Performance Of Endoscopic Procedures Research Articles

Safety of endoscopy in patients undergoing treatments with antiangiogenic agents: A 5-year retrospective review.

BACKGROUNDAntiangiogenic agents (AAs) are increasingly used to treat malignant tumors and have been associated with gastrointestinal (GI) bleeding and perforation. Elective surgeries and endoscopy are recommended to be delayed for 31 d until after AAs treatment. Data regarding the safety of endoscopy while on antiangiogenic agents is extremely limited. No guidelines are in place to address the concern about withholding these anti-angiogenic drugs. AIMTo evaluate the risks of endoscopy in patients on antiangiogenic agents from 2015 to 2020 at our institution. METHODSThis is a single centered retrospective study approved by the institutional review board statement of the institution. Patients that underwent endoscopy within 28 d of antiangiogenic agents’ treatment were included in the study. Primary outcome of interest was death, and secondary outcomes included perforation and GI bleeding. Data were analyzed utilizing descriptive statistics. Fifty-nine patients were included in the final analysis and a total of eighty-five procedures were performed that were characterized as low risk and high risk. RESULTSAmong the 59 patients a total of 85 endoscopic procedures were performed with 24 (28.2%) categorized as high-risk and 61 (71.8%) procedures as low-risk. Of the total number of patients, (50%) were on bevacizumab and the rest were on imatinib (11.7%), lenvatinib (6.7%) and, ramucirumab (5%). The average duration between administration of AAs and the performance of endoscopic procedures was 9.9 d. No procedure-related adverse events were noted among our study population. We did observe two deaths with one patient, on lenvatinib for metastatic hepatocellular carcinoma, who had persistent bleeding despite esophageal variceal banding and died 4 d later from hemorrhagic shock. Another patient was diagnosed with acute myeloid leukemia died 24 d after an esophagogastroduodenoscopy with biopsy after transition to comfort care.CONCLUSIONAs per this single center retrospective study, the rate of endoscopic procedure-related adverse events and death within 28 d of AA administration appears to be low.

Characteristics of the endoscopic procedures performed in a hybrid tertiary-level hospital during the first year of the COVID-19 pandemic.

The COVID-19 pandemic caused many changes in gastrointestinal endoscopy units. To describe the changes that occurred in a gastrointestinal endoscopy unit of a hybrid hospital during the COVID-19 pandemic. We performed a retrospective study of endoscopies performed in the first year of the COVID-19 pandemic. We collected and described the data of interest to the study, which is presented with numbers and percentages or measures of central tendency and dispersion as appropriate. Fisher's exact test or the χ2 test were used as appropriate. A total of 507 procedures were performed. There was a 92.5% reduction in the performance of endoscopic procedures. In all, 77 (15%) procedures were performed on patients with COVID-19. The most frequent procedures were esophagogastroduodenoscopy (EGD), colonoscopy, and endoscopic retrograde cholangiopancreatography (ERCP). The main indications were gastrointestinal bleeding, placement of enteral accesses, and alterations in the biliary and pancreatic ducts. Of these, 37 (48%) were therapeutic. Patients with COVID-19 were more susceptible to the development of complications. During the first year of the COVID-19 pandemic, the number of endoscopic procedures performed decreased significantly. The procedures most often required were EGD, colonoscopy, and ERCP, mainly indicated by gastrointestinal bleeding, placement of enteral accesses, and alterations of the bile and pancreatic ducts.

Changes in Policy and Endoscopic Procedures during the 2019 Coronavirus Disease Outbreak: A Single Center Experience.

Background/AimsThe coronavirus disease-19 (COVID-19) pandemic forced endoscopy units to enact major changes on daily practice and policy. The Chaim Sheba Medical Center is a tertiary referral center located in the center of Israel, and serves cities with high infection rates. Our aim was to review the policies enacted during this outbreak and study their influence on the performance of endoscopic procedures. MethodsFollowing the revision of work protocols, personnel were divided into two permanent and physically separate working groups and screening procedures were rescheduled. Relevant data including the number of endoscopic examinations, type of procedure performed, and patient referrals and indications were taken from a computerized database and evaluated. The study included data for January–March 2018–2020, and a comparison among the data from each year was performed. ResultsAs of March 2020, the total number of endoscopic examinations performed reduced by 44% (p<0.0001) as compared to previous years, gastroscopy examinations reduced by 39% (p=0.02), and lower endoscopy procedures reduced by 57% (p<0.0001). Meanwhile, the number of advanced endoscopic procedures performed remained consistent with previous years. The indications for performance of gastroscopy and lower endoscopy were different in March 2020, while these remained unchanged for advanced endoscopic procedures. ConclusionsThe current policy appears to serve both our initial goals: protecting personnel and patients’ safety and minimizing potential damage from delayed endoscopic procedures. A longer term follow-up study is needed in order to fully analyze our results.

Guidelines for safety in the gastrointestinal endoscopy unit

In 2009, the Centers for Medicare and Medicaid Services (CMS) Conditions for Coverage eliminated the distinction between a sterile operating room and a non-sterile procedure room. Hence, GI endoscopy units are now held to the same standards as sterile operating rooms by CMS1 without evidence demonstrating that safety or clinical outcomes in endoscopy are thereby improved. Although the ASGE has previously published guidelines on staffing, sedation, infection control, and endoscope reprocessing for endoscopic procedures (Multisociety guideline on reprocessing flexible gastrointestinal endoscopes: 2011; Infection control during GI endoscopy; Minimum staffing requirements for the performance of GI endoscopy; Multisociety sedation curriculum for gastrointestinal endoscopy)2, 3, 4, 5 the purpose of this document is to present recommendations for endoscopy units in implementing and prioritizing safety efforts and to provide an endoscopy-specific guideline by which to evaluate endoscopy units. As a general principle, requirements for safety ought to be rooted in evidence that demonstrates a benefit in outcomes. Where data is absent, these requirements may be derived from experts with experience in the safe delivery of care in the GI endoscopy setting. Additionally, consideration should be given to the promotion of efficient care and cost containment with avoidance of requirements unsupported by evidence that then contribute to rising healthcare costs. Over the past 2 years, surveyors have called into question accepted practices at many accredited endoscopy units seeking re-accreditation. Many of these issues relate to the Ambulatory Surgical Center (ASC) Conditions for Coverage set forth by CMS and the lack of distinction between the sterile operating room and the endoscopy setting. The following is a summary of issues that have been faced by endoscopy units throughout the country along with ASGE’s position and accompanying rationale. Issue: Structural requirements for 40-inch doors and room sizes >400 square feet required of sterile operating rooms. Position: Standard 36-inch doors, if they accommodate patient transport mechanisms, and room sizes 180 square feet are adequate and safe for endoscopy units because they do not use the same large equipment or number of staff as in the operating room.6 Issue: Requirement for a written policy on traffic patterns in the endoscopy unit. Position: The unit should define low-risk exposure and high-risk exposure areas and activities within the endoscopy unit, and describe the attire and personal protective equipment that should be worn in each area. Endoscopy staff can move freely throughout the unit provided that there is appropriate use and changing of personal protective equipment. Issue: Requirement for endoscopy personnel to don full sterile operating room personal protective equipment including new scrubs, hair covers and booties. Position: It is recommended that staff directly engaged in GI endoscopy or in processes where splash or contamination could occur should wear gloves, face/eye shields, and an impervious gown. Units should develop policies that are consistent with OSHA and state-mandated recommendations for wearing face/eye shields or masks.7 Scrubs or other attire may be worn from home because endoscopy is not a sterile procedure. Likewise, there is no need for hair covers or booties. Staff must remove and appropriately discard used PPE before leaving the procedure area. Issue: Supervision of moderate sedation. Position: Moderate sedation may be administered safely under the supervision of a non-anesthesia physician who is credentialed and privileged to do so. Issue: Role of capnography. Position: There is inadequate data to support the routine use of capnography where moderate sedation is the target. Issue: Requirement that 2 nurses (one monitoring, one circulating) are present when moderate sedation is performed. Position: When moderate sedation is the target, a nurse should monitor the patient and can perform interruptible tasks. If more technical assistance is required, a second assistant (nurse, licensed practical nurse, or unlicensed assistive personnel) should be available to join the care team. Issues: Staffing requirements when sedation and monitoring is provided by anesthesia personnel. Position: When sedation and monitoring is provided by anesthesia personnel, a single additional staff person (nurse, licensed practical nurse, or unlicensed assistive personnel) is sufficient to assist with technical aspects of the procedure. Issue: Technical capabilities of technicians. Position: Unlicensed technicians, who have received initial orientation and ongoing training, and are deemed competent by their unit, can assist with and participate in tissue acquisition during the endoscopic procedure, including but not limited to the opening and closing of forceps, snares, and other accessories.

Évaluation de la formation à l’endoscopie digestive sur modèle animal « EASIE »

Aim Training in the performance of endoscopic procedures is very heterogeneous even today from a center to other in spite of different training methods available. The aim of the study is to assess the effectiveness of “EASIE” models on getting endoscopic skills. Materials and methods: Our study is a forward-looking study randomized in two arms, aiming at comparing the training of diagnosis endoscopy by classic way on endoscopic suite versus that on animal model “EASIE”, through training sessions of two groups of physicians, novices in endoscopy.

Safety of Endoscopy After Myocardial Infarction Based on Cardiovascular Risk Categories

To establish the safety of endoscopic procedures performed in patients with recent myocardial infarction (MI) based upon specific cardiac risk categories. There are no specific guidelines that dictate when to perform endoscopy in patients after recent MI, as this population may be at increased risk for cardiopulmonary complications at the time of endoscopy. Retrospective analysis of data collected over 48 months on 135 patients who experienced a MI and within the next 30 days had an endoscopic procedure performed. Data on chronology of complications and certain cardiac risk categories were collected and analyzed. There was early termination of endoscopic procedures for a major cardiopulmonary complication in 2 of 135 patients (1.5%). The complications occurred on hospital day 0 postMI. Performance of endoscopic procedures on the day of the MI was found to be a risk factor for a procedure-related complication (P=0.02). ST segment elevation myocardial infarction was seen in 19 patients (16.0%), severely depressed ejection fraction in 30 patients (22.2%), and troponin-I peak greater than 1.6 ng/mL in 96 patients (71.0%). No statistically significant increased risk of endoscopy was found in these subsets of patients (P=0.99). Endoscopic procedures can be safely performed early post-MI without imparting a significant cardiopulmonary risk. Timing of endoscopy increases risk of complications, but evidence of significant recent cardiac damage as demonstrated by ST segment elevation, depressed left ventricular ejection fraction, or troponin-I peak greater than 1.6 ng/mL does not increase risk of cardiopulmonary complication.

Endoscopic procedures and diagnoses are not influenced by seasonal variations

The occurrences of various GI diseases are thought to be influenced by seasonal variations. The present study was done to test the hypothesis that seasonal variations in endoscopic diagnoses reflect underlying patterns in the performance of endoscopic procedures. The Clinical Outcomes Research Initiative (CORI) uses a computerized endoscopic report generator to collect endoscopic data from 73 diverse practice sites throughout the United States. We used the CORI database to analyze the date-specific occurrence of EGD and colonoscopy, as well as the endoscopic diagnoses of gastric ulcer, duodenal ulcer, and colorectal cancer. Time trends are analyzed by autocorrelation and by linear and nonlinear regression. Between January 2000 and December 2003, the number of EGDs and colonoscopies increased 2.5- and 4.1-fold, respectively. The rate of duodenal ulcer fell from 21.2 (15.6-27.5) to 19.0 (15.8-22.8) per 1000 EGDs. The rate of gastric ulcer fell from 42.6 (33.3-50.1) to 33.4 (29.5-38.7) per 1000 EGDs. The rate of colorectal cancer fell from 109.9 (98.3-122.8) to 72.2 (67.4-77.2) per 1000 colonoscopies. The time trends of neither endoscopic procedures nor endoscopic diagnoses revealed any seasonal variation or other cyclic pattern. The performance of endoscopic procedures is unaffected by any seasonal variation.

The changing landscape of practice patterns regarding unsedated endoscopy and propofol use: a national Web survey

Lower reimbursements for endoscopic procedures and increasing demand for screening endoscopy over the past decade have spurred efforts to increase efficiency in the performance of endoscopic procedures. Two dichotomous approaches have emerged: (1) unsedated endoscopy and (2) propofol sedation. The aim was to determine national practice patterns of unsedated endoscopy and propofol sedation, and to assess endoscopists' attitudes toward unsedated screening with an electronic survey. A short survey was developed and then was converted to a Web-based format. All national members of the American Society for Gastrointestinal Endoscopy (ASGE) were invited via electronic mail (e-mail) to participate. Survey data were collected electronically. Two e-mails elicited responses to the Web survey from 18% (724) of national ASGE members contacted, within 2 weeks. Of the respondents, 45% do not routinely offer unsedated EGD and colonoscopy, and only 15% of those respondents plan to incorporate unsedated endoscopy into their practice in the next year. Of the 55% who currently perform unsedated endoscopy, 85% do no more than 25 unsedated procedures per year. Lack of patient acceptance was the most common reason cited for not offering unsedated endoscopy. Most endoscopists felt that the availability of unsedated esophagoscopy or colonoscopy would not significantly increase screening for Barrett's esophagus or colonic polyps/colorectal cancer, respectively. Routine use of propofol sedation for EGD, colonoscopy, and ERCP/EUS was reported by 19%, 22%, and 19%, respectively. Community practitioners were more likely to use propofol than those at academic centers (p < 0.0002 for all). Of those not currently using propofol, 43% plan to incorporate it into their practice within the next year. Over 70% of respondents would themselves choose to be sedated for routine endoscopic procedures. Electronic surveys allow for rapid distribution and data collection but suffer from a limited response rate. The survey suggests that unsedated endoscopy has limited acceptance in the United States, and, without a major intervention that affects endoscopists' attitudes, its use is not likely to increase significantly. Unsedated endoscopy will not have a great impact on endoscopic screening. In contrast, propofol sedation has already gained acceptance in the community, and the routine use of propofol in endoscopy units will likely increase in the future.

The Impact of 3-D Video Endoscopy on Binocular Perception and Visually Guided Manipulation

Monocular video endoscopic systems are established in the clinical routine of surgical endoscopy. The introduction of 3-D video systems could improve visualisation of the intracorporal operating site because of the stereoscopic depth information. The goal of our investigations has been to quantify the influence of this visualisation technology on visual perception, on visually controlled endoscopic manipulations, and on the intraoperative performance, including ergonomic and psychophysical aspects. These results are used to define guidelines for improvement and for the integration of such systems into clinical routine so as to achieve optimal support of the medical team. The comparison of 2-D and 3-D video endoscopic systems showed a general improvement in the performance of endoscopic procedures. However, 30% – 50% of the users had perceptive problems with 3-D endoscopy. To study the problems quantitatively, we compared the case of stereoscopic visualisation with the real situation of direct view onto the specific objects. The users with problems had insufficient binocular depth perception of stereoscopic images for visual discrimination tasks, although their depth perception of real objects was good. Analysis of their eye movements showed significant differences compared with those of users with good binocular depth perception of stereo images. In particular, there were differences in the relation of vergence movements and accommodation. When we compared visually guided manipulations under stereoscopic video sight and direct view, we found the overall manipulative performance of all users to be the same, but the users with problems showed a lower performance in general. The experimental design and the results are discussed in detail.