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대한소화기내시경학회> Clinical Endoscopy> When to Discharge a Patient After Endoscopy: A Narrative Review

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When to Discharge a Patient After Endoscopy: A Narrative Review

Swapnil Sahebrao Walke , Shamshersingh Chauhan , Vikas Pandey , Rahul Jadhav , Vipul Chaudhari , Deepti Vishwanathan , Kailash Kolhe , Meghraj Ingle
  • : 대한소화기내시경학회
  • : Clinical Endoscopy 55권1호
  • : 연속간행물
  • : 2022년 01월
  • : 8-14(7pages)
Clinical Endoscopy

DOI


목차

INTRODUCTION
POST-ANESTHESIA DISCHARGE SCORES
NONVARICEAL BLEEDING
VARICEAL BLEEDING
LUMINAL DILATATION AND STENTING
FOREIGN BODY REMOVAL
PERCUTANEOUS ENDOSCOPIC GASTROSTOMY
ENDOSCOPIC MUCOSAL RESECTION AND ENDOSCOPIC SUBMUCOSAL DISSECTION
PERORAL ENDOSCOPIC MYOTOMY
ERCP
ENDOSCOPIC ULTRASOUND-ASSISTED INTERVENTIONAL PROCEDURES
CONCLUSIONS
Conflicts of Interest
Funding
Author Contributions
ORCID
REFERENCES

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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

UCI(KEPA)

I410-ECN-0102-2022-500-001028676

간행물정보

  • : 의약학분야  > 내과학
  • : KCI등재
  • : SCOPUS
  • : 격월
  • : 2234-2400
  • : 2234-2443
  • : 학술지
  • : 연속간행물
  • : 2011-2022
  • : 1270


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1Quality indicators in esophagogastroduodenoscopy

저자 : Sang Yoon Kim , Jae Myung Park

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 3호 발행 연도 : 2022 페이지 : pp. 319-331 (13 pages)

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Esophagogastroduodenoscopy (EGD) has been used to diagnose a wide variety of upper gastrointestinal diseases. In particular, EGD is used to screen high-risk subjects of gastric cancer. Quality control of EGD is important because the diagnostic rate is examiner-dependent. However, there is still no representative quality indicator that can be uniformly applied in EGD. There has been growing awareness of the importance of quality control in improving EGD performance. Therefore, we aimed to review the available and emerging quality indicators for diagnostic EGD.

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2Quality indicators in colonoscopy: the chasm between ideal and reality

저자 : Su Bee Park , Jae Myung Cha

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 3호 발행 연도 : 2022 페이지 : pp. 332-338 (7 pages)

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Continuous measurement of quality indicators (QIs) should be a routine part of colonoscopy, as a wide variation still exists in the performance and quality levels of colonoscopy in Korea. Among the many QIs of colonoscopy, the adenoma detection rate, average withdrawal time, bowel preparation adequacy, and cecal intubation rate should be monitored in daily clinical practice to improve the quality of the procedure. The adenoma detection rate is the best indicator of the quality of colonoscopy; however, it has many limitations for universal use in daily practice. With the development of natural language processing, the adenoma detection rate is expected to become more effective and useful. It is important that colonoscopists do not strictly and mechanically maintain an average withdrawal time of 6 minutes but instead perform careful colonoscopy to maximally expose the colonic mucosa with a withdrawal time of at least 6 minutes. To achieve adequate bowel preparation, documentation of bowel preparation with the Boston Bowel Preparation Scale (BBPS) should be a routine part of colonoscopy. When colonoscopists routinely followed the bowel preparation protocols, ≥85% of outpatient screening colonoscopies had a BBPS score of ≥6. In addition, the cecal intubation rate should be ≥95% of all screening colonoscopies. The first step in improving colonoscopy quality in Korea is to apply these key performance measurements in clinical practice.

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3Endoscopic clipping in non-variceal upper gastrointestinal bleeding treatment

저자 : Giuseppe Galloro , Angelo Zullo , Gaetano Luglio , Alessia Chini , Donato Alessandro Telesca , Rosa Maione , Matteo Pollastro , Giovanni Domenico De Palma , Raffaele Manta

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 3호 발행 연도 : 2022 페이지 : pp. 339-346 (8 pages)

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Since the earliest reports, advanced clipping systems have been developed, and it is possible to choose among many models with different structural and technical features. The main drawback of through-the-scope clips is their small size, which allows the compression of limited amounts of tissue needed for large-size vessel treatment. Therefore, the over-the-scope clip system was realized, allowing a larger and stronger mechanical compression of large tissue areas, with excellent results in achieving a definitive hemostasis in difficult cases. Many studies have analyzed the indications and efficacy of two-pronged endoclips and have shown good results for initial and permanent hemostasis. The aim of this review was to provide updated information on indications, positioning techniques, and results of clip application for endoscopic treatment of upper gastrointestinal non-variceal bleeding lesions.

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4Comparing palliative treatment options for cholangiocarcinoma: photodynamic therapy vs. radiofrequency ablation

저자 : Tayyaba Mohammad , Michel Kahaleh

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 3호 발행 연도 : 2022 페이지 : pp. 347-354 (8 pages)

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Referral to an endoscopist is often done once curative resection is no longer an option for cholangiocarcinoma management. In such cases, palliation has become the main objective of the treatment. Photodynamic therapy and radiofrequency ablation can be performed to achieve palliation, with both procedures associated with improved stent patency and survival. Despite the greatly increased cost and association with photosensitivity, photodynamic therapy allows transmission to the entire biliary tree. In contrast, radiofrequency ablation is cheaper and faster to apply, but requires intraductal contact. This paper reviews both modalities and compares their efficacy and safety for bile duct cancer palliation.

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5Does computer-aided diagnostic endoscopy improve the detection of commonly missed polyps? A meta-analysis

저자 : Arun Sivananthan , Scarlet Nazarian , Lakshmana Ayaru , Kinesh Patel , Hutan Ashrafian , Ara Darzi , Nisha Patel

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 3호 발행 연도 : 2022 페이지 : pp. 355-364 (10 pages)

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Background/Aims: Colonoscopy is the gold standard diagnostic method for colorectal neoplasia, allowing detection and resection of adenomatous polyps; however, significant proportions of adenomas are missed. Computer-aided detection (CADe) systems in endoscopy are currently available to help identify lesions. Diminutive (≤5 mm) and nonpedunculated polyps are most commonly missed. This meta-analysis aimed to assess whether CADe systems can improve the real-time detection of these commonly missed lesions.
Methods: A comprehensive literature search was performed. Randomized controlled trials evaluating CADe systems categorized by morphology and lesion size were included. The mean number of polyps and adenomas per patient was derived. Independent proportions and their differences were calculated using DerSimonian and Laird random-effects modeling.
Results: Seven studies, including 2,595 CADe-assisted colonoscopies and 2,622 conventional colonoscopies, were analyzed. CADe-assisted colonoscopy demonstrated an 80% increase in the mean number of diminutive adenomas detected per patient compared with conventional colonoscopy (0.31 vs. 0.17; effect size, 0.13; 95% confidence interval [CI], 0.09-0.18); it also demonstrated a 91.7% increase in the mean number of nonpedunculated adenomas detected per patient (0.32 vs. 0.19; effect size, 0.05; 95% CI, 0.02-0.07).
Conclusions: CADe-assisted endoscopy significantly improved the detection of most commonly missed adenomas. Although this method is a potentially exciting technology, limitations still apply to current data, prompting the need for further real-time studies.

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6Lessons learned in clinical epidemiology of esophageal adenocarcinoma

저자 : Hye Kyung Jung

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 3호 발행 연도 : 2022 페이지 : pp. 365-366 (2 pages)

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7A new band ligation device to treat colonic diverticular bleeding

저자 : Yunho Jung

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 3호 발행 연도 : 2022 페이지 : pp. 367-368 (2 pages)

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8Covered self-expandable metal stents for distal biliary obstruction from pancreatic carcinoma: what type of stent is preferred?

저자 : Hideyuki Shiomi , Ryota Nakano , Shogo Ota

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 3호 발행 연도 : 2022 페이지 : pp. 369-371 (3 pages)

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9Epidemiology of early esophageal adenocarcinoma

저자 : Thuy-van P. Hang , Zachary Spiritos , Anthony M. Gamboa , Zhengjia Chen , Seth Force , Vaishali Patel , Saurabh Chawla , Steven Keilin , Nabil F. Saba , Bassel El-rayes , Qiang Cai , Field F. Willingham

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 3호 발행 연도 : 2022 페이지 : pp. 372-380 (9 pages)

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Background/Aims: Endoscopic resection has become the preferred treatment approach for select early esophageal adenocarcinoma (EAC); however, the epidemiology of early stage disease has not been well defined.
Methods: Surveillance Epidemiology and End Results (SEER) data were analyzed to determine age-adjusted incidence rates among major epithelial carcinomas, including EAC, from 1973 to 2017. The percent change in incidence over time was compared according to tumor subtype. Early T-stage, node-negative EAC without metastasis was examined from 2004 to 2017 when precise T-stage data were available.
Results: The percent change in annual incidence from 1973 to 2017 was 767% for EAC. Joinpoint analysis showed that the average annual percent change in EAC from 1973 to 2017 was 5.11% (95% confidence interval, 4.66%-5.56%). The annual percent change appeared to plateau between 2004 and 2017; however, early EAC decreased from 2010 to 2017, with an annual percent change of -5.78%.
Conclusions: There has been a 7-fold increase in the incidence of EAC, which was significantly greater than that of the other major epithelial malignancies examined. More recently, the incidence of early EAC has been decreasing. Approximately one in five patients has node negative, potentially resectable early stage disease.

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10Outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms in patients with liver cirrhosis

저자 : Young Kwon Choi , Jin Hee Noh , Do Hoon Kim , Hee Kyong Na , Ji Yong Ahn , Jeong Hoon Lee , Kee Wook Jung , Kee Don Choi , Ho June Song , Gin Hyug Lee , Hwoon-yong Jung

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 3호 발행 연도 : 2022 페이지 : pp. 381-389 (9 pages)

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Background/Aims: The treatment of superficial esophageal neoplasms (SENs) in cirrhotic patients is challenging and rarely investigated. We evaluated the outcomes of endoscopic submucosal dissection (ESD) to determine the efficacy and safety of treating SENs in patients with liver cirrhosis.
Methods: The baseline characteristics and treatment outcomes of patients who underwent ESD for SENs between November 2005 and December 2017 were retrospectively reviewed.
Results: ESD was performed in 437 patients with 481 SENs, including 15 cirrhotic patients with 17 SENs. En bloc resection (88.2% vs. 97.0%) and curative resection (64.7% vs. 78.9%) rates were not different between the cirrhosis and non-cirrhosis groups (p=0.105 and p=0.224, respectively). Bleeding was more common in cirrhotic patients (p=0.054), and all cases were successfully controlled endoscopically. The median procedure and hospitalization duration did not differ between the groups. Overall survival was lower in cirrhotic patients (p=0.003), while disease-specific survival did not differ between the groups (p=0.85).
Conclusions: ESD could be a safe and effective treatment option for SENs in patients with cirrhosis. Detailed preprocedural assessments are needed, including determination of liver function, esophageal varix status, and remaining life expectancy, to identify patients who will obtain the greatest benefit.

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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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