Gastrointestinal Procedures Research Articles

ID: 3516858 OUTCOMES OF HIGH-BLEEDING RISK GASTROINTESTINAL ENDOSCOPIC PROCEDURES IN PATIENTS WITH CIRRHOSIS ON ANTI-THROMBOTIC AGENTS

Antiplatelet and anticoagulant agents can pose a significant bleeding risk during gastrointestinal (GI) endoscopic procedures. In addition, patients with cirrhosis can be at higher risk for bleeding as well due to the imbalance between pro-coagulation and anti-coagulation. We aim to describe outcomes of high-bleeding risk GI endoscopic procedures in patients with cirrhosis on anti-thrombotic agents.

RELATIONSHIP BETWEEN SURGEON'S PHYSIOLOGICAL AND KINEMATIC PARAMETERS AND THE QUALITY OF SURGICAL PERFORMANCE AND WORKLOAD IN LAPAROSCOPIC TRAINING

Abstract INTRODUCTION This study presents the first steps and results towards the development of a system for predicting the quality of surgical performance and workload in laparoscopic training. MATERIAL AND METHODS Surgeons wore a smartwatch which recorded their heart rate and hand motion during each laparoscopic procedure. Data was then correlated with both the Surgery Task Load Index (SURG-TLX) subjective questionnaire and the Global Operational Assessment of Laparoscopic Skills (GOALS) objective evaluation tool. Statistical analysis was conducted in order to study the relationship between parameters and to compare the results according to the surgeons’ level of experience. RESULTS Nine laparoscopic surgeons participated in this study, five gynecologists and four digestive surgeons. Gynecological surgeons showed a positive correlation between their level of experience, heart rate, hand motion, and GOALS score, except for bimanual dexterity. The reduction in the variability of hand accelerations led to improved tissue handling. Digestive surgeons showed a negative correlation between their level of experience and the reported temporal demand and complexity of the procedure. Novice digestive surgeons reported increased workload during surgery, mainly in mental, physical, and temporal workload. In both surgical specialties, it was observed that reduction in surgical workload was associated with improved GOALS score. CONCLUSIONS Preliminary results showed that bimanual dexterity is independent of the experience of gynecological surgeons. During laparoscopic surgical procedures, reduced variability in hand accelerations leads to better tissue manipulation. In addition, in gynecological and upper gastrointestinal procedures, reduced surgical workload is associated with improved surgical performance.

Propofol Combined with Fentanyl Is Superior to Propofol Alone in Sedation Protocols for Painless Gastrointestinal Endoscopy

Sufficient propofol or fentanyl doses necessary to prevent the response to skin incision do not necessarily reduce hemodynamic responses during surgery. The purpose of this study was to characterize the pharmacodynamic interaction between propofol and fentanyl with respect to the sedative effects and safety during painless gastrointestinal endoscopy. From October 2018 to October 2020, 200 patients undergoing painless gastrointestinal endoscopy in our department’s outpatient or inpatient clinic were selected and randomly divided into a control group and an observation group, 100 patients per group. Prior to surgery, the patients in the two groups were required to be connected to an electrocardiogram monitor and then were instructed to lie on the left side and receive continuous oxygen infusion of 2-3 L/min with a nasal cannula. The control group was injected with propofol injection (100 mg/min). The observation group was given fentanyl intravenous injection at a dose of 0.1 μg/kg followed by propofol injection (100 mg/min). Painless gastrointestinal endoscopy was performed after the patients entered a sleep state and the eyelash reaction disappeared. Outcome analysis was performed on preoperative and intraoperative hemodynamic indicators, including heart rate, blood oxygen saturation, dose of propofol, time for endoscopy, recovery time, hospitalization after recovery, Montreal Cognitive Assessment (MoCA) score, and Mini-Mental State Examination (MMSE) score. The incidence rate of adverse reactions in the observation group was 6%, which was notably lower than that of the control group (18%). The total response rate of the observation group was 98%, which was significantly higher than that of the control group (90%) ( P < 0.05 ). The intraoperative heart rate and blood oxygen saturation of the observation group were higher than those of the control group ( P < 0.0 ss ). The patients receiving sedation with propofol plus fentanyl had fewer doses of propofol and shorter recovery time than those receiving propofol alone ( P < 0.05 ). It was also revealed that the patients receiving sedation with propofol plus fentanyl exhibited more MoCA and MMSE scores than those receiving propofol alone 30 min after sedation during painless gastrointestinal endoscopy. Taken together, sedation with propofol combined with fentanyl was more effective and safer than that with propofol alone in painless gastrointestinal endoscopy, which can ensure a wake-up state, stable breathing cycle, and better gastrointestinal painless procedure.

Gastrointestinal symptomatology, diagnosis, and treatment history in patients with underweight avoidant/restrictive food intake disorder and anorexia nervosa: Impact on weight restoration in a meal‐based behavioral treatment program

Gastrointestinal (GI) concerns are often presumed to complicate nutritional rehabilitation for restrictive eating disorders, yet their relationship to weight restoration outcomes is unclear. This retrospective chart review examined GI history and weight-related discharge outcomes in primarily adult, underweight inpatients with anorexia nervosa (AN, N=107) or avoidant/restrictive food intake disorder (ARFID, N=22) treated in a meal-based, behavioral eating disorder program. Lifetime GI symptomatology, diagnoses, diagnostic tests, and procedures were abstracted from medical records. Generalized linear models examined associations of GI diagnoses, tests, and procedures with discharge BMI and rate of weight gain. Ninety-nine percent of patients reported GI symptomatology and 83% had one or more GI diagnoses; with constipation and GERD most common. GI diagnoses (p <.01) and testing (p <.001) were more common in ARFID than AN. Average inpatient weight gain (1.59 kg/week), and discharge BMI (18.5kg/m2 ), did not differ by group. Slower weight gain in patients with (1.3kg/week), versus without (1.7kg/week), history of tube feeding (p=.02), accounted for a main effect of GI procedures on inpatient rate of gain (p=.01). Despite ubiquitous GI symptomatology, meal-based weight restoration achieved average weekly weight gain above recommended APA guidelines for hospitalized patients with an eating disorder. History of tube feeding was associated with slower mean weight gain, which remained, however, within recommended APA guidelines.

Development of AGA’s Policy Agenda During the COVID-19 Pandemic

Development of AGA’s Policy Agenda During the COVID-19 Pandemic

Gastrointestinal Pathology in Samples From Coronavirus Disease 2019 (COVID-19)-Positive Patients.

Although primarily considered a respiratory illness, coronavirus disease 2019 (COVID-19) can cause gastrointestinal manifestations. To evaluate histopathology and in situ hybridization for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in gastrointestinal samples from patients with recent and remote COVID-19. Patients with positive SARS-CoV-2 nasopharyngeal tests and a gastrointestinal tissue specimen were included. SARS-CoV-2 in situ hybridization (ISH) was performed on each sample. A subset had SARS-CoV-2 next-generation sequencing (NGS) performed. Twenty-five patients met inclusion criteria. Five had positive SARS-CoV-2 nasopharyngeal tests within 7 days of their gastrointestinal procedure. Two were ulcerative colitis patients on steroid therapy who lacked typical COVID-19 symptoms. Their colectomies showed severe ulcerative colitis; one demonstrated SARS-CoV-2 by NGS but a negative ISH. Another had an ischemic colon resected as a complication of the COVID-19 course; however, both ISH and NGS were negative. A fourth had a normal-appearing terminal ileum but positive ISH and NGS. The fifth patient had ileal ulcers with SARS-CoV-2 negativity by both modalities. The remaining 20 patients had positive nasopharyngeal tests an average of 53 days prior to procedure. None of their samples demonstrated SARS-CoV-2 ISH positivity, but one was positive on NGS despite a negative nasopharyngeal test. Gastrointestinal findings from SARS-CoV-2-infected patients ranged from normal with virus detected by ISH and NGS to bowel ischemia secondary to systemic viral effects without evidence of virus in the tissue. No distinct histologic finding was identified in those with gastrointestinal tissue specimens demonstrating SARS-CoV-2 positivity in this cohort.

Patient Positioning Guidelines for Gastrointestinal Endoscopic Procedures.

Patient positioning during gastrointestinal endoscopic procedures has received minimal attention compared with surgical procedures performed in the surgical setting. However, prolonged endoscopic interventions on patients and the increasing requirement for general anesthesia have changed to need for patient positioning guidelines. The objective of this study was to test whether patient positioning guidelines for surgical procedures in surgical suites are suitable for gastrointestinal endoscopic procedures without negatively impacting safety and procedure duration. This was an observational feasibility study with volunteers of different body mass index categories. Volunteers were positioned in supine, lateral, and prone positions on an operating table and thereafter on an endoscopy stretcher and asked for comfort levels. Except for arm and head positioning in lateral and prone positions, it was possible to replicate the patient positioning guidelines. Alternative options were explored for the positioning of arms and head to optimize oral access. Besides minor adjustments, we were able to replicate the positioning guidelines and adhere to pressure and nerve injury prevention guidelines. Concept endoscopic patient positioning guidelines were developed. It is recommended to review the "swimmer's" position. Endoscopic patient positioning guidelines should become part of the National Practice Standards and education curriculum of endoscopy nurses.

Endoscopy in a COVID-19 Referral National University Hospital: A Single-center Experience and Recommendations

Rationale. COVID-19 pandemic disease, can be transmitted during gastrointestinal procedures, via aerosolized droplets, and via fecal shedding. Both international and local endoscopy societies have issued strategies to alleviate the risk to endoscopy personnel. However, several barriers against the implementation of these recommendations exist thus individual center’s policies are employed whenever applicable.&#x0D; Objectives. This narrative study aims to describe the current experience and set-up in the endoscopy unit of a COVID referral center, discuss the stratification of patients for endoscopy, the operational management of the personnel and endoscopy unit in line with the adapted local and international guidelines and offer endoscopists a quick reference guide to adapt endoscopy practice during the pandemic in a resource-limited setting.&#x0D; Methodology. This paper reviews and consolidates current endoscopy guidelines and describes the single-center experience of Philippine General Hospital.&#x0D; Results. In resource-limited settings, with uncertainties of prolonged COVID-19 impact to healthcare, modification of practice, adherence to strategies and recommendations, empowerment of workforce, establishing the sustainability of resources, training, and service to patients, are essential components to combat current dilemma brought about by this pandemic.&#x0D; Conclusion. Integration of current local and international guidelines encompass all aspects of endoscopy practice during the pandemic. The recommendations cited are aimed to guide other resource-limited endoscopy units for potential changes and guidance in the overall practice.

Small Bowel Epithelial Precursor Lesions: A Focus on Molecular Alterations.

The wider use of gastrointestinal endoscopic procedures has led to an increased detection of small intestinal preneoplastic and neoplastic epithelial lesions, most of which are identified in the duodenum and ampullary region. Like their malignant counterparts, small intestinal glandular precursor lesions, which include adenomas and hamartomas, may arise sporadically or be associated with hereditary tumor syndromes, such as familial adenomatous polyposis, MUTYH-associated polyposis, Lynch syndrome, Peutz-Jeghers syndrome, juvenile polyposis syndrome, and Cowden syndrome. In addition, dysplastic, preinvasive lesions have been observed adjacent to small bowel adenocarcinomas complicating immune-related disorders, such as celiac or Crohn’s disease. Adenomatous lesions may exhibit an intestinal-type, gastric-type, or, very rarely, serrated differentiation, related to different molecular pathogenetic mechanisms. Finally, in the background of multiple endocrine neoplasia 1 syndrome, precursor neuroendocrine growths have been described. In this review we offer a comprehensive description on the histo-molecular features of the main histotypes of small bowel epithelial precursors lesions, including: (i) sporadic adenomas (intestinal-type and gastric-type; non-ampullary and ampullary); (ii) syndromic adenomas; (iii) small bowel dysplasia in celiac and Crohn’s disease; (iv) serrated lesions; (v) hamartomatous lesions; and (vi) neuroendocrine precursor lesions.

Identifying who best tolerates moderate sedation: Results from a national database of gastrointestinal endoscopic outcomes.

BACKGROUNDWith increasing volume and cost of gastrointestinal endoscopic procedures, the proper selection of patients for moderate sedation becomes increasingly relevant. The current literature lacks consistent findings that allow for appropriate selection of patients for moderate sedation. AIMTo analyze a nationwide registry of patients to identify patient and procedural factors associated with lower sedation requirements for endoscopy.METHODSThe Clinical Outcomes Research Initiative National Endoscopic Database was queried to assess adult patients undergoing moderate sedation for esophagogastroduodenoscopy (EGD) and colonoscopy from 2008 to 2014. Patients were stratified into two groups [low dose (LD) and high dose sedation] based on sedation requirements. Anthropometric, procedural, and anesthesia data were compared, and multivariable analysis was performed to identify factors associated with LD sedation.RESULTSOf the 371102 patients included in the study, 63137 where stratified into the LD sedation group and 307965 were in the high dose group. Moderate sedation was managed primarily by endoscopists (50%) and anesthesia providers (47%). Patients undergoing EGDs and procedures performed in the inpatient setting, in ambulatory surgery centers, intensive care units or hospital wards, required less sedation than colonoscopies, outpatient procedures and procedures done in endoscopy suites, respectively (P < 0.0001 for all). On multivariable analysis, factors predictive of tolerance with lower sedation requirements for EGDs and colonoscopies were female gender, age ≥ 50, non-White race, Hispanic descent, body mass index ≤ 25 kg/m2, and higher American Society of Anesthesia Class (P < 0.0001 for all).CONCLUSIONClinicians should consider these patient profiles in determining which patients will better tolerate moderate sedation vs those better suited for alternative sedation methods.

O2 Facilitating engagement in surgical research through a virtual systematic review network: The RoboSurg Collaborative

IntroductionFor students and trainees, COVID-19 has restricted opportunities for training and development. We sought to develop a virtual network to facilitate remote engagement and training in surgical research during COVID-19.RoboSurg aims to conduct a series of systematic reviews, to summarise and critique the reporting of studies of robot-assisted surgery across seven upper gastrointestinal procedures.MethodsA protocol was developed based on previously published work. Searches were undertaken to identify studies evaluating robotic pancreas, liver, oesophagus, stomach, gallbladder, bariatric and anti-reflux surgery. Participants were identified through social media and collaborative research networks. s were screened for inclusion by two participants. Data extraction is completed by teams of collaborators, entered into a bespoke REDCap database and verified by senior team member. Changes are logged, with rationale and feedback provided to collaborators and reviewed by a third reviewer to assess consistency. Results of each review will be summarised in narrative syntheses.ResultsA total of 134 collaborators have registered, with 73 active participants. Collaborators range from second year medical students to surgical registrars across the UK. To date, 9444 abstracts and 1653 full texts have been screened with 422 eligible articles identified. Data extraction for two systematic reviews, including 193 articles, has been completed using this approach.ConclusionRoboSurg has developed a network and methodological framework for the remote conduction of complex systematic reviews, which can be utilised to engage and train students and trainees in surgical research.

Guillain-Barre syndrome after coronary artery bypass graft surgery: a case report and literature review

BackgroundGuillain-Barre syndrome (GBS) is an acute polyradiculoneuropathy, often preceded by an infection. Rarely, it is preceded by a surgical procedure. Most of the postsurgical GBS cases are reported with the neurosurgical, gastrointestinal, orthopedic, and cardiac procedures. GBS is rarely reported after a coronary artery bypass grafting (CABG). To date, only 12 cases have been reported in the literature. Our case is 13th in number and the first case from Pakistan.Case presentationWe report a case of a 54-year-old man presented with acute flaccid quadriparesis and areflexia after a CABG procedure. He was subsequently diagnosed with an acute inflammatory demyelinating polyneuropathy (AIDP) variant of GBS and underwent five sessions of plasmapheresis. His weakness improved and could ambulate unassisted on follow-up visits.ConclusionGBS is a potentially treatable condition if timely diagnosed and managed. It should be considered in every patient presenting with an acute-onset weakness after surgery.

Self-reported awareness during general anesthesia in pediatric patients: A study from Wake Up Safe.

Awareness under general anesthesia occurs rarely, but can result in emotional trauma. Although well-studied in adults, there is a paucity of data on unintentional awareness in children. This case series examines instances of self-reported awareness registered with Wake Up Safe, a patient safety organization that maintains a database of adverse events in pediatric anesthesia. Cases of self-reported intraoperative awareness submitted to Wake Up Safe from January 1, 2010 to May 31, 2020 were reviewed for circumstances, causative factors, and level of harm. Fourteen cases of self-reported intraoperative awareness out of 555360 cases in patients aged 5-20years were noted during the study period. Overall incidence of awareness was 2.52 (95% CI: 1.38-4.23) cases per 100000 patients, or approximately 1:40000. Self-reported intraoperative awareness was more frequently associated with cardiac and gastrointestinal endoscopic procedures. Incidence for cardiac procedures was 20.34 (95% CI: 8.18-41.90) cases per 100000 patients. Incidence for gastrointestinal endoscopic procedures was 7.74 (95% CI: 1.60-22.62) cases per 100000 patients. Most patients were assessed to have suffered harm. Self-reported intraoperative awareness is a rare complication in pediatric patients that has implications for harm. Compared to awareness cases elicited by a questionnaire method, cases of self-reported awareness during general anesthesia may represent those that have a greater impact. A preoperative discussion of intraoperative awareness should be considered for procedures that carry a higher likelihood of awareness in order to mitigate harm.

Does postal consent for flexible cystoscopy work?

Informed consent is an integral part of the process prior to any surgical procedure [1]. Flexible cystoscopy is a common day case urological procedure and it is the gold standard investigation for visible haematuria [2]. To assess if postal consent is a suitable form of gaining informed consent for flexible cystoscopy. Patients booked for a flexible cystoscopy are initially reviewed in clinic. An information leaflet with an attached consent form is then posted to their home 2weeks prior to their procedure. We designed a short questionnaire, to assess patient's satisfaction and understanding of the literature, given to them after the procedure. Sixty-seven questionnaires were completed. The mean age was 54. Sixty patients (93%) think that postal consent is of benefit to the patient. Sixty-one patients (91%) read the information sheet and felt that there was enough information regarding the procedure on it. Fifty-four patients (81%) had no difficulty understanding the consent form. Forty patients (60%) signed the form prior to arrival in the hospital. Postal consent is commonly used for gastro-intestinal endoscopy procedures. Postal consent for flexible cystoscopy is not well reported in the literature. Our study shows postal consent to be a suitable form of gaining informed consent for flexible cystoscopy.

The Readability of Patient Education Materials Pertaining to Gastrointestinal Procedures.

Introduction Due to the ubiquity and ease of access of Internet, patients are able to access online health information more easily than ever. The American Medical Association recommends that patient education materials be targeted at or below the 6th grade level in order to accommodate a wider audience. In this study, we evaluate the difficulty of educational materials pertaining to common GI procedures; we analyze on the readability of online education materials for colonoscopy, flexible sigmoidoscopy, and esophagogastroduodenoscopy (EGD). Methods Google search was performed using keywords of “colonoscopy,” “sigmoidoscopy,” and “EGD” with “patient information” at the end of each search term. The texts from a total of 18 studies, 6 for each of the procedures, were then saved. Each study was also subdivided into “Introduction,” “Preparation,” “Complications,” and if available, “Alternatives.” Furthermore, medical terminology that was properly explained, proper nouns, medication names, and other copyright text were removed in order to prevent inflation of the difficulty. Five validated readability tests were used to analyze each study and subsections: Coleman-Liau, New Dale-Chall, Flesch-Kincaid, Gunning Fog, SMOG. Results Studies on colonoscopy, flexible sigmoidoscopy, and EGD had median readability grades of 9.7, 10.2, and 11.0, respectively. Analysis of the subsections revealed that the “Alternative” subsection was the most difficult to comprehend with a readability score of 11.4, whereas the “Introduction” subsection was the easiest to comprehend with a readability score of 9.5. Conclusion Despite modifications to the studies that improved the readability scores, patient education materials were still significantly above the recommended 6th grade level across all websites. This study emphasizes that clear and simple language is warranted in order to create information that is suitable for most patients.

The Role of Health Disparities and Socioeconomic Status in Emergent Gastrointestinal Procedures.

Objectives: There is limited data describing the role of health disparity factors and socioeconomic status (SES) on emergent versus nonemergent gastrointestinal (GI) procedures within pediatrics. We aimed to characterize risk factors and determine the role of SES on emergent versus nonemergent GI care. We hypothesized that patients with lower SES incur higher risk of having emergent procedures performed.Methods: Retrospective chart review was performed between 2012 and 2016, with 2556 patient records reviewed. Demographic data and SES categories were determined. The majority of emergent procedures were performed on an inpatient basis. Health disparity factors analyzed included age, gender, insurance type, race, language, and SES using census tracts. Logistic regression analyses and paired t-tests were utilized.Results: Two hundred eighty-six (11.2%) patients had emergent GI procedures performed. Logistic regression (odds ratio [OR], confidence interval (95% CI)] showed patients from 6–11 to 12–17 years of age were less likely to seek emergent care than the youngest group [0.47, 0.33–0.66 and 0.61, 0.45–0.84]. Patients with Medicaid insurance [1.68, 1.27–2.26], African American or “other” race [2.07, 1.48–2.90 and 2.43, 1.77–3.36, respectively], as well as “other” language [2.1, 1.14–3.99] more often sought emergent care. Using geocoded data, we found that as SES increases by 1, emergent risk for procedures decreased by 2.9% (OR 0.97, p=0.045).Conclusions: Children with lower SES, at extremes of age (<5, >18 years), non-English or Spanish speaking and with Medicaid insurance are at higher risk of undergoing emergent GI procedures. This study gives us an opportunity to plan targeted interventions to improve access and quality of care.

A multicenter survey on endoscopic retrograde cholangiopancreatography during the COVID-19 pandemic in northern and central Italy.

Background and study aims COVID-19 has dramatically impacted endoscopy practice because upper endoscopy procedures can be aerosol-generating. Most elective procedures have been rescheduled. Endoscopic retrograde cholangiopancreatography (ERCP) is frequently performed in emergency or urgent settings in which rescheduling is not possible. We evaluated the impact of the COVID-19 pandemic on ERCP in Italy during the SARS-CoV-2 lockdown, in areas with high incidence of COVID-19. Patients and methods We performed a retrospective survey of centers performing ERCP in high COVID-19 prevalence areas in Italy to collect information regarding clinical data from patients undergoing ERCP, staff, case-volume and organization of endoscopy units from March 8, 2020 to April 30, 2020. Results We collected data from 31 centers and 804 patients. All centers adopted a triage and/or screening protocol for SARS-CoV-2 and performed follow-up of patients 2 weeks after the procedure. ERCP case-volume was reduced by 44.1 % compared to the respective 2019 timeframe. Of the 804 patients undergoing ERCP, 22 (2.7 %) were positive for COVID-19. Adverse events occurred at a similar rate to previously published data. Of the patients, endoscopists, and nurses, 1.6 %, 11.7 %, and 4.9 %, respectively, tested positive for SARS-CoV-2 at follow up. Only 38.7 % of centers had access to a negative-pressure room for ERCP. Conclusion The case-volume reduction for ERCP during lockdown was lower than for other gastrointestinal endoscopy procedures. No definitive conclusions can be drawn about the percentage of SARS-CoV-2-positive patients and healthcare workers observed after ERCP. Appropriate triage and screening of patients and adherence to society recommendations are paramount.

Operative versus nonoperative techniques in emergency management of iatrogenic esophageal perforations

Background Iatrogenic esophageal perforation is a rare, challenging, and life-threatening clinical condition. It can be cervical, thoracic, or abdominal. Its diagnosis depends on clinical suspicion combined with radiological modalities. It can be managed by either nonoperative or operative means. The aim of the study is to evaluate the efficacy of nonoperative compared with operative management of iatrogenic esophageal perforations. Study design This was a nonrandomized controlled study. Patients and methods This study included 30 patients presented with iatrogenic esophageal perforations after undergoing upper gastrointestinal tract endoscopic procedures. There were two groups of patients: group A included 12 patients who were subjected to nonoperative management, and group B included 18 patients who were subjected to operative management. Results The mean age of group A patients was 43 years, whereas for group B patients was 46 years. Most of the group A patients were males (66.66%), and 61.2% of the group B patients were males. The average length of hospital stay was 11 days (range, 8–15 days) for the group A patients and 14 days (range, 9–22 days) for the group B patients. Mortality was 16.6 and 22.3% for group A and group B, respectively. Conclusion Iatrogenic esophageal perforation is a rare and dangerous event. It can be managed by either nonoperative or operative techniques. Both methods have nearly the same success and morbidity and mortality rates when applied; however, the nonoperative techniques can be used only in certain cases under specific criteria.

POS-636 Risk of Peritonitis after Gastroscopy in Peritoneal Dialysis Patients

Peritonitis is a common infective complication of peritoneal dialysis (PD), which causes serious adverse sequelae including peritoneal membrane failure, necessitating conversion to hemodialysis and even mortality. Peritonitis could be secondary to enteric bacterial translocation during gastrointestinal endoscopic procedure. Although gastroscopy is often regarded as having a low infective risk, peritonitis after gastroscopy had been described previously. Owing to the limitation of small sample size in previous series, the risk of peritonitis after gastroscopy is not yet well characterized.

An analysis of the management and incidence of postoperative nausea and vomiting.

Postoperative nausea and vomiting significantly increases recovery time, reduces patient satisfaction, and increases time to discharge. Consensus guidelines for the management of postoperative nausea and vomiting highlight effective methods for prophylaxis and treatment. Implications of adherence to these guidelines include both improved patient outcomes and reduced healthcare costs. This study aimed to assess the incidence, contributing factors, and current prescribing practices for prophylaxis and treatment of postoperative nausea and vomiting. Electronic medical records were assessed for adult patients who had an elective gastrointestinal or gynaecologic surgical procedure over a one-year period. Patient demographics and perioperative data were collected to assess risk factors and the incidence of postoperative nausea and vomiting. The appropriateness of prophylaxis and treatment was assessed according to current guidelines. The incidence of postoperative nausea and vomiting was consistent with previously noted findings. The average time spent under anaesthesia was significantly higher in patients who experienced postoperative nausea and vomiting. Appropriate evidence-based rescue therapy was administered in a minority of the cohort experiencing postoperative nausea and vomiting. There is substantial opportunity for provider education and adherence to best prescribing practices. Enhanced adherence to evidence-based rescue therapy prescribing may improve patient outcomes and satisfaction.