Implementation of esophageal endoscopic submucosal dissection in Spain: Results from the nationwide registry

INTRODUCTION AND AIMS

The outcomes of endoscopic submucosal dissection (ESD) in the esophagus have not been assessed in our country. Our primary aim was to analyze the effectiveness and safety of the technique.

MATERIAL AND METHODS

Analysis of the prospectively maintained national registry of ESD. We included all superficial esophageal lesions removed by ESD in 17 hospitals (20 endoscopists) between January 2016 and December 2021. Subepithelial lesions were excluded. The primary outcome was curative resection. We conducted a survival analysis and used logistic regression analysis to assess predictors of non-curative resection.

RESULTS

A total of 102 ESD were performed on 96 patients. The technical success rate was 100% and the percentage of en-bloc resection was 98%. The percentage of R0 and curative resection was 77.5% (n=79; 95%CI: 68%-84%) and 63.7% (n=65; 95%CI: 54%-72%), respectively. The most frequent histology was Barrett-related neoplasia (n=55 [53.9%]). The main reason for non-curative resection was deep submucosal invasion (n=25). The centers with a lower volume of ESD obtained worse results in terms of curative resection. The rate of perforation, delayed bleeding and post-procedural stenosis were 5%, 5% and 15.7%, respectively. No patient died or required surgery due to an adverse effect. After a median follow-up of 14months, 20patients (20.8%) underwent surgery and/or chemoradiotherapy, and 9 patients died (mortality 9.4%).

CONCLUSIONS

In Spain, esophageal ESD is curative in approximately two out of three patients, with an acceptable risk of adverse events.

Physico-Chemical and Physiological Changes during Fruit Development and Ripening of Five Loquat (Eriobotrya Japonica Lindl.) Cultivars

Physico-chemical and physiological changes during development and ripening of five loquat cultivars ( Eriobotrya japonica Lindl., cv. Algerie, Cardona, Golden, Magdall and Peluche) were determined. Fruit growth showed a sigmoid curve in all loquat cultivars. A good relationship between duration of fast growth phase and fruit size was found. In addition, a positive correlation was also established between seed number and fruit size, and between seed weight and both fruit and flesh weight. Colour changes, sugar content increase and the decrease in fruit firmness and organic acids started simultaneously when loquat fruits were in the phase of fast growth, and at about 70-80% of their final weight. These physico-chemical changes related to fruit ripening coincided with an increase in both ethylene production rate and free and total 1-aminocyclopropane-1 -carboxylic acid (ACC) content in the flesh. In addition, a small respiration peak associated with ripening was also detected. These results indicated that loquat fruits of all five studied cultivars showed a pattern of ripening in the tree that could be classified as climacteric, with relatively low ethylene production evolving at an early phase of fruit development.

Physicochemical Changes during Date Ripening Related to Ethylene Production

Some physicochemical parameters related to ripening and their relationship with ethylene were studied in date fruits ( Phoenix dactyliferaL. type Negros). Dates were harvested and classified into sixteen ripening stages according to their color, ranging from yellow-greenish to dark brown. Fruit firmness decreased through the different ripening stages, while the ripening index, expressed as the relation between soluble solids and acidity, increased. The greatest loss of fruit firmness correlated with the greatest increases in both polygalacturonase and •-galactosidase activities. In early ripening stages, a small peak in ethylene production was detected, followed by a peak in respiration rate, suggesting that a date could be considered as a climacteric fruit, with the plant hormone ethylene being responsible for changes in color, fruit firmness, soluble solids content and acidity.

Micro-ureteroscopy: Initial experience in the endoscopic treatment of pelvic ureteral lithiasis

OBJECTIVES

To present to report the first case of ureteral lithiasis resolved using a new endoscopic approach, which we call microureteroscopy (m-URS) and attempts to reduce the ureteral damage caused by conventional instrumentation.

MATERIAL AND METHODS

We selected a 53-year-old patient with a 16-mm calculus in the right distal ureter. For endoscopic access, we used a 4.8 Fr sheath from the microperc set and fragmented the stone with a 230-micron laser fiber.

RESULTS

Complete fragmentation of the stone was achieved. We placed a JJ catheter due to significant ureteral edema. The surgical time and postsurgical stay were 156minutes and 24hours, respectively. There were no complications, the requirements for analgesia were minimal, and the patient was free of residual stones.

CONCLUSIONS

The m-URS technique is feasible, simple and effective for the treatment of pelvic ureteral lithiasis in women and optimizes minimal invasion, with results that can be comparable to conventional endoscopic techniques in terms of ease of access and quality of endoscopic vision without affecting the resolution capacity. Larger studies and greater technological development is needed to define the definitive role of this procedure. Currently, its major limitations lie in the treatment of proximal ureter lithiasis and in the treatment of men. This technique could also be a viable alternative for pediatric patients.

Treatment of hemorrhagic complications of percutaneous nephrolithotomy in Galdakao position

OBJECTIVE

Percutaneous Nephrolithotomy (PCNL) is a technique with good results for the treatment of kidney stones, however, bleeding complications derived can be serious if not diagnosed and treated effectively. The aim of this study is to assess bleeding complications resulting from PCNL in Galdakao position and therapeutic management.

MATERIAL AND METHODS

Retrospective-longitudinal study of 172 PCNL performed in La Ribera Hospital between January 2005 and December 2011, analyzing their bleeding complications and the treatment provided for resolution.

RESULTS

Had bleeding complications 20 patients (11.6%). The need for transfusion in this series was 8.1% and the most common cause of blood transfusion the presence of postoperative retroperitoneal (7.5%). There were 6 arterial injuries (3.5%), 5 of them successfully treated with angiography and arterial selective embolization.

CONCLUSIONS

The arterial injuries following PCNL are rare but can be serious. The possibility of an urgent arteriography and selective embolization to the diagnosis permits an effective and safe treatment of bleeding without risk to the affected renal unit.

Study of predictive factors for complications after percutaneous nephrolithotomy according to the Clavien classification

OBJECTIVE

Set predictors of complications in percutaneous nephrolithotomy (PCNL) using the modified Clavien system.

MATERIAL AND METHODS

Retrospective study included 172 PCNL in Galdakao position made in the La Ribera Hospital between January 2005 and December 2011. They classified the complications of these procedures using the modified Clavien system. We performed a univariate analysis (Chi(2) Test and Cramer's V) and multivariate (logistic regression) of predictors of these complications (P < .05).

RESULTS

In 49 of the 172 procedures complications were detected (28.5%).The most frequent complications were grade 1 (9.9%), 12 complications (6.9%) were classified as grade 2 by requiring additional medical treatment, 6 as grade 3A (3.5%), 7 as grade 3B (4.1%), 2 and 4A (1.1%), 4 and 4B (2.3%) and one and 5 (0.6%). In the univariate analysis, positive urine culture before surgery, the stones complex and larger than 40 mm of the same, showed a statistically significant association with the occurrence of complications (P < .05). The positive culture (OR: 2.96) and complex stones (OR: 3.03) proved to be independent variables predicting complications in multivariate analysis.

CONCLUSIONS

Clavien system allows a common language for classifying complications, expressing the degree of the same as the complexity of treatment required for resolution. The preoperative urine culture positivity and complex stone proved predictors of these complications in our serie.

Antioxidant and Nutritional Properties of Date Fruit from Elche Grove as Affected by Maturation and Phenotypic Variability of Date Palm

Some parameters related to nutritive and functional properties were evaluated in date fruit from seven date palms from the Elche grove along the maturation process, in order to obtain information about differences due to phenotypic variability. Results showed that sugar and organic acid concentration were different depending on date palm, the highest levels being reached at 100% Rutab stage, with glucose and fructose as the predominant sugars and malic acid as the major organic acid. Hydrophilic total antioxidant activity (HTAA) was high and correlated to phenolic content, with maxima levels being found at early, medium or late Khalal stages, depending on date palm. In addition, significant differences were found in both, phenolic concentration and HTAA among date palm and maturation stages, while lipophilic total antioxidant activity (LTAA) was very low, without changes along maturation and not correlated to HTAA. Then, date fruit from Elche grove could serve as a good source of natural antioxidant and it would be advisable to consume them at medium or late Khalal stages, in order to achieve the maxima nutritional (high concentration of sugars and organic acids), organoleptic (appropriated firmness levels, yellow or red color and low astringency) and functional properties with benefits to human health.

[A cost-effectiveness study of hepatic venous pressure gradient measurement in the secondary prevention of variceal bleeding]

OBJECTIVE

variceal rebleeding is common following a first episode of hemorrhage in cirrhotic patients. The objective of this study was to determine the cost-effectiveness of monitoring hepatic venous pressure gradient (HVPG) to guide secondary prophylaxis.

METHODS

we created a Markov decision model to calculate cost-effectiveness for two strategies: Group 1: HVPG monitoring to decide treatment -when portal pressure was reduced by at least 20 percent or HVPG was less than 12 mmHg after beta-blocker administration, patients received beta-blockers; when portal pressure did not meet these criteria therapy was endoscopic band ligation. Group 2: in this group there was no monitoring of HVPG. Patients with large varices received treatment with beta-blockers combined with EBL; patients with small varices received beta-blockers plus isosorbide mononitrate.

RESULTS

there was no recurrent variceal bleeding in group 1 for good responders, and for 17% of poor responders. In group 2 a 25% rebleeding rate was detected in patients with small varices and 13% for those with big varices. Overall cost in group 1 was 14,100.49 euros, and 14,677.16 in group 2.

CONCLUSIONS

HVPG measurement is cost-effective for the secondary prophylaxis of variceal bleeding.

Use of Modified Atmosphere Packaging with Microperforated Polypropylene Films to Maintain Postharvest Loquat Fruit Quality

Loquat fruits (Eriobotrya japonica Lindl cv. `Algerie') were stored in modified atmosphere packaging (MAP), using five types of microperforated polypropylene (PP) films during 2, 4, and 6 weeks at 2 °C and for a subsequent period of 4 days at 20 °C shelf life (SL) out of the bags. Loquat fruits stored without packaging and in normal air served as control. The atmosphere composition at the steady state depended on the film permeability, ranging from 1.2 to 8.5 kPa for CO2 and from 19.5 to 13 kPa for O2 as film permeability decreased. Weight loss was drastically reduced by MAP conditions. Softening, color evolution, and decreases in sugars and organic acids were delayed, these effects also being evident after the SL period. Scores for visual aspect and facility of peeling were also higher for loquat stored in MAP than for controls. Taking into account results form all quality parameters, the most suitable atmosphere for loquat storage was found to be around 2—4 and 16—18 kPa for CO2 and O2, respectively, reached in the PA-80 and PA-60 films. In addition, the storage period for optimum loquat quality maintenance was established as 2 weeks of cold storage plus SL for control fruits, while under MAP conditions, storage periods could be extended up to 6 weeks plus SL, especially using PA-80 and PA-60 films.