臨牀消化器内科 Vol.33 No.5(2)


特集名 緊急内視鏡の適応と実際
題名 望ましい緊急内視鏡診療体制
発刊年月 2018年 05月
著者 落合 頼業 虎の門病院消化器内科
著者 菊池 大輔 虎の門病院消化器内科
著者 飯塚 敏郎 虎の門病院消化器内科
著者 布袋屋 修 虎の門病院消化器内科
【 要旨 】 緊急内視鏡は日々の診療で施行する機会が多い.対象疾患は緊急を要し,不安定,かつ重篤な場合もある.緊急内視鏡を安全に,かつ確実に施行するためには適応疾患,緊急内視鏡の禁忌の把握,処置前の十分な問診,診察,検査,またバイタルサインの安定化,出血源予測などが重要である.さらに前処置,鎮静,使用デバイスなどの特徴を把握する必要がある.加えて,内視鏡医単独で処置を行うことは不可能であるため,各施設の緊急体制を確認しておくこと,また設備,人員の把握,内視鏡スタッフ以外にも外科医や放射線科医などを含むほかのスタッフとの連携が必要不可欠である.
Theme Indications and Standards of Practice for Emergency Endoscopy
Title An Ideal Medical System for Urgent Endoscopic Procedures
Author Yorinari Ochiai Department of Gastroenterology, Toranomon Hospital
Author Daisuke Kikuchi Department of Gastroenterology, Toranomon Hospital
Author Toshiro Iizuka Department of Gastroenterology, Toranomon Hospital
Author Shu Hoteya Department of Gastroenterology, Toranomon Hospital
[ Summary ] Endoscopists occasionally need to perform urgent endoscopic procedures in unstable and critically ill patients. Urgent and safe endoscopic treatment requires a thorough understanding of the indications and contraindications of the procedure in the management of gastroenterological disease. Additionally, it is important to obtain an accurate history and perform medical examination and investigations such as blood tests and computed tomography (CT) scans. Prior to performing an urgent endoscopy, the patient's vital signs need to be stabilized and a probable source of bleeding must be suspected/considered. Furthermore, details regarding anesthesia/sedation and endoscopic devices ought to be understood. These details form the basis/principles to perform an optimal urgent endoscopy. The most important aspect is to determine the medical system that is operational to handle emergency situations at each hospital because endoscopists cannot perform urgent endoscopic procedures in isolation without coordination with the hospital system.
Interagency cooperation is essential between endoscopists, surgeons, radiologists, technicians, and nurses to function as a team.
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