Hemodynamic changes after endoscopic variceal ligation: a cohort study.

BACKGROUND: there is controversy about the need to maintain vasoconstrictor treatment after adequate haemostasis is achieved through endoscopic band ligation (EBL) in bleeding esophageal varices (BEV). Measuring a "before and after urgent-EBL" hepatic venous pressure gradient (HVPG) in acute variceal hemorrhage is very difficult. Thus, the goal of this study was to determine hemodynamic variations after an EBL session. A "before" HVPG (PRE) was performed and another one 24 hours "after-ligation" (POST), in cirrhotic patients undergoing endoscopic band ligation as BEV prophylaxis. PATIENTS AND METHODS: this was a single-center, cohort, prospective study. Patients followed a program of repeated sessions of EBL until eradication of their varices and underwent a basal hepatic venous pressure gradient (PRE HVPG), without changing their usual treatment with beta-blockers. Subsequently, an endoscopic ligation session was performed, following the clinical practices guidelines. A second pressure measurement (POST HVPG) was taken 24 hours after the endoscopic treatment. RESULTS: 30 patients were included. PRE and POST HVPG median results were 16.5 mmHg (14-20) and 19.5 mmHg (17-21), respectively, with a significant increase after the procedure (p < 0.001). Percentage variations in portal pressure, based on the baseline gradient values (12, 16 and 20 mmHg), were higher for patients with a lower basal HVPG versus a higher HVPG for any of the categories compared (p = 0.087, p = 0.016 and p < 0.001, respectively). In our series, 36.7 % of patients showed a ≥ 20 % gradient increase after ligation. CONCLUSION: endoscopic band ligation causes an increase in portal pressure, at least for a transitional period, determined by the hepatic venous pressure gradient.

Feasibility and safety of pulmonary vein isolation by high-power short-duration radiofrequency application: short-term results of the POWER-FAST PILOT study.

PURPOSE: Pulmonary vein (PV) isolation (PVI) by point-by-point radiofrequency application (PPRF) results in longer procedures than that achieved by single-shot ablation techniques. In addition, it is associated with significant risk of oesophageal injury. The POWER-FAST pilot study evaluated the feasibility and safety of PVI by high-power short-duration (HPSD) PPRF. METHODS: HPSD PPRF around the PVs was done in 48 consecutive patients with atrial fibrillation. Fifty watts was delivered until a predefined lesion index value was reached (LSI ≥ 5 or Abl-I ≥ 350) and 60 W during 7-10 s in the first 18 and last 30 patients, respectively. A control group of 47 consecutive patients who had undergone PVI before the HPSD group with conventional PPRF (30 W for 30 s) was included for reference. Echocardiography and oesophageal endoscopy was performed shortly after ablation in all patients. RESULTS: PVI of all targeted veins was achieved in 98% and 100% of patients of the conventional and HPSD groups, respectively (p = 0.59). Total radiofrequency time was 34 ± 11, 24 ± 8, and 15 ± 5 min in groups 30 W, 50 W, and 60 W (p < 0.001). Audible steam pops occurred in 4 out of 48 (8%) patients in the HPSD group, accounting for 4 (0.08%) out of 5 269 HPSD radiofrequency applications. No patient in the HPSD group developed pericardial effusion. The incidence of oesophageal lesions was 28%, 22%, and 0% in groups 30 W, 50 W, and 60 W, respectively (p = 0.007) CONCLUSIONS: PVI can be achieved with HPSD PPRF in most patients. This approach appears safe and associated with low risk of esophageal damage.

[Cultural adaptation to Spanish and validation of the Gastrointestinal Short Form Questionnaire]. / Adaptación cultural al español y validación de la escala GSFQ (Gastrointestinal Short Form Questionnaire).

OBJECTIVE: To describe the process followed for the cultural and psychometric adaptation (validation) to Spanish of the Gastrointestinal Short Form Questionnaire (GSFQ), used to measure the interference of symptoms of gastroesophageal reflux disease GERD and to report the psychometric properties of this instrument. MATERIAL AND METHODS: The adaptation process was supervised by a five-member expert panel. After forward and backward translations in duplicate, a Spanish version was obtained, which was administered to two samples; a five-patient pilot sample to check comprehension and face validity, and a 4,000-patient sample to check structural validity (factor analysis and reliability), construct validity, and discriminative validity. RESULTS: The questionnaire showed a unique dimension that matched that of the original questionnaire. Reliability was high (alpha=0.83), and the correlation between even-odd items was good (r=0.69). The overall score correlated with generic health-related quality of life measures evaluated by the EQ-5D tariff (r=0.499) and VAS (r=-0.481). The scale discriminated between GERD severity levels (p<0.008) as measured by the Savary-Miller scale, except for the most severe level with respect to the levels immediately below. The questionnaire was able to detect differences between diverse concomitant diseases and antecedents. Sensitivity with respect to the GERD clinician criterion was 60.5% and specificity was 68.3%. Normative comparison scaling values are reported. CONCLUSIONS: The results show acceptable psychometric properties. A new instrument to assess the interference of GERD symptoms is thus available to health professionals. This instrument takes the patient's perspective into account.