Pub Date : 2024-12-01Epub Date: 2024-06-05DOI: 10.23736/S2724-5985.24.03656-8
Mauro Manno, Giuliano F Bonura, Paola Soriani, Roberta Pileggi, Giovanni Aragona, Vincenzo Cennamo, Antonio Colecchia, Rita Conigliaro, Marco DI Marco, Carlo Fabbri, Lorenzo Fuccio, Rosa F LA Fortezza, Alberto Merighi, Alessandro Mussetto, Giorgio Nervi, Paolo Orsi, Romano Sassatelli, Rocco M Zagari, Paolo Biancheri
Background: Sedation, ranging from minimal, moderate and deep sedation to general anesthesia, improves patient comfort and procedure quality in gastrointestinal endoscopy (GIE). There are currently no comprehensive recommendations on sedation practice in diagnostic and therapeutic GIE. We aimed to investigate real-life sedation practice in elective GIE.
Methods: We performed a multicentric observational study across 14 Endoscopy Units in Italy. We recorded consecutive data on all diagnostic procedures performed with Anesthesiologist-directed care (ADC) and all therapeutic procedures performed with ADC or non-Anesthesiologist sedation (NAS) over a three-month period.
Results: Dedicated ADC is available five days/week in 28.6% (4/14), four days/week in 21.5% (3/14), three days/week in 35.7% (5/14), two days/week in 7.1% (1/14) and one day/week in 7.1% (1/14) of participating Centers. ADC use for elective diagnostic GIE varied from 15.4% to 75.1% of the total number of procedures performed with ADC among different Centers. ADC use for elective therapeutic GIE varied from 10.8% to 98.9% of the total number of elective therapeutic procedures performed among different Centers.
Conclusions: Our study highlights the lack of standardization and consequent great variability in sedation practice for elective GIE, with ADC being potentially overused for diagnostic procedures and underused for complex therapeutic procedures. A collaborative effort involving Endoscopists, Anesthesiologist and Institutions is needed to optimize sedation practice in GIE.
背景：从最小镇静、中度镇静、深度镇静到全身麻醉，镇静可提高胃肠镜检查（GIE）中患者的舒适度和手术质量。目前还没有关于诊断性和治疗性 GIE 中镇静做法的全面建议。我们旨在调查择期 GIE 的实际镇静做法：我们在意大利的 14 个内镜室开展了一项多中心观察研究。我们记录了三个月内所有使用麻醉师指导护理（ADC）进行的诊断程序和所有使用ADC或非麻醉师镇静（NAS）进行的治疗程序的连续数据：在参与研究的中心中，28.6%（4/14）的中心每周提供五天的专职 ADC，21.5%（3/14）的中心每周提供四天的专职 ADC，35.7%（5/14）的中心每周提供三天的专职 ADC，7.1%（1/14）的中心每周提供两天的专职 ADC，7.1%（1/14）的中心每周提供一天的专职 ADC。在不同的中心，ADC用于择期诊断性GIE的比例从18.2%到75.1%不等。在不同中心进行的选择性治疗 GIE 手术总数中，ADC 的使用率从 10.8% 到 98.9% 不等：我们的研究凸显了择期GIE镇静实践缺乏标准化，因而存在巨大差异，ADC可能被过度用于诊断程序，而未被充分用于复杂的治疗程序。需要内镜医师、麻醉师和医疗机构通力合作，优化 GIE 的镇静方法。
{"title":"Anesthesiologist-directed care for elective gastrointestinal endoscopy: results of an Italian multicentric prospective observational study.","authors":"Mauro Manno, Giuliano F Bonura, Paola Soriani, Roberta Pileggi, Giovanni Aragona, Vincenzo Cennamo, Antonio Colecchia, Rita Conigliaro, Marco DI Marco, Carlo Fabbri, Lorenzo Fuccio, Rosa F LA Fortezza, Alberto Merighi, Alessandro Mussetto, Giorgio Nervi, Paolo Orsi, Romano Sassatelli, Rocco M Zagari, Paolo Biancheri","doi":"10.23736/S2724-5985.24.03656-8","DOIUrl":"10.23736/S2724-5985.24.03656-8","url":null,"abstract":"<p><strong>Background: </strong>Sedation, ranging from minimal, moderate and deep sedation to general anesthesia, improves patient comfort and procedure quality in gastrointestinal endoscopy (GIE). There are currently no comprehensive recommendations on sedation practice in diagnostic and therapeutic GIE. We aimed to investigate real-life sedation practice in elective GIE.</p><p><strong>Methods: </strong>We performed a multicentric observational study across 14 Endoscopy Units in Italy. We recorded consecutive data on all diagnostic procedures performed with Anesthesiologist-directed care (ADC) and all therapeutic procedures performed with ADC or non-Anesthesiologist sedation (NAS) over a three-month period.</p><p><strong>Results: </strong>Dedicated ADC is available five days/week in 28.6% (4/14), four days/week in 21.5% (3/14), three days/week in 35.7% (5/14), two days/week in 7.1% (1/14) and one day/week in 7.1% (1/14) of participating Centers. ADC use for elective diagnostic GIE varied from 15.4% to 75.1% of the total number of procedures performed with ADC among different Centers. ADC use for elective therapeutic GIE varied from 10.8% to 98.9% of the total number of elective therapeutic procedures performed among different Centers.</p><p><strong>Conclusions: </strong>Our study highlights the lack of standardization and consequent great variability in sedation practice for elective GIE, with ADC being potentially overused for diagnostic procedures and underused for complex therapeutic procedures. A collaborative effort involving Endoscopists, Anesthesiologist and Institutions is needed to optimize sedation practice in GIE.</p>","PeriodicalId":94142,"journal":{"name":"Minerva gastroenterology","volume":" ","pages":"405-412"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-05-10DOI: 10.23736/S2724-5985.24.03609-X
Ahmed Edhi, Manesh K Gangwani, Muhammad Aziz, Fouad Jaber, Zubair Khan, Sumant Inamdar, Aaron P Thrift, Tusar K Desai
Introduction: We conducted a meta-analysis evaluating the overall risk of esophageal adenocarcinoma (EAC) in individuals with Helicobacter pylori infection, and a network meta-analysis to assess the role of H. pylori infection in the progression from Barrett's esophagus (BE) to EAC.
Evidence acquisition: The MEDLINE, EMBASE and Cochrane databases were searched between 1988 and June 2023 for observational studies of H. pylori infection and the risk of EAC. Summary odds ratios (OR) and 95% confidence intervals (95% CI) were calculated using the DerSimonian-Laird method. I2 statistics were calculated to examine heterogeneity.
Evidence synthesis: Thirteen studies were included in the meta-analysis and 3 additional studies were included in the network meta-analysis. For comparisons with controls, individuals with H. pylori infection were 46% less likely to develop EAC than individuals without H. pylori infection (OR, 0.54; 95% CI: 0.46, 0.64), with low heterogeneity between studies (I2=4.4%). The magnitude of the inverse association was stronger in the two large cohort studies (OR=0.31) than in the 11 case-control studies (OR=0.55). When comparing to controls, the network meta-analysis of 6 studies showed that H. pylori infection was associated with a lower risk of GERD (OR=0.68) or BE (OR=0.59) or EAC (OR=0.54); however, H. pylori infection was not associated with risk of EAC in patients with BE (OR=0.91; 95% CI: 0.68, 1.21).
Conclusions: This meta-analysis provides the strongest evidence yet that H. pylori infection is inversely associated with EAC. H. pylori does not appear to be associated with BE progression to EAC.
{"title":"Helicobacter pylori infection does not influence the progression from gastroesophageal reflux disease to Barrett's esophagus to esophageal adenocarcinoma.","authors":"Ahmed Edhi, Manesh K Gangwani, Muhammad Aziz, Fouad Jaber, Zubair Khan, Sumant Inamdar, Aaron P Thrift, Tusar K Desai","doi":"10.23736/S2724-5985.24.03609-X","DOIUrl":"10.23736/S2724-5985.24.03609-X","url":null,"abstract":"<p><strong>Introduction: </strong>We conducted a meta-analysis evaluating the overall risk of esophageal adenocarcinoma (EAC) in individuals with Helicobacter pylori infection, and a network meta-analysis to assess the role of H. pylori infection in the progression from Barrett's esophagus (BE) to EAC.</p><p><strong>Evidence acquisition: </strong>The MEDLINE, EMBASE and Cochrane databases were searched between 1988 and June 2023 for observational studies of H. pylori infection and the risk of EAC. Summary odds ratios (OR) and 95% confidence intervals (95% CI) were calculated using the DerSimonian-Laird method. I<sup>2</sup> statistics were calculated to examine heterogeneity.</p><p><strong>Evidence synthesis: </strong>Thirteen studies were included in the meta-analysis and 3 additional studies were included in the network meta-analysis. For comparisons with controls, individuals with H. pylori infection were 46% less likely to develop EAC than individuals without H. pylori infection (OR, 0.54; 95% CI: 0.46, 0.64), with low heterogeneity between studies (I<sup>2</sup>=4.4%). The magnitude of the inverse association was stronger in the two large cohort studies (OR=0.31) than in the 11 case-control studies (OR=0.55). When comparing to controls, the network meta-analysis of 6 studies showed that H. pylori infection was associated with a lower risk of GERD (OR=0.68) or BE (OR=0.59) or EAC (OR=0.54); however, H. pylori infection was not associated with risk of EAC in patients with BE (OR=0.91; 95% CI: 0.68, 1.21).</p><p><strong>Conclusions: </strong>This meta-analysis provides the strongest evidence yet that H. pylori infection is inversely associated with EAC. H. pylori does not appear to be associated with BE progression to EAC.</p>","PeriodicalId":94142,"journal":{"name":"Minerva gastroenterology","volume":" ","pages":"454-462"},"PeriodicalIF":1.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 10.23736/S2724-5985.24.03760-4
Shunping Mao
{"title":"The role and mechanisms of long non-coding RNA HOTAIR in regulating the Wnt/β-catenin signaling pathway in gastric cancer cells and its impact on tumor invasion and metastasis.","authors":"Shunping Mao","doi":"10.23736/S2724-5985.24.03760-4","DOIUrl":"https://doi.org/10.23736/S2724-5985.24.03760-4","url":null,"abstract":"","PeriodicalId":94142,"journal":{"name":"Minerva gastroenterology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 10.23736/S2724-5985.24.03774-4
Yueying Huang, Bo Huang, Lingling Liu
{"title":"Evaluation of the effect of moxibustion therapy combined with press needle stimulation of bilateral Zusanli (ST36) and Neiguan (PC6) points on gastric motility recovery in patients with gastroparesis after pancreatoduodenectomy.","authors":"Yueying Huang, Bo Huang, Lingling Liu","doi":"10.23736/S2724-5985.24.03774-4","DOIUrl":"https://doi.org/10.23736/S2724-5985.24.03774-4","url":null,"abstract":"","PeriodicalId":94142,"journal":{"name":"Minerva gastroenterology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-26DOI: 10.23736/S2724-5985.24.03724-0
Connor Ryan, Robert S O'Neill, David Williams
{"title":"Successful endoscopic decompression of an intramural duodenal hematoma secondary to pancreatitis causing duodenal and common bile duct obstruction.","authors":"Connor Ryan, Robert S O'Neill, David Williams","doi":"10.23736/S2724-5985.24.03724-0","DOIUrl":"https://doi.org/10.23736/S2724-5985.24.03724-0","url":null,"abstract":"","PeriodicalId":94142,"journal":{"name":"Minerva gastroenterology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-26DOI: 10.23736/S2724-5985.24.03754-9
Juan Li, Xiangrong Zhu, Tingting Shao, Lisong Teng
{"title":"Impact of early enteral nutrition support on immune function in patients undergoing radical rectal cancer surgery.","authors":"Juan Li, Xiangrong Zhu, Tingting Shao, Lisong Teng","doi":"10.23736/S2724-5985.24.03754-9","DOIUrl":"https://doi.org/10.23736/S2724-5985.24.03754-9","url":null,"abstract":"","PeriodicalId":94142,"journal":{"name":"Minerva gastroenterology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-05DOI: 10.23736/S2724-5985.24.03720-3
Fan Xie, Yan Zhang, Tianye Wang
{"title":"Effects of mesalazine suppository combined with Kangfuxin solution retention enema on inflammatory markers and adverse reactions in patients with active ulcerative colitis.","authors":"Fan Xie, Yan Zhang, Tianye Wang","doi":"10.23736/S2724-5985.24.03720-3","DOIUrl":"https://doi.org/10.23736/S2724-5985.24.03720-3","url":null,"abstract":"","PeriodicalId":94142,"journal":{"name":"Minerva gastroenterology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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