Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item APAGE position statements on green and sustainability in gastroenterology, hepatology, and gastrointestinal endoscopy(Blackwell Scientific Publications, 2025-01) Ang, T.L.; Hang, D.V.; Li, J.W.; Ho, J.C.L.; Sy‐Janairo, M.L; Ali, R.A.R.; Makharia, G.K.; Sundaram, S.; Chantarojanasiri, T.; Kim, H.G.; Isayama, H.; Pausawasdi, N.; Wu, K.; Syam, A.F.; Aye, T.T.; Rehman, S.; Niriella, M.A.; Jurawan, R.; Wang, L.; Leung, W.K.; Liou, J.M.; Rizan, C.; Wu, J.C.Y.; Ooi , C.J.BACKGROUND AND AIM The APAGE Position Statements aimed to provide guidance to healthcare practitioners on clinical practices aligned with climate sustainability.METHODS A taskforce convened by APAGE proposed provisional statements. Twenty-two gastroenterologists from the Asian Pacific region participated in online voting and consensus was assessed through an anonymized and iterative Delphi process.RESULTS There were five sections that addressed the rationale for climate action, the importance of adopting principles of waste management, clinical practice, gastrointestinal endoscopy, and issues related to advocacy and research. Sixteen statements achieved consensus and included the following: 1. APAGE recommends adopting prompt measures to reduce the carbon footprint of clinical practice due to the importance of climate action and its health cobenefits. 5. APAGE recommends adherence to professional clinical guidelines to optimize clinical care delivery in gastroenterology and hepatology to avoid the environmental impact of unnecessary procedures and tests. 8. APAGE recommends an emphasis on health promotion, disease prevention, and appropriate screening and surveillance, when resources are available, to reduce the environmental impact of managing more advanced diseases that require more intensive resources. 12. APAGE recommends that technological advances in endoscopic imaging and artificial intelligence, when available, be used to improve the precision of endoscopic diagnosis to reduce the risk of missed lesions and need for unnecessary biopsies. 13. APAGE recommends against the routine use of single-use endoscopes.CONCLUSION The position statements provide guidance to healthcare practitioners on clinical practices in gastroenterology, hepatology, and endoscopy that promote climate sustainability.Item Evidence based guidelines for gastrointestinal endoscopy (GIE) in a tropical setting(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) de Silva, A.P.Upper gastrointestinal endoscopy (UGIE) is fast becoming a very common investigation worldwide. Current guidelines for patients undergoing upper gastrointestinal endoscopy (UGIE) advice at least 6-8 hours fasting for solids and at least 4 hours for liquids. Several anesthetic guidelines now recommend a 2-hour pre-operative fast for clear fluids. We studied if a one hour fast for water was sufficient prior to upper UGIE. We have shown that a one hour fast for water is sufficient prior to UGIE. The six hour fast for solids prior to UGIE advised in most guidelines favours a Western diet. In our second study we set out to examine if this was sufficient in the Asian context where the diet is mainly rice based. We found that a six hour fast is inadequate for a rice based meal and patients should fast at least 10 hrs prior to endoscopy. We then studied the best way to intubate the terminal ileum during colonoscopy. We showed that the 6 o’clock position with the patient prone was the best position for ileoscopy. Nest we looked at if routine ileoscopy was indicated during routine colonoscopy. We showed that routine ileoscopy was indicated during colonoscopy.