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Medicine (Baltimore) ; 100(3): e24375, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546076


RATIONALE: The diagnosis of type IV branchial cleft cyst (BCC) according to the Bailey classification is very challenging due to lack of specific clinical manifestations in the early stage of the disease. Here, we present the transoral surgical route of endoscopic resection of second BCC in the parapharyngeal space (PPS) with good outcomes. PATIENT CONCERNS: A 21-year-old man with a 1-year history of snoring complained about sore throat for 1 month and a fever that lasted for 3 days. DIAGNOSES: On admission, physical examination revealed a temperature of 39°C, pain when swallowing accompanied with a lump sensation in the throat, and inability to open mouth more than 3 cm. Blood testing revealed 19.29 × 109 white blood cells (WBCs)/L and 14.94 × 109 neutrophils/L. A cervical computed tomography (CT) examination revealed a mass with liquid density of 6.2 × 4.0 × 7.7 cm3 in the left parapharyngeal space (PPS) and pharyngeal cavity stenosis. Postoperative pathology showed the existence of lymphoepithelial cysts (left PPS), which was in accordance with the diagnosis of BCC. INTERVENTIONS: The patient was administered 1.5 g ceftazidime every 12 hours, anti-inflammatory drugs, and incision drainage was performed subsequently. Then, endoscopy-assisted resection of the left PPS was performed via the transoral route. We used low-temperature plasma and an 8-Fr Foley catheter with a water capsule during the surgery. OUTCOMES: After resection of the mass, the patient's blood results returned to within the normal range and his symptoms improved. Five days postoperatively, the incision made in the palatine arch of the pharynx opened up by 1 cm, and eventually the wound and laceration healed. Normal oral eating was restored, and no complications were observed. LESSONS: Magnetic resonance imaging (MRI), and color Doppler ultrasound can be useful to diagnose BCC in PPS, which rarely occurs in the clinical setting. Extended endoscopy provides a satisfactory surgical field for trans-oral resection allowing complete resection of the BCC without serious postoperative complications.

Branquioma/cirurgia , Endoscopia/normas , Endoscopia/métodos , Feminino , Humanos , Masculino , Espaço Parafaríngeo/cirurgia , Adulto Jovem
Medicine (Baltimore) ; 100(3): e23934, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33545965


BACKGROUND: Conventional white-light imaging endoscopy (C-WLI) had a significant number of misdiagnosis in early gastric cancer (EGC), and magnifying endoscopy (ME) combined with different optical imaging was more accurate in the diagnosis of EGC. This study aimed to evaluate the accuracy of ME and compare the accuracy of ME with different optical imaging in detecting EGC. METHODS: A comprehensive literature search was conducted to identify all relevant studies. Pair-wise meta-analysis was conducted to evaluate the accuracy of ME, and Bayesian network meta-analysis was performed to combine direct and indirect evidence and estimate the relative effects. RESULTS: Eight prospective studies were identified with a total of 5948 patients and 3 optical imaging in ME (ME with WLI (M-WLI), ME with narrow-band imaging (M-NBI), and ME with blue laser imaging (M-BLI)). Pair-wise meta-analysis showed a higher accuracy of ME than C-WLI (OR: 2.97, 95% CI: 1.68∼5.25). In network meta-analysis, both M-NBI and M-BLI were more accurate than M-WLI (OR: 2.56, 95% CI: 2.13∼3.13; OR: 3.13, 95% CI: 1.85∼5.71). There was no significant difference between M-NBI and M-BLI. CONCLUSION: ME was effective in improving the detecting rate of EGC, especially with NBI or BLI.

Endoscopia/métodos , Neoplasias Gástricas/diagnóstico , Detecção Precoce de Câncer/métodos , Endoscopia/normas , Endoscopia/estatística & dados numéricos , Humanos , Metanálise em Rede , Razão de Chances , Estudos Prospectivos , Neoplasias Gástricas/fisiopatologia
Otolaryngol Clin North Am ; 54(1): 11-23, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33243372


A new era of surgical visualization and magnification is poised to disrupt the field of otology and neurotology. The once revolutionary benefits of the binocular microscope now are shared with rigid endoscopes and exoscopes. These 2 modalities are complementary. The endoscope improves visualization of the hidden recesses through the external auditory canal or canal-up mastoidectomy. The exoscope provides an immersive visual experience and superior ergonomics compared with binocular microscopy. Endoscopes and exoscopes are poised to disrupt the standard of care for surgical visualization and magnification in otology and neurotology.

Endoscópios/normas , Endoscopia/instrumentação , Neuro-Otologia/instrumentação , Otolaringologia/instrumentação , Pandemias , Meato Acústico Externo/cirurgia , Endoscopia/normas , Desenho de Equipamento/normas , Humanos , Mastoidectomia/instrumentação , Microcirurgia/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Neurocirúrgicos/instrumentação , Neuro-Otologia/normas , Otolaringologia/normas , Padrão de Cuidado/normas , Estados Unidos
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
Surg Clin North Am ; 100(6): 1021-1047, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33128878


Quality improvement is a dynamic process that requires continuously monitoring quality indicators and benchmarking these with national and professional standards. Endoscopists have formed societal task forces to propose quality indicators and performance goals. Institutions are now incentivized by payers and value-based reimbursement agreements to have processes in place to measure, report, and act on these quality metrics. Nationwide registries, such as the Gastrointestinal Quality Improvement Consortium, are used to report quality data to these merit-based incentive payment systems. Quality improvement processes such as these are instrumental to improve patient safety, health, and satisfaction while decreasing costs and medical errors.

Endoscopia do Sistema Digestório/normas , Guias de Prática Clínica como Assunto/normas , Melhoria de Qualidade , Benchmarking/normas , Competência Clínica , Endoscopia/normas , Endossonografia/normas , Humanos , Segurança do Paciente/normas , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas
Acta otorrinolaringol. esp ; 71(5): 309-315, sept.-oct. 2020.
Artigo em Espanhol | IBECS | ID: ibc-195218


Este documento pretende ser una guía para los otorrinolaringólogos españoles que deseen realizar endoscopia del sueño inducido por fármacos, normalmente conocida como DISE de sus siglas en inglés drug-induced sleep endoscopy. Las indicaciones, el método de sedación y la valoración de los hallazgos se comentarán para tratar de unificar metodología y criterios

This document is intended as a guide for Spanish ENT specialists who want to perform drug-induced sleep endoscopy. Indications, sedation method and important findings are discussed to unify criteria and methodology

Humanos , Criança , Guias de Prática Clínica como Assunto , Endoscopia/métodos , Sedação Profunda/métodos , Apneia Obstrutiva do Sono/diagnóstico , Obstrução das Vias Respiratórias/diagnóstico , Endoscopia/normas , Sedação Profunda/normas
Acta otorrinolaringol. esp ; 71(5): 316-320, sept.-oct. 2020.
Artigo em Espanhol | IBECS | ID: ibc-195219


Este documento pretende dar a conocer la endoscopia de sueño inducido entre los distintos especialistas que tratan a los pacientes con trastornos respiratorios del sueño y ser una guía para los especialistas que vayan a realizarla de modo que pueda ser reproducible

This document introduces drug-induced sleep endoscopy to the specialist treating sleep breathing disorders and is intended as a guide for those willing to perform the procedure so that it can be reproducible

Humanos , Guias de Prática Clínica como Assunto , Endoscopia/métodos , Sedação Profunda/métodos , Apneia Obstrutiva do Sono/diagnóstico , Endoscopia/normas , Sedação Profunda/normas , Apneia Obstrutiva do Sono/terapia , Propofol/uso terapêutico , Hipnóticos e Sedativos/uso terapêutico , Midazolam/uso terapêutico
PLoS One ; 15(9): e0239740, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32976548


BACKGROUND: Studies on gastrointestinal (GI) tract involvement in mantle cell lymphoma (MCL) are lacking. We investigated the clinical characteristics and prognosis of MCL with GI tract involvement. METHODS: We retrospectively analyzed 64 patients diagnosed with MCL from January 2009 to April 2017. At the time of MCL diagnosis, patients who were identified to have GI involvement by endoscopic or radiologic examination were assigned to the GI-MCL group. The other patients were assigned to the non GI-MCL group. RESULTS: The GI-MCL group included 28 patients (43.8%). The most common endoscopic finding of MCL was lymphomatous polyposis (20/28, 71.4%). The GI-MCL group had higher stage and International Prognostic Index status (P = 0.012 and P = 0.003, respectively). Among the total 51 GI lesions in the GI-MCL group, 31.4% (16/51) were detected only by endoscopic examinations and were not detected on CT or PET-CT. The cumulative incidence of recurrence was higher in the GI-MCL group compared with the non GI-MCL group but the difference was not statistically significant (P = 0.082). Stage (HR 1.994, 95% CI 1.007-3.948) and auto PBSCT (HR 0.133, 95% CI 0.041-0.437) were identified as independent predictive factors for recurrence. Recurrences at GI tract were identified in 59.1% (13/22) and 11.1% (2/18) of the GI-MCL and non GI-MCL group, respectively. Among 15 GI tract recurrences, five recurrences were detected only with endoscopic examinations. CONCLUSIONS: Endoscopy can reveal the GI involvement of MCL that is not visualized by radiological imaging. Endoscopic examinations are recommended during staging workup and the follow-up period of MCL patients.

Endoscopia/normas , Neoplasias Gastrointestinais/patologia , Linfoma de Célula do Manto/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Endoscopia/métodos , Feminino , Humanos , Limite de Detecção , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias
Eur J Obstet Gynecol Reprod Biol ; 253: 133-140, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32866856


The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has raised some important interrogations on minimally invasive gynaecological surgery. The International Society for Gynecologic Endoscopy (ISGE) has taken upon itself the task of providing guidance and best practice policies for all practicing gynaecological endoscopists. Factors affecting decision making processes in minimal invasive surgery (MIS) vary depending on factors such as the phase of the pandemic, policies on control and prevention, expertise and existing infrastructure. Our responsibility remains ensuring the safety of all health care providers, ancillary staff and patients during this unusual period. We reviewed the current literature related to gynecological and endoscopic surgery during the Coronavirus Disease 19 (COVID-19) crisis. Regarding elective surgery, universal testing for SARS-CoV-2 infection should be carried out wherever possible 40 h prior to surgery. In case of confirmed positive case of SARS-CoV-2, surgery should be delayed. Priority should be given to relatively urgent cases such as malignancies. ISGE supports medical optimization and delaying surgery for benign non-life-threatening surgeries. When possible, we recommend to perform cases by laparoscopy and to allow early discharges. Any procedure with risk of bowel involvement should be performed by open surgery as studies have found a high amount of viral RNA (ribonucleic acid) in stool. Regarding urgent surgery, each unit should create a risk assessment flow chart based on capacity. Patients should be screened for symptoms and symptomatic patients must be tested. In the event that a confirmed case of SARS-CoV-2 is found, every attempt should be made to optimize medical management and defer surgery until the patient has recovered and only emergency or life-threatening surgery should be performed in these cases. We recommend to avoid intubation and ventilation in SARS-CoV-2 positive patients and if at all possible local or regional anesthesia should be utilized. Patients who screen or test negative may have general anesthesia and laparoscopic surgery while strict protocols of infection control are upheld. Surgery in screen-positive as well as SARS-CoV-2 positive patients that cannot be safely postponed should be undertaken with full PPE with ensuring that only essential personnel are exposed. If available, negative pressure theatres should be used for patients who are positive or screen high risk. During open and vaginal procedures, suction can be used to minimize droplet and bioaerosol spread. In a patient who screens low risk or tests negative, although carrier and false negatives cannot be excluded, laparoscopy should be strongly considered. We recommend, during minimal access surgeries, to use strategies to reduce production of bioaerosols (such as minimal use of energy, experienced surgeon), to reduce leakage of smoke aerosols (for example, minimizing the number of ports used and size of incisions, as well as reducing the operating pressures) and to promote safe elimination of smoke during surgery and during the ports' closure (such as using gas filters and smoke evacuation systems). During the post-peak period of pandemic, debriefing and mental health screening for staff is recommended. Psychological support should be provided as needed. In conclusion, based on the existent evidence, ISGE largely supports the current international trends favoring laparoscopy over laparotomy on a case by case risk evaluation basis, recognizing the different levels of skill and access to minimally invasive procedures across various countries.

Infecções por Coronavirus/prevenção & controle , Endoscopia/normas , Procedimentos Cirúrgicos em Ginecologia/normas , Controle de Infecções/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Betacoronavirus , Infecções por Coronavirus/etiologia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/normas , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Humanos , Pneumonia Viral/etiologia , Sociedades Médicas
Gastroenterol. hepatol. (Ed. impr.) ; 43(7): 389-407, ago.-sept. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-188817


INTRODUCCIÓN: La pandemia por COVID-19 ha conllevado la suspensión de la actividad programada en la mayoría de las Unidades de Endoscopia de nuestro medio. El objetivo del presente documento es facilitar el reinicio de la actividad endoscópica electiva de forma eficiente y segura. MATERIAL Y MÉTODOS: Se formularon una serie de preguntas consideradas de relevancia clínica y logística. Para la elaboración de las respuestas, se realizó una búsqueda bibliográfica estructurada en las principales bases de datos y se revisaron las recomendaciones de las principales instituciones de Salud Pública y de endoscopia digestiva. Las recomendaciones finales se consensuaron por vía telemática. RESULTADOS: Se han elaborado un total de 33 recomendaciones. Los principales aspectos que se discuten son: 1) La reevaluación y priorización de la indicación, 2) La restructuración de espacios, agendas y del personal sanitario, 3) El cribado de la infección, 4) Las medidas de higiene y los equipos de protección individual. CONCLUSIÓN: La AEG y la SEED recomiendan reiniciar la actividad endoscópica de forma escalonada, segura, adaptada a los recursos locales y a la situación epidemiológica de la infección por SARS-CoV-2

INTRODUCTION: The COVID-19 pandemic has led to the suspension of programmed activity in most of the Endoscopy Units in our environment. The aim of this document is to facilitate the resumption of elective endoscopic activity in an efficient and safe manner. MATERIAL AND METHODS: A series of questions considered to be of clinical and logistical relevance were formulated. In order to elaborate the answers, a structured bibliographic search was carried out in the main databases and the recommendations of the main Public Health and Digestive Endoscopy institutions were reviewed. The final recommendations were agreed upon through telematic means. RESULTS: A total of 33 recommendations were made. The main aspects discussed are: 1) Reassessment and prioritization of the indication, 2) Restructuring of spaces, schedules and health personnel, 3) Screening for infection, 4) Hygiene measures and personal protective equipment. CONCLUSION: The AEG and SEED recommend restarting endoscopic activity in a phased, safe manner, adapted to local resources and the epidemiological situation of SARS-CoV-2 infection

Humanos , Sociedades Médicas/normas , Endoscopia/normas , Infecções por Coronavirus/epidemiologia , Pandemias/prevenção & controle , Programas de Triagem Diagnóstica/normas , Assistência à Saúde/organização & administração , Sociedades Médicas/organização & administração , Comissão Para Atividades Profissionais e Hospitalares/normas , Contaminação de Equipamentos , Técnicas e Procedimentos Diagnósticos/normas , Endoscopia Gastrointestinal/normas , Gastroscopia/métodos , Colonoscopia , Cápsulas Endoscópicas , Espanha/epidemiologia
Gastroenterology ; 159(5): 1935-1948.e5, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32735862
J Laryngol Otol ; 134(8): 744-746, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32641171


BACKGROUND: Fibre-optic nasoendoscopy and fibre-optic laryngoscopy are high-risk procedures in the coronavirus disease 2019 era, as they are potential aerosol-generating procedures. Barrier protection remains key to preventing transmission. METHODS: A device was developed that patients can wear to reduce potential aerosol contamination of the surroundings. CONCLUSION: This device is simple, reproducible, easy to use, economical and well-tolerated. Full personal protection equipment should additionally be worn by the operator.

Líquidos Corporais/virologia , Infecções por Coronavirus/transmissão , Endoscopia/efeitos adversos , Laringoscopia/normas , Equipamento de Proteção Individual/virologia , Pneumonia Viral/transmissão , Aerossóis , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Transmissão de Doença Infecciosa/prevenção & controle , Endoscopia/normas , Desenho de Equipamento , Humanos , Nariz/diagnóstico por imagem , Otorrinolaringologistas/estatística & dados numéricos , Pandemias , Equipamento de Proteção Individual/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Inquéritos e Questionários
Gastroenterology ; 159(5): 1962-1964, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32682767
Clinics (Sao Paulo) ; 75: e1989, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555947


OBJECTIVES: The present coronavirus disease (COVID-19) pandemic has ushered in an unprecedented era of quality control that has necessitated advanced safety precautions and the need to ensure the adequate protection of healthcare professionals (HCPs). Endoscopy units, endoscopists, and other HCP may be at a significant risk for transmission of the virus. Given the immense burden on the healthcare system and surge in the number of patients with COVID-19, well-designed protocols and recommendations are needed. We aimed to systematically characterize our approach to endoscopic procedures in a quaternary university hospital setting and provide summary protocol recommendations. METHOD: This descriptive study details a COVID-19-specific protocol designed to minimize infection risks to patients and healthcare workers in the endoscopy unit. RESULTS: Our institution, located in São Paulo, Brazil, includes a 900-bed hospital, with a 200-bed-specific intensive care unit exclusively designed for patients with moderate and severe COVID-19. We highlighted recommendations for infection prevention and control during endoscopic procedures, including appropriate triage and screening, outpatient management and procedural recommendations, role and usage of personal protective equipment (PPE), and role and procedural logistics involving COVID-19-positive patients. We also detailed hospital protocols for reprocessing endoscopes and cleaning rooms and also provided recommendations to minimize severe acute respiratory syndrome coronavirus 2 transmission. CONCLUSION: This COVID-19-specific administrative and clinical protocol can be replicated or adapted in multiple institutions and endoscopy units worldwide. Furthermore, the recommendations and summary protocol may improve patient and HCP safety in these trying times.

Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Endoscopia/normas , Hospitais Universitários/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Equipamento de Proteção Individual/normas , Pneumonia Viral/prevenção & controle , Brasil , Infecções por Coronavirus/transmissão , Endoscopia/métodos , Pessoal de Saúde/normas , Humanos , Pneumonia Viral/transmissão , Guias de Prática Clínica como Assunto , Fatores de Risco