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Ribeiro T, Mascarenhas M, Cardoso H, Macedo G. Bowel Obstruction after Liver Transplant: A Rare Cause. GE Port J Gastroenterol 2024; 31:145-147. [PMID: 38572441 PMCID: PMC10987167 DOI: 10.1159/000533162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/21/2023] [Indexed: 04/05/2024]
Affiliation(s)
- Tiago Ribeiro
- Department of Gastroenterology, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, Porto, Portugal
- World Gastroenterology Organization Gastroenterology and Hepatology Training Center, Porto, Portugal
| | - Miguel Mascarenhas
- Department of Gastroenterology, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, Porto, Portugal
- World Gastroenterology Organization Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro, Porto, Portugal
| | - Hélder Cardoso
- Department of Gastroenterology, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, Porto, Portugal
- World Gastroenterology Organization Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro, Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, Porto, Portugal
- World Gastroenterology Organization Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro, Porto, Portugal
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Rosa B, Andrade P, Lopes S, Gonçalves AR, Serrazina J, Marílio Cardoso P, Silva A, Macedo Silva V, Cotter J, Macedo G, Figueiredo PN, Chagas C. Pan-Enteric Capsule Endoscopy: Current Applications and Future Perspectives. GE Port J Gastroenterol 2024; 31:89-100. [PMID: 38572440 PMCID: PMC10987171 DOI: 10.1159/000533960] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/13/2023] [Indexed: 04/05/2024]
Abstract
Background The role of capsule endoscopy in the evaluation of the small bowel is well established, and current guidelines position it as a first-line test in a variety of clinical scenarios. The advent of double-headed capsules further enabled the endoscopic assessment of colonic mucosa and the opportunity for a one-step noninvasive examination of the entire bowel (pan-enteric capsule endoscopy [PCE]). Summary We reviewed the technical procedure and preparation of patients for PCE, as well as its current clinical applications and future perspectives. In non-stricturing and non-penetrating Crohn's disease affecting the small bowel and colon, PCE monitors disease activity by assessing mucosal healing, a major treatment outcome, with a higher diagnostic yield than cross-sectional imaging or conventional colonoscopy. Also in ulcerative colitis, double-headed capsules have been used to monitor disease activity noninvasively. Currently, validated scoring systems have been specifically devised for these double-headed capsules and permit a standardized assessment of the inflammatory burden. In suspected mid-lower digestive bleeding, some exploratory studies have demonstrated the feasibility and high diagnostic yield of PCE, which may work as a filter indicating which patients may benefit of further invasive procedures, namely, for planned hemostatic procedures. The possibility of using PCE is also discussed in the context of polyposis syndromes with simultaneous involvement of the small intestine and colon. Key Messages PCE is a feasible, effective, and safe diagnostic procedure to evaluate the small bowel and colon. It has been increasingly explored in the setting of inflammatory bowel diseases and, more recently, in suspected mid-lower digestive bleeding. PCE is expected to reduce the demand for invasive procedures and expand the scope of noninvasive intestinal evaluation in the coming future.
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Affiliation(s)
- Bruno Rosa
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Patrícia Andrade
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center Porto, Porto, Portugal
| | - Sandra Lopes
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Rita Gonçalves
- Gastroenterology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Juliana Serrazina
- Gastroenterology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Pedro Marílio Cardoso
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center Porto, Porto, Portugal
| | - Andrea Silva
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Vítor Macedo Silva
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - José Cotter
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center Porto, Porto, Portugal
| | - Pedro Narra Figueiredo
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Cristina Chagas
- Gastroenterology Department, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
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Ribeiro T, Lopes S, Moutinho-Ribeiro P, Macedo G, Vilas-Boas F. Performance of Intracystic Glucose Measurement for the Characterization of Pancreatic Cystic Lesions. J Gastrointestin Liver Dis 2024; 33:74-78. [PMID: 38554431 DOI: 10.15403/jgld-5330] [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] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/17/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND AND AIMS Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) is essential for the classification of pancreatic cystic lesions (PCLs). Recently, intracystic glucose has been suggested as an alternative to carcinoembryonic antigen (CEA) level as a predictor of mucinous cystic lesions (M-PCLs). This study aims to evaluate the diagnostic performance of intra-cystic glucose in distinguishing between M-PCLs and non M-PCLs (NM-PCLs) and to analyze the possibility of on-site glucose measurement with a standard glucometer. METHODS Patients with PCLs submitted to EUS-FNA with simultaneous intracystic glucose measurement between 2017 and 2022 were included. The diagnostic performance of glucose versus CEA for the differentiation between M-PCLs and NM-PCLs was compared to a final diagnosis based on the analysis of surgical specimen, intracystic biopsy or, if this data was unavailable, multidisciplinary evaluation. A cut-off of <50 mg/dL was used for the diagnosis of MCLs. Additionally, the agreement between on-site glucose determination with a standard glucometer and laboratory glucose measurement was assessed. RESULTS Mucinous lesions accounted for 56% of all PCLs. The median values of glucose and CEA for M-PCLs were 18 mg/dL and 286 ng/mL, respectively. Intracystic glucose had a sensitivity and specificity of 93.2% and 76.5%, respectively, for the diagnosis of MCLs (versus 55.6% and 87.5%, respectively, for CEA). The area under the curve was 0.870 for on-site glucose (versus 0.806 for CEA). An excellent correlation was observed between on-site and laboratory glucose measurement (ρ=0.919). CONCLUSIONS The measurement of intracystic glucose showed superior performance compared with CEA in distinguishing between M-PCLs and NM-PCLs, with excellent correlation between on-site and conventional lab glucose measurement. Thus, on-site intracystic glucose appears to be an excellent biomarker for the characterization of PCLs due to its low cost, high availability, and the need for a minimal cyst fluid volume for its determination.
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Affiliation(s)
- Tiago Ribeiro
- Department of Gastroenterology Centro Hospitalar e Universitário de São João Alameda Professor Hernani Monteiro 4200-319 Porto, Portugal.
| | - Susana Lopes
- Department of Gastroenterology Centro Hospitalar e Universitário de São João Alameda Professor Hernani Monteiro 4200-319 Porto, Portugal.
| | - Pedro Moutinho-Ribeiro
- Department of Gastroenterology Centro Hospitalar e Universitário de São João Alameda Professor Hernani Monteiro 4200-319 Porto, Portugal.
| | - Guilherme Macedo
- Department of Gastroenterology Centro Hospitalar e Universitário de São João Alameda Professor Hernani Monteiro 4200-319 Porto, Portugal.
| | - Filipe Vilas-Boas
- Department of Gastroenterology Centro Hospitalar e Universitário de São João Alameda Professor Hernani Monteiro 4200-319 Porto, Portugal.
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Slooter CD, van den Brand FF, Lleo A, Colapietro F, Lenzi M, Muratori P, Kerkar N, Dalekos GN, Zachou K, Lucena MI, Robles-Díaz M, Di Zeo-Sánchez DE, Andrade RJ, Montano-Loza AJ, Lytvyak E, Lissenberg-Witte BI, Maisonneuve P, Bouma G, Macedo G, Liberal R, de Boer YS. Lack of complete biochemical response in autoimmune hepatitis leads to adverse outcome: First report of the IAIHG retrospective registry. Hepatology 2024; 79:538-550. [PMID: 37676683 DOI: 10.1097/hep.0000000000000589] [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: 02/05/2023] [Accepted: 08/02/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND AND AIMS The International Autoimmune Hepatitis Group retrospective registry (IAIHG-RR) is a web-based platform with subjects enrolled with a clinical diagnosis of autoimmune hepatitis (AIH). As prognostic factor studies with enough power are scarce, this study aimed to ascertain data quality and identify prognostic factors in the IAIHG-RR cohort. METHODS This retrospective, observational, multicenter study included all patients with a clinical diagnosis of AIH from the IAIHG-RR. The quality assessment consisted of external validation of completeness and consistency for 29 predefined variables. Cox regression was used to identify risk factors for liver-related death and liver transplantation (LT). RESULTS This analysis included 2559 patients across 7 countries. In 1700 patients, follow-up was available, with a completeness of individual data of 90% (range: 30-100). During a median follow-up period of 10 (range: 0-49) years, there were 229 deaths, of which 116 were liver-related, and 143 patients underwent LT. Non-White ethnicity (HR 4.1 95% CI: 2.3-7.1), cirrhosis (HR 3.5 95% CI: 2.3-5.5), variant syndrome with primary sclerosing cholangitis (PSC) (HR 3.1 95% CI: 1.6-6.2), and lack of complete biochemical response within 6 months (HR 5.7 95% CI: 3.4-9.6) were independent prognostic factors. CONCLUSIONS The IAIHG-RR represents the world's largest AIH cohort with moderate-to-good data quality and a relevant number of liver-related events. The registry is a suitable platform for patient selection in future studies. Lack of complete biochemical response to treatment, non-White ethnicity, cirrhosis, and PSC-AIH were associated with liver-related death and LT.
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Affiliation(s)
- Charlotte D Slooter
- Department of Gastroenterology and Hepatology, Amsterdam UMC, AGEM Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Floris F van den Brand
- Department of Gastroenterology and Hepatology, Amsterdam UMC, AGEM Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ana Lleo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Francesca Colapietro
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marco Lenzi
- Department of Clinical Medicine, University of Bologna, Bologna, Italy
| | - Paolo Muratori
- Department of Sciences for the Quality of Life, University of Bologna, Bologna, Italy
| | - Nanda Kerkar
- Department of Gastroenterology, Hepatology and Nutrition, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, USA
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, Expertise Center of Greece in Autoimmune Liver Diseases, European Reference Network on Hepatological Diseases (ERN-RARE LIVER), General University Hospital of Larissa, Larissa, Greece
| | - Kalliopi Zachou
- Department of Medicine and Research Laboratory of Internal Medicine, Expertise Center of Greece in Autoimmune Liver Diseases, European Reference Network on Hepatological Diseases (ERN-RARE LIVER), General University Hospital of Larissa, Larissa, Greece
| | - M Isabel Lucena
- Liver Unit, Gastroenterology Service and Department of Medicine, Vírgen de Victoria University Hospital, University of Málaga, Malaga, Spain
| | - Mercedes Robles-Díaz
- Liver Unit, Gastroenterology Service and Department of Medicine, Vírgen de Victoria University Hospital, University of Málaga, Malaga, Spain
| | - Daniel E Di Zeo-Sánchez
- Liver Unit, Gastroenterology Service and Department of Medicine, Vírgen de Victoria University Hospital, University of Málaga, Malaga, Spain
| | - Raúl J Andrade
- Liver Unit, Gastroenterology Service and Department of Medicine, Vírgen de Victoria University Hospital, University of Málaga, Malaga, Spain
| | - Aldo J Montano-Loza
- Department of Gastroenterology and Hepatology, University of Alberta Hospital, Edmonton, Canada
| | - Ellina Lytvyak
- Department of Gastroenterology and Hepatology, University of Alberta Hospital, Edmonton, Canada
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Gerd Bouma
- Department of Gastroenterology and Hepatology, Amsterdam UMC, AGEM Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Guilherme Macedo
- Department of Gastroenterology and Hepatology, Centro Hospitalar São João, Porto, Portugal
| | - Rodrigo Liberal
- Department of Gastroenterology and Hepatology, Centro Hospitalar São João, Porto, Portugal
| | - Ynto S de Boer
- Department of Gastroenterology and Hepatology, Amsterdam UMC, AGEM Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Brandão M, Mendes F, Martins M, Cardoso P, Macedo G, Mascarenhas T, Mascarenhas Saraiva M. Revolutionizing Women's Health: A Comprehensive Review of Artificial Intelligence Advancements in Gynecology. J Clin Med 2024; 13:1061. [PMID: 38398374 PMCID: PMC10889757 DOI: 10.3390/jcm13041061] [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: 12/31/2023] [Revised: 02/04/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Artificial intelligence has yielded remarkably promising results in several medical fields, namely those with a strong imaging component. Gynecology relies heavily on imaging since it offers useful visual data on the female reproductive system, leading to a deeper understanding of pathophysiological concepts. The applicability of artificial intelligence technologies has not been as noticeable in gynecologic imaging as in other medical fields so far. However, due to growing interest in this area, some studies have been performed with exciting results. From urogynecology to oncology, artificial intelligence algorithms, particularly machine learning and deep learning, have shown huge potential to revolutionize the overall healthcare experience for women's reproductive health. In this review, we aim to establish the current status of AI in gynecology, the upcoming developments in this area, and discuss the challenges facing its clinical implementation, namely the technological and ethical concerns for technology development, implementation, and accountability.
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Affiliation(s)
- Marta Brandão
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (M.B.); (P.C.); (G.M.); (T.M.)
| | - Francisco Mendes
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (F.M.); (M.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-427 Porto, Portugal
| | - Miguel Martins
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (F.M.); (M.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-427 Porto, Portugal
| | - Pedro Cardoso
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (M.B.); (P.C.); (G.M.); (T.M.)
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (F.M.); (M.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-427 Porto, Portugal
| | - Guilherme Macedo
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (M.B.); (P.C.); (G.M.); (T.M.)
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (F.M.); (M.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-427 Porto, Portugal
| | - Teresa Mascarenhas
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (M.B.); (P.C.); (G.M.); (T.M.)
- Department of Obstetrics and Gynecology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Miguel Mascarenhas Saraiva
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (M.B.); (P.C.); (G.M.); (T.M.)
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (F.M.); (M.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-427 Porto, Portugal
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Razavi-Shearer D, Child H, Razavi-Shearer K, Voeller A, Razavi H, Buti M, Tacke F, Terrault N, Zeuzem S, Abbas Z, Aghemo A, Akarca U, Al Masri N, Alalwan A, Blomé MA, Jerkeman A, Aleman S, Kamal H, Alghamdi A, Alghamdi M, Alghamdi S, Al-Hamoudi W, Ali E, Aljumah A, Altraif I, Amarsanaa J, Asselah T, Baatarkhuu O, Babameto A, Ben-Ari Z, Berg T, Biondi M, Braga W, Brandão-Mello C, Brown R, Brunetto M, Cabezas J, Cardoso M, Martins A, Chan H, Cheinquer H, Chen CJ, Yang HI, Chen PJ, Chien CH, Chuang WL, Garza LC, Coco B, Coffin C, Coppola N, Cornberg M, Craxi A, Crespo J, Cuko L, De Ledinghen V, Duberg AS, Etzion O, Ferraz M, Ferreira P, Forns X, Foster G, Fung J, Gaeta G, García-Samaniego J, Genov J, Gheorghe L, Gholam P, Gish R, Glenn J, Hamid S, Hercun J, Hsu YC, Hu CC, Huang JF, Idilman R, Jafri W, Janjua N, Jelev D, Jia J, Kåberg M, Kaita K, Kao JH, Khan A, Kim D, Kondili L, Lagging M, Lampertico P, Lázaro P, Lazarus J, Lee MH, Yang HI, Lim YS, Lobato C, Macedo G, Marinho R, Marotta P, Mendes-Correa M, Méndez-Sánchez N, Navas MC, Ning Q, Örmeci N, Orrego M, Osiowy C, Pan C, Pessoa M, Piracha Z, Pop C, Qureshi H, Raimondo G, Ramji A, Ribeiro S, Ríos-Hincapié C, Rodríguez M, Rosenberg W, Roulot D, Ryder S, Saeed U, Safadi R, Shouval D, Sanai F, Sanchez-Avila J, Santantonio T, Sarrazin C, Seto WK, Seto WK, Simonova M, Tanaka J, Tergast T, Tsendsuren O, Valente C, Villalobos-Salcedo J, Waheed Y, Wong G, Wong V, Yip T, Wong V, Wu JC, Yang HI, Yu ML, Yuen MF, Yurdaydin C, Zuckerman E. Adjusted estimate of the prevalence of hepatitis delta virus in 25 countries and territories. J Hepatol 2024; 80:232-242. [PMID: 38030035 DOI: 10.1016/j.jhep.2023.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND & AIMS Hepatitis delta virus (HDV) is a satellite RNA virus that requires the hepatitis B virus (HBV) for assembly and propagation. Individuals infected with HDV progress to advanced liver disease faster than HBV-monoinfected individuals. Recent studies have estimated the global prevalence of anti-HDV antibodies among the HBV-infected population to be 5-15%. This study aimed to better understand HDV prevalence at the population level in 25 countries/territories. METHODS We conducted a literature review to determine the prevalence of anti-HDV and HDV RNA in hepatitis B surface antigen (HBsAg)-positive individuals in 25 countries/territories. Virtual meetings were held with experts from each setting to discuss the findings and collect unpublished data. Data were weighted for patient segments and regional heterogeneity to estimate the prevalence in the HBV-infected population. The findings were then combined with The Polaris Observatory HBV data to estimate the anti-HDV and HDV RNA prevalence in each country/territory at the population level. RESULTS After adjusting for geographical distribution, disease stage and special populations, the anti-HDV prevalence among the HBsAg+ population changed from the literature estimate in 19 countries. The highest anti-HDV prevalence was 60.1% in Mongolia. Once adjusted for the size of the HBsAg+ population and HDV RNA positivity rate, China had the highest absolute number of HDV RNA+ cases. CONCLUSIONS We found substantially lower HDV prevalence than previously reported, as prior meta-analyses primarily focused on studies conducted in groups/regions that have a higher probability of HBV infection: tertiary care centers, specific risk groups or geographical regions. There is large uncertainty in HDV prevalence estimates. The implementation of reflex testing would improve estimates, while also allowing earlier linkage to care for HDV RNA+ individuals. The logistical and economic burden of reflex testing on the health system would be limited, as only HBsAg+ cases would be screened. IMPACT AND IMPLICATIONS There is a great deal of uncertainty surrounding the prevalence of hepatitis delta virus among people living with hepatitis B virus at the population level. In this study, we aimed to better understand the burden in 25 countries and territories, to refine techniques that can be used in future analyses. We found a lower prevalence in the majority of places studied than had been previously reported. These data can help inform policy makers on the need to screen people living with hepatitis B virus to find those coinfected with hepatitis delta virus and at high risk of progression, while also highlighting the pitfalls that other researchers have often fallen into.
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Ferreira MF, Marques M, Morais R, Lemmers A, Macedo G, Santos-Antunes J. Endoscopic Submucosal Dissection Is Safe and Effective for Lesions Located at the Anorectal Junction: Analysis from Two Referral European Centers. GE Port J Gastroenterol 2024; 31:41-47. [PMID: 38476304 PMCID: PMC10928857 DOI: 10.1159/000528107] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/06/2022] [Indexed: 03/14/2024]
Abstract
Introduction Endoscopic submucosal dissection (ESD) is a well-established resection technique for colorectal superficial tumors, but its role in the treatment of anorectal junction (ARJ) lesions still remains to be determined. With this study, we aimed to evaluate the feasibility, safety, and efficacy of ESD for the resection of ARJ lesions, in comparison to more proximal rectal lesions. Methods We performed a retrospective analysis of prospectively collected data concerning all consecutive rectal ESD procedures performed in two European centers, from 2015 to 2021. Results A total of two hundred and fifty-two rectal lesions were included. Sixty (24%) were ARJ lesions, and the remaining 192 (76%) were located proximally. Technical success was achieved in 248 procedures (98%), and its rate was similar in both locations (p = 0.246). Most of the lesions presented high-grade dysplasia/Tis adenocarcinoma (54%); 36 (15%) had submucosal adenocarcinoma, including 20 superficial (sm1) and 16 deeply invasive (>SM1) T1 cancers. We found no differences between ARJ and rectal lesions in regard to en bloc resection rate (100% vs. 96%, p = 0.204), R0 resection rate (76% vs. 75%, p = 0.531), curative resection rate (70% vs. 70%, p = 0.920), procedures' median duration (120 min vs. 90 min, p = 0.072), ESD velocity (14 vs. 12 mm2/min, p = 0.415), histopathology result (p = 0.053), and the need for surgery due to a non-curative ESD (5% vs. 3%, p = 0.739). Also, there was no statistically significant difference that concerns delayed bleeding (7% vs. 8%, p = 0.709), perforation (0% vs. 5%, p = 0.075), or the need for readmission (2% vs. 2%, p = 0.939). Nevertheless, anorectal stenosis (5% vs. 0%, p = 0.003) and anorectal pain (9% vs. 1%, p = 0.002) were significantly more frequent in ARJ lesions. Conclusion ESD is a safe and efficient resection technique for the treatment of rectal lesions located in the ARJ.
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Affiliation(s)
- Mariana Figueiredo Ferreira
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Margarida Marques
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal
| | - Rui Morais
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Guilherme Macedo
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal
| | - João Santos-Antunes
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal
- Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), Porto, Portugal
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Mota J, Almeida MJ, Mendes F, Martins M, Ribeiro T, Afonso J, Cardoso P, Cardoso H, Andrade P, Ferreira J, Mascarenhas M, Macedo G. From Data to Insights: How Is AI Revolutionizing Small-Bowel Endoscopy? Diagnostics (Basel) 2024; 14:291. [PMID: 38337807 PMCID: PMC10855436 DOI: 10.3390/diagnostics14030291] [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: 11/13/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024] Open
Abstract
The role of capsule endoscopy and enteroscopy in managing various small-bowel pathologies is well-established. However, their broader application has been hampered mainly by their lengthy reading times. As a result, there is a growing interest in employing artificial intelligence (AI) in these diagnostic and therapeutic procedures, driven by the prospect of overcoming some major limitations and enhancing healthcare efficiency, while maintaining high accuracy levels. In the past two decades, the applicability of AI to gastroenterology has been increasing, mainly because of the strong imaging component. Nowadays, there are a multitude of studies using AI, specifically using convolutional neural networks, that prove the potential applications of AI to these endoscopic techniques, achieving remarkable results. These findings suggest that there is ample opportunity for AI to expand its presence in the management of gastroenterology diseases and, in the future, catalyze a game-changing transformation in clinical activities. This review provides an overview of the current state-of-the-art of AI in the scope of small-bowel study, with a particular focus on capsule endoscopy and enteroscopy.
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Affiliation(s)
- Joana Mota
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Maria João Almeida
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Francisco Mendes
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Miguel Martins
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Tiago Ribeiro
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - João Afonso
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Pedro Cardoso
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Helder Cardoso
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Patrícia Andrade
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - João Ferreira
- Department of Mechanical Engineering, Faculty of Engineering, University of Porto, R. Dr. Roberto Frias, 4200-465 Porto, Portugal;
- Digestive Artificial Intelligence Development, R. Alfredo Allen 455-461, 4200-135 Porto, Portugal
| | - Miguel Mascarenhas
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- ManopH Gastroenterology Clinic, R. de Sá da Bandeira 752, 4000-432 Porto, Portugal
| | - Guilherme Macedo
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
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Saraiva MM, Spindler L, Fathallah N, Beaussier H, Mamma C, Quesnée M, Ribeiro T, Afonso J, Carvalho M, Moura R, Andrade P, Cardoso H, Adam J, Ferreira J, Macedo G, de Parades V. Deep Learning in High-Resolution Anoscopy: Assessing the Impact of Staining and Therapeutic Manipulation on Automated Detection of Anal Cancer Precursors. Clin Transl Gastroenterol 2024:01720094-990000000-00229. [PMID: 38270249 DOI: 10.14309/ctg.0000000000000681] [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: 08/18/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION High-resolution anoscopy (HRA) is the gold standard for detecting anal squamous cell cancer (ASCC) precursors. Preliminary studies on the application of artificial intelligence (AI) models to this modality have revealed promising results. However, the impact of staining techniques and anal manipulation on the effectiveness of these algorithms has not been evaluated. We aimed to develop a deep learning system for automatic differentiation of high (HSIL) versus low-grade (LSIL) squamous intraepithelial lesions in HRA images in different subsets of patients (non-stained, acetic acid, lugol, and after manipulation). METHODS A convolutional neural network (CNN) was developed to detect and differentiate high and low-grade anal squamous intraepithelial lesions based on 27,770 images from 103 HRA exams performed in 88 patients. Subanalyses were performed to evaluate the algorithm's performance in subsets of images without staining, acetic acid, lugol, and after manipulation of the anal canal. The sensitivity, specificity, accuracy, positive and negative predictive values, and area under the curve (AUC) were calculated. RESULTS The CNN achieved an overall accuracy of 98.3%. The algorithm had a sensitivity and specificity of 97.4% and 99.2%, respectively. The accuracy of the algorithm for differentiating HSIL vs LSIL varied between 91.5% (post-manipulation) and 100% (lugol) for the categories at subanalysis. The AUC ranged between 0.95 and 1.00. DISCUSSION The introduction of AI to HRA may provide an accurate detection and differentiation of ASCC precursors. Our algorithm showed excellent performance at different staining settings. This is extremely important as real-time AI models during HRA exams can help guide local treatment or detect relapsing disease.
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Affiliation(s)
- Miguel Mascarenhas Saraiva
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro, 4200-427, Porto, Portugal
| | - Lucas Spindler
- Department of Proctology, GH Paris Saint-Joseph, 85, Rue Raymond Losserand, 75014, Paris, France
| | - Nadia Fathallah
- Department of Proctology, GH Paris Saint-Joseph, 85, Rue Raymond Losserand, 75014, Paris, France
| | - Hélene Beaussier
- Department of Clinical Research, GH Paris Saint-Joseph, 85, Rue Raymond Losserand, 75014, Paris, France
| | - Célia Mamma
- Department of Clinical Research, GH Paris Saint-Joseph, 85, Rue Raymond Losserand, 75014, Paris, France
| | - Mathilde Quesnée
- Department of Proctology, GH Paris Saint-Joseph, 85, Rue Raymond Losserand, 75014, Paris, France
| | - Tiago Ribeiro
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
| | - João Afonso
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
| | - Mariana Carvalho
- Department of Mechanical Engineering, Faculty of Engineering of the University of Porto, Rua Dr. Roberto Frias, 4200-465, Porto, Portugal
- INEGI - Institute of Science and Innovation in Mechanical and Industrial Engineering, Rua Dr. Roberto Frias, 4200-465, Porto, Portugal
| | - Rita Moura
- Department of Mechanical Engineering, Faculty of Engineering of the University of Porto, Rua Dr. Roberto Frias, 4200-465, Porto, Portugal
- INEGI - Institute of Science and Innovation in Mechanical and Industrial Engineering, Rua Dr. Roberto Frias, 4200-465, Porto, Portugal
| | - Patrícia Andrade
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro, 4200-427, Porto, Portugal
| | - Hélder Cardoso
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro, 4200-427, Porto, Portugal
| | - Julien Adam
- Department of Pathology, GH Paris Saint-Joseph, 85, Rue Raymond Losserand, 75014, Paris, France
| | - João Ferreira
- Department of Mechanical Engineering, Faculty of Engineering of the University of Porto, Rua Dr. Roberto Frias, 4200-465, Porto, Portugal
- INEGI - Institute of Science and Innovation in Mechanical and Industrial Engineering, Rua Dr. Roberto Frias, 4200-465, Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro, 4200-427, Porto, Portugal
| | - Vincent de Parades
- Department of Proctology, GH Paris Saint-Joseph, 85, Rue Raymond Losserand, 75014, Paris, France
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Ribeiro T, Morais R, Monteiro C, Carvalho A, Barros S, Fernando A, Pioche M, de Santiago ER, Macedo G. Estimating the environmental impact of endoscopic activity at a tertiary center: a pilot study. Eur J Gastroenterol Hepatol 2024; 36:39-44. [PMID: 37942729 DOI: 10.1097/meg.0000000000002667] [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: 11/10/2023]
Abstract
INTRODUCTION The growing number of endoscopic procedures, frequently requiring single-use disposable instruments, is responsible for the production of a large amount of waste. To this date, the reality of waste production at large European Gastroenterology centers is unknown. This study aimed to estimate the amount of waste due to endoscopic practice at a tertiary center in Portugal. METHODS We performed a prospective study to calculate the mass (in kg) of residues generated during a period of 5 working days of endoscopic practice. We included residues produced at endoscopy suites, pre and postprocedure areas and during endoscope reprocessing. Residues were categorized as non-dangerous (groups I/II), of biologic risk (group III) and specific hazardous hospital residues (group IV). The production of residues separated for recycling/valorization (paper/card and plastic) was also quantified. The volume of water used for reprocessing an endoscope was also assessed. RESULTS During the analyzed period, 241 endoscopic procedures were performed. A total of 443.2 kg of waste (22.6 kg from groups I/II, 266.9 kg from group III and 3.9 kg from group IV) were produced, most from group III (75%). For each endoscopic procedure, 1.8 kg of waste was generated. Of the total waste mass, 17.8% was separated for recycling/valorization. A volume of 55L of water was required for reprocessing one endoscope. CONCLUSION Each endoscopic procedure generated a significant amount of waste and water consumption during reprocessing. These real-life analyses are a pivotal step before implementing effective measures to improve resource utilization and more sustainable practices.
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Affiliation(s)
- Tiago Ribeiro
- Department of Gastroenterology, Centro Hospitalar Universitário de São João
- WGO Gastroenterology and Hepatology Training Center
| | - Rui Morais
- Department of Gastroenterology, Centro Hospitalar Universitário de São João
- WGO Gastroenterology and Hepatology Training Center
- Faculty of Medicine of the University of Porto
| | - Cristiana Monteiro
- Department of Gastroenterology, Centro Hospitalar Universitário de São João
- WGO Gastroenterology and Hepatology Training Center
| | - Ana Carvalho
- Department of Gastroenterology, Centro Hospitalar Universitário de São João
- WGO Gastroenterology and Hepatology Training Center
| | - Sónia Barros
- Department of Gastroenterology, Centro Hospitalar Universitário de São João
- WGO Gastroenterology and Hepatology Training Center
| | - André Fernando
- Department of Facilities Operations, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Mathieu Pioche
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Lyon, France
| | - 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
| | - Guilherme Macedo
- Department of Gastroenterology, Centro Hospitalar Universitário de São João
- WGO Gastroenterology and Hepatology Training Center
- Faculty of Medicine of the University of Porto
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Mendes F, Mascarenhas M, Ribeiro T, Afonso J, Cardoso P, Martins M, Cardoso H, Andrade P, Ferreira JPS, Mascarenhas Saraiva M, Macedo G. Artificial Intelligence and Panendoscopy-Automatic Detection of Clinically Relevant Lesions in Multibrand Device-Assisted Enteroscopy. Cancers (Basel) 2024; 16:208. [PMID: 38201634 PMCID: PMC10778030 DOI: 10.3390/cancers16010208] [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: 12/05/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
Device-assisted enteroscopy (DAE) is capable of evaluating the entire gastrointestinal tract, identifying multiple lesions. Nevertheless, DAE's diagnostic yield is suboptimal. Convolutional neural networks (CNN) are multi-layer architecture artificial intelligence models suitable for image analysis, but there is a lack of studies about their application in DAE. Our group aimed to develop a multidevice CNN for panendoscopic detection of clinically relevant lesions during DAE. In total, 338 exams performed in two specialized centers were retrospectively evaluated, with 152 single-balloon enteroscopies (Fujifilm®, Porto, Portugal), 172 double-balloon enteroscopies (Olympus®, Porto, Portugal) and 14 motorized spiral enteroscopies (Olympus®, Porto, Portugal); then, 40,655 images were divided in a training dataset (90% of the images, n = 36,599) and testing dataset (10% of the images, n = 4066) used to evaluate the model. The CNN's output was compared to an expert consensus classification. The model was evaluated by its sensitivity, specificity, positive (PPV) and negative predictive values (NPV), accuracy and area under the precision recall curve (AUC-PR). The CNN had an 88.9% sensitivity, 98.9% specificity, 95.8% PPV, 97.1% NPV, 96.8% accuracy and an AUC-PR of 0.97. Our group developed the first multidevice CNN for panendoscopic detection of clinically relevant lesions during DAE. The development of accurate deep learning models is of utmost importance for increasing the diagnostic yield of DAE-based panendoscopy.
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Affiliation(s)
- Francisco Mendes
- Alameda Professor Hernâni Monteiro, Department of Gastroenterology, São João University Hospital, 4200-427 Porto, Portugal; (F.M.); (T.R.); (P.C.); (M.M.); (P.A.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4050-345 Porto, Portugal
| | - Miguel Mascarenhas
- Alameda Professor Hernâni Monteiro, Department of Gastroenterology, São João University Hospital, 4200-427 Porto, Portugal; (F.M.); (T.R.); (P.C.); (M.M.); (P.A.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4050-345 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Tiago Ribeiro
- Alameda Professor Hernâni Monteiro, Department of Gastroenterology, São João University Hospital, 4200-427 Porto, Portugal; (F.M.); (T.R.); (P.C.); (M.M.); (P.A.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4050-345 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - João Afonso
- Alameda Professor Hernâni Monteiro, Department of Gastroenterology, São João University Hospital, 4200-427 Porto, Portugal; (F.M.); (T.R.); (P.C.); (M.M.); (P.A.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4050-345 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Pedro Cardoso
- Alameda Professor Hernâni Monteiro, Department of Gastroenterology, São João University Hospital, 4200-427 Porto, Portugal; (F.M.); (T.R.); (P.C.); (M.M.); (P.A.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4050-345 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Miguel Martins
- Alameda Professor Hernâni Monteiro, Department of Gastroenterology, São João University Hospital, 4200-427 Porto, Portugal; (F.M.); (T.R.); (P.C.); (M.M.); (P.A.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4050-345 Porto, Portugal
| | - Hélder Cardoso
- Alameda Professor Hernâni Monteiro, Department of Gastroenterology, São João University Hospital, 4200-427 Porto, Portugal; (F.M.); (T.R.); (P.C.); (M.M.); (P.A.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4050-345 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Patrícia Andrade
- Alameda Professor Hernâni Monteiro, Department of Gastroenterology, São João University Hospital, 4200-427 Porto, Portugal; (F.M.); (T.R.); (P.C.); (M.M.); (P.A.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4050-345 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - João P. S. Ferreira
- Department of Mechanical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal;
- DigestAID—Digestive Artificial Intelligence Development, R. Alfredo Allen n°. 455/461, 4200-135 Porto, Portugal
| | | | - Guilherme Macedo
- Alameda Professor Hernâni Monteiro, Department of Gastroenterology, São João University Hospital, 4200-427 Porto, Portugal; (F.M.); (T.R.); (P.C.); (M.M.); (P.A.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4050-345 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
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Colapietro F, Maisonneuve P, Lytvyak E, Beuers U, Verdonk RC, van der Meer AJ, van Hoek B, Kuiken SD, Brouwer JT, Muratori P, Aghemo A, Carella F, van den Berg AP, Zachou K, Dalekos GN, Di Zeo-Sánchez DE, Robles M, Andrade RJ, Montano-Loza AJ, van den Brand FF, Slooter CD, Macedo G, Liberal R, de Boer YS, Lleo A. Incidence and predictors of hepatocellular carcinoma in patients with autoimmune hepatitis. J Hepatol 2024; 80:53-61. [PMID: 37802188 DOI: 10.1016/j.jhep.2023.09.010] [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: 02/01/2023] [Revised: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND AND AIMS Autoimmune hepatitis (AIH) is a rare chronic liver disease of unknown aetiology; the risk of hepatocellular carcinoma (HCC) remains unclear and risk factors are not well-defined. We aimed to investigate the risk of HCC across a multicentre AIH cohort and to identify predictive factors. METHODS We performed a retrospective, observational, multicentric study of patients included in the International Autoimmune Hepatitis Group Retrospective Registry. The assessed clinical outcomes were HCC development, liver transplantation, and death. Fine and Gray regression analysis stratified by centre was applied to determine the effects of individual covariates; the cumulative incidence of HCC was estimated using the competing risk method with death as a competing risk. RESULTS A total of 1,428 patients diagnosed with AIH from 1980 to 2020 from 22 eligible centres across Europe and Canada were included, with a median follow-up of 11.1 years (interquartile range 5.2-15.9). Two hundred and ninety-three (20.5%) patients had cirrhosis at diagnosis. During follow-up, 24 patients developed HCC (1.7%), an incidence rate of 1.44 cases/1,000 patient-years; the cumulative incidence of HCC increased over time (0.6% at 5 years, 0.9% at 10 years, 2.7% at 20 years, and 6.6% at 30 years of follow-up). Patients who developed cirrhosis during follow-up had a significantly higher incidence of HCC. The cumulative incidence of HCC was 2.6%, 4.6%, 5.6% and 6.6% at 5, 10, 15, and 20 years after the development of cirrhosis, respectively. Obesity (hazard ratio [HR] 2.94, p = 0.04), cirrhosis (HR 3.17, p = 0.01), and AIH/PSC variant syndrome (HR 5.18, p = 0.007) at baseline were independent risk factors for HCC development. CONCLUSIONS HCC incidence in AIH is low even after cirrhosis development and is associated with risk factors including obesity, cirrhosis, and AIH/PSC variant syndrome. IMPACT AND IMPLICATIONS The risk of developing hepatocellular carcinoma (HCC) in individuals with autoimmune hepatitis (AIH) seems to be lower than for other aetiologies of chronic liver disease. Yet, solid data for this specific patient group remain elusive, given that most of the existing evidence comes from small, single-centre studies. In our study, we found that HCC incidence in patients with AIH is low even after the onset of cirrhosis. Additionally, factors such as advanced age, obesity, cirrhosis, alcohol consumption, and the presence of the AIH/PSC variant syndrome at the time of AIH diagnosis are linked to a higher risk of HCC. Based on these findings, there seems to be merit in adopting a specialized HCC monitoring programme for patients with AIH based on their individual risk factors.
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Affiliation(s)
- Francesca Colapietro
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Ellina Lytvyak
- Department of Medicine, Division of Preventive Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ulrich Beuers
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - Robert C Verdonk
- Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Bart van Hoek
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Sjoerd D Kuiken
- Department of Gastroenterology and Hepatology, OLVG, Amsterdam, the Netherlands
| | | | - Paolo Muratori
- Division of Internal Medicine, Morgagni-Pierantoni Hospital, Forlì 47100, Italy; Department of Science for the Quality of Life, University of Bologna, Bologna, Italy
| | - Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Francesco Carella
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Ad P van den Berg
- University Medical Center Groningen, University of Groningen, the Netherlands
| | - Kalliopi Zachou
- Department of Medicine and Research, Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, 41110, Larissa, Greece
| | - George N Dalekos
- Department of Medicine and Research, Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, 41110, Larissa, Greece
| | - Daniel E Di Zeo-Sánchez
- Liver Unit, Vírgen de Victoria University Hospital-IBIMA, University of Málaga, CIBERehd, Malaga, Spain
| | - Mercedes Robles
- Liver Unit, Vírgen de Victoria University Hospital-IBIMA, University of Málaga, CIBERehd, Malaga, Spain
| | - Raul J Andrade
- Liver Unit, Vírgen de Victoria University Hospital-IBIMA, University of Málaga, CIBERehd, Malaga, Spain
| | - Aldo J Montano-Loza
- Department of Medicine, Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, Alberta, Canada
| | - Floris F van den Brand
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Charlotte D Slooter
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Guilherme Macedo
- Department of Gastroenterology and Hepatology, Centro Hospitalar São João, Porto, Portugal
| | - Rodrigo Liberal
- Department of Gastroenterology and Hepatology, Centro Hospitalar São João, Porto, Portugal
| | - Ynto S de Boer
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ana Lleo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
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Mascarenhas M, Martins M, Afonso J, Ribeiro T, Cardoso P, Mendes F, Andrade P, Cardoso H, Ferreira J, Macedo G. The Future of Minimally Invasive Capsule Panendoscopy: Robotic Precision, Wireless Imaging and AI-Driven Insights. Cancers (Basel) 2023; 15:5861. [PMID: 38136403 PMCID: PMC10742312 DOI: 10.3390/cancers15245861] [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: 11/04/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
In the early 2000s, the introduction of single-camera wireless capsule endoscopy (CE) redefined small bowel study. Progress continued with the development of double-camera devices, first for the colon and rectum, and then, for panenteric assessment. Advancements continued with magnetic capsule endoscopy (MCE), particularly when assisted by a robotic arm, designed to enhance gastric evaluation. Indeed, as CE provides full visualization of the entire gastrointestinal (GI) tract, a minimally invasive capsule panendoscopy (CPE) could be a feasible alternative, despite its time-consuming nature and learning curve, assuming appropriate bowel cleansing has been carried out. Recent progress in artificial intelligence (AI), particularly in the development of convolutional neural networks (CNN) for CE auxiliary reading (detecting and diagnosing), may provide the missing link in fulfilling the goal of establishing the use of panendoscopy, although prospective studies are still needed to validate these models in actual clinical scenarios. Recent CE advancements will be discussed, focusing on the current evidence on CNN developments, and their real-life implementation potential and associated ethical challenges.
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Affiliation(s)
- Miguel Mascarenhas
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, 4200-427 Porto, Portugal; (M.M.); (J.A.); (T.R.); (P.C.); (F.M.); (P.A.); (H.C.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-047 Porto, Portugal
- Faculty of Medicine, University of Porto, 4200-427 Porto, Portugal
| | - Miguel Martins
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, 4200-427 Porto, Portugal; (M.M.); (J.A.); (T.R.); (P.C.); (F.M.); (P.A.); (H.C.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-047 Porto, Portugal
| | - João Afonso
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, 4200-427 Porto, Portugal; (M.M.); (J.A.); (T.R.); (P.C.); (F.M.); (P.A.); (H.C.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-047 Porto, Portugal
- Faculty of Medicine, University of Porto, 4200-427 Porto, Portugal
| | - Tiago Ribeiro
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, 4200-427 Porto, Portugal; (M.M.); (J.A.); (T.R.); (P.C.); (F.M.); (P.A.); (H.C.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-047 Porto, Portugal
- Faculty of Medicine, University of Porto, 4200-427 Porto, Portugal
| | - Pedro Cardoso
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, 4200-427 Porto, Portugal; (M.M.); (J.A.); (T.R.); (P.C.); (F.M.); (P.A.); (H.C.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-047 Porto, Portugal
- Faculty of Medicine, University of Porto, 4200-427 Porto, Portugal
| | - Francisco Mendes
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, 4200-427 Porto, Portugal; (M.M.); (J.A.); (T.R.); (P.C.); (F.M.); (P.A.); (H.C.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-047 Porto, Portugal
| | - Patrícia Andrade
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, 4200-427 Porto, Portugal; (M.M.); (J.A.); (T.R.); (P.C.); (F.M.); (P.A.); (H.C.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-047 Porto, Portugal
- Faculty of Medicine, University of Porto, 4200-427 Porto, Portugal
| | - Helder Cardoso
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, 4200-427 Porto, Portugal; (M.M.); (J.A.); (T.R.); (P.C.); (F.M.); (P.A.); (H.C.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-047 Porto, Portugal
- Faculty of Medicine, University of Porto, 4200-427 Porto, Portugal
| | - João Ferreira
- Department of Mechanic Engineering, Faculty of Engineering, University of Porto, 4200-065 Porto, Portugal;
- DigestAID—Digestive Artificial Intelligence Development, 455/461, 4200-135 Porto, Portugal
| | - Guilherme Macedo
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, 4200-427 Porto, Portugal; (M.M.); (J.A.); (T.R.); (P.C.); (F.M.); (P.A.); (H.C.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-047 Porto, Portugal
- Faculty of Medicine, University of Porto, 4200-427 Porto, Portugal
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14
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Mascarenhas M, Ribeiro T, Afonso J, Mendes F, Cardoso P, Martins M, Ferreira J, Macedo G. Smart Endoscopy Is Greener Endoscopy: Leveraging Artificial Intelligence and Blockchain Technologies to Drive Sustainability in Digestive Health Care. Diagnostics (Basel) 2023; 13:3625. [PMID: 38132209 PMCID: PMC10743290 DOI: 10.3390/diagnostics13243625] [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: 10/20/2023] [Revised: 11/14/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023] Open
Abstract
The surge in the implementation of artificial intelligence (AI) in recent years has permeated many aspects of our life, and health care is no exception. Whereas this technology can offer clear benefits, some of the problems associated with its use have also been recognised and brought into question, for example, its environmental impact. In a similar fashion, health care also has a significant environmental impact, and it requires a considerable source of greenhouse gases. Whereas efforts are being made to reduce the footprint of AI tools, here, we were specifically interested in how employing AI tools in gastroenterology departments, and in particular in conjunction with capsule endoscopy, can reduce the carbon footprint associated with digestive health care while offering improvements, particularly in terms of diagnostic accuracy. We address the different ways that leveraging AI applications can reduce the carbon footprint associated with all types of capsule endoscopy examinations. Moreover, we contemplate how the incorporation of other technologies, such as blockchain technology, into digestive health care can help ensure the sustainability of this clinical speciality and by extension, health care in general.
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Affiliation(s)
- Miguel Mascarenhas
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Precision Medicine Unit, Department of Gastroenterology, Hospital São João, 4200-437 Porto, Portugal; (T.R.); (J.A.); (P.C.); (M.M.)
- WGO Training Center, 4200-437 Porto, Portugal
| | - Tiago Ribeiro
- Precision Medicine Unit, Department of Gastroenterology, Hospital São João, 4200-437 Porto, Portugal; (T.R.); (J.A.); (P.C.); (M.M.)
- WGO Training Center, 4200-437 Porto, Portugal
| | - João Afonso
- Precision Medicine Unit, Department of Gastroenterology, Hospital São João, 4200-437 Porto, Portugal; (T.R.); (J.A.); (P.C.); (M.M.)
- WGO Training Center, 4200-437 Porto, Portugal
| | - Francisco Mendes
- Precision Medicine Unit, Department of Gastroenterology, Hospital São João, 4200-437 Porto, Portugal; (T.R.); (J.A.); (P.C.); (M.M.)
- WGO Training Center, 4200-437 Porto, Portugal
| | - Pedro Cardoso
- Precision Medicine Unit, Department of Gastroenterology, Hospital São João, 4200-437 Porto, Portugal; (T.R.); (J.A.); (P.C.); (M.M.)
- WGO Training Center, 4200-437 Porto, Portugal
| | - Miguel Martins
- Precision Medicine Unit, Department of Gastroenterology, Hospital São João, 4200-437 Porto, Portugal; (T.R.); (J.A.); (P.C.); (M.M.)
- WGO Training Center, 4200-437 Porto, Portugal
| | - João Ferreira
- Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal;
| | - Guilherme Macedo
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Precision Medicine Unit, Department of Gastroenterology, Hospital São João, 4200-437 Porto, Portugal; (T.R.); (J.A.); (P.C.); (M.M.)
- WGO Training Center, 4200-437 Porto, Portugal
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15
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Morais R, Libanio D, Dinis Ribeiro M, Ferreira A, Barreiro P, Bourke MJ, Gupta S, Amaro P, Küttner Magalhães R, Cecinato P, Boal Carvalho P, Pinho R, Rodríguez de Santiago E, Sferrazza S, Lemmers A, Figueiredo M, Pioche M, Gallego F, Albéniz E, Ramos Zabala F, Uchima H, Berr F, Wagner A, Marques M, Pimentel-Nunes P, Gonçalves M, Mascarenhas A, Soares EG, Xavier S, Faria-Ramos I, Sousa-Pinto B, Gullo I, Carneiro F, Macedo G, Santos-Antunes J. Predicting residual neoplasia after a non-curative gastric ESD: validation and modification of the eCura system in the Western setting: the W-eCura score. Gut 2023; 73:105-117. [PMID: 37666656 DOI: 10.1136/gutjnl-2023-330804] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/25/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE To evaluate the risk factors for lymph node metastasis (LNM) after a non-curative (NC) gastric endoscopic submucosal dissection (ESD) and to validate and eventually refine the eCura scoring system in the Western setting. Also, to assess the rate and risk factors for parietal residual disease. DESIGN Retrospective multicentre multinational study of prospectively collected registries from 19 Western centres. Patients who had been submitted to surgery or had at least one follow-up endoscopy were included. The eCura system was applied to assess its accuracy in the Western setting, and a modified version was created according to the results (W-eCura score). The discriminative capacities of the eCura and W-eCura scores to predict LNM were assessed and compared. RESULTS A total of 314 NC gastric ESDs were analysed (72% high-risk resection (HRR); 28% local-risk resection). Among HRR patients submitted to surgery, 25% had parietal disease and 15% had LNM in the surgical specimen. The risk of LNM was significantly different across the eCura groups (areas under the receiver operating characteristic curve (AUC-ROC) of 0.900 (95% CI 0.852 to 0.949)). The AUC-ROC of the W-eCura for LNM (0.916, 95% CI 0.870 to 0.961; p=0.012) was significantly higher compared with the original eCura. Positive vertical margin, lymphatic invasion and younger age were associated with a higher risk of parietal residual lesion in the surgical specimen. CONCLUSION The eCura scoring system may be applied in Western countries to stratify the risk of LNM after a gastric HRR. A new score is proposed that may further decrease the number of unnecessary surgeries.
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Affiliation(s)
- Rui Morais
- Department of Gastroenterology, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Diogo Libanio
- Department of Gastroenterology, IPO Porto, Porto, Portugal
- MEDCIDS-Department of Community Medicine, University of Porto, Porto, Portugal
| | - Mario Dinis Ribeiro
- Department of Gastroenterology, IPO Porto, Porto, Portugal
- MEDCIDS-Department of Community Medicine, University of Porto, Porto, Portugal
| | - Aníbal Ferreira
- Department of Gastroenterology, Hospital Braga, Braga, Portugal
| | - Pedro Barreiro
- Gastroenterology Department, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Sunil Gupta
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Pedro Amaro
- Department of Gastroenterology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | | | - Paolo Cecinato
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pedro Boal Carvalho
- Department of Gastroenterology, Centro Hospitalar do Alto Ave, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Rolando Pinho
- Department of Gastrenterology, Centro Hospitalar de Vila Nova de Gaia, Gaia, Portugal
| | - 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
| | - Sandro Sferrazza
- Department of Gastroenterology and Endoscopy, ARNAS Civico Hospital, Palermo, Italy
| | - Arnaud Lemmers
- Department of Gastroenterology and Hepatopancreatology, Erasme Hospital, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Mariana Figueiredo
- Department of Gastroenterology and Hepatopancreatology, Erasme Hospital, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Marhieu Pioche
- Department of Hepatology and Gastroenterology, Edouard Herriot Hospital, Lyon, France
| | | | - Eduardo Albéniz
- Gastroenterology Department, Complejo Hospitalario de Navarra, Navarrabiomed Research Institute, Public University of Navarra, IdiSNA, Navarra, Spain
| | - Felipe Ramos Zabala
- Departamento de Gastroenterología, Departamento de Ciencias Médicas Clínicas, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Hugo Uchima
- Servicio de Endoscopia Digestiva Centro Médico Teknon, Barcelona, Spain
- Servicio de Gastroenterología, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | - Frieder Berr
- Department of Internal Medicine I, Paracelsus Medical University, Salzburg, Austria
| | - Andrej Wagner
- Department of Internal Medicine I, Paracelsus Medical University, Salzburg, Austria
| | - Margarida Marques
- Department of Gastroenterology, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Pimentel-Nunes
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Gastroenterology, IPO Porto, Porto, Portugal
| | | | - André Mascarenhas
- Gastroenterology Department, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
| | - Elisa Gravito Soares
- Department of Gastroenterology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Sofia Xavier
- Department of Gastroenterology, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - Isabel Faria-Ramos
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
| | - Bernardo Sousa-Pinto
- MEDCIDS-Department of Community Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE-Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Irene Gullo
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
- Department of Pathology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Fatima Carneiro
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
- Department of Pathology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Santos-Antunes
- Department of Gastroenterology, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
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Rodrigues-Pinto E, Dias E, Medas R, Macedo G. Use of mechanical lithotripter to assist in the endoscopic removal of an impacted long chicken bone in sigmoid diverticula. Endoscopy 2023; 55:E856-E857. [PMID: 37433324 PMCID: PMC10335860 DOI: 10.1055/a-2106-0612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Affiliation(s)
- Eduardo Rodrigues-Pinto
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Emanuel Dias
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Renato Medas
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
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Medas R, Rodrigues-Pinto E, Silva JC, Pereira P, Macedo G. Endoscopic closure of a rectal fistula using a cardiac septal defect occluder: the final redemption. Endoscopy 2023; 55:E955-E956. [PMID: 37604448 PMCID: PMC10442213 DOI: 10.1055/a-2133-6176] [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: 08/23/2023]
Affiliation(s)
- Renato Medas
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Eduardo Rodrigues-Pinto
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - João Carlos Silva
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Pedro Pereira
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
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18
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Omary MB, Leddin D, Metz G, Veitch AM, El-Omar EM, Macedo G, Perman ML. World Gastroenterology Organisation - Gut commentary series on digestive health and climate change. Gut 2023; 72:2193-2196. [PMID: 37977581 DOI: 10.1136/gutjnl-2023-331193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 11/19/2023]
Affiliation(s)
- M Bishr Omary
- Rutgers Biomedical and Health Sciences, Rutgers University, Piscataway, New Jersey, USA
| | | | - Geoffrey Metz
- The University of Melbourne and Monash University, Melbourne, Victoria, Australia
| | | | - Emad M El-Omar
- UNSW Microbiome Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Guilherme Macedo
- Gastroenterology, Centro Hospitalar de São João, Porto, Portugal
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Garrido I, Peixoto A, Lopes J, Macedo G. Gelée blanche. Am J Gastroenterol 2023:00000434-990000000-00943. [PMID: 37975604 DOI: 10.14309/ajg.0000000000002607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Isabel Garrido
- - Gastroenterology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
- - World Gastroenterology Organization (WGO) Porto Training Center, Portugal
| | - Armando Peixoto
- - Gastroenterology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
- - World Gastroenterology Organization (WGO) Porto Training Center, Portugal
| | - Joanne Lopes
- - Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Guilherme Macedo
- - Gastroenterology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
- - World Gastroenterology Organization (WGO) Porto Training Center, Portugal
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20
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Kow L, Sharaiha RZ, O'Kane M, White KP, Macedo G, Toouli J, Shikora S. Methodology and Results of a Joint IFSO-WGO Delphi Survey of 94 Intercontinental, Interdisciplinary Experts in Obesity Management. Obes Surg 2023; 33:3337-3352. [PMID: 37831326 PMCID: PMC10602939 DOI: 10.1007/s11695-023-06757-2] [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] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/05/2023] [Accepted: 07/18/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Obesity affects 1.5 billion people worldwide, yet few are treated effectively and considerable variability exists in its management. In 2020, a joint International Federation of Surgery for Obesity and Metabolic Diseases (IFSO) and World Gastroenterology Organization (WGO) advisory committee initiated the drafting of consensus guidelines on obesity management, to be based on detailed literature reviews and the results of an extensive multi-disciplinary survey of intercontinental experts. This paper reports on the latter. The objective of this study is to identify areas of consensus and non-consensus among intercontinental, inter-disciplinary experts in obesity management. METHODS Guided by an international consensus-survey expert, a three-round online Delphi survey was conducted in the summer of 2021 of international obesity-management experts spanning the fields of medicine, bariatric endoscopy and surgery, psychology, and nutrition. Issues like epidemiology and risk factors, patient selection for metabolic and bariatric surgery (ASMBS-Clinical-Issues-Committee, Surg Obes Relat Dis : Off J Am Soc Bariatric Surg. 8:e27-32, 1), psychological issues, patient preparation for MBS, bariatric endoscopy, and outcomes and follow-up were addressed. RESULTS Ninety-four experts from six continents voted on 180 statements, with consensus reached on 158, including consensus agreement with 96 and disagreement with 24 statements (38 had other response options besides agree/disagree). Among unanimous opinions were the need for all medical societies to work together to address obesity, for regular regional and national obesity surveillance, for multi-disciplinary management, to recognize the increasing impact of childhood and adolescent obesity, to accept some weight regain as normal after MBS, and for life-long follow-up of MBS patients. CONCLUSIONS Obesity is a major health issue that requires aggressive surveillance and thoughtful multidisciplinary management.
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Affiliation(s)
- Lilian Kow
- Dept. of Surgery, Flinders University, Adelaide, SA, Australia.
| | - Reem Z Sharaiha
- Dept. of Gastroenterology, Weill Cornell Medical College, New York, NY, USA
| | - Mary O'Kane
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kevin P White
- ScienceRight International Health Research Consulting (SRIHRC), London, ON, Canada
| | - Guilherme Macedo
- Dept. of Gastroenterology & Hepatology, Centro Hospitalar de São João, Porto, Portugal
| | - Jim Toouli
- Dept. of Surgery, Flinders University, Adelaide, SA, Australia
| | - Scott Shikora
- Center for Metabolic and Bariatric Surgery, Brigham and Women's Hospital Harvard Medical School, Boston, MA, USA
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21
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Sharaiha RZ, Shikora S, White KP, Macedo G, Toouli J, Kow L. Summarizing Consensus Guidelines on Obesity Management: A Joint, Multidisciplinary Venture of the International Federation for the Surgery of Obesity & Metabolic Disorders (IFSO) and World Gastroenterology Organisation (WGO). J Clin Gastroenterol 2023; 57:967-976. [PMID: 37831466 PMCID: PMC10566600 DOI: 10.1097/mcg.0000000000001916] [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] [Received: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Reem Z. Sharaiha
- Department of Gastroenterology, Weill Cornell Medical College, New York, NY
| | - Scott Shikora
- Center for Metabolic and Bariatric Surgery, Brigham and Women’s Hospital Harvard Medical School, Boston, MA
| | - Kevin P. White
- ScienceRight International Health Research Consulting (SRIHRC), London, ON, Canada
| | - Guilherme Macedo
- Department of Gastroenterology & Hepatology, São João University Hospital Center, Porto, Portugal
| | - Jim Toouli
- Department of Surgery, Flinders University, Adelaide, SA, Australia
| | - Lillian Kow
- Department of Surgery, Flinders University, Adelaide, SA, Australia
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22
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Cardoso P, Elias C, Medas R, Cardoso L, Peixoto A, Macedo G, Almeida J. Eosinophilic Colitis, an Uncommon Cause of Diarrhea: Case Report and Literature Review. GE Port J Gastroenterol 2023; 30:57-61. [PMID: 38020823 PMCID: PMC10661707 DOI: 10.1159/000526853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 07/22/2022] [Indexed: 12/01/2023]
Abstract
Eosinophilic colitis and hypereosinophilic syndrome with colic involvement are rare diagnosis that are characterized by wide-ranging gastrointestinal symptoms and idiopathic infiltration of eosinophils in the colon. The diagnostic workup is challenging since there are no standardized criteria. We report a case of a man admitted to the hospital with a history of nonbloody chronic diarrhea. The detailed workup demonstrated blood eosinophilia, and the colonic biopsies revealed extensive eosinophilic infiltration. He was treated with steroids with clinical and analytical improvement. Due to relapsing colitis after therapy withdrawal, he was chronically medicated with 10 mg of prednisolone with ultimate symptom control. This case report describes the diagnostic workup and highlights the most important features of this often underdiagnosed entity.
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Affiliation(s)
- Pedro Cardoso
- Department of Gastroenterology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Catarina Elias
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Renato Medas
- Department of Gastroenterology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Leila Cardoso
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Armando Peixoto
- Department of Gastroenterology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Jorge Almeida
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
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Ribeiro T, Mascarenhas Saraiva M, Afonso J, Brozzi L, Macedo G. Predicting Factors of Clinical Outcomes in Patients Hospitalized after Esophageal Foreign Body or Caustic Injuries: The Experience of a Tertiary Center. Diagnostics (Basel) 2023; 13:3304. [PMID: 37958198 PMCID: PMC10648504 DOI: 10.3390/diagnostics13213304] [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: 08/15/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/15/2023] Open
Abstract
Ingestion of foreign bodies (IFB) and ingestion of caustic agents are frequent non-hemorrhagic causes of endoscopic urgencies, with the potential for severe complications. This study aimed to evaluate the predicting factors of the clinical outcomes of patients hospitalized as a result of IFB or ingestion of caustics (IC). This was a retrospective single-center study of patients admitted for IFB or IC between 2000 and 2019 at a tertiary center. Demographic and clinical data, as well as preliminary exams, were evaluated. Also, variables of the clinical outcomes, including the length of stay (LS) and other inpatient complications, were assessed. Sixty-six patients were included (44 IFB and 22 IC). The median LS was 7 days, with no differences between the groups (p = 0.07). The values of C-reactive protein (CRP) upon admission correlated with the LS in the IFB group (p < 0.01) but not with that of those admitted after IC. In the IFB patients, a diagnosis of perforation on both an endoscopy (p = 0.02) and CT scan (p < 0.01) was correlated with the LS. The Zargar classification was not correlated with the LS in the IC patients (p = 0.36). However, it was correlated with antibiotics, nosocomial pneumonia and an increased need for intensive care treatment. CT assessment of the severity of the caustic lesions did not correlate with the LS. In patients admitted for IFB, CRP values may help stratify the probability of complications. In patients admitted due to IC, the Zargar classification may help to predict inpatient complications, but it does not correlate with the LS.
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Affiliation(s)
- Tiago Ribeiro
- Department of Gastroenterology, Centro Hospitalar Universitário de São João, 4200-427 Porto, Portugal; (T.R.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
| | - Miguel Mascarenhas Saraiva
- Department of Gastroenterology, Centro Hospitalar Universitário de São João, 4200-427 Porto, Portugal; (T.R.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
- Department of Medicine, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
| | - João Afonso
- Department of Gastroenterology, Centro Hospitalar Universitário de São João, 4200-427 Porto, Portugal; (T.R.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
| | - Lorenzo Brozzi
- Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, Department of Medicine, G.B. Rossi University Hospital, 37134 Verona, Italy;
| | - Guilherme Macedo
- Department of Gastroenterology, Centro Hospitalar Universitário de São João, 4200-427 Porto, Portugal; (T.R.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
- Department of Medicine, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
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Medas R, Morais R, Marques M, Soares C, Macedo G. Small bowel entrapment after OTSC deployment for endoscopic closure of a colonic iatrogenic perforation. Clin Res Hepatol Gastroenterol 2023; 47:102184. [PMID: 37495203 DOI: 10.1016/j.clinre.2023.102184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Renato Medas
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine of the University of Porto, Porto, Portugal.
| | - Rui Morais
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Margarida Marques
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Carlos Soares
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine of the University of Porto, Porto, Portugal
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Mascarenhas M, Mendes F, Ribeiro T, Afonso J, Cardoso P, Martins M, Cardoso H, Andrade P, Ferreira J, Mascarenhas Saraiva M, Macedo G. Deep Learning and Minimally Invasive Endoscopy: Automatic Classification of Pleomorphic Gastric Lesions in Capsule Endoscopy. Clin Transl Gastroenterol 2023; 14:e00609. [PMID: 37404050 PMCID: PMC10584281 DOI: 10.14309/ctg.0000000000000609] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/02/2023] [Indexed: 07/06/2023] Open
Abstract
INTRODUCTION Capsule endoscopy (CE) is a minimally invasive examination for evaluating the gastrointestinal tract. However, its diagnostic yield for detecting gastric lesions is suboptimal. Convolutional neural networks (CNNs) are artificial intelligence models with great performance for image analysis. Nonetheless, their role in gastric evaluation by wireless CE (WCE) has not been explored. METHODS Our group developed a CNN-based algorithm for the automatic classification of pleomorphic gastric lesions, including vascular lesions (angiectasia, varices, and red spots), protruding lesions, ulcers, and erosions. A total of 12,918 gastric images from 3 different CE devices (PillCam Crohn's; PillCam SB3; OMOM HD CE system) were used from the construction of the CNN: 1,407 from protruding lesions; 994 from ulcers and erosions; 822 from vascular lesions; and 2,851 from hematic residues and the remaining images from normal mucosa. The images were divided into a training (split for three-fold cross-validation) and validation data set. The model's output was compared with a consensus classification by 2 WCE-experienced gastroenterologists. The network's performance was evaluated by its sensitivity, specificity, accuracy, positive predictive value and negative predictive value, and area under the precision-recall curve. RESULTS The trained CNN had a 97.4% sensitivity; 95.9% specificity; and positive predictive value and negative predictive value of 95.0% and 97.8%, respectively, for gastric lesions, with 96.6% overall accuracy. The CNN had an image processing time of 115 images per second. DISCUSSION Our group developed, for the first time, a CNN capable of automatically detecting pleomorphic gastric lesions in both small bowel and colon CE devices.
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Affiliation(s)
- Miguel Mascarenhas
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro, Porto, Portugal
| | - Francisco Mendes
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
| | - Tiago Ribeiro
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
| | - João Afonso
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
| | - Pedro Cardoso
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
| | - Miguel Martins
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
| | - Hélder Cardoso
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro, Porto, Portugal
| | - Patrícia Andrade
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro, Porto, Portugal
| | - João Ferreira
- Department of Mechanical Engineering, Faculty of Engineering of the University of Porto, Porto, Portugal
- Digestive Artificial Intelligence Development, Porto, Portugal
| | | | - Guilherme Macedo
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine of the University of Porto, Alameda Professor Hernâni Monteiro, Porto, Portugal
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Saraiva MM, Pouca MV, Ribeiro T, Afonso J, Cardoso H, Sousa P, Ferreira J, Macedo G, Junior IF. Artificial Intelligence and Anorectal Manometry: Automatic Detection and Differentiation of Anorectal Motility Patterns-A Proof-of-Concept Study. Clin Transl Gastroenterol 2023; 14:e00555. [PMID: 36520781 PMCID: PMC10584284 DOI: 10.14309/ctg.0000000000000555] [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: 09/10/2022] [Accepted: 11/18/2022] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Anorectal manometry (ARM) is the gold standard for the evaluation of anorectal functional disorders, prevalent in the population. Nevertheless, the accessibility to this examination is limited, and the complexity of data analysis and report is a significant drawback. This pilot study aimed to develop and validate an artificial intelligence model to automatically differentiate motility patterns of fecal incontinence (FI) from obstructed defecation (OD) using ARM data. METHODS We developed and tested multiple machine learning algorithms for the automatic interpretation of ARM data. Four models were tested: k-nearest neighbors, support vector machines, random forests, and gradient boosting (xGB). These models were trained using a stratified 5-fold strategy. Their performance was assessed after fine-tuning of each model's hyperparameters, using 90% of data for training and 10% of data for testing. RESULTS A total of 827 ARM examinations were used in this study. After fine-tuning, the xGB model presented an overall accuracy (84.6% ± 2.9%), similar to that of random forests (82.7% ± 4.8%) and support vector machines (81.0% ± 8.0%) and higher that of k-nearest neighbors (74.4% ± 3.8%). The xGB models showed the highest discriminating performance between OD and FI, with an area under the curve of 0.939. DISCUSSION The tested machine learning algorithms, particularly the xGB model, accurately differentiated between FI and OD manometric patterns. Subsequent development of these tools may optimize the access to ARM studies, which may have a significant impact on the management of patients with anorectal functional diseases.
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Affiliation(s)
- Miguel Mascarenhas Saraiva
- Department of Gastroenterology, São João University Hospital, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Maria Vila Pouca
- Department of Mechanical Engineering, Faculty of Engineering of the University of Porto, Porto, Portugal
- INEGI—Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Tiago Ribeiro
- Department of Gastroenterology, São João University Hospital, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
| | - João Afonso
- Department of Gastroenterology, São João University Hospital, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
| | - Hélder Cardoso
- Department of Gastroenterology, São João University Hospital, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Pedro Sousa
- Department of Mechanical Engineering, Faculty of Engineering of the University of Porto, Porto, Portugal
- INEGI—Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - João Ferreira
- Department of Mechanical Engineering, Faculty of Engineering of the University of Porto, Porto, Portugal
- INEGI—Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, São João University Hospital, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Ilario Froehner Junior
- Department of Gastrointestinal Motility, Nossa Senhora das Graças Hospital, Curitiba, Paraná, Brazil
- Department of Coloproctology, Pelvia—Gastrointestinal Motility and Continence, Curitiba, Paraná, Brazil
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Gaspar R, Silva M, Cardoso P, Goncalves R, Andrade P, Macedo G. Spleen stiffness: a new tool to predict high-risk varices in cirrhotic patients. J Gastroenterol Hepatol 2023; 38:1840-1846. [PMID: 37655720 DOI: 10.1111/jgh.16344] [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: 01/29/2023] [Revised: 07/23/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION Cirrhosis is one of the major causes of morbidity and mortality worldwide. Portal hypertension is the major contributor of cirrhosis-related complications and is defined as a hepatic venous pressure gradient (HVPG) > 5 mmHg. Measurement of HVPG is an invasive, difficult, and costly procedure. Therefore, it is only performed in specialized centers. Liver stiffness measured with transient elastography is one of the most studied noninvasive markers of portal hypertension, and spleen elastography has recently emerged as an important adjuvant tool. The development of a new probe (100 Hz) that more reliably reflect the grade of portal hypertension evaluated by spleen stiffness measurement has improved the accuracy of this technique. The aim of this work was to evaluate the accuracy of spleen stiffness with the new dedicated probe to predict the presence of high-risk varices, as well as to determine the ideal cutoff to predict it. METHODS Prospective study of cirrhotic patients admitted to upper endoscopy that were also submitted to liver and spleen elastography with the 100-Hz probe by the same blinded operator in a tertiary center. RESULTS We included 209 cirrhotic patients, with mean age of 61.9 years (±9.9), 77.0% male. The most common etiology was alcoholic liver disease (72.7%). The median value of liver elastography was 25.3 [4.5-75] kPa, and the median value of spleen elastography was 42.4 [7.6-100] kPa. At the cutoff of 53.25 kPa, we obtained sensitivity of 100% and specificity of 72.6% to predict high-risk varices, and, according to this cutoff, 133/175 of esophagogastroduodenoscopy could have been spared (76.0%), while according to Baveno guidelines, only 51/175 would have been spared (29.1%). CONCLUSION In the era of noninvasive exams, spleen elastography with the 100-Hz probe emerges as an excellent tool for prediction of presence of high-risk varices. At the cutoff of 53.25 kPa, spleen elastography avoids upper endoscopy for screening for high-risk varices, promising to be become part of the hepatologists' daily routine.
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Affiliation(s)
- Rui Gaspar
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Marco Silva
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Pedro Cardoso
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Raquel Goncalves
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Patrícia Andrade
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
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Garrido I, Coelho R, Macedo G. Hospital discharge after percutaneous liver biopsy - less is more? Eur J Gastroenterol Hepatol 2023; 35:1186-1191. [PMID: 37577843 DOI: 10.1097/meg.0000000000002611] [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: 08/15/2023]
Abstract
INTRODUCTION Liver biopsy is a technique frequently performed in clinical practice. However, the recommended surveillance period after the procedure is not established in the guidelines. The aim of this study was to assess the safety and patient satisfaction of hospital discharge 2 h after a percutaneous liver biopsy. METHODS Prospective monocentric study which included all patients who underwent percutaneous liver biopsy between December 2020 and November 2022. Individuals were discharged 2 h after the procedure according to a protocol that was implemented in our institution. RESULTS A total of 200 patients were included, the majority male (52.0%), with a median age of 52 years old (interquartile range (IQR) 40-60). Forty-two (21.0%) individuals had mild adverse events at the time of or within 2 h of the procedure. Most (90.4%) occurred in the first hour after the liver biopsy. Only 5 (2.5%) patients were kept under observation for 4 h due to abdominal/shoulder pain. There were no serious complications and no patient required subsequent admission. The majority of patients reported being satisfied/very satisfied (99.4%) and felt safe (98.9%) with this protocol. Most of the individuals showed a preference for early hospital discharge (97.3%). CONCLUSION We showed that patients requiring percutaneous liver biopsy can be safely discharged 2 h after the procedure.
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Affiliation(s)
- Isabel Garrido
- Gastroenterology and Hepatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- World Gastroenterology Organization (WGO) Porto Training Center, Porto, Portugal
| | - Rosa Coelho
- Gastroenterology and Hepatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- World Gastroenterology Organization (WGO) Porto Training Center, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology and Hepatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- World Gastroenterology Organization (WGO) Porto Training Center, Porto, Portugal
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Dias E, Santos-Antunes J, Portugal R, Pinheiro J, Carneiro F, Macedo G. Primary gastric choriocarcinoma: a rare and aggressive gastrointestinal malignancy. Rev Esp Enferm Dig 2023; 115:585-586. [PMID: 36633164 DOI: 10.17235/reed.2022.9433/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A 40-year-old male with no previous medical history presented to emergency department with a 2-week history of progressive dyspnea. He also described night sweats and weight loss (15 kg) during the last 3 months. Thoraco-abdominal computed tomography showed multiple bilateral lung nodules associated with supra-clavicular, hilar and peri-esophageal lymphadenopathies and gastric parietal thickening. These imaging features were suggestive of primary gastric cancer with lung and lymph node metastases. Therefore, he undergone upper digestive endoscopy that showed a large ulcerated protruding lesion at the greater curvature of the body suggestive of malignancy. Gastric biopsies of the lesion confirmed a solid neoplasia constituted by solid nests and sheets of highly pleomorphic, bizarre cells with cytotrophoblastic and syncytiotrophoblastic differentiation that, on immunohistochemistry, stained positive for β-HCG, SALL-4 and glypican-3. CT-guided biopsy of lung nodules revealed malignant cells with similar histopathological and immunohistochemical features. Elevated serum alpha-fetoprotein and β-HCG were also detected. Clinical and ultrasound examination were negative for testicular masses. These findings were consistent with a primary gastric choriocarcinoma presenting with lung and lymph node metastases (stage IV). Although chemotherapy was started, the patient evolved unfavorably and died after 9 months. Primary gastric choriocarcinoma is a rare and aggressive gastrointestinal malignancy. This case demonstrates its rapid growth rate and high metastatic potential that may lead to symptoms from secondary involvement of distant organs.
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Affiliation(s)
- Emanuel Dias
- Gastrenterology Department, Centro Hospitalar de São João, Portugal
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Dias E, Cardoso H, Rodrigues-Pinto E, Portugal R, Macedo G. A challenging alpha-fetoprotein after liver transplantation. Gastroenterol Hepatol 2023; 46:628-629. [PMID: 35964815 DOI: 10.1016/j.gastrohep.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Emanuel Dias
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
| | - Hélder Cardoso
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Raquel Portugal
- Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
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Saraiva MM, Ribeiro T, González-Haba M, Agudo Castillo B, Ferreira JPS, Vilas Boas F, Afonso J, Mendes F, Martins M, Cardoso P, Pereira P, Macedo G. Deep Learning for Automatic Diagnosis and Morphologic Characterization of Malignant Biliary Strictures Using Digital Cholangioscopy: A Multicentric Study. Cancers (Basel) 2023; 15:4827. [PMID: 37835521 PMCID: PMC10571941 DOI: 10.3390/cancers15194827] [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: 08/03/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
Digital single-operator cholangioscopy (D-SOC) has enhanced the ability to diagnose indeterminate biliary strictures (BSs). Pilot studies using artificial intelligence (AI) models in D-SOC demonstrated promising results. Our group aimed to develop a convolutional neural network (CNN) for the identification and morphological characterization of malignant BSs in D-SOC. A total of 84,994 images from 129 D-SOC exams in two centers (Portugal and Spain) were used for developing the CNN. Each image was categorized as either a normal/benign finding or as malignant lesion (the latter dependent on histopathological results). Additionally, the CNN was evaluated for the detection of morphologic features, including tumor vessels and papillary projections. The complete dataset was divided into training and validation datasets. The model was evaluated through its sensitivity, specificity, positive and negative predictive values, accuracy and area under the receiver-operating characteristic and precision-recall curves (AUROC and AUPRC, respectively). The model achieved a 82.9% overall accuracy, 83.5% sensitivity and 82.4% specificity, with an AUROC and AUPRC of 0.92 and 0.93, respectively. The developed CNN successfully distinguished benign findings from malignant BSs. The development and application of AI tools to D-SOC has the potential to significantly augment the diagnostic yield of this exam for identifying malignant strictures.
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Affiliation(s)
- Miguel Mascarenhas Saraiva
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Tiago Ribeiro
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
| | - Mariano González-Haba
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro Majadahonda, C/Joaquín Rodrigo, 28220 Majadahonda, Madrid, Spain
| | - Belén Agudo Castillo
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro Majadahonda, C/Joaquín Rodrigo, 28220 Majadahonda, Madrid, Spain
| | - João P. S. Ferreira
- Department of Mechanical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
- DigestAID—Digestive Artificial Intelligence Development, Rua Alfredo Allen n.º 455/461, 4200-135 Porto, Portugal
| | - Filipe Vilas Boas
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - João Afonso
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
| | - Francisco Mendes
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
| | - Miguel Martins
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
| | - Pedro Cardoso
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
| | - Pedro Pereira
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
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32
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Lanas Á, Balaguer F, Sánchez‐Luengo M, Hijos‐Mallada G, Hernández‐Mesa G, Piñero M, Castillo J, Ocaña T, Cubiella J, Crespo A, Iglesias Á, Medeiros I, Cacho G, Jover‐Martínez R, Alustiza M, Diaz‐Tasende J, Poves C, Macedo G, Quintero E. Fecal occult blood and calprotectin testing to prioritize primary care patients for colonoscopy referral: The advantage study. United European Gastroenterol J 2023; 11:692-699. [PMID: 37614054 PMCID: PMC10493338 DOI: 10.1002/ueg2.12446] [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: 03/24/2023] [Accepted: 06/26/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Colonoscopy is the gold standard for colorectal cancer (CRC) diagnosis and screening, but endoscopy services are usually overburdened. This study aims to investigate the usefulness of fecal hemoglobin (fHb) and calprotectin (FC) for the identification of patients with high probability of CRC who need urgent referral. METHODS In a multicenter prospective study, we enrolled symptomatic patients referred from primary care for colonoscopy. Prior to bowel preparation, fHb and FC quantitative tests were performed. The diagnostic performance was estimated for each biomarker/combination. We built a multivariable predictive model based on logistic regression, translated to a nomogram and a risk calculator to assist clinicians in the decision-making process. RESULTS The study included 1224 patients, of whom 69 (5.6%) had CRC. At the fHb cut-offs of >0 and 10 μg/g, the negative predictive values for CRC were 98.8% (95% confidence interval 97.8%-99.3%) and 98.6% (95%CI 97.7%-99.1%), and the sensitivities were 85.5% (95%CI 75.0%-92.8%) and 79.7% (95%CI 68.3%-88.4%), respectively. When we added the cut-off of 150 μg/g of FC to both fHb thresholds, the sensitivity of fecal tests improved. In the multivariate logistic regression model, the concentration of fHb was an independent predictor for CRC; age and gender were also independently associated with CRC. CONCLUSIONS fHb and FC are useful as part of a triage tool to identify those symptomatic patients with high probability of CRC. This can be easily applied by physicians to prioritize high-risk patients for urgent colonoscopy.
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Affiliation(s)
- Ángel Lanas
- University Clinic Hospital Lozano Blesa. University of Zaragoza. IIS Aragón. CIBERHEDZaragozaSpain
| | - Francesc Balaguer
- Department of GastroenterologyHospital Clínic de BarcelonaInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD)University of BarcelonaBarcelonaSpain
| | - Marta Sánchez‐Luengo
- Department of GastroenterologyHospital Clínico Universitario Lozano BlesaZaragozaSpain
| | - Gonzalo Hijos‐Mallada
- Department of GastroenterologyHospital Clínico Universitario Lozano BlesaZaragozaSpain
| | - Goretti Hernández‐Mesa
- Department of GastroenterologyHospital Universitario de CanariasInstituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN)Universidad de La LagunaTenerifeSpain
| | - Melisa Piñero
- Department of GastroenterologyHospital Universitario de CanariasInstituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN)Universidad de La LagunaTenerifeSpain
| | - Joaquin Castillo
- Department of GastroenterologyHospital Clínic de BarcelonaInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD)University of BarcelonaBarcelonaSpain
| | - Teresa Ocaña
- Department of GastroenterologyHospital Clínico Universitario Lozano BlesaZaragozaSpain
| | - Joaquín Cubiella
- Department of GastroenterologyComplexo Hospitalario Universitario de OurenseOurenseSpain
| | - Anais Crespo
- Department of GastroenterologyComplexo Hospitalario Universitario de OurenseOurenseSpain
| | - Águeda Iglesias
- Department of GastroenterologyComplexo Hospitalario Universitario de OurenseOurenseSpain
| | - Isabel Medeiros
- Department of GastroenterologyHospital Espirito Santo de ÉvoraÉvoraPortugal
| | - Guillermo Cacho
- Department of GastroenterologyHospital Universitario Fundación AlcorcónMadridSpain
| | | | - Miren Alustiza
- Department of GastroenterologyHospital General Universitario de AlicanteMadridSpain
| | - José Diaz‐Tasende
- Department of GastroenterologyHospital Universitario 12 de OctubreMadridSpain
| | - Carmen Poves
- Department of GastroenterologyHospital Clínico Universitario San CarlosMadridSpain
| | - Guilherme Macedo
- Department of GastroenterologyCentro Hospitalar São JoãoPortoPortugal
| | - Enrique Quintero
- Department of GastroenterologyHospital Universitario de CanariasInstituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN)Universidad de La LagunaTenerifeSpain
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33
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Silva JF, Lopes S, Macedo G. An unexpected cause of common bile duct obstruction diagnosed by endoscopic ultrasound-guided fine-needle biopsy. Rev Esp Enferm Dig 2023; 115:533. [PMID: 36633171 DOI: 10.17235/reed.2023.9393/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
A 43-years-old woman with previous cholecystectomy presented as an outpatient with abnormal liver tests. A diagnosis of well-differentiated neuroendocrine tumor (NET) was made and a 68Ga-DOTA-somatostatin analogue positron emission tomography revealed no apparent metastatic disease.
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Affiliation(s)
| | - Susana Lopes
- Gastroenterology , Centro Hospitalar Universitário de São João
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34
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Santos-Antunes J, Berr F, Pioche M, Ramos-Zabala F, Cecinato P, Gallego F, Barreiro P, Félix C, Sferrazza S, Wagner A, Lemmers A, Figueiredo Ferreira M, Albéniz E, Küttner-Magalhães R, Fernandes C, Morais R, Gupta S, Martinho-Dias D, Rios E, Faria-Ramos I, Marques M, Bourke MJ, Macedo G. Deep submucosal invasion as a risk factor for recurrence after endoscopic submucosal dissection for T1 colorectal cancer. Endoscopy 2023; 55:881-882. [PMID: 37643603 DOI: 10.1055/a-2073-3986] [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: 08/31/2023]
Affiliation(s)
- João Santos-Antunes
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
- Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), Porto, Portugal
| | - Frieder Berr
- Department of Internal Medicine I, University Clinics Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Mathieu Pioche
- Department of Hepatology and Gastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Felipe Ramos-Zabala
- Departamento de Gastroenterología, Departamento de Ciencias Médicas Clínicas, Hospital Universitario HM Montepríncipe, HM Hospitales, Universidad San Pablo-CEU, CEU Universities Madrid, Spain
| | - Paolo Cecinato
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Pedro Barreiro
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental EPE, Lisbon, Portugal
- Lisbon Advanced Endoscopic Center, Hospital Lusíadas, Lisbon, Portugal
| | - Catarina Félix
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental EPE, Lisbon, Portugal
| | - Sandro Sferrazza
- Gastroenterology and Endoscopy Unit, Santa Chiara Hospital, Trento, Italy
| | - Andrej Wagner
- Department of Internal Medicine I, University Clinics Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Mariana Figueiredo Ferreira
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Eduardo Albéniz
- Complejo Hospitalario de Navarra, Navarrabiomed Research Institute, Public University of Navarra, IdiSNA, Pamplona, Spain
| | - Ricardo Küttner-Magalhães
- Gastroenterology Department, Hospital Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Carlos Fernandes
- Gastroenterology Department, Centro Hospitalar de Vila Nova de Gaia/ Espinho, Vila Nova de Gaia, Portugal
| | - Rui Morais
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Sunil Gupta
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
| | - Daniel Martinho-Dias
- Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Elisabete Rios
- Pathology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Isabel Faria-Ramos
- Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), Porto, Portugal
| | - Margarida Marques
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
| | - Guilherme Macedo
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
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35
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Santos-Antunes J, Pioche M, Ramos-Zabala F, Cecinato P, Gallego F, Barreiro P, Mascarenhas A, Sferrazza S, Berr F, Wagner A, Lemmers A, Ferreira MF, Albéniz E, Uchima H, Küttner-Magalhães R, Fernandes C, Morais R, Gupta S, Martinho-Dias D, Faria-Ramos I, Marques M, Bourke MJ, Macedo G. Risk of Residual Neoplasia after a Local-Risk Resection of Colorectal Lesions by Endoscopic Submucosal Dissection: A Multinational Study. J Clin Med 2023; 12:5356. [PMID: 37629398 PMCID: PMC10455482 DOI: 10.3390/jcm12165356] [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: 06/30/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) in colorectal lesions is demanding, and a significant rate of non-curative procedures is expected. We aimed to assess the rate of residual lesion after a piecemeal ESD resection, or after an en bloc resection but with positive horizontal margins (local-risk resection-LocRR), for colorectal benign neoplasia. A retrospective multicenter analysis of consecutive colorectal ESDs was performed. Patients with LocRR ESDs for the treatment of benign colorectal lesions with at least one follow-up endoscopy were included. A cohort of en bloc resected lesions, with negative margins, was used as the control. A total of 2255 colorectal ESDs were reviewed; 352 of the ESDs were "non-curative". Among them, 209 were LocRR: 133 high-grade dysplasia and 76 low-grade dysplasia. Ten cases were excluded due to missing data. A total of 146 consecutive curative resections were retrieved for comparison. Compared to the "curative group", LocRRs were observed in lengthier procedures, with larger lesions, and in non-granular LSTs. Recurrence was higher in the LocRR group (16/199, 8% vs. 1/146, 0.7%; p = 0.002). However, statistical significance was lost when considering only en bloc resections with positive horizontal margins (p = 0.068). In conclusion, a higher rate of residual lesion was found after a piecemeal ESD resection, but not after an en bloc resection with positive horizontal margins.
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Affiliation(s)
- João Santos-Antunes
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, 4200-319 Porto, Portugal
- Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), 4200-135 Porto, Portugal
| | - Mathieu Pioche
- Department of Hepatology and Gastroenterology, Edouard Herriot Hospital, 69003 Lyon, France
| | - Felipe Ramos-Zabala
- Servicio de Gastroenterología, Departamento de Ciencias Médicas Clínicas, Hospital Universitario HM Montepríncipe, HM Hospitales, 28660 Madrid, Spain
| | - Paolo Cecinato
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Francisco Gallego
- Gastroenterology Department, Hospital de Poniente, 04700 Almería, Spain
| | - Pedro Barreiro
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental EPE, 1169-050 Lisbon, Portugal
- Lisbon Advanced Endoscopic Center, Hospital Lusíadas, 2724-002 Lisbon, Portugal
| | - André Mascarenhas
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental EPE, 1169-050 Lisbon, Portugal
| | - Sandro Sferrazza
- Gastroenterology and Endoscopy Unit, Santa Chiara Hospital, 38123 Trento, Italy
| | - Frieder Berr
- Department of Internal Medicine I, University Clinics Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Andrej Wagner
- Department of Internal Medicine I, University Clinics Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium
| | - Mariana Figueiredo Ferreira
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium
| | - Eduardo Albéniz
- Complejo Hospitalario de Navarra, Navarrabiomed Research Institute, Public University of Navarra, IdiSNA, 31006 Pamplona, Spain
| | - Hugo Uchima
- Servicio de Endoscopia Digestiva Centro Médico Teknon, 08022 Barcelona, Spain
- Servicio de Gastroenterología Hospital Universitario Germans Trias i Pujol, 08916 Barcelona, Spain
| | - Ricardo Küttner-Magalhães
- Gastroenterology Department, Hospital Santo António, Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal
| | - Carlos Fernandes
- Gastroenterology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4400-129 Vila Nova de Gaia, Portugal
| | - Rui Morais
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, 4200-319 Porto, Portugal
| | - Sunil Gupta
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney 2145, Australia
| | - Daniel Martinho-Dias
- Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, 4169-007 Porto, Portugal
| | - Isabel Faria-Ramos
- Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), 4200-135 Porto, Portugal
| | - Margarida Marques
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, 4200-319 Porto, Portugal
| | - Michael J. Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney 2145, Australia
| | - Guilherme Macedo
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, 4200-319 Porto, Portugal
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36
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Moreira P, Cardoso PM, Macedo G, Santos-Antunes J. Endoscopic Submucosal Dissection, Endoscopic Mucosal Resection, and Transanal Minimally Invasive Surgery for the Management of Rectal and Anorectal Lesions: A Narrative Review. J Clin Med 2023; 12:4777. [PMID: 37510892 PMCID: PMC10381236 DOI: 10.3390/jcm12144777] [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: 06/14/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and transanal minimally invasive surgery (TAMIS) are modern techniques that now play a crucial role in the treatment of colorectal lesions. ESD is a minimally invasive endoscopic procedure that allows for the resection of lesions of any size in a single piece, with clear advantages regarding oncological outcomes and recurrences. However, it is a complex technique, requiring high endoscopic skills, expertise, and specialized training, with higher rates of adverse events expected compared with EMR. EMR is another endoscopic technique used to remove superficial gastrointestinal tumors, particularly those that are limited to the mucosal layer. It is a faster and more accessible procedure, with fewer adverse events, although it only allows for an en-bloc resection of lesions measuring 15-20 mm. TAMIS is a minimally invasive surgical technique used to remove rectal tumors, involving the insertion of a single-port device through the anus, allowing for a better visualization and removal of the tumor with minimal disruption. This article reviews the current applications and evidence regarding these techniques, in search for the most adequate treatment for the removal of lesions in the rectum and anorectal junction, as these locations possess distinct characteristics that demand a more specific approach.
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Affiliation(s)
- Pedro Moreira
- Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Pedro Marílio Cardoso
- Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Gastroenterology Department, Centro Hospitalar São João, 4200-319 Porto, Portugal
| | - Guilherme Macedo
- Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Gastroenterology Department, Centro Hospitalar São João, 4200-319 Porto, Portugal
| | - João Santos-Antunes
- Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Gastroenterology Department, Centro Hospitalar São João, 4200-319 Porto, Portugal
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, 4099-030 Porto, Portugal
- IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, 4200-450 Porto, Portugal
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37
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Silva JF, Pereira P, Macedo G. A rare case of ulcerative colitis following Bacillus Calmette-Guérin therapy. Rev Esp Enferm Dig 2023; 115:403. [PMID: 36353959 DOI: 10.17235/reed.2022.9191/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
A 60-years-old male was referred to us due to frequent discharge of blood and mucus during the last 2 months. The patient had a history of bladder cancer and was under therapy with intra-vesical Bacillus Calmette Guerin (BCG) for the last 4 months. Colonoscopy revealed loss of vascular pattern, erythematous appearance, granularity, and friability in the mucosa of the distal rectum.
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Affiliation(s)
| | - Pedro Pereira
- Gastroenterology, Centro Hospitalar Universitário de São João, Portugal
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38
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Medas R, Santos AL, Ferreira M, Macedo G. Pneumatosis intestinalis: a rare endoscopic feature of colonic ischemia. Rev Esp Enferm Dig 2023; 115:385-386. [PMID: 35704358 DOI: 10.17235/reed.2022.8980/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A 71-year-old male was admitted on intensive care unit after endovascular aneurysm repair of ruptured infrarenal abdominal aortic aneurysm. 2 weeks later, he had multiple episodes of bloody diarrhea. Colonoscopy revealed diffuse dusky mucosal coloration with loss of vasculature pattern, diseased haustrations, and diffuse areas of pneumatosis, suggestive of severe colonic ischemia.
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Affiliation(s)
- Renato Medas
- Gastroenterology, Centro Hospitalar Universitário São João, Portugal
| | - Ana Luísa Santos
- Gastrenterology, Centro Hospitalar Universitário São João, Portugal
| | - Mariana Ferreira
- Gastroenterology, Sanatorio Municipal Dr. Julio Méndez, Argentina
| | - Guilherme Macedo
- Gastroenterology , Centro Hospitalar Universitário São João, Portugal
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39
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Lopes SO, Gonçalves AR, Macedo G, Santos-Antunes J. Endoscopic treatment of gastroesophageal reflux: a narrative review. Porto Biomed J 2023; 8:e226. [PMID: 37547707 PMCID: PMC10400068 DOI: 10.1097/j.pbj.0000000000000226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 08/08/2023] Open
Abstract
Gastroesophageal reflux disease (GERD) is a common chronic disease that affects one-third of the population worldwide. In recent years, there have been significant advances for diagnostic workup, which leads to better identification of reflux-related complications. Classically, the mainstay of therapy has been proton pump inhibitor and lifestyle and dietary modifications. For refractory GERD the gold-standard therapies are surgical antireflux procedures. Recently, endoscopic procedures have emerged as safe and efficient alternatives to surgery. These could represent a less invasive approach, with scarce morbidity and with a well-tolerated profile. Each of the existing endoscopic techniques for the treatment of GERD are addressed in this report, highlighting their potential advantages, aiming at helping decide the best management of these patients. Future studies, with larger numbers of patients, may allow a definitive role for these techniques in the management of GERD to be established.
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Affiliation(s)
| | - Ana Raquel Gonçalves
- Faculty of Medicine, University of Porto, Porto, Portugal
- Gastroenterology Department, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Guilherme Macedo
- Faculty of Medicine, University of Porto, Porto, Portugal
- Gastroenterology Department, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - João Santos-Antunes
- Faculty of Medicine, University of Porto, Porto, Portugal
- Gastroenterology Department, Centro Hospitalar Universitário S. João, Porto, Portugal
- Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), Porto, Portugal
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40
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Correia F, Garrido I, Chaves V, Peixoto A, Lopes J, Macedo G, Almeida J. A Rare Case of Autoimmune Enteropathy Associated with Autoimmune Hepatitis. J Gastrointestin Liver Dis 2023; 32:257-260. [PMID: 37345595 DOI: 10.15403/jgld-4624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/25/2022] [Indexed: 06/23/2023]
Abstract
A 74-year-old woman was admitted for weight loss, abdominal pain and diarrhea for a year. Blood tests showed elevated transaminases, cholestasis and hyperbilirubinemia. Capsule endoscopy revealed extensively scattered lymphangiectasias, shortened villi and erosions in the jejunum and ileum. The histological examination of the small bowel mucosa biopsies evidenced severe mucosal atrophy and crypt hyperplasia, without significant intraepithelial lymphocytosis. The clinical picture, lack of response to a gluten-free diet and endoscopic and histopathologic findings were compatible with autoimmune enteropathy. Simultaneously, autoimmune hepatitis was also diagnosed. The patient showed significant improvement after starting treatment with prednisolone and azathioprine. To our knowledge, this is the first case of autoimmune enteropathy diagnosed simultaneously with autoimmune hepatitis.
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Affiliation(s)
- Francisca Correia
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal.
| | - Isabel Garrido
- Gastroenterology and Hepatology Department, Centro Hospitalar Universitário de São João, Porto; World Gastroenterology Organization (WGO) Porto Training Center, Porto, Portugal.
| | - Vanessa Chaves
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal.
| | - Armando Peixoto
- Gastroenterology and Hepatology Department, Centro Hospitalar Universitário de São João, Porto; World Gastroenterology Organization (WGO) Porto Training Center, Porto, Portugal.
| | - Joanne Lopes
- Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
| | - Guilherme Macedo
- Gastroenterology and Hepatology Department, Centro Hospitalar Universitário de São João, Porto; World Gastroenterology Organization (WGO) Porto Training Center, Porto, Portugal.
| | - Jorge Almeida
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal.
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41
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Estevinho MM, Cabeda J, Santiago M, Machado E, Silva R, Duro M, Pita I, Morais R, Macedo G, Bull TJ, Magro F, Sarmento A. Viable Mycobacterium avium subsp. paratuberculosis Colonizes Peripheral Blood of Inflammatory Bowel Disease Patients. Microorganisms 2023; 11:1520. [PMID: 37375022 DOI: 10.3390/microorganisms11061520] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 06/29/2023] Open
Abstract
Pathobionts, particularly Mycobacterium avium subsp. paratuberculosis (MAP) and Escherichia coli isolates with adherence/invasive ability (AIEC) have been associated with inflammatory bowel disease (IBD), particularly Crohn's disease (CD). This study aimed to evaluate the frequency of viable MAP and AIEC in a cohort of IBD patients. As such, MAP and E. coli cultures were established from faecal and blood samples (with a total n = 62 for each) of patients with CD (n = 18), ulcerative colitis (UC, n = 15), or liver cirrhosis (n = 7), as well as from healthy controls (HC, n = 22). Presumptive positive cultures were tested by polymerase chain reaction (PCR), for a positive confirmation of MAP or E. coli identity. E. coli-confirmed isolates were then tested for AIEC identity using adherence and invasion assays in the epithelial cell line of Caco-2 and survival and replication assays in the macrophage cell line of J774. MAP sub-culture and genome sequencing were also performed. MAP was more frequently cultured from the blood and faecal samples of patients with CD and cirrhosis. E. coli presumptive colonies were isolated from the faecal samples of most individuals, in contrast to what was registered for the blood samples. Additionally, from the confirmed E. coli isolates, only three had an AIEC-like phenotype (i.e., one CD patient and two UC patients). This study confirmed the association between MAP and CD; however, it did not find a strong association between the presence of AIEC and CD. It may be hypothesized that the presence of viable MAP in the bloodstream of CD patients contributes to disease reactivation.
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Affiliation(s)
- Maria Manuela Estevinho
- Department of Gastroenterology, Vila Nova de Gaia/Espinho Hospital Center, 4434-502 Vila Nova de Gaia, Portugal
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, 4050-313 Porto, Portugal
| | - José Cabeda
- FP-I3ID, Universidade Fernando Pessoa, 4200-150 Porto, Portugal
- Escola Superior de Saúde Fernando Pessoa, 4200-253 Porto, Portugal
- Centro Interdisciplinar de Investigação Marinha e Ambiental (CIIMAR, CIMAR), 4450-208 Matosinhos, Portugal
| | - Mafalda Santiago
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, 4050-313 Porto, Portugal
| | - Elisabete Machado
- FP-I3ID, Universidade Fernando Pessoa, 4200-150 Porto, Portugal
- UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Microbiology, Department of Biological Sciences, REQUIMTE, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, 4200-150 Porto, Portugal
| | - Ricardo Silva
- FP-I3ID, Universidade Fernando Pessoa, 4200-150 Porto, Portugal
- Escola Superior de Saúde Fernando Pessoa, 4200-253 Porto, Portugal
| | - Mary Duro
- FP-I3ID, Universidade Fernando Pessoa, 4200-150 Porto, Portugal
- Escola Superior de Saúde Fernando Pessoa, 4200-253 Porto, Portugal
- LAQV@REQUIMTE, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Inês Pita
- Department of Gastroenterology, Entre Douro e Vouga Hospital Center, 4520-211 Santa Maria da Feira, Portugal
| | - Rui Morais
- Department of Gastroenterology, São João University Hospital Center, 4200-319 Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, São João University Hospital Center, 4200-319 Porto, Portugal
| | - Tim J Bull
- Institute of Infection and Immunity, St George's University of London, London SW17 ORE, UK
| | - Fernando Magro
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, 4050-313 Porto, Portugal
- Department of Gastroenterology, São João University Hospital Center, 4200-319 Porto, Portugal
| | - Amélia Sarmento
- FP-I3ID, Universidade Fernando Pessoa, 4200-150 Porto, Portugal
- Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, 4200-150 Porto, Portugal
- I3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-150 Porto, Portugal
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Medas R, Pereira P, Ribeiro T, Silva M, Santos AL, Macedo G. Triple-sized intragastric balloon due to spontaneous hyperinflation. Rev Esp Enferm Dig 2023. [PMID: 37204089 DOI: 10.17235/reed.2023.9702/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
A 38-year-old female with medical history of breast cancer, hypertension, diabetes mellitus and obesity (body max index 55kg/m2), was admitted to the emergency room with complains of nausea and vomits. Three weeks prior to the presentation, she placed an intragastric balloon (IGB) (Orbera365™, Apollo endosurgery Inc., Austin, TX), for weight loss, filled with 600ml solution of saline and methylene blue dye. Upon physical examination, she was dehydrated and presented with a bulging of the upper abdominal wall associated with mild abdominal pain. Laboratory tests showed severe metabolic alkalosis, hypocalcemia and hypokalemia. Abdominal x-ray revealed gastric distension with an increased size IGB, measuring 164.3*145.6*144.1 mm (estimated volume of 1800mL), with an air-fluid level. Upper endoscopy revealed the balloon stuck in the antrum. A catheter needle was used to puncture and deflate the balloon. Once deflated it was removed with endoscopic forceps. The fluid was not sent for microbiologic culture. After IGB removal, hydroelectrolytic disturbances were resolved and oral feeding was promptly resumed without further complications.
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Affiliation(s)
- Renato Medas
- Gastroenterology, Centro Hospitalar Universitário de São João, Portugal
| | - Pedro Pereira
- Gastroenterology, Centro Hospitalar Universitário de São João
| | - Tiago Ribeiro
- Gastroenterology, Centro Hospitalar Universitário de São João, Portugal
| | - Marco Silva
- Gastroenterology, Centro Hospitalar Universitário de São João, Portugal
| | - Ana Luísa Santos
- Gastroenterology, Centro Hospitalar Universitário de São João, Portugal
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Dias E, Medas R, Marques M, Andrade P, Cardoso H, Macedo G. Clinicopathological characteristics and prognostic factors of small bowel lymphomas: a retrospective single-center study. Porto Biomed J 2023; 8:e217. [PMID: 37362020 PMCID: PMC10289779 DOI: 10.1097/j.pbj.0000000000000217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/21/2023] [Indexed: 06/28/2023] Open
Abstract
Background There is little information on diagnosis and management of small bowel lymphomas, and optimal management strategies are still undefined. This study aims to describe their main clinical and pathological characteristics and identify poor prognostic factors. Methods A retrospective observational study of all patients with histological diagnosis of small bowel lymphoma between January 2010 and December 2020 was performed. Results We included 40 patients, with male predominance (60%) and mean age of 60.7 years. The ileum was the most common location, and the most common histological subtypes were follicular lymphoma and diffuse large B-cell lymphoma. Clinical presentation was variable from asymptomatic patients (30%) to acute surgical complications (35%) including perforation, intestinal obstruction, ileal intussusception, or severe bleeding. Diagnosis was established by endoscopy in 22 patients (55%), and the most common findings included polyps, single mass, diffuse infiltration, or ulceration, whereas 18 (45%) required surgery because of acute presentations or tumor resection, and lymphoma was diagnosed postoperatively. Surgery was curative in one-third of those patients. Median survival was 52 months. Acute presentation (P = 0.001), symptomatic disease (P = 0.003), advanced stage (P = 0.008), diffuse large B-cell lymphoma (P = 0.007), anemia (P = 0.006), hypoalbuminemia (P < 0.001), elevated lactate dehydrogenase (P = 0.02), elevated C-reactive protein (P < 0.001), and absence of treatment response (P < 0.001) were significant predictors of mortality. Conclusion Small bowel lymphoma is a rare malignancy with diverse clinical and endoscopic presentations that require a high index of suspicion. Primary factors associated with worse outcome included acute presentation, advanced stage, histological subtype, biochemical abnormalities, and absence of treatment response.
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Affiliation(s)
- Emanuel Dias
- Corresponding author. Address: Gastrenterology Department, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal. E-mail address: (Emanuel Dias)
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Coelho R, Ribeiro T, Abreu N, Gonçalves R, Macedo G. Infectious proctitis: what every gastroenterologist needs to know. Ann Gastroenterol 2023; 36:275-286. [PMID: 37144018 PMCID: PMC10152816 DOI: 10.20524/aog.2023.0799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/15/2023] [Indexed: 05/06/2023] Open
Abstract
The incidence of sexually transmitted infections (STI) is rising, especially in high-risk groups, namely people living with human immunodeficiency virus (HIV), men who have sex with men, and people with multiple sexual partners. Additionally, the growing availability and use of pre-exposure prophylaxis to prevent HIV infection appears to be associated with an increased risk of infection by venereal agents. The correct recognition of these infections is crucial, not only for individual patients, but also in terms of public health. Furthermore, a diligent diagnostic assessment is key for an efficient therapeutic approach. Infectious proctitis (IP) predominantly occurs in individuals with a history of receptive anal exposure, being a frequent cause for referral to a gastroenterology specialist. The most frequently identified agents are Neisseria gonorrhoeae, Chlamydia trachomatis, Herpes simplex virus, and Treponema pallidum. This paper aims to provide a practice-oriented and up-to-date review regarding the diagnostic and therapeutic approaches to patients with suspected IP. The authors reviewed the most important issues in terms of clinical history, physical examination, and specific diagnostic and therapeutic methods. It is also highlighted the most important topics regarding vaccination, screening for other STIs and differential diagnosis with inflammatory bowel disease. Identification of high-risk groups, screening of potential STIs, and notification of diagnosed anorectal diseases are extremely important and essential to prevent transmission and other complications.
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Affiliation(s)
- Rosa Coelho
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto (Rosa Coelho, Tiago Ribeiro, Raquel Gonçalves, Guilherme Macedo)
- World Gastroenterology Organisation Training Center, Porto (Rosa Coelho, Tiago Ribeiro, Raquel Gonçalves, Guilherme Macedo)
- Faculty of Medicine, University of Porto, Porto (Rosa Coelho, Guilherme Macedo)
| | - Tiago Ribeiro
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto (Rosa Coelho, Tiago Ribeiro, Raquel Gonçalves, Guilherme Macedo)
- World Gastroenterology Organisation Training Center, Porto (Rosa Coelho, Tiago Ribeiro, Raquel Gonçalves, Guilherme Macedo)
| | - Nélia Abreu
- Gastroenterology Department, Hospital Central do Funchal, Madeira (Nélia Abreu), Portugal
| | - Raquel Gonçalves
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto (Rosa Coelho, Tiago Ribeiro, Raquel Gonçalves, Guilherme Macedo)
- World Gastroenterology Organisation Training Center, Porto (Rosa Coelho, Tiago Ribeiro, Raquel Gonçalves, Guilherme Macedo)
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto (Rosa Coelho, Tiago Ribeiro, Raquel Gonçalves, Guilherme Macedo)
- World Gastroenterology Organisation Training Center, Porto (Rosa Coelho, Tiago Ribeiro, Raquel Gonçalves, Guilherme Macedo)
- Faculty of Medicine, University of Porto, Porto (Rosa Coelho, Guilherme Macedo)
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Ribeiro T, Mascarenhas Saraiva MJ, Afonso J, Cardoso P, Mendes F, Martins M, Andrade AP, Cardoso H, Mascarenhas Saraiva M, Ferreira J, Macedo G. Design of a Convolutional Neural Network as a Deep Learning Tool for the Automatic Classification of Small-Bowel Cleansing in Capsule Endoscopy. Medicina (Kaunas) 2023; 59:medicina59040810. [PMID: 37109768 PMCID: PMC10145655 DOI: 10.3390/medicina59040810] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023]
Abstract
Background and objectives: Capsule endoscopy (CE) is a non-invasive method to inspect the small bowel that, like other enteroscopy methods, requires adequate small-bowel cleansing to obtain conclusive results. Artificial intelligence (AI) algorithms have been seen to offer important benefits in the field of medical imaging over recent years, particularly through the adaptation of convolutional neural networks (CNNs) to achieve more efficient image analysis. Here, we aimed to develop a deep learning model that uses a CNN to automatically classify the quality of intestinal preparation in CE. Methods: A CNN was designed based on 12,950 CE images obtained at two clinical centers in Porto (Portugal). The quality of the intestinal preparation was classified for each image as: excellent, ≥90% of the image surface with visible mucosa; satisfactory, 50-90% of the mucosa visible; and unsatisfactory, <50% of the mucosa visible. The total set of images was divided in an 80:20 ratio to establish training and validation datasets, respectively. The CNN prediction was compared with the classification established by consensus of a group of three experts in CE, currently considered the gold standard to evaluate cleanliness. Subsequently, how the CNN performed in diagnostic terms was evaluated using an independent validation dataset. Results: Among the images obtained, 3633 were designated as unsatisfactory preparation, 6005 satisfactory preparation, and 3312 with excellent preparation. When differentiating the classes of small-bowel preparation, the algorithm developed here achieved an overall accuracy of 92.1%, with a sensitivity of 88.4%, a specificity of 93.6%, a positive predictive value of 88.5%, and a negative predictive value of 93.4%. The area under the curve for the detection of excellent, satisfactory, and unsatisfactory classes was 0.98, 0.95, and 0.99, respectively. Conclusions: A CNN-based tool was developed to automatically classify small-bowel preparation for CE, and it was seen to accurately classify intestinal preparation for CE. The development of such a system could enhance the reproducibility of the scales used for such purposes.
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Affiliation(s)
- Tiago Ribeiro
- Department of Gasteroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- Gastroenterology and Hepatology, WGO Gastroenterology and Hepatology Training Centre, 4050-345 Porto, Portugal
| | - Miguel José Mascarenhas Saraiva
- Department of Gasteroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- Gastroenterology and Hepatology, WGO Gastroenterology and Hepatology Training Centre, 4050-345 Porto, Portugal
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - João Afonso
- Department of Gasteroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- Gastroenterology and Hepatology, WGO Gastroenterology and Hepatology Training Centre, 4050-345 Porto, Portugal
| | - Pedro Cardoso
- Department of Gasteroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- Gastroenterology and Hepatology, WGO Gastroenterology and Hepatology Training Centre, 4050-345 Porto, Portugal
| | - Francisco Mendes
- Department of Gasteroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- Gastroenterology and Hepatology, WGO Gastroenterology and Hepatology Training Centre, 4050-345 Porto, Portugal
| | - Miguel Martins
- Department of Gasteroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- Gastroenterology and Hepatology, WGO Gastroenterology and Hepatology Training Centre, 4050-345 Porto, Portugal
| | - Ana Patrícia Andrade
- Department of Gasteroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- Gastroenterology and Hepatology, WGO Gastroenterology and Hepatology Training Centre, 4050-345 Porto, Portugal
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Hélder Cardoso
- Department of Gasteroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- Gastroenterology and Hepatology, WGO Gastroenterology and Hepatology Training Centre, 4050-345 Porto, Portugal
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | | | - João Ferreira
- Department of Mechanical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
- INEGI-Institute of Science and Innovation in Mechanical and Industrial Engineering, 4200-465 Porto, Portugal
| | - Guilherme Macedo
- Department of Gasteroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- Gastroenterology and Hepatology, WGO Gastroenterology and Hepatology Training Centre, 4050-345 Porto, Portugal
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
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Mascarenhas M, Afonso J, Ribeiro T, Andrade P, Cardoso H, Macedo G. The Promise of Artificial Intelligence in Digestive Healthcare and the Bioethics Challenges It Presents. Medicina (Kaunas) 2023; 59:medicina59040790. [PMID: 37109748 PMCID: PMC10145124 DOI: 10.3390/medicina59040790] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/27/2023] [Accepted: 04/02/2023] [Indexed: 04/29/2023]
Abstract
With modern society well entrenched in the digital area, the use of Artificial Intelligence (AI) to extract useful information from big data has become more commonplace in our daily lives than we perhaps realize. Medical specialties that rely heavily on imaging techniques have become a strong focus for the incorporation of AI tools to aid disease diagnosis and monitoring, yet AI-based tools that can be employed in the clinic are only now beginning to become a reality. However, the potential introduction of these applications raises a number of ethical issues that must be addressed before they can be implemented, among the most important of which are issues related to privacy, data protection, data bias, explainability and responsibility. In this short review, we aim to highlight some of the most important bioethical issues that will have to be addressed if AI solutions are to be successfully incorporated into healthcare protocols, and ideally, before they are put in place. In particular, we contemplate the use of these aids in the field of gastroenterology, focusing particularly on capsule endoscopy and highlighting efforts aimed at resolving the issues associated with their use when available.
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Affiliation(s)
- Miguel Mascarenhas
- Faculty of Medicine, University of Porto, 4200-437 Porto, Portugal
- Precision Medicine Unit, Department of Gastroenterology, Hospital São João, 4200-437 Porto, Portugal
- WGO Training Center, 4200-437 Porto, Portugal
| | - João Afonso
- Precision Medicine Unit, Department of Gastroenterology, Hospital São João, 4200-437 Porto, Portugal
- WGO Training Center, 4200-437 Porto, Portugal
| | - Tiago Ribeiro
- Precision Medicine Unit, Department of Gastroenterology, Hospital São João, 4200-437 Porto, Portugal
- WGO Training Center, 4200-437 Porto, Portugal
| | - Patrícia Andrade
- Faculty of Medicine, University of Porto, 4200-437 Porto, Portugal
- Precision Medicine Unit, Department of Gastroenterology, Hospital São João, 4200-437 Porto, Portugal
- WGO Training Center, 4200-437 Porto, Portugal
| | - Hélder Cardoso
- Faculty of Medicine, University of Porto, 4200-437 Porto, Portugal
- Precision Medicine Unit, Department of Gastroenterology, Hospital São João, 4200-437 Porto, Portugal
- WGO Training Center, 4200-437 Porto, Portugal
| | - Guilherme Macedo
- Faculty of Medicine, University of Porto, 4200-437 Porto, Portugal
- Precision Medicine Unit, Department of Gastroenterology, Hospital São João, 4200-437 Porto, Portugal
- WGO Training Center, 4200-437 Porto, Portugal
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Garrido I, Lopes S, Dias CC, Macedo G. IBD-disk - a new tool for assessing disability in inflammatory bowel disease. Dig Liver Dis 2023; 55:824-827. [PMID: 37037765 DOI: 10.1016/j.dld.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/13/2023] [Accepted: 03/22/2023] [Indexed: 04/12/2023]
Affiliation(s)
- Isabel Garrido
- Gastroenterology and Hepatology Department, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, Porto 4200-319, Portugal; World Gastroenterology Organization (WGO) Porto Training Center, Porto, Portugal.
| | - Susana Lopes
- Gastroenterology and Hepatology Department, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, Porto 4200-319, Portugal; World Gastroenterology Organization (WGO) Porto Training Center, Porto, Portugal
| | - Cláudia Camila Dias
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of Porto University, Porto, Portugal; Department of Community Medicine, Information and Decision in Health, Faculty of Medicine of Porto University, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology and Hepatology Department, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, Porto 4200-319, Portugal; World Gastroenterology Organization (WGO) Porto Training Center, Porto, Portugal
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48
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Dias E, Santos-Antunes J, Marques M, Fonseca E, Lopes J, Macedo G. Juvenile polyps with osseous metaplasia treated by endoscopic mucosal resection. Rev Esp Enferm Dig 2023; 115:214-215. [PMID: 36719331 DOI: 10.17235/reed.2023.9489/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A 17-year-old male with no previous medical history presented with a 1-year history of rectal bleeding, mucus discharge and occasional rectal prolapse. Colonoscopy revealed several polypoidal growth masses in the distal rectum, formed by multiple sessile polyps with a glistening mucus-covered surface and fleshy, friable appearance, that coalesced forming large conglomerates. Given their complexity and large size, piecemeal endoscopic mucosal resection of the rectal lesions was performed and histopathological examination revealed ulcerated polypoid mucosa with mixed inflammatory cell infiltrate in the lamina propria and dilated cystic mucus-filled glands. Remarkably, bony trabeculae surrounded by osteoblastic cells were also seen. These findings were consistent with juvenile polyps with foci of osseous metaplasia. Osseous metaplasia has been described in a wide variety of tissue types, such as prostate, uterus, breasts, lungs and urinary tract, with respect to both neoplastic and non-neoplastic conditions. However, it is exceedingly rare in colonic polyps and, to the best of our knowledge, only 9 cases have been described in juvenile polyps.
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Affiliation(s)
- Emanuel Dias
- Gastrenterology , Centro Hospitalar Universitário de São João, Portugal
| | | | - Margarida Marques
- Gastrenterology, Centro Hospitalar Universitário de São João, Portugal
| | - Elsa Fonseca
- Pathology , Centro Hospitalar Universitário de São João, Portugal
| | - Joanne Lopes
- Pathology, Centro Hospitalar Universitário de São João
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Macedo G, Lopes S. How Gastroenterology Leaders Performed while Navigating in Rough Seas: Lessons from the COVID-19 Pandemic. J Gastrointestin Liver Dis 2023; 32:7-9. [PMID: 37004217 DOI: 10.15403/jgld-4878] [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: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 04/03/2023]
Affiliation(s)
- Guilherme Macedo
- World Gastroenterology Organization Porto Training Center, Porto, Portugal.
| | - Susana Lopes
- World Gastroenterology Organization Porto Training Center, Porto, Portugal.
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50
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Santos-Antunes J, Pioche M, Ramos-Zabala F, Cecinato P, Gallego Rojo FJ, Barreiro P, Félix C, Sferrazza S, Berr F, Wagner A, Lemmers A, Figueiredo Ferreira M, Albéniz E, Uchima H, Küttner-Magalhães R, Fernandes C, Morais R, Gupta S, Martinho-Dias D, Rios E, Faria-Ramos I, Marques M, Bourke MJ, Macedo G. Risk of residual neoplasia after a noncurative colorectal endoscopic submucosal dissection for malignant lesions: a multinational study. Endoscopy 2023; 55:235-244. [PMID: 35863354 DOI: 10.1055/a-1906-8000] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND : Endoscopic submucosal dissection (ESD) in colorectal lesions is technically demanding and a significant rate of noncurative procedures is expected. We aimed to assess the rate of residual lesions after a noncurative ESD for colorectal cancer (CRC) and to establish predictive scores to be applied in the clinical setting. METHODS : Retrospective multicenter analysis of consecutive colorectal ESDs. Patients with noncurative ESDs performed for the treatment of CRC lesions submitted to complementary surgery or with at least one follow-up endoscopy were included. RESULTS : From 2255 colorectal ESDs, 381 (17 %) were noncurative, and 135 of these were performed in CRC lesions. A residual lesion was observed in 24 patients (18 %). Surgery was performed in 96 patients and 76 (79 %) had no residual lesion in the colorectal wall or in the lymph nodes. The residual lesion rate for sm1 cancers was 0 %, and for > sm1 cancers was also 0 % if no other risk factors were present. Independent risk factors for lymph node metastasis were poor differentiation and lymphatic permeation (NC-Lymph score). Risk factors for the presence of a residual lesion in the wall were piecemeal resection, poor differentiation, and positive/indeterminate vertical margin (NC-Wall score). CONCLUSIONS : Lymphatic permeation or poor differentiation warrant surgery owing to their high risk of lymph node metastasis, mainly in > sm1 cancers. In the remaining cases, en bloc and R0 resections resulted in a low risk of residual lesions in the wall. Our scores can be a useful tool for the management of patients who undergo noncurative colorectal ESDs.
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Affiliation(s)
- João Santos-Antunes
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
- Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), Porto, Portugal
| | - Mathieu Pioche
- Department of Hepatology and Gastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Felipe Ramos-Zabala
- Department of Gastroenterology, Department of Clinical Medical Sciences, Hospital Universitario HM Montepríncipe, HM Hospitales, Universidad San Pablo-CEU, CEU Universities Madrid, Madrid, Spain
| | - Paolo Cecinato
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Pedro Barreiro
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental EPE, Lisbon, Portugal
- Lisbon Advanced Endoscopic Center, Hospital Lusíadas, Lisbon, Portugal
| | - Catarina Félix
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental EPE, Lisbon, Portugal
| | - Sandro Sferrazza
- Gastroenterology and Endoscopy Unit, Santa Chiara Hospital, Trento, Italy
| | - Frieder Berr
- Department of Internal Medicine I, University Clinics Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Andrej Wagner
- Department of Internal Medicine I, University Clinics Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Mariana Figueiredo Ferreira
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Eduardo Albéniz
- Navarrabiomed Research Institute, Complejo Hospitalario de Navarra, Public University of Navarra, IdiSNA, Pamplona, Spain
| | - Hugo Uchima
- Digestive Endoscopy Service, Centro Médico Teknon, Barcelona, Spain
- Gastroenterology Service, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
| | - Ricardo Küttner-Magalhães
- Gastroenterology Department, Hospital Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Carlos Fernandes
- Gastroenterology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Rui Morais
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Sunil Gupta
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
| | - Daniel Martinho-Dias
- Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Elisabete Rios
- Pathology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Isabel Faria-Ramos
- Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), Porto, Portugal
| | - Margarida Marques
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
| | - Guilherme Macedo
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
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