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Rodríguez de Santiago E, Herreros-de-Tejada A, Albéniz E, Ramos Zabala F, Fernández-Esparrach G, Nogales O, Rosón P, Peñas García B, Uchima H, Terán Á, Rodríguez Sánchez J, de Frutos D, Parejo Carbonell S, Santiago J, Díaz Tasende J, Guarner Argente C, de María Pallarés P, Amorós A, Barranco D, Álvarez de Castro D, Muñoz González R, Marín-Gabriel JC. Implementation of esophageal endoscopic submucosal dissection in Spain: Results from the nationwide registry. Gastroenterol Hepatol 2024; 47:119-129. [PMID: 36870477 DOI: 10.1016/j.gastrohep.2023.02.008] [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] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/24/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION AND AIMS The outcomes of endoscopic submucosal dissection (ESD) in the esophagus have not been assessed in our country. Our primary aim was to analyze the effectiveness and safety of the technique. MATERIAL AND METHODS Analysis of the prospectively maintained national registry of ESD. We included all superficial esophageal lesions removed by ESD in 17 hospitals (20 endoscopists) between January 2016 and December 2021. Subepithelial lesions were excluded. The primary outcome was curative resection. We conducted a survival analysis and used logistic regression analysis to assess predictors of non-curative resection. RESULTS A total of 102 ESD were performed on 96 patients. The technical success rate was 100% and the percentage of en-bloc resection was 98%. The percentage of R0 and curative resection was 77.5% (n=79; 95%CI: 68%-84%) and 63.7% (n=65; 95%CI: 54%-72%), respectively. The most frequent histology was Barrett-related neoplasia (n=55 [53.9%]). The main reason for non-curative resection was deep submucosal invasion (n=25). The centers with a lower volume of ESD obtained worse results in terms of curative resection. The rate of perforation, delayed bleeding and post-procedural stenosis were 5%, 5% and 15.7%, respectively. No patient died or required surgery due to an adverse effect. After a median follow-up of 14months, 20patients (20.8%) underwent surgery and/or chemoradiotherapy, and 9 patients died (mortality 9.4%). CONCLUSIONS In Spain, esophageal ESD is curative in approximately two out of three patients, with an acceptable risk of adverse events.
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Affiliation(s)
- Enrique Rodríguez de Santiago
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España.
| | - Alberto Herreros-de-Tejada
- Servicio de Digestivo, Hospital Universitario Puerta de Hierro, Instituto de Investigación Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, España; Hospital La Luz, QuirónSalud, Madrid, España
| | - Eduardo Albéniz
- Unidad de Endoscopia, Servicio de Gastroenterología, Hospital Universitario de Navarra NavarraBiomed, Universidad Pública de Navarra (UPNA), IdisNA, Pamplona, España
| | - Felipe Ramos Zabala
- Servicio de Gastroenterología, Hospital Universitario HM Montepríncipe, Grupo HM hospitales, Boadilla del Monte, Madrid, España
| | - Gloria Fernández-Esparrach
- Sección de Endoscopia, Servicio de Gastroenterología, ICMDM, Hospital Clínic de Barcelona; Institut d'Investigacions Biomèdiques August Pi i Sunyer. CIBEREHD. Universidad de Barcelona, Barcelona, España
| | - Oscar Nogales
- Servicio de Gastroenterología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Pedro Rosón
- Servicio de Aparato Digestivo, Hospital Vithas Xanit internacional Málaga, Málaga, España
| | - Beatriz Peñas García
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España
| | - Hugo Uchima
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España; Centro Médico Teknon, Barcelona, España
| | - Álvaro Terán
- Servicio de Gastroenterología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, España
| | - Joaquín Rodríguez Sánchez
- Servicio de Medicina del Aparato Digestivo, Unidad de Endoscopias, Hospital Universitario 12 de Octubre; Instituto de Investigación «i+12», Madrid, España; Servicio de Gastroenterología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Diego de Frutos
- Servicio de Digestivo, Hospital Universitario Puerta de Hierro, Instituto de Investigación Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, España
| | - Sofía Parejo Carbonell
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España
| | - José Santiago
- Servicio de Digestivo, Hospital Universitario Puerta de Hierro, Instituto de Investigación Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, España
| | - José Díaz Tasende
- Servicio de Medicina del Aparato Digestivo, Unidad de Endoscopias, Hospital Universitario 12 de Octubre; Instituto de Investigación «i+12», Madrid, España
| | - Charly Guarner Argente
- Servicio de Gastroenterología, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, España
| | | | - Ana Amorós
- Servicio de Gastroenterología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - Daniel Barranco
- Unidad de Endoscopia, Servicio de Gastroenterología, Hospital Universitario de Navarra NavarraBiomed, Universidad Pública de Navarra (UPNA), IdisNA, Pamplona, España
| | - Daniel Álvarez de Castro
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España
| | - Raquel Muñoz González
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España; Centro Médico Teknon, Barcelona, España
| | - José Carlos Marín-Gabriel
- Servicio de Medicina del Aparato Digestivo, Unidad de Endoscopias, Hospital Universitario 12 de Octubre; Instituto de Investigación «i+12», Madrid, España
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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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Uchima H, Muñoz-González R, Calm A, Caballero N, Espinos J, Moreno de Vega V, Marin I. The "furrow sign" in confirming proper gastric extent and direction of the myotomy at the end of peroral endoscopic myotomy. Endoscopy 2023; 55:E1209-E1210. [PMID: 37989235 PMCID: PMC10762689 DOI: 10.1055/a-2199-6956] [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: 11/23/2023]
Affiliation(s)
- Hugo Uchima
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
| | - Raquel Muñoz-González
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
| | - Anna Calm
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Noemí Caballero
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Jorge Espinos
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
| | - Vicente Moreno de Vega
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Ingrid Marin
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Uchima H, Calm A, Muñoz-González R, Caballero N, Rosinach M, Marín I, Colán-Hernández J, Iborra I, Castillo-Regalado E, Temiño R, Mata A, Turró R, Espinós J, Moreno De Vega V, Pellisé M. Underwater cap-suction pseudopolyp formation for endoscopic mucosal resection: a simple technique for treating flat, appendiceal orifice or ileocecal valve colorectal lesions. Endoscopy 2023; 55:1045-1050. [PMID: 37348544 DOI: 10.1055/a-2115-7797] [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: 06/24/2023]
Abstract
BACKGROUND We aimed to evaluate the safety and technical success of an easy-to-use technique that applies underwater cap suction pseudopolyp formation to facilitate the resection of flat lesions or those at the appendiceal orifice or ileocecal valve. METHODS We retrospectively analyzed a register of consecutive cap suction underwater endoscopic mucosal resection (CAP-UEMR) procedures performed at two centers between September 2020 and December 2021. Procedures were performed using a cone-shaped cap, extending 7 mm from the endoscope tip, to suction the lesion while submerged underwater, followed by underwater snare resection. Our primary end point was technical success, defined as macroscopic complete resection. RESULTS We treated 83 lesions (median size 20 mm; interquartile range [IQR] 15-30 mm) with CAP-UEMR: 64 depressed or flat lesions (18 previously manipulated, 9 with difficult access), 11 from the appendix, and 8 from the ileocecal valve. Technical success was 100 %. There were seven intraprocedural bleedings and two delayed bleedings, all managed endoscopically. No perforations or other complications occurred. Among the 64 lesions with follow-up colonoscopy, only one recurrence was detected, which was treated endoscopically. CONCLUSIONS CAP-UEMR was a safe and effective technique for removing nonpolypoid colorectal lesions, including those arising from the appendiceal orifice or ileocecal valve.
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Affiliation(s)
- Hugo Uchima
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
| | - Anna Calm
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Raquel Muñoz-González
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
| | - Noemí Caballero
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | | | - Ingrid Marín
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Juan Colán-Hernández
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Ignacio Iborra
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Edgar Castillo-Regalado
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Rocío Temiño
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
| | - Alfredo Mata
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
| | - Román Turró
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
| | - Jorge Espinós
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
| | - Vicente Moreno De Vega
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Maria Pellisé
- Gastroenterology, Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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5
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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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Uchima H, Muñoz-González R, Marín Í, Caballero N, Cepero C, Iborra I, Colán-Hernández J, Castillo E, Moreno V. Endocitoscopia de la muscular propia en acalasia de rápida evolución y recidiva de acalasia post-Heller. Gastroenterol Hepatol 2023:S0210-5705(23)00343-6. [PMID: 37236306 DOI: 10.1016/j.gastrohep.2023.05.012] [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] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Hugo Uchima
- Unidad de Endoscopias, Servicio de Gastroenterología, Hospital Universitari Germans Trias I Pujol, Badalona, España; Unidad de Endoscopias, Centro Médico Teknon, Barcelona, España.
| | - Raquel Muñoz-González
- Unidad de Endoscopias, Servicio de Gastroenterología, Hospital Universitari Germans Trias I Pujol, Badalona, España; Unidad de Endoscopias, Centro Médico Teknon, Barcelona, España
| | - Íngrid Marín
- Unidad de Endoscopias, Servicio de Gastroenterología, Hospital Universitari Germans Trias I Pujol, Badalona, España
| | - Noemí Caballero
- Unidad de Endoscopias, Servicio de Gastroenterología, Hospital Universitari Germans Trias I Pujol, Badalona, España
| | - Claudia Cepero
- Unidad de Endoscopias, Servicio de Gastroenterología, Hospital Universitari Joan XXIII, Tarragona, España
| | - Ignacio Iborra
- Unidad de Endoscopias, Servicio de Gastroenterología, Hospital Universitari Germans Trias I Pujol, Badalona, España
| | - Juan Colán-Hernández
- Unidad de Endoscopias, Servicio de Gastroenterología, Hospital Universitari Germans Trias I Pujol, Badalona, España
| | - Edgar Castillo
- Unidad de Endoscopias, Servicio de Gastroenterología, Hospital Universitari Germans Trias I Pujol, Badalona, España
| | - Vicente Moreno
- Unidad de Endoscopias, Servicio de Gastroenterología, Hospital Universitari Germans Trias I Pujol, Badalona, España
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7
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Rodríguez Sánchez J, Alvarez-Gonzalez MA, Pellisé M, Coto-Ugarte D, Uchima H, Aranda-Hernández J, Santiago García J, Marín-Gabriel JC, Riu Pons F, Nogales O, Carreño Macian R, Herreros-de-Tejada A, Hernández L, Patrón GO, Rodriguez-Tellez M, Redondo-Cerezo E, Sánchez Alonso M, Daca M, Valdivielso-Cortazar E, Álvarez Delgado A, Enguita M, Montori S, Albéniz E. Underwater versus conventional EMR of large nonpedunculated colorectal lesions: a multicenter randomized controlled trial. Gastrointest Endosc 2023; 97:941-951.e2. [PMID: 36572129 DOI: 10.1016/j.gie.2022.12.013] [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] [Received: 10/26/2022] [Revised: 11/23/2022] [Accepted: 12/17/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Underwater EMR (UEMR) is an alternative procedure to conventional EMR (CEMR) to treat large, nonpedunculated colorectal lesions (LNPCLs). In this multicenter, randomized controlled clinical trial, we aimed to compare the efficacy and safety of UEMR versus CEMR on LNPCLs. METHODS We conducted a multicenter, randomized controlled clinical trial from February 2018 to February 2020 in 11 hospitals in Spain. A total of 298 patients (311 lesions) were randomized to the UEMR (n = 149) and CEMR (n = 162) groups. The main outcome was the lesion recurrence rate in at least 1 follow-up colonoscopy. Secondary outcomes included technical aspects, en bloc resection rate, R0 resection rates, and adverse events, among others. RESULTS There were no differences in the overall recurrence rate (9.5% UEMR vs 11.7% CEMR; absolute risk difference, -2.2%; 95% CI, -9.4 to 4.9). However, considering polyp sizes between 20 and 30 mm, the recurrence rate was lower for UEMR (3.4% UEMR vs 13.1% CEMR; absolute risk difference, -9.7%; 95% CI, -19.4 to 0). The R0 resection showed the same tendency, with significant differences favoring UEMR only for polyps between 20 and 30 mm. Overall, UEMR was faster and easier to perform than CEMR. Importantly, the techniques were equally safe. CONCLUSIONS UEMR is a valid alternative to CEMR for treating LNPCLs and could be considered the first option of treatment for lesions between 20 and 30 mm due to its higher en bloc and R0 resection rates. (Clinical trial registration number: NCT03567746.).
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Affiliation(s)
- Joaquín Rodríguez Sánchez
- Endoscopy Unit, Hospital Universitario 12 de Octubre de Madrid, Madrid, Spain; Hospital General Universitario de Ciudad Real, Ciudad Real, Spain.
| | - Marco A Alvarez-Gonzalez
- Department of Digestive Diseases, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - María Pellisé
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - David Coto-Ugarte
- Cruces University Hospital Endoscopy Unit Barakaldo, Basque Country, Spain
| | - Hugo Uchima
- Endoscopy Unit, Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Javier Aranda-Hernández
- Endoscopy Unit, Department of Gastroenterology & Hepatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Santiago García
- Gastroenterology Department, Research Institute Segovia de Arana, Puerta de Hierro University Hospital, Autonomous University of Madrid, Madrid, Spain
| | - José Carlos Marín-Gabriel
- Endoscopy Unit, Gastroenterology Department, "i+12 Research Institute," Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Fausto Riu Pons
- Gastroenterology Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Oscar Nogales
- Endoscopy Unit, Department of Gastroenterology & Hepatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Alberto Herreros-de-Tejada
- Gastroenterology Department, Research Institute Segovia de Arana, Puerta de Hierro University Hospital, Autonomous University of Madrid, Madrid, Spain
| | | | - G Oliver Patrón
- Hospital Manacor and Hospital Parque Llevant, Palma de Mallorca, Spain
| | | | - Eduardo Redondo-Cerezo
- Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Granada, Spain
| | | | - Maria Daca
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | | | | | - Mónica Enguita
- Methodology Unit,. Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Sheyla Montori
- Gastrointestinal Endoscopy Research Unit, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Eduardo Albéniz
- Endoscopy Unit, Gastroenterology Department, Hospital Universitario de Navarra (HUN), Navarrabiomed, Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.
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8
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Uchima H, Da Fieno A, Bonilla A, Melo-Borges J, Sánchez-Montes C, Cuatrecasas M, Córdova H, Elizalde I, Rakislova N, Gratacós-Ginès J, Bayarri C, Casanova G, Ginès À, Llach J, Balaguer F, Fernández-Esparrach G. Serological levels of IGF-1 and IGFBP-3 in patients with Barrett's esophagus and esophageal adenocarcinoma: Longitudinal study. Gastroenterol Hepatol 2023; 46:360-368. [PMID: 36179948 DOI: 10.1016/j.gastrohep.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 05/09/2023]
Abstract
BACKGROUND Barrett's esophagus (BE) is an entity with a known histological progression to malignancy. The insulin-like growth factor (IGF) system is involved in the carcinogenesis through obesity-related mechanisms that include IGF and it has been associated with several types of cancer. OBJECTIVES To evaluate the serological levels of IGF-1 and IGFBP-3 in patients with BE and esophageal adenocarcinoma. PATIENTS AND METHODS Prospective study of patients with BE and esophageal adenocarcinoma who underwent upper endoscopy between September 2012 and December 2015. A baseline determination of IGF-1 and IGFBP-3 was performed. We included a control group of patients without BE. RESULTS One hundred sixteen patients were included: 36 controls, 62 with BE (42 without dysplasia and 20 with dysplasia) and 18 with adenocarcinoma. IGF-1 and IGF-1/IGFBP-3 molar ratio showed a progression to high levels in BE and adenocarcinoma than in controls (IGF-1: 135.55±66.07ng/ml, 148.33±81.5ng/ml, 108.19±46.69ng/ml, respectively; P=.049) (molar ratio: 0.23±0.91, 0.29±0.11, 0.19±0.06, respectively; P=.001), without differences between the histological types of BE. Fifty-four out of the 65 patients with BE were followed up (median of 58.50 months, range 12-113) and 11 of them (20.4%) presented progression to low-grade dysplasia (n=8) or high-grade dysplasia/adenocarcinoma (n=3), without differences in the IGF system compared with patients without progression. CONCLUSIONS Patients with BE and esophageal adenocarcinoma have changes in the IGF system although the serological levels of IGF-1 and IGFBP-3 do not correlate with histological progression of BE.
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Affiliation(s)
- Hugo Uchima
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Angella Da Fieno
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Araceli Bonilla
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Jordana Melo-Borges
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Cristina Sánchez-Montes
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Míriam Cuatrecasas
- Servicio de Anatomía Patológica, Hospital Clinic de Barcelona, Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España
| | - Henry Córdova
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España
| | - Ignasi Elizalde
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España
| | - Natalia Rakislova
- Servicio de Anatomía Patológica, Hospital Clinic de Barcelona, Barcelona, España
| | - Jordi Gratacós-Ginès
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Carolina Bayarri
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Gherzon Casanova
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España
| | - Àngels Ginès
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España
| | - Josep Llach
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España
| | - Francesc Balaguer
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España
| | - Glòria Fernández-Esparrach
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut de Malalties Digestives i Metaboliques, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, España; IDIBAPS. CIBEREHD, Barcelona, España; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España.
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9
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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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Uchima H, Garsot E, Colán-Hernández J, Viciano M, Clavell A, Marín I, Moreno V. Endoscopic full-thickness resection of a duodenal gastrointestinal stromal tumor with extraluminal component: the usefulness of traction and sutures. Endoscopy 2022; 54:E730-E731. [PMID: 35272380 DOI: 10.1055/a-1773-0260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Hugo Uchima
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Elisenda Garsot
- Esophagogastric Surgery Unit, General Surgery Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Juan Colán-Hernández
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Marta Viciano
- Esophagogastric Surgery Unit, General Surgery Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Arantxa Clavell
- Esophagogastric Surgery Unit, General Surgery Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Ingrid Marín
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Vicente Moreno
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
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11
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Uchima H, Calm A, Colán-Hernández J, López R, Fumagalli C, Hernández A, Moreno V. Cap-suction underwater endoscopic mucosal resection for en bloc resection of nongranular pseudodepressed colonic lesion: a novel technique when conventional snaring is not possible. Endoscopy 2022; 55:E106-E107. [PMID: 36241181 PMCID: PMC9829831 DOI: 10.1055/a-1948-2054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Hugo Uchima
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Anna Calm
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Juan Colán-Hernández
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Raquel López
- Pathology Department, Hospital Universitari Germans Trias i Pujol , Badalona, Barcelona, Spain
| | - Caterina Fumagalli
- Pathology Department, Hospital Universitari Germans Trias i Pujol , Badalona, Barcelona, Spain
| | - Alba Hernández
- Pathology Department, Hospital Universitari Germans Trias i Pujol , Badalona, Barcelona, Spain
| | - Vicente Moreno
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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12
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Uchima H, Diez-Caballero A, Capdevila J, Rosinach M, Mata A, Turró R, Espinós J. Underwater endoscopic mucosal resection for en bloc resection of a neuroendocrine tumor in the duodenal bulb. Endoscopy 2022; 54:E264-E265. [PMID: 34144620 DOI: 10.1055/a-1512-8954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Hugo Uchima
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain.,Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | | | - Jaume Capdevila
- Teknon Oncology Institute, Teknon Medical Center, Barcelona, Spain
| | | | - Alfredo Mata
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
| | - Román Turró
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
| | - Jorge Espinós
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
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13
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Uchima H, Blé M, Busquets D, Serra I, López C, Aldeguer X, Huertas C. Eradication of neoplastic Barrett's esophagus in patients with esophageal varices with a modified endoscopic mucosal resection technique and radiofrequency ablation. Endoscopy 2022; 54:E261-E263. [PMID: 34144619 DOI: 10.1055/a-1516-3400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Hugo Uchima
- University Hospital Dr. Josep Trueta, Girona, Spain.,Germans Trias i Pujol Hospital, Badalona, Spain.,Endoscopy Unit, Teknon Medical Center, Quirónsalud Hospital, Barcelona, Spain
| | - Michel Blé
- Endoscopy Unit, Teknon Medical Center, Quirónsalud Hospital, Barcelona, Spain
| | | | - Isabel Serra
- University Hospital Dr. Josep Trueta, Girona, Spain
| | - Carmen López
- University Hospital Dr. Josep Trueta, Girona, Spain
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14
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Castillo-Regalado E, Uchima H. Endoscopic management of difficult laterally spreading tumors in colorectum. World J Gastrointest Endosc 2022; 14:113-128. [PMID: 35432746 PMCID: PMC8984535 DOI: 10.4253/wjge.v14.i3.113] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/01/2021] [Accepted: 02/16/2022] [Indexed: 02/06/2023] Open
Abstract
Due to the advent of the screening programs for colorectal cancer and the era of quality assurance colonoscopy the number the polyps that can be considered difficult, including large (> 20 mm) laterally spreading tumors (LSTs), has increased in the last decade. All LSTs should be assessed carefully, looking for suspicious areas of submucosal invasion (SMI), such as nodules or depressed areas, describing the morphology according to the Paris classification, the pit pattern, and vascular pattern. The simplest, most appropriate and safest endoscopic treatment with curative intent should be selected. For LST-granular homogeneous type, piecemeal endoscopic mucosal resection should be the first option due to its biological low risk of SMI. LST-nongranular pseudodepressed type has an increased risk of SMI, and en bloc resection should be mandatory. Underwater endoscopic mucosal resection is useful in situations where submucosal injection alters the operative field, e.g., for the resection of scar lesions, with no lifting, adjacent tattoo, incomplete resection attempts, lesions into a colonic diverticulum, in ileocecal valve and lesions with intra-appendicular involvement. Endoscopic full thickness resection is very useful for the treatment of difficult to resect lesions of less than 20 up to 25 mm. Among the indications, we highlight the treatment of polyps with suspected malignancy because the acquired tissue allows an exact histologic risk stratification to assign patients individually to the best treatment and avoid surgery for low-risk lesions. Endoscopic submucosal dissection is the only endoscopic procedure that allows completes en bloc resection regardless of the size of the lesion. It should therefore be indicated in the treatment of lesions with risk of SMI.
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Affiliation(s)
- Edgar Castillo-Regalado
- Endoscopy Unit, Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Barcelona 08916, Spain
- Endoscopic Unit, Creu Groga Medical Center, Calella 08370, Spain
| | - Hugo Uchima
- Endoscopy Unit, Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Barcelona 08916, Spain
- Endoscopic Unit, Teknon Medical Center, Barcelona 08022, Spain
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Uchima H, Colán-Hernández J, Aguilar A, Haya J, Domènech E, Moreno V, Marín I. A simple method to determine the proper length of the gastric myotomy during peroral endoscopic myotomy for achalasia. Endoscopy 2022; 54:E85-E87. [PMID: 33723848 DOI: 10.1055/a-1388-6444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Hugo Uchima
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Juan Colán-Hernández
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Ariadna Aguilar
- Motility Disorders Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jenny Haya
- Gastroenterology Department, Althaia, Manresa, Barcelona, Spain
| | - Eugeni Domènech
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona.,CIBER, Madrid, Spain
| | - Vicente Moreno
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Ingrid Marín
- Motility Disorders Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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16
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Castillo-Regalado E, Huertas C, Torrealba L, Hombrados M, Figa M, Busquets D, Uchima H. Endoscopic full-thickness resection in the rectum closed with PolyLoop-and-clips method using single-channel endoscope. Endoscopy 2022; 54:E24-E25. [PMID: 33607659 DOI: 10.1055/a-1352-2356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
| | - Carlos Huertas
- Gastroenterology Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Leyanira Torrealba
- Gastroenterology Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Manuela Hombrados
- Gastroenterology Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Montserrat Figa
- Gastroenterology Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - David Busquets
- Gastroenterology Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Hugo Uchima
- Gastroenterology Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain.,Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
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17
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Fernández-Esparrach G, Marín-Gabriel JC, de Tejada AH, Albéniz E, Nogales O, Del Pozo-García AJ, Rosón PJ, Goicotxea U, Uchima H, Terán A, Alberto A, Joaquín RS, Liseth RS, José S. Implementation of endoscopic submucosal dissection in a country with a low incidence of gastric cancer: Results from a prospective national registry. United European Gastroenterol J 2021; 9:718-726. [PMID: 34077636 PMCID: PMC8280798 DOI: 10.1002/ueg2.12101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/16/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction Endoscopic submucosal dissection (ESD) has become the treatment of choice for early gastric malignancies. In recent years, the ESD technique has been implemented in Western countries with increasing use. Objectives To describe the results of gastric ESD in a Western country with a low incidence of gastric cancer. Patients and Methods The prospective national registry was conducted over 4 years in 23 hospitals, including 30 endoscopists. Epithelial and subepithelial lesions (SEL) qualified to complete removal with ESD were assessed. The technique, instruments, and solution for submucosal injection varied at the endoscopist's discretion. ESD was defined as difficult when: en‐bloc resection was not achieved, had to be converted to a hybrid resection, lasted more than 2 h or an intraprocedural perforation occurred. Additionally, independent risk factors for difficult ESD were analyzed. Results Two hundred and thirty gastric ESD in 225 patients were performed from January 2016 to December 2019 (196 epithelial and 34 SEL). Most lesions were located in the lower stomach (111; 48.3%). One hundred and twenty‐eight (55.6%) ESD were considered difficult. The median procedure time was 105 min (interquartile range [IQR]: 60–150). The procedure time for SEL was shorter than for epithelial lesions (90 min [45–121] vs. 110 min [62–160]; p = 0.038). En‐bloc, R0, and curative resection rates were 91.3%, 75.2%, and 70.9%, respectively. Difficult ESD had lower R0 resection rates than ESD that did not meet the difficulty criteria (64.8% and 87.6%; p = 0.000, respectively). Fibrosis and poor maneuverability were independent factors associated with difficult ESD (OR 3.6, 95%CI 1.1–11.74 and OR 5.07, 95%CI 1.6–16.08; respectively). Conclusions Although the number of cases is limited, the results of this analysis show acceptable en‐bloc and R0 rates in gastric ESD considering the wide variability in experience among the operators. Fibrosis and poor maneuverability were associated with more difficulty in completing ESD. Summarize the established knowledge on this subjectEndoscopic submucosal dissection (ESD) is the standard of care for treatment of early gastric cancers (GC). Due to a lower incidence of GC in European countries, the introduction of gastric ESD has been more gradual than in the East. ESD complications, technical and clinical success depend on the endoscopist's experience, the presence of submucosal fibrosis or invasive cancer, and poor access location.
What are the significant and/or new findings of this study?This study shows the results from a prospective nationwide registry of gastric ESD in a low GC incidence country. Despite a relative low number of cases, quite acceptable outcomes (en‐bloc, R0 and curative resection of 91.3%, 75.2% and 70.9%, respectively) were observed considering the wide variability in experience among the operators. Difficult ESD were mainly associated with the presence of submucosal fibrosis and poor maneuverability; however, independent pre‐procedural factors were not identified. There was a trend of association between ESD difficulty and the location of the lesion in the upper/middle stomach
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Affiliation(s)
- Gloria Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Department, ICMDM, CIBEREHD, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - José-Carlos Marín-Gabriel
- Endoscopy Unit, Gastroenterology Department, "i+12 Research Institute", Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Alberto H de Tejada
- Endoscopy Unit, Gastroenterology Department, IDIPHISA, Hospital Universitario Puerta de Hierro, Autonomous University of Madrid, Madrid, Spain
| | - Eduardo Albéniz
- Complejo Hospitalario de Navarra, Navarrabiomed Biomedical Research Center, UPNA, IdiSNA, Pamplona, Spain
| | | | - Andres J Del Pozo-García
- Endoscopy Unit, Gastroenterology Department, "i+12 Research Institute", Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | | | - Unai Goicotxea
- Hospital Universitario de Donostia, San Sebastián, Spain
| | - Hugo Uchima
- Centro Médico Teknon, Barcelona, Barcelona, Spain
| | - Alvaro Terán
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | - Rivero-Sánchez Liseth
- Endoscopy Unit, Gastroenterology Department, ICMDM, CIBEREHD, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Santiago José
- Endoscopy Unit, Gastroenterology Department, IDIPHISA, Hospital Universitario Puerta de Hierro, Autonomous University of Madrid, Madrid, Spain
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18
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Cadoni S, Ishaq S, Hassan C, Falt P, Fuccio L, Siau K, Leung JW, Anderson J, Binmoeller KF, Radaelli F, Rutter MD, Sugimoto S, Muhammad H, Bhandari P, Draganov PV, de Groen P, Wang AY, Yen AW, Hamerski C, Thorlacius H, Neumann H, Ramirez F, Mulder CJJ, Albéniz E, Amato A, Arai M, Bak A, Barret M, Bayupurnama P, Cheung R, Ching HL, Cohen H, Dolwani S, Friedland S, Harada H, Hsieh YH, Hayee B, Kuwai T, Lorenzo-Zúñiga V, Liggi M, Mizukami T, Mura D, Nylander D, Olafsson S, Paggi S, Pan Y, Parra-Blanco A, Ransford R, Rodriguez-Sanchez J, Senturk H, Suzuki N, Tseng CW, Uchima H, Uedo N, Leung FW. Water-assisted colonoscopy: an international modified Delphi review on definitions and practice recommendations. Gastrointest Endosc 2021; 93:1411-1420.e18. [PMID: 33069706 DOI: 10.1016/j.gie.2020.10.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/08/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Since 2008, a plethora of research studies has compared the efficacy of water-assisted (aided) colonoscopy (WAC) and underwater resection (UWR) of colorectal lesions with standard colonoscopy. We reviewed and graded the research evidence with potential clinical application. We conducted a modified Delphi consensus among experienced colonoscopists on definitions and practice of water immersion (WI), water exchange (WE), and UWR. METHODS Major databases were searched to obtain research reports that could potentially shape clinical practice related to WAC and UWR. Pertinent references were graded (Grading of Recommendations, Assessment, Development and Evaluation). Extracted data supporting evidence-based statements were tabulated and provided to respondents. We received responses from 55 (85% surveyed) experienced colonoscopists (37 experts and 18 nonexperts in WAC) from 16 countries in 3 rounds. Voting was conducted anonymously in the second and third round, with ≥80% agreement defined as consensus. We aimed to obtain consensus in all statements. RESULTS In the first and the second modified Delphi rounds, 20 proposed statements were decreased to 14 and then 11 statements. After the third round, the combined responses from all respondents depicted the consensus in 11 statements (S): definitions of WI (S1) and WE (S2), procedural features (S3-S5), impact on bowel cleanliness (S6), adenoma detection (S7), pain score (S8), and UWR (S9-S11). CONCLUSIONS The most important consensus statements are that WI and WE are not the same in implementation and outcomes. Because studies that could potentially shape clinical practice of WAC and UWR were chosen for review, this modified Delphi consensus supports recommendations for the use of WAC in clinical practice.
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Affiliation(s)
- Sergio Cadoni
- CTO Hospital, Digestive Endoscopy Unit, Iglesias, Italy
| | - Sauid Ishaq
- Russell Hall, Dept. of Gastroenterology, Birmingham, United Kingdom; Birmingham City University, Birmingham, United Kingdom
| | - Cesare Hassan
- Nuovo Regina Margherita Hospital, Digestive Endoscopy Unit, Rome, Italy
| | - Přemysl Falt
- University Hospital and Faculty of Medicine, Palacky University, Olomouc, Czech Republic; Faculty of Medicine, Charles University, Hradec Králové, Czech Republic
| | - Lorenzo Fuccio
- S. Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences, Bologna, Italy
| | - Keith Siau
- JAG Clinical Fellow, JAG, Royal College of Physicians, London, United Kingdom
| | - Joseph W Leung
- Division of Gastroenterology and Hepatology, Sacramento VA Medical Center and University of California Davis School of Medicine, Sacramento, California, USA
| | - John Anderson
- Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, United Kingdom
| | - Kenneth F Binmoeller
- California Pacific Medical Center, Interventional Endoscopy Services, San Francisco, California, United States
| | | | - Matt D Rutter
- University Hospital North Tees NHS, Department of Gastroenterology, Stockton-on-Tees, United Kingdom; Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Shinya Sugimoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | | | - Pradeep Bhandari
- Portsmouth University Hospital, Dept. of Gastroenterology, Portsmouth, United Kingdom
| | | | - Piet de Groen
- University of Minnesota, Division of Gastroenterology, Minneapolis, Minnesota, United States
| | - Andrew Y Wang
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, United States
| | - Andrew W Yen
- Division of Gastroenterology and Hepatology, Sacramento VA Medical Center and University of California Davis School of Medicine, Sacramento, California, USA
| | - Chris Hamerski
- California Pacific Medical Center, Interventional Endoscopy Services, San Francisco, California, United States
| | - Henrik Thorlacius
- Lund University Surgery, Department of Gastrointestinal Surgery, Malmö, Sweden
| | - Helmut Neumann
- University Medical Center, Interventional Endoscopy Center, Medizinische Klinik und Poliklinik, Mainz, Germany
| | | | - Chris J J Mulder
- VU University Medical Center, Department of Gastroenterology, Amsterdam, The Netherlands
| | - Eduardo Albéniz
- Gastroenterology Department, Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Arnaldo Amato
- Ospedale Valduce, Gastroenterology Unit, Como, Italy
| | - Makoto Arai
- Chiba University, Gastroenterology Department, Chiba, Japan
| | - Adrian Bak
- University of British Columbia, Department of Medicine, Kelowna, Canada
| | | | - Putut Bayupurnama
- Division of Gastroenterology and Hepatology, Internal Medicine Department, Faculty of Medicine, Gadjah Mada University, Sardjito General Hospital, Yogyakarta, Indonesia
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, VA Palo Alto, California, United States
| | - Hey-Long Ching
- Sheffield Teaching Hospitals, Gastroenterology Department, Sheffield, United Kingdom
| | - Hartley Cohen
- Department of Medicine, VA Greater Los Angeles Health Care System, Los Angeles, United States; David Geffen School of Medicine at UCLA, Department of Medicine, Los Angeles, California, United States
| | - Sunil Dolwani
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Shai Friedland
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, VA Palo Alto, California, United States
| | - Hideaki Harada
- Department of Gastroenterology, New Tokyo Hospital, Gastroenterology, Matsudo, Chiba, Japan
| | - Yu-Hsi Hsieh
- Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin Township, Taiwan
| | - Bu Hayee
- King's College Hospital NHS foundation Trust, Gastroenterology Department, London, United Kingdom
| | - Toshio Kuwai
- NHO Kure Medical Center and Chugoku Cancer Center, Gastroenterology Department, Kure, Japan
| | | | - Mauro Liggi
- ASSL Carbonia, Sirai Hospital, Digestive Endoscopy Unit, Carbonia, Italy
| | - Takeshi Mizukami
- NHO Kurihama Medical and Addiction Center, Endoscopy Center, Yokosuka, Japan
| | - Donatella Mura
- ASSL Carbonia, Sirai Hospital, Digestive Endoscopy Unit, Carbonia, Italy
| | - David Nylander
- Newcastle Upon Tyne NHS Foundation Trust, Gastroenterology Department, Newcastle Upon Tyne, United Kingdom
| | - Snorri Olafsson
- Telemark Hospital, Gastroenterology Department, Skien, Norway
| | - Silvia Paggi
- Ospedale Valduce, Gastroenterology Unit, Como, Italy
| | - Yanglin Pan
- Xijing Hospital, Department of Gastroenterology, Xian, Republic of China
| | - Adolfo Parra-Blanco
- NIHR Nottingham Biomedical Research Centre, Department of Gastroenterology, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
| | - Rupert Ransford
- Endoscopy Department Hereford County Hospital, Hereford, United Kingdom
| | | | - Hakan Senturk
- Bezmialem Vakif University Medicine Faculty, Department of Medicine, Istanbul, Turkey
| | - Noriko Suzuki
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, United Kingdom
| | - Chih-Wei Tseng
- Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin Township, Taiwan
| | - Hugo Uchima
- Hospital Germans Triasi i Pujol, Teknon Medical Center, Gastroenterology, Barcelona, Spain
| | - Noriya Uedo
- Osaka International Cancer Institute, Department of Gastrointestinal Oncology, Osaka, Japan
| | - Felix W Leung
- Department of Medicine, VA Greater Los Angeles Health Care System, Los Angeles, United States; David Geffen School of Medicine at UCLA, Department of Medicine, Los Angeles, California, United States
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19
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Uchima H, Colán-Hernández J, Binmoeller KF. Peristaltic contractions help snaring during underwater endoscopic mucosal resection of colonic non-granular pseudodepressed laterally spreading tumor. Dig Endosc 2021; 33:e74-e76. [PMID: 33710689 DOI: 10.1111/den.13952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/08/2021] [Indexed: 01/30/2023]
Affiliation(s)
- Hugo Uchima
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.,Endoscopic Unit, Teknon Medical Center, Barcelona, Spain
| | - Juan Colán-Hernández
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Kenneth F Binmoeller
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, USA
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20
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Rodríguez de Santiago E, Shimamura Y, Pioche M, Eleftheriadis N, Albéniz E, Bechara R, Yan Chiu PW, Guarner-Argente C, Herreros de Tejada A, Uchima H, Fujiyoshi Y, Ponchon T, González-Gete G, Hew S, Murzi-Pulgar M, Matallana V, Parejo-Carbonell S, Estremera-Arévalo F, Moll F, Onimaru M, Inoue H. Safety and effectiveness of peroral endoscopic myotomy in patients on antiplatelet or anticoagulant therapy: an international multicenter case-control study. Gastrointest Endosc 2021; 93:839-849. [PMID: 32717366 DOI: 10.1016/j.gie.2020.07.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/30/2020] [Accepted: 07/14/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The risk of bleeding and thromboembolic events in patients undergoing peroral endoscopic myotomy (POEM) who are receiving antithrombotic therapy is unknown. Our primary aim was to assess the safety of POEM in this patient subset. Secondary outcomes were rates of clinical success, GERD, and procedure-related outcomes. METHODS This was an international, 1:1, case-control study performed at 10 centers using prospectively maintained databases. All consecutive patients who underwent POEM before November 2019 were considered for inclusion. Cases were patients on antiplatelet and/or anticoagulant therapy. Controls not receiving antithrombotics were matched for age and esophageal motility disorder. Primary outcomes were major bleeding and thromboembolic events on postprocedural day 30. RESULTS Of 2895 patients who underwent POEM, 126 cases (103 on antiplatelets, 35 anticoagulants, 12 both) and 126 controls were enrolled. The rate of major bleeding was higher for the antithrombotics users (5.6% vs 0.8%, P = .03). Anticoagulants and clopidogrel were temporarily interrupted in all cases. Aspirin was continued in 40.5% of users without increasing the bleeding risk. One thromboembolic event occurred in each group (0.79%; P = 1.00). No POEM-related deaths were noted. Rates of clinical success (91.7% vs 96% in controls, P = .20), postprocedural GERD, and technical-related outcomes were similar in both groups. Antithrombotic management was heterogeneous, and guidelines were not adhered to in 23.8% of cases. CONCLUSIONS POEM is safe and effective in patients receiving antithrombotic therapy although it is associated with a greater risk of major bleeding.
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Affiliation(s)
- Enrique Rodríguez de Santiago
- Digestive Diseases Center, Showa University, Koto-Toyosu Hospital, Koto-Ku, Tokyo, Japan; Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Yuto Shimamura
- Digestive Diseases Center, Showa University, Koto-Toyosu Hospital, Koto-Ku, Tokyo, Japan
| | - Mathieu Pioche
- Service d'Hépato-Gastro-Entérologie et d'Endoscopie Digestive, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | | | - Eduardo Albéniz
- Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Navarrabiomed Biomedical Research Center, UPNA, IdiSNA, Pamplona, Spain
| | - Robert Bechara
- Queen's University, Division of Gastroenterology, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Philip Way Yan Chiu
- Department of Surgery, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | - Carlos Guarner-Argente
- Department of Gastroenterology, Hospital of Santa Creu and Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Alberto Herreros de Tejada
- Department of Gastroenterology IDIPHISA-Research Institute Segovia Arana Puerta de Hierro University Hospital, Madrid, Spain
| | - Hugo Uchima
- Endoscopy Unit, Gastroenterology Department, Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Yusuke Fujiyoshi
- Digestive Diseases Center, Showa University, Koto-Toyosu Hospital, Koto-Ku, Tokyo, Japan
| | - Thierry Ponchon
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Gonzalo González-Gete
- Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Navarrabiomed Biomedical Research Center, UPNA, IdiSNA, Pamplona, Spain
| | - Simon Hew
- Queen's University, Division of Gastroenterology, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Marianette Murzi-Pulgar
- Department of Gastroenterology, Hospital of Santa Creu and Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Virginia Matallana
- Department of Gastroenterology IDIPHISA-Research Institute Segovia Arana Puerta de Hierro University Hospital, Madrid, Spain
| | - Sofía Parejo-Carbonell
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Fermín Estremera-Arévalo
- Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Navarrabiomed Biomedical Research Center, UPNA, IdiSNA, Pamplona, Spain
| | - Frederic Moll
- Service d'Hépato-Gastro-Entérologie et d'Endoscopie Digestive, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Manabu Onimaru
- Digestive Diseases Center, Showa University, Koto-Toyosu Hospital, Koto-Ku, Tokyo, Japan
| | - Haruhiro Inoue
- Digestive Diseases Center, Showa University, Koto-Toyosu Hospital, Koto-Ku, Tokyo, Japan
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21
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Uchima H, Colan-Hernandez J, Caballero N, Marín I, Calafat M, Luna D, Moreno V. Underwater endoscopic mucosal resection of an adenomatous lesion with deep extension into the appendiceal orifice. Endoscopy 2021; 53:334-335. [PMID: 32659810 DOI: 10.1055/a-1202-1192] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Hugo Uchima
- Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Juan Colan-Hernandez
- Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Noemí Caballero
- Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Ingrid Marín
- Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Margalida Calafat
- Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Daniel Luna
- Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Vicente Moreno
- Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
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22
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Uchima H, Yao K. White Opaque Substance (WOS) in gastrointestinal lesions. Gastroenterol Hepatol 2020; 45:377-378. [PMID: 33249115 DOI: 10.1016/j.gastrohep.2020.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/22/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Hugo Uchima
- Servicio de Endoscopia Digestiva Centro Médico Teknon, Barcelona, Spain; Servicio de Gastroenterología Hospital Universitario Germans Trias i Pujol, Badalona, Spain.
| | - Kenshi Yao
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
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23
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Oliveras B, Albert M, López C, Fort E, Peries L, Gutiérrez L, Busquets D, Uchima H, Aldeguer X, Piñol V. A case report of gastrointestinal histoplasmosis in a patient treated with infliximab. Clin J Gastroenterol 2020; 14:690-692. [PMID: 33231849 DOI: 10.1007/s12328-020-01298-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 11/06/2020] [Indexed: 11/28/2022]
Abstract
Histoplasmosis is an endemic mycosis in some areas of North and South America. This disease is usually asymptomatic, but it can result in severe and disseminated infection involving gastrointestinal tract, especially in immunocompromised individuals. We report a case of a 33-years-old Ecuadorian male treated with infliximab who developed disseminated histoplasmosis with gastrointestinal affection. Due to the non-specific presentation of gastrointestinal histoplasmosis, the diagnosis is often delayed and it causes poor outcomes. It is important to consider this diagnosis in immunocompromised patients with compatible symptoms, like patients on TNF inhibitors.
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Affiliation(s)
- Berta Oliveras
- Department of Gastroenterology, Hospital Universitari Doctor Josep Trueta, C/França SN, 17007, Girona, Spain.
| | - Marc Albert
- Department of Gastroenterology, Hospital Universitari Doctor Josep Trueta, C/França SN, 17007, Girona, Spain
| | - Carme López
- Department of Gastroenterology, Hospital Universitari Doctor Josep Trueta, C/França SN, 17007, Girona, Spain
| | - Esther Fort
- Department of Gastroenterology, Hospital Universitari Doctor Josep Trueta, C/França SN, 17007, Girona, Spain
| | - Laia Peries
- Department of Gastroenterology, Hospital Universitari Doctor Josep Trueta, C/França SN, 17007, Girona, Spain
| | - Laia Gutiérrez
- Department of Gastroenterology, Hospital Universitari Doctor Josep Trueta, C/França SN, 17007, Girona, Spain
| | - David Busquets
- Department of Gastroenterology, Hospital Universitari Doctor Josep Trueta, C/França SN, 17007, Girona, Spain
| | - Hugo Uchima
- Department of Gastroenterology, Hospital Universitari Doctor Josep Trueta, C/França SN, 17007, Girona, Spain
| | - Xavier Aldeguer
- Department of Gastroenterology, Hospital Universitari Doctor Josep Trueta, C/França SN, 17007, Girona, Spain
| | - Virginia Piñol
- Department of Gastroenterology, Hospital Universitari Doctor Josep Trueta, C/França SN, 17007, Girona, Spain
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Uchima H, Colan J, Marín I, Moreno V, Larios G, Tazi R, Serra J. Underwater peroral endoscopic myotomy (u-POEM) after tension capnoperitoneum and capnothorax during POEM. Endoscopy 2020; 52:E396-E397. [PMID: 32303086 DOI: 10.1055/a-1144-2547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Hugo Uchima
- Endoscopy Unit, Gastroenterology Department, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Juan Colan
- Endoscopy Unit, Gastroenterology Department, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Ingrid Marín
- Endoscopy Unit, Gastroenterology Department, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Vicente Moreno
- Endoscopy Unit, Gastroenterology Department, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Guillermo Larios
- Anesthesiology Department, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Rachid Tazi
- Respiratory Diseases Department, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jordi Serra
- Motility Disorders Unit, Gastroenterology Department, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
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Delgado-Guillena P, Morales-Alvarado V, Ramírez Salazar C, Jimeno Ramiro M, Llibre Nieto G, Galvez-Olortegui J, Uchima H. Frequency and clinical characteristics of early gastric cancer in comparison to advanced gastric cancer in a health area of Spain. Gastroenterol Hepatol 2020; 43:506-514. [PMID: 32826088 DOI: 10.1016/j.gastrohep.2020.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/06/2020] [Accepted: 01/13/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Gastric cancer (GC) incidence is currently decreasing; however, survival is still low. Early GC (EGC) has better prognosis and it could be cured by endoscopic methods. PATIENTS AND METHODS Observational study of a retrospective cohort of all patients with GC during a five-year period in a health area of Spain. EGC diagnosis was defined as mucosal or submucosal (T1) cancers regardless of lymph node involvement, whereas the advanced GC were T2-T4. RESULTS 209 patients were included, and 26 (12%) of them were EGC. There was no difference between EGC and advanced GC in age, sex, HP infection, precancerous lesions or histological type. Other characteristics of EGC were different from advanced GC: location (antrum and incisura in 76% vs 38%, p=0.01), alarm symptoms (69% vs 90%, p<0.01), curative treatment (100% vs 30%, p<0.01), performance status (PS 0-1: 92% vs 75%, p=0.03) and survival (85% vs 20%, p<0.001). Among patients who received curative treatment, 98% (79/81) underwent surgery and 2% (2/81) were treated by mucosectomy. Seven (27%) patients with EGC could have benefited from treatment by endoscopic submucosal resection. DISCUSSION EGC frequency was low (12% of GCs) in our health area. EGC had a high percentage of alarm symptoms, and was located in the distal third of the stomach (antrum and incisura) and had better prognosis compared to advanced GC. Strategies to increase detection and endoscopic treatment of EGC should be implemented.
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Affiliation(s)
- Pedro Delgado-Guillena
- Unidad de Aparato Digestivo, Hospital General de Granollers, Barcelona, España; Universitat de Barcelona, Barcelona, España.
| | | | | | - Mireya Jimeno Ramiro
- Unidad de Anatomía Patológica, Hospital General de Granollers, Barcelona, España
| | - Gemma Llibre Nieto
- Unidad de Aparato Digestivo, Hospital General de Granollers, Barcelona, España
| | - Jose Galvez-Olortegui
- Unidad Generadora de Evidencias y Vigilancia Epidemiológica, Scientia Clinical and Epidemiological Research Institute, Trujillo, Perú; Vicerrectorado de Investigación, Universidad Nacional Santiago Antúnez de Mayolo, Huaraz, Perú
| | - Hugo Uchima
- Hospital Germans Trias i Pujol, Badalona, España
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Sendino O, Loras C, Mata A, Momblán D, Andujar X, Cruz M, Cárdenas A, Marquez I, Uchima H, Cordova H, de Lacy AM, Espinós J. Safety and efficacy of endoscopic vacuum therapy for the treatment of perforations and anastomotic leaks of the upper gastrointestinal tract. Gastroenterol Hepatol 2020; 43:431-438. [PMID: 32680732 DOI: 10.1016/j.gastrohep.2020.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/19/2020] [Accepted: 01/23/2020] [Indexed: 12/24/2022]
Abstract
AIM To evaluate the efficacy and safety of endoscopic vacuum therapy (EVT) in the management of perforations and anastomotic leaks of the upper gastrointestinal tract. PATIENTS AND METHODS This is a retrospective observational study which included patients who underwent EVT due to any upper gastrointestinal defect between April 2017 and February 2019 in three Spanish Hospitals. To this end, we used the only medical device approved to date for endoscopic use (Eso-SPONGEr; B. Braun Melsungen AG, Melsungen, Germany). RESULTS 11 patients were referred for EVT of an anastomotic leak after esophagectomy (n=7), gastrectomy (n=2), esophageal perforation secondary to endoscopic Zenker's septomiotomy (n=1) and Boerhaave syndrome (n=1). The median size of the cavity was 8×3cm. The median delay between surgery and EVT was 7 days. The median of EVT duration was 28 days. The median number of sponges used was 7 and the mean period replacement was 3.7 days. In 10 cases (91%), the defect was successfully closed. In 9 cases (82%) clinical resolution of the septic condition was achieved. 5 patients presented some adverse event: 3 anastomotic strictures, 1 retropharyngeal pain and 1 case of new-onset pneumonia. The median hospital stay from the start of EVT was 45 days. 1 patient died owing to septic complications secondary to the anastomotic leak. CONCLUSION EVT was successful in over 90% of perforations and anastomotic leaks of the upper gastrointestinal tract. Moreover, this is a safe therapy with only mild adverse events associated.
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Affiliation(s)
- O Sendino
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, España.
| | - C Loras
- Servicio Digestivo, Hospital Universitari Mútua de Terrassa, Terrassa, España
| | - A Mata
- Unidad de Endoscopia, Departamento de Gastroenterología, Centro Médico Teknon, Barcelona, España
| | - D Momblán
- Servicio de Cirugía Gastrointestinal, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - X Andujar
- Servicio Digestivo, Hospital Universitari Mútua de Terrassa, Terrassa, España
| | - M Cruz
- Unidad de Endoscopia, Departamento de Gastroenterología, Centro Médico Teknon, Barcelona, España
| | - A Cárdenas
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - I Marquez
- Servicio Digestivo, Hospital Universitari Mútua de Terrassa, Terrassa, España
| | - H Uchima
- Unidad de Endoscopia, Departamento de Gastroenterología, Centro Médico Teknon, Barcelona, España
| | - H Cordova
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - A M de Lacy
- Servicio de Cirugía Gastrointestinal, ICMDiM, IDIBAPS, CIBEREHD, AIS Channel, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - J Espinós
- Servicio Digestivo, Hospital Universitari Mútua de Terrassa, Terrassa, España; Unidad de Endoscopia, Departamento de Gastroenterología, Centro Médico Teknon, Barcelona, España
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Uchima H, Alvarez-Gonzalez MA, Colan-Hernandez J, Rivero-Sánchez L, Barquero D, Gornals JB, Loras C. Endoscopy activity in a covid-19 high-risk area (Barcelona): Moving forward (or backwards) according to the necessary resources available. Gastroenterol Hepatol 2020; 43:482-484. [PMID: 32651041 PMCID: PMC7284225 DOI: 10.1016/j.gastrohep.2020.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Hugo Uchima
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol de Badalona, Barcelona, Spain; Endoscopy Unit, Teknon Medical Center, Barcelona, Spain.
| | - Marco Antonio Alvarez-Gonzalez
- Endoscopy Unit, Department of Digestive Diseases, Hospital Del Mar, Barcelona, Spain; IMIM, Hospital del Mar Medical Research Institute, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Juan Colan-Hernandez
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol de Badalona, Barcelona, Spain
| | | | - David Barquero
- Endoscopy Unit, Department of Digestive Diseases, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | - Joan B Gornals
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
| | - Carme Loras
- Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, Terrassa, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
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Uchima H, Colan-Hernandez J, Marín I, Moreno V, Serra J. Evaluation of sling fibers and two penetrating vessels for guiding extent of the tunnel and myotomy during posterior peroral endoscopic myotomy in a Western cohort. VideoGIE 2020; 5:507-509. [PMID: 33204901 PMCID: PMC7649978 DOI: 10.1016/j.vgie.2020.05.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Hugo Uchima
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.,Endoscopic Unit, Teknon Medical Center, Barcelona, Spain
| | - Juan Colan-Hernandez
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Ingrid Marín
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Vicente Moreno
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jordi Serra
- Motility and Functional Gut Disorders Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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Uchima H, Yao K. Endoscopic microanatomy of the normal gastrointestinal mucosa with narrow band technology and magnification. Gastroenterol Hepatol 2018; 42:117-126. [PMID: 30471720 DOI: 10.1016/j.gastrohep.2018.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/16/2018] [Accepted: 10/01/2018] [Indexed: 01/03/2023]
Abstract
The development of high-definition endoscopes with optical zoom, along with the use of the digital chromoendoscopy and staining, has given endoscopists the possibility to study the microanatomy of the gastrointestinal mucosa in vivo. The recognition of the changes in the microstructure of the surface and microvascular architecture such as those that occur in neoplastic lesions allow us to characterize these lesions in order to decide on the best course of clinical action. The current greater availability of endoscopes with optical zoom in western countries has allowed the use of this technology in routine clinical practice to spread. In this article we review the basic concepts of magnifying endoscopy and the normal endoscopic microanatomy of the oesophageal, gastric, duodenal, ileal and colonic mucosa.
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Affiliation(s)
- Hugo Uchima
- Department of Endoscopy, Hospital Universitari Doctor Josep Trueta, Girona, Spain; Department of Endoscopy, Teknon Medical Center, Barcelona, Spain.
| | - Kenshi Yao
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
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Argüello Viúdez L, Córdova H, Uchima H, Sánchez-Montes C, Ginès À, Araujo I, González-Suárez B, Sendino O, Llach J, Fernández-Esparrach G. Gastric polyps: Retrospective analysis of 41,253 upper endoscopies. Gastroenterol Hepatol 2017; 40:507-514. [PMID: 28222897 DOI: 10.1016/j.gastrohep.2017.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 12/31/2016] [Accepted: 01/05/2017] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Gastric polyps are usually asymptomatic lesions incidentally discovered during endoscopy. OBJECTIVE To study the frequency of different types of gastric polyps in our population and their possible association with other factors. PATIENTS AND METHODS Retrospective study of gastroscopies performed in a tertiary hospital over a ten-year period. Demographics, medical history, indication for gastroscopy and morphological and histological characteristics of polyps were collected. RESULTS Gastric polyps were found in 827 out of 41253 (2%) reviewed gastroscopies, corresponding to 709 patients. Mean age was 65.6 years, and 62% were female. 53.9% of patients had multiple polyps. The most common location was the fundus and 83.3% were smaller than 1cm. Histopathology was obtained in 607 patients: hyperplastic polyps were the most common (42.8%), followed by fundic gland polyps (37.7%). Factors independently associated with hyperplastic polyps were age and single polyp, size ≥6mm and location other than fundus. In contrast, fundic gland polyps were associated with reflux and multiple polyps, size <6mm and located in fundus. Adenomas were independently associated with single polyp. CONCLUSIONS Fundic gland and hyperplastic polyps are the most common in our population and have characteristic features that can guide histological diagnosis. With single polyps it is advisable to take biopsies to rule out adenoma.
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Affiliation(s)
| | - Henry Córdova
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CiberEHD, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Hugo Uchima
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CiberEHD, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Cristina Sánchez-Montes
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CiberEHD, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Àngels Ginès
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CiberEHD, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Isis Araujo
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CiberEHD, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Begoña González-Suárez
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CiberEHD, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Oriol Sendino
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CiberEHD, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Josep Llach
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CiberEHD, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Gloria Fernández-Esparrach
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CiberEHD, IDIBAPS, Universitat de Barcelona, Barcelona, España.
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Fernández-Esparrach G, Sendino O, Araujo I, Pellisé M, Almela M, González-Suárez B, López-Cerón M, Córdova H, Sanabria E, Uchima H, Llach J, Ginès À. Incidence of bacteremia in cirrhotic patients undergoing upper endoscopic ultrasonography. Gastroenterología y Hepatología 2014; 37:327-33. [DOI: 10.1016/j.gastrohep.2014.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 02/06/2014] [Accepted: 02/18/2014] [Indexed: 01/16/2023]
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Rodríguez-D'Jesús A, Gordillo J, Uchima H, Araujo I, Saperas E, Elizalde I, Fernández-Esparrach G. [Prevalence and epidemiology of Barrett's esophagus in the province of Barcelona]. Gastroenterol Hepatol 2014; 37:397-401. [PMID: 24674710 DOI: 10.1016/j.gastrohep.2014.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/17/2014] [Accepted: 01/21/2014] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The prevalence of Barrett's esophagus (BE) varies from 0.45% to 2.2% in patients who undergo upper endoscopy and is >12% when the indication is for reflux symptoms. The prevalence has progressively increased in recent years but is unknown in the population of the province of Barcelona. OBJECTIVES To determine the prevalence of BE and its epidemiological characteristics in our population. PATIENTS AND METHODS We prospectively evaluated patients referred to the Endoscopy Unit of Hospital Clinic and Hospital General de Catalunya for an upper endoscopy. We excluded patients with known BE, prior upper endoscopy, esophagogastric surgery or refusal to participate in the study. Demographic data, alcohol intake, Helicobacter pylori infection and consumption of antisecretory agents were recorded, among other information. Participants completed a standardized questionnaire to assess the presence of gastroesophageal reflux disease (GERD) symptoms and their severity. RESULTS Between July 2010 and July 2012, we included 200 patients (100 in each center). The mean age was 48.9 ± 15.6 years and the majority were women (n=120, 60%). Symptoms of GERD were present in 46 patients (23%) and some degree of esophagitis was present in 31 (15.5%). Infection by H. pylori was present in 29.7%. BE was found endoscopically in 14 (7%) patients, but was histologically confirmed in only 8 (4%). The only variable that correlated with the finding of BE was male sex. CONCLUSION The prevalence of BE in our environment is similar to that reported in Western countries. The absence of reflux symptoms does not rule out the possibility of BE.
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Affiliation(s)
| | - Jordi Gordillo
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Hugo Uchima
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Isis Araujo
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Esteban Saperas
- Servicio de Digestivo, Hospital General de Catalunya, Barcelona, España
| | - Ignasi Elizalde
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Gloria Fernández-Esparrach
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España.
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Iseki K, Arima H, Kohagura K, Komiya I, Ueda S, Tokuyama K, Shiohira Y, Uehara H, Toma S, Tomiyama N, Arima H, Chinen S, Tokashiki K, Hirano-Nakasone A, Nohara C, Ueda S, Ueda S, Kohagura K, Toma S, Tana T, Higa A, Yamazato M, Ishida Y, Tokuyama K, Nagayoshi N, Miyagi S, Asato T, Kobayashi R, Shiohira Y, Yonaha T, Uezu Y, Kuwae N, Nakasato S, Oshiro Y, Nashiro K, Asato T, Katsuren H, Kagawa H, Naika-Geka K, Higa T, Ikema M, Akamine K, Nishihira M, Jahana M, Imai C, Yonaha T, Ikemura M, Uechi M, Yamazato M, Yoshihara K, Arakaki M, Iha K, Afuso H, Kiyuna S, Shiroma K, Miyara T, Itokazu M, Naka T, Naka S, Yamaguchi E, Uechi Y, Kowatari T, Yamada H, Yoshi S, Sunagawa H, Tozawa M, Uechi M, Adaniya M, Afuso H, Uehara H, Miyazato H, Sakuda C, Taminato T, Uchima H, Nakasone Y, Funakoshi T, Nakazato M, Nagata N, Miyazato S, Katsuren H, Miyagi T, Hirano H, Iwashiro K, Sunagawa T, Yoshida H, Oshiro Y, Shimabukuro T, Oura T, Henzan H, Kyan I, Maeshiro S, Wake T, Tagawa S, Inoue T, Tokashiki T, Ishii H, Miyagi S, Takishita S, Saito S, Shimizu K, Ohya Y, Barzi F. Effects of angiotensin receptor blockade (ARB) on mortality and cardiovascular outcomes in patients with long-term haemodialysis: a randomized controlled trial. Nephrol Dial Transplant 2013; 28:1579-89. [DOI: 10.1093/ndt/gfs590] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
A 39-year-old housewife who underwent intramammary injections of a proprietary silicone fluid mixture showed clinical and novel transbronchial lung biopsy (TBLB) findings. She presented with complaints of progressive dyspnea, dry cough, and pleuritic chest pain 2 days after the last silicone injections. The chest X-ray and CT scan showed diffuse interstitial infiltrates. TBLB demonstrated translucent, presumably silicone globules embolized within the pulmonary capillaries. The documentation of intramammary injections, the clinical and radiographic features of acute pneumonitis, and the histopathologic evidence by TBLB, may support the causal relationship between illicit injections and the silicone embolism. We discuss the pathogenesis and urge that this potentially toxic source of pulmonary embolism be removed.
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Affiliation(s)
- T Matsuba
- Department of Medicine, Okinawa Chubu Hospital
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Ohshiro K, Hanashiro Y, Shimabukuro K, Hori A, Nagata Y, Matsumoto H, Uchima H. A hepatobiliary study with Tc-99m N-pyridoxyl-5-methyltryptophan (PMT) in a patient with hepatoblastoma. Clin Nucl Med 1991; 16:10-2. [PMID: 1847848 DOI: 10.1097/00003072-199101000-00003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A patient with hepatoblastoma in whom a hepatobiliary study with Tc-99m PMT demonstrated homogeneous uptake in the tumor is presented. Sonography showed a large solid mass pedunculated from the right hepatic lobe with a "tumor-in-tumor" pattern. It was hypodense relative to normal hepatic parenchyma on CT scanning without contrast material and turned isodense with contrast material. This represented its hypervascularity, which was confirmed by selective celiac arteriography.
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Affiliation(s)
- K Ohshiro
- Department of Radiology, Okinawa Chubu Hospital, Japan
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Sato K, Miyasaka N, Nishioka K, Yamaoka K, Okuda M, Nishido T, Uchima H. Primary Sjögren's syndrome associated with systemic necrotizing vasculitis: a fatal case. Arthritis Rheum 1987; 30:717-8. [PMID: 3606688 DOI: 10.1002/art.1780300620] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Oshima S, Okayasu I, Uchima H, Hatakeyama S. Histopathological and morphometrical study of the human epididymis and testis. Acta Pathol Jpn 1984; 34:1327-42. [PMID: 6441451 DOI: 10.1111/j.1440-1827.1984.tb00558.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Histopathological and morphometrical observations of the epididymis and testis were performed on 159 autopsy cases and 3 surgical materials of orchiectomy. The serum values of testosterone, FSH, LH, and values of intratesticular testosterone were measured in a certain number of the cases. Concerning the epididymis, increasing arteriosclerotic change was observed in the older epididymis. A high incidence of hyalinization of small arteries and arterioles was found in the younger epididymis. Eosinophilic microbodies were seen in the epithelial nuclei of the ductus epididymidis with high incidence in the older age groups. They were thought to be a catabolic compound containing phospholipids and protein resulting from cell degeneration of the mucosal epithelium. The diameter of the ductus epididymidis decreased with age. Inflammatory changes and ensued periductal sclerosis were found in the efferent duct area with an extremely high incidence. Serum values of testosterone correlated with both the age and morphological scoring calculated on the basis of either clusters or individual Leydig cells. Furthermore, testicular volume was inversely correlated with age.
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Uchima H, Eishi Y, Takemura T, Hirokawa K. Immunohistochemical studies of ulcerative colitis. With special reference to localization of immunoglobulins, secretory component, and lysozyme in view of suffering periods. Acta Pathol Jpn 1983; 33:1183-96. [PMID: 6670552 DOI: 10.1111/j.1440-1827.1983.tb02163.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Surgically resected large bowels with ulcerative colitis (UC) and biopsies specimens from UC patients were studied immunohistochemically in terms of localization of immunoglobulins, secretory component (SC), complement (C3), and lysozyme in relation to suffering periods. In the long-standing group (suffering periods more than nine months) of UC, marked decrease or absence of IgA as well as IgM was frequently observed in the columnar epithelial cells despite residue of SC positivity. However, in the short-standing group (suffering periods from one month to four months) both SC and IgA were well preserved in the apical portion of the epithelial cells in the similar manner as observed in the control group. There was moderate to marked increase of IgA-producing cells and slight to moderate increase of IgM-producing cells in the majority of the UC cases regardless of suffering periods. Lysozyme was not demonstrable in the normal epithelial cells of the large intestine but occasionally observed in those of UC cases.
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