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Tontini GE, Ciprandi G, Vecchi M. Colonic gas explosions associated with mannitol bowel preparation: myth or fact? We have to open our minds. Minerva Gastroenterol (Torino) 2025; 71:76-77. [PMID: 37712944 DOI: 10.23736/s2724-5985.23.03551-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Affiliation(s)
- Gian E Tontini
- Department of Pathophysiology and Organ Transplantation, University of Milan, Milan, Italy
- Division of Gastroenterology and Endoscopy, Maggiore Polyclinic Hospital, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Ciprandi
- Outpatient Department, Villa Montallegro Nursing Home, Genoa, Italy -
| | - Maurizio Vecchi
- Department of Pathophysiology and Organ Transplantation, University of Milan, Milan, Italy
- Division of Gastroenterology and Endoscopy, Maggiore Polyclinic Hospital, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Tontini GE, Rimondi A, Pessarelli T, Ciprandi G, Kurihara H, Sorge A, Vecchi M. Clinical features and risk factors for colorectal gas explosion during digestive endoscopy and surgery: a systematic review. Surg Endosc 2025; 39:384-393. [PMID: 39548011 PMCID: PMC11666635 DOI: 10.1007/s00464-024-11370-0] [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: 07/04/2024] [Accepted: 10/19/2024] [Indexed: 11/17/2024]
Abstract
BACKGROUND AND AIMS Colorectal gas explosion (CGE) is an exceptional but potentially fatal complication of digestive endoscopy or surgery. The role played by bowel preparations and endoscopic or surgical devices in the risk of CGE is still unclear. We conducted a systematic review of the literature to identify risk factors for CGE. METHODS We conducted a comprehensive literature search of multiple databases from inception to September 16, 2024 including all reports of CGE according to a systematic review protocol preregistered on the PROSPERO database (CRD42023455049). Additionally, we analyzed all trials that measured explosive gas levels after different bowel preparation strategies. RESULTS Twenty-nine case reports, three case series, and eleven trials were included. Thirty-six cases of CGE were described, 12 surgical and 24 endoscopic. Perforation and death following CGE occurred in 81% and 14% of patients, respectively. The most common bowel preparations taken before CGE were enemas (42%) and oral preparations (31%), while 28% of patients did not undergo any bowel preparation. Bowel preparation was reported as inadequate in most CGE (solid stool in 65% and poor in 11%). The most frequent devices that triggered CGE were argon plasma coagulation during endoscopy (58%) and the electric scalpel during surgical procedures (75%). Published trials showed that adequate bowel preparation, together with endoscopic insufflation and suction, reduces intestinal levels of hydrogen and methane. CONCLUSIONS CGE predominantly occurs in patients undergoing interventional procedures with inadequate bowel preparation. Achieving optimal bowel preparation, together with endoscopic aspiration, washing, and CO2 insufflation practically abolishes potentially explosive gas concentrations.
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Affiliation(s)
- Gian Eugenio Tontini
- Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy.
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Alessandro Rimondi
- Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Tommaso Pessarelli
- Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
| | | | - Hayato Kurihara
- Emergency Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Sorge
- Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Maurizio Vecchi
- Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Jena A, Jain S, Sundaram S, Singh AK, Chandnani S, Rathi P. Electrosurgical unit in GI endoscopy: the proper settings for practice. Expert Rev Gastroenterol Hepatol 2023; 17:825-835. [PMID: 37497836 DOI: 10.1080/17474124.2023.2242243] [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: 02/12/2023] [Revised: 06/14/2023] [Accepted: 07/26/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION Electrosurgical unit (ESU) is integral to the endoscopy unit. The proper knowledge of the Mode with setting is essential for good therapeutic outcomes and the safety of the patients. AREAS COVERED ESU generates high-frequency electric current, which could perform cutting and coagulation for various therapeutic interventions. We review the proper settings for common endoscopic interventions like hemostasis, polypectomy, sphincterotomy, and advanced procedures like endoscopic ultrasound-guided cysto-gastrostomy, bile duct drainage, and endoscopic Ampullectomy. We review the various waveforms of ESU in practice in endoscopy, including special conditions like patients with pacemakers. EXPERT OPINION Knowledge of the waveforms' duty cycle and crest factor is necessary. A high-duty cycle and lower crest factor lead to a good cutting effect on the tissue. Endocut is the most commonly used Mode in ESU in endoscopic practices like sphincterotomy and polypectomy. Endocut I mode (effect 1-2, duration 3, interval 3) is used for endoscopic sphincterotomy, while Forced Coag mode (Effect 2, 60 W) controls post-sphincterotomy bleeding. Endocut Q mode (Effect 2-3, duration 1, interval 3) is used for cutting the polyp, while Forced Coag mode (Effect 2, 60 W) is used before cutting for pre-coagulation of the stalk.
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Affiliation(s)
- Anuraag Jena
- Department of Gastroenterology, BYL Nair Hospital and Topiwala National Medical College, Mumbai, India
| | - Shubham Jain
- Department of Gastroenterology, BYL Nair Hospital and Topiwala National Medical College, Mumbai, India
| | - Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, India
| | - Anupam Kumar Singh
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Chandnani
- Department of Gastroenterology, BYL Nair Hospital and Topiwala National Medical College, Mumbai, India
| | - Pravin Rathi
- Department of Gastroenterology, BYL Nair Hospital and Topiwala National Medical College, Mumbai, India
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Li AA, Zhou MJ, Hwang JH. Understanding the Principles of Electrosurgery for Endoscopic Surgery and Third Space Endoscopy. Gastrointest Endosc Clin N Am 2023; 33:29-40. [PMID: 36375884 DOI: 10.1016/j.giec.2022.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Electrosurgery is the application of high-frequency electrical alternating current to biologic tissue to cut, coagulate, desiccate, and/or fulgurate. Electrosurgery is commonly used in gastrointestinal endoscopy, with applications including biliary sphincterotomy, polypectomy, hemostasis, the ablation of lesions, and endoscopic surgery. Understanding electrosurgical principles is important in endoscopic surgery to achieve the desired therapeutic effect, optimize procedural outcomes, and minimize risks or adverse events. This article describes fundamental principles that apply to electrosurgical units, operator technique, and practical considerations for achieving desired tissue effects in endoscopic surgery; and provides practical guidance and safety considerations when using electrosurgical units in endoscopic surgery.
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Affiliation(s)
- Andrew A Li
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA; 430 Broadway, Pavilion C-3rd Floor, GI Suite, Redwood City, CA 94063, USA
| | - Margaret J Zhou
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA; 430 Broadway, Pavilion C-3rd Floor, GI Suite, Redwood City, CA 94063, USA
| | - Joo Ha Hwang
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA; 430 Broadway, Pavilion C-3rd Floor, GI Suite, Redwood City, CA 94063, USA.
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Tontini GE, Ciprandi G, Vecchi M. Oral Mannitol for Bowel Preparation: A Safe and Effective Reappraisal. Curr Pharm Des 2023; 29:2521-2523. [PMID: 37957862 DOI: 10.2174/0113816128259838231101062452] [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: 05/07/2023] [Revised: 08/21/2023] [Accepted: 09/21/2023] [Indexed: 11/15/2023]
Affiliation(s)
- Gian Eugenio Tontini
- Department of Pathophysiology and Organ Transplantation, Humanitas Clinical and Research Center IRCCS, University of Milan, Milan, Italy
- Gastroenterology and Endoscopy Division, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Ciprandi
- Outpatients Departmnent, Casa di Cura Villa Montallegro, Genoa, Italy
| | - Maurizio Vecchi
- Department of Pathophysiology and Organ Transplantation, Humanitas Clinical and Research Center IRCCS, University of Milan, Milan, Italy
- Gastroenterology and Endoscopy Division, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Mendoza Ladd A, Espinoza J, Garcia C. Endoscopic mucosal ablation - an alternative treatment for colonic polyps: Three case reports. World J Gastroenterol 2020; 26:7258-7262. [PMID: 33362381 PMCID: PMC7723667 DOI: 10.3748/wjg.v26.i45.7258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/09/2020] [Accepted: 11/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic resection of non-invasive lesions is now the standard of care for lesions in the GI tract. However, resection techniques require extensive training, are not available in all endoscopy centers and are prone to complications. Endoscopic mucosal ablation (EMA) is a combination of resection and ablation techniques and it may offer an alternative in the management of such lesions. CASE SUMMARY In this case series we report the successful treatment of three flat colonic polyps using the EMA technique. Two lesions were treatment naïve and 1 was a recurrence after an endoscopic mucosal resection. The sizes ranged from 2 to 4 cm. All three polyps were ablated successfully with no immediate or delayed complications. The recurrence rate at 1 year of follow up was 0%. CONCLUSION Based on this initial experience, we conclude that EMA is a safe and effective technique for the treatment of non-invasive colonic polyps when endoscopic resection techniques are not available.
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Affiliation(s)
- Antonio Mendoza Ladd
- Department of Internal Medicine, Division of Gastroenterology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine, El Paso, TX 79905, United States
| | - Joaquin Espinoza
- Escuela de Medicina Luis Razetti, Universidad Central de Venezuela, Caracas 999188, Venezuela
| | - Cesar Garcia
- Department of Endoscopy, University Medical Center of El Paso, El Paso, TX 79905, United States
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Lee SB. Intra-Abdominal Explosion due to Pneumoperitoneum Following Colon Perforation. JOURNAL OF ACUTE CARE SURGERY 2020. [DOI: 10.17479/jacs.2020.10.1.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Carannante F, Caricato M, Ripetti V. The valdoni technique for bowel anastomosis. A rare complication. Ann Med Surg (Lond) 2019; 44:68-71. [PMID: 31316770 PMCID: PMC6612045 DOI: 10.1016/j.amsu.2019.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Valdoni technique involves leaving the mucosa layer, between the two anastomosed bowel tract intact, providing for a subsequent breakage of the intestine. It is a technique that allows you to keep the operating field clean.Surgical technique and Case Report: We describe the Valdoni technique. We also report a case of 75 years old man affected by an ascending colon cancer with no metastasis. The patient underwent right hemicolectomy. Making the anastomose, the surgeon did the Valdoni technique, with no intraoperative complications.The postoperative course was characterized by an abdominal pain with swollen abdomen, no flatus and vomit. A computed tomography (CT) revealed a sub-stenosis of the anastomose. We decided to do an urgent colonoscopy, with a resection of the mucosa layer not totally opened, using a Needle-knife Precut. The post procedure course was uneventful. The patient was discharged three days later. CONCLUSION Valdoni technique allows the surgeon to keep the operating field clean. It is a valid alternative when the surgeons have to make a colonic anastomosis, doing open surgery.
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Affiliation(s)
- F. Carannante
- Department of General Surgery, Università Campus Bio-Medico, Via Alvaro del Portillo 21, 00128, Rome, Italy
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Abstract
PURPOSE OF REVIEW This review summarizes the current body of research, define high-risk patients and endoscopic processes, and outline evidence-based countermeasures aimed at minimizing the incidence of complications during endoscopy in children. RECENT FINDINGS Significant complications of endoscopy requiring emergency department or inpatient admission in otherwise healthy children are unusual, but more common with therapeutic procedures; risk from procedures increases incrementally with preoperative coexisting conditions. Duodenal hematoma is predominantly a pediatric endoscopic complication and is more likely in hematology-oncology patients. Air embolism is a well-defined endoscopic retrograde cholangiopancreatography (ERCP) complication in adults and is likely to increase in children with increased performance of pediatric ERCP. Increased physician expertise is the most often proposed countermeasure, especially in the context of endoscopy complications in the higher-risk patient and procedure. Endoscopy in children remains a very safe group of procedures, although a more detailed understanding of risk factors and ideal training and practice organization is lacking.
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Affiliation(s)
- Thomas M Attard
- Department of Gastroenterology, Children's Mercy Hospital, 1MO2.37; 2401 Gilham Road, Kansas City, MO, 64108, USA.
| | - Anne-Marie Grima
- Pediatric Liver, Gastroenterology and Nutrition Centre, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Mike Thomson
- Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, UK
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Freiman JS, Hampe T. Gastric explosion induced by argon plasma coagulation and prevention strategies. Clin Gastroenterol Hepatol 2014; 12:2131-3.e1. [PMID: 25041867 DOI: 10.1016/j.cgh.2014.06.033] [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: 06/03/2014] [Revised: 06/25/2014] [Accepted: 06/29/2014] [Indexed: 02/07/2023]
Abstract
We describe the occurrence of an iatrogenic explosion induced by argon plasma coagulation in a 70-year-old man undergoing gastroscopy. Combustible gases in the stomach may have been released by bacterial overgrowth as a result of partial gastric outlet obstruction (caused by a gastric tumor) and reduced acidity (from proton pump inhibitor therapy). We propose a stepwise process during upper endoscopy to prevent this devastating complication, comprising aspiration, preinsufflation with CO2, and then coagulation.
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Affiliation(s)
- John Saul Freiman
- Department of Gastroenterology and Hepatology, St George Hospital, Kogarah, New South Wales, Australia.
| | - Toni Hampe
- Department of Gastroenterology and Hepatology, St George Hospital, Kogarah, New South Wales, Australia
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Jacques J, Legros R, Chaussade S, Sautereau D. Endoscopic haemostasis: an overview of procedures and clinical scenarios. Dig Liver Dis 2014; 46:766-76. [PMID: 25022337 DOI: 10.1016/j.dld.2014.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/01/2014] [Accepted: 05/08/2014] [Indexed: 02/07/2023]
Abstract
Acute gastrointestinal bleeding is among the most urgent situations in daily gastroenterological practise. Endoscopy plays a key role in the diagnosis and treatment of such cases. Endoscopic haemostasis is probably the most important technical challenge that must be mastered by gastroenterologists. It is essential for both the management of acute gastrointestinal haemorrhage and the prevention of bleeding during high-risk endoscopic procedures. During the last decade, endoscopic haemostasis techniques and tools have grown in parallel with the number of devices available for endotherapy. Haemostatic powders, over-the-scope clips, haemostatic forceps, and other emerging technologies have changed daily practise and complement the standard available armamentarium (injectable, thermal, and mechanical therapy). Although there is a lack of strong evidence-based information on these procedures because of the difficulty in designing statistically powerful trials on this topic, physicians must be aware of all available devices to be able to choose the best haemostatic tool for the most effective procedure. We herein present an overview of procedures and clinical scenarios to optimise the management of gastrointestinal bleeding in daily practise.
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Affiliation(s)
- Jérémie Jacques
- Gastroenterology Department, University Hospital of Limoges, Limoges, France.
| | - Romain Legros
- Gastroenterology Department, University Hospital of Limoges, Limoges, France
| | | | - Denis Sautereau
- Gastroenterology Department, University Hospital of Limoges, Limoges, France
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Panos MZ, Koumi A. Argon plasma coagulation in the right and left colon: safety-risk profile of the 60W-1.2 l/min setting. Scand J Gastroenterol 2014; 49:632-41. [PMID: 24694332 DOI: 10.3109/00365521.2014.903510] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND STUDY AIM The 40W-0.8 l/min setting is widely recommended for argon plasma coagulation (APC) in the right colon. Until March 2012, we used the 60W-1.2 l/min setting for all sites of the colon. By auditing our experience, we assessed the safety-risk profile of the 60W-1.2 l/min setting in the right and left colon. PATIENTS AND METHODS All cases treated with APC by a single endoscopist, using the 60W-1.2 l/min setting for all sites of the colon between October 2001 and December 2007 were identified retrospectively and site, type, number of lesions, and complications were recorded. Between January 2008 and March 2012, information was recorded prospectively. RESULTS In the retrospective audit, 290 lesions (101 cecum/ascending, 120 sigmoid/descending, 69 transverse) were treated in 241 patient endoscopies. There were no perforations. In the prospective audit, 156 lesions (83 cecum/ascending, 47 sigmoid/descending, 26 transverse) were treated in 132 patient endoscopies. There was 1/83 (1.2%) perforation in the cecum/ascending colon and none in the transverse or sigmoid/descending (n.s.). Combined, the results yield a cecal/ascending perforation rate of 1/153 (0.6%) patient endoscopies, 1/184 (0.5%) lesions treated and overall perforation rate for all sites of the colon of 1/373 (0.3%) patient endoscopies and 1/446 (0.2%) lesions. Post-polypectomy syndrome and delayed bleeding each occurred in 3/373 (0.8%) patient endoscopies and 3/446 (0.7%) lesions. There were no deaths. CONCLUSION In the cecum and ascending colon, the APC perforation rate at the 60W-1.2 l/min setting was no higher than in the left colon and is similar to that reported in previously published series. Therefore, it appears safe, provided the precautions we describe are strictly followed.
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Affiliation(s)
- Marios Z Panos
- Department of Gastroenterology, Euroclinic of Athens , Athens , Greece
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Mansfield SK, Borrowdale R. Intraperitoneal explosion following gastric perforation. Asian J Surg 2014; 37:110-3. [PMID: 24703752 DOI: 10.1016/j.asjsur.2012.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 07/17/2012] [Accepted: 09/06/2012] [Indexed: 10/27/2022] Open
Abstract
The object of this study is to report a rare case of explosion during laparotomy where diathermy ignited intraperitoneal gas from a spontaneous stomach perforation. Fortunately, the patient survived but the surgeon experienced a finger burn. A literature review demonstrates other examples of intraoperative explosion where gastrointestinal gases were the fuel source. Lessons learned from these cases provide recommendations to prevent this potentially lethal event from occurring.
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Abstract
Gastrointestinal (GI) bleeding from the colon is a common reason for hospitalization and is becoming more common in the elderly. While most cases will cease spontaneously, patients with ongoing bleeding or major stigmata of hemorrhage require urgent diagnosis and intervention to achieve definitive hemostasis. Colonoscopy is the primary modality for establishing a diagnosis, risk stratification, and treating some of the most common causes of colonic bleeding, including diverticular hemorrhage which is the etiology in 30% of cases. Other interventions, including angiography and surgery, are usually reserved for instances of bleeding that cannot be stabilized or allow for adequate bowel preparation for colonoscopy. We discuss the colonoscopic diagnosis, risk stratification, and definitive treatment of colonic hemorrhage in patients presenting with severe hematochezia.
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Rolanda C, Caetano AC, Dinis-Ribeiro M. Emergencies after endoscopic procedures. Best Pract Res Clin Gastroenterol 2013; 27:783-98. [PMID: 24160934 DOI: 10.1016/j.bpg.2013.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 07/25/2013] [Accepted: 08/11/2013] [Indexed: 02/08/2023]
Abstract
Endoscopy adverse events (AEs), or complications, are a rising concern on the quality of endoscopic care, given the technical advances and the crescent complexity of therapeutic procedures, over the entire gastrointestinal and bilio-pancreatic tract. In a small percentage, not established, there can be real emergency conditions, as perforation, severe bleeding, embolization or infection. Distinct variables interfere in its occurrence, although, the awareness of the operator for their potential, early recognition, and local organized facilities for immediate handling, makes all the difference in the subsequent outcome. This review outlines general AEs' frequencies, important predisposing factors and putative prophylactic measures for specific procedures (from conventional endoscopy to endoscopic cholangio-pancreatography and ultrasonography), with comprehensive approaches to the management of emergent bleeding and perforation.
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Affiliation(s)
- Carla Rolanda
- Department of Gastroenterology, Hospital Braga, Braga, Portugal; Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
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Lin OS, Biehl T, Jiranek GC, Kozarek RA. Explosion from argon cautery during proctoileoscopy of a patient with a colectomy. Clin Gastroenterol Hepatol 2012; 10:1176-1178.e2. [PMID: 22728385 DOI: 10.1016/j.cgh.2012.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 05/30/2012] [Accepted: 06/03/2012] [Indexed: 02/07/2023]
Abstract
We report a unique case of a 70-year-old woman with Gardner's syndrome who had a subtotal colectomy with ileoproctostomy. Since then, she has undergone 12 uncomplicated proctoileoscopies, each time with argon plasma coagulation ablation of small polyps without any bowel preparation. However, during the most recent procedure, when we attempted to cauterize some rectal polyps, an immediate explosion occurred, leading to multiple rectal and ileal perforations that required surgical repair with a temporary end ileostomy. This event suggests that bacterial fermentation of colonic content or visible feces is not necessary for combustion because we observed a cautery-related explosion in the absence of a colon. This case shows the need for adequate bowel preparation if cautery is to be used, even in patients who have undergone a colectomy.
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Affiliation(s)
- Otto S Lin
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA 98101, USA.
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A randomized controlled trial comparing colonic irrigation and oral antibiotics administration versus 4% formalin application for treatment of hemorrhagic radiation proctitis. Dis Colon Rectum 2012; 55:1053-8. [PMID: 22965404 DOI: 10.1097/dcr.0b013e318265720a] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Several treatments have been described for hemorrhagic radiation proctitis. The treatment outcomes are variable. Colonic irrigation and oral antibiotics for hemorrhagic radiation proctitis have been recently reported to be a novel and promising therapeutic approach. However, a comparative study of this treatment has never been investigated. OBJECTIVE This study aimed to compare colonic irrigation and oral antibiotics (irrigation group) versus 4% formalin application (formalin group) for treatment of hemorrhagic radiation proctitis. DESIGN This was a randomized controlled trial. SETTING This study was conducted in a tertiary care/university-based hospital. PATIENTS Fifty patients with hemorrhagic radiation proctitis were randomly assigned to each treatment group (n = 25). INTERVENTIONS For individuals allocated to the irrigation group, daily self-administered colonic irrigation with 1 L of tap water and a 1-week period of oral antibiotics (ciprofloxacin and metronidazole) were prescribed. For individuals allocated to the formalin group, 4% formalin application for 3 minutes was performed. MAIN OUTCOME MEASURES Patients' symptoms and the endoscopic findings of each group were collected. Patient satisfaction was surveyed. The outcomes were evaluated at 8 weeks after the initiation of treatment. RESULTS There was a significant improvement in rectal bleeding and bowel frequency in both treatment groups, but significant improvement in urgency, diarrhea, and tenesmus was demonstrated only in the irrigation group. The comparative study between 2 treatments revealed greater improvement in rectal bleeding, urgency, and diarrhea in the irrigation group. Twenty of 24 patients in the irrigation group and 10 of 23 patients in the formalin group were satisfied with the treatment. LIMITATIONS This trial cannot illustrate whether the antibiotics and the irrigation were equally important because of the limitation of a 2-armed design. CONCLUSIONS The treatment with colonic irrigation and oral antibiotics appears to be more effective than 4% formalin application for hemorrhagic radiation proctitis treatment and achieves higher patient satisfaction.
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Trastulli S, Barillaro I, Desiderio J, DI Rocco G, Cochetti G, Mecarelli V, Cirocchi R, Santoro A, Boselli C, Redler A, Avenia N, Noya G. Colonic explosion during treatment of radiotherapy complications in prostatic cancer. Oncol Lett 2012; 4:915-918. [PMID: 23162622 DOI: 10.3892/ol.2012.873] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 04/20/2012] [Indexed: 11/05/2022] Open
Abstract
The use of lasers has been of great importance in the field of endoscopy and surgery for their applications in coagulation and the ability to vaporize tissue. In the 1990s, new machines were introduced based on a different technology, the argon-plasma-coagulation (APC) system. This technology causes different biological effects without direct contact. An example is the hemostasis of bleeding. In the literature, several cases of complications have been reported during endoscopic treatment with APC. In this study, we report our experience of a case with colon explosion during an APC procedure for bleeding due to radiotherapy and also review the literature on the complications of APC treatment.
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Lin OS, Dwyer RM, Gluck M, Jiranek GC, McCormick SE, Park J, Kozarek RA. A pilot study on crystalline lactulose for colonoscopy bowel preparation. J Clin Gastroenterol 2012; 46:620-621. [PMID: 22772742 DOI: 10.1097/mcg.0b013e3182582e79] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Endoscopic management of gastrointestinal bleeding from multifocal lymphangioendotheliomatosis with thrombocytopenia: limited efficacy and complications. J Pediatr Gastroenterol Nutr 2012; 54:822-4. [PMID: 21788915 DOI: 10.1097/mpg.0b013e31822aa2db] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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The incidence of 30-day adverse events after colonoscopy among outpatients in the Netherlands. Am J Gastroenterol 2012; 107:878-84. [PMID: 22391645 DOI: 10.1038/ajg.2012.40] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Colonoscopy is the gold standard for visualization of the colon. It is generally accepted as a safe procedure and major adverse events occur at a low rate. However, few data are available on structured assessment of (minor) post-procedural adverse events. METHODS Consecutive outpatients undergoing colonoscopy were asked for permission to be called 30 days after their procedure. A standard telephone interview was developed to assess the occurrence of (i) major adverse events (hospital visit required), (ii) minor adverse events, and (iii) days missed from work. Adverse events were further categorized in definite-, possible-, and unrelated adverse events. Patients were contacted between January 2010 and September 2010. RESULTS Out of a total of 1,528 patients who underwent colonoscopy and gave permission for a telephone call, 1,144 patients were contacted (response: 75%), 49% were male, the mean age was 59 years (s.d.: 14). Thirty-four patients (3%) reported major adverse events. These were definite-related in nine (1%) patients, possible-related in 6 (1%), and unrelated in 19 patients (2%). Minor adverse events were reported by 466 patients (41%). These were definite-related in 336 patients (29%), possible-related in 36 (3%), and unrelated in the remaining 94 patients (8%). Female gender (odds ratio (OR): 1.5), age <50 years (OR: 1.5), colonoscopy for colorectal cancer screening/surveillance (OR: 1.6), and fellow-endoscopy (OR: 1.7) were risk factors for the occurrence of any definite-related adverse event. Patients who reported definite-related adverse events were significantly less often willing to return for colonoscopy (81 vs. 88%, P<0.01) and were less often positive about the entire colonoscopy experience (84 vs. 89%, P=0.04). CONCLUSIONS Structured assessment of post-colonoscopy adverse events shows that these are more common than generally reported. Close to one-third of patients report definite-related adverse events, which are major in close to 1 in 100 patients. The occurrence of adverse events does have an impact on the willingness to return for colonoscopy.
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Muguruma N, Okamoto K, Kimura T, Kishi K, Okahisa T, Okamura S, Takayama T. Endoscopic ablation therapy for gastrointestinal superficial neoplasia. Dig Endosc 2012; 24:139-149. [PMID: 22507086 DOI: 10.1111/j.1443-1661.2011.01227.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AIM In Japan, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been widely accepted and standardized for the treatment of gastrointestinal superficial neoplasia. METHODS In contrast, mucosal ablation techniques are more common in Western countries and a variety of endoscopic ablation modalities, including argon plasma coagulation (APC), photodynamic therapy (PDT) and lasers, are used. RESULTS Recently developed modalities such as radiofrequency ablation (RFA) and cryotherapy are also available for the treatment of superficial lesions such as dysplasia of Barrett's esophagus. CONCLUSION Although we should understand that the completeness of destruction of neoplastic tissue can only be judged at follow up, endoscopic ablation is a viable alternative to endoscopic resection for dysplasia and early-stage malignancies, especially for poor candidates of surgery or endoscopic resection.
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Affiliation(s)
- Naoki Muguruma
- Department of Gastroenterology and Oncology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan.
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Manser CN, Bauerfeind P, Gubler C. Iatrogenic Complications in Five Patients with Upper Gastrointestinal Bleeding due to Ambient Air: Case Series and Literature Review. Case Rep Gastroenterol 2012; 6:197-204. [PMID: 22649332 PMCID: PMC3362206 DOI: 10.1159/000338647] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Despite the increasing use of carbon dioxide for endoscopies during the last years, ambient air is still used. The amount of air depends on several factors such as examination time, presumable diameter of the endoscope channel and of course active use of air by the operator. Although endoscopic complications due to ambient air in the gastrointestinal (GI) tract are a rare observation and mostly described in the colon, we report five cases in the upper GI tract due to insufflating large amounts of air through the endoscopes. All 5 patients needed an emergency upper endoscopy for acute presumed upper GI bleeding. In two cases both esophageal variceal bleeding and ulcer bleeding were detected; the fifth case presented with a bleeding due to gastric cancer. Due to insufflation of inadequate amounts of air through the endoscope channel, all patients deteriorated in circulation and ventilation. Two rumenocenteses and consecutively three laparotomies had to be performed in three patients. In the other two, gastroscopies had to be stopped for an emergency computed tomography. All critical incidents were believed to be a consequence of a long-lasting examination with use of too much air. Therefore in emergency situations, endoscopies should be performed with either submersion, low air flow pumps or even better by the use of carbon dioxide.
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Affiliation(s)
- Christine N Manser
- Clinic of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital, Zurich, Switzerland
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Raju GS, Saito Y, Matsuda T, Kaltenbach T, Soetikno R. Endoscopic management of colonoscopic perforations (with videos). Gastrointest Endosc 2011; 74:1380-8. [PMID: 22136781 DOI: 10.1016/j.gie.2011.08.007] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 08/04/2011] [Indexed: 02/08/2023]
Affiliation(s)
- Gottumukkala S Raju
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
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Abstract
Lower gastrointestinal bleeding is common and can result from several colonic causes including diverticulosis, arteriovenous malformations, ischemia, inflammatory bowel disease, infectious colitis, neoplasm, postpolypectomy, and anastomotic and radiation proctitis. Following resuscitation and evaluation, colonoscopy can be used for diagnosis and treatment. Most physicians prescribe a bowel preparation for their patients. Therapeutic options include injection, coagulation (monopolar or bipolar cautery, argon plasma coagulator), and mechanical (clips, bands, detachable loops) devices.
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Affiliation(s)
- Charles B Whitlow
- Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana
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Seth AK, Kapoor N, Puri P. Colonic explosion with use of argon plasma coagulation for radiation proctitis. Indian J Gastroenterol 2010; 28:118-9. [PMID: 19907967 DOI: 10.1007/s12664-009-0043-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Lohsiriwat V. Colonoscopic perforation: incidence, risk factors, management and outcome. World J Gastroenterol 2010; 16:425-430. [PMID: 20101766 PMCID: PMC2811793 DOI: 10.3748/wjg.v16.i4.425] [Citation(s) in RCA: 157] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2009] [Revised: 11/09/2009] [Accepted: 11/16/2009] [Indexed: 02/06/2023] Open
Abstract
This review discusses the incidence, risk factors, management and outcome of colonoscopic perforation (CP). The incidence of CP ranges from 0.016% to 0.2% following diagnostic colonoscopies and could be up to 5% following some colonoscopic interventions. The perforations are frequently related to therapeutic colonoscopies and are associated with patients of advanced age or with multiple comorbidities. Management of CP is mainly based on patients' clinical grounds and their underlying colorectal diseases. Current therapeutic approaches include conservative management (bowel rest plus the administration of broad-spectrum antibiotics), endoscopic management, and operative management (open or laparoscopic approach). The applications of each treatment are discussed. Overall outcomes of patients with CP are also addressed.
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Morris ML, Tucker RD, Baron TH, Song LMWK. Electrosurgery in gastrointestinal endoscopy: principles to practice. Am J Gastroenterol 2009; 104:1563-74. [PMID: 19491874 DOI: 10.1038/ajg.2009.105] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
An electrosurgery generator unit is a critical piece of equipment in any therapeutic endoscopy setting. Electrosurgery generators produce high-frequency alternating electric current and differ from electrocautery units in that both cutting and coagulation effects can be achieved. This ability to cut and coagulate at the same time makes electrosurgery an ideal therapeutic tool for gastrointestinal endoscopy. Although education and familiarity with these devices are accepted as the primary avenue to the safest and most effective clinical outcomes, concise information linking the basic properties of electrosurgery directly to clinical practice is not widespread. The following are the aims of this article: (i) to relate the fundamental electrosurgical principles to commonly performed procedures such as snare polypectomy, hot biopsy, sphincterotomy, bipolar hemostasis, and argon plasma coagulation, and (ii) to provide practical suggestions for the use of these devices on the basis of an understanding of electrosurgical principles and the available clinical data.
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Conway JD, Adler DG, Diehl DL, Farraye FA, Kantsevoy SV, Kaul V, Kethu SR, Kwon RS, Mamula P, Rodriguez SA, Tierney WM. Endoscopic hemostatic devices. Gastrointest Endosc 2009; 69:987-96. [PMID: 19410037 DOI: 10.1016/j.gie.2008.12.251] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Accepted: 12/29/2008] [Indexed: 12/15/2022]
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