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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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Orhurhu V, Hussain N, Karri J, Mariano ER, Abd-Elsayed A. Perioperative and anesthetic considerations for the management of neuromodulation systems. Reg Anesth Pain Med 2023; 48:327-336. [PMID: 37080581 DOI: 10.1136/rapm-2022-103660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/04/2022] [Indexed: 04/22/2023]
Abstract
The use of neuromodulation systems is increasing for the treatment of various pathologies ranging from movement disorders to urinary incontinence to chronic pain syndromes. While the type of neuromodulation devices varies, they are largely categorized as intracranial (eg, deep brain stimulation), neuraxial (eg, spinal cord stimulation, dorsal root ganglion stimulation, and intrathecal drug delivery systems), or peripheral (eg, sacral nerve stimulation and peripheral nerve stimulation) systems. Given the increasing prevalence of these systems in the overall population, it is important for anesthesiologists, surgeons, and the perioperative healthcare team to familiarize themselves with these systems and their unique perioperative considerations. In this review, we explore and highlight the various neuromodulation systems, their general perioperative considerations, and notable special circumstances for perioperative management.
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Affiliation(s)
- Vwaire Orhurhu
- Anesthesiology, University of Pittsburgh Medical Center, Williamsport, Pennsylvania, USA
- Pain Medicine, MVM Health, East Stroudsburg, Pennsylvania, USA
| | - Nasir Hussain
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jay Karri
- Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Edward R Mariano
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesia, Divsion of Pain Medicine, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
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Itoi T, Ryozawa S, Katanuma A, Kawashima H, Iwasaki E, Hashimoto S, Yamamoto K, Ueki T, Igarashi Y, Inui K, Fujita N, Fujimoto K. Clinical practice guidelines for endoscopic papillectomy. Dig Endosc 2022; 34:394-411. [PMID: 35000226 DOI: 10.1111/den.14233] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/27/2021] [Accepted: 01/06/2022] [Indexed: 12/24/2022]
Abstract
The Japan Gastroenterological Endoscopy Society has developed the "Clinical Practice Guidelines for Endoscopic Papillectomy (EP)" as a fundamental guideline using scientific approach. EP is a recently spreading therapeutic modality for ampullary tumors ranked as high risk endoscopic technique. Because of the paucity of high level of evidence, strength of recommendations had to be determined by a consensus among specialists. These guidelines, shed light on the following five issues: Indications, Preoperative/intraoperative preparations and techniques, Early adverse events, Therapeutic outcomes and remnants/recurrences, and Follow-up and late adverse events, to guide current clinical practice on EP.
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Affiliation(s)
- Takao Itoi
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Shomei Ryozawa
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Akio Katanuma
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Eisuke Iwasaki
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | | | - Toshiharu Ueki
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Kazuo Inui
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Naotaka Fujita
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
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Zimmer V. Upfront endoscopic band ligation for symptomatic gastric angioectasias to reduce peri-endoscopic complexity with an automated implantable cardioverter defibrillator in situ. Clin Case Rep 2022; 10:e05312. [PMID: 35154710 PMCID: PMC8819643 DOI: 10.1002/ccr3.5312] [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: 06/14/2021] [Revised: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 12/02/2022] Open
Abstract
Argon plasma coagulation (APC) remains the mainstay endoscopic treatment of gastrointestinal angioectasia. Vis-a-vis automated implanted cardioverter defibrillators (AICD) endoscopic band ligation (EBL) represents an alternative without need for heart-rhythm specialty support.
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Affiliation(s)
- Vincent Zimmer
- Department of MedicineMarienhausklinik St. Josef KohlhofNeunkirchenGermany
- Department of Medicine IISaarland University Medical CenterSaarland UniversityHomburgGermany
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Williams EJ, Krishnan B, Lau SY. Difficult Biliary Cannulation and Sphincterotomy: What to Do. GASTROINTESTINAL AND PANCREATICO-BILIARY DISEASES: ADVANCED DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2022:1121-1153. [DOI: 10.1007/978-3-030-56993-8_65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
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Samuels JM, Overbey DM, Wikiel KJ, Jones TS, Robinson TN, Jones EL. Electromagnetic interference on cardiac pacemakers and implantable cardioverter defibrillators during endoscopy as reported to the US Federal Drug Administration. Surg Endosc 2020; 35:3796-3801. [PMID: 32804270 DOI: 10.1007/s00464-020-07872-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/05/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION More than 3 million patients have a cardiac implanted electronic device (CIED) such as a pacemaker or implanted cardioverter-defibrillator in the USA. These devices are susceptible to electromagnetic interference (EMI) leading to malfunction and injury. Radiofrequency energy, the most common modality for obtaining hemostasis during endoscopy, is the most common source of EMI. Few studies have evaluated the effect of endoscopic radiofrequency energy on CIEDs. We aim to characterize CIED dysfunction related to endoscopic procedures. We hypothesize that EMI from endoscopic energy can result in patient injury. METHODS We queried the Manufacturer and User Facility Device Experience (MAUDE) database for CIED dysfunction related to electrosurgical devices over a 10-year period (2009-2019). CIED dysfunction events were identified using seven problem codes (malfunction, electromagnetic interference, ambient noise, pacing problem, over-sensing, inappropriate shock, defibrillation). These were cross-referenced for the terms "cautery, electrocautery, endoscopy, esophagus, colonoscopy, colon, esophagoscopy, and esophagogastroduodenoscopy." Reports were individually reviewed to confirm and characterize CIED malfunction due to an endoscopic procedure. RESULTS A search for CIED dysfunction resulted in 43,759 reports. Three hundred and eleven reports (0.7%) were associated with electrocautery, and of these, 45 reports (14.5%) included endoscopy. Ten reports involving endoscopy (22%) specified upper (3, 7%) or lower (7, 16%) endoscopy while the remainder were non-specific. Twenty-six of reports involving endoscopy (58%) suffered injury because of CIED dysfunction: Of these, 17 (65%) received inappropriate shocks, 5 (19%) had pacing inhibition with bradycardia or asystole, 3 (12%) had CIED damage requiring explant and replacement, and 1 (4%) patient suffered ventricular tachycardia requiring hospital admission. CONCLUSION The use of energy during endoscopy can cause dysfunction of CIEDs. This most commonly results in inappropriate defibrillation, symptomatic bradycardia, and asystole. Patients with CIEDs undergoing endoscopy should undergo pre- and post-procedure device interrogation and re-programming to avoid patient injury.
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Affiliation(s)
- Jason M Samuels
- Department of Surgery, University of Colorado, Aurora, CO, USA
| | | | - Krzysztof J Wikiel
- Rocky Mountain Regional Veterans Affairs Medical Center, University of Colorado, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Teresa S Jones
- Rocky Mountain Regional Veterans Affairs Medical Center, University of Colorado, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Thomas N Robinson
- Rocky Mountain Regional Veterans Affairs Medical Center, University of Colorado, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Edward L Jones
- Rocky Mountain Regional Veterans Affairs Medical Center, University of Colorado, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA.
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Martinsen T, Pettersen FJ, Kalvøy H, Tronstad C, Kvarstein G, Bakken A, Høgetveit JO, Martinsen ØG, Grimnes S, Frich L. Electrosurgery and Temperature Increase in Tissue With a Passive Metal Implant. Front Surg 2019; 6:8. [PMID: 30915337 PMCID: PMC6422872 DOI: 10.3389/fsurg.2019.00008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/14/2019] [Indexed: 01/09/2023] Open
Abstract
Importance: During monopolar electrosurgery in patients, current paths can be influenced by metal implants, which can cause unintentional tissue heating in proximity to implants. Guidelines concerning electrosurgery and active implants such as pacemakers or implantable cardioverter defibrillators have been published, but most describe interference between electrosurgery and the active implant rather than the risk of unintended tissue heating. Tissue heating in proximity to implants during electrosurgery may cause an increased risk of patient injury. Objective: To determine the temperature of tissue close to metal implants during electrosurgery in an in-vitro model. Design, Setting, and Participants: Thirty tissue samples (15 with a metal implant placed in center, 15 controls without implant) were placed in an in vitro measurement chamber. Electrosurgery was applied at 5–60 W with the active electrode at three defined distances from the implant while temperatures at four defined distances from the implant were measured using fiber-optic sensors. Main Outcomes and Measures: Tissue temperature increase at the four tissue sites was determined for all power levels and each of the electrode-to-implant distances. Based on a linear mixed effects model analysis, the primary outcomes were the difference in temperature increase between implant and control tissue, and the estimated temperature increase per watt per minute. Results: Tissues with an implant had higher temperature increases than controls at all power levels after 1 min of applied electrosurgery (mean difference of 0.16°C at 5 W, 0.50°C at 15 W, 1.11°C at 30 W, and 2.22°C at 60 W, all with p < 0.001). Temperature increase close to the implant was estimated to be 0.088°C/W/min (95% CI: 0.078–0.099°C/W/min; p < 0.001). Temperature could increase to above 43°C after 1 min of 60 W. Active electrode position had no significant effect on temperature increases for tissues with implant (p = 0.6). Conclusions and Relevance: The temperature of tissue close to a metal implant increases with passing electrosurgery current. There is a significant risk of high tissue temperature when long activation times or high power levels are used.
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Affiliation(s)
- Tormod Martinsen
- Department of Clinical and Biomedical Engineering, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Fred Johan Pettersen
- Department of Clinical and Biomedical Engineering, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Håvard Kalvøy
- Department of Clinical and Biomedical Engineering, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Christian Tronstad
- Department of Clinical and Biomedical Engineering, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Gunnvald Kvarstein
- Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Andre Bakken
- Department of Clinical and Biomedical Engineering, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Jan Olav Høgetveit
- Department of Clinical and Biomedical Engineering, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Department of Physics, University of Oslo, Oslo, Norway
| | - Ørjan G Martinsen
- Department of Clinical and Biomedical Engineering, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Department of Physics, University of Oslo, Oslo, Norway
| | - Sverre Grimnes
- Department of Clinical and Biomedical Engineering, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Department of Physics, University of Oslo, Oslo, Norway
| | - Lars Frich
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital Radiumhospitalet, Oslo, Norway
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Itoi T, Ryozawa S, Katanuma A, Okabe Y, Kato H, Horaguchi J, Tsuchiya T, Gotoda T, Fujita N, Yasuda K, Igarashi Y, Fujimoto K. Japan Gastroenterological Endoscopy Society guidelines for endoscopic papillary large balloon dilation. Dig Endosc 2018; 30:293-309. [PMID: 29411902 DOI: 10.1111/den.13029] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/29/2018] [Indexed: 02/08/2023]
Abstract
The Japan Gastroenterological Endoscopy Society has developed the 'EPLBD Clinical Practice Guidelines' as fundamental guidelines based on new scientific techniques. EPLBD is a treatment method that has recently become widely used for choledocolithiasis. The evidence level in this field is usually low, and in many instances, the recommendation grading has to be determined on the basis of expert consensus. At this point, the guidelines are divided into the following six sections according to the 'EST Clinical Practice Guidelines': (i) Indications, (ii) procedures, (iii) special cases, (iv) procedure-related adverse events, (v) treatment outcomes, and (vi) postoperative follow up observation.
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Affiliation(s)
- Takao Itoi
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Shomei Ryozawa
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Akio Katanuma
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Hironori Kato
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Jun Horaguchi
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Takuji Gotoda
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Naotaka Fujita
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Kenjiro Yasuda
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
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9
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García García de Paredes A, Mateos Muñoz B, Albillos A. [Gastrointestinal endoscopy in patients of advanced age]. Rev Esp Geriatr Gerontol 2018; 53:293-298. [PMID: 29598971 DOI: 10.1016/j.regg.2018.02.006] [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: 01/10/2018] [Revised: 02/06/2018] [Accepted: 02/09/2018] [Indexed: 11/17/2022]
Abstract
The dramatic increase in life expectancy is leading to a significant increase in the use of gastrointestinal endoscopy in the elderly. Taking into account these demographic changes, the use of gastrointestinal endoscopy in this age group is of great importance. Although these procedures are generally safe and well tolerated even in very elderly patients, the onset of physiological changes associated with aging and the increased prevalence of cardiovascular and pulmonary comorbidities raise the risk of sedation related complications in these patients. Age alone is not a contraindication for performing any endoscopic procedure. However, elderly patients have their own peculiarities that require a detailed review of the characteristics, risks and benefits of endoscopic procedures in this specific context.
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Affiliation(s)
- Ana García García de Paredes
- Departamento de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España.
| | - Beatriz Mateos Muñoz
- Departamento de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
| | - Agustín Albillos
- Departamento de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
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Albéniz E, Pellisé M, Gimeno-García AZ, Lucendo AJ, Alonso-Aguirre PA, Herreros de Tejada A, Álvarez MA, Fraile M, Herráiz Bayod M, López Rosés L, Martínez Ares D, Ono A, Parra Blanco A, Redondo E, Sánchez-Yagüe A, Soto S, Díaz-Tasende J, Montes Díaz M, Rodríguez-Téllez M, García O, Zuñiga Ripa A, Hernández Conde M, Alberca de Las Parras F, Gargallo CJ, Saperas E, Muñoz Navas M, Gordillo J, Ramos Zabala F, Echevarría JM, Bustamante M, González-Haba M, González-Huix F, González-Suárez B, Vila Costas JJ, Guarner Argente C, Múgica F, Cobián J, Rodríguez Sánchez J, López Viedma B, Pin N, Marín Gabriel JC, Nogales Ó, de la Peña J, Navajas León FJ, León Brito H, Remedios D, Esteban JM, Barquero D, Martínez Cara JG, Martínez Alcalá F, Fernández-Urién I, Valdivielso E. Clinical guidelines for endoscopic mucosal resection of non-pedunculated colorectal lesions. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 110:179-194. [PMID: 29421912 DOI: 10.17235/reed.2018.5086/2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This document summarizes the contents of the Clinical Guidelines for the Endoscopic Mucosal Resection of Non-Pedunculated Colorectal Lesions that was developed by the working group of the Spanish Society of Digestive Endoscopy (GSEED of Endoscopic Resection). This document presents recommendations for the endoscopic management of superficial colorectal neoplastic lesions.
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Affiliation(s)
- Eduardo Albéniz
- Aparato Digestivo. Unidad de Endoscopia Digestiva, Complejo Hospitalario de Navarra, España
| | | | | | | | | | | | | | | | - Maite Herráiz Bayod
- Unidad de Endoscopia. Departamento de Digestivo, Clínica Universidad de Navarra
| | | | | | - Akiko Ono
- Digestivo/Endoscopias, Hospital Clínico Universitario Virgen de la Arrixaca
| | | | | | | | | | - José Díaz-Tasende
- Servicio de Medicina del Aparato Digestivo, Hospital Universitario 12 de Octubre, España
| | - Marta Montes Díaz
- Departamento de Anatomía Patológica, Complejo Hospitalario de Navarra, España
| | | | | | | | - Marta Hernández Conde
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, Spain
| | | | | | | | | | | | | | | | - Marco Bustamante
- Digestive Endoscopy Unit. Gastoenterology, Hospital Universitari i Politècnic La Fe, España
| | | | | | | | | | | | | | | | | | | | | | | | - Óscar Nogales
- Aparato Digestivo, Hospital General Universitario Gregorio Marañón, España
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Ryozawa S, Itoi T, Katanuma A, Okabe Y, Kato H, Horaguchi J, Fujita N, Yasuda K, Tsuyuguchi T, Fujimoto K. Japan Gastroenterological Endoscopy Society guidelines for endoscopic sphincterotomy. Dig Endosc 2018; 30:149-173. [PMID: 29247546 DOI: 10.1111/den.13001] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/10/2017] [Indexed: 02/06/2023]
Abstract
The Japan Gastroenterological Endoscopy Society (JGES) has recently compiled guidelines for endoscopic sphincterotomy (EST) using evidence-based methods. Content regarding actual clinical practice, including detailed endoscopic procedures, instruments, device types and usage, has already been published by the JGES postgraduate education committee in May 2015 and, thus, in these guidelines we avoided duplicating such content as much as possible. The guidelines do not address pancreatic sphincterotomy, endoscopic papillary balloon dilation (EPBD), and endoscopic papillary large balloon dilation (EPLBD). The guidelines for EPLBD are planned to be developed separately. The evidence level in this field is often low and, in many instances, strong recommendation has to be determined on the basis of expert consensus. At this point in time, the guidelines are divided into six items including indications, techniques, specific cases, adverse events, outcomes, and postoperative follow up.
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Affiliation(s)
- Shomei Ryozawa
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Takao Itoi
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Akio Katanuma
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Hironari Kato
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Jun Horaguchi
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Naotaka Fujita
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Kenjiro Yasuda
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
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12
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Albéniz E, Pellisé M, Gimeno García AZ, Lucendo AJ, Alonso Aguirre PA, Herreros de Tejada A, Álvarez MA, Fraile M, Herráiz Bayod M, López Rosés L, Martínez Ares D, Ono A, Parra Blanco A, Redondo E, Sánchez Yagüe A, Soto S, Díaz Tasende J, Montes Díaz M, Téllez MR, García O, Zuñiga Ripa A, Hernández Conde M, Alberca de Las Parras F, Gargallo C, Saperas E, Navas MM, Gordillo J, Ramos Zabala F, Echevarría JM, Bustamante M, González Haba M, González Huix F, González Suárez B, Vila Costas JJ, Guarner Argente C, Múgica F, Cobián J, Rodríguez Sánchez J, López Viedma B, Pin N, Marín Gabriel JC, Nogales Ó, de la Peña J, Navajas León FJ, León Brito H, Remedios D, Esteban JM, Barquero D, Martínez Cara JG, Martínez Alcalá F, Fernández Urién I, Valdivielso E. Clinical guidelines for endoscopic mucosal resection of non-pedunculated colorectal lesions. GASTROENTEROLOGIA Y HEPATOLOGIA 2018; 41:175-190. [PMID: 29449039 DOI: 10.1016/j.gastrohep.2017.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 07/07/2017] [Indexed: 02/07/2023]
Abstract
This document summarizes the contents of the Clinical Guidelines for the Endoscopic Mucosal Resection of Non-Pedunculated Colorectal Lesions that was developed by the working group of the Spanish Society of Digestive Endoscopy (GSEED of Endoscopic Resection). This document presents recommendations for the endoscopic management of superficial colorectal neoplastic lesions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Akiko Ono
- Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - Adolfo Parra Blanco
- Nottingham Digestive Diseases Biomedical Research Unit, Nottingham, Reino Unido
| | - Eduardo Redondo
- Hospital Universitario Virgen de las Nieves, Granada, España
| | | | | | | | | | | | - Orlando García
- Hospital Moisés Broggi, Sant Joan Despí, Barcelona, España
| | | | | | | | - Carla Gargallo
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Esteban Saperas
- Hospital General de Catalunya, Sant Cugat del Vallés, Barcelona, España
| | | | | | | | | | | | | | | | | | | | | | - Fernando Múgica
- Hospital Universitario Donostia, Donostia-San Sebastián, Guipúzcoa, España
| | | | | | | | - Noel Pin
- Complejo Hospitalario de Ourense, Ourense, España
| | | | - Óscar Nogales
- Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | | | | | | | | | - David Barquero
- Hospital Moisés Broggi, Sant Joan Despí, Barcelona, España
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13
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Malagù M, Ferri A, Mancuso O, Trevisan F, Nardozza M, Bertini M. Implantable cardioverter defibrillator management: an update. Future Cardiol 2016; 12:673-688. [PMID: 27762625 DOI: 10.2217/fca-2016-0031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Implantable cardioverter defibrillator (ICD) is the cornerstone of primary and secondary prevention of sudden cardiac death. In 35 years of technologic improvement and clinical trials, there has been a continuous increase in implantation rate. Purpose of this review is to point out and discuss every aspect related to actual ICD management, investigating implantation procedure and predischarge care, office and remote monitoring follow-up, diagnostic evaluations, management of patients with suspected therapies or malfunctions, heart failure, surgery, radiotherapy and endoscopic procedures. Also, ICD backface such as infections and other complications will be discussed. Finally, we will focus on interesting future perspectives for this setting of patients.
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Affiliation(s)
- Michele Malagù
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Alessandra Ferri
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Ottavia Mancuso
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Filippo Trevisan
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Marianna Nardozza
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Matteo Bertini
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
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Moneghini D, Lipari A, Missale G, Minelli L, Cengia G, Bontempi L, Curnis A, Cestari R. Lack of interference between small bowel capsule endoscopy and implantable cardiac defibrillators: an 'in vivo' electrophysiological study. United European Gastroenterol J 2016; 4:216-20. [PMID: 27087949 PMCID: PMC4804376 DOI: 10.1177/2050640615608570] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 09/01/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Capsule endoscopy is a widely performed procedure for small bowel investigation. Once swallowed by the patient, the capsule transmits images to an external recorder over a digital radiofrequency communication channel. Potential electromagnetic interferences with implantable cardiac devices have been postulated. Clinical studies on the safety of capsule endoscopy in patients with cardiac defibrillators are lacking. OBJECTIVE The aim of this study was to assess potential mutual electromagnetic interferences between capsule and defibrillators. METHODS This study used the Given M2A video capsule system. Ten different types of defibrillators were tested in a clinical setting. Before capsule ingestion, defibrillator electrical therapies were switched off. During capsule endoscopy patients were monitored with cardiac telemetry. At the end of capsule endoscopy the following defibrillator's parameters were analysed: change in device settings; inappropriate shocks; inappropriate anti-tachycardia therapy; inappropriate sensing or pacing; noise detection; device reset; programming changes; permanent electrical damages. Any technical problem related to capsule image transmission was recorded. RESULTS Neither defibrillator malfunction nor interference in sensing or pacing was recorded; conversely, no capsule malfunction potentially caused by defibrillators was registered. CONCLUSION Our results suggest that capsule endoscopy can be safely performed in patients with cardiac defibrillators.
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Affiliation(s)
- Dario Moneghini
- U.O. Chirurgia Endoscopica Digestiva, Spedali Civili, Brescia, Italy
| | - Alessandro Lipari
- Laboratorio di Elettrofisiologia ed Elettrostimolazione, Università degli Studi, Brescia, Italy
| | - Guido Missale
- U.O. Chirurgia Endoscopica Digestiva, Spedali Civili, Brescia, Italy
| | - Luigi Minelli
- U.O. Chirurgia Endoscopica Digestiva, Spedali Civili, Brescia, Italy
| | - Gianpaolo Cengia
- U.O. Chirurgia Endoscopica Digestiva, Spedali Civili, Brescia, Italy
| | - Luca Bontempi
- Laboratorio di Elettrofisiologia ed Elettrostimolazione, Università degli Studi, Brescia, Italy
| | - Antonio Curnis
- Laboratorio di Elettrofisiologia ed Elettrostimolazione, Università degli Studi, Brescia, Italy
| | - Renzo Cestari
- U.O. Chirurgia Endoscopica Digestiva, Spedali Civili, Brescia, Italy
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15
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Kim EY. Is It Safe to Perform Therapeutic Endoscopic Procedures in Patients with Implanted Electronic Cardiac Devices? Clin Endosc 2016; 49:104-5. [PMID: 27012289 PMCID: PMC4821511 DOI: 10.5946/ce.2016.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 03/18/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Eun Young Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
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16
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Lenz L, Rohr R, Nakao F, Libera E, Ferrari A. Chronic radiation proctopathy: A practical review of endoscopic treatment. World J Gastrointest Surg 2016; 8:151-60. [PMID: 26981189 PMCID: PMC4770169 DOI: 10.4240/wjgs.v8.i2.151] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 11/20/2015] [Accepted: 12/13/2015] [Indexed: 02/06/2023] Open
Abstract
Chronic radiation proctopathy (CRP) is a troublesome complication of pelvic radiotherapy. The most common presentation is rectal bleeding. CRP symptoms interfere with daily activities and decrease quality of life. Rectal bleeding management in patients with CRP represents a conundrum for practitioners. Medical therapy is ineffective in general and surgical approach has a high morbid-mortality. Endoscopy has a role in the diagnosis, staging and treatment of this disease. Currently available endoscopic modalities are formalin, potassium titanyl phosphate laser, neodymium:yttrium-aluminum-garnet laser, argon laser, bipolar electrocoagulation (BiCAP), heater probe, band ligation, cryotherapy, radiofrequency ablation and argon plasma coagulation (APC). Among these options, APC is the most promising.
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17
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Baeg MK, Kim SW, Ko SH, Lee YB, Hwang S, Lee BW, Choi HJ, Park JM, Lee IS, Oh YS, Choi MG. Endoscopic Electrosurgery in Patients with Cardiac Implantable Electronic Devices. Clin Endosc 2016; 49:176-81. [PMID: 26867552 PMCID: PMC4821527 DOI: 10.5946/ce.2015.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/19/2015] [Accepted: 05/11/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND/AIMS Patients with cardiac implantable electronic devices (CIEDs) undergoing endoscopic electrosurgery (EE) are at a risk of electromagnetic interference (EMI). We aimed to analyze the effects of EE in CIED patients. METHODS Patients with CIED who underwent EE procedures such as snare polypectomy, endoscopic submucosal dissection (ESD), and endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) were retrospectively analyzed. Postprocedural symptoms as well as demographic and outpatient follow-up data were reviewed through medical records. Electrical data, including preprocedural and postprocedural arrhythmia records, were reviewed through pacemaker interrogation, 24-hour Holter monitoring, or electrocardiogram. RESULTS Fifty-nine procedures in 49 patients were analyzed. Fifty procedures were performed in 43 patients with a pacemaker, and nine were performed in six patients with an implantable cardioverter-defibrillator. There were one gastric and 44 colon snare polypectomies, five gastric and one colon ESDs, and eight ERCPs with EST. Fifty-five cases of electrical follow-up were noted, with two postprocedural changes not caused by EE. Thirty-one pacemaker interrogations had procedure recordings, with two cases of asymptomatic tachycardia. All patients were asymptomatic with no adverse events. CONCLUSIONS Our study reports no adverse events from EE in patients with CIED, suggesting that this procedure is safe. However, because of the possibility of EMI, recommendations on EE should be followed.
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Affiliation(s)
- Myong Ki Baeg
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Woo Kim
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun-Hye Ko
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Bum Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seawon Hwang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bong-Woo Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye Jin Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Myung Park
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In-Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong-Seog Oh
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myung-Gyu Choi
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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18
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Pettersen FJ, Martinsen T, Hogetveit JO, Martinsen OG. Unintentional heating at implants when using electrosurgery. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:5805-8. [PMID: 26737611 DOI: 10.1109/embc.2015.7319711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Electrosurgery is a commonly used device in the operating room, but it has some adverse effects, which are only partly described in literature. Interference issues are well described, but unintended heating in and around implants is not well studied. We simulated different scenarios using a Finite Element Model to investigate unintended heating caused by electrosurgery. We looked at different shapes, sizes, and active electrode placements. We found that all these factors play a role in the amount of heating.
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Abstract
Electrosurgery allows both cutting and coagulation of tissue and is an essential tool for therapeutic endoscopy. Electrosurgery is also the most commonly used and misunderstood technology by all surgical and medical disciplines. In other words, everyone uses it, but few understand it! The aims of this article are to (1) present a useful review of the fundamentals of electrosurgery technology; (2) relate the fundamentals to commonly performed flexible endoscopy procedures; and (3) provide a review of the safe application of grounding pads, careful management of accessories, and special patient safety considerations.
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20
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Li Y, Han Z, Sun Y, Li A, Zhang W, Li A, Liu S. Endoscopic polypectomy for pacemaker patients: is it safe? ANZ J Surg 2014; 85:834-7. [PMID: 24990118 DOI: 10.1111/ans.12747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Endoscopic polypectomy is believed to reduce the incidence of colorectal cancer, and it has become a standard practice for the removal of gastrointestinal polyps. However, for patients with implanted cardiac devices, endoscopic polypectomy is thought to be relatively contraindicated. Aside from two case reports from around 10 years ago, few studies have evaluated the safety of endoscopic polypectomy for this population. In this study, polypectomy was performed in 14 consecutive pacemaker patients to determine the safety of endoscopic polypectomy using high-frequency current in patients with implanted cardiac devices. METHODS Fourteen patients with gastrointestinal polyps and implanted cardiac devices were evaluated, and endoscopic polypectomy was performed. Continuous monitoring of heart rate, blood pressure, oxygen saturation and electrocardiographic tracing was conducted. A trained cardiologist was present during the procedures. At the end of the procedures, the cardiac devices were reinterrogated to check for any changes. RESULTS Our results showed that a total of 61 procedures in 14 patients were all successfully completed, and no abnormalities were identified during continuous monitoring. There were no statistically significant differences in the preoperation, intraoperation and postoperation data. None of the patients suffered any arrhythmias or functional disruption to their cardiac devices. CONCLUSIONS Endoscopic polypectomy using high-frequency current appears to be safe when performed in patients with pacemakers. However, larger multicentre studies are needed to confirm the safety of this procedure in this patient population.
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Affiliation(s)
- Yue Li
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zelong Han
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yaqing Sun
- Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Anbing Li
- Department of Applied Psychology, School of Psychology, South China Normal University, Guangzhou, China
| | - Wei Zhang
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Aimin Li
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Side Liu
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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21
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Parekh PJ, Buerlein RC, Shams R, Herre J, Johnson DA. An update on the management of implanted cardiac devices during electrosurgical procedures. Gastrointest Endosc 2013; 78:836-841. [PMID: 24139080 DOI: 10.1016/j.gie.2013.08.013] [Citation(s) in RCA: 15] [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: 05/16/2013] [Accepted: 08/15/2013] [Indexed: 12/11/2022]
Abstract
To date, the major guidelines for the management of implanted cardiac devices during electrosurgical procedures have come from 1 of several major medical societies.These most recent guidelines are from the ACCF/AHA in 2009, a combined consensus statement from the Heart Rhythm Society and the American Society of Anesthesiologists in 2011, as well as an update from the ASGE in 2007. Tables 1 and 2 summarize the most recent recommendations by society. Further studies are needed so that data can be available for the specialty societies to unify consensus on guidelines on the proper management of patients with implanted cardiac devices.
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Affiliation(s)
- Parth J Parekh
- Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Ross C Buerlein
- Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Rouzbeh Shams
- Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - John Herre
- Cardiology, Eastern Virginia Medical School, Norfolk, Virginia, USA; Sentara Cardiology Specialists, Norfolk, Virginia, USA
| | - David A Johnson
- Gastroenterology, Eastern Virginia Medical School, Norfolk, Virginia, USA
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22
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Tokar JL, Barth BA, Banerjee S, Chauhan SS, Gottlieb KT, Konda V, Maple JT, Murad FM, Pfau PR, Pleskow DK, Siddiqui UD, Wang A, Rodriguez SA. Electrosurgical generators. Gastrointest Endosc 2013; 78:197-208. [PMID: 23867369 DOI: 10.1016/j.gie.2013.04.164] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 04/03/2013] [Indexed: 02/08/2023]
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23
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Chandrasekhara V, Early DS, Acosta RD, Chathadi KV, Decker GA, Evans JA, Fanelli RD, Fisher DA, Foley KQ, Fonkalsrud L, Hwang JH, Jue T, Khashab MA, Lightdale JR, Muthusamy VR, Pasha SF, Saltzman JR, Sharaf R, Shergill AK, Cash BD. Modifications in endoscopic practice for the elderly. Gastrointest Endosc 2013; 78:1-7. [PMID: 23664042 DOI: 10.1016/j.gie.2013.04.161] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 04/03/2013] [Indexed: 12/12/2022]
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Corbett GD, Buttery PC, Pugh PJ, Cameron EAB. Endoscopy and implantable electronic devices. Frontline Gastroenterol 2012; 3:72-75. [PMID: 28839637 PMCID: PMC5517255 DOI: 10.1136/flgastro-2011-100010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Accepted: 01/10/2012] [Indexed: 02/04/2023] Open
Abstract
The increasing use of implantable electronic devices such as cardiac pacemakers and neurostimulators means that they are being increasingly encountered in endoscopy departments. The electromagnetic fields generated during electrosurgery and with magnetic imaging systems have the potential to interfere with such devices. The authors present a case that highlights some of the steps necessary for minimising risk, review the evidence and summarise the currently available guidance.
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Affiliation(s)
- G D Corbett
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - P C Buttery
- Department of Neurology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - P J Pugh
- Department of Cardiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - E A B Cameron
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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25
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Hudák J. [Digestive system endoscopy in the elderly and in patients with severe comorbidities]. Orv Hetil 2011; 152:2078-85. [PMID: 22155515 DOI: 10.1556/oh.2011.29242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Besides the technical equipment, the endoscopic team's theoretical and practical skills, the success of endoscopic intervention is influenced by the patient's general condition. Advanced age, severe co-morbidities may increase the risk, especially in case of operative endoscopy. The decision is more complicated when alarm symptoms urge the examination. The endoscopic examination of digestive system, biliary track and pancreas in advanced age can safely be performed as alternatives of surgical intervention. It is important to know the exact stage of cardiovascular and pulmonary diseases, besides, in case of stroke the patient's cooperation is very important. In everyday practice the most common problems are the endoscopic examination of the patient in oral anticoagulant and/or thrombocyte aggregation inhibition therapy and the question of suspending, modifying or restarting the therapy. Examining the patients with implanted electronic device as well as antibiotic prophylaxis in expanding range of indications are special issues. The gastroenterologist makes the decision based on the knowledge of the endoscopic intervention, the patient's risk classification, the indications, the contradictions and the alternative diagnostic possibilities. This review attempts to give an overview with some practical aspects.
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Affiliation(s)
- János Hudák
- Városi Önkormányzat Kórháza Belgyógyászat-Gasztroenterológia Orosháza Könd u. 59. 5900.
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26
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Fisher L, Lee Krinsky M, Anderson MA, Appalaneni V, Banerjee S, Ben-Menachem T, Cash BD, Decker GA, Fanelli RD, Friis C, Fukami N, Harrison ME, Ikenberry SO, Jain R, Jue T, Khan K, Maple JT, Strohmeyer L, Sharaf R, Dominitz JA. The role of endoscopy in the management of obscure GI bleeding. Gastrointest Endosc 2010; 72:471-9. [PMID: 20801285 DOI: 10.1016/j.gie.2010.04.032] [Citation(s) in RCA: 162] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 04/19/2010] [Indexed: 02/06/2023]
Abstract
This is one of a series of statements discussing the use of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE) prepared this text. In preparing this guideline, we performed a search of the medical literature by using PubMed. Additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. Guidelines for appropriate use of endoscopy are based on a critical review of the available data and expert consensus at the time the guidelines were drafted. Further controlled clinical studies may be needed to clarify aspects of this guideline. This guideline may be revised as necessary to account for changes in technology, new data, or other aspects of clinical practice. The recommendations are based on reviewed studies and are graded on the strength of the supporting evidence (Table 1).(1) The strength of individual recommendations is based both upon the aggregate evidence quality and an assessment of the anticipated benefits and harms. Weaker recommendations are indicated by phrases such as "we suggest," whereas stronger recommendations are typically stated as "we recommend." This guideline is intended to be an educational device to provide information that may assist endoscopists in providing care to patients. This guideline is not a rule and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment. Clinical decisions in any particular case involve a complex analysis of the patient's condition and available courses of action. Therefore, clinical considerations may lead an endoscopist to take a course of action that varies from these guidelines.
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Manner H, Enderle MD, Pech O, May A, Plum N, Riemann JF, Ell C, Eickhoff A. Second-generation argon plasma coagulation: two-center experience with 600 patients. J Gastroenterol Hepatol 2008; 23:872-8. [PMID: 18565020 DOI: 10.1111/j.1440-1746.2008.05437.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIM Second-generation argon plasma coagulation (APC; APC 2/VIO APC) with its modes 'forced', 'pulsed', and 'precise' is a further development of the ICC/APC 300 system (first-generation APC). Until now, only limited data has existed on the use of APC 2. METHODS Fundamental data on the characteristics of the various APC 2 modes and clinical data from more than 600 patients treated in two high-volume endoscopy centers were analyzed. On the basis of these data, recommendations for the use of APC in daily gastroenterological practice were made. RESULTS In comparison to the ICC system, second-generation APC offers a broadened bandwidth of settings including different APC modes and a range of power settings from 1 to 120 W. Using the various modes of APC 2 in a variety of gastrointestinal diseases, minor complications were observed in 9-21% of patients. Major complications occurred in 1-7% of patients. CONCLUSIONS In a two-center experience treating a large group of patients with a wide variety of gastrointestinal conditions, the different APC 2 modes appeared to be safe and effective. Certain preventive measures before and during clinical application are recommended in order to avoid complications.
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Affiliation(s)
- Hendrik Manner
- Department of Internal Medicine II, HSK Wiesbaden, Wiesbaden, Germany.
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28
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Petersen BT. Reducing Risk During Endoscopy in Patients with Implanted Electronic Devices. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2007. [DOI: 10.1016/j.tgie.2007.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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