Introduction

Pancreatobiliary disease during pregnancy, though uncommon, poses significant risks. Gallstone-related disorders affect 3–12% of pregnancies and may progress to life-threatening complications such as cholangitis or biliary pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) is a highly effective therapeutic approach; however, concerns about foetal radiation exposure and procedure-related maternal complications limit its broader acceptance. There remains a need for rigorous real-world data on the safety and neonatal outcomes of ERCP during pregnancy.

Aims & Methods

This retrospective observational study aimed to evaluate the safety of ERCP in pregnant patients, focusing on two key outcomes:
(1) Maternal and foetal safety during and after the procedure, and
(2) Effectiveness of radiation-minimisation strategies, including fluoroscopy reduction and abdominal shielding.
We reviewed 25 pregnant patients undergoing ERCP at a tertiary referral centre. Indications included choledocholithiasis (84%), cholangitis (4%), biliary pancreatitis (4%), and stent management (8%). Mean maternal age was 19.2 years; mean gestational age at ERCP was 28.3 weeks. Fluoroscopy usage, post-ERCP complications, Apgar scores, and neonatal follow-up at day 30 were recorded. Fluoroscopy-minimising techniques included suction-verification of bile and stent release without imaging.

Results

No maternal or foetal adverse events occurred peri- or post-procedure. ERCP was performed successfully in all 25 patients, with 23 (92%) undergoing sphincterotomy. Fluoroscopy was utilised in 20 cases (80%), with lead shielding employed in all. In five cases (20%), ERCP was conducted without fluoroscopy by using alternative bile verification techniques. Apgar scores ranged from 7 to 10, and all neonates exhibited normal development at 30-day follow-up.

Conclusion

This study confirms that ERCP can be safely performed during pregnancy when executed by skilled endoscopists adhering to radiation-limiting protocols. Fluoroscopy-free ERCP appears feasible in selected cases, significantly reducing foetal radiation exposure without compromising efficacy. Our findings support ERCP as a viable and safe therapeutic option in pregnant patients with biliary obstruction, providing novel evidence for the growing implementation of protective strategies and alternative imaging techniques in high-risk obstetric settings.

References

• Cappell MS, Friedel D. The role of endoscopy in pregnant and lactating women. Gastrointest Endosc Clin N Am. 2020;30(1):69–95.

• Lee SH, et al. Safety of ERCP during pregnancy: systematic review. World J Gastroenterol. 2009;15(4):357–64.

• Ko CW, et al. Complications of ERCP: a prospective study. Gastrointest Endosc. 2007;66(5):1114–9

Introduction

In modern medicine, the increasing number and complexity of diagnostic and therapeutic endoscopic procedures require more controlled and optimized working conditions, thus making sedation a crucial component of these procedures. Sedation is a pharmacologically induced, reversible state of reduced consciousness, used during medical procedures to reduce discomfort, anxiety, and pain in patients. Given the ethical principle of rejecting unnecessary pain, the use of sedation is a cornerstone of humane and dignified healthcare.

Results & Findings

The most commonly used sedatives are midazolam and remimazolam. Remimazolam is a new short-acting intravenous sedative from the benzodiazepine class.
Approved in Croatia in 2021 for procedural sedation, a study was conducted on 43 participants at the Clinical Hospital Centre Sestre milosrdnice during esophagogastroduodenoscopy and colonoscopy to evaluate patient satisfaction and sedation efficacy. The average age of the participants was 57 years. According to the Brice questionnaire, remimazolam was sufficient to achieve the desired sedation level in 32 patients, while only a smaller number required additional propofol administration. Side effects were minimal and rare, such as mild bradycardia.
Patient satisfaction was high, and medical staff also reported ease of application.
A significant advantage is that, in many countries, the administration of sedatives does not require the presence of an anesthesiologist alongside the gastroenterologist, as is the case in Croatia.

Summary & Discussion

The use of sedatives carries the risk of hemodynamic and respiratory complications, requiring preparedness for managing emergencies. It is crucial to understand the responsibilities of all healthcare team members, particularly the nurse, who plays a pivotal role in ensuring patient safety during the sedation process.
The nurses' tasks include preparation of sedatives, physiological solutions, monitoring equipment (pulse oximeter, ECG, blood pressure monitor), basic oxygen therapy, and availability of antidotes (flumazenil) and emergency medications.
During the procedure, the nurse performs continuous monitoring of vital signs and must react promptly in case of complications such as hypotension, bradycardia, or respiratory depression. The successful response includes correct patient positioning, airway management, therapy administration, and preparedness for CPR.
Collaboration between nurses and doctors is key, as is calm and rapid decision-making.

Conclusion

Sedation plays an irreplaceable role in enabling safe, effective, and comfortable gastroenterological endoscopy. For successful outcomes, it is necessary to ensure appropriate education, competence, and coordination of all healthcare team members.
The nurses response in emergency situations significantly contributes to the safety and success of procedures under sedation.

References

M. Škrtić, L. Lijović, N. Kovač, I. Pažur, B. Bodulica, N. Periša, O. Ožegić, M. Vučić, T. Radoča “Remimazolam: Patient satisfaction and safety for procedural sedation”
Remimazolam: Patient satisfaction and safety for procedural sedation
American Society of Anesthesiologists “Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018”
Anesthesiology

Introduction

Intravenous iron administration carries a small but potentially life-threatening risk of allergic reactions. European Medicines Agency (EMA) guidelines underscore the importance of preventive strategies. This study evaluates the incidence and characteristics of allergic reactions to intravenous iron in routine clinical practice.

Results & Findings

The incidence of hypersensitivity reactions to intravenous iron preparations was 1,3% (2 out of 150 patients) during the one-year period. One allergic reaction was recorded with ferric derisomaltose, and one with ferric carboxymaltose, resulting in the discontinuation of therapy in both instances.

Summary & Discussion

The low incidence of hypersensitivity reactions to intravenous iron preparations was 1,3% in our one-year cohort of 150 patients indicates the relative safety of these drugs in clinical practice, alignin with the findings of a study A.Kumar, M.J.Brookes 2020. However, our observation highlights the crucial role of nursing interventions in minimizing potential risks. Careful patient monitoring, adherence to standardized administration protocols, and prompt recognition of early signs of hypersensitivity were key factors in ensuring patient safety. Further research is needed to identify specific nursing interventions and protocols that can further reduce the risk of these reactions and improve patient outcomes. Future studies should explore the effectiveness of infusion rate and patient edukation in preventing hypersensitivity reactions to intravenous iron.

Conclusion

An individualized, holistic approach minimizes the risk of hypersensitivity and allergic reactions. A care strategy grounded in empathy significantly influences the reduction of patient anxiety and fear associated with high- dose iron administration. Skilled and educated personnel are essential for safe and high- quality care, reacting promptly and decisively. Work experience and the ability to anticipate situations play a crucial roles in timely and effective management.

References

https://pmc.ncbi.nlm.nih.gov/articles/PMC9600424/
https://pmc.ncbi.nlm.nih.gov/articles/PMC7697745/
https://hrcak.srce.hr/file/454702
https://jhoponline.com/issue-archive/2023-issues/december-2023-vol-13-no-6/19590:management-of-iron-infusion-reactions

Disclosure

No

Introduction

​Anastomotic leak is a major complication following upper gastro-intestinal (UGI) surgery and is associated with high morbidity and mortality. Endoscopic vacuum therapy (EVT) is a promising method - we aimed to evaluate the treatment success in our treated population, and describe the nurse interventions that allows procedure efficiency

Results & Findings

We included 34 patients, 29 of them were male. The average age at surgery was 67,9 years; 9 patients were diagnosed with Squamous cell carcinoma; 21 with Adenocarcinoma, 1 with melanoma and 3 patients had iatrogenic benign surgery complications 8 received neoadjuvant chemotherapy, 19 received both chemo and radiotherapy. The median size of fistula opening was 11mm (average 19,9mm). A median of 6 interventions was performed per patient. EVT therapy was the first line of treatment in 23 patients while stent placement was performed previously in 12 patients. The average intervals between leak diagnosis and first treatment when EVT was the first line (was 4,77 days); 19 patients had complete closure of the defect, while 5 had partial closures (followed by stent placement in 4). We had two migrations. Due to pulmonary disease, we had to stop the treatment in one patient.

Summary & Discussion

All cases were in patients (4 needed Invasive mechanical ventilation and were in the Intensive Care Unit and 30 underwent therapy at Gastroenterology unit). Nurse staff prepared all the equipment and necessary materials; confirmed all anesthetic safety requirements (fasting, dental prosthesis, current medication, allergies); checked the bottle contents, cut the sponge according to the size of the cavity (when necessary) and wrapped it in lubricant gel. The nurse also secured the overtube while the gastroenterologist pushed the sponge into the cavity and held the forceps used to convert the draining tube from oro- to nasogastric. The sponge was then connected to the vacuum bottle. All connections were verified and sealed with waterproof tape before switching on the vacuum device, this is a very important step because it prevents the loss of vacuum pressure. It was necessary to confirm the pressure level. During the period that patients had EVT, gastroenterology nursing staff communicated with in patient nursing staff, giving all the indications, support and necessary training.

Conclusion

EVT is a safe and effective treatment for management of anastomotic leaks following esophageal surgery. Trained nursing staff improves the outcomes of this therapy, allows the efficiency of the procedure, and reduces anesthetic risks.

Disclosure

No conflit of interest

Introduction

Video capsule endoscopy is a diagnostic method for examination of the small intestine. It is completely non-invasive and painless method that ensures complete examination of the small intestine because the video capsule allows a visual examination of the entire small intestine including parts that are difficult to reach with other endoscopic methods. Capsule provide high-quality images of the inner walls of the small intestine. This allows a better detection of pathological changes such as polyps, inflammation or bleeding. In a certain population of patients there is a risk that capsule "get stuck" in the intestine. This especially applies to patients with previous operations in the small intestine, in those who are on long-term therapy with nonsteroidal antirheumatic drugs, in patients who have had radiation to the pelvic region, or in patients where there is a suspicion of stenosis of the small intestine which is possible in patients with Crohn's disease.

Results & Findings

Patient underwent a small bowel video capsule examination. After the patient did not notice that the capsule had come out of the large intestine he come to our department. We performed a radiological evaluation which determined that capsule had remained in the small intestine. It was suggested to try to remove it through a single balloon enteroscope in order to avoid surgery. He was prepared for single balloon enteroscopy under general anesthesia. The endoscope was advanced through the small intestine to the site where the capsule had remained (middle part of jejunum) and with the help of a net loop the capsule was grasped and safely removed.

Summary & Discussion

One of the common risks of the procedure is capsule retention which is defined as a capsule remaining in the gastrointestinal system for longer than two weeks. Capsule retrieval is not emergent in asymptomatic retainers. In this case, the patient had no symptoms but was concerned because the capsule did not come out as expected. Considering the passage of time since installation and the type of capsule itself it was not possible to see online where the capsule is located. We used a radiological methods to detect capsule retention. Because we gave the patient clear instructions on what to expect after the capsule was placed so the retention condition was recognized in time and the extraction procedure was performed which ultimately resulted in avoiding patient surgery.

Conclusion

In order to avoid potential complications in the form of retention of the capsule in the small intestine in patients with Crohn's disease, before the actual placement of the capsule, the patient can be given a capsule to check the patency of the small intestine. A successful patency test minimizes the risk of retention and allows the safe administration of a capsule. On the other hand single baloon enteroscopy provides us possibility of therapeutic action in the small intestine and using of this endoscopic method spare patient from other invasive solutions.

References

1. Boysen M and Ritter M, Small Bowel Obstruction from Capsule Endoscopy, West J Emerg Med. 2010 Feb;11(1):71–73.
2. Mitselos IV, Katsanos KH, Tsianos, Eliakim R, Christodoulou DK, Clinical Use of Patency Capsule: A Comprehensive Review of the Literature, Inflammatory Bowel Diseases, Volume 24, Issue 11, November 2018, Pages 2339–2347