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Domínguez Muñoz JE, Martínez Moneo E, Bolado Concejo F, Alberca de Las Parras F, Carballo Álvarez F, Elola Somoza FJ. Pancreas units within gastroenterology departments. Organizational and operational standards for a patient-centered service. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024; 116. [PMID: 38835233 DOI: 10.17235/reed.2024.10147/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
The Asociación Española de Pancreatología (AESPANC), Asociación Española de Gastroenterología (AEG), and Sociedad Española de Patología Digestiva (SEPD) have developed a consensus document on the standards and recommendations they consider essential for the organization of pancreas units (PUs) within gastroenterology services (GSs) in order to conduct their activities in an efficient, high-quality manner. The consensus document defines PUs and lays down standards relating to their organization, structure, service portfolio, processes, and teaching and research activities. Standards have been categorized as mandatory (requirements to be met to qualify for certification by the scientific societies responsible for the standards) or recommendations. Standards should be updated at most within five years based on the experience gained in Spanish PUs and the advance of knowledge regarding pancreas disease. Development of health outcome indicators, including patient-reported outcome measures (PROMs), is considered a relevant challenge, as is evidence on the association of PU structure and activity standards with health outcomes.
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Domínguez-Muñoz JE, Martínez Moneo E, Bolado Concejo F, Alberca de Las Parras F, Carballo Álvarez F, Elola Somoza FJ. Pancreas units within gastroenterology departments. Organizational and operational standards for a patient-centered service. GASTROENTEROLOGIA Y HEPATOLOGIA 2024:S0210-5705(24)00134-1. [PMID: 38862300 DOI: 10.1016/j.gastrohep.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/12/2024] [Indexed: 06/13/2024]
Abstract
The Asociación Española de Pancreatología (AESPANC), Asociación Española de Gastroenterología (AEG), and Sociedad Española de Patología Digestiva (SEPD) have developed a consensus document on the standards and recommendations they consider essential for the organization of pancreas units (PUs) within gastroenterology services (GSs) in order to conduct their activities in an efficient, high-quality manner. The consensus document defines PUs and lays down standards relating to their organization, structure, service portfolio, processes, and teaching and research activities. Standards have been categorized as mandatory (requirements to be met to qualify for certification by the scientific societies responsible for the standards) or recommendations. Standards should be updated at most within five years based on the experience gained in Spanish PUs and the advance of knowledge regarding pancreas disease. Development of health outcome indicators, including patient-reported outcome measures (PROMs), is considered a relevant challenge, as is evidence on the association of PU structure and activity standards with health outcomes.
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Affiliation(s)
- J Enrique Domínguez-Muñoz
- Servicio de Aparato Digestivo, Hospital Clínico Universitario de Santiago, Instituto de Investigación Clínica de Santiago (IDIS), Santiago de Compostela, A Coruña, España.
| | | | | | | | | | - F Javier Elola Somoza
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, España
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Córdova H, Barreiro-Alonso E, Castillo-Regalado E, Cubiella J, Delgado-Guillena P, Díez Redondo P, Galdín M, García-Rodríguez A, Hernández L, Huerta A, Jover R, Núñez H, Rodríguez-D'Jesús A, Seoane A, Surís G, Tejedor-Tejada J, Jiménez Sánchez J, Martín F, Moreira L, Carballal S, Rivero L, Da Fieno A, Casanova G, Luzko Scheid I, Llach J, Fernández-Esparrach G. Applicability of the Barcelona scale to assess the quality of cleanliness of mucosa at esophagogastroduodenoscopy. GASTROENTEROLOGIA Y HEPATOLOGIA 2024; 47:246-252. [PMID: 37236304 DOI: 10.1016/j.gastrohep.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/11/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND OBJECTIVES There are few scales with prospective validation for the assessment of the upper gastrointestinal mucosal cleanliness during an esophagogastroduodenoscopy (EGD). The aim of this study was to develop a valid and reproducible cleanliness scale for use during an EGD. METHODS We developed a cleanliness scale (Barcelona scale) with a score (0-2 points) of five segments of the upper gastrointestinal tract with thorough cleaning techniques (esophagus, fundus, body, antrum, and duodenum). First, 125 photos (25 of each area) were assessed, and a score was assigned to each image by consensus among 7 experts endoscopists. Subsequently, 100 of the 125 images were selected and the inter- and intra-observer variability of 15 previously trained endoscopists was evaluated using the same images at two different times. RESULTS In total, 1500 assessments were performed. In 1336/1500 observations (89%) there was agreement with the consensus score, with a mean kappa value of 0.83 (0.45-0.96). In the second evaluation, in 1330/1500 observations (89%) there was agreement with the consensus score, with a mean kappa value of 0.82 (0.45-0.93). The intra-observer variability was 0.89 (0.76-0.99). CONCLUSIONS The Barcelona cleanliness scale is a valid measure and reproducible with minimal training. Its application in clinical practice is a significant step to standardize the quality of the EGD.
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Affiliation(s)
- Henry Córdova
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Eva Barreiro-Alonso
- Department of Gastroenterology, Hospital Universitario Central de Asturias and Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Edgar Castillo-Regalado
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Joaquín Cubiella
- Department of Gastroenterology, Hospital Universitario de Ourense. Research Group in Gastrointestinal Oncology-Ourense. CIBERehd, Ourense, Spain
| | | | | | | | - Ana García-Rodríguez
- Servicio de Digestivo, Unidad de Endoscopia, Hospital de Viladecans, Barcelona, Spain
| | | | - Alain Huerta
- Hospital Universitario de Galdakao, Biocruces Bizkaia, Departamento Medicina UPV-EHU Leioa, Spain
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria ISABIAL, Universidad Miguel Hernández, Alicante, Spain
| | - Henar Núñez
- Hospital Universitario Río Hortega, Valladolid, Spain
| | | | - Agustín Seoane
- Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Gerard Surís
- Servicio de Digestivo, Unidad de Endoscopia, Hospital de Viladecans, Barcelona, Spain
| | | | | | | | - Leticia Moreira
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Sabela Carballal
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Liseth Rivero
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Angella Da Fieno
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Gherzon Casanova
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Irina Luzko Scheid
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Joan Llach
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Gloria Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain.
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Cunha Neves JA, Delgado-Guillena PG, Queirós P, Libânio D, Rodríguez de Santiago E. Curative criteria for endoscopic treatment of gastric cancer. Best Pract Res Clin Gastroenterol 2024; 68:101884. [PMID: 38522882 DOI: 10.1016/j.bpg.2024.101884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 01/23/2024] [Indexed: 03/26/2024]
Abstract
Endoscopic treatment, particularly endoscopic submucosal dissection, has become the primary treatment for early gastric cancer. A comprehensive optical assessment, including white light endoscopy, image-enhanced endoscopy, and magnification, are the cornerstones for clinical staging and determining the resectability of lesions. This paper discusses factors that influence the indication for endoscopic resection and the likelihood of achieving a curative resection. Our review stresses the critical need for interpreting the histopathological report in accordance with clinical guidelines and the imperative of tailoring decisions based on the patients' and lesions' characteristics and preferences. Moreover, we offer guidance on managing complex scenarios, such as those involving non-curative resection. Finally, we identify future research avenues, including the role of artificial intelligence in estimating the depth of invasion and the urgent need to refine predictive scores for lymph node metastasis and metachronous lesions.
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Affiliation(s)
- João A Cunha Neves
- Department of Gastroenterology, Centro Hospitalar Universitário Do Algarve, Portimão, Portugal
| | | | - Patrícia Queirós
- Department of Gastroenterology, Centro Hospitalar Universitário Do Algarve, Portimão, Portugal
| | - Diogo Libânio
- Department of Gastroenterology, Porto Comprehensive Cancer Center Raquel Seruca, and RISE@CI-IPO (Health Research Network), Porto, Portugal; MEDCIDS (Department of Community Medicine, Health Information, and Decision), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Enrique Rodríguez de Santiago
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
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Delgado-Guillena P, Velamazan-Sandalinas R, Jiménez Sánchez J, Fuentes-Valenzuela E, García-Morales N, Cuatrecasas M, Jimeno M, Moreira L, Albéniz E. History and clinical guidelines for chronic atrophic gastritis and the assessment of gastric cancer risk. GASTROENTEROLOGIA Y HEPATOLOGIA 2023; 46:727-731. [PMID: 37708969 DOI: 10.1016/j.gastrohep.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/04/2023] [Indexed: 09/16/2023]
Affiliation(s)
| | - Raúl Velamazan-Sandalinas
- Department of Gastroenterology, Hospital Universitario Vall d'Hebrón, Instituto de Investigacción Vall d'Hebrón (VHIR), Barcelona, Spain
| | | | | | - Natalia García-Morales
- Department of Gastroenterology, Complejo Hospitalario Universitario de Vigo, Instituto de Investigación Sanitaria Galicia Sur, Vigo, Spain
| | - Miriam Cuatrecasas
- Department of Pathology, CDB, Hospital Clínic of Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Spain
| | - Mireya Jimeno
- Department of Pathology, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Leticia Moreira
- Department of Gastroenterology, Hospital Clinic of Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Spain
| | - Eduardo Albéniz
- Department of Gastroenterology, Hospital Universitario de Navarra (HUN), Navarrabiomed, Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
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Moreno-Sánchez M, Cubiella J, Fernández Esparrach G, Marin-Gabriel JC. Image-enhanced endoscopy in the diagnosis of gastric premalignant conditions and gastric cancer. GASTROENTEROLOGIA Y HEPATOLOGIA 2023; 46:397-409. [PMID: 35780957 DOI: 10.1016/j.gastrohep.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 05/09/2023]
Abstract
Diagnosis of early gastric cancer and its precancerous lesions remains a challenge for great part of western endoscopists. Changes seen in the mucosal pattern are generally subtle and hence difficult to identify. In this article, we will review the usefulness of conventional and virtual chromoendoscopy and magnification endoscopy in the recognition and classification of these lesions.
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Affiliation(s)
- Maria Moreno-Sánchez
- Servicio de Medicina del Aparato Digestivo, Hospital Universitario 12 de Octubre, Madrid, España.
| | - Joaquín Cubiella
- Servicio de Aparato Digestivo, Hospital Universitario de Ourense, Ourense, España; Centro de Investigaciones Biomédicas en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), España
| | - Gloria Fernández Esparrach
- Centro de Investigaciones Biomédicas en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), España; Sección de Endoscopia, Servicio de Gastroenterología, Hospital Clínic de Barcelona; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Facultat de Medicina i Ciències de la Salut, Universidad de Barcelona (UB), Barcelona, España
| | - Jose Carlos Marin-Gabriel
- Servicio de Medicina del Aparato Digestivo, Instituto de Investigación «i+12», Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
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Fuentes-Valenzuela E, Pérez-Arenas E, de Benito Sanz M, Chavarría C, Miguel Peña A, Carbajo López A, Tejedor-Tejada J, Burgueño Gómez B, Sánchez-Ocaña R, Albillos-Blanco M, Salvador de Las Heras A, García-Alonso FJ. Prospective cohort study to evaluate premedication with simethicone and n-acetilcysteine for upper diagnostic gastrointestinal endoscopy. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:10-15. [PMID: 35297256 DOI: 10.17235/reed.2022.8576/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION The use of premedication for upper gastrointestinal endoscopy (UGE) is not widely established in western countries. The primary aim of the study was to compare gastric visibility according to the total visibility score (TVS). The secondary aim was to assess complications, diagnostic yield, endoscopic procedure time, sedation dose and patient satisfaction. METHODS A single center prospective cohort study was performed of consecutive adults undergoing an UGE in the afternoon working shift. After completing enrolment in the control group, patients were administered 200 mg simethicone and 500 mg N-acetylcysteine diluted in 100 ml of water >15 minutes before the procedure. All procedures were recorded and a single, blinded endoscopist evaluated the TVS after recruitment of both cohorts. Patient satisfaction was evaluated using the Spanish translation of the American Society of Gastrointestinal Endoscopy satisfaction questionnaire. RESULTS 205 patients were included in the study, 103 females (50.2%) with a median age of 54.8-years (IQR: 41.2-65.2). 104 were enrolled to the control group and 101 to the intervention group. Patients receiving premedication presented a higher rate of adequate (74.3% vs 45.2; difference 95% CI: 16,3-41,9%, p<0.001) and excellent gastric visibility (23.8% vs 7.7%; difference 95% CI: 6,3-25,8%, p=0.002). Propofol dose was similar, although the median procedure time was lower in the group of no intervention [5 (IQR: 4-7) vs 6 minutes (IQR: 5-7); p=0.03]. Procedure related adverse events were similar, except that patient without premedication experienced more nausea episodes. Major and minor endoscopic findings and the satisfaction questionnaire showed no differences between both groups. CONCLUSION Patients receiving premedication with simethicone and N-acetylcysteine had a better gastric visibility score, without any increase in adverse events or affecting the patients' satisfaction.
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Affiliation(s)
| | | | - Marina de Benito Sanz
- Endoscopy Unit, Gastroenterology Department, Hospital Universitario Río Hortega, Spain
| | - Carlos Chavarría
- Endoscopy Unit, Gastroenterology Department, Hospital Universitario Río Hortega, Spain
| | - Aleida Miguel Peña
- Endoscopy Unit, Gastroenterology Department, Hospital Universitario Río Hortega, Spain
| | - Ana Carbajo López
- Endoscopy Unit, Gastroenterology department. , Hospital Universitario Río Hortega, Spain
| | - Javier Tejedor-Tejada
- Endoscopy Unit, Gastroenterology Department, Hospital Universitario Río Hortega, Spain
| | | | - Ramon Sánchez-Ocaña
- Endoscopy Unit, Gastroenterology Department, Hospital Universitario Río Hortega, Spain
| | - María Albillos-Blanco
- Endoscopy Unit, Gastroenterology Department, Hospital Universitario Río Hortega, Spain
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Herrera-Pariente C, Montori S, Llach J, Bofill A, Albeniz E, Moreira L. Biomarkers for Gastric Cancer Screening and Early Diagnosis. Biomedicines 2021; 9:biomedicines9101448. [PMID: 34680565 PMCID: PMC8533304 DOI: 10.3390/biomedicines9101448] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 12/24/2022] Open
Abstract
Gastric cancer is one of the most common cancers worldwide, with a bad prognosis associated with late-stage diagnosis, significantly decreasing the overall survival. This highlights the importance of early detection to improve the clinical course of these patients. Although screening programs, based on endoscopic or radiologic approaches, have been useful in countries with high incidence, they are not cost-effective in low-incidence populations as a massive screening strategy. Additionally, current biomarkers used in daily routine are not specific and sensitive enough, and most of them are obtained invasively. Thus, it is imperative to discover new noninvasive biomarkers able to diagnose early-stage gastric cancer. In this context, liquid biopsy is a promising strategy. In this review, we briefly discuss some of the potential biomarkers for gastric cancer screening and diagnosis identified in blood, saliva, urine, stool, and gastric juice.
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Affiliation(s)
- Cristina Herrera-Pariente
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Gastroenterology Department, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain; (C.H.-P.); (J.L.); (A.B.)
| | - Sheyla Montori
- UPNA, IdiSNA, Navarrabiomed Biomedical Research Center, Gastrointestinal Endoscopy Research Unit, 31008 Pamplona, Spain; (S.M.); (E.A.)
| | - Joan Llach
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Gastroenterology Department, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain; (C.H.-P.); (J.L.); (A.B.)
| | - Alex Bofill
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Gastroenterology Department, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain; (C.H.-P.); (J.L.); (A.B.)
| | - Eduardo Albeniz
- UPNA, IdiSNA, Navarrabiomed Biomedical Research Center, Gastrointestinal Endoscopy Research Unit, 31008 Pamplona, Spain; (S.M.); (E.A.)
- Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
| | - Leticia Moreira
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Gastroenterology Department, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain; (C.H.-P.); (J.L.); (A.B.)
- Correspondence:
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