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Vader JP, Larequi-Lauber T, Froehlich F, Burnand B, Dubois RW, Gonvers JJ. 4. Appropriateness of gastroscopy: atypical chest pain. Endoscopy 1999; 31:611-4. [PMID: 10571132 DOI: 10.1055/s-1999-64] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Gonvers JJ, Bochud M, Burnand B, Froehlich F, Dubois RW, Vader JP. 10. Appropriateness of colonoscopy: diarrhea. Endoscopy 1999; 31:641-6. [PMID: 10571138 DOI: 10.1055/s-1999-70] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Bochud M, Burnand B, Froehlich F, Dubois RW, Vader JP, Gonvers JJ. 12. Appropriateness of colonoscopy: surveillance after polypectomy. Endoscopy 1999; 31:654-63. [PMID: 10571140 DOI: 10.1055/s-1999-127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Bochud M, Gonvers JJ, Vader JP, Dubois RW, Burnand B, Froehlich F. 2. Appropriateness of gastroscopy: gastro-esophageal reflux disease. Endoscopy 1999; 31:596-603. [PMID: 10571130 DOI: 10.1055/s-1999-63] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Bochud M, Gonvers JJ, Vader JP, Dubois RW, Burnand B, Froehlich F. 3. Appropriateness of gastroscopy: Barrett's esophagus. Endoscopy 1999; 31:604-10. [PMID: 10571131 DOI: 10.1055/s-1999-13268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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De Bosset V, Gonvers JJ, Vader JP, Dubois RW, Burnand B, Froehlich F. 9. Appropriateness of colonoscopy: lower abdominal pain or constipation. Endoscopy 1999; 31:637-40. [PMID: 10571137 DOI: 10.1055/s-1999-69] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Froehlich F, Larequi-Lauber T, Gonvers JJ, Dubois RW, Burnand B, Vader JP. 11. Appropriateness of colonoscopy: inflammatory bowel disease. Endoscopy 1999; 31:647-53. [PMID: 10571139 DOI: 10.1055/s-1999-126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Bochud M, Burnand B, Froehlich F, Dubois RW, Vader JP, Gonvers JJ. 13. Appropriateness of colonoscopy: surveillance after curative resection of colorectal cancer. Endoscopy 1999; 31:664-72. [PMID: 10571141 DOI: 10.1055/s-1999-128] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Vader JP, Burnand B, Froehlich F, Dubois RW, Bochud M, Gonvers JJ. The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE): project and methods. Endoscopy 1999; 31:572-8. [PMID: 10571128 DOI: 10.1055/s-1999-71] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Froehlich F, Bochud M, Gonvers JJ, Dubois RW, Vader JP, Wietlisbach V, Burnand B. 1. Appropriateness of gastroscopy: dyspepsia. Endoscopy 1999; 31:579-95. [PMID: 10571129 DOI: 10.1055/s-1999-62] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Froehlich F, Gonvers JJ, Vader JP, Dubois RW, Burnand B. Appropriateness of gastrointestinal endoscopy: risk of complications. Endoscopy 1999; 31:684-6. [PMID: 10571143 DOI: 10.1055/s-1999-130] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The balance between risks and benefits of gastrointestinal endoscopy for a given patient is essential in defining the appropriate use of endoscopic procedures. The current literature suggests that gastrointestinal endoscopy infrequently results in major procedure-related morbidity and mortality, while cardio-respiratory events occur commonly. However, true complication rates may be underestimated due to inconsistencies in the types of complications reported. No formal reporting requirements exist, and most of the published studies on complications come from centres with highly-skilled endoscopists.
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Jornod P, Wiesel PH, Pescatore P, Gonvers JJ. Hemobilia, a rare cause of acute pancreatitis after percutaneous liver biopsy: diagnosis and treatment by endoscopic retrograde cholangiopancreatography. Am J Gastroenterol 1999; 94:3051-4. [PMID: 10520869 DOI: 10.1111/j.1572-0241.1999.01460.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We here report the case history of a 75-yr-old woman who developed pancreatitis and recurrent symptomatic, cholestasis-induced hemobilia after percutaneous liver biopsy. An endoscopic sphincterotomy with clot extraction led to relief of symptoms. The risk of hemobilia after percutaneous liver biopsy is less than one per 1000 procedures, and only two cases of acute pancreatitis after percutaneous liver biopsy have previously been reported. To our knowledge, this is the first case in which endoscopic retrograde cholangiopancreatography was used to both diagnostic and therapeutic ends.
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Gonvers JJ, De Bosset V, Froehlich F, Dubois RW, Burnand B, Vader JP. 8. Appropriateness of colonoscopy: hematochezia. Endoscopy 1999; 31:631-6. [PMID: 10571136 DOI: 10.1055/s-1999-68] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Burnand B, Bochud M, Froehlich F, Dubois RW, Vader JP, Gonvers JJ. 14. Appropriateness of colonoscopy: screening for colorectal cancer in asymptomatic individuals. Endoscopy 1999; 31:673-83. [PMID: 10571142 DOI: 10.1055/s-1999-129] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Vader JP, Froehlich F, Dubois RW, Beglinger C, Wietlisbach V, Pittet V, Ebel N, Gonvers JJ, Burnand B. European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE): conclusion and WWW site. Endoscopy 1999; 31:687-94. [PMID: 10571144 DOI: 10.1055/s-1999-72] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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de Bosset V, Gonvers JJ, Froehlich F, Dubois RW, Burnand B, Vader JP. 5. Appropriateness of gastroscopy: bleeding and dysphagia. Endoscopy 1999; 31:615-22. [PMID: 10571133 DOI: 10.1055/s-1999-65] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Gonvers JJ, De Bosset V, Vader JP, Dubois RW, Burnand B, Froehlich F. 6. Appropriateness of gastroscopy: risk factors for gastric cancer. Endoscopy 1999; 31:623-6. [PMID: 10571134 DOI: 10.1055/s-1999-66] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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De Bosset V, Gonvers JJ, Burnand B, Dubois RW, Vader JP, Froehlich F. 7. Appropriateness of colonoscopy: iron-deficiency anemia. Endoscopy 1999; 31:627-30. [PMID: 10571135 DOI: 10.1055/s-1999-67] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Henry H, Froehlich F, Perret R, Tissot JD, Eilers-Messerli B, Lavanchy D, Dionisi-Vici C, Gonvers JJ, Bachmann C. Microheterogeneity of serum glycoproteins in patients with chronic alcohol abuse compared with carbohydrate-deficient glycoprotein syndrome type I. Clin Chem 1999; 45:1408-13. [PMID: 10471642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND Chronic alcohol abuse alters the normal N-glycosylation of transferrin, producing the carbohydrate-deficient transferrin isoforms. This alteration could be similar to that present in patients with carbohydrate-deficient glycoprotein syndrome type 1 (CDG1). We thus compared the alterations of N-glycans present in patients with alcoholism and patients with CDG1. METHODS The N-glycans of serum glycoproteins were compared in sera of patients with alcoholism, patients with CDG1, and controls by two-dimensional electrophoresis, neuraminidase, peptide:N-glycosidase F, and endoglycosidase F2 treatments. A specific antibody directed against the amino acid sequence surrounding the N-432 N-glycosylation site of transferrin was prepared (SZ-350 antibody). RESULTS In patients with alcoholism, the abnormal transferrin and alpha(1)-antitrypsin isoforms were devoid of a variable number of entire N-glycan moieties and were identical with those present in CDG1. In the serum of patients with alcoholism, this finding was less pronounced than in CDG1. In contrast to CDG1, there was no decrease in clusterin or serum amyloid P in patients with alcoholism. The SZ-350 antibody recognized only transferrin isoforms with one or no N-glycan moieties. CONCLUSION Antibodies directed against specific N-glycosylation sites of glycoproteins could be useful for developing more specific immunochemical tests for the diagnosis of chronic alcohol abuse.
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Seematter-Bagnoud L, Vader JP, Wietlisbach V, Froehlich F, Gonvers JJ, Burnand B. Overuse and underuse of diagnostic upper gastrointestinal endoscopy in various clinical settings. Int J Qual Health Care 1999; 11:301-8. [PMID: 10501600 DOI: 10.1093/intqhc/11.4.301] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To describe and compare both overuse and underuse of diagnostic upper gastrointestinal endoscopy in different settings. DESIGN Merging of data from three prospective observational studies. The appropriateness and necessity of indications for gastroscopy were evaluated using explicit criteria developed by a standardized expert panel method (RAND-UCLA). Inappropriate endoscopies represent overuse. Necessary indications not referred for the procedure constitute underuse. SETTING Three primary care outpatient clinics, 20 general practices, three gastroenterology practices, two district and one university hospitals. SUBJECTS A third of the collective were consecutive ambulatory patients with upper abdominal complaints, whereas the other two thirds were ambulatory and hospitalized patients referred for the procedure. MAIN OUTCOME MEASURES Proportions of overuse and underuse in the different settings. RESULTS A total of 2885 patients were included (mean age, 49 years, 52% male, 2442 outpatients), 1858 patients underwent > or = 1 endoscopy. Among 2086 endoscopies, 805 (39%) were inappropriate, most of which were performed for dyspepsia (83%). Overuse was higher in young, foreign, female patients and lower in inpatient settings, the latter reflecting a different distribution of presenting symptoms. Among 1646 patient visits in primary care, overuse represented 148 endoscopies (9%). Underuse was identified in 104 of the same patient visits (6%) and was higher as patient age increased; there were no significant differences between men and women. CONCLUSIONS Rates of overuse and underuse depend mainly on case presentation and patient characteristics. Both over- and underuse should be addressed to maintain and improve quality of care.
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Froehlich F, Gonvers JJ, Vader JP, Burnand B. Gastrointestinal endoscopy: Do we perform too many or not enough procedures? CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 1999; 13:345-6. [PMID: 10360996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Ghilardi G, Gonvers JJ, So A. Hypothyroid myopathy as a complication of interferon alpha therapy for chronic hepatitis C virus infection. BRITISH JOURNAL OF RHEUMATOLOGY 1998; 37:1349-51. [PMID: 9973163 DOI: 10.1093/rheumatology/37.12.1349] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Interferon alpha (IFN-alpha) therapy is associated with a number of immunological side-effects, including autoimmune diseases and a 10% prevalence of thyroiditis. Hepatitis C virus (HCV) infection itself predisposes to autoimmune phenomena including hypothyroidism and myositis. The development of clinical hypothyroidism in the presence of positive thyroid antibodies in patients infected with HCV and treated with IFN-alpha suggests a possible association between the viral disease and the therapy. HCV infection may predispose to autoimmune thyroid disease and IFN-alpha therapy may secondarily lead to the development of thyroid dysfunctions. We report the single case of a female patient who developed a severe proximal myopathy in conjunction with primary hypothyroidism (Hoffmann's syndrome) secondarily to IFN-alpha therapy for HCV infection. This case highlights the need for careful clinical and biological monitoring for potential side-effects in such patients.
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Froehlich F, Pache I, Burnand B, Vader JP, Fried M, Beglinger C, Stalder G, Gyr K, Thorens J, Schneider C, Kosecoff J, Kolodny M, DuBois RW, Gonvers JJ, Brook RH. Performance of panel-based criteria to evaluate the appropriateness of colonoscopy: a prospective study. Gastrointest Endosc 1998; 48:128-36. [PMID: 9717777 DOI: 10.1016/s0016-5107(98)70153-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Prospective data describing the appropriateness of use of colonoscopy based on detailed panel-based clinical criteria are not available. METHODS In a cohort of 553 consecutive patients referred for colonoscopy to two university-based Swiss outpatient clinics, the percentage of patients who underwent colonoscopy for appropriate, equivocal, and inappropriate indications and the relationship between appropriateness of use and the presence of relevant endoscopic lesions was prospectively assessed. This assessment was based on criteria of the American Society for Gastrointestinal Endoscopy and explicit American and Swiss criteria developed in 1994 by a formal panel process using the RAND/UCLA appropriateness method. RESULTS The procedures were rated appropriate or equivocal in 72.2% by criteria of the American Society for Gastrointestinal Endoscopy, in 68.5% by explicit American criteria, and in 74.4% by explicit Swiss criteria (not statistically significant, NS). Inappropriate use (overuse) of colonoscopy was found in 27.8%, 31.5%, and 25.6%, respectively (NS). The proportion of appropriate procedures was higher with increasing age. Almost all reasons for using colonoscopy could be assessed by the two explicit criteria sets, whereas 28.4% of reasons for using colonoscopy could not be evaluated by the criteria of the American Society for Gastrointestinal Endoscopy (p < 0.0001). The probability of finding a relevant endoscopic lesion was distinctly higher in the procedures rated appropriate or equivocal than in procedures judged inappropriate. CONCLUSIONS The rate of inappropriate use of colonoscopy is substantial in Switzerland. Explicit criteria allow assessment of almost all indications encountered in clinical practice. In this study, all sets of appropriateness criteria significantly enhanced the probability of finding a relevant endoscopic lesion during colonoscopy.
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Abstract
We here describe a young patient who presented with chronic Budd-Chiari syndrome. An exhaustive etiological investigation to detect a procoagulable state was negative except for factor V mutation (factor V Leiden), a factor associated with resistance to activated protein C. Factor V Leiden is known to be a common, high risk factor for thrombosis. This factor should be routinely investigated in patients with Budd-Chiari syndrome, as factor V Leiden mutation is probably the procoagulable state responsible for many cases of "idiopathic" Budd-Chiari syndrome.
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Burnand B, Vader JP, Froehlich F, Dupriez K, Larequi-Lauber T, Pache I, Dubois RW, Brook RH, Gonvers JJ. Reliability of panel-based guidelines for colonoscopy: an international comparison. Gastrointest Endosc 1998; 47:162-6. [PMID: 9512282 DOI: 10.1016/s0016-5107(98)70350-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND This study examined the reliability of explicit guidelines developed using the RAND-UCLA appropriateness method. METHODS The appropriateness of over 400 indications for colonoscopy was rated by two multispecialty expert panels (United States and Switzerland). A nine-point scale was used, which was consolidated into three categories of appropriateness: appropriate, uncertain, inappropriate. The distribution of appropriateness ratings between the two panels and the intrapanel and interpanel agreement for categories of appropriateness were calculated for all possible indications. Similar statistics were calculated for a series of 577 primary care patients referred for colonoscopy in Switzerland. RESULTS Over 80% of all indications (348) could be directly compared. The proportions of indications classified as appropriate, uncertain, or inappropriate were 28.4%, 24.7%, 46.6% and 33.0%, 23.0%, 44.0% for the U.S. and the Swiss panels, respectively. Interpanel agreement was excellent for all the possible indications (kappa value: 0.75) and lower for actual cases (kappa value: 0.51) because of lower agreement for the most frequently encountered indications. CONCLUSIONS Good agreement between the two sets of criteria was found, pointing to the reliability of the method. Partial disagreement occurred essentially for a few, albeit frequently encountered, indications for use of colonoscopy in cases of uncomplicated lower abdominal pain or constipation.
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