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PubMed1998

Ambience in the endoscopy room has little effect on patients.

With hopes of alleviating discomfort and improving the tolerance of patients undergoing endoscopy, we have assessed the influence of various background conditions in the endoscopy room. Two hundred twenty-one candidates for upper endoscopy were randomly allocated to four groups, each with one of the following conditions in the endoscopy room: background music and conversation related to the patient's complaints (n=50); background music and conversation unrelated to the patient (n=53); background music only, with the staff maintaining silence (n=49); and complete silence (n=47). Before endoscopy patients answered a 26-item questionnaire that included an evaluation of their degree of anxiety before the examination. Conscious sedation was induced by using 3 mg midazolam. After complete recovery from sedation, patients answered another set of questions. Patients in all four groups felt quite comfortable with the atmosphere in which gastroscopy was performed. Neither music, conversation, nor silence had a great effect on patients as far as improving tolerance or diminishing anxiety. Therefore, endoscopists and nurses may have a free hand in choosing the prevailing conditions during the examination. This conclusion may be valid for both patients and the staff involved in other invasive procedures performed under light sedation.

Anxiety↗
PubMed2000

APACHE II scores and deaths after upper gastrointestinal endoscopy in hospital inpatients.

Advanced age and comorbidity as well as gastrointestinal (GI) disease contribute to the increased mortality after upper GI endoscopy in inpatients when compared to outpatients. The aim of this study was to measure comorbidity in inpatients undergoing endoscopy using the Acute Physiology and Chronic Health Evaluation (APACHE) II severity of disease classification and to assess the usefulness of the APACHE II system in predicting outcome. During a 10-week period, 155 consecutive inpatients undergoing upper GI endoscopy were prospectively scored using APACHE II. They were followed up for 30 days, the measured endpoint being death. Of these, 92 (59%) inpatients were admitted with GI hemorrhage, 14 (9%) were admitted for other reasons but subsequently bled, and 49 (32%) were endoscoped for reasons other than bleeding. The mean (SEM) APACHE II score in patients with GI bleeding was 8.0 (0.5), and in patients without bleeding was 6.5 (0.6; p = 0.07). Eighteen patients (12%) died within 30 days of endoscopy. APACHE scores were higher at 10.5 (1.2) in patients who died, compared to 7.1 (0.4) in those who lived (p < 0.01). Increased acute physiology scores led to this difference. Age and chronic health scores were similar in both groups. In the 18 patients who died, 9 had GI bleeding and their mean APACHE score was 13.8 (1.5); 9 had been endoscoped for other reasons and had a lower score of 7.2 (1.3; p < 0.01). These latter 9 deaths amounted to a 18% mortality in the nonbleeding group, which was greater than expected. APACHE II scores can help predict poor outcome in inpatients referred for endoscopy. However, the APACHE II system has limitations and failed to identify (by means of a high score) some patients without GI bleeding who subsequently died. A tool to measure comorbidity, such as the APACHE II system, is necessary when comparing groups of patients in different settings.

APACHE↗
PubMed2000

Correlation of endoscopy and histology in the gastroesophageal mucosa in children: are routine biopsies justified?

Guidelines for obtaining biopsies during endoscopy in children are needed. The endoscopic evaluation may be considered deficient on many occasions if not accompanied by a histopathologic evaluation. A retrospective review of our endoscopic records and biopsies was undertaken to determine the correlation of the visualized endoscopic appearance and the histopathologic findings in the upper gastrointestinal (GI) tract in children. Over a 1-year period, 204 patients, all of whom had esophageal biopsies and 59 of whom had gastric biopsies as well, were evaluated by an upper GI endoscopy. Endoscopic findings included erythema, granularity, abnormal vascular pattern, friability, erosions, plaques, ulceration, and strictures. Histologic evaluation of biopsies was undertaken by one pathologist according to the presence of and type of cellular infiltrate and cellular morphologic abnormalities in the mucosa and submucosa where available. In this study, the correlation of endoscopic appearance with histology was rather limited in both the esophagus and the gastric mucosa. Low specificity and sensitivity of endoscopy in both locations (41% and 81% for the esophagus; and 43% and 86% for the gastric mucosa, respectively) illustrated the discrepancy. The overall accuracy of endoscopic evaluation in matching the histologic diagnosis was not more than two out of three (63.8%). No single endoscopic finding had a reliable correlation with histologic diagnosis but some had higher predictive value than others. Of the multiple indications for endoscopy in children, recurrent abdominal pain had the least diagnostic yield. Endoscopic appearance correlates poorly with histologic diagnosis in the gastroesophageal mucosa in children. Regardless of the appearance of the mucosa, routine biopsy during upper GI endoscopy in children should be encouraged.

Biopsy↗
PubMed2002

Outcomes of endoscopy in patients with iron deficiency anemia after Billroth II partial gastrectomy.

GOALS: To determine the frequency of gastrointestinal lesions detected by upper endoscopy and colonoscopy in patients who developed iron deficiency anemia after Billroth II surgery. STUDY: The authors reviewed the medical records of 116 consecutive patients with a Billroth II partial gastrectomy and 232 age- and gender-matched controls without gastric surgery who were referred for endoscopy to evaluate iron deficiency anemia over a 5-year period. RESULTS: Clinically important lesions were detected in 22.4% of the patients with gastric surgery and in 59.5% of those with intact stomachs (p < 0.001). In the gastric surgery group, clinically important lesions were found more often in the upper gastrointestinal tract than in the colon (19.0% vs. 3.4%, p < 0.001). In the nonsurgical group, the diagnostic yields of upper endoscopy and colonoscopy were not significantly different (38.4% vs. 32.8%, p = 0.24). Synchronous lesions in the upper and lower gastrointestinal tract were significantly less common in the group of patients with gastric surgery compared with those without gastric surgery (0.0% vs. 11.6%, p < 0.001). Small bowel biopsies and small bowel follow-through did not identify any additional lesions. In the gastric surgery group, multivariate analysis identified abdominal symptoms (OR = 11.2, 95% CI 3.2-39.2, p < 0.001), a positive result on fecal occult blood testing (OR = 6.4, 95% CI 2.0-20.3, p = 0.002), and Billroth II surgery at least 10 years before evaluation (OR = 5.4, 95% CI 1.7-16.7, p = 0.004) as independent predictors of identifying a clinically important lesion by endoscopy. CONCLUSIONS: Upper endoscopy had a significantly higher diagnostic yield than colonoscopy in patients who developed iron deficiency anemia after Billroth II surgery. Prospective studies are necessary to determine the role and cost-effectiveness of colonoscopy in the evaluation of iron deficiency anemia in this patient population.

Aged↗
PubMed2004

Patient anxiety and elective gastrointestinal endoscopy.

BACKGROUND: Esophagogastroduodenoscopy (EGD) and colonoscopy (CS) are commonly performed procedures that can cause anxiety related to potential findings, embarrassment and concern over discomfort. The objective of this study is to evaluate patient anxiety associated with diagnostic, sedated outpatient endoscopy and to correlate endoscopists' estimations of patient anxiety with those of the patient. METHODS: Consecutive patients referred for diagnostic upper endoscopy or colonoscopy were evaluated. Anxiety was rated at baseline and immediately before the procedure using the State-Trait Anxiety Index (STAI-Y). Patients were categorized as whether they had been previously seen by a gastroenterologist in the clinic or were referred directly by another physician for endoscopy. Patients were also asked to rate their knowledge of the procedure using a visual analog scale. Physicians rated patient anxiety and procedure difficulty using 100 mm visual analog scales. Sedation administered during each procedure was recorded. RESULTS: Ninety-four patients were enrolled; 47 had been referred from the gastroenterology clinic and 47 had been directly referred from primary care physicians. Thirty-nine percent completed baseline and pre-procedure STAI-Y. Endoscopy was associated with a significant increase in state anxiety (baseline, 31.2 +/- 1.8; procedure, 39.8 +/- 2.2; P = 0.001) but not trait anxiety (baseline, 35.4 +/- 1.7; procedure, 36.2 +/- 1.6; P = 0.59). Procedural state anxiety was not influenced by age, sex, referral source, type of procedure or perceived procedural knowledge but was correlated with trait anxiety (r = 0.38; P = 0.02). Physician estimates of patient anxiety did not correlate with either procedural state anxiety (r = -0.15; P = 0.37) or the change in state anxiety from baseline to the procedure (r = -0.04; P = 0.82). CONCLUSIONS: Diagnostic outpatient endoscopy is associated with modest increases in state anxiety that are not significantly influenced by age, sex, procedure type, indication, or referral source. Endoscopists' ability to estimate patient anxiety is poor but this may reflect the generally mild increases in state anxiety that were encountered.

Anxiety↗
PubMed2001

Experience with an anesthesiologist interventional model for endoscopy in a pediatric hospital.

BACKGROUND: Endoscopy is now a routine part of the work-up for many patients with gastrointestinal symptoms. Adults tolerate these procedures well, with either no sedation or a relatively light level. In contrast, children often require deep sedation or a general anesthetic to successfully perform these procedures. Therefore, pediatric endoscopies may require more time, personnel, and monitoring equipment to provide optimal conditions for the patient. The goals of this retrospective case series were to describe the anesthesia times and recovery duration of the different procedures, the types and amounts of medications commonly used, and the types and rates of complications experienced. METHODS: Patients (2,306) who underwent endoscopy in the Arkansas Children's Hospital endoscopy suite during a 4-year period were identified. A random sample of 720 charts was reviewed retrospectively. RESULTS: Patients ranged in age from younger than 1 year to 29 years. Patients most often had abdominal pain or multiple gastrointestinal symptoms. Sixty-eight percent of patients underwent esophagogastroduodenoscopies; 30% colonoscopy or a combination of the two. Ninety-five percent of patients received a propofol-based anesthetic. Midazolam, fentanyl, and alfentanil were frequently used as supplemental agents. Complications occurred infrequently and were airway related. All complications were easily treated, with no adverse sequelae. CONCLUSIONS: This model of anesthesiologist-provided sedation/anesthesia for gastrointestinal endoscopy procedures has been extremely successful in the Arkansas Children's Hospital and has served to heighten awareness of many issues surrounding sedation and anesthesia outside of the operating room, while ensuring a high level of care is provided.

Adolescent↗
PubMed2004

Diagnostic role of upper gastrointestinal endoscopy in pediatric inflammatory bowel disease.

BACKGROUND: Discrimination between ulcerative colitis (UC) and Crohn disease (CD) may be difficult on ileo-colonoscopy alone because of a lack of definitive lesions. Retrospective studies show upper gastrointestinal endoscopy may be helpful in confirming diagnosis in such cases. AIMS: To prospectively determine importance of upper gastrointestinal endoscopy in diagnosis of inflammatory bowel disease (IBD) and assess factors predictive of upper gastrointestinal involvement in IBD. METHODS: All pediatric patients were enrolled prospectively and consecutively over a 2-year period and investigated with an ileo-colonoscopy and barium meal follow-through. Children with procto-sigmoiditis, later confirmed histologically to be typical of UC, were excluded from the study. The remainder underwent upper gastrointestinal endoscopy. The protocol and methodology were determined a priori. RESULTS: 65 children suspected of IBD underwent colonoscopy. Of the total, 11 had recto-sigmoiditis with typical macroscopic appearances of UC; once this was confirmed on histology these patients were excluded from the study. Of the 54 children (males, 31; median age, 11.1 years) remaining, 23 were initially diagnosed with CD on ileo-colonoscopy and 18 (33%) were diagnosed with UC. The diagnosis remained ambiguous in 13 (six colonic, four ileo-colonic, three normal colon) on clinical, radiologic and histologic grounds. Upper GI endoscopy helped to confirm CD in a further 11 (20.4%). Two patients were diagnosed with indeterminate colitis. Upper gastrointestinal inflammation was seen in 29 of 54 (22 CD; 7 UC ). Epigastric and abdominal pain, nausea and vomiting, weight loss and pan-ileocolitis were predictive of upper gastrointestinal involvement (P < 0.05). However, 9 children with upper gastrointestinal involvement were asymptomatic at presentation (31%). Overall upper gastrointestinal tract inflammation was most common in the stomach (67%), followed by the esophagus (54%) and duodenum (22%). CONCLUSIONS: Upper gastrointestinal tract endoscopy should be part of the first-line investigation in all new cases suspected of IBD. Absence of specific upper gastrointestinal symptoms do not preclude presence of upper gastrointestinal inflammation.

Adolescent↗
PubMed1997

Virtual endoscopy of the paranasal sinuses using perspective volume rendered helical sinus computed tomography.

Our goal was to use three-dimensional information obtained from helical computed tomographic (CT) data to explore and evaluate the nasal cavity, nasopharynx, and paranasal sinuses by simulated virtual endoscopy (VE). This was done by utilizing a new image reconstruction method known as perspective volume rendering (PVR). Thin-section helical CT of the nasal cavity, nasopharynx, and paranasal sinuses was performed on a conventional CT scanner. The data were transferred to a workstation to create views similar to those seen with endoscopy. Additional views not normally accessible by conventional endoscopy were generated. Key perspectives were selected, and a video "flight" model was choreographed and synthesized through the nasal cavity and sinuses based on the CT data. VE allows evaluation of the nasal cavity, nasopharynx, and paranasal sinuses with appreciation of the relationships of these spatially complex structures. In addition, this technique allows structural visualization with unconventional angles, perspectives, and locations not conventionally accessible. Although biopsies, cultures, and lavages routinely done with endoscopy cannot be performed with VE, this technique holds promise for improving the diagnostic evaluation of the nasal cavity, the nasopharynx, and the paranasal sinuses. The unconventional visual perspectives and very low morbidity may complement many applications of simple diagnostic endoscopy.

Endoscopy↗
PubMed1999

Prevalence of previous appendectomy among patients needing gastrointestinal endoscopy.

BACKGROUND: The appendix may be an immune modulator of the gut, and its absence may lead to an increase in gastrointestinal illnesses. If this is true, we may expect patients needing endoscopy to have a higher prevalence of previous appendectomy. METHODS: We did a case-control study at the University of Oklahoma Hospital for 13 months. Subjects having endoscopic evaluation at the University of Oklahoma Hospital formed the study group. Patients seen at the general medicine clinic of the University of Oklahoma served as controls. We recorded the patient's name, age, sex, race, history of smoking, and history of appendectomy or tonsillectomy. RESULTS: The endoscopy group had 524 patients; 469 patients were in the control group. There were no differences based on race or history of smoking. There was greater prevalence of previous appendectomy in the endoscopy group (33.46% vs. 20.55%). The prevalence of tonsillectomy was 29.28% in the study group vs. 21.61% among the controls. Multiple regression revealed that history of appendectomy and not tonsillectomy was related to the performance of endoscopy. CONCLUSION: History of appendectomy is associated with greater performance of endoscopy.

Analysis of Variance↗
PubMed2002

A test-and-treat policy does not save endoscopy workload in a non-referral hospital.

AIM: To assess the impact that a test-and-treat policy with open-access urea breath testing (UBT) has had on the referral rates for endoscopy in a district hospital. Additionally, we examined for any change in the proportion of serious pathology detected endoscopically after adopting the policy. METHODS: Analysis of data on all open-access endoscopy referrals in a 12-month period before (October 1994 to September 1995) and 2 years after (October 1997 to September 1998) the introduction of the UBT service. This was compared with the same service in our sister hospital, which had not provided a UBT service. Results of patients attending the UBT service during the period of study were also examined. RESULTS: A total of 798 patients attended for endoscopy (18% aged < 40 years, 82% aged > 40 years) in the pre-UBT year compared with 1905 patients (16% aged < 40 years, 84% aged > 40 years) in the post-UBT year. The standardized referral ratios were significantly higher for both age groups in the post-UBT year: 210 in the < 40 years group (95% CI 187 to 235) and 244 in the > 40 years group (95% CI 233 to 257). Six per cent of the < 40 years group in the post-UBT year had serious pathology compared with 7% pre-UBT (P < 0.1). However, the proportion of serious pathology decreased from 37 to 27% in the > 40 years group (P < 0.01). The total number of open-access endoscopies had increased steadily over the 3 years, despite the introduction of the UBT service. This trend was mirrored in our sister hospital. A total of 457 patients attended the UBT service during the 12 months. Of these, 24.5% were Helicobacter pylori positive, with a 66.3% eradication rate. CONCLUSIONS: A test-and-treat policy has not saved endoscopy workload in this non-referral hospital. We feel that results from centres with an H. pylori interest cannot be generalized for the vast majority.

Adult↗
PubMed2004

The role of capsule endoscopy in the work-up of obscure gastrointestinal bleeding.

OBJECTIVE: To evaluate the role of capsule endoscopy in the detection of causes of obscure gastrointestinal bleeding. METHODS: Fifteen patients, nine males and six females, mean age 46 years (range 20-75 years), were investigated. All patients had undergone upper and lower gastrointestinal endoscopy with no evidence of causes of bleeding. Indication for capsule endoscopy was overt bleeding in 10 patients (eight with melaena and two with rectal bleeding) and anaemia in five patients. RESULTS: Diagnosis was made in four out of 10 patients with overt bleeding (40%) and in four out of five (80%) in the group with anaemia. The overall detection rate was 53%. Of the eight patients with melaena, two had angiodysplasia, one showed a diffuse inflammation of the jejunum and ileum probably related to associated portal hypertension, and five had a normal examination. Of the two patients with rectal bleeding, one had a polyp in the terminal ileum and the other a normal examination. Of the five patients with anaemia, one had jejunal carcinoma, three had Crohn's disease and one had a normal endoscopy. CONCLUSION: Wireless capsule endoscopy is safe, effective, non-invasive, and provides definitive diagnosis in about one-half of patients presenting with obscure gastrointestinal bleeding and previous negative endoscopic examinations.

Adenocarcinoma↗
PubMed2005

A survey of credentialing practices of gastrointestinal endoscopy centers in the United States.

BACKGROUND: Competence in gastrointestinal (GI) endoscopy correlates with the number of procedures performed by the endoscopist. For each GI endoscopic procedure, the American Society for Gastrointestinal Endoscopy (ASGE) guidelines recommend minimum numbers needed to assess competence. METHODS: We conducted an anonymous mail survey to determine whether GI endoscopy centers in the United States follow ASGE or other guidelines for granting and renewing endoscopic privileges. RESULTS: Completed surveys were received from 479 respondents in 46 states, Puerto Rico, and the District of Columbia. Most respondents were either the physician director (24%) or nurse manager (57%) of the endoscopy center. Most centers have more than 5 endoscopists (62%), and gastroenterologists performed procedures in the majority of the centers (89%). For initial endoscopic credentialing, few centers require a minimum number of procedures and only 10% meet ASGE criteria. To maintain credentials, less than one third require a minimum number and only 2% require more than 25 procedures/year. Although three fourths report periodic review of procedures, less than 5% review them more frequently than every 6 months. Only 20% of centers had ever denied endoscopic privileges (poor skills [80%], no references [27%], poor communication [7%], and excess complications [6%]) for which half faced litigation. CONCLUSIONS: Most GI endoscopy centers responding to this survey have no minimum standards for determining endoscopic competence and may credential GI endoscopists with suboptimal training. Only 10% adhere to ASGE guidelines. Moreover, there is lack of uniformity to application of these guidelines, and few centers use resulting data to deny or renew credentials. To guarantee high-quality endoscopic practice, more stringent, universal credentialing standards are required.

Clinical Competence↗
PubMed2006

Application of magnetic resonance virtual endoscopy as a presurgical procedure before sialoendoscopy.

OBJECTIVES: The objectives of this study were to investigate the feasibility of clinical application of magnetic resonance (MR) virtual endoscopy as a presurgical procedure before sialoendoscopy and to evaluate its value in the diagnosis of obstructive salivary gland diseases and preoperative visualization of endoluminal views. STUDY DESIGN: This study presents our initial experience to use MR virtual endoscopy for the presurgical visualization of salivary duct lumen and ductal pathologies in comparison to the sialoendoscopy findings in a feasibility study. METHODS: Six consecutive patients with suspected obstructive salivary gland diseases underwent MR sialography with a three-dimensional fast imaging using steady-state acquisition. The three-dimensional MR data were transferred to an independent workstation and were postprocessed with navigator software to generate three-dimensional reconstruction and virtual endoscopic images. The fly-through mode was used to imitate the sialoendoscopic exploratory procedure. Then the patients underwent sialoendoscopy and the endoscopic findings were compared with the preoperative virtual endoscopic images. RESULTS: The MR data acquisition and postprocessing protocol were feasible. The virtual endoscopy created clear endoluminal views of salivary duct and the ductal pathologies. The diagnoses were all confirmed by surgical sialoendoscopy. The virtual endoscopic images showed close resemblance to the sialoendoscopic findings. CONCLUSIONS: MR virtual endoscopy is an effective and noninvasive diagnostic method for evaluating the endoluminal anatomy and pathologies of the salivary duct. The clinical application of MR virtual endoscopy as a presurgical procedure before sialoendoscopy is a valuable and promising approach, which can provide surgeons useful morphologic and pathologic information.

Adult↗
PubMed1990

Rapid intravenous low-dose diazepam as sedation for upper gastrointestinal endoscopy.

One hundred patients for endoscopy, aged, between 18 and 74 years were randomly allocated to two equal groups. Group A received 10 mg diazepam intravenously rapidly over 2-4 s; Group B received diazepam intravenously over 1-2 min, titrated to provide a satisfactory level of sedation (mean dose 15.9 mg). Patient co-operation during endoscopy was similar in both groups, but one patient in Group A developed respiratory depression. Tests of psychomotor function after endoscopy showed greater impairment 30 min following injection for Group B, compared with Group A (P less than 0.02). Total or partial amnesia for endoscopy was present in 62% of Group A, and 90% in Group B (P less than 0.005). However, postal follow-up showed that endoscopy was acceptable to 96% of Group A and 98% of Group B. Delayed sedation later in the day was reported by 26% of Group A compared with 48% of Group B.

Adolescent↗
PubMed1992

Is oropharyngeal anaesthesia with topical lignocaine useful in upper gastrointestinal endoscopy?

The aim of this study was to determine whether patients' tolerance of upper gastrointestinal endoscopy is related to the dose of lignocaine spray used for oropharyngeal anaesthesia and to measure plasma concentrations at these doses. Sixty consecutive patients undergoing routine upper gastrointestinal endoscopy with sedation were randomized to receive lignocaine spray 50 mg (Group A), 100 mg (Group B) or 200 mg (Group C). Patient, endoscopist and endoscopy nurse were unaware of the variation in dose used. Each patient's tolerance of the intubation and of the remainder of the gastroscopy was assessed independently by the patient, endoscopy nurse, and endoscopist using a visual analogue scale. Plasma lignocaine concentration was measured at 20, 40, 60 and 80 min after administration of the spray. Fifty (83%) patients were unable to recall either the intubation, or the procedure. On the endoscopy nurse's assessment, the patients in Group B tolerated the intubation better than those in Group A, and Groups B and C tolerated the remainder of the gastroscopy better than those in Group A. On the endoscopist's assessment, Groups B and C tolerated the remainder of the gastroscopy better than Group A. There were fewer gags per min in Groups B and C compared to Group A. Mean plasma lignocaine concentrations showed a dose-dependent absorption of the spray, but none exceeded the potentially toxic level of 5 mg/L.

Administration, Oral↗
PubMed2006

Reducing admission times in the endoscopy unit.

Pre-procedural admission of outpatients to a day-case endoscopy facility is time-consuming. Collecting and recording routine but necessary information distracts nurses from spending time that could be used to counsel patients. This study assessed whether patients can record some pre-procedural details and whether such self-recording quickens nurse admission times. A new admission document was devised and posted to patients. Patients completed personal/administrative details and information about drugs and allergies and brought the document with them when attending for outpatient endoscopy. Endoscopy nurses anonymously timed 100 admissions, 50 using the new admission form and 50 using the old admission form. Overall, the median (range) time to admit using the old form was 6 (3-15.5) min. Using the new form, the median time to admit was lower at 4 (0.5-10) min. No patient completing the new form reported any particular difficulties. An admission document that patients partially complete at home leads to a faster pre-procedural admission in the endoscopy unit. This allows more nursing time to discuss patients' anxieties and answer patient queries, helps to prevent delays and facilitates increased capacity in the endoscopy unit.

Ambulatory Surgical Procedures↗
PubMed2006

Characteristics of Australian after-hours emergency endoscopy services.

BACKGROUND AND AIM: Early endoscopic intervention reduces morbidity and mortality for patients with high-risk gastrointestinal hemorrhage and gallstones causing pancreatitis or ascending cholangitis. For low-risk bleeds 'after-hours' endoscopy services allow risk stratification and early, safe discharge leading to reduced length of stay. Recognized standards for these services include availability of endoscopically trained medical and nursing staff, access to a specialized endoscopy unit and full availability of the service. The aim of the present study was to assess 'after-hours' endoscopy services at Australian teaching hospitals using the British Society of Gastroenterology (BSG) criteria. METHODS: A standardized questionnaire based on the BSG guidelines was developed. The Gastroenterology Society of Australia provided a list of accredited sites for gastroenterology training. An advanced gastroenterology trainee at each hospital was interviewed by telephone. RESULTS: Thirty-four centers (100%) provided complete data. Gastroscopy, colonoscopy and endoscopic retrograde cholangiopancreatography were provided in 100, 58 and 84% of centers, respectively. The operation suite followed by endoscopy unit was the most frequently used site. However, one-third of centers performed procedures at the bedside, including the emergency department or ward. Support staff were not consistently trained endoscopically and, in 15 centers (44%), the advanced trainees participated in the 'on call' roster with a consultant present for the procedure, although this was not consistently the case. CONCLUSIONS: Most Australian hospitals offer comprehensive emergency endoscopy services. However, few centers fulfill all BSG recommendations. The registrar training and patient safety implications of emergency endoscopic services need to be considered in the light of these findings.

After-Hours Care↗
PubMed1999

Topical pharyngeal anesthesia does not improve upper gastrointestinal endoscopy in conscious sedated patients.

OBJECTIVE: We undertook this study to determine whether topical pharyngeal anesthesia with conscious sedation is superior to conscious sedation alone, with respect to procedure performance or tolerance in patients undergoing diagnostic upper gastrointestinal endoscopy. METHODS: Ninety-five patients undergoing diagnostic upper endoscopy with conscious sedation were randomized to receive either topical pharyngeal anesthesia with 2% tetracaine/14% benzocaine spray or no pharyngeal anesthesia. Conscious sedation was achieved in all patients using intravenous midazolam and meperidine. Patients were asked to rate their pretest anxiety, comfort during endoscopy, recollection of the procedure, and willingness to undergo subsequent examinations using a 100-mm visual analog scale. Additionally, they were asked to estimate procedure duration and rate their tolerance for topical pharyngeal anesthesia. All examinations were performed by two endoscopists who were blinded to whether or not patients had received pharyngeal anesthesia. Endoscopists were asked to determine whether they believed that patients had received topical pharyngeal anesthesia and to estimate ease of esophageal intubation and procedure performance using a 100-mm visual analog scale. Procedure duration and doses of midazolam and meperidine were measured. RESULTS: The two groups did not differ with respect to age, gender, and previous endoscopic history. There were no significant differences between the two groups with respect to pretest anxiety, procedural comfort, and willingness to undergo subsequent examinations. Patients receiving topical pharyngeal anesthesia rated it as moderately unpleasant. Endoscopists were able to discriminate patients who received pharyngeal anesthesia from those who did not with a sensitivity of 0.73 and a specificity of 0.59. There were no significant differences between the two groups with respect to ease of intubation, procedure performance, procedure duration, and dosing of midazolam or meperidine. CONCLUSIONS: In patients undergoing diagnostic upper endoscopy using intravenous midazolam and meperidine, the use of topical pharyngeal anesthesia does not improve patient tolerance or procedure performance. Elimination of this agent in the performance of diagnostic upper endoscopy will save time and money without adversely affecting patient care or outcomes.

Anesthesia, Local↗