Interventional Endoscopic Procedures Research Articles

Laparoscopic floppy Nissen fundoplication with valve calibration: a safe and efficient procedure.

A floppy Nissen fundoplication with valve calibration (FNF-VC) performed by laparotomy has been described, to reduce postoperative dysphagia and gas bloating after 360°-fundoplication. As laparoscopy is the gold standard for fundoplication, this study reports the first results of a modified FNF-VC adapted for laparoscopy (LFNF). Seventy-two consecutive patients, who underwent LFNF for refractory GERD between 2012 and 2021, were included. Postoperative outcomes and quality of life (QoL) by GERSS, GERD-HRQL, and GIQLI scores before and after surgery were assessed. The main symptoms were pyrosis (81%), regurgitation (39%), Ear-Nose-Throat symptoms (22%), and thoracic pain (24%). Hiatal hernia was present in 85% (n = 61) of the patients. There was no postoperative mortality, and the severe postoperative morbidity rate (Dindo-Clavien ≥ III) was 6%. After a median follow-up of 3.6years, only 8% of patients were still taking proton-pump inhibitors. Long-term residual dysphagia was noted in 15% of the patients, but none required reoperation or interventional endoscopic procedures. QoL improved, with a significant reduction in GERSS and GERD-HRQL scores and a postoperative GIQLI of 101.75 (75-117.5). This series reports the safety and efficacy of an FNF-VC adapted for laparoscopy to treat GERD with a limited rate of residual dysphagia.

Incidence and outcomes of postoperative fluid collections after minimally invasive distal pancreatectomy without placement of surgical drain. A prospective observational cohort study.

There is uncertainty about the role of prophylactic intra-abdominal drains after distal pancreatectomy. In the present study, we aimed to describe the long-term outcomes of postoperative pancreatic collections in patients who underwent a minimally invasive distal pancreatectomy (MIDP) without surgical drain placement. From 2018 to 2022, consecutive patients who underwent a MIDP were recorded. Patients were followed at 90 days, 6 months, and in the long term. The use of interventional procedures and antibiotic therapy were documented, and the overall evolution of the collections was assessed. A total of 91 patients underwent MIDP; 11 were excluded; 80 were analyzed. Median age was 63 (51-73) years; 61.3% were women. Most lesions (71.3%) were malignant; 15 patients received neoadjuvant therapy. Procedures were laparoscopic (87.5%) or robotic (12.5%). Incidence of postoperative pancreatic collections was 33%; 10 patients were symptomatic. Interventional endoscopic (n = 3) or percutaneous (n = 3) procedures were required. At a follow-up of 24 (17.5-33.1) months, 18 collections resolved completely, eight partially, and one increased. Patients who undergo MIDP without surgical drain placement develop well-tolerated pancreatic collections. Although a minority may require endoscopic or percutaneous drainage, the majority can be managed conservatively and resolve spontaneously in the long term.

Expert opinion on bleeding risk from invasive procedures in cirrhosis

Despite several recent international guidelines, no consensus exists on the bleeding risk nor haemostatic parameter thresholds that define the safety of invasive procedures in patients with cirrhosis. The aim of this study was to establish a position paper on the bleeding risk associated with invasive procedures in patients with cirrhosis among the experts involved in various guidelines. All experts involved in recent guidelines on the management of invasive procedures in patients with cirrhosis were invited to classify 80 procedures as "high risk" or "low risk" with respect to bleeding. Procedures were considered high risk when the estimated risk of major bleeding was 1.5% or more, or when even minor bleeding might lead to significant morbidity or death. The experts were also asked to choose safety thresholds for laboratory test values at which elective invasive procedures could be safely performed. The predetermined threshold considered as "consensus" was ≥75% agreement. Fifty-two experts participated in the study. Out of 80 procedures, a consensus opinion was reached for 52 procedures (65%): 17 procedures were classified as "high risk", primarily interventional endoscopic procedures, percutaneous organ biopsies, or procedures involving the central nervous system; and 35 as "low risk", primarily "diagnostic" procedures. The lowest platelet counts at which performance of a low-risk procedure or a high-risk procedure/surgery were deemed acceptable were 30×109/L and 50×109/L, respectively. Experts did not believe that international normalised ratio should be considered before performing low-risk procedures; 71% also indicated that it should not be considered before performing high-risk procedures. This experience-based classification may be helpful to refine future study designs and to guide clinical decision making regarding invasive procedures in patients with cirrhosis. Several risk classifications and management guidelines for invasive procedures in patients with cirrhosis have been proposed, but with conflicting recommendations. By providing a position paper, based on the opinion of a broad panel of experts, on the bleeding risk associated with 52 invasive procedures in patients with cirrhosis, this survey will help to provide a framework for future study design. The consensus on platelet count, international normalised ratio, fibrinogen and activated partial thromboplastin time identified in this survey will inform physicians regarding the laboratory test values considered acceptable by the experts prior to the performance of an elective invasive procedure in patients with cirrhosis.

Analysis of anatomical variations of the Cystic Duct in Magnetic Resonance Cholangiopancreatography  

Background and objectives- Anatomical variants of the cystic duct (CD) are important be identified and described in the radiological report. This facilitates proper interpretation of the pathological process related to the biliary tree. Also, prior information is important before surgical, percutaneous and endoscopic interventional procedures related to the biliary tree, to avoid inadvertent complications and for successful outcomes. Magnetic Resonance Cholangiopancreatography (MRCP)is the best non-invasive imaging modality in detecting anatomy of the non-dilated cystic duct. This study was carried out to demonstrate imaging appearance of the cystic duct and its anatomical variants detected on MRCP and to document their prevalence in the study group. Methods- This is a single centre retrospective cross-sectional study including all consecutive patients who underwent MRCP form May 2020 to May 2021 at the neurosurgical MRI unit at National Hospital of Sri Lanka. Patients who had undergone cholecystectomies and images with poor quality were excluded.Results- Total 180 MRCP studies were analysed. Normally inserting CD to the lateral aspect of the Common Hepatic Duct (CHD) was observed in 127cases out of 180 (70.5%). 10(5.5%) demonstrated high inserting CD.12(6.6%) cases demonstrated low inserting CD.3(1.6%) had short CD. Parallel course of CD was noted in 12(6.6%). Low and medially inserting CD was present in 4(2.2%) cases. Anterior insertion was demonstrated in 5(2.7%) cases, and posterior insertion was demonstrated in 7(3.8%). Conclusion- Anatomical variants of the CD observed in our study group were comparable to reported frequencies, however posterior insertion was lesser than that found in literature.

Structural, procedural, and personnel requirements for cross-sectoral provision of endoscopic gastroenterological procedures

Gastroenterology has made crucial advances in diagnostic and interventional endoscopic procedures, opening up improvements in the treatment of many patients. Thus, organ-preserving treatments are increasingly being made possible, replacing more invasive organ resecting surgical procedures. At the same time, the degree of complexity and risks varies widely between different endoscopic procedures. In many cases, simpler endoscopic procedures are now offered on an outpatient basis. Further potential for cross-sectoral performance of endoscopic procedures exists in the case of complex endoscopic procedures, which, however, require special structural, procedural and personnel requirements in order to provide quality-assured treatment, enable post-interventional monitoring and, if necessary, take measures to ensure the success of the treatment. We summarize the essential prerequisites and limitations for cross-sector performance of endoscopic procedures in gastroenterology.

Biodegradable Stents In Benign Gastrointestinal And Biliopancreatic Strictures: State Of The Art

The use of endoscopic stents is a well-recognized and accepted option to treat malignant obstructions of the gastrointestinal tract. Advances in stent technology have led to the development of devices with previously unimagined materials. We are constantly exposed to the development of stents with contemporary designs and materials. In this article I focus on the importance and use of biodegradable stents. Biodegradable stents are an attractive option for use in patients with recurrent/recalcitrant benign strictures of the esophagus, bile duct, small intestine, and colon. In theory, using these biodegradable stents, repetitive dilations of recalcitrant digestive stenosis can be avoided, as well as surgical resections of the gastrointestinal tract, mainly in patients with high surgical risk or patients who refuse surgical treatment, and the number of interventional endoscopic procedures can also be minimized. The role of prophylactic biodegradable stents in preventing strictures secondary to gastrointestinal surgery is an idea that needs to be investigated.

Design and Development of a Flexible 3D-Printed Endoscopic Grasping Instrument

(1) Background: Interventional endoscopic procedures are growing more popular, requiring innovative instruments and novel techniques. Three-dimensional printing has demonstrated great potential for the rapid development of prototypes that can be used for the early assessment of various concepts. In this work, we present the development of a flexible endoscopic instrument and explore its potential benefits. (2) Methods: The properties of the instrument, such as its maneuverability, flexibility, and bending force, were evaluated in a series of bench tests. Additionally, the effectiveness of the instrument was evaluated in an ex vivo porcine model by medical experts, who graded its properties and performance. Furthermore, the time necessary to complete various interventional endoscopic tasks was recorded. (3) Results: The instrument achieved bending angles of ±216° while achieving a bending force of 7.85 (±0.53) Newtons. The time needed to reach the operating region was 120 s median, while it took 70 s median to insert an object in a cavity. Furthermore, it took 220 s median to insert the instrument and remove an object from the cavity. (4) Conclusions: This study presents the development of a flexible endoscopic instrument using three-dimensional printing technology and its evaluation. The instrument demonstrated high bending angles and forces, and superior properties compared to the current state of the art. Furthermore, it was able to complete various interventional endoscopic tasks in minimal time, thus potentially leading to the improved safety and effectiveness of interventional endoscopic procedures in the future.

WEO Newsletter.

WEO Newsletter.

What can the Interventional Endoscopist Offer in the Management of Upper Gastrointestinal Malignancies?

The therapeutic possibilities of endoscopy have rapidly increased in the last decades and now allow organ-sparing treatment of early upper gastrointestinal malignancy as well as an increasing number of options for symptom palliation. This review contains an overview of the interventional endoscopic procedures in upper gastrointestinal malignancies. It describes endoscopic treatment of early oesophageal and gastric cancers, and the palliative options in managing dysphagia and gastric outlet obstruction. It also provides an overview of the therapeutic possibilities of biliary endoscopy, such as retrograde stenting and radiofrequency biliary ablation. Endoscopic ultrasound-guided therapeutic options are discussed, including biliary drainage, gastrojejunostomy and coeliac axis block. To aid in clinical decision making, the procedures are described in the context of their indication, efficacy, risks and limitations.

New Concept of External and Independent Next-to-the-Scope Intraluminal Grasping Device (EINTS).

Background: Interventional endoscopic procedures require complex manipulations and precise maneuvering of end-effectors. One focus in research on improved endoscopic instrument function was based on surgical experience to gain additional traction. The idea has emerged using assisting instruments by applying external tools next-to-the endoscope to follow surgical concepts. The aim of this study is the assessment of flexible endoscopic grasping instruments regarding their function and working-radius introducing the concept of an intraluminal "next-to the-scope" endoscopic grasper. Methods: In this study endoscopic graspers are evaluated (1:through-the-scope-grasper, TTSG; 2:additional-working-channel-system AWC-S;3:external-independent-next-to-the-scope-grasper EINTS-G) regarding their working-radius, grasping abilities, maneuverability and the ability to expose tissue with varying angulation. Results: The working radius of the tools attached or within the endoscope (TTS-G and AWC-S) benefit from the steering abilities of the scope reaching 180-210 degrees in retroflexion; EINTS-G is limited to 110-degrees. The robust EINTS-grasper has the advantage of stronger grip for grasping and pulling force, which enables manipulation of larger objects. The independent maneuverability during ESD-dissection provides better tissue-exposure by changing the traction-angulation. Conclusion: The working radius of tools attached to the endoscope benefit from scope- steering. The EINTS-grasper has the advantage of stronger grasping force and pulling within the GI-tract and independent maneuverability enables improved tissue-exposure. WC200.

S1069 Endoscopic vs Surgical Procedures for Gastroesophageal Reflux Disease - A Network Meta-Analysis

Introduction: Various surgical fundoplication (SF) procedures have been the mainstay therapy for medication refractory GERD. Over the last couple of decades, interventional endoscopic procedures such as radiofrequency energy delivery with Stretta, endoscopic fundoplication (EF) procedures with EsophyX and GERDx systems, and laparoscopic magnetic sphincter augmentation (Linx), have emerged as alternative options. Objective of our study was to compare the efficacy of these various procedures. Methods: A comprehensive search of the available electronic databases was conducted, and only RCTs with our procedures of interest were included in our network meta-analysis using random-effects analysis. Outcomes of interest were lower esophageal sphincter pressure (LESP), esophagitis, cessation of use of proton pump inhibitors (PPIs), and percentage of time with a pH less than 4 on a 24-hour esophageal pH monitoring (% time pH< 4) at a follow-up of one year or less. Results: Thirty-one studies with a total of 4,371 patients were included in the analysis. EF and SF were associated with significantly higher LESP compared to PPI. There was no significant difference between EF and Nissen [Mean Difference (MD): 0.23, 95%CI: -7.01-7.48], anterior (MD: 1.76, 95% CI: -5.75-9.16) or Toupet (MD: 2.4, 95%CI: -4.94-9.75) fundoplications. In contrast, Stretta was inferior to Nissen (MD: -9.00, 95%CI: -14.55 - -3.45), Toupet (MD: -6.83, 95%CI: -12.50 - -1.55) and anterior (MD: -7.5, 95%CI: -13.35 - -1.71). Regarding % time pH< 4, EF was significantly better than Nissen (MD: 4.72, 95%CI: 0.71-8.73), but not significantly different from either Toupet (MD: 3.62, 95%CI: -1.90-9.14) or anterior (MD: -0.16, 95%CI: -6.29-5.96) fundoplications, and none of the procedures were significantly different from the PPI group. Cessation of PPI usage was significantly higher for endoscopic and surgical (only Linx) procedures compared to PPI group, but none of the procedures had significant differences when compared to each other. Endoscopic and surgical procedures (only SF) did not differ significantly from each other or from the PPI group in terms of presence of esophagitis at follow-up. (Figure) Conclusion: Efficacy of EF seemed comparable to SF in the short-term. Stretta was found to be inferior to all procedures in terms of LESP. Further studies focusing on head to head trials between EF and SF, and long term outcomes of EF are required to understand the place of EF in the treatment hierarchy.Figure 1.: A. Direct, indirect and network estimates of post-intervention lower esophageal sphincter pressures; B. Direct, indirect and network estimates of percentage of time with a esophageal pH less than 4; C. Forest plot of cessation of PPI usage at follow-up comparing various interventions to PPI alone

Intermittent Manually Controlled versus Continuous Infusion of Propofol for Procedural Sedation during Interventional Endoscopic Procedures: A Single-blinded Randomised Study

Introduction: Sedation with propofol during interventional gastrointestinal endoscopy is usually accomplished with two main modes-intermittent manually controlled using a syringe, and continuous infusion using an infusion device. Aim: To compare the effect of bolus administration and infusion of propofol on recovery profile during sedation in patients undergoing interventional endoscopy procedures. Materials and Methods: The present study was a singleblinded randomised study in which 120 patients, belonging to American Society of Anaesthesiologists (ASA) grade I and II, of either gender, and age 18-70 years, were randomly assigned to receive intermittent bolus (Bolus Group, BG) or continuous infusion (Infusion Group, IG) of propofol sedation after induction with 2 mg Midazolam for deep sedation. BG patients received an initial dose of propofol, 1%, according to body weight (&lt;60 kg: 40 mg, &gt;60 kg: 60 mg), followed by boluses of 10- 20 mg adjusted to maintain a Modified Observer’s Assessment of Alertness /Sedation Scale (MOAA/S) of 0 or 1. In the IG, continuous propofol infusion (4-6 mg/kg/hr) via Graseby 2000 (Smiths Medical) was administered after a bolus of 1 mg/ kg of propofol. Vital signs, recovery time, quality of recovery, total dose of propofol, side-effects as well as patient and endoscopist satisfaction score were evaluated. The data was compiled systematically and analysed using unpaired Student’s t-test and Chi-square test. The p-value &lt;0.05 was considered significant. Results: The demographic profile of patients was comparable in both the groups. The recovery time (6.30±2.06 minutes in BG versus 5.71±2.19 minutes in IG) and total propofol dose (327.74±45.52 mg in BG versus 314.46±64.52 mg in IG) were comparable. Similarly, the quality of recovery was identical in both groups. At 10 and 15 minutes after induction, arterial blood pressure was significantly lower in group BG as compared to group IG (114±16.96 in BG versus 120.34±8.78 in IG; p-value=0.031). The endoscopist’s satisfaction score was better in IG (p-value=0.001), whereas, the patient satisfaction score was comparable in both the groups (p-value=0.162). Conclusion: Both regimes allowed good controllability of propofol sedation. However, endoscopist satisfaction score was significantly better and haemodynamic fluctuations were less in infusion group.

Risk factors of poor prognosis and impairment of activities of daily living in patients with hemorrhagic gastroduodenal ulcers

BackgroundImpairment of activities of daily living (ADL) due to hemorrhagic gastroduodenal ulcers (HGU) has rarely been evaluated. We analyzed the risk factors of poor prognosis, including mortality and impairment of ADL, in patients with HGU.MethodsIn total, 582 patients diagnosed with HGU were retrospectively analyzed. Admission to a care facility or the need for home adaptations during hospitalization were defined as ADL decline. The clinical factors were evaluated: endoscopic features, need for interventional endoscopic procedures, comorbidities, symptoms, and medications. The risk factors of outcomes were examined with multivariate analysis.ResultsAdvanced age (> 75 years) was a significant predictor of poor prognosis, including impairment of ADL. Additional significant risk factors were renal disease (odds ratio [OR] 3.43; 95% confidence interval [CI] 1.44–8.14) for overall mortality, proton pump inhibitor (PPIs) usage prior to hemorrhage (OR 5.80; 95% CI 2.08–16.2), and heart disease (OR 3.05; 95% CI 1.11–8.43) for the impairment of ADL. Analysis of elderly (> 75 years) subjects alone also revealed that use of PPIs prior to hemorrhage was a significant predictor for the impairment of ADL (OR 8.24; 95% CI 2.36–28.7).ConclusionIn addition to advanced age, the presence of comorbidities was a risk of poor outcomes in patients with HGU. PPI use prior to hemorrhage was a significant risk factor for the impairment of ADL, both in overall HGU patients and in elderly patients alone. These findings suggest that the current strategy for PPI use needs reconsideration.

Usefulness of Routine Plain CT the Day After an Interventional EUS Procedure.

Background:Interventional endoscopic ultrasound-guided procedures (I-EUS) are widely accepted as salvage procedures in ERCP-failed cases, and to drain fluid collected in the abdominal cavity. Although I-EUS has a relatively high incidence of complications and is severe/fatal in some cases, no follow-up strategy has been established. In our institution, plain computed tomography (P-CT) is performed routinely the day after I-EUS. In this study, we evaluated the usefulness of routine P-CT the day after I-EUS, as a follow-up method, and propose an algorithm.Methods:We retrospectively reviewed 81 patients who underwent I-EUS and evaluated the usefulness of P-CT, abdominal X-ray, laboratory data, and symptoms as a follow-up method. An adverse event (AE) was defined as an event requiring any treatment.Results:Technical success, clinical success, and AE rates were 96.3%, 90.1%, and 18.9%, respectively. In total, 30 patients had abnormal findings among the follow-up methods: 6 cases underwent additional procedures, 8 underwent medical treatments, and 16 were observed. The sensitivity, specificity, and accuracy for detecting AEs were assessed based on P-CT (85.7%, 100%, and 97.5%), X-ray (7.1%, 100%, and 83.5%), laboratory data (71.4%, 83.0%, and 81.0%), and symptoms (92.9%, 86.2%, and 87.3%). The sensitivity and accuracy of the latter two items were as high as those for X-ray, but specificity was lower than those for X-ray and P-CT.Conclusions:Routine P-CT the day after I-EUS was useful for detecting complications and deciding to perform an invasive salvage procedure. Symptoms and laboratory data were useful to supplement routine P-CT.

Bleeding After Elective Interventional Endoscopic Procedures in a Large Cohort of Patients With Cirrhosis.

INTRODUCTION:Elective therapeutic endoscopy is an important component of care of cirrhotic patients, but there are concerns regarding the risk of bleeding. This study examined the incidence, risk factors, and outcomes of bleeding after endoscopic variceal ligation (EVL), colonoscopic polypectomy, and endoscopic retrograde cholangiopancreatography with sphincterotomy in cirrhotic patients.METHODS:A cohort study of patients with cirrhosis who underwent the above procedures at a single center between 2012 and 2014 was performed. Patients with active bleeding at the time of procedure were excluded. Patients were followed for 30 days to assess for postprocedural bleeding and for 90 days for mortality.RESULTS:A total of 1,324 procedures were performed in 857 patients (886 upper endoscopies, 358 colonoscopies, and 80 endoscopic retrograde cholangiopancreatograpies). After EVL, bleeding occurred in 2.8%; after polypectomy, bleeding occurred in 2.0%; and after sphincterotomy, bleeding occurred in 3.8%. Independent predictors of bleeding after EVL and polypectomy included younger age and lower hemoglobin. For EVL, bleeding was also associated with infection and model for end-stage liver disease-Na. International normalized ratio was associated with bleeding in univariate analysis only, and platelet count was not associated with bleeding in any procedure. Bleeding after EVL was associated with 29% 90-day mortality, and bleeding after polypectomy was associated with 14% mortality. Of the 3 patients with postsphincterotomy bleeding, none were outliers regarding their baseline characteristics.DISCUSSION:In patients with cirrhosis, bleeding occurs infrequently after elective therapeutic endoscopy and is associated with younger age, lower hemoglobin, and high mortality. Consideration of these risk factors may guide appropriate timing and preprocedural management to optimize outcomes.

Influence of COVID-19 Pandemic on Endoscopic Procedures in Two European Large-Capacity Endoscopy Units: “Keep Calm, Keep Safe and Scope on?”

Background: The COVID-19-pandemic poses challenges to the medical system and especially to endoscopic staff and patients. National, European and International societies provided recommendations on how to safely perform endoscopic procedures during the current pandemic. Until now, the effect of the current pandemic on tertiary endoscopy centers has not been reported. Objective: The aim of this was to analyze the influence of the early SARS-CoV2-pandemic on endoscopic care and work flow in 2 European tertiary endoscopy units. Methods: Data from 2 tertiary endoscopy units (Katowice and Munich) were retrospectively collected during the early pandemic and compared to an equivalent pre-pandemic period. Data include procedures, complications, benchmarks, and influence on endoscopy training. Results: During the early pandemic, we noted a highly significant decrease (49.1%) in the overall number of all endoscopies with a significant increase in therapeutic procedures. Besides, there were no significant differences in the number of urgent endoscopic retrograde cholangiopancreatography or interventional endoscopic ultrasound procedures. The exceptional situation reduced endoscopic procedures performed by trainees significantly. Conclusions: The SARS-CoV2-pandemic halved the endoscopy service of 2 tertiary centers while maintaining an urgent therapeutic service. Recommended personal safety measures in endoscopy proved to be efficient and safe in preventing SARS-CoV2 infection of staff or spreading. Unnecessarily, the SARS-CoV2 pandemic prevented routine endoscopy training.

Bronchoscopic treatment of a bronchopleural fistula after pneumonectomy.

Bronchoscopic treatment of a bronchopleural fistula after pneumonectomy.

LMA Gastro\u2122 airway is feasible during upper gastrointestinal interventional endoscopic procedures in high risk patients: a single-center observational study

BackgroundNonoperating room anesthesia during gastroenterological procedures is a growing field in anesthetic practice. While the numbers of patients with severe comorbidities are rising constantly, gastrointestinal endoscopic interventions are moving closer to minimally invasive endoscopic surgery. The LMA Gastro™ is a new supraglottic airway device, developed specifically for upper gastrointestinal endoscopy and interventions. The aim of this study was to evaluate the feasibility of LMA Gastro™ in patients with ASA physical status ≥3 undergoing advanced endoscopic procedures.MethodsWe analyzed data from 214 patients retrospectively who received anesthesia for gastroenterological interventions. Inclusion criteria were upper gastrointestinal endoscopic interventions, airway management with LMA Gastro™ and ASA status ≥3. The primary outcome measure was successful use of LMA Gastro™ for airway management and endoscopic intervention.ResultsThirtyone patients with ASA physical status ≥3, undergoing complex and prolonged upper gastrointestinal endoscopic procedures were included. There were 7 endoscopic retrograde cholangiopancreatographies, 7 peroral endoscopic myotomies, 5 percutaneous endoscopic gastrostomies and 12 other complex procedures (e.g. endoscopic submucosal dissection, esophageal stent placement etc.). Of these, 27 patients were managed successfully using the LMA Gastro™. Placement of the LMA Gastro™ was reported as easy. Positive pressure ventilation was performed without difficulty. The feasibility of the LMA Gastro™ for endoscopic intervention was rated excellent by the endoscopists. In four patients, placement or ventilation with LMA Gastro™ was not possible.ConclusionsWe demonstrated the feasibility of the LMA Gastro™ during general anesthesia for advanced endoscopic procedures in high-risk patients.Trial registrationGerman Clinical Trials Register (DRKS00017396) Date of registration: 23rd May 2019, retrospectively registered.

LMA Gastro™ Airway is feasible during upper gastrointestinal interventional endoscopic procedures in high risk patients

LMA Gastro™ Airway is feasible during upper gastrointestinal interventional endoscopic procedures in high risk patients

Dexmedetomidine or midazolam in combination with propofol for sedation in endoscopic retrograde cholangiopancreatography: a randomized double blind prospective study.

IntroductionInterventional endoscopic procedures, such as endoscopic retrograde cholangiopancreatography (ERCP), often require sedation during the procedure. The most commonly used drugs for this purpose are midazolam and propofol, which are used as sedative and hypnotic agents with minimal analgesic potential.AimTo compare the analgesic sedative effects of midazolam-propofol and dexmedetomidine-propofol combinations and their influence on hemodynamic and respiratory variables in patients undergoing ERCP.Material and methodsForty adult patients aged 20-78 and undergoing ERCP were randomized to two groups. Patients were premedicated with midazolam (0.05 mg/kg 10 min before the procedure) in group M and with dexmedetomidine (1 μg/kg for 10 min) in group D. Propofol was used for maintenance. The sedation level was monitored using the bispectral index (BIS) to maintain a score between 70 and 80. Hemodynamic and respiratory variables, recovery time and adverse events were recorded.ResultsThe hemodynamic and respiratory variables were similar in both groups. Total propofol consumption was significantly lower in the dexmedetomidine group (208.5 ±80.0 vs. 154.5 ±66.7 mg; p = 0.011). The recovery period was shorter in group D (time to achieve the Aldrete score 9 was 9.4 ±2.1 vs. 6.6 ±1.1 min; p < 0.001). Changes in hemodynamic and respiratory variables and adverse events were not different between the two groups.ConclusionsWe found a shorter recovery time and comparable sedative and adverse effects with the dexmedetomidine-propofol combination compared with the midazolam-propofol combination. Dexmedetomidine in combination with propofol may be a safe and useful alternative for sedation for ERCP patients.