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Introduction and Overview
Published in Suzanne Amador Kane, Boris A. Gelman, Introduction to Physics in Modern Medicine, 2020
Suzanne Amador Kane, Boris A. Gelman
For the most part, Asimov's vision remains a fantasy. While modern surgeons can employ lasers to destroy blood clots, they do so without being shrunk to the size of a pinhead! However, physicians using medical endoscopes (Chapter 2) see essentially the same view as would Asimov's tiny heroes while cruising the body in their microscopic submarine (Figure 1.1). Endoscopes consist of slender tubes equipped with special optics and cameras for viewing far inside the body, even around curving passages; their size allows them to be inserted through natural body openings, or through incisions the size of a buttonhole. The surgeon watches the endoscope's images on a television screen while manipulating tiny surgical tools, much as though playing a videogame. You may be more familiar with these devices by their specific names: laparoscopes for abdominal surgery; sigmoidoscopes and colonoscopes for colon cancer screening; arthroscopes for performing surgery on the knee, shoulder, and other joints; and many others.
Acute non-variceal gastrointestinal bleeding
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
Endoscopy should be done with the help of at least two trained assistants. Supplementary oxygen and pulse oximetry should always be used. The endoscopists must be experienced and have the ability to apply a range of therapeutic endoscopic modalities. Accessories including catheters to wash bleeding points and disposable injection needles are necessary. Intravenous sedation (midazolam or diazemuls) is often employed, but the combination of sedation plus anaesthetic throat spray is avoided because this predisposes to aspiration [6]. The minimal possible dose of sedation is chosen, particularly in patients who are hypotensive or have a history of cardiorespiratory or liver disease.
Common gastrointestinal investigations and psychological concerns
Published in Simon R. Knowles, Laurie Keefer, Antonina A. Mikocka-Walus, Psychogastroenterology for Adults, 2019
Endoscopic procedures (upper endoscopy [Figure 7.3] and lower endoscopy) are commonly performed to investigate and manage oesophageal, gastric, duodenal, and ileo-colonic conditions. Verbal and written instructions are given to patients before the test. Certain medications may need to be stopped or changed in the days prior, and it is important that patients inform doctors about antiplatelet and anticoagulation medications (blood thinners) in particular. People with diabetes also need to inform their doctor as they may need to modify their diabetic medications and insulin dose. This will depend on how long they are fasting and whether they need to take bowel preparation for colonoscopy. Iron tablets should be stopped seven days before colonoscopy as they make viewing difficult.
EMR-P for small rectal neuroendocrine tumors: is it a preferred treatment?
Published in Scandinavian Journal of Gastroenterology, 2022
Zhaohui Liu, Chunsi Zheng, Shihua Ding, Chong Chen, Jingbo Yang, Ruinuan Wu, Dayong Sun
This study has several limitation. First, because this was a retrospective study, so the number of cases was limited and randomized grouping was unsuitable. Second, the median follow-up time of this study was short, which cannot better evaluate the postoperative recurrence and metastasis, It is necessary to extend the follow-up time in the further study. Third, five endoscopists performed endoscopic resection in this study. We cannot avoid the difference of our staff ability in endoscopic evaluation and treatment, but all endoscopists had more than 5 years endoscopic working experience, and they all had completed more than 1000 cases of EMR and more than 200 cases of ESD. Fourth, in selecting endoscopic treatment strategies (ESD or P-EMR), endoscopists chose according to the requirements of the guidelines [4] and personal experience, this may lead to some biased results. However, due to they owned rich endoscopic experience, this deviation would be minimized.
Analysis of risk factors for post-endoscopic papillectomy bleeding
Published in Scandinavian Journal of Gastroenterology, 2022
Ting-Ting Cui, Ning-Li Chai, Feng-Chun Cai, Ming-Yang Li, Xiang-Dong Wang, Nian-Jun Xiao, Zi-Kai Wang, Fang Liu, En-Qiang Ling-Hu, Wen Li
A total of 11 experienced therapeutic endoscopists who were proficient in both polypectomy and endoscopic retrograde cholangiopancreatography (ERCP) performed the EP. Most of EP (159 cases) were done by five of them, and the remaining 14 cases were done by the six other endoscopists. The mean operation time was 41.61 ± 31.23 min. En bloc resection rate was 78.6%. Procedure-related adverse events occurred in 64/173 (36.99%) patients (Table 2). All lesions were successfully resected endoscopically. In the 173 procedures, post-EP bleeding was experienced in 33 patients (19.07%). Delayed bleeding was more common than early bleeding (22 vs. 11 cases), and the longest one occurred on the sixth day after the procedure. Seventeen required blood transfusion (4.47 ± 2.85 U). Nine patients were treated successfully by conservative only, whereas 23 required endoscopic hemostasis. Four of these patients experienced repeated secondary endoscopic treatment. One among them finally accepted interventional therapy. Two patients merged perforation, and one accepted salvage operation.
The bleeding risk after endoscopic ultrasound-guided puncture of pancreatic masses
Published in Scandinavian Journal of Gastroenterology, 2021
Marcel Razpotnik, Simona Bota, Mathilde Kutilek, Gerolf Essler, Jutta Weber-Eibel, Andreas Maieron, Markus Peck-Radosavljevic
There is substantial literature describing adverse events in endoscopic procedures. But lack of standardization and different definitions of adverse events make it difficult to compare the outcomes between the studies. For this purpose, the American Society for Gastrointestinal Endoscopy published a report on endoscopic adverse events [14], which define significant bleeding according to the dynamics of hemoglobin levels, typical signs of gastrointestinal bleeding, and the need for interventional hemostasis. In general, a hemoglobin drop of more than 2 g/dL has been widely accepted in the literature to be clinically significant. However, bleeding which does not meet these criteria can also occur and has been barely described in previous studies. We decide to define the minor bleeding more accurately, taking into account the size of the coagulum and the duration of the endoscopically observed bleeding, based on our clinical experience.