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Rev Esp Enferm Dig ; 110(8): 505-509, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29667415


OBJECTIVE: rectal diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that is used to prevent pancreatitis in high-risk patients during endoscopic retrograde cholangiopancreatography (ERCP). The European Society of Gastrointestinal Endoscopy (ESGE) recommends the use of prophylaxis with indomethacin or diclofenac in all patients undergoing ERCP, including those at low or intermediate risk of pancreatitis. A study to investigate the efficacy of this recommendation was performed. METHODS: this was a mixed cohort study. A total of 1,512 ERCP procedures performed in our institution from January 2009 to July 2016 were included in the study. Until June 2012, 718 patients did not receive diclofenac. Subsequently, 794 patients without contraindications received 100 mg of rectal diclofenac at the onset of the procedure. Risk factors for post-ERCP pancreatitis (PEAP) and PEAP cases defined using consensus criteria were recorded. RESULTS: a total of 47 PEAP events (3.1%) were reported, 3.4% in the diclofenac group and 2.8% in the non-diclofenac group (p = 0.554); 26.1% of patients had risk factors for PEAP. In the diclofenac group, PEAP developed in 4.4%, 0.5% and 2.6% of subjects with intact papillae, prior sphincterotomy and extended sphincterotomy, respectively. The results were similar for the non-diclofenac group: 4% with intact papillae, 0.9% with prior sphincterotomy, and 2.5% with extended sphincterotomy, respectively. PEAP severity was similar in both groups. CONCLUSIONS: rectal diclofenac before ERCP did not prevent the development of post-ERCP acute pancreatitis in non-selected consecutive patients.

Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Diclofenaco/administração & dosagem , Diclofenaco/uso terapêutico , Pancreatite/etiologia , Pancreatite/prevenção & controle , Administração Retal , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
Rev Esp Enferm Dig ; 109(10): 731-733, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28942655


Recent advances in endoscopic therapeutics allow conditions such as fistulas of the digestive system to be treated endoscopically. These cases were recently managed with surgery. The Padlock® system includes a nitinol clip that was recently introduced for endoscopic therapy. There are few reports with regard to its use in the daily clinical practice. We report a case of a colonic fistula that was endoscopically managed with this novel over-the-scope nitinol clip system.

Doenças do Colo/cirurgia , Endoscopia Gastrointestinal/métodos , Fístula Intestinal/cirurgia , Hepatopatias/cirurgia , Idoso , Ligas , Feminino , Humanos , Instrumentos Cirúrgicos
Gastroenterol Hepatol ; 40(1): 10-15, 2017 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27085915


INTRODUCTION: The impact of the accumulated experience of the capsule endoscopy (CE) reader on the accuracy of this test is discussed. AIM: To determine whether the negative predictive value of CE findings changes along the learning curve. METHODS: We reviewed the first 900 CE read by 3 gastroenterologists experienced in endoscopy over 8 years. These 900 CE were divided into 3 groups (300 CE each): group 1 consisted of the sum of the first 100 CE read by each of the 3 endoscopists; group 2, the sum of the second 100 and groups 3, the sum of the third 100. Patients with normal CE were monitored for at least 28 months to estimate the negative predictive value. RESULTS: A total of 54 (18%) CE in group 1, 58 (19.3%) in group 2 and 47 (15.6%) in group 3 were normal, although only 34 patients in group 1, 38 in group 2 and 36 in group 3 with normal CE completed follow up and were eventually studied. The negative predictive value was 88.2% in group 1, 89.5% in group 2 and 97% in group 3 (P>.05). CONCLUSION: The negative predictive value tended to increase, but remained high and did not change significantly after the first 100 when readers are experienced in conventional endoscopy and have preliminary specific training.

Endoscopia por Cápsula , Gastroenterologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Competência Clínica , Feminino , Humanos , Curva de Aprendizado , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
Gastroenterol Hepatol ; 39(10): 647-655, 2016 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-26996465


BACKGROUND: Colonoscopy is the gold standard for the detection and prevention of colorectal cancer (CRC). However, some individuals are diagnosed with CRC soon after a previous colonoscopy. AIMS: To evaluate the rate of new onset or missed CRC after a previous colonoscopy and to study potential risk factors. METHODS: Patients in our endoscopy database diagnosed with CRC from March 2004 to September 2011 were identified, selecting those with a colonoscopy performed within the previous 5years. Medical records included age, gender, comorbidities and colonoscopy indication. Tumour characteristics studied were localization, size, histological grade and TNM stage and possible cause. These patients were compared with those diagnosed with CRC at their first endoscopy (sporadic CRC-control group). RESULTS: A total of 712 patients with CRC were included; 24 patients (3.6%) had undergone colonoscopy within the previous 5 years (50% male, 50% female, mean age 72). Post-colonoscopy CRCs were attributed to: 1 (4.2%) incomplete colonoscopy, 4 (16.6%) incomplete polyp removal, 1 (4.2%) failed biopsy, 8 (33.3%) 'missed lesions' and 10 (41.7%) new onset CRC. Post-colonoscopy CRCs were smaller in size than sporadic CRCs (3.2cm vs. 4.5cm, P<.001) and were mainly located in the proximal colon (63% vs. 35%, P=.006); no difference in histological grade was found (P=.125), although there was a tendency towards a lower TNM stage (P=.053). CONCLUSIONS: There is a minor risk of CRC development after a previous colonoscopy (3.6%). Most of these (58.4%) are due to preventable factors. Post-colonoscopy CRCs were smaller and mainly right-sided, with a tendency towards an earlier TNM stage.

Colonoscopia , Neoplasias Colorretais/etiologia , Adolescente , Adulto , Idoso de 80 Anos ou mais , Biópsia , Estudos de Casos e Controles , Transformação Celular Neoplásica , Pólipos do Colo/diagnóstico , Pólipos do Colo/cirurgia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Erros de Diagnóstico , Progressão da Doença , Reações Falso-Negativas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasia Residual , Prevalência , Estudos Retrospectivos , Espanha/epidemiologia , Adulto Jovem
Diagn Interv Radiol ; 21(3): 247-51, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25835076


Enterocutaneous fistula is a challenging entity and a gold-standard treatment is not settled so far. Here, we describe the successful closure of a duodenocutaneous fistula with the use of the Biodesign enterocutaneous fistula plug (Cook Medical), which is derived from a biological plug that has been used in recent years in order to close anorectal fistula tracts.

Fístula Cutânea/cirurgia , Duodenopatias/cirurgia , Fístula Intestinal/cirurgia , Idoso , Curativos Biológicos , Fístula Cutânea/diagnóstico por imagem , Duodenopatias/diagnóstico por imagem , Seguimentos , Humanos , Fístula Intestinal/diagnóstico por imagem , Masculino , Estudos Prospectivos , Radiografia Intervencionista/métodos , Instrumentos Cirúrgicos , Resultado do Tratamento
Rev Esp Enferm Dig ; 105(9): 521-8, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24467496


INTRODUCTION: care overload, aging of population, and increased chronic diseases lead to increased referrals from primary care, which may sometimes overload the health system. Thus, different interventions have been carried out attempting to improve these aspects. OBJECTIVES: to assess the most frequent causes of consultation of general physicians, both in joint consultations and clinical sessions held jointly with specialist consultant in primary care, in the urban and rural setting, and the influence on referrals to first consultations of gastroenterology. MATERIAL AND METHODS: a mainly training type of intervention was carried out, consisting of regular meetings in both urban and rural primary care center, to perform joint consultations and clinical sessions on patients and topics related to the specialty of gastroenterology. The intervention period (divided in two subperiods) was compared with a control period. RESULTS: most reasons for consultation were those corresponding to lower gastrointestinal tract, followed by liver disease and upper gastrointestinal tract. Significant differences were only found in distribution of diagnoses between the two centers in joint consultations. There was a relative (percent) decrease in referrals at the global level in both subperiods, only significant in the first (51.45 %), as well as in rural setting (45.24 %). CONCLUSION: common consultations motifs were similar in urban and rural settings, with some relevance of lower gastrointestinal tract disease. Most of them can be solved at primary care, with the help of consultant specialist. There is impact on referrals to the outpatient first consultations of gastroenterology, mainly in rural setting.

Gastroenterologia/organização & administração , Atenção Primária à Saúde/organização & administração , Encaminhamento e Consulta/organização & administração , Adulto , Idoso , Feminino , Gastroenterologia/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Prospectivos , Encaminhamento e Consulta/estatística & dados numéricos , População Rural , População Urbana