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Lv XH, Lu Q, Wang ZJ, Wang Z, Yang JL. Colonoscopy-Related Adverse Events in the 21st Century: An Updated Systematic Review and Meta-Analysis. Am J Gastroenterol 2025:00000434-990000000-01655. [PMID: 40146012 DOI: 10.14309/ajg.0000000000003429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 03/12/2025] [Indexed: 03/28/2025]
Abstract
INTRODUCTION Colonoscopy is one of the most commonly performed endoscopic procedures and is generally considered low-risk. However, when adverse events (AEs) occur, they can present significant challenges in clinical practice. The aim of this study was to estimate the global incidence of colonoscopy-related AEs. METHODS We searched multiple databases for population-based studies reporting the incidence of colonoscopy-related AEs up to December 22, 2024. Meta-analyses were conducted for both gastrointestinal and nongastrointestinal AEs. Subgroup analyses were performed based on factors including World Health Organization region, publication year, sample size, data collection method, and study design. RESULTS Among the 30,818 records identified, 82 population-based studies from 24 countries were included, involving a total of 38.5 million colonoscopies. The estimated incidence per 10,000 colonoscopies was as follows: gastrointestinal AEs, including perforation (5.15; 95% confidence interval [CI] 4.19-6.34, I2 = 99%), bleeding (18.39; 95% CI 13.53-24.99, I2 = 100%), and splenic injury (0.61; 95% CI 0.43-0.85, I2 = 93%); nongastrointestinal AEs, including cardiovascular events (52.11; 95% CI 18.67-144.59, I2 = 100%), respiratory events (4.26; 95% CI 0.73-24.99, I2 = 100%), and deaths related to colonoscopy (0.18; 95% CI 0.10-0.34, I2 = 74%). Subgroup analyses yielded partially divergent findings. The majority of the included studies exhibited a low to moderate risk of bias. DISCUSSION This comprehensive meta-analysis provides valuable insights into the global incidence of colonoscopy-related AEs and underscores the imperative need for continuous efforts to enhance the safety of this procedure.
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Affiliation(s)
- Xiu-He Lv
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Department of Gastroenterology and Hepatology, Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qing Lu
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Department of Gastroenterology and Hepatology, Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Zi-Jing Wang
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Department of Gastroenterology and Hepatology, Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Zhu Wang
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Department of Gastroenterology and Hepatology, Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jin-Lin Yang
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Department of Gastroenterology and Hepatology, Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Maieron A, Duller C, Püspök A, Steiner E, Kapral C. SASE, Success and Adverse event Score in Endoscopic Retrograde Cholangiopancreatography: a Novel Grading System. BMC Gastroenterol 2023; 23:314. [PMID: 37715151 PMCID: PMC10504789 DOI: 10.1186/s12876-023-02942-w] [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: 03/20/2023] [Accepted: 08/31/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Validated, accepted grading tools for preprocedural complexity assessment in ERCP are lacking. We therefore created a grading system for ERCP based on the classification used by the American Society for Gastrointestinal Endoscopy (ASGE). METHODS Data on ERCP adverse events (AE) and success were collected in a multicenter, prospective uncontrolled study. Multiple logistic regressions were applied to success and AEs in accordance with the ASGE classification. Each procedure suggested by ASGE was tested against different outcomes. Results were used to create a score and were evaluated in a control cohort. RESULTS 16,327 ERCPs were documented in 27 centers. Analysis of ASGE categorization (10,904 cases) showed that this model fails to adequately predict parameters of complexity; only for cardiopulmonary AEs and perforation was no significant variance evident. Depending on the specific clinical circumstances, probability of success of the intervention sometimes varied significantly in risk, implying a twofold score, one part for probability of success and one for risk. A split score with three levels each was designed and tested in a validation cohort (5,423 procedures). Achieving therapeutic targets / post-ERCP pancreatitis could be correctly predicted in 87.0%/95.3%. CONCLUSIONS Grading ERCP success and AEs have to be considered independently. Onefold grading systems appear incomplete and unable to provide an adequate classification of severity. SASE (Success and Adverse Event Score in Endoscopic Retrograde Cholangiopancreatography) was created to incorporate these findings. Showing high predictive value, this score could be a potent tool for planning ERCP and training in endoscopy.
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Affiliation(s)
- Andreas Maieron
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems, 3500, Austria.
- Division of Internal Medicine, Gastroenterology & Hepatology, University Hospital of St. Pölten, Dunant-Platz 1, St. Pölten, A - 3100, Austria.
- Quality Assurance Working Group: Benchmarking ERCP, Austrian society of Gastroenterology and Hepatology, Freyung 6, Vienna, 1010 A, Austria.
| | - Christine Duller
- Quality Assurance Working Group: Benchmarking ERCP, Austrian society of Gastroenterology and Hepatology, Freyung 6, Vienna, 1010 A, Austria
- Institute of Applied Statistics, Johannes Kepler University Linz, Altenberger Strasse 69, Linz, A - 4040, Austria
| | - Andreas Püspök
- Department of Internal Medicine 2, St. John´s Hospital Eisenstadt, Johannes von Gott-Platz 1, Eisenstadt, A - 7000, Austria
| | - Emanuel Steiner
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems, 3500, Austria
- Division of Internal Medicine, Gastroenterology & Hepatology, University Hospital of St. Pölten, Dunant-Platz 1, St. Pölten, A - 3100, Austria
- Quality Assurance Working Group: Benchmarking ERCP, Austrian society of Gastroenterology and Hepatology, Freyung 6, Vienna, 1010 A, Austria
| | - Christine Kapral
- Quality Assurance Working Group: Benchmarking ERCP, Austrian society of Gastroenterology and Hepatology, Freyung 6, Vienna, 1010 A, Austria
- Department of Gastroenterology and Hepatology, Ordensklinikum Barmherzige Schwestern, Seilerstätte 4, Linz, A - 4020, Austria
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Analysis of Decreasing Adverse Events with Endoscopic Ultrasound in a New Advanced Endoscopy Program Over Time. Dig Dis Sci 2022; 67:2074-2080. [PMID: 34014440 DOI: 10.1007/s10620-021-07050-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 05/09/2021] [Indexed: 12/09/2022]
Abstract
OBJECTIVE New innovations and increasing utility of endoscopic ultrasound (EUS) are associated with rare but serious risks. We investigate the rates and risk factors for post-procedural complications over a four-year period at a new advanced endoscopy program. METHODS We conducted a retrospective review of all adult patients who underwent upper EUS at an academic level-1 trauma center between April 2015 and November 2019. The primary outcome was the incidence of adverse events within 1 week of EUS. Secondary outcomes included emergency department visits and mortality within 30 days after EUS. Chi-square test, t test, and multivariable logistic regression were used to assess risk factors for post-procedural complications. RESULTS A total of 968 EUS procedures were performed on 864 patients (54% female; 79% Caucasian; mean age 61 years). The overall incidence of post-procedural adverse event with EUS was 5.6%. The probability of an adverse event decreased by an average of 22% per year (p =0.01, OR 0.78). The risk for adverse events were 3.3% acute pancreatitis, 1.9% clinically significant bleeding, 0.3% bacteremia, 0.2% perforation, and 2.4% 30-day mortality. The adverse event rate was highest among low volume proceduralists (p =0.04). The 30-day mortality was more than threefolds among patients who had an adverse event within 7 days after EUS. CONCLUSION The overall incidence of post-procedural adverse events at a new EUS program was 5.6%, with an average of 22% relative decrease in adverse events per year in the first 4 years.
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Walsh CM, Lightdale JR, Fishman DS, Furlano RI, Mamula P, Gillett PM, Narula P, Hojsak I, Oliva S, Homan M, Riley MR, Huynh HQ, Rosh JR, Jacobson K, Tavares M, Leibowitz IH, Utterson EC, Croft NM, Mack DR, Brill H, Liu QY, Bontems P, Lerner DG, Amil-Dias J, Kramer RE, Otley AR, Ambartsumyan L, Connan V, McCreath GA, Thomson MA. Pediatric Endoscopy Quality Improvement Network Pediatric Endoscopy Reporting Elements: A Joint NASPGHAN/ESPGHAN Guideline. J Pediatr Gastroenterol Nutr 2022; 74:S53-S62. [PMID: 34402488 DOI: 10.1097/mpg.0000000000003266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION High-quality procedure reports are a cornerstone of high-quality pediatric endoscopy as they ensure the clear communication of procedural events and outcomes, guide patient care and facilitate continuous quality improvement. The aim of this document is to outline standardized reporting elements that achieved international consensus as requirements for high-quality pediatric endoscopy procedure reports. METHODS With support from the North American and European Societies of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN and ESPGHAN), an international working group of the Pediatric Endoscopy Quality Improvement Network (PEnQuIN) used Delphi methodology to identify key elements that should be found in all pediatric endoscopy reports. Item reduction was attained through iterative rounds of anonymized online voting using a 6-point scale. Responses were analyzed after each round and items were excluded from subsequent rounds if ≤50% of panelists rated them as 5 ("agree moderately") or 6 ("agree strongly"). Reporting elements that ≥70% of panelists rated as "agree moderately" or "agree strongly" were considered to have achieved consensus. RESULTS Twenty-six PEnQuIN group members from 25 centers internationally rated 63 potential reporting elements that were generated from a systematic literature review and the Delphi panelists. The response rates were 100% for all three survey rounds. Thirty reporting elements reached consensus as essential for inclusion within a pediatric endoscopy report. DISCUSSION It is recommended that the PEnQuIN Reporting Elements for pediatric endoscopy be universally employed across all endoscopists, procedures and facilities as a foundational means of ensuring high-quality endoscopy services, while facilitating quality improvement activities in pediatric endoscopy.
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Affiliation(s)
- Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jenifer R Lightdale
- Division of Gastroenterology and Nutrition, UMass Memorial Children's Medical Center, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States
| | - Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Raoul I Furlano
- Pediatric Gastroenterology & Nutrition, Department of Pediatrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Petar Mamula
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Peter M Gillett
- Paediatric Gastroenterology, Hepatology and Nutrition Department, Royal Hospital for Sick Children, Edinburgh, Scotland, United Kingdom
| | - Priya Narula
- Department of Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
| | - Iva Hojsak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, University J.J. Strossmayer Medical School, Osijek, Croatia
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Umberto I - University Hospital, Sapienza - University of Rome, Rome, Italy
| | - Matjaž Homan
- Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Matthew R Riley
- Department of Pediatric Gastroenterology, Providence St. Vincent's Medical Center, Portland, OR, United States
| | - Hien Q Huynh
- Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Joel R Rosh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Goryeb Children's Hospital, Icahn School of Medicine at Mount Sinai, Morristown, NJ, United States
| | - Kevan Jacobson
- Division of Gastroenterology, Hepatology and Nutrition, British Columbia's Children's Hospital and British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marta Tavares
- Division of Pediatrics, Pediatric Gastroenterology Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Ian H Leibowitz
- Division of Gastroenterology, Hepatology and Nutrition, Children's National Medical Center, Department of Pediatrics, George Washington University, Washington, DC, United States
| | - Elizabeth C Utterson
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, MO, United States
| | - Nicholas M Croft
- Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - David R Mack
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Herbert Brill
- Division of Gastroenterology & Nutrition, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Department of Paediatrics, William Osler Health System, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Quin Y Liu
- Division of Gastroenterology and Hepatology, Medicine and Pediatrics, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Patrick Bontems
- Division of Pediatrics, Department of Pediatric Gastroenterology, Queen Fabiola Children's University Hospital, ICBAS - Université Libre de Bruxelles, Brussels, Belgium
| | - Diana G Lerner
- Division of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Children's of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jorge Amil-Dias
- Pediatric Gastroenterology, Department of Pediatrics, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Robert E Kramer
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Colorado, University of Colorado, Aurora, CO, United States
| | - Anthony R Otley
- Gastroenterology & Nutrition, Department of Pediatrics, IWK Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lusine Ambartsumyan
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Veronik Connan
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Graham A McCreath
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mike A Thomson
- Department of Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
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Lightdale JR, Walsh CM, Narula P, Utterson EC, Tavares M, Rosh JR, Riley MR, Oliva S, Mamula P, Mack DR, Liu QY, Lerner DG, Leibowitz IH, Jacobson K, Huynh HQ, Homan M, Hojsak I, Gillett PM, Furlano RI, Fishman DS, Croft NM, Brill H, Bontems P, Amil-Dias J, Kramer RE, Ambartsumyan L, Otley AR, McCreath GA, Connan V, Thomson MA. Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopy Facilities: A Joint NASPGHAN/ESPGHAN Guideline. J Pediatr Gastroenterol Nutr 2022; 74:S16-S29. [PMID: 34402485 DOI: 10.1097/mpg.0000000000003263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION There is increasing international recognition of the impact of variability in endoscopy facilities on procedural quality and outcomes. There is also growing precedent for assessing the quality of endoscopy facilities at regional and national levels by using standardized rating scales to identify opportunities for improvement. METHODS With support from the North American and European Societies of Pediatric Gastroenterology Hepatology and Nutrition (NASPGHAN and ESPGHAN), an international working group of the Pediatric Endoscopy Quality Improvement Network (PEnQuIN) used the methodological strategy of the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument to develop standards and indicators relevant for assessing the quality of facilities where endoscopic care is provided to children. Consensus was reached via an iterative online Delphi process and subsequent in-person meeting. The quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development and Evaluation) approach. RESULTS The PEnQuIN working group achieved consensus on 27 standards for facilities supporting pediatric endoscopy, as well 10 indicators that can be used to identify high-quality endoscopic care in children. These standards were subcategorized into three subdomains: Quality of Clinical Operations (15 standards, 5 indicators); Patient and Caregiver Experience (9 standards, 5 indicators); and Workforce (3 standards). DISCUSSION The rigorous PEnQuIN process successfully yielded standards and indicators that can be used to universally guide and measure high-quality facilities for procedures around the world where endoscopy is performed in children. It also underscores the current paucity of evidence for pediatric endoscopic care processes, and the need for research into this clinical area.
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Affiliation(s)
- Jenifer R Lightdale
- Department of Pediatrics, Division of Gastroenterology and Nutrition, UMass Memorial Children's Medical Center, University of Massachusetts Medical School, Worcester, MA, United States
| | - Catharine M Walsh
- Department of Paediatrics and the Wilson Centre, Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Priya Narula
- Department of Paediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
| | - Elizabeth C Utterson
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, MO, United States
| | - Marta Tavares
- Pediatric Gastroenterology Department, Division of Pediatrics, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Joel R Rosh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Goryeb Children's Hospital, Icahn School of Medicine at Mount Sinai, Morristown, NJ, United States
| | - Matthew R Riley
- Department of Pediatric Gastroenterology, Providence St. Vincent's Medical Center, Portland, OR, United States
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Umberto I - University Hospital, Sapienza - University of Rome, Rome, Italy
| | - Petar Mamula
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - David R Mack
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Quin Y Liu
- Division of Gastroenterology and Hepatology, Medicine and Pediatrics, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Diana G Lerner
- Division of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Children's of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Ian H Leibowitz
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Children's National Medical Center, George Washington University, Washington, DC, United States
| | - Kevan Jacobson
- Division of Gastroenterology, Hepatology and Nutrition, British Columbia's Children's Hospital and British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hien Q Huynh
- Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Matjaž Homan
- Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Iva Hojsak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, University J.J. Strossmayer Medical School, Osijek, Croatia
| | - Peter M Gillett
- Paediatric Gastroenterology, Hepatology and Nutrition Department, Royal Hospital for Sick Children, Edinburgh, Scotland, United Kingdom
| | - Raoul I Furlano
- Pediatric Gastroenterology & Nutrition, Department of Pediatrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Nicholas M Croft
- Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Herbert Brill
- Division of Gastroenterology & Nutrition, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Department of Paediatrics, William Osler Health System, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Bontems
- Division of Pediatrics, Department of Pediatric Gastroenterology, Queen Fabiola Children's University Hospital, ICBAS - Université Libre de Bruxelles, Brussels, Belgium
| | - Jorge Amil-Dias
- Pediatric Gastroenterology, Department of Pediatrics, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Robert E Kramer
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Colorado, University of Colorado, Aurora, CO, United States
| | - Lusine Ambartsumyan
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Anthony R Otley
- Gastroenterology & Nutrition, Department of Pediatrics, IWK Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Graham A McCreath
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Veronik Connan
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mike A Thomson
- Department of Paediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
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Li S, Monachese M, Salim M, Arya N, Sahai AV, Forbes N, Teshima C, Yaghoobi M, Chen YI, Lam E, James P. Standard reporting elements for the performance of EUS: Recommendations from the FOCUS working group. Endosc Ultrasound 2021; 10:84-92. [PMID: 33666183 PMCID: PMC8098847 DOI: 10.4103/eus-d-20-00234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background and Objectives Quality indicators for the performance of EUS have been developed to monitor and improve service value and patient outcomes. To support the incorporation of these indicators and standardize EUS documentation, we propose standard EUS reporting elements for endosonographers and endoscopy units. Methods A comprehensive literature search and review was performed to identify EUS quality indicators and key components of high-quality standardized EUS reporting. Guidance statements regarding standard EUS reporting elements were developed and reviewed at the Forum for Canadian Endoscopic Ultrasound (FOCUS) 2019 Annual Meeting. Results EUS reporting elements can be divided into preprocedural, intraprocedural, and postprocedural items. Preprocedural components include the type, indication, and urgency of the procedure and patient clinical information and consent. Intraprocedural components include the adequacy and extent of examination, relevant landmarks, lesion characteristics, sampling method, specimen quality, and intraprocedural adverse events. Postprocedural components include a summary and synthesis of relevant findings as well as recommended management and follow-up. Conclusions Standardizing reporting elements may help improve the care of patients undergoing EUS procedures. Our review provides a practical guide and compilation of recommended reporting elements to ensure ongoing best practices and quality improvement in EUS.
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Affiliation(s)
- Suqing Li
- Division of Gastroenterology and Hepatology, University Health Network, University of Toronto, Toronto, Canada
| | - Marc Monachese
- Division of Gastroenterology and Hepatology, University Health Network, University of Toronto, Toronto, Canada
| | - Misbah Salim
- Division of Gastroenterology and Hepatology, University Health Network, University of Toronto, Toronto, Canada
| | - Naveen Arya
- Division of Gastroenterology, Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - Anand V Sahai
- Division of Gastroenterology, University of Montreal, Montreal, Quebec, Canada
| | - Nauzer Forbes
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada
| | - Christopher Teshima
- Department of Medicine, Division of Gastroenterology, St. Michael's Hospital, University of Calgary, Toronto, Canada
| | - Mohammad Yaghoobi
- Division of Gastroenterology, McMaster University Medical Center, McMaster University, Hamilton, Canada
| | - Yen-I Chen
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Canada
| | - Eric Lam
- Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - Paul James
- Division of Gastroenterology and Hepatology, University Health Network, University of Toronto, Toronto, Canada
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Zilli A, Capogreco A, Furfaro F, Allocca M, Roda G, Loy L, Fiorino G, Danese S. Improving quality of care in endoscopy of inflammatory bowel disease: can we do better? Expert Rev Gastroenterol Hepatol 2020; 14:819-828. [PMID: 32543983 DOI: 10.1080/17474124.2020.1780913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Endoscopy plays a key role in the management of inflammatory bowel disease (IBD). There is an increased need for quality assurance programs that evaluate the quality, safety and patient experiences of endoscopy, by assessing procedural and clinical outcomes. AREAS COVERED This review aims to summarize the most important quality indicators of endoscopy in IBD patients and could serve as the basis to improve quality endoscopic procedures and patients' perception of endoscopy in the future. However, further studies and consensus reports are necessary to standardize the quality of care in the endoscopy unit of all IBD centers. EXPERT COMMENTARY Developing an understanding of the patient-reported perception is important for both clinicians and patients, as it facilitates patient engagement with their care. Moreover, implementing education in reporting is crucial f and the use of verifiable databases, generated from electronic reporting systems, should be encouraged rather than unverified self-reporting, to have greater validity for documenting and to formally evaluate endoscopic practice data with audits. The use of artificial intelligence may improve the quality of endoscopy, by increasing the adenoma detection rate and helping endoscopists in the challenging differentiation between inflammatory and neoplastic lesions.
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Affiliation(s)
- Alessandra Zilli
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute , Milan, Italy
| | - Antonio Capogreco
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute , Milan, Italy
| | - Federica Furfaro
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute , Milan, Italy
| | - Mariangela Allocca
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute , Milan, Italy.,Department of Biomedical Sciences, Humanitas University , Milan, Italy
| | - Giulia Roda
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute , Milan, Italy
| | - Laura Loy
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute , Milan, Italy
| | - Gionata Fiorino
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute , Milan, Italy.,Department of Biomedical Sciences, Humanitas University , Milan, Italy
| | - Silvio Danese
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute , Milan, Italy.,Department of Biomedical Sciences, Humanitas University , Milan, Italy
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8
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Kumta NA, Tyberg A, Bhagat VH, Siddiqui AA, Kowalski TE, Loren DE, Desai AP, Sarkisian AM, Brown EG, Karia K, Gaidhane M, Kedia P, Tarnasky PR, Patel U, Adler D, Taylor LJ, Petrone M, Arcidiacono P, Yachimski PS, Weine D, Sundararajan S, Deprez PH, Mouradides C, Ho S, Javed S, Easler JJ, Raijman I, Vazquez-Sequeiros E, Sawhney M, Berzin TM, Kahaleh M. EUS-guided drainage of pancreatic fluid collections using lumen apposing metal stents: An international, multicenter experience. Dig Liver Dis 2019; 51:1557-1561. [PMID: 31272934 DOI: 10.1016/j.dld.2019.05.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 04/28/2019] [Accepted: 05/28/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Lumen apposing metal stents (LAMS) have been used increasingly for drainage of pancreatic fluid collections (PFC). We present an international, multicenter study evaluating the safety and efficacy of LAMS in PFCs. METHODS Consecutive patients undergoing LAMS placement for PFC at 12 international centers were included (ClinicalTrials.gov NCT01522573). Demographics, clinical history, and procedural details were recorded. Technical success was defined as successful LAMS deployment. Clinical success was defined as PFC resolution at three-month follow-up. RESULTS 192 patients were included (140 males (72.9%), mean-age 53.8 years), with mean follow-up of 4.2 months ± 3.8. Mean PFC size was 11.9 cm (range 2-25). The median number of endoscopic interventions was 2 (range 1-14). Etiologies for PFC were gallstone (n = 82, 42.7%), alcohol (n = 50, 26%), idiopathic (n = 26, 13.5%), and other (n = 34, 17.7%). Technical success was achieved in 189 patients (98.4%). Clinical success was observed in 125 of 135 patients (92.6%). Adverse events included bleeding (n = 11, 5.7), infection (n = 2, 1%), and perforation (n = 2, 1%). Three or more endoscopy sessions were a positive predictor for PFC resolution and the only significant predictor for AEs. CONCLUSION LAMS has a high technical and clinical success rate with a low rate of AEs. PFC drainage via LAMS provides a minimally invasive, safe, and efficacious procedure for PFC resolution.
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Affiliation(s)
- Nikhil A Kumta
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Amy Tyberg
- Division of Gastroenterology, Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, United States
| | - Vicky H Bhagat
- Division of Gastroenterology, Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, United States
| | - Ali A Siddiqui
- Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, PA Medicine, New York, NY, United States
| | - Thomas E Kowalski
- Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, PA Medicine, New York, NY, United States
| | - David E Loren
- Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, PA Medicine, New York, NY, United States
| | - Amit P Desai
- Division of Gastroenterology, New York Presbyterian Hospital - Weill Cornell, United States
| | - Alex M Sarkisian
- Division of Gastroenterology, New York Presbyterian Hospital - Weill Cornell, United States
| | - Elizabeth G Brown
- Division of Gastroenterology, New York Presbyterian Hospital - Weill Cornell, United States
| | - Kunal Karia
- Division of Gastroenterology, New York Presbyterian Hospital - Weill Cornell, United States
| | - Monica Gaidhane
- Division of Gastroenterology, Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, United States
| | - Prashant Kedia
- Methodist Dallas Medical Center, Dallas, TX, United States
| | | | - Umangi Patel
- Methodist Dallas Medical Center, Dallas, TX, United States
| | - Douglas Adler
- Division of Gastroenterology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Linda J Taylor
- Division of Gastroenterology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Maria Petrone
- Division of Pancreato-Biliary Endoscopy and Endosonography, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Arcidiacono
- Division of Pancreato-Biliary Endoscopy and Endosonography, San Raffaele Scientific Institute, Milan, Italy
| | - Patrick S Yachimski
- Division of Gastroenterology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Douglas Weine
- Riverview Medical Center, Red Bank Gastroenterology, Red Bank, NJ, United States
| | - Subha Sundararajan
- Riverview Medical Center, Red Bank Gastroenterology, Red Bank, NJ, United States
| | - Pierre H Deprez
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Christina Mouradides
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Sammy Ho
- Division of Gastroenterology, Montefiore Medical Center, Bronx, NY, United States
| | - Safeera Javed
- Division of Gastroenterology, Montefiore Medical Center, Bronx, NY, United States
| | - Jeffrey J Easler
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Isaac Raijman
- Digestive Associates of Houston, St. Luke's Episcopal Hospital, Houston, TX, United States
| | | | - Mandeep Sawhney
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Tyler M Berzin
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Michel Kahaleh
- Division of Gastroenterology, Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, United States.
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9
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Tsaousi G, Stavrou G, Kapanidis K, Michalopoulos A, Kotzampassi K. Unsedated Outpatient Percutaneous Endoscopic Gastrostomy in Stroke Patients: Is It Feasible and Safe? Surg Laparosc Endosc Percutan Tech 2019; 29:383-388. [PMID: 31033632 DOI: 10.1097/sle.0000000000000661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Percutaneous endoscopic gastrostomy (PEG) is an established practice for long-term nutrition in dysphagia-suffering stroke patients. This study sought to determine the feasibility and safety of outpatient, unsedated PEG implementation in stroke patients. This retrospective cohort study involved stroke victims who underwent unsedated outpatient PEG insertion from 2014 to 2017 at our Surgical Endoscopy Unit. Patients were given pharyngeal anesthesia with lidocaine 10% spray, while the PEG tube was placed under local anesthesia. The incidence of intraprocedural and postprocedural complications and 30-day mortality rate were recorded. Data from 127 cases were analyzed. The procedures were performed with minor, transient complications, which resolved after rescue maneuvers. No intraprocedural and postprocedural major complications or death were observed. During the 30-day follow-up, the most important complication involved a single case of accidental PEG removal that was successfully resolved surgically. Unsedated PEG insertion appears to be a feasible, well-tolerated, and safe option for stroke-related dysphagia.
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Affiliation(s)
- Georgia Tsaousi
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
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10
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Jiang TA, Xie LT. Algorithm for the multidisciplinary management of hemorrhage in EUS-guided drainage for pancreatic fluid collections. World J Clin Cases 2018; 6:308-321. [PMID: 30283794 PMCID: PMC6163138 DOI: 10.12998/wjcc.v6.i10.308] [Citation(s) in RCA: 12] [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: 05/16/2018] [Revised: 07/05/2018] [Accepted: 07/16/2018] [Indexed: 02/05/2023] Open
Abstract
Pancreatic fluid collections (PFCs), common sequelae of acute or chronic pancreatitis, are broadly classified as pancreatic pseudocysts or walled-off necrosis according to the revised Atlanta classification. Endoscopic ultrasound (EUS)-guided drainage is often considered a standard first-line therapy preferable to surgical or interventional radiology approaches for patients with symptomatic PFC. EUS-guided drainage is effective and successful; it has a technical success rate of 90%-100% and a clinical success rate of 85%-98%. Recent studies have shown a 5%-30% adverse events (AEs) rate for the procedure. The most common AEs include infection, hemorrhage, perforation and stent migration. Hemorrhage, a severe and sometimes deadly outcome, requires a well-organized and appropriate treatment strategy. However, few studies have reported the integrated management of hemorrhage during EUS-guided drainage of PFC. Establishing a practical therapeutic strategy is an essential and significant step in standardized management. The aim of this review is to describe the current situation of EUS-guided drainage of PFCs, including the etiology and treatment of procedure-related bleeding as well as current problems and future perspectives. We propose a novel and meaningful algorithm for systematically managing hemorrhage events. To our limited knowledge, a multidisciplinary algorithm for managing EUS-guided drainage for PFC-related bleeding has not been previously reported.
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Affiliation(s)
- Tian-An Jiang
- Department of Ultrasound, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Li-Ting Xie
- Department of Ultrasound, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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11
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Liou SC, Hsu CM, Chen C, Su MY, Chiu CT. Assessment of the Berlin Questionnaire for evaluation of hypoxemia risk in subjects undergoing deep sedation for screening gastrointestinal endoscopy. Ther Clin Risk Manag 2018; 14:1331-1336. [PMID: 30104879 PMCID: PMC6071626 DOI: 10.2147/tcrm.s170498] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Subjects with obstructive sleep apnea (OSA) are vulnerable to sedation-related complications during endoscopic procedures. A significant portion of subjects undergoing routine endoscopy is at high risk of OSA, but most are undiagnosed. The purpose of this study was to estimate the prevalence of high risk for OSA among Chinese subjects undergoing deep sedation for screening gastrointestinal endoscopy and to evaluate the hypoxemia risk of these examinees stratified by Berlin Questionnaire (BQ). Patients and methods We performed a prospective cohort study in subjects undergoing deep sedation with monitored anesthesia care for combined esophagogastroduodenoscopy plus colonoscopy. Subjects who were Chinese were stratified into high- and low-risk groups for OSA by administration of BQ. Deep sedation was achieved via a propofol target-controlled infusion system. Hypoxemia was defined as pulse oximetry reading of less than 90%. The frequency of hypoxemia was compared between high- and low-risk groups for OSA. Results A total of 615 Chinese subjects were recruited during the study period, and 614 subjects were included for analysis. Two hundred eighteen (35.5%) subjected were classified to be at high risk of OSA, and 396 (64.5%) were stratified to be at low risk of OSA by BQ. Hypoxemia occurred in 83 (13.5%) subjects during endoscopy procedures. The risk of developing hypoxemia in the high-risk group was significantly higher when compared to that of the low-risk group subjects (24.8% vs 7.3%; relative risk, 3.37; 95% CI, 2.22–5.13). Conclusion About one-third Chinese subjects undergoing deep sedation for screening endoscopy were at high risk of OSA. Subjects at high risk of OSA are associated with an increased risk of hypoxemia in comparison to the low-risk group when undergoing deep sedation for screening gastrointestinal endoscopy.
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Affiliation(s)
- Shiue-Chin Liou
- Department of Anesthesiology, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan
| | - Chen-Ming Hsu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan,
| | - Chit Chen
- Department of Anesthesiology, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan
| | - Ming-Yao Su
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan,
| | - Cheng-Tang Chiu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan,
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12
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Hellhammer K, Afzal S, Tigges R, Spieker M, Rassaf T, Zeus T, Westenfeld R, Kelm M, Horn P. High body mass index is a risk factor for difficult deep sedation in percutaneous mitral valve repair. PLoS One 2018; 13:e0190590. [PMID: 29304185 PMCID: PMC5755851 DOI: 10.1371/journal.pone.0190590] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 12/15/2017] [Indexed: 12/15/2022] Open
Abstract
Background The safety and efficacy of deep sedation (DS) in MitraClip® procedures have been shown previously. However, clinical experience demonstrates that in some patients DS is difficult to achieve. We hypothesize that some patient characteristics can predict difficult DS. Methods We prospectively analysed 69 patients undergoing MitraClip® procedures using DS. Application of DS was graded as simple (group 1) or difficult (group 2) depending on a cumulative score based on one point for each of the following criteria: decrease in oxygen saturation, retention of carbon dioxide, disruptive body movements, and the need for catecholamines. Patients with one point or less were classified as group 1, and patients with two or more points were classified as group 2. Results In 58 of 69 patients (84.1%), the performance of DS was simple, while in 11 patients (15.9%), DS was difficult to achieve. Patients with difficult DS were characterized by a higher body mass index (33.7 ± 6.0 kg/m2 vs. 26.1 ± 4.1; p = 0.001), younger age (67 ± 13 years vs. 75 ± 13 years; p = 0.044), and reduced left ventricular ejection fraction (36% ± 10 vs. 45% ± 14; p = 0.051) and presented more often with an obstructive sleep apnoea syndrome (6.9% vs. 45.5%; p = 0.003). In the multivariate analysis, body mass index was an independent predictor of difficult DS. Using a body mass index of 31 kg/m2 as a cut-off value, the sensitivity of predicting difficult DS was 73%, and the specificity was 88%. Using a body mass index of 35 kg/m2 as a cut-off value, the specificity increased to 97%, with a sensitivity of 36%. Conclusion In patients with a higher body mass index who undergo MitraClip® procedures, DS might be difficult to perform.
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Affiliation(s)
- Katharina Hellhammer
- University Hospital Düsseldorf, Medical Faculty, Dept. of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Shazia Afzal
- University Hospital Düsseldorf, Medical Faculty, Dept. of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Renate Tigges
- University Hospital Düsseldorf, Medical Faculty, Dept. of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Maximilian Spieker
- University Hospital Düsseldorf, Medical Faculty, Dept. of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Tienush Rassaf
- University Hospital Essen, Medical Faculty, Dept. of Medicine, Division of Cardiology and Vascular Medicine, Essen, Germany
| | - Tobias Zeus
- University Hospital Düsseldorf, Medical Faculty, Dept. of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Ralf Westenfeld
- University Hospital Düsseldorf, Medical Faculty, Dept. of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Malte Kelm
- University Hospital Düsseldorf, Medical Faculty, Dept. of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Patrick Horn
- University Hospital Düsseldorf, Medical Faculty, Dept. of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
- * E-mail:
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13
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Hanafy AS, Badawi R, Basha MAA, Selim A, Yousef M, Elnawasany S, Mansour L, Elkhouly RA, Hawash N, Abd-Elsalam S. A novel scoring system for prediction of esophageal varices in critically ill patients. Clin Exp Gastroenterol 2017; 10:315-325. [PMID: 29263686 PMCID: PMC5724407 DOI: 10.2147/ceg.s144700] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND AIMS Patients with advanced systemic illness or critically ill patients may present with upper gastrointestinal tract (GIT) bleeding which may need endoscopic intervention; however, this may expose them to unnecessary endoscopy. The aim was to validate a novel scoring system for risk stratification for urgency of GIT endoscopy in critically ill patients. METHODS This is an observational study conducted from January 2013 to January 2016 to analyze 300 patients with critical medical conditions and presenting with upper gastrointestinal bleeding. Meticulous clinical, laboratory, and sonographic evaluations were performed to calculate Glasgow Blatchford score (GBS) and variceal metric score for risk stratification and prediction of the presence of esophageal varices (OV). Finally, this score was applied on a validation group (n=100). RESULTS The use of GBS and variceal metric scores in critically ill patients revealed that patients who showed a low risk score value for OV (0-4 points) and GBS <2 can be treated conservatively and discharged safely without urgent endoscopy. In patients with a low risk for varices but GBS >2, none of them had OV on endoscopy. In patients with intermediate risk score value for OV (5-8 points) and with GBS >2, 33.33% of them had varices on endoscopy. In patients with high risk score value for varices (9-13) and GBS >2, endoscopy revealed varices in 94.4% of them. Finally, in patients with very high risk score for varices (14-17), endoscopy revealed varices in 100% of them. CONCLUSION GBS and variceal metric score were highly efficacious in identifying critically ill patients who will benefit from therapeutic endoscopic intervention.
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Affiliation(s)
- Amr Shaaban Hanafy
- Internal Medicine Department, Hepatology Division, Zagazig University, Zagazig
| | - Rehab Badawi
- Tropical Medicine Department, Tanta University, Tanta
| | | | - Amal Selim
- Internal Medicine Department, Tanta University, Tanta, Egypt
| | | | | | - Loai Mansour
- Tropical Medicine Department, Tanta University, Tanta
| | | | - Nehad Hawash
- Tropical Medicine Department, Tanta University, Tanta
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14
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López-Picazo J, Alberca de Las Parras F, Sánchez Del Río A, Pérez Romero S, León Molina J, Júdez FJ. Quality indicators in digestive endoscopy: introduction to structure, process, and outcome common indicators. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 109:435-450. [PMID: 28553719 DOI: 10.17235/reed.2017.5035/2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The general goal of the project wherein this paper is framed is the proposal of useful quality and safety procedures and indicators to facilitate quality improvement in digestive endoscopy units. This initial offspring sets forth procedures and indicators common to all digestive endoscopy procedures. First, a diagram of pre- and post-digestive endoscopy steps was developed. A group of health care quality and/or endoscopy experts under the auspices of the Sociedad Española de Patología Digestiva (Spanish Society of Digestive Diseases) carried out a qualitative review of the literature regarding the search for quality indicators in endoscopic procedures. Then, a paired analysis was used for the selection of literature references and their subsequent review. Twenty indicators were identified, including seven for structure, eleven for process (five pre-procedure, three intra-procedure, three post-procedure), and two for outcome. Quality of evidence was analyzed for each indicator using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification.
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Affiliation(s)
- Julio López-Picazo
- Servicio de Calidad Asistencial, Hospital Clínico Universitario Virgen de la Arrixaca
| | | | | | - Shirley Pérez Romero
- Servicio de Calidad Asistencial, Hospital Clínico Universitario Virgen de la Arrixaca
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15
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Sharaiha RZ, Khan MA, Kamal F, Tyberg A, Tombazzi CR, Ali B, Tombazzi C, Kahaleh M. Efficacy and safety of EUS-guided biliary drainage in comparison with percutaneous biliary drainage when ERCP fails: a systematic review and meta-analysis. Gastrointest Endosc 2017; 85:904-914. [PMID: 28063840 DOI: 10.1016/j.gie.2016.12.023] [Citation(s) in RCA: 282] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 12/27/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS EUS-guided biliary drainage (EUS-BD) is increasingly used as an alternate therapeutic modality to percutaneous transhepatic biliary drainage (PTBD) for biliary obstruction in patients who fail ERCP. We conducted a systematic review and meta-analysis to compare the efficacy and safety of these 2 procedures. METHODS We searched several databases from inception to September 4, 2016 to identify comparative studies evaluating the efficacy and safety of EUS-BD and PTBD. Primary outcomes of interest were the differences in technical success and postprocedure adverse events. Secondary outcomes of interest included clinical success, rate of reintervention, length of hospital stay, and cost comparison for these 2 procedures. Odds ratios (ORs) and standard mean difference were calculated for categorical and continuous variables, respectively. These were analyzed using random effects model of meta-analysis. RESULTS Nine studies with 483 patients were included in the final analysis. There was no difference in technical success between 2 procedures (OR, 1.78; 95% CI, .69-4.59; I2 = 22%) but EUS-BD was associated with better clinical success (OR, .45; 95% CI, .23-.89; I2 = 0%), fewer postprocedure adverse events (OR, .23; 95% CI, .12-.47; I2 = 57%), and lower rate of reintervention (OR, .13; 95% CI, .07-.24; I2 = 0%). There was no difference in length of hospital stay after the procedures, with a pooled standard mean difference of -.48 (95% CI, -1.13 to .16), but EUS-BD was more cost-effective, with a pooled standard mean difference of -.63 (95% CI, -1.06 to -.20). However, the latter 2 analyses were limited by considerable heterogeneity. CONCLUSIONS When ERCP fails to achieve biliary drainage, EUS-guided interventions may be preferred over PTBD if adequate advanced endoscopy expertise and logistics are available. EUS-BD is associated with significantly better clinical success, lower rate of postprocedure adverse events, and fewer reinterventions.
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Affiliation(s)
- Reem Z Sharaiha
- Department of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | - Muhammad Ali Khan
- Division of Gastroenterology and Hepatology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Faisal Kamal
- Division of Gastroenterology and Hepatology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Amy Tyberg
- Department of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | - Claudio R Tombazzi
- Division of Gastroenterology and Hepatology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Bilal Ali
- Division of Gastroenterology and Hepatology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Claudio Tombazzi
- Division of Gastroenterology and Hepatology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Michel Kahaleh
- Department of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
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16
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Sharaiha RZ, Kumta NA, Saumoy M, Desai AP, Sarkisian AM, Benevenuto A, Tyberg A, Kumar R, Igel L, Verna EC, Schwartz R, Frissora C, Shukla A, Aronne LJ, Kahaleh M. Endoscopic Sleeve Gastroplasty Significantly Reduces Body Mass Index and Metabolic Complications in Obese Patients. Clin Gastroenterol Hepatol 2017; 15:504-510. [PMID: 28017845 DOI: 10.1016/j.cgh.2016.12.012] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/11/2016] [Accepted: 12/12/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Endoscopic sleeve gastroplasty (ESG) is an incisionless, minimally invasive bariatric procedure that reduces the length and width of the gastric cavity to facilitate weight loss. We performed a prospective study to evaluate the effects of ESG on total body weight loss and obesity-related comorbidities. METHODS We collected data from 91 consecutive patients (mean age, 43.86 ± 11.26 years; 68% female) undergoing ESG from August 2013 through March 2016. All patients had a body mass index (BMI) greater than 30 kg/m2 and had failed noninvasive weight-loss measures or had a BMI greater than 40 kg/m2 and were not considered as surgical candidates or refused surgery. All procedures were performed with a cap-based flexible endoscopic suturing system to facilitate a triangular pattern of sutures to imbricate the greater curvature of the stomach. Patients were evaluated after 6 months (n = 73), 12 months (n = 53), and 24 months (n = 12) for anthropometric features (BMI, weight, waist circumference, blood pressure) and underwent serologic (hemoglobin A1c), lipid panel, serum triglycerides, and liver function tests. The primary outcomes were total body weight loss at 6, 12, and 24 months. Secondary outcomes were the effects of ESG on metabolic factors (blood pressure, diabetes, hyperlipidemia, steatohepatitis) and safety. RESULTS The patients' mean BMI before the procedure was 40.7 ± 7.0 kg/m2. Patients had lost 14.4% of their total body weight at 6 months (80% follow-up rate), 17.6% at 12 months (76% follow-up rate), and 20.9% at 24 months (66% follow-up rate) after ESG. At 12 months after ESG, patients had statistically significant reductions in levels of hemoglobin A1c (P = .01), systolic blood pressure (P = .02), waist circumference (P < .001), alanine aminotransferase (P < .001), and serum triglycerides (P = .02). However, there was no significant change in low-density lipoprotein after vs before ESG (P = .79). There was one serious adverse event (1.1%) (perigastric leak) that occurred that was managed non-operatively. CONCLUSIONS ESG is a minimally invasive and effective endoscopic weight loss intervention. In addition to sustained total body weight loss up to 24 months, ESG reduced markers of hypertension, diabetes, and hypertriglyceridemia.
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Affiliation(s)
- Reem Z Sharaiha
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York.
| | - Nikhil A Kumta
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
| | - Monica Saumoy
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
| | - Amit P Desai
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
| | - Alex M Sarkisian
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
| | - Andrea Benevenuto
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
| | - Amy Tyberg
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
| | - Rekha Kumar
- Department of Endocrinology, Weill Cornell Medicine, New York, New York
| | - Leon Igel
- Department of Endocrinology, Weill Cornell Medicine, New York, New York
| | - Elizabeth C Verna
- Department of Gastroenterology, Columbia University Medical Center, New York, New York
| | - Robert Schwartz
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
| | - Christina Frissora
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
| | - Alpana Shukla
- Department of Endocrinology, Weill Cornell Medicine, New York, New York
| | - Louis J Aronne
- Department of Endocrinology, Weill Cornell Medicine, New York, New York
| | - Michel Kahaleh
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
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Management of the Airway in Challenging Patients Undergoing Upper Endoscopic Procedures. Int Anesthesiol Clin 2016; 55:2-10. [PMID: 27941365 DOI: 10.1097/aia.0000000000000129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sharaiha RZ, Tyberg A, Khashab MA, Kumta NA, Karia K, Nieto J, Siddiqui UD, Waxman I, Joshi V, Benias PC, Darwin P, DiMaio CJ, Mulder CJ, Friedland S, Forcione DG, Sejpal DV, Gonda TA, Gress FG, Gaidhane M, Koons A, DeFilippis EM, Salgado S, Weaver KR, Poneros JM, Sethi A, Ho S, Kumbhari V, Singh VK, Tieu AH, Parra V, Likhitsup A, Womeldorph C, Casey B, Jonnalagadda SS, Desai AP, Carr-Locke DL, Kahaleh M, Siddiqui AA. Endoscopic Therapy With Lumen-apposing Metal Stents Is Safe and Effective for Patients With Pancreatic Walled-off Necrosis. Clin Gastroenterol Hepatol 2016; 14:1797-1803. [PMID: 27189914 DOI: 10.1016/j.cgh.2016.05.011] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/29/2016] [Accepted: 05/03/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Endoscopic ultrasound-guided transmural drainage and necrosectomy have become the standard treatment for patients with pancreatic walled-off necrosis (WON). Lumen-apposing metal stents (LAMS) have shown success in the management of pancreatic fluid collections. However, there are few data on their specific roles in management of WON. We investigated the efficacy and safety of LAMS in treatment of WON. METHODS We performed a retrospective multicenter case series of 124 patients with WON who underwent endoscopic transmural drainage by using LAMS at 17 tertiary care centers from January 2014 through May 2015. Patients underwent endoscopic ultrasound-guided cystogastrostomy or cystoenterostomy with placement of an LAMS into the WON collection. At the discretion of the endoscopist, we performed direct endoscopic necrosectomy, irrigation with hydrogen peroxide, and/or nasocystic drain placement. We performed endoscopic retrograde cholangiopancreatography with pancreatic duct stent placement when indicated. Concomitant therapies included direct endoscopic debridement (n = 78), pancreatic duct stent placement for leak (n = 19), hydrogen peroxide-assisted necrosectomy (n = 38), and nasocystic irrigation (n = 22). We collected data for a median time of 4 months (range, 1-34 months) after the LAMS placement. The primary outcomes were rates of technical success (successful placement of the LAMS), clinical success (resolution of WON, on the basis of image analysis, without need for further intervention via surgery or interventional radiology), and adverse events. RESULTS The median size of the WON was 9.5 cm (range, 4-30 cm). Eight patients had 2 LAMS placed for multiport access, all with technical success (100%). Clinical success was achieved in 107 patients (86.3%) after 3 months of follow-up. Thirteen patients required a percutaneous drain, and 3 required a surgical intervention to manage their WON. The stents remained patent in 94% of patients (117 of 124) and migrated in 5.6% of patients (7 of 124). The median number of endoscopic interventions was 2 (range, 1-9 interventions). CONCLUSIONS On the basis of a retrospective analysis of 124 patients, endoscopic therapy of WON by using LAMS is safe and effective. Creation of a large and sustained cystogastrostomy or cystoenterostomy tract is effective in the drainage and treatment of WON.
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Affiliation(s)
- Reem Z Sharaiha
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York.
| | - Amy Tyberg
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - Mouen A Khashab
- Gastroenterology and Hepatology, Johns Hopkins Medical Institute, Baltimore, Maryland
| | - Nikhil A Kumta
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - Kunal Karia
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - Jose Nieto
- Department of Gastroenterology and Hepatology, Borland Groover Clinic, Jacksonville, Florida
| | - Uzma D Siddiqui
- Center for Endoscopic Research and Therapeutics (CERT), University of Chicago Medicine and Biological Sciences, Chicago, Illinois
| | - Irving Waxman
- Center for Endoscopic Research and Therapeutics (CERT), University of Chicago Medicine and Biological Sciences, Chicago, Illinois
| | - Virendra Joshi
- Gastroenterology and Hepatology, Ochsner Health System, New Orleans, Louisiana
| | - Petros C Benias
- Gastroenterology and Hepatology, Beth Israel Mt Sinai, New York, New York
| | - Peter Darwin
- Gastroenterology and Hepatology, University of Maryland, Baltimore, Maryland
| | | | - Christopher J Mulder
- Gastroenterology and Hepatology, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Shai Friedland
- Gastroenterology and Hepatology, Stanford Hospital and Clinics, Palo Alto, California
| | - David G Forcione
- Gastroenterology and Hepatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Divyesh V Sejpal
- Gastroenterology and Hepatology, North Shore-Long Island Jewish Health System, New York, New York
| | - Tamas A Gonda
- Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York
| | - Frank G Gress
- Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York
| | - Monica Gaidhane
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - Ann Koons
- Center for Endoscopic Research and Therapeutics (CERT), University of Chicago Medicine and Biological Sciences, Chicago, Illinois
| | - Ersilia M DeFilippis
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - Sanjay Salgado
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - Kristen R Weaver
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - John M Poneros
- Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York
| | - Amrita Sethi
- Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York
| | - Sammy Ho
- Gastroenterology and Hepatology, Montefiore, New York, New York
| | - Vivek Kumbhari
- Gastroenterology and Hepatology, Johns Hopkins Medical Institute, Baltimore, Maryland
| | - Vikesh K Singh
- Gastroenterology and Hepatology, Johns Hopkins Medical Institute, Baltimore, Maryland
| | - Alan H Tieu
- Gastroenterology and Hepatology, Johns Hopkins Medical Institute, Baltimore, Maryland
| | - Viviana Parra
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - Alisa Likhitsup
- Gastroenterology and Hepatology, University of Missouri Kansas City, Kansas City, Missouri
| | - Craig Womeldorph
- Gastroenterology and Hepatology, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Brenna Casey
- Gastroenterology and Hepatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sreeni S Jonnalagadda
- Gastroenterology and Hepatology, University of Missouri Kansas City, Kansas City, Missouri
| | - Amit P Desai
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - David L Carr-Locke
- Gastroenterology and Hepatology, Beth Israel Mt Sinai, New York, New York
| | - Michel Kahaleh
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - Ali A Siddiqui
- Gastroenterology and Hepatology, Jefferson University, Philadelphia, Pennsylvania
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Kochhar GS, Gill A, Vargo JJ. On the Horizon: The Future of Procedural Sedation. Gastrointest Endosc Clin N Am 2016; 26:577-92. [PMID: 27372779 DOI: 10.1016/j.giec.2016.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Sedation plays an integral part in endoscopy. By achieving patient comfort, it allows for a better examination and enhances patient satisfaction. Various medications have been used, propofol being the current favorite. With emphasis on patient safety and quality of endoscopy, various new medications in different combinations are being used to achieve adequate sedation and not escalate the cost of the procedure. With the advent of newer medications and newer modalities to administer these medications, there is need for more specialized training for the endoscopist to feel comfortable while using these medications.
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Affiliation(s)
- Gursimran S Kochhar
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anant Gill
- Saraswathi Institute of Medical Sciences, Anwarpur, Uttar Pradesh, India
| | - John J Vargo
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland Clinic Foundation, A-30, 9500 Euclid Avenue, Cleveland, OH, USA.
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Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage: predictors of successful outcome in patients who fail endoscopic retrograde cholangiopancreatography. Surg Endosc 2016; 30:5500-5505. [PMID: 27129552 DOI: 10.1007/s00464-016-4913-y] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/02/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with failed endoscopic retrograde cholangiopancreatography (ERCP) are conventionally offered percutaneous transhepatic biliary drainage (PTBD). While PTBD is effective, it is associated with catheter-related complications, pain, and poor quality of life. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a minimally invasive endoscopic option increasingly offered as an alternative to PTBD. We compare outcomes of EUS-BD and PTBD in patients with biliary obstruction at a single tertiary care center. METHODS A retrospective review was performed in patients with biliary obstruction who underwent EUS-BD or PTBD after failed ERCP from June 2010 through December 2014 at a single tertiary care center. Patient demographics, procedural data, and clinical outcomes were documented for each group. The aim was to compare efficacy and safety of EUS-BD and PTBD and evaluate predictors of success. RESULTS A total of 60 patients were included (mean age 67.5 years, 65 % male). Forty-seven underwent EUS-BD, and thirteen underwent PTBD. Technical success rates of PTBD and EUS-BD were similar (91.6 vs. 93.3 %, p = 1.0). PTBD patients underwent significantly more re-interventions than EUS-BD patients (mean 4.9 versus 1.3, p < 0.0001), had more late (>24-h) adverse events (53.8 % vs. 6.6 %, p = 0.001) and experienced more pain (4.1 vs. 1.9, p = 0.016) post-procedure. In univariate analysis, clinical success was lower in the PTBD group (25 vs. 62.2 %, p = 0.03). In multivariable logistic regression analysis, EUS-BD was the sole predictor of clinical success and long-term resolution (OR 21.8, p = 0.009). CONCLUSION Despite similar technical success rates compared to PTBD, EUS-BD results in a lower need for re-intervention, decreased rate of late adverse events, and lower pain scores, and is the sole predictor for clinical success and long-term resolution. EUS-BD should be the treatment of choice after a failed ERCP.
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Capnographic Monitoring in Routine EGD and Colonoscopy With Moderate Sedation: A Prospective, Randomized, Controlled Trial. Am J Gastroenterol 2016; 111:395-404. [PMID: 26902229 DOI: 10.1038/ajg.2015.437] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 11/02/2015] [Accepted: 12/01/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Regulatory changes requiring the use of capnographic monitoring for endoscopic procedures using moderate sedation have placed financial challenges on ambulatory and hospital endoscopy centers across the United States due to the increased cost of training endoscopy personnel and purchasing both capnography-monitoring devices and specialized sampling ports. To date, there has been no published data supporting the use of capnographic monitoring in adult patients undergoing routine endoscopic procedures with moderate sedation. The aim of this randomized, parallel group assignment trial was to determine whether intervention based on capnographic monitoring improves detection of hypoxemia in patients undergoing routine esophagogastroduodenoscopy (EGD) or colonoscopy with moderate sedation. METHODS Healthy patients (ASA Physical Classification (ASAPS) I and II)) scheduled for routine outpatient EGD or colonoscopy under moderate sedation utilizing opioid and benzodiazepine combinations were randomly assigned to a blinded capnography alarm or open capnography alarm group. In both study arms, standard cardiopulmonary monitoring devices were utilized with additional capnographic monitoring. The primary end point was the incidence of hypoxemia defined as a fall in oxygen saturation (SaO2) to <90% for ≥10 s. Secondary outcomes included severe hypoxemia, apnea, disordered respirations, hypotension, bradycardia, and early procedure termination for any cause. RESULTS A total of 452 patients were randomized; 218 in the EGD and 234 in the colonoscopy groups; 75 subjects in the EGD group (35.9%) and 114 patients (49.4%) in the colonoscopy group were male, and average body mass index was 27.9 and 29.1 (kg/m(2)), respectively. The blinded and open alarm groups in each study arm were similar in regards to use of opioids and/or benzodiazepines and ASAPS classification. There was no significant difference in rates of hypoxemia between the blinded and open capnography arms for EGD (54.1% vs. 49.5; P=0.5) or colonoscopy (53.8 vs. 52.1%; P=0.79). CONCLUSIONS Capnographic monitoring in routine EGD or colonoscopy for ASAPS I and II patients does not reduce the incidence of hypoxemia (ClinicalTrials.gov number, NCT01994785).
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Park S, Ahn JY, Ahn YE, Jeon SB, Lee SS, Jung HY, Kim JH. Two Cases of Cerebral Air Embolism That Occurred during Esophageal Ballooning and Endoscopic Retrograde Cholangiopancreatography. Clin Endosc 2016; 49:191-6. [PMID: 26898514 PMCID: PMC4821521 DOI: 10.5946/ce.2015.071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 06/22/2015] [Indexed: 01/14/2023] Open
Abstract
Cerebral air embolism is an extremely rare complication of endoscopic procedure and often life threatening. We present two cases of cerebral infarction due to air embolization caused by an endoscopic intervention. The first case occurred during esophageal balloon dilatation for the treatment of a stricture of an anastomosis site in a 59-year-old man and the second case occurred during endoscopic papillary balloon dilatation in a 69-year-old man who had distal common bile duct stones. After the procedure, cardiopulmonary instability and altered mental status were observed in both patients, and cerebral air embolism was diagnosed in both cases. Hyperbaric oxygen therapy was started in the first case, and high FiO2 therapy was applied in the second case. Although this complication is rare, patient outcomes can be improved if physicians are aware of this potential complication, and immediately begin proper management.
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Affiliation(s)
- Suyeon Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Eun Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Beom Jeon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Soo Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Ho Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Efficacy and safety of therapeutic ERCP in patients with cirrhosis: a large multicenter study. Gastrointest Endosc 2016; 83:353-9. [PMID: 26297868 DOI: 10.1016/j.gie.2015.08.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 08/06/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Patients with cirrhosis may be less than optimal candidates for ERCP because of underlying ascites, coagulopathy, encephalopathy, and other problems. Although the risks of surgery in patients with cirrhosis are well known, few data are available regarding ERCP in patients with cirrhosis. We performed a retrospective, multicenter study of ERCP in patients with cirrhosis to evaluate outcomes, efficacy, and safety. METHODS Multicenter retrospective study. RESULTS A total of 538 ERCP procedures were performed on 328 patients with cirrhosis. A total of 229 patients had Child-Pugh (CP) class A, 229 patients had CP class B, and 80 patients had CP class C. Thrombocytopenia and coagulopathy were corrected before ERCP. The 30-day, procedure-related adverse events included post-ERCP pancreatitis (n = 25, 4.6%: 21 mild, 3 moderate, 1 severe), hemorrhage (n = 6, 1.1%), cholangitis (n = 15, 2.8%), perforation (n = 2, 0.4%), aspiration pneumonia (n = 5, 0.9%), bile leakage (n = 1, 0.2%), cholecystitis (n = 1, 0.2%), and death (n = 1, 0.2%). There was a higher incidence of adverse events in patients with CP class B and C disease when compared with those with CP class A disease (11.4%, 11.3%, and 6.1%, respectively; P = .048). There was no correlation between the risk of significant hemorrhage and the presence of coagulopathy or CP class, even in those who underwent a sphincterotomy. The presence of poorly controlled encephalopathy correlated with a higher overall adverse event rate (P = .003). Sub-analysis revealed that patients without primary sclerosing cholangitis had a significantly higher overall rate of adverse events, pancreatitis, bleeding, and cardiopulmonary adverse events after ERCP when compared with those with primary sclerosing cholangitis. CONCLUSIONS Our study was performed on a large series of patients with cirrhosis undergoing ERCP. Overall, the adverse events seen in patients with cirrhosis are similar to those seen in the general population of patients undergoing ERCP, although patients with CP classes B and C have higher adverse event rates compared with those with CP class A. Patients with cirrhosis without primary sclerosing cholangitis had significantly greater adverse event rates when compared with patients with primary sclerosing cholangitis.
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Sharaiha RZ, DeFilippis EM, Kedia P, Gaidhane M, Boumitri C, Lim HW, Han E, Singh H, Ghumman SS, Kowalski T, Loren D, Kahaleh M, Siddiqui A. Metal versus plastic for pancreatic pseudocyst drainage: clinical outcomes and success. Gastrointest Endosc 2015; 82:822-7. [PMID: 25936453 DOI: 10.1016/j.gie.2015.02.035] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 02/18/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endoscopic transmural drainage of pancreatic pseudocysts (PPs) by using double-pigtail (DP) plastic stents requires placement of multiple stents and can be restricted by inadequate drainage and leakage risk. Recently, the use of fully covered self-expanding metal stents (FCSEMSs) has been reported as an alternative to DP plastic stents. OBJECTIVE To evaluate the clinical outcomes, success rate, and adverse events of EUS-guided drainage of PPs with DP plastic stents and FCSEMSs. DESIGN Retrospective cohort study. SETTING Two tertiary-care academic medical centers. PATIENTS This study involved 230 patients (mean age, 52.6 years) with PPs who underwent EUS-guided transmural drainage including 118 that were drained by using DP plastic stents and 112 by using FCSEMSs. A transgastric approach was used in 210 patients (91%), and transduodenal drainage was performed in 20 patients (9%). INTERVENTIONS Stent deployment under EUS guidance. MAIN OUTCOME MEASUREMENTS Technical success, early adverse events, stent occlusion requiring reintervention, and long-term success. RESULTS At 12-month follow-up after the initial procedure, complete resolution of PPs by using DP plastic stents was lower compared with those that underwent drainage with FCSEMSs (89% vs 98%; P = .01). Procedural adverse events were noted in 31% in the DP plastic stent group and 16% in the FCSEMS group (P = .006). On multivariable analysis, patients with plastic stents were 2.9 times more likely to experience adverse events (odds ratio 2.9; 95% confidence interval, 1.4-6.3). LIMITATIONS Retrospective study. CONCLUSION In patients with PPs, EUS-guided drainage by using FCSEMSs improves clinical outcomes and lowers adverse event rates compared with those drained with DP plastic stents.
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Affiliation(s)
| | | | | | | | | | - Huei-Wen Lim
- Jefferson Medical College, Philadelphia, Pennsylvania, USA
| | - Eugene Han
- Jefferson Medical College, Philadelphia, Pennsylvania, USA
| | - Harkarit Singh
- Jefferson Medical College, Philadelphia, Pennsylvania, USA
| | - Saad S Ghumman
- Jefferson Medical College, Philadelphia, Pennsylvania, USA
| | | | - David Loren
- Jefferson Medical College, Philadelphia, Pennsylvania, USA
| | | | - Ali Siddiqui
- Jefferson Medical College, Philadelphia, Pennsylvania, USA
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Romagnuolo J. Risk assessment and reduction. ERCP 2015:41-58. [DOI: 10.1002/9781118769409.ch5] [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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Abstract
Defining the risk of procedural sedation for gastrointestinal endoscopic procedures remains a vexing challenge. The definitions as to what constitutes a cardiopulmonary unplanned event are beginning to take focus but the existing literature is an amalgam of various definitions and subjective outcomes, providing a challenge to patient, practitioner, and researcher. Gastrointestinal endoscopy when undertaken by trained personnel after the appropriate preprocedural evaluation and in the right setting is a safe experience. However, significant challenges exist in further quantifying the sedation risks to patients, optimizing physiologic monitoring, and sublimating the pharmacoeconomic and regulatory embroglios that limit the scope of practice and the quality of services delivered to patients.
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Affiliation(s)
- John J Vargo
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue Desk A30, Cleveland, OH 44195, USA.
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Chawla S, Willingham FF. Cardiopulmonary complications of endoscopic retrograde cholangiopancreatography. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2014; 16:144-149. [DOI: 10.1016/j.tgie.2014.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Endoscopy reporting standards. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2014; 27:286-92. [PMID: 23712304 DOI: 10.1155/2013/145894] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The Canadian Association of Gastroenterology (CAG) recently published consensus recommendations for safety and quality indicators in digestive endoscopy. The present article focuses specifically on the identification of key elements that should be found in all electronic endoscopy reports detailing recommendations adopted by the CAG consensus group. METHODS A committee of nine individuals steered the CAG Safety and Quality Indicators in Endoscopy Consensus Group, which had a total membership of 35 voting individuals with knowledge on the subject relating to endoscopic services. A comprehensive literature search was performed with regard to the key elements that should be found in an electronic endoscopy report. A task force reviewed all published, full-text, adult and human studies in French or English. RESULTS Components to be entered into the standardized report include identification of procedure, timing, procedural personnel, patient demographics and history, indication(s) for procedure, comorbidities, type of bowel preparation, consent for the procedure, pre-endoscopic administration of medications, type and dose of sedation used, extent and completeness of examination, quality of bowel preparation, relevant findings and pertinent negatives, adverse events and resulting interventions, patient comfort, diagnoses, endoscopic interventions performed, details of pathology specimens, details of follow-up arrangements, appended pathology report(s) and, when available, management recommendations. Summary information should be provided to the patient or family. CONCLUSION Continuous quality improvement should be the responsibility of every endoscopist and endoscopy facility to ensure improved patient care. Appropriate documentation of endoscopic procedures is a critical component of such activities.
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Xu CX, Chen X, Jia Y, Xiao DH, Zou HF, Guo Q, Wang F, Wang XY, Shen SR, Tong LL, Cao K, Liu XM. Stepwise sedation for elderly patients with mild/moderate COPD during upper gastrointestinal endoscopy. World J Gastroenterol 2013; 19:4791-8. [PMID: 23922479 PMCID: PMC3732854 DOI: 10.3748/wjg.v19.i29.4791] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 07/02/2013] [Accepted: 07/09/2013] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate stepwise sedation for elderly patients with mild/moderate chronic obstructive pulmonary disease (COPD) during upper gastrointestinal (GI) endoscopy. METHODS Eighty-six elderly patients with mild/moderate COPD and 82 elderly patients without COPD scheduled for upper GI endoscopy were randomly assigned to receive one of the following two sedation methods: stepwise sedation involving three-stage administration of propofol combined with midazolam [COPD with stepwise sedation (group Cs), and non-COPD with stepwise sedation (group Ns)] or continuous sedation involving continuous administration of propofol combined with midazolam [COPD with continuous sedation (group Cc), and non-COPD with continuous sedation (group Nc)]. Saturation of peripheral oxygen (SpO2), blood pressure, and pulse rate were monitored, and patient discomfort, adverse events, drugs dosage, and recovery time were recorded. RESULTS All endoscopies were completed successfully. The occurrences of hypoxemia in groups Cs, Cc, Ns, and Nc were 4 (9.3%), 12 (27.9%), 3 (7.3%), and 5 (12.2%), respectively. The occurrence of hypoxemia in group Cs was significantly lower than that in group Cc (P < 0.05). The average decreases in value of SpO2, systolic blood pressure, and diastolic blood pressure in group Cs were significantly lower than those in group Cc. Additionally, propofol dosage and overall rate of adverse events in group Cs were lower than those in group Cc. Finally, the recovery time in group Cs was significantly shorter than that in group Cc, and that in group Ns was significantly shorter than that in group Nc (P < 0.001). CONCLUSION The stepwise sedation method is effective and safer than the continuous sedation method for elderly patients with mild/moderate COPD during upper GI endoscopy.
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Combination of water immersion and carbon dioxide insufflation for minimal sedation colonoscopy: a prospective, randomized, single-center trial. Eur J Gastroenterol Hepatol 2012; 24:971-7. [PMID: 22569079 DOI: 10.1097/meg.0b013e3283543f16] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Water immersion insertion and carbon dioxide (CO2) insufflation, as alternative colonoscopic techniques, are able to reduce patient discomfort during and after the procedure. We assessed whether the combination of water immersion and CO2 insufflation is superior in efficacy and patient comfort to other colonoscopic techniques. METHODS In a prospective, randomized study, a total of 420 patients were randomized to either water immersion insertion and CO2 insufflation during withdrawal (water/CO2), water insertion and air insufflation during withdrawal (water/air), CO2 insufflation during both insertion and withdrawal (CO2/CO2), or air insufflation during both insertion and withdrawal (air/air). The main outcome was the success of minimal sedation colonoscopy, which was defined as reaching the cecum without switching to another insertion method and without additional sedation beyond the initial 2 mg of midazolam. Patient comfort during and after the procedure was assessed. RESULTS A total of 404 patients were analyzed. The success rate of minimal sedation colonoscopy in the water insertion arm (water/CO2 and water/air) was 97% compared with 83.3% in the gas insertion arm (CO2/CO2 and air/air; P<0.0001). Intraprocedural pain and bloating were significantly lower in the water/CO2 group than in all other groups. Patient discomfort in the water/CO2 group during 24 h after the procedure was comparable with that in the CO2/CO2 group and significantly lower than that in the air groups (water/air and air/air). No complications were recorded during the study. CONCLUSION The combination of water immersion and CO2 insufflation appears to be an effective and safe method for minimal sedation colonoscopy. Overall patient discomfort was significantly reduced compared with that in other techniques.
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Cotton PB. Endoscopic retrograde cholangiopancreatography: maximizing benefits and minimizing risks. Gastrointest Endosc Clin N Am 2012; 22:587-99. [PMID: 22748250 DOI: 10.1016/j.giec.2012.05.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) has become enormously popular throughout the world because of its proven value in the management of patients with known and suspected biliary and pancreatic disease. The results of ERCP are operator dependent, and there are significant risks. Adverse events are more likely when procedures are performed by endoscopists with inadequate training and experience. The best outcomes should occur when procedures are done for the best reasons, using optimal techniques in an ideal environment and a well-trained team, conscious of the risks and the ways to minimize them. This article discusses these intertwining elements of ERCP.
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Affiliation(s)
- Peter B Cotton
- Department of Digestive Disease Center, Medical University of South Carolina, Charleston, SC 29425-2900, USA.
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Romagnuolo J. Quality measurement and improvement in advanced procedures. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2012. [DOI: 10.1016/j.tgie.2011.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Obesity as a risk factor for sedation-related complications during propofol-mediated sedation for advanced endoscopic procedures. Gastrointest Endosc 2011; 74:1238-47. [PMID: 22136773 PMCID: PMC4124898 DOI: 10.1016/j.gie.2011.09.006] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 09/01/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND There are limited data on the safety of anesthesia-assisted endoscopy by using propofol-mediated sedation in obese individuals undergoing advanced endoscopic procedures (AEPs). OBJECTIVE To study the association between obesity (as measured by body mass index [BMI]) and the frequency of sedation-related complications (SRCs) in patients undergoing AEPs. DESIGN Prospective cohort study. SETTING Tertiary referral center. PATIENTS A total of 1016 consecutive patients undergoing AEPs (BMI <30, 730 [72%]; 30-35, 159 [16%]; >35, 127 [12%]). INTERVENTION Monitored anesthesia sedation with propofol alone or in combination with benzodiazepines and/or opioids. MAIN OUTCOME MEASUREMENTS SRCs, airway maneuvers (AMs), hypoxemia, hypotension requiring vasopressors, and early procedure termination were compared across 3 groups. RESULTS There were 203 AMs in 13.9% of patients, hypoxemia in 7.3%, need for vasopressors in 0.8%, and premature termination in 0.6% of patients. Increasing BMI was associated with an increased frequency of AMs (BMI <30, 10.5%; 30-35, 18.9%; >35-26.8%; P < .001) and hypoxemia (BMI <30, 5.3%; 30-35, 9.4%; >35, 13.4%; P = .001); there was no difference in the frequency of need for vasopressors (P = .254) and premature termination of procedures (P = .401). On multivariable analysis, BMI (odds ratio [OR] 2.0; 95% CI, 1.3-3.1), age (OR 1.1; 95% CI, 1.0-1.1), and American Society of Anesthesiologists class 3 or higher (OR 2.4; 95% CI, 1.1-5.0) were independent predictors of SRCs. In obese individuals (n = 286), there was no difference in the frequency of SRCs in patients receiving propofol alone or in combination (P = .48). LIMITATIONS Single tertiary center study. CONCLUSIONS Although obesity was associated with an increased frequency of SRCs, propofol sedation can be used safely in obese patients undergoing AEPs when administered by trained professionals.
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Hoeks SE, Bouw E, Poldermans D. Quality assurance in perioperative care. Best Pract Res Clin Gastroenterol 2011; 25:435-41. [PMID: 21764011 DOI: 10.1016/j.bpg.2011.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 05/06/2011] [Accepted: 05/07/2011] [Indexed: 01/31/2023]
Abstract
Nowadays more and more clinical guidelines are developed. Clinical guidelines aim to assist practitioner and patient decision making about appropriate care for specific clinical conditions. Furthermore, guidelines can play a crucial role in the quality cycle form guidelines to clinical practice. However, this does not necessarily mean that these guidelines are actually implemented and the ultimately goal, improved patient outcome, is achieved. Care gaps exist between guidelines and daily clinical practice in perioperative care. Research should be focused on identification of barriers to adherence and subsequent effect implementation strategies to achieve higher standards of quality of care. A multifactorial approach to improving use of guidelines in clinical practice may improve the treatment of patients with peripheral arterial disease.
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Affiliation(s)
- Sanne E Hoeks
- Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands
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