Viabilidad de la enteroscopia monobalón realizada bajo sedación dirigida por endoscopista / Viability of single balloon enteroscopy performed under endoscopist-directed sedation

Introducción: existe controversia sobre quién debe responsabilizarse de la sedación en endoscopia digestiva, sobre todo en los procedimientos avanzados que exigen sedación profunda. La enteroscopia es uno de ellos. El objetivo del trabajo es valorar la viabilidad de la sedación controlada por endoscopista durante la enteroscopia de monobalón. Material y método: estudio prospectivo observacional de una serie de enteroscopias consecutivas. Personal dedicado: endoscopista, enfermera instrumentista y enfermera encargada de monitorización y administración de sedantes. Monitorización: pulsioximetría, tensión arterial cada cinco minutos, registro electrocardiográfico y frecuencia respiratoria. Administración continua de oxígeno. Insuflación con CO2. Posición del paciente: decúbito izquierdo. Control fluoroscópico. Resultados: cuarenta y cuatro exploraciones en 39 pacientes (24 hombres, 15 mujeres). Edad 74 (18-89). Grado ASA: I-12, II-23, III-9. Comorbilidades en el 68% de los casos. Fármacos empleados: propofol, 23 casos; propofol y midazolam, diez casos; propofol, midazolam y fentanilo, dos casos; propofol y fentanilo, dos casos; y midazolam y fentanilo, siete casos. Procedimientos completados: 100%. Tiempo de exploración: 52 minutos (20-120). Hallazgos diagnósticos en el 65,9% de los casos; maniobras terapéuticas en el 47,7%. Complicaciones graves: ninguna. Complicaciones menores derivadas de la sedación: 22,7%. Conclusión: la sedación controlada por endoscopista es eficaz y segura en la realización de enteroscopia con monobalón. Son convenientes estudios multicéntricos y con mayor número de casos para una mejor valoración de la eficacia, seguridad y eficiencia de la sedación por no anestesista en endoscopia avanzada en nuestro medio

Introduction: there is a lot of controversy with regard to who should be responsible for sedation during digestive endoscopy, particularly in advanced procedures that require deep sedation such as enteroscopy. The aim of this study was to evaluate the endoscopist-directed sedation viability during single balloon enteroscopy. Material and method: this was a prospective, observational study of a series of consecutive enteroscopies. The clinical staff included an endoscopist, scrub nurse and a nurse in charge of monitoring and sedative administration. The following parameters were monitored: pulse oximetry, blood pressure (every five minutes), electrocardiogram and respiratory rate. There was continuous supplemental oxygen and CO2 insufflation. The patient was in the left lateral decubitus position and a fluoroscopic control was used. Results: forty-four explorations were performed in 39 patients, 24 were male and 15 female. The median age was 74 (18-89) and the ASA score was I in 12 cases, II in 23 cases and III in nine cases. Comorbidities were present in 68% of cases. The drugs used included propofol in 23 cases, propofol and midazolam in ten cases, propofol/midazolam/fentanyl in two cases, propofol and fentanyl in two cases, and midazolam/fentanyl in seven cases. All procedures were complete. The length of the procedure was 52 minutes (20-120). There were diagnostic findings in 65.9% of cases and therapeutic measures in 47.7%. There were no severe complications and the rate of complications derived from sedation was 22.7%. Conclusion: endoscopist-directed sedation is effective and safe for single balloon enteroscopy. Multi-center and wider studies are needed in order to better assess the efficacy, safety and efficiency of sedation controlled by a non-anesthetist during advanced endoscopy in this field

Viability of single balloon enteroscopy performed under endoscopist-directed sedation.

INTRODUCTION: there is a lot of controversy with regard to who should be responsible for sedation during digestive endoscopy, particularly in advanced procedures that require deep sedation such as enteroscopy. The aim of this study was to evaluate the endoscopist-directed sedation viability during single balloon enteroscopy. MATERIAL AND METHOD: this was a prospective, observational study of a series of consecutive enteroscopies. The clinical staff included an endoscopist, scrub nurse and a nurse in charge of monitoring and sedative administration. The following parameters were monitored: pulse oximetry, blood pressure (every five minutes), electrocardiogram and respiratory rate. There was continuous supplemental oxygen and CO2 insufflation. The patient was in the left lateral decubitus position and a fluoroscopic control was used. RESULTS: forty-four explorations were performed in 39 patients, 24 were male and 15 female. The median age was 74 (18-89) and the ASA score was I in 12 cases, II in 23 cases and III in nine cases. Comorbidities were present in 68% of cases. The drugs used included propofol in 23 cases, propofol and midazolam in ten cases, propofol/midazolam/fentanyl in two cases, propofol and fentanyl in two cases, and midazolam/fentanyl in seven cases. All procedures were complete. The length of the procedure was 52 minutes (20-120). There were diagnostic findings in 65.9% of cases and therapeutic measures in 47.7%. There were no severe complications and the rate of complications derived from sedation was 22.7%. CONCLUSION: endoscopist-directed sedation is effective and safe for single balloon enteroscopy. Multi-center and wider studies are needed in order to better assess the efficacy, safety and efficiency of sedation controlled by a non-anesthetist during advanced endoscopy in this field.

EUS-guided methylene blue cholangiopancreatography for benign biliopancreatic diseases after failed ERCP.

BACKGROUND AND AIMS: When ERCP fails, EUS-guided interventional techniques may be an alternative. The aim of this study was to evaluate the general outcomes and safety of EUS-guided methylene blue cholangiopancreatography in patients with failed ERCP in benign biliopancreatic diseases. METHODS: Patients with benign biliopancreatic diseases and failed ERCP were included. EUS-guided cholangiopancreatography plus injection of methylene blue was performed, and then ERCP using coloring agent flow as an indicator of papilla orifice was performed. Procedures were prospectively collected in this observational, single-center study. Technical success, clinical success, and adverse events were analyzed retrospectively. RESULTS: Eleven patients were included (10 choledocholithiasis, 1 pancreatic stricture). The main reason for failed ERCP was an unidentifiable papilla. EUS-guided ductal access with cholangiopancreatography and papilla orifice identification was obtained in all cases. Technical success and clinical success rates of 91% were achieved, with successful biliopancreatic drainage in 10 patients. Adverse events included 1 peripancreatic abscess attributed to a precut, which was successfully treated. No adverse events were related to the first EUS-guided stage. CONCLUSION: EUS-guided cholangiopancreatography with methylene blue injection seems to be a feasible and helpful technique for treatment in patients with benign biliopancreatic diseases with previous failed ERCP because of an undetectable papilla.

Three cases of liver toxicity with a dietary supplement intended to stop hair loss.

Liver toxicity associated with herbal remedies and dietary supplements is an increasing concern. Several toxic hepatitis cases have been reported in the literature in association with products intended for weight loss where green tea extracts are an ingredient.Three hepatotoxicity cases are reported below in association with the use of Inneov masa capilar®, a dietary supplement intended to stop hair loss whose primary component is green tea catechins. In all of them, other potential causes of acute hepatitis were ruled out.We highlight the importance of awareness regarding these substances at history taking in order to identify and report hepatic adverse reactions secondary to apparently safe herbs as described in the present manuscript.

Tres casos de hepatotoxicidad por un suplemento dietético destinado a frenar la caída del cabello / Three cases of liver toxicity with a dietary supplement intended to stop hair loss

La toxicidad hepática asociada al uso de productos de herboristería y suplementos nutricionales es un fenómeno creciente. En la literatura se han comunicado varios casos de hepatitis tóxica en relación con productos utilizados para la pérdida de peso que incluyen extractos de té verde en su composición. A continuación se describen tres casos de hepatotoxicidad relacionados con la toma de Inneov masa capilar®, un suplemento nutricional destinado a detener la caída del cabello cuyo componente principal son las catequinas de té verde. En todos ellos se descartaron otras posibles causas de hepatitis aguda. Recalcamos la importancia de incluir la ingesta de este tipo de sustancias a la hora de realizar la anamnesis para poder detectar y notificar las reacciones hepáticas adversas secundarias a productos herbales de apariencia inocua, como el descrito en el manuscrito (AU)

Liver toxicity associated with herbal remedies and dietary supplements is an increasing concern. Several toxic hepatitis cases have been reported in the literature in association with products intended for weight loss where green tea extracts are an ingredient. Three hepatotoxicity cases are reported below in association with the use of Inneov masa capilar®, a dietary supplement intended to stop hair loss whose primary component is green tea catechins. In all of them, other potential causes of acute hepatitis were ruled out. We highlight the importance of awareness regarding these substances at history taking in order to identify and report hepatic adverse reactions secondary to apparently safe herbs as described in the present manuscript (AU)