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1.
Z Gastroenterol ; 58(2): 137-145, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32050284

RESUMO

PURPOSE: Rectal neuroendocrine tumors are rare with good prognosis. Several endoscopic methods such as endoscopic polypectomy, endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and modified endoscopic mucosal resection (m-EMR) are used in the treatment of rectal neuroendocrine tumors. Although m-EMR is derived from traditional EMR, it has not been widely used in clinical practice. In this study, we compared the efficacy and safety of EMR and m-EMR in the treatment of rectal neuroendocrine tumors by performing a meta-analysis. MATERIALS AND METHODS: We searched PubMed, Web of Science, and EMBASE index up to the end of January 2017 for all published literature about EMR and m-EMR in the treatment of rectal neuroendocrine tumors. RESULTS: A total of 11 studies involving 811 patients were included. The pooled data suggested that there was a significantly higher rate of histologic complete resection and endoscopic complete resection among patients treated with m-EMR than those treated with EMR (histologic complete resection: OR = 0.23, 95 % CI = 0.10-0.51, p < 0.01; endoscopic complete resection: OR = 0.13, 95 % CI = 0.02-0.74, p = 0.02). The procedure time of EMR was longer than m-EMR (MD = 2.40, 95 % CI = 0.33-4.46, p = 0.02). There was a significantly higher rate of vertical margin involvement among patients treated with EMR than those treated with m-EMR; whereas, there was no significant difference of lateral margin involvement between the m-EMR and EMR groups (vertical margin involvement: OR = 5.00, 95 % CI = 2.67-9.33, p < 0.01; lateral margin involvement: OR = 1.44, 95 % CI = 0.48-4.37, p = 0.52). There was no significant difference in mean tumor size among patients treated with m-EMR versus those treated with EMR (MD = -0.30, 95 % CI = -0.75-0.14, p = 0.18); further, there was no significant difference in endoscopic mean sizes of the tumor and pathological mean sizes of the tumor between the m-EMR and EMR groups (endoscopic mean sizes of the tumor: MD = 0.20, 95 % CI = -0.44-0.84, p = 0.43; pathological mean sizes of the tumor: MD = 0.62, 95 % CI = -0.68-1.92, p = 0.05). No significant differences were detected among the treatment groups with regard to complications (bleeding: OR = 0.87, 95 % CI = 0.39-1.95, p = 0.73; complications (bleeding and perforation): OR = 0.87, 95 % CI = 0.40-1.88, p = 0.73). CONCLUSION: The efficacy of m-EMR are better than EMR among patients undergoing endoscopic treatment of rectal neuroendocrine tumors, and the safety of m-EMR is equivalent to EMR treatment.


Assuntos
Ressecção Endoscópica de Mucosa/métodos , Endoscopia Gastrointestinal/efeitos adversos , Tumores Neuroendócrinos/cirurgia , Neoplasias Retais/cirurgia , Humanos , Mucosa Intestinal/patologia , Mucosa Intestinal/cirurgia , Tumores Neuroendócrinos/patologia , Neoplasias Retais/patologia , Estudos Retrospectivos , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(3): e18806, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011485

RESUMO

RATIONALE: Esophagopleural fistula (EPF) is a rare critical life-threatening condition that features high misdiagnosis rate. Although various surgical and conservative techniques have been developed for the treatment of EPF, the mortality rate of EPF remains high. PATIENT CONCERNS: An 81-year-old man with hepatic cirrhosis caused by schistosomiasis was admitted with upper gastrointestinal bleeding. DIAGNOSES: Upper endoscopy revealed bleeding large esophageal varices, and endoscopic injection sclerotherapy (EIS) was performed. Two weeks after the EIS was performed, the patient developed pyrexia, left-sided pleuritic chest pain. Air and pleural effusion were showed in the left pleural cavity by high-resolution computed tomography (HRCT), and a linear fistulous communication was noticed from the distal esophagus. These findings were consistent with hepatic cirrhosis, esophageal varices, upper gastrointestinal bleeding, and esophagopleural fistula. INTERVENTIONS: The patient was intensively treated with endoscopic self-expandable metallic stent (covered-SEMS) implantation and comprehensive treatments (including thoracic closed drainage, antibiotics, nasojejunal nutrition, and antacids). OUTCOMES: The patient was completely cured without recurrence during a 6 months of follow-up by comprehensive conservative treatments. LESSONS: This case indicates that pleural effusion with food residue is a specific finding in EPF. Thorax CT exhibited high sensitivity for the diagnosis of EPF. Endoscopic self-expandable metallic stent implantation and comprehensive conservative treatments may be preferable for the severe liver disease with EPF.


Assuntos
Endoscopia Gastrointestinal , Fístula Esofágica/etiologia , Varizes Esofágicas e Gástricas/terapia , Escleroterapia , Idoso de 80 Anos ou mais , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/métodos , Fístula Esofágica/diagnóstico por imagem , Fístula Esofágica/terapia , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/etiologia , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/terapia , Masculino , Esquistossomose mansoni/complicações , Esquistossomose mansoni/terapia , Escleroterapia/efeitos adversos , Escleroterapia/métodos , Stents Metálicos Autoexpansíveis
3.
Z Gastroenterol ; 57(12): 1493-1513, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31826281

RESUMO

Neuroendocrine tumors of the gastrointestinal tract (GI-NET) are rare tumors. Functional tumors with hormonal syndromes (e. g., insulinoma, gastrinoma) are less common than non-functional tumors, which usually have an indolent course. Therapy for GI-NET is multimodal, including endoscopic or surgical procedures aiming at complete removal of tumor tissue. Patients in later stages may benefit from interventional radiology or medical therapy. This article gives an overview regarding the key aspects of GI-NET therapy in daily gastroenterology practice with emphasis on endoscopic diagnosis and therapy.


Assuntos
Gastroenterologia , Neoplasias Gastrointestinais/cirurgia , Tumores Neuroendócrinos/cirurgia , Guias de Prática Clínica como Assunto , Endoscopia Gastrointestinal/efeitos adversos , Gastrinoma , Neoplasias Gastrointestinais/patologia , Humanos , Tumores Neuroendócrinos/patologia , Neoplasias Pancreáticas , Resultado do Tratamento
4.
Artigo em Inglês | MEDLINE | ID: mdl-31569448

RESUMO

The aim of this study was to investigate the relationship between body mass index (BMI) categories and comorbidity in 9067 patients (age range 18‒94 years) who underwent upper digestive endoscopy in Northern Sardinia, Italy. The majority of participants (62.2%) had a BMI under 25 kg/m2, overweight was detected in 30.4%, and obesity (BMI ≥ 30 kg/m2) in 7.4% of patients. The most frequent illness recorded was hypertension followed by cardiovascular and liver disease. The multivariate analysis, after adjusting for sex, residence, marital status, smoking habits, occupation and hospitalization detected an association between comorbidity and aging that was statistically significant and progressive. Among patients younger than 60 years (n = 5612) the comorbidity risk was higher for BMI ranging 27.5‒29.9 kg/m2 compared with BMI 25.0‒27.4 kg/m2 (RR = 1.38; 95% CI 1.27‒1.50 vs. RR = 0.86; 95% CI 0.81‒0.90). In patients older than 60 years (n= 3455) the risk was lower for a BMI in the range 27.5-29.9 kg/m2 compared with a BMI in the range 25.0-27.4 kg/m2 (RR = 1.11; 95% CI 1.05‒1.18 vs. RR = 1.28; 95% CI 1.21‒1.35). These results suggest that being moderately overweight is a marker of a healthy aging process and might protect, at least in part, against comorbidity. However, further research is needed to better understand this unexpected finding.


Assuntos
Doenças Cardiovasculares/epidemiologia , Endoscopia Gastrointestinal/efeitos adversos , Hipertensão/epidemiologia , Hepatopatias/epidemiologia , Sobrepeso/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Comorbidade , Estudos Transversais , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Proteção , Adulto Jovem
5.
J Stroke Cerebrovasc Dis ; 28(12): 104403, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31563566

RESUMO

BACKGROUND: Air embolism is an extremely rare complication that can follow gastrointestinal endoscopy. The most accepted treatment of cerebral air embolism (CAE) is hyperbaric oxygen (HBO). Limited evidence suggests that lidocaine may have a neuroprotective effect. The exact mechanism does not appear to be well elucidated. METHODS: We conducted a literature search using multiple combinations of keywords from PubMed and Ovid Medline databases according to the PRISMA guidelines. We included articles with cases of air embolism caused by an esophagogastroduodenoscopy (EGD). We excluded cases related to other procedures e.g. colonoscopy, endoscopic retrograde cholangiopancreatography, cholangioscopy, Kasai procedure, bronchoscopy, laparoscopy or thoracoscopy. We were able to identify 30 cases of CAE associated with EGD. We included our experience in treating one patient with CAE after elective EGD. RESULTS: Given the results of our literature search and this patient's characteristics, we chose to treat our patient with HBO and lidocaine infusion. Our case series consists of 31 patients of post EGD CAE, the mean age was 63.7 ± 11.14 years, 38.7% of the patients were women (n = 12). 38.7% of the cases underwent esophageal dilatation (n = 12), while 19.35% had EGD biopsy (n = 6), 9.6% had variceal ligation (n = 3), and 3.22% had variceal banding (n = 1). In 20 out of 31 cases, echocardiography has been documented, 20% of those patients (n = 4) had patent foramen ovale. HBO was used in treatment of 48% of cases (n = 15), among the included patients, 61% survived (n = 19). Our patient showed significant neurological improvement. CONCLUSIONS: Despite the rare incidence of CAE during or after EGD, physicians should be aware of this potential complication. In patients who develop sudden acute neurological symptoms, early diagnosis and intervention may prevent devastating neurological injury and death. The most accepted emergent treatment for CAE includes HBO, consideration of lidocaine, and work-up of source of the air embolism.


Assuntos
Embolia Aérea , Endoscopia Gastrointestinal/efeitos adversos , Embolia Intracraniana , Idoso , Idoso de 80 Anos ou mais , Embolia Aérea/epidemiologia , Embolia Aérea/fisiopatologia , Embolia Aérea/prevenção & controle , Embolia Aérea/terapia , Feminino , Humanos , Oxigenação Hiperbárica , Incidência , Infusões Parenterais , Embolia Intracraniana/epidemiologia , Embolia Intracraniana/fisiopatologia , Embolia Intracraniana/prevenção & controle , Embolia Intracraniana/terapia , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Fármacos Neuroprotetores/administração & dosagem , Medição de Risco , Fatores de Risco , Resultado do Tratamento
6.
S Afr J Surg ; 57(3): 50-53, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31392865

RESUMO

BACKGROUND: Colorectal surgery has developed into an established surgical subspecialty in South Africa, however there is a paucity of data regarding the epidemiology and surgical outcomes of patients with colorectal disease in this country. The objective is to present the findings of a one-year audit of the Wits Donald Gordon Medical Centre (WDGMC) Colorectal Unit with specific reference to indications, surgical procedures and patient outcomes. METHOD: Patient files from December 2016 to November 2017 were included in a retrospective analysis. The Mann-Whitney U test was used to analyse continuous variables and the Chi-squared test was used to compare categorical variables. RESULTS: During the audit period, 1264 patients were admitted to the Colorectal Unit and a further 564 outpatient endoscopic procedures were performed. There were 306 emergency admissions. 139 elective colorectal resections took place, with a 16% major complication rate, a 12% anastomotic leak rate and no deaths. Rectal resections constituted 66% of the operations and 34% were colonic resections. The median length of stay for all patients undergoing resection was 9 days and there was no statistically significant difference in length of stay between open and laparoscopic cases. CONCLUSION: The WDGMC Colorectal Unit manages a high volume of patients presenting with the full spectrum of colorectal disease.


Assuntos
Colectomia/estatística & dados numéricos , Doenças do Colo/cirurgia , Complicações Pós-Operatórias/etiologia , Protectomia/estatística & dados numéricos , Doenças Retais/cirurgia , Centros Médicos Acadêmicos/estatística & dados numéricos , Fístula Anastomótica/etiologia , Colectomia/efeitos adversos , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/estatística & dados numéricos , Unidades Hospitalares/estatística & dados numéricos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/estatística & dados numéricos , Tempo de Internação , Auditoria Médica , Readmissão do Paciente/estatística & dados numéricos , Protectomia/efeitos adversos , Estudos Retrospectivos
7.
Surg Clin North Am ; 99(5): 955-965, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446920

RESUMO

Surgeons are often asked to perform tracheostomies and percutaneous endoscopic gastrostomies for a wide variety of patients. As consultants, surgeons are tasked with honoring the relationship between the referring provider and the patient while also assessing whether the consult is appropriate given the patient's prognosis and goals of care. This article discusses the most common conditions for which these procedures are requested and reviews the evidence supporting either the placement or avoidance of these tubes in each condition. It provides a framework for surgeons to use when discussing these procedures in the context of goals of care.


Assuntos
Endoscopia Gastrointestinal , Nutrição Enteral , Neoplasias de Cabeça e Pescoço/cirurgia , Doenças do Sistema Nervoso/cirurgia , Traqueostomia , Ferimentos e Lesões/cirurgia , Estado Terminal/terapia , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/mortalidade , Humanos , Cuidados Paliativos/ética , Traqueostomia/efeitos adversos , Traqueostomia/mortalidade
8.
Cir Cir ; 87(4): 423-427, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31264993

RESUMO

Background: Choledocholithiasis is one of the main complications of cholelithiasis with a prevalence in the Mexican population of 14%. The management through the guide proposed by the American Society for Gastrointestinal Endoscopy (ASGE) in 2010 can support the surgeon for the timely resolution of the pathology. Objective: To determine that the guide proposed by ASGE for the management of choledocholithiasis in patients with "high risk" reduces the complications of this pathology. Methods: A comparative, retrospective case-control study was conducted from January 1, 2015 to December 31, 2017. We included patients who were stratified at high risk of choledocholithiasis according to the ASGE guidelines. They were divided into 2 groups: the case group (diagnosis by ASGE guidelines) was submitted directly to endoscopic retrograde cholangiopancreatography (ERCP), the second group (no ASGE) followed the protocol of performing computed tomography, magnetic cholangioresonance, and finally ERCP. Results: Of 61 patients with choledocholithiasis, the following groups were compared: the appearance of cholangitis, the complications after ERCP, time of ERCP, days of hospital stay and mortality. Obtaining significant difference in: "complications post ERCP" group ASGE 3/35 (9%), group no ASGE 8/26 (30.7%) with OR of 0.2 (0.05 - 0.9 IC 95%) and a p = 0.03; "Cholangitis" group ASGE 2/35 (5.7%), group no ASGE 8/26 (30-7%) with ORP 0.13 (0.03-0.71 IC 95%) and p = 0.009. Conclusion: In our setting, the use of the ASGE guideline reduces the presence of cholangitis and post-ERCP complications.


Assuntos
Colangite/prevenção & controle , Coledocolitíase/diagnóstico por imagem , Endoscopia do Sistema Digestório/normas , Guias de Prática Clínica como Assunto , Sociedades Médicas/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/mortalidade , Colangiopancreatografia Retrógrada Endoscópica/normas , Colangite/etiologia , Coledocolitíase/complicações , Coledocolitíase/mortalidade , Estudos Transversais , Endoscopia do Sistema Digestório/efeitos adversos , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/mortalidade , Endoscopia Gastrointestinal/normas , Feminino , Humanos , Tempo de Internação , Imagem por Ressonância Magnética , Masculino , México , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Risco , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Estados Unidos , Adulto Jovem
9.
Korean J Gastroenterol ; 73(6): 315-321, 2019 Jun 25.
Artigo em Coreano | MEDLINE | ID: mdl-31234621

RESUMO

Because gastrointestinal (GI) endoscopy examinations are being performed increasingly frequently, the rate of detection of cancer and of precancerous lesions has increased. Moreover, development of more advanced endoscopic technologies has expanded the indications for, and thus frequency of, therapeutic endoscopic procedures. However, the incidence of complications associated with diagnostic or therapeutic GI endoscopy has also increased. The complications associated with GI endoscopy can be ameliorated by endoscopic or conservative treatment, but caution is needed as some of the more serious complications, such as perforation, can lead to death. In this chapter, we review the possible complications of GI endoscopy and discuss methods for their prevention and treatment.


Assuntos
Dissidências e Disputas/legislação & jurisprudência , Endoscopia Gastrointestinal/efeitos adversos , Perfuração Intestinal/etiologia , Agonistas Adrenérgicos beta/uso terapêutico , Anafilaxia/etiologia , Anafilaxia/prevenção & controle , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Bacteriemia/etiologia , Bacteriemia/prevenção & controle , Hemorragia/etiologia , Hemorragia/prevenção & controle , Humanos , Perfuração Intestinal/prevenção & controle , Perfuração Intestinal/cirurgia
10.
Curr Opin Anaesthesiol ; 32(4): 498-503, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31246712

RESUMO

PURPOSE OF REVIEW: Although the NORA setting continues to outgrow the main operating room in cases, there are few studies addressing efficiency metrics, and even fewer studies addressing those of a single specialty outpatient gastroenterology facility. In order to capitalize on this growing trend, gastrointestinal endoscopies must be scheduled in a way that prevents lost potential revenue while maintaining patient convenience, comfort, safety, and satisfaction. By standardizing our scheduling for procedure block time among various endoscopists and converting our sedation practices from conscious sedation to solely Propofol sedation in a 4 : 1 CRNA to Anesthesiologist model, we increased revenue while maximizing physician efficiency and site utilization. RECENT FINDINGS: The commonly used main operating room efficiency benchmarks cannot effectively be applied in NORA as these two locations have widely different procedure times, turn-around-times, and recovery times. In fact, procedures in gastrointestinal endoscopy suites can be completed in less time than a typical operating room takes for turnover. SUMMARY: By adapting our sedation practices to solely Propofol sedation and by standardizing our procedural schedule times among all the endoscopists, we maximized the number of cases and revenue in our outpatient gastrointestinal endoscopy suite while increasing patient satisfaction through reduction in overall patient facility time and procedure to discharge time.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Sedação Consciente/métodos , Eficiência Organizacional , Satisfação do Paciente , Admissão e Escalonamento de Pessoal/organização & administração , Instituições de Assistência Ambulatorial/economia , Sedação Consciente/economia , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/economia , Humanos , Dor Processual/etiologia , Dor Processual/prevenção & controle , Dor Processual/psicologia , Alta do Paciente , Admissão e Escalonamento de Pessoal/economia , Propofol/administração & dosagem , Fatores de Tempo
11.
Curr Opin Anaesthesiol ; 32(4): 453-456, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31169549

RESUMO

PURPOSE OF REVIEW: Capnography is an excellent tool for early detection of hypoxemia and apnea in patients undergoing sedation for gastrointestinal endoscopy. The current American Society of Anesthesiology (ASA) guidelines recommend the use of capnography in any patient undergoing moderate sedation. The purpose of this review was to compile the most recent data available on capnography use in gastrointestinal endoscopy with the focus primarily on the use of capnography in moderate sedation cases. RECENT FINDINGS: Recent high-quality studies have evaluated the utility of capnography in low risk patients undergoing moderate sedation and have found no benefit with addition of capnography. SUMMARY: Capnography is beneficial when used for patients who are at a higher risk for sedation-related complications. There is no benefit when capnography is used in low risk patients undergoing routine upper endoscopy and colonoscopy under moderate sedation but there is benefit when used in advanced endoscopic procedures that require deeper sedation and have longer procedure times.


Assuntos
Capnografia/normas , Sedação Consciente/efeitos adversos , Sedação Profunda/efeitos adversos , Endoscopia Gastrointestinal/efeitos adversos , Monitorização Fisiológica/normas , Dor Processual/prevenção & controle , Apneia/diagnóstico , Apneia/etiologia , Humanos , Hipóxia/diagnóstico , Hipóxia/etiologia , Monitorização Fisiológica/métodos , Dor Processual/etiologia , Guias de Prática Clínica como Assunto , Fatores de Risco , Fatores de Tempo
12.
Pancreatology ; 19(4): 608-613, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31101469

RESUMO

BACKGROUND: External pancreatic fistulae (EPF) developing in setting of disconnected pancreatic duct syndrome (DPDS) are associated with significant morbidity and surgery is the only effective treatment. AIM: To describe safety and efficacy of various endoscopic including endoscopic ultrasound (EUS) guided drainage techniques for resolving EPF in DPDS. METHODS: Retrospective analysis of data base of 18 patients (15 males; mean age: 37.6 ±â€¯7.1years) with EPF and DPDS who were treated with various endoscopic techniques including EUS guided transmural drainage. RESULTS: EPF developed post percutaneous drainage (PCD) (n = 15) or post-surgical necrosectomy (n = 3) of acute necrotic collections. All patients had refractory EPF with daily output of >50 ml/day with mean duration being 19.2 ±â€¯6.1 weeks. One patient had failed surgical fistulo-jejunostomy. Various endoscopic techniques used were: transmural placement of pigtail stent through gastric opening of trans-gastric PCD (n = 5), EUS guided transmural puncture of fluid collection created by clamping PCD (n = 5) or by instillation of water though PCD (n = 3), direct EUS-guided puncture of fistula tract (n = 1) and EUS guided pancreaticogastrostomy (n = 4). EPF healed in 17/18 (94%) patients within 5-21 days and there has been no recurrence over follow up of 16.7 ±â€¯12.8 weeks. Asymptomatic spontaneous external migration of stents was observed in 5/18 (29.4%) patients. CONCLUSION: Management of refractory EPFs in setting of DPDS is challenging. In our experience, combination of various endoscopic techniques including EUS guided transmural drainage appears to be safe and effective treatment modality for treating these complex EPF's. However, further studies to identify patient selection and best treatment approaches are needed.


Assuntos
Endoscopia Gastrointestinal/métodos , Ductos Pancreáticos/patologia , Fístula Pancreática/cirurgia , Adulto , Colangiopancreatografia Retrógrada Endoscópica , Drenagem , Endoscopia Gastrointestinal/efeitos adversos , Feminino , Gastrostomia , Humanos , Masculino , Pessoa de Meia-Idade , Ductos Pancreáticos/diagnóstico por imagem , Fístula Pancreática/diagnóstico por imagem , Fístula Pancreática/patologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Stents , Cirurgia Assistida por Computador , Resultado do Tratamento , Ultrassonografia de Intervenção
13.
Dig Liver Dis ; 51(7): 934-943, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31138509

RESUMO

After more than 15 years since its introduction into clinical practice, indications for device-assisted enteroscopy have greatly expanded. Alongside the consolidated indications such as the diagnosis and treatment of small bowel bleeding, Crohn's disease, hereditary polyposis, small-bowel tumors and complicated celiac disease, device-assisted enteroscopy is nowadays largely used to perform endoscopic retrograde cholangiopancreatography in patients with altered anatomy, stent placement, retrieval of foreign bodies, direct insertion of jejunal feeding tubes, and in selected cases of incomplete colonoscopy. This has been made possible by the technical improvements of the enteroscopes and accessories and by the widespread use of the method. Device-assisted enteroscopy endotherapy currently offers a safe and effective alternative to major surgery and often represents the preferred option for treatment of small-bowel pathology. Its safety profile is favourable even in the elderly patient, provided that it is performed in high-volume and experienced centers. The evolution of the enteroscopy technique is a challenge for the future and could be facilitated by the new enteroscopes models. These prototypes need a thorough clinical and safety assessment especially for the complex therapeutic procedures. Large prospective, multicenter studies should be performed to assess whether the use of device-assisted enteroscopy leads to improved patients' long-term outcomes.


Assuntos
Endoscopia Gastrointestinal/métodos , Gastroenteropatias/diagnóstico por imagem , Gastroenteropatias/terapia , Intestino Delgado/diagnóstico por imagem , Enteroscopia de Balão/métodos , Endoscopia por Cápsula/efeitos adversos , Endoscopia por Cápsula/métodos , Doença Celíaca/diagnóstico por imagem , Doença Celíaca/terapia , Colangiopancreatografia Retrógrada Endoscópica/métodos , Contraindicações de Procedimentos , Doença de Crohn/diagnóstico por imagem , Doença de Crohn/terapia , Endoscopia Gastrointestinal/efeitos adversos , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/terapia , Humanos , Neoplasias Intestinais/diagnóstico por imagem , Neoplasias Intestinais/terapia , Síndrome de Peutz-Jeghers/diagnóstico por imagem , Síndrome de Peutz-Jeghers/terapia
14.
Pancreas ; 48(5): 690-697, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31091217

RESUMO

OBJECTIVES: Pancreatic duct stones contribute to pain in patients with chronic pancreatitis, and per-oral pancreatoscopy (POP) allows visualization, fragmentation, and removal of these stones. This study compared the safety and efficacy of endoscopic retrograde pancreatography (ERP) with and without POP. METHODS: This single-center retrospective review compared ERP with and without POP for treatment of main-duct pancreatic duct stones. The primary outcome was technical success, defined as partial or complete stone removal, which was compared between the 2 groups. RESULTS: In all, 223 patients underwent 549 ERPs with a technical success rate of 92.4% and complete stone clearance rate of 74.9%. Patients undergoing ERP with POP (n = 94) had higher technical success than patients undergoing ERP without POP (n = 129, 98.9% vs 87.6%, P < 0.001), but required more ERPs (3.1 vs 1.9, P = 0.02). Endoscopic retrograde pancreatography with POP was associated with larger stone size (8.9 vs 6.1 mm, P = 0.001), more stones per case (5+ stones: 33.8% vs 21.1%, P = 0.002), and more impacted stones (48.8% vs 10.3%, P < 0.001). CONCLUSIONS: Per-oral pancreatoscopy-guided lithotripsy permits effective stone removal in cases not amenable to standard ERP techniques, including those with larger or more numerous stones.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Endoscopia Gastrointestinal/métodos , Litotripsia/métodos , Pancreatopatias/terapia , Ductos Pancreáticos/patologia , Cálculos Urinários/terapia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Idoso , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Endoscopia Gastrointestinal/efeitos adversos , Feminino , Humanos , Litotripsia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Dor/complicações , Dor/prevenção & controle , Pancreatite Crônica/complicações , Pancreatite Crônica/terapia , Estudos Retrospectivos , Resultado do Tratamento , Cálculos Urinários/complicações
15.
Curr Opin Anaesthesiol ; 32(4): 517-522, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31082826

RESUMO

PURPOSE OF REVIEW: To review the anesthestic and airway management for gastrointestinal procedures outside of the operating room. RECENT FINDINGS: The number of gastrointestinal endoscopic procedures performed is steadily increasing worldwide. As complexity, duration and invasiveness of procedures increase, there is ever greater requirement for deeper sedation or general anesthesia. A close relationship between anesthetic practitioners and endoscopists is required to ensure safe and successful outcomes. The American Society of Gastrointestinal endoscopy and the British Society of Gastroenterology have recently released guidelines for sedation and general anesthesia in gastrointestinal endoscopy, highlighting the need for careful monitoring for all cases, and anesthetic expertise in complex cases. The recent advances in high-flow nasal oxygenation in sedation may provide alternative options for oxygenation during gastrointestinal sedation, especially in deep sedation and this may reduce the need for general anesthesia. SUMMARY: The advances in gastrointestinal endoscopic intervention have increased the requirement for deep sedation and anesthetic involvement outside of the operating room. Careful titration of anesthetic intervention and close monitoring are required to ensure patient safety.


Assuntos
Anestesiologia/normas , Endoscopia Gastrointestinal/efeitos adversos , Dor Processual/prevenção & controle , Guias de Prática Clínica como Assunto , Manuseio das Vias Aéreas/métodos , Manuseio das Vias Aéreas/normas , Anestesiologia/métodos , Anestésicos/administração & dosagem , Sedação Consciente/métodos , Sedação Consciente/normas , Sedação Profunda/métodos , Sedação Profunda/normas , Endoscopia Gastrointestinal/normas , Gastroenterologia/normas , Humanos , Dor Processual/etiologia , Sociedades Médicas/normas , Reino Unido
16.
Eur J Anaesthesiol ; 36(6): 390-399, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30950900

RESUMO

BACKGROUND: Better understanding of risk factors for adverse events during monitored anaesthesia care (MAC) for paediatric gastrointestinal endoscopy may improve outcome in children. OBJECTIVES: To identify the prevalence and predictors of adverse events during MAC for paediatric endoscopy. DESIGN: An observational study. SETTING: Tertiary university hospital, single-centre cohort, from January 2010 to August 2016. PATIENTS: The prospectively collected electronic anaesthetic records of 3435 children aged up to 16 years who underwent diagnostic gastrointestinal endoscopy under MAC were analysed retrospectively. Children with an American Society of Anesthesiologists' physical status at least 4, and those requiring mechanical ventilation and therapeutic or urgent endoscopy were excluded. MAIN OUTCOME MEASURES: The prevalence and predictors of adverse events during MAC for paediatric gastrointestinal endoscopy, with particular reference to the use of different anaesthetic or sedative agents. RESULTS: Mean ±â€ŠSD age of the children was 8.5 ±â€Š4.4 years. The incidences of adverse events and adverse respiratory events were 3.4 and 3.3%, respectively. Multivariate analysis identified 12 independent predictors: age [odds ratio (OR) 0.92, P = 0.002], children's size for example underweight (OR 1.78, P = 0.039), overweight (OR 2.20, P = 0.039), (morbid) obesity (OR 4.25, P = 0.006), presence of respiratory comorbidities (OR 8.18, P < 0.001), recent respiratory infection (OR 23.55, P < 0.001) or both (OR 17.46, P < 0.001), neurological comorbidities (OR 2.18, P = 0.007), upper gastrointestinal endoscopy (OR 5.66, P < 0.001), propofol co-administration with ketamine (OR 10.34, P < 0. 001) or after sevoflurane induction (OR 44.95, P < 0.001), and propofol induction dose (OR 18.97, P < 0.001). Posthoc secondary analyses revealed a significantly higher risk of adverse events (OR 3.9, P < 0.0001) and also significantly more respiratory comorbidities and respiratory infections (P < 0.0001) in children aged less than 2 years when compared with children aged at least 2 years. No cardiovascular events were observed and outcome was uneventful. CONCLUSION: The present cohort demonstrated the feasibility and safety of MAC for paediatric gastrointestinal endoscopy by an experienced team. Although adverse events occurred rarely, their predictive factors were clinically identifiable. Applying this information in risk assessment and modifying anaesthetic management accordingly could improve outcome. TRIAL REGISTRATION: ISRCTN70362666.


Assuntos
Anestesia Geral/efeitos adversos , Sedação Profunda/efeitos adversos , Endoscopia Gastrointestinal/efeitos adversos , Complicações Intraoperatórias/epidemiologia , Monitorização Neurofisiológica Intraoperatória , Adolescente , Anestesia Geral/métodos , Criança , Pré-Escolar , Sedação Profunda/métodos , Estudos de Viabilidade , Feminino , Humanos , Incidência , Lactente , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Masculino , Prevalência , Estudos Prospectivos , Medição de Risco , Fatores de Risco
17.
Rinsho Shinkeigaku ; 59(3): 153-156, 2019 Mar 28.
Artigo em Japonês | MEDLINE | ID: mdl-30814443

RESUMO

We analyzed 14 patients in our hospital, who underwent levodopa-carbidopa intestinal gel (LCIG) treatment through a percutaneous endoscopic gastrojejunostomy (PEG-J). The PEG-J related complications were observed in 10 patients (71.4%). Detailed complications are as followings: J-tube related complications such as kinking (3 cases, 21.4%), pump malfunctions (3 cases, 21.4%), skin troubles in the gastrostoma (7 cases, 50.0%), duodenal perforation, peritonitis, and ulcers (2 cases, 14.3%). These results indicated that the sufficient care for PEG-J associated complications are important in LCIG treatment.


Assuntos
Antiparkinsonianos/administração & dosagem , Carbidopa/administração & dosagem , Endoscopia Gastrointestinal/efeitos adversos , Gastrostomia/efeitos adversos , Jejunostomia/efeitos adversos , Levodopa/administração & dosagem , Doença de Parkinson/tratamento farmacológico , Adulto , Idoso , Combinação de Medicamentos , Duodenopatias/epidemiologia , Duodenopatias/etiologia , Úlcera Duodenal/epidemiologia , Úlcera Duodenal/etiologia , Endoscopia Gastrointestinal/instrumentação , Endoscopia Gastrointestinal/métodos , Feminino , Gastrostomia/instrumentação , Gastrostomia/métodos , Géis , Humanos , Perfuração Intestinal/epidemiologia , Perfuração Intestinal/etiologia , Jejunostomia/instrumentação , Jejunostomia/métodos , Masculino , Pessoa de Meia-Idade , Peritonite/epidemiologia , Peritonite/etiologia , Estudos Retrospectivos , Dermatopatias/epidemiologia , Dermatopatias/etiologia , Estomas Cirúrgicos
18.
World J Gastroenterol ; 25(8): 1024-1030, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30833807

RESUMO

BACKGROUND: Tens of millions of gastrointestinal endoscopic procedures are performed every year in China, but the quality varies significantly and related factors are complex. Individual endoscopist- and endoscopy division-related factors may be useful to establish a model to measure and predict the quality of endoscopy. AIM: To establish a model to measure and predict the quality of gastrointestinal endoscopic procedures in mainland China. METHODS: Selected data on endoscopy experience, equipment, facility, qualification of endoscopists, and other relevant variables were collected from the National Database of Digestive Endoscopy of China. The multivariable logistic regression analysis was used to identify the potential predictive variables for occurrence of medical malpractice and patient disturbance. Linear and nonlinear regressions were used to establish models to predict incidence of endoscopic complications. RESULTS: In 2012, gastroscopy/colonoscopy-related complications in mainland China included bleeding in 4,359 cases (0.02%) and perforation in 914 (0.003%). Endoscopic-retrograde-cholangiopancreatography-related complications included severe acute pancreatitis in 593 cases (0.3%), bleeding in 2,151 (1.10%), perforation in 257 (0.13%) and biliary infection in 4,125 (2.11%). Moreover, 1,313 (5.0%) endoscopists encountered with medical malpractice, and 5,243 (20.0%) encountered with the disturbance from patients. The length of endoscopy experience, weekly working hours, weekly night shifts, annual vacation days and job satisfaction were predictors for the occurrence of medical malpractice and patient disturbance. However, the length of endoscopy experience and the ratio of endoscopists to nurses were not adequate to establish an effective predictive model for endoscopy complications. CONCLUSION: The workload and job satisfaction of endoscopists are valuable predictors for medical malpractice or patient disturbance. More comprehensive data are needed to establish quality-predictive models for endoscopic complications.


Assuntos
Doenças do Sistema Digestório/cirurgia , Endoscopia Gastrointestinal/efeitos adversos , Gastroenterologistas/estatística & dados numéricos , Complicações Pós-Operatórias/diagnóstico , Qualidade da Assistência à Saúde/estatística & dados numéricos , China , Competência Clínica/estatística & dados numéricos , Doenças do Sistema Digestório/diagnóstico por imagem , Endoscopia Gastrointestinal/normas , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/estatística & dados numéricos , Gastroenterologistas/psicologia , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Satisfação no Emprego , Imperícia/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Prognóstico , Controle de Qualidade , Qualidade da Assistência à Saúde/organização & administração , Carga de Trabalho
19.
J Int Med Res ; 47(5): 2097-2103, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30913936

RESUMO

OBJECTIVE: This study was designed to assess clinical predictors of hypoxemia and develop an artificial neural network (ANN) model for prediction of hypoxemia during sedation for gastrointestinal endoscopy examination. METHODS: A total of 220 patients were enrolled in this prospective observational study. Data on demographics, chronic concomitant disease information, neck circumference, thyromental distance and anaesthetic dose were collected and statistically analysed. RESULTS: Univariate analysis indicated that body mass index (BMI), habitual snoring and neck circumference were associated with hypoxemia. An ANN model was developed with three variables (BMI, habitual snoring and neck circumference). The area under the receiver operating characteristic curve for the ANN model was 0.80. CONCLUSIONS: The ANN model developed here, comprising BMI, habitual snoring and neck circumference, was useful for prediction of hypoxemia during sedation for gastrointestinal endoscopy.


Assuntos
Anestesia/efeitos adversos , Endoscopia Gastrointestinal/efeitos adversos , Hipóxia/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Resultado do Tratamento
20.
J Med Case Rep ; 13(1): 81, 2019 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-30905321

RESUMO

BACKGROUND: Gastrointestinal endoscopies are safe and follow guidelines that emphasize patient care. Although adverse outcomes are rare, high-risk patients may be predisposed to certain events. CASE PRESENTATION: We report a unique case of a Caucasian woman with takotsubo cardiomyopathy following an upper and lower endoscopy. CONCLUSIONS: Our report suggests the importance of understanding possible endoscopic complications in patients who may experience stress cardiomyopathy.


Assuntos
Endoscopia Gastrointestinal/efeitos adversos , Cardiomiopatia de Takotsubo/etiologia , Idoso , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Estresse Fisiológico , Estresse Psicológico , Cardiomiopatia de Takotsubo/diagnóstico por imagem
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