1
|
Dirven I, Leclercq P, D'Hondt L, Delmotte V, Lefesvre P, Reynaert H, Vandenbroucke F, Surmont M. Primary splenic angiosarcoma: a case series of a rare oncological entity and diagnostic challenge. Acta Oncol 2024; 63:192-197. [PMID: 38619338 DOI: 10.2340/1651-226x.2023.35412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/08/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND AND PURPOSE Primary angiosarcoma of the spleen (PAS), an exceptionally rare and aggressive neoplasm with high metastatic risk (70%-85%), is frequently diagnosed in an advanced or metastatic stage. It presents diagnostic challenges due to its nonspecific symptomatology and resemblance to benign vascular lesions in various imaging modalities. PATIENTS AND METHODS This case series aims to clarify the diagnostic difficulties by comparing imaging characteristics (CT-scan, MRI, and [18F]FDG-PET/CT) as well as pathological findings of three PAS cases diagnosed in different stages of the diseases (localized, metastatic, and metastatic with organ failure). Furthermore, a brief review on diagnostic and therapeutic features is included. RESULTS AND INTERPRETATION We suggest [18F]FDG-PET/CT as a differentiating tool between benign and malignant splenic lesions and propose a flowchart of a diagnostic algorithm for PAS. For treatment, we advocate for early splenectomy and when systemic therapy is warranted, paclitaxel emerges as a viable first-line option. While it is crucial to acknowledge that further trial data is required to evaluate the efficacy of emerging treatment regimens, designing and conducting trials for PAS is challenging given its scarcity and aggressive behavior. Therefore case reporting remains important.
Collapse
Affiliation(s)
- Iris Dirven
- Department of Gastro-enterology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
| | | | - Lionel D'Hondt
- Department of Oncology, CHU UCL Namur site Godinne, Yvoir, Belgium
| | | | - Pierre Lefesvre
- Department of Pathology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Hendrik Reynaert
- Department of Gastro-enterology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Frederik Vandenbroucke
- Department of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Magali Surmont
- Department of Gastro-enterology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| |
Collapse
|
2
|
Albouys J, Manzah I, Schaefer M, Legros R, Masrour O, Henno S, Leclercq P, Dahan M, Guyot A, Charissoux A, Grainville T, Loustaud-Ratti V, Lepetit H, Geyl S, Carrier P, Pioche M, Wallenhorst T, Jacques J. Prevalence and clinical significance of the muscle retracting sign during endoscopic submucosal dissection of large macronodular colorectal lesions (with videos). Gastrointest Endosc 2024; 99:398-407. [PMID: 37866709 DOI: 10.1016/j.gie.2023.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 10/05/2023] [Accepted: 10/17/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND AND AIMS The muscle retracting sign (MRS) can be present during endoscopic submucosal dissection (ESD) of macronodular colorectal lesions. The prevalence of MRS and its pathologic and clinical implications is unclear. This study evaluated the effect of MRS on the technical and clinical outcomes of ESD. METHODS All patients referred for ESD of protruding lesions or granular mixed lesions with >10 mm macronodule granular mixed laterally spreading tumors (LST-GMs) in 2 academic centers from January 2017 to October 2022 were prospectively included. Size of the macronodule was analyzed retrospectively. The primary outcome was the curative resection rate according to MRS status. Secondary outcomes were R0 resection, perforation, secondary surgery rate, and risk factors for MRS. RESULTS Of 694 lesions, 84 (12%) had MRS (MRS+). The curative resection rate was decreased by MRS (MRS+ 41.6% vs lesions without MRS [MRS-] 81.3%), whereas the perforation (MRS+ 22.6% vs MRS- 9.2%), submucosal cancer (MRS+ 34.9% vs MRS- 9.2%), and surgery (MRS+ 45.2% vs MRS- 6%) rates were increased. The R0 resection rate of MRS+ colonic lesions was lower than that of rectal lesions (53% vs 74.3%). In multivariate analysis, protruding lesions (odds ratio, 2.47; 95% confidence interval, 1.27-4.80) and macronodules >4 cm (odds ratio, 4.24; 95% confidence interval, 2.23-8.05) were risk factors for MRS. CONCLUSIONS MRS reduces oncologic outcomes and increases the perforation rate. Consequently, procedures in the colon should be stopped if MRS is detected, and those in the rectum should be continued due to the morbidity of alternative therapy.
Collapse
Affiliation(s)
- Jérémie Albouys
- Service d'Hepato Gastro Entérologie et endoscopie digestive, CHU Dupuytren, Limoges, France.
| | - Imane Manzah
- Service d'Hepato Gastro Entérologie et endoscopie digestive, CHU Dupuytren, Limoges, France
| | - Marion Schaefer
- Service d'Hepato Gastro Entérologie et endoscopie digestive, CHU de Nancy, Nancy, France
| | - Romain Legros
- Service d'Hepato Gastro Entérologie et endoscopie digestive, CHU Dupuytren, Limoges, France
| | - Oumnia Masrour
- Service de gastroenterologie et endoscopie digestive, Centre hospitalier Universitaire Pontchaillou, Rennes, France
| | - Sebastien Henno
- Service d'anatomopathologie, Centre hospitalier Universitaire Pontchaillou, Rennes, France
| | - Philippe Leclercq
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven and Clinique Montlegia, Liege, Belgium
| | - Martin Dahan
- Service de gastroenterologie et endoscopie digestive, Clinique mutualiste de Pessac, Pessac, France
| | - Anne Guyot
- Service d'anatomopathologie, Dupuytren University CHU Dupuytren, Limoges, France
| | - Aurélie Charissoux
- Service d'anatomopathologie, Dupuytren University CHU Dupuytren, Limoges, France
| | - Thomas Grainville
- Service de gastroenterologie et endoscopie digestive, Centre hospitalier Universitaire Pontchaillou, Rennes, France
| | | | - Hugo Lepetit
- Service d'Hepato Gastro Entérologie et endoscopie digestive, CHU Dupuytren, Limoges, France
| | - Sophie Geyl
- Service d'Hepato Gastro Entérologie et endoscopie digestive, CHU Dupuytren, Limoges, France
| | - Paul Carrier
- Service d'Hepato Gastro Entérologie et endoscopie digestive, CHU Dupuytren, Limoges, France
| | - Mathieu Pioche
- Service de gastroenterologie et endoscopie digestive, Hôpital universitaire Edouard Herriot, Lyon, France
| | - Timothee Wallenhorst
- Service de gastroenterologie et endoscopie digestive, Centre hospitalier Universitaire Pontchaillou, Rennes, France
| | - Jeremie Jacques
- Service d'Hepato Gastro Entérologie et endoscopie digestive, CHU Dupuytren, Limoges, France
| |
Collapse
|
3
|
Dehanne F, Pirson M, Leclercq P, Libert B, Gourdin M. Evaluation of patient reported outcome measures and costs of managing osteoarthritis of the hip. Acta Orthop Belg 2024; 90:27-34. [PMID: 38669645 DOI: 10.52628/90.1.12054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
The number of hospital admissions for a hip prosthesis increased by more than 91% between 2002 and 2019 in Belgium (1), making it one of the most common interventions in hospitals. The objective of this study is to evaluate patient-report- ed outcomes and hospital costs of hip replacement six months after surgery. Both generic (EQ-5D) and specific (HOOS) PROMs of general hospital patients undergoing hip replacement surgery in 2021 were conducted. The results of these PROMs were then combined with financial and health management data. The mean difference (SD) in QALYs between the preoperative and postoperative phases is 0.20 QALYs (0.32 QALYs). The average cost (SD) of all stays is €4,792 (€1,640). Amongst the five dimensions evaluated in the EQ-5D health questionnaire, the 'pain' dimension seems to be associated with the greatest improvement in quality of life. As regards Belgium, the 26,066 arthroplasties performed in 2020 might constitute a gain of 123,000 years of life in good health. The relationship between QALYs and costs described in this study posits a ratio of €23,960 per year of life gained in good health. Given that in Belgium more than 3% of the hospital healthcare budget is devoted to hip prostheses, it would seem relevant to us to apply PROM tools to the entire patient population to assess treatment effectiveness more broadly, identify patient needs and, also, monitor the quality of care provided.
Collapse
|
4
|
Leclercq P, Bisschops R, Bergman JJGHM, Pouw RE. Management of high risk T1 esophageal adenocarcinoma following endoscopic resection. Best Pract Res Clin Gastroenterol 2024; 68:101882. [PMID: 38522880 DOI: 10.1016/j.bpg.2024.101882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/17/2024] [Indexed: 03/26/2024]
Abstract
High-risk T1 esophageal adenocarcinoma (HR-T1 EAC) is defined as T1 cancer, with one or more of the following histological criteria: submucosal invasion, poorly or undifferentiated cancer, and/or presence of lympho-vascular invasion. Esophagectomy has long been the only available treatment for these HR-T1 EACs and was considered necessary because of a presumed high risk of lymph node metastases up to 46%. However, endoscopic submucosal disscection have made it possible to radically remove HR-T1 EAC, irrespective of size, while leaving the esophageal anatomy intact. Parallel to this development, new publications demonstrated that the risk of lymph node metastases for HR-T1 EAC may be even <24%. Therefore, indications for endoscopic treatment of HR-T1 EAC are being reconsidered and current research aims at finding the optimal management strategy for this indication, where watchful waiting may proof to be an acceptable strategy in selected patients. In this review, we will discuss the latest developments in this field.
Collapse
Affiliation(s)
- Philippe Leclercq
- Departement of Gastroenterology, Universitair Ziekenhuis Leuven, 49 Herestraat, 3000, LEUVEN, Belgium.
| | - Raf Bisschops
- Departement of Gastroenterology, Universitair Ziekenhuis Leuven, 49 Herestraat, 3000, LEUVEN, Belgium.
| | - Jacques J G H M Bergman
- Dept. of Gastroenterology and Hepatology, Amsterdam University Medical Centers, De Boelelaan 1117, Amsterdam, 1081, HV, Netherlands.
| | - Roos E Pouw
- Dept. of Gastroenterology and Hepatology, Amsterdam University Medical Centers, De Boelelaan 1117, Amsterdam, 1081, HV, Netherlands.
| |
Collapse
|
5
|
van Munster SN, Leclercq P, Haidry R, Messmann H, Probst A, Ragunath K, Bhandari P, Repici A, Munoz-Navas M, Seewald S, Lemmers A, Fernández-Esparrach G, Pech O, Schoon EJ, Kariv R, Neuhaus H, Weusten BLAM, Siersema PD, Correale L, Meijer SL, de Hertogh G, Bergman JJGHM, Hassan C, Bisschops R. Wide-area transepithelial sampling with computer-assisted analysis to detect high grade dysplasia and cancer in Barrett's esophagus: a multicenter randomized study. Endoscopy 2023; 55:303-310. [PMID: 36150646 DOI: 10.1055/a-1949-9542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Current surveillance for Barrett's esophagus (BE), consisting of four-quadrant random forceps biopsies (FBs), has an inherent risk of sampling error. Wide-area transepithelial sampling (WATS) may increase detection of high grade dysplasia (HGD) and esophageal adenocarcinoma (EAC). In this multicenter randomized trial, we aimed to evaluate WATS as a substitute for FB. METHODS Patients with known BE and a recent history of dysplasia, without visible lesions, at 17 hospitals were randomized to receive either WATS followed by FB or vice versa. All WATS samples were examined, with computer assistance, by at least two experienced pathologists at the CDx Diagnostics laboratory. Similarly, all FBs were examined by two expert pathologists. The primary end point was concordance/discordance for detection of HGD/EAC between the two techniques. RESULTS 172 patients were included, of whom 21 had HGD/EAC detected by both modalities, 18 had HGD/EAC detected by WATS but missed by FB, and 12 were detected by FB but missed by WATS. The detection rate of HGD/EAC did not differ between WATS and FB (P = 0.36). Using WATS as an adjunct to FB significantly increased the detection of HGD/EAC vs. FB alone (absolute increase 10 % [95 %CI 6 % to 16 %]). Mean procedural times in minutes for FB alone, WATS alone, and the combination were 6.6 (95 %CI 5.9 to 7.1), 4.9 (95 %CI 4.1 to 5.4), and 11.2 (95 %CI 10.5 to 14.0), respectively. CONCLUSIONS Although the combination of WATS and FB increases dysplasia detection in a population of BE patients enriched for dysplasia, we did not find a statistically significant difference between WATS and FB for the detection of HGD/EAC as single modality.
Collapse
Affiliation(s)
- Sanne N van Munster
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Philippe Leclercq
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Rehan Haidry
- Department of Gastroenterology and Hepatology, University Hospital London, London, UK
| | - Helmut Messmann
- Department of Gastroenterology, University Clinics Augsburg, Augsburg, Germany
| | - Andreas Probst
- Department of Gastroenterology, University Clinics Augsburg, Augsburg, Germany
| | - Krish Ragunath
- Department of Gastroenterology and Hepatology, NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Pradeep Bhandari
- Department of Gastroenterology and Hepatology, Queen Alexandra Hospital Solent Centre for Digestive Diseases, Portsmouth, UK
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Miguel Munoz-Navas
- Department of Gastroenterology, University of Navarra Clinic. Pamplona, Spain
| | - Stefan Seewald
- Department of Gastroenterology and Hepatology, Hirslanden Private Clinic Group, Zurich, Switzerland
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Glòria Fernández-Esparrach
- Endoscopy Unit, Department of Gastroenterology, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Oliver Pech
- Department of Gastroenterology and Hepatology, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - Erik J Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Revital Kariv
- Department of Gastroenterology and Hepatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Horst Neuhaus
- Department of Gastroenterology and Hepatology, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
| | - Bas L A M Weusten
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Loredana Correale
- Department of Gastroenterology and Hepatology, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Sybren L Meijer
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Gert de Hertogh
- Translational Cell and Tissue Research Laboratory, KU Leuven, Leuven, Belgium
| | - Jacques J G H M Bergman
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Cesare Hassan
- Department of Gastroenterology and Hepatology, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
6
|
Libânio D, Pimentel-Nunes P, Bastiaansen B, Bisschops R, Bourke MJ, Deprez PH, Esposito G, Lemmers A, Leclercq P, Maselli R, Messmann H, Pech O, Pioche M, Vieth M, Weusten BLAM, Fuccio L, Bhandari P, Dinis-Ribeiro M. Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 2023; 55:361-389. [PMID: 36882090 DOI: 10.1055/a-2031-0874] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [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: 03/09/2023]
Abstract
ESGE suggests conventional endoscopic submucosal dissection (ESD; marking and mucosal incision followed by circumferential incision and stepwise submucosal dissection) for most esophageal and gastric lesions. ESGE suggests tunneling ESD for esophageal lesions involving more than two-thirds of the esophageal circumference. ESGE recommends the pocket-creation method for colorectal ESD, at least if traction devices are not used. The use of dedicated ESD knives with size adequate to the location/thickness of the gastrointestinal wall is recommended. It is suggested that isotonic saline or viscous solutions can be used for submucosal injection. ESGE recommends traction methods in esophageal and colorectal ESD and in selected gastric lesions. After gastric ESD, coagulation of visible vessels is recommended, and post-procedural high dose proton pump inhibitor (PPI) (or vonoprazan). ESGE recommends against routine closure of the ESD defect, except in duodenal ESD. ESGE recommends corticosteroids after resection of > 50 % of the esophageal circumference. The use of carbon dioxide when performing ESD is recommended. ESGE recommends against the performance of second-look endoscopy after ESD. ESGE recommends endoscopy/colonoscopy in the case of significant bleeding (hemodynamic instability, drop in hemoglobin > 2 g/dL, severe ongoing bleeding) to perform endoscopic hemostasis with thermal methods or clipping; hemostatic powders represent rescue therapies. ESGE recommends closure of immediate perforations with clips (through-the-scope or cap-mounted, depending on the size and shape of the perforation), as soon as possible but ideally after securing a good plane for further dissection.
Collapse
Affiliation(s)
- Diogo Libânio
- Department of Gastroenterology, Portuguese Oncology Institute - Porto, Portugal.,MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal.,Porto Comprehensive Cancer Center (Porto.CCC) & RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Pedro Pimentel-Nunes
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, FMUP, Porto, Portugal.,Gastroenterology, Unilabs, Portugal
| | - Barbara Bastiaansen
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology & Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium
| | - Michael J Bourke
- Department of Gastroenterology, Westmead Hospital, Sydney, Australia.,Western Clinical School, University of Sydney, Sydney, Australia
| | - Pierre H Deprez
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Gianluca Esposito
- Department of Surgical and Medical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Philippe Leclercq
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium
| | - Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy. Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Oliver Pech
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brueder Regensburg, Germany
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Michael Vieth
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Bas L A M Weusten
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands.,University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, Gastroenterology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Mario Dinis-Ribeiro
- Department of Gastroenterology, Portuguese Oncology Institute - Porto, Portugal.,MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal.,Porto Comprehensive Cancer Center (Porto.CCC) & RISE@CI-IPOP (Health Research Network), Porto, Portugal
| |
Collapse
|
7
|
Ching HL, Lau MS, Azmy IA, Hopper AD, Keuchel M, Gyökeres T, Kuvaev R, Macken EJ, Bhandari P, Thoufeeq M, Leclercq P, Rutter MD, Veitch AM, Bisschops R, Sanders DS. Performance measures for the SACRED team-centered approach to advanced gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2022; 54:712-722. [PMID: 35636453 DOI: 10.1055/a-1832-4232] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 12/10/2022]
Abstract
The European Society of Gastrointestinal Endoscopy and United European Gastroenterology have defined performance measures for upper and lower gastrointestinal, pancreaticobiliary, and small-bowel endoscopy. Quality indicators to guide endoscopists in the growing field of advanced endoscopy are also underway. We propose that equal attention is given to developing the entire advanced endoscopy team and not the individual endoscopist alone.We suggest that the practice of teams intending to deliver high quality advanced endoscopy is underpinned by six crucial principles concerning: selection, acceptance, complications, reconnaissance, envelopment, and documentation (SACRED).
Collapse
Affiliation(s)
- Hey-Long Ching
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Michelle S Lau
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Iman A Azmy
- Department of Breast Surgery, Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, UK
| | - Andrew D Hopper
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Martin Keuchel
- Clinic for Internal Medicine, Bethesda Krankenhaus Bergedorf, Hamburg, Germany
| | - Tibor Gyökeres
- Department of Gastroenterology, Medical Center Hungarian Defence Forces, Budapest, Hungary
| | - Roman Kuvaev
- Endoscopy Department, Yaroslavl Regional Cancer Hospital, Yaroslavl, Russian Federation.,Gastroenterology Department, Faculty of Additional Professional Education, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Elisabeth J Macken
- Division of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Mo Thoufeeq
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | | | - Matthew D Rutter
- North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK.,Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Andrew M Veitch
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, KU Leuven, Belgium
| | - David S Sanders
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| |
Collapse
|
8
|
Leclercq P, Bardiaux S, Azzi D, Pirson M. Nomenclatures d'actes médicaux et comparaisons internationales. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.01.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
9
|
Leclercq P, Jadot V, Bours V, Oliveira C, Neumann H, Bisschops R. Inherited CDH1 pathogenic variant: is there a place for surveillance of esophageal gastric inlet patch? Therap Adv Gastroenterol 2020; 13:1756284820916399. [PMID: 32523621 PMCID: PMC7236565 DOI: 10.1177/1756284820916399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
| | | | | | - Carla Oliveira
- Head of Expression Regulation in Cancer Group, Porto, Portugal
| | - Helmut Neumann
- Department of Medicine I, University Hospital, Erlangen, Germany
| | | |
Collapse
|
10
|
Leclercq P, Melin N, Van den Bulcke J, Bardiaux S, Azzi D, Pirson M. La révision de la nomenclature belge des procédures médicales pourrait-elle profiter de l’expérience de la Classification commune des actes médicaux ? Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.01.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
11
|
Dermine S, Leconte M, Leblanc S, Dousset B, Terris B, Berger A, Berger A, Rahmi G, Lepilliez V, Plomteux O, Leclercq P, Coriat R, Chaussade S, Prat F, Barret M. Outcomes of esophagectomy after noncurative endoscopic resection of early esophageal cancer. Therap Adv Gastroenterol 2019; 12:1756284819892556. [PMID: 31839807 PMCID: PMC6902379 DOI: 10.1177/1756284819892556] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 04/25/2019] [Accepted: 11/11/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Current guidelines recommend performing esophagectomy after endoscopic resection for early esophageal cancer when the risk of lymph node metastasis or residual cancer is found to be significant and endoscopic treatment is therefore noncurative. Our aim was to assess the safety and oncological outcomes of esophagogastric resection in this specific clinical setting. PATIENTS AND METHODS A retrospective review from 2012 to 2018 was performed at four tertiary referral centers. All patients had a noncurative endoscopic resection of a clinical T1 esophageal cancer, followed by esophagectomy. Outcome measures were the rates of T0N0 specimens, overall survival, disease-free and cancer-specific survival, postoperative morbidity and mortality. RESULTS A total of 30 patients (13 with squamous cell carcinoma and 17 with adenocarcinoma) were included. The reasons for noncurative endoscopic resection were: positive vertical margins (n = 12), squamous cell carcinoma with muscularis mucosae or submucosal layer invasion (n = 3 and 9), adenocarcinoma with deep submucosal invasion (n = 11), poorly differentiated tumor (n = 6) and lymphovascular invasion (n = 6). Overall, 63% of the esophagi were T0N0: most residual lesions were T1a metachronous lesions, and four (13%) patients had advanced pT status (n = 3) or lymph node metastases (n = 2). Overall survival, disease-free survival and cancer-specific survival were 83%, 75%, and 90% respectively. A total of 43% of patients had severe postoperative complications, and postoperative mortality was 7%. CONCLUSION In this cohort, esophagectomy allowed the resection of residual advanced cancer or lymph node metastases in 13% of cases, at the cost of 43% severe morbidity and 7% mortality. Therefore, the possibility of close follow up needs to be balanced with a highly morbid surgical management in these patients.
Collapse
Affiliation(s)
- Solène Dermine
- Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Paris Descartes University, Paris, France
| | - Mahaut Leconte
- Department of Digestive Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sarah Leblanc
- Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bertrand Dousset
- Paris Descartes University, Paris, France,Department of Digestive Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benoit Terris
- Paris Descartes University, Paris, France,Department of Pathology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Arthur Berger
- Gastroenterology and Gastrointestinal Endoscopy, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne Berger
- Paris Descartes University, Paris, France,Department of Digestive Surgery, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gabriel Rahmi
- Paris Descartes University, Paris, France,Gastroenterology and Gastrointestinal Endoscopy, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Olivier Plomteux
- Department of Gastroenterology, Les Cliniques Saint Joseph, Liège, Belgium
| | | | - Romain Coriat
- Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Paris Descartes University, Paris, France
| | - Stanislas Chaussade
- Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Paris Descartes University, Paris, France
| | - Frédéric Prat
- Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Paris Descartes University, Paris, France
| | | |
Collapse
|
12
|
Valdes-Socin H, Leclercq P, Polus M, Rohmer V, Beckers A, Louis E. [Chronic autoimmune gastritis : a multidisciplinary management]. Rev Med Liege 2019; 74:598-605. [PMID: 31729849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Chronic autoimmune gastritis (CAG) is a continuum of histological changes in gastric mucosa including: atrophy, intestinal metaplasia, dysplasia and finally, the occurrence of a neoplasm (gastric Neuroendocrine Tumors -NETs- and adenocarcinoma). The association with Hashimoto and Graves-Basedow disease is known as the thyrogastric autoimmune syndrome. While Helicobacter pylori (Hp) infection may be associated with CAG, the role of the gastric microbiota is ill-defined. The gastric hypochlorhydria determines a malabsorption of different micronutrients (iron, magnesium, calcium, vitamin B12) as well as drugs (thyroxine, etc.). Pernicious anemia is favoured by the deficit of parietal intrinsic factor that contributes to B12 malabsorption. Serology for Hp, serum pepsinogen I/II, increased gastrin levels, the presence of parietal cell antibodies and intrinsic factor antibodies may reveal CAG. High definition endoscopy associated with virtual chromoendoscopy seems promising for CAG diagnosis and follow-up. NETs type 1 treatment includes: endoscopic and surgical resection, somatostatin analogues and the recent availability of netazepide, a gastrin antagonist. We review herein advances in the treatment and diagnosis of CAG and associated autoimmune disorders, which may involve, in a multidisciplinary way, all practitioners.
Collapse
Affiliation(s)
| | - P Leclercq
- Service de Gastroentérologie, CHU Liège, Belgique
| | - M Polus
- Service de Gastroentérologie, CHU Liège, Belgique
| | - V Rohmer
- Service de Gastroentérologie, CHU Liège, Belgique
| | - A Beckers
- Service d'Endocrinologie, CHU Liège, Belgique
| | - E Louis
- Service de Gastroentérologie, CHU Liège, Belgique
| |
Collapse
|
13
|
Lion L, Leclercq P, Plomteux O, Bours V. [Study of cancer risks associated with Lynch syndrome in the Liège region]. Rev Med Liege 2019; 74:479-483. [PMID: 31486319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Lynch syndrome is a hereditary predisposition to several cancers. The goals of our study were to know the different mutations in our Lynch population, to evaluate the prevalence of cancers in this population and to determine the mean age of onset of those cancers. This retrospective study includes proven carriers of a MMR mutation diagnosed either by the CHU of Liège or either by the CHC Saint-Joseph in Liège, Belgium. We noted a clear majority of MSH2 mutations (50 %) in the Lynch families recorded in Liège, which is different from the main literature. In our study population (106 subjects), 65 % of subjects were affected by at least one cancer. Prevalences for colorectal and endometrial cancers are, respectively, 50 % and 27.5 %. We found no difference in the mean age of onset of cancers compared to literature. We discuss the follow-up of Lynch patients and the interest of additional exams such as hysteroscopy and cystoscopy.
Collapse
Affiliation(s)
- L Lion
- Faculté de Médecine, Liège Université, Belgique
| | - P Leclercq
- Service de Gastroentérologie, Hépatologie et Oncologie digestive, CHU Liège, Belgique
| | - O Plomteux
- Service de Gastroentérologie, CHC Saint-Joseph, Belgique
| | - V Bours
- Service de Génétique humaine, CHU Liège, Belgique
| |
Collapse
|
14
|
Gonzalez JA, Vanzieleghem T, Dumazy A, Meuris C, Mutsers J, Christiaens G, Leclercq P, Loly JP, Louis E, Gast P. On-site comparison of an enzymatic detergent and a non-enzymatic detergent-disinfectant for routine manual cleaning of flexible endoscopes. Endosc Int Open 2019; 7:E412-E420. [PMID: 30931371 PMCID: PMC6428680 DOI: 10.1055/a-0838-4995] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 04/16/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022] Open
Abstract
Background and study aims Flexible endoscopes are potential vectors of pathogen transmission to patients that are subjected to cleaning and high-level disinfection after each procedure. Efficient manual cleaning is a prerequisite for effective high-level disinfection. The goal of this study was to demonstrate the impact of the cleaning chemistry in the outcome of the manual cleaning of endoscopes. Materials and methods Twelve endoscopes were included in this study: four colonoscopes, four gastroscopes, two duodenoscopes and two bronchoscopes. This study was designed with two phases; in each of them, the manual cleaning procedure remained identical, but a different detergent was used: a non-enzymatic detergent-disinfectant (NEDD) and an enzymatic detergent (ED). Biopsy and suction channels of endoscopes were sampled using 10 mL of physiological saline at two points: before and after manual cleaning, and adenosine triphosphate (ATP) was measured on each sample. In total, 208 procedures were analyzed for the NEDD phase and 253 for the ED phase. Results For each endoscope type, cleaning endoscopes with ED resulted in larger median decrease in ATP than with NEDD: respectively 99.43 % and 95.95 % for bronchoscopes ( P = 0.0007), 99.28 % and 96.93 % for colonoscopes ( P < 0.0001) and 98.36 % and 95.36 % for gastroscopes ( P < 0.0001). In addition, acceptability rates of endoscopes based on defined post-manual cleaning ATP thresholds (200, 150, 100 or 50 relative light units) for all endoscope types were significantly higher with ED compared to NEDD. Conclusions With all other parameters of manual cleaning remaining unchanged, the enzymatic chemistry of ED provided more consistent and improved cleaning of endoscopes compared to NEDD. Therefore, choice of the detergent for endoscope cleaning has an impact on the outcome of this process.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Pierrette Gast
- Gastroenterology Department, University Hospital of Liège, Belgium
| |
Collapse
|
15
|
Deflandre LA, Loly JP, Leclercq P, Loly C, Louis É, Gast P. [Locally advanced pancreatic adenocarcinoma with biliary compression: need for early drainage]. Rev Med Suisse 2018; 14:1443-1447. [PMID: 30136459] [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: 06/08/2023]
Abstract
The incidence of pancreatic cancer is increasing, but proportion of resectable cases and survival do not increase. Then, our care strategies have to be optimized. Chemotherapy is the principal treatment of locally advanced pancreatic cancer. When the tumour triggers biliary obstruction, chemotherapy-associated morbidity increases, and biliary drainage becomes crucial. Gold-standard is endoscopic retrograde cholangiography, which could be impossible when duodenum or papilla are involved by the tumour. Other options are percutaneous radiologic drainage, surgical double by-pass or EUS-guided drainage. When EUS-guided procedures are available, they are proposed today as the best options.
Collapse
Affiliation(s)
| | | | | | - Catherine Loly
- Service de gastroentérologie, CHU Sart-Tilman, 4000 Liège, Belgique
| | - Édouard Louis
- Service de gastroentérologie, CHU Sart-Tilman, 4000 Liège, Belgique
| | - Pierrette Gast
- Service de gastroentérologie, CHU Sart-Tilman, 4000 Liège, Belgique
| |
Collapse
|
16
|
Pirson M, Dehanne F, Van den Bulcke J, Leclercq P, Martins D, De Wever A. Evaluation of cost and length of stay, linked to complications associated with major surgical procedures. Acta Clin Belg 2018. [PMID: 28629305 DOI: 10.1080/17843286.2017.1338850] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION A lot of studies have demonstrated the possibility of reducing the number of post-operative complications in the domain of major surgical procedures with the use of medical preventive techniques. However, complications following surgical procedures are unfortunately frequent and are a major problem, not only because of the impact for the patient, but also because of economic consequences that they provoke. The aim of the present study is to evaluate the extra length of stay and the extra cost, born by the hospital and the social security, linked to complications, incurring after major surgical procedures. MATERIAL AND METHODS Study based on the data from 13 Belgian hospitals for the year 2012. Complications were extracted through medical discharge summaries. The cost born by the social security was assessed on the basis of the billing data, hospital cost are taken from cost accounting studies. RESULTS The rate of complication for all the hospitals is 6.6%. About 30.3% of inpatient stays having a major or extreme severity of index had a complication during the stay, 1.8% of stays with a minor or moderate severity of index had a complication. The extra length of stay is 19.38 days when the stay has had a complication (p < 0.001). The additional mean cost borne from the hospital perspective is €21 353.07 and €8 026.65 for the social security. This additional mean cost varies greatly from one hospital to another. DISCUSSION/CONCLUSION The present study has shown that the actual financing do not cover real hospital costs in the field of major surgical procedures having caused complications. Results should encourage Belgian authorities to propose and finance preventive measures in order to reduce these complications, which represent major economic impacts, not only for authorities but also for hospitals.
Collapse
Affiliation(s)
- M. Pirson
- Centre de recherche en Economie de la Santé, Gestion des Institutions de Soins et Sciences Infirmières, Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgique
| | - F. Dehanne
- Centre de recherche en Economie de la Santé, Gestion des Institutions de Soins et Sciences Infirmières, Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgique
- CHU UCL Namur, Belgique
| | - J. Van den Bulcke
- Centre de recherche en Economie de la Santé, Gestion des Institutions de Soins et Sciences Infirmières, Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgique
| | - P. Leclercq
- Centre de recherche en Economie de la Santé, Gestion des Institutions de Soins et Sciences Infirmières, Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgique
| | - D. Martins
- Centre de recherche en Economie de la Santé, Gestion des Institutions de Soins et Sciences Infirmières, Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgique
| | - A. De Wever
- Centre de recherche en Economie de la Santé, Gestion des Institutions de Soins et Sciences Infirmières, Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgique
| |
Collapse
|
17
|
De Foor J, Leclercq P, Martins D, Van den Bulcke J, Pirson M. Quel est l’impact sur les coûts hospitaliers du manque de structures d’accueil après une hospitalisation ? Étude prospective au sein de quatre hôpitaux belges. Rev Epidemiol Sante Publique 2017. [DOI: 10.1016/j.respe.2017.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
18
|
Leclercq P, Ruyssens M, Martins D, Pirson M. Le projet belge de tarification à la pathologie pourrait-il profiter de l’expérience de la T2A française ? Rev Epidemiol Sante Publique 2017. [DOI: 10.1016/j.respe.2017.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
19
|
Marzeion B, Champollion N, Haeberli W, Langley K, Leclercq P, Paul F. Observation-Based Estimates of Global Glacier Mass Change and Its Contribution to Sea-Level Change. Surv Geophys 2017; 38:105-130. [PMID: 28203035 PMCID: PMC5283499 DOI: 10.1007/s10712-016-9394-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 10/21/2016] [Indexed: 05/11/2023]
Abstract
Glaciers have strongly contributed to sea-level rise during the past century and will continue to be an important part of the sea-level budget during the twenty-first century. Here, we review the progress in estimating global glacier mass change from in situ measurements of mass and length changes, remote sensing methods, and mass balance modeling driven by climate observations. For the period before the onset of satellite observations, different strategies to overcome the uncertainty associated with monitoring only a small sample of the world's glaciers have been developed. These methods now yield estimates generally reconcilable with each other within their respective uncertainty margins. Whereas this is also the case for the recent decades, the greatly increased number of estimates obtained from remote sensing reveals that gravimetry-based methods typically arrive at lower mass loss estimates than the other methods. We suggest that strategies for better interconnecting the different methods are needed to ensure progress and to increase the temporal and spatial detail of reliable glacier mass change estimates.
Collapse
Affiliation(s)
- B. Marzeion
- Institute of Geography, University of Bremen, Postfach 330 440, 28334 Bremen, Germany
| | - N. Champollion
- International Space Science Institute, Hallerstrasse 6, 3012 Bern, Switzerland
| | - W. Haeberli
- Department of Geography, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - K. Langley
- Asiaq Greenland Survey, Qatserisut 8, 3900 Nuuk, Greenland
| | - P. Leclercq
- Department of Geosciences, University of Oslo, P.O. Box 1047, Blindern, 0316 Oslo, Norway
| | - F. Paul
- Department of Geography, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| |
Collapse
|
20
|
Bardiaux S, Martins D, Leclercq P, Pirson M. [Cost evaluation of organ harvesting in a Belgian academic hospital]. Rev Med Brux 2017; 38:409-419. [PMID: 29178690] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The aim of this study is (1) to describe the characteristics of the organ harvesting activity conducted in 2012 at the Erasme's Hospital, Brussels University Hospital, (2) to highlight the different combinations " type of donor/types of organ's retrieved " in relation to organ harvestings carried out within the hospital, and (3) to calculate the organ harvesting's cost of acts. METHODS The study is conducted according to the hospital perspective. It assesses the consumption of medical and nursing staff resources, disposable material costs, medical device costs, drugs costs, sterile instruments and biomedical equipment costs, of the 34 organ harvesting procedures that has been conducted this year. Costs are calculated by procedure, by donor's type, by organ and by combinations. RESULTS Total cost is 99.442 €, with an average cost per donor of 3.016 €, 3.292 € for DBD postmortem donor (Donor Brain Death) and 2.456 € for DCD type (Donor Cardio-Circulatory Death). The average cost per organ leading to a transplantation is 1.842 € for DCD type and 1.297 € for DBD. CONCLUSION The results show that there is as many costs as the number of organ harvesting's combinations. Integrate the revenue generated by organ harvestings could establish whether funding sources cover the costs generated by this activity or if a reform of the nomenclature should be considered.
Collapse
Affiliation(s)
- S Bardiaux
- Centre de recherche en Economie de la Santé, Gestion des Institutions de Soins et Sciences infirmières, Ecole de Santé Publique, ULB
| | - D Martins
- Centre de recherche en Economie de la Santé, Gestion des Institutions de Soins et Sciences infirmières, Ecole de Santé Publique, ULB
| | - P Leclercq
- Centre de recherche en Economie de la Santé, Gestion des Institutions de Soins et Sciences infirmières, Ecole de Santé Publique, ULB
| | - M Pirson
- Centre de recherche en Economie de la Santé, Gestion des Institutions de Soins et Sciences infirmières, Ecole de Santé Publique, ULB
| |
Collapse
|
21
|
Gast P, Loly JP, Leclercq P, Louis É. [Esophago-gastric complications after ablation in atrial fibrillation]. Rev Med Suisse 2016; 12:1362-1366. [PMID: 28671789] [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: 06/07/2023]
Abstract
Atrial-esophageal fistula (AOF) after ablation in atrial fibrillation has a fatal outcome. Fully documented in 2004, AOF has never completely disappeared despite technological evolvements. Survival depends on early recognition and treatment. Gastroscopy allows early detection of esophageal lesions. We summarize here AOF mechanisms, evoking symptoms and treatment ; contribution of gastroscopy in early detection ; and finally symptoms from vagal and phrenic nerve injuries. This information is useful for emergency doctors, gastroenterologists / endoscopists, and general practitioners.
Collapse
Affiliation(s)
- Pierrette Gast
- Service de gastroentérologie, CHU Sart-Tilman, 4000 Liège, Belgique
| | | | | | - Édouard Louis
- Service de gastroentérologie, CHU Sart-Tilman, 4000 Liège, Belgique
| |
Collapse
|
22
|
Seivert M, Plomteux O, Colard A, Leclercq P, Gauthier D, Houbiers G, Dupont P, Demoulin JC, Fontaine F, Namur G, Witvrouw N, Bastens B. Endoscopic findings in case of incidental colonic uptake in PET-CT how to improve PET-CT specificity? Acta Gastroenterol Belg 2014; 77:413-417. [PMID: 25682631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Unexpected colonic 18FDG focal uptakes (UCFU) in PET CT occur in 1.3-3.3% of cases in retrospective study and are often associated with significant colorectal findings in endoscopy, especially neoplastic lesions. The purpose of our prospective study was to evaluate the significance of UCFU and to assess criteria improving PET CT specificity for advanced adenoma and neoplasia. This study was conducted in a single institution from April 2012 to September 2013. In the 2904 patients who benefit from PET CT, 52 had an UCFU and 43 were referred for colonoscopy. After endoscopy, 8 examinations showed no colonic abnormality (18.6%), 7 showed benign lesion (16.3%), 18 showed advanced adenoma (42.9%) and 10 showed carcinoma (23.3%). There were more false positives results in the proximal colon compared to distal colon. Eighteen patients had UCFU and tomodensitometric abnormalities in the same colonic area. This pathological combination was strongly associated to the diagnosis of malignancy. Comparing standardized uptake values (SUV), we showed statistically significant difference between the adenocarcinoma and advanced adenoma groups and a difference at the margin of statistical significance between adenocarcinoma and benign lesion groups. Any cut off value could be determined. In conclusion, we confirmed that UCFU are often associated to endoscopic findings and neoplastic lesions and justify systematic endoscopic exploration. Considering the fragility of oncologic patients, criteria improving PET CT specificity are needed to select endoscopies which should be performed quickly from those who could be delayed. We showed that associated tomodensitometric abnormality and high focal FDG activity are more predictive of a neoplastic lesion.
Collapse
|
23
|
Pirson M, Martins D, Leclercq P. Analyse médico-économique de la patientèle oncologique de 13 hôpitaux. Rev Epidemiol Sante Publique 2014. [DOI: 10.1016/j.respe.2014.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
24
|
Pirson M, Schenker L, Martins D, Dung D, Chalé JJ, Leclercq P. What can we learn from international comparisons of costs by DRG? Eur J Health Econ 2013; 14:67-73. [PMID: 22237779 DOI: 10.1007/s10198-011-0373-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 12/13/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The objective of this study was to compare costs data by diagnosis related group (DRG) between Belgium and Switzerland. Our hypotheses were that differences between countries can probably be explained by methodological differences in cost calculations, by differences in medical practices and by differences in cost structures within the two countries. METHODS Classifications of DRG used in the two countries differ (AP-DRGs version 1.7 in Switzerland and APR-DRGs version 15.0 in Belgium). The first step of this study was to transform Belgian summaries into Swiss AP-DRGs. Belgian and Swiss data were calculated with a clinical costing methodology (full costing). Belgian and Swiss costs were converted into US$ PPP (purchasing power parity) in order to neutralize differences in purchasing power between countries. RESULTS The results of this study showed higher costs in Switzerland despite standardization of cost data according to PPP. The difference is not explained by the case-mix index because this was similar for inliers between the two countries. The length of stay (LOS) was also quite similar for inliers between the two countries. The case-mix index was, however, higher for high outliers in Belgium, as reflected in a higher LOS for these patients. Higher costs in Switzerland are thus probably explained mainly by the higher number of agency staff by service in this country or because of differences in medical practices. CONCLUSIONS It is possible to make international comparisons but only if there is standardization of the case-mix between countries and only if comparable accountancy methodologies are used. Harmonization of DRGs groups, nomenclature and accountancy is thus required.
Collapse
Affiliation(s)
- M Pirson
- Unité Economie et Gestion des Institutions de Soins, Département d'économie de la santé, Ecole de Santé Publique, Université Libre de Bruxelles, 808, Route de Lennik, CP592, 1070 Bruxelles, Belgium.
| | | | | | | | | | | |
Collapse
|
25
|
Jiang S, Couralet M, Girault A, Fourcade A, LeVaillant M, Loirat P, Minvielle E, Eryuruk U, Leclercq P. The Rationale for the French Hospital Experiment with P4P (IFAQ): Lessons from abroad. ACTA ACUST UNITED AC 2012. [DOI: 10.3917/jgem.127.0435] [Citation(s) in RCA: 7] [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] [Indexed: 11/14/2022]
|
26
|
Pirson M, Delo C, Di Pierdomenico L, Biloque V, Martins D, Eryuruk U, Leclercq P. Analysis of the variability of nursing care by pathology in a sample of nine Belgian hospitals. BMC Health Serv Res 2011. [PMCID: PMC3238186 DOI: 10.1186/1472-6963-11-s1-a11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
27
|
Pirson M, Delo C, Martins D, Leclercq P. Comparison of cost-weights scales methodologies in the perspective of a financing system based on pathologies. Eur J Health Econ 2011; 12:503-508. [PMID: 20607342 DOI: 10.1007/s10198-010-0262-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 06/15/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Objectives of this article are to evaluate the possibility to create a CW scale by pathology on the basis of cost data from Belgian hospitals, to compare several methodologies to create this CW scale, and to evaluate the financial impact of a modification of the financing system on hospitals' income. METHODS CW scales were elaborated according to various methodologies in order to isolate the scale allowing the most adequate financing system, i.e. approaching the real costs as much as possible. Twelve scales were created. They vary according to the type of data used, according to DRGs and severities of illness included within the scale, and according to the variable used in order to isolate outliers. RESULTS For a similar case-mix, Hospitals H2 and H5 would see their financing increased through a prospective system based on the selected CW scale (No. 6). This modification would generate a reduction in financing going from -1 to -9% according to hospitals. CONCLUSIONS The cost database created made it possible to create a CW scale according to a technique which could constitute the first step of a PPS if advantages of a such financing system were established. In the Belgian context, it would be probably judicious to envisage regional databases allowing diversified methodological approaches whose results would be confronted, discussed, and coordinated at the federal level.
Collapse
Affiliation(s)
- M Pirson
- Département d'Economie de la Santé, CP592, Ecole de Santé Publique de l'Université Libre de Bruxelles, 806, Route de Lennik, 1070 Bruxelles, Belgium.
| | | | | | | |
Collapse
|
28
|
Mohammedi I, Fumex F, Vial V, Leclercq P, Napoléon B. [End-tidal carbon dioxine is increasing during CO(2) insufflation in endoscopy]. Ann Fr Anesth Reanim 2010; 29:497. [PMID: 20547032 DOI: 10.1016/j.annfar.2010.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
29
|
Affiliation(s)
- Philippe Leclercq
- Department of Gastroenterology, Centre Hospitalier Universitaire de Liège, Hôpital du Sart-Tilman, Liège, Belgium
| | | |
Collapse
|
30
|
Pirson M, Zeippen B, Martins D, Leclercq P. [Are extra costs generated by patients justifiable? Methodology and results from a study carried out in a Belgian general hospital]. Rev Med Brux 2010; 31:103-110. [PMID: 20677665] [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: 05/29/2023]
Abstract
Cost outliers account for 6 to 8% of hospital inpatient stays and concentrate 22 to 30% of inpatient costs. Explanatory factors were highlighted in various studies. They are the lenght of stay, an intensive care unit stay, the severity of illness index related to DRG and social factors. Patients are not always explained by these factors. The objective of this study is to analyse cases not explained by those factors, through a detailed analysis of medical files. In the studied hospital, there are 6,3% high cost outliers and 1,1% low cost outliers. These stays were isolated on the basis of a rule based on percentiles. Extra costs generated by high cost outliers are 6.999 euro per stay. The extra lenght of stay for these patients is 20,42 days. Among the 454 patients high cost outliers, 334 patients are explained by factors extracted from a statistical analysis based on a logistic regression (intensive care unit stay, severity of illness index, lenght of stay and social factors). The analysis of medical files of the 120 not explained inpatient stays highlights new explanatory factors (coding errors, heterogeneity of DRGs, etc.). At the end of this study, the conclusion is that a statistical analysis combined with a precise analysis of medical files allowed to explain the majority of cost outliers. An explanation is however not necessarily synonymous with medical justification.
Collapse
Affiliation(s)
- M Pirson
- Département d'Economie de la Santé, Ecole de Santé Publique, ULB, Bruxelles.
| | | | | | | |
Collapse
|
31
|
|
32
|
Leclercq P, Lambermont B. Morphine abuse and bilateral digital ischemia. CMAJ 2009; 181:927. [DOI: 10.1503/cmaj.081281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
33
|
Leclercq P. Quels bénéfices cliniques d’une indétectabilité rapide ? Med Mal Infect 2009. [DOI: 10.1016/s0399-077x(09)72492-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
34
|
Blanc M, Durand D, Leclercq P. H-25 Insuffisance cortico-surrénalienne induite par l’association ritonavir et corticoïdes inhalés. Med Mal Infect 2009. [DOI: 10.1016/s0399-077x(09)74398-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
35
|
Affiliation(s)
- Philippe Leclercq
- Deparment of Intensive Care Medicine, CHU Sart Tilman, University of Liège, B-4000 Liège, Belgium
| | | | | | | | | |
Collapse
|
36
|
Duminil G, Muller-Bolla M, Brun JP, Leclercq P, Bernard JP, Dohan Ehrenfest DM. Success Rate of the EVL Evolution Implants (SERF): A Five-Year Longitudinal Multicenter Study. J ORAL IMPLANTOL 2008; 34:282-9. [DOI: 10.1563/1548-1336(2008)34[283:srotee]2.0.co;2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
37
|
|
38
|
|
39
|
Pirson M, Leclercq P, Jackson T, Leclercq M, Garrino M, Sion C. Financial consequences of hospital-acquired bacteraemia in three Belgian hospitals in 2003 and 2004. J Hosp Infect 2008; 68:9-16. [DOI: 10.1016/j.jhin.2007.10.006] [Citation(s) in RCA: 9] [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: 09/26/2007] [Accepted: 10/04/2007] [Indexed: 10/22/2022]
|
40
|
Leclercq P, Zenati C, Amr S, Dohan DM. Ultrasonic Bone Cut Part 1: State-of-the-Art Technologies and Common Applications. J Oral Maxillofac Surg 2008; 66:177-82. [DOI: 10.1016/j.joms.2005.12.054] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2005] [Revised: 11/01/2005] [Accepted: 12/29/2005] [Indexed: 11/28/2022]
|
41
|
|
42
|
Leclercq P, Dohan DM. [Rationale for a fixed implant-supported transitional prosthesis in full-arch implant restorations]. ACTA ACUST UNITED AC 2007; 108:530-5. [PMID: 17889090 DOI: 10.1016/j.stomax.2007.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Accepted: 06/12/2007] [Indexed: 11/22/2022]
Abstract
The use of a fixed transitional prosthesis in implantology remains quite seldom, although the concept of temporization and progressive loading of prosthetic restorations has become a main issue in modern dentistry. Fixed tansitional prostheses play an important role in the validation of full-arch implant-supported restorations, and in the success of implant treatments in general. This paper reviews the basic treatment principles, and discusses the different technical options available to the clinician. In simple cases, a hard resin bridge may be sufficient. However, for complex cases, we should better use fixed implant-supported temporary prosthesis, made in resin on a metallic infrastructure. Moreover, this one could be use as the framework of the permanent prosthesis. This technical solution offers the best guaranty for implant and oral rehabilitation validation before the permanent prosthesis installation.
Collapse
MESH Headings
- Acrylic Resins
- Dental Alloys
- Dental Implants
- Dental Materials
- Dental Prosthesis, Implant-Supported
- Denture Design
- Denture Retention
- Denture, Complete, Immediate
- Denture, Complete, Lower
- Denture, Complete, Upper
- Denture, Overlay
- Esthetics, Dental
- Humans
- Mouth, Edentulous/rehabilitation
Collapse
Affiliation(s)
- P Leclercq
- Private practice, 45, rue de Courcelles, 75008 Paris, France.
| | | |
Collapse
|
43
|
Leclercq P, Meurisse N, Honore P. Autoimmune pancreatitis. N Engl J Med 2007; 356:1586-7; author reply 1587. [PMID: 17436433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
|
44
|
Leclercq P, Thomas A, Sadzot B. G - 44 La maladie de Rendu-Osler : une cause rare d’AVC ischémique chez un sujet jeune. Rev Neurol (Paris) 2007. [DOI: 10.1016/s0035-3787(07)90550-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
45
|
Leclercq P, Loly C, Giot JB, Frippiat F, Medart L, Malaise MG. [Spondylodiscitis complicated by psoas abscess]. Rev Med Suisse 2007; 3:620-1. [PMID: 17436801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- P Leclercq
- Service de gastroentérologie Département de médecine interne, CHU Sart-Tilman, Liege, Belgique
| | | | | | | | | | | |
Collapse
|
46
|
Leclercq P, Betz R, Lambermont B, Leonard P, Frippiat F. When the book is wrong. Lancet 2007; 369:369-70. [PMID: 17276775 DOI: 10.1016/s0140-6736(07)60190-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
47
|
Roch N, Descloux E, Perpoint T, Biron F, Chaumentin G, Leclercq P, Stahl JP, Peyramond D. Hépatite syphilitique secondaire et infection par le VIH: étude de 16 cas. Rev Med Interne 2006. [DOI: 10.1016/j.revmed.2006.10.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
48
|
Leclercq P, Zenati C, Dohan DM. The Relevance of a New Generation of Monobloc Posts and Impression Copings for Implant-supported Fixed Partial Dentures: A 2-year Clinical Prospective Study With the FM-Clip System on EVL Implants (SERF). J ORAL IMPLANTOL 2006; 32:251-5. [PMID: 17069170 DOI: 10.1563/810.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract
The use of monobloc posts for implant-supported fixed partial dentures is interesting for biomechanical and biological reasons, but it suffers from a lack of precision during the impression phase. The use of a new generation of monobloc posts associated with individual impression copings with a piston offers a simple and efficient impression procedure for small and medium implant-supported fixed partial dentures. This article presents the FM-Clip system for EVL implants composed of new straight monobloc posts and small impression copings with a piston for precise impressions and easy production of implant-supported fixed partial dentures.
Collapse
|
49
|
Méan M, Pavese P, Blanc M, Leclercq P, Brion JP, Stahl JP. [Immune reconstitution syndrome and mycobacterial disease during highly active antiretroviral therapy. Retrospective study of six cases]. Presse Med 2005; 34:1511-4. [PMID: 16301962 DOI: 10.1016/s0755-4982(05)84214-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Soon after starting highly active antiretroviral therapy (HAART), some patients experience clinical deterioration due to the reactivation of their immune system. Mycobacteria are the principal agents complicating this immune reconstitution period. CASES A retrospective examination of patients with mycobacterial disease before or shortly after beginning HAART at Grenoble University Hospital from January 2001 through July 2004 identified six subjects (among 650 outpatients per year) with a new or aggravated mycobacterial disease after starting HAART. Clinical manifestations were: adenopathy (4/6), hyperthermia (3/6), thoracic pain (2/6), abscess (2/6), and neurological deterioration (1/6). DISCUSSION Severely immunosuppressed patients who begin HAART may reactivate or aggravate a mycobacterial disease such as tuberculosis. In such cases, current recommendations call for continuing HAART, beginning or continuing the antimycobacterial therapy, and considering corticosteroids on a case-by-case basis. For patients with AIDS, opportunistic infections that might be reactivated should be actively sought before HAART.
Collapse
Affiliation(s)
- M Méan
- Maladies infectieuses, Département de médecine aiguë et spécialisée, Centre hospitalier universitaire de Grenoble, La Tronche
| | | | | | | | | | | |
Collapse
|
50
|
Beckers C, Jeukens X, Ribbens C, André B, Marcelis S, Leclercq P, Kaiser MJ, Foidart J, Hustinx R, Malaise MG. (18)F-FDG PET imaging of rheumatoid knee synovitis correlates with dynamic magnetic resonance and sonographic assessments as well as with the serum level of metalloproteinase-3. Eur J Nucl Med Mol Imaging 2005; 33:275-80. [PMID: 16247604 DOI: 10.1007/s00259-005-1952-3] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Accepted: 08/11/2005] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of this study was to assess rheumatoid arthritis (RA) synovitis with positron emission tomography (PET) and( 18)F-fluorodeoxyglucose ((18)F-FDG) in comparison with dynamic magnetic resonance imaging (MRI) and ultrasonography (US). METHODS Sixteen knees in 16 patients with active RA were assessed with PET, MRI and US at baseline and 4 weeks after initiation of anti-TNF-alpha treatment. All studies were performed within 4 days. Visual and semi-quantitative (standardised uptake value, SUV) analyses of the synovial uptake of FDG were performed. The dynamic enhancement rate and the static enhancement were measured after i.v. gadolinium injection and the synovial thickness was measured in the medial, lateral patellar and suprapatellar recesses by US. Serum levels of C-reactive protein (CRP) and metalloproteinase-3 (MMP-3) were also measured. RESULTS PET was positive in 69% of knees while MRI and US were positive in 69% and 75%. Positivity on one imaging technique was strongly associated with positivity on the other two. PET-positive knees exhibited significantly higher SUVs, higher MRI parameters and greater synovial thickness compared with PET-negative knees, whereas serum CRP and MMP-3 levels were not significantly different. SUVs were significantly correlated with all MRI parameters, with synovial thickness and with serum CRP and MMP-3 levels at baseline. Changes in SUVs after 4 weeks were also correlated with changes in MRI parameters and in serum CRP and MMP-3 levels, but not with changes in synovial thickness. CONCLUSION (18)F-FDG PET is a unique imaging technique for assessing the metabolic activity of synovitis. The PET findings are correlated with MRI and US assessments of the pannus in RA, as well as with the classical serum parameter of inflammation, CRP, and the synovium-derived parameter, serum MMP-3. Further studies are warranted to establish the place of metabolic imaging of synovitis in RA.
Collapse
Affiliation(s)
- Catherine Beckers
- Division of Nuclear Medicine, Center for Cellular and Molecular Therapy, University Hospital of Liège, Liège, Belgium
| | | | | | | | | | | | | | | | | | | |
Collapse
|