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Gornals JB, Velasquez-Rodriguez JG, Bas-Cutrina F, Garcia Garcia De Paredes A, Esteban JM, Teran A, Gonzalez-Huix F, Perez-Miranda M, Guarner-Argente C, Vila JJ, Garcia-Sumalla A, Foruny JR, Fisac-Vazquez J, Moris M, Miquel-Salas I, De-la-Serna Higuera C, Murzi-Pulgar M, Sanchez-Yague A, Salord S, Ruiz-Osuna S, Busquets J, Sanllorente-Melenchon M, Videla S, Moreno R, Tebe-Cordomi C, Hereu P, Vazquez-Sequeiros E. Plastic pigtail vs lumen-apposing metal stents for drainage of walled-off necrosis (PROMETHEUS study): an open-label, multicenter randomized trial. Surg Endosc 2024; 38:2148-2159. [PMID: 38448625 DOI: 10.1007/s00464-024-10699-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/14/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Lumen-apposing metal stents (LAMS) have displaced double-pigtail plastic stents (DPS) as the standard treatment for walled-off necrosis (WON),β but evidence for exclusively using LAMS is limited. We aimed to assess whether the theoretical benefit of LAMS was superior to DPS. METHODS This multicenter, open-label, randomized trial was carried out in 9 tertiary hospitals. Between June 2017, and Oct 2020, we screened 99 patients with symptomatic WON, of whom 64 were enrolled and randomly assigned to the DPS group (n = 31) or the LAMS group (n = 33). The primary outcome was short-term (4-weeks) clinical success determined by the reduction of collection. Secondary endpoints included long-term clinical success, hospitalization, procedure duration, recurrence, safety, and costs. Analyses were by intention-to-treat. CLINICALTRIALS gov, NCT03100578. RESULTS A similar clinical success rate in the short term (RR, 1.41; 95% CI 0.88-2.25; p = 0.218) and in the long term (RR, 1.2; 95% CI 0.92-1.58; p = 0.291) was observed between both groups. Procedure duration was significantly shorter in the LAMS group (35 vs. 45-min, p = 0.003). The hospital admission after the index procedure (median difference, - 10 [95% CI - 17.5, - 1]; p = 0.077) and global hospitalization (median difference - 4 [95% CI - 33, 25.51]; p = 0.82) were similar between both groups. Reported stent-related adverse events were similar for the two groups (36 vs.45% in LAMS vs. DPS), except for de novo fever, which was significantly 26% lower in LAMS (RR, 0.26 [0.08-0.83], p = 0.015). CONCLUSIONS The clinical superiority of LAMS over DPS for WON therapy was not proved, with similar clinical success, hospital stay and similar safety profile between both groups, yet a significant reduction in procedure time was observed. TRIAL REGISTRATION NUMBER ClinicalTrials.gov, NCT03100578.
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Affiliation(s)
- Joan B Gornals
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907, L'Hospitalet, Barcelona, Catalonia, Spain.
- Universitat de Barcelona (UB), Barcelona, Catalonia, Spain.
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain.
| | - Julio G Velasquez-Rodriguez
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907, L'Hospitalet, Barcelona, Catalonia, Spain
- Universitat de Barcelona (UB), Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
| | - Francesc Bas-Cutrina
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907, L'Hospitalet, Barcelona, Catalonia, Spain
- Universitat de Barcelona (UB), Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
| | - Ana Garcia Garcia De Paredes
- Endoscopy Unit, Gastroenterology and Hepatology Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
- Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Jose-Miguel Esteban
- Endoscopy Unit, Department of Digestive Diseases, Hospital Clínico San Carlos, Madrid, Spain
| | - Alvaro Teran
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Ferran Gonzalez-Huix
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari Arnau de Vilanova, Lleida, Catalonia, Spain
| | - Manuel Perez-Miranda
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Carlos Guarner-Argente
- Endoscopy Unit, Digestive Pathology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Juan J Vila
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitario de Navarra, Pamplona, Spain
| | - Albert Garcia-Sumalla
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907, L'Hospitalet, Barcelona, Catalonia, Spain
- Universitat de Barcelona (UB), Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
| | - Jose Ramon Foruny
- Endoscopy Unit, Gastroenterology and Hepatology Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
- Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Joaquin Fisac-Vazquez
- Endoscopy Unit, Department of Digestive Diseases, Hospital Clínico San Carlos, Madrid, Spain
| | - Maria Moris
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Isabel Miquel-Salas
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari Arnau de Vilanova, Lleida, Catalonia, Spain
| | | | - Marianette Murzi-Pulgar
- Endoscopy Unit, Digestive Pathology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Andres Sanchez-Yague
- Endoscopy Unit, Department of Digestive Diseases, Hospital Costa del Sol, Marbella, Spain
| | - Silvia Salord
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Hepato-Bilio-Pancreatic Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
| | - Sandra Ruiz-Osuna
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Radiology Department, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
| | - Juli Busquets
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Hepato-bilio-Pancreatic Unit, Department of General Surgery, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
| | - Mireia Sanllorente-Melenchon
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Clinical Research and Clinical Trial Unit (UICEC), Plataforma Spanish Clinical Research Network (SCRen), Clinical Pharmacology Department, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
| | - Sebas Videla
- Universitat de Barcelona (UB), Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Clinical Research and Clinical Trial Unit (UICEC), Plataforma Spanish Clinical Research Network (SCRen), Clinical Pharmacology Department, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
- Clinical Pharmacology Department, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
| | - Ramon Moreno
- Economics and Finance Department, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
| | - Cristian Tebe-Cordomi
- Universitat de Barcelona (UB), Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Biostatistics Department, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
| | - Pilar Hereu
- Universitat de Barcelona (UB), Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Clinical Research and Clinical Trial Unit (UICEC), Plataforma Spanish Clinical Research Network (SCRen), Clinical Pharmacology Department, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
- Clinical Pharmacology Department, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
| | - Enrique Vazquez-Sequeiros
- Endoscopy Unit, Gastroenterology and Hepatology Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
- Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
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2
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Bazaga S, García-Alonso FJ, Aparicio Tormo JR, Martinez Moreno B, Sanchiz V, Gornals JB, Loras C, Terán Á, Vazquez-Sequeiros E, Pedraza Sanz R, Súbtil JC, Pérez-Millan A, Uceda Porta F, Vila JJ, de la Serna-Higuera C, Couto-Worner I, Guarner-Argente C, Perez-Miranda M. Endoscopic ultrasound-guided gallbladder drainage with long-term lumen-apposing metal stent indwell: 1-year results from a prospective nationwide observational study. J Gastroenterol Hepatol 2024; 39:360-368. [PMID: 37920889 DOI: 10.1111/jgh.16392] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND AND AIM This study aimed to determine safety and risk factors for adverse events (AEs) of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with long-term indwell of lumen-apposing metal stents (LAMS). METHODS This study is a multicenter prospective observational study on consecutive high surgical-risk patients requiring gallbladder drainage who underwent EUS-GBD with LAMS over 12 months. Centralized telephone follow-up interviews were conducted every 3 months for 1 year. Patients were censored at LAMS removal, cholecystectomy, or death. AE-free survival was determined using log-rank tests. Cumulative risks were estimated using life-table analysis. RESULTS Eighty-two patients were included (53.7% male, median [interquartile range] age of 84.6 [76.5-89.8] years, and 85.4% with acute cholecystitis). Technical success was achieved in 79 (96.3%), and clinical success in 73 (89%). No patient was lost to follow-up; 45 patients (54.9%) completed 1-year follow-up with in situ LAMS. Median (interquartile range) LAMS indwell time was 364 (47-367) days. Overall, 12 (14.6%) patients presented 14 AEs, including 5 (6.1%) recurrent biliary events (3 acute cholangitis, 1 mild acute pancreatitis, and 1 acute cholecystitis). Patients with pancreatobiliary malignancy had an increased risk of recurrent biliary events (33% vs 1.5%, P = 0.001). The overall 1-year cumulative risk of recurrent biliary events was 9.7% (4.1-21.8%). The 1-year risk of AEs and of severe AEs was 18.8% (11-31.2%) and 7.9% (3.3-18.2%), respectively. Pancreatobiliary malignancy was the single risk factor for recurrent biliary events; LAMS misdeployment was the strongest risk factor for AEs. CONCLUSIONS Long-term LAMS indwell does not increase the risk of delayed AEs following EUS-GBD.
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Affiliation(s)
- Sergio Bazaga
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
- Department of Medicine, Universitat Autónoma de Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | | | | | - Joan B Gornals
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Carme Loras
- Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, Terrassa, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Álvaro Terán
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Enrique Vazquez-Sequeiros
- Endoscopy Unit, Department of Gastroenterology and Hepatology, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | | | - José Carlos Súbtil
- Department of Gastroenterology, Endoscopy Unit, University of Navarra Clinic, University of Navarra, Pamplona, Spain
| | | | | | - Juan J Vila
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | | | - Carlos Guarner-Argente
- Department of Medicine, Universitat Autónoma de Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Perez-Miranda
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
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3
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Shimamura Y, Inoue H, Tanabe M, Ushikubo K, Yamamoto K, Kimoto Y, Nishikawa Y, Ando R, Sumi K, Navarro MJ, Teruel Sanchez-Vegazo C, Peñas B, Parejo S, Martínez Sánchez A, Vazquez-Sequeiros E, Onimaru M, Albillos A, Rodriguez de Santiago E. Clinical outcomes of anti-reflux mucosal ablation for gastroesophageal reflux disease: An international bi-institutional study. J Gastroenterol Hepatol 2024; 39:149-156. [PMID: 37787176 DOI: 10.1111/jgh.16370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/08/2023] [Accepted: 09/17/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND AND AIM Anti-reflux mucosal ablation (ARMA) is an emerging endoscopic treatment aimed at enhancing the gastroesophageal junction flap valve. This study aimed to evaluate its feasibility, effectiveness, and safety. METHODS Between May 2018 and December 2022, patients with gastroesophageal reflux disease (GERD) symptoms refractory to acid suppression medications or those dependent on such medications were enrolled for ARMA. This retrospective analysis utilized prospectively collected data from an international bi-center study. GERD questionnaire, upper endoscopy, and 24-h pH monitoring were conducted at 2-6 months and 12 months post-ARMA. Clinical success was defined as a > 50% reduction in a validated GERD questionnaire. RESULTS A total of 68 patients underwent ARMA. Definitive GERD was diagnosed in 44 (64.7%) patients, while 24 (35.3%) exhibited reflux hypersensitivity. Clinical success rates at 2-6 months and 1 year post-ARMA were 60% (39/65) and 70% (21/30), respectively. The median GERD-health-related quality of life score significantly improved from 26 to 11 at 2-6 months (P < 0.001). Among the 51 patients (71.8%) who underwent 24-h pH monitoring, the median acid exposure time decreased from 5.3% to 0.7% (P = 0.003), accompanied by a significant reduction in esophagitis rates (P < 0.001). Multivariate analysis did not identify predictors of short-term success. Nine (13.2%) patients experienced transient stenosis requiring balloon dilation. CONCLUSIONS ARMA demonstrates both technical feasibility and reproducibility as a safe procedure that effectively ameliorates GERD symptoms in approximately two-thirds of patients during short-term follow up. Both reflux hypersensitivity and confirmed GERD patients, regardless of their response to acid suppression medication, may be suitable candidates.
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Affiliation(s)
- Yuto Shimamura
- Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Haruhiro Inoue
- Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Mayo Tanabe
- Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Kei Ushikubo
- Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Kazuki Yamamoto
- Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Yoshiaki Kimoto
- Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Yohei Nishikawa
- Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Ryohei Ando
- Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Kazuya Sumi
- Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Marc Julius Navarro
- Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Carlos Teruel Sanchez-Vegazo
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Beatriz Peñas
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Sofía Parejo
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Alba Martínez Sánchez
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Enrique Vazquez-Sequeiros
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Manabu Onimaru
- Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Agustín Albillos
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Enrique Rodriguez de Santiago
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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4
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Shahid HM, Bareket R, Tyberg A, Sarkar A, Simon A, Gurram K, Gress FG, Bhenswala P, Chalikonda D, Loren DE, Kowalski TE, Kumar A, Vareedayah AA, Abhyankar PR, Parker K, Gabr MM, Nieto J, De Latour R, Zolotarevsky M, Barber J, Zolotarevsky E, Vazquez-Sequeiros E, Gaidhane M, Andalib I, Kahaleh M. Comparing the Safety and Efficacy of Two Commercially Available Single-Use Duodenoscopes: A Multicenter Study. J Clin Gastroenterol 2023; 57:798-803. [PMID: 35997700 DOI: 10.1097/mcg.0000000000001752] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/07/2022] [Indexed: 12/10/2022]
Abstract
INTRODUCTION Single-use disposable duodenoscopes (SDD) have been developed to mitigate infectious risks related to reusable duodenoscopes. The aim of this study is to compare the safety and efficacy of the two available SDDs in the United States. METHODS We conducted a comparative study of 2 SDD in consecutive ERCP procedures performed by expert endoscopists from 9 academic centers. Performance ratings, procedure details, and adverse events were collected. RESULTS A total of 201 patients were included: 129 patients underwent ERCP with Exalt (mean age 63, Males- 66 (51%), 72 with aScope Duodeno (mean age 65, males=30 (42%). A majority of endoscopists had performed >2000 ERCPs in both groups (71% Exalt, 93% aScope Duodeno). Technical success was 92% in both groups (n=119 Exalt-group, n=66 aScope-Duodeno-group). The procedural complexity for the ERCP cases performed were: Grade 1: 35 cases (18%), Grade 2: 83 cases (41%), Grade 3: 65 cases (32%), and Grade 4: 18 cases (9%). Thirteen patients (10%) from the Exalt group and 16 patients (22%) from the aScope Duodeno group required conversion to a reusable duodenoscope. On a scale of 1 to 5, Exalt and aScope Duodeno, respectively, were rated: 2.31 versus 2.60 for location and visualization quality, 1.38 versus 1.57 for maneuverability based on papillary orientation, 1.48 versus 1.15 for suction/air control, and 2.31 versus 2.34 for elevator efficiency. None of the adverse events were related to the SDDs. CONCLUSIONS The 2 SDDs were comparable. Further ongoing enhancements to these devices will improve maneuverability and clinical effectiveness.
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Affiliation(s)
- Haroon M Shahid
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Romy Bareket
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Amy Tyberg
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Avik Sarkar
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Alexa Simon
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | | | | | | | | | | | - Anand Kumar
- Thomas Jefferson University, Philadelphia, PA
| | | | | | | | | | - Jose Nieto
- Borland Groover Clinic, Jacksonville, FL
| | | | | | | | | | | | - Monica Gaidhane
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Iman Andalib
- Elmhurst Mount Sinai, Icahn School of Medicine New York
| | - Michel Kahaleh
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
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5
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Bazaga S, García-Alonso FJ, Aparicio Tormo JR, Martinez Moreno B, Sanchiz V, Suria C, Garcia-Sumalla A, Gornals JB, Chavarría C, Loras C, García-Fernandez FJ, Terán Á, Vazquez-Sequeiros E, Pedraza Sanz R, Pérez-Carazo L, Súbtil JC, Pérez-Millan A, Uceda Porta F, Busto Bea V, de la Serna-Higuera C, Pinto Garcia I, Colán-Hernández J, Huertas C, Guarner-Argente C, Perez-Miranda M. Endoscopic removal of lumen-apposing metal stents - risk factors for stent embedment, complex removals, and adverse events: analysis from a multicenter prospective case series. Endoscopy 2023; 55:591-598. [PMID: 36882089 DOI: 10.1055/a-2030-4158] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Removing lumen-apposing metal stents (LAMSs) may be difficult and even harmful, but these features have seldom been analyzed. We aimed to generate a comprehensive assessment of the feasibility and safety of LAMS retrieval procedures. METHODS A prospective multicenter case series including all technically successfully deployed LAMSs between January 2019 and January 2020 that underwent endoscopic stent removal. All retrieval-related data were prospectively recorded using standardized telephone questionnaires as part of centralized follow-up that ended after stent removal had been performed. Multivariable logistic regression models assessed the potential risk factors for complex removal. RESULTS For the 407 LAMSs included, removal was attempted in 158 (38.8 %) after an indwell time of 46.5 days (interquartile range [IQR] 31-70). The median (IQR) removal time was 2 (1-4) minutes. Removal was labelled as complex in 13 procedures (8.2 %), although advanced endoscopic maneuvers were required in only two (1.3 %). Complex removal risk factors were stent embedment (relative risk [RR] 5.84, 95 %CI 2.14-15.89; P = 0.001), over-the-wire deployment (RR 4.66, 95 %CI 1.60-13.56; P = 0.01), and longer indwell times (RR 1.14, 95 %CI 1.03-1.27; P = 0.01). Partial and complete embedment were observed in 14 (8.9 %) and five cases (3.2 %), respectively. The embedment rate during the first 6 weeks was 3.1 % (2/65), reaching 15.9 % (10/63) during the following 6 weeks (P = 0.02). The adverse event rate was 5.1 %, including seven gastrointestinal bleeds (5 mild, 2 moderate). CONCLUSIONS LAMS removal is a safe procedure, mostly requiring basic endoscopic techniques attainable in conventional endoscopy rooms. Referral to advanced endoscopy units should be considered for stents with known embedment or long indwell times, which may require more technically demanding procedures.
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Affiliation(s)
- Sergio Bazaga
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | | | | | - Carles Suria
- Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Albert Garcia-Sumalla
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Joan B Gornals
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Carlos Chavarría
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Carme Loras
- Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | | | - Álvaro Terán
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Enrique Vazquez-Sequeiros
- Endoscopy Unit, Department of Gastroenterology and Hepatology, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | | | | | - José Carlos Súbtil
- Department of Gastroenterology, Endoscopy Unit, University of Navarra Clinic, University of Navarra, Pamplona, Spain
| | | | | | | | | | | | | | - Carlos Huertas
- Hospital Universitari de Girona Josep Trueta, Girona, Spain
| | - Carlos Guarner-Argente
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Perez-Miranda
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
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Bazaga S, García-Alonso FJ, Aparicio Tormo JR, Martinez Moreno B, Sanchiz V, Suria C, Garcia-Sumalla A, Gornals JB, Chavarría C, Loras C, García-Fernandez FJ, Terán Á, Vazquez-Sequeiros E, Pedraza Sanz R, Pérez-Carazo L, Súbtil JC, Pérez-Millan A, Uceda Porta F, Busto Bea V, de la Serna-Higuera C, Pinto Garcia I, Colán-Hernández J, Huertas C, Guarner-Argente C, Perez-Miranda M. Correction: Endoscopic removal of lumen-apposing metal stents - risk factors for stent embedment, complex removals, and adverse events: analysis from a multicenter prospective case series. Endoscopy 2023; 55:C8. [PMID: 38016667 DOI: 10.1055/a-2215-2453] [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: 11/30/2023]
Affiliation(s)
- Sergio Bazaga
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | | | | | - Carles Suria
- Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Albert Garcia-Sumalla
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Joan B Gornals
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Carlos Chavarría
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Carme Loras
- Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | | | - Álvaro Terán
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Enrique Vazquez-Sequeiros
- Endoscopy Unit, Department of Gastroenterology and Hepatology, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | | | | | - José Carlos Súbtil
- Department of Gastroenterology, Endoscopy Unit, University of Navarra Clinic, University of Navarra, Pamplona, Spain
| | | | | | | | | | | | | | - Carlos Huertas
- Hospital Universitari de Girona Josep Trueta, Girona, Spain
| | - Carlos Guarner-Argente
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Perez-Miranda
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
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7
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Kedia P, Shah-Khan S, Tyberg A, Gaidhane M, Sarkar A, Shahid H, Zhao E, Thakkar S, Winkie M, Krafft M, Singh S, Zolotarevsky E, Barber J, Zolotarevsky M, Greenberg I, Eke D, Lee D, Gress F, Andalib I, Bills G, Carey P, Gabr M, Lajin M, Vazquez-Sequeiros E, Pleskow D, Mehta N, Schulman A, Kwon R, Platt K, Nasr J, Kahaleh M. Endoscopic ultrasound-directed transgastric ERCP (EDGE): A multicenter US study on long-term follow-up and fistula closure. Endosc Int Open 2023; 11:E529-E537. [PMID: 37251793 PMCID: PMC10219784 DOI: 10.1055/a-2057-5984] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/09/2023] [Indexed: 05/31/2023] Open
Abstract
Background and study aims Endoscopic ultrasound-directed transgastric ERCP (EDGE) is a safe and efficacious procedure to treat pancreaticobiliary diseases in Roux-en-Y gastric bypass (RYGB). This multicenter study aimed to determine the long-term outcomes of EDGE focusing on fistula persistence rates and post-procedure weight change. Patients and methods Information about patients with Roux-en-Y gastric bypass anatomy who underwent EDGE between 2015 and 2021 from 10 institutions was captured in a registry. Patient demographics, procedural details, and clinical outcomes were analyzed. Results One hundred seventy-two patients were included in the study (mean age 60, 25 % male). Technical success of lumen-apposing metal stent (LAMS) placement was 171 of 172 (99.4 %) while clinical success of intervention was 95%. The mean procedure time was 65 minutes. The most commonly reported complication was stent dislodgement/migration (n = 29, 17). Mean length of time of LAMS duration was 69 days. Mean follow-up time was 6 months. Endoscopic fistula closure was performed in 40 % of patients (69/172) at the time of LAMS removal. Persistence of fistula was observed in 19 of 62 patients (31 %) assessed. Length of LAMS indwell time (days) was a predictor of persistent fistula. The average weight gain while the LAMS was in place was 12 lb in 63 patients (36.6 %); 59.4 % of patients gained < 5 lb. Conclusions EDGE is a safe and efficacious procedure for RYGB patients requiring ERCP. Post-procedure evaluation and management of the enteral fistula varies widely among centers currently and would benefit from further standardization. Fistula persistence appears to be uncommon and can be managed endoscopically but may be related to length of indwell times of the LAMS.
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Affiliation(s)
- Prashant Kedia
- Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
| | - Sardar Shah-Khan
- Rutgers Robert Wood Johnson Medical School – Gastroenterology, New Brunswick, New Jersey, United States
| | - Amy Tyberg
- Weill Cornell Medical College – Gastroenterology & Hepatology, New York, New York, United States
| | - Monica Gaidhane
- Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
| | - Avik Sarkar
- Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
| | - Haroon Shahid
- Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
| | - Eric Zhao
- Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
| | - Shyam Thakkar
- West Virginia University – Gastroenterology, New Brunswick, New Jersey, United States
| | - Mason Winkie
- West Virginia University – Gastroenterology, New Brunswick, New Jersey, United States
| | - Matthew Krafft
- Ruby Memorial Hospital – Digestive Diseases, Morgantown, West Virginia, United States
| | - Shailendra Singh
- Ruby Memorial Hospital – Digestive Diseases, Morgantown, West Virginia, United States
| | - Eugene Zolotarevsky
- Spectrum Health Butterworth Hospital – Advanced Endoscopy/Gastroenterology, Grand Rapids, Michigan, United States
| | - Jeremy Barber
- Spectrum Health Butterworth Hospital – Advanced Endoscopy/Gastroenterology, Grand Rapids, Michigan, United States
| | - Mitchelle Zolotarevsky
- Spectrum Health Butterworth Hospital – Advanced Endoscopy/Gastroenterology, Grand Rapids, Michigan, United States
| | - Ian Greenberg
- Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
| | - Dhiemeziem Eke
- Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
| | - David Lee
- Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
| | - Frank Gress
- Icahn School of Medicine at Mount Sinai – Gastroenterology, New York, New York, United States
| | - Iman Andalib
- Robert Wood Johnson Health System – Gastroenterology, New Brunswick, New Jersey, United States
| | - Gregory Bills
- University of Kentucky Medical Center – Gastroenterology, New Brunswick, Kentucky, United States
| | - Patrick Carey
- University of Kentucky Medical Center – Gastroenterology, New Brunswick, Kentucky, United States
| | - Moamen Gabr
- Tanta University Faculty of Medicine – Gastroenterology and Hepatology – Internal Medicine, Tanta, Egypt
| | - Michael Lajin
- Sharp Grassmont Hospital – Gastroenterology/Internal Medicine, Mesa, California, United States
| | | | - Douglas Pleskow
- Beth Israel Deaconess Medical Center – Gastroenterology, Boston, Massachusetts, United States
| | - Neal Mehta
- Beth Israel Deaconess Medical Center – Gastroenterology, Boston, Massachusetts, United States
| | - Allison Schulman
- University of Michigan Medicine – Gastroenterology, New Brunswick, Michigan, United States
| | - Richard Kwon
- University of Michigan Health System – Gastroenterology, Ann Arbor, Michigan, United States
| | - Kevin Platt
- University of Michigan Michigan Medicine – Internal Medicine, Ann Arbor, Michigan, United States
| | - John Nasr
- West Virginia University – Gastroenterology, New Brunswick, New Jersey, United States
| | - Michel Kahaleh
- Rutgers Robert Wood Johnson Medical School – Gastroenterology, New Brunswick, New Jersey, United States
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8
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Pérez-Cuadrado-Robles E, Bronswijk M, Prat F, Barthet M, Palazzo M, Arcidiacono P, Schaefer M, Devière J, van Wanrooij RLJ, Tarantino I, Donatelli G, Camus M, Sanchez-Yague A, Pham KDC, Gonzalez JM, Anderloni A, Vila JJ, Jezequel J, Larghi A, Jaïs B, Vazquez-Sequeiros E, Deprez PH, Van der Merwe S, Cellier C, Rahmi G. Endoscopic ultrasound-guided drainage using lumen-apposing metal stent of malignant afferent limb syndrome in patients with previous Whipple surgery: Multicenter study (with video). Dig Endosc 2022; 34:1433-1439. [PMID: 35429360 DOI: 10.1111/den.14330] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 01/30/2022] [Accepted: 04/14/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Endoscopic ultrasound-guided digestive anastomosis (EUS-A) is a new alternative under evaluation in patients presenting with afferent limb syndrome (ALS) after Whipple surgery. The aim of the present study is to analyze the safety and effectiveness of EUS-A in ALS. METHODS This is an observational multicenter study. All patients ≥18 years old with previous Whipple surgery presenting with ALS who underwent an EUS-A using a lumen-apposing metal stent (LAMS) between 2015 and 2021 were included. The primary outcome was clinical success, defined as resolution of the ALS or ALS-related cholangitis. Furthermore, technical success, adverse event rate, and mortality were evaluated. RESULTS Forty-five patients (mean age: 65.5 ± 10.2 years; 44.4% male) were included. The most common underlying disease was pancreatic cancer (68.9%). EUS-A was performed at a median of 6 weeks after local tumor recurrence. The most common approach used was the direct/freehand technique (66.7%). Technical success was achieved in 95.6%, with no differences between large (≥15 mm) and small LAMS (97.4% vs. 100%, P = 0.664). Clinical success was retained in 91.1% of patients. A complementary treatment by dilation of the stent followed by endoscopic retrograde cholangiopancreatography through the LAMS was performed in three cases (6.7%). There were six recurrent episodes of cholangitis (14.6%) and two procedure-related adverse events (4.4%) after a median follow-up of 4 months. Twenty-six patients (57.8%) died during the follow-up due to disease progression. CONCLUSION EUS-A is a safe and effective technique in the treatment of malignant ALS, achieving high clinical success with an acceptable recurrence rate.
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Affiliation(s)
- Enrique Pérez-Cuadrado-Robles
- Department of Gastroenterology, University of Paris, Georges-Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium
| | - Fréderic Prat
- Department of Endoscopy, Hopital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France
| | - Marc Barthet
- Department of Gastroenterology and Endoscopy, Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - Maxime Palazzo
- Department of Endoscopy, Hopital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France
| | - Paolo Arcidiacono
- Division of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Marion Schaefer
- Department of Endoscopy and Hepatogastroenterology, Regional University Hospital of Nancy, Nancy, France
| | - Jacques Devière
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme University Hospital - Université Libre de Bruxelles, Brussels, Belgium
| | - Roy L J van Wanrooij
- Department of Gastroenterology and Hepatology, AG&M Research Institute, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ilaria Tarantino
- Endoscopy Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS - ISMETT), Palermo, Italy
| | - Gianfranco Donatelli
- Department of Surgical, Interventional Endoscopy Unit, Private Hospital Peupliers-Ramsay Santé, Paris, France
| | - Marine Camus
- Sorbonne University, Endoscopic Unit, Saint Antoine Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Khanh Do-Cong Pham
- Section of Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Jean-Michel Gonzalez
- Department of Gastroenterology and Endoscopy, Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Juan J Vila
- Endoscopy Unit, Gastroenterology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Julien Jezequel
- Department of Gastroenterology, University Hospital of Brest, Brest, France
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Bénédicte Jaïs
- Department of Endoscopy, Hopital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France
| | - Enrique Vazquez-Sequeiros
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Pierre H Deprez
- Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Schalk Van der Merwe
- Department of Surgical, Interventional Endoscopy Unit, Private Hospital Peupliers-Ramsay Santé, Paris, France
| | - Christophe Cellier
- Department of Gastroenterology, University of Paris, Georges-Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Gabriel Rahmi
- Department of Gastroenterology, University of Paris, Georges-Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
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9
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Garcia-Sumalla A, Loras C, Sanchiz V, Sanz RP, Vazquez-Sequeiros E, Aparicio JR, de la Serna-Higuera C, Luna-Rodriguez D, Andujar X, Capilla M, Barberá T, Foruny-Olcina JR, Martínez B, Dura M, Salord S, Laquente B, Tebe C, Videla S, Perez-Miranda M, Gornals JB. Correction to: Multicenter study of lumen-apposing metal stents with or without pigtail in endoscopic ultrasound-guided biliary drainage for malignant obstruction—BAMPI TRIAL: an open-label, randomized controlled trial protocol. Trials 2022; 23:214. [PMID: 35287708 PMCID: PMC8922869 DOI: 10.1186/s13063-022-06138-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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10
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Garcia-Sumalla A, Loras C, Sanchiz V, Sanz RP, Vazquez-Sequeiros E, Aparicio JR, de la Serna-Higuera C, Luna-Rodriguez D, Andujar X, Capilla M, Barberá T, Foruny-Olcina JR, Martínez B, Dura M, Salord S, Laquente B, Tebe C, Videla S, Perez-Miranda M, Gornals JB. Multicenter study of lumen-apposing metal stents with or without pigtail in endoscopic ultrasound-guided biliary drainage for malignant obstruction-BAMPI TRIAL: an open-label, randomized controlled trial protocol. Trials 2022; 23:181. [PMID: 35216619 PMCID: PMC8874735 DOI: 10.1186/s13063-022-06106-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 01/22/2022] [Accepted: 02/12/2022] [Indexed: 11/18/2022] Open
Abstract
Background It is unclear whether the insertion of an axis-orienting double-pigtail plastic stent (DPS) through biliary lumen-apposing meal stent (LAMS) in EUS-guided choledochoduodenostomy (CDS) improves the stent patency. The aim of this study is to determine whether this technical variant offers a clinical benefit in EUS-guided biliary drainage (BD) for the management of distal malignant biliary obstruction. Methods/design This is a multicenter open-label, randomized controlled trial with two parallel groups. Eighty-four patients with malignant biliary obstruction will undergo EUS-BD (CDS type) using LAMS in 7 tertiary hospitals in Spain and will be randomized to the LAMS and LAMS plus DPS groups. The primary endpoint is the rate of recurrent biliary obstruction, as a stent dysfunction parameter, detected during follow-up. Secondary endpoints: technical and clinical success (reduction in bilirubin > 50% within 14 days of stent placement), safety, and others (number of reinterventions, time to biliary obstruction, prognostic factors, survival rate). Discussion The BAMPI trial has been designed to determine whether the addition of a coaxial axis-orienting DPS through LAMS is superior to LAMS alone to prevent stent dysfunction. Trial registration ClinicalTrials.govNCT04595058. Registered on October 14, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06106-1.
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Affiliation(s)
- Albert Garcia-Sumalla
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Carme Loras
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, CIBERehd, Terrassa, Spain.,Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Vicente Sanchiz
- Endoscopy Unit, Department of Digestive Diseases, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Rafael Pedraza Sanz
- Endoscopy Unit, Department of Digestive Diseases Endoscopy Unit, Hospital General Universitario de Castellón, Castelló de la Plana, Spain
| | - Enrique Vazquez-Sequeiros
- Endoscopy Unit, Gastroenterology and Hepatology Service, Hospital Ramon y Cajal, IRYCIS, Madrid, Spain
| | - Jose Ramon Aparicio
- Endoscopy Unit, Department of Digestive Diseases, Hospital General Universitario de Alicante; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | | | - Daniel Luna-Rodriguez
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Xavier Andujar
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, CIBERehd, Terrassa, Spain
| | - María Capilla
- Endoscopy Unit, Department of Digestive Diseases, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Tatiana Barberá
- Endoscopy Unit, Department of Digestive Diseases Endoscopy Unit, Hospital General Universitario de Castellón, Castelló de la Plana, Spain
| | - Jose Ramon Foruny-Olcina
- Endoscopy Unit, Gastroenterology and Hepatology Service, Hospital Ramon y Cajal, IRYCIS, Madrid, Spain
| | - Belen Martínez
- Endoscopy Unit, Department of Digestive Diseases, Hospital General Universitario de Alicante; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Miguel Dura
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Silvia Salord
- Hepato-Bilio-Pancreatic Unit, Digestive Diseases Department, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
| | - Berta Laquente
- Clinical Oncology Department, Hospital Duran y Reynalds, Institu Oncologic de Catalunya, Barcelona, Catalonia, Spain
| | - Cristian Tebe
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Biostatistics Unit, Institute of Biomedical Research of Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sebastia Videla
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Clinical Research and Clinical Trial Unit (UICEC), Clinical Pharmacology Department, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
| | - Manuel Perez-Miranda
- Endoscopy Unit, Department of Digestive Diseases, Hospital General Universitario de Alicante; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Joan B Gornals
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain. .,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain. .,University of Barcelona, Barcelona, Spain. .,Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.
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11
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Rodríguez de Santiago E, Sanchez-Vegazo CT, Peñas B, Shimamura Y, Tanabe M, Álvarez-Díaz N, Parejo S, Kazuya S, Marcos-Carrasco N, Vazquez-Sequeiros E, Inoue H, Albillos A. Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) for gastroesophageal reflux disease: a systematic review and meta-analysis. Endosc Int Open 2021; 9:E1740-E1751. [PMID: 34790538 PMCID: PMC8589565 DOI: 10.1055/a-1552-3239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 04/17/2021] [Accepted: 07/09/2021] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) are new endoscopic procedures for patients with gastroesophageal reflux disease (GERD). We conducted a meta-analysis to systematically assess the feasibility, clinical success, and safety of these procedures. Patients and methods We searched Embase, PubMed, and Cochrane Central from inception to October 2020. Overlapping reports, animal studies, and case reports were excluded. Our primary outcomes were clinical success and adverse events (AEs). Secondary outcomes included technical success, endoscopic esophagitis, 24-hour pH monitoring, and proton pump inhibitor (PPI) use. A random effects model was used to pool data. Results In total, 15 nonrandomized studies (12 ARMS, n = 331; 3 ARMA, n = 130) were included; 10 were conducted in patients with refractory GERD. The technical success rate was 100 %. The pooled short-term (first assessment within the first 6 months), 1-year, and 3-year clinical success rates were 78 % (95 % confidence interval [95 %CI] 70 %-85 %), 72% (95 %CI 47 %-92 %), and 73 % (95 %CI 65 %-81 %), respectively. ARMS and ARMA yielded similar clinical success. The proportion of patients off PPIs at 1 year was 64 % (95 %CI 52 %-75 %). There were significant drops ( P < 0.01) in validated clinical questionnaires scores, presence of esophagitis, and acid exposure time. The most common AE (11 %, 95 %CI 8 %-15 %) was dysphagia requiring dilation (7%, 95 %CI 5 %-11 %). Four cases of perforation were recorded, all in patients undergoing ARMS. Conclusions Our meta-analysis of nonrandomized studies suggests that ARMS and ARMA are safe and effective for patients with GERD.
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Affiliation(s)
- Enrique Rodríguez de Santiago
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBEREHD, Universidad de Alcalá, Madrid, Spain
| | - Carlos Teruel Sanchez-Vegazo
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBEREHD, Universidad de Alcalá, Madrid, Spain
| | - Beatriz Peñas
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBEREHD, Universidad de Alcalá, Madrid, Spain
| | - Yuto Shimamura
- Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Mayo Tanabe
- Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | | | - Sofía Parejo
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBEREHD, Universidad de Alcalá, Madrid, Spain
| | - Sumi Kazuya
- Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Natalia Marcos-Carrasco
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBEREHD, Universidad de Alcalá, Madrid, Spain
| | - Enrique Vazquez-Sequeiros
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBEREHD, Universidad de Alcalá, Madrid, Spain
| | - Haruhiro Inoue
- Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Agustín Albillos
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBEREHD, Universidad de Alcalá, Madrid, Spain
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12
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Tyberg A, Napoleon B, Robles-Medranda C, Shah JN, Bories E, Kumta NA, Yague AS, Vazquez-Sequeiros E, Lakhtakia S, El Chafic AH, Shah SL, Sameera S, Tawadros A, Ardengh JC, Kedia P, Gaidhane M, Giovannini M, Kahaleh M. Hepaticogastrostomy versus choledochoduodenostomy: An international multicenter study on their long-term patency. Endosc Ultrasound 2021; 11:38-43. [PMID: 34494590 PMCID: PMC8887039 DOI: 10.4103/eus-d-21-00006] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background and Objectives: EUS-guided biliary drainage (EUS-BD) offers minimally invasive decompression when conventional endoscopic retrograde cholangiopancreatography fails. Stents can be placed from the intrahepatic ducts into the stomach (hepaticogastrostomy [HG]) or from the extrahepatic bile duct into the small intestine (choledochoduodenostomy [CCD]). Long-term patency of these stents is unknown. In this study, we aim to compare long-term patency of CCD versus HG. Methods: Consecutive patients from 12 centers were included in a registry over 14 years. Demographics, procedure info, adverse events, and follow-up data were collected. Student's t-test, Chi–square, and logistic regression analyses were conducted. Only patients with at least 6-month follow-up or who died within 6-month postprocedure were included. Results: One-hundred and eighty-two patients were included (93% male; mean age: 70; HG n = 95, CCD n = 87). No significant difference in indication, diagnosis, dissection instrument, or stent type was seen between the two groups. Technical success was 92% in both groups. Clinical success was achieved in 75/87 (86%) in the HG group and 80/80 (100%) in the CCD group. A trend toward higher adverse events was seen in the CCD group. A total of 25 patients out of 87 needed stent revision in the HG group (success rate 71%), while eight out of 80 were revised in the CCD group (success rate 90%). Chi square shows CCD success higher than HG (90% vs. 71%, P = 0.010). After adjusting for diagnosis, jaundice or cholangitis presentation, instrument used for dissection, and gender, CCD was 4.5 times more likely than HG to achieve longer stent patency or manage obstruction (odds ratio 4.5; 95% 1.1548–17.6500, P = 0.0302). Conclusion: CCD is associated with superior long-term patency than HG but with a trend toward higher adverse events. This is particularly important in patients with increased survival. Additional studies are required before recommending a change in practice.
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Affiliation(s)
- Amy Tyberg
- Rutgers Robert Wood Johnson Medical Hospital, New Brunswick, New Jersey, USA
| | | | | | - Janak N Shah
- Ochsner Medical Center, New Orleans, Lousiana, USA
| | - Erwan Bories
- Ochsner Medical Center, New Orleans, Lousiana, USA
| | | | | | | | | | | | | | - Sohini Sameera
- Rutgers Robert Wood Johnson Medical Hospital, New Brunswick, New Jersey, USA
| | - Augustine Tawadros
- Rutgers Robert Wood Johnson Medical Hospital, New Brunswick, New Jersey, USA
| | | | | | - Monica Gaidhane
- Rutgers Robert Wood Johnson Medical Hospital, New Brunswick, New Jersey, USA
| | - Marc Giovannini
- Department of Endoscopy, Institut Paoli-Calmettes, Marseille, France
| | - Michel Kahaleh
- Rutgers Robert Wood Johnson Medical Hospital, New Brunswick, New Jersey, USA
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Garcia Garcia de Paredes A, Gleeson FC, Rajan E, Vazquez-Sequeiros E. Current clinical and research fluid biomarkers to aid risk stratification of pancreatic cystic lesions. Rev Esp Enferm Dig 2021; 113:714-720. [PMID: 33947199 DOI: 10.17235/reed.2021.7948/2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pancreatic cystic lesions (PCL) are composed of a heterogeneous group of entities that are increasingly diagnosed, generally as incidental findings in asymptomatic patients. In conjunction with this growing incidence, the potential for malignant transformation of mucin-producing cysts makes PCL a challenging clinical conundrum for the clinician, patient, and healthcare system. Cyst characterization based on morphology is often difficult and inaccurate, therefore several intracystic fluid biomarkers have been evaluated as ancillary testing to enhance the difficult balance between sparing a patient from an unnecessary high-risk pancreatic surgery and missing the opportunity to prevent or diagnose pancreatic adenocarcinoma at an early disease stage. There are two questions that are key to guide the care of patients with PCL: 1) is it a non-mucinous cyst that does not require any follow-up? and 2) if mucinous, does the cyst harbor advanced neoplasia (high-grade dysplasia or invasive carcinoma) that requires surgical resection, or is it a low-risk lesion that will benefit from a surveillance program? The purpose of this review is to give a general and practical overview of the different cyst fluid biomarkers that have been studied to address these specific questions, from classic biochemical markers to include carcinoembryonic antigen to novel genetic and epigenetic markers, such as microRNA or intracystic bacterial DNA.
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Sánchez Aldehuelo R, Albillos A, Vazquez-Sequeiros E. A novel EUS-guided rescue therapy for non-drainable walled-off pancreatic necrosis. Gastroenterol Hepatol 2021; 45 Suppl 1:83-84. [PMID: 33746029 DOI: 10.1016/j.gastrohep.2021.01.015] [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: 10/26/2020] [Revised: 12/13/2020] [Accepted: 01/24/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Rubén Sánchez Aldehuelo
- Endoscopy Unit. Gastroenterology and Hepatology Service. IRYCIS. University Hospital Ramón y Cajal, Madrid, Spain
| | - Agustin Albillos
- Endoscopy Unit. Gastroenterology and Hepatology Service. IRYCIS. University Hospital Ramón y Cajal, Madrid, Spain
| | - Enrique Vazquez-Sequeiros
- Endoscopy Unit. Gastroenterology and Hepatology Service. IRYCIS. University Hospital Ramón y Cajal, Madrid, Spain.
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Garcia-Sumalla A, Subtil JC, de la Serna C, Maisterra S, Aparicio JR, Bojorquez AE, Montañes RL, Vazquez-Sequeiros E, Gornals JB. Endoscopic ultrasound-guided transvascular needle biopsy of thoracic and abdominal lesions: a multicenter experience. Endosc Int Open 2020; 8:E1900-E1908. [PMID: 33269327 PMCID: PMC7695512 DOI: 10.1055/a-1288-0030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 07/08/2020] [Accepted: 09/21/2020] [Indexed: 12/27/2022] Open
Abstract
Background and study aims Traditionally in the case of a vascular interposition, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has been contraindicated. A transvascular route (TV) is feasible and probably a safe alternative approach in selected patients, but data are scarce. The primary aim of this study was to analyze the diagnostic yield and safety of EUS-TV-FNA in thoracic and abdominal lesions. Secondary aims included evaluation of the clinical impact and technical aspects. Patients and methods A retrospective multicenter study was conducted with inclusion of all consecutive patients that underwent EUS-TV-FNA from July 2007 to January 2020. Feasibility, cytopathology, procedure details, and safety were evaluated. Univariate analysis was performed to identify variables associated with incidents, cytopathological diagnosis, and clinical impact. Results Data were collected from a total of 49 cases and 50 EUS-TV-FNAs. The aorta (n = 19) and portal system (n = 17) were the most frequently punctured. The most frequent lesions were mediastinal lymph nodes (n = 13) and pancreatic tumors (n = 11). The diagnostic yield was 86 %, and there were nondiagnostic samples in seven cases. Overall sensitivity, specificity, and accuracy were 88 % (95 %CI,0.74-0.96), 100 % (95 %CI,0.59-1), and 90 % (95 %CI,0.78-0.96), respectively. Only three incidents were detected: two mural hematomas and a self-limited bleeding of gastroduodenal artery. In most patients, there was a significant impact on clinical management (88 %). Arterial vessel and ASA-III had a trend with incidents (both, P < 0.08). Rapid on-site evlauation was found to be an independent predictor for obtaining a conclusive sample (OR 6.2; 95 %CI, 1.06-36.73, P < 0.04). Conclusions EUS-TV-FNA is feasible, seems to be safe, and can be recommended when no other targets are available, and the information obtained would impact on the clinical plan.
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Affiliation(s)
- Albert Garcia-Sumalla
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Catalonia, Spain
| | - Jose C. Subtil
- Endoscopy Unit, Department of Digestive Diseases, Complejo Universitario de Navarra, Pamplona, Spain
| | - Carlos de la Serna
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Sandra Maisterra
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Catalonia, Spain
| | - Jose Ramon Aparicio
- Endoscopy Unit, Department of Digestive Diseases, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Rafael Leon Montañes
- Endoscopy Unit, Department of Digestive Disease, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Enrique Vazquez-Sequeiros
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Joan B. Gornals
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Catalonia, Spain,Health Science Department, Universitat Oberta de Catalunya, Barcelona, Catalonia, Spain
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Vazquez-Sequeiros E. Endosonography-guided fine-needle aspiration for re-evaluation of lymph node status after neoadjuvant therapy in patients with esophageal cancer: is there any role for it? Endoscopy 2020; 52:164-165. [PMID: 32097961 DOI: 10.1055/a-1095-3597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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)
- Enrique Vazquez-Sequeiros
- Endoscopy Unit, Gastroenterology and Hepatology Service, University Hospital Ramón y Cajal, Alcala University, Madrid, Spain
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17
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Garcia Garcia de Paredes A, Gonzalez Martin JA, Foruny Olcina JR, Juzgado Lucas D, Gonzalez Panizo F, Lopez Duran S, Martinez Sanchez A, Sanjuanbenito A, Caminoa A, Albillos A, Vazquez-Sequeiros E. Lumen-apposing metal stents versus biliary fully-covered metal stents for EUS-guided drainage of pancreatic fluid collections: a case control study: Meeting presentations: European Society of Gastrointestinal Endoscopy ESGE Days 2018. Endosc Int Open 2020; 8:E6-E12. [PMID: 31921978 PMCID: PMC6949174 DOI: 10.1055/a-1031-9295] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 08/06/2019] [Indexed: 02/08/2023] Open
Abstract
Background and study aims Endoscopic ultrasound (EUS)-guided drainage has become first-line treatment for pancreatic fluid collections (PFC). The aim of this study was to compare the effectiveness and safety of biliary fully-covered self-expandable metal stents (BFCSEMS) and lumen-apposing metal stents with electrocautery (EC-LAMS). Patients and methods From April 2008 to March 2017, consecutive patients with symptomatic PFC drained under EUS-guidance with metal stents were included. Patients drained with EC-LAMS were considered the study group and those drained with BFCSEMS the control group. Two primary endpoints were evaluated: effectiveness (defined as reduction of ≥ 50 % of PFC size in cross-sectional imaging and improvement of symptoms 6 months after the transmural drainage) and safety. Results Thirty patients were drained with EC-LAMS and 60 patients with BFCSEMS. Patients and PFC baseline characteristics in both groups were similar. Use of a coaxial double pigtail plastic stent and a nasocystic lavage catheter was significantly less frequent in patients drained with EC-LAMS (33 % vs. 100 %, and 13 % vs. 58 %, respectively; P < 0.0001). Technical success was 100 % in both groups. Procedure time was < 30 minutes in all patients drained with EC-LAMS and over 30 minutes in all patients drained with BFCSEMS ( P = 0.0001). Clinical success was higher with a tendency to significance in patients drained with EC-LAMS (96 % vs. 82 %, P = 0.055) and the adverse event rate was lower (4 % vs. 18 %, P = 0.04). No case of procedure-related mortality was recorded. Conclusions EC-LAMS and BFCSEMS are both effective for EUS-guided drainage of PFC. However, EC-LAMS requires less time to be performed and appears to be safer.
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Affiliation(s)
- Ana Garcia Garcia de Paredes
- Gastroenterology and Hepatology Department. Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
| | - Juan Angel Gonzalez Martin
- Gastroenterology and Hepatology Department. Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
| | - Jose Ramon Foruny Olcina
- Gastroenterology and Hepatology Department. Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
| | - Diego Juzgado Lucas
- Department of Gastroenterology. Hospital Universitario Quiron Madrid. Madrid, Spain
| | | | - Sergio Lopez Duran
- Gastroenterology and Hepatology Department. Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
| | - Alba Martinez Sanchez
- Gastroenterology and Hepatology Department. Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
| | - Alfonso Sanjuanbenito
- Surgery Department. Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
| | - Alejandra Caminoa
- Pathology Department. Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
| | - Agustin Albillos
- Gastroenterology and Hepatology Department. Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
| | - Enrique Vazquez-Sequeiros
- Gastroenterology and Hepatology Department. Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
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18
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Gornals JB, Perez-Miranda M, Vazquez-Sequeiros E, Vila J, Esteban JM, Gonzalez-Huix F, Guarner-Argente C, Sanchez-Yague A, Teran A, Bas-Cutrina F, De La Serna C, De Paredes AG, Ballester R, Velasquez-Rodriguez J, Salord S, Tebe C, Hereu P, Videla S. Multicenter study of plastic vs. self-expanding metal stents in endoscopic ultrasound-guided drainage of walled-off pancreatic necrosis - PROMETHEUS: a randomized controlled trial protocol. Trials 2019; 20:791. [PMID: 31888751 PMCID: PMC6937819 DOI: 10.1186/s13063-019-3988-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/11/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND It seems that lumen-apposing metal stents (LAMS) are displacing plastic stents in the therapy of pancreatic-fluid collection in walled-off necrosis (WON). To date, there is no quality of evidence to recommend LAMS as the standard treatment in the management of WON. The theoretical benefit of LAMS over plastic stents needs to be proven. METHODS/DESIGN This is a randomized controlled, multicenter, prospective clinical trial with two parallel groups, without masking. One-hundred and fourteen patients with WON will undergo endoscopic ultrasound (EUS)-guided transmural draining in nine tertiary hospitals in Spain and will be randomized to the LAMS or plastic-stent group. The primary endpoint is the short-term (4 weeks) clinical success determined by the reduction of the collection (to < 50% or < 5 cm in size), along with clinical improvement. Secondary endpoints: long-term (4 months) clinical success (total resolution or 5 cm), procedure duration, level of difficulty, safety, and recurrences. DISCUSSION The PROMETHEUS trial has been designed to determine whether LAMS are superior to plastic stents in EUS-guided transmural drainage of WON. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03100578. Registered on 4 April 2017. https://clinicaltrials.gov/ct2/home.
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Affiliation(s)
- Joan B Gornals
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain.
- Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.
| | | | - Enrique Vazquez-Sequeiros
- Endoscopy Unit, Gastroenterology and Hepatology Service, Hospital Ramon y Cajal, IRYCIS, Madrid, Spain
| | - Juan Vila
- Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - José M Esteban
- Endoscopy Unit, Department of Digestive Diseases, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | | | - Alvaro Teran
- Department of Digestive Diseases, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Francesc Bas-Cutrina
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | | | - Ana Garcia De Paredes
- Endoscopy Unit, Gastroenterology and Hepatology Service, Hospital Ramon y Cajal, IRYCIS, Madrid, Spain
| | | | - Julio Velasquez-Rodriguez
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Silvia Salord
- Hepato-Bilio-Pancreatic Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Cristian Tebe
- Biostatistics Unit, Institute of Biomedical Research of Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pilar Hereu
- Clinical Research and Clinical Trial Unit (UICEC IDIBELL), Plataforma SCRen, Clinical Pharmacology Department, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Catalonia, Spain
| | - Sebas Videla
- Clinical Research and Clinical Trial Unit (UICEC IDIBELL), Plataforma SCRen, Clinical Pharmacology Department, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Catalonia, Spain
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19
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Martin-Cardona A, Fernandez-Esparrach G, Subtil JC, Iglesias-Garcia J, Garcia-Guix M, Barturen Barroso A, Gimeno-Garcia AZ, Esteban JM, Pardo Balteiro A, Velasco-Guardado A, Vazquez-Sequeiros E, Loras C, Martinez-Moreno B, Castellot A, Huertas C, Martinez-Lapiedra M, Sanchez-Yague A, Teran A, Morales-Alvarado VJ, Betes M, de la Iglesia D, Sánchez-Montes C, Lozano MD, Lariño-Noia J, Gines A, Tebe C, Gornals JB. EUS-guided tissue acquisition in the study of the adrenal glands: Results of a nationwide multicenter study. PLoS One 2019; 14:e0216658. [PMID: 31170163 PMCID: PMC6553722 DOI: 10.1371/journal.pone.0216658] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 12/19/2018] [Accepted: 04/25/2019] [Indexed: 02/07/2023] Open
Abstract
Background There are limited data about the role of endoscopic ultrasound-guided tissue acquisition (EUS-TA), by fine needle aspiration (EUS-FNA) or biopsy (EUS-FNB), in the evaluation of the adrenal glands (AG). The primary aim was to assess the diagnostic yield and safety. The secondary aims were the malignancy predictors, and to create a predictive model of malignancy. Methods This was a retrospective nationwide study involving all Spanish hospitals experienced in EUS-TA of AGs. Inclusion period was from April-2003 to April-2016. Inclusion criteria: all consecutive cases that underwent EUS-TA of AGs. EUS and cytopathology findings were evaluated. Statistical analyses: diagnostic accuracy of echoendoscopist’s suspicion using cytology by EUS-TA, as gold standard; multivariate logistic regression model to predict tumor malignancy. Results A total of 204 EUS-TA of AGs were evaluated. Primary tumor locations were lung70%, others19%, and unknown11%. AG samples were adequate for cytological diagnosis in 91%, and confirmed malignancy in 60%. Diagnostic accuracy of the endosonographer's suspicion was 68%. The most common technique was: a 22-G (65%) and cytological needle (75%) with suction-syringe (66%). No serious adverse events were described. The variables most associated with malignancy were size>30mm (OR2.27; 95%CI, 1.16–4.05), heterogeneous echo-pattern (OR2.11; 95%CI, 1.1–3.9), variegated AG shape (OR2.46; 95%CI, 1–6.24), and endosonographer suspicion (OR17.46; 95%CI, 6.2–58.5). The best variables for a predictive multivariate logistic model of malignancy were age, sex, echo-pattern, and AG-shape. Conclusions EUS-TA of the AGs is a safe, minimally invasive procedure, allowing an excellent diagnostic yield. These results suggest the possibility of developing a pre-EUS procedure predictive malignancy model.
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Affiliation(s)
- A Martin-Cardona
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain.,Department of Digestive Diseases, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, CIBERehd, Terrassa, Spain
| | - G Fernandez-Esparrach
- Endoscopy Unit, ICMDiM, Hospital Clinic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - J C Subtil
- Endoscopy Unit, University of Navarra Clinic, Pamplona, Spain
| | - J Iglesias-Garcia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago, Spain
| | - M Garcia-Guix
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
| | - A Barturen Barroso
- Department of Digestive Diseases, Hospital Universitario Cruces, Bilbao, Spain
| | - A Z Gimeno-Garcia
- Department of Gastroenterology and Hepatology, Hospital Universitario de Canarias, Tenerife, Spain
| | - J M Esteban
- Endoscopy Unit, Department of Digestive Diseases, Hospital Clínico San Carlos, Madrid, Spain
| | - A Pardo Balteiro
- Department of Digestive Diseases, Hospital Universitario Joan XXIII, Tarragona, Spain
| | - A Velasco-Guardado
- Department of Digestive Diseases, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - E Vazquez-Sequeiros
- Endoscopy unit, Gastroenterology and Hepatology Service, Hospital Ramon y Cajal, IRYCIS, Madrid, Spain
| | - C Loras
- Department of Digestive Diseases, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, CIBERehd, Terrassa, Spain.,Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - B Martinez-Moreno
- Department of Digestive Diseases, Hospital General Universitario de Alicante, Alicante, Spain
| | - A Castellot
- Department of Digestive Diseases, Hospital Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - C Huertas
- Department of Digestive Diseases, Hospital Dr. Josep Trueta Girona, Girona, Spain
| | | | | | - A Teran
- Department of Digestive Diseases, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - V J Morales-Alvarado
- Endoscopy Unit, ICMDiM, Hospital Clinic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - M Betes
- Endoscopy Unit, University of Navarra Clinic, Pamplona, Spain
| | - D de la Iglesia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago, Spain
| | - C Sánchez-Montes
- Endoscopy Unit, ICMDiM, Hospital Clinic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - M D Lozano
- Endoscopy Unit, University of Navarra Clinic, Pamplona, Spain
| | - J Lariño-Noia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago, Spain
| | - A Gines
- Endoscopy Unit, ICMDiM, Hospital Clinic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - C Tebe
- Biostatistics Unit, Institute of Biomedical Research of Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - J B Gornals
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain.,Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
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Yoon WJ, Park DH, Choi JH, Jang S, Samarasena J, Lee TH, Paik WH, Oh D, Song TJ, Choi JH, Hara K, Iwashita T, Perez-Miranda M, Lee JG, Vazquez-Sequeiros E, Naitoh I, Vila JJ, Brugge WR, Takenaka M, Lee SS, Seo DW, Lee SK, Kim MH. The underutilization of EUS-guided biliary drainage: Perception of endoscopists in the East and West. Endosc Ultrasound 2019; 8:188-193. [PMID: 30719996 PMCID: PMC6590002 DOI: 10.4103/eus.eus_57_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background and Objectives EUS-guided biliary drainage (EUS-BD) is increasingly utilized to manage unresectable malignant biliary obstruction after a failed ERCP. However, there is no data on how endoscopists perceive EUS-BD. The aim of this study was to investigate the perception of endoscopists on EUS-BD. Patients and Methods A survey questionnaire of six topics with 22 survey statements was developed. A total of 17 pancreatobiliary endoscopists (10 from East and 7 from West) were invited to survey. The participants were asked to answer the multiple choice questionnaire and give comments. The opinions of the participants for individual survey statements were assessed using 5-point Likert scale. Results All participants completed the survey. The endoscopists had a trend to perceive EUS-BD as a procedure indicated after a failed ERCP. Various EUS-BD methods were regarded as having different efficacy and safety. The superiority of EUS-BD over percutaneous transhepatic BD (PTBD) with regard to efficacy, procedure-related adverse events, and unscheduled re-intervention was not in agreement. Conclusions EUS-BD was not yet perceived as the initial procedure to relieve the unresectable malignant biliary obstruction. Various EUS-BD methods were regarded as having different efficacy and safety. The superiority of EUS-BD over PTBD was not in agreement. Refining the procedure, developing dedicated devices, and gaining expertise in the procedure are necessary to popularize EUS-BD.
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Affiliation(s)
- Won Jae Yoon
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Do Hyun Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jun Ho Choi
- Department of Internal Medicine, Dankook University College of Medicine, South Korea
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Jason Samarasena
- Department of Medicine, University of California-Irvine, Orange, CA, USA
| | - Tae Hoon Lee
- Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan, South Korea
| | - Woo Hyun Paik
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Dongwook Oh
- Department of Gastroenterology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Tae Jun Song
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon Hyuk Choi
- Department of Internal Medicine, Inje University College of Medicine, Busan, South Korea
| | - Kazuo Hara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takuji Iwashita
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Manuel Perez-Miranda
- Department of Gastroenterology and Hepatology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - John G Lee
- Department of Medicine, University of California-Irvine, Orange, CA, USA
| | - Enrique Vazquez-Sequeiros
- Department of Gastroenterology and Hepatology, University Hospital Ramon Y Cajal, IRYCIS, Madrid, Spain
| | - Itaru Naitoh
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Juan J Vila
- Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - William R Brugge
- Division of Gastroenterology, Mount Auburn Hospital, Cambridge, MA, USA
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Sang Soo Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong-Wan Seo
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung Koo Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Myung-Hwan Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Nam K, Kim DU, Lee TH, Iwashita T, Nakai Y, Bolkhir A, Castro LA, Vazquez-Sequeiros E, de la Serna C, Perez-Miranda M, Lee JG, Lee SS, Seo DW, Lee SK, Kim MH, Park DH. Patient perception and preference of EUS-guided drainage over percutaneous drainage when endoscopic transpapillary biliary drainage fails: An international multicenter survey. Endosc Ultrasound 2018; 7:48-55. [PMID: 29451169 PMCID: PMC5838728 DOI: 10.4103/eus.eus_100_17] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background and Objectives: EUS-guided biliary drainage (EUS-BD) is a feasible procedure when ERCP fails, as is percutaneous transhepatic BD (PTBD). However, little is known about patient perception and preference of EUS-BD and PTBD. Patients and Methods: An international multicenter survey was conducted in seven tertiary referral centers. In total, 327 patients, scheduled to undergo ERCP for suspected malignant biliary obstruction, were enrolled in the study. Patients received decision aids with visual representation regarding the techniques, benefits, and adverse events (AEs) of EUS-BD and PTBD. Patients were then asked the choice between the two simulated scenarios (EUS-BD or PTBD) after failed ERCP, the reasons for their preference, and whether altering AE rates would influence their prior choice. Results: In total, 313 patients (95.7%) responded to the questionnaire and 251 patients (80.2%) preferred EUS-BD. The preference of EUS-BD was 85.7% (186/217) with EUS-BD expertise, compared to 67.7% (65/96) without EUS-BD expertise (P < 0.001). The main reason for choosing EUS-BD was the possibility of internal drainage (78.1%). In multivariate analysis, the availability of EUS-BD expertise was the single independent factor that influenced patient preference (odds ratio: 3.168; 95% of confidence interval, 1.714–5.856; P < 0.001). The preference of EUS-BD increased as AE rates decreased (P < 0.001). Conclusions: In this simulated scenario, approximately 80% of patients preferred EUS-BD over PTBD after failed ERCP. However, preference of EUS-BD declined as its AE rates increased. Further technical innovations and improved proficiency in EUS-BD for reducing AEs may encourage the use of this procedure as a routine clinical practice when ERCP fails.
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Affiliation(s)
- Kwangwoo Nam
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, South Korea
| | - Dong Uk Kim
- Division of Gastroenterology, Department of Internal Medicine, Biomedical Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Tae Hoon Lee
- Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan, South Korea
| | - Takuji Iwashita
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ahmed Bolkhir
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Lara Aguilera Castro
- Department of Gastroenterology and Hepatology, IRYCIS, University Hospital Ramon y Cajal, Móstoles, Madrid, Spain
| | - Enrique Vazquez-Sequeiros
- Department of Gastroenterology and Hepatology, IRYCIS, University Hospital Ramon y Cajal, Móstoles, Madrid, Spain
| | - Carlos de la Serna
- Department of Gastroenterology and Hepatology, Rio Hortega University Hospital, Valladolid, Spain
| | - Manuel Perez-Miranda
- Department of Gastroenterology and Hepatology, Rio Hortega University Hospital, Valladolid, Spain
| | - John G Lee
- Division of Gastroenterology and Hepatology, The University of California Irvine Health, Orange, CA, USA
| | - Sang Soo Lee
- Department of Internal Medicine, Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong-Wan Seo
- Department of Internal Medicine, Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung Koo Lee
- Department of Internal Medicine, Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Myung-Hwan Kim
- Department of Internal Medicine, Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Do Hyun Park
- Department of Internal Medicine, Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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22
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Vazquez-Sequeiros E. Treatment of walled-off pancreatic necrosis: when and how? Endosc Int Open 2017; 5:E1060-E1061. [PMID: 29090246 PMCID: PMC5658210 DOI: 10.1055/s-0043-116380] [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] [Indexed: 11/17/2022] Open
Affiliation(s)
- Enrique Vazquez-Sequeiros
- Endoscopy Unit, Gastroenterology Division, University Hospital Ramón y Cajal, IRYCIS, Madrid, Spain,Corresponding author Enrique Vazquez-Sequeiros MD, PhD Endoscopy UnitGastroenterology DivisionUniversity Hospital Ramón y CajalIRYCIS MadridCarretera de Colmenar km 9,10028034 MadridSpain+34918835348
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23
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Vazquez-Sequeiros E, Baron TH, Pérez-Miranda M, Sánchez-Yagüe A, Gornals J, Gonzalez-Huix F, de la Serna C, Gonzalez Martin JA, Gimeno-Garcia AZ, Marra-Lopez C, Castellot A, Alberca F, Fernandez-Urien I, Aparicio JR, Legaz ML, Sendino O, Loras C, Subtil JC, Nerin J, Perez-Carreras M, Diaz-Tasende J, Perez G, Repiso A, Vilella A, Dolz C, Alvarez A, Rodriguez S, Esteban JM, Juzgado D, Albillos A. Evaluation of the short- and long-term effectiveness and safety of fully covered self-expandable metal stents for drainage of pancreatic fluid collections: results of a Spanish nationwide registry. Gastrointest Endosc 2016; 84:450-457.e2. [PMID: 26970012 DOI: 10.1016/j.gie.2016.02.044] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/17/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Initial reports suggest that fully covered self-expandable metal stents (FCSEMSs) may be better suited for drainage of dense pancreatic fluid collections (PFCs), such as walled-off pancreatic necrosis. The primary aim was to analyze the effectiveness and safety of FCSEMSs for drainage of different types of PFCs in a large cohort. The secondary aim was to investigate which type of FCSEMS is superior. METHODS This was a retrospective, noncomparative review of a nationwide database involving all hospitals in Spain performing EUS-guided PFC drainage. From April 2008 to August 2013, all patients undergoing PFC drainage with an FCSEMS were included in a database. The main outcome measurements were technical success, short-term (2 weeks) and long-term (6 months) effectiveness, adverse events, and need for surgery. RESULTS The study included 211 patients (pseudocyst/walled-off pancreatic necrosis, 53%/47%). The FCSEMSs used were straight biliary (66%) or lumen-apposing (34%). Technical success was achieved in 97% of patients (95% confidence interval [CI], 93%-99%). Short-term- and long-term clinical success was obtained in 94% (95% CI, 89%-97%) and 85% (95% CI, 79%-89%) of patients, respectively. Adverse events occurred in 21% of patients (95% CI, 16%-27%): infection (11%), bleeding (7%), and stent migration and/or perforation (3%). By multivariate analysis, patient age (>58 years) and previous failed drainage were the most important factors associated with negative outcome. CONCLUSIONS An FCSEMS is effective and safe for PFC drainage. Older patients with a history of unsuccessful drainage are more likely to fail EUS-guided drainage. The type of FCSEMS does not seem to influence patient outcome.
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Affiliation(s)
- Enrique Vazquez-Sequeiros
- Endoscopy Unit, Gastroenterology Division, University Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain; Gastroenterology Division, University Hospital Quirón, Madrid, Spain
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Manuel Pérez-Miranda
- Department of Gastroenterology and Hepatology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Andres Sánchez-Yagüe
- Gastroenterology Department, Hospital Costa del Sol, Marbella, Spain; Gastroenterology Department, Vithas Xanit Internacional Hospital, Benalmadena, Spain
| | - Joan Gornals
- Endoscopy Unit, Digestive Disease Department, Hospital Universitari de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
| | | | - Carlos de la Serna
- Department of Gastroenterology and Hepatology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Juan Angel Gonzalez Martin
- Endoscopy Unit, Gastroenterology Division, University Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Antonio Z Gimeno-Garcia
- Gastroenterology Department, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Spain
| | - Carlos Marra-Lopez
- Gastroenterology Department, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Ana Castellot
- Complejo Hospitalario Universitario Insular Materno Infantil, Gran Canaria, Spain
| | - Fernando Alberca
- Gastroenterology Department, Unidad de Gestión Clínica Digestivo, Hospital Clinico Universitario de la Arrixava, Murcia, Spain
| | | | | | - Maria Luisa Legaz
- Gastroenterology Department, Hospital General La Mancha Centro, Alcázar de San Juan, Spain
| | - Oriol Sendino
- Endoscopy Unit, Gastroenterology Department, Institute of Digestive and Metabolic Diseases, Hospital Clínic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona, Spain
| | - Carmen Loras
- Gastroenterology Department, Servei Aparell Digestiu-Unitat d'Endoscòpia, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Jose Carlos Subtil
- Gastroenterology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Juan Nerin
- Gastroenterology Department, Hospital Clínico Universitario "Lozano Blesa," Zaragoza, Spain
| | - Mercedes Perez-Carreras
- Endoscopy Unit, Gastroenterology Department, Servicio de Medicina de Aparato Digestivo, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jose Diaz-Tasende
- Endoscopy Unit, Gastroenterology Department, Servicio de Medicina de Aparato Digestivo, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Gustavo Perez
- Endoscopy Unit, Gastroenterology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Alejandro Repiso
- Endoscopy Unit, Gastroenterology Department, Hospital Virgen de la Salud, Toledo, Spain
| | - Angels Vilella
- Endoscopy Unit, Gastroenterology Department. Hospital Son Llatzer, Palma de Mallorca, Spain
| | - Carlos Dolz
- Endoscopy Unit, Gastroenterology Department. Hospital Son Llatzer, Palma de Mallorca, Spain
| | - Alberto Alvarez
- Gastroenterology Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Santiago Rodriguez
- Gastroenterology Department, Complejo Asistencial Universitario de Zamora, Zamora, Spain
| | | | - Diego Juzgado
- Gastroenterology Division, University Hospital Quirón, Madrid, Spain
| | - Agustin Albillos
- Endoscopy Unit, Gastroenterology Division, University Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
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Tang SJ, Vilmann AS, Saftoiu A, Wang W, Streba C, Fink PP, Griswold M, Wu R, Dietrich CF, Jenssen C, Hocke M, Kantowski M, Pohl J, Fockens P, Annema JT, van der Heijden EH, Havre RF, Pham KDC, Kunda R, Deprez PH, Mariana J, Vazquez-Sequeiros E, Larghi A, Buscarini E, Fusaroli P, Lahav M, Puri R, Garg PK, Sharma M, Maluf-Filho F, Sahai A, Brugge WR, Lee LS, Aslanian HR, Wang AY, Shami VM, Markowitz A, Siddiqui AA, Mishra G, Scheiman JM, Isenberg G, Siddiqui UD, Shah RJ, Buxbaum J, Watson RR, Willingham FF, Bhutani MS, Levy MJ, Harris C, Wallace MB, Nolsøe CP, Lorentzen T, Bang N, Sørensen SM, Gilja OH, D’Onofrio M, Piscaglia F, Gritzmann N, Radzina M, Sparchez ZA, Sidhu PS, Freeman S, McCowan TC, de Araujo CR, Patel A, del Ali MA, Campbell G, Chen E, Vilmann P. EUS Needle Identification Comparison and Evaluation study (with videos). Gastrointest Endosc 2016; 84:424-433.e2. [PMID: 26873530 PMCID: PMC5570521 DOI: 10.1016/j.gie.2016.01.068] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/29/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS EUS-guided FNA or biopsy sampling is widely practiced. Optimal sonographic visualization of the needle is critical for image-guided interventions. Of the several commercially available needles, bench-top testing and direct comparison of these needles have not been done to reveal their inherent echogenicity. The aims are to provide bench-top data that can be used to guide clinical applications and to promote future device research and development. METHODS Descriptive bench-top testing and comparison of 8 commonly used EUS-FNA needles (all size 22 gauge): SonoTip Pro Control (Medi-Globe); Expect Slimline (Boston Scientific); EchoTip, EchoTip Ultra, EchoTip ProCore High Definition (Cook Medical); ClearView (Conmed); EZ Shot 2 (Olympus); and BNX (Beacon Endoscopic), and 2 new prototype needles, SonoCoat (Medi-Globe), coated by echogenic polymers made by Encapson. Blinded evaluation of standardized and unedited videos by 43 EUS endoscopists and 17 radiologists specialized in GI US examination who were unfamiliar with EUS needle devices. RESULTS There was no significant difference in the ratings and rankings of these needles between endosonographers and radiologists. Overall, 1 prototype needle was rated as the best, ranking 10% to 40% higher than all other needles (P < .01). Among the commercially available needles, the EchoTip Ultra needle and the ClearView needle were top choices. The EZ Shot 2 needle was ranked statistically lower than other needles (30%-75% worse, P < .001). CONCLUSIONS All FNA needles have their inherent and different echogenicities, and these differences are similarly recognized by EUS endoscopists and radiologists. Needles with polymeric coating from the entire shaft to the needle tip may offer better echogenicity.
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Affiliation(s)
- Shou-jiang Tang
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Adrian Saftoiu
- Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology Craiova, Craiova, Romania
| | - Wanmei Wang
- Center of Biostatistics & Bioinformatics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Costin Streba
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology Craiova, Craiova, Romania
| | | | - Michael Griswold
- Center of Biostatistics & Bioinformatics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ruonan Wu
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | | | | | | | - Jürgen Pohl
- Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | | | | | | | | | | | | | | | - Jinga Mariana
- University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | | | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, University of Bologna/Hospital of Imola, Italy
| | | | - Rajesh Puri
- Institute of Digestive and Hepatobiliary Sciences, Gurgaon, India
| | | | - Malay Sharma
- Jaswant Rai Speciality Hospital, Uttar Pradersh, India
| | | | - Anand Sahai
- Centre Hospitalier de l’Universite de Montreal, Canada
| | | | - Linda S. Lee
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | - Andrew Y. Wang
- University of Virginia Health System, Division of Gastroenterology and Hepatology, Charlottesville, Virginia, USA
| | - Vanessa M. Shami
- University of Virginia Health System, Division of Gastroenterology and Hepatology, Charlottesville, Virginia, USA
| | | | - Ali A. Siddiqui
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Girish Mishra
- Wake Forest University Hospital, Winston-Salem, North Carolina, USA
| | | | | | | | - Raj J. Shah
- University of Colorado Hospital, Denver, Colorado, USA
| | - James Buxbaum
- University of Southern California Keck School of Medicine, California, USA
| | | | | | | | | | | | | | | | - Torben Lorentzen
- Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Niels Bang
- Aarhus University Hospital, Aarhus, Denmark
| | | | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Fabio Piscaglia
- Department of Medical and Surgical Sciences, University of Bologna/Hospital of Imola, Italy
| | | | - Maija Radzina
- Paula Stradina Clinical University Hospital, Riga, Latvia
| | - Zeno Adrian Sparchez
- 3rd Medical Department, University of Medicine and Pharmacy, Institute for Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | | | | | | | | | - Akash Patel
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Garth Campbell
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Edward Chen
- UT Southwestern Medical Center, Dallas, Texas, USA
| | - Peter Vilmann
- Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
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25
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Vazquez-Sequeiros E, Maluf-Filho F. Endosonography-guided ablation of pancreatic cystic tumors: Is it justified? Gastrointest Endosc 2016; 83:921-3. [PMID: 27102528 DOI: 10.1016/j.gie.2015.10.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 10/03/2015] [Accepted: 10/25/2015] [Indexed: 12/11/2022]
Affiliation(s)
| | - Fauze Maluf-Filho
- Endoscopy Unit, Cancer Institute of São Paulo - ICESP, Department of Gastroenterology, University of São Paulo, São Paulo, Brazil
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26
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Vasen H, Ibrahim I, Ponce CG, Slater EP, Matthäi E, Carrato A, Earl J, Robbers K, van Mil AM, Potjer T, Bonsing BA, de Vos Tot Nederveen Cappel WH, Bergman W, Wasser M, Morreau H, Klöppel G, Schicker C, Steinkamp M, Figiel J, Esposito I, Mocci E, Vazquez-Sequeiros E, Sanjuanbenito A, Muñoz-Beltran M, Montans J, Langer P, Fendrich V, Bartsch DK. Benefit of Surveillance for Pancreatic Cancer in High-Risk Individuals: Outcome of Long-Term Prospective Follow-Up Studies From Three European Expert Centers. J Clin Oncol 2016; 34:2010-9. [PMID: 27114589 DOI: 10.1200/jco.2015.64.0730] [Citation(s) in RCA: 230] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis. Hereditary factors play a role in the development of PDAC in 3% to 5% of all patients. Surveillance of high-risk groups, may facilitate detection of PDAC at an early stage. The aim of this study was to assess whether surveillance aids detection of early-stage PDAC or precursor lesions (PRLs) and improves the prognosis. PATIENTS AND METHODS Screening outcomes were collected from three European centers that conduct prospective screening in high-risk groups including families with clustering of PDAC (familial pancreatic cancer [FPC]) or families with a gene defect that predisposes to PDAC. The surveillance program consisted of annual magnetic resonance imaging, magnetic resonance cholangiopancreatography, and/or endoscopic ultrasound. RESULTS Four hundred eleven asymptomatic individuals participated in the surveillance programs, including 178 CDKN2A mutation carriers, 214 individuals with FPC, and 19 BRCA1/2 or PALB2 mutation carriers. PDAC was detected in 13 (7.3%) of 178 CDKN2A mutation carriers. The resection rate was 75%, and the 5-year survival rate was 24%. Two CDKN2A mutation carriers (1%) underwent surgical resection for low-risk PRL. Two individuals (0.9%) in the FPC cohort had a pancreatic tumor, including one advanced PDAC and one early grade 2 neuroendocrine tumor. Thirteen individuals with FPC (6.1%) underwent surgical resection for a suspected PRL, but only four (1.9%) had high-risk lesions (ie, high-grade intraductal papillary mucinous neoplasms or grade 3 pancreatic intraepithelial neoplasms). One BRCA2 mutation carrier was found to have PDAC, and another BRCA2 mutation carrier and a PALB2 mutation carrier underwent surgery and were found to have low-risk PRL. No serious complications occurred as consequence of the program. CONCLUSION Surveillance of CDNK2A mutation carriers is relatively successful, detecting most PDACs at a resectable stage. The benefit of surveillance in families with FPC is less evident.
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Affiliation(s)
- Hans Vasen
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria.
| | - Isaura Ibrahim
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
| | - Carmen Guillen Ponce
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
| | - Emily P Slater
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
| | - Elvira Matthäi
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
| | - Alfredo Carrato
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
| | - Julie Earl
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
| | - Kristin Robbers
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
| | - Anneke M van Mil
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
| | - Thomas Potjer
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
| | - Bert A Bonsing
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
| | - Wouter H de Vos Tot Nederveen Cappel
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
| | - Wilma Bergman
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
| | - Martin Wasser
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
| | - Hans Morreau
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
| | - Günter Klöppel
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
| | - Christoph Schicker
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
| | - Martin Steinkamp
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
| | - Jens Figiel
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
| | - Irene Esposito
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
| | - Evelina Mocci
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
| | - Enrique Vazquez-Sequeiros
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
| | - Alfonso Sanjuanbenito
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
| | - Maria Muñoz-Beltran
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
| | - José Montans
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
| | - Peter Langer
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
| | - Volker Fendrich
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
| | - Detlef K Bartsch
- Hans Vasen, Isaura Ibrahim, Kristin Robbers, Anneke M. van Mil, Thomas Potjer, Bert A. Bonsing, Wilma Bergman, Martin Wasser, and Hans Morreau, Leiden University Medical Center, Leiden; Wouter H. de Vos tot Nederveen Cappel, Isala Clinics, Zwolle, the Netherlands; Carmen Guillen Ponce, Alfredo Carrato, Julie Earl, Evelina Mocci, Enrique Vazquez-Sequeiros, Alfonso Sanjuanbenito, Maria Muñoz-Beltran, and José Montans, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute, Madrid, Spain; Emily P. Slater, Elvira Matthäi, Volker Fendrich, and Detlef K. Bartsch, University Hospital Marburg; Christoph Schicker, Martin Steinkamp, and Jens Figiel, Philipps University Marburg, Marburg; Günter Klöppel, Consultation Centre for Pancreatic and Endocrine Tumors, Technical University Munich; Peter Langer, Klinikum Hanau, Hanau, Germany; and Irene Esposito, Innsbruck University Hospital, Innsbruck, Austria
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Vilmann P, Frost Clementsen P, Colella S, Siemsen M, De Leyn P, Dumonceau JM, Herth FJ, Larghi A, Vazquez-Sequeiros E, Hassan C, Crombag L, Korevaar DA, Konge L, Annema JT. Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg 2015; 48:1-15. [DOI: 10.1093/ejcts/ezv194] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Vilmann P, Clementsen PF, Colella S, Siemsen M, De Leyn P, Dumonceau JM, Herth FJ, Larghi A, Vazquez-Sequeiros E, Hassan C, Crombag L, Korevaar DA, Konge L, Annema JT, Annema JT. Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). Endoscopy 2015; 47:545-59. [PMID: 26030890 DOI: 10.1055/s-0034-1392040] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE), produced in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). It addresses the benefit and burden associated with combined endobronchial and esophageal mediastinal nodal staging of lung cancer. The Scottish Intercollegiate Guidelines Network (SIGN) approach was adopted to define the strength of recommendations and the quality of evidence.The article has been co-published with permission in the European Journal of Cardio-Thoracic Surgery and the European Respiratory Journal. Recommendations 1 For mediastinal nodal staging in patients with suspected or proven non-small-cell lung cancer (NSCLC) with abnormal mediastinal and/or hilar nodes at computed tomography (CT) and/or positron emission tomography (PET), endosonography is recommended over surgical staging as the initial procedure (Recommendation grade A). The combination of endobronchial ultrasound with real-time guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic (esophageal) ultrasound with fine needle aspiration, with use of a gastrointestinal (EUS-FNA) or EBUS (EUS-B-FNA) scope, is preferred over either test alone (Recommendation grade C). If the combination of EBUS and EUS-(B) is not available, we suggest that EBUS alone is acceptable (Recommendation grade C).Subsequent surgical staging is recommended, when endosonography does not show malignant nodal involvement (Recommendation grade B). 2 For mediastinal nodal staging in patients with suspected or proven non-small-cell peripheral lung cancer without mediastinal involvement at CT or CT-PET, we suggest that EBUS-TBNA and/or EUS-(B)-FNA should be performed before therapy, provided that one or more of the following conditions is present: (i) enlarged or fluorodeoxyglucose (FDG)-PET-avid ipsilateral hilar nodes; (ii) primary tumor without FDG uptake; (iii) tumor size ≥ 3 cm (Fig. 3a - c) (Recommendation grade C). If endosonography does not show malignant nodal involvement, we suggest that mediastinoscopy is considered, especially in suspected N1 disease (Recommendation grade C).If PET is not available and CT does not reveal enlarged hilar or mediastinal lymph nodes, we suggest performance of EBUS-TBNA and/or EUS-(B)-FNA and/or surgical staging (Recommendation grade C). 3 In patients with suspected or proven < 3 cm peripheral NSCLC with normal mediastinal and hilar nodes at CT and/or PET, we suggest initiation of therapy without further mediastinal staging (Recommendation grade C). 4 For mediastinal staging in patients with centrally located suspected or proven NSCLC without mediastinal or hilar involvement at CT and/or CT-PET, we suggest performance of EBUS-TBNA, with or without EUS-(B)-FNA, in preference to surgical staging (Fig. 4) (Recommendation grade D). If endosonography does not show malignant nodal involvement, mediastinoscopy may be considered (Recommendation grade D). 5 For mediastinal nodal restaging following neoadjuvant therapy, EBUS-TBNA and/or EUS-(B)-FNA is suggested for detection of persistent nodal disease, but, if this is negative, subsequent surgical staging is indicated (Recommendation grade C). 6 A complete assessment of mediastinal and hilar nodal stations, and sampling of at least three different mediastinal nodal stations (4 R, 4 L, 7) (Fig. 1, Fig. 5) is suggested in patients with NSCLC and an abnormal mediastinum by CT or CT-PET (Recommendation grade D). 7 For diagnostic purposes, in patients with a centrally located lung tumor that is not visible at conventional bronchoscopy, endosonography is suggested, provided the tumor is located immediately adjacent to the larger airways (EBUS) or esophagus (EUS-(B)) (Recommendation grade D). 8 In patients with a left adrenal gland suspected for distant metastasis we suggest performance of endoscopic ultrasound fine needle aspiration (EUS-FNA) (Recommendation grade C), while the use of EUS-B with a transgastric approach is at present experimental (Recommendation grade D). 9 For optimal endosonographic staging of lung cancer, we suggest that individual endoscopists should be trained in both EBUS and EUS-B in order to perform complete endoscopic staging in one session (Recommendation grade D). 10 We suggest that new trainees in endosonography should follow a structured training curriculum consisting of simulation-based training followed by supervised practice on patients (Recommendation grade D). 11 We suggest that competency in EBUS-TBNA and EUS-(B)-FNA for staging lung cancer be assessed using available validated assessment tools (Recommendation Grade D).
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Affiliation(s)
- Peter Vilmann
- Department of Surgical Gastroenterology, Endoscopy Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | | | - Sara Colella
- Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark
| | - Mette Siemsen
- Department of Thoracic Surgery, Rigshospitalet, Copenhagen Hospital Union, Copenhagen, Denmark
| | - Paul De Leyn
- Department of Thoracic Surgery, University Hospitals Leuven, Belgium
| | | | - Felix J Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Alberto Larghi
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | | | - Cesare Hassan
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Laurence Crombag
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniël A Korevaar
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Lars Konge
- Centre for Clinical Education, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Jouke T Annema
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jouke T Annema
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Vilmann P, Clementsen PF, Colella S, Siemsen M, De Leyn P, Dumonceau JM, Herth FJ, Larghi A, Vazquez-Sequeiros E, Hassan C, Crombag L, Korevaar DA, Konge L, Annema JT. Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). Endoscopy 2015; 47:c1. [PMID: 26062074 DOI: 10.1055/s-0034-1392453] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [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)
- Peter Vilmann
- Department of Surgical Gastroenterology, Endoscopy Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | | | - Sara Colella
- Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark
| | - Mette Siemsen
- Department of Thoracic Surgery, Rigshospitalet, Copenhagen Hospital Union, Copenhagen, Denmark
| | - Paul De Leyn
- Department of Thoracic Surgery, University Hospitals Leuven, Belgium
| | | | - Felix J Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Alberto Larghi
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Enrique Vazquez-Sequeiros
- Department of Gastroenterology, University Hospital Ramón y Cajal, Universidad de Alcala, Madrid, Spain
| | - Cesare Hassan
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Laurence Crombag
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniël A Korevaar
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Lars Konge
- Centre for Clinical Education, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Jouke T Annema
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Vilmann P, Clementsen PF, Colella S, Siemsen M, De Leyn P, Dumonceau JM, Herth FJ, Larghi A, Vazquez-Sequeiros E, Hassan C, Crombag L, Korevaar DA, Konge L, Annema JT. Combined endobronchial and oesophageal endosonography for the diagnosis and staging of lung cancer. Eur Respir J 2015; 46:40-60. [DOI: 10.1183/09031936.00064515] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 04/27/2015] [Indexed: 12/25/2022]
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Vila JJ, Pérez-Miranda M, Vazquez-Sequeiros E, Abadia MAS, Pérez-Millán A, González-Huix F, Gornals J, Iglesias-Garcia J, De la Serna C, Aparicio JR, Subtil JC, Alvarez A, de la Morena F, García-Cano J, Casi MA, Lancho A, Barturen A, Rodríguez-Gómez SJ, Repiso A, Juzgado D, Igea F, Fernandez-Urien I, González-Martin JA, Armengol-Miró JR. Initial experience with EUS-guided cholangiopancreatography for biliary and pancreatic duct drainage: a Spanish national survey. Gastrointest Endosc 2012; 76:1133-41. [PMID: 23021167 DOI: 10.1016/j.gie.2012.08.001] [Citation(s) in RCA: 168] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 08/01/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND EUS-guided cholangiopancreatography (ESCP) allows transmural access to biliopancreatic ducts when ERCP fails. Data regarding technical details, safety, and outcomes of ESCP are still unknown. OBJECTIVE To evaluate outcomes of ESCP in community and referral centers at the initial development phase of this procedure, to identify the ESCP stages with higher risk of failure, and to evaluate the influence on outcomes of factors related to the endoscopist. DESIGN Multicenter retrospective study. SETTING Public health system hospitals with experience in ESCP in Spain. PATIENTS A total of 125 patients underwent ESCP in 19 hospitals, with an experience of <20 procedures. INTERVENTION ESCP. MAIN OUTCOME MEASUREMENTS Technical success and complication rates in the initial phase of implantation of ESCP are described. The influence of technical characteristics and endoscopist features on outcomes was analyzed. RESULTS A total of 125 patients from 19 hospitals were included. Biliary ESCP was performed in 106 patients and pancreatic ESCP was performed in 19. Technical success was achieved in 84 patients (67.2%) followed by clinical success in 79 (63.2%). Complications occurred in 29 patients (23.2%). Unsuccessful manipulation of the guidewire was responsible for 68.2% of technical failures, and 58.6% of complications were related to problems with the transmural fistula. LIMITATIONS Retrospective study. CONCLUSION Outcomes of ESCP during its implantation stage reached a technical success rate of 67.2%, with a complication rate of 23.2%. Intraductal manipulation of the guidewire seems to be the most difficult stage of the procedure.
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Affiliation(s)
- Juan J Vila
- Department of Gastroenterology, Endoscopy Unit A, Complejo Hospitalario de Navarra, Pamplona, Spain.
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Guillen-Ponce C, Mocci E, Amendolara A, Vazquez-Sequeiros E, Gonzalez Gordaliza C, Muñoz Beltran M, Sanjuanbenito A, Gonzalez Garcia C, Custodio A, Carrato A. Endoscopic Ultrasonography in High-Risk Population for Pancreatic Cancer. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)34014-x] [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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Dumonceau JM, Polkowski M, Larghi A, Vilmann P, Giovannini M, Frossard JL, Heresbach D, Pujol B, Fernández-Esparrach G, Vazquez-Sequeiros E, Ginès A. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2011; 43:897-912. [PMID: 21842456 DOI: 10.1055/s-0030-1256754] [Citation(s) in RCA: 225] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This article is part of a combined publication that expresses the current view of the European Society of Gastrointestinal Endoscopy (ESGE) about endoscopic ultrasound (EUS)-guided sampling in gastroenterology, including EUS-guided fine needle aspiration (EUS-FNA) and EUS-guided trucut biopsy (EUS-TCB), of submucosal tumors, diffuse esophageal/gastric wall thickening, pancreatic solid masses and cystic-appearing lesions, mediastinal lesions unrelated to lung or esophageal cancer, cancer of the esophagus, stomach, and rectum, lymph nodes of unknown origin, adrenal gland masses, and focal liver lesions. False-positive cytopathological results and needle tract seeding are also discussed. The present Clinical Guideline describes the results of EUS-guided sampling in the different clinical settings, considers the role of this technique in patient management, and makes recommendations on circumstances that warrant its use. A two-page executive summary of evidence statements and recommendations is provided. A separate Technical Guideline describes the general technique of EUS-guided sampling, particular techniques to maximize the diagnostic yield depending on the nature of the target lesion, and sample processing. The target readership for the Clinical Guideline mostly includes gastroenterologists, oncologists, internists, and surgeons while the Technical Guideline should be most useful to endoscopists who perform EUS-guided sampling.
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Affiliation(s)
- J-M Dumonceau
- Service of Gastroenterology and Hepatology, Geneva University Hospitals, Geneva, Switzerland.
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Vazquez-Sequeiros E, Olcina JRF. Endoscopic ultrasound guided vascular access and therapy: A promising indication. World J Gastrointest Endosc 2010; 2:198-202. [PMID: 21160933 PMCID: PMC2999134 DOI: 10.4253/wjge.v2.i6.198] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 05/25/2010] [Accepted: 06/01/2010] [Indexed: 02/05/2023] Open
Abstract
Endoscopic ultrasound (EUS) is an imaging technique that has consolidated its role as an important tool for diagnosis and therapeutics. In recent years we have seen a dramatic increase in the number of EUS-guided therapeutic indications (celiac plexus neurolysis/block, pseudocyst drainage, etc). Preliminary reports have suggested EUS may also be used to guide vascular access for both imaging and treating different vascular diseases. This review aims to objectively describe the existing evidence in the field.
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Affiliation(s)
- Enrique Vazquez-Sequeiros
- Enrique Vazquez-Sequeiros, Jose Ramon Foruny Olcina, University Hospital Ramon y Cajal, Madrid 28801, Spain
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Vazquez-Sequeiros E. Looking for new features to improve accuracy of EUS lymph node criteria. J Gastrointestin Liver Dis 2009; 18:135-136. [PMID: 19565038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Gines A, Cassivi SD, Martenson JA, Schleck C, Deschamps C, Sinicrope FA, Alberts SR, Murray JA, Zinsmeister AR, Vazquez-Sequeiros E, Nichols FC, Miller RC, Quevedo JF, Allen MS, Alexander JA, Zais T, Haddock MG, Romero Y. Impact of endoscopic ultrasonography and physician specialty on the management of patients with esophagus cancer. Dis Esophagus 2008; 21:241-50. [PMID: 18430106 PMCID: PMC2577373 DOI: 10.1111/j.1442-2050.2007.00766.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
While endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) are the most accurate techniques for locoregional staging of esophageal cancer, little evidence exists that these innovations impact on clinical care. The objective on this study was to determine the frequency with which EUS and EUS-FNA alter the management of patients with localized esophageal cancer, and assess practice variation among specialists at a tertiary care center. Three gastroenterologists, three medical oncologists, three radiation oncologists and four thoracic surgeons were asked to independently report their management recommendations as the anonymized staging information of 50 prospectively enrolled patients from another study were sequentially disclosed on-line. Compared to initial management recommendations, that were based upon history, physical examination, upper endoscopy and CT scan results, EUS prompted a change in management 24% (95% CI: 12-36%) of the time; usually to a more resource-intensive approach (71%), for example from recommending palliation to recommending neoadjuvant chemoradiation therapy. EUS-FNA plus cytology results altered management an additional 8% (95% CI: 6-15%) of the time. Agreement between specialists ranged from fair (intraclass correlation [ICC=0.32) to substantial (ICC=0.65); improving with additional information. Among specialists, agreement was greatest for patients with stage I disease. EUS and EUS-FNA changed patient management the most for patients with stages IIA, IIB or III disease. EUS, with or without FNA, significantly impacts the management of patients with localized esophageal cancer. With respect to the optimal treatment for each patient, agreement among physicians incrementally increases with endoscopic ultrasound results. Specialty training appears to influence therapeutic decision-making behavior.
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Affiliation(s)
- A. Gines
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota
| | - S. D. Cassivi
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - J. A. Martenson
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - C. Schleck
- Division of Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - C. Deschamps
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - F. A. Sinicrope
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota,Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - S. R. Alberts
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - J. A. Murray
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | | | - F. C. Nichols
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - R. C. Miller
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - J. F. Quevedo
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - M. S. Allen
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - J. A. Alexander
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota
| | - T. Zais
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota
| | - M. G. Haddock
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Y. Romero
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota,Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
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Vazquez-Sequeiros E, Foruny-Olcina JR. Linear EUS: the clinical impact of N staging in esophageal carcinoma. Minerva Med 2007; 98:313-319. [PMID: 17921943] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This review article focuses on nodal staging of esophageal cancer. Transesophageal endoscopic ultrasound (EUS) is the most accurate technique for preoperative local-regional staging of esophageal carcinoma (TN staging), once the CT and/or the PET scan have excluded the presence of distant metastasis. EUS guided fine needle aspiration (EUS-FNA) helps improve diagnostic accuracy in esophageal cancer lymph node staging. In certain subgroup of patients who present with a number of EUS lymph node criteria, EUS FNA may be avoided without affecting diagnostic accuracy. In tumors of the distal esophagus detection and biopsy of celiac lymph nodes may be successfully performed by EUS and EUS FNA, and important therapeutic decissions may be derived from such a practice.
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Affiliation(s)
- E Vazquez-Sequeiros
- Division of Gastroenterology, Hospital Ramon, University of Alcala, Cajal, Madrid, Spain.
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Vazquez-Sequeiros E. Endoscopic ultrasound and fine needle aspiration in inflammatory and cystic pancreatic pathology. Minerva Med 2007; 98:357-360. [PMID: 17921950] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
To achieve an accurate diagnosis on the nature of pancreatic cystic lesions may be difficult. This review article attempts to provide an overview of the potential role of endoscopic ultrasound (EUS) and EUS guided fine needle aspiration in the evaluation of cystic lesions of the pancreas.
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Affiliation(s)
- E Vazquez-Sequeiros
- Division of Gastroenterology, Hospital Ramon y Cajal, University of Alcala, Alcala de Henares, Madrid, Spain.
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Affiliation(s)
- E Vazquez-Sequeiros
- Gastroenterology Division, Hospital Ramon y Cajal, Madrid, Alcala University, Spain.
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Lowe VJ, Booya F, Fletcher JG, Nathan M, Jensen E, Mullan B, Rohren E, Wiersema MJ, Vazquez-Sequeiros E, Murray JA, Allen MS, Levy MJ, Clain JE. Comparison of positron emission tomography, computed tomography, and endoscopic ultrasound in the initial staging of patients with esophageal cancer. Mol Imaging Biol 2006; 7:422-30. [PMID: 16270235 DOI: 10.1007/s11307-005-0017-0] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Improvement in esophageal cancer staging is needed. Positron emission tomography (PET), computed tomography (CT), and endoscopic ultrasound (EUS) in the staging of esophageal carcinoma were compared. METHODS PET, CT, and EUS were performed and interpreted prospectively in 75 patients with newly diagnosed esophageal cancer. Either tissue confirmation or fine needle aspiration (FNA) was used as the gold standard of disease. Sensitivity and specificity for tumor, nodal, and metastatic (TNM) disease for each test were determined. TNM categorizations from each test were used to assign patients to subgroups corresponding to the three treatment plans that patients could theoretically receive, and these were then compared. RESULTS Local tumor staging (T) was done correctly by CT and PET in 42% and by EUS in 71% of patients (P value > 0.14). The sensitivity and specificity for nodal involvement (N) by modality were 84% and 67% for CT, 86% and 67% for EUS, and 82% and 60% for PET (P value > 0.38). The sensitivity and specificity for distant metastasis were 81% and 82% for CT, 73% and 86% for EUS, and 81% and 91% for PET (P value > 0.25). Treatment assignment was done correctly by CT in 65%, by EUS in 75%, and by PET in 70% of patients (P value > 0.34). CONCLUSIONS EUS had superior T staging ability over PET and CT in our study group. The tests showed similar performance in nodal staging and there was a trend toward improved distant disease staging with CT or PET over EUS. Assignment to treatment groups in relation to TNM staging tended to be better by EUS. Each test contributed unique patient staging information on an individual basis.
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Affiliation(s)
- Val J Lowe
- Department of Radiology, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905, USA.
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Vazquez-Sequeiros E, Levy MJ, Clain JE, Schwartz DA, Harewood GC, Salomao D, Wiersema MJ. Routine vs. selective EUS-guided FNA approach for preoperative nodal staging of esophageal carcinoma. Gastrointest Endosc 2006; 63:204-11. [PMID: 16427921 DOI: 10.1016/j.gie.2005.08.053] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2005] [Accepted: 08/31/2005] [Indexed: 12/21/2022]
Abstract
BACKGROUND EUS-guided FNA (EUS-FNA) is the most accurate method for lymph-node staging of esophageal carcinoma; however, it may not be necessary when EUS features are present that strongly suggest a benign or a malignant origin. AIMS (1) To identify a combination of EUS criteria that have a sufficient sensitivity and specificity to preclude the need for EUS-FNA and (2) to assess the cost savings derived from a selective EUS-FNA approach. METHODS A total of 144 patients with esophageal carcinoma were prospectively evaluated with EUS. Accuracy of standard (hypoechoic, smooth border, round, or width > 5 mm) and modified (4 standard plus EUS identified celiac lymph nodes, >5 lymph nodes, or EUS T3/4 tumor) criteria were compared (receiver operating characteristic curves). Resource utilization of two diagnostic strategies, routine (all patients with lymph nodes) and selective EUS-FNA (FNA only in those patients in whom the number of EUS malignant criteria provides a sensitivity and a specificity <100%), were compared. RESULTS Modified EUS criteria for lymph-node staging were more accurate than standard criteria (area under the curve 0.88 vs. 0.78, respectively). No criterion alone was predictive of malignancy; sensitivity and specificity reached 100% when a cutoff value of >1 and >6 modified criteria were used, respectively. The EUS-FNA selective approach may avoid performing FNA in 61 patients (42%). CONCLUSIONS Modified EUS lymph-node criteria are more accurate than standard criteria. A selective EUS-FNA approach reduced the cost by avoiding EUS-FNA in 42% of patients with esophageal carcinoma. These results require confirmation in future studies.
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Affiliation(s)
- Enrique Vazquez-Sequeiros
- ivision of Gastroenterology and Hepatology, Pathology Department, Mayo Clinic Rochester, Rochester, Minnesota, USA
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Montalban C, Santón A, Redondo C, García-Cosio M, Boixeda D, Vazquez-Sequeiros E, Norman F, de Argila CM, Alvarez I, Abraira V, Bellas C. Long-term persistence of molecular disease after histological remission in low-grade gastric MALT lymphoma treated with H. pylori eradication. Lack of association with translocation t(11;18): a 10-year updated follow-up of a prospective study. Ann Oncol 2005; 16:1539-44. [PMID: 15946976 DOI: 10.1093/annonc/mdi277] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Localized low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma can regress after Helicobacter pylori eradication, but IgV(H) gene monoclonality may persist. We studied the long-term histological and molecular follow-up of 24 patients and the possible association of t(11;18) with the persistent monoclonality. PATIENTS AND METHODS From January 1994, 24 untreated patients with stage I low-grade gastric MALT lymphoma associated with H. pylori were prospectively studied. They all received eradication treatment and were sequentially followed-up with endoscopies for histological and molecular studies. Rearrangement of the IgV(H) gene was studied by PCR analysis. MALT1 locus alterations were studied by FISH. RESULTS Twenty-two of the 24 patients (91%) achieved disappearance of the lymphoma. Eighteen (82%) of the 22 histologically cured patients and 16 of the 19 (84%) with long follow-up had monoclonality. Three patterns of development of IgV(H) gene rearrangements were observed: four patients (21%) had polyclonal rearrangements; eight (58%) had maintained/intermittent monoclonality and four (21%) had occasional monoclonality, mostly after H. pylori reinfection. Only one patient (6%) with persistent monoclonality relapsed. The remaining 18 patients maintained the remission, despite the persistent monoclonality in 15, for a median of 66 months (range 20-113). t(11;18) was not found in any of the patients with persistent monoclonality. Time and the number of endoscopies performed were not related with the occurrence of monoclonality. CONCLUSIONS In stage I low-grade gastric MALT lymphoma eradication of H. pylori achieves prolonged histological remission in 90% of patients, but molecular remission is not accomplished in most cases. Molecular disease persists for years, but is not associated with t(11;18).
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MESH Headings
- Anti-Bacterial Agents/administration & dosage
- Chromosomes, Human, Pair 11
- Chromosomes, Human, Pair 18
- Helicobacter pylori/drug effects
- Humans
- Lymphoma, B-Cell, Marginal Zone/drug therapy
- Lymphoma, B-Cell, Marginal Zone/genetics
- Lymphoma, B-Cell, Marginal Zone/microbiology
- Prospective Studies
- Stomach Neoplasms/drug therapy
- Stomach Neoplasms/genetics
- Stomach Neoplasms/microbiology
- Translocation, Genetic
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Affiliation(s)
- C Montalban
- Department of Internal Medicine, Hospital Ramón y Cajal, Madrid, Spain.
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Rajan E, Clain JE, Levy MJ, Norton ID, Wang KK, Wiersema MJ, Vazquez-Sequeiros E, Nelson BJ, Jondal ML, Kendall RK, Harmsen WS, Zinsmeister AR. Age-related changes in the pancreas identified by EUS: a prospective evaluation. Gastrointest Endosc 2005; 61:401-6. [PMID: 15758911 DOI: 10.1016/s0016-5107(04)02758-0] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND EUS is an important modality for the diagnosis of pancreatic disease. An understanding of normal pancreatic ductal and parenchymal variation in asymptomatic individuals is essential to improve EUS accuracy. The primary aim of this study was to determine age-related pancreatic parenchymal and ductular changes identifiable on EUS in individuals with no history or symptoms of pancreaticobiliary disease. Secondary aims were to define demographic and clinical factors associated with identifiable pancreatic parenchymal and ductular changes, and to determine the main pancreatic-duct diameter and pancreatic-gland width according to age. METHODS Patients referred for either upper endoscopy or EUS for an indication unrelated to pancreaticobiliary disease were prospectively enrolled. Patients were stratified by age (<40, 40-60, >60 years). Each patient was assessed for the presence of EUS findings for chronic pancreatitis. Logistic regression was used to identify factors associated with an abnormality. RESULTS A total of 120 patients (63 men, 57 women; median age, 52 years, interquartile range [IQR] 40-61 years) were prospectively evaluated. At least one parenchymal and/or ductular abnormality was identified in 28% of the patients, with a trend of increasing abnormality with age: <40 years (23%), 40 to 60 years (25%), and >60 years (39%); p = 0.13. No patient had more than 3 abnormal EUS features. Hyperechoic stranding (n = 22) was the most common finding in all age groups. The odds for any abnormality in men (relative to women) was significantly higher (OR 2.9: 95% CI[1.2, 6.8], p = 0.01), with 38% of men and 18% of women having an abnormality. Smoking, low alcohol intake, body mass index, and endoscopic finding were not significantly associated with an abnormal EUS. The overall median pancreatic-gland width and main pancreatic duct diameter were 15 mm (IQR 6-25 mm) and 1.7 mm (IQR 0.9-4.3 mm), respectively. CONCLUSIONS The frequency of EUS abnormalities in patients without clinical evidence of chronic pancreatitis increases with age, particularly after 60 years of age. The threshold number of EUS criteria for the diagnosis of chronic pancreatitis is variable. However, the typically used standard of 3 or more criteria appears appropriate. A higher number of threshold criteria may be needed in males and to a lesser extent in patients over 40 years of age, which should be related to clinical history and other structural or functional studies. Ductal or parenchymal calculi, ductal narrowing, ductal dilatation, or more than 3 abnormalities appear to be more specific features for the EUS diagnosis of chronic pancreatitis at any age.
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Affiliation(s)
- Elizabeth Rajan
- Division of Gastroenterology and Hepatology, Charlton 8-A, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
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Vazquez-Sequeiros E, Wiersema MJ, Clain JE, Norton ID, Levy MJ, Romero Y, Salomao D, Dierkhising R, Zinsmeister AR. Impact of lymph node staging on therapy of esophageal carcinoma. Gastroenterology 2003; 125:1626-35. [PMID: 14724814 DOI: 10.1053/j.gastro.2003.08.036] [Citation(s) in RCA: 153] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND & AIMS Therapy of esophageal carcinoma is stage dependent. The role of EUS-guided fine-needle aspiration (EUS FNA) in this setting is unclear. The aims of this study were to compare the performance characteristics of CT, EUS, and EUS FNA for preoperative nodal staging of esophageal carcinoma and to measure the impact of each staging test on treatment decisions. METHODS From December 1999 to March 2001, all patients with esophageal carcinoma seen at the Mayo Clinic Rochester were prospectively evaluated with CT, EUS, and EUS FNA. The impact of tumor stage on final therapy was assessed. RESULTS A total of 125 patients with esophageal carcinoma were enrolled. EUS FNA was more sensitive (83% vs. 29%; P < 0.001) than CT and more accurate than CT (87% vs. 51%; P < 0.001) or EUS (87% vs. 74%; P = 0.012) for nodal staging. Direct surgical resection was contraindicated in 77% of patients evaluated due to advanced locoregional/metastatic disease. Tumor location, patient age, comorbidities, and tumor stage determined by CT, EUS, and EUS FNA were associated with treatment decisions (P < 0.05). EUS FNA resulting in a higher/worse stage than CT (41 patients) was associated with a greater rate of treatments that were not direct surgeries compared with cases in which the stage was the same or better. CONCLUSIONS EUS FNA is more accurate for nodal staging and impacts on therapy of patients with esophageal carcinoma. EUS FNA should be included in the preoperative staging algorithm of these patients.
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Levy MJ, Norton ID, Wiersema MJ, Schwartz DA, Clain JE, Vazquez-Sequeiros E, Wilson WR, Zinsmeister AR, Jondal ML. Prospective risk assessment of bacteremia and other infectious complications in patients undergoing EUS-guided FNA. Gastrointest Endosc 2003; 57:672-8. [PMID: 12709695 DOI: 10.1067/mge.2003.204] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND There are few data regarding the risk of bacteremia with EUS-guided FNA. This study prospectively evaluated the frequency of bacteremia and other infectious complications after EUS-guided FNA. METHODS Patients referred for EUS-guided FNA of the upper GI tract lesions were considered for enrollment. Patients were excluded if there was an indication for preprocedure administration of antibiotics based on ASGE guidelines, had taken antibiotics within the prior 7 days, or if they had a pancreatic cystic lesion. Blood cultures were obtained immediately before the procedure, after routine endoscopy/radial EUS, and 15 minutes after EUS-guided FNA. RESULTS Fifty-two patients underwent EUS-guided FNA at 74 sites (mean 1.4 sites/patient) totaling 266 passes of the fine needle (mean 5.1 FNA/patient). Coagulase negative Staphylococcus was grown in cultures from 3 patients (5.8%; 95% CI [1%, 15%]) and was considered a contaminant. Three patients (5.8%; 95% CI [1%, 15%]) developed bacteremia: Streptococcus viridans (n = 2), unidentified gram-negative bacillus (n = 1). No signs or symptoms of infection developed in any patient. CONCLUSION EUS-guided FNA of solid lesions in the upper GI tract should be considered a low-risk procedure for infectious complications that does not warrant prophylactic administration of antibiotics for prevention of bacterial endocarditis.
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Affiliation(s)
- Michael J Levy
- Division of Gastroenterology and Hepatology, Mayo Clinic Foundation, Rochester, Minnesota 55905, USA
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Abstract
BACKGROUND The learning curve for EUS-guided FNA (EUS-FNA) is formidable. Development of a phantom to assist in teaching the technique may be beneficial. This study assessed the feasibility of using a low-cost phantom made of commonly available materials to practice EUS-FNA. METHODS A 2500-mL barium enema bag was modified by running a plastic tube (3-mm inner diameter) through it and sealing one end. One hundred grams of standard agar were suspended in 4 liters of tap water. The broth was heated slowly to boiling. The dissolved agar was then transferred to the barium enema bag after mixing in diced carrots, elbow macaroni, peas, and fingertips of surgical gloves filled with 5 mL of normal saline solution (6 of each) to simulate solid and cystic lesions. Immersion of the phantom in a basin of water provided acoustic coupling. One end of the 3-mm plastic tubing was attached to the nozzle of a water jet device and the other end to its reservoir to create a closed system allowing water recirculation. A linear array echoendoscope and a fine needle were used to perform EUS-FNA. The analysis is descriptive. OBSERVATIONS The phantom was readily made with inexpensive components (total cost <$50). With refrigeration the phantom was used repetitively during a 4-month period. It produced EUS images with an echotexture comparable with liver. The solid and cystic components resembled hepatic cysts and solid masses encountered when performing EUS in humans. Under EUS-guidance, fine-needle aspirates of selected lesions could be performed allowing targeting, aspiration, and sampling of selected lesions. The Doppler flow effect allowed examination of a simulated vascular structure during FNA. CONCLUSIONS Once validated, an EUS phantom made of simple components may become an invaluable educational tool for teaching EUS-FNA. Further studies are needed to determine how it affects the skills of gastroenterologists with and without EUS experience.
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Affiliation(s)
- Darius Sorbi
- Mayo Clinic Scottsdale, Scottsdale, Arizona 85259, USA
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Vazquez-Sequeiros E, Wiersema MJ. Peroral pancreatoscopy and intraductal ultrasound for diagnosis of intraductal papillary mucinous tumors of the pancreas. Am J Gastroenterol 2002; 97:2915-7. [PMID: 12425569 DOI: 10.1111/j.1572-0241.2002.07040.x] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
BACKGROUND Preoperative differentiation of benign and malignant/potentially malignant pancreatic cystic lesions is problematic. Data to support the role of EUS and EUS-guided fine-needle aspiration (EUS-FNA) are limited. This study assessed the sensitivity, specificity, and accuracy of EUS, cytopathology, and analysis of cyst fluid for pancreatic cystic lesions. METHODS Retrospectively, 111 consecutive patients were identified (54 men, 57 women; mean age 59 years, range 18-79 years) who underwent EUS from July 1997 to September 2000 because of known or suspected pancreatic cystic lesions based on CT or transabdominal US. Thirty-four patients (16 men, 18 women; mean age 55 years, 25-79 years) who underwent surgery formed the basis for this analysis. EUS diagnosis was compared with surgical pathology. Selected patients underwent EUS-FNA to obtain specimens for cytopathologic analysis and for determination of carcinoembryonic antigen levels. Based on surgical pathology, cysts were classified as benign (simple cyst, pseudocyst, serous cystadenoma) or malignant/potentially malignant (mucinous cystadenoma, intraductal papillary mucinous tumor, cystic islet cell tumor, cystic adenocarcinoma). RESULTS EUS-FNA with cytopathologic assessment of cyst fluid was performed for 18 of the 34 patients; carcinoembryonic antigen level was determined in 11 cases. For EUS, cytopathology, and carcinoembryonic antigen, sensitivity was, respectively, 91%, (p = 0.01 vs. cytology), 27%, and 28%; specificity was, respectively, 60%, 100%, and 25%; and, accuracy was, respectively, 82%, 55%, and 27%. The sensitivity of EUS in all 13 patients with cystic islet cell tumor, intraductal papillary mucinous tumor, or cystic adenocarcinoma was 100%. Combining EUS, cytopathology, and carcinoembryonic antigen results did not improve accuracy. There were no complications related to the EUS or EUS-FNA. CONCLUSIONS EUS alone is sensitive and accurate in identifying malignant/potentially malignant pancreatic cystic lesions. EUS-FNA to obtain specimens for cytopathologic analysis and determination of carcinoembryonic antigen levels, although safe, does not enhance diagnostic yield.
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Affiliation(s)
- Robert Sedlack
- Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA
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Abstract
BACKGROUND Existing EUS catheter probes have limited depth of penetration and lack color flow and Doppler capabilities. This study prospectively assessed the feasibility and safety of using a phased vector array US catheter in the human GI tract. METHODS Eleven patients underwent EUS with a steerable 9F phased vector array catheter. Images obtained with the catheter were compared with standard EUS images. RESULTS The GI wall layers were equally well imaged with the catheter compared with standard echoendoscopes in 90% of the cases. Images of the liver, spleen, pancreatic parenchyma, and pancreatic duct were of equal quality and resolution with both techniques in the majority of patients. Some deeper structures and blood vessels were better visualized with the catheter. No complications were encountered. CONCLUSION The steerable phased vector array US catheter is a safe device when used in the GI tract and offers images comparable with those obtained with a dedicated echoendoscope. Further studies are needed to determine the accuracy of tumor staging and clinical utility of this device.
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Affiliation(s)
- Dany K Shamoun
- Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA
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