Use of N-acetylcysteine plus simethicone to improve mucosal visibility in upper digestive endoscopy via systematic alphanumeric-coded endoscopy: a randomized, double-blind controlled trial.

Background: The use of antifoaming and mucolytic agents prior to upper gastrointestinal (GI) endoscopy and a thorough systematic review are essential to optimize lesion detection. This study evaluated the effect of simethicone and N-acetylcysteine on the adequate mucosal visibility (AMV) of the upper GI tract by an innovative systematic method. Methods: This randomized, double-blind controlled trial included consecutive patients who underwent diagnostic upper GI endoscopy for screening for early neoplasms between August 2019 and December 2019. The upper GI tract was systematically assessed by systematic alphanumeric-coded endoscopy. Patients were divided into 4 groups: 1) water; 2) only simethicone; 3) N-acetylcysteine + simethicone; and 4) only N-acetylcysteine. The following parameters were assessed in each group: age, sex, body mass index, level of adequate mucosal visibility, and side-effects. Results: A total of 4564 images from upper GI areas were obtained for evaluation. The mean AMV in the 4 groups was 93.98±7.36%. The N-acetylcysteine + simethicone group had a higher cleaning percentage compared with the other groups (P=0.001). There was no significant difference among the remaining groups, but several areas had better cleaning when a mucolytic or antifoam alone was used. No side-effects were found in any group. Conclusion: The combination of N-acetylcysteine plus simethicone optimizes the visibility of the mucosa of the upper GI tract, which could potentially increase diagnostic yield.

Endoscopic Management of a Long-Duration Esophageal Food Impaction: A Case Report.

Foreign object ingestion (FOI) is a potentially life-threatening pathology that affects all ages, from children to older adults. The classification includes true FOI and esophageal food impaction (EFI), and each presents unique challenges. Endoscopic intervention is often required to prevent complications. Flexible endoscopes are the preferred management tool, ensuring a high success rate and safety. The following text presents a case of a 48-year-old male with a 5-day undiagnosed esophageal food impaction and the approach taken.

Development and status quo of digestive endoscopy in China: An analysis based on the national census in 2013 and 2020.

Background and Objectives: Technique and practice of digestive endoscopy are undergoing speedy development all over the world. This study aimed to evaluate its status quo and development in China. Methods: All hospitals performing digestive endoscopy in mainland China participated in the national census in 2013 and 2020. Retrospective data of hospitals, endoscopists, volumes, and qualities were collected via an online structured questionnaire, and its accuracy and rationality were verified by logical tests and manual reviews. Data from other countries were used to compare with that of China. Results: From 2012 to 2019, the number of hospitals performing digestive endoscopy increased from 6,128 to 7,470 (1.22-fold), in which primary healthcare played a minor role. The median hospitals per 100,000 inhabitants per provincial region increased from 0.49 (IQR, 0.39-0.57) to 0.55 (IQR, 0.49-0.63). The endoscopists increased from 26,203 to 39,638 (1.51-fold), but their average workload even expanded. Overall volume increased from 28.8 million to 44.5 million (1.55-fold), and most types of endoscopic procedures recorded a high growth rate. Contrastingly, the specific utilization rates were low and paled in comparison with some developed countries. Nationwide, regional utilization rates showed a significant correlation with GDP per capita (P <0.001). Overall qualities of digestive endoscopy were excellent, but certain results of quality indicators posed a huge challenge, such as the detection rates of adenoma and early cancers. Conclusions: Impressive progress has been made in digestive endoscopy with rapidly expanding economy in China. However, primary healthcare, utilization rates, and income-related inequality of regional services were needed to be improved to promote public health better.

Computer-aided diagnostic system with automated deep learning method based on the AutoGluon framework improved the diagnostic accuracy of early esophageal cancer.

Background: There have been studies on the application of computer-aided diagnosis (CAD) in the endoscopic diagnosis of early esophageal cancer (EEC), but there is still a significant gap from clinical application. We developed an endoscopic CAD system for EEC based on the AutoGluon framework, aiming to explore the feasibility of automatic deep learning (DL) in clinical application. Methods: The endoscopic pictures of normal esophagus, esophagitis, and EEC were collected from The First Affiliated Hospital of Soochow University (September 2015 to December 2021) and the Norwegian HyperKvasir database. All images of non-cancerous esophageal lesions and EEC in this study were pathologically examined. There were three tasks: task A was normal vs. lesion classification under non-magnifying endoscopy (n=932 vs. 1,092); task B was non-cancer lesion vs. EEC classification under non-magnifying endoscopy (n=594 vs. 429); and task C was non-cancer lesion vs. EEC classification under magnifying endoscopy (n=505 vs. 824). In all classification tasks, we took 100 pictures as the verification set, and the rest comprised as the training set. The CAD system was established based on the AutoGluon framework. Diagnostic performance of the model was compared with that of endoscopists grouped according to years of experience (senior >15 years; junior <5 years). Model evaluation indicators included accuracy, recall rate, precision, F1 value, interpretation time, and the area under the receiver operating characteristic (ROC) curve (AUC). Results: In tasks A and B, the accuracies of medium-performance CAD and high-performance CAD were lower than those of junior doctors and senior doctors. In task C, the medium-performance and high-performance CAD accuracies were close to those of junior doctors and senior doctors. The high-performance CAD model outperformed the junior doctors in both task A (0.850 vs. 0.830) and task C (0.840 vs. 0.830) in sensitivity comparison, but there was still a large gap between high-performance CAD models and doctors in sensitivity comparison. In task A, with the aid of CAD pre-interpretation, the accuracy of junior and senior physicians were significantly improved (from 0.880 to 0.915 and from 0.920 to 0.945, respectively); the time spent on film reading was significantly shortened (junior: from 11.3 to 8.7 s; senior: from 6.7 to 5.5 s). In task C, with the aid of CAD pre-interpretation, the accuracy of junior and senior physicians were significantly improved (from 0.850 to 0.865 and from 0.915 to 0.935, respectively); the reading time was significantly shortened (junior: from 9.5 to 7.7 s; senior: from 5.6 to 3.0 s). Conclusions: The CAD system based on the AutoGluon framework can assist doctors to improve the diagnostic accuracy and reading time of EEC under endoscopy. This study reveals that automatic DL methods are promising in clinical application.

Efficient-gastro: optimized EfficientNet model for the detection of gastrointestinal disorders using transfer learning and wireless capsule endoscopy images.

Gastrointestinal diseases cause around two million deaths globally. Wireless capsule endoscopy is a recent advancement in medical imaging, but manual diagnosis is challenging due to the large number of images generated. This has led to research into computer-assisted methodologies for diagnosing these images. Endoscopy produces thousands of frames for each patient, making manual examination difficult, laborious, and error-prone. An automated approach is essential to speed up the diagnosis process, reduce costs, and potentially save lives. This study proposes transfer learning-based efficient deep learning methods for detecting gastrointestinal disorders from multiple modalities, aiming to detect gastrointestinal diseases with superior accuracy and reduce the efforts and costs of medical experts. The Kvasir eight-class dataset was used for the experiment, where endoscopic images were preprocessed and enriched with augmentation techniques. An EfficientNet model was optimized via transfer learning and fine tuning, and the model was compared to the most widely used pre-trained deep learning models. The model's efficacy was tested on another independent endoscopic dataset to prove its robustness and reliability.

As how artificial intelligence is revolutionizing endoscopy.

With incessant advances in information technology and its implications in all domains of our lives, artificial intelligence (AI) has emerged as a requirement for improved machine performance. This brings forth the query of how this can benefit endoscopists and improve both diagnostic and therapeutic endoscopy in each part of the gastrointestinal tract. Additionally, it also raises the question of the recent benefits and clinical usefulness of this new technology in daily endoscopic practice. There are two main categories of AI systems: computer-assisted detection (CADe) for lesion detection and computer-assisted diagnosis (CADx) for optical biopsy and lesion characterization. Quality assurance is the next step in the complete monitoring of high-quality colonoscopies. In all cases, computer-aided endoscopy is used, as the overall results rely on the physician. Video capsule endoscopy is a unique example in which a computer operates a device, stores multiple images, and performs an accurate diagnosis. While there are many expectations, we need to standardize and assess various software packages. It is important for healthcare providers to support this new development and make its use an obligation in daily clinical practice. In summary, AI represents a breakthrough in digestive endoscopy. Screening for gastric and colonic cancer detection should be improved, particularly outside expert centers. Prospective and multicenter trials are mandatory before introducing new software into clinical practice.

Reprocessamento em endoscopia digestiva: contributo para a prevenção da infeção associada aos cuidados de saúde / Reprocessing in digestive endoscopy: a contribution to healthcare-associated infection prevention

O presente relatório surge como a etapa final do Estágio de Natureza Profissional, inserido no Mestrado em Enfermagem Médico-Cirúrgica da Escola Superior de Saúde do Instituto Politécnico de Viana do Castelo, que decorreu de 3 de outubro de 2022 a 31 de março de 2023. A elaboração deste relatório visa uma análise crítico-reflexiva das experiências e atividades realizadas, bem como das competências desenvolvidas durante o estágio, que decorreu em dois contextos clínicos: Grupo de Coordenação Local do Programa de Prevenção e Controlo de Infeções e de Resistência aos Antimicrobianos e Unidade de Endoscopia Digestiva, de um hospital central. A realização deste estágio proporcionou a aquisição e o desenvolvimento de competências comuns e específicas do Enfermeiro Especialista em Enfermagem Médico-Cirúrgica. Este relatório tem também como objetivo descrever o desenvolvimento do estudo de investigação intitulado Reprocessamento em Endoscopia Digestiva - contributo para a prevenção da Infeção Associada aos Cuidados de Saúde. Sendo os endoscópios dispositivos reutilizáveis com uma estrutura muito complexa, o reprocessamento destes equipamentos inclui várias etapas, que devem ser rigorosamente cumpridas, de forma a se prevenir a infeção associada à endoscopia e com isso garantir a segurança dos utentes e profissionais envolvidos. Trata-se de um estudo de natureza quantitativa, do tipo exploratório e descritivo, sustentado pela descrição de práticas de 22 profissionais de saúde (13 enfermeiros e 9 assistentes operacionais), no reprocessamento de endoscópios altos e endoscópios baixos, com deteção das principais falhas, principais dificuldades sentidas e estratégias de melhoria apresentadas pelos mesmos. Para a recolha de dados utilizámos a observação estruturada e o inquérito por questionário. Os resultados obtidos evidenciaram que apesar de serem executadas a maioria das etapas de reprocessamento, existem vários desvios das boas práticas, comprometendo a adequada desinfeção dos dispositivos e consequentemente aumentando o risco de transmissão de infeção através dos equipamentos. O espaço físico desadequado ao reprocessamento e os rácios de assistentes operacionais baixos na sala de descontaminação foram os principais aspetos mencionados pelos profissionais como dificultadores do cumprimento das etapas de reprocessamento. A resolução destas situações, foi as principais sugestões de melhoria descritas pelos profissionais como forma de prevenir as infeções associadas ao reprocessamento de endoscópios. Podemos concluir que este estudo contribuiu para a melhoria das práticas associadas ao reprocessamento de endoscópios no respetivo contexto, tendo evidenciado a necessidade de formação teórica e prática, de forma a possibilitar aos profissionais envolvidos a aquisição de conhecimentos e a adoção de práticas seguras, maximizando a prevenção, intervenção e controlo da infeção.

This report emerges as the final stage of the Professional Internship, integrated into the Master's in Medical-Surgical Nursing at the School of Health of the Polytechnic Institute of Viana do Castelo, which took place from 3rd of October, 2022, to 31st of March 2023. The preparation of this report aims for a critical-reflexive analysis of the experiences and activities carried out, as well as the skills developed during the Professional Internship, which took place in two clinical contexts: the Local Coordination Group of the Infection Prevention and Control and Antimicrobial Resistance Program and the Digestive Endoscopy Unit of a central hospital. The completion of this internship provided the acquisition and development of common and specific competencies of a Nurse Specialist in Medical-Surgical Nursing. This report also aims to describe the development of the research study entitled Reprocessing in Digestive Endoscopy - contribution to the prevention of healthcare-associated infection. Since endoscopes are reusable devices with a highly complex structure, the reprocessing of these equipment involves several stages that must be rigorously followed to prevent infection associated with endoscopy and ensure the safety of patients and professionals involved. This is a quantitative, exploratory, and descriptive study, supported by the description of the practices of 22 healthcare professionals (13 nurses and 9 operational assistants) in the reprocessing of high and low endoscopes, with the detection of key failures, main difficulties experienced, and improvement strategies presented by them. To collect data, structured observation and questionnaire surveys were used. The results obtained showed that despite most of the reprocessing steps being carried out, there are several deviations from best practices, compromising the proper disinfection of devices and consequently increasing the risk of infection transmission through the equipment. Inadequate physical space for reprocessing and low operational assistant ratios in the decontamination room were the main aspects mentioned by professionals as hindrances to complying with the reprocessing steps. The resolution of these situations was the primary improvement suggestions described by professionals as a way to prevent infections associated with endoscope reprocessing. In conclusion this study contributed to the improvement of practices associated with the reprocessing of endoscopes in the respective context, having highlighted the need for theoretical and practical training, in order to enable the professionals involved to acquire knowledge and adopt safe practices, maximizing prevention, intervention and control of infection.

Ingestion of corrosive substances and the endoscopic role in assessing the severity of caustic injury.

Introduction: The ingestion of caustic substances into the upper gastrointestinal tract is an unusual but potentially life-threatening problem. Aim: To evaluate the most commonly ingested corrosive substances, and the endoscopic findings, complications, and final outcomes of caustic intake. Material and methods: This cross-sectional study included 220 inpatient participants with corrosive poisonings during a 3-year period (2017-2019). Data from the national patient electronic system "My term" and from the "Poisoning information centre" at the University Clinic for Toxicology, Skopje were used. Demographic characteristics, type of corrosive substance, endoscopic findings by Kikendall classification, emerging complications, fatal outcome, and hospitalization were analysed. Data obtained were analysed with the SPSS software package, version 22.0 for Windows. Results: During the period 2017-2019, out of 220 hospitalized cases with corrosive substance intake, 132 (60%) were with ingestion of acids, 19 (8.6%) with bases, 32 (14.6%) with bleaches, and 37 (16.8%) with other household products (p = 0.3469). The mean age of patients was 49.89 ±19.86 years. The most severe endoscopy findings (high-grade injury) were significantly more often associated with acid and base ingestion (p = 0.00001). Out of all strictures, 25 (64.1%) were on one location (either oesophagus or stomach), and 12 (30.8%) were on 2 locations. Conclusions: Upper gastrointestinal endoscopy is very important procedure for rapid assessment of severity of caustic injury, early appropriate therapy, as well as the potential development of strictures. The obtained data are very important for the development of a national program for the prevention of corrosive poisoning in our country.

News in gastroenterology, hepatology and digestive endoscopy.

Gastroenterology, hepatology and digestive endoscopy are rapidly evolving disciplines with significant advances in the diagnostics and treatment in the entire gastrointestinal tract. The aim of our article was to summarize new perspectives on relevant situations in gastroenterology and hepatology like acute pancreatitis, functional dyspepsia, rational indication of proton pump inhibitors, inflammatory bowel diseases (IBD), cholestatic liver diseases, alcohol induced hepatitis, non-alcoholic fatty live disease (NAFLD) and patophysiology of bilirubin and bile acids. Digestive endoscopy represents an interventional part of gastroenterology and key recent topics are mentioned like pancreatic cancer screening, arteficial intelligence, resection of low-risk neoplastic lesions, enteroscopy techniques, cholangio- and pancreatiscopy and extraluminal expansion of endoscopy techniques by means of endoscopic submucosal and transmural dissection, endoscopic myotomy and lumen apposing stents.

Pediatric Gastroenterology and Hepatology in Italy before and after the COVID-19: Lessons learned and management changes by SIGENP.

Around the world, the 2019 Coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has raised serious public health problems and major medical challenges. The Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) published several papers on the impact of COVID-19 on the current management, diagnosis, and treatment of acute and chronic gastrointestinal, hepatic, immune-mediated, and functional disorders. The present article summarizes the most relevant SIGENP reports and consensus during and after the peak of the COVID-19 outbreak, including the diagnosis and treatment of inflammatory bowel disease (IBD), indications and timing of digestive endoscopy, and insights into the novel hepatitis.

Development and evaluation of acceptance scale for artificial intelligence in digestive endoscopy by subjects. / å—æ£€è€ å¯¹æ¶ˆåŒ–å† é•œäººå·¥æ™ºèƒ½æŽ¥å—åº¦é‡è¡¨çš„ç¼–åˆ¶åŠè¯„ä»·.

OBJECTIVES: Digestive endoscopy is an important diagnostic and therapeutic tool for digestive system diseases. The artificial intelligence (AI)-assisted system in endoscopy (hereinafter referred to as AI in digestive endoscopy) has broad application prospects in the field of digestive endoscopy. The trust and acceptance of endoscopic subjects are the cornerstone of the research, application, and promotion of AI in digestive endoscopy. Currently, the tools for measuring the acceptance of AI in digestive endoscopy by subjects are limited at home and abroad. This study aims to develop a scale for measuring the acceptance of AI in digestive endoscopy by subjects, then to evaluate its reliability and validity. METHODS: By conducting literature research, an item pool and dimensions were constructed, and a preliminary scale was constructed using Delphi method. Through the first stage of the survey on the subjects, the reliability and validity of the scale were tested, and the revised scale was used for the second stage of survey on the subjects to further verify the structural validity of the scale. RESULTS: The acceptance scale for AI in digestive endoscopy included 11 items in 3 dimensions: accuracy, ethics, benefit and willingness. In the first stage of the survey, 351 valid questionnaires were collected, and the Cronbach's α was 0.864. The correlation coefficient between the total score of the scale and the score of the test item was 0.636, and the Kaiser-Meyer-Olkin (KMO) value in exploratory factor analysis was 0.788. In the second stage of the survey, 335 valid questionnaires were collected, and in confirmatory factor analysis, the χ2/df was 3.774, while the root mean squared error of approximation (RMSEA) was 0.091. CONCLUSIONS: Acceptance scale for AI in digestive endoscopy by subjects developed in this study has good reliability and validity.

Endoscopie digestive haute à l'hôpital national de Zinder: indications et résultats / Upper digestive endoscopy at Zinder National Hospital: indications and results

Objectif : déterminer les indications et résultats de l'endoscopie digestive haute (EDH) à l'Hôpital National de Zinder. Matériels et méthodes : il s'agit d'une analyse rétrospective des comptes rendus d'EDH, à partir des registres d'endoscopie digestive du 1er Janvier 2020 au 28 Février 2021, portant sur 667 examens, soit une fréquence mensuelle de 48 EDH. . Résultats : l'âge moyen des patients était de 38,98±14,84 (13-80 ans) avec un sex ratio de 1,02. Les épigastralgies représentent 42,8% (n= 363) d'indication d'EDH, la dyspepsie 15,2% (n=129), les douleurs abdominales diffuses 11,9% (n= 101), les vomissements 8,1% (n= 69), la recherche des signes endoscopiques d'hypertension portale 5,1% (n= 43), la dysphagie 4,9% (n=42) et les hémorragies digestives 3,2% (n=27). Selon le segment anatomique concerné, l'estomac comptait pour 55,51% (n=419), l'œsophage 19,6% (n=148) et le duodénum 6,68% (n=50). Les lésions inflammatoires représentent 63,04% (n=475), les ulcères 6,65% (n=50), les tumeurs 3,03% (n=23) et les lésions diverses 27,28% (n=205). La biopsie était réalisée chez 22 patients (3,46%) et 10 comptes rendus histologiques étaient parvenus, repartis en 06 adénocarcinomes gastriques, 02 gastriques chroniques avec métaplasie intestinale, 01 carcinome épidermoÏde de l'œsophage et 01 polype gastrique hyperplasique. Conclusion : Les épigastralgies dominent les indications de l'EDH. La pathologie digestive haute est certes dominée par les lésons inflammatoires, mais les ulcères et les tumeurs sont de plus en plus diagnostiqués. Ces lésions allaient être mieux évaluées si des biopsies systématiques étaient réalisées chez nos patient

Objective: to determine the indications and results of upper digestive endoscopy (EDH) at the Zinder National Hospital. Materials and methods: this is a retrospective analysis of EDH reports, from digestive endoscopy registers from January 1, 2020 to February 28, 2021, covering 667 examinations, or a monthly frequency of 48 EDH. Results: the average age of patients was 38.98±14.84 (13-80 years) with a sex ratio of 1.02. Epigastralgia represents 42.8% (n = 363) of indication of EDH, dyspepsia 15.2% (n = 129), diffuse abdominal pain 11.9% (n = 101), vomiting 8.1% (n = 69), search for endoscopic signs of portal hypertension 5.1% (n = 43), dysphagia 4.9% (n = 42) and digestive hemorrhages 3.2% (n = 27Depending on the anatomical segment concerned, the stomach accounted for 55.51% (n=419), the esophagus 19.6% (n=148) and the duodenum 6.68% (n=50). Inflammatory lesions account for 63.04% (n=475), ulcers 6.65% (n=50), tumours 3.03% (n=23) and miscellaneous lesions 27.28% (n=205). The biopsy was performed in 22 patients (3.46%) and 10 histological reports were obtained, divided into 06 gastric adenocarcinomas, 02 chronic gastric with intestinal metaplasia, 01 epidermoidal carcinoma of the esophagus and 01 hyperplastic gastric polypConclusion: Epigastralgia dominates the indications of HRE. Upper digestive pathology is certainly dominated by inflammatory lesons, but ulcers and tumors are increasingly diagnosed. These lesions would be better evaluated if systematic biopsies were performed in our patients

Antithrombotic therapy and digestive endoscopy.

Antithrombotic therapy and digestive endoscopy Antithrombotic therapy comprises anticoagulation and antiplatelet treatment. The number of patients treated with various forms of antithrombotic therapy is growing. Procedures of digestive endoscopy are very frequently indicated by general practitioners and doctors of various specialisations. Interdisciplinary cooperation and mutual understanding are required in order for digestive endoscopy to be effective and safe. Hence, we present an overview based on recent European, British (1), and North American guidelines (2) for endoscopic procedures, with respect to guidelines for perioperative care in general (3). Antithrombotic therapy management in patients undergoing digestive endoscopy procedures is based on individual consideration of postprocedural bleeding (particularly a delayed one) on one hand, and thromboembolic risk on the other hand, ideally in cooperation with the physician prescribing antithrombotic therapy. Despite all efforts, patients taking antithrombotic medication are at a higher risk of postprocedural bleeding in comparison with those without this risk; this fact should be accepted by attending physicians and patients should be informed of it. Postprocedural bleeding is mostly manageable with a subsequent endoscopic procedure. By contrast, cerebral and cardiovascular thromboembolic complications are often life-threatening and not uncommonly disabling. One should always consider postponing an elective procedure in a patient with temporary antithrombotic therapy (after pulmonary embolism or after coronary stent insertion). Basic principles of administration of antithrombotic therapy in the context of an endoscopic procedure are described in Table 1. Digestive endoscopy procedures can be categorized according to postprocedural bleeding risk (Table 2). Postprocedural bleeding risk can be specifically reduced in some procedures (ERCP with papillary balloon dilation instead of sphincterotomy, mechanical securing of polypectomy base, etc.). Acetylsalicylic acid administered as secondary prevention (primary preventive indications are very narrow nowadays) should not be discontinued perioperatively (discontinuation is associated with an approximately threefold increase in thrombotic complications!). The riskiest procedures are the only exception in which discontinuation is explicitly requested by the digestive endoscopist. Reduction of dual antiplatelet therapy is better abandoned in high-risk patients - particularly those with recently implanted coronary stents (Table 3) - and postponement of an elective procedure should always be considered. Bridging of warfarin with low-molecular-weight heparin (LMWH) is not indicated routinely (in some cases, this practice increases the bleeding risk). Bridging with LMWH is appropriate in patients with high (or moderate) thromboembolic risk (Table 5). Furthermore, LMWH therapy carries specific risks, particularly in patients with renal function impairment (Table 4). In patients with a high thromboembolic risk, a statement of the physician indicating anticoagulation is always appropriate before an elective procedure (Table 6). Direct oral anticoagulants (DOACs) should not be administered on the day of the procedure, not even in one with a low risk (e.g., biopsy); a longer withdrawal is recommended in high-risk procedures (this cessation should not be bridged with LMWH given the rapid onset and elimination half-time) (Table 7). Recommencement of antithrombotic therapy after a high-risk endoscopic procedure should always be determined by the endoscopist and the recommended intervals should be considered minimal: 1-2 days after the procedure in the case of P2Y12 inhibitors; 2-3 days after the procedure in the case of DOACs; in the evening of the day of the procedure for warfarin with a maintenance (not saturation) dose; and 48 hours after the procedure in the case of LMWH at a therapeutic dose. Earlier administration of a lower-than-therapeutic dose of LMWH (twice a day per weight) can be considered in this context: prophylactic (once a day) or higher prophylactic (once a day per weight) doses. In general, a full anticoagulation effect should not be achieved earlier than approximately 48 hours after the procedure. The patient should be properly informed of the course of antithrombotic therapy before and after the endoscopic procedure, including a written form (a calendar can be downloaded online for this purpose).

Efficacy and safety of midazolam combined with dezocine for sedation and analgesia in digestive endoscopy: A prospective open single-center study.

Objective: Digestive endoscopy is an important means of diagnosing and treating gastrointestinal diseases and a tool for screening and monitoring early gastrointestinal tumors. Digestive endoscopy can be performed using midazolam combined with dezocine for sedation and analgesia. This study explored the efficacy and safety of midazolam combined with dezocine. Methods: A total of 135 patients undergoing digestive endoscopy in the Department of Gastrointestinal Endoscopy of the Sixth Affiliated Hospital, Sun Yat-sen University, from June 2021 to September 2021, were enrolled and non-blindly and non-randomly divided into a sedation-endoscopy-group (SEG, n = 45), anesthesia-endoscopy-group (AEG, n = 44), and ordinary-endoscopy-group (OEG, n = 46). Vital signs, levels of sedation and analgesia, the degree of pain during colonoscopy, satisfaction, and the incidence of complications were compared among the three groups. Results: There were no statistically significant differences in vital signs (blood pressure, pulse, respiration, and blood oxygen saturation) among the three groups before endoscopy (p > 0.05). The AEG reported no pain during colonoscopy, and the pain score during colonoscopy for the SEG was lower than that for the OEG (1.11 ± 1.21 vs. 3.00 ± 1.16, p < 0.001). The scores for satisfaction were 8.84 ± 1.30 points in the SEG, 8.95 ± 1.10 points in the AEG, and 6.37 ± 0.90 points in the OEG; the differences were statistically significant (p < 0.001). The total incidence of complications in the AEG was 38.64% (17/44), which was significantly higher than that in the SEG [13.33% (6/45)] and OEG [13.04% (6/46)] (p < 0.001). In the SEG, the overall incidence of complications in women was significantly higher than that in men (p = 0.027). Conclusion: Digestive endoscopy using midazolam combined with dezocine for sedation makes patients more comfortable, more satisfied and more compliant than the ordinary endoscopy. Additionally, it is comparable to endoscopy under general anesthesia with propofol with regard to comfort, satisfaction, and patient compliance and comparable to the ordinary endoscopy with regard to safety. Considering the shortage of anesthesiologists, the application of midazolam combined with dezocine in digestive endoscopy is worthy of clinical popularization. This study has been registered in the Hospital Ethics Committee of the Sun Yat-sen University Sixth Affiliated Hospital (Ethical Number: 2021ZSLYEC-182).

RLLB/Alb ratio: a promising noninvasive diagnostic marker in assessing esophageal varices in cirrhotic patients.

BACKGROUND: Endoscopy has long been widely used to screen for esophageal varices (EV) in cirrhotic patients. Recurrent endoscopy is a significant burden for the healthcare system of the endoscopic unit as well as uncomfortable and high costs for patients. This study intended to prognosticate Right Liver Lobe Diameter/Serum Albumin Ratio (RLLD/Alb) as a non-invasive approach in the early diagnosis of EV among chronic liver disease (CLD) Bangladeshi patients enrolled in a specific hospital. PARTICIPANTS AND METHODS: A total of 150 admitted patients with CLD were included in the study. Patients were subjected through a comprehensive biochemical checkup and upper digestive endoscopic or ultrasonographic inspection. The correlation was evaluated between the RLLD/Alb ratio and esophageal varices grades. RESULTS: The upper digestive endoscopy demonstration among 150 patients resulted in no EV in 18%, while 24% of patients was identified as EV grade I, 20% as grade II, 20% as grade III, and 18% patients as grade IV. The mean value of the RLLD/Alb ratio was 4.89 ± 1.49 (range from 2.30 to 8.45). The RLLD/Alb ratio diagnosed the EV employing the cut-off value of 4.01 with 85.3% sensitivity and 68.8% specificity. Furthermore, it was positively correlated with the grading of EV, when this ratio increased the grading of EV increases and vice versa (r = 0.630, p < 0.001). CONCLUSION: The RLLD/Alb ratio is a non-invasive parameter giving exact guidance relevant to the ascertainment of the existence of EV and their grading in chronic liver disease patients.

Systematic review and meta-analysis of the incidence rates of adverse events after digestive endoscopy in children.

Background: With the widespread use of digestive endoscopy in children, a variety of adverse events (AEs) have occurred after digestive endoscopy. However, there are notable differences in the incidence of adverse reactions in digestive endoscopy in children at present, which makes it difficult to assess the safety of digestive endoscopy in children. Methods: Studies related to digestive endoscopy in children were screened from January 2005 to October 2021 from PubMed, Web of Science, Spring, CNKI, and Science Direct databases. RevMan5.3 and Stata were employed to carry out meta-analysis on the incidence of adverse respiratory events, myoclonus, abdominal pain, fever, bleeding, chest pain, sore throat, vomiting, and delayed capsule discharge after digestive endoscopy in children. The article quality was evaluated by the Agency for Healthcare Research and Quality (AHRQ). The chi-square test and I2 were adopted to test literature heterogeneity, and the article publication bias was assessed by displaying an inverted funnel plot as a funnel plot. Results: In all, 15 articles were included, involving a total of 27,770 children. In all, 15 articles were included, involving a total of 27,770 children. The risk ratio (RR) value of adverse respiratory events after digestive endoscopy in children was 1.31 [95% confidence interval (CI): 1.17 to 1.47, P<0.00001]; the odds ratio (OR) value of the incidence of myoclonus was 1.21 (95% CI: 1.01 to 1.46, P=0.04); the incidence of abdominal pain was 1.18 (95% CI: 1.11 to 1.27, P<0.00001); the incidence of fever was 1.09 (95% CI: 1.06 to 1.12, P<0.00001); the incidence of bleeding was 1.24 (95% CI: 0.94 to 1.64, P=0.13); the incidence of chest pain was 1.06 (95% CI: 1.03 to 1.09, P<0.0001); incidence of sore throat was 1.11 (95% CI: 1.05 to 1.18, P=0.0004); incidence of vomiting was 1.13 (95% CI: 1.06 to 1.21, P=0.0001); and the incidence of delayed capsule expulsion was 1.18 (95% CI: 1.00 to 1.40, P=0.05). Discussion: The incidence of AEs after digestive endoscopy in children was low, which can be used in the diagnosis and therapy of digestive system diseases in children.

Use of a specialty endoscopy online platform for continuing medical education for clinical endoscopists during the COVID-19 pandemic.

BACKGROUND: To explore the use of a digestive endoscopy professional online platform by domestic endoscopists and its application effect on endoscopists' continuing medical education, analyse the related problems of continuing medical education using this method, and propose targeted improvement suggestions. METHODS: Based on the "Doctor's Circle" app, a questionnaire was sent to all members who successfully registered on the Hebei Biliary and Pancreatic Endoscopy Diagnosis and Treatment Alliance online platform. The questionnaire was available for 30 days. The questionnaire survey results were collected and counted for a grouping comparison. RESULTS: By the deadline, 703 completed questionnaires had been received. After the registered doctors joined the platform, 469 (66.7%) experienced a significant influence on their own endoscopic operation ability level, and 354 (50.3%) felt a significant improvement in their ability to diagnose biliary- and pancreatic-related diseases. The application effect of the platform on members' continuing medical education was affirmed by the vast majority of registered doctors. The clinical specialty of registered doctors, the length of time they joined the platform, the length of time they participated in the platform activities each time, and whether they played back course videos after the live broadcast of the course on the platform were the main factors affecting the application effect on continuing medical education (P < 0.05). Registered doctors who benefited significantly from the platform used it for 6-12 months, participated in activities for 1-2 hours each time, and often played back course videos. CONCLUSION: The new model of continuing medical education based on an online platform breaks through the constraints of traditional models and meets the individualized needs of every medical worker to improve their comprehension level. At present, the global outbreak of COVID-19 makes this learning mode increasingly popular among medical workers. We should constantly improve the organization of the content and methods of continuing medical education courses, make the online platform better serve the majority of medical workers, and effectively improve the comprehension levels of clinicians.

Retrospective observational study on safety of sedation for colonoscopies in ASA I and II patients performed by a nurse and under the supervision of anesthesiology.

INTRODUCTION: Out of operating room sedation with propofol by non-anaesthesiologists (Non Anaesthesiologist Administration of Propofol: NAAP) is a growing practice. This is due to the increase in minimally invasive diagnostic and therapeutic procedures requiring sedation, and the difficulty of anaesthesiology services to respond adequately to this demand. OBJECTIVE: The main objective of this study is to assess the safety of a programme of nurse sedationist-administered target controlled infusion (TCI) of propofol in colonoscopies supervised by anaesthesiologists. MATERIAL AND METHODS: Over a period of 6 months, all ASA I and II patients who required colonoscopy and met the inclusion criteria were included in the study. A total of 381 colonoscopies were performed. Episodes of desaturation, hypo- or hypertension, bradycardia or tachyarrhythmia and the need for anaesthesiology assistance during sedation were analysed. After the procedure, patient satisfaction was assessed on a scale of 1-5, and pain was assessed on a numerical verbal scale of 1-5. RESULTS: A small percentage (5%) of patients presented oxygen saturation of less than 90%, without requiring mask ventilation; 7.35% presented hypotension, 3.94% presented bradycardia, and the supervising anaesthesiologist was called in 22% of cases. Patient satisfaction at the end of the procedure was 4.27 out of 5. CONCLUSION: Sedation during colonoscopy in ASA I and II patients following an agreed protocol can be safely administered by nurse sedationists under the supervision of an anaesthesiologist.