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Medicina
Special Issues
Application of Endoscopy in Gastrointestinal Disease
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Application of Endoscopy in Gastrointestinal Disease

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Gastroenterology & Hepatology".

Deadline for manuscript submissions: closed (30 April 2026) | Viewed by 1186

Special Issue Editors

Dr. Irina Girleanu

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Guest Editor
Department of Gastroenterology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
Interests: liver diseases; liver transplantation; acute on chronic liver disease; viral hepatitis; portal hypertension; liver cirrhosis
Special Issues, Collections and Topics in MDPI journals
Dr. Cristina Muzica

E-Mail Website
Guest Editor
1. Department of Gastroenterology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
2. Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency University Hospital, 700111 Iasi, Romania
Interests: liver diseases; liver transplantation; acute on chronic liver disease; viral hepatitis; portal hypertension; liver cirrhosis
Special Issues, Collections and Topics in MDPI journals
Dr. Ana Maria Trofin

E-Mail Website
Guest Editor Assistant
1. Department of Surgery, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
2. Surgery Clinic, “Sf Spiridon” Emergency County Hospital, 700111 Iasi, Romania
Interests: gastrointestinal endoscopy; colonoscopy; colorectal cancer screening; endoscopic therapy; EMR and ESD; artificial intelligence in endoscopy; upper GI endoscopy; GI bleeding; image-enhanced endoscopy; therapeutic endoscopy

Special Issue Information

Dear Colleagues,

We are pleased to invite you to contribute to this Special Issue on the application of endoscopy in gastrointestinal (GI) disease. Endoscopic procedures are fundamental tools in modern gastroenterology, providing unparalleled opportunities for early diagnosis, risk stratification, and targeted treatment. The ability to directly visualize the GI tract has transformed the management of diseases ranging from colorectal cancer to inflammatory bowel disease, polyps, bleeding lesions and submucosal tumours. The integration of high-definition imaging, advanced therapeutic techniques and artificial intelligence continues to improve diagnostic accuracy and clinical outcomes.

This Special Issue aims to highlight recent advances and clinical applications of endoscopic techniques in the diagnosis and treatment of GI diseases. It aligns with the journal’s scope by focusing on innovative diagnostic and therapeutic strategies in gastroenterology, hepatology and surgical endoscopy. The collection of papers will serve as a platform for interdisciplinary dialogue and contribute to evidence-based clinical practice.

In this Special Issue, original research articles and reviews are welcome. Research areas may include (but are not limited to) the following:

  • Diagnostic innovations in upper- and lower-GI endoscopy;
  • Endoscopic treatment of GI bleeding, strictures, and tumours;
  • Screening and surveillance strategies for colorectal cancer;
  • Advances in endoscopic mucosal resection (EMR) and submucosal dissection (ESD);
  • Artificial intelligence and image-enhanced endoscopy;
  • Training and quality assurance in endoscopy;
  • Patient outcomes and complication management.

We look forward to receiving your valuable contributions.

Dr. Irina Girleanu
Dr. Cristina Muzica
Guest Editors

Dr. Ana Maria Trofin
Guest Editor Assistant

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • gastrointestinal endoscopy
  • colonoscopy
  • colorectal cancer screening
  • endoscopic therapy
  • EMR and ESD
  • artificial intelligence in endoscopy
  • upper GI endoscopy
  • GI bleeding
  • image-enhanced endoscopy
  • therapeutic endoscopy

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  • Greater discoverability: Special Issues support the reach and impact of scientific research. Articles in Special Issues are more discoverable and cited more frequently.
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Further information on MDPI's Special Issue policies can be found here.

Published Papers (2 papers)

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Research

18 pages, 1449 KB  
Article
EEG-Derived Entropy Monitoring During Propofol Sedation for ERCP: Sedation Profiles, Age-Related Effects, and Implications for Procedure-Specific Target Ranges
by Sonia Elena Popovici, Stelian Adrian Ritiu, Ioan Sporea, Dorel Sandesc, Ovidiu Horea Bedreag, Marius Păpurică and Alina Popescu
Medicina 2026, 62(6), 1047; https://doi.org/10.3390/medicina62061047 - 28 May 2026
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Abstract
Background and Objectives: Conventional EEG-derived sedation targets for Entropy monitoring (State Entropy SE 40–60) were established in the context of general anaesthesia and may not be directly applicable to procedural sedation for endoscopic retrograde cholangiopancreatography (ERCP). This study aimed to characterize SE [...] Read more.
Background and Objectives: Conventional EEG-derived sedation targets for Entropy monitoring (State Entropy SE 40–60) were established in the context of general anaesthesia and may not be directly applicable to procedural sedation for endoscopic retrograde cholangiopancreatography (ERCP). This study aimed to characterize SE and Response Entropy (RE) trajectories during propofol-based sedation for ERCP and to evaluate their relationships with clinical sedation depth, patient characteristics, and procedural outcomes. Materials and Methods: In this prospective, single-center observational study, 50 consecutive adult patients undergoing elective ERCP under propofol-based sedation were enrolled. SE and RE were recorded at baseline and at serial intra-procedural timepoints. Time-in-zone analysis classified SE values into predefined ranges. Correlations between Entropy indices and MOAA/S scores, patient factors, Aldrete recovery scores, and adverse events were assessed using Spearman’s rank correlation. Results: The median patient age was 72.5 years (IQR 65.0–79.0), and the median ASA score was 3 (IQR 2–3). Following induction, SE declined from a baseline mean of 89.3 ± 1.5 to a mean of 68.8 ± 5.3 at 10 min, the lowest group-level value recorded; the mean individual SE nadir across patients was 67.2 ± 5.3. No SE values below 40 were observed at any timepoint. Mean time spent within the conventional SE 40–60 target range was 3.7% ± 10.6, while mean time within SE 60–85 was 80.7% ± 8.3. SE at 3 min correlated moderately with MOAA/S at 3 min (Spearman rho = 0.430, p = 0.002), with substantial within-category variability. Age showed a strong negative correlation with SE at 3 min (rho = −0.612, p < 0.001), an effect that persisted at 5 min, consistent with deeper early EEG suppression in older patients, which may reflect increased pharmacodynamic sensitivity, age-related changes in spectral substrate, or both. ASA score was associated with SE at 15 min only (rho = −0.299, p = 0.035). Patients who experienced adverse events demonstrated higher SE instability, though differences did not reach statistical significance. Recovery was rapid, with a median Aldrete score of 10 at 15 min. Conclusions: During propofol sedation for ERCP, observed SE values operated predominantly between 60 and 85, well above the conventional general anaesthesia target of 40–60. Older age was the strongest predictor of early sedation depth. These findings suggest that in elderly, high-ASA patients receiving propofol-based multi-drug sedation for ERCP, numerical SE values differ systematically from conventional general anaesthesia-derived target ranges. Whether this reflects true procedure-specific sedation requirements or cohort-specific spectral substrate differences warrants prospective outcome-anchored investigation. Full article
(This article belongs to the Special Issue Application of Endoscopy in Gastrointestinal Disease)
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12 pages, 2278 KB  
Article
Continuous Remimazolam Administration by Gastroenterologists for Endoscopic Sedation
by Tanya M. Bisseling, Angela van Zuuk, Michiel Vaneker, Hennie Hukker, Cariline Roosen, Jasmijn Olde, Marjolijn Duijvestein, Geert J. Bulte, Lucas T. van Eijk and Jörgen Bruhn
Medicina 2026, 62(4), 723; https://doi.org/10.3390/medicina62040723 - 10 Apr 2026
Viewed by 556
Abstract
Background and Objectives: Gastrointestinal (GI) endoscopy requires safe and effective sedation. Remimazolam, an ultra-short-acting benzodiazepine, may offer advantages over traditional sedatives like midazolam and propofol, including rapid onset, short half-life, and a favorable safety profile. This study evaluates the feasibility, safety, and patient [...] Read more.
Background and Objectives: Gastrointestinal (GI) endoscopy requires safe and effective sedation. Remimazolam, an ultra-short-acting benzodiazepine, may offer advantages over traditional sedatives like midazolam and propofol, including rapid onset, short half-life, and a favorable safety profile. This study evaluates the feasibility, safety, and patient satisfaction of continuous remimazolam infusion administered by trained gastroenterologists for GI endoscopy. Materials and Methods: This prospective registry included patients with ASA physical status I and II undergoing standard endoscopic procedures. Continuous remimazolam sedation was administered, with boluses given as needed. Vital signs were monitored, and patient satisfaction was assessed before and after the procedure using standardized questionnaires. Results: A total of 159 procedures were performed in 141 patients. Sedation was successful in all patients, with a mean induction dose of 7.1 mg and total infusion of 15.1 mg. Recovery time averaged 3.3 min. Adverse events, including transient hypotension and hypoxia, occurred in 11.3% of patients but were easily managed. Most patients (97%) reported sufficient comfort, with an average satisfaction score of 8.1/10. Conclusions: Continuous remimazolam infusion administered by trained gastroenterologists is a safe and effective alternative to traditional propofol sedation for GI endoscopy. It offers stable sedation, rapid recovery and high patient satisfaction, potentially reducing anesthesiology workload and improving procedural efficiency. Further studies are needed to confirm these findings in broader patient populations. Full article
(This article belongs to the Special Issue Application of Endoscopy in Gastrointestinal Disease)
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