Endoscopy
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Comparative Study
Feasibility and safety of endoscopic evaluation of gastric emptying.
Scintigraphy is the currently accepted method for evaluation of gastric emptying. Although quantitative, this method is complicated, time-consuming, and costly. If a simple endoscopic technique was available for those instances when quantification of an emptying abnormality is not needed, the same clinical information could be obtained in less time and with resource savings. Our aims in this study were therefore to assess the technical feasibility, tolerability, and safety of unsedated transnasal esophagogastroscopy (T-EG) as a technique for qualitative assessment of gastric emptying. ⋯ Evaluation of gastric emptying by unsedated T-EG is both feasible and safe. In healthy, asymptomatic individuals, complete gastric emptying of solid food may take as long as 6 hours.
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Case Reports
Acute esophageal necrosis associated with alcoholic hepatitis: is it black or is it white?
Acute esophageal necrosis is an uncommon condition diagnosed during endoscopy from the black appearance of the esophagus. We report three cases of acute esophageal necrosis, associated with severe alcoholic hepatitis. The pathogenesis was multifactorial in our patients, with gastroesophageal reflux combined with hypoperfusion probably being the key factor for the esophageal lesions. ⋯ However, esophageal biopsy specimens from all three patients had the same histological pattern of severe inflammation and necrosis. Thus, the possibility of acute esophageal necrosis should also be considered in patients with extensive necrosis covered by a white exudate, but without the characteristic pattern of a "black esophagus"; and the diagnosis should subsequently be confirmed by mucosal biopsies. Our report showed that ethanol-induced acute esophageal necrosis can appear in patients with a high alcohol intake, especially in immunosupressed patients with alcoholic hepatitis.
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In the year since the last review, continuing pressure on endoscopy suites to improve efficiency and reduce costs without compromising patient care has led to growing interest in alternatives to pharmacological sedation and in the use of short-acting sedatives. Relaxation music, acupuncture, and the use of small-caliber endoscopes for unsedated peroral gastroscopy have therefore been suggested as ways of increasing tolerance and reducing discomfort. With regard to ultrathin and superthin endoscopes, the results are interesting, but further data from controlled trials and in studies including larger numbers of patients are still needed. ⋯ Recently, it has been proposed that the bispectral index (BIS), an electroencephalography-based technique, can be used to monitor the depth of sedation during gastrointestinal endoscopy. However, the results of a recent study cast some doubt on the usefulness of the BIS, in its current version, for titrating boluses of propofol to an adequate level of sedation. Further data therefore appear to be needed to assess whether or not BIS values can help avoid unnecessary propofol dosage and can replace continuous assessment of the ventilatory effort.
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Comparative Study
Changing patterns of sedation and monitoring practice during endoscopy: results of a nationwide survey in Switzerland.
Little is known about how practices in sedation and in monitoring during gastrointestinal endoscopy and the complication rates of sedation have changed over time. The aim of this nationwide survey was to assess the present practice among Swiss gastroenterologists, with a particular focus on the use of propofol, and to compare the results with similar data obtained in 1990. ⋯ The use of sedation in gastrointestinal endoscopy has markedly increased over the last 13 years and the use of electronic monitoring has become standard practice. A significant percentage of Swiss gastroenterologists report that they use propofol, mainly in a hospital setting.