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Simkova D, Mares J, Vackova Z, Hucl T, Stirand P, Kieslichova E, Ryska O, Spicak J, Drazilova S, Veseliny E, Martinek J. Periprocedural safety profile of peroral endoscopic myotomy (POEM)-a retrospective analysis of adverse events according to two different classifications. Surg Endosc 2023; 37:1242-1251. [PMID: 36171448 DOI: 10.1007/s00464-022-09621-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 09/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Peroral endoscopic myotomy (POEM) is nowadays a standard method for treatment of achalasia; nevertheless, it remains an invasive intervention with corresponding risk of adverse events (AEs). The classification and grading of AEs are still a matter of discussion. The aim of our retrospective study was to assess the occurrence of all "undesirable" events and "true" adverse events in patients undergoing POEM and to compare the outcomes when either Clavien-Dindo classification (CDC) or American Society of Gastrointestinal Endoscopy (ASGE) lexicon classification applied. METHODS This was a retrospective analysis of prospectively managed database of all patients who had undergone POEM between December 2012 and August 2018. We assessed the pre-, peri-, and early-postoperative (up to patient's discharge) undesirable events (including those not fulfilling criteria for AEs) and "true" AEs according the definition in either of the classifications. RESULTS A total of 231 patients have successfully undergone 244 POEM procedures (13 × re-POEM). Twenty-nine procedures (11.9%) passed uneventfully, while in 215 procedures (88.1%), a total of 440 undesirable events occurred. The CDC identified 27 AEs (17 minor, 10 major) occurring in 23/244 (9.4%) procedures. The ASGE lexicon identified identical 27 AEs (21 mild or moderate, 6 severe or fatal) resulting in the severity distribution of AEs being the only difference between the two classifications. Only the absence of previous treatment was found to be a risk factor [p = 0.047, OR with 95% CI: 4.55 (1.02; 20.25)] in the combined logistic regression model. CONCLUSION Undesirable events are common in patients undergoing POEM but the incidence of true AEs is low according to both classifications. Severe adverse events are infrequent irrespective of the classification applied. CDC may be more appropriate than ASGE lexicon for classifying POEM-related AEs given a surgical nature of this procedure.
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Affiliation(s)
- Dagmar Simkova
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine IKEM, Videnska 1921, 140 21, Prague 4, Czech Republic
| | - Jan Mares
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine IKEM, Videnska 1921, 140 21, Prague 4, Czech Republic
| | - Zuzana Vackova
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine IKEM, Videnska 1921, 140 21, Prague 4, Czech Republic
| | - Tomas Hucl
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine IKEM, Videnska 1921, 140 21, Prague 4, Czech Republic
| | - Petr Stirand
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine IKEM, Videnska 1921, 140 21, Prague 4, Czech Republic
| | - Eva Kieslichova
- Department of Anesthesiology and Intensive Care, Institute for Clinical and Experimental Medicine IKEM, Videnska 1921, 140 21, Prague, Czech Republic
| | - Ondrej Ryska
- Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
| | - Julius Spicak
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine IKEM, Videnska 1921, 140 21, Prague 4, Czech Republic
| | - Sylvia Drazilova
- 2Nd Department of Internal Medicine, PJ Safarik University and L. Pasteur University Hospital, Trieda SNP 1, 040 11, Kosice, Slovakia
| | - Eduard Veseliny
- 2Nd Department of Internal Medicine, PJ Safarik University and L. Pasteur University Hospital, Trieda SNP 1, 040 11, Kosice, Slovakia
| | - Jan Martinek
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine IKEM, Videnska 1921, 140 21, Prague 4, Czech Republic. .,Institute of Physiology, 1St Faculty of Medicine, Charles University, Prague, Czech Republic. .,Faculty of Medicine, Ostrava University, Ostrava, Czech Republic.
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Hujova A, Stirand P, Turza P, Spicak J, Hucl T. Endoscopic management of gastrojejunocolic fistula as an unusual complication of endoscopic ultrasound-guided gastroenterostomy. Endoscopy 2022; 55:E151-E152. [PMID: 36307072 PMCID: PMC9829763 DOI: 10.1055/a-1937-9558] [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: 01/26/2023]
Affiliation(s)
- Alzbeta Hujova
- Department of Gastroenterology and Hepatology, Institute of Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Petr Stirand
- Department of Gastroenterology and Hepatology, Institute of Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Patrik Turza
- Radiodiagnostic and Interventional Radiology Department, Institute of Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Julius Spicak
- Department of Gastroenterology and Hepatology, Institute of Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Tomas Hucl
- Department of Gastroenterology and Hepatology, Institute of Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
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Vackova Z, Mares J, Krajciova J, Rabekova Z, Zdrhova L, Loudova P, Spicak J, Stirand P, Hucl T, Martinek J. Peristaltic Recovery After Peroral Endoscopic Myotomy for Achalasia: Dream or Reality?: Author's Reply. J Neurogastroenterol Motil 2022; 28:162-163. [PMID: 34980700 PMCID: PMC8748853 DOI: 10.5056/jnm21157] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Zuzana Vackova
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jan Mares
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jana Krajciova
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Zuzana Rabekova
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Lucie Zdrhova
- Department of Internal Medicine, University Hospital Plzen, Pilsen, Czech Republic
| | - Pavla Loudova
- Department of Gastroenterology, Hospital Kolin, Kolin, Czech Republic
| | - Julius Spicak
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Stirand
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Tomas Hucl
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jan Martinek
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Vackova Z, Mares J, Krajciova J, Rabekova Z, Zdrhova L, Loudova P, Spicak J, Stirand P, Hucl T, Martinek J. Esophageal Motility Patterns After Peroral Endoscopic Myotomy in Patients With Achalasia. J Neurogastroenterol Motil 2021; 27:205-214. [PMID: 33462158 PMCID: PMC8026367 DOI: 10.5056/jnm20126] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 06/03/2020] [Revised: 08/28/2020] [Accepted: 09/20/2020] [Indexed: 01/16/2023] Open
Abstract
Background/Aims Several studies have reported partial recovery of peristalsis in patients with achalasia after myotomy. The aim of our study is to analyze esophageal motility patterns after peroral endoscopic myotomy (POEM) and to assess the potential predictors and clinical impact of peristaltic recovery. Methods We performed a retrospective analysis of prospectively collected data of consecutive patients with achalasia undergoing POEM at a tertiary center. High-resolution manometry (HRM) studies prior to and after POEM were reviewed and the Chicago classification was applied. Results A total of 237 patients were analyzed. The initial HRM diagnoses were achalasia type I, 42 (17.7%); type II, 173 (73.0%); and type III, 22 (9.3%). Before POEM, peristaltic fragments were present in 23 (9.7%) patients. After POEM the Chicago classification diagnoses were 112 absent contractility, 42 type I achalasia, 15 type II, 11 type III, 26 ineffective esophageal motility, 18 esophagogastric junction outflow obstruction, 10 fragmented peristalsis, and 3 distal esophageal spasm. Altogether 68 patients (28.7%) had signs of contractile activity, but the contractions newly appeared in 47 patients (47/214, 22.0%). Type II achalasia showed a trend for appearance of contractions (P = 0.097). Logistic regression analysis did not identify any predictors of peristaltic recovery. The post-POEM Eckardt score did not differ between patients with and without contractions nor did the parameters of timed barium esophagogram. Conclusions More than 20% of achalasia patients have signs of partial recovery of esophageal peristalsis after POEM. It occurs predominantly in type II achalasia but the clinical relevance seems to be negligible.
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Affiliation(s)
- Zuzana Vackova
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.,Institute of Physiology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Mares
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jana Krajciova
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.,Institute of Physiology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Zuzana Rabekova
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.,Institute of Physiology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lucie Zdrhova
- Department of Internal Medicine, University Hospital Plzen, Czech Republic
| | - Pavla Loudova
- Department of Gastroenterology, Hospital Kolin, Czech Republic; and 5Ostrava University, Faculty of Medicine, Ostrava, Czech Republic
| | - Julius Spicak
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Stirand
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Tomas Hucl
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jan Martinek
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.,Institute of Physiology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
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Martinek J, Svecova H, Vackova Z, Dolezel R, Ngo O, Krajciova J, Kieslichova E, Janousek R, Pazdro A, Harustiak T, Zdrhova L, Loudova P, Stirand P, Spicak J. Per-oral endoscopic myotomy (POEM): mid-term efficacy and safety. Surg Endosc 2017; 32:1293-1302. [PMID: 28799005 DOI: 10.1007/s00464-017-5807-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 07/31/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Per-oral endoscopic myotomy (POEM) is becoming a standard treatment for achalasia. Long-term efficacy and the rate of post-POEM reflux should be further investigated. The main aim of this study was to analyze safety and mid-term (12 and 24 months) clinical outcomes of POEM. METHODS Data on single tertiary center procedures were collected prospectively. The primary outcome was treatment success defined as an Eckardt score < 3 at 12 and 24 months. A total of 155 consecutive patients with achalasia underwent POEM; 133 patients were included into the analysis (22 patients will be analyzed separately as part of a multicenter randomized clinical trial). RESULTS POEM was successfully completed in 132 (99.2%) patients, and the mean length of the procedure was 69.8 min (range 31-136). One patient underwent a drainage for pleural effusion; no other serious adverse events occurred. Treatment success at 3, 12, and 24 months was observed in 95.5% (CI 89.6-98.1), 93.4% (86.5-96.8), and 84.0% (71.4-91.4) of patients, respectively. A total of 11 patients (8.3%) reported initial treatment failure (n = 5) or later recurrence (n = 6). The majority of relapses occurred in patients with achalasia type I (16.7 vs. 1.1% achalasia type II vs. 0% achalasia type III; p<0.05). At 12 months, post-POEM reflux symptoms were present in 29.7% of patients. At 3 months, mild reflux esophagitis was diagnosed in 37.6% of patients, and pathological gastroesophageal reflux was detected in 41.5% of patients. A total of 37.8% of patients had been treated with a proton pump inhibitor. CONCLUSION POEM resulted in greater than 90% treatment success at 12 months which tends to decrease to 84% after 2 years. More than one-third of the patients had mild reflux symptoms and/or mild esophagitis.
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Affiliation(s)
- Jan Martinek
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, IKEM, Videnska 1921, 140 21, Prague 4, Czech Republic.
- Institute of Physiology, Charles University, Prague, Czech Republic.
- Faculty of Medicine, Ostrava University, Ostrava, Czech Republic.
| | - Hana Svecova
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, IKEM, Videnska 1921, 140 21, Prague 4, Czech Republic
| | - Zuzana Vackova
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, IKEM, Videnska 1921, 140 21, Prague 4, Czech Republic
| | - Radek Dolezel
- Department of Surgery, Charles University, Military University Hospital, Prague, Czech Republic
| | - Ondrej Ngo
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jana Krajciova
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, IKEM, Videnska 1921, 140 21, Prague 4, Czech Republic
| | - Eva Kieslichova
- Department of Anesthesiology and Intensive Care, IKEM, Prague, Czech Republic
| | | | - Alexander Pazdro
- 3rd Department of Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Tomas Harustiak
- 3rd Department of Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Lucie Zdrhova
- Department of Internal Medicine, University Hospital Plzen, Charles University, Pilsen, Czech Republic
| | - Pavla Loudova
- Department of Gastroenterology, Hospital Kolin, Kolin, Czech Republic
| | - Petr Stirand
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, IKEM, Videnska 1921, 140 21, Prague 4, Czech Republic
| | - Julius Spicak
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, IKEM, Videnska 1921, 140 21, Prague 4, Czech Republic
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Bayer J, Vackova Z, Svecova H, Stirand P, Spicak J, Martinek J. Gentamicin submucosal lavage during peroral endoscopic myotomy (POEM): a retrospective analysis. Surg Endosc 2017; 32:300-306. [DOI: 10.1007/s00464-017-5677-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
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Spičák J, Beneš M, Hucl T, Stirand P, Drastich P, Wohl P, Kamenář D, Kliment M, Kundratová E, Urban O, Pintová J, Pícha J, Suchánek S, Zelízko V, Stefanová M, Rehoř M, Nosek V, Zavoral M. [A detailed study of colon polyps]. Vnitr Lek 2012; 58:18-23. [PMID: 22448696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
UNLABELLED INTRODUCTION, STUDY AIM: Colorectal carcinoma is one of the most frequent malignancies. Most frequently, neoplasms, including malignant precursors, are in the form of polyps, although these might be of a non-tumour origin. The aim of this prospective multicentre study was to provide an overview of coloscopic identification and biological nature of polyps. RESULTS 3,400 consecutive coloscopies performed between 2009 and 2010 were analyzed. At different centres, the top of the cecum was reached in 89% to 93% and terminal ileum in 73% to 87% of cases. In the above 40 age group, 26.6% were screening coloscopies. The mean age of the above 40 patients was 56 years. The incidence of potential neoplastic lesions (polyps, carcinomas), advanced adenomas and carcinomas were: 7.8 %, 0.8 % and 0.16 %, respectively, in the above 40 age group, 41.5 %, 9.8 % and 1.6 %, respectively, in the 40-50 years age group and 70.5 %, 31.3 % and 6.8 %, respectively, in the above 50 age group. The incidence of tubular adenoma and hyperplastic polyps was 23.9% and 66.2%, respectively, in the below 40 age group and 53.1% and 26.1% in the above 50 age group. 57.8% of advances neoplasms were located in the rectosigmoid a descendent colon. The incidence ratio for adenomas and hyperplastic polyps was 76.6% and 14%, respectively, for rectosigmoid colon, 63.6 and 17.4 %, respectively, for descendent colon, 63.6 and 11.4 % for traverse colon and 63,4 a 17,9 %, respectively, for cecum and ascendant colon. The incidence of tubulovillous adenomas and hyperplastic polyps in pedunculated polyps larger than 1 cm was 19.4 % and 20.4 %, respectively, and 34.2 % and 13.1 %, respectively, in other polyps. The incidence of potential lesions (polyps and carcinomas), advanced adenomas, carcinomas and advanced neoplasms was 66.7 %, 23.1 %, 5.8 % and 28.9 %, respectively, in women and 63.1 %, 30.0 %, 5.7 % and 34.7 %, respectively, in men. CONCLUSION The top of the cecum was reached in a higher proportion of cases than required, although this was lower than in the majority of other recent studies. Terminal ileum was reached in high number of cases. The incidence of polyps and neoplasms rose sharply from 40 years of age. Therefore, the screening threshold should be extended to the below 50 age group. Hyperplastic polyps predominated in younger age and adenomas in the above 40 age group. Histological profile was similar and did not suggest importantly different pathogenesis with respect to localization. There were relatively fewer adenomas and more hyperplastic polyps in pedunculated polyps and vice verse in other types of polyps, suggesting a higher risk associated with non-pedunculated lesions. Both sexes differed less than suggested based on epidemiological statistics.
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Affiliation(s)
- J Spičák
- Klinika Hepatogastroenterologie IKEM Praha, Prednosta prof. MUDr. Julius Spičák, DrSc.
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Kucera M, Adamec M, Oliverius M, Janousek L, Kocík M, Spicák J, Stirand P, Drastich P, Peregrin J, Trunecka P. [Early biliary complications following liver transplantation]. Rozhl Chir 2011; 90:117-121. [PMID: 21638850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Biliary complications (BC) after liver transplantation (LTx) are serious problems with an incidence rate of 6-35%. There are two types of BC, early and late. Early BC is observed for 30 days post LTx or during the entire period of the patient's first hospital stay after LTx. The main causes of early BC are ischemia of the biliary tree (the bile duct of the transplanted liver is supplied only from the right hepatic artery descendingly; the supply from the gastroduodenal artery is lacking) as well as implementation of the biliary anastomosis surgical technique. Treatment of BC is administered by a surgeon, a gastroenterologist and a radiologist. AIM To evaluate early biliary complications after LTx PATIENTS AND METHODS We reviewed patients with early BC after LTx from 4/2004 - 12/2009. We defined early BC as a complication that is present during the first 30 days post LTx or during the entire period of the patient's first hospital stay after LTx. RESULTS We performed 384 LTx during the above-mentioned period. We carried out reconstruction of the biliary tree in the form of a choledochocholedochostomy (CDD) in 312 cases and in the form of a choledochojejunostomy (CDJ) in 72 cases. Sixty-eight patients had early BC (17.7%), 25 patients experienced biliary leak (6.5%), 40 patients had anastomotic stenosis (10.4%) and 3 patients (0.8%) experienced both complications (biliary leak and stenosis). Most complications were eliminated by ERCP with a papilosfincterotomy, a balloon dilatation of stenosis, and a biliary stent implant with repeated stent replacements (45 cases in total- all patients with biliary stenosis). Twenty-two patients were reoperated on (16x CDJ, 3x re-CDD, 2x suture of aberrant bile duct, 1x suture common bile duct) and 1 patient was treated by percutaneous transhepatic bilary drainage (PTD). The mortality rate was zero. CONCLUSION BC after LTx continue to pose a serious surgical problem. The treatment of choice when dealing with BC is ERCP, which has more than a 70% success rate. If ERCP or PTD are not successful, or when biliary peritonitis is present, we perform a reanastomosis of the bile duct. The combined effort of the surgeon, gastroenterologist and radiologist is the most important factor for successful treatment. The incidence of BC after LTx at IKEM is similar to that of treatment centers all over the world.
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Affiliation(s)
- M Kucera
- Klinika transplantacní chirurgie, IKEM, Praha.
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Gürlich R, Oliverius M, Lipár K, Varga M, Spicák J, Stirand P, Valsamis A, Novotný J, Vyhnánek F. [One-year survival outcomes in patients with pancreatic head and portomesenteric veins resection]. Rozhl Chir 2009; 88:417-421. [PMID: 20055293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Hemipancreatoduodenectomy is a standard technique for surgical management of pancreatic head carcinomas. However, so far, mesenteric and/or portal vein resections have not been commonly indicated. This original report presents one-year survival outcomes in a group of operated subjects. METHODOLOGY From 7/2005 to 7/2008, 13 pancreatic resections with concomitant resection of the mesenteric or portal vein were performed in the IKEM Transplant Surgery Clinic. The study objective was to assess the perioperative complications and 30-day mortality rates, and the overall survival period. RESULTS The study group included 13 patients, 8 males and 5 females, the mean age was 66 (48 to 85) years. Concomitantly, resection of the portal vein (6x) or the superior mesenteric vein (3x), or of the both veins (4x) was performed. In 11 subjects of this patient group, the time period between the surgical procedure and the assessment was over a year. During the portomesenteric reconstruction phase, end-to-end anastomoses were performed in eight subjects, and the resected vein was replaced with the internal jugular vein in two subjects. In three subjects, the venous wall excision site was closed using a simple defect suture. Out of the study group, 5 subjects were surviving at 12 months. Three patients exited due to their primary diagnosis and the fourth one for internal complications two months after the procedure. CONCLUSION The authors belive that hemipancreatoduodenectomy with concomitant resection of portomesenteric veins should become a standard treatment method in indicated patients, performed in specialized centres.
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Affiliation(s)
- R Gürlich
- Chirurgická klinika 3. LF UK a FNKV, Praha.
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Martínek J, Benes M, Hucl T, Drastich P, Stirand P, Spicák J. Non-erosive and erosive gastroesophageal reflux diseases: No difference with regard to reflux pattern and motility abnormalities. Scand J Gastroenterol 2008; 43:794-800. [PMID: 18584517 DOI: 10.1080/00365520801908928] [Citation(s) in RCA: 20] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To investigate whether gastroesophageal reflux disease (GERD) with mild to moderate erosive esophagitis (ERD) is a more severe disease regarding the amount of acid reflux, motor abnormalities, and the presence/absence of hiatus hernia than non-erosive reflux disease (NERD). MATERIAL AND METHODS The study comprised a retrospective analysis of prospectively collected data on 313 consecutive subjects referred for endoscopy, pH-metry, and esophageal manometry. The patients were divided into four groups: Group I (n=92), subjects without GERD with normal pH-metry, without esophagitis and without reflux symptoms; Group II (n=111), patients with NERD (no esophagitis, abnormal pH-metry); Group III (n=77), patients with mild to moderate ERD (LA A, B; abnormal pH-metry); Group IV (n=33), patients with severe or complicated esophagitis (LA C, D; Barrett's esophagus). All data are expressed as medians with 5th-95th percentiles. RESULTS No difference was found in the amount of acid reflux between patients with mild to moderate ERD and those with NERD. The DeMeester score was 34.5 (17-105) in NERD patients and 31.6 (15-102) in ERD patients. No significant differences were found between NERD and ERD patients regarding lower esophageal sphincter (LES) basal pressure (11.6 mmHg; 3-25 in NERD versus 10.7 mmHg; 3-22 in ERD). Similar proportions of patients with NERD and ERD had low LES basal pressure (20.7% in NERD versus 24.7% in ERD; NS) and hiatus hernia (44% and 56%; NS). A relatively high proportion of patients without GERD (Group I) had ineffective esophageal motility (39%) and hiatus hernia (30%). CONCLUSIONS No difference was found between NERD and mild to moderate ERD in terms of acid exposure time and esophageal motor abnormalities. To a certain extent, ERD is a "more complicated" form of the disease. Host factors related to a particular patient (e.g. mucosal defense, genetics, acid clearance) might be responsible for the development of esophagitis.
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Affiliation(s)
- Jan Martínek
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.
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Spicák J, Ryska M, Trunecka P, Skála I, Stirand P, Bĕlina F, Sperl J, Hrncárková H, Taimr P, Vítko S, Filip K. The role of ERCP in management of biliary complications after liver transplantation. Ann Transplant 2002; 6:29-32. [PMID: 11803615] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Biliary complications remain to pose a serious problem in patients after liver transplantation. In the past, they occurred in as many as 50% of patients, and were associated with a height mortality. This has changed and at present the incidence of this complications is lower. The authors present their own series and discuss the role of ERCP in the management of complications.
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Affiliation(s)
- J Spicák
- Institute for Clinical and Experimental Medicine, Praha, Czech Republic
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