ABSTRACT
OBJECTIVE: The Italian Society of Anesthesia, Analgesia, Reanimation and Intensive Care Medicine (SIAARTI) and the Italian Society of Digestive Endoscopy (SIED) worked together to produce a joint Good Clinical Practice (GCP) on analgo-sedation in digestive endoscopy and launched a survey to support the document. The aim was to identify and describe the actual clinical practice of sedation in Italian digestive endoscopy units and offer material for a wider and more widespread discussion among anesthetists and endoscopists. SUBJECTS AND METHODS: A national survey was planned, in order to support the statements of the GCP. Twelve thousand and five hundred questionnaires were sent to the members of SIAARTI and SIED in June 2020. RESULTS: A total of 662 forms (5.3%) returned completed. Highly complex procedures are performed according to 70% of respondents; daily anesthesiologist's assistance is guaranteed in 26%, for scheduled sessions in 14.5% and as needed in 8%. 69% of respondents declared not to have a dedicated team of anesthesiologists, while just 5% reported an anesthesiologist in charge. A complete monitoring system was assured by 70% of respondents. Dedicated pathways for COVID-19-positive patients were confirmed in <40% of the answers. With regard to moderate/deep sedation, 90% of respondents stated that an anesthetist decides timing and doses. Propofol was exclusively administered by anesthetists according to 94% of answers, and for 6% of respondents the endoscopist is allowed to administer propofol in presence of a dedicated nurse, but with a readily available anesthetist. Only 32.8% of respondents reported institutional training courses on procedural analgo-sedation. CONCLUSIONS: The need to provide patients scheduled for endoscopy procedures with an adequate analgo-sedation is becoming an increasing concern, well-known in almost all countries, but many factors compromise the quality of patient care. Results of a national survey would give strength to the need for a shared GCP in gastrointestinal endoscopy. Training and certification of non-anesthetist professionals should be one of the main ways to center the objective.
Subject(s)
Anesthesia , COVID-19 , Propofol , Humans , Hypnotics and Sedatives , Societies, Scientific , Endoscopy, Gastrointestinal/methods , Conscious Sedation/methodsABSTRACT
Background and aim: Endoscopic submucosal dissection (ESD) and endoscopic full thickness resection (EFTR) are recognized as valid advanced techniques for the treatment of pre-neoplastic/neoplastic lesions of the gastrointestinal tract. However, complication rate and need of hospitalization still remain a matter of discussion. The application of suturing devices have been suggested as an option to prevent complications and reduce hospital stay. The aim of our study was to analyse the feasibility and safety of Overstitch suturing devices applied after large and deep ESD/EFTR. The secondary aim was to evaluate the efficacy of suturing system to reduce hospital stay and complication rate. Materials and methods: From September 2020 to November 2021 (in Covid-19 pandemic era) all consecutive patients sutured with Apollo SX Overstich after complex resection were prospectively enrolled. Feasibility, complications, hospital stay were analyzed. Results: Fourteen patients(6 female, mean 79 +-8 yo) were enrolled;lesions were located in the stomach (3), in the rectum (7), in the sigmoid colon (2), in the descending colon (2). Final diagnosis were 10 HGD/T1 (sm1) and 4 lesions T1 (sm2/3) or T2 colo-rectal cancer. Eight patients were treated with ESD as outpatients whereas 4 underwent eFTR as inpatients with uneventful medium hospital stay of 4.7 days (range 4-6). Overstich suture was feasible in all the lesions, and all locations. No major complications occurred. One minor complications (colonic luminal stenosis) occurred and was successfully treated with temporaray placement of covered metal stent. (Figure Presented) Conclusions: Endoscopic overstitch system is safe and a useful tool to close large wall defect after ESD/EFTR.