Defining Standards for Fluoroscopy in Gastrointestinal Endoscopy using a Delphi Methodology

Background and Study Aims The use of fluoroscopy in gastrointestinal endoscopy is an essential aid in advanced endoscopic interventions. However, it also raises concerns about radiation exposure. This study aimed to develop consensus-based statements for the safe and effective use of fluoroscopy in gastrointestinal endoscopy, prioritizing the safety and well-being of healthcare workers and patients. Methods A modified Delphi approach was employed to achieve consensus over three rounds of surveys. Proposed statements were generated in round 1. In the second round, panelists rated potential statements on a 5-point scale, with consensus defined as ≥80% agreement. Statements were subsequently prioritized in round 3, using a 1 (lowest priority) to 10 (highest priority) scale. Results Forty-six experts participated, consisting of 34 therapeutic endoscopists and 12 endoscopy nurses from six continents, with an overall 45.6% female representation (n=21). Forty-three item statements were generated in the first round. Out of these, 31 statements achieved consensus after the second round. These statements were categorized into General Considerations (n=6), Education (n=10), Pregnancy (n=4), Family Planning (n=2), Patient Safety (n=4), and Staff Safety (n=5). In the third round, accepted statements received mean priority scores ranging from 7.28 to 9.36, with 87.2% of statements rated as very high priority (mean score of ≥9). Conclusion This study presents consensus-based statements for the safe and effective use of fluoroscopy in gastrointestinal endoscopy, addressing the well-being of healthcare workers and patients. These consensus-based statements aim to mitigate the risks associated with radiation exposure while maintaining the benefits of fluoroscopy, ultimately promoting a culture of safety in healthcare settings

A Benefit–Risk Assessment of the Use of Proton Pump Inhibitors in the Elderly

Proton pump inhibitors (PPIs) are among the most commonly used drugs worldwide, and their intake increases with age. Despite a relatively safe profile, a range of studies have reported associations between use of PPIs and various adverse events. The most important adverse events, such as pneumonia, bone fractures, bacterial enteric infections, and diminished vitamin absorption are critically discussed in this review in view of the body of evidence, including underlying biological mechanisms, evidence of causality, and consistency. Most of the reported risks are relatively small and sometimes based on inconsistent evidence. For an individual patient, and particularly the elderly, it is relevant to question the indication of use and balance the benefit and potential harm of PPI therapy. This approach can minimize morbidity and reduce healthcare costs. In this review, the use and safety of PPIs among the elderly is described