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Mönkemüller K, Fry LC. Gastrointestinal Endoscopy: Considerations. GERIATRIC GASTROENTEROLOGY 2021:879-908. [DOI: 10.1007/978-3-030-30192-7_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Device assisted enteroscopy in the elderly - A systematic review and meta-analysis. Dig Liver Dis 2019; 51:1249-1256. [PMID: 31036473 DOI: 10.1016/j.dld.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 03/19/2019] [Accepted: 04/01/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Device assisted enteroscopy (DAE) is increasingly being carried out in elderly patients. This provides a challenge due to the underlying varied physiology and comorbidities these patients have. METHODS We performed a systematic literature search for studies on elderly patients undergoing DAE. We calculated the pooled diagnostic (DY) and therapeutic yields (TY), major adverse events, length of small bowel examined and sedation administered. These were also compared to younger patients. RESULTS Fourteen high quality articles on DAE in the elderly were included in this analysis (3289 total, 1712 elderly) patients. Nine of these studies were included in the final meta-analysis (681 elderly, 1577 young patients). The overall DY of DAE, double balloon enterosocpy (DBE) and single balloon enteroscopy (SBE) were 0.68 (p = 0.000001), 1.74 (p = 0.0001) and 1.90 (p = 0.009). The TY of DAE, DBE and SBE were 0.45 (p = 0.00001), 2.20 (p = 0.00001) and 2.36 (p = 0.00001). On comparison of elderly and young patients, DY (1.83; 95% CI: 1.49, 2.24; p = 0.00001) and TY (2.28; 95% CI: 1.79, 2.89) were better in elderly patients. There was no difference in adverse events in both groups (2.16; 95% CI: 0.82, 5.69, p = 0.12). Elderly patients were given less sedation than younger patients during DAE. CONCLUSIONS DAE has a higher DY and TY in the elderly than younger patients. DAE can be safely carried out in the elderly with less sedation.
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Ribeiro Gomes AC, Pinho R, Rodrigues A, Ponte A, Carvalho J. Enteroscopy in the Elderly: Review of Procedural Aspects, Indications, Yield, and Safety. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2019; 27:18-28. [PMID: 31970236 DOI: 10.1159/000499678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/25/2019] [Indexed: 12/14/2022]
Abstract
Background As human longevity continues to increase, age-related diseases are more common, which leads to a higher use of gastroenterology services. Endoscopic procedures are generally considered to be of higher risk in the elderly with multiple comorbidities. However, some endoscopic techniques have already been proved to be well tolerated in the elderly. Summary <underline></underline>Enteroscopy enables the nonsurgical diagnosis and therapeutic management of a wide variety of small bowel diseases. Although it has been shown to be safe and effective, with high diagnostic yield and therapeutic success rate in the general population, its safety and efficacy in the elderly is largely unknown, and there are still some concerns about its use in these patients. Key Messages This review will focus on enteroscopy in elderly people, taking into account patient and procedure characteristics, indications, findings, yield, and complication rate.
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Affiliation(s)
- Ana Catarina Ribeiro Gomes
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Rolando Pinho
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Adélia Rodrigues
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ana Ponte
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - João Carvalho
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Ching HL, Branchi F, Sanders DS, Turnbull D, Sidhu R. Paradigm shift: should the elderly undergo propofol sedation for DBE? A prospective cohort study. Frontline Gastroenterol 2018; 9:192-199. [PMID: 30046423 PMCID: PMC6056081 DOI: 10.1136/flgastro-2017-100847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/23/2017] [Accepted: 09/02/2017] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Evaluate the safety of propofol-assisted double balloon enteroscopy (DBE) in elderly patients against a younger cohort. DESIGN Prospective cohort study. SETTING All patients undergoing DBE over a 30-month period were recruited at our tertiary centre. PATIENTS 215 procedures in 161 patients were performed. An age cut-off of 65 years and above was used to define those who were elderly. INTERVENTIONS Patients were subcategorised into four groups: elderly or young undergoing DBE with propofol or conventional sedation (with midazolam±fentanyl). MAIN OUTCOME MEASURES Patient demographics, comorbidities, procedural data, complications, diagnostic and therapeutic yield were compared. RESULTS Cardiovascular disease and a higher American Society of Anaethesiologists (ASA) status were more prevalent in elderly patients undergoing DBE with propofol (p<0.05). Common indications for DBE were occult and overt obscure gastrointestinal bleeding and suspected Crohn's disease (elderly vs young: 50.7% vs 42.3%, 17.8% vs 12% and 19.2% vs 26.1%, respectively). Diagnostic yield was higher in elderly compared with young patients (75.3% vs 58.5%, p=0.016). The most common findings in elderly and young patients were angioectasia (30.1% and. 18.3%, respectively) and ulcers (17.8% and 9.2%, respectively), while therapeutic intervention rates were comparable (42.5% vs 32.4%, p=0.18). ASA status did not affect propofol dose (p=0.55) or procedure duration (p=0.31). Tolerance scores were favourable in those receiving propofol compared with conventional sedation (p<0.05). There was no difference in complications between the four groups (p=0.17). CONCLUSION Compared with young patients, propofol-assisted DBE in the elderly is safe and has a high diagnostic yield.
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Affiliation(s)
- Hey-Long Ching
- Department of Gastroenterology, Royal Hallamshire Hospital Sheffield Teaching Hospitals, Sheffield, UK
| | - Federica Branchi
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda, Milano, Italy
| | - David S Sanders
- Department of Gastroenterology, Royal Hallamshire Hospital Sheffield Teaching Hospitals, Sheffield, UK
| | - David Turnbull
- Department of Anaesthesia, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Reena Sidhu
- Department of Gastroenterology, Royal Hallamshire Hospital Sheffield Teaching Hospitals, Sheffield, UK
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Chen Y, Liu G, Zhang T, Yang K, Yu H, Tie Y, Liang J, Zhou J, Gan H. Diagnostic yield and safety of double balloon-assisted enteroscopy in the elderly: A systematic review and meta-analysis. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2017.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Chang CW, Chang CW, Lin WC, Wu CH, Wang HY, Wang TE, Chu CH, Chen MJ. Efficacy and Safety of Single-Balloon Enteroscopy in Elderly Patients. INT J GERONTOL 2017; 11:176-178. [DOI: 10.1016/j.ijge.2017.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
Deep enteroscopy allows for the diagnosis and treatment of small bowel disorders that historically required operative intervention. There are a variety of endoscopic platforms using balloons and rotational overtubes to facilitate small bowel intubation and even allow for total enteroscopy. Obscure gastrointestinal bleeding is the most common indication for deep enteroscopy. By visualizing segments of the small bowel not possible through standard EGD or push enteroscopy, deep enteroscopy has an established high rate of identification and treatment of bleeding sources. In addition to obscure bleeding, other common indications include diagnosis and staging of Crohn's disease, evaluation of findings on capsule endoscopy and investigation of possible small bowel tumors. Large endoscopy databases have shown deep enteroscopy to be not only effective but safe. Recent research has focused on comparing the diagnostic rates, efficacy, and total enteroscopy rates of the different endoscopic platforms.
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Affiliation(s)
- Brian P Riff
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1069, New York, NY, 10029, USA
| | - Christopher J DiMaio
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1069, New York, NY, 10029, USA.
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Chen WG, Shan GD, Zhang H, Yang M, L L, Yue M, Chen GW, Gu Q, Zhu HT, Xu GQ, Chen LH. Double-balloon enteroscopy in small bowel diseases: Eight years single-center experience in China. Medicine (Baltimore) 2016; 95:e5104. [PMID: 27759639 PMCID: PMC5079323 DOI: 10.1097/md.0000000000005104] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/12/2016] [Accepted: 09/18/2016] [Indexed: 02/05/2023] Open
Abstract
The aim of the study was to evaluate the diagnostic and therapeutic value of double-balloon entoroscopy (DBE) in small bowel diseases (SBDs) in China.A retrospective review of 674 consecutive patients who underwent DBE between January 2007 and November 2015 was conducted. Patients were divided into 3 groups by age, young group (<45 years), middle-aged group (45-65 years), and elderly group (>65 years). Data were collected with regard to demographics, clinical, endoscopic findings, complications, diagnostic yield, and management.A total of 729 DBE procedures were performed successfully in our series. More than 20 types of SBDs were found with the detection rate of 70.9%(517/729). The majority of patients were Crohn's disease (33.4%,225/674), followed by tumor (18.8%,127/674) and angioectasia (7.9%, 53/674). Endoscopic treatment was performed in 60 patients in which hemostasis (17,28.3%) and polypectomy (15,25%) were the predominant form of intervention used. Adverse events occurred in 6 patients (0.96%,6/729) including perforation, hemorrhage, aspiration pneumonia. No acute pancreatitis or other major complications occurred. Adenocarcinoma, GIST, and lymphoma were the most common tumor detected, the majority of tumors located in the jejunum (56.7%), The detection rate of angioectasia was also higher in the jejunum (54.7%),77.8% of Crohn's disease was located in the ileum. The positive rate of DBE in small bowel tumor and Crohn's disease were significantly higher than that of angioectasia (P<0.05). In young cohort, Crohn's disease (48.1%) was the most commonly diseases followed by tumor (10.4%) and nonspecific enteritis (7.1%). Yet in the elderly group, the majority of patients were tumor (27.6%); angioectasia (21.3%) was also detected frequently. The positive rate of capsule endoscopy was 75.44 %(202/268) which was a little high than DBE (67.9%, 182/268) (P > 0.05). The obscure gastrointestinal bleeding (OGIB) was the most common indication, and the diagnostic yield was 71.8%.DBE is a useful diagnostic and therapeutic tool with high clinical practice value for the investigation of SBDs. With growing experience of endoscopist, we believe that DBE must be kept in mind as the first-line modality for suspected SBDs.
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Affiliation(s)
| | | | | | | | - Lin L
- Department of Gastroenterology
| | - Min Yue
- Department of Gastroenterology
| | - Guang-Wu Chen
- Department of Endoscopy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Qing Gu
- Department of Endoscopy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | | | - Guo-Qiang Xu
- Department of Gastroenterology
- Correspondence: Guo-Qiang Xu and Li-Hua Chen, Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China (e-mail: [Xu GQ]; e-mail: [Chen LH])
| | - Li-Hua Chen
- Department of Gastroenterology
- Correspondence: Guo-Qiang Xu and Li-Hua Chen, Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China (e-mail: [Xu GQ]; e-mail: [Chen LH])
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Pinho R, Mascarenhas-Saraiva M, Mão-de-Ferro S, Ferreira S, Almeida N, Figueiredo P, Rodrigues A, Cardoso H, Marques M, Rosa B, Cotter J, Vilas-Boas G, Cardoso C, Salgado M, Marcos-Pinto R. Multicenter survey on the use of device-assisted enteroscopy in Portugal. United European Gastroenterol J 2016; 4:264-274. [PMID: 27087956 PMCID: PMC4804373 DOI: 10.1177/2050640615604775] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 08/15/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Device-assisted enteroscopies (DAEs) are recent endoscopic techniques that enable direct endoscopic small-bowel evaluation. OBJECTIVE The objective of this article is to evaluate the implementation of DAEs in Portugal and assess the main indications, diagnoses, diagnostic yield, therapeutic yield and complication rate. METHODS We conducted a multicenter retrospective series using a national Web-based survey on behalf of the Portuguese Small-Bowel Study Group. Participants were asked to fill out two online databases regarding procedural data, indications, diagnoses, endoscopic therapy and complications using prospectively collected institutional data records. RESULTS A total of eight centers were enrolled in the survey, corresponding to 1411 DAEs. The most frequent indications were obscure gastrointestinal bleeding (OGIB), inflammatory bowel disease and small-bowel tumors. The pooled diagnostic yield was 63%. A relation between the diagnostic yield and the indications was clear, with a diagnostic yield for OGIB of 69% (p = 0.02) with a 52% therapeutic yield. Complications occurred in 1.2%, with a major complication rate of 0.57%. Perforations occurred in four patients (0.28%). CONCLUSION DAEs are safe and effective procedures, with complication rates of 1.2%, the most serious of which is perforation. Most procedures are performed in the setting of OGIB. Diagnostic and therapeutic yields are dependent on the indication, hence appropriate patient selection is crucial.
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Affiliation(s)
- Rolando Pinho
- ManopH, Instituto CUF, Portugal
- Serviço de Gastrenterologia, Centro Hospitalar de Gaia/Espinho, Portugal
| | | | - Susana Mão-de-Ferro
- Serviço de Gastrenterologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Portugal
| | - Sara Ferreira
- Serviço de Gastrenterologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Portugal
| | - Nuno Almeida
- Faculdade de Medicina da Universidade de Coimbra, Portugal
- Serviço de Gastrenterologia, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Pedro Figueiredo
- Faculdade de Medicina da Universidade de Coimbra, Portugal
- Serviço de Gastrenterologia, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Adélia Rodrigues
- Serviço de Gastrenterologia, Centro Hospitalar de Gaia/Espinho, Portugal
| | - Hélder Cardoso
- Serviço de Gastrenterologia, Centro Hospitalar de São João, Portugal
| | - Margarida Marques
- Serviço de Gastrenterologia, Centro Hospitalar de São João, Portugal
| | - Bruno Rosa
- Serviço de Gastrenterologia, Centro Hospitalar do Alto Ave, Portugal
| | - José Cotter
- Serviço de Gastrenterologia, Centro Hospitalar do Alto Ave, Portugal
- Instituto de Ciências da Vida e Saúde (ICVS), Escola de Ciências da Saúde, Universidade do Minho, Portugal
- ICVS/3B’s, Laboratório Associado, Braga/Guimarães, Portugal
| | | | - Carla Cardoso
- Serviço de Gastrenterologia, Hospital Pedro Hispano, Portugal
| | - Marta Salgado
- Serviço de Gastrenterologia, Centro Hospitalar do Porto, Portugal
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