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Kawai T, Kawai Y, Hamada M, Iwata E, Niikura R, Nagata N, Yanagisawa K, Sugimoto M, Fukuzawa M, Yamagishi T, Itoi T. Present status and the future of ultrathin endoscopy. Dig Endosc 2022; 34:1110-1120. [PMID: 35266224 DOI: 10.1111/den.14297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/01/2022] [Accepted: 03/06/2022] [Indexed: 02/08/2023]
Abstract
Endoscopic population-based screening for gastric cancer began in April 2016, and the use of transnasal ultrathin esophagogastroduodenoscopy (UT-EGD) has rapidly become popular. With UT-EGD, discomfort associated with an examination is reduced, patient satisfaction is high, and adverse effects on cardiopulmonary function are fewer. Consequently, UT-EGD is a good option for gastric screening in an aging society. Because of the narrower diameter of the endoscope, however, image quality is inferior to that obtained using transoral conventional esophagogastroduodenoscopy (C-EGD). As a result, lesions observed by UT-EGD must be viewed at close proximity and chromoendoscopy should be used concurrently, which is burdensome for the endoscopist. Recent innovations by endoscope manufacturers have enabled dramatic improvements in transnasal UT-EGD and facilitated Hi-Vision imaging. Furthermore, image enhancement that allows for observation on a par with transoral C-EGD is now feasible. In the future, UT-EGD will be equipped with functions that permit magnified endoscopic image. It is anticipated that a multiroute transition between transnasal and transoral UT-EGD will become possible.
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Affiliation(s)
- Takashi Kawai
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Yusuke Kawai
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Mariko Hamada
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Eri Iwata
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Ryota Niikura
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Naoyoshi Nagata
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Kyosuke Yanagisawa
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Mitsushige Sugimoto
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Masakatsu Fukuzawa
- Department of, Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Tetsuya Yamagishi
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Takao Itoi
- Department of, Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
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2
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Tian Y, Hong Y, Wang Y, Tian Y, Wang Z, Ai M, Ma J. Superior stretchable and tough P(
AA‐
co
‐AAm
)/silica hybrid hydrogels enabled by acid‐mediated radiation polymerization. J Appl Polym Sci 2022. [DOI: 10.1002/app.52918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yukun Tian
- College of Materials Science and Technology Nanjing University of Aeronautics and Astronautics Nanjing China
| | - Yongzhi Hong
- College of Materials Science and Technology Nanjing University of Aeronautics and Astronautics Nanjing China
| | - Yunlong Wang
- College of Materials Science and Technology Nanjing University of Aeronautics and Astronautics Nanjing China
| | - Yuan Tian
- College of Materials Science and Technology Nanjing University of Aeronautics and Astronautics Nanjing China
| | - Zhihao Wang
- College of Materials Science and Technology Nanjing University of Aeronautics and Astronautics Nanjing China
| | - Meixing Ai
- College of Materials Science and Technology Nanjing University of Aeronautics and Astronautics Nanjing China
| | - Jun Ma
- College of Materials Science and Technology Nanjing University of Aeronautics and Astronautics Nanjing China
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PH van Trijp M, Wilms E, Ríos-Morales M, Masclee AA, Brummer RJ, Witteman BJ, Troost FJ, Hooiveld GJ. Using naso- and oro-intestinal catheters in physiological research for intestinal delivery and sampling in vivo: practical and technical aspects to be considered. Am J Clin Nutr 2021; 114:843-861. [PMID: 34036315 PMCID: PMC8408849 DOI: 10.1093/ajcn/nqab149] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 04/09/2021] [Indexed: 01/19/2023] Open
Abstract
Intestinal catheters have been used for decades in human nutrition, physiology, pharmacokinetics, and gut microbiome research, facilitating the delivery of compounds directly into the intestinal lumen or the aspiration of intestinal fluids in human subjects. Such research provides insights about (local) dynamic metabolic and other intestinal luminal processes, but working with catheters might pose challenges to biomedical researchers and clinicians. Here, we provide an overview of practical and technical aspects of applying naso- and oro-intestinal catheters for delivery of compounds and sampling luminal fluids from the jejunum, ileum, and colon in vivo. The recent literature was extensively reviewed, and combined with experiences and insights we gained through our own clinical trials. We included 60 studies that involved a total of 720 healthy subjects and 42 patients. Most of the studies investigated multiple intestinal regions (24 studies), followed by studies investigating only the jejunum (21 studies), ileum (13 studies), or colon (2 studies). The ileum and colon used to be relatively inaccessible regions in vivo. Custom-made state-of-the-art catheters are available with numerous options for the design, such as multiple lumina, side holes, and inflatable balloons for catheter progression or isolation of intestinal segments. These allow for multiple controlled sampling and compound delivery options in different intestinal regions. Intestinal catheters were often used for delivery (23 studies), sampling (10 studies), or both (27 studies). Sampling speed decreased with increasing distance from the sampling syringe to the specific intestinal segment (i.e., speed highest in duodenum, lowest in ileum/colon). No serious adverse events were reported in the literature, and a dropout rate of around 10% was found for these types of studies. This review is highly relevant for researchers who are active in various research areas and want to expand their research with the use of intestinal catheters in humans in vivo.
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Affiliation(s)
- Mara PH van Trijp
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Ellen Wilms
- Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Melany Ríos-Morales
- Laboratory of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ad Am Masclee
- Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Robert Jan Brummer
- Nutrition-Gut-Brain Interactions Research Centre, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ben Jm Witteman
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands,Hospital Gelderse Vallei, Department of Gastroenterology and Hepatology, Ede, The Netherlands
| | - Freddy J Troost
- Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands,Food Innovation and Health, Centre for Healthy Eating and Food Innovation, Maastricht University, Maastricht, The Netherlands
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Nagaya T, Miyahara R, Funasaka K, Furukawa K, Yamamura T, Ishikawa T, Ohno E, Nakamura M, Kawashima H, Nakashima T, Nakata S, Hirooka Y. Nasal patency as a factor for successful transnasal endoscopy. NAGOYA JOURNAL OF MEDICAL SCIENCE 2020; 81:587-595. [PMID: 31849376 PMCID: PMC6892663 DOI: 10.18999/nagjms.81.4.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In recent years, transnasal endoscopy had been more widely accepted for its safety and convenience, and although it can lead to a weaker pharyngeal reflex, compared with the effects of transoral endoscopy, examinees often suffer intolerable pain and discomfort during passage of the endoscope through the nasal cavity. The aim of this study was to estimate the relationship between the uncomfortable factors during transnasal endoscopy and nasal patency. The subjects comprised 23 consecutive patients who underwent transnasal endoscopy from October 2007 to April 2009 at our Gastroenterology and Otorhinolaryngology Departments. Immediately prior to endoscopy, the left and right nasal resistance was measured with an active anterior rhinomanometer; a value of 100 Pa was determined as nasal resistance. The transnasal endoscope was inserted in the subjectively preferred side by the examinee. Thereafter, the subjects were asked to fill in a questionnaire on physical tolerance during the procedure, to quantify the sensations of nasal pain, nausea, and choking on a 10-point visual analogue scale. The mean scores were 3.0 ± 2.7 for nasal pain, 1.7 ± 2.0 for choking, and 1.6 ± 1.9 for nausea. The most intolerable factor among the complaints was pain (45%), which was followed by nausea (18%) and choking (9%). Unilateral nasal resistance was significantly related with nasal pain only (P = 0.0135). In conclusion, the most difficult problem during transnasal endoscopy was pain, which was related to nasal patency. We successfully demonstrated the clinical significance of nasal patency in determining the side of insertion for transnasal endoscopy.
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Affiliation(s)
- Toshihiko Nagaya
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Internal Medicine, Tohno Kosei Hospital, Mizunami, Japan
| | - Ryoji Miyahara
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kohei Funasaka
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Yamamura
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsutomu Nakashima
- Ichinomiya Medical Treatment & Habilitation Center, Ichinomiya, Japan
| | - Seiichi Nakata
- Department of Otorhinolaryngology, Second Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Yoshiki Hirooka
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
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Schuldt AL, Kirsten H, Tuennemann J, Heindl M, van Bommel F, Feisthammel J, Hollenbach M, Hoffmeister A. Necessity of transnasal gastroscopy in routine diagnostics: a patient-centred requirement analysis. BMJ Open Gastroenterol 2019; 6:e000264. [PMID: 31139423 PMCID: PMC6506089 DOI: 10.1136/bmjgast-2018-000264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/10/2019] [Accepted: 02/22/2019] [Indexed: 12/14/2022] Open
Abstract
Introduction Numerous indications require regular upper gastrointestinal endoscopy (oesophagogastroduodenoscopy; EGD) in outpatients. In most cases, peroral gastroscopy is performed. The aim of this study was to evaluate the need of transnasal gastroscopy (nEGD) in outpatients. Methods A questionnaire was used to assess patients’ preferred choice of method, previous experience with EGD, psychological aspects and sociodemographic data. Furthermore, patient satisfaction with and potentially perceived discomfort during the examination as well as preference for a method in regard to future examinations was evaluated. Results From September 2016 to March 2017, a total of 283 outpatients at endoscopy of the University Hospital of Leipzig were approached to participate in the study. 196 patients were eligible, of whom 116 (60%) chose nEGD. For 87 patients (87/283, 31%) nEGD had to be excluded for medical reasons. The average age in the total sample was 53 (±17) years. 147 (77%) have had previous experience with peroral EGD (oEGD). Of the nEGD examined patients 83% were fairly up to extremely satisfied with the procedure. Satisfaction significantly predicted the choice of future EGD examinations. Nasal pain experienced during nEGDs was associated with rejection of nEGD in further EGD examinations (p<0.01). Patients who did choose a specific procedure were more likely to select the same procedure as their future preference (χ²= 73.6, df=1, p<0.001); this preference was unaffected by the procedure that had been chosen previously (reselecting nEGD: 84%, oEGD: 89%, p=0.874). Conclusion nEGD without sedation is a viable alternative. Patient satisfaction with nEGD is high, and reselection rate for nEGD is similar to that for oEGD. As a result of this study nEGD is now offered as a routine procedure at the University of Leipzig. Trial registration number NCT03663491.
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Affiliation(s)
- Anna-Livia Schuldt
- Division of Gastroenterology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig, Leipzig, Germany
| | - Holger Kirsten
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), Leipzig, Germany
| | - Jan Tuennemann
- Division of Gastroenterology, University Hospital Leipzig, Leipzig, Germany
| | - Mario Heindl
- Division of Gastroenterology, University Hospital Leipzig, Leipzig, Germany
| | - Florian van Bommel
- Klinik für Gastroenterologie und Rheumatologie, University Hospital Leipzig, Leipzig, Germany
| | - Juergen Feisthammel
- Division of Gastroenterology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig, Leipzig, Germany
| | - Marcus Hollenbach
- Division of Gastroenterology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig, Leipzig, Germany
| | - Albrecht Hoffmeister
- Division of Gastroenterology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig, Leipzig, Germany
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Wellenstein DJ, Honings J, Schutte HW, Herruer JM, van den Hoogen FJA, Marres HAM, Takes RP, van den Broek GB. Cost analysis of office-based transnasal esophagoscopy. Eur Arch Otorhinolaryngol 2019; 276:1457-1463. [PMID: 30806806 PMCID: PMC6458968 DOI: 10.1007/s00405-019-05357-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/20/2019] [Indexed: 12/23/2022]
Abstract
Purpose Although office-based transnasal esophagoscopy has been investigated extensively, a cost analysis is still lacking. We performed a cost analysis combined with feasibility study for two diagnostic processes: patients with globus pharyngeus and/or dysphagia, and hypopharyngeal carcinoma. Methods Prospective cohort study. Results Forty-one procedures were performed, of which 35 were fully completed. The procedure was well tolerated with mild complaints such as nasal or pharyngeal pain and burping. Four complications occurred: two minor epistaxis and two vasovagal reactions. In patients with globus pharyngeus and/or dysphagia, transnasal esophagoscopy resulted in a cost saving of €94.43 (p 0.026) per procedure, compared to our regular diagnostic process. In patients with suspicion of hypopharyngeal carcinoma, cost savings were €831.41 (p 0.000) per case. Conclusions Cost analysis showed that office-based transnasal esophagoscopy can provide significant cost savings for the current standard of care. Furthermore, this procedure resulted in good patient acceptability and few complications.
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Affiliation(s)
- David J Wellenstein
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands.
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Henrieke W Schutte
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Jasmijn M Herruer
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Henri A M Marres
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Philips van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
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Wellenstein DJ, Schutte HW, Marres HAM, Honings J, Belafsky PC, Postma GN, Takes RP, van den Broek GB. Office-based procedures for diagnosis and treatment of esophageal pathology. Head Neck 2017; 39:1910-1919. [DOI: 10.1002/hed.24819] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- David J. Wellenstein
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Henrieke W. Schutte
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Henri A. M. Marres
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Peter C. Belafsky
- Center for Voice and Swallowing; Department of Otolaryngology and Head and Neck Surgery, University of California, Davis School of Medicine; Sacramento California
| | - Gregory N. Postma
- Department of Otolaryngology; Medical College of Georgia at Augusta University; Augusta Georgia
| | - Robert P. Takes
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Guido B. van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
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8
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Parker C, Alexandridis E, Plevris J, O'Hara J, Panter S. Transnasal endoscopy: no gagging no panic! Frontline Gastroenterol 2016; 7:246-256. [PMID: 28839865 PMCID: PMC5369487 DOI: 10.1136/flgastro-2015-100589] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/01/2015] [Accepted: 06/10/2015] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Transnasal endoscopy (TNE) is performed with an ultrathin scope via the nasal passages and is increasingly used. This review covers the technical characteristics, tolerability, safety and acceptability of TNE and also diagnostic accuracy, use as a screening tool and therapeutic applications. It includes practical advice from an ear, nose, throat (ENT) specialist to optimise TNE practice, identify ENT pathology and manage complications. METHODS A Medline search was performed using the terms "transnasal", "ultrathin", "small calibre", "endoscopy", "EGD" to identify relevant literature. RESULTS There is increasing evidence that TNE is better tolerated than standard endoscopy as measured using visual analogue scales, and the main area of discomfort is nasal during insertion of the TN endoscope, which seems remediable with adequate topical anaesthesia. The diagnostic yield has been found to be similar for detection of Barrett's oesophagus, gastric cancer and GORD-associated diseases. There are some potential issues regarding the accuracy of TNE in detecting small early gastric malignant lesions, especially those in the proximal stomach. TNE is feasible and safe in a primary care population and is ideal for screening for upper gastrointestinal pathology. It has an advantage as a diagnostic tool in the elderly and those with multiple comorbidities due to fewer adverse effects on the cardiovascular system. It has significant advantages for therapeutic procedures, especially negotiating upper oesophageal strictures and insertion of nasoenteric feeding tubes. CONCLUSIONS TNE is well tolerated and a valuable diagnostic tool. Further evidence is required to establish its accuracy for the diagnosis of early and small gastric malignancies. There is an emerging role for TNE in therapeutic endoscopy, which needs further study.
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Affiliation(s)
- Clare Parker
- South Tyneside NHS Foundation Trust, South Tyneside District Hospital, South Shields, UK
| | | | - John Plevris
- Centre for Liver and Digestive Disorders, The Royal Infirmary, University of Edinburgh, Edinburgh, UK
| | - James O'Hara
- Department of Otolaryngology, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Simon Panter
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, Newcastle upon Tyne, UK
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Alexandridis E, Inglis S, McAvoy NC, Falconer E, Graham C, Hayes PC, Plevris JN. Randomised clinical study: comparison of acceptability, patient tolerance, cardiac stress and endoscopic views in transnasal and transoral endoscopy under local anaesthetic. Aliment Pharmacol Ther 2014; 40:467-76. [PMID: 25039412 DOI: 10.1111/apt.12866] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 06/10/2014] [Accepted: 06/19/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Transnasal endoscopy (TNE) with ultrathin endoscopes has been advocated as an attractive alternative, for diagnostic upper endoscopy. AIM To assess tolerability, acceptability and quality of TNE, in comparison with standard upper endoscopy (SOGD, standard oesophago-gastro-duodenoscopy) under local anaesthetic. METHODS We prospectively recruited 157 patients (83 females/74 males) mean age 57 years. The Fujinon EG530N (5.9 mm) and EG530WR (9.4 mm) endoscopes were used. The endoscopist and all patients completed detailed questionnaires regarding tolerability, acceptance and quality of endoscopy using standard visual analogue scales (VAS). Oxygen saturation (SaO2 ), heart rate (HR) and systolic blood pressure (SBP) were recorded. Quality of biopsies was evaluated. RESULTS Analysis included 161 procedures (TNE:79, SOGD:82) with duodenal intubation achieved in all patients. VAS scores for patient comfort were significantly better in the TNE group (7.3 vs. 5.3 respectively, P < 0.001). Twenty patients with previous experience of standard endoscopy were randomised to TNE and 19 of them (95.5%) preferred the TNE. Gagging was significantly less in the TNE group (0.12 vs. 3.41 respectively, P < 0.001). Cardiovascular stress was significantly less in the TNE group irrespective of the degree of gagging or comfort. TNE biopsies were smaller, but adequate for definitive diagnosis, similarly to standard endoscopy. CONCLUSIONS Transnasal endoscopy is superior to SOGD in terms of comfort and patient acceptance with significantly less cardiovascular stress. TNE can routinely be used as alternative to SOGD under local anaesthetic, for diagnosis and should be preferentially offered in cardiorespiratory compromised patients.
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Affiliation(s)
- E Alexandridis
- Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
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10
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Ji YL, Lu W, Zhang ZG, Li M, Zhang XL, Liu X. Gastric mucosal injury induced by dual antiplatelet drugs in rats. Shijie Huaren Xiaohua Zazhi 2014; 22:2414-2420. [DOI: 10.11569/wcjd.v22.i17.2414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the effect of different antiplatelet drugs on gastric mucosal injury in rats and the possible mechanisms involved.
METHODS: Eighty 6-7-week-old male SD rats were randomly allocated into four groups. Except a negative control group, the other three groups were given clopidogrel [7.81 mg/(kg•d), n = 20], aspirin [10.41 mg/(kg•d), n = 20] and clopidogrel plus aspirin (n = 20), respectively. The drugs were intragastrically administered once daily, and the negative control group was given normal saline (n = 20). All rats received operation after the final intragastric administration to observe gastric injury. The degree of gastric and small intestinal mucosal injury was assessed by HE staining, and the expression of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) in gastric mucosal cells was detected by immunohistochemistry.
RESULTS: The scores of gross and pathological lesions were significantly higher in each drug treatment group than in the negative control group (P < 0.01), in the aspirin group than in the clopidogrel group (13.4000 ± 3.28634 vs 8.8000 ± 1.48324, P < 0.01), and in the combination group than in the two monotherapy groups (P < 0.01). Immunohistochemistry analysis revealed that the expression of TNF-α and IL-1β in the gastric and small intestinal mucosa was significantly higher in each drug treatment group than in the negative control group (P < 0.01), in the aspirin group than in the clopidogrel group (P < 0.01), and in the combination group than in the two monotherapy groups (P < 0.01).
CONCLUSION: Routine doses of antiplatelet drugs can cause gastrointestinal injury in rats, and the combination of antiplatelet drugs aggravates the injury compared with monotherapy. The high expression of TNF-α and IL-1β may be involved in mucosal injury induced by antiplatelet drugs.
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Rivory J, Lépilliez V, Gincul R, Guillaud O, Vallin M, Bouffard Y, Sagnard P, Ponchon T, Dumortier J. "First look" unsedated transnasal esogastroduodenoscopy in patients with upper gastrointestinal bleeding? A prospective evaluation. Clin Res Hepatol Gastroenterol 2014; 38:209-18. [PMID: 24268304 DOI: 10.1016/j.clinre.2013.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 09/04/2013] [Accepted: 10/10/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS With small diameter endoscopes, transnasal esophagogastroduodenoscopy (t-EGD) is routinely performed. The aim of this prospective observational study was to evaluate the role of t-EGD for upper gastrointestinal bleeding (UGIB). PATIENTS AND METHODS One hundred and forty-five consecutive patients (mean age, 66±18.4 years) with suspicion of UGIB were classified a priori into 3 groups according to initial clinical presentation: (1) intensive care unit with EGD under sedation, (2) endoscopy unit with EGD under transient sedation and (3) unsedated t-EGD as "first look". Demographic, clinical and biological parameters, Rockall and Blatchford scores, endoscopic diagnosis and treatment, and outcome were analysed. RESULTS Unsedated t-EGD was attempted in 89 patients, performed in 52 (5 failures, 28 contraindications) and the procedure was converted under sedation for 2 patients. Based on ASA classification, clinical (blood pressure, hemodynamical failure) and biological variables (hemoglobin, platelets, creatinine), these patients were less severe than in the other groups. Pre-endoscopic Rockall and Blatchford scores were significantly lower in this group. More patients in this group presented significant cardiovascular co-morbidity (47.2%), taking aspirin, clopidogrel and/or anticoagulant. CONCLUSIONS Our results strongly support that "first look" unsedated t-EGD can avoid unnecessary sedation in selected patients with UGIB, presenting a low probability for endoscopic haemostatic treatment and high sedation risks.
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Affiliation(s)
- Jérôme Rivory
- Hospices civils de Lyon, hôpital Edouard-Herriot, fédération des spécialités digestives, Lyon, France; Université Claude-Bernard Lyon-1, Villeurbanne, France
| | - Vincent Lépilliez
- Hospices civils de Lyon, hôpital Edouard-Herriot, fédération des spécialités digestives, Lyon, France
| | - Rodica Gincul
- Hospices civils de Lyon, hôpital Edouard-Herriot, fédération des spécialités digestives, Lyon, France
| | - Olivier Guillaud
- Hospices civils de Lyon, hôpital Edouard-Herriot, fédération des spécialités digestives, Lyon, France
| | - Mélanie Vallin
- Hospices civils de Lyon, hôpital Edouard-Herriot, fédération des spécialités digestives, Lyon, France; Université Claude-Bernard Lyon-1, Villeurbanne, France
| | - Yves Bouffard
- Hospices civils de Lyon, hôpital Edouard-Herriot, département d'anesthésie-réanimation, Lyon, France
| | - Pierre Sagnard
- Hospices civils de Lyon, hôpital Edouard-Herriot, département d'anesthésie-réanimation, Lyon, France
| | - Thierry Ponchon
- Hospices civils de Lyon, hôpital Edouard-Herriot, fédération des spécialités digestives, Lyon, France; Université Claude-Bernard Lyon-1, Villeurbanne, France
| | - Jérôme Dumortier
- Hospices civils de Lyon, hôpital Edouard-Herriot, fédération des spécialités digestives, Lyon, France; Université Claude-Bernard Lyon-1, Villeurbanne, France.
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Analysis of cardiopulmonary stress during endoscopy: is unsedated transnasal esophagogastroduodenoscopy appropriate for elderly patients? Can J Gastroenterol Hepatol 2014; 28:31-4. [PMID: 24288691 PMCID: PMC4071900 DOI: 10.1155/2014/291204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Transnasal esophagogastroduodenoscopy (EGD) without sedation has been reported to be safe and tolerable. It has recently been used widely in Japan for the detection of upper gastrointestinal disease. Alternatively, transoral examination using a thin endoscope has also been reported to be highly tolerable. OBJECTIVE To examine the cardiocirculatory effects of transoral versus transnasal EGD in an attempt to determine the most suitable endoscopic methods for patients ≥75 years of age. METHODS Subjects who underwent monitoring of respiratory and circulatory dynamics without sedation during endoscopic screening examinations were enrolled at the New Ooe Hospital (Kyoto, Japan) between April 2008 and March 2009. A total of 165 patients (age ≥75 years) provided written informed consent and were investigated in the present study. Patients were randomly divided into three subgroups: UO group--thin endoscope; SO group--standard endoscope; and UT group--transnasal EGD. Percutaneous arterial blood oxygen saturation, heart rate and blood pressure were evaluated just before EGD and at five time points during EGD. After transnasal EGD, patients who had previously been examined using transoral EGD with a standard endoscope were asked about preferences for their next examination. RESULTS There were no statistical differences in the characteristics among the groups. Percutaneous oxygen saturation in the UT group showed a transient drop compared with the SO and UO groups at the beginning of the endoscopic procedure. Heart rate showed no significant differences among the SO, UO and UT groups; Systolic blood pressure in the UO group was lower immediately after insertion compared with the SO and UT groups. The rate pressure product in the UO group was comparable with that in the UT group during endoscopy, and the SO group showed a continuously higher level than the UO and UT groups. More than one-half (54.4%) of patients were 'willing to choose transnasal EGD for next examination'. CONCLUSIONS For elderly patients, unsedated transnasal EGD failed to show an advantage over unsedated standard endoscopy. Transoral thin EGD was estimated to be safe and tolerable.
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Streckfuss A, Bosch N, Plinkert PK, Baumann I. Transnasal flexible esophagoscopy (TNE): an evaluation of the patient’s experience and time management. Eur Arch Otorhinolaryngol 2013; 271:323-8. [DOI: 10.1007/s00405-013-2633-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 07/09/2013] [Indexed: 01/05/2023]
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Miyake K, Kusunoki M, Ueki N, Yamada A, Nagoya H, Kodaka Y, Shindo T, Kawagoe T, Gudis K, Futagami S, Tsukui T, Sakamoto C. Classification of patients who experience a higher distress level to transoral esophagogastroduodenoscopy than to transnasal esophagogastroduodenoscopy. Dig Endosc 2013; 25:397-405. [PMID: 23368664 DOI: 10.1111/den.12006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 10/15/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND In Japanese routine clinical practice, endoscopy is generally carried out without sedation. The present study aimed to identify the factors essential for appropriate selection of transnasal esophagogastroduodenoscopy (TN-EGD) as an alternative to unsedated transoral esophagogastroduodenoscopy (TO-EGD). PATIENTS AND METHODS Subjects in this prospective cohort study comprised consecutive outpatients who underwent EGD at a single center. Factors predicting TO-EGD-induced distress were evaluated on a visual analog scale (VAS) and analyzed. Patients were classified into a two-layered system on the basis of these predictive factors, and the severity of distress between the TN-EGD and TO-EGD groups was compared using VAS and the change in the rate-pressure product as subjective and objective indices, respectively. RESULTS In total, 728 outpatients (390 male, 338 female; mean age, 63.1 ± 0.5 years; TO-EGD group, 630; TN-EGD group, 98)met the inclusion criteria. Multivariate logistic regression analysis confirmed that age <65 years (P < 0.01; odds ratio [OR], 1.69; 95% confidence interval [CI], 1.14-2.52), gender (female; P < 0.01; OR,1.97; 95% CI, 1.34-2.91), marital status (single; P < 0.01; OR, 1.96; 95% CI, 1.18-3.27), and anxiety towards TO-EGD (P < 0.001; OR, 3.62; 95% CI, 2.44-5.37) were independently associated with intolerance. Both indices were significantly higher in the TO-EGD subgroup than in the TN-EGD subgroup in the high predictive class, but not in the low predictive class. CONCLUSION Predictive factors for detecting intolerance to unsedated TO-EGD may be useful to appropriately select patients who transpose unsedated TO-EGD to TN-EGD.
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Affiliation(s)
- Kazumasa Miyake
- Department of Gastroenterology, Nippon Medical School, Tokyo, Japan.
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15
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Enomoto S, Watanabe M, Yoshida T, Mukoubayashi C, Moribata K, Muraki Y, Shingaki N, Deguchi H, Ueda K, Inoue I, Maekita T, Iguchi M, Tamai H, Kato J, Fujishiro M, Oka M, Mohara O, Ichinose M. Relationship between vomiting reflex during esophagogastroduodenoscopy and dyspepsia symptoms. Dig Endosc 2012; 24:325-30. [PMID: 22925284 DOI: 10.1111/j.1443-1661.2012.01241.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM Although frequent vomiting reflexes during esophagogastroduodenoscopy (EGD) causes suffering in patients, very few studies have investigated the characteristics of subjects who frequently develop vomiting reflexes. This study examined the incidence of the vomiting reflex and related factors, especially upper gastrointestinal symptoms, among individuals undergoing transoral EGD. METHODS Subjects included 488 consecutive adults (mean age, 56.1 ± 8.9 years) who underwent transoral EGD for gastric cancer screening between February 2010 and March 2011. All procedures were performed by an endoscopist with 15 years of experience. Based on a questionnaire survey using the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG), symptoms (dyspepsia and acid reflux symptoms) and the number of vomiting reflexes during EGD were recorded. RESULTS Of the 488 subjects, 271 (56%) developed vomiting reflexes (mean, 4.2 times). This reflex-positive group was younger (54.3 ± 9.5 years) than the reflex-negative group (58.3 ± 7.7 years, P < 0.001). The number of subjects in the reflex-positive group with a high FSSG dyspepsia score (2.27 ± 2.57 vs 1.23 ± 1.84; P < 0.001), acid reflux symptom score (1.96 ± 2.22 vs 1.34 ± 2.14; P < 0.01) or an esophageal hiatal hernia (14.8% vs 4.6%; P < 0.001) was significantly higher than in the reflex-negative group. Multivariate analysis also showed a significant correlation between these four factors and the occurrence of vomiting reflexes. Using an FSSG dyspepsia score of 1 as the cut-off offered 68% sensitivity and 57% specificity for predicting the occurrence of vomiting reflexes. CONCLUSION Based on FSSG questionnaire responses on upper gastrointestinal symptoms, dyspepsia symptoms, in particular, are related to presence of vomiting reflexes during EGD.
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Affiliation(s)
- Shotaro Enomoto
- Second Department of Internal Medicine, Wakayama Medical University, Japan.
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A randomized trial of topical anesthesia comparing lidocaine versus lidocaine plus xylometazoline for unsedated transnasal upper gastrointestinal endoscopy. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2010; 24:317-21. [PMID: 20485707 DOI: 10.1155/2010/154791] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The optimal topical anesthesia regimen for unsedated transnasal endoscopy is unknown. The addition of a nasal decongestant, such as xylometazoline (X), to a topical anesthestic may improve patient comfort. OBJECTIVE To determine the effectiveness of lidocaine (L) versus L plus X (LX) for anesthesia in unsedated transnasal endoscopy. METHODS Consecutive participants of the Aklavik Helicobacter pylori project were prospectively randomly assigned to receive LX or L for unsedated transnasal 4.9 mm ultrathin endoscopy. The primary outcome was overall procedure discomfort on a validated 10-point visual analogue scale (1 = no discomfort, 10 = severe discomfort). Secondary outcomes included pain, endoscope insertion difficulty, gagging, adverse events and encounter times. Results were presented as mean +/- SD, difference in mean, 95% CI. RESULTS A total of 181 patients were randomly assigned to receive LX (n=94) and L (n=87). Baseline characteristics between the two groups were similar (mean age 40 years, 59% women). Overall, patient procedural discomfort with LX and L were 4.2+/-2.4 versus 3.9+/-2.1, respectively (0.29; 95% CI -0.39 to 0.96). Transnasal insertion difficulty was significantly lower with LX than with L (2.4+/-2.1 versus 3.2+/-2.8, respectively [-0.80; 95% CI -1.54 to -0.06]). Compared with L, the use of LX was associated with significantly less time needed to apply anesthesia (2.4+/-1.8 min versus 3.5+/-2.2 min, respectively [-1.10; 95% CI -1.71 min to -0.50 min]) and less time for insertion (3.2+/-1.8 min versus 3.9+/-2.2 min, respectively [-0.70 min; 95% CI -1.30 min to -0.10 min]). Epistaxis was rare but occurred less frequently with LX (1.1%) than with L (4.6%) (P=0.19). CONCLUSIONS LX did not improve patient comfort for transnasal endoscopy compared with L alone. However, LX was associated with less difficulty with endoscope transnasal insertion and reduced insertion time. Further studies on the optimal regimen and dosing of anesthesia are required.
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Rodriguez SA, Banerjee S, Desilets D, Diehl DL, Farraye FA, Kaul V, Kwon RS, Mamula P, Pedrosa MC, Varadarajulu S, Song LMWK, Tierney WM. Ultrathin endoscopes. Gastrointest Endosc 2010; 71:893-8. [PMID: 20438882 DOI: 10.1016/j.gie.2010.01.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 01/13/2010] [Indexed: 01/11/2023]
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Watanabe H, Watanabe N, Ogura R, Nishino N, Saifuku Y, Hitomi G, Okamoto Y, Tominaga K, Yoshitake N, Yamagata M, Orui M, Hiraishi H. A randomized prospective trial comparing unsedated endoscopy via transnasal and transoral routes using 5.5-mm video endoscopy. Dig Dis Sci 2009; 54:2155-60. [PMID: 19082719 DOI: 10.1007/s10620-008-0614-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Accepted: 11/03/2008] [Indexed: 12/09/2022]
Abstract
We performed a randomized prospective trial to compare unsedated endoscopy via transnasal and transoral routes using a small-caliber endoscope. Two hundred patients referred for diagnostic esophagogastroduodenoscopy (EGD) were randomly allocated to two groups: those undergoing transnasal (TN) and transoral (TO) endoscopy. We examined the insertion rate, examination duration, nasal pain, pharyngeal pain, number of occurrences of pharyngeal reflex, severity of discomfort throughout the examination, and rate of adverse events. Patients were asked to rate the severity of their pain or discomfort on a 10-cm visual analog scale (VAS). We identified statistically significant differences between the TN and TO groups in rate of insertion (95% versus 100%, respectively, P < 0.05) and examination duration (9.7 +/- 3.0 min versus 8.4 +/- 2.7 min, respectively, P < 0.005). Severity of discomfort throughout the examination was comparable in the TN and TO groups (3.0 +/- 1.8 versus 2.9 +/- 2.3, NS). Nasal bleeding occurred as an adverse event in 4.1% of patients in the TN group. Patients in the TO group were more likely than those in the TN group to prefer the present method in the subsequent endoscopic examination (99.0% versus 82.1%, P < 0.00005). These results indicated that transoral insertion is superior to transnasal insertion in endoscopy procedures performed with small-caliber endoscope.
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Affiliation(s)
- Hidetaka Watanabe
- Department of Gastroenterology, Dokkyo Medical University, Mibu, Tochigi 321-0293, Japan.
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Yasaka S, Murakami K, Abe T, Anan J, Mizukami K, Tanahashi J, Okimoto T, Kodama M, Kudo Y, Kawasaki H, Fujioka T. Evaluation of esophageal function in patients with gastroesophageal reflux disease using transnasal endoscopy. J Gastroenterol Hepatol 2009; 24:1677-82. [PMID: 19788608 DOI: 10.1111/j.1440-1746.2009.05973.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS To investigate the utility of a new method of carrying out esophageal manometry using a narrow gauge manometry catheter via a transnasal endoscope. METHODS The Frequency Scale for the Symptoms of gastroesophageal reflux disease (GERD) (FSSG), a GERD-specific questionnaire, was given to 45 subjects. Subjects underwent transnasal endoscopy with three dry and three wet (3 mL water) swallows. Direct observations of the primary peristaltic wave and peristaltic pressure measurement were conducted simultaneously. RESULTS Endoscopic observation of lower esophageal motility associated with swallowing revealed dilatation of the esophageal lumen after swallowing, followed by contraction in association with the primary peristaltic wave. The peristaltic pressure was significantly lower with increased FSSG scores for dry swallows (r = -0.347, P = 0.0212), but no significant correlation was seen for wet swallows. CONCLUSIONS The significant negative correlation between reflux symptoms and peristaltic pressure in dry swallows was thought to be that reduced pressure immediately rostral to the lower esophageal sphincter leads to decreased clearance following gastric acid reflux, playing a large part in the onset of symptoms.
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Affiliation(s)
- Shigeaki Yasaka
- Department of Gastroenterology, Oita University Faculty of Medicine, Yufu, Oita 879-5593, Japan.
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Adoption of a sitting position in transnasal gastroscopy: a new approach. Am J Gastroenterol 2009; 104:790-1. [PMID: 19262530 DOI: 10.1038/ajg.2008.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
Transnasal esophagogastroduodenoscopy (TN-EGD) has recently become one of the frequently used methods of upper gastrointestinal endoscopy in some countries. Changes in blood pressure, heart rate, and oxygen saturation are smaller for TN-EGD than for conventional transoral esophagogastroduodenoscopy, making it a safer procedure. Lower pain and gag reflex enable TN-EGD to be performed without conscious sedation. TN-EGD is applied in various gastrointestinal (GI) procedures such as percutaneous endoscopic gastrostomy, nasoenteric feeding tube placement, endoscopic retrograde cholangiopancreaticography with nasobiliary drainage and lithotripsy, long intestinal tube placement in small-bowel obstruction, esophageal manometry, foreign body removal, botulinum toxin injection for achalasia, esophageal varix evaluation with the aid of endoscopic ultrasonography, and the double-scope technique for endoscopic submucosal dissection. The establishment of standard training programs and nationwide guidelines, the dissemination of educational information, the improvement in endoscopy devices and accessories, and the availability of insurance coverage for the procedure will obviously further widen the adoption of TN-EGD.
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Affiliation(s)
- Sun-Young Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
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Dumonceau JM, Dumortier J, Deviere J, Kahaleh M, Ponchon T, Maffei M, Costamagna G. Transnasal OGD: practice survey and impact of a live video retransmission. Dig Liver Dis 2008; 40:776-83. [PMID: 18436491 DOI: 10.1016/j.dld.2008.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Revised: 03/02/2008] [Accepted: 03/03/2008] [Indexed: 12/11/2022]
Abstract
BACKGROUND Unsedated transnasal oesogastroduodenoscopy significantly improves patient tolerance compared to unsedated conventional peroral oesogastroduodenoscopy. AIMS To assess the adoption of transnasal oesogastroduodenoscopy among endoscopists from various European countries and its determinants. METHODS A survey was distributed to 624 endoscopists attending a live course on digestive endoscopy; a poll was also performed immediately before and after live video retransmission of a transnasal oesogastroduodenoscopy. RESULTS Answer rate was 48%; transnasal oesogastroduodenoscopy was practised by 31% of respondents. In multivariate analysis, practice of transnasal oesogastroduodenoscopy was associated with location in France and Netherlands (P<0.0001), availability of many gastroscopes (P<0.0001) and less frequent use of sedation (P=0.006). Endoscopists who did not practise transnasal oesogastroduodenoscopy cited doubts about its advantages over conventional oesogastroduodenoscopy and lack of training (34% each) as barriers to adoption. Seventy-four percent of endoscopists practicing transnasal oesogastroduodenoscopy did actually use it in <20% of eligible cases. Live video retransmission of a transnasal oesogastroduodenoscopy increased the proportion of endoscopists interested in this technique (P=0.006). CONCLUSIONS Adoption of transnasal oesogastroduodenoscopy largely varies between European countries; endoscopists practicing this technique use it in a minority of eligible cases. Live case demonstration may decrease barriers to the adoption of this technique.
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Affiliation(s)
- J M Dumonceau
- Division of Gastroenterology and Hepatology, Geneva University Hospital, Micheli-du-Crest Street 24, 1205 Geneva, Switzerland.
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Stroppa I, Grasso E, Paoluzi OA, Razzini C, Tosti C, Andrei F, Biancone L, Palmieri G, Romeo F, Pallone F. Unsedated transnasal versus transoral sedated upper gastrointestinal endoscopy: a one-series prospective study on safety and patient acceptability. Dig Liver Dis 2008; 40:767-75. [PMID: 18424197 DOI: 10.1016/j.dld.2008.02.033] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Revised: 02/14/2008] [Accepted: 02/18/2008] [Indexed: 12/11/2022]
Abstract
BACKGROUND While conventional oesophagogastroduodenoscopy is frequently performed under sedation to improve acceptability, transnasal oesophagogastroduodenoscopy would appear to be less invasive. STUDY AIMS To compare diagnostic accuracy, feasibility, acceptability and safety of transnasal oesophagogastroduodenoscopy without sedation versus conventional oesophagogastroduodenoscopy under sedation. PATIENTS Following anxiety assessment, 30 dyspeptic patients underwent transnasal oesophagogastroduodenoscopy under local anaesthesia (lidocaine) and conventional oesophagogastroduodenoscopy under conscious sedation (i.v. midazolam) on two consecutive days. Transnasal oesophagogastroduodenoscopy was performed with an ultrathin and conventional oesophagogastroduodenoscopy with a standard endoscope. METHODS Safety, evaluated by monitoring cardio-respiratory functions. Acceptability, rated according to discomfort and preference between the two examinations. Diagnostic accuracy evaluated taking into account endoscopic patterns and adequacy of biopsy specimens for histology. Feasibility, defined according to endoscopic performance, quality of images and overall opinion of the endoscopist. Only gastric biopsies were evaluated. RESULTS All patients but one who refused conventional oesophagogastroduodenoscopy underwent both transnasal oesophagogastroduodenoscopy and conventional oesophagogastroduodenoscopy. No cardiorespiratory complications occurred during either technique. Majority of patients (87%) preferred transnasal oesophagogastroduodenoscopy. Examinations were completed in all cases, with comparable endoscopic patterns. All biopsy specimens were suitable for histology. CONCLUSIONS Transnasal oesophagogastroduodenoscopy without sedation provides good diagnostic accuracy, is safer and better accepted than conventional oesophagogastroduodenoscopy under sedation and, therefore, represents a valid alternative in routine diagnosis of upper digestive tract diseases.
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Affiliation(s)
- I Stroppa
- Gastrointestinal Unit, Department of Internal Medicine, Tor Vergata University, Rome, Italy.
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Hu CT. Endoscopic-guided versus cotton-tipped applicator methods of nasal anesthesia for transnasal esophagogastroduodenoscopy: a randomized, prospective, controlled study. Am J Gastroenterol 2008; 103:1114-21. [PMID: 18445099 DOI: 10.1111/j.1572-0241.2007.01769.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ultrathin transnasal esophagogastroduodenoscopy (UT-EGD) is well tolerated by patients, but the methods of nasal anesthesia are various. AIM To compare patient tolerance, safety, and adverse events between the endoscopic-guided (EGNA) and cotton-tipped applicator (CTNA) methods of nasal anesthesia. METHODS Between September 2005 and September 2006, we conducted a prospective, randomized, controlled study in a large tertiary referral hospital in eastern Taiwan. In total, 235 consecutive patients were randomly assigned to the CTNA group or EGNA group before unsedated UT-EGD. We compared demographic data, procedural discomfort using a validated 5-point visual analog scale, optical quality, total procedure time, and adverse events between the two groups. RESULTS After randomization and exclusion, 101 (43 men and 58 women) and 103 (44 men and 59 women) patients were allocated to the CTNA and EGNA groups, respectively. Baseline characteristics and periprocedural hemodynamics of patients in the two groups were similar. There was no statistical difference in insertion failure rates between the two methods (CTNA 10.9%vs EGNA 7.7%, P= 0.59). Pain scores during both anesthesia (2.3 +/- 0.4 vs 3.5 +/- 0.6, P < 0.001) and insertion (2.8 +/- 1.2 vs 3.8 +/- 1.8, P < 0.001) were significantly lower in the EGNA group; however, the sensation of bad taste was significantly worse in the EGNA group (2.3 +/- 1.3 vs 1.9 +/- 1.4, P= 0.040). Less epistaxis happened in the EGNA group than in the CTNA group. The EGNA method had a significantly better visual capacity and shorter procedure time. More patients in the EGNA group said they would like to receive the same procedure the next time. CONCLUSION Compared with the CTNA method, in which the taste of lidocaine gel was more acceptable, EGNA appeared to be more tolerable, caused less epistaxis, improved visualization capacity, and reduced procedure time.
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Affiliation(s)
- Chi-Tan Hu
- Division of Gastroenterology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
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Dumortier J, Josso C, Roman S, Fumex F, Lepilliez V, Prost B, Lot M, Guillaud O, Petit-Laurent F, Lapalus MG, Ponchon T. Prospective evaluation of a new ultrathin one-plane bending videoendoscope for transnasal EGD: a comparative study on performance and tolerance. Gastrointest Endosc 2007; 66:13-9. [PMID: 17591468 DOI: 10.1016/j.gie.2006.11.058] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Accepted: 11/27/2006] [Indexed: 12/14/2022]
Abstract
BACKGROUND EGD, with small-diameter endoscopes, is routinely performed via a nasal route in adults. OBJECTIVE To evaluate a new ultrathin one-plane bending videoendoscope for transnasal EGD. DESIGN Single center, prospective, randomized study. SETTING Edouard Herriot University Hospital. PATIENTS A total of 122 outpatients (median age, 49 years [18-81 years], 62 men and 60 women) were randomized into 2 groups (on a 2:1 basis) according to the endoscope used: (1) a standard 5.9-mm-diameter videoendoscope (80 patients) or (2) a one-plane bending high resolution 4.9-mm-diameter videoendoscope (42 patients). MAIN OUTCOME MEASUREMENTS The operator assessed the quality of examination by using standard scores or a 100-mm visual scale. Patients quantified tolerance by using a 100-mm visual scale. RESULTS The duration of the procedure was the same in each group. The feasibility of transnasal insertion was significantly higher when using the 4.9-mm-diameter endoscope (97.61% [41/42 patients] vs 88.75% [71/80 patients], P<.05). The tolerance of EGD was significantly better in the group with the small videoendoscope, for global discomfort, pain, belching, and bloating. Similarly, acceptation of a new EGD in similar conditions was higher in group 2 (92.9% vs 80%, P<.05). The quality of examination (global, lavage, inflation, suction) was not different between the 2 groups. LIMITATIONS Evaluation of patient tolerance and quality of examination was based on subjective features. CONCLUSIONS Availability of a new ultrathin one-plane bending videoendoscope represents a major technical improvement for transnasal EGD, which significantly improves both feasibility and patient tolerance, without affecting the quality of the examination.
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Affiliation(s)
- Jérôme Dumortier
- Department of Digestive Diseases, Hôpital Edouard Herriot, Lyon, France
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Trevisani L, Cifalà V, Sartori S, Gilli G, Matarese G, Abbasciano V. Unsedated ultrathin upper endoscopy is better than conventional endoscopy in routine outpatient gastroenterology practice: A randomized trial. World J Gastroenterol 2007; 13:906-11. [PMID: 17352021 PMCID: PMC4065927 DOI: 10.3748/wjg.v13.i6.906] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM: to compare the feasibility and patients’ tolerance of esophagogastroduodenoscopy (EGD) using a thin endoscope with those of conventional oral EGD and to determine the optimal route of introduction of small-caliber endoscopes.
METHODS: One hundred and sixty outpatients referred for diagnostic EGD were randomly allocated to 3 groups: conventional (C)-EGD (9.8 mm in diameter), transnasal (TN)-EGD and transoral (TO)-EGD (5.9 mm in diameter). Pre-EGD anxiety was measured using a 100-mm visual analogue scale (VAS). After EGD, patients and endoscopists completed a questionnaire on the pain, nausea, choking, overall discomfort, and quality of the examination either using VAS or answering some questions. The duration of EGD was timed. Blood oxygen saturation (SaO2) and heart rate (HR) were monitored during EGD.
RESULTS: Twenty-one patients refused to participate in the study. The 3 groups were well-matched for age, gender, experience with EGD, and anxiety. EGD was completed in 91.1% (41/45), 97.5% (40/41), and 96.2% (51/53) of cases in TN-EGD, TO-EGD, and C-EGD groups, respectively. TN-EGD lasted longer (3.11 ± 1.60 min) than TO-EGD (2.25 ± 1.45 min) and C-EGD (2.49 ± 1.64 min) (P < 0.05). The overall tolerance was higher (P < 0.05) and the overall discomfort was lower (P < 0.05) in TN-EGD group than in C-EGD group. EGD was tolerated “better than expected” in 73.2% of patients in TN-EGD group and 55% and 39.2% of patients in TO-EGD and C-EGD groups, respectively (P < 0.05). Endoscopy was tolerated “worst than expected” in 4.9% of patients in TN-EGD group and 17.5% and 23.5% of patients in TO-EGD and C-EGD groups, respectively (P < 0.05). TN-EGD caused mild epistaxis in one case. The ability to insufflate air, wash the lens, and suction of the thin endoscope were lower than those of conventional instrument (P < 0.001). All biopsies performed were adequate for histological assessment.
CONCLUSION: Diagnostic TN-EGD is better tolerated than C-EGD. Narrow-diameter endoscope has a level of diagnostic accuracy comparable to that of conventional gastroscope, even though some technical characteristics of these instruments should be improved. Transnasal EGD with narrow-diameter endoscope should be proposed to all patients undergoing diagnostic EGD.
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Affiliation(s)
- Lucio Trevisani
- Centro di Endoscopia Digestiva, Azienda Ospedaliera-Universitaria Arcispedale S. Anna, C.so Giovecca 203, Ferrara 44100, Italy.
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Simón MA, Bordas JM, Campo R, González-Huix F, Igea F, Monés J. [Consensus document of the Spanish Association of Gastroenterology on sedoanalgesia in digestive endoscopy]. GASTROENTEROLOGIA Y HEPATOLOGIA 2006; 29:131-49. [PMID: 16507280 DOI: 10.1157/13085143] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- M A Simón
- Unidad de Endoscopia Digestiva, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
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Lin CH, Liu NJ, Lee CS, Tang JH, Wei KL, Yang C, Sung KF, Cheng CL, Chiu CT, Chen PC. Nasogastric feeding tube placement in patients with esophageal cancer: application of ultrathin transnasal endoscopy. Gastrointest Endosc 2006; 64:104-7. [PMID: 16813813 DOI: 10.1016/j.gie.2005.12.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2004] [Accepted: 12/28/2005] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients with esophageal cancer often present with dysphagia and malnutrition. Obstructive symptoms may improve after radiotherapy and chemotherapy. Nutrition support via a nasogastric tube (NG) or gastrostomy is very important during treatment. The newly developed ultrathin endoscope (Olympus, GIF-N230, outer diameter: 6 mm) has a smaller diameter than the standard endoscope and can be introduced into the esophagus via the nasal cavity. This article reports on the use of an ultrathin endoscope for NG placement for patients with esophageal cancer who presented with dysphagia and failed traditional NG tube placement. METHODS A consecutive series of 40 patients with esophageal cancer were referred to our hospital from November 2001 to October 2002 for endoscopic placement of NG tubes due to failure of traditional methods of NG placement. An ultrathin endoscope was used to advance the guidewire into the stomach via the nasal cavity. After withdrawal of the scope, the NG tube was inserted over the guidewire under fluoroscopy. OBSERVATIONS A total of 71 procedures were performed in 40 patients (37 males, 3 females), age 57 +/- 15 years (range, 37-91 y). Seventy procedures (99%) were successful in completing NG tube placement by using an ultrathin transnasal endoscope. Only one procedure failed because the esophageal lumen was completely occluded and the guidewire was not able to be passed through the obstructed site. The average duration that the NG tube was left in place was 49 +/- 35 days (range, 2-144 days). No procedure-related complications, such as bleeding or perforation, occurred. CONCLUSIONS Using ultrathin transnasal endoscopy to place an NG tube for esophageal cancer patients is effective and safe. It simplifies the procedures and increases the success rate.
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Affiliation(s)
- Cheng-Hui Lin
- Division of Digestive Therapeutic Endoscopy, Department of Hepatogastroenterology, Chang Gung Memorial Hospital, Linkou, 5 Fu-Shin Street, Kweishan, Taoyuan, Taiwan
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Abstract
Endoscopy during pregnancy raises the unique issue of fetal safety. Endoscopic medications comprise a significant component of fetal risks from endoscopy. Before endoscopy, the gastroenterologist or anesthesiologist should evaluate the potential fetal risks of sedation and analgesia, identify any contraindications to endoscopy, stabilize the maternal medical status as necessary, and correct maternal hypoxia or hypotension. The mother should be informed about the potential teratogenic risks of endoscopic medications during pregnancy. Patients who receive sedation and analgesia should be monitored during endoscopy by continuous electrocardiography, continuous pulse oximetry, and intermittent sphygmomanometry, as well as by the pulse and respiratory rate. General principles of sedation and analgesia during pregnancy include use of the minimal effective dose, avoidance of unnecessary medications, and preferable use of Food and Drug Administration category B medications.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, Albert Einstein Medical Center, Klein Professional Building, Philadelphia, PA 19141, USA.
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Abstract
Unsedated endoscopy will likely play an increasingly important role in the daily practice of GI endoscopy. Although there is adequate evidence that un-sedated endoscopy is technically feasible in selected patient populations, there area number of obstacles preventing its widespread adoption. Small-caliber endoscopy is not as accurate as conventional EGD. This may be remedied as improvements in endoscope technology emerge. Many patients refuse to consider an unsedated examination, and those who do participate report more symptoms of discomfort than patients undergoing conventional endoscopy. Whether patients will accept mild discomfort in exchange for substantial cost savings has not been evaluated. Finally, although unsedated endoscopy seems to have a low complication rate, its safety has not been formally addressed in large studies. Large, randomized, controlled studies are needed to better determine the role of un-sedated small-caliber endoscopy in daily practice. Unsedated colonoscopy may follow the footsteps of unsedated upper endoscopy with even more obstacles to overcome before its widespread application.
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Affiliation(s)
- Elizabeth J Carey
- Division of Gastroenterology and Hepatology, Mayo Clinic Scottsdale, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA
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Affiliation(s)
- Darius Sorbi
- Division of Gastroenterology and Hepatology, Mayo Clinic Scottsdale, Scottsdale, Arizona 85259, USA
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Cappell MS. The fetal safety and clinical efficacy of gastrointestinal endoscopy during pregnancy. Gastroenterol Clin North Am 2003; 32:123-79. [PMID: 12635415 DOI: 10.1016/s0889-8553(02)00137-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
More than 12,000 pregnant patients in the United States per annum have conditions that are normally evaluated by EGD. More than 6000 pregnant patients in the United States per annum have conditions that are normally evaluated by sigmoidoscopy or colonoscopy. About one thousand more have symptomatic choledocholithiasis during pregnancy, which is a strong indication for endoscopic sphincterotomy in nonpregnant patients. Endoscopy during pregnancy raises the unique issue of fetal safety. Endoscopic medications comprise a significant component of fetal endoscopic risks. Safety of EGD during pregnancy has been examined in a case-controlled study of 83 patients, a mailed survey of 73 patients, and 28 case reports. Safety of sigmoidoscopy during pregnancy has been examined in a case-controlled study of 46 patients, a mailed survey of 13 patients, and 10 case reports. Safety of therapeutic ERCP during pregnancy has been analyzed in studies of 23, 10, 6, and 5 patients, and in 32 case reports. These studies suggested that EGD, sigmoidoscopy, and ERCP should be performed when strongly indicated: EGD for significant upper gastrointestinal bleeding, sigmoidoscopy for nonhemorrhoidal rectal bleeding, and ERCP for symptomatic choledocholithiasis when sphincterotomy is contemplated. PEG and colonoscopy are currently considered experimental during pregnancy because of insufficient data on fetal safety. Several cases of PEG and colonoscopy were successfully performed during pregnancy. Performance of endoscopy during pregnancy should increase with further technical refinements, and greater awareness of procedure safety.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, Woodhull Medical Center, 760 Broadway Avenue, Brooklyn, NY 11206, USA
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Dumortier J, Napoleon B, Hedelius F, Pellissier PE, Leprince E, Pujol B, Ponchon T. Unsedated transnasal EGD in daily practice: results with 1100 consecutive patients. Gastrointest Endosc 2003; 57:198-204. [PMID: 12556784 DOI: 10.1067/mge.2003.59] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND EGD can be performed transnasally in adults by using small-diameter endoscopes. A large prospective study was conducted to evaluate the feasibility and tolerance of diagnostic transnasal EGD in daily practice. METHODS Unsedated transnasal EGD was attempted in 1100 consecutive patients, in 3 different institutions, by using a 5.9-mm or a 5.3-mm diameter endoscope. The operator determined whether the procedure was successful or unsuccessful, the reason for failures, and any side effects. The influence of gender, age, endoscope diameter, and type of topical anesthesia on the success or failure of the procedure was evaluated. Patients who previously had undergone peroral EGD were queried as to which procedure they preferred. RESULTS Transnasal EGD was feasible in 93.9% of the patients. The causes of failure were as follows: unsuccessful transnasal insertion (62.7%), patient refusal (19.4%), and nasal pain (17.9%). Female gender, young age (< or =35 years), and larger-endoscope diameter were significant predictive factors for procedure failure. Side effects included the following: epistaxis (2.3%), nasal pain (1.6%), and vaso-vagal reaction (0.3%). A majority (91%) of the patients who previously had undergone unsedated peroral EGD with a standard 9.8-mm diameter endoscope preferred transnasal EGD with a small-diameter endoscope. CONCLUSIONS Transnasal EGD is feasible in daily endoscopic practice and is preferred by patients. Side effects are rare.
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Affiliation(s)
- Jérôme Dumortier
- Department of Digestive Diseases, Hôpital Edouard Herriot, Lyon, France
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Cappell MS, Friedel D. The role of esophagogastroduodenoscopy in the diagnosis and management of upper gastrointestinal disorders. Med Clin North Am 2002; 86:1165-216. [PMID: 12510452 DOI: 10.1016/s0025-7125(02)00075-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Esophagogastroduodenoscopy has revolutionized the clinical management of upper gastrointestinal diseases. Millions of EGDs are performed annually in the United States for many indications, such as gastrointestinal bleeding, abdominal pain, dysphagia, or surveillance of premalignant lesions. Esophagogastroduodenoscopy is very safe, with a low risk of serious complications such as perforation, cardiopulmonary arrest, or aspiration pneumonia. It is a highly sensitive and specific diagnostic test, especially when combined with endoscopic biopsy. Esophagogastroduodenoscopy is increasingly being used therapeutically to avoid surgery. New endoscopic technology such as endosonography, endoscopic sewing, and the endoscopic videocapsule will undoubtedly extend the frontiers and increase the indications for endoscopy.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, Woodhull Medical Center, Department of Medicine, State University of New York, Downstate Medical School, Brooklyn, NY, USA
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Abraham N, Barkun A, Larocque M, Fallone C, Mayrand S, Baffis V, Cohen A, Daly D, Daoud H, Joseph L. Predicting which patients can undergo upper endoscopy comfortably without conscious sedation. Gastrointest Endosc 2002; 56:180-9. [PMID: 12145594 DOI: 10.1016/s0016-5107(02)70175-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Eliminating conscious sedation for diagnostic endoscopy may be advantageous for patient safety and cost containment. The aim of this study was to identify and validate independent predictors of a comfortable, technically adequate, unsedated diagnostic upper endoscopy in Canadian patients. METHODS Patients were consecutively enrolled in a prospective fashion. Data collected on an initial cohort of 268 patients included demographics, a validated anxiety questionnaire, use of sedatives/analgesics, upper endoscopy experience, pharyngeal sensitivity, technical adequacy, and patient assessment of comfort after the procedure. The main outcome measure was "satisfactory upper endoscopy," a composite of optimal scores for patient comfort and technical adequacy. Univariate and multivariate analyses were performed to identify the optimal predictive model of a satisfactory unsedated diagnostic upper endoscopy. Once identified, 68 additional patients were enrolled in a similar fashion from an independent prospective sample for purposes of outcome validation. Multivariate analysis was then repeated with the total cohort (N = 336). These results were then compared for concordance with those obtained from the initial cohort. RESULTS Among the initial 268 patients (54.3% women; mean age 51 +/- 17 years), 49% were anxious, 15% regularly used sedatives and analgesics, 28% experienced increased pharyngeal sensitivity, and 41% had previously undergone upper endoscopy. Endoscopy was completed in 94.7% of patients without sedation and was technically adequate in 97%, and 80.1% were willing to repeat the procedure under similar conditions. Satisfactory upper endoscopy was achieved in only 59% of the initial cohort. The only independent and significant predictors of a satisfactory upper endoscopy were advancing age (OR 1.2: 95% CI [1.1, 1.4]) and decreased pharyngeal sensitivity (OR 0.5: 95% CI [0.27, 0.93]). Concordance of results were noted after validation with the second cohort. Satisfactory endoscopy was achieved in only 59.5% of the total cohort (n = 336); only 61% reported a comfortable procedural experience. CONCLUSIONS The proportion of patients who can comfortably undergo technically adequate unsedated upper endoscopy is modest. Unsedated upper endoscopy is most likely to be successful under these procedural conditions in patients of advancing age with decreased pharyngeal sensitivity. The generalizability of these findings to an American population requires further study and may assist in identifying a subgroup of patients in whom it is cost-effective to perform upper endoscopy comfortably without sedation.
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Affiliation(s)
- Neena Abraham
- The Division of Gastroenterology of the Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
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Zuccaro G. Esophagoscopy and endoscopic esophageal ultrasound in the assessment of esophageal function. Semin Thorac Cardiovasc Surg 2001; 13:226-33. [PMID: 11568868 DOI: 10.1053/stcs.2001.25314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Esophagoscopy is an ideal method to detect mucosal or structural abnormalities of the esophagus and proximal stomach. The exclusion of malignant dysphagia is the prime role of esophagoscopy in assessment of esophageal function. Esophagoscopy and biopsy are mandatory for mucosal assessment of patients with gastroesophageal reflux disease (GERD). Indirect and sometimes subtle evidence of abnormal esophageal motility is a valuable and underused aspect of esophagoscopy in the evaluation of swallowing disorders. Esophagoscopy has multiple roles in the appraisal and treatment of esophageal motility disorders, including the detection of secondary or pseudoachalasia, placement of manometry catheters, and dilation of peptic strictures caused by GERD associated with disorders such as scleroderma.
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Affiliation(s)
- G Zuccaro
- Section of Gastrointestinal Endoscopy, Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Lustberg A, Fleisher AS, Darwin PE. Transnasal placement of percutaneous endoscopic gastrostomy with a pediatric endoscope in oropharyngeal obstruction. Am J Gastroenterol 2001; 96:936-7. [PMID: 11280597 DOI: 10.1111/j.1572-0241.2001.03662.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Külling D, Bauerfeind P, Fried M. Transnasal versus transoral endoscopy for the placement of nasoenteral feeding tubes in critically ill patients. Gastrointest Endosc 2000; 52:506-10. [PMID: 11023568 DOI: 10.1067/mge.2000.107729] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Nasoenteral feeding tube placement with the Seldinger technique using transoral endoscopy is a tedious procedure. This study compared the transoral approach with a new technique that uses a transnasal endoscope without the need for a mouth-to-nose wire transfer. METHODS Critically ill patients requiring nasoenteral feeding tube placement were randomly assigned to the transoral technique using a standard upper endoscope (n = 80) or the transnasal method using a 5.3 mm fiberscope (n = 80). Procedure time, medication requirement, technical difficulty, patient tolerance, and radiologic tube position were assessed. RESULTS The two groups were similar with regard to baseline medication, endoscopic findings, as well as overall technical difficulty and patient tolerance. The transnasal technique required less procedure time (median 8.0 versus 12.0 minutes, p < 0.001) and less relaxant medication (p = 0.029). Furthermore, it caused fewer circulatory (p = 0.040) and respiratory (p = 0.016) alterations regardless of the application of sedative or relaxant medication. The transnasal endoscope was inferior with respect to passage through the pylorus (p = 0.003) and duodenum (p = 0.020). These differences were significant in univariate hypothesis testing. Bonferroni correction for multiple testing of data removed the significance at p > 0.0031. Both techniques achieved similar rates of successful tube placement in the small bowel (86% versus 84%, p = 0.82). CONCLUSION Transnasal endoscopy allows accurate placement of nasoenteral feeding tubes in critically ill patients and is superior to transoral endoscopy in terms of procedure time, medication requirement, and safety.
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Affiliation(s)
- D Külling
- Division of Gastroenterology, Department of Internal Medicine, University Hospital of Zürich, Switzerland.
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Nelson DB, Block KP, Bosco JJ, Burdick JS, Curtis WD, Faigel DO, Greenwald DA, Kelsey PB, Rajan E, Slivka A, Smith P, Wassef W, VanDam J, Wang KK. Technology status evaluation report: ultrathin endoscopes esophagogastroduodenoscopy: March 2000. Gastrointest Endosc 2000; 51:786-9. [PMID: 10840336 DOI: 10.1053/ge.2000.v51.age516786] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Al-Karawi MA, Sanai FM, Al-Madani A, Kfoury H, Yasawy MI, Sandokji A. Comparison of peroral versus ultrathin transnasal endoscopy in the diagnosis of upper gastrointestinal pathology. Ann Saudi Med 2000; 20:328-30. [PMID: 17322695 DOI: 10.5144/0256-4947.2000.328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- M A Al-Karawi
- Department of Gastroenterology, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia
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Abstract
Endoscopic therapy improves the outcome of nonvariceal upper gastrointestinal hemorrhage. Routine second-look procedures may not improve outcome. Patients who rebleed after endoscopic therapy for ulcer hemorrhage should be treated by further endoscopic therapy, rather than urgent surgery. Thinner endoscopes offer adequate visualization with improved patient tolerance, and new endoscopic therapeutic methods continue to be evaluated. Stigmata of recent hemorrhage and their endoscopic interpretation remain a topic for discussion. The Rockall scoring system is validated. Percutaneous endoscopic gastrostomy insertion may be possible without prior transillumination of the stomach. Routine use of antibiotics prior to insertion reduces wound infection. Percutaneous endoscopic gastrostomy feeding is well established, and follow-up studies confirm its value. Endoscopic ultrasound is a rapidly developing technique. Its uses and potential have evolved, resulting in wider applications in benign disease of the esophagus, biliary tree, and pancreas, in addition to its increasing role in the diagnosis and staging of malignancy.
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Affiliation(s)
- N I Church
- Western General Hospital, Gastrointestinal Unit, Edinburgh, Scotland, UK
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Jamieson J. Anesthesia and sedation in the endoscopy suite? (influences and options). Curr Opin Anaesthesiol 1999; 12:417-23. [PMID: 17013344 DOI: 10.1097/00001503-199908000-00004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Advances in technology and pharmacology have enabled gastrointestinal endoscopists to expand the diagnostic and therapeutic capabilities of the specialty. Research into the impact of the endoscopy environment on patient stress, acknowledgement of the various patient coping styles, development and deployment of procedural preparative programs and information streamlining have been shown to be of value in decreasing anxiety and reducing sedative requirements. Being aware of procedure-related stressors, and factors associated with complications, allows us to tailor our sedation or anesthesia plan to the individual patient.
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Affiliation(s)
- J Jamieson
- Department of Anesthesiology, Memorial University of NFLD, Health Sciences Center, St John's, Newfoundland, Canada
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