Gastrointestinal endoscopy
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Gastrointest. Endosc. · Apr 2016
Propofol sedation with a target-controlled infusion pump and bispectral index monitoring system in elderly patients during a complex upper endoscopy procedure.
Although the usefulness of propofol sedation during endoscopic submucosal dissection (ESD) for gastric neoplasms was reported previously, information is limited on its use in elderly patients. We investigated the safety and efficacy of propofol sedation with a target-controlled infusion (TCI) pump and bispectral index (BIS) monitoring system (TCI/BIS system) in elderly patients during gastric ESD. ⋯ Elderly patients required lower doses of propofol with the TCI/BIS system than younger patients. Attention to hypoxemia is necessary in elderly patients, particularly patients with abnormal pulmonary function.
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Gastrointest. Endosc. · Mar 2016
Multicenter StudyAssessment of competency in endoscopy: establishing and validating generalizable competency benchmarks for colonoscopy.
The Mayo Colonoscopy Skills Assessment Tool (MCSAT) has previously been used to describe learning curves and competency benchmarks for colonoscopy; however, these data were limited to a single training center. The newer Assessment of Competency in Endoscopy (ACE) tool is a refinement of the MCSAT tool put forth by the Training Committee of the American Society for Gastrointestinal Endoscopy, intended to include additional important quality metrics. The goal of this study is to validate the changes made by updating this tool and establish more generalizable and reliable learning curves and competency benchmarks for colonoscopy by examining a larger national cohort of trainees. ⋯ Nationally generalizable learning curves for colonoscopy skills in gastroenterology fellows are described. Average ACE scores of 3.5, cecal intubation rates of 90%, and intubation times less than 15 minutes are recommended as minimal competency criteria. On average, it takes 250 procedures to achieve competence in colonoscopy. The thresholds found in this multicenter cohort by using the ACE tool are nearly identical to the previously established MCSAT benchmarks and are consistent with recent gastroenterology training recommendations but far higher than current training requirements in other specialties.
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Gastrointest. Endosc. · Dec 2015
Gastrojejunal tube placement through an established gastrostomy via an endoscopic transgastric approach in a pediatric population.
Gastrojejunal feeding tubes (GJTs) are typically converted from gastrostomy feeding tubes by interventional radiology in many pediatric centers to provide both postpyloric feeding and gastric decompression. Endoscopic transgastric GJT placement via an established gastric stoma can be performed without sedation and with minimal fluoroscopy but is relatively new in pediatrics with limited description. This study analyzed the success rate, adverse events, and technical issues associated with endoscopic GJT placement via a transgastric approach in pediatric patients at a large children's hospital. ⋯ Endoscopic transgastric GJT placement via an established gastrostomy with fluoroscopic confirmation can be safely performed by pediatric gastroenterologists without sedation and with minimal radiation exposure.