Browsing by Subject "endoscopy"

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  • Leppäniemi, A.; Tolonen, M.; Tarasconi, A.; Segovia-Lohse, H.; Gamberini, E.; Kirkpatrick, A.W.; Ball, C.G.; Parry, N.; Sartelli, M.; Wolbrink, D.; Van Goor, H.; Baiocchi, G.; Ansaloni, L.; Biffl, W.; Coccolini, F.; Di Saverio, S.; Kluger, Y.; Moore, E.; Catena, F. (2019)
    Although most patients with acute pancreatitis have the mild form of the disease, about 20-30% develops a severe form, often associated with single or multiple organ dysfunction requiring intensive care. Identifying the severe form early is one of the major challenges in managing severe acute pancreatitis. Infection of the pancreatic and peripancreatic necrosis occurs in about 20-40% of patients with severe acute pancreatitis, and is associated with worsening organ dysfunctions. While most patients with sterile necrosis can be managed nonoperatively, patients with infected necrosis usually require an intervention that can be percutaneous, endoscopic, or open surgical. These guidelines present evidence-based international consensus statements on the management of severe acute pancreatitis from collaboration of a panel of experts meeting during the World Congress of Emergency Surgery in June 27-30, 2018 in Bertinoro, Italy. The main topics of these guidelines fall under the following topics: Diagnosis, Antibiotic treatment, Management in the Intensive Care Unit, Surgical and operative management, and Open abdomen. © 2019 The Author(s).
  • Jokelainen, J.; Ismail, S.; Kylänpää, L.; Udd, M.; Mustonen, H.; Lindström, O.; Pöyhiä, R. (2020)
    Background and Aims: Several studies and guidelines are questioning routine preoperative laboratory tests in surgical and endoscopic procedures. Their effect in endoscopic retrograde cholangiopancreatography is not currently known. This study was carried out to evaluate the risk of adverse effects in endoscopic retrograde cholangiopancreatography and their association with preoperative lab tests. Materials and Methods: A single-center, prospective observational study on all 956 patients undergoing 1196 endoscopic retrograde cholangiopancreatographies in the Endoscopy Unit of Helsinki University Central Hospital from 1 March 2012 to 28 February 2013. Routine preoperative laboratory test results (basic blood count, creatinine, potassium, sodium, international normalized ratio/thromboplastin time, and amylase), health status, medication, and demographic information of all patients were analyzed in relation to adverse effects related to endoscopic retrograde cholangiopancreatography and procedural sedation. Results: Multivariate analysis showed post-endoscopic retrograde cholangiopancreatography pancreatitis (43 cases, 3.6%) to have no association with abnormal routine preoperative laboratory tests. Respiratory depression caused by sedation (128 cases, 11%) was not associated with abnormal routine preoperative laboratory tests, and anemia was found to be a slightly protecting factor. Cardiovascular depression caused by sedation was associated with thrombocytopenia (odds ratio = 1.87, p = 0.025) and, in male patients, hyponatremia (odds ratio = 3.66, p <0.001). Incidence of other adverse effects was too low for statistical analysis. Conclusion: Routine universal preoperative lab testing was not found to be successful in predicting adverse effects in endoscopic retrograde cholangiopancreatography procedures. Laboratory testing should be done focusing on each patient's individual needs.
  • Resal, Tamas; Bor, Renata; Szanto, Kata; Fabian, Anna; Rutka, Mariann; Sacco, Marco; Ribaldone, Davide Guiseppe; Molander, Pauliina; Nancey, Stephane; Kopytov, Uri; Vavricka, Stephan; Drobne, David; Lukas, Milan; Farkas, Klaudia; Szepes, Zoltan; Molnar, Tamas (2021)
    Introduction: The coronavirus disease 2019 (COVID-19) pandemic poses a challenge to healthcare. Staff and patients are at increased risk during an examination or intervention, so certain restrictions ought to be introduced. Hence, we aimed to measure the effect of the pandemic on endoscopy units in real-life settings. Methods: This was an observational, cross-sectional, questionnaire-based study, carried out between 7 April and 15 June 2020. Responds came from many countries, and the participation was voluntary. The survey contained 40 questions, which evaluated the effect of the COVID-19 pandemic on the endoscopy units and assessed the infection control. Results: A total of 312 questionnaires were filled, 120 from Hungary, and 192 internationally, and 54 questionnaires (17.3%) were sent from high-risk countries; 84.9% of the gastroenterologists declared that they read the European Society of Gastrointestinal Endoscopy (ESGE) statement, while only 32.1% participated in any advanced training at their workplace. Overall, 92.1% of gastroenterologists realized risk stratification, and 72.1% claimed to have enough protective equipment. In 52.6% of the endoscopy units, at least one endoscopist had to discontinue the work due to any risk factor, while 40.6% reported that the reduced staff did not affect the workflow. Gastroenterologists considered that the five most important examinations both in low and high-risk patients are the following: lower/upper gastrointestinal (GI) bleeding with hemodynamic instability, endoscopic retrograde cholangiopancreatography (ERCP) in obstructive jaundice, foreign body in the esophagus, ERCP in acute biliary pancreatitis, and iron deficiency anemia with hemodynamic instability, which correlates well with the ESGE recommendation. Significant correlation was found in the usage of the necessary protective equipment in high-risk patients depending on the countries (p < 0.001). Conclusions: The survey found weak correlation in preliminary training depending on countries; nevertheless, in Hungary during the examined period, endoscopists considered the recommendations more strictly than in other countries. Although many physicians left the endoscopy lab, the workflow was not affected, probably due to the reduced number of examinations.
  • Björkman, Kajsa; Pietarinen, Petra; Mäkitie, Antti; Markkanen-Leppänen, Mari (Helsingfors universitet, 2017)
    Background: Fiberoptic endoscopic evaluation of swallowing (FEES) is an established non-invasive and radiation-safe evaluation method of the pharyngeal swallowing function. The focus is in the diagnosis of dysphagia, consideration of its treatment and in finding compensation techniques for impaired swallowing. We aimed at investigating the feasibility and outcome of FEES at our institution. Patients and Methods: The study group comprised all the 117 patients who had a FEES performed during the years 2011 and 2012 at the Department of Otorhinolaryngology – Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland. Results: Patients who were considered otherwise healthy prior to FEES presented significantly more often with globus symptoms compared with patients with a neurological disorder (p=0.009) or those diagnosed with a head and neck (HN) malignancy (p=0.011). Patients with a neurological disorder had significantly more aspiration (p=0.014), suffered more from swallowing initiation difficulties (p=0.031) and more often had a pneumonia (p<0.005) compared to the patients who had been considered healthy. Aspiration and pneumonia correlated with the underlying disease (r=0.382 p<0.005), as well as with the degree of dysphagia. Conclusions: FEES served well as a second-stage diagnostic tool for dysphagia in a multidisciplinary environment. Patients with no obvious underlying cause for dysphagia presented more often with globus, compared to patients with a diagnosed malignant tumour in the head and neck region, or with a neurological diagnosis. Aspiration, pneumonia and the degree of dysphagia correlated with the underlying cause of dysphagia.
  • Huhtamo, Sanna (Helsingin yliopisto, 2019)
    Henkitorven ahtauma on harvinainen sairaus ja syntyy yleensä intubaation tai trakeostomian jälkeen. Muita tekijöitä ovat autoimmuuniperäiset sairaudet ja traumat. Jos selvää syytä ahtaumalle ei löydy, on kyseessä idiopaattinen ahtauma. Ahtaumia hoidetaan nykyään joko endoskooppisesti tai avoleikkauksella. Retrospektiivisen asiakirjatutkimuksen tavoitteena oli tutkia subglottisen stenoosin endoskooppisen kirurgian tuloksia HYKS Korva-, nenä- ja kurkkutautien klinikassa. Tutkimuksen hypoteesina oli, että osalle potilaista pelkät endoskooppiset toimenpiteen ovat riittävä hoito. Tutkimuksessa kerättiin lista potilaista viiden vuoden ajalta (1.1.2013-31.12.2017) diagnoosilla J38.6 (henkitorven ahtauma). Näistä potilaista valittiin tarkempaan tarkasteluun ne, joille oli tehty endoskooppinen toimenpide. Kuudesta potilaasta, joille oli tehty endoskooppinen leikkaus, viidellä oli idiopaattinen ahtauma ja yhdellä ahtauma oli syntynyt trakeostomian jälkeen. Kaikki idiopaattista ahtaumaa sairastavat potilaat olivat naisia ja potilas, jolle ahtauma syntyi trakeostomian jälkeen oli mies. Potilaiden keski-ikä oli 42,2 ± 8,8 vuotta. Seuranta-ajan mediaani oli 475 päivää ja seuranta jatkui 31.12.2018 asti. Viidelle potilaista tehtiin yksi endoskooppinen toimenpide, eivätkä oireet palanneet seuranta-aikana. Yksi potilaista päätyi kahden endoskooppisen toimenpiteen jälkeen resektio-rekonstruktioleikkaukseen. Kaikkien potilaiden oireet helpottuivat ensimmäisen toimenpiteen jälkeen, ja viidellä potilaista myös videoendoskopiassa ahtauma pieneni, yhdellä ei tapahtunut muutosta. Tutkimuksen lyhyen seuranta-ajan sekä pienen potilasmäärän takia tutkimustulokset ovat viitteellisiä. Tulosten perusteella on kuitenkin todennäköistä, että ainakin osa potilaista hyötyy pelkästä endoskooppisesta toimenpiteestä ahtauman hoitona.