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Parrales-Mora M, Cremades M, Parés D, García RD, Pardo Aranda F, Zárate Pinedo A, Navinés López J, Espin Alvarez F, Julian-Ibanez JF, Cugat Andorra E. Morbidity and mortality of elderly patients with pancreaticobiliary disease according to age and comprehensive geriatric assessment: A prospective observational study. GASTROENTEROLOGIA Y HEPATOLOGIA 2024; 47:439-447. [PMID: 37741326 DOI: 10.1016/j.gastrohep.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/11/2023] [Accepted: 09/15/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND This study was designed to analyze the influence of age and comprehensive geriatric evaluation on clinical results of pancreaticobiliary disease management in elderly patients. METHODS A prospective observational study has been undertaken, including 140 elderly patients (over 75 years) with benign pancreaticobiliary disease. Patients were divided according to age in the following groups: group 1: 75-79 years old; group 2: 80-84 years old; group 3: 85 years and older. They underwent a comprehensive geriatric assessment with different scales: Barthel Index, Pfeiffer Index, Charlson Index, and Fragility scale, at admission and had been follow-up 90 days after hospital discharge to analyze its influence on morbidity and mortality. RESULTS Overall, 140 patients have been included (group 1=51; group 2=43 and group 3=46). Most of them, 52 cases (37.8%), had acute cholecystitis, followed by 29 cases of acute cholangitis (20.2%) and acute pancreatitis with 25 cases (17.9%). Significant differences has been observed on complications in different age groups (p=0.033). Especially in patients with a Barthel Index result ≤60, which suggests that these less functional patients had more severe complications after their treatment (p=0.037). The mortality rate was 7.1% (10 patients). CONCLUSIONS No significant differences were found between age, morbidity and mortality in elderly patients with pancreaticobiliary disease. Comprehensive geriatric scales showed some utility in their association with specific complications.
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Affiliation(s)
- Mauricio Parrales-Mora
- Hepatobiliary and Pancreas Unit, Department of General and Digestive Surgery, Spain; Department of General and Digestive Surgery, School of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Manel Cremades
- Hepatobiliary and Pancreas Unit, Department of General and Digestive Surgery, Spain; Department of General and Digestive Surgery, School of Medicine, Universitat Autònoma de Barcelona, Spain
| | - David Parés
- Department of General and Digestive Surgery, School of Medicine, Universitat Autònoma de Barcelona, Spain.
| | - Rebeca D García
- Department of General and Digestive Surgery, School of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Fernando Pardo Aranda
- Department of General and Digestive Surgery, School of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Alba Zárate Pinedo
- Hepatobiliary and Pancreas Unit, Department of General and Digestive Surgery, Spain; Department of General and Digestive Surgery, School of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Jordi Navinés López
- Hepatobiliary and Pancreas Unit, Department of General and Digestive Surgery, Spain
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Lin X, Sun H, Lin X, Liu Y, Hu S, Song C, Yu Y. Application of topical pharyngeal anesthesia to reduce adverse reactions during painless gastroscopy: A prospective randomized study. Technol Health Care 2023:THC220516. [PMID: 36847030 DOI: 10.3233/thc-220516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Studies have reported that certain adverse reactions can occur during painless gastroscopy examination. Knowing how to decrease the risks and incidence of adverse reactions is of great importance. OBJECTIVE To investigate whether topical pharyngeal anesthesia combined with intravenous anesthesia is superior to intravenous anesthesia alone in patients undergoing painless gastroscopy and to determine whether this combined approach had any additional benefits. METHODS Three hundred patients undergoing painless gastroscopy were randomly assigned to either the control group or the experimental group. In the control group, patients were anesthetized with propofol, while patients in the experimental group received propofol combined with 2% lidocaine spray for topical pharyngeal anesthesia. Hemodynamic parameters before and after the procedure, including the heart rate (HR), mean arterial pressure (MAP), and pulse oxygen saturation (SPO2) were recorded. Any adverse reactions experienced by the patient, including choking and respiratory depression, and the total dosage of propofol required during each procedure were also documented. RESULTS Compared with pre-anesthetic data, the HR, MAP, and SPO2 were reduced after the completion of the painless gastroscopy procedure in both groups. However, the HR, MAP, and SPO2 measurements taken after the gastroscopy were significantly lower in the control group than those of the experimental group (P< 0.05); thus, the hemodynamic parameters of the experimental group were more stable. Compared with the control group, there was significant reduction in the total amount of propofol administered in the experimental group (P< 0.05). The incidence of adverse reactions, including choking and respiratory depression, was significantly lower in the experimental group (P< 0.05). CONCLUSION The results demonstrated that the application of topical pharyngeal anesthesia in painless gastroscopy can significantly reduce the incidence of adverse reactions. Thus, the combination of topical pharyngeal and intravenous anesthesia is worthy of clinical application and promotion.
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Ergenç M, Uprak TK. Esophagogastroduodenoscopy in Patients Aged 75 Years and Older: A Single-Center Study. Cureus 2022; 14:e21846. [PMID: 35291530 PMCID: PMC8896878 DOI: 10.7759/cureus.21846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 12/13/2022] Open
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Ellis R, Livovsky DM, Shapiro DS, Friedmann R, Shafrir A, Goldin E, Koslowsky B. Safety of oesophagogastroduodenoscopy in a nonagenarian population. Age Ageing 2021; 50:1840-1844. [PMID: 34120168 DOI: 10.1093/ageing/afab129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND invasive gastrointestinal (GI) procedures are increasingly performed on much older patients but data regarding oesophagogastroduodenoscopy (OGD) in this population are limited. We compared the indications, safety and benefits of OGD for nonagenarians compared to octogenarians. METHODS an observational retrospective review of patients who underwent OGD between 2013 and 2018 at a gastroenterology institute in one large hospital. Patients aged 90 and above 'nonagenarians' were compared to those aged 80-89 'octogenarians'. RESULTS 472 patients (231 nonagenarians and 241 octogenarians), median age of 91 for nonagenarians (201 aged 90-94, 30 aged 95 and older) and 82 (174 aged 80-84, 67 aged 85-89) for octogenarians. GI bleeding was a more common and dyspepsia, a less common, indication for nonagenarians compared to octogenarians (55 and 7%, versus 43 and 18%). Significant findings and need for endoscopic treatments were both more commonly found in nonagenarians compared to octogenarians (25 and 24% versus 15 and 8%, respectively). General anaesthesia was more commonly given to nonagenarians (35 versus 10%). Immediate complications and 30-day mortality rate were similar between the groups: (2.6% of nonagenarians versus 1.6% of octogenarians). Of 30 patients aged 95 and older, 13% had late adverse events, compared to 1% of the overall cohort. CONCLUSIONS OGD appears safe in nonagenarians. Pathological findings and endoscopic interventions are more common. Decisions regarding OGD should not be based on age alone.
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Affiliation(s)
- Raphael Ellis
- Geriatric Department, Faculty of Medicine, Shaare-Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dan Meir Livovsky
- Faculty of Medicine, Shaare-Zedek Medical Center, Digestive Diseases Institute, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dvorah Sara Shapiro
- Geriatric Department, Faculty of Medicine, Shaare-Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Reuven Friedmann
- Geriatric Department, Faculty of Medicine, Shaare-Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Asher Shafrir
- Faculty of Medicine, Shaare-Zedek Medical Center, Digestive Diseases Institute, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eran Goldin
- Faculty of Medicine, Shaare-Zedek Medical Center, Digestive Diseases Institute, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Benjamin Koslowsky
- Faculty of Medicine, Shaare-Zedek Medical Center, Digestive Diseases Institute, Hebrew University of Jerusalem, Jerusalem, Israel
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Basturk A, Artan R, Yılmaz A. Investigation of Efficacy of Lidocaine Spray for Sedated Esophagogastroduodenoscopy in Children. Pediatr Gastroenterol Hepatol Nutr 2017; 20:87-93. [PMID: 28730132 PMCID: PMC5517384 DOI: 10.5223/pghn.2017.20.2.87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 12/27/2016] [Accepted: 01/01/2017] [Indexed: 12/02/2022] Open
Abstract
PURPOSE Our aim in this study is to investigate efficacy of topical lidocaine spray for sedated esophagogastroduodenoscopy (EGD) in children. METHODS The endoscopy of children aged between 3-18 years who underwent EGD in our endoscopy unit. Intravenous (IV) midazolam and ketamine were used for sedation. Prior to sedation, endoscopy nurse applied topical lidocaine 10% with pump spray at 1 mg/kg dose in group 1, and distilled water via identically scaled pump spray in group 2, in a double blinded fashion. RESULTS Sedation was not applied in 24.1% of the cases in topical lidocaine spray group (LS group) and in 5.7% of the cases in distilled water spray group (DS group). Gag reflex was observed in 6.5% of cases in LS group and 33.3% of cases in DS group (p=0.024), increased oral secretion was observed in 9.3% of cases in LS group and 51.7% of cases in DS group (p=0.038), sore throat was observed in 3.7% of cases in LS group and 35.6% of cases in DS group (p=0.019) and the difference was statistically significant. CONCLUSION The study showed that topical pharyngeal lidocaine reduces both requirement and amount of IV sedation before EGD in children and sore throat, gag reflex and decreased oral secretion increase.
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Affiliation(s)
- Ahmet Basturk
- Department of Pediatric Gastroenterology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Reha Artan
- Department of Pediatric Gastroenterology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Aygen Yılmaz
- Department of Pediatric Gastroenterology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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Celik M. Efficacy of early endoscopy and colonoscopy in very elderly patients with gastrointestinal bleeding. Pak J Med Sci 2017; 33:187-190. [PMID: 28367197 PMCID: PMC5368306 DOI: 10.12669/pjms.331.11616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE We aimed to determine the efficacy and safety of early (within the first 24 hour from application) endoscopy and colonoscopy in very elderly patients with GIS bleeding. METHODS In this study, 95 patients were included who underwent early endoscopy with the pre-diagnosis of upper GIS bleeding or endoscopy-colonoscopy with the pre-diagnosis of lower GIS bleeding between 2012 and 2016. Endoscopy and colonoscopy procedures were compared in terms of the development of complications, tolerance of procedure, detection of bleeding site, and rate of therapeutic interventions performed for bleeding. In addition, the adequacy of colonoscopy preparation was evaluated. RESULTS There was no significant difference between endoscopy and colonoscopy on procedural complication (2.1% vs 2.8%) and tolerance rates (81% vs 74.2), (p>0.05). The bleeding site was detected during endoscopy in 34(56.6%) patients, and an endoscopic intervention was required for 15(25%) of these patients. The bleeding site was detected during colonoscopy in 12(34.3%) patients, and an endoscopic intervention was performed for two (5.7%) patients (p<0.05). In addition, the colonoscopy procedure was suboptimal in 26 of 35 patients (74.2%) because of poor preparations. CONCLUSION Early endoscopy and colonoscopy are safe and well tolerated in very elderly patients with GIS bleeding. Upper GIS endoscopy in this patient population enables the detection of the bleeding site and an endoscopic intervention for the bleeding. However, colonoscopy is insufficient for detecting bleeding sites, and colonoscopic treatment of bleeding sites is difficult because of poor or no preparation in this patient population.
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Affiliation(s)
- Mustafa Celik
- Mustafa Celik, Department of Gastroenterology, Pamukkale University Training and Research Hospital, Denizli; Turkey
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Abdelmessih R, Packey CD, Lawlor G. Endoscopy in the Elderly: a Cautionary Approach, When to Stop. ACTA ACUST UNITED AC 2016; 14:305-14. [DOI: 10.1007/s11938-016-0101-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Davis-Yadley AH, Lipka S, Rodriguez AC, Nelson KK, Doraiswamy V, Rabbanifard R, Kumar A, Brady PG. The safety and efficacy of single balloon enteroscopy in the elderly. Therap Adv Gastroenterol 2016; 9:169-79. [PMID: 26929779 PMCID: PMC4749853 DOI: 10.1177/1756283x15614517] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Single balloon enteroscopy (SBE) is an important tool in the management of small bowel disease with limited data available on its performance in the elderly. We aimed to evaluate the safety, efficacy, diagnostic and therapeutic outcomes of SBE in the elderly. METHODS A retrospective review was performed on 366 patients undergoing 428 SBEs from 2010 to 2014. Patients were divided into different age groups: control <55, 55-64, 65-74 and ⩾75 years. Data on comorbidities, complications, findings, diagnostic and therapeutic yield were compared between groups. RESULTS Anterograde and retrograde SBE were performed in 340 and 49 patients, respectively, with 63 patients requiring more than 1 procedure. Diagnostic yield was significantly higher for age ⩾75 years compared with <55, 66.3% versus 50%, odds ratio (OR) 1.97 [95% confidence interval (CI) 1.14-3.41]. Therapeutic yield was significantly higher in all three older age groups compared with <55 years, 20.3%: 55-64 years, 44.4%, OR 3.13(95% CI 1.7-5.78); 65-74 years, 42%, OR 2.84 (95% CI 1.59-5.06); and >75 years, 47.5%, OR 3.55 (95% CI 1.96-6.43). No significant difference was seen between age groups in complications or failures. Our overall complication rate was 2.3% with 5 minor and 5 major complications. There was a higher yield of angioectasias in the elderly. Argon plasma coagulation (APC) and multipolar electrocoagulation were used more often in older age groups. CONCLUSION SBE is safe in elderly patients and delivers higher diagnostic and therapeutic yields compared to younger patients. The elderly are more likely to have angioectasias and undergo APC and electrocoagulation.
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Affiliation(s)
| | - Seth Lipka
- Digestive Diseases and Nutrition, University of South Florida, Tampa, FL, USA
| | - Andrea C. Rodriguez
- Departments of Internal Medicine, University of South Florida, Tampa, FL, USA
| | - Kirbylee K. Nelson
- Departments of Internal Medicine, University of South Florida, Tampa, FL, USA
| | - Vignesh Doraiswamy
- Morsani College of Medicine Medical School, University of South Florida, Tampa, FL, USA
| | | | - Ambuj Kumar
- Evidence Based Medicine and Research Outcomes, University of South Florida, Tampa, FL, USA
| | - Patrick G. Brady
- Digestive Diseases and Nutrition, University of South Florida, Tampa, FL, USA
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Chandrasekhara V, Early DS, Acosta RD, Chathadi KV, Decker GA, Evans JA, Fanelli RD, Fisher DA, Foley KQ, Fonkalsrud L, Hwang JH, Jue T, Khashab MA, Lightdale JR, Muthusamy VR, Pasha SF, Saltzman JR, Sharaf R, Shergill AK, Cash BD. Modifications in endoscopic practice for the elderly. Gastrointest Endosc 2013; 78:1-7. [PMID: 23664042 DOI: 10.1016/j.gie.2013.04.161] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 04/03/2013] [Indexed: 12/12/2022]
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Ortega Ramírez M, Linares Segovia B, García Cuevas MA, Sánchez Romero JL, Botello Buenrostro I, Amador Licona N, Guízar Mendoza JM, Guerrero Romero JF, Vázquez Zárate VM. Glossopharyngeal Nerve Block versus Lidocaine Spray to Improve Tolerance in Upper Gastrointestinal Endoscopy. Gastroenterol Res Pract 2013; 2013:264509. [PMID: 23533386 PMCID: PMC3603156 DOI: 10.1155/2013/264509] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 02/04/2013] [Accepted: 02/09/2013] [Indexed: 11/22/2022] Open
Abstract
Aim of the Study. To compare the effect of glossopharyngeal nerve block with topical anesthesia on the tolerance of patients to upper gastrointestinal endoscopy. Methods. We performed a clinical trial in one hundred patients undergoing upper gastrointestinal endoscopy. Subjects were randomly assigned to one of the following two groups: (1) treatment with bilateral glossopharyngeal nerve block (GFNB) and intravenous midazolam or (2) treatment with topical anesthetic (TASS) and intravenous midazolam. We evaluated sedation, tolerance to the procedure, hemodynamic stability, and adverse symptoms. Results. We studied 46 men and 54 women, from 17 to 78 years of age. The procedure was reported without discomfort in 48 patients (88%) in the GFNB group and 32 (64%) in the TAAS group; 6 patients (12%) in GFNB group and 18 (36%) in TAAS group reported the procedure as little discomfort (χ (2) = 3.95, P = 0.04). There was no difference in frequency of nausea (4% in both groups) and retching, 4% versus 8% for GFNB and TASS group, respectively (P = 0.55). Conclusions. The use of glossopharyngeal nerve block provides greater comfort and tolerance to the patient undergoing upper gastrointestinal endoscopy. It also reduces the need for sedation.
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Affiliation(s)
- Moisés Ortega Ramírez
- PEMEX Regional Hospital Salamanca, Subdirección de Servicios de Salud, Gerencia de Servicios Médicos. Av. Tampico 910 Col. Bellavista, 36730 Salamanca, Guanajuato, Mexico
| | - Benigno Linares Segovia
- PEMEX Regional Hospital Salamanca, Subdirección de Servicios de Salud, Gerencia de Servicios Médicos. Av. Tampico 910 Col. Bellavista, 36730 Salamanca, Guanajuato, Mexico
- Division of Health Sciences, Department of Medicine and Nutrition, Campus Leon, University of Guanajuato, 20 de Enero No. 929, Colonia Obregón, 37320 León, Guanajuato, Mexico
| | - Marco Antonio García Cuevas
- PEMEX Regional Hospital Salamanca, Subdirección de Servicios de Salud, Gerencia de Servicios Médicos. Av. Tampico 910 Col. Bellavista, 36730 Salamanca, Guanajuato, Mexico
- Division of Health Sciences, Department of Medicine and Nutrition, Campus Leon, University of Guanajuato, 20 de Enero No. 929, Colonia Obregón, 37320 León, Guanajuato, Mexico
| | - Jorge Luis Sánchez Romero
- PEMEX Regional Hospital Salamanca, Subdirección de Servicios de Salud, Gerencia de Servicios Médicos. Av. Tampico 910 Col. Bellavista, 36730 Salamanca, Guanajuato, Mexico
| | - Illich Botello Buenrostro
- PEMEX Regional Hospital Salamanca, Subdirección de Servicios de Salud, Gerencia de Servicios Médicos. Av. Tampico 910 Col. Bellavista, 36730 Salamanca, Guanajuato, Mexico
| | - Norma Amador Licona
- Instituto Mexicano del Seguro Social, Director of Education and Research, UMAE HE 1, Paseo de los Insurgentes SN, Colonia Paraísos, 37150 León, Guanajuato, Mexico
| | - Juan Manuel Guízar Mendoza
- Universidad De LaSalle Bajío, School of Dentistry, Av. Universidad 602, Col. Lomas del Campestre, 37150 León, Guanajuato, Mexico
| | - Jesús Francisco Guerrero Romero
- PEMEX Regional Hospital Salamanca, Subdirección de Servicios de Salud, Gerencia de Servicios Médicos. Av. Tampico 910 Col. Bellavista, 36730 Salamanca, Guanajuato, Mexico
| | - Víctor Manuel Vázquez Zárate
- PEMEX Subdirección de Servicios de Salud, Av. Marina Nacional 350 Col. Petroleos Mexicanos, 11311 Distrito Federal, Mexico
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Byeon JS, Mann NK, Jamil LH, Lo SK. Double balloon enteroscopy can be safely done in elderly patients with significant co-morbidities. J Gastroenterol Hepatol 2012; 27:1831-6. [PMID: 23034065 DOI: 10.1111/j.1440-1746.2012.07284.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Performance of double balloon enteroscopy (DBE) on older patients with comorbidities is a matter of safety. We aimed to investigate the utility and safety of DBE in older patients. METHODS We retrospectively reviewed the medical records of patients 75 years or older who underwent DBE in our open-access endoscopy unit in a tertiary center. We analyzed the diagnostic yield, therapeutic intervention, and safety including complications of DBE. RESULTS Four scheduled DBEs were canceled because of poor conditions. Two hundred and fourteen DBEs were performed in 167 elderly patients. All DBEs were performed under monitored anesthesia care using intravenous propofol administered by anesthesiologists. One half of the patients were male (female : male = 80:87). The mean age of patients was 80.1 ± 3.7 years. Co-morbidity of significant chronic diseases was noted in 208 (97.2%) DBEs. Fifty-one (23.8%) DBEs were performed in patients with American Society of Anesthesiologists (ASA) physical status II, 151 (70.6%) DBEs with ASA class III, and 12 (5.6%) DBEs with ASA class IV. The most common indication was obscure gastrointestinal bleeding. The mean DBE procedure time was 131 ± 51 min. Abnormalities were detected in 129 (60.3%) DBEs with therapeutic interventions performed in 83 (38.8%) cases. Pancreatitis, hypoxia, and aspiration pneumonia developed after three (1.4%), three (1.4%), and two (0.9%) DBEs, respectively, all of which resolved with conservative care. CONCLUSIONS Double balloon enteroscopy can be done with acceptable safety in the elderly with high ASA class. DBE shows a high diagnostic yield and can deliver many therapeutic applications.
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Affiliation(s)
- Jeong-Sik Byeon
- David Geffen School of Medicine at UCLA, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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He Q, Zhang Q, Li JD, Wang YD, Wan TM, Chen ZY, Pan DS, Cai JQ, Liu SD, Xiao B, Zhang YL, Jiang B, Bai Y, Zhi FC. Double balloon enteroscopy in the old: experience from China. World J Gastroenterol 2012; 18:2859-66. [PMID: 22719197 PMCID: PMC3374992 DOI: 10.3748/wjg.v18.i22.2859] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 02/20/2012] [Accepted: 03/09/2012] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the safety, efficacy and management of double balloon enteroscopy (DBE) carried out in those aged individuals with suspicious small intestine diseases. METHODS DBE is a wonderful invention of the past decade and is widely used as an examination tool for the gastrointestinal tract. From January 2003 to July 2011, data from patients who were ≥ 65 years old and underwent DBE examination in the Nanfang Hospital were included in a retrospective analysis. RESULTS Fifty-nine individuals were found and subsequently analyzed. The mean age was 69.63 ± 3.89 years (range 65-84), 34 were males. Indications for DBE were melena/hematochezia (36 cases), abdominal pain (15 cases), diarrhea (3 cases), stool change (1 case), weight loss (1 case), vomiting (2 cases), and debilitation (1 case). The average duration of symptoms was 33.34 ± 64.24 mo. Twenty-seven patients suffered from age-related diseases. Severe complications were not found during and after DBE. Comparison between systolic and diastolic blood pressure before and after DBE was statistically significant (mean ± SD, P < 0.01, P < 0.05, respectively). Small bowel pathologies were found by DBE in 35 patients, definite diagnoses were made in 31 cases, and detection rate and diagnostic yield for DBE were 68.6% and 60.8%, respectively. CONCLUSION DBE is a safe and effective method for gastrointestinal examination in the aged population. Aging alone is not a risk factor for elderly patients with suspicious gastrointestinal diseases and thorough preparation prior to the DBE procedure should be made for individuals with multiple diseases especially cardiopulmonary disorders.
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Soweid AM, Yaghi SR, Jamali FR, Kobeissy AA, Mallat ME, Hussein R, Ayoub CM. Posterior lingual lidocaine: A novel method to improve tolerance in upper gastrointestinal endoscopy. World J Gastroenterol 2011; 17:5191-6. [PMID: 22215944 PMCID: PMC3243886 DOI: 10.3748/wjg.v17.i47.5191] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 11/11/2010] [Accepted: 11/18/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the effect of posterior lingual lidocaine swab on patient tolerance to esophagogastroduodenoscopy, the ease of performance of the procedure, and to determine if such use will reduce the need for intravenous sedation.
METHODS: Eighty patients undergoing diagnostic esophagogastroduodenoscopy in a tertiary care medical center were randomized to either lidocaine swab or spray. Intravenous meperidine and midazolam were given as needed during the procedure.
RESULTS: Patients in the lidocaine swab group (SWG) tolerated the procedure better than those in the spray group (SPG) with a median tolerability score of 2 (1, 4) compared to 4 (2, 5) (P < 0.01). The endoscopists encountered less difficulty performing the procedures in the SWG with lower median difficulty scores of 1 (1, 5) compared to 4 (1, 5) in the SPG (P < 0.01). In addition, the need for intravenous sedation was also lower in the SWG compared to the SPG with fewer patients requiring intravenous sedation (13/40 patients vs 38/40 patients, respectively, P < 0.01). The patients in the SWG were more satisfied with the mode of local anesthesia they received as compared to the SPG. In addition, the endoscopists were happier with the use of lidocaine swab.
CONCLUSION: The use of a posterior lingual lidocaine swab in esophagogastroduodenoscopy improves patient comfort and tolerance and endoscopist satisfaction and decreases the need for intravenous sedation.
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Hegde SR, Iffrig K, Li T, Downey S, Heller SJ, Tokar JL, Haluszka O. Double-balloon enteroscopy in the elderly: safety, findings, and diagnostic and therapeutic success. Gastrointest Endosc 2010; 71:983-9. [PMID: 20189563 DOI: 10.1016/j.gie.2009.10.054] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 10/20/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND Double-balloon enteroscopy (DBE) is an important tool in the evaluation and management of small-bowel disease. Limited data are available on the safety, findings, and outcomes of DBE in elderly patients. OBJECTIVE To determine the safety and efficacy of DBE in elderly patients. DESIGN Single-center, retrospective analysis of prospectively collected database. SETTING Open-access, tertiary care referral center. PATIENTS A total of 176 patients undergoing DBE (216 procedures) for evaluation of small-bowel disease between August 2007 and August 2008. INTERVENTIONS Argon plasma coagulation of bleeding small-bowel lesions. MAIN OUTCOME MEASUREMENTS DBE complication rate, diagnostic/therapeutic success of DBE. METHODS An age cutoff of 75 years and older was used to designate patients as elderly. Data on complications, indications, findings, and diagnostic and therapeutic success of DBE were compared between age groups. RESULTS The mean age of patients was 66 +/- 16.4 years (range 20-95 years). DBE was performed in 185 patients, including 60 patients age 75 years and older and 110 patients younger than age 75. An overall complication rate of 0.9% was seen for DBE in this study, with no significant difference between age groups. No major complications were observed in elderly patients. Elderly patients were more likely to have angioectasias (39% vs 23%; P = .01) and were more likely to require endoscopic therapy during DBE (46.8% vs 29.2%; P = .01). LIMITATIONS Single-center, retrospective study. CONCLUSIONS DBE is safe in elderly patients. Elderly patients are more likely to have angioectasias and to require endoscopic therapy during DBE.
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Affiliation(s)
- Sanjay R Hegde
- Division of Gastroenterology and Hepatology, University of Maryland Medical Center, Baltimore, Maryland, USA
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Ladas SD. Ethical issues in the management of elderly patients in gastroenterology and digestive endoscopy. Expert Rev Gastroenterol Hepatol 2007; 1:257-63. [PMID: 19072418 DOI: 10.1586/17474124.1.2.257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Over the past 30 years, the population of old-aged citizens in most Western countries has been dramatically increasing. These people usually have several comorbidities and often lose their independence, mostly due to neurodegenerating diseases. Benign and malignant gastrointestinal disorders are very common in all age groups, but their incidence increases with age, requiring investigation and therapy. In this setting several ethical issues arise, mostly related to the extent of invasive investigations, adverse drug reactions due to polypharmacy, the risk:benefit ratio of endoscopic therapy, and the quality and validity of informed consent in this frail elderly population.
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Affiliation(s)
- Spiros D Ladas
- 1st Department of Internal Medicine-Propaedeutic, University of Athens, Laiko General Hospital of Athens, Medical School, Athens, Greece.
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Salles N, Mégraud F. Current management of Helicobacter pylori infections in the elderly. Expert Rev Anti Infect Ther 2007; 5:845-56. [PMID: 17914918 DOI: 10.1586/14787210.5.5.845] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Helicobacter pylori infection is a chronic gastric gram-negative infection that increases with age worldwide. However, the percentage age of H. pylori-positive elderly patients who are tested and treated for their infection remains very low. It is now demonstrated that H. pylori infection induces a whole cascade of events leading to gastric pathologies, such as peptic ulcer diseases, gastric precancerous lesions and gastric cancer. Recent data also demonstrated that H. pylori chronic infection can play a role in gastric aging, appetite regulation and extradigestive diseases, such as Alzheimer's disease, in the elderly. The diagnosis of H. pylori infection remains difficult to realize in the very old population, and the urea breath test obtains the best performance in this population. 1-week proton pump inhibitor-based triple therapy regimens are highly effective and well tolerated in elderly patients, and antibiotic resistance remains very low. Low compliance is the main factor related to treatment failure in this population.
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Affiliation(s)
- Nathalie Salles
- Pôle de gérontologie clinique, Hôpital Xavier-Arnozan, CHU Bordeaux, 33604 Pessac, France.
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Ayoub C, Skoury A, Abdul-Baki H, Nasr V, Soweid A. Lidocaine lollipop as single-agent anesthesia in upper GI endoscopy. Gastrointest Endosc 2007; 66:786-93. [PMID: 17905023 DOI: 10.1016/j.gie.2007.03.1086] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Accepted: 03/29/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND Conscious sedation is usually achieved during EGD by a combination of intravenous benzodiazepines and opiates; however, these have potential serious adverse effects. The addition of topical oropharyngeal anesthetics such as lidocaine may be useful. Recent data suggest that the administration of topical lidocaine by means of a lollipop is effective for endotracheal intubation and bronchoscopy. OBJECTIVE Our purpose was to evaluate the safety and efficacy of a lidocaine lollipop as single-agent anesthesia for EGD and to determine whether its use reduces the need for intravenous sedatives and analgesics. DESIGN Single-blinded, randomized, prospective study. SETTING University hospital. PATIENTS 50 patients undergoing diagnostic EGD. INTERVENTIONS Patients were randomized to either lidocaine lollipop or lidocaine spray. Intravenous meperidine and midazolam were administered during the procedure as needed. MAIN OUTCOME MEASUREMENTS The success and safety of local anesthesia by lidocaine lollipop in addition to the need for intravenous sedation. RESULTS Patients were equally randomized between the lollipop and the spray groups. The lollipop group had less gag reflex, accommodated scope introduction more, and tolerated the procedure better. Thirty-two percent of patients receiving the lollipop required sedation compared with 96% of patients in the spray group (P < .001). The majority in the lollipop group were satisfied with their mode of anesthesia compared with the spray group. CONCLUSIONS Lidocaine lollipop is a promising form of local oropharyngeal anesthesia for EGD. Its use resulted in sparing the use of intravenous sedation. It is well tolerated and safe and may be particularly important in the elderly, patients with comorbidities, and office-based endoscopy.
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Affiliation(s)
- Chakib Ayoub
- Department of Anesthesia, American University of Beirut Medical Center, Beirut, Lebanon
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Salles N. Infection à Helicobacter pylori chez la personne âgée. Rev Med Interne 2007; 28:400-11. [PMID: 17321643 DOI: 10.1016/j.revmed.2007.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Accepted: 01/17/2007] [Indexed: 12/28/2022]
Abstract
PURPOSES Helicobacter pylori (H. pylori) infection is a chronic gastric Gram-negative infection that increases with age. Acquired in childhood, H. pylori infection may induce a whole cascade of events leading to gastric pathologies such as peptic ulcer diseases, gastric precancerous lesions, and gastric lymphomas (MALT). The characteristics of the diagnosis and the treatment of this infection in geriatrics are thus particularly important to take into account. MAIN POINTS 1) The incidence of gastric and duodenal ulcers and their bleeding complications is increasing in old-aged populations. Clinical signs such as anorexia and malnutrition are proven to be excellent indications for endoscopic explorations in the elderly. NSAID-use and H. pylori infection were shown to be independent and unrelated risk factors for peptic ulcer and gastroduodenal bleeding in elderly subjects; 2) H. pylori infection diagnosis is difficult to realize in the very old population, and the urea breath test is the test which obtain the best performances in this population. PERSPECTIVES Recent work showed the part played by H. pylori chronic infection in gastric aging and in appetite regulation in the elderly. Research tasks should be continued in this field in order to better understand the part played by this chronic infection in gastric aging and in other pathologies (i.e. neurological or cardiovascular diseases) in this population.
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Affiliation(s)
- N Salles
- Département de Gériatrie, CHU de Bordeaux, Hôpital Xavier-Arnozan, avenue du Haut-Lévêque, 33604 Pessac, France.
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Fisher L, Fisher A, Thomson A. Cardiopulmonary complications of ERCP in older patients. Gastrointest Endosc 2006; 63:948-55. [PMID: 16733108 DOI: 10.1016/j.gie.2005.09.020] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2005] [Accepted: 09/01/2005] [Indexed: 02/08/2023]
Abstract
BACKGROUND Biochemical markers of ERCP-related myocardial injury have not previously been investigated. OBJECTIVE To evaluate ERCP-related cardiac troponin I (cTnI) release, myocardial ischemia, hemodynamic changes, and arterial hypoxemia in a series of consecutive patients according to age and to determine their relationship to preexisting cardiovascular risk factors (RF) and the development of post-ERCP pancreatitis. DESIGN Prospective cohort study. SETTING Tertiary teaching hospital, Canberra, Australia. PATIENTS Data were collected on 130 consecutive ERCPs performed on 100 unselected patients (aged 18-93 years) by one endoscopist. Patients were divided into two groups: 65 years of age and older (group 1, n = 53; 27 women) and less than 65 years of age (group 2, n = 47; 33 women). INTERVENTIONS ERCP. MAIN OUTCOME MEASUREMENTS Cardiovascular RFs were identified, and electrocardiogram (ECG), cTnI, creatine kinase (CK), amylase, and lipase were measured before and 24 hours after ERCP. Oxygen saturation (SpO(2)), heart rate (HR), blood pressure (BP), and ECG were monitored continuously during each procedure. RESULTS New ECG changes (ischemia, arrhythmias) occurred in 24% of procedures in group 1 and in 9.3% in group 2 (p = 0.168), and episodic arterial hypoxemia (SpO(2) < 90%) in 16.2% (group 1) and 21.4% (group 2) (p = 0.596). A post-ERCP rise in cTnI levels was documented in 6 patients in the older group. Two of these patients died: one from acute myocardial infarction and one from undiagnosed ascending aortic aneurysm. A cTnI rise was not related to any comorbid conditions, total number of RFs, hemodynamic or ECG changes, or arterial desaturation. In patients with a new cTnI rise, the duration of ERCP was significantly longer (59.5 vs. 26.4 minutes, p = 0.026), being 30 minutes or longer in 5 of 6 patients. Post-ERCP pancreatitis was associated with desaturation (relative risk [RR] = 5.9; 95% confidence interval [CI] [1.2, 32.0], p = 0.027) and myocardial ischemia/injury (RR = 4.4; 95% CI [1.4, 7.8]; p = 0.009). CONCLUSIONS Although the majority of older patients tolerated ERCP well, in 8% of procedures, most of which were prolonged (>30 minutes), myocardial injury, as defined by the release of cTnI, occurred. Desaturation and myocardial ischemia/injury were associated with post-ERCP pancreatitis.
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Affiliation(s)
- Leon Fisher
- Department of Gastroenterology, The Canberra Hospital, Woden, Canberra, ACT 2606, Australia
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Qureshi WA, Zuckerman MJ, Adler DG, Davila RE, Egan JV, Gan SI, Lichtenstein DR, Rajan E, Shen B, Fanelli RD, Van Guilder T, Baron TH. ASGE guideline: modifications in endoscopic practice for the elderly. Gastrointest Endosc 2006; 63:566-9. [PMID: 16564853 DOI: 10.1016/j.gie.2006.02.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Waqar A Qureshi
- American Society for Gastrointestinal Endoscopy, 1520 Kensington Road, Ste. 202, Oak Brook, IL 60523, USA
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Davidovic M, Milosevic DP. Are all dilemmas in gerontology being swept under the carpet of intra-individual variability? Med Hypotheses 2005; 66:432-6. [PMID: 16226393 DOI: 10.1016/j.mehy.2005.08.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Revised: 08/21/2005] [Accepted: 08/22/2005] [Indexed: 11/16/2022]
Abstract
It is considered that there are great differences among elderly individuals, because the intra-individual variability is great. The differences among specific individuals grow with their age, so when adults reach a very old age, it seems that there are great differences among them--some are able to do some work, the others are not so able-bodied, whereas among high school students there is usually little difference in their physical ability. The research that supports the above mentioned points, however, does not exist and this opinion came about as a result of deduction. The goal of this study is to examine the fluctuations in the elderly and prove that the genetic difference plays a bigger role than the variability, as the intra-individual (or the between-person) variability is present everywhere, not only in very old people.
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Affiliation(s)
- Mladen Davidovic
- Geriatric Clinic KBC Zvezdara, 1 Rifata Burdzevica 31, 11050 Beograd, Serbia and Montenegro.
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