Endoscopy
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Randomized Controlled Trial Clinical Trial
Botulinum toxin injection after biliary sphincterotomy.
Endoscopic biliary sphincterotomy in patients with sphincter of Oddi dysfunction (SOD) is associated with a high risk of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP), which may be secondary to residual pancreatic sphincter hypertension. It was hypothesized that botulinum toxin injection could be used to reduce pancreatic sphincter hypertension temporarily in SOD patients after biliary sphincterotomy, thereby reducing the rate of procedure-induced pancreatitis. ⋯ Biliary sphincterotomy in patients with sphincter of Oddi dysfunction without pancreatic protection is risky and should no longer be carried out. This study demonstrates that botulinum toxin injection into the residual pancreatic sphincter after biliary sphincterotomy is technically feasible and safe, showing a trend toward a reduced post-ERCP pancreatitis rate in patients with sphincter of Oddi dysfunction. Further studies will need to confirm the validity of these experimental results before this technique can be used routinely.
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Randomized Controlled Trial Comparative Study Clinical Trial
Patient-controlled sedation for colonoscopy: a randomized trial comparing patient-controlled administration of propofol and alfentanil with physician-administered midazolam and pethidine.
Patient-controlled sedation (PCS) using propofol and alfentanil provides effective sedation for colonoscopy, with the advantage of a shorter recovery time in comparison with diazepam and pethidine. However, most endoscopy units in the United Kingdom are currently using midazolam (a shorter-acting benzodiazepine) as a sedative agent. This study compares the efficacy of sedation and recovery times between PCS and a combination of midazolam and pethidine. ⋯ PCS provides an acceptable alternative to sedation with midazolam and pethidine with the advantage of significantly faster recovery times, which are of relevance in the outpatient setting.
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective randomized trial comparing a virtual reality simulator to bedside teaching for training in sigmoidoscopy.
Clinical investigation using endoscopy simulators is now possible due to recent advances in virtual reality technology. A prospective randomized trial was conducted to compare the exclusive use of a virtual reality endoscopy simulator with bedside teaching for training in sigmoidoscopy. ⋯ The use of a state-of-the-art virtual reality-based endoscopy simulator is inferior to traditional bedside teaching techniques when used exclusively for training medical residents to perform sigmoidoscopy.
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Randomized Controlled Trial Clinical Trial
Evaluation of a virtual endoscopy simulator for training in gastrointestinal endoscopy.
Skills in gastrointestinal endoscopy mainly depend on experience and practice. Training on endoscopy simulators may decrease the time needed to reach competency in endoscopy. The purpose of the study was to determine whether the GI-Mentor, a virtual reality endoscopy simulator, can distinguish between beginners and experts in endoscopy and to assess whether training improves the performance of beginners. ⋯ This virtual endoscopy simulator is capable of identifying differences between beginners and experts in gastrointestinal endoscopy. A 3-week training improves the performance of beginners significantly. This quite fast improvement in endoscopic skills certainly cannot be seen in clinical practice; no conclusions can be made about the impact of virtual simulator training on real-life endoscopy, and this must be evaluated.
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Randomized Controlled Trial Comparative Study Clinical Trial
Propofol versus midazolam for conscious sedation guided by processed EEG during endoscopic retrograde cholangiopancreatography: a prospective, randomized, double-blind study.
Endoscopic retrograde cholangiopancreatography (ERCP) is a complex procedure, which requires appropriate sedation. The aim of this prospective, randomized, double-blind study was to compare the quality and characteristics of sedation with midazolam or propofol in patients undergoing ERCP. ⋯ ERCP is better tolerated by patients sedated with propofol compared with midazolam, with a shorter recovery time and lesser hemodynamic side effects. Propofol should be considered to be the sedative drug of choice for ERCP.