RESUMO
Reflections in order to agree on who should be responsible for the deep sedation with propofol in gastrointestinal endoscopies, after so many squabble between anaesthesiologists and endoscopists.
Assuntos
Sedação Profunda/métodos , Endoscopia Gastrointestinal/métodos , Hipnóticos e Sedativos , Propofol , Sedação Consciente , Humanos , Hipnóticos e Sedativos/efeitos adversos , Propofol/efeitos adversosRESUMO
The present review describes the various indications of biliary stent placement in patients with biliary malignancies. It deals in depth with biliary accesses and their effectiveness, as well as with the use of different stents according to lesion type and expected patient survival. For liver hilum lesions, which are somewhat more complex, the usefulness of and need for unilateral or bilateral drainage is assessed, as it is the most appropriate method. All in all, this is an up-to-date literature review that may help clinicians in their daily decision-making, as well as to improve and optimize patient outcomes.
Assuntos
Neoplasias do Sistema Biliar/cirurgia , Colestase/cirurgia , Endoscopia/métodos , Stents , Neoplasias do Sistema Biliar/complicações , Colestase/etiologia , Drenagem , Endoscopia do Sistema Digestório , HumanosRESUMO
BACKGROUND AND AIMS: Controversial data have been reported regarding the prevalence of Non-Alcoholic Fatty Liver Disease (NAFLD) in Inflammatory Bowel Disease (IBD) population and IBD-related risk factors. The aim of the study was to assess the prevalence and risk factors associated with NAFLD and liver fibrosis in IBD participants compared with non-IBD controls. METHODS: Cross-sectional, case-control study including 741 IBD cases and 170 non-IBD controls, matched by sex and age. All participants underwent liver ultrasound, transient elastography and laboratory tests. A logistic regression multivariable analysis was performed adjusting for classic metabolic risk factors and history of systemic steroid use. RESULTS: The prevalence of NAFLD and significant liver fibrosis was 45 % and 10 % in IBD group, and 40 % and 2.9 % in non-IBD group (p = 0.255 and 0.062, respectively). Longer IBD duration (aOR 1.02 95% CI (1.001-1.04)) and older age at IBD diagnosis (aOR 1.02 95 % CI (1.001-1.04)) were independent risk factors for NAFLD in IBD group. Crohn´s Disease was an independent risk factor for significant liver fibrosis in participants with IBD and NAFLD (aOR 3.97 95 % CI (1.78-8.96)). NAFLD occurred at lower BMI levels in IBD group with NAFLD compared to non-IBD group with NAFLD (aOR 0.92 95 % CI (0.87-0.98)). CONCLUSIONS: Although we found no differences in the prevalence of NAFLD and liver fibrosis between IBD group and non-IBD group, our findings suggest that liver fibrosis progression should be closely monitored in patients with concomitant CD and NAFLD, more in particular in those with long standing active disease.
Assuntos
Doença de Crohn , Doenças Inflamatórias Intestinais , Hepatopatia Gordurosa não Alcoólica , Humanos , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Doença de Crohn/complicações , Doença de Crohn/epidemiologia , Estudos de Casos e Controles , Estudos Transversais , Fatores de Risco , Doenças Inflamatórias Intestinais/complicações , Cirrose Hepática/complicações , PrevalênciaRESUMO
BACKGROUND: Despite classical association between metabolic dysfunction-associated steatotic liver disease (MASLD) and obesity, there is increasing evidence on the development of MASLD in lean individuals. The aim of the study was to assess the prevalence and risk factors of MASLD and significant liver fibrosis in lean participants with inflammatory bowel disease (IBD). METHODS: This was a cross-sectional, case-control study including 300 lean cases with IBD and 80 lean controls without IBD, matched by sex and age. All participants underwent a liver ultrasound, transient elastography, and laboratory tests. RESULTS: The lean IBD group showed a significantly higher prevalence of MASLD compared with lean non-IBD group (21.3% vs 10%; P = .022), but no differences were observed in the prevalence of significant liver fibrosis (4.7% vs 0.0%; Pâ =â 1.000). No differences were found between the prevalence of MASLD in IBD and non-IBD participants who were overweight/obese (66.8% vs 70.8%; P = .442). In addition, the prevalence of MASLD was significantly higher in the overweight/obese IBD group compared with the lean IBD group (P < .001). IBD was an independent risk factor for MASLD in lean participants (odds ratio [OR], 2.71; 95% confidence interval [CI], 1.05-7.01; P = .04), after adjusting for classic metabolic risk factors and prior history of systemic steroid use. Nevertheless, no association between IBD related factors and MASLD was identified in lean IBD participants. When the overweight/obese and lean IBD groups with MASLD were compared, the overweight/obese IBD group with MASLD showed higher levels of the homeostatic model assessment of insulin resistance (OR, 1.49; 95% CI, 1.11-1.98; P = .007) and history of smoking (OR, 4.66; 95% CI, 1.17-18.49; P = .029). CONCLUSIONS: MASLD prevalence was higher in the lean IBD group compared with lean non-IBD group, independent of classic metabolic risk factors.
Assuntos
Hepatite C/tratamento farmacológico , Quimioterapia de Indução , Interferon-alfa/uso terapêutico , Oligopeptídeos/uso terapêutico , Polietilenoglicóis/uso terapêutico , Prolina/análogos & derivados , Ribavirina/uso terapêutico , Quimioterapia Combinada , Humanos , Interferon alfa-2 , Prolina/uso terapêutico , Proteínas Recombinantes/uso terapêuticoRESUMO
No disponible
Assuntos
Humanos , Propofol/administração & dosagem , Propofol/uso terapêutico , Endoscopia do Sistema Digestório/métodos , Endoscopia do Sistema Digestório/normas , Sedação Profunda/métodos , Segurança do Paciente/normas , Satisfação do Paciente , Hipnóticos e Sedativos/administração & dosagem , Endoscopia/normasRESUMO
En la presente revisión se describen las diferentes indicaciones para la colocación de prótesis biliares en pacientes con neoplasias malignas de la vía biliar. Se profundiza en los accesos a la vía biliar y en la efectividad de los mismos, así como en el uso de las diferentes prótesis en función del tipo de lesión y de la expectativa de sobrevida del paciente. En las lesiones de hilio hepático, algo más complejas, se valoran la utilidad y necesidad de un drenaje uni- o bilateral y el método más apropiado. En conjunto, se trata de una revisión actual de la literatura que puede ayudar al clínico a la toma de decisiones en su práctica diaria y a mejorar y optimizar los resultados en los pacientes (AU)
The present review describes the various indications of biliary stent placement in patients with biliary malignancies. It deals in depth with biliary accesses and their effectiveness, as well as with the use of different stents according to lesion type and expected patient survival. For liver hilum lesions, which are somewhat more complex, the usefulness of and need for unilateral or bilateral drainage is assessed, as it is the most appropriate method. All in all, this is an up-to-date literature review that may help clinicians in their daily decision-making, as well as to improve and optimize patient outcomes (AU)
Assuntos
Humanos , Colestase/cirurgia , Endoscopia Gastrointestinal/métodos , Neoplasias do Sistema Biliar/cirurgia , Colangiopancreatografia Retrógrada Endoscópica/métodos , Resultado do Tratamento , Cuidados Paliativos/métodos , Implantação de PróteseRESUMO
No disponible