RESUMO
BACKGROUND: non-anesthesiologist administration of propofol (NAAP) using continuous infusion systems may achieve a more sustained sedative action. AIM: to compare intermittent boluses (IB) with pump continuous infusion (PCI) for NAAP, targeted to moderate sedation, for colonoscopy. METHODS: 192 consecutive outpatients were randomized to receive IB (20 mg propofol boluses on demand) or PCI (3 mg/kg/h plus 20 mg boluses on demand). Sedation could be stopped at cecal intubation at the discretion of the endoscopist. Satisfaction rates of the patient, nurses and endoscopist, propofol doses, depth of sedation (at the beginning, at cecal intubation and at the end), recovery times, complications and were collected. RESULTS: there were no differences between groups regarding patient, nurse or endoscopist satisfaction rates with procedural sedation. Propofol doses (mg) were significantly higher during the induction phase -86 (30-172) vs. 78 [30-160], p 0.03- and overall -185 (72-400) vs. 157 (60-460), p = 0.003- for PCI group. 81 % of assessments of the depth of sedation were moderate. The level of sedation (O/AAS scale) was borderline significantly deeper at cecal intubation (2.38 vs. 2.72; p = 0.056) and at the end of the procedure (4.13 vs. 4.45; p = 0.05) for PCI group, prolonging thus early recovery time (6.3 vs. 5.1 minutes, p = 0.008), but not discharge time. Complications, all of them in minors, were non-significantly more frequent in the PCI group (9 vs. 7 %, p = 0.07). CONCLUSIONS: NAAP for colonoscopy was safely administered with comparable satisfaction and complication rates with either IB or PCI.
Assuntos
Anestésicos Intravenosos/administração & dosagem , Colonoscopia , Propofol/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Feminino , Humanos , Bombas de Infusão , Infusões Intravenosas/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto JovemRESUMO
Background: non-anesthesiologist administration of propofol (NAAP) using continuous infusion systems may achieve a more sustained sedative action. Aim: to compare intermittent boluses (IB) with pump continuous infusion (PCI) for NAAP, targeted to moderate sedation, for colonoscopy. Methods: 192 consecutive outpatients were randomized to receive IB (20 mg propofol boluses on demand) or PCI (3 mg/ kg/h plus 20 mg boluses on demand). Sedation could be stopped at cecal intubation at the discretion of the endoscopist. Satisfaction rates of the patient, nurses and endoscopist, propofol doses, depth of sedation (at the beginning, at cecal intubation and at the end), recovery times, complications and were collected. Results: there were no differences between groups regarding patient, nurse or endoscopist satisfaction rates with procedural sedation. Propofol doses (mg) were significantly higher during the induction phase (86 [30-172] vs. 78 [30-160], p 0.03) and overall (185 [72-400] vs. 157 [60-460], p = 0.003) for PCI group. 81 % of assessments of the depth of sedation were moderate. The level of sedation (O/AAS scale) was borderline significantly deeper at cecal intubation (2.38 vs. 2.72; p = 0.056) and at the end of the procedure (4.13 vs. 4.45; p = 0.05) for PCI group, prolonging thus early recovery time (6.3 vs. 5.1 minutes, p = 0.008), but not discharge time. Complications, all of them in minors, were non-significantly more frequent in the PCI group (9 vs. 7 %, p = 0.07). Conclusions: NAAP for colonoscopy was safely administered with comparable satisfaction and complication rates with either IB or PCI (AU)
Assuntos
Humanos , Masculino , Feminino , Propofol/uso terapêutico , Colonoscopia/instrumentação , Colonoscopia/normas , Colonoscopia , Sedação Consciente/instrumentação , Sedação Consciente/métodos , Sedação Consciente , Satisfação do Paciente , Colonoscopia/métodos , Colonoscopia/tendências , Endoscopia/métodos , Endoscopia , Estudos Prospectivos , Eletrocardiografia/instrumentação , Eletrocardiografia/métodos , Eletrocardiografia , Inquéritos e QuestionáriosRESUMO
Introducción La preparación de la colonoscopia en dosis fraccionadas (DF) mejora la calidad de la limpieza. Objetivo Comparar la preparación para colonoscopias de mañana con picosulfato sódico/citrato de magnesio (Citrafleet®) en DF con su administración el día previo. Material y métodos Pacientes consecutivos fueron aleatorizados a Citrafleet® el día anterior o en DF administrándose la segunda mitad individualizadamente con un intervalo de 2 a 6 h antes del procedimiento, sin bisacodilo. La sedación fue realizada con propofol, definiéndose una limpieza adecuada si ≥ 6 (escala de Boston), sin ninguna puntuación 0/1.ResultadosSe incluyeron 193 pacientes. La calidad de la limpieza fue significativamente mejor en el grupo DF de manera global (7 vs. 5,2, p<0,001), en ciego (2,4 vs. 1,4, p<0,001), colon ascendente (2,5 vs.1,6, p = 0,001) y colon transverso (2,4 vs. 2, p = 0,004). La limpieza adecuada del colon se detectó en un porcentaje significativamente superior de pacientes con DF (71 vs. 30%, p<0,001). Los pacientes del grupo DF bebieron un volumen de líquido superior (4,9 vs. 4 l, p = 0,006) y percibieron con mayor frecuencia el proceso como fácil o muy fácil de completar (89 vs. 68%, p = 0,04), aunque durmieron menor número de horas (6,5 vs.7,9, p<0,001). No se registró ninguna bronconeumonía aspirativa. Conclusiones La preparación en DF con Citrafleet® incrementó en un 40% las exploraciones con una limpieza adecuada, especialmente en colon proximal, aumentó el volumen de ingesta líquida y mejoró la percepción de facilidad para su cumplimiento, sin complicaciones derivadas de la sedación (AU)
Background Split dosage of bowel preparations has been shown to substantially improve bowel cleansing. Aim To compare the split dose (SD) sodium picosulphate/magnesium oxide/anhydrous citric acid (Citrafleet®) regimen for morning colonoscopies with standard cleansing the day before. Methods Consecutive outpatients were randomized to receive Citrafleet® the day before colonoscopy or SD, in whom the second half was administered on an individual basis from 2 to 6hours before the procedure. No bisacodyl was administered. All procedures were performed with non-anesthesiologist administered propofol sedation. The Boston scale was used to assess the quality of bowel preparation (adequate cleansing if score ≥ 6, with no score of 0/1 in any segment).Results A total of 193 patients were included. Overall bowel cleansing was significantly better in the SD group (7 vs. 5.2, p<0.001), as well as in the cecum (2.4 vs. 1.4, p < 0.001), ascending colon (2.5vs. 1.6, p<0.001) and transverse colon (2.4 vs. 2, p = 0.004). A significant proportion of SD patients had adequate bowel cleansing (71% vs. 30%, p<0.001). Patients in the SD group drank a greater amount of liquid (4.9 vs. 4 liters, p = 0.006) and more frequently perceived the cleansing process to be easy or very easy to complete (89 vs. 68%, p = 0.04), although they slept significantly fewer hours (6.5 vs. 7.9, p<0.001). No bronchoaspiration pneumonia was reported. Conclusions SD Citrafleet® 2 to 6hours before colonoscopy increased the rate of procedures with adequate bowel cleansing by 40%, especially in the proximal colon, allowed more liquids to be drunk and increased the perception of ease in completing the preparation, with no sedation-related complications (AU)
Assuntos
Humanos , Colonoscopia/métodos , /métodos , Doenças do Colo/diagnóstico , Esvaziamento Gástrico , Óxido de Magnésio/uso terapêutico , Sedação Consciente/métodosRESUMO
BACKGROUND: Split dosage of bowel preparations has been shown to substantially improve bowel cleansing. AIM: To compare the split dose (SD) sodium picosulphate/magnesium oxide/anhydrous citric acid (Citrafleet(®)) regimen for morning colonoscopies with standard cleansing the day before. METHODS: Consecutive outpatients were randomized to receive Citrafleet(®) the day before colonoscopy or SD, in whom the second half was administered on an individual basis from 2 to 6 hours before the procedure. No bisacodyl was administered. All procedures were performed with non-anesthesiologist administered propofol sedation. The Boston scale was used to assess the quality of bowel preparation (adequate cleansing if score ≥ 6, with no score of 0/1 in any segment). RESULTS: A total of 193 patients were included. Overall bowel cleansing was significantly better in the SD group (7 vs. 5.2, p<0.001), as well as in the cecum (2.4 vs. 1.4, p < 0.001), ascending colon (2.5 vs. 1.6, p<0.001) and transverse colon (2.4 vs. 2, p=0.004). A significant proportion of SD patients had adequate bowel cleansing (71% vs. 30%, p<0.001). Patients in the SD group drank a greater amount of liquid (4.9 vs. 4 liters, p=0.006) and more frequently perceived the cleansing process to be easy or very easy to complete (89 vs. 68%, p=0.04), although they slept significantly fewer hours (6.5 vs. 7.9, p<0.001). No bronchoaspiration pneumonia was reported. CONCLUSIONS: SD Citrafleet(®) 2 to 6 hours before colonoscopy increased the rate of procedures with adequate bowel cleansing by 40%, especially in the proximal colon, allowed more liquids to be drunk and increased the perception of ease in completing the preparation, with no sedation-related complications.
Assuntos
Catárticos/administração & dosagem , Citratos/administração & dosagem , Ácido Cítrico/administração & dosagem , Colonoscopia , Compostos Organometálicos/administração & dosagem , Picolinas/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Catárticos/efeitos adversos , Citratos/efeitos adversos , Ácido Cítrico/efeitos adversos , Diarreia/induzido quimicamente , Comportamento de Ingestão de Líquido , Esquema de Medicação , Medo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Compostos Organometálicos/efeitos adversos , Aceitação pelo Paciente de Cuidados de Saúde , Picolinas/efeitos adversos , Privação do Sono , Adulto JovemRESUMO
BACKGROUND: Using quadruple clarithromycin-containing regimens for Helicobacter pylori eradication is controversial with high rates of macrolide resistance. AIM: To evaluate antibiotic resistance rates and the efficacy of empirical and tailored nonbismuth quadruple (concomitant) therapy in a setting with cure rates <80% for triple and sequential therapies. METHODS: 209 consecutive naive H. pylori-positive patients without susceptibility testing were empirically treated with 10-day concomitant therapy (proton pump inhibitors (PPI), amoxicillin 1 g, clarithromycin 500 mg, and metronidazole 500 mg; all drugs b.i.d.). Simultaneously, 89 patients with positive H. pylori culture were randomized to receive triple versus concomitant therapy for clarithromycin-susceptible H. pylori, and sequential versus concomitant therapy for clarithromycin-resistant strains. Eradication was confirmed with ¹³C-urea breath test or histology 8 weeks after completion of treatment. RESULTS: Per-protocol (PP) and intention-to-treat eradication rates after empirical concomitant therapy without susceptibility testing were 89% (95%CI:84-93%) and 87% (83-92%). Antibiotic resistance rates were: clarithromycin, 20%; metronidazole, 34%; and both clarithromycin and metronidazole, 10%. Regarding clarithromycin-susceptible H. pylori, concomitant therapy was significantly better than triple therapy by per protocol [92% (82-100%) vs 74% (58-91%), p = 0.05] and by intention to treat [92% (82-100%) vs 70% (57-90%), p = 0.02]. As for antibiotic-resistant strains, eradication rates for concomitant and sequential therapies were 100% (5/5) vs 75% (3/4), for clarithromycin-resistant/metronidazole-susceptible strains and 75% (3/4) vs 60% (3/5) for dual-resistant strains. CONCLUSIONS: Empirical 10-day concomitant therapy achieves good eradication rates, close to 90%, in settings with multiresistant H. pylori strains. Tailored concomitant therapy is significantly superior to triple therapy for clarithromycin-susceptible H. pylori and at least as effective as sequential therapy for resistant strains.
Assuntos
Antibacterianos/uso terapêutico , Claritromicina/uso terapêutico , Farmacorresistência Bacteriana , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/efeitos dos fármacos , Metronidazol/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amoxicilina/uso terapêutico , Quimioterapia Combinada , Feminino , Infecções por Helicobacter/microbiologia , Helicobacter pylori/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Bomba de Prótons/uso terapêutico , Adulto JovemRESUMO
BACKGROUND: Nonanesthesiologist-administered propofol (NAAP) is controversial due to deep sedation concerns. AIM: The purpose of this study was to evaluate the feasibility of moderate sedation with two different NAAP regimens for colonoscopy. METHODS: This was a double-blinded, randomised, placebo-controlled trial allocating 135 consecutive outpatients to placebo (group P) or midazolam 2 mg (group M+P) before NAAP targeted to moderate sedation. Depth of sedation every 2 min throughout the procedure, propofol doses, recovery times, complications and patient and endoscopist satisfaction were measured. RESULTS: A total of 84 % of assessments of the depth of sedation were moderate. Mean induction (76 [40-150] vs. 53 [30-90]) and total propofol doses (mg) (136 [60-270] vs. 104 [50-190]) were significantly higher for group P (p < 0.001). However, deep sedation was significantly more prevalent in group M+P in minutes 4 (16 vs. 1 %, p = 0.05), 6 (20 vs. 3.5 %, p = 0.046) and 8 (17 vs. 1.8 %, p = 0.06) of the procedure, coinciding with midazolam peak action. From minute 8 on, moderate sedation was significantly deeper for M+P (p = 0.002). Early recovery time (6.8 min vs. 5.2, p = 0.007), but not discharge time (10.4 min vs. 9.8, p = 0.5), was longer for M+P. Pain perception (P 1.03 vs. M+P 0.3, p = 0.009) and patient satisfaction scores (P 9.4 vs. M+P 9.8, p = 0.047) were better for M+P. No major complications occurred. CONCLUSIONS: Moderate sedation was feasible with both NAAP regimens. Drug synergy in the midazolam plus propofol sedation regimen promotes a deeper and longer moderate sedation, improving patient satisfaction rates but prolonging early recovery time (Clinical Trials gov NCT01428882).
Assuntos
Sedação Consciente/métodos , Hipnóticos e Sedativos/farmacologia , Midazolam/farmacologia , Propofol/farmacologia , Período de Recuperação da Anestesia , Colonoscopia , Relação Dose-Resposta a Droga , Sinergismo Farmacológico , Quimioterapia Combinada , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Masculino , Midazolam/administração & dosagem , Satisfação do Paciente , Propofol/administração & dosagem , Fatores de TempoAssuntos
Abscesso/microbiologia , Abscesso/cirurgia , Doença de Crohn/microbiologia , Drenagem , Íleo/microbiologia , Abscesso/tratamento farmacológico , Biópsia , Criança , Colonoscopia , Doença de Crohn/diagnóstico , Doença de Crohn/tratamento farmacológico , Infecções por Escherichia coli/tratamento farmacológico , Humanos , Infecções por Klebsiella/tratamento farmacológico , Piperacilina/uso terapêutico , Prednisona/uso terapêuticoAssuntos
Angiodisplasia/tratamento farmacológico , Hemorragia Gastrointestinal/tratamento farmacológico , Octreotida/uso terapêutico , Somatostatina/análogos & derivados , Talidomida/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Angiodisplasia/complicações , Inibidores da Angiogênese/efeitos adversos , Inibidores da Angiogênese/uso terapêutico , Hemorragia Gastrointestinal/etiologia , Humanos , Talidomida/efeitos adversos , Resultado do TratamentoRESUMO
There is little experience regarding the use of argon plasma coagulation (APC) to trim malpositioned or migrated, endoscopic, metallic, self-expanding, colorectal stents. We report a case of a distally migrated, uncovered rectal stent complicated with several ulcerations because of impaction against the rectal wall and embedment within the healthy mucosa distal to the neoplasm. Endoscopic en bloc removal was not possible because of diffuse tumoral ingrowth. By using a second generation APC device (60 W, 0.6 L/min), the stent was trimmed allowing access to the back wall, which was tailored after digging up the embedded wires with gentle traction of the stent. Complete extraction of the protruding end of the stent by a 2.5 cm, fully covered pseudoepithelization tissue, was carried out through a flexible overtube. This is the first report of APC endoscopic transection of a long embedded segment from a distally migrated colorectal stent.
Assuntos
Endoscopia Gastrointestinal/métodos , Migração de Corpo Estranho/cirurgia , Fotocoagulação a Laser/métodos , Reto , Stents , Idoso , Humanos , Lasers de Gás/uso terapêutico , MasculinoRESUMO
Fundamento y objetivo: El octreótido long acting release (OCT-LAR) ha demostrado resultados preliminares prometedores en el tratamiento de la hemorragia recurrente digestiva de origen oscuro. Pacientes y método: Once pacientes con comorbilidades graves se trataron con 20mg intramusculares mensuales de OCT-LAR. No se cambió la medicación concomitante y se monitorizaron trimestralmente los requerimientos transfusionales, los días de ingreso hospitalario y los efectos secundarios. Resultados: La mediana (extremos) de edad y de seguimiento fue de 74 años (6586) y 15 meses (548), respectivamente. Cinco pacientes estaban anticoagulados y otros 5 antiagregados; 8 pacientes tenían (72%) angiodisplasias difusas de intestino delgado. Cuatro pacientes (36%) fallecieron durante el estudio. Únicamente 2 pacientes (18%) permanecieron libres de transfusiones, aunque durante el primer año se redujeron significativamente los requerimientos transfusionales (mediana de concentrados de hematíes de 14 [extremos 949] frente a 4 [09]; p=0,002) y los días de ingreso hospitalario (mediana de 27 [1099] frente a 7 [023] días; p=0,001). No se registraron efectos secundarios (AU)
Background and objective: Octreotide LAR has shown preliminary promising results in the treatment of recurrent obscure gastrointestinal haemorrhage. Patients and methods: Eleven patients with severe comorbidities were treated with continuous octreotide LAR 20mg once a month. No changes were performed in concomitant drugs. Haemoglobin levels, blood transfusions, hospital admissions and adverse effects were recorded every three months. Results: Median age and follow-up were 74 yr (6586) and 15 months (548). Five patients were on acenocoumarol therapy and other five on antiplatelet drugs. Eight patients (72%) had diffuse small bowel angiodysplasia and 4 patients died during follow-up. Only two patients (18%) remained free of transfusions but it resulted for the first year in an outstanding decrease in the need of red cell packets (14 (949) vs 4 (09), p=0,002) and in admission days related to gastrointestinal bleeding (27 (1099) vs 7(023), p=0,001). No side effects were reported. Conclusion: Octreotide LAR is an effective, safe and comfortable palliative therapy for severe obscure gastrointestinal bleeding. Medical resources saving and improved quality of life may warrant its use irrespective of comorbidities or life expectancy (AU)
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Hemorragia Gastrointestinal/tratamento farmacológico , Octreotida/uso terapêutico , Hemorragia Gastrointestinal/complicações , Estudos Prospectivos , Fármacos Gastrointestinais/uso terapêutico , Preparações de Ação Retardada/uso terapêutico , Índice de Gravidade de Doença , Vasoconstritores/uso terapêuticoRESUMO
BACKGROUND AND OBJECTIVE: Octreotide LAR has shown preliminary promising results in the treatment of recurrent obscure gastrointestinal haemorrhage. PATIENTS AND METHODS: Eleven patients with severe comorbidities were treated with continuous octreotide LAR 20mg once a month. No changes were performed in concomitant drugs. Haemoglobin levels, blood transfusions, hospital admissions and adverse effects were recorded every three months. RESULTS: Median age and follow-up were 74 yr (65-86) and 15 months (5-48). Five patients were on acenocoumarol therapy and other five on antiplatelet drugs. Eight patients (72%) had diffuse small bowel angiodysplasia and 4 patients died during follow-up. Only two patients (18%) remained free of transfusions but it resulted for the first year in an outstanding decrease in the need of red cell packets (14 (9-49) vs 4 (0-9), p=0,002) and in admission days related to gastrointestinal bleeding (27 (10-99) vs 7(0-23), p=0,001). No side effects were reported. CONCLUSION: Octreotide LAR is an effective, safe and comfortable palliative therapy for severe obscure gastrointestinal bleeding. Medical resources saving and improved quality of life may warrant its use irrespective of comorbidities or life expectancy.
Assuntos
Hemorragia Gastrointestinal/complicações , Hemorragia Gastrointestinal/tratamento farmacológico , Octreotida/uso terapêutico , Vasoconstritores/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Preparações de Ação Retardada , Feminino , Humanos , Masculino , Estudos Prospectivos , Índice de Gravidade de DoençaAssuntos
Adenocarcinoma/complicações , Alopecia em Áreas/etiologia , Síndromes Paraneoplásicas/etiologia , Neoplasias Gástricas/complicações , Adenocarcinoma/diagnóstico , Adenocarcinoma/secundário , Evolução Fatal , Humanos , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Neoplasias Peritoneais/secundário , Neoplasias Gástricas/diagnósticoAssuntos
Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/complicações , Neoplasias Gástricas/diagnóstico , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico , Alopecia em Áreas/etiologia , Síndromes Paraneoplásicas/complicações , Síndromes Paraneoplásicas/diagnóstico , Evolução FatalRESUMO
No disponible
Assuntos
Humanos , Feminino , Adulto , Metformina/efeitos adversos , Pancreatite/induzido quimicamente , Insuficiência Renal , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/efeitos adversosRESUMO
Eosinophilic esophagitis (EE) and gastroesophageal reflux disease (GERD) have overlapping clinical, manometric, endoscopic and histopathologic features. The diagnosis of EE is nowadays based upon the presence of 15 or more eosinophils per high power field (eo/HPF) in esophageal biopsies. We report the cases of two young males suffering from dysphagia and recurrent food impaction with reflux esophagitis and more than 20 eo/HPF in upper-mid esophagus biopsies, both of which became asymptomatic on proton pump inhibitor (PPI) therapy. The first patient also achieved a histologic response, while EE remained in the other patient after effective PPI treatment, as shown by 24-h esophageal pH monitoring. Topical steroid therapy combined with PPI led to complete remission in this latter patient. GERD and EE may be undistinguishable, even by histology, so diagnosis of EE should only be established after a careful correlation of clinical, endoscopic and pathologic data obtained under vigorous acid suppression. These diagnostic difficulties are maximal when both diseases overlap. Limited data are available about this topic, and the interaction between EE and GERD is a matter of debate. In this setting, upper-mid esophagus step biopsies and esophageal pH monitoring of patients on PPI therapy are pivotal to evaluate the role of each disease. A PPI trial is mandatory in patients with a histopathologic diagnosis of EE; in those unresponsive to PPI treatment, EE should be suggested. However, a clinical response to PPI may not rule out quiescent EE, as shown in this report.
Assuntos
Eosinofilia/tratamento farmacológico , Esofagite Péptica/tratamento farmacológico , Esofagite/tratamento farmacológico , Adulto , Androstadienos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Eosinofilia/diagnóstico , Esofagite/diagnóstico , Esofagite Péptica/diagnóstico , Esôfago/patologia , Fluticasona , Humanos , Masculino , Inibidores da Bomba de Prótons/uso terapêuticoAssuntos
Ar , Cáusticos/intoxicação , Esofagite/induzido quimicamente , Gastrite/induzido quimicamente , Intubação Gastrointestinal/efeitos adversos , Veia Porta , Adulto , Queimaduras Químicas/etiologia , Procedimentos Cirúrgicos Eletivos , Emergências , Estenose Esofágica/induzido quimicamente , Feminino , Humanos , Jejuno , Fígado/irrigação sanguínea , Veia Porta/diagnóstico por imagem , Baço/irrigação sanguínea , Tentativa de Suicídio , Tomografia Computadorizada por Raios XRESUMO
No disponible