Third-space endoscopy(TSE)has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors.TSE is based on the concept of working in the submucosa using a mucos...Third-space endoscopy(TSE)has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors.TSE is based on the concept of working in the submucosa using a mucosal flap valve technique,which is the underlying premise for all TSE procedures;thus,some complications are shared across the spectrum of TSE procedures.Despite the high safety profiles of most TSE procedures,studies have reported various adverse events,including insufflation-related complications,bleeding,perforation,and infection.Although the occurrence rate of those complications is not very high,they sometimes result in critical conditions.No reports of chylous effusion following TSE procedures,particularly per-oral endoscopic myotomy,have been documented previously.We are presenting the first reported case of chylous pleural effusion after per-oral endoscopic myotomy.Additionally,we aim to present a comprehensive overview,discuss the existing data,and provide insights into pulmonary post-endoscopic complications in light of recent advancements in endoscopic procedures,especially TSE.展开更多
In this letter,we comment on a recent article published in the World Journal of Gastroenterology by Xiao et al,where the authors aimed to use a deep learning model to automatically detect gastrointestinal lesions duri...In this letter,we comment on a recent article published in the World Journal of Gastroenterology by Xiao et al,where the authors aimed to use a deep learning model to automatically detect gastrointestinal lesions during capsule endoscopy(CE).CE was first presented in 2000 and was approved by the Food and Drug Administration in 2001.The indications of CE overlap with those of regular diagnostic endoscopy.However,in clinical practice,CE is usually used to detect lesions in areas inaccessible to standard endoscopies or in cases of bleeding that might be missed during conventional endoscopy.Since the emergence of CE,many physiological and technical challenges have been faced and addressed.In this letter,we summarize the current challenges and briefly mention the proposed methods to overcome these challenges to answer a central question:Do we still need CE?展开更多
Sedation practices in gastrointestinal endoscopy have evolved considerably,driven by patient demand for comfort and the need to minimize cardiopulmonary complications.Recent guidelines emphasize personalized sedation ...Sedation practices in gastrointestinal endoscopy have evolved considerably,driven by patient demand for comfort and the need to minimize cardiopulmonary complications.Recent guidelines emphasize personalized sedation strategies,risk assessment,and vigilant hemodynamic monitoring to ensure that sedation depth aligns with each patient’s comorbidities and procedural requirements.Within this landscape,the trial by Luo et al highlights the value of adding etomidate to propofol target-controlled infusion,demonstrating significantly reduced hypotension,faster induction,and fewer respiratory complications in typical American Society of Anesthesiologists I-III candidates.These findings align with broader recommendations from both European and American societies advo-cating sedation regimens that preserve stable circulation.Etomidate’s favorable hemodynamic profile,coupled with propofol’s reliability,suggests potential applications in advanced endoscopic interventions such as endoscopic retrograde cholangiopancreatography,interventional endoscopic ultrasound,and endoscopic submucosal dissection,where deeper or more sustained sedation is often required.Remimazolam,a novel short-acting benzodiazepine,has similarly been associated with reduced cardiovascular depression and faster recovery,partic-ularly in high-risk populations,although direct comparisons between etomidate-propofol and remimazolam-based regimens remain limited.Further investig-ations into these sedation strategies in higher-risk cohorts,as well as complex the-rapeutic endoscopy,will likely inform more nuanced,patient-specific protocols aimed at maximizing both safety and procedural efficiency.展开更多
The field of gastroenterology has experienced revolutionary advances over the past years,as flexible endoscopes have become widely accessible.In addition to enabling faster,less invasive,and more affordable treatment,...The field of gastroenterology has experienced revolutionary advances over the past years,as flexible endoscopes have become widely accessible.In addition to enabling faster,less invasive,and more affordable treatment,flexible endoscopes have greatly improved the detection and endoscopic screening of malignancies and prevented many cancer-related deaths.The development and clinical application of new diagnostic endoscopic technologies,such as magnification endoscopy,narrow-band imaging,endoscopic ultrasound with biopsy,and more recently,artificial intelligence enhanced technologies,have made the recognition and detection of various neoplasms and sub-epithelial tumors more possible.This review demonstrates the latest advancements in endoscopic procedures,techniques,and devices applied in the diagnosis and management of gastrointestinal cancer.展开更多
The challenge of effectively eliminating air during gastrointestinal endoscopy using ultrasound techniques is apparent.This difficulty arises from the intricacies of removing concealed air within the folds of the gast...The challenge of effectively eliminating air during gastrointestinal endoscopy using ultrasound techniques is apparent.This difficulty arises from the intricacies of removing concealed air within the folds of the gastrointestinal tract,resulting in artifacts and compromised visualization.In addition,the overlap of folds with lesions can obscure their depth and size,presenting challenges for an accurate assessment.Conversely,in intricately folded regions of the gastrointestinal tract,such as the stomach,intestine,and colon,insufficient delivery of air or CO_(2) into the cavity impedes luminal expansion,hindering the accurate visualization of lesions concealed within the folds.Although this underscores the requirement for substantial airflow,excessive airflow can hinder visualization of bleeding lesions and other abnormalities.Considering these challenges,an ideal endoscopic device would facilitate the observation of lesions without the requirement for air or CO_(2) delivery whereas,ensuring optimal expansion of the gastrointestinal tract.Recently,transparent gels with specific viscosities have been employed more frequently to address this issue.This review aims to elucidate how these gels address these challenges and provide a solution for enhanced endoscopic visualization.展开更多
BACKGROUND Surveillance colonoscopies are predominantly normal,identifying patients for potential polypectomy is advantageous.AIM To assess colon capsule endoscopy(CCE)and/or faecal immunochemical test(FIT)as filters ...BACKGROUND Surveillance colonoscopies are predominantly normal,identifying patients for potential polypectomy is advantageous.AIM To assess colon capsule endoscopy(CCE)and/or faecal immunochemical test(FIT)as filters in surveillance.METHODS Patients aged≥18 due for polyp surveillance were invited for CCE and FIT.Identifying polyps or colorectal cancer resulted in a positive CCE.Significant lesions(≥3 polyps or≥6 mm polyps),incomplete studies and positive FITs(≥225 ng/mL)were referred for endoscopy.CCE and endoscopy results,FIT accuracy and patient preference were assessed.RESULTS From a total of 126 CCEs[mean age 64(31-80),67(53.2%)males),70.6%(89/126)were excreted,86.5%(109/126)had adequate image quality.CCE positivity was 70.6%(89/126),42.9%(54/126)having significant polyps with 63.5%(80/126)referred for endoscopy(19 sigmoidoscopies,61 colonoscopies).CCE reduced endoscopy need by 36.5%(46/126)and 51.6%(65/126)were spared a colonoscopy.CCE positive predictive value was 88.2%(45/51).Significant extracolonic findings were reported in 3.2%(4/126).Patients with positive CCEs were older>65[odds ratio(OR)=2.5,95%confidence interval(CI):1.1517-5.5787,P=0.0159],with personal history of polyps(OR=2.3,95%CI:0.9734-5.4066,P=0.045),with high/intermediate polyp surveillance risk(OR=5.4,95%CI:1.1979-24.3824,P=0.0156).Overall,5/114(4.4%)FITs were positive(range:0-1394 ng/mL,mean:54 ng/mL).Sensitivity(9.6%)and negative predictive values(20.3%)were inadequate.Receiver operating curve analysis gave a sensitivity and specificity of 26.9%and 91.7%,for FIT of 43 ng/mL.Patients preferred CCE 63.3%(76/120),with less impact on daily activities(21.7%vs 93.2%)and time off work(average days 0.9 vs 1.2,P=0.0201).CONCLUSION CCE appears effective in low-risk polyp surveillance.FIT does not appear to be of benefit in surveillance.展开更多
BACKGROUND Propofol has been widely used in bidirectional gastrointestinal endoscopy sedation;however,it frequently leads to cardiovascular adverse events and respiratory depression.Propofol target-controlled infusion...BACKGROUND Propofol has been widely used in bidirectional gastrointestinal endoscopy sedation;however,it frequently leads to cardiovascular adverse events and respiratory depression.Propofol target-controlled infusion(TCI)can provide safe sedation but may require higher dosages of propofol.On the contrary,etomidate offers hemodynamic stability.AIM To evaluate the effect of different dose etomidate added to propofol TCI sedation during same-visit bidirectional endoscopy.METHODS A total of 330 patients from Fujian Provincial Hospital were randomly divided into three groups:P,0.1EP,and 0.15EP.Patients in the P group received propofol TCI only,with an initial effect-site concentration of the propofol TCI system of 3.0 mg/mL.Patients in the 0.1EP and 0.15EP groups received 0.1 and 0.15 mg/kg etomidate intravenous injection,respectively,followed by propofol TCI.RESULTS Patients in the 0.15EP group had higher mean blood pressure after induction than the other groups(P group:78 mmHg,0.1EP group:82 mmHg,0.15EP group:88 mmHg;P<0.05).Total doses of propofol consumption significantly decreased in the 0.15EP group compared with that in the other groups(P group:260.6 mg,0.1EP group:228.1 mg,0.15EP group:201.2 mg;P<0.05).The induction time was longer in the P group than in the other groups(P group:1.9±0.7 minutes,0.1EP group:1.2±0.4 minutes,0.15EP group:1.1±0.3 minutes;P<0.01).The recovery time was shorter in the 0.15EP group than in the other groups(P group:4.8±2.1 minutes,0.1EP group:4.5±1.6 minutes,0.15EP group:3.9±1.4 minutes;P<0.01).The incidence of hypotension(P group:36.4%,0.1EP group:29.1%,0.15EP group:11.8%;P<0.01)and injection pain was lower in the 0.15EP group than in the other groups(P<0.05).Furthermore,the incidence of respiratory depression was lower in the 0.15EP group than in the P group(P<0.05).Additionally,the satisfaction of the patient,endoscopist,and anesthesiologist was higher in the 0.15EP group than in the other groups(P<0.05).CONCLUSION Our findings suggest that 0.15 mg/kg etomidate plus propofol TCI can significantly reduce propofol consumption,which is followed by fewer cardiovascular adverse events and respiratory depression,along with higher patient,endoscopist,and anesthesiologist satisfaction.展开更多
Sedation is the standard of care in gastrointestinal(GI)endoscopy in most institutions.Various protocols are employed to ensure a comfor patient experience and a high procedural success rate.Benzodiazepines combined w...Sedation is the standard of care in gastrointestinal(GI)endoscopy in most institutions.Various protocols are employed to ensure a comfor patient experience and a high procedural success rate.Benzodiazepines combined with opioids are the most commonly used methods.However,these drugs have been associated with numerous adverse effects,including respiratory depression,hypoxia,and hypotension.Cohen et al conducted a study in this issue demonstrating the ability to minimize or eliminate opioid use without compromising procedural success rate or patient comfort.In this editorial,we explore the diverse sedation methods employed in GI procedures,assess the efficacy and safety of the drugs used,and highlight best practices.展开更多
Gastrointestinal endoscopy is a common examination for digestive system.The stimulation of endoscope often causes cough,nausea and vomiting,increased heart rate and blood pressure,arrhythmia,and even cardiovascular an...Gastrointestinal endoscopy is a common examination for digestive system.The stimulation of endoscope often causes cough,nausea and vomiting,increased heart rate and blood pressure,arrhythmia,and even cardiovascular and cerebrovascular accidents,thus makes people fear of this procedure.Sedation or anesthesia can effectively improve the safety,comfort and quality of gastrointestinal endoscopy.A small dose of opioids is a good adjuvant to sedatives.In this narrative review,we summarized the main roles of opioid analgesics in gastrointestinal endoscopy,including reducing visceral pain,throat irritation and the dose of sedatives.Moreover,the frequently used and novel opioids are reviewed.Classic fentanyl,sufentanil and dezocine are preferable by anesthesiologists.Newly approved oliceridine is promising to render ideal analgesic effects for gastrointestinal endoscopy.Clinical studies on oliceridine in endoscopic procedures are urgently needed.展开更多
BACKGROUND Video capsule endoscopy(VCE)is a noninvasive technique used to examine small bowel abnormalities in both adults and children.However,manual review of VCE images is time-consuming and labor-intensive,making ...BACKGROUND Video capsule endoscopy(VCE)is a noninvasive technique used to examine small bowel abnormalities in both adults and children.However,manual review of VCE images is time-consuming and labor-intensive,making it crucial to develop deep learning methods to assist in image analysis.AIM To employ deep learning models for the automatic classification of small bowel lesions using pediatric VCE images.METHODS We retrospectively analyzed VCE images from 162 pediatric patients who underwent VCE between January 2021 and December 2023 at the Children's Hospital of Nanjing Medical University.A total of 2298 high-resolution images were extracted,including normal mucosa and lesions(erosions/erythema,ulcers,and polyps).The images were split into training and test datasets in a 4:1 ratio.Four deep learning models:DenseNet121,Visual geometry group-16,ResNet50,and vision transformer were trained using 5-fold cross-validation,with hyperparameters adjusted for optimal classification performance.The models were evaluated based on accuracy,precision,recall,F1-score,and area under the receiver operating curve(AU-ROC).Lesion visualization was performed using gradient-weighted class activation mapping.RESULTS Abdominal pain was the most common indication for VCE,accounting for 62%of cases,followed by diarrhea,vomiting,and gastrointestinal bleeding.Abnormal lesions were detected in 93 children,with 38 diagnosed with inflammatory bowel disease.Among the deep learning models,DenseNet121 and ResNet50 demonstrated excellent classification performance,achieving accuracies of 90.6%[95%confidence interval(CI):89.2-92.0]and 90.5%(95%CI:89.9-91.2),respectively.The AU-ROC values for these models were 93.7%(95%CI:92.9-94.5)for DenseNet121 and 93.4%(95%CI:93.1-93.8)for ResNet50.CONCLUSION Our deep learning-based diagnostic tool developed in this study effectively classified lesions in pediatric VCE images,contributing to more accurate diagnoses and increased diagnostic efficiency.展开更多
BACKGROUND Elderly patients often display age-related physiological decline,which increases their susceptibility to complications during medical procedures.Therefore,it is clinically imperative to refine anesthetic pr...BACKGROUND Elderly patients often display age-related physiological decline,which increases their susceptibility to complications during medical procedures.Therefore,it is clinically imperative to refine anesthetic protocols for painless gastroscopy in this vulnerable population.AIM To explore the effects of the etomidate-propofol combination on anesthesia quality,compliance,and adverse reactions in elderly patients undergoing painless gastrointestinal endoscopy.METHODS A total of 103 elderly patients scheduled for painless gastrointestinal endoscopy at the Hospital of Wuhan Economic and Technological Development Zone(Hannan District)between October 2022 and October 2024 were enrolled.The participants were divided into a control group(n=50)receiving propofol anesthesia and an observation group(n=53)that received a combination of etomidate and propofol anesthesia.The anesthesia quality(including induction time,recovery time,and orientation recovery time),compliance,hemodynamic parameters(heart rate,oxygen saturation,systolic/diastolic blood pressure),adverse reactions(muscle tremors,injection pain,respiratory depression,hypotension,and nausea/vomiting),and analgesic and sedative effects[evaluated using the visual analog scale(VAS)and Ramsay score]were comparatively analyzed.RESULTS The observation group had significantly shorter anesthesia induction,recovery,and orientation recovery times than the control group.Moreover,the observation group showed higher compliance;greater hemodynamic stability at preanesthesia(T0),during anesthesia(T1),and postrecovery(T2)time points;and a significantly lower incidence of adverse reactions.The VAS and Ramsay scores at 5,30,and 60 minutes after anesthesia recovery were also significantly lower in the observation group than in the control group.CONCLUSION The etomidate-propofol combination for painless gastrointestinal endoscopy in elderly patients may provide superior anesthesia quality and improved compliance and safety,making it a promising approach for clinical application.展开更多
Background:To evaluate the feasibility and safety of a novel cable-transmitted magnetically controlled capsule endoscopy(CTMCE)system for upper gastrointestinal examination.Methods:Twenty-six participants(19 healthy v...Background:To evaluate the feasibility and safety of a novel cable-transmitted magnetically controlled capsule endoscopy(CTMCE)system for upper gastrointestinal examination.Methods:Twenty-six participants(19 healthy volunteers and seven patients with gastrointestinal symptoms)willing to undergo upper gastrointestinal endoscopy were recruited.Each participant underwent CT-MCE followed by conventional gastroscopy within 24 h.Maneuverability and visibility of the CT-MCE capsule in the upper gastrointestinal tract,adverse events,and discomfort during the procedure were evaluated.The sensitivity and specificity of CT-MCE for diagnosing upper gastrointestinal lesions were evaluated using conventional gastroscopy findings as the standard.Results:Maneuverability was graded as“good”for all segments of the esophagus.The percentage of participants in which maneuverability was good according to gastric region was as follows:cardia(100.00%),pylorus(96.15%),angulus(92.31%),antrum(88.46%),fundus(84.62%),and body(73.08%).In the duodenal bulb and descending duodenum,it was good in only 20.83% and 16.67% of participants,respectively.Visibility was graded as“excellent”or“good”in the esophagus,Z line,and duodenal bulb in all participants;excellent/good visibility was achieved in the stomach and descending duodenum in 96.15% and 79.17% of participants,respectively.Forty-one lesions were detected overall.The sensitivity and specificity of CT-MCE in diagnosing upper gastrointestinal lesions were 85.00% and 98.15%,respectively.The CT-MCE capsule was successfully removed through the mouth in all participants.No serious adverse events or capsule retention occurred.Conclusions:CT-MCE showed good feasibility and safety for upper gastrointestinal examination.The system was effective in examining the esophagus and stomach with no risk of capsule retention.展开更多
Digestive endoscopy is widely performed in clinical practice,including in children,and has revolutionized the diagnosis and treatment of many gastro-intestinal(GI)disorders.Interventional procedures are increasingly u...Digestive endoscopy is widely performed in clinical practice,including in children,and has revolutionized the diagnosis and treatment of many gastro-intestinal(GI)disorders.Interventional procedures are increasingly utilized,particularly for hepatobiliary and pancreatic diseases.However,only a limited number of gastroenterologists are trained and experienced to perform endoscopic retrograde cholangiopancreatography and endoscopic ultrasound in pediatric patients.While GI endoscopic emergencies in children are uncommon,they can be serious.Effective care demands true multidisciplinary teamwork,with close and ongoing collaboration between gastroenterologists,anesthetists,and the pe-diatric team especially in centres where pediatric endoscopy specialists are not available.This mini-review outlines current practices in pediatric digestive endoscopy and explores recent advances in interventional endoscopy compared to adult patients.展开更多
BACKGROUND Small-bowel capsule endoscopy(SBCE)is widely used to evaluate obscure gastrointestinal bleeding;however,its interpretation is time-consuming and reader-dependent.Although artificial intelligence(AI)has emer...BACKGROUND Small-bowel capsule endoscopy(SBCE)is widely used to evaluate obscure gastrointestinal bleeding;however,its interpretation is time-consuming and reader-dependent.Although artificial intelligence(AI)has emerged to address these limitations,few models simultaneously perform small-bowel(SB)loca lization and abnormality detection.AIMTo develop an AI model that automatically distinguishes the SB from the stomach and colon and diagnoses SBabnormalities.METHODSWe developed an AI model using 87005 CE images (11925, 33781, and 41299 from the stomach, SB, and colon,respectively) for SB localization and 28405 SBCE images (1337 erosions/ulcers, 126 angiodysplasia, 494 bleeding,and 26448 normal) for abnormality detection. The diagnostic performances of AI-assisted reading and conventionalreading were compared using 32 SBCE videos in patients with suspicious SB bleeding.RESULTSRegarding organ localization, the AI model achieved an area under the receiver operating characteristic curve(AUC) and accuracy exceeding 0.99 and 97%, respectively. For SB abnormality detection, the performance was asfollows: Erosion/ulcer: 99.4% accuracy (AUC, 0.98);angiodysplasia: 99.8% accuracy (AUC, 0.99);bleeding: 99.9%accuracy (AUC, 0.99);normal: 99.3% accuracy (AUC, 0.98). In external validation, AI-assisted reading (8.7 minutes)was significantly faster than conventional reading (53.9 minutes;P < 0.001). The SB localization accuracies (88.6% vs72.7%, P = 0.07) and SB abnormality detection rates (77.3% vs 77.3%, P = 1.00) of the conventional reading and AIassistedreading were comparable.CONCLUSIONOur AI model decreased SBCE reading time and achieved performance comparable to that of experiencedendoscopists, suggesting that AI integration into SBCE reading enables efficient and reliable SB abnormalitydetection.展开更多
Objective:To investigate the clinical application effect of ciprofol combined with low-dose esketamine in painless gastrointestinal endoscopy.Methods:A retrospective analysis was conducted on the clinical data of 160 ...Objective:To investigate the clinical application effect of ciprofol combined with low-dose esketamine in painless gastrointestinal endoscopy.Methods:A retrospective analysis was conducted on the clinical data of 160 patients who underwent painless gastrointestinal endoscopy at the Digestive Endoscopy Center of Chengdu Integrated Traditional Chinese and Western Medicine Hospital from June 2023 to June 2024.The patients were divided into a control group(ciprofol+sufentanil,n=80)and a study group(ciprofol+esketamine,n=80)based on the anesthesia protocol they received.Hemodynamic indicators[mean arterial pressure(MAP),heart rate(HR),and blood oxygen saturation(SpO2)],anesthesia-related indicators,sedation effectiveness,and the incidence of adverse events were observed and compared between the two groups at different time points during the examination.Results:The fluctuations in HR and MAP at three time points(after induction,during endoscope insertion,and during the examination)were significantly smaller in the study group than in the control group(all P<0.05),indicating more stable hemodynamics.The total amount of sedative drugs used,the number of additional sedative doses administered,and the time spent in the post-anesthesia care unit were significantly lower in the study group than in the control group(all P<0.05).There was no significant difference in the success rate of sedation between the two groups(98.75%vs.96.25%,P>0.05).The incidence of adverse events was lower in the study group than in the control group(3.75%vs.13.75%,P<0.05).Conclusion:The use of low-dose esketamine as an adjuvant analgesic drug based on ciprofol sedation can effectively maintain hemodynamic stability,reduce the amount of sedative drugs used,facilitate rapid recovery of patients,and lower the risk of adverse events.展开更多
BACKGROUND Gastrointestinal bleeding(GIB)is a critical complication often seen in patients with acute coronary syndrome(ACS),especially those undergoing dual antiplatelet therapy.GIB is associated with increased morta...BACKGROUND Gastrointestinal bleeding(GIB)is a critical complication often seen in patients with acute coronary syndrome(ACS),especially those undergoing dual antiplatelet therapy.GIB is associated with increased mortality and prolonged hospitalization,particularly in ACS patients.Despite advancements in management strategies,the role of gastrointestinal endoscopy(GIE)in this population remains controversial,with concerns about timing,safety,and clinical outcomes.AIM To evaluate the safety and efficacy of GIE in patients with ACS and acute GIB,focusing on outcomes such as mortality,hospital length of stay(LOS),hemorrhage control,rebleeding,and blood transfusion requirements.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines,a systematic review was conducted using databases including PubMed,Cochrane,and EMBASE,up to December 2024.The protocol was registered with the International Prospective Register of Systematic Reviews(CRD42025630188).Study quality was assessed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials(RCTs)and the Newcastle-Ottawa Scale for cohort studies.RESULTS Four studies met the inclusion criteria,comprising one RCT and three cohort studies with a total population of 1676130 patients.Most studies indicated that GIE was associated with improved survival in ACS patients with GIB.Three of our studies reported lower mortality rates in patients undergoing GIE compared to those managed without endoscopy,although this varied by study.While GIE demonstrated effectiveness in controlling hemorrhage and reducing rebleeding rates in one study.The rest of the studies did not evaluate these outcomes comprehensively.Hospital LOS outcomes were inconsistent,with two studies suggesting no significant difference,while only one study indicated potential reductions in LOS with GIE.Blood transfusion requirements were reported in one study to be higher in patients undergoing GIE,reflecting its frequent use in severe cases.The safety and effectiveness of GIE varied depending on patient characteristics,timing of the procedure,and type of intervention.CONCLUSION GIE has the potential to improve survival in certain patients with ACS complicated by GIB;however,determining the ideal timing and appropriate candidates necessitates careful individual assessment.While evidence suggests benefits,the limitations of observational studies warrant caution.Collaboration between cardiology and gastroenterology is essential to optimizing outcomes.Future randomized trials should focus on timing,severity,and diverse populations to refine guidelines and improve care for this high-risk group.展开更多
BACKGROUND Gastrointestinal bleeding(GIB)is a major cause of hospitalization worldwide.Patients with hematologic malignancies have a higher risk of GIB as a result of thrombocytopenia and platelet dysfunction.There is...BACKGROUND Gastrointestinal bleeding(GIB)is a major cause of hospitalization worldwide.Patients with hematologic malignancies have a higher risk of GIB as a result of thrombocytopenia and platelet dysfunction.There is no consensus on the optimal platelet level that would be safe for endoscopic intervention,although a platelet level of>50×10^(9)/L was suggested based on expert opinion.There is a paucity of data on whether endoscopic intervention and the timing of endoscopy impacted the outcome of patients with hematologic malignancy and severe thrombocytopenia who experienced acute overt GIB.AIM To assess the safety of endoscopic intervention of inpatients with hematological malignancies and severe thrombocytopenia presenting with acute overt GIB.METHODS This is a single center retrospective study.The data was collected from the electronic health record from 2018 to 2020.Inpatients with hematologic malignancy who presented with acute overt GIB and platelet count≤50×10^(9)/L were included in the study.Outcomes included mortality,transfusion requirements,length of stay,intensive care unit admission and recurrent bleeding.A subgroup analysis was performed to compare the outcomes of urgent endoscopy within 24 hours of GIB vs endoscopy>24 hours.RESULTS A total of 76 patients were identified.The mean platelet count is 24.3 in the endoscopy arm and 14.6 in the conservative management arm.There was no statistically significant difference between patients who had endoscopy vs conservative management in 30-day(P=0.13)or 1 year(P=0.78)mortality,recurrent bleeding(P=0.68),transfusion of red blood cells(P=0.47),platelets(P=0.31),or length of stay(P=0.94).A subgroup analysis comparing urgent endoscopy within 24 hours compared with delayed endoscopy showed urgent endoscopy was not associated with improved 30-day or 1 year mortality(P=0.11 and 0.46,respectively)compared to routine endoscopy,but was associated with decreased recurrent bleeding in 30 days(P=0.01).CONCLUSION Medical supportive treatment without endoscopy could be considered as an alternative to endoscopic therapy for patients with hematologic malignancy complicated by severe thrombocytopenia and acute non-variceal GIB.展开更多
BACKGROUND Colorectal cancer(CRC)has become the third leading cancer with the third highest occurrence rate and the second highest death ratio globally.Its incidence and mortality rates have been increasing annually i...BACKGROUND Colorectal cancer(CRC)has become the third leading cancer with the third highest occurrence rate and the second highest death ratio globally.Its incidence and mortality rates have been increasing annually in recent years,posing a serious threat to global public health.Digestive endoscopy technology can not only be used for the diagnosis of CRC,but it can also be used in determining the depth of infiltration in early CRC.There are significant deficiencies in care measures in this area.METHODS A total of 120 CRC patients were randomly and equally divided into a control group and an observation group.The patients in the control group received basic routine nursing care,and the patients in the observation group received sys-tematic digestive endoscopy center nursing care.The patients'compliance and nursing satisfaction were observed and recorded,as well as the Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS)and Visual Analogue Scale(VAS)scores.RESULTS After care,the SAS and SDS scale scores of patients in both groups significantly decreased compared to before care(P<0.05).The VAS scale scores significantly increased for each group compared to before examination(P<0.05).The SAS,SDS and VAS scale scores of the observation group were significantly lower than those of the control group after nursing care(P<0.05),and compliance and satisfaction of nursing care were significantly higher than those of the control group(P<0.05).CONCLUSION Digestive endoscopy center nursing can effectively intervene in and improve the psychological state and pain level of CRC patients,suggesting it is a valuable approach to adopt in the clinic.展开更多
There is still a dearth of systematic study on picture stitching techniques for the natural tubular structures of intestines,and traditional stitching techniques have a poor application to endoscopic images with deep ...There is still a dearth of systematic study on picture stitching techniques for the natural tubular structures of intestines,and traditional stitching techniques have a poor application to endoscopic images with deep scenes.In order to recreate the intestinal wall in two dimensions,a method is developed.The normalized Laplacian algorithm is used to enhance the image and transform it into polar coordinates according to the characteristics that intestinal images are not obvious and usually arranged in a circle,in order to extract the new image segments of the current image relative to the previous image.The improved weighted fusion algorithm is then used to sequentially splice the segment images.The experimental results demonstrate that the suggested approach can improve image clarity and minimize noise while maintaining the information content of intestinal images.In addition,the method's seamless transition between the final portions of a panoramic image also demonstrates that the stitching trace has been removed.展开更多
BACKGROUND Air embolism(AE)is a rare but potentially fatal complication of intestinal endoscopy(IE).CASE SUMMARY Herein,we report the case of an 18-year-old woman who underwent a successful Kasai portoenterostomy(KPE)...BACKGROUND Air embolism(AE)is a rare but potentially fatal complication of intestinal endoscopy(IE).CASE SUMMARY Herein,we report the case of an 18-year-old woman who underwent a successful Kasai portoenterostomy(KPE)for biliary atresia but died of AE during intraoperative IE for stone removal at the portoenterostomy site.Our review of the English literature identified only four similar cases of fatal AE during IE in patients undergoing KPE.The common clinical setting in the five patients,including our case,was high-pressure air insufflation into the blind closed afferent loop of the KPE to secure visibility.We hypothesize that the highly pressurized air injected into the closed loop entered the bile canaliculi—previously opened by KPE for bile drainage—passed through the tiny,microscopic pores of the fenestrated liver sinusoid endothelial cells,and finally entered the bloodstream with ease,resulting in fatal AE.CONCLUSION Meticulous performance of IE,especially on the KPE blind loop,is warranted owing to the risk of AE.展开更多
文摘Third-space endoscopy(TSE)has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors.TSE is based on the concept of working in the submucosa using a mucosal flap valve technique,which is the underlying premise for all TSE procedures;thus,some complications are shared across the spectrum of TSE procedures.Despite the high safety profiles of most TSE procedures,studies have reported various adverse events,including insufflation-related complications,bleeding,perforation,and infection.Although the occurrence rate of those complications is not very high,they sometimes result in critical conditions.No reports of chylous effusion following TSE procedures,particularly per-oral endoscopic myotomy,have been documented previously.We are presenting the first reported case of chylous pleural effusion after per-oral endoscopic myotomy.Additionally,we aim to present a comprehensive overview,discuss the existing data,and provide insights into pulmonary post-endoscopic complications in light of recent advancements in endoscopic procedures,especially TSE.
文摘In this letter,we comment on a recent article published in the World Journal of Gastroenterology by Xiao et al,where the authors aimed to use a deep learning model to automatically detect gastrointestinal lesions during capsule endoscopy(CE).CE was first presented in 2000 and was approved by the Food and Drug Administration in 2001.The indications of CE overlap with those of regular diagnostic endoscopy.However,in clinical practice,CE is usually used to detect lesions in areas inaccessible to standard endoscopies or in cases of bleeding that might be missed during conventional endoscopy.Since the emergence of CE,many physiological and technical challenges have been faced and addressed.In this letter,we summarize the current challenges and briefly mention the proposed methods to overcome these challenges to answer a central question:Do we still need CE?
文摘Sedation practices in gastrointestinal endoscopy have evolved considerably,driven by patient demand for comfort and the need to minimize cardiopulmonary complications.Recent guidelines emphasize personalized sedation strategies,risk assessment,and vigilant hemodynamic monitoring to ensure that sedation depth aligns with each patient’s comorbidities and procedural requirements.Within this landscape,the trial by Luo et al highlights the value of adding etomidate to propofol target-controlled infusion,demonstrating significantly reduced hypotension,faster induction,and fewer respiratory complications in typical American Society of Anesthesiologists I-III candidates.These findings align with broader recommendations from both European and American societies advo-cating sedation regimens that preserve stable circulation.Etomidate’s favorable hemodynamic profile,coupled with propofol’s reliability,suggests potential applications in advanced endoscopic interventions such as endoscopic retrograde cholangiopancreatography,interventional endoscopic ultrasound,and endoscopic submucosal dissection,where deeper or more sustained sedation is often required.Remimazolam,a novel short-acting benzodiazepine,has similarly been associated with reduced cardiovascular depression and faster recovery,partic-ularly in high-risk populations,although direct comparisons between etomidate-propofol and remimazolam-based regimens remain limited.Further investig-ations into these sedation strategies in higher-risk cohorts,as well as complex the-rapeutic endoscopy,will likely inform more nuanced,patient-specific protocols aimed at maximizing both safety and procedural efficiency.
文摘The field of gastroenterology has experienced revolutionary advances over the past years,as flexible endoscopes have become widely accessible.In addition to enabling faster,less invasive,and more affordable treatment,flexible endoscopes have greatly improved the detection and endoscopic screening of malignancies and prevented many cancer-related deaths.The development and clinical application of new diagnostic endoscopic technologies,such as magnification endoscopy,narrow-band imaging,endoscopic ultrasound with biopsy,and more recently,artificial intelligence enhanced technologies,have made the recognition and detection of various neoplasms and sub-epithelial tumors more possible.This review demonstrates the latest advancements in endoscopic procedures,techniques,and devices applied in the diagnosis and management of gastrointestinal cancer.
文摘The challenge of effectively eliminating air during gastrointestinal endoscopy using ultrasound techniques is apparent.This difficulty arises from the intricacies of removing concealed air within the folds of the gastrointestinal tract,resulting in artifacts and compromised visualization.In addition,the overlap of folds with lesions can obscure their depth and size,presenting challenges for an accurate assessment.Conversely,in intricately folded regions of the gastrointestinal tract,such as the stomach,intestine,and colon,insufficient delivery of air or CO_(2) into the cavity impedes luminal expansion,hindering the accurate visualization of lesions concealed within the folds.Although this underscores the requirement for substantial airflow,excessive airflow can hinder visualization of bleeding lesions and other abnormalities.Considering these challenges,an ideal endoscopic device would facilitate the observation of lesions without the requirement for air or CO_(2) delivery whereas,ensuring optimal expansion of the gastrointestinal tract.Recently,transparent gels with specific viscosities have been employed more frequently to address this issue.This review aims to elucidate how these gels address these challenges and provide a solution for enhanced endoscopic visualization.
文摘BACKGROUND Surveillance colonoscopies are predominantly normal,identifying patients for potential polypectomy is advantageous.AIM To assess colon capsule endoscopy(CCE)and/or faecal immunochemical test(FIT)as filters in surveillance.METHODS Patients aged≥18 due for polyp surveillance were invited for CCE and FIT.Identifying polyps or colorectal cancer resulted in a positive CCE.Significant lesions(≥3 polyps or≥6 mm polyps),incomplete studies and positive FITs(≥225 ng/mL)were referred for endoscopy.CCE and endoscopy results,FIT accuracy and patient preference were assessed.RESULTS From a total of 126 CCEs[mean age 64(31-80),67(53.2%)males),70.6%(89/126)were excreted,86.5%(109/126)had adequate image quality.CCE positivity was 70.6%(89/126),42.9%(54/126)having significant polyps with 63.5%(80/126)referred for endoscopy(19 sigmoidoscopies,61 colonoscopies).CCE reduced endoscopy need by 36.5%(46/126)and 51.6%(65/126)were spared a colonoscopy.CCE positive predictive value was 88.2%(45/51).Significant extracolonic findings were reported in 3.2%(4/126).Patients with positive CCEs were older>65[odds ratio(OR)=2.5,95%confidence interval(CI):1.1517-5.5787,P=0.0159],with personal history of polyps(OR=2.3,95%CI:0.9734-5.4066,P=0.045),with high/intermediate polyp surveillance risk(OR=5.4,95%CI:1.1979-24.3824,P=0.0156).Overall,5/114(4.4%)FITs were positive(range:0-1394 ng/mL,mean:54 ng/mL).Sensitivity(9.6%)and negative predictive values(20.3%)were inadequate.Receiver operating curve analysis gave a sensitivity and specificity of 26.9%and 91.7%,for FIT of 43 ng/mL.Patients preferred CCE 63.3%(76/120),with less impact on daily activities(21.7%vs 93.2%)and time off work(average days 0.9 vs 1.2,P=0.0201).CONCLUSION CCE appears effective in low-risk polyp surveillance.FIT does not appear to be of benefit in surveillance.
文摘BACKGROUND Propofol has been widely used in bidirectional gastrointestinal endoscopy sedation;however,it frequently leads to cardiovascular adverse events and respiratory depression.Propofol target-controlled infusion(TCI)can provide safe sedation but may require higher dosages of propofol.On the contrary,etomidate offers hemodynamic stability.AIM To evaluate the effect of different dose etomidate added to propofol TCI sedation during same-visit bidirectional endoscopy.METHODS A total of 330 patients from Fujian Provincial Hospital were randomly divided into three groups:P,0.1EP,and 0.15EP.Patients in the P group received propofol TCI only,with an initial effect-site concentration of the propofol TCI system of 3.0 mg/mL.Patients in the 0.1EP and 0.15EP groups received 0.1 and 0.15 mg/kg etomidate intravenous injection,respectively,followed by propofol TCI.RESULTS Patients in the 0.15EP group had higher mean blood pressure after induction than the other groups(P group:78 mmHg,0.1EP group:82 mmHg,0.15EP group:88 mmHg;P<0.05).Total doses of propofol consumption significantly decreased in the 0.15EP group compared with that in the other groups(P group:260.6 mg,0.1EP group:228.1 mg,0.15EP group:201.2 mg;P<0.05).The induction time was longer in the P group than in the other groups(P group:1.9±0.7 minutes,0.1EP group:1.2±0.4 minutes,0.15EP group:1.1±0.3 minutes;P<0.01).The recovery time was shorter in the 0.15EP group than in the other groups(P group:4.8±2.1 minutes,0.1EP group:4.5±1.6 minutes,0.15EP group:3.9±1.4 minutes;P<0.01).The incidence of hypotension(P group:36.4%,0.1EP group:29.1%,0.15EP group:11.8%;P<0.01)and injection pain was lower in the 0.15EP group than in the other groups(P<0.05).Furthermore,the incidence of respiratory depression was lower in the 0.15EP group than in the P group(P<0.05).Additionally,the satisfaction of the patient,endoscopist,and anesthesiologist was higher in the 0.15EP group than in the other groups(P<0.05).CONCLUSION Our findings suggest that 0.15 mg/kg etomidate plus propofol TCI can significantly reduce propofol consumption,which is followed by fewer cardiovascular adverse events and respiratory depression,along with higher patient,endoscopist,and anesthesiologist satisfaction.
文摘Sedation is the standard of care in gastrointestinal(GI)endoscopy in most institutions.Various protocols are employed to ensure a comfor patient experience and a high procedural success rate.Benzodiazepines combined with opioids are the most commonly used methods.However,these drugs have been associated with numerous adverse effects,including respiratory depression,hypoxia,and hypotension.Cohen et al conducted a study in this issue demonstrating the ability to minimize or eliminate opioid use without compromising procedural success rate or patient comfort.In this editorial,we explore the diverse sedation methods employed in GI procedures,assess the efficacy and safety of the drugs used,and highlight best practices.
基金Supported by Wu Jieping Foundation,No.320.6750.2024-05-55.
文摘Gastrointestinal endoscopy is a common examination for digestive system.The stimulation of endoscope often causes cough,nausea and vomiting,increased heart rate and blood pressure,arrhythmia,and even cardiovascular and cerebrovascular accidents,thus makes people fear of this procedure.Sedation or anesthesia can effectively improve the safety,comfort and quality of gastrointestinal endoscopy.A small dose of opioids is a good adjuvant to sedatives.In this narrative review,we summarized the main roles of opioid analgesics in gastrointestinal endoscopy,including reducing visceral pain,throat irritation and the dose of sedatives.Moreover,the frequently used and novel opioids are reviewed.Classic fentanyl,sufentanil and dezocine are preferable by anesthesiologists.Newly approved oliceridine is promising to render ideal analgesic effects for gastrointestinal endoscopy.Clinical studies on oliceridine in endoscopic procedures are urgently needed.
文摘BACKGROUND Video capsule endoscopy(VCE)is a noninvasive technique used to examine small bowel abnormalities in both adults and children.However,manual review of VCE images is time-consuming and labor-intensive,making it crucial to develop deep learning methods to assist in image analysis.AIM To employ deep learning models for the automatic classification of small bowel lesions using pediatric VCE images.METHODS We retrospectively analyzed VCE images from 162 pediatric patients who underwent VCE between January 2021 and December 2023 at the Children's Hospital of Nanjing Medical University.A total of 2298 high-resolution images were extracted,including normal mucosa and lesions(erosions/erythema,ulcers,and polyps).The images were split into training and test datasets in a 4:1 ratio.Four deep learning models:DenseNet121,Visual geometry group-16,ResNet50,and vision transformer were trained using 5-fold cross-validation,with hyperparameters adjusted for optimal classification performance.The models were evaluated based on accuracy,precision,recall,F1-score,and area under the receiver operating curve(AU-ROC).Lesion visualization was performed using gradient-weighted class activation mapping.RESULTS Abdominal pain was the most common indication for VCE,accounting for 62%of cases,followed by diarrhea,vomiting,and gastrointestinal bleeding.Abnormal lesions were detected in 93 children,with 38 diagnosed with inflammatory bowel disease.Among the deep learning models,DenseNet121 and ResNet50 demonstrated excellent classification performance,achieving accuracies of 90.6%[95%confidence interval(CI):89.2-92.0]and 90.5%(95%CI:89.9-91.2),respectively.The AU-ROC values for these models were 93.7%(95%CI:92.9-94.5)for DenseNet121 and 93.4%(95%CI:93.1-93.8)for ResNet50.CONCLUSION Our deep learning-based diagnostic tool developed in this study effectively classified lesions in pediatric VCE images,contributing to more accurate diagnoses and increased diagnostic efficiency.
文摘BACKGROUND Elderly patients often display age-related physiological decline,which increases their susceptibility to complications during medical procedures.Therefore,it is clinically imperative to refine anesthetic protocols for painless gastroscopy in this vulnerable population.AIM To explore the effects of the etomidate-propofol combination on anesthesia quality,compliance,and adverse reactions in elderly patients undergoing painless gastrointestinal endoscopy.METHODS A total of 103 elderly patients scheduled for painless gastrointestinal endoscopy at the Hospital of Wuhan Economic and Technological Development Zone(Hannan District)between October 2022 and October 2024 were enrolled.The participants were divided into a control group(n=50)receiving propofol anesthesia and an observation group(n=53)that received a combination of etomidate and propofol anesthesia.The anesthesia quality(including induction time,recovery time,and orientation recovery time),compliance,hemodynamic parameters(heart rate,oxygen saturation,systolic/diastolic blood pressure),adverse reactions(muscle tremors,injection pain,respiratory depression,hypotension,and nausea/vomiting),and analgesic and sedative effects[evaluated using the visual analog scale(VAS)and Ramsay score]were comparatively analyzed.RESULTS The observation group had significantly shorter anesthesia induction,recovery,and orientation recovery times than the control group.Moreover,the observation group showed higher compliance;greater hemodynamic stability at preanesthesia(T0),during anesthesia(T1),and postrecovery(T2)time points;and a significantly lower incidence of adverse reactions.The VAS and Ramsay scores at 5,30,and 60 minutes after anesthesia recovery were also significantly lower in the observation group than in the control group.CONCLUSION The etomidate-propofol combination for painless gastrointestinal endoscopy in elderly patients may provide superior anesthesia quality and improved compliance and safety,making it a promising approach for clinical application.
基金supported by the National Key Research and Development Program(2019YFC0120303)and was sponsored by the Beijing Nova Program(20240484678).
文摘Background:To evaluate the feasibility and safety of a novel cable-transmitted magnetically controlled capsule endoscopy(CTMCE)system for upper gastrointestinal examination.Methods:Twenty-six participants(19 healthy volunteers and seven patients with gastrointestinal symptoms)willing to undergo upper gastrointestinal endoscopy were recruited.Each participant underwent CT-MCE followed by conventional gastroscopy within 24 h.Maneuverability and visibility of the CT-MCE capsule in the upper gastrointestinal tract,adverse events,and discomfort during the procedure were evaluated.The sensitivity and specificity of CT-MCE for diagnosing upper gastrointestinal lesions were evaluated using conventional gastroscopy findings as the standard.Results:Maneuverability was graded as“good”for all segments of the esophagus.The percentage of participants in which maneuverability was good according to gastric region was as follows:cardia(100.00%),pylorus(96.15%),angulus(92.31%),antrum(88.46%),fundus(84.62%),and body(73.08%).In the duodenal bulb and descending duodenum,it was good in only 20.83% and 16.67% of participants,respectively.Visibility was graded as“excellent”or“good”in the esophagus,Z line,and duodenal bulb in all participants;excellent/good visibility was achieved in the stomach and descending duodenum in 96.15% and 79.17% of participants,respectively.Forty-one lesions were detected overall.The sensitivity and specificity of CT-MCE in diagnosing upper gastrointestinal lesions were 85.00% and 98.15%,respectively.The CT-MCE capsule was successfully removed through the mouth in all participants.No serious adverse events or capsule retention occurred.Conclusions:CT-MCE showed good feasibility and safety for upper gastrointestinal examination.The system was effective in examining the esophagus and stomach with no risk of capsule retention.
文摘Digestive endoscopy is widely performed in clinical practice,including in children,and has revolutionized the diagnosis and treatment of many gastro-intestinal(GI)disorders.Interventional procedures are increasingly utilized,particularly for hepatobiliary and pancreatic diseases.However,only a limited number of gastroenterologists are trained and experienced to perform endoscopic retrograde cholangiopancreatography and endoscopic ultrasound in pediatric patients.While GI endoscopic emergencies in children are uncommon,they can be serious.Effective care demands true multidisciplinary teamwork,with close and ongoing collaboration between gastroenterologists,anesthetists,and the pe-diatric team especially in centres where pediatric endoscopy specialists are not available.This mini-review outlines current practices in pediatric digestive endoscopy and explores recent advances in interventional endoscopy compared to adult patients.
基金Supported by The Bio and Medical Technology Development Program of the National Research Foundation,No.NRF-2022R1C1C1010643.
文摘BACKGROUND Small-bowel capsule endoscopy(SBCE)is widely used to evaluate obscure gastrointestinal bleeding;however,its interpretation is time-consuming and reader-dependent.Although artificial intelligence(AI)has emerged to address these limitations,few models simultaneously perform small-bowel(SB)loca lization and abnormality detection.AIMTo develop an AI model that automatically distinguishes the SB from the stomach and colon and diagnoses SBabnormalities.METHODSWe developed an AI model using 87005 CE images (11925, 33781, and 41299 from the stomach, SB, and colon,respectively) for SB localization and 28405 SBCE images (1337 erosions/ulcers, 126 angiodysplasia, 494 bleeding,and 26448 normal) for abnormality detection. The diagnostic performances of AI-assisted reading and conventionalreading were compared using 32 SBCE videos in patients with suspicious SB bleeding.RESULTSRegarding organ localization, the AI model achieved an area under the receiver operating characteristic curve(AUC) and accuracy exceeding 0.99 and 97%, respectively. For SB abnormality detection, the performance was asfollows: Erosion/ulcer: 99.4% accuracy (AUC, 0.98);angiodysplasia: 99.8% accuracy (AUC, 0.99);bleeding: 99.9%accuracy (AUC, 0.99);normal: 99.3% accuracy (AUC, 0.98). In external validation, AI-assisted reading (8.7 minutes)was significantly faster than conventional reading (53.9 minutes;P < 0.001). The SB localization accuracies (88.6% vs72.7%, P = 0.07) and SB abnormality detection rates (77.3% vs 77.3%, P = 1.00) of the conventional reading and AIassistedreading were comparable.CONCLUSIONOur AI model decreased SBCE reading time and achieved performance comparable to that of experiencedendoscopists, suggesting that AI integration into SBCE reading enables efficient and reliable SB abnormalitydetection.
基金China Red Cross Foundation Medical Empowerment Special Fund-“Medical Empowerment and Talent Cultivation Program”Clinical Research ProjectProject Title:A Clinical Study on the Use of Esketamine at Different Dosages Combined with Propofol for Painless Gastroscopy(Project No.:GCP-2022-022)。
文摘Objective:To investigate the clinical application effect of ciprofol combined with low-dose esketamine in painless gastrointestinal endoscopy.Methods:A retrospective analysis was conducted on the clinical data of 160 patients who underwent painless gastrointestinal endoscopy at the Digestive Endoscopy Center of Chengdu Integrated Traditional Chinese and Western Medicine Hospital from June 2023 to June 2024.The patients were divided into a control group(ciprofol+sufentanil,n=80)and a study group(ciprofol+esketamine,n=80)based on the anesthesia protocol they received.Hemodynamic indicators[mean arterial pressure(MAP),heart rate(HR),and blood oxygen saturation(SpO2)],anesthesia-related indicators,sedation effectiveness,and the incidence of adverse events were observed and compared between the two groups at different time points during the examination.Results:The fluctuations in HR and MAP at three time points(after induction,during endoscope insertion,and during the examination)were significantly smaller in the study group than in the control group(all P<0.05),indicating more stable hemodynamics.The total amount of sedative drugs used,the number of additional sedative doses administered,and the time spent in the post-anesthesia care unit were significantly lower in the study group than in the control group(all P<0.05).There was no significant difference in the success rate of sedation between the two groups(98.75%vs.96.25%,P>0.05).The incidence of adverse events was lower in the study group than in the control group(3.75%vs.13.75%,P<0.05).Conclusion:The use of low-dose esketamine as an adjuvant analgesic drug based on ciprofol sedation can effectively maintain hemodynamic stability,reduce the amount of sedative drugs used,facilitate rapid recovery of patients,and lower the risk of adverse events.
文摘BACKGROUND Gastrointestinal bleeding(GIB)is a critical complication often seen in patients with acute coronary syndrome(ACS),especially those undergoing dual antiplatelet therapy.GIB is associated with increased mortality and prolonged hospitalization,particularly in ACS patients.Despite advancements in management strategies,the role of gastrointestinal endoscopy(GIE)in this population remains controversial,with concerns about timing,safety,and clinical outcomes.AIM To evaluate the safety and efficacy of GIE in patients with ACS and acute GIB,focusing on outcomes such as mortality,hospital length of stay(LOS),hemorrhage control,rebleeding,and blood transfusion requirements.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines,a systematic review was conducted using databases including PubMed,Cochrane,and EMBASE,up to December 2024.The protocol was registered with the International Prospective Register of Systematic Reviews(CRD42025630188).Study quality was assessed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials(RCTs)and the Newcastle-Ottawa Scale for cohort studies.RESULTS Four studies met the inclusion criteria,comprising one RCT and three cohort studies with a total population of 1676130 patients.Most studies indicated that GIE was associated with improved survival in ACS patients with GIB.Three of our studies reported lower mortality rates in patients undergoing GIE compared to those managed without endoscopy,although this varied by study.While GIE demonstrated effectiveness in controlling hemorrhage and reducing rebleeding rates in one study.The rest of the studies did not evaluate these outcomes comprehensively.Hospital LOS outcomes were inconsistent,with two studies suggesting no significant difference,while only one study indicated potential reductions in LOS with GIE.Blood transfusion requirements were reported in one study to be higher in patients undergoing GIE,reflecting its frequent use in severe cases.The safety and effectiveness of GIE varied depending on patient characteristics,timing of the procedure,and type of intervention.CONCLUSION GIE has the potential to improve survival in certain patients with ACS complicated by GIB;however,determining the ideal timing and appropriate candidates necessitates careful individual assessment.While evidence suggests benefits,the limitations of observational studies warrant caution.Collaboration between cardiology and gastroenterology is essential to optimizing outcomes.Future randomized trials should focus on timing,severity,and diverse populations to refine guidelines and improve care for this high-risk group.
文摘BACKGROUND Gastrointestinal bleeding(GIB)is a major cause of hospitalization worldwide.Patients with hematologic malignancies have a higher risk of GIB as a result of thrombocytopenia and platelet dysfunction.There is no consensus on the optimal platelet level that would be safe for endoscopic intervention,although a platelet level of>50×10^(9)/L was suggested based on expert opinion.There is a paucity of data on whether endoscopic intervention and the timing of endoscopy impacted the outcome of patients with hematologic malignancy and severe thrombocytopenia who experienced acute overt GIB.AIM To assess the safety of endoscopic intervention of inpatients with hematological malignancies and severe thrombocytopenia presenting with acute overt GIB.METHODS This is a single center retrospective study.The data was collected from the electronic health record from 2018 to 2020.Inpatients with hematologic malignancy who presented with acute overt GIB and platelet count≤50×10^(9)/L were included in the study.Outcomes included mortality,transfusion requirements,length of stay,intensive care unit admission and recurrent bleeding.A subgroup analysis was performed to compare the outcomes of urgent endoscopy within 24 hours of GIB vs endoscopy>24 hours.RESULTS A total of 76 patients were identified.The mean platelet count is 24.3 in the endoscopy arm and 14.6 in the conservative management arm.There was no statistically significant difference between patients who had endoscopy vs conservative management in 30-day(P=0.13)or 1 year(P=0.78)mortality,recurrent bleeding(P=0.68),transfusion of red blood cells(P=0.47),platelets(P=0.31),or length of stay(P=0.94).A subgroup analysis comparing urgent endoscopy within 24 hours compared with delayed endoscopy showed urgent endoscopy was not associated with improved 30-day or 1 year mortality(P=0.11 and 0.46,respectively)compared to routine endoscopy,but was associated with decreased recurrent bleeding in 30 days(P=0.01).CONCLUSION Medical supportive treatment without endoscopy could be considered as an alternative to endoscopic therapy for patients with hematologic malignancy complicated by severe thrombocytopenia and acute non-variceal GIB.
文摘BACKGROUND Colorectal cancer(CRC)has become the third leading cancer with the third highest occurrence rate and the second highest death ratio globally.Its incidence and mortality rates have been increasing annually in recent years,posing a serious threat to global public health.Digestive endoscopy technology can not only be used for the diagnosis of CRC,but it can also be used in determining the depth of infiltration in early CRC.There are significant deficiencies in care measures in this area.METHODS A total of 120 CRC patients were randomly and equally divided into a control group and an observation group.The patients in the control group received basic routine nursing care,and the patients in the observation group received sys-tematic digestive endoscopy center nursing care.The patients'compliance and nursing satisfaction were observed and recorded,as well as the Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS)and Visual Analogue Scale(VAS)scores.RESULTS After care,the SAS and SDS scale scores of patients in both groups significantly decreased compared to before care(P<0.05).The VAS scale scores significantly increased for each group compared to before examination(P<0.05).The SAS,SDS and VAS scale scores of the observation group were significantly lower than those of the control group after nursing care(P<0.05),and compliance and satisfaction of nursing care were significantly higher than those of the control group(P<0.05).CONCLUSION Digestive endoscopy center nursing can effectively intervene in and improve the psychological state and pain level of CRC patients,suggesting it is a valuable approach to adopt in the clinic.
基金the Special Research Fund for the Natural Science Foundation of Chongqing(No.cstc2019jcyjmsxm1351)the Science and Technology Research Project of Chongqing Education Commission(No.KJQN2020006300)。
文摘There is still a dearth of systematic study on picture stitching techniques for the natural tubular structures of intestines,and traditional stitching techniques have a poor application to endoscopic images with deep scenes.In order to recreate the intestinal wall in two dimensions,a method is developed.The normalized Laplacian algorithm is used to enhance the image and transform it into polar coordinates according to the characteristics that intestinal images are not obvious and usually arranged in a circle,in order to extract the new image segments of the current image relative to the previous image.The improved weighted fusion algorithm is then used to sequentially splice the segment images.The experimental results demonstrate that the suggested approach can improve image clarity and minimize noise while maintaining the information content of intestinal images.In addition,the method's seamless transition between the final portions of a panoramic image also demonstrates that the stitching trace has been removed.
文摘BACKGROUND Air embolism(AE)is a rare but potentially fatal complication of intestinal endoscopy(IE).CASE SUMMARY Herein,we report the case of an 18-year-old woman who underwent a successful Kasai portoenterostomy(KPE)for biliary atresia but died of AE during intraoperative IE for stone removal at the portoenterostomy site.Our review of the English literature identified only four similar cases of fatal AE during IE in patients undergoing KPE.The common clinical setting in the five patients,including our case,was high-pressure air insufflation into the blind closed afferent loop of the KPE to secure visibility.We hypothesize that the highly pressurized air injected into the closed loop entered the bile canaliculi—previously opened by KPE for bile drainage—passed through the tiny,microscopic pores of the fenestrated liver sinusoid endothelial cells,and finally entered the bloodstream with ease,resulting in fatal AE.CONCLUSION Meticulous performance of IE,especially on the KPE blind loop,is warranted owing to the risk of AE.
