Gastroenterology & Endoscopy最新文献

Objective

To systematically evaluate the value of endocytoscopy (ECS) in the diagnosis of early esophageal cancer (EC).

Methods

Pubmed, Ovid and EMbase databases were searched to collect diagnostic tests of ECS assisted diagnosis of early EC. The retrieval time was from the establishment of the database to August 2022. Review manager 5.4, Stata 16.0 and Meta-Disc 1.4 were used for meta-analysis after two researchers independently screened literature, extracted data and evaluated the bias risk of included studies.

Results

A total of 7 studies were included, including 520 lesions. Meta-analysis results showed that the combined sensitivity (SE), specificity (SP), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and positive posterior probability (PPP) of ECS screening for early EC were 0.95 [95%CI: 0.84, 0.98], 0.92 [95%CI: 0.83, 0.96], 11.8 [95%CI: 5.3, 26.1], 0.06 [95%CI: 0.02, 0.18], 203 [95%CI: 50, 816], and 75%, respectively. The area (AUC) under the summary receiver Operating Characteristic curve (SROC) was 0.98 [95%CI: 0.96, 0.99].

Conclusions

Current evidence suggests that ECS can be used as an effective screening tool for early EC. Due to the limited number and quality of included studies, it is imperative to conduct more high-quality studies to verify the above conclusions.

Objective

To use etomidate in combination with different opioids (sufentanil, fentanyl, and dezocine) to compare several anesthesia options from the aspects of the patient's index of consciousness (IoC).

Methods

This was a prospective pilot study of consecutive patients who were scheduled for elective painless gastroscopy at PLA Strategic Force Characteristic Medical Center, Beijing, China, between December 2020 and May 2022. The patients were randomized to control (etomidate), S (sufentanil ​+ ​etomidate), F (fentanyl ​+ ​etomidate), and D (dezocine ​+ ​etimidate). IoC was measured before anesthesia (T1), opioids (T2), etomidate (T3), the start of endoscopy (T4), drug withdrawal (T5), OAA/S ​> ​2 (T6), and OAA/S ​> ​4) (T7). The primary outcome was the observation of IoC at T6 and T7. The adverse reaction and recovery time were secondary outcomes.

Results

With 20 patients in each group, there were no differences in the operation and awakening times among the four groups (P ​> ​0.05). Compared with group C, the IoC values of groups S and F at T5, T6, and T7 were increased after drug administration (P ​< ​0.05), with intragroup differences (P ​< ​0.001). Compared with group C, the IoC values of groups S, F, and D were higher at T6 and T7 (P_S-T6 ​= ​0.003, P_F-T6 ​= ​0.013, P_D-T6 ​= ​0.015; P_S-T7 ​= ​0.015, P_F-T7 ​= ​0.040, P_D-T7 ​= ​0.028). There were differences in nausea and vomiting between groups D and C (P_D-C ​= ​0.044) and myoclonus (P_S–_CP_F-C<0.001, and P_D-C<0.001). SpO2 <90% (two cases in group S and one in group F) were observed.

Conclusion

IoC value has a good correlation with OAA/S score, which can accurately monitor the effect of etomidate combined with opioids on the depth of anesthesia of patients undergoing painless gastroscopic anesthesia.

Trial registration

ChiCTR, ChiCTR2000040927. Registered December 16, 2020 –Prospective registration, http://www.chictr.org.cn/ChiCTR2000040927.

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