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Velho S, Costa Santos MP, Cunha C, Agostinho L, Cruz R, Costa F, Garcia M, Oliveira P, Maio R, Baracos VE, Cravo M. Body Composition Influences Post-Operative Complications and 90-Day and Overall Survival in Pancreatic Surgery Patients. GE Port J Gastroenterol 2020; 28:13-25. [PMID: 33564701 DOI: 10.1159/000507206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/20/2020] [Indexed: 01/06/2023]
Abstract
Introduction Pancreatic surgery still carries a high morbidity and mortality even in specialized centers. The aim of this study was to evaluate the influence of patients' body composition on postoperative complications and survival after pancreatic surgery. Methods This was a retrospective study on patients undergoing pancreatic surgery between March 2012 and December 2017. Demographics, clinical data, and postoperative complications classified according to Clavien-Dindo were recorded. Body composition was assessed using routine diagnostic or staging computed tomography (CT). Multiple Cox proportional hazards models were adjusted. Results Ninety patients were included, 55% were male, and the mean age was 68 ± 10.9 years. Of these 90, 92% had a total pancreatectomy or pancreaticoduodenectomy, 7% a distal pancreatectomy, and 1% a pancreaticoduodenectomy with multi-visceral resection; 84% had malignant disease. The incidence of major complications was 27.8% and the 90-day mortality was 8.8%. The ratio of visceral fat area/skeletal muscle area (VFA:SMA) was associated with an increased risk of complications (OR 2.24, 95% CI 1.14-4.87, p = 0.03) and 90-day survival (HR 2.13, 95% CI 1.13-4.01, p = 0.019). On simple analysis, shorter overall survival (OS) was observed in patients aged ≥70 years (p = 0.0009), with postoperative complications ≥IIIb (p = 0.01), an increased VFA:SMA (p = 0.007), and decreased muscle radiation attenuation (p = 1.6 × 10-5). In an OS model adjusted for age, disease malignancy, postoperative complications, and body composition parameters, muscle radiation attenuation remained significantly associated with survival (HR 0.94, 95% CI 0.90-0.98, p = 0.0016). A model which included only body composition variables had a discrimination ability (C-statistic 0.76) superior to a model which comprised conventional clinical variables (C-statistic 0.68). Conclusion Body composition is a major determinant of postoperative complications and survival in pancreatic surgery patients.
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Affiliation(s)
- Sónia Velho
- Dietetics and Nutrition, Hospital Beatriz Ângelo, Loures, Portugal
| | | | - Cátia Cunha
- Surgery, Hospital Beatriz Ângelo, Loures, Portugal
| | | | - Rita Cruz
- Radiology, Hospital Beatriz Ângelo, Loures, Portugal
| | | | | | | | - Rui Maio
- Surgery, Hospital Beatriz Ângelo, Loures, Portugal.,Oncology, Hospital da Luz, Lisboa, Portugal
| | | | - Marília Cravo
- Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal.,Oncology, Hospital da Luz, Lisboa, Portugal.,Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
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Morais R, Vilas-Boas F, Pereira P, Lopes P, Simões C, Dantas E, Cunha I, Roseira J, Cortez-Pinto J, Silva J, Lage J, Caine M, Rocha M, Flor de Lima M, Costa Santos MP, Garrido M, Sousa P, Marcos P, Azevedo R, Castro R, Cúrdia Gonçalves T, Leal T, Magno-Pereira V, Ramalho R, Rodrigues-Pinto E, Macedo G. Prevalence, risk factors and global impact of musculoskeletal injuries among endoscopists: a nationwide European study. Endosc Int Open 2020; 8:E470-E480. [PMID: 32258368 PMCID: PMC7089795 DOI: 10.1055/a-1038-4343] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/15/2019] [Indexed: 02/08/2023] Open
Abstract
Background and study aims Previous studies have suggested a high prevalence of musculoskeletal injuries (MI) in endoscopists. Little evidence has come from European countries. Our main aim was to evaluate the prevalence, type, and impact of MI among Portuguese endoscopists. We also sought to identify risk factors for the development, severity and number of endoscopy-related MI. Material and methods A 48-question electronic survey was developed by a multidisciplinary group. The electronic survey was sent to all members of Portuguese Society of Gastroenterology (n = 705) during May 2019. Study data were collected and managed using REDCap electronic data capture tools hosted at SPG - CEREGA. Results The survey was completed by 171 endoscopists (response rate of 24.3 %), 55.0 % female with a median age of 36 years (range 26-78). The prevalence of at least one MI related to endoscopy was 69.6 % (n = 119), the most frequent being neck pain (30.4 %) and thumb pain (29.2 %). The median time for MI development was 6 years (range 2 months-30 years). Severe pain was reported by 19.3 %. Change in endoscopic technique was undertaken by 61.3 % and reduction in endoscopic caseload was undertaken by 22.7 %. Missing work was reported by 10.1 %, with the median time off from work being 30 days (range 1-90). Female gender and ≥ 15 years in practice were independently associated with MI and severe pain. Years in practice, weekly-time performing endoscopy, and gender were significant predictors of the number of MI. Conclusions Prevalence of MI was significant among Portuguese endoscopists and had a relevant impact on regular and professional activities.
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Affiliation(s)
- Rui Morais
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal,Corresponding author Rui Morais, MD Gastroenterology DepartmentCentro Hospitalar São JoãoPorto. Al. Prof. Hernâni Monteiro4200 - 319 PortoPortugal+351 22 551 3601
| | - Filipe Vilas-Boas
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Pedro Pereira
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Pedro Lopes
- Physical Medicine and Rehabilitation Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Carolina Simões
- Gastroenterology Department, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Eduardo Dantas
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Inês Cunha
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra Coimbra, Portugal
| | - Joana Roseira
- Gastroenterology Department, Centro Hospitalar Universitário Algarve, Faro, Portugal
| | | | - João Silva
- Gastroenterology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Jorge Lage
- Gastroenterology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Mafalda Caine
- Gastroenterology Department, IPO Coimbra, Coimbra, Portugal
| | - Manuel Rocha
- Gastroenterology Department, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Margarida Flor de Lima
- Gastroenterology Department, Hospital do Divino Espírito Santo de Ponta Delgada, Ponta Delgada, Portugal
| | | | - Mónica Garrido
- Gastroenterology Department, Centro Hospitalar Porto, Porto, Portugal
| | - Paula Sousa
- Gastroenterology Department, Centro Hospitalar Tondela-Viseu, Tondedla-Visue, Portugal
| | - Pedro Marcos
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Richard Azevedo
- Gastroenterology Department, Centro Hospitalar de Castelo-Branco, Castelo-Branco, Portugal
| | - Rui Castro
- Gastroenterology Department, IPO Porto, Porto, Portugal
| | - Tiago Cúrdia Gonçalves
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães Braga, Portugal,Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga/Guimarães, Braga, Portugal,ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Braga, Portugal
| | - Tiago Leal
- Gastroenterology Department, Hospital de Braga, Braga, Portugal
| | | | - Rosa Ramalho
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
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Abstract
Familial aggregation in inflammatory bowel disease (IBD) has been established for several decades, reflecting shared genetic and environmental susceptibility. A positive family history remains the strongest recognizable risk factor for the development of IBD and is reported in around 8-12% of IBD patients. Crohn’s disease shows a more frequent familial pattern than ulcerative colitis. The risk of developing IBD in first-degree relatives of an affected proband is increased 4- to 8-fold. The risk for twins and children born from couples who both have IBD is also substantially higher; a cumulative effect of the number of family members affected has been described, with the highest incidence being described for families with three or more affected members. Herein, we review the available evidence regarding familial IBD, and briefly discuss the variation of IBD across different races and ethnicities, hoping to provide a useful update and a practical guide that can serve clinicians as a guide for counseling.
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Affiliation(s)
- Maria Pia Costa Santos
- Gastroenterology Division, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Catarina Gomes
- Gastroenterology Division, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Joana Torres
- Gastroenterology Division, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
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Torres J, Palmela C, Gomes de Sena P, Santos MPC, Gouveia C, Oliveira MH, Henriques AR, Rodrigues C, Cravo M, Borralho P. Farnesoid X Receptor Expression in Microscopic Colitis: A Potential Role in Disease Etiopathogenesis. GE Port J Gastroenterol 2017; 25:30-37. [PMID: 29457048 DOI: 10.1159/000481197] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/04/2017] [Indexed: 12/20/2022]
Abstract
Introduction Microscopic colitis (MC) is a chronic inflammatory bowel disease with unclear etiology. Bile acid (BA) malabsorption has been described in MC patients. Farnesoid X receptor (FXR) is the main BA receptor; FXR-mediated mechanisms prevent the noxious effects of BA accumulation, preserving the integrity of the intestinal epithelial barrier and preventing intestinal inflammation. Aim Our aim was to describe the expression of FXR in patients with MC. Methods Archival formalin-fixed paraffin-embedded samples from the terminal ileum, right and left colon were obtained from patients with MC and matched controls. Immunohistochemistry was performed and nuclear FXR expression scored in a semi-quantitative way. Results 169 formalin-fixed paraffin-embedded samples from 35 patients with MC and 31 controls were retrieved. There was a significant reduction of FXR expression in patients with MC versus controls both in the right colon (moderate-strong FXR expression: 21.1 vs. 64.3%; p = 0.003) and left colon (moderate-strong FXR expression: 8.3 vs. 38.7%; p = 0.027). No significant differences in FXR expression were observed in the ileum of patients with MC (moderate-strong FXR expression: 76.9 vs. 90.9%; p = 0.5). We found no difference in FXR expression between the two types of MC. No association between the degree of lymphocyte infiltration or the thickness of collagen band and FXR expression was found. Conclusions Patients with MC present a significantly lower expression of FXR in the colon. This could render colonic epithelial cells more susceptible to the deleterious effects of BA, contributing to disease pathogenesis and symptoms in MC.
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Affiliation(s)
- Joana Torres
- Gastroenterology Department, Hospital Beatriz Ângelo, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - Carolina Palmela
- Gastroenterology Department, Hospital Beatriz Ângelo, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - Pedro Gomes de Sena
- Pathology Department, Hospital Beatriz Ângelo, Loures, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - Maria Pia Costa Santos
- Gastroenterology Department, Hospital Beatriz Ângelo, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - Catarina Gouveia
- Gastroenterology Department, Hospital Beatriz Ângelo, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - Maria Helena Oliveira
- Pathology Department, Hospital Beatriz Ângelo, Loures, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Raquel Henriques
- Faculty of Medicine, Universidade de Lisboa, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - Cecília Rodrigues
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - Marília Cravo
- Gastroenterology Department, Hospital Beatriz Ângelo, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - Paula Borralho
- Gastroenterology Department, Hospital Beatriz Ângelo, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal.,Pathology Department, Hospital Cuf Descobertas, Lisbon, Portugal
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Gouveia C, Loureiro R, Ferreira R, Oliveira Ferreira A, Santos AA, Santos MPC, Palmela C, Cravo M. Performance of the Choledocholithiasis Diagnostic Score in Patients with Acute Cholecystitis. GE Port J Gastroenterol 2017; 25:24-29. [PMID: 29457047 DOI: 10.1159/000479973] [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: 11/16/2016] [Revised: 07/04/2017] [Indexed: 01/27/2023]
Abstract
Introduction The prevalence of choledocholithiasis among patients with acute cholecystitis is estimated to be between 9 and 16.5%. There are no validated algorithms to predict choledocholithiasis in this group of patients. Aim The aim of this study was to evaluate the performance of the choledocholithiasis diagnostic score proposed by the American Society for Gastrointestinal Endoscopy, in patients with acute cholecystitis. Material/Methods A retrospective cross-sectional study, covering a 4-year period at a secondary care hospital, was performed. All patients with an encoded diagnosis of acute cholecystitis and with at least one of the following procedures were included: endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound, magnetic resonance cholangiopancreatography, and intraoperative cholangiography. Results Among 4,369 patients with the diagnosis of acute cholecystitis, 40 (0.92%) had clinical or sonographic suspicion of choledocholithiasis. Their mean age was 68.1 ± 15 years, and 22 (55%) were men. Thirty-one of the patients included (77.5%) had a high risk of choledocholithiasis, and 9 (22.5%) had an intermediate risk. In 16 (51.6%) of the 31 patients with a high risk, the diagnosis of choledocholithiasis was confirmed. In 2 (22.2%) of the 9 patients with an intermediate risk, the diagnosis of choledocholithiasis was also confirmed. The high risk score for choledocholithiasis had a positive predictive value of 52% and a sensitivity of 89%. The intermediate risk score for choledocholithiasis had a positive predictive value of 22% and a sensitivity of 11%. Discussion and Conclusions Suspicion of choledocholithiasis in patients with acute cholecystitis was a rare event (<1%). The sensitivity of the high risk score was approximately the same as found in published series with patients with suspected choledocholithiasis overall (86%), while the positive predictive value was substantially lower (52 vs. 79.8%). Therefore, in patients with acute cholecystitis and suspected choledocholithiasis, this score should not be used to screen for common bile duct stones, and a sensitive method should be used prior to ERCP.
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Affiliation(s)
- Catarina Gouveia
- Serviço de Gastrenterologia, Hospital Beatriz Ângelo, Lisbon, Portugal
| | - Rui Loureiro
- Serviço de Gastrenterologia, Hospital Beatriz Ângelo, Lisbon, Portugal
| | - Rosa Ferreira
- Serviço de Gastrenterologia, Hospital Beatriz Ângelo, Lisbon, Portugal
| | | | | | | | - Carolina Palmela
- Serviço de Gastrenterologia, Hospital Beatriz Ângelo, Lisbon, Portugal
| | - Marília Cravo
- Serviço de Gastrenterologia, Hospital Beatriz Ângelo, Lisbon, Portugal
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Cravo ML, Velho S, Torres J, Costa Santos MP, Palmela C, Cruz R, Strecht J, Maio R, Baracos V. Lower skeletal muscle attenuation and high visceral fat index are associated with complicated disease in patients with Crohn's disease: An exploratory study. Clin Nutr ESPEN 2017; 21:79-85. [PMID: 30014873 DOI: 10.1016/j.clnesp.2017.04.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 04/01/2017] [Accepted: 04/09/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS The prognostic value of body composition analysis in patients with Crohn's disease (CD) is poorly explored. The aims of the present study were to assess fat and skeletal muscle compartments including muscle radiation attenuation (MA) in patients with CD, and to analyze its predictive value to identify complicated phenotypes. METHODS Seventy one patients with CD who have had an abdominal CT within one month of clinical, laboratory, and endoscopic evaluation were included. Skeletal muscle area (SMA) and index (SMI), visceral fat area (VFA) and index (VFI), subcutaneous fat area (SFA), and mean MA were measured using appropriate software. Sarcopenia, as defined by Martin's criteria was assessed. Montreal classification was used to characterize disease phenotype. RESULTS Mean MA was lower in patients >40 years (p = 0.001), L2 (p = 0.09) and stricturing/penetrating disease (p = 0.03) whereas SMA and SMI were significantly lower in patients with positive C-reactive protein and previous hospital admissions (p < 0.01). On multivariate analysis, higher MA was protective against the complicated disease phenotype (stricturing/penetrating disease and/or previous surgeries) (OR 0.81; p = 0.002) whereas a high visceral fat index increased such risk (OR 26.1; p = 0.02). A ROC curve showed a 82.4% sensibility, 90.3% specificity, 17.6% positive predictive value, 9.7% negative predictive value and an area under the curve (AUC) of 0.91 for body composition analysis to predict complicated disease. CONCLUSIONS A lower muscle attenuation and a high visceral fat index seem to be associated with more severe phenotypes in patients with CD.
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Affiliation(s)
- Marília L Cravo
- Department of Gastroenterology, Hospital Beatriz Ângelo, Portugal
| | - Sónia Velho
- Department of Nutrition and Dietetics, Hospital Beatriz Ângelo, Portugal
| | - Joana Torres
- Department of Gastroenterology, Hospital Beatriz Ângelo, Portugal
| | | | - Carolina Palmela
- Department of Gastroenterology, Hospital Beatriz Ângelo, Portugal
| | - Rita Cruz
- Department of Radiology, Hospital Beatriz Ângelo, Portugal
| | - João Strecht
- Department of Radiology, Hospital Beatriz Ângelo, Portugal
| | - Rui Maio
- Department of Surgery, Hospital Beatriz Ângelo, Portugal
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Palmela C, Velho S, Agostinho L, Branco F, Santos M, Santos MPC, Oliveira MH, Strecht J, Maio R, Cravo M, Baracos VE. Body Composition as a Prognostic Factor of Neoadjuvant Chemotherapy Toxicity and Outcome in Patients with Locally Advanced Gastric Cancer. J Gastric Cancer 2017; 17:74-87. [PMID: 28337365 PMCID: PMC5362836 DOI: 10.5230/jgc.2017.17.e8] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 03/03/2017] [Accepted: 03/03/2017] [Indexed: 12/29/2022] Open
Abstract
Purpose Neoadjuvant chemotherapy has been shown to improve survival in locally advanced gastric cancer, but it is associated with significant toxicity. Sarcopenia and sarcopenic obesity have been studied in several types of cancers and have been reported to be associated with higher chemotherapy toxicity and morbi-mortality. The aim of this study was to assess the prevalence of sarcopenia/sarcopenic obesity in patients with gastric cancer, as well as its association with chemotherapy toxicity and long-term outcomes. Materials and Methods A retrospective analysis was performed using an academic cancer center patient cohort diagnosed with locally advanced gastric cancer between January 2012 and December 2014 and treated with neoadjuvant chemotherapy. We analyzed body composition (skeletal muscle and visceral fat index) in axial computed tomography images. Results A total of 48 patients met the inclusion criteria. The mean age was 68±10 years, and 33 patients (69%) were men. Dose-limiting toxicity was observed in 22 patients (46%), and treatment was terminated early owing to toxicity in 17 patients (35%). Median follow-up was 17 months. Sarcopenia and sarcopenic obesity were found at diagnosis in 23% and 10% of patients, respectively. We observed an association between termination of chemotherapy and both sarcopenia (P=0.069) and sarcopenic obesity (P=0.004). On multivariate analysis, the odds of treatment termination were higher in patients with sarcopenia (odds ratio=4.23; P=0.050). Patients with sarcopenic obesity showed lower overall survival (median survival of 6 months [95% confidence interval {CI}=3.9–8.5] vs. 25 months [95% CI=20.2–38.2]; log-rank test P=0.000). Conclusions Sarcopenia and sarcopenic obesity were associated with early termination of neoadjuvant chemotherapy in patients with gastric cancer; additionally, sarcopenic obesity was associated with poor survival.
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Affiliation(s)
- Carolina Palmela
- Division of Gastroenterology, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Sónia Velho
- Nutrition Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Lisa Agostinho
- Radiology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | | | - Marta Santos
- General Surgery Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Maria Pia Costa Santos
- Division of Gastroenterology, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
| | | | - João Strecht
- Radiology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Rui Maio
- General Surgery Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Marília Cravo
- Division of Gastroenterology, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Vickie E Baracos
- Division of Palliative Care Medicine, Department of Oncology, Cross Cancer Institute, University of Alberta, Alberta, Canada
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Oliveira Ferreira A, Fidalgo C, Palmela C, Costa Santos MP, Torres J, Nunes J, Loureiro R, Ferreira R, Barjas E, Glória L, Santos AA, Cravo M. Adenoma Detection Rate: I Will Show You Mine if You Show Me Yours. GE Port J Gastroenterol 2016; 24:61-67. [PMID: 28848785 DOI: 10.1159/000450901] [Citation(s) in RCA: 6] [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: 06/29/2016] [Revised: 09/13/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is the first cause of cancer-related mortality in Portugal. CRC screening reduces disease-specific mortality. Colonoscopy is currently the preferred method for screening as it may contribute to the reduction of CRC incidence. This beneficial effect is strongly associated with the adenoma detection rate (ADR). AIM Our aim was to evaluate the quality of colonoscopy at our unit by measuring the currently accepted quality parameters and publish them as benchmarking indicators. METHODS From 5,860 colonoscopies, 654 screening procedures (with and without previous fecal occult blood testing) were analyzed. RESULTS The mean age of the patients was 66.4 ± 7.8 years, and the gender distribution was 1:1. The overall ADR was 36% (95% confidence interval [CI] 32-39), the mean number of adenomas per colonoscopy was 0.66 (95% CI 0.56-0.77), and the sessile serrate lesion detection rate was 1% (95% CI 0-2). The bowel preparation was rated as adequate in 496 (76%) patients. The adjusted cecal intubation rate (CIR) was 93.7% (95% CI 91.7-95.8). Most colonoscopies were performed under monitored anesthesia care (53%), and 35% were unsedated. The use of sedation (propofol or midazolam based) was associated with a higher CIR with an odds ratio of 3.60 (95% CI 2.02-6.40, p < 0.001). CONCLUSION Our data show an above-standard ADR. The frequency of poor bowel preparation and the low sessile serrated lesion detection rate were acknowledged, and actions were implemented to improve both indicators. Quality auditing in colonoscopy should be compulsory, and while many units may do so internally, this is the first national report from a high-throughput endoscopy unit.
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Affiliation(s)
| | - Catarina Fidalgo
- Gastroenterology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Carolina Palmela
- Gastroenterology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | | | - Joana Torres
- Gastroenterology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Joana Nunes
- Gastroenterology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Rui Loureiro
- Gastroenterology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Rosa Ferreira
- Gastroenterology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Elídio Barjas
- Gastroenterology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Luísa Glória
- Gastroenterology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | | | - Marília Cravo
- Gastroenterology Department, Hospital Beatriz Ângelo, Loures, Portugal
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9
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Costa Santos MP, Palmela C, Ferreira R, Barjas E, Santos AA, Maio R, Cravo M. Self-Expandable Metal Stents for Colorectal Cancer: From Guidelines to Clinical Practice. GE Port J Gastroenterol 2016; 23:293-299. [PMID: 28868482 PMCID: PMC5580185 DOI: 10.1016/j.jpge.2016.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/21/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Colonic self-expandable metal stent placement is widely used for palliation of obstructive colorectal cancer. The European recommendations for stent placement as a bridge to elective surgery in obstructive colorectal cancer were recently reviewed. The aim of this study was to evaluate the efficacy and safety of stent placement in obstructive colorectal cancer and to discuss these recent guidelines. MATERIALS AND METHODS Demographic characteristics, procedure indications, complications and final outcome in patients with obstructive colorectal cancer who underwent endoscopic stent placement between January 2012 and June 2015 were retrospectively analyzed. Statistical analysis was performed with SPSS V22. RESULTS Thirty-six patients were included, 20 (56%) women, mean age 70.6 ± 10.9 years. Stent placement as a bridge to elective surgery was performed in 75% (n = 27) of patients and with palliation intent in 25% (n = 9). In 94% (n = 34) of procedures, technical and clinical success was achieved. A total of eleven (11%) complications were observed: 2 migrations and 9 perforations. No procedure related death was recorded. When stents were placed as a bridge to surgery, average time between endoscopic procedure and surgery was 11.7 ± 9.4 days (excluding three patients who underwent neoadjuvant chemotherapy). Six perforations were recorded in this group: one overt and five silent (three during surgery and two after histopathological examination of the resected specimen). Twenty-one patients underwent adjuvant chemotherapy. During the follow-up period of 14.7 ± 10.9 months recurrence was observed in five patients. None of the recurrence occurred in the group of patients with perforation. CONCLUSIONS In this study, stent placement was an effective procedure in obstructive colorectal cancer. It was mainly used as a bridge to elective surgery. However, a significant rate of silent perforation was observed, which may compromise the oncological outcome of these potentially curable patients. Prospective real life studies are warranted for a better definition of actual recommendations.
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Affiliation(s)
| | - Carolina Palmela
- Gastroenterology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Rosa Ferreira
- Gastroenterology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Elídio Barjas
- Gastroenterology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | | | - Rui Maio
- General Surgery Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Marília Cravo
- Gastroenterology Department, Hospital Beatriz Ângelo, Loures, Portugal
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