Complex and lengthy endoscopic examinations like endoscopic ultrasonography and/or endoscopic retrograde cholangiopancreatography benefit from deep sedation, due to an enhanced quality of examinations, reduced discomf...Complex and lengthy endoscopic examinations like endoscopic ultrasonography and/or endoscopic retrograde cholangiopancreatography benefit from deep sedation, due to an enhanced quality of examinations, reduced discomfort and anxiety of patients, as well as increased satisfaction for both the patients and medical personnel. Current guidelines support the use of propofol sedation, which has the same rate of adverse effects as traditional sedation with benzodiazepines and/or opioids, but decreases the procedural and recovery time. Non-anesthesiologist administered propofol sedation has become an option in most of the countries, due to limited anesthesiology resources and the increasing evidence from prospective studies and metaanalyses that the procedure is safe with a similar rate of adverse events with traditional sedation. The advantages include a high quality of endoscopic examination, improved satisfaction for patients and doctors, as well as decreased recovery and discharge time. Despite the advantages of non-anesthesiologist administered propofol, there is still a continuous debate related to the successful generalization of the procedures.展开更多
Gastrointestinal stromal tumors(GISTs)are the most common mesenchymal tumors of the gastrointestinal tract and arise from the interstitial cells of Cajal.They predominantly affect individuals between 50 and 70 years o...Gastrointestinal stromal tumors(GISTs)are the most common mesenchymal tumors of the gastrointestinal tract and arise from the interstitial cells of Cajal.They predominantly affect individuals between 50 and 70 years of age and often carry malignant potential despite being frequently asymptomatic.The stomach and small intestine are the most common locations,while involvement of the esophagus,colon,or rectum is relatively rare.GISTs are often discovered incidentally during endoscopic or radiologic evaluations,and the diagnosis is confirmed through tissue biopsy and immunohistochemical staining,particularly for KIT(CD117),DOG1,and PDGFRA.In the past decade,laparoscopic resection has been considered the standard treatment for localized GISTs smaller than 5 cm.However,recent advances in endoscopic technology have led to a growing role for endoscopic resection as a safe and effective treatment option for selected nonmetastatic GISTs.Endoscopic techniques such as endoscopic submucosal dissection,endoscopic submucosal excavation,submucosal tunneling endoscopic resection,and endoscopic full-thickness resection have demonstrated favorable outcomes,including high complete resection(R0)rates,shorter hospital stays,and quicker recovery compared to traditional surgery.The selection of an appropriate resection method depends on tumor size,location,depth of invasion,and proximity to vital structures.Endoscopic ultrasound has become an essential tool for preprocedural assessment,providing detailed information on tumor characteristics and helping to guide management decisions.While endoscopic resection is a promising minimally invasive approach,it should be performed by skilled endoscopists with appropriate training due to the technical complexity and risk of complications such as bleeding or perforation.This review summarizes recent developments in endoscopic resection of GISTs,with a focus on indications,procedural safety,clinical outcomes,and recommendations for optimal patient selection and procedural planning.展开更多
The use of simulation based training in endoscopy hasbeen increasingly described,simulation has the potential reduce the harm caused to patients by novicesperforming procedures,increase efficiency by reducingthe time ...The use of simulation based training in endoscopy hasbeen increasingly described,simulation has the potential reduce the harm caused to patients by novicesperforming procedures,increase efficiency by reducingthe time needed to train in the clinical environment andincrease the opportunity to repeatedly practice rareprocedures as well as allowing the assessment of performance.Simulators can consist of mechanical devices,employ cadaveric animal tissue or use virtual realitytechnology.Simulators have been used to teach upperand lower gastrointestinal endoscopy as well as interventional procedures.This review reviews the currentlyavailable endoscopic simulators,and the evidence fortheir efficacy,demonstrating that the ability of simulators to differentiate between novice and expert endoscopists is well established.There is limited evidencefor improved patient outcome as a result of simulationtraining.We also consider how the environment withinwhich a simulation is placed can be manipulated toalter the learning achieved,broadening the scope ofsimulation to develop communication as well as technical skills.Finally the implications for future practice areconsidered; technology is likely improve the fidelity of simulators,increasing the potential for simulation to improve patient outcomes.The impact of the simulation environment,and the correct place of simulation within the training curriculum are both issues which need addressing.展开更多
BACKGROUND Endoscopic submucosal dissection is considered curative for patients with early rectal cancer when level of submucosal invasion is<1000 microns with favourable histopathological features.Recent data sugg...BACKGROUND Endoscopic submucosal dissection is considered curative for patients with early rectal cancer when level of submucosal invasion is<1000 microns with favourable histopathological features.Recent data suggests even deeper submucosal invasion can potentially be curative if R0 resection can be achieved and when no high-risk histopathological features are seen in the resected specimen.To achieve R0 resection,deeper dissection is required.CASE SUMMARY A 66 year old New Zealand European male presented with 3 mo history of per rectal bleeding.He was referred for a colonoscopy test to investigate this further.This revealed a malignant appearing lesion in the rectum.Biopsies however showed high grade dysplasia only.Given endoscopic appearances suspicious for deep submucosal invasion,patient was consented for endoscopic intermuscular dissection(EID).The case was successfully performed,and the presence of muscularis propria was confirmed in the resected specimen.There were no complications and total procedure time was 124 min.Lesion was clear of radial margins however deep margins were positive confirming it was at least a pT2 cancer.Patient was recommended to have further treatment but could not have radical surgery due to comorbidities and instead was referred for long course chemoradiotherapy.CONCLUSION EID is a safe and feasible option for management of rectal cancer in highly selected patients.展开更多
基金The Partnership program in priority areas-PN II,implemented with support from National Authority of Scientific Research(ANCS)CNDI-Uefiscdi,Romania,No.2011-3.1-0252(Nano-Ablation)
文摘Complex and lengthy endoscopic examinations like endoscopic ultrasonography and/or endoscopic retrograde cholangiopancreatography benefit from deep sedation, due to an enhanced quality of examinations, reduced discomfort and anxiety of patients, as well as increased satisfaction for both the patients and medical personnel. Current guidelines support the use of propofol sedation, which has the same rate of adverse effects as traditional sedation with benzodiazepines and/or opioids, but decreases the procedural and recovery time. Non-anesthesiologist administered propofol sedation has become an option in most of the countries, due to limited anesthesiology resources and the increasing evidence from prospective studies and metaanalyses that the procedure is safe with a similar rate of adverse events with traditional sedation. The advantages include a high quality of endoscopic examination, improved satisfaction for patients and doctors, as well as decreased recovery and discharge time. Despite the advantages of non-anesthesiologist administered propofol, there is still a continuous debate related to the successful generalization of the procedures.
文摘Gastrointestinal stromal tumors(GISTs)are the most common mesenchymal tumors of the gastrointestinal tract and arise from the interstitial cells of Cajal.They predominantly affect individuals between 50 and 70 years of age and often carry malignant potential despite being frequently asymptomatic.The stomach and small intestine are the most common locations,while involvement of the esophagus,colon,or rectum is relatively rare.GISTs are often discovered incidentally during endoscopic or radiologic evaluations,and the diagnosis is confirmed through tissue biopsy and immunohistochemical staining,particularly for KIT(CD117),DOG1,and PDGFRA.In the past decade,laparoscopic resection has been considered the standard treatment for localized GISTs smaller than 5 cm.However,recent advances in endoscopic technology have led to a growing role for endoscopic resection as a safe and effective treatment option for selected nonmetastatic GISTs.Endoscopic techniques such as endoscopic submucosal dissection,endoscopic submucosal excavation,submucosal tunneling endoscopic resection,and endoscopic full-thickness resection have demonstrated favorable outcomes,including high complete resection(R0)rates,shorter hospital stays,and quicker recovery compared to traditional surgery.The selection of an appropriate resection method depends on tumor size,location,depth of invasion,and proximity to vital structures.Endoscopic ultrasound has become an essential tool for preprocedural assessment,providing detailed information on tumor characteristics and helping to guide management decisions.While endoscopic resection is a promising minimally invasive approach,it should be performed by skilled endoscopists with appropriate training due to the technical complexity and risk of complications such as bleeding or perforation.This review summarizes recent developments in endoscopic resection of GISTs,with a focus on indications,procedural safety,clinical outcomes,and recommendations for optimal patient selection and procedural planning.
文摘The use of simulation based training in endoscopy hasbeen increasingly described,simulation has the potential reduce the harm caused to patients by novicesperforming procedures,increase efficiency by reducingthe time needed to train in the clinical environment andincrease the opportunity to repeatedly practice rareprocedures as well as allowing the assessment of performance.Simulators can consist of mechanical devices,employ cadaveric animal tissue or use virtual realitytechnology.Simulators have been used to teach upperand lower gastrointestinal endoscopy as well as interventional procedures.This review reviews the currentlyavailable endoscopic simulators,and the evidence fortheir efficacy,demonstrating that the ability of simulators to differentiate between novice and expert endoscopists is well established.There is limited evidencefor improved patient outcome as a result of simulationtraining.We also consider how the environment withinwhich a simulation is placed can be manipulated toalter the learning achieved,broadening the scope ofsimulation to develop communication as well as technical skills.Finally the implications for future practice areconsidered; technology is likely improve the fidelity of simulators,increasing the potential for simulation to improve patient outcomes.The impact of the simulation environment,and the correct place of simulation within the training curriculum are both issues which need addressing.
文摘BACKGROUND Endoscopic submucosal dissection is considered curative for patients with early rectal cancer when level of submucosal invasion is<1000 microns with favourable histopathological features.Recent data suggests even deeper submucosal invasion can potentially be curative if R0 resection can be achieved and when no high-risk histopathological features are seen in the resected specimen.To achieve R0 resection,deeper dissection is required.CASE SUMMARY A 66 year old New Zealand European male presented with 3 mo history of per rectal bleeding.He was referred for a colonoscopy test to investigate this further.This revealed a malignant appearing lesion in the rectum.Biopsies however showed high grade dysplasia only.Given endoscopic appearances suspicious for deep submucosal invasion,patient was consented for endoscopic intermuscular dissection(EID).The case was successfully performed,and the presence of muscularis propria was confirmed in the resected specimen.There were no complications and total procedure time was 124 min.Lesion was clear of radial margins however deep margins were positive confirming it was at least a pT2 cancer.Patient was recommended to have further treatment but could not have radical surgery due to comorbidities and instead was referred for long course chemoradiotherapy.CONCLUSION EID is a safe and feasible option for management of rectal cancer in highly selected patients.
