Gastrointestinal endoscopy

胃肠内窥镜检查
  • 文章类型: Journal Article
    目的:低氧血症是胃肠镜检查过程中观察到的最常见的不良事件。最佳氧疗仍未最终确定。
    方法:随机临床试验的系统评价和网络荟萃分析。
    方法:消化内镜中心。
    方法:成人(≥18岁,男女)在胃肠镜检查过程中在程序镇静下进行。
    方法:发布,MEDLINE,WebofScience,Embase,和临床试验。一直搜索到2023年6月30日。随机临床试验(RCT)将任何氧疗与另一种氧疗或安慰剂(鼻插管,NC)包括在内。
    方法:主要结果是低氧血症的发生率,定义为脉搏氧饱和度(SpO2)。进行随机效应网络荟萃分析。数据报告为优势比(OR),预测区间(PrI)和95%CI。根据Cochrane合作组织概述的指南评估偏差风险。通过建议分级评估来评估证据质量,发展和评价(等级)框架。
    结果:我们纳入了27个RCTs,共7552例患者。与使用NC相比,无创正压通气(NIPPV)在缓解低氧血症方面表现出优异的疗效(NIPPV与NC,OR=0.16,95%CI:0.08-0.31,95%PrI:0.06-0.41),其次是Wei鼻喷射管(WNJT)(WNJTvs.NC,OR=0.17,95%CI:0.10-0.30,95%PrI:0.07-0.42)。预防低氧血症的疗效排序如下:NIPPV>WNJT>口咽/鼻咽导管>高流量鼻氧合>鼻罩>NC。
    结论:在胃肠镜检查过程中,所有其他高级氧疗均比鼻插管更有效.NIPPV和WNJT似乎是预防低氧血症最有效的氧疗。此外,临床医生应根据风险人群选择最合适的氧疗,内窥镜检查的类型和不良事件。
    OBJECTIVE: Hypoxemia is the most frequent adverse event observed during gastrointestinal endoscopy under procedural sedation. An optimum oxygen therapy has still not been conclusively determined.
    METHODS: A systematic review and network meta-analysis of randomized clinical trials.
    METHODS: Digestive Endoscopy Center.
    METHODS: Adults (≥18 years old and of both sexes) during gastrointestinal endoscopy under procedural sedation.
    METHODS: Pubmed, MEDLINE, Web of Science, Embase, and Clinicaltrials.gov. were searched until June 30, 2023. Randomized clinical trials (RCTs) comparing any oxygen therapy with another oxygen therapy or with placebo (nasal cannula, NC) were included.
    METHODS: The primary outcome was the incidence of hypoxemia, defined as the pulse oxygen saturation (SpO2). Random-effects network meta-analyses were performed. Data are reported as odds ratios (OR), prediction intervals (PrI) and 95% CI. Bias risk was evaluated following the guidelines outlined by the Cochrane Collaboration. The quality of evidence was evaluated through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.
    RESULTS: We included 27 RCTs with a total of 7552 patients. Compared to the use of NC, non-invasive positive pressure ventilation (NIPPV) demonstrated superior efficacy in mitigating hypoxemia (NIPPV vs. NC, OR = 0.16, 95% CI: 0.08-0.31, 95% PrI: 0.06-0.41), followed by Wei nasal jet tube (WNJT) (WNJT vs. NC, OR = 0.17, 95% CI: 0.10-0.30, 95% PrI: 0.07-0.42). The efficacy for preventing hypoxemia was ranked as follows: NIPPV > WNJT > oropharynx/nasopharyngeal catheter > high-flow nasal oxygenation > nasal mask > NC.
    CONCLUSIONS: During gastrointestinal endoscopy under procedural sedation, all other advanced oxygen therapies were found to be more efficacious than nasal cannula. NIPPV and WNJT appear to be the most efficacious oxygen therapy for preventing hypoxemia. Additionally, clinicians should make a choice regarding the most suitable oxygen therapy based on the risk population, type of endoscopy and adverse events.
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  • 文章类型: Case Reports
    胃肠道结核(TB),特别是胃结核,是一种罕见的肺外结核.非特异性体征和症状证明诊断具有挑战性。在这个案例报告中,一名22岁男性主诉复发性呕血和黑便。
    我们在食管十二指肠镜检查(EGD)中发现了一个粘膜下肿块,并在胃贲门中溃疡。内镜超声(EUS)发现是低回声粘膜下病变,边缘清晰;使用细针抽吸(FNA)采集标本进行进一步的组织病理学检查。病理结果提示结核分枝杆菌肉芽肿,提示诊断为胃结核.然后患者接受抗结核治疗方案治疗9个月。先前记录的胃贲门肿块在后续内窥镜检查中不再可见,患者被认为治愈了。
    该病例表明,有胃肠道症状的患者应考虑胃结核,特别是那些生活在结核病流行地区。内窥镜检查,如EGD和EUS,可能有助于胃结核的诊断。
    UNASSIGNED: Gastrointestinal tuberculosis (TB), specifically gastric TB, is a rare form of extrapulmonary TB. Diagnosis proves challenging with nonspecific signs and symptoms. In this case report, a 22-year-old male came in with complaints of recurrent hematemesis and melena.
    UNASSIGNED: We found a submucosal mass with ulceration in the stomach cardia on esophagoduodenoscopy (EGD). The endoscopic ultrasound (EUS) finding was a hypoechoic submucosal lesion with a clear margin; specimens were taken using fine needle aspiration (FNA) for further histopathological examination. The result indicated granuloma of Mycobacterium Tuberculosis in pathology, suggesting that the diagnosis was gastric TB. The patient was then treated with antitubercular therapy regimen for 9 months. The previously documented mass in the stomach cardia was no longer visible on the follow-up endoscopy examination, and the patient was considered cured.
    UNASSIGNED: This case shows that gastric tuberculosis should be considered in patients with gastrointestinal symptoms, especially those living in TB endemic regions. Endoscopic examinations, such as EGD and EUS, may aid in the diagnosis of gastric tuberculosis.
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  • 文章类型: Journal Article
    目标:双耳节拍,或同时向每只耳朵分别呈现两个相似频率时产生的感知听觉错觉,在各种程序中被用来减少焦虑。不幸的是,在接受上消化道内窥镜检查的患者中,先前没有涉及手术前双耳音乐暴露的研究,这项研究旨在探讨其对接受无镇静上消化道内镜检查的参与者的焦虑和耐受性的影响。方法:前瞻性,控制,随机试验包括96名年龄在18至70岁之间的土耳其患者参与,这些患者计划进行上消化道内窥镜检查,不管性别或疾病,并随机分为两组进行内窥镜检查,即,双耳搏动组(n=48)和对照组(n=48)。双耳节拍音乐组的患者戴着耳机,和音乐是在内窥镜检查前15分钟;然而,两组均未给予特殊治疗.使用状态特质焦虑量表评估焦虑水平,除了内镜检查前后的变化以根据医生记录的医生记录的干咳次数来衡量患者满意度外,还记录并比较了两组之间的耐受性。结果:结果表明,按照此程序,在音乐小组中,状态分数仍然显著低于之前的水平(p=0.016),与对照组比较(p>0.05)。在舒张压、收缩压或心率的变化方面无显著性差异(p>0.05)。然而,音乐组的程序耐受性和满意度得分明显高于无音乐组(p<0.05)。结论:对于接受上消化道内镜检查的患者,音乐与双耳节拍被发现显着降低焦虑水平和增加患者的耐受性,提供镇静药物的替代选择作为潜在的镇静治疗选择。临床试验登记号:NCT06114524。
    Objective: Binaural beats, or the perceptual auditory illusions created when simultaneously presenting two similar frequencies to each ear separately, have been used to reduce anxiety in various procedures. Unfortunately, no prior study involved preprocedure binaural music exposure among patients undergoing upper gastrointestinal endoscopy, and this study sought to investigate its effect on anxiety and tolerance among participants undergoing sedation-free upper gastrointestinal endoscopy. Methods: The prospective, controlled, randomized trial included the participation of 96 Turkish patients aged between 18 and 70 years who were scheduled for an upper gastrointestinal endoscopy, regardless of sex or illness, and were divided randomly into two different groups to undergo endoscopy, namely, the binaural beats group (n = 48) and a control group (n = 48). Patients in the binaural beat music group wore headphones, and music was given 15 mins before endoscopy; however, no particular treatment was given for either group. Anxiety levels were assessed by using the State Trait Anxiety Inventory questionnaire, in addition to changes before and after endoscopy to measure patient satisfaction based on the physician\'s recorded numbers of retches noted by doctors as tolerance was documented and compared among both groups. Results: The results showed that following this procedure, in the music group, state scores remained significantly lower than before them (p = 0.016), compared with the control group (p > 0.05). There was no significant difference regarding changes in diastolic or systolic heart rate or blood pressure (p > 0.05). However, the procedure tolerance and satisfaction scores were significantly higher in the music group than those without music (p < 0.05). Conclusion: For patients undergoing upper gastrointestinal endoscopy, music with binaural beats was found to significantly reduce anxiety levels and increase patient tolerance, providing an alternative option to sedative medications as a potential sedative treatment option.Clinical trials registration number: NCT06114524.
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  • 文章类型: Journal Article
    背景:胃肠内窥镜检查期间的麻醉可能导致麻醉后认知功能障碍(PACD),对认知功能有不利影响。这项研究旨在评估知识,态度,温州地区胃肠镜检查患者对PACD的实践(KAP)。
    方法:这项横断面研究于2023年6月至8月进行,招募了接受胃肠内窥镜检查的个体。通过问卷调查收集人口统计数据和KAP评分。Pearson相关性分析用于评估KAP得分之间的相关性,并利用logistic回归分析确定影响因素。
    结果:我们收集了405份有效问卷,54.57%为男性,29.88%为31-40岁。平均KAP评分分别为13.99±4.80、16.19±2.35和15.61±2.86(可能范围:0-16、0-25和0-25)。Pearson相关分析显示知识与实践之间存在显著正相关(r=0.209,P<0.001)。态度与实践(r=0.233,P<0.001),知识和态度(r=0.328,P<0.001)。多因素logistic回归分析显示,选择标准胃肠镜检查(未麻醉)与知识(OR=0.227,95CI:0.088-0.582,P=0.002)和实践得分(OR=0.336,95CI:0.154-0.731,P=0.006)呈负相关。此外,接受胃肠内镜检查前认知相关疾病或症状的存在与知识评分呈负相关(OR=0.429,95CI:0.225~0.818,P=0.010).
    结论:接受胃肠内窥镜检查的患者表现出良好的知识,中立的态度,以及关于PACD的适度实践。建议进行教育干预和行为矫正,特别是对于月收入较低的个人,接受标准胃肠内窥镜检查,或经历与认知相关的疾病。
    BACKGROUND: The administration of anesthesia during gastrointestinal endoscopy potentially contributes to post-anesthesia cognitive dysfunction (PACD), with detrimental impacts for cognitive function. This study aimed to assess the knowledge, attitudes, and practices (KAP) towards PACD among patients undergoing gastrointestinal endoscopy in Wenzhou region.
    METHODS: This cross-sectional study was conducted between June and August 2023, and recruited individuals undergoing gastrointestinal endoscopy. Demographic data and KAP scores were collected through questionnaires. Pearson correlation analysis was applied to evaluate correlations between KAP scores, and logistic regression was utilized to identify influential factors.
    RESULTS: We collected 405 valid questionnaires, with 54.57% being male and 29.88% aged 31-40 years. Mean KAP scores were 13.99 ± 4.80, 16.19 ± 2.35, and 15.61 ± 2.86, respectively (possible range: 0-16, 0-25, and 0-25). Pearson correlation analysis demonstrated significant positive correlations between knowledge and practice (r = 0.209, P < 0.001), attitude and practice (r = 0.233, P < 0.001), and knowledge and attitude (r = 0.328, P < 0.001). Multivariate logistic regression revealed negative associations of opting for standard gastrointestinal endoscopy (without anesthesia) with knowledge (OR = 0.227, 95%CI: 0.088-0.582, P = 0.002) and practice scores (OR = 0.336, 95%CI: 0.154-0.731, P = 0.006). Additionally, the presence of cognitive-related diseases or symptoms before undergoing gastrointestinal endoscopy was negatively associated with knowledge scores (OR = 0.429, 95%CI: 0.225-0.818, P = 0.010).
    CONCLUSIONS: Patients undergoing gastrointestinal endoscopy demonstrated good knowledge, neutral attitudes, and moderate practices regarding PACD. Educational interventions and behavior modification are recommended, particularly for individuals with lower monthly income, undergoing standard gastrointestinal endoscopy, or experiencing cognitive-related conditions.
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  • 文章类型: Journal Article
    背景:甲苯磺酸雷马唑仑是目前用于胃肠内窥镜检查的新型苯二氮卓类药物,可与阿芬太尼联合使用。
    目的:本试验比较了瑞马唑仑联合阿芬太尼与异丙酚联合阿芬太尼在胃肠镜检查患者中的有效性和安全性。
    方法:160例患者随机分为丙泊酚-阿芬太尼麻醉(P组)和瑞咪唑安定-阿芬太尼麻醉(R组)。主要结果是围手术期血流动力学变量,包括收缩压(SBP),舒张压(DBP),平均动脉压(MAP),术前(T0)心率(HR)和氧饱和度(SpO2);麻醉诱导后(T1);当胃镜通过口咽时(T2);3分钟(T3),T2后5min(T4)和7min(T5);手术结束时(T6);患者苏醒成功时(T7)。次要结果包括诱导时间和觉醒时间,患者满意度,操作员满意度,和不良事件发生。
    结果:与P组相比,R组T1、T2、T3、T6时SBP明显增高(P<0.05);T1、T2、T3、T5、T6时DBP、MAP明显增高(P<0.05);T1~T6时HR明显加快(P<0.05);T1~T4时SpO2明显增高(P<0.05);低血压,药物注射痛明显低于R组(P<0.05);打嗝发生率高于R组(P<0.05);苏醒时间短于R组(P<0.05);操作者满意度得分高(P<0.05)。
    结论:与异丙酚和阿芬太尼相比,瑞马唑仑联合阿芬太尼可安全有效地用于胃肠镜检查患者的镇静,对患者循环和呼吸系统的影响较小,不良事件发生率较低。
    背景:该试验方案已在中国临床试验注册中心注册(ChiCR2300077252,日期:2023-11-02)。
    BACKGROUND: Remimazolam tosilate is a new type of benzodiazepine currently used for gastrointestinal endoscopy and can be combined with alfentanil.
    OBJECTIVE: This trial compared the effectiveness and safety of remimazolam with alfentanil to propofol with alfentanil in patients undergoing gastrointestinal endoscopy.
    METHODS: One hundred and sixty-six patients were randomly divided into propofol-alfentanil anaesthesia (Group P) and remimazolam-alfentanil anaesthesia (Group R). The primary outcomes were perioperative haemodynamic variables, including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) and oxygen saturation (SpO2) preoperatively (T0); after anaesthesia induction (T1); when the gastroscope passed through the oropharynx (T2); 3 min (T3), 5 min (T4) and 7 min (T5) after T2; at the end of surgery (T6); and when patients successfully awakened (T7). The secondary outcomes included induction and awakening time, patient satisfaction, operator satisfaction, and adverse event occurrences.
    RESULTS: Compared with those in Group P, the SBP in Group R was significantly higher at T1, T2, T3, and T6 (P < 0.05); the DBP and MAP were significantly higher at T1, T2, T3, T5, and T6 (P < 0.05); the HR was significantly faster at T1 to T6 (P < 0.05); the SpO2 was significantly higher at T1 to T4 (P < 0.05); the incidences of hypoxemia, hypotension, and drug injection pain were significantly lower in Group R (P < 0.05); the incidence of hiccups was higher (P < 0.05); the awakening time was shorter in Group R (P < 0.05); and the operator satisfaction score was high (P < 0.05).
    CONCLUSIONS: Compared to propofol with alfentanil, remimazolam with alfentanil can be used safely and effectively for sedation in patients undergoing gastrointestinal endoscopy, with less impact on the patient\'s circulatory and respiratory systems and a lower incidence of adverse events.
    BACKGROUND: This trial protocol was registered in the Chinese Clinical Trial Registry (ChiCR2300077252, date: 2023-11-02).
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  • 文章类型: Case Reports
    慢性肉芽肿病(CGD)是一种通常在婴儿期诊断的罕见疾病。
    一名27岁的男性因CGD的非特异性症状而首次接受了内窥镜检查,和结肠镜检查程序作为临床表现的主要评估。第一次入院18个月后,他因呕血被转诊到急诊室,和危急情况,如Hgb=2.6mg/dl的严重贫血。由于这种特殊的临床表现,进行了紧急紧急治疗,内镜检查显示十二指肠球部和空肠溃疡和异常。其他成像程序,比如超声检查,腹部CT扫描,表现为脾肿大.他做了脾切除术,之后,计划采用球囊TTS扩张的内镜治疗,但是这个程序失败了。所以,我们决定做胃造口术以减轻临床症状。九个月后,他被称为GOO,内镜检查显示巨大溃疡伴十二指肠严重狭窄,和空肠造口术中的息肉.最后,根据活检的临床表现和病理证据,患者将CGD作为最终诊断。
    循序渐进,排除不同的高度可疑疾病可能导致明确的CGD诊断,和这些患者的快速管理可能会增加生存的机会。
    UNASSIGNED: Chronic granulomatous disease (CGD) is a rare disorder normally diagnosed in infancy.
    UNASSIGNED: A 27-year-old man admitted with non-specific symptoms of CGD first underwent endoscopy, and colonoscopy procedures as primary evaluation of clinical presentation. Eighteen months after the first admission, he was referred to the emergency department for hematemesis, and critical situations, such as a severe anemic with Hgb= 2.6 mg/dl. As a result of this specific clinical presentation, urgent emergency treatment was performed, and endoscopic examination revealed ulcers and abnormalities in the duodenal bulb and jejunum. Other imaging procedures, such as sonography, and abdominal CT scans, showed splenomegaly. He underwent splenectomy, and after that, endoscopic treatment with balloon TTS dilation was scheduled, but this procedure failed. So, we decided to do a gastro-jujenostomy that alleviated the clinical symptoms. After nine months, he was referred to GOO, and endoscopic evaluation showed giant ulceration with severe stricture in the duodenum, and a polyp in the jejunostomy. Finally, Based on clinical presentation and pathologic evidence of biopsies, the patient approached CGD as the final diagnosis.
    UNASSIGNED: Step-by-step, rule out of different highly suspicious diseases may result in a definite CGD diagnosis, and rapid management of these patients may increase the chance of survival.
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  • 文章类型: Journal Article
    本研究旨在系统地评估在接受胃肠内窥镜检查的患者中使用经鼻高流量鼻套管(HFNC)和常规氧疗(COT)的临床效果。
    从2004年至2024年4月进行了全面的文献检索,以收集有关HFNC在接受胃肠内窥镜检查的患者中应用的相关研究。多个中文和英文数据库,包括中国国家知识基础设施(CNKI),万方数据,WebofScience,PubMed,和Cochrane图书馆,系统搜索随机对照试验(RCTs)。两名研究人员独立筛选了文献,提取的数据,并评估纳入研究的偏倚风险。采用RevMan5.4软件进行网络荟萃分析。
    共纳入12个RCT,涉及3,726例患者。Meta分析结果显示,与COT相比,HFNC降低了低氧血症的发生率,改善了最低血氧饱和度(SpO2)[比值比(OR)=0.39,95%置信区间(CI):0.29-0.53]。[平均差(MD)=4.07,95%CI:3.14-5.01],差异有统计学意义。然而,HFNC组和COT组的基线SpO2水平和高碳酸血症发生率无统计学差异[MD=-0.21,95%CI:-0.49~0.07];[OR=1.43,95%CI:0.95~2.15].就手术时间而言,HFNC和COT之间的差异无统计学意义,并对不同类型的研究进行了亚组分析,胃镜组(MD=0.09,95%CI:-0.07-0.24)和内镜逆行胰胆管造影术组(MD=0.36,95%CI:-0.50-1.23)的标准偏差。结果表明,与COT组相比,HFNC组采用气道干预措施显着减少(OR=0.16,95%CI:0.05-0.53),差异具有统计学意义;该结果与纳入研究的结果一致。
    HFNC的应用改善了低氧血症的发生率,增强氧合,并减少胃肠内窥镜检查期间的气道干预。然而,HFNC不显著影响基线SpO2、高碳酸血症、或程序时间。必须承认这项研究的局限性,应开展进一步的高质量研究来验证这些发现.
    This study aimed to systematically evaluate the clinical effects of using transnasal high-flow nasal cannula (HFNC) and conventional oxygen therapy (COT) in patients undergoing gastrointestinal endoscopy.
    A comprehensive literature search was conducted from 2004 to April 2024 to collect relevant studies on the application of HFNC in patients undergoing gastrointestinal endoscopy. Multiple Chinese and English databases, including China National Knowledge Infrastructure (CNKI), Wanfang Data, Web of Science, PubMed, and Cochrane Library, were searched systematically for randomized controlled trials (RCTs). Two researchers independently screened the literature, extracted data, and assessed the risk of bias in the included studies. RevMan 5.4 software was utilized for conducting the network meta-analysis.
    A total of 12 RCTs involving 3,726 patients were included. Meta-analysis results showed that HFNC reduced the incidence of hypoxemia and improved the minimum oxygen saturation (SpO2) compared with COT [odds ratio (OR) = 0.39, 95% confidence interval (CI): 0.29-0.53], [mean difference (MD) = 4.07, 95% CI: 3.14-5.01], and the difference was statistically significant. However, the baseline SpO2 levels and incidence of hypercapnia were not statistically significantly different between the HFNC and COT groups [MD = -0.21, 95% CI: -0.49-0.07]; [OR = 1.43, 95% CI: 0.95-2.15]. In terms of procedure time, the difference between HFNC and COT was not statistically significant, and subgroup analyses were performed for the different types of studies, with standard deviation in the gastroscopy group (MD = 0.09, 95% CI: -0.07-0.24) and the endoscopic retrograde cholangiopancreatography group (MD = 0.36, 95% CI: -0.50-1.23). The results demonstrated a significant reduction in the adoption of airway interventions in the HFNC group compared to the COT group (OR = 0.16, 95% CI: 0.05-0.53), with a statistically significant difference; this result was consistent with those of the included studies.
    The application of HFNC improves the incidence of hypoxemia, enhances oxygenation, and reduces airway interventions during gastrointestinal endoscopy. However, HFNC does not significantly affect baseline SpO2, hypercapnia, or procedure time. The limitations of this study must be acknowledged, and further high-quality studies should be conducted to validate these findings.
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  • 文章类型: Journal Article
    雷马唑仑是一种新型的短效苯二氮卓类药物,用于镇静和全身麻醉。本研究旨在评估在接受诊断性胃肠镜检查的老年患者中使用苯磺酸瑞咪唑安定的有效性和安全性。
    将120名年龄在60-75岁的患者随机分为两组。采用瑞芬太尼0.3μg/kg镇痛。患者分别给予苯磺酸瑞米唑仑7mg(R组)或依托咪酯0.1mg/kg联合1%丙泊酚0.5mg/kg(EP组)进行诱导,根据需要给予补充重复剂量。一些时间指标,生命体征,对不良事件进行了评估.比较患者的Mini-cog评分和康复问卷。
    与EP组相比,R组诱导时间稍长(1.50VS1.15分钟)(P<0.05),在麻醉后监护病房(PACU)中花费的时间较短(15.17VS17.40分钟)(P<0.05)。与EP组相比,在T15和T25时间点,R组SBP较低,T2、T3、T5时心率较高(P<0.05)。术后Mini-Cog评分较高(2.83VS2.58)(P<0.05)。EP组呼吸不良事件发生率高于R组(18.3%VS5.0%,P<0.05)。R组最常见的不良事件是打嗝。R组患者的镇静满意率和健忘症程度均较高(66.7%VS11.7%)(P<0.05),对患者24小时内生活的影响较低(12.0%VS30.5%)(P<0.05)。
    苯磺酸瑞马唑仑的安全性和有效性不亚于依托咪酯联合丙泊酚,使其成为ASAI-II老年患者在胃肠内窥镜检查期间镇静的安全选择,但是应该注意监控打嗝的发生。
    UNASSIGNED: Remimazolam is a novel short-acting benzodiazepine used for sedation and general anesthesia. This study aimed to evaluate the efficacy and safety of remimazolam besylate in elderly patients who underwent diagnostic gastrointestinal endoscopy.
    UNASSIGNED: A total of 120 patients aged 60-75 years were randomly allocated to one of two groups. Remifentanil 0.3μg/kg was used for analgesia. Patients were administered remimazolam besylate 7 mg (R group) or etomidate 0.1 mg/kg combined with 1% propofol 0.5 mg/kg (EP group) for induction, supplemental repeated doses were given as needed. Some time metrics, vital signs, adverse events were evaluated. Patients\' Mini-cog score and recovery questionnaires were compared.
    UNASSIGNED: Compared to the EP group, the induction time was slightly longer in the R group (1.50 VS 1.15 minutes) (P<0.05), the time spent in the post-anesthesia care unit (PACU) was shorter (15.17 VS 17.40 minutes) (P<0.05). Compare with EP group, SBP was lower in R group at T15 and T25 time point, but heart rate was higher in T2, T3, T5 (P< 0.05). The Mini-Cog score was higher after the procedure (2.83 VS 2.58) (P<0.05). The incidence of respiratory adverse events was higher in the EP group than R group (18.3% VS 5.0%, P < 0.05). The most common adverse event in R group was hiccups. The sedation satisfaction rate and degree of amnesia were higher in the R group (66.7% VS 11.7%) (P < 0.05), and the effect on patient\'s life within 24 hours was lower (12.0% VS 30.5%) (P < 0.05).
    UNASSIGNED: The safety and efficacy of remimazolam besylate are not inferior to those of etomidate combined with propofol, rendering it a safe option for sedation during gastrointestinal endoscopy in ASA I-II elderly patients, but care should be taken to monitor the occurrence of hiccups.
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  • 文章类型: Journal Article
    目标:尽管每年进行内窥镜检查,近端胃切除术(PG)后异时性残胃癌(MRGC)患者有时不适合进行内镜切除术(ER).本研究旨在阐明ER不适用的临床危险因素。
    方法:我们回顾了2006年至2015年间因cT1胃癌而接受PG治疗的203例患者的记录。剩余的胃被归类为假穹窿,语料库,或者胃窦.
    结果:在29例患者中发现32例MRGC。20个MRGC被归类为ER(ER组,62.5%),而12个不是(非ER组,37.5%)。在ER组中,MRGC位于1个假穹窿,5个语料库和14个胃窦。在非ER组中,在6个假穹窿中,在4个语料库中,在2个胃窦中(P=0.019)。多因素分析显示,假穹窿是非ER的独立危险因素(P=0.014)。在非ER组中,假穹窿(n=6)的MRGC具有更频繁的未分化型组织学(4/6vs.0/6),更深(≥pT1b2;6/6vs.2/6)和淋巴结转移(3/6vs.0/6)比非假性穹窿病变(n=6)。我们在MRGC检测前一年的年度随访内窥镜检查中检查了发展MRGC的区域的可见性。在假穹窿的七个病变中,由于食物残渣,能见度只有两个(28.6%)。在非假穹窿的25个病变中,在21个病灶中可见性得到了保证(84%;P=0.010).
    结论:内窥镜可见性增加了ER适用性的机会。需要特殊的准备,以确保完全清除假穹窿中的食物残渣。
    OBJECTIVE: Despite annual endoscopy, patients with metachronous remnant gastric cancer (MRGC) following proximal gastrectomy (PG) are at times ineligible for endoscopic resection (ER). This study aimed to clarify the clinical risk factors for ER inapplicability.
    METHODS: We reviewed the records of 203 patients who underwent PG for cT1 gastric cancer between 2006 and 2015. The remnant stomach was categorized as a pseudofornix, corpus, or antrum.
    RESULTS: Thirty-two MRGCs were identified in the 29 patients. Twenty MRGCs were classified as ER (ER group, 62.5%), whereas 12 were not (non-ER group, 37.5%). MRGCs were located in the pseudo-fornix in 1, corpus in 5, and antrum in 14 in the ER group, and in the pseudo-fornix in 6, corpus in 4, and antrum in 2 in the non-ER group (P=0.019). Multivariate analysis revealed that the pseudo-fornix was an independent risk factor for non-ER (P=0.014). In the non-ER group, MRGCs at the pseudo-fornix (n=6) had more frequent undifferentiated-type histology (4/6 vs. 0/6), deeper (≥pT1b2; 6/6 vs. 2/6) and nodal metastasis (3/6 vs. 0/6) than non-pseudo-fornix lesions (n=6). We examined the visibility of the region developing MRGC on an annual follow-up endoscopy one year before MRGC detection. In seven lesions at the pseudofornix, visibility was only secured in two (28.6%) because of food residues. Of the 25 lesions in the non-pseudo-fornix, visibility was secured in 21 lesions (84%; P=0.010).
    CONCLUSIONS: Endoscopic visibility increases the chances of ER applicability. Special preparation is required to ensure the complete clearance of food residues in the pseudo-fornix.
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  • 文章类型: Journal Article
    随着西方世界肥胖患病率的惊人增长,有必要为肥胖患者提供更多可接受的治疗方案.微创内窥镜技术在不断发展。目前,代谢和减肥内镜包括几种不同的技术,这些技术可以显著减轻体重并改善合并症,同时具有良好的安全性.限制性减肥手术包括使用胃内球囊和具有不同缝合装置的胃重塑技术。一些研究已经证明了这些技术在临床实践中广泛使用的有效性和安全性。小肠靶向代谢内窥镜检查是一个有趣且快速发展的研究领域,尽管它在常规实践中并不普遍。这些技术包括十二指肠-空肠旁路衬垫,十二指肠粘膜重修,和无切口吻合.这篇评论文章的目的是提供西方国家目前可用的减肥内窥镜技术的详细更新。
    With the alarmingly increasing prevalence of obesity in the Western world, it has become necessary to provide more acceptable treatment options for patients with obesity. Minimally invasive endoscopic techniques are continuously evolving. Currently, metabolic and bariatric endoscopies encompass several different techniques that can offer significant weight loss and improvement in comorbidities with a favorable safety profile. Restrictive bariatric procedures include the use of intragastric balloons and gastric remodeling techniques with different suturing devices. Several studies have demonstrated the efficacy and safety of these techniques that are widely used in clinical practice. Small intestine-targeted metabolic endoscopy is an intriguing and rapidly evolving field of research, although it is not widespread in routine practice. These techniques include duodenal-jejunal bypass liners, duodenal mucosal resurfacing, and incisionless anastomoses. The aim of this review article is to provide a detailed update on the currently available bariatric endoscopy techniques in Western countries.
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