Gastrointestinal endoscopy clinics of North America
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Gastrointest. Endosc. Clin. N. Am. · Jan 2005
ReviewEndoscopic ultrasound and staging of non-small cell lung cancer.
This article outlines the basic principals of lung cancer staging and EUS-FNA techniques and suggests appropriate and inappropriate indications of EUS-FNA for lung cancer.
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Gastrointest. Endosc. Clin. N. Am. · Jan 2005
ReviewEndoscopic ultrasound-guided fine-needle injection.
With the development of linear array echoendoscopes and the ability to perform endoscopic ultrasound (EUS)-guided fine-needle aspiration, the delivery of therapeutic agents with fine-needle injection (FNI) emerged. EUS-guided FNI is an attractive delivery system because of its minimal invasiveness and low complication rate. ⋯ The most exciting area of interest involves the delivery of antitumor agents in patients with locally advanced cancer, such as cancer of the pancreas or esophagus. The involvement of EUS-guided FNI in tumor therapy adds a host of potential new applications that continue to swing the pendulum of EUS from a diagnostic to a therapeutic modality.
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Gastrointest. Endosc. Clin. N. Am. · Apr 2004
ReviewExtended/advanced monitoring techniques in gastrointestinal endoscopy.
The practice of sedation and analgesia is under increasing scrutiny by numerous regulatory agencies, with the aim of making these procedures safer and reducing the incidence of cardiopulmonary complications during GI endoscopy. As we move toward more evidence-based medicine, new technologies will have to be assessed in a manner that demonstrates their efficacy and utility in clinical practice. Although there have been no controlled studies examining whether more intensive monitoring during endoscopy improves outcomes, extended monitoring with capnography seems to offer an advantage over conventional monitoring in that, by providing a real-time indication of any change in adequate ventilation before oxygen desaturation occurs, it can detect early phases of respiratory depression, which can allow a more precise and safer titration of medications. ⋯ Their potential role in improving sedation practice during endoscopy needs to be confirmed by controlled trials. If we consider the lack of proven efficacy of these emerging monitoring techniques in reducing the adverse outcomes associated with sedation and analgesia, the importance of appropriate monitoring cannot be overemphasized. However, it is vital for the endoscopist to be thoroughly familiar with the type of sedation chosen, to be able to recognize the various levels of sedation, and, above all, to rescue patients should they unintentionally progress to a deeper level of sedation than intended.
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Gastrointest. Endosc. Clin. N. Am. · Apr 2004
ReviewSedation and analgesia in the pediatric patient.
The administration of sedation and analgesia for pediatric gastrointestinal procedures has become routine but is not standardized. For the most part, pediatric endoscopists are encouraged to use their clinical judgment to select between using intravenous (IV) sedation or general anesthesia on an individual patient basis. Commonly administered IV sedation regimens in children combine benzodiazepines with narcotics, but anesthesiologist administered propofol sedation is gaining acceptance among pediatric gastroenterologists. Guidelines for patient monitoring and new technologic advances may help to ensure patient safety for children undergoing endoscopic procedures, no matter what sedation regimen is used.
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Gastrointest. Endosc. Clin. N. Am. · Apr 2004
ReviewEfficacy, safety, and limitations in current practice of sedation and analgesia.
The ease and availability of endoscopy as a diagnostic and therapeutic modality for gastrointestinal disorders has greatly increased the number of procedures performed in the United States. One of the main factors in achieving a flawless procedure is the use of sedation and analgesia in endoscopy. This article examines the efficacy, safety, and limitations inherent in the current practice of sedation and analgesia.