丙泊酚联合瑞芬太尼用于胃镜检查对上消化道蠕动的影响

目的：探讨丙泊酚联合瑞芬太尼应用在无痛胃镜检查中的麻醉效果及对上消化道蠕动情况影响。方法选择行无痛胃镜检查的患者130例,采用随机数字表法分为观察组和对照组,对照组采用丙泊酚麻醉,观察组联合瑞芬太尼进行麻醉,记录麻醉效果。结果观察组麻醉优良率为93．85％,对照组麻醉优良率为80．00％,组间差异有统计学意义（χ2＝5．481,P ＜0．05）。观察组丙泊酚用量（1．73±0．24）mg／kg、患者清醒时间（5．91±1．03）min、离院时间（14．58±2．79）min,对照组丙泊酚用量（3．06±0．57）mg／kg、患者清醒时间（9．44±1．87）min、离院时间（22．05±4．86）min,组间差异均有统计学意义（t ＝17．337、13．330、10.747,均 P ＜0．05）。上消化道蠕动观察组轻度36例、中度24例、剧烈5例,对照组轻度23例、中度27例、剧烈15例,组间差异有统计学意义（χ2＝5．376,P ＜0．05）。结论丙泊酚联合瑞芬太尼应用在无痛胃镜检查中麻醉效果优于单纯丙泊酚麻醉,对患者上消化道系统影响小,丙泊酚用量少,可缩短患者清醒时间和离院时间,值得在临床上推广应用。     

One- or two-operator techniques for oesophago-gastro-duodenoscopy in unsedated patients: A comparative prospective randomized study

BackgroundThe standard oesophago-gastro-duodenoscopy procedure is performed with a single endoscopist (SE). Nurse-assisted (NA) oesophago-gastro-duodenoscopies have not yet been studied. We aimed to evaluate the efficacy of an NA endoscopy compared to an SE endoscopy.MethodsA prospective, single-center, randomized trial, in which 500 adult patients were divided into two groups. In the first group, patients underwent an endoscopy with an SE. In the second group, the endoscopy was performed with an NA. The ease of the procedure (scores 1–4; 1 difficult, 2 satisfactory, 3 easy, 4 very easy), evaluation of patient satisfaction (scores 1–4; 1 uncomfortable, 2 satisfactory, 3 comfortable, 4 very comfortable), total time of the procedure and vocal cord observation were determined as quality indicators.ResultsMean patient satisfaction scores in groups 1 and 2 were 2.98 ± 0.79 and 3.11 ± 0.78, respectively (p = 0.043), with uncomfortable ratings in 5.2% vs 4%, satisfactory in 16.8% vs 13.2%, comfortable in 53.2% vs 50.4%, and very comfortable in 24.8% vs 32.4% of patients in groups 1 and 2, respectively. Retching rates during the procedure were 54.4% and 45.2% (p = 0.040) in groups 1 and 2, respectively. No differences were seen in vocal cord observation (54.4% vs 56.0%), total procedure time (2.35 ± 1.56 vs 2.41 ± 1.48 min) and easy score (3.26 ± 0.603 vs 3.25 ± 0.64) in groups 1 and 2 for the procedures. Very easy, easy, satisfactory, and difficult ratings were given by 33.6% vs 34.8%, 60.4% vs 56.4%, 4.8% vs 7.6% and 1.2% vs 1.2% of groups 1 and 2, respectively.ConclusionsCompared with the conventional method, the assisted endoscopic technique provides more comfort and less gag reflex without increasing the processing time or difficulty of performing the procedure.     

Documento de posicionamiento de la AEG,la SEED y la SEAP sobre calidad de la endoscopia digestiva alta para la detección y vigilancia de las lesiones precursoras de cáncer gástrico

This position paper, sponsored by the Asociación Española de Gastroenterología [Spanish Association of Gastroenterology], the Sociedad Española de Endoscopia Digestiva [Spanish Gastrointestinal Endoscopy Society] and the Sociedad Española de Anatomía Patológica [Spanish Anatomical Pathology Society], aims to establish recommendations for performing an high quality upper gastrointestinal endoscopy for the screening of gastric cancer precursor lesions (GCPL) in low-incidence populations, such as the Spanish population. To establish the quality of the evidence and the levels of recommendation, we used the methodology based on the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). We obtained a consensus among experts using a Delphi method. The document evaluates different measures to improve the quality of upper gastrointestinal endoscopy in this setting and makes recommendations on how to evaluate and treat the identified lesions. We recommend that upper gastrointestinal endoscopy for surveillance of GCPL should be performed by endoscopists with adequate training, administering oral premedication and use of sedation. To improve the identification of GCPL, we recommend the use of high definition endoscopes and conventional or digital chromoendoscopy and, for biopsies, NBI should be used to target the most suspicious areas of intestinal metaplasia. Regarding the evaluation of visible lesions, the risk of submucosal invasion should be evaluated with magnifying endoscopes and endoscopic ultrasound should be reserved for those with suspected deep invasion. In lesions amenable to endoscopic resection, submucosal endoscopic dissection is considered the technique of choice.     

胃镜检查对心率、血氧饱和度的影响

目的:探讨胃镜检查对各年龄段患者心率、血氧饱和度的影响。方法:对53名不同年龄的患者(被分为老年组、中年组、青年组)分别在胃镜检查的4个阶段(胃镜检查前1 min、经咽-贲门、进入胃腔、退镜后1 min)进行心率和血氧饱和度的监测,并进行比较。结果:心率各组检查前无显著差异,术中各阶段较术前显著增快(P<0.05~<0.01),以经咽-贲门时为最快(P<0.01);术中老年组心率上升幅度较低(P<0.05)。血氧饱和度术前后各组均无显著差异,但老年组的胃镜检查时有所降低。结论:对于老年人,心血管病人的胃镜检查最好是术时进行心电图和血氧饱和度的动态监测,以免不测。     

胃镜下无恶变征象的胃巨大溃疡145例诊疗分析

目的探讨胃镜下无恶变征象的胃巨大溃疡的发病趋势和特点、诊断性治疗的价值、内镜诊断与病理诊断的相关性。方法收集2005～2013年间胃镜诊断胃巨大溃疡、无典型恶变特征、且首次活检病理未报告"癌"的住院患者145例,均接受抗溃疡加抗幽门螺旋杆菌(Helicobacter pylori,H.pylori)四联疗法,分析其多次胃镜检查的转归及病理诊断的变化。结果胃镜下无恶变征象的胃巨大溃疡年均检出率为5.63%,无明显增高趋势,男性明显高于女性;总恶变率为45.52%,其恶变与性别、部位、大小和形态无相关性(P0.05),但与年龄、H.pylori感染相关(P0.01)。2次胃镜诊断巨大溃疡与病理诊断符合率分别为55.86%和98.62%。结论胃镜下无恶变征象胃巨大溃疡的恶变与性别、部位、大小和形态无关,但与H.pylori感染正相关,且41～70岁年龄段高发,诊断性治疗联合多次胃镜活检是其定性诊断的最佳方法。     

Outcome of gastric antral vascular ectasia and related anemia after orthotopic liver transplantation

BACKGROUNDGastric antral vascular ectasia (GAVE) is a significant complication of cirrhosis. Numerous medical, surgical, and endoscopic treatment modalities have been proposed with varied satisfactory results. In a few small studies, GAVE and associated anemia have resolved after orthotopic liver transplantation (OLT). AIMTo assess the impact of OLT on the resolution of GAVE and related anemia.METHODSWe retrospectively reviewed clinical records of adult patients with GAVE who underwent OLT between September 2012 and September 2019. Demographics and other relevant clinical findings were collected, including hemoglobin levels and upper endoscopy findings before and after OLT. The primary outcome was the resolution of GAVE and its related anemia after OLT.RESULTSSixteen patients were identified. Mean pre-OLT Hgb was 7.7 g/dL and mean 12 mo post-OLT Hgb was 11.9 g/dL, (P = 0.001). Anemia improved (defined as Hgb increased by 2g) in 87.5% of patients within 6 to 12 mo after OLT and resolved completely in half of the patients. Post-OLT esophagogastroduodenoscopy was performed in 10 patients, and GAVE was found to have resolved entirely in 6 of those patients (60%). CONCLUSIONAlthough GAVE and associated anemia completely resolved in the majority of our patients after OLT, GAVE persisted in a few patients after transplant. Further studies in a large group of patients are necessary to understand the causality of disease and to better understand the factors associated with the persistence of GAVE post-transplant.     

血清胃蛋白酶原检测在胃癌筛查中的价值

背景:我国在亚太地区属于胃癌高危地区。亚太地区胃癌预防共识指出,低血清胃蛋白酶原(PG)Ⅰ水平和低PGⅠ/PGⅡ比值可作为筛查胃癌高危人群的标记物。目的:明确血清PG检测在胃癌筛查中的价值。方法:纳入1880例2010年3月～2011年12月南京市市级机关医院的健康体检人员以及有上腹部不适症状的门诊患者,行血清PGⅠ、PGⅡ检测,其中1028例(包括所有血清PG筛查结果阳性者和部分筛查结果阴性但有上腹部不适症状或胃癌家族史者)接受胃镜和活检组织病理检查。结果:各年龄段受检者血清PGⅠ、PGⅡ水平差异均无统计学意义,≥70岁年龄段组PGⅠ/PGⅡ比值显著低于其他各年龄段组(P<0.05)。萎缩性胃炎组、上皮内瘤变组和胃癌组血清PGⅠ水平和PGⅠ/PGⅡ比值显著低于正常/非萎缩性胃炎组(P<0.01)。以PGⅠ<70 ng/mL+PGⅠ/PGⅡ<3.0为界值,血清PG检测筛查胃癌的敏感性为74.1%,特异性为84.9%,阳性似然比为4.93,阴性似然比为0.30。结论:血清PG检测用于胃癌初筛具有敏感性高、易于接受、成本低等优势,适用于大面积人群普查,结果阳性者应进一步行胃镜筛查。     

幽门螺杆菌与病理同标本检查方法的应用

在华北食管癌高发区开展内镜普查工作中，我们结合农村情况，将内镜采取的活检组织经ＨＰＵＴ试剂盒法检测幽门螺杆菌后，立即以４％的甲醛固定制成石腊切片供病理诊断。这种方法操作简便，效果良好，效率提高，值得推广。     

腹腔镜联合胃镜治疗胃间质瘤的临床体会(附4例报告)

目的:探讨腹腔镜联合胃镜手术治疗胃间质瘤的可行性和临床价值。方法:采用胃镜定位、腹腔镜胃部分切除术治疗2例胃体前壁,1例胃体后壁大弯侧,1例胃窦部前壁间质瘤。结果:4例手术均获成功,手术时间75~105m in,术中出血量20~50m1,术后住院4~6d,随访6个月~5年,无并发症及复发病例。结论:腹腔镜联合胃镜手术治疗胃间质瘤是可行、安全和有效的。     

意识指数用于无痛胃镜中麻醉用药的指导意义

【目的】探讨意识指数（IOC）应用于无痛胃镜检查对麻醉用药的指导意义。【方法】选取本院拟进行无痛胃镜检查的80例患者采用随机数字表法分为IOC组和常规组各40例,两组均给予芬太尼1μg／kg、丙泊酚2 mg／kg后,IOC组根据IOC监测值（45～60）给予丙泊酚维持量调节,常规组术中根据一般监测指标和患者体征进行丙泊酚用量调节,比较两组患者麻醉诱导前（T1）、麻醉诱导后（T2）、胃镜插入即刻（T3）、苏醒时（T4）时间点的心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）的波动及麻醉情况。【结果】IOC组和常规组的丙泊酚诱导用量、手术时间比较差异无显著性（P＞00．5）,IOC组患者的追加丙泊酚次数、丙泊酚总用量、苏醒时间均显著的低于常规组（P＜00．5）;T1、T2、T4时刻IOC组和常规组患者的 HR、MAP及SpO2监测值相比较差异均无显著性（P＞00．5）;在T3时刻IOC组患者的HR、MAP值显著高于常规组（P＜00．5）;IOC组患者发生体动反应、恶心呕吐、心动过缓的发生率显著的低于常规组（P＜00．5）;两组呼吸抑制、头晕的发生率相比较差异无显著性（P＞00．5）。【结论】IOC应用于无痛胃镜检查有利于更加准确的对患者应用麻醉药物用量,可以有效的达到麻醉效果并且减少不良反应的发生。