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Velegraki M, Arna D, Nikolaou P, Psistakis A, Fragaki M, Chlouverakis G, Vardas E, Paspatis G. Endoscopic papillary large-balloon dilation with sphincterotomy for difficult common bile duct stones ≤12 mm: a prospective study. Ann Gastroenterol 2024; 37:89-94. [PMID: 38223243 PMCID: PMC10785022 DOI: 10.20524/aog.2023.0855] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/30/2023] [Indexed: 01/16/2024] Open
Abstract
Background Stone recurrence is a significant complication following endoscopic bile duct clearance. Endoscopic papillary large-balloon dilation (EPLBD) with biliary sphincterotomy (EBS) has shown satisfactory results in preventing recurrence of "large" common bile duct stones (CBDS). However, data on outcomes after EPLBD+EBS for CBDS ≤12 mm remain scarce. The present study prospectively evaluated the mid- and long-term efficacy of EPLBD+EBS for CBDS recurrence among this group of patients. Methods Consecutive patients with CBDS ranging from 8-12 mm, treated with EPLBD+EBS from June 2018 through June 2020, were prospectively followed-up for at least 36 months. CBDS recurrence was defined as recurrent stones confirmed by endoscopic retrograde cholangiopancreatography (ERCP) during the follow-up period. Results Overall, 72 patients (mean age: 67 years, 52.8% male) were included, of whom 22 (30.5%) had multiple (≥3) CBDS, 23 (31.9%) had a history of cholecystectomy, 13 (18.1%) had a periampullary diverticulum and 22 (30.5%) had a previous EBS. The mean CBD diameter was 11.6±1 mm, while a tapered duct was noted in 7 (9.7%). Post-procedural bleeding and cholangitis occurred in 1 and 2 cases respectively. No cases of perforation and post-ERCP pancreatitis were observed. During a mean follow up of 46.4±6.2 months (range 37-60), no mid-term recurrence was observed, whereas CBDS recurred in 2/72 (2.7%) in the long term. Conclusions EPLBD+EBS in patients with CBDS ≤12 mm was associated with a very low rate of mid- and long-term CBDS recurrence. Our results need to be further investigated with randomized controlled trials.
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Affiliation(s)
- Magdalini Velegraki
- Department of Gastroenterology, Venizeleion General Hospital, Heraklion, Crete, Greece (Magdalini Velegraki, Despoina Arna, Pinelopi Nikolaou, Andreas Psistakis, Maria Fragaki, Emmanouil Vardas, Gregorios Paspatis)
| | - Despoina Arna
- Department of Gastroenterology, Venizeleion General Hospital, Heraklion, Crete, Greece (Magdalini Velegraki, Despoina Arna, Pinelopi Nikolaou, Andreas Psistakis, Maria Fragaki, Emmanouil Vardas, Gregorios Paspatis)
| | - Pinelopi Nikolaou
- Department of Gastroenterology, Venizeleion General Hospital, Heraklion, Crete, Greece (Magdalini Velegraki, Despoina Arna, Pinelopi Nikolaou, Andreas Psistakis, Maria Fragaki, Emmanouil Vardas, Gregorios Paspatis)
| | - Andreas Psistakis
- Department of Gastroenterology, Venizeleion General Hospital, Heraklion, Crete, Greece (Magdalini Velegraki, Despoina Arna, Pinelopi Nikolaou, Andreas Psistakis, Maria Fragaki, Emmanouil Vardas, Gregorios Paspatis)
| | - Maria Fragaki
- Department of Gastroenterology, Venizeleion General Hospital, Heraklion, Crete, Greece (Magdalini Velegraki, Despoina Arna, Pinelopi Nikolaou, Andreas Psistakis, Maria Fragaki, Emmanouil Vardas, Gregorios Paspatis)
| | - Gregorios Chlouverakis
- Department of Social Medicine, Biostatistics Lab, School of Medicine, University of Crete, Heraklion, Crete, Greece (Gregorios Chlouverakis)
| | - Emmanouil Vardas
- Department of Gastroenterology, Venizeleion General Hospital, Heraklion, Crete, Greece (Magdalini Velegraki, Despoina Arna, Pinelopi Nikolaou, Andreas Psistakis, Maria Fragaki, Emmanouil Vardas, Gregorios Paspatis)
| | - Gregorios Paspatis
- Department of Gastroenterology, Venizeleion General Hospital, Heraklion, Crete, Greece (Magdalini Velegraki, Despoina Arna, Pinelopi Nikolaou, Andreas Psistakis, Maria Fragaki, Emmanouil Vardas, Gregorios Paspatis)
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2
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Yanai H, Kagramanova A, Knyazev O, Sabino J, Haenen S, Mantzaris GJ, Mountaki K, Armuzzi A, Pugliese D, Furfaro F, Fiorino G, Drobne D, Kurent T, Yassin S, Maharshak N, Castiglione F, de Sire R, Nardone OM, Farkas K, Molnar T, Krznaric Z, Brinar M, Chashkova E, Livne Margolin M, Kopylov U, Bezzio C, Bar-Gil Shitrit A, Lukas M, Chaparro M, Truyens M, Nancey S, Lobaton T, Gisbert JP, Saibeni S, Bacsúr P, Bossuyt P, Schulberg J, Hoentjen F, Viganò C, Palermo A, Torres J, Revés J, Karmiris K, Velegraki M, Savarino E, Markopoulos P, Tsironi E, Ellul P, Calviño Suárez C, Weisshof R, Ben-Hur D, Naftali T, Eriksson C, Koutroubakis IE, Foteinogiannopoulou K, Limdi JK, Liu E, Surís G, Calabrese E, Zorzi F, Filip R, Ribaldone DG, Snir Y, Goren I, Banai-Eran H, Broytman Y, Amir Barak H, Avni-Biron I, Ollech JE, Dotan I, Aharoni Golan M. Endoscopic Postoperative Recurrence in Crohn's Disease After Curative Ileocecal Resection with Early Prophylaxis by Anti-TNF, Vedolizumab or Ustekinumab: A Real-World Multicentre European Study. J Crohns Colitis 2022; 16:1882-1892. [PMID: 35895074 DOI: 10.1093/ecco-jcc/jjac100] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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] [Indexed: 12/14/2022]
Abstract
BACKGROUND Endoscopic-post-operative-recurrence [ePOR] in Crohn's disease [CD] after ileocecal resection [ICR] is a major concern. We aimed to evaluate the effectiveness of early prophylaxis with biologics and to compare anti-tumour necrosis factor [anti-TNF] therapy to vedolizumab [VDZ] and ustekinumab [UST] in a real-world setting. METHODS A retrospective multicentre study of CD-adults after curative ICR on early prophylaxis was undertaken. ePOR was defined as a Rutgeerts score [RS] ≥ i2 or colonic-segmental-SES-CD ≥ 6. Multivariable logistic regression was used to evaluate risk factors, and inverse probability treatment weighting [IPTW] was applied to compare the effectiveness between agents. RESULTS The study included 297 patients (53.9% males, age at diagnosis 24 years [19-32], age at ICR 34 years [26-43], 18.5% smokers, 27.6% biologic-naïve, 65.7% anti-TNF experienced, 28.6% two or more biologics and 17.2% previous surgery). Overall, 224, 39 and 34 patients received anti-TNF, VDZ or UST, respectively. Patients treated with VDZ and UST were more biologic experienced with higher rates of previous surgery. ePOR rates within 1 year were 41.8%. ePOR rates by treatment groups were: anti-TNF 40.2%, VDZ 33% and UST 61.8%. Risk factors for ePOR at 1 year were: past-infliximab (adjusted odds ratio [adj.OR] = 1.73 [95% confidence interval, CI: 1.01-2.97]), past-adalimumab [adj.OR = 2.32 [95% CI: 1.35-4.01] and surgical aspects. After IPTW, the risk of ePOR within 1 year of VDZ vs anti-TNF or UST vs anti-TNF was comparable (OR = 0.55 [95% CI: 0.25-1.19], OR = 1.86 [95% CI: 0.79-4.38]), respectively. CONCLUSION Prevention of ePOR within 1 year after surgery was successful in ~60% of patients. Patients treated with VDZ or UST consisted of a more refractory group. After controlling for confounders, no differences in ePOR risk were seen between anti-TNF prophylaxis and other groups.
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Affiliation(s)
- Henit Yanai
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Anna Kagramanova
- Moscow Clinical Scientific Centre named after. A.S. Loginov, Moscow, Russian Federation
| | - Oleg Knyazev
- Moscow Clinical Scientific Centre named after. A.S. Loginov, Moscow, Russian Federation.,State Scientific Centre of Coloproctology named after A.N. Ryzhyh, Moscow, Russian Federation.,Research Institute of Health Organization and Medical Management, Moscow, Russian Federation
| | - João Sabino
- Department of Gastroenterology, University Hospitals of Leuven, Leuven, Belgium
| | - Shana Haenen
- Department of Gastroenterology, University Hospitals of Leuven, Leuven, Belgium
| | - Gerassimos J Mantzaris
- Department of Gastroenterology, GHA 'Evaggelismos-Ophthalmiatreion Athinon-Polykliniki', Athens, Greece
| | - Katerina Mountaki
- Department of Gastroenterology, GHA 'Evaggelismos-Ophthalmiatreion Athinon-Polykliniki', Athens, Greece
| | | | - Daniela Pugliese
- CEMAD, IBD UNIT, Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy
| | | | - Gionata Fiorino
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - David Drobne
- Department of Internal Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.,Department of Gastroenterology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tina Kurent
- Department of Gastroenterology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Sharif Yassin
- Sackler Faculty of Medicine, Tel Aviv University, Israel.,Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Nitsan Maharshak
- Sackler Faculty of Medicine, Tel Aviv University, Israel.,Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Roberto de Sire
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Olga Maria Nardone
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Klaudia Farkas
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamas Molnar
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Zeljko Krznaric
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre, Zagreb, Croatia
| | - Marko Brinar
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre, Zagreb, Croatia
| | - Elena Chashkova
- Irkutsk Scientific Center of Surgery and Traumatology, Russia
| | - Moran Livne Margolin
- Sackler Faculty of Medicine, Tel Aviv University, Israel.,Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
| | - Uri Kopylov
- Sackler Faculty of Medicine, Tel Aviv University, Israel.,Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
| | - Cristina Bezzio
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho (MI), Italy
| | - Ariella Bar-Gil Shitrit
- Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Milan Lukas
- Clinical and Research Centre for Inflammatory Bowel Disease, ISCARE Clinical Centre, Prague, Czech Republic.,Institute of Medical Biochemistry and Laboratory Medicine, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - María Chaparro
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS- Princesa), Universidad Autónoma de Madrid (UAM), Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Marie Truyens
- IBD unit, Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Stéphane Nancey
- Department of Gastroenterology, Lyon-Sud hospital, Hospices Civils de Lyon, Lyon and INSERM U1111, CIRI, Lyon, France
| | - Triana Lobaton
- IBD unit, Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Javier P Gisbert
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS- Princesa), Universidad Autónoma de Madrid (UAM), Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho (MI), Italy
| | - Péter Bacsúr
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Peter Bossuyt
- Imelda GI clinical Research Center, Department of Gastroenterology, Imelda General Hospital, Bonheiden, Belgium
| | - Julien Schulberg
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.,Department of Gastroenterology, Austin Hospital, Melbourne, VIC, Australia
| | - Frank Hoentjen
- Inflammatory Bowel Disease Center, Department of Gastroenterology, Radboud University Medical Center, Nijmegen, The Netherlands and Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Chiara Viganò
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Andrea Palermo
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Joana Torres
- Division of Gastroenterology, Hospital da Luz Lisboa, Portugal.,Division of Gastroenterology, Hospital Beatriz Ângelo, Loures, Lisbon, Portugal
| | - Joana Revés
- Division of Gastroenterology, Hospital Beatriz Ângelo, Loures, Lisbon, Portugal
| | - Konstantinos Karmiris
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Crete, Greece
| | - Magdalini Velegraki
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Crete, Greece
| | - Edoardo Savarino
- Department of Surgical Oncological & Gastroenterological Sciences (DiSCOG), Gastroenterology Unit, Padua University, Padua, Italy
| | | | - Eftychia Tsironi
- Department of Gastroenterology, Metaxa Memorial General Hospital, Piraeus, Greece
| | - Pierre Ellul
- Division of Gastroenterology Mater Dei Hospital, Msida, Malta
| | - Cristina Calviño Suárez
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Roni Weisshof
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, The Technion - Israel Institute of Technology, Haifa, Israel
| | - Dana Ben-Hur
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, The Technion - Israel Institute of Technology, Haifa, Israel
| | - Timna Naftali
- Institute of Gastroenterology, Meir Hospital Sapir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Carl Eriksson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | | | - Jimmy K Limdi
- Department of Gastroenterology, The Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Sciences, University of Manchester, Manchester, UK
| | - Eleanor Liu
- Department of Gastroenterology, The Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Sciences, University of Manchester, Manchester, UK
| | - Gerard Surís
- Gastroenterology Department, Hospital de Bellvitge and IDIBELL, L'Hospitalet, Spain
| | - Emma Calabrese
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Francesca Zorzi
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Rafał Filip
- Department of Gastroenterology with IBD Unit, Clinical Hospital No. 2, Rzeszów, Poland
| | | | - Yifat Snir
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Idan Goren
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Hagar Banai-Eran
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Yelena Broytman
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Hadar Amir Barak
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Irit Avni-Biron
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Jacob E Ollech
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Iris Dotan
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Maya Aharoni Golan
- Department of Gastroenterology and Hepatology, Kaplan Medical Center, Rehovot, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Concord Medical Center, Clalit Health Services, Bnei Brak, Israel
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Paspatis GA, Papastergiou V, Mpitouli A, Velegraki M, Nikolaou P, Fragkaki M, Voudoukis E, Theodoropoulou A, Chlouverakis G, Vardas E, Paraskeva KD. Distal Biliary Stent Migration in Patients with Irretrievable Bile Duct Stones: Long-Term Comparison Between Straight and Double-Pigtail Stents. Dig Dis Sci 2022; 67:4557-4564. [PMID: 35305168 DOI: 10.1007/s10620-022-07461-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 06/21/2021] [Accepted: 11/08/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Prolonged biliary stenting may be considered in high-risk patients with irretrievable bile duct stones (IBDS). Distal stent migration (DSM) is a known complication, although data beyond the recommended interval of temporary stenting (3-6 months) are lacking. We compared the long-term incidence of DSM between straight and double-pigtail stents in patients with IBDS. METHODS Consecutive patients with IBDS undergoing plastic biliary stenting (1/2009-12/2019) were retrospectively reviewed. DSM was confirmed on follow-up examination when the stent was no longer present at the papillary orifice nor fluoroscopically visible in the bile duct. Kaplan-Meier and Cox regression analyses were used to determine estimates and predictors of DSM. RESULTS Overall, 618 biliary stenting procedures (410 patients) were included: 289 with a straight stent (group A) and 329 with a double-pigtail (group B). By Kaplan-Meier analysis, the DSM rates were 8.4 and 14.6% at 6 months, 21.4 and 27.7% at 12 months, 27 and 43.5% at 18 months, and 37.2 and 60.4% at 24 months, for groups A and B, respectively (p = 0.004). Double-pigtail stents were at higher risk for DSM (HR = 7.38, p = 0.04), whereas an inverse correlation was noted with age (HR = 0.97, p = 0.0001). Considering only temporary stenting procedures (≤ 6 months; n = 297), the probability of DSM was not significantly different between the two groups (p = 0.07). CONCLUSIONS In a setting of prolonged stenting for IBDS, the probability of DSM appears to be higher when a double-pigtail stent is used and in younger patients. A relative anti-migratory advantage of double-pigtail over straight stents appears negligible in this study.
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Affiliation(s)
- Gregorios A Paspatis
- Department of Gastroenterology, Benizelion" General Hospital, L. Knossou, 71409, Heraklion, Crete, Greece.
| | - Vasilios Papastergiou
- Department of Gastroenterology, "Konstantopoulio-Patision" General Hospital, Athens, Greece
| | - Afroditi Mpitouli
- Department of Gastroenterology, Benizelion" General Hospital, L. Knossou, 71409, Heraklion, Crete, Greece
| | - Magdalini Velegraki
- Department of Gastroenterology, Benizelion" General Hospital, L. Knossou, 71409, Heraklion, Crete, Greece
| | - Pinelopi Nikolaou
- Department of Gastroenterology, Benizelion" General Hospital, L. Knossou, 71409, Heraklion, Crete, Greece
| | - Maria Fragkaki
- Department of Gastroenterology, Benizelion" General Hospital, L. Knossou, 71409, Heraklion, Crete, Greece
| | - Evangelos Voudoukis
- Department of Gastroenterology, Benizelion" General Hospital, L. Knossou, 71409, Heraklion, Crete, Greece
| | - Angeliki Theodoropoulou
- Department of Gastroenterology, Benizelion" General Hospital, L. Knossou, 71409, Heraklion, Crete, Greece
| | | | - Emmanouil Vardas
- Department of Gastroenterology, Benizelion" General Hospital, L. Knossou, 71409, Heraklion, Crete, Greece
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Nicolaou P, Velegraki M, Arna D, Psistakis A, Bachlitzanakis E, Flamourakis M, Paspatis GA. Iatrogenic colonic perforation closure with an over-the-scope clip applied with a gastroscope 4 hours after index colonoscopy. Endoscopy 2022; 54:E1068-E1069. [PMID: 36007907 PMCID: PMC9737424 DOI: 10.1055/a-1889-5278] [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: 12/14/2022]
Affiliation(s)
- Pinelopi Nicolaou
- Department of Gastroenterology, Benizelion General Hospital, Heraklion, Crete, Greece
| | - Magdalini Velegraki
- Department of Gastroenterology, Benizelion General Hospital, Heraklion, Crete, Greece
| | - Despoina Arna
- Department of Gastroenterology, Benizelion General Hospital, Heraklion, Crete, Greece
| | - Andrew Psistakis
- Department of Gastroenterology, Benizelion General Hospital, Heraklion, Crete, Greece
| | | | | | - Gregorios A. Paspatis
- Department of Gastroenterology, Benizelion General Hospital, Heraklion, Crete, Greece
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Velegraki M, Manolaraki M, Chainaki I, Vardas E, Petrodaskalaki M, Androulakis N, Georgakaki C, Lazanaki E, Chlouverakis G, Paspatis GA. Cerebral oximetry monitoring in non-intubated patients undergoing endoscopic retrograde cholangiopancreatography under propofol-induced sedation: a prospective observational study. Ann Gastroenterol 2021; 34:736-742. [PMID: 34475746 PMCID: PMC8375660 DOI: 10.20524/aog.2021.0637] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/18/2021] [Indexed: 11/30/2022] Open
Abstract
Background Prolonged propofol-induced deep sedation increases the risk for sedation-related complications. Cerebral oximetry enables prompt assessment of tissue oxygenation by demonstrating the regional hemoglobin oxygen saturation (rSO2) of the cerebral cortex. This study aimed to: evaluate cerebral oxygenation under deep sedation during an endoscopic retrograde cholangiopancreatography (ERCP) procedure; determine the cerebral desaturation event (CDE) rate; and assess the predictive capacity of CDEs for sedation-related complications. Methods All consecutive patients who underwent ERCP between September and December 2019 were included prospectively. Propofol monotherapy was used and sedation level was assessed using the bispectral index (BIS). The target level of sedation was deep sedation, defined by BIS values 40-60. Participants were monitored with arterial blood gas analysis and INVOS 5100C cerebral oximeter. RSO2 values were registered prior to sedation (baseline value), every 5 min during the sedation period and at recovery of consciousness. BIS values were recorded simultaneously. CDE was defined as a drop >10% from individual baseline rSO2. Results Sixty patients were enrolled. Mean baseline rSO2 was 65.1% and BIS values ranged from 18-85. No significant correlation was observed between mean rSO2 measurements and mean BIS values throughout the recordings (P = 0.193). Data from patients aged ≥65 years were analyzed separately and the results were similar. The CDE rate was 2.7%, but no CDE was associated with clinical manifestations. Twelve sedation-related complications occurred without the presence of cerebral desaturation. Conclusion Cerebral oxygenation remained independent of changes in sedation depth and cerebral oximetry monitoring did not detect complications earlier than standard monitors.
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Affiliation(s)
- Magdalini Velegraki
- Department of Gastroenterology, Venizeleion General Hospital (Magdalini Velegraki, Emmanouil Vardas, Gregorios A. Paspatis)
| | - Maria Manolaraki
- Department of Anesthesiology, Venizeleion General Hospital (Maria Manolaraki, Irene Chainaki, Nikolaos Androulakis, Chrysanthi Georgakaki, Evangelia Lazanaki)
| | - Irene Chainaki
- Department of Anesthesiology, Venizeleion General Hospital (Maria Manolaraki, Irene Chainaki, Nikolaos Androulakis, Chrysanthi Georgakaki, Evangelia Lazanaki)
| | - Emmanouil Vardas
- Department of Gastroenterology, Venizeleion General Hospital (Magdalini Velegraki, Emmanouil Vardas, Gregorios A. Paspatis)
| | - Maria Petrodaskalaki
- Department of Quality and Research, University Hospital of Heraklion (Maria Petrodaskalaki)
| | - Nikolaos Androulakis
- Department of Anesthesiology, Venizeleion General Hospital (Maria Manolaraki, Irene Chainaki, Nikolaos Androulakis, Chrysanthi Georgakaki, Evangelia Lazanaki)
| | - Chrysanthi Georgakaki
- Department of Anesthesiology, Venizeleion General Hospital (Maria Manolaraki, Irene Chainaki, Nikolaos Androulakis, Chrysanthi Georgakaki, Evangelia Lazanaki)
| | - Evangelia Lazanaki
- Department of Anesthesiology, Venizeleion General Hospital (Maria Manolaraki, Irene Chainaki, Nikolaos Androulakis, Chrysanthi Georgakaki, Evangelia Lazanaki)
| | - Gregorios Chlouverakis
- Department of Social Medicine, Biostatistics Lab, School of Medicine, University of Crete, Voutes University Campus (Gregorios Chlouverakis); Crete, Greece
| | - Gregorios A Paspatis
- Department of Gastroenterology, Venizeleion General Hospital (Magdalini Velegraki, Emmanouil Vardas, Gregorios A. Paspatis)
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Foteinogiannopoulou K, Karmiris K, Axiaris G, Velegraki M, Gklavas A, Kapizioni C, Karageorgos C, Kateri C, Katsoula A, Kokkotis G, Koureta E, Lamouri C, Markopoulos P, Palatianou M, Pastras P, Fasoulas K, Giouleme O, Zampeli E, Theodoropoulou A, Theocharis G, Thomopoulos K, Karatzas P, Katsanos KH, Kapsoritakis A, Kourikou A, Mathou N, Manolakopoulos S, Michalopoulos G, Michopoulos S, Boubonaris A, Bamias G, Papadopoulos V, Papatheodoridis G, Papaconstantinou I, Pachiadakis I, Soufleris K, Tzouvala M, Triantos C, Tsironi E, Christodoulou DK, Koutroubakis IE. Correction to: The burden and management of anemia in Greek patients with inflammatory bowel disease: a retrospective, multicenter, observational study. BMC Gastroenterol 2021; 21:301. [PMID: 34325662 PMCID: PMC8323283 DOI: 10.1186/s12876-021-01872-9] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Kalliopi Foteinogiannopoulou
- Gastroenterology Department, University Hospital of Heraklion, Medical School University of Crete, P.O. BOX 1352, 71110, Heraklion, Crete, Greece.
| | | | - Georgios Axiaris
- Department of Gastroenterology, General Hospital of Athens "Alexandra", Athens, Greece
| | - Magdalini Velegraki
- Department of Gastroenterology, Venizelio General Hospital, Heraklion, Greece
| | - Antonios Gklavas
- 2nd Department of Surgery, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Kapizioni
- Department of Gastroenterology, General Hospital of Piraeus "Tzaneio", Athens, Greece
| | - Charalabos Karageorgos
- Hepato-Gastroenterology/Endoscopy Unit, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Athens General Hospital "Heppocratio", Athens, Greece
| | - Christina Kateri
- Department of Gastroenterology, University General Hospital of Larissa, Larissa, Greece
| | - Anastasia Katsoula
- 2nd Internal Medicine Department, General Hospital of Thessaloniki "Ippokratio", Thessaloniki, Greece
| | - Georgios Kokkotis
- Gastroenterology Unit, 3rd Academic Department of Internal Medicine, National and Kapodistrian Univeristy of Athens, "Sotiria" General Hospital, Athens, Greece
| | - Evgenia Koureta
- Department of Gastroenterology, National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Charikleia Lamouri
- Department of Gastroenterology, University General Hospital of Ioannina, Ioannina, Greece
| | - Panagiotis Markopoulos
- Department of Gastroenterology, "Metaxa" General Anticancer Hospital of Piraeus, Piraeus, Greece
| | - Maria Palatianou
- Department of Gastroenterology, General Hospital of Nikaia Piraeus "Ag. Panteleimon"-General Hospital Dytikis Attikis "Agia Varvara", Athens, Greece
| | - Ploutarchos Pastras
- Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - Konstantinos Fasoulas
- Department of Gastroenterology-Oncology, Theageneio Cancer Hospital of Thessaloniki, Thessaloniki, Greece
| | - Olga Giouleme
- 2nd Internal Medicine Department, General Hospital of Thessaloniki "Ippokratio", Thessaloniki, Greece
| | - Evanthia Zampeli
- Department of Gastroenterology, General Hospital of Athens "Alexandra", Athens, Greece
| | | | - Georgios Theocharis
- Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - Konstantinos Thomopoulos
- Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - Pantelis Karatzas
- Department of Gastroenterology, National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | | | - Andreas Kapsoritakis
- Department of Gastroenterology, University General Hospital of Larissa, Larissa, Greece
| | - Anastasia Kourikou
- Hepato-Gastroenterology/Endoscopy Unit, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Athens General Hospital "Heppocratio", Athens, Greece
| | - Nikoleta Mathou
- Department of Gastroenterology, General Hospital of Nea Ionia "Konstantopoulio - Patision", Athens, Greece
| | - Spilios Manolakopoulos
- Hepato-Gastroenterology/Endoscopy Unit, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Athens General Hospital "Heppocratio", Athens, Greece
| | | | - Spyridon Michopoulos
- Department of Gastroenterology, General Hospital of Athens "Alexandra", Athens, Greece
| | | | - Giorgos Bamias
- Gastroenterology Unit, 3rd Academic Department of Internal Medicine, National and Kapodistrian Univeristy of Athens, "Sotiria" General Hospital, Athens, Greece
| | | | - George Papatheodoridis
- Department of Gastroenterology, National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Ioannis Papaconstantinou
- 2nd Department of Surgery, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Pachiadakis
- Department of Gastroenterology, 424 General Military Hospital, Thessaloniki, Greece
| | - Konstantinos Soufleris
- Department of Gastroenterology-Oncology, Theageneio Cancer Hospital of Thessaloniki, Thessaloniki, Greece
| | - Maria Tzouvala
- Department of Gastroenterology, General Hospital of Nikaia Piraeus "Ag. Panteleimon"-General Hospital Dytikis Attikis "Agia Varvara", Athens, Greece
| | - Christos Triantos
- Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - Eftychia Tsironi
- Department of Gastroenterology, "Metaxa" General Anticancer Hospital of Piraeus, Piraeus, Greece
| | | | - Ioannis E Koutroubakis
- Gastroenterology Department, University Hospital of Heraklion, Medical School University of Crete, P.O. BOX 1352, 71110, Heraklion, Crete, Greece
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Paspatis GA, Nikolaou P, Velegraki M, Mpitouli A, Fragaki M. The use of endocuff for the facilitation of endoscopic mucosal resection in defiant colonic polyps. A case series. Hippokratia 2021; 25:134-137. [PMID: 36683903 PMCID: PMC9851142] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Endocuff has been suggested as a safe and useful device facilitating complex endoscopic mucosal resection (EMR) in the sigmoid colon; however, the existing data are sparse. In this case series, we report our experience with endocuff in facilitating EMR in defiant polyps throughout the colon. CASE SERIES In colonoscopies where sufficient stability and, thus, reliable visualization of the lesion was not possible (defiant polyp), the endoscope was removed, and subsequently, an ENDOCUFF VISIONTM was mounted on its tip. Thereafter, the colonic area of interest underwent endoscopic re-examination. The study prospectively included fifteen patients with 16 sessile/flat polyps. Fifteen of the 16 EMRs were considered successful. CONCLUSIONS This case series indicates the use of endocuff as an auxiliary device for facilitating EMR in defiant colonic polyps. HIPPOKRATIA 2021, 25 (3):134-137.
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Affiliation(s)
- G A Paspatis
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion-Crete, Greece
| | - P Nikolaou
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion-Crete, Greece
| | - M Velegraki
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion-Crete, Greece
| | - A Mpitouli
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion-Crete, Greece
| | - M Fragaki
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion-Crete, Greece
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Paspatis GA, Fragaki M, Velegraki M, Mpitouli A, Nikolaou P, Tribonias G, Voudoukis E, Karmiris K, Theodoropoulou A, Vardas E. Paradigm shift in management of acute iatrogenic colonic perforations: 24-year retrospective comprehensive study. Endosc Int Open 2021; 9:E874-E880. [PMID: 34079870 PMCID: PMC8159597 DOI: 10.1055/a-1396-4086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 11/25/2020] [Accepted: 02/11/2021] [Indexed: 02/06/2023] Open
Abstract
Background and study aims Through advanced endoscopic clipping techniques, endoscopic treatment of both diagnostic and therapeutic acute iatrogenic colonic perforations has been shown effective. The main purpose of this study was to compare the management of acute iatrogenic perforations (AIPs) of the colon before and after the introduction of advanced clipping techniques. Methods We conducted a retrospective study from July 1996 to February 2020. The period was divided into two sub periods, Period 1: from July 1996 to December 2012 and Period 2: from January 2013 to March 2020. All AIPs occurring during a colonoscopy and detected during or immediately (< 4 hours) after the procedure, were included in the study. Results The total number of colonoscopies performed at our hospital was 33055 and 36831 during Periods 1 and 2 respectively. Fifteen perforations were observed in Period 1 and 11 in Period 2. The rate of surgery was 93.3 % % (14/15) in Period 1 and 27.2 % (3 /11) in Period 2 ( P < 0.01). The mean hospital stay in Period 1 was 6.9 days and 4 in Period 2 ( P < 0.01). Conclusions Data from this historical cohort have clearly shown a decrease in the surgery rate and the length of hospitalization of AIPs in Period 2 compared to Period 1.
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Affiliation(s)
- Gregorios A. Paspatis
- Department of Gastroenterology, Benizelion General Hospital, Heraklion-Crete, Greece
| | - Maria Fragaki
- Department of Gastroenterology, Benizelion General Hospital, Heraklion-Crete, Greece
| | - Magdalini Velegraki
- Department of Gastroenterology, Benizelion General Hospital, Heraklion-Crete, Greece
| | - Afroditi Mpitouli
- Department of Gastroenterology, Benizelion General Hospital, Heraklion-Crete, Greece
| | - Pinelopi Nikolaou
- Department of Gastroenterology, Benizelion General Hospital, Heraklion-Crete, Greece
| | - Georgios Tribonias
- Department of Gastroenterology, Benizelion General Hospital, Heraklion-Crete, Greece
| | - Evangelos Voudoukis
- Department of Gastroenterology, Benizelion General Hospital, Heraklion-Crete, Greece
| | - Konstantinos Karmiris
- Department of Gastroenterology, Benizelion General Hospital, Heraklion-Crete, Greece
| | | | - Emmanouil Vardas
- Department of Gastroenterology, Benizelion General Hospital, Heraklion-Crete, Greece
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9
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Velegraki M, Vardas E, Dervenis C, Fragaki M, Nikolaou P, Mpitouli A, Kazamias G, Sepsa A, Giannikaki E, Paspatis GA. IgG4-related sclerosing cholangitis: not always an obvious entity. Ann Gastroenterol 2021; 34:594-596. [PMID: 34276201 PMCID: PMC8276355 DOI: 10.20524/aog.2021.0610] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/11/2020] [Indexed: 12/04/2022] Open
Abstract
Immunoglobulin G4-related sclerosing cholangitis (IgG4-SC) is a distinct type of cholangitis, currently recognized as a biliary manifestation of IgG4-related disease. We present a case of type 3 IgG4-SC in a patient with normal IgG4 serum levels, surgically treated for suspicion of cholangiocarcinoma. This case highlights that differentiating between isolated IgG4-SC and cholangiocarcinoma can present a challenging diagnostic dilemma.
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Affiliation(s)
- Magdalini Velegraki
- Department of Gastroenterology, Venizeleion General Hospital, Heraklion (Magdalini Velegraki, Emmanouil Vardas, Maria Fragaki, Pinelopi Nikolaou, Afroditi Mpitouli, Gregorios A. Paspatis)
| | - Emmanouil Vardas
- Department of Gastroenterology, Venizeleion General Hospital, Heraklion (Magdalini Velegraki, Emmanouil Vardas, Maria Fragaki, Pinelopi Nikolaou, Afroditi Mpitouli, Gregorios A. Paspatis)
| | - Christos Dervenis
- Hepatobiliary and Pancreatic Surgery Clinic, Metropolitan Hospital, Athens (Christos Dervenis)
| | - Maria Fragaki
- Department of Gastroenterology, Venizeleion General Hospital, Heraklion (Magdalini Velegraki, Emmanouil Vardas, Maria Fragaki, Pinelopi Nikolaou, Afroditi Mpitouli, Gregorios A. Paspatis)
| | - Pinelopi Nikolaou
- Department of Gastroenterology, Venizeleion General Hospital, Heraklion (Magdalini Velegraki, Emmanouil Vardas, Maria Fragaki, Pinelopi Nikolaou, Afroditi Mpitouli, Gregorios A. Paspatis)
| | - Afroditi Mpitouli
- Department of Gastroenterology, Venizeleion General Hospital, Heraklion (Magdalini Velegraki, Emmanouil Vardas, Maria Fragaki, Pinelopi Nikolaou, Afroditi Mpitouli, Gregorios A. Paspatis)
| | - George Kazamias
- Department of Histopathology, Venizeleion General Hospital, Heraklion (George Kazamias, Elpida Giannikaki)
| | - Athanasia Sepsa
- Department of Histopathology, Metropolitan Hospital, Athens (Athanasia Sepsa), Greece
| | - Elpida Giannikaki
- Department of Histopathology, Venizeleion General Hospital, Heraklion (George Kazamias, Elpida Giannikaki)
| | - Gregorios A Paspatis
- Department of Gastroenterology, Venizeleion General Hospital, Heraklion (Magdalini Velegraki, Emmanouil Vardas, Maria Fragaki, Pinelopi Nikolaou, Afroditi Mpitouli, Gregorios A. Paspatis)
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Velegraki M, Flamourakis M, Kazamias G, Georgiou G, Karmiris K. Replacement Resistant Iron Deficiency Anemia in a Patient With Ulcerative Colitis in Remission: Investigating Beyond the Obvious. Inflamm Bowel Dis 2019; 25:e123-e124. [PMID: 31301172 DOI: 10.1093/ibd/izz152] [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: 12/09/2022]
Affiliation(s)
- Magdalini Velegraki
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
| | | | - Georgios Kazamias
- Department of Histopathology, Venizeleio General Hospital, Heraklion, Greece
| | - Georgios Georgiou
- Department of Histopathology, Venizeleio General Hospital, Heraklion, Greece
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Velegraki M, Stylianou KG, Xydakis D, Gakiopoulou H, Voudoukis E, Lygerou D, Dermitzaki EK, Mpitouli A, Paspatis G, Theodoropoulou A. PLA2R-Negative Membranous Nephropathy Presenting as a Prodrome of IgG4-Related Autoimmune Pancreatitis. Case Rep Nephrol Dial 2019; 9:85-91. [PMID: 31367609 PMCID: PMC6616050 DOI: 10.1159/000501260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 04/04/2019] [Accepted: 05/27/2019] [Indexed: 01/11/2023] Open
Abstract
Membranous nephropathy (MN) with tubulointerstitial nephritis (TIN) is an established manifestation of immunoglobulin G4 (IgG4)-related disease (IgG4-RD). A pathological feature aiming to distinguish between primary and secondary MN is the presence or absence of glomerular staining for phospholipase A2 receptor (PLA2R), respectively. Isolated MN without TIN has been rarely reported in the context of IgG4-RD. This case report describes a patient with a history of MN successfully treated with steroids and cyclophosphamide, who, 3 years later, presented with unexplained exacerbation of diabetes mellitus due to IgG4-related autoimmune pancreatitis. Pancreatitis was treated, and diabetes improved after treatment with steroids. Based on the presence of isolated IgG4 glomerular capillary deposits along with negative staining for PLA2R and the metachronous appearance of autoimmune pancreatitis, MN was retrospectively classified as secondary to IgG4-RD. Isolated IgG4-positive/PLA2R-negative MN without TIN can be a prodrome of IgG4-RD, reminiscent of MN secondary to neoplasms.
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Affiliation(s)
| | - Kostas G Stylianou
- Department of Nephrology, University Hospital of Heraklion, Heraklion, Greece
| | | | - Hariklia Gakiopoulou
- Pathology Department, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Dimitra Lygerou
- Department of Nephrology, University Hospital of Heraklion, Heraklion, Greece
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Velegraki M, Trikola A, Vasiliadis K, Fragaki M, Mpitouli A, Dimas I, Voudoukis E, Giannikaki E, Kapranou A, Kordelas A, Stefanidis G, Paspatis GA. Endoscopic full-thickness resection of colorectal lesions with the full-thickness resection device: clinical experience from two referral centers in Greece. Ann Gastroenterol 2019; 32:482-488. [PMID: 31474795 PMCID: PMC6686092 DOI: 10.20524/aog.2019.0392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 02/18/2019] [Accepted: 05/22/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Endoscopic full-thickness resection (EFTR) using the full-thickness resection device (FTRD®) is an invasive treatment for colorectal lesions not resectable by conventional endoscopic techniques. This study presents the first Greek experience of the FTRD® procedure, assessing the efficacy and safety of EFTR. Methods: We conducted a retrospective analysis of 17 consecutive patients treated with the FTRD® at 2 referral centers from October 2015 through December 2018. The indications included difficult adenomas (non-lifting and/or at difficult locations), early adenocarcinomas and subepithelial tumors. Primary endpoints were technical success and R0 resection. Results: Technical success and R0 resection were achieved in 82.3% procedures (14/17) and in 87.5% of those with difficult adenomas (8 patients). In the subgroup with carcinomas (n=3), the rate of technical success and R0 resection was 66.6%, while in the subgroup with subepithelial tumors (n=6) the rate was 83.3%. Technical success and R0 resection were significantly lower for lesions >20 mm vs. ≤20 mm (P=0.0429). In the 17 patients a total of 3 adverse events occurred (17.6%) and one of the patients underwent laparoscopic appendectomy because of EFTR around the appendix. Conclusions: Our study showed favorable results concerning EFTR feasibility, efficacy and safety, especially for lesions ≤20 mm, non-lifting adenomas, and subepithelial tumors. Technical success, R0 resection, and adverse events rates were comparable with previously published data. Larger randomized studies are needed to better define the clinical benefit and long-term outcomes of EFTR in selected patients.
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Affiliation(s)
- Magdalini Velegraki
- Department of Gastroenterology, Venizeleion General Hospital, Heraklion, Crete (Magdalini Velegraki, Maria Fragaki, Afroditi Mpitouli, Ioannis Dimas, Evangelos Voudoukis, Gregorios A. Paspatis)
| | - Artemis Trikola
- Department of Gastroenterology, Athens Naval Hospital, Athens (Artemis Trikola, Konstantinos Vasiliadis, Gerasimos Stefanidis)
| | - Konstantinos Vasiliadis
- Department of Gastroenterology, Athens Naval Hospital, Athens (Artemis Trikola, Konstantinos Vasiliadis, Gerasimos Stefanidis)
| | - Maria Fragaki
- Department of Gastroenterology, Venizeleion General Hospital, Heraklion, Crete (Magdalini Velegraki, Maria Fragaki, Afroditi Mpitouli, Ioannis Dimas, Evangelos Voudoukis, Gregorios A. Paspatis)
| | - Afroditi Mpitouli
- Department of Gastroenterology, Venizeleion General Hospital, Heraklion, Crete (Magdalini Velegraki, Maria Fragaki, Afroditi Mpitouli, Ioannis Dimas, Evangelos Voudoukis, Gregorios A. Paspatis)
| | - Ioannis Dimas
- Department of Gastroenterology, Venizeleion General Hospital, Heraklion, Crete (Magdalini Velegraki, Maria Fragaki, Afroditi Mpitouli, Ioannis Dimas, Evangelos Voudoukis, Gregorios A. Paspatis)
| | - Evangelos Voudoukis
- Department of Gastroenterology, Venizeleion General Hospital, Heraklion, Crete (Magdalini Velegraki, Maria Fragaki, Afroditi Mpitouli, Ioannis Dimas, Evangelos Voudoukis, Gregorios A. Paspatis)
| | - Elpida Giannikaki
- Department of Histopathology, Venizeleion General Hospital, Heraklion, Crete (Elpida Giannikaki)
| | - Amalia Kapranou
- Department of Histopathology, Athens Naval Hospital, Athens (Amalia Kapranou, Athanasios Kordelas), Greece
| | - Athanasios Kordelas
- Department of Histopathology, Athens Naval Hospital, Athens (Amalia Kapranou, Athanasios Kordelas), Greece
| | - Gerasimos Stefanidis
- Department of Gastroenterology, Athens Naval Hospital, Athens (Artemis Trikola, Konstantinos Vasiliadis, Gerasimos Stefanidis)
| | - Gregorios A Paspatis
- Department of Gastroenterology, Venizeleion General Hospital, Heraklion, Crete (Magdalini Velegraki, Maria Fragaki, Afroditi Mpitouli, Ioannis Dimas, Evangelos Voudoukis, Gregorios A. Paspatis)
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Fragaki M, Voudoukis E, Chliara E, Dimas I, Mpitouli A, Velegraki M, Vardas E, Theodoropoulou A, Karmiris K, Giannikaki L, Paspatis G. Complete endoscopic mucosal resection of malignant colonic sessile polyps and clinical outcome of 51 cases. Ann Gastroenterol 2019; 32:174-177. [PMID: 30837790 PMCID: PMC6394258 DOI: 10.20524/aog.2018.0343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/26/2018] [Indexed: 12/27/2022] Open
Abstract
Background Meta-analyses and guidelines recommend that deep submucosal invasion (>1 mm) of malignant sessile colonic polyps is an important risk factor for lymph node metastasis. However, existing data are based on small retrospective studies with marked heterogeneity. We herein aimed to investigate the long-term outcomes of patients who underwent complete endoscopic mucosal resection (EMR) of malignant colonic sessile polyps invading the submucosal layer. Methods Endoscopy records for the period 2000-2016 were reviewed retrospectively. All enrolled patients exhibited an endoscopically resected malignant colonic sessile polyp. All patients were advised to undergo surgery, but some opted for conservative treatment and endoscopic follow up. Results Fifty-one patients with confirmed infiltrative submucosal adenocarcinoma in sessile colonic polyps that had undergone complete EMR were detected. A total of 32 (62.7%) patients opted for surgery after EMR and 19 (37.3%) chose endoscopic follow up. In 44 (86.3%) patients the submucosal invasion was >1 mm. Residual malignant disease was identified in the surgical pathological specimen of only 1 patient. During a median follow up of 23.41 months (interquartile range 33.45, range 1.84-144.92), no local recurrences or lymph node metastasis were identified. Forty-nine patients are alive without evidence of disease and 2 died of other causes (without evidence of local or metastatic disease at last follow up). Conclusion Our data suggest that complete EMR of cancerous colonic sessile polyps, even in cases of submucosal invasion >1 mm carries a low risk of recurrence and therefore may need further evaluation as an alternative strategy to surgical resection.
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Affiliation(s)
- Maria Fragaki
- Department of Gastroenterology (Maria Fragaki, Evangelos Voudoukis, Ioannis Dimas, Afroditi Mpitouli, Magdalini Velegraki, Emmanouil Vardas, Angeliki Theodoropoulou, Konstantinos Karmiris, Gregorios Paspatis), Venizeleion General Hospital, Heraklion, Greece
| | - Evangelos Voudoukis
- Department of Gastroenterology (Maria Fragaki, Evangelos Voudoukis, Ioannis Dimas, Afroditi Mpitouli, Magdalini Velegraki, Emmanouil Vardas, Angeliki Theodoropoulou, Konstantinos Karmiris, Gregorios Paspatis), Venizeleion General Hospital, Heraklion, Greece
| | - Evdoxia Chliara
- Histopathology (Evdoxia Chliara, Linda Giannikaki), Venizeleion General Hospital, Heraklion, Greece
| | - Ioannis Dimas
- Department of Gastroenterology (Maria Fragaki, Evangelos Voudoukis, Ioannis Dimas, Afroditi Mpitouli, Magdalini Velegraki, Emmanouil Vardas, Angeliki Theodoropoulou, Konstantinos Karmiris, Gregorios Paspatis), Venizeleion General Hospital, Heraklion, Greece
| | - Afroditi Mpitouli
- Department of Gastroenterology (Maria Fragaki, Evangelos Voudoukis, Ioannis Dimas, Afroditi Mpitouli, Magdalini Velegraki, Emmanouil Vardas, Angeliki Theodoropoulou, Konstantinos Karmiris, Gregorios Paspatis), Venizeleion General Hospital, Heraklion, Greece
| | - Magdalini Velegraki
- Department of Gastroenterology (Maria Fragaki, Evangelos Voudoukis, Ioannis Dimas, Afroditi Mpitouli, Magdalini Velegraki, Emmanouil Vardas, Angeliki Theodoropoulou, Konstantinos Karmiris, Gregorios Paspatis), Venizeleion General Hospital, Heraklion, Greece
| | - Emmanouil Vardas
- Department of Gastroenterology (Maria Fragaki, Evangelos Voudoukis, Ioannis Dimas, Afroditi Mpitouli, Magdalini Velegraki, Emmanouil Vardas, Angeliki Theodoropoulou, Konstantinos Karmiris, Gregorios Paspatis), Venizeleion General Hospital, Heraklion, Greece
| | - Angeliki Theodoropoulou
- Department of Gastroenterology (Maria Fragaki, Evangelos Voudoukis, Ioannis Dimas, Afroditi Mpitouli, Magdalini Velegraki, Emmanouil Vardas, Angeliki Theodoropoulou, Konstantinos Karmiris, Gregorios Paspatis), Venizeleion General Hospital, Heraklion, Greece
| | - Konstantinos Karmiris
- Department of Gastroenterology (Maria Fragaki, Evangelos Voudoukis, Ioannis Dimas, Afroditi Mpitouli, Magdalini Velegraki, Emmanouil Vardas, Angeliki Theodoropoulou, Konstantinos Karmiris, Gregorios Paspatis), Venizeleion General Hospital, Heraklion, Greece
| | - Linda Giannikaki
- Histopathology (Evdoxia Chliara, Linda Giannikaki), Venizeleion General Hospital, Heraklion, Greece
| | - Gregorios Paspatis
- Department of Gastroenterology (Maria Fragaki, Evangelos Voudoukis, Ioannis Dimas, Afroditi Mpitouli, Magdalini Velegraki, Emmanouil Vardas, Angeliki Theodoropoulou, Konstantinos Karmiris, Gregorios Paspatis), Venizeleion General Hospital, Heraklion, Greece
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Dimas ID, Vardas E, Papastergiou V, Fragaki M, Velegraki M, Mpitouli A, Voudoukis E, Theodoropoulou A, Giannikaki E, Chlouverakis G, Paspatis GA. Comparison of digital versus fiberoptic cholangioscopy in patients requiring evaluation of bile duct disease or treatment of biliary stones. Ann Gastroenterol 2019; 32:199-204. [PMID: 30837794 PMCID: PMC6394257 DOI: 10.20524/aog.2019.0358] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 10/29/2018] [Accepted: 01/09/2019] [Indexed: 02/07/2023] Open
Abstract
Background Recently, the introduction of the novel digital SpyGlass™ DS Direct Visualization system (Boston Scientific Corp., Natick, MA, USA) has signaled the transition into the era of digital single-operator cholangioscopy (D-SOC). We sought to compare the clinical utility between fiberoptic single-operator cholangioscopy (F-SOC) and D-SOC in a tertiary-care referral center in Greece. Methods This was a retrospective analysis of a prospective database of single-operator cholangioscopy (SOC) procedures performed over an 8-year period (2009-2017) at a single tertiary-care referral center. The study population consisted of consecutive adults referred for cholangioscopy for a variety of clinical indications, including biliary strictures, difficult biliary stones and migrated or occluded pancreatic or biliary stents. Results A total of 2763 endoscopic retrograde cholangiopancreatography procedures were performed during the study period. Overall, SOC was performed in 68 (2.46%) procedures (F-SOC=39, D-SOC=29), showing a significant increase in the utilization of cholangioscopy during the D-SOC (29/599; 4.84%) compared with the F-SOC (39/2124; 1.83%) period (P=0.0001). The overall technical success of diagnostic SOC was 69.1% (38/55), being marginally higher for D-SOC (83.3%) than for F-SOC (58.1%), although not reaching statistical significance (P=0.07). Conclusions D-SOC was utilized more frequently in our tertiary-care non-academic referral center, demonstrating a favorable safety profile and a trend towards a marginally higher technical success rate for the diagnosis of biliary strictures compared with F-SOC.
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Affiliation(s)
- Ioannis D Dimas
- Department of Gastroenterology, Venizelion General Hospital, Heraklion, Crete
| | - Emmanouil Vardas
- Department of Gastroenterology, Venizelion General Hospital, Heraklion, Crete
| | | | - Maria Fragaki
- Department of Gastroenterology, Venizelion General Hospital, Heraklion, Crete
| | - Magdalini Velegraki
- Department of Gastroenterology, Venizelion General Hospital, Heraklion, Crete
| | - Afroditi Mpitouli
- Department of Gastroenterology, Venizelion General Hospital, Heraklion, Crete
| | - Evangelos Voudoukis
- Department of Gastroenterology, Venizelion General Hospital, Heraklion, Crete
| | | | - Elpida Giannikaki
- Department of Pathology, Venizelion General Hospital, Heraklion, Crete
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Voudoukis E, Velegraki M, Khamaysi I, Karoumpalis I, Kazamias G, Fragaki M, Mastorakis E, Paspatis G. Large adrenal cyst masquerading as a pancreatic cystic tumor: a rare diagnosis based on endoscopic ultrasound. Endosc Int Open 2018; 6:E1109-E1111. [PMID: 30211299 PMCID: PMC6133668 DOI: 10.1055/a-0658-1389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/05/2018] [Accepted: 05/14/2018] [Indexed: 11/03/2022] Open
Abstract
Adrenal cystic lesions constitute a rare finding and usually are diagnosed incidentally as retroperitoneal cysts during imaging studies. A major issue, especially for the large-sized ones, is their preoperative diagnosis and management, as imaging modalities often fail to detect their exact origin prior to surgery. We report a case of a big adrenal cyst that was mistakenly diagnosed and followed up as pancreatic cystic tail tumor. Our thorough workup, which included endoscopic ultrasound (EUS), managed to delineate an adrenal gland-originated cyst and altered further management of the patient. According to our knowledge, this is the first report in literature in which EUS proved its superiority over other imaging studies in clarifying the origin of an ambiguous big retroperitoneal cyst. We believe that for cases of large retroperitoneal cystic lesions, EUS consists the optimal diagnostic and sampling tool.
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Affiliation(s)
- Evangelos Voudoukis
- Department of Gastroenterology, Venizeleion Hospital, Heraklion-Crete,Corresponding author Evangelos Voudoukis MD, PhD Consultant of GastroenterologyVenizeleion Hospital HeraklionKnossou AvenuePO Box 4471409 Heraklion, CreteGreece+302810368017
| | | | - Iyad Khamaysi
- Department of Gastroenterology, Rambam Medical Center, Haifa-Israel
| | | | | | - Maria Fragaki
- Department of Gastroenterology, Venizeleion Hospital, Heraklion-Crete
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Velegraki M, Ioannou P, Theodorakopoulou V, Papadakis JA. A case of pheochromocytoma crisis simulating acute coronary syndrome and multiple organ dysfunction syndrome. Hellenic J Cardiol 2018; 59:370-372. [PMID: 29452308 DOI: 10.1016/j.hjc.2018.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/22/2018] [Accepted: 01/27/2018] [Indexed: 10/18/2022] Open
Affiliation(s)
- Magdalini Velegraki
- Hypertension Unit (ESH Excellence Centre), Internal Medicine Department, University Hospital of Heraklion, Stavrakia and Voutes, Heraklion, Crete, Greece.
| | - Petros Ioannou
- Hypertension Unit (ESH Excellence Centre), Internal Medicine Department, University Hospital of Heraklion, Stavrakia and Voutes, Heraklion, Crete, Greece.
| | - Vasiliki Theodorakopoulou
- Hypertension Unit (ESH Excellence Centre), Internal Medicine Department, University Hospital of Heraklion, Stavrakia and Voutes, Heraklion, Crete, Greece.
| | - John A Papadakis
- Hypertension Unit (ESH Excellence Centre), Internal Medicine Department, University Hospital of Heraklion, Stavrakia and Voutes, Heraklion, Crete, Greece.
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Papadakis I, Velegraki M, Ioannou P, Theodorakopoulou V. [PP.27.14] PHEOCHROMOCYTOMA PRESENTED WITH ACUTE HEART FAILURE AND MULTIPLE ORGAN DAMAGE. J Hypertens 2017. [DOI: 10.1097/01.hjh.0000523930.43751.c9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Papadaki H, Koutala H, Velegraki M, Pyrovolaki K, Mavroudi I, Spanoudakis M, Mastrodimou S, Stavroulaki E, Psyllaki M, Kalpadakis C. P039 The diagnostic utility of bone marrow flow-cytometric immunophenotyping for the differential diagnosis of chronic idiopathic neutropenia from myelodysplastic syndromes. Leuk Res 2009. [DOI: 10.1016/s0145-2126(09)70119-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Papadaki H, Velegraki M, Kozana A, Zamboulaki A, Kanellias N, Gvazava G, Kanellou P, Kaparou M, Psyllaki M, Kalpadakis C. C019 Functional abnormalities of neutrophils in patients with myelodysplastic syndromes. Leuk Res 2009. [DOI: 10.1016/s0145-2126(09)70057-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Velegraki M, Kalpadaki C, Gvazava G, Galanopoulos A, Viniou N, Parcharidou A, Papa V, Psyllaki M, Samonis G, Eliopoulos G, Papadaki H. P044 Increased expression of Toll-like receptor 4 and 9 in the bone marrow of patients with myelodysplastic syndromes. Leuk Res 2007. [DOI: 10.1016/s0145-2126(07)70114-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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