Endoscopy
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Following the recent success of the Second International Symposium on Complications in Gastrointestinal Endoscopy (17-18 June 2011, Hannover, Germany), it would be worth reminding ourselves of the key points and highlights of the first symposium held in Hannover in June 2009. The congress, which is endorsed by the American Society for Gastrointestinal Endoscopy (ASGE) under the patronage of the European Society for Gastrointestinal Endoscopy (ESGE), is designed to bring together endoscopists and support staff to present and discuss the diagnosis, treatment, and prevention of complications associated with gastrointestinal endoscopy, including effective communication strategies and management in particular patient groups. This current report is a brief summary of topics discussed at the inaugural symposium in 2009.
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Training standards in gastrointestinal endoscopy are poorly defined even though different simulators are increasingly used for skills training. In 2001 a new training concept called "GATE--gastroenterological education-training endoscopy" was established, which provides a combination of background theory, video demonstrations, and simulator training. We aimed to evaluate the acceptance and training effect of this training model. ⋯ The integrated GATE training improved theoretical knowledge and manual skill. The GATE courses have been accredited by the German Society of Gastroenterology, underlining the demand for implementing preclinical training courses in endoscopic training.
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The aim of the present study was to perform a risk analysis during the implementation phase of nurse-administered propofol sedation (NAPS) and to validate our structured training program. ⋯ These results were obtained after development of a structured training program both for endoscopists and nurses using propofol for sedation, and can be used as basis for further comparison. NAPS for endoscopic procedures is safe when performed by personnel properly trained in airway handling and sedation with propofol, and has considerable advantages compared with conventional sedation for endoscopy.
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Controlled Clinical Trial
Propofol sedation during endoscopy in patients with cirrhosis, and utility of psychometric tests and critical flicker frequency in assessment of recovery from sedation.
Patients with cirrhosis who undergo endoscopy under sedation could be at increased risk of complications. We assessed the utility of the critical flicker frequency (CFF) in the recovery of cognitive function. ⋯ Propofol is safe in patients with cirrhosis and the CFF is a useful tool for the assessment of recovery from sedation in these patients.
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The role of urgent endoscopy in high-risk nonvariceal upper gastrointestinal bleeding (NVUGIB) is unclear. The aim of this study was to determine whether esophagogastroduodenoscopy (EGD) performed sooner than the currently recommended 24 h in high-risk patients presenting with NVUGIB is associated with lower all-cause in-hospital mortality. ⋯ Endoscopy within 13 h of presentation was associated with lower mortality in high-risk but not low-risk NVUGIB.