Lower Gastrointestinal Endoscopy Research Articles

S918 The Impact of GLP-1 Receptor Agonists on Upper and Lower GI Endoscopy: A Systematic Review and Meta-Analysis

S918 The Impact of GLP-1 Receptor Agonists on Upper and Lower GI Endoscopy: A Systematic Review and Meta-Analysis

Hemorragia digestiva grave debido a ectasia vascular de yeyuno

Introduction: bleeding from the small bowel represents 5% of all cases of gastrointestinal (GI) bleeding and is mainly due to vascular malformations. Diagnosis is made by capsule endoscopy, although it depends on the patient´s condition as well as capsule endoscopy availability. Case report: a 22-year-old female patient presenting with hematochezia leading to hypovolemic shock and cardiorespiratory arrest, with negative upper and lower GI endoscopies. Given the impossibility of accessing capsule endoscopy, a surgical intervention was performed which identified jejunal vascular ectasia.

Risk of colorectal cancer and adenoma after an appendectomy: results from three large prospective cohort studies and meta-analysis.

The relationship between appendectomy and subsequent colorectal cancer risk remains unclear, and no study has examined its association with colorectal adenoma. We used data from three prospective cohorts: Health Professionals Follow-up Study, Nurses' Health Study (NHS), and NHSII. Appendectomy history was self-reported at baseline. Colorectal cancer risk was analyzed with Cox proportional hazard models among 224,109 participants followed up to 32years. Colorectal adenoma risk was evaluated among 157,490 participants with at least one lower gastrointestinal endoscopy during follow-up with logistic regression models accounting for repeated observations. We also performed a meta-analysis of cohort studies that examined association between appendectomy and colorectal cancer risk. We documented 3,384 colorectal cancers, 13,006 conventional adenomas, and 11,519 serrated polyps during the follow-up period. Compared to participants without appendectomy, those whoreported appendectomy history were not at higher risk of colorectal (HR [95% CI], 0.92 [0.84-1.00]), colon (0.92 [0.83-1.01]), or rectal (0.85 [0.70-1.03]) cancer. Similarly, appendectomy history was not associated with higher risk of conventional adenoma (OR [95% CI], 1.00 [0.97-1.02]), serrated polyp (0.97 [0.94-1.00]), or high-risk adenoma (0.96 [0.92-1.01]). The meta-analysis showed appendectomy was associated with a higher risk of colorectal cancer within a short time after the procedure (1.68 [1.01-2.81]), while the long-term risk was slightly inverse (0.94 [0.90-0.97]). We found no evidence of an association between appendectomy history and long-term risk of colorectal cancer or its precursors. The observed higher risk of colorectal cancer right after appendectomy in the first few years is likely due to reverse causation.

Validating the accuracy of the Omron HBP-M4500 blood pressure measuring device according to the ISO81060-2:2018+ Amd 1:2020 protocol.

Blood pressure (BP) naturally undergoes fluctuations and variations, particularly during anesthesia administration during surgery, hemodialysis, upper and lower gastrointestinal endoscopy, exercise testing, arterial and venous catheterization, and rehabilitation. These changes in BP may lead to life-threatening events. The performance of the Omron HBP-M4500 device in monitoring blood pressure (BP) in the upper arm was validated according to the International Organization for Standardization (ISO) 81060-2:2018+amendment (Amd) 1:2020 protocol. The device was used to assess 113 participants in the inflation mode, and 107 participants in the deflation mode. All the patients fulfilled the inclusion criteria, including the arm circumference range and systolic and diastolic BP levels, outlined in the protocol. Data validation and analysis were performed according to the manufacturer's instructions. In criterion 1, the mean ± standard deviation (SD) values of the differences between the test device and reference BP were -0.6 ± 5.80/2.8 ± 6.78 mmHg (systolic/diastolic) and -1.0 ± 5.35/3.2 ± 6.52 mmHg for the inflation and deflation modes, respectively. These data fulfilled the ISO81060-2:2018+Amd1:2020 requirements of ⩽ 5 ±⁣⩽ 8 mmHg. In criterion 2, the differences were -0.6 ± 4.44/2.8 ± 6.26 and -1.0 ± 3.84/3.2 ± 6.09 mmHg for the inflation and deflation modes, respectively, fulfilling criterion 2 with SD values of ⩽ 6.91 and ⩽ 6.87 for systolic BP and ⩽ 6.34 and ⩽ 6.14 for diastolic BP in the inflation and deflation modes, respectively. These two criteria were fulfilled in both studies. The Omron HBP-M4500 device, either in inflation or deflation mode, fulfilled the criteria outlined in the ISO protocol. Therefore, this device is valuable for BP measurement in clinical and hospital settings.

A case of hemorrhagic Meckel's diverticulum diagnosed by transabdominal ultrasound.

A 23-year-old man with a history of anemia of unknown cause was referred to our hospital. He had experienced melena three times: at 6months, 10years, and 20years of age. He underwent upper and lower gastrointestinal endoscopy at 10 and 20years of age, and small intestinal capsule endoscopy twice at 20years of age, but the site of bleeding could not be identified. At first, a transabdominal ultrasound was performed for suspected Meckel's diverticulum. A cystic diverticulum was found in the ileum, with an apertural diameter of 5mm and a total size of 4cm. The cyst showed an area of loss of wall stratification, which appeared to be an ulcer scar. Based on these observations, we diagnosed anemia resulting from a hemorrhagic Meckel's diverticulum and performed laparoscopic resection. Postoperative histopathology revealed ectopic gastric mucosa and ulcer formation within the Meckel's diverticulum, which was thought to be the cause of the bleeding. Meckel's diverticulum should be considered in cases of hemorrhage in young patients. A transabdominal ultrasound as a screening test detected a diverticulum with an ulcer scar in the ileum, which led to the identification of the underlying disease.

A Case Report on Peritoneal Tuberculosis in an Immunocompromised Patient

Background: Peritoneal tuberculosis (PTB) is one of the most challenging forms of extra pulmonary tuberculosis. Abdominal TB cases make up above 3% of all extra pulmonary TB as per the Index TB Guidelines. PTB is commonly due to reactivation of latent tuberculosis in the peritoneum. Numerous cases were still misdiagnosed due to nonspecific presentation. The golden standard for diagnosis is laparoscopic biopsy. Presenting signs and symptoms of PTB are unspecific such as ascites, abdominal pain and distension, fever, weight loss, diarrhea/constipation. Peritoneal tuberculosis is a significant cause of ascites in developing countries. The causative agent of peritoneal tuberculosis is Mycobacterium tuberculosis. Case Presentation: In this case study, a 52 year old male had complaints of progressive abdominal distension and fever for 2 weeks. Patient underwent diagnostic paracentesis, upper and lower GI endoscopy, biopsy and gene xpert to confirm peritoneal tuberculosis. Patient with peritoneal TB have gradually progressive abdominal swelling due to ascites and abdominal pain. Conclusion: Peritoneal tuberculosis should be considered in differential diagnosis. Differential diagnosis, especially in the developing countries or under developed countries. This case highlights the easy diagnosis of the condition other than the other case reports.

Peutz-Jeghers syndrome: management for recurrent intussusceptions.

Peutz-Jeghers syndrome (PJS) is an autosomal dominant disorder characterized by hamartomatous gastrointestinal polyps along with the characteristic mucocutaneous freckling. Multiple surgeries for recurrent intussusception in these children may lead to short bowel syndrome. Here we present our experience of management in such patients. From January 2015 to December 2023, we reviewed children of PJS, presented with recurrent intussusceptions. Data were collected regarding presentation, management, and follow-up with attention on management dilemma. Diagnosis of PJS was based on criteria laid by World Health Organization (WHO). A total of nine patients were presented with age ranging from 4 to 17years (median 9years). A total of eighteen laparotomies were performed (7 outside, 11 at our centre). Among 11 laparotomies done at our centre, resection and anastomosis of bowel was done 3 times while 8 times enterotomy and polypectomy was done after reduction of intussusception. Upper and lower gastrointestinal endoscopy (UGIE & LGIE) was done in all cases while intraoperative enteroscopy (IOE) performed when required. Follow-up ranged from 2months to 7years. Children with PJS have a high risk of multiple laparotomies due to polyps' complications. Considering the diffuse involvement of the gut, early decision of surgery and extensive bowel resection should not be done. Conservative treatment must be tried under close observation whenever there is surgical dilemma. The treatment should be directed in the form of limited resection or polypectomy after reduction of intussusception.

A case of laparoscopic lymphadenectomy for adenocarcinoma of unknown primary incidentally detected as a solitary enlarged lymph node along the common hepatic artery

BackgroundEven in cancer of unknown primary (CUP), which is rare clinical condition, solitary anterosuperior lymph node (LN) along the common hepatic artery (No.8a LN) enlargement diagnosed as metastatic adenocarcinoma has never been reported.Case presentationA 68-year-old Japanese male, with a history of early gastric cancer that had been completely treated by endoscopic submucosal dissection 26 years ago, was detected a single enlarged nodule along the common hepatic artery, No.8a LN, incidentally by computed tomography performed for monitoring of interstitial pneumonia. Endoscopic ultra-sound-guided fine needle aspiration revealed that this nodule was adenocarcinoma suggestive of metastasis, but other imaging studies, including upper and lower gastrointestinal endoscopy, positron emission tomography, and ultrasonography did not detect any primary cancer. We have finally diagnosed as the LN metastasis of CUP and performed laparoscopic lymphadenectomy for this tumor. The tumor was approximately 5 cm in size, was in close proximity to the pancreas, and involved part of the right gastric artery and vein. LNs in the No.5 and No.8a areas, including this tumor, were dissected laparoscopically, and radical resection was achieved. The patient had no postoperative complication and was discharged on postoperative day 10. Immunohistopathological findings revealed that the tumor was poorly differentiated adenocarcinoma, and different from the histology of gastric cancer resected 26 years ago, although the tumor was suggestive of gastrointestinal origin. Imaging studies performed 2 and 6 months after discharge also did not reveal a primary site.ConclusionWe reported a case of solitary No.8a LN adenocarcinoma of CUP. For diagnostic and therapeutic purposes, radical resection is recommended for single enlarged intra-abdominal LN of CUP.

Prevention of Musculoskeletal Injuries in Gastrointestinal Endoscopists

Gastroenterologists are exposed daily to musculoskeletal (MSK) stress during upper and lower gastrointestinal endoscopy, both during routine endoscopies and during long, demanding therapeutic procedures. There is evidence that endoscopy-related MSK injuries are becoming more common, particularly in the back, neck, shoulders, elbows, and hands. The aims of this study were to identify the most stressed muscle groups during endoscopy; to measure their activity using surface electromyographical (EMG) sensors; to detect areas of muscle overload; and to identify the number of microbreaks taken in specific muscles. Furthermore, we measured differences in the loading of these muscle groups with and without the use of special support systems such as a belt-like holder. Measurements were performed on 15 subjects (7 experienced endoscopists and 8 non-endoscopists). Due to this small sample size, inside each group, we achieved inconclusive results regarding statistically significant differences in different muscle groups. We increased the sample size by comparing all participants with and without the belt support system, disregarding their endoscopic background. There was a statistically significant difference (p < 0.05) in muscle tension and in levels of microbreaks in the muscles of the left forearm, biceps, and trapezius muscles. No statistically significant difference was observed in the muscle tension and level of microbreaks in the left deltoid muscle (p > 0.05). We hypothesize that the increased level of muscle loading and decreased level of microbreaks in the deltoid muscle are due to different muscle activity and different shoulder movements. Additionally, the deltoid muscle is not connected to the kinetic chain of body posture and stabilization. It is our belief that MSK injuries in gastrointestinal (GI) endoscopy can be prevented with the use of a belt-like support system.

A review of bioinspired locomotion in lower GI endoscopy

Abstract Flexible endoscopy is the gold standard modality for diagnosis and therapeutic intervention of various colorectal conditions. A high bar is currently set for any new technology to replace the current modern colonoscope, but limitations do exist. For a robotic system to gain acceptance, ideally a clear advantage over the established standard needs to be demonstrated. The application of robotic technology inspired by locomotion observed in animals has been demonstrated in many fields including colonoscopy. A myriad of novel concepts has been proposed, which can overcome the anatomical and technical challenges. This review discusses novel and innovative examples of bioinspired robotic locomotion in the colon with a detailed comparison of studies alongside separating the discussion by animal sections of insect, marine and reptile locomotion. We also discuss the current advantages and challenges a bioinspired robot will bring to the colon. Bioinspired robotics in the colon is an exciting field of research with the potential to improve upon current existing high standards of practice in colonoscopy. By addressing areas that the conventional colonoscope is weaker in, studies are demonstrating improvement upon current limitations of standard practice and providing an insight into new methods of engineering and fabrication. Focus on the technological, mechanical and regulatory barriers is key to achieve acceptance into standard practice and will allow the aspiration of a safe, low discomfort, low cost and potentially fully autonomous robotic colonoscope to be not too distant in the future of colonoscopy.

The Fundamentals of Inflammatory Bowel Disease Management in Pregnancy: A Practical Review for the Gastroenterologist.

This narrative review explores the management of Inflammatory Bowel Disease (IBD) during pregnancy, emphasizing its unique challenges to maternal and fetal health, particularly within the Canadian Gastroenterology setting. Seven key principles are highlighted: 1) Preconception counselling, aiming for steroid-free remission confirmed by objective markers, should be routine for female IBD patients. 2) Medication safety, with an eye to future pregnancies, should be addressed upon initiation. Methotrexate and small molecules are contraindicated during pregnancy, while most 5-ASA therapies, biologics, and thiopurines can be continued throughout pregnancy and breastfeeding. Steroids, though not without risks, can be utilized if necessary. 3) Routine monitoring during remission should include serum biomarkers and fecal calprotectin each trimester. 4) Routine endoscopy and imaging are not required, but if indicated, lower GI endoscopy, ultrasound, and unenhanced MRI can be used. Computed tomography and gadolinium enhanced MRI should be avoided. 5) Caesarean section is advised for patients with previous ileal pouch surgeries or active perianal disease, but other patients should follow obstetric indications for delivery. 6) Postpartum period may see more active disease, requiring continued monitoring. Breastfeeding is encouraged, and routine childhood vaccinations are advised, but live vaccinations in the first 6 months warrant detailed review. 7) Complex IBD patients may benefit from a multidisciplinary approach with robust communication between gastroenterologists and obstetricians.

Diagnostic Yield of Small Bowel Videocapsule Endoscopy in Patients with Iron Deficiency Anemia. A Systematic Review and meta-analysis.

Gastrointestinal (GI) bleeding or malabsorption represents the most frequent aetiologies of iron deficiency anemia (IDA). The cause of IDA remains undetermined in ~10% to 20% of patients undergoing upper and lower GI endoscopies. In this scenario, a small bowel examination with videocapsule endoscopy (VCE) is recommended. We performed a systematic review with meta-analysis to evaluate the diagnostic yield of VCE in patients with IDA without overt bleeding, assessing the prevalence of either any lesion or lesions at high potential of bleeding. A computerized literature search was performed using relevant keywords to identify all the pertinent articles published until March 2023. Twelve studies with a total of 1703 IDA patients (Males: 47%; age range: 19-92y) were included in this systematic review. The diagnostic yield of VCE for overall lesions in the small bowel was 61% (95% CI=44-77; 95 CI=97.2-98.1; I2=97.7%). When analyzing only small bowel lesions likely responsible of IDA, the diagnostic yield was 40% (95% CI=27-53; 95% CI=95.3-97; I2=96.3%). VCE plays a relevant role in the diagnostic work-up of patients with IDA without overt bleeding with a satisfactory diagnostic yield.

Clinicoetiological profile of patients with gastrointestinal bleed presenting to a tertiary care hospital in Kumaon Region of Uttarakhand

Background: Gastrointestinal (GI) bleed is a common cause of medical emergency resulting in significant morbidity and mortality. GI bleeding can be classified as upper (bleeding source proximal to the ligament of Treitz) and lower (bleeding source distal to the ligament of Treitz). Aims and Objectives: The present study was aimed to determine the current clinicoetiological profile of GI bleeding in Kumaon Region of Uttarakhand. Materials and Methods: All patients presented with GI bleed (GIB) to outpatient department and Emergency department or developed the GIB during hospitalization are managed in intensive care unit (preferably) and high-dependency unit. Results: Both upper and lower GI endoscopy were twice normal in 2.7% of patients (obscure bleeding). On upper GI endoscopy findings showing esophageal varices (45.83%), gastroesophageal varices (8.33%), isolated gastric varices (8.33%), gastric ulcer (8.33%), duodenal ulcer (6.25%), Mallory-Weiss tear (6.25%), erosive gastritis (6.25%), gastric antral vascular ectasia (4.16%), gastric carcinoma (4.16%), and Dieulafoy’s lesion (2.08%). Upper GIB (UGIB) had more mortality than lower GIB, among UGIB variceal bleed having higher mortality than non-variceal bleeding. Conclusion: Unlike the evidence from the west that peptic ulcer is the most common cause of upper gastrointestinal bleeding, we found varices as the common cause, followed by peptic ulcer and erosive gastritis. Hence, the variable spectrum of the etiology of the GIB seen in our country could represent either a true epidemiological difference or reflect skewed access to health care.

Incidence of persistent SARS-CoV-2 gut infection in patients with a history of COVID-19: Insights from endoscopic examination.

Background and study aims Gut infection is common during acute COVID-19, and persistent SARS-CoV-2 gut infection has been reported months after the initial infection, potentially linked to long-COVID syndrome. This study tested the incidence of persistent gut infection in patients with a history of COVID-19 undergoing endoscopic examination. Patients and methods Endoscopic biopsies were prospectively collected from patients with previous COVID-19 infection undergoing upper or lower gastrointestinal endoscopy (UGE or LGE). Immunohistochemistry was used to detect the presence of persistent SARS-CoV-2 nucleocapsid proteins. Results A total of 166 UGEs and 83 LGE were analyzed. No significant differences were observed between patients with positive and negative immunostaining regarding the number of previous COVID-19 infections, time since the last infection, symptoms, or vaccination status. The incidence of positive immunostaining was significantly higher in UGE biopsies than in LGE biopsies (37.34% vs. 16.87%, P =0.002). Smokers showed a significantly higher incidence of positive immunostaining in the overall cohort and UGE and LGE subgroups ( P <0.001). Diabetic patients exhibited a significantly higher incidence in the overall cohort ( P =0.002) and UGE subgroup ( P =0.022), with a similar trend observed in the LGE subgroup ( P =0.055). Conclusions Gut mucosal tissues can act as a long-term reservoir for SARS-CoV-2, retaining viral particles for months following the primary COVID-19 infection. Smokers and individuals with diabetes may be at an increased risk of persistent viral gut infection. These findings provide insights into the dynamics of SARS-CoV-2 infection in the gut and have implications for further research.

Association of various symptoms and histological alterations in the diagnosis of pediatric ulcerative colitis.

Ulcerative colitis (UC) is a chronic, relapsing inflammatory bowel disease (IBD) of the colon. Its presentation is varied, with the main symptoms being mucosanguineous diarrhea, abdominal pain, and weight loss. However, the diagnostic utility of these symptoms in pediatric populations is controversial. This study evaluates the clinicopathological association of different symptoms in UC through an analytical study of patients under 15 years of age who underwent upper and lower gastrointestinal endoscopy at a pediatric hospital between 2015 and 2022 for suspected IBD.

Training in basic gastrointestinal endoscopic procedures: a European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement.

This ESGE Position Statement provides structured and evidence-based guidance on the essential requirements and processes involved in training in basic gastrointestinal (GI) endoscopic procedures. The document outlines definitions; competencies required, and means to their assessment and maintenance; the structure and requirements of training programs; patient safety and medicolegal issues. 1: ESGE and ESGENA define basic endoscopic procedures as those procedures that are commonly indicated, generally accessible, and expected to be mastered (technically and cognitively) by the end of any core training program in gastrointestinal endoscopy. 2: ESGE and ESGENA consider the following as basic endoscopic procedures: diagnostic upper and lower GI endoscopy, as well as a limited range of interventions such as: tissue acquisition via cold biopsy forceps, polypectomy for lesions ≤ 10 mm, hemostasis techniques, enteral feeding tube placement, foreign body retrieval, dilation of simple esophageal strictures, and India ink tattooing of lesion location. 3: ESGE and ESGENA recommend that training in GI endoscopy should be subject to stringent formal requirements that ensure all ESGE key performance indicators (KPIs) are met. 4: Training in basic endoscopic procedures is a complex process and includes the development and acquisition of cognitive, technical/motor, and integrative skills. Therefore, ESGE and ESGENA recommend the use of validated tools to track the development of skills and assess competence. 5: ESGE and ESGENA recommend incorporating a multimodal approach to evaluating competence in basic GI endoscopic procedures, including procedural thresholds and the measurement and documentation of established ESGE KPIs. 7: ESGE and ESGENA recommend the continuous monitoring of ESGE KPIs during GI endoscopy training to ensure the trainee's maintenance of competence. 9: ESGE and ESGENA recommend that GI endoscopy training units fulfil the ESGE KPIs for endoscopy units and, furthermore, be capable of providing the dedicated personnel, infrastructure, and sufficient case volume required for successful training within a structured training program. 10: ESGE and ESGENA recommend that trainers in basic GI endoscopic procedures should be endoscopists with formal educational training in the teaching of endoscopy, which allows them to successfully and safely teach trainees.

Management of collagenous gastritis in children: Case series and literature review.

Collagenous gastritis (CG) is a rare histopathological finding on gastric biopsies in children. It is associated with abdominal pain and iron deficiency anemia, usually not respondent to oral iron supplements. The aim of this study was to describe our experience in the management of pediatric patients with CG. Moreover, we propose to review the literature on this topic.We retrospectively reviewed all pediatric patients diagnosed with CG at our centre from January 2014 to January 2019.Three pediatric patients (2 F, mean age 12.3) were diagnosed with CG during the study period. Two presented with moderate and one with severe anemia. Symptoms were abdominal pain, asthenia and headache in two and asthenia and abdominal pain in one. All underwent upper and lower gastrointestinalendoscopy. All were firstly started with oral iron supplements with no benefit, principally due to poor compliance secondary to the worsening of the epigastric pain and proton pump inhibitor resistance. Therefore, they underwent ferric carboxymaltose (FCM) infusion with good clinical and laboratory response. Patients received a mean of two infusions/year, with stable hemoglobin levels and no adverse outcomes.Our review failed to identify a consistent response to specific treatments. Considering the apparent benign nature of the disease, symptomatic and supportive treatments are advisable. Iron deficiency anemia is largely present and therapy with oral iron supplements is not always successful. In our study, FCM infusion was effective in increasing the key blood indices in patients who poorly tolerated oral supplements.

International Guideline for Idiopathic Inflammatory Myopathy-Associated Cancer Screening: an International Myositis Assessment and Clinical StudiesGroup (IMACS)initiative.

Adult-onset idiopathic inflammatory myopathy (IIM) is associated with an increased cancer risk within the 3 years preceding and following IIM onset. Evidence- and consensus-based recommendations for IIM-associated cancer screening can potentially improve outcomes. This International Guideline for IIM-Associated Cancer Screening provides recommendations addressing IIM-associated cancer risk stratification, cancer screening modalities and screening frequency. The international Expert Group formed a total of 18 recommendations via a modified Delphi approach using a series of online surveys. First, the recommendations enable an individual patient's IIM-associated cancer risk to be stratified into standard, moderate or high risk according to the IIM subtype, autoantibody status and clinical features. Second, the recommendations outline a 'basic' screening panel (including chest radiography and preliminary laboratory tests) and an 'enhanced' screening panel (including CT and tumour markers). Third, the recommendations advise on the timing and frequency of screening via basic and enhanced panels, according to risk status. The recommendations also advise consideration of upper or lower gastrointestinal endoscopy, nasoendoscopy and 18F-FDG PET-CT scanning in specific patient populations. These recommendations are aimed at facilitating earlier IIM-associated cancer detection, especially in those who are at a high risk, thus potentially improving outcomes, including survival.

Assessing the Correlation between Helicobacter Pylori Infection and Increased Incidence of Colorectal Cancer, Gastric Atrophy, and Intestinal Metaplasia

Aim: Our retrospective study was designed to explore the potential link between Helicobacter pylori (H. pylori) infection and the occurrence of colorectal cancer (CRC), gastric atrophy, and intestinal metaplasia.&#x0D; Material and Methods: We assembled two groups of 150 patients each, categorized based on their endoscopic biopsy results for H. pylori - one group testing positive (study group), the other negative (control group). All subjects underwent upper and lower gastrointestinal endoscopies, and we assessed their endoscopic gastric biopsy results as well as any indications of colorectal malignancies.&#x0D; Results: Our investigation established a noteworthy association between the presence of H. pylori infection and the incidences of CRC, gastric atrophy, and intestinal metaplasia (p

Post-Operative Cognitive Dysfunction in Elderly Patients Receiving Propofol Sedation for Gastrointestinal Endoscopies: An Observational Study Utilizing Processed Electroencephalography.

Propofol sedation is commonly administered during gastrointestinal (GI) procedures. The Patient State Index (PSI) is a processed electroencephalography (EEG) parameter obtained with the SedLine® Sedation Monitoring system (Masimo Corporation, Irvine, CA). When used to objectively assess the patient's level of consciousness, PSI may provide a more effective, safer titration of sedation during GI procedures. We hypothesize that having more or longer episodes of deep sedation as assessed by PSI (i.e., PSI<26) would correlate with developing new-onset or worsening post-operative cognitive dysfunction (POCD). This was a pragmatic, double-blinded observational study of 400 patients aged ≥65 years undergoing upper GI endoscopy, lower GI endoscopy, or a combined procedure utilizing propofol sedation at a tertiary-care [A1]academic medical center. The patients were monitored with the SedLine®Brain Function Monitor, software version 2 (Masimo Corporation, Irvine, CA), throughout the case, starting at baseline (i.e., before administration of propofol) and stopping at case end. We assessed the subjects' cognitive function via an in-person interview at baseline (pre-procedure) and telephone interviews at 1, 7 (±1), and 90 days after study enrollment. Cognitive function was assessed by administering the short blessed test (SBT), which is a validated brief cognitive screening appropriate for in-person and telephone administration. The correlations between the change in SBT score and the pre-defined parameters of PSI were not significant (allp-values >5%). There was a significant drop in SBT scores on day seven. Higher age was also significantly associated with a drop in SBT from baseline. Deep sedation, as evidenced by the number of times PSI was lower than 26, was not predictive of the change in SBT, nor was gender, total propofol dose, or vasoactive drug use during the procedure. The observed incidence of POCD after GI procedures with propofol sedation was low (1.3% at seven days and 2.95% at 90 days) and lower than at the baseline. Age was associated with a greater average decline in SBT score, although the absolute change was small (-0.067 per year of age increase). Deeper sedation, as documented by the PSI score, was not associated with a change in POCD measured with the SBT.