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Sorge A, Elli L, Rondonotti E, Pennazio M, Spada C, Cadoni S, Cannizzaro R, Calabrese C, de Franchis R, Girelli CM, Marmo R, Riccioni ME, Marmo C, Oliva S, Scarpulla G, Soncini M, Vecchi M, Tontini GE. Enteroscopy in diagnosis and treatment of small bowel bleeding: A Delphi expert consensus. Dig Liver Dis 2023; 55:29-39. [PMID: 36100515 DOI: 10.1016/j.dld.2022.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/14/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Enteroscopy plays an important role in the management of small bowel bleeding. However, current guidelines are not specifically designed for small bowel bleeding and recommendations from different international societies do not always align. Consequently, there is heterogeneity in the definitions of clinical entities, clinical practice policies, and adherence to guidelines among clinicians. This represents an obstacle to providing the best patient care and to obtain homogeneous data for clinical research. AIMS The aims of the study were to establish a consensus on the definitions of bleeding entities and on the role of enteroscopy in the management of small bowel bleeding using a Delphi process. METHODS A core group of eight experts in enteroscopy identified five main topics of small bowel bleeding management and drafted statements on each topic. An expert panel of nine gastroenterologists participated in three rounds of the Delphi process, together with the core group. RESULTS A total of 33 statements were approved after three rounds of Delphi voting. CONCLUSION This Delphi consensus proposes clear definitions and a unifying strategy to standardize the management of small bowel bleeding. Furthermore, it provides a useful guide in daily practice for both clinical and technical issues of enteroscopy.
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Affiliation(s)
- Andrea Sorge
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Luca Elli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Marco Pennazio
- University Division of Gastroenterology, City of Health and Science University Hospital, Turin, Italy
| | - Cristiano Spada
- Digestive Endoscopy Unit, Catholic University of Rome, Rome, Italy; Digestive Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Sergio Cadoni
- Digestive Endoscopy Unit, Centro Traumatologico Ortopedico, Iglesias, Italy
| | - Renato Cannizzaro
- Experimental Oncological Gastroenterology Unit, Centro di Riferimento Oncologico di Aviano (CRO), Istituto Nazionale Tumori IRCCS, Aviano, Italy
| | - Carlo Calabrese
- University of Bologna Alma Mater - School of Medicine, Department of Medical and Surgical Sciences - Regional Referral Center for IBD, Bologna, Italy
| | | | | | | | - Maria Elena Riccioni
- Digestive Endoscopy Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Clelia Marmo
- Digestive Endoscopy Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Salvatore Oliva
- Gastroenterology and Paeditric Hepatology Unit, Università La Sapienza, Rome, Italy
| | | | - Marco Soncini
- Department of Internal Medicine, "A. Manzoni" Hospital, ASST Lecco, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Gian Eugenio Tontini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Fusaroli P, Eloubeidi M, Calvanese C, Dietrich C, Jenssen C, Saftoiu A, De Angelis C, Varadarajulu S, Napoleon B, Lisotti A. Quality of reporting in endoscopic ultrasound: Results of an international multicenter survey (the QUOREUS study). Endosc Int Open 2021; 9:E1171-E1177. [PMID: 34222644 PMCID: PMC8216784 DOI: 10.1055/a-1482-7769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/18/2021] [Indexed: 02/06/2023] Open
Abstract
Background and study aims The endoscopic report has a key role in quality improvement for gastrointestinal endoscopy. High quality standards have been set by the endoscopic societies in this field. Unlike other digestive endoscopy procedures, the quality of reporting in endoscopic ultrasound (EUS) has not been thoroughly evaluated and a reference standard is lacking. Methods We performed an international online survey concerning the attitudes of endosonographers towards EUS reports in order to understand the needs for standardization and quality improvement. Endosonographers from different countries and institutional setting, with varying case volume and experience were invited to take part to complete a structured questionnaire. Results We collected replies from 171 endosonographers. Overall analysis of results according to case volume, experience and working environment of respondents (academic, public hospital, private) are provided. In brief, everyone agreed on the need for standardization of EUS reporting. The use of minimal standard terminology and a structured tree with mandatory items was considered of primary importance. Image documentation was also deemed fundamental in complementing EUS reports both for patient documentation and research purposes. A strong demand for connection and consultation among endosonographers for clinical and training needs was also found. In this respect, a formal expert consultation network was advocated in order to improve the quality of reporting in EUS. Conclusions Our survey showed a strong agreement among endosonographers who expressed the need for a standardization in order to improve the report and, as a consequence, the quality of EUS.
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Affiliation(s)
- Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, Department of Medical and Surgical Sciences – DIMEC, University of Bologna, Italy
| | | | - Claudio Calvanese
- Gastroenterology Unit, Hospital of Imola, Department of Medical and Surgical Sciences – DIMEC, University of Bologna, Italy
| | - Christoph Dietrich
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen; Brandenburg Institute of Clinical Ultrasound, Medical University Brandenburg, Neuruppin, Germany
| | - Adrian Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Claudio De Angelis
- Department of General and Specialist Medicine, Gastroenterologia-U, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Shyam Varadarajulu
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, Florida, USA.
| | - Bertrand Napoleon
- Digestive Endoscopy Unit, Hopital Privé J Mermoz Ramsay Générale de Santé, Lyon, France
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, Department of Medical and Surgical Sciences – DIMEC, University of Bologna, Italy
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Maserat E, Safdari R, Maserat E, Zali MR. Endoscopic electronic record: A new approach for improving management of colorectal cancer prevention. World J Gastrointest Oncol 2012; 4:76-81. [PMID: 22532880 PMCID: PMC3334383 DOI: 10.4251/wjgo.v4.i4.76] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 03/01/2012] [Accepted: 03/10/2012] [Indexed: 02/05/2023] Open
Abstract
Digestive endoscopy is currently the main diagnostic procedure for investigation of the digestive tract when a digestive disease is suspected. The use of computers and electronic medical records for the management of endoscopic data are an important key to improving endoscopy unit efficiency and productivity. This technology supports optimal program operation, monitoring and evaluation colorectal cancer screening. This article is a comprehensive survey of endoscopic electronic medical records and information systems. Computerized clinical records have the capability of identifying patients due for screening and to calculate baseline rates of colorectal cancer screening by patient characteristics and by primary care physician and practice group. This paper describes data flow in the endoscopy unit, the minimum data set of colorectal cancer and key features of endoscopic electronic medical record. In addition, the researchers state standards in different aspects, especially terminology standards and interoperability standards for image and text.
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Affiliation(s)
- Elham Maserat
- Elham Maserat, Reza Safdari, Elnaz Maserat, Mohamad Reza Zali, Tehran University of Medical Sciences and Research Center for Gastroenterology and Liver Disease of Shahid Beheshti University, M.C., 7th floor of Taleghani Hospital, Tabnak Street, Evin, Tehran 1985711151, Iran
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Affiliation(s)
- J K Marshall
- Division of Gastroenterology, McMaster University Medical Centre, Hamilton, Ontario.
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L'Her E, Cassaz C, Le Gal G, Cholet F, Renault A, Boles JM. Gut dysfunction and endoscopic lesions after out-of-hospital cardiac arrest. Resuscitation 2006; 66:331-4. [PMID: 16039032 DOI: 10.1016/j.resuscitation.2005.03.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2004] [Revised: 03/03/2005] [Accepted: 03/21/2005] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cardiac arrest induces severe mesenteric ischaemia. The objective of this study was to assess the frequency of gut dysfunction and endoscopic lesions following resuscitation after cardiac arrest, and to evaluate the potential value of gut endoscopy performance in these circumstances. METHODS This is a retrospective data files survey of 3617 patients from the database in a medical intensive care unit. A systematic review of medical and endoscopic files was performed within this database, using a standardised chart. PATIENTS One-hundred and thirty consecutive patients who survived up to 48 h were admitted to our unit after out-of-hospital cardiac arrest. Seventy-eight of these patients (60%) presented with early clinical signs of gut dysfunction and/or lesions. Thirty-six patients underwent gut endoscopies (26%) and were included in the survey. RESULTS Endoscopic lesions were observed in all cases; in 15 cases, gastrointestinal haemorrhage requiring intervention was identified. The occurrence of haemorrhagic and/or necrotic lesions was found to be associated with an initial rhythm of asystole, higher SAPS II values and epinephrine requirements, compared with cardiac arrest patients without such lesions. CONCLUSION The frequent occurrence of endoscopic lesions in the presence of gut dysfunction following a cardiac arrest could suggest systematic gut endoscopy in such patients. However, an alternative recommendation would be to watch these patients very closely, treat all with prophylactic proton pump inhibitors, and endoscope only those with evidence of bleeding.
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Affiliation(s)
- Erwan L'Her
- Réanimation et Urgences Médicales, CHU de la Cavale Blanche, 29609 Brest Cedex, France.
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Dolz Abadía C. [Advantages of computerized management in a gastrointestinal endoscopy unit]. Gastroenterol Hepatol 2005; 28:298-305. [PMID: 15871815 DOI: 10.1157/13074067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Computerized management of the activity of a gastrointestinal endoscopy unit in a hospital requires technological resources that include an intrahospital network, a computerized endoscopy program, a computerized appointments program and electronic medical records. The endoscopy unit should define the portfolio of services it provides and establish the time required to perform each procedure, probably using distinct criteria for outpatient and inpatient requests. Computerized management should establish forms designed to receive, accept and schedule requests, and should transfer all the contents of the request to the endoscopy program. The endoscopy program makes and stores reports and images. Integration among the programs allows these contents to be transferred to the electronic medical record. Measures to guarantee the confidentiality and safety of the medical information in each center should be implemented in accordance with its policy on access to medical information.
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Affiliation(s)
- C Dolz Abadía
- Servicio de Aparato Digestivo, Hospital Son Llàtzer, Palma de Mallorca, Islas Baleares, Spain.
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Abstract
The endoscopic electronic medical record (EEMR) has the potential to increase greatly the efficiency of both the endoscopist and the entire endoscopy unit. Potential efficiencies depend on the specific situation of the endoscopist and the type of endoscopy unit. This article describes a number of features available in current EEMRs as well as some emerging features that are important for future databases. Additionally, some aspects of equipment and staff needed to implement a successful EEMR are discussed.
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Affiliation(s)
- Thomas J Savides
- Division of Gastroenterology, University of California, San Diego School of Medicine, UCSD Thornton Gastroenterology (0956), 9320 Campus Point Drive, La Jolla, CA 92037-0956, USA.
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Shinji A, Sano K, Hamano H, Unno H, Fukushima M, Nakamura N, Akamatsu T, Kawa S, Kiyosawa K. Autoimmune pancreatitis is closely associated with gastric ulcer presenting with abundant IgG4-bearing plasma cell infiltration. Gastrointest Endosc 2004; 59:506-11. [PMID: 15044886 DOI: 10.1016/s0016-5107(03)02874-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Autoimmune pancreatitis is characterized by high serum IgG4 concentrations and lymphoplasmacytic infiltration. Because of the diversity of extrapancreatic involvement in this disease, the present study sought to identify other associated GI-tract lesions. METHODS EGD findings were compared between a group of 23 patients with autoimmune pancreatitis undergoing ERCP for obstructive jaundice and 230 age- and gender-matched control patients. To clarify the histopathologic differences found between these two groups, the histopathologic findings (Updated Sydney System) and the immunohistochemistry of each IgG subclass were compared between 8 patients with autoimmune pancreatitis and gastric ulcer, and 23 control patients with gastric ulcer from which biopsy specimens had been obtained. RESULTS Gastric ulcer was found significantly more frequently in patients with autoimmune pancreatitis compared with control patients (34.8% vs. 13.5%; p=0.007). There was no significant difference between the groups with respect to the frequency of other GI lesions. Four of 8 gastric ulcers in patients with autoimmune pancreatitis were linear, with the long axis perpendicular to the incisura on the lesser curvature of the stomach. The activity score for the gastric lesions was significantly lower in patients with autoimmune pancreatitis compared with control patients (mean score 0.38 vs. 1.08; p=0.012). There were no significant differences in histopathologic findings with respect to inflammation, atrophy, metaplasia, or Helicobacter pylori scores between the two groups. IgG4-bearing plasma cells were significantly more abundant in gastric lesions in patients with autoimmune pancreatitis compared with those in control patients (mean score 1.75 vs. 0.39; p=0.0008). CONCLUSIONS Autoimmune pancreatitis is closely associated with gastric ulcer with abundant IgG4-bearing plasma cell infiltration.
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Affiliation(s)
- Akihiro Shinji
- Department of Medicine, Department of Laboratory Medicine, and Department of Endoscopy, Shinshu University School of Medicine, Matsumoto, Japan
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