Objective:Drug-induced sleep endoscopy(DISE)allows for the evaluation of dynamic airway collapse in patients with obstructive sleep apnea.However,a standardized sedation regimen for DISE is not yet available.This stud...Objective:Drug-induced sleep endoscopy(DISE)allows for the evaluation of dynamic airway collapse in patients with obstructive sleep apnea.However,a standardized sedation regimen for DISE is not yet available.This study aimed to investigate the safety profiles and efficacies of dexmedetomidine combined with butorphanol for DISE.Methods:Sixty patients with obstructive sleep apnea scheduled to undergo DISE were randomly divided into Group D and Group DB.All recipients were initially given intravenous butorphanol(1 mg)(Group DB)or saline(Group D).Subsequently,both groups were sedated using a loading dose of 1.0 pg/kg/h of dexmedetomidine.Hemodynamic and respiratory parameters,the time to attain sufficient sedation,wakeup time,and adverse events during DISE were recorded.Results:Compared with Group D,the time until sufficient sedation and wakeup time in Group DB were significantly reduced.A higher performer satisfaction level was achieved in Group DB.Patients in Group DB showed a higher incidence of bradycardia compared with Group D.However,the bradycardia resolved spontaneously in both groups without any treatment.There was no instance of cough,hypotension,arrhythmia,nausea or vomiting in either group.Conclusion:Compared to dexmedetomidine alone,a small dose of butorphanol infusion(1 mg)as an adjunct treatment to dexmedetomidine during DISE can reduce the dosage of dexmedetomidine,shorten the time until sufficient sedation and enhance the performer satisfaction level.This synergistic combination could be a promising sedation regimen for DISE in terms of procedural convenience and patient safety.展开更多
The field of drug-induced sleep endoscopy(DISE)has grown considerably over the last 10~15 years,to now include its use in pediatric patients.In this review article,we outline our approach to the use of this technology...The field of drug-induced sleep endoscopy(DISE)has grown considerably over the last 10~15 years,to now include its use in pediatric patients.In this review article,we outline our approach to the use of this technology in Children with Airway Obstruction,most specifically in the management of children with airway obstruction and known or suspected adenotonsillar enlargement.展开更多
BACKGROUND Interleukin-17(IL-17)inhibitors are known to cause exacerbation or new onset of inflammatory bowel disease upon administration.However,few reports have described characteristic endoscopic and histopathologi...BACKGROUND Interleukin-17(IL-17)inhibitors are known to cause exacerbation or new onset of inflammatory bowel disease upon administration.However,few reports have described characteristic endoscopic and histopathologic findings,and no small intestinal lesions have been reported so far.CASE SUMMARY A woman in her 60s with psoriasis was administered ixekizumab(IXE),an anti-IL-17A antibody,for the treatment of psoriasis.Twenty months after commencing treatment,the patient visited our hospital because of persistent diarrhea.Blood tests performed at the time of the visit revealed severe inflammation,and colonoscopy revealed multiple round ulcers throughout the colon.A tissue biopsy of the ulcer revealed infiltration of inflammatory cells and granuloma-like findings in the submucosal layer.Capsule endoscopy revealed multiple jejunal erosions.After the withdrawal of IXE,the symptoms gradually improved,and ulcer reduction and scarring of the colon were endoscopically confirmed.CONCLUSION To the best of our knowledge,17 reports have documented IL-17 inhibitorinduced entero-colitis with endoscopic images,endoscopic findings,and pathological characteristics,including the present case.Nine of these cases showed diffuse loss of vascular pattern,coarse mucosa/ulcer formation in the left colon,and endoscopic findings similar to those of ulcerative colitis.In the remaining eight cases,discontinuous erosions and ulcerations from the terminal ileum to the rectum were seen,with endoscopic findings similar to those of Crohn’s disease.In this case,the findings were confirmed by capsule endoscopy,which has not been previously reported.展开更多
Objective:To determine the level of agreement among experienced operators of candidacy for upper airway stimulation (UAS) based on evaluation of drug-induced sleep endoscopy (DISE).Methods:The trial was designed as a ...Objective:To determine the level of agreement among experienced operators of candidacy for upper airway stimulation (UAS) based on evaluation of drug-induced sleep endoscopy (DISE).Methods:The trial was designed as a single-blinded cross-sectional study.Four otolaryngologists with extensive DISE experience were given 63 video clips from the STAR trial video library.These videos were graded using the VOTE classification.Percentage agreement and Cohen's k (for inter-rater reliability) were calculated between pairs of reviewers,assessing palatal complete concentric collapse (CCC) and determining UAS eligibility.Subjects were also grouped based on collapse severity for each reviewer.Results:The reviewers had excellent (approximately 90％) agreement on findings at the level of the soft palate and tongue base.The inter-rater reliability for palatal CCC ranged from mod erate to substantial The agreement on determining the criteria for UAS implantation ranged from poor to moderate.All 4 upper airway structures as classified by the criteria of the VOTE were graded by all the reviewers as contributing to obstruction in a majority of subjects who were performed via application of DISE.Conclusion:Application of DISE remains a subjective examination,even among those experienced operators,therefore more studies need to be performed for evaluation of improvement in inter-rater reliability after implantation of training videos.展开更多
AIM To perform a systematic review and meta-analysis to assess the safety of conscious sedation in patients with obstructive sleep apnea(OSA).METHODS A comprehensive electronic search of MEDLINE and EMBASE was perform...AIM To perform a systematic review and meta-analysis to assess the safety of conscious sedation in patients with obstructive sleep apnea(OSA).METHODS A comprehensive electronic search of MEDLINE and EMBASE was performed from inception until March 1, 2015. In an effort to include unpublished data, abstracts from prior gastroenterological society meetings as well as other reference sources were interrogated. After study selection, two authors utilizing a standardized data extraction form collected the data independently. Any disagreements between authors were resolved by consensus among four authors. The methodological quality was assessed using the Newcastle Ottawa tool for observational studies. The primary variables of interest included incidence of hypoxia, hypotension, tachycardia, and bradycardia. Continuous data were summarized as odds ratio(OR) and 95%CI and pooled using generic inverse variance under the random-effects model. Heterogeneity between pooled studies was assessed using the I2 statistic.RESULTS Initial search of MEDLINE and EMBASE identified 357 citations. A search of meeting abstracts did not yield any relevant citations. After systematic review and exclusion consensus meetings, seven studies met the a priori determined inclusion criteria. The overall methodological quality of included studies ranged from moderate to low. No significant differences between OSA patients and controls were identified among any of the study variables: Incidence of hypoxia(7 studies, 3005 patients; OR = 1.11; 95%CI: 0.73-1.11; P = 0.47; I2 = 0%), incidence of hypotension(4 studies, 2125 patients; OR = 1.10; 95%CI: 0.75-1.60; P = 0.63; I2 = 0%), incidence of tachycardia(3 studies, 2030 patients; OR = 0.94; 95%CI: 0.53-1.65; P = 0.28; I2 = 21%), and incidence of bradycardia(3 studies, 2030 patients; OR = 0.88; 95%CI: 0.63-1.22; P = 0.59; I2 = 0%).CONCLUSION OSA is not a significant risk factor for cardiopulmonary complications in patients undergoing endoscopic procedures with conscious sedation.展开更多
AIM: To investigate whether patients with obstructive sleep apnea (OSA) are at risk of sedation-related complications during diagnostic esophagogastroduodenoscopy (EGD). METHODS: A prospective study was performed in c...AIM: To investigate whether patients with obstructive sleep apnea (OSA) are at risk of sedation-related complications during diagnostic esophagogastroduodenoscopy (EGD). METHODS: A prospective study was performed in consecutive patients with OSA, who were confirmed with full-night polysomnography between July 2010 and April 2011. The occurrence of cardiopulmonary complications related to sedation during diagnostic EGD was compared between OSA and control groups. RESULTS: During the study period, 31 patients with OSA and 65 controls were enrolled. Compared with the control group, a higher dosage of midazolam was administered (P = 0.000) and a higher proportion of deep sedation was performed (P = 0.024) in the OSA group. However, all adverse events, including sedation fail-ure, paradoxical responses, snoring or apnea, hypoxia, hypotension, oxygen or flumazenil administration, and other adverse events were not different between the two groups (all P > 0.1). Patients with OSA were not predisposed to hypoxia with multivariate logistic regression analysis (P = 0.068). CONCLUSION: In patients with OSA, this limited sized study did not disclose an increased risk of cardiopulmonary complications during diagnostic EGD under sedation.展开更多
Background: Although post-endoscopy fever (PEF) without colon perforation or haemorrhage is believed to be rare, incidence, risk factors and causes in the adult population have not been fully investigated. The purpose...Background: Although post-endoscopy fever (PEF) without colon perforation or haemorrhage is believed to be rare, incidence, risk factors and causes in the adult population have not been fully investigated. The purpose of the present study was to investigate the incidence of PEF and identify the risk factors associated with the development of PEF and its outcomes. Material and Methods: Over a three-month period, 1054 non-hospitalised patients who had an endoscopic procedure at Cleveland Clinic Abu Dhabi received a post-procedure phone call within the first 24 hours. After identifying patients with fever and obtaining verbal consent, patients were enrolled in the study using a standardised telephone interview. Results: Thirty-four patients with PEF were identified. The highest temperature measured was 39.8 degrees Celsius. Oesophagogastroduodenoscopy, as a single procedure, was the most commonly performed (41.2%). Logistic regression revealed that no significant group differences across procedure types existed in terms of adjusted odds of fever. However, results also indicated that age has a significant negative relationship with fever—higher age is associated with lower odds of fever (b = -0.033, p = 0.024). Conclusion: PEF is an unpleasant side effect and it is associated with patient discomfort, dissatisfaction and fear during post-endoscopy recovery. Although our findings do not fully explain the possible mechanisms underlying post-endoscopy fever, this study data should increase awareness about PEF as a common side effect related to endoscopy.展开更多
目的 探讨儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopneasyndrome,OSAHS)患儿的治疗方法和疗效观察。方法 经多道睡眠监测(polysomnography,PSG)确诊的4-12岁OSAHS患儿59例:扁桃体切除和(或)经口内镜(内窥镜,下...目的 探讨儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopneasyndrome,OSAHS)患儿的治疗方法和疗效观察。方法 经多道睡眠监测(polysomnography,PSG)确诊的4-12岁OSAHS患儿59例:扁桃体切除和(或)经口内镜(内窥镜,下同)引导下腺样体刮除54例;选择长期正压通气治疗(continue positive airway pressure,CPAP)2例;保守治疗3例。采用儿童OSAHS生活质量调查表(quality of life for children with obstructive sleep apnea 18 items,OSA-18)对患儿进行治疗前后的随访。结果 围手术期无术后出血、急性呼吸道梗阻发生。随访12-18个月,手术患儿无鼻咽闭锁、咽鼓管功能障碍、腺样体残留等并发症;OSA-18调查评分显示:治疗后76.3％(45例)的患儿生活质量总体指标,88.1％(52例)的患儿睡眠呼吸障碍,67.8％(40例)的患儿身体症状得到显著改善。长期CPAP治疗的有效治疗压力在5.6-7.8 em H2O左右。3例保守治疗者略有改善。结论 手术切除引起上气道阻塞的肥大的扁桃体和(或)腺样体是儿童OSAHS有效的治疗手段之一,纤维鼻咽镜检查、头颅侧位X线摄片有助于手术适应证的确定。经口内镜引导下腺样体刮除术具有直视下操作,视野清晰,切除彻底,可避免损伤周围重要结构的特点。展开更多
基金supported by the National Natural Science Foundation of China(No.81470677)the Natural Science Foundation of Hubei Province(No.2020CFB562).
文摘Objective:Drug-induced sleep endoscopy(DISE)allows for the evaluation of dynamic airway collapse in patients with obstructive sleep apnea.However,a standardized sedation regimen for DISE is not yet available.This study aimed to investigate the safety profiles and efficacies of dexmedetomidine combined with butorphanol for DISE.Methods:Sixty patients with obstructive sleep apnea scheduled to undergo DISE were randomly divided into Group D and Group DB.All recipients were initially given intravenous butorphanol(1 mg)(Group DB)or saline(Group D).Subsequently,both groups were sedated using a loading dose of 1.0 pg/kg/h of dexmedetomidine.Hemodynamic and respiratory parameters,the time to attain sufficient sedation,wakeup time,and adverse events during DISE were recorded.Results:Compared with Group D,the time until sufficient sedation and wakeup time in Group DB were significantly reduced.A higher performer satisfaction level was achieved in Group DB.Patients in Group DB showed a higher incidence of bradycardia compared with Group D.However,the bradycardia resolved spontaneously in both groups without any treatment.There was no instance of cough,hypotension,arrhythmia,nausea or vomiting in either group.Conclusion:Compared to dexmedetomidine alone,a small dose of butorphanol infusion(1 mg)as an adjunct treatment to dexmedetomidine during DISE can reduce the dosage of dexmedetomidine,shorten the time until sufficient sedation and enhance the performer satisfaction level.This synergistic combination could be a promising sedation regimen for DISE in terms of procedural convenience and patient safety.
文摘The field of drug-induced sleep endoscopy(DISE)has grown considerably over the last 10~15 years,to now include its use in pediatric patients.In this review article,we outline our approach to the use of this technology in Children with Airway Obstruction,most specifically in the management of children with airway obstruction and known or suspected adenotonsillar enlargement.
文摘BACKGROUND Interleukin-17(IL-17)inhibitors are known to cause exacerbation or new onset of inflammatory bowel disease upon administration.However,few reports have described characteristic endoscopic and histopathologic findings,and no small intestinal lesions have been reported so far.CASE SUMMARY A woman in her 60s with psoriasis was administered ixekizumab(IXE),an anti-IL-17A antibody,for the treatment of psoriasis.Twenty months after commencing treatment,the patient visited our hospital because of persistent diarrhea.Blood tests performed at the time of the visit revealed severe inflammation,and colonoscopy revealed multiple round ulcers throughout the colon.A tissue biopsy of the ulcer revealed infiltration of inflammatory cells and granuloma-like findings in the submucosal layer.Capsule endoscopy revealed multiple jejunal erosions.After the withdrawal of IXE,the symptoms gradually improved,and ulcer reduction and scarring of the colon were endoscopically confirmed.CONCLUSION To the best of our knowledge,17 reports have documented IL-17 inhibitorinduced entero-colitis with endoscopic images,endoscopic findings,and pathological characteristics,including the present case.Nine of these cases showed diffuse loss of vascular pattern,coarse mucosa/ulcer formation in the left colon,and endoscopic findings similar to those of ulcerative colitis.In the remaining eight cases,discontinuous erosions and ulcerations from the terminal ileum to the rectum were seen,with endoscopic findings similar to those of Crohn’s disease.In this case,the findings were confirmed by capsule endoscopy,which has not been previously reported.
文摘Objective:To determine the level of agreement among experienced operators of candidacy for upper airway stimulation (UAS) based on evaluation of drug-induced sleep endoscopy (DISE).Methods:The trial was designed as a single-blinded cross-sectional study.Four otolaryngologists with extensive DISE experience were given 63 video clips from the STAR trial video library.These videos were graded using the VOTE classification.Percentage agreement and Cohen's k (for inter-rater reliability) were calculated between pairs of reviewers,assessing palatal complete concentric collapse (CCC) and determining UAS eligibility.Subjects were also grouped based on collapse severity for each reviewer.Results:The reviewers had excellent (approximately 90％) agreement on findings at the level of the soft palate and tongue base.The inter-rater reliability for palatal CCC ranged from mod erate to substantial The agreement on determining the criteria for UAS implantation ranged from poor to moderate.All 4 upper airway structures as classified by the criteria of the VOTE were graded by all the reviewers as contributing to obstruction in a majority of subjects who were performed via application of DISE.Conclusion:Application of DISE remains a subjective examination,even among those experienced operators,therefore more studies need to be performed for evaluation of improvement in inter-rater reliability after implantation of training videos.
文摘AIM To perform a systematic review and meta-analysis to assess the safety of conscious sedation in patients with obstructive sleep apnea(OSA).METHODS A comprehensive electronic search of MEDLINE and EMBASE was performed from inception until March 1, 2015. In an effort to include unpublished data, abstracts from prior gastroenterological society meetings as well as other reference sources were interrogated. After study selection, two authors utilizing a standardized data extraction form collected the data independently. Any disagreements between authors were resolved by consensus among four authors. The methodological quality was assessed using the Newcastle Ottawa tool for observational studies. The primary variables of interest included incidence of hypoxia, hypotension, tachycardia, and bradycardia. Continuous data were summarized as odds ratio(OR) and 95%CI and pooled using generic inverse variance under the random-effects model. Heterogeneity between pooled studies was assessed using the I2 statistic.RESULTS Initial search of MEDLINE and EMBASE identified 357 citations. A search of meeting abstracts did not yield any relevant citations. After systematic review and exclusion consensus meetings, seven studies met the a priori determined inclusion criteria. The overall methodological quality of included studies ranged from moderate to low. No significant differences between OSA patients and controls were identified among any of the study variables: Incidence of hypoxia(7 studies, 3005 patients; OR = 1.11; 95%CI: 0.73-1.11; P = 0.47; I2 = 0%), incidence of hypotension(4 studies, 2125 patients; OR = 1.10; 95%CI: 0.75-1.60; P = 0.63; I2 = 0%), incidence of tachycardia(3 studies, 2030 patients; OR = 0.94; 95%CI: 0.53-1.65; P = 0.28; I2 = 21%), and incidence of bradycardia(3 studies, 2030 patients; OR = 0.88; 95%CI: 0.63-1.22; P = 0.59; I2 = 0%).CONCLUSION OSA is not a significant risk factor for cardiopulmonary complications in patients undergoing endoscopic procedures with conscious sedation.
文摘AIM: To investigate whether patients with obstructive sleep apnea (OSA) are at risk of sedation-related complications during diagnostic esophagogastroduodenoscopy (EGD). METHODS: A prospective study was performed in consecutive patients with OSA, who were confirmed with full-night polysomnography between July 2010 and April 2011. The occurrence of cardiopulmonary complications related to sedation during diagnostic EGD was compared between OSA and control groups. RESULTS: During the study period, 31 patients with OSA and 65 controls were enrolled. Compared with the control group, a higher dosage of midazolam was administered (P = 0.000) and a higher proportion of deep sedation was performed (P = 0.024) in the OSA group. However, all adverse events, including sedation fail-ure, paradoxical responses, snoring or apnea, hypoxia, hypotension, oxygen or flumazenil administration, and other adverse events were not different between the two groups (all P > 0.1). Patients with OSA were not predisposed to hypoxia with multivariate logistic regression analysis (P = 0.068). CONCLUSION: In patients with OSA, this limited sized study did not disclose an increased risk of cardiopulmonary complications during diagnostic EGD under sedation.
文摘Background: Although post-endoscopy fever (PEF) without colon perforation or haemorrhage is believed to be rare, incidence, risk factors and causes in the adult population have not been fully investigated. The purpose of the present study was to investigate the incidence of PEF and identify the risk factors associated with the development of PEF and its outcomes. Material and Methods: Over a three-month period, 1054 non-hospitalised patients who had an endoscopic procedure at Cleveland Clinic Abu Dhabi received a post-procedure phone call within the first 24 hours. After identifying patients with fever and obtaining verbal consent, patients were enrolled in the study using a standardised telephone interview. Results: Thirty-four patients with PEF were identified. The highest temperature measured was 39.8 degrees Celsius. Oesophagogastroduodenoscopy, as a single procedure, was the most commonly performed (41.2%). Logistic regression revealed that no significant group differences across procedure types existed in terms of adjusted odds of fever. However, results also indicated that age has a significant negative relationship with fever—higher age is associated with lower odds of fever (b = -0.033, p = 0.024). Conclusion: PEF is an unpleasant side effect and it is associated with patient discomfort, dissatisfaction and fear during post-endoscopy recovery. Although our findings do not fully explain the possible mechanisms underlying post-endoscopy fever, this study data should increase awareness about PEF as a common side effect related to endoscopy.
文摘目的 探讨儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopneasyndrome,OSAHS)患儿的治疗方法和疗效观察。方法 经多道睡眠监测(polysomnography,PSG)确诊的4-12岁OSAHS患儿59例:扁桃体切除和(或)经口内镜(内窥镜,下同)引导下腺样体刮除54例;选择长期正压通气治疗(continue positive airway pressure,CPAP)2例;保守治疗3例。采用儿童OSAHS生活质量调查表(quality of life for children with obstructive sleep apnea 18 items,OSA-18)对患儿进行治疗前后的随访。结果 围手术期无术后出血、急性呼吸道梗阻发生。随访12-18个月,手术患儿无鼻咽闭锁、咽鼓管功能障碍、腺样体残留等并发症;OSA-18调查评分显示:治疗后76.3％(45例)的患儿生活质量总体指标,88.1％(52例)的患儿睡眠呼吸障碍,67.8％(40例)的患儿身体症状得到显著改善。长期CPAP治疗的有效治疗压力在5.6-7.8 em H2O左右。3例保守治疗者略有改善。结论 手术切除引起上气道阻塞的肥大的扁桃体和(或)腺样体是儿童OSAHS有效的治疗手段之一,纤维鼻咽镜检查、头颅侧位X线摄片有助于手术适应证的确定。经口内镜引导下腺样体刮除术具有直视下操作,视野清晰,切除彻底,可避免损伤周围重要结构的特点。
