• Acid
• Alkali
• Corrosive injury
• Dilatation
• Dysphagia
• Endoscopy
• Gastric outlet obstruction
• Stricture

• Humans
• Gastroenterology
• Endoscopy, Gastrointestinal
• Gastrointestinal Tract
• Metabolic Diseases

• Virtual reality
• anxiety
• endoscopy
• procedure
• sedation

• Humans
• Anxiety
• Endoscopy
• Patient Satisfaction
• Virtual Reality
• Anesthesia

• Disparity
• Gastric Intestinal Metaplasia
• Helicobacter pylori
• Screening

• Ethnicity
• Healthcare Disparities
• Helicobacter Infections/epidemiology
• Helicobacter pylori
• Hispanic or Latino
• Humans
• Secondary Prevention
• Stomach Neoplasms/epidemiology
• Stomach Neoplasms/prevention & control
• United States/epidemiology

• IK2 CX002027 CSRD VA
• K08 CA252635 NCI NIH HHS
• K12 HS026395 AHRQ HHS
• R44 CA180425 NCI NIH HHS

• Acupuncture
• Adverse events
• Colonoscopy
• Meta-analysis
• Systematic review

• distraction
• esophagogastroduodenoscopy
• sedation

The aim of the study was to determine the feasibility of interstitial brachytherapy under non-anesthetist-administered moderate sedation, to identify factors influencing the insertion, and the total procedural time.

A total of 47 insertions with hybrid intracavitary and interstitial applicators were performed in 23 patients from March 2017 to March 2020. Moderate sedation was achieved with intravenous midazolam and fentanyl administered by non-anesthetist. Insertion time and procedural time was recorded. Univariate and multivariate analysis were performed to evaluate the impact of different factors on insertion and procedural time.

A total of 238 needles (range, 2-8 per insertion) were implanted, with an average insertion depth of 30 mm (range, 20-40 mm). The mean doses for midazolam and fentanyl were 3 mg (standard deviation [SD] = 1) and 53.3 mcg (SD = 23.9) per insertion, respectively. The median insertion time was 30 minutes (interquartile range [IQR] = 22-40), and the median total procedural time was 4.3 hours (IQR = 3.6-5.2). First time insertion, insertions performed before 2019, and higher midazolam dose were associated with significantly longer insertion time, whereas longer insertion time, MRI-based planning, and insertions performed before 2019 were associated with significantly longer total procedural time.

Outpatient interstitial brachytherapy with non-anesthetist-administered sedation is achievable and well-tolerated. This method may significantly lessen the burden on hospital resources and has the potential to be cost-effective.

• MRI-aided
• interstitial brachytherapy
• sedation

• Endoscopic ultrasound
• adverse events
• diagnostic
• intervention
• mortality

• Acute Disease
• Endosonography/adverse effects
• Humans
• Pancreatitis
• Retrospective Studies
• Ultrasonography, Interventional/adverse effects

Esophagogastroduodenoscopy (EGD) provides an indispensable and unambiguous inspection allowing the discovery upper gastrointestinal lesions. However, many patients are anxious about undergoing EGD. Few studies have investigated the influence on patients’ vital signs and tolerance during EGD using subjective and objective assessments. This study was a prospective randomized controlled study that investigated the influence of audio and visual distraction on EGD.

We randomly divided 289 subjects who underwent EGD into 4 groups (control group, audio group, visual group, combination group) and examined their vital signs, heart rate variability (HRV), psychological items, and acceptance of distraction.

Pulse rate (PR) at post-distraction and post-EGD in the 3 distraction groups were significantly lower than those of control group (p <  0.001 and p <  0.01, respectively). Blood pressure (BP) during and post-EGD was significantly higher than that at pre-EGD in control group (p <  0.05), but no significant elevation of BP was observed during the latter half of EGD and post-EGD in the 3 distraction groups. BP at post-distraction improved significantly compared to pre-distraction in the 3 distraction groups (p <  0.05). There was a significant difference in the low-frequency (LF) power/ high-frequency (HF) power at post-distraction and post-EGD among the 4 groups (p <  0.001 and p <  0.001, respectively). The LF power/HF power at post-distraction and post-EGD in the 3 distraction groups was significantly lower than that in control group (p <  0.05). Several items of profile of mood states (POMS) and the impression of EGD at post-distraction improved significantly compared to those at pre-distraction among the 3 distraction groups (p <  0.05). Visual analog scale (VAS) of willingness for the next use of distraction in the 3 distraction groups was excellent because VAS was more than 70.

Distractions effectively improved psychological factors, vital signs and some of HRV at pre and post-EGD. Distractions may suppress BP elevation during the latter half of EGD and lead to stability of HRV on EGD.

This prospective trial was registered in the University Hospital Medical Information Network (UMIN) Clinical Trials Registry as UMIN000029637. Registered on 20 October 2017.

• Distraction
• Esophagogastroduodenoscopy
• Heart rate variability
• Subjective and objective assessment
• Vital signs

Conscious sedation is not routinely administered for therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in many countries. The aim of our retrospective study was to compare the safety and rate of success and complications during common bile duct (CBD) stone extraction using ERCPs performed with no-sedation (NS) or under general endotracheal anesthesia (GET).

The medical records of all patients who underwent ERCP for biliary stone extraction between January 2010 and September 2013 were reviewed, and patients classified to the NS and GET groups. The primary outcomes were the rate of success of complete stone removal and rate of complications, including post-ERCP pancreatitis (PEP), perforation, bleeding, pneumonia, and mortality within 30 days post-ERCP. Operative time was recorded for analysis.

During the study period, 630 patients underwent ERCP, 402 with NS and 105 with GET. Among the 402 patients in the NS group, 37 (9.2%) could not complete the procedure due to an inability to tolerate the procedure. The success rate of complete stone extraction was higher among patients in the GET group than the NS group (94.3% versus 75.6%, respectively; p < 0.001). The rate of contrast injection into the pancreatic duct was higher for the NS than GET group (24.9% versus 15.2%, respectively; p = 0.008). Although non-significant, there was a higher incidence of post-ERCP pancreatitis (PEP) in the NS than in the GET group (10.4% versus 5.7%, respectively; p = 0.105), while the incidence of pneumonia was higher for the GET group. Biliary pancreatitis, contrast injection into the pancreatic duct and an operation time ≥30 min were independent risks factors for PEP.

ERCP under GET is effective for CBD stone removal, but with slightly higher pneumonia rate after the procedure than non-sedated ERCP.

• Endoscopic papillary balloon dilation
• Endoscopic papillotomy
• Endoscopic retrograde cholangiopancreatography
• General endotracheal anesthesia
• Non sedation
• Post-ERCP pancreatitis

• Aged
• Aged, 80 and over
• Anesthesia, Endotracheal/adverse effects
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Cholangiopancreatography, Endoscopic Retrograde/methods
• Common Bile Duct/surgery
• Female
• Gallstones/surgery
• Humans
• Male
• Middle Aged
• Pancreatitis/surgery
• Risk Factors
• Time Factors
• Treatment Outcome

• Autonomic nervous system
• Distraction
• Esophagoscopy
• Image
• Music
• Vital signs

The development of cardiac complications during or after endoscopic procedures is rare. However, mortality from myocardial ischemia, particularly in the elderly population, is elevated. We illustrate the rare case of a 79-year-old man with multiple cardiovascular risk factors who developed a non-ST elevation myocardial infarction (NSTEMI) after endoscopic removal of a foreign body. This case report summarizes a rare complication of a low-risk procedure and highlights the importance of considering this potential adverse event, particularly in patients with significant cardiovascular risk factors, to promote early diagnosis and proper treatment.

There is limited knowledge on practice patterns in procedural sedation and analgesia (PSA), the use of propofol, and monitoring during flexible bronchoscopy (FB). The purpose of this study was to assess the current practice patterns of FBs and to focus on the use of propofol, the education of the proceduralist, and the involvement of anaesthesiologists during FB.

An anonymous questionnaire was sent to 299 pulmonologists. Only respondents who were active physicians in adult respiratory medicine performing FB were subsequently analysed.

The response rate was 78 % and 27,149 FB in the previous 12 months were analysed. The overall sedation-related morbidity rate was 0.02 % and mortality was 7/100’000 FB. Sedation was used in 95 % of bronchoscopies. The main drugs used for PSA were propofol (77 %) and midazolam (46 %). In 84 % of PSAs propofol was used without the attendance of an anaesthesiologist. The use of propofol was associated with high volume bronchoscopists (p < 0.010) and career-young pulmonologists (p < 0.001). While monitoring vital parameters has become standard practice, pulmonologists reported a very low rate of systematic basic education and training in the field of PSA (50 %).

In Switzerland, PSA during FB is mostly performed with propofol without the attendance of an anaesthesiologist and the use of this drug is expected to increase in the future. While monitoring standards are very high there is need for policies to improve education, systematic training, and support for pulmonologists for PSA during FB.

• Bronchoscopy
• Education
• Midazolam
• Propofol
• Sedation
• Survey

• Catheterization/methods
• Conscious Sedation
• Digestive System Diseases/diagnosis
• Digestive System Diseases/therapy
• Endoscopy, Digestive System/instrumentation
• Endoscopy, Digestive System/methods
• Enteral Nutrition
• Equipment Design
• Humans
• Nose
• Video Recording

• K23 DK066165-01 NIDDK NIH HHS
• R03 CA105959-01 NCI NIH HHS

Aim. We aimed to evaluate whether histrionic personality traits are associated with irritability during conscious sedation endoscopy (CSE). Materials and Methods. A prospective cross-sectional study was planned. Irritability during CSE was classified into five grades: 0, no response; I, minimal movement; II, moderate movement; III, severe movement; IV, fighting against procedure. Patients in grades III and IV were defined as the irritable group. Participants were required to complete questionnaire sheet assessing the extent of histrionic personality traits, extraversion-introversion, and current psychological status. The present authors also collected basic sociodemographic data including alcohol use history. Results. A total of 32 irritable patients and 32 stable patients were analyzed. The histrionic personality trait score of the irritable group was higher than that of the stable group (9.5 ± 3.1 versus 6.9 ± 2.9; P = 0.001), as was the anxiety score (52.8 ± 8.6 versus 46.1 ± 9.6; P = 0.004). Heavy alcohol use was more frequently observed in the irritable group (65.6% versus 28.1%; P = 0.003). In multivariate analysis, all these three factors were independently correlated with irritability during CSE. Conclusion. This study revealed that histrionic personality traits, anxiety, and heavy alcohol use can affect irritability during CSE.

AIM: To evaluate the effect of a relaxing visual distraction alone on patient pain, anxiety, and satisfaction during colonoscopy.

METHODS: This study was designed as an endoscopist-blinded randomized controlled trial with 60 consecutively enrolled patients who underwent elective colonoscopy at Yokohama City University Hospital, Japan. Patients were randomly assigned to two groups: group 1 watched a silent movie using a head-mounted display, while group 2 only wore the display. All of the colonoscopies were performed without sedation. We examined pain, anxiety, and the satisfaction of patients before and after the procedure using questionnaires that included the Visual Analog Scale. Patients were also asked whether they would be willing to use the same method for a repeat procedure.

RESULTS: A total of 60 patients were allocated to two groups. Two patients assigned to group 1 and one patient assigned to group 2 were excluded after the randomization. Twenty-eight patients in group 1 and 29 patients in group 2 were entered into the final analysis. The groups were similar in terms of gender, age, history of prior colonoscopy, and pre-procedural anxiety score. The two groups were comparable in terms of the cecal insertion rate, the time to reach the cecum, the time needed for the total procedure, and vital signs. The median anxiety score during the colonoscopy did not differ significantly between the two groups (median scores, 20 vs 24). The median pain score during the procedure was lower in group 1, but the difference was not significant (median scores, 24.5 vs 42). The patients in group 1 reported significantly higher median post-procedural satisfaction levels, compared with the patients in group 2 (median scores, 89 vs 72, P = 0.04). Nearly three-quarters of the patients in group 1 wished to use the same method for repeat procedures, and the difference in rates between the two groups was statistically significant (75.0% vs 48.3%, P = 0.04). Patients with greater levels of anxiety before the procedure tended to feel a painful sensation. Among patients with a pre-procedural anxiety score of 50 or higher, the anxiety score during the procedure was significantly lower in the group that received the visual distraction (median scores, 20 vs 68, P = 0.05); the pain score during the colonoscopy was also lower (median scores, 23 vs 57, P = 0.04). No adverse effects arising from the visual distraction were recognized.

CONCLUSION: Visual distraction alone improves satisfaction in patients undergoing colonoscopy and decreases anxiety and pain during the procedure among patients with a high pre-procedural anxiety score.

• Colonoscopy
• Photic stimulation
• Patient satisfaction
• Colorectal cancer screening
• Anesthesia

• Adult
• Aged
• Anxiety/prevention & control
• Anxiety/psychology
• Colonoscopy/adverse effects
• Female
• Hospitals, University
• Humans
• Japan
• Male
• Middle Aged
• Motion Pictures
• Pain/diagnosis
• Pain/etiology
• Pain/prevention & control
• Pain/psychology
• Pain Measurement
• Pain Perception
• Patient Satisfaction
• Photic Stimulation
• Predictive Value of Tests
• Surveys and Questionnaires
• Time Factors
• Visual Perception

• Barrett's oesophagus
• bowel preparation
• colon capsule
• colorectal polyps
• esophageal capsule
• esophageal varices

• Capnography
• Cardiopulomonary unplanned events
• Pulse oximetry

• Capsule
• Cirrhosis
• Diagnosis
• Endoscopy
• Esophageal varices
• Portal hypertension
• Tolerance

AIM: To explore the effectiveness of acupuncture transcutaneous electrical nerve stimulation (Acu-TENS), a non-invasive modality in reduction of rectal discomfort during barostat-induced rectal distension.

METHODS: Forty healthy subjects were randomized to receive 45 min of either Acu-TENS or placebo-TENS (no electrical output) over acupuncture points Hegu (large-intestine 4), Neiguan (pericardium 6) and Zusanli (stomach 36). A balloon catheter attached to a dual-drive barostat machine was then inserted into the subjects’ rectum. A step-wise (4 mmHg) increase in balloon pressure was induced until maximal tolerable or 48 mmHg. Visual analogue scale and a 5-point subjective discomfort scale (no perception, first perception of distension, urge to defecate, discomfort/pain and extreme pain) were used to assess rectal discomfort at each distension pressure. Blood beta-endorphin levels were measured before, immediately after intervention, at 24 mmHg and at maximal tolerable distension pressure.

RESULTS: There was no difference in the demographic data and baseline plasma beta-endorphin levels between the two groups. Perception threshold levels were higher in the Acu-TENS group when compared to the placebo group, but the difference reached statistical significance only at the sensations “urge to defecate” and “pain”. The distension pressures recorded at the “urge to defecate” sensation for the Acu-TENS and placebo-TENS groups were 28.0 ± 4.5 mmHg and 24.6 ± 5.7 mmHg, respectively (P = 0.043); and the pressures recorded for the “pain” sensation for these two groups were 36.0 ± 4.2 mmHg and 30.5 ± 4.3 mmHg respectively (P = 0.002). Compared to the placebo group, a higher number of participants in the Acu-TENS group tolerated higher distension pressures (> 40 mmHg) (65% in Acu-TENS vs 25% in placebo, P = 0.02). The plasma beta-endorphin levels of the Acu-TENS group were significantly higher than that of the placebo group at barostat inflation pressure of 24 mmHg (1.31 ± 0.40 ng/mL vs 1.04 ± 0.43 ng/mL, P = 0.044) and at maximal inflation pressure (1.46 ± 0.53 ng/mL vs 0.95 ± 0.38 ng/mL, P = 0.003).

CONCLUSION: Acu-TENS reduced rectal discomfort during barostat-induced rectal distension and concurrently associated with a rise in beta-endorphin level.

• Colonoscopy
• Rectal discomfort
• Transcutaneous electrical nerve stimulation
• Acupuncture
• Visceral pain

• Ablation Techniques/adverse effects
• Dilatation/adverse effects
• Endoscopy, Gastrointestinal/adverse effects
• Endoscopy, Gastrointestinal/methods
• Esophageal Perforation/etiology
• Esophageal Perforation/prevention & control
• Esophageal Perforation/surgery
• Foreign Bodies/surgery
• Hemostatic Techniques/adverse effects
• Humans
• Intestinal Perforation/etiology
• Intestinal Perforation/prevention & control
• Intestinal Perforation/surgery
• Intraoperative Complications/etiology
• Intraoperative Complications/therapy
• Risk Factors
• Sclerotherapy/adverse effects
• Stents/adverse effects
• Stomach/injuries
• Stomach/surgery

• Cough/epidemiology
• Deep Sedation
• Endoscopy, Gastrointestinal
• Female
• Hemodynamics/physiology
• Humans
• Male
• Oxygen/metabolism

• Gastrointestinal endoscopy
• Nigeria
• Sedation

• Analgesics, Opioid/administration & dosage
• Anesthetics, Intravenous/administration & dosage
• Benzodiazepines/administration & dosage
• Colonoscopy
• Drug Utilization/statistics & numerical data
• Female
• Humans
• Male
• Middle Aged
• Practice Patterns, Physicians'/statistics & numerical data
• Propofol/administration & dosage
• Surveys and Questionnaires

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anesthetics, Intravenous/administration & dosage
• Colonoscopy/methods
• Conscious Sedation/methods
• Dose-Response Relationship, Drug
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Pain/prevention & control
• Pain Measurement
• Patient Satisfaction
• Propofol/administration & dosage
• Prospective Studies
• Young Adult

Esophagogastroduodenoscopy is an often-used and safe diagnostic method in gastroenterology. Transnasal esophagogastroduodenoscopy is now an established addition to the endoscopic instrumentarium. Although the two examination methods can be used alongside each other, there is a lack of studies on the comparability of the localization data obtained with the transoral and transnasal methods.

In 135 adult patients presenting for routine outpatient esophagogastroduodenoscopy, transoral esophagogastroduodenoscopy (TOG) was carried out after transnasal esophagogastroduodenoscopy (TNG), and the distance from the naris or incisors, respectively, to the esophagogastric junction was measured.

The data for 135 patients were analyzed. With the transoral access route, the distance from the upper incisors to the cardia was a mean of 40.5 cm (SD ± 3.4 cm). In the transnasal examinations, the mean distance between the naris and the cardia was 45.6 cm (SD ± 3.5 cm). The correlation analysis showed a very close correlation between the peroral and transnasal data, with a correlation coefficient of r = 0.925. On the basis of the regression line calculated using these data, the formula TNG (cm) = 1.1 × TOG (cm) was developed. Using this formula, localization details obtained with one method can be converted into those for the other method.

There is a strong correlation between the localization details obtained with the transnasal and transoral examination methods. The formula for converting localization details from one method to the other, presented here for the first time, is practicable for everyday use and allows rapid conversion.

• Anesthesiology
• Endoscopy, Gastrointestinal
• Humans
• Propofol/administration & dosage
• Propofol/adverse effects