1
|
Loras C, Ruiz-Ramirez P, Romero J, Andújar X, Bargallo J, Bernardos E, Boscá-Watts MM, Brugiotti C, Brunet E, Busquets D, Cerrillo E, Cortina FJ, Díaz-Milanés JA, Dueñas C, Farrés R, Golda T, González-Huix F, Gornals JB, Guardiola J, Julià D, Lira A, Llaó J, Mañosa M, Marin I, Millán M, Monfort D, Moro D, Mullerat J, Navarro M, Pérez Roldán F, Pijoan E, Pons V, Reyes J, Rufas M, Sainz E, Sanchiz V, Serracant A, Sese E, Soto C, Troya J, Zaragoza N, Tebé C, Paraira M, Sudrià-Lopez E, Mayor V, Fernández-Bañares F, Esteve M. Endoscopic treatment (endoscopic balloon dilation/self-expandable metal stent) vs surgical resection for the treatment of de novo stenosis in Crohn's disease (ENDOCIR study): an open-label, multicentre, randomized trial. Trials 2023; 24:432. [PMID: 37365665 DOI: 10.1186/s13063-023-07447-1] [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: 12/19/2022] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Stenosis is one of the most common complications in patients with Crohn's disease (CD). Endoscopic balloon dilation (EBD) is the treatment of choice for a short stenosis adjacent to the anastomosis from previous surgery. Self-expandable metal stents (SEMS) may be a suitable treatment option for longer stenoses. To date, however, there is no scientific evidence as to whether endoscopic (EBD/SEMS) or surgical treatment is the best approach for de novo or primary stenoses that are less than 10 cm in length. METHODS/DESIGN Exploratory study as "proof-of-concept", multicentre, open-label, randomized trial of the treatment of de novo stenosis in the CD; endoscopic treatment (EBD/SEMS) vs surgical resection (SR). The type of endoscopic treatment will initially be with EDB; if a therapeutic failure occurs, then a SEMS will be placed. We estimate 2 years of recruitment and 1 year of follow-up for the assessment of quality of life, costs, complications, and clinical recurrence. After the end of the study, patients will be followed up for 3 years to re-evaluate the variables over the long term. Forty patients with de novo stenosis in CD will be recruited from 15 hospitals in Spain and will be randomly assigned to the endoscopic or surgical treatment groups. The primary aim will be the evaluation of the patient quality of life at 1 year follow-up (% of patients with an increase of 30 points in the 32-item Inflammatory Bowel Disease Questionnaire (IBDQ-32). The secondary aim will be evaluation of the clinical recurrence rate, complications, and costs of both treatments at 1-year follow-up. DISCUSSION The ENDOCIR trial has been designed to determine whether an endoscopic or surgical approach is therapeutically superior in the treatment of de novo stenosis in CD. TRIAL REGISTRATION ClinicalTrials.gov NCT04330846. Registered on 1 April 1 2020. https://clinicaltrials.gov/ct2/home.
Collapse
Affiliation(s)
- Carme Loras
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari Mútua Terrassa, Plaça Dr Robert n° 5, Terrassa, Barcelona, 08221, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.
| | - Pablo Ruiz-Ramirez
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari Mútua Terrassa, Plaça Dr Robert n° 5, Terrassa, Barcelona, 08221, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Juan Romero
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari Mútua Terrassa, Plaça Dr Robert n° 5, Terrassa, Barcelona, 08221, Spain
| | - Xavier Andújar
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari Mútua Terrassa, Plaça Dr Robert n° 5, Terrassa, Barcelona, 08221, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | | | - Esther Bernardos
- Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
| | | | | | - Eduard Brunet
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
- Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain
| | - David Busquets
- Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - Elena Cerrillo
- Hospital Universitari i Politècnic la Fe, Valencia, Spain
| | | | | | | | | | - Thomas Golda
- Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain
| | | | - Joan B Gornals
- Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Jordi Guardiola
- Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - David Julià
- Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - Alba Lira
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
- Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain
| | - Jordina Llaó
- Althaia, Xarxa Assistencial Universitaria de Manresa, Manresa, Spain
| | - Miriam Mañosa
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Ingrid Marin
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Mónica Millán
- Hospital Universitari i Politècnic la Fe, Valencia, Spain
| | | | - David Moro
- Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Josep Mullerat
- Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Spain
| | - Mercè Navarro
- Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Spain
| | | | | | - Vicente Pons
- Hospital Universitari i Politècnic la Fe, Valencia, Spain
| | - José Reyes
- Hospital Comarcal d'Inca, Inca, Mallorca, Spain
- IdISBa- Institut de Investigació Sanitaria de les Illes Balears, Palma, Spain
| | - María Rufas
- Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Empar Sainz
- Althaia, Xarxa Assistencial Universitaria de Manresa, Manresa, Spain
| | | | - Anna Serracant
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
- Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain
| | - Eva Sese
- Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Cristina Soto
- Althaia, Xarxa Assistencial Universitaria de Manresa, Manresa, Spain
| | - Jose Troya
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Cristian Tebé
- Unitat de Bioestadística, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Marta Paraira
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari Mútua Terrassa, Plaça Dr Robert n° 5, Terrassa, Barcelona, 08221, Spain
| | - Emma Sudrià-Lopez
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari Mútua Terrassa, Plaça Dr Robert n° 5, Terrassa, Barcelona, 08221, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Vicenç Mayor
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari Mútua Terrassa, Plaça Dr Robert n° 5, Terrassa, Barcelona, 08221, Spain
| | - Fernando Fernández-Bañares
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari Mútua Terrassa, Plaça Dr Robert n° 5, Terrassa, Barcelona, 08221, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Maria Esteve
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari Mútua Terrassa, Plaça Dr Robert n° 5, Terrassa, Barcelona, 08221, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| |
Collapse
|
2
|
Rodríguez J, Isern J, Pons N, Carmona A, Vallejo E, Cassadó J, De Marcos JA, Paraira M, Giménez N, Pessarrodona A. Pregnancy outcomes after ultrasound-guided high-intensity focused ultrasound (USgHIFU) for conservative treatment of uterine fibroids: experience of a single institution. Int J Hyperthermia 2021; 38:9-17. [PMID: 34420443 DOI: 10.1080/02656736.2021.1908633] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To assess the impact of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation for uterine fibroids on fertility. MATERIAL AND METHODS A retrospective observational study was conducted of 560 reproductive-age women with symptomatic uterine fibroids who underwent USgHIFU therapy at Mútua Terrassa University Hospital, Spain, between February 2008 and February 2018. We analyzed pregnancy outcomes including time to conception, pregnancy approach, gestational age, delivery mode, neonatal outcomes and complications during pregnancy and delivery. RESULTS After USgHIFU treatment, 71 pregnancies were obtained in 55 patients. Of these, 58 (82%) cases were natural pregnancies and 13 (18%) were in vitro fertilization (IVF) pregnancies. The median time to conception was 12 (range 1-72) months. There were 43 (61%) successful deliveries, including a twin gestation, 22 (31%) spontaneous abortions and 6 (8%) therapeutic abortions. The rate of full-term deliveries was 91% (39/43) and the remaining 9% (4/43) were preterm deliveries. Of the 44 live births, 25 (57%) were born vaginally and 19 (43%) by cesarean section. The complications reported included 3 women with retained placenta (7%), 2 with placenta previa (5%) and 1 with severe preeclampsia (2%). The mean birth weight was 3.1 (range: 1.4-4.3) kg, and except for a baby born with a tetralogy of Fallot, all newborns developed well without complications during postpartum and breastfeeding. CONCLUSION Patients undergoing USgHIFU treatment of uterine fibroids can achieve full-term pregnancies with few intrapartum or postpartum complications. More studies are required to compare fertility and perinatal outcomes between patients who underwent or not USgHIFU.
Collapse
Affiliation(s)
- J Rodríguez
- HIFU Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain.,Department of Obstetrics and Gynecology, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - J Isern
- HIFU Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain.,Department of Obstetrics and Gynecology, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - N Pons
- HIFU Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain.,Department of Obstetrics and Gynecology, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - A Carmona
- HIFU Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain.,Department of Obstetrics and Gynecology, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - E Vallejo
- Department of Obstetrics and Gynecology, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - J Cassadó
- Department of Obstetrics and Gynecology, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - J A De Marcos
- Department of Radiology, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - M Paraira
- Department of Radiology, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - N Giménez
- Research Unit, Research Foundation Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - A Pessarrodona
- HIFU Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain.,Department of Obstetrics and Gynecology, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| |
Collapse
|