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Machlab Mashlab S, Martínez-Bauer E, López P, Pujals MDM, Fernández-Bañares F, Selva A, Calvet X, Campo R. Unrestricted vs 3-day low-residue diet for colonoscopy preparation. Results of a feasibility randomized trial. Rev Esp Enferm Dig 2024. [PMID: 38591600 DOI: 10.17235/reed.2024.10417/2024] [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] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
AIM To compare the impact of an unrestricted diet with a 3-day low-residue diet before colonoscopy on bowel preparation quality. METHODS A randomized, multicenter, researcher-blinded, parallel-group feasibility trial was conducted to assess the efficacy of an unrestricted diet versus a 3-day low-residue diet for colonoscopy preparation. Participants, aged 50 to 69, were enrolled in a colorectal cancer screening program with no factors linked to poor bowel cleansing. The Boston Bowel Preparation Scale was used to evaluate colon preparation during intubation and withdrawal. Secondary outcomes included bowel exploration time, adenoma and polyp detection rates, and preparation and diet tolerability. The trial is registered under Clinical Trials (NCT04664543). RESULTS One hundred and two individuals (mean age 59.3 ± 5.5 years, 40.1% female) were randomly assigned to each diet. All participants in both groups achieved adequate preparation (Boston scores ≥ 2 in each segment). Complete adherence to preparation was observed in the majority of participants in both groups. No significant differences were noted between groups in withdrawal or cecal intubation times, or in adenoma detection rates. The unrestricted diet was better tolerated than the 3-day low-residue diet (82.5% vs. 32.3%). Preparation assessed during intubation was adequate in 82.5% of the unrestricted diet group and in 90.3% of the 3-day low-residue diet group. CONCLUSIONS It is feasible to test the impact of an unrestricted diet for adequate bowel preparation. Comparable cleansing results were achieved, but the unrestricted diet showed better tolerability.
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Affiliation(s)
- Salvador Machlab Mashlab
- Endoscopy Unit. Gastroenterology, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, España
| | - Eva Martínez-Bauer
- Endoscopy Unit. Gastroenterology , Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, España
| | - Pilar López
- Clinical Epidemiology and Cancer Screening, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Spain
| | | | | | - Anna Selva
- Clinical Epidemiology and Cancer Screening, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Spain
| | - Xavier Calvet
- Endoscopy Unit. Gastroenterology, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Spain
| | - Rafel Campo
- Endoscopy Unit. Gastroenterology, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Spain
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Machlab S, Martínez-Bauer E, López P, Ruiz-Ramirez P, Gómez B, Gimeno-Garcia AZ, Pujals MDM, Tanco S, Sargatal L, Pérez B, Justicia R, Enguita M, Piqué N, Valero O, Calvet X, Campo R. Restrictive diets are unnecessary for colonoscopy: Non-inferiority randomized trial. Endosc Int Open 2024; 12:E352-E360. [PMID: 38464979 PMCID: PMC10919995 DOI: 10.1055/a-2256-5356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/06/2024] [Indexed: 03/12/2024] Open
Abstract
Background and study aims In colonoscopy, preparation is often regarded as the most burdensome part of the intervention. Traditionally, specific diets have been recommended, but the evidence to support this policy is insufficient. The aim of this study was to evaluate the impact of the decision not to follow a restrictive diet on bowel preparation and colonoscopy outcomes. Patients and methods This was a multicenter, controlled, non-inferiority randomized trial with FIT-positive screening colonoscopy. The subjects were assigned to follow the current standard (1-day low residue diet [LRD]) or a liberal diet. The allocation was balanced for the risk of inadequate cleansing using the Dik et al. score. All participants received the same instructions for morning colonoscopy preparation. The primary outcome was the rate of adequate preparations as defined by the Boston Bowel Preparation Scale. Secondary outcomes included tolerability and measures of colonoscopy performance and quality. Results A total of 582 subjects were randomized. Of these, 278 who received the liberal diet and 275 who received the 1-day LRD were included in the intent-to-treat analysis. Non-inferiority was demonstrated with adequate preparation rates of 97.8% in the 1-day LRD and 96.4% in the liberal diet group. Tolerability was higher with the liberal diet (94.7% vs. 83.2%). No differences were found with respect to cecal intubation time, aspirated volume, or length of the examination. Global and right colon average adenoma detection rates per colonoscopy were similar. Conclusions The liberal diet was non-inferior to the 1-day LRD, and increased tolerability. Colonoscopy performance and quality were not affected. (NCT05032794).
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Affiliation(s)
- Salvador Machlab
- Digestive Endoscopy Unit, Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Sabadell, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Eva Martínez-Bauer
- Digestive Endoscopy Unit, Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Sabadell, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Pilar López
- Clinical Epidemiology and Cancer Screening, Parc Taulí Hospital Universitari. Institut d’Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | - Pablo Ruiz-Ramirez
- Gastroenterology Department, Hospital Universitari Mùtua de Terrassa, Terrassa, Spain
| | - Bárbara Gómez
- Gastroenterology Department, Hospital de Mataró, Mataró, Spain
| | | | - María del Mar Pujals
- Gastroenterology Department, Hospital Universitari Mùtua de Terrassa, Terrassa, Spain
| | - Sara Tanco
- Gastroenterology Department, Hospital de Mataró, Mataró, Spain
| | - Lluïsa Sargatal
- Gastroenterology Department, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Betty Pérez
- Gastroenterología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Reyes Justicia
- Colorectal Cancer Screening Office, Consorci Sanitari de Terrassa, Terrassa, Spain
| | | | - Nùria Piqué
- Institut de Recerca en Nutrició i Seguretat Alimentària de la UB (INSA-UB), Universitat de Barcelona Facultat de Farmàcia i Ciències de l'Alimentació, Barcelona, Spain
| | - Oliver Valero
- Mathematics Department and Applied Statistics, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Xavier Calvet
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Gastroenterology Department, Parc Taulí Hospital Universitari. Institut d’Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | - Rafel Campo
- Digestive Endoscopy Unit, Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Sabadell, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
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3
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Machlab S, Martínez-Bauer E, López P, Piqué N, Puig-Diví V, Junquera F, Lira A, Brullet E, Selva A, García-Iglesias P, Calvet X, Campo R. Comparable quality of bowel preparation with single-day versus three-day low-residue diet: Randomized controlled trial. Dig Endosc 2021; 33:797-806. [PMID: 33015912 DOI: 10.1111/den.13860] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 07/26/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIMS There is controversy about the length of low-residue diet (LRD) for colonoscopy preparation. The aim of the study was to compare one-day vs. three-day LRD associated to standard laxative treatment for achieving an adequate colonoscopy preparation in average risk subjects with positive fecal immunochemical test undergoing screening colonoscopy. METHODS A non-inferiority, randomized, controlled, parallel-group clinical trial was performed in the setting of average risk colorectal cancer screening program. Participants were randomized to receive 1-day vs. 3-day LRD in addition to standard polyethilenglicol treatment. Adequacy of preparation was evaluated using the Boston Bowel Preparation Scale (BBPS). Primary outcome was achieving a BBPS ≥ 2 in all colon segments. Analysis was performed for a non-inferiority margin of 5%, a 95% statistical power and one-sided 0.05 significance level. RESULTS A total of 855 patients were randomized. Adequate bowel preparation was similar between groups: 97.9% of patients in the 1-day LRD group vs 96.9% in the 3-day LRD group achieved the primary outcome (P-value for non-inferiority < 0.001). The percentage of patients with BBPS scores ≥ 8 was superior in the 1-day LRD group (254 vs 221 in the 3-day LRD group, P = 0.032). The 1-day regimen was better tolerated than the 3-day diet. 47.7% (vs 28.7%, P < 0.05) of patients rated the 1-day LRD as very easy to follow. CONCLUSION The 1-day LRD is non-inferior to 3-day LRD for achieving an adequate colon cleansing before average risk screening colonoscopy and it is better tolerated.
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Affiliation(s)
- Salvador Machlab
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eva Martínez-Bauer
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Pilar López
- Clinical Epidemiology and Cancer Screening, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain
| | - Núria Piqué
- Microbiology Section, Department of Biology, Healthcare and Environment, Faculty of Pharmacy and Food Sciences, Universitat de Barcelona (UB), Barcelona, Spain.,Institut de Recerca en Nutrició i Seguretat Alimentària de la UB (INSA-UB), Universitat de Barcelona (UB), Barcelona, Spain
| | - Valentí Puig-Diví
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain
| | - Félix Junquera
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Alba Lira
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain
| | - Enric Brullet
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain
| | - Anna Selva
- Clinical Epidemiology and Cancer Screening, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain
| | - Pilar García-Iglesias
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain
| | - Xavier Calvet
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Rafel Campo
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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Pin-Vieito N, Iglesias MJ, Remedios D, Álvarez-Sánchez V, Fernández-Bañares F, Boadas J, Martínez-Bauer E, Campo R, Bujanda L, Ferrández Á, Piñol V, Rodríguez-Alcalde D, Menéndez-Rodríguez M, García-Morales N, Pérez-Mosquera C, Cubiella J. Predictive Value of Carcinoembryonic Antigen in Symptomatic Patients without Colorectal Cancer: A Post-Hoc Analysis within the COLONPREDICT Cohort. Diagnostics (Basel) 2020; 10:diagnostics10121036. [PMID: 33276621 PMCID: PMC7770570 DOI: 10.3390/diagnostics10121036] [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: 10/06/2020] [Revised: 11/20/2020] [Accepted: 12/01/2020] [Indexed: 02/06/2023] Open
Abstract
We aimed to assess the risk of cancer in patients with abdominal symptoms after a complete colonoscopy without colorectal cancer (CRC), according to the carcinoembryonic antigen (CEA) concentration, as well as its diagnostic accuracy. For this purpose, we performed a post-hoc analysis within a cohort of 1431 patients from the COLONPREDICT study, prospectively designed to assess the fecal immunochemical test accuracy in detecting CRC. Over 36.5 ± 8.4 months, cancer was detected in 115 (8%) patients. Patients with CEA values higher than 3 ng/mL revealed an increased risk of cancer (HR 2.0, 95% CI 1.3-3.1), CRC (HR 4.4, 95% CI 1.1-17.7) and non-gastrointestinal cancer (HR 1.7, 95% CI 1.0-2.8). A new malignancy was detected in 51 (3.6%) patients during the first year and three variables were independently associated: anemia (OR 2.8, 95% CI 1.3-5.8), rectal bleeding (OR 0.3, 95% CI 0.1-0.7) and CEA level >3 ng/mL (OR 3.4, 95% CI 1.7-7.1). However, CEA was increased only in 31.8% (95% CI, 16.4-52.7%) and 50% (95% CI, 25.4-74.6%) of patients with and without anemia, respectively, who would be diagnosed with cancer during the first year of follow-up. On the basis of this information, CEA should not be used to assist in the triage of patients presenting with lower bowel symptoms who have recently been ruled out a CRC.
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Affiliation(s)
- Noel Pin-Vieito
- Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 32005 Ourense, Spain; (M.J.I.); (D.R.); (C.P.-M.); (J.C.)
- Instituto de Investigación Biomedica Galicia Sur, 32005 Ourense, Spain
- Department of Biochemistry, Genetics and Immunology, Faculty of Biology, University of Vigo, 36200 Vigo, Spain
- Correspondence: ; Tel./Fax: +34-988-385-399
| | - María José Iglesias
- Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 32005 Ourense, Spain; (M.J.I.); (D.R.); (C.P.-M.); (J.C.)
- Instituto de Investigación Biomedica Galicia Sur, 32005 Ourense, Spain
| | - David Remedios
- Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 32005 Ourense, Spain; (M.J.I.); (D.R.); (C.P.-M.); (J.C.)
- Instituto de Investigación Biomedica Galicia Sur, 32005 Ourense, Spain
| | | | | | - Jaume Boadas
- Gastroenterology Department, ConsorciSanitari de Terrassa, 08221 Terrassa, Spain;
| | - Eva Martínez-Bauer
- Gastroenterology Department, Hospital de Sabadell, Corporació Sanitàriai Universitària Parc Taulí, 08208 Sabadell, Spain; (E.M.-B.); (R.C.)
| | - Rafael Campo
- Gastroenterology Department, Hospital de Sabadell, Corporació Sanitàriai Universitària Parc Taulí, 08208 Sabadell, Spain; (E.M.-B.); (R.C.)
| | - Luis Bujanda
- Donostia Hospital, Biodonostia Institute, University of the Basque Country UPV/EHU, CIBERehd, 20010 San Sebastian, Spain;
| | - Ángel Ferrández
- Servicio de Aparato Digestivo, Hospital Clínico Universitario, IIS Aragón, University of Zaragoza, CIBERehd, 50009 Zaragoza, Spain;
| | - Virginia Piñol
- Gastroenterology Department, Hospital Dr. Josep Trueta, 17007 Girona, Spain;
| | | | | | - Natalia García-Morales
- Gastroenterology Department, Complexo Hospitalario Universitario Vigo, Pontevedra, 36001 Vigo, Spain;
| | - Cristina Pérez-Mosquera
- Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 32005 Ourense, Spain; (M.J.I.); (D.R.); (C.P.-M.); (J.C.)
| | - Joaquín Cubiella
- Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 32005 Ourense, Spain; (M.J.I.); (D.R.); (C.P.-M.); (J.C.)
- Instituto de Investigación Biomedica Galicia Sur, 32005 Ourense, Spain
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Martínez Vila C, Oliveres Montero de Novoa H, Martínez-Bauer E, Serra-Aracil X, Mora L, Casalots-Casado A, Macías-Declara I, Pericay C. A real world analysis of recurrence risk factors for early colorectal cancer T1 treated with standard endoscopic resection. Int J Colorectal Dis 2020; 35:921-927. [PMID: 32146501 DOI: 10.1007/s00384-020-03553-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND STUDY AIM Currently, endoscopic resection of early colorectal cancer defined as carcinoma with limited invasion of the mucosa (Tis) and submucosa (T1) is possible. However, lymph node spreading increases to 16.2% of cases when tumor invades the submucosa. We analyzed the previously identified factors for lymph node dissemination and recurrence, in our population. PATIENTS AND METHODS We analyzed retrospectively all patients with T1 tumors, treated at our center with endoscopic resection and some with additional surgery between January 2006 and January 2018. Statistical analysis was performed using IBM SPSS Statistics 25.0. RESULTS One hundred fifty-nine patients were treated with endoscopic resection, 56.6% with additional surgery. The mean age was 68.74 years and 69. 9% were male. All patients who underwent additional surgery presented negative margins and 8.8% presented positive lymph nodes. In a mean follow-up of 23.36 months, 13 patients had relapsed. The risk of relapse did not differ between patients treated with additional surgery from those who only underwent endoscopic resection (p = 0.506). On the other hand, lymph node dissemination (p = 0.007) and a positive endoscopic margin (p = 0.01) were independent risk factors for relapse. There was a positive association between lymph node dissemination and lymphatic (p = 0.07), vascular (p = 0.007), and perineural (p = 0.001) invasion and also with degree of histological differentiation (p = 0.001). CONCLUSION In our study, lymphatic, vascular, and perineural invasion and also the degree of histological differentiation were associated with lymph node dissemination. However, the only independent risk factors for long-term recurrence were a positive margin and lymph node dissemination.
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Affiliation(s)
- C Martínez Vila
- Department of Medical Oncology, Corporació Sanitària Parc Taulí Sabadell, Parc del Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - H Oliveres Montero de Novoa
- Department of Medical Oncology, Corporació Sanitària Parc Taulí Sabadell, Parc del Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - E Martínez-Bauer
- Department of Digestology-Endoscopy, Corporació Sanitària Parc Taulí Sabadell, Parc del Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - X Serra-Aracil
- Department of Surgery, Corporació Sanitària Parc Taulí Sabadell, Parc del Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - L Mora
- Department of Surgery, Corporació Sanitària Parc Taulí Sabadell, Parc del Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - A Casalots-Casado
- Department of Pathology, Corporació Sanitària Parc Taulí Sabadell, Parc del Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - I Macías-Declara
- Department of Medical Oncology, Corporació Sanitària Parc Taulí Sabadell, Parc del Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - C Pericay
- Department of Medical Oncology, Corporació Sanitària Parc Taulí Sabadell, Parc del Taulí 1, 08208, Sabadell, Barcelona, Spain.
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6
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Pin-Vieito N, Iglesias MJ, Remedios D, Rodríguez-Alonso L, Rodriguez-Moranta F, Álvarez-Sánchez V, Fernández-Bañares F, Boadas J, Martínez-Bauer E, Campo R, Bujanda L, Ferrandez Á, Piñol V, Rodríguez-Alcalde D, Guardiola J, Cubiella J, on behalf of the COLONPREDICT study investigators. Risk of gastrointestinal cancer in a symptomatic cohort after a complete colonoscopy: Role of faecal immunochemical test. World J Gastroenterol 2020; 26:70-85. [PMID: 31933515 PMCID: PMC6952298 DOI: 10.3748/wjg.v26.i1.70] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/11/2019] [Accepted: 12/22/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Faecal immunochemical test (FIT) has been recommended to assess symptomatic patients for colorectal cancer (CRC) detection. Nevertheless, some conditions could theoretically favour blood originating in proximal areas of the gastrointestinal tract passing through the colon unmetabolized. A positive FIT result could be related to other gastrointestinal cancers (GIC).
AIM To assess the risk of GIC detection and related death in FIT-positive symptomatic patients (threshold 10 μg Hb/g faeces) without CRC.
METHODS Post hoc cohort analysis performed within two prospective diagnostic test studies evaluating the diagnostic accuracy of different FIT analytical systems for CRC and significant colonic lesion detection. Ambulatory patients with gastrointestinal symptoms referred consecutively for colonoscopy from primary and secondary healthcare, underwent a quantitative FIT before undergoing a complete colonoscopy. Patients without CRC were divided into two groups (positive and negative FIT) using the threshold of 10 μg Hb/g of faeces and data from follow-up were retrieved from electronic medical records of the public hospitals involved in the research. We determined the cumulative risk of GIC, CRC and upper GIC. Hazard rate (HR) was calculated adjusted by age, sex and presence of significant colonic lesion.
RESULTS We included 2709 patients without CRC and a complete baseline colonoscopy, 730 (26.9%) with FIT ≥ 10 µgr Hb/gr. During a mean time of 45.5 ± 20.0 mo, a GIC was detected in 57 (2.1%) patients: An upper GIC in 35 (1.3%) and a CRC in 14 (0.5%). Thirty-six patients (1.3%) died due to GIC: 22 (0.8%) due to an upper GIC and 9 (0.3%) due to CRC. FIT-positive subjects showed a higher CRC risk (HR 3.8, 95%CI: 1.2-11.9) with no differences in GIC (HR 1.5, 95%CI: 0.8-2.7) or upper GIC risk (HR 1.0, 95%CI: 0.5-2.2). Patients with a positive FIT had only an increased risk of CRC-related death (HR 10.8, 95%CI: 2.1-57.1) and GIC-related death (HR 2.2, 95%CI: 1.1-4.3), with no differences in upper GIC-related death (HR 1.4, 95%CI: 0.6-3.3). An upper GIC was detected in 22 (0.8%) patients during the first year. Two variables were independently associated: anaemia (OR 5.6, 95%CI: 2.2-13.9) and age ≥ 70 years (OR 2.7, 95%CI: 1.1-7.0).
CONCLUSION Symptomatic patients without CRC have a moderate risk increase in upper GIC, regardless of the FIT result. Patients with a positive FIT have an increased risk of post-colonoscopy CRC.
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Affiliation(s)
- Noel Pin-Vieito
- Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Ourense 32005, Spain
- Instituto de Investigación Biomedica Galicia Sur, Ourense 32005, Spain
- Department of Biochemistry, Genetics and Immunology, Faculty of Biology, University of Vigo, Vigo 36200, Spain
| | - María J Iglesias
- Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Ourense 32005, Spain
- Instituto de Investigación Biomedica Galicia Sur, Ourense 32005, Spain
| | - David Remedios
- Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Ourense 32005, Spain
- Instituto de Investigación Biomedica Galicia Sur, Ourense 32005, Spain
| | - Lorena Rodríguez-Alonso
- Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona 08907, Spain. Ciber de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Francisco Rodriguez-Moranta
- Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona 08907, Spain. Ciber de Epidemiología y Salud Pública (CIBERESP), Spain
| | | | | | - Jaume Boadas
- Gastroenterology Department, Consorci Sanitari de Terrassa, Terrassa 08221, Spain
| | - Eva Martínez-Bauer
- Gastroenterology Department, Hospital de Sabadell, Corporació Sanitària i Universitària Parc Taulí, Sabadell 08208, Spain
| | - Rafael Campo
- Gastroenterology Department, Hospital de Sabadell, Corporació Sanitària i Universitària Parc Taulí, Sabadell 08208, Spain
| | - Luis Bujanda
- Donostia Hospital, Biodonostia Institute, University of the Basque Country UPV/EHU, CIBERehd, San Sebastian 20010, Spain
| | - Ángel Ferrandez
- Servicio de Aparato Digestivo, Hospital Clínico Universitario, IIS Aragón, University of Zaragoza, CIBERehd, Zaragoza 50009, Spain
| | - Virginia Piñol
- Gastroenterology Department, Hospital Dr. Josep Trueta, Girona 17007, Spain
| | | | - Jordi Guardiola
- Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona 08907, Spain. Ciber de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Joaquín Cubiella
- Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Ourense 32005, Spain
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Fernández-Bañares F, Clèries R, Boadas J, Ribes J, Oliva JC, Alsius A, Sanz X, Martínez-Bauer E, Galter S, Pujals M, Pujol M, Del Pozo P, Campo R. Prediction of advanced colonic neoplasm in symptomatic patients: a scoring system to prioritize colonoscopy (COLONOFIT study). BMC Cancer 2019; 19:734. [PMID: 31345180 PMCID: PMC6659265 DOI: 10.1186/s12885-019-5926-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 05/13/2019] [Accepted: 07/11/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fast-track colonoscopy to detect patients with colorectal cancer based on high-risk symptoms is associated with low sensitivity and specificity. The aim was to derive a predictive score of advanced colonic neoplasia in symptomatic patients in fast-track programs. METHODS All patients referred for fast-track colonoscopy were evaluated. Faecal immunological haemoglobin test (3 samples; positive> 4 μg Hb/g), and a survey to register clinical variables of interest were performed. Colorectal cancer and advanced adenoma were considered as advanced colonic neoplasia. A sample size of 600 and 500 individuals were calculated for each phase 1 and phase 2 of the study, respectively (Phase 1, derivation and Phase 2, validation cohort). A Bayesian logistic regression analysis was used to derive a predictive score. RESULTS 1495 patients were included. Age (OR, 21), maximum faecal-Hb value (OR, 2.3), and number of positive samples (OR, 28) presented the highest ORs predictive of advanced colonic neoplasia. The additional significant predictive variables adjusted for age and faecal-Hb variables in Phase 1 were previous colonoscopy (last 5 years) and smoking (no, ex/active). With these variables a predictive score of advanced colonic neoplasia was derived. Applied to Phase 2, patients with a Score > 20 had an advanced colonic neoplasia probability of 66% (colorectal cancer, 32%), while those with a Score ≤ 10, a probability of 10% (colorectal cancer, 1%). Prioritizing patients with Score > 10, 49.4% of patients would be referred for fast-track colonoscopy, diagnosing 98.3% of colorectal cancers and 77% of advanced adenomas. CONCLUSIONS A scoring system was derived and validated to prioritize fast-track colonoscopies according to risk, which was efficient, simple, and robust.
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Affiliation(s)
- Fernando Fernández-Bañares
- Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Plaza Dr Robert 5, 08221, Terrassa, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto Salud Carlos III, Madrid, Spain.
| | - Ramon Clèries
- Pla Director d'Oncologia, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jaume Boadas
- Department of Gastroenterology, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain
| | - Josepa Ribes
- Pla Director d'Oncologia, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Joan Carles Oliva
- Pla Director d'Oncologia, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Xavier Sanz
- Pla Director d'Oncologia, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Eva Martínez-Bauer
- Department of Gastroenterology, Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - Sara Galter
- Department of Gastroenterology, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain
| | - Mar Pujals
- Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Plaza Dr Robert 5, 08221, Terrassa, Barcelona, Spain
| | - Marta Pujol
- Department of Gastroenterology, Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - Patricia Del Pozo
- Department of Gastroenterology, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain
| | - Rafel Campo
- Department of Gastroenterology, Hospital Parc Taulí, Sabadell, Barcelona, Spain
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Machlab S, García-Iglesias P, Martínez-Bauer E, Campo R, Calvet X, Brullet E. Diagnostic utility of nasogastric tube aspiration and the ratio of blood urea nitrogen to creatinine for distinguishing upper and lower gastrointestinal tract bleeding. Emergencias 2019; 30:419-423. [PMID: 30638348] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The American College of Gastroenterology's 2016 clinical guidelines for treating lower gastrointestinal (GI) tract bleeding recommends evaluating of nasogastric tube aspiration and the ratio of blood urea nitrogen (BUN) to creatinine to differentiate upper from lower GI bleeds. However, the evidence base to support recommending these 2 diagnostic variables is low. This study aimed to evaluate the diagnostic utility of nasogastric tube aspiration and the BUN-to-creatinine ratio for distinguishing between upper and lower GI bleeding. MATERIAL AND METHODS We conducted a systematic review of the literature to find studies reporting the diagnostic precision of the BUN-to-creatinine ratio and nasogastric aspiration in patients with GI bleeding without hematemesis. RESULTS The sensitivity of both methods is low for detecting upper GI bleeding. Both blood in the aspirate and an elevated BUN-to-creatinine ratio significantly increase the probability of finding an upper GI source. The positive likelihood ratio varies from positive 2 to 11. However, the sensitivity of both tests for a diagnosis of upper GI bleeding is very low (negative likelihood ratio of 0.6). CONCLUSION A negative result on either of the 2 diagnostic tests provides little useful information and does not firmly rule out an upper GI bleed. Nasogastric tube aspiration cannot be recommended for distinguishing between upper and lower GI bleeding. If the diagnosis is in doubt, endoscopic exploration of the upper GI tract is necessary.
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Affiliation(s)
- Salvador Machlab
- Servicio de Aparato Digestivo, Hospital Universitari ParcTaulí. Institut d'Investigació i Innovació ParcTaulí, Barcelona, España. Departamento de Medicina. Universitat Autònoma de Barcelona, España
| | - Pilar García-Iglesias
- Servicio de Aparato Digestivo, Hospital Universitari ParcTaulí. Institut d'Investigació i Innovació ParcTaulí, Barcelona, España. Departamento de Medicina. Universitat Autònoma de Barcelona, España
| | - Eva Martínez-Bauer
- Servicio de Aparato Digestivo, Hospital Universitari ParcTaulí. Institut d'Investigació i Innovació ParcTaulí, Barcelona, España. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd). Instituto de Salud Carlos III, Madrid, España
| | - Rafael Campo
- Servicio de Aparato Digestivo, Hospital Universitari ParcTaulí. Institut d'Investigació i Innovació ParcTaulí, Barcelona, España. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd). Instituto de Salud Carlos III, Madrid, España
| | - Xavier Calvet
- Servicio de Aparato Digestivo, Hospital Universitari ParcTaulí. Institut d'Investigació i Innovació ParcTaulí, Barcelona, España. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd). Instituto de Salud Carlos III, Madrid, España
| | - Enric Brullet
- Servicio de Aparato Digestivo, Hospital Universitari ParcTaulí. Institut d'Investigació i Innovació ParcTaulí, Barcelona, España. Departamento de Medicina. Universitat Autònoma de Barcelona, España
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9
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Bella MR, Casas M, Vergara M, Brullet E, Junquera F, Martínez-Bauer E, Miquel M, Sánchez-Delgado J, Dalmau B, Campo R, Calvet X. Utility of histology for the diagnosis of portal hypertensive gastroenteropathy. Concordance between the endoscopic image and gastrointestinal biopsies. Role of the CD34 marker. Gastroenterol Hepatol 2019; 42:150-156. [PMID: 30459058 DOI: 10.1016/j.gastre.2019.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 05/29/2018] [Revised: 09/17/2018] [Accepted: 09/21/2018] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Upper gastroscopy in patients with cirrhosis often reveals non-specific lesions, which are usually oriented as portal hypertensive gastropathy (PHG). However, the diagnosis of PHG can be difficult, both from an endoscopic and histological point of view. The study of CD34 expression, which enhances the endothelial cells of the microvasculature, could help the differential diagnosis. The objectives of this study were to evaluate the correlation between endoscopy and histology in the diagnosis of PHG and to assess the utility of CD34 in the diagnosis of PHG. MATERIAL AND METHODS The results of immunostaining with CD34 gastric fundus biopsies from 100 cirrhotic patients and 20 controls were compared with the endoscopic images. RESULTS The correlation between the histology and the endoscopic diagnosis of PHG was very low (kappa=0.15). In addition, the measurement of the diameter of the gastric vessels enhanced by the use of immunohistochemical staining (CD34) did not show good correlation with the endoscopic diagnosis (p=.26) and did not provide relevant information for the histological diagnosis of PHG either. DISCUSSION The correlation between histology and endoscopy is low for the diagnosis of PHG. The use of immunostaining for CD34 does not seem to improve the diagnostic yield of the histological study.
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Affiliation(s)
- Maria Rosa Bella
- Servicio de Anatomía Patológica, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Meritxell Casas
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Mercedes Vergara
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España.
| | - Enric Brullet
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
| | - Félix Junquera
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
| | - Eva Martínez-Bauer
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Mireia Miquel
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
| | - Jordi Sánchez-Delgado
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
| | - Blai Dalmau
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Rafael Campo
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
| | - Xavier Calvet
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
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Puig I, López-Cerón M, Arnau A, Rosiñol Ò, Cuatrecasas M, Herreros-de-Tejada A, Ferrández Á, Serra-Burriel M, Nogales Ó, Vida F, de Castro L, López-Vicente J, Vega P, Álvarez-González MA, González-Santiago J, Hernández-Conde M, Díez-Redondo P, Rivero-Sánchez L, Gimeno-García AZ, Burgos A, García-Alonso FJ, Bustamante-Balén M, Martínez-Bauer E, Peñas B, Pellise M. Accuracy of the Narrow-Band Imaging International Colorectal Endoscopic Classification System in Identification of Deep Invasion in Colorectal Polyps. Gastroenterology 2019; 156:75-87. [PMID: 30296432 DOI: 10.1053/j.gastro.2018.10.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [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: 03/11/2018] [Revised: 09/19/2018] [Accepted: 10/02/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS T1 colorectal polyps with at least 1 risk factor for metastasis to lymph node should be treated surgically and are considered endoscopically unresectable. Optical analysis, based on the Narrow-Band Imaging International Colorectal Endoscopic (NICE) classification system, is used to identify neoplasias with invasion of the submucosa that require endoscopic treatment. We assessed the accuracy of the NICE classification, along with other morphologic characteristics, in identifying invasive polyps that are endoscopically unresectable (have at least 1 risk factor for metastasis to lymph node). METHODS We performed a multicenter, prospective study of data collected by 58 endoscopists, from 1634 consecutive patients (examining 2123 lesions) at 17 university and community hospitals in Spain from July 2014 through June 2016. All consecutive lesions >10 mm assessed with narrow-band imaging were included. The primary end point was the accuracy of the NICE classification for identifying lesions with deep invasion, using findings from histology analysis as the reference standard. Conditional inference trees were fitted for the analysis of diagnostic accuracy. RESULTS Of the 2123 lesions analyzed, 89 (4.2%) had features of deep invasion and 91 (4.3%) were endoscopically unresectable. The NICE classification system identified lesions with deep invasion with 58.4% sensitivity (95% CI, 47.5-68.8), 96.4% specificity (95% CI, 95.5-97.2), a positive-predictive value of 41.6% (95% CI, 32.9-50.8), and a negative-predictive value of 98.1% (95% CI, 97.5-98.7). A conditional inference tree that included all variables found the NICE classification to most accurately identify lesions with deep invasion (P < .001). However, pedunculated morphology (P < .007), ulceration (P = .026), depressed areas (P < .001), or nodular mixed type (P < .001) affected accuracy of identification. Results were comparable for identifying lesions that were endoscopically unresectable. CONCLUSIONS In an analysis of 2123 colon lesions >10 mm, we found the NICE classification and morphologic features identify those with deep lesions with >96% specificity-even in non-expert hands and without magnification. ClinicalTrials.gov number NCT02328066.
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Affiliation(s)
- Ignasi Puig
- Digestive Diseases Department, Althaia Xarxa Assistencial Universitària de Manresa, Barcelona, Spain; Universitat Internacional de Catalunya, Barcelona, Spain.
| | - María López-Cerón
- Gastroenterology Department, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Anna Arnau
- Clinical Research Unit, Althaia Xarxa Assistencial Universitària de Manresa, Barcelona, Spain
| | - Òria Rosiñol
- Pathology Department, Althaia Xarxa Assistencial Universitària de Manresa, Barcelona, Spain
| | - Miriam Cuatrecasas
- Pathology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain; Banc de Tumors, Biobanc Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Alberto Herreros-de-Tejada
- Gastroenterology Department, Research Institute Segovia Arana, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Ángel Ferrández
- Digestive Diseases Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Biomedical Research Networking Center in Hepatic and Digestive Diseases, Madrid, Spain
| | - Miquel Serra-Burriel
- Center for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Spain
| | - Óscar Nogales
- Digestive Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Francesc Vida
- Digestive Diseases Department, Althaia Xarxa Assistencial Universitària de Manresa, Barcelona, Spain
| | - Luisa de Castro
- Digestive Diseases Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Jorge López-Vicente
- Digestive Diseases Department, Hospital Universitario de Móstoles, Madrid, Spain
| | - Pablo Vega
- Digestive Diseases Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | | | - Jesús González-Santiago
- Digestive Diseases Department, Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain
| | - Marta Hernández-Conde
- Gastroenterology Department, Research Institute Segovia Arana, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Pilar Díez-Redondo
- Digestive Diseases Department, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Liseth Rivero-Sánchez
- Gastroenterology Department, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | | | - Aurora Burgos
- Digestive Diseases Department, Hospital Universitario La Paz, Madrid, Spain
| | | | - Marco Bustamante-Balén
- Digestive Diseases Department, Hospital Universitario y Politécnico de La Fe, Valencia, Spain
| | - Eva Martínez-Bauer
- Digestive Diseases Department, Corporació Sanitària Parc Taulí, Barecelon, Spain
| | - Beatriz Peñas
- Digestive Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Maria Pellise
- Gastroenterology Department, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Biomedical Research Networking Center in Hepatic and Digestive Diseases, Madrid, Spain
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Bella MR, Casas M, Vergara M, Brullet E, Junquera F, Martínez-Bauer E, Miquel M, Sánchez-Delgado J, Dalmau B, Campo R, Calvet X. Utility of histology for the diagnosis of portal hypertensive gastroenteropathy. Concordance between the endoscopic image and gastrointestinal biopsies. Role of the CD34 marker. Gastroenterol Hepatol 2018; 42:150-156. [PMID: 30459058 DOI: 10.1016/j.gastrohep.2018.09.008] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/17/2018] [Accepted: 09/21/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Upper gastroscopy in patients with cirrhosis often reveals non-specific lesions, which are usually oriented as portal hypertensive gastropathy (PHG). However, the diagnosis of PHG can be difficult, both from an endoscopic and histological point of view. The study of CD34 expression, which enhances the endothelial cells of the microvasculature, could help the differential diagnosis. The objectives of this study were to evaluate the correlation between endoscopy and histology in the diagnosis of PHG and to assess the utility of CD34 in the diagnosis of PHG. MATERIAL AND METHODS The results of immunostaining with CD34 gastric fundus biopsies from 100 cirrhotic patients and 20 controls were compared with the endoscopic images. RESULTS The correlation between the histology and the endoscopic diagnosis of PHG was very low (kappa=0.15). In addition, the measurement of the diameter of the gastric vessels enhanced by the use of immunohistochemical staining (CD34) did not show good correlation with the endoscopic diagnosis (p=.26) and did not provide relevant information for the histological diagnosis of PHG either. DISCUSSION The correlation between histology and endoscopy is low for the diagnosis of PHG. The use of immunostaining for CD34 does not seem to improve the diagnostic yield of the histological study.
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Affiliation(s)
- Maria Rosa Bella
- Servicio de Anatomía Patológica, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Meritxell Casas
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Mercedes Vergara
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España.
| | - Enric Brullet
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
| | - Félix Junquera
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
| | - Eva Martínez-Bauer
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Mireia Miquel
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
| | - Jordi Sánchez-Delgado
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
| | - Blai Dalmau
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Rafael Campo
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
| | - Xavier Calvet
- Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
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Casas M, Vergara M, Brullet E, Junquera F, Martínez-Bauer E, Miquel M, Sánchez-Delgado J, Dalmau B, Campo R, Calvet X. Inter and intra-observer concordance for the diagnosis of portal hypertension gastropathy. Rev Esp Enferm Dig 2018; 110:166-171. [PMID: 29320862 DOI: 10.17235/reed.2018.5169/2017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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
INTRODUCTION At present there is no fully accepted endoscopic classification for the assessment of the severity of portal hypertensive gastropathy (PHG). Few studies have evaluated inter and intra-observer concordance or the degree of concordance between different endoscopic classifications. OBJECTIVES To evaluate inter and intra-observer agreement for the presence of portal hypertensive gastropathy and enteropathy using different endoscopic classifications. METHODS Patients with liver cirrhosis were included into the study. Enteroscopy was performed under sedation. The location of lesions and their severity was recorded. Images were videotaped and subsequently evaluated independently by three different endoscopists, one of whom was the initial endoscopist. The agreement between observations was assessed using the kappa index. RESULTS Seventy-four patients (mean age 63.2 years, 53 males and 21 females) were included. The agreement between the three endoscopists regarding the presence or absence of PHG using the Tanoue and McCormack classifications was very low (kappa scores = 0.16 and 0.27, respectively). CONCLUSIONS The current classifications of portal hypertensive gastropathy have a very low degree of intra and inter-observer agreement for the diagnosis and assessment of gastropathy severity.
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Affiliation(s)
- Meritxell Casas
- Servicio de Aparato Digestivo, Corporació Sanitària Universitària Parc Taulí. Universitat Autònoma de Barcelona, españa
| | - Mercedes Vergara
- Servicio de Aparato Digestivo, Corporació Sanitària Universitària Parc Taulí. Universitat Autònoma de Barcelona
| | - Enric Brullet
- Servicio de Aparato Digestivo, Corporació Sanitària Universitària Parc Taulí. Universitat Autònoma de Barcelona, españa
| | - Félix Junquera
- Servicio de Aparato Digestivo, Corporació Sanitària Universitària Parc Taulí. Universitat Autònoma de Barcelona, España
| | - Eva Martínez-Bauer
- Servicio de Aparato Digestivo, Corporació Sanitària Universitària Parc Taulí. Universitat Autònoma de Barcelona, España
| | - Mireia Miquel
- Servicio de Aparato Digestivo, Corporació Sanitària Universitària Parc Taulí. Universitat Autònoma de Barcelona
| | - Jordi Sánchez-Delgado
- Servicio Aparato Digestivo, Corporació Sanitària Universitària Parc Taulí. Universitat Autònoma de Barcelona, España
| | - Blai Dalmau
- Servicio Aparato Digestivo, Corporació Sanitària Universitària Parc Taulí. Universitat Autònoma de Barcelona
| | - Rafael Campo
- Servicio de Aparato Digestivo, Corporació Sanitària Universitària Parc Taulí. Universitat Autònoma de Barcelona, España
| | - Xavier Calvet
- Servicio de Aparato Digestivo, Corporació Sanitària Universitària Parc Taulí. Universitat Autònoma de Barcelona, España
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Serra-Aracil X, Pallisera-Lloveras A, Mora-Lopez L, Serra-Pla S, Puig-Diví V, Casalots À, Martínez-Bauer E, Navarro-Soto S. Transanal endoscopic surgery is effective and safe after endoscopic polypectomy of potentially malignant rectal polyps with questionable margins. Colorectal Dis 2018; 20:789-796. [PMID: 29577555 DOI: 10.1111/codi.14108] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 01/10/2018] [Accepted: 03/06/2018] [Indexed: 02/08/2023]
Abstract
AIM To determine the percentage of residual lesion observed in the pathology study of transanal endoscopic surgery (TEM) specimens after endoscopic polypectomy of malignant rectal polyps with questionable margins, and the need for further surgery. Secondary aims: to determine the morbidity and mortality associated with this procedure and to identify the percentage of recurrence after excision by TEM. METHODS Observational study with prospective data collection of all patients undergoing TEM after endoscopic polypectomy for malignant rectal polyps or non-invasive high-grade neoplasia, from January 2004 to December 2016. An en bloc full-thickness wall excision of the scar was performed. Variables recorded: histology of TEM specimen, 30-day morbidity and mortality according to the Clavien-Dindo classification, need for salvage surgery and recurrence. RESULTS Fifty out of 690 patients undergoing TEM during the study period (36 adenocarcinomas, five non-invasive high-grade neoplasias and 9 neuroendocrine tumors) were included. Post-surgery histology showed residual lesion in 21 (42%) patients: 7 neuroendocrine tumors, 10 adenomas and 4 adenocarcinomas (two pT1, one pT2 and one pT3). The pT2 and pT3 patients (4%) underwent salvage surgery. No recurrence was observed, and mean follow-up was 29.1Â ± 21.6 months. The 30-day morbidity rate was 14%, but 4/7 with Clavien-Dindo grade I. CONCLUSIONS After endoscopic polypectomy of malignant rectal polyps with questionable margins, the presence of residual lesion in the pathology study of transanal resection specimens is high. TEM with full-thickness resection of these lesions is an appropriate treatment, allowing disease control and achieving minimal morbidity.
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Affiliation(s)
- X Serra-Aracil
- Coloproctology Unit, General and Digestive Surgery Department, Parc Taulí University Hospital, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - A Pallisera-Lloveras
- Coloproctology Unit, General and Digestive Surgery Department, Parc Taulí University Hospital, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - L Mora-Lopez
- Coloproctology Unit, General and Digestive Surgery Department, Parc Taulí University Hospital, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - S Serra-Pla
- Coloproctology Unit, General and Digestive Surgery Department, Parc Taulí University Hospital, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - V Puig-Diví
- Digestive Department, Parc Taulí University Hospital, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - À Casalots
- Pathology Department, Parc Taulí University Hospital, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - E Martínez-Bauer
- Digestive Department, Parc Taulí University Hospital, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - S Navarro-Soto
- Coloproctology Unit, General and Digestive Surgery Department, Parc Taulí University Hospital, Universitat Autònoma de Barcelona, Sabadell, Spain
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Lario S, Ramírez-Lázaro MJ, Montserrat A, Quílez ME, Junquera F, Martínez-Bauer E, Sanfeliu I, Brullet E, Campo R, Segura F, Calvet X. Diagnostic accuracy of three monoclonal stool tests in a large series of untreated Helicobacter pylori infected patients. Clin Biochem 2016; 49:682-687. [PMID: 26794025 DOI: 10.1016/j.clinbiochem.2016.01.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 01/13/2016] [Accepted: 01/16/2016] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Immunochromatographic tests need to be improved in order to enhance their reliability. Recently, several new kits have appeared on the market. The objective was to evaluate the diagnostic accuracy of three monoclonal rapid stool tests - the new Uni-Gold™ H.pylori Antigen (Trinity Biotech, Ireland), the RAPID Hp StAR (Oxoid Ltd., UK) and the ImmunoCard STAT! HpSA (Meridian Diagnostics, USA) - for detecting H. pylori infection prior to eradication treatment. DESIGN AND METHODS Diagnostic accuracy (sensitivity and specificity) and reliability (concordance between observers) were evaluated in 250 untreated consecutive dyspeptic patients. The gold standard for diagnosing H. pylori infection was defined as the concordance of two or more of rapid urease test (RUT), histopathology and urease breath test (UBT) or positive culture in isolation. Readings of immunochromatographic tests were performed by two different observers. Sensitivity, specificity, positive and negative predictive values and 95% confidence intervals were calculated. Sensitivity and specificity were compared using the McNemar test. RESULTS The three tests showed a good correlation, with Kappa values>0.9. RAPID Hp StAR had a sensitivity of 91%-92% and a specificity ranging from 77% to 85%. Its sensitivity was higher than that of Uni-Gold™ H.pylori Antigen and ImmunoCard STAT! HpSA (p<0.01). Uni-Gold™ H.pylori Antigen kit showed a sensitivity of 83%, similar to ImmunoCard STAT! HpSA. Specificity of Uni-Gold™ H.pylori Antigen approached 90% (87-89%) and was superior to that of RAPID Hp StAR (p<0.01). CONCLUSIONS Uni-Gold™ H.pylori Antigen and ImmunoCard STAT! HpSA present similar levels of diagnostic accuracy. RAPID Hp StAR was the most sensitive but less reliable of the three immunochromatographic stool tests. None are as accurate and reliable as UBT, RUT and histology.
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Affiliation(s)
- Sergio Lario
- Digestive Diseases Service, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-UAB, Sabadell, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Fundació Parc Taulí, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-UAB, Sabadell, Spain
| | - María José Ramírez-Lázaro
- Digestive Diseases Service, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-UAB, Sabadell, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Antònia Montserrat
- Digestive Diseases Service, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-UAB, Sabadell, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - María Elisa Quílez
- Digestive Diseases Service, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-UAB, Sabadell, Spain; Fundació Parc Taulí, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-UAB, Sabadell, Spain
| | - Félix Junquera
- Digestive Diseases Service, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-UAB, Sabadell, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Eva Martínez-Bauer
- Digestive Diseases Service, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-UAB, Sabadell, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Isabel Sanfeliu
- Microbiology Laboratory, UDIAT-CD, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-UAB, Sabadell, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD06/0018), Spain
| | - Enric Brullet
- Digestive Diseases Service, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-UAB, Sabadell, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Rafael Campo
- Digestive Diseases Service, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-UAB, Sabadell, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Ferran Segura
- Infectious Disease Service, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-UAB, Sabadell, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD06/0018), Spain
| | - Xavier Calvet
- Digestive Diseases Service, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-UAB, Sabadell, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
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Sopeña-Falco J, Poch-Vall N, Brullet E, Mendez-Reyes H, Martínez-Bauer E, Junquera F, Pujol-Caballe G, Campo R. Fatal massive air embolism following diagnostic colonoscopy. Endoscopy 2013; 45 Suppl 2 UCTN:E91. [PMID: 23526536 DOI: 10.1055/s-0032-1326254] [Citation(s) in RCA: 3] [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: 12/10/2022]
Affiliation(s)
- J Sopeña-Falco
- Digestive Diseases Department, Corporació Sanitaria Parc Tauli, Sabadell, Spain.
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Junquera F, Martínez-Bauer E, Miquel M, Fort M, Gallach M, Brullet E, Campo R. OVESCO: un sistema prometedor de cierre endoscópico de las perforaciones del tracto digestivo. Gastroenterología y Hepatología 2011; 34:568-72. [DOI: 10.1016/j.gastrohep.2011.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Accepted: 05/18/2011] [Indexed: 02/09/2023]
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Martínez-Bauer E, Forns X, Armelles M, Planas R, Solà R, Vergara M, Fàbregas S, Vega R, Salmerón J, Diago M, Sánchez-Tapias JM, Bruguera M. Hospital admission is a relevant source of hepatitis C virus acquisition in Spain. J Hepatol 2008; 48:20-7. [PMID: 17998149 DOI: 10.1016/j.jhep.2007.07.031] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [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: 12/28/2006] [Revised: 06/18/2007] [Accepted: 07/05/2007] [Indexed: 12/21/2022]
Abstract
BACKGROUND/AIMS Isolated cases of acute hepatitis C, as well as hepatitis C outbreaks transmitted by health-care related procedures, have drawn attention to nosocomial transmission of HCV. The aim of this study was to investigate the current relevance of nosocomial HCV infection. METHODS For this purpose, we performed a retrospective epidemiological analysis of all cases of acute hepatitis C diagnosed in 18 Spanish hospitals. Between 1998 and 2005, 109 cases were documented. RESULTS The most relevant risk factors registered during the 6-month period preceding the diagnosis of acute hepatitis C were: hospital admission in 73 (67%) cases, intravenous drug use in 9 (8%), accidental needlestick injury in 7 (6%) and sexual contact in 6 (5%). Among the 73 patients in whom hospital admission was the only risk factor, 33 underwent surgery and 24 were admitted to a medical emergency unit or a medical ward; the remaining 16 patients underwent an invasive diagnostic or therapeutic procedure. Sixty two patients underwent antiviral therapy and 51 (82%) achieved a sustained virological response. In 47 patients treatment was not indicated (in 24 due to spontaneous resolution of HCV infection). CONCLUSIONS In most patients with acute hepatitis C the only documented risk factor associated with the infection is hospital admission. These results stress the need for strict adherence to universal precaution measures. Fortunately, most cases of acute hepatitis C either resolve spontaneously or after antiviral therapy.
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Affiliation(s)
- Eva Martínez-Bauer
- Liver Unit, Hospital Clínic de Barcelona, IDIBAPS, Ciber de Enfermedades Hepáticas y Digestivas, Ciberehd, Spain
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Sánchez-Tapias JM, Diago M, Escartín P, Enríquez J, Romero-Gómez M, Bárcena R, Crespo J, Andrade R, Martínez-Bauer E, Pérez R, Testillano M, Planas R, Solá R, García-Bengoechea M, Garcia-Samaniego J, Muñoz-Sánchez M, Moreno-Otero R. Peginterferon-alfa2a plus ribavirin for 48 versus 72 weeks in patients with detectable hepatitis C virus RNA at week 4 of treatment. Gastroenterology 2006; 131:451-60. [PMID: 16890599 DOI: 10.1053/j.gastro.2006.05.016] [Citation(s) in RCA: 289] [Impact Index Per Article: 16.1] [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: 12/30/2005] [Accepted: 04/20/2006] [Indexed: 01/03/2023]
Abstract
BACKGROUND & AIMS Patients with chronic hepatitis C who do not respond rapidly to therapy have a low chance of developing a sustained virologic response (SVR) when treated for 48 weeks. This study investigated whether treatment for 72 weeks increases the rate of SVR in patients with detectable hepatitis C virus (HCV)-RNA levels at week 4 of treatment. METHODS A total of 510 treatment-naive patients were treated with peginterferon-alfa2a (180 microg/wk) plus ribavirin (800 mg/day). Patients with detectable HCV-RNA levels at week 4 (n = 326) were randomized to complete 48 (group A, n = 165) or 72 weeks (group B, n = 161) of treatment. Patients with undetectable HCV-RNA levels at week 4 (n = 184) were allocated into group C (n = 148) or group D (n = 36), according to HCV genotype and baseline viremia, and treated for 24 or 48 weeks, respectively. All patients were followed-up for 24 weeks after the end of treatment. RESULTS The end-of-treatment response rate (61%) was similar in groups A and B, but the SVR rate was higher in group B (45% vs 32% in A; P = .01). In genotype 1-infected patients randomized to group A (n = 149) or B (n = 142), SVR rates were 28% and 44%, respectively (P = .003). The incidence of adverse events was similar in all groups. Treatment discontinuation was more frequent in group B (36%) than in group A (18%) (P = .0004). SVR rates in groups C and D were 79% and 64%, respectively. CONCLUSIONS Extension of treatment with peginterferon-alfa2a plus ribavirin from 48 to 72 weeks significantly increases the rate of SVR in patients with detectable viremia at week 4 of treatment.
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Affiliation(s)
- José M Sánchez-Tapias
- Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
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20
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Feliu A, Carrión JA, Massaguer A, Martínez-Bauer E, García-Retortillo M, González P, Costa J, Sánchez-Tapias JM, Forns X. Sensitivity to antiviral therapy may change after liver transplantation in patients with chronic hepatitis C virus infection. J Viral Hepat 2006; 13:544-51. [PMID: 16901285 DOI: 10.1111/j.1365-2893.2006.00714.x] [Citation(s) in RCA: 13] [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] [Indexed: 01/28/2023]
Abstract
In hepatitis C virus (HCV)-infected patients, it is generally assumed that the pattern of response to antiviral therapy remains unaltered after liver transplantation (LT). However, changes in the circulating HCV quasispecies and in the gene expression profiles of the graft might influence response to treatment after LT. We evaluated 22 HCV-infected patients who received antiviral treatment while awaiting LT and in whom HCV infection recurred. Eleven of these patients underwent a new antiviral treatment course. Our study analyses the early virological response to both treatment courses to assess the influence of the changes in HCV on the response to therapy. Patients were considered early virological responders (EVR) if viral load declined > or = 2 log10 during the first 12 weeks of therapy. The remaining individuals were considered nonresponders (NR). HCV sequences from hypervariable region 1 and nonstructural 5A (NS5A) region before both treatment regimens were compared. Of 11 patients, 8 (73%) showed identical early response to both courses of therapy (group A: five EVR-EVR, three NR-NR). Interestingly, the response changed in three patients (27%) (group B): two NR became EVR after transplantation, whereas one EVR became NR. Fixation of mutations within the NS5A occurred preferentially in group B (100%) compared with group A (37%)(P = 0.12). However, the number of fixed mutations was not significantly different between groups, suggesting that the changes in sensitivity to therapy after LT are not exclusively dependent on variations in HCV strains. In conclusion, in HCV-infected patients undergoing LT, the pattern of response to antiviral treatment may change after transplantation, and this possibility needs to be incorporated in clinical practice.
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Affiliation(s)
- A Feliu
- Liver Unit, Institut de Malalties Digestives, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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21
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Martínez-Bauer E, Crespo J, Romero-Gómez M, Moreno-Otero R, Solá R, Tesei N, Pons F, Forns X, Sánchez-Tapias JM. Development and validation of two models for early prediction of response to therapy in genotype 1 chronic hepatitis C. Hepatology 2006; 43:72-80. [PMID: 16374857 DOI: 10.1002/hep.21002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [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: 01/01/2023]
Abstract
Early prediction of response to therapy in genotype 1 chronic hepatitis C is difficult. Two predictive models, a pretreatment scoring model (PreT-SM) and a fourth week of therapy scoring model (4w-SM) were constructed in a cohort of 104 patients from a single center (estimation cohort) and validated in a cohort of 141 patients from four independent centers (validation cohort). Individual scores were calculated using variables independently associated with sustained virological response (SVR). Baseline viral load, aspartate aminotransferase/alanine aminotransferase ratio, serum cholesterol, and a numerical score for noninvasive estimation of liver fibrosis were included in the PreT-SM; HCV RNA clearance and PreT-SM scores were included in the 4w-SM. Receiver operating characteristic analysis revealed the area under the curve in the estimation cohort and in the validation cohort to be, respectively, 0.856 and 0.847 for the PreT-SM and 0.908 and 0.907 for the 4w-SM. Low scores were associated with SVR, high scores with non-SVR. The best cutoff scores from the PreT-SM (7 and 9.70) identified, respectively, 36% of patients with SVR and 41% of those with non-SVR from the validation cohort, with high accuracy (> or =90% positive predictive value [PPV] and specificity). Similarly, cutoff scores of 3.20 and 5.60 from the 4w-SM identified, respectively, 71% of patients with SVR and 53% of those with non-SVR from the same cohort with high accuracy (PPV and specificity >92%). In conclusion, these models predicted response to therapy before or after 4 weeks of treatment in approximately 60% of genotype 1 patients and may be valuable for the management of this condition.
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Forns X, Martínez-Bauer E, Feliu A, García-Retortillo M, Martín M, Gay E, Navasa M, Sánchez-Tapias JM, Bruguera M, Rodés J. Nosocomial transmission of HCV in the liver unit of a tertiary care center. Hepatology 2005; 41:115-22. [PMID: 15619236 DOI: 10.1002/hep.20515] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [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] [Indexed: 12/15/2022]
Abstract
Despite its medical and legal implications, there are no prospective studies analyzing the incidence and mechanisms involved in the nosocomial transmission of hepatitis C virus (HCV) in liver units. This study prospectively investigates the nosocomial transmission of HCV in the liver unit of a tertiary care center from August 2000 to October 2002. The median prevalence of HCV infection among hospitalized patients was 50%. Anti-HCV-negative patients admitted to the liver unit during the study period were prospectively followed, and serum markers of HCV infection were repeated 6 months after discharge. All known risk factors for HCV transmission (including the physical allocation of HCV-infected and noninfected patients during hospitalization) were recorded. Complete follow-up data were available in 1301 (84.5%) of 1540 patients. Six patients (0.46%) acquired HCV infection (annual incidence: 0.27/100 admissions). Phylogenetic analyses of recovered HCV sequences identified the source of infection as an HCV-infected roommate (3 cases) and a patient receiving care by the same nurse team (1 case). The most relevant risk factors associated with HCV acquisition were duration of hospitalization (>10 days; OR, 35; 95% CI, 1.96-622) and hospitalization with an HCV-infected roommate (>5 days; OR, 12; 95% CI, 1.39-103). In fact, HCV infection occurred in 1.7% of the 357 patients hospitalized longer than 10 days. In conclusion, HCV nosocomial infection appears to occur via patient-to-patient transmission in liver units, particularly in individuals who require long hospitalizations. Continuous reinforcement of universal prevention measures and, when possible, isolation of patients at higher risk might further reduce nosocomial HCV transmission.
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Affiliation(s)
- Xavier Forns
- Liver Unit, Institut de Malalties Digestives, Hospital Clinic, IDIBAPS, Barcelona, Spain.
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Martínez-Bauer E, Forns X. [Antiviral treatment in liver cirrhosis due to hepatitis C virus]. Gastroenterol Hepatol 2003; 26:303-6. [PMID: 12732104 DOI: 10.1016/s0210-5705(03)70362-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- E Martínez-Bauer
- Servicio de Hepatología. Institut de Malalties Digestives. Hospital Clínic. Barcelona. España
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Forns X, Ampurdanès S, Llovet JM, Aponte J, Quintó L, Martínez-Bauer E, Bruguera M, Sánchez-Tapias JM, Rodés J. Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model. Hepatology 2002; 36:986-92. [PMID: 12297848 DOI: 10.1053/jhep.2002.36128] [Citation(s) in RCA: 751] [Impact Index Per Article: 34.1] [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
Liver biopsy is required for staging hepatic fibrosis in patients with chronic hepatitis C, but it is an expensive procedure with occasional complications and poor patient acceptance. This cohort study was designed to assess the accuracy of a noninvasive method aimed to discriminate between patients with and without significant liver fibrosis (stages 2-4 versus 0-1). Clinically relevant variables were analyzed in a cohort of 476 consecutive untreated patients (estimation group, 351 patients; validation group, 125 patients) with chronic hepatitis C who underwent a liver biopsy. Multivariate analysis identified age, gamma glutamyl transpeptidase (GGT), cholesterol, platelet count, and prothrombin time as independent predictors of fibrosis. We constructed a model and a score system combining age, GGT, cholesterol, and platelet count that proved useful to identify patients without significant hepatic fibrosis. The area under the ROC curve was 0.86 for the estimation group and 0.81 for the validation group. Using the best cutoff score (less than 4.2), presence of significant fibrosis (F2 to F4) could be excluded with high accuracy (negative predictive value of 96%) in 125 (36%) of 351 patients. Similarly, it could be excluded with the same certainty in 49 (39%) of the 125 patients of the validation group. Only 2 patients with liver fibrosis stage 2 were incorrectly classified. In conclusion, a combination of easily accessible variables accurately predicts the absence of significant fibrosis and might render liver biopsy unnecessary in more than one third of patients with chronic hepatitis C.
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Affiliation(s)
- Xavier Forns
- Liver Unit, Institut de Malalties Digestives, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Catalonia, Spain.
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