Sedation, analgesia, and monitoring.

Endoscopic procedures are common and sedation is frequently used to minimize anxiety and discomfort, reduce the potential for physical injury during the procedure, and improve overall patient tolerability and satisfaction. In this article, the authors review the variety of options for sedation and analgesia available to the gastroenterologist or surgical endoscopist.

Evaluation of percutaneous endoscopic feeding tube placement in obese patients.

BACKGROUND: Percutaneous endoscopic feeding tube placement is generally safe and effective for establishing enteral access. In certain subpopulations, such as obese patients, substantial data are limited. This study evaluates the success rate and potential for late complications with placement of feeding tubes in obese patients. METHODS: The Medical University of South Carolina endoscopy database was queried for adult patients with a body mass index >or=30 kg/m(2) who had undergone percutaneous endoscopic gastrostomy, percutaneous endoscopic gastrojejunostomy, and direct percutaneous jejunostomy placement procedures between the years 2000 and 2006. RESULTS: Sixty-seven subjects met the inclusion criteria. Percutaneous endoscopic feeding tube placement was successful in 60 of 67 individuals (89.6%) with an average procedure time of 15.5 minutes (range, 5-70 minutes). Postplacement complications occurred in 26 of 59 subjects (44.1%) and included peristomal pain (8.5%), cellulitis (8.5%), inadvertent removal (6.8%), peritubular leak (6.8%), nausea (3.4%), and hemoperitoneum (3.4%). In multivariable logistic regression analysis, weight >250 pounds (>113 kg) predicted a significantly increased likelihood of complications (adjusted odds ratio = 3.86; 95% confidence interval, 1.02-14.57). Other covariates did not significantly affect the complication rate. CONCLUSIONS: Percutaneous enteral access device placement in obese patients is generally safe, and a body mass index >or=30 kg/m(2) alone should not be a procedural contraindication. Adherence to safe enteral access placement techniques and close periprocedure follow-up should occur in obese patients, especially those weighing >250 pounds (>113 kg). More research is needed to fully evaluate the efficacy of enteral access in this population.

Evaluation of a new technique for endoscopic nasojejunal feeding-tube placement.

OBJECTIVES: Multiple techniques for endoscopic nasojejunal tube (NJT) placement exist. However, poor experience with these techniques has limited more routine practice of NJT placement for many endoscopists. We evaluated endoscopic NJT placement with a new stiff jejunal (J)-tube method (push technique). METHODS: The GI Tract database at the Medical University of South Carolina was queried for NJT-placement procedures. Records of 42 patients who had undergone NJT placement by using the push technique between the years 2001 and 2004 at our institution were reviewed for information regarding procedure success and tube-related outcomes. RESULTS: The push technique of NJT placement was successful in 41 of 42 patients (97.6%), with an average procedure time of 11.6 minutes (range, 5-50 minutes). Negative outcomes occurred in 61% of properly positioned NJTs and included inadvertent tube removal by the patient or the staff (42.1%), dislodging (10.5%), clogging (5.3%), and kinking (5.3%). The average longevity of the NJT was 7.8 days (range, 1-37 days). Most patients were ultimately converted to a percutaneous enteral access device or to oral feedings. CONCLUSIONS: Endoscopic placement of NJT by using the push technique is an efficient, reliable method of accessing the small bowel for enteral nutrition.