Digestive Diseases and Sciences最新文献

Background: Propofol is the most commonly used intravenous anesthetic for endoscopic surgery, although it comes with various adverse effects. Research indicates that Remimazolam, which is considered a safe general anesthetic, is being increasingly adopted as an alternative to propofol in clinical settings. Our meta-analysis sought to evaluate whether the rate of adverse reactions associated with Remimazolam in gastrointestinal endoscopic procedures is acceptable, and whether its surgical success rate is at least comparable to that of propofol.

Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched five electronic databases (PubMed, Scopus, Cochrane Library, Embase, and Web of Science) to identify eligible studies published up to January 2025. Using R version R.4.4, we reported outcomes as risk ratios (RRs) or mean differences (MDs) and confidence intervals (CIs). A P-value of ≤ 0.05 is considered statistically significant.

Results: Our meta-analysis included 37 studies encompassing 8533 patients. The results, analyzed using a random effects model, demonstrated no statistically significant difference in induction time between the two sedative groups, with an overall MD of 0.11 min (95% [- 0.10; 0.31], p = 0.2977). Patients in the Remimazolam group experienced longer total sedation times than those receiving Propofol, with an MD of 1.84 min (95% CI [0.61; 3.07], p = 0.0033). The pooled analysis indicated low heterogeneity (I² = 4.2%). There was no statistically significant difference between the two sedatives in procedure time, with an MD of 0.16 (95% CI: [-0.13; 0.45], p = 0.2689). The pooled analysis displayed moderate heterogeneity (I² = 43.5%, p = 0.0052).

Conclusion: Remimazolam has demonstrated safety, showing a reduced incidence of hypotension, bradycardia, respiratory depression, and hypoxemia compared to propofol. However, efficacy outcomes including the induction time and total procedure time were comparable between the two groups. However, the results were heterogeneous, which could be due to variability in the perfumed procedures, co-analgesics or dosing.

Introduction: Endoscopic transmural drainage (ETD) using a therapeutic oblique-viewing echoendoscope is procedure of choice for symptomatic walled-off necrosis (WON). However, occasionally the procedure fails because of poor visualization, non-negotiation of proximal luminal narrowing, presence of intervening venous collaterals or difficult puncture because of oblique angle. In such situations, a forward-viewing echoendoscope (FVE) may offer technical advantages.

Objective: To evaluate safety and efficacy of EUS-guided ETD of WON using a FVE in patients in whom drainage could not be completed using oblique-viewing echoendoscope.

Methods: The endoscopic database of a tertiary-care center was retrospectively reviewed and patients who underwent ETD of WON using a FVE following failure with a conventional oblique-viewing echoendoscope were identified. Demographic data, characteristics of WON, procedural details, technical success, and procedure-related adverse events were analyzed.

Results: Twenty-one patients (18 males; age range 12-54 years) underwent ETD using a FVE. The size of the WON ranged from 9 to 18 cm. Collections were located in the head (n = 2), body (n = 5), tail (n = 2), and body and tail (n = 12) of the pancreas. ETD was performed 5-24 weeks after an episode of acute necrotizing pancreatitis. Technical success was achieved in all patients (100%). Lumen-apposing metal stents were placed in 12 patients, multiple plastic stents in 7 patients, and a nasocystic drain in 2 patients. No immediate or early procedure-related complications or stent maldeployment were observed.

Conclusions: ETD of WON using an FVE is safe and effective in patients in whom drainage using a conventional oblique-viewing echoendoscope is technically challenging or unsuccessful.