Making gastrointestinal endoscopy safer
- Publication Type:
- Thesis
- Issue Date:
- 2012
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Endoscopic procedures have become the ‘gold standard’ of diagnosis and therapy in the
alimentary tract and are frequently delivered in high volume centres. Given that the
generic term endoscopy is broad, in this thesis, panendoscopy will refer to “upper
gastrointestinal” procedure and colonoscopy will refer to “lower gastrointestinal”
procedure.
In such procedures, complications can be attributed to the bowel preparation, the
procedure itself and/or the effects of the sedative/anaesthesia. This thesis reports on an
anonymous postal survey of Australian practice of endoscopic procedures and identifies
system issues in the delivery of sedation. In particular, there is an unacceptable
morbidity and mortality rate seen in some public endoscopy units. Therefore, there is
scope to improve levels of safety in gastrointestinal endoscopy.
The first half of this thesis focuses on sedation-associated cardio respiratory
embarrassment, a common cause of morbidity and mortality. This thesis examines the
changes in cardio- respiratory parameters associated with sedation. Expanding on this
knowledge the thesis describes the development of a novel oxygenating bite-block with
capacity to sample carbon dioxide. The device, when tested against conventional
delivery systems in a comparative clinical study shows, superiority in monitoring of
ventilation.
The second half of this thesis focuses on the complications associated with bowel
preparations relating to their palatability, their purgative effect and dehydration.
Effective purgation is essential to reduce the missed pathology rate. The development of
a novel bowel preparation to improve safety was trialled in a comparative clinical study
against three other methods. Lessons learnt from this study led to the process of further
enhancement to the development to formulate a capsule bowel preparation.
Improvements in oxygen delivery, ventilation monitoring and bowel preparation
described in this thesis will significantly increase the safety of gastrointestinal
endoscopy
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