endoscopist delay duration for either types of endoscopy (5.9 vs 8.3 min for gastroscopy and 6.7 vs 11.4 min for colonoscopy), shorter endoscopy room duration for gastroscopy (22.2 vs 30.0 min), shorter recovery time for colonoscopy (23.4 vs 27.4 min) and shorter Endoscopy Unit Duration for either type of endoscopy (77.1 vs 101.4 min for gastroscopy and 99.6 vs 123.2 min for colonoscopy). There was a weak correlation between dose of midazolam and recovery time. Conclusions In contrast to other studies, propofol administration leads to more time spent at different steps in the workflow at our unit. Implementing propofol sedation will not improve efficacy if other steps in the workflow are not taken into account.
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Affiliation(s)
- Simon Söderberg
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Nils Nyhlin
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Axelina Moro
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Christina Figaro
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Emelie Fransson
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jennie Stefansdotter
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Malin Schagerström
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Maria Lindblad
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Martin Ahlzén
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Olga Zukovets
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Sofia Borell
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Viktoria Johansson
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Marianne Axman
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anette Wendt
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Hanna Falck
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Michiel A van Nieuwenhoven
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Januszewicz W, Witczak K, Wieszczy P, Socha M, Turkot MH, Wojciechowska U, Didkowska J, Kaminski MF, Regula J. Prevalence and risk factors of upper gastrointestinal cancers missed during endoscopy: a nationwide registry-based study. Endoscopy 2022; 54:653-660. [PMID: 34674210 DOI: 10.1055/a-1675-4136] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND A significant proportion of upper gastrointestinal cancers (UGICs) remain undetected during esophagogastroduodenoscopy (EGD). We investigated the characteristics and risk factors of UGICs missed during endoscopy. METHODS In this nationwide registry-based study, we analyzed two large Polish datasets (National Health Fund and National Cancer Registry) to identify individuals who underwent EGD and were subsequently diagnosed with UGIC. Cancers diagnosed < 6 months after EGD were defined as "prevalent" and those within ≥ 6- < 36 months as "missed." We compared the characteristics of missed and prevalent cancers, and analyzed the risk factors for missed UGICs in a multivariable regression model. RESULTS We included 4 105 399 patients (mean age 56.0 years [SD 17.4]; 57.5 % female) who underwent 5 877 674 EGDs in 2012-2018. Within this cohort, 33 241 UGICs were diagnosed, of which 1993 (6.0 %) were missed. Within esophageal neoplasms, adenocarcinomas were more frequently missed than squamous cell cancers (6.1 % vs. 4.2 %), with a relative risk of 1.4 (95 % confidence interval [CI] 1.1-1.8, P = 0.01). Most gastric cancers were adenocarcinomas, of which 5.7 % were classified as missed. Overall, a higher proportion of missed UGICs than prevalent cancers presented at an advanced stage (42.2 % vs. 36.2 %, P < 0.001). Risk factors for missed UGICs included initial EGD performed within primary (vs. secondary) care (odds ratio [OR] 1.3, 95 %CI 1.2-1.5), female sex (OR 1.3, 95 %CI 1.2-1.4), and higher comorbidity (Charlson comorbidity index ≥ 5 vs. 0; OR 6.0, 95 %CI 4.7-7.5). CONCLUSIONS Among UGICs, esophageal adenocarcinomas were missed most frequently. Missed cancers occur more frequently within the primary care sector and are found more often in women and individuals with multiple comorbidities.
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Affiliation(s)
- Wladyslaw Januszewicz
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Klaudiusz Witczak
- Department of Analyses and Strategy, Ministry of Health of the Republic of Poland, Warsaw, Poland
| | - Paulina Wieszczy
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Magda Socha
- Department of Analyses and Strategy, Ministry of Health of the Republic of Poland, Warsaw, Poland
| | - Maryla H Turkot
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Urszula Wojciechowska
- Department of Epidemiology and Cancer Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Joanna Didkowska
- Department of Epidemiology and Cancer Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Michal F Kaminski
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jaroslaw Regula
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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3
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Gao N, Chen H, Wang Y, Guo Y, Liu Z, Wang W. Acupuncture to Improve Patient Discomfort During Upper Gastrointestinal Endoscopy: Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:865035. [PMID: 35721049 PMCID: PMC9204029 DOI: 10.3389/fmed.2022.865035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/14/2022] [Indexed: 12/25/2022] Open
Abstract
Background and Aims Severe discomfort during an upper gastrointestinal endoscopy (UGE) is often a stressful experience for patients undergoing the procedure. An increasing number of studies have shown that acupuncture may reduce discomfort during UGE. A systematic review in 2004 investigated the effect of acupuncture for gastrointestinal endoscopy, but these data have not been recently reviewed. Therefore, this study was conducted to evaluate the current evidence and provide up-to-date knowledge for clinical decision-making. Methods Nine databases were searched from inception to June 2021. Eligible randomized controlled trials (RCTs) were included. The outcome data were synthesized where necessary, and risks of bias of included studies were assessed using RevMan V.5.3. Results Twenty-three eligible RCTs with 3,349 patients were identified. It was found that acupuncture plus topical pharyngeal anesthesia with lidocaine hydrochloride (TPALH) resulted in greater improvements regarding visual analog scale (VAS) scores and the incidence of nausea and vomiting (INV) when compared with TPALH alone. These results were consistent among studies of manual acupuncture, electroacupuncture, auricular-plaster, superficial needle (SFN) and acupressure. In the meta-analysis, SFN plus TPALH showed significant improvement of VAS scores compared to sham SFN plus TPALH (MD -1.11, 95% CI -1.52 to -0.70, P < 0.00001). Most of included studies did not report any side effects in their findings, and were of medium-to-high risk of bias. Conclusion Acupuncture, as adjunctive therapy to TPA, may result in less patient discomfort than TPA alone. Findings from this review should be interpreted with caution due to the high heterogeneity identified. There is low-quality evidence supporting the use of acupuncture over sham. More rigorously designed RCTs are needed to inform clinical decision-making. Systematic Review Registration PROSPERO [CRD42014008966].
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Affiliation(s)
- Ning Gao
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Huan Chen
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- School of Acupuncture-Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yang Wang
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yufeng Guo
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhishun Liu
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Weiming Wang
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Pontone S, Lauriola M, Palma R, Panetta C, Tomai M, Baker R. Do difficulties in emotional processing predict procedure pain and shape the patient's colonoscopy experience? BMJ Open 2022; 12:e050544. [PMID: 35190415 PMCID: PMC8860019 DOI: 10.1136/bmjopen-2021-050544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Pain and fear of colonoscopy are inter-related; they make the colonoscopy experience unpleasant and impede adherence to colorectal cancer screening and prevention campaigns. According to previous research, fear and pain have been found to depend on patients' maladaptive cognitions and exaggerated emotional responses. The present study investigated whether emotional processing difficulties predicted colonoscopy pain and the associated catastrophising thoughts. DESIGN Prospective, observational, blinded. METHOD A sample of 123 patients was assessed for specific emotional processing difficulties (ie, suppression of emotions, unprocessed emotions, failure to control emotions, avoidance of emotional triggers and impoverished emotional experience) and anxiety-related variables (ie, worry, anxiety and depression) before colonoscopy. A trained medical doctor rated patients' behavioural manifestations of pain during colonoscopy. After complete recovery from sedation, the patients rated the endoscopy experience using perceived pain and situation-specific pain catastrophising scales. RESULTS About half of the patients were above the cut-off for anxiety before the procedure. Notwithstanding sedation, behavioural manifestations of pain during colonoscopy indicated probable or moderate pain for about one-third of the patients. Failure to control emotions, poor emotional experience and avoiding emotional triggers were positively correlated with behavioural manifestations of pain, self-reported pain and pain catastrophising. Regression analyses, controlling for gender, age, colonoscopy experience and sedation, revealed that avoidance of emotional triggers uniquely contributed to predicting pain outcomes. CONCLUSIONS Early identification of emotional processing difficulties associated with pain catastrophising can help define personalised psychological preparation paths to manage negative emotions in patients who fear colonoscopy pain.
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Affiliation(s)
- Stefano Pontone
- Department of Surgical Sciences, Sapienza University of Rome, Roma, Italy
| | - Marco Lauriola
- Department of Social and Developmental Psychology, Sapienza University of Rome, Roma, Italy
| | - Rossella Palma
- Department of Surgical Sciences, Sapienza University of Rome, Roma, Italy
| | - Cristina Panetta
- Department of Surgical Sciences, Sapienza University of Rome, Roma, Italy
| | - Manuela Tomai
- Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Roma, Italy
| | - Roger Baker
- Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Poole, UK
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5
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Passi M, Rahman F, Gurram S, Kumar S, Koh C. Identifying who best tolerates moderate sedation: Results from a national database of gastrointestinal endoscopic outcomes. World J Gastrointest Endosc 2021; 13:97-110. [PMID: 33959232 PMCID: PMC8080537 DOI: 10.4253/wjge.v13.i4.97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/19/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND With increasing volume and cost of gastrointestinal endoscopic procedures, the proper selection of patients for moderate sedation becomes increasingly relevant. The current literature lacks consistent findings that allow for appropriate selection of patients for moderate sedation.
AIM To analyze a nationwide registry of patients to identify patient and procedural factors associated with lower sedation requirements for endoscopy.
METHODS The Clinical Outcomes Research Initiative National Endoscopic Database was queried to assess adult patients undergoing moderate sedation for esophagogastroduodenoscopy (EGD) and colonoscopy from 2008 to 2014. Patients were stratified into two groups [low dose (LD) and high dose sedation] based on sedation requirements. Anthropometric, procedural, and anesthesia data were compared, and multivariable analysis was performed to identify factors associated with LD sedation.
RESULTS Of the 371102 patients included in the study, 63137 where stratified into the LD sedation group and 307965 were in the high dose group. Moderate sedation was managed primarily by endoscopists (50%) and anesthesia providers (47%). Patients undergoing EGDs and procedures performed in the inpatient setting, in ambulatory surgery centers, intensive care units or hospital wards, required less sedation than colonoscopies, outpatient procedures and procedures done in endoscopy suites, respectively (P < 0.0001 for all). On multivariable analysis, factors predictive of tolerance with lower sedation requirements for EGDs and colonoscopies were female gender, age ≥ 50, non-White race, Hispanic descent, body mass index ≤ 25 kg/m2, and higher American Society of Anesthesia Class (P < 0.0001 for all).
CONCLUSION Clinicians should consider these patient profiles in determining which patients will better tolerate moderate sedation vs those better suited for alternative sedation methods.
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Affiliation(s)
- Monica Passi
- Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, United States
| | - Farial Rahman
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, United States
| | - Sandeep Gurram
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, United States
| | - Sheila Kumar
- Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, United States
| | - Christopher Koh
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, United States
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6
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Riley OF, Mamtora S, Carroll E, Luck J. <p>Surgical Grade and Repeat Laser Peripheral Iridotomy Procedures with Risk Stratification and Educational Considerations</p>. Clin Ophthalmol 2020; 14:4319-4323. [PMID: 33335384 PMCID: PMC7737541 DOI: 10.2147/opth.s283370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/19/2020] [Indexed: 12/01/2022] Open
Abstract
Background/Aims Peripheral laser iridotomy (PLI) is a commonly performed procedure. While effective, repeat procedures (RPs) may be required for a variety of causes. We report the causes and rate of RP PLI and whether surgical grade is a risk factor. Methods Two years of retrospective data from 282 patients who had undergone PLI at a single UK ophthalmology department were retrieved using an electronic medical record system (Medisoft, Leeds, UK). Results A total of 253 patients underwent analysis with 20 requiring RPs. Our data identified a correlation between experience of the operating surgeon and an increase in RP rate, with statistical significance (p=0.036) observed between consultants and registrars. No other statistically significant risk factors were identified from our study. Prescriber preference for iopidine was observed. From our findings and the current literature, prognostic factors that appear to influence RP rate include surgical grade, patient compliance, Asian ethnicity, and anticoagulation. Conclusion RP rate increases in PLI when a junior surgeon is performing the procedure, and thus cases with established prognostic factors for RPs should have senior input. Formal and standardized YAG-laser training should be implemented alongside risk stratification of patients to improve both trainee education and patient care.
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Affiliation(s)
- Oliver Francis Riley
- Ophthalmology Department, Royal United Hospital, BathBA1 3NG, UK
- Correspondence: Oliver Francis Riley Ophthalmology Department, Royal United Hospital, BathBA1 3NG, UKTel +44 1225 428-331 Email
| | - Sunil Mamtora
- Ophthalmology Department, Royal United Hospital, BathBA1 3NG, UK
| | - Emma Carroll
- Ophthalmology Department, Royal United Hospital, BathBA1 3NG, UK
| | - Jon Luck
- Ophthalmology Department, Royal United Hospital, BathBA1 3NG, UK
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7
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Lauriola M, Tomai M, Palma R, La Spina G, Foglia A, Panetta C, Raniolo M, Pontone S. Procedural Anxiety, Pain Catastrophizing, and Procedure-Related Pain during EGD and Colonoscopy. South Med J 2020; 113:8-15. [PMID: 31897492 DOI: 10.14423/smj.0000000000001058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Although sedatives and analgesic drugs defuse anxiety and relieve pain, digestive endoscopy still is uncomfortable and painful for some patients. Identifying patients who tolerate digestive endoscopy less well remains difficult. The present study evaluated the relations between procedural anxiety, catastrophizing thoughts, and pain, using a prospective design and multimodal assessments of pain. METHODS A total of 118 consecutive patients were assessed for procedural anxiety before endoscopy. During endoscopy, a doctor rated the patients' pain behavior. Before discharge, the patients retrospectively rated endoscopy pain and related catastrophizing thoughts. RESULTS Notwithstanding sedation, our study revealed large between-subject variability in pain. Catastrophizing thoughts mediated the relation between procedure-related pain observed by the doctor and pain intensity reported by the patient. Catastrophizing thoughts also mediated the effect of procedural anxiety. Our study showed that anxiety exacerbates endoscopy pain when the patient engages in ruminative thinking and feels unable to cope with unpleasant bodily sensations. CONCLUSIONS This study shows that catastrophizing thoughts account for between-subject differences in endoscopy pain. Rumination and helplessness but not magnification explain how procedural anxiety may evolve in a painful endoscopy experience. To the extent that one can address catastrophizing thoughts, endoscopy pain can be mitigated, especially for patients who are difficult to sedate.
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Affiliation(s)
- Marco Lauriola
- From Social and Developmental Psychology, Dynamic and Clinical Psychology, and the Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Manuela Tomai
- From Social and Developmental Psychology, Dynamic and Clinical Psychology, and the Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Rossella Palma
- From Social and Developmental Psychology, Dynamic and Clinical Psychology, and the Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Gaia La Spina
- From Social and Developmental Psychology, Dynamic and Clinical Psychology, and the Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Anastasia Foglia
- From Social and Developmental Psychology, Dynamic and Clinical Psychology, and the Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Cristina Panetta
- From Social and Developmental Psychology, Dynamic and Clinical Psychology, and the Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Marilena Raniolo
- From Social and Developmental Psychology, Dynamic and Clinical Psychology, and the Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Stefano Pontone
- From Social and Developmental Psychology, Dynamic and Clinical Psychology, and the Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
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8
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Lauriola M, Tomai M, Palma R, La Spina G, Foglia A, Panetta C, Raniolo M, Pontone S. Intolerance of Uncertainty and Anxiety-Related Dispositions Predict Pain During Upper Endoscopy. Front Psychol 2019; 10:1112. [PMID: 31156518 PMCID: PMC6529782 DOI: 10.3389/fpsyg.2019.01112] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/29/2019] [Indexed: 12/16/2022] Open
Abstract
Although sedatives can defuse anxiety and relieve pain, Esophagogastroduodenoscopy (EGD) still is uncomfortable and threatening for some patients. Identifying patients who tolerate digestive endoscopy less well remains difficult. Using a prospective design and a multimodal assessment of pain, the present study evaluated how anxiety-related variables predicted subsequent pain outcomes. Sixty-two consecutive patients referred for elective EGD were assessed for intolerance of uncertainty (IU), procedure-related worries, anxiety sensitivity and health distress before endoscopy. During endoscopy, a doctor rated patients’ pain behavior. After complete recovery from sedation, the patients retrospectively rated endoscopy pain and situation specific catastrophizing thoughts. Descriptive analyses showed that patients undergoing EGD for the first time were more distressed and anxious than patients accustomed to the procedure and needed a higher sedative dose. Notwithstanding sedation, the behavioral rating of pain was above the cut-off value for probable pain for more than half of the patients. IU assessed before endoscopy predicted situational pain catastrophizing (PC) and self-reported pain after endoscopy through procedure related worries. Situational PC not only mediated the effect of worry, but also female gender and younger age were associated with self-reported pain through increased catastrophizing thoughts. Health distress and anxiety sensitivity predicted PC only for women, younger patients, and those not accustomed to the procedure. Our study showed that psychological preparation before sedation is needed especially for first-timers, women, and younger patients, addressing maladaptive cognitive beliefs and acquainting patients with the somatic sensations that they might experience during the procedure.
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Affiliation(s)
- Marco Lauriola
- Department of Social and Developmental Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Manuela Tomai
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Rossella Palma
- Department of Surgical Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Gaia La Spina
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Anastasia Foglia
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Cristina Panetta
- Department of Surgical Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Marilena Raniolo
- Department of Surgical Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Stefano Pontone
- Department of Surgical Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
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9
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Lee TH, Lee JS. Safety of flexible endoscopic evaluation of swallowing examination in gastroenterological practice. TURKISH JOURNAL OF GASTROENTEROLOGY 2018; 30:148-154. [PMID: 30459134 DOI: 10.5152/tjg.2018.18279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS In South Korea, the flexible endoscopic evaluation of swallowing (FEES) has been increasingly performed by gastroenterologists. The principal concern was the safety of the FEES performed by gastroenterologists without any involvement of speech-language pathologists. We aimed to characterize the safety and tolerance of gastroenterologist-directed FEES examinations (GDFEES). MATERIALS AND METHODS We evaluated the GDFEES failures, safety profile (laryngospasm, epistaxis, vasovagal syncope, airway compromise, heart rate, blood pressure, and significant change in cardiovascular function), and discomfort level in patients undergoing GDFEES. These outcomes were also analyzed based on gender, age, and calendar period. RESULTS A total 303 examinations in 268 adult patients with dysphagia were performed during the study period. The GDFEES failures occurred in 5 patients (1.7%). The causes of failures were poor co-operation and insertion difficulty. There were no instances of laryngospasm or vasovagal syncope or significant cardiovascular changes in any of the examinations. Self-limiting epistaxis occurred in 22 examinations (7.3%). The discomfort ratings were as follows: 128 examinations (43.0%) rated the overall discomfort of the test as none, 150 (50.3%) as mild, 18 (6.0%) as moderate, and 2 (0.7%) as severe discomfort. The discomfort level was significantly different only between the first and second half periods (p <0.001), but it was related to neither gender nor age. CONCLUSION The GDFEES can be endorsed as an appropriate paradigm for clinical practice based on our study investigating its safety and tolerance.
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Affiliation(s)
- Tae Hee Lee
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Joon Seong Lee
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
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10
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Grilo-Bensusan I, Herrera Martín P, Jiménez-Mesa R, Aguado Álvarez V. Prospective study of the factors associated with poor tolerance to ambulatory colonoscopy under conscious sedation. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 110:223-230. [PMID: 29578352 DOI: 10.17235/reed.2018.5287/2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND conscious sedation with benzodiazepines and opiates for colonoscopy is a widespread clinical practice. OBJECTIVE to determine the patient's tolerance to colonoscopy and identify the factors associated with lower tolerance. METHODS a prospective, single-center, descriptive study of patients undergoing ambulatory colonoscopy under conscious sedation. The pain was assessed using a visual analogue scale with a score of 0 to 100 and also qualitatively. RESULTS three hundred patients with a median age of 54 years completed the study (p25-75: 45-64); 138 were men (46%). Tolerance was good in 273 cases (91%). The median value of tolerance was 13 (p25-p75: 4-33). Pain was considered as mild in 215 (71.7%), moderate in 57 (19%) and intense in 28 (9.3%). In the univariate study, greater pain was associated with females, anxiety, the indication for the procedure, the length of time and difficulty of the examination, and the doses of sedatives. In the multivariate study, both the indication (OR 2.92, 95% CI = 1.03-8.2, p < 0.05) and the difficulty of the examination (OR 4.68, 95% CI = 1.6-13.6, p < 0.01) were significant. Complications were found in 16 patients (5.3%), although all of them were insignificant. CONCLUSIONS tolerance of patients undergoing ambulatory colonoscopy under conscious sedation is good in most cases and complications are infrequent and minor. A worse tolerance to the test is associated with women patients, individuals with anxiety prior to colonoscopy, indication, difficult and longer exploration and lower doses of sedatives.
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Affiliation(s)
| | - Pablo Herrera Martín
- Aparato digestivo. , Hospital de Alta Resolución de Écija. APS Bajo Guadalquivir
| | - Remedios Jiménez-Mesa
- Supervisora de enfermería, Hospital de Alta Resolución de Écija. APS Bajo Guadalquivir
| | - Valle Aguado Álvarez
- Enfermera. Área de consulta. , Hospital de Alta Resolución de Écija. APS Bajo Guadalquivir
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Ching HL, Hale MF, Sidhu R, McAlindon ME. Reassessing the value of gastroscopy for the investigation of dyspepsia. Frontline Gastroenterol 2018; 9:62-66. [PMID: 29484162 PMCID: PMC5824766 DOI: 10.1136/flgastro-2017-100838] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/29/2017] [Accepted: 07/03/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate the diagnostic yield of investigating dyspepsia with oesophagogastroduodenoscopy (OGD) with or without mucosal biopsy. DESIGN Retrospective service evaluation study. SETTING Two teaching hospitals: The Royal Hallamshire Hospital and Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, UK. PATIENTS 500 patients, 55 years of age and over, who underwent OGD to investigate dyspepsia were included. The study period included a 3-month window. All OGDs were performed on an outpatient basis. INTERVENTIONS Data were extracted from electronic OGD records within the study period. MAIN OUTCOME MEASURES Diagnostic yield provided by endoscopic examination and histological assessment. RESULTS 378 patients (75.6%) were reported to have some form of endoscopic abnormality, and 417 patients (83.4%) had biopsies taken. The most common findings at OGD were gastritis (47.2%) and oesophagitis (24.4%). Oesophagogastric malignancy was seen in 1%. Diagnoses made endoscopically or histologically that would not have been appropriately managed by empirical therapies were seen in 16.2%. CONCLUSION OGD in dyspepsia influences patient management in approximately one-sixth of cases. However, the majority of patients are sufficiently managed with Helicobacter pylori testing and eradication and/or a trial of proton pump inhibitor therapy. Further non-invasive approaches are needed to identify patients who need endoscopy for biopsy or therapy.
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Affiliation(s)
- Hey-Long Ching
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Melissa F Hale
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Reena Sidhu
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Mark E McAlindon
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK
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Silvester JA, Kalkat H, Graff LA, Walker JR, Singh H, Duerksen DR. Information seeking and anxiety among colonoscopy-naïve adults: Direct-to-colonoscopy vs traditional consult-first pathways. World J Gastrointest Endosc 2016; 8:701-708. [PMID: 27909550 PMCID: PMC5114459 DOI: 10.4253/wjge.v8.i19.701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/28/2016] [Accepted: 07/22/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate the effects of direct to colonoscopy pathways on information seeking behaviors and anxiety among colonoscopy-naïve patients.
METHODS Colonoscopy-naïve patients at two tertiary care hospitals completed a survey immediately prior to their scheduled outpatient procedure and before receiving sedation. Survey items included clinical pathway (direct or consult), procedure indication (cancer screening or symptom investigation), telephone and written contact from the physician endoscopist office, information sources, and pre-procedure anxiety. Participants reported pre-procedure anxiety using a 10 point scale anchored by “very relaxed” (1) and “very nervous” (10). At least three months following the procedure, patient medical records were reviewed to determine sedative dose, procedure indications and any adverse events. The primary comparison was between the direct and consult pathways. Given the very different implications, a secondary analysis considering the patient-reported indication for the procedure (symptoms or screening). Effects of pathway (direct vs consult) were compared both within and between the screening and symptom subgroups.
RESULTS Of 409 patients who completed the survey, 34% followed a direct pathway. Indications for colonoscopy were similar in each group. The majority of the participants were women (58%), married (61%), and internet users (81%). The most important information source was family physicians (Direct) and specialist physicians (Consult). Use of other information sources, including the internet (20% vs 18%) and Direct family and friends (64% vs 53%), was similar in the Direct and Consult groups, respectively. Only 31% of the 81% who were internet users accessed internet health information. Most sought fundamental information such as what a colonoscopy is or why it is done. Pre-procedure anxiety did not differ between care pathways. Those undergoing colonoscopy for symptoms reported greater anxiety [mean 5.3, 95%CI: 5.0-5.7 (10 point Likert scale)] than those for screening colonoscopy (4.3, 95%CI: 3.9-4.7).
CONCLUSION Procedure indication (cancer screening or symptom investigation) was more closely associated with information seeking behaviors and pre-procedure anxiety than care pathway.
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Cheung D, Menon S, Hoare J, Dhar A, Trudgill N. Factors Associated with Upper Gastrointestinal Cancer Occurrence After Endoscopy that Did Not Diagnose Cancer. Dig Dis Sci 2016; 61:2674-84. [PMID: 27129486 DOI: 10.1007/s10620-016-4176-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/18/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND AIMS Up to 14 % of upper gastrointestinal cancer (UGIC) subjects underwent esophago-gastro-duodenoscopy (EGD) in the preceding 3 years, which did not detect UGIC. The frequency of such events and associated risk factors was evaluated. METHODS UGIC subjects were identified from a UK primary care database. Post-EGD upper gastrointestinal cancers (PEUGIC) cases were subjects undergoing EGD 12-36 months prior to UGIC diagnosis. Controls had not undergone EGD during the same period. Logistic regression analysis examined associations with PEUGIC. RESULTS 4249 gastric cancer (GC) subjects (44.8 %) and 5238 esophageal cancer (EC) subjects (55.2 %) were analyzed. There were 633 (6.7 %) PEUGIC subjects [279 EC and 354 GC]. Multivariate analysis revealed that younger age [OR 1.02, (95 % CI 1.01-1.03), p < 0.0001], female gender [1.39 (1.17-1.64), p < 0.0001], increasing comorbidity [1.35 (1.13-1.61), p < 0.0001], and greater deprivation [1.31 (1.09-1.59), p = 0.005] were associated with PEUGIC. Alarm symptoms on presentation [0.32 (0.26-0.40), p < 0.0001] were less likely to be associated with PEUGIC. GC was more likely to be associated with PEUGIC than EC [1.33 (1.13-1.58), p = 0.001]. PEUGIC EGDs reported findings associated with UGIC (stricture or ulceration) in 8.3 % of cases, and only 60.9 % had a follow-up EGD within 90 days. PEUGIC rate declined from 7.9 to 2.7 % for EC and 9.0-6.5 % for GC during the study period. CONCLUSIONS PEUGIC occurs in 6.7 % of UGIC. PEUGIC was associated with GC, younger age, female gender, increasing comorbidity and deprivation, and a lack of alarm symptoms.
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Affiliation(s)
- Danny Cheung
- Sandwell General Hospital, Lyndon, West Bromwich, UK
| | - Shyam Menon
- New Cross Hospital, Wolverhampton Road, Wolverhampton, UK
| | | | - Anjan Dhar
- Darlington Memorial Hospital, Hollyhurst Road, Darlington, UK
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Vaessen H, Bruens E, Knape J. Clinical analysis of moderate-to-deep-sedation by nonmedical sedation practitioners in 597 patients undergoing gastrointestinal endoscopy: a retrospective study. Endosc Int Open 2016; 4:E564-71. [PMID: 27227116 PMCID: PMC4874805 DOI: 10.1055/s-0042-103238] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/08/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND STUDY AIM The purpose of this study was to evaluate whether moderate-to-deep sedation with propofol and alfentanil can be administered safely by nonmedical sedation practitioners, and the outcomes of this practice in the Netherlands. We retrospectively analyzed the occurrence of sedation-related complications in patients undergoing gastrointestinal endoscopic procedures. PATIENTS AND METHODS In this study, 597 adult patients consecutively underwent upper gastrointestinal endoscopic procedures. The health status of the patients was screened according to a standardized protocol, and the patients were sedated by trained nonmedical sedation practitioners. Their vital signs were continuously monitored and recorded. All patients received oxygen, and the depth of sedation was continuously assessed and recorded. Mild and severe complications were recorded and analyzed. RESULTS All patients recovered uneventfully, and no mortality occurred. Overall, of the 597 sedated patients, 85 had mild and 4 had severe complications. Hypoxemia and upper airway obstruction, which were easily managed by trained nonmedical sedation practitioners, were the most common events. Hypotension was rare. No signs or symptoms suggestive of aspiration were reported. CONCLUSION Moderate-to-deep sedation has been and continues to be a risky medical procedure. Serious complications of propofol/opioid-based sedation, especially respiratory and cardiovascular adverse events, may occur. These complications need to be recognized rapidly and appropriately managed. Our study shows that well-trained nonmedical sedation practitioners can be entrusted to take responsibility for the safe administration of moderate-to-deep sedation.
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Affiliation(s)
- Hermanus Vaessen
- Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Centre Utrecht, the Netherlands,Corresponding author H. H. B. (Paul) Vaessen, RNA, PSA Specialist University Medical Centre UtrechtDepartment of Anesthesiology, Intensive Care and Emergency MedicineHeidelberglaan 100Huispostnr.: F02.8113584 CX UtrechtThe Netherlands+ 31-30-7555442
| | - Elisabeth Bruens
- Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Centre Utrecht, the Netherlands
| | - Johannes Knape
- Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Centre Utrecht, the Netherlands
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Tsou YK, Lien JM, Chen CK, Lin CH, Chen HY, Lee MS. Esophagogastroduodenoscopy with conscious sedation does not interfere with catheter-based 24-h pH monitoring. World J Gastroenterol 2013; 19:1805-1810. [PMID: 23555169 PMCID: PMC3607757 DOI: 10.3748/wjg.v19.i11.1805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 12/27/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the impact of esophagogastroduodenoscopy with conscious sedation on the subsequent 24-h catheter-based pH monitoring.
METHODS: Fifty patients with extra-esophageal symptoms of gastroesophageal reflux disease undergoing ambulatory dual-probe 24-h pH monitoring were enrolled from March 2010 to August 2011. All of the data were collected prospectively and analyzed retrospectively. Thirty-six patients (72%, group A) underwent pH monitoring shortly after esophagogastroduodenoscopy (EGD) with conscious sedation, and 14 patients (28%, group B) underwent pH monitoring without conscious sedation. The 24-h pH data from two time periods were analyzed: the first 4 h (Period I) and the remaining time of the study (Period II).
RESULTS: The mean age of the patients was 49.6 ± 12.5 years; 20 patients (40%) were men. The baseline data, including age, sex, body mass index, reflux esophagitis, the Reflux Symptom Index, and the Reflux Findings Score, were comparable between the two groups. The percentage of total time with a pH < 4 and the frequency of acid reflux during Period I were not significantly different between the two groups, as measured using both pharyngeal (0.03% ± 0.10% vs 0.07% ± 0.16%, P = 0.32; and 0.07 ± 0.23 episodes/h vs 0.18 ± 0.47 episodes/h, P = 0.33, respectively) and esophageal probes (0.96% ± 1.89% vs 0.42% ± 0.81%, P = 0.59; and 0.74 ± 1.51 episodes/h vs 0.63 ± 0.97 episodes/h, P = 0.49, respectively). The percentage of total time with a pH < 4 and the frequency of acid reflux were also not significantly different between Periods I and II in group A patients, as measured using both pharyngeal (0.03% ± 0.10% vs 0.23% ± 0.85%, P = 0.21; and 0.07 ± 0.23 episodes/h vs 0.29 ± 0.98 episodes/h, P = 0.22, respectively) and esophageal probes (0.96% ± 1.89% vs 1.11% ± 2.57%, P = 0.55; and 0.74 ± 1.51 episodes/h vs 0.81 ± 1.76 episodes/h, P = 0.55, respectively).
CONCLUSION: EGD with conscious sedation does not interfere with the results of subsequent 24-h pH monitoring in patients with extra-esophageal symptoms of gastroesophageal reflux disease.
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USSUI VM, SILVA ALWD, BORGES LV, SILVA JGND, ZEITUNE JMR, HASHIMOTO CL. WHAT ARE THE MOST IMPORTANT FACTORS REGARDING ACCEPTANCE TO THE COLONOSCOPY? ARQUIVOS DE GASTROENTEROLOGIA 2013; 50:23-30. [DOI: 10.1590/s0004-28032013000100006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 10/18/2012] [Indexed: 02/06/2023]
Abstract
ContextColonoscopy plays an indubitable role in the setting of clinical practice, however, it is an invasive exam; complex, lengthy, embarrassing, not devoid of risks and discomfort that yields fear and anxiety in the majority of patients. In a new era of rising competition between health institutions, where the quality of health care and client satisfaction are praised, studies regarding tolerance-related colonoscopy issues yield great potential to be explored. In the present study, tolerance is defined as willingness to repeat the exam.ObjectivesEvaluate information associated to bowel preparation, the exam itself and post-examination period that might interfere with the tolerance to the colonoscopy.MethodsAnalysis of the tolerance to the colonoscopy at three stages (pre, post, and during) through a checklist: patient's questionnaire and a medical assessment form were used.ResultsIn this present study, 91.2% of 373 patients exhibited positive tolerance to the colonoscopy. Aspects related to a negative level of tolerance were patient gender (12.9% of women versus 3.2% of men would not repeat the exam), age extremes (less than 20 years and greater than 80 years of age), and abdominal pain, both during the bowel preparation and after the procedure.ConclusionsGender, age, patient cooperation and abdominal pain were the decisive components regarding tolerance to the colonoscopy. Notably, in two phases of the exam, the abdominal pain was the most important feature associated to a lessened tolerance.
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Bannert C, Reinhart K, Dunkler D, Trauner M, Renner F, Knoflach P, Ferlitsch A, Weiss W, Ferlitsch M. Sedation in screening colonoscopy: impact on quality indicators and complications. Am J Gastroenterol 2012; 107:1837-48. [PMID: 23147522 DOI: 10.1038/ajg.2012.347] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Quality indicators including cecal intubation rate (CIR) and adenoma detection rate (ADR) are established. Sex differences of quality indicators are observed, but the influence of sedation has not been investigated so far. The objective of this study is to assess the impact of sedation on quality indicators, including CIR and ADR, according to sex. METHODS We analyzed data of 52,506 screening colonoscopies performed by 196 endoscopists between November 2007 and April 2011 according to the Austrian "quality management for colon cancer prevention" program. RESULTS Sedation did not affect polyp detection rate (women P=0.7972, men P=0.3711) or ADR for both sexes (women P=0.2773, men P=0.8676). ADR was not significantly influenced by sedation (P=0.1272), but by age and sex (both P<0.0001), when the executing endoscopist was considered. Although women were more often sedated than men (90.70 vs. 81.83%; P<0.0001), CIR was slightly lower in women than in men (94.69 vs. 96.58%; P<0.0001). Sedation improved the CIR in women by 2.95% (94.96 vs. 92.01%; P<0.0001), whereas in men it was just by 1.28% (96.81 vs. 95.53%; P<0.0001). Sedated women only reached the CIR of unsedated men (94.96 vs. 95.53%; P=0.1005). Accounting for the intra-observer influence of the endoscopist, the overall CIR was influenced by the interaction of sex and age (P=0.0049), but not by sedation (P=0.1435). CONCLUSIONS Sedation does not increase adenoma or polyp detection, although it leads to an increase in CIR in men and women. This effect is more pronounced in women, yet CIR of men remains higher compared with women. Quality indicators are mainly influenced by the patient's age, sex, and the endoscopists' individual performance, rather than the endoscopists' subspeciality or procedural experience.
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Affiliation(s)
- Christina Bannert
- Quality Assurance Working Group of Austrian Society for Gastroenterology and Hepatology, Vienna, Austria
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Ai ZL, Lan CH, Fan LL, Lan L, Cao Y, Li P, Song O, Chen DF. Unsedated transnasal upper gastrointestinal endoscopy has favorable diagnostic effectiveness, cardiopulmonary safety, and patient satisfaction compared with conventional or sedated endoscopy. Surg Endosc 2012; 26:3565-72. [DOI: 10.1007/s00464-012-2367-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 05/02/2012] [Indexed: 01/01/2023]
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This month in Scandinavian Journal of Gastroenterology. Scand J Gastroenterol 2010. [DOI: 10.3109/00365521.2010.520878] [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: 10/10/2023]
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