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Fairman CM, Kava CM, Beima-Sofie K, Sakhuja M, Masud M, Dias E, Sheng J, Gorzelitz J, Morshed A, Green BB, Skiba MB, Madhivanan P, Parthasarathy N, Hirschey R, Vander Weg MW, Hebert J. Addressing differences in cancer: a framework for synergistic programming in cancer prevention and control. Res Sq 2024:rs.3.rs-4046415. [PMID: 38562683 PMCID: PMC10984020 DOI: 10.21203/rs.3.rs-4046415/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background Cancer remains a leading cause of death worldwide and continues to disproportionately impact certain populations. Several frameworks have been developed that illustrate the multiple determinants of cancer. Expanding upon the work of others, we present an applied framework for cancer prevention and control designed to help clinicians, as well as public health practitioners and researchers, better address differences in cancer outcomes. Methods The framework was developed by the Cancer Prevention and Control Research Network's Health Behaviors Workgroup. An initial framework draft was developed based on workgroup discussion, public health theory, and rapid literature review on the determinants of cancer. The framework was refined through interviews and focus groups with Federally Qualified Health Center providers (n=2) and cancer patients (n=2); participants were asked to provide feedback on the framework's causal pathways, completeness, and applicability to their work and personal life. Results The framework provides an overview of the relationships between sociodemographic inequalities, social and structural determinants, and key risk factors associated with cancer diagnosis, survivorship, and cancer morbidity and mortality across the lifespan. The framework emphasizes how health-risk behaviors like cigarette smoking interact with psychological, psychosocial, biological, and psychosocial risk factors, as well as healthcare-related behavior and other chronic diseases. Importantly, the framework emphasizes addressing social and structural determinants that influence health behaviors to reduce the burden of cancer and improve health equity. Aligned with previous theory, our framework underscores the importance of addressing co-occurring risk factors and disease states, understanding the complex relationships between factors that influence cancer, and assessing how multiple forms of inequality or disadvantage intersect to increase cancer risk across the lifespan. Conclusions This paper presents an applied framework for cancer prevention and control to address cancer differences. Because the framework highlights determinants and factors that influence cancer risk at multiple levels, it can be used to inform the development, implementation, and evaluation of interventions to address cancer morbidity and mortality.
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Affiliation(s)
| | | | | | | | | | - E Dias
- UTHealth Houston School of Public Health
| | - J Sheng
- University of Wisconsin-Madison
| | | | | | - B B Green
- Kaiser Permanente Washington Health Research Institute
| | | | | | | | - R Hirschey
- University of North Carolina and Lineberger Comprehensive Cancer Center
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Correia E, Granadeiro JP, Santos B, Mata VA, Dias E, Regalla A, Catry T. Diet of the critically endangered blackchin guitarfish Glaucostegus cemiculus revealed using DNA metabarcoding. J Fish Biol 2024; 104:324-328. [PMID: 37787164 DOI: 10.1111/jfb.15574] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/14/2023] [Accepted: 09/27/2023] [Indexed: 10/04/2023]
Abstract
We present the first assessment of the diet of the blackchin guitarfish Glaucostegus cemiculus (Geoffroy Saint-Hilaire, 1817) for West Africa using DNA metabarcoding on stomach contents of individuals captured in the Bijagós Archipelago, Guinea-Bissau. The diet was dominated by crustaceans, particularly caramote prawn Penaeus kerathurus (frequency of occurrence [FO] = 74%, numerical frequency [NF] = 54%) and fiddler crab Afruca tangeri (FO = 74%, NF = 12%). Bony fishes were present in 30% of the stomachs. We highlight the importance of conservation action for intertidal habitats and their associated benthic invertebrates for the survival of the critically endangered blackchin guitarfish.
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Affiliation(s)
- Edna Correia
- Centro de Estudos do Ambiente e do Mar, Departamento de Biologia Animal, Faculdade de Ciências da Universidade de Lisboa, Lisboa, Portugal
| | - José Pedro Granadeiro
- Centro de Estudos do Ambiente e do Mar, Departamento de Biologia Animal, Faculdade de Ciências da Universidade de Lisboa, Lisboa, Portugal
| | - Bárbara Santos
- CIBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, InBIO Laboratório Associado, Vairão, Portugal
- BIOPOLIS Program in Genomics, Biodiversity and Land Planning, CIBIO, Campus de Vairão, Vairão, Portugal
| | - Vanessa A Mata
- CIBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, InBIO Laboratório Associado, Vairão, Portugal
- BIOPOLIS Program in Genomics, Biodiversity and Land Planning, CIBIO, Campus de Vairão, Vairão, Portugal
| | - Emanuel Dias
- Instituto da Biodiversidade e das Áreas Protegidas, Dr. Alfredo Simão da Silva (IBAP), Bissau, Guinea-Bissau
| | - Aissa Regalla
- Instituto da Biodiversidade e das Áreas Protegidas, Dr. Alfredo Simão da Silva (IBAP), Bissau, Guinea-Bissau
| | - Teresa Catry
- Centro de Estudos do Ambiente e do Mar, Departamento de Biologia Animal, Faculdade de Ciências da Universidade de Lisboa, Lisboa, Portugal
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Rodrigues-Pinto E, Dias E, Medas R, Macedo G. Use of mechanical lithotripter to assist in the endoscopic removal of an impacted long chicken bone in sigmoid diverticula. Endoscopy 2023; 55:E856-E857. [PMID: 37433324 PMCID: PMC10335860 DOI: 10.1055/a-2106-0612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Affiliation(s)
- Eduardo Rodrigues-Pinto
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Emanuel Dias
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Renato Medas
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
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Dias E, Santos-Antunes J, Portugal R, Pinheiro J, Carneiro F, Macedo G. Primary gastric choriocarcinoma: a rare and aggressive gastrointestinal malignancy. Rev Esp Enferm Dig 2023; 115:585-586. [PMID: 36633164 DOI: 10.17235/reed.2022.9433/2022] [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: 12/25/2022]
Abstract
A 40-year-old male with no previous medical history presented to emergency department with a 2-week history of progressive dyspnea. He also described night sweats and weight loss (15 kg) during the last 3 months. Thoraco-abdominal computed tomography showed multiple bilateral lung nodules associated with supra-clavicular, hilar and peri-esophageal lymphadenopathies and gastric parietal thickening. These imaging features were suggestive of primary gastric cancer with lung and lymph node metastases. Therefore, he undergone upper digestive endoscopy that showed a large ulcerated protruding lesion at the greater curvature of the body suggestive of malignancy. Gastric biopsies of the lesion confirmed a solid neoplasia constituted by solid nests and sheets of highly pleomorphic, bizarre cells with cytotrophoblastic and syncytiotrophoblastic differentiation that, on immunohistochemistry, stained positive for β-HCG, SALL-4 and glypican-3. CT-guided biopsy of lung nodules revealed malignant cells with similar histopathological and immunohistochemical features. Elevated serum alpha-fetoprotein and β-HCG were also detected. Clinical and ultrasound examination were negative for testicular masses. These findings were consistent with a primary gastric choriocarcinoma presenting with lung and lymph node metastases (stage IV). Although chemotherapy was started, the patient evolved unfavorably and died after 9 months. Primary gastric choriocarcinoma is a rare and aggressive gastrointestinal malignancy. This case demonstrates its rapid growth rate and high metastatic potential that may lead to symptoms from secondary involvement of distant organs.
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Affiliation(s)
- Emanuel Dias
- Gastrenterology Department, Centro Hospitalar de São João, Portugal
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5
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Dias E, Cardoso H, Rodrigues-Pinto E, Portugal R, Macedo G. A challenging alpha-fetoprotein after liver transplantation. Gastroenterol Hepatol 2023; 46:628-629. [PMID: 35964815 DOI: 10.1016/j.gastrohep.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Emanuel Dias
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
| | - Hélder Cardoso
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Raquel Portugal
- Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
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Cunha R, Silva M, Henrique A, Maximiano P, Correia M, Vieira I, Cássio I, Oliveira N, Dias E. Pseudoaneurysm of radial artery after coronary angiography. J Surg Case Rep 2023; 2023:rjad446. [PMID: 37560606 PMCID: PMC10409588 DOI: 10.1093/jscr/rjad446] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/18/2023] [Indexed: 08/11/2023] Open
Abstract
Iatrogenic pseudoaneurysms (IPA) are a rare complication of transradial coronary intervention. This brief report aims to present a case report of a radial artery pseudoaneurysm and to review the current management of this entity. Because of the increased performance of transradial coronary intervention, IPA have become more common. Doppler ultrasonography is a fundamental tool to aid the differential diagnosis with other pathologies. There is no consensus on the treatment, which may range from conservative management to surgical repair. Close surveillance after the procedure and early diagnosis are essential to avoid serious complications, such as ischemia of the hand. The management of IPA depends upon morphological characteristics and associated symptoms.
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Affiliation(s)
- Roberto Cunha
- Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, Azores, Portugal
| | - Manuel Silva
- Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, Azores, Portugal
| | - Alberto Henrique
- Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, Azores, Portugal
| | - Pedro Maximiano
- Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, Azores, Portugal
| | - Mafalda Correia
- Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, Azores, Portugal
| | - Isabel Vieira
- Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, Azores, Portugal
| | - Isabel Cássio
- Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, Azores, Portugal
| | - Nelson Oliveira
- Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, Azores, Portugal
| | - Emanuel Dias
- Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, Azores, Portugal
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Cunha R, Silva M, Henrique A, Maximiano P, Correia M, Vieira I, Cássio I, Oliveira N, Dias E. Management of median arcuate ligament syndrome: a case-based review. J Surg Case Rep 2023; 2023:rjad424. [PMID: 37485493 PMCID: PMC10359179 DOI: 10.1093/jscr/rjad424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023] Open
Abstract
Dunbar syndrome or median arcuate ligament syndrome is a rare pathology that has a great impact on the quality of life of patients. This brief report aims to present a case report of a successful treatment of Dunbar syndrome and to review the current management of this entity. We present the case of a 37 year-old patient, who was treated by median arcuate ligament laparoscopic resection. The median arcuate ligament syndrome is associated with significant morbidity. There are no diagnostic criteria established so alternative causes of abdominal pain must be excluded. Celiac artery decompression by laparoscopic approach is currently the preferred treatment. Early diagnosis and treatment of this pathology allow a significant improvement in the quality of life of patients.
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Affiliation(s)
- Roberto Cunha
- Correspondence address. Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Av. D. Manuel I, 9500-370, Ponta Delgada, São Miguel Island, Azores, Portugal. Tel: +351 296 203 000; E-mail:
| | - Manuel Silva
- Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, São Miguel Island, Azores, Portugal
| | - Alberto Henrique
- Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, São Miguel Island, Azores, Portugal
| | - Pedro Maximiano
- Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, São Miguel Island, Azores, Portugal
| | - Mafalda Correia
- Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, São Miguel Island, Azores, Portugal
| | - Isabel Vieira
- Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, São Miguel Island, Azores, Portugal
| | - Isabel Cássio
- Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, São Miguel Island, Azores, Portugal
| | - Nelson Oliveira
- Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, São Miguel Island, Azores, Portugal
| | - Emanuel Dias
- Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, São Miguel Island, Azores, Portugal
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Cunha R, Silva M, Henrique A, Maximiano P, Correia M, Vieira I, Cássio I, Oliveira N, Dias E. Paradoxical embolism: a rare cause of acute upper limb ischemia. J Surg Case Rep 2023; 2023:rjad435. [PMID: 37520078 PMCID: PMC10374347 DOI: 10.1093/jscr/rjad435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 07/04/2023] [Indexed: 08/01/2023] Open
Abstract
Paradoxical embolism is a rare cause of arterial embolism, even more those resulting in acute ischemia of the upper limb. A case of a 45-year-old patient with acute paradoxical upper limb embolization and acute limb ischemia is presented. A review of the most recent evidence on the diagnosis and management of paradoxical embolism were explored. The cardiac defect most associated with paradoxical embolism is a patent foramen oval. The diagnosis can be performed by transthoracic or transesophageal echocardiography. Closure of the foramen oval is a safe and effective procedure; however, there is no clear consensus on when it should be performed, so the strategy should be individualized. A high level of suspicion of paradoxical embolism should exist in the presence of simultaneous venous and arterial embolism. The investigation of the embolic source is fundamental to avoid the recurrence of events.
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Affiliation(s)
- Roberto Cunha
- Correspondence address. Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Av. D. Manuel I, 9500-370, Ponta Delgada, São Miguel Island, Azores, Portugal. Tel: +351 296 203 000; E-mail:
| | - Manuel Silva
- Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, São Miguel Island, Azores, Portugal
| | - Alberto Henrique
- Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, São Miguel Island, Azores, Portugal
| | - Pedro Maximiano
- Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, São Miguel Island, Azores, Portugal
| | - Mafalda Correia
- Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, São Miguel Island, Azores, Portugal
| | - Isabel Vieira
- Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, São Miguel Island, Azores, Portugal
| | - Isabel Cássio
- Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, São Miguel Island, Azores, Portugal
| | - Nelson Oliveira
- Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, São Miguel Island, Azores, Portugal
| | - Emanuel Dias
- Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, São Miguel Island, Azores, Portugal
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Dias E, Medas R, Marques M, Andrade P, Cardoso H, Macedo G. Clinicopathological characteristics and prognostic factors of small bowel lymphomas: a retrospective single-center study. Porto Biomed J 2023; 8:e217. [PMID: 37362020 PMCID: PMC10289779 DOI: 10.1097/j.pbj.0000000000000217] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/21/2023] [Indexed: 06/28/2023] Open
Abstract
Background There is little information on diagnosis and management of small bowel lymphomas, and optimal management strategies are still undefined. This study aims to describe their main clinical and pathological characteristics and identify poor prognostic factors. Methods A retrospective observational study of all patients with histological diagnosis of small bowel lymphoma between January 2010 and December 2020 was performed. Results We included 40 patients, with male predominance (60%) and mean age of 60.7 years. The ileum was the most common location, and the most common histological subtypes were follicular lymphoma and diffuse large B-cell lymphoma. Clinical presentation was variable from asymptomatic patients (30%) to acute surgical complications (35%) including perforation, intestinal obstruction, ileal intussusception, or severe bleeding. Diagnosis was established by endoscopy in 22 patients (55%), and the most common findings included polyps, single mass, diffuse infiltration, or ulceration, whereas 18 (45%) required surgery because of acute presentations or tumor resection, and lymphoma was diagnosed postoperatively. Surgery was curative in one-third of those patients. Median survival was 52 months. Acute presentation (P = 0.001), symptomatic disease (P = 0.003), advanced stage (P = 0.008), diffuse large B-cell lymphoma (P = 0.007), anemia (P = 0.006), hypoalbuminemia (P < 0.001), elevated lactate dehydrogenase (P = 0.02), elevated C-reactive protein (P < 0.001), and absence of treatment response (P < 0.001) were significant predictors of mortality. Conclusion Small bowel lymphoma is a rare malignancy with diverse clinical and endoscopic presentations that require a high index of suspicion. Primary factors associated with worse outcome included acute presentation, advanced stage, histological subtype, biochemical abnormalities, and absence of treatment response.
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Affiliation(s)
- Emanuel Dias
- Corresponding author. Address: Gastrenterology Department, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal. E-mail address: (Emanuel Dias)
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Dias E, Santos-Antunes J, Marques M, Fonseca E, Lopes J, Macedo G. Juvenile polyps with osseous metaplasia treated by endoscopic mucosal resection. Rev Esp Enferm Dig 2023; 115:214-215. [PMID: 36719331 DOI: 10.17235/reed.2023.9489/2023] [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: 01/27/2023]
Abstract
A 17-year-old male with no previous medical history presented with a 1-year history of rectal bleeding, mucus discharge and occasional rectal prolapse. Colonoscopy revealed several polypoidal growth masses in the distal rectum, formed by multiple sessile polyps with a glistening mucus-covered surface and fleshy, friable appearance, that coalesced forming large conglomerates. Given their complexity and large size, piecemeal endoscopic mucosal resection of the rectal lesions was performed and histopathological examination revealed ulcerated polypoid mucosa with mixed inflammatory cell infiltrate in the lamina propria and dilated cystic mucus-filled glands. Remarkably, bony trabeculae surrounded by osteoblastic cells were also seen. These findings were consistent with juvenile polyps with foci of osseous metaplasia. Osseous metaplasia has been described in a wide variety of tissue types, such as prostate, uterus, breasts, lungs and urinary tract, with respect to both neoplastic and non-neoplastic conditions. However, it is exceedingly rare in colonic polyps and, to the best of our knowledge, only 9 cases have been described in juvenile polyps.
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Affiliation(s)
- Emanuel Dias
- Gastrenterology , Centro Hospitalar Universitário de São João, Portugal
| | | | - Margarida Marques
- Gastrenterology, Centro Hospitalar Universitário de São João, Portugal
| | - Elsa Fonseca
- Pathology , Centro Hospitalar Universitário de São João, Portugal
| | - Joanne Lopes
- Pathology, Centro Hospitalar Universitário de São João
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Dias E, Marques M, Lopes S, Gullo I, Bastos J, Macedo G. Acute gastrointestinal graft-versus-host disease with cytomegalovirus and Epstein-Barr virus superinfection in a patient with COVID-19. Rev Esp Enferm Dig 2023; 115:92-93. [PMID: 35748474 DOI: 10.17235/reed.2022.9001/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 60-year-old female was diagnosed with acute myeloid leukemia. After initial remission with chemotherapy, she relapsed and underwent allogeneic hematopoietic stem cell transplantation (HSCT). Two months later, she presented to emergency department with watery diarrhea, abdominal pain and fever. She also tested positive for SARS-CoV2 on nasopharyngeal swab by polymerase chain reaction (PCR) and both cytomegalovirus (CMV) and Epstein-Barr virus (EBV) were detected in peripheral blood. Flexible sigmoidoscopy showed diffuse edema, erythema and loss of vascular pattern with interspersed segments of mucosal denudation and exudate and bBiopsies revealed epithelial cell apoptosis, diffuse crypt atrophy and dropout, with ulceration and both CMV and EBV were detected in colon mucosa, consistent with acute severe gastrointestinal graft-versus-host disease complicated by CMV and EBV superinfection. Despite starting therapy with methylprednisolone, ganciclovir and rituximab,she presented unfavorable evolution and died after 5 weeks.
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Affiliation(s)
- Emanuel Dias
- Gastrenterology , Centro Hospitalar Universitário de São João, Portugal
| | - Margarida Marques
- Gastrenterology, Centro Hospitalar Universitário de São João, Portugal
| | - Susana Lopes
- Gastroenterology, Centro Hospitalar Universitário de São João, Portugal
| | - Irene Gullo
- Pathology, Centro Hospitalar Universitário de São João
| | - Juliana Bastos
- Hemathology, Centro Hospitalar Universitário de São João
| | - Guilherme Macedo
- Gastroenterology , Centro Hospitalar Universitário de São João, Portugal
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Dias E, Silva MA, Almeida JC, Pinheiro J, Macedo G. Colonic perineurioma of the transverse colon: presentation of a rare neoplasm in an atypical location. Rev Esp Enferm Dig 2023; 115:221. [PMID: 36645065 DOI: 10.17235/reed.2023.9440/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
A 51-year-old male with previous medical history of dyslipidemia performed screening colonoscopy, which revealed a sessile polypoid lesion with a diameter of approximately 8 mm located at the proximal transverse colon, which was resected en bloc with a cold snare. Remarkably, histopathological examination revealed a proliferation of spindle cells in the lamina propria entrapping colonic crypts without evidence of nuclear pleomorphism, mitotic figures or necrosis. On immunohistochemistry, spindle cells were diffusely positive for glucose transporter-1 and negative for S100, DOG1, CD34 and smooth muscle actin. These features were consistent with a diagnosis of colonic perineurioma.
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Affiliation(s)
- Emanuel Dias
- Gastrenterology , Centro Hospitalar de São João, Portugal
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Haasnoot KJC, Baldaque-Silva F, Koch A, Figueiredo Ferreira M, Santos-Antunes J, Dias E, Omae M, van Tilburg L, Dang H, Lemmers A, Boonstra JJ, Moons LMG. Low risk of local recurrence after a successful en bloc endoscopic submucosal dissection for noninvasive colorectal lesions with positive horizontal resection margins (R-ESD study). Endoscopy 2023; 55:245-251. [PMID: 36228648 PMCID: PMC9974332 DOI: 10.1055/a-1960-3552] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND : During endoscopic submucosal dissection (ESD), the normal mucosa is cut under constant optical control. We studied whether a positive horizontal resection margin after a complete en bloc ESD predicts local recurrence. METHODS In this European multicenter cohort study, patients with a complete en bloc colorectal ESD were selected from prospective registries. Cases were defined by a horizontal resection margin that was positive or indeterminate for dysplasia (HM1), whereas controls had a free resection margin (HM0). Low risk lesions with submucosal invasion (T1) and margins free of carcinoma were analyzed separately. The main outcome was local recurrence. RESULTS From 928 consecutive ESDs (2011-2020), 354 patients (40 % female; mean age 67 years, median follow-up 23.6 months), with 308 noninvasive lesions and 46 T1 lesions, were included. The recurrence rate for noninvasive lesions was 1/212 (0.5 %; 95 %CI 0.02 %-2.6 %) for HM0 vs. 2/96 (2.1 %; 95 %CI 0.57 %-7.3 %) for HM1. The recurrence rate for T1 lesions was 1/38 (2.6 %; 95 %CI 0.14 %-13.5 %) for HM0 vs. 2/8 (25 %; 95 %CI 7.2 %-59.1 %) for HM1. CONCLUSION A positive horizontal resection margin after an en bloc ESD for noninvasive lesions is associated with a marginal nonsignificant increase in the local recurrence rate, equal to an ESD with clear horizontal margins. This could not be confirmed for T1 lesions.
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Affiliation(s)
- Krijn J. C. Haasnoot
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Francisco Baldaque-Silva
- Endoscopy Unit, Center for Upper Digestive Diseases, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden,Pedro Hispano Hospital, Advanced Endoscopy Center Carlos Moreira da Silva, Porto, Portugal
| | - Arjun Koch
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Mariana Figueiredo Ferreira
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - João Santos-Antunes
- Department of Gastroenterology and Hepatology, University Hospital Center of São João, Porto, Portugal,IPATIMUP/i3S, University of Porto, Porto, Portugal
| | - Emanuel Dias
- Department of Gastroenterology and Hepatology, University Hospital Center of São João, Porto, Portugal
| | - Masami Omae
- Endoscopy Unit, Center for Upper Digestive Diseases, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Laurelle van Tilburg
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Hao Dang
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jurjen J. Boonstra
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Leon M. G. Moons
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
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14
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Dias E, Andrade P, Cardoso H, Gullo I, Fonseca E, Macedo G. Primary small bowel follicular lymphoma: the role of balloon-assisted enteroscopy in diagnosis and follow-up. Rev Esp Enferm Dig 2023; 115:43-44. [PMID: 35656922 DOI: 10.17235/reed.2022.8943/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
An asymptomatic 38-year-old male with no significant previous medical history performed routine laboratory studies that revealed iron-deficiency anemia. Esophagogastroduodenoscopy and colonoscopy were unremarkable and he undergone videocapsule endoscopy that revealed multiple small polyps along jejunum and ileum. Double-balloon enteroscopy confirmed the presence of scattered small whitish nodules and small polyps carpeting segments of jejunal mucosal and sometimes forming conglomerates with a nodular appearance. Histopathological examination showed lamina propria expansion by neoplastic follicles, predominantly composed by small lymphoid cells that, by immunohistochemistry, showed expression of CD20, CD10 and bcl-2. Computed tomography scan of abdomen and pelvis did not reveal systemic involvement, consistent with primary small bowel follicular lymphoma. Chemotherapy was started and, at reevaluation enteroscopy, although nodular jejunal segments persisted, biopsies did not show involvement by lymphoproliferative disease, which was interpreted as complete remission. Periodic clinical and biochemical evaluation and annual enteroscopic surveillance was maintained and, after three years, local recurrence of low-grade follicular lymphoma was detected. As previously, there was no evidence of systemic involvement and the decision was to maintain close surveillance. After one year, the patient remains asymptomatic and without evidence of disease progression. This case illustrates the essential role of balloon-assisted enteroscopy for diagnosis and surveillance of primary small bowel follicular lymphoma.
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Affiliation(s)
- Emanuel Dias
- Gastrenterology , Centro Hospitalar Universitário de São João, Portugal
| | | | - Hélder Cardoso
- Gastroenterology, Centro Hospitalar Universitário de São João
| | - Irene Gullo
- Pathology, Centro Hospitalar Universitário de São João
| | - Elsa Fonseca
- Pathology , Centro Hospitalar Universitário de São João, Portugal
| | - Guilherme Macedo
- Gastroenterology , Centro Hospitalar Universitário de São João, Portugal
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15
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Dias E, Cardoso H, Marques M, Liberal R, Lopes S, Pereira P, Santos-Antunes J, Pinheiro J, Lopes J, Carneiro F, Macedo G. Hepatic amyloidosis: a prevalence study and clinical characterization of a rare and severe disease. Rev Esp Enferm Dig 2023; 115:16-21. [PMID: 35297258 DOI: 10.17235/reed.2022.8622/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND AIM Amyloidosis is a systemic disease characterized by extracellular deposition of amyloid protein, most commonly in the heart and kidney. Hepatic amyloidosis is a rare form of presentation that ranges from mild hepatomegaly and altered liver biochemical tests to acute liver failure. The aims of this study were to evaluate the prevalence of amyloidosis in patients undergoing liver biopsy and describe its main clinical characteristics and prognostic impact. METHODS A retrospective analysis of all patients with a histological diagnosis of hepatic amyloidosis between January 2010 and December 2019 was performed. MAJOR RESULTS A total of 7 patients were identified from a total of 1773 liver biopsy procedures (0.4%), with a female predominance (6/7) and median age of diagnosis of 62 years. The most common clinical manifestations included hepatomegaly (4/7), jaundice (2/7) and peripheral edema (2/7), whereas 3/7 patients were asymptomatic. Every patient presented abnormalities in liver biochemical tests, more commonly cholestasis (6/7), but also cytolysis (4/7) or hyperbilirubinemia (2/7). Abnormal imaging findings included hepatomegaly, steatosis or parenchymal heterogeneity. In most patients (5/7), other organs were involved, most commonly with nephrotic syndrome (3/7) and infiltrative cardiomyopathy (3/7). The most common type was AA amyloidosis (3/7) followed by AL amyloidosis (2/7). The 1-year mortality rate was 43% and the median survival was 24 months. CONCLUSIONS We report a low prevalence (0.4%) of amyloidosis among patients undergoing liver biopsy. Although rare, hepatic amyloidosis is associated with a dismal prognosis and a high index of suspicion is crucial to achieve an early diagnosis. .
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Affiliation(s)
- Emanuel Dias
- Gastrenterology , Centro Hospitalar Universitário de São João, Portugal
| | - Hélder Cardoso
- Gastroenterology, Centro Hospitalar Universitário de São João
| | - Margarida Marques
- Gastrenterology, Centro Hospitalar Universitário de São João, Portugal
| | - Rodrigo Liberal
- Gastroenterology, Centro Hospitalar Universitário de São João
| | - Susana Lopes
- Gastroenterology, Centro Hospitalar Universitário de São João, Portugal
| | - Pedro Pereira
- Gastroenterology, Centro Hospitalar Universitário de São João, Portugal
| | | | | | - Joanne Lopes
- Pathology, Centro Hospitalar Universitário de São João
| | | | - Guilherme Macedo
- Gastroenterology, Centro Hospitalar Universitário de São João, Portugal
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16
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Gomes C, Dias E, Pinho R. Nonwhite light endoscopy in capsule endoscopy: Fujinon Intelligent Chromo Endoscopy and blue mode. Artificial Intelligence in Capsule Endoscopy 2023:243-254. [DOI: 10.1016/b978-0-323-99647-1.00002-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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17
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Dias E, Marques M, Gonçalves R, Cardoso P, Macedo G. CLINICAL AND PATHOLOGICAL CHARACTERIZATION OF HEPATIC LYMPHOMAS: A RETROSPECTIVE SINGLE-CENTER STUDY. Arq Gastroenterol 2023; 60:65-73. [PMID: 37194782 DOI: 10.1590/s0004-2803.202301000-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/15/2022] [Indexed: 05/18/2023]
Abstract
BACKGROUND The incidence of hepatic lymphoma has been increasing recently and diagnosis can be challenging as clinical presentation and radiological findings are usually variable and non-specific. OBJECTIVE The aims of this study were to describe their main clinical, pathological and imaging characteristics and identify poor prognostic factors. METHODS A retrospective study that included all patients with histological diagnosis of liver lymphoma over a 10-year period at our center was performed. RESULTS A total of 36 patients were identified, with mean age of 56.6 years and male predominance (58%). There were three patients with primary liver lymphoma (8.3%) and 33 with secondary liver lymphoma (91.7%). The most common histological type was diffuse large B-cell lymphoma (33.3%). The most common clinical manifestations included fever, lymphadenopathy, weight loss, night sweats and abdominal discomfort; three patients (11.1%) were asymptomatic. Computed tomography scan revealed heterogenous radiological patterns including a single nodule (26.5%), multiple nodules (41.2%) or diffuse infiltration (32.4%). The mortality rate during follow-up was 55.6%. Higher levels of C-reactive protein (P=0.031) and absence of treatment response (P<0.001) were significantly associated with higher mortality. CONCLUSION Hepatic lymphoma is a rare disease that may involve liver as part of a systemic disease or, less commonly, be confined to this organ. Clinical presentation and radiological findings are often variable and non-specific. It is associated with high mortality and poor prognostic factors include higher levels of C-reactive protein and absence of response to treatment.
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Affiliation(s)
- Emanuel Dias
- Gastroenterology Department, University Hospital Center of São João, Porto, Portugal
| | - Margarida Marques
- Gastroenterology Department, University Hospital Center of São João, Porto, Portugal
| | - Raquel Gonçalves
- Gastroenterology Department, University Hospital Center of São João, Porto, Portugal
| | - Pedro Cardoso
- Gastroenterology Department, University Hospital Center of São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, University Hospital Center of São João, Porto, Portugal
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18
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Dias E, Andrade P, Lopes S, Gonçalves R, Cardoso P, Gaspar R, Cardoso H, Lopes J, Carneiro F, Macedo G. Liver biopsy in inflammatory bowel disease patients with sustained abnormal liver function tests: a retrospective single-center study. Ann Gastroenterol 2023; 36:54-60. [PMID: 36593810 PMCID: PMC9756023 DOI: 10.20524/aog.2023.0761] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/21/2022] [Indexed: 01/04/2023] Open
Abstract
Background Inflammatory bowel disease (IBD) may be associated with a wide range of hepatobiliary manifestations. This study aimed to characterize the spectrum of hepatobiliary disorders in patients with IBD who underwent liver biopsy for sustained abnormal liver function tests (LFT). Method A retrospective study was performed of all patients with IBD who underwent liver biopsy between January 2010 and December 2020 for sustained abnormal LFT (at least 6-month duration). Results A total of 101 patients were included, mostly male (62.4%), with a mean age of 44.4±13.3 years. The most common IBD type was Crohn's disease (61.4%). Median time interval between abnormal LFT and biopsy was 14 (7-36) months. Abnormal LFT was predominantly hepatocellular in 40 patients (39.6%), cholestatic in 26 (25.7%) and mixed in 35 (34.7%). The most frequent diseases were nonalcoholic fatty liver disease (NAFLD) in 33 patients (32.7%), drug-induced liver disease (DILI) in 30 (29.7%), autoimmune hepatitis (AIH) in 13 (12.9%) and primary sclerosing cholangitis (PSC) in 13 (12.9%). Three patients had primary biliary cholangitis. Remarkably, 70 patients (69.3%) already had fibrosis by the time of liver biopsy and in 6 (5.9%) liver disease was already detected in the stage of cirrhosis. Conclusions Abnormal LFT in IBD patients had a wide range of etiologies and histology was often essential for reaching a correct diagnosis. NAFLD, DILI, AIH and PSC were the most common diagnoses and patients often presented in cirrhotic stage. Therefore, liver biopsy must be considered early in IBD patients with unexplained sustained abnormal LFT.
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Affiliation(s)
- Emanuel Dias
- Gastroenterology Department (Emanuel Dias, Patrícia Andrade, Susana Lopes, Raquel Gonçalves, Pedro Cardoso, Rui Gaspar, Hélder Cardoso, Guilherme Macedo)
| | - Patrícia Andrade
- Gastroenterology Department (Emanuel Dias, Patrícia Andrade, Susana Lopes, Raquel Gonçalves, Pedro Cardoso, Rui Gaspar, Hélder Cardoso, Guilherme Macedo)
| | - Susana Lopes
- Gastroenterology Department (Emanuel Dias, Patrícia Andrade, Susana Lopes, Raquel Gonçalves, Pedro Cardoso, Rui Gaspar, Hélder Cardoso, Guilherme Macedo)
| | - Raquel Gonçalves
- Gastroenterology Department (Emanuel Dias, Patrícia Andrade, Susana Lopes, Raquel Gonçalves, Pedro Cardoso, Rui Gaspar, Hélder Cardoso, Guilherme Macedo)
| | - Pedro Cardoso
- Gastroenterology Department (Emanuel Dias, Patrícia Andrade, Susana Lopes, Raquel Gonçalves, Pedro Cardoso, Rui Gaspar, Hélder Cardoso, Guilherme Macedo)
| | - Rui Gaspar
- Gastroenterology Department (Emanuel Dias, Patrícia Andrade, Susana Lopes, Raquel Gonçalves, Pedro Cardoso, Rui Gaspar, Hélder Cardoso, Guilherme Macedo)
| | - Hélder Cardoso
- Gastroenterology Department (Emanuel Dias, Patrícia Andrade, Susana Lopes, Raquel Gonçalves, Pedro Cardoso, Rui Gaspar, Hélder Cardoso, Guilherme Macedo)
| | - Joanne Lopes
- Pathology Department (Joanne Lopes, Fátima Carneiro), Centro Hospitalar de São João, Porto, Portugal
| | - Fátima Carneiro
- Pathology Department (Joanne Lopes, Fátima Carneiro), Centro Hospitalar de São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department (Emanuel Dias, Patrícia Andrade, Susana Lopes, Raquel Gonçalves, Pedro Cardoso, Rui Gaspar, Hélder Cardoso, Guilherme Macedo)
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19
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Dias E, Santos-Antunes J, Peixoto A, Ramalho R, Macedo G. Buried bumper syndrome: incidence study and clinical characterization of a rare complication of percutaneous endoscopic gastrostomy. J Gastrointestin Liver Dis 2022; 31:476-477. [PMID: 36535046 DOI: 10.15403/jgld-4483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/25/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Emanuel Dias
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal.
| | - João Santos-Antunes
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal.
| | - Armando Peixoto
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal.
| | - Rosa Ramalho
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal.
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal.
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20
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Dias E, Marques M, Silva M, Macedo G. Prevalence and Clinical Impact of Abnormal Findings in Routine Upper Digestive Endoscopy Before Bariatric Surgery. Chirurgia (Bucur) 2022; 117:681-688. [PMID: 36584060 DOI: 10.21614/chirurgia.2797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 12/31/2022]
Abstract
Background: The role of preoperative upper digestive endoscopy has been discussed with controversy in bariatric surgery. This study aims to evaluate the prevalence of endoscopic findings in obese patients undergoing bariatric surgery and their clinical impact. Methods: A retrospective observational study of all patients who performed upper endoscopy before bariatric surgery between January 2019 and December 2021 was performed. A total of 612 patients were identified, mostly females (79.2%), with a mean age of 43.9 years. Abnormal endoscopic findings were identified in 474 (77.5%) patients, including erythematous gastropathy (59.2%), reflux esophagitis (13.6%), erosive gastritis (10.6%), and hiatal hernia (8.0%). Importantly, Barrettâ??s esophagus was also identified in four patients and gastric adenocarcinoma in one. All performed gastric biopsies that revealed H. pylori gastritis in 368 (60.1%). Taken together, abnormal endoscopic and histological findings influenced perioperative management of 403 (65.8%) patients, including preoperative medical therapy in 378 (61.8%), endoscopic treatment of mucosal lesions in 47 (7.7%), direct influence in surgical strategy in 27 (7.8%) and contraindication to bariatric surgery in 1 (0.2%). Conclusion: Preoperative upper endoscopy identifies a wide range of abnormal findings in obese patients, which often influence peri-operative management. Therefore, it must be considered in all patients prior to bariatric surgery.
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21
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Dias E, Cardoso H, Pereira P, Moutinho-Ribeiro P, Macedo G. Bronchial-biliary fistula secondary to cholangiocarcinoma: long-term efficacy of biliary self-expandable metal stent. Rev Esp Enferm Dig 2022; 114:758-760. [PMID: 35704365 DOI: 10.17235/reed.2022.8970/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A 77-year-old female with previous medical history of non-cirrhotic chronic hepatitis B and hepatocellular carcinoma treated with sequential partial hepatectomy followed by transarterial chemoembolization complained of pruritus and jaundice. Magnetic resonance cholangiopancreatography revealed a peri-hilar ill-defined stenosing lesion suggestive of malignancy. Endoscopic retrograde cholangiopancreatography with cholangioscopy confirmed a circumferential peri-hilar stenosis with fragile mucosa and tortuous dilated vessels and biopsies of this area were consistent cholangiocarcinoma. After 3 months, she presented with new-onset dyspnea and bilioptysis and abdominal computed tomography revealed a bronchial-biliary fistula. ERCP was performed to place a self-expandable metal stent in the biliary tract, which resulted in rapid clinical improvement. The patient has been followed for 2 years and remains globally stable with two episodes of worsening of bilioptysis secondary to stent obstruction by lithiasis that were easily resolved with Fogarty balloon-assisted extraction, with rapid improvement. This case demonstrates the long-term efficacy of endoscopic biliary drainage with self-expandable metallic stent for bronchial-biliary fistula in the setting of cholangiocarcinoma. .
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Affiliation(s)
- Emanuel Dias
- Gastrenterology , Centro Hospitalar Universitário de São João, Portugal
| | - Hélder Cardoso
- Gastroenterology, Centro Hospitalar Universitário de São João
| | - Pedro Pereira
- Gastroenterology, Centro Hospitalar Universitário de São João, Portugal
| | | | - Guilherme Macedo
- Gastroenterology , Centro Hospitalar Universitário de São João, Portugal
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22
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Dias E, Andrade P, Cardoso H, Fonseca E, Macedo G. Primary Localized Small Bowel Amyloidosis: A Rare Cause of Diarrhea Detected by Balloon-Assisted Enteroscopy. Case Rep Gastroenterol 2022; 16:577-582. [PMID: 36353370 PMCID: PMC9638858 DOI: 10.1159/000526913] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/19/2022] [Indexed: 12/31/2022] Open
Abstract
Gastrointestinal involvement occurs in approximately 4% of cases of systemic amyloidosis and may be associated with heterogeneous and nonspecific clinical manifestations and endoscopic findings, which poses important diagnostic challenges. A 76-year-old female with previous medical history of breast cancer, hypertension, dyslipidemia, asthma, and depression presented to emergency department with a 1-month history of diarrhea, abdominal pain, anorexia, asthenia, and weight loss. Physical examination revealed dehydration and abdominal tenderness. Stool microbiologic studies, Clostridium difficile toxin, fecal leukocyte count, stool fat, and celiac serology were all negative. Remarkably, an axillary lymphadenopathy was also noted and its investigation revealed multiple myeloma, which raised suspicion for gastrointestinal amyloidosis. However, upper digestive endoscopy and colonoscopy did not reveal abnormalities and both gastric and colon biopsies were negative for amyloid, as was abdominal fat biopsy. As the patient also presented hypoproteinemia and hypoalbuminemia suggestive of protein-losing enteropathy, videocapsule endoscopy was performed where petechiae, villous atrophy, and fissures were seen along jejunal mucosa. These findings were confirmed with double-balloon enteroscopy and jejunal biopsies revealed extensive deposition of an amorphous hyaline material in lamina propria and muscularis mucosae that exhibited apple-green birefringence under polarized light after Congo red staining, consistent with localized small bowel amyloidosis secondary to multiple myeloma. Chemotherapy was started, but she would die after 3 weeks. This case illustrates the role of balloon-assisted enteroscopy in diagnosis of localized small bowel amyloidosis with jejunal involvement.
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Affiliation(s)
- Emanuel Dias
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Patricia Andrade
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Helder Cardoso
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Elsa Fonseca
- Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
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23
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Dias E, Amaral P, Zucchini G, Pivetta L, Carvalho JP, Macret J, Malheiros C, Roll S. OC-072 SYSTEMATIC REVIEW AND META-ANALYSIS OF PREOPERATIVE ADMINISTRATION OF BOTULINUM TOXIN AS ADJUNCT TO VENTRAL HERNIA REPAIRS. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
Preoperative application of botulinum toxin (BTX), with or without preoperative progressive pneumoperitoneum (PPP), is an adjunct to complex ventral hernia repairs, causing flaccid paralysis. We aim to evaluate the benefit of BTX in the advancement of the lateral musculature and decrease hernia defect width.
Material & Methods
It was elaborated a systematic review and meta-analysis following PRISMA guidelines and registered at PROSPERO. “Ventral hernia”, “incisional hernia”, “abdominal wall” and “botulinum toxin” were searched. PubMed (Medline), EMBASE (OVID) and LILACS databases research.
Results
Five studies (235 patients) showed tha BTX significantly increases the lateral abdominal wall muscles length (4,07cm) (95%CI (3.65;4.49), p<0,1 I2=47%). Two studies (113 patients) showes that hernia defect width raised 1.24 cm (95%CI (-3.06;5.53), p<0,05, I2=76%) after BTX with or without PPP.
Conclusions
Increase in the volume of the abdominal cavity after BTX and PPP by enlargement of abdominal wall muscles may be related to improve outcomes such as decreasing abdominal compartiment syndrome and surgical site occurrences.
Despite the Increase in the lateral abdominal wall after BTX, the decrease in hernia defect width was not obseved. Insted, meta-analysis showed a tendency of width increasing, taking into account considerable heterogeneity, witch may be related to PPP association.
BTX in complex ventral hernias increases lateral abdominal muscles length and, thus, is suposed to decrease poor surgical outcomes, although the transverse diameter of the defect does not reduced as expected. Futher studies are necessary to evaluate benefits of BTX in complete fascial closure.
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Affiliation(s)
- E Dias
- Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo , São Paulo , Brazil
| | - P Amaral
- Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo , São Paulo , Brazil
| | - G Zucchini
- Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo , São Paulo , Brazil
| | - L Pivetta
- Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo , São Paulo , Brazil
| | - J P Carvalho
- Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo , São Paulo , Brazil
| | - J Macret
- Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo , São Paulo , Brazil
| | - C Malheiros
- Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo , São Paulo , Brazil
| | - S Roll
- Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo , São Paulo , Brazil
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24
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Amaral P, Dias E, Carvalho JP, Macret J, Pivetta L, Malheiros CA, Roll S. P-131 SHORT TERM RESULTS OF PREOPERATIVE TOXIN BOTULINUM A IN PREPARATION FOR ABDOMINAL WALL RECONSTRUCTION. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
to report short term outcomes of preoperative toxin botulinum A (TBA) in preparation for abdominal wall reconstruction (AWR).
Material and Methods
Patient with a hernia width>10cm and/or loss of domain who underwent elective AWR from April 2021 through March 2022 were included. All patients received ultrasound-guided administration of 300 units of TBA prior the surgery. Outcomes of interest included: changes in hernia dimensions and CT-Scan volumetric measurements after treatment, rates of complete fascial closure, postoperative intraabdominal hypertension, unplanned readmission and hernia recurrence.
Results
Fifteen patients were included (53% males; mean age 61years, mean body mass index 28.9kg/m2). Median hernia width decreased by 2cm (before 15cm [IQR 14–18.5], after 13cm [IQR 10.3–15]; p=0.002) and median abdominal cavity volume increased by 1.4L (before 4.8L [IQR 3.8–11.1], after 6.2L [4.2–9.2]; p=0.594). Thickness of lateral abdominal wall muscles decreased (before 2cm [IQR 1.6–3], after 1.1cm [IQR 1–1.3]; p=0.008 and the Tanaka Index decreased (12% [IQR 3.6–24.2] and 5% [IQR 1.4–16.8]; p=0.066)
Complete fascial closure was achieved in 13cases(87%). Three patients did not require component separation. Mean endotracheal pressure was 19mmHg. There were no intraabdominal hypertension. At a median 9months follow-up [range 6.2–11.5] wound morbidity rate was 20%(N=3), N=1 recurrence, N=1 unplanned readmission.
Conclusions
TBA promotes changes to the lateral abdominal wall with decrease on defect width and thickness of lateral muscles and increase in cavity volume and Tanaka index. Randomized clinical trials are needed to determine the clinical implication of preoperative TBA in preparation for AWR.
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Affiliation(s)
- P Amaral
- Surgery Department , Santa Casa, São Paulo , Brazil
| | - E Dias
- Surgery Department , Santa Casa, São Paulo , Brazil
| | - J P Carvalho
- Surgery Department , Santa Casa, São Paulo , Brazil
| | - J Macret
- Surgery Department , Santa Casa, São Paulo , Brazil
| | - L Pivetta
- Hernia Center, Hospital Alemão Oswaldo Cruz , São Paulo , Brazil
| | | | - S Roll
- Surgery Department , Santa Casa, São Paulo , Brazil
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25
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Dias E, Santos-Antunes J, Gonà Alves D, Macedo G. Predictive Factors and Surgical Impact of Colonoscopy Accuracy for Localization of Colorectal Malignancy. Chirurgia (Bucur) 2022; 117:535-543. [PMID: 36318683 DOI: 10.21614/chirurgia.2791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2022] [Indexed: 09/05/2023]
Abstract
Background: Colonoscopy is currently the gold-standard for the detection of colorectal lesions, but its accuracy in tumor localization is limited. This study aims to determine the accuracy of colonoscopy in localization of colorectal malignancy, identify possible influencing factors and evaluate the surgical consequences of an incorrect preoperative localization. Methods: A retrospective cross-sectional study of all patients with colorectal malignant lesions diagnosed by colonoscopy who underwent subsequent resection surgery between January 2019 and December 2020 was performed. Colonoscopy accuracy was evaluated in terms of correspondence between endoscopic and intra-operative tumor localization. Results: A total of 115 patients were included, mostly males (63.5%), with mean age of 68.7 years. There was concordance between endoscopic and intra-operative localization in 76 cases, which corresponds to an accuracy of 66.1%. Colonoscopy completeness (p=0.008) and adequate bowel preparation (p=0.023) were significantly associated with greater concordance between endoscopic and intra-operative tumor location. Of the 39 incorrectly localized lesions, 19 (48.7%) required changes in surgical management. Conclusion: Colonoscopy is often inaccurate for localizing malignant colorectal lesions, which may frequently result in intra-operative changes in surgical strategy. Colonoscopy completeness and adequate bowel preparation were significant predictors for a correct endoscopic localization, underscoring the importance of colonoscopy quality for this particular indication.
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Dias E, Marques M, Azevedo F, Macedo G. Spontaneous Resolution of Cholecystoduodenal Fistula Secondary to Duodenal Ulcer. J Gastrointestin Liver Dis 2022; 31:271. [PMID: 36112710 DOI: 10.15403/jgld-4250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/21/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Emanuel Dias
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
| | - Margarida Marques
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
| | - Fernando Azevedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
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Dias E, Cardoso H, Pacheco J, Lopes J, Macedo G. Ciliated hepatic foregut cyst: An uncommon cystic liver lesion. Clin Res Hepatol Gastroenterol 2022; 46:101949. [PMID: 35688377 DOI: 10.1016/j.clinre.2022.101949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Emanuel Dias
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
| | - Hélder Cardoso
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - João Pacheco
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Joanne Lopes
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
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Dias E, Marques M, Macedo G. Post-transplant primary liver lymphoma: always to remember. J Gastrointestin Liver Dis 2022; 31:254-255. [PMID: 35694984 DOI: 10.15403/jgld-4239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/14/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Emanuel Dias
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal.
| | - Margarida Marques
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal.
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal.
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Dias E, Mascarenhas Saraiva M, Moreira F, Cardoso H, Macedo G. Small Bowel Adenocarcinoma in a Patient with Crohn’s Disease: The Role of Balloon-Assisted Enteroscopy. GE Port J Gastroenterol 2022; 30:141-146. [PMID: 37008524 PMCID: PMC10050865 DOI: 10.1159/000520906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/13/2021] [Indexed: 11/19/2022]
Abstract
<b><i>Introduction:</i></b> Small bowel adenocarcinoma is a rare but well-known complication of Crohn’s disease. Diagnosis can be challenging, as clinical presentation may mimic an exacerbation of Crohn’s disease and imaging findings may be indistinguishable from benign strictures. The result is that the majority of cases are diagnosed at the time of operation or postoperatively at an advanced stage. <b><i>Case Presentation:</i></b> A 48-year-old male with a previous 20-year history of ileal stenosing Crohn’s disease presented with iron deficiency anemia. The patient reported melena approximately 1 month earlier but was currently asymptomatic. There were no other laboratory abnormalities. Anemia was refractory to intravenous iron replacement. The patient underwent computerized tomography enterography, which revealed multiple ileal strictures with features suggesting underlying inflammation and an area of sacculation with circumferential thickening of adjacent bowel loops. Therefore, the patient underwent retrograde balloon-assisted small bowel enteroscopy, where an area of irregular mucosa and ulceration was found at the region of ileo-ileal anastomosis. Biopsies were performed and histopathological examination revealed tubular adenocarcinoma infiltrating the muscularis mucosae. The patient underwent right hemicolectomy plus segmental enterectomy of the anastomotic region where the neoplasia was located. After 2 months, he is asymptomatic and there is no evidence of recurrence. <b><i>Discussion:</i></b> This case demonstrates that small bowel adenocarcinoma may have a subtle clinical presentation and that computed tomography enterography may not be accurate enough to distinguish benign from malignant strictures. Clinicians must, therefore, maintain a high index of suspicion for this complication in patients with long-standing small bowel Crohn’s disease. In this setting, balloon-assisted enteroscopy may be a useful tool when there is raised concern for malignancy, and it is expected that its more widespread use could contribute to an earlier diagnosis of this severe complication.
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Affiliation(s)
- Emanuel Dias
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
- *Emanuel Dias,
| | | | - Francisco Moreira
- Pathology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Hélder Cardoso
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
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Dias E, Liberal R, Costa-Moreira P, Príncipe F, Fonseca E, Macedo G. Primary Myelofibrosis in the Prefibrotic Stage Presenting as Portal, Splenic, and Superior Mesenteric Vein Thrombosis: A Case Report and Review of the Literature. GE Port J Gastroenterol 2022; 29:125-131. [PMID: 35497670 PMCID: PMC8995663 DOI: 10.1159/000514658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/29/2020] [Indexed: 08/30/2023]
Abstract
INTRODUCTION Myeloproliferative neoplasms are the most common cause of splanchnic vein thrombosis in the absence of cirrhosis or nearby malignancy. CASE PRESENTATION A 31-year-old male presented to the emergency department with epigastric pain associated with mild thrombocytosis and elevated levels of aminotransferases, lactate dehydrogenase, and C-reactive protein. Contrast-enhanced abdominal computed tomography revealed splanchnic venous thrombosis that involved the portal, splenic, and superior mesenteric veins, without signs of chronic liver disease. Anticoagulation with warfarin was immediately started. Diagnostic work-up was remarkable for the presence of the JAK2 V617T mutation and hypercellular bone marrow, with increased myeloid cells and atypical megakaryocytes, consistent with primary myelofibrosis in a prefibrotic stage. No other hypercoagulable conditions were identified. DISCUSSION We present a rare case of primary myelofibrosis in the prefibrotic stage presenting as portal-splenic-superior mesenteric vein thrombosis. This demonstrates that extensive splanchnic vein thrombosis may be the onset manifestation of myeloproliferative neoplasms, even in early stages and in the absence of concomitant hypercoagulable conditions. The presence of the JAK2 mutation is an important prothrombotic risk factor that can, per se, contribute to large venous thrombosis.
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Affiliation(s)
- Emanuel Dias
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Rodrigo Liberal
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
| | | | - Fernando Príncipe
- Hematology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Elsa Fonseca
- Pathology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
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Dias E, Santos-Antunes J, Marques M, Andrade P, Peixoto A, Santos AL, Carneiro F, Macedo G. Clinical and endoscopic findings in gastrointestinal amyloidosis: a single-center experience. Rev Esp Enferm Dig 2022; 114:425-427. [PMID: 35105152 DOI: 10.17235/reed.2022.8656/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Gastrointestinal involvement occurs in approximately 4% of cases of systemic amyloidosis. The most common site of amyloid deposition is small bowel, followed by stomach, colorectum and esophagus. Although rare, gastrointestinal amyloidosis may be associated with severe complications including gastrointestinal bleeding or perforation and may be mistaken for malignancy.
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Affiliation(s)
- Emanuel Dias
- Gastrenterology , Centro Hospitalar Universitário de São João, Portugal
| | | | - Margarida Marques
- Gastrenterology, Centro Hospitalar Universitário de São João, Portugal
| | | | - Armando Peixoto
- Gastrenterology, Centro Hospitalar Universitário de São João, Portugal
| | - Ana Luísa Santos
- Gastrenterology, Centro Hospitalar Universitário de São João, Portugal
| | | | - Guilherme Macedo
- Gastroenterology, Centro Hospitalar Universitário de São João, Portugal
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Dias E, Cardoso H, Costa C, Macedo G. Gastric ulcer with liver penetration. Rev Esp Enferm Dig 2022; 114:248-249. [PMID: 35000403 DOI: 10.17235/reed.2022.8528/2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 54-year-old male with previous history of chronic hepatitis C complained of postprandial epigastric discomfort and weight loss. Esophagogastroduodenoscopy revealed a large gastric ulcer on the lesser antral curvature, with biopsies showing granulation tissue and inflammatory activity without other significant changes. Despite therapy with double-dose proton pump inhibitor, the ulcer had not healed or diminished in size at reevaluation endoscopy eight weeks later. Biopsies were repeated and again only revealed granulation tissue and inflammation. The patient undergone partial gastrectomy where fibrotic adhesions to liver and peritoneum were noted. Remarkably, macroscopical analysis of the surgical specimen revealed an hepatic fragment adherent to the ulcer and histopathological examination was consistent with liver penetration. Liver penetration is a rare but important complication that must be considered in the differential diagnosis of medically refractory gastric ulcers, even in the absence of hepatic tissue in endoscopic biopsies.
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Affiliation(s)
- Emanuel Dias
- Gastrenterology, Centro Hospitalar de São João, Portugal
| | - Hélder Cardoso
- Gastroenterology, Centro Hospitalar Universitário de São João
| | | | - Guilherme Macedo
- Gastroenterology, Centro Hospitalar Universitário de São João, Portugal
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Dias E. Liver biopsy in inflammatory bowel disease patients with sustained abnormal liver function tests: a retrospective single-center study. Ann Gastroenterol 2022. [DOI: 10.20524/aog.2022.0761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Dias E, Marques M, Macedo G. Endoscopic management of esophageal and gastric lesions with underlying varices. Ann Gastroenterol 2022; 35:452-461. [PMID: 36061164 PMCID: PMC9399580 DOI: 10.20524/aog.2022.0739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/21/2022] [Indexed: 11/21/2022] Open
Abstract
Recent developments in endoscopic techniques have contributed to establishing endoscopy as an essential tool in the management of different types of esophageal and gastric lesions. However, management of these lesions with underlying varices is challenging, considering the technical difficulties and increased risk of bleeding it entails with current endoscopic techniques. Consequently, most endoscopists are hesitant to use this technically challenging procedure. Nevertheless, rare cases of successful endoscopic resection of superficial lesions on or adjacent to varices have been reported. Several endoscopic techniques, including endoscopic mucosal resection, endoscopic submucosal dissection or radiofrequency ablation, have demonstrated safety and feasibility in this setting, sometimes with technical modifications, or in combination with previous variceal eradication procedures that aim to decrease the risk of bleeding. In this review, we summarize the current evidence regarding endoscopic management of gastroesophageal lesions in patients with portal hypertension and underlying varices. It appears that liver cirrhosis, portal hypertension and gastroesophageal varices are not absolute contraindications in selected patients at specialized referral centers. Nevertheless, specific recommendations are lacking and further studies are needed to define the most appropriate endoscopic techniques and to determine which patients may be the best candidates.
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Affiliation(s)
- Emanuel Dias
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal (Emanuel Dias, Margarida Marques, Guilherme Macedo)
- Correspondence to: Emanuel Dias, Gastroenterology Department, Centro Hospitalar de São João, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal, e-mail:
| | - Margarida Marques
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal (Emanuel Dias, Margarida Marques, Guilherme Macedo)
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal (Emanuel Dias, Margarida Marques, Guilherme Macedo)
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Mascarenhas Saraiva M, Ribeiro T, Dias E, Lopes JL, Cardoso H, Macedo G. Vedolizumab-Induced Liver Injury. GE Port J Gastroenterol 2021; 28:410-415. [PMID: 34901448 DOI: 10.1159/000511644] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 09/13/2020] [Indexed: 11/19/2022]
Abstract
Drug-induced liver injury is an important cause of acute liver injury. Immunomodulatory therapies, such as vedolizumab (VDZ), are being increasingly used for the treatment of several diseases, most importantly inflammatory bowel disease. Several studies have demonstrated the safety of this substance. To date, only one post-marketing study has reported a case of hepatotoxicity attributable to VDZ. The authors present the case of a 41-year-old woman followed at the gastroenterology outpatient clinic for ulcerative colitis (UC) and autoimmune hepatitis (AIH). This patient was being treated with low-dose glucocorticoids for AIH (prednisolone 10 mg), with adequate disease control. Additionally, she was being treated with oral salicylates (mesalamine 3 g/day) and oral budesonide (9 mg/day) for her UC. For uncontrolled UC, she was started on VDZ. Two weeks after the first infusion of VDZ, the patient developed a clinical and analytical phenotype compatible with acute hepatitis. Diagnostic workup for causes of hepatocellular liver injury retrieved no results. A liver biopsy corroborated the diagnosis of toxic hepatitis overlapping chronic liver disease. VDZ was withdrawn and the patient experienced complete recovery of liver tests over the following weeks. In this case report, we present the first post-marketing case of hepatocellular liver injury in probable relation to VDZ.
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Affiliation(s)
| | - Tiago Ribeiro
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Emanuel Dias
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Joanne Lopes Lopes
- Pathology Department, Centro Hospitalar de São João, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Hélder Cardoso
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
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Dias E, Marques M, Santos-Antunes J, Baldaque-Silva F, Moutinho-Ribeiro P, Macedo G. The role of endoscopic submucosal dissection in the management of gastric inflammatory fibroid polyps: a single-center experience. Rev Esp Enferm Dig 2021; 114:592-598. [PMID: 34818895 DOI: 10.17235/reed.2021.8347/2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIM Gastric inflammatory fibroid polyps constitute only 0.1% of all gastric polyps. They are usually asymptomatic and are most often found in the antrum. These lesions are in the majority of cases amenable to resection by snare polypectomy. However, there are rare case reports of gastric IFP requiring resection by endoscopic submucosal dissection. This study aimed to evaluate the effectiveness and safety of endoscopic submucosal dissection in the management of gastric inflammatory fibroid polyps not amenable to resection with snare polypectomy because of large size and/or deep subepithelial engagement. METHODS A retrospective study of all consecutive patients who undergone endoscopic submucosal dissection for gastric inflammatory fibroid polyps between January 2011 and December 2020 was performed. MAJOR RESULTS There were 9 cases of gastric inflammatory fibroid polyps resected by endoscopic submucosal dissection. Most patients were female (7/9) with a mean age of 62.2 years. All gastric inflammatory polyps were described as solitary antral subepithelial lesions with mean diameter of 16.7 mm. Helicobacter pylori was detected in only one patient. At endoscopic ultrasound, these lesions were uniformly described as well-circumscribed, homogeneous lesions located at muscularis mucosa and submucosa without invasion of muscularis propria. All lesions were successfully resected en-bloc by endoscopic submucosal dissection and complete resection with free margins was obtained in 8/9 specimens. Adverse events were reported in 2/9 cases including one case of intra-procedural bleeding successfully controlled with hemostatic clips and one case of aspiration pneumonia that evolved favorably. Mean follow-up duration was 33.7 months (range 0-120) and no delayed complications or cases of recurrence were detected during follow-up. CONCLUSIONS Endoscopic submucosal dissection appears to be a safe and effective approach for resection of gastric inflammatory fibroid polyps that present as large subepithelial lesions if performed by experienced endoscopists after adequate characterization by endoscopic ultrasound with high rates of technical success and low recurrence rates. .
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Affiliation(s)
- Emanuel Dias
- Gastrenterology, Centro Hospitalar Universitário de São João, Portugal
| | - Margarida Marques
- Gastrenterology, Centro Hospitalar Universitário de São João, Portugal
| | | | - Francisco Baldaque-Silva
- Upper Gastrointestinal Diseases, Karolinska University Hospital and Karolinska institute, Sweden
| | | | - Guilherme Macedo
- Gastroenterology, Centro Hospitalar Universitário de São João, Portugal
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Cardoso A, Calaia R, Tinoco C, Rodrigues R, Anacleto S, Lima E, Dias E. Is prostate cancer diagnosis affected by biopsy needle length? A prospective study. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)03102-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Dias E, Azevedo F, Afonso A, Macedo G. Upper Gastrointestinal Bleeding in a Patient with Liver Cirrhosis: Gastroesophageal Varices Are not Always to Blame. J Gastrointestin Liver Dis 2021; 30:323. [PMID: 34551026 DOI: 10.15403/jgld-3472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/06/2021] [Indexed: 11/01/2022]
Abstract
A 45-year-old male with active alcoholism and liver cirrhosis was brought to emergency room with hypovolemic shock in context of diarrhea and melena. He presented with hemodynamic instability, hyperlactatemia and anemia. Aggressive supportive therapy with vasopressor support, packed red blood cell transfusion and intra-venous proton pump inhibitor was started. Upper digestive endoscopy revealed diffuse circumferential black discoloration of middle and distal esophagus with areas of linear ulceration and mucosal sloughing, consistent with acute esophageal necrosis. There was no evidence of esophageal varices. Abdominal computerized tomography scan revealed concomitant extensive bowel ischemia involving small and large bowel. Despite supportive measures, the disease had a fulminant evolution and the patient died after a few hours. Acute esophageal necrosis is defined endoscopically by diffuse and circumferential black mucosal discoloration of distal esophagus with abrupt transition at gastroesophageal junction and variable proximal extension. It is more common in older males with general debilitation and multiple comorbidities and typically presents with hematemesis or melena. An association with liver cirrhosis is well established, probably related to a state of malnutrition that decreases esophageal mucosal defenses and impairs regenerative ability. This case demonstrates that, although gastroesophageal varices and peptic ulcer bleeding are the most common sources of gastrointestinal bleeding in cirrhotic patients, acute esophageal necrosis must also be considered, particularly in the setting of hemodynamic instability.
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Affiliation(s)
- Emanuel Dias
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal.
| | - Fernando Azevedo
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal.
| | - Ana Afonso
- Intensive Care Department, Centro Hospitalar de São João, Porto, Portugal.
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal.
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Anacleto S, Mota P, Fernandes V, Carvalho N, Morais N, Passos P, Rodrigues R, Cardoso A, Tinoco C, Dias E, Lima E, Correia-Pinto J. Can narration and guidance in video-enhanced learning improve performance on E-BLUS exercises? Cent European J Urol 2021; 74:131-138. [PMID: 33976929 PMCID: PMC8097647 DOI: 10.5173/ceju.2021.0005] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/06/2021] [Accepted: 02/06/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction This study aimed to compare trainees’ laparoscopic performance concerning the peg-transfer (PT) and needle-guidance (NG) exercises after watching the original European Basic Laparoscopic Urologic Skills (E-BLUS) video or after watching a video-mentored tutorial (VMT) with ‘tips and tricks’, narration and didactic illustrations. Material and methods An experimental, unblinded, parallel, 2-intervention, 2-period randomized trial with an allocation ratio of 1:1 was conducted. Forty-two participants were randomized into 2 groups. Prior to task initiation, Group 1 watched the VMT in both trials and Group 2 watched, firstly, the original E-BLUS examination video and, in the second trial, the VMT. Each participant performed 2 trials for each exercise. Outcome measures were task time and total number of errors. Results In the first period, participants who visualized the PT and NG VMT had fewer errors than participants who visualized the E-BLUS video (p = 0.001 and p = 0.014, respectively). In the second period, after watching the VMT, a decrease in the total number of errors in PT and NG exercises was observed in the participants who previously watched the E-BLUS video (p = 0.001 and p = 0.002, respectively). In the second period, a decrease in median task time was observed for Group 1 and 2 after watching the PT VMT (p ≤0.001 and p = 0.003, respectively) and NG VMT (p = 0.005 and p = 0.01, respectively). Conclusions The use of VMT can lead to a smaller number of errors and, if coupled with deliberate practice, could lead to a shorter task time in exercise performance among participants with no previous laparoscopic experience.
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Affiliation(s)
- Sara Anacleto
- Hospital de Braga, Department of Urology, Braga, Portugal
| | - Paulo Mota
- Hospital de Braga, Department of Urology, Braga, Portugal.,University of Minho, School of Health Sciences, Braga, Portugal
| | - Vitor Fernandes
- University of Minho, School of Health Sciences, Braga, Portugal
| | - Nuno Carvalho
- University of Minho, School of Health Sciences, Braga, Portugal
| | - Nuno Morais
- Hospital de Braga, Department of Urology, Braga, Portugal
| | - Pedro Passos
- Hospital da Senhora da Oliveira, Department of Urology, Guimarães, Portugal
| | | | | | | | - Emanuel Dias
- Hospital de Braga, Department of Urology, Braga, Portugal.,University of Minho, School of Health Sciences, Braga, Portugal
| | - Estevão Lima
- Hospital de Braga, Department of Urology, Braga, Portugal.,University of Minho, School of Health Sciences, Braga, Portugal
| | - Jorge Correia-Pinto
- Hospital de Braga, Department of Urology, Braga, Portugal.,University of Minho, School of Health Sciences, Braga, Portugal
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Dias E, Santos-Antunes J, Santos AL, Coelho R, Melo D, Macedo G. Colonic granular cell tumor identified in an adenomatous polyp. Gastroenterol Hepatol 2021; 45 Suppl 1:41-42. [PMID: 33545239 DOI: 10.1016/j.gastrohep.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Emanuel Dias
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal.
| | | | - Ana Luísa Santos
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Rosa Coelho
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Daniel Melo
- Pathology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
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Rodrigues-Pinto E, Morais R, Sousa-Pinto B, Ferreira da Silva J, Costa-Moreira P, Santos AL, Silva M, Coelho R, Gaspar R, Peixoto A, Dias E, Baron TH, Vilas-Boas F, Moutinho-Ribeiro P, Pereira P, Macedo G. Development of an Online App to Predict Post-Endoscopic Retrograde Cholangiopancreatography Adverse Events Using a Single-Center Retrospective Cohort. Dig Dis 2021; 39:283-293. [PMID: 33429393 DOI: 10.1159/000514279] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/10/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Endoscopic retrograde cholangiopancreatography (ERCP) is a technically demanding procedure with a high risk for adverse events (AEs). AIM evaluate patient- and procedure-related risk factors for ERCP-related AEs and develop an online app to estimate risk of AEs. METHODS retrospective study of 1,491 consecutive patients who underwent 1,991 ERCPs between 2012 and 2017 was conducted. AEs definition and severity were classified according to most recent ESGE guidelines. Each variable was tested for association with occurrence of overall AEs, post-ERCP pancreatitis (PEP) and cholangitis. For each outcome, 2 regression models were built, from which an online Shiny-based app was created. RESULTS Overall AE rate was 15.3%; in 19 procedures, >1 AE occurred. Main post-ERCP AE was PEP (7.5%), followed by cholangitis (4.9%), bleeding (1.3%), perforation (1%), cardiopulmonary events (0.9%), and cholecystitis (0.3%). Seventy-eight percent of AEs were mild/moderate; of severe (n = 55) and fatal (n = 20) AEs, more than half were related to infection, cardiac/pulmonary AEs, and perforation. AE-related mortality rate was 1%. When testing precannulation, procedural covariates, and ERCP findings, AE occurrence was associated with age (odds ratio [OR] 0.991), previous PEP (OR 2.198), ERCP complexity grade III/IV (OR 1.924), standard bile duct cannulation (OR 0.501), sphincterotomy (OR 1.441), metal biliary stent placement (OR 2.014), periprocedural bleeding (OR 3.024), and biliary duct lithiasis (OR 0.673). CONCLUSION Our app may allow an optimization of the patients' care, by helping in the process of decision-making, not only regarding patient or endoscopist's selection but also definition of an adequate and tailored surveillance plan after the procedure.
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Affiliation(s)
| | - Rui Morais
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Bernardo Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | | | | | - Ana L Santos
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Marco Silva
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Rosa Coelho
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Rui Gaspar
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Armando Peixoto
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Emanuel Dias
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Filipe Vilas-Boas
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | | | - Pedro Pereira
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
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Dias E, Santos-Antunes J, Macedo G. A case of severe diverticulosis in a patient with ulcerative colitis. Rev Esp Enferm Dig 2020; 113:550-551. [PMID: 33267601 DOI: 10.17235/reed.2020.7529/2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 50-year-old female with ulcerative colitis (UC) (pancolitis) for 13 years was referred for a screening colonoscopy. At onset, she presented with severely active disease and required intravenous corticosteroids to induce remission. Since then, the disease has been in remission with oral mesalamine and azathioprine and she remains steroid-free, without new episodes of hospitalization. She was asymptomatic and had no other relevant medical history.
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Affiliation(s)
- Emanuel Dias
- Gastrenterology, Centro Hospitalar de São João, Portugal
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Küttner-Magalhães R, Rodrigues-Pinto E, Lemos-Rocha M, Dias E, Pinto C, Ferreira JM, Pedroto I. Dealing with a misdeployed esophageal stent placed for variceal bleeding. Endoscopy 2020; 52:E450-E451. [PMID: 32396957 DOI: 10.1055/a-1164-5942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Ricardo Küttner-Magalhães
- Department of Gastroenterology, Santo António Hospital, Porto University Hospital Center, Porto, Portugal
| | | | - Marta Lemos-Rocha
- Department of Gastroenterology, Santo António Hospital, Porto University Hospital Center, Porto, Portugal
| | - Emanuel Dias
- Department of Gastroenterology, São João University Hospital Center, Porto, Portugal
| | - Cláudia Pinto
- Department of Gastroenterology, Santo António Hospital, Porto University Hospital Center, Porto, Portugal.,Department of Gastroenterology, Oncology Portuguese Institute of Porto, Porto, Portugal
| | - José Manuel Ferreira
- Department of Gastroenterology, Santo António Hospital, Porto University Hospital Center, Porto, Portugal
| | - Isabel Pedroto
- Department of Gastroenterology, Santo António Hospital, Porto University Hospital Center, Porto, Portugal
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Dias E, Marques M, Melo D, Macedo G. Mantle cell lymphoma: A rare cause of colon polyposis. Gastroenterol Hepatol 2020; 44:377-379. [PMID: 33183891 DOI: 10.1016/j.gastrohep.2020.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Emanuel Dias
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal.
| | - Margarida Marques
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Daniel Melo
- Pathology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Guilherme Macedo
- Pathology Department, Centro Hospitalar de São João, Porto, Portugal
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Dias E, Santos-Antunes J, Peixoto A, Gaspar R, Macedo G. Co-existence of eosinophilic esophagitis and Barrett's esophagus: a possible association? Acta Gastroenterol Belg 2020; 83:669-670. [PMID: 33321029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- E Dias
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
| | - J Santos-Antunes
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
| | - A Peixoto
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
| | - R Gaspar
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
| | - G Macedo
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
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Silva M, Peixoto A, Santos AL, Costa-Moreira P, Ferreira da Silva J, Dias E, Macedo G. Predictive Factors and Clinical Impact of Deep Remission in Celiac Disease. GE Port J Gastroenterol 2020; 27:304-311. [PMID: 32999902 PMCID: PMC7506239 DOI: 10.1159/000505035] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/12/2019] [Indexed: 04/28/2023]
Abstract
INTRODUCTION The ultimate indicator of adherence to a gluten-free diet is the demonstration of mucosal healing. However, the need for histological reassessment is subject to controversy among "experts". The aim of this study was to evaluate celiac patients who underwent histological reevaluation after starting a gluten-free diet in order to identify those with histological remission and associated factors. METHODS This retrospective study included patients who agreed to a histological reassessment after apparent clinical and serological remission and reported at least 12 months of diet adherence. In all cases, informed consent was signed for upper endoscopy. RESULTS A total of 69 patients were included. In 67.9% of cases, the diagnosis was made in the context of "classic" symptomatology, 17% had "nonclassical" presentation, and 15.1% were in latent phase. 69.2% of the diagnoses were initially suspected by serology. Endoscopically, 11.8% of the patients did not present suggestive features macroscopically, and a histological grade of Marsh IIIa-c was observed in 75.5% of all cases. The histological findings were normalized in 37.7%, which was associated with the presence of lower Marsh score values at diagnosis (p = 0.014) and lower DEXA T-score values (p = 0.038). A histological improvement was observed in 55 patients (≥2 grades in 37 cases), which was related to the initial transferrin saturation (p = 0.027) and with higher Marsh scores at diagnosis (p = 0.007). CONCLUSION Even under a gluten-free diet, celiac histology normalization is difficult to obtain and appears to be independent of most clinical and serological findings at diagnosis. Patients with less severe histological levels at diagnosis reach remission more easily, but only represent the -minority of the population.
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Affiliation(s)
- Marta Silva
- Porto Medical School, University of Porto, Porto, Portugal
| | - Armando Peixoto
- Porto Medical School, University of Porto, Porto, Portugal
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
- Porto WGO Training Center, Porto, Portugal
- *Armando Peixoto, Hospitalar Center of São João, Alameda Prof. Hernâni Monteiro, PT–4200-319 Porto (Portugal),
| | - Ana Luísa Santos
- Porto Medical School, University of Porto, Porto, Portugal
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
- Porto WGO Training Center, Porto, Portugal
| | - Pedro Costa-Moreira
- Porto Medical School, University of Porto, Porto, Portugal
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
- Porto WGO Training Center, Porto, Portugal
| | - Joel Ferreira da Silva
- Porto Medical School, University of Porto, Porto, Portugal
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
- Porto WGO Training Center, Porto, Portugal
| | - Emanuel Dias
- Porto Medical School, University of Porto, Porto, Portugal
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
- Porto WGO Training Center, Porto, Portugal
| | - Guilherme Macedo
- Porto Medical School, University of Porto, Porto, Portugal
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
- Porto WGO Training Center, Porto, Portugal
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Matos Rodrigues R, Silva B, Morais N, Pereira J, Anacleto S, Passos P, Torres J, Dias E, Lima E, Mota P. Percutaneous nephrostomy, ureteral stent or primary ureteroscopy with stone removal for the treatment of hydronephrosis secondary to ureteric calculi: A prospective evaluation of the impact on complications, stone management and health-related QoL. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33280-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Dias E, Santos-Antunes J, Macedo G. Authors' reply. Ann Gastroenterol 2020; 33:441-442. [PMID: 32624672 PMCID: PMC7315713 DOI: 10.20524/aog.2020.0490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/09/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Emanuel Dias
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar de São João, Porto, Portugal
| | - João Santos-Antunes
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar de São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar de São João, Porto, Portugal
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Dias E, Farinha I, Costa F. Alpha-1-antitrypsin deficiency (AATD) and spontaneous pneumothorax: Guidelines do not recommend screening for AATD in patients with pneumothorax - What did we find in 10 years of clinical evidence? Pulmonology 2020; 27:80-81. [PMID: 32553825 DOI: 10.1016/j.pulmoe.2020.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- E Dias
- Serviço de Pneumologia do Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal.
| | - I Farinha
- Serviço de Pneumologia do Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - F Costa
- Serviço de Pneumologia do Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
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Rodrigues-Pinto E, Costa-Moreira P, Santos AL, Dias E, Macedo G. Endoscopic removal of migrated Nissen fundoplication mesh. VideoGIE 2020; 5:238-240. [PMID: 32529156 PMCID: PMC7277046 DOI: 10.1016/j.vgie.2020.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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