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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; 116:363-368. [PMID: 38835233 DOI: 10.17235/reed.2024.10147/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [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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Serracant A, Consola B, Ballesteros E, Sola M, Novell F, Montes N, Serra-Aracil X. How to Study the Location and Size of Rectal Tumors That Are Candidates for Local Surgery: Rigid Rectoscopy, Magnetic Resonance, Endorectal Ultrasound or Colonoscopy? An Interobservational Study. Diagnostics (Basel) 2024; 14:315. [PMID: 38337831 PMCID: PMC10855339 DOI: 10.3390/diagnostics14030315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
1. BACKGROUND Preoperative staging of rectal lesions for transanal endoscopic surgery (TES) comprises digital rectal examination, intraoperative rigid rectoscopy (IRR), endorectal ultrasound (EUS), colonoscopy and rectal magnetic resonance imaging (rMRI). The gold standard for topographic features is IRR. Are the results of the other tests sufficiently reliable to eliminate the need for IRR? rMRI is a key test in advanced rectal cancer and is not operator-dependent. Description of anatomical landmarks is variable. Can we rely on the information regarding topographic features provided by all radiologists? 2. MATERIALS AND METHODS This is a concordance interobservational study involving four diagnostic tests of anatomical characteristics of rectal lesions (colonoscopy, EUS, rectal MRI and IRR), performed by four expert radiologists, regarding topographic rectal features with rMRI. 3. RESULTS Fifty-five rectal tumors were operated on by using TES. The distance of the tumor from the anal verge, location by quadrants, size by quadrants and size of tumor were assessed (IRR as gold standard). For most of the tumors, the correlation between IRR and colonoscopy or EUS was very good (ICC > 0.75); the correlation between rMRI and IRR in respect of the size by quadrants (ICC = 0.092) and location by quadrants (ICC = 0.292) was weak. Topographic landmarks studied by the expert radiologists had an excellent correlation, except for distance from the peritoneal reflection to the anal verge (ICC = 0.606). 4. CONCLUSIONS Anatomical description of rectal lesions by IRR, EUS, colonoscopy and rMRI is reliable. Topographic data obtained by EUS and colonoscopy can serve as a reference to avoid IRR. Determination of these topographic data by rMRI is less reliable. As performed by the expert radiologists, the anatomical study by rMRI is accurate and reproducible.
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Affiliation(s)
- Anna Serracant
- Coloproctology Unit, General and Digestive Surgery Department, Institut d’Investigació i Innovació Parc Tauli I3PT-CERCA, Parc Tauli Hospital Universitari, Universitat Autònoma de Barcelona, Parc Tauli s/n, 08208 Sabadell, Spain; (A.S.); (N.M.)
| | - Beatriz Consola
- Diagnostic Radiology Department, Institut d’Investigació i Innovació Parc Tauli I3PT-CERCA, Parc Tauli Hospital Universitari, Universitat Autònoma de Barcelona, Parc Tauli s/n, 08208 Sabadell, Spain; (B.C.); (E.B.); (M.S.); (F.N.)
| | - Eva Ballesteros
- Diagnostic Radiology Department, Institut d’Investigació i Innovació Parc Tauli I3PT-CERCA, Parc Tauli Hospital Universitari, Universitat Autònoma de Barcelona, Parc Tauli s/n, 08208 Sabadell, Spain; (B.C.); (E.B.); (M.S.); (F.N.)
| | - Marta Sola
- Diagnostic Radiology Department, Institut d’Investigació i Innovació Parc Tauli I3PT-CERCA, Parc Tauli Hospital Universitari, Universitat Autònoma de Barcelona, Parc Tauli s/n, 08208 Sabadell, Spain; (B.C.); (E.B.); (M.S.); (F.N.)
| | - Francesc Novell
- Diagnostic Radiology Department, Institut d’Investigació i Innovació Parc Tauli I3PT-CERCA, Parc Tauli Hospital Universitari, Universitat Autònoma de Barcelona, Parc Tauli s/n, 08208 Sabadell, Spain; (B.C.); (E.B.); (M.S.); (F.N.)
| | - Noemi Montes
- Coloproctology Unit, General and Digestive Surgery Department, Institut d’Investigació i Innovació Parc Tauli I3PT-CERCA, Parc Tauli Hospital Universitari, Universitat Autònoma de Barcelona, Parc Tauli s/n, 08208 Sabadell, Spain; (A.S.); (N.M.)
| | - Xavier Serra-Aracil
- Coloproctology Unit, General and Digestive Surgery Department, Institut d’Investigació i Innovació Parc Tauli I3PT-CERCA, Parc Tauli Hospital Universitari, Universitat Autònoma de Barcelona, Parc Tauli s/n, 08208 Sabadell, Spain; (A.S.); (N.M.)
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Lorenzo-Zúñiga V, Bustamante-Balén M, Pons-Beltrán V, Peña-Gil C. Development of knowledge-based clinical decision support system for patients included in colorectal screening program. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 45:419-423. [PMID: 34118316 DOI: 10.1016/j.gastrohep.2021.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/05/2021] [Accepted: 05/08/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND & AIMS Colorectal (CRC) screening programs represent a large volume of procedures that need a follow-up endoscopy. A knowledge-based clinical decision support system (K-CDSS) is a technology which contains clinical rules and associations of compiled data that assist with clinical decision-making tasks. We develop a K-CDSS for management of patients included in CRC screening and surveillance of colorectal polyps. METHODS We collected information on 48 variables from hospital colonoscopy records. Using DILEMMA Solutions Platform © (https://www.dilemasolution.com) we designed a prototype K-CDSS (PoliCare CDSS), to provide tailored recommendations by combining patients data and current guidelines recommendations. The accuracy of rules was verified using four scenarios (normal colonoscopy, lesions different than polyps, non-advanced adenomas and advanced adenomas). We studied the degree of agreement between the clinical assessments made by expert doctors and nurses equipped with PoliCare CDSS. Two experts confirmed a correlation between guidelines and PoliCare recommendations. RESULTS 56 consecutive endoscopy cases from colorectal screening program were included (62.8 years; range 53-71). Colonoscopy results were: absence of colon lesions (n=7, 12.5%), lesions in the colon that are not polyps (n=3, 5.4%) and resected colonic polyps (n=46, 82.1%; 100% R0 resection). Patients with resected polyps presented non-advanced adenoma (n=21, 45.6%) or advanced lesions (n=25, 54.4%). There were no differences in erroneous orders with PoliCare CDSS (Kappa value 1.0). CONCLUSIONS PoliCare CDSS can easily be integrated into the workflow for improving the overall efficiency and better adherence to evidence-based guidelines.
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Affiliation(s)
| | | | - Vicente Pons-Beltrán
- Endoscopy Unit, Hospital Universitari i Politècnic La Fe/IIS La Fe, Valencia, Spain
| | - Carlos Peña-Gil
- Cardiology Department, Hospital Clínico Universitario de Santiago de Compostela, Sergas, IDIS, Spain
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Pérez Romero S, Alberca de Las Parras F, Sánchez Del Río A, López-Picazo J, Júdez Gutiérrez J, León Molina J. Quality indicators in gastroscopy. Gastroscopy procedure. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 111:699-709. [PMID: 31190549 DOI: 10.17235/reed.2019.6023/2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Within the project "Quality indicators in digestive endoscopy", pioneered by the Spanish Society for Digestive Diseases (SEPD), the objective of this research is to suggest the structure, process, and results procedures and indicators necessary to implement and assess quality in the gastroscopy setting. First, a chart was designed with the steps to be followed during a gastroscopy procedure. Secondly, a team of experts in care quality and/or endoscopy performed a qualitative review of the literature searching for quality indicators for endoscopic procedures, including gastroscopies. Finally, using a paired analysis approach, a selection of the literature obtained was undertaken. For gastroscopy, a total of nine process indicators were identified (one preprocedure, eight intraprocedure). Evidence quality was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification scale.
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Esteban Delgado P, Alberca de Las Parras F, López-Picazo Ferrer JJ, León Molina J. Quality indicators in enteroscopy. Enteroscopy procedure. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:299-308. [PMID: 32193937 DOI: 10.17235/reed.2020.6946/2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Within the project "Quality Indicators in Gastrointestinal Endoscopy," under the leadership of the Sociedad Española de Patología Digestiva (SEPD), our goal is to propose the procedures and the structure, process, and outcome indicators required for the application and assessment of quality in enteroscopy. To this end a search was performed for quality indicators in enteroscopy. Quality of evidence was measured by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system, and classified as high, moderate, low, and very low. A total of 10 process indicators (one preprocedure, eight procedure, one postprocedure) were identified for enteroscopy, with appropriate indication and choice of most efficient route being most significant.
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Affiliation(s)
| | | | | | - Joaquín León Molina
- Instituto Murciano de Investigación Biosanitaria,, Hospital Clínico Universitario Virgen de la Arrixaca
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Pérez-Cuadrado Martínez E. Does it matter how long the small bowel is? REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:246-248. [PMID: 32149523 DOI: 10.17235/reed.2020.6980/2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The small bowell (SB) is a very long organ hardly accessible to conventional endoscopy. The revolution entailed by its complete diagnostic exploration with capsule endoscopy (CE) has led to a change in traditional surgical management and its related gold standard - intraoperative enteroscopy. CE is currently the first-line diagnostic strategy for the SB. An emergent technique in its wake has played a key role in the management of patients with SB conditions: to wit, device-assisted enteroscopy (DAE). Thus were developed first double-balloon enteroscopy (DBE), then single-balloon enteroscopy, and most recently motorized spiral enteroscopy.
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Alberca de Las Parras F, López-Picazo J, Pérez Romero S, Sánchez Del Río A, Júdez Gutiérrez J, León Molina J. Quality indicators for endoscopic retrograde cholangiopancreatography. The procedure of endoscopic retrograde cholangiopancreatography. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 110:658-666. [PMID: 30071737 DOI: 10.17235/reed.2018.5652/2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The goal of the project encompassing the present paper is to propose useful quality procedures and indicators in order to improve quality in digestive endoscopy units. In this third part outcome procedures and indicators are suggested for endoscopic retrograde cholangiopancreatography (ERCP). First, a diagram of pre- and post-ERCP steps was developed. A group of experts in healthcare quality and/or endoscopy, under the shelter of the Spanish Society of Digestive Diseases (Sociedad Española de Patología Digestiva - SEPD), carried out a qualitative review of the literature regarding quality indicators for ERCP. Then, a paired analysis was used for the selection of identified references. A total of six specific indicators, apart from the common indicators already described, were identified, all of them process indicators (two pre-procedure and four post-procedure). Evidence quality was analyzed for each indicator using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) classification.
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Affiliation(s)
| | - Julio López-Picazo
- Servicio de Calidad Asistencial, Hospital Clínico Universitario Virgen de la Arrixaca
| | - Shirley Pérez Romero
- Servicio de Calidad Asistencial, Hospital Clínico Universitario Virgen de la Arrixaca
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