Gastrointestinal Endoscopic Procedures Research Articles

Paediatric gastrointestinal endoscopy: Experience in Red Cross War Memorial Children’s Hospital, Cape Town, South Africa


 Background. Endoscopy is an important diagnostic and therapeutic mode of management in children with gastrointestinal disorders.
 Objective. To determine the indications, endoscopic yields and impact of the service on the ongoing health and complications among children who underwent gastrointestinal endoscopy at Red Cross War Memorial Children’s Hospital, Cape Town.
 Methods. A 10-year (2007 - 2016) retrospective study of children <18 years old who underwent gastrointestinal endoscopy was undertaken using relevant patients’ variables obtained from their hospital medical records. Data were analysed using Stata 13.1 (p<0.05).
 Results. A total of 402 children underwent a total of 695 gastrointestinal endoscopic procedures: 592 (85.2%) were gastroscopies, 78 (11.2%) combined gastroscopies with colonoscopies and 25 (3.6%) colonoscopy-only procedures, respectively. The main diagnostic indications for gastroscopy, gastroscopy combined with colonoscopy and colonoscopy-only were chronic abdominal pain (n=49; 12.2%), suspected inflammatory bowel disease (n=30; 7.5%) and rectal bleeding (n=13; 52.0%) respectively. The most common therapeutic indication for gastroscopy was change of a percutaneous endoscopic gastrostomy (n=143; 35.6%) while for colonoscopy 6 (5.8%) had polypectomy. Abnormal histopathological results were made from both macroscopically normal- and abnormal-looking tissues, though with no statistically significant relationship.
 Conclusion. Endoscopy offers diagnostic and therapeutic options in children. Positive histological findings were obtained in some cases where gastrointestinal mucosae appeared normal. There is need to obtain biopsies from both macroscopically normal- and abnormallooking gastrointestinal mucosae as positive histological findings could be made from them and hence improve diagnostic yield.

DSRD-Net: Dual-stream residual dense network for semantic segmentation of instruments in robot-assisted surgery

In conventional robot-assisted minimally invasive procedures (RMIS), surgeons have narrow visual and complex working spaces, along with specular reflection, blood, camera-lens fogging, and complex backgrounds, which increase the risk of human error and tissue damage. The use of deep learning-based techniques can decrease these risks by providing segmented instruments, real-time tracking, pose estimation, and surgeons’ skill assessment. Recently, several deep learning-based methods have been proposed for surgical instrument segmentation. These methods have shown significant performance for the RMIS. However, we found that most of these methods still have scope for improvement in terms of accuracy, robustness, and computational cost. In addition, gastrointestinal pathologies have not been explored in previous studies. Therefore, we propose a dual-stream residual dense network (DSRD-Net), an accurate and robust deep learning-based surgical instrument segmentation method that mainly utilizes the strength of residual, dense, and atrous spatial pyramid pooling architectures. Our proposed method was tested on publicly available gastrointestinal endoscopy (the Kvasir-Instrument Dataset) and abdominal porcine procedures datasets (The 2017 Robotic Instrument Segmentation Challenge Dataset). The experimental results show that the proposed method outperforms the state-of-the-art methods.

Bowel Preparation for Colonoscopy in Nigeria

Background: Bowel preparation is a part of necessary preparation for all gastrointestinal endoscopic procedures. Its goal is to have a comfortable, safe, and complete examination for a possibly well motivated patient. The aim of this study was to evaluate bowel preparation carried out for lower gastrointestinal endoscopy by gastrointestinal endoscopy practitioners in Nigeria in the year 2021. Materials and Methods: A cross-sectional descriptive study was carried out among gastrointestinal endoscopy practitioners at a conference using self-administered questionnaires. Data was collected, and analysed using the Statistical Package for the Social Sciences (SPSS) version 20.0. Results: A total of eighty-two (82) respondents participated in the study. Twenty-two (26.8%) respondents asserted to carrying out ≥15 colonoscopies per month in their center of practice, and 56 (68.3%) respondents had practiced for 1-14years. Three-day bowel preparation was carried out by 22 (26.8%) respondents, and other regimens were carried out by fewer number of respondents. Bisacodyl (Dulcolax) tablets and Magnesium Sulphate (Epson salt) combination was used by 20 (24.4%) respondents. Forty (48.8%) respondents asserted to achieving ≥90% bowel preparation adequacy for colonoscopy with preferred regimen. However, twenty (24.4%) respondents have had to abandon the procedure 11 - 20% of the time due to poor bowel preparation, and 54 (65.9%) experienced procedure abandonment in less than 10% of the time. Conclusion: The practitioners of gastrointestinal endoscopy are relatively few. There is need to improve on practice by training more practitioners, and ensure uniform practice to improve outcome and patient care.

Gastrointestinal Endoscopy-Associated Infections: Update on an Emerging Issue.

Over 17.7 million gastrointestinal (GI) endoscopic procedures are performed annually, contributing to 68% of all endoscopic procedures in the United States. Usually, endoscopic procedures are low risk, but adverse events may occur, including cardiopulmonary complications, bleeding, perforation, pancreatitis, cholangitis, and infection. Infections after the GI endoscopies most commonly result from the patient's endogenous gut flora. Although many studies have reported infection after GI endoscopic procedures, a true estimate of the incidence rate of post-endoscopy infection is lacking. In addition, the infection profile and causative organisms have evolved over time. In recent times, multi-drug-resistant microorganisms have emerged as a cause of outbreaks of endoscope-associated infections (EAI). In addition, lapses in endoscope reprocessing have been reported, with some but not all outbreaks in recent times. This systematic review summarizes the demographical, clinical, and management data of EAI events reported in the literature. A total of 117 articles were included in the systematic review, with the majority reported from North America and Western Europe. The composite infection rate was calculated to be 0.2% following GI endoscopic procedures, 0.8% following ERCP, 0.123% following non-ERCP upper GI endoscopic procedures, and 0.073% following lower GI endoscopic procedures. Pseudomonas aeruginosa was the most common culprit organism, followed by other Enterobacteriaceae groups of organisms and Gram-positive cocci. We have also elaborated different prevention methods such as antimicrobial prophylaxis, adequate sterilization methods for reprocessing endoscopes, periodic surveillance, and current evidence supporting their utilization. Finally, we discuss disposable endoscopes, which could be an alternative to reprocessing to minimize the chances of EAIs with their effects on the environmental and financial situation.

Practices in Paediatric Gastrointestinal Endoscopy at Kenyatta National Hospital and Gertrude’s Children’s Hospital in Nairobi, Kenya

Background: Gastrointestinal (GI) diseases are common in children worldwide and pediatric GI endoscopy has become a fundamental component of healthcare for infants and children. There is a wide range of diagnostic and therapeutic indications for pediatric upper and lower GI endoscopy as well as new diagnostic and therapeutic interventions for the endoscopic findings Objectives: To document the indications, endoscopic findings and therapeutic procedures in pediatric upper and lower gastrointestinal endoscopy at the Kenyatta National Hospital (KNH) and Gertrude’s children’s hospital. Design: Cross-sectional, consecutive entry study Setting: Kenyatta National Hospital and Gertrude’s children’s hospital Materials and Methods: This study was done over a period of 5 months involving participants of age 13 years and below who underwent GI endoscopy at the endoscopy units of KNH and Gertrude’s children’s hospital. The subjects who met the eligibility criteria were recruited by the Principal Investigator through consecutive sampling. Data was recorded in a data abstraction form. Permission to undertake the study was obtained from the combined institutional Research and Ethics Committee (IREC) of KNH and University of Nairobi as well as the Ethics Review Board of Gertrude’s Children Hospital.Data was anonymized prior to analysis. Written informed consent for the study was obtained from the participants’ parents or guardians. The data collected was coded and entered in MsAccess data base. Data cleaning was done and the data exported into SPSS version 23.0statistical software. All statistical tests were performed at 5% level of significance. Results: Mean age of the children was 7.3 years (std=3.9). Males were 58 (52.7%). OGD involved 79.1% of the participants. In KNH, the main indications for OGD (oesophagogastroduodenoscopy) were upper GI bleed and dysphagia while in Gertrude’s hospital, they were abdominal pain and emesis. Hematochezia was the predominant indication for colonoscopy. More study participants had normal than abnormal gross and histological findings. The commonest gastroscopic findings were gastritis and esophagitis. Hiatus hernia was detected in only 4.8% of the children. The commonest colonoscopic finding was colonic polyps. 69(62.7%) patients had results of biopsies taken being present. The commonest positive findings in the colon and rectum were chronic ulcerative colitis and juvenile polyps, respectively. The main therapeutic procedures done were banding for oesophageal varices, FB removal and oesophageal dilatation. Conclusions: The higher percentages of normal gross and histologic findings indicate more a functional than organic etiology to the GI presentations. Hiatus hernia is relatively uncommon in our population. Juvenile polyps are more common than ulcerative colitis as a cause of hematochezia in children. Recommendations: Considerations for higher possibility of functional diagnoses should be made for patients with recurrent abdominal pains and recurrent emesis. Emphasis should be made for parents/guardians of children who require biopsy that histology forms a crucial part of management

Abstract No. : ABS1275: Efficacy of novel dual channel LMAGastro™ with colour coded pressure gauge in day care GI endoscopy procedures

Background &Aims:The aims and objectives were to evaluate the utility ofGastro™Laryngealmaskairway(LMA) for gastrointestinal(GI)endoscopic procedures for improvement of airway control, to prevent hypoxia andto avoid intubation.Methods:A prospective randomised observational study was conducted in 50 patients, 25 in each group for elective GI endoscopy procedures.Group G : LMA Gastro Group N : Nasal Cannula .All were observed for intraoperative hypoxia/any adverse events/endotracheal intubation. Inclusion criteriawere 18 -60 years, AmericanSocietyofAnesthesiologists(ASA) gradel,ll,lll,ModifiedMallampatiscorEclassIandII,supine/lateral position, Day care,,fasting. Exclusion criteriawere emergency procedure,notnil by mouth,prone position, pregnant and lactating females.Results:50 patients of ASAI,IIand III undergoing GI endoscopic procedure were divided into two groups. Gastro LMA and nasal prong groups;each having 25 patients. In Gastro™ LMA group, 1 patient (4%) required endotracheal intubation and in nasal prong group, 2 patients (8%) required endotracheal intubation. No postoperative complication was noted in any of the two groups.Conclusion:LMA Gastro™ airway is auser friendly device for the gastro physician and anaesthesiologists. It isa useful airway management tool for clinical use in day care GIendoscopic procedures.

Abstract No. : ABS2330 : Comparison of three different sedative regimens for gastrointestinal endoscopic procedures

Background &Aims:Gastrointestinal (GI) endoscopic procedures are relatively invasive and unpleasant and need high level of patient co-operation. Aim of our study was to compare three different sedative regimens using propofol, dexmedetomidine and fentanyl-midazolam combination for safer sedation in GI endoscopic procedures.Methods:The patients who satisfied the inclusion criteria were randomly allocated into three groups of 30 each. Group P patients received propofol 1mg/kg i.v followed by 0.5mg/kg/hr infusion. Group- D received dexmedetomidine1µg/kg i.v. infusion over 10min followed by 0.5µg/kg/hr infusion. Group- FM received fentanyl 1µg/kg and midazolam 20 µg/kg i.v. followed by fentanyl 0.5µg/kg/hr infusion. The endoscopic procedure was started when the patient attained a level of conscious sedation [score of 2-4 on the Observer Assessment of Alertness/Sedation Scale(OAA/S scale)].The patient’s and endoscopist level of satisfaction was assessed using the 10 - point visual analogue scaleResults:Demographic data and the duration of the procedure between the three groups were similar and statistically insignificant. The heart rate, mean arterial pressure and oxygen saturation were lower in Group-D and were statistically significant. The onset of sedation was earlier with Group-P. The time to recovery, requirement of additional fentanyl, incidence of gagging, patient and surgeon’s satisfaction scores and maximum OAA/S score were similar in Groups D and P and better than Group-MF.Conclusion:I We conclude that dexmedetomidine provides an overall better experience for the patient, endoscopist and anaesthesiologist than propofol and midazolam-fentanyl combination.

Impact of Coronavirus Disease 2019 on Screening Colonoscopy Utilization in a Large Integrated Health System

Coronavirus disease 2019 (COVID-19)–related backlogs in high-volume gastrointestinal endoscopic procedures, such as colonoscopy, are projected to lead to a rise in avoidable cancers. Almost one-third of colonoscopies performed in Veterans Health Administration (VHA), the largest integrated health system in the United States, are for screening. However, colonoscopy is not the only option for colorectal cancer (CRC) screening. Indeed, the US Preventive Services Task Force endorses several different testing modalities, including annual fecal immunochemical testing (FIT), as alternatives to colonoscopy for average-risk screening.

Efficacy of high flow nasal oxygenation against hypoxemia in sedated patients receiving gastrointestinal endoscopic procedures: A systematic review and meta-analysis

Study objectiveTo evaluate the impact of high flow nasal oxygenation (HFNO) on the risk of hypoxemia during gastrointestinal endoscopic procedures (GEPs) under sedation. DesignMeta-analysis of randomized controlled trials. SettingGastrointestinal endoscopy. InterventionHFNO. PatientsAdults patients undergoing GEPs under sedation. MeasurementsThe primary outcome was risk of hypoxemia, while the secondary outcomes included risks of severe hypoxemia, hypercapnia, need for jaw thrust or other airway interventions, and procedural interruption as well as procedure time, minimum SpO2, and level of carbon dioxide (CO2). Analyses based on age, gender, flow rate, risk status of patients were performed to investigate subgroup effects. ResultsMedline, Google scholar, Cochrane Library, and EMBASE databases were searched from inception to July 2021. Seven randomized controlled trials (RCTs) involving 2998 patients published from 2019 to 2021 were included. All GEPs were performed under propofol sedation. Pooled results revealed significantly lower risks of hypoxemia [relative risk (RR) = 0.31, 95% CI:0.13–0.75; 2998 patients], severe hypoxemia (RR = 0.38, 95% CI:0.2–0.74; 2766 patients), other airway interventions (RR = 0.34, 95% CI:0.22–0.52; 2736 patients), procedural interruption (RR = 0.12, 95% CI:0.02–0.64, 451 patients) and a lower CO2 level [standard mean difference (MD) = −0.21, 95% CI: −0.4 to −0.03; 458 patients] in HFNO group compared to control group. Subgroup analysis focusing on risk of hypoxemia showed no significant subgroup effects, indicating consistent benefits of HFNO in different clinical settings. There were no difference in minimum SpO2 (p = 0.06; 262 patients), risk of hypercapnia (p = 0.09; 393 patients), need for jaw thrust (p = 0.28; 2256 patients), and procedure time (p = 0.41, 1004 patients) between the two groups. ConclusionOur results demonstrated the efficacy of high flow nasal oxygenation for reducing the risk of hypoxemia in patients receiving elective gastrointestinal endoscopic procedures under sedation. Further studies are warranted to verify its cost-effectiveness in the gastrointestinal endoscopy setting.

Analysis of the effects of the first and second/third waves of the COVID-19 pandemic on an Interdisciplinary Endoscopy Unit in a German 'hotspot' area: a single-center experience.

Background:Since December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has posed a pandemic threat to global health. We are now in the fourth wave of this pandemic. As the pandemic developed, the requirements and therapeutic endoscopic procedures for SARS-CoV-2-positive patients underwent changes.Methods:Analysis of implications for an endoscopy unit during the first and second/third waves of the COVID-19 pandemic with a focus on COVID-19-related process changing. Addressed are number of SARS-CoV-2-positive patients and endoscopic examinations performed in patients who tested positive for SARS-CoV-2 during the various waves, adherence to scheduled examinations, rotation of staff to COVID-dedicated structures and, finally, impact of vaccination on infection rate among endoscopic staff.Results:During the first wave, 10 SARS-CoV-2-positive in-house patients underwent a total of 22 gastrointestinal (GI) endoscopic procedures. During the second and third waves, 59 GI endoscopies were performed in 38 patients. While in the first wave, GI bleeding was the main indication for endoscopy (82%), in the second and third waves the main indication for endoscopy was endoscopic insertion of deep feeding tubes (78%; p < 0.001). During the first wave, 5 (17%) of 29 Interdisciplinary Endoscopy Unit (IEU) staff members were moved to designated COVID wards, which was not necessary during the following waves. Lack of protective clothing was critical during the first wave, but not in the later waves. Screening tests for patients and staff were widely available after the first wave, and IEU staff was vaccinated during the second wave.Conclusion:Strategies to ensure safe endoscopies with respect to preventing transmission of SARS-CoV-2 from patients to staff were effective. Organizational adjustments allowed the routine program to continue unaffected. Indications for GI endoscopies changed over time: during the first wave, GI endoscopies were performed for life-threatening indications, whereas later supportive procedures were the main indication.

Late presentation of windsock type congenital duodenal stenosis after mushroom impaction

Late-onset congenital duodenal stenosis is often diagnosed by computed tomography (CT) or upper gastrointestinal series (UGIS). However, there is a high risk of aspiration when performing UGIS with a large amount of gastric residue and we want to avoid unnecessary radiation exposure as much as possible in infants. We performed ultrasonography (US) and impaction of mushrooms into the stenotic portion at the duodenal descending portion was found clearly. Two impacted shimeji mushrooms were successfully removed by an upper gastrointestinal endoscopic procedure. In the procedure, the stenotic portion looked like a pin hole, and the papilla of Vater could not be seen. After the endoscopic procedure, a laparotomy was performed and the membrane was identified and resected; the membrane was in the form of a “windsock”. Ultrasonographic diagnosis and surgical membrane resection by laparotomy are safe and effective procedures for the management of late-onset congenital duodenal stenosis in children. • We found impaction of mushrooms by ultrasonography in congenital duodenal stenosis. • Before surgery two shimeji mushrooms were removed by an endoscopic procedure. • Ultrasonographic diagnosis and membrane resection by laparotomy are safe procedures.

IMPACT OF COVID-19 PANDEMIC ON GASTROINTESTINAL ENDOSCOPY PROCEDURES

Background- COVID-19, an emerging coronavirus disease is a major health problem. It has markedly affected the routine medical procedures including Gastrointestinal(GI) endoscopies. Inspite of guidelines suggested by various GI societies,for safe GI endoscopy procedures in period of COVID pandemic, most of the endoscopists as well as the patients were hesitant for the endoscopy procedures.We sought to measure the impact of the same on GI endoscopy activity in Pune. Method- A pre-validated questionnaire containing 28 questions was sent across to the GI endoscopy surgeons. Responses were collected to assess the perception of GI endoscopists regarding the practice of endoscopy and the risk of self-contamination during COVID-19 Pandemic. This data was analysed using appropriate statistical applications. Result-51 GI endoscopists from Pune participated in our study out of which 80.3% (41/51) were involved in the management of COVID-19 patients outside the endoscopy department. During the study period, 86.28% (44/51) of endoscopists had to cancel procedures on grounds of COVID19 pandemic.Symptoms compatible with COVID-19 infection were reported by 29.41% (15/51) of the endoscopists out of which 13 (86%) responders had a positive RTPCR test for COVID-19 Conclusion- COVID-19 pandemic has seriously affected GI endoscopy practice. COVID 19 infection rate was also remarkable in endoscopists and endoscopy staff. As the screening of patients with GI problems was hampered, there was definitive delay in diagnosis and treatment. Nevertheless, endoscopy centers should adapt and make changes in their practice to face future pandemic, emphasizing safety of staff without delaying patient care.

Infection Control of Gastrointestinal Endoscopic Procedures Performed by Nurses at Hawler and Rizgary Teaching Hospitals in Erbil City /Iraq

Background and objectives: Gastrointestinal endoscopy is a valuable diagnostic and therapeutic tool for the care of patients with gastrointestinal and pancreaticobiliary disorders. Compliance with accepted guidelines for the reprocessing of gastrointestinal endoscopes between patients is critical to the safety and success of their use. This study aimed to assess the nurses' infection control practice and identify the prevalence of fungal and bacterial growth on gastroscopy and colonoscopy instruments. Methods: A descriptive study was carried out on a purposive (non-probability) sample of all nurses who worked in the gastrointestinal endoscopy units at Hawler and Rizgari Teaching Hospitals in Erbil City from January to June 2016 from where the sample specimens were also taken. The questionnaire consisted of three parts. The first part included sociodemographic data, the second part contained nurses' infection control practice before, during and after the endoscopy procedure including pre-cleaning, leak testing, manual cleaning rising, disinfection, rinsing, drying and storing instruments. The third part of the questionnaire was used to document 80 endoscopic specimens, which were collected from the endoscopic instruments. Results: The findings of the study revealed that the majority of nurses (38.5%) were within the 25-35 years age group, 61.5% were males and having less than 5 years experience. The infection control practices for endoscopy procedure showed that a majority (69.2%) of nurses practised at a fair level. The Grams stain smear results showed positivity of 65.62% for fungus and 34.375% for bacteria. All the fungi isolated belonged to the Candida species. Conclusion: The study concluded that the infection control of endoscopic procedures performed by nurses was inadequate. The swab cultures from the automated endoscope reprocessors, in combination with other bacterial isolates, showed that the Candida species were present in the endoscopic specimens.

Guidance for the implementation of a safety checklist for gastrointestinal endoscopic procedures: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement.

Guidance for the implementation of a safety checklist for gastrointestinal endoscopic procedures: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement.

Low prevalence of SARS-CoV-2 specific antibodies among endoscopists and their assistants in a university hospital in Tochigi prefecture-A single-center study.

ObjectivesGastrointestinal endoscopic procedures have a risk to transmit severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) through aerosols. Little information is available on the seroprevalence of SARS‐CoV‐2 antibodies among healthcare workers (HCWs) in endoscopy units. Thus, the seroprevalence was examined in HCWs who do and do not participate in gastrointestinal endoscopy.MethodsA total of 382 HCWs at Jichi Medical University Hospital were enrolled in this study through March 2021. Among 382 HCWs, 63 are in the endoscopy unit. Serum antibody levels against SARS‐CoV‐2 were determined by immunochromatography, chemiluminescent immunoassay (CLIA), electric CLIA (ECLIA), and chemiluminescence microparticle immunoassay (CMIA). HCWs in the endoscopy unit underwent testing up to three times. We defined antibody‐positive as when at least one test was positive.ResultsThe seroprevalence of SARS‐CoV‐2 antibodies in 63 HCWs in the endoscopy unit was 0%–1.9%, 0%–1.7%, and 0%–1.7% during the first (Ap–May 2020), second (Jun–Nov 2020), and third intervals (Dec 2020–Mar 2021), respectively. This seroprevalence was comparable to that of other HCWs not involved with gastrointestinal endoscopy. Two HCWs in the endoscopy unit were positive for antibodies: one was ECLIA‐positive and the another was CMIA‐positive. The ECLIA‐positive HCW was PCR negative and converted to negative for the second and third tests. Another HCW was CMIA‐positive at all three evaluations and the titers were unchanged. No HCWs in the endoscopy unit contracted a SARS‐CoV‐2 infection.ConclusionsThe seroprevalence of SARS‐CoV‐2 antibodies was low among HCWs in the endoscopy unit through March 2021 (UMIN000039997).

Three year experience of Upper Gastrointestinal Endoscopic procedures at a tertiary care hospital of South Punjab

Introduction: Endoscopy has become a necessity in diagnosing gastrointestinal (GI) disorders. The objective of our study was to evaluate the different indications and findings of upper GI endoscopy. Methods: This retrospective analysis was undertaken at department of Gastroenterology, Nishtar Hospital Multan. Records of all upper GI endoscopic procedures from 1st January 2018 till 31st December 2020 were evaluated. Results: A total 3299 upper GI endoscopic procedures were perfumed during the three-year time period. Mean age was 47 years. Majority of patients were males. Almost 48% of patients belonged to the middle-aged group. The most common indication was upper GI bleeding (57%), followed by dyspepsia (15%). The most common finding was esophageal varices (43%), followed by portal gastropathy (26%) and gastritis (16%). Conclusion: This study concludes that the majority of endoscopies are being undertaken as a result of complications of cirrhosis and portal hypertension. Keywords: Endoscopy, audit, indications, findings

Efficacy of polyglycolic acid sheeting with fibrin glue for perforations related to gastrointestinal endoscopic procedures: a multicenter retrospective cohort study.

Gastrointestinal (GI) perforations are one of the major adverse events of endoscopic procedures. Polyglycolic acid (PGA) sheets with fibrin glue have been reported to close GI perforations. However, its clinical outcome has not yet been fully investigated; thus, we conducted a multicenter retrospective observational study to assess the efficacy of PGA sheeting for GI perforation. The medical records of patients who underwent PGA sheeting for endoscopic GI perforations between April 2013 and March 2018 in 18 Japanese institutions were retrospectively analyzed. PGA sheeting was applied when the clip closure was challenging or failed to use. Perforations were filled with one or several pieces of PGA sheets followed by fibrin glue application through an endoscopic catheter. Nasal or percutaneous drainage and endoscopic clipping were applied as appropriate. Clinical outcomes after PGA sheeting for intraoperative or delayed perforations were separately evaluated. There were 66 intraoperative and 24 delayed perforation cases. In intraoperative cases, successful closure was attained in 60 cases (91%). The median period from the first sheeting to diet resumption was 6days (interquartile range [IQR], 4-8.8days). Large perforation size (≥ 10mm) and duodenal location showed marginal significant relationship to higher closure failure of intraoperative perforations. In delayed perforation cases, all cases had successful closure. The median period from the first sheeting to diet resumption was 10days (IQR, 6-37.8days). No adverse events related to PGA sheeting occurred. Endoscopic PGA sheeting could be a therapeutic option for GI perforations related to GI endoscopic procedures.

Surgical mask designed for endoscopic procedures to prevent the diffusion of droplets

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2) has become a global pandemic. The human-tohuman transmission of SARS-CoV-2 occurs primarily through droplets, aerosols, and direct contact. Endoscopy is performed at a short physical distance between an endoscopist and patient, which increases the risk of SARS-CoV-2 transmission to the endoscopist through contact with body fluids and exposure to droplets due to vomiting, retching, and coughing during endoscopic procedures (1). Gastrointestinal endoscopic procedures generate aerosols, which mandates the use of appropriate personal protective equipment (PPE) (1,2). To further reduce the risk of viral infection during endoscopy, additional infection protection is needed to assist PPE from not only the side of endoscopists but also the side of patients (3). Various infection prevention devices, such as a reusable plastic cube barrier, have been reported (3); however, we focused on a surgical mask as a simple and inexpensive method (4). Previous studies proposed modified surgical masks with an endoscopic insertion port, which were handmade with an incision for endoscope insertion into commercially available surgical masks (2,4). Although these “handmade” masks may be easily modified, their preparation is burdensome and not sterile. We developed a novel disposal surgical mask with a mask manufacturer that is specifically designed as a droplet prevention device for endoscopic procedures that may be massproduced with uniform quality and easily introduced into endoscopy units. This novel surgical mask has a 10-mm slit in the center for the insertion of an endoscope and two small 6-mm slits for suction on the left and right. The width of the pleats in the center have been widened to easily cut the slits, which allows for cost-effective mass production. Despite its close fit, the narrow slit allows for the easy passage of an endoscope and smooth endoscopic manipulation. Furthermore, the leakage of droplets and aerosols through the slit in the surgical mask is minimized (Fig. 1A-D).

Clinical evaluation of intravenous sedation in pediatric endoscopic procedures: A retrospective observational study

Objective: The main benefits of sedation are to reduce the patient’s anxiety and discomfort, to improve their tolerability. The aim of study was evaluate intravenous sedation for pediatric gastrointestinal endoscopic procedures&#x0D; Materials and Methods: We analyzed patients’ data, who underwent gastrointestinal endoscopic procedures in our pediatric endoscopy unit, retrospectively. All gastrointestinal endoscopic procedures were performed by a pediatric gastroenterologist and sedations were managed by an anaesthesia team, including two staff anesthesiologists.&#x0D; Results: During the study period, 530 gastrointestinal endoscopic procedures were performed. 461 (87%) were esophagogastroduodenoscopy, 56 (10.6%) were both esophagogastroduodenoscopy and colonoscopy and 13 (2.5%) were percutaneous endoscopic gastrostomy. Propofol was given all of the patients either as a single drug (6 patients, 1%) or in combinations (77.4% with midazolam; 12.3% with ketamine and 9.2% with fentanyl). Overall adverse event rate due to sedation was 19.6%, but no serious side effects were documented. The most frequent side effects were injection pain (10.4%), and nausea (7.5%). Allergic reactions were experienced in 1.3% patients and resolved with methylprednisolone and antihistaminic medications. Respiratory depression was observed in only two girls (3 and17 years old) and did not need advanced interventions to control the problem. Seven patients’ gastroscopies were interrupted by gastroenterologist due to gastric content in order to prevent vomiting and aspiration.&#x0D; Conclusions: Intravenous sedation for pediatric gastrointestinal endoscopic procedures can be applied safely and successfully with a trained team and organized endoscopy unit.

The effects of diabetes mellitus on gastric emptying: A prospective observational cohort study

Study objectiveOur goal was to evaluate the effect of diabetic severity and duration on preoperative residual gastric volume. Secondarily we compared ultrasonic estimates of residual gastric volume with actual volume determined by aspiration during endoscopy. DesignThis was a prospective, observational cohort study that included adults with a history of diabetes mellitus and/or opioid use scheduled for gastrointestinal endoscopic procedures. SettingEndoscopy unit at Cleveland Clinic Main Campus from 2017 to 2019. ParticipantAdults scheduled for upper endoscopy with or without colonoscopy. Intervention and measurementsResidual gastric volumes were primarily determined by aspiration during endoscopy, and secondarily estimated with ultrasound. We evaluated the relationship between gastric residual volume and preoperative HBA1C concentration and duration of diabetes. Secondarily, we conducted an agreement analysis between the two gastric volume measurement techniques. Main resultsAmong 145 enrolled patients, 131 were diabetic and 17 were chronic opioid users. Among 131 diabetic patients, the mean ± SD HbA1c was 7.2 ± 1.5% and the median (Q1, Q3) duration of diabetes was 8.5 (3, 15) years. Neither HbA1c nor duration of diabetes was associated with residual gastric volume. The adjusted mean ratio of residual gastric volume was 1.07 (98.3% CI: 0.89, 1.28; P = 0.38) for 1% increase in HbA1c concentration, and 0.84 (98.3% CI: 0.63, 1.14; P = 0.17) for each 10-year increase induration of diabetes. The median [Q1–Q3] absolute difference between gastric ultrasound measurement and endoscopic measurement was 25 [15, 65] ml. ConclusionsIn this prospective observational cohort study, neither the duration nor severity of diabetes influenced preoperative residual gastric volume. Gastric ultrasound can help identify patients who have excessive residual volumes despite overnight fasting.