scholarly journals National Survey Regarding the Timing of Endoscopic Procedures during the Covid-19 Pandemic

2020 ◽  
Author(s):  
José Daniel Marroquín-Reyes ◽  
Sergio Zepeda-Gómez ◽  
Alejandra Tepox-Padrón ◽  
Mariana Quintanar-Martínez ◽  
Omar Edel Trujillo-Benavides ◽  
...  
Keyword(s):  
Response Rate ◽  
Upper Gastrointestinal Bleeding ◽  
Nationwide Survey ◽  
Hemodynamic Instability ◽  
Severe Anaemia ◽  
Benign Disease ◽  
Endoscopic Procedures ◽  
Electronic Survey ◽  
Clinical Scenarios ◽  
Upper Gastrointestinal

Abstract Background: During the COVID-19 pandemic, several questions have arisen about which endoscopic procedures (EPs) must be performed and which ones can be postponed. The aim of this study was to conduct a nationwide survey regarding the appropriate timing of EPs during the COVID-19 pandemic. Methods: This prospective study was performed through a nationwide electronic survey. The survey consisted of 15 questions divided into three sections. The first evaluated the agreement for EPs classified as “time sensitive” and “not time sensitive”. Two other sections assessed “high-priority” and “low-priority” scenarios. Agreement was considered when >75% of respondents answered a question in the same direction. Results: The response rate was 27.2% (214/784). Among the respondents, agreement for the need to perform EP in <72 hours was only reached for variceal bleeding (93.4%). Dysphagia with alarm symptoms was the scenario in which the highest percentage of physicians (95.9%) agreed that an EP needed to be performed within a month. Less than 30% of endoscopists would perform an EP within the first 72 hours for patients with mild cholangitis, non-variceal upper gastrointestinal bleeding without hemodynamic instability, or severe anaemia without overt bleeding. In time-sensitive clinical scenarios suggestive of benign disease, none of the scenarios reached agreement in any sense. Among the time-sensitive clinical scenarios suggestive of malignancy, >90% of the surveyed respondents considered that EP could not be postponed for >8 weeks. Conclusions: There was no consensus among endoscopists about the timing of EPs in patients with pathologies considered time sensitive or in those with high-priority pathologies. Agreement was only reached in five (17%) of the evaluated clinical scenarios.

scholarly journals Rhinitis medicamentosa: a nationwide survey of Canadian otolaryngologists

2019 ◽  
Vol 48 (1) ◽  
Author(s):  
James Fowler ◽  
Christopher J. Chin ◽  
Emad Massoud
Keyword(s):  
Practice Patterns ◽  
Response Rate ◽  
Nationwide Survey ◽  
Neck Surgery ◽  
Electronic Survey ◽  
Nasal Decongestants ◽  
Intranasal Steroids ◽  
Oral Steroids ◽  
Topical Medications ◽  
Rhinitis Medicamentosa

Abstract Background Rhinitis medicamentosa is a non-allergic form of rhinitis that is typically caused by prolonged use of topical nasal decongestants. This condition commonly affects young adults and treatment is not trivial. We aimed to survey Canadian Otolaryngologists to determine practice patterns and their opinions regarding this under-studied condition. Methods An electronic survey was sent to practicing Otolaryngologists within the Canadian Society of Otolaryngology – Head and Neck Surgery. The survey contained 16 questions pertaining to the diagnosis and treatment of rhinitis medicamentosa, as well as opinions on public and primary care awareness of proper use of nasal decongestants. Results The survey was distributed to 533 Otolaryngologists and 69 surveys were returned (response rate of 13%). Cessation and weaning of decongestant (96%), and intranasal steroids (94%) were the most common methods for treating RM. Intranasal saline rinses (55%) and oral steroids (25%) were also supported by some respondents. For those who recommended cessation/weaning, 61% also concurrently introduced an intranasal steroid during this process. The majority responded that current warnings on nasal decongestants were inadequate (75%), and were not visible enough (79%). Conclusions Rhinitis medicamentosa is a common, and very preventable condition. Although the literature lacks a standardized approach to RM, our survey has shown that many Otolaryngologists diagnose and treat RM in a similar manner. Treatment tends to focus on decongestant cessation, often with concurrent introduction of intranasal steroids. It was felt the warning labels on the topical medications are not currently satisfactory.

Efficacy of a novel hemostatic adhesive powder in patients with refractory upper gastrointestinal bleeding: a pilot study

Endoscopy ◽  
2019 ◽  
Vol 51 (05) ◽  
pp. 458-462 ◽  
Author(s):  
Jin-Seok Park ◽  
Byung Wook Bang ◽  
Su Jin Hong ◽  
Eunhye Lee ◽  
Kye Sook Kwon ◽  
...  
Keyword(s):  
Pilot Study ◽  
Gastrointestinal Bleeding ◽  
Success Rate ◽  
Salvage Therapy ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Hemostasis ◽  
High Success Rate ◽  
Bleeding Site ◽  
Endoscopic Procedures ◽  
Upper Gastrointestinal

Abstract Background A new hemostatic adhesive powder (UI-EWD) has been developed to reduce the high re-bleeding rates associated with the currently available hemostatic powders. The current study aimed to assess the efficacy of UI-EWD as a salvage therapy for the treatment of refractory upper gastrointestinal bleeding (UGIB). Methods A total of 17 consecutive patients who had failed to achieve hemostasis with conventional endoscopic procedures and had undergone treatment with UI-EWD for endoscopic hemostasis in refractory UGIB were prospectively enrolled in the study. We evaluated the success rate of initial hemostasis and rate of re-bleeding within 30 days. Results All patients underwent successful UI-EWD application at the bleeding site. Initial hemostasis occurred in 16/17 patients (94 %). Re-bleeding within 30 days occurred in 3/16 patients (19 %) who had achieved initial hemostasis. In the second-look endoscopy after 24 hours, hydrogel from UI-EWD was found attached at the bleeding site in 11/16 patients (69 %). Conclusion UI-EWD has a high success rate for initial hemostasis in refractory UGIB and shows promising results in the prevention of re-bleeding.

scholarly journals In-Hospital Nonvariceal Upper Gastrointestinal Bleeding following Cardiac Surgery: Patient Characteristics, Endoscopic Lesions and Prognosis

Ulcers ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Marcos Amorim ◽  
Alan N. Barkun ◽  
Martin Larocque ◽  
Karl Herba ◽  
Benoit DeVarennes ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Patient Characteristics ◽  
Hemodynamic Instability ◽  
Predictors Of Outcome ◽  
Surgery Patient ◽  
Endoscopic Characteristics ◽  
Upper Gastrointestinal

Background. Nonvariceal upper gastrointestinal bleeding (NVUGIB) can occur following cardiac surgery, with sparse contemporary data on patient characteristics and predictors of outcome in this setting. Aim. To describe the clinical and endoscopic characteristics of patients with NVUGIB following cardiac surgery and characterize predictors of outcome. Methods. Retrospective review of 131 consecutive patients with NVUGIB following cardiac surgery from 2002 to 2005. Demographic characteristics, therapeutic management, and predictors of outcomes were determined. Results. 69.5% were male, mean age: 68.8 ± 10.2 yrs, mean Parsonnet score: 24.6 ± 14.2. Commonest symptoms included melena (59.4%) or coffee ground emesis (25.8%). In-hospital medications included ASA (88.5%), heparin (95.4%, low molecular weight 6.9%), coumadin (48.1%), clopidogrel (22.9%), and NSAIDS (42%). Initial hemodynamic instability was noted in 47.1%. Associated laboratory results included hematocrit 26 ± 6, platelets 243 ± 133 109/L, INR 1.7 ± 1.6, and PTT 53.3 ± 35.6 s. Endoscopic evaluation (122 patients) yielded ulcers (85.5%) with high-risk lesions in 45.5%. Ulcers were located principally in the stomach (22.5%) or duodenum (45.9%). Many patients had more than one lesion, including esophagitis (28.7%) or erosions (26.8%). 48.8% received endoscopic therapy. Mean lengths of intensive care unit and overall stays were 10.4 ± 18.4 and 39.4 ± 46.9 days, respectively. Overall mortality was 19.1%. Only mechanical ventilation under 48 hours predicted mortality (O.R = 0.11; 95% CI = 0.04−0.34). Conclusions. This contemporary cohort of consecutive patients with NVUGIB following cardiac surgery bled most often from ulcers or esophagitis; many had multiple lesions. ICU and total hospital stays as well as mortality were significant. Mechanical ventilation for under 48 hours was associated with improved survival.

scholarly journals Hemorragia digestiva alta y divertículo duodenal. Reporte de un caso

2020 ◽  
Vol 50 (2) ◽  
Author(s):  
Juan Jerónimo Solé ◽  
Hernán Figgini ◽  
Leonela Aloy ◽  
Otto Ritondale ◽  
Hugo Daniel Ruiz
Keyword(s):  
Upper Gastrointestinal Bleeding ◽  
Hemodynamic Instability ◽  
Duodenal Diverticulum ◽  
Duodenal Wall ◽  
Digestive Endoscopy ◽  
Hemodynamic Stability ◽  
Hemorragia Digestiva ◽  
Radiological Control ◽  
Mechanical Suture ◽  
Upper Gastrointestinal

Bleeding duodenal diverticulum is an infrequent pathology in need of emergency treatment due to its high mortality. We present the clinical case of a 72-year-old patient with multiple comorbidities, who was admitted with upper gastrointestinal bleeding, abdominal pain and hemodynamic instability. Once hemodynamic stability was achieved, upper digestive endoscopy was performed, showing duodenal diverticulum in the upper knee with bleeding in the fundus, performing hemostatic control. CT was requested: at the level of the upper duodenal knee, wide base diverticulum. Surgery was scheduled for the high risk of new bleeding. In surgery, cholecystectomy and diverticulectomy were performed laparoscopically with mechanical suture. Anatomopathological report: duodenal wall with parietal thinning of the duodenum, suggestive of diverticulum by pulsion. The discharge was granted with radiological control on the 3rd postoperative day. The aim of this case is to show the importance of endoscopic resolution of urgency and subsequent laparoscopic management in a patient with important risk factors, evidencing the short hospital stay without postoperative complications.

scholarly journals Training in endotherapy for acute upper gastrointestinal bleeding: a UK-wide gastroenterology trainee survey

2020 ◽  
Vol 11 (6) ◽  
pp. 430-435 ◽  
Author(s):  
Jonathan Segal ◽  
Keith Siau ◽  
Cynthia Kanagasundaram ◽  
Alan Askari ◽  
Paul Dunckley ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Ad Hoc ◽  
Upper Gastrointestinal Bleeding ◽  
First Year ◽  
Questionnaire Response ◽  
Electronic Survey ◽  
Acute Upper Gastrointestinal Bleeding ◽  
National Certification ◽  
The Uk ◽  
Upper Gastrointestinal

IntroductionCompetence in endoscopic haemostasis for acute upper gastrointestinal bleeding (AUGIB) is typically expected upon completion of gastroenterology training. However, training in haemostasis is currently variable without a structured training pathway. We conducted a national gastroenterology trainee survey on haemostasis exposure and on attitudes and barriers to training.MethodsA 24-item electronic survey was distributed to UK gastroenterology trainees covering the following domains: demographics, training setup, attitudes and barriers, confidence in managing AUGIB independently and exposure to individual haemostatic modalities (supervised and independent). Responses were analysed by region and training grade to assess potential variation in training.ResultsA total of 181 trainees completed the questionnaire (response rate 33.5%). There was significant variation in AUGIB training setup across the UK (p<0.001), with 22.7% of trainees declaring no access to structured or ad hoc training. 31.5% expressed confidence in managing AUGIB independently; this varied by trainee grade (0% of first-year specialty trainees (ST3s) to 60.7% of final-years (ST7s)) and by training setup (p=0.001). ST7 trainees reported lack of experience with independently applying glue (86%), Hemospray (54%), heater probe (36%) and variceal banding (36%). Overall, 88% of trainees desired additional haemostasis training and 89% indicated support for a national certification process to ensure competence in AUGIB.ConclusionAUGIB training in the UK is variable. The majority of gastroenterology trainees lacked confidence in haemostasis management and desired additional training. Training provision should be urgently reviewed to ensure that trainees receive adequate haemostasis exposure and are competent by completion of training.

Upper Gastrointestinal Bleeding

2017 ◽  
Author(s):  
Chasen A Croft ◽  
Frederick Moore
Keyword(s):  
Intensive Care ◽  
Gastrointestinal Bleeding ◽  
Surgical Intervention ◽  
Upper Gastrointestinal Bleeding ◽  
Hemodynamic Instability ◽  
Therapeutic Modality ◽  
Endoscopic Management ◽  
Angiographic Embolization ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Upper Gastrointestinal

Acute upper gastrointestinal bleeding (UGIB) is a common and potentially life-threatening emergency. Despite significant advances in intensive care resuscitation, medical treatment of gastric acid hypersecretion, and progress in endoscopic and surgical management, mortality from upper gastrointestinal hemorrhage has remained steady over the past four decades. One of the major challenges of managing UGIB involves identifying patients who are at high risk for rebleeding and death and who require admission to the intensive care unit. Regardless of the cause, initial evaluation of patients with UGIB is based on the degree of hemodynamic instability and the presumed rate of bleeding. Those patients with evidence of active bleeding and hemodynamic instability require aggressive resuscitation and hospitalization. Although diagnostic imaging may be useful in identifying the source of bleeding, endoscopy remains the “gold standard” diagnostic and therapeutic modality. Recent advances in transcatheter angiographic embolization have made this modality an attractive alternative to surgical intervention in patients who fail endoscopic management. However, in the hemodynamically unstable patient, surgical intervention is often necessary. In this review, we describe the most common causes of acute UGIB and detail the initial workup and management of each cause.  This review contains 6 figures, 3 tables, and 71 references. Key words: acute upper gastrointestinal bleeding, angiographic embolization, Billroth, Dieulafoy, esophagogastroduodenoscopy, peptic ulcer disease, scintigraphy, varices

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