Clinical Endoscopy

Original Article

Risk Factors for Prolonged Hospital Stay after Endoscopy: Toshihiro Nishizawa, Shuntaro Yoshida, Osamu Toyoshima, Tatsuya Matsuno, Masataka Irokawa, Toru Arano, Hirotoshi Ebinuma, Hidekazu Suzuki, Takanori Kanai, Kazuhiko Koike; Clin Endosc 2021;54(6):851-856. Published online March 16, 2021; DOI: https://doi.org/10.5946/ce.2020.292

Background
/Aims: The recovery room used after endoscopy has limited capacity, and an efficient flow of the endoscopy unit is desired. We investigated the duration of hospital stay after endoscopy and the risk factors for prolonged hospital stay among outpatients.
Methods
We retrospectively studied consecutive patients who underwent esophagogastroduodenoscopy or colonoscopy at the Toyoshima Endoscopy Clinic. We collected data on age, sex, body weight, midazolam and pethidine dosage, respiratory depression during endoscopy, and duration of hospital stay after endoscopy (scope out to check out). Risk factors for prolonged hospital stay (>100 minutes) were identified using multiple logistic regression analysis.
Results
We enrolled 3,898 patients, including 3,517 (90.2%) patients tested under sedation and 381 (9.8%) patients tested without sedation. Overall, 442 (11.3%) patients had prolonged stay (>100 min). The mean time difference between sedation group and non-sedation group was 44.2 minutes for esophagogastroduodenoscopy and 39.1 minutes for colonoscopy. Age (odds ratio [OR], 1.025; 95% confidence interval [CI], 1.014−1.036), female sex (OR, 1.657; 95% CI, 1.220−2.249), and midazolam dose (OR, 1.019; 95% CI, 1.013−1.026) were independently associated with prolonged hospital stay after esophagogastroduodenoscopy, with similar results for colonoscopy.
Conclusions
Old age, female sex, and midazolam dose were independent risk factors for prolonged hospital stay after endoscopy.

Citations

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Focused review series

Current Status of Endoscopic Ultrasound Techniques for Pancreatic Neoplasms: Yousuke Nakai, Naminatsu Takahara, Suguru Mizuno, Hirofumi Kogure, Kazuhiko Koike; Clin Endosc 2019;52(6):527-532. Published online July 24, 2019; DOI: https://doi.org/10.5946/ce.2019.025

Abstract PDF PubReader ePub

Endoscopic ultrasound (EUS) now plays an important role in the management of pancreatic neoplasms. There are various types of pancreatic neoplasms, from benign to malignant lesions, and the role of EUS ranges from the imaging diagnosis to treatment. EUS is useful for the detection, characterization, and tissue acquisition of pancreatic lesions. Recent advancement of contrast-enhanced harmonic EUS and elastography enables better characterization of pancreatic lesions. In addition to these enhanced EUS imaging techniques, EUS-guided tissue acquisition is now the standard procedure to establish the pathological diagnosis of pancreatic neoplasms. While these diagnostic roles of EUS have been established, EUS-guided interventions such as ablation and drainage are also increasingly utilized in the management of pancreatic neoplasms. However, most of these EUS-guided interventions are not yet standardized in terms of techniques and devices and thus need further investigations.

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Focused Review Series: Expanding Indication: Interventional Endoscopic Management for Pancreaticobiliary Diseaseses

Endoscopic Ultrasound-Guided Biliary Drainage for Benign Biliary Diseases: Yousuke Nakai, Hirofumi Kogure, Hiroyuki Isayama, Kazuhiko Koike; Clin Endosc 2019;52(3):212-219. Published online March 14, 2019; DOI: https://doi.org/10.5946/ce.2018.188

Abstract PDF PubReader ePub

Although endoscopic retrograde cholangiopancreatography (ERCP) is the first-line treatment for benign biliary diseases, this procedure is technically difficult in some conditions such as a surgically altered anatomy and gastric outlet obstruction. After a failed ERCP, a surgical or a percutaneous approach is selected as a rescue procedure; however, various endoscopic ultrasound (EUS)-guided interventions are increasingly utilized in pancreatobiliary diseases, including EUS-guided rendezvous for failed biliary cannulation, EUS-guided antegrade treatment for stone management, and EUS-guided hepaticogastrostomy for anastomotic strictures in patients with a surgically altered anatomy. There are some technical hurdles in EUS-guided interventions for benign biliary diseases owing to the difficulty in puncturing a relatively small bile duct and in subsequent guidewire manipulation, as well as the lack of dedicated devices. A recent major advancement in this field is the introduction of a 2-step approach, in which EUS-guided drainage is placed in the first session and antegrade treatment is performed in subsequent sessions. This approach allows the use of various techniques such as mechanical lithotripsy and cholangioscopy without a risk of bile leak. In summary, EUS-guided interventions are among the treatment options for benign biliary diseases; however, standardization of the procedure and development of a treatment algorithm are needed.

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Endoscopic Ultrasound-Guided Biliary Drainage for Unresectable Hilar Malignant Biliary Obstruction: Yousuke Nakai, Hirofumi Kogure, Hiroyuki Isayama, Kazuhiko Koike; Clin Endosc 2019;52(3):220-225. Published online November 29, 2018; DOI: https://doi.org/10.5946/ce.2018.094

Abstract PDF PubReader ePub

Endoscopic transpapillary biliary drainage is the current standard of care for unresectable hilar malignant biliary obstruction (MBO) and bilateral metal stent placement is shown to have longer patency. However, technical and clinical failure is possible and percutaneous transhepatic biliary drainage (PTBD) is sometimes necessary. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is increasingly being reported as an alternative rescue procedure to PTBD. EUS-BD has a potential advantage of not traversing the biliary stricture and internal drainage can be completed in a single session. Some approaches to bilateral biliary drainage for hilar MBO under EUS-guidance include a bridging method, hepaticoduodenostomy, and a combination of EUS-BD and transpapillary biliary drainage. The aim of this review is to summarize data on EUS-BD for hilar MBO and to clarify its advantages over the conventional approaches such as endoscopic transpapillary biliary drainage and PTBD.

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Reviews

Recent Development of Techniques and Devices in Colorectal Endoscopic Submucosal Dissection: Hiroya Mizutani, Satoshi Ono, Daisuke Ohki, Chihiro Takeuchi, Seiichi Yakabi, Yosuke Kataoka, Itaru Saito, Yoshiki Sakaguchi, Chihiro Minatsuki, Yosuke Tsuji, Keiko Niimi, Shinya Kodashima, Nobutake Yamamichi, Mitsuhiro Fujishiro, Kazuhiko Koike; Clin Endosc 2017;50(6):562-568. Published online November 30, 2017; DOI: https://doi.org/10.5946/ce.2017.108

Abstract PDF PubReader ePub

Colorectal endoscopic submucosal dissection (ESD) is now a well-established endoscopic treatment for early-stage colorectal neoplasms, especially in Asian countries, including Japan. Despite the spread of colorectal ESD, there are still situations in which achieving successful submucosal dissection is difficult. Various novel techniques and devices have been developed to overcome these difficulties, and past reports have shown that some of these strategies can be applied to colorectal ESD. We review several recent developments in the field. The techniques reviewed include the pocket creation method and traction methods and the devices reviewed include the overtube with balloon and electrosurgical knives with water-jet function. These improved techniques and devices can facilitate safer, more reliable ESDs and expand its applicability and acceptability all over the world.

Citations

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Complications Related to Gastric Endoscopic Submucosal Dissection and Their Managements: Itaru Saito, Yosuke Tsuji, Yoshiki Sakaguchi, Keiko Niimi, Satoshi Ono, Shinya Kodashima, Nobutake Yamamichi, Mitsuhiro Fujishiro, Kazuhiko Koike; Clin Endosc 2014;47(5):398-403. Published online September 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.5.398

Abstract PDF PubReader ePub

Endoscopic submucosal dissection (ESD) for early gastric cancer is a well-established procedure with the advantage of resection in an en bloc fashion, regardless of the size, shape, coexisting ulcer, and location of the lesion. However, gastric ESD is a more difficult and meticulous technique, and also requires a longer procedure time, than conventional endoscopic mucosal resection. These factors naturally increase the risk of various complications. The two most common complications accompanying gastric ESD are bleeding and perforation. These complications are known to occur both intraoperatively and postoperatively. However, there are other rare but serious complications related to gastric ESD, including aspiration pneumonia, stenosis, venous thromboembolism, and air embolism. Endoscopists should have sufficient knowledge about such complications and be prepared to deal with them appropriately, as successful management of complications is necessary for the successful completion of the entire ESD procedure.

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Journal of Clinical Medicine.2021; 10(19): 4423. CrossRef
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Yu Hidaka, Toru Imai, Tomoki Inaba, Tomo Kagawa, Katsuhiro Omae, Shiro Tanaka, Sanjiv Mahadeva
PLOS ONE.2021; 16(12): e0261703. CrossRef
Skeletal Muscle Depletion: A Risk Factor for Pneumonia following Gastric Endoscopic Submucosal Dissection in Elderly Patients
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Digestive Diseases.2021; 39(5): 435. CrossRef
Prophylactic antibiotics may be unnecessary in gastric endoscopic submucosal dissection due to the low incidence of bacteremia
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Surgical Endoscopy.2020; 34(9): 3788. CrossRef
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Clinical Journal of Gastroenterology.2020; 13(3): 354. CrossRef
Efficacy and safety of endoscopic submucosal dissection for large gastric stromal tumors
Qiaofeng Chen, Mingju Yu, Yupeng Lei, Chang Zhong, Zhijian Liu, Xiaojiang Zhou, Guohua Li, Xiaodong Zhou, Youxiang Chen
Clinics and Research in Hepatology and Gastroenterology.2020; 44(1): 90. CrossRef
A Single-Center Early Experience of Endoscopic Submucosal Dissection for Gastric Lesions in Thailand
Prasit Mahawongkajit
Gastroenterology Research and Practice.2020; 2020: 1. CrossRef
Bleeding after endoscopic submucosal dissection of gastric lesions
Chao Hu Yang, Yu Qiu, Xiao Li, Rui Hua Shi
Journal of Digestive Diseases.2020; 21(3): 139. CrossRef
EMR/ESD: Techniques, Complications, and Evidence
Yahya Ahmed, Mohamed Othman
Current Gastroenterology Reports.2020;[Epub] CrossRef
Life on a knife edge: the optimal approach to the management of perforations during endoscopic submucosal dissection (ESD)
Shria Kumar, Young Hoon Youn, Jeffrey H. Lee
Expert Review of Gastroenterology & Hepatology.2020; 14(10): 965. CrossRef
Pneumothorax Following Gastric Endoscopic Mucosal Resection
Myeongseok Koh, Jin Seok Jang, Jae Hwang Cha
The Korean Journal of Gastroenterology.2020; 76(2): 83. CrossRef
Endoscopic submucosal dissection under D‐sorbitol solution in an animal model
Asahiro Morishita, Hideki Kobara, Tsutomu Masaki
Digestive Endoscopy.2019;[Epub] CrossRef
Safety and effectiveness of endoscopic mucosal resection or endoscopic submucosal dissection for gastric neoplasia within 2 days’ hospital stay
Joon Young Choi, Young Soo Park, Gyeongjae Na, Sung Jae Park, Hyuk Yoon, Cheol Min Shin, Nayoung Kim, Dong Ho Lee
Medicine.2019; 98(32): e16578. CrossRef
Endoscopic full-thickness resection using suture loop needle T-tag tissue anchors in the porcine stomach (with video)
Akira Dobashi, Elizabeth Rajan, Mary A. Knipschield, Christopher J. Gostout
Gastrointestinal Endoscopy.2018; 87(2): 590. CrossRef
Endoskopische Techniken bei Frühkarzinomen im oberen und unteren Gastrointestinaltrakt
A. Probst, A. Ebigbo, H. Messmann
Der Chirurg.2018; 89(5): 365. CrossRef
Endoscopic Submucosal Dissection of Early Gastric Cancer in Patients with Liver Cirrhosis
Won Hyeok Choe, Jeong Hwan Kim, Jung Ho Park, Heung Up Kim, Dae Hyeon Cho, Sang Pyo Lee, Tae Yoon Lee, Sun-Young Lee, In Kyung Sung, Hyung Seok Park, Chan Sup Shim
Digestive Diseases and Sciences.2018; 63(2): 466. CrossRef
USEFULNESS OF GASTRIC SUBMUCOSAL DISSECTION DEPTH TO EVALUATE SKILL ACQUIREMENT IN SHORT TERM TRAINING COURSES IN ESD: AN EXPERIMENTAL STUDY
Kendi YAMAZAKI, Eduardo Guimarães Hourneaux de MOURA, Mariana Matera VERAS, Luiz Henrique MESTIERI, Paulo SAKAI
Arquivos de Gastroenterologia.2018; 55(3): 221. CrossRef
Multicenter Prospective Study on the Safety of Upper Gastrointestinal Endoscopic Procedures in Antithrombotic Drug Users
Yoshiyasu Kono, Minoru Matsubara, Tatsuya Toyokawa, Ryuta Takenaka, Seiyu Suzuki, Junichirou Nasu, Masao Yoshioka, Masahiro Nakagawa, Motowo Mizuno, Hiroyuki Sakae, Makoto Abe, Tatsuhiro Gotoda, Ko Miura, Hiromitsu Kanzaki, Masaya Iwamuro, Keisuke Hori, T
Digestive Diseases and Sciences.2017; 62(3): 730. CrossRef
Is the Reinitiation of Antiplatelet Agents Safe at 1 Week after Gastric Endoscopic Submucosal Dissection? Assessment of Bleeding Risk Using the Forrest Classification
Jong Yeul Lee, Chan Gyoo Kim, Soo-Jeong Cho, Young-Il Kim, Il Ju Choi
Gut and Liver.2017; 11(4): 489. CrossRef
Preoperative Pulmonary Function Tests Predict Aspiration Pneumonia After Gastric Endoscopic Submucosal Dissection
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Digestive Diseases and Sciences.2017; 62(11): 3084. CrossRef
Acute Phlegmonous Gastritis Developing after Endoscopic Submucosal Dissection That Was Successfully Treated by Antibiotics Alone
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The Korean Journal of Medicine.2016; 90(2): 127. CrossRef
Feasibility of optical coherence tomography for the evaluation of Barrett's mucosa buried underneath esophageal squamous epithelium
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Digestive Endoscopy.2016; 28(4): 427. CrossRef
Current Practices in the Management of Antithrombotic Therapy During the Periendoscopic Period for Patients With Cardiovascular Disease
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International Heart Journal.2016; 57(5): 530. CrossRef
Endoscopic resection of gastric and esophageal cancer
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Gastroenterology Report.2015; : gov050. CrossRef
Prevention of gastrointestinal events in patients on antithrombotic therapy in the peri‐endoscopy period: Review of new evidence and recommendations from recent guidelines
Raymond S. Y. Tang, Francis K. L. Chan
Digestive Endoscopy.2015; 27(5): 562. CrossRef
A Case of Pneumothorax Following Gastric Endoscopic Submucosal Dissection
Yu Rim Lee, Jun Heo, Min Kyu Jung, Sung Kook Kim, Eun Jeong Kang, Seong Jae Yeo, Hye Yoon Park
Korean Journal of Medicine.2015; 88(1): 54. CrossRef
Giant Solitary Fibrous Tumor of Esophagus Resected by Endoscopic Submucosal Dissection
Xiao-San Zhu, Yi-Chen Dai, Zhang-Xing Chen
The Annals of Thoracic Surgery.2015; 100(6): 2340. CrossRef
Endoscopic Resection Compared with Gastrectomy to Treat Early Gastric Cancer: A Systematic Review and Meta-Analysis
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PLOS ONE.2015; 10(12): e0144774. CrossRef
International Digestive Endoscopy Network 2014: Turnpike to the Future
Eun Young Kim, Kwang An Kwon, Il Ju Choi, Ji Kon Ryu, Ki Baik Hahm
Clinical Endoscopy.2014; 47(5): 371. CrossRef

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