1
|
Lluís N, Asbun H, Basso S, Corzo-Zamora N, Gelrud A, Guzmán-Calderón E, Lozada-Hernández EE, Mancilla C, Mansilla-Vivar R, Pasqua AV, Peláez-Luna M, Roig GVG, Zapater P, Lluís F, Vaquero E, Ramia JM, Madaria ED. Survey on initial management of acute pancreatitis in Latin America. Gastroenterol Hepatol 2023; 46:603-611. [PMID: 36731725 DOI: 10.1016/j.gastrohep.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/25/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The population of Latin America harbors the highest incidence of gallstones and acute biliary pancreatitis, yet little is known about the initial management of acute pancreatitis in this large geographic region. PARTICIPANTS AND METHODS We performed a post hoc analysis of responses from physicians based in Latin America to the international multidisciplinary survey on the initial management of acute pancreatitis. The questionnaire asked about management of patients during the first 72h after admission, related to fluid therapy, prescription of prophylactic antibiotics, feeding and nutrition, and timing of cholecystectomy. Adherence to clinical guidelines in this region was compared with the rest of the world. RESULTS The survey was completed by 358 participants from 19 Latin American countries (median age, 39 years [33-47]; women, 27.1%). The proportion of participants in Latin America vs. the rest of the world who chose non-compliant options with clinical guidelines were: prescription of fluid therapy rate other than moderate (42.2% vs 34.3%, P=.02); prescription of prophylactic antibiotics for severe (10.6% vs 18.0%, P=.002), necrotizing (28.5% vs 36.9%, P=.008), or systemic inflammatory response syndrome-associated (21.2% vs 30.6%, P=.002) acute pancreatitis; not starting an oral diet to patients with oral tolerance (77.9% vs 71.1%, P=.02); and delayed cholecystectomy (16.2% vs 33.8%, P<.001). CONCLUSIONS Surveyed physicians in Latin America are less likely to prescribe antibiotics and to delay cholecystectomy when managing patients in the initial phase of acute pancreatitis compared to physicians in the rest of the world. Feeding and nutrition appear to require the greatest improvement.
Collapse
Affiliation(s)
- Núria Lluís
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA.
| | - Horacio Asbun
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA
| | - Sandra Basso
- Department of Gastroenterology, Bonorino Udaondo Hospital, Buenos Aires, Argentina
| | - Natalia Corzo-Zamora
- Department of Gastroenterology, Bolivian Japanese Bolivian Gastroenterological Institute, Cochabamba, Bolivia
| | - Andrés Gelrud
- Pancreatic Disease Center, Interventional Endoscopy, Miami Cancer Institute, Gastro Health, Miami, FL, USA
| | - Edson Guzmán-Calderón
- Gastroenterology Unit, Edgardo Rebagliati Martins National Hospital, Anglo-American Clinic, and School of Medicine of the Peruvian University of Applied Sciences, Lima, Peru
| | - Edgard E Lozada-Hernández
- General Surgery, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Guanajuato, Mexico
| | - Carla Mancilla
- Gastroenterology Section and Critical Care Unit, University of Chile Clinical Hospital, Santiago, Chile
| | - Rodrigo Mansilla-Vivar
- Digestive Endoscopy Unit, Puerto Montt Hospital, Puerto Montt, Chile; University San Sebastian, Chile
| | - Analía V Pasqua
- Department of Gastroenterology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Mario Peláez-Luna
- Research Division, School of Medicine, National Autonomous University of Mexico, Mexico; Department of Gastroenterology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | | | - Pedro Zapater
- Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain; CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Félix Lluís
- Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Eva Vaquero
- Gastroenterology Department, Hospital Clínic, University of Barcelona, CIBERehd IDIBAPS, Barcelona, Spain
| | - José Manuel Ramia
- Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain; Department of Surgery, Dr. Balmis General University Hospital, Alicante, Spain
| | - Enrique de Madaria
- Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain; Department of Gastroenterology, Dr. Balmis General University Hospital, Alicante, Spain
| |
Collapse
|
2
|
Mohamed SY, Tarek-Hefnawy M, Amer SA, Mansour B, Mostafa-Asla M, Piscoya A, Mansilla-Vivar R, Emara MH. Utility of YouTube online learning for junior gastrointestinal endoscopists: A rewarding or deterring practice? Rev Gastroenterol Peru 2023; 43:20-30. [PMID: 37226066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Endoscopy is a competitive field in clinical practice, in which skilled endoscopists are in high demand. The learning process for Junior Gastrointestinal Endoscopists (JGEs) is difficult, quite long, and technically demanding. This directs JGEs to seek additive learning sources, including online sources. The purpose of this study was to determine the frequency, context, attitudes, perceived benefits, drawbacks, and recommendations for using YouTube videos as an educational platform among JGEs from the uses'prespective. We disseminated a cross-sectional online questionnaire from January 15th to March 17th, 2022, and recruited 166 JGE from 39 different countries. The majority of surveyed JGEs (138, 85.2%) were already using YouTube as a learning tool. The majority of JGEs (97, 59.8%) reported gaining knowledge and applying it in their clinical practice, but 56 (34.6 %) reported gaining knowledge without application in real practice. Most participants (124, 76.5 %) reported missing procedure details in YouTube endoscopy videos. The majority of JGEs (110, 80.9%) reported that YouTube videos are provided by endoscopy specialists. Only one participant, 0.6% out of the 166 JGEs surveyed, disliked video records, including YouTube as a source of learning. Based on their experience, 106 (65.4%) of participants recommended YouTube as an educational tool for the coming generation of JGEs. We consider that YouTube represents a potentially useful tool for JGEs, supplying them with both knowledge and clinical practice tricks. However, many drawbacks could make the experience misleading and time-consuming. Consequently, we encourage educational providers on YouTube and other platforms to upload well-constructed, peerreviewed, interactive educational endoscopy videos.
Collapse
Affiliation(s)
- Salem Youssef Mohamed
- Gastroenterology and Hepatology Unit, Internal Medicine Department, Faculty of Medicine, Zagazig University, Egypt
| | - Mahmoud Tarek-Hefnawy
- Faculty of Medicine, Zagazig University, Egypt - Medical Research Group of Egypt (MRGE), Cairo, Egypt
| | - Samar A Amer
- Department of Community Medicine and Public Health, Faculty of Medicine, Zagazig University, Egypt
| | - Bassam Mansour
- Infectious and Endemic Diseases Department, Faculty of Medicine, Suez Canal University, Egypt
| | | | | | | | - Mohamed H Emara
- Department of Hepatology, Gastroenterology an Infectious Diseases, Kafrelsheikh University, Egypt
| |
Collapse
|
3
|
Mansilla-Vivar R, Petruzzellis C, Olivari N, Milluzzo SM, Grassano A, Cesari P, Zorzi F, Spada C. Serrated polyps: innocent or guilty? Rev Gastroenterol Peru 2021; 41:245-253. [PMID: 35613395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Serrated lesions represent a group of lesions with different genetic and biological features causing important clinical repercussions. Three types of serrated lesions are identified: hyperplastic, sessile adenomas (with and without dysplasia) and traditional serrated adenomas. Such lesions are now recognized as precancerous lesions.The carcinogenic process of serrated lesions follows a pathway including: alterations concerning activation of mitogen and protein kinase regulating the extracellular signal of other intracellular kinases (MAPK-ERK), inhibition of the apoptosis and hypermethylation of DNA and instability of microsatellites. Like for adenomatous polyps, the risk factors for serrated lesions are environmental factors, related to lifestyle and diet. The cancerogenic risk is increased by excessive alcohol consumption, obesity and poor intake of folate. When a high number of colorectal polyps with architecture serrated is diagnosed, it could be considered as serrated polyposis syndrome (SPS). According the most recent ESGE guidelines, the diagnostic criteria of the SPS, are: at least 5 polyps resected proximal to the sigmoid colon, 2 of which> 10 mm, or >20 serrated lesions of any size distributed in the entire colon. This condition presents a high risk for personal and/or familiar CRC, for this reason a regular screening colonoscopy should be performed in these patients and in their first-degree relatives.
Collapse
Affiliation(s)
- Rodrigo Mansilla-Vivar
- Digestive Endoscopy Unit, Hospital Puerto Montt. Puerto Montt, Chile; Gastrointestinal Endoscopy Research Group. IIS Hospital La Fe. Valencia, Spain
| | - Carlo Petruzzellis
- Dipartimento di Endoscopia Digestiva e Gastroenterologia, Fondazione Poliambulanza. Brescia, Italy
| | - Nicola Olivari
- Dipartimento di Endoscopia Digestiva e Gastroenterologia, Fondazione Poliambulanza. Brescia, Italy
| | | | - Alessandra Grassano
- Dipartimento di Gastroenterología, Azienda Ospedaliera Universitaria Federico II. Napoli, Italy
| | - Pietro Cesari
- Dipartimento di Endoscopia Digestiva e Gastroenterologia, Fondazione Poliambulanza. Brescia, Italy
| | - Fausto Zorzi
- Dipartimento di Patología, Fondazione Poliambulanza. Brescia, Italy
| | - Cristiano Spada
- Dipartimento di Endoscopia Digestiva e Gastroenterologia, Fondazione Poliambulanza. Brescia, Italy
| |
Collapse
|
4
|
Mansilla-Vivar R, Vargas JI, Parra-Blanco A. Endoscopic hemostasis with hemoclips for post-variceal ligation bleeding ulcer. VideoGIE 2020; 5:56-57. [PMID: 32051909 PMCID: PMC7003062 DOI: 10.1016/j.vgie.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Rodrigo Mansilla-Vivar
- Endoscopy Unit, Digestive Diseases Department, La Fe Polytechnic University Hospital, Gastrointestinal Endoscopy Research Group, IIS Hospital La Fe, Valencia, Spain
- Digestive Endoscopy Unit, Hospital Puerto Montt, Puerto Montt, Chile
| | - José Ignacio Vargas
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Adolfo Parra-Blanco
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Nottingham Digestive Diseases Centre, The University of Nottingham, Nottingham, UK
| |
Collapse
|
5
|
Mansilla-Vivar R, Serrano CA, Palma C, Vera M, Hernandez C, Pizarro M, Torres J, Harris PR, Fuentes-López E, Riquelme A, Espino A. High Helicobacter pylori Bacterial Load and Low Cytokine Expression Levels Are Associated with Nodular Gastropathy. Dig Dis Sci 2020; 65:565-575. [PMID: 31392473 DOI: 10.1007/s10620-019-05769-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 07/29/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS Nodular gastropathy (NG) is an inflammatory condition of the gastric mucosa characterized by the endoscopic detection of multiple millimeter protrusions. A strong association between NG and Helicobacter pylori and a possible role of NG as a risk factor for undifferentiated gastric cancer have been described. The aim of this study was to characterize the pathogenic and inflammatory profile of patients with NG. METHODS Adult patients referred for upper gastrointestinal endoscopy were prospectively enrolled in this study. H. pylori infection status was determined by rapid urease test. Biopsies were stained with hematoxylin-eosin. Sydney and OLGA scores were used to assess gastritis characteristics and gastric cancer risk. PCR analysis was performed to determine bacterial load and virulence factors CagA (and its EPIYA motifs) and VacA alleles. Finally, gastric mucosa cytokine gene expression (IL-8, IL-1β, and TNF-α) was determined by real-time RT-PCR. RESULTS Forty-eight patients, mean age of 36 years, were recruited. All NG patients were infected by H. pylori. OLGA score was similar in both groups (NG patients and non-NG patients). NG patients had higher bacterial load in the gastric corpus (p = 0.01) and significantly less pro-inflammatory cytokine levels than non-NG infected patients (p = 0.01). CONCLUSIONS In our study, NG is not associated with preneoplastic lesions. An increase in bacterial load without a concomitant increase in mucosal inflammatory cytokine responses in H. pylori-infected subjects with NG may represent a general dampening of immune responses or an additional mechanism of H. pylori active immune evasion.
Collapse
Affiliation(s)
- Rodrigo Mansilla-Vivar
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. .,Digestive Endoscopy Unit, Hospital Puerto Montt, Calle Los Aromos 65, Puerto Montt, Chile.
| | - Carolina A Serrano
- Department of Pediatric Gastroenterology and Nutrition, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camila Palma
- Department of Pediatric Gastroenterology and Nutrition, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Macarena Vera
- Department of Pediatric Gastroenterology and Nutrition, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Caroll Hernandez
- Department of Pediatric Gastroenterology and Nutrition, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Margarita Pizarro
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javiera Torres
- Department of Pathology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paul R Harris
- Department of Pediatric Gastroenterology and Nutrition, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo Fuentes-López
- Department of Health Sciences, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Arnoldo Riquelme
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Department of Health Sciences, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alberto Espino
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
6
|
Argüello L, Sánchez-Montes C, Mansilla-Vivar R, Artés J, Prieto M, Alonso-Lázaro N, Satorres-Paniagua C, Pons-Beltrán V. Diagnostic yield of endoscopic ultrasound with fine-needle aspiration in pancreatic cystic lesions. Gastroenterol Hepatol 2019; 43:1-8. [PMID: 31753518 DOI: 10.1016/j.gastrohep.2019.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/14/2019] [Accepted: 07/15/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Despite advances in imaging techniques, in many cases they are insufficient to establish the diagnosis of pancreatic cystic lesions (PCL). There are few publications in our setting that evaluate the combination of several methods obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). The aim of the study was to evaluate the overall utility of EUS-FNA in the diagnosis of PCL. MATERIAL AND METHODS Retrospective study based on a database updated prospectively of a cohort of patients referred for EUS-FNA due to PCL detected in an imaging test. The sensitivity, specificity and diagnostic yield of carcinoembryonic antigen (CEA), cytology and viscosity were studied to detect mucinous lesions. RESULTS From November 2013 to April 2018, 122 EUS were performed for PCL. EUS-FNA was performed in 94/122 (77%) and 21/122 (17.2%) patients were operated on. We included 33/122 patients who had diagnostic confirmation by histology, imaging (serous cyst with typical pattern) or clinical evolution. The study of the ROC curve determined the cutoff point ≥419 ng/ml to differentiate mucinous/non-mucinous cystic lesions. The diagnostic yield of CEA was 87.5% (21/24), cytology 81.8% (27/33) and viscosity 84.4% (27/32). The three parameters in combination obtained the best result (30/33, 90.9%). CONCLUSION The combination of CEA analysis, cytology and viscosity of pancreatic fluid obtained by EUS-FNA increases the performance in the diagnosis of mucinous pancreatic cystic lesions, with it being greater than 90%.
Collapse
Affiliation(s)
- Lidia Argüello
- Unidad de Endoscopia Digestiva, Hospital Universitari i Politècnic La Fe, Valencia, España; Grupo de Investigación de Endoscopia Digestiva, IIS La Fe, Valencia, España
| | - Cristina Sánchez-Montes
- Unidad de Endoscopia Digestiva, Hospital Universitari i Politècnic La Fe, Valencia, España; Grupo de Investigación de Endoscopia Digestiva, IIS La Fe, Valencia, España.
| | - Rodrigo Mansilla-Vivar
- Unidad de Endoscopia Digestiva, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - Josefa Artés
- Servicio de Anatomía Patológica, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - Mireya Prieto
- Servicio de Anatomía Patológica, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - Noelia Alonso-Lázaro
- Unidad de Endoscopia Digestiva, Hospital Universitari i Politècnic La Fe, Valencia, España; Grupo de Investigación de Endoscopia Digestiva, IIS La Fe, Valencia, España
| | - Carla Satorres-Paniagua
- Unidad de Endoscopia Digestiva, Hospital Universitari i Politècnic La Fe, Valencia, España; Grupo de Investigación de Endoscopia Digestiva, IIS La Fe, Valencia, España
| | - Vicente Pons-Beltrán
- Unidad de Endoscopia Digestiva, Hospital Universitari i Politècnic La Fe, Valencia, España; Grupo de Investigación de Endoscopia Digestiva, IIS La Fe, Valencia, España
| |
Collapse
|
7
|
Mansilla-Vivar R, Argüello-Viúdez L, Sánchez-Montes C, Alonso-Lázaro N, Pons-Beltrán V. Endoluminal radiofrequency ablation with SpyGlass™ in the management of cholangiocarcinoma. Rev Esp Enferm Dig 2019; 111:803-805. [PMID: 31353916 DOI: 10.17235/reed.2019.6230/2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Most extrahepatic cholangiocarcinomas are unresectable at the time of diagnosis and even in case of a resectable cancer, surgery is not an option for the elderly or patients with comorbidities (1). Current treatment alternatives in these scenarios are very limited. Biliary stenting with self-expanding metal stents (SEMS) is the mainstay palliative treatment for biliary obstruction (2). However, emerging experience with endoscopic RF ablation (RFA) in this setting has been reported in the literature.
Collapse
Affiliation(s)
| | | | | | - Noelia Alonso-Lázaro
- Unidad de Endoscopia Digestiva, Hospital Universitari i Politècnic La Fe, España
| | - Vicente Pons-Beltrán
- Unidad de Endoscopia Digestiva, Hospital Universitari i Politècnic La Fe, España
| |
Collapse
|
8
|
Mansilla-Vivar R, Alonso-Lázaro N, Argüello-Viudez L, Ponce Romero M, Bustamante-Balen M, Pons Beltrán V. Peroral cholangiopancreatoscopy as a rescue method for a trapped pancreatic guidewire. Endoscopy 2019; 51:E59-E60. [PMID: 30634188 DOI: 10.1055/a-0820-1160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Rodrigo Mansilla-Vivar
- Digestive Endoscopy Unit, Digestive Diseases Department, La Fe Polytechnic University Hospital, Valencia, Spain.,Gastrointestinal Endoscopy Research Group, IIS Hospital La Fe, Valencia, Spain.,Digestive Endoscopy Unit, Hospital Puerto Montt, Puerto Montt, Chile
| | - Noelia Alonso-Lázaro
- Digestive Endoscopy Unit, Digestive Diseases Department, La Fe Polytechnic University Hospital, Valencia, Spain.,Gastrointestinal Endoscopy Research Group, IIS Hospital La Fe, Valencia, Spain
| | - Lidia Argüello-Viudez
- Digestive Endoscopy Unit, Digestive Diseases Department, La Fe Polytechnic University Hospital, Valencia, Spain.,Gastrointestinal Endoscopy Research Group, IIS Hospital La Fe, Valencia, Spain
| | - Marta Ponce Romero
- Digestive Endoscopy Unit, Digestive Diseases Department, La Fe Polytechnic University Hospital, Valencia, Spain.,Gastrointestinal Endoscopy Research Group, IIS Hospital La Fe, Valencia, Spain
| | - Marco Bustamante-Balen
- Digestive Endoscopy Unit, Digestive Diseases Department, La Fe Polytechnic University Hospital, Valencia, Spain.,Gastrointestinal Endoscopy Research Group, IIS Hospital La Fe, Valencia, Spain
| | - Vicente Pons Beltrán
- Digestive Endoscopy Unit, Digestive Diseases Department, La Fe Polytechnic University Hospital, Valencia, Spain.,Gastrointestinal Endoscopy Research Group, IIS Hospital La Fe, Valencia, Spain
| |
Collapse
|
9
|
Pons Beltrán V, Alonso-Lázaro N, Mansilla-Vivar R, Sáez González E, Ponce Romero M, Argüello-Viudez L, Ramos Soler D, Pérez Rojas J, Leathers J, Bustamante Balen M. Single-operator cholangiopancreatoscopy in pancreatobiliary diseases: clinical experience in a tertiary referral hospital. Rev Esp Enferm Dig 2018; 110:748-754. [PMID: 30362360 DOI: 10.17235/reed.2018.5837/2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS to assess the usefulness, efficacy and safety of single-operator cholangiopancreatoscopy (SOCP) with the SpyGlass™ system for the management of biliopancreatic diseases. METHODS a retrospective analysis of patients undergoing SOCP with the SpyGlass™ between September 2008 and April 2016 was performed. Data was obtained from a prospectively-maintained database at a tertiary referral center. The primary study outcomes were technical and complete endoscopic success of the procedure. Two different SpyGlass™ systems were employed; the former is called legacy and the latter, digital system (DS). RESULTS a total of 107 SOCP procedures in 93 patients performed by a single operator were analyzed. Technical success of the SpyGlass™ examination was achieved in 90/93 (97%) of patients and complete success by resolving the biliopancreatic condition in 82/93 (88%) cases. In indeterminate biliary strictures, a complete success was achieved in 45/52 (85%) of cases. With regard to stone treatment, technical success was achieved in 34/34 (100%) patients and complete success, in 31/34 (91%) cases. Electrohydraulic lithotripsy was applied in 16/34 (47%) of cases. There were a total of 7/93 adverse effects (7.5%). CONCLUSIONS SOCP is a useful and safe technique for the treatment of biliopancreatic diseases with a low rate of adverse effects. The procedure seems technically demanding and dedication is required.
Collapse
Affiliation(s)
- Vicente Pons Beltrán
- Unidad de Endoscopia Digestiva, Hospital Universitario y Politécnico La Fe, España
| | - Noelia Alonso-Lázaro
- Unidad de Endoscopia Digestiva, Hospital Universitario y Politécnico La Fe, España
| | | | | | - Marta Ponce Romero
- Unidad de Endoscopia Digestiva, Hospital Universitario y Politécnico La Fe, España
| | | | - David Ramos Soler
- Departamento de Patología, Hospital Universitario y Politécnico La Fe, España
| | - Judith Pérez Rojas
- Departamento de Patología, Hospital Universitario y Politécnico La Fe, España
| | | | | | | |
Collapse
|
10
|
Ortiz-Fernandez-Sordo J, Sami SS, Mansilla-Vivar R, Subramanian V, Mannath J, Telakis E, Ragunath K. Corrigendum: Evaluation of a novel infra-red endoscopy system in the assessment of early neoplasia in Barretts esophagus: pilot study from a single center. Dis Esophagus 2018; 31:4975513. [PMID: 29912361 DOI: 10.1093/dote/doy035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
11
|
Ortiz-Fernandez-Sordo J, Sami SS, Mansilla-Vivar R, Subramanian V, Mannath J, Telakis E, Ragunath K. Evaluation of a novel infra-red endoscopy system in the assessment of early neoplasia in Barretts esophagus: pilot study from a single center. Dis Esophagus 2018; 31:4714778. [PMID: 29228128 DOI: 10.1093/dote/dox137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Received: 07/14/2017] [Indexed: 12/11/2022]
Abstract
Infrared endoscopy (IRE) has been shown to be useful in detecting submucosal (SM) invasion in early gastric cancer. Its role in the endoscopic assessment of Barrett's neoplasia has not been reported to date. We aimed in this study to evaluate the role of IRE in the detection and characterization of early neoplastic lesions within Barrett's esophagus (BE). The secondary aim was to explore its usefulness for the assessment of the presence of submucosal invasion in these early neoplastic Barrett's lesions. We included in the study patients with dysplastic BE who were referred to our institution for endoscopic therapy of a previously diagnosed early Barrett's neoplasia. An examination with white light high resolution endoscopy (HRE) and near IRE after intravenous injection of indocyanine green was performed for all patients using an infrared endoscope prototype. Staining on IRE and correlation with final histological staging by endoscopic mucosal resection/surgery or histological diagnosis on mapping biopsies was analyzed. A total of 23 patients were enrolled in our study: 17 of them with 19 visible lesions and 6 patients with flat BE and no lesions. Staining on IRE was noted in 18 cases: 17 (94%) had at least high grade dysplasia (HGD). No stain was noted in 7 cases: final histology was <HGD in 5 (71%) and ≥HGD in 2 (29%). There was statistically significant difference between cases with no stain and any staining on IRE with regard to the presence of ≥HGD [2/7 (29%) vs. 17/18 (94%) P = 0.0022]. Stain was reported as faint in 12 and dense in 6. All 6 cases with dense staining had at least HGD. We concluded that IRE can provide additional information to the currently available white light endoscopy for detecting early neoplastic lesions within BE. IRE also allows detecting HGD and most advanced histology in BE. Usefulness of IRE to detect submucosal involvement in early Barrett's neoplastic lesions needs to be assessed further in larger cohort studies.
Collapse
Affiliation(s)
- J Ortiz-Fernandez-Sordo
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - S S Sami
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - R Mansilla-Vivar
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - V Subramanian
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - J Mannath
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - E Telakis
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - K Ragunath
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| |
Collapse
|
12
|
Mansilla-Vivar R, Espino A. Massive small-bowel bleeding treated with hemostatic powder. VideoGIE 2017; 2:227-228. [PMID: 29905296 PMCID: PMC5992094 DOI: 10.1016/j.vgie.2017.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
13
|
Mansilla-Vivar R, Sainza Caballero E, Saldaña Dueñas C, Casanova Ortiz L, Fernandez-Urien I, Vila Costas JJ. Biliary ascariasis as etiology of recurrent abdominal pain. Endoscopy 2017; 48 Suppl 1:E196. [PMID: 27285651 DOI: 10.1055/s-0042-107593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Rodrigo Mansilla-Vivar
- Department of Gastroenterology, Pontificia Universidad Católica, Santiago de Chile, Chile
| | | | | | | | | | - Juan J Vila Costas
- Department of Gastroenterology, Complejo Hospitalario of Pamplona, Spain
| |
Collapse
|
14
|
Sami SS, Ragunath K, Wilkes EA, James M, Mansilla-Vivar R, Ortiz-Fernández-Sordo J, White J, Khanna A, Coletta M, Samuel S, Aithal GP, Guha IN. The detection of oesophageal varices using a novel, disposable, probe-based transnasal endoscope: a prospective diagnostic pilot study. Liver Int 2016; 36:1639-1648. [PMID: 27125510 DOI: 10.1111/liv.13152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/17/2016] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Screening for oesophageal varices (OV) using conventional oesophagogastroduodenoscopy (C-OGD) is invasive and requires costly monitoring, recovery, and decontamination facilities. We aimed to evaluate the technical feasibility, acceptability and accuracy of a novel, portable and disposable office-based transnasal endoscope (EG Scan™ ) compared to C-OGD as the reference standard. METHODS This was a prospective cohort study. Consecutive adult patients with cirrhosis were invited to participate. All subjects underwent the two procedures on the same day performed by two endoscopists in a blinded design. Patients completed preference and validated tolerability (10-point visual analogue scale (VAS)) questionnaires on day 0 and day 14 post procedures. RESULTS Forty-five of 50 patients (90%) completed both interventions. Mean age was 59 years and OV prevalence was 49%. Patients reported higher preference (percentage) and better experience (mean VAS) with EG Scan compared to C-OGD on day 0 (76.5% vs. 23.5%, P < 0.001; 7.8 vs. 6.8, P = 0.058, respectively) and day 14 (77.8% vs. 22.2%, P < 0.001; 7.0 vs. 5.5, P = 0.0013 respectively). Sensitivity and specificity of the EG Scan for the diagnosis of any size OV were 0.82 (95% confidence interval (CI) 0.60-0.95), and 0.78 (95% CI 0.56-0.93) respectively. Corresponding values for the diagnosis of clinically significant (medium/large) OV were 0.92 (95% CI 0.62-1.0), 0.97 (95% CI 0.84-1.0) respectively. No serious adverse events occurred. CONCLUSIONS EG Scan accuracy was higher for the diagnosis of medium/large OV compared to any size OV. Patients' preference and overall experience of the EG Scan was favourable compared to C-OGD 14 days after procedures.
Collapse
Affiliation(s)
- Sarmed S Sami
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Krish Ragunath
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Emilie A Wilkes
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Martin James
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Rodrigo Mansilla-Vivar
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Jacobo Ortiz-Fernández-Sordo
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Jonathan White
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Amardeep Khanna
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Marina Coletta
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Sunil Samuel
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Guruprasad P Aithal
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Indra Neil Guha
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK.
| |
Collapse
|
15
|
Ortiz-Fernández-Sordo J, Sami S, Mansilla-Vivar R, De Caestecker J, Cole A, Ragunath K. Incidence of metachronous visible lesions in patients referred for radiofrequency ablation (RFA) therapy for early Barrett's neoplasia: a single-centre experience. Frontline Gastroenterol 2016; 7:24-29. [PMID: 26834956 PMCID: PMC4717434 DOI: 10.1136/flgastro-2015-100561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 01/07/2015] [Revised: 02/05/2015] [Accepted: 02/09/2015] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Evaluate the incidence of metachronous visible lesions (VLs) in patients referred for radiofrequency ablation (RFA) for early Barrett's neoplasia. DESIGN This study was conducted as part of the service evaluation audit. SETTING Tertiary referral centre. PATIENTS All patients with dysplastic Barrett's oesophagus referred for RFA were included for analysis. White light high-resolution endoscopy (HRE), autofluorescence imaging and narrow band imaging were sequentially performed. Endoscopic mucosal resection (EMR) was performed for all VL. Three to six months after EMR, all patients underwent initial RFA and then repeat RFA procedures at three monthly intervals. INTERVENTIONS All endoscopy reports and final staging by EMR/surgery were evaluated and included for analysis. RESULTS Fifty patients were analysed; median age 73 years, 84% men. 38/50 patients (76%) had a previous EMR due to the presence of VL before referred for ablation; twelve patients had no previous treatment. In total, 151 ablation procedures were performed, median per patient 2.68. Twenty metachronous VL were identified in 14 patients before the first ablation or during the RFA protocol; incidence was 28%. All metachronous lesions were successfully resected by EMR. Upstaging after rescue EMR compared with the initial histology was observed in four patients (28%). CONCLUSIONS In total, 28% of patients enrolled in the RFA programme were diagnosed to have metachronous lesions. This high-incidence rate highlights the importance of a meticulous examination to identify and resect any VL before every ablation session. RFA treatment for early Barrett's neoplasia should be performed in tertiary referral centres with HRE and EMR facilities and expertise.
Collapse
Affiliation(s)
- J Ortiz-Fernández-Sordo
- Nottingham Digestive Diseases Centre and NIHR Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham , Nottingham , UK
| | - S Sami
- Nottingham Digestive Diseases Centre and NIHR Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham , Nottingham , UK
| | - R Mansilla-Vivar
- Nottingham Digestive Diseases Centre and NIHR Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham , Nottingham , UK
| | - J De Caestecker
- Digestive Diseases Centre, University Hospitals of Leicester NHS Trust , Leicester , UK
| | - A Cole
- Gastroenterology and Hepatology Department , Derby Hospitals NHS Foundation Trust , Derby , UK
| | - K Ragunath
- Nottingham Digestive Diseases Centre and NIHR Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham , Nottingham , UK
| |
Collapse
|