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Papanikolaou IS, Tziatzios G, Karatzas PS, Gkolfakis P, Facciorusso A, Triantafyllou K. Quality in pancreatic endoscopic ultrasound: what's new in 2020? Ann Gastroenterol 2020; 33:547-553. [PMID: 33162731 PMCID: PMC7599358 DOI: 10.20524/aog.2020.0537] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022] Open
Abstract
Quality assessment and improvement of an endoscopic service has emerged as a basic component of everyday gastrointestinal endoscopy. In order to ensure a high level of quality, a series of actions must be adopted when performing an endoscopic examination. Nonetheless, quality still remains a qualitative parameter; thus, implementation of specific indicators of quality is warranted. Irrespective of the nature of the endoscopic procedure, quality indicators usually refer to either structural properties of an endoscopy unit (e.g., examination availability), procedural factors (e.g., diagnostic accuracy), or patient outcomes (e.g., occurrence of an adverse event related to performance of an endoscopic procedure). Moreover, they are usually classified into 3 distinct sections, according to the phase of the procedure they relate to: i.e., before, during, and after the examination. The aim of this review is to present measures that need to be adopted in order to reach an optimal quality level during an endoscopic ultrasound examination and to provide up-to-date data regarding the respective quality indicators implicated.
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Affiliation(s)
- Ioannis S Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Center, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece (Ioannis S. Papanikolaou, Georgios Tziatzios, Konstantinos Triantafyllou)
| | - Georgios Tziatzios
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Center, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece (Ioannis S. Papanikolaou, Georgios Tziatzios, Konstantinos Triantafyllou)
| | - Pantelis S Karatzas
- Academic Department of Gastroenterology and Hepatology, Laiko General Hospital, University of Athens, Medical School, Athens, Greece (Pantelis S. Karatzas)
| | - Paraskevas Gkolfakis
- Department of Gastroenterology Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium (Paraskevas Gkolfakis)
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia AOU, Foggia, Italy (Antonio Facciorusso)
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Center, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece (Ioannis S. Papanikolaou, Georgios Tziatzios, Konstantinos Triantafyllou)
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Karatzas PS, Rösch T, Papanikolaou IS, de Heer J, Schachschal G, Groth S. Recognizing Post-Endoscopy Complications: A Database Filter Reduces Quality Assurance Workload for Inpatients. Dig Dis 2020; 39:171-178. [PMID: 32777788 DOI: 10.1159/000510757] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND AIMS Documentation of complications of gastrointestinal endoscopy within the commonly used endoscopy documentation systems are mostly limited to acute complications during endoscopy included in the post-procedural endoscopy report. We tested a documentation system-based filter to reduce the workload by maintaining a high sensitivity to recognize post-endoscopy complications. METHODS Of all inpatient endoscopic resections during 1 year and all endoscopic retrograde cholangiopancreatography (ERCP) procedures during 4 months in 1 tertiary referral centre, post-procedural complications during hospital stay were individually analyzed retrospectively from the hospital databases (gold standard). In comparison, information technology-based filters were assessed searching for specific tests and data within 2 days after endoscopy and/or until discharge. These were second endoscopy, surgery, or an abdominal computed tomography (CT) or haemoglobin drop ≥2 g/dL for endoscopic resection. For ERCP cases, any case with lipase determination and post-ERCP CT scan was selected. Main outcomes were the sensitivity of these filters to recognize post-endoscopy complications and the percentage of workload reduction. RESULTS Three hundred twenty-two inpatients who underwent endoscopic resections and 302 ERCP cases (all inpatients) were included. Post-endoscopy complications occurred in 7.14% (endoscopic resection) and 3.7% (ERCP). The above-mentioned filters identified 100% of all resection and post-ERCP complications compared to detailed case file analysis, at the same time reducing the quality management workload to 14 and 31%, respectively. CONCLUSIONS Post-procedural monitoring of advanced endoscopic procedures performed on inpatient procedures has a high sensitivity (100%) and reduces case-by-case screening workload for complications by 70-85%. Outpatient interventions, however, require a different system for monitoring of post-endoscopy complications after discharge.
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Affiliation(s)
- Pantelis S Karatzas
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany.,Hepatogastroenterology Unit, Second Department of Internal Medicine, Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany,
| | - Ioannis S Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine, Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Jocelyn de Heer
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Schachschal
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Groth
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Galanopoulos M, Varytimiadis L, Tsigaridas A, Karatzas PS, Archavlis E, Viazis N, Vourlakou C, Mantzaris GJ. Small bowel enteropathy associated with olmesartan medoxomil treatment. Ann Gastroenterol 2017; 30:131-133. [PMID: 28042253 PMCID: PMC5198241 DOI: 10.20524/aog.2016.0052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 04/03/2016] [Accepted: 05/10/2016] [Indexed: 12/22/2022] Open
Abstract
Sprue-like enteropathy associated with treatment with olmesartan medoxomil, an angiotensin II receptor blocker, has been described recently. Herein, we report two patients who developed chronic severe non-bloody diarrhea, weight loss, and muscle wasting after prolonged use of olmesartan. Histologic and immunohistochemical examination of multiple duodenal biopsies revealed severe villous atrophy. Clinical signs ceased upon drug discontinuation. Physicians should be aware of this enteropathy even if olmesartan has been taken for months or years. Whether this adverse event is specific for olmesartan or is a class effect of angiotensin II receptor blockers is currently unknown. To the best of our knowledge, these case reports are the first reported in Greece.
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Affiliation(s)
- Michail Galanopoulos
- Department of Gastroenterology (Michail Galanopoulos, Lazaros Varytimiadis, Athanasios Tsigaridas, Pantelis S. Karatzas, Emmanuel Archavlis, Nikos Viazis, Gerassimos J. Mantzaris)
| | - Lazaros Varytimiadis
- Department of Gastroenterology (Michail Galanopoulos, Lazaros Varytimiadis, Athanasios Tsigaridas, Pantelis S. Karatzas, Emmanuel Archavlis, Nikos Viazis, Gerassimos J. Mantzaris)
| | - Athanasios Tsigaridas
- Department of Gastroenterology (Michail Galanopoulos, Lazaros Varytimiadis, Athanasios Tsigaridas, Pantelis S. Karatzas, Emmanuel Archavlis, Nikos Viazis, Gerassimos J. Mantzaris)
| | - Pantelis S Karatzas
- Department of Gastroenterology (Michail Galanopoulos, Lazaros Varytimiadis, Athanasios Tsigaridas, Pantelis S. Karatzas, Emmanuel Archavlis, Nikos Viazis, Gerassimos J. Mantzaris)
| | - Emmanuel Archavlis
- Department of Gastroenterology (Michail Galanopoulos, Lazaros Varytimiadis, Athanasios Tsigaridas, Pantelis S. Karatzas, Emmanuel Archavlis, Nikos Viazis, Gerassimos J. Mantzaris)
| | - Nikos Viazis
- Department of Gastroenterology (Michail Galanopoulos, Lazaros Varytimiadis, Athanasios Tsigaridas, Pantelis S. Karatzas, Emmanuel Archavlis, Nikos Viazis, Gerassimos J. Mantzaris)
| | - Christina Vourlakou
- Department of Pathology (Christina Vourlakou), Evaggelismos-Ophthalmiatreion Athinon-Polycliniki, Athens, Greece
| | - Gerassimos J Mantzaris
- Department of Gastroenterology (Michail Galanopoulos, Lazaros Varytimiadis, Athanasios Tsigaridas, Pantelis S. Karatzas, Emmanuel Archavlis, Nikos Viazis, Gerassimos J. Mantzaris)
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Papanikolaou IS, Karatzas PS, Varytimiadis LT, Tsigaridas A, Galanopoulos M, Viazis N, Karamanolis DG. Effective colonoscopy training techniques: strategies to improve patient outcomes. Adv Med Educ Pract 2016; 7:201-210. [PMID: 27099542 PMCID: PMC4822804 DOI: 10.2147/amep.s99617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Colonoscopy has substantially evolved during the last 20 years and many different training techniques have been developed in order to improve the performance of endoscopists. The most known are mechanical simulators, virtual reality simulators, computer-simulating endoscopy, magnetic endoscopic imaging, and composite and explanted animal organ simulators. Current literature generally indicates that the use of simulators improves performance of endoscopists and enhances safety of patients, especially during the initial phase of training. Moreover, newer endoscopes and imaging techniques such as high-definition colonoscopes, chromocolonoscopy with dyes spraying, and third-eye retroscope have been incorporated in everyday practice, offering better visualization of the colon and detection of polyps. Despite the abundance of these different technological features, training devices are not widely used and no official guideline or specified training algorithm or technique for lower gastrointestinal endoscopy has been evolved. In this review, we present the most important training methods currently available and evaluate these using existing literature. We also try to propose a training algorithm for novice endoscopists.
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Affiliation(s)
- Ioannis S Papanikolaou
- Hepato-gastroenterology Unit, 2nd Department of Internal Medicine, Attikon University General Hospital, University of Athens, Athens, Greece
| | | | | | | | | | - Nikos Viazis
- Gastroenterology Department, Evangelismos Hospital, Athens, Greece
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Karatzas PS, Mantzaris GJ, Safioleas M, Gazouli M. DNA methylation profile of genes involved in inflammation and autoimmunity in inflammatory bowel disease. Medicine (Baltimore) 2014; 93:e309. [PMID: 25526479 PMCID: PMC4603097 DOI: 10.1097/md.0000000000000309] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 10/14/2014] [Accepted: 10/30/2014] [Indexed: 12/17/2022] Open
Abstract
The contribution of epigenetic alterations to disease pathogenesis is emerging as a research priority. In this study, we aimed to seek DNA methylation changes in peripheral blood and tissue biopsies from patients with inflammatory bowel disease. The promoter methylation status of genes involved in inflammation and autoimmunity was profiled using the Human Inflammatory Response and Autoimmunity EpiTect Methyl II Signature PCR Array profiles. Methylation was considered to be hypermethylated if >20% according to the instructions of the manufacturer. The microarrays were validated with Quantitative Real-time PCR. Regarding Crohn disease (CD) no gene appeared hypermethylated compared to healthy controls. In ulcerative colitis (UC) 5 genes (CXCL14, CXCL5, GATA3, IL17C, and IL4R) were hypermethylated compared to healthy controls. Some of the examined genes show different methylation patterns between CD and UC. Concerning tissue samples we found that all hypermethylated genes appear the same methylation pattern and confirmed a moderate-strong correlation between methylation levels in colon biopsies and peripheral blood (Pearson coefficients r=0.089-0.779, and r=0.023-0.353, respectively). The epigenetic changes observed in this study indicate that CD and UC exhibit specific DNA methylation signatures with potential clinical applications in IBD non-invasive diagnosis and prognosis.
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Affiliation(s)
- Pantelis S Karatzas
- From the 1 Department of Gastroenterology, Evaggelismos Hospital, Athens, Greece (PSK, GJM); 4 Department of Surgery, Attikon University Hospital, University of Athens, Athens, Greece (MS); and Department of Basic Medical Sciences, Laboratory of Biology, University of Athens, Athens, Greece (MG)
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Karatzas PS, Gazouli M, Safioleas M, Mantzaris GJ. DNA methylation changes in inflammatory bowel disease. Ann Gastroenterol 2014; 27:125-132. [PMID: 24733658 PMCID: PMC3982627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 11/25/2013] [Indexed: 10/27/2022] Open
Abstract
The cause of inflammatory bowel disease, encompassing Crohn's disease and ulcerative colitis, remains a mystery but evidence is accumulating that complex interactions between the genetic background and the gut microbiota of the host and environmental factors associated with rapid industrialization and westernized life styles may underlie its pathogenesis. Recent epigenetic studies have suggested that interactions between environment and host DNA may play a leading role in the phenotypical expression of both diseases, explaining amongst others the differences in disease expression in monozygotic twins. DNA methylation is the most studied epigenetic modification and during the last decade its correlation to IBD pathogenesis has been well established. Genes from different molecular pathways have been studied but till now there is no standardized database of methylated genes in IBD. Thus, a thorough and in depth study of DNA methylation, its potential relation to IBD and its interaction with the available pharmaceutical armamentarium is of great interest.
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Affiliation(s)
- Pantelis S. Karatzas
- 1st Department of Gastroenterology, Evangelismos General Hospital (Pantelis S. Karatzas, Gerasimos J. Mantzaris)
| | - Maria Gazouli
- Department of Basic Medical Science, Laboratory of Biology, School of Medicine, University of Athens (Maria Gazouli),
Correspondence to: Maria Gazouli, Assist. Professor, Laboratory of Biology, School of Medicine, University of Athens, Michalakopoulou 176, 11527, Athens, Greece, Tel. - Fax: +30 210 7462231, e-mail:
| | - Michael Safioleas
- 4th Department of General Surgery, Attikon University Hospital, University of Athens (Michael Safioleas), Athens, Greece
| | - Gerasimos J. Mantzaris
- 1st Department of Gastroenterology, Evangelismos General Hospital (Pantelis S. Karatzas, Gerasimos J. Mantzaris)
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Papanikolaou IS, Karatzas PS, Triantafyllou K, Adler A. Role of pancreatic endoscopic ultrasonography in 2010. World J Gastrointest Endosc 2010; 2:335-43. [PMID: 21160583 PMCID: PMC2999104 DOI: 10.4253/wjge.v2.i10.335] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 01/20/2010] [Revised: 09/04/2010] [Accepted: 09/11/2010] [Indexed: 02/05/2023] Open
Abstract
Endoscopic ultrasonography (EUS) was introduced 25 years ago aiming at better visualization of the pancreas compared to transabdominal ultrasonography. This update discusses the current evidence in 2010 concerning the role of EUS in the clinical management of patients with pancreatic disease. Major indications of EUS are: (1) Detection of common bile duct stones (e.g. in acute pancreatitis); (2) Detection of small exo- and endocrine pancreatic tumours; and (3) Performance of fine needle aspiration in pancreatic masses depending on therapeutic consequences. EUS seems to be less useful in cases of chronic pancreatitis and cystic pancreatic lesions. Moreover the constant improvement of computed tomography has limited the role of EUS in pancreatic cancer staging. On the other hand, new therapeutic options are available due to EUS, such as pancreatic cyst drainage and celiac plexus neurolysis, offering a new field in which new techniques may arise. So the main goal of this review is to determine the exact role of EUS in a number of pancreatic and biliary diseases.
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Affiliation(s)
- Ioannis S Papanikolaou
- Ioannis S Papanikolaou, Pantelis S Karatzas, Konstantinos Triantafyllou, Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, Attikon University General Hospital, Medical School, University of Athens, Athens 12462, Greece
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