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Al-Otaibi S, Rehman A, Mujahid M, Alotaibi S, Saba T. Efficient-gastro: optimized EfficientNet model for the detection of gastrointestinal disorders using transfer learning and wireless capsule endoscopy images. PeerJ Comput Sci 2024; 10:e1902. [PMID: 38660212 PMCID: PMC11041956 DOI: 10.7717/peerj-cs.1902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/31/2024] [Indexed: 04/26/2024]
Abstract
Gastrointestinal diseases cause around two million deaths globally. Wireless capsule endoscopy is a recent advancement in medical imaging, but manual diagnosis is challenging due to the large number of images generated. This has led to research into computer-assisted methodologies for diagnosing these images. Endoscopy produces thousands of frames for each patient, making manual examination difficult, laborious, and error-prone. An automated approach is essential to speed up the diagnosis process, reduce costs, and potentially save lives. This study proposes transfer learning-based efficient deep learning methods for detecting gastrointestinal disorders from multiple modalities, aiming to detect gastrointestinal diseases with superior accuracy and reduce the efforts and costs of medical experts. The Kvasir eight-class dataset was used for the experiment, where endoscopic images were preprocessed and enriched with augmentation techniques. An EfficientNet model was optimized via transfer learning and fine tuning, and the model was compared to the most widely used pre-trained deep learning models. The model's efficacy was tested on another independent endoscopic dataset to prove its robustness and reliability.
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Affiliation(s)
- Shaha Al-Otaibi
- Department of Information Systems, College of Computer and Information Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Amjad Rehman
- Artificial Intelligence & Data Analytics Lab CCIS, Prince Sultan University, Riyadh, Saudi Arabia
| | - Muhammad Mujahid
- Artificial Intelligence & Data Analytics Lab CCIS, Prince Sultan University, Riyadh, Saudi Arabia
| | - Sarah Alotaibi
- Department of Computer Science, College of Computer and Information Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Tanzila Saba
- Artificial Intelligence & Data Analytics Lab CCIS, Prince Sultan University, Riyadh, Saudi Arabia
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Rey JF. As how artificial intelligence is revolutionizing endoscopy. Clin Endosc 2024:ce.2023.230. [PMID: 38454543 DOI: 10.5946/ce.2023.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/15/2023] [Indexed: 03/09/2024] Open
Abstract
With incessant advances in information technology and its implications in all domains of our lives, artificial intelligence (AI) has emerged as a requirement for improved machine performance. This brings forth the query of how this can benefit endoscopists and improve both diagnostic and therapeutic endoscopy in each part of the gastrointestinal tract. Additionally, it also raises the question of the recent benefits and clinical usefulness of this new technology in daily endoscopic practice. There are two main categories of AI systems: computer-assisted detection (CADe) for lesion detection and computer-assisted diagnosis (CADx) for optical biopsy and lesion characterization. Quality assurance is the next step in the complete monitoring of high-quality colonoscopies. In all cases, computer-aided endoscopy is used, as the overall results rely on the physician. Video capsule endoscopy is a unique example in which a computer operates a device, stores multiple images, and performs an accurate diagnosis. While there are many expectations, we need to standardize and assess various software packages. It is important for healthcare providers to support this new development and make its use an obligation in daily clinical practice. In summary, AI represents a breakthrough in digestive endoscopy. Screening for gastric and colonic cancer detection should be improved, particularly outside expert centers. Prospective and multicenter trials are mandatory before introducing new software into clinical practice.
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Affiliation(s)
- Jean-Francois Rey
- Institut Arnaut Tzanck Gastrointestinal Unt, Saint Laurent du Var, France
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Dipasquale V, Deganello Saccomani M, Di Giorgio A, Oliva S, Salvatore S, Strisciuglio C, Tambucci R, Lionetti P, Romano C. Pediatric Gastroenterology and Hepatology in Italy before and after the COVID-19: Lessons learned and management changes by SIGENP. Ital J Pediatr 2023; 49:15. [PMID: 36698148 PMCID: PMC9877500 DOI: 10.1186/s13052-023-01418-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/21/2023] [Indexed: 01/27/2023] Open
Abstract
Around the world, the 2019 Coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has raised serious public health problems and major medical challenges. The Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) published several papers on the impact of COVID-19 on the current management, diagnosis, and treatment of acute and chronic gastrointestinal, hepatic, immune-mediated, and functional disorders. The present article summarizes the most relevant SIGENP reports and consensus during and after the peak of the COVID-19 outbreak, including the diagnosis and treatment of inflammatory bowel disease (IBD), indications and timing of digestive endoscopy, and insights into the novel hepatitis.
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Affiliation(s)
- Valeria Dipasquale
- grid.10438.3e0000 0001 2178 8421Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | - Marco Deganello Saccomani
- grid.411475.20000 0004 1756 948XDepartment of Pediatrics, Woman’s & Children’s University Hospital of Verona, 37126 Verona, Italy
| | - Angelo Di Giorgio
- grid.460094.f0000 0004 1757 8431Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Salvatore Oliva
- grid.7841.aPediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza University of Rome, Rome, Italy
| | - Silvia Salvatore
- grid.18147.3b0000000121724807Department of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania “Vanvitelli”, Naples, Italy
| | - Renato Tambucci
- grid.414125.70000 0001 0727 6809Digestive Endoscopy Unit, Department of Gastroenterology, Hepatology and Nutrition, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Paolo Lionetti
- grid.8404.80000 0004 1757 2304Department NEUROFARBA, University of Florence, Gastroenterology and Nutrition Unit, Meyer Children’s Hospital, Florence, Italy
| | - Claudio Romano
- grid.10438.3e0000 0001 2178 8421Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
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Monsma-Muñoz M, Romero-García E, Montero-Sánchez F, Tevar-Yudego J, Silla-Aleixandre I, Pons-Beltrán V, Argente-Navarro MP. Retrospective observational study on safety of sedation for colonoscopies in ASA I and II patients performed by a nurse and under the supervision of anesthesiology. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:319-325. [PMID: 35760692 DOI: 10.1016/j.redare.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/03/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Out of operating room sedation with propofol by non-anaesthesiologists (Non Anaesthesiologist Administration of Propofol: NAAP) is a growing practice. This is due to the increase in minimally invasive diagnostic and therapeutic procedures requiring sedation, and the difficulty of anaesthesiology services to respond adequately to this demand. OBJECTIVE The main objective of this study is to assess the safety of a programme of nurse sedationist-administered target controlled infusion (TCI) of propofol in colonoscopies supervised by anaesthesiologists. MATERIAL AND METHODS Over a period of 6 months, all ASA I and II patients who required colonoscopy and met the inclusion criteria were included in the study. A total of 381 colonoscopies were performed. Episodes of desaturation, hypo- or hypertension, bradycardia or tachyarrhythmia and the need for anaesthesiology assistance during sedation were analysed. After the procedure, patient satisfaction was assessed on a scale of 1-5, and pain was assessed on a numerical verbal scale of 1-5. RESULTS A small percentage (5%) of patients presented oxygen saturation of less than 90%, without requiring mask ventilation; 7.35% presented hypotension, 3.94% presented bradycardia, and the supervising anaesthesiologist was called in 22% of cases. Patient satisfaction at the end of the procedure was 4.27 out of 5. CONCLUSION Sedation during colonoscopy in ASA I and II patients following an agreed protocol can be safely administered by nurse sedationists under the supervision of an anaesthesiologist.
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Affiliation(s)
- M Monsma-Muñoz
- Servicio Anestesiología-Reanimación, Hospital La Fe, Valencia, Spain.
| | - E Romero-García
- Servicio Anestesiología-Reanimación, Hospital La Fe, Valencia, Spain
| | - F Montero-Sánchez
- Servicio Anestesiología-Reanimación, Hospital La Fe, Valencia, Spain
| | - J Tevar-Yudego
- Servicio Anestesiología-Reanimación, Hospital La Fe, Valencia, Spain
| | | | - V Pons-Beltrán
- Servicio Anestesiología-Reanimación, Hospital La Fe, Valencia, Spain; Servicio Digestivo, Hospital La Fe, Valencia, Spain
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Abstract
After nearly 40 years of development, digestive endoscopy in children has been widely applied, and it has helped to expand the spectrum of pediatric digestive system diseases and greatly improve the diagnosis and treatment of pediatric digestive system diseases. Pediatric digestive endoscopy has become a subject. However, there are some problems such as the unbalanced development of pediatric digestive endoscopy across China, the lack of homogeneity in diagnosis and treatment system, the tendency of adult-oriented diagnosis and treatment techniques, and the localization of training quality, which affect the standardized and healthy development of pediatric digestive endoscopy. The diagnosis and treatment with digestive endoscopy in children should adhere to both pediatric characteristics and technological innovation to propose the concept of comfort, emphasize the importance of standardization (including the space and process for endoscopic diagnosis and treatment, perioperative evaluation, training mode, and access qualification), standardize the minimally invasive techniques, and develop artificial intelligence. It is of great importance to formulate related consensus statements and guidelines on the basis of medical safety and the features of the growth and development of children, so as to achieve the high-quality development of pediatric digestive endoscopy, effectively improve the diagnosis and treatment levels of pediatric digestive endoscopy, and bring benefits to more pediatric patients.
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Affiliation(s)
- Mi-Zu Jiang
- Department of Gastroenterology and Pediatric Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine/National Clinical Research Center for Child Health/National Children's Regional Medical Center, Hangzhou 310052, China
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Zhang YX, He XX, Chen YP, Yang S. The effectiveness of high-flow nasal cannula during sedated digestive endoscopy: a systematic review and meta-analysis. Eur J Med Res 2022; 27:30. [PMID: 35209948 PMCID: PMC8876126 DOI: 10.1186/s40001-022-00661-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 02/14/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Studies evaluating the role of high-flow nasal cannula (HFNC) in sedated digestive endoscopy have reported conflicting results. This meta-analysis evaluates the effectiveness of HFNC in patients undergoing digestive endoscopy procedures under sedation. METHODS PubMed, Medline, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science, were searched from inception to 31 July 2021. Only randomized clinical trials comparing HFNC with standard nasal cannula oxygen (SNC) during sedated digestive endoscopy were included. The incidence of hypoxemia was the primary outcome, and the secondary outcome was the percentage of patients who needed airway interventions. RESULTS Seven studies that enrolled 2998 patients were included. When compared to SNC, HFNC was associated with a significant reduction in hypoxemia incidence (OR 0.24, 95% CI 0.09 to 0.64) and airway intervention requirements (OR 0.15, 95% CI 0.03 to 0.69), with both high heterogeneity (I2 = 81% and 94%). In subgroup analysis, when hypoxemia was defined as pulse oxygen saturation (SpO2) < 90%, low risk of hypoxemia subjects who received HFNC were associated with a significant reduction in hypoxemia incidence (OR 0.02, 95% CI 0.00 to 0.07; heterogeneity I2 = 39%) and airway intervention requirements (OR 0.02, 95% CI 0.01 to 0.04; heterogeneity I2 = 15%). However, in the high risk of hypoxemia subjects, there were no significant differences between the two oxygen administration techniques in both primary (OR 0.81, 95% CI 0.36 to 1.78; heterogeneity I2 = 0%) and secondary outcomes (OR 0.85, 95% CI 0.46 to 1.59; heterogeneity I2 = 0%). CONCLUSIONS Compared to SNC, HFNC not only reduce the incidence of hypoxemia but also reduce the requirements for airway interventions during sedated digestive endoscopy procedures, especially in patients at low risk for hypoxemia. In high risk of hypoxemia patients, there were no significant differences between the two oxygen administration techniques. Trial registration PROSPERO International prospective register of systematic reviews on 28 July 2021, registration no. CRD42021264556.
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Affiliation(s)
- Yu-Xin Zhang
- Department of Gastroenterology, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, 519000, China
| | - Xing-Xiang He
- Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, 510080, China
| | - Yu-Ping Chen
- Department of Gastroenterology, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, 519000, China
| | - Shuai Yang
- Department of Emergency Intensive Care Unit, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), 79 Kangning Road, Xiangzhou District, Zhuhai, 519000, China.
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Tang P, Zha Q, Zhou L, Yang Q, He M, Zhu S, Liu Y. Effectiveness of digestive endoscopy and surgery in the treatment of necrotizing pancreatitis: a meta-analysis and systematic review. Gland Surg 2021; 10:2754-2765. [PMID: 34733725 DOI: 10.21037/gs-21-516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/09/2021] [Indexed: 12/12/2022]
Abstract
Background Digestive endoscopy and surgery are the primary invasive methods for the clinical treatment of necrotizing pancreatitis. However, there are relatively few studies evaluating the effectiveness and safety of these two methods. Methods Randomized controlled trials (RCTs) on endoscopic and surgical treatment of necrotizing pancreatitis published from January 2000 to December 2020 were searched in the PubMed, Medline, Embase, China Biology Medicine Disc (CBM), and WanFang databases. The Cochrane System Review Manual was adopted to evaluate the quality of the included literature, and Review Manager 5.3 was used for data analysis. Results Ten articles were included in this meta-analysis, involving a total of 401 patients, including 188 in the endoscopy group and 213 in the surgery group. Meta-analysis results revealed that the clinical remission rate (CRR) [odds ratio (OR) =1.30, 95% confidence interval (CI): 0.58-2.92, P=0.52], new organ failure rate (OFR) (OR =0.53, 95% CI: 0.26-1.09, P=0.08), abdominal bleeding rate (ABR) (OR =0.62, 95% CI: 0.33-1.15, P=0.13), and intensive care unit (ICU) stay time (IST) [mean deviation (MD) =-7.33, 95% CI: -16.76 to 2.11, P=0.13] were not significantly different between the endoscopy and surgery groups. In the endoscopy group, the mortality rate (OR =0.56, 95% CI: 0.31-1.02, P=0.05), intestinal fistula rate (IFR) or gastrointestinal perforation rate (GPR) (OR =0.50, 95% CI: 0.26-0.99, P=0.05), and pancreatic fistula rate (PFR) (OR =0.09, 95% CI: 0.04-0.23, P<0.00001) were markedly lower compared to the surgery group. Discussion There was no obvious difference in the clinical efficacy of endoscopic and surgical treatment of necrotizing pancreatitis. However, endoscopy can greatly reduce the incidence of postoperative death and major complications in patients.
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Affiliation(s)
- Peng Tang
- Department of Gastroenterology, Eastern Hospital, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Qinqing Zha
- Digestive Endoscopy Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Lihua Zhou
- Digestive Endoscopy Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Qiulian Yang
- Second Internal Medicine, Yilong County People's Hospital, Nanchong, China
| | - Mingfeng He
- Digestive Endoscopy Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Shaomin Zhu
- Department of Anesthesiology, Eastern Hospital, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Yan Liu
- Department of Geriatric Internal Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
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Liu XM, Tuo BG. [Endoscopic diagnosis and treatment of gastrointestinal neuroendocrine neoplasms]. Zhonghua Wei Chang Wai Ke Za Zhi 2021; 24:854-60. [PMID: 34674459 DOI: 10.3760/cma.j.cn.441530-20210713-00278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The incidence of neuroendocrine neoplasms (NEN) is increasing globally, and gastrointestinal NEN (GI-NEN) is the most common type of NEN. Diagnosis and treatment of GI-NEN are quite different, according to tumor's location, size, background, cell origin, and pathogenesis. Digestive endoscopy has unique advantages in detecting of GI-NEN. However, endoscopist should not perform endoscopic resection arbitrarily, due to the high heterogeneity and complexity of GI-NEN. We need to establish the concept about comprehensive assessment for GI-NEN, including medical history and physical signs, serology, imaging, radionuclide and end·oscopic examination, to make an individualized treatment after rigorous multidisciplinary discussion.
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Dipasquale V, Passanisi S, Cucinotta U, Cascio A, Romano C. Implications of SARS-COV-2 infection in the diagnosis and management of the pediatric gastrointestinal disease. Ital J Pediatr 2021; 47:71. [PMID: 33761992 PMCID: PMC7988257 DOI: 10.1186/s13052-021-01020-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/03/2021] [Indexed: 02/07/2023] Open
Abstract
Gastrointestinal diseases such as celiac disease, functional gastrointestinal disorders (FGIDs), inflammatory bowel disease (IBDs) and acute or chronic diarrhea are quite frequent in the pediatric population. The approach, the diagnosis and management can be changed in the 2019 coronavirus disease (COVID-19) pandemic era. This review has focused on: i) the current understanding of digestive involvement in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected children and adolescents and the clinical implications of COVID-19 for pediatric gastroenterologists, ii) the impact of COVID-19 on the clinical approach to patients with pre-existing or onset diseases, including diagnosis and treatment, and iii) the role and limited access to the instrumental diagnosis such as digestive endoscopy. To date, it is unclear if immunosuppression in patients with IBD and chronic liver disease represents a risk factor for adverse outcomes. Scheduled outpatient follow-up visits may be postponed, especially in patients in remission. Conversely, telemedicine services are strongly recommended. The introduction of new therapeutic regimens should be made on an individual basis, discussing the benefits and risks with each patient. Furthermore, psychological care in all children with chronic disease and their parents should be ensured. All non-urgent and elective endoscopic procedures may be postponed as they must be considered at high risk of viral transmission. Finally, until SARS-CoV-2 vaccination is not available, strict adherence to standard social distancing protocols and the use of personal protective equipment should continue to be recommended.
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Affiliation(s)
- Valeria Dipasquale
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Via Consolare Valeria, 98124, Messina, Italy
| | - Stefano Passanisi
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Via Consolare Valeria, 98124, Messina, Italy
| | - Ugo Cucinotta
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Via Consolare Valeria, 98124, Messina, Italy
| | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Via Consolare Valeria, 98124, Messina, Italy.
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Cao L, Guo Q, Chen Y, Chen N, Liu M, Tian D. Management of gastrointestinal endoscopy unit during post covid-19 endemic outbreak: A report from Wuhan epicenter. Am J Infect Control 2021; 49:361-365. [PMID: 32798632 PMCID: PMC7426222 DOI: 10.1016/j.ajic.2020.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 01/19/2023]
Abstract
The COVID-19 pandemic is caused by severe acute respiratory syndrome coronavirus 2 and causing a global public health emergency. During the outbreak, Wuhan was the first reported and hardest-hit city. With the dramatic drop in number of confirmed cases and subsequent ending of Wuhan lock down, asymptomatic carriers and patients in their recovery period still pose an increased risk. Strict and effective infection control protocols should be established and followed.
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Affiliation(s)
- Li Cao
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Digestive Endoscopy Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiaozhen Guo
- Digestive Endoscopy Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yao Chen
- Digestive Endoscopy Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nianjun Chen
- Digestive Endoscopy Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mei Liu
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Digestive Endoscopy Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Dean Tian
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Digestive Endoscopy Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Fiori G, Trovato C, Staiano T, Magarotto A, Stigliano V, Masci E, Ciuffi M, Rossi GB, Fantin A, Realdon S, Ugenti I, Cannizzaro R. Reorganization of the endoscopic activity of Cancer Institutes during phase II of the Covid-19 emergency. Dig Liver Dis 2020; 52:1346-1350. [PMID: 32601037 PMCID: PMC7294252 DOI: 10.1016/j.dld.2020.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 12/11/2022]
Abstract
After the lockdown during the emergency phase of the Covid-19 pandemic, we have to deal with phase 2, a period of uncertain duration, with a controlled and progressive return to normalization, in which we need to reconcile our work and our movements with the presence of the virus on our territory. Digestive endoscopic activity is a high-risk transmission procedure for Covid-19. The measures put in place to protect healthcare personnel and patients are stressful and "time-consuming" and lead to a reduction in the number of endoscopic procedures that can be performed. In this scenario, the Oncological Institutes are forced to make a rigorous selection of patients to undergo endoscopic examinations and treatments, according to lists of exceptional priorities, in order to guarantee cancer patients and subjects at high risk of developing digestive tumors, a preferential diagnostic and therapeutic process, protected from contagion risks. For this purpose, cuts and postponing times of endoscopic performances are here proposed, which go beyond the guidelines of scientific societies and have little evidences in the literature. These changes should be applied limited to this exceptional period and in proportion to the capacity of each operating unit in order to meet the demands of the patients.
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Affiliation(s)
- Giancarla Fiori
- Division of Endoscopy, European Institute of Oncology, Istituto di Ricovero a Cura e Carattere Scientifico (IRCCS), Milan, Italy
| | - Cristina Trovato
- Division of Endoscopy, European Institute of Oncology, Istituto di Ricovero a Cura e Carattere Scientifico (IRCCS), Milan, Italy
| | - Teresa Staiano
- Diagnostic and Interventional Endoscopy, Candiolo Cancer Institute, FPO - IRCCS - Str. Prov.le 142, km. 3,95 - Candiolo (TO) 10060, Italy
| | - Andrea Magarotto
- Diagnostic and Therapeutic Endoscopy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Vittoria Stigliano
- Division of Gastroenterology and Digestive Endoscopy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Enzo Masci
- Diagnostic and Therapeutic Endoscopy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Mario Ciuffi
- Endoscopy Unit, IRCCS Centro di Riferimento Oncologico di Basilicata (CROB), 85028 Rionero in Vulture (PZ), Italy
| | - Giovanni Battista Rossi
- Gastroenterology and Digestive Endoscopy Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS, Fondazione Giovanni Pascale I-80131 Naples, Italy
| | - Alberto Fantin
- U.O. Gastroenterologia IRCCS- Istituto Oncologico Veneto Castelfranco Veneto (TV), Italy
| | - Stefano Realdon
- Digestive Endoscopy Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Ippazio Ugenti
- Division of Digestive Endoscopy, Istituto Tumori Giovanni Paolo II, IRCCS, Bari, Italy,D.E.T.O. University of Bari, Italy
| | - Renato Cannizzaro
- Gastroenterologia Oncologica Sperimentale, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Via Franco Gallini, 2, 33081 Aviano, Italy,Corresponding author
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Galloro G, Pisani A, Zagari RM, Lamazza A, Cengia G, Ciliberto E, Conigliaro RL, Da Massa Carrara P, Germanà B, Pasquale L. Safety in digestive endoscopy procedures in the covid era recommendations in progres of the italian society of digestive endoscopy. Dig Liver Dis 2020; 52:800-807. [PMID: 32405285 PMCID: PMC7218383 DOI: 10.1016/j.dld.2020.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/02/2020] [Accepted: 05/03/2020] [Indexed: 01/08/2023]
Abstract
The new corona virus disease has started in Wuhan - China at the end of 2019 and quickly spread with a pandemic trend across the rest of the world. The scientific community is making an extraordinary effort to study and control the situation, but the results are just partial. Based on the most recent scientific literature and strong statements by the most prestigious international health institutions, the Italian Society of Digestive Endoscopy has drawn up some recommendations about the use of personal protective equipment, the correct way of dressing and undressing of endoscopists and nurses, before and after digestive endoscopy procedures. In addition, some other important indications are given to reduce the risk of contamination of healthcare providers during endoscopic activities, in the setting of a pandemic. Nevertheless, because of the very quick evolution of our knowledge on this issue, these recommendations must be considered as evolving, because they could change in a short time.
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Affiliation(s)
- Giuseppe Galloro
- Department of Clinical Medicine and Surgery. Surgical Endoscopy Unit. University Federico II of Naples. Via S. Pansini, 5 80131 Napoli Italy.
| | - Antonio Pisani
- Gastroenterology and Digestive Endoscopy Unit. S. De Bellis Hospital of Castellana Grotte. Via Turi, 27 70013 Castellana Grotte (BA) Italy
| | - Rocco Maurizio Zagari
- Department of Medical and Surgical Sciences. Gastroenterology Unit, University Alma Mater of Bologna. Via G Masserenti, 9 40138 Bologna Italy
| | - Antonietta Lamazza
- Department of Surgery P. Valdoni. Digestive Endoscopy Unit, University La Sapienza of Rome Viale del Policlinico, 155 00161 Rome Italy
| | - Gianpaolo Cengia
- Digestive Endoscopy Unit, Manerbio Hospital, Via Lungomella Valsecchi, 2 25025 Manerbio (BS) Italy
| | - Enrico Ciliberto
- Gastroenterology Unit, S. Giovanni di Dio Hospital of Crotone, Via Bologna 88900 Crotone Italy
| | - Rita L Conigliaro
- Gastroenterology and Digestive Endoscopy Unit, Baggiovara University Hospital, Via P. Giardini, 1355 41126 Baggiovara (MO) Italy
| | - Paola Da Massa Carrara
- Gastroenterology and Digestive Endoscopy Unit, S. Jacopo Hospital of Pistoia. Via Ciliegiole, 97 51100 Pistoia Italy
| | - Bastianello Germanà
- Gastroenterology Unit, S. Martino Hospital of Belluno, Viale Europa, 22 32100 Belluno Italy
| | - Luigi Pasquale
- Gastroenterology Unit, S. O. Frangipane Hospital of A. Irpino, Via R. Maddalena 83031 A. Irpino (AV) Italy
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Ma XP, Wang H, Bai DM, Zou Y, Zhou SM, Wen FQ, Dai DL. Prevention program for the COVID-19 in a children’s digestive endoscopy center. World J Clin Cases 2020; 8:1343-1349. [PMID: 32368528 PMCID: PMC7190955 DOI: 10.12998/wjcc.v8.i8.1343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/30/2020] [Accepted: 04/04/2020] [Indexed: 02/05/2023] Open
Abstract
The pneumonia caused by the coronavirus disease-2019 (COVID-19) outbreak in Wuhan, China constitutes a public health emergency of international concern. The gastrointestinal symptoms of vomiting, diarrhea and abdominal pain and the detection of COVID-19 nucleic acid from fecal specimens in a small number of patients suggest the possibility of transmission via the gastrointestinal tract. People of all ages are vulnerable to this virus, including children. Digestive endoscopy is an invasive procedure during which children cannot wear masks; therefore, they have higher risks of exposure to COVID-19, and the digestive endoscopy center is a relatively high-risk area for COVID-19 infection. Based on these factors and in combination with related policies and regulations, a prevention and control program for the COVID-19 pneumonia in a children's digestive endoscopy center was established to prevent the COVID-19 nosocomial infection.
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Affiliation(s)
- Xiao-Peng Ma
- Digestive Endoscopy Center, Department of Gastroenterology, Shenzhen Children's Hospital, Shenzhen 518036, Guangdong Province, China
| | - Huan Wang
- Digestive Endoscopy Center, Department of Gastroenterology, Shenzhen Children's Hospital, Shenzhen 518036, Guangdong Province, China
| | - Da-Ming Bai
- Digestive Endoscopy Center, Department of Gastroenterology, Shenzhen Children's Hospital, Shenzhen 518036, Guangdong Province, China
| | - Yu Zou
- Digestive Endoscopy Center, Department of Gastroenterology, Shenzhen Children's Hospital, Shenzhen 518036, Guangdong Province, China
| | - Shao-Ming Zhou
- Digestive Endoscopy Center, Department of Gastroenterology, Shenzhen Children's Hospital, Shenzhen 518036, Guangdong Province, China
- Pediatric Committee of Shenzhen Medical Association, Shenzhen 518036, Guangdong Province, China
| | - Fei-Qiu Wen
- Digestive Endoscopy Center, Department of Gastroenterology, Shenzhen Children's Hospital, Shenzhen 518036, Guangdong Province, China
- Pediatric Committee of Shenzhen Medical Association, Shenzhen 518036, Guangdong Province, China
- Shenzhen Pediatric Medical Quality Control Center, Shenzhen 518036, Guangdong Province, China
| | - Dong-Ling Dai
- Digestive Endoscopy Center, Department of Gastroenterology, Shenzhen Children's Hospital, Shenzhen 518036, Guangdong Province, China
- Pediatric Committee of Shenzhen Medical Association, Shenzhen 518036, Guangdong Province, China
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Delgado AADA, de Moura DTH, Ribeiro IB, Bazarbashi AN, dos Santos MEL, Bernardo WM, de Moura EGH. Propofol vs traditional sedatives for sedation in endoscopy: A systematic review and meta-analysis. World J Gastrointest Endosc 2019; 11:573-588. [PMID: 31839876 PMCID: PMC6885729 DOI: 10.4253/wjge.v11.i12.573] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/17/2019] [Accepted: 09/11/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Propofol is commonly used for sedation during endoscopic procedures. Data suggests its superiority to traditional sedatives used in endoscopy including benzodiazepines and opioids with more rapid onset of action and improved post-procedure recovery times for patients. However, Propofol requires administration by trained healthcare providers, has a narrow therapeutic index, lacks an antidote and increases risks of cardio-pulmonary complications.
AIM To compare, through a systematic review of the literature and meta-analysis, sedation with propofol to traditional sedatives with or without propofol during endoscopic procedures.
METHODS A literature search was performed using MEDLINE, Scopus, EMBASE, the Cochrane Library, Scopus, LILACS, BVS, Cochrane Central Register of Controlled Trials, and The Cumulative Index to Nursing and Allied Health Literature databases. The last search in the literature was performed on March, 2019 with no restriction regarding the idiom or the year of publication. Only randomized clinical trials with full texts published were included. We divided sedation therapies to the following groups: (1) Propofol versus benzodiazepines and/or opiate sedatives; (2) Propofol versus Propofol with benzodiazepine and/or opioids; and (3) Propofol with adjunctive benzodiazepine and opioid versus benzodiazepine and opioid. The following outcomes were addressed: Adverse events, patient satisfaction with type of sedation, endoscopists satisfaction with sedation administered, dose of propofol administered and time to recovery post procedure. Meta-analysis was performed using RevMan5 software version 5.39.
RESULTS A total of 23 clinical trials were included (n = 3854) from the initial search of 6410 articles. For Group I (Propofol vs benzodiazepine and/or opioids): The incidence of bradycardia was not statistically different between both sedation arms (RD: -0.01, 95%CI: −0.03–+0.01, I2: 22%). In 10 studies, the incidence of hypotension was not statistically difference between sedation arms (RD: 0.01, 95%CI: −0.02–+0.04, I2: 0%). Oxygen desaturation was higher in the propofol group but not statistically different between groups (RD: −0.03, 95%CI: −0.06–+0.00, I2: 25%). Patients were more satisfied with their sedation in the benzodiazepine + opioid group compared to those with monotherapy propofol sedation (MD: +0.89, 95%CI: +0.62–+1.17, I2: 39%). The recovery time after the procedure showed high heterogeneity even after outlier withdrawal, there was no statistical difference between both arms (MD: -15.15, 95%CI: −31.85–+1.56, I2: 99%). For Group II (Propofol vs propofol with benzodiazepine and/or opioids): Bradycardia had a tendency to occur in the Propofol group with benzodiazepine and/or opioid-associated (RD: -0.08, 95%CI: −0.13–−0.02, I2: 59%). There was no statistical difference in the incidence of bradycardia (RD: -0.00, 95%CI: −0.08–+0.08, I2: 85%), desaturation (RD: −0.00, 95%CI: −0.03–+0.02, I2: 44%) or recovery time (MD: -2.04, 95%CI: −6.96–+2.88, I2: 97%) between sedation arms. The total dose of propofol was higher in the propofol group with benzodiazepine and/or opiates but with high heterogeneity. (MD: 70.36, 95%CI: +53.11–+87.60, I2: 61%). For Group III (Propofol with benzodiazepine and opioid vs benzodiazepine and opioid): Bradycardia and hypotension was not statistically significant between groups (RD: -0.00, 95%CI: −0.002–+0.02, I2: 3%; RD: 0.04, 95%CI: −0.05–+0.13, I2: 77%). Desaturation was evaluated in two articles and was higher in the propofol + benzodiazepine + opioid group, but with high heterogeneity (RD: 0.15, 95%CI: 0.08–+0.22, I2: 95%).
CONCLUSION This meta-analysis suggests that the use of propofol alone or in combination with traditional adjunctive sedatives is safe and does not result in an increase in negative outcomes in patients undergoing endoscopic procedures.
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Affiliation(s)
- Aureo Augusto de Almeida Delgado
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 05403000, Brazil
| | - Diogo Turiani Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 05403000, Brazil
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Igor Braga Ribeiro
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 05403000, Brazil
| | - Ahmad Najdat Bazarbashi
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Marcos Eduardo Lera dos Santos
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 05403000, Brazil
| | - Wanderley Marques Bernardo
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 05403000, Brazil
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Xue P, Qiao YL, Jiang Y. [Application of artificial intelligence in diagnosis of medical endoscope]. Zhonghua Zhong Liu Za Zhi 2018; 40:890-3. [PMID: 30605977 DOI: 10.3760/cma.j.issn.0253-3766.2018.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Through a brief overview of the origin and development of artificial intelligence, the research progress of artificial intelligence in digestive endoscopy, ophthalmoscopy and electronic colposcopy was summarized, and the importance of its application was clarified. This article induced the main problems and suggestions of artificial intelligence in the development of medical endoscopes, and prospected the future application of artificial intelligence in medical endoscopy diagnosis.
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Feng LL, Ma S, Ding WX, Liu Y, Xi HJ. Research status and prospect on risk assessment of sedation and anesthesia in endoscopy. Shijie Huaren Xiaohua Zazhi 2018; 26:1289-1294. [DOI: 10.11569/wcjd.v26.i21.1289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Digestive endoscopy plays an important role in the prevention and treatment of gastrointestinal cancer. Although the safety of anesthesia for digestive endoscopy is very high, pre-anesthesia evaluation is still a key step to ensure the safety of the patients. Due to the lack of anesthesia risk assessment procedures and methods worldwide, we need to establish an anesthesia nurse training management system with Chinese characteristics to facilitate convenient and cost-effective anesthesia assessment on an outpatient basis or by telephone. Moreover, an anesthesia risk assessment system for digestive endoscopy should be established. With the wide use of digestive endoscopy, it is believed that China will construct a comprehensive assessment system as well as an assessment form for pre-anesthesia evaluation as soon as possible.
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Affiliation(s)
- Li-Li Feng
- Department of Anesthesiology, Changhai Hospital, Shanghai 200433, China
| | - Su Ma
- Department of Gastroenterology, Changhai Hospital, Shanghai 200433, China
| | - Wen-Xia Ding
- Department of Gastroenterology, Changhai Hospital, Shanghai 200433, China
| | - Yi Liu
- Department of Anesthesiology, Changhai Hospital, Shanghai 200433, China
| | - Hui-Jun Xi
- Department of Gastroenterology, Changhai Hospital, Shanghai 200433, China
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Sivero L, Telesca DA, Ruggiero S, Russo T, Amato M, Bianco T, Amato B, Formisano C, Avellino M, Napolitano V. Endoscopic diagnosis and treatment of neuroendocrine tumors of the digestive system. Open Med (Wars) 2017; 11:369-373. [PMID: 28352822 PMCID: PMC5329854 DOI: 10.1515/med-2016-0067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/06/2016] [Indexed: 12/31/2022] Open
Abstract
The authors evaluated the role of endoscopic techniques in the diagnosis and in the potential treatment of neuroendocrine tumors (NET) localized in the gastro-entero-pancreatic system, on the basis of their experience and of the international literature. NET are rare tumors that arise from neuroendocrine cells of the gastrointestinal tract and pancreas. It is a possibility that both the digestive endoscopy and EUS play an important role in the diagnosis, staging and surveillance of this disease. In some cases, especially in the early stages, surgical endoscopy allows the treatment of such tumors.
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Affiliation(s)
- Luigi Sivero
- Department of Gastroenterology, Endocrinology, Surgery. University Federico II of Naples. School of Medicine, Naples, Italy . Via Sergio Pansini 5, 80131, Napoli
| | - Donato Alessandro Telesca
- Department of Clinical Medicine and Surgery. University of Naples Federico II School of Medicine. Naples, Italy
| | - Simona Ruggiero
- Department of Clinical Medicine and Surgery. University of Naples Federico II School of Medicine. Naples, Italy
| | - Teresa Russo
- Department of Clinical Medicine and Surgery. University of Naples Federico II School of Medicine. Naples, Italy
| | - Maurizio Amato
- Department of Clinical Medicine and Surgery. University of Naples Federico II School of Medicine. Naples, Italy
| | - Tommaso Bianco
- Department of Clinical Medicine and Surgery. University of Naples Federico II School of Medicine. Naples, Italy
| | - Bruno Amato
- Department of Clinical Medicine and Surgery. University of Naples Federico II School of Medicine. Naples, Italy
| | - Cesare Formisano
- Department of Clinical Medicine and Surgery. University of Naples Federico II School of Medicine. Naples, Italy
| | - Manuela Avellino
- Department of General and Specialized Surgery, Second University of Naples. School of Medicine, Naples, Italy
| | - Vincenzo Napolitano
- Department of General and Specialized Surgery, Second University of Naples. School of Medicine, Naples, Italy
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Wang T, Wang DN, Liu WT, Zheng ZQ, Chen X, Fang WL, Li S, Liang L, Wang BM. Hemostatic effect of topical hemocoagulase spray in digestive endoscopy. World J Gastroenterol 2016; 22:5831-5836. [PMID: 27433096 PMCID: PMC4932218 DOI: 10.3748/wjg.v22.i25.5831] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 04/21/2016] [Accepted: 05/04/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the hemostatic effect of topical hemocoagulase spray in digestive endoscopy.
METHODS: Eighty-nine patients who developed oozing bleeding during endoscopic treatment from September 2014 to October 2014 at Center for Digestive Endoscopy, Tianjin Medical University General Hospital were randomly divided into either a study group (n = 39) or a control group (n = 50). The study group was given topical hemocoagulase spray intraoperatively, while the control group was given traditional 8% norepinephrine spray. Hemostatic efficacy was compared between the two groups. Bleeding site, wound cleanliness and perforation were recorded, and the rates of perforation and late bleeding were compared.
RESULTS: Successful hemostasis was achieved in 39 (100%) patients of the study group and in 47 (94.0%) patients of the control group, and there was no significant difference in the rate of successful hemostasis between the two groups. Compared with the control group, after topical hemocoagulase spray in the study group, the surgical field was clearer, the bleeding site was more easily identified, and the wound was cleaner. There was no significant difference in the rate of perforation between the study and control groups (16.7% vs 35.0%, P = 0.477), but the rates of late bleeding (0% vs 15.8%, P = 0.048) and overall complications (P = 0.032) were significantly lower in the study group.
CONCLUSION: Topical hemocoagulase spray has a definite hemostatic effect for oozing bleeding in digestive endoscopy, and this method is convenient, safe, and reliable. It is expected to become a new method for endoscopic hemostasis.
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Wang XF, Wang GX, Jiang Y. Impact of nursing care program on psychological stress reaction in patients undergoing digestive endoscopy. Shijie Huaren Xiaohua Zazhi 2016; 24:2077-2080. [DOI: 10.11569/wcjd.v24.i13.2077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the impact of nursing care program on psychological stress reaction in patients undergoing digestive endoscopy.
METHODS: Eighty patients who would undergo gastrointestinal endoscopy at our hospital from March 2014 to March 2015 were randomly divided into either an observation group or a control group, with 40 cases in each group. The control group received routine psychological intervention, and the observation group received specialized psychological intervention based on a comprehensive assessment of patients' psychological stress reactions. Prior to the implementation of gastrointestinal endoscopy, a homemade general information questionnaire, the Self-rating Anxiety Scale (SAS) and the Self-rating Depression Scale (SDS) were administered to obtain the patients' general information and psychological status. Mean arterial pressure (MAP) and heart rate (HR) levels were recorded.
RESULTS: In the observation group, three cases had mild anxiety and one case had severe anxiety, while the corresponding figures in the control group were eight and two. There was a statistically significant difference in the number of cases of mild anxiety and severe anxiety between the two groups (P < 0.05). The SAS score and SDS score were significantly lower in the observation group than in the control group (SAS score: 51.45 ± 9.55 vs 58.37 ± 15.02; SDS score: 49.91 ± 10.63 vs 54.58 ± 14.37, P < 0.05). In the control group, MAP and HR were increased significantly, while the observation group had no significant changes.
CONCLUSION: Patients undergoing digestive endoscopy patients are prone to varying degrees of psychological stress, and psychological nursing care could significantly reduce the psychological side effects in patients.
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Ciuti G, Caliò R, Camboni D, Neri L, Bianchi F, Arezzo A, Koulaouzidis A, Schostek S, Stoyanov D, Oddo CM, Magnani B, Menciassi A, Morino M, Schurr MO, Dario P. Frontiers of robotic endoscopic capsules: a review. J Microbio Robot 2016; 11:1-18. [PMID: 29082124 PMCID: PMC5646258 DOI: 10.1007/s12213-016-0087-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/24/2016] [Accepted: 04/07/2016] [Indexed: 12/15/2022]
Abstract
Digestive diseases are a major burden for society and healthcare systems, and with an aging population, the importance of their effective management will become critical. Healthcare systems worldwide already struggle to insure quality and affordability of healthcare delivery and this will be a significant challenge in the midterm future. Wireless capsule endoscopy (WCE), introduced in 2000 by Given Imaging Ltd., is an example of disruptive technology and represents an attractive alternative to traditional diagnostic techniques. WCE overcomes conventional endoscopy enabling inspection of the digestive system without discomfort or the need for sedation. Thus, it has the advantage of encouraging patients to undergo gastrointestinal (GI) tract examinations and of facilitating mass screening programmes. With the integration of further capabilities based on microrobotics, e.g. active locomotion and embedded therapeutic modules, WCE could become the key-technology for GI diagnosis and treatment. This review presents a research update on WCE and describes the state-of-the-art of current endoscopic devices with a focus on research-oriented robotic capsule endoscopes enabled by microsystem technologies. The article also presents a visionary perspective on WCE potential for screening, diagnostic and therapeutic endoscopic procedures.
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Affiliation(s)
- Gastone Ciuti
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
| | - R Caliò
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
| | - D Camboni
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
| | - L Neri
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy.,Ekymed S.r.l., Livorno, Italy
| | - F Bianchi
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
| | - A Arezzo
- Department of Surgical Disciplines, University of Torino, Torino, Italy
| | - A Koulaouzidis
- Endoscopy Unit, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | | | - D Stoyanov
- Centre for Medical Image Computing and the Department of Computer Science, University College London, London, UK
| | - C M Oddo
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
| | | | - A Menciassi
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
| | - M Morino
- Department of Surgical Disciplines, University of Torino, Torino, Italy
| | - M O Schurr
- Ovesco Endoscopy AG, Tübingen, Germany.,Steinbeis University Berlin, Berlin, Germany
| | - P Dario
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
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Shen SS, Zhang XQ, Li ZL, Zou XP, Ling TS. Over-the-scope clip to close a gastrocutaneous fistula after esophagectomy. World J Gastroenterol 2015; 21:13396-13399. [PMID: 26715825 PMCID: PMC4679774 DOI: 10.3748/wjg.v21.i47.13396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 06/15/2015] [Accepted: 09/14/2015] [Indexed: 02/07/2023] Open
Abstract
Over-the-scope clip (OTSC) system is becoming a new reliable technique which is available for the endoscopic closure of fistulas, bleeding, perforations and so on. We describe the case of a patient with a non-healing gastrocutaneous fistula after esophagectomy for esophageal squamous cell carcinoma which was successfully closed using an OTSC system. This is the first report of the use of OTSC to treat a non-healing gastrocutaneous fistula successfully after esophagectomy. We believe our experience will give such patients an ideal way to cure the fistula without suffering too much and also explore new application of OTSC.
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Li F, Li N. Endoscopic molecular imaging of gastrointestinal tumors. Shijie Huaren Xiaohua Zazhi 2015; 23:5333-5341. [DOI: 10.11569/wcjd.v23.i33.5333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In China, the incidence and mortality of gastrointestinal cancers are high, and early diagnosis is the key to improving the survival rate. In recent years, endoscopic molecular imaging in tumor diagnosis with its unique advantages has attracted more and more attention. With the rapid development of molecular biology, the mechanism of tumor occurrence and development has been gradually elucidated. The advent of fluorescent labeled molecular probes and targeted binding to molecular targets of gastrointestinal tumors makes it possible achieve real-time endoscopic molecular diagnosis of digestive tract tumors, which has a significant impact on tumor targeted therapy. In this paper, we review the progress in endoscopic molecular imaging of digestive tract tumors.
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Fu ZJ, Wang X, Ji NL, Liu JJ, Ding WX, Xi HJ. Training program for nurse specialists of digestive endoscopy department: A qualitative research. Shijie Huaren Xiaohua Zazhi 2015; 23:2671-2676. [DOI: 10.11569/wcjd.v23.i16.2671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the needs of specialized nursing training for nurses of digestive endoscopy department and to investigate the current situation of specialized nursing training in digestive endoscopy department, so as to provide a reference for establishing standardized training program for nurses of digestive endoscopy department.
METHODS: Based on analyzing literature review and authoritative sources, the research group confirmed the interview framework. Totally, 17 head nurses who came from digestive endoscopy centers in different provinces and cities participated in this qualitative study. Focus group interview was used in this study.
RESULTS: It is necessary for nurses of digestive endoscopy department to receive specialized nursing training. Current training programs are lack of standardization and accordance. The training content should include two parts: comprehensive nursing skills and endoscopic specialist skills. The training methods can be showed as theoretical study, video study, simulation training, and teaching by doing and so on. These methods match different levels of training.
CONCLUSION: There should be a unified regulation in the training program of nurse specialists from digestive endoscopy department in which trainers should pay more attention to the cultivation of comprehensive ability on the basis of handling specialized skills. The training program should be divided into different grades according to nurses' ability.
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Zhou YK, Tuo BG, Liu MR. Current status of diagnostic and therapeutic levels of digestive endoscopy practitioners in Guizhou Province. Shijie Huaren Xiaohua Zazhi 2015; 23:701-706. [DOI: 10.11569/wcjd.v23.i4.701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the current status of diagnostic and therapeutic levels of digestive endoscopy practitioners in Guizhou, so as to provide a reference for improving their diagnostic and therapeutic levels and the training modes.
METHODS: We adopted an on-site survey by handing out questionnaires to each subject.
RESULTS: The technical levels of diagnosis and treatment in Guizhou Province were low, and the medical knowledge was lacking. There were obvious differences among different grades of hospitals, and the hospitals in developed provinces were much better than those in Guizhou Province. However, the facilities and implementation of further training were not ideal. The diagnostic and therapeutic levels of digestive endoscopy practitioners and training situation in Guizhou Province need to be improved.
CONCLUSION: To improve the diagnostic and therapeutic levels of digestive endoscopy practitioners in Guizhou, endoscope room should be independently set and associated professionals should be arranged in second-class hospitals. The connections between third- and second-class hospitals should be strengthened, the training facilities should be improved, and standardized training of endoscopists should be reinforced.
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Bruno M, Marengo A, Elia C, Caronna S, Debernardi-Venon W, Manfrè SF, Musso A, Puglisi F, Sguazzini C, Rizzetto M, De Angelis C. Antiplatelet and anticoagulant drugs management before gastrointestinal endoscopy: do clinicians adhere to current guidelines? Dig Liver Dis 2015; 47:45-9. [PMID: 25464898 DOI: 10.1016/j.dld.2014.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/11/2014] [Accepted: 10/26/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Managing antiplatelet and anticoagulant drugs before endoscopy may be challenging. AIMS To assess whether the pre-endoscopic management of antiplatelet/anticoagulant drugs is adherent to current guidelines and the influence of patients' characteristics, referring physician's specialty, type of endoscopic procedure and therapeutic regimen on adherence. METHODS Two hundred and twenty patients taking aspirin, thienopyridines or warfarin and scheduled for upper endoscopy (± biopsies), variceal band ligation, colonoscopy (± biopsies or polypectomy), were prospectively analyzed. RESULTS In 109 patients (49.5%) the management of antiplatelet/anticoagulant drugs was thoroughly compliant with guidelines. Neither demographic characteristics, nor in/outpatient status, nor type of endoscopic procedure, nor physician's specialty influenced the adherence but the therapeutic regimen had a significant impact (p < 0.0001) as compliance was less likely in patients on warfarin. Unwarranted drugs withholding was more frequent before colonoscopy than upper endoscopy (p = 0.0001). Warfarin was stopped longer than recommended more frequently than aspirin (p = 0.009). The International Normalized Ratio was properly checked before endoscopy in 47.7% of patients. Among the 55 patients who withheld warfarin, the decision about bridging to low molecular weight heparin was appropriate in 21 (38.2%). CONCLUSIONS Compliance with guidelines is low especially in the management of warfarin, both among gastroenterologists and other physicians.
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Affiliation(s)
- Mauro Bruno
- Department of Gastroenterology and Digestive Endoscopy, Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, University of Turin, Italy
| | - Andrea Marengo
- Department of Gastroenterology and Digestive Endoscopy, Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, University of Turin, Italy
| | - Chiara Elia
- Department of Gastroenterology and Digestive Endoscopy, Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, University of Turin, Italy
| | - Stefania Caronna
- Department of Gastroenterology and Digestive Endoscopy, Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, University of Turin, Italy
| | - Wilma Debernardi-Venon
- Department of Gastroenterology and Digestive Endoscopy, Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, University of Turin, Italy
| | - Selene Francesca Manfrè
- Department of Gastroenterology and Digestive Endoscopy, Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, University of Turin, Italy
| | - Alessandro Musso
- Department of Gastroenterology and Digestive Endoscopy, Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, University of Turin, Italy
| | - Flavia Puglisi
- Department of Gastroenterology and Digestive Endoscopy, Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, University of Turin, Italy
| | - Carlo Sguazzini
- Department of Gastroenterology and Digestive Endoscopy, Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, University of Turin, Italy
| | - Mario Rizzetto
- Department of Gastroenterology and Digestive Endoscopy, Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, University of Turin, Italy
| | - Claudio De Angelis
- Department of Gastroenterology and Digestive Endoscopy, Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, University of Turin, Italy.
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Ruan GZ, Dong ZY, Gao F, Ruan XL. Clinical effect of digestive endoscopy combined with quadruple therapy in treatment of gastric ulcer bleeding. Shijie Huaren Xiaohua Zazhi 2013; 21:3409-3412. [DOI: 10.11569/wcjd.v21.i31.3409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the clinical efficacy of endoscopy combined with quadruple therapy in the treatment of gastric ulcer bleeding.
METHODS: One hundred and sixty-four patients with gastric ulcer bleeding treated at our hospital from February 2010 to February 2012 were randomly divided into either a treatment group or a control group, with 82 cases in each group. The treatment group underwent endoscopic therapy combined with quadruple therapy, while the control group received quadruple therapy only. The efficacy and factors associated with re-bleeding were analyzed.
RESULTS: The response rate was 96.2% in the treatment group. Of all 164 patients, 23.8% developed re-bleeding. The amount of bleeding and the percentage of patients with phase A1 or more ulcer were higher in the control group than in the treatment group. Hemoglobin, platelet count, and the percentage of patients undergoing endoscopic treatment were less in the control group than in the treatment group. Multivariate analysis showed that ulcer grade, hemoglobin and endoscopic treatment were independent risk factors for re-bleeding.
CONCLUSION: Digestive endoscopy combined with quadruple therapy is safe and effective in the treatment of gastric ulcer bleeding. Endoscopic treatment, lower hemoglobin, and higher ulcer grade are risk factors for re-bleeding.
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Kwon KA, Choi IJ, Kim EY, Dong SH, Hahm KB. International digestive endoscopy network 2012: a patchwork of networks for the future. Clin Endosc 2012; 45:209-10. [PMID: 22977803 PMCID: PMC3429737 DOI: 10.5946/ce.2012.45.3.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 07/18/2012] [Accepted: 07/18/2012] [Indexed: 11/23/2022] Open
Abstract
This special September issue of Clinical Endoscopy will discuss various aspects of diagnostic and therapeutic advancement of gastrointestinal (GI) endoscopy, explaining what is new in digestive endoscopy and why international network should be organized. We proposed an integrated model of international conference based on the putative occurrence of Digestive Endoscopy Networks. In International Digestive Endoscopy Network (IDEN) 2012, role of endoscopy in gastroesophageal reflux disease and Barrett's esophagus, endoscopy beyond submucosa, endoscopic treatment for stricture and leakage in upper GI, how to estimate the invasion depth of early GI cancers, colonoscopy in inflammatory bowel disease (IBD), a look into the bowel beyond colon in IBD, management of complications in therapeutic colonoscopy, revival of endoscopic papllirary balloon dilation, evaluation and tissue acquisition for indeterminate biliopancreatic stricture, updates in the evaluation of pancreatic cystic lesions, issues for tailored endoscopic submucosal dissection (ESD), endoluminal stents, management of upper GI bleeding, endoscopic management of frustrating situations, small bowel exploration, colorectal ESD, valuable tips for frustrating situations in colonoscopy, choosing the right stents for endoscopic stenting of biliary strictures, advanced techniques for pancreaticobiliary visualization, endoscopic ultrasound-guided biliopancreatic drainage, and how we can overcome the obstacles were deeply touched. We hope that IDEN 2012, as the very prestigious endoscopy networks, served as an opportunity to gain some clues for further understanding of endoscopic technologies and to enhance up-and-coming knowledge and their clinical implications from selected 25 peer reviewed articles and 112 invited lectures.
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Affiliation(s)
- Kwang An Kwon
- Department of Gastroenterology Gachon University Gil Medical Center, Incheon, Korea
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Liao GQ, Wang H, Zhu GY, Zhu KB, Lv FX, Tai S. Management of acquired bronchobiliary fistula: A systematic literature review of 68 cases published in 30 years. World J Gastroenterol 2011; 17:3842-9. [PMID: 21987628 PMCID: PMC3181447 DOI: 10.3748/wjg.v17.i33.3842] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Revised: 01/22/2011] [Accepted: 01/29/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To outline the appropriate diagnostic methods and therapeutic options for acquired bronchobiliary fistula (BBF).
METHODS: Literature searches were performed in Medline, EMBASE, PHMC and LWW (January 1980-August 2010) using the following keywords: biliobronchial fistula, bronchobiliary fistula, broncho-biliary fistula, biliary-bronchial fistula, tracheobiliary fistula, hepatobronchial fistula, bronchopleural fistula, and biliptysis. Further articles were identified through cross-referencing.
RESULTS: Sixty-eight cases were collected and reviewed. BBF secondary to tumors (32.3%, 22/68), including primary tumors (19.1%, 13/68) and hepatic metastases (13.2%, 9/68), shared the largest proportion of all cases. Biliptysis was found in all patients, and other symptoms were respiratory symptoms, such as irritating cough, fever (36/68) and jaundice (20/68). Half of the patients were treated by less-invasive methods such as endoscopic retrograde biliary drainage. Invasive approaches like surgery were used less frequently (41.7%, 28/67). The outcome was good at the end of the follow-up period in 28 cases (range, 2 wk to 72 mo), and the recovery rate was 87.7% (57/65).
CONCLUSION: The clinical diagnosis of BBF can be established by sputum analysis. Careful assessment of this condition is needed before therapeutic procedure. Invasive approaches should be considered only when non-invasive methods failed.
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