Propofol-based sedation does not increase rate of perforation during colonoscopic procedur

Sedation-related colonoscopic perforation (CP) has been under much debate. Our aim was to assess and compare the CP rate during colonoscopy by using sedation with or without propofol adjuvant. All patients who underwent colonoscopic procedure at the WGO Endoscopy Training Center, Siriraj Hospital, Thailand from March 2005 to October 2007 by using the intravenous sedation (IVS) technique were analyzed. The primary outcome was the CP rate; the secondary outcomes were sedation-related complications and death during and immediately after the procedure. There were 6140 colonos-copies and 1532 flexible sigmoidoscopies during the study period, of which 6122 colonoscopic procedures were performed by using IVS. All of these procedures were categorized into two groups: group A, the IVS technique was propofol-based sedation and group B, the IVS technique was non-propofol-based sedation. After matching the indications of procedure, there were 2022 colonoscopies in group A and 512 colonoscopies in group B. Colonoscopic procedures were performed by staff endoscopists (10.8%) or residents and fellows (89.2%). The characteristics of patients and sedative agents used in perforated patients in both groups were not significantly different. In group A, five patients (0.25%) suffered from perforation and two of them died. In group B, one patient (0.20%) had CP; the difference was not significant (P=0.829). Our data showed that colonoscopy under propofol-based sedation did not increase the perforation rate. Serious complications are uncommon

Comparison of Prevention of NSAID-Induced Gastrointestinal Complications by Rebamipide and Misoprostol: A Randomized, Multicenter, Controlled Trial—STORM STUDY

Nonsteroidal anti-inflammatory drugs (NSAIDs) have gastrointestinal side effects such as dyspepsia, peptic ulcer, hemorrhage, and perforation. Misoprostol and PPIs have been used to prevent NSAID-induced gastroduodenal injury. Rebamipide increases gastric mucus and stimulates the production of endogenous prostaglandins. The prophylactic effect of rebamipide on NSAID-induced gastrointestinal complications is unknown. The aim of this study was to compare NSAID-induced gastrointestinal complications in rebamipide- and misoprostol-treated groups. Patients were randomized to two groups and took a conventional NSAID plus rebamipide or misoprostol for 12 weeks. Gastric mucosal damage was evaluated by endoscopy at screening and the end of the study. The prevalences of active gastric ulcer were 7/176 (3.9%) in the rebamipide group and 3/156 (1.9%) in the misoprostol group. The prevalences of peptic ulcer were 8/176 (4.5%) in the rebamipide group and 7/156 (4.4%) in the misoprostol group. The cumulative incidences of peptic ulcer in the high-risk subgroup were 6/151 (4.0%) for rebamipide and 6/154 (3.9%) for misoprostol. In conclusion, rebamipide prevented NSAID-induced peptic ulcer as effectively as misoprostol in patients on long-term NSAID therapy. Rebamipide may be a useful therapeutic option for the prevention of NSAID-induced gastrointestinal ulcer because of its therapeutic effect and safety

Anesthetic management for small bowel enteroscopy in a World Gastroenterology Organization Endoscopy Training Center

AIM: To study the anesthetic management of patients undergoing small bowel enteroscopy in the World Gastroenterology Organization (WGO) Endoscopy Training Center in Thailand