Digestive diseases and sciences
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General endotracheal (GET) anesthesia is often used during single-balloon enteroscopy (SBE). However, there is currently limited data regarding monitored anesthesia care (MAC) without endotracheal intubation for this procedure. ⋯ MAC is a safe and efficacious sedation approach for most patients undergoing SBE. Sedation-related complications in SBE are uncommon, but are more frequent in longer procedures.
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Proton pump inhibitors (PPIs) may reduce the risk of esophageal adenocarcinoma (EAC) in patients with Barrett's esophagus. PPIs are prescribed for virtually all patients with Barrett's esophagus, irrespective of the presence of reflux symptoms, and represent a de facto chemopreventive agent in this population. However, long-term PPI use has been associated with several adverse effects, and the cost-effectiveness of chemoprevention with PPIs has not been evaluated. ⋯ Chemoprevention with PPIs in patients with Barrett's esophagus without reflux is cost-effective if PPIs reduce EAC by a minimum of 19%. The identification of subgroups of Barrett's esophagus patients at increased risk for progression would lead to more cost-effective strategies for the prevention of esophageal adenocarcinoma.
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In May 2013, the FDA (Federal Drug Administration) approved SEDASYS(®), a device that enables non-anesthesia physicians to provide mild-to-moderate sedation to patients undergoing colonoscopy and esophagogastroduodenoscopy. SEDASYS(®) is the first among the devices being built to provide computer-assisted personalized sedation. ⋯ Deep sedation is required frequently for a successful completion of the procedure, which poses unforeseen challenges. The present review aims to provide clear information to the users regarding pre-procedure assessment, possible sedation related complications and management options.