Conscious sedation using propofolversusmidazolam in cirrhotic patients during upper GI endoscopy: A comparative study

Background: Peptic ulcer disease in patients with liver cirrhosis poses significant morbidity and mortality . It is also a cause for gastrointestinal bleed . Our study aims at providing a clinical and endoscopic profile of peptic ulcer disease in patients suffering from liver cirrhosis . Objective: Providing an insight into the clinical and endoscopic profile of patients suffering from liver cirrhosis and peptic ulcer disease, with special reference to Child Pugh score, spontaneous bacterial peritonitis, refractory ascites and other comorbidities. Methods: This study was conducted in the Department of Medical Gastroenterology, Govt Stanley medical college, Chennai from September 2018 to April 2019. All cirrhotic patients underwent relevant blood investigations, ultrasound abdomen, portal vein doppler and upper GI endoscopy. Gastric ulcers were biopsied according to standard protocol. RUT was not performed in all cases for H.Pylori detection . Results: A total of 361 cirrhotic patients that underwent upper GI endoscopy, 45 patients were incuded in our study based on the inclusion criteria. The prevalence of peptic ulcer disease in liver cirrhotics was 12.4% . Males to females ratio of 38:7. Mean age was 38 years ±2.8. Mean CTP score was 8.42±1.90 . median of 8 , mode 10 . Ascites was noted in 37, SBP in 22 and refractory ascites in 4. Etiology for cirrhosis was alcohol (44.4%) , cryptogenic(17.8%) , hepatitis B(15.6%) , Budd Chiari syndrome(8.9%) , hepatitis C(4.4%), wilsons disease (2.2%) , secondary biliary cirrhosis(2.2%) , autoimmune hepatitis(2.2%) . 23 had CPT score B, followed by CPT C in 15 and CPT A in 7 . Conclusion: In conclusion, a significant proportion of patients with cirrhosis develop PUD. Furthermore, H pylori infection and NSAIDs are not the only, or perhaps even the most important, risk factors for PUD in patients with cirrhosis. These observations have important practical implications for physicians caring for patients with chronic liver disease.

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Towards Noninvasive Detection of Oesophageal Varices

International Journal of Hepatology ◽

10.1155/2012/343591 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 8

Author(s):

Kara Rye ◽

Robert Scott ◽

Gerri Mortimore ◽

Adam Lawson ◽

Andrew Austin ◽

...

Keyword(s):

Clinical Signs ◽

Primary Prophylaxis ◽

Oesophageal Varices ◽

Repeated Testing ◽

Gi Endoscopy ◽

Upper Gi ◽

Screening Endoscopy ◽

Upper Gi Endoscopy ◽

Heavy Burden ◽

Cirrhotic Patients

Current guidelines recommend that all cirrhotic patients should undergo screening endoscopy at diagnosis to identify patients with varices at high risk of bleeding who will benefit from primary prophylaxis. This approach places a heavy burden upon endoscopy units and the repeated testing over time may have a detrimental effect on patient compliance. Noninvasive identification of patients at highest risk for oesophageal varices would limit investigation to those most likely to benefit. Upper GI endoscopy is deemed to be the gold standard against which all other tests are compared, but is not without its limitations. Multiple studies have been performed assessing clinical signs and variables relating to liver function, variables relating to liver fibrosis, and also to portal hypertension and hypersplenism. Whilst some tests are clearly preferable to patients, none appear to be as accurate as upper GI endoscopy in the diagnosis of oesophageal varices. The search for noninvasive tests continues.

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USE OF ROADMAP FLUOROSCOPY IN UPPER GI ENDOSCOPY

10.1055/s-0040-1705058 ◽

2020 ◽

Author(s):

J Weigt ◽

W Elhossary ◽

W Obst ◽

P Maciej

Keyword(s):

Gi Endoscopy ◽

Upper Gi ◽

Upper Gi Endoscopy

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A study of therapeutic role of upper GI endoscopy at tertiary health care centre

MedPulse International Journal of Pediatrics ◽

10.26611/1014928 ◽

2019 ◽

Vol 9 (2) ◽

pp. 71-74

Author(s):

Kudlappa Angadi ◽

◽

Nagaraj Kotli ◽

Keyword(s):

Health Care ◽

Care Centre ◽

Health Care Centre ◽

Therapeutic Role ◽

Gi Endoscopy ◽

Upper Gi ◽

Upper Gi Endoscopy

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A radiological profile of the patients undergoing upper GI endoscopy at tertiary health care centre

MedPulse International Journal of Pediatrics ◽

10.26611/1014926 ◽

2019 ◽

Vol 9 (2) ◽

pp. 63-66

Author(s):

Kudlappa Angadi ◽

◽

Pooja Patil ◽

Keyword(s):

Health Care ◽

Care Centre ◽

Health Care Centre ◽

Gi Endoscopy ◽

Upper Gi ◽

Upper Gi Endoscopy

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A comparative study of multi-detector CT portography versus endoscopy in evaluation of gastro-esophageal varices in portal hypertension patients

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-019-0117-5 ◽

2020 ◽

Vol 51 (1) ◽

Author(s):

Hany El-Assaly ◽

Lamiaa I. A. Metwally ◽

Heba Azzam ◽

Mohamed Ibrahim Seif-Elnasr

Keyword(s):

Portal Hypertension ◽

Portal Vein ◽

Esophageal Varices ◽

Imaging Modality ◽

Splenic Vein ◽

Gastric Varices ◽

Gi Endoscopy ◽

Upper Gi ◽

Upper Gi Endoscopy ◽

Vein Diameter

Abstract Background Portal hypertension is a major complication resulting from obstruction of portal blood flow, like cirrhosis or portal vein thrombosis, that leads to portal hypertension. MDCT angiography has become an important tool for investigation of the liver as well as potentially challenging varices by detailing the course of these tortuous vessels. This information is decisive for liver transplantation as well as for common procedures in which an unexpected varix can cause significant bleeding. Results This study included an assessment of 60 cases of portal hypertension (28 males and 32 females), their age ranged from 42 to 69 years (mean age = 57.2 ± 6.63). All patients were diagnosed with portal hypertension, underwent upper GI endoscopy followed by a triphasic CT scan with CT angiographic assessment for the screening of gastro-esophageal varices. CT is highly sensitive as compared to upper GI endoscopy (sensitivity 93%) in detecting esophageal varices. Gastric varices detected by CT in 22 patients (37%) compared to 14 patients (23%) detected by endoscopy. While paraesophageal varices were detected in 63% of patients and retro-gastric varices in 80% of patients that were not visualized by endoscopy. Our study reported that the commonest type of collaterals were the splenic collaterals, and we also found there is a significant correlation between the portal vein diameter and the number of collaterals as well as between the portal vein diameter and splenic vein diameter. Conclusions Multi-slice CT serves as an important non-invasive imaging modality in the diagnosis of collaterals in cases of portal hypertension. CT portography can replace endoscopy in the detection of high-risk varices. It also proved that there is a correlation between portal vein diameter, splenic vein diameter, and number of collaterals.

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LMA® Gastro™: A paediatric experience

Anaesthesia and Intensive Care ◽

10.1177/0310057x20981591 ◽

2021 ◽

pp. 0310057X2098159

Author(s):

Charlotte L Taylor ◽

Steven R Wilson ◽

Laura L Burgoyne ◽

Yasmin Endlich

Keyword(s):

Success Rate ◽

Education Programme ◽

Paediatric Population ◽

Airway Device ◽

Older Children ◽

Gi Endoscopy ◽

Upper Gi ◽

Upper Gi Endoscopy ◽

Trial Basis ◽

Endoscopy Outcomes

The laryngeal mask airway, the LMA® Gastro™ (Teleflex Medical, Athlone, Ireland), is a novel airway device which permits upper gastrointestinal (GI) endoscopy to be performed via a dedicated large calibre oesophageal lumen. It has been validated in adult studies, but to our knowledge, there have been no data published regarding its use in a paediatric population. Following a brief education programme, the LMA Gastro was introduced on a trial basis at our institution and made freely available. Over a four-month period, our pre-existing endoscopy audit framework captured data on a total of 55 patients who had the LMA Gastro device chosen as the primary airway for elective upper GI endoscopy. These data were collected prospectively by the treating anaesthetist and included a range of airway and endoscopy outcomes. Of the 55 patients, the LMA Gastro provided an adequate airway in 52 (94.5%). Forty-six (88.5%) were sited on first attempt, and 50 (96.2%) insertions were rated ‘easy’ by the anaesthetist. Aside from three insertion failures, there were no airway events. The endoscopy success rate was 100% in the 52 patients who had an LMA Gastro airway successfully inserted. First-pass oesophageal access was achieved in 51 (98%) cases, and 100% of insertions were rated ‘easy’ by the gastroenterologist. Despite our relative inexperience with it, the device had a high success rate for airway maintenance and oesophageal access in our paediatric patient population. In our institution, the LMA Gastro provided a useful airway option in older children undergoing elective upper GI endoscopy.

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