1
|
Llop E, Perelló C, Fontanilla T, de la Revilla J, Conde MH, López M, Minaya J, Ferre C, Abad J, Carrillo CF, Martínez JL, Puga NF, Trapero M, Hajra IE, Santos E, Calleja JL. Spleen Transient Elastography and Damping Index Identify a Subgroup of Patients Without an Acute or Chronic Response to Beta-Blockers. Front Med (Lausanne) 2022; 9:900073. [PMID: 35814751 PMCID: PMC9258685 DOI: 10.3389/fmed.2022.900073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022] Open
Abstract
Background and Aims Monitoring of acute or chronic response to beta-blockers in patients with liver cirrhosis is based on the measurement of the HVPG. Our aim was to evaluate the response to beta-blockers with non-invasive techniques. Patients and Methods This is a prospective observational study. Consecutive patients with an indication of primary or secondary prophylaxis of variceal bleeding who did not meet exclusion criteria were included. Acute response and chronic response were evaluated. Baseline and after acute and chronic response hepatosplenic measurements of TE and ARFI were obtained. Contrast-enhanced Doppler ultrasound was performed before and after acute and chronic responses. Results From June 2015 to May 2018, 55 patients (14 with exclusion criteria) were included. We analyzed 41 patients, mean age 57 (SD: 8), 82.9% men, alcohol 43.9%, children A/B/C 78%/17.1%/4.9%, and 87.8% on primary prophylaxis. In all, the acute response was performed and was positive in 68.3% (CI 95: 55–85%). The chronic response was performed in 30 (73.2%) and was positive in 36.7% (CI 95: 18–55%). Basal measurements significantly related to acute response were spleen TE [responders 58.4 (SD: 23.0) KPa vs. non-responders 75 (SD: 0) KPa; p = 0.02] and damping index [non-responders 0.96 (0.8) vs. responders 0.44 (0.4), p = 0.01], and with chronic response, the spleen TE [responders 58.1 (SD: 21.4) KPa vs. non-responders 73.2 (SD: 5.5) KPa; p = 0.02], and damping index [non-chronic responders 0.8 (0.7) vs. chronic responders 0.4 (0.4), p = 0.04]. A spleen TE ≥ 74 KPa had a high sensitivity of 100% and specificity of 60% and a high NPV100% for predicting poor acute response to beta-blockers. The damping index > 0.6 showed moderate sensitivity of 67% and specificity of 69% with a high NPV of 82% for predicting poor acute response to beta-blockers. The combination of both measurements for predicting poor acute response to beta-blockers had an AUC of 0.8 (CI 95: 0.5–0.9). A spleen TE ≥ 74 KPa had a high sensitivity of 87% and specificity of 71% with a high NPV of 71% for predicting poor chronic response to beta-blockers. A damping index > 0.6 had moderate sensitivity of 60%, specificity of 82%, and NPV of 56% for predicting poor chronic response to beta-blockers. The combination of both measurements for predicting poor chronic response to beta-blockers had an AUC of 0.8 (CI 95: 0.7–0.9). Conclusion Spleen TE and damping index can identify a subgroup of patients with poor acute or chronic response to beta-blockers.
Collapse
Affiliation(s)
- Elba Llop
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Instituto de Investigación Sanitaria Puerta Hierro-Segovia Arana (IDIPHISA), Madrid, Spain
- CIBERHD, Madrid, Spain
| | - Christie Perelló
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Instituto de Investigación Sanitaria Puerta Hierro-Segovia Arana (IDIPHISA), Madrid, Spain
- CIBERHD, Madrid, Spain
| | - Teresa Fontanilla
- Instituto de Investigación Sanitaria Puerta Hierro-Segovia Arana (IDIPHISA), Madrid, Spain
- Department of Radiology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Juan de la Revilla
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Marta Hernández Conde
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Instituto de Investigación Sanitaria Puerta Hierro-Segovia Arana (IDIPHISA), Madrid, Spain
- CIBERHD, Madrid, Spain
| | - Marta López
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Instituto de Investigación Sanitaria Puerta Hierro-Segovia Arana (IDIPHISA), Madrid, Spain
- CIBERHD, Madrid, Spain
| | - Javier Minaya
- Instituto de Investigación Sanitaria Puerta Hierro-Segovia Arana (IDIPHISA), Madrid, Spain
- Department of Radiology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Carlos Ferre
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Instituto de Investigación Sanitaria Puerta Hierro-Segovia Arana (IDIPHISA), Madrid, Spain
- CIBERHD, Madrid, Spain
| | - Javier Abad
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Instituto de Investigación Sanitaria Puerta Hierro-Segovia Arana (IDIPHISA), Madrid, Spain
- CIBERHD, Madrid, Spain
| | - Carlos Fernández Carrillo
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Instituto de Investigación Sanitaria Puerta Hierro-Segovia Arana (IDIPHISA), Madrid, Spain
- CIBERHD, Madrid, Spain
| | - José Luís Martínez
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Instituto de Investigación Sanitaria Puerta Hierro-Segovia Arana (IDIPHISA), Madrid, Spain
- CIBERHD, Madrid, Spain
| | - Natalia Fernández Puga
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Instituto de Investigación Sanitaria Puerta Hierro-Segovia Arana (IDIPHISA), Madrid, Spain
- CIBERHD, Madrid, Spain
| | - María Trapero
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Instituto de Investigación Sanitaria Puerta Hierro-Segovia Arana (IDIPHISA), Madrid, Spain
- CIBERHD, Madrid, Spain
| | - Ismael El Hajra
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Elena Santos
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - José Luis Calleja
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Instituto de Investigación Sanitaria Puerta Hierro-Segovia Arana (IDIPHISA), Madrid, Spain
- CIBERHD, Madrid, Spain
- *Correspondence: José Luis Calleja,
| |
Collapse
|
2
|
Lopez-Gomez M, Llop E, Puente A, Hernández Conde M, Ruiz P, Alvárez S, Martínez JL, Abad J, Fernández N, Perelló C, Fernández-Carrillo C, Ferre C, Trapero M, Fraga E, Crespo J, Calleja Panero JL. Non-malignant portal vein thrombosis in a cohort of cirrhotic patients: Incidence and risk factors. Hepatol Res 2021; 51:1064-1072. [PMID: 34324766 DOI: 10.1111/hepr.13703] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/06/2021] [Accepted: 07/21/2021] [Indexed: 01/04/2023]
Abstract
AIM Non-malignant portal vein thrombosis (PVT) is a complication of liver cirrhosis. The aim of this study was to evaluate the annual incidence of PVT and related risk factors. METHODS We retrospectively reviewed clinical, laboratory, and radiological data collected prospectively from September 2016 to September 2017. A follow-up of 36 months was performed in a subset of patients to determine the cumulative incidence of PVT and related complications. RESULTS The study included 567 patients. The incidence of PVT at 12, 24, and 36 months was 3.7%, 0.8%, and 1.4%, respectively. Patients with PVT were compared with patients without PVT, and showed differences in albumin (p = 0.04), aspartate aminotransferase (p = 0.04), hemoglobin (p = 0.01), and prothrombin activity (p = 0.01). The presence of hydropic decompensation (57.1% vs. 30.1%; p 0.004), gastroesophageal varices (76.2% vs. 39.5%; p = 0.05), variceal bleeding (52.4% vs. 22.7%; p < 0.001), hepatic encephalopathy (38.1% vs. 9.9%; p = 0.01), spontaneous bacterial peritonitis (9.5% vs. 1.7%; p < 0.001), and use of beta-blockers (71.4% vs. 27.7%; p < 0.001) were significantly associated. In the multivariate analysis, use of beta-blockers and hepatic encephalopathy appeared as risk factors, and high albumin levels a protective factor. CONCLUSIONS The incidence of PVT was 3.7%. Beta-blockers and hepatic encephalopathy were risks factors. High albumin levels were a protective factor.
Collapse
Affiliation(s)
- Marta Lopez-Gomez
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Elba Llop
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Angela Puente
- Department of Gastroenterology and Hepatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Marta Hernández Conde
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Patricia Ruiz
- Department of Gastroenterology and Hepatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Silvia Alvárez
- Department of Gastroenterology and Hepatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Jose Luis Martínez
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Javier Abad
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Natalia Fernández
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Christie Perelló
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Carlos Fernández-Carrillo
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Carlos Ferre
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Maria Trapero
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Enrique Fraga
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Javier Crespo
- Department of Gastroenterology and Hepatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Jose Luis Calleja Panero
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| |
Collapse
|
3
|
Llop E, Iruzubieta P, Perelló C, Fernández Carrillo C, Cabezas J, Escudero MD, González M, Hernández Conde M, Puchades L, Arias-Loste MT, Serra MÁ, Crespo J, Calleja JL. High liver stiffness values by transient elastography related to metabolic syndrome and harmful alcohol use in a large Spanish cohort. United European Gastroenterol J 2021; 9:892-902. [PMID: 34077628 PMCID: PMC8498397 DOI: 10.1002/ueg2.12109] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/03/2021] [Indexed: 12/31/2022] Open
Abstract
Background and Aims Transient elastography (TE) to estimate liver stiffness has proved to be very useful in the diagnosis of chronic liver disease. Here, we intend to evaluate its use in a large Spanish cohort. Method Nested study within the PREVHEP‐ETHON (Epidemiological sTudy of Hepatic infectiONs; NCT02749864) population‐based, cross‐sectional study performed between July 2015 and April 2017. An epidemiological questionnaire, laboratory tests and TE and anthropometric measurements were obtained. Results Data from 11,440 subjects were analyzed. Mean age was 50.3 (SD 12.4), of which 58.1% were women. 15.4% showed metabolic syndrome (NCEP ATP‐III), 1.3% were positive for hepatitis C antibodies, 0.8% positive for HBsAg, 9.1% reported harmful use of alcohol. The prevalence of significant fibrosis (LSM > 8 kPa), suggestive compensated advanced chronic liver disease (cACLD) (LSM ≥ 10 kPa) and highly suggestive cACLD (LSM > 15 kPa) was 5.6%, 2.9%, and 1.2% respectively. Risk factors associated with significant fibrosis were age (OR 1.03 [1.02–1.04; p < 0.001]), sex (OR 0.8 [0.6–0.95; p = 0.02]), AST (OR 1.01 [1.01–1.02; p < 0.001]), GGT (OR 1.005 [1.003–1.006; p < 0.001]) and metabolic syndrome (OR 2.1 [1.7–2.6; p < 0.001]); risk factors associated with suggestive cACLD were age (OR 1.04 [1.02–1.05; p < 0.001]), AST (OR 1.01 [1.01–1.02; p < 0.001]), GGT (OR 1.006 [1.004–1.008; p < 0.001]), low platelets (OR 0.997 [0.994–0.999; p = 0.02]) and metabolic syndrome (OR 2.2 [1.6–2.9; p < 0.001]); and risk factors associated with highly suggestive cACLD were age (OR 1.04 [1.02–1.06; p = 0.001]), AST (OR 1.02 [1.01–1.03; p < 0.001]), GGT (OR 1.005 [1.003–1.007; p < 0.001]), low platelets (OR 0.993 [0.989–0.997; p < 0.001]), metabolic syndrome (OR 2.1 [1.4–3.3; p = 0.001]) and alcohol consumption (OR 1.8 [1.05–3.1; p = 0.03]). A non‐negligible proportion of patients with normal transaminase levels, even with healthy transaminase levels, showed significant fibrosis and suggestive and highly suggestive cACLD 4.6% (95% CI 2.4–3.0), 2.1% (95% CI 1.9–2.5) and 1% (95% CI 0.7–1.1), respectively. Conclusion We found high proportion of significant fibrosis and cACLD measured by TE. The most relevant factor associated with significant fibrosis was metabolic syndrome, however TE is still an imperfect method since it overestimated the fibrosis stage in 50% of the histologically analyzed subjects.
Collapse
Affiliation(s)
- Elba Llop
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Puerta de Hierro Health Research Institute (IDIPHIM), CIBERhd, Majadahonda, Spain
| | - Paula Iruzubieta
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla Research Institute (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Christie Perelló
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Puerta de Hierro Health Research Institute (IDIPHIM), CIBERhd, Majadahonda, Spain
| | - Carlos Fernández Carrillo
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Puerta de Hierro Health Research Institute (IDIPHIM), CIBERhd, Majadahonda, Spain
| | - Joaquín Cabezas
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla Research Institute (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Marta González
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla Research Institute (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Marta Hernández Conde
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Puerta de Hierro Health Research Institute (IDIPHIM), CIBERhd, Majadahonda, Spain.,Department of Gastroenterology and Hepatology, Marqués de Valdecilla Research Institute (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, Spain.,Department of Gastroenterology and Hepatology, Hospital Clínic-La Malvarrosa, Valencia, Spain
| | - Laura Puchades
- Department of Gastroenterology and Hepatology, Hospital Clínic-La Malvarrosa, Valencia, Spain
| | - María Teresa Arias-Loste
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla Research Institute (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Miguel Ángel Serra
- Department of Gastroenterology and Hepatology, Hospital Clínic-La Malvarrosa, Valencia, Spain
| | - Javier Crespo
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla Research Institute (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - José Luis Calleja
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Puerta de Hierro Health Research Institute (IDIPHIM), CIBERhd, Majadahonda, Spain
| |
Collapse
|
4
|
Crespo J, Cuadrado A, Perelló C, Cabezas J, Llerena S, Llorca J, Cedillo S, Llop E, Escudero MD, Hernández Conde M, Puchades L, Redondo C, Fortea JI, Gil de Miguel A, Serra MA, Lazarus JV, Calleja JL. Epidemiology of hepatitis C virus infection in a country with universal access to direct-acting antiviral agents: Data for designing a cost-effective elimination policy in Spain. J Viral Hepat 2020; 27:360-370. [PMID: 31755634 DOI: 10.1111/jvh.13238] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 08/05/2019] [Revised: 10/30/2019] [Accepted: 11/05/2019] [Indexed: 12/29/2022]
Abstract
Accurate HCV prevalence estimates are necessary for guiding elimination policies. Our aim was to determine the HCV prevalence and assess the cost-effectiveness of a screen-and-treat strategy in the Spanish population. A population-based, cross-sectional study (PREVHEP-ETHON Cohort, Epidemiological sTudy of Hepatic infectiONs; NCT02749864) was performed from July 2015-April 2017. Participants from three Spanish regions were selected using two-stage conglomerate sampling, and stratified by age, with randomized subject selection. Anthropometric and demographic data were collected, and blood samples were taken to detect anti-HCV antibodies/quantify HCV RNA. The cost-effectiveness of the screening strategies and treatment were analysed using a Markov model. Among 12 246 participants aged 20-74 (58.4% females), the overall anti-HCV prevalence was 1.2% (95% CI 1.0-1.4), whereas the detectable HCV-RNA prevalence was 0.3% (0.2-0.4). Infection rates were highest in subjects aged 50-74 years [anti-HCV 1.6% (1.3-1.9), HCV RNA 0.4% (0.3-0.6]. Among the 147 anti-HCV + subjects, 38 (25.9%) had active infections while 109 (74.1%) had been cleared of infection; 44 (40.4%) had cleared after antiviral treatment, whereas 65 (59.6%) had cleared spontaneously. Overall, 59.8% of the anti-HCV + participants were aware of their serological status. Considering a cost of treatment of €7000/patient, implementing screening programmes is cost-effective across all age cohorts, particularly in patients aged 50-54 (negative incremental cost-effectiveness ratio which indicates a cost-saving strategy). The current HCV burden is lower than previously estimated, with approximately 25% of anti-HCV + individuals having an active infection. A strategy of screening and treatment at current treatment prices in Spain is cost-effective across all age cohorts.
Collapse
Affiliation(s)
- Javier Crespo
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Santander, Spain.,Marqués de Valdecilla Research Institute (IDIVAL), s/n, Calle Cardenal Herrera Oria, Santander, Spain
| | - Antonio Cuadrado
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Santander, Spain.,Marqués de Valdecilla Research Institute (IDIVAL), s/n, Calle Cardenal Herrera Oria, Santander, Spain
| | - Christie Perelló
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Majadahonda, School of Medicine, Universidad Autónoma Madrid, Majadahonda, Spain
| | - Joaquin Cabezas
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Santander, Spain.,Marqués de Valdecilla Research Institute (IDIVAL), s/n, Calle Cardenal Herrera Oria, Santander, Spain
| | - Susana Llerena
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Santander, Spain.,Marqués de Valdecilla Research Institute (IDIVAL), s/n, Calle Cardenal Herrera Oria, Santander, Spain
| | - Javier Llorca
- Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, Santander, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), IDIVAL, s/n, Santander, Spain
| | - Sergio Cedillo
- Outcomes Research Department, Chiltern International/MSD, Tres Cantos, Spain
| | - Elba Llop
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Majadahonda, School of Medicine, Universidad Autónoma Madrid, Majadahonda, Spain
| | - María Desamparados Escudero
- Gastroenterology and Hepatology, Servicio Medicina Digestiva del Hospital Clinico Universitario de Valencia (HUCV) Av. de Blasco Ibáñez, Valencia, Spain
| | - Marta Hernández Conde
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Majadahonda, School of Medicine, Universidad Autónoma Madrid, Majadahonda, Spain
| | - Laura Puchades
- Gastroenterology and Hepatology, Servicio Medicina Digestiva del Hospital Clinico Universitario de Valencia (HUCV) Av. de Blasco Ibáñez, Valencia, Spain
| | - Carlos Redondo
- Marqués de Valdecilla Research Institute (IDIVAL), s/n, Calle Cardenal Herrera Oria, Santander, Spain
| | - José I Fortea
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Santander, Spain.,Marqués de Valdecilla Research Institute (IDIVAL), s/n, Calle Cardenal Herrera Oria, Santander, Spain
| | | | - Miguel A Serra
- Gastroenterology and Hepatology, Servicio Medicina Digestiva del Hospital Clinico Universitario de Valencia (HUCV) Av. de Blasco Ibáñez, Valencia, Spain
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - José Luis Calleja
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Majadahonda, School of Medicine, Universidad Autónoma Madrid, Majadahonda, Spain
| |
Collapse
|
5
|
Albéniz E, Pellisé M, Gimeno-García AZ, Lucendo AJ, Alonso-Aguirre PA, Herreros de Tejada A, Álvarez MA, Fraile M, Herráiz Bayod M, López Rosés L, Martínez Ares D, Ono A, Parra Blanco A, Redondo E, Sánchez-Yagüe A, Soto S, Díaz-Tasende J, Montes Díaz M, Rodríguez-Téllez M, García O, Zuñiga Ripa A, Hernández Conde M, Alberca de Las Parras F, Gargallo CJ, Saperas E, Muñoz Navas M, Gordillo J, Ramos Zabala F, Echevarría JM, Bustamante M, González-Haba M, González-Huix F, González-Suárez B, Vila Costas JJ, Guarner Argente C, Múgica F, Cobián J, Rodríguez Sánchez J, López Viedma B, Pin N, Marín Gabriel JC, Nogales Ó, de la Peña J, Navajas León FJ, León Brito H, Remedios D, Esteban JM, Barquero D, Martínez Cara JG, Martínez Alcalá F, Fernández-Urién I, Valdivielso E. Clinical guidelines for endoscopic mucosal resection of non-pedunculated colorectal lesions. Rev Esp Enferm Dig 2018; 110:179-194. [PMID: 29421912 DOI: 10.17235/reed.2018.5086/2017] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This document summarizes the contents of the Clinical Guidelines for the Endoscopic Mucosal Resection of Non-Pedunculated Colorectal Lesions that was developed by the working group of the Spanish Society of Digestive Endoscopy (GSEED of Endoscopic Resection). This document presents recommendations for the endoscopic management of superficial colorectal neoplastic lesions.
Collapse
Affiliation(s)
- Eduardo Albéniz
- Aparato Digestivo. Unidad de Endoscopia Digestiva, Complejo Hospitalario de Navarra, España
| | | | | | | | | | | | | | | | - Maite Herráiz Bayod
- Unidad de Endoscopia. Departamento de Digestivo, Clínica Universidad de Navarra
| | | | | | - Akiko Ono
- Digestivo/Endoscopias, Hospital Clínico Universitario Virgen de la Arrixaca
| | | | | | | | | | - José Díaz-Tasende
- Servicio de Medicina del Aparato Digestivo, Hospital Universitario 12 de Octubre, España
| | - Marta Montes Díaz
- Departamento de Anatomía Patológica, Complejo Hospitalario de Navarra, España
| | | | | | | | - Marta Hernández Conde
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, Spain
| | | | | | | | | | | | | | | | - Marco Bustamante
- Digestive Endoscopy Unit. Gastoenterology, Hospital Universitari i Politècnic La Fe, España
| | | | | | | | | | | | | | | | | | | | | | | | - Óscar Nogales
- Aparato Digestivo, Hospital General Universitario Gregorio Marañón, España
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Albéniz E, Pellisé M, Gimeno García AZ, Lucendo AJ, Alonso Aguirre PA, Herreros de Tejada A, Álvarez MA, Fraile M, Herráiz Bayod M, López Rosés L, Martínez Ares D, Ono A, Parra Blanco A, Redondo E, Sánchez Yagüe A, Soto S, Díaz Tasende J, Montes Díaz M, Téllez MR, García O, Zuñiga Ripa A, Hernández Conde M, Alberca de las Parras F, Gargallo C, Saperas E, Navas MM, Gordillo J, Ramos Zabala F, Echevarría JM, Bustamante M, González Haba M, González Huix F, González Suárez B, Vila Costas JJ, Guarner Argente C, Múgica F, Cobián J, Rodríguez Sánchez J, López Viedma B, Pin N, Marín Gabriel JC, Nogales Ó, de la Peña J, Navajas León FJ, León Brito H, Remedios D, Esteban JM, Barquero D, Martínez Cara JG, Martínez Alcalá F, Fernández Urién I, Valdivielso E. Guía clínica para la resección mucosa endoscópica de lesiones colorrectales no pediculadas. Gastroenterología y Hepatología 2018; 41:175-190. [DOI: 10.1016/j.gastrohep.2017.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 07/07/2017] [Indexed: 02/07/2023]
|
7
|
Hernández Conde M, Llop Herrera E, de la Revilla Negro J, Pons Renedo F, Fernández Puga N, Martínez Porras JL, Trapero Marugan M, Cuervas-Mons V, Sánchez Turrión V, Calleja Panero JL. Prevalence and outcome of portal thrombosis in a cohort of cirrhotic patients undergoing liver transplantation. Rev Esp Enferm Dig 2017; 108:716-720. [PMID: 27756145 DOI: 10.17235/reed.2016.4211/2016] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The prevalence of portal vein thrombosis (PVT) in patients that have undergone liver transplantation (LT) is 9.7% (SD 4.5). The aim of our study was to determine the prevalence, assess the factors that are associated with PVT and clarify their association with prognosis in patients with liver cirrhosis (LC) and LT. AIMS AND METHODS From 2005 to 2014, laboratory, radiological and surgical data were collected from patients with LC in our center who had undergone LT for the first time. RESULTS One hundred and ninety-one patients were included. The mean age was 55 (SD 9), 75.4% of patients were male and 48.7% had HCV. The Child-Pugh scores were A/B/C 41.9%/35.9%/25.5% and the MELD score was 15 (SD 6). Previous decompensations were: ascites (61.4%), hepatic encephalopathy (34.4%), variceal bleeding (25.4%), hepatocellular carcinoma (48.9%) and spontaneous bacterial peritonitis (SPB) (14.3%). The mean post-transplant follow-up was 42 months (0-113). PVT was diagnosed at LT in 18 patients (9.4%). Six patients were previously diagnosed using imaging tests (33.3%): 2 patients (11.1%) by DU and 4 patients (22.2%) by CT scan. All patients with PVT had DU in a mean time of 6 months before LT (0-44) and 90 patients (47.1%) had a CT scan in a median time of 6 months before LT (0-45). PVT was significantly related to the presence of SBP (33.3% vs 12.6%; p = 0.02) and lower levels of albumin (3.1g/dl vs 3.4g/dl; p = 0.05). MELD was higher in patients with PVT (16.6 vs 14.9; p = 0.3). There were no significant differences with regard to the need for transfusion of blood components. Moreover, the surgery time was similar in both groups. PVT correlated with a higher mortality in the first 30 days (8.8% vs 16.7%; p = 0.2). CONCLUSION Prior history of SBP and lower levels of albumin were identified as factors associated with PVT. The pre-transplant diagnosis rate is very low and the presence of PVT may have implications for short-term mortality.
Collapse
Affiliation(s)
- Marta Hernández Conde
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, Spain
| | - Elba Llop Herrera
- Department of Gastroenterology and Hepatology,Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda
| | - Juan de la Revilla Negro
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda
| | - Fernando Pons Renedo
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda
| | - Natalia Fernández Puga
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda
| | | | - María Trapero Marugan
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda
| | - Valentín Cuervas-Mons
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro Majadahonda
| | | | - José Luis Calleja Panero
- Department of Gastroenterology and Hepatology, Universitario Puerta de Hierro Majadahonda, España
| |
Collapse
|
8
|
González-Partida I, Hernández Conde M, Llop Herrera E, Oliva del Río B, López Gómez M, Calleja Panero JL, Abreu García L. [Extrahepatic shunt. Unusual cause of hepatic encephalopathy]. Rev Esp Enferm Dig 2015; 107:518-519. [PMID: 26228960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|