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Treatment of Variceal Bleeding in Cirrhotic Patients
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Airway protection including endotracheal intubation is especially important in patients presenting with hematemesis. Endotracheal intubation will also facilitate the timely performance of diagnostic and therapeutic endoscopy. Nasogastric tube placement to remove particulate matter and administration of a prokinetic agent such as erythromycin can facilitate successful endoscopic management of variceal hemorrhage. The prophylactic administration of short term antibiotics including ceftriaxone has been shown to decrease the development of infections, recurrent hemorrhage, and death [4].
Introduction
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
It is vital that the patient understands what is entailed in therapeutic endoscopy. The general public have a reasonable appreciation that surgical operations carry an element of risk. However, many patients have come to be aware that endoscopy is a routine procedure, and frequently do not appreciate that there are risks associated with sedation and diagnostic upper or lower endoscopy. When therapeutic procedures are involved, it may be necessary to appraise the patient that this is a surgical operation undertaken through the endoscope, particularly where they are undertaken as ‘day-case’ procedures.
Electrocoagulation
Published in John P. Papp, Endoscopie Control of Gastrointestinal Hemorrhage, 2019
The secret to therapeutic endoscopy is to get the stomach clear of blood clots. An Edlich gastric lavage tube is passed into the stomach and lavage with two or more units of saline instituted. Thereafter, the patient is sedated as necessary with intravenous diazepam. If no lesion is seen in the esophagus, the endoscope is passed along the lesser curvature of the stomach into the duodenum. If no duodenal site of bleeding is found, the endoscope is withdrawn into the stomach for delineation of the cause of bleeding. If an arterial vessel is seen actively bleeding, or if a vessel is seen, one may use one of three techniques in applying electrocoagulation. Electrocoagulation should not be attempted if torrential bleeding is present nor in esophageal varices.
Factors associated with the efficacy and safety of endoscopic dilatation of symptomatic strictures in Crohn’s disease: a retrospective cohort study
Published in Scandinavian Journal of Gastroenterology, 2023
Pierre Dandoy, Edouard Louis, Pierrette Gast, Maxime Poncin, Laurence Seidel, Jean-Philippe Loly
EBDs were performed during colonoscopy under conscious sedation in an ambulatory setting. All endoscopic procedures were performed by the three gastroenterologists specialized in therapeutic endoscopy in our department. These EBD procedures were wire-guided. We used one brand of balloons: CRE Wireguided Boston Scientific balloons of 12–15, 15–18 and 18–20 mm diameter, with the following dilatation sizes: 12–13, 5–15–16–16, 5–18–20 mm. Choice of balloon size and duration of inflation was at the discretion of the endoscopist. Regarding the insufflation pressure, it could vary according to the caliber of the balloon used, for the same diameter (e.g., a 15 mm dilatation caliber can be obtained by using a 12–15 balloon with a maximum insufflation pressure, or with a 15–18 mm balloon with a minimum pressure), this variable was therefore not studied.
Esophageal perforations – a population-based nationwide study in Sweden with survival analysis
Published in Scandinavian Journal of Gastroenterology, 2022
David Edholm, Roland E. Andersson, Adam Frankel
All patients over the age of 18 years with a diagnosis of esophageal perforation (ICD code K22.3) between the 1st of January 2007 and 31st of December 2017 were identified from the Swedish National Patient Register and included in the study. The date and cause of death were obtained by linkage with the Cause of Death Registry. Both of these registers are well described and have high validity [14,15]. Comorbidities present at the time of perforation were assessed from discharge diagnoses that were registered within 12 months before the perforation (Appendix A for all ICD codes). Treatment was defined as surgical if the patient had undergone surgical procedures such as thoracotomy, thoracoscopy, laparotomy or laparoscopy for the condition. Endoscopic treatment was defined as the use of therapeutic endoscopy such as stent placement. If neither surgery nor endoscopy was registered the treatment was labeled as best supportive care, which may include antibiotics and nil-by-mouth. The incidence of esophageal perforations was calculated from the annual disease rates and the respective population census of Sweden obtained from Statistics Sweden [16].
Efficacy and safety of ligation-assisted endoscopic submucosal resection combined with endoscopic ultrasonography for treatment of rectal neuroendocrine tumors
Published in Scandinavian Journal of Gastroenterology, 2022
Dazhou Li, Jiao Xie, Donggui Hong, Gang Liu, Rong Wang, Chuanshen Jiang, Zhou Ye, Binbin Xu, Wen Wang
The procedures were performed by five different endoscopists, each with >8 years of experience in therapeutic endoscopy (cumulative experience of >3000 EMRs and >1000 EUS). Bowel preparation was with 4 L of polyethylene glycol solution before endoscopic resection. Lesion size was estimated by the opening width of biopsy forceps. ESMR-LUS and ESMR-L were carried out using a conventional single-channel endoscope (CV-290 or CV-260; Olympus Medical Systems, Tokyo, Japan) with an attached band ligator device (Stiegmann-Goff Clearvue endoscopic ligator, ConMed, NY), snares (Boston Scientific Captivator 13 mm and JHY-SD-23-230-15-AI 15 mm), and forceps (UPN SFBF, China); hemostatic clip (MD850; Boston Scientific Resolution Clip); and tissue clip (ROCC-D-24-195 and AG-5108-1950-135-9). All procedures were performed under conscious sedation using midazolam 1–5 mg alone or in combination with fentanyl 25–50 μg. EUS was performed using the MAJ-935 endoscope (Olympus EndoEcho EU-M2000, Tokyo, Japan).