Endoscopy In Adult Patients Research Articles

Sedation Techniques for Drug-induced Sleep Endoscopy in Adult Patients with Sleep-disordered Breathing

Drug-induced sleep endoscopy emerged and developed as an essential alternative diagnosis tool in sleep-disordered breathing patients. Accurate identification and dynamic characteristics of upper respiratory airway obstruction are paramount in establishing an adequate therapeutic plan and selecting for particular surgical or non-surgical strategies. This article reviews the current aspects of intravenous sedation for drug-induced sleep endoscopy (DISE) in adults, emphasizing its implications for patients with sleep apnea. The ideal sedative agent for DISE should replicate natural sleep patterns while maintaining upper airway dynamics. The clinical practice exhibits a significant variability in drug selection, with midazolam and propofol often being preferred. The review presents emerging trends and advancements in DISE, emphasizing its role in optimizing surgical indications, predicting outcomes, and screening patients for alternative therapeutic strategies for OSA. Future research is needed to understand better the impact of specific sedative drugs on DISE findings, contributing to the development of standardized protocols and the evolution of new sedative drugs with improved effects and optimized techniques for delivering sedation.

P128 Accuracy of the combination of transabdominal and transperineal ultrasound for the evaluation of Ulcerative Colitis activity

Abstract Background Transabdominal Bowel Ultrasound (TBUS) is useful technique to assess disease activity and extent in patients with ulcerative colitis (UC); however, the evaluation of the rectum by TBUS is difficult. Recently, transperineal ultrasound (TPUS) has been proposed as a useful diagnostic tool in the evaluation of rectal disease. The aim of the study is to to assess the concordance between the combination of TPUS/TBUS and endoscopy in adult patients with UC. Methods Fifteen consecutive adult patients with UC were prospectively enrolled from June to November 2021. Disease activity was determined using Partial Mayo Score (PMS) and Mayo Endoscopic Subscore (MES). TBUS and TPUS were performed within a week from endoscopy. MES ≤ 1, bowel wall thickness ≤ 3mm in the colon and ≤ 4mm in the rectum were defined as remission. A concordance analysis comparing endoscopy and US was performed by kappa statistics Results Ten patients were male (66%) and 8 female (34%), with a median age of 39± 13,9. Two patients had a pancolitis, 6 a distal colitis, and 3 a proctitis. 4 patients were in remission. The agreement between endoscopy and rectal evaluation with TBUS was fair (k =0.40), while the agreement with TPUS was excellent (k =0.86). The evaluation of the colon with TBUS showed good concordance in the right colon (k= 0.63), left colon (k=0.65), and sigmoid colon (k=0.72), and excellent agreement in the transverse colon (k= 1). Conclusion These preliminary data showed that the combination of TBUS and TPUS allows to easily and accurately study all the segments of the large intestine in patients with UC, overcoming the limitation related to the reduced accessibility to the rectum with only trans abdominal approach.

Ketamine Efficacy During Endoscopy in Adults

The use of Upper Gastrointestinal Endoscopy (UGE) for diagnosis and treatment is becoming increasingly more frequent in children. Unlike adults, children require deep sedation. The effects of ketamine, one of the most commonly used agents in UGE of children, are rapid, but short; ketamine offers quick recovery and has wide confidence intervals. The basic aim of this review is to explain the Ketamine efficacy during endoscopy in adult patients. Ketamine is a general anaesthetic agent widely used for paediatric procedural sedation outside the operating theatre by non-anesthesiologists. It is considered a dissociative anaesthetic. Endoscopy is the most accurate and beneficial way for the diagnosis of dyspepsia, peptic ulcers, and malignancies. Sedative drugs are used for both patient and physician satisfaction during the procedure; type of endoscopy, duration, degree of difficulty, and patients’ physical status are the criteria which determine the suitable type of sedation for endoscopy. It is concluded from the literature and previously published data low-dose oral administration of ketamine could make a suitable sedation for gastro-enteric endoscopy.

Diagnostic value of endoscopy in adult patients with dyspepsia.

Dyspepsia is a common gastrointestinal (GI) complaint with predominant underlying normal findings or trivial lesions and may be a symptom of serious morbidity. To assess the significance of endoscopic findings in the case of uninvestigated dyspepsia in adults. This is a single-centre cross-sectional descriptive study of 372 patients (198 females, 174 males) who presented with dyspepsia and underwent endoscopic examination. Demographic, clinical complaints with alarm features, drug use, and endoscopic findings were collected and analysed. Gastric biopsy was performed to detect Helicobacter pylori (H. pylori) infection. Findings of erosions, ulcers, and neoplasms were regarded as significant lesions. Mean age of patients was 35.7 ±13.5 years. The main presenting symptom of dyspepsia was epigastric pain (61.6%). The endoscopic findings were gastroduodenitis (GD) (47.6%), esophagitis (15.1%), peptic ulcers (7.3%), cancer of the stomach (0.8%), and gastric polyps (0.5%). Non-significant and normal findings represented 70.2% (261/372, p < 0.001). Age group ≥ 50 years manifested significant lesions in 45.7% (32/70), and age group < 50 years 26.2% (79/302). Weight loss, anaemia, vomiting, and nonsteroidal anti-inflammatory drugs (NSAIDs) were associated with significant lesions in 85.7%, 84.2%, 32.7%, and 58.3%, respectively. H. pylori prevalence in patients without organic lesions was 47.7%. In two thirds of patients presented with dyspepsia, endoscopy revealed minor or normal findings. Age group ≥ 50 years, alarm features, and use of NSAIDs were predictive of significant endoscopic findings. Strict clinical criteria should be adopted before referring patients with dyspepsia to endoscopy.

Prevalence of Gerlach tonsil: a mucosa associated lymphoid tissue aggregation in the nasopharynx

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The major aggregate of mucosa associated lymphoid tissue located in the nasopharynx is the adenoid. The minor aggregate located in the nasopharynx is the Gerlach tonsils or tubal tonsils. The Gerlach tonsils are well described in the text books. But unlike the adenoids they are rarely visualized during routine endoscopic examination. Several studies conducted in children for recurrence of adenoids or serous otitis media after surgery; have reported tubal tonsil hypertrophy widely. This study in adults aims to see the prevalence of Gerlach or tubal tonsils visible during nasal endoscopy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The case records of 155 adult patients, aged between 18-50 years, who underwent pre-operative diagnostic nasal endoscopy for the management of septal deviations, chronic Sinusitis, nasal polyposis or eustachian dysfunction between Jan. 2019 to March 2020 are retrospectively reviewed and the endoscopy findings analyzed and presented. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Gerlach tonsil hypertrophy is reported to be more prevalent in children than in adults. When hypertrophied, the Gerlach tonsils can cause symptoms in adults also and can be visualized during nasal endoscopy. In this adult study, we report a 0.6% incidence of Gerlach tonsil hypertrophy. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The possibility of a Gerlach tonsil hypertrophy is to be remembered during nasal endoscopy in adult patients presenting with symptoms of eustachian dysfunction and past history of allergic rhinitis and adeno tonsillectomy. Comparing the size of the contra lateral torus tubaris and the eustachian tube opening during the act of swallowing is helpful in diagnosis.&lt;/p&gt;

Analysis of ketamine efficacy during endoscopy in adult patients

Analysis of ketamine efficacy during endoscopy in adult patients

Dexmedetomidine added to propofol for drug-induced sleep endoscopy in adult patients with obstructive sleep apnea: Randomized controlled trial

BackgroundThe aim of this study was to evaluate if the addition of dexmedetomidine to propofol could improve the success and reduce the complications during drug induced sleep endoscopy in obstructive sleep apnea patients.Patient and methodsFifty adult patients scheduled for drug induced sleep endoscopy were randomly allocated to one of two groups. Group P (25 patients) received propofol loading dose of 0.5 mg/kg over 3 min then continuous infusion in a dose of 25–75 mcg/kg/min. Group PD (25 patients) received propofol infusion as group P and dexmedetomidine intravenous infusion with a loading dose of 0.5 mcg/kg over 5 min then continuous infusion in a dose of 0.2–0.7 mcg/kg/h. The primary outcome was successful completion of the procedure. The secondary outcomes included the time to start endoscopy, procedure duration, the incidence of adverse events and surgeons and patients satisfaction.ResultsSuccessful completion of the procedure was significantly higher in group PD (96%) compared to group P (72%). The total propofol dose needed/patient (mg) was significantly more in group P compared to group PD (173.5 ± 41.6 versus98.4 ± 19.8 with shorter recovery time in group PD. Both surgeons and patients satisfaction were significantly higher in group PD compared to group P. The incidence of cough and gag reflexes were significantly higher in group P compared to group PD. Heart rate (HR) was significantly lower in group PD compared to group P at 5, 10, 15, 20, 25 and 30 min from the start of the studied drugs. Respiratory rate (RR) was significantly lower in group P compared to group PD at 5, 10, 15 and 20 min from the start of the studied drugs (p < 0.05).ConclusionAddition of dexmedetomidine to propofol is associated with higher incidence of successful completion of the procedure with faster recovery. Cough and gag reflexes were significantly lower with the addition of dexmedetomidine with higher surgeons and patients satisfaction.

Feasibility of a single-stage tracheostomy decannulation protocol with endoscopy in adult patients.

Gradual decrease in tube size and tube capping are considered the standard of care for tracheostomy decannulation. Both of these actions result in increased airway resistance. Immediate decannulation may offer a more tolerable approach. To assess the feasibility of immediate tracheostomy decannulation compared with the traditional decannulation methods. This study is a single institute, case-control retrospective study of patients between the years 2009 to 2014. The study group included all patients who underwent immediate decannulation, whereas the control group comprised patients who underwent traditional staged decannulation. An immediate decannulation protocol included admission to the intensive care unit, a comprehensive evaluation, decannulation, 24 hours of monitoring, and observation until discharge. Twenty-nine patients were included in the study group and 20 in the control group. No significant statistical difference was found between the two groups in the patients' medical history and tracheostomy data, except for the Acute Physiology and Chronic Health Evaluation II score and duration of the deflated cuff, which were significantly higher in the control group. A significant difference was found in the complication rate between the groups. In the staged decannulation group, four patients failed decannulation and required reinsertion of the tracheostomy cannula, whereas there were no such failures in the immediate decannulation group. Hospitalization duration after decannulation of the study group patients was significantly shorter than that of the control group. Immediate decannulation may offer a safe alternative for weaning from tracheostomy. It may also reduce the duration of the weaning process and hospitalization. 3b Laryngoscope, 126:2057-2062, 2016.

Treatment of Obstructive Sleep Apnea Syndrome with Nasal Positive Airway Pressure Improves Golf Performance

Obstructive sleep apnea syndrome (OSAS) is associated with impairment of cognitive function, and improvement is often noted with treatment. Golf is a sport that requires a range of cognitive skills. We evaluated the impact of nasal positive airway pressure (PAP) therapy on the handicap index (HI) of golfers with OSAS. Golfers underwent a nocturnal polysomnogram (NPSG) to determine whether they had significant OSAS (respiratory disturbance index > 15). Twelve subjects with a positive NPSG were treated with PAP. HI, an Epworth Sleepiness Scale (ESS), and sleep questionnaire (SQ) were submitted upon study entry. After 20 rounds of golf on PAP treatment, the HI was recalculated, and the questionnaires were repeated. A matched control group composed of non-OSAS subjects was studied to assess the impact of the study construct on HI, ESS, and SQ. Statistical comparisons between pre- and post-PAP treatment were calculated. The control subjects demonstrated no significant change in HI, ESS, or SQ during this study, while the OSAS group demonstrated a significant drop in average HI (11.3%, p = 0.01), ESS, (p = 0.01), and SQ (p = 0.003). Among the more skilled golfers (defined as HI ≤ 12), the average HI dropped by an even greater degree (31.5%). Average utilization of PAP was 91.4% based on data card reporting. Treatment of OSAS with PAP enhanced performance in golfers with this condition. Treatment adherence was unusually high in this study. Non-medical performance improvement may be a strong motivator for selected subjects with OSAS to seek treatment and maximize adherence.

Erythromycin in Acute Upper Gastrointestinal Bleeding: A Meta-Analysis of Randomized Controlled Trials

Purpose: Emergent upper endoscopy is the standard of care in patients with upper gastrointestinal bleeding (UGIB). Adequate visualization of the upper gastrointestinal tract is important for diagnosis and therapy. Several studies have evaluated the role of erythromycin before endoscopy with mixed results. We performed a meta-analysis of randomized controlled trials (RCTs) to assess the efficacy of erythromycin for acute UGIB prior to endoscopy. Methods: MEDLINE, Cochrane Central Register of Controlled Trials & Database of Systematic Reviews, PubMed, and recent abstracts from major conference proceedings were searched (through 6/12). RCTs evaluating the role of erythromycin in acute UGIB in adult patients were included. Standard forms were used to extract data by two independent reviewers. Data regarding the following outcomes were extracted: visualization of the mucosa, need for repeat endoscopy, blood transfusion and the length of stay. Summary statistics was computed using Comprehensive Meta-analysis software. Publication bias was assessed by funnel plots. All studies were graded by Jadad score. Heterogeneity among studies was assessed. Results: Seven studies met the inclusion criteria (n=657). Patients with both variceal and non-variceal bleeding were included in the studies. Mean age ranged from 56-64.5 years. Dose of erythromycin that was administered varied from 125 mg to 3 mg/kg. Endoscopy was performed 20-120 mins after administration of erythromycin. Mucosal visualization was improved with erythromycin (RR 1.6; 95% CI 1.14-2.35, p=0.008). The NNT was 4 (95% CI, 2-11). Erythromycin decreased the need for repeat endoscopy (RR 0.52, 95% CI 0.31-0.89, p=0.02, I2=18, NNT 11). The need for blood transfusion were lower with erythromycin (WMD -0.52; 95% CI -0.957 to 0.08), p=0.02). Length of hospital stay was shorter (mean difference: 1.56, 95% CI 0.6-2.5). Conclusion: Erythromycin prior to endoscopy in adult patients with upper GI bleed improves visualization of the mucosa and decreases the need for repeat endoscopy. Hospital stay was shorter and need for blood transfusion was less with erythromycin.

Australian Anaesthetists’ Practice of Sedation for Gastrointestinal Endoscopy in Adult Patients

A wide spectrum of practice in sedation for gastrointestinal endoscopy in adult patients is documented overseas, but a current profile of the practice of Australian anaesthetists is unavailable. We therefore surveyed 200 Fellows of the Australian and New Zealand College of Anaesthetists on the choice of drugs and monitoring, use of analgesic throat spray and prophylactic intravenous fluids and the depth of sedation for gastrointestinal endoscopy. Our response rate was 57% and endoscopy formed a significant part of most respondents' practices. Propofol was used for almost all procedures, in combination with midazolam alone (14%), fentanyl alone (6%), midazolam and fentanyl (61%), another drug (15%) or no adjuvant (4%). The majority of patients received prophylactic intravenous fluids for endoscopic retrograde cholangio-pancreatography (83%) and colonoscopy (64%), but not for gastroscopy (20%). All patients received supplemental oxygen and monitoring with pulse oximetry. However over 20% of patients having gastroscopy or colonoscopy did not have non-invasive blood pressure monitoring. A maximum depth of sedation during which the patient was unresponsive to painful stimulation (commensurate with general anaesthesia) was targeted by 54% of respondents. Significant variations exist in the practice of sedation and monitoring for endoscopy in adult patients by anaesthetists in Australia.

Propofol Use for Sedation during Endoscopy in Adults: A Canadian Association of Gastroenterology Position Statement

Over the past decade, multiple clinical reports have demonstrated that the use of propofol sedation for gastrointestinal endoscopy by gastroenterologists and trained endoscopy nurses is safe and effective in appropriately selected patients. Proposed benefits of propofol sedation include rapid onset of action, improved patient comfort and rapid clearance, as well as prompt recovery and discharge from the endoscopy unit. As a result of medical evidence, a number of international professional societies have endorsed the use of propofol in gastrointestinal endoscopy. In Canada, no formal guidelines currently exist. In the present article, the Clinical Affairs Committee of the Canadian Association of Gastroenterology presents a position statement, incorporating updated information on the use of propofol sedation for endoscopy in adult patients.

Special considerations for endoscopy in pediatric and adolescent patients with inflammatory bowel disease

Pediatric endoscopy and colonoscopy are essential for the accurate diagnosis of inflammatory bowel disease (IBD). These procedures, when performed in children and adolescents, do not significantly differ in technical aspects compared with endoscopy in adult patients. However, important nuances unique to the pediatric population, like sedation, preparation for endoscopy, instruments, and technique remain and may warrant special attention. Preparation for endoscopic procedures involves appropriate bowel cleansing, adequate anticipation of the psychological needs, and sedation of the patient. All of these aspects of preparation should be individualized to allow for a successful and safe procedure. Upper endoscopy performed as part of the initial evaluation helps to distinguish between Crohn’s disease and ulcerative colitis early in disease presentation and commonly demonstrates upper tract disease, even in asymptomatic individuals. New endoscopic technologies, once evaluated in clinical trials, may offer improved comfort and safety leading to faster and more complete procedures in the pediatric age group.

Peroral ultrathin endoscopy in adult patients

Peroral ultrathin endoscopy in adult patients

Clinical utility of ultrathin endoscopy in adult patients

Clinical utility of ultrathin endoscopy in adult patients

Ultrathin endoscopy in adult patients

Ultrathin endoscopy in adult patients