Prevention, detection and management of adverse events of third-space endoscopy.

IF 2 Q3 GASTROENTEROLOGY & HEPATOLOGY Indian Journal of Gastroenterology Pub Date : 2024-10-01 Epub Date: 2024-09-11 DOI:10.1007/s12664-024-01665-4
Rohan Yewale, Amit Daphale, Ashish Gandhi, Amol Bapaye
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Abstract

Third space endoscopy (TSE) or sub-mucosal endoscopy using a mucosal flap valve (SEMF) enables the endoscopist to operate in the deeper layers of the gastrointestinal tract or gain access to the mediastinal/peritoneal cavity for natural orifice transoral endoscopic surgery (NOTES). TSE procedures are essentially endoscopic surgical procedures with a variable learning curve. Adverse events (AEs) during TSE are specific and follow a certain pattern across the spectrum of TSE procedures. These can be broadly categorized according to either type of AE, time of presentation relative to the procedure or according to degree of severity. Three major categories of AEs encountered during TSE include insufflation related AEs, mucosal injuries (MIs) and bleeding. Other relevant AEs include infectious complications, aspiration pneumonia, post-procedural chest/abdominal pain, atelectasis, cardiac arrhythmias, pleural effusion and pulmonary embolism. Reported incidence of AEs during TSE procedures varies according to the type and complexity of procedure. Acquaintance regarding potential risk factors, technical tips and precautions, alarm signs for early recognition, assessment of degree of severity, morphological characterization of AEs and finally, expeditious selection of appropriate management strategy are crucial and imperative for successful clinical outcomes. The current review discusses the current evidence and practical guidelines for prevention, early detection and management of TSE-related AEs.

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第三空间内窥镜检查不良事件的预防、检测和管理。
第三空间内窥镜(TSE)或使用粘膜瓣阀的粘膜下内窥镜(SEMF)使内窥镜医师能够在胃肠道深层进行手术,或进入纵隔/腹膜腔进行自然孔经口内窥镜手术(NOTES)。TSE 手术本质上是内窥镜外科手术,学习曲线不尽相同。TSE 过程中发生的不良事件(AEs)是特定的,在整个 TSE 过程中都遵循一定的模式。这些不良事件可根据不良事件的类型、相对于手术的出现时间或严重程度进行大致分类。在 TSE 过程中会遇到的三大类 AE 包括充气相关 AE、粘膜损伤 (MI) 和出血。其他相关的 AE 包括感染性并发症、吸入性肺炎、术后胸痛/腹痛、肺不张、心律失常、胸腔积液和肺栓塞。根据手术类型和复杂程度的不同,TSE 手术中 AEs 的报告发生率也不尽相同。了解潜在的风险因素、技术提示和预防措施、早期识别的报警信号、严重程度评估、AEs 形态学特征,最后迅速选择适当的管理策略,这些对于成功的临床结果至关重要,势在必行。本综述讨论了预防、早期发现和处理 TSE 相关 AE 的现有证据和实用指南。
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来源期刊
Indian Journal of Gastroenterology
Indian Journal of Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
3.90
自引率
10.00%
发文量
73
期刊介绍: The Indian Journal of Gastroenterology aims to help doctors everywhere practise better medicine and to influence the debate on gastroenterology. To achieve these aims, we publish original scientific studies, state-of -the-art special articles, reports and papers commenting on the clinical, scientific and public health factors affecting aspects of gastroenterology. We shall be delighted to receive articles for publication in all of these categories and letters commenting on the contents of the Journal or on issues of interest to our readers.
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