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Córdova H, Barreiro-Alonso E, Castillo-Regalado E, Cubiella J, Delgado-Guillena P, Díez Redondo P, Galdín M, García-Rodríguez A, Hernández L, Huerta A, Jover R, Núñez H, Rodríguez-D'Jesús A, Seoane A, Surís G, Tejedor-Tejada J, Jiménez Sánchez J, Martín F, Moreira L, Carballal S, Rivero L, Da Fieno A, Casanova G, Luzko Scheid I, Llach J, Fernández-Esparrach G. Applicability of the Barcelona scale to assess the quality of cleanliness of mucosa at esophagogastroduodenoscopy. Gastroenterol Hepatol 2024; 47:246-252. [PMID: 37236304 DOI: 10.1016/j.gastrohep.2023.05.011] [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: 03/15/2023] [Revised: 05/11/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND OBJECTIVES There are few scales with prospective validation for the assessment of the upper gastrointestinal mucosal cleanliness during an esophagogastroduodenoscopy (EGD). The aim of this study was to develop a valid and reproducible cleanliness scale for use during an EGD. METHODS We developed a cleanliness scale (Barcelona scale) with a score (0-2 points) of five segments of the upper gastrointestinal tract with thorough cleaning techniques (esophagus, fundus, body, antrum, and duodenum). First, 125 photos (25 of each area) were assessed, and a score was assigned to each image by consensus among 7 experts endoscopists. Subsequently, 100 of the 125 images were selected and the inter- and intra-observer variability of 15 previously trained endoscopists was evaluated using the same images at two different times. RESULTS In total, 1500 assessments were performed. In 1336/1500 observations (89%) there was agreement with the consensus score, with a mean kappa value of 0.83 (0.45-0.96). In the second evaluation, in 1330/1500 observations (89%) there was agreement with the consensus score, with a mean kappa value of 0.82 (0.45-0.93). The intra-observer variability was 0.89 (0.76-0.99). CONCLUSIONS The Barcelona cleanliness scale is a valid measure and reproducible with minimal training. Its application in clinical practice is a significant step to standardize the quality of the EGD.
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Affiliation(s)
- Henry Córdova
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Eva Barreiro-Alonso
- Department of Gastroenterology, Hospital Universitario Central de Asturias and Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Edgar Castillo-Regalado
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Joaquín Cubiella
- Department of Gastroenterology, Hospital Universitario de Ourense. Research Group in Gastrointestinal Oncology-Ourense. CIBERehd, Ourense, Spain
| | | | | | | | - Ana García-Rodríguez
- Servicio de Digestivo, Unidad de Endoscopia, Hospital de Viladecans, Barcelona, Spain
| | | | - Alain Huerta
- Hospital Universitario de Galdakao, Biocruces Bizkaia, Departamento Medicina UPV-EHU Leioa, Spain
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria ISABIAL, Universidad Miguel Hernández, Alicante, Spain
| | - Henar Núñez
- Hospital Universitario Río Hortega, Valladolid, Spain
| | | | - Agustín Seoane
- Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Gerard Surís
- Servicio de Digestivo, Unidad de Endoscopia, Hospital de Viladecans, Barcelona, Spain
| | | | | | | | - Leticia Moreira
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Sabela Carballal
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Liseth Rivero
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Angella Da Fieno
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Gherzon Casanova
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Irina Luzko Scheid
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Joan Llach
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Gloria Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain.
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2
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Rodríguez de Santiago E, Herreros-de-Tejada A, Albéniz E, Ramos Zabala F, Fernández-Esparrach G, Nogales O, Rosón P, Peñas García B, Uchima H, Terán Á, Rodríguez Sánchez J, de Frutos D, Parejo Carbonell S, Santiago J, Díaz Tasende J, Guarner Argente C, de María Pallarés P, Amorós A, Barranco D, Álvarez de Castro D, Muñoz González R, Marín-Gabriel JC. Implementation of esophageal endoscopic submucosal dissection in Spain: Results from the nationwide registry. Gastroenterol Hepatol 2024; 47:119-129. [PMID: 36870477 DOI: 10.1016/j.gastrohep.2023.02.008] [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: 10/21/2022] [Revised: 01/24/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION AND AIMS The outcomes of endoscopic submucosal dissection (ESD) in the esophagus have not been assessed in our country. Our primary aim was to analyze the effectiveness and safety of the technique. MATERIAL AND METHODS Analysis of the prospectively maintained national registry of ESD. We included all superficial esophageal lesions removed by ESD in 17 hospitals (20 endoscopists) between January 2016 and December 2021. Subepithelial lesions were excluded. The primary outcome was curative resection. We conducted a survival analysis and used logistic regression analysis to assess predictors of non-curative resection. RESULTS A total of 102 ESD were performed on 96 patients. The technical success rate was 100% and the percentage of en-bloc resection was 98%. The percentage of R0 and curative resection was 77.5% (n=79; 95%CI: 68%-84%) and 63.7% (n=65; 95%CI: 54%-72%), respectively. The most frequent histology was Barrett-related neoplasia (n=55 [53.9%]). The main reason for non-curative resection was deep submucosal invasion (n=25). The centers with a lower volume of ESD obtained worse results in terms of curative resection. The rate of perforation, delayed bleeding and post-procedural stenosis were 5%, 5% and 15.7%, respectively. No patient died or required surgery due to an adverse effect. After a median follow-up of 14months, 20patients (20.8%) underwent surgery and/or chemoradiotherapy, and 9 patients died (mortality 9.4%). CONCLUSIONS In Spain, esophageal ESD is curative in approximately two out of three patients, with an acceptable risk of adverse events.
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Affiliation(s)
- Enrique Rodríguez de Santiago
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España.
| | - Alberto Herreros-de-Tejada
- Servicio de Digestivo, Hospital Universitario Puerta de Hierro, Instituto de Investigación Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, España; Hospital La Luz, QuirónSalud, Madrid, España
| | - Eduardo Albéniz
- Unidad de Endoscopia, Servicio de Gastroenterología, Hospital Universitario de Navarra NavarraBiomed, Universidad Pública de Navarra (UPNA), IdisNA, Pamplona, España
| | - Felipe Ramos Zabala
- Servicio de Gastroenterología, Hospital Universitario HM Montepríncipe, Grupo HM hospitales, Boadilla del Monte, Madrid, España
| | - Gloria Fernández-Esparrach
- Sección de Endoscopia, Servicio de Gastroenterología, ICMDM, Hospital Clínic de Barcelona; Institut d'Investigacions Biomèdiques August Pi i Sunyer. CIBEREHD. Universidad de Barcelona, Barcelona, España
| | - Oscar Nogales
- Servicio de Gastroenterología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Pedro Rosón
- Servicio de Aparato Digestivo, Hospital Vithas Xanit internacional Málaga, Málaga, España
| | - Beatriz Peñas García
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España
| | - Hugo Uchima
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España; Centro Médico Teknon, Barcelona, España
| | - Álvaro Terán
- Servicio de Gastroenterología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, España
| | - Joaquín Rodríguez Sánchez
- Servicio de Medicina del Aparato Digestivo, Unidad de Endoscopias, Hospital Universitario 12 de Octubre; Instituto de Investigación «i+12», Madrid, España; Servicio de Gastroenterología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Diego de Frutos
- Servicio de Digestivo, Hospital Universitario Puerta de Hierro, Instituto de Investigación Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, España
| | - Sofía Parejo Carbonell
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España
| | - José Santiago
- Servicio de Digestivo, Hospital Universitario Puerta de Hierro, Instituto de Investigación Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, España
| | - José Díaz Tasende
- Servicio de Medicina del Aparato Digestivo, Unidad de Endoscopias, Hospital Universitario 12 de Octubre; Instituto de Investigación «i+12», Madrid, España
| | - Charly Guarner Argente
- Servicio de Gastroenterología, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, España
| | | | - Ana Amorós
- Servicio de Gastroenterología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - Daniel Barranco
- Unidad de Endoscopia, Servicio de Gastroenterología, Hospital Universitario de Navarra NavarraBiomed, Universidad Pública de Navarra (UPNA), IdisNA, Pamplona, España
| | - Daniel Álvarez de Castro
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España
| | - Raquel Muñoz González
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España; Centro Médico Teknon, Barcelona, España
| | - José Carlos Marín-Gabriel
- Servicio de Medicina del Aparato Digestivo, Unidad de Endoscopias, Hospital Universitario 12 de Octubre; Instituto de Investigación «i+12», Madrid, España
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Giordano A, Escapa M, Urpí-Ferreruela M, Casanova G, Fernández-Esparrach G, Ginès À, Llach J, González-Suárez B. Diagnostic accuracy of artificial intelligence-aided capsule endoscopy (TOP100) in overt small bowel bleeding. Surg Endosc 2023; 37:7658-7666. [PMID: 37495849 PMCID: PMC10520091 DOI: 10.1007/s00464-023-10273-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/02/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Capsule endoscopy (CE) is the first-choice exploration in case of overt small bowel bleeding (SBB). An early CE is known to increase diagnostic yield, but long reading times may delay therapeutics. The study evaluates the diagnostic performance of the artificial intelligence tool TOP100 in patients with overt SBB undergoing early CE with Pillcam SB3. METHODS Patients who underwent early CE (up to 14 days from the bleeding episode) for suspected overt SBB were included. One experienced endoscopist prospectively performed standard reading (SR) and a second blind experienced endoscopist performed a TOP100-based reading (TR). The primary endpoint was TR diagnostic accuracy for lesions with high bleeding potential (P2). RESULTS A total of 111 patients were analyzed. The most common clinical presentation was melena (64%). CE showed angiodysplasias in 40.5% of patients (45/111). In per-patient analysis, TR showed a sensitivity of 90.48% (95% CI 82.09-95.80), specificity of 100% (95% CI 87.23-100) with a PPV of 100% (95% CI 94.01-100), NPV of 77.14% (95% CI 63.58-86.71) and diagnostic accuracy of 92.79 (86.29-96.84). At multivariate analysis, adequate intestinal cleansing was the only independent predictor of concordance between TR and SR (OR 2.909, p = 0.019). The median reading time for SR and TR was 23 min (18.0-26.8) and 1.9 min (range 1.7-2.1), respectively (p < 0.001). CONCLUSIONS TOP100 provides a fast-reading mode for early CE in case of overt small bowel bleeding. It identifies most patients with active bleeding and angiodysplasias, aiding in the prioritization of therapeutic procedures. However, its accuracy in detecting ulcers, varices and P1 lesions seems insufficient.
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Affiliation(s)
- Antonio Giordano
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Miriam Escapa
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Miquel Urpí-Ferreruela
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Gherzon Casanova
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Gloria Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Àngels Ginès
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Josep Llach
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Begoña González-Suárez
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain.
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
- Faculty of Medicine, University of Barcelona, Barcelona, Spain.
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4
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Pedrosa L, Araujo IK, Cuatrecasas M, Soy G, López S, Maurel J, Sánchez-Montes C, Montironi C, Saurí T, Sendino O, Pérez FM, Ausania F, Fernández-Esparrach G, Espósito FM, Vaquero EC, Ginès A. Targeted transcriptomic analysis of pancreatic adenocarcinoma in EUS-FNA samples by NanoString technology. Front Mol Biosci 2023; 10:1161893. [PMID: 37266332 PMCID: PMC10230066 DOI: 10.3389/fmolb.2023.1161893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/24/2023] [Indexed: 06/03/2023] Open
Abstract
Background: Integration of transcriptomic testing into EUS-FNA samples is a growing need for precision oncology in pancreatic ductal adenocarcinoma (PDAC). The NanoString platform is suitable for transcriptome profiling in low yield RNA samples. Methods: Inclusion of patients that underwent EUS-FNA cytological diagnosis of pancreatic ductal adenocarcinoma using 19G and/or 22G needles and subsequent surgical resection. Formalin-fixed, paraffin-embedded (FFPE) cytological and surgical samples underwent RNA extraction and transcriptomic analysis using a custom 52-gene NanoString panel of stromal PDAC features. Cell type abundance was quantified in FFPE specimens and correlated. Results: 18 PDAC patients were included. Mean EUS-FNA passes was 2 + 0.7. All FFPE passed the RNA quality control for genomic analysis. Hierarchical clustering on the global gene expression data showed that genes were differentially expressed between EUS and surgical samples. A more enriched cancer-associated fibroblasts and epithelial-mesenchymal transition transcriptomic profile was observed across surgical specimens whereas immunological biomarkers were more represented in EUS-FNA samples. Cytological examination confirmed a scanty representation of CAF and more immunological cell abundance in cytological samples in comparison to surgical specimens. Conclusion: Targeted transcriptomic NanoString profiling of PDAC samples obtained by EUS-FNA is a feasible approach for pre-surgical molecular analysis although stromal CAF/EMT mRNA biomarkers are underrepresented.
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Affiliation(s)
- L. Pedrosa
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - I. K. Araujo
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clínic, Barcelona, Spain
| | - M. Cuatrecasas
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Pathology Department, Centre of Biomedical Diagnosis (CDB), Hospital Clínic, Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, University of Barcelona (UB), Barcelona, Spain
| | - G. Soy
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clínic, Barcelona, Spain
| | - S. López
- Pathology Department, Centre of Biomedical Diagnosis (CDB), Hospital Clínic, Barcelona, Spain
| | - J. Maurel
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, University of Barcelona (UB), Barcelona, Spain
- Medical Oncology Department, Translational Genomics and Targeted Therapies in Solid Tumors, ICMHO, Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - C. Sánchez-Montes
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clínic, Barcelona, Spain
| | - C. Montironi
- Pathology Department, Centre of Biomedical Diagnosis (CDB), Hospital Clínic, Barcelona, Spain
- Molecular Biology Core, CDB, Hospital Clinic, Barcelona, Spain
| | - T. Saurí
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, University of Barcelona (UB), Barcelona, Spain
- Medical Oncology Department, Translational Genomics and Targeted Therapies in Solid Tumors, ICMHO, Hospital Clínic, Barcelona, Spain
| | - O. Sendino
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clínic, Barcelona, Spain
| | - F. M. Pérez
- Pathology Department, Centre of Biomedical Diagnosis (CDB), Hospital Clínic, Barcelona, Spain
| | - F. Ausania
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, University of Barcelona (UB), Barcelona, Spain
- Department of General and Digestive Surgery, ICMDM, Hospital Clínic, Barcelona, Spain
| | - G. Fernández-Esparrach
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clínic, Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, University of Barcelona (UB), Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - F. M. Espósito
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Medical Oncology Department, Translational Genomics and Targeted Therapies in Solid Tumors, ICMHO, Hospital Clínic, Barcelona, Spain
| | - E. C. Vaquero
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Gastroenterology Department, ICMDM, Hospital Clínic, Barcelona, Spain
| | - A. Ginès
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clínic, Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, University of Barcelona (UB), Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
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5
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Crinò SF, Conti Bellocchi MC, Di Mitri R, Inzani F, Rimbaș M, Lisotti A, Manfredi G, Teoh AYB, Mangiavillano B, Sendino O, Bernardoni L, Manfrin E, Scimeca D, Unti E, Carlino A, Voiosu T, Mateescu RB, Fusaroli P, Lega S, Buscarini E, Pergola L, Chan SM, Lamonaca L, Ginès À, Fernández-Esparrach G, Facciorusso A, Larghi A. Wet-suction versus slow-pull technique for endoscopic ultrasound-guided fine-needle biopsy: a multicenter, randomized, crossover trial. Endoscopy 2023; 55:225-234. [PMID: 35915956 DOI: 10.1055/a-1915-1812] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND : It is unknown whether there is an advantage to using the wet-suction or slow-pull technique during endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) with new-generation needles. We aimed to compare the performance of each technique in EUS-FNB. METHODS This was a multicenter, randomized, single-blind, crossover trial including patients with solid lesions of ≥ 1 cm. Four needle passes with 22 G fork-tip or Franseen-type needles were performed, alternating the wet-suction and slow-pull techniques in a randomized order. The primary outcome was the histological yield (samples containing an intact piece of tissue of at least 550 μm). Secondary end points were sample quality (tissue integrity and blood contamination), diagnostic accuracy, and adequate tumor fraction. RESULTS Overall, 210 patients with 146 pancreatic and 64 nonpancreatic lesions were analyzed. A tissue core was retrieved in 150 (71.4 %) and 129 (61.4 %) cases using the wet-suction and the slow-pull techniques, respectively (P = 0.03). The mean tissue integrity score was higher using wet suction (P = 0.02), as was the blood contamination of samples (P < 0.001). In the two subgroups of pancreatic and nonpancreatic lesions, tissue core rate and tissue integrity score were not statistically different using the two techniques, but blood contamination was higher with wet suction. Diagnostic accuracy and tumor fraction did not differ between the two techniques. CONCLUSION Overall, the wet-suction technique in EUS-FNB resulted in a higher tissue core procurement rate compared with the slow-pull method. Diagnostic accuracy and the rate of samples with adequate tumor fraction were similar between the two techniques.
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Affiliation(s)
- Stefano Francesco Crinò
- Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
| | | | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, Arnas Civico Di Cristina Benfratelli Hospital, Palermo, Italy
| | - Frediano Inzani
- Pathology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mihai Rimbaș
- Gastroenterology Department, Clinic of Internal Medicine, Colentina Clinical Hospital, Carol Davila University of Medicine, Bucharest, Romania
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | - Guido Manfredi
- Gastroenterology and Digestive Endoscopy Department, ASST Ospedale Maggiore Crema, Crema, Italy
| | - Anthony Y B Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Benedetto Mangiavillano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Oriol Sendino
- Endoscopy Unit, Department of Gastroenterology, Hospital Clínic Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Laura Bernardoni
- Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
| | - Erminia Manfrin
- Department of Diagnostics and Public Health, G.B. Rossi University Hospital, Verona, Italy
| | - Daniela Scimeca
- Gastroenterology and Endoscopy Unit, Arnas Civico Di Cristina Benfratelli Hospital, Palermo, Italy
| | - Elettra Unti
- Pathology Unit, ARNAS Civico Di Cristina Benfratelli Hospital, Palermo, Italy
| | - Angela Carlino
- Pathology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Theodor Voiosu
- Gastroenterology Department, Clinic of Internal Medicine, Colentina Clinical Hospital, Carol Davila University of Medicine, Bucharest, Romania
| | - R Bogdan Mateescu
- Gastroenterology Department, Clinic of Internal Medicine, Colentina Clinical Hospital, Carol Davila University of Medicine, Bucharest, Romania
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | | | - Elisabetta Buscarini
- Gastroenterology and Digestive Endoscopy Department, ASST Ospedale Maggiore Crema, Crema, Italy
| | - Lorena Pergola
- Pathology Department, ASST Ospedale Maggiore Crema, Crema, Italy
| | - Shannon M Chan
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Laura Lamonaca
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy
| | - Àngels Ginès
- Endoscopy Unit, Department of Gastroenterology, Hospital Clínic Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Gloria Fernández-Esparrach
- Endoscopy Unit, Department of Gastroenterology, Hospital Clínic Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Antonio Facciorusso
- Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy.,Department of Medical and Surgical Sciences, Section of Gastroenterology, University of Foggia, Foggia, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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6
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Garcés-Durán R, Llach J, Da Fieno A, Córdova H, Fernández-Esparrach G. Diagnóstico endoscópico de la infección por H. pylori. Gastroenterología y Hepatología 2022; 46:483-488. [DOI: 10.1016/j.gastrohep.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/15/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022]
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7
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Romero-Mascarell C, Fernández-Esparrach G, Rodríguez-De Miguel C, Masamunt MC, Rodríguez S, Rimola J, Urpí M, Casanova GS, Ordás I, Ricart E, Caballol B, Fernández-Clotet A, Panés J, Llach J, González-Suárez B. Fecal Calprotectin for Small Bowel Crohn's Disease: Is It a Cutoff Issue? Diagnostics (Basel) 2022; 12:diagnostics12092226. [PMID: 36140627 PMCID: PMC9497577 DOI: 10.3390/diagnostics12092226] [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] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/03/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Fecal calprotectin (FC) correlates well with colonic inflammatory activity of Crohn’s disease (CD); data about relation of FC and small bowel (SB) lesions are still contradictory. The main aim was to analyze the relationship between FC levels and SB inflammatory activity in patients with established or suspected Crohn’s disease, assessed by small bowel capsule endoscopy (SBCE) or magnetic resonance enterography (MRE). (2) Methods: Two cohorts of patients were included: 1. Prospective data were collected from patients with established or suspected CD who underwent SBCE and FC (Cohort A); 2. A retrospective cohort of patients who underwent MRE and FC determination (Cohort B). Different cutoffs for FC were tested in both cohorts. (3) Results: 83 patients were included and 66 were finally analyzed. A total of 69.6% had SB lesions seen by SBCE (n = 25) or MRE (n = 21). FC mean levels were 605.74 + 607.07 μg/g (IQ range: 99.00−878.75), being significantly higher in patients with SB lesions compared to patients without lesions (735.91 + 639.70 μg/g (IQ range: 107.75−1366.25) vs. 306.35 + 395.26 μg/g (IQ range: 78.25−411.0), p < 0.005). For cohort A, 25 out of 35 patients had SB lesions and a significant correlation between Lewis Score and FC levels was achieved (R2: 0.34; p = 0.04). FC sensitivity (S), specificity (E), positive predictive value (PPV), and negative predictive values (NPV) for predicting SB lesions were 80%, 50%, 80%, and 50%, respectively, for FC > 100 µg/g. For cohort B, inflammatory SB activity, measured by MaRIA score, was detected in 21 out of 31 patients (67.7%). Patients with positive findings in MRE had significantly higher values of FC than those with no lesions (944.9 + 672.1 µg/g vs. 221 + 212.2 µg/g, p < 0.05). S, E, PPV, and NPV of FC were 89%, 50%, 77.2%, and 71.4% for FC levels > 100 µg/g. The higher sensitivity and specificity of the FC levels for the detection of SB lesions with SBCE and MRE was obtained for an FC cutoff >265 μg/g and >430 μg/g, respectively. (4) Conclusions: FC has a good correlation with the presence of SB lesions, assessed by SBCE and MRE, in patients with established or suspected Crohn’s disease. However, the ideal cutoff is here proven to be higher than previously reported. Multicenter and large prospective studies are needed in order to establish definitive FC cutoff levels.
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Affiliation(s)
- Cristina Romero-Mascarell
- Endoscopy Unit, Gastroenterology Department, ICMDiM, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain
| | - Gloria Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Department, ICMDiM, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
| | - Cristina Rodríguez-De Miguel
- Endoscopy Unit, Gastroenterology Department, ICMDiM, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain
| | - Maria Carme Masamunt
- Inflammatory Bowel Disease Unit, Gastroenterology Department, ICMDiM, 08036 Barcelona, Spain
| | - Sonia Rodríguez
- Department of Radiology, Centre de Diagnòstic per la Imatge (CDI), Hospital Clínic Barcelona, University of Barcelona, 08036 Barcelona, Spain
| | - Jordi Rimola
- Department of Radiology, Centre de Diagnòstic per la Imatge (CDI), Hospital Clínic Barcelona, University of Barcelona, 08036 Barcelona, Spain
| | - Miguel Urpí
- Endoscopy Unit, Gastroenterology Department, ICMDiM, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain
| | - Gherzon Simon Casanova
- Endoscopy Unit, Gastroenterology Department, ICMDiM, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain
| | - Ingrid Ordás
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
- Inflammatory Bowel Disease Unit, Gastroenterology Department, ICMDiM, 08036 Barcelona, Spain
| | - Elena Ricart
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
- Inflammatory Bowel Disease Unit, Gastroenterology Department, ICMDiM, 08036 Barcelona, Spain
| | - Berta Caballol
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
- Inflammatory Bowel Disease Unit, Gastroenterology Department, ICMDiM, 08036 Barcelona, Spain
| | - Agnès Fernández-Clotet
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
- Inflammatory Bowel Disease Unit, Gastroenterology Department, ICMDiM, 08036 Barcelona, Spain
| | - Julià Panés
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
- Inflammatory Bowel Disease Unit, Gastroenterology Department, ICMDiM, 08036 Barcelona, Spain
| | - Josep Llach
- Endoscopy Unit, Gastroenterology Department, ICMDiM, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
| | - Begoña González-Suárez
- Endoscopy Unit, Gastroenterology Department, ICMDiM, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
- Correspondence:
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8
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Giordano A, Casanova G, Escapa M, Fernández-Esparrach G, Ginès À, Sendino O, Araujo IK, Cárdenas A, Córdova H, Martínez-Ocon J, Martínez-Palli G, Balaguer F, Llach J, Ricart E, González-Suárez B. Motorized Spiral Enteroscopy Is Effective in Patients with Prior Abdominal Surgery. Dig Dis Sci 2022; 68:1447-1454. [PMID: 36104534 PMCID: PMC10102144 DOI: 10.1007/s10620-022-07688-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/31/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Motorized Spiral Enteroscopy (MSE) reduces procedure time and increases insertion depth into the small bowel; however, there is scarce evidence on factors affecting MSE efficacy. AIMS To evaluate diagnostic yield and adverse events of MSE including patients with prior major abdominal surgery. METHODS A prospective observational study was conducted on patients undergoing MSE from June 2019 to December 2021. Demographic characteristics, procedure time, depth of maximum insertion (DMI), technical success, diagnostic yield, and adverse events were collected. RESULTS Seventy-four anterograde (54.4%) and 62 retrograde (45.6%) enteroscopies were performed in 117 patients (64 males, median age 67 years). Fifty patients (42.7%) had prior major abdominal surgery. Technical success was 91.9% for anterograde and 90.3% for retrograde route. Diagnostic yield was 71.6% and 61.3%, respectively. The median DMI was 415 cm (264-585) for anterograde and 120 cm (37-225) for retrograde enteroscopy. In patients with prior major abdominal surgery, MSE showed significantly longer small bowel insertion time (38 vs 29 min, p = 0.004), with similar diagnostic yield (61 vs 71.4%, p = 0.201) and DMI (315 vs 204 cm, p = 0.226). The overall adverse event rate was 10.3% (SAE 1.5%), with no differences related to prior abdominal surgery (p = 0.598). Patients with prior surgeries directly involving the gastrointestinal tract showed lower DMI (189 vs 374 cm, p = 0.019) with equal exploration time (37.5 vs 38 min, p = 0.642) compared to those with other abdominal surgeries. CONCLUSIONS MSE is effective and safe in patients with major abdominal surgery, although longer procedure times were observed. A lower depth of insertion was detected in patients with gastrointestinal surgery.
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Affiliation(s)
- Antonio Giordano
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Gherzon Casanova
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Miriam Escapa
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Gloria Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Àngels Ginès
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Oriol Sendino
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Isis K Araujo
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Andrés Cárdenas
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain.,GI & Liver Transplant Unit, Institut de Malalties Digestives i Metaboliques, Hospital Clinic, Barcelona, Spain
| | - Henry Córdova
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | | | - Graciela Martínez-Palli
- Faculty of Medicine, University of Barcelona, Barcelona, Spain.,Anesthesiology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Francesc Balaguer
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Josep Llach
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Elena Ricart
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Begoña González-Suárez
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain. .,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain. .,Faculty of Medicine, University of Barcelona, Barcelona, Spain.
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9
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Deprez PH, Moons LMG, OʼToole D, Gincul R, Seicean A, Pimentel-Nunes P, Fernández-Esparrach G, Polkowski M, Vieth M, Borbath I, Moreels TG, Nieveen van Dijkum E, Blay JY, van Hooft JE. Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2022; 54:412-429. [PMID: 35180797 DOI: 10.1055/a-1751-5742] [Citation(s) in RCA: 86] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
1: ESGE recommends endoscopic ultrasonography (EUS) as the best tool to characterize subepithelial lesion (SEL) features (size, location, originating layer, echogenicity, shape), but EUS alone is not able to distinguish among all types of SEL.Strong recommendation, moderate quality evidence. 2: ESGE suggests providing tissue diagnosis for all SELs with features suggestive of gastrointestinal stromal tumor (GIST) if they are of size > 20 mm, or have high risk stigmata, or require surgical resection or oncological treatment.Weak recommendation, very low quality evidence. 3: ESGE recommends EUS-guided fine-needle biopsy (EUS-FNB) or mucosal incision-assisted biopsy (MIAB) equally for tissue diagnosis of SELs ≥ 20 mm in size.Strong recommendation, moderate quality evidence. 4: ESGE recommends against surveillance of asymptomatic gastrointestinal (GI) tract leiomyomas, lipomas, heterotopic pancreas, granular cell tumors, schwannomas, and glomus tumors, if the diagnosis is clear.Strong recommendation, moderate quality evidence. 5: ESGE suggests surveillance of asymptomatic esophageal and gastric SELs without definite diagnosis, with esophagogastroduodenoscopy (EGD) at 3-6 months, and then at 2-3-year intervals for lesions < 10 mm in size, and at 1-2-year intervals for lesions 10-20 mm in size. For asymptomatic SELs > 20 mm in size that are not resected, ESGE suggests surveillance with EGD plus EUS at 6 months and then at 6-12-month intervals.Weak recommendation, very low quality evidence. 6: ESGE recommends endoscopic resection for type 1 gastric neuroendocrine neoplasms (g-NENs) if they grow larger than 10 mm. The choice of resection technique should depend on size, depth of invasion, and location in the stomach.Strong recommendation, low quality evidence. 7: ESGE suggests considering removal of histologically proven gastric GISTs smaller than 20 mm as an alternative to surveillance. The decision to resect should be discussed in a multidisciplinary meeting. The choice of technique should depend on size, location, and local expertise.Weak recommendation, very low quality evidence. 8: ESGE suggests that, to avoid unnecessary follow-up, endoscopic resection is an option for gastric SELs smaller than 20 mm and of unknown histology after failure of attempts to obtain diagnosis.Weak recommendation, very low quality evidence. 9: ESGE recommends basing the surveillance strategy on the type and completeness of resection. After curative resection of benign SELs no follow-up is advised, except for type 1 gastric NEN for which surveillance at 1-2 years is advised.Strong recommendation, low quality evidence. 10: For lower or upper GI NEN with a positive or indeterminate margin at resection, ESGE recommends repeating endoscopy at 3-6 months and another attempt at endoscopic resection in the case of residual disease.Strong recommendation, low quality evidence.
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Affiliation(s)
- Pierre H Deprez
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Leon M G Moons
- Divisie Interne Geneeskunde en Dermatologie, Maag-, Darm- en Leverziekten, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Dermot OʼToole
- Neuroendocrine Tumor Service, ENETS Centre of Excellence, St. Vincent's University Hospital and Department of Clinical Medicine, Trinity College Dublin, University of Dublin St. James's Hospital, Dublin, Ireland
| | - Rodica Gincul
- Service de Gastroentérologie et Endoscopie Digestive, Hôpital Privé Jean Mermoz, Lyon, France
| | - Andrada Seicean
- Regional Institute of Gastroenterology and Hepatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Pedro Pimentel-Nunes
- Department of Gastroenterology, Portuguese Oncology Institute of Porto; Department of Surgery and Physiology, Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Portugal
| | | | - Marcin Polkowski
- Department of Gastroenterology, Hepatology and Clinical Oncology, Center for Postgraduate Medical Education, and Department of Oncological Gastroenterology, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Michael Vieth
- Institut of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Ivan Borbath
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Tom G Moreels
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Els Nieveen van Dijkum
- Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, The Netherlands
| | - Jean-Yves Blay
- Centre Léon Bérard, Université Claude Bernard Lyon 1, Lyon, France
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
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10
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Rodríguez de Santiago E, Sánchez Aldehuelo R, Riu Pons F, Rodríguez Escaja C, Fernández-Esparrach G, Cañete-Ruiz Á, Ferre Aracil C, Pérez-Corte D, Ríos León R, Marcos-Prieto HM, Delgado-Guillena PG, García-Rodríguez A, Guarner-Argente C, Muriel A, de la Fuente-Briongos E, García García de Paredes A, Parejo-Carbonell S, Téllez L, Senosiaín-Lalastra C, Burgos-Santamaría D, Aicart-Ramos M, Mateos Muñoz B, Peñas-García B, Pagano G, Casals Urquiza G, Urpi Ferreruela M, Ángel de Jorge-Turrión M, Barreiro-Alonso E, Fraile-López M, Gómez-Outomuro A, Altamirano MI, Núñez Esteban M, Ruiz-Andreu M, Arribas-Anta J, de Frutos D, Herreros-de-Tejada A, Arias-Rivera ML, Roldán-Fernández M, Marcos Martín ÁF, Zamora J, Vázquez-Sequeiros E, Albillos A. Endoscopy-Related Bleeding and Thromboembolic Events in Patients on Direct Oral Anticoagulants or Vitamin K Antagonists. Clin Gastroenterol Hepatol 2022; 20:e380-e397. [PMID: 33279783 DOI: 10.1016/j.cgh.2020.11.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/19/2020] [Accepted: 11/25/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Few prospective studies have assessed the safety of direct oral anticoagulants (DOACs) in elective endoscopy. Our primary aim was to compare the risks of endoscopy-related gastrointestinal bleeding and thromboembolic events in patients on DOACs or vitamin K antagonists (VKAs) in this setting. Secondarily, we examined the impact of the timing of anticoagulant resumption on the risk of delayed bleeding in high-risk therapeutic procedures. METHODS We conducted a multicenter, prospective, observational study from January 2018 to March 2020 of 1602 patients on oral anticoagulants (1004 on VKAs and 598 on DOACs) undergoing 1874 elective endoscopic procedures. Our primary outcomes were 90-day thromboembolic events and 30-day endoscopy-related gastrointestinal bleeding. The inverse probability of treatment weighting propensity score method was used for baseline covariate adjustment. RESULTS The 2 groups had similar risks of endoscopy-related gastrointestinal bleeding (VKAs vs DOACs, 6.2% vs 6.7%; adjusted odds ratio [OR], 1.05; 95% CI, 0.67-1.65) and thromboembolic events (VKAs vs DOACs, 1.3% vs 1.5%; adjusted OR, 0.90; 95% CI, 0.34-2.38). In high bleeding risk procedures (n = 747), delayed anticoagulant resumption (> 48 hours or 24-48 hours vs < 24 hours) did not reduce the risk of postprocedural bleeding (10.3%, 9%, and 5.8%, respectively; adjusted P = .43). Hot and cold snare polypectomy were the most frequent high-risk interventions (41.8% and 39.8%, respectively). CONCLUSION In a prospective study of patients on DOACs or VKAs undergoing elective endoscopy, endoscopy-related bleeding and thromboembolic events showed similar risk. Our study suggests that early anticoagulant resumption is safe in most patients, but more data are needed for advanced high-risk therapeutic procedures.
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Affiliation(s)
- Enrique Rodríguez de Santiago
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas, Universidad de Alcalá, Madrid, Spain.
| | - Rubén Sánchez Aldehuelo
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas, Universidad de Alcalá, Madrid, Spain
| | - Fausto Riu Pons
- Department of Gastroenterology, Endoscopy Unit, Hospital del Mar, Barcelona, Spain; Hospital del Mar Medical Research Institute, Barcelona, Spain
| | | | - Gloria Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Department, Instituto Clínic de Enfermedades Digestivas y Metabólicas, Hospital Clinic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Ángel Cañete-Ruiz
- Endoscopy Unit, Gastroenterology Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Carlos Ferre Aracil
- Gastroenterology Department, Research Institute Segovia de Arana, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - Raquel Ríos León
- Servicio de Aparato Digestivo, Hospital General de Villalba, Madrid, Spain
| | - Héctor Miguel Marcos-Prieto
- Servicio de Aparato Digestivo, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain
| | | | | | - Charly Guarner-Argente
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Spain
| | - Alfonso Muriel
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Elsa de la Fuente-Briongos
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas, Universidad de Alcalá, Madrid, Spain
| | - Ana García García de Paredes
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas, Universidad de Alcalá, Madrid, Spain
| | - Sofía Parejo-Carbonell
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas, Universidad de Alcalá, Madrid, Spain
| | - Luis Téllez
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas, Universidad de Alcalá, Madrid, Spain
| | - Carla Senosiaín-Lalastra
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas, Universidad de Alcalá, Madrid, Spain
| | - Diego Burgos-Santamaría
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas, Universidad de Alcalá, Madrid, Spain
| | - Marta Aicart-Ramos
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas, Universidad de Alcalá, Madrid, Spain
| | - Beatriz Mateos Muñoz
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas, Universidad de Alcalá, Madrid, Spain
| | - Beatriz Peñas-García
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas, Universidad de Alcalá, Madrid, Spain
| | - Giulia Pagano
- Department of Gastroenterology, Endoscopy Unit, Hospital del Mar, Barcelona, Spain
| | - Gemma Casals Urquiza
- Department of Gastroenterology, Endoscopy Unit, Hospital del Mar, Barcelona, Spain
| | | | | | - Eva Barreiro-Alonso
- Department of Gastroenterology, Hospital de Avilés, Avilés, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | | | | | - María Isabel Altamirano
- Endoscopy Unit, Gastroenterology Department, Instituto Clínic de Enfermedades Digestivas y Metabólicas, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Matilde Núñez Esteban
- Endoscopy Unit, Gastroenterology Department, Instituto Clínic de Enfermedades Digestivas y Metabólicas, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Mireia Ruiz-Andreu
- Endoscopy Unit, Gastroenterology Department, Instituto Clínic de Enfermedades Digestivas y Metabólicas, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Julia Arribas-Anta
- Endoscopy Unit, Gastroenterology Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Diego de Frutos
- Gastroenterology Department, Research Institute Segovia de Arana, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Alberto Herreros-de-Tejada
- Gastroenterology Department, Research Institute Segovia de Arana, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - Marta Roldán-Fernández
- Servicio de Aparato Digestivo, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain
| | - Ángel F Marcos Martín
- Servicio de Aparato Digestivo, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain
| | - Javier Zamora
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Enrique Vázquez-Sequeiros
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas, Universidad de Alcalá, Madrid, Spain
| | - Agustín Albillos
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas, Universidad de Alcalá, Madrid, Spain
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11
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Delgado-Guillena PG, Morales-Alvarado VJ, Elosua-González A, Murcia Pomares O, Pérez-Aisa A, Córdova H, Alcedo J, Calvet X, Fernández-Esparrach G. Gastroenterologists' attitudes on the detection and management of gastric premalignant conditions: results of a nationwide survey in Spain. Eur J Cancer Prev 2021; 30:431-436. [PMID: 33369947 DOI: 10.1097/cej.0000000000000648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Gastric premalignant conditions (GPC) surveillance has been proposed to improve the prognosis of gastric cancer (GC), but the early GC detection rate remaining low, and missing GC during an esophago-gastro-duodenoscopy is still a problem. We aimed to explore the gastroenterologists' attitudes on the detection and management of GPC. METHODS A cross-sectional study was designed based on a survey among gastroenterologists from Asociación Española de Gastroenterología. RESULTS The participation rate was 12% (146/1243). Eighty-one percent worked at secondary or tertiary-care hospitals with the capability to perform mucosectomy (80%), but with a lesser availability of endoscopic submucosal dissection (35%). Most respondents had high-definition endoscopes (88%), and virtual chromoendoscopy (86%), but during performing an upper endoscopy, 34% never or rarely use chromoendoscopy, and 73% apply a biopsy protocol often/very often when atrophy or intestinal metaplasia (IM) is suspected. Half of the respondents self-reported their ability to recognize atrophy or IM ≤7 (on a scale from 0 to 10), whereas ≤6 for dysplasia or early GC. Helicobacter pylori infection is eradicated and verified by ≥90%. Endoscopic surveillance of atrophy/IM is performed by 62%. An immediate endoscopy for dysplasia is not always performed. For low-grade dysplasia, 97.6% consider endoscopic management, but for high-grade dysplasia, 23% regard gastric surgery. CONCLUSION There is a wide variability in the detection and management of GPC among Spanish gastroenterologists, and compliance with guidelines and biopsy protocols could be improved. Performance of high-quality gastroscopies including use of virtual chromoendoscopy, that might allow an improvement in the GPC detection, needs also to be generalized.
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Affiliation(s)
| | | | | | | | | | - Henry Córdova
- Endoscopy Unit, ICMDiM, Hospital Clínic of Barcelona, University of Barcelona, Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIPAPS), Barcelona
| | - Javier Alcedo
- Gastroenterology Department, Hospital Universitario Miguel Servet, Zaragoza
| | - Xavier Calvet
- Gastroenterology Department, Hospital Parc Taulí, Universitat Autónoma of Barcelona, CIBEREHD, Sabadell, Spain
| | - Gloria Fernández-Esparrach
- Endoscopy Unit, ICMDiM, Hospital Clínic of Barcelona, University of Barcelona, Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIPAPS), Barcelona
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12
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Crinò SF, Di Mitri R, Nguyen NQ, Tarantino I, de Nucci G, Deprez PH, Carrara S, Kitano M, Shami VM, Fernández-Esparrach G, Poley JW, Baldaque-Silva F, Itoi T, Manfrin E, Bernardoni L, Gabbrielli A, Conte E, Unti E, Naidu J, Ruszkiewicz A, Amata M, Liotta R, Manes G, Di Nuovo F, Borbath I, Komuta M, Lamonaca L, Rahal D, Hatamaru K, Itonaga M, Rizzatti G, Costamagna G, Inzani F, Curatolo M, Strand DS, Wang AY, Ginès À, Sendino O, Signoretti M, van Driel LMJW, Dolapcsiev K, Matsunami Y, van der Merwe S, van Malenstein H, Locatelli F, Correale L, Scarpa A, Larghi A. Endoscopic Ultrasound-guided Fine-needle Biopsy With or Without Rapid On-site Evaluation for Diagnosis of Solid Pancreatic Lesions: A Randomized Controlled Non-Inferiority Trial. Gastroenterology 2021; 161:899-909.e5. [PMID: 34116031 DOI: 10.1053/j.gastro.2021.06.005] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [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: 04/27/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS The benefit of rapid on-site evaluation (ROSE) on the diagnostic accuracy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) has never been evaluated in a randomized study. This trial aimed to test the hypothesis that in solid pancreatic lesions (SPLs), diagnostic accuracy of EUS-FNB without ROSE was not inferior to that of EUS-FNB with ROSE. METHODS A noninferiority study (noninferiority margin, 5%) was conducted at 14 centers in 8 countries. Patients with SPLs requiring tissue sampling were randomly assigned (1:1) to undergo EUS-FNB with or without ROSE using new-generation FNB needles. The touch-imprint cytology technique was used to perform ROSE. The primary endpoint was diagnostic accuracy, and secondary endpoints were safety, tissue core procurement, specimen quality, and sampling procedural time. RESULTS Eight hundred patients were randomized over an 18-month period, and 771 were analyzed (385 with ROSE and 386 without). Comparable diagnostic accuracies were obtained in both arms (96.4% with ROSE and 97.4% without ROSE, P = .396). Noninferiority of EUS-FNB without ROSE was confirmed with an absolute risk difference of 1.0% (1-sided 90% confidence interval, -1.1% to 3.1%; noninferiority P < .001). Safety and sample quality of histologic specimens were similar in both groups. A significantly higher tissue core rate was obtained by EUS-FNB without ROSE (70.7% vs. 78.0%, P = .021), with a significantly shorter mean sampling procedural time (17.9 ± 8.8 vs 11.7 ± 6.0 minutes, P < .0001). CONCLUSIONS EUS-FNB demonstrated high diagnostic accuracy in evaluating SPLs independently on execution of ROSE. When new-generation FNB needles are used, ROSE should not be routinely recommended. (ClinicalTrial.gov number NCT03322592.).
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Affiliation(s)
- Stefano Francesco Crinò
- Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy.
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, ARNAS Civico Di Cristina Benfratelli Hospital, Palermo, Italy
| | - Nam Q Nguyen
- Department of Gastroenterology, Royal Adelaide Hospital, South Australia
| | - Ilaria Tarantino
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo, Italy
| | - Germana de Nucci
- Department of Gastroenterology, Rho and Garbagnate Milanese Hospital, ASST Rhodense, Milano, Italy
| | - Pierre H Deprez
- Department of Gastroenterology and Hepatology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium
| | - Silvia Carrara
- Department of Gastroenterology, Endoscopic Unit, Humanitas Clinical and Research Center- IRCCS, Rozzano (MI), Italy
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Vanessa M Shami
- Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia
| | - Gloria Fernández-Esparrach
- Endoscopy Unit, Department of Gastroenterology, Hospital Clínic Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Jan-Werner Poley
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Francisco Baldaque-Silva
- Department of Upper GI Diseases, Unit of Gastrointestinal Endoscopy, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Erminia Manfrin
- Department of Diagnostics and Public Health, Section of Pathology, G.B. Rossi University Hospital, Verona, Italy
| | - Laura Bernardoni
- Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
| | - Armando Gabbrielli
- Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
| | - Elisabetta Conte
- Gastroenterology and Endoscopy Unit, ARNAS Civico Di Cristina Benfratelli Hospital, Palermo, Italy
| | - Elettra Unti
- Pathology Unit, ARNAS Civico Di Cristina Benfratelli Hospital, Palermo, Italy
| | - Jeevinesh Naidu
- Department of Gastroenterology, Royal Adelaide Hospital, South Australia
| | | | - Michele Amata
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo, Italy
| | - Rosa Liotta
- Pathology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS - ISMETT), Palermo, Italy
| | - Gianpiero Manes
- Department of Gastroenterology, Rho and Garbagnate Milanese Hospital, ASST Rhodense, Milano, Italy
| | - Franca Di Nuovo
- Pathology Unit, ASST Rhodense, Garbagnate Milanese (MI), Italy
| | - Ivan Borbath
- Department of Gastroenterology and Hepatology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium
| | - Mina Komuta
- Department of Pathology, School of Medicine, Keio University, Tokyo, Japan; Department of Pathology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium
| | - Laura Lamonaca
- Department of Gastroenterology, Endoscopic Unit, Humanitas Clinical and Research Center- IRCCS, Rozzano (MI), Italy
| | - Daoud Rahal
- Department of Pathology, Humanitas Clinical and Research Center-IRCCS, Rozzano (MI), Italy
| | - Keiichi Hatamaru
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masahiro Itonaga
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Gianenrico Rizzatti
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; CERTT, Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy
| | - Frediano Inzani
- Pathology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Mariangela Curatolo
- Pathology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Daniel S Strand
- Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia
| | - Andrew Y Wang
- Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia
| | - Àngels Ginès
- Endoscopy Unit, Department of Gastroenterology, Hospital Clínic Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Oriol Sendino
- Endoscopy Unit, Department of Gastroenterology, Hospital Clínic Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Marianna Signoretti
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Digestive and Liver Disease Unit, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Lydi M J W van Driel
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Karoly Dolapcsiev
- Department of Pathology, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
| | - Yukitoshi Matsunami
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Schalk van der Merwe
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
| | - Hannah van Malenstein
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
| | - Francesca Locatelli
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, G.B. Rossi University Hospital, Verona, Italy
| | - Loredana Correale
- Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, Section of Pathology, G.B. Rossi University Hospital, Verona, Italy; ARC-Net Research Centre, University of Verona, G.B. Rossi University Hospital, Verona, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; CERTT, Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy
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13
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Guerrero JA, Pérez-Anker J, Fernández-Esparrach G, Archilla I, Diaz A, Lopez-Prades S, Rodrigo-Calvo M, Lahoz S, Camps J, Puig S, Malvehy J, Cuatrecasas M. Ex vivo Fusion Confocal Microscopy of Colorectal Polyps: A Fast Turnaround Time of Pathological Diagnosis. Pathobiology 2021; 88:392-399. [PMID: 34407541 DOI: 10.1159/000517190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/11/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Colorectal cancer screening programs have accomplished a mortality reduction from the disease but have created bottlenecks in endoscopy units and pathology departments. We aimed to explore the feasibility of ex vivo fusion confocal microscopy (FuCM) to improve the histopathology diagnostic efficiency and reduce laboratory workload. METHODS Consecutive fresh polyps removed at colonoscopy were scanned using ex vivo FuCM, then went through histopathologic workout and hematoxylin and eosin (H&E) diagnosis. Two pathologists blinded to H&E diagnosis made a diagnosis based on FuCM scanned images. RESULTS Thirty-six fresh polyps from 22 patients were diagnosed with FuCM and H&E. Diagnostic agreement between H&E and FuCM was 97.2% (kappa = 0.96) for pathologist #1 and 91.7% (kappa = 0.87) for pathologist #2. Diagnostic performance concordance between FuCM and H&E to discern adenomatous from nonadenomatous polyps was 100% (kappa = 1) for pathologist #1 and 97.2% (kappa = 0.94) for pathologist #2. Global interobserver agreement was 94.44% (kappa = 0.91) and kappa = 0.94 to distinguish adenomatous from nonadenomatous polyps. CONCLUSIONS Ex vivo FuCM shows an excellent correlation with standard H&E for the diagnosis of colorectal polyps. The clinical direct benefit for patients, pathologists, and endoscopists allows adapting personalized surveillance protocols after colonoscopy and a workload decrease in pathology departments.
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Affiliation(s)
- Jose Andres Guerrero
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clinic, Barcelona, Spain
| | | | - Gloria Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Madrid, Spain
| | - Ivan Archilla
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clinic, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alba Diaz
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clinic, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sandra Lopez-Prades
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clinic, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maite Rodrigo-Calvo
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clinic, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sara Lahoz
- University of Barcelona, Barcelona, Spain.,Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Madrid, Spain.,Gastrointestinal and Pancreatic Oncology Team, Hospital Clínic, Barcelona, Spain
| | - Jordi Camps
- University of Barcelona, Barcelona, Spain.,Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Madrid, Spain.,Gastrointestinal and Pancreatic Oncology Team, Hospital Clínic, Barcelona, Spain.,Department of Cell Biology, Physiology and Immunology, Faculty of Medicine, University Autonomous of Barcelona, Bellaterra, Spain
| | - Susana Puig
- Dermatology Department, Hospital Clinic, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Josep Malvehy
- Dermatology Department, Hospital Clinic, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Miriam Cuatrecasas
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clinic, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Madrid, Spain.,Banc de Teixits-Biobanc Clinic-IDIBAPS, Barcelona, Spain
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14
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Fernández-Esparrach G, Marín-Gabriel JC, de Tejada AH, Albéniz E, Nogales O, Del Pozo-García AJ, Rosón PJ, Goicotxea U, Uchima H, Terán A, Alberto A, Joaquín RS, Liseth RS, José S. Implementation of endoscopic submucosal dissection in a country with a low incidence of gastric cancer: Results from a prospective national registry. United European Gastroenterol J 2021; 9:718-726. [PMID: 34077636 PMCID: PMC8280798 DOI: 10.1002/ueg2.12101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/16/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction Endoscopic submucosal dissection (ESD) has become the treatment of choice for early gastric malignancies. In recent years, the ESD technique has been implemented in Western countries with increasing use. Objectives To describe the results of gastric ESD in a Western country with a low incidence of gastric cancer. Patients and Methods The prospective national registry was conducted over 4 years in 23 hospitals, including 30 endoscopists. Epithelial and subepithelial lesions (SEL) qualified to complete removal with ESD were assessed. The technique, instruments, and solution for submucosal injection varied at the endoscopist's discretion. ESD was defined as difficult when: en‐bloc resection was not achieved, had to be converted to a hybrid resection, lasted more than 2 h or an intraprocedural perforation occurred. Additionally, independent risk factors for difficult ESD were analyzed. Results Two hundred and thirty gastric ESD in 225 patients were performed from January 2016 to December 2019 (196 epithelial and 34 SEL). Most lesions were located in the lower stomach (111; 48.3%). One hundred and twenty‐eight (55.6%) ESD were considered difficult. The median procedure time was 105 min (interquartile range [IQR]: 60–150). The procedure time for SEL was shorter than for epithelial lesions (90 min [45–121] vs. 110 min [62–160]; p = 0.038). En‐bloc, R0, and curative resection rates were 91.3%, 75.2%, and 70.9%, respectively. Difficult ESD had lower R0 resection rates than ESD that did not meet the difficulty criteria (64.8% and 87.6%; p = 0.000, respectively). Fibrosis and poor maneuverability were independent factors associated with difficult ESD (OR 3.6, 95%CI 1.1–11.74 and OR 5.07, 95%CI 1.6–16.08; respectively). Conclusions Although the number of cases is limited, the results of this analysis show acceptable en‐bloc and R0 rates in gastric ESD considering the wide variability in experience among the operators. Fibrosis and poor maneuverability were associated with more difficulty in completing ESD. Summarize the established knowledge on this subjectEndoscopic submucosal dissection (ESD) is the standard of care for treatment of early gastric cancers (GC). Due to a lower incidence of GC in European countries, the introduction of gastric ESD has been more gradual than in the East. ESD complications, technical and clinical success depend on the endoscopist's experience, the presence of submucosal fibrosis or invasive cancer, and poor access location.
What are the significant and/or new findings of this study?This study shows the results from a prospective nationwide registry of gastric ESD in a low GC incidence country. Despite a relative low number of cases, quite acceptable outcomes (en‐bloc, R0 and curative resection of 91.3%, 75.2% and 70.9%, respectively) were observed considering the wide variability in experience among the operators. Difficult ESD were mainly associated with the presence of submucosal fibrosis and poor maneuverability; however, independent pre‐procedural factors were not identified. There was a trend of association between ESD difficulty and the location of the lesion in the upper/middle stomach
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Affiliation(s)
- Gloria Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Department, ICMDM, CIBEREHD, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - José-Carlos Marín-Gabriel
- Endoscopy Unit, Gastroenterology Department, "i+12 Research Institute", Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Alberto H de Tejada
- Endoscopy Unit, Gastroenterology Department, IDIPHISA, Hospital Universitario Puerta de Hierro, Autonomous University of Madrid, Madrid, Spain
| | - Eduardo Albéniz
- Complejo Hospitalario de Navarra, Navarrabiomed Biomedical Research Center, UPNA, IdiSNA, Pamplona, Spain
| | | | - Andres J Del Pozo-García
- Endoscopy Unit, Gastroenterology Department, "i+12 Research Institute", Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | | | - Unai Goicotxea
- Hospital Universitario de Donostia, San Sebastián, Spain
| | - Hugo Uchima
- Centro Médico Teknon, Barcelona, Barcelona, Spain
| | - Alvaro Terán
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | - Rivero-Sánchez Liseth
- Endoscopy Unit, Gastroenterology Department, ICMDM, CIBEREHD, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Santiago José
- Endoscopy Unit, Gastroenterology Department, IDIPHISA, Hospital Universitario Puerta de Hierro, Autonomous University of Madrid, Madrid, Spain
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15
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Anker JP, Córdova H, Guerrero JA, Fernández-Esparrach G, Cuatrecasas M. Colonic perforation after piecemeal mucosectomy diagnosed by confocal microscopy. Gastrointest Endosc 2020; 92:971-973. [PMID: 32376329 DOI: 10.1016/j.gie.2020.04.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 04/25/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Javiera P Anker
- Melanoma Unit, Dermatology Department, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Henry Córdova
- Endoscopy Unit, Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - José A Guerrero
- Pathology Department, CDB, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain; Banc de Tumors Biobanc Clinic-IDIBAPS, Barcelona, Spain
| | - Gloria Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Miriam Cuatrecasas
- Pathology Department, CDB, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Banc de Tumors Biobanc Clinic-IDIBAPS, Barcelona, Spain
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16
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Alcaraz Serrat JA, Córdova H, Moreira L, Pocurull A, Ureña R, Delgado-Guillena PG, Garcés-Durán R, Sendino O, García-Rodríguez A, González-Suárez B, Araujo IK, Ginès À, Llach J, Fernández-Esparrach G. Evaluation of long-term adherence to oesophagogastroduodenoscopy quality indicators. Gastroenterol Hepatol 2020; 43:589-597. [PMID: 32674879 DOI: 10.1016/j.gastrohep.2020.01.017] [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] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/23/2020] [Accepted: 01/28/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In a previous study we demonstrated that a simple training programme improved quality indicators of Oesophagogastroduodenoscopy (OGD) achieving the recommended benchmarks. However, the long-term effect of this intervention is unknown. The aim of this study was to assess the quality of OGDs performed 3 years after of having completed a training programme. MATERIAL AND METHODS A comparative study of 2 cohorts was designed as follows: Group A included OGDs performed in 2016 promptly after a training programme and Group B with OGDs performed from January to March 2019, this group was also divided into 2 subgroups: subgroup B1 of Endoscopists who had participated in the previous training programme and subgroup B2 of Endoscopists who had not. The intra-procedure quality indicators proposed by ASGE-ACG were used. RESULTS A total of 1236 OGDs were analysed, 600 from Group A and 636 from Group B (439 subgroup B1 and 197 subgroup B2). The number of complete examinations was lower in Group B (566 [94.3%] vs. 551 [86.6%]; p<0.001). A significant decrease was observed in nearly all quality indicators and they did not reach the recommended benchmarks: retroflexion in the stomach (96% vs. 81%; p<0.001); Seattle biopsy protocol (86% vs. 50%; p=0.03), description of the upper GI bleeding lesion (100% vs. 62%; p<0.01), sufficient intestinal biopsy specimens (at least 4) in suspected coeliac disease (92.5% vs. 18%; p<0.001), photo documentation of the lesion (94% vs. 90%; p<0.05). Regarding the overall assessment of the procedure (including correct performance and adequate photo documentation), a significant decrease was also observed (90.5% vs. 62%; p<0.001). There were no differences between subgroups B1 and B2. CONCLUSIONS The improvement observed in 2016 after a training programme did not prevail after 3 years. In order to keep the quality of OGDs above the recommended benchmarks, it is necessary to implement continuous training programmes.
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Affiliation(s)
- José Andrés Alcaraz Serrat
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España
| | - Henry Córdova
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España
| | - Leticia Moreira
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España
| | - Anna Pocurull
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España
| | - Romina Ureña
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España
| | | | - Rodrigo Garcés-Durán
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España
| | - Oriol Sendino
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España
| | - Ana García-Rodríguez
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España
| | - Begoña González-Suárez
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España
| | - Isis K Araujo
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España
| | - Àngels Ginès
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España
| | - Josep Llach
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España
| | - Gloria Fernández-Esparrach
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España.
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17
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Colán-Hernández J, Sendino O, Loras C, Pardo A, Gornals JB, Concepción M, Sánchez-Montes C, Murzi M, Andujar X, Velasquez-Rodriguez J, Rodriguez de Miguel C, Fernández-Esparrach G, Ginés A, Guarner-Argente C. Antibiotic Prophylaxis Is Not Required for Endoscopic Ultrasonography-Guided Fine-Needle Aspiration of Pancreatic Cystic Lesions, Based on a Randomized Trial. Gastroenterology 2020; 158:1642-1649.e1. [PMID: 31972236 DOI: 10.1053/j.gastro.2020.01.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 11/15/2019] [Revised: 01/08/2020] [Accepted: 01/11/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Guidelines recommend routine antibiotic prophylaxis for patients undergoing endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) of pancreatic cysts, but there is conflicting evidence for its necessity. We investigated whether performing the procedure without antimicrobial prophylaxis increases the incidence of infection. METHODS We performed a multicenter, randomized, noninferiority trial to compare prophylaxis with ciprofloxacin vs placebo in patients with a pancreatic cyst requiring EUS-FNA at multiple centers in Spain. From September 2014 to June 2018, patients were randomly assigned to groups that received the prophylaxis with ciprofloxacin (n = 112) or saline solution (n = 114, placebo). We recorded patients' demographic data, lesion characteristics, and procedure data and followed patients for 21 days. A total of 205 patients completed the trial (90.7%), receiving ciprofloxacin or the control, with no statistically significant differences in demographics, baseline data, or procedure characteristics between groups. The primary outcome was FNA-related infection. Secondary outcomes were incidence of fever, procedure complications, and medication-related adverse events. RESULTS The only case of FNA-related infection (0.44%) occurred in a patient in the placebo group (0.87%); this patient developed acute pancreatitis and bacteremia after the procedure. Prevention of infection was not inferior in the control group; the difference between proportions was 0.87% (95% confidence interval, -0.84% to 2.59%). There were no differences between groups in fever (2 patients in each group: 1.78% vs 1.76%; P = 1.00) or other adverse events. CONCLUSIONS In a randomized trial of patients undergoing EUS-FNA for pancreatic cyst evaluation, we found the risk of infection to be low. The incidence of infections did not differ significantly with vs without ciprofloxacin prophylaxis. (ClinicalTrials.gov, Number: NCT02261896).
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Affiliation(s)
- Juan Colán-Hernández
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | - Oriol Sendino
- Hospital Clínic, Universitat de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, CIBERehd Spain; Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona
| | - Carme Loras
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, CIBERehd Spain; Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, Terrassa, Spain
| | | | - Joan B Gornals
- Hospital de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Barcelona, Spain
| | - Mar Concepción
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | | | - Marianette Murzi
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | - Xavier Andujar
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, CIBERehd Spain; Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, Terrassa, Spain
| | | | | | - Gloria Fernández-Esparrach
- Hospital Clínic, Universitat de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, CIBERehd Spain; Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona
| | - Angels Ginés
- Hospital Clínic, Universitat de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, CIBERehd Spain; Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona
| | - Carlos Guarner-Argente
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain.
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18
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Valdés Del Pino Y, Giordano A, Escapa M, Ricart E, Ordás I, Rodríguez S, Rimola J, Fernández-Esparrach G, Ginès À, Llach J, Panés J, González-Suárez B. Is endoscopic treatment of small bowel strictures effective and safe in patients with Crohn's disease? Rev Esp Enferm Dig 2020; 112:284-289. [PMID: 32216446 DOI: 10.17235/reed.2020.6852/2019] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION there is very little scientific evidence about the efficacy of endoscopic balloon dilation (EBD) performed with balloon-assisted enteroscopy (BAE) for the treatment of small bowel strictures (SBS) in Crohn's disease (CD). OBJECTIVE to evaluate the efficacy and safety of EBD using BAE in patients with CD and SBS. METHODS a retrospective observational study was performed in a tertiary care medical center in patients with CD and SBS, evaluated by CT enterography or MRI enterography. RESULTS from 2009 to 2019, 205 endoscopic dilations were performed in 80 patients with CD. 17 (21.25 %) had only SBS and 70.6 % were male with a median age of 42.2 (±14.4) years. The mean follow-up was 37.8 ±28.7 months. A total of 39 dilations were performed, 94.1 % were native and less than 5cm long, all strictures were ulcerated. The overall technical success was 82.4 % and clinical success was 88.2 %. During follow-up, 23.5 % of patients required surgery and 29.4 % were re-dilated. The long-term efficacy was 76.5 % and no severe adverse events (AE) were observed. No factors were identified to predict the need for surgery after dilation. CONCLUSIONS SBS can be safely and effectively treated with EBD using BAE, thus reducing the need for surgery in the long term.
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Affiliation(s)
| | - Antonio Giordano
- Unidad de Endoscopia.Servicio de Gastroenterología, Hospital Clínic
| | - Miriam Escapa
- Unidad de Endoscopia.Servicio de Gastroenterología, Hospital Clínic
| | - Elena Ricart
- Unidad de EII. Servicio de Gastroenterología, Hospital Clínic
| | - Ingrid Ordás
- Unidad de EII. Servicio de Gastroenterología, Hospital Clínic
| | | | | | | | - Àngels Ginès
- Unidad de Endoscopia.Servicio de Gastroenterología, Hospital Clínic
| | - Josep Llach
- Unidad de Endoscopia.Servicio de Gastroenterología, Hospital Clínic
| | - Julià Panés
- Unidad de EII. Servicio de Gastroenterología, Hospital Clínic
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19
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Sánchez-Montes C, Bernal J, García-Rodríguez A, Córdova H, Fernández-Esparrach G. Review of computational methods for the detection and classification of polyps in colonoscopy imaging. Gastroenterol Hepatol 2020; 43:222-232. [PMID: 32143918 DOI: 10.1016/j.gastrohep.2019.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/24/2019] [Indexed: 02/06/2023]
Abstract
Computer-aided diagnosis (CAD) is a tool with great potential to help endoscopists in the tasks of detecting and histologically classifying colorectal polyps. In recent years, different technologies have been described and their potential utility has been increasingly evidenced, which has generated great expectations among scientific societies. However, most of these works are retrospective and use images of different quality and characteristics which are analysed off line. This review aims to familiarise gastroenterologists with computational methods and the particularities of endoscopic imaging, which have an impact on image processing analysis. Finally, the publicly available image databases, needed to compare and confirm the results obtained with different methods, are presented.
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Affiliation(s)
- Cristina Sánchez-Montes
- Unidad de Endoscopia Digestiva, Hospital Universitari i Politècnic La Fe, Grupo de Investigación de Endoscopia Digestiva, IIS La Fe, Valencia, España
| | - Jorge Bernal
- Centro de Visión por Computador, Departamento de Ciencias de la Computación, Universidad Autónoma de Barcelona, Barcelona, España
| | - Ana García-Rodríguez
- Unidad de Endoscopia, Servicio de Gastroenterología, Hospital Clínic, IDIBAPS, CIBEREHD, Universidad de Barcelona, Barcelona, España
| | - Henry Córdova
- Unidad de Endoscopia, Servicio de Gastroenterología, Hospital Clínic, IDIBAPS, CIBEREHD, Universidad de Barcelona, Barcelona, España; IDIBAPS, CIBEREHD, Barcelona, España
| | - Gloria Fernández-Esparrach
- Unidad de Endoscopia, Servicio de Gastroenterología, Hospital Clínic, IDIBAPS, CIBEREHD, Universidad de Barcelona, Barcelona, España; IDIBAPS, CIBEREHD, Barcelona, España.
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20
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García-Rodríguez A, Bernal J, Sánchez FJ, Córdova H, Garcés Durán R, Rodríguez de Miguel C, Fernández-Esparrach G. Polyp fingerprint: automatic recognition of colorectal polyps' unique features. Surg Endosc 2020; 34:1887-1889. [PMID: 32048018 DOI: 10.1007/s00464-019-07240-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 10/28/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Content-based image retrieval (CBIR) is an application of machine learning used to retrieve images by similarity on the basis of features. Our objective was to develop a CBIR system that could identify images containing the same polyp ('polyp fingerprint'). METHODS A machine learning technique called Bag of Words was used to describe each endoscopic image containing a polyp in a unique way. The system was tested with 243 white light images belonging to 99 different polyps (for each polyp there were at least two images representing it in two different temporal moments). Images were acquired in routine colonoscopies at Hospital Clínic using high-definition Olympus endoscopes. The method provided for each image the closest match within the dataset. RESULTS The system matched another image of the same polyp in 221/243 cases (91%). No differences were observed in the number of correct matches according to Paris classification (protruded: 90.7% vs. non-protruded: 91.3%) and size (< 10 mm: 91.6% vs. > 10 mm: 90%). CONCLUSIONS A CBIR system can match accurately two images containing the same polyp, which could be a helpful aid for polyp image recognition.
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Affiliation(s)
- Ana García-Rodríguez
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Jorge Bernal
- Computer Science Department, Universitat Autònoma de Barcelona and Computer Vision Center, Barcelona, Spain
| | - F Javier Sánchez
- Computer Science Department, Universitat Autònoma de Barcelona and Computer Vision Center, Barcelona, Spain
| | - Henry Córdova
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Rodrigo Garcés Durán
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Cristina Rodríguez de Miguel
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Gloria Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain.
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Sánchez-Montes C, García-Rodríguez A, Córdova H, Pellisé M, Fernández-Esparrach G. Advanced endoscopy technologies to improve the detection and characterisation of colorrectal polyps. Gastroenterol Hepatol 2019; 43:46-56. [PMID: 31813615 DOI: 10.1016/j.gastrohep.2019.09.008] [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: 06/05/2019] [Revised: 08/20/2019] [Accepted: 09/13/2019] [Indexed: 11/19/2022]
Abstract
Colorectal cancer is a major health problem. An improvement to its survival has been demonstrated by performing colonoscopy screenings and removing its precursor lesions: polyps. However, colonoscopy is not infallible and multiple strategies have been proposed aimed at improving the quality thereof. This report describes the endoscopic systems available to improve the detection and characterization of polyps, the different classifications for histological prediction and the current indications of advanced endoscopic diagnostic techniques.
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Affiliation(s)
- Cristina Sánchez-Montes
- Unidad de Endoscopia Digestiva, Hospital Universitari i Politècnic La Fe, Grupo de Investigación de Endoscopia Digestiva, IIS La Fe, Valencia, España
| | - Ana García-Rodríguez
- Unidad de Endoscopia, Servicio de Gastroenterología, Hospital Clínic, IDIBAPS, CIBEREHD, Universidad de Barcelona, Barcelona, España
| | - Henry Córdova
- Unidad de Endoscopia, Servicio de Gastroenterología, Hospital Clínic, IDIBAPS, CIBEREHD, Universidad de Barcelona, Barcelona, España
| | - María Pellisé
- Unidad de Endoscopia, Servicio de Gastroenterología, Hospital Clínic, IDIBAPS, CIBEREHD, Universidad de Barcelona, Barcelona, España
| | - Gloria Fernández-Esparrach
- Unidad de Endoscopia, Servicio de Gastroenterología, Hospital Clínic, IDIBAPS, CIBEREHD, Universidad de Barcelona, Barcelona, España.
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22
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Garcés-Durán R, García-Rodríguez A, Córdova H, Cuatrecasas M, Ginès À, González-Suárez B, Araujo I, Llach J, Fernández-Esparrach G. Association between a regular arrangement of collecting venules and absence of Helicobacter pylori infection in a European population. Gastrointest Endosc 2019; 90:461-466. [PMID: 31108089 DOI: 10.1016/j.gie.2019.05.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 03/04/2019] [Accepted: 05/11/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Helicobacter pylori is the major cause of gastritis and gastritis-associated diseases. Detection of a regular arrangement of collecting venules (RAC) in the lesser gastric curvature correlates with negative H pylori status with a sensitivity and negative predictive value (NPV) higher than 90% in Asian countries. The aim of the study was to evaluate the value of RAC as a diagnostic method of H pylori infection in a European population. METHODS A prospective study with high-definition endoscopes without magnification was performed by 3 endoscopists. The presence of starfish-like minute points regularly distributed throughout the lesser curvature of the gastric body was considered RAC positive (RAC+). Gastric biopsies were performed during the procedure for H pylori diagnosis. RESULTS One hundred forty patients were included from February 2017 to May 2018. The prevalence of H pylori infection was 31% and 47 of 140 patients (34%) were RAC+; 13 of 23 patients in whom H pylori was eradicated were RAC+. The mean age of RAC+ patients was lower (44.4 vs 52.4 years, P = .004) and they had less- significant endoscopic findings (9; 19.1% vs 38; 80.9%; P = .017). Gender, use of nonsteroidal anti-inflammatory drugs, antithrombotic or anticoagulants treatments, and a history of H pylori eradication did not show differences in the RAC pattern. The absence of RAC was associated with H pylori infection in 47.3% (44/93) of cases. In contrast, all RAC+ patients were free of H pylori infection, with sensitivity and NPV of 100% for the exclusion of H pylori infection. CONCLUSION The presence of RAC+ in the lesser curvature evaluated with high-definition endoscopy can accurately identify patients without H pylori.
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Affiliation(s)
- Rodrigo Garcés-Durán
- Endoscopy Unit, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, University of Barcelona, Barcelona, Catalonia
| | - Ana García-Rodríguez
- Endoscopy Unit, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, University of Barcelona, Barcelona, Catalonia
| | - Henry Córdova
- Endoscopy Unit, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, University of Barcelona, Barcelona, Catalonia
| | - Miriam Cuatrecasas
- Pathology Department, CDB, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Banc de Tumors Biobanc Clínic-IDIBAPS, Barcelona, Catalonia, Spain
| | - Àngels Ginès
- Endoscopy Unit, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, University of Barcelona, Barcelona, Catalonia
| | - Begoña González-Suárez
- Endoscopy Unit, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, University of Barcelona, Barcelona, Catalonia
| | - Isis Araujo
- Endoscopy Unit, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, University of Barcelona, Barcelona, Catalonia
| | - Josep Llach
- Endoscopy Unit, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, University of Barcelona, Barcelona, Catalonia
| | - Gloria Fernández-Esparrach
- Endoscopy Unit, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, University of Barcelona, Barcelona, Catalonia
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23
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Córdova H, Cuatrecasas M, García-Rodríguez A, Montenegro A, Melo J, Rodríguez-de Miguel C, Martínez-Pallí G, Garcés-Durán R, Llach J, Fernández-Esparrach G. Successful outcomes of a new combined solution of hyaluronic acid, chondroitin sulfate and poloxamer 407 for submucosal injection: animal survival study. Endosc Int Open 2019; 7:E576-E582. [PMID: 30994113 PMCID: PMC6461554 DOI: 10.1055/a-0869-7757] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/07/2019] [Indexed: 12/13/2022] Open
Abstract
Background and study aims Endoscopic resection requires use of submucosal injection. This study was conducted to assess efficacy and impact on early healing of hyaluronic acid combined with chondroitin sulfate and poloxamer 407 (Ziverel) when used as a solution for submucosal injection. Materials and methods Prospective and comparative study of gastric endoscopic mucosal resection (EMR) with three groups of two Yorkshire pigs. Six submucosal cushions were created in each animal by injecting 2 mL of Ziverel (Group 1) or succinylated gelatin (SG) (Group 2), enabling 12 EMR in each group. Submucosal cushions were created with Ziverel in Group 3, without resection. Electrosurgery unit settings were the same in all cases. EMR defects and injection sites were marked with clips. The animals were sacrificed 7 days later. EMR specimen size and duration of procedure were recorded. EMR specimens and EMR scars and injection sites were evaluated by a blinded pathologist. Results We successfully performed 24 EMR (15 en-bloc and 9 piecemeal, without differences between groups 1 and 2). Mean EMR specimen dimensions were significantly larger in Group 1 (median 19 mm, range 6 - 40 vs 16.6 mm, range 5‑25; P = 0.019), without changing the electrocautery unit settings. Blinded histopathologist assessment of EMR specimens showed less fibrosis in the submucosa and a trend to fewer cautery artifacts with Ziverel and did not identify any significant differences in early healing of resection sites. Conclusion The combination of Ziverel enables EMR and does not negatively affect early healing.
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Affiliation(s)
- Henry Córdova
- Endoscopy Unit, Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Miriam Cuatrecasas
- Pathology Department, CDB, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Banc de Tumors Biobanc Clinic-IDIBAPS, Barcelona, Spain
| | - Ana García-Rodríguez
- Endoscopy Unit, Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Andrea Montenegro
- Endoscopy Unit, Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jordana Melo
- Endoscopy Unit, Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Cristina Rodríguez-de Miguel
- Endoscopy Unit, Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | | | - Rodrigo Garcés-Durán
- Endoscopy Unit, Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Josep Llach
- Endoscopy Unit, Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Gloria Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain,Corresponding author G. Fernández-Esparrach Villarroel 17008036 BarcelonaSpain+34 932279387
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García-Rodríguez A, Fernández-Esparrach G, Sendino O, Ginès A. State of endoscopic ultrasonography in Spain in 2017. Gastroenterol Hepatol 2018; 41:672-678. [PMID: 30060962 DOI: 10.1016/j.gastrohep.2018.06.009] [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] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/31/2018] [Accepted: 06/04/2018] [Indexed: 02/07/2023]
Abstract
AIM To understand the current state of endoscopic ultrasonography (EUS) in Spain. METHODS Descriptive analysis from a national survey with 11 questions: 10 related to technique and 1 to the training and experience of the endoscopists. RESULTS Sixty endoscopists from 48 of the 97 (49.5%) hospitals that perform EUS in Spain responded to the survey. A total of 28,678 procedures (20,311 diagnostic, 7,446 with puncture and 921 therapeutic) were recorded over the course of one year. Approximately 64% of the hospitals perform between 300 and 999 tests per year. All have radial and sectorial echoendoscopes, with a median of 2 (2-8) scopes. For cytological diagnosis, the 22-gauge needle is the most commonly used (98%) and, for histological diagnosis, the Procore (72%). The study of the pancreas and bile duct is the most common indication for diagnostic EUS (60%), followed by the staging of digestive tract neoplasms (20%). Approximately 72% of the hospitals perform on-site cytopathology evaluations and sedation is administered in equal parts by both endoscopists and anaesthetists. In terms of experience, 45% of echoendoscopists perform fewer than 300 annual exams and the median training duration is 6months (0.5-36). CONCLUSIONS EUS is adequately implemented in Spain and good equipment is available. However, it is necessary to establish a standardised EUS training program since the one undertaken by many echoendoscopists could prove insufficient according to the standards established by Scientific Societies.
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Affiliation(s)
- Ana García-Rodríguez
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Gloria Fernández-Esparrach
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España.
| | - Oriol Sendino
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Angels Ginès
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España
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- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España
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25
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González-Suárez B, Rodriguez S, Ricart E, Ordás I, Rimola J, Díaz-González Á, Romero C, de Miguel CR, Jáuregui A, Araujo IK, Ramirez A, Gallego M, Fernández-Esparrach G, Ginés Á, Sendino O, Llach J, Panés J. Comparison of Capsule Endoscopy and Magnetic Resonance Enterography for the Assessment of Small Bowel Lesions in Crohn's Disease. Inflamm Bowel Dis 2018; 24:775-780. [PMID: 29506048 PMCID: PMC6231365 DOI: 10.1093/ibd/izx107] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [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: 09/07/2017] [Accepted: 11/10/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Diagnostic yield of Small Bowel Capsule Endoscopy (SBCE) for the assessment of small bowel (SB) lesions is higher than radiologic imaging techniques. However, magnetic resonance enterography (MRE) data are scarce and inconclusive. Colon Capsule Endoscopy (CCE) is a new capsule modality. The primary aim of our study was to compare MRE and capsule endoscopy (CE) for the assessment of Crohn's disease (CD). The secondary objectives were to compare the diagnostic accuracy of both CE modalities and changes in Montreal classification after each examination. METHODS We included 47 patients with established (n = 32) or suspected CD (n = 15). MRE was performed first to rule out strictures. In patients with a suspected stricture by MRE, an Agile Patency Capsule was performed. SB disease activity was measured by MaRIA score (MRE) and Lewis Index (CE). RESULTS SB lesions were found in 36 of47 patients with CE and in 21 of47 patients with MRE (76.6% vs 44.7%, P = 0.001). Jejunal inflammation was detected by CE in 31.9% of patients and by MRE in 6.4% of patients (15/47 vs 3/47; P = 0.03); lesions in ileum were detected in 57.4% of patients by CE, and in 21.3% of patients by MRE (27/ 47 vs 10/ 47; P = 0.04). Finally, in terminal ileum, CE showed lesions in 68.1% (32/47) of patients, whereas MRE detected lesions in 38.3% (18/ 47 patients), (P = 0.001). The original Montreal classification was changed in 53.1% of patients (25/ 47) based on CE findings and in 12.7% of patients (6/47) based on MRE findings (P < 0.05). CONCLUSIONS In our cohort CE was significantly superior to MRE for detecting SB lesions, mainly superficial and proximal lesions. CE is useful for a appropriate patients' classification according to Montreal classification.
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Affiliation(s)
- Begoña González-Suárez
- Endoscopy Unit. Gastroenterology Department, ICMDiM; Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain,Address correspondence to: Begoña González-Suárez MD PhD, Endoscopy Unit. Gastroenterology Department, Hospital Clinic, Villarroel 170, Barcelona 08036, 661334362. E-mail:
| | - Sonia Rodriguez
- Department of Radiology, Centre de Diagnòstic per la Imatge (CDI), Hospital Clínic Barcelona, University of Barcelona, Spain
| | - Elena Ricart
- Endoscopy Unit. Gastroenterology Department, ICMDiM; Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Ingrid Ordás
- Endoscopy Unit. Gastroenterology Department, ICMDiM; Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Jordi Rimola
- Department of Radiology, Centre de Diagnòstic per la Imatge (CDI), Hospital Clínic Barcelona, University of Barcelona, Spain
| | - Álvaro Díaz-González
- Endoscopy Unit. Gastroenterology Department, ICMDiM; Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Cristina Romero
- Endoscopy Unit. Gastroenterology Department, ICMDiM; Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Cristina Rodríguez de Miguel
- Endoscopy Unit. Gastroenterology Department, ICMDiM; Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Arantxa Jáuregui
- Endoscopy Unit. Gastroenterology Department, ICMDiM; Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Isis K Araujo
- Endoscopy Unit. Gastroenterology Department, ICMDiM; Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Anna Ramirez
- Endoscopy Unit. Gastroenterology Department, ICMDiM; Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Marta Gallego
- Endoscopy Unit. Gastroenterology Department, ICMDiM; Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Gloria Fernández-Esparrach
- Endoscopy Unit. Gastroenterology Department, ICMDiM; Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Ángels Ginés
- Endoscopy Unit. Gastroenterology Department, ICMDiM; Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Oriol Sendino
- Endoscopy Unit. Gastroenterology Department, ICMDiM; Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Josep Llach
- Endoscopy Unit. Gastroenterology Department, ICMDiM; Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Julian Panés
- Endoscopy Unit. Gastroenterology Department, ICMDiM; Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
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Córdova H, Argüello L, Loras C, Naranjo Rodríguez A, Riu Pons F, Gornals JB, Nicolás-Pérez D, Andújar Murcia X, Hernández L, Santolaria S, Leal C, Pons C, Pérez-Cuadrado-Robles E, García-Bosch O, Papo Berger M, Ulla Rocha JL, Sánchez-Montes C, Fernández-Esparrach G. Rate of adverse events of gastroduodenal snare polypectomy for non-flat polyp is low: A prospective and multicenter study. World J Gastroenterol 2017; 23:8405-8414. [PMID: 29308000 PMCID: PMC5743511 DOI: 10.3748/wjg.v23.i47.8405] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/03/2017] [Accepted: 10/26/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the rate of adverse events (AEs) during consecutive gastric and duodenal polypectomies in several Spanish centers.
METHODS Polypectomies of protruded gastric or duodenal polyps ≥ 5 mm using hot snare were prospectively included. Prophylactic measures of hemorrhage were allowed in predefined cases. AEs were defined and graded according to the lexicon recommended by the American Society for Gastrointestinal Endoscopy. Patients were followed for 48 h, one week and 1 mo after the procedure.
RESULTS 308 patients were included and a single polypectomy was performed in 205. Only 36 (11.7%) were on prior anticoagulant therapy. Mean polyp size was 15 ± 8.9 mm (5-60) and in 294 cases (95.4%) were located in the stomach. Hemorrhage prophylaxis was performed in 219 (71.1%) patients. Nine patients presented AEs (2.9%), and 6 of them were bleeding (n = 6, 1.9%) (in 5 out of 6 AE, different types of endoscopic treatment were performed). Other 24 hemorrhagic episodes could be managed without any change in the outcome of the endoscopy and, consequently, were considered incidents. We did not find any independent risk factor of bleeding.
CONCLUSION Gastroduodenal polypectomy using prophylactic measures has a rate of AEs small enough to consider this procedure a safe and effective method for polyp resection independently of the polyp size and location.
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Affiliation(s)
- Henry Córdova
- Endoscopy Unit. Institut de Malalties Digestives, Hospital Clínic, IDIBAPS, CIBERehd, Universitat de Barcelona, Barcelona 08036, Spain
| | - Lidia Argüello
- Digestive Endoscopy Unit, Digestive Diseases Department, Gastrointestinal Endoscopy Research Group, IIS, La Fe Polytechnic University Hospital, Valencia 46026, Spain
| | - Carme Loras
- Hospital Universitari Mútua de Terrassa, CIBERehd, Terrassa 08221, Spain
| | | | | | - Joan B Gornals
- Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Hospitalet de Llobregat, Barcelona 08907, Spain
| | | | | | - Luis Hernández
- Hospital Santos Reyes, Aranda de Duero, Burgos 09400, Spain
| | | | - Carles Leal
- Consorci Hospitalari de Vic, Universitat de Vic, Vic 08500, Spain
| | - Carles Pons
- Hospital de Viladecans, Viladecans, Barcelona 08840, Spain
| | | | | | | | | | - Cristina Sánchez-Montes
- Endoscopy Unit. Institut de Malalties Digestives, Hospital Clínic, IDIBAPS, CIBERehd, Universitat de Barcelona, Barcelona 08036, Spain
| | - Gloria Fernández-Esparrach
- Endoscopy Unit. Institut de Malalties Digestives, Hospital Clínic, IDIBAPS, CIBERehd, Universitat de Barcelona, Barcelona 08036, Spain
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Polkowski M, Jenssen C, Kaye P, Carrara S, Deprez P, Gines A, Fernández-Esparrach G, Eisendrath P, Aithal GP, Arcidiacono P, Barthet M, Bastos P, Fornelli A, Napoleon B, Iglesias-Garcia J, Seicean A, Larghi A, Hassan C, van Hooft JE, Dumonceau JM. Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline - March 2017. Endoscopy 2017; 49:989-1006. [PMID: 28898917 DOI: 10.1055/s-0043-119219] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [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] [Indexed: 02/08/2023]
Abstract
For routine EUS-guided sampling of solid masses and lymph nodes (LNs) ESGE recommends 25G or 22G needles (high quality evidence, strong recommendation); fine needle aspiration (FNA) and fine needle biopsy (FNB) needles are equally recommended (high quality evidence, strong recommendation).When the primary aim of sampling is to obtain a core tissue specimen, ESGE suggests using 19G FNA or FNB needles or 22G FNB needles (low quality evidence, weak recommendation).ESGE recommends using 10-mL syringe suction for EUS-guided sampling of solid masses and LNs with 25G or 22G FNA needles (high quality evidence, strong recommendation) and other types of needles (low quality evidence, weak recommendation). ESGE suggests neutralizing residual negative pressure in the needle before withdrawing the needle from the target lesion (moderate quality evidence, weak recommendation).ESGE does not recommend for or against using the needle stylet for EUS-guided sampling of solid masses and LNs with FNA needles (high quality evidence, strong recommendation) and suggests using the needle stylet for EUS-guided sampling with FNB needles (low quality evidence, weak recommendation).ESGE suggests fanning the needle throughout the lesion when sampling solid masses and LNs (moderate quality evidence, weak recommendation).ESGE equally recommends EUS-guided sampling with or without on-site cytologic evaluation (moderate quality evidence, strong recommendation). When on-site cytologic evaluation is unavailable, ESGE suggests performance of three to four needle passes with an FNA needle or two to three passes with an FNB needle (low quality evidence, weak recommendation).For diagnostic sampling of pancreatic cystic lesions without a solid component, ESGE suggests emptying the cyst with a single pass of a 22G or 19G needle (low quality evidence, weak recommendation). For pancreatic cystic lesions with a solid component, ESGE suggests sampling of the solid component using the same technique as in the case of other solid lesions (low quality evidence, weak recommendation).ESGE does not recommend antibiotic prophylaxis for EUS-guided sampling of solid masses or LNs (low quality evidence, strong recommendation), and suggests antibiotic prophylaxis with fluoroquinolones or beta-lactam antibiotics for EUS-guided sampling of cystic lesions (low quality evidence, weak recommendation). ESGE suggests that evaluation of tissue obtained by EUS-guided sampling should include histologic preparations (e. g., cell blocks and/or formalin-fixed and paraffin-embedded tissue fragments) and should not be limited to smear cytology (low quality evidence, weak recommendation).
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Affiliation(s)
- Marcin Polkowski
- Department of Gastroenterology, Hepatology, and Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland.,Department of Gastroenterological Oncology, The M. Skłodowska-Curie Memorial Cancer Centre, Warsaw, Poland
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Academic Teaching Hospital of the Medical University of Brandenburg, Germany
| | - Philip Kaye
- Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK
| | - Silvia Carrara
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Italy
| | - Pierre Deprez
- Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Angels Gines
- Endoscopy Unit, Department of Gastroenterology, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Barcelona, Spain
| | - Gloria Fernández-Esparrach
- Endoscopy Unit, Department of Gastroenterology, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Barcelona, Spain
| | - Pierre Eisendrath
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Université Libre de Bruxelles, Hôpital Erasme & Hôpital Saint-Pierre, Brussels, Belgium
| | - Guruprasad P Aithal
- Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK
| | - Paolo Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele University, Milan, Italy
| | - Marc Barthet
- Service de Gastroentérologie, Hôpital NORD AP-HM, Aix-Marseille-Université, Marseille, France
| | - Pedro Bastos
- Gastroenterology Department Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Adele Fornelli
- Anatomic Pathology Unit, AUSL of Bologna, Maggiore Hospital, Bologna, Italy
| | - Bertrand Napoleon
- Department of Gastroenterology, Ramsay Générale de Santé, Private Hospital Jean Mermoz, Lyon, France
| | - Julio Iglesias-Garcia
- Gastroenterology Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Andrada Seicean
- Regional Institute of Gastroenterology and Hepatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alberto Larghi
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Cesare Hassan
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
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Vázquez D, Bernal J, Sánchez FJ, Fernández-Esparrach G, López AM, Romero A, Drozdzal M, Courville A. A Benchmark for Endoluminal Scene Segmentation of Colonoscopy Images. J Healthc Eng 2017; 2017:4037190. [PMID: 29065595 PMCID: PMC5549472 DOI: 10.1155/2017/4037190] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/22/2017] [Indexed: 01/08/2023]
Abstract
Colorectal cancer (CRC) is the third cause of cancer death worldwide. Currently, the standard approach to reduce CRC-related mortality is to perform regular screening in search for polyps and colonoscopy is the screening tool of choice. The main limitations of this screening procedure are polyp miss rate and the inability to perform visual assessment of polyp malignancy. These drawbacks can be reduced by designing decision support systems (DSS) aiming to help clinicians in the different stages of the procedure by providing endoluminal scene segmentation. Thus, in this paper, we introduce an extended benchmark of colonoscopy image segmentation, with the hope of establishing a new strong benchmark for colonoscopy image analysis research. The proposed dataset consists of 4 relevant classes to inspect the endoluminal scene, targeting different clinical needs. Together with the dataset and taking advantage of advances in semantic segmentation literature, we provide new baselines by training standard fully convolutional networks (FCNs). We perform a comparative study to show that FCNs significantly outperform, without any further postprocessing, prior results in endoluminal scene segmentation, especially with respect to polyp segmentation and localization.
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Affiliation(s)
- David Vázquez
- Computer Vision Center, Computer Science Department, Universitat Autonoma de Barcelona, Barcelona, Spain
- Montreal Institute for Learning Algorithms, Université de Montréal, Montreal, QC, Canada
| | - Jorge Bernal
- Computer Vision Center, Computer Science Department, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - F. Javier Sánchez
- Computer Vision Center, Computer Science Department, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Gloria Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Service, CIBERHED, IDIBAPS, Hospital Clinic, Universidad de Barcelona, Barcelona, Spain
| | - Antonio M. López
- Computer Vision Center, Computer Science Department, Universitat Autonoma de Barcelona, Barcelona, Spain
- Montreal Institute for Learning Algorithms, Université de Montréal, Montreal, QC, Canada
| | - Adriana Romero
- Montreal Institute for Learning Algorithms, Université de Montréal, Montreal, QC, Canada
| | - Michal Drozdzal
- École Polytechnique de Montréal, Montréal, QC, Canada
- Imagia Inc., Montréal, QC, Canada
| | - Aaron Courville
- Montreal Institute for Learning Algorithms, Université de Montréal, Montreal, QC, Canada
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Dumonceau JM, Deprez PH, Jenssen C, Iglesias-Garcia J, Larghi A, Vanbiervliet G, Aithal GP, Arcidiacono PG, Bastos P, Carrara S, Czakó L, Fernández-Esparrach G, Fockens P, Ginès À, Havre RF, Hassan C, Vilmann P, van Hooft JE, Polkowski M. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline - Updated January 2017. Endoscopy 2017; 49:695-714. [PMID: 28511234 DOI: 10.1055/s-0043-109021] [Citation(s) in RCA: 202] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
For pancreatic solid lesions, ESGE recommends performing endoscopic ultrasound (EUS)-guided sampling as first-line procedure when a pathological diagnosis is required. Alternatively, percutaneous sampling may be considered in metastatic disease.Strong recommendation, moderate quality evidence.In the case of negative or inconclusive results and a high degree of suspicion of malignant disease, ESGE suggests re-evaluating the pathology slides, repeating EUS-guided sampling, or surgery.Weak recommendation, low quality evidence.In patients with chronic pancreatitis associated with a pancreatic mass, EUS-guided sampling results that do not confirm cancer should be interpreted with caution.Strong recommendation, low quality evidence.For pancreatic cystic lesions (PCLs), ESGE recommends EUS-guided sampling for biochemical analyses plus cytopathological examination if a precise diagnosis may change patient management, except for lesions ≤ 10 mm in diameter with no high risk stigmata. If the volume of PCL aspirate is small, it is recommended that carcinoembryonic antigen (CEA) level determination be done as the first analysis.Strong recommendation, low quality evidence.For esophageal cancer, ESGE suggests performing EUS-guided sampling for the assessment of regional lymph nodes (LNs) in T1 (and, depending on local treatment policy, T2) adenocarcinoma and of lesions suspicious for metastasis such as distant LNs, left liver lobe lesions, and suspected peritoneal carcinomatosis.Weak recommendation, low quality evidence.For lymphadenopathy of unknown origin, ESGE recommends performing EUS-guided (or alternatively endobronchial ultrasound [EBUS]-guided) sampling if the pathological result is likely to affect patient management and no superficial lymphadenopathy is easily accessible.Strong recommendation, moderate quality evidence.In the case of solid liver masses suspicious for metastasis, ESGE suggests performing EUS-guided sampling if the pathological result is likely to affect patient management, and (i) the lesion is poorly accessible/not detected at percutaneous imaging, or (ii) a sample obtained via the percutaneous route repeatedly yielded an inconclusive result.Weak recommendation, low quality evidence.
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Affiliation(s)
| | - Pierre H Deprez
- Cliniques universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland Strauberg/Wriezen, Germany
| | - Julio Iglesias-Garcia
- Gastroenterology Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Alberto Larghi
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Geoffroy Vanbiervliet
- Department of Gastroenterology and Endoscopy, Hôpital Universitaire l'Archet, Nice, France
| | - Guruprasad P Aithal
- Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, United Kingdom
| | - Paolo G Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele University, Milan, Italy
| | - Pedro Bastos
- Gastroenterology Department Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Silvia Carrara
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Italy
| | - László Czakó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Gloria Fernández-Esparrach
- Endoscopy Unit, Department of Gastroenterology, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Barcelona, Spain
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Àngels Ginès
- Endoscopy Unit, Department of Gastroenterology, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Barcelona, Spain
| | - Roald F Havre
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Cesare Hassan
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Peter Vilmann
- Department of Surgical Gastroenterology, Herlev Hospital and Gentofte, Hospital, Copenhagen University, Denmark
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marcin Polkowski
- Department of Gastroenterology and Hepatology, Medical Centre for Postgraduate Education and Department of Gastroenterology, M. Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
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Córdova H, Sánchez-Montes C, Delgado-Guillena PG, Morales VJ, Sendino O, González-Suárez B, Cárdenas A, Pellisé M, Araujo IK, Ginés À, Llach J, Fernández-Esparrach G. Quality indicators for esophagogastroduodenoscopy: A comparative study of outcomes after an improvement programme in a tertiary hospital. Gastroenterol Hepatol 2017. [PMID: 28648767 DOI: 10.1016/j.gastrohep.2017.05.007] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION There is an opportunity for improvement in the recording and measuring of quality indicators. However, no previous experiences exist in our field in terms of their compliance in esophagogastroduodenoscopy (EGD). OBJECTIVE To analyse compliance with EGD quality criteria and evaluate improvement after conducting a training programme. PATIENTS AND METHODS Comparative study of 2 cohorts: one retrospective (control group) and one prospective (intervention group), before and after a training programme consisting of an information session and the report writing improvement programme. The quality indicators proposed by the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology were used. RESULTS A total of 1,200 EGDs were included in a sequential manner (600 in each group). Following the training programme, a significant improvement was observed in the following indicators: documented indication (93 vs. 99.8%; P<0.01), documented full examinations (94.7 vs. 97.3%; P<0.01), correct performance (63.7 vs. 87.9%; P<0.01), appropriate biopsies according to protocols (57.9 vs. 83.8%; P<0.01), photo-documentation of described lesions (84.1 vs. 94.9%; P<0.01), photo-documentation per segment (52.9 vs. 70.5%; P<0.01) and correct overall assessment (56,9 vs. 90.5%; P<0.01). Biopsies for coeliac disease, documented indication, full examination and correct performance, if it went ahead, exceeded the recommended standard. CONCLUSION A very simple training programme improves EGD quality indicators, with the majority reaching the standards recommended by the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology.
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Affiliation(s)
- Henry Córdova
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut Clínic de Malalties Digestives i Metabòliques (ICMDiM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Cristina Sánchez-Montes
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut Clínic de Malalties Digestives i Metabòliques (ICMDiM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Pedro G Delgado-Guillena
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut Clínic de Malalties Digestives i Metabòliques (ICMDiM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic, Universitat de Barcelona, Barcelona, España; Servicio de Gastroenterología, Hospital General de Granollers, Granollers, Barcelona, España
| | - Victor J Morales
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut Clínic de Malalties Digestives i Metabòliques (ICMDiM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic, Universitat de Barcelona, Barcelona, España; Servicio de Gastroenterología, Hospital General de Granollers, Granollers, Barcelona, España
| | - Oriol Sendino
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut Clínic de Malalties Digestives i Metabòliques (ICMDiM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Begoña González-Suárez
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut Clínic de Malalties Digestives i Metabòliques (ICMDiM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Andrés Cárdenas
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut Clínic de Malalties Digestives i Metabòliques (ICMDiM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Maria Pellisé
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut Clínic de Malalties Digestives i Metabòliques (ICMDiM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Isis K Araujo
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut Clínic de Malalties Digestives i Metabòliques (ICMDiM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Àngels Ginés
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut Clínic de Malalties Digestives i Metabòliques (ICMDiM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Josep Llach
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut Clínic de Malalties Digestives i Metabòliques (ICMDiM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Gloria Fernández-Esparrach
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut Clínic de Malalties Digestives i Metabòliques (ICMDiM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic, Universitat de Barcelona, Barcelona, España.
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Fernández-Esparrach G, Cuatrecasas M, Rodríguez de Miguel C, Sánchez-Montes C, Córdova H. Efficacy and safety of a combination of hyaluronic acid, chondroitin sulfate, and poloxamer 407 as a submucosal injection solution for endoscopic resection: pilot study on a swine model. Endosc Int Open 2017; 5:E450-E454. [PMID: 28573177 PMCID: PMC5451276 DOI: 10.1055/s-0043-107614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 01/13/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIMS Endoscopic resection techniques require use of submucosal injection. The aim of this study was to assess a new solution that combines hyaluronic acid, chondroitin sulfate, and poloxamer 407 for submucosal injection. METHODS A total of 48 gastric submucosal cushions were created in fresh porcine stomachs using gelafundin (n = 16) or the new solution diluted at 50 % (n = 16), or 80 % (n = 16). The duration of mucosal elevation was measured. In an in vivo model, 10 gastric submucosal cushions were created by injecting 2 mL of the new solution at 80 % and the animal was euthanized 30 minutes after the last injection. RESULTS Submucosal cushions with the new solution at 80 % and 50 % concentration lasted longer than with gelafundin (23.13 ± 15.57, 13.1 ± 6.6, 3.94 ± 1.53 minutes, respectively; P = 0.000). In the in vivo study, no damage or necrosis was observed in the mucosa or muscularis propria. CONCLUSION The combination of hyaluronic acid, chondroitin sulfate, and poloxamer 407 produces a long-lasting submucosal cushion and does not seem to induce acute damage in the tissue making it suitable for submucosal injection.
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Affiliation(s)
- G. Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain,Corresponding author Gloria Fernández-Esparrach, MD PhD Villarroel 17008036 BarcelonaSpain+34-932-279387
| | - M. Cuatrecasas
- Pathology Department, CDB, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Banc de Tumors Biobanc Clinic-IDIBAPS, Barcelona, Spain
| | - C. Rodríguez de Miguel
- Endoscopy Unit, Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - C. Sánchez-Montes
- Endoscopy Unit, Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - H. Córdova
- Endoscopy Unit, Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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Argüello Viúdez L, Córdova H, Uchima H, Sánchez-Montes C, Ginès À, Araujo I, González-Suárez B, Sendino O, Llach J, Fernández-Esparrach G. Gastric polyps: Retrospective analysis of 41,253 upper endoscopies. Gastroenterol Hepatol 2017; 40:507-514. [PMID: 28222897 DOI: 10.1016/j.gastrohep.2017.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 12/31/2016] [Accepted: 01/05/2017] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Gastric polyps are usually asymptomatic lesions incidentally discovered during endoscopy. OBJECTIVE To study the frequency of different types of gastric polyps in our population and their possible association with other factors. PATIENTS AND METHODS Retrospective study of gastroscopies performed in a tertiary hospital over a ten-year period. Demographics, medical history, indication for gastroscopy and morphological and histological characteristics of polyps were collected. RESULTS Gastric polyps were found in 827 out of 41253 (2%) reviewed gastroscopies, corresponding to 709 patients. Mean age was 65.6 years, and 62% were female. 53.9% of patients had multiple polyps. The most common location was the fundus and 83.3% were smaller than 1cm. Histopathology was obtained in 607 patients: hyperplastic polyps were the most common (42.8%), followed by fundic gland polyps (37.7%). Factors independently associated with hyperplastic polyps were age and single polyp, size ≥6mm and location other than fundus. In contrast, fundic gland polyps were associated with reflux and multiple polyps, size <6mm and located in fundus. Adenomas were independently associated with single polyp. CONCLUSIONS Fundic gland and hyperplastic polyps are the most common in our population and have characteristic features that can guide histological diagnosis. With single polyps it is advisable to take biopsies to rule out adenoma.
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Affiliation(s)
| | - Henry Córdova
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CiberEHD, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Hugo Uchima
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CiberEHD, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Cristina Sánchez-Montes
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CiberEHD, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Àngels Ginès
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CiberEHD, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Isis Araujo
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CiberEHD, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Begoña González-Suárez
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CiberEHD, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Oriol Sendino
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CiberEHD, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Josep Llach
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CiberEHD, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Gloria Fernández-Esparrach
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CiberEHD, IDIBAPS, Universitat de Barcelona, Barcelona, España.
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Córdova H, Cubas G, Boada M, Rodríguez de Miguel C, Martínez-Pallí G, Gimferrer JM, Fernández-Esparrach G. Adverse events of NOTES mediastinoscopy compared to conventional video-assisted mediastinoscopy: a randomized survival study in a porcine model. Endosc Int Open 2015; 3:E571-6. [PMID: 26716115 PMCID: PMC4683132 DOI: 10.1055/s-0034-1392599] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/16/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Safety is a concern in natural orifice transluminal endoscopic surgery (NOTES) mediastinoscopy. The objective of this study was to compare the safety of NOTES mediastinoscopy with video-assisted mediastinoscopy (VAM). METHODS Twenty-four pigs were randomly assigned to NOTES or VAM. Thirty-minute mediastinoscopies were performed with the identification of seven predetermined structures. The animals were euthanized after 7 days and necropsy was performed. RESULTS Mediastinoscopy was not possible in one animal in each group. There were more intraoperative adverse events with NOTES than VAM (7 vs. 2, P = 0.04); hemorrhage was the most frequent adverse event (4 and 1, respectively). At necropsy, pathological findings were observed in 13 animals (9 NOTES and 4 VAM; P = 0.03). Inflammatory parameters were not different between groups and were not related to adverse events. CONCLUSION Systematic NOTES mediastinoscopy is possible and comparable to VAM in terms of number of organs identified and inflammatory impact. However, the safety profile of NOTES mediastinoscopy has to be improved before it can be adopted in a clinical setting.
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Affiliation(s)
- Henry Córdova
- Department of Gastroenterology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Georgina Cubas
- Anesthesiology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Marc Boada
- Department of Thoracic Surgery, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | | | - Josep M. Gimferrer
- Department of Thoracic Surgery, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Gloria Fernández-Esparrach
- Department of Gastroenterology, Hospital Clínic, University of Barcelona, Barcelona, Spain,Corresponding author G. Fernández-Esparrach, MD PhD Department of GastroenterologyICMDiMHospital ClínicVillarroel 17008036 BarcelonaSpain+34-93-2279387
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Fernández-Esparrach G, Calderón Á, De-la-Peña J, Díaz-Tasende JB, Esteban JM, Gimeno-García AZ, Herreros-de-Tejada A, Martínez-Ares D, Nicolás-Pérez D, Nogales Ó, Ono A, Orive-Calzada A, Parra-Blanco A, Rodríguez-Muñoz S, Sánchez-Hernández E, Sánchez-Yague A, Vázquez-Sequeiros E, Vila J, López-Rosés L. Endoscopic submucosal dissection. Sociedad Española de Endoscopia Digestiva (SEED) clinical guideline. Rev Esp Enferm Dig 2015; 106:120-32. [PMID: 24852737 DOI: 10.4321/s1130-01082014000200007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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De-la-Peña J, Calderón Á, Esteban JM, López-Rosés L, Martínez-Ares D, Nogales Ó, Orive-Calzada A, Rodríguez S, Sánchez-Hernández E, Vila J, Fernández-Esparrach G. Experimental study of hybrid-knife endoscopic submucosal dissection (ESD) versus standard ESD in a Western country. Rev Esp Enferm Dig 2015; 106:98-102. [PMID: 24852735 DOI: 10.4321/s1130-01082014000200005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is an effective but time-consuming treatment for early neoplasia that requires a high level of expertise. OBJECTIVE The objective of this study was to assess the efficacy and learning curve of gastric ESD with a hybrid knife with high pressure water jet and to compare with standard ESD. MATERIAL AND METHODS We performed a prospective non survival animal study comparing hybrid-knife and standard gastric ESD. Variables recorded were: Number of en-bloc ESD, number of ESD with all marks included (R0), size of specimens, time and speed of dissection and adverse events. Ten endoscopists performed a total of 50 gastric ESD (30 hybrid-knife and 20 standard). RESULTS Forty-six (92 %) ESD were en-bloc and 25 (50 %) R0 (hybrid-knife: n = 13, 44 %; standard: n = 16, 80 %; p = 0.04). Hybrid-knife ESD was faster than standard (time: 44.6 +/- 21.4 minutes vs. 68.7 +/- 33.5 minutes; p = 0.009 and velocity: 20.8 +/- 9.2 mm(2)/min vs. 14.3 +/- 9.3 mm(2)/min (p = 0.079). Adverse events were not different. There was no change in speed with any of two techniques (hybrid-knife: From 20.33 +/- 15.68 to 28.18 +/- 20.07 mm(2)/min; p = 0.615 and standard: From 6.4 +/- 0.3 to 19.48 +/- 19.21 mm(2)/min; p = 0.607). The learning curve showed a significant improvement in R0 rate in the hybrid-knife group (from 30 % to 100 %). CONCLUSION despite the initial performance of hybrid-knife ESD is worse than standard ESD, the learning curve with hybrid knife ESD is short and is associated with a rapid improvement. The introduction of new tools to facilitate ESD should be implemented with caution in order to avoid a negative impact on the results.
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Bernal J, Sánchez FJ, Fernández-Esparrach G, Gil D, Rodríguez C, Vilariño F. WM-DOVA maps for accurate polyp highlighting in colonoscopy: Validation vs. saliency maps from physicians. Comput Med Imaging Graph 2015. [DOI: 10.1016/j.compmedimag.2015.02.007 10.1016/j.compmedimag.2015.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Vila JJ, Kutz M, Fernández-Esparrach G, López-Rosés L, Rodríguez S, Sánchez-Yague A. Endoscopic submucosal dissection in Spain: outcomes and development possibilities. Rev Esp Enferm Dig 2015; 105:544-52. [PMID: 24467499 DOI: 10.4321/s1130-01082013000900006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Endoscopic submucosal dissection (ESD) allows endoscopic, curative, en-bloc resection of superficial malignant or premalignant lesions. This procedure was conceived over 10 years ago in Japan, but has not experienced great expansion in Western countries for different reasons. This article reviews ESD indications and outcomes, and reflects on the reasons that prevent ESD from becoming common clinical practice in Western hospitals. Finally, recommendations on ESD training in our setting are made.
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Dávila JS, Momblán D, Ginès À, Sánchez-Montes C, Araujo I, Saavedra-Pérez D, Lacy AM, Fernández-Esparrach G. Endoscopic-assisted laparoscopic resection for gastric subepithelial tumors. Surg Endosc 2015; 30:199-203. [PMID: 25860952 DOI: 10.1007/s00464-015-4183-0] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 03/14/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic resection is considered the treatment of choice for gastric subepithelial tumors. Occasionally, it is necessary to perform an intraoperative gastroscopy to localize the lesion. There are no data in the literature addressing the factors that can predict when a combined laparoscopic-endoscopic approach will be needed. METHODS A retrospective cohort study using a prospectively collected database was conducted. From January 2005 to December 2013, all the patients undergoing a laparoscopic gastric resection for subepithelial tumors irresectable by endoscopy were reviewed. Potential predictive factors for the need of an intraoperative endoscopy were analyzed. RESULTS Thirty-eight consecutive patients (22 men and 16 women) with a mean age of 67 (41-86) years underwent laparoscopic gastric resection for subepithelial tumors. Fourteen (36.8%) patients required intraoperative endoscopic assessment. The only significant factors related to the need of endoscopic assessment during surgery were tumor growth pattern (P = 0.002) and size (P = 0.001). CONCLUSIONS An accurate description of tumor growth pattern and size by EUS is recommended in the preoperative assessment of gastric subepithelial tumors. Small tumors (≤18 mm) with an intraluminal growth may need a combined endoscopic-assisted laparoscopic management.
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Affiliation(s)
- Jaime Sampson Dávila
- Department of General and Digestive Surgery, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Dulce Momblán
- Department of General and Digestive Surgery, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Àngels Ginès
- Endoscopy Unit, Gastroenterology Department, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Cristina Sánchez-Montes
- Endoscopy Unit, Gastroenterology Department, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Isis Araujo
- Endoscopy Unit, Gastroenterology Department, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - David Saavedra-Pérez
- Department of General and Digestive Surgery, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Antonio M Lacy
- Department of General and Digestive Surgery, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - Gloria Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Department, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
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Bernal J, Sánchez FJ, Fernández-Esparrach G, Gil D, Rodríguez C, Vilariño F. WM-DOVA maps for accurate polyp highlighting in colonoscopy: Validation vs. saliency maps from physicians. Comput Med Imaging Graph 2015; 43:99-111. [PMID: 25863519 DOI: 10.1016/j.compmedimag.2015.02.007] [Citation(s) in RCA: 308] [Impact Index Per Article: 34.2] [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: 09/23/2014] [Accepted: 02/20/2015] [Indexed: 12/16/2022]
Abstract
We introduce in this paper a novel polyp localization method for colonoscopy videos. Our method is based on a model of appearance for polyps which defines polyp boundaries in terms of valley information. We propose the integration of valley information in a robust way fostering complete, concave and continuous boundaries typically associated to polyps. This integration is done by using a window of radial sectors which accumulate valley information to create WM-DOVA (Window Median Depth of Valleys Accumulation) energy maps related with the likelihood of polyp presence. We perform a double validation of our maps, which include the introduction of two new databases, including the first, up to our knowledge, fully annotated database with clinical metadata associated. First we assess that the highest value corresponds with the location of the polyp in the image. Second, we show that WM-DOVA energy maps can be comparable with saliency maps obtained from physicians' fixations obtained via an eye-tracker. Finally, we prove that our method outperforms state-of-the-art computational saliency results. Our method shows good performance, particularly for small polyps which are reported to be the main sources of polyp miss-rate, which indicates the potential applicability of our method in clinical practice.
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Affiliation(s)
- Jorge Bernal
- Computer Science, Department of Universitat Autònoma de Barcelona and Computer, Vision Center, Barcelona, Spain.
| | - F Javier Sánchez
- Computer Science, Department of Universitat Autònoma de Barcelona and Computer, Vision Center, Barcelona, Spain
| | - Gloria Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Service, CIBERHED, IDIBAPS, Hospital Clinic, Universidad de Barcelona, Barcelona, Spain
| | - Debora Gil
- Computer Science, Department of Universitat Autònoma de Barcelona and Computer, Vision Center, Barcelona, Spain
| | - Cristina Rodríguez
- Endoscopy Unit, Gastroenterology Service, CIBERHED, IDIBAPS, Hospital Clinic, Universidad de Barcelona, Barcelona, Spain
| | - Fernando Vilariño
- Computer Science, Department of Universitat Autònoma de Barcelona and Computer, Vision Center, Barcelona, Spain
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Rodríguez de Miguel C, Serradesanferm A, López-Cerón M, Carballal S, Pozo A, Balaguer F, Cárdenas A, Fernández-Esparrach G, Ginés A, González-Suárez B, Moreira L, Ordás I, Ricart E, Sendino O, Vaquero E, Ubré M, del Manzano S, Grau J, Llach J, Castells A, Pellisé M. Ascorbic acid PEG-2L is superior for early morning colonoscopies in colorectal cancer screening programs: A prospective non-randomized controlled trial. Gastroenterología y Hepatología 2015; 38:62-70. [DOI: 10.1016/j.gastrohep.2014.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 09/14/2014] [Accepted: 09/16/2014] [Indexed: 01/10/2023]
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Fernández-Esparrach G, Ginès A. The problem of an incidental uniloculated cyst. Minerva Med 2014; 105:437-445. [PMID: 24867189] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Incidental uniloculated cysts are diagnosed more frequently due to the increase in availability of high-quality abdominal imaging. The prevalence of incidental pancreatic cysts detected on abdominal imaging is 2.6% and is even higher in old patients. Pancreatic cysts are also found in up to 25% of autopsies, 3% of which present progression to carcinoma in situ. The most frequently incidental cysts detected are <10 mm in size and the spectrum has changed from inflammatory to mucinous lesions. Although some morphological and cytological features can help to establish the nature of these cysts, it is unclear how many of them carry a risk of malignant degeneration, how to identify those accurately, and, once recognized, how to establish which ones are likely to harbor incipient cancer and how to manage them. In the last years, some guidelines have been elaborated that summarize all the evidence published up to now and provide clinicians with useful recommendations regarding the management of pancreatic uniloculated cysts.
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Affiliation(s)
- G Fernández-Esparrach
- Unit of Endoscopy, Department of Gastroenterology, ICMDM Hospital Clínic, IDIBAPS CIBEREHDUniversitat de Barcelona, Barcelona, Spain -
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42
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Fernández-Esparrach G, Sendino O, Araujo I, Pellisé M, Almela M, González-Suárez B, López-Cerón M, Córdova H, Sanabria E, Uchima H, Llach J, Ginès À. Incidence of bacteremia in cirrhotic patients undergoing upper endoscopic ultrasonography. Gastroenterología y Hepatología 2014; 37:327-33. [DOI: 10.1016/j.gastrohep.2014.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 02/06/2014] [Accepted: 02/18/2014] [Indexed: 01/16/2023]
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Fernández-Esparrach G, Calderón A, de la Peña J, Díaz Tasende JB, Esteban JM, Gimeno-García AZ, Herreros de Tejada A, Martínez-Ares D, Nicolás-Pérez D, Nogales O, Ono A, Orive-Calzada A, Parra-Blanco A, Rodríguez Muñoz S, Sánchez Hernández E, Sánchez-Yagüe A, Vázquez-Sequeiros E, Vila J, López Rosés L. Endoscopic submucosal dissection. Endoscopy 2014; 46:361-70. [PMID: 24671864 DOI: 10.1055/s-0034-1364921] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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: 12/24/2022]
Affiliation(s)
- Gloria Fernández-Esparrach
- Unidad de Endoscopia. Servicio de Gastroenterología. CIBEREHD. IDIBAPS. Hospital Clínic. Universidad de Barcelona. Barcelona
| | - Angel Calderón
- Unidad de Endoscopia. Servicio de Aparato Digestivo. Hospital de Basurto. Bilbao
| | - Joaquín de la Peña
- Unidad de Endoscopia. Servicio de Aparato Digestivo. Hospital Universitario Marqués de Valdecilla. Hospital Virtual Valdecilla. Santander
| | | | - José Miguel Esteban
- Unidad de Endoscopia. Servicio de Aparato Digestivo. Hospital Clínico San Carlos
| | | | - Alberto Herreros de Tejada
- Servicio de Digestivo. IDIPHIM. Hospital Universitario Puerta de Hierro Majadahonda. Universidad Autónoma de Madrid
| | | | - David Nicolás-Pérez
- Servicio de Aparato Digestivo. Hospital Universitario de Canarias. La Laguna. Tenerife
| | - Oscar Nogales
- Unidad de Endoscopia Digestiva. Servicio de Aparato Digestivo. Hospital General Universitario Gregorio Marañón
| | - Akiko Ono
- Unidad de Gestion Clinica de Digestivo. Hospital Clinico Universitario Virgen de la Arrixaca, Murcia
| | - Aitor Orive-Calzada
- Unidad de Endoscopia. Servicio de Aparato Digestivo. Hospital de Galdakao-Usansolo. Bizkaia
| | - Adolfo Parra-Blanco
- Departamento de Gastroenterología. FacultaddeMedicina. Pontificia Universidad Católica de Chile. Santiago. Chile
| | | | | | | | - Enrique Vázquez-Sequeiros
- Unidad de Endoscopia. Servicio de Gastroenterología. Hospital Universitario Ramón y Cajal. Madrid. Universidad de Alcalá, IRYCIS
| | - Juan Vila
- Unidad de Endoscopia. Servicio de Aparato Digestivo. Complejo Hospitalario de Navarra. Pamplona
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Rodríguez-D'Jesús A, Gordillo J, Uchima H, Araujo I, Saperas E, Elizalde I, Fernández-Esparrach G. [Prevalence and epidemiology of Barrett's esophagus in the province of Barcelona]. Gastroenterol Hepatol 2014; 37:397-401. [PMID: 24674710 DOI: 10.1016/j.gastrohep.2014.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/17/2014] [Accepted: 01/21/2014] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The prevalence of Barrett's esophagus (BE) varies from 0.45% to 2.2% in patients who undergo upper endoscopy and is >12% when the indication is for reflux symptoms. The prevalence has progressively increased in recent years but is unknown in the population of the province of Barcelona. OBJECTIVES To determine the prevalence of BE and its epidemiological characteristics in our population. PATIENTS AND METHODS We prospectively evaluated patients referred to the Endoscopy Unit of Hospital Clinic and Hospital General de Catalunya for an upper endoscopy. We excluded patients with known BE, prior upper endoscopy, esophagogastric surgery or refusal to participate in the study. Demographic data, alcohol intake, Helicobacter pylori infection and consumption of antisecretory agents were recorded, among other information. Participants completed a standardized questionnaire to assess the presence of gastroesophageal reflux disease (GERD) symptoms and their severity. RESULTS Between July 2010 and July 2012, we included 200 patients (100 in each center). The mean age was 48.9 ± 15.6 years and the majority were women (n=120, 60%). Symptoms of GERD were present in 46 patients (23%) and some degree of esophagitis was present in 31 (15.5%). Infection by H. pylori was present in 29.7%. BE was found endoscopically in 14 (7%) patients, but was histologically confirmed in only 8 (4%). The only variable that correlated with the finding of BE was male sex. CONCLUSION The prevalence of BE in our environment is similar to that reported in Western countries. The absence of reflux symptoms does not rule out the possibility of BE.
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Affiliation(s)
| | - Jordi Gordillo
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Hugo Uchima
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Isis Araujo
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Esteban Saperas
- Servicio de Digestivo, Hospital General de Catalunya, Barcelona, España
| | - Ignasi Elizalde
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Gloria Fernández-Esparrach
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España.
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45
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Navarro-Ripoll R, Córdova H, Rodríguez-D'Jesús A, Boada M, Rodríguez de Miguel C, Beltrán M, Cubas G, Perdomo J, Llach J, Balust J, Gimferrer JM, Fernández-Esparrach G, Martínez-Pallí G. Cardiorespiratory impact of transesophageal endoscopic mediastinoscopy compared with cervical mediastinoscopy: a randomized experimental study. Surg Innov 2014; 21:487-95. [PMID: 24435021 DOI: 10.1177/1553350613517943] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Transesophageal natural-orifice transluminal endoscopic surgery (NOTES) mediastinoscopy has been described as a feasible, less-invasive alternative to video-assisted mediastinoscopy (VAM). We aimed to investigate hemodynamic and respiratory effects during transesophageal NOTES mediastinoscopy compared with VAM. PATIENTS AND METHODS This was a short-survival experiment in 20 female pigs randomized to NOTES (n = 10) or VAM (n = 10) mediastinoscopy. In the NOTES group, an endoscopist accessed the mediastinum through a 5-cm submucosal tunnel in the esophageal wall, and CO2 was used to create the pneumomediastinum. Conventional VAM was carried out by thoracic surgeons. A 30-minute systematic exploration of the mediastinum was then performed, including invasive monitoring for hemodynamic and respiratory data. Blood samples were drawn for gas analyses. RESULTS All experiments except 2 in the NOTES group (one because of technical difficulties, the other because of thoracic lymphatic duct lesion) were completed as planned, and animals survived 24 hours. Also, 3 animals in the NOTES group presented a tension pneumothorax that was immediately recognized and percutaneously drained. VAM and NOTES animals showed similar pulmonary and systemic hemodynamic behavior during mediastinoscopy. Pulmonary gas exchange pattern was mildly impaired during the NOTES procedure, showing lower partial arterial oxygen pressure associated with higher airway pressures (more important in animals that presented with pneumothorax). CONCLUSIONS NOTES mediastinoscopy induces minimal deleterious respiratory effects and hemodynamic changes similar to conventional cervical VAM and could be feasible when performed under strict hemodynamic and respiratory surveillance. Notably, serious complications caused by the injury of pleura are more frequent in NOTES, which mandates an improvement in technique and suitable equipment.
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Affiliation(s)
| | - Henry Córdova
- Hospital Clínic Barcelona, University of Barcelona, Spain
| | | | - Marc Boada
- Hospital Clínic Barcelona, University of Barcelona, Spain
| | | | - Mireia Beltrán
- Hospital Clínic Barcelona, University of Barcelona, Spain
| | - Georgina Cubas
- Hospital Clínic Barcelona, University of Barcelona, Spain
| | - Juan Perdomo
- Hospital Clínic Barcelona, University of Barcelona, Spain
| | - Josep Llach
- Hospital Clínic Barcelona, University of Barcelona, Spain Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Jaume Balust
- Hospital Clínic Barcelona, University of Barcelona, Spain
| | | | - Gloria Fernández-Esparrach
- Hospital Clínic Barcelona, University of Barcelona, Spain Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Graciela Martínez-Pallí
- Hospital Clínic Barcelona, University of Barcelona, Spain Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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46
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Meining A, Spaun G, Fernández-Esparrach G, Arezzo A, Wilhelm D, Martinek J, Spicak J, Feussner H, Fuchs KH, Hucl T, Meisner S, Neuhaus H. NOTES in Europe: summary of the working group reports of the 2012 EURO-NOTES meeting. Endoscopy 2013; 45:214-7. [PMID: 23446668 DOI: 10.1055/s-0032-1326205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The sixth EURO-NOTES workshop (4 - 6 October 2012, Prague, Czech Republic) focused on enabling intensive scientific dialogue and interaction between surgeons, gastroenterologists, and engineers/industry representatives and discussion of the state of the practice and development of natural orifice transluminal endoscopic surgery (NOTES) in Europe. In accordance with previous meetings, five working groups were formed. In 2012, emphasis was put on specific indications for NOTES and interventional endoscopy. Each group was assigned an important indication related to ongoing research in NOTES and interventional endoscopy: cholecystectomy and appendectomy, therapy of colorectal diseases, therapy of adenocarcinoma and neoplasia in the upper gastrointestinal tract, treating obesity, and new therapeutic approaches for achalasia. This review summarizes consensus statements of the working groups.
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Affiliation(s)
- A Meining
- Medical Department II, Technische Universität München, Munich, Germany.
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47
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Vázquez-Sequeiros E, González-Panizo-Tamargo F, Barturen Á, Calderón Á, Esteban JM, Fernández-Esparrach G, Gimeno-García A, Ginés A, Lariño J, Pérez-Carreras M, Romero R, Súbtil JC, Vila J. The role of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in non small cell lung cancer (NSCLC) patients: SEED-SEPD-AEG Joint Guideline. Rev Esp Enferm Dig 2013; 105:215-24. [PMID: 23859450 DOI: 10.4321/s1130-01082013000400006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Lung cancer is one of the most frequent neoplasms in our environment, and represents the first cause of cancer related death in western countries. Diagnostic and therapeutic approach to these patients may be complicated, with endoscopic ultrasound guided fine needle aspiration (EUS-FNA), classically performed by gastroenterologists, playing a very important role. As this disease is not closely related to the "digestive tract", gastroenterologists have been forced to update their knowledge on this field o adequately diagnose this significant group of patients. The recent advent of modern and promising techniques like endobronchial ultrasound guided fine needle aspiration (EBUS-FNA) have prompted new approaches for diagnosis and staging of this type of patients. In this clinical guideline, the "Sociedad Española de Endoscopia Digestiva" (SEED), "Sociedad Española de Patología Digestiva" (SEPD) and the "AsociaciónEspañola de Gastroenterología", have jointed efforts to update the existing knowledge on the field and provide their members with evidence based recommendations.
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48
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Abstract
Thoracoscopy and mediastinoscopy are common procedures with painful incisions and prominent scars. Transesophageal endoscopic mediastinoscopy could reduce pain, improve cosmesis, and provide better access to the posterior mediastinal compartment, especially in patients with a complex mediastinum because of previous mediastinoscopy or with tracheostoma. We describe a new way to access the mediastinum through a natural orifice that provides excellent visualization of mediastinal structures.
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Affiliation(s)
- Henry Córdova
- Endoscopy Unit, Department of Gastroenterology, ICMDiM, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Catalonia, Spain
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49
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Córdova H, Estépar RSJ, Rodríguez-D’Jesús A, Martínez-Pallí G, Arguis P, de Miguel CR, Navarro-Ripoll R, Perdomo JM, Cuatrecasas M, Llach J, Vosburgh KG, Fernández-Esparrach G. Comparative study of NOTES alone versus NOTES guided by a new image registration system for navigation in the mediastinum: a study in a porcine model. Gastrointest Endosc 2013; 77:102-7. [PMID: 23261099 PMCID: PMC3684696 DOI: 10.1016/j.gie.2012.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 09/07/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Natural orifice transluminal endoscopic surgery (NOTES) mediastinoscopy (MED) through the esophagus has proved to be feasible in the animal model. However, injury of the adjacent pleura and pneumothorax has been reported as a frequent adverse event when using a blind access. OBJECTIVE To assess the utility and safety of a CT-based image registration system (IRS) for navigation in the mediastinum. DESIGN Prospective, randomized, controlled trial in 30 Yorkshire pigs. Thirty-minute MEDs were performed: 15 MEDs were performed with IRS guidance (MED-IRS), and 15 MEDs were performed with a blind access. SETTING Animal research laboratory. INTERVENTIONS In both groups, the mediastinum was accessed through a 10-cm submucosal tunnel in the esophageal wall. Timed exploration was performed with identification of 8 mediastinal structures. MAIN OUTCOME MEASUREMENTS Technical feasibility, adverse events, and the number of mediastinal structures identified. RESULTS Thirty animals weighing 31.5 ± 3.5 kg were included in this study. MED was not possible in 2 animals in the "MED with blind access" group but was possible in all MEDs performed with IRS. The mean number of identified organs was slightly higher in "with IRS-MED" (6.13 ± 1.3) than with MED with blind access (4.7 ± 2.3; P = .066). Moreover, the right atrium and vena cava were identified in more cases with IRS-MED than in MED with blind access (13 vs 3 and 15 vs 11, P = .000 and P = .03, respectively). There were 3 (23%) adverse events with IRS-MED and 4 (27%) with "MED with blind access" (P = not significant), with pneumothorax being the most frequent (2 and 3, respectively). LIMITATIONS Nonsurvival animal study. CONCLUSIONS This study demonstrates that the IRS system appears feasible in natural orifice transluminal endoscopic surgery MED and suggests that IRS guidance might be useful for selected procedures.
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Affiliation(s)
- Henry Córdova
- Department of Gastroenterology, CDB, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain
| | | | | | - Graciela Martínez-Pallí
- ICMDiM, Department of Anesthesiology, CDB, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Pedro Arguis
- ICMDiM, Department of Radiology, CDB, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain
| | | | - Ricard Navarro-Ripoll
- ICMDiM, Department of Anesthesiology, CDB, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Juan M. Perdomo
- ICMDiM, Department of Anesthesiology, CDB, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Miriam Cuatrecasas
- ICMDiM, Department of Pathology, CDB, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Josep Llach
- Department of Gastroenterology, CDB, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Kirby G. Vosburgh
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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50
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Pereira V, Sosa A, Reig Ó, Victoria I, Féliz LR, Ayuso JR, Bombí JA, Castells A, Conill C, Cuatrecasas M, Delgado S, Fernández-Esparrach G, Ginés À, Lacy A, Miquel R, Pagés M, Pineda E, Garcia-Albeniz X, Gallego R, Maurel J. Do we need adjuvant therapy in rectal cancer with complete pathologic response (ypT0N0) after induction chemoradiation and laparoscopic mesorectal excision? J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.3536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3536 Background: Neoadjuvant chemo-radiotherapy (CRT) is the standard of care for patients (pts) with u>T3 by endoscopic ultrasound (EUS) rectal cancer. Although pts with complete pathological response (ypT0N0) fare well in multiple series, there is uncertainty of whether it’s due to the induction (CRT), due to the adjuvant chemotherapy (ACT) or due to the combination of both therapies. We have evaluated long-term outcomes in CRT-treated pts. Those with ypT0N0, were not treated with ACT. Methods: Pts with u>T3 rectal cancer, received neoadjuvant chemotherapy (225mg/m2/day 5-fluorouracil (FU)) in continuous infusion (CI) per 5 weeks (wks) and concomitant radiotherapy (45 Gy). Laparoscopic surgery (LAP) was planned after an interval of 5-8 wks. Pts achieving ypT0N0 were no treated with ACT. Pts with ypT>1 or N1 were treated with 3 gr/m2 FU in 48 hour CI and LV 200 mg/m2 every 2 wks x 6 cycles. Results: From November 2000 to November 2008, a cohort of 173 pts were treated with induction CRT and 167 pts underwent total mesorectal excision (LAP, n=158, open surgery n=9). Complete pathological response was achieved in 26/167 pts (15.5%). After a median follow-up of 58.3 months, pts with ypT0N0 have a 5-year disease-free survival and overall survival rate of 96% (95% CI 76 to 99%) and 100% (95% CI not estimable) respectively. Conclusions: Using these results, a clinical trial comparing observation versus adjuvant therapy in ypT0N0 after standard CRT, would need to enroll 3088 pts to show a HR of 0.75 in favor of ACT after 5 years of follow-up (alpha=.05, beta=.2). In case that the true DFS lied in the lower bound of the 95% CI, 636 patients would be needed under the same assumptions. These results do not support the administration of ACT to ypT0N0 patients.
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Affiliation(s)
- Verónica Pereira
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Aarón Sosa
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Óscar Reig
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Iván Victoria
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Luis Roberto Féliz
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Juan Ramón Ayuso
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Antoni Castells
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Carles Conill
- Department of Radiation Oncology, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Salvadora Delgado
- Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Àngels Ginés
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Antonio Lacy
- Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Rosa Miquel
- Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Mario Pagés
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Estela Pineda
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Rosa Gallego
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Juan Maurel
- Medical Oncology Department, Hospital Clínic de Barcelona, Barcelona, Spain
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