ABSTRACT
The use of intravenous sedatives is common in gastrointestinal endoscopy. This study is to evaluate the safety and efficacy of propofol and/or midazolam in induction of proper sedation in esophagogastroduodenoscopy [EGD] compared with a control group, which does not receive sedation for EGD. Four groups [A, B, C and D] of 30 patients each for whom EGD had been indicated were defined. Group A received no sedative, whereas groups B, C and D received midazolam, propofol and midazolam plus propofol intravenously, respectively. The four groups were compared with each other regarding heart rate [HR], oxygen saturation [O2S], systolic blood pressure [SBP], diastolic blood pressure [DBP], duration of endoscopy [DE], patient compliance [CM], retrograde amnesia [RA], antegrade amnesia [AA], patient activity [PA], skin color [SC], patient consciousness [CS], blood flow [BF], respiration state [RS] and pain. Patient compliance, retrograde amnesia, antegrade amnesia, patient activity, patient consciousness and pain were significantly different in our patient groups. On the contrary, no significant difference was found among the four groups regarding heart rate, oxygen saturation, systolic and diastolic blood pressures, duration of endoscopy, skin color, blood flow and respiratory state. Based on our findings, no sedation is necessary for EGD unless the patient feels anxious and therefore can not cooperate appropriately. For this case, the administration of propofol alone is a priority over midazolam alone and propofol plus midazolam
ABSTRACT
Palliative procedures in esophageal cancer to restore swallowing are preferable to- major surgery in most cases. The aim of this prospective study was to provide further information on treatment techniques, complications, and survival in the patients with malignant esophageal obstruction undergoing endoscopic palliative therapy using Self-Expanding Metal Stents [SEMS]. Patients with obstruction of the esophagus secondary to carcinoma who referred for stenting with SEMS between October 2004 and July 2005 were studied. In all cases the tumor was considered non-respectable and the stage of the disease was III or IV. All patients had aphagia or severe dysphagia to liquids and saliva, due to which, stenting was indicated. A follow-up in 1-11 months was taken, with physical and laboratory examinations. Symptom relief, survival rate, and complications were analyzed using Wilcoxon signed ranks test and student t-test by SPSS software version 10.0. Results were considered statistically significant for p<0.05. Between October 2004 and July 2005 twenty two stents were placed under fluoroscopic guidance in 19 patients [13 males and 6 females with mean age of 65.5+/-12.6 years] with the obstruction of the esophagus secondary to carcinoma. Technical success rate was 100%. The dysphagia score improved significantly in a month after stenting [p=0.001]. During this time period, appetite score of the patients was not improved significantly [p=0.070]. Major immediate complications including severe pain occurred in two patients [10.5%]. Eight [42.1%] patients died. The survival rate was 68.4%, 63.2% and 57.9% for 3, 6 and 9 months, respectively. Our results suggest that self-expandable metallic stent placement is a simple, quick, safe and efficient method to palliate esophageal carcinoma obstruction and its implantation will efficiently palliate dysphagia. The major problem of these patients, however, seems to be loss of appetite due to the underlying disease