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La Torre D, Van Oudenhove L, Vanuytsel T, Verbeke K. Psychosocial stress-induced intestinal permeability in healthy humans: What is the evidence? Neurobiol Stress 2023; 27:100579. [PMID: 37842017 PMCID: PMC10569989 DOI: 10.1016/j.ynstr.2023.100579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/17/2023] Open
Abstract
An impaired intestinal barrier function can be detrimental to the host as it may allow the translocation of luminal antigens and toxins into the subepithelial tissue and bloodstream. In turn, this may cause local and systemic immune responses and lead to the development of pathologies. In vitro and animal studies strongly suggest that psychosocial stress is one of the factors that can increase intestinal permeability via mast-cell dependent mechanisms. Remarkably, studies have not been able to yield unequivocal evidence that such relation between stress and intestinal permeability also exists in (healthy) humans. In the current Review, we discuss the mechanisms that are involved in stress-induced intestinal permeability changes and postulate factors that influence these alterations and that may explain the translational difficulties from in vitro and animal to human studies. As human research differs highly from animal research in the extent to which stress can be applied and intestinal permeability can be measured, it remains difficult to draw conclusions about the presence of a relation between stress and intestinal permeability in (healthy) humans. Future studies should bear in mind these difficulties, and more research into in vivo methods to assess intestinal permeability are warranted.
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Affiliation(s)
- Danique La Torre
- Translational Research Center in Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Lukas Van Oudenhove
- Translational Research Center in Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Cognitive and Affective Neuroscience Lab, Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Tim Vanuytsel
- Translational Research Center in Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Division of Gastroenterology and Hepatology, Leuven University Hospital, Leuven, Belgium
| | - Kristin Verbeke
- Translational Research Center in Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism, Faculty of Medicine, KU Leuven, Leuven, Belgium
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Is the choice of anesthesia during gastrointestinal endoscopic procedures a result of anxiety? Arab J Gastroenterol 2021; 22:56-60. [PMID: 33551348 DOI: 10.1016/j.ajg.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/08/2020] [Accepted: 09/08/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND STUDY AIMS Esophagogastroduodenoscopy (EGD) and colonoscopy (CS) are vital endoscopic procedures in the diagnosis and follow-up of gastrointestinal tract diseases. Endoscopic procedures can be performed with or without anesthesia as per patient preferences. These procedures can cause some anxiety in almost all patients, and the degree of anxiety differs for each individual. Thus, we aimed to evaluate the trait and state anxiety levels of the patients and assess the relationship between the preference of anesthesia and anxiety levels. PATIENTS AND METHODS To investigate this issue, 723 patients who underwent elective endoscopy (EGD and/or CS) were enrolled. The researchers collected sociodemographic data and medical history records as reported by the patients. State and trait anxiety levels of the patients were evaluated using the State and Trait Anxiety Inventory (STAI). RESULTS The patients were divided into two groups as with anesthesia and without anesthesia. Of the respondents, 43.4% requested anesthesia during endoscopic procedure. Sociodemographic data, except sex, showed similar characteristics. The STAI trait scores of the two groups were similar; however, there was a significant difference in the STAI state scores of the groups (p = 0.018). A significant difference was observed in the anesthesia preference and the type of endoscopic procedure (EGD, CS, or both) (p < 0.001). Type of endoscopic procedure, STAI state scores, and sex were determined as the predictors of the anesthesia choice. CONCLUSION Endoscopic procedures are known to cause anxiety among many patients. Our findings suggest that the anesthesia preferences of patients are an important factor in preventing these situational concerns. However, this study found that being a woman and undergoing a CS procedure are important factors related to anesthesia preferences. Thus, more detailed assessments on this subject are required.
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The Effects of Music on the Life Signs of Patients in the Reanimation Unit/Recovery Room After Laparoscopic Cholecystectomy. Holist Nurs Pract 2019; 33:295-302. [DOI: 10.1097/hnp.0000000000000344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ortiz V, Sáez-González E, Blé M, Díaz-Jaime FC, Vinaixa C, Garrigues V. Effects of high-resolution esophageal manometry on oxygen saturation and hemodynamic function. Dis Esophagus 2017; 30:1-4. [PMID: 27859989 DOI: 10.1111/dote.12523] [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: 12/11/2022]
Abstract
The effect of high-resolution esophageal manometry (HRM) on oxygen saturation (SaO2) and hemodynamic function has not been previously evaluated. This was a prospective study of consecutive patients referred for HRM. Demographic and clinical data were collected on all patients. The study variables included SaO2, heart rate (HR) and blood pressure (BP). SaO2 and HR were measured at baseline, during intubation, during and 5 min after HRM. BP was measured at baseline, during and after HRM. 158 (56% women) patients with a mean age of 56 (SD 15) years were included. Thirty-five (22%) were obese and 55 (35%) were overweight. Eighteen (12%) patients had a history of respiratory disease and 27 (17%) were smokers. Intubation was difficult in 22%. Exploration tolerance was poor in 17% or very poor in 6%. The average duration of the test was 9.9 (SD 2.8) minutes. Sixty-four (47%) and 59 (37%) patients had SaO2 below 95% during intubation and during HRM, respectively. Three patients had SaO2 ≤90%. Sixty-nine (44%) patients had tachycardia during intubation and 8 (5%) during HRM. The appearance of desaturation (SaO2 <95%) during intubation was associated with a lower basal SaO2; desaturation during HRM and 5 minutes after HRM was associated with a higher age, a higher BMI and a lower basal SaO2. HRM decreases SaO2 and increases heart rate primarily during the insertion of the probe, as part of the standard stress response and therefore HMR can be considered a safe procedure. However, in older and overweight patients, respiratory parameters should be monitored.
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Affiliation(s)
- Vicente Ortiz
- Digestive Functional Disorders Unit, Gastroenterology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Esteban Sáez-González
- Digestive Functional Disorders Unit, Gastroenterology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Michel Blé
- Digestive Functional Disorders Unit, Gastroenterology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Francia Carolina Díaz-Jaime
- Digestive Functional Disorders Unit, Gastroenterology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Carmen Vinaixa
- Digestive Functional Disorders Unit, Gastroenterology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Vicente Garrigues
- Digestive Functional Disorders Unit, Gastroenterology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Department of Medicine, Universitat de Valencia, Valencia, Spain
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Nasiri J, Khatib N, Kheiri S, Najafi M. The influence of escort during upper endoscopy and colonoscopy on patient satisfaction and anxiety. J Family Med Prim Care 2016; 5:134-8. [PMID: 27453858 PMCID: PMC4943120 DOI: 10.4103/2249-4863.184638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM Endoscopy, including esophagogastroduodenoscopy (EGD) and colonoscopy (CS), is a diagnostic and treatment method for various diseases. We aimed to evaluate the effects of the presence of an escort by the patient on patients' satisfaction and anxiety level before and after upper endoscopy and CS. SUBJECTS AND METHODS Patients who referred to the Hajar Hospital for elective EGD and CS were recruited. The patients were divided into two groups: The first group underwent endoscopy/CS with an escort beside the patient and the escort was waiting in the waiting room in the second group. After interventions, patients' and their escort's levels of anxiety and satisfaction were evaluated. Anxiety level was compared before and after endoscopy. RESULTS Of 211 patients, 106 were referred for EGD and 105 for CS. Anxiety was same in both groups before the interventions (P > 0.05), which decreased in both after the EGD or CS (P < 0.05). Anxiety reduction after CS was influenced by the presence of the escort and the level of anxiety was less in this group than other group (P < 0.05). Satisfaction of the EGD and CS in the group that had an escort by their side was more than the other (P < 0.05). Escorts had a moderate level of anxiety in both groups with a marked reduction after endoscopy and CS (P < 0.05). However, the level of anxiety before and after endoscopy was similar in both groups (P > 0.05). CONCLUSION Having an escort at the time of endoscopy or CS appears to be an effective costless complication-free measure for increasing satisfaction and reducing anxiety in patients.
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Affiliation(s)
- Jafar Nasiri
- Department of Internal Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Narges Khatib
- Department of Internal Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Soleiman Kheiri
- Department of Epidemiology and Biostatistics, Faculty of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mostafa Najafi
- Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Ueki S, Matsunaka E, Swa T, Ohashi K, Makimoto K. Effectiveness of inhalation of aromatherapy in reducing anxiety in patients before colonoscopy: a systematic review protocol. ACTA ACUST UNITED AC 2015. [DOI: 10.11124/01938924-201513090-00006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Panic Attack during Elective Gastrointestinal Endoscopy. Gastroenterol Res Pract 2011; 2011:162574. [PMID: 22007196 PMCID: PMC3189558 DOI: 10.1155/2011/162574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 07/14/2011] [Indexed: 01/04/2023] Open
Abstract
Background. Esophagogastroduodenoscopy (EGD) and colonoscopy (CS) can evoke anxiety, embarrassment, and discomfort. These concerns can culminate in panic attacks, which may traumatize patients and significantly decrease their compliance to the procedure. The objective of this study was to evaluate the relationship between preendoscopic anxiety and the possibility of a panic attack during an elective gastrointestinal endoscopy (EGE). Methods. The study population comprised of 79 Greek outpatients. The examination was carried out without the use of conscious sedation. Patients' anxiety levels were assessed before the procedure using the Greek version of the Spielberger State-Trait Anxiety Inventory (STAI-Y). Results. Seventy-nine patients were enrolled: 45 EGD and 34 CS. Females had higher state and trait anxiety levels than males (48.14 ± 7.94 versus 44.17 ± 7.43, P < 0.05; and 43.68 ± 6.95 versus 39.86 ± 7.46, P < 0.05). Patients who experienced panic attack had significantly higher levels of both trait and state anxiety, compared to those who were panic-free. There was no significant relationship between panic attacks and sex or type of procedure. Conclusions. Patients who experience panic attacks during endoscopic procedures appear to have significantly higher anxiety levels before the procedure. Administering the STAI questionnaire prior to the endoscopy seems to be a useful screening method for vulnerable patients.
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Lee CT, Lee TL, Liao WC, Chang CY, Tai CM, Chiang TH, Tu CH, Tseng WK, Lin JT. Myocardial ischemia during endoscopic retrograde cholangiopancreatography: an overlooked issue with significant clinical impact. J Gastroenterol Hepatol 2010; 25:1518-24. [PMID: 20796149 DOI: 10.1111/j.1440-1746.2010.06274.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND AIM The occurrence of peri-procedural myocardial ischemia with endoscopic retrograde cholangiopancreatography (ERCP) has been documented, but its significance remains controversial. This study aimed to investigate the incidence and risk factors of myocardial ischemia during ERCP procedures and to analyze the potential association between myocardial ischemia and post-ERCP complications. METHODS Ambulatory 24-h ST-segment monitoring from 30 min prior to 24 h after ERCP was obtained on 71 patients from September 2006 to August 2007. Changes in vital signs during ERCP, post-ERCP complications, and their outcomes were recorded and analyzed. RESULTS Cardiac ischemia occurred in 13 patients (18.3%) during ERCP and one patient developed myocardial infarction. More patients in the ischemic group (38.5%) than in the non-ischemic group (5.2%) had ST-T changes in pre-ERCP resting electrocardiography (P < 0.01). Hypotension during ERCP was found only in the ischemic group (15.4% vs 0%; P = 0.03). Patients with cardiac ischemia during ERCP had a significantly higher rate of elevated serum amylase and lipase levels (53.8% vs 15.5%; P < 0.01) and post-ERCP pancreatitis (30.8% vs 6.9%; P = 0.03). Multivariable logistic regression analysis revealed that cardiac ischemia during ERCP (OR: 5.21, P = 0.050) and pancreatic duct cannulation (OR: 5.7, P = 0.036) were independent predictors for post-ERCP pancreatitis. CONCLUSIONS ST-T changes on resting electrocardiography and intra-procedural hypotension are risk factors of myocardial ischemia during ERCP. Post-ERCP hyperamylasemia, hyperlipasemia, and pancreatitis were associated with myocardial ischemia during ERCP.
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Affiliation(s)
- Ching-Tai Lee
- Division of Gastroenterology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohisung, Taiwan
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Choi JH, Jeong HS, Lee DW, Park KH, Kim GM. Factors Related to Pre-Procedural Anxiety for Gastroscopy in Health Check Examinee. Korean J Fam Med 2010. [DOI: 10.4082/kjfm.2010.31.12.923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Jeong Hwa Choi
- Department of Family Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Hwee Soo Jeong
- Department of Family Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Dong Wook Lee
- Department of Family Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Ki Heum Park
- Department of Family Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Gyeong Min Kim
- Department of Family Medicine, Dongguk University College of Medicine, Gyeongju, Korea
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Abstract
Gastrointestinal endoscopies are common procedures for diagnosis and treatment. Patients with various cardiovascular conditions can undergo these procedures, including those patients with acute myocardial infarction, but appropriate precautions need to be maintained, especially with procedure-induced autonomic nervous system pertubations that can affect heart rate and blood pressure. In this article, treatment recommendations are included for those patients undergoing endoscopy who are receiving anticoagulation and for those who are at risk for bacterial endocarditis.
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Yetkin G, Oba S, Uludag M, Paksoy I, Akgün I, Eren N. Effects of sedation during upper gastrointestinal endoscopy on endocrine response and cardiorespiratory function. ACTA ACUST UNITED AC 2007; 40:1647-52. [PMID: 17876425 DOI: 10.1590/s0100-879x2006005000177] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Accepted: 07/31/2007] [Indexed: 11/21/2022]
Abstract
Upper gastrointestinal endoscopy is often accompanied by tachycardia which is known to be an important pathogenic factor in the development of myocardial ischemia. The pathogenesis of tachycardia is unknown but the condition is thought to be due to the endocrine response to endoscopy. The purpose of the present study was to investigate the effects of sedation on the endocrine response and cardiorespiratory function. Forty patients scheduled for diagnostic upper gastrointestinal endoscopy were randomized into 2 groups. While the patients in the first group did not receive sedation during upper gastrointestinal endoscopy, the patients in the second group were sedated with intravenous midazolam at the dose of 5 mg for those under 65 years or 2.5 mg for those aged 65 years or more. Midazolam was administered by slow infusion. In both groups, blood pressure, ECG tracing, heart rate, and peripheral oxygen saturation (SpO2) were monitored during endoscopy. In addition, blood samples for the determination of cortisol, glucose and C-reactive protein levels were obtained from patients in both groups prior to and following endoscopy. Heart rate and systolic arterial pressure changes were within normal limits in both groups. Comparison of the two groups regarding the values of these two parameters did not reveal a significant difference, while a statistically significant reduction in SpO2 was found in the sedation group. No significant differences in serum cortisol, glucose or C-reactive protein levels were observed between the sedated and non-sedated group. Sedation with midazolam did not reduce the endocrine response and the tachycardia developing during upper gastrointestinal endoscopy, but increased the reduction in SpO2.
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Affiliation(s)
- G Yetkin
- Department of Surgery and Surgical Endoscopy Unit, Sisli Etfal Training and Research Hospital.
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Mori A, Fushimi N, Asano T, Maruyama T, Ohashi N, Okumura S, Inoue H, Takekoshi S, Friedman SL, Okuno M. CARDIOVASCULAR TOLERANCE IN UNSEDATED UPPER GASTROINTESTINAL ENDOSCOPY: PROSPECTIVE RANDOMIZED COMPARISON BETWEEN TRANSNASAL AND CONVENTIONAL ORAL PROCEDURES. Dig Endosc 2006. [DOI: 10.1111/j.1443-1661.2006.00656.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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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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Christensen M, Milland T, Rasmussen V, Schulze S, Rosenberg J. ECG changes during endoscopic retrograde cholangio-pancreatography and coronary artery disease. Scand J Gastroenterol 2005; 40:713-20. [PMID: 16036532 DOI: 10.1080/00365520510012307] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Myocardial ischaemia has been described during endoscopic retrograde cholangio-pancreatography (ERCP), but the pathogenesis remains unclear. The aim of the present study was to evaluate whether coronary artery disease was present in patients with ST-segment changes during ERCP. MATERIAL AND METHODS Forty patients were monitored with a Holter tape recorder during ERCP. Patients with ST-segment deviation during ERCP subsequently underwent a standard exercise ECG test. RESULTS Twelve patients developed signs of myocardial ischaemia during ERCP (30%) and 9 had concomitant tachycardia. None had a cardiac history or cardiorespiratory symptoms. Ten of the 12 patients did an exercise test and one patient developed silent ischaemia. Subsequent coronary angiography showed no evidence of coronary artery disease. CONCLUSIONS No signs of existing coronary artery disease were found in patients developing ST deviation during ERCP when evaluated with a 12-lead exercise ECG test. Further studies should evaluate other mechanisms responsible for myocardial ischaemia during ERCP.
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Affiliation(s)
- Merete Christensen
- Department of Surgery and Holter Lab, Hvidovre University Hospital, Hvidovre, Denmark.
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Adachi W, Yazawa K, Owa M, Koide N, Hanazaki K, Kajikawa S, Kobayashi S, Amano J. Quantification of cardiac stress during EGD without sedation. Gastrointest Endosc 2002; 55:58-64. [PMID: 11756916 DOI: 10.1067/mge.2002.119732] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Although the complication rate of endoscopy is low, EGD may induce cardiac stress. The aim of this study was to quantify cardiac stress during EGD. METHODS Heart rate, blood pressure, cardiac output, and peripheral oxygen saturation were measured during endoscopy without sedation in 7 volunteers. Cardiac output was measured with an automated echocardiographic technique. Cardiac index, left ventricular work index, and rate-pressure product were calculated. Serum catecholamine concentrations were measured before and after the examination. RESULTS Heart rate increased significantly when the endoscope was located in the esophagus compared with the rate before insertion (p < 0.05). No significant changes in cardiac index and left ventricular work index were observed during endoscopy. Rate-pressure product increased significantly at the point of esophageal observation compared with that before insertion (p < 0.05). The rate-pressure product was maximally increased during esophageal observation at 66% over baseline (95% CI [45%, 86%]). Serum concentration of norepinephrine rose significantly after the examination (p < 0.05). CONCLUSIONS Cardiac output did not increase during EGD without sedation in healthy male volunteers. Cardiac stress increased during EGD as indicated by a 66% increase in rate-pressure product. The cardiac stress was approximately equal to that observed in 3.3 to 5 metabolic equivalents of treadmill exercises.
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Affiliation(s)
- Wataru Adachi
- Second Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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