笑气镇静下用于胃肠镜检查静脉麻醉高风险人群的效果分析

[目的]探讨笑气镇静下用于胃肠镜检查静脉麻醉高风险人群中的效果与安全性。[方法]选取120例经胃肠镜检查的静脉麻醉高风险人群为研究对象,将其按照随机数字表法分为研究组与对照组,各60例。研究组采取笑气镇静下胃肠镜检查,对照组采取常规氧气吸入下胃肠镜检查。[结果]心电监护的过程中,研究组心动过速0例、低氧血症1例,对照组心动过速2例、低氧血症1例;研究组、对照组患者对医师检查操作满意度评分分别为(87.3±4.6)分、(72.6±5.7)分,自我感觉满意度评分分别为(86.1±4.8)分、(70.4±4.5)分,耐受性好分别为80.0%、50.0%,2组比较均差异有统计学意义(P0.05)。[结论]笑气镇静下用于胃肠镜检查静脉麻醉高风险人群能够有效避免常规胃肠镜检查所导致的心动过速的发生,患者耐受力好,值得临床中应用。     

经鼻胃镜导丝引导下放置鼻肠管的临床应用

目的总结经鼻胃镜导丝引导下放置鼻肠管的技术方法及经验教训,探讨该方法在临床中的应用价值。方法我科自2007年8月至2011年2月共对104例患者进行了115例次经鼻胃镜鼻肠管放置术及肠内营养支持治疗,记录每例置管时间,计算平均时间,观察术中及术后并发症。结果一次置管成功率为94.78%,6例次需二次置管,全部成功。从插入内镜至完成置管时间一般为5～14min,平均约10min,无腹痛、消化道穿孔、消化道出血等并发症。鼻肠管留置时间15～92d。结论经鼻胃镜导丝引导下放置鼻肠管置管适应症广,耐受性好,操作时间短,成功率高,并发症很少,值得在临床上推广应用。     

经鼻胃镜取出食管异物19例

目的:探讨经鼻胃镜治疗食管异物的方法及技巧.方法:2010-01/2011-10我院共发现食管异物患者32例,其中,13例通过其他手术方法取出.19例经鼻插入胃镜的方法取出.本文回顾性分析急诊经鼻胃镜下食管异物取出术患者19例的临床资料.结果:32例患者中12例球型或团块状异物经常规胃镜圈套取出;1例为义齿嵌顿1wk,位于主动脉弓附近,义齿钢丝穿透食管壁,内镜试取不成功,转外科手术取出.19例食管尖锐异物和扁平规则异物经鼻胃镜成功取出.操作时间2-10min,术中未出现咽部及食管出血、撕裂、穿孔等严重并发症.结论:经鼻胃镜取出食管尖锐异物、扁平规则异物具有安全简便,患者痛苦小,并发症少,成功率高等特点,是一种较为理想的治疗方法,为临床治疗食管异物提供了新的途径.     

经鼻胃镜在肝硬化患者的临床应用

目的探讨经鼻胃镜在肝硬化患者中的临床应用价值。方法 85例肝硬化患者进行了经鼻胃镜检查,术后评估患者反应情况;曾接受经口胃镜检查治疗的患者,评估两种胃镜检查的不良反应程度;评估局部出血并发症与凝血功能、血小板计数的相关性。结果 85例肝硬化患者均完成经鼻胃镜上消化道检查,基本无不适者75例,稍有不适者8例,反应较大者2例;5例患者检查结束后出现鼻出血,占全部人群的5.9%;6例患者略感鼻腔内不适,观察后自行缓解消失。结论经鼻胃镜可完成经口胃镜的诊断功能,术中不适感及术中、术后并发症轻而少,经鼻胃镜适于肝硬化患者常规检查。     

一种新型经鼻内镜与普通胃镜的临床对比研究

目的探讨Fujifilm EG-530NW经鼻胃镜的临床应用价值。方法295例接受胃镜检查的患者,按检查序号的随机数字表法随机分成普通胃镜组（172例）和新型经鼻胃镜组（123例）,观察新型经鼻胃镜组的检查情况,并比较两组患者的血压、心率波动情况以及检查过程中的不适程度差异。结果新型经鼻胃镜组获得的图像与普通胃镜组相似,反转观察无盲区且图像清晰。新型经鼻胃镜组无不适或一般不适的比例明显高于对照组（81．3％比68．6％）,差异有统计学意义（P〈0．05）;心率波动亦明显小于普通胃镜组[（7．4±11．6）次／min比（11．t±14．6）次／min],差异有统计学意义（P〈0．05）;而血压波动两组间比较差异无统计学意义（P〉0．05）。在年龄较大患者（年龄〉50岁）中,新型经鼻胃镜组心率、血压波动均显著小于普通胃镜组,差异有统计学意义（P〈0．05）。结论Fujifilm EG-530NW经鼻胃镜可以获得高质量的图像,较普通胃镜更能减轻患者检查时的不适感,并可减少患者心率与血压的波动,尤其对于年龄较大的患者更具有明显优势,更加安全。     

气郁质型患者经鼻胃镜与经口胃镜检查的对比观察

[目的]比较气郁质型患者行经鼻胃镜和经口胃镜检查时的不同反应,为其提供选择最佳的胃镜检查。[方法]将416例气郁质型患者随机分为观察组(经鼻胃镜)211例,对照组(经口胃镜)205例。观察检查前、检查中收缩压、心率、血氧饱和度变化;检查中患者的反应及检查后患者的感受。[结果]2组在检查前收缩压、心率、血氧饱和度差异均无统计学意义(P0.05),检查中观察组收缩压、心率、血氧饱和度变化小于对照组(P0.05);观察组检查时不适反应(恶心、呕吐、呛咳、流泪、流涕)较对照组少(P0.01),术后自觉痛苦较对照组轻(P0.01)。[结论]2组对比观察,气郁质型患者更适合经鼻胃镜检查。     

经鼻超细胃镜下导丝辅助难置胃管放置的体会

目的 探讨吞咽困难病人经鼻超细胃镜下放置胃管建立肠内营养途径的配合及护理.方法 胃管插入困难的患者在经鼻超细胃镜下放置导丝,通过导丝放入胃管,推送将其送至胃内.结果 使用经鼻超细胃镜时,患者术中可以与医护人员交流,缓解紧张情绪,能更好的主动配合.经鼻超细胃镜镜身细,对于部分食管狭窄不完全性梗阻的病人,较普通胃镜更容易通...     

鼻胃镜经口临床应用1 020例

自２０００年５月至２００１年５月，我院用ＧＩＦ－１６Ｖ、Ｘ鼻胃镜经口使用，共诊断及治疗多种上消化道疾患者１０２０例，现报告如下。一、资料与方法１、一般情况：１　０２０例患者，男５０２例、女５１８例，年龄为２～８８岁。２、器械：日本Ｐｅｎｔａｘ－ＧＩＦ－１６Ｖ、Ｘ前视式鼻胃镜，视野角１２５。，焦距３～５０　ｍｍ，工作长度９３５　ｍｍ，镜身全长１２７０　ｍｍ，插入部外径５．２　ｍｍ，活检孔道２　ｍｍ，弯曲角上下１８０。、左右１６０。，镜端有一个象束窗、两个导光窗、一个活检孔道，注气、注水通道与活检孔…     

经鼻胃镜检查的临床应用

使用超细胃镜经鼻插入（简称经鼻胃镜）是一种新的胃镜检查方法，我院消化内镜室于2005年3月至2006年2月共进行了125例经鼻胃镜检查，取得良好效果，报道如下。     

经鼻胃镜在高龄高危人群中的应用体会

由于“无痛”技术消除了患者在胃镜检查过程中的恶心不适等反应,因此被越来越多的患者和医生所接受并喜爱,但麻醉药物本身的风险限制了其在高龄高危患者中的应用。本院白2007年开始应用经鼻胃镜对352例患者进行了检查,效果较好,现总结如下。     

A randomized trial of topical anesthesia comparing lidocaine versus lidocaine plus xylometazoline for unsedated transnasal upper gastrointestinal endoscopy

BACKGROUND:

The optimal topical anesthesia regimen for unsedated transnasal endoscopy is unknown. The addition of a nasal decongestant, such as xylometazoline (X), to a topical anesthestic may improve patient comfort.

OBJECTIVE:

To determine the effectiveness of lidocaine (L) versus L plus X (LX) for anesthesia in unsedated transnasal endoscopy.

METHODS:

Consecutive participants of the Aklavik Helicobacter pylori project were prospectively randomly assigned to receive LX or L for unsedated transnasal 4.9 mm ultrathin endoscopy. The primary outcome was overall procedure discomfort on a validated 10-point visual analogue scale (1 = no discomfort, 10 = severe discomfort). Secondary outcomes included pain, endoscope insertion difficulty, gagging, adverse events and encounter times. Results were presented as mean ± SD, difference in mean, 95% CI.

RESULTS:

A total of 181 patients were randomly assigned to receive LX (n=94) and L (n=87). Baseline characteristics between the two groups were similar (mean age 40 years, 59% women). Overall, patient procedural discomfort with LX and L were 4.2±2.4 versus 3.9±2.1, respectively (0.29; 95% CI −0.39 to 0.96). Transnasal insertion difficulty was significantly lower with LX than with L (2.4±2.1 versus 3.2±2.8, respectively [−0.80; 95% CI −1.54 to −0.06]). Compared with L, the use of LX was associated with significantly less time needed to apply anesthesia (2.4±1.8 min versus 3.5±2.2 min, respectively [−1.10; 95% CI −1.71 min to −0.50 min]) and less time for insertion (3.2±1.8 min versus 3.9±2.2 min, respectively [−0.70 min; 95% CI −1.30 min to −0.10 min]). Epistaxis was rare but occurred less frequently with LX (1.1%) than with L (4.6%) (P=0.19).

CONCLUSIONS:

LX did not improve patient comfort for transnasal endoscopy compared with L alone. However, LX was associated with less difficulty with endoscope transnasal insertion and reduced insertion time. Further studies on the optimal regimen and dosing of anesthesia are required.     

Risk factors for nasal bleeding in patients undergoing transnasal gastrointestinal endoscopy

Transnasal endoscopy is widely used in screening for upper gastrointestinal lesions because of less associated pain. Nasal bleeding is the most severe adverse effect, but specific risk factors have not been identified. The aim of this study is to identify risk factors for nasal bleeding during transnasal endoscopy. Nasal bleeding occurred in 160/3035 (5.3%) of patients undergoing transnasal endoscopy as part of health checkups. Patient data were retrospectively evaluated including anthropometric, medical, and life-style parameters with multiple logistic regression analysis. Multiple logistic regression revealed that nasal bleeding was significantly associated with age in decades [odds ratio/10 years 0.78, 95% confidence interval (CI) 0.63–0.97, p = 0.027], female gender (2.15, 95% CI 1.48–3.12, p < 0.001), a history of previous upper gastrointestinal endoscopy (0.55, 95% CI 0.36–0.82, p = 0.004), and chronic/allergic rhinitis (0.60, 95% CI 0.36–0.98, p = 0.043). Other factors including the use of antiplatelet and/or anticoagulant drugs were not significantly associated with nasal bleeding. Female and young patients are significantly associated with an increased risk of bleeding from transnasal endoscopy, but antiplatelet and/or anticoagulant medications and a history of chronic/allergic rhinitis may not be associated.     

Unsedated transnasal versus transoral sedated upper gastrointestinal endoscopy: A one-series prospective study on safety and patient acceptability

BACKGROUND: While conventional oesophagogastroduodenoscopy is frequently performed under sedation to improve acceptability, transnasal oesophagogastroduodenoscopy would appear to be less invasive. STUDY AIMS: To compare diagnostic accuracy, feasibility, acceptability and safety of transnasal oesophagogastroduodenoscopy without sedation versus conventional oesophagogastroduodenoscopy under sedation. PATIENTS: Following anxiety assessment, 30 dyspeptic patients underwent transnasal oesophagogastroduodenoscopy under local anaesthesia (lidocaine) and conventional oesophagogastroduodenoscopy under conscious sedation (i.v. midazolam) on two consecutive days. Transnasal oesophagogastroduodenoscopy was performed with an ultrathin and conventional oesophagogastroduodenoscopy with a standard endoscope. METHODS: Safety, evaluated by monitoring cardio-respiratory functions. Acceptability, rated according to discomfort and preference between the two examinations. Diagnostic accuracy evaluated taking into account endoscopic patterns and adequacy of biopsy specimens for histology. Feasibility, defined according to endoscopic performance, quality of images and overall opinion of the endoscopist. Only gastric biopsies were evaluated. RESULTS: All patients but one who refused conventional oesophagogastroduodenoscopy underwent both transnasal oesophagogastroduodenoscopy and conventional oesophagogastroduodenoscopy. No cardiorespiratory complications occurred during either technique. Majority of patients (87%) preferred transnasal oesophagogastroduodenoscopy. Examinations were completed in all cases, with comparable endoscopic patterns. All biopsy specimens were suitable for histology. CONCLUSIONS: Transnasal oesophagogastroduodenoscopy without sedation provides good diagnostic accuracy, is safer and better accepted than conventional oesophagogastroduodenoscopy under sedation and, therefore, represents a valid alternative in routine diagnosis of upper digestive tract diseases.     

Randomized controlled study of the safety and efficacy of nitrous oxide-sedated endoscopic ultrasound-guided fine needle aspiration for digestive tract diseases

AIM To evaluate the efficacy and safety of nitrous oxidesedated endoscopic ultrasound-guided fine needle aspiration. METHODS Enrolled patients were divided randomly into an experimental group(inhalation of nitrous oxide) and a control group(inhalation of pure oxygen) and heart rate, blood oxygen saturation, blood pressure, electrocardiogram(ECG) changes, and the occurrence of complications were monitored and recorded. All patients and physicians completed satisfaction questionnaires about the examination and scored the process using a visual analog scale. RESULTS There was no significant difference in heart rate, blood oxygen saturation, blood pressure, ECG changes, or complication rate between the two groups of patients(P 0.05). However, patient and physician satisfaction were both significantly higher in the nitrous oxide compared with the control group(P 0.05).CONCLUSION Nitrous oxide-sedation is a safe and effective option for patients undergoing endoscopic ultrasound-guided fine needle aspiration.     

Prospective randomized trial of transnasal versus peroral endoscopy using an ultrathin videoendoscope in unsedated patients

AIM: The aim of this study was to compare the acceptance and tolerance of transnasal and peroral esophagogastroduodenoscopy (EGD) using an ultrathin videoendoscope in unsedated patients. METHODS: A total of 124 patients referred for diagnostic endoscopy were assigned randomly to have an unsedated transnasal EGD (n = 64) or peroral EGD (n = 60) with local anesthesia. An ultrathin videoendoscope with a diameter of 5.9 mm was used in this study. A questionnaire for tolerance was completed by the patient (a validated 0-10 scale where '0' represents no discomfort/well tolerated and '10' represents severe discomfort/poorly tolerated). RESULTS: Of the 64 transnasal EGD patients, 60 patients (94%) had a complete examination. Four transnasal EGD examinations failed for anatomical reasons; all four patients were successfully examined when switched to the peroral EGD. All 60 peroral EGD patients had a complete examination. Between the transnasal and peroral groups, there was a statistically significant difference in scores for discomfort during local anesthesia (1.5 +/- 0.2 vs 2.6 +/- 0.3, P = 0.003), discomfort during insertion (2.3 +/- 0.3 vs 4.3 +/- 0.3, P = 0.001), and overall tolerance during procedure (1.6 +/- 0.2 vs 3.8 +/- 0.2, P = 0.001). In all, 95% of transnasal EGD patients and 75% of peroral EGD patients (P = 0.002) were willing to undergo the same procedure in the future. Four patients in the transnasal EGD group experienced mild epistaxis. CONCLUSION: For unsedated endoscopy using an ultrathin videoendoscope, transnasal EGD is well tolerated and considerably reduces patient discomfort compared with peroral EGD.     

Effect of capsule placement with transnasal endoscopy

Aim: One of the prohibiting factors in achieving complete small bowel capsule endoscopy is slow gastric transit of the capsule. The present study retrospectively investigated the success rate of, and the time required for, transnasal endoscope‐assisted capsule placement to assess its clinical utility. Methods: In 24 of 27 patients who underwent capsule placement assisted by a transnasal endoscope, the capsule was successfully transported to and released in the duodenum (capsule placement group). For each patient in the capsule placement group, three age‐ and sex‐matched patients who underwent conventional capsule endoscopy were assigned as controls (n = 72). Gastric transit time, small bowel transit time, and rate of capsule arrival at the cecum within 8 h were compared between the two patient groups. Results: Among the 27 patients in whom capsule placement was carried out, the capsule was successfully placed in the duodenum in 24 patients (88.9% success rate). In the capsule placement group, gastric transit time was significantly shorter (10.5 vs 46.2 min, P = 0.0021), small bowel transit time was significantly longer (354.7 vs 301.3 min, P = 0.0134), and completion rate (capsule arrival at the cecum within 8 h) was significantly higher (83.3 vs 61.1%, P = 0.0455) than in the control group. There were no procedural accidents associated with capsule placement. Conclusion: Transnasal endoscope‐assisted capsule placement appears to be a safe and reliable procedure, achieving complete small bowel capsule endoscopy, and is considered clinically useful.     

Utility of single and double balloon endoscopy in patients with difficult colonoscopy: A randomized controlled trial

AIM: To compare the utility of single-balloon colonoscopy (SBC) or double-balloon colonoscopy (DBC) for difficult colonoscopies. METHODS: Between August 2008 and June 2010, patients in whom total colonoscopy failed within 30 min of insertion were assigned randomly to undergo either SBC or DBC. No sedatives were used. After the endoscopy, all patients were asked to evaluate pain during the procedure on a 10-point analog scale (1 = no pain; 10 = worst imaginable pain) with a questionnaire. The study outcomes were the cecal intubation rate and time, endoscopic findings, complications, and pain score. RESULTS: The SBC and DBC groups included 11 and 10 patients, respectively. All but one SBC patient achieved total colonoscopy successfully. The cecal intubation times were 18 min (range: 10-85 min) and 12.8 min (range: 9.5-42 min) in the SBC and DBC groups, respectively (P= 0.17). No difference was observed in the prevalence of colon polyps between the SBC and DBC groups (45% vs 30%, P = 0.66). SBC showed advanced colon cancer in the ascending colon, which was inaccessible using conventional colonoscopy. The respective pain scores were 5 (1-10) [median (range)] and 5 (1-6) in the SBC and DBC groups (P = 0.64). No complications were noted in any patient. CONCLUSION: The utility of singleand double-balloon endoscopy for colonoscopy seems comparable in patients with incomplete colonoscopy using a conventional colonoscope.     

Small bowel cleansing for capsule endoscopy in paediatric patients: A prospective randomized single-blind study

BackgroundSmall bowel cleansing by capsule endoscopy has never been addressed in children.MethodsRandomized controlled trial to evaluate the effect of five bowel preparation regimens on the mucosal visibility surface (as percentage of visualized surface area). Group A: a clear liquid diet for 12 h on the day before; Group B: high volume polyethylene glycol (50 mL/kg, up to 2 Lt/die); Group C: low volume polyethylene glycol (25 mL/kg up to 1 Lt/die); Group D: 20 mL (376 mg) of oral simethicone; Group E: 25 mL/kg (up to 1 Lt/die) of polyethylene glycol solution plus 20 mL (376 mg) of oral simethicone.ResultsOverall, 198 patients (53% male, median age 13 years) were enrolled. Preparation regimen visualization scores were 14.1 ± 4.2, 18.9 ± 5.1, 17.8 ± 5.5, 14.9 ± 4.8 and 20.9 ± 4.6 in groups A, B, C, D and E, respectively (P < 0.01). Positive findings were found in 172 cases (87%), but no significant differences were observed in the diagnostic yield and tolerability. Interobserver agreement, k = 0.89 (95% CI 0.83 ± 0.71).ConclusionThis is the first report in children that supports the use of 25 mL/kg (up to 1 Lt/die) of polyethylene glycol solution plus 20 mL (376 mg) of oral simethicone as the preparation of choice for capsule endoscopy.     

Gastric preparation for magnetically controlled capsule endoscopy: A prospective,randomized single-blinded controlled trial

Background and aimsMagnetically controlled capsule endoscopy (MCE) is a novel technique for which there is no agreed gastric preparation. We aimed to determine an optimal standardized gastric preparation regimen.Methods120 patients referred for MCE were randomly assigned to gastric preparation with either water alone (A), water with simethicone (B) or water, simethicone and pronase (C). Image quality was assessed using cleanliness and visualization scores, higher scores equating to better image quality.ResultsThe total cleanliness scores were (mean ± SD) 15.83 ± 2.41 (A), 21.35 ± 1.23 (B), and 20.82 ± 1.90 (C). The total visualization scores (mean ± SD) were 10.75 ± 2.02 (A), 15.20 ± 1.32 (B), and 15.08 ± 1.86 (C). While the image quality of the whole stomach in groups B and C were significantly better than group A (P < 0.0001), there was no statistical difference between group B and C (P > 0.05). MCE detected positive findings in 21 (52.5%), 27 (67.5%) and 21 (53.8%) patients in group A, B and C respectively, with no significant difference between groups (P > 0.5).ConclusionsSimethicone swallowed with water prior to MCE produced the optimal gastric mucosal image quality. The addition of pronase had no demonstrable additional benefit.