Gastrointestinal endoscopy clinics of North America
-
Gastrointest. Endosc. Clin. N. Am. · Apr 2011
ReviewEndoscopy unit considerations in the care of obese patients.
The dramatic increase in obesity in the general population is accompanied by a concomitant increase in bariatric surgical programs. Gastrointestinal endoscopy has an important role in patient evaluation, postoperative management, and emerging endoscopic bariatric therapies. ⋯ Obese people require more health care resources than nonobese people, with increased physical challenges for staff in administering that care. This article details endoscopy unit considerations pertaining to the bariatric patient, which may apply to pretreatment endoscopic evaluation, managing postoperative bariatric surgical complications, and emerging endoluminal bariatric therapies.
-
Gastrointest. Endosc. Clin. N. Am. · Apr 2011
ReviewBariatric surgical anatomy and mechanisms of action.
Because bariatric surgery is becoming increasingly common, gastroenterologists need to be familiar with the surgical and endoscopic anatomy of the operations in use today. This review focuses on the 4 most commonly performed bariatric operations in the United States: Roux-en-Y gastric bypass, adjustable gastric band, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch. ⋯ Emphasis is placed on the endoscopic anatomy, with review of the commonly encountered complications. Emerging techniques and devices are reviewed.
-
Colonoscopy is a well recognized diagnostic and therapeutic tool. Endoscope reprocessing must be done correctly every time; a breach of protocol leading to transmission of infection has the potential to bring endoscopy to a halt. Standards exist that guide the practitioner in all health care settings to minimize the chance of transmission of infection. Safe injection practices and reprocessing of endoscopes using high-level disinfection and sterilization methods may help avert the risk of contracting possible infections during colonoscopy procedures.
-
Gastrointest. Endosc. Clin. N. Am. · Oct 2010
ReviewThe use of databases and registries to enhance colonoscopy quality.
Administrative databases, registries, and clinical databases are designed for different purposes and therefore have different advantages and disadvantages in providing data for enhancing quality. Administrative databases provide the advantages of size, availability, and generalizability, but are subject to constraints inherent in the coding systems used and from data collection methods optimized for billing. ⋯ Electronic health records contain all of the data needed for quality research and measurement, but that data is too often locked in narrative text and unavailable for analysis. National mandates for electronic health record implementation and functionality will likely change this landscape in the near future.
-
The subject of endoscopic sedation for colonoscopy remains controversial because of unresolved questions concerning the relative benefits, risks, and cost of service. There is also disagreement about the most appropriate sedation drug(s), delegation of responsibility for drug administration, and patient monitoring. This article examines recent trends in endoscopic sedation; the impact of sedation on the quality, safety, and patient tolerability of colonoscopy; and reviews the economic implications of current sedation practices.