ABSTRACT
Pancreaticobiliary maljunction (PBM) is a congenital disease with pancreatic and bile ducts joining outside of the duodenal wall. The clinical symptoms of PBM are often characterized by a series of gallbladder and pancreatic disease. PBM has also gradually drawn attention due to recurrent of pancreatitis, bile duct stones and the malignant tumors of biliary system. With the innovative development of endoscopic minimally invasive technology, therapeutic endoscopy may provide new treatment options and ideas for PBM patients, and is expected to achieve the goal of endoscopic minimally invasive intervention to correct structural abnormalities in the pancreaticobiliary duct junction. This paper provided an overview of the definition, endoscopy diagnosis, the pathogenesis and therapeutic endoscopy progress of pancreaticobiliary maljunction.
ABSTRACT
Abstract Background and objectives: Sedation for endoscopic procedures aims to provide high quality sedation, lower risks, short recovery time, superior recovery quality and absence of side effects, seeking high patient level of satisfaction. The goal of the study was to assess administration of remifentanil combined with propofol regarding the effects of the drug association during sedation and recovery for patients submitted to upper gastrointestinal diagnostic endoscopy. Method: One hundred and five patients were assessed, randomly divided into three groups of 35 patients. The Control Group was sedated with propofol alone. Study Group 1 was sedated with a fixed dose of 0.2 µg.kg−1 remifentanil combined with propofol. Study Group 2 was sedated with 0.3 µg.kg−1 remifentanil combined with propofol. We assessed the quality of sedation, hemodynamic parameters, incidence of significant hypoxemia, time for spontaneous eye opening, post-anesthetic recovery time, quality of post-anesthetic recovery, presence of side effects and patient satisfaction. Results: Study Group 1 showed better quality of sedation. The groups in which remifentanil was administered combined with propofol showed shorter eye-opening time and shorter post-anesthetic recovery time compared to the control group. The three groups presented hemodynamic changes at some of the moments assessed. The incidence of significant hypoxemia, the quality of post-anesthetic recovery, the incidence of side effects and patient satisfaction were similar in the three groups. Conclusions: The combination of propofol with remifentanil at a dose of 0.2 µg.kg−1 was effective in improving the quality of sedation, and at doses of 0.2 µg.kg−1 and 0.3 µg.kg−1 reduced the time to spontaneous eye opening and post-anesthetic recovery in comparison to sedation with propofol administered alone.
Resumo Justificativa e objetivos: A sedação para procedimentos endoscópicos pretende fornecer boa qualidade de sono, menores riscos, tempo de recuperação mais curto, qualidade de recuperação superior e ausência de efeitos colaterais, buscando um elevado nível de satisfação dos pacientes. O objetivo deste estudo foi avaliar a influência da associação do remifentanil ao propofol e seus efeitos durante a sedação e a recuperação em exames de endoscopia digestiva alta diagnóstica. Método: Foram avaliados 105, divididos aleatoriamente em três grupos de 35 pacientes. O Grupo Controle foi sedado apenas com o uso de propofol, o Grupo de Estudo 1 foi sedado com uso de remifentanil em dose fixa de 0,2 µg.Kg-1 associado ao propofol. E o Grupo de Estudo 2 foi sedado com o uso de remifentanil em dose fixa de 0,3 µg.Kg-1 associado ao propofol. Foram avaliadas a qualidade da sedação, comportamento hemodinâmico, incidência de hipoxemia significativa, tempo para abertura ocular espontânea, tempo de recuperação pós-anestésica, qualidade da recuperação pós-anestésica, presença de efeitos colaterais e satisfação do paciente. Resultado: O Grupo de Estudo 1 apresentou melhor qualidade de sedação. Os grupos em que se associou o remifentanil apresentaram tempo para abertura ocular e tempo de recuperação anestésica mais curtos em relação ao grupo controle. Os três grupos apresentaram alterações hemodinâmicas em algum dos momentos avaliados. A incidência de hipoxemia significativa, a qualidade da recuperação pós-anestésica, a incidência de efeitos colaterais e a satisfação dos pacientes foram similares nos três grupos. Conclusão: Conclui-se que a associação do remifentanil na dose de 0,2 µg.kg-1 mostrou-se efetivo na melhora da qualidade da sedação, e nas doses 0,2 µg.kg-1 e de 0,3 µg.kg-1 reduziu o tempo de abertura ocular espontânea e o tempo de recuperação pós-anestésica dos pacientes em relação a sedação apenas com propofol.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Propofol/administration & dosage , Endoscopy, Digestive System , Deep Sedation , Remifentanil/administration & dosage , Analgesics, Opioid/administration & dosage , Hypnotics and Sedatives/administration & dosage , Anesthesia Recovery Period , Double-Blind Method , Drug Combinations , Middle AgedABSTRACT
Resumen La sedación es una técnica anestésica de amplio uso en los procedimientos endoscópicos digestivos actuales dado su claro beneficio en la tolerancia y comodidad para el paciente y el endoscopista. El medicamento de mayor uso en la actualidad para utilizarse como monosedación es el propofol, pero los esquemas balanceados utilizando más de un medicamento ahora son ampliamente usados en endoscopia diagnóstica o terapéutica. La sedación balanceada utilizando propofol y remifentanilo permite la potenciación sinérgica de un sedante con un opioide de ultracorta acción, lo que a su vez favorece la disminución respectiva de cada dosis. Se presenta una serie de 1148 pacientes llevados a endoscopia digestiva alta diagnóstica con dosis promedio de remifentanilo de 0,9 µg/kg de peso y de propofol de 0,47 mg/kg de peso, sin eventos adversos graves, con excelente satisfacción para el endoscopista y con muy bajo costo de la dosis por medicamento, con lo que se infiere que es un esquema seguro y eficiente.
Abstract Sedation is an anesthetic technique that is widely used in current digestive endoscopic procedures because of its clear benefits for patients' tolerance and comfort and for the endoscopist. Propofol is the most commonly used drug in monosedation, but balanced regimens using more than one drug are now widely used in diagnostic and therapeutic endoscopy. Balanced sedation using Propofol and Remifentanil allows synergistic potentiation of a sedative with an ultra-short acting opioid which in turn favors decreases of each dose. This is a series of 1,148 patients who underwent diagnostic endoscopy under balanced sedation with average Remifentanil doses of 0.9 mcg/kg of body weight and average Propofol doses of 0.47 mg/kg of body weight. There were no serious adverse events, endoscopists were highly satisfied with the procedures, and costs per drug dose were very low. This is clearly a safe and efficient scheme.
Subject(s)
Endoscopy, Digestive System , Propofol , Analgesics, OpioidABSTRACT
In this July issue of Clinical Endoscopy, state-of-the-art articles selected from the lectures delivered during the 52nd Seminar of the Korean Society of Gastrointestinal Endoscopy (KSGE) on March 29, 2015 are covered, focusing on highlighted educational contents relevant to either diagnostic or therapeutic gastrointestinal (GI) endoscopy. Our society, the KSGE, has continued to host this opportunity for annual seminars twice a year over the last 26 years and it has become a large-scale prestigious seminar accommodating over 4,000 participants. Definitely, the KSGE seminar is considered as one of the premier state-of-the-art seminars dealing with GI endoscopy, appealing to both the beginner and advanced experts. Lectures, live demonstrations, hands-on courses, as well as an editor school, which was an important consensus meeting on how to upgrade our society journal, Clinical Endoscopy, to a Science Citation Index (Expanded) designation were included in this seminar. The 52nd KSGE seminar consisted of more than 20 sessions, including special lectures, concurrent sessions for GI endoscopy nurses, and sessions exploring new technologies. This is a very special omnibus article to highlight the core contents divided into four sessions: upper GI tract, lower GI tract, pancreatobiliary system, and other specialized sessions.
Subject(s)
Humans , Consensus , Endoscopy , Endoscopy, Gastrointestinal , Lecture , Lower Gastrointestinal Tract , Upper Gastrointestinal TractABSTRACT
La técnica endoscópica IBA, representa un importante avance en el diagnóstico endoscópico, al mejorar la visualización de la superficie de la mucosa y su patrón vascular. Los datos aportados por esta técnica son útiles en el diagnóstico diferencial entre lesiones superficiales benignas y malignas, permitiendo la toma de biopsias dirigidas a áreas de riesgo, sin la necesidad del uso de colorantes y las dificultades técnicas que se relacionan con su uso.
The NBI, is a new tool that represent an important advance in endoscopy, improving observation of the mucosal surface and vascular pattern. These findings are useful for, differential diagnosis between benign and malignant superficial lesions and allows to target areas of risk and to obtain biopsies in several mucosal lesions, without use of dye spraying and technical problems related to this procedure