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Medina-Prado L, Hassan C, Dekker E, Bisschops R, Alfieri S, Bhandari P, Bourke MJ, Bravo R, Bustamante-Balen M, Dominitz J, Ferlitsch M, Fockens P, van Leerdam M, Lieberman D, Herráiz M, Kahi C, Kaminski M, Matsuda T, Moss A, Pellisé M, Pohl H, Rees C, Rex DK, Romero-Simó M, Rutter MD, Sharma P, Shaukat A, Thomas-Gibson S, Valori R, Jover R. When and How To Use Endoscopic Tattooing in the Colon: An International Delphi Agreement. Clin Gastroenterol Hepatol 2021; 19:1038-1050. [PMID: 33493699 DOI: 10.1016/j.cgh.2021.01.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/19/2020] [Revised: 12/27/2020] [Accepted: 01/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There is a lack of clinical studies to establish indications and methodology for tattooing, therefore technique and practice of tattooing is very variable. We aimed to establish a consensus on the indications and appropriate techniques for colonic tattoo through a modified Delphi process. METHODS The baseline questionnaire was classified into 3 areas: where tattooing should not be used (1 domain, 6 questions), where tattooing should be used (4 domains, 20 questions), and how to perform tattooing (1 domain 20 questions). A total of 29 experts participated in the 3 rounds of the Delphi process. RESULTS A total of 15 statements were approved. The statements that achieved the highest agreement were as follows: tattooing should always be used after endoscopic resection of a lesion with suspicion of submucosal invasion (agreement score, 4.59; degree of consensus, 97%). For a colorectal lesion that is left in situ but considered suitable for endoscopic resection, tattooing may be used if the lesion is considered difficult to detect at a subsequent endoscopy (agreement score, 4.62; degree of consensus, 100%). A tattoo should never be injected directly into or underneath a lesion that might be removed endoscopically at a later point in time (agreement score, 4.79; degree of consensus, 97%). Details of the tattoo injection should be stated clearly in the endoscopy report (agreement score, 4.76; degree of consensus, 100%). CONCLUSIONS This expert consensus has developed different statements about where tattooing should not be used, when it should be used, and how that should be done.
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Affiliation(s)
- Lucía Medina-Prado
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Cesare Hassan
- Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
| | - Sergio Alfieri
- Surgery Department, Fondazione Policlinico A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital. Portsmouth Hospital NHS Trust, Portsmouth, United Kingdom
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
| | - Raquel Bravo
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, University of Barcelona, Centro Esther Koplowitz, Cellex Biomedical Research Center, Barcelona, Catalonia, Spain
| | - Marco Bustamante-Balen
- Gastrointestinal Endoscopy Unit, Gastrointestinal Endoscopy Research Group, Health Research Institute (Instituto de Investigación Sanitaria La Fe. NHS: National Health Service), Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Jason Dominitz
- Gastroenterology Department, VA Puget Sound Health Care System, University of Washington, Seattle, Washington
| | - Monika Ferlitsch
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Wien, Austria
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Monique van Leerdam
- Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - David Lieberman
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon
| | - Maite Herráiz
- Departamento de Digestivo, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Charles Kahi
- Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, Indiana
| | - Michal Kaminski
- Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center, Institute of Oncology, Warsaw, Poland
| | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Alan Moss
- Department of Endoscopic Services, Western Health, Melbourne Medical School Western Precinct, The University of Melbourne, St. Albans, Victoria, Australia
| | - Maria Pellisé
- Gastroenterology Department, Institute of Digestive and Metabolic Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, University of Barcelona, Centro Esther Koplowitz, Cellex Biomedical Research Center, Barcelona, Catalonia Spain
| | - Heiko Pohl
- Department of Gastroenterology and Hepatology, VA Medical Center, White River Junction, Vermont; Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Colin Rees
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, United Kingdom
| | - Douglas K Rex
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Manuel Romero-Simó
- Unidad de Coloproctología, Servicio de Cirugía General, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Matthew D Rutter
- University Hospital of North Tees, Stockton on Tees, United Kingdom; Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Prateek Sharma
- Department of Gastroenterology and Hepatology, VA Medical Center, University of Kansas School of Medicine, Kansas City, Kansas
| | - Aasma Shaukat
- Section of Gastroenterology, Department of Medicine, Minneapolis VA Medical Center, University of Minnesota, Minneapolis, Minnesota
| | - Siwan Thomas-Gibson
- Wolfson Unit for Endoscopy, St. Mark's Hospital, Harrow, and Imperial College, London, United Kingdom
| | - Roland Valori
- Gloucestershire Hospitals National Health Service Foundation Trust, Gloucestershire, United Kingdom
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain.
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Arroyo A, Sánchez-Guillén L, Parra PA, García-Catalá L, Peña-Ros E, Ferrer-Márquez M, Nofuentes Riera C, Barber-Valles X, Romero-Simó M. Photodynamic Therapy for the Treatment of Complex Anal Fistula. Lasers Surg Med 2019; 52:503-508. [PMID: 31536149 DOI: 10.1002/lsm.23162] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES To validate and analyze the results of intralesional photodynamic therapy in the treatment of complex anal fistula. STUDY DESIGN/MATERIALS AND METHODS This prospective multicentric observational study enrolled patients treated for complex anal fistula who underwent intralesional photodynamic therapy (i-PDT). The included patients were treated from January 2016 to December 2018 with a minimum follow-up of 1 year to evaluate recurrence, continence and postoperative morbidity. Intralesional 5-aminolevulinic acid (ALA) gel (2%) was injected directly into the fistula. The internal and external orifices were closed. After an incubation period of 2 hours, the fistula was irradiated using an optical fiber connected to a red laser (Multidiode 630 PDT) operating at 1 W/cm for 3 minutes (180 J). RESULTS In total, 49 patients were included (61.2% male). The mean age was 48 years, and the mean duration of fistula was 13 months. Of the fistulas included, 75.5% were medium transphincteric, and 24.5% were high transphincteric. The median fistula length was 4 ± 1,14 cm (range: 3-5). A total of 41 patients (83.7%) had a previous history of fistula surgery. Preoperatively, some degree of anal incontinence was found in 5 patients (10.2%). No center reported any other procedure-related complications intraoperatively. Phototoxicity was found in one patient. In the first 48 hours after the procedure, fever was reported in 2 patients (4%). At the end of follow-up, total healing was observed in 32/49 patients (65.3%). No patient reported new incontinence postoperatively. CONCLUSION i-PDT could be considered a good choice in patients with complex anal fistulas to avoid surgery and its complications. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Antonio Arroyo
- Colorectal Unit, Department of General Surgery, Elche University Hospital, Miguel Hernández University, Carrer Almazara, 11, Elche, Alicante, 03203, Spain
| | - Luis Sánchez-Guillén
- Colorectal Unit, Department of General Surgery, Elche University Hospital, Miguel Hernández University, Carrer Almazara, 11, Elche, Alicante, 03203, Spain
| | - Pedro Antonio Parra
- Colorectal Unit, Department of General Surgery, Reina Sofía University Hospital, UCAM Universidad Católica de Murcia, Av. Intendente Jorge Palacios, 1, Murcia, 30003, Spain
| | - Luis García-Catalá
- Colorectal Unit, Department of General Surgery, Elche University Hospital, Miguel Hernández University, Carrer Almazara, 11, Elche, Alicante, 03203, Spain
| | - Emilio Peña-Ros
- Colorectal Unit, Department of General Surgery, Reina Sofía University Hospital, UCAM Universidad Católica de Murcia, Av. Intendente Jorge Palacios, 1, Murcia, 30003, Spain
| | - Manuel Ferrer-Márquez
- Colorectal Unit, Department of General Surgery, Torrecardenas University Hospital, Calle Hermandad de Donantes de Sangre, s/n, Almería, 04009, Spain
| | - Carmen Nofuentes Riera
- Colorectal Unit, Department of General Surgery, San Juan University Hospital, Miguel Hernandez University, Ctra. Nnal. 332, s/n, 03550 Sant Joan d'Alacant, Elche, Alicante, Spain
| | - Xavier Barber-Valles
- Center of Operations Research, Miguel Hernandez University, Avinguda de la Universitat d'Elx, s/n, Elche, Alicante, 03202, Spain
| | - Manuel Romero-Simó
- Colorectal Unit, Department of General Surgery, Alicante University General Hospital, Miguel Hernandez University, Pintor Baeza, 11, Elche, Alicante, 03010, Spain
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Rojas-Machado SA, Romero-Simó M, Arroyo A, Rojas-Machado A, López J, Calpena R. Prediction of anastomotic leak in colorectal cancer surgery based on a new prognostic index PROCOLE (prognostic colorectal leakage) developed from the meta-analysis of observational studies of risk factors. Int J Colorectal Dis 2016; 31:197-210. [PMID: 26507962 DOI: 10.1007/s00384-015-2422-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 10/14/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE To obtain a prognostic index, which has been named PROCOLE (prognostic colorectal leakage), it can predict the risk that a certain individual may suffer anastomotic leakage. METHODS The methodology consists of a systematic review to identify potential risk factors for anastomotic leakage and a meta-analysis of studies of each of these factors. In the meta-analysis, the prognostic index integrates factors that are statistically significant, which are weighted according to the estimated value of the effect size. The prognostic index was validated using retrospectively collected data from patients who underwent colorectal cancer surgery anastomosis at our institution. RESULTS The mean and standard deviation of the PROCOLE prognostic index in patients with anastomotic leakage is 1.9 ± 6.13, whereas in controls, it is 3.63 ± 2.1. The predictive ability of the PROCOLE, assessed by calculating the area under the curve (AUC) of the receiver operating characteristic (ROC), results in an AUC of 0.82 with a 95% confidence interval (CI) (0.75, 0.89) of the AUC, and it can be considered a good prognostic indicator. CONCLUSIONS The PROCOLE prognostic index predicts the risk of a certain individual developing anastomotic leakage after colorectal cancer surgery. Specifically, the PROCOLE prognostic index establishes a discrimination value threshold of 4.83 for recommending the implementation of a protective stoma. We have developed free software with a simple interface that only requires the selection of risk factors to obtain the PROCOLE value.
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Affiliation(s)
- S A Rojas-Machado
- Coloproctology Unit, Department of Surgery, University Hospital of Alicante, Alicante, Spain.,Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain
| | - M Romero-Simó
- Coloproctology Unit, Department of Surgery, University Hospital of Alicante, Alicante, Spain.,Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain
| | - A Arroyo
- Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain. .,Coloproctology Unit, Department of Surgery, University Hospital of Elche, C/ Camí de l'Almazara no. 11, 03203, Elche, Spain.
| | - A Rojas-Machado
- Coloproctology Unit, Department of Surgery, University Hospital of Alicante, Alicante, Spain.,Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain
| | - J López
- Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain
| | - R Calpena
- Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain.,Coloproctology Unit, Department of Surgery, University Hospital of Elche, C/ Camí de l'Almazara no. 11, 03203, Elche, Spain
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