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Zheng L, Wu X, Gu W, Wang R, Wang J, He H, Wang Z, Yi B, Zhang Y. Development and validation of a hypoxemia prediction model in middle-aged and elderly outpatients undergoing painless gastroscopy. Sci Rep 2025; 15:17965. [PMID: 40410303 PMCID: PMC12102271 DOI: 10.1038/s41598-025-02540-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 05/14/2025] [Indexed: 05/25/2025] Open
Abstract
Hypoxemia is a common complication associated with anesthesia in painless gastroscopy. With the aging of the social population, the number of cases of hypoxemia among middle-aged and elderly patients is increasing. However, tools for predicting hypoxemia in middle-aged and elderly patients are lacking. In this study, we investigated the risk factors for hypoxemia in middle-aged and elderly outpatients undergoing painless gastroscopy based on machine learning and constructed a risk prediction model. In this retrospective study, we included the data on 1,348 outpatients undergoing painless gastroscopy. In total, 26 characteristic variables, including demographic information, past medical history, and clinical data of the patients were included, and BorutaShap was used for feature selection. Five machine learning algorithm models, including logistic regression (LR), support vector machine (SVM), random forest (RF), extreme gradient boosting (XGB), and light gradient boosting machine (LightGBM), were selected. The best models were selected based on the area under the receiver operating characteristic curve (AUROC). Model feature importance was explained and analyzed using Shapley Additive Explanations (SHAP). The endpoint event of this study was considered to be hypoxemia during the procedure, defined as at least one occurrence of pulse oxygen saturation below 90% without probe misalignment or interference from the beginning of anesthesia induction to the end of painless gastroscopy. In the final cohort of 984 patients, 11% of patients (108/984) experienced hypoxemia during the painless gastroscopy procedure. The AUROCs of the five models were as follows: Logistic Regression (AUROC = 0.893, 95CI: 0.881-0.899), SVM (AUROC = 0.855, 95CI: 0.812-0.884), Random Forest (AUROC = 0.914, 95CI: 0.889-0.924), XGB (AUROC = 0.902, 95CI: 0.865-0.919), and LightGBM (AUROC = 0.891, 95CI: 0.847-0.917). Regarding the explanation of the importance of SHAP features, preoperative variables (baseline SpO2, body mass index, and micrognathia) and intraoperative variables (operating time of gastroscopy, induction dose of etomidate and propofol mixture, append anesthetic, cough, and repeated pharyngeal irritation) significantly contributed to the model. We identified eight potential risk factors related to the occurrence of hypoxemia in middle-aged and elderly patients undergoing painless gastroscopy, based on machine learning feature engineering. Among the five machine learning algorithms, RF exhibited the best predictive performance in the internal test set and had a certain degree of generalization ability in the external validation set, which indicated that the RF model was more suitable for the data framework of this study. This model was more likely to enhance the accuracy of hypoxemia prediction in middle-aged and elderly patients undergoing painless gastroscopy, and thus, it is suitable for assisting anesthesiologists in clinical decision-making.
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Affiliation(s)
- Leilei Zheng
- Department of Anesthesiology, Second Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Xinyan Wu
- Department of Anesthesiology, Second Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Wei Gu
- Department of Anesthesiology, Minhang Hospital of Fudan University, Shanghai, 201199, China
| | - Rui Wang
- Department of Anesthesiology, Third Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Jing Wang
- Department of Anesthesiology, Second Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Hongying He
- Department of Anesthesiology, Second Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Zhao Wang
- Department of Anesthesiology, Second Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Bin Yi
- Department of Anesthesiology, First Affiliated Hospital of Army Medical University, Chongqing, 400038, China.
| | - Yi Zhang
- Department of Anesthesiology, Second Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China.
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Zhao L, Zhou X, Chen L, Mao W, Guo Y, Liu X, Zhang L, Xie Y, Li L. The 50% effective dose of remimazolam combined with different doses of esketamine for painless gastroscopy. Sci Rep 2025; 15:12770. [PMID: 40229355 PMCID: PMC11997078 DOI: 10.1038/s41598-025-97649-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 04/07/2025] [Indexed: 04/16/2025] Open
Abstract
OBJECTIVE Remimazolam is a novel benzodiazepine sedative that provides effective sedation, stable haemodynamics, and minimal adverse effects during intravenous general anaesthesia. The aim of this study was to determine the 50% effective dose (ED50) of remimazolam combined with different doses of esketamine for painless gastroscopy and to evaluate the efficacy and safety of this combination. METHODS This was a randomised, double-blind, up-and-down sequential allocation study. Patients undergoing painless gastroscopy who met all the inclusion criteria and did not meet any of the exclusion criteria were randomised in a 1:1:1 ratio into the ES0 group (0 mg/kg of esketamine), ES1 group (0.2 mg/kg of esketamine), and ES2 group (0.4 mg/kg of esketamine). The initial dose of remimazolam was 0.3 mg/kg in each group, with the dose increased or decreased by 0.05 mg/kg for the subsequent patient based on the success or failure of sedation in the previous patient. The trial was concluded when seven successful failure crossovers were achieved. The ED50 and 95% confidence intervals (CI) of remimazolam were calculated using Probit regression. Haemodynamic parameters, time to induction of anaesthesia, time to gastroscopy, time to awakening from anaesthesia, and adverse events were recorded. RESULTS A total of 59 patients were included in the final analysis: 19 in the ES0 group, 23 in the ES1 group, and 17 in the ES2 group. The ED50 (95% CI) of remimazolam in the ES0, ES1, and ES2 groups was 0.344 (0.302-0.389) mg/kg, 0.289 (0.249-0.328) mg/kg, and 0.193 (0.145-0.239) mg/kg, respectively. Additionally, the ES1 and ES2 groups exhibited more stable haemodynamics compared to the ES0 group. However, the ES1 and ES2 groups had significantly longer recovery times than the ES0 group. The incidence of hypotension was higher in the ES0 group compared to the ES1 and ES2 groups. CONCLUSION The ED50 of remimazolam combined with 0 mg/kg, 0.2 mg/kg, and 0.4 mg/kg of esketamine for induction of anaesthesia during painless gastroscopy was 0.344 mg/kg, 0.289 mg/kg, and 0.193 mg/kg, respectively. Combining esketamine with remimazolam for induction of anaesthesia during painless gastroscopy offers advantages in terms of haemodynamic stability and reduced adverse effects.
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Affiliation(s)
- Li Zhao
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospital, Nanchong, China
| | - Xuelei Zhou
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospital, Nanchong, China
| | - Linlin Chen
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospital, Nanchong, China
| | - Wei Mao
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospital, Nanchong, China
| | - Yiping Guo
- Nanchong Center for Disease Control and Prevention, Nanchong, China
| | - Xianchun Liu
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospital, Nanchong, China
| | - Longyi Zhang
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospital, Nanchong, China
| | - Ying Xie
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospital, Nanchong, China
| | - Linji Li
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospital, Nanchong, China.
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Masuda H, Nishida T, Matsumoto K, Nakamatsu D, Hayashi S, Yamamoto M. The effectiveness of a body positioning device for controlling patient movement and additional sedative use during endoscopic retrograde cholangiopancreatography: A retrospective analysis. DEN OPEN 2025; 5:e70095. [PMID: 40070930 PMCID: PMC11894692 DOI: 10.1002/deo2.70095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Revised: 02/14/2025] [Accepted: 02/28/2025] [Indexed: 03/14/2025]
Abstract
Background Endoscopic retrograde cholangiopancreatography requires precise body movement control for procedural safety and efficiency. Sedatives are commonly used but pose risks, especially in elderly patients. This study evaluated the effectiveness of the Medo V-Fix device in controlling patient movement during endoscopic retrograde cholangiopancreatography. Methods Of 1723 endoscopic retrograde cholangiopancreatography procedures performed between January 2021 and March 2024, 1,528 were analyzed after excluding cases with missing data. Patients were divided into two groups, the device group (n = 697) and the nondevice group (n = 831). The groups were compared with respect to body movement control, additional sedative administration, sedation-related complications, and procedure discontinuation. Results Baseline characteristics were similar between the groups. Body movement control was better with the device (good, 65.7%; poor, 24.0%; and very poor, 10.3%) than without it (good, 48.1%; poor, 30.7%; and very poor, 21.2%; p < 0.0001). The device reduced the need for manual assistance and additional sedatives. Fewer patients in the device group (9.5% vs. 15.6%, p = 0.0003) required an additional thiopental dose, and the dose was lower (4.5 mg vs. 6 mg, p = 0.0015). No procedure discontinuation occurred in the device group, whereas five discontinuations occurred in the nondevice group. Although hypoxemia was more frequent in the device group (14.5% vs. 8.8%, p = 0.0005), no severe adverse events occurred. Conclusions The Medo V-Fix device significantly improved body movement control and reduced the need for additional doses of sedatives and manual intervention. Despite a higher incidence of mild hypoxemia, these events were appropriately managed with routine monitoring, indicating that the device increases procedural safety and efficiency.
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Affiliation(s)
- Haruka Masuda
- Department of GastroenterologyToyonaka Municipal HospitalOsakaJapan
| | - Tsutomu Nishida
- Department of GastroenterologyToyonaka Municipal HospitalOsakaJapan
| | - Kengo Matsumoto
- Department of GastroenterologyToyonaka Municipal HospitalOsakaJapan
| | - Dai Nakamatsu
- Department of GastroenterologyToyonaka Municipal HospitalOsakaJapan
| | - Shiro Hayashi
- Department of GastroenterologyToyonaka Municipal HospitalOsakaJapan
- Department of Gastroenterology and Internal MedicineHayashi ClinicOsakaJapan
| | - Masashi Yamamoto
- Department of GastroenterologyToyonaka Municipal HospitalOsakaJapan
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Tan X, Yao L, Dong Z, Li Y, Yu Y, Gao X, Zhu K, Su W, Yin H, Wang W, Luo C, Li J, You H, Hu H, Zhou W, Yu H. Artificial Intelligence as a Surrogate for Inspection Time to Assess Completeness in Esophagogastroduodenoscopy: A Prospective, Randomized, Noninferiority Study. Clin Transl Gastroenterol 2025:01720094-990000000-00383. [PMID: 40125855 DOI: 10.14309/ctg.0000000000000839] [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: 10/23/2024] [Accepted: 03/13/2025] [Indexed: 03/25/2025] Open
Abstract
INTRODUCTION The completeness of esophagogastroduodenoscopy (EGD) is a prerequisite for detecting lesions. This study aims to explore whether the quality of complete examinations assisted by artificial intelligence (AI) would be comparable with those conducted within the guideline-recommended inspection time. METHODS Patients referred for diagnostic, screening, or surveillance EGD were enrolled at Renmin Hospital of Wuhan University. Patients were randomly assigned to 2 groups in a 1:1 ratio. In the AI-assisted group, endoscopists completed observation of the entire upper gastrointestinal tract with AI assistance. In the control group, endoscopists were instructed to spend no less than 7 minutes on each procedure. The primary outcome was the detection rate of neoplastic lesions. Noninferiority was confirmed when the lower bound of the 95% confidence interval (CI) was greater than the margin of -1.5%. RESULTS A total of 1,723 patients were prospectively enrolled between July 3, 2023, and April 7, 2024. Seven hundred ninety-six and 763 patients in the AI-assisted and control groups were included in the final analysis, respectively. The detection rates of neoplastic lesions in the AI-assisted and control groups were 3.14% and 2.36%, respectively, resulting in an absolute proportion difference of 0.78% (95% CI -0.58% to 2.14%; odds ratio 1.342 [95% CI 0.726-2.480]). The median inspection time was reduced by 1.5 minutes in the AI-assisted group (6.18 [2.87] vs 7.70 [1.90], P < 0.001). DISCUSSION Inspection time of complete EGD can be significantly shortened by AI without compromising its quality. These findings provide crucial evidence to support that AI-assisted procedural completeness serves as an objective and effective quality indicator for EGD.
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Affiliation(s)
- Xia Tan
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
- Engineering Research Center for Artificial Intelligence Endoscopy Interventional Treatment of Hubei Province, Wuhan, China
| | - Liwen Yao
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
- Engineering Research Center for Artificial Intelligence Endoscopy Interventional Treatment of Hubei Province, Wuhan, China
| | - Zehua Dong
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
- Engineering Research Center for Artificial Intelligence Endoscopy Interventional Treatment of Hubei Province, Wuhan, China
| | - Yanxia Li
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
- Engineering Research Center for Artificial Intelligence Endoscopy Interventional Treatment of Hubei Province, Wuhan, China
| | - Yuanjie Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
- Engineering Research Center for Artificial Intelligence Endoscopy Interventional Treatment of Hubei Province, Wuhan, China
| | - Xin Gao
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
- Engineering Research Center for Artificial Intelligence Endoscopy Interventional Treatment of Hubei Province, Wuhan, China
| | - Kai Zhu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
- Engineering Research Center for Artificial Intelligence Endoscopy Interventional Treatment of Hubei Province, Wuhan, China
| | - Wenhao Su
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
- Engineering Research Center for Artificial Intelligence Endoscopy Interventional Treatment of Hubei Province, Wuhan, China
| | - Haisen Yin
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
- Engineering Research Center for Artificial Intelligence Endoscopy Interventional Treatment of Hubei Province, Wuhan, China
| | - Wen Wang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
- Engineering Research Center for Artificial Intelligence Endoscopy Interventional Treatment of Hubei Province, Wuhan, China
| | - Chaijie Luo
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
- Engineering Research Center for Artificial Intelligence Endoscopy Interventional Treatment of Hubei Province, Wuhan, China
| | - Jialing Li
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
- Engineering Research Center for Artificial Intelligence Endoscopy Interventional Treatment of Hubei Province, Wuhan, China
| | - Hang You
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
- Engineering Research Center for Artificial Intelligence Endoscopy Interventional Treatment of Hubei Province, Wuhan, China
| | - Huiyan Hu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
- Engineering Research Center for Artificial Intelligence Endoscopy Interventional Treatment of Hubei Province, Wuhan, China
| | - Wei Zhou
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
- Engineering Research Center for Artificial Intelligence Endoscopy Interventional Treatment of Hubei Province, Wuhan, China
| | - Honggang Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
- Engineering Research Center for Artificial Intelligence Endoscopy Interventional Treatment of Hubei Province, Wuhan, China
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Li H, Wang J, Cheng D, Li Y, Li P, Ma Q, Yao Y, Chen J, Zhang Q, Guo J, Wang S, Xing N. Bilevel positive airway pressure ventilation to prevent hypoxaemia during gastroscopy under sedation in patients at risk of hypoxaemia: study protocol for a prospective randomised controlled trial. BMJ Open 2025; 15:e096800. [PMID: 40074253 PMCID: PMC11904358 DOI: 10.1136/bmjopen-2024-096800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Accepted: 02/14/2025] [Indexed: 03/14/2025] Open
Abstract
INTRODUCTION During sedation for gastroscopy, hypoxaemia represents the most common adverse event. The objective of this trial is to assess the efficacy and safety of bilevel positive airway pressure (BPAP) for the prevention of hypoxaemia, in comparison with nasal cannula oxygen therapy, among patients predisposed to hypoxaemia during sedation for gastroscopy. METHODS AND ANALYSIS This randomised controlled trial (RCT) will include 616 patients at risk of hypoxaemia when undergoing gastroscopy, including those with advanced age, frailty, American Society of Anesthesiologists grades III-IV, obesity, obstructive sleep apnoea-hypopnoea syndrome, cardiac disease, respiratory disease and diabetes. The patients will be randomly assigned to either the BPAP or nasal cannula group in a 1:1 ratio. The primary analysis for this study will use the modified intention-to-treat analysis set. The primary outcome is defined as the incidence of hypoxaemia (SpO275%-90%, duration 5-60 s). Outcomes data will be compared using the χ2 or Fisher's exact tests. Effect sizes will be used to assess the clinical effects of the intervention using absolute risk differences and 95% CIs. To assess the efficacy of BPAP in different patient subgroups, analyses will be performed based on clinical characteristics and risk factors associated with hypoxaemia. ETHICS AND DISSEMINATION The Ethics Committee of the First Affiliated Hospital of Zhengzhou University reviewed and approved this RCT (Scientific Research Ethics Review: 2023-KY-0815-003). Subsequently, the outcome will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ChiCTR2400084596.
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Affiliation(s)
- Huixin Li
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, China
| | - Jinguang Wang
- Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dan Cheng
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, China
| | - Yanna Li
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, China
| | - Pingle Li
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiaoling Ma
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yongchao Yao
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiaqi Chen
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Qingli Zhang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junping Guo
- Zhengzhou University College of Medicine, Zhengzhou, Henan, China
| | - Shuailei Wang
- Department of Anesthesiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Na Xing
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, China
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Xin Y, Lu P, Guan S, Si S, Sun R, Xia W, Xu H. Efficacy and Safety of Remimazolam in Short Endoscopic Procedures: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:453. [PMID: 40142264 PMCID: PMC11943698 DOI: 10.3390/medicina61030453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2025] [Revised: 02/23/2025] [Accepted: 02/27/2025] [Indexed: 03/28/2025]
Abstract
Background and Objectives: Appropriate sedation and anesthesia are crucial for ensuring comfortable endoscopic procedures. Propofol is one of the most often used sedatives. However, its safety and adverse effects restrict its usage. Remimazolam is a relatively new intravenous benzodiazepine that offers many benefits. Our analysis aims to evaluate the effectiveness and safety of remimazolam during short endoscopic procedures. Materials and Methods: We conducted a comprehensive search of the PubMed, Web of Science, ClinicalTrials.gov, and Turning Research Into Practice databases up to 31 December 2023, for randomized controlled trials published in English. Statistical analyses were performed using Cochrane Review Manager 5.4.1 and Stata Software/MP. Results: The success rate of sedation with remimazolam was slightly lower than that with propofol (RR: 0.99, 95% CI: 0.98~1.00; p = 0.004; I2 = 42%). As for anesthetic effect-related outcomes, remimazolam did not show advantages in onset time (MD = 12.72, 95% CI: 6.53~18.90, p < 0.001, I2 = 94%), recovery time (MD = 0.86, 95% CI: -0.55~2.27, p = 0.23, I2 = 98%), or intraoperative body movement (RR: 1.18, 95% CI: 0.60~2.32, p = 0.62, I2 = 87%). However, compared to propofol, remimazolam significantly reduced the incidence of several adverse events, including injection pain (RR: 0.07, 95% CI: 0.03~0.14, p < 0.001, I2 = 69%), intraoperative hypotension (RR: 0.38, 95% CI: 0.31~0.47, p < 0.001, I2 = 65%), bradycardia (RR: 0.25, 95% CI: 0.15~0.45, p < 0.001, I2 = 0%), and respiratory depression (RR: 0.34, 95% CI: 0.25~0.46, p < 0.001, I2 = 50%). The incidence of postoperative nausea and vomiting (PONV) was slightly higher with remimazolam (RD: 0.01, 95% CI: 0.00~0.03, p = 0.04, I2 = 33%). Conclusions: Remimazolam is a promising sedative for short endoscopic procedures due to its superior safety profile despite a slightly lower sedation success rate compared to propofol.
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Affiliation(s)
| | | | | | | | | | - Wei Xia
- Department of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hui Xu
- Department of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Machlab S, Lorenzo-Zúñiga V, Pantaleon MA, Sábado F, Arieira C, Pérez Arellano E, Cotter J, Carral D, Turbí Disla C, Gorjão R, Esteban JM, Rodriguez S. Real-world effectiveness and safety of 1L polyethylene glycol and ascorbic acid for bowel preparation in patients aged 80 years or older. Endosc Int Open 2025; 13:a25259938. [PMID: 40018074 PMCID: PMC11866040 DOI: 10.1055/a-2525-9938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Accepted: 01/15/2025] [Indexed: 03/01/2025] Open
Abstract
Background and study aims Clinical trials and real-world studies show a 1L polyethene glycol and ascorbic acid solution (1L PEG-ASC) to be an effective and safe bowel preparation for colonoscopy in the general population. Here, the effectiveness and safety of 1L PEG-ASC were evaluated in patients aged 80 years or older in a real-world setting. Patients and methods A post-hoc analysis of an observational, multicenter, retrospective study assessed the effectiveness and safety of 1L PEG-ASC on outpatients aged ≥ 80 years old undergoing colonoscopy at eight centers in Spain and Portugal. Cleansing quality was assessed using the Boston Bowel Preparation Scale, with overall scores ≥ 6 and all segmental scores ≥ 2 considered adequate colon cleansing, and overall scores ≥ 8 or 3 in the right colon considered high-quality cleansing. Cecal intubation rate, withdrawal time, polyp and adenoma detection rates (ADR), and adverse events (AEs) were also monitored. Results Data were analyzed from 423 patients aged ≥ 80 years; mean age 83.5 years (±3.2) and 49.2% males. The adequate colon cleansing success rate was 88.9%, with high-quality cleansing of the overall and right colon achieved in 54.1% and 46.1% of patients, respectively. Colonoscopy was complete in 94.1% of cases and the ADR was 51.3%. At least one AE was experienced by 4.5% of participants, the most frequent being mild dehydration (2.8%) and nausea (1.2%). Conclusions This post-hoc analysis confirms 1L PEG-ASC to be an effective and safe bowel cleansing preparation for patients aged 80 years or older in a real-world setting.
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Affiliation(s)
- Salvador Machlab
- Gastroenterology, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | | | | | - Fernando Sábado
- Gastroenterology, Consorcio Hospitalario Provincial de Castelló, Castellón, Spain
| | - Cátia Arieira
- Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | | | - José Cotter
- Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal
- School of Medicine, Universidade do Minho, Life and Health Sciences Research Institute (ICVS), Braga/Guimarães, Portugal
- Gastroenterology, ICVS/3B’s – PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - David Carral
- Gastroenterology, Hospital San Rafael, A Coruña, Spain
| | - Carmen Turbí Disla
- Medical Affairs, Norgine, Harefield, United Kingdom of Great Britain and Northern Ireland
| | - Ricardo Gorjão
- Gastroenterology, Hospital CUF Descobertas, Lisboa, Portugal
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Crosby BT, Munglani L, Wright K, Charles K, Evans W, Mathias M, Davies S, Abdalla B, Turner J, Crosby T, Trudgill N, Haboubi H. Impact of introducing transnasal endoscopy on expanding diagnostic endoscopy services. BMJ Open Qual 2025; 14:e002992. [PMID: 39884722 PMCID: PMC11784182 DOI: 10.1136/bmjoq-2024-002992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 12/23/2024] [Indexed: 02/01/2025] Open
Abstract
INTRODUCTION Demand for endoscopic services is outstripping capacity in the UK. Transnasal endoscopy (TNE) utilises a narrow calibre endoscope to pass through the nasal passages, thereby reducing retching and discomfort. It is better tolerated compared with standard transoral endoscopy (TOE) but is still rarely used as a diagnostic modality. There is still uncertainty about how well it performs against TOE in diagnostic ability, cost and efficiency. METHODS We explored utilising TNE to deal with the growing demand for endoscopy. We compared findings to TOE procedures undertaken during the same time period. We evaluated cost differences, duration/time in the department for procedures as well as quality of procedures (both in terms of performance indicators as well as image quality using the validated POLPREP score). RESULTS A total of 241 upper gastrointestinal endoscopy procedures were evaluated (100 TNE and 141 matched TOE) between December 2021 and February 2022. TNE outperformed TOE in obtaining >95% success rate in nationally approved key performance indicators (retroflexion and duodenal intubation, both p=0.026). It also was associated with better image quality in the oesophagus with a POLPREP A3 Score (excellent image quality) in 36/98 available images compared with 26/136 TOE (p=0.028) and was equivalent to TOE in the stomach and duodenum. TNE was identified as having a key role in facilitating complex cases, previously failed via the TOE route with a success rate in 11/12 (91.7%) of such cases. TNE also shows promise in correcting misdiagnoses of short-segment Barrett's oesophagus (39%) compared with TOE (14.8%) (p=0.087). CONCLUSION TNE is an emerging endoscopic modality, which shows great promise in replacing TOE in most diagnostic circumstances. In a modern healthcare service, TNE is cheaper, better tolerated and outperforms TOE in multiple domains.
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Affiliation(s)
| | - Laura Munglani
- Cwmbran, The Grange University Hospital, Cwmbran, Wales, UK
| | - Karen Wright
- Department of Gastroenterology, University Hospital Llandough, Llandough, South Glamorgan, UK
| | - Kay Charles
- Department of Gastroenterology, University Hospital Llandough, Llandough, South Glamorgan, UK
| | | | | | - Stevie Davies
- Ysbyty Glan Clwyd, Rhyl, Denbighshire, UK
- Wales Cancer Network, Cardiff, UK
| | - Badr Abdalla
- Department of Gastroenterology, University Hospital Llandough, Llandough, South Glamorgan, UK
| | - Jeff Turner
- Department of Gastroenterology, University Hospital Llandough, Llandough, South Glamorgan, UK
| | | | - Nigel Trudgill
- Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Hasan Haboubi
- Department of Gastroenterology, University Hospital Llandough, Llandough, South Glamorgan, UK
- Cancer Biomarker Group, Swansea University Institute of Life Science, Swansea, UK
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9
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Yin C, Sun Y, Liang J, Sui X, He Z, Song A, Xu W, Zhang L, Sun Y, Zhao J, Han F. Sedated and unsedated gastroscopy has no influence on the outcomes of patients with gastric cancer: a retrospective study. BMC Cancer 2025; 25:13. [PMID: 39762806 PMCID: PMC11702075 DOI: 10.1186/s12885-024-13413-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 12/31/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND Different anesthetic drugs and techniques may affect survival outcomes for gastric cancer (GC) after surgery. In this study, we investigated the association between sedated and unsedated gastroscopy on survival outcomes in patients with GC after surgery. METHODS This was a retrospective study of patients who were diagnosed with GC by gastroscopy and underwent gastrectomy from January 2013 to December 2017. They were grouped based on the examination modality: propofol-based sedated gastroscopy or unsedated gastroscopy. Propensity score matching (PSM) was used to balance the baseline variables. Survival outcomes and distant metastases were compared between these two groups. RESULTS Finally, 673 patients were enrolled, 160 in the sedated gastroscopy group and 513 in the unsedated gastroscopy group. After PSM, there were 160 patients in each group. There was no significant difference in overall survival outcomes in the sedated gastroscopy group compared to the unsedated gastroscopy group before PSM (HR = 0.761, 95% CI: 0.531-1.091, P = 0.139) or after PSM (HR = 0.874, 95% CI: 0.564-1.355, P = 0.547). There was no significant difference in the incidence of distant metastases between the two groups before PSM (16.9% vs. 20.7%, P = 0.294) or after PSM (16.9% vs. 23.8%, P = 0.126). To confirm that our patients behaved similarly to other studies, we performed a multivariate analysis and the results showed that sex, pathological TNM stage, Borrmann type, adjuvant treatment, and surgical resection range were all independent factors affecting survival outcomes in our patients. CONCLUSION Our results showed no significant difference in the effects of sedated gastroscopy vs. unsedated gastroscopy on survival outcomes or distant metastases of patients after gastrectomy for GC.
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Affiliation(s)
- Chengke Yin
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, 150 Haping Rd, Nangang District, Harbin, Heilongjiang, 150081, China
| | - Yiwu Sun
- Department of Anesthesiology, Dazhou Central Hospital, 56 Nanyuemiao Rd, Tongchuan District, Dazhou, Sichuan, 635000, China
| | - Jie Liang
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, 150 Haping Rd, Nangang District, Harbin, Heilongjiang, 150081, China
| | - Xin Sui
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, 150 Haping Rd, Nangang District, Harbin, Heilongjiang, 150081, China
| | - Zhaoyi He
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, 150 Haping Rd, Nangang District, Harbin, Heilongjiang, 150081, China
| | - Ailing Song
- Department of Anesthesiology, Shanghai Jiaotong University First People's Hospital, 85 Wujin Rd, Hongkou District, Shanghai, 200080, China
| | - Wenjia Xu
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, 150 Haping Rd, Nangang District, Harbin, Heilongjiang, 150081, China
| | - Lei Zhang
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, 150 Haping Rd, Nangang District, Harbin, Heilongjiang, 150081, China
| | - Yufei Sun
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, 150 Haping Rd, Nangang District, Harbin, Heilongjiang, 150081, China
| | - Jingshun Zhao
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, 150 Haping Rd, Nangang District, Harbin, Heilongjiang, 150081, China
| | - Fei Han
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, 150 Haping Rd, Nangang District, Harbin, Heilongjiang, 150081, China.
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10
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Dahiya DS, Kumar G, Parsa S, Gangwani MK, Ali H, Sohail AH, Alsakarneh S, Hayat U, Malik S, Shah YR, Pinnam BSM, Singh S, Mohamed I, Rao A, Chandan S, Al-Haddad M. Remimazolam for sedation in gastrointestinal endoscopy: A comprehensive review. World J Gastrointest Endosc 2024; 16:385-395. [PMID: 39072252 PMCID: PMC11271717 DOI: 10.4253/wjge.v16.i7.385] [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] [Received: 03/30/2024] [Revised: 05/05/2024] [Accepted: 06/04/2024] [Indexed: 07/08/2024] Open
Abstract
Worldwide, a majority of routine endoscopic procedures are performed under some form of sedation to maximize patient comfort. Propofol, benzodiazepines and opioids continue to be widely used. However, in recent years, Remimazolam is gaining immense popularity for procedural sedation in gastrointestinal (GI) endoscopy. It is an ultra-short-acting benzodiazepine sedative which was approved by the Food and Drug Administration in July 2020 for use in procedural sedation. Remimazolam has shown a favorable pharmacokinetic and pharmacodynamic profile in terms of its non-specific metabolism by tissue esterase, volume of distribution, total body clearance, and negligible drug-drug interactions. It also has satisfactory efficacy and has achieved high rates of successful sedation in GI endoscopy. Furthermore, studies have demonstrated that the efficacy of Remimazolam is non-inferior to Propofol, which is currently a gold standard for procedural sedation in most parts of the world. However, the use of Propofol is associated with hemodynamic instability and respiratory depression. In contrast, Remimazolam has lower incidence of these adverse effects intra-procedurally and hence, may provide a safer alternative to Propofol in procedural sedation. In this comprehensive narrative review, highlight the pharmacologic characteristics, efficacy, and safety of Remimazolam for procedural sedation. We also discuss the potential of Remimazolam as a suitable alternative and how it can shape the future of procedural sedation in gastroenterology.
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Affiliation(s)
- Dushyant Singh Dahiya
- Division of Gastroenterology, Hepatology & Motility, The University of Kansas School of Medicine, Kansas City, MO 66160, United States
| | - Ganesh Kumar
- Department of Internal Medicine, Chandka Medical College, Sindh 77280, Pakistan
| | - Syeda Parsa
- Department of Internal Medicine, Chandka Medical College, Sindh 77280, Pakistan
| | - Manesh Kumar Gangwani
- Department of Gastroenterology and Hepatology, University of Arkansas For Medical Sciences, Little Rock, AR 72205, United States
| | - Hassam Ali
- Division of Gastroenterology, Hepatology and Nutrition, East Carolina University/Brody School of Medicine, Greenville, NC 27858, United States
| | - Amir Humza Sohail
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM 87106, United States
| | - Saqr Alsakarneh
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, United States
| | - Umar Hayat
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes Barre, PA 18711, United States
| | - Sheza Malik
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY 14621, United States
| | - Yash R Shah
- Department of Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, MI 48341, United States
| | - Bhanu Siva Mohan Pinnam
- Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, IL 60612, United States
| | - Sahib Singh
- Department of Internal Medicine, Sinai hospital, Baltimore, MD 21215, United States
| | - Islam Mohamed
- Department of Hepatology, University of Missouri, Columbia, MO 65211, United States
| | - Adishwar Rao
- Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA 18840, United States
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, NE 68131, United States
| | - Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN 46202, United States
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11
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Guo Y, Yao Z, Feng Y, Wang D, Wang Y, Lin J. ED50 and ED95 of Remimazolam Tosilate Combined with Different Doses of Fentanyl in Elderly Patients for Painless Gastroscopy. Drug Des Devel Ther 2024; 18:2347-2356. [PMID: 38915865 PMCID: PMC11194286 DOI: 10.2147/dddt.s462607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 06/11/2024] [Indexed: 06/26/2024] Open
Abstract
Background The novel short-acting benzodiazepine drug, remimazolam tosilate, has been employed for sedation during endoscopic procedures. The optimal loading dosage of remimazolam tosilate in gastroscopy for elderly patients when co-administered with fentanyl remains unclear. Therefore, the primary objective of our research was to ascertain the median effective dose (ED50) and the 95% effective dose (ED95) of remimazolam tosilate in combination with various fentanyl dosages for elderly patients undergoing painless gastroscopy. Methods Seventy-five patients aged ≥65 years and American Society of Anesthesiologists (ASA) class I-III were recruited to undergo elective painless gastroscopy. All patients were randomized assigned to group F1, group F2, and group F3, and were injected intravenously with different doses of fentanyl (0.5 ug/kg, 1 ug/kg, and 1.5 ug/kg) 3 minutes prior to the administration of remimazolam tosilate, respectively. The initial preset dose of remimazolam tosilate was 0.3 mg/kg in group F1, 0.2 mg/kg in group F2, 0.15 mg/kg in group F3. The dose gradient was 0.02 mg/kg per group according to the up-and-down sequential method. Probibt regression model was employed to determine the ED50 and ED95 of remimazolam tosilate. Results The ED50 of remimazolam tosilate in group F3 was lower than that in group F1 and F2 (0.095 [0.088-0.108] mg/kg vs 0.162 [0.153-0.171] mg/kg; 0.258 [0.249-0.266] mg/kg, p < 0.05). The ED95 of remimazolam tosilate was 0.272 mg/kg (95% CI: 0.264-0.295 mg/kg) in group F1, 0.175 mg/kg (95% CI: 0.167-0.200 mg/kg) in group F2 and 0.109 mg/kg (95% CI: 0.101-0.135 mg/kg) in group F3. The total dosage of remimazolam tosilate decreased gradually with the increasing of fentanyl (p < 0.001). The frequency of injection pain was higher in group F1 compared to groups F2 and F3 (p < 0.05). The patients in group F3 had a lower incidence of hypotension than in groups F1 and F2 (p < 0.05). There was no respiratory depression, intraoperative consciousness, dizziness or delirium in the three groups. Conclusion The concurrent use of fentanyl reduces the dosage of remimazolam tosilate required for sedative gastroscopy in elderly patients in a dose-dependent manner. Moreover, 1.5 ug/kg fentanyl combined with remimazolam tosilate may reduce the incidence of hypotension and injection pain. These findings should be confirmed in a large-scale study.
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Affiliation(s)
- Yanxia Guo
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People’s Republic of China
| | - Zhihua Yao
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People’s Republic of China
| | - Yan Feng
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People’s Republic of China
| | - Dan Wang
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People’s Republic of China
| | - Yizheng Wang
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People’s Republic of China
| | - Jingyan Lin
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People’s Republic of China
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12
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Ju J, Su Y, Zeng Q, Liang J, Zhang X, Ren J, Wu L, Zheng R. Sonographic features of Lemmel's syndrome: Differential diagnosis from stones in the lower portion of the common bile duct. Arab J Gastroenterol 2024; 25:143-149. [PMID: 38403494 DOI: 10.1016/j.ajg.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 09/28/2023] [Accepted: 01/03/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND STUDY AIMS Periampullary diverticula (PAD), a location-specific type of duodenal diverticula, can cause serious complications. PAD is difficult to differentially diagnose, mainly due to its nonspecific symptoms. This study aimed to identify sonographic features of PAD and to evaluate their value in the differential diagnosis of PAD from stones in the lower common bile duct (CBD). PATIENTS AND METHODS A total of 30 patients with PAD and 60 patients with lower CBD stones were retrospectively enrolled, and sonographic features were analyzed. Measurements of sonographic features included echo shaped, posterior echo changes, location and relation to surrounding organs, and status of intrahepatic and extrahepatic bile duct dilation, and their diagnostic performance was assessed. RESULTS Characteristic sonographic features of PAD were identified, including strong echoes (28/30, 93.3 %), strip shape (28/30, 93.3 %), multiple reflections in the posterior echo (27/30, 90.0 %), and location outside the CBD or near the biliary wall in connection with the duodenum (27/30, 90.0 %). Inter-observer agreement was good (Kappa values = 0.69-0.82). Comparative analysis of sonographic features revealed significant differences in echo shape, posterior echo changes (multiple reflections and acoustic shadowing), location and relation to surrounding organs, and intrahepatic and extrahepatic bile duct dilatation status between the dilatation status of the two groups. In particular, these characteristics achieved a sensitivity of 100 % and a specificity of 98 % for the differential diagnosis of PAD and lower CBD stones. CONCLUSIONS This study identified characteristic sonographic features of PAD, which could be used as potential diagnostic indicators to distinguish PAD from lower CBD stones.
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Affiliation(s)
- Jinxiu Ju
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, China
| | - Yating Su
- Department of Ultrasound, The First Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Qingjing Zeng
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, China.
| | - Jiayi Liang
- Huangpu District Luogang Street Community Health Service Center, Guangzhou, Guangdong, P.R. China
| | - Xiaodan Zhang
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, China.
| | - Jie Ren
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, China.
| | - Lili Wu
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, China.
| | - Rongqin Zheng
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, China.
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Kim SY, Lee JK, Lee KH, Jang JY, Kim BW, Endoscopic Sedation Committee of Korean Society of Gastrointestinal Endoscopy (KSGE). The Impact of Sedation on Cardio-Cerebrovascular Adverse Events after Surveillance Esophagogastroduodenoscopy in Patients with Gastric Cancer: A Nationwide Population-Based Cohort Study. Gut Liver 2024; 18:245-256. [PMID: 37317513 PMCID: PMC10938152 DOI: 10.5009/gnl230043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 06/16/2023] Open
Abstract
Background/Aims The impact of sedation on cardio-cerebrovascular (CCV) adverse events after esophagogastroduodenoscopy (EGD) in patients with gastric cancer (GC) is unclear. We investigated the incidence rate and impact of sedation on CCV adverse events after surveillance EGD in patients with GC. Methods We performed a nationwide population-based cohort study using the Health Insurance Review and Assessment Service databases from January 1, 2018, to December 31, 2020. Using a propensity score-matched analysis, patients with GC were divided into two groups: sedative agent users and nonusers for surveillance EGD. We compared the occurrence of CCV adverse events within 14 days between the two groups. Results Of the 103,463 patients with GC, newly diagnosed CCV adverse events occurred in 2.57% of patients within 14 days after surveillance EGD. Sedative agents were used in 41.3% of the patients during EGD. The incidence rates of CCV adverse events with and without sedation were 173.6/10,000 and 315.4/10,000, respectively. Between sedative agent users and nonusers based on propensity score matching (28,008 pairs), there were no significant differences in the occurrence of 14-day CCV, cardiac, cerebral, and other vascular adverse events (2.28% vs 2.22%, p=0.69; 1.44% vs 1.31%, p=0.23; 0.74% vs 0.84%, p=0.20; 0.10% vs 0.07%, p=0.25, respectively). Conclusions Sedation during surveillance EGD was not associated with CCV adverse events in patients with GC. Therefore, the use of sedative agents may be considered in patients with GC during surveillance EGD without excessive concerns about CCV adverse events.
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Affiliation(s)
- Sang Yoon Kim
- Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Jun Kyu Lee
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Kwang Hyuck Lee
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Young Jang
- Department of Internal Medicine, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Byung-Wook Kim
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
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14
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Li FZ, Zhao C, Tang YX, Liu JT. Safety and efficacy comparison of remimazolam and propofol for intravenous anesthesia during gastroenteroscopic surgery of older patients: A meta-analysis. World J Clin Cases 2024; 12:1272-1283. [PMID: 38524507 PMCID: PMC10955534 DOI: 10.12998/wjcc.v12.i7.1272] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/21/2024] [Accepted: 02/05/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Remimazolam is characterized by rapid action and inactive metabolites. It is used as the general anesthetic for many clinical surgeries. In this study, we performed a meta-analysis to evaluate whether remimazolam is superior to propofol for gastroenteroscopy in older patients. AIM To compare the adverse events and efficacy of remimazolam and propofol during gastroenteroscopy in older adults. METHODS The PubMed, Web of Science, the Cochrane Library databases were queried for the relevant key words "remimazolam," "and propofol," "and gastrointestinal endoscopy or gastroscopy." The search scope was "Title and Abstract," and the search was limited to human studies and publications in English. Seven studies wherein remimazolam and propofol were compared were included for the meta-analysis. RESULTS We selected seven randomized controlled trials involving 1445 cases for the analysis. Remimazolam reduced the hypotension (relative risk, RR = 0.44, 95%CI: 0.29-0.66, P = 0.000), respiratory depression (RR = 0.46, 95%CI: 0.30-0.70, P = 0.000), injection pain (RR = 0.12, 95%CI: 0.05-0.25, P = 0.000), bradycardia (RR = 0.37, 95%CI: 0.24-0.58, P = 0.000), and time to discharge [weighted mean difference (WMD) = -0.58, 95%CI: -0.97 to -0.18, P = 0.005], compared to those after propofol administration. No obvious differences were observed for postoperative nausea and vomiting (RR = 1.09, 95%CI: 0.97-1.24, P = 0.151), dizziness (RR = 0.77, 95%CI: 0.43-1.36, P = 0.361), successful sedation rate (RR = 0.96, 95%CI: 0.93-1.00, P = 0.083), or the time to become fully alert (WMD = 0.00, 95%CI: -1.08-1.08, P = 0.998). CONCLUSION Remimazolam appears to be safer than propofol for gastroenteroscopy in older adults. However, further studies are required to confirm these findings.
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Affiliation(s)
- Fang-Zhuo Li
- Department of Anesthesiology, The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People’s Hospital), Changsha 410005, Hunan Province, China
| | - Cheng Zhao
- Department of Anesthesiology, Zhangjiajie People's Hospital, Zhangjiajie 427000, Hunan Province, China
| | - Yi-Xun Tang
- Department of Anesthesiology, The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People’s Hospital), Changsha 410005, Hunan Province, China
| | - Ji-Tong Liu
- Department of Anesthesiology, The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People’s Hospital), Changsha 410005, Hunan Province, China
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Takahashi K, Ohyama H, Takiguchi Y, Sekine Y, Toyama S, Yamada N, Sugihara C, Kan M, Ouchi M, Nagashima H, Iino Y, Kusakabe Y, Okitsu K, Ohno I, Kato N. Safety of endoscopic ultrasound-guided fine-needle aspiration for pancreatic solid mass in the elderly: A single-center retrospective study. Geriatr Gerontol Int 2023; 23:836-841. [PMID: 37752034 DOI: 10.1111/ggi.14693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 08/14/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023]
Abstract
AIM There are few reports on the safety of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in the elderly. In this study, we investigated the safety of EUS-FNA for pancreatic solid masses in patients aged ≥80 years. METHODS This is a single-center retrospective study. A total of 600 patients with pancreatic solid masses who underwent EUS-FNA under midazolam-based sedation at our institution between September 2016 and December 2022 were enrolled in this study. Eligible patients were divided into two groups: an elderly group aged ≥80 (n = 84), as well as a nonelderly group aged ≤79 (n = 516). These two groups were compared. RESULTS The elderly group required significantly fewer midazolam doses for sedation (P < 0.001). Adverse events occurred in eight patients (1.3%), including one (1.2%) and seven (1.4%) in the elderly and nonelderly groups, respectively (P = 0.90). There were no cases of early adverse events in the elderly group and six cases (1.2%) in the nonelderly group (P = 0.32). There was one case of late adverse events in both the elderly and nonelderly groups (P = 0.14), and both were needle tract seeding. There was no significant difference between the two groups in the proportion of cases in which percutaneous oxygen saturation decreased to ≤90% during the EUS-FNA. CONCLUSIONS Our analysis suggests that EUS-FNA for pancreatic solid masses can be safely performed in patients aged >80 years without increasing the adverse event rate compared to nonelderly patients aged <80 years. Geriatr Gerontol Int 2023; 23: 836-841.
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Affiliation(s)
- Koji Takahashi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroshi Ohyama
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuichi Takiguchi
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yu Sekine
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shodai Toyama
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nana Yamada
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Chihei Sugihara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Motoyasu Kan
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Mayu Ouchi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroki Nagashima
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yotaro Iino
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuko Kusakabe
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kohichiroh Okitsu
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Izumi Ohno
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Lim KY, Kim KO, Kim EY, Lee YJ, Jang BI, Kim SK, Yang CH. Efficacy and safety of 1 L polyethylene glycol plus ascorbic acid for bowel preparation in elderly: comparison with oral sulfate solution. Korean J Intern Med 2023; 38:651-660. [PMID: 37482653 PMCID: PMC10493436 DOI: 10.3904/kjim.2023.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/13/2023] [Accepted: 04/25/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND/AIMS Recently, 1 L of polyethylene glycol (PEG) plus ascorbic acid (Asc) has been introduced in Korea as a colonoscopy preparation agent. Data on its efficacy and safety in older adults have been limited. We aimed to evaluate the safety and efficacy of 1 L PEG/Asc in older adults by comparing it with oral sulfate solution (OSS). METHODS A prospective multicenter randomized study was conducted with subjects aged ≥ 65 years who underwent colonoscopy. The participants were randomized to receive 1 L PEG/Asc or OSS. The primary endpoint was successful bowel preparation, defined as total Boston Bowel Preparation Scale ≥ 6, and ≥ 2 at each segment. Patient satisfaction, adverse events, and renal function changes were compared between the groups. RESULTS Among the 106 patients, 104 were finally included in the analysis. Overall, successful bowel preparation was achieved in 96.2% of both 1 L PEG/Asc and OSS groups. The satisfaction scores for taste, total amount ingested, overall feeling, and willingness to repeat the same regimen were not significantly different between the groups. Adverse events of moderate or higher severity occurred in 16 and 10 cases in the 1 L PEG/Asc and OSS group, respectively. There were no significant changes in electrolyte levels or renal function from baseline. CONCLUSION The successful bowel preparation rate was > 90% in both groups without severe adverse effects and significant changes in renal function. As a new low-dose preparation regimen for colonoscopy in older adults, 1 L PEG/Asc, is as effective and safe as OSS.
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Affiliation(s)
- Ki Young Lim
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu,
Korea
| | - Kyeong Ok Kim
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu,
Korea
| | - Eun Young Kim
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu,
Korea
| | - Yoo Jin Lee
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu,
Korea
| | - Byung Ik Jang
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu,
Korea
| | - Sung Kook Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu,
Korea
| | - Chang Heon Yang
- Health Promotion Center, Yeungnam University College of Medicine, Daegu,
Korea
- Deparment of Internal Medicine, Dongguk University School of Medicine, Gyeongju,
Korea
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17
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Chen J, Qian K, Liu CH, Li XL, Chen Y, Wang JQ. Effects of intravenous administration of magnesium sulfate in propofol-based sedation for ERCP in elderly patients: a randomized, double-blind, placebo-controlled study. BMC Geriatr 2023; 23:413. [PMID: 37420201 PMCID: PMC10326926 DOI: 10.1186/s12877-023-04107-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 06/14/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Propofol-based sedations are widely used in elderly patients for endoscopic retrograde cholangiopancreatography (ERCP) procedure, but respiratory depression and cardiovascular adverse events commonly occur. Magnesium administered intravenously can alleviate pain and decrease propofol requirements during surgery. We hypothesized that intravenous magnesium was used as adjuvant to propofol might be beneficial in elderly patients undergoing ERCP procedures. METHODS Eighty patients aged from 65 to 79 years who were scheduled for ERCP were enrolled. All patients were intravenously administered 0.1 µg/kg sufentanil as premedication. The patients were randomized to receive either intravenous magnesium sulfate 40 mg/kg (group M, n = 40) or the same volume of normal saline (group N, n = 40) over 15 min before the start of sedation. Intraoperative sedation was provided by propofol. Total propofol requirement during ERCP was the primary outcome. RESULTS The total propofol consumption were reduced by 21.4% in the group M compared with the group N (151.2 ± 53.3 mg vs. 192.3 ± 72.1 mg, P = 0.001). The incidences of respiratory depression episodes and involuntary movement were less in the group M than those in the group N (0/40 vs. 6/40, P = 0.011; 4/40 vs. 11/40, P = 0.045; respectively). In the group M, the patients experienced less pain than those in the group N at 30 min after the procedure (1 [0-1] vs. 2 [1-2], P < 0.001). Correspondingly, the patients' satisfaction was clearly higher in the group M (P = 0.005). There was a tendency towards lower intraoperative heart rate and mean arterial pressure in group M. CONCLUSIONS A single bolus of 40 mg/kg of intravenous magnesium can significantly reduce propofol consumption during ERCP, with higher sedation success and lower adverse events. TRIAL REGISTRATION ID UMIN000044737. Registered 02/07/2021.
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Affiliation(s)
- Jie Chen
- Department of Anaesthesiology, People's Hospital of Chongqing Banan District, Chongqing, China
| | - Ke Qian
- Department of Anaesthesiology, People's Hospital of Chongqing Banan District, Chongqing, China
| | - Chun-Hong Liu
- Department of Anaesthesiology, People's Hospital of Chongqing Banan District, Chongqing, China
| | - Xiao-Li Li
- Department of Anaesthesiology, People's Hospital of Chongqing Banan District, Chongqing, China
| | - Yan Chen
- Department of Anaesthesiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Jin-Quan Wang
- Department of Anaesthesiology, The Ninth People's Hospital of Chongqing, No. 69, Hejia Road, Jialing village, Beibei District, Chongqing, 400700, P. R. China.
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18
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Lian X, Lin Y, Luo T, Jing Y, Yuan H, Guo Y. Efficacy and safety of esketamine for sedation among patients undergoing gastrointestinal endoscopy: a systematic review and meta-analysis. BMC Anesthesiol 2023; 23:204. [PMID: 37312027 DOI: 10.1186/s12871-023-02167-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 06/07/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Patients who undergo gastrointestinal endoscopy often require propofol-based sedation combined with analgesics. At present, the efficacy and safety of esketamine as an adjunct to propofol for sedation during endoscopic procedures in patients remains controversial. Moreover, there is no universal agreement regarding the appropriate dose of esketamine supplementation. This study aimed to assess the efficacy and safety of esketamine as an adjunct to propofol for sedation during endoscopic procedures in patients. METHODS Seven electronic databases and three clinical trial registry platforms were searched and the deadline was February 2023. Randomized controlled trials (RCTs) evaluating the efficacy of esketamine for sedation were included by two reviewers. Data from the eligible studies were combined to calculate the pooled risk ratio or standardized mean difference. RESULTS Eighteen studies with 1962 esketamine participants were included in the analysis. As an adjunct to propofol, the administration of esketamine reduced the recovery time compared to normal saline (NS). However, there was no significant difference between the opioids group and ketamine group. For propofol dosage, the administration of esketamine required a lower propofol dosage compared to the NS group and opioids group].For complications, the esketamine group had fewer complications compared to the NS group and opioid group in patients, but there were no significant differences between the esketamine group and ketamine group. Notably, the coadministration of esketamine was associated with a higher risk of visual disturbance compared to the NS group. In addition, we used subgroup analysis to investigate whether 0.2-0.5 mg/kg esketamine was effective and tolerable for patients. CONCLUSION Esketamine as an adjunct to propofol, is an appropriate effective alternative for sedation in participants undergoing gastrointestinal endoscopy. However, considering the possibility of its psychotomimetic effects, esketamine should be used with caution.
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Affiliation(s)
- Xianghong Lian
- Department of Pharmacy, West China Second University Hospital, Sichuan University, No.20, Third Section, Renmin Nan Lu, Chengdu, Sichuan, 610041, People's Republic of China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People's Republic of China
| | - Yunzhu Lin
- Department of Pharmacy, West China Second University Hospital, Sichuan University, No.20, Third Section, Renmin Nan Lu, Chengdu, Sichuan, 610041, People's Republic of China.
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People's Republic of China.
| | - Ting Luo
- Department of Pharmacy, West China Second University Hospital, Sichuan University, No.20, Third Section, Renmin Nan Lu, Chengdu, Sichuan, 610041, People's Republic of China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People's Republic of China
| | - Yang Jing
- Department of Pharmacy, West China Second University Hospital, Sichuan University, No.20, Third Section, Renmin Nan Lu, Chengdu, Sichuan, 610041, People's Republic of China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People's Republic of China
| | - Hongbo Yuan
- Department of Pharmacy, West China Second University Hospital, Sichuan University, No.20, Third Section, Renmin Nan Lu, Chengdu, Sichuan, 610041, People's Republic of China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People's Republic of China
| | - Yixin Guo
- Department of Pharmacy, West China Second University Hospital, Sichuan University, No.20, Third Section, Renmin Nan Lu, Chengdu, Sichuan, 610041, People's Republic of China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People's Republic of China
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19
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Liu F, Cheng X, Wang Y, Li K, Peng T, Fang N, Pasunooti KK, Jun S, Yang X, Wu J. Effect of remimazolam tosilate on the incidence of hypoxemia in elderly patients undergoing gastrointestinal endoscopy: A bi-center, prospective, randomized controlled study. Front Pharmacol 2023; 14:1131391. [PMID: 37144222 PMCID: PMC10151819 DOI: 10.3389/fphar.2023.1131391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 04/03/2023] [Indexed: 05/06/2023] Open
Abstract
Background: Remimazolam tosilate is a new ultra-short-acting benzodiazepine sedative medicine. In this study, we evaluated the effect of remimazolam tosilate on the incidence of hypoxemia during sedation in elderly patients undergoing gastrointestinal endoscopy. Methods: Patients in the remimazolam group received an initial dose of 0.1 mg/kg and a bolus dose of 2.5 mg of remimazolam tosilate, whereas patients in the propofol group received an initial dose of 1.5 mg/kg and a bolus dose of 0.5 mg/kg of propofol. Patients received ASA standard monitoring (heart-rate, non-invasive blood pressure, and pulse oxygen saturation) during the entire examination process. The primary outcome was the incidence of moderate hypoxemia (defined as 85%≤ SpO2< 90%, >15s) during the gastrointestinal endoscopy. The secondary outcomes included the incidence of mild hypoxemia (defined as SpO2 90%-94%) and severe hypoxemia (defined as SpO2< 85%, >15s), the lowest pulse oxygen saturation, airway maneuvers used to correct hypoxemia, patient's hemodynamic as well as other adverse events. Results: 107 elderly patients (67.6 ± 5.7 years old) in the remimazolam group and 109 elderly patients (67.5 ± 4.9 years old) in the propofol group were analyzed. The incidence of moderate hypoxemia was 2.8% in the remimazolam group and 17.4% in the propofol group (relative risk [RR] = 0.161; 95% confidence interval [CI], 0.049 to 0.528; p < 0.001). The frequency of mild hypoxemia was less in the remimazolam group, but not statistically significant (9.3% vs. 14.7%; RR = 0.637; 95% CI, 0.303 to 1.339; p = 0.228). There was no significant difference in the incidence of severe hypoxemia between the two groups (4.7% vs. 5.5%; RR = 0.849; 95% CI, 0.267 to 2.698; p = 0.781). The median lowest SpO2 during the examination was 98% (IQR, 96.0%-99.0%) in patients in the remimazolam group, which was significantly higher than in patients in the propofol group (96%, IQR, 92.0%-99.0%, p < 0.001). Patients in the remimazolam group received more drug supplementation during endoscopy than patients in the propofol group (p = 0.014). There was a statistically significant difference in the incidence of hypotension between the two groups (2.8% vs. 12.8%; RR = 0.218; 95% CI, 0.065 to 0.738; p = 0.006). No significant differences were found in the incidence of adverse events such as nausea and vomiting, dizziness, and prolonged sedation. Conclusion: This study explored the safety of remimazolam compared with propofol during gastrointestinal endoscopy in elderly patients. Despite the increased supplemental doses during sedation, remimazolam improved risk of moderate hypoxemia (i.e., 85%≤ SpO2 < 90%) and hypotension in elderly patients.
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Affiliation(s)
- Fang Liu
- Department of Anaesthesiology, Qilu Hospital of Shandong University, Jinan, China
- School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaoyan Cheng
- Department of Anaesthesiology, Weifang People’s Hospital (The First Affiliated Hospital of Weifang Medical University), Weifang, China
| | - Yingjie Wang
- Department of Anaesthesiology, Qilu Hospital of Shandong University, Jinan, China
- School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Kai Li
- Department of Anaesthesiology, Qilu Hospital of Shandong University, Jinan, China
| | - Tianliang Peng
- Department of Anaesthesiology, Weifang People’s Hospital (The First Affiliated Hospital of Weifang Medical University), Weifang, China
| | - Ningning Fang
- Department of Anaesthesiology, Qilu Hospital of Shandong University, Jinan, China
| | - Kalyan K. Pasunooti
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
- Department of Pharmacology and Molecular Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Seungho Jun
- Division of Cardiology, Johns Hopkins University Medical Institutions, Baltimore, MD, United States
| | - Xiaomei Yang
- Department of Anaesthesiology, Qilu Hospital of Shandong University, Jinan, China
- School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Cardiology, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Xiaomei Yang, ; Jianbo Wu,
| | - Jianbo Wu
- Department of Anaesthesiology, Qilu Hospital of Shandong University, Jinan, China
- Department of Anaesthesiology and Perioperative Medicine, Qilu Hospital Dezhou Hospital, Shandong University, Dezhou, China
- *Correspondence: Xiaomei Yang, ; Jianbo Wu,
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Vanella S, Baiamonte M, Crafa F. Multimodal treatments of “gallstone cholangiopancreatitis”. World J Gastrointest Endosc 2022; 14:467-470. [PMID: 36051992 PMCID: PMC9329854 DOI: 10.4253/wjge.v14.i7.467] [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] [Received: 01/20/2022] [Revised: 04/11/2022] [Accepted: 06/03/2022] [Indexed: 02/06/2023] Open
Abstract
Gallstone cholangiopancreatitis is a potentially life-threatening pathology which requires quick intervention involving endoscopists, interventional radiologists, anesthesiologists and surgeons in relation to clinical conditions. Treatment possibilities are varied, especially with current progress in advanced endoscopy, interventional radiology, and minimally invasive surgery. The following treatments are available: endoscopic sphincterotomy (ES) with stone extraction followed by laparoscopic cholecystectomy; simultaneous endoscopic stone extraction with laparoscopic cholecystectomy (rendezvous technique); combined laparoscopic cholecystectomy and common bile duct (CBD) exploration; open CBD exploration; ES post-cholecystectomy; percutaneous placement of biliary drains for unstable patients, followed by percutaneous cholangioscopy; and lithotripsy with different approaches, including a laser and balloon dilation of the sphincter of Oddi. Each technique has its strengths and weaknesses, and there is great discussion in the literature on choosing the ideal approach based on the patient’s clinical conditions.
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Affiliation(s)
- Serafino Vanella
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
| | - Mario Baiamonte
- General and Emergency Surgery Unit, Civico Benfratelli Di Cristina Hospital, Palermo 90121, Italy
| | - Francesco Crafa
- Oncological and General Surgery Unit, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
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21
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Gornick D, Kadakuntla A, Trovato A, Stetzer R, Tadros M. Practical considerations for colorectal cancer screening in older adults. World J Gastrointest Oncol 2022; 14:1086-1102. [PMID: 35949211 PMCID: PMC9244986 DOI: 10.4251/wjgo.v14.i6.1086] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/23/2022] [Accepted: 04/30/2022] [Indexed: 02/06/2023] Open
Abstract
Recent guidelines recommend that colorectal cancer (CRC) screening after age 75 be considered on an individualized basis, and discourage screening for people over 85 due to competing causes of mortality. Given the heterogeneity in the health of older individuals, and lack of data within current guidelines for personalized CRC screening approaches, there remains a need for a clearer framework to inform clinical decision-making. A revision of the current approach to CRC screening in older adults is even more compelling given the improvements in CRC treatment, post-treatment survival, and increasing life expectancy in the population. In this review, we aim to examine the personalization of CRC screening cessation based on specific factors influencing life and health expectancy such as comorbidity, frailty, and cognitive status. We will also review screening modalities and endoscopic technique for minimizing risk, the risks of screening unique to older adults, and CRC treatment outcomes in older patients, in order to provide important information to aid CRC screening decisions for this age group. This review article offers a unique approach to this topic from both the gastroenterologist and geriatrician perspective by reviewing the use of specific clinical assessment tools, and addressing technical aspects of screening colonoscopy and periprocedural management to mitigate screening-related complications.
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Affiliation(s)
- Dana Gornick
- Albany Medical College, Albany Medical College, Albany, NY 12208, United States
| | - Anusri Kadakuntla
- Albany Medical College, Albany Medical College, Albany, NY 12208, United States
| | - Alexa Trovato
- Albany Medical College, Albany Medical College, Albany, NY 12208, United States
| | - Rebecca Stetzer
- Division of Geriatrics, Albany Medical Center, Albany, NY 12208, United States
| | - Micheal Tadros
- Division of Gastroenterology, Albany Medical Center, Albany, NY 12208, United States
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22
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Guo J, Qian Y, Zhang X, Han S, Shi Q, Xu J. Remimazolam tosilate compared with propofol for gastrointestinal endoscopy in elderly patients: a prospective, randomized and controlled study. BMC Anesthesiol 2022; 22:180. [PMID: 35689208 PMCID: PMC9185932 DOI: 10.1186/s12871-022-01713-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/23/2022] [Indexed: 02/01/2023] Open
Abstract
Background Remimazolam tosilate (HR7056, RT), a novel ultrashort-acting benzodiazepine, can be used for procedural sedation and general anaesthesia. However, few studies have focused on the sedative effect of RT during gastrointestinal endoscopy in elderly patients. The purpose of this study is to compare the sedative effect of RT and propofol for gastrointestinal endoscopy in elderly patients. Methods A total of 82 patients aged ≥65 years with an American Society of Anaesthesiologists (ASA) grade I-II and a body mass index (BMI) of 18.0 to 30.0 kg/m2 who were scheduled for gastrointestinal endoscopy from Jan 2021 to Aug 2021 were selected and randomly divided into a RT group and a propofol group. Alfentanil 5 μg/kg was used for analgesia in both groups. The RT group was given remimazolam tosilate 0.15 mg/kg with supplemental doses of 0.05 mg/kg as need, while the propofol group was given propofol 1.5 mg/kg with supplemental doses of 0.5 mg/kg. The supplemental doses were determined by the modified observational alertness/sedation assessment (MOAA/S) score and the patients’ body movements. Sedative effects, such as the time to loss of consciousness (LOC) (MOAA/S score ≤ 1), successful sedation in one dose, number of supplemental doses after successful induction, and recovery time, were evaluated. Sedation-related side effects, such as injection pain, haemodynamic events and respiratory depression, were also noted. Postoperative nausea and vomiting (PONV), visual analogue scale (VAS) scores at rest, remedial analgesics, and dizziness or headache were recorded. In addition, patients’ satisfaction and physician’s satisfaction of the procedure were compared between the two groups. Results Data from 77 patients were analysed. The success rate of sedation in both groups was 100%. The time to LOC (MOAA/S score ≤ 1) in the RT group was longer than that in the propofol group (20.7 ± 6.1s vs. 13.2 ± 5.2s, P < 0.001). There were fewer patients in the RT group reporting injection pain than that in the propofol group (0/39 vs. 5/38, P = 0.025). Haemodynamic events and respiratory depression in the RT group were less frequent than those in the propofol group ((6/39 vs. 17/38, P = 0.005), (2/39 vs. 9/38, P = 0.026), respectively). The number of supplemental doses after successful induction in the RT group was greater than that in the propofol group (4/9/11/13/1/1 vs. 8/4/18/6/2/0 requiring 0, 1, 2, 3, 4 or 5 supplemental doses, P = 0.014). The characteristics of the patients enrolled, postoperative parameters of the patients, and patients’ and physician’s satisfaction of the procedure were comparable in the two groups. Conclusions Compared with propofol, RT can be safely and effectively used for gastrointestinal endoscopy sedation in elderly patients, and the incidence of sedation-related adverse reactions, especially haemodynamic events and respiratory depression, is lower. When RT is used, the number of supplemental doses after successful induction may increase slightly. Trial registration Chictr.org.cn ChiCTR2000040498. Retrospectively registered (date of registration: December 1, 2020).
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Affiliation(s)
- Jian Guo
- Department of Anaesthesiology, The Fourth Affiliated Hospital, Zhejiang University, School of Medicine, Yiwu, 322000, Zhejiang, China
| | - Yitao Qian
- Department of Anaesthesiology, The Fourth Affiliated Hospital, Zhejiang University, School of Medicine, Yiwu, 322000, Zhejiang, China
| | - Xiaojin Zhang
- Department of Obstetrics, The Fourth Affiliated Hospital, Zhejiang University, School of Medicine, Yiwu, 322000, Zhejiang, China
| | - Shuangjian Han
- Department of Anaesthesiology, The Fourth Affiliated Hospital, Zhejiang University, School of Medicine, Yiwu, 322000, Zhejiang, China
| | - Qinye Shi
- Department of Anaesthesiology, The Fourth Affiliated Hospital, Zhejiang University, School of Medicine, Yiwu, 322000, Zhejiang, China
| | - Jianhong Xu
- Department of Anaesthesiology, The Fourth Affiliated Hospital, Zhejiang University, School of Medicine, Yiwu, 322000, Zhejiang, China.
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Ergenç M, Uprak TK. Esophagogastroduodenoscopy in Patients Aged 75 Years and Older: A Single-Center Study. Cureus 2022; 14:e21846. [PMID: 35291530 PMCID: PMC8896878 DOI: 10.7759/cureus.21846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 12/13/2022] Open
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Xiao AY, Anandabaskaran S, Ow MM. Risk Factors Associated with Colorectal Cancer in Octogenarians Can Help Stratify the Need for Colonoscopy. JOURNAL OF COLOPROCTOLOGY 2022. [DOI: 10.1055/s-0041-1742256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Objective Colonoscopy is increasingly performed in octogenarians for the detection of colorectal cancer (CRC), but its benefits may be outweighed by its risks. The aim of the present study was to identify the risk factors for CRC in octogenarians presenting for colonoscopy to help stratify the need for this procedure.
Methods A retrospective analysis of 434 patients aged ≥ 80 years referred for a colonoscopy between January 2018 and December 2019. Comparisons were made between those with and without CRC and advanced adenoma (AA). The primary endpoint was to identify the clinical variables predictive of CRC and AA, and the secondary endpoints were complications and death 30 days after the procedure.
Results Colonoscopy was performed in 434 octogenarians, predominantly for symptoms, with CRC in 65 (15.0%) patients. Iron deficiency was associated with a higher risk of having CRC identified on colonoscopy (odds ratio [OR]: 2.33; 95% confidence interval [95%CI] = 1.36–4.00), but not symptoms such as bleeding, weight loss, or diarrhea. A colonoscopy in the last 10 years was protective, with a lower risk of CRC (OR: 0.45; 95%CI = 0.22–0.93). Patients with both normal iron stores and a colonoscopy within 10 years had a 92.5% chance of not having CRC. No variables were predictive of AA. Patients with complications, including death, were older and more likely to have underlying cardiorespiratory disease.
Conclusion Iron status and colonoscopy within 10 years can be used to predict the risk of CRC in octogenarians. Those with low predicted risk, especially if older and with cardiorespiratory disease, should be considered for non-invasive tests, such as computed tomography (CT) colonography, over colonoscopy.
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Affiliation(s)
- Amy Y. Xiao
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | | | - Maggie M. Ow
- Department of Medicine, University of Auckland, Auckland, New Zealand
- Department of Gastroenterology and Hepatology, Auckland City Hospital, Auckland, New Zealand
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Garg S, Syed S, Perisetti A, Inamdar S, Vargo J. Patient characteristics and procedural outcomes of moderate sedation for endoscopic procedures in patients with obesity: A retrospective, propensity score-matched study. Endosc Int Open 2021; 9:E1674-E1679. [PMID: 34790529 PMCID: PMC8589532 DOI: 10.1055/a-1555-2762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Endoscopic procedures are performed commonly with moderate sedation. Obesity can pose a challenge in its safe administration. This study was aimed at assessing outcomes of endoscopy procedures performed with moderate sedation in obese patients. Patients and methods This was a retrospective study of patients undergoing esophagogastroduodenoscopy (EGD) and/or colonoscopy with moderate sedation from July 17, 2017 to December 31, 2019. Demographics, comorbidities, outpatient medications and procedure-related outcomes (procedure time, recovery time, cardiopulmonary adverse events, 7-day post-procedure hospitalization, cecal intubation time, withdrawal time, tolerance of moderate sedation and sedation medications administered) were compared for patient with and without obesity after propensity score matching. Standard statistical methods were used for analysis. Results A total of 7601 procedures were performed with moderate sedation for 5746 patients. Propensity score matching identified 1360 and 1740 pairs of EGDs and colonoscopies with moderate sedation for patients with and without obesity. Recovery time was found to be shorter for obese patients undergoing EGD (OR: 0.989, 95 % CI: 0.981-.998; P = 0.01). Obese patients did not differ from non-obese patients in any other procedure-related outcomes for EGDs or colonoscopies. Conclusions Outcomes for endoscopy procedures performed with moderate sedation were noted to be similar between obese and non-obese patients. These findings suggest that moderate sedation can be used safely for endoscopic procedures in patients with obesity.
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Affiliation(s)
- Shashank Garg
- Division of Gastroenterology and Hepatology, Department of Medicine, UAMS, Little Rock, Arkansas, United States
| | - Shorabuddin Syed
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Abhilash Perisetti
- Division of Gastroenterology and Hepatology, Department of Medicine, UAMS, Little Rock, Arkansas, United States
| | - Sumant Inamdar
- Division of Gastroenterology and Hepatology, Department of Medicine, UAMS, Little Rock, Arkansas, United States
| | - John Vargo
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, United States
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Jung H, Kim HJ, Choi ES, Lee JY, Park KS, Cho KB, Lee YJ. Effectiveness of oral phloroglucinol as a premedication for unsedated esophagogastroduodenoscopy: A prospective, double-blinded, placebo-controlled, randomized trial. PLoS One 2021; 16:e0255016. [PMID: 34347808 PMCID: PMC8336830 DOI: 10.1371/journal.pone.0255016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/05/2021] [Indexed: 12/12/2022] Open
Abstract
Background Anti-spasmodic agents are commonly injected during esophagogastroduodenoscopy (EGD) to improve visualization of the gastric mucosa by inhibiting gastrointestinal (GI) peristalsis. The availability of oral anti-spasmodic agents would increase convenience. In this study, we evaluated the effectiveness of oral phloroglucinol (Flospan®) as a premedication for unsedated EGD. Methods A prospective, double-blinded, placebo-controlled, randomized controlled trial was conducted in a tertiary hospital. Individuals scheduled to undergo unsedated EGD were randomly assigned to receive either oral phloroglucinol or matching placebo 15 min before EGD. The primary outcome was the rate of complete gastric peristalsis suppression. Outcomes were assessed by independent investigators according to the classification of gastric peristalsis and ease of intragastric observation at the beginning (Period A) and end (Period B) of EGD. Results Overall, 71 phloroglucinol-treated and 71 placebo-treated participants (n = 142 total) were included. The phloroglucinol group showed significantly higher proportions of participants with complete gastric peristalsis suppression than the placebo group (22.5% vs. 9.9%, P = 0.040). The ease of intragastric observation was significantly better in the phloroglucinol group than in the placebo group at Periods A (P < 0.001) and B (P = 0.005). Patients in both groups had comparable adverse events and showed willingness to take the premedication at their next examination. Conclusions Oral phloroglucinol significantly suppressed gastrointestinal peristalsis during unsedated EGD compared with placebo (Clinical trial registration number: NCT03342118).
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Affiliation(s)
- HyeIn Jung
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Hyun Jung Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Eun Sung Choi
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Ju Yup Lee
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Kyung Sik Park
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Kwang Bum Cho
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Yoo Jin Lee
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
- * E-mail:
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Kim HI, Yoon JY, Kwak MS, Cha JM. Gastrointestinal and Nongastrointestinal Complications of Esophagogastroduodenoscopy and Colonoscopy in the Real World: A Nationwide Standard Cohort Using the Common Data Model Database. Gut Liver 2021; 15:569-578. [PMID: 33402543 PMCID: PMC8283291 DOI: 10.5009/gnl20222] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/09/2020] [Accepted: 09/12/2020] [Indexed: 12/30/2022] Open
Abstract
Background/Aims The global trend of an expanding aged population has increased concerns about complications correlated with gastrointestinal (GI) endoscopy in elderly patients; however, there have been few reports published on this issue. Methods In this retrospective, observational cohort study performed between 2012 and 2017, serious complications of esophagogastroduodenoscopy (EGD), colonoscopy, and colonoscopic polypectomy were compared between patients according to age (≥65 years vs 18–64 years). We used the Health Insurance Review and Assessment-National Patient Samples database, previously converted to the standardized Observational Medical Outcomes Partnership-Common Data Model. Serious complications within 30 days of the procedure included both GI complications (bleeding and perforation) and non-GI complications (cerebrovascular accident [CVA], acute myocardial infarction [AMI], congestive heart failure [CHF], and death). Results A total of 387,647 patients who underwent EGD, 241,094 who underwent colonoscopy, and 89,059 who underwent colonoscopic polypectomy were assessed as part of this investigation. During the study period, endoscopic procedures in the older group steadily increased in number in all endoscopy groups (all p<0.001). Further, pooled complication rates of bleeding, CVA, AMI, CHF, and death were approximately three times higher among older patients who underwent EGD or colonoscopy. Moreover, pooled complication rates of CVA, AMI, CHF, and death were approximately 2.2 to 5.0 times higher among older patients who underwent colonoscopic polypectomy. Conclusions Elderly patients experienced approximately three times more GI and non-GI complications after EGD or colonoscopy than young patients. Physicians should pay attention to the potential risks of GI endoscopy in elderly patients.
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Affiliation(s)
- Ha Il Kim
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jin Young Yoon
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea.,Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Min Seob Kwak
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea.,Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Myung Cha
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea.,Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
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Martinez-Dolz L, Pajares A, López-Cantero M, Osca J, Díez JL, Paniagua P, Argente P, Arana E, Alonso C, Rodriguez T, Vicente R, Anguita M, Alvarez J. Consensus document for anaesthesiologist-assisted sedation in interventional cardiology procedures. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 68:309-337. [PMID: 34147407 DOI: 10.1016/j.redare.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Affiliation(s)
- L Martinez-Dolz
- Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, IIS La Fe, CIBERCV, Valencia, Spain.
| | - A Pajares
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, IIS La Fe, Valencia, Spain
| | - M López-Cantero
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, IIS La Fe, Valencia, Spain
| | - J Osca
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, IIS La Fe, Valencia, Spain
| | - J L Díez
- Unidad de Hemodinámica, Servicio de Cardiología del Hospital Universitari i Politècnic La Fe, IIS La Fe, Valencia, Spain
| | - P Paniagua
- Servicio de Anestesiología y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - P Argente
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, IIS La Fe, Valencia, Spain
| | - E Arana
- Unidad de Arritmias, Servicio de Cardiología, Hospital Virgen del Rocío, Sevilla, Spain
| | - C Alonso
- Unidad de Arritmias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - T Rodriguez
- Unidad de Hemodinámica, Servicio de Cardiología, Hospital Clínico de Valladolid, Valladolid, Spain
| | - R Vicente
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, IIS La Fe, Valencia, Spain
| | - M Anguita
- Servicio de Cardiología, Hospital Reina Sofía de Córdoba, Córdoba, Spain
| | - J Alvarez
- Servicio de Anestesia y Reanimación, Complejo Hospitalario Universitario de Santiago, Universidad de Santiago, Santiago de Compostela, Spain
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Martinez-Dolz L, Pajares A, López-Cantero M, Osca J, Díez JL, Paniagua P, Argente P, Arana E, Alonso C, Rodriguez T, Vicente R, Anguita M, Alvarez J. Consensus document for anaesthesiologist-assisted sedation in interventional cardiology procedures. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 68:309-337. [PMID: 33931263 DOI: 10.1016/j.redar.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/01/2020] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Affiliation(s)
- L Martinez-Dolz
- Servicio de Cardiología, Hospital Universitari i Politècnic La Fe. IIS La Fe. CIBERCV, Valencia, España.
| | - A Pajares
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe. IIS La Fe, Valencia, España
| | - M López-Cantero
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe. IIS La Fe, Valencia, España
| | - J Osca
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitari i Politècnic La Fe. IIS La Fe, Valencia, España
| | - J L Díez
- Unidad de Hemodinámica, Servicio de Cardiología del Hospital Universitari i Politècnic La Fe. IIS La Fe, Valencia, España
| | - P Paniagua
- Servicio de Anestesiología y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - P Argente
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe. IIS La Fe, Valencia, España
| | - E Arana
- Unidad de Arritmias, Servicio de Cardiología, Hospital Virgen del Rocío, Sevilla, España
| | - C Alonso
- Unidad de Arritmias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - T Rodriguez
- Unidad de Hemodinámica, Servicio de Cardiología, Hospital Clínico de Valladolid, Valladolid, España
| | - R Vicente
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe. IIS La Fe, Valencia, España
| | - M Anguita
- Servicio de Cardiología, Hospital Reina Sofía de Córdoba., Córdoba, España
| | - J Alvarez
- Servicio Anestesia y Reanimación. Complejo Hospitalario Universitario de Santiago. Universidad de Santiago, Santiago de Compostela, España
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Zhang L, Li C, Zhao C, Zhao Z, Feng Y. Analgesic comparison of dezocine plus propofol versus fentanyl plus propofol for gastrointestinal endoscopy: A meta-analysis. Medicine (Baltimore) 2021; 100:e25531. [PMID: 33847679 PMCID: PMC8051973 DOI: 10.1097/md.0000000000025531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/23/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION As the adjunctive anesthesia to propofol, both dezocine and fentanyl showed some potential for gastrointestinal endoscopy. This meta-analysis aimed to compare their efficacy and safety. METHODS PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of dezocine versus fentanyl for the anesthesia of patients undergoing gastrointestinal endoscopy were included. RESULTS Five RCTs involving 677 patients were included in the meta-analysis. Overall, compared with fentanyl plus propofol for gastrointestinal endoscopy, dezocine plus propofol resulted in the reduction in propofol dose(mean difference [MD] = -11.72; 95% confidence interval [CI] = -22.83 to -0.61; P = .04), awakening time (std. MD = -1.79; 95% CI = -3.31 to -0.27; P = .02) and hypopnea (risk ratio [RR] = 0.16; 95% CI = 0.06-0.41; P = .0002), but had no remarkable effect on induction time (MD = 1.20; 95% CI = -0.98 to 3.39; P = .28), postoperative pain score (MD = -0.38; 95% CI = -1.00 to 0.24; P = .24), nausea or vomiting (RR = 0.45; 95% CI = 0.10-1.98; P = .29). CONCLUSION Dezocine plus propofol may be better for the anesthesia of gastrointestinal endoscopy than fentanyl plus propofol.
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Affiliation(s)
| | - Chun Li
- Department of Neurology, Jiangjin District Central Hospital, Chongqing, China
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Tan E, Lam S, Han SP, Storey D, Sandroussi C. Perioperative outcomes and survival in elderly patients aged ≥ 75 years undergoing gastrectomy for gastric cancer: an 18-year retrospective analysis in a single Western centre. Langenbecks Arch Surg 2021; 406:1057-1069. [PMID: 33770264 DOI: 10.1007/s00423-021-02116-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 02/03/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Surgical resection for elderly patients with gastric cancer is controversial. This study aims to evaluate the preoperative features and postoperative short- and long-term outcomes of elderly patients following surgical resection for gastric adenocarcinoma. METHODS Between January 2000 and May 2018, a total of 177 consecutive patients underwent curative gastrectomy for gastric adenocarcinoma was retrospectively reviewed. Propensity score matching (PSM) analysis was used to balance confounding covariates between the elderly and non-elderly groups. Clinicopathological characteristics, intraoperative characteristics, postoperative complications and long-term survival outcomes including overall survival (OS) and Disease Specific Survival (DSS) were compared and analysed using the Kaplan-Meier log-rank test. Multivariate cox proportional hazards regression analysis of clinicopathological factors influencing survival were evaluated. RESULTS There were 50 patients in the elderly group (age ≥ 75 years) and 127 patients in the non-elderly group (age < 75 years). Elderly patients had more comorbid conditions (p < 0.001), lower albumin concentration (p = 0.034), lower haemoglobin levels (p = 0.001), and poorer renal function (p = 0.043). TNM stage was similar between both groups (p = 0.174); however, lymphatic invasion (p = 0.006) and lymph node metastasis (p = 0.029) were higher in the elderly group. Elderly patients were much less likely to receive any chemo- (p < 0.001) or radiotherapy treatment (p = 0.007) with surgical treatment. After PSM, there were 50 patients in each group. Elderly patients were more likely to develop complications (Clavien Dindo ≥ 2: 50% vs. 26%, p = 0.003). The most common postoperative complications were pneumonia (12% vs. 6%, p = 0.498) and delirium (10% vs. 0%, p = 0.066). Elderly patients had a longer median length of hospital stay (median (IQR): 15.6(9.5) vs. 11.3 (9.9), p = 0.030). There were no differences in 30-day mortality (elderly vs. non-elderly: 1% vs. 1%, p = 0.988). Before and after PSM, age remains an independent predictor of postoperative complications. Before PSM, the estimated mean OS for the elderly and non-elderly patients were 108 months (95%CI, 72.5-143.5) and 143 months (95%CI, 123.0-163.8), respectively (p = 0.264). After PSM, the estimated mean OS for the elderly and non-elderly patients were 108 months (95%CI, 72.5-143.5) and 140 months (95%CI, 112.1-168.2), respectively, (p = 0.360). Before PSM, the estimated mean DSS for the elderly and non-elderly patients were 94 months (95%CI, 61.9-127.5) and 121 months (95%CI, 100.9-141.0), respectively (p = 0.405). After PSM, the estimated mean DSS for the elderly and non-elderly patients were 94 months (95%CI, 61.9-127.5) and 115 months (95%CI, 87.3-143.3), respectively (p = 0.721). Age was not an independent predictor of mortality following gastrectomy for gastric cancer in both PSM matched and unmatched cohort. CONCLUSION Chronological age alone is not a contraindication to curative resection of gastric adenocarcinoma in elderly patients with acceptable risk. Whilst age affects perioperative complications, the incidence of postoperative mortality and overall survival were not significantly different between elderly and non-elderly gastric cancer patients treated with curative surgery. Gastrectomy with D2 lymphadenectomy can also be performed in carefully selected elderly patients by surgeons with expertise in gastric resection along with appropriate perioperative management.
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Affiliation(s)
- Elinor Tan
- Department of Upper Gastrointestinal Surgery, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, New South Wales, 2050, Australia.
- Surgical Outcomes Research Centre (SOuRCe), The University of Sydney, Sydney, New South Wales, 2006, Australia.
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2006, Australia.
| | - Susanna Lam
- Department of Upper Gastrointestinal Surgery, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, New South Wales, 2050, Australia
- Surgical Outcomes Research Centre (SOuRCe), The University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Shew Phyo Han
- Department of Upper Gastrointestinal Surgery, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, New South Wales, 2050, Australia
| | - David Storey
- Department of Upper Gastrointestinal Surgery, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, New South Wales, 2050, Australia
- Surgical Outcomes Research Centre (SOuRCe), The University of Sydney, Sydney, New South Wales, 2006, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Charbel Sandroussi
- Department of Upper Gastrointestinal Surgery, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, New South Wales, 2050, Australia
- Surgical Outcomes Research Centre (SOuRCe), The University of Sydney, Sydney, New South Wales, 2006, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2006, Australia
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Gotoda T, Akamatsu T, Abe S, Shimatani M, Nakai Y, Hatta W, Hosoe N, Miura Y, Miyahara R, Yamaguchi D, Yoshida N, Kawaguchi Y, Fukuda S, Isomoto H, Irisawa A, Iwao Y, Uraoka T, Yokota M, Nakayama T, Fujimoto K, Inoue H. Guidelines for sedation in gastroenterological endoscopy (second edition). Dig Endosc 2021; 33:21-53. [PMID: 33124106 DOI: 10.1111/den.13882] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/12/2020] [Accepted: 10/21/2020] [Indexed: 12/14/2022]
Abstract
Sedation in gastroenterological endoscopy has become an important medical option in routine clinical care. Here, the Japan Gastroenterological Endoscopy Society and the Japanese Society of Anesthesiologists together provide the revised "Guidelines for sedation in gastroenterological endoscopy" as a second edition to address on-site clinical questions and issues raised for safe examination and treatment using sedated endoscopy. Twenty clinical questions were determined and the strength of recommendation and evidence quality (strength) were expressed according to the "MINDS Manual for Guideline Development 2017." We were able to release up-to-date statements related to clinical questions and current issues relevant to sedation in gastroenterological endoscopy (henceforth, "endoscopy"). There are few reports from Japan in this field (e.g., meta-analyses), and many aspects have been based only on a specialist consensus. In the current scenario, benzodiazepine drugs primarily used for sedation during gastroenterological endoscopy are not approved by national health insurance in Japan, and investigations regarding expense-related disadvantages have not been conducted. Furthermore, including the perspective of beneficiaries (i.e., patients and citizens) during the creation of clinical guidelines should be considered. These guidelines are standardized based on up-to-date evidence quality (strength) and supports on-site clinical decision-making by patients and medical staff. Therefore, these guidelines need to be flexible with regard to the wishes, age, complications, and social conditions of the patient, as well as the conditions of the facility and discretion of the physician.
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Affiliation(s)
- Takuji Gotoda
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Takuji Akamatsu
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Seiichiro Abe
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Yousuke Nakai
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Waku Hatta
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Naoki Hosoe
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Yoshimasa Miura
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Ryoji Miyahara
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Naohisa Yoshida
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Shinsaku Fukuda
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Hajime Isomoto
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Atsushi Irisawa
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Yasushi Iwao
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Toshio Uraoka
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Kazuma Fujimoto
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Haruhiro Inoue
- Japanese Gastroenterological Endoscopy Society, Tokyo, Japan
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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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Jirapinyo P, de Moura DTH, Horton LC, Thompson CC. Effect of Aspiration Therapy on Obesity-Related Comorbidities: Systematic Review and Meta-Analysis. Clin Endosc 2020; 53:686-697. [PMID: 32106362 PMCID: PMC7719414 DOI: 10.5946/ce.2019.181] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/31/2019] [Accepted: 11/05/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS Aspiration therapy (AT) involves endoscopic placement of a gastrostomy tube with an external device that allows patients to drain 30% of ingested calories after meals. Its efficacy for inducing weight loss has been shown. This study aimed to assess the effect of AT on obesity-related comorbidities. METHODS A meta-analysis of studies that assessed AT outcomes was conducted through December 2018. Primary outcomes were changes in comorbidities at 1 year following AT. Secondary outcomes were the amount of weight loss at up to 4 years and pooled serious adverse events (SAEs). RESULTS Five studies with 590 patients were included. At 1 year, there were improvements in metabolic conditions: mean difference (MD) in systolic blood pressure: -7.8 (-10.7 - -4.9) mm Hg; MD in diastolic blood pressure: -5.1 (-7.0 - 3.2) mm Hg; MD in triglycerides: -15.8 (-24.0 - -7.6) mg/dL; MD in high-density lipoprotein: 3.6 (0.7-6.6) mg/dL; MD in hemoglobin A1c (HbA1c): -1.3 (-1.8 - -0.8) %; MD in aspartate transaminase: -2.7 (-4.1 - -1.3) U/L; MD in alanine transaminase: -7.5 (-9.8 - -5.2) U/L. At 1 (n=218), 2 (n=125), 3 (n=46), and 4 (n=27) years, the patients experienced 17.8%, 18.3%, 19.1%, and 18.6% total weight loss (TWL), corresponding to 46.3%, 46.2%, 48.0%, and 48.7% excess weight loss (EWL) (p<0.0001 for all). Subgroup analysis of 2 randomized controlled trials (n=225) showed that AT patients lost more weight than did controls by 11.6 (6.5-16.7) %TWL and 25.6 (16.0-35.3) %EWL and experienced greater improvement in HbA1c and alanine transaminase by 1.3 (0.8-1.8) % and 9.0 (3.9-14.0) U/L. The pooled SAE rate was 4.1%. CONCLUSION Obesity-related comorbidities significantly improved at 1 year following AT. Additionally, a subgroup of patients who continued to use AT appeared to experience significant weight loss that persisted up to at least 4 years.
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Affiliation(s)
- Pichamol Jirapinyo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, MA, USA
| | - Diogo T. H. de Moura
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, MA, USA
| | - Laura C. Horton
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Christopher C. Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, MA, USA
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Thakur K, Singh CA, Thakar A, Kakkar A, Sikka K, Kumar R, Sharma SC. Prevalence of Synchronous ESCN in Head and Neck Cancer: A Single-Institution Perspective. Laryngoscope 2020; 131:E807-E814. [PMID: 32619324 DOI: 10.1002/lary.28821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The primary objective was to determine the prevalence of synchronous esophageal squamous cell carcinoma in head and neck squamous cell carcinoma (HNSCC) patients. The secondary objective was to determine risk factors for the development of synchronous esophageal squamous cell carcinoma (ESCN). STUDY DESIGN Cross sectional observation study. METHODS A prospective cross sectional, observational study on consecutive 300 newly diagnosed oral cavity, oropharynx, hypopharynx, and laryngeal squamous cell carcinoma patients who underwent trans-nasal esophageal endoscopy with white light imaging and narrow band imaging. RESULTS Among 300 patients, index HNSCCs were located in the oral cavity (n = 154, 51.3%), oropharynx (n = 63, 21%), larynx (n = 53, 17.7%), and hypopharynx (n = 30, 10%). The prevalence of synchronous ESCN was 2.7% (n = 8), including four low-grade, two high-grade dysplasia, and two squamous cell carcinomas. On logistic regression analysis, moderate to heavy alcohol consumption (OR 8.7, P = .01) and primary HNSCC involving supraglottis [(OR 12.5, P = .02) were risk factors for synchronous ESCN. The association of pyriform sinus carcinoma and synchronous ESCN was of borderline significance (P = .054, OR 10.92). CONCLUSION The prevalence of synchronous ESCN in HNSCC was 2.7%. Routine trans-nasal esophagoscopy should be performed in all newly diagnosed patients with carcinoma of the supraglottis and pyriform sinus, and those with consumption of moderate to heavy alcohol for the screening of synchronous ESCN. LEVEL OF EVIDENCE 2b Laryngoscope, 131:E807-E814, 2021.
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Affiliation(s)
- Kuldeep Thakur
- Department of Otolaryngology, Head and Neck Surgery, All India Institute of Medical Sciences New Delhi, Delhi, India
| | - Chirom A Singh
- Department of Otolaryngology, Head and Neck Surgery, All India Institute of Medical Sciences New Delhi, Delhi, India
| | - Alok Thakar
- Department of Otolaryngology, Head and Neck Surgery, All India Institute of Medical Sciences New Delhi, Delhi, India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences New Delhi, Delhi, India
| | - Kapil Sikka
- Department of Otolaryngology, Head and Neck Surgery, All India Institute of Medical Sciences New Delhi, Delhi, India
| | - Rajeev Kumar
- Department of Otolaryngology, Head and Neck Surgery, All India Institute of Medical Sciences New Delhi, Delhi, India
| | - Suresh C Sharma
- Department of Otolaryngology, Head and Neck Surgery, All India Institute of Medical Sciences New Delhi, Delhi, India
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Burton JK, Yates LC, Whyte L, Fitzsimons E, Stott DJ. New horizons in iron deficiency anaemia in older adults. Age Ageing 2020; 49:309-318. [PMID: 32103233 DOI: 10.1093/ageing/afz199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/17/2019] [Accepted: 01/02/2020] [Indexed: 12/24/2022] Open
Abstract
Iron deficiency anaemia (IDA) is common in older adults and associated with a range of adverse outcomes. Differentiating iron deficiency from other causes of anaemia is important to ensure appropriate investigations and treatment. It is possible to make the diagnosis reliably using simple blood tests. Clinical evaluation and assessment are required to help determine the underlying cause and to initiate appropriate investigations. IDA in men and post-menopausal females is most commonly due to occult gastrointestinal blood loss until proven otherwise, although there is a spectrum of underlying causative pathologies. Investigation decisions should take account of the wishes of the patient and their competing comorbidities, individualising the approach. Management involves supplementation using oral or intravenous (IV) iron then consideration of treatment of the underlying cause of deficiency. Future research areas are outlined including the role of Hepcidin and serum soluble transferrin receptor measurement, quantitative faecal immunochemical testing, alternative dosing regimens and the potential role of IV iron preparations.
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Affiliation(s)
- Jennifer Kirsty Burton
- Academic Section of Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Luke C Yates
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Lindsay Whyte
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Edward Fitzsimons
- Department of Haematology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - David J Stott
- Academic Section of Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Baranovsky AY, Kondrashina EA, Shchukina OB, Raikhelson KL, Palgova LK, Marchenko NV, Prashnova MK, Pazenko EV, Kovyazina VP, Segal AM. Clinical Features of Inflammatory Bowel Disease (Ulcerative Colitis and Crohn’s Disease) in Geriatric Practice in St. Petersburg. ADVANCES IN GERONTOLOGY 2020. [DOI: 10.1134/s2079057020020034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Noh JH, Gong EJ, Kim DH, Na HK, Ahn JY, Lee JH, Jung KW, Choi KD, Song HJ, Lee GH, Jung HY. Endoscopic submucosal dissection for superficial esophageal neoplasms in elderly patients: A single-center, large-scale, retrospective study. Geriatr Gerontol Int 2020; 20:430-435. [PMID: 32133752 DOI: 10.1111/ggi.13892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/02/2020] [Accepted: 02/02/2020] [Indexed: 12/28/2022]
Abstract
AIM The number of elderly patients with superficial esophageal neoplasms has steadily increased, but few studies have focused on the clinical outcomes of esophageal endoscopic submucosal dissection in these patients. Therefore, the aim of our study was to investigate the feasibility and safety of endoscopic submucosal dissection among elderly patients with superficial esophageal neoplasms. METHODS Patients who underwent endoscopic submucosal dissection for superficial esophageal neoplasms between December 2005 and December 2017 were eligible. The patients were divided into two groups according to age: Not-old (<75 years, n = 369) and Old (≥75 years, n = 44). Clinical features and treatment outcomes were retrospectively investigated by reviewing medical records. RESULTS In total, 413 patients with 459 lesions were enrolled in to this study. Comorbidities, except for a previous history of malignancy, were not significantly different between the two groups. Procedure-related characteristics and the rate of adverse events were similar in the two groups. During a median follow-up period of 33.4 months, the overall survival rate was lower in the Old group (P = 0.046), and the cumulative recurrence rate did not differ significantly between the two groups (P = 0.334). CONCLUSION Based on these favorable outcomes, endoscopic submucosal dissection is as feasible and effective for the treatment of superficial esophageal neoplasms among elderly patients as it is among non-elderly patients. Geriatr Gerontol Int 2020; 20: 430-435.
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Affiliation(s)
- Jin Hee Noh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eun Jeong Gong
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hee Kyong Na
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Eghbali E, Tarzamni MK, Shirmohammadi M, Javadrashid R, Fouladi DF. Diagnostic performance of 64-MDCT in detecting ERCP-proven periampullary duodenal diverticula. Radiol Med 2020; 125:339-347. [PMID: 31893332 DOI: 10.1007/s11547-019-01121-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/28/2019] [Indexed: 11/29/2022]
Abstract
AIM To determine the diagnostic performance of 64-slice multidetector computed tomography (64-MDCT) in detecting periampullary duodenal diverticula. MATERIALS AND METHODS Medical profiles of 120 endoscopic retrograde cholangiopancreatography (ERCP)-proven patients with (n = 100) and without (n = 20) periampullary duodenal diverticula who had undergone 64-MDCT were retrospectively reviewed. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 64-MDCT in detecting periampullary duodenal diverticula were calculated. Potential factors that might influence the diagnostic performance of 64-MDCT in such patients were also examined. RESULTS Patients were 60 males and 60 females with the mean age of 68.8 ± 12.7 (27-93) years. Indications of ERCP were common bile duct stricture (n = 62) or stone (n = 41), biliary cholestasis (n = 16) and acute cholangitis (n = 1). The sensitivity, specificity, PPV, and NPV of 64-MDCT in detecting periampullary duodenal diverticula were 76%, 100%, 100%, and 45.5%, respectively. The size of diverticula was the only predictor of 64-MDCT performance, with better results observed in larger (> 20 mm) diverticula. CONCLUSION 64-MDCT is a highly specific imaging modality in detecting periampullary duodenal diverticula. The diagnostic performance of 64-MDCT increases for larger diverticula.
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Affiliation(s)
- Elham Eghbali
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Kazem Tarzamni
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Shirmohammadi
- Department of Gastroenterology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Javadrashid
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, Iran
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Numan T, van Dellen E, Vleggaar FP, van Vlieberghe P, Stam CJ, Slooter AJC. Resting State EEG Characteristics During Sedation With Midazolam or Propofol in Older Subjects. Clin EEG Neurosci 2019; 50:436-443. [PMID: 31106583 PMCID: PMC6719396 DOI: 10.1177/1550059419838938] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Despite widespread application, little is known about the neurophysiological effects of light sedation with midazolam or propofol, particularly in older subjects. The aim of this study was to assess the effects of light sedation with midazolam or propofol on a variety of EEG measures in older subjects. Methods. In patients (≥60 years without neuropsychiatric disease such as delirium), 2 EEG recordings were performed, before and after administration of either midazolam (n = 22) or propofol (n = 26) to facilitate an endoscopic procedure. Power spectrum, functional connectivity, and network topology based on the minimum spanning tree (MST) were compared within subjects. Results. Midazolam and propofol administration resulted in Richmond Agitation and Sedation Scale levels between 0 and -4 and between -2 and -4, respectively. Both agents altered the power spectra with increased delta (0.5-4 Hz) and decreased alpha (8-13 Hz) power. Only propofol was found to significantly reduce functional connectivity. In the beta frequency band, the MST was more integrated during midazolam sedation. Propofol sedation resulted in a less integrated network in the alpha frequency band. Conclusion. Despite the different levels of light sedation with midazolam and propofol, similar changes in power were found. Functional connectivity and network topology showed differences between midazolam and propofol sedation. Future research should establish if these differences are caused by the different levels of sedation or the mechanism of action of these agents.
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Affiliation(s)
- Tianne Numan
- 1 Department of Intensive Care Medicine and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Edwin van Dellen
- 2 Department of Psychiatry and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,3 Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - Frank P Vleggaar
- 4 Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Paul van Vlieberghe
- 4 Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Cornelis J Stam
- 5 Department of Clinical Neurophysiology and MEG Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
| | - Arjen J C Slooter
- 1 Department of Intensive Care Medicine and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Zhang S, Sun T, Xie Y, Yu C, Jin S, Yu J, Mao H. Clinical Efficiency and Safety of Magnetic-Controlled Capsule Endoscopy for Gastric Diseases in Aging Patients: Our Preliminary Experience. Dig Dis Sci 2019; 64:2911-2922. [PMID: 31032524 DOI: 10.1007/s10620-019-05631-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/17/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The elderly assess higher incidence of gastric diseases and may meet challenges and contraindications when flexible esophagogastroduodenoscopy intubating. Magnetic-controlled capsule endoscopy (MCE) is declared as a promising alternative, but its applications in elderly population do not attach enough importance. AIMS To explore MCE's efficiency and safety in the elderly. METHODS A single-center retrospective study has been conducted. Data from the elderly group (>65 year-old) who underwent MCE examination, including indications, MCE outcomes, gastric conditions, evaluations from MCE manipulators and endoscopists, subjective discomforts, adverse events, etc., had been collected, then analyzed, and compared with the ones from the middle-aged group (>40, ≤ 65 year-old). RESULTS During April 2015 and September 2018, 98 elderly patients and 72 middle-aged patients underwent MCE examination. In the elderly, the indications included poor physical condition (28.6%), severe angiocardiopathy (39.8%), EGD rejection (13.3%), severe respiratory disorder (8.2%), craniocerebral injury (8.2%), and allergy to anesthetics (2.0%). Rate of complete gastric observation and positive finding were 98.0% and 72.4% (vs. middle-aged group, 94.4%, 56.9%, P = 0.220, 0.035), and gastric conditions showed relatively inferior. Gastric preparation and MCE procedure were generally tolerated, but three elderly patients (3.1%) experienced capsule blockage in stomach. CONCLUSIONS Our preliminary data support that MCE offers considerable benefit and is general safe for the elderly. We hope such data promote greater awareness of innovative attempts for the specific elderly, and expect multi-center, large-scale trials with randomized controlled design bring optimized strategies for better gastric visibility, efficacy and lower potential risk.
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Affiliation(s)
- Shaoheng Zhang
- Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, No. 253 Industrial Avenue, Haizhu District, Guangzhou, 510282, Guangdong Province, China
| | - Tao Sun
- Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, No. 253 Industrial Avenue, Haizhu District, Guangzhou, 510282, Guangdong Province, China
| | - Yue Xie
- Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, No. 253 Industrial Avenue, Haizhu District, Guangzhou, 510282, Guangdong Province, China
| | - Changhui Yu
- Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, No. 253 Industrial Avenue, Haizhu District, Guangzhou, 510282, Guangdong Province, China
| | - Shaoqin Jin
- Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, No. 253 Industrial Avenue, Haizhu District, Guangzhou, 510282, Guangdong Province, China
| | - Jianlin Yu
- Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, No. 253 Industrial Avenue, Haizhu District, Guangzhou, 510282, Guangdong Province, China
| | - Hua Mao
- Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, No. 253 Industrial Avenue, Haizhu District, Guangzhou, 510282, Guangdong Province, China.
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Dilatation Therapy and Demographic Characteristics Significantly Influence the Amount of Propofol for Therapeutic Endoscopic Retrograde Cholangiography. Int J Hepatol 2019; 2019:4793096. [PMID: 31355004 PMCID: PMC6632492 DOI: 10.1155/2019/4793096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/06/2019] [Accepted: 05/26/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Patients undergoing therapeutic endoscopic retrograde cholangiography (ERC) may require different amounts of sedative agents depending on demographic characteristics, indication of ERC, and/or endoscopic intervention. PATIENTS AND METHODS We retrospectively analyzed all patients undergoing therapeutic ERC from 2008 - 2014 who received deep sedation with propofol ± midazolam. RESULTS A total of 2448 ERC procedures were performed in 781 patients. The cumulative per procedure propofol dose in the different groups was as follows: PSC 479 mg (±256), bile duct stones 356 mg (±187), benign stenosis/cholestasis 395 mg (±228), malignant stenosis 401 mg (±283), and postliver transplant complications 391 mg (±223) (p < 0.05). Multivariable analysis showed that dilatation therapy (p = 0.001), age (p = 0.001), duration of the intervention (p = 0.001), BMI (p = 0.001), gender (p = 0.001), platelet count (p = 0.003), and bilirubin (p = 0.043) influence independently the propofol consumption. CONCLUSIONS Demographic characteristics and endoscopic interventions have a distinct influence on the amount of sedation required for therapeutic ERC. Although the sedation-associated complication rate is low optimization of sedative regimens is a prime goal to further reduce adverse events of therapeutic ERC.
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Proton pump inhibitors: why this gap between guidelines and prescribing practices in geriatrics? Eur J Clin Pharmacol 2019; 75:1327-1329. [DOI: 10.1007/s00228-019-02692-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/14/2019] [Indexed: 02/07/2023]
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Inatomi O, Imai T, Fujimoto T, Takahashi K, Yokota Y, Yamashita N, Hasegawa H, Nishida A, Bamba S, Sugimoto M, Andoh A. Dexmedetomidine is safe and reduces the additional dose of midazolam for sedation during endoscopic retrograde cholangiopancreatography in very elderly patients. BMC Gastroenterol 2018; 18:166. [PMID: 30400828 PMCID: PMC6219039 DOI: 10.1186/s12876-018-0897-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 10/24/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) often requires deep sedation. Dexmedetomidine, a highly selective α2-adrenoceptor agonist with sedative activity and minimal effects on respiration, has recently been widely used among patients in the intensive care unit. However, its use in endoscopic procedures in very elderly patients is unclear. In this study, we retrospectively investigated the safety and efficacy of dexmedetomidine sedation during ERCP. METHODS The study included 62 very elderly patients (aged over 80 years) who underwent ERCP from January 2014, with sedation involving dexmedetomidine (i.v. infusion at 3.0 μg/kg/h over 10 min followed by continuous infusion at 0.4 μg/kg/h) along with midazolam. For comparison, the study included 78 patients who underwent ERCP before January 2014, with midazolam alone. We considered additional administration of midazolam as needed to maintain a sedation level of 3-4, according to the Ramsay sedation scale. The outcome measures were amount of midazolam, adverse events associated with sedation, and hemodynamics. RESULTS The incidence of decreased SpO2 and median dose of additional midazolam were significantly lower in the dexmedetomidine group than in the conventional group. The minimum systolic blood pressure and minimum heart rate during and after examination was significantly lower in the dexmedetomidine group than in the conventional group. However, serious acute heart failure or arrhythmia was not noted. CONCLUSIONS Dexmedetomidine can decrease the incidence of respiratory complications and the total dose of other sedative agents. It can be used as an alternative to conventional methods with midazolam for adequate sedation during ERCP in very elderly patients.
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Affiliation(s)
- Osamu Inatomi
- Division of Gastroenterology, Department of Medicine, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192 Japan
| | - Takayuki Imai
- Division of Gastroenterology, Department of Medicine, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192 Japan
| | - Takehide Fujimoto
- Division of Gastroenterology, Department of Medicine, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192 Japan
| | - Kenichiro Takahashi
- Division of Gastroenterology, Department of Medicine, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192 Japan
| | - Yoshihiro Yokota
- Division of Gastroenterology, Department of Medicine, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192 Japan
| | - Noriaki Yamashita
- Division of Gastroenterology, Department of Medicine, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192 Japan
| | - Hiroshi Hasegawa
- Division of Gastroenterology, Department of Medicine, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192 Japan
| | - Atsushi Nishida
- Division of Gastroenterology, Department of Medicine, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192 Japan
| | - Shigeki Bamba
- Division of Clinical Nutrition, Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Mitsushige Sugimoto
- Division of Digestive Endoscopy, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Akira Andoh
- Division of Gastroenterology, Department of Medicine, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192 Japan
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Isohata N, Shimojima R, Utano K, Nemoto D, Endo S, Kato H, Takayanagi D, Aizawa M, Nemoto T, Kawarai Lefor A, Togashi K. Colonoscopy in Patients Aged 85 Years or Older: An Observational Study. J Anus Rectum Colon 2018; 2:155-161. [PMID: 31559358 PMCID: PMC6752140 DOI: 10.23922/jarc.2018-014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/17/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Colonoscopy is the first-line modality to examine the colon even in the very elderly but may have an increased risk of complications. This study aimed to evaluate the efficacy and safety of colonoscopy in the very elderly. METHODS Patients ≥85y old, who underwent colonoscopy between September 2010 and August 2012 in two tertiary-care hospitals in Japan were enrolled. Main outcome measures were cecal intubation rate, detection rate of adenomas and cancers, treatment, adverse events, and long-term outcomes. RESULTS A total of 207 colonoscopies were performed in 177 patients (females 72, males 105; maximum age 95 years). Of these, 202 attempted to reach the cecum, with success in 92%. Excluding patients with known colorectal neoplasms, invasive cancers were detected in 12%, including T1 lesions in 2% and T2 or deeper in 9%. No cancers were detected in patients referred for surveillance or mild abdominal symptoms. Cancers were found in 25% of patients with positive fecal immunochemical tests, 22% with altered bowel habits, 21% with anemia, and 18% with hematochezia. Treatment of 29 patients with cancer included surgery in 22, endoscopic resection in two and no treatment (due to comorbidities) in five. There were no complications. During 730 days (mean) of follow up, 27 patients died but only three died from recurrent colorectal cancer. CONCLUSIONS Colonoscopy for patients aged ≥85 years is safe. A relatively high detection rate of cancers was found, and most were treatable and even curable. (UMIN000018575).
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Affiliation(s)
- Noriyuki Isohata
- Department of Coloproctology, Aizu Medical Center Fukushima Medical University, Fukushima, Japan
| | - Rieko Shimojima
- Department of Endoscopy, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Kenichi Utano
- Department of Coloproctology, Aizu Medical Center Fukushima Medical University, Fukushima, Japan
| | - Daiki Nemoto
- Department of Coloproctology, Aizu Medical Center Fukushima Medical University, Fukushima, Japan
| | - Shungo Endo
- Department of Coloproctology, Aizu Medical Center Fukushima Medical University, Fukushima, Japan
| | - Hiroyuki Kato
- Department of Endoscopy, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Daisuke Takayanagi
- Department of Coloproctology, Aizu Medical Center Fukushima Medical University, Fukushima, Japan
| | - Masato Aizawa
- Department of Coloproctology, Aizu Medical Center Fukushima Medical University, Fukushima, Japan
| | - Tetsutaro Nemoto
- Department of Coloproctology, Aizu Medical Center Fukushima Medical University, Fukushima, Japan
| | | | - Kazutomo Togashi
- Department of Coloproctology, Aizu Medical Center Fukushima Medical University, Fukushima, Japan
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Bernica J, Elhanafi S, Kalakota N, Jia Y, Dodoo C, Dwivedi A, Sealock RJ, Patel K, Raijman I, Zuckerman MJ, Othman MO. Cholangioscopy Is Safe and Feasible in Elderly Patients. Clin Gastroenterol Hepatol 2018; 16:1293-1299.e2. [PMID: 29505911 DOI: 10.1016/j.cgh.2018.02.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 01/21/2018] [Accepted: 02/13/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Although cholangioscopy is widely used during endoscopic retrograde cholangiopancreatiography (ERCP), its safety and feasibility for elderly patients are not well established. We aimed to evaluate the safety and feasibility of cholangioscopy in elderly patients. METHODS We performed a retrospective study of all ERCPs with single-operator cholangioscopy (SOC) performed at 3 tertiary referral hospitals from March 2012 through October 2015. We collected data on patient demographics, procedure indications, findings, complications, and success rates (complete success was achieved if all intended diagnostic and therapeutic procedures were performed, such as tissue sample collection or complete removal of stones). The cohort was divided into 3 groups: patients younger than 65 years (group 1, n = 178), patients 65-75 years old (group 2, n = 86), and patients older than 75 years (group 3, n = 77). We used 1-way ANOVA, the χ2 test, and the Wilcoxon sum rank test to compare study variables. The primary aim was to assess rates of complications from ERCP with SOC in elderly patients compared with younger patients. RESULTS Baseline clinical features were similar among groups, except for a higher prevalence of co-morbidities in group 3. The indication for and findings from ERCP with SOC differed among the groups; stricture or tumor was the most common indication in groups 1 and 3-the most common findings were strictures and masses, respectively. In group 2, choledocholithiasis was the most common indication and finding. The success rate, analyzed in a subset of 209 patients, was 88.5% overall and did not differ significantly among groups. The overall rate of complication was 7.33% with no significant difference among groups (7.30% for group 1, 6.98% for group 2, and 7.79% for group 3) (P < .17). CONCLUSIONS In a retrospective analysis of ERCPs with SOCs, we found this procedure to be safe for elderly patients (older than 75 years), who had rates of complications and hospital admission similar to those of younger patients.
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Affiliation(s)
- Jessica Bernica
- Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas
| | - Sherif Elhanafi
- Gastroenterology and Hepatology Section, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neeharika Kalakota
- Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas
| | - Yi Jia
- Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Christopher Dodoo
- Division of Biostatistics and Epidemiology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Alok Dwivedi
- Division of Biostatistics and Epidemiology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Robert J Sealock
- Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas
| | - Kalpesh Patel
- Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas
| | - Isaac Raijman
- Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas
| | - Marc J Zuckerman
- Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Mohamed O Othman
- Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas.
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Park CH, Kim NH, Park JH, Park DI, Sohn CI, Jung YS. Individualized colorectal cancer screening based on the clinical risk factors: beyond family history of colorectal cancer. Gastrointest Endosc 2018; 88:128-135. [PMID: 29510145 DOI: 10.1016/j.gie.2018.02.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 02/20/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Individuals without a family history of colorectal cancer (CRC) are screened uniformly despite interpersonal risk. To assess individual risk, we examined the age-specific prevalence of advanced colorectal neoplasia (ACRN) according to clinical risk factors and fecal immunochemical test (FIT) results. METHODS Participants without a family history of CRC who underwent screening colonoscopies and FITs were included. Clinical risk factors for ACRN were identified by using a logistic regression model. Point scores were assigned to each associated factor based on a regression coefficient. RESULTS A total of 34,658 participants were included. Age, male sex, smoking, and obesity were identified as risk factors. One-, 2-, and 1-point scores were assigned to male sex, smoking, and obesity, respectively. The prevalence of ACRN in individuals with 0, 1, and ≥2 risk score points was 1.4%, 1.6%, and 2.9% among those aged 50 to 51 years and 3.1%, 5.5%, and 7.5% among those aged ≥66 years, respectively. Among FIT-positive individuals, the prevalence of ACRN was 11.0% and 21.2% in those aged between 50 and 51 years and those aged ≥66 years, respectively. Among FIT-negative individuals with ≥2 risk score points, the prevalence of ACRN was 2.5% and 6.0% among those aged 50 to 51 years and those aged ≥66 years, respectively. CONCLUSION If the clinical risk score is ≥2 points (persons with smoking history or obese men), early colonoscopy may be recommended, even with no family history of CRC. Additionally, FIT may be an appropriate initial screening modality for average-risk individuals if the clinical risk score is 0 to 1.
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Affiliation(s)
- Chan Hyuk Park
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Nam Hee Kim
- Preventive Health Care, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Ho Park
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Il Park
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chong Il Sohn
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Suk Jung
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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European Society of Anaesthesiology and European Board of Anaesthesiology guidelines for procedural sedation and analgesia in adults. Eur J Anaesthesiol 2018; 35:6-24. [PMID: 28877145 DOI: 10.1097/eja.0000000000000683] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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