Unsedated transnasal PEG placement
Jérôme DumortierMarie-George LapalusAdelino PereiraJean-Pierre LagarrigueAnnick ChavaillonThierry Ponchon
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Endoscope
Stoma (medicine)
Gastroscopy is often an unpleasant procedure for the patient. Sedation improves the tolerance, but it causes inconvenience both for patients and for endoscopy units. The aim of the present study was to compare the feasibility, safety, and tolerance of transnasal gastroscopy using a thin endoscope with conventional oral gastroscopy.One hundred eighty-one consecutive outpatients referred for diagnostic gastroscopy were randomized to undergo transnasal or oral conventional gastroscopy. The tolerance (discomfort, retching, throat pain, and desire for sedation in any further procedures) and examination difficulty (intubation, examination, aspiration, and visibility) were assessed by the patients and the endoscopists, respectively, using visual analogue scales and a questionnaire.Endoscope insertion failed in six patients (four transnasal, two conventional). The tolerance was significantly better with transnasal gastroscopy in comparison to conventional oral gastroscopy. Only 3% of patients undergoing transnasal gastroscopy desired sedation in any further examinations, compared to 15% in the conventional oral gastroscopy group (P = 0.01). The examination time was longer in the transnasal group (5 min 25 sec +/- 1 min 46 sec vs. 3 min 22 sec +/- 1 min 9 sec, P < 0.001). Visualization capability and aspiration using the thin endoscope were considered more difficult by the endoscopists.Nasal introduction of thin endoscopes is better tolerated by patients than conventional gastroscopy, minimizing the need for sedation. However, technical improvements in thin endoscopes (a wider working channel, increased length and better image quality) would increase their usefulness.
Endoscope
Retching
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To evaluate the risk factors of postoperative complications after reoperation for recurrent Crohn disease(CD).From 1995 to 2009, 65 patients undergoing reoperation for recurrent CD were identified in the First Affiliated Hospital of Fujian Medical University. Risk factors of postoperative complications were analyzed. These patients were matched by age to 65 patients undergoing primary operation and treatment outcomes were compared between primary operation and reoperation.Postoperative complications were observed in 25 cases(38.5%) undergoing reoperation for CD recurrence and the rate of postoperative complication was higher than that after primary operation(12.3%). Postoperative complications rate in patients with stoma was significantly lower than those without stoma(15.8% vs. 47.8%, χ(2)=5.831, P=0.016). Compared to primary operation, reoperation had longer operative time, more severe intraperitoneal adhesion, and a longer postoperative hospital stay(all P<0.05).Reoperation for CD recurrence is associated with higher postoperative complications. Temporary stoma may decrease the rate of postoperative complication.
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Endoscope
Concomitant
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Background: The ideal medication to administer to children before gastrointestinal endoscopy procedures has yet to be found. The efficacy of using inhaled nitrous oxide during endoscopy in children was assessed in a pilot study. Methods: Patients aged 5 to 17 years, referred to our hospital for diagnostic upper gastrointestinal endoscopy or rectosigmoidoscopy procedures, were eligible for enrollment in this study. All received 50% nitrous oxide in oxygen (Entonox; AGA, Rueil-Malmaison, France) before endoscopy and some of them again during endoscopy. The pediatric endoscopist and the nurse performing the procedure were separately asked to rate cooperation, emotional state, drowsiness and overall efficacy of sedation. Oxygen saturation and adverse effects were recorded throughout the procedure. After endoscopy, children scored their degree of pain during the procedures on a visual analog scale (0, no pain; 100, agony) and on a body outline (projective method). Any adverse effects were noted. Results: Thirty-seven patients were enrolled in the study. Thirty patients underwent diagnostic upper gastrointestinal endoscopy and seven diagnostic rectosigmoidoscopy. The median time from administration of nitrous oxide until insertion of the endoscope was 5 minutes (range, 3-8 minutes). Good or excellent efficacy of the sedation was noted in 92% of children by the endoscopist and in 89% by the nurses. Good or excellent cooperation was noted in 92% of the children by the endoscopist and in 78% by the nurses. The children's pain score on the visual analog scale ranged from 5 to 100 (median, 20) for upper gastrointestinal endoscopy and from 0 to 30 (median, 0) for rectosigmoidoscopy. The time of discharge after endoscopy, defined as the time elapsed between the end of the endoscopy and discharge from the endoscopy suite, varied from 1 to 7 minutes (median, 1.5 minutes). Conclusion: Entonox provides rapid and effective analgesia without heavy sedation, leads to adequate relaxation and cooperation, and facilitates quick and efficient endoscopy. The effect of Entonox was of short duration, allowing the children to leave the endoscopy unit without need for a long recovery period. The adverse effects of Entonox appeared to be minor, and their duration was always brief. Nitrous oxide-oxygen inhalation may provide a valuable alternative to conventional sedation regimens during gastrointestinal endoscopy in children, but randomized and prospective studies comparing nitrous oxide sedation and conventional sedation regimens are necessary.
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Upper gastrointestinal endoscopy
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Background/Aims: Propofol sedation is increasingly being used when performing upper gastrointestinal endoscopy because of its rapid onset and good recovery profile. For achieving safe sedation during endoscopy, close monitoring of the vital signs is necessary because of the sedation’s potentially serious adverse effects. There are only a few studies on the induction of sedation with using propofol for endoscopy in Korea. The present study was undertaken to evaluate the adequate initial injected dose of propofol for achieving safe and effective sedation when performing upper gastrointestinal endoscopy in Koreans. Methods: From March 2008 to July 2008, 150 subjects who visited Kwangju Christian Hospital were randomized into 3 groups. An initial bolus dose of 0.5 mg/kg, 1.0 mg/kg and 1.5 mg/kg of propofol was allocated to groups A, B and C, respectively. The effectiveness and safety profiles of each injected dose of propofol were prospectively assessed by measuring various parameters of the vital signs and the adverse events. Results: Group C had a significantly shorter induction time and the patients in group C did not require additional injections of propofol without increasing adverse events, as compared to that of the other 2 groups. Conclusions: 1.5 mg/kg of propofol was found to be more appropriate than 0.5 mg/kg or 1.0 mg/kg of propofol as the initial injected dose for induction of sedation during performance of upper gastrointestinal endoscopy in Koreans.
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Therapeutic Endoscopy
Upper endoscopy
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Upper gastrointestinal endoscopy
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Identification of patients likely to experience high levels of discomfort during unsedated gastroscopy would be useful as these patients could be prospectively targeted for sedation. We prospectively assessed patient and endoscopic variables in subjects attending for endoscopy in order to identify factors associated with patients' experience of the unsedated examination.We studied 508 patients attending for routine diagnostic gastroscopy. Clinical and endoscopic data were collected and patients completed a two-part questionnaire assessing their anxiety with, and experience of, the procedure.Thirty-nine subjects failed to complete the initial unsedated endoscopy. Failure to tolerate endoscopy was associated with younger age (P = 0.002) and examination with a standard-bore (> or = 9.0 mm) endoscope (P = 0.004). High levels of patient discomfort during the procedure were associated with younger age (P < 0.001), high levels of pre-endoscopic anxiety (P < 0.001), high levels of pre-endoscopic discomfort due to throat spray (P = 0.02) and examination with a standard-bore endoscope (P < 0.001). Preference for sedation during future examinations was related to female gender (P = 0.02), young age (P = 0.02), high levels of apprehension (P < 0.001), the examining doctor (P = 0.002) and use of a standard-bore endoscope (P < 0.001).Discrete clinical characteristics and endoscopic variables are associated with patients' experience of unsedated endoscopy. Further work might result in an algorithm for identifying patients who would benefit from sedation prior to gastroscopy.
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Background and Study Aims: Upper gastrointestinal endoscopy is performed without sedation in many countries. Unsedated patients experience more discomfort during endoscopy than sedated patients, but few studies have examined factors which could be modified to minimize discomfort during the procedure. We assessed the effect of endoscope diameter on patient discomfort during unsedated transoral gastroscopy.
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Upper gastrointestinal endoscopy
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Midazolam
Alfentanil
Endoscope
Regimen
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