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대한소화기내시경학회> Clinical Endoscopy> Anesthesia for Advanced Endoscopic Procedures

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Anesthesia for Advanced Endoscopic Procedures

Basavana Goudra , Monica Saumoy
  • : 대한소화기내시경학회
  • : Clinical Endoscopy 55권1호
  • : 연속간행물
  • : 2022년 01월
  • : 1-7(7pages)
Clinical Endoscopy

DOI


목차

INTRODUCTION
GENERAL CONSIDERATIONS
ENDOBARIATRICS
POEM
ESD
ERCP
EUS-GUIDED DRAINAGE OF PERIPANCREATIC COLLECTIONS
CONCLUSIONS
Conflicts of Interest
Funding
Author Contributions
ORCID
REFERENCES

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The gastrointestinal endoscopy paradigm is rapidly changing, and technological advancements are largely responsible. In tandem, anesthesia providers are adapting to the changing needs and demands. The challenges are unique. Complications arising from the procedures are both routine, such as aspiration and hypoxia, and procedure specific, such as bleeding, pneumothorax, pneumopericardium, and pneumoperitoneum. It is crucial for the anesthesia provider to have a good understanding of the techniques employed by the endoscopist. A higher index of suspicion is also essential to diagnose and appropriately manage many of the complications. In this review, an effort is made to discuss both procedural aspects and anesthesia challenges. We hope that both endoscopists and anesthesia providers will benefit from this review. Clin Endosc 2022;55:1-7

UCI(KEPA)

I410-ECN-0102-2022-500-001028661

간행물정보

  • : 의약학분야  > 내과학
  • : KCI등재
  • : SCOPUS
  • : 격월
  • : 2234-2400
  • : 2234-2443
  • : 학술지
  • : 연속간행물
  • : 2011-2022
  • : 1288


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1Recent developments in small bowel endoscopy: the “black box” is now open!

저자 : Luigina Vanessa Alemanni , Stefano Fabbri , Emanuele Rondonotti , Alessandro Mussetto

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 473-479 (7 pages)

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Over the last few years, capsule endoscopy has been established as a fundamental device in the practicing gastroenterologist's toolbox. Its utilization in diagnostic algorithms for suspected small bowel bleeding, Crohn's disease, and small bowel tumors has been approved by several guidelines. The advent of double-balloon enteroscopy has significantly increased the therapeutic possibilities and release of multiple devices (single-balloon enteroscopy and spiral enteroscopy) aimed at improving the performance of small bowel enteroscopy. Recently, some important innovations have appeared in the small bowel endoscopy scene, providing further improvement to its evolution. Artificial intelligence in capsule endoscopy should increase diagnostic accuracy and reading efficiency, and the introduction of motorized spiral enteroscopy into clinical practice could also improve the therapeutic yield. This review focuses on the most recent studies on artificial-intelligence-assisted capsule endoscopy and motorized spiral enteroscopy.

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2Endoscopic activity in inflammatory bowel disease: clinical significance and application in practice

저자 : Kyeong Ok Kim

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 480-488 (9 pages)

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Endoscopy is vital for diagnosis, assessing treatment response, monitoring and surveillance in patients with inflammatory bowel disease (IBD). With the growing importance of mucosal healing as a treatment target, the assessment of disease activity by endoscopy has been accepted as the standard of care for IBD. There are many endoscopic activity indices for facilitating standardized reporting of the gastrointestinal mucosal appearance in IBD, and each index has its strengths and weaknesses. Although most endoscopic indices do not have a clear-cut validated definition, endoscopic remission or mucosal healing is associated with favorable outcomes, such as a decreased risk of relapse. Therefore, experts suggest utilizing endoscopic indices for monitoring disease activity and optimizing treatment to achieve remission. However, the regular monitoring of endoscopic activity is limited in practice owing to several factors, such as the complexity of the procedure, time consumption, inter-observer variability, and lack of a clear-cut, validated definition of endoscopic response or remission. Although experts have recently suggested consensus-based definitions, further studies are needed to define the values that can predict long-term outcomes.

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3Post-polypectomy surveillance: the present and the future

저자 : Masau Sekiguchi , Takahisa Matsuda , Kinichi Hotta , Yutaka Saito

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 489-495 (7 pages)

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An appropriate post-polypectomy surveillance program requires the effectiveness of reducing colorectal cancer and safety. In addition, the post-polypectomy surveillance program should consider the burden of limited medical resource capacity, cost-effectiveness, and patient adherence. In this sense, a risk-stratified surveillance program based on baseline colonoscopy results is ideal. Major international guidelines for post-polypectomy surveillance, such as those from the European Union and the United States, have recommended risk-stratified surveillance programs. Both guidelines have recently been updated to better differentiate between high- and low-risk individuals. In both updated guidelines, more individuals have been downgraded to lower-risk groups that require less frequent or no surveillance. Furthermore, increased attention has been paid to the surveillance of patients who undergo serrated polyp removal. Previous guidelines in Japan did not clearly outline the risk stratification in post-polypectomy surveillance. However, the new colonoscopy screening and surveillance guidelines presented by the Japan Gastroenterological Endoscopy Society include a risk-stratified post-polectomy surveillance program. Further discussion and analysis of unresolved issues in this field, such as the optimal follow-up after the first surveillance, the upper age limit for surveillance, and the ideal method for improving adherence to surveillance guidelines, are warranted.

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4Endoscopic treatment for rectal neuroendocrine tumor: which method is better?

저자 : Seung Min Hong , Dong Hoon Baek

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 496-506 (11 pages)

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Recently, research on rectal neuroendocrine tumors (NETs) has increased during the last few decades. Rectal NETs measuring <10 mm without atypical features and confined to the submucosal layer have only 1% risk of metastasis, and the long-term survival probability of patients without metastasis at the time of diagnosis is approximately 100%. Therefore, the current guidelines suggest endoscopic resection of rectal NETs of <10 mm is regarded as a safe therapeutic option. However, there are currently no clear recommendations for technique selection for endoscopic resection. The choice of treatment modality for rectal NETs should be based on the lesion size, endoscopic characteristics, grade of differentiation, depth of vertical involvement, lymphovascular invasion, and risk of metastasis. Moreover, the complete resection rate, complications, and experience at the center should be considered. Modified endoscopic mucosal resection is the most suitable resection method for rectal NETs of < 10 mm, because it is an effective and safe technique that is relatively simple and less time-consuming compared with endoscopic submucosal dissection. Endoscopic submucosal dissection should be considered when the tumor size is >10 mm, suctioning is not possible due to fibrosis in the lesion, or when the snaring for modified endoscopic mucosal resection does not work well.

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5Endoscopic diagnosis of gastric metastases from malignant melanoma: systematic review

저자 : Helena Campoli Reggiani , Ana Clara Aguiar Pongeluppi , Vitória Froes Miraglia Martins Ferreira , Isadora Pinheiro Felix , Paulo Moacir De Oliveira Campoli

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 507-515 (9 pages)

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Background/Aims: Metastases of malignant melanoma (MM) are rare and associated with poor prognosis. The objective of this study was to analyze the clinical and endoscopic characteristics of gastric metastases of MM by systematically reviewing cases and case series involving patients diagnosed using upper gastrointestinal endoscopy.
Methods: The PubMed and LILACS databases were searched. Reports containing individual patient data were included. Outcomes such as clinical data, endoscopic findings, treatments, and survival were analyzed.
Results: A total of 88 studies with individual data from 113 patients with gastric metastases of MM were included. The primary sites of MM were the skin (62%), eyes (10%), and mucous membranes (6%). Most patients (56%) had multiple metastases in the stomach, located predominantly in the gastric body (approximately 80%). The overall survival rate at 2 years was 4%. There was a significant reduction in the survival of patients with multiple gastric metastases compared to that of patients with single metastasis (hazard ratio, 0.459; 95% confidence interval, 0.235-0.895; p=0.022).
Conclusions: Gastric metastases of MM have a poor prognosis, especially in patients with multiple implants in the stomach. Additional studies are needed to verify whether ocular and mucosal melanomas are associated with a higher risk of gastric metastases than that of cutaneous melanomas.

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6Prevention of stricture after endoscopic submucosal dissection for esophageal cancer: intralesional steroid infusion using a spray tube

저자 : Jong Yeul Lee

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 516-517 (2 pages)

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7Clinical and economic value of bispectral index monitoring for adequate endoscopic sedation

저자 : Se Woo Park

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 518-519 (2 pages)

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8Intralesional steroid infusion using a spray tube to prevent stenosis after endoscopic submucosal dissection of esophageal cancer

저자 : Atsushi Goto , Takeshi Okamoto , Ryo Ogawa , Kouichi Hamabe , Shinichi Hashimoto , Jun Nishikawa , Taro Takami

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 520-524 (5 pages)

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Background/Aims: Intralesional steroid injections have been administered as prophylaxis for stenosis after esophageal endoscopic submucosal dissection. However, this method carries a risk of potential complications such as perforation because a fine needle is used to directly puncture the postoperative ulcer. We devised a new method of steroid intralesional infusion using a spray tube and evaluated its efficacy and safety.
Methods: Intralesional steroid infusion using a spray tube was performed on 27 patients who underwent endoscopic submucosal dissection for superficial esophageal cancer with three-quarters or more of the lumen circumference resected. The presence or absence of stenosis, complications, and the number of endoscopic balloon dilations (EBDs) performed were evaluated after treatment.
Results: Although stenosis was not observed in 22 of the 27 patients, five patients had stenosis and dysphagia requiring EBD. The stenosis in these five patients was relieved after four EBDs. No complications related to intralesional steroid infusion using the spray tube were observed.
Conclusions: Intralesional steroid infusion using a spray tube is a simple and safe technique that is adequately effective in preventing stenosis (clinical trial number, UMIN000037567).

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9Application of a traction metal clip with a fishhook-like device in wound sutures after endoscopic resection

저자 : Wang Fangjun , Leng Xia , Gao Yi , Shen Xiuyun , Wang Wenping , Liu Huamin , Liu Pengfei

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 525-531 (7 pages)

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Background/Aims: Endoscopic wound suturing is an important factor that affects the ability to remove large and full-thickness lesions during endoscopic resection. We aimed to evaluate the effect of a traction metal clip with a fishhook-like device on wound sutures after endoscopic resection.
Methods: From July 2020 to April 2021, patients who met the enrollment criteria were treated with a fishhook-like device during the operation to suture the postoperative wound (group A). Patients with similar conditions and similar size wounds who were treated with a “purse-string suture” to suture the wounds were retrospectively analyzed as the control group (group B). Difference in the suture rate, adverse events, time required for suturing, and number of metal clips were compared between the two groups.
Results: The time required for suturing was 7.72±0.51 minutes in group A and 11.50±0.91 minutes in group B. This difference was statistically significant (F=13.071, p=0.001). The number of metal clamps used in group A averaged 8.1 pieces/case, and the number of metal clamps used in group B averaged 7.3 pieces/case. This difference was not statistically significant (F=0.971, p=0.331).
Conclusions: The traction metal clip with the fishhook-like device is ingeniously designed and easy to operate. It has a good suture effect on the wound after endoscopic submucosal dissection and effectively prevents postoperative adverse events.

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10Capsule enteroscopy versus small-bowel ultrasonography for the detection and differential diagnosis of intestinal diseases

저자 : Luca Elli , Erica Centorrino , Andrea Costantino , Maurizio Vecchi , Stefania Orlando , Mirella Fraquelli

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 532-539 (8 pages)

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Background/Aims: Capsule enteroscopy (CE) and intestinal ultrasonography (IUS) are techniques that are currently used for investigating small-bowel (SB) diseases. The aim of this study was to compare the main imaging findings and the lesion detection rate (LDR) of CE and IUS in different clinical scenarios involving the SB.
Methods: We retrospectively enrolled patients who underwent CE and IUS for obscure gastrointestinal bleeding (OGIB), complicated celiac disease (CeD), and suspected or known inflammatory bowel disease (IBD). We evaluated the LDR of both techniques. The accuracy of IUS was determined using CE as the reference standard.
Results: A total of 159 patients (113 female; mean age, 49±19 years) were enrolled. The LDR was 55% and 33% for CE and IUS (p<0.05), respectively. Subgroup analysis showed that the LDR of CE was significantly higher than that of IUS in patients with OGIB (62% vs. 14%, p<0.05) and CeD (55% vs. 35%, p<0.05). IUS showed a similar LDR to CE in patients with suspected or known IBD (51% vs. 46%, p=0.83).
Conclusions: CE should be preferred in cases of OGIB and CeD, whereas IUS should be considered an early step in the diagnosis and follow-up of IBD even in patients with a proximal SB localization of the disease.

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1Anesthesia for Advanced Endoscopic Procedures

저자 : Basavana Goudra , Monica Saumoy

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 1호 발행 연도 : 2022 페이지 : pp. 1-7 (7 pages)

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The gastrointestinal endoscopy paradigm is rapidly changing, and technological advancements are largely responsible. In tandem, anesthesia providers are adapting to the changing needs and demands. The challenges are unique. Complications arising from the procedures are both routine, such as aspiration and hypoxia, and procedure specific, such as bleeding, pneumothorax, pneumopericardium, and pneumoperitoneum. It is crucial for the anesthesia provider to have a good understanding of the techniques employed by the endoscopist. A higher index of suspicion is also essential to diagnose and appropriately manage many of the complications. In this review, an effort is made to discuss both procedural aspects and anesthesia challenges. We hope that both endoscopists and anesthesia providers will benefit from this review. Clin Endosc 2022;55:1-7

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2When to Discharge a Patient After Endoscopy: A Narrative Review

저자 : Swapnil Sahebrao Walke , Shamshersingh Chauhan , Vikas Pandey , Rahul Jadhav , Vipul Chaudhari , Deepti Vishwanathan , Kailash Kolhe , Meghraj Ingle

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 1호 발행 연도 : 2022 페이지 : pp. 8-14 (7 pages)

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Video endoscopy is an important modality for the diagnosis and treatment of various gastrointestinal diseases. Most endoscopic procedures are performed as outpatient basis, sometimes requiring sedation and deeper levels of anesthesia. Moreover, advances in endoscopic techniques have allowed invasion into the third space and the performance of technically difficult procedures that require the utmost precision. Hence, formulating strategies for the discharge of patients requiring endoscopy is clinically and legally challenging. In this review, we have discussed the various criteria and scores for the discharge of patients who have undergone endoscopic procedures with and without anesthesia. Clin Endosc 2022;55:8-14

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3Current Treatment Strategy for Superficial Nonampullary Duodenal Epithelial Tumors

저자 : Tetsuya Suwa , Kohei Takizawa , Noboru Kawata , Masao Yoshida , Yohei Yabuuchi , Yoichi Yamamoto , Hiroyuki Ono

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 1호 발행 연도 : 2022 페이지 : pp. 15-21 (7 pages)

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Endoscopic submucosal dissection (ESD) is the standard treatment method for esophageal, gastric, and colorectal cancers. However, it has not been standardized for duodenal lesions because of its high complication rates. Recently, minimally invasive and simple methods such as cold snare polypectomy and underwater endoscopic mucosal resection have been utilized more for superficial nonampullary duodenal epithelial tumors (SNADETs). Although the rate of complications associated with duodenal ESD has been gradually decreasing because of technical advancements, performing ESD for all SNADETs is unnecessary. As such, the appropriate treatment plan for SNADETs should be chosen according to the lesion type, patient condition, and endoscopist's skill. Clin Endosc 2022;55:15-21

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4Radiation Proctitis and Management Strategies

저자 : Dushyant Singh Dahiya , Asim Kichloo , Faiz Tuma , Michael Albosta , Farah Wani

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 1호 발행 연도 : 2022 페이지 : pp. 22-32 (11 pages)

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Radiotherapy (RT) is a treatment modality that uses high-energy rays or radioactive agents to generate ionizing radiation against rapidly dividing cells. The main objective of using radiation in cancer therapy is to impair or halt the division of the tumor cells. Over the past few decades, advancements in technology, the introduction of newer methods of RT, and a better understanding of the pathophysiology of cancers have enabled physicians to deliver doses of radiation that match the exact dimensions of the tumor for greater efficacy, with minimal exposure of the surrounding tissues. However, RT has numerous complications, the most common being radiation proctitis (RP). It is characterized by damage to the rectal epithelium by secondary ionizing radiation. Based on the onset of signs and symptoms, post-radiotherapy RP can be classified as acute or chronic, each with varying levels of severity and complication rates. The treatment options available for RP are limited, with most of the data on treatment available from case reports or small studies. Here, we describe the types of RT used in modern-day medicine and radiation-mediated tissue injury. We have primarily focused on the classification, epidemiology, pathogenesis, clinical features, treatment strategies, complications, and prognosis of RP. Clin Endosc 2022;55:22-32

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5Contamination Rates in Duodenoscopes Reprocessed Using Enhanced Surveillance and Reprocessing Techniques: A Systematic Review and Meta-Analysis

저자 : Shivanand Bomman , Munish Ashat , Navroop Nagra , Mahendran Jayaraj , Shruti Chandra , Richard A Kozarek , Andrew Ross , Rajesh Krishnamoorthi

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 1호 발행 연도 : 2022 페이지 : pp. 33-40 (8 pages)

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Background/Aims: Multiple outbreaks of multidrug-resistant organisms have been reported worldwide due to contaminated duodenoscopes. In 2015, the United States Food and Drug Administration recommended the following supplemental enhanced surveillance and reprocessing techniques (ESRT) to improve duodenoscope disinfection: (1) microbiological culture, (2) ethylene oxide sterilization, (3) liquid chemical sterilant processing system, and (4) double high-level disinfection. A systematic review and meta-analysis was performed to assess the impact of ESRT on the contamination rates.
Methods: A thorough and systematic search was performed across several databases and conference proceedings from inception until January 2021, and all studies reporting the effectiveness of various ESRTs were identified. The pooled contamination rates of post-ESRT duodenoscopes were estimated using the random effects model.
Results: A total of seven studies using various ESRTs were incorporated in the analysis, which included a total of 9,084 post-ESRT duodenoscope cultures. The pooled contamination rate of the post-ESRT duodenoscope was 5% (95% confidence interval [CI]: 2.3%-10.8%, inconsistency index [I2]=97.97%). Pooled contamination rates for high-risk organisms were 0.8% (95% CI: 0.2%-2.7%, I2=94.96).
Conclusions: While ESRT may improve the disinfection process, a post-ESRT contamination rate of 5% is not negligible. Ongoing efforts to mitigate the rate of contamination by improving disinfection techniques and innovations in duodenoscope design to improve safety are warranted. Clin Endosc 2022;55:33-40

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6Endoscopic Endoluminal Vacuum Therapy or Self-Expandable Metallic Stent: Treatment Option in Anastomotic Leakage after Esophageal Surgery

저자 : Chul-hyun Lim

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 1호 발행 연도 : 2022 페이지 : pp. 41-42 (2 pages)

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7Is General Anesthesia Needed in Endoscopic Submucosal Dissection for Lesions Located in the Mid to Upper Stomach?

저자 : Prasit Mahawongkajit , Jirawat Swangsri

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 1호 발행 연도 : 2022 페이지 : pp. 43-44 (2 pages)

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8Artificial Intelligence-Based Colorectal Polyp Histology Prediction: High Accuracy in Larger Polyps

저자 : Naoki Muguruma , Tetsuji Takayama

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 1호 발행 연도 : 2022 페이지 : pp. 45-46 (2 pages)

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9Value of Endoscopic Ultrasonography in Evaluating Unexplained Isolated Common Bile Duct Dilation on Imaging

저자 : Seifeldin Hakim , Amrita Sethi

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 1호 발행 연도 : 2022 페이지 : pp. 47-48 (2 pages)

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10Impact of the COVID-19 Outbreak on Anesthesiologist Assistance for Endoscopic Procedures

저자 : Calcedonio Calcara , Camilla Ciscato , Arnaldo Amato , Emanuele Sinagra , Costanza Alvisi , Sandro Ardizzone , Andrea Anderloni , Pietro Gambitta

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 1호 발행 연도 : 2022 페이지 : pp. 49-57 (9 pages)

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Background/Aims: The coronavirus disease 2019 (COVID-19) outbreak has modified the activities of endoscopy units worldwide. Herein, we investigated the impact of the COVID-19 outbreak on anesthesiologist assistance for endoscopic procedures in Lombardy, Italy.
Methods: A questionnaire concerning anesthesiologist assistance provided from October 26 to December 6, 2020, in comparison with the same period in 2019, was sent to endoscopic units in Lombardy.
Results: Approximately 54% (34/63) of the units responded. A reduction in the number of all endoscopies (-33.5%; 18792 in 2020 vs. 28264 in 2019) and anesthesiologist-assisted endoscopies (-15.3%; 2652 in 2020 vs. 3132 in 2019) was reported. A greater reduction in anesthesiologist assistance was observed in government community units (-29.5%) than in academic (-14%) and private community units (-4.6%). Among all units, 85% reported a reduction in anesthesiologist assistance; 65% observed a delay/ cancellation of procedures; 59%, a restricted patient selection; 17%, the need to transfer some patients to other hospitals; and 32%, a related worsening of procedure quality.
Conclusion: The COVID-19 pandemic compromised the anesthesiologist assistance for endoscopic procedures in Lombardy, which worsened the procedure quality mainly in government community units. The COVID-19 “stress test” suggests a more balanced allocation of anesthesiologic resources in the future. Clin Endosc 2022;55:49-57

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