Maridi Aerts - Academia.edu (original) (raw)
Papers by Maridi Aerts
Journal of Hepatology, Jul 1, 2022
Acta Chirurgica Belgica, 2014
Abstract Background: Gastrointestinal stromal tumour (GIST) is a rare tumour that can arise anywh... more Abstract Background: Gastrointestinal stromal tumour (GIST) is a rare tumour that can arise anywhere within the gastrointestinal tract. Objectives: Our objective was to present our experience managing this rare tumour of the gastrointestinal tract. We reviewed the clinico-pathological and morphological features, our experience with surgical treatment, and the outcome GIST in our centre. Patients and methods: The current retrospective analysis included 64 patients with GIST observed between February 1995 and September 2012. Results: There were 39 males and 25 females. The mean age was 63.2 (range 36–83). The GISTs were located in the stomach in the majority of patients (60 patients, 94.0%). The tumour was asymptomatic in 14 (21.9%) patients. The tumour size varied from 0.4 to 25 cm with a mean size of 7.9 cm. Five patients showed peritoneal or liver metastasis at diagnosis. All patients had surgery. Five patients had a R2 resection and in one patient the resection-free margin was uncertain. In our cohort we had 5 patients with metastasis at diagnosis who received adjuvant imatinib. Four patients developed metastasis in the follow-up period. Three patients died due to GIST, three other patients died due to other disease. Conclusions: Gastric GIST were more common than GIST at other locations. Surgical treatment was the main therapeutic option. Tyosine kinase receptor inhibitors was used as a first line treatment in patients with metastatic GISTs or in patients with recurrence of the disease.
Gastrointestinal Endoscopy, Jun 1, 2021
Annals of Oncology, Jun 1, 2012
Introduction: After coronary heart disease and accidents, cancer is the third main cause of death... more Introduction: After coronary heart disease and accidents, cancer is the third main cause of death and gastrointestinal cancers are comprised nearly half of deaths arising from cancer in Iran. Therefore this study was designed to explain frequency of gastrointestinal cancers among patients who referred to Shahid Rajai radiotherapy Center during 10 years. Methods: Study was a retrospective research. Data were obtained by the review of patients' documents with gastrointestinal cancers during 2000-2009. Data included demographic variables and type of cancers. This center is located in Mazandaran province in the north of Iran which is the only radiotherapy center in this area. Data were analyzed by SPSS 19. Results: Among 2086 patients (25.1% of all patients), 60.8% were male. Nearly half of them (47.9%) were elderly persons (above 65 years old) followed by, 39.3% middle aged (45-64) and 12.6% young (15-44). Mean age of men (62.1±14) was significantly higher than women (60.44 ±14) (P=0.003). Most common cancers among males were esophagus (20.4%), stomach (20.1%) and colorectal (16.6%) and females were esophagus (16.3%), colorectal (12.3%) and stomach (8.4%). Patients with esophagus cancer were older than others (67.2±14) (P=0.001). Frequency trend of stomach cancer during 10 years went up from 13 to 84 (in 2000 to 2009) (P=0.001). Conclusion: Gastrointestinal cancers were the most common cancer among elderly persons. This study also found the same results. Esophagus was in the first place. Findings indicated that growth trend of stomach cancer was more than others which can be caused by geographic factors, genetics or changing the dietary habits.
Endoscopy, Dec 14, 2021
Background Endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs) by ... more Background Endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs) by cautery-enhanced lumen-apposing metal stents (LAMS) has largely been limited to collections located < 10 mm from the luminal wall. We present outcomes of the use of a novel 15-mm-long cautery-enhanced LAMS for drainage of PFCs located ≥ 10 mm away. Methods This international, multicenter study analyzed all adults with PFCs located ≥ 10 mm from the luminal wall who were treated by EUS-guided drainage using the 15-mm-long cautery-enhanced LAMS. The primary outcome was technical success. Secondary outcomes included clinical success (decrease in PFC size by ≥ 50 % at 30 days and resolution of clinical symptoms without surgical intervention), complications, and recurrence. Results 35 patients (median age 57 years; interquartile range [IQR] 47–64 years; 49 % male) underwent novel LAMS placement for drainage of PFCs (26 walled-off necrosis, 9 pseudocysts), measuring 85 mm (IQR 64–117) maximal diameter and located 11.8 mm (IQR 10–12.3; range 10–14) from the gastric/duodenal wall. Technical and clinical success were high (both 97 %), with recurrence in one patient (3 %) at a median follow-up of 123 days (58–236). Three complications occurred (9 %; one mild, two moderate). Conclusions The 15-mm-long cautery-enhanced LAMS was feasible and safe for drainage of PFCs located 10–14 mm from the luminal wall.
Case Reports in Gastroenterology, Dec 3, 2020
Pseudoachalasia, also known as secondary achalasia, is a rare clinical condition mimicking idiopa... more Pseudoachalasia, also known as secondary achalasia, is a rare clinical condition mimicking idiopathic achalasia but unrelated to primary loss of nitrergic innervation. It has mostly been attributed to malignancy infiltrating the oesophageal wall, but several other benign underlying pathologies have been reported. Because of similar manometric appearance, high-resolution manometry (HRM) of the oesophagus alone cannot distinguish between idiopathic achalasia and pseudoachalasia. Misdiagnosis can result in ineffective treatment by dilatation or even more invasive therapy. This is the first case-report of pseudoachalasia secondary to oesophageal deviation resulting from mediastinal shift and left atrial enlargement following prior left
Ejso, Apr 1, 2007
Aims: For patients with unresectable liver metastases from colorectal cancer (CRC), hepatic arter... more Aims: For patients with unresectable liver metastases from colorectal cancer (CRC), hepatic artery infusion chemotherapy (HAIC) can produce higher response rates as compared to systemic chemotherapy. However, the added morbidity and early dysfunction after catheter placement have negatively influenced the outcomes of randomized studies. Methods: Between July 1998 and March 2006, 29 patients with unresectable liver metastases from CRC were included in three different HAIC protocols. A catheter was laparoscopically placed in the gastroduodenal artery, retrograde to the common hepatic artery and was attached to a subcutaneous access port. Perioperative parameters and catheter-associated adverse events during chemotherapy were studied. Results: Mean operating time was 106 AE 29 min and median duration of hospitalization was 2 days (range: 1e13). No major perioperative complications occurred but there was 1 death (3.6%) 1 week after surgery due to hemorrhagic shock after necrosis and rupture of the hepatic artery. During a median follow-up of 10 months (range: 0e35) we observed 5 (17%) catheter-associated adverse events, but in only 2 patients (7%) this resulted in a loss of catheter function before the end of chemotherapy. Overall median duration of HAIC was 8 months (range: 1e28). Conclusion: Laparoscopic placement of a hepatic artery catheter is associated with a low operative morbidity. The observed functionality of the hepatic artery ports in our series is encouraging for the use in future studies of HAIC.
Digestive Endoscopy
ObjectivesThe aim of the current study was to compare the efficacy of partially covered duodenal ... more ObjectivesThe aim of the current study was to compare the efficacy of partially covered duodenal stent (PCDS) vs. uncovered duodenal stent (UCDS) in patients suffering from unresectable primary malignant gastric outlet obstruction (GOO).MethodsThis was a prospective international randomized controlled study conducted in 10 high‐volume institutions. Consecutive patients suffering from malignant GOO were recruited. The primary outcome measurement was the reintervention rate. Secondary outcomes included technical and clinical success, 30‐day adverse events, 30‐day mortality, causes of stent dysfunction, and the duration of stent patency.ResultsBetween March 2017 and October 2020, 115 patients (59 PCDS, 56 UCDS) were recruited. The 1‐year reintervention was not significantly different (PCDS vs. UDCS = 12/59, 20.3% vs. 14/56, 25%, P = 0.84). There was a trend to fewer patients with tumor ingrowth in the PCDS group (6/59 [10.2%]) vs. 13/56 [23.2%], P = 0.07). There were no significant dif...
World Journal of Hepatology
BACKGROUND Emphysematous hepatitis (EH) is a rare, rapidly progressive fulminant gas-forming infe... more BACKGROUND Emphysematous hepatitis (EH) is a rare, rapidly progressive fulminant gas-forming infection of the liver parenchyma. It is often fatal and mostly affects diabetes patients. CASE SUMMARY We report a case of EH successfully managed by a step-up approach consisting of aggressive hemodynamic support, intravenous antibiotics, and percutaneous drainage, ultimately followed by laparoscopic deroofing. Of 11 documented cases worldwide, only 1 of the patients survived, treated by urgent laparotomy and surgical debridement. CONCLUSION EH is a life-threatening infection. Its high mortality rate makes timely diagnosis essential, in order to navigate treatment accordingly.
44 Congreso de la Sociedad Española de Endoscopia Digestiva Abstracts Publication, Sep 5, 2022
Gastrointestinal Endoscopy
International journal of immunology and immunobiology, 2018
Endoscopy, 2021
Background Endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs) by ... more Background Endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs) by cautery-enhanced lumen-apposing metal stents (LAMS) has largely been limited to collections located < 10 mm from the luminal wall. We present outcomes of the use of a novel 15-mm-long cautery-enhanced LAMS for drainage of PFCs located ≥ 10 mm away. Methods This international, multicenter study analyzed all adults with PFCs located ≥ 10 mm from the luminal wall who were treated by EUS-guided drainage using the 15-mm-long cautery-enhanced LAMS. The primary outcome was technical success. Secondary outcomes included clinical success (decrease in PFC size by ≥ 50 % at 30 days and resolution of clinical symptoms without surgical intervention), complications, and recurrence. Results 35 patients (median age 57 years; interquartile range [IQR] 47–64 years; 49 % male) underwent novel LAMS placement for drainage of PFCs (26 walled-off necrosis, 9 pseudocysts), measuring 85 mm (IQR 64–117) maxima...
Belgian Week of Gastroenterology, Feb 1, 2020
Gastrointestinal Endoscopy, 2020
Introduction: Large walled-off necrosis (WON) are challenging to manage endoscopically even with ... more Introduction: Large walled-off necrosis (WON) are challenging to manage endoscopically even with the use of large caliber lumen-apposing metal stents (LAMS). Therefore, some experts suggest percutaneous drainage (PCD) to facilitate endoscopic management with LAMS. The aim of this study is to determine the impact of PCD on WON resolution in patients undergoing LAMS drainage. Methods: A retrospective cohort study was performed for patients who underwent Endoscopic Ultrasound (EUS)-guided LAMS drainage of WON from 4/2014 to 10/2019. Demographic and procedural information and patient clinical outcomes were recorded. Cross-sectional imaging was reviewed by two abdominal radiologists blinded to patient outcome to independently determine size and percentage of solid necrosis within the WON. Wilcoxon rank sum test and Fisher's exact tests were used to compare continuous and categorical variables, respectively. A 2-sided p-value <0.05 was regarded as statistically significant. Results: A total of 62 patients underwent LAMS drainage for WON >10cm during the study period, of whom 54 (87%) did not undergo PCD. Baseline characteristics were similar between both groups including size, rate of paracolic gutter extension, percentage of solid necrosis, and presence of disconnected pancreatic duct (Table 1). Both groups were noted to contain a median of 60% solid necrosis (pZ0.66). Although no statistical procedural differences were noted between the groups (Table 2), use of a multigateway technique was more common in those without PCD (30% vs 0%; pZ0.21). Patients with PCD had no observed improvement in time to WON resolution (103 vs 78 days; pZ0.63) and did not reduce the number of endoscopic necrosectomy procedures (3.5 vs 1.0; pZ0.12) compared to those without PCD. Conclusions: In this cohort study, the majority of patients with large WON were successfully managed endoscopically with LAMS drainage and necrosectomy without the need for additional percutaneous drainage. Further studies are needed to clarify the role of percutaneous drainage in the setting of LAMS placement for WON.
Gastrointestinal Endoscopy, 2020
3. Mean EI intubation time was over 4-fold lower than SI intubation time. 4. EI significantly enh... more 3. Mean EI intubation time was over 4-fold lower than SI intubation time. 4. EI significantly enhanced endoscopy unit efficiency, while minimizing patient/staff injury. This approach would save 3.6 hours/day assuming 10 daily ERCPs scheduled with general anesthesia. 5. This approach allows endoscopists to partner with anesthesiologists, enhancing endoscopy unit safety and efficiency.
Journal of Hepatology, Jul 1, 2022
Acta Chirurgica Belgica, 2014
Abstract Background: Gastrointestinal stromal tumour (GIST) is a rare tumour that can arise anywh... more Abstract Background: Gastrointestinal stromal tumour (GIST) is a rare tumour that can arise anywhere within the gastrointestinal tract. Objectives: Our objective was to present our experience managing this rare tumour of the gastrointestinal tract. We reviewed the clinico-pathological and morphological features, our experience with surgical treatment, and the outcome GIST in our centre. Patients and methods: The current retrospective analysis included 64 patients with GIST observed between February 1995 and September 2012. Results: There were 39 males and 25 females. The mean age was 63.2 (range 36–83). The GISTs were located in the stomach in the majority of patients (60 patients, 94.0%). The tumour was asymptomatic in 14 (21.9%) patients. The tumour size varied from 0.4 to 25 cm with a mean size of 7.9 cm. Five patients showed peritoneal or liver metastasis at diagnosis. All patients had surgery. Five patients had a R2 resection and in one patient the resection-free margin was uncertain. In our cohort we had 5 patients with metastasis at diagnosis who received adjuvant imatinib. Four patients developed metastasis in the follow-up period. Three patients died due to GIST, three other patients died due to other disease. Conclusions: Gastric GIST were more common than GIST at other locations. Surgical treatment was the main therapeutic option. Tyosine kinase receptor inhibitors was used as a first line treatment in patients with metastatic GISTs or in patients with recurrence of the disease.
Gastrointestinal Endoscopy, Jun 1, 2021
Annals of Oncology, Jun 1, 2012
Introduction: After coronary heart disease and accidents, cancer is the third main cause of death... more Introduction: After coronary heart disease and accidents, cancer is the third main cause of death and gastrointestinal cancers are comprised nearly half of deaths arising from cancer in Iran. Therefore this study was designed to explain frequency of gastrointestinal cancers among patients who referred to Shahid Rajai radiotherapy Center during 10 years. Methods: Study was a retrospective research. Data were obtained by the review of patients' documents with gastrointestinal cancers during 2000-2009. Data included demographic variables and type of cancers. This center is located in Mazandaran province in the north of Iran which is the only radiotherapy center in this area. Data were analyzed by SPSS 19. Results: Among 2086 patients (25.1% of all patients), 60.8% were male. Nearly half of them (47.9%) were elderly persons (above 65 years old) followed by, 39.3% middle aged (45-64) and 12.6% young (15-44). Mean age of men (62.1±14) was significantly higher than women (60.44 ±14) (P=0.003). Most common cancers among males were esophagus (20.4%), stomach (20.1%) and colorectal (16.6%) and females were esophagus (16.3%), colorectal (12.3%) and stomach (8.4%). Patients with esophagus cancer were older than others (67.2±14) (P=0.001). Frequency trend of stomach cancer during 10 years went up from 13 to 84 (in 2000 to 2009) (P=0.001). Conclusion: Gastrointestinal cancers were the most common cancer among elderly persons. This study also found the same results. Esophagus was in the first place. Findings indicated that growth trend of stomach cancer was more than others which can be caused by geographic factors, genetics or changing the dietary habits.
Endoscopy, Dec 14, 2021
Background Endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs) by ... more Background Endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs) by cautery-enhanced lumen-apposing metal stents (LAMS) has largely been limited to collections located < 10 mm from the luminal wall. We present outcomes of the use of a novel 15-mm-long cautery-enhanced LAMS for drainage of PFCs located ≥ 10 mm away. Methods This international, multicenter study analyzed all adults with PFCs located ≥ 10 mm from the luminal wall who were treated by EUS-guided drainage using the 15-mm-long cautery-enhanced LAMS. The primary outcome was technical success. Secondary outcomes included clinical success (decrease in PFC size by ≥ 50 % at 30 days and resolution of clinical symptoms without surgical intervention), complications, and recurrence. Results 35 patients (median age 57 years; interquartile range [IQR] 47–64 years; 49 % male) underwent novel LAMS placement for drainage of PFCs (26 walled-off necrosis, 9 pseudocysts), measuring 85 mm (IQR 64–117) maximal diameter and located 11.8 mm (IQR 10–12.3; range 10–14) from the gastric/duodenal wall. Technical and clinical success were high (both 97 %), with recurrence in one patient (3 %) at a median follow-up of 123 days (58–236). Three complications occurred (9 %; one mild, two moderate). Conclusions The 15-mm-long cautery-enhanced LAMS was feasible and safe for drainage of PFCs located 10–14 mm from the luminal wall.
Case Reports in Gastroenterology, Dec 3, 2020
Pseudoachalasia, also known as secondary achalasia, is a rare clinical condition mimicking idiopa... more Pseudoachalasia, also known as secondary achalasia, is a rare clinical condition mimicking idiopathic achalasia but unrelated to primary loss of nitrergic innervation. It has mostly been attributed to malignancy infiltrating the oesophageal wall, but several other benign underlying pathologies have been reported. Because of similar manometric appearance, high-resolution manometry (HRM) of the oesophagus alone cannot distinguish between idiopathic achalasia and pseudoachalasia. Misdiagnosis can result in ineffective treatment by dilatation or even more invasive therapy. This is the first case-report of pseudoachalasia secondary to oesophageal deviation resulting from mediastinal shift and left atrial enlargement following prior left
Ejso, Apr 1, 2007
Aims: For patients with unresectable liver metastases from colorectal cancer (CRC), hepatic arter... more Aims: For patients with unresectable liver metastases from colorectal cancer (CRC), hepatic artery infusion chemotherapy (HAIC) can produce higher response rates as compared to systemic chemotherapy. However, the added morbidity and early dysfunction after catheter placement have negatively influenced the outcomes of randomized studies. Methods: Between July 1998 and March 2006, 29 patients with unresectable liver metastases from CRC were included in three different HAIC protocols. A catheter was laparoscopically placed in the gastroduodenal artery, retrograde to the common hepatic artery and was attached to a subcutaneous access port. Perioperative parameters and catheter-associated adverse events during chemotherapy were studied. Results: Mean operating time was 106 AE 29 min and median duration of hospitalization was 2 days (range: 1e13). No major perioperative complications occurred but there was 1 death (3.6%) 1 week after surgery due to hemorrhagic shock after necrosis and rupture of the hepatic artery. During a median follow-up of 10 months (range: 0e35) we observed 5 (17%) catheter-associated adverse events, but in only 2 patients (7%) this resulted in a loss of catheter function before the end of chemotherapy. Overall median duration of HAIC was 8 months (range: 1e28). Conclusion: Laparoscopic placement of a hepatic artery catheter is associated with a low operative morbidity. The observed functionality of the hepatic artery ports in our series is encouraging for the use in future studies of HAIC.
Digestive Endoscopy
ObjectivesThe aim of the current study was to compare the efficacy of partially covered duodenal ... more ObjectivesThe aim of the current study was to compare the efficacy of partially covered duodenal stent (PCDS) vs. uncovered duodenal stent (UCDS) in patients suffering from unresectable primary malignant gastric outlet obstruction (GOO).MethodsThis was a prospective international randomized controlled study conducted in 10 high‐volume institutions. Consecutive patients suffering from malignant GOO were recruited. The primary outcome measurement was the reintervention rate. Secondary outcomes included technical and clinical success, 30‐day adverse events, 30‐day mortality, causes of stent dysfunction, and the duration of stent patency.ResultsBetween March 2017 and October 2020, 115 patients (59 PCDS, 56 UCDS) were recruited. The 1‐year reintervention was not significantly different (PCDS vs. UDCS = 12/59, 20.3% vs. 14/56, 25%, P = 0.84). There was a trend to fewer patients with tumor ingrowth in the PCDS group (6/59 [10.2%]) vs. 13/56 [23.2%], P = 0.07). There were no significant dif...
World Journal of Hepatology
BACKGROUND Emphysematous hepatitis (EH) is a rare, rapidly progressive fulminant gas-forming infe... more BACKGROUND Emphysematous hepatitis (EH) is a rare, rapidly progressive fulminant gas-forming infection of the liver parenchyma. It is often fatal and mostly affects diabetes patients. CASE SUMMARY We report a case of EH successfully managed by a step-up approach consisting of aggressive hemodynamic support, intravenous antibiotics, and percutaneous drainage, ultimately followed by laparoscopic deroofing. Of 11 documented cases worldwide, only 1 of the patients survived, treated by urgent laparotomy and surgical debridement. CONCLUSION EH is a life-threatening infection. Its high mortality rate makes timely diagnosis essential, in order to navigate treatment accordingly.
44 Congreso de la Sociedad Española de Endoscopia Digestiva Abstracts Publication, Sep 5, 2022
Gastrointestinal Endoscopy
International journal of immunology and immunobiology, 2018
Endoscopy, 2021
Background Endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs) by ... more Background Endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs) by cautery-enhanced lumen-apposing metal stents (LAMS) has largely been limited to collections located < 10 mm from the luminal wall. We present outcomes of the use of a novel 15-mm-long cautery-enhanced LAMS for drainage of PFCs located ≥ 10 mm away. Methods This international, multicenter study analyzed all adults with PFCs located ≥ 10 mm from the luminal wall who were treated by EUS-guided drainage using the 15-mm-long cautery-enhanced LAMS. The primary outcome was technical success. Secondary outcomes included clinical success (decrease in PFC size by ≥ 50 % at 30 days and resolution of clinical symptoms without surgical intervention), complications, and recurrence. Results 35 patients (median age 57 years; interquartile range [IQR] 47–64 years; 49 % male) underwent novel LAMS placement for drainage of PFCs (26 walled-off necrosis, 9 pseudocysts), measuring 85 mm (IQR 64–117) maxima...
Belgian Week of Gastroenterology, Feb 1, 2020
Gastrointestinal Endoscopy, 2020
Introduction: Large walled-off necrosis (WON) are challenging to manage endoscopically even with ... more Introduction: Large walled-off necrosis (WON) are challenging to manage endoscopically even with the use of large caliber lumen-apposing metal stents (LAMS). Therefore, some experts suggest percutaneous drainage (PCD) to facilitate endoscopic management with LAMS. The aim of this study is to determine the impact of PCD on WON resolution in patients undergoing LAMS drainage. Methods: A retrospective cohort study was performed for patients who underwent Endoscopic Ultrasound (EUS)-guided LAMS drainage of WON from 4/2014 to 10/2019. Demographic and procedural information and patient clinical outcomes were recorded. Cross-sectional imaging was reviewed by two abdominal radiologists blinded to patient outcome to independently determine size and percentage of solid necrosis within the WON. Wilcoxon rank sum test and Fisher's exact tests were used to compare continuous and categorical variables, respectively. A 2-sided p-value <0.05 was regarded as statistically significant. Results: A total of 62 patients underwent LAMS drainage for WON >10cm during the study period, of whom 54 (87%) did not undergo PCD. Baseline characteristics were similar between both groups including size, rate of paracolic gutter extension, percentage of solid necrosis, and presence of disconnected pancreatic duct (Table 1). Both groups were noted to contain a median of 60% solid necrosis (pZ0.66). Although no statistical procedural differences were noted between the groups (Table 2), use of a multigateway technique was more common in those without PCD (30% vs 0%; pZ0.21). Patients with PCD had no observed improvement in time to WON resolution (103 vs 78 days; pZ0.63) and did not reduce the number of endoscopic necrosectomy procedures (3.5 vs 1.0; pZ0.12) compared to those without PCD. Conclusions: In this cohort study, the majority of patients with large WON were successfully managed endoscopically with LAMS drainage and necrosectomy without the need for additional percutaneous drainage. Further studies are needed to clarify the role of percutaneous drainage in the setting of LAMS placement for WON.
Gastrointestinal Endoscopy, 2020
3. Mean EI intubation time was over 4-fold lower than SI intubation time. 4. EI significantly enh... more 3. Mean EI intubation time was over 4-fold lower than SI intubation time. 4. EI significantly enhanced endoscopy unit efficiency, while minimizing patient/staff injury. This approach would save 3.6 hours/day assuming 10 daily ERCPs scheduled with general anesthesia. 5. This approach allows endoscopists to partner with anesthesiologists, enhancing endoscopy unit safety and efficiency.