Gastrointestinal endoscopy clinics of North America
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In the United States sedation and analgesia is the standard of practice when performing upper and lower gastrointestinal endoscopy. Many of these endoscopic procedures are performed in ambulatory endoscopy centers, including ambulatory surgery centers. This article reviews new Joint Commission on Accreditation of Healthcare Organizations standards for sedation and analgesia, drugs used for sedation and analgesia (including side effects), patient assessment and monitoring (before, during, and postprocedure), and discharge of patients from the ambulatory endoscopy center.
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Gastrointest. Endosc. Clin. N. Am. · Apr 2002
ReviewContinuous quality improvement in the ambulatory endoscopy center.
What does quality assessment have to do with the practicing gastroenterologist? Why should one spend the time and effort to incorporate CQI activities into an already busy practice? First and foremost, quality improvement should directly benefit the patient by ensuring that they receive the highest quality of care possible. For example, comparing endoscopic use or outcomes, such as procedure success or complications, with national standards or other endoscopists in the same community may identify physicians who could benefit from additional training. Similar analyses may likewise identify outstanding physicians who might serve as resources for other physicians. ⋯ This new-found attention to quality must be extended to the level of the individual practitioner to ensure that individual patients' interests are protected and the best possible care is delivered regardless of the economic implications. As providers of health care, endoscopists need to take an active role in these efforts both in understanding and implementing the techniques of quality assessment into their practices. If physicians are not actively involved in data collection and measurement to improve the quality and value of their own work, someone else will undoubtedly assume this role.
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Gastrointest. Endosc. Clin. N. Am. · Oct 2001
Review Comparative StudySedation in pediatric endoscopy.
The increase in diagnostic, radiologic, and minor surgical procedures performed on pediatric patients outside of the traditional surgical suite setting has resulted in a marked increase in the use of conscious sedation. Not long ago, pediatric gastroenterologists were reticent about using intravenous sedation for pediatric endoscopy. With increased experience, careful screening, and the specialization of pediatric gastroenterology, however, endoscopy can now be performed safely with intravenous sedation on almost all patients.
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Variceal bleeding is the most common cause of severe gastro-intestinal bleeding in childhood. Biliary atresia and portal venous obstruction are the most common causes. Each center should have a defined management protocol reflecting local practice and expertise. ⋯ All of these patients should undergo therapeutic endoscopy with band ligation or sclerotherapy. All children surviving variceal hemorrhage should undergo secondary prophylaxis with band ligation. No evidence supports the routine use of primary prophylaxis in children with esophageal varices.