Complex and lengthy endoscopic examinations like endoscopic ultrasonography and/or endoscopic retrograde cholangiopancreatography benefit from deep sedation, due to an enhanced quality of examinations, reduced discomf...Complex and lengthy endoscopic examinations like endoscopic ultrasonography and/or endoscopic retrograde cholangiopancreatography benefit from deep sedation, due to an enhanced quality of examinations, reduced discomfort and anxiety of patients, as well as increased satisfaction for both the patients and medical personnel. Current guidelines support the use of propofol sedation, which has the same rate of adverse effects as traditional sedation with benzodiazepines and/or opioids, but decreases the procedural and recovery time. Non-anesthesiologist administered propofol sedation has become an option in most of the countries, due to limited anesthesiology resources and the increasing evidence from prospective studies and metaanalyses that the procedure is safe with a similar rate of adverse events with traditional sedation. The advantages include a high quality of endoscopic examination, improved satisfaction for patients and doctors, as well as decreased recovery and discharge time. Despite the advantages of non-anesthesiologist administered propofol, there is still a continuous debate related to the successful generalization of the procedures.展开更多
BACKGROUND Endoscopic submucosal dissection is considered curative for patients with early rectal cancer when level of submucosal invasion is<1000 microns with favourable histopathological features.Recent data sugg...BACKGROUND Endoscopic submucosal dissection is considered curative for patients with early rectal cancer when level of submucosal invasion is<1000 microns with favourable histopathological features.Recent data suggests even deeper submucosal invasion can potentially be curative if R0 resection can be achieved and when no high-risk histopathological features are seen in the resected specimen.To achieve R0 resection,deeper dissection is required.CASE SUMMARY A 66 year old New Zealand European male presented with 3 mo history of per rectal bleeding.He was referred for a colonoscopy test to investigate this further.This revealed a malignant appearing lesion in the rectum.Biopsies however showed high grade dysplasia only.Given endoscopic appearances suspicious for deep submucosal invasion,patient was consented for endoscopic intermuscular dissection(EID).The case was successfully performed,and the presence of muscularis propria was confirmed in the resected specimen.There were no complications and total procedure time was 124 min.Lesion was clear of radial margins however deep margins were positive confirming it was at least a pT2 cancer.Patient was recommended to have further treatment but could not have radical surgery due to comorbidities and instead was referred for long course chemoradiotherapy.CONCLUSION EID is a safe and feasible option for management of rectal cancer in highly selected patients.展开更多
基金The Partnership program in priority areas-PN II,implemented with support from National Authority of Scientific Research(ANCS)CNDI-Uefiscdi,Romania,No.2011-3.1-0252(Nano-Ablation)
文摘Complex and lengthy endoscopic examinations like endoscopic ultrasonography and/or endoscopic retrograde cholangiopancreatography benefit from deep sedation, due to an enhanced quality of examinations, reduced discomfort and anxiety of patients, as well as increased satisfaction for both the patients and medical personnel. Current guidelines support the use of propofol sedation, which has the same rate of adverse effects as traditional sedation with benzodiazepines and/or opioids, but decreases the procedural and recovery time. Non-anesthesiologist administered propofol sedation has become an option in most of the countries, due to limited anesthesiology resources and the increasing evidence from prospective studies and metaanalyses that the procedure is safe with a similar rate of adverse events with traditional sedation. The advantages include a high quality of endoscopic examination, improved satisfaction for patients and doctors, as well as decreased recovery and discharge time. Despite the advantages of non-anesthesiologist administered propofol, there is still a continuous debate related to the successful generalization of the procedures.
文摘BACKGROUND Endoscopic submucosal dissection is considered curative for patients with early rectal cancer when level of submucosal invasion is<1000 microns with favourable histopathological features.Recent data suggests even deeper submucosal invasion can potentially be curative if R0 resection can be achieved and when no high-risk histopathological features are seen in the resected specimen.To achieve R0 resection,deeper dissection is required.CASE SUMMARY A 66 year old New Zealand European male presented with 3 mo history of per rectal bleeding.He was referred for a colonoscopy test to investigate this further.This revealed a malignant appearing lesion in the rectum.Biopsies however showed high grade dysplasia only.Given endoscopic appearances suspicious for deep submucosal invasion,patient was consented for endoscopic intermuscular dissection(EID).The case was successfully performed,and the presence of muscularis propria was confirmed in the resected specimen.There were no complications and total procedure time was 124 min.Lesion was clear of radial margins however deep margins were positive confirming it was at least a pT2 cancer.Patient was recommended to have further treatment but could not have radical surgery due to comorbidities and instead was referred for long course chemoradiotherapy.CONCLUSION EID is a safe and feasible option for management of rectal cancer in highly selected patients.
