J Dorais

A randomized, double-blind study of the use of droperidol for conscious sedation during therapeutic endoscopy in difficult to sedate patients.

BACKGROUND Droperidol has been used in combination with narcotics and benzodiazepines to achieve conscious sedation. We performed a randomized, double-blind, study of droperidol in patients at risk for difficult sedation scheduled for therapeutic endoscopy. METHODS Patients with regular ethanol, narcotic, or benzodiazepine usage, suspected sphincter of Oddi dysfunction, or a history of difficult sedation were eligible for the study. Patients were randomized to receive either droperidol or placebo along with midazolam and meperidine as preprocedure sedation. Time to achieve sedation, interruptions due to undersedation, medication dosages, recovery time, and subjective assessments of sedation were recorded. RESULTS One hundred one patients were randomized. The droperidol group had significantly fewer procedure interruptions and observer ratings of difficulty with sedation and required significantly less midazolam (23%) and meperidine (16%) than the placebo group. There were no significant differences in time to achieve sedation, incomplete procedures, procedure length, recovery room time, or complications. There were significantly higher observer ratings of the quality of sedation for patients who received droperidol. CONCLUSIONS Droperidol is a useful adjunct to conscious sedation in patients who are difficult to sedate. Its use results in significantly fewer interruptions due to poor sedation and improved sedation ratings compared with sedation using midazolam and meperidine alone.

A prospective study of the repeated use of sterilized papillotomes and retrieval baskets for ERCP: quality and cost analysis

BACKGROUND The impact on instrument quality and cost of the practice of reusing ERCP accessories has not been fully addressed. METHODS Twenty-five new papillotomes and 15 new retrieval baskets were labeled and evaluated over time by staff blinded to the number of prior uses. Instruments were scored as to their function for the designated task. The cost of this practice was calculated from the purchase price of accessories and the costs of cleaning, sterilization, and disposal, and then compared with the estimated cost of a practice of one-time use of similar instruments. RESULTS Twenty-five papillotomes were used 246 times (median 8; mean 9.8). Fifteen retrieval baskets were used 193 times (median 13; mean 12.9). The median survival of both papillotomes and baskets before being considered inadequate (score < 6 out of 10) was 9 uses. There were no complications attributable to using reused equipment. The projected yearly cost savings of using reusable versus disposable instruments was

A randomized, controlled study of placement of 10 French tannenbaum biliary stents across malignant strictures with and without sphincterotomy

94,095 for papillotomes and

Endoscopic snare ampullectomy for resection of benign ampullary neoplasms

61,809 for baskets, a 475% and 322% cost reduction, respectively. CONCLUSION The papillotomes and baskets in this study could be reused reliably and safely multiple times, with considerable cost savings compared with the practice of using disposable instruments.

Argon plasma coagulation: A new effective technique of non-contact thermal coagulation. Experience in 44 cases of GI angiomata

A RANDOMIZED, CONTROLLED STUDY OF PLACEMENT OF IO FRENCH TANNENBAUM BILIARY STENTS ACROSS MALIGNANT STRICTURES WITH AND WITHOUT SPHINCTEROTOMY. JCoben. M. Bourke, J Dorais, D Scbeider, P Kortan, G Haber. The Wellesley Hospital, Toronto, Canada. Purpose: To determine whether an endoscopic biliary sphineterotomy (EBS) is of any benefit in the placement of I0 French biliary stents across malignant biliary strictures in terms o f successful stent placement, efficiency o f technique, complications, aad stent pateney. Methods: Patients with non-hilar malignant strictures who were referred for ERCP were randomized to stent placement with or without EBS. In the sphinetcrotomy group, EBS was performed after obtaining a cholangiogrmn with a single lumen, 5 French papillotome. A guide catheter with a guide wire was then used to place a wire past the stricture, over which a 10 French Tannenbaura stent (Wilson-Ccok) was placed. In the no-EBS group, a wire-guided papillotome was used for bile duet cannulation. After the cholangiogram, a wire was advanced across the stricture. The papillotome was then removed, and the guide catheter and stent were placed. The time required to obtain a eholangiogram, the time from cholangiogram to guide wire placement past the stricture, and the time from wire placement to successful stent deployment were recorded. A successful attempt was defined as stent placement within 30 minutes of attempting eannutation. Patients were telephoned at 3 and 30 days to assess complication rates or evidence of stent occlusion. Results: To date, 7 patients have been randomized into each group. All attempts to place stents were successful. The mean time data were not significantly different: EBS GROUP NO-EBS GROUP CHOLANGIOGRAM 3.8 minutes 7.1 minutes CHOLANGIOGRAM TO WIRE 5.4 minutes 6.4 minutes WIRE TO STENT IN PLACE 3.2 minutes 4.5 minutes TOTAL 12.5 minutes 18 minutes In follow~up (2-16 weeks), stents have remained patent in all but 1 (no EBS) of the surviving patients and were patent at the time of death in 4 of the 5 individuals who have not survived. 1 patient in the EBS group died at 9 weeks with sepsis and jaundice. 4 stents have remained patent for 13 weeks or greater. Conclusion: EBS is not required for the successful placement of a 10 French bilinry endoprostbesis through malignant strictures. Whether EBS makes steat placement significantly easier, and whether stent placement without EBS is associated with fewer complications or longer stent pateney remains to be determined,