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BACKGROUND AND AIMS: The Endoscopic Resection Group of the Spanish Society of Endoscopy (GSEED-RE) model and the Australian Colonic Endoscopic Resection (ACER) model were proposed to predict delayed bleeding (DB) after EMR of large superficial colorectal lesions, but neither has been validated. We validated and updated these models. METHODS: A multicenter cohort study was performed in patients with nonpedunculated lesions ≥20 mm removed by EMR. We assessed the discrimination and calibration of the GSEED-RE and ACER models. Difficulty performing EMR was subjectively categorized as low, medium, or high. We created a new model, including factors associated with DB in 3 cohort studies. RESULTS: DB occurred in 45 of 1034 EMRs (4.5%); it was associated with proximal location (odds ratio [OR], 2.84; 95% confidence interval [CI], 1.31-6.16), antiplatelet agents (OR, 2.51; 95% CI, .99-6.34) or anticoagulants (OR, 4.54; 95% CI, 2.14-9.63), difficulty of EMR (OR, 3.23; 95% CI, 1.41-7.40), and comorbidity (OR, 2.11; 95% CI, .99-4.47). The GSEED-RE and ACER models did not accurately predict DB. Re-estimation and recalibration yielded acceptable results (GSEED-RE area under the curve [AUC], .64 [95% CI, .54-.74]; ACER AUC, .65 [95% CI, .57-.73]). We used lesion size, proximal location, comorbidity, and antiplatelet or anticoagulant therapy to generate a new model, the GSEED-RE2, which achieved higher AUC values (.69-.73; 95% CI, .59-.80) and exhibited lower susceptibility to changes among datasets. CONCLUSIONS: The updated GSEED-RE and ACER models achieved acceptable prediction levels of DB. The GSEED-RE2 model may achieve better prediction results and could be used to guide the management of patients after validation by other external groups. (Clinical trial registration number: NCT03050333.).
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Resección Endoscópica de la Mucosa , Australia , Estudios de Cohortes , Colonoscopía , Neoplasias Colorrectales/cirugía , Humanos , Factores de RiesgoRESUMEN
Endoscopic ampullectomy is indicated for the resection of non-invasive papillary adenomas in selected patients. Cholangitis is an uncommon complication (0-2%) that may be secondary to contamination during the procedure, poor emptying of the bile duct and prosthesis dysfunction or migration. Placement of a prophylactic biliary stent after the resection is not well established. We present a rare case of acute cholangitis after endoscopic ampullectomy secondary to a biliary prosthesis obstruction, due to a pancreatic prosthesis intrusion.
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Colangitis , Colestasis , Conductos Biliares , Colangiopancreatografia Retrógrada Endoscópica , Colangitis/etiología , Humanos , StentsRESUMEN
Background and study aims Effective bowel cleansing is critical for detecting lesions during colonoscopy, highlighting the importance of bowel preparations. 1L polyethylene glycol (PEG) + ascorbate (Asc) is the only recommended 1L PEG product in Europe and the United States. Its efficacy was demonstrated in large-scale controlled trials and confirmed in smaller-scale real-world studies. However, no large-scale real-world data exist. Patients and methods This observational, retrospective, multicenter study, used outpatient follow-up data from medical records from 10 centers in Spain and two in Portugal. Outpatients aged ≥18 years using 1L PEG + Asc as bowel preparation were included. The main outcome measures were overall adequate colon cleansing (Boston Bowel Preparation Scale [BBPS] score ≥6 with BBPS score ≥2 in each segment) and high-quality cleansing of the right colon (BBPS score=3). Results Data from 13169 eligible patients were included. Overall cleansing success was achieved in 89.3% (95%CI 88.7%-89.8%) and high-quality cleansing in the right colon in 49.3% (95%CI 48.4%-50.2%) of patients. For the overnight split-dose and same-day regimens, overall adequate quality cleansing success rate was 94.7% and 86.7% ( P <0.0001) and high-quality cleansing of the right colon rate was 65.4% and 41.4% ( P <0.0001), respectively. Colonoscopy was completed in 97.3% of patients, with non-completion due to poor preparation in only 0.8%; 2.3% of patients experienced at least one adverse event (AE). Conclusions This large-scale, real-world study demonstrates the effectiveness of 1L PEG + Asc in the total and right colon, with a low percentage of patients with AEs in routine clinical practice.
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Adenoma/cirugía , Apendicectomía , Colon/patología , Pólipos del Colon/cirugía , Colonoscopía/métodos , Neoplasias del Colon Sigmoide/cirugía , Pólipos del Colon/diagnóstico por imagen , Colonografía Tomográfica Computarizada , Constricción Patológica/complicaciones , Constricción Patológica/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Gastroscopía , Infecciones por VIH/complicaciones , VIH-1 , Dolor/etiología , Sarcoma de Kaposi/etiología , Neoplasias Gástricas/etiología , Vómitos/etiología , Adulto , Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Leucoencefalopatía Multifocal Progresiva/complicaciones , Nigeria/etnología , Sarcoma de Kaposi/diagnóstico , Neoplasias Gástricas/diagnóstico , Toxoplasmosis Cerebral/complicacionesRESUMEN
No disponible
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Humanos , Masculino , Anciano , Colangitis/etiología , Endoscopía/efectos adversos , Enfermedad AgudaRESUMEN
No disponible