Revistas
Autores:
Mangas-Sanjuan, C.; Seoane, A.; Álvarez-González, M. A.; et al.
Revista:
UNITED EUROPEAN GASTROENTEROLOGY JOURNAL
ISSN:
2050-6406
Año:
2022
Vol.:
10
N°:
9
Págs.:
1008 - 1019
Background and objective Different factors may influence colonoscopy performance measures. We aimed to analyze procedure- and endoscopist-related factors associated with detection of colorectal lesions and whether these factors have a similar influence in the context of different colonoscopy indications: positive fecal immunochemical test (+FIT) and post-polypectomy surveillance colonoscopies. Methods This multicenter cross-sectional study included adults aged 40-80 years. Endoscopists (N = 96) who had performed >= 50 examinations were assessed for physician-related factors. Adenoma detection rate (ADR), adenomas per colonoscopy rate (APCR), advanced ADR, serrated polyp detection (SDR), and serrated polyps per colonoscopy rate (SPPCR) were calculated. Results We included 12,932 procedures, with 4810 carried out after a positive FIT and 1967 for surveillance. Of the 96 endoscopists evaluated, 43.8% were women, and the mean age was 41.9 years. The ADR, advanced ADR, and SDR were 39.7%, 17.7%, and 12.8%, respectively. Adenoma detection rate was higher in colonoscopies after a +FIT (50.3%) with a more than doubled advanced ADR compared to non-FIT procedures (27.6% vs. 13.0%) and similar results in serrated lesions (14.7% vs. 13.5%). Among all the detection indicators analyzed, withdrawal time was the only factor independently related to improvement (p < 0.001). Regarding FIT-positive and surveillance procedures, for both indications, withdrawal time was also the only factor associated with a higher detection of adenomas and serrated polyps (p < 0.001). Endoscopist-related factors (i.e., weekly hours dedicated to endoscopy, annual colonoscopy volume and lifetime number of colonoscopies performed) had also impact on lesion detection (APCR, advanced ADR and SPPCR). Conclusions Withdrawal time was the factor most commonly associated with improved detection of colonic lesions globally and in endoscopies for + FIT and post-polypectomy surveillance. Physician-related factors may help to address strategies to support training and service provision. Our results can be used for establishing future benchmarking and quality improvement in different colonoscopy indications.
Autores:
Giner-Calabuig, M.; De León, S.; Wang, J. L.; et al.
Revista:
BRITISH JOURNAL OF CANCER
ISSN:
0007-0920
Año:
2022
Vol.:
126
N°:
11
Págs.:
1595 - 1603
Background Mismatch repair (MMR) deficiency is the hallmark of tumours from Lynch syndrome (LS), sporadic MLH1 hypermethylated and Lynch-like syndrome (LLS), but there is a lack of understanding of the variability in their mutational profiles based on clinical phenotypes. The aim of this study was to perform a molecular characterisation to identify novel features that can impact tumour behaviour and clinical management. Methods We tested 105 MMR-deficient colorectal cancer tumours (25 LS, 35 LLS and 45 sporadic) for global exome microsatellite instability, cancer mutational signatures, mutational spectrum and neoepitope load. Results Fifty-three percent of tumours showed high contribution of MMR-deficient mutational signatures, high level of global exome microsatellite instability, loss of MLH1/PMS2 protein expression and included sporadic tumours. Thirty-one percent of tumours showed weaker features of MMR deficiency, 62% lost MSH2/MSH6 expression and included 60% of LS and 44% of LLS tumours. Remarkably, 9% of all tumours lacked global exome microsatellite instability. Lastly, HLA-B07:02 could be triggering the neoantigen presentation in tumours that show the strongest contribution of MMR-deficient tumours. Conclusions Next-generation sequencing approaches allow for a granular molecular characterisation of MMR-deficient tumours, which can be essential to properly diagnose and treat patients with these tumours in the setting of personalised medicine.
Autores:
Sánchez, A.; Roos, V. H.; Navarro, M.; et al.
Revista:
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
ISSN:
1542-3565
Año:
2022
Vol.:
20
N°:
3
Págs.:
611 - 621.e9
BACKGROUND & AIMS: Colonoscopy reduces colorectal cancer (CRC) incidence and mortality in Lynch syndrome (LS) carriers. However, a high incidence of postcolonoscopy CRC (PCCRC) has been reported. Colonoscopy is highly dependent on endoscopist skill and is subject to quality variability. We aimed to evaluate the impact of key colonoscopy quality indicators on adenoma detection and prevention of PCCRC in LS. METHODS: We conducted a multicenter study focused on LS carriers without previous CRC undergoing colonoscopy surveillance (n = 893). Incident colorectal neoplasia during surveillance and quality indicators of all colonoscopies were analyzed. We performed an emulated target trial comparing the results from the first and second surveillance colonoscopies to assess the effect of colonoscopy quality indicators on adenoma detection and PCCRC incidence. Risk analyses were conducted using a multivariable logistic regression model. RESULTS: The 10-year cumulative incidence of adenoma and PCCRC was 60.6% (95% CI, 55.5%-65.2%) and 7.9% (95% CI, 5.2%-10.6%), respectively. Adequate bowel preparation (odds ratio [OR], 2.07; 95% CI, 1.06-4.3), complete colonoscopies (20% vs 0%; P = .01), and panchromoendoscopy use (OR, 2.14; 95% CI, 1.15-3.95) were associated with significant improvement in adenoma detection. PCCRC risk was significantly lower when colonoscopies were performed during a time interval of less than every 3 years (OR, 0.35; 95% CI, 0.14-0.97). We observed a consistent but not significant reduction in PCCRC risk for a previous complete examination (OR, 0.16; 95% CI, 0.03-1.28), adequate bowel preparation (OR, 0.64; 95% CI, 0.17-3.24), or previous use of high-definition colonoscopy (OR, 0.37; 95% CI, 0.02-2.33). CONCLUSIONS: Complete colonoscopies with adequate bowel preparation and chromoendoscopy use are associated with improved adenoma detection, while surveillance intervals of less than 3 years are associated with a reduction of PCCRC incidence. In LS, high-quality colonoscopy surveillance is of utmost importance for CRC prevention.
Autores:
Rivero-Sánchez, L.; Gavric, A.; Herrero, J.; et al.
Revista:
ENDOSCOPY
ISSN:
0013-726X
Año:
2022
Vol.:
54
N°:
01
Págs.:
27 - 34
Background: The "diagnose-and-leave-in" policy has been established to reduce the risks and costs related to unnecessary polypectomies in the average-risk population. In individuals with Lynch syndrome, owing to accelerated carcinogenesis, the general recommendation is to remove all polyps, irrespective of size, location, and appearance. We evaluated the feasibility and safety of the diagnose-and-leave-in strategy in individuals with Lynch syndrome. METHODS : We performed a post hoc analysis based on per-polyp data from a randomized, clinical trial conducted by 24 dedicated colonoscopists at 14 academic centers, in which 256 patients with confirmed Lynch syndrome underwent surveillance colonoscopy from July 2016 to January 2018. In vivo optical diagnosis with confidence level for all detected lesions was obtained before polypectomy using virtual chromoendoscopy alone or with dye-based chromoendoscopy. Primary outcome was the negative predictive value (NPV) for neoplasia of high-confidence optical diagnosis among diminutive (¿ 5 mm) rectosigmoid lesions. Histology was the reference standard.
Results: Of 147 rectosigmoid lesions, 128 were diminutive. In 103 of the 128 lesions (81 %), the optical diagnostic confidence was high and showed an NPV of 96.0 % (95 % confidence interval [CI] 88.9 %-98.6 %) and accuracy of 89.3 % (95 %CI 81.9 %-93.9 %). By following the diagnose-and-leave-in policy, we would have avoided 59 % (75/128) of polypectomies at the expense of two diminutive low grade dysplastic adenomas and one diminutive sessile serrated lesion that would have been left in situ.
Conclusion: In patients with Lynch syndrome, the diagnose-and-leave-in strategy for diminutive rectosigmoid polyps would be feasible and safe.
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN:
1130-0108
Año:
2021
Vol.:
113
N°:
8
Págs.:
580-584
Obscure gastrointestinal bleeding is defined as bleeding from a source that cannot be identified on upper or lower gastrointestinal endoscopy, being capsule endoscopy the next step in those patients. Some patients may be unsuitable for conventional endoscopy and performing a capsule pan-endoscopic test as a first line procedure might potentially reduce the number of endoscopies and their subsequent risk. The aim of our study was to analyse our experience with capsule endoscopy in the bleeding patient setting. We retrospectively reviewed the first 100 pan-endoscopic capsule procedures performed in our centre from August 2011 until December 2016. 61.2% of our patients had positive findings; 46.26% had a previous negative gastroscopy and in 67.7% of them the capsule detected small bowel lesions and in 80.64%, colonic findings. Taking into consideration that our population were high-risk patients (mainly because of comorbidities), and that we use up to 45 ml of sodium phosphate, we analysed sodium, potassium and creatinine changes before and after procedure. The mean "before" values were respectively 140.68, 4.04 and 1.36. The mean "after" values were 140.28, 3.9 and 1.35 (p=n.s) According to our findings in 64.5% of patients with negative gastroscopy no other endoscopic studies would be needed. According to capsule results, in all our study sample, in 68.6% of cases conventional endoscopy could have been avoided. Panendoscopy with capsule may be useful and safe in bleeding high-risk patients, by selecting the patients who need therapeutic endoscopy, avoiding up to 68.6% of diagnostic endoscopies in our series.
Revista:
REVISTA ESPAÑOLA DE MEDICINA NUCLEAR E IMAGEN MOLECULAR
ISSN:
2253-654X
Año:
2021
Vol.:
40
N°:
6
Págs.:
351 - 357
Objetive: To evaluate the enterohepatic circulation of 75-Selenium turoselecolic acid (Se-75-SeHCAT) during the first 3 hours and its correlation with the abdominal retention at the 7th day (AR(7)), as contribution to the clinical study of biliar acid malabsorption (BAM). Materials and methods: 38 patients with chronic diarrhea were retrospectively studied. Acquisition protocol included static abdominal images at 1st , 2nd an d 3rd hour and the 7th day after oral administration of the radiopharmaceutical. Images of 1 to 3 hours determined 5 patterns of enterohepatic circulation that, due to their location, were characterized as: 1) gallbladder 2-3 hours, 2) gallbladder 3 hours, 3) gallbladder-abdomen 2-3 hours, 4) abdomen, 5) upper left abdomen. The association of these patterns with the AR(7) (Fisher, STATA) were investigated. Patients were classified as Non BAM (AR(7) >15%), mild-BAM (AR(7) : 15-10%), moderate-RAM (AR(7): 10-5%) or severe-BAM (AR(7) <5%). Results: 19 patients had an AR(7) diagnostic of BAM (7 mild-BAM, 5 moderate-RAM, 7 severe-BAM). The pattern gallbladder at 2-3 hours was statistically associated with Non BAM (p 0,008), while gallbladder-abdomen at 2-3 hours was correlated with having BAM (p 0,029). Conclusion: Variations detected at the abdominal level in images during the first 3 hours were associated with changes in intestinal absorption and the incorporation of the radiopharmaceutical into the pool of bile acids, so visual interpretation of the images at 2nd and 3rd hour could be useful in the final assessment of the study.
Revista:
REVISTA ESPAÑOLA DE MEDICINA NUCLEAR E IMAGEN MOLECULAR
ISSN:
2253-654X
Año:
2021
Vol.:
40
N°:
6
Págs.:
351 - 357
Objetive: To evaluate the enterohepatic circulation of 75-Selenium turoselecolic acid (75Se-SeHCAT) during the first 3 hours and its correlation with the abdominal retention at the 7th day (AR7), as contribution to the clinical study of biliar acid malabsorption (BAM).
Materials and methods: 38 patients with chronic diarrhea were retrospectively studied. Acquisition protocol included static abdominal images at 1st, 2nd and 3rd hour and the 7th day after oral administration of the radiopharmaceutical. Images of 1 to 3 hours determined 5 patterns of enterohepatic circulation that, due to their location, were characterized as: 1) gallbladder 2-3 hours, 2) gallbladder 3 hours, 3) gallbladder-abdomen 2-3 hours, 4) abdomen, 5) upper left abdomen. The association of these patterns with the AR7 (Fisher, STATA) were investigated. Patients were classified as Non BAM (AR7>15%), mild-BAM (AR7: 15-10%), moderate-BAM (AR7: 10-5%) or severe-BAM (AR7<5%).
Results: 19 patients had an AR7 diagnostic of BAM (7 mild-BAM, 5 moderate-BAM, 7 severe-BAM). The pattern "gallbladder at 2-3 hours" was statistically associated with Non BAM (p 0,008), while "gallbladder-abdomen at 2-3 hours" was correlated with having BAM (p 0,029).
Conclusion: Variations detected at the abdominal level in images during the first 3 hours were associated with changes in intestinal absorption and the incorporation of the radiopharmaceutical into the pool of bile acids, so visual interpretation of the images at 2nd and 3rd hour could be useful in the final assessment of the study.
Autores:
Medina-Prado, L.; Hassan, C.; Dekker, E.; et al.
Revista:
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
ISSN:
1542-3565
Año:
2021
Vol.:
19
N°:
5
Págs.:
1038 - 1050
BACKGROUND & AIMS: There is a lack of clinical studies to establish indications and methodology for tattooing, therefore technique and practice of tattooing is very variable. We aimed to establish a consensus on the indications and appropriate techniques for colonic tattoo through a modified Delphi process. METHODS: The baseline questionnaire was classified into 3 areas: where tattooing should not be used (1 domain, 6 questions), where tattooing should be used (4 domains, 20 questions), and how to perform tattooing (1 domain 20 questions). A total of 29 experts participated in the 3 rounds of the Delphi process. RESULTS: A total of 15 statements were approved. The statements that achieved the highest agreement were as follows: tattooing should always be used after endoscopic resection of a lesion with suspicion of submucosal invasion (agreement score, 4.59; degree of consensus, 97%). For a colorectal lesion that is left in situ but considered suitable for endoscopic resection, tattooing may be used if the lesion is considered difficult to detect at a subsequent endoscopy (agreement score, 4.62; degree of consensus, 100%). A tattoo should never be injected directly into or underneath a lesion that might be removed endoscopically at a later point in time (agreement score, 4.79; degree of consensus, 97%). Details of the tattoo injection should be stated clearly in the endoscopy report (agreement score, 4.76; degree of consensus, 100%). CONCLUSIONS: This expert consensus has developed different statements about where tattooing should not be used, when it should be used, and how that should be done.
Autores:
Pico, M. D.; Castillejo, A.; Murcia, O.; et al.
Revista:
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
ISSN:
1542-3565
Año:
2020
Vol.:
18
N°:
2
Págs.:
368 - 374
BACKGROUND & AIMS: Lynch syndrome is characterized by DNA mismatch repair (MMR) deficiency. Some patients with suspected Lynch syndrome have DNA MMR deficiencies but no detectable mutations in genes that encode MMR proteins-this is called Lynch-like syndrome (LLS). There is no consensus on management of patients with LLS. We collected data from a large series of patients with LLS to identify clinical and pathology features. METHODS: We collected data from a nationwide-registry of patients with colorectal cancer (CRC) in Spain. We identified patients whose colorectal tumors had loss of MSH2, MSH6, PMS2, or MLH1 (based on immunohistochemistry), without the mutation encoding V600E in BRAF (detected by real-time PCR), and/or no methylation at MLH1 (determined by methylation-specific multiplex ligation-dependent probe amplification), and no pathogenic mutations in MMR genes, BRAF, or EPCAM (determined by DNA sequencing). These patients were considered to have LLS. We collected data on demographic, clinical, and pathology features and family history of neoplasms. The chi(2) test was used to analyze the association between qualitative variables, followed by the Fisher exact test and the Student t test or the Mann-Whitney test for quantitative variables. RESULTS: We identified 160 patients with LLS; their mean age at diagnosis of CRC was 55 years and 66 patients were female (41%). The Amsterdam I and II criteria for Lynch syndrome were fulfilled by 11% of cases and the revised Bethesda guideline criteria by 65% of cases. Of the patients with LLS, 24% were identified in universal screening. There were no proportional differences in sex, indication for colonoscopy, immunohistochemistry, pathology findings, or personal history of CRC or other Lynch syndrome-related tumors between patients who met the Amsterdam and/or Bethesda criteria for Lynch syndrome and patients identified in universal screening for Lynch syndrome, without a family history of CRC. CONCLUSIONS: Patients with LLS have homogeneous clinical, demographic, and pathology characteristics, regardless of family history of CRC.
Autores:
Rivero-Sanchez, L. ; Arnau-Collell, C. ; Herrero, J. ; et al.
Revista:
GASTROENTEROLOGY
ISSN:
0016-5085
Año:
2020
Vol.:
158
N°:
4
Págs.:
895 - 904.e1
BACKGROUND & AIMS: Dye-based pancolonic chromoendoscopy is recommended for colorectal cancer surveillance in patients with Lynch syndrome. However, there is scarce evidence to support its superiority to high-definition white-light endoscopy. We performed a prospective study assess whether in the hands of high detecting colonoscopists, high-definition, white-light endoscopy is noninferior to pancolonic chromoendoscopy for detection of adenomas in patients with Lynch syndrome. METHODS: We conducted a parallel controlled study, from July 2016 through January 2018 at 14 centers in Spain of adults with pathogenic germline variants in mismatch repair genes (60% women; mean age, 47 +/- 14 years) under surveillance. Patients were randomly assigned to groups that underwent high-definition white-light endoscopy (n = 128) or pancolonic chromoendoscopy (n = 128) evaluations by 24 colonoscopists who specialized in detection of colorectal lesions in high-risk patients for colorectal cancer. Adenoma detection rates (defined as the proportion of patients with at least 1 adenoma) were compared between groups, with a noninferiority margin (relative difference) of 15%. RESULTS: We found an important overlap of confidence intervals (CIs) and no significant difference in adenoma detection rates by pancolonic chromoendoscopy (34.4%; 95% CI 26.4%-43.3%) vs white-light endoscopy (28.1%; 95% CI 21.1%-36.4%; P = .28). However, pancolonic chromoendoscopy detected serrated lesions in a significantly higher proportion of patients (37.5%; 95% CI 29.5-46.1) than white-light endoscopy (23.4%; 95% CI 16.9-31.4; P = .01). However, there were no significant differences between groups in proportions of patients found to have serrated lesions of 5 mm or larger (9.4% vs 7.0%; P = .49), of proximal location (11.7% vs 10.2%; P = .68), or sessile serrated lesions (3.9% vs 5.5%; P = .55), respectively. Total procedure and withdrawal times with pancolonic chromoendoscopy (30.7 +/- 12.8 minutes and 18.3 +/- 7.6 minutes, respectively) were significantly longer than with white-light endoscopy (22.4 +/- 8.7 minutes and 13.5 +/- 5.6 minutes; P <.001). CONCLUSIONS: In a randomized parallel trial, we found that for Lynch syndrome surveillance, high-definition white-light endoscopy is not inferior to pancolonic chromoendoscopy if performed by experienced and dedicated endoscopists.
Autores:
Pico, M. D.; Jover, R.; Murcia, O.; et al.
Revista:
GASTROENTEROLOGY
ISSN:
0016-5085
Año:
2018
Vol.:
154
N°:
6
Págs.:
S206 - S207
Autores:
Mangas, C.; Santana, E.; Cubiella, J.; et al.
Revista:
GASTROINTESTINAL ENDOSCOPY
ISSN:
0016-5107
Año:
2018
N°:
50(04)
Págs.:
86 - 87
Autores:
Mangas-San Juan, C.; Santana, E.; Cubiella, J.; et al.
Revista:
GASTROINTESTINAL ENDOSCOPY
ISSN:
0016-5107
Año:
2018
Vol.:
87
N°:
6
Págs.:
368 - 369
Autores:
Albeniz, E.; Pellise, M.; Gimeno-García, A. Z.; et al.
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN:
1130-0108
Año:
2018
Vol.:
41
N°:
3
Págs.:
175 - 190
his document summarizes the contents of the Clinical Guidelines for the Endoscopic Mucosal Resection of Non-Peduncutated Colorectal Lesions that was developed by the working group of the Spanish Society of Digestive Endoscopy (GSEED of Endoscopic Resection). This document presents recommendations for the endoscopic management of superficial colorectal neoplastic lesions.
Autores:
Esteban, I. (Autor de correspondencia); Vilaro, M. ; Adrover, E. ; et al.
Revista:
PSYCHO-ONCOLOGY
ISSN:
1057-9249
Año:
2018
Vol.:
27
N°:
6
Págs.:
1530 - 1537
ObjectivePatients' psychological reactions to multigene cancer panel testing might differ compared with the single-gene testing reactions because of the complexity and uncertainty associated with the different possible results. Understanding patients' preferences and psychological impact of multigene panel testing is important to adapt the genetic counselling model. MethodsOne hundred eighty-seven unrelated patients with clinical suspicion of hereditary cancer undergoing a 25-gene panel test completed questionnaires after pretest genetic counselling and at 1week, 3 months, and 12months after results to elicit their preferences regarding results disclosure and to measure their cancer worry and testing-specific distress and uncertainty. ResultsA pathogenic variant was identified in 38 patients (34 high penetrance and 4 moderate penetrance variants), and 54 patients had at least one variant of uncertain significance. Overall, cancer panel testing was not associated with an increase in cancer worry after results disclosure (P value=.87). Twelve months after results, carriers of a moderate penetrance variant had higher distress and uncertainty scores compared with carriers of high penetrance variants. Cancer worry prior to genetic testing predicted genetic testing specific distress after results, especially at long term (P value <.001). Most of the patients reported the wish to know all genetic results. ConclusionsOur results suggest that patients can psychologically cope with cancer panel testing, but distress and uncertainty observed in carriers of moderate penetrance cancer variants in this cohort warrant further research.
Revista:
GASTRIC CANCER
ISSN:
1436-3291
Año:
2017
Vol.:
20
N°:
6
Págs.:
998-1003
BACKGROUND:
Type I gastric neuroendocrine tumors (gNETs) classically arise because of hypergastrinemia and involve destruction of parietal cells, which are responsible for gastric acid secretion through the ATP4A proton pump and for intrinsic factor production.
METHODS:
By whole exome sequencing, we studied a family with three members with gNETs plus hypothyroidism and rheumatoid arthritis to uncover their genetic origin.
RESULTS:
A heterozygous missense mutation in the ATP4A gene was identified. Carriers of this variant had low ferritin and vitamin B12 levels but did not develop gNETs. A second heterozygous mutation was also uncovered (PTH1R p.E546K). Carriers exhibited hypothyroidism and one of them had rheumatoid arthritis. Gastrin activates parathyroid hormone like hormone/parathyroid hormone 1 receptor (PTH1R) signaling, which is involved in gastric cell homeostasis. Activation of parathyroid hormone/PTH1R, which is upregulated by thyrotropin in the thyroid, is also involved in RANKL expression, which regulates bone homeostasis. Thyrotropin and RANKL expression were deregulated in PTH1R mutation carriers, suggesting a link between the PTH1R gene, hypothyroidism, rheumatoid arthritis, and gastric disease. Only patients with both mutations developed gNETs plus hypothyroidism and rheumatoid arthritis.
CONCLUSION:
Both mutations suggest that a collaborative mechanism is operative in this family, in which mutations in these genes affect the function and viability of parietal cells and lead to the achlorhydria that drives hypergastrinemia and the formation of gNETs.
Autores:
1; 2; 3; et al.
Revista:
ENDOSCOPY
ISSN:
0013-726X
Año:
2016
Vol.:
48
N°:
1
Págs.:
56-61
Patients with more than 10 neoplastic polyps required frequent colonoscopies within a short follow-up period. More than 10¿% of patients required colorectal surgery within 4 years, more than half for incident CRC.
Revista:
NUTRICION CLINICA Y DIETETICA HOSPITALARIA
ISSN:
0211-6057
Año:
2016
Vol.:
36
N°:
1
Págs.:
64-74
Revista:
GASTROINTESTINAL ENDOSCOPY
ISSN:
0016-5107
Año:
2016
Vol.:
83
N°:
3
Págs.:
566 - 573
Background and Aims: It is known that sodium picosulfate-magnesium citrate (SPMC) bowel preparations are effective, well tolerated and safe, and that split-dosing is more effective for colon cleansing than previous-day regimens. Anesthetic guidelines consider that residual gastric fluid is independent of clear liquid fasting times. However, reluctance to use split-dosing persists. This may be due to limited data on residual gastric fluid volumes (RGFVs) and split-dosing bowel preparations, and that these may not be perceived as standard clear liquids. Furthermore, no studies are available on RGFV/residual gastric fluid pH (RGFpH) and SPMC. We aimed to evaluate the cleansing effectiveness and the RGFV/RGFpH achieved after an SPMC split-dosing regimen compared with a SPMC previous-day regimen.
Methods: This was a single-center observational study. A total of 328 outpatients scheduled for simultaneous EGD and colonoscopy and following a split-dosing or previous-day regimen of SPMC were included. We prospectively measured colon cleanliness by using the Ottawa Bowel Preparation Scale, RGFV, and RGFpH.
Results: Ottawa Bowel Preparation Scale scores for overall, right, mid-colon, and colon fluid were significantly better in the split-dosing group. In the split-dosing group, the 3- to 4-hour fasting time consistently achieved the best cleansing quality. RGFV was significantly lower in the split-dosing group (11.09 vs 18.62, P < .001). No significant differences in RGFpH were detected.
Conclusions: Split-dosing SPMC provides higher colon cleansing quality with lower RGFVs than previous-day SPMC regimens. SPMC in split-dosing acts exactly as a standard clear liquid acts, and thus anesthetic guidelines on this issue may be applied with no concerns.
Autores:
1; 2; 3; et al.
Revista:
CLINICAL CANCER RESEARCH
ISSN:
1078-0432
Año:
2014
Vol.:
20
N°:
5
Págs.:
1158-1168
We observed a low frequency of MUTYH mutations among patients with multiple adenomatous and serrated polyps. The MAP phenotype frequently included patients with serrated polyps, especially when G396D mutation was involved. Our results show that somatic molecular markers of polyps can be useful in identifying MAP cases and support the need for the complete MUTYH gene analysis only in patients heterozygous for recurrent variants.
Autores:
1; 2; 3; et al.
Revista:
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
ISSN:
1542-3565
Año:
2013
Vol.:
11
N°:
6
Págs.:
705-711
Except for a greater likelihood of familial history of colorectal cancer or colonic polyps in patients with type 2 SPS, we found no significant demographic, pathologic, or molecular differences between types 1 and 2 SPS. All patients had a BRAF or KRAS mutation in at least 25% of their polyps.
Revista:
GASTROENTEROLOGIA Y HEPATOLOGIA
ISSN:
0210-5705
Año:
2013
Vol.:
36
N°:
1
Págs.:
43-47
Colonoscopy is an essential diagnostic and therapeutic tool for many gastrointestinal diseases and is also a key element in the prevention and early diagnosis of colon cancer. Despite numerous technical advances, colonoscopy continues to be uncomfortable for patients, both during and after the procedure. To a large extent, the discomfort of colonoscopy depends on the need to distend the colon, which usually produces abdominal pain. Although ambient air is usually employed to expand and inflate the colon, in the last few years devices that allow carbon dioxide (CO2) insufflation in colonoscopy have been developed. This gas is a highly attractive option for pain-free colonoscopy. (c) 2012 Elsevier Espana, S.L. and AEEH y AEG. All rights reserved.
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN:
1130-0108
Año:
2013
Vol.:
105
N°:
4
Págs.:
208 - 214
Background and objectives: recently, Olympus developed a new prototype (XCF-Q180AY2L) with responsive insertion technology (RIT), which besides the still known variable stiffness technology, included a passive bending section and a new high force insertion tube. Our objective was to investigate whether the use of this prototype could ease colonoscope insertion, increasing the cecal intubation rate, and/or shortening the cecal intubation time.
Material and methods: the study was designed as a prospective observational study in 305 consecutive patients from a colo-rectal cancer screening program. We compared colonoscopies performed with conventional colonoscopes (CFH180AL/CFQ160L) with those performed with the prototype XCF-Q180AY2L. End points were mean cecal and terminal ileal intubation times, cecum intubation rate, and need for specific maneuvers. All colonoscopies were performed under sedation with intravenous propofol. Finally, 288 patients were included.
Results: no complications were observed. Complete cecal intubation rate was 100 % in both groups. The ileum could be reached in 98.95 % of cases. Mean time required to reach the cecum was shorter in the prototype endoscope group (4.31 min, SD 2.63 min) than in the conventional endoscope group (4.66 min, SD 2.52 min) (p < 0.05). Compared with the standard colonoscope group, we observed in the prototype group less subjective sensation of difficulty in the passage of the sigma (p < 0.01), fewer maneuvers when it proved necessary to straighten the scope (p < 0.01), and less frequent need to modify the stiffness of the endoscope (p < 0.05).
Conclusion: we concluded that the prototype endoscope (XCF-Q180AY2L) facilitated colonoscope insertion, requiring slightly less time to reach the cecum than a standard colonoscope.
Revista:
WORLD JOURNAL OF GASTROENTEROLOGY
ISSN:
1007-9327
Año:
2013
Vol.:
19
N°:
19
Págs.:
2935 - 2940
IM: To evaluate the long-term natural history of the gastroduodenal lesions secondary to extrahepatic embolization with Ytrium 90(Y-90) spheres.
METHODS: From September 2003 to January 2012, 379 procedures of liver radioembolization(RE) using resin microspheres loaded with Y-90 were performed in our center. We have retrospectively compiled the data from 379 RE procedures performed in our center. We report a comprehensive clinical, analytical, endoscopic and histologic long-term follow-up of a series of patients who developed gastroduodenal lesions after the treatment.
RESULTS: Six patients(1.5%) developed gastrointestinal symptoms and had gastrointestinal lesions as shown by upper endoscopy in the next 12 wk after RE. The mean time between RE and the appearance of symptoms was 5 wk. Only one patient required endoscopic and surgical treatment. The incidence of gastrointestinal ulcerations was 3.75%(3/80) when only planar images were used for the pre-treatment evaluation. It was reduced to 1%(3/299) when single-photon emission computed tomography(SPECT) images were also performed. The symptoms that lasted for a longer time were nausea and vomiting, until 25 mo after the treatment.
CONCLUSION: All patients were free from severe symptoms at the end of follow-up. The routine use of SPECT has decreased the incidence of gastrointestinal lesions due to unintended deployment of Y-90 particles.
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN:
1130-0108
Año:
2012
Vol.:
104
N°:
5
Págs.:
237 - 241
Introduction: insufflation with carbon dioxide (CO2) during endoscopies compared to air is associated with a decrease in abdominal discomfort after the examination, because CO2 is readily absorbed through the small intestine and eliminated by the lungs.
Aim: the objective of this randomized clinical trial was to assess the effect of CO2 insufflation on pain and abdominal distension after an ileo-colonoscopy (I) and after an ileo-colonoscopy plus gastroscopy (I+G).
Material and methods: we included a total of 309 patients in the study and all endoscopies were performed under sedation with propofol. Two hundred fourteen patients underwent an I (132 with CO2 / 82 with air) and 95 underwent an I+G (53 with CO2 / 42 with air). Abdominal pain was studied at 10, 30 and 120 minutes of exploration and abdominal perimeter difference before and after the procedure.
Results: both in group I and in group I+G, the use of CO2 translated into an average of abdominal pain significantly lower (p < 0.05). Similarly, a smaller increase in waist circumference was found among group I and group I+G, in patients where CO2 was used (p < 0.05).
Conclusion: the insufflation of CO2 instead of air during the performance of endoscopy significantly reduces the discomfort and abdominal pain after an ileo-colonoscopy and after a gastroscopy + ileo-colonoscopy.
Revista:
ENDOSCOPY
ISSN:
0013-726X
Año:
2012
Vol.:
44
N°:
4
Págs.:
444-51
Revista:
Revista española de enfermedades digestivas
ISSN:
1130-0108
Año:
2012
Vol.:
104
N°:
6
Págs.:
326 - 329
La Consulta de Alto Riesgo de Tumores Digestivos tiene como objetivo fundamental identificar individuos con mayor riesgo de desarrollar tumores para hacer un diagnóstico presintomático de los mismos detectándolos en estadios en los que son potencialmente
Revista:
ENDOSCOPY
ISSN:
0013-726X
Año:
2012
Vol.:
44
N°:
Suppl. 2
Págs.:
UCTN:E366-7
Autores:
1; 2; 3; et al.
Revista:
GASTROENTEROLOGIA Y HEPATOLOGIA
ISSN:
0210-5705
Año:
2012
Vol.:
35
N°:
3
Págs.:
109-28
Colorectal cancer (CRC) is the most common malignant tumor in Spain, when men and women are considered together, and the second leading cause of cancer death. Every week in Spain over 500 cases of CRC are diagnosed, and nearly 260 people die from the disease. Epidemiologic estimations for the coming years show a significant increase in the number of annual cases. CRC is a perfectly preventable tumor and can be cured in 90% of cases if detected in the early stages. Population-based screening programs have been shown to reduce the incidence of CRC and mortality from the disease. Unless early detection programs are established in Spain, it is estimated that in the coming years, 1 out of 20 men and 1 out of 30 women will develop CRC before the age of 75. The Alliance for the Prevention of Colorectal Cancer in Spain is an independent and non-profit organization created in 2008 that integrates patients¿ associations, altruistic non-governmental organizations and scientific societies. Its main objective is to raise awareness and disseminate information on the social and healthcare importance of CRC in Spain and to promote screening measures, early detection and prevention programs. Health professionals, scientific societies, healthcare institutions and civil society should be sensitized to this highly important health problem that requires the participation of all sectors of society. The early detection of CRC is an issue that affects the whole of society and therefore it is imperat
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN:
1130-0108
Año:
2012
Vol.:
104
N°:
10
Págs.:
509-511
Las variaciones interindividuales en la anatomía del colon descendente podrían contribuir a explicar esta dificultad en la localización y, por tanto, es necesario conocerlas para tenerlo en cuenta (7). En definitiva, se podría decir que el trabajo de Borda y cols. sugiere un nuevo aspecto de calidad de la colonoscopia relevante, que merecerá estudios ulteriores con el fin de incrementar la precisión de la colonoscopia para la localización anatómica de los tumores de forma consistente y reproducible.
Autores:
1; 2; 3; et al.
Revista:
GASTROENTEROLOGIA Y HEPATOLOGIA
ISSN:
0210-5705
Año:
2012
Vol.:
35
N°:
4
Págs.:
278-292
teóricamente los métodos revisados pueden emplearse en el colon para aumentar la detección de lesiones, facilitar la observación del margen y relieve de los pólipos, y predecir la histología de las lesiones (no neoplásicas, neoplásicas, neoplásicas invasivas). En la práctica, ningún sistema ha podido demostrar rotundamente un aumento en la detección de lesiones, el margen de las lesiones sí se observa mejor con ellos (aunque no tanto como con índigo carmín), y todos pueden ayudar a predecir la histología, especialmente si se emplean endoscopios de magnificación óptica. Se requieren más investigaciones para determinar el papel de estos equipos en la endoscopia a pacientes de alto riesgo.
Revista:
CELL PHYSIOL BIOCHEM
ISSN:
1015-8987
Año:
2010
Vol.:
26
N°:
3
Págs.:
281 - 290
Autores:
1; 2; 3; et al.
Revista:
MEDICINA CLINICA
ISSN:
0025-7753
Año:
2010
Vol.:
135
N°:
3
Págs.:
103-108
Background and objectives: Familial adenomatous polyposis is an inherited disorder characterized by the presence of multiple colorectal adenomas (more than 100 in the classic form and between 10 and 100 in the attenuated one), with a high risk of colorectal cancer development. To improve the diagnostic and therapeutic management of these patients, the Spanish Registry of Familial Adenomatous Polyposis was created in 2007. We aimed to evaluate the clinicopathological characteristics of patients with familial adenomatous polyposis in Spain. Patients and methods: All patients included in the Registry during one year were evaluated with respect to their demographic, clinical, pathological, and genetic characteristics. Results: 243 patients of 156 unrelated families from 15 Spanish centers were included. One hundred thirty patients were male, and the mean age at diagnosis was 40 years. According to the clinical presentation, 127 corresponded to the classic form and 116 to the attenuated one. Colorectal adenoma with high-grade dysplasia was identified in 67 (28%) patients, and colorectal cancer in 42 (17%). Extracolonic manifestations were: duodenal involvement (n=46), gastric involvement (n=44), desmoid tumors (n=24), thyroid cancer (n=8), osteomas (n=6) and brain tumor (n=1). APC and/or MYH gene testing was performed in 140 (90%) families, detecting the causative mutation in 75 (54%) of them (70 in the APC gene and 5 in the MYH gene). Conclusions: During its first year of operabi
Autores:
1; 2; 3; et al.
Revista:
GASTROENTEROLOGY
ISSN:
0016-5085
Año:
2010
Vol.:
138
N°:
4
Págs.:
1406-17
These findings define a unique genotype-phenotype relationship between TGFBR2 and EMT that may contribute to the improved prognosis consistently observed in colon cancers with MSI.
