Evaluation of 30-day mortality in patients undergoing gastrointestinal endoscopy in a tertiary hospital: a 3-year retrospective survey.

OBJECTIVE: Despite international guidelines recommendations to use mortality as a quality criterion for gastrointestinal (GI) procedures, recent studies reporting these data are lacking. Our objective was to report death causes and rate following GI endoscopies in a tertiary university hospital. DESIGN: We retrospectively reviewed all GI procedures made between January 2017 and December 2019 in our tertiary hospital in Switzerland. Data from patients who died within 30 days of the procedure were recorded. RESULTS: Of 18 233 procedures, 251 patients died within 30 days following 345 (1.89%) procedures (244/9180 gastroscopies, 53/5826 colonoscopies, 23/2119 endoscopic ultrasound, 19/911 endoscopic retrograde cholangiopancreatography, 6/197 percutaneous endoscopic gastrostomies). Median age was 70 years (IQR 61-79) and 173/251 (68.92%) were male. Median Charlson Comorbidity Index was 5 (IQR 3-7), and 305/345 procedures (88.4%) were undertaken on patients with an ASA score ≥3. Most frequent indications were suspected GI bleeding (162/345; 46.96%) and suspected cancer or tumourous staging (50/345; 14.49%). Major causes of death were oncological progression (72/251; 28.68%), cardiopulmonary failure or cardiac arrest of unkown origin (62/251; 24,7%) and liver failure (20/251; 7.96%). No deaths were caused by complications such as perforation or bleeding. CONCLUSIONS: Progression of malignancies unrelated to the procedure was the leading cause of short-term death following a GI procedure. After improvements in periprocedural care in the last decades, we should focus on patient selection in this era of new oncological and intensive care therapies. Death rate as a quality criterion is subject to caution as it depends on indication, setting and risk benefit ratio.

[The video capsule endoscopy]. / Vidéocapsule endoscopique.

The video capsule endoscopy allows the exploration or the unreachable part of the small intestine by a standard bidirectional endoscopy. It requires a specific device and a bowel preparation but it's an outpatient examination with an acceptable tolerance of the patients. There are several indications including an obscure gastrointestinal bleeding, an iron deficit anemia, Crohn's disease extension and phenotype, hereditary polyposis and coeliac disease. It doesn't include therapeutic options itself requiring an assisted enteroscopy if any lesion is detected. The use of a dissolvable Patency Capsule lowers the risk of a mechanical intestinal occlusion if a stenosis is suspected. The colon capsule endoscopy is very promising for the colorectal cancer screening and follow-up of inflammatory bowel diseases but it's not currently validated nor recommended.

La vidéocapsule endoscopique permet l'examen de l'intestin grêle, inaccessible par un bilan endoscopique bidirectionnel. C'est un examen ambulatoire peu contraignant nécessitant toutefois un dispositif spécifique et certaines consignes d'utilisation. Plusieurs indications sont reconnues, comme le saignement gastro-intestinal obscur, l'anémie ferriprive, la recherche de tumeur de l'intestin grêle et les maladies de Crohn ou cœliaque. Elle ne permet pas de geste thérapeutique et peut être complétée par une entéroscopie en cas de lésion décelée. Le risque d'occlusion intestinale par rétention de la capsule est restreint par l'essai d'une Patency Capsule soluble. La capsule colique semble prometteuse dans le dépistage du cancer colorectal ou le suivi de maladie inflammatoire chronique mais l'évidence est insuffisante pour la recommander.

[Salt sensitivity and hypertension]. / Sensibilité au sel et hypertension artérielle.

The salt sensitivity of the blood pressure (SSBP) is defined as a rise or fall in blood pressure induced by a change in sodium intake. There is an interindividual variation and no strong diagnostic criteria exist to date. The SSBP may lead to underestimation of the beneficial effect of sodium restriction in some patients in meta-analyzes. High sodium intake in salt sensitive patients results in an increase in the prevalence of hypertension and target organ damage. The etiology seems to be a failure of one or more natriuretic mechanisms. Some environmental, genetic and epidemiological factors increase its susceptibility. Per se, SSBP cannot be treated, but its identification may help in preventing hypertension and adapt the treatment in some populations.

La sensibilité au sel de la pression artérielle (SSPA) est définie par une élévation ou une baisse de la pression artérielle induite par un changement d'apport sodé. Cette réponse tensionnelle varie selon les individus et aucun critère diagnostique clair n'est établi à ce jour. La SSPA masque probablement l'effet bénéfique d'une restriction sodée chez certains patients dans les méta-analyses. La consommation exagérée de sodium chez les individus dits sensibles au sodium a pour conséquence une augmentation de la prévalence de l'hypertension et des atteintes d'organes cibles. L'étiologie semble être essentiellement une défaillance d'un ou plusieurs mécanismes natriurétiques. La SSPA en soit ne se traite pas, mais son identification permet une meilleure prévention et une adaptation de la prise en charge de l'hypertension artérielle dans certaines populations.

[Risk factors and prophylaxis of Pneumocystis jirovecii pneumonia in HIV-negative patients]. / Facteurs de risque et prophylaxie de la pneumonie à Pneumocystis jirovecii chez les patients non VIH.

Pneumocystis jirovecii (formely carinii) pneumonia (PcP) affects immunosuppressed patients. Cotrimoxazole prophylaxis has proven to be effective and its indications in HIV patients are well established. In non-HIV patients, the prognosis is poorer and diagnostic tests are of lower sensitivity. Recommendations for prophylaxis in hematology, oncology and solid organ transplantation are based on expert consensus. In rheumatology, the incidence of PcP is mainly related to the administration of corticosteroids. For some inflammatory diseases, a low CD4 cell count, and the administration of anti-TNFα, rituximab or cyclophosphamide may increase the risk. There are currently no well-defined concise guidelines concerning prophylaxis for immunosuppressed patients with inflammatory bowel diseases.

La pneumonie à Pneumocystis jirovecii (PcP) atteint les patients immunosupprimés. La prophylaxie par cotrimoxazole est efficace et ses indications chez les patients infectés par le VIH sont bien établies. Chez les patients non VIH, le pronostic est plus sombre et les examens diagnostiques sont de plus faible sensibilité. Les recommandations de prophylaxie en hématologie, en oncologie et lors de transplantation d'organes solides sont basées sur des avis d'experts. En milieu rhumatologique, l'incidence de PcP est principalement liée à l'administration de corticostéroïdes. Certaines maladies inflammatoires, un taux de lymphocytes CD4 bas et l'administration d'anti-TNFα, de rituximab ou de cyclophosphamide augmenteraient le risque. L'immunosuppression pour les maladies inflammatoires de l'intestin ne semble pas justifier une prophylaxie.