Gastrointestinal endoscopy
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Gastrointest. Endosc. · Jun 2006
Comparative StudyA comparison of covered and uncovered Wallstents for the management of distal malignant biliary obstruction.
The efficacy and complications of covered self-expandable metal stents (SEMS) remain controversial. ⋯ Covered Wallstents are safe with acceptable complication rates. However, we found no significant difference between the stent patencies of covered and uncovered Wallstents.
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Gastrointest. Endosc. · Jun 2006
Randomized Controlled Trial Comparative StudyCovered metal versus plastic stents for malignant common bile duct stenosis: a prospective, randomized, controlled trial.
Most patients with malignant common bile duct strictures are suited only for palliation of jaundice by placement of a polyethylene (PE) stent using an endoscopic retrograde cholangiographic technique. Occlusion of these stents occurs after 3 to 4 months, whereas uncovered self-expanding metal stents (SEMS) remain open twice as long. The initial higher cost of the latter might be balanced by a decreased need for repeat intervention. ⋯ The more-effective SEMS are recommended in unresectable patients with malignant common bile duct strictures, who survive a median of 4.5 months. Less costly plastic stents are preferable in the one third of patients who have distant metastases. In our study, the cost was equal.
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Gastrointest. Endosc. · Jun 2006
Droperidol, when used for sedation during ERCP, may prolong the QT interval.
Droperidol is a known effective adjunctive agent for sedation/analgesia during endoscopic procedures, particularly in patients who are difficult to sedate with narcotics and benzodiazepines alone. However, the Food and Drug Administration (FDA) warning about potential droperidol-related fatal cardiac arrhythmias, issued in December 2001, led to concern about its safety in current clinical practice. ⋯ Droperidol at usual doses during sedation/analgesia may precipitate QTcB prolongation above the normal range. However, no QT-related arrhythmias were noted in this study. Clinically significant cardiac events are probably rare with droperidol, despite documented QTcB effects. Baseline electrocardiogram for excluding patients with prolonged baseline QTcB and 1 to 3 hours afterward monitoring appears adequate when using droperidol. The study is still too small to detect very infrequent arrhythmia events.