Endoscopic argon plasma coagulation for vascular lesions in the digestive tract
1
Purpose: Upper gastrointestinal endoscopy (UGIE) may have some car- diac stress. The effect of sedation on hemodynamics during UGIE has not been fully studied. Recently, cardiac output has been able to be measured non-invasively, easily and accurately by color doppler echocardiography with automated cardiac flow measurement (ACM). In this study, we in- vestigated several hemodynamic factors including cardiac output and plasma catecholamine responses to clarify whether or not sedation can reduce the cardiac stress during routine UGIE. Methods: Eight normal male volunteers undergoing UGIE twice with sedation (0.1 mg/kg of midazolam) and without it were monitored by means of electrocardiogram, blood pressure and peripheral oxygen satura- tion throughout the procedure. Cardiac output was measured at six points before, during and after endoscopy from automated cardiac flow measure- ment by color doppler echocardiography. Serum norepinephrine, epineph- rine, dopamine and ACTH concentrations were measured before and after the examination. Results: No significant differences in heart rate, systolic blood pressure, rate-pressure product, cardiac output and left ventricular work index were observed between sedated and non-sedated groups. Peripheral oxygen saturation hardly changed during endoscopy in non-sedated group, but slightly decreased in sedated group (p 0.075). Although all serum catecholamine concentration changes were within normal limits in both groups, only epinephrine concentration was significantly lower in sedated group than in non-sedated group after endoscopy (p 0.012). Conclusions: Conscious sedation with midazolam does not affect hemo- dynamics during UGIE. We do not recommend the routine use of sedation for UGIE in patients with heart disease, because sedation has the potential pitfall of hypoxia and does not reduce the cardiac stress. 906 Procedure related abdominal discomfort in patients undergoing colorectal cancer screening (CRCS): A comparison of colonoscopy and flexible sigmoidoscopy (FOS) Richard Zubarik 1 , Eric Ganguly 1 , Nicholas Ferrentino 1 , Peter Moses 1 and James Vecchio 1 *. 1 Gastroenterology, University of Vermont, Burlington, Vermont, United States. Purpose: To determine if patients undergoing screening colonoscopy or FOS have: 1. A difference in procedure-related abdominal discomfort 2. A difference in willingness to have subsequent screening exams. Methods: Consecutive patients referred for CRCS were prospectively included in this study. The two groups were 1) patients referred for screening FOS 2) patients referred for screening colonoscopy. All patients were asymptomatic for colorectal cancer, and did not have occult bleeding. A group of five university-based gastroenterologists performed all proce- dures. Patients received conscious sedation for colonoscopy but not for FOS. One week after the procedure a single trained research nurse, blinded to the procedure performed, administered a standardized telephone ques- tionnaire assessing and quantifying peri-procedural discomfort. The Fish- er’s exact test was used to determine significance. Results: A cohort of 272 patients underwent subsequent screening exams and 85% (141 colonoscopy, 91 FOS) were contacted subsequent to their exam. The average age was 56, and 50% were female. Procedure-related discomfort, post-procedural discomfort, or discomfort at either of these two times occured in 26% (37/141), 15%(21/141), and 35%(49/141) of patients undergoing colonoscopy, respectively. Procedure-related discomfort, post- procedural discomfort or discomfort at either of these two times occured in 57%(52/91), 25%(23/91), and 63%(57/91) of patients undergoing FOS, respectively. Procedural discomfort, post-procedural discomfort or discom- fort at either of these two periods were significantly more common in patients undergoing FOS than those undergoing colonoscopy (p-values: .0005, .049, .0005, respectively). Patients undergoing colonoscopy were more likely to say they would undergo the procedure again than those undergoing FOS (140/140 vs 86/90; p-value .022) Conclusions: Patients undergoing screening colonoscopy with conscious sedation are less likely to experience peri-procedural abdominal discomfort than those undergoing screening FOS. Most patients who have colonos- copy or FOS screening are willing to have subsequent exams. Patients undergoing screening colonoscopy are significantly more likely to undergo a subsequent exam than those undergoing FOS. 907 Endoscopic argon plasma coagulation for vascular lesions in the digestive tract Guilherme Macedo, M.D., FACG, Susana Lopes, M.D., Pedro Moutinho-Ribeiro, M.D., So ´nia Barroso, M.D., Luis Lobo, M.D., Armando Ribeiro, M.D., Tome ´ Ribeiro, M.D., PhD. Gastroenterology Unit, Hosp.S. Joa ˜o, Porto, Portugal. Endoscopic hemostasis with Argon Plasma Coagulation (APC) is a recent coagulation modality employing ionized argon gas and might have a substantial role in the therapy of nonvariceal vascular lesions of the digestive tract. In a 2 years period, we have used this technique in 15 patients (10 females) with mean age 65,6 17 years old (39 – 87). Endoscopy was performed under conscious sedation and APC application consisted of multiple brief pulses at 40-50 watts, with flux of 1,0 –1,5 1/min. Indications for endoscopy were: anemia- 13 patients, hematemesis- 1, melenae- 1, in four occasions the procedure was performed in the ER. The treated lesions were: angiodysplasia- 11 (multiple lesions in 4 patients), gastric antral vascular ectasia (GAVE)- 4. Angiodysplasias were found in the gastric lumen in 9 patients, the pylorus in 1, and proximal jejunum in one. In 2 patients, there was active bleeding, promptly resolved with APC. In other 2, we have used additionally adrenaline for total erradication (multiple angiodysplasia, GAVE). As complications we have only found 2 gaseous infiltrations of the submucosa, limited in extension, that subsided spontaneously. There has not been persistent or recurrent bleeding. GAVE patients reduced substantially their transferrin needs, and all patients with anemia had recovery of their hematocrit. ACP proved to be an user-friendly endoscopic technology, safe and efficient for treatment of nonvariceal vascular lesions of the digestive tract. INFLAMMATORY BOWEL DISEASE 908 Poor concordance for clinical features among Crohn’s disease- affected siblings Jean-Paul Achkar 1 , Aaron Brzezinski 1 , Bret Lashner 1 , Deborah Vogel 1 and Richard Duerr 2 *. 1 Gastroenterology, Cleveland Clinic Foundation, Cleveland, OH, United States; and 2 Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States. Purpose: A shared genetic predisposition among Crohn’s disease (CD) affected relatives could predispose to a particular clinical course of CD. In familial cases of CD, reports have suggested that affected members within a family have a high rate of concordance for clinical parameters such as disease behavior. Our aim was to determine concordance rates for clinical parameters among CD-affected siblings. Methods: 32 families with 2 or more CD-affected siblings were analyzed. Medical records were reviewed and telephone interviews were conducted to confirm all collected data. Disease behavior was classified as inflam- matory, perforating, or fibrostenotic. Concordance was defined as sharing of a clinical parameter by all affected siblings within a family. McNemar’s test was used to determine if the clinical course of first diagnosed sibling predicted the subsequent clinical course of the second diagnosed sibling. S285 AJG – September, Suppl., 2001 Abstracts
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Transcript of Endoscopic argon plasma coagulation for vascular lesions in the digestive tract
Purpose: Upper gastrointestinal endoscopy (UGIE) may have some car-diac stress. The effect of sedation on hemodynamics during UGIE has notbeen fully studied. Recently, cardiac output has been able to be measurednon-invasively, easily and accurately by color doppler echocardiographywith automated cardiac flow measurement (ACM). In this study, we in-vestigated several hemodynamic factors including cardiac output andplasma catecholamine responses to clarify whether or not sedation canreduce the cardiac stress during routine UGIE.Methods: Eight normal male volunteers undergoing UGIE twice withsedation (0.1 mg/kg of midazolam) and without it were monitored bymeans of electrocardiogram, blood pressure and peripheral oxygen satura-tion throughout the procedure. Cardiac output was measured at six pointsbefore, during and after endoscopy from automated cardiac flow measure-ment by color doppler echocardiography. Serum norepinephrine, epineph-rine, dopamine and ACTH concentrations were measured before and afterthe examination.Results: No significant differences in heart rate, systolic blood pressure,rate-pressure product, cardiac output and left ventricular work index wereobserved between sedated and non-sedated groups. Peripheral oxygensaturation hardly changed during endoscopy in non-sedated group, butslightly decreased in sedated group (p � 0.075). Although all serumcatecholamine concentration changes were within normal limits in bothgroups, only epinephrine concentration was significantly lower in sedatedgroup than in non-sedated group after endoscopy (p � 0.012).Conclusions: Conscious sedation with midazolam does not affect hemo-dynamics during UGIE. We do not recommend the routine use of sedationfor UGIE in patients with heart disease, because sedation has the potentialpitfall of hypoxia and does not reduce the cardiac stress.
906
Procedure related abdominal discomfort in patients undergoingcolorectal cancer screening (CRCS): A comparison of colonoscopyand flexible sigmoidoscopy (FOS)Richard Zubarik1, Eric Ganguly1, Nicholas Ferrentino1, Peter Moses1
and James Vecchio1*. 1Gastroenterology, University of Vermont,Burlington, Vermont, United States.
Purpose: To determine if patients undergoing screening colonoscopy orFOS have: 1. A difference in procedure-related abdominal discomfort 2. Adifference in willingness to have subsequent screening exams.Methods: Consecutive patients referred for CRCS were prospectivelyincluded in this study. The two groups were 1) patients referred forscreening FOS 2) patients referred for screening colonoscopy. All patientswere asymptomatic for colorectal cancer, and did not have occult bleeding.A group of five university-based gastroenterologists performed all proce-dures. Patients received conscious sedation for colonoscopy but not forFOS. One week after the procedure a single trained research nurse, blindedto the procedure performed, administered a standardized telephone ques-tionnaire assessing and quantifying peri-procedural discomfort. The Fish-er’s exact test was used to determine significance.Results: A cohort of 272 patients underwent subsequent screening examsand 85% (141 colonoscopy, 91 FOS) were contacted subsequent to theirexam. The average age was 56, and 50% were female. Procedure-relateddiscomfort, post-procedural discomfort, or discomfort at either of these twotimes occured in 26% (37/141), 15%(21/141), and 35%(49/141) of patientsundergoing colonoscopy, respectively. Procedure-related discomfort, post-procedural discomfort or discomfort at either of these two times occured in57%(52/91), 25%(23/91), and 63%(57/91) of patients undergoing FOS,respectively. Procedural discomfort, post-procedural discomfort or discom-fort at either of these two periods were significantly more common inpatients undergoing FOS than those undergoing colonoscopy (p-values:�.0005, � .049, �.0005, respectively). Patients undergoing colonoscopywere more likely to say they would undergo the procedure again than thoseundergoing FOS (140/140 vs 86/90; p-value � .022)
Conclusions: Patients undergoing screening colonoscopy with conscioussedation are less likely to experience peri-procedural abdominal discomfortthan those undergoing screening FOS. Most patients who have colonos-copy or FOS screening are willing to have subsequent exams. Patientsundergoing screening colonoscopy are significantly more likely to undergoa subsequent exam than those undergoing FOS.
907
Endoscopic argon plasma coagulation for vascular lesions in thedigestive tractGuilherme Macedo, M.D., FACG, Susana Lopes, M.D., PedroMoutinho-Ribeiro, M.D., Sonia Barroso, M.D., Luis Lobo, M.D.,Armando Ribeiro, M.D., Tome Ribeiro, M.D., PhD. GastroenterologyUnit, Hosp.S. Joao, Porto, Portugal.
Endoscopic hemostasis with Argon Plasma Coagulation (APC) is a recentcoagulation modality employing ionized argon gas and might have asubstantial role in the therapy of nonvariceal vascular lesions of thedigestive tract.
In a 2 years period, we have used this technique in 15 patients (10females) with mean age 65,6 � 17 years old (39–87). Endoscopy wasperformed under conscious sedation and APC application consisted ofmultiple brief pulses at 40-50 watts, with flux of 1,0–1,5 1/min. Indicationsfor endoscopy were: anemia- 13 patients, hematemesis- 1, melenae- 1, infour occasions the procedure was performed in the ER.
The treated lesions were: angiodysplasia- 11 (multiple lesions in 4patients), gastric antral vascular ectasia (GAVE)- 4. Angiodysplasias werefound in the gastric lumen in 9 patients, the pylorus in 1, and proximaljejunum in one. In 2 patients, there was active bleeding, promptly resolvedwith APC. In other 2, we have used additionally adrenaline for totalerradication (multiple angiodysplasia, GAVE). As complications we haveonly found 2 gaseous infiltrations of the submucosa, limited in extension,that subsided spontaneously. There has not been persistent or recurrentbleeding. GAVE patients reduced substantially their transferrin needs, andall patients with anemia had recovery of their hematocrit. ACP proved tobe an user-friendly endoscopic technology, safe and efficient for treatmentof nonvariceal vascular lesions of the digestive tract.
INFLAMMATORY BOWEL DISEASE
908
Poor concordance for clinical features among Crohn’s disease-affected siblingsJean-Paul Achkar1, Aaron Brzezinski1, Bret Lashner1, Deborah Vogel1
and Richard Duerr2*. 1Gastroenterology, Cleveland Clinic Foundation,Cleveland, OH, United States; and 2Medicine, University of PittsburghSchool of Medicine, Pittsburgh, PA, United States.
Purpose: A shared genetic predisposition among Crohn’s disease (CD)affected relatives could predispose to a particular clinical course of CD. Infamilial cases of CD, reports have suggested that affected members withina family have a high rate of concordance for clinical parameters such asdisease behavior. Our aim was to determine concordance rates for clinicalparameters among CD-affected siblings.Methods: 32 families with 2 or more CD-affected siblings were analyzed.Medical records were reviewed and telephone interviews were conductedto confirm all collected data. Disease behavior was classified as inflam-matory, perforating, or fibrostenotic. Concordance was defined as sharingof a clinical parameter by all affected siblings within a family. McNemar’stest was used to determine if the clinical course of first diagnosed siblingpredicted the subsequent clinical course of the second diagnosed sibling.
S285AJG – September, Suppl., 2001 Abstracts
