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Visser E, Heuthorst L, Pathmakanthan S, Bemelman WA, D'Haens GR, Handley K, Fakis A, Pinkney TD, Buskens CJ, Dijkgraaf MGW. Clinical statistical analysis plan for the ACCURE trial: the effect of appendectomy on the clinical course of ulcerative colitis, a randomised international multicentre trial. Trials 2024; 25:218. [PMID: 38532488 DOI: 10.1186/s13063-024-08037-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/04/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND The primary treatment of ulcerative colitis (UC) is medical therapy using a standard step-up approach. An appendectomy might modulate the clinical course of UC, decreasing the incidence of relapses and reducing need for medication. The objective of the ACCURE trial is to assess the efficacy of laparoscopic appendectomy in addition to standard medical treatment in maintaining remission in UC patients. This article presents the statistical analysis plan to evaluate the outcomes of the ACCURE trial. DESIGN AND METHODS The ACCURE trial was designed as a multicentre, randomised controlled trial. UC patients with a new diagnosis or a disease relapse within the past 12 months, treated with 5-ASA, corticosteroids, or immunomodulators until complete clinical and endoscopic remission (defined as total Mayo score < 3 with endoscopic subscore of 0 or 1), were counselled for inclusion. Also, patients previously treated with biologicals who had a washout period of at least 3 months were considered for inclusion. Patients were randomised (1:1) to laparoscopic appendectomy plus maintenance treatment or a control group (maintenance therapy only). The primary outcome is the 1-year UC relapse rate (defined as a total Mayo-score ≥ 5 with endoscopic subscore of 2 or 3, or clinically as an exacerbation of symptoms and rectal bleeding or FCP > 150 or intensified medical therapy other than 5-ASA therapy). Secondary outcomes include number of relapses per patient, time to first relapse, disease activity, number of colectomies, medication usage, and health-related quality of life. DISCUSSION The ACCURE trial will provide comprehensive evidence whether adding an appendectomy to maintenance treatment is superior to maintenance treatment only in maintaining remission in UC patients. TRIAL REGISTRATION Dutch Trial Register (NTR) NTR2883 . Registered May 3, 2011. ISRCTN, ISRCTN60945764 . Registered August 12, 2019.
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Affiliation(s)
- Eva Visser
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands.
| | - Lianne Heuthorst
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Shri Pathmakanthan
- Department of Gastroenterology, Queen Elizabeth University Hospital Birmingham, Birmingham, UK
| | - Willem A Bemelman
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Geert R D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Kelly Handley
- University of Birmingham Clinical Trials Unit, Birmingham, UK
| | - Apostolos Fakis
- Derby Clinical Trials Support Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Thomas D Pinkney
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - Christianne J Buskens
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, University Medical Centre, Amsterdam, the Netherlands
- Methodology, Amsterdam Public Health, Amsterdam, the Netherlands
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Zwanenburg ES, El Klaver C, Wisselink DD, Punt CJA, Snaebjornsson P, Crezee J, Aalbers AGJ, Brandt-Kerkhof ARM, Bremers AJA, Burger PJWA, Fabry HFJ, Ferenschild FTJ, Festen S, van Grevenstein WMU, Hemmer PHJ, de Hingh IHJT, Kok NFM, Kusters M, Musters GD, Schoonderwoerd L, Tuynman JB, van de Ven AWH, van Westreenen HL, Wiezer MJ, Zimmerman DDE, van Zweeden A, Dijkgraaf MGW, Tanis PJ. Adjuvant Hyperthermic Intraperitoneal Chemotherapy in Patients With Locally Advanced Colon Cancer (COLOPEC): 5-Year Results of a Randomized Multicenter Trial. J Clin Oncol 2024; 42:140-145. [PMID: 37922442 DOI: 10.1200/jco.22.02644] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/14/2023] [Accepted: 09/01/2023] [Indexed: 11/05/2023] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.Whether adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) might prevent peritoneal metastases after curative surgery for high-risk colon cancer is an ongoing debate. This study aimed to determine 5-year oncologic outcomes of the randomized multicenter COLOPEC trial, which included patients with clinical or pathologic T4N0-2M0 or perforated colon cancer and randomly assigned (1:1) to either adjuvant systemic chemotherapy and HIPEC (n = 100) or adjuvant systemic chemotherapy alone (n = 102). HIPEC was performed using a one-time administration of oxaliplatin (460 mg/m2, 30 minutes, 42°C, concurrent fluorouracil/leucovorin intravenously), either simultaneously (9%) or within 5-8 weeks (91%) after primary tumor resection. Outcomes were analyzed according to the intention-to-treat principle. Long-term data were available of all 202 patients included in the COLOPEC trial, with a median follow-up of 59 months (IQR, 54.5-64.5). No significant difference was found in 5-year overall survival rate between patients assigned to adjuvant HIPEC followed by systemic chemotherapy or only adjuvant systemic chemotherapy (69.6% v 70.9%, log-rank; P = .692). Five-year peritoneal metastases rates were 63.9% and 63.2% (P = .907) and 5-year disease-free survival was 55.7% and 52.3% (log-rank; P = .875), respectively. No differences in quality-of-life outcomes were found. Our findings implicate that adjuvant HIPEC should still be performed in trial setting only.
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Affiliation(s)
- Emma Sophia Zwanenburg
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Charlotte El Klaver
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Daniel D Wisselink
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Cornelis J A Punt
- UMC Utrecht, Department of Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands
| | - P Snaebjornsson
- Netherlands Cancer Institute, Department of Pathology, Amsterdam, the Netherlands
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Johannes Crezee
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Amsterdam UMC Location University of Amsterdam, Department of Radiation Oncology, Amsterdam, the Netherlands
| | - Arend G J Aalbers
- Netherlands Cancer Institute, Department of Surgery, Amsterdam, the Netherlands
| | | | - Andre J A Bremers
- Radboud University Medical Center, Department of Surgery, Nijmegen, the Netherlands
| | - Pim J W A Burger
- Catharina Hospital, Department of Surgery, Eindhoven, the Netherlands
| | - Hans F J Fabry
- Bravis Hospital, Department of Surgery, Roosendaal, the Netherlands
| | | | - Sebastiaan Festen
- Department of Surgery, Onze Lieve Vrouwen Gasthuis, Amsterdam, the Netherlands
| | | | - Patrick H J Hemmer
- University Medical Center Groningen, Department of Surgery, Groningen, the Netherlands
| | | | - Niels F M Kok
- Netherlands Cancer Institute, Department of Surgery, Amsterdam, the Netherlands
| | - M Kusters
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
| | - G D Musters
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
| | | | - J B Tuynman
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Amsterdam UMC Location Free University, Department of Surgery, Amsterdam, the Netherlands
| | | | | | - M J Wiezer
- St Antonius Hospital, Department of Surgery, Nieuwegein, the Netherlands
| | - David D E Zimmerman
- Elisabeth-Tweesteden Hospital, Department of Surgery, Tilburg, the Netherlands
| | - Annette van Zweeden
- Amstelland Hospital, Department of Internal Medicine, Amstelveen, the Netherlands
| | - Marcel G W Dijkgraaf
- Amsterdam UMC Location University of Amsterdam, Department of Epidemiology and Data Science, Amsterdam, the Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, the Netherlands
| | - Pieter J Tanis
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Erasmus Medical Center, Department of Oncological and Gastrointestinal Surgery, Rotterdam, the Netherlands
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3
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Posthuma LM, Breteler MJM, Lirk PB, Nieveen van Dijkum EJ, Visscher MJ, Breel JS, Wensing CAGL, Schenk J, Vlaskamp LB, van Rossum MC, Ruurda JP, Dijkgraaf MGW, Hollmann MW, Kalkman CJ, Preckel B. Surveillance of high-risk early postsurgical patients for real-time detection of complications using wireless monitoring (SHEPHERD study): results of a randomized multicenter stepped wedge cluster trial. Front Med (Lausanne) 2024; 10:1295499. [PMID: 38249988 PMCID: PMC10796990 DOI: 10.3389/fmed.2023.1295499] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024] Open
Abstract
Background Vital signs measurements on the ward are performed intermittently. This could lead to failure to rapidly detect patients with deteriorating vital signs and worsens long-term outcome. The aim of this study was to test the hypothesis that continuous wireless monitoring of vital signs on the postsurgical ward improves patient outcome. Methods In this prospective, multicenter, stepped-wedge cluster randomized study, patients in the control group received standard monitoring. The intervention group received continuous wireless monitoring of heart rate, respiratory rate and temperature on top of standard care. Automated alerts indicating vital signs deviation from baseline were sent to ward nurses, triggering the calculation of a full early warning score followed. The primary outcome was the occurrence of new disability three months after surgery. Results The study was terminated early (at 57% inclusion) due to COVID-19 restrictions. Therefore, only descriptive statistics are presented. A total of 747 patients were enrolled in this study and eligible for statistical analyses, 517 patients in the control group and 230 patients in the intervention group, the latter only from one hospital. New disability at three months after surgery occurred in 43.7% in the control group and in 39.1% in the intervention group (absolute difference 4.6%). Conclusion This is the largest randomized controlled trial investigating continuous wireless monitoring in postoperative patients. While patients in the intervention group seemed to experience less (new) disability than patients in the control group, results remain inconclusive with regard to postoperative patient outcome due to premature study termination. Clinical trial registration ClinicalTrials.gov, ID: NCT02957825.
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Affiliation(s)
- Linda M. Posthuma
- Department of Anesthesiologie, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
| | | | - Philipp B. Lirk
- Department of Anesthesiologie, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
- Department of Anesthesiologie, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Els J. Nieveen van Dijkum
- Department of Surgery, Amsterdam University Medical Center, Location University of Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Maarten J. Visscher
- Department of Anesthesiologie, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
| | - Jennifer S. Breel
- Department of Anesthesiologie, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
| | - Carin A. G. L. Wensing
- Department of Anesthesiologie, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
| | - Jimmy Schenk
- Department of Anesthesiologie, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
| | - Lyan B. Vlaskamp
- Department of Anesthesiologie, University Medical Center, Utrecht, Netherlands
| | | | - Jelle P. Ruurda
- Department of Gastro-Intestinal and Oncologic Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marcel G. W. Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, Location AMC, Amsterdam, Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, Netherlands
| | - Markus W. Hollmann
- Department of Anesthesiologie, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
| | - Cor J. Kalkman
- Department of Anesthesiologie, University Medical Center, Utrecht, Netherlands
| | - Benedikt Preckel
- Department of Anesthesiologie, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
- Amsterdam Cardiovascular Science, Diabetes and Metabolism, Amsterdam, Netherlands
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4
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Görgec B, Hansen IS, Kemmerich G, Syversveen T, Abu Hilal M, Belt EJT, Bosscha K, Burgmans MC, Cappendijk VC, D'Hondt M, Edwin B, van Erkel AR, Gielkens HAJ, Grünhagen DJ, Gobardhan PD, Hartgrink HH, Horsthuis K, Klompenhouwer EG, Kok NFM, Kint PAM, Kuhlmann K, Leclercq WKG, Lips DJ, Lutin B, Maas M, Marsman HA, Meijerink M, Meyer Y, Morone M, Peringa J, Sijberden JP, van Delden OM, van den Bergh JE, Vanhooymissen IJS, Vermaas M, Willemssen FEJA, Dijkgraaf MGW, Bossuyt PM, Swijnenburg RJ, Fretland ÅA, Verhoef C, Besselink MG, Stoker J. MRI in addition to CT in patients scheduled for local therapy of colorectal liver metastases (CAMINO): an international, multicentre, prospective, diagnostic accuracy trial. Lancet Oncol 2024; 25:137-146. [PMID: 38081200 DOI: 10.1016/s1470-2045(23)00572-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/22/2023] [Accepted: 10/30/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Guidelines are inconclusive on whether contrast-enhanced MRI using gadoxetic acid and diffusion-weighted imaging should be added routinely to CT in the investigation of patients with colorectal liver metastases who are scheduled for curative liver resection or thermal ablation, or both. Although contrast-enhanced MRI is reportedly superior than contrast-enhanced CT in the detection and characterisation of colorectal liver metastases, its effect on clinical patient management is unknown. We aimed to assess the clinical effect of an additional liver contrast-enhanced MRI on local treatment plan in patients with colorectal liver metastases amenable to local treatment, based on contrast-enhanced CT. METHODS We did an international, multicentre, prospective, incremental diagnostic accuracy trial in 14 liver surgery centres in the Netherlands, Belgium, Norway, and Italy. Participants were aged 18 years or older with histological proof of colorectal cancer, a WHO performance status score of 0-4, and primary or recurrent colorectal liver metastases, who were scheduled for local therapy based on contrast-enhanced CT. All patients had contrast-enhanced CT and liver contrast-enhanced MRI including diffusion-weighted imaging and gadoxetic acid as a contrast agent before undergoing local therapy. The primary outcome was change in the local clinical treatment plan (decided by the individual clinics) on the basis of liver contrast-enhanced MRI findings, analysed in the intention-to-image population. The minimal clinically important difference in the proportion of patients who would have change in their local treatment plan due to an additional liver contrast-enhanced MRI was 10%. This study is closed and registered in the Netherlands Trial Register, NL8039. FINDINGS Between Dec 17, 2019, and July 31, 2021, 325 patients with colorectal liver metastases were assessed for eligibility. 298 patients were enrolled and included in the intention-to-treat population, including 177 males (59%) and 121 females (41%) with planned local therapy based on contrast-enhanced CT. A change in the local treatment plan based on liver contrast-enhanced MRI findings was observed in 92 (31%; 95% CI 26-36) of 298 patients. Changes were made for 40 patients (13%) requiring more extensive local therapy, 11 patients (4%) requiring less extensive local therapy, and 34 patients (11%) in whom the indication for curative-intent local therapy was revoked, including 26 patients (9%) with too extensive disease and eight patients (3%) with benign lesions on liver contrast-enhanced MRI (confirmed by a median follow-up of 21·0 months [IQR 17·5-24·0]). INTERPRETATION Liver contrast-enhanced MRI should be considered in all patients scheduled for local treatment for colorectal liver metastases on the basis of contrast-enhanced CT imaging. FUNDING The Dutch Cancer Society and Bayer AG - Pharmaceuticals.
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Affiliation(s)
- Burak Görgec
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands
| | - Ingrid S Hansen
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway; The Intervention Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gunter Kemmerich
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Trygve Syversveen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Mohammed Abu Hilal
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Eric J T Belt
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - Koop Bosscha
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
| | - Mark C Burgmans
- Department of Radiology, Leiden University Medical Centre, Leiden, Netherlands
| | | | - Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Bjørn Edwin
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway; The Intervention Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Arian R van Erkel
- Department of Radiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Hugo A J Gielkens
- Department of Radiology, Medical Spectrum Twente, Enschede, Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus Medical Centre, Rotterdam, Netherlands; Erasmus Medical Centre Cancer Institute, Erasmus Medical Centre, Rotterdam, Netherlands
| | | | - Henk H Hartgrink
- Department of Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Karin Horsthuis
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
| | | | - Niels F M Kok
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Peter A M Kint
- Department of Radiology, Amphia Hospital, Breda, Netherlands
| | - Koert Kuhlmann
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Daan J Lips
- Department of Surgery, Medical Spectrum Twente, Enschede, Netherlands
| | - Bart Lutin
- Department of Radiology, Groeninge Hospital, Kortrijk, Belgium
| | - Monique Maas
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Martijn Meijerink
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands
| | - Yannick Meyer
- Department of Surgical Oncology, Erasmus Medical Centre, Rotterdam, Netherlands; Erasmus Medical Centre Cancer Institute, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Mario Morone
- Department of Radiology, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Jan Peringa
- Department of Radiology, OLVG, Amsterdam, Netherlands
| | - Jasper P Sijberden
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands
| | - Otto M van Delden
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands
| | - Janneke E van den Bergh
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands
| | - Inge J S Vanhooymissen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
| | - Maarten Vermaas
- Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, Netherlands
| | | | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Public Health, Methodology, Amsterdam, Netherlands
| | - Patrick M Bossuyt
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Rutger-Jan Swijnenburg
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands
| | - Åsmund A Fretland
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway; The Intervention Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus Medical Centre, Rotterdam, Netherlands; Erasmus Medical Centre Cancer Institute, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands.
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5
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van der Sangen NMR, Küçük IT, Sivanesan S, Appelman Y, Ten Berg JM, Verburg A, Azzahhafi J, Arkenbout EK, Kikkert WJ, Pisters R, Jukema JW, Arslan F, van 't Hof A, Ilhan M, Hoebers LP, van der Schaaf RJ, Damman P, Woudstra P, van de Hoef TP, Bax M, Anthonio RL, Polad J, Adriaenssens T, Dewilde W, Zivelonghi C, Laanmets P, Majas R, Dijkgraaf MGW, Claessen BEPM, Henriques JPS. Less bleeding by omitting aspirin in non-ST-segment elevation acute coronary syndrome patients: Rationale and design of the LEGACY study. Am Heart J 2023; 265:114-120. [PMID: 37517430 DOI: 10.1016/j.ahj.2023.07.011] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Early aspirin withdrawal, also known as P2Y12-inhibitor monotherapy, following percutaneous coronary intervention (PCI) for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) can reduce bleeding without a trade-off in efficacy. Still the average daily bleeding risk is highest during the first months and it remains unclear if aspirin can be omitted immediately following PCI. METHODS The LEGACY study is an open-label, multicenter randomized controlled trial evaluating the safety and efficacy of immediate P2Y12-inhibitor monotherapy versus dual antiplatelet therapy (DAPT) for 12 months in 3,090 patients. Patients are randomized immediately following successful PCI for NSTE-ACS to 75-100 mg aspirin once daily versus no aspirin. The primary hypothesis is that immediately omitting aspirin is superior to DAPT with respect to major or minor bleeding defined as Bleeding Academic Research Consortium type 2, 3, or 5 bleeding, while maintaining noninferiority for the composite of all-cause mortality, myocardial infarction and stroke compared to DAPT. CONCLUSIONS The LEGACY study is the first randomized study that is specifically designed to evaluate the impact of immediately omitting aspirin, and thus treating patients with P2Y12-inhibitor monotherapy, as compared to DAPT for 12 months on bleeding and ischemic events within 12 months following PCI for NSTE-ACS.
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Affiliation(s)
- Niels M R van der Sangen
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - I Tarik Küçük
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Shabiga Sivanesan
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Jurriën M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands; Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), University Medical Center Maastricht, Maastricht, The Netherlands
| | - Ashley Verburg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Jaouad Azzahhafi
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - E Karin Arkenbout
- Department of Cardiology, Tergooi Hospital, Hilversum, The Netherlands
| | - Wouter J Kikkert
- Department of Cardiology, Tergooi Hospital, Hilversum, The Netherlands
| | - Ron Pisters
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fatih Arslan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arnoud van 't Hof
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), University Medical Center Maastricht, Maastricht, The Netherlands; Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Mustafa Ilhan
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), University Medical Center Maastricht, Maastricht, The Netherlands; Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Loes P Hoebers
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), University Medical Center Maastricht, Maastricht, The Netherlands; Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | - Peter Damman
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Pier Woudstra
- Department of Cardiology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Tim P van de Hoef
- Department of Cardiology, University Medical Center Maastricht, Maastricht, The Netherlands
| | - Matthijs Bax
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Rutger L Anthonio
- Department of Cardiology, Treant Zorggroep, Scheper Hospital, Emmen, The Netherlands
| | - Jawed Polad
- Department of Cardiology, Jeroen Bosch Ziekenhuis, Hertogenbosch, The Netherlands
| | - Tom Adriaenssens
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Willem Dewilde
- Department of Cardiology, Imelda Hospital Bonheiden, Bonheiden, Belgium
| | - Carlo Zivelonghi
- Department of Cardiology, HartCentrum, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium
| | - Peep Laanmets
- Department of Cardiology, North Estonia Medical Center Foundation, Tallinn, Estonia
| | - Risko Majas
- Department of Cardiology, North Estonia Medical Center Foundation, Tallinn, Estonia
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bimmer E P M Claessen
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - José P S Henriques
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
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Vossen LE, van Netten JJ, Bakker CD, Berendsen HA, Busch-Westbroek TE, Peters EJG, Sabelis LWE, Dijkgraaf MGW, Bus SA. An integrated personalized assistive devices approach to reduce the risk of foot ulcer recurrence in diabetes (DIASSIST): study protocol for a multicenter randomized controlled trial. Trials 2023; 24:663. [PMID: 37828618 PMCID: PMC10568814 DOI: 10.1186/s13063-023-07635-z] [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: 07/04/2023] [Accepted: 09/08/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Preventing foot ulcers in people with diabetes can increase quality of life and reduce costs. Despite the availability of various interventions to prevent foot ulcers, recurrence rates remain high. We hypothesize that a multimodal treatment approach incorporating various footwear, self-management, and education interventions that matches an individual person's needs can reduce the risk of ulcer recurrence with beneficial cost-utility. The aim of this study is to assess the effect on foot ulcer recurrence, footwear adherence, and cost-utility of an integrated personalized assistive devices approach in high-risk people with diabetes. METHODS In a parallel-group multicenter randomized controlled trial, 126 adult participants with diabetes mellitus type 1 or 2, loss of protective sensation based on the presence of peripheral neuropathy, a healed plantar foot ulcer in the preceding 4 years, and possession of any type of custom-made footwear will be included. Participants will be randomly assigned to either enhanced therapy or usual care. Enhanced therapy consists of usual care and additionally a personalized treatment approach including pressure-optimized custom-made footwear, pressure-optimized custom-made footwear for indoor use, at-home daily foot temperature monitoring, and structured education, which includes motivational interviewing and personalized feedback on adherence and self-care. Participants will be followed for 12 months. Assessments include barefoot and in-shoe plantar pressure measurements; questionnaires concerning quality of life, costs, disease, and self-care knowledge; physical activity and footwear use monitoring; and clinical monitoring for foot ulcer outcomes. The study is powered for 3 primary outcomes: foot ulcer recurrence, footwear adherence, and cost-utility, the primary clinical, patient-related, and health-economic outcome respectively. DISCUSSION This is the first study to integrate multiple interventions for ulcer prevention into a personalized state-of-the-art treatment approach and assess their combined efficacy in a randomized controlled trial in people with diabetes at high ulcer risk. Proven effectiveness, usability, and cost-utility will facilitate implementation in healthcare, improve the quality of life of high-risk people with diabetes, and reduce treatment costs. TRIAL REGISTRATION ClinicalTrials.gov NCT05236660. Registered on 11 February 2022.
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Affiliation(s)
- Lisa E Vossen
- Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| | - Jaap J van Netten
- Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Chantal D Bakker
- Department of Rehabilitation Medicine, Máxima Medisch Centrum Veldhoven, de Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Heleen A Berendsen
- Department of Rehabilitation Medicine, Reinier de Graaf Gasthuis Delft, Reinier de Graafweg 5, 2625 AD, Delft, the Netherlands
| | - Tessa E Busch-Westbroek
- Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Edgar J G Peters
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Internal Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, the Netherlands
| | - Louise W E Sabelis
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Rehabilitation Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, the Netherlands
| | - Marcel G W Dijkgraaf
- Epidemiology and Data Science, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Methodology, Amsterdam Public Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - Sicco A Bus
- Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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7
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van Bodegraven EA, Francken MFG, Verkoulen KCHA, Abu Hilal M, Dijkgraaf MGW, Besselink MG. Costs of complications following distal pancreatectomy: a systematic review. HPB (Oxford) 2023; 25:1145-1150. [PMID: 37391314 DOI: 10.1016/j.hpb.2023.03.007] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Postoperative complications following distal pancreatectomy (DP) are common, especially postoperative pancreatic fistula (POPF). In order to design adequate prophylactic strategies, it is of relevance to determine the costs of these complications. An overview of the literature on the costs of complications following DP is lacking. METHODS A systematic literature search was performed in PubMed, Embase, and Cochrane Library (inception until 1 August 2022). The primary outcome was the costs (i.e. cost differential) of major morbidity, individual complications and prolonged hospital stay. Quality of non-RCTs were assessed using the Newcastle-Ottawa scale. Costs were compared with the use of Purchasing Power parity. This systematic review was registered with PROSPERO (CRD42021223019). RESULTS Overall, seven studies were included with 854 patients after DP. The rate POPF grade B/C varied between 13% and 27% (based on five studies) with a corresponding cost differential of EUR 18,389 (based on two studies). The rate of severe morbidity varied between 13% and 38% (based on five studies) with a corresponding cost differential of EUR 19,281 (based on five studies). CONCLUSION This systematic review reported considerable costs for POPF grade B/C and severe morbidity after DP. Prospective databases and studies should report on all complications in a uniform matter to better display the economic burden of complications of DP.
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Affiliation(s)
- Eduard A van Bodegraven
- Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands.
| | - Michiel F G Francken
- Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands
| | - Koen C H A Verkoulen
- Department of Surgery, Maastricht Universitair Medisch Centrum, Maastricht, the Netherlands
| | - Mohammad Abu Hilal
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Marcel G W Dijkgraaf
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy; Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Marc G Besselink
- Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands.
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8
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Pronk AJM, Roelofs A, Flum DR, Bonjer HJ, Abu Hilal M, Dijkgraaf MGW, Besselink MG, Ahmed Ali U. Two decades of surgical randomized controlled trials: worldwide trends in volume and methodological quality. Br J Surg 2023; 110:1300-1308. [PMID: 37379487 PMCID: PMC10480038 DOI: 10.1093/bjs/znad160] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/07/2023] [Accepted: 05/04/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND RCTs are essential in guiding clinical decision-making but are difficult to perform, especially in surgery. This review assessed the trend in volume and methodological quality of published surgical RCTs over two decades. METHODS PubMed was searched systematically for surgical RCTs published in 1999, 2009, and 2019. The primary outcomes were volume of trials and RCTs with a low risk of bias. Secondary outcomes were clinical, geographical, and funding characteristics. RESULTS Some 1188 surgical RCTs were identified, of which 300 were published in 1999, 450 in 2009, and 438 in 2019. The most common subspecialty in 2019 was gastrointestinal surgery (50.7 per cent). The volume of surgical RCTs increased mostly in Asia (61, 159, and 199 trials), especially in China (7, 40, and 81). In 2019, countries with the highest relative volume of published surgical RCTs were Finland and the Netherlands. Between 2009 and 2019, the proportion of RCTs with a low risk of bias increased from 14.7 to 22.1 per cent (P = 0.004). In 2019, the proportion of trials with a low risk of bias was highest in Europe (30.5 per cent), with the UK and the Netherlands as leaders in this respect. CONCLUSION The volume of published surgical RCTs worldwide remained stable in the past decade but their methodological quality improved. Considerable geographical shifts were observed, with Asia and especially China leading in terms of volume. Individual European countries are leading in their relative volume and methodological quality of surgical RCTs.
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Affiliation(s)
- Aagje J M Pronk
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - Anne Roelofs
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - David R Flum
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - H Jaap Bonjer
- Cancer Centre Amsterdam, Amsterdam, the Netherlands
- Department of Surgery, Amsterdam UMC, location Vrije Universiteit, Amsterdam, the Netherlands
| | - Mohammed Abu Hilal
- Department of Surgery, Fondazione Poliambulanza Hospital, Brescia, Italy
| | - Marcel G W Dijkgraaf
- Epidemiology and Data Science, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam, the Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - Usama Ahmed Ali
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Amsterdam, the Netherlands
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9
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Hoepelman RJ, Driessen MLS, de Jongh MAC, Houwert RM, Marzi I, Lecky F, Lefering R, van de Wall BJM, Beeres FJP, Dijkgraaf MGW, Groenwold RHH, Leenen LPH. Concepts, utilization, and perspectives on the Dutch Nationwide Trauma registry: a position paper. Eur J Trauma Emerg Surg 2023; 49:1619-1626. [PMID: 36624221 PMCID: PMC10449938 DOI: 10.1007/s00068-022-02206-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/17/2022] [Indexed: 01/11/2023]
Abstract
Over the last decades, the Dutch trauma care have seen major improvements. To assess the performance of the Dutch trauma system, in 2007, the Dutch Nationwide Trauma Registry (DNTR) was established, which developed into rich source of information for quality assessment, quality improvement of the trauma system, and for research purposes. The DNTR is one of the most comprehensive trauma registries in the world as it includes 100% of all trauma patients admitted to the hospital through the emergency department. This inclusive trauma registry has shown its benefit over less inclusive systems; however, it comes with a high workload for high-quality data collection and thus more expenses. The comprehensive prospectively collected data in the DNTR allows multiple types of studies to be performed. Recent changes in legislation allow the DNTR to include the citizen service numbers, which enables new possibilities and eases patient follow-up. However, in order to maximally exploit the possibilities of the DNTR, further development is required, for example, regarding data quality improvement and routine incorporation of health-related quality of life questionnaires. This would improve the quality assessment and scientific output from the DNTR. Finally, the DNTR and all other (European) trauma registries should strive to ensure that the trauma registries are eligible for comparisons between countries and healthcare systems, with the goal to improve trauma patient care worldwide.
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Affiliation(s)
- R J Hoepelman
- Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - M L S Driessen
- Dutch Network for Emergency Care (LNAZ), Utrecht, The Netherlands
| | - M A C de Jongh
- Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, The Netherlands
| | - R M Houwert
- Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - I Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - F Lecky
- The Trauma Audit and Research Network, The University of Manchester, Salford Royal-Northern Care Alliance NHS Foundation Trust, Salford, UK
- Centre for Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - R Lefering
- Faculty of Health, IFOM-Institute for Research in Operative Medicine, University Witten/Herdecke, Cologne, Germany
| | - B J M van de Wall
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - F J P Beeres
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - M G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Methodology, Amsterdam Public Health, Amsterdam, The Netherlands
| | - R H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - L P H Leenen
- Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
- Dutch Network for Emergency Care (LNAZ), Utrecht, The Netherlands
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10
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van den Berg LA, Berkhemer OA, Fransen PSS, Beumer D, Majoie CBL, Dippel DWJ, van der Lugt A, van Oostenbrugge RJ, van Zwam WH, Roos YB, Dijkgraaf MGW. Budget impact of endovascular treatment for acute ischaemic stroke patients in the Netherlands for 2015-2021. Neth Heart J 2023; 31:254-259. [PMID: 37171711 DOI: 10.1007/s12471-023-01788-x] [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] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION Endovascular treatment (EVT) has been proven to be both effective and cost-effective for patients with acute ischaemic stroke. We investigated the budget impact of large-scale implementation of EVT for acute ischaemic stroke patients in the Netherlands for 2015-2021. METHODS An analysis was performed from a healthcare perspective as a preplanned substudy of the Multicenter Randomized Clinical trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN). Estimated yearly costs during follow-up after stroke for patients who had or had not been treated with EVT as add-on to usual care were linked to numbers of new patients retrieved from 2 Dutch registries of EVT that started after the last inclusion in MR CLEAN (2014). Aggregated costs and costs per care sector were calculated based on prevalence using a population dynamic tool. RESULTS From 2015, the yearly number of new acute ischaemic stroke patients receiving EVT increased almost threefold, from 812 in 2015 to 2,370 in 2021. The introduction of EVT plus usual care resulted in estimated net annual savings that increased from € 2.9 million in 2015 to € 58 million in 2021. CONCLUSION Offering EVT as add-on to usual care for acute ischaemic stroke patients was increasingly cost saving from a national healthcare perspective but affected distinct healthcare sectors differently.
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Affiliation(s)
- Lucie A van den Berg
- Department of Neurology, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands.
- Department of Epidemiology and Data Science, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands.
- Amsterdam Neuroscience Research Institute, Neurovascular disorders research programme, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands.
- Amsterdam Cardiovascular Sciences Research Institute, Atherosclerosis and Ischemic syndromes, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands.
- Microcirculation research programme, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Methodology research programme, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands.
| | - Olvert A Berkhemer
- Amsterdam Neuroscience Research Institute, Neurovascular disorders research programme, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Atherosclerosis and Ischemic syndromes, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands
- Microcirculation research programme, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Methodology research programme, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands
| | - Puck S S Fransen
- Departments of Neurology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Debbie Beumer
- Departments of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Charles B L Majoie
- Amsterdam Neuroscience Research Institute, Neurovascular disorders research programme, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Atherosclerosis and Ischemic syndromes, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands
- Microcirculation research programme, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Methodology research programme, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands
| | - Diederik W J Dippel
- Departments of Neurology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Aad van der Lugt
- Radiology and Nuclear Medicine, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Robert J van Oostenbrugge
- Departments of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Wim H van Zwam
- Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Yvo B Roos
- Department of Neurology, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Neurovascular disorders research programme, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Atherosclerosis and Ischemic syndromes, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands
- Microcirculation research programme, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Methodology research programme, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands
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11
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van Engelen TSR, Kanglie MMNP, van den Berk IAH, Altenburg J, Dijkgraaf MGW, Bossuyt PMM, Stoker J, Prins JM. Limited Clinical Impact of Ultralow-Dose Computed Tomography in Suspected Community-Acquired Pneumonia. Open Forum Infect Dis 2023; 10:ofad215. [PMID: 37213423 PMCID: PMC10199111 DOI: 10.1093/ofid/ofad215] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/19/2023] [Indexed: 05/23/2023] Open
Abstract
Patients clinically suspected of community-acquired pneumonia (CAP) were randomized between ultralow-dose chest computed tomography ([ULDCT] 261 patients) and chest radiograph ([CXR] 231 patients). We did not find evidence that performing ULDCT instead of CXR affects antibiotic treatment policy or patient outcomes. However, in a subgroup of afebrile patients, there were more patients diagnosed with CAP in the ULDCT group (ULDCT, 106 of 608 patients; CXR, 71 of 654 patients; P = .001).
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Affiliation(s)
- Tjitske S R van Engelen
- Correspondence: Tjitske S. R. van Engelen, MD, Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Room G2-105, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands (); Jan M. Prins, MD, Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Room D3-217, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands ()
| | - Maadrika M N P Kanglie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Inge A H van den Berk
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Josje Altenburg
- Department of Pulmonary Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Patrick M M Bossuyt
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Jan M Prins
- Correspondence: Tjitske S. R. van Engelen, MD, Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Room G2-105, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands (); Jan M. Prins, MD, Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Room D3-217, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands ()
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12
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van Munster KN, Mol B, Goet JC, van Munster SN, Weersma RK, de Vries AC, van der Meer AJ, Inderson A, Drenth JP, van Erpecum KJ, Boonstra K, Beuers U, Dijkgraaf MGW, Ponsioen CY. Disease burden in primary sclerosing cholangitis in the Netherlands: A long-term follow-up study. Liver Int 2023; 43:639-648. [PMID: 36328957 DOI: 10.1111/liv.15471] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/31/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND & AIMS Primary sclerosing cholangitis (PSC) is a progressive, cholestatic liver disease which greatly impacts the lives of individuals. Burden of disease due to shortened life expectancy and impaired quality of life is ill-described. The aim of this study was to assess long-term disease burden in a large population-based registry with regard to survival, clinical course, quality adjusted life years (QALYs), medical consumption and work productivity loss. METHODS All PSC patients living in a geographically defined area covering ~50% of the Netherlands were included, together with patients from the three liver transplant centres. Survival was estimated by competing risk analysis. Proportional shortfall of QALYs during disease course was measured relative to a matched reference cohort using validated questionnaires. Work productivity loss and medical consumption were evaluated over time. RESULTS A total of 1208 patients were included with a median follow-up of 11.2 year. Median liver transplant-free survival was 21.0 years. Proportional shortfall of QALYs increased to 48% >25 years after diagnosis. Patients had on average 12.4 hospital contact days among which 3.17 admission days per year, annual medical costs were €12 169 and mean work productivity loss was 25%. CONCLUSIONS Our data quantify for the first time disease burden in terms of QALYs lost, clinical events, medical consumption, costs as well as work productivity loss, and show that all these are substantial and increase over time.
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Affiliation(s)
- Kim N van Munster
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location AMC, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
| | - Bregje Mol
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location AMC, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
| | - Jorn C Goet
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sanne N van Munster
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location AMC, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
| | - Rinse K Weersma
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Annemarie C de Vries
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Adriaan J van der Meer
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Akin Inderson
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Joost P Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kirsten Boonstra
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location VUmc, Amsterdam Gastroenterology & Metabolism, Amsterdam, The Netherlands
| | - Ulrich Beuers
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location AMC, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, location University of Amsterdam, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Cyriel Y Ponsioen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location AMC, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
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13
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Hallensleben ND, Stassen PMC, Schepers NJ, Besselink MG, Anten MPGF, Bakker OJ, Bollen TL, da Costa DW, van Dijk SM, van Dullemen HM, Dijkgraaf MGW, van Eijck B, van Eijck CHJ, Erkelens W, Erler NS, Fockens P, van Geenen EJM, van Grinsven J, Hazen WL, Hollemans RA, van Hooft JE, Jansen JM, Kubben FJGM, Kuiken SD, Poen AC, Quispel R, de Ridder RJ, Römkens TEH, Schoon EJ, Schwartz MP, Seerden TCJ, Smeets XJNM, Spanier BWM, Tan ACITL, Thijs WJ, Timmer R, Umans DS, Venneman NG, Verdonk RC, Vleggaar FP, van de Vrie W, van Wanrooij RLJ, Witteman BJ, van Santvoort HC, Bouwense SAW, Bruno MJ. Patient selection for urgent endoscopic retrograde cholangio-pancreatography by endoscopic ultrasound in predicted severe acute biliary pancreatitis (APEC-2): a multicentre prospective study. Gut 2023:gutjnl-2022-328258. [PMID: 36849226 DOI: 10.1136/gutjnl-2022-328258] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 02/13/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVE Routine urgent endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic biliary sphincterotomy (ES) does not improve outcome in patients with predicted severe acute biliary pancreatitis. Improved patient selection for ERCP by means of endoscopic ultrasonography (EUS) for stone/sludge detection may challenge these findings. DESIGN A multicentre, prospective cohort study included patients with predicted severe acute biliary pancreatitis without cholangitis. Patients underwent urgent EUS, followed by ERCP with ES in case of common bile duct stones/sludge, within 24 hours after hospital presentation and within 72 hours after symptom onset. The primary endpoint was a composite of major complications or mortality within 6 months after inclusion. The historical control group was the conservative treatment arm (n=113) of the randomised APEC trial (Acute biliary Pancreatitis: urgent ERCP with sphincterotomy versus conservative treatment, patient inclusion 2013-2017) applying the same study design. RESULTS Overall, 83 patients underwent urgent EUS at a median of 21 hours (IQR 17-23) after hospital presentation and at a median of 29 hours (IQR 23-41) after start of symptoms. Gallstones/sludge in the bile ducts were detected by EUS in 48/83 patients (58%), all of whom underwent immediate ERCP with ES. The primary endpoint occurred in 34/83 patients (41%) in the urgent EUS-guided ERCP group. This was not different from the 44% rate (50/113 patients) in the historical conservative treatment group (risk ratio (RR) 0.93, 95% CI 0.67 to 1.29; p=0.65). Sensitivity analysis to correct for baseline differences using a logistic regression model also showed no significant beneficial effect of the intervention on the primary outcome (adjusted OR 1.03, 95% CI 0.56 to 1.90, p=0.92). CONCLUSION In patients with predicted severe acute biliary pancreatitis without cholangitis, urgent EUS-guided ERCP with ES did not reduce the composite endpoint of major complications or mortality, as compared with conservative treatment in a historical control group. TRIAL REGISTRATION NUMBER ISRCTN15545919.
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Affiliation(s)
- Nora D Hallensleben
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Pauline M C Stassen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nicolien J Schepers
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Noord-Holland, The Netherlands
| | - Marie-Paule G F Anten
- Department of Gastroenterology and Hepatology, Sint Franciscus Vlietland Groep, Rotterdam, Zuid-Holland, The Netherlands
| | - Olaf J Bakker
- Department of Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Thomas L Bollen
- Department of Radiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - David W da Costa
- Department of Radiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Sven M van Dijk
- Department of Surgery, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands
| | - Hendrik M van Dullemen
- Department of Gastroenterology, Universtiy of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands
- Methodology department, Amsterdam Public Health Research Institute, Amsterdam, North Holland, The Netherlands
| | - Brechje van Eijck
- Department of Gastroenterology and Hepatology, Spaarne Gasthuis, Haarlem, Noord-Holland, The Netherlands
| | - Casper H J van Eijck
- Department of Surgery, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Willemien Erkelens
- Department of Gastroenterology and Hepatology, Gelre Hospitals, Apeldoorn, Gelderland, The Netherlands
| | - Nicole S Erler
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands
| | | | | | - Wouter L Hazen
- Department of Gastroenterology and Hepatology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Noord-Brabant, The Netherlands
| | - Robbert A Hollemans
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen M Jansen
- Department of Gastroenterology, OLVG, Amsterdam, Noord-Holland, The Netherlands
| | - Frank J G M Kubben
- Department of Gastroenterology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Sjoerd D Kuiken
- Department of Gastroenterology and Hepatology, OLVG, Amsterdam, Noord-Holland, The Netherlands
| | - Alexander C Poen
- Department of Gastroenterology and Hepatology, Isala Hospital, Zwolle, Overijssel, Netherlands
| | - Rutger Quispel
- Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft, Zuid-Holland, The Netherlands
| | - Rogier J de Ridder
- Department of Gastroenterology and Hepatology, Maastricht UMC+, Maastricht, Limburg, The Netherlands
| | - Tessa E H Römkens
- Department of Gastroenterology and Hepatology, Jeroen Bosch Ziekenhuis, Den Bosch, Noord-Brabant, The Netherlands
| | - Erik J Schoon
- Gastroenterology, Catharina Hospital, Eindhoven, The Netherlands
| | - Matthijs P Schwartz
- Department of Internal Medicine and Gastroenterology, Meander Medical Center, Amersfoort, The Netherlands
| | - Tom C J Seerden
- Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, The Netherlands
| | - Xavier J N M Smeets
- Gastroenterology and Hepatology, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - B W Marcel Spanier
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Willem J Thijs
- Department of Gastroenterology and Hepatology, Martini Hospital, Groningen, Groningen, The Netherlands
| | - Robin Timmer
- Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Devica S Umans
- Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands
| | - Niels G Venneman
- Department of Gastroenterology and Hepatology, Medical Spectrum Twente, Enschede, The Netherlands
| | - Robert C Verdonk
- Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Frank P Vleggaar
- Department of Gastroenterology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wim van de Vrie
- Department of Gastroenterology and Heptatology, Albert Schweitzer Hospital, Dordrecht, Zuid-Holland, The Netherlands
| | - Roy L J van Wanrooij
- Department of Gastroenterology and Hepatology, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands
| | - Ben J Witteman
- Department of Gastroenterology, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, Dutch Acute Pancreatitis Study Group, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefan A W Bouwense
- Department of Surgery, Maastricht Universitair Medisch Centrum+, Maastricht, Limburg, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
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Frequin HL, Schouten J, Verschuur CVM, Suwijn SR, Boel JA, Post B, Bloem BR, van Hilten JJ, van Laar T, Tissingh G, Munts AG, Dijk JM, Deuschl G, Lang A, Dijkgraaf MGW, de Haan RJ, de Bie RMA. Levodopa Response in Patients With Early Parkinson Disease: Further Observations of the LEAP Study. Neurology 2023; 100:e367-e376. [PMID: 36253105 DOI: 10.1212/wnl.0000000000201448] [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] [Received: 12/29/2021] [Accepted: 09/08/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The Levodopa in EArly Parkinson's Disease (LEAP) study enabled us to conduct post hoc analyses concerning the effects of levodopa in patients with early Parkinson disease. METHODS The LEAP study was a double-blind, placebo-controlled, randomized, delayed-start trial in which patients with early Parkinson disease were randomized to receive levodopa/carbidopa 300/75 mg daily for 80 weeks (early-start group) or to placebo for 40 weeks followed by levodopa/carbidopa 300/75 mg daily for 40 weeks (delayed-start group). We analyzed the effect of levodopa with the Unified Parkinson's Disease Rating Scale on bradykinesia, rigidity, and tremor. At week 80, participants answered 3 questions regarding motor response fluctuations. RESULTS A total of 222 patients were randomized to the early-start group (mean ± SD age at baseline 64.8 ± 8.7 years; 71% male) and 223 to the delayed-start group (mean ± SD age at baseline 65.5 ± 8.8 years; 69% male). The difference between the early- and delayed-start groups in mean change from baseline to week 4, expressed as Hedges g effect size, was -0.33 for bradykinesia, -0.29 for rigidity, and -0.25 for tremor (for all symptoms indicating a small effect in favor of the early-start group); from baseline to week 22, respectively, -0.49, -0.36, and -0.44 (small to medium effect); and from baseline to week 40, respectively, -0.32, -0.19, and -0.27 (small effect). At 80 weeks, fewer patients in the early-start group (46 of 205 patients, 23%) experienced motor response fluctuations than patients in the delayed-start group (81 of 211, 38%; p < 0.01). DISCUSSION In patients with early Parkinson disease, levodopa improves bradykinesia, rigidity, and tremor to the same order of magnitude. For all 3 symptoms, effects were larger at 22 weeks compared with 4 weeks. At 80 weeks, there were fewer patients with motor response fluctuations in the group that had started levodopa earlier. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that the effect of levodopa on bradykinesia, rigidity, and tremor is larger after 22 weeks compared with 4 weeks of treatment. TRIAL REGISTRATION INFORMATION ISRCTN30518857, EudraCT number 2011-000678-72.
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Affiliation(s)
- Henrieke L Frequin
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Jason Schouten
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Constant V M Verschuur
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Sven R Suwijn
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Judith A Boel
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Bart Post
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Bastiaan R Bloem
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Johannes J van Hilten
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Teus van Laar
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Gerrit Tissingh
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Alexander G Munts
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Joke M Dijk
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Günther Deuschl
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Anthony Lang
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Marcel G W Dijkgraaf
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Rob J de Haan
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
| | - Rob M A de Bie
- From the Department of Neurology (H.L.F., J.S., C.V.M.V., S.R.S., J.M.D., R.M.A.d.B.) and Department of Medical Psychology (J.A.B.), Amsterdam University Medical Centers; Radboud University Medical Center (B.P., B.R.B.), Department of Neurology; Leiden University Medical Center (J.J.H.), Department of Neurology; University Medical Center Groningen (T.L.), Department of Neurology; Zuyderland Medical Center (G.T.), Department of Neurology; Excellent Klinieken (A.G.M.), Dordrecht, Department of Neurology; University Medical Center Schleswig-Holstein (G.D.), Department of Neurology; Toronto Western Hospital (A.L.), University of Toronto, Department of Neurology; Amsterdam University Medical Centers (M.G.W.D.), Department of Epidemiology and Data Science; and Amsterdam University Medical Centers (R.J.H.), Clinical Research Unit
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15
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Spaans LN, Bousema JE, Meijer P, Bouwman RA(A, van den Broek R, Mourisse J, Dijkgraaf MGW, Verhagen AFTM, van den Broek FJC. Acute pain management after thoracoscopic lung resection: a systematic review and explorative meta-analysis. Interdiscip Cardiovasc Thorac Surg 2023; 36:6978197. [PMID: 36802255 PMCID: PMC9931052 DOI: 10.1093/icvts/ivad003] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Pain after thoracoscopic surgery may increase the incidence of postoperative complications and impair recovery. Guidelines lack consensus regarding postoperative analgesia. We performed a systematic review and meta-analysis to determine the mean pain scores of different analgesic techniques (thoracic epidural analgesia, continuous or single-shot unilateral regional analgesia and only systemic analgesia) after thoracoscopic anatomical lung resection. METHODS Medline, Embase and Cochrane databases were searched until 1 October 2022. Patients undergoing at least >70% anatomical resections through thoracoscopy reporting postoperative pain scores were included. Due to a high inter-study variability an explorative meta-analysis next to an analytic meta-analysis was performed. The quality of evidence has been evaluated using the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS A total of 51 studies comprising 5573 patients were included. Mean 24, 48 and 72 h pain scores with 95% confidence interval on a 0-10 scale were calculated. Length of hospital stay, postoperative nausea and vomiting, additional opioids and the use of rescue analgesia were analysed as secondary outcomes. A common-effect size was estimated with an extreme high heterogeneity for which pooling of the studies was not appropriate. An exploratory meta-analysis demonstrated acceptable mean pain scores of Numeric Rating Scale <4 for all analgesic techniques. CONCLUSIONS This extensive literature review and attempt to pool mean pain scores for meta-analysis demonstrates that unilateral regional analgesia is gaining popularity over thoracic epidural analgesia in thoracoscopic anatomical lung resection, despite great heterogeneity and limitations of current studies precluding such recommendations. PROSPERO REGISTRATION ID number 205311.
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Affiliation(s)
- Louisa N Spaans
- Department of Surgery, Máxima Medical Center, Veldhoven, Netherlands
| | - Jelle E Bousema
- Department of Surgery, Máxima Medical Center, Veldhoven, Netherlands
| | - Patrick Meijer
- Department of Anesthesiology, Máxima Medical Center, Veldhoven, Netherlands
| | - R A (Arthur) Bouwman
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, Netherlands
| | - Renee van den Broek
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, Netherlands
| | - Jo Mourisse
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Ad F T M Verhagen
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Frank J C van den Broek
- Corresponding author. Department of Surgery, Máxima MC, PO Box 7777, 5500 MB Veldhoven, Netherlands. Tel: +31-040-8888550; e-mail: (F.J.C. van den Broek)
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16
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Dijkgraaf MGW, Haukoos J, Itani KMF. Practical Guide to Design Choice of Randomized Clinical Trials in Surgery. JAMA Surg 2022; 157:1154-1155. [PMID: 36287547 DOI: 10.1001/jamasurg.2022.4889] [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: 01/11/2023]
Abstract
This Guide to Statistics and Methods provides an overview of the strengths and weaknesses of several randomized clinical trial design options.
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Affiliation(s)
- Marcel G W Dijkgraaf
- Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.,Methodology, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Jason Haukoos
- Department of Emergency Medicine, Denver Health Medical Center, University of Colorado School of Medicine, Denver.,Department of Epidemiology, Colorado School of Public Health, Aurora.,Statistical Editor, JAMA Surgery
| | - Kamal M F Itani
- Department of Surgery, Veterans Affairs Boston Health Care System, Boston, Massachusetts.,Department of Surgery, Boston Medical Center, Boston University, Boston, Massachusetts.,Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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17
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Haal S, Guman MSS, de Brauw LM, Schouten R, van Veen RN, Fockens P, Gerdes VEA, Voermans RP, Dijkgraaf MGW. Cost-effectiveness of ursodeoxycholic acid in preventing new-onset symptomatic gallstone disease after Roux-en-Y gastric bypass surgery. Br J Surg 2022; 109:1116-1123. [PMID: 35979609 PMCID: PMC10364680 DOI: 10.1093/bjs/znac273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 08/02/2023]
Abstract
BACKGROUND The aim was to evaluate the cost-effectiveness and cost-utility of ursodeoxycholic acid (UDCA) prophylaxis for the prevention of symptomatic gallstone disease after Roux-en-Y gastric bypass (RYGB) in patients without gallstones before surgery. METHODS Data from a multicentre, double-blind, randomized placebo-controlled superiority trial were used. Patients scheduled for laparoscopic RYGB or sleeve gastrectomy were randomized to receive 900 mg UDCA or placebo for 6 months. Indicated by the clinical report, prophylactic prescription of UDCA was evaluated economically against placebo from a healthcare and societal perspective for the subgroup of patients without gallstones before surgery who underwent RYGB. Volumes and costs of in-hospital care, out-of-hospital care, out-of-pocket expenses, and productivity loss were assessed. Main outcomes were the costs per patient free from symptomatic gallstone disease and the costs per quality-adjusted life-year (QALY). RESULTS Patients receiving UDCA prophylaxis were more likely to remain free from symptomatic gallstone disease (relative risk 1.06, 95 per cent c.i. 1.02 to 1.11; P = 0.002) compared with patients in the placebo group. The gain in QALYs, corrected for a baseline difference in health utility, was 0.047 (95 per cent bias-corrected and accelerated (Bca) c.i. 0.007 to 0.088) higher (P = 0.022). Differences in costs were -€356 (95 per cent Bca c.i. €-1573 to 761) from a healthcare perspective and -€1392 (-3807 to 917) from a societal perspective including out-of-pocket expenses and productivity loss, both statistically non-significant, in favour of UDCA prophylaxis. The probability of UDCA prophylaxis being cost-effective was at least 0.872. CONCLUSION UDCA prophylaxis after RYGB in patients without gallstones before surgery was cost-effective.
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Affiliation(s)
- Sylke Haal
- Correspondence to: Sylke Haal, Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands (e-mail: )
| | - Maimoena S S Guman
- Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, the Netherlands
- Department of Internal and Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | | | - Ruben Schouten
- Department of Surgery, Flevohospital, Almere, the Netherlands
| | | | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Victor E A Gerdes
- Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, the Netherlands
- Department of Internal and Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Rogier P Voermans
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, the Netherlands
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18
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Spaans LN, Dijkgraaf MGW, Meijer P, Mourisse J, Bouwman RA, Verhagen AFTM, van den Broek FJC. Optimal postoperative pain management after VATS lung resection by thoracic epidural analgesia, continuous paravertebral block or single-shot intercostal nerve block (OPtriAL): study protocol of a three-arm multicentre randomised controlled trial. BMC Surg 2022; 22:330. [PMID: 36058900 PMCID: PMC9441091 DOI: 10.1186/s12893-022-01765-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 07/19/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adequate pain control after video-assisted thoracoscopic surgery (VATS) for lung resection is important to improve postoperative mobilisation, recovery, and to prevent pulmonary complications. So far, no consensus exists on optimal postoperative pain management after VATS anatomic lung resection. Thoracic epidural analgesia (TEA) is the reference standard for postoperative pain management following VATS. Although the analgesic effect of TEA is clear, it is associated with patient immobilisation, bladder dysfunction and hypotension which may result in delayed recovery and longer hospitalisation. These disadvantages of TEA initiated the development of unilateral regional techniques for pain management. The most frequently used techniques are continuous paravertebral block (PVB) and single-shot intercostal nerve block (ICNB). We hypothesize that using either PVB or ICNB is non-inferior to TEA regarding postoperative pain and superior regarding quality of recovery (QoR). Signifying faster postoperative mobilisation, reduced morbidity and shorter hospitalisation, these techniques may therefore reduce health care costs and improve patient satisfaction. METHODS This multi-centre randomised study is a three-arm clinical trial comparing PVB, ICNB and TEA in a 1:1:1 ratio for pain (non-inferiority) and QoR (superiority) in 450 adult patients undergoing VATS anatomic lung resection. Patients will not be eligible for inclusion in case of contraindications for TEA, PVB or ICNB, chronic opioid use or if the lung surgeon estimates a high probability that the operation will be performed by thoracotomy. PRIMARY OUTCOMES (1) the proportion of pain scores ≥ 4 as assessed by the numerical rating scale (NRS) measured during postoperative days (POD) 0-2; and (2) the QoR measured with the QoR-15 questionnaire on POD 1 and 2. Secondary outcome measures are cumulative use of opioids and analgesics, postoperative complications, hospitalisation, patient satisfaction and degree of mobility. DISCUSSION The results of this trial will impact international guidelines with respect to perioperative care optimization after anatomic lung resection performed through VATS, and will determine the most cost-effective pain strategy and may reduce variability in postoperative pain management. Trial registration The trial is registered at the Netherlands Trial Register (NTR) on February 1st, 2021 (NL9243). The NTR is no longer available since June 24th, 2022 and therefore a revised protocol has been registered at ClinicalTrials.gov on August 5th, 2022 (NCT05491239). PROTOCOL VERSION version 3 (date 06-05-2022), ethical approval through an amendment (see ethical proof in the Study protocol proof).
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Affiliation(s)
- L N Spaans
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.,University of Amsterdam, Amsterdam, The Netherlands
| | - M G W Dijkgraaf
- University of Amsterdam, Amsterdam, The Netherlands.,Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - P Meijer
- Department of Anesthesiology, Máxima Medical Center, Veldhoven, The Netherlands
| | - J Mourisse
- Department of Anesthesiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R A Bouwman
- Department of Anaesthesiology, Catharina Hospital, Eindhoven, The Netherlands
| | - A F T M Verhagen
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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19
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Onnekink AM, Boxhoorn L, Timmerhuis HC, Bac ST, Besselink MG, Boermeester MA, Bollen TL, Bosscha K, Bouwense SAW, Bruno MJ, van Brunschot S, Cappendijk VC, Consten ECJ, Dejong CH, Dijkgraaf MGW, van Eijck CHJ, Erkelens WG, van Goor H, van Grinsven J, Haveman JW, van Hooft JE, Jansen JM, van Lienden KP, Meijssen MAC, Nieuwenhuijs VB, Poley JW, Quispel R, de Ridder RJ, Römkens TEH, van Santvoort HC, Scheepers JJ, Schwartz MP, Seerden T, Spanier MBW, Straathof JWA, Timmer R, Venneman NG, Verdonk RC, Vleggaar FP, van Wanrooij RL, Witteman BJM, Fockens P, Voermans RP. Endoscopic Versus Surgical Step-Up Approach for Infected Necrotizing Pancreatitis (ExTENSION): Long-term Follow-up of a Randomized Trial. Gastroenterology 2022; 163:712-722.e14. [PMID: 35580661 DOI: 10.1053/j.gastro.2022.05.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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] [Received: 11/23/2021] [Revised: 05/02/2022] [Accepted: 05/11/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND & AIMS Previous randomized trials, including the Transluminal Endoscopic Step-Up Approach Versus Minimally Invasive Surgical Step-Up Approach in Patients With Infected Pancreatic Necrosis (TENSION) trial, demonstrated that the endoscopic step-up approach might be preferred over the surgical step-up approach in patients with infected necrotizing pancreatitis based on favorable short-term outcomes. We compared long-term clinical outcomes of both step-up approaches after a period of at least 5 years. METHODS In this long-term follow-up study, we reevaluated all clinical data on 83 patients (of the originally 98 included patients) from the TENSION trial who were still alive after the initial 6-month follow-up. The primary end point, similar to the TENSION trial, was a composite of death and major complications. Secondary end points included individual major complications, pancreaticocutaneous fistula, reinterventions, pancreatic insufficiency, and quality of life. RESULTS After a mean follow-up period of 7 years, the primary end point occurred in 27 patients (53%) in the endoscopy group and in 27 patients (57%) in the surgery group (risk ratio [RR], 0.93; 95% confidence interval [CI], 0.65-1.32; P = .688). Fewer pancreaticocutaneous fistulas were identified in the endoscopy group (8% vs 34%; RR, 0.23; 95% CI, 0.08-0.83). After the initial 6-month follow-up, the endoscopy group needed fewer reinterventions than the surgery group (7% vs 24%; RR, 0.29; 95% CI, 0.09-0.99). Pancreatic insufficiency and quality of life did not differ between groups. CONCLUSIONS At long-term follow-up, the endoscopic step-up approach was not superior to the surgical step-up approach in reducing death or major complications in patients with infected necrotizing pancreatitis. However, patients assigned to the endoscopic approach developed overall fewer pancreaticocutaneous fistulas and needed fewer reinterventions after the initial 6-month follow-up. Netherlands Trial Register no: NL8571.
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Affiliation(s)
- Anke M Onnekink
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Amsterdam, the Netherlands; Department of Research and Development, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Lotte Boxhoorn
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Amsterdam, the Netherlands; Department of Research and Development, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Hester C Timmerhuis
- Department of Research and Development, St. Antonius Hospital, Nieuwegein, the Netherlands; Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Simon T Bac
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Amsterdam, the Netherlands
| | - Marc G Besselink
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Amsterdam, the Netherlands; Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Marja A Boermeester
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Amsterdam, the Netherlands; Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Thomas L Bollen
- Department of Radiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Koop Bosscha
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Stefan A W Bouwense
- Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Sandra van Brunschot
- Department of Research and Development, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Vincent C Cappendijk
- Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Esther C J Consten
- Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, the Netherlands
| | - Cornelis H Dejong
- Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Marcel G W Dijkgraaf
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Amsterdam, the Netherlands; Epidemiology and Data Science, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Casper H J van Eijck
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Willemien G Erkelens
- Department of Gastroenterology and Hepatology, Gelre Hospital, Apeldoorn, the Netherlands
| | - Harry van Goor
- Department of Surgery, Radboudumc, University Medical Center, Nijmegen, the Netherlands
| | - Janneke van Grinsven
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Amsterdam, the Netherlands; Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Jan-Willem Haveman
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeroen M Jansen
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, the Netherlands
| | - Krijn P van Lienden
- Department of Radiology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Maarten A C Meijssen
- Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, the Netherlands
| | | | - Jan-Werner Poley
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Rutger Quispel
- Department of Gastroenterology and Hepatology, Reinier de Graaf Group, Delft, the Netherlands
| | - Rogier J de Ridder
- Department of Gastroenterology and Hepatology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Tessa E H Römkens
- Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joris J Scheepers
- Department of Surgery, Reinier de Graaf Group, Delft, the Netherlands
| | - Matthijs P Schwartz
- Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, the Netherlands
| | - Tom Seerden
- Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, the Netherlands
| | - Marcel B W Spanier
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Jan Willem A Straathof
- Department of Gastroenterology and Hepatology, Máxima Medical Center, Veldhoven, the Netherlands
| | - Robin Timmer
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Niels G Venneman
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Robert C Verdonk
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Frank P Vleggaar
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Roy L van Wanrooij
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Amsterdam, the Netherlands; Department of Gastroenterology and Hepatology, Amsterdam UMC, VU University Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Ben J M Witteman
- Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede, the Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Amsterdam, the Netherlands
| | - Rogier P Voermans
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Amsterdam, the Netherlands.
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20
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van Munster KN, Dijkgraaf MGW, Oude Elferink RPJ, Beuers U, Ponsioen CY. Symptom patterns in the daily life of PSC patients. Liver Int 2022; 42:1562-1570. [PMID: 35396817 PMCID: PMC9325051 DOI: 10.1111/liv.15271] [Citation(s) in RCA: 2] [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: 01/22/2022] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Patients with primary sclerosing cholangitis (PSC) may suffer from complaints such as pruritus, right upper abdominal quadrant pain (RUQ-A) and fatigue. However, the severity of these complaints, daily and/or seasonal patterns and other factors of influence in PSC are largely unknown. The aim of this study is to assess daily symptoms and patterns thereof in PSC patients in their natural setting. METHODS A mobile application was designed according to the experience sampling method. Push notifications with a response time of max 4 h were sent during tiers of 3 months. Questions comprised VAS scales on degree of pruritus, fatigue, RUQ-A, time of the day these symptoms were worst, as well as time of intake of medication. Linear mixed modelling was used to identify patient- and external factors associated with pruritus, fatigue and RUQ-A pain. RESULTS A total of 6713 questionnaires were completed by 137 patients. Fatigue was the most prevalent symptom among PSC patients being reported in a striking 71% of measurements, followed by pruritus (38%). Both increased during the day and were associated with longer disease duration. A highly significant correlation between pruritus and day temperature was observed (ρ = -0.14, p = .000), and itch was generally worse during winter (p = .000). Patient preference for the tool was high. CONCLUSION Pruritus and fatigue are prevalent symptoms in the daily life of PSC patients and show a distinct diurnal pattern. This may have implications for efficient dosing of anti-pruritic agents. The level of pruritus is highly correlated with day temperature, which may have several implications.
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Affiliation(s)
- Kim N. van Munster
- Department of Gastroenterology and Hepatology, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | | | - Ronald P. J. Oude Elferink
- Tytgat Laboratory for Liver and Intestinal DiseasesAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamthe Netherlands
| | - Ulrich Beuers
- Department of Gastroenterology and Hepatology, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Cyriel Y. Ponsioen
- Department of Gastroenterology and Hepatology, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
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21
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Meima-van Praag EM, van Rijn KL, Wasmann KATGM, Snijder HJ, Stoker J, D'Haens GR, Gecse KB, Gerhards MF, Jansen JM, Dijkgraaf MGW, van der Bilt JDW, Mundt MW, Spinelli A, Danese S, Bemelman WA, Buskens CJ. Short-term anti-TNF therapy with surgical closure versus anti-TNF therapy in the treatment of perianal fistulas in Crohn's disease (PISA-II): a patient preference randomised trial. Lancet Gastroenterol Hepatol 2022; 7:617-626. [PMID: 35427495 DOI: 10.1016/s2468-1253(22)00088-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 01/21/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Guidelines on Crohn's perianal fistulas recommend anti-tumour necrosis factor (TNF) treatment and suggest considering surgical closure for patients with surgically amenable disease. However, long-term outcomes following these two strategies have not been directly compared. The aim of this study was to assess radiological healing in patients who received short-term anti-TNF treatment and surgical closure compared with those who received anti-TNF treatment alone. METHODS The PISA-II trial was a multicentre, patient preference study done in nine hospitals in the Netherlands and one hospital in Italy. Adult patients with Crohn's disease and an active high perianal fistula with a single internal opening were eligible for inclusion. After counselling, patients with no treatment preference were randomly assigned (1:1) using random block randomisation (block sizes of six without statification), to 4-month anti-TNF therapy and surgical closure or anti-TNF therapy for 1 year, after seton insertion. Patients with a treatment preference received their preferred therapy. The primary outcome was radiological healing assessed by MRI at 18 months, defined as a complete fibrotic tract or a MAGNIFI-CD (Magnetic Resonance Index for Fistula Imaging in Crohn's Disease) score of 0, assessed according to the intention-to-treat principle. Secondary outcomes included clinical closure, number of patients undergoing surgical reintervention and number of reinterventions, recurrences, and impact on quality of life measured by the Perianal Disease Activity Index (PDAI). Analyses were performed on an intention-to-treat basis and additionally an as-treated analysis for radiological healing and clinical closure. This study was registered at the Dutch Trial Registry, NL7625, and with EudraCT, 2018-002064-15, and is closed to accrual due to completion. FINDINGS Between Sept 14, 2013, and Dec 7, 2019, 94 patients were enrolled onto the trial, of whom 32 (34%) were randomly assigned and 62 (66%) chose a specific treatment. 38 (40%) patients were assigned to the surgical closure group and 56 (60%) patients to the anti-TNF group. At 18 months, radiological healing was significantly more common in the surgical closure group (12 [32%] patients) than in the anti-TNF group (five [9%] patients; p=0·005). By contrast, clinical closure was not significantly different between the two treatment groups (26 [68%] patients in the surgical closure group vs 29 [52%] patients in the anti-TNF group; p=0·076). Significantly fewer patients required a reintervention in the surgical closure group than in the anti-TNF therapy group (five [13%] patients in the surgical closure group, median one reintervention [IQR one to three] vs 24 [43%] patients in the anti-TNF group, median two reinterventions [one to two]; p=0·005). Among patients who reached clinical closure during follow-up, four (14%) of 29 in the surgical closure group and five (16%) of 31 in the anti-TNF therapy group had a recurrence, which occurred only in patients without radiological healing. PDAI was significantly lower in the surgical closure group than in the anti-TNF group after 18 months (p=0·031). Adverse events and serious adverse events were similar in both treatment groups and mostly entailed reinterventions. Ten (11%) patients had side-effects associated with anti-TNF treatment. Two serious adverse events unrelated to study treatment occurred (appendicitis and myocardial infarction). One patient died from a tongue base carcinoma, unrelated to study treatment. INTERPRETATION Short-term anti-TNF treatment combined with surgical closure induces long-term MRI healing more frequently than anti-TNF therapy in patients with Crohn's perianal fistulas. These data suggest that patients with Crohn's perianal fistula amenable for surgical closure should be counselled for this therapeutic approach. FUNDING Netherlands Organisation for Health Research and Development and Broad Medical Research Program.
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Affiliation(s)
- Elise M Meima-van Praag
- Department of Surgery, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Kyra L van Rijn
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Karin A T G M Wasmann
- Department of Surgery, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Harmanna J Snijder
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Geert R D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Krisztina B Gecse
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Michael F Gerhards
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Jeroen M Jansen
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | | | - Marco W Mundt
- Department of Gastroenterology and Hepatology, Flevoziekenhuis, Almere, Netherlands
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Willem A Bemelman
- Department of Surgery, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands; Department of Gastroenterology and Endoscopy, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Christianne J Buskens
- Department of Surgery, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands.
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22
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Klopotowska JE, Kuks PFM, Wierenga PC, Stuijt CCM, Arisz L, Dijkgraaf MGW, de Keizer N, Smorenburg SM, de Rooij SE. The effect of structured medication review followed by face-to-face feedback to prescribers on adverse drug events recognition and prevention in older inpatients - a multicenter interrupted time series study. BMC Geriatr 2022; 22:505. [PMID: 35715742 PMCID: PMC9206349 DOI: 10.1186/s12877-022-03118-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/22/2021] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background The effectiveness of interventions to improve medication safety in older inpatients is unclear, given a paucity of properly designed intervention studies applying clinically relevant endpoints such as hospital-acquired preventable Adverse Drug Events (pADEs) and unrecognized Adverse Drug Events (uADEs). Therefore, we conducted a quality improvement study and used hospital-acquired pADEs and uADEs as main outcomes to assess the effect of an intervention aimed to improve medication safety in older inpatients. Method The study followed an interrupted time series design and consisted of three equally spaced sampling points during baseline and during intervention measurements. Each sampling point included between 80 to 90 patients. A total of 500 inpatients ≥65 years and admitted to internal medicine wards of three Dutch hospitals were included. An expert team retrospectively identified and assessed ADEs via a structured patient chart review. The findings from baseline measurement and meetings with the internal medicine and hospital pharmacy staff were used to design the intervention. The intervention consisted of a structured medication review by hospital pharmacists, followed by face-to-face feedback to prescribers, on average 3 days per week. Results The rate of hospital-acquired pADEs per 100 hospitalizations was reduced by 50.6% (difference 16.8, 95% confidence interval (CI): 9.0 to 24.6, P < 0.001), serious hospital-acquired pADEs by 62.7% (difference 12.8, 95% CI: 6.4 to 19.2, P < 0.001), and uADEs by 51.8% (difference 11.2, 95% CI: 4.4 to 18.0, P < 0.001). Additional analyses confirmed the robustness of the intervention effect, but residual bias cannot be excluded. Conclusions The intervention significantly decreased the overall and serious hospital-acquired pADE occurrence in older inpatients, and significantly improved overall ADE recognition by prescribers. Trial registration International Standard Randomized Controlled Trial Number Register, trial registration number: ISRCTN64974377, registration date (date assigned): 07/02/2011. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03118-z.
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Affiliation(s)
- Joanna E Klopotowska
- Amsterdam University Medical Centers location University of Amsterdam, Medical Informatics, Amsterdam, The Netherlands. .,Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands.
| | - Paul F M Kuks
- Amsterdam University Medical Centers location University of Amsterdam, Pharmacy and Clinical Pharmacology, Amsterdam, The Netherlands
| | - Peter C Wierenga
- Gelderse Vallei Hospital, Hospital Pharmacy, Ede, The Netherlands
| | - Clementine C M Stuijt
- Center of Excellence on Parkinson's disease (Punt voor Parkinson), Groningen, The Netherlands
| | - Lambertus Arisz
- Amsterdam University Medical Centers location University of Amsterdam, Internal Medicine, Amsterdam, The Netherlands
| | - Marcel G W Dijkgraaf
- Amsterdam University Medical Centers location University of Amsterdam, Epidemiology and Data Science, Amsterdam, The Netherlands.,Amsterdam Public Health, Methodology, Amsterdam, the Netherlands
| | - Nicolette de Keizer
- Amsterdam University Medical Centers location University of Amsterdam, Medical Informatics, Amsterdam, The Netherlands.,Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - Susanne M Smorenburg
- Amsterdam University Medical Centers location University of Amsterdam, Internal Medicine, Amsterdam, The Netherlands
| | - Sophia E de Rooij
- Amstelland Hospital, Board of Directors, Amstelveen, The Netherlands
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23
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van den Berk IAH, Kanglie MMNP, van Engelen TSR, Altenburg J, Annema JT, Beenen LFM, Boerrigter B, Bomers MK, Bresser P, Eryigit E, Groenink M, Hochheimer SMR, Holleman F, Kooter JAJ, van Loon RB, Keijzers M, van der Lee I, Luijendijk P, Meijboom LJ, Middeldorp S, Schijf LJ, Soetekouw R, Sprengers RW, Montauban van Swijndregt AD, de Monyé W, Ridderikhof ML, Winter MM, Bipat S, Dijkgraaf MGW, Bossuyt PMM, Prins JM, Stoker J. Ultra-low-dose CT versus chest X-ray for patients suspected of pulmonary disease at the emergency department: a multicentre randomised clinical trial. Thorax 2022; 78:515-522. [PMID: 35688623 PMCID: PMC10176343 DOI: 10.1136/thoraxjnl-2021-218337] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/14/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Chest CT displays chest pathology better than chest X-ray (CXR). We evaluated the effects on health outcomes of replacing CXR by ultra-low-dose chest-CT (ULDCT) in the diagnostic work-up of patients suspected of non-traumatic pulmonary disease at the emergency department. METHODS Pragmatic, multicentre, non-inferiority randomised clinical trial in patients suspected of non-traumatic pulmonary disease at the emergency department. Between 31 January 2017 and 31 May 2018, every month, participating centres were randomly allocated to using ULDCT or CXR. Primary outcome was functional health at 28 days, measured by the Short Form (SF)-12 physical component summary scale score (PCS score), non-inferiority margin was set at 1 point. Secondary outcomes included hospital admission, hospital length of stay (LOS) and patients in follow-up because of incidental findings. RESULTS 2418 consecutive patients (ULDCT: 1208 and CXR: 1210) were included. Mean SF-12 PCS score at 28 days was 37.0 for ULDCT and 35.9 for CXR (difference 1.1; 95% lower CI: 0.003). After ULDCT, 638/1208 (52.7%) patients were admitted (median LOS of 4.8 days; IQR 2.1-8.8) compared with 659/1210 (54.5%) patients after CXR (median LOS 4.6 days; IQR 2.1-8.8). More ULDCT patients were in follow-up because of incidental findings: 26 (2.2%) versus 4 (0.3%). CONCLUSIONS Short-term functional health was comparable between ULDCT and CXR, as were hospital admissions and LOS, but more incidental findings were found in the ULDCT group. Our trial does not support routine use of ULDCT in the work-up of patients suspected of non-traumatic pulmonary disease at the emergency department. TRIAL REGISTRATION NUMBER NTR6163.
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Affiliation(s)
- Inge A H van den Berk
- Department of Radiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Maadrika M N P Kanglie
- Department of Radiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Department of Radiology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Tjitske S R van Engelen
- Department of Internal Medicine, division of Infectious Diseases, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Josje Altenburg
- Department of Pulmonary Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Jouke T Annema
- Department of Pulmonary Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Ludo F M Beenen
- Department of Radiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Bart Boerrigter
- Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marije K Bomers
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Paul Bresser
- Department of Pulmonary Medicine, OLVG, Amsterdam, The Netherlands
| | - Elvin Eryigit
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maarten Groenink
- Department of Cardiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Frits Holleman
- Department of Internal Medicine, division of Infectious Diseases, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Jos A J Kooter
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ramon B van Loon
- Department of Cardiology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mitran Keijzers
- Department of Cardiology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Ivo van der Lee
- Department of Pulmonary Medicine, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Paul Luijendijk
- Department of Cardiology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lilian J Meijboom
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Saskia Middeldorp
- Department of Internal Medicine, division of Vascular Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Laura J Schijf
- Department of Radiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Robin Soetekouw
- Department of Internal Medicine, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Ralf W Sprengers
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Wouter de Monyé
- Department of Radiology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Milan L Ridderikhof
- Department of Emergency Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Michiel M Winter
- Department of Cardiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Shandra Bipat
- Department of Radiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology & Data Science, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Patrick M M Bossuyt
- Department of Epidemiology & Data Science, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Jan M Prins
- Department of Internal Medicine, division of Infectious Diseases, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Jaap Stoker
- Department of Radiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
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24
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Bom WJ, Scheijmans JCG, Ubels S, van Geloven AAW, Gans SL, Tytgat KMAJ, van Rossem CC, Koens L, Stoker J, Bemelman WA, Dijkgraaf MGW, Boermeester MA. Optimising diagnostics to discriminate complicated from uncomplicated appendicitis: a prospective cohort study protocol. BMJ Open 2022; 12:e054304. [PMID: 35365522 PMCID: PMC8977816 DOI: 10.1136/bmjopen-2021-054304] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Growing evidence is showing that complicated and uncomplicated appendicitis are two different entities that may be treated differently. A correct diagnosis of the type of appendicitis is therefore essential. The Scoring system of Appendicitis Severity (SAS) combines clinical, laboratory and imaging findings. The SAS rules out complicated appendicitis in 95% (negative predictive value, NPV) and detects 95% (sensitivity) of patients with complicated appendicitis in adults suspected of acute appendicitis. However, this scoring system has not yet been validated externally. In this study, we aim to provide a prospective external validation of the SAS in a new cohort of patients with clinical suspicion of appendicitis. We will optimise the score when necessary. METHODS AND ANALYSIS The SAS will be validated in 795 consecutive adult patients diagnosed with acute appendicitis confirmed by imaging. Data will be collected prospectively in multiple centres. The predicted diagnosis based on the SAS score will be compared with the combined surgical and histological diagnosis. Diagnostic accuracy for ruling out complicated appendicitis will be calculated. If the SAS does not reach a sensitivity and NPV of 95% in its present form, the score will be optimised. After optimisation, a second external validation will be performed in a new group of 328 patients. Furthermore, the diagnostic accuracy of the clinical perspective of the treating physician for differentiation between uncomplicated and complicated appendicitis and the patient's preferences for different treatment options will be assessed. ETHICS AND DISSEMINATION Ethical approval was granted by the Amsterdam UMC Medical Ethics Committee (reference W19_416 # 19.483). Because of the observational nature of this study, the study does not fall under the scope of the Medical Research Involving Human Subjects Act. Results will be presented in peer-reviewed journals. This protocol is submitted for publication before analysis of the results.
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Affiliation(s)
- Wouter J Bom
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Surgery, Tergooi Hospitals, Hilversum, The Netherlands
| | - Jochem C G Scheijmans
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sander Ubels
- Departement of Surgery, Universitair Medisch Centrum Sint Radboud, Nijmegen, The Netherlands
| | | | - Sarah L Gans
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Kristien M A J Tytgat
- Gastroenterology and Hepatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | | | - Lianne Koens
- Pathology, Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Willem A Bemelman
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel G W Dijkgraaf
- Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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25
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Bastiaenen VP, van Vliet JLP, de Savornin Lohman EAJ, Corten BJGA, de Jonge J, Kraima AC, Swank HA, van Acker GJD, van Geloven AAW, In 't Hof KH, Koens L, de Reuver PR, van Rossem CC, Slooter GD, Tanis PJ, Terpstra V, Dijkgraaf MGW, Bemelman WA. Safety and economic analysis of selective histopathology following cholecystectomy: multicentre, prospective, cross-sectional FANCY study. Br J Surg 2022; 109:355-362. [PMID: 35245363 PMCID: PMC10364776 DOI: 10.1093/bjs/znab469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/12/2021] [Accepted: 12/22/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND There is ongoing debate concerning the necessity of routine histopathological examination following cholecystectomy. In order to reduce the pathology workload and save costs, a selective approach has been suggested, but evidence regarding its oncological safety is lacking. METHODS In this multicentre, prospective, cross-sectional study, all gallbladders removed for gallstone disease or cholecystitis were systematically examined by the surgeon for macroscopic abnormalities indicative of malignancy. Before sending all specimens to the pathologist, the surgeon judged whether histopathological examination was indicated. The main outcomes were the number of patients with hypothetically missed malignancy with clinical consequences (upper limit two-sided 95 per cent c.i. below 3:1000 considered oncologically safe) and potential cost savings of selective histopathological examination. RESULTS Twenty-two (2.19:1000) of 10 041 specimens exhibited malignancy with clinical consequences. In case of a selective policy, surgeons would have held back 7846 of 10041 (78.1 per cent) gallbladders from histopathological examination. Malignancy with clinical consequences would have been missed in seven of 7846 patients (0.89:1000, upper limit 95% c.i. 1.40:1000). No patient benefitted from the clinical consequences, while two were harmed (futile additional surgery). Of 15 patients in whom malignancy with clinical consequences would have been diagnosed, one benefitted (residual disease radically removed), two potentially benefitted (palliative systemic therapy), and four experienced harm (futile additional surgery). Estimated cost savings established by replacing routine for selective histopathological examination were €703 500 per 10 000 patients. CONCLUSION Selective histopathological examination following cholecystectomy is oncologically safe and could reduce pathology workload, costs, and futile re-resections.
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Affiliation(s)
- Vivian P Bastiaenen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Jaap L P van Vliet
- Department of Surgery, Haaglanden Medical Centre, 2512 VA The Hague, The Netherlands
| | | | | | - Joske de Jonge
- Department of Surgery, Tergooi Hospital, 1213 XZ Hilversum, The Netherlands
| | - Anne C Kraima
- Department of Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.,Department of Surgery, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands
| | - Hilko A Swank
- Department of Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.,Department of Surgery, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands
| | - Gijs J D van Acker
- Department of Surgery, Haaglanden Medical Centre, 2512 VA The Hague, The Netherlands
| | | | - Klaas H In 't Hof
- Department of Surgery, Flevo Hospital, 1315 RA Almere, The Netherlands
| | - Lianne Koens
- Department of Pathology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Philip R de Reuver
- Department of Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | | | - Gerrit D Slooter
- Department of Surgery, Máxima Medical Centre, 5504 DB Veldhoven, The Netherlands
| | - Pieter J Tanis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Valeska Terpstra
- Department of Pathology, Haaglanden Medical Centre, 2512 VA The Hague, The Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Willem A Bemelman
- Department of Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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26
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Timmer AS, Wolfhagen N, Pianka F, Knebel P, Justinger C, Stravodimos C, Ichida K, Rikiyama T, Baracs J, Vereczkei A, Gianotti L, Ruiz-Tovar J, Hernández AM, Nakamura T, Dijkgraaf MGW, Boermeester MA, de Jonge SW. Effect of triclosan-coated sutures for abdominal wound closure on the incidence of abdominal wound dehiscence: a protocol for an individual participant data meta-analysis. BMJ Open 2022; 12:e054534. [PMID: 35197346 PMCID: PMC8867322 DOI: 10.1136/bmjopen-2021-054534] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Acute abdominal wound dehiscence (AWD) or burst abdomen is a severe complication after abdominal surgery with an incidence up to 3.8%. Surgical site infection (SSI) is the biggest risk factor for the development of AWD. It is strongly suggested that the use of triclosan-coated sutures (TCS) for wound closure reduces the risk of SSI. We hypothesise that the use of TCS for abdominal wound closure may reduce the risk of AWD. Current randomised controlled trials (RCTs) lack power to investigate this. Therefore, the purpose of this individual participant data meta-analysis is to evaluate the effect of TCS for abdominal wound closure on the incidence of AWD. METHODS AND ANALYSIS We will conduct a systematic review of Medline, Embase and Cochrane Central Register of Controlled Trials for RCTs investigating the effect of TCS compared with non-coated sutures for abdominal wound closure in adult participants scheduled for open abdominal surgery. Two independent reviewers will assess eligible studies for inclusion and methodological quality. Authors of eligible studies will be invited to collaborate and share individual participant data. The primary outcome will be AWD within 30 days after surgery requiring reoperation. Secondary outcomes include SSI, all-cause reoperations, length of hospital stay and all-cause mortality within 30 days after surgery. Data will be analysed with a one-step approach, followed by a two-step approach. In the one-step approach, treatment effects will be estimated as a risk ratio with corresponding 95% CI in a generalised linear mixed model framework with a log link and binomial distribution assumption. The quality of evidence will be judged using the Grading of Recommendations Assessment Development and Evaluation approach. ETHICS AND DISSEMINATION The medical ethics committee of the Amsterdam UMC, location AMC in the Netherlands waived the necessity for a formal approval of this study, as this research does not fall under the Medical Research involving Human Subjects Act. Collaborating investigators will deidentify data before sharing. The results will be submitted to a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42019121173.
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Affiliation(s)
- Allard S Timmer
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam Infection and Immunity, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Niels Wolfhagen
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam Infection and Immunity, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Frank Pianka
- Department of General, Visceral and Transplantation Surgery, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | - Phillip Knebel
- Department of General, Visceral and Transplantation Surgery, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | - Christoph Justinger
- Department of Surgery, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Germany
| | | | - Kosuke Ichida
- Department of Surgery, Jichi Medical University, Saitama, Japan
| | | | - József Baracs
- Department of Surgery, University of Pecs, Pecs, Hungary
| | | | - Luca Gianotti
- Department of Surgery, San Gerardo Hospital, Monza, Italy
| | - Jaime Ruiz-Tovar
- Department of Surgery, Rey Juan Carlos University, Madrid, Spain
| | - Artur M Hernández
- Department of Humanities and Social Sciences, University Isabel I, Burgos, Spain
| | - Toru Nakamura
- Department of Surgery, Hokkaido University, Sapporo, Japan
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam Infection and Immunity, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Stijn W de Jonge
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam Infection and Immunity, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
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27
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Adrichem ME, Lucke IM, Vrancken AFJE, Goedee HS, Wieske L, Dijkgraaf MGW, Voermans NC, Notermans NC, Faber CG, Visser LH, Kuitwaard K, van Doorn PA, Merkies ISJ, de Haan RJ, van Schaik IN, Eftimov F. Withdrawal of intravenous immunoglobulin in chronic inflammatory demyelinating polyradiculoneuropathy. Brain 2022; 145:1641-1652. [PMID: 35139161 PMCID: PMC9166547 DOI: 10.1093/brain/awac054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/09/2021] [Revised: 12/07/2021] [Accepted: 12/21/2021] [Indexed: 12/01/2022] Open
Abstract
Intravenous immunoglobulins are an efficacious treatment for chronic inflammatory demyelinating polyradiculoneuropathy. Biomarkers for disease activity are lacking, making the need for ongoing treatment difficult to assess, leading to potential overtreatment and high health-care costs. Our objective was to determine whether intravenous immunoglobulin withdrawal is non-inferior to continuing intravenous immunoglobulin treatment and to determine how often patients are overtreated. We performed a randomized, double-blind, intravenous immunoglobulin-controlled non-inferiority trial in seven centres in the Netherlands (Trial registration: ISRCTN 13637698; www.isrctn.com/ISRCTN13637698). Adults with clinically stable chronic inflammatory demyelinating polyradiculoneuropathy using intravenous immunoglobulin maintenance treatment for at least 6 months were included. Patients received either intravenous immunoglobulin withdrawal (placebo) as investigational treatment or continuation of intravenous immunoglobulin treatment (control). The primary outcome was the mean change in logit scores from baseline to 24-week follow-up on the patient-reported Inflammatory Rasch–Overall Disability Scale. The non-inferiority margin was predefined as between-group difference in mean change scores of −0.65. Patients who deteriorated could reach a relapse end point according to predefined criteria. Patients with a relapse end point after intravenous immunoglobulin withdrawal entered a restabilization phase. All patients from the withdrawal group who remained stable were included in an open-label extension phase of 52 weeks. We included 60 patients, of whom 29 were randomized to intravenous immunoglobulin withdrawal and 31 to continuation of treatment. The mean age was 58 years (SD 14.7) and 67% was male. The between-group difference in mean change Inflammatory Rasch–Overall Disability Scale scores was −0.47 (95% CI −1.24 to 0.31), indicating that non-inferiority of intravenous immunoglobulin withdrawal could not be established. In the intravenous immunoglobulin withdrawal group, 41% remained stable for 24 weeks, compared to 58% in the intravenous immunoglobulin continuation group (−17%; 95% CI −39 to 8). Of the intravenous immunoglobulin withdrawal group, 28% remained stable at the end of the extension phase. Of the patients in the restabilization phase, 94% restabilized within 12 weeks. In conclusion, it remains inconclusive whether intravenous immunoglobulin withdrawal is non-inferior compared to continuing treatment, partly due to larger than expected confidence intervals leading to an underpowered study. Despite these limitations, a considerable proportion of patients could stop treatment and almost all patients who relapsed were restabilized quickly. Unexpectedly, a high proportion of intravenous immunoglobulin-treated patients experienced a relapse end point, emphasizing the need for more objective measures for disease activity in future trials, as the patient-reported outcome measures might not have been able to identify true relapses reliably. Overall, this study suggests that withdrawal attempts are safe and should be performed regularly in clinically stable patients.
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Affiliation(s)
- Max E Adrichem
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ Amsterdam, The Netherlands
| | - Ilse M Lucke
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ Amsterdam, The Netherlands
| | - Alexander F J E Vrancken
- Department of Neurology, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - H Stephan Goedee
- Department of Neurology, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Luuk Wieske
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ Amsterdam, The Netherlands
| | - Marcel G W Dijkgraaf
- Department of Clinical Epidemiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ Amsterdam, The Netherlands
| | - Nicol C Voermans
- Department of Neurology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Nicolette C Notermans
- Department of Neurology, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Catharina G Faber
- Department of Neurology, Maastricht Academic Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Leo H Visser
- Department of Neurology, Elisabeth-Tweesteden Hospital, Hilvarenbeekse weg 60, 5022 GC Tilburg, The Netherlands
| | - Krista Kuitwaard
- Department of Neurology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25 3318 AT Dordrecht, The Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Ingemar S J Merkies
- Department of Neurology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.,Department of Neurology, Curaçao Medical Center, 193 JHJ. Hamelbergweg, Willemstad, Curacao, The Netherlands
| | - Rob J de Haan
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ Amsterdam, The Netherlands
| | - Ivo N van Schaik
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ Amsterdam, The Netherlands.,Board of directors, Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC Haarlem, The Netherlands
| | - Filip Eftimov
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ Amsterdam, The Netherlands
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van Netten JJ, Dijkgraaf MGW, Bus SA. Response to: Remote Diabetic Foot Temperature Monitoring for Early Detection of Diabetic Foot Ulcers: A Cost-Effectiveness Analysis [Letter]. Clinicoecon Outcomes Res 2022; 14:49-50. [PMID: 35082505 PMCID: PMC8784254 DOI: 10.2147/ceor.s354729] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 01/07/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Jaap J van Netten
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Correspondence: Jaap J van Netten, Email
| | - Marcel G W Dijkgraaf
- Amsterdam UMC, University of Amsterdam, Department of Epidemiology and Data Science, Amsterdam, the Netherlands
| | - Sicco A Bus
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Blok RD, Sharabiany S, Stoker J, Laan ETM, Bosker RJI, Burger JWA, Chaudhri S, van Duijvendijk P, van Etten B, van Geloven AAW, de Graaf EJR, Hoff C, Hompes R, Leijtens JWA, Rothbarth J, Rutten HJT, Singh B, Vuylsteke RJCLM, de Wilt JHW, Dijkgraaf MGW, Bemelman WA, Musters GD, Tanis PJ. Cumulative 5-year Results of a Randomized Controlled Trial Comparing Biological Mesh With Primary Perineal Wound Closure After Extralevator Abdominoperineal Resection (BIOPEX-study). Ann Surg 2022; 275:e37-e44. [PMID: 33534231 DOI: 10.1097/sla.0000000000004763] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine long-term outcomes of a randomized trial (BIOPEX) comparing biological mesh and primary perineal closure in rectal cancer patients after extralevator abdominoperineal resection and preoperative radiotherapy, with a primary focus on symptomatic perineal hernia. SUMMARY BACKGROUND DATA BIOPEX is the only randomized trial in this field, which was negative on its primary endpoint (30-day wound healing). METHODS This was a posthoc secondary analysis of patients randomized in the BIOPEX trial to either biological mesh closure (n = 50; 2 dropouts) or primary perineal closure (n = 54; 1 dropout). Patients were followed for 5 years. Actuarial 5-year probabilities were determined by the Kaplan-Meier statistic. RESULTS Actuarial 5-year symptomatic perineal hernia rates were 7% (95% CI, 0-30) after biological mesh closure versus 30% (95% CI, 10-49) after primary closure (P = 0.006). One patient (2%) in the biomesh group underwent elective perineal hernia repair, compared to 7 patients (13%) in the primary closure group (P = 0.062). Reoperations for small bowel obstruction were necessary in 1/48 patients (2%) and 5/53 patients (9%), respectively (P = 0.208). No significant differences were found for chronic perineal wound problems, locoregional recurrence, overall survival, and main domains of quality of life and functional outcome. CONCLUSIONS Symptomatic perineal hernia rate at 5-year follow-up after abdominoperineal resection for rectal cancer was significantly lower after biological mesh closure. Biological mesh closure did not improve quality of life or functional outcomes.
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Affiliation(s)
- Robin D Blok
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- LEXOR, Center for Experimental and Molecular Medicine, Oncode Institute, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Sarah Sharabiany
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands
| | - Ellen T M Laan
- Department of Sexology and Psychosomatic Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Sanjay Chaudhri
- Department of Surgery, University Hospitals Leicester, Leicester, United Kingdom
| | | | - Boudewijn van Etten
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Eelco J R de Graaf
- Department of Surgery, IJsselland Hospital, Capelle aan de IJssel, the Netherlands
| | - Christiaan Hoff
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Roel Hompes
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Joost Rothbarth
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Harm J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Baljit Singh
- Department of Surgery, University Hospitals Leicester, Leicester, United Kingdom
| | | | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Willem A Bemelman
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Gijsbert D Musters
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Pieter J Tanis
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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30
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Francken MFG, van Roessel S, Swijnenburg RJ, Erdmann JI, Busch OR, Dijkgraaf MGW, Besselink MG. Hospital costs of delayed gastric emptying following pancreatoduodenectomy and the financial headroom for novel prophylactic treatment strategies. HPB (Oxford) 2021; 23:1865-1872. [PMID: 34144889 DOI: 10.1016/j.hpb.2021.04.025] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/23/2021] [Accepted: 04/26/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Delayed gastric emptying (DGE) is one of the most common complications following pancreatoduodenectomy (PD). In-hospital costs of DGE are unknown as well as the financial headroom for novel prophylactic treatments. This retrospective study aims to estimate the hospital costs of DGE and model the financial headroom per patient for new prophylactic treatment strategies within budget. METHODS Retrospective analysis of a single-center prospective database including patients after PD (2010-2017). In-hospital costs for clinically relevant DGE (ISGPS grade B/C) were calculated by comparing patient groups with and without DGE or other complications. The financial headroom per patient was modelled for potential reductions (0-100%) of empirical DGE baseline risks (15-30%). RESULTS Overall, DGE was present in 156 (26.9%) of 581 patients after PD. Costs for patients with isolated DGE (n = 90) were €10,295 higher than for patients without complications (n = 333). Costs for patients with other complications including DGE (n = 66) were €9008 higher than for patients with other complications without DGE (n = 92). The financial headroom for a novel prophylactic treatment per patient undergoing PD was €975 per 10% absolute decrease of DGE risk. CONCLUSION Hospital costs of DGE after PD are substantial. The financial headroom per patient for new DGE prophylactic treatments can be easily calculated via www.pancreascalculator.com.
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Affiliation(s)
- Michiel F G Francken
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Stijn van Roessel
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Rutger-Jan Swijnenburg
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Joris I Erdmann
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Olivier R Busch
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
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31
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Haal S, Guman MSS, Boerlage TCC, Acherman YIZ, de Brauw LM, Bruin S, de Castro SMM, van Hooft JE, van de Laar AWJM, Moes DE, Schouten M, Schouten R, van Soest EJ, van Veen RN, de Vries CEE, Fockens P, Dijkgraaf MGW, Gerdes VEA, Voermans RP. Ursodeoxycholic acid for the prevention of symptomatic gallstone disease after bariatric surgery (UPGRADE): a multicentre, double-blind, randomised, placebo-controlled superiority trial. Lancet Gastroenterol Hepatol 2021; 6:993-1001. [PMID: 34715031 DOI: 10.1016/s2468-1253(21)00301-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 05/26/2021] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Rapid weight loss is a major risk factor for the formation of cholesterol gallstones. Consequently, patients with morbid obesity undergoing bariatric surgery frequently develop symptomatic gallstone disease. This trial assessed the efficacy of ursodeoxycholic acid versus placebo for the prevention of symptomatic gallstone disease after bariatric surgery. METHODS This multicentre, double-blind, randomised, placebo-controlled superiority trial enrolled patients with an intact gallbladder scheduled for laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy in three hospitals in the Netherlands. Patients were randomly assigned (1:1) by a web-based randomisation module to receive 900 mg ursodeoxycholic acid daily for 6 months or matched placebo. Randomisation was stratified by the presence of asymptomatic gallstones at baseline and type of surgery. Patients, clinicians, and study staff were masked to treatment allocation. The primary endpoint was symptomatic gallstone disease within 24 months, assessed in the modified intention-to-treat population (all randomly assigned eligible patients with any post-randomisation measurement). Prespecified subgroup analyses were done based on the stratification groups. Safety was assessed in all patients who took at least one dose of the study drug. This trial is registered with the Netherlands Trial Register, NL5954. FINDINGS Between Jan 11, 2017, and Oct 22, 2018, 985 patients were randomly assigned to receive either ursodeoxycholic acid (n=492) or placebo (n=493). 967 patients were included in the modified intention-to-treat population, of whom 959 had data available for primary endpoint assessment. 189 (20%) patients had asymptomatic gallstones at baseline and 78 (8%) received a sleeve gastrectomy. Symptomatic gallstone disease occurred in 31 (6·5%) of 475 patients in the ursodeoxycholic acid group and in 47 (9·7%) of 484 patients in the placebo group (relative risk 0·67, 95% CI 0·43-1·04, p=0·071). Logistic regression showed a significant interaction between ursodeoxycholic acid and the presence of asymptomatic gallstones at baseline (p=0·046), with an effect of ursodeoxycholic acid in patients without (0·47, 0·27-0·84, p=0·0081), and no effect in patients with asymptomatic gallstones at baseline (1·22, 0·61-2·47, p=0·57). The effect was stronger in patients without gallstones at baseline undergoing RYGB (0·37, 0·20-0·71, p=0·0016), whereas the subgroup of patients undergoing sleeve gastrectomy was too small to draw clear conclusions. Adverse events were rare. In the ursodeoxycholic acid group, diarrhoea occurred in four (0·9%) of 444 patients and skin rash in two (0·5%) patients. In the placebo group, diarrhoea occurred in two (0·4%) of 453 patients and skin rash in two (0·4%) patients. The total number of serious adverse events did not significantly differ between the trial groups (75 [17%] in 444 patients in the ursodeoxycholic acid group and 102 [23%] in 453 patients in the placebo group). The most common serious adverse events were abdominal pain and internal hernia. No serious adverse event was attributed to the study drug. INTERPRETATION Ursodeoxycholic acid prophylaxis did not significantly reduce the occurrence of symptomatic gallstone disease in all patients after bariatric surgery. In patients without gallstones before RYGB surgery, ursodeoxycholic acid treatment reduced the occurrence of symptomatic gallstone disease compared with placebo. Further research is needed to assess the efficacy of ursodeoxycholic acid after sleeve gastrectomy. FUNDING The Netherlands Organization for Health Research and Development, Zambon Netherlands BV, Foundation for Clinical Research of the Slotervaart Hospital, the Spaarne Gasthuis Academy, and Amsterdam Gastroenterology Endocrinology Metabolism.
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Affiliation(s)
- Sylke Haal
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands; Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, Netherlands
| | - Maimoena S S Guman
- Department of Internal and Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands; Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, Netherlands
| | - Thomas C C Boerlage
- Department of Gastroenterology and Hepatology, UMC Utrecht, Utrecht, Netherlands
| | | | | | - Sjoerd Bruin
- Department of Surgery, Spaarne Gasthuis, Hoofddorp, Netherlands
| | | | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Daan E Moes
- Department of Surgery, Dijklander Hospital, Hoorn, Netherlands
| | - Manon Schouten
- Department of Surgery, Flevohospital, Almere, Netherlands
| | - Ruben Schouten
- Department of Surgery, Flevohospital, Almere, Netherlands
| | - Ellert J van Soest
- Department of Gastroenterology and Hepatology, Spaarne Gasthuis, Hoofddorp, Netherlands
| | | | | | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands
| | - Victor E A Gerdes
- Department of Internal and Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands; Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, Netherlands
| | - Rogier P Voermans
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands.
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van den Berg LA, Berkhemer OA, Fransen PSS, Beumer D, Lingsma H, Majoie CBM, Dippel DWJ, van der Lugt A, van Oostenbrugge RJ, van Zwam WH, Roos YB, Dijkgraaf MGW. Economic Evaluation of Endovascular Treatment for Acute Ischemic Stroke. Stroke 2021; 53:968-975. [PMID: 34645287 DOI: 10.1161/strokeaha.121.034599] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular treatment for acute ischemic stroke has been proven clinically effective, but evidence of the cost-effectiveness based on real-world data is scarce. The aim of this study was to assess whether endovascular therapy plus usual care is cost-effective in comparison to usual care alone in acute ischemic stroke patients. METHODS An economic evaluation was performed from a societal perspective with a 2-year time horizon. Empirical data on health outcomes and the use of resources following endovascular treatment were gathered parallel to the MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) and its 2-year follow-up study. Incremental cost-effectiveness ratios were calculated as the extra costs per additional patient with functional independence (modified Rankin Scale score 0-2) and the extra cost per quality-adjusted life year gained. RESULTS The mean costs per patient in the intervention group were $126 494 versus $143 331 in the control group (mean difference, -$16 839 [95% CI, -$38 113 to $5456]). Compared with patients in the control group, more patients in the intervention group achieved functional independence, 37.2% versus 23.9% (absolute difference, 13.3% [95% CI, 4.0%-22.0%]) and they generated more quality-adjusted life years, 0.99 versus 0.83 (mean difference of 0.16 [95% CI, 0.04-0.29]). Endovascular treatment dominated standard treatment with $18 233 saved per extra patient with a good outcome and $105 869 saved per additional quality-adjusted life year. CONCLUSIONS Endovascular treatment added to usual care is clinically effective, and cost saving in comparison to usual care alone in patients with acute ischemic stroke. REGISTRATION URL: https://www.trialregister.nl/trial/695; Unique identifier: NL695. https://www.isrctn.com/ISRCTN10888758; Unique identifier: ISRCTN10888758.
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Affiliation(s)
- Lucie A van den Berg
- Departments of Neurology, Amsterdam University Medical Center, the Netherlands. (L.A.v.d.B., Y.B.R.)
| | - Olvert A Berkhemer
- Radiology and Nuclear Medicine, Amsterdam University Medical Center, the Netherlands. (C.B.M.M., O.A.B.).,Department of Neurology, Erasmus MC University Medical Center Rotterdam, the Netherlands. (O.A.B., P.S.S.F., D.W.J.D.).,Department of Radiology, Erasmus MC University Medical Center Rotterdam, the Netherlands. (O.A.B., A.v.d.L.).,Department of Radiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands. (O.A.B., W.H.v.Z.)
| | - Puck S S Fransen
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, the Netherlands. (O.A.B., P.S.S.F., D.W.J.D.)
| | - Debbie Beumer
- Department of Neurology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands. (D.B., R.J.v.O.)
| | - Hester Lingsma
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, the Netherlands. (H.L.)
| | - Charles B M Majoie
- Radiology and Nuclear Medicine, Amsterdam University Medical Center, the Netherlands. (C.B.M.M., O.A.B.)
| | - Diederik W J Dippel
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, the Netherlands. (O.A.B., P.S.S.F., D.W.J.D.)
| | - Aad van der Lugt
- Department of Radiology, Erasmus MC University Medical Center Rotterdam, the Netherlands. (O.A.B., A.v.d.L.)
| | - Robert J van Oostenbrugge
- Department of Neurology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands. (D.B., R.J.v.O.)
| | - Wim H van Zwam
- Department of Radiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands. (O.A.B., W.H.v.Z.)
| | - Yvo B Roos
- Departments of Neurology, Amsterdam University Medical Center, the Netherlands. (L.A.v.d.B., Y.B.R.)
| | - Marcel G W Dijkgraaf
- Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam University Medical Center, the Netherlands. (M.G.W.D.)
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Boxhoorn L, van Dijk SM, van Grinsven J, Verdonk RC, Boermeester MA, Bollen TL, Bouwense SAW, Bruno MJ, Cappendijk VC, Dejong CHC, van Duijvendijk P, van Eijck CHJ, Fockens P, Francken MFG, van Goor H, Hadithi M, Hallensleben NDL, Haveman JW, Jacobs MAJM, Jansen JM, Kop MPM, van Lienden KP, Manusama ER, Mieog JSD, Molenaar IQ, Nieuwenhuijs VB, Poen AC, Poley JW, van de Poll M, Quispel R, Römkens TEH, Schwartz MP, Seerden TC, Stommel MWJ, Straathof JWA, Timmerhuis HC, Venneman NG, Voermans RP, van de Vrie W, Witteman BJ, Dijkgraaf MGW, van Santvoort HC, Besselink MG. Immediate versus Postponed Intervention for Infected Necrotizing Pancreatitis. N Engl J Med 2021; 385:1372-1381. [PMID: 34614330 DOI: 10.1056/nejmoa2100826] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [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] [Indexed: 12/12/2022]
Abstract
BACKGROUND Infected necrotizing pancreatitis is a potentially lethal disease that is treated with the use of a step-up approach, with catheter drainage often delayed until the infected necrosis is encapsulated. Whether outcomes could be improved by earlier catheter drainage is unknown. METHODS We conducted a multicenter, randomized superiority trial involving patients with infected necrotizing pancreatitis, in which we compared immediate drainage within 24 hours after randomization once infected necrosis was diagnosed with drainage that was postponed until the stage of walled-off necrosis was reached. The primary end point was the score on the Comprehensive Complication Index, which incorporates all complications over the course of 6 months of follow-up. RESULTS A total of 104 patients were randomly assigned to immediate drainage (55 patients) or postponed drainage (49 patients). The mean score on the Comprehensive Complication Index (scores range from 0 to 100, with higher scores indicating more severe complications) was 57 in the immediate-drainage group and 58 in the postponed-drainage group (mean difference, -1; 95% confidence interval [CI], -12 to 10; P = 0.90). Mortality was 13% in the immediate-drainage group and 10% in the postponed-drainage group (relative risk, 1.25; 95% CI, 0.42 to 3.68). The mean number of interventions (catheter drainage and necrosectomy) was 4.4 in the immediate-drainage group and 2.6 in the postponed-drainage group (mean difference, 1.8; 95% CI, 0.6 to 3.0). In the postponed-drainage group, 19 patients (39%) were treated conservatively with antibiotics and did not require drainage; 17 of these patients survived. The incidence of adverse events was similar in the two groups. CONCLUSIONS This trial did not show the superiority of immediate drainage over postponed drainage with regard to complications in patients with infected necrotizing pancreatitis. Patients randomly assigned to the postponed-drainage strategy received fewer invasive interventions. (Funded by Fonds NutsOhra and Amsterdam UMC; POINTER ISRCTN Registry number, ISRCTN33682933.).
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Affiliation(s)
- Lotte Boxhoorn
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Sven M van Dijk
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Janneke van Grinsven
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Robert C Verdonk
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Marja A Boermeester
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Thomas L Bollen
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Stefan A W Bouwense
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Marco J Bruno
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Vincent C Cappendijk
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Cornelis H C Dejong
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Peter van Duijvendijk
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Casper H J van Eijck
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Paul Fockens
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Michiel F G Francken
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Harry van Goor
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Muhammed Hadithi
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Nora D L Hallensleben
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Jan Willem Haveman
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Maarten A J M Jacobs
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Jeroen M Jansen
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Marnix P M Kop
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Krijn P van Lienden
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Eric R Manusama
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - J Sven D Mieog
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - I Quintus Molenaar
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Vincent B Nieuwenhuijs
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Alexander C Poen
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Jan-Werner Poley
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Marcel van de Poll
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Rutger Quispel
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Tessa E H Römkens
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Matthijs P Schwartz
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Tom C Seerden
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Martijn W J Stommel
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Jan Willem A Straathof
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Hester C Timmerhuis
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Niels G Venneman
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Rogier P Voermans
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Wim van de Vrie
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Ben J Witteman
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Marcel G W Dijkgraaf
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Hjalmar C van Santvoort
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
| | - Marc G Besselink
- From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands
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Latenstein CSS, Hannink G, van der Bilt JDW, Donkervoort SC, Eijsbouts QAJ, Heisterkamp J, Nieuwenhuijs VB, Schreinemakers JMJ, Wiering B, Boermeester MA, Drenth JPH, van Laarhoven CJHM, Dijkgraaf MGW, de Reuver PR. A Clinical Decision Tool for Selection of Patients With Symptomatic Cholelithiasis for Cholecystectomy Based on Reduction of Pain and a Pain-Free State Following Surgery. JAMA Surg 2021; 156:e213706. [PMID: 34379080 DOI: 10.1001/jamasurg.2021.3706] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance There is currently no consensus on the indication for cholecystectomy in patients with uncomplicated gallstone disease. Objective To report on the development and validation of a multivariable prediction model to better select patients for surgery. Design, Setting, and Participants This study evaluates data from 2 multicenter prospective trials (the previously published Scrutinizing (In)efficient Use of Cholecystectomy: A Randomized Trial Concerning Variation in Practice [SECURE] and the Standardized Work-up for Symptomatic Cholecystolithiasis [Success] trial) collected from the outpatient clinics of 25 Dutch hospitals between April 2014 and June 2019 and including 1561 patients with symptomatic uncomplicated cholelithiasis, defined as gallstone disease without signs of complicated cholelithiasis (ie, biliary pancreatitis, cholangitis, common bile duct stones or cholecystitis). Data were analyzed from January 2020 to June 2020. Exposures Patient characteristics, comorbidity, surgical outcomes, pain, and symptoms measured at baseline and at 6 months' follow-up. Main Outcomes and Measures A multivariable regression model to predict a pain-free state or a clinically relevant reduction in pain after surgery. Model performance was evaluated using calibration and discrimination. Results A total of 1561 patients were included (494 patients in 7 hospitals in the development cohort and 1067 patients in 24 hospitals in the validation cohort; 6 hospitals included patients in both cohorts). In the development cohort, 395 patients (80.0%) underwent cholecystectomy. After surgery, 225 patients (57.0%) reported that they were pain free and 295 (74.7%) reported a clinically relevant reduction in pain. A multivariable prediction model showed that increased age, no history of abdominal surgery, increased visual analog scale pain score at baseline, pain radiation to the back, pain reduction with simple analgesics, nausea, and no heartburn were independent predictors of clinically relevant pain reduction after cholecystectomy. After internal validation, good discrimination was found (C statistic, 0.80; 95% CI, 0.74-0.84) between patients with and without clinically relevant pain reduction. The model had very good overall calibration and minimal underestimation of the probability. External validation indicated a good discrimination between patients with and without clinically relevant pain reduction (C statistic, 0.74; 95% CI, 0.70-0.78) and fair calibration with some overestimation of probability by the model. Conclusions and Relevance The model validated in this study may help predict the probability of pain reduction after cholecystectomy and thus aid surgeons in deciding whether patients with uncomplicated cholelithiasis will benefit from cholecystectomy.
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Affiliation(s)
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | | | - Joos Heisterkamp
- Department of Surgery, Elisabeth-Tweesteden Ziekenhuis, Tilburg, the Netherlands
| | | | | | - Bastiaan Wiering
- Department of Surgery, Slingeland Ziekenhuis, Doetinchem, the Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Biostatistics and Bioinformatics, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Philip R de Reuver
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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Treskes K, Sierink JC, Edwards MJR, Beuker BJA, Van Lieshout EMM, Hohmann J, Saltzherr TP, Hollmann MW, Van Dieren S, Goslings JC, Dijkgraaf MGW. Cost-effectiveness of immediate total-body CT in patients with severe trauma (REACT-2 trial). Br J Surg 2021; 108:277-285. [PMID: 33793734 PMCID: PMC10364909 DOI: 10.1093/bjs/znaa091] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/05/2020] [Accepted: 10/22/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND The effect of immediate total-body CT (iTBCT) on health economic aspects in patients with severe trauma is an underreported issue. This study determined the cost-effectiveness of iTBCT compared with conventional radiological imaging with selective CT (standard work-up (STWU)) during the initial trauma evaluation. METHODS In this multicentre RCT, adult patients with a high suspicion of severe injury were randomized in-hospital to iTBCT or STWU. Hospital healthcare costs were determined for the first 6 months after the injury. The probability of iTBCT being cost-effective was calculated for various levels of willingness-to-pay per extra patient alive. RESULTS A total of 928 Dutch patients with complete clinical follow-up were included. Mean costs of hospital care were €25 809 (95 per cent bias-corrected and accelerated (bca) c.i. €22 617 to €29 137) for the iTBCT group and €26 155 (€23 050 to €29 344) for the STWU group, a difference per patient in favour of iTBCT of €346 (€4987 to €4328) (P = 0.876). Proportions of patients alive at 6 months were not different. The proportion of patients alive without serious morbidity was 61.6 per cent in the iTBCT group versus 66.7 per cent in the STWU group (difference -5.1 per cent; P = 0.104). The probability of iTBCT being cost-effective in keeping patients alive remained below 0.56 for the whole group, but was higher in patients with multiple trauma (0.8-0.9) and in those with traumatic brain injury (more than 0.9). CONCLUSION Economically, from a hospital healthcare provider perspective, iTBCT should be the diagnostic strategy of first choice in patients with multiple trauma or traumatic brain injury.
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Affiliation(s)
- K Treskes
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, Location AMC, Amsterdam, the Netherlands
| | - J C Sierink
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, Location AMC, Amsterdam, the Netherlands
| | - M J R Edwards
- Trauma Unit, Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - B J A Beuker
- Trauma Unit, Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - E M M Van Lieshout
- Trauma Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - J Hohmann
- Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - T P Saltzherr
- Department of Surgery, Haaglanden Medical Centre, Den Haag, the Netherlands
| | - M W Hollmann
- Department of Anaesthesiology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - S Van Dieren
- Department of Surgery, Amsterdam University Medical Centre, Location AMC, Amsterdam, the Netherlands
| | - J C Goslings
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, Location AMC, Amsterdam, the Netherlands.,Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - M G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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Verstraelen TE, van Barreveld M, van Dessel PHFM, Boersma LVA, Delnoy PPPHM, Tuinenburg AE, Theuns DAMJ, van der Voort PH, Kimman GP, Buskens E, Hulleman M, Allaart CP, Strikwerda S, Scholten MF, Meine M, Abels R, Maass AH, Firouzi M, Widdershoven JWMG, Elders J, van Gent MWF, Khan M, Vernooy K, Grauss RW, Tukkie R, van Erven L, Spierenburg HAM, Brouwer MA, Bartels GL, Bijsterveld NR, Borger van der Burg AE, Vet MW, Derksen R, Knops RE, Bracke FALE, Harden M, Sticherling C, Willems R, Friede T, Zabel M, Dijkgraaf MGW, Zwinderman AH, Wilde AAM. Development and external validation of prediction models to predict implantable cardioverter-defibrillator efficacy in primary prevention of sudden cardiac death. Europace 2021; 23:887-897. [PMID: 33582797 PMCID: PMC8184225 DOI: 10.1093/europace/euab012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 09/03/2020] [Accepted: 01/08/2021] [Indexed: 11/24/2022] Open
Abstract
Aims This study was performed to develop and externally validate prediction models for appropriate implantable cardioverter-defibrillator (ICD) shock and mortality to identify subgroups with insufficient benefit from ICD implantation. Methods and results We recruited patients scheduled for primary prevention ICD implantation and reduced left ventricular function. Bootstrapping-based Cox proportional hazards and Fine and Gray competing risk models with likely candidate predictors were developed for all-cause mortality and appropriate ICD shock, respectively. Between 2014 and 2018, we included 1441 consecutive patients in the development and 1450 patients in the validation cohort. During a median follow-up of 2.4 (IQR 2.1–2.8) years, 109 (7.6%) patients received appropriate ICD shock and 193 (13.4%) died in the development cohort. During a median follow-up of 2.7 (IQR 2.0–3.4) years, 105 (7.2%) received appropriate ICD shock and 223 (15.4%) died in the validation cohort. Selected predictors of appropriate ICD shock were gender, NSVT, ACE/ARB use, atrial fibrillation history, Aldosterone-antagonist use, Digoxin use, eGFR, (N)OAC use, and peripheral vascular disease. Selected predictors of all-cause mortality were age, diuretic use, sodium, NT-pro-BNP, and ACE/ARB use. C-statistic was 0.61 and 0.60 at respectively internal and external validation for appropriate ICD shock and 0.74 at both internal and external validation for mortality. Conclusion Although this cohort study was specifically designed to develop prediction models, risk stratification still remains challenging and no large group with insufficient benefit of ICD implantation was found. However, the prediction models have some clinical utility as we present several scenarios where ICD implantation might be postponed.
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Affiliation(s)
- Tom E Verstraelen
- Department of Cardiology, Amsterdam UMC, Location AMC, University of Amsterdam, Heart Center, Amsterdam, the Netherlands
| | - Marit van Barreveld
- Department of Cardiology, Amsterdam UMC, Location AMC, University of Amsterdam, Heart Center, Amsterdam, the Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bio-informatics, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Pascal H F M van Dessel
- Department of Cardiology, Thorax Center Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Lucas V A Boersma
- Department of Cardiology, Amsterdam UMC, Location AMC, University of Amsterdam, Heart Center, Amsterdam, the Netherlands.,Cardiology Department, St. Antonius Ziekenhuis Nieuwegein, the Netherlands
| | | | - Anton E Tuinenburg
- Division of Heart and Lungs, Department of Cardiology, University Medical Centre, Utrecht, the Netherlands
| | | | | | - Gerardus P Kimman
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Erik Buskens
- Department of Epidemiology, University Medical Centre Groningen, Groningen, the Netherlands
| | - Michiel Hulleman
- Department of Cardiology, Amsterdam UMC, Location AMC, University of Amsterdam, Heart Center, Amsterdam, the Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Location VUMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Sipke Strikwerda
- Department of Cardiology, Amphia Hospitals, Breda, the Netherlands
| | - Marcoen F Scholten
- Department of Cardiology, Thorax Center Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Mathias Meine
- Division of Heart and Lungs, Department of Cardiology, University Medical Centre, Utrecht, the Netherlands
| | - René Abels
- Department of Cardiology, Haga hospitals, the Hague, the Netherlands
| | - Alexander H Maass
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Mehran Firouzi
- Department of Cardiology, Maasstad hospital, Rotterdam, the Netherlands
| | - Jos W M G Widdershoven
- Department of Cardiology, Elisabeth Tweesteden Hospital Tilburg, Tilburg, the Netherlands
| | - Jan Elders
- Department of Cardiology, Canisius Wilhelmina hospital, Nijmegen, the Netherlands
| | - Marco W F van Gent
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Muchtiar Khan
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Robert W Grauss
- Department of Cardiology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Raymond Tukkie
- Department of Cardiology, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Lieselot van Erven
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Han A M Spierenburg
- Department of Cardiology, Sint Franciscus Vlietland Group, Schiedam, the Netherlands
| | - Marc A Brouwer
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gerard L Bartels
- Department of Cardiology, Martini hospital, Groningen, the Netherlands
| | | | | | - Mattheus W Vet
- Department of Cardiology, Scheper Hospital, Emmen, the Netherlands
| | - Richard Derksen
- Department of Cardiology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Reinoud E Knops
- Department of Cardiology, Amsterdam UMC, Location AMC, University of Amsterdam, Heart Center, Amsterdam, the Netherlands
| | - Frank A L E Bracke
- Department of Cardiology, Catharina Ziekenhuis Eindhoven, Eindhoven, the Netherlands
| | - Markus Harden
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany and DZHK (German Center for Cardiovascular Research), Partnersite, Göttingen, Germany
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Rik Willems
- Department of Cardiovascular Sciences, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany and DZHK (German Center for Cardiovascular Research), Partnersite, Göttingen, Germany
| | - Markus Zabel
- Department of Cardiology and Pneumology-Heart Center, University of Göttingen Medical Center, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), Partner site, Göttingen, Germany
| | - Marcel G W Dijkgraaf
- Department of Clinical Epidemiology, Biostatistics and Bio-informatics, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology, Biostatistics and Bio-informatics, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Amsterdam UMC, Location AMC, University of Amsterdam, Heart Center, Amsterdam, the Netherlands
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Latenstein CSS, van Dijk AH, Wennmacker SZ, Drenth JPH, Westert GP, van Laarhoven CJHM, Boermeester MA, Dijkgraaf MGW, de Reuver PR. Budget Impact of Restrictive Strategy Versus Usual Care for Cholecystectomy (SECURE-trial). J Surg Res 2021; 268:59-70. [PMID: 34284321 DOI: 10.1016/j.jss.2021.06.033] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/03/2021] [Accepted: 06/10/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES A cost-effectiveness analysis of a multicenter randomized-controlled trial comparing restrictive strategy versus usual care in patients with gallstones showed that savings by restrictive strategy could not compensate for the lower proportion of pain-free patients. However, four subgroups based on combined stratification factors resulted in less cholecystectomies and more pain-free patients in restrictive strategy (female-low volume-BMI > 30, female-low volume-BMI25-30, female-high volume-BMI25-30, and male-low volume-BMI < 25). The aim of this study was to explore the budget impact from a hospital healthcare perspective of implementation of restrictive strategy in these subgroups. METHODS Data of the SECURE-trial were used to calculate the hospital budget impact with a time horizon of four years. Based on a study into practice variation, about 19% of hospitals treat patients according restrictive strategy. This represents the proportion of patients treated according restrictive strategy at the start of budget period. Three subanalyses were performed: a scenario analysis in which 30% of patients fall under a restrictive strategy in clinical practice, a sensitivity analysis in which we calculated the budget impact with the low and high 95% confidence limits of the expected future number of patients, a subgroup analysis in which restrictive strategy was also implemented in two additional subgroups (male-high volume-BMI < 25 and female-high volume-BMI >30). RESULTS Budget impact analysis showed savings of €6.7-€15.6 million (2.2%-5.6%) for the period 2021-2024/2025 by implementing the restrictive strategy in the four subgroups and provision of usual care in other patients. Sensitivity analysis with 30% of patients already in the restrictive strategy at the start of the budget period, resulted in savings between €5.4 million and €14.0 million (1.7%-5.0%). CONCLUSION Performing a restrictive strategy for selection of cholecystectomy in subgroups of patients and provision of usual care in other patients will result in a lower overall hospital budget needed to treat patients with abdominal pain and gallstones. TRIAL REGISTRATION The Netherlands National Trial Register NTR4022. Registered on June 5, 2013.
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Affiliation(s)
- Carmen S S Latenstein
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands.
| | - Aafke H van Dijk
- Department of Surgery, Amsterdam UMC - University of Amsterdam, Amsterdam, the Netherlands, the Netherlands
| | - Sarah Z Wennmacker
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Gert P Westert
- IQ healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - Marja A Boermeester
- Department of Surgery, Amsterdam UMC - University of Amsterdam, Amsterdam, the Netherlands, the Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam UMC - University of Amsterdam, Amsterdam, the Netherlands
| | - Philip R de Reuver
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands.
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38
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Rovers KP, Bakkers C, Nienhuijs SW, Burger JWA, Creemers GJM, Thijs AMJ, Brandt-Kerkhof ARM, Madsen EVE, van Meerten E, Tuynman JB, Kusters M, Versteeg KS, Aalbers AGJ, Kok NFM, Buffart TE, Wiezer MJ, Boerma D, Los M, de Reuver PR, Bremers AJA, Verheul HMW, Kruijff S, de Groot DJA, Witkamp AJ, van Grevenstein WMU, Koopman M, Nederend J, Lahaye MJ, Kranenburg O, Fijneman RJA, van 't Erve I, Snaebjornsson P, Hemmer PHJ, Dijkgraaf MGW, Punt CJA, Tanis PJ, de Hingh IHJT. Perioperative Systemic Therapy vs Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Alone for Resectable Colorectal Peritoneal Metastases: A Phase 2 Randomized Clinical Trial. JAMA Surg 2021; 156:710-720. [PMID: 34009291 DOI: 10.1001/jamasurg.2021.1642] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Importance To date, no randomized clinical trials have investigated perioperative systemic therapy relative to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) alone for resectable colorectal peritoneal metastases (CPM). Objective To assess the feasibility and safety of perioperative systemic therapy in patients with resectable CPM and the response of CPM to neoadjuvant treatment. Design, Setting, and Participants An open-label, parallel-group phase 2 randomized clinical trial in all 9 Dutch tertiary centers for the surgical treatment of CPM enrolled participants between June 15, 2017, and January 9, 2019. Participants were patients with pathologically proven isolated resectable CPM who did not receive systemic therapy within 6 months before enrollment. Interventions Randomization to perioperative systemic therapy or CRS-HIPEC alone. Perioperative systemic therapy comprised either four 3-week neoadjuvant and adjuvant cycles of CAPOX (capecitabine and oxaliplatin), six 2-week neoadjuvant and adjuvant cycles of FOLFOX (fluorouracil, leucovorin, and oxaliplatin), or six 2-week neoadjuvant cycles of FOLFIRI (fluorouracil, leucovorin, and irinotecan) and either four 3-week adjuvant cycles of capecitabine or six 2-week adjuvant cycles of fluorouracil with leucovorin. Bevacizumab was added to the first 3 (CAPOX) or 4 (FOLFOX/FOLFIRI) neoadjuvant cycles. Main Outcomes and Measures Proportions of macroscopic complete CRS-HIPEC and Clavien-Dindo grade 3 or higher postoperative morbidity. Key secondary outcomes were centrally assessed rates of objective radiologic and major pathologic response of CPM to neoadjuvant treatment. Analyses were done modified intention-to-treat in patients starting neoadjuvant treatment (experimental arm) or undergoing upfront surgery (control arm). Results In 79 patients included in the analysis (43 [54%] men; mean [SD] age, 62 [10] years), experimental (n = 37) and control (n = 42) arms did not differ significantly regarding the proportions of macroscopic complete CRS-HIPEC (33 of 37 [89%] vs 36 of 42 [86%] patients; risk ratio, 1.04; 95% CI, 0.88-1.23; P = .74) and Clavien-Dindo grade 3 or higher postoperative morbidity (8 of 37 [22%] vs 14 of 42 [33%] patients; risk ratio, 0.65; 95% CI, 0.31-1.37; P = .25). No treatment-related deaths occurred. Objective radiologic and major pathologic response rates of CPM to neoadjuvant treatment were 28% (9 of 32 evaluable patients) and 38% (13 of 34 evaluable patients), respectively. Conclusions and Relevance In this randomized phase 2 trial in patients diagnosed with resectable CPM, perioperative systemic therapy seemed feasible, safe, and able to induce response of CPM, justifying a phase 3 trial. Trial Registration ClinicalTrials.gov Identifier: NCT02758951.
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Affiliation(s)
- Koen P Rovers
- Department of Surgery, Catharina Cancer Institute, Eindhoven, the Netherlands
| | - Checca Bakkers
- Department of Surgery, Catharina Cancer Institute, Eindhoven, the Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Cancer Institute, Eindhoven, the Netherlands
| | - Jacobus W A Burger
- Department of Surgery, Catharina Cancer Institute, Eindhoven, the Netherlands
| | - Geert-Jan M Creemers
- Department of Medical Oncology, Catharina Cancer Institute, Eindhoven, the Netherlands
| | - Anna M J Thijs
- Department of Medical Oncology, Catharina Cancer Institute, Eindhoven, the Netherlands
| | | | - Eva V E Madsen
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Esther van Meerten
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Jurriaan B Tuynman
- Department of Surgery, Amsterdam University Medical Centers, location VUMC, Amsterdam, the Netherlands
| | - Miranda Kusters
- Department of Surgery, Amsterdam University Medical Centers, location VUMC, Amsterdam, the Netherlands
| | - Kathelijn S Versteeg
- Department of Medical Oncology, Amsterdam University Medical Centers, location VUMC, Amsterdam, the Netherlands
| | - Arend G J Aalbers
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Niels F M Kok
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Tineke E Buffart
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Marinus J Wiezer
- Department of Surgery, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Djamila Boerma
- Department of Surgery, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Maartje Los
- Department of Medical Oncology, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Philip R de Reuver
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Andreas J A Bremers
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Henk M W Verheul
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Schelto Kruijff
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Derk Jan A de Groot
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Arjen J Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Joost Nederend
- Department of Radiology, Catharina Cancer Institute, Eindhoven, the Netherlands
| | - Max J Lahaye
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Onno Kranenburg
- Cancer Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Remond J A Fijneman
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Iris van 't Erve
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Petur Snaebjornsson
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Patrick H J Hemmer
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Cornelis J A Punt
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Pieter J Tanis
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Ignace H J T de Hingh
- Department of Surgery, Catharina Cancer Institute, Eindhoven, the Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
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Bousema JE, Aarts MJ, Dijkgraaf MGW, Annema JT, van den Broek FJC. Trends in mediastinal nodal staging and its impact on unforeseen N2 and survival in lung cancer. Eur Respir J 2021; 57:13993003.01549-2020. [PMID: 33008940 DOI: 10.1183/13993003.01549-2020] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 09/22/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Guidelines for invasive mediastinal nodal staging in resectable nonsmall cell lung cancer (NSCLC) have changed over the years. The aims of this study were to describe trends in invasive staging and unforeseen N2 (uN2) and to assess a potential effect on overall survival. METHODS A nationwide Dutch cohort study included all clinical stage IA-IIIB NSCLC patients primarily treated by surgical resection between 2005 and 2017 (n=22 555). We assessed trends in invasive nodal staging (mediastinoscopy 2005-2017; endosonography 2011-2017), uN2 and overall survival and compared outcomes in the entire group and in clinical nodal stage (cN)1-3 patients with or without invasive staging. RESULTS An overall increase in invasive nodal staging from 26% in 2005 to 40% in 2017 was found (p<0.01). Endosonography increased from 19% in 2011 to 32% in 2017 (p<0.01), while mediastinoscopy decreased from 24% in 2011 to 21% in 2017 (p=0.08). Despite these changes, uN2 was stable over the years at 8.7%. 5-year overall survival rate was 41% for pN1 compared to 37% in single node uN2 (p=0.18) and 26% with more than one node uN2 (p<0.01). 5-year overall survival rate of patients with cN1-3 with invasive staging was 44% versus 39% in patients without invasive staging (p=0.12). CONCLUSION A significant increase in invasive mediastinal nodal staging in patients with resectable NSCLC was found between 2011 and 2017 in the Netherlands. Increasing use of less invasive endosonography prior to (or as a substitute for) surgical staging did not lead to more cases of uN2. Performance of invasive staging indicated a possible overall survival benefit in patients with cN1-3 disease.
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Affiliation(s)
| | - Mieke J Aarts
- Dept of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Marcel G W Dijkgraaf
- Dept of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jouke T Annema
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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40
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van Barreveld M, Verstraelen TE, van Dessel PFHM, Boersma LVA, Delnoy PPHM, Tuinenburg AE, Theuns DAMJ, van der Voort PH, Kimman GJ, Buskens E, Zwinderman AH, Wilde AAM, Dijkgraaf MGW. Dutch Outcome in Implantable Cardioverter-Defibrillator Therapy: Implantable Cardioverter-Defibrillator-Related Complications in a Contemporary Primary Prevention Cohort. J Am Heart Assoc 2021; 10:e018063. [PMID: 33787324 PMCID: PMC8174382 DOI: 10.1161/jaha.120.018063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/17/2022]
Abstract
Background One third of primary prevention implantable cardioverter‐defibrillator patients receive appropriate therapy, but all remain at risk of defibrillator complications. Information on these complications in contemporary cohorts is limited. This study assessed complications and their risk factors after defibrillator implantation in a Dutch nationwide prospective registry cohort and forecasts the potential reduction in complications under distinct scenarios of updated indication criteria. Methods and Results Complications in a prospective multicenter registry cohort of 1442 primary implantable cardioverter‐defibrillator implant patients were classified as major or minor. The potential for reducing complications was derived from a newly developed prediction model of appropriate therapy to identify patients with a low probability of benefitting from the implantable cardioverter‐defibrillator. During a follow‐up of 2.2 years (interquartile range, 2.0–2.6 years), 228 complications occurred in 195 patients (13.6%), with 113 patients (7.8%) experiencing at least one major complication. Most common ones were lead related (n=93) and infection (n=18). Minor complications occurred in 6.8% of patients, with lead‐related (n=47) and pocket‐related (n=40) complications as the most prevailing ones. A surgical reintervention or additional hospitalization was required in 53% or 61% of complications, respectively. Complications were strongly associated with device type. Application of stricter implant indication results in a comparable proportional reduction of (major) complications. Conclusions One in 13 patients experiences at least one major implantable cardioverter‐defibrillator–related complication, and many patients undergo a surgical reintervention. Complications are related to defibrillator implantations, and these should be discussed with the patient. Stricter implant indication criteria and careful selection of device type implanted may have significant clinical and financial benefits.
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Affiliation(s)
- Marit van Barreveld
- Department of Cardiology, Heart Center Amsterdam UMC, University of Amsterdam the Netherlands.,Department of Epidemiology and Data Science Amsterdam UMC, University of Amsterdam the Netherlands
| | - Tom E Verstraelen
- Department of Cardiology, Heart Center Amsterdam UMC, University of Amsterdam the Netherlands
| | - Pascal F H M van Dessel
- Department of Cardiology, Thorax Center Twente Medisch Spectrum Twente Enschede the Netherlands
| | - Lucas V A Boersma
- Department of Cardiology, Heart Center Amsterdam UMC, University of Amsterdam the Netherlands.,Cardiology Department St. Antonius Ziekenhuis Nieuwegein Nieuwegein the Netherlands
| | | | - Anton E Tuinenburg
- Division of Heart and Lungs Department of Cardiology University Medical Centre Utrecht the Netherlands
| | | | | | - Geert-Jan Kimman
- Department of Cardiology Noordwest Ziekenhuisgroep Alkmaar the Netherlands
| | - Erik Buskens
- Department of Epidemiology University Medical Centre Groningen Groningen the Netherlands
| | - Aeilko H Zwinderman
- Department of Epidemiology and Data Science Amsterdam UMC, University of Amsterdam the Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Heart Center Amsterdam UMC, University of Amsterdam the Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science Amsterdam UMC, University of Amsterdam the Netherlands
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41
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Bousema JE, Annema JT, van der Heijden EHFM, Verhagen AFTM, Dijkgraaf MGW, van den Broek FJC. MEDIASTinal staging of non-small cell lung cancer by endobronchial and endoscopic ultrasonography with or without additional surgical mediastinoscopy (MEDIASTrial): a statistical analysis plan. Trials 2021; 22:168. [PMID: 33639999 PMCID: PMC7913384 DOI: 10.1186/s13063-021-05127-6] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/11/2021] [Indexed: 12/26/2022] Open
Abstract
Background Invasive mediastinal nodal staging is recommended by guidelines in selected patients with resectable non-small cell lung cancer (NSCLC). Endosonography is recommended as initial staging technique, followed by confirmatory mediastinoscopy in case of negative N2 or N3 cytology after endosonography. Confirmatory mediastinoscopy however is under debate owing its limited additional diagnostic value, its associated morbidity and its delay in the start of lung cancer treatment. The MEDIASTrial examines whether confirmatory mediastinoscopy can be safely omitted after negative endosonography in mediastinal nodal staging of NSCLC. The present work is the proposed statistical analysis plan of the clinical consequences of omitting mediastinoscopy, which is submitted before closure of the MEDIASTrial and before knowledge of any results was done to enhance transparency of scientific behaviour. Methods The primary outcome measure of this non-inferiority trial will be unforeseen N2 disease resulting from lobe-specific mediastinal lymph node dissection. For non-inferiority, the upper limit of the 95% confidence interval of the unforeseen N2 rate in the group without mediastinoscopy should not exceed 14.3% in order to probably have no negative impact on survival. Since this is a non-inferiority trial, both an intention to treat (ITT) and a per protocol (PP) analyses will be done. The ITT and the PP analyses should both indicate non-inferiority before the diagnostic strategy omitting mediastinoscopy will be interpreted as non-inferior to the strategy with mediastinoscopy. Secondary outcome measures include 30-day major morbidity and mortality, the total number of days of hospital care, overall and disease free 2-year survival, generic and disease-specific health related quality of life and cost-effectiveness and cost-utility of staging strategies with and without mediastinoscopy. Discussion The MEDIASTrial will determine if confirmatory mediastinoscopy can be omitted after tumour negative systematic endosonography in invasive mediastinal staging of patients with resectable NSCLC. Trial registration Netherlands Trial Register NL6344/NTR6528. Registered on 2017 July 06 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05127-6.
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Affiliation(s)
- Jelle E Bousema
- Department of Surgery, Máxima MC, Veldhoven, PO BOX 7777, 5500 MB, Veldhoven, The Netherlands.
| | - Jouke T Annema
- Department of Respiratory Medicine, Amsterdam University Medical Centre, University of Amsterdam, PO BOX 22700, 1100 DE, Amsterdam, The Netherlands
| | - Erik H F M van der Heijden
- Department of Pulmonary Medicine, Radboud University Medical Centre, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands
| | - Ad F T M Verhagen
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam University Medical Centre, University of Amsterdam, PO BOX 22700, 1100 DE, Amsterdam, The Netherlands
| | - Frank J C van den Broek
- Department of Surgery, Máxima MC, Veldhoven, PO BOX 7777, 5500 MB, Veldhoven, The Netherlands.
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van Voorst H, Kunz WG, van den Berg LA, Kappelhof M, Pinckaers FME, Goyal M, Hunink MGM, Emmer BJ, Mulder MJHL, Dippel DWJ, Coutinho JM, Marquering HA, Boogaarts HD, van der Lugt A, van Zwam WH, Roos YBWEM, Buskens E, Dijkgraaf MGW, Majoie CBLM. Quantified health and cost effects of faster endovascular treatment for large vessel ischemic stroke patients in the Netherlands. J Neurointerv Surg 2021; 13:1099-1105. [PMID: 33479037 PMCID: PMC8606465 DOI: 10.1136/neurintsurg-2020-017017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 10/22/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 12/04/2022]
Abstract
Background The effectiveness of endovascular treatment (EVT) for large vessel occlusion (LVO) stroke severely depends on time to treatment. However, it remains unclear what the value of faster treatment is in the years after index stroke. The aim of this study was to quantify the value of faster EVT in terms of health and healthcare costs for the Dutch LVO stroke population. Methods A Markov model was used to simulate 5-year follow-up functional outcome, measured with the modified Rankin Scale (mRS), of 69-year-old LVO patients. Post-treatment mRS was extracted from the MR CLEAN Registry (n=2892): costs per unit of time and Quality-Adjusted Life Years (QALYs) per mRS sub-score were retrieved from follow-up data of the MR CLEAN trial (n=500). Net Monetary Benefit (NMB) at a willingness to pay of €80 000 per QALY was reported as primary outcome, and secondary outcome measures were days of disability-free life gained and costs. Results EVT administered 1 min faster resulted in a median NMB of €309 (IQR: 226;389), 1.3 days of additional disability-free life (IQR: 1.0;1.6), while cumulative costs remained largely unchanged (median: -€15, IQR: −65;33) over a 5-year follow-up period. As costs over the follow-up period remained stable while QALYs decreased with longer time to treatment, which this results in a near-linear decrease of NMB. Since patients with faster EVT lived longer, they incurred more healthcare costs. Conclusion One-minute faster EVT increases QALYs while cumulative costs remain largely unaffected. Therefore, faster EVT provides better value of care at no extra healthcare costs.
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Affiliation(s)
- Henk van Voorst
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands .,Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Münich, Germany
| | - Lucie A van den Berg
- Department of Neurology, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Manon Kappelhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Floor M E Pinckaers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mayank Goyal
- Department of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Myriam G M Hunink
- Department of Clinical Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Departments of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Bart J Emmer
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Maxim J H L Mulder
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Diederik W J Dippel
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk A Marquering
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hieronymus D Boogaarts
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Aad van der Lugt
- Departments of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Wim H van Zwam
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Yvo B W E M Roos
- Department of Neurology, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Erik Buskens
- Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands
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Beijnink CWH, Thim T, van der Heijden DJ, Klem I, Al-Lamee R, Vos JL, Koop Y, Dijkgraaf MGW, Beijk MAM, Kim RJ, Davies J, Raposo L, Baptista SB, Escaned J, Piek JJ, Maeng M, van Royen N, Nijveldt R. Instantaneous wave-free ratio guided multivessel revascularisation during percutaneous coronary intervention for acute myocardial infarction: study protocol of the randomised controlled iMODERN trial. BMJ Open 2021; 11:e044035. [PMID: 33452200 PMCID: PMC7813313 DOI: 10.1136/bmjopen-2020-044035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Recent randomised clinical trials showed benefit of non-culprit lesion revascularisation in ST-elevation myocardial infarction (STEMI) patients. However, it remains unclear whether revascularisation should be performed at the index procedure or at a later stage. METHODS AND ANALYSIS The instantaneous wave-free ratio (iFR) Guided Multivessel Revascularisation During Percutaneous Coronary Intervention for Acute Myocardial Infarction trial is a multicentre, randomised controlled prospective open-label trial with blinded evaluation of endpoints. After successful primary percutaneous coronary intervention (PCI), eligible STEMI patients with residual non-culprit lesions are randomised, to instantaneous wave-free ratio guided treatment of non-culprit lesions during the index procedure versus deferred cardiac MR-guided management within 4 days to 6 weeks. The primary endpoint of the study is the combined occurrence of all-cause death, recurrent myocardial infarction and hospitalisation for heart failure at 12 months follow-up. Clinical follow-up includes questionnaires at 3 months and outpatient visits at 6 months and 12 months after primary PCI. Furthermore, a cost-effectiveness analysis will be performed. ETHICS AND DISSEMINATION Permission to conduct this trial has been granted by the Medical Ethical Committee of the Amsterdam University Medical Centres (loc. VUmc, ID NL60107.029.16). The primary results of this trial will be shared in a main article and subgroup analyses or spin-off studies will be shared in secondary papers. TRIAL REGISTRATION NUMBER NCT03298659.
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Affiliation(s)
| | - Troels Thim
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Igor Klem
- Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Rasha Al-Lamee
- Cardiology, Imperial College London Faculty of Medicine, London, UK
| | | | - Yvonne Koop
- Cardiology, Radboudumc, Nijmegen, The Netherlands
| | - Marcel G W Dijkgraaf
- Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
| | - Marcel A M Beijk
- Cardiology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Raymond J Kim
- Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Justin Davies
- Faculty of Medicine, Imperial College London, London, UK
| | - Luis Raposo
- Cardiology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | | | - Javier Escaned
- Interventional Cardiology, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Jan J Piek
- Cardiology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
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Bousema JE, Hoeijmakers F, Dijkgraaf MGW, Annema JT, van den Broek FJC, van den Akker-van Marle ME. Patients' Preferences Regarding Invasive Mediastinal Nodal Staging of Resectable Lung Cancer. Patient Prefer Adherence 2021; 15:2185-2196. [PMID: 34588768 PMCID: PMC8473019 DOI: 10.2147/ppa.s319790] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/06/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Variability in practice and ongoing debate on optimal invasive mediastinal staging of patients with resectable non-small cell lung cancer (NSCLC) are widely described in the literature. Patients' preferences on this topic have, however, been underexposed so far. METHODS An internet-based questionnaire was distributed among MEDIASTrial participants (NTR6528, randomization of patients to mediastinoscopy or not in the case of negative endosonography). Literature, expert opinion and patient interviews resulted in five attributes: the risk of a futile lung resection (oncologically futile in case of unforeseen N2 disease), the length of the staging period, resection of the primary tumor, complications of staging procedures and the mediastinoscopy scar. The relative importance (RI) of each attribute was assessed by using adaptive conjoint analysis and hierarchical Bayes estimation. A treatment trade-off was used to examine the acceptable proportion of avoided futile lung resections to cover the burden of confirmatory mediastinoscopy. RESULTS Ninety-seven patients completed the questionnaire (57%). The length of the staging period was significantly the most important attribute (RI 26.24; 95% CI: 25.05-27.43), followed by the risk of a futile surgical lung resection (RI 23.44; 95% CI: 22.28-24.60) and resection of the primary tumor (RI 22.21; 95% CI: 21.09-23.33). Avoidance of 7% (IQR 1- >14%) futile lung resections would cover the burden of confirmatory mediastinoscopy, with a dichotomy among patients always (39%) or never (38%) willing to undergo confirmatory mediastinoscopy after N2 and N3-negative endosonography. CONCLUSION Although a strong dichotomy among patients always or never willing to undergo confirmatory mediastinoscopy was found, the length of the staging period was the most important attribute in invasive mediastinal staging according to patients with resectable NSCLC. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Jelle E Bousema
- Department of Surgery, Máxima MC, Veldhoven, 5500 MB, the Netherlands
| | - Fieke Hoeijmakers
- Department of Surgery, Leiden University Medical Center, Leiden, 2300 RC, the Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, 1100 DE, the Netherlands
| | - Jouke T Annema
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, 1100 DE, the Netherlands
| | - Frank J C van den Broek
- Department of Surgery, Máxima MC, Veldhoven, 5500 MB, the Netherlands
- Correspondence: Frank JC van den Broek Department of Surgery, Máxima MC, Veldhoven, P.O. BOX 7777, Veldhoven, 5500 MB, the Netherlands Email
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45
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de Wit K, Schaapman JJ, Nevens F, Verbeek J, Coenen S, Cuperus FJC, Kramer M, Tjwa ETTL, Mostafavi N, Dijkgraaf MGW, van Delden OM, Beuers UHW, Coenraad MJ, Takkenberg RB. Prevention of hepatic encephalopathy by administration of rifaximin and lactulose in patients with liver cirrhosis undergoing placement of a transjugular intrahepatic portosystemic shunt (TIPS): a multicentre randomised, double blind, placebo controlled trial (PEARL trial). BMJ Open Gastroenterol 2020; 7:bmjgast-2020-000531. [PMID: 33372103 PMCID: PMC7783616 DOI: 10.1136/bmjgast-2020-000531] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 08/28/2020] [Revised: 11/12/2020] [Accepted: 11/26/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction Cirrhotic patients with portal hypertension can suffer from variceal bleeding or refractory ascites and can benefit from a transjugular intrahepatic portosystemic shunt (TIPS). Post-TIPS hepatic encephalopathy (HE) is a common (20%–54%) and often severe complication. A prophylactic strategy is lacking. Methods and analysis The Prevention of hepatic Encephalopathy by Administration of Rifaximin and Lactulose in patients with liver cirrhosis undergoing placement of a TIPS (PEARL) trial, is a multicentre randomised, double blind, placebo controlled trial. Patients undergoing covered TIPS placement are prescribed either rifaximin 550 mg two times per day and lactulose 25 mL two times per day (starting dose) or placebo 550 mg two times per day and lactulose 25 mL two times per day from 72 hours before and until 3 months after TIPS placement. Primary endpoint is the development of overt HE (OHE) within 3 months (according to West Haven criteria). Secondary endpoints include 90-day mortality; development of a second episode of OHE; time to development of episode(s) of OHE; development of minimal HE; molecular changes in peripheral and portal blood samples; quality of life and cost-effectiveness. The total sample size is 238 patients and recruitment period is 3 years in six hospitals in the Netherlands and one in Belgium. Ethics and dissemination This study protocol was approved in the Netherlands by the Medical Research Ethics Committee of the Academic Medical Centre, Amsterdam (2018-332), in Belgium by the Ethics Committee Research UZ/KU Leuven (S62577) and competent authorities. This study will be conducted in accordance with Good Clinical Practice guidelines and the principles of the Declaration of Helsinki. Study results will be submitted for publication in a peer-reviewed journal. Trial registration numbers ClinicalTrials.gov (NCT04073290) and EudraCT database (2018-004323-37).
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Affiliation(s)
- K de Wit
- Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - J J Schaapman
- Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - F Nevens
- Gastroenterology and Hepatology, University Hospitals KU Leuven, Leuven, Belgium
| | - J Verbeek
- Gastroenterology and Hepatology, University Hospitals KU Leuven, Leuven, Belgium
| | - S Coenen
- Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - F J C Cuperus
- Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands
| | - M Kramer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - E T T L Tjwa
- Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - N Mostafavi
- Biostatistics Unit, Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - M G W Dijkgraaf
- Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - O M van Delden
- Interventional Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - U H W Beuers
- Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - M J Coenraad
- Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - R B Takkenberg
- Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
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van Munster KN, Dijkgraaf MGW, van Gennep S, Beuers U, Ponsioen CY. The Simple Cholestatic Complaints Score is a valid and quick patient-reported outcome measure in primary sclerosing cholangitis. Liver Int 2020; 40:2758-2766. [PMID: 32841496 PMCID: PMC7702029 DOI: 10.1111/liv.14644] [Citation(s) in RCA: 4] [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: 03/09/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Measuring symptoms and disease burden in patients with primary sclerosing cholangitis (PSC) is increasingly important for daily practice and clinical trials. The Simple Cholestatic Complaints Score (SCCS) is a four-item questionnaire, that measures cholestatic symptoms (pruritus, fatigue, RUQ abdominal pain and fever) in PSC patients. The aim of this study was to evaluate reliability and validity of SCCS in a Dutch population. METHODS The study population consisted of 212 patients from the Dutch prospective PSC registry. Data were collected via digital surveys. Reliability was evaluated by internal consistency and reproducibility. Construct-, criterion- and discriminant validity were determined. The ability to detect clinical change with SCCS was evaluated in patients who underwent endoscopic intervention. Simple Cholestatic Complaints Score collected by email and by a mobile application were compared. RESULTS A total of 153 patients completed the questionnaire. Internal consistency was moderate and increased to 0.71 after removal of the fever item. Test-re-test reproducibility was high (intraclass correlation coefficient = 0.96). Criterion validity was good (all > 0.82). Construct validity was in line with a priori hypothesized correlations in 80%. SCCS was able to differentiate between clinically different groups. There was no difference between inflammatory bowel disease (IBD) and non-IBD patients. Simple Cholestatic Complaints Score was responsive to change after endoscopic intervention in successfully treated patients. Simple Cholestatic Complaints Score measurement by digital questionnaire and a mobile application was comparable. CONCLUSION The SCCS is a valid instrument to measure cholestatic symptoms in PSC patients. Because of its quick and easy to use properties it is suitable for frequent monitoring of symptoms in clinical trials and daily practice.
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Affiliation(s)
- Kim N. van Munster
- Department of Gastroenterology and HepatologyAmsterdam University Medical Centerslocation AMCAmsterdam Gastroenterology & MetabolismAmsterdamThe Netherlands
| | - Marcel G. W. Dijkgraaf
- Department of Epidemiology and Data ScienceAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Sara van Gennep
- Department of Gastroenterology and HepatologyAmsterdam University Medical Centerslocation AMCAmsterdam Gastroenterology & MetabolismAmsterdamThe Netherlands
| | - Ulrich Beuers
- Department of Gastroenterology and HepatologyAmsterdam University Medical Centerslocation AMCAmsterdam Gastroenterology & MetabolismAmsterdamThe Netherlands
| | - Cyriel Y. Ponsioen
- Department of Gastroenterology and HepatologyAmsterdam University Medical Centerslocation AMCAmsterdam Gastroenterology & MetabolismAmsterdamThe Netherlands
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Bronzwaer MES, Vleugels JLA, van Doorn SC, Dijkgraaf MGW, Fockens P, Dekker E. Are adenoma and serrated polyp detection rates correlated with endoscopists' sensitivity of optical diagnosis? Endoscopy 2020; 52:763-772. [PMID: 32349138 DOI: 10.1055/a-1151-8691] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Indexed: 02/06/2023]
Abstract
UNLABELLED INTRODUCTION : Endoscopists with a high adenoma detection rate (ADR) and proximal serrated polyp detection rate (PSPDR) detect these polyps more frequently, which may be attributable to better recognition of their endoscopic features. Little is known about the association between endoscopic lesion detection and differentiation skills. Therefore, we evaluated the correlation between the ADR, PSPDR, and the sensitivity of optical diagnosis for adenomas and serrated polyps. METHODS We performed an exploratory post-hoc analysis of the DISCOUNT-2 study, including complete colonoscopies after a positive fecal immunochemical test (FIT) performed by endoscopists who performed ≥ 50 colonoscopies. The correlations between the ADR, PSPDR, and the sensitivity of optical diagnosis were calculated using Pearson's rho correlation coefficient. RESULTS 24 endoscopists performed ≥ 50 colonoscopies, resulting in a total of 2889 colonoscopies. The overall ADR was 84.5 % (range 71.4 % - 95.3 %) and overall PSPDR was 13.7 % (4.3 % - 29.0 %). The sensitivity of optical diagnosis for adenomas and serrated polyps were 94.5 % (83.3 % - 100 %) and 74.0 % (37.5 % - 94.1 %), respectively. No correlation could be demonstrated between the ADR and the sensitivity of optical diagnosis for adenomas (-0.20; P = 0.35) or between the PSPDR and the sensitivity of optical diagnosis for serrated polyps (-0.12; P = 0.57). CONCLUSIONS In a homogeneous FIT-positive population, no correlation between the ADR, PSPDR, and the sensitivity of optical diagnosis for adenomas and serrated polyps could be demonstrated. These exploratory results suggest that lesion detection and differentiation require different endoscopic skills. Further prospective studies are needed; until then, monitoring of both performance indicators is important to secure optimal efficacy of FIT-based colorectal cancer screening.
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Affiliation(s)
- Maxime E S Bronzwaer
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Jasper L A Vleugels
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Sascha C van Doorn
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel G W Dijkgraaf
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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Körver S, Geurtsen GJ, Hollak CEM, van Schaik IN, Longo MGF, Lima MR, Dijkgraaf MGW, Langeveld M. Cognitive functioning and depressive symptoms in Fabry disease: A follow-up study. J Inherit Metab Dis 2020; 43:1070-1081. [PMID: 32510623 PMCID: PMC7540266 DOI: 10.1002/jimd.12271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/19/2020] [Accepted: 06/04/2020] [Indexed: 12/13/2022]
Abstract
Patients with Fabry disease (FD) have a high prevalence of depressive symptoms and can suffer from cognitive impairment, negatively affecting their life. The course of cognitive functioning and depressive symptoms in FD is unknown. The aim of this prospective cohort study was to describe changes in cognitive functioning and depressive symptoms and to identify related variables in patients with FD over 1 year. Assessments were conducted twice, using a neuropsychological test battery and the Centre of Epidemiological Studies Depression scale (CESD). Eighty-one patients were included of which 76 patients (94%) completed both assessments (age: 44 years, 34% men, 75% classical phenotype). A significant decrease in cognitive functioning was found in four patients (5%), with patients regressing from excellent to average/good. Changes were not related to sex, phenotype, stroke, IQ or CESD scores. CESD scores ≥16 were present in 29 patients (38%) at baseline. Using the reliable change index a decrease in CESD scores was found in six patients (8%). Decreased CESD scores were independently related to employing a positive and problem solving coping style and increased CESD scores to an avoiding and brooding coping style and worsening health perception. We found no major changes in cognitive functioning in patients with FD during 1 year follow-up making it an unsuitable outcome in FD treatment trials. Considering the high prevalence of persistent depressive symptoms, assessment of depressive symptoms should be part of routine follow-up. Altering coping styles and health perception may improve psychological well-being in FD.
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Affiliation(s)
- Simon Körver
- Department of Endocrinology and MetabolismAmsterdam UMC, Location AMC, University of AmsterdamAmsterdamThe Netherlands
| | - Gert J. Geurtsen
- Department of Medical PsychologyAmsterdam UMC, Location AMC, University of Amsterdam, Amsterdam NeuroscienceAmsterdamThe Netherlands
| | - Carla E. M. Hollak
- Department of Endocrinology and MetabolismAmsterdam UMC, Location AMC, University of AmsterdamAmsterdamThe Netherlands
| | - Ivo N. van Schaik
- Department of Neurology, Amsterdam UMC, Location AMCUniversity of AmsterdamAmsterdamThe Netherlands
- Spaarne GasthuisHaarlemThe Netherlands
| | - Maria G. F. Longo
- Department of RadiologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Marjana R. Lima
- Department of RadiologyHospital Moinhos de VentoPorto AlegreBrazil
| | - Marcel G. W. Dijkgraaf
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Location AMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Mirjam Langeveld
- Department of Endocrinology and MetabolismAmsterdam UMC, Location AMC, University of AmsterdamAmsterdamThe Netherlands
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Haal S, Guman MSS, de Brauw LM, van Veen RN, Schouten R, Fockens P, Gerdes VEA, Dijkgraaf MGW, Voermans RP. Ursodeoxycholic acid for the prevention of symptomatic gallstone disease after bariatric surgery: statistical analysis plan for a randomised controlled trial (UPGRADE trial). Trials 2020; 21:676. [PMID: 32703246 PMCID: PMC7376318 DOI: 10.1186/s13063-020-04605-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 04/16/2020] [Accepted: 07/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately 8-15% of patients undergoing bariatric surgery develop symptomatic gallstone disease within 24 months after surgery. Ursodeoxycholic acid (UDCA) seems to effectively prevent the formation of gallstones detectable by ultrasound after bariatric surgery. The aim of the UPGRADE trial is to provide evidence on the prophylactic use of UDCA in preventing symptomatic gallstone disease postoperatively. METHODS The UPGRADE trial is designed as a randomised, placebo-controlled, double-blind multicentre trial in patients with morbid obesity undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Patients are randomly assigned to either UDCA 900 mg daily for 6 months or placebo treatment. This paper details the statistical analysis plan (SAP) of this trial and was submitted before outcome data were available. RESULTS The primary endpoint of this trial is symptomatic gallstone disease within 24 months after bariatric surgery, defined as admission or hospital visit for symptomatic gallstone disease. Secondary outcomes consist of the development of gallstones/sludge on ultrasound at 24 months in the gallstone-negative group at baseline, presence of gallstones/sludge on ultrasound at 24 months, number of cholecystectomies, side effects of UDCA, therapy compliance, quality of life, costs and revenues. Analyses will be completed according to this pre-specified SAP. The main analysis will be performed as a standard ITT analysis using the chi-squared test. DISCUSSION The UPGRADE trial will show if prophylactic use of UDCA reduces the incidence of symptomatic gallstone disease after bariatric surgery. Unforeseen deviations from the SAP at the time of analysis will be motivated and discussed. TRIAL REGISTRATION The Netherlands Trial Register NL5954 . Registered on 21 November 2016.
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Affiliation(s)
- Sylke Haal
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. .,Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, the Netherlands.
| | - Maimoena S S Guman
- Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, the Netherlands.,Department of Internal and Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | - Ruben Schouten
- Department of Surgery, Flevoziekenhuis, Almere, the Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Victor E A Gerdes
- Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, the Netherlands.,Department of Internal and Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Rogier P Voermans
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Hoogland J, van Barreveld M, Debray TPA, Reitsma JB, Verstraelen TE, Dijkgraaf MGW, Zwinderman AH. Handling missing predictor values when validating and applying a prediction model to new patients. Stat Med 2020; 39:3591-3607. [PMID: 32687233 PMCID: PMC7586995 DOI: 10.1002/sim.8682] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 02/01/2019] [Revised: 05/10/2020] [Accepted: 06/10/2020] [Indexed: 12/23/2022]
Abstract
Missing data present challenges for development and real‐world application of clinical prediction models. While these challenges have received considerable attention in the development setting, there is only sparse research on the handling of missing data in applied settings. The main unique feature of handling missing data in these settings is that missing data methods have to be performed for a single new individual, precluding direct application of mainstay methods used during model development. Correspondingly, we propose that it is desirable to perform model validation using missing data methods that transfer to practice in single new patients. This article compares existing and new methods to account for missing data for a new individual in the context of prediction. These methods are based on (i) submodels based on observed data only, (ii) marginalization over the missing variables, or (iii) imputation based on fully conditional specification (also known as chained equations). They were compared in an internal validation setting to highlight the use of missing data methods that transfer to practice while validating a model. As a reference, they were compared to the use of multiple imputation by chained equations in a set of test patients, because this has been used in validation studies in the past. The methods were evaluated in a simulation study where performance was measured by means of optimism corrected C‐statistic and mean squared prediction error. Furthermore, they were applied in data from a large Dutch cohort of prophylactic implantable cardioverter defibrillator patients.
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Affiliation(s)
- Jeroen Hoogland
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marit van Barreveld
- Department of Clinical Epidemiology, Biostatistics, & Bioinformatics, Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Heart Center, Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas P A Debray
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johannes B Reitsma
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Tom E Verstraelen
- Heart Center, Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel G W Dijkgraaf
- Department of Clinical Epidemiology, Biostatistics, & Bioinformatics, Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology, Biostatistics, & Bioinformatics, Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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