Society Of Digestive Endoscopy Research Articles

Sedation and monitoring for gastrointestinal endoscopy: A nationwide web survey in Italy

Background Best strategy of sedation/analgesia in gastrointestinal (GI) endoscopy is still debated. Aims of the study To evaluate sedation and monitoring practice among Italian gastroenterologists and to assess their opinion about non-anaesthesiologist propofol administration. Methods A 19-item survey was mailed to all 1192 members of the Italian Society of Digestive Endoscopy (SIED). For each respondent were recorded demographic data, medical specialty, years of practise and practise setting. Results A total of 494 SIED members returned questionnaires, representing a response rate of 41.4%. The most employed sedation pattern was benzodiazepines for oesophagogastroduodenoscopies (EGDS) in 50.8% of procedures, benzodiazepines plus opioids for colonoscopy and enteroscopy in 39.5% and 35.3% of procedures, respectively, propofol for endoscopic retrograde colangiopancreatography (ERCP) and endoscopic ultrasound (EUS) in 42.3% and 35.6% of procedures, respectively. With regard to propofol use, 66% respondents stated that propofol was exclusively administered by anaesthesiologists. However, 76.9% respondents would consider non-anaesthesiologist propofol administration after appropriate training. Pulse oximetry is the most employed system for procedural monitoring. Supplemental O 2 is routinely administered by 39.3% respondents. Conclusions Use of sedation has become a standard practise during GI endoscopy in Italy. Pattern varies for each type of procedure. Pulse oximetry is the most employed system of monitoring. Administration of propofol is still directed by anaesthesiologists.

Administration of conscious sedation by a neuroradiology team during percutaneous vertebroplasty and spinal biopsy procedures

Percutaneous vertebroplasty, i.e. the consolidation of a vertebral body with polymethylmethacrylate, is a safe and effective image-guided technique increasingly used as a treatment option for different pathologic conditions, mainly vertebral body fractures secondary to osteoporosis, hemangiomas and metastasis. The procedure, although minimally invasive, could be painful and is better tolerated if a conscious sedation regimen is added to local anesthesia. An anesthesiologist usually performs the sedo/analgesia, but frequently, he is not available in our angiography unit, so we have begun to perform the sedo/analgesia ourselves following an analogous situation that physicians of the Digestive Endoscopic Unit of our institution experienced some years ago. Using the guidelines developed by Italian Society of Digestive Endoscopy, Italian Society of Anesthesia, Analgesia, Reanimation and Intensive Therapy and National Association of Endoscopy Operators and Technicians as a starting point, we then adapted their protocol to our vertebroplasty requirements, after an adequate training period carried out by our anesthesiologist staff. The results have been very satisfactory, greatly appreciated by patients for good pain control; we have never registered any adverse effects nor have we had any particular problems in controlling sedation or monitoring procedures. In our experience, we have observed that conscious sedation can be safely administered by neuroradiologists during spinal procedures, provided that some basic rules are respected regarding patient selection and monitoring, personnel training and angiography equipment.

Long-term follow-up after biliary stent placement for postcholecystectomy bile duct strictures: a multicenter study

Endoscopic stenting is a recognized treatment of postcholecystectomy biliary strictures. Large multicenter reports of its long-term efficacy are lacking. Our aim was to analyze the long-term outcomes after stenting in this patient population, based on a large experience from several centers in France. Members of the French Society of Digestive Endoscopy were asked to identify patients treated for a common bile duct postcholecystectomy stricture. Patients with successful stenting and follow-up after removal of stent(s) were subsequently included and analyzed. Main outcome measures were long-term success of endoscopic stenting and related predictors for recurrence (after one stenting period) or failure (at the end of follow-up). A total of 96 patients were eligible for inclusion. The mean number of stents inserted at the same time was 1.9±0.89 (range 1-4). Stent-related morbidity was 22.9% (n=22). The median duration of stenting was 12 months (range 2-96 months). After a mean follow-up of 6.4±3.8 years (range 0-20.3 years) the overall success rate was 66.7% (n=64) after one period of stenting and 82.3% (n=79) after additional treatments. The mean time to recurrence was 19.7±36.6 months. The most significant independent predictor of both recurrence and failure was a pathological cholangiography at the time of stent removal. Endoscopic stenting helps to avoid surgery in more than 80% of patients bearing postcholecystectomy common bile duct strictures. However, a persistent anomaly on cholangiography at the time of stent removal is a strong predictor of recurrence and may lead to consideration of surgery.

ESGE Newsletter

The ESGE sponsored Endoscopy Workshop took place in Yaroslavl (Russia) on July the 1st and 2nd, 2010. This was the first time that an official ESGE activity was organized in Russia, and it could not have been more successful. The event had been very well prepared in all the details by the local organizing committee chaired by Dr Serghey Kashin with the support of the local administrative powers, both political and academic. On the other hand, ESGE and ESGENA together with the official technical sponsors Olympus and Cook Endoscopy gave, once again, the proof of a perfect symbiotic organizing effort leading to a great success. More than 350 doctors coming from all over Russia, but also from several surrounding countries attended the meeting, together with more than 60 nurses. The program, as usual, comprehended both state of the art lectures and live demonstrations broadcasted to the beautiful Auditorium of the House of the Government of the Yaroslavl Region from the state-of-the-art equipped Endoscopy Unit of the Oncological Centre of Yaroslavl, directed by Dr. Kashin. Six ESGE experts, Guido Costamagna (Italy) (who was also Co-Director of the Workshop together with Boris Poddubny, President of the Russian Society of Digestive Endoscopy), Hans-Dieter Allescher (Germany), Thierry Ponchon (France), Olivier Le Moine (Belgium), Stefan Seewald (Switzerland) and Hiroshi Kashida (Japan) with the excellent assistance of 4 ESGENA experts (Michael Ortmann – Switzerland, Sylvia Lahey – The Netherlands, Jadranka Brljak – Croatia, and Herta Pomper – Austria) and the indispensable help of Russian doctors and nurses were able to treat more than twenty five patients during the live sessions. Several endoscopic diagnostic and therapeutic techniques were demonstrated: EMR and ESD and ploypectomy in the upper and lower GI tract, single-balloon enteroscopy, EUS-guided FNA and pancreatic cyst drainage, esophageal stent placement, biliary stones removal, stenting of the bile duct, etc. The technical support of Olympus and Cook Endoscopy has been, as usual, of paramount importance for the smooth progress of the program. Parallel to the main session, there were special sessions dedicated to nurses, both theoretical and practical (hands-on). In particular, the hands-on training which was very much appreciated by the attendees, has been realized thanks to the enormous effort put in this activity by the team of Olympus Europe.

SPED Newsletter

The Portuguese Society of Digestive Endoscopy (SPED) has been intimately involved in gastroenterology and endoscopy education since its early days, 30 years ago. Working side by side with her sister gastroenterology society, SPED has been setting the stage for the creation of a framework upon which training objectives, teaching skills, and clinical evaluation could be readily achieved and ensured. Furthermore, with the growing challenges in ensuring and assessing quality that endoscopists and other health care providers have been facing in the last years, many concerns have been devoted to the definition of basic components of physician's training and education, not only in endoscopic skills but also in terms of core knowledge and clinical experience. We held recently an International Symposium on Quality in Endoscopy: From Training to Practice, specifically addressing these topics, in the sequence of which a broad document was generated to establish quality indicators and practice guidelines for Portuguese endoscopists.

Appropriateness Guidelines and Predictive Rules to Select Patients for Upper Endoscopy: A Nationwide, Multicenter Study On Behalf of the Italian Society of Digestive Endoscopy (SIED)

Background: To efficiently select patients referred for upper endoscopy (UE) is of major importance. Methods: SIED designed a nationwide, multicentre, prospective study enrolling patients consecutively referred to UE in a period of 1 month. Before UE, the endoscopist assessed the appropriateness of the referral with ASGE guidelines, also collecting clinical and demographic variables. Outcome of the study was the new diagnosis of malignancy at UE. Sensitivity and specificity of five different options were compared: 1) ASGE appropriateness guidelines 2) Age and alarm features (>45 yrs. or alarm feature vs. <45 yrs. without alarm features) 3) Only alarm features 4) Stepwise multiple logistic regression analysis 5) Artificial neural networks (ANN) models. Results: 7,193 patients were enrolled in 57 centres and 215 new cases of gastro-oesophageal cancers were detected. As shown in Figure 1, sensitivity and specificity of ASGE guidelines for cancer (97.1%/20.4%; LR+: 1.2; LR-: 0.14) were very similar to those of age and alarm features (97.2/22.7%; LR+: 1.2; LR-: 0.12). Only alarm features without age criteria were highly specific (73%), but less sensitive (75%). The overall accuracy of only alarm features (74%) was similar to those of multivariate model (77%) and ANN models (79%). Conclusions: A simple predictive rule based on age and alarm feature is equally effective to the more complex ASGE guidelines in excluding the risk of gastro-oesophageal cancer, and it could be used to select those patients who need UE. The simple presence of alarm features (i.e. without the age criteria) improves the specificity and it could be used to prioritize the waiting list.

Portuguese Society of Digestive Endoscopy: Prizes for best research work at national meeting

Portuguese Society of Digestive Endoscopy: Prizes for best research work at national meeting

Portuguese Society of Digestive Endoscopy: publications

The Portuguese Society of Digestive Endoscopy (SPED), set up in 1979, is a scientific society for doctors and other professionals working with or interested in Digestive Endoscopy. Its objectives include promoting the development of Digestive Endoscopy at the service of health in Portugal and the dissemination of knowledge and research in this field. SPED also seeks to further national and international exchanges between professionals, implement standards of training and practice in Digestive Endoscopy, and promote educational initiatives for doctors and other technicians.

Portuguese Society of Digestive Endoscopy: recommendations for endoscopic mucosal resection

Endoscopic mucosectomy or mucosal resection (EMR) is the resection through an endoscopic procedure of a piece of digestive wall including mucosal layer, muscularis mucosae and partially or completely the submucosal layer.

Appropriateness of upper-GI endoscopy: an Italian survey on behalf of the Italian Society of Digestive Endoscopy

Appropriateness of upper-GI endoscopy: an Italian survey on behalf of the Italian Society of Digestive Endoscopy

Digestive endoscopies are not a risk factor for transmission of virus C

Journal of Viral HepatitisVolume 15, Issue 2 p. 155-155 Digestive endoscopies are not a risk factor for transmission of virus C Ch. Boustiere, Ch. Boustiere French Society of Digestive Endoscopy (SFED)Search for more papers by this authorB. Napoleon, B. Napoleon French Society of Digestive Endoscopy (SFED)Search for more papers by this authorP. Delasalle, P. Delasalle Hepatology Commission of Gastroenterology Reflexion Group (CREGG)Search for more papers by this authorP. Coulom, P. Coulom Hepatology Commission of Gastroenterology Reflexion Group (CREGG)Search for more papers by this author Ch. Boustiere, Ch. Boustiere French Society of Digestive Endoscopy (SFED)Search for more papers by this authorB. Napoleon, B. Napoleon French Society of Digestive Endoscopy (SFED)Search for more papers by this authorP. Delasalle, P. Delasalle Hepatology Commission of Gastroenterology Reflexion Group (CREGG)Search for more papers by this authorP. Coulom, P. Coulom Hepatology Commission of Gastroenterology Reflexion Group (CREGG)Search for more papers by this author First published: 05 December 2007 https://doi.org/10.1111/j.1365-2893.2007.00882.xCitations: 1 Ch. Boustiere, Gastroenterology Unit, Saint Joseph Hospital, 13825 Marseille, France. E-mail: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume15, Issue2February 2008Pages 155-155 RelatedInformation

French Society of Digestive Endoscopy (SFED) Guideline

The clinical practice guidelines on the indications for colonoscopy in the diagnosis of neoplasia, published in 1996 by the French National Agency for Accreditation and Evaluation in Healthcare (ANAES, recently renamed “Haute Autorité de Santé” or HAS) [1], were updated in 2004. These guidelines were produced using the three-step method employed by ANAES-HAS: (i) a critical appraisal of the literature, (ii) three meetings of a multidisciplinary working group, and (iii) comments on the draft guidelines obtained from 45 peer reviewers. The guidelines are available in both French and English on the HAS website (www.has.fr) [2]. The report outlining the supportive arguments on which the guidelines are based is available in French only. The guidelines are summarized here in [Table 1].

Current practice compared with the international guidelines: endoscopic surveillance of Barrett’s esophagus

To describe the current practice for the surveillance of patients with Barrett's esophagus, to compare this practice with the national guidelines published by the French Society of Digestive Endoscopy in 1998 and to identify the factors associated with the compliance to guidelines. To determine the attitudes of French hepatogastroenterologists to screening for Barrett's oesophagus, a postal anonymous questionnaire survey was undertaken. It was sent to 246 hepatogastroenterologists in the Rhone-Alpes area. We defined eight criteria allowed to assess the conformity of practices with the guidelines. We created three topics composed of several criterion. The topics analysed were 'Biopsies', 'Surveillance' and the diagnosis of high grade dysplasia. We studied the factors which could be associated with the compliance with the guidelines. The response rate was 81.3%. For 58.0% of the gastroenterologists, endoscopic biopsy sampling were made according to French guidelines (four-quadrant biopsies at 2 cm intervals). Agreement was 78.0% regarding the interval of surveillance for no dysplasia (every 2 or 3 years) and 78.5% regarding the low-grade dysplasia (every 6 or 12 months). For the management of high-grade dysplasia, 28.6% actually confirm the diagnosis by a second anatomopathologist and 42.0% treated by proton pump inhibitor during 2 months. Concerning the biopsies, the young gastroenterologists and gastroenterologists practising in university hospitals had a better adherence to the guidelines (Relative Risk: 2.22, 95% CI 1.25-3.95 and 3.74, 95% CI 1.04-13.47, respectively). The other factors of risk were not statistically significant. The endoscopic follow-up is mostly realized in accordance with the national guidelines. However, there is a wide variability in individual current practice.

Appropriateness of upper-GI endoscopy: an Italian survey on behalf of the Italian Society of Digestive Endoscopy

Open-access endoscopy allows physicians to directly schedule endoscopic procedures for their patients without prior consultation. An evaluation of both appropriateness and diagnostic yield of endoscopic procedures is critical when assessing the costs and benefits of endoscopy in an open-access setting. The aim of this Italian multicenter study was to assess the appropriate use of upper endoscopy (EGD) in an open-access system and to establish the yield of diagnostic information relevant to patient care. Cross-sectional, prospective, multicenter study. A total of 6270 patients referred to 44 Italian centers for open-access EGD during 1 month were prospectively enrolled. The American Society for Gastrointestinal Endoscopy (ASGE) guidelines were used to assess the relation between the appropriate use of EGD and the presence of relevant endoscopic findings. The rate for "generally not indicated" EGDs was 22.9%: 29.4% for primary care physicians and 12.9% for specialists (P < .01). A relevant endoscopic finding was detected in 2929 examinations (46.7%). The diagnostic yield was significantly higher for "generally indicated" EGDs compared with "generally not indicated" procedures (52% vs 29%; odds ratio [OR] 2.65, 99% confidence interval [CI] 2.23-3.20; P < .01). Of the 133 malignant lesions diagnosed, all but 1 were diagnosed in patients with an appropriate indication (OR >20, 99% CI 3 to >100; P < .01). Open-access EGD is an useful procedure for clinical practice. Because most of the relevant findings were detected during examinations performed for appropriate indications, the use of ASGE guidelines emerges as crucial to the cost-effectiveness of an open-access system.

Barett's Esophagus Diagnosis and Lugol Staining. An Additional Result of a National Prospective Study of the French Digestive Endoscopy Society (SFED)

Barett's Esophagus Diagnosis and Lugol Staining. An Additional Result of a National Prospective Study of the French Digestive Endoscopy Society (SFED)

Appropriateness of colonoscopy: Diagnostic yield and safety in guidelines

To evaluate if the guidelines for the appropriateness of performing colonoscopy by American Society for Gastrointestinal Endoscopy (AGSE) and Italian Society of Digestive Endoscopy (SIED) yield a good diagnostic efficacy and do not present risks of missing important colonic pathologies in an Italian population sample. A total of 1017 consecutive patients (560 men and 457 women; mean age 64.4 +/- 16 years) referred to an open-access endoscopy unit for colonoscopy from July 2004 to May 2006 were evaluated according to ASGE and SIED guidelines for appropriateness of performing the procedure. Diagnostic yield was defined as the percentage of relevant colonic pathologies of the total number of colonoscopies performed. About 85.2% patients underwent colonoscopy that was considered appropriate based on at least one ASGE or SIED criterion, while it was considered inappropriate for 14.8% of patients. The diagnostic yield of colonoscopy was significantly higher for appropriate colonoscopies (26.94% vs 10.6%, P < 0.001) than for inappropriate colonoscopies (5.3%). There was no missed colorectal cancer following the ASGE/SIED criteria. ASGE/SIED guidelines have shown a good diagnostic yield and the rate of missing relevant colonic pathologies seems very low. Unfortunately, the percentage of inappropriate referrals for colonoscopy in an open-access endoscopy system is still high, despite the number of papers published on the issue and the definition of international guidelines. Further steps are required to update and standardize the guidelines to increase their diffusion and to promote educational programs for general practitioners.

French Society of Digestive Endoscopy (SFED) Guidelines on performing a colonoscopy

Colonoscopy is the standard examination for diagnosing colorectal diseases and treating colorectal superficial neoplasms. Colonoscopy must be performed under the best conditions for optimum results. However, it is difficult to lay down rules as there is a scant amount of scientific data or available references on numerous points and because the practice is different from country to country, so that consulting the international literature is of limited use. Most of the options set out below are only the result of consulting experts. These guidelines are provisional and for guidance only as they are liable to change as and when new scientific information comes to light.

Colorectal cancer screening: Recommendations and guideline adherence by physicians from digestive endoscopy centers in the Lazio region, Italy

Introduction Endoscopy plays a key role in colorectal cancer screening; at the beginning of a mass screening campaign, it is important for public health officials to assess physicians' attitudes and adherence to guidelines regarding colorectal cancer screening. Methods In April 2004, a questionnaire was sent to all 80 digestive endoscopy centers in the Lazio region, identified by the annual census of the Italian Society of Digestive Endoscopy. The results were compared to those from a similar survey of general practitioners (GPs). Results Seventy-one centers (89%) returned the questionnaire. Only 3% of physicians said they did not recommend any colorectal cancer screening test. Colonoscopy was perceived as the most effective screening test and was the most recommended (80%). Fecal occult blood test was recommended by 61% of physicians and flexosigmoidoscopy by 11%. Endoscopy centers' physicians recommend screening more than GPs (96.9% vs. 78.3%), while they have a similar level of over-recommending (50.8% vs. 47.2%). Almost 95% of endoscopy physicians properly recommended colonoscopy after positive FOBT. Conclusions Neither physicians at endoscopy centers nor GPs tend to follow screening guidelines. Screening programmes should not rely on a single medical specialist, but on interdisciplinary management of the disease to strengthen adherence to existing guidelines.

An evidence-based, Latin-American consensus on gastro-oesophageal reflux disease

In recognition of the high prevalence of gastro-oesophageal reflux disease (GORD) and its importance in Latin America, the InterAmerican Association of Gastroenterology and the InterAmerican Society of Digestive Endoscopy organized a Latin-American Consensus on GORD in Cancun, Mexico in September 2004. The main objectives of the consensus meeting were to provide evidence-based guidance with respect to the diagnosis and treatment of GORD, relevant to all countries in the region. The methodology, results and recommendations of the consensus are described in detail.

Upper Gastrointestinal Endoscopy with Lugol Staining Screens Early and Curable Lesions Among a High-Risk Patients Population. National Prospective Study of the French Digestive Endoscopy Society (SFED)

Introduction: The national prospective study of the SFED showed (1) a 20% increase of the sensitivity of the upper gastro-intestinal endoscopy after 2% lugol staining in the screening of dysplasia and cancers, especially among patients with a history of head and neck or lung cancers. This study allowed to screen high-grade dysplasia and cancers in the very high-risk patients: history of head and neck or lung cancers, alcoholic cirrhosis. The aim of this complementary study was to evaluate the clinical relevance of these diagnosis among patients with contra-indications to some treatments due to the complications of alcohol and tobacco consumption or due to the treatment of the first cancer. Patients and Methods: Among the 611 patients included between 2000 and 2003 in these both groups, 21 cancers (prevalence = 5.3%) were observed in patients with a history of head and neck or lung cancers and 7 (prevalence = 3.2%) in patients with alcoholic cirrhosis. Esophageal varices or important deterioration of hemostasis were exclusion criterias of the study. All the cancer diagnosis were confirmed by a second histologic examination. Only the superficial cancers were included in this complementary study among the gastroenterologists who screened the lesions. ResultsAmong the 28 cancers, 5 were diagnosed after the 2% lugol staining only (18%). Six were classified as superficial after a CT-scan and most often after an endoscopic ultrasonography. Three were resected (1 endoscopic mucosal resection, 2 surgical resection). The resected lesions were classified as 1 in situ cancer and 2 pT1N0 cancers. The 3 other patients were respectively treated with radiotherapy only, chemotherapy only and chemo-radiotherapy. One patient died in the post-operative period, the 5 other were alive 3 years after the diagnosis. Among these patients, 1 relapsed at month 41 and died 5 months later. Conclusion: Among the screened cancers, 21% were early cancers open to a curative treatment with an attractive survival (>36 months). (1) Oesophageal squamous cell carcinoma screening among high-risk patients: national prospective study of the French Digestive Endoscopy Society (SFED). Gastrointest Endosc 2004;59:W1560.