Hugo Guedes

SEDATION IN COLONOSCOPY BY USING THREE DIFFERENT PROPOFOL INFUSION METHODS AND ANALYSIS OF PLASMA CONCENTRATION LEVELS: A PROSPECTIVE COMPARATIVE STUDY

ABSTRACT Background: The propofolemia becomes directly linked to the clinical effects of this anesthetic and is the focus for studies comparing propofol clinical use, in different administration methods routinely used in endoscopy units where sedation is widely administered to patients. Aim: To evaluate the effects of three different regimens of intravenous propofol infusion in colonoscopies. Methods: A total of 50 patients that underwent colonoscopies were consecutively assigned to three groups: 1) intermittent bolus infusion; 2) continuous manually controlled infusion; 3) continuous automatic infusion. Patients were monitored with Bispectral IndexTM (BIS) and propofol serum levels were collected at three different timepoints. The development of an original dilution of propofol and an inventive capnography catheter were necessary. Results: Regarding clinical outcomes, statistical differences in agitation (higher in group 1, p=0.001) and initial blood pressure (p=0.008) were found. As for propofol serum levels, findings were similar in consumption per minute (p=0.748) and over time (p=0.830). In terms of cost analysis, group 1 cost was R

Endoluminal appendectomy: the first description in humans for acute appendicitis

7.00 (approximately US

Computed tomography colonography versus colonoscopy for the diagnosis of colorectal cancer: a systematic review and meta-analysis

2,25); group2, R

Endoscopic Dilation with Bougies versus Balloon Dilation in Esophageal Benign Strictures: Systematic Review and Meta-Analysis

17.50 (approximately US

Metallic vs plastic stents to treat biliary stricture after liver transplantation: a systematic review and meta-analysis based on randomized trials

5,64); and group 3, R

Single-guidewire double-tip cannulation for difficult biliary access: the DTC technique

112.70 (approximately US

A comparison of the efficiency of 22G versus 25G needles in EUS-FNA for solid pancreatic mass assessment: A systematic review and meta-analysis

36,35, p<0.001). Capnography was able to predict 100% of the oxygen saturation drop (below 90%). Conclusion: The use of propofol bolus administration for colonoscopies, through continuous manually controlled infusion or automatic infusion are similar regarding propofolemia and the clinical outcomes evaluated. The use of an innovative capnography catheter is liable and low-cost solution for the early detection of airway obstruction.

Maximizing the Diagnostic Yield of Endoscopic Ultrasound-Guided Fine-Needle Aspiration Biopsy

Appendix inversion into the cecal lumen can be demonstrated, and its endoluminal appendectomy is feasible [1]. We describe the first procedure to remove the appendix using colonoscopy during acute appendicitis presentation. A video colonoscope (Pentax Medical, Tokyo, Japan) and a handmade doublechannel colonoscope prototype with an adapted 20Fr nasogastric tube were used for the colonoscopy (▶Fig. 1). Shark Tooth grasping forceps (Olympus Medical Systems, Tokyo, Japan), an endoloop (Olympus), a standard diathermic snare wire loop (Boston Scientific Corp., Marlborough, Massachusetts, USA), and endoclips (Olympus) were also used. Owing to such an unconventional procedure, informed consent was obtained from the patient’s wife and from his surgeon after the colonoscopic findings during the same procedure. A 67-year-old man with transverse colostomy secondary to surgical resection of a prior obstructive sigmoid neoplasm, presented with vague lower abdominal pain and fever. Two days earlier, an ultrasonography showed an enlarged appendix. A colonoscopy was performed to investigate synchronic lesions and showed only a purulent discharge from the appendiceal orifice. The endoloop from the attached nasogastric tube was opened and positioned close to the appendiceal orifice. The Shark Tooth grasping forceps was passed through the endoloop and gently into the appendix until tissue resistance was detected. The appendix tip was grasped and inverted back into the lumen in a single pull-through motion (▶Video1). The appendix presented with a reddish orange mucosa in its tail. A diathermic snare wire loop (Blend 1, 30W) was then placed over the inverted appendix to cut. Another endoloop was loaded, and then endoclips were used to fix the ligating loop into position and close the ligated appendix base (▶Fig. 2, ▶Video1). No bleeding was observed. Pathological assessment confirmed acute appendicitis (▶Fig. 3). The patient experienced abdominal discomfort and low-grade fever on the first postoperative day. He received ceftriaxone 2g/day and metronidazole 1.5 g/day for 2 days; oral diet was started on the same day. On the second postoperative day, the patient’s condition improved, without any report of pain.

Competing interests: None

Colorectal cancer (CRC) is a significant cause of morbidity and mortality. Optical colonoscopy (OC) is the first choice of investigation for assessing the state of the colon and it is excellent for CRC screening. Newer technologies such as computed tomography colonography (CTC) may also be useful in CRC screening. This systematic review compares the benefits of CTC and OC for CRC screening. This review includes all the available randomized clinical trials comparing CTC and OC for CRC screening in asymptomatic patients. Three studies were included in the systematic review and were submitted for meta-analysis. In the analysis of participation rates, only 2,333 of 8,104 (29%) patients who were invited for screening underwent the CTC, and only 1,486 of the 7,310 (20%) patients who were invited for screening underwent OC. The absolute risk difference in participation rate in the two procedures was 0.1 (95% CI, 0.05–0.14) in favor of CTC. In the analysis of advanced colorectal neoplasia (ACN) detection rates, 2,357 patients undergoing CTC and 1,524 patients undergoing OC were included. Of these, 135 patients (5.7%) who underwent a CTC and 130 patients (8.5%) who underwent an OC were diagnosed with ACN. The absolute risk difference in ACN detection rate in the two procedure types was −0.02 (with a 95% CI between −0.04 and −0.00) in favor of OC. CTC is an option for CRC screening in asymptomatic patients. However, as CTC was inferior in detecting ACN, it should not replace OC, which remains the gold standard.

A very rare postcholecystectomy complication

Background The use of bougies and balloons to dilate benign esophageal strictures (BES) is a consolidated procedure. However, the amount of evidence available in scientific literature supporting which is the best technique is very low, despite the great prevalence and importance of such pathology. This systematic review with meta-analysis aims at comparing both techniques, providing good quality of evidence. Methods We searched for randomized clinical trials (RCTs) published from insertion to November 2017, using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, LILACS, and grey literature. After the data extraction, a meta-analysis was performed. The main outcomes were symptomatic relief and recurrence rate. The secondary outcomes were bleeding, perforation, and postprocedure pain. Results We included 5 randomized clinical trials (RCTs), totalizing 461 patients. Among them, 151 were treated with bougie dilation and 225 underwent balloon dilation. Regarding symptomatic relief, recurrence, bleeding, and perforation rates, there were no differences between the methods. Concerning postprocedure pain, patients submitted to balloon dilation had less intense pain (RD 0.27, 95% IC −0.42 to −0.07, P = 0.007). Conclusion We conclude that there is no difference between bougie and balloon dilation of BESs regarding symptomatic relief, recurrence rate at 12 months, bleeding, and perforation. Patients undergoing balloon dilation present less severe postprocedure pain.