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Anticancer Res ; 41(4): 2039-2044, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33813411


BACKGROUND/AIM: The aim of the present study was to assess the value of panendoscopy of the upper aero-digestive tract in the identification of synchronous tumors in OSCC patients without clinical signs of a second primary tumor. PATIENTS AND METHODS: In this retrospective study, patients diagnosed with a primary OSCC who received surgical therapy between January 1st, 2012 and December 31st, 2017 were included. Participants must have undergone panendoscopy during the staging process. None of these patients showed clinical signs of a second primary tumor. RESULTS: A total of 265 patients (99 females and 166 males; mean age=63.3 years, range=26-96 years) were included. The mean (SD) follow-up was 25.88 (±20.479 SD) months. Five synchronous secondary tumors (1.9%) could be identified within this cohort. Of these, only two (0.8%) were located within the area of panendoscopy and were diagnosed in patients with regular alcohol and/or tobacco abuse. Eighteen metachronous second primary tumors were diagnosed, 10 being located within the upper aero-digestive tract. CONCLUSION: The relevance of routinely performed panendoscopy in patients suffering from an oral squamous cell carcinoma without clinical signs of a secondary tumor should be critically re-evaluated, especially in patients without typical risk factors.

Carcinoma de Células Escamosas/diagnóstico , Endoscopia do Sistema Digestório/métodos , Neoplasias Bucais/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/patologia , Neoplasias Primárias Múltiplas/patologia , Segunda Neoplasia Primária/diagnóstico , Segunda Neoplasia Primária/patologia , Valor Preditivo dos Testes , Estudos Retrospectivos
Medicine (Baltimore) ; 100(9): e24975, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655966


RATIONALE: Jejunal varices are rare in portal hypertension and are often difficult to diagnose and treat. Herein, we present a case of gastrointestinal bleeding due to jejunal varices after hepatobiliary surgery. PATIENT CONCERNS: A 69-year-old man presented with recurrent massive gastrointestinal bleeding. He underwent partial right hepatectomy and cholangiojejunostomy 2 years prior to the first onset of bleeding. Two sessions of endoscopic vessel ligation for esophageal varices were performed afterwards, and hematemesis resolved completely, but massive melena still recurred during the following 5 years. DIAGNOSIS: The patient was diagnosed with jejunal varices caused by portal venous stenosis after hepatobiliary surgery. INTERVENTION: Portal venous angioplasty using balloon dilation and stent implantation was performed. OUTCOMES: After the intervention procedure, the patient did not experience any onset of gastrointestinal bleeding during follow-up. LESSONS: Hepatopancreatobiliary could lead to the formation of jejunal varices. The combined use of capsule endoscopy, contrast-enhanced computed tomography, and sometimes portal venography is a promising strategy to search for jejunal varices. Transcatheter angioplasty appears to be a safe and effective method for treatment of jejunal varices in certain appropriate cases.

Hemorragia Gastrointestinal/etiologia , Hepatectomia/efeitos adversos , Jejunostomia/efeitos adversos , Litíase/cirurgia , Hepatopatias/cirurgia , Hemorragia Pós-Operatória/etiologia , Idoso , Endoscopia por Cápsula , Colonoscopia/métodos , Diagnóstico Diferencial , Endoscopia do Sistema Digestório/métodos , Hemorragia Gastrointestinal/diagnóstico , Humanos , Masculino , Hemorragia Pós-Operatória/diagnóstico
Lancet Gastroenterol Hepatol ; 6(5): 381-390, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33713606


BACKGROUND: The COVID-19 pandemic has led to a substantial reduction in gastrointestinal endoscopies, creating a backlog of procedures. We aimed to quantify this backlog nationally for England and assess how various interventions might mitigate the backlog. METHODS: We did a national analysis of data for colonoscopies, flexible sigmoidoscopies, and gastroscopies from National Health Service (NHS) trusts in NHS England's Monthly Diagnostic Waiting Times and Activity dataset. Trusts were excluded if monthly data were incomplete. To estimate the potential backlog, we used linear logistic regression to project the cumulative deficit between actual procedures performed and expected procedures, based on historical pre-pandemic trends. We then made further estimations of the change to the backlog under three scenarios: recovery to a set level of capacity, ranging from 90% to 130%; further disruption to activity (eg, second pandemic wave); or introduction of faecal immunochemical testing (FIT) triaging. FINDINGS: We included data from Jan 1, 2018, to Oct 31, 2020, from 125 NHS trusts. 10 476 endoscopy procedures were done in April, 2020, representing 9·5% of those done in April, 2019 (n=110 584), before recovering to 105 716 by October, 2020 (84·5% of those done in October, 2019 [n=125 072]). Recovering to 100% capacity on the current trajectory would lead to a projected backlog of 162 735 (95% CI 143 775-181 695) colonoscopies, 119 025 (107 398-130 651) flexible sigmoidoscopies, and 194 087 (172 564-215 611) gastroscopies in January, 2021, attributable to the pandemic. Increasing capacity to 130% would still take up to June, 2022, to eliminate the backlog. A further 2-month interruption would add an extra 15·4%, a 4-month interruption would add an extra 43·8%, and a 6-month interruption would add an extra 82·5% to the potential backlog. FIT triaging of cases that are found to have greater than 10 µg haemoglobin per g would reduce colonoscopy referrals to around 75% of usual levels, with the backlog cleared in early 2022. INTERPRETATION: Our work highlights the impact of the pandemic on endoscopy services nationally. Even with mitigation measures, it could take much longer than a year to eliminate the pandemic-related backlog. Urgent action is required by key stakeholders (ie, individual NHS trusts, Clinical Commissioning Groups, British Society of Gastroenterology, and NHS England) to tackle the backlog and prevent delays to patient management. FUNDING: Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) at University College London, National Institute for Health Research University College London Hospitals Biomedical Research Centre, and DATA-CAN, Health Data Research UK.

Fortalecimento Institucional , Endoscopia do Sistema Digestório , Gastroenteropatias , Utilização de Procedimentos e Técnicas , Triagem , /epidemiologia , Fortalecimento Institucional/métodos , Fortalecimento Institucional/organização & administração , Gestão de Mudança , Endoscopia do Sistema Digestório/métodos , Endoscopia do Sistema Digestório/estatística & dados numéricos , Gastroenteropatias/epidemiologia , Gastroenteropatias/terapia , Humanos , Imunoquímica , Controle de Infecções , Avaliação de Processos e Resultados em Cuidados de Saúde , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Utilização de Procedimentos e Técnicas/tendências , Medicina Estatal/organização & administração , Medicina Estatal/tendências , Triagem/métodos , Triagem/estatística & dados numéricos , Reino Unido/epidemiologia , Listas de Espera
Arq Bras Cir Dig ; 33(3): e1543, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33470373


BACKGROUND: Endoscopic aspect of fundoplication anatomy: Normal aspect of Nissen fundoplication. Upper digestive endoscopy is important for the evaluation of patients submitted to fundoplication, especially to elucidate postoperative symptoms. However, endoscopic assessment of fundoplication anatomy and its complications is poorly standardized among endoscopists, which leads to inadequate agreement. AIM: To assess the frequency of postoperative abnormalities of fundoplication anatomy using a modified endoscopic classification and to correlate endoscopic findings with clinical symptoms. METHOD: This is a prospective observational study, conducted at a single center. Patients were submitted to a questionnaire for data collection. Endoscopic assessment of fundoplication was performed according to the classification in study, which considered four anatomical parameters including the gastroesophageal junction position in frontal view (above or at the level of the pressure zone); valve position at retroflex view (intra-abdominal or migrated); valve conformation (total, partial, disrupted or twisted) and paraesophageal hernia (present or absent). RESULTS: One hundred patients submitted to fundoplication were evaluated, 51% male (mean age: 55.6 years). Forty-three percent reported postoperative symptoms. Endoscopic abnormalities of fundoplication anatomy were reported in 46% of patients. Gastroesophageal junction above the pressure zone (slipped fundoplication), and migrated fundoplication, were significantly correlated with the occurrence of postoperative symptoms. There was no correlation between symptoms and conformation of the fundoplication (total, partial or twisted). CONCLUSION: This modified endoscopic classification proposal of fundoplication anatomy is reproducible and seems to correlate with symptomatology. The most frequent abnormalities observed were slipped and migrated fundoplication, and both correlated with the presence of symptoms.

Endoscopia do Sistema Digestório/métodos , Fundoplicatura/efeitos adversos , Refluxo Gastroesofágico/cirurgia , Hérnia Hiatal/cirurgia , Laparoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Resultado do Tratamento
J Clin Rheumatol ; 27(1): 40-41, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33347033


BACKGROUND/AIMS: A role for Helicobacter pylori in triggering systemic sclerosis (SSc) has been proposed, but data are conflicting. In previous studies, infection has been generally searched for by using serology. We designed this study to assess H. pylori prevalence in SSc patients with histology of gastric mucosa, considered the criterion standard for infection diagnosis. METHODS: This cross-sectional study enrolled 30 SSc patients who complained of upper gastrointestinal symptoms. All underwent upper endoscopy with gastric biopsies. Endoscopic alterations were recorded, and gastric mucosa biopsies were used for both histological examination and searching for H. pylori. The role for proton-pump inhibitor (PPI) therapy was considered. Fisher exact test was used for statistical analysis. RESULTS: Data of 28 SSc patients were available, 14 with ongoing PPI therapy. Helicobacter pylori infection at histology was detected in 14.3% patients, and it equally occurred in patients with or without PPI therapy. Erosive esophagitis/Barrett esophagus was detected in 26.6% of cases. Among patients with PPI therapy, 30% received half dose only. The prevalence of intestinal metaplasia was low (14.3%). Endoscopic esophageal alterations were significantly more frequent in those patients showing anti-Scl70 antibody positivity. CONCLUSIONS: This study showed that prevalence of H. pylori is very low in SSc patients, so that it seems not having a role in triggering SSc. Management of gastroesophageal diseases in SSc patients needs to be improved, and looking to the autoimmune profile may be of help. Thus, collaboration between rheumatologist and gastroenterologist is highly recommended.

Infecções por Helicobacter/patologia , Helicobacter pylori/isolamento & purificação , Proteínas Nucleares/imunologia , Inibidores da Bomba de Prótons/uso terapêutico , Escleroderma Sistêmico , Trato Gastrointestinal Superior , Autoanticorpos/sangue , Esôfago de Barrett/patologia , Biópsia/métodos , Endoscopia do Sistema Digestório/métodos , Feminino , Mucosa Gástrica/microbiologia , Mucosa Gástrica/patologia , Refluxo Gastroesofágico/tratamento farmacológico , Infecções por Helicobacter/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Escleroderma Sistêmico/sangue , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/microbiologia , Escleroderma Sistêmico/fisiopatologia , Trato Gastrointestinal Superior/diagnóstico por imagem , Trato Gastrointestinal Superior/microbiologia , Trato Gastrointestinal Superior/patologia
Gastroenterol. hepatol. (Ed. impr.) ; 43(10): 589-597, dic. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-197973


INTRODUCCIÓN: En un estudio previo demostramos que un pequeño programa de formación mejoraba los indicadores de calidad de la esofagogastroduodenoscopia (EGD) que llegaban a los estándares recomendados. Sin embargo, desconocemos el efecto de esta formación a largo plazo. El objetivo de este estudio fue valorar la calidad de las EGD después de 3años de haber realizado un programa de mejora. MATERIAL Y MÉTODOS: Estudio comparativo de 2 cohortes: EGD posteriores a un programa de formación realizado en 2016 (grupo A) y EGD en enero-marzo de 2019 (grupo B). El grupo B se dividió en 2 subgrupos: endoscopistas que habían participado en el programa de formación previo (B1) y los que no (B2). Se utilizaron los indicadores de calidad intraprocedimiento recomendados por la ASGE-ACG. RESULTADOS: Se analizaron un total de 1.236 EGD, 600 en el grupo A y 636 en el B (439 subgrupo B1 y 197 subgrupo B2). El número de exploraciones completas fue inferior en el grupo B (566 [94,3%] vs. 551 [86,6%]; p < 0,001). Se observó una disminución significativa en prácticamente todos los indicadores de calidad que, además, no alcanzaron los estándares recomendados: retroversión gástrica (96% vs. 81%; p < 0,001); protocolo de biopsias de Seattle (86% vs. 50%; p = 0,03), descripción de la lesión en la hemorragia (100% vs. 62%; p < 0,01), toma de ≥4 biopsias en sospecha de celiaquía (92,5% vs. 18%; p < 0,001), fotodocumentación de lesión (94% vs. 90%; p < 0,05). Cuando consideramos el global de la prueba (incluyendo la actuación correcta y la fotodocumentación adecuada), también se observó una disminución significativa (90,5% vs. 62%; p < 0,001). No hubo diferencias entre los subgrupos B1 y B2. CONCLUSIONES: La mejora observada en 2016 tras un programa de formación no perdura a los 3años. Es necesario hacer programas de formación continuados para mantener la calidad de la EGD por encima de los estándares recomendados

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

Humanos , Indicadores de Qualidade em Assistência à Saúde/normas , Endoscopia do Sistema Digestório/métodos , Endoscopia do Sistema Digestório/normas , Estudos de Coortes , Assistência ao Paciente/normas , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Assistência ao Paciente/métodos , Sociedades Médicas/normas , Estudos Prospectivos , Estudos Retrospectivos , Endoscopia/normas
Rev. medica electron ; 42(6): 2575-2585, nov.-dic. 2020. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1150038


RESUMEN Introducción: en los últimos años, se aprecia a nivel global un aumento del cáncer gástrico. La mayoría de los tumores gástricos primarios son malignos. En Matanzas, existe un incremento de esta patología. Objetivo: determinar el comportamiento clínico, endoscópico e histológico del cáncer gástrico diagnosticado. Materiales y métodos: se realizó un estudio observacional, descriptivo y prospectivo en el Departamento de Gastroenterología del Hospital "Dr. Mario Muñoz Monroy", de la ciudad de Matanzas, en el período de enero del 2017 a octubre del 2019. El universo fue 25 pacientes que presentaron cáncer gástrico por diagnóstico endoscópico e histológico. Resultados: el grupo de edad más afectado correspondió a los pacientes entre 61 y 70 años, (44 %). El sexo masculino predominó en un 68 %. Los factores de riesgo de mayor incidencia, fueron la dieta inadecuada y el hábito de fumar. Las manifestaciones clínicas más relevantes fueron: epigastralgia, plenitud gástrica y pérdida de peso. La variedad hística que predominó fue el adenocarcinoma difuso y la localización el antro. Conclusiones: el cáncer gástrico constituye un problema de salud que, al actuar sobre los factores de riesgo se puede disminuir su incidencia; con un diagnóstico precoz se logrará disminuir la mortalidad (AU).

ABSTRACT Introduction: an increase of gastric cancer is appreciated in the world in the last years. Most of the primary gastric tumors are malignant. There is an increase of this disease also in Matanzas. Objective: to determine the histological, endoscopic and clinical behavior of the diagnosed gastric cancer. Materials and methods: a prospective, descriptive and observational study was carried out in the Department of Gastroenterology of the Hospital "Mario Munoz Monroy, of Matanzas, in the period from January 2017 to October 2019. The universe were 25 patients presenting gastric cancer by histologic and endoscopic diagnosis. Results: The most affected age group was the one of patients among 61 and 70 years old (44 %). Male sex predominated in 68 %. The risk factors having higher incidence were an inadequate diet and smoking. The more relevant clinical manifestation were epigastralgia, gastric fullness and weight loss. The predominating tissue variety was the diffuse adenocarcinoma and antrum location. Conclusions: gastric cancer is a health problem the incidence of which could be reduced when acting on its risk factors; with a precocious diagnosis mortality will be reduced (AU).

Humanos , Masculino , Feminino , Neoplasias Gástricas/epidemiologia , Comportamentos Relacionados com a Saúde , Sinais e Sintomas , Neoplasias Gástricas/complicações , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologia , Fatores de Risco , Endoscopia do Sistema Digestório/métodos
Surg Clin North Am ; 100(6): 1151-1168, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33128885


The evolution of advanced pancreaticobiliary endoscopy in the past 50 years is remarkable. Endoscopic retrograde cholangiopancreatography (ERCP) has progressed from a diagnostic test to an almost entirely therapeutic procedure. The endoscopist must have a clear understanding of the indications for ERCP to avoid unnecessary complications, including post-ERCP pancreatitis. Endoscopic ultrasound initially was used as a diagnostic tool but now is equipped with accessary channels allowing endoscopic ultrasound-guided interventions in various pancreaticobiliary conditions. This review discusses the endoscopic management of common pancreatic and biliary diseases along with the techniques, indications, outcomes, and complications of pancreaticobiliary endoscopy.

Doenças Biliares , Endoscopia do Sistema Digestório , Pancreatopatias , Doenças Biliares/diagnóstico , Doenças Biliares/cirurgia , Colangiopancreatografia Retrógrada Endoscópica , Endoscopia do Sistema Digestório/instrumentação , Endoscopia do Sistema Digestório/métodos , Endoscopia do Sistema Digestório/normas , Endossonografia/instrumentação , Endossonografia/métodos , Endossonografia/normas , Humanos , Pancreatopatias/diagnóstico , Pancreatopatias/cirurgia
Surg Clin North Am ; 100(6): 1169-1182, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33128886


Intramural surgery is a minimally invasive surgical technique based on flexible endoscopy. The first step involves the initial mucosal incision for entry point. Then a submucosal tunnel is dissected to the site of the target anatomy. The procedure performed may include myotomy or lesion removal. When complete, the initial mucosal incision is closed. This technique separates the mucosal flap from the surgical site, minimizing the risk of full-thickness perforation and gastrointestinal leakage. Peroral endoscopic myotomy is the most studied application of intramural surgery but other procedures have emerged. This article explores principles of intramural surgery and summarizes its applications.

Endoscopia do Sistema Digestório/métodos , Gastroenteropatias/cirurgia , Trato Gastrointestinal/cirurgia , Membrana Mucosa/cirurgia , Dissecação , Endoscopia do Sistema Digestório/normas , Humanos , Cirurgia Endoscópica por Orifício Natural/métodos , Cirurgia Endoscópica por Orifício Natural/normas
Gastroenterol. hepatol. (Ed. impr.) ; 43(8): 431-438, oct. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-196894


OBJETIVO: Evaluar la eficacia y seguridad de la terapia de vacío endoscópica (TVE) en perforaciones y dehiscencias del tracto digestivo superior. PACIENTES Y MÉTODOS: Estudio retrospectivo observacional donde se incluyeron todos los pacientes que presentaron algún defecto del tracto gastrointestinal superior y que fueron sometidos a TVE en el período comprendido entre abril de 2017 y febrero de 2019 en 3 centros españoles. Para ello se utilizó el único sistema de terapia de vacío aprobado para uso endoscópico hasta la fecha (Eso-SPONGEr; B. Braun Melsungen AG, Melsungen, Alemania). RESULTADOS: Un total de 11 pacientes fueron sometidos a TVE como tratamiento de una dehiscencia de sutura anastomótica tras esofaguectomía (n=7), gastrectomía (n=2), como tratamiento de una perforación esofágica tras septomiotomía endoscópica de Zenker (n=1) y tras una perforación esofágica espontánea o síndrome de Boerhaave (n=1). La mediana del tamaño de la cavidad fue de 8×3cm. De mediana, la TVE se inició a los 7días de la cirugía inicial. La mediana de duración de la TVE fue de 28días. La mediana de esponjas colocadas fue de 7 y el intervalo de recambio de las esponjas, de 3,7días. En 10 casos (91%) se consiguió el cierre del defecto y en 9 casos (82%) la resolución clínica del cuadro infeccioso asociado. Cinco pacientes presentaron algún evento adverso: 3 estenosis anastomóticas, un episodio de dolor retrofaríngeo y un caso de neumonía de nueva aparición. La mediana de estancia hospitalaria desde el inicio de la TVE fue de 45días. Un paciente falleció debido a complicaciones sépticas secundarias a la dehiscencia de sutura. CONCLUSIÓN: La TVE tiene una eficacia superior al 90% en las perforaciones y fugas anastomóticas del tracto digestivo superior. Adicionalmente es una terapia segura, siendo los eventos adversos leves

AIM: To evaluate the efficacy and safety of endoscopic vacuum therapy (EVT) in the management of perforations and anastomotic leaks of the upper gastrointestinal tract. PATIENTS AND METHODS: This is a retrospective observational study which included patients who underwent EVT due to any upper gastrointestinal defect between April 2017 and February 2019 in three Spanish Hospitals. To this end, we used the only medical device approved to date for endoscopic use (Eso-SPONGEr; B. Braun Melsungen AG, Melsungen, Germany). RESULTS: 11 patients were referred for EVT of an anastomotic leak after esophagectomy (n=7), gastrectomy (n=2), esophageal perforation secondary to endoscopic Zenker's septomiotomy (n=1) and Boerhaave syndrome (n=1). The median size of the cavity was 8×3cm. The median delay between surgery and EVT was 7 days. The median of EVT duration was 28 days. The median number of sponges used was 7 and the mean period replacement was 3.7 days. In 10 cases (91%), the defect was successfully closed. In 9 cases (82%) clinical resolution of the septic condition was achieved. 5 patients presented some adverse event: 3 anastomotic strictures, 1 retropharyngeal pain and 1 case of new-onset pneumonia. The median hospital stay from the start of EVT was 45 days. 1 patient died owing to septic complications secondary to the anastomotic leak. CONCLUSION: EVT was successful in over 90% of perforations and anastomotic leaks of the upper gastrointestinal tract. Moreover, this is a safe therapy with only mild adverse events associated

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Deiscência da Ferida Operatória/terapia , Endoscopia do Sistema Digestório/métodos , Resultado do Tratamento , Perfuração Intestinal/cirurgia , Estudos Retrospectivos , Perfuração Intestinal/diagnóstico , Fístula do Sistema Digestório/cirurgia , Fístula Anastomótica
Medicine (Baltimore) ; 99(36): e22090, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899087


BACKGROUND: Although surgical resection holds promise for curing pancreatic cancer, <20% of patients are suitable; however, early postoperative recurrence is common. Currently, radiographic examination is the primary method to determine whether pancreatic cancer has metastasized and to inform clinical staging before surgery. However, the method has a limited detection rate for micro-metastasis within the abdominal cavity; therefore, patients with advanced pancreatic cancer and existing micro-metastasis may receive unnecessary surgical treatment, delaying the timing of adjuvant chemotherapy and resulting in poor prognosis. Laparoscopic staging might be used as a supplement to detect micro-metastasis in patients with pancreatic cancer; however, there is no consistent standard to guide the use of this procedure. Therefore, it is necessary to conduct a trial to further explore the consistency and short-term and long-term efficacy of an intraoperative staging strategy for patients with radiographic non-metastasis. METHODS/DESIGN: This is a single-center cross-sectional and follow-up study. Patients diagnosed with pancreatic cancer without metastasis by radiographic examination and histopathological biopsy, who received intraoperative restaging, will be enrolled. The total sample size required for the trial is approximately 125 patients from May 2020 to December 2022. First, radiographic examination staging will be used. Then, laparoscopic exploration will be performed for patients without definite metastatic lesions. Data collection will include preoperative blood examination, radiographic examination, surgical information, and postoperative recovery. The patients will undergo follow-up every 3 months after surgery until death. The primary endpoint is the metastasis-positive rate via laparoscopic exploration. The secondary endpoints are the consistency, sensitivity, and specificity of the intraoperative restaging strategy and radiographic examination, the incidence of postoperative complications within 30 days, the 6-month relapse-free survival rate, and perioperative indicators (total cost, hospital stay, length of surgery, and intraoperative blood loss). DISCUSSION: We are conducting the trial to explore the metastasis-positive rate of intraoperative restaging strategy for diagnosing pancreatic cancer micro-metastasis. This new intraoperative restaging strategy would help pancreatic cancer patients with potential micro-metastasis avoid receiving unnecessary resection, allow systemic treatment as early as possible, and improve the prognosis of patients.

Endoscopia do Sistema Digestório/métodos , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Seguimentos , Testes Hematológicos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Pancreáticas/diagnóstico por imagem , Assistência Perioperatória/economia , Assistência Perioperatória/estatística & dados numéricos , Sensibilidade e Especificidade , Adulto Jovem
Gut ; 69(11): 1915-1924, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32816921


The COVID-19 pandemic has had a profound impact on provision of endoscopy services globally as staff and real estate were repurposed. As we begin to recover from the pandemic, a cohesive international approach is needed, and guidance on how to resume endoscopy services safely to avoid unintended harm from diagnostic delays. The aim of these guidelines is to provide consensus recommendations that clinicians can use to facilitate the swift and safe resumption of endoscopy services. An evidence-based literature review was carried out on the various strategies used globally to manage endoscopy during the COVID-19 pandemic and control infection. A modified Delphi process involving international endoscopy experts was used to agree on the consensus statements. A threshold of 80% agreement was used to establish consensus for each statement. 27 of 30 statements achieved consensus after two rounds of voting by 34 experts. The statements were categorised as pre-endoscopy, during endoscopy and postendoscopy addressing relevant areas of practice, such as screening, personal protective equipment, appropriate environments for endoscopy and infection control precautions, particularly in areas of high disease prevalence. Recommendations for testing of patients and for healthcare workers, appropriate locations of donning and doffing areas and social distancing measures before endoscopy are unique and not dealt with by any other guidelines. This international consensus using a modified Delphi method to produce a series of best practice recommendations to aid the safe resumption of endoscopy services globally in the era of COVID-19.

Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Endoscopia do Sistema Digestório/estatística & dados numéricos , Saúde do Trabalhador , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Consenso , Infecções por Coronavirus/epidemiologia , Técnica Delfos , Endoscopia do Sistema Digestório/métodos , Feminino , Seguimentos , Humanos , Incidência , Internacionalidade , Masculino , Pandemias/estatística & dados numéricos , Segurança do Paciente , Pneumonia Viral/epidemiologia , Medição de Risco , Fatores de Tempo , Estados Unidos