Gastrointestinal endoscopy
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Gastrointest. Endosc. · Dec 2004
Comparative StudyColonic stent vs. emergency surgery for management of acute left-sided malignant colonic obstruction: a decision analysis.
Acute colonic obstruction because of malignancy is often a surgical emergency. Surgical decompression with colostomy with or without resection and eventual re-anastomosis is the traditional treatment of choice. Endoscopic colonic stent insertion effectively decompresses the obstructed colon, allowing for surgery to be performed electively. This study sought to determine the cost-effectiveness of colonic stent vs. surgery for emergent management of acute malignant colonic obstruction. ⋯ Colonic stent insertion followed by elective surgery appears more effective and less costly than emergency surgery under base-case conditions. This finding remains robust over a wide range of assumptions for clinical inputs in sensitivity analysis. Our findings suggest that colonic stent insertion should be offered, whenever feasible, as a bridge to elective surgery in patients presenting with malignant colonic obstruction.
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Tumors of the major and the minor duodenal papillae can be malignant or premalignant, and traditionally are treated by surgical excision. This study evaluated the safety and the outcome of endoscopic snare resection of such tumors. ⋯ Most adenomas of the duodenal papillae without intraductal extension can be fully resected by snare papillectomy. However, adenoma recurs in about a third of patients. Endoscopic therapy appears to be a reasonable alternative to surgery for management of papillary tumors. Longer follow-up is needed to determine the true recurrence rate and if endoscopic re-treatments are effective.
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Gastrointest. Endosc. · Nov 2004
Comparative StudyA prospective comparison of the yield of EUS in primary vs. recurrent idiopathic acute pancreatitis.
It is uncertain whether EUS should be performed after a single episode of idiopathic pancreatitis vs. recurrent episodes or if clinical factors can predict positive EUS findings. ⋯ In patients with idiopathic pancreatitis, the yield of EUS is not significantly different after an initial attack or after recurrent attacks. Therefore, it is reasonable to perform EUS after an initial attack of idiopathic acute pancreatitis, especially in older patients.
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Gastrointest. Endosc. · Sep 2004
Endoscopist administered propofol for upper-GI EUS is safe and effective: a prospective study in 500 patients.
The administration of propofol for endoscopic sedation by a qualified person, other than the endoscopist, is safe and effective. The aim of this study was to determine if propofol can be administered safely and effectively by the endoscopist performing the procedure. ⋯ Endoscopist-administered propofol is safe and effective in selected patients.
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Gastrointest. Endosc. · Sep 2004
Target-controlled propofol infusion during monitored anesthesia in patients undergoing ERCP.
A target-controlled infusion system automatically adjusts the rate of infusion of propofol to maintain a desired (target) concentration. The aim of this study was to determine whether administration of propofol with a target-controlled infusion system could improve the sedation of patients undergoing ERCP. ⋯ A target-controlled infusion system for administration of propofol provides safe and effective sedation during ERCP. Further studies are needed to determine the cost-effectiveness and the safety profile for infusion of propofol with a target-controlled infusion system by a nonanesthesiologist during ERCP.