Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society
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Review Meta Analysis Comparative Study
Comparison of propofol monotherapy and propofol combination therapy for sedation during gastrointestinal endoscopy: A systematic review and meta-analysis.
Previous randomized controlled trials have reported conflicting findings comparing propofol combination therapy (PCT) with propofol monotherapy (PMT) for sedation of patients undergoing gastrointestinal endoscopy. Therefore, a systematic review was carried out to compare the efficacy and safety of PCT and PMT in such patients. ⋯ PCT showed comparable efficacy and safety to PMT with respect to respiratory complications, hypotension and arrhythmia, recovery time, procedure duration, patient satisfaction, and doctor satisfaction. However, the average dose of propofol used was higher in PMT.
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Endoscopic ultrasonography (EUS) is an essential diagnostic tool for various types of pancreatic diseases such as pancreatic tumors and chronic pancreatitis; however, EUS imaging has low specificity for the diagnosis of pancreatic diseases. Artificial intelligence (AI) is a mathematical prediction technique that automates learning and recognizes patterns in data. This review describes the details and principles of AI and deep learning algorithms. ⋯ For this, conventional machine learning architectures are used, and deep learning architecture has been used in only two reports. Although the diagnostic abilities in these reports were about 85-95%, these were exploratory research and very few reports have included substantial evidence. AI is increasingly being used for medical image diagnosis due to its high performance and will soon become an essential technique for medical diagnosis.
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Capsule endoscopy is ideally suited to artificial intelligence-based interpretation given its reliance on pattern recognition in still images. Time saving viewing modes and lesion detection features currently available rely on machine learning algorithms, a form of artificial intelligence. Current software necessitates close human supervision given poor sensitivity relative to an expert reader. ⋯ We review the major advances in artificial intelligence for capsule endoscopy in recent publications and briefly review artificial intelligence development for historical understanding. Importantly, recent advancements in artificial intelligence have not yet been incorporated into practice and it is immature to judge the potential of this technology based on current platforms. Remaining regulatory and standardization hurdles are being overcome and artificial intelligence-based clinical applications are likely to proliferate rapidly.
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Some situations may require endoscopy during the COVID-19 (Coronavirus Disease 2019) pandemic. Here, we describe the necessary precautions in the form of clinical questions and answers (Q&A) regarding the safe deployment of gastrointestinal endoscopy in such situations while protecting endoscopy staff and patients from infection. Non-urgent endoscopy should be postponed. ⋯ When a patient who undergoes endoscopy is later found to have COVID-19, the members of staff involved are considered exposed to the virus and must not work for at least 14 days if their PPE is considered insufficient. When PPE resources are limited, some equipment may be used continuously throughout a shift as long as it is not contaminated. Details of the aforementioned protective measures are described.