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Maan R, Lauw MN, China L, Patch D, Baiges A, Garcia-Pagan JC, Hernández-Gea V, Hilleret MN, Tjwa ET, Kounis I, Bureau C, Giguet B, Heurgué A, Ollivier-Hourmand I, Causse X, Nery F, Eshraghian A, Plessier A, Darwish Murad S. Extensive splanchnic vein thrombosis after SARS-CoV-2 vaccination: A Vascular Liver Disease Group (VALDIG) initiative. Hepatology 2024:01515467-990000000-00747. [PMID: 38358465 DOI: 10.1097/hep.0000000000000787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/20/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND AND AIMS Since the introduction of SARS-CoV-2 vaccines, several cases of vaccine-induced immune thrombocytopenia and thrombosis (VITT) have been described, especially cerebral vein thrombosis. We aimed to retrospectively collect all new cases of acute onset first or recurrent splanchnic vein thrombosis (SVT) following a recent SARS-CoV-2 vaccination within the Vascular Liver Disease Group network. APPROACH AND RESULTS New cases of SVT were identified from April 2021 to April 2022; follow-up was completed on December 31, 2022. Criteria to define VITT were derived from previous studies. Data from a pre-COVID cohort of patients with SVT (N=436) were used for comparison of clinical presentation, etiology, and outcome. Twenty-nine patients were identified with SVT occurring with a median of 11 days (range 2-76) after the first (48%), second (41%), or third (10%) vaccination (ChAdOx1 nCov-19 (n=12) or BNT162b2 (n=14), other (n=3) Only 2 patients(7%) fulfilled criteria for definite VITT. Twenty (69%) had SVT at multiple sites, including 4 (14%) with concomitant extra-abdominal thrombosis. Only 28% had an underlying prothrombotic condition, compared to 52% in the pre-COVID SVT cohort ( p =0.01). Five patients (17%) underwent bowel resection for mesenteric ischemia, compared with 3% in pre-COVID SVT ( p <0.001). Two patients died shortly after diagnosis (7%). CONCLUSIONS Although definite VITT was rare, in 72% of cases, no other cause for SVT could be identified following SARS-CoV-2 vaccination. These cases were different from patients with nonvaccine-related SVT, with lower incidence of prothrombotic conditions, higher rates of bowel ischemia, and poorer outcome. Although SVT after SARS-CoV-2 vaccination is rare in absolute terms, these data remain relevant considering ongoing revaccination programs.
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Affiliation(s)
- Raoel Maan
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mandy N Lauw
- Department of Hematology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Loise China
- Institute of Liver and Digestive Health, University College London, United Kingdom
| | - David Patch
- Hepatology and Liver Transplantation, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Anna Baiges
- v Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic Barcelona, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona. CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas)
| | - Juan Carlos Garcia-Pagan
- v Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic Barcelona, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona. CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas)
| | - Virginia Hernández-Gea
- v Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic Barcelona, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona. CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas)
| | - Marie-Noelle Hilleret
- Service d'Hépato-Gastroentérologie, CHU Grenoble Alpes, 38043 Grenoble Cedex, France
| | - Eric T Tjwa
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ilias Kounis
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire ; Inserm, Université Paris-Saclay, Université Paris-Saclay, Inserm, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, France
| | - Christophe Bureau
- University Hospital of Toulouse and Toulouse III Paul Sabatier University, Toulouse, France
| | - Baptiste Giguet
- Liver Disease Department, CHU Rennes, Univ Rennes, Rennes, France
| | | | | | - Xavier Causse
- Department of Hepatology and Gastroenterology, Orleans, France
| | - Filipe Nery
- Centro Hospitalar Universitário de Santo António, Porto, Portugal
- EpiUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Ahad Eshraghian
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz, Iran
| | - Aurélie Plessier
- Université de Paris, AP-HP, Hôpital Beaujon, Service d'Hépatologie, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, Centre de recherche sur l'inflammation, Inserm, Paris, France
| | - Sarwa Darwish Murad
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Kocheise L, Piseddu I, Vonderlin J, Tjwa ET, Buescher G, Meunier L, Goeggelmann P, Fianchi F, Dumortier J, Barciela MR, Gevers TJG, Beretta-Piccoli BT, Londoño MC, Frankova S, Roesner T, Joerg V, Schmidt C, Glaser F, Sutter JP, Fründt TW, Lohse AW, Huber S, von Felden J, Sebode M, Schulze K. Corrigendum: PD-1/PD-L1 immune checkpoint therapy demonstrates favorable safety profile in patients with autoimmune and cholestatic liver disease. Front Immunol 2024; 15:1369747. [PMID: 38327519 PMCID: PMC10848160 DOI: 10.3389/fimmu.2024.1369747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 02/09/2024] Open
Abstract
[This corrects the article DOI: 10.3389/fimmu.2023.1326078.].
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Affiliation(s)
- Lorenz Kocheise
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Ignazio Piseddu
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Department of Medicine II, University Hospital, Ludwig-Maximilians-Universität (LMU) München, Munich, Germany
| | - Joscha Vonderlin
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Department of Hepatology and Gastroenterology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Eric T. Tjwa
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Department of Gastroenterology and Hepatology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Gustav Buescher
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Lucy Meunier
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Service Hépato-Gastro Entérologie, Hôpital St-Eloi, CHU Montpellier, Montpellier, France
| | - Pia Goeggelmann
- Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany
| | - Francesca Fianchi
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- CEMAD-Centro Malattie dell’Apparato Digerente, Fondazione Policlinico Universitario Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Jérôme Dumortier
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Service d’hépato-gastroentérologie, Hôpital Edouard Herriot – Hospices civils de Lyon, Université de Lyon, Lyon, France
| | - Mar Riveiro Barciela
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Liver Unit, Department of Internal Medicine, Hospital Universitari Valle d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tom J. G. Gevers
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Department of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, Netherlands
- Nutrim School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Benedetta Terziroli Beretta-Piccoli
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Epatocentro Ticino, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- MowatLabs, Faculty of Life Sciences & Medicine, King’s College London, King’s College Hospital, London, United Kingdom
| | - Maria-Carlota Londoño
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Liver Unit, Hospital Clinic Barcelona, FCRB-IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Sona Frankova
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Thomas Roesner
- Department of Medical Oncology, National Center of Tumor Diseases (NCT) Heidelberg and Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Vincent Joerg
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Constantin Schmidt
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Fabian Glaser
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Jan P. Sutter
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Thorben W. Fründt
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Ansgar W. Lohse
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Samuel Huber
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Johann von Felden
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Marcial Sebode
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Kornelius Schulze
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
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Kocheise L, Piseddu I, Vonderlin J, Tjwa ET, Buescher G, Meunier L, Goeggelmann P, Fianchi F, Dumortier J, Riveiro Barciela M, Gevers TJG, Terziroli Beretta-Piccoli B, Londoño MC, Frankova S, Roesner T, Joerg V, Schmidt C, Glaser F, Sutter JP, Fründt TW, Lohse AW, Huber S, von Felden J, Sebode M, Schulze K. PD-1/PD-L1 immune checkpoint therapy demonstrates favorable safety profile in patients with autoimmune and cholestatic liver disease. Front Immunol 2024; 14:1326078. [PMID: 38268921 PMCID: PMC10805832 DOI: 10.3389/fimmu.2023.1326078] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Immune checkpoint inhibitors (ICI) have revolutionized the treatment of many malignancies in recent years. However, immune-related adverse events (irAE) are a frequent concern in clinical practice. The safety profile of ICI for the treatment of malignancies in patients diagnosed with autoimmune and cholestatic liver disease (AILD) remains unclear. Due to this uncertainty, these patients were excluded from ICI clinical trials and ICI are withheld from this patient group. In this retrospective multicenter study, we assessed the safety of ICI in patients with AILD. Methods We contacted tertiary referral hospitals for the identification of AILD patients under ICI treatment in Europe via the European Reference Network on Hepatological Diseases (ERN RARE-LIVER). Fourteen centers contributed data on AILD patients with malignancies being treated with ICI, another three centers did not treat these patients with ICI due to fear of irAEs. Results In this study, 22 AILD patients under ICI treatment could be identified. Among these patients, 12 had primary biliary cholangitis (PBC), five had primary sclerosing cholangitis (PSC), four had autoimmune hepatitis (AIH), and one patient had an AIH-PSC variant syndrome. Eleven patients had hepatobiliary cancers and the other 11 patients presented with non-hepatic tumors. The applied ICIs were atezolizumab (n=7), durvalumab (n=5), pembrolizumab (n=4), nivolumab (n=4), spartalizumab (n=1), and in one case combined immunotherapy with nivolumab plus ipilimumab. Among eight patients who presented with grade 1 or 2 irAEs, three demonstrated liver irAEs. Cases with grades ≥ 3 irAEs were not reported. No significant changes in liver tests were observed during the first year after the start of ICI. Discussion This European multicenter study demonstrates that PD-1/PD-L1 inhibitors appear to be safe in patients with AILD. Further studies on the safety of more potent dual immune checkpoint therapy are needed. We conclude that immunotherapy should not categorically be withheld from patients with AILD.
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Affiliation(s)
- Lorenz Kocheise
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Ignazio Piseddu
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Department of Medicine II, University Hospital, Ludwig-Maximilians-Universität (LMU) München, Munich, Germany
| | - Joscha Vonderlin
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Department of Hepatology and Gastroenterology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Eric T. Tjwa
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Department of Gastroenterology and Hepatology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Gustav Buescher
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Lucy Meunier
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Service Hépato-Gastro Entérologie, Hôpital St-Eloi, CHU Montpellier, Montpellier, France
| | - Pia Goeggelmann
- Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany
| | - Francesca Fianchi
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- CEMAD-Centro Malattie dell’Apparato Digerente, Fondazione Policlinico Universitario Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Jérôme Dumortier
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Service d’hépato-gastroentérologie, Hôpital Edouard Herriot – Hospices civils de Lyon, Université de Lyon, Lyon, France
| | - Mar Riveiro Barciela
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Liver Unit, Department of Internal Medicine, Hospital Universitari Valle d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tom J. G. Gevers
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Department of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, Netherlands
- Nutrim School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Benedetta Terziroli Beretta-Piccoli
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Epatocentro Ticino, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- MowatLabs, Faculty of Life Sciences & Medicine, King’s College London, King’s College Hospital, London, United Kingdom
| | - Maria-Carlota Londoño
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Liver Unit, Hospital Clinic Barcelona, FCRB-IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Sona Frankova
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Thomas Roesner
- Department of Medical Oncology, National Center of Tumor Diseases (NCT) Heidelberg and Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Vincent Joerg
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Constantin Schmidt
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Fabian Glaser
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Jan P. Sutter
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Thorben W. Fründt
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Ansgar W. Lohse
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Samuel Huber
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Johann von Felden
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Marcial Sebode
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Kornelius Schulze
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
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van den Reek JMPA, Menting SP, Janssen WWL, Dhaliwal R, Heijboer AC, van Herwaarden AE, Sweep FCGJ, de Jong LM, Tjwa ET, Otero ME, Spuls PI, de Jong EMGJ. Procollagen-3 N-terminal peptide measurements for the detection of liver fibrosis in methotrexate-treated patients with psoriasis: daily practice use and clinical implications. Br J Dermatol 2017; 177:1454-1457. [PMID: 28112796 DOI: 10.1111/bjd.15313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- J M P A van den Reek
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - S P Menting
- Department of Dermatology, Academic Medical Centre, Amsterdam, the Netherlands
| | - W W L Janssen
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - R Dhaliwal
- Department of Allergology, University Medical Center, Groningen, the Netherlands
| | - A C Heijboer
- Department of Clinical Chemistry, Endocrine Laboratory, VU University Medical Center, Amsterdam, the Netherlands
| | - A E van Herwaarden
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - F C G J Sweep
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - L M de Jong
- Department of Dermatology, Ziekenhuis Gelderse Vallei, Ede, the Netherlands
| | - E T Tjwa
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - M E Otero
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - P I Spuls
- Department of Dermatology, Academic Medical Centre, Amsterdam, the Netherlands
| | - E M G J de Jong
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands.,Radboud University, Nijmegen, the Netherlands
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Veldhuijzen G, Klemt-Kropp M, Noomen C, Van Esch AA, Tjwa ET, Drenth J. Computer-assisted instruction before colonoscopy is as effective as nurse counselling, a clinical pilot trial. Endosc Int Open 2017; 5:E792-E797. [PMID: 28791330 PMCID: PMC5546893 DOI: 10.1055/s-0043-110813] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 10/25/2016] [Accepted: 03/02/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Better patient education prior to colonoscopy improves adherence to instructions for bowel preparation and leads to cleaner colons. We reasoned that computer assisted instruction (CAI) using video and 3 D animations followed by nurse contact maximizes the effectiveness of nurse counselling, increases proportion of clean colons and improves patient experience. PATIENTS AND METHODS Adults referred for colonoscopy in a high-volume endoscopy unit in the Netherlands were included. Exclusion criteria were illiteracy in Dutch and audiovisual handicaps. Patients were prospectively divided into 2 groups, 1 group received nurse counselling and 1 group received CAI and a nurse contact before colonoscopy. The main outcome, cleanliness of the colon during examination, was measured with Ottawa Bowel Preparation Scale (OBPS) and Boston Bowel Preparation Scale (BBPS). We assessed patient comfort and anxiety at 3 different time points. RESULTS We included 385 patients: 197 received traditional nurse counselling and 188 received CAI. Overall patient response rates were 99 %, 76.4 % and 69.9 % respectively. Endoscopists scored cleanliness in 60.8 %. Comparative analysis of the 39.2 % of patients with missing scores showed no significant difference on age, gender or educational level. Baseline characteristics were evenly distributed over the groups. Bowel cleanliness was satisfactory and did not differ amongst groups: nurse vs. CAI group scores in BBPS: (6.54 ± 1.69 vs. 6.42 ± 1.62); OBPS: (6.07 ± 2.53 vs. 5.80 ± 2.90). Patient comfort scores were significantly higher (4.29 ± 0.62 vs. 4.42 ± 0.68) in the CAI group shortly before colonoscopy. Anxiety and knowledge scores were similar. CONCLUSION CAI is a safe and practical tool to instruct patients before colonoscopy. We recommend the combination of CAI with a short nurse contact for daily practice.
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Affiliation(s)
- Govert Veldhuijzen
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands,Corresponding author Govert Veldhuijzen Department of Gastroenterology and HepatologyRadboud University Medical CentreGeert Grooteplein 8Nijmegen 6500 HB, the Netherlands+31243635129
| | - Michael Klemt-Kropp
- Department of Gastroenterology and Hepatology, Medical Centre Alkmaar, Alkmaar, The Netherlands
| | - Casper Noomen
- Department of Gastroenterology and Hepatology, Medical Centre Alkmaar, Alkmaar, The Netherlands
| | - Aura A. Van Esch
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Eric T. Tjwa
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Joost Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
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