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Furumaya A, Nooijen LE, Haring MPD, van Oers HA, van Beneden M, van Rosmalen BV, Takkenberg RB, Kazemier G, Besselink MG, de Meijer VE, Erdmann JI. Development of a set of patient reported outcome measures for patients with benign liver tumours and cysts: patient focus groups and systematic review. J Patient Rep Outcomes 2022; 6:124. [PMID: 36484883 PMCID: PMC9733760 DOI: 10.1186/s41687-022-00531-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Patient reported outcome measures (PROMs) may be useful for patients with benign liver tumours and cysts (BLTC) to evaluate the impact of treatment and/or guide shared decision making. Yet, a set of PROMs relevant to patients with BLTC is currently unavailable. In this study, we selected a PROMs set for patients with BLTC. METHODS Potentially relevant patient reported outcomes (PROs) were selected by psychologist-researchers based on keywords used or suggested by participants of two virtual focus groups meetings consisting of thirteen female BLTC patients with a median age of 50 years. Subsequently, patients were asked to report their most relevant PROs. PROMs identified by systematic literature review and computerized adaptive tests (CATs) in the Patient-Reported Outcomes Measurement Information System (PROMIS) were considered in selecting the final PROMs set to assess relevant outcomes. RESULTS The most important PROs were: insecurity/anxiety (11/12 patients), pain (9/12 patients), fatigue (8/12 patients), and limitations in daily life (5/12 patients). The literature review included 23 studies, which used various generic and disease-specific PROMs, often not measuring (all) relevant PROs. The final selected PROMs set included numerical rating scales for pain, two questions on overall health and quality of life and four PROMIS CATs. CONCLUSIONS A PROMs set generically and efficiently measuring outcomes relevant for patients with BLTC was developed and may be used in future research and clinical practice.
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Affiliation(s)
- Alicia Furumaya
- grid.7177.60000000084992262Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands ,Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Lynn E. Nooijen
- grid.7177.60000000084992262Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands ,Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Martijn P. D. Haring
- grid.4494.d0000 0000 9558 4598Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hedy A. van Oers
- grid.7177.60000000084992262Child and Adolescent Psychiatry and Psychosocial Care, Emma Children’s Hospital, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands ,Amsterdam Reproduction and Development and Amsterdam Public Health, Amsterdam, The Netherlands
| | - Marlou van Beneden
- grid.12380.380000 0004 1754 9227Department of Strategy and Policy and Care Support, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Belle V. van Rosmalen
- grid.7177.60000000084992262Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands ,Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - R. Bart Takkenberg
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands ,grid.7177.60000000084992262Department of Gastroenterology and Hepatology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Geert Kazemier
- grid.12380.380000 0004 1754 9227Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, The Netherlands
| | - Marc G. Besselink
- grid.7177.60000000084992262Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands ,Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Vincent E. de Meijer
- grid.4494.d0000 0000 9558 4598Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joris I. Erdmann
- grid.7177.60000000084992262Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands ,Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
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Junqueira JOG, de Pinho JHS, de Oliveira Junqueira TB, de Oliveira Junqueira BB, Vidigal FM, Furtado MCV, de Souza GS. Symptomatic giant solitary bile cyst with intracystic bleeding in a 13-year-old girl: a case report and literature review. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00218-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
Simple hepatic cyst is a rare disease in childhood. They occur in the general population with a prevalence of up to 5%. The incidence and size of cysts increase dramatically in adults older than 50 years. We performed a systematic literature review of all cases of simple hepatic cysts in the pediatric population undergoing surgical treatment. We found 52 cases reported in literature with a mean age of 2.54 years, 15% were pedicled cysts and only one case reported intracystic bleeding, detected only in the anatomopathological examination. We report a case of a 13-year-old girl who was presented with a symptomatic giant solitary bile cyst, the second biggest simple hepatic cyst reported in pediatric population, the biggest pedicled cyst and the only case of intracystic bleeding detected in pre-operative image examination in this group. This case brings important considerations about this complication and its pre-operative diagnosis.
Case presentation
We report a case of a 13-year-old girl with a giant solitary biliary cyst in the left hepatic lobe, symptomatic and with intracystic bleeding noted on magnetic resonance imaging. Diagnosis was difficult due to nonspecific symptoms and the non-typical images of simple hepatic cyst due to intracystic bleeding. The patient underwent a laparotomy, showing a large pedicled cyst, linked to segments II and III without adherence to other organs. Complete excision of the lesion was performed because the risk of torsion. The postoperative period passed without complications.
Conclusions
Although intracystic bleeding is the most common complication in adults, this is not reported in the pediatric population according to our review. Knowing how to recognize intracystic bleeding is important, because this complication predisposes the cyst to rupture and changes the appearance of the lesion on imaging tests, which can be more easily confused with cystadenoma or a cystadenocarcinoma. The magnetic resonance imaging is essential in the intracystic bleeding investigation. Comparisons between ultrasound and computed tomography findings associated with anemia history can prove the probability of this complication.
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Madha ES, Mateo RB, Hawksworth JS. Identification of biliary duct branches with indocyanine green during robot-assisted laparoscopic hepatic cyst fenestration. ANZ J Surg 2022; 92:3061-3062. [PMID: 35119178 DOI: 10.1111/ans.17527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Emad S Madha
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Rodrigo B Mateo
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jason S Hawksworth
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Georgetown University Hospital, Washington, District of Columbia, USA
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Gomez A, Wisneski AD, Luu HY, Hirose K, Roberts JP, Hirose R, Freise CE, Nakakura EK, Corvera CU. Contemporary Management of Hepatic Cyst Disease: Techniques and Outcomes at a Tertiary Hepatobiliary Center. J Gastrointest Surg 2021; 25:77-84. [PMID: 33083858 PMCID: PMC7850990 DOI: 10.1007/s11605-020-04821-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/01/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hepatic cyst disease is often asymptomatic, but treatment is warranted if patients experience symptoms. We describe our management approach to these patients and review the technical nuances of the laparoscopic approach. METHODS Medical records were reviewed for operative management of hepatic cysts from 2012 to 2019 at a single, tertiary academic medical center. RESULTS Fifty-three patients (39 female) met the inclusion criteria with median age at presentation of 65 years. Fifty cases (94.3%) were performed laparoscopically. Fourteen patients carried diagnosis of polycystic liver disease. Dominant cyst diameter was median 129 mm and located within the right lobe (30), left lobe (17), caudate (2), or was bilobar (4). Pre-operative concern for biliary cystadenoma/cystadenocarcinoma existed for 7 patients. Operative techniques included fenestration (40), fenestration with decapitation (7), decapitation alone (3), and excision (2). Partial hepatectomy was performed in conjunction with fenestration/decapitation for 15 cases: right sided (7), left sided (7), and central (1). One formal left hepatectomy was performed in a polycystic liver disease patient. Final pathology yielded simple cyst (52) and one biliary cystadenoma. Post-operative complications included bile leak (2), perihepatic fluid collection (1), pleural effusion (1), and ascites (1). At median 7.1-month follow-up, complete resolution of symptoms occurred for 34/49 patients (69.4%) who had symptoms preoperatively. Reintervention for cyst recurrence occurred for 5 cases (9.4%). CONCLUSIONS Outcomes for hepatic cyst disease are described with predominantly laparoscopic approach, approach with minimal morbidity, and excellent clinical results.
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Affiliation(s)
- Axel Gomez
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Andrew D Wisneski
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Hubert Y Luu
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Kenzo Hirose
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - John P Roberts
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Ryutaro Hirose
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Christopher E Freise
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Eric K Nakakura
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Carlos U Corvera
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA.
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Bernts LHP, Echternach SG, Kievit W, Rosman C, Drenth JPH. Clinical response after laparoscopic fenestration of symptomatic hepatic cysts: a systematic review and meta-analysis. Surg Endosc 2018; 33:691-704. [PMID: 30334152 PMCID: PMC6394680 DOI: 10.1007/s00464-018-6490-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/11/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopic fenestration is one of the treatment options for symptomatic hepatic cysts, either solitary or in context of polycystic liver disease (PLD), but indications, efficacy and surgical techniques are under debate. METHODS A systematic literature search (1950-2017) of PubMed, Embase, Web of Science and the Cochrane Library was performed (CRD42017071305). Studies assessing symptomatic relief or symptomatic recurrence after laparoscopic fenestration in patients with symptomatic, non-parasitic, hepatic cysts were included. Complications were scored according to Clavien-Dindo. Methodological quality was assessed by Newcastle-Ottawa scale (NOS) for cohort studies. Pooled estimates were calculated using a random effects model for meta-analysis. RESULTS Out of 5277 citations, 62 studies with a total of 1314 patients were included. Median NOS-score was 6 out of 9. Median follow-up duration was 30 months. Symptomatic relief after laparoscopic fenestration was 90.2% (95% CI 84.3-94.9). Symptomatic recurrence was 9.6% (95% CI 6.9-12.8) and reintervention rate was 7.1% (95% CI 5.0-9.4). Post-operative complications occurred in 10.8% (95% CI 8.1-13.9) and major complications in 3.3% (95% CI 2.1-4.7) of patients. Procedure-related mortality was 1.0% (95% CI 0.5-1.6). In a subgroup analysis of PLD patients (n = 146), symptomatic recurrence and reintervention rates were significantly higher with respective rates of 33.7% (95% CI 18.7-50.4) and 26.4% (95% CI 12.6-43.0). Complications were more frequent in PLD patients, with a rate of 29.3% (95% CI 16.0-44.5). CONCLUSIONS Laparoscopic fenestration is an effective procedure for treatment of symptomatic hepatic cysts with a low symptomatic recurrence rate. The symptomatic recurrence rate and risk of complications are significantly higher in PLD patients.
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Affiliation(s)
- Lucas H P Bernts
- Department of Gastroenterology and Hepatology, Radboudumc, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Sebastiaan G Echternach
- Department of Gastroenterology and Hepatology, Radboudumc, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Wietske Kievit
- Department for Health Evidence, Radboudumc, Nijmegen, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboudumc, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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Long-term Patient-reported Outcomes After Laparoscopic Fenestration of Symptomatic Liver Cysts. Surg Laparosc Endosc Percutan Tech 2018; 27:e80-e82. [PMID: 28708767 DOI: 10.1097/sle.0000000000000441] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Laparoscopic fenestration is the treatment of choice for symptomatic liver cysts. Despite the benefits of minimally invasive surgery, there is limited data on long-term outcomes after laparoscopic fenestration, in terms of symptom recurrence and quality of life. The purpose of this study was to evaluate long-term patient-reported outcomes and satisfaction following this procedure. METHODS All patients who underwent laparoscopic liver cyst fenestration in a single center between 2001 and 2012 were identified from a prospectively maintained database. Long-term patient-reported outcomes including symptom relief and quality of life were prospectively evaluated by a structured telephone interview. RESULTS A total of 98 patients underwent laparoscopic liver cyst fenestration. The median follow-up was 62 months (range, 22 to 173 mo). Follow-up data was available in 48 patients. Four patients developed radiologically confirmed evidence of recurrence with 3 undergoing further surgery. No mortality was reported in the series. Four complications occurred and the median postoperative length of hospital stay was 2 days (range, 1 to 7 d). Thirty-nine patients received immediate symptomatic relief with 98% reporting long-term satisfaction. RESULTS Laparoscopic liver cyst fenestration is associated with low morbidity and long-term alleviation of symptoms. This should be considered the treatment modality of choice in managing patients with nonparasitic cysts.
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Pitchaimuthu M, Duxbury M. Cystic lesions of the liver-A review. Curr Probl Surg 2017; 54:514-542. [PMID: 29173653 DOI: 10.1067/j.cpsurg.2017.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/08/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Maheswaran Pitchaimuthu
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom; Department of HPB and Transplant Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
| | - Mark Duxbury
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
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Long-term outcomes and quality of life after surgical or conservative treatment of benign simple liver cysts. Surg Endosc 2017. [PMID: 28639041 DOI: 10.1007/s00464-017-5645-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Benign liver cysts are common and are often detected incidentally. Most patients do not require intervention. Occasionally, large dominant or multifocal small cysts cause symptoms as a result of rapid growth, secondary infection, intra-cystic bleeding or compression of adjacent organs. AIM To compare presenting symptoms and outcomes of a consecutive series of patients with benign liver cysts treated either conservatively or by surgical intervention. Long-term quality of life (QoL) was also assessed. METHODS Retrospective analysis of prospectively collected data was conducted. Long-term general and disease-specific quality of life was also documented. RESULTS Ninety-five patients were included in the study (46 treated operatively, 49 treated conservatively). 80% were female, and the mean age of the cohort was 58 years. Those who had surgical intervention were older (62 vs 55 years, p = 0.004), were more likely to have shortness of breath at presentation (11 vs 5%, p = 0.018) and had larger cysts (12 vs 4 cm, p < 0.001) compared with those offered conservative treatment. Laparoscopic stapled excision was the most common operative procedure (70%) and the overall complication rate was 20%. At a median follow-up of 64 months, 17% (8/46) of the surgically treated patients had radiological evidence of cyst recurrence but only 9% (4/46) were symptomatic. At median follow-up of 71 months, 37% (14/38) of conservatively treated patients had unchanged or new symptoms compared to the first presentation. Furthermore, 10% (4/38) of this group had additional radiological or surgical intervention for persistent symptoms during the follow-up period. Overall, there was no difference in long-term QoL between the two groups. CONCLUSION Surgical intervention for selected patients with symptomatic benign liver cysts results in low long-term recurrence rates and excellent patient-reported outcomes and quality of life. Laparoscopic-stapled excision can be done safely and reliably in carefully selected patients.
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Laparoscopic Surgery in Nonparasitic Cysts of the Liver: Results Observed in a Series of Consecutive Cases. Surg Laparosc Endosc Percutan Tech 2016; 26:308-12. [DOI: 10.1097/sle.0000000000000303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wang LM, Wang XY, Zhao YC, Peng P, Zhu CQ. Laparoscopic unroofing of liver cysts. Shijie Huaren Xiaohua Zazhi 2016; 24:267-271. [DOI: 10.11569/wcjd.v24.i2.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM: To explore the method of decreasing liver cyst recurrence after laparoscopic decompression.
METHODS: The clinical and postoperative follow-up data for 72 patients who underwent liver cyst surgery at Tangshan Worker Hospital were analyzed retrospectively. Efficacy of open surgery and laparoscopic liver cyst drainage for treatment of liver cysts was compared.
RESULTS: Compared with open surgery, laparoscopic liver cyst drainage had the advan-
tages of less pain and shorter hospitalization time. However, the liver cyst recurrence rate was 5/24 (20.1%) after drainage, which was higher than 3/48 (6.3%) after open surgery. Sodium hyaluronate could effectively reduce cyst recurrence after laparoscopic liver cyst drainage by preventing postoperative liver wound adhesions.
CONCLUSION: Laparoscopic liver cyst drainage is safe and feasible. Unroofing of the liver cyst as much as possible, using sclerosing agents rationally to inactivate residual cyst epithelial cells, and effective drainage on the premise of proper use of sodium hyaluronate and other anti-adhesion agents could effectively reduce cyst recurrence after laparoscopic surgery.
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Casteleijn NF, Visser FW, Drenth JPH, Gevers TJG, Groen GJ, Hogan MC, Gansevoort RT. A stepwise approach for effective management of chronic pain in autosomal-dominant polycystic kidney disease. Nephrol Dial Transplant 2014; 29 Suppl 4:iv142-53. [PMID: 25165181 DOI: 10.1093/ndt/gfu073] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Chronic pain, defined as pain existing for >4-6 weeks, affects >60% of patients with autosomal-dominant polycystic disease (ADPKD). It can have various causes, indirectly or directly related to the increase in kidney and liver volume in these patients. Chronic pain in ADPKD patients is often severe, impacting physical activity and social relationships, and frequently difficult to manage. This review provides an overview of pathophysiological mechanisms that can lead to pain and discusses the sensory innervation of the kidneys and the upper abdominal organs, including the liver. In addition, the results of a systematic literature search of ADPKD-specific treatment options are presented. Based on pathophysiological knowledge and evidence derived from the literature an argumentative stepwise approach for effective management of chronic pain in ADPKD is proposed.
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Affiliation(s)
- Niek F Casteleijn
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Folkert W Visser
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Tom J G Gevers
- Department of Gastroenterology and Hepatology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Gerbrand J Groen
- Pain Centre, Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marie C Hogan
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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