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Reply to "Questions About Endoscopic Balloon Dilation"

Thanks for your replies, and Jan, for the link to the Shen article.

Scott, although my GI doctor said he would only perform an EBD by using propofol rather than conscious sedation because he "wants to be focused on what he is doing and not on monitoring sedation", I have elected to have him refer me to the Yale specialist to do the EBD, for 2 very good and totally unrelated reasons: (1) my GI doctor frankly admitted to me that he has done only 5 EBD procedures and that the Yale specialist is more experienced in doing them; (2) my GI doctor is out for the entire month of August and could not schedule the procedure until September, and I don't wanna wait til then, with the blockage threat looming over my head like a dark cloud that is ready to throw a lightning bolt down at any moment.

So the conscious sedation vs. propofol debate will be preserved for another day when I meet the Yale specialist, and I will tell him my feelings on the subject as well as that everything I read online suggests that the EBD procedure is typically done with conscious sedation.  I did not find my GI's "I need to focus" explanation satisfactory, but I did not argue with him about it, except to say that if the patient is effectively sedated, I would not not think there would be any issues.  I should note that my scopes, and the EBD if my GI did it, are done at a small endoscopy center which is owned by my GI doctor.  If I have the EBD done at Yale New Haven Hospital, I suspect there will be adequate staff or an anesthesiologist on hand that will monitor sedation and allow the EBD specialist to focus on the task at hand, such that no legitimate "focus" issues exist.  In any event, I will post back here after they do the EBD procedure to report on that issue and the outcome of it.

Jan, regarding perforations, perhaps I am naively over-confident in modern technology, but I had hoped that there was some advance that removes the patient from being left to his or her own devices on such a complication and "we'll see you in the ER when your fever spikes to 105 and you start vomiting and feeling the most intense nausea you have ever experienced."  One reason for that overconfidence is that before my scope on Tuesday, my GI was telling me about this fascinating new AI technology he purchased foe his endoscopy center.  The computer program is some AI which somehow, during an endoscopy, identifies and either circles or otherwise designates any areas of concern that are visualized on the digital monitors.  This is an interesting technology, to me, with many possible applications.  I can recall being in recovery rooms and overhearing doctors tell patients that they may have missed this or that, because the patient was not fully cleaned out.  It occurred to me that, perhaps, such technology could also be applied to perforations and the AI would alert the doctor to a perforation that occurred, even during the procedure.  My understanding is the AI can visualize stuff that doctors cannot see, like an extra set of super-hero eyes with microscopic visual capabilities.  This would be a whole lot more ideal than "we will see you in the ER if a perforation issue develops in the next few days and you start manifesting symptoms of sepsis."

Last edited by CTBarrister
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