Document Detail


The concept of bedside EUS.
MedLine Citation:
PMID:  18423463     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Although the role of bedside endoscopy for the provision of emergent diagnosis and therapy is well known, the concept of bedside EUS requires further validation. OBJECTIVE: To evaluate the concept of bedside EUS and assess its impact on patient management. DESIGN: A prospective study. SETTING: A tertiary-referral center. PATIENTS: Patients included those with pancreaticobiliary and thoracic disorders who required EUS but who were clinically unstable to be evaluated in the endoscopy suite. INTERVENTIONS: All procedures were performed by one endosonographer at the patient's bedside by using an EUS cart that was equipped with a therapeutic curvilinear echoendoscope. MAIN OUTCOME MEASUREMENTS: To evaluate the technical feasibility, safety, and impact of bedside EUS in the clinical management of patients. EUS was considered to have a significant impact if a new diagnosis was established and/or if the findings altered subsequent management. RESULTS: Within a 3-month period, 6 patients (4 men; median age 56 years; American Society of Anesthesiologists class III/IV) were evaluated in the intensive care unit by using the mobile EUS cart. Procedural indications were the following: drainage of symptomatic pseudocyst (n = 2), evaluate the cause of cholangitis (n = 2), diagnose and treat a suspected postoperative (distal esophagectomy) fluid collection (n = 1), and provide tissue diagnosis in one patient with a pancreatic-head mass, who presented with intrahepatic bleeding. The procedure was technically successful in all 6 patients (100%), and no complications were encountered. Bedside EUS established a diagnosis of choledocholithiasis (n = 1), mediastinal abscess (n = 1), and pancreatic abscess (n = 1) in 3 patients, and ruled out the presence of choledocholithiasis (n = 1) and pancreatic pseudocyst (n = 1) in 2 other patients. Also, by using bedside EUS, transmural drainage of a pancreatic pseudocyst and mediastinal abscess was successfully undertaken in 2 patients. Bedside EUS had an impact on management in all 6 patients (100%): established a new diagnosis (n = 3), precluded the need for an ERCP and/or other interventions (n = 2), and enabled focused endotherapy (n = 3). LIMITATIONS: Small number of patients; a single endosonographer. CONCLUSIONS: Bedside EUS is technically feasible, safe, facilitates both diagnosis and therapy, and enables the clinical management of patients who are critically ill.
Authors:
Shyam Varadarajulu; Mohamad A Eloubeidi; C Mel Wilcox
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Publication Detail:
Type:  Journal Article     Date:  2008-04-18
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  67     ISSN:  1097-6779     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-06-02     Completed Date:  2008-08-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1180-4     Citation Subset:  IM    
Affiliation:
Division of Gastroenterology-Hepatology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama 35294, USA.
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MeSH Terms
Descriptor/Qualifier:
Abdominal Abscess / therapy,  ultrasonography
Child
Choledocholithiasis / therapy,  ultrasonography
Critical Illness*
Endosonography / methods*
Evaluation Studies as Topic
Female
Humans
Male
Middle Aged
Pancreatic Pseudocyst / therapy,  ultrasonography
Pancreatitis / therapy,  ultrasonography
Point-of-Care Systems / standards*,  trends
Prospective Studies
Risk Assessment
Sensitivity and Specificity

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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