BACKGROUND:In general,the dose requirement and complications of propofol are lower when used in the diluted form than in the undiluted form.The aim of this study was to determine the dose requirement and complications...BACKGROUND:In general,the dose requirement and complications of propofol are lower when used in the diluted form than in the undiluted form.The aim of this study was to determine the dose requirement and complications of diluted and undiluted propofol for deep sedation in endoscopic retrograde cholangiopancreatography.METHODS:Eighty-six patients were randomly assigned to either group D (diluted propofol) or U (undiluted propofol).All patients were sedated with 0.02-0.03 mg/kg midazolam (total dose ≤2 mg for age <70 years and 1 mg for age ≥70) and 0.5-1 μg/kg fentanyl (total dose ≤75 μg for age <70 and ≤50 μg for age ≥70).Patients in group U (42) were sedated with standard undiluted propofol (10 mg/mL).Patients in group D (44) were sedated with diluted propofol (5 mg/mL).All patients in both groups were monitored for the depth of sedation using the Narcotrend system.The primary outcome variable was the total dose of propofol used during the procedure.The secondary outcome variables were complications during and immediately after the procedure,and recovery time.RESULTS:All endoscopies were completed successfully.Mean propofol doses per body weight and per body weight per hour in groups D and U were 3.0 mg/kg,6.2 mg/kg per hour and 4.7 mg/kg,8.0 mg/kg per hour,respectively.The mean dose of propofol,expressed as total dose,dose/kg or dose/kg per hour and the recovery time were not significantly different between the two groups.Sedation-related adverse events during and immediately after the procedure were higher in group U (42.9%) than in group D (18.2%) (P=0.013).CONCLUSIONS:Propofol requirement and recovery time in the diluted and undiluted propofol groups were comparable.However,the sedation-related hypotension was significantly lower in the diluted group than the undiluted group.展开更多
AIM To evaluate the clinical and economical efficacy of lumen apposing metal stent(LAMS) in the treatment of benign foregut strictures.METHODS A single center retrospective database of patients who underwent endoscopi...AIM To evaluate the clinical and economical efficacy of lumen apposing metal stent(LAMS) in the treatment of benign foregut strictures.METHODS A single center retrospective database of patients who underwent endoscopic treatment of benign foregut strictures between January 2014 and May 2017 was analyzed. A control group of non-stented patients who underwent three endoscopic dilations was compared to patients who underwent LAMS placement. Statistical tests performed included independent t-tests and fiveparameter regression analysis RESULTS Nine hundred and ninety-eight foregut endoscopic dilations were performed between January 2014 and May 2017. 15 patients underwent endoscopic LAMS placement for treatment of benign foregut stricture. Thirty-six patients with recurrent benign foregut strictures underwent three or more endoscopic dilations without stent placement. The cost ratio of endoscopic dilation to LAMS(stent, placement and retrieval) is 5.77. Cost effective analysis demonstrated LAMS to be economical after three endoscopic dilation overall.LAMS was cost effective after two dilations in the Postsurgical stricture subgroup. CONCLUSION Endoscopists should consider LAMS for the treatment of benign foregut strictures if symptoms persist past three endoscopic dilations. Post-surgical strictures may benefit from LAMS if symptoms persist after two dilations in a post-surgical. Early intervention with LAMS appears to be a clinically and economically viable option for durable symptomatic relief in patients with these strictures.展开更多
AIM: To assess the tolerability and safety of same-day tandem procedures, endoscopic ultrasound (EUS) followed by endoscopic retrograde cholangiopancreatography (ERCP) under conscious sedation. METHODS: A retrospectiv...AIM: To assess the tolerability and safety of same-day tandem procedures, endoscopic ultrasound (EUS) followed by endoscopic retrograde cholangiopancreatography (ERCP) under conscious sedation. METHODS: A retrospective review was conducted at Loma Linda University Medical Center, a tertiary-care center. All 54 patients who underwent EUS followed by ERCP (group A) from 2004 to 2006 were included in the study. A second group of 56 patients who underwent EUS only (group B), and a third group of 53 patients who underwent ERCP only (group C) during the same time period were selected consecutively as control groups for comparison. RESULTS: Conscious sedation was used in 96% of patients in group A. Mean dosages of meperidine and midazolam used in group A were signifi cantly higher than in group B or C. Mean recovery time in group A was not statistically longer than in group B or C. Therewas no signifi cant difference in the incidence of sedation-related and procedural-related complications. CONCLUSION: Tandem EUS/ERCP procedure can be safely performed under conscious sedation with minimal adverse events. Combined procedures, however, are associated with higher dosages of sedatives, and slightly longer recovery time.展开更多
文摘BACKGROUND:In general,the dose requirement and complications of propofol are lower when used in the diluted form than in the undiluted form.The aim of this study was to determine the dose requirement and complications of diluted and undiluted propofol for deep sedation in endoscopic retrograde cholangiopancreatography.METHODS:Eighty-six patients were randomly assigned to either group D (diluted propofol) or U (undiluted propofol).All patients were sedated with 0.02-0.03 mg/kg midazolam (total dose ≤2 mg for age <70 years and 1 mg for age ≥70) and 0.5-1 μg/kg fentanyl (total dose ≤75 μg for age <70 and ≤50 μg for age ≥70).Patients in group U (42) were sedated with standard undiluted propofol (10 mg/mL).Patients in group D (44) were sedated with diluted propofol (5 mg/mL).All patients in both groups were monitored for the depth of sedation using the Narcotrend system.The primary outcome variable was the total dose of propofol used during the procedure.The secondary outcome variables were complications during and immediately after the procedure,and recovery time.RESULTS:All endoscopies were completed successfully.Mean propofol doses per body weight and per body weight per hour in groups D and U were 3.0 mg/kg,6.2 mg/kg per hour and 4.7 mg/kg,8.0 mg/kg per hour,respectively.The mean dose of propofol,expressed as total dose,dose/kg or dose/kg per hour and the recovery time were not significantly different between the two groups.Sedation-related adverse events during and immediately after the procedure were higher in group U (42.9%) than in group D (18.2%) (P=0.013).CONCLUSIONS:Propofol requirement and recovery time in the diluted and undiluted propofol groups were comparable.However,the sedation-related hypotension was significantly lower in the diluted group than the undiluted group.
文摘AIM To evaluate the clinical and economical efficacy of lumen apposing metal stent(LAMS) in the treatment of benign foregut strictures.METHODS A single center retrospective database of patients who underwent endoscopic treatment of benign foregut strictures between January 2014 and May 2017 was analyzed. A control group of non-stented patients who underwent three endoscopic dilations was compared to patients who underwent LAMS placement. Statistical tests performed included independent t-tests and fiveparameter regression analysis RESULTS Nine hundred and ninety-eight foregut endoscopic dilations were performed between January 2014 and May 2017. 15 patients underwent endoscopic LAMS placement for treatment of benign foregut stricture. Thirty-six patients with recurrent benign foregut strictures underwent three or more endoscopic dilations without stent placement. The cost ratio of endoscopic dilation to LAMS(stent, placement and retrieval) is 5.77. Cost effective analysis demonstrated LAMS to be economical after three endoscopic dilation overall.LAMS was cost effective after two dilations in the Postsurgical stricture subgroup. CONCLUSION Endoscopists should consider LAMS for the treatment of benign foregut strictures if symptoms persist past three endoscopic dilations. Post-surgical strictures may benefit from LAMS if symptoms persist after two dilations in a post-surgical. Early intervention with LAMS appears to be a clinically and economically viable option for durable symptomatic relief in patients with these strictures.
文摘AIM: To assess the tolerability and safety of same-day tandem procedures, endoscopic ultrasound (EUS) followed by endoscopic retrograde cholangiopancreatography (ERCP) under conscious sedation. METHODS: A retrospective review was conducted at Loma Linda University Medical Center, a tertiary-care center. All 54 patients who underwent EUS followed by ERCP (group A) from 2004 to 2006 were included in the study. A second group of 56 patients who underwent EUS only (group B), and a third group of 53 patients who underwent ERCP only (group C) during the same time period were selected consecutively as control groups for comparison. RESULTS: Conscious sedation was used in 96% of patients in group A. Mean dosages of meperidine and midazolam used in group A were signifi cantly higher than in group B or C. Mean recovery time in group A was not statistically longer than in group B or C. Therewas no signifi cant difference in the incidence of sedation-related and procedural-related complications. CONCLUSION: Tandem EUS/ERCP procedure can be safely performed under conscious sedation with minimal adverse events. Combined procedures, however, are associated with higher dosages of sedatives, and slightly longer recovery time.
