1
|
Vila JJ, Jusué Irurita V, Rullán Iriarte M. Is ERCP still the elective primary biliary drainage technique in patients with malignant distal biliary obstruction? Rev Esp Enferm Dig 2024; 116:182-185. [PMID: 38095214 DOI: 10.17235/reed.2023.10029/2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) has been established as the first line therapy for the resolution of biliary and pancreatic diseases. The main disadvantage of the procedure is the rate of adverse events, around 10%1. So, despite being a minimally invasive procedure, ERCP has a non-negligible rate of adverse effects (AEs) and secondary mortality.
Collapse
Affiliation(s)
- Juan J Vila
- Endoscopy Unit. Gastroenterology Department, Hospital Universitario de Navarra, España
| | | | | |
Collapse
|
2
|
Gornals JB, Velasquez-Rodriguez JG, Bas-Cutrina F, Garcia Garcia De Paredes A, Esteban JM, Teran A, Gonzalez-Huix F, Perez-Miranda M, Guarner-Argente C, Vila JJ, Garcia-Sumalla A, Foruny JR, Fisac-Vazquez J, Moris M, Miquel-Salas I, De-la-Serna Higuera C, Murzi-Pulgar M, Sanchez-Yague A, Salord S, Ruiz-Osuna S, Busquets J, Sanllorente-Melenchon M, Videla S, Moreno R, Tebe-Cordomi C, Hereu P, Vazquez-Sequeiros E. Plastic pigtail vs lumen-apposing metal stents for drainage of walled-off necrosis (PROMETHEUS study): an open-label, multicenter randomized trial. Surg Endosc 2024; 38:2148-2159. [PMID: 38448625 DOI: 10.1007/s00464-024-10699-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/14/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Lumen-apposing metal stents (LAMS) have displaced double-pigtail plastic stents (DPS) as the standard treatment for walled-off necrosis (WON),β but evidence for exclusively using LAMS is limited. We aimed to assess whether the theoretical benefit of LAMS was superior to DPS. METHODS This multicenter, open-label, randomized trial was carried out in 9 tertiary hospitals. Between June 2017, and Oct 2020, we screened 99 patients with symptomatic WON, of whom 64 were enrolled and randomly assigned to the DPS group (n = 31) or the LAMS group (n = 33). The primary outcome was short-term (4-weeks) clinical success determined by the reduction of collection. Secondary endpoints included long-term clinical success, hospitalization, procedure duration, recurrence, safety, and costs. Analyses were by intention-to-treat. CLINICALTRIALS gov, NCT03100578. RESULTS A similar clinical success rate in the short term (RR, 1.41; 95% CI 0.88-2.25; p = 0.218) and in the long term (RR, 1.2; 95% CI 0.92-1.58; p = 0.291) was observed between both groups. Procedure duration was significantly shorter in the LAMS group (35 vs. 45-min, p = 0.003). The hospital admission after the index procedure (median difference, - 10 [95% CI - 17.5, - 1]; p = 0.077) and global hospitalization (median difference - 4 [95% CI - 33, 25.51]; p = 0.82) were similar between both groups. Reported stent-related adverse events were similar for the two groups (36 vs.45% in LAMS vs. DPS), except for de novo fever, which was significantly 26% lower in LAMS (RR, 0.26 [0.08-0.83], p = 0.015). CONCLUSIONS The clinical superiority of LAMS over DPS for WON therapy was not proved, with similar clinical success, hospital stay and similar safety profile between both groups, yet a significant reduction in procedure time was observed. TRIAL REGISTRATION NUMBER ClinicalTrials.gov, NCT03100578.
Collapse
Affiliation(s)
- Joan B Gornals
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907, L'Hospitalet, Barcelona, Catalonia, Spain.
- Universitat de Barcelona (UB), Barcelona, Catalonia, Spain.
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain.
| | - Julio G Velasquez-Rodriguez
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907, L'Hospitalet, Barcelona, Catalonia, Spain
- Universitat de Barcelona (UB), Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
| | - Francesc Bas-Cutrina
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907, L'Hospitalet, Barcelona, Catalonia, Spain
- Universitat de Barcelona (UB), Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
| | - Ana Garcia Garcia De Paredes
- Endoscopy Unit, Gastroenterology and Hepatology Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
- Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Jose-Miguel Esteban
- Endoscopy Unit, Department of Digestive Diseases, Hospital Clínico San Carlos, Madrid, Spain
| | - Alvaro Teran
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Ferran Gonzalez-Huix
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari Arnau de Vilanova, Lleida, Catalonia, Spain
| | - Manuel Perez-Miranda
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Carlos Guarner-Argente
- Endoscopy Unit, Digestive Pathology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Juan J Vila
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitario de Navarra, Pamplona, Spain
| | - Albert Garcia-Sumalla
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907, L'Hospitalet, Barcelona, Catalonia, Spain
- Universitat de Barcelona (UB), Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
| | - Jose Ramon Foruny
- Endoscopy Unit, Gastroenterology and Hepatology Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
- Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Joaquin Fisac-Vazquez
- Endoscopy Unit, Department of Digestive Diseases, Hospital Clínico San Carlos, Madrid, Spain
| | - Maria Moris
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Isabel Miquel-Salas
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari Arnau de Vilanova, Lleida, Catalonia, Spain
| | | | - Marianette Murzi-Pulgar
- Endoscopy Unit, Digestive Pathology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Andres Sanchez-Yague
- Endoscopy Unit, Department of Digestive Diseases, Hospital Costa del Sol, Marbella, Spain
| | - Silvia Salord
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Hepato-Bilio-Pancreatic Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
| | - Sandra Ruiz-Osuna
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Radiology Department, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
| | - Juli Busquets
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Hepato-bilio-Pancreatic Unit, Department of General Surgery, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
| | - Mireia Sanllorente-Melenchon
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Clinical Research and Clinical Trial Unit (UICEC), Plataforma Spanish Clinical Research Network (SCRen), Clinical Pharmacology Department, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
| | - Sebas Videla
- Universitat de Barcelona (UB), Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Clinical Research and Clinical Trial Unit (UICEC), Plataforma Spanish Clinical Research Network (SCRen), Clinical Pharmacology Department, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
- Clinical Pharmacology Department, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
| | - Ramon Moreno
- Economics and Finance Department, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
| | - Cristian Tebe-Cordomi
- Universitat de Barcelona (UB), Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Biostatistics Department, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
| | - Pilar Hereu
- Universitat de Barcelona (UB), Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Clinical Research and Clinical Trial Unit (UICEC), Plataforma Spanish Clinical Research Network (SCRen), Clinical Pharmacology Department, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
- Clinical Pharmacology Department, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
| | - Enrique Vazquez-Sequeiros
- Endoscopy Unit, Gastroenterology and Hepatology Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
- Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
3
|
Vila JJ, Jusué Irurita V, Rullán Iriarte M. Is ERCP still the elective primary biliary drainage technique in patients with malignant distal biliary obstruction? Response to Garcia-Cano et al. Rev Esp Enferm Dig 2024. [PMID: 38469796 DOI: 10.17235/reed.2024.10380/2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
We have read the letter from García-Cano et al. regarding our Editorial and are very grateful for the response as it contributes to deepening the debate we aim to generate on the topic. We are aware that changing a paradigm is always difficult, takes years, and requires publication of good quality studies. However, the way to progress in medicine and provide the best for patients involves questioning existing paradigms and considering the possibility of changing them. Currently, the outcomes of endoscopic ultrasonography guided transmural biliary drainage (EUS-TBD) have been progressively improving and the rate of adverse events (AE) has considerably decreased. The data currently available suggest that primary EUS-TBD in a specific setting is not inferior to ERCP drainage and may even entail a lower rate of AE.
Collapse
Affiliation(s)
- Juan J Vila
- Endoscopy Unit. Gastroenterology, Hospital Universitario de Navarra, España
| | | | | |
Collapse
|
4
|
Bazaga S, García-Alonso FJ, Aparicio Tormo JR, Martinez Moreno B, Sanchiz V, Gornals JB, Loras C, Terán Á, Vazquez-Sequeiros E, Pedraza Sanz R, Súbtil JC, Pérez-Millan A, Uceda Porta F, Vila JJ, de la Serna-Higuera C, Couto-Worner I, Guarner-Argente C, Perez-Miranda M. Endoscopic ultrasound-guided gallbladder drainage with long-term lumen-apposing metal stent indwell: 1-year results from a prospective nationwide observational study. J Gastroenterol Hepatol 2024; 39:360-368. [PMID: 37920889 DOI: 10.1111/jgh.16392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND AND AIM This study aimed to determine safety and risk factors for adverse events (AEs) of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with long-term indwell of lumen-apposing metal stents (LAMS). METHODS This study is a multicenter prospective observational study on consecutive high surgical-risk patients requiring gallbladder drainage who underwent EUS-GBD with LAMS over 12 months. Centralized telephone follow-up interviews were conducted every 3 months for 1 year. Patients were censored at LAMS removal, cholecystectomy, or death. AE-free survival was determined using log-rank tests. Cumulative risks were estimated using life-table analysis. RESULTS Eighty-two patients were included (53.7% male, median [interquartile range] age of 84.6 [76.5-89.8] years, and 85.4% with acute cholecystitis). Technical success was achieved in 79 (96.3%), and clinical success in 73 (89%). No patient was lost to follow-up; 45 patients (54.9%) completed 1-year follow-up with in situ LAMS. Median (interquartile range) LAMS indwell time was 364 (47-367) days. Overall, 12 (14.6%) patients presented 14 AEs, including 5 (6.1%) recurrent biliary events (3 acute cholangitis, 1 mild acute pancreatitis, and 1 acute cholecystitis). Patients with pancreatobiliary malignancy had an increased risk of recurrent biliary events (33% vs 1.5%, P = 0.001). The overall 1-year cumulative risk of recurrent biliary events was 9.7% (4.1-21.8%). The 1-year risk of AEs and of severe AEs was 18.8% (11-31.2%) and 7.9% (3.3-18.2%), respectively. Pancreatobiliary malignancy was the single risk factor for recurrent biliary events; LAMS misdeployment was the strongest risk factor for AEs. CONCLUSIONS Long-term LAMS indwell does not increase the risk of delayed AEs following EUS-GBD.
Collapse
Affiliation(s)
- Sergio Bazaga
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
- Department of Medicine, Universitat Autónoma de Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | | | | | - Joan B Gornals
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Carme Loras
- Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, Terrassa, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Álvaro Terán
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Enrique Vazquez-Sequeiros
- Endoscopy Unit, Department of Gastroenterology and Hepatology, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | | | - José Carlos Súbtil
- Department of Gastroenterology, Endoscopy Unit, University of Navarra Clinic, University of Navarra, Pamplona, Spain
| | | | | | - Juan J Vila
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | | | - Carlos Guarner-Argente
- Department of Medicine, Universitat Autónoma de Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Perez-Miranda
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
| |
Collapse
|
5
|
Morão B, Carrascosa Gil J, Jusué Irurita V, Vila JJ. Endoscopic treatment of disconnected pancreatic duct syndrome secondary to acute necrotizing pancreatitis in a patient with pancreas divisum. Rev Esp Enferm Dig 2023. [PMID: 37706476 DOI: 10.17235/reed.2023.9883/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
A 50-year old male with acute necrotizing pancreatitis had an unfavorable evolution in the third week of disease, with development of large volume ascites and walled-off necrosis affecting the head and body of pancreas, suspected to be infected, with viable parenchyma in the tail of pancreas. Endoscopic ultrasound guided drainage of the collection was performed through placement of a lumen apposing metal stent. Selective cannulation of main pancreatic duct was only possible though the minor papilla and after contrast media injection a type 1 pancreas divisum and partial disruption of dorsal pancreatic duct were diagnosed.
Collapse
Affiliation(s)
| | | | | | - Juan J Vila
- Gastroenterology, Hospital Universitario de Navarra, España
| |
Collapse
|
6
|
Garcia-Alonso FJ, Chavarria C, Subtil JC, Aparicio JR, Busto Bea V, Martinez-Moreno B, Vila JJ, Martín-Álvarez V, Sanchez-Delgado L, de la Serna-Higuera C, Perez-Miranda M. Prospective multicenter assessment of the impact of EUS-guided gastroenterostomy on patient quality of life in unresectable malignant gastric outlet obstruction. Gastrointest Endosc 2023; 98:28-35. [PMID: 36801458 DOI: 10.1016/j.gie.2023.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/30/2022] [Accepted: 02/13/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND AND AIMS EUS-guided gastroenterostomy (EUS-GE) is increasingly used for malignant gastric outlet obstruction (GOO) in inoperable patients. However, the impact of EUS-GE on patient quality of life (QoL) has not been evaluated prospectively. METHODS Consecutive patients with unresectable malignant GOO who underwent EUS-GE between August 2019 and May 2021 at 4 Spanish centers were prospectively assessed using the European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 at baseline and 1 month after the procedure. Centralized follow-up by telephone calls was undertaken. The Gastric Outlet Obstruction Scoring System (GOOSS) was used to assess oral intake, defining clinical success as a GOOSS ≥2. Differences between baseline and 30-day QoL scores were assessed using a linear mixed model. RESULTS Sixty-four patients were enrolled, 33 (51.6%) men, with a median age of 77.3 years (interquartile range, 65.5-86.5). The most common diagnoses were pancreatic (35.9%) and gastric (31.3%) adenocarcinoma. Thirty-seven patients (57.9%) presented a 2/3 baseline Eastern Cooperative Oncology Group performance status score. Oral intake was restarted within 48 hours in 61 patients (95.3%), and the median postprocedure hospital stay was 3.5 days (interquartile range, 2-5). The 30-day clinical success rate was 83.3%. A clinically significant increase of 21.6 points (95% confidence interval, 11.5-31.7) in the global health status scale was documented, with significant improvements in nausea and vomiting, pain, constipation, and appetite loss. CONCLUSIONS EUS-GE relieves GOO symptoms in patients with unresectable malignancy, allowing rapid oral intake and hospital discharge. It also provides a clinically relevant increase in QoL scores at 30 days from baseline. (Clinical trial registration number: NCT04660695.).
Collapse
Affiliation(s)
| | - Carlos Chavarria
- Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Jose Carlos Subtil
- Gastroenterology Department, Clínica Universitaria de Navarra, Navarra, Pamplona, Spain
| | - Jose Ramón Aparicio
- Endoscopy Unit, Hospital General Universitario Dr Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, Alicante, Spain
| | - Victoria Busto Bea
- Gastroenterology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Belén Martinez-Moreno
- Endoscopy Unit, Hospital General Universitario Dr Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, Alicante, Spain
| | - Juan J Vila
- Gastroenterology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | | | | | | | - Manuel Perez-Miranda
- Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid, Spain
| |
Collapse
|
7
|
Vila JJ, Arrubla Gamboa A, Jusué V, Estremera-Arévalo F, González de la Higuerra B, Carrascosa Gil J, Rodríguez Mendiluce I, Hervás N, Prieto C, Gómez Alonso M, Fernández-Urién I, Ibáñez Beroiz B. The volume of ERCP per endoscopist is associated with a higher technical success and a lower post-ERCP pancreatitis rate. A prospective analysis. Rev Esp Enferm Dig 2023; 115:368-373. [PMID: 36043537 DOI: 10.17235/reed.2022.9056/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION conflicting results have been reported regarding the influence of the annual volume of endoscopic retrograde cholangiopancreatography (ERCP) on outcome. OBJECTIVE to evaluate the influence of case volume on ERCP outcomes. PATIENTS AND METHODS an analysis of a prospective database was performed, comparing the outcomes of ERCP in three consecutive periods defined by the number of endoscopists performing ERCP: five endoscopists in period I (P1), four in period II (P2) and three in period III (P3). Only patients with biliary ERCP in accessible and naïve papilla were included. Primary variables were cannulation rates and adverse effects (AE). The American Society of Gastrointestinal Endoscopy (ASGE) complexity grades III and IV were considered as highly complex procedures. RESULTS a total of 2,561 patients were included: 727 (P1), 972 (P2) and 862 (P3). There were no differences in age and sex between groups (p > 0.05). The cannulation rate was significantly higher in P2 and P3: 92.4 % vs 93.3 % vs 93 % (p = 0.037). The AE rate was 13.8 %, 12.6 % and 10.3 % (p > 0.05), respectively. The rate of post-ERCP pancreatitis was significantly lower in P3: 8.5 %, 7.3 % and 5 % (p = 0.01). The rate of complex procedures was 12 %, 14.8 % and 27 % (p < 0.0001), respectively. Two endoscopists participated in all periods and only one had significantly improved outcomes. Cannulation and post-ERCP pancreatitis rates remained significantly better in P3 after adjusting for sex, complexity and endoscopist. CONCLUSION a higher annual volume of ERCP per endoscopist was associated with a higher rate of cannulation and a lower rate of post-ERCP pancreatitis, despite the greater complexity of the procedures. These beneficial effects seem to differ between endoscopists.
Collapse
Affiliation(s)
- Juan J Vila
- Digestivo A, Hospital Universitario de Navarra, España
| | - Amaia Arrubla Gamboa
- Endoscopia. Servicio de Aparato Digestivo, Hospital Universitario de Navarra, España
| | - Vanesa Jusué
- Endoscopia. Servicio de Aparato Digestivo, Hospital Universitario de Navarra
| | | | | | - Juan Carrascosa Gil
- Endoscopia. Servicio de Aparato Digestivo, Hospital Universitario de Navarra
| | | | - Nerea Hervás
- Endoscopia. Servicio de Aparato Digestivo, Hospital Universitario de Navarra
| | - Carlos Prieto
- Endoscopia. Servicio de Aparato Digestivo, Hospital Universitario de Navarra
| | - Marta Gómez Alonso
- Endoscopia. Servicio de Aparato Digestivo, Hospital Universitario de Navarra
| | | | | |
Collapse
|
8
|
Zabalza L, Ezcurra I, Fuertes C, Rullán M, Jusué V, Montón S, Vila JJ. Esophageal actinomycosis simulating circumferential neoplasia. Gastroenterol Hepatol 2023; 46:195-196. [PMID: 35605826 DOI: 10.1016/j.gastrohep.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022]
Affiliation(s)
- L Zabalza
- Servicio de Aparato Digestivo, Hospital Universitario de Navarra, Pamplona, Navarra, España.
| | - I Ezcurra
- Sección de Aparato Digestivo, Hospital García Orcoyen, Estella, Navarra, España
| | - C Fuertes
- Servicio de Anatomía Patológica, Hospital Universitario de Navarra, Pamplona, Navarra, España
| | - M Rullán
- Sección de Aparato Digestivo, Hospital García Orcoyen, Estella, Navarra, España
| | - V Jusué
- Servicio de Aparato Digestivo, Hospital Universitario de Navarra, Pamplona, Navarra, España
| | - S Montón
- Servicio de Cirugía General, Hospital García Orcoyen, Estella, Navarra, España
| | - J J Vila
- Servicio de Aparato Digestivo, Hospital Universitario de Navarra, Pamplona, Navarra, España
| |
Collapse
|
9
|
Couselo M, Ibáñez V, Ortolá P, Carazo E, Valdés E, Vila JJ. Adequate timing of diagnostic tests for gastroesophageal reflux in children with esophageal atresia. Cir Pediatr 2023; 36:5-11. [PMID: 36629342 DOI: 10.54847/cp.2023.01.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Recent guidelines made recommendations for the management of gastroesophageal reflux in patients with esophageal atresia (EA). However, the timing for some diagnostic tests remained somehow unclear. This investigation studied the tests for gastroesophageal reflux in children aged one year old and children aged two or three. MATERIALS AND METHODS Patients with EA who underwent Multichannel Intraluminal Impedance-pH monitoring (MII-pH) and endoscopy-histology were studied retrospectively. Patients aged one when the test was performed were the YO group and patients aged two or three years old formed the OL group. Substantially impaired MII-pH was defined as total number of reflux episodes >105 or >85 (depending on age), or reflux index >10%. Substantially impaired endoscopy was defined as erosive esophagitis or Barrett's esophagus. Substantially impaired histology was defined as moderate-severe esophagitis or Barrett's esophagus. Conventional parameters and substantially impaired values of the tests were compared. RESULTS Twenty-four patients were studied. Twenty-three MII-pH were performed (12 in YO and 11 in OL): percentages of abnormal conventional parameters of MII-pH were not significantly different in both groups. Twenty endoscopies with biopsies were performed (7 in YO and 13 in OL): percentages of esophagitis were not significantly different. Interestingly, 26.9% of all the tests performed in YO were substantially impaired vs. 10.8% of all the tests in OL (χ2 = 2.7; p = 0.1). CONCLUSION Considering the percentage of alarming results of diagnostic tests in the YO group it would be advisable that patients with EA undergo MII-pH and endoscopy-histology at one year of age.
Collapse
Affiliation(s)
- M Couselo
- Pediatric Surgery Department. Hospital Universitario y Politécnico La Fe. Valencia (Spain)
| | - V Ibáñez
- Pediatric Surgery Department. Hospital Universitario y Politécnico La Fe. Valencia (Spain)
| | - P Ortolá
- Pediatric Surgery Department. Hospital Universitario y Politécnico La Fe. Valencia (Spain)
| | - E Carazo
- Pediatric Surgery Department. Hospital Universitario y Politécnico La Fe. Valencia (Spain)
| | - E Valdés
- Pediatric Surgery Department. Hospital Universitario y Politécnico La Fe. Valencia (Spain)
| | - J J Vila
- Pediatric Surgery Department. Hospital Universitario y Politécnico La Fe. Valencia (Spain)
| |
Collapse
|
10
|
Pérez-Cuadrado-Robles E, Bronswijk M, Prat F, Barthet M, Palazzo M, Arcidiacono P, Schaefer M, Devière J, van Wanrooij RLJ, Tarantino I, Donatelli G, Camus M, Sanchez-Yague A, Pham KDC, Gonzalez JM, Anderloni A, Vila JJ, Jezequel J, Larghi A, Jaïs B, Vazquez-Sequeiros E, Deprez PH, Van der Merwe S, Cellier C, Rahmi G. Endoscopic ultrasound-guided drainage using lumen-apposing metal stent of malignant afferent limb syndrome in patients with previous Whipple surgery: Multicenter study (with video). Dig Endosc 2022; 34:1433-1439. [PMID: 35429360 DOI: 10.1111/den.14330] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/14/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Endoscopic ultrasound-guided digestive anastomosis (EUS-A) is a new alternative under evaluation in patients presenting with afferent limb syndrome (ALS) after Whipple surgery. The aim of the present study is to analyze the safety and effectiveness of EUS-A in ALS. METHODS This is an observational multicenter study. All patients ≥18 years old with previous Whipple surgery presenting with ALS who underwent an EUS-A using a lumen-apposing metal stent (LAMS) between 2015 and 2021 were included. The primary outcome was clinical success, defined as resolution of the ALS or ALS-related cholangitis. Furthermore, technical success, adverse event rate, and mortality were evaluated. RESULTS Forty-five patients (mean age: 65.5 ± 10.2 years; 44.4% male) were included. The most common underlying disease was pancreatic cancer (68.9%). EUS-A was performed at a median of 6 weeks after local tumor recurrence. The most common approach used was the direct/freehand technique (66.7%). Technical success was achieved in 95.6%, with no differences between large (≥15 mm) and small LAMS (97.4% vs. 100%, P = 0.664). Clinical success was retained in 91.1% of patients. A complementary treatment by dilation of the stent followed by endoscopic retrograde cholangiopancreatography through the LAMS was performed in three cases (6.7%). There were six recurrent episodes of cholangitis (14.6%) and two procedure-related adverse events (4.4%) after a median follow-up of 4 months. Twenty-six patients (57.8%) died during the follow-up due to disease progression. CONCLUSION EUS-A is a safe and effective technique in the treatment of malignant ALS, achieving high clinical success with an acceptable recurrence rate.
Collapse
Affiliation(s)
- Enrique Pérez-Cuadrado-Robles
- Department of Gastroenterology, University of Paris, Georges-Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium
| | - Fréderic Prat
- Department of Endoscopy, Hopital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France
| | - Marc Barthet
- Department of Gastroenterology and Endoscopy, Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - Maxime Palazzo
- Department of Endoscopy, Hopital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France
| | - Paolo Arcidiacono
- Division of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Marion Schaefer
- Department of Endoscopy and Hepatogastroenterology, Regional University Hospital of Nancy, Nancy, France
| | - Jacques Devière
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme University Hospital - Université Libre de Bruxelles, Brussels, Belgium
| | - Roy L J van Wanrooij
- Department of Gastroenterology and Hepatology, AG&M Research Institute, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ilaria Tarantino
- Endoscopy Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS - ISMETT), Palermo, Italy
| | - Gianfranco Donatelli
- Department of Surgical, Interventional Endoscopy Unit, Private Hospital Peupliers-Ramsay Santé, Paris, France
| | - Marine Camus
- Sorbonne University, Endoscopic Unit, Saint Antoine Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Khanh Do-Cong Pham
- Section of Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Jean-Michel Gonzalez
- Department of Gastroenterology and Endoscopy, Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Juan J Vila
- Endoscopy Unit, Gastroenterology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Julien Jezequel
- Department of Gastroenterology, University Hospital of Brest, Brest, France
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Bénédicte Jaïs
- Department of Endoscopy, Hopital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France
| | - Enrique Vazquez-Sequeiros
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Pierre H Deprez
- Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Schalk Van der Merwe
- Department of Surgical, Interventional Endoscopy Unit, Private Hospital Peupliers-Ramsay Santé, Paris, France
| | - Christophe Cellier
- Department of Gastroenterology, University of Paris, Georges-Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Gabriel Rahmi
- Department of Gastroenterology, University of Paris, Georges-Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| |
Collapse
|
11
|
Albéniz E, Estremera-Arevalo F, Rosón PJ, Fernandez Cano F, Heredia ML, Ishaq S, Vila JJ. Cricopharyngeal peroral endoscopic myotomy for achalasia of the cricopharynx: "to do or not to do". Endoscopy 2022; 54:E382-E383. [PMID: 34374042 DOI: 10.1055/a-1544-7677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Eduardo Albéniz
- Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain.,Navarrabiomed Biomedical Research Center, Public University of Navarre, Navarre Institute for Health Research, Pamplona, Spain
| | | | - Pedro J Rosón
- Gastroenterology Endoscopy Unit, Hospital Quirónsalud Málaga, Málaga, Spain
| | | | - María L Heredia
- Gastroenterology Department, Mateu Orfila General Hospital, Mahon, Spain
| | - Sauid Ishaq
- Health and Science, Birmingham City University, Birmingham, United Kingdom.,University of Birmingham, Russells Hall Hospital, Birmingham, United Kingdom
| | - Juan J Vila
- Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| |
Collapse
|
12
|
Uribarri-González L, Pérez-Aguado G, Arrubla Gamboa A, Vila JJ. EUS-guided therapy of nonvariceal refractory bleeding: A prospective observational study. Endosc Ultrasound 2022:346862. [PMID: 35708360 PMCID: PMC9526097 DOI: 10.4103/eus-d-21-00169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Laura Uribarri-González
- Department of Gastroenterology, Endoscopy Unit, Hospital Universitario de Navarra, Navarra, Spain
| | - Guillermo Pérez-Aguado
- Department of Gastroenterology, Complejo Hospitalario Insular-Materno Infantil de Gran Canaria, Las Palmas, Spain
| | - Amaia Arrubla Gamboa
- Department of Gastroenterology, Endoscopy Unit, Hospital Universitario de Navarra, Navarra, Spain
| | - Juan J Vila
- Department of Gastroenterology, Endoscopy Unit, Hospital Universitario de Navarra, Navarra, Spain
| |
Collapse
|
13
|
Arechederra M, Rullán M, Amat I, Oyon D, Zabalza L, Elizalde M, Latasa MU, Mercado MR, Ruiz-Clavijo D, Saldaña C, Fernández-Urién I, Carrascosa J, Jusué V, Guerrero-Setas D, Zazpe C, González-Borja I, Sangro B, Herranz JM, Purroy A, Gil I, Nelson LJ, Vila JJ, Krawczyk M, Zieniewicz K, Patkowski W, Milkiewicz P, Cubero FJ, Alkorta-Aranburu G, G Fernandez-Barrena M, Urman JM, Berasain C, Avila MA. Next-generation sequencing of bile cell-free DNA for the early detection of patients with malignant biliary strictures. Gut 2022; 71:1141-1151. [PMID: 34285068 PMCID: PMC9120390 DOI: 10.1136/gutjnl-2021-325178] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/08/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Despite significant progresses in imaging and pathological evaluation, early differentiation between benign and malignant biliary strictures remains challenging. Endoscopic retrograde cholangiopancreatography (ERCP) is used to investigate biliary strictures, enabling the collection of bile. We tested the diagnostic potential of next-generation sequencing (NGS) mutational analysis of bile cell-free DNA (cfDNA). DESIGN A prospective cohort of patients with suspicious biliary strictures (n=68) was studied. The performance of initial pathological diagnosis was compared with that of the mutational analysis of bile cfDNA collected at the time of first ERCP using an NGS panel open to clinical laboratory implementation, the Oncomine Pan-Cancer Cell-Free assay. RESULTS An initial pathological diagnosis classified these strictures as of benign (n=26), indeterminate (n=9) or malignant (n=33) origin. Sensitivity and specificity of this diagnosis were 60% and 100%, respectively, as on follow-up 14 of the 26 and eight of the nine initially benign or indeterminate strictures resulted malignant. Sensitivity and specificity for malignancy of our NGS assay, herein named Bilemut, were 96.4% and 69.2%, respectively. Importantly, one of the four Bilemut false positives developed pancreatic cancer after extended follow-up. Remarkably, the sensitivity for malignancy of Bilemut was 100% in patients with an initial diagnosis of benign or indeterminate strictures. Analysis of 30 paired bile and tissue samples also demonstrated the superior performance of Bilemut. CONCLUSION Implementation of Bilemut at the initial diagnostic stage for biliary strictures can significantly improve detection of malignancy, reduce delays in the clinical management of patients and assist in selecting patients for targeted therapies.
Collapse
Affiliation(s)
- Maria Arechederra
- Hepatology Program, CIMA, University of Navarra, Pamplona, Spain,Navarra Institute for Health Research, IdiSNA, Pamplona, Spain
| | - María Rullán
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain,Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, Pamplona, Spain
| | - Irene Amat
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain,Department of Pathology, Navarra University Hospital Complex, Pamplona, Spain
| | - Daniel Oyon
- Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, Pamplona, Spain
| | - Lucia Zabalza
- Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, Pamplona, Spain
| | - Maria Elizalde
- Hepatology Program, CIMA, University of Navarra, Pamplona, Spain
| | - M Ujue Latasa
- Hepatology Program, CIMA, University of Navarra, Pamplona, Spain,Navarra Institute for Health Research, IdiSNA, Pamplona, Spain
| | - Maria R Mercado
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain,Department of Pathology, Navarra University Hospital Complex, Pamplona, Spain
| | - David Ruiz-Clavijo
- Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, Pamplona, Spain
| | - Cristina Saldaña
- Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, Pamplona, Spain
| | - Ignacio Fernández-Urién
- Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, Pamplona, Spain
| | - Juan Carrascosa
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain,Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, Pamplona, Spain
| | - Vanesa Jusué
- Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, Pamplona, Spain
| | - David Guerrero-Setas
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain,Molecular Pathology of Cancer Group, Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), Pamplona, Spain
| | - Cruz Zazpe
- Department of General Surgery, Navarra University Hospital Complex, Pamplona, Spain
| | | | - Bruno Sangro
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain,Liver Unit, Dept. of Internal Medicine, Clinica Universitaria de Navarra, Pamplona, Spain,CIBEREHD, Madrid, Spain
| | - Jose M Herranz
- Hepatology Program, CIMA, University of Navarra, Pamplona, Spain,CIBEREHD, Madrid, Spain
| | - Ana Purroy
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain,Biobank Unit, Navarrabiomed, Pamplona, Spain
| | - Isabel Gil
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain,Biobank Unit, Navarrabiomed, Pamplona, Spain
| | - Leonard J Nelson
- Institute for Bioengineering, University of Edinburgh, Edinburgh, UK
| | - Juan J Vila
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain,Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, Pamplona, Spain
| | - Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany,Liver and Internal Medicine Unit, Medical University of Warsaw, Warszawa, Poland
| | - Krzysztof Zieniewicz
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Waldemar Patkowski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Milkiewicz
- Liver and Internal Medicine Unit, Medical University of Warsaw, Warsaw, Poland,Translational Medicine Group, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Francisco Javier Cubero
- CIBEREHD, Madrid, Spain,Department of Immunology, Ophtalmology and ENT, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | | | - Maite G Fernandez-Barrena
- Hepatology Program, CIMA, University of Navarra, Pamplona, Spain,Navarra Institute for Health Research, IdiSNA, Pamplona, Spain,CIBEREHD, Madrid, Spain
| | - Jesus M Urman
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain,Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, Pamplona, Spain
| | - Carmen Berasain
- Hepatology Program, CIMA, University of Navarra, Pamplona, Spain .,Navarra Institute for Health Research, IdiSNA, Pamplona, Spain.,CIBEREHD, Madrid, Spain
| | - Matias A Avila
- Hepatology Program, CIMA, University of Navarra, Pamplona, Spain .,Navarra Institute for Health Research, IdiSNA, Pamplona, Spain.,CIBEREHD, Madrid, Spain
| |
Collapse
|
14
|
Martínez-Acitores de la Mata D, Zabalza L, Ubieto V, Moya JL, Carrascosa J, Montón S, Vila JJ. Endoscopic ultrasound-guided rendezvous for extrahepatic bile duct recanalization after surgical transection. Endoscopy 2022; 54:431-432. [PMID: 33910250 DOI: 10.1055/a-1471-1685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
| | - Lucía Zabalza
- Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Verónica Ubieto
- Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - José Luis Moya
- Surgery Department, Hospital Garcia Orcoyen, Estella, Spain
| | - Juan Carrascosa
- Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Soledad Montón
- Surgery Department, Hospital Garcia Orcoyen, Estella, Spain
| | - Juan J Vila
- Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| |
Collapse
|
15
|
Diéguez I, Costa A, Miró I, March Villalba JA, Del Peral M, Marco Macián A, Vila JJ. En bloc resection vs. Gips procedure in pilonidal sinus surgery. Cir Pediatr 2022; 35:75-79. [PMID: 35485755 DOI: 10.54847/cp.2022.02.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Pilonidal sinus (PS) is an infectious/inflammatory condition of the sacrococcygeal region, with frequent relapses. There is no clear consensus as to which management technique is best. The most widely used technique is en bloc resection (EBR), but less invasive methods (Gips procedure) are now being developed. OBJECTIVE To compare complications and progression of pediatric patients undergoing PS surgery in our institution using two different surgical techniques. MATERIAL AND METHODS A retrospective study of patients under 16 years of age undergoing PS surgery (EBR/Gips procedure) for the first time from 2014 to 2020 was carried out. Demographic variables, complications in the first month (exudate, wound infection, dehiscence, and bleeding), and result at the end of follow-up were collected. Qualitative variables were expressed as absolute frequency and percentage, whereas quantitative variables were expressed as mean and standard deviation. RESULTS 60 patients underwent surgery. EBR was used in the first group, and the Gips procedure was used in the second group (76.67%, n = 46 vs. 23.33%, n = 14). Both were comparable in terms of sex (32.61% vs. 35.71% male), age (14.04 vs. 13.79 years old), and BMI (26.63 vs. 26.20 kg/m2) at surgery. 6 patients underwent re-intervention (10.87% vs. 7.14%; p = 0.684). Median follow-up time to healing was 6.13 ± 0.98 months vs. 3.31 ± 1.26 months (p < 0.024). The Gips procedure caused no dehiscence, whereas dehiscence rate in EBR was 65.22%. CONCLUSION The Gips procedure is a minimally invasive alternative to EBR. It avoids dehiscence, and time to healing is shorter. Therefore, it should be regarded as the first-line treatment in PS patients.
Collapse
Affiliation(s)
- I Diéguez
- La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - A Costa
- La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - I Miró
- La Fe University and Polytechnic Hospital. Valencia (Spain)
| | | | - M Del Peral
- La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - A Marco Macián
- La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - J J Vila
- La Fe University and Polytechnic Hospital. Valencia (Spain)
| |
Collapse
|
16
|
Stassen PMC, Goodchild G, de Jonge PJF, Erler NS, Anderloni A, Cennamo V, Church NI, Fernandez-Urien Sainz I, Huggett MT, James MW, Joshi D, Kylänpää L, Laleman W, Nayar MK, Oppong KW, Poley JW, Potts JR, Repici A, Udd M, Vila JJ, Wong T, Bruno MJ, Webster GJM. Diagnostic accuracy and interobserver agreement of digital single-operator cholangioscopy for indeterminate biliary strictures. Gastrointest Endosc 2021; 94:1059-1068. [PMID: 34216597 DOI: 10.1016/j.gie.2021.06.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/22/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Digital single-operator cholangioscopy (d-SOC) with cholangioscopic biopsy sampling has shown promise in the evaluation of indeterminate biliary strictures. Some studies have suggested higher sensitivity for visual impression compared with biopsy sampling, although assessors were not blinded to previous investigations. We aimed to investigate the diagnostic accuracy and interobserver agreement (IOA) of d-SOC in the visual appraisal of biliary strictures when blinded to additional information. METHODS A multicenter, international cohort study was performed. Cholangioscopic videos in patients with a known final diagnosis were systematically scored. Pseudonymized videos were reviewed by 19 experts in 2 steps: blinded for patient history and investigations and unblinded. RESULTS Forty-four high-quality videos were reviewed of 19 benign and 25 malignant strictures. The sensitivity and specificity for the diagnosis of malignancy was 74.2% and 46.9% (blinded) and 72.7% and 62.5% (unblinded). Cholangioscopic certainty of a malignant diagnosis led to overdiagnosis (sensitivity, 90.6%; specificity, 33%), especially if no additional information was provided. The IOA for the presence of malignancy was fair for both assessments (Fleiss' κ = .245 [blinded] and κ = .321 [unblended]). For individual visual features, the IOA ranged from slight to moderate for both assessments (κ = .059-.400 vs κ = .031-.452). CONCLUSIONS This study showed low sensitivity and specificity for blinded and unblinded d-SOC video appraisal of indeterminate biliary strictures, with considerable interobserver variation. Although reaching a consensus on the optical features of biliary strictures remains important, optimizing visually directed biopsy sampling may be the most important role of cholangioscopy in biliary stricture assessment.
Collapse
Affiliation(s)
- Pauline M C Stassen
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - George Goodchild
- Department of Gastroenterology, University College London Hospitals, London, UK
| | - Pieter Jan F de Jonge
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nicole S Erler
- Department of Biostatistics, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Milan, Italy
| | - Vincenzo Cennamo
- Gastroenterology and Interventional Endoscopy Unit, Local Health Authority of Bologna, Bologna, Italy
| | - Nicholas I Church
- Department of Gastroenterology and Hepatology, Lothian University Hospitals NHS Trust, Edinburgh, UK
| | | | - Matthew T Huggett
- Department of Gastroenterology, St James's University Hospital, Leeds, UK
| | - Martin W James
- Nottingham Digestive Disease Centre (NDDC) and NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University and Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, UK
| | - Deepak Joshi
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Leena Kylänpää
- Department of Gastroenterological surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Wim Laleman
- Department of Gastroenterology and Hepatology, Section of Liver and Biliopancreatic disorders, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Manu K Nayar
- HPB Unit Newcastle upon Tyne Hospitals, and Translational and Clinical Research Institute Newcastle University, Newcastle, UK
| | - Kofi W Oppong
- HPB Unit Newcastle upon Tyne Hospitals, and Translational and Clinical Research Institute Newcastle University, Newcastle, UK
| | - Jan-Werner Poley
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Alessandro Repici
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Marianne Udd
- Department of Gastroenterological surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juan J Vila
- Department of Gastroenterology and Hepatology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Terence Wong
- Department of Gastroenterology and Hepatology, Guys and St Thomas' Hospital, London, UK
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - George J M Webster
- Department of Gastroenterology, University College London Hospitals, London, UK; Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK
| | | |
Collapse
|
17
|
Costa-Roig A, Martín F, Diéguez I, Escrig R, Fonseca R, Barrios JE, Pérez-Tarazona S, López J, Ibáñez I, Gutiérrez C, Vila JJ. Management of congenital and acquired airway pathologies in newborns by a cross-disciplinary committee at a third level hospital. Cir Pediatr 2021; 34:180-185. [PMID: 34606697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Neonatal airway examination through flexible/rigid bronchoscopy has proved to be useful in the presence of persistent stridor and extubation failure, as well as to assess complications following cardiac surgery. At our institution, these examinations are carried out by a pulmonologist, a neonatologist, an otorhinolaryngologist, and a pediatric surgeon from the pediatric airway committee, established in 2014. OBJECTIVE To analyze the airway examinations performed in neonates during their stay at the neonatology/neonatal intensive care unit since the airway committee was established. MATERIAL AND METHODS A retrospective study of the airway examinations conducted in neonates from 2015 to 2019 was carried out. Clinical and demographic data, number of examinations, indications, findings, and complications were collected. Results are presented as mean and standard deviation. Statistical significance was established at p < 0.05. RESULTS 92 airway examinations were analyzed in 51 patients (54.9% of whom were female). 51% of the patients were premature. Extubation failure and persistent respiratory symptoms following successful extubation were the most frequent indications for airway examination (35.3%). Stratification by gestational age or weight at birth was not associated with an increased risk of pathological findings at examination (p > 0.05). The most frequent finding was vocal cord paralysis (n = 14; 27.5%). In 10 patients (19.6%), no pathological findings were observed. CONCLUSION Airway examination is useful in patients with stridor to identify vocal cord paralysis following extubation failure. It also allows congenital airway pathologies to be diagnosed and treated. The number of examinations with no pathological findings was similar to that reported in international series.
Collapse
Affiliation(s)
- A Costa-Roig
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - F Martín
- Neonatology Department and Pediatric Neonatal Intensive Care Unit. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - I Diéguez
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - R Escrig
- Neonatology Department and Pediatric Neonatal Intensive Care Unit. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - R Fonseca
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - J E Barrios
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - S Pérez-Tarazona
- Pediatric Pulmonology Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - J López
- Pediatric Pulmonology Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - I Ibáñez
- Pediatric Otorhinolaryngology Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - C Gutiérrez
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - J J Vila
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| |
Collapse
|
18
|
Diéguez I, Fonseca R, Cortés J, Miró I, Costa A, Del Peral M, Vila JJ. Usefulness of digestive biopsy in the diagnosis of graft-versus-host disease. Cir Pediatr 2021; 34:125-129. [PMID: 34254749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Graft-versus-host disease (GVHD) is a frequent complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT), with high morbidity and mortality rates. Intestinal clinical signs are unspecific, which means differential diagnosis with infections and drug-related etiology should be carried out. Even though intestinal biopsy is widely considered as the gold standard technique, there is no consensus as to which sampling method is best. OBJECTIVE To assess the results of the biopsy techniques used in patients with suspected intestinal GVHD. MATERIAL AND METHODS A retrospective study of patients with suspected intestinal GVHD undergoing allo-HSCT from 2010 to 2019 was carried out. They were assessed through digestive biopsy - esophagogastroduodenal biopsy (upper GI endoscopy - UGIE) or rectal biopsy (colonoscopy or direct biopsy). Quantitative variables, expressed as median and interquartile range, and qualitative variables, expressed as absolute frequency and percentage, were collected. RESULTS 23 patients were studied, 60.9% of whom were male. Median age at biopsy was 9 years (7-14 years). UGIE was used in 47.8% of patients (n=11), colonoscopy was used in 26.1% of patients (n=6), and direct biopsy was used in 34.8% of patients (n=8), with GVHD positive results in 2 (18.2%), 2 (33.3%), and 4 (50%) patients, respectively. CONCLUSIONS Samples taken through direct biopsy stand as an effective alternative in GVHD diagnosis.
Collapse
Affiliation(s)
- I Diéguez
- Pediatric Surgery Department. La Fe Polytechnic and University Hospital. Valencia (Spain)
| | - R Fonseca
- Pediatric Surgery Department. La Fe Polytechnic and University Hospital. Valencia (Spain)
| | - J Cortés
- Pediatric Surgery Department. La Fe Polytechnic and University Hospital. Valencia (Spain)
| | - I Miró
- Pediatric Surgery Department. La Fe Polytechnic and University Hospital. Valencia (Spain)
| | - A Costa
- Pediatric Surgery Department. La Fe Polytechnic and University Hospital. Valencia (Spain)
| | - M Del Peral
- Pediatric Surgery Department. La Fe Polytechnic and University Hospital. Valencia (Spain)
| | - J J Vila
- Pediatric Surgery Department. La Fe Polytechnic and University Hospital. Valencia (Spain)
| |
Collapse
|
19
|
Zabalza L, Jusué V, Martínez-Acitores D, Ubieto V, Aburruza L, González Gete G, De Lima G, Vila JJ. [Duodenal capillary hemangioma as an atypical cause of iron deficiency. Case report]. An Sist Sanit Navar 2021; 44:119-122. [PMID: 33853215 DOI: 10.23938/assn.0916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hemangiomas are benign vascular gastrointestinal tumours. They are infrequent, located in the submucosa, and can be asymptomatic or cause intestinal obstruction, anaemia or ferropenia. Their initial diagnosis is usually endoscopic despite the absence of pathognomonic features. Traditionally their treatment has been surgical although endoscopic resection is now possible. We present a case of ferropenia resolved after endoscopic resection of a capillary duodenal hemangioma.
Collapse
Affiliation(s)
- L Zabalza
- Servicio de Digestivo. Complejo Hospitalario de Navarra. Pamplona..
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Vila JJ, Carrascosa J, Fernández-Urién I, Yeaton P, González G, Aburruza L, Zozaya JM. Biliary hitch and ride technique for blind pancreatic duct cannulation. Endoscopy 2021; 53:E29-E30. [PMID: 32483790 DOI: 10.1055/a-1173-7910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Juan J Vila
- Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Juan Carrascosa
- Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Ignacio Fernández-Urién
- Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Paul Yeaton
- Endoscopy Unit, Gastroenterology Department, Carilion Clinic, Roanoke, Virginia, United States
| | - Gonzalo González
- Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Leire Aburruza
- Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - José Manuel Zozaya
- Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| |
Collapse
|
21
|
Abstract
ERCP and EUS are complementary techniques in the management of biliary and pancreatic diseases. Combination of these two techniques can reach different levels of complexity with increasing rates of adverse events. In this article we propose a categorization of the relationship between EUS and ERCP based on whether EUS indicates, complements, facilitates or replaces ERCP. It has implications for the complexity of the technique, the training of the endoscopist and the necessary hospital resources. This classification can also be useful in planning endoscopist training and patient management.
Collapse
Affiliation(s)
- Juan J Vila
- Department of Gastroenterology, Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Iñaki Fernández-Urién
- Department of Gastroenterology, Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Juan Carrascosa
- Department of Gastroenterology, Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| |
Collapse
|
22
|
Vila JJ, Bolado F. Endoscopic management of local complications of chronic pancreatitis. Rev Esp Enferm Dig 2020; 113:602-609. [PMID: 33267598 DOI: 10.17235/reed.2020.7372/2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Endoscopic treatment of local complications in patients with chronic pancreatitis has gained ground over the surgical alternative in the last few years. The lower aggressiveness of endoscopic treatment, as well as the possibility to use it repeatedly in high-risk patients, has favored this development. In addition, the incorporation of new, highly accurate endoscopic therapeutic options such as pancreatoscopy-guided lithotripsy and endoscopic ultrasound-guided treatments make endoscopic treatment the first choice in many cases, despite discordant data in the literature. This article reviews the endoscopic treatment of the most common local complications of chronic pancreatitis, such as pancreatolithiasis, pseudocysts, and pancreatic, biliary, and duodenal ductal stenosis.
Collapse
Affiliation(s)
- Juan J Vila
- Aparato Digestivo, Complejo Hospitalario de Navarra, España
| | | |
Collapse
|
23
|
Vila JJ, Mendioroz FJJ, Yeaton P, Fernández-Urién I, Sanchotena JLG, Goñi S, Alonso MG, Carrascosa J, Borda A, Prieto C, Urman J, Zozaya JM. EUS is superior to secretin-enhanced cholangio-MRI to establish the etiology of idiopathic acute pancreatitis. Endosc Int Open 2020; 8:E1441-E1447. [PMID: 33043111 PMCID: PMC7541189 DOI: 10.1055/a-1233-1849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 07/08/2020] [Indexed: 11/21/2022] Open
Abstract
Background and study aims The etiology of idiopathic acute pancreatitis (IAP) should always be defined. Our aim was to compare the diagnostic value of endoscopic ultrasound (EUS) versus secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) in patients with IAP. Patients and Methods Patients admitted to a single tertiary care University hospital with IAP were invited to participate in the study. Enrolled patients underwent EUS and S-MRCP in a single-blinded comparative study. EUS and S-MRCP were performed no sooner than 4 weeks after discharge. The diagnostic yield of EUS and S-MRCP and demographic variables were included in the analysis. Additional follow-up, results of subsequent serology, radiographic exams, and relevant histological analysis were considered in determination of the final diagnosis. Results A total of 34 patients were enrolled; EUS was normal in six, cholelithiasis was defined in 15, choledocholithiasis in two, pancreas divisum in three, branch-type intraductal papillary mucinous tumor (IPMT) in three, and chronic pancreatitis in five. S-MRCP identified choledocholithiasis in one, divisum in four, branch-type IPMT in three, chronic pancreatitis in two; 24 subjects diagnosed as normal by S-MRCP. Diagnostic correlation between EUS and S-MRCP was slight (kappa = 0.236, 95 % confidence interval: 0.055-0.416). EUS provided a statistically significantly higher diagnostic yield than S-MRCP: 79.4 % (CI95 %: 65 %-94 %) vs 29.4 % (CI95 %: 13 %-46 %) (P = 0.0002). The sensitivity, specificity, and positive and negative predictive values of EUS and S-MRCP were 90 %, 80 %, 96 %, 57 % and 33 %, 100 %, 100 % and 16 %, respectively. Conclusion The diagnostic yield of EUS is higher than S-MRCP in patients with IAP.
Collapse
Affiliation(s)
- Juan J. Vila
- Endoscopy Unit, Gastroenterology Dpt, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - Paul Yeaton
- Endoscopy Unit, Gastroenterology Department, Carilion Clinic, Roanoke, Virginia, United States
| | - Iñaki Fernández-Urién
- Endoscopy Unit, Gastroenterology Dpt, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - Silvia Goñi
- Endoscopy Unit, Gastroenterology Dpt, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Marta Gómez Alonso
- Endoscopy Unit, Gastroenterology Dpt, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Juan Carrascosa
- Endoscopy Unit, Gastroenterology Dpt, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Ana Borda
- Endoscopy Unit, Gastroenterology Dpt, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Carlos Prieto
- Biliary and Pancreatic Diseases Unit, Gastroenterology Dpt, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Jesús Urman
- Biliary and Pancreatic Diseases Unit, Gastroenterology Dpt, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - José M Zozaya
- Endoscopy Unit, Gastroenterology Dpt, Complejo Hospitalario de Navarra, Pamplona, Spain,Biliary and Pancreatic Diseases Unit, Gastroenterology Dpt, Complejo Hospitalario de Navarra, Pamplona, Spain
| |
Collapse
|
24
|
Miró I, Gutiérrez C, Carazo E, Mínguez A, Crehuet C, Costa A, Del Peral M, Diéguez I, Fonseca R, Barrios JE, Lluna J, Vila JJ. Fibrin glue treatment associated or not with diathermy for recurrent tracheoesophageal fistula: our results after more than 20 years' experience. Cir Pediatr 2020; 33:115-118. [PMID: 32657094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Recurrent tracheoesophageal fistula (RTEF) is a frequent complication (5-10%) in patients with esophageal atresia (EA). Open RTEF surgery has a high morbidity and mortality, so the endoscopic approach represents a promising alternative. We present the long-term results of fibrin glue (FG) bronchoscopic application in patients with RTEF secondary to EA, which was first used by our team in 1994. MATERIAL AND METHODS A retrospective review of all patients diagnosed with RTEF following EA repair and treated with FG bronchoscopic application from 1993 to 2019 was carried out. In most cases, diathermy was applied prior to FG sealing. The maximum number of endoscopic sessions was 5. In case of persistent RTEF following the fifth session, open surgery was performed. RESULTS 14 RTEF patients were treated with FG. In all but the first 3 cases (11 patients, 78.6%), diathermy was applied concomitantly. Mean first treatment day was day 85 of life (range: 14-770). Patients received a mean of 2.1 (1-5) endoscopic sessions. Mean follow-up was 12.1 (10-20) years. Overall success rate was 71.4%, without significant differences according to whether diathermy was concomitantly applied or not (72.7% vs. 66.6%). CONCLUSIONS Fibrin glue bronchoscopic application associated or not associated with diathermy is an excellent option for RTEF treatment in EA patients. The endoscopic approach should be considered as the first-choice treatment for RTEF.
Collapse
Affiliation(s)
- I Miró
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - C Gutiérrez
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - E Carazo
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - A Mínguez
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - C Crehuet
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - A Costa
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - M Del Peral
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - I Diéguez
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - R Fonseca
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - J E Barrios
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - J Lluna
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - J J Vila
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| |
Collapse
|
25
|
Urman JM, Herranz JM, Uriarte I, Rullán M, Oyón D, González B, Fernandez-Urién I, Carrascosa J, Bolado F, Zabalza L, Arechederra M, Alvarez-Sola G, Colyn L, Latasa MU, Puchades-Carrasco L, Pineda-Lucena A, Iraburu MJ, Iruarrizaga-Lejarreta M, Alonso C, Sangro B, Purroy A, Gil I, Carmona L, Cubero FJ, Martínez-Chantar ML, Banales JM, Romero MR, Macias RI, Monte MJ, Marín JJG, Vila JJ, Corrales FJ, Berasain C, Fernández-Barrena MG, Avila MA. Pilot Multi-Omic Analysis of Human Bile from Benign and Malignant Biliary Strictures: A Machine-Learning Approach. Cancers (Basel) 2020; 12:cancers12061644. [PMID: 32575903 PMCID: PMC7352944 DOI: 10.3390/cancers12061644] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 12/11/2022] Open
Abstract
Cholangiocarcinoma (CCA) and pancreatic adenocarcinoma (PDAC) may lead to the development of extrahepatic obstructive cholestasis. However, biliary stenoses can also be caused by benign conditions, and the identification of their etiology still remains a clinical challenge. We performed metabolomic and proteomic analyses of bile from patients with benign (n = 36) and malignant conditions, CCA (n = 36) or PDAC (n = 57), undergoing endoscopic retrograde cholangiopancreatography with the aim of characterizing bile composition in biliopancreatic disease and identifying biomarkers for the differential diagnosis of biliary strictures. Comprehensive analyses of lipids, bile acids and small molecules were carried out using mass spectrometry (MS) and nuclear magnetic resonance spectroscopy (1H-NMR) in all patients. MS analysis of bile proteome was performed in five patients per group. We implemented artificial intelligence tools for the selection of biomarkers and algorithms with predictive capacity. Our machine-learning pipeline included the generation of synthetic data with properties of real data, the selection of potential biomarkers (metabolites or proteins) and their analysis with neural networks (NN). Selected biomarkers were then validated with real data. We identified panels of lipids (n = 10) and proteins (n = 5) that when analyzed with NN algorithms discriminated between patients with and without cancer with an unprecedented accuracy.
Collapse
Affiliation(s)
- Jesús M. Urman
- Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, 31008 Pamplona, Spain; (J.M.U.); (M.R.); (D.O.); (B.G.); (I.F.-U.); (J.C.); (F.B.); (L.Z.); (J.J.V.)
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain; (M.A.); (B.S.); (A.P.); (I.G.); (C.B.); (M.G.F.-B.)
| | - José M. Herranz
- National Institute for the Study of Liver and Gastrointestinal Diseases, CIBERehd, Carlos III Health Institute, 28029 Madrid, Spain; (J.M.H.); (I.U.); (G.A.-S.); (M.L.M.-C.); (J.M.B.); (M.R.R.); (R.I.R.M.); (M.J.M.); (J.J.G.M.); (F.J.C.)
- Program of Hepatology, Center for Applied Medical Research (CIMA), University of Navarra, 31008 Pamplona, Spain; (L.C.); (M.U.L.)
| | - Iker Uriarte
- National Institute for the Study of Liver and Gastrointestinal Diseases, CIBERehd, Carlos III Health Institute, 28029 Madrid, Spain; (J.M.H.); (I.U.); (G.A.-S.); (M.L.M.-C.); (J.M.B.); (M.R.R.); (R.I.R.M.); (M.J.M.); (J.J.G.M.); (F.J.C.)
- Program of Hepatology, Center for Applied Medical Research (CIMA), University of Navarra, 31008 Pamplona, Spain; (L.C.); (M.U.L.)
| | - María Rullán
- Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, 31008 Pamplona, Spain; (J.M.U.); (M.R.); (D.O.); (B.G.); (I.F.-U.); (J.C.); (F.B.); (L.Z.); (J.J.V.)
| | - Daniel Oyón
- Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, 31008 Pamplona, Spain; (J.M.U.); (M.R.); (D.O.); (B.G.); (I.F.-U.); (J.C.); (F.B.); (L.Z.); (J.J.V.)
| | - Belén González
- Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, 31008 Pamplona, Spain; (J.M.U.); (M.R.); (D.O.); (B.G.); (I.F.-U.); (J.C.); (F.B.); (L.Z.); (J.J.V.)
| | - Ignacio Fernandez-Urién
- Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, 31008 Pamplona, Spain; (J.M.U.); (M.R.); (D.O.); (B.G.); (I.F.-U.); (J.C.); (F.B.); (L.Z.); (J.J.V.)
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain; (M.A.); (B.S.); (A.P.); (I.G.); (C.B.); (M.G.F.-B.)
| | - Juan Carrascosa
- Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, 31008 Pamplona, Spain; (J.M.U.); (M.R.); (D.O.); (B.G.); (I.F.-U.); (J.C.); (F.B.); (L.Z.); (J.J.V.)
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain; (M.A.); (B.S.); (A.P.); (I.G.); (C.B.); (M.G.F.-B.)
| | - Federico Bolado
- Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, 31008 Pamplona, Spain; (J.M.U.); (M.R.); (D.O.); (B.G.); (I.F.-U.); (J.C.); (F.B.); (L.Z.); (J.J.V.)
| | - Lucía Zabalza
- Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, 31008 Pamplona, Spain; (J.M.U.); (M.R.); (D.O.); (B.G.); (I.F.-U.); (J.C.); (F.B.); (L.Z.); (J.J.V.)
| | - María Arechederra
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain; (M.A.); (B.S.); (A.P.); (I.G.); (C.B.); (M.G.F.-B.)
- Program of Hepatology, Center for Applied Medical Research (CIMA), University of Navarra, 31008 Pamplona, Spain; (L.C.); (M.U.L.)
| | - Gloria Alvarez-Sola
- National Institute for the Study of Liver and Gastrointestinal Diseases, CIBERehd, Carlos III Health Institute, 28029 Madrid, Spain; (J.M.H.); (I.U.); (G.A.-S.); (M.L.M.-C.); (J.M.B.); (M.R.R.); (R.I.R.M.); (M.J.M.); (J.J.G.M.); (F.J.C.)
- Program of Hepatology, Center for Applied Medical Research (CIMA), University of Navarra, 31008 Pamplona, Spain; (L.C.); (M.U.L.)
| | - Leticia Colyn
- Program of Hepatology, Center for Applied Medical Research (CIMA), University of Navarra, 31008 Pamplona, Spain; (L.C.); (M.U.L.)
| | - María U. Latasa
- Program of Hepatology, Center for Applied Medical Research (CIMA), University of Navarra, 31008 Pamplona, Spain; (L.C.); (M.U.L.)
| | - Leonor Puchades-Carrasco
- Drug Discovery Unit, Instituto de Investigación Sanitaria La Fe, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain;
| | - Antonio Pineda-Lucena
- Drug Discovery Unit, Instituto de Investigación Sanitaria La Fe, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain;
- Program of Molecular Therapeutics, Center for Applied Medical Research (CIMA), University of Navarra, 31008 Pamplona, Spain;
| | - María J. Iraburu
- Department of Biochemistry and Genetics, School of Sciences; University of Navarra, 31008 Pamplona, Spain;
| | | | - Cristina Alonso
- OWL Metabolomics, Bizkaia Technology Park, 48160 Derio, Spain; (M.I.-L.); (C.A.)
| | - Bruno Sangro
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain; (M.A.); (B.S.); (A.P.); (I.G.); (C.B.); (M.G.F.-B.)
- National Institute for the Study of Liver and Gastrointestinal Diseases, CIBERehd, Carlos III Health Institute, 28029 Madrid, Spain; (J.M.H.); (I.U.); (G.A.-S.); (M.L.M.-C.); (J.M.B.); (M.R.R.); (R.I.R.M.); (M.J.M.); (J.J.G.M.); (F.J.C.)
- Hepatology Unit, Department of Internal Medicine, University of Navarra Clinic, 31008 Pamplona, Spain
| | - Ana Purroy
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain; (M.A.); (B.S.); (A.P.); (I.G.); (C.B.); (M.G.F.-B.)
- Navarrabiomed Biobank Unit, IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - Isabel Gil
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain; (M.A.); (B.S.); (A.P.); (I.G.); (C.B.); (M.G.F.-B.)
- Navarrabiomed Biobank Unit, IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - Lorena Carmona
- Proteomics Unit, Centro Nacional de Biotecnología (CNB) Consejo Superior de Investigaciones Científicas (CSIC), 28049 Madrid, Spain;
| | - Francisco Javier Cubero
- Department of Immunology, Ophtalmology & Ear, Nose and Throat (ENT), Complutense University School of Medicine and 12 de Octubre Health Research Institute (Imas12), 28040 Madrid, Spain;
| | - María L. Martínez-Chantar
- National Institute for the Study of Liver and Gastrointestinal Diseases, CIBERehd, Carlos III Health Institute, 28029 Madrid, Spain; (J.M.H.); (I.U.); (G.A.-S.); (M.L.M.-C.); (J.M.B.); (M.R.R.); (R.I.R.M.); (M.J.M.); (J.J.G.M.); (F.J.C.)
- Liver Disease Laboratory, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Bizkaia Technology Park, 48160 Derio, Spain
| | - Jesús M. Banales
- National Institute for the Study of Liver and Gastrointestinal Diseases, CIBERehd, Carlos III Health Institute, 28029 Madrid, Spain; (J.M.H.); (I.U.); (G.A.-S.); (M.L.M.-C.); (J.M.B.); (M.R.R.); (R.I.R.M.); (M.J.M.); (J.J.G.M.); (F.J.C.)
- Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute, Donostia University Hospital, 20014 San Sebastian, Spain
- IKERBASQUE, Basque Foundation for Science, 48013 Bilbao, Spain
| | - Marta R. Romero
- National Institute for the Study of Liver and Gastrointestinal Diseases, CIBERehd, Carlos III Health Institute, 28029 Madrid, Spain; (J.M.H.); (I.U.); (G.A.-S.); (M.L.M.-C.); (J.M.B.); (M.R.R.); (R.I.R.M.); (M.J.M.); (J.J.G.M.); (F.J.C.)
- Experimental Hepatology and Drug Targeting (HEVEFARM) Group, University of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), 37007 Salamanca, Spain
| | - Rocio I.R. Macias
- National Institute for the Study of Liver and Gastrointestinal Diseases, CIBERehd, Carlos III Health Institute, 28029 Madrid, Spain; (J.M.H.); (I.U.); (G.A.-S.); (M.L.M.-C.); (J.M.B.); (M.R.R.); (R.I.R.M.); (M.J.M.); (J.J.G.M.); (F.J.C.)
- Experimental Hepatology and Drug Targeting (HEVEFARM) Group, University of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), 37007 Salamanca, Spain
| | - Maria J. Monte
- National Institute for the Study of Liver and Gastrointestinal Diseases, CIBERehd, Carlos III Health Institute, 28029 Madrid, Spain; (J.M.H.); (I.U.); (G.A.-S.); (M.L.M.-C.); (J.M.B.); (M.R.R.); (R.I.R.M.); (M.J.M.); (J.J.G.M.); (F.J.C.)
- Experimental Hepatology and Drug Targeting (HEVEFARM) Group, University of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), 37007 Salamanca, Spain
| | - Jose J. G. Marín
- National Institute for the Study of Liver and Gastrointestinal Diseases, CIBERehd, Carlos III Health Institute, 28029 Madrid, Spain; (J.M.H.); (I.U.); (G.A.-S.); (M.L.M.-C.); (J.M.B.); (M.R.R.); (R.I.R.M.); (M.J.M.); (J.J.G.M.); (F.J.C.)
- Experimental Hepatology and Drug Targeting (HEVEFARM) Group, University of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), 37007 Salamanca, Spain
| | - Juan J. Vila
- Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, 31008 Pamplona, Spain; (J.M.U.); (M.R.); (D.O.); (B.G.); (I.F.-U.); (J.C.); (F.B.); (L.Z.); (J.J.V.)
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain; (M.A.); (B.S.); (A.P.); (I.G.); (C.B.); (M.G.F.-B.)
| | - Fernando J. Corrales
- National Institute for the Study of Liver and Gastrointestinal Diseases, CIBERehd, Carlos III Health Institute, 28029 Madrid, Spain; (J.M.H.); (I.U.); (G.A.-S.); (M.L.M.-C.); (J.M.B.); (M.R.R.); (R.I.R.M.); (M.J.M.); (J.J.G.M.); (F.J.C.)
- Proteomics Unit, Centro Nacional de Biotecnología (CNB) Consejo Superior de Investigaciones Científicas (CSIC), 28049 Madrid, Spain;
| | - Carmen Berasain
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain; (M.A.); (B.S.); (A.P.); (I.G.); (C.B.); (M.G.F.-B.)
- National Institute for the Study of Liver and Gastrointestinal Diseases, CIBERehd, Carlos III Health Institute, 28029 Madrid, Spain; (J.M.H.); (I.U.); (G.A.-S.); (M.L.M.-C.); (J.M.B.); (M.R.R.); (R.I.R.M.); (M.J.M.); (J.J.G.M.); (F.J.C.)
- Program of Hepatology, Center for Applied Medical Research (CIMA), University of Navarra, 31008 Pamplona, Spain; (L.C.); (M.U.L.)
| | - Maite G. Fernández-Barrena
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain; (M.A.); (B.S.); (A.P.); (I.G.); (C.B.); (M.G.F.-B.)
- National Institute for the Study of Liver and Gastrointestinal Diseases, CIBERehd, Carlos III Health Institute, 28029 Madrid, Spain; (J.M.H.); (I.U.); (G.A.-S.); (M.L.M.-C.); (J.M.B.); (M.R.R.); (R.I.R.M.); (M.J.M.); (J.J.G.M.); (F.J.C.)
- Program of Hepatology, Center for Applied Medical Research (CIMA), University of Navarra, 31008 Pamplona, Spain; (L.C.); (M.U.L.)
| | - Matías A. Avila
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain; (M.A.); (B.S.); (A.P.); (I.G.); (C.B.); (M.G.F.-B.)
- National Institute for the Study of Liver and Gastrointestinal Diseases, CIBERehd, Carlos III Health Institute, 28029 Madrid, Spain; (J.M.H.); (I.U.); (G.A.-S.); (M.L.M.-C.); (J.M.B.); (M.R.R.); (R.I.R.M.); (M.J.M.); (J.J.G.M.); (F.J.C.)
- Program of Hepatology, Center for Applied Medical Research (CIMA), University of Navarra, 31008 Pamplona, Spain; (L.C.); (M.U.L.)
- Correspondence: ; Tel.: +34-948-194700 (ext. 4003)
| |
Collapse
|
26
|
Anderloni A, Fabbri C, Nieto J, Uwe W, Dollhopf M, Aparicio JR, Perez-Miranda M, Tarantino I, Arlt A, Vleggaar F, Vanbiervliet G, Hampe J, Kahaleh M, Vila JJ, Dayyeh BKA, Storm AC, Fugazza A, Binda C, Charachon A, Sevilla-Ribota S, Tyberg A, Robert M, Wani S, Repici A, Sethi A, Khashab MA, Kunda R. The safety and efficacy of a new 20-mm lumen apposing metal stent (lams) for the endoscopic treatment of pancreatic and peripancreatic fluid collections: a large international, multicenter study. Surg Endosc 2020; 35:1741-1748. [PMID: 32323015 DOI: 10.1007/s00464-020-07567-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 04/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lumen apposing metal stent (LAMS) allows an easy access to peripancreatic fluid collections (PPFCs) and the possibility of performing direct endoscopic necrosectomy (DEN). The aim of our study was to evaluate the safety and efficacy of a new 20-mm LAMS in the management of PPFCs. This novel stent represents the largest diameter LAMS available on the market to date. METHODS This is an international, multicenter retrospective study involving 20 centers. Consecutive patients who underwent EUS-guided PPFC drainage using a 20-mm LAMS were included. Primary outcomes were technical and clinical success. Secondary outcomes were rate and the severity of adverse events. RESULTS A total 105 patients underwent PPFC drainage using the new 20-mm LAMS and 106 LAMS were placed. Technical success was 100% (106/106). 7/105 patients died due to causes not related to the stent. Clinical success was achieved in 92/98 patients (93.9%). Significant adverse events occurred in 8/98 patients (8.16%): 4 cases (4.08%) of bleeding, 3 cases (3.06%) of suprainfection, 1 case of gastric outlet obstruction. CONCLUSIONS This multicenter study demonstrated acceptable rates of technical and clinical success using a new 20-mm LAMS for PPFC, including walled-off pancreatic necrosis (WOPN). The results of our study suggest that a new 20-mm LAMS is non-inferior in terms of safety, efficacy, and adverse events as compared to smaller diameter LAMS in the management of PPFCs, including pancreatic psuedocysts (PP) and WOPN. Randomized controlled studies will be needed to determine the ideal size of LAMS need to achieve the greatest clinical benefit with the minimized risk exposure for this high-risk patient population.
Collapse
Affiliation(s)
- Andrea Anderloni
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milano, Italy.
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Jose Nieto
- Advanced Therapeutic Endoscopy Center Borland Groover Clinic, Jacksonville, FL, USA
| | - Will Uwe
- Department of Gastroenterology, Municipal Hospital, Gera, Germany
| | - Markus Dollhopf
- Department of Gastroenterology, Klinikum Neuperlach, Munich, Germany
| | - José Ramón Aparicio
- Endoscopy Unit, Digestive Service, Alicante University General Hospital, Alicante, Spain
| | - Manuel Perez-Miranda
- Gastroenterology & Hepatology Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Ilaria Tarantino
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, Palermo, Italy
| | - Alexander Arlt
- Department of Medicine I, University Hospital Schleswig-Holstein, Christian-Albrechts-University Kiel, Kiel Campus, Kiel, Germany
| | - Frank Vleggaar
- Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, Netherlands
| | | | - Jochen Hampe
- Medical Department 1, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | | | - Juan J Vila
- Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic Alix School of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | - Andrew C Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic Alix School of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | - Alessandro Fugazza
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milano, Italy
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Antoine Charachon
- Service d'Hépato-gastro-entérologie, CH Princesse Grace, Monaco, Monaco
| | | | - Amy Tyberg
- Weill Cornell Medical, New York, NY, USA
| | - Moran Robert
- Therapeutic Endoscopy, Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, USA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alessandro Repici
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milano, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Amrita Sethi
- Pancreaticobiliary Endoscopy Services Division of Digestive and Liver Disease, Columbia University Medical Center-NYPH, New York, NY, USA
| | - Mouen A Khashab
- Therapeutic Endoscopy, Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, USA
| | - Rastislav Kunda
- Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.,Department of Surgery, Department of Gastroenterology-Hepatology, Department of Advanced Interventional Endoscopy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
27
|
Guo J, Sahai AV, Teoh A, Arcidiacono PG, Larghi A, Saftoiu A, Siddiqui AA, Arturo Arias BL, Jenssen C, Adler DG, Lakhtakia S, Seo DW, Itokawa F, Giovannini M, Mishra G, Sabbagh L, Irisawa A, Iglesias-Garcia J, Poley JW, Vila JJ, Jesse L, Kubota K, Kalaitzakis E, Kida M, El-Nady M, Mukai SU, Ogura T, Fusaroli P, Vilmann P, Rai P, Nguyen NQ, Ponnudurai R, Achanta CR, Baron TH, Yasuda I, Wang HP, Hu J, Duan B, Bhutani MS, Sun S. An international, multi-institution survey on performing EUS-FNA and fine needle biopsy. Endosc Ultrasound 2020; 9:319-328. [PMID: 32883921 PMCID: PMC7811723 DOI: 10.4103/eus.eus_56_20] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background and Objectives Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and fine needle biopsy (FNB) are effective techniques that are widely used for tissue acquisition. However, it remains unclear how to obtain high-quality specimens. Therefore, we conducted a survey of EUS-FNA and FNB techniques to determine practice patterns worldwide and to develop strong recommendations based on the experience of experts in the field. Methods This was a worldwide multi-institutional survey among members of the International Society of EUS Task Force (ISEUS-TF). The survey was administered by E-mail through the SurveyMonkey website. In some cases, percentage agreement with some statements was calculated; in others, the options with the greatest numbers of responses were summarized. Another questionnaire about the level of recommendation was designed to assess the respondents' answers. Results ISEUS-TF members developed a questionnaire containing 17 questions that was sent to 53 experts. Thirty-five experts completed the survey within the specified period. Among them, 40% and 54.3% performed 50-200 and more than 200 EUS sampling procedures annually, respectively. Some practice patterns regarding FNA/FNB were recommended. Conclusion This is the first worldwide survey of EUS-FNA and FNB practice patterns. The results showed wide variations in practice patterns. Randomized studies are urgently needed to establish the best approach for optimizing the FNA/FNB procedures.
Collapse
Affiliation(s)
- Jintao Guo
- Department of Gastroenterology, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Anand V Sahai
- Center Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Anthony Teoh
- Department of Surgery, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Paolo Giorgio Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Adrian Saftoiu
- Department of Endoscopy, University of Medicine and Pharmacy, Craiova, Romania
| | - Ali A Siddiqui
- Endoscopy Center, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Brenda Lucia Arturo Arias
- Endoscopy Center, Medical Research Group University of Manizales, SES University Hospital of Caldas, Caldas, Colombia
| | - Christian Jenssen
- Department of Medical, Krankenhaus Märkisch Oderland Strausberg, Wriezen, Germany
| | - Douglas G Adler
- Department of Gastroenterology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sundeep Lakhtakia
- Endoscopy Center, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Dong-Wan Seo
- Department of Gastroenterology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Fumihide Itokawa
- Department of Gastroenterology and Hepatology, Tokyo Adventist Hospital, Tokyo, Japan
| | - Marc Giovannini
- Department of Gastroenterology, Institute Paoli-Calmettes, Marseille, France
| | - Girish Mishra
- Department of Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Luis Sabbagh
- Department of Gastroenterology, Sanitas University Foundation, Clinica Reina Sofia, Bogota, Colombia
| | - Atsushi Irisawa
- Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | - Julio Iglesias-Garcia
- Endoscopy Center, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jan Werner Poley
- Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Juan J Vila
- Department of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Lachter Jesse
- Department of Gastroenterology, Rambam Healthcare Campus, Haifa, Israel
| | - Kensuke Kubota
- Department of Gastroenterology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Evangelos Kalaitzakis
- Department of Gastroenterology, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Mitsuhiro Kida
- Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Japan
| | - Mohamed El-Nady
- Department of Gastroenterology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Sh Untaro Mukai
- Department of Gastroenterology, Tokyo Medical University, Tokyo, Japan
| | - Takeshi Ogura
- Department of Gastroenterology, Osaka Medical College, Osaka, Japan
| | - Pietro Fusaroli
- Department of Gastroenterology, University of Bologna, Bologna, Italy
| | - Peter Vilmann
- Department of Gastroenterology, GastroUnit, Herlev and Gentofte Hospital, Copenhagen University, Copenhagen, Denmark
| | - Praveer Rai
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nam Q Nguyen
- Department of Gastroenterology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
| | | | - Chalapathi Rao Achanta
- Department of Gastroenterology, KIMS Icon Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Todd H Baron
- Department of Gastroenterology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ichiro Yasuda
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
| | - Hsiu-Po Wang
- Department of Gastroenterology, National Taiwan University Hospital, Taipei, Taiwan, China
| | - Jinlong Hu
- Department of Gastroenterology, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Bowen Duan
- Department of Gastroenterology, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Manoop S Bhutani
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Siyu Sun
- Department of Gastroenterology, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning Province, China
| |
Collapse
|
28
|
Miró I, Ibáñez V, Carazo E, Couselo M, Vila JJ. [Applicability of a clinical score in patients with suspected foreign body aspiration]. Cir Pediatr 2019; 32:172-176. [PMID: 31626400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To validate the clinical score of Valdivieso et al. in the management of patients with suspected foreign body aspiration in a tertiary hospital. This score raises different scenarios according to the result: bronchoscopy, CT, observation or discharge. MATERIAL AND METHODS Retrospective study of patients who underwent a bronchoscopy due to suspected tracheobronchial foreign body between November-2015 and November-2018. The variables proposed by the score were collected (choking, stridor, wheezing, unilateral hypoventilation, altered chest X-ray and high-risk foreign body) and the score was calculated for each patient, analyzing the performance of the test using the ROC (Receiver Operating Characteristic) curve. RESULTS Bronchoscopy was performed in 81 patients with a mean age of 2.1 years (7 months-11 years), finding foreign body in 33.3%. The area under the ROC curve of the score was 0.803 (0.695-0.911). In 6 (22.2%) patients with confirmed foreign body the score initially indicated observation in 5 cases and discharge in 1. Excluding the 49 patients with unilateral altered auscultation or when there was a nut suspected, which in our environment are clear indications for bronchoscopy, the score correctly classified the remaining 32 patients, which would have reduced the rate of normal bronchoscopies from 66% to 45%. CONCLUSIONS The score in our sample presents a high diagnostic power but a non-negligible false negative rate. It has a special utility in patients who do not have unilateral altered auscultation and/or choking with nuts, allowing to reduce the rate of normal bronchoscopies.
Collapse
Affiliation(s)
- I Miró
- Hospital Universitario y Politécnico La Fe. Valencia
| | - V Ibáñez
- Hospital Universitario y Politécnico La Fe. Valencia
| | - E Carazo
- Hospital Universitario y Politécnico La Fe. Valencia
| | - M Couselo
- Hospital Universitario y Politécnico La Fe. Valencia
| | - J J Vila
- Hospital Universitario y Politécnico La Fe. Valencia
| |
Collapse
|
29
|
Pérez-Cuadrado-Robles E, Uribarri-González L, Borbath I, Vila JJ, López-López S, Deprez PH. Risk of advanced lesions in patients with branch-duct IPMN and relative indications for surgery according to European evidence-based guidelines. Dig Liver Dis 2019; 51:882-886. [PMID: 30591368 DOI: 10.1016/j.dld.2018.11.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 10/31/2018] [Accepted: 11/26/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND European evidence-based guidelines proposed surgery for branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) based on the presence of 1-2 relative indications, depending on the comorbidity burden. AIMS To assess the accuracy of the guidelines in patients with relative indications in a surgical cohort of demonstrated BD-IPMNs. METHODS This report describes a multi-centre, observational, retrospective study. All consecutive patients with relative indications and histologically confirmed BD-IPMN were included. The main outcome was risk of invasive carcinoma in patients with relative indications. RESULTS Ninety-one patients with BD-IPMN underwent surgery because of absolute (n = 21), relative (n = 60), or no formal indications (n = 10). In total, there were 60 patients (mean age: 66 ± 9, 50% male) with one (n = 35, 58.3%) or ≥2 relative indications (n = 25, 41.7%). The global advanced lesion and invasive carcinoma rates were 40% and 13.3%, respectively. No risk factor was associated with high-grade dysplasia or invasive carcinoma. Patients with one indication had a lower risk of invasive carcinoma than did those with ≥2 relative indications (5.7% vs. 24%, respectively, p = 0.048); however, the advanced lesion rates were comparable (37.1% vs. 44%, p = 0.593). CONCLUSIONS Invasive carcinoma is considerably more frequent in patients with two or more relative indications. The surgical strategy in these selected cases should be decided on an individual basis.
Collapse
Affiliation(s)
| | | | - Ivan Borbath
- Department of Gastroenterology and Hepatology, University Hospitals St-Luc, Brussels, Belgium
| | - Juan J Vila
- Department of Gastroenterology, Navarra Hospital, Navarra, Spain
| | | | - Pierre H Deprez
- Department of Gastroenterology and Hepatology, University Hospitals St-Luc, Brussels, Belgium
| |
Collapse
|
30
|
Yoon WJ, Park DH, Choi JH, Jang S, Samarasena J, Lee TH, Paik WH, Oh D, Song TJ, Choi JH, Hara K, Iwashita T, Perez-Miranda M, Lee JG, Vazquez-Sequeiros E, Naitoh I, Vila JJ, Brugge WR, Takenaka M, Lee SS, Seo DW, Lee SK, Kim MH. The underutilization of EUS-guided biliary drainage: Perception of endoscopists in the East and West. Endosc Ultrasound 2019; 8:188-193. [PMID: 30719996 PMCID: PMC6590002 DOI: 10.4103/eus.eus_57_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background and Objectives EUS-guided biliary drainage (EUS-BD) is increasingly utilized to manage unresectable malignant biliary obstruction after a failed ERCP. However, there is no data on how endoscopists perceive EUS-BD. The aim of this study was to investigate the perception of endoscopists on EUS-BD. Patients and Methods A survey questionnaire of six topics with 22 survey statements was developed. A total of 17 pancreatobiliary endoscopists (10 from East and 7 from West) were invited to survey. The participants were asked to answer the multiple choice questionnaire and give comments. The opinions of the participants for individual survey statements were assessed using 5-point Likert scale. Results All participants completed the survey. The endoscopists had a trend to perceive EUS-BD as a procedure indicated after a failed ERCP. Various EUS-BD methods were regarded as having different efficacy and safety. The superiority of EUS-BD over percutaneous transhepatic BD (PTBD) with regard to efficacy, procedure-related adverse events, and unscheduled re-intervention was not in agreement. Conclusions EUS-BD was not yet perceived as the initial procedure to relieve the unresectable malignant biliary obstruction. Various EUS-BD methods were regarded as having different efficacy and safety. The superiority of EUS-BD over PTBD was not in agreement. Refining the procedure, developing dedicated devices, and gaining expertise in the procedure are necessary to popularize EUS-BD.
Collapse
Affiliation(s)
- Won Jae Yoon
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Do Hyun Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jun Ho Choi
- Department of Internal Medicine, Dankook University College of Medicine, South Korea
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Jason Samarasena
- Department of Medicine, University of California-Irvine, Orange, CA, USA
| | - Tae Hoon Lee
- Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan, South Korea
| | - Woo Hyun Paik
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Dongwook Oh
- Department of Gastroenterology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Tae Jun Song
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon Hyuk Choi
- Department of Internal Medicine, Inje University College of Medicine, Busan, South Korea
| | - Kazuo Hara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takuji Iwashita
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Manuel Perez-Miranda
- Department of Gastroenterology and Hepatology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - John G Lee
- Department of Medicine, University of California-Irvine, Orange, CA, USA
| | - Enrique Vazquez-Sequeiros
- Department of Gastroenterology and Hepatology, University Hospital Ramon Y Cajal, IRYCIS, Madrid, Spain
| | - Itaru Naitoh
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Juan J Vila
- Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - William R Brugge
- Division of Gastroenterology, Mount Auburn Hospital, Cambridge, MA, USA
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Sang Soo Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong-Wan Seo
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung Koo Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Myung-Hwan Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| |
Collapse
|
31
|
Miró I, Gutiérrez C, Fonseca R, Barrios JE, Carazo E, Alamar A, Ibáñez I, López J, Ortolá P, Vila JJ. [Multidisciplinary approach on subglottic pathology: a 5-year review]. Cir Pediatr 2018; 31:66-70. [PMID: 29978956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Pediatric subglottic pathology still represents a challenge when it comes to choosing the right treatment. We present the management of patients followed in our center for this reason during the last 5 years. MATERIAL AND METHODS Retrospective study of patients followed by glotosubglottic pathology (stenosis, cysts or granulomas) between 2011 and 2016 in a third level hospital. RESULTS Twenty-seven patients were included in the review. Treatment options varied according to the nature, location and severity of the subglottic stenosis. Two patients with congenital subglottic stenosis were treated by laryngotracheoplasty. Seventeen patients with acquired subglottic stenosis were included: in one (5.9%) laryngotracheoplasty was performed, one (5.9%) received cricotracheal split, two of them (11.8%) underwent partial cricotracheal resection (PCTR) , seven patients (41.2%) underwent microsurgery, three (17.6%) received tracheal dilatation, and the last three (17.6%) were submitted to observation without needing further treatment. Five patients with post-intubation subglottic cysts received microsurgery. Of three patients diagnosed with post-intubation subglottic granuloma, two (66%) resolved spontaneously and one (33%) required microsurgery. CONCLUSIONS Management of pediatric subglottic pathology remains a major challenge. Since the creation of the Airway Committee in our center, the improvement in the management of these patients has led to a multidisciplinary management, with the consequent impact on the clinical results.
Collapse
Affiliation(s)
- I Miró
- Servicio de Cirugía Pediátrica. Hospital Universitari i Politècnic La Fe. València
| | - C Gutiérrez
- Servicio de Cirugía Pediátrica. Hospital Universitari i Politècnic La Fe. València
| | - R Fonseca
- Servicio de Cirugía Pediátrica. Hospital Universitari i Politècnic La Fe. València
| | - J E Barrios
- Servicio de Cirugía Pediátrica. Hospital Universitari i Politècnic La Fe. València
| | - E Carazo
- Servicio de Cirugía Pediátrica. Hospital Universitari i Politècnic La Fe. València
| | - A Alamar
- Servicio de Cirugía Pediátrica. Hospital Universitari i Politècnic La Fe. València
| | - I Ibáñez
- Servicio de Cirugía Pediátrica. Hospital Universitari i Politècnic La Fe. València
| | - J López
- Servicio de Cirugía Pediátrica. Hospital Universitari i Politècnic La Fe. València
| | - P Ortolá
- Servicio de Cirugía Pediátrica. Hospital Universitari i Politècnic La Fe. València
| | - J J Vila
- Servicio de Cirugía Pediátrica. Hospital Universitari i Politècnic La Fe. València
| |
Collapse
|
32
|
Guo J, Giovannini M, Sahai AV, Saftoiu A, Dietrich CF, Santo E, Fusaroli P, Siddiqui AA, Bhutani MS, Bun Teoh AY, Irisawa A, Arturo Arias BL, Achanta CR, Jenssen C, Seo DW, Adler DG, Kalaitzakis E, Artifon E, Itokawa F, Poley JW, Mishra G, Ho KY, Wang HP, Okasha HH, Lachter J, Vila JJ, Iglesias-Garcia J, Yamao K, Yasuda K, Kubota K, Palazzo L, Sabbagh LC, Sharma M, Kida M, El-Nady M, Nguyen NQ, Vilmann P, Garg PK, Rai P, Mukai S, Carrara S, Parupudi S, Sridhar S, Lakhtakia S, Rana SS, Ogura T, Baron TH, Dhir V, Sun S. A multi-institution consensus on how to perform EUS-guided biliary drainage for malignant biliary obstruction. Endosc Ultrasound 2018; 7:356-365. [PMID: 30531022 PMCID: PMC6289007 DOI: 10.4103/eus.eus_53_18] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background and Objectives: EUS-guided biliary drainage (EUS-BD) was shown to be useful for malignant biliary obstruction (MBO). However, there is lack of consensus on how EUS-BD should be performed. Methods: This was a worldwide multi-institutional survey among members of the International Society of EUS conducted in February 2018. The survey consisted of 10 questions related to the practice of EUS-BD. Results: Forty-six endoscopists of them completed the survey. The majority of endoscopists felt that EUS-BD could replace percutaneous transhepatic biliary drainage after failure of ERCP. Among all EUS-BD methods, the rendezvous stenting technique should be the First choice. Self-expandable metal stents (SEMSs) were recommended by most endoscopists. For EUS-guided hepaticogastrostomy (HGS), superiority of partially-covered SEMS over fully-covered SEMS was not in agreement. 6-Fr cystotomes were recommended for fistula creation. During the HGS approach, longer SEMS (8 or 10 cm) was recommended. During the choledochoduodenostomy approach, 6-cm SEMS was recommended. During the intrahepatic (IH) approach, the IH segment 3 was recommended. Conclusion: This is the first worldwide survey on the practice of EUS-BD for MBO. There were wide variations in practice, and randomized studies are urgently needed to establish the best approach for the management of this condition.
Collapse
Affiliation(s)
- Jintao Guo
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Marc Giovannini
- Pathology Unit (Flora Poizat), Institute Paoli-Calmettes, Marseille, France
| | - Anand V Sahai
- Center Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Adrian Saftoiu
- Department of Endoscopy, University of Medicine and Pharmacy, Craiova, Romania
| | | | - Erwin Santo
- Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastroenterology Unit, Hospital of Imola, University of Bologna, Bologna, Italy
| | - Ali A Siddiqui
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Manoop S Bhutani
- Department of Gastroenterology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University, Mibu, Japan
| | | | | | | | - Dong-Wan Seo
- Department of Internal Medicine, Division of Gastroenterology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Douglas G Adler
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Evangelos Kalaitzakis
- Division of Endoscopy, Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Everson Artifon
- Department of Surgery, University of Sao Paulo, Sao Paulo, Brazil
| | - Fumihide Itokawa
- Department of Gastroenterology and Hepatology, Tokyo Adventist Hospital, Tokyo, Japan
| | - Jan Werner Poley
- Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Girish Mishra
- Department of Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Khek Yu Ho
- Department of Medicine, National University of Singapore, Singapore, Singapore
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, China
| | | | | | - Juan J Vila
- Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Julio Iglesias-Garcia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Spain
| | | | - Kenjiro Yasuda
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Kensuke Kubota
- Department of Endoscopy, Yokohama City University School of Medicine, Yokohama, Japan
| | | | | | - Malay Sharma
- Department of Gastroenterology, Jaswant Rai Specialty Hospital, Meerut, Uttar Pradesh, India
| | - Mitsuhiro Kida
- Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Japan
| | - Mohamed El-Nady
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nam Q Nguyen
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
| | - Peter Vilmann
- Division of Endoscopy, Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Praveer Rai
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Silvia Carrara
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | | | - Subbaramiah Sridhar
- Section of Gastroenterology/Hepatology, Augusta University, Augusta, GA, USA
| | - Sundeep Lakhtakia
- Asian Institute of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Todd H Baron
- Division of Gastroenterology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Vinay Dhir
- Department of Gastroenterology, SL Raheja Hospital, Mumbai, Maharashtra, India
| | - Siyu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| |
Collapse
|
33
|
Suárez J, Marín G, Vera R, Colibaseanu D, Vila JJ, Ciga MA, Oronoz B. Stent placement prior to initiation of chemotherapy in patients with obstructive, nonoperative left sided tumors is associated with fewer stomas. J Surg Oncol 2017; 115:856-863. [DOI: 10.1002/jso.24588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/07/2017] [Accepted: 02/02/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Javier Suárez
- Department of General Surgery; Coloproctology Unit, Complejo Hospitalario de Navarra; Pamplona Spain
| | - Gabriel Marín
- Department of General Surgery; Coloproctology Unit, Complejo Hospitalario de Navarra; Pamplona Spain
| | - Ruth Vera
- Department of Medical Oncology; Complejo Hospitalario de Navarra; Pamplona Spain
| | - Dorin Colibaseanu
- Department of Surgery; Section of Colon and Rectal Surgery, Mayo Clinic; Jacksonville Florida
| | - Juan J. Vila
- Department of Gastroenterology; Complejo Hospitalario de Navarra; Pamplona Spain
| | - Miguel A. Ciga
- Department of General Surgery; Coloproctology Unit, Complejo Hospitalario de Navarra; Pamplona Spain
| | - Begoña Oronoz
- Department of General Surgery; Coloproctology Unit, Complejo Hospitalario de Navarra; Pamplona Spain
| |
Collapse
|
34
|
Wyse JM, Battat R, Sun S, Saftoiu A, Siddiqui AA, Leong AT, Arturo Arias BL, Fabbri C, Adler DG, Santo E, Kalaitzakis E, Artifon E, Mishra G, Okasha HH, Poley JW, Guo J, Vila JJ, Lee LS, Sharma M, Bhutani MS, Giovannini M, Kitano M, Eloubeidi MA, Khashab MA, Nguyen NQ, Saxena P, Vilmann P, Fusaroli P, Garg PK, Ho S, Mukai S, Carrara S, Sridhar S, Lakhtakia S, Rana SS, Dhir V, Sahai AV. Practice guidelines for endoscopic ultrasound-guided celiac plexus neurolysis. Endosc Ultrasound 2017; 6:369-375. [PMID: 29251270 PMCID: PMC5752758 DOI: 10.4103/eus.eus_97_17] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objectives: The objective of guideline was to provide clear and relevant consensus statements to form a practical guideline for clinicians on the indications, optimal technique, safety and efficacy of endoscopic ultrasound guided celiac plexus neurolysis (EUS-CPN). Methods: Six important clinical questions were determined regarding EUS-CPN. Following a detailed literature review, 6 statements were proposed attempting to answer those questions. A group of expert endosonographers convened in Chicago, United States (May 2016), where the statements were presented and feedback provided. Subsequently a consensus group of 35 expert endosonographers voted based on their individual level of agreement. A strong recommendation required 80% voter agreement. The modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria were used to rate the strength of recommendations and the quality of evidence. Results: Eighty percent agreement was reached on 5 of 6 consensus statements, 79.4% agreement was reached on the remaining one. Conclusions: EUS-CPN is efficacious, should be integrated into the management of pancreas cancer pain, and can be considered early at the time of diagnosis of inoperable disease. Techniques may still vary based on operator experience. Serious complications exist, but are rare.
Collapse
Affiliation(s)
- Jonathan M Wyse
- Division of Gastroenterology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Robert Battat
- Division of Gastroenterology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Siyu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Adrian Saftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy, Craiova, Romania
| | - Ali A Siddiqui
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ang Tiing Leong
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | | | - Carlo Fabbri
- Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy
| | - Douglas G Adler
- Department of Internal Medicine, Division of Gastroenterology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Erwin Santo
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Everson Artifon
- Department of Surgery, Ana Costa Hospital, Sao Paulo, Brazil
| | - Girish Mishra
- Department of Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | | | - Jan Werner Poley
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jintao Guo
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Juan J Vila
- Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Linda S Lee
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, USA
| | - Malay Sharma
- Department of Gastroenterology, Jaswant Rai Specialty Hospital, Meerut, Uttar Pradesh, India
| | - Manoop S Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marc Giovannini
- Endoscopic Unit, Institut Paoli-Calmettes, Marseille, France
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Mohamad Ali Eloubeidi
- Division of Gastroenterology, Northeast Alabama Regional Medical Center, Anniston, AL, USA
| | - Mouen A Khashab
- Department of Medicine and Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nam Q Nguyen
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
| | - Payal Saxena
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Peter Vilmann
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Pietro Fusaroli
- Department of Medical and Surgical Science, Gastroenterology Unit, Hospital of Imola, University of Bologna, Bologna, Italy
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Sammy Ho
- Division of Gastroenterology and Liver Diseases, Montefiore Medical Center, Bronx, New York, USA
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Silvia Carrara
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | - Subbaramiah Sridhar
- Section of Gastroenterology/Hepatology, Augusta University, Augusta, GA, USA
| | - Sundeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vinay Dhir
- Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, Maharashtra, India
| | - Anand V Sahai
- Division of Gastroenterology, Center Hospitalier de l'Université de Montréal, Montreal, Canada
| |
Collapse
|
35
|
Guo J, Saftoiu A, Vilmann P, Fusaroli P, Giovannini M, Mishra G, Rana SS, Ho S, Poley JW, Ang TL, Kalaitzakis E, Siddiqui AA, De La Mora-Levy JG, Lakhtakia S, Bhutani MS, Sharma M, Mukai S, Garg PK, Lee LS, Vila JJ, Artifon E, Adler DG, Sun S. A multi-institutional consensus on how to perform endoscopic ultrasound-guided peri-pancreatic fluid collection drainage and endoscopic necrosectomy. Endosc Ultrasound 2017; 6:285-291. [PMID: 29063871 PMCID: PMC5664848 DOI: 10.4103/eus.eus_85_17] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
There is a lack of consensus on how endoscopic ultrasound (EUS)-guided pseudocyst drainage and endoscopic necrosectomy should be performed. This survey was carried out amongst members of the EUS Journal Editorial Board to describe their practices in performing this procedure. This was a worldwide multi-institutional survey amongst members of the EUS Journal Editorial Board in May 2017. The responses to a 22-question survey with respect to the practice of EUS-guided pseudocyst drainage and endoscopic necrosectomy were obtained. Twenty-two endoscopists responded to the questionnaire as follows: 72.7% (16/22) were of the opinion that lumen-apposing metal stents (LAMS) should be the standard of care for the creation of an endoscopic cystenterostomy in patients with pancreatic walled-off necrosis (WON); 95.5% (21/22) recommended large diameter (d=15 mm) LAMS for drainage in patients with WON; 54.5% (12/22) would not dilate LAMS after placement into the WOPN; 86.4% (19/22) would not perform endoscopic necrosectomy during the same procedure as the creation of the cystenterostomy; 45.5% (10/22) recommend that agents, such as diluted hydrogen peroxide, should be used to lavage the peri-pancreatic fluid collection (PFC) cavity in patients with WON; and 45.5% (10/22) considered a naso-cystic or other tube to be necessary for lavage of WON after initial drainage. The mean optimal interval recommended for endoscopic necrosectomy procedures after EUS-guided drainage was 6.23 days. The mean optimal interval recommended for repeat imaging in patients undergoing endoscopic necrosectomy was 12.32 days. The mean time recommended for LAMS removal was 4.59 weeks. This is the first worldwide survey on the practice of EUS-guided pseudocyst drainage and endoscopic necrosectomy. There were wide variations in practice and randomized studies are urgently needed to establish the best approach for management of this condition. There is also a pressing need to establish a best practice consensus.
Collapse
Affiliation(s)
- Jintao Guo
- Endoscopy Center, Sheng Jing Hospital of Medical University, Shenyang, China
| | - Adrian Saftoiu
- Department of Endoscopy, University of Medicine and Pharmacy, Craiova, Romania
| | - Peter Vilmann
- Endoscopy Department, GastroUnit, Copenhagen University Hospital, Copenhagen, Denmark
| | - Pietro Fusaroli
- Gastroenterology Unit, University of Bologna, Bologna, Italy
| | - Marc Giovannini
- Pathology Unit (Flora Poizat), Institute Paoli-Calmettes, Marseille, France
| | | | - Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sammy Ho
- Montefiore Medical Center, New York, USA
| | - Jan-Werner Poley
- Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tiing Leong Ang
- Gastroenterology Department, Changi General Hospital, Singapore
| | - Evangelos Kalaitzakis
- Endoscopy Unit, Digestive Disease Center, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ali A Siddiqui
- Division of Digestive and Liver Diseases, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Sundeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, USA
| | - Manoop S Bhutani
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Malay Sharma
- Department of Gastroenterology, Jaswant Rai Specialty Hospital, Meerut, Uttar Pradesh, USA
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Pramod Kumar Garg
- Department of Gastroenterology, All Institute of Medical Sciences, New Delhi, India
| | - Linda S Lee
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA
| | - Juan J Vila
- Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Everson Artifon
- Department of Surgery, Ana Costa Hospital, Sao Paulo, Brazil
| | - Douglas G Adler
- Division of Gastroenterology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Siyu Sun
- Endoscopy Center, Sheng Jing Hospital of Medical University, Shenyang, China
| |
Collapse
|
36
|
Vila JJ, Martín L, Prieto C, Urman J, de la Peña J. Challenging combined EUS-and-ERCP-endoscopic retrieval of proximally migrated pancreatic stent. Gastrointest Endosc 2016; 84:187-8. [PMID: 26802195 DOI: 10.1016/j.gie.2016.01.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/13/2016] [Indexed: 02/08/2023]
Affiliation(s)
- Juan J Vila
- Endoscopy Unit, Biliary and Pancreatic Diseases Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Luis Martín
- Endoscopy Unit, Gastroenterology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Carlos Prieto
- Endoscopy Unit, Biliary and Pancreatic Diseases Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Jesús Urman
- Endoscopy Unit, Biliary and Pancreatic Diseases Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Joaquín de la Peña
- Endoscopy Unit, Gastroenterology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| |
Collapse
|
37
|
Ibáñez V, Montalvá E, Vila JJ, López-Andújar R. Surgical anterior cavoplasty for managing a case of early acute outflow obstruction after liver transplantation. Pediatr Transplant 2016; 20:151-4. [PMID: 26566858 DOI: 10.1111/petr.12629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2015] [Indexed: 12/01/2022]
Abstract
HVOO following liver transplantation is rarely treated surgically because it tends to debut subacutely. However, acute HVOO is a surgical emergency that compromises the viability of the graft. We report a case of HVOO diagnosed intra-operatively during surgical revision for a suspected arterial thrombosis in a 10-month-old male recipient of a second graft (segments II-III) for familial intrahepatic cholestasis. HVOO was related to a stenosis at the first transplant hepato-caval anastomosis, left in place to obtain longer venous cuffs for retransplantation. An anterior cavoplasty was necessary to resolve the issue. The new anastomosis was created under total vascular exclusion after gaining control of the supradiaphragmatic vena cava, because the inferior vena cava was unsuitable for further surgery. This approach (normally used as a means to avoid sternotomy in patients with hepatic or renal tumours associated with venous thrombosis) allows adequate vascular control and, in selected cases, offers a surgical alternative for treating HVOO.
Collapse
Affiliation(s)
- Vicente Ibáñez
- Liver Transplant Unit, La Fe University and Politecnic Hospital, Valencia, Spain
| | - Eva Montalvá
- Liver Transplant Unit, La Fe University and Politecnic Hospital, Valencia, Spain
| | - Juan J Vila
- Liver Transplant Unit, La Fe University and Politecnic Hospital, Valencia, Spain
| | - Rafael López-Andújar
- Liver Transplant Unit, La Fe University and Politecnic Hospital, Valencia, Spain
| |
Collapse
|
38
|
Vila JJ, Ruiz-Clavijo D, de la Higuera BG, Prieto C, Casi MA, Bolado F, Urman J. EUS-guided transgastric drainage of a peripancreatic collection containing an arterial bypass graft. Gastrointest Endosc 2015; 82:569-70. [PMID: 25979816 DOI: 10.1016/j.gie.2015.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 04/01/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Juan J Vila
- Biliary and Pancreatic Diseases Unit, Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - David Ruiz-Clavijo
- Biliary and Pancreatic Diseases Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - Carlos Prieto
- Biliary and Pancreatic Diseases Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - María A Casi
- Biliary and Pancreatic Diseases Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Federico Bolado
- Biliary and Pancreatic Diseases Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Jesús Urman
- Biliary and Pancreatic Diseases Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| |
Collapse
|
39
|
Ruiz-Clavijo D, Higuera BGDL, Vila JJ. Advances in the endoscopic management of pancreatic collections. World J Gastrointest Endosc 2015; 7:381-388. [PMID: 25901217 PMCID: PMC4400627 DOI: 10.4253/wjge.v7.i4.381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/30/2014] [Accepted: 01/19/2015] [Indexed: 02/05/2023] Open
Abstract
Treatment of pancreatic collections has experienced great progress in recent years with the emergence of alternative minimally invasive techniques comparing to the classic surgical treatment. Such techniques have been shown to improve outcomes of morbidity vs surgical treatment. The recent emergence of endoscopic drainage is noteworthy. The advent of endoscopic ultrasonography has been crucial for treatment of these specific lesions. They can be characterized, their relationships with neighboring structures can be evaluated and the drainage guided by this technique has been clearly improved compared with the conventional endoscopic drainage. Computed tomography is the technique of choice to characterize the recently published new classification of pancreatic collections. For this reason, the radiologist’s role establishing and classifying in a rigorously manner the collections according to the new nomenclature is essential to making therapeutic decisions. Ideal scenario for comprehensive treatment of these collections would be those centers with endoscopic ultrasound and interventional radiology expertise together with hepatobiliopancreatic surgery. This review describes the different types of pancreatic collections: acute peripancreatic fluid collection, pancreatic pseudocysts, acute necrotic collection and walled-off necrosis; the indications and the contraindications for endoscopic drainage, the drainage technique and their outcomes. The integrated management of pancreatic collections according to their type and evolution time is discussed.
Collapse
|
40
|
Vila JJ, Kutz M, Fernández-Esparrach G, López-Rosés L, Rodríguez S, Sánchez-Yague A. Endoscopic submucosal dissection in Spain: outcomes and development possibilities. Rev Esp Enferm Dig 2015; 105:544-52. [PMID: 24467499 DOI: 10.4321/s1130-01082013000900006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Endoscopic submucosal dissection (ESD) allows endoscopic, curative, en-bloc resection of superficial malignant or premalignant lesions. This procedure was conceived over 10 years ago in Japan, but has not experienced great expansion in Western countries for different reasons. This article reviews ESD indications and outcomes, and reflects on the reasons that prevent ESD from becoming common clinical practice in Western hospitals. Finally, recommendations on ESD training in our setting are made.
Collapse
|
41
|
Vila JJ, Pérez-Miranda M, Basterra M, Gómez M, Fernández-Urién I, Jiménez FJ. Endoscopic ultrasound-guided therapy of a rectal Dieulafoy lesion. Endoscopy 2014; 46 Suppl 1 UCTN:E84-5. [PMID: 24676828 DOI: 10.1055/s-0033-1344776] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- J J Vila
- Endoscopy Unit, Department of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - M Pérez-Miranda
- Endoscopy Unit, Department of Gastroenterology, Hospital Río Hortega, Valladolid, Spain
| | - M Basterra
- Endoscopy Unit, Department of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - M Gómez
- Endoscopy Unit, Department of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - I Fernández-Urién
- Endoscopy Unit, Department of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - F J Jiménez
- Endoscopy Unit, Department of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona, Spain
| |
Collapse
|
42
|
Carazo ME, Moratalla T, Couselo M, Pemartín B, Barrios JE, Vila JJ. [Complicated omental cyst after a herniorrhaphy in an infant]. Cir Pediatr 2014; 27:140-142. [PMID: 25845104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Omental cysts are uncommon benign masses localized in the abdomen. This article describes the case of a male infant who underwent surgery due to a left inguinal hernia. During the operation a small omental cyst was found inside the sac that was resected. The first postoperative days were uneventful but the infant came back to hospital seven days after. Subsequent imaging and operative findings revealed a complicated omental cyst. This cyst was removed and the histopathology report described an inflammatory pseudotumor. The postoperative evolution was satisfactory and the patient has remained asymptomatic since he was discharged from hospital. In conclusion, it is important to explore the contents of the hernial sac during inguinal hernia repair. The finding of a small omental cyst inside the sac should encourage to study other potential intraabdominal lesions.
Collapse
|
43
|
Domènech AB, López J, Rodríguez P, Serrano F, Fernández B, Gutiérrez C, Vila JJ. [Vascular rings, our experience with 18 cases]. Cir Pediatr 2014; 27:110-116. [PMID: 25845099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM Vascular rings are a rare cause of compression of the trachea and/or the esophagus, causing stridor and/or severe dysphagia. We present our experience in the diagnosis and management of vascular rings. METHODS Retrospective study in which we analyzed clinical history, diagnosis and management of 18 patients diagnosed with vascular ring between January 1985 and December 2013. We evaluate endoscopy as a diagnostic method. RESULTS A total of 18 patients were included, with a median age of 2 years. 83.3% (15/18) had some type of symptom: 46.7% (7/15) had respiratory symptoms such as respiratory distress, stridor, recurrent respiratory infections, bronchospasm with wheezing or asthma in older children; 20% (3/15) had digestive symptoms such as dysphagia, vomiting and regurgitation; and 33.3% (5/15) combined respiratory and digestive symptoms. The remaining patients, 16.7% (3/18) were asymptomatic and the diagnosis was casual. The most common types of vascular rings were double aortic arch (27.8%) and aberrant subclavian right artery (27.8%). In 3 cases (16.7%) a Kommerell diverticulum was associated. 44.4% (n = 8) was operated on, the remaining did not present symp- toms which justify the intervention (n = 10). 37.5% of patients had postoperative complications (iatrogenic recurrent paralysis and persistent tracheomalacia). There was no mortality in our series. The median follow-up was 6.4 years. At the moment, 88.9% of patients are asymptomatic, and 33.3% have been definitely discharged. CONCLUSIONS Vascular rings are rare, and usually presented with common symptoms in childhood. Therefore, in front of a longstanding and recurrent respiratory symptoms, or dysphagia, we should think of a vascular ring. Not all subjects are candidates for surgical correction; therefore a multidisciplinary evaluation is essential.
Collapse
|
44
|
Dhir V, Artifon ELA, Gupta K, Vila JJ, Maselli R, Frazao M, Maydeo A. Multicenter study on endoscopic ultrasound-guided expandable biliary metal stent placement: choice of access route, direction of stent insertion, and drainage route. Dig Endosc 2014; 26:430-5. [PMID: 23941261 DOI: 10.1111/den.12153] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 07/04/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Endoscopic ultrasonography-guided biliary drainage (EUS-BD) using expandable biliary metal stents has emerged as an acceptable alternative in patients with failed endoscopic retrograde cholangiopancreatography for malignant biliary obstruction. However, there is no consensus over the preferred access route (transhepatic or extrahepatic), direction of stent insertion (antegrade or retrograde) or drainage route (transluminal or transpapillary) in patients potentially suitable for multiple methods. The present study compares success and complication rates in patients undergoing EUS-BD via different methods. METHODS This was a multicenter retrospective analysis. Records of patients who underwent EUS-BD for malignant obstructive jaundice at four centers were entered in a standard database. Success and complications were compared for different techniques. RESULTS Sixty-eight patients were analyzed. EUS-BD was successful in 65 patients (95.6%). There was no significant difference in the success rates of different techniques. Complications were seen in 14 patients (20.6%) and mortality in three patients (4.4%). Complications were significantly higher for the transhepatic route compared to the transduodenal route (30.5% vs 9.3%, P=0.03). There was no significant difference in complication rates among transluminal and transpapillary stent placements, or direct and rendezvous stenting. Logistic regression analysis showed transhepatic access to be the only independent risk factor for complications (P=0.031, t=2.2). CONCLUSION EUS-BD can be carried out with high success rates regardless of the choice of access route, stent direction or drainage route. However, complications are significantly higher with transhepatic access. The transduodenal route should be chosen for EUS-guided and rendezvous stent placements, when both routes are available.
Collapse
Affiliation(s)
- Vinay Dhir
- Baldota Institute of Digestive Sciences, Global Hospital, Mumbai, India
| | | | | | | | | | | | | |
Collapse
|
45
|
|
46
|
|
47
|
Domènech AB, Gutiérrez C, Moratalla T, Lluna J, Barrios JE, Vila JJ. [Long gap esophageal atresia: Schärli versus Foker]. Cir Pediatr 2013; 26:69-74. [PMID: 24228356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE. To submit the short and long term results of long-gap esophageal atresia (EA) with two surgical techniques. METHODS. We carried out a retrospective study of long-gap type EA without fistula (n=8) and with fistula (n=2) over the last 18 years, comparing the outcome of the Schärli technique (1992) with that of the Foker technique (1997). RESULTS. We included 10 patients with long gap EA. Mean birth weight was 2,418 grams. 30% had associated diseases (VACTERL, Down Syndrome, DiGeorge Syndrome). Gastrostomy or jejunostomy was initially placed in 7 patients. Schärli technique was performed in 4 patients (mean age: 3.3 months), and Foker technique in 6 patients (median age: 23.5 days of life). Complications were: a) Schärli: dehiscence (25%), stenosis (75%), one patient died from his heart disease (25%), colonic herniation through diaphragmatic hiatus (25%). The mean number of stricture dilatations was 7 sessions (S.D. 9.2). a) Foker: dehiscence (83.3%), stenosis (83.3%), gastroesophageal reflux (GER) (83.3%), fistula (16.7%). Mean number of dilatations was 13.7 sessions (S.D. 12.8). All patients operated on with Schärli technique (6-18 years, median follow-up 12 years) were asymptomatic at the time of the study, although one of them had grade III esophagitis in the last biopsy. As for the Foker's, 5 had undergone antireflux surgery and only one was asymptomatic. The rest had complications that were still being treated (stenosis and development of fistulae). CONCLUSION. Treatment of long gap EA remains a surgical challenge. In our experience patients developed fewer complications with the Schärli technique. Nevertheless, it is difficult to make a comparison with such a limited number of patients.
Collapse
Affiliation(s)
- A B Domènech
- Hospital Universitari i Politècnica La Fe, València.
| | | | | | | | | | | |
Collapse
|
48
|
Affiliation(s)
- M Perez-Miranda
- Gastroenterology Department, Hospital Universitario Rio Hortega, Valladolid, Spain.
| | | | | |
Collapse
|
49
|
Ruiz Clavijo D, Fernández-Urién I, Vila JJ, Goñi S, González de la Higuera B, Martínez Echeverría A. [Severe lower gastrointestinal bleeding in a 25-year-old patient]. An Sist Sanit Navar 2013; 35:517-20. [PMID: 23296238 DOI: 10.23938/assn.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Lower gastrointestinal bleeding refers to blood loss originating from a site distal to the ligament of Treitz. The aetiology varies depending on the age of patients. Excluding benign anorectal pathology in children and young people, Meckel's diverticulum, juvenile polyps and inflammatory bowel disease are the main causes. Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, being present in about 2% of the general population. Most Meckel's diverticulum are asymptomatic and are diagnosed incidentally. The risk of complications is 4-6%, with bleeding as one of them.
Collapse
Affiliation(s)
- D Ruiz Clavijo
- Servicio de Aparato Digestivo, Complejo Hospitalario de Navarra, Pamplona, 31008, Spain.
| | | | | | | | | | | |
Collapse
|
50
|
Vila JJ, Pérez-Miranda M, Vazquez-Sequeiros E, Abadia MAS, Pérez-Millán A, González-Huix F, Gornals J, Iglesias-Garcia J, De la Serna C, Aparicio JR, Subtil JC, Alvarez A, de la Morena F, García-Cano J, Casi MA, Lancho A, Barturen A, Rodríguez-Gómez SJ, Repiso A, Juzgado D, Igea F, Fernandez-Urien I, González-Martin JA, Armengol-Miró JR. Initial experience with EUS-guided cholangiopancreatography for biliary and pancreatic duct drainage: a Spanish national survey. Gastrointest Endosc 2012; 76:1133-41. [PMID: 23021167 DOI: 10.1016/j.gie.2012.08.001] [Citation(s) in RCA: 168] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 08/01/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND EUS-guided cholangiopancreatography (ESCP) allows transmural access to biliopancreatic ducts when ERCP fails. Data regarding technical details, safety, and outcomes of ESCP are still unknown. OBJECTIVE To evaluate outcomes of ESCP in community and referral centers at the initial development phase of this procedure, to identify the ESCP stages with higher risk of failure, and to evaluate the influence on outcomes of factors related to the endoscopist. DESIGN Multicenter retrospective study. SETTING Public health system hospitals with experience in ESCP in Spain. PATIENTS A total of 125 patients underwent ESCP in 19 hospitals, with an experience of <20 procedures. INTERVENTION ESCP. MAIN OUTCOME MEASUREMENTS Technical success and complication rates in the initial phase of implantation of ESCP are described. The influence of technical characteristics and endoscopist features on outcomes was analyzed. RESULTS A total of 125 patients from 19 hospitals were included. Biliary ESCP was performed in 106 patients and pancreatic ESCP was performed in 19. Technical success was achieved in 84 patients (67.2%) followed by clinical success in 79 (63.2%). Complications occurred in 29 patients (23.2%). Unsuccessful manipulation of the guidewire was responsible for 68.2% of technical failures, and 58.6% of complications were related to problems with the transmural fistula. LIMITATIONS Retrospective study. CONCLUSION Outcomes of ESCP during its implantation stage reached a technical success rate of 67.2%, with a complication rate of 23.2%. Intraductal manipulation of the guidewire seems to be the most difficult stage of the procedure.
Collapse
Affiliation(s)
- Juan J Vila
- Department of Gastroenterology, Endoscopy Unit A, Complejo Hospitalario de Navarra, Pamplona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|