Clinical Endoscopy最新文献

Chronic pancreatitis (CP), a progressive inflammatory disease that results in irreversible pancreatic damage, is often complicated by ductal strictures and debilitating pain. Fully covered self-expandable metal stents (FCSEMS) have emerged as significant innovations in the endoscopic management of refractory pancreatic duct strictures. This review synthesizes recent evidence highlighting the benefits and limitations of FCSEMS, such as superior patency, reduced need for reinterventions, and effective symptom relief compared to traditional plastic stents, alongside risks, such as stent migration and de novo strictures. A comparison with plastic stents and an algorithm for pancreatic duct stricture management are provided. Regional variations in clinical guidelines from the United States, Europe, Japan, and Korea reflect diverse approaches to integrating FCSEMS into practice. Emerging innovations in stent technology are promising for improving CP management outcomes.

Background: Propofol is the most effective sedative for colonoscopy; however, opioids do have several adverse effects that need to be discussed. The objective of this study was to compare the ease of colonoscopy during propofol-based sedation with and without fentanyl, while closely monitoring ventilatory data and the safety of the procedure.

Methods: This prospective single-center trial randomized 50 patients who underwent minor colonoscopies. The propofol group received sedation exclusively via propofol, whereas the propofol+fentanyl group was premedicated with 1 µg/kg fentanyl. Patients were monitored using a bioimpedance ventilatory monitor, and both the patients and endoscopists were questioned regarding their level of satisfaction.

Results: The endoscopists reported a higher level of ease with the colonoscopy procedure (mean on a 5-point scale, 1.2 vs. 1.72; p=0.028) and the overall patient satisfaction score was higher (1.15 vs. 1.28, p=0.026) in the propofol+fentanyl group. No significant differences were observed in the ventilatory parameters between the groups. No major adverse events were reported in any of the groups.

Conclusions: The inclusion of fentanyl leads to enhanced levels of satisfaction for both the endoscopist and the patient, without any impact on ventilation and safety. The use of bioimpedance monitoring of ventilation during colonoscopy is a suitable approach that may enhance the safety of procedural sedation.

Background: Propofol is widely used for sedation during upper endoscopy; however, oversedation may increase the risk of complications, including aspiration pneumonia. This study aimed to determine whether propofol overdose is a risk factor for suspected postendoscopic infectious fever (SPIF).

Methods: We retrospectively analyzed 1,474 in-patients who underwent upper endoscopy at Inha University Hospital between October 2021 and October 2022. After excluding 400 patients who received interventional procedures, SPIF was defined as new-onset fever (≥38 °C) within three days post-endoscopy with at least one of the following: intravenous antibiotic initiation, leukocytosis (white blood cell≥10,000/mm³), positive blood or sputum cultures, or pneumonia on chest X-ray. The risk factors assessed included comorbidities, sedative type and dosage, procedure duration, and endoscopist's experience.

Results: New-onset fever occurred in 40 patients (3.7%), with 20 (1.9%) meeting SPIF criteria. Multivariable analysis showed propofol overdose (>2.2 mg/kg) significantly increased risks of new-onset fever (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.00-1.06; p=0.023) and SPIF (OR, 1.04; 95% CI, 1.00-1.04; p=0.034). Dementia (OR, 1.11, p<0.001) and prolonged procedure (>5 minutes; OR, 1.01; p=0.012) were also risk factors for SPIF.

Conclusions: Propofol overdose significantly increases the risk of SPIF. Careful sedation management is essential, especially for patients with dementia or prolonged procedures.

The emergence of Mpox as a significant zoonotic viral threat presents new challenges in gastrointestinal endoscopy. This article outlines the risk of Mpox transmission during gastrointestinal endoscopy, particularly through respiratory droplets and contact with the mucosal surfaces. Gastrointestinal endoscopy may also facilitate transmission by fomites, as the Mpox virus can persist on medical instruments and surfaces for long periods. Nosocomial Mpox transmission is a significant concern in both endemic and non-endemic regions. This highlights the necessity for enhanced infection control measures in gastrointestinal endoscopy, including pre-endoscopic assessment, proper use of personal protective equipment, and rigorous post-procedural disinfection. Additionally, vaccination of healthcare workers frequently exposed to high-risk situations is emphasized. Ongoing surveillance and monitoring of healthcare workers are key components in minimizing the transmission risk. Although no direct cases of Mpox transmission via gastrointestinal endoscopy have been reported, these recommendations mitigate the potential risks associated with such procedures and necessitate strict adherence to infection control protocols. By adhering to these protocols and adapting to current practices, gastrointestinal endoscopy can be safely performed during the Mpox upsurge, ensuring the protection of both patients and healthcare workers.

Background: The effectiveness of colonoscopy largely depends on the quality of bowel preparation. Polyethylene glycol (PEG) is commonly used but has certain limitations. This review evaluates whether combining PEG with linaclotide improves preparation efficacy and safety compared with PEG alone.

Methods: A search was conducted in Medline, Embase, and ClinicalTrials.gov up to October 2024. Only randomized controlled trials comparing PEG combined with linaclotide versus PEG alone and reporting adenoma detection rates (ADR) or polyp detection rates (PDR) were included. Mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were reported.

Results: A total of eight studies, including 3,071 participants, were included. Pooled analysis indicated that PEG combined with linaclotide was significantly associated with a higher ADR (RR, 1.15; 95% CI, 1.03-1.28), higher Boston bowel preparation scale score (MD, 0.31; 95% CI, 0.02-0.61), and greater willingness to repeat colonoscopy (RR, 1.16; 95% CI, 1.08-1.24). Although PDR (RR, 1.05; 95% CI, 0.89-1.24) was numerically higher in the intervention group, the difference was not statistically significant. Additionally, the intervention significantly reduced the incidence of nausea, vomiting, bloating, and abdominal pain.

Conclusions: PEG combined with linaclotide is a safe alternative to PEG alone, improving ADR, bowel preparation quality, and patient comfort.

Background: This study aimed to review and update the evidence regarding the efficacy and safety of percutaneous cholecystolithotomy/lithotripsy (PCCL) for managing acute calculous cholecystitis (ACC) in non-surgical candidates.

Methods: A systematic search of PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase was conducted. We included studies focusing on the use of PCCL in patients deemed ineligible for surgery owing to ACC and reporting outcomes such as technical success, stone clearance, recurrence, and length of hospital stay. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: Meta-analysis of 13 studies showed a technical success rate of 97%, with stone and cholecystitis recurrence in 10% and 1% of cases, respectively. The pooled average length of hospital stay was 2.79 days. Complications included retained stones (3%), duct perforations (6%), catheter displacement (5%), bleeding (4%), and bile leakage (5%). A sensitivity analysis confirmed the robustness of these results.

Conclusions: PCCL demonstrated high efficacy with minimal recurrence and low complication rates in managing ACC in non-surgical candidates. Further randomized controlled trials are necessary to compare its efficacy and safety with standard care approaches, such as cholecystectomy or percutaneous cholecystostomy.