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Tam THC, Lui RN. Pancreatic cancer-associated thrombosis. Hong Kong Med J 2023; 29:378-379. [PMID: 37814396 DOI: 10.12809/hkmj235151] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Affiliation(s)
- T H C Tam
- Division of Haematology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong SAR, China
| | - R N Lui
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong SAR, China
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
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Seleq S, Khan R, Gimpaya N, Vargas JI, Amin S, Bilal M, Bollipo S, Charabaty A, de-Madaria E, Hashim A, Kral J, Pawlak KM, Sandhu DS, Lui RN, Sanchez-Luna S, Siau K, Mosko J, Grover S. A32 DEVELOPMENT AND VALIDATION OF THE TORONTO UPPER GASTROINTESTINAL CLEANING SCORE. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859122 DOI: 10.1093/jcag/gwab049.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
High quality esophagogastroduodenoscopy (EGD) depends on the ability to appropriately visualize upper gastrointestinal (GI) mucosa pathology. Evaluation can be limited by the presence of mucus, foam, bubbles and solid materials. Currently, there is no standardized method to assess mucosal visualization for use in clinical or research settings.
Aims
To develop and establish the content validity of the Toronto Upper Gastrointestinal Cleaning Score (TUGCS) and evaluate its interrater reliability.
Methods
An international panel of endoscopy experts rated potential items and their associated anchors for importance as indicators of adequacy of mucosal visualization during EGD. The survey utilized a Likert scale (1 (strongly disagree) to 5 (strongly agree)). The Delphi process was repeated until consensus was reached. Consensus was defined priori as ≥80% of experts in a given round scoring ≥4 on all survey items. To assess content validity, 48 EGD procedures were evaluated in real-time by two endoscopist reviewers using the TUGCS at a single institution. The interrater agreement between assessments was calculated for TUGCS total scores using intraclass correlation coefficient, one-way random effects model (ICC 1,1).
Results
Fourteen experts agreed to be part of the Delphi panel. An anatomical framework representing the upper GI mucosa and anchors for each mucosal portion representing various levels of visibility was generated through systematic review. Three survey rounds, with response rates of 100%, 100% and 71% respectively, achieved consensus. The final TUGCS includes four anatomical areas (fundus, body, antrum, duodenum) and mucosal visualization anchors ranging from 0 to 3 (Figure 1). TUGCS was used to assess foregut cleaning in 48 procedures (Table 1). The mean TUGCS for staff and trainee were 8.1 (±2.4) and 8.1 (±2.6), respectively. The ICC was 0.78 (95% confidence interval 0.62–0.88) indicating good reliability.
Conclusions
We developed and generated content validity evidence for the TUGCS through rigorous Delphi methodology, reflective of practice across different centres. Planned as future research is a video survey distributed to endoscopists internationally to further validate the TUGCS to create a tool that may be used to judge mucosal visualization for EGD in research and clinical settings.
Funding Agencies
None
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Affiliation(s)
- S Seleq
- St Michael’s Hospital, Toronto, ON, Canada
| | - R Khan
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - N Gimpaya
- St Michael’s Hospital, Toronto, ON, Canada
| | - J I Vargas
- Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - S Amin
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, Miami, FL
| | - M Bilal
- Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Boston, MA
| | - S Bollipo
- Gastroenterology Department, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia, Newcastle, New South Wales, Australia
| | - A Charabaty
- Division of Gastroenterology, Johns Hopkins-Sibley Memorial Hospital, Washington, DC, Washington, DC
| | - E de-Madaria
- Alicante University General Hospital, Alicante Institute for Health and Biomedical Research, Alicante, Spain, Alicante, Spain
| | - A Hashim
- Department of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - J Kral
- Institution for Clinical and Experimental Medicine, Prague, Czech Republic, Prague, Czechia
| | - K M Pawlak
- Hospital of the Ministry of Interior and Administration, Szczecin, Poland, Szczecin, Poland
| | - D S Sandhu
- Division of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, Ohio, Cleveland, OH
| | - R N Lui
- Division of Gastroenterology and Hepatology, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China, Hong Kong, China
| | - S Sanchez-Luna
- Division of Gastroenterology and Hepatology, The University of New Mexico, Albuquerque, NM
| | - K Siau
- Institute of Translational Medicine, University Hospitals Birmingham, Birmingham, Birmingham, United Kingdom
| | - J Mosko
- St Michael’s Hospital, Toronto, ON, Canada
| | - S Grover
- St Michael’s Hospital, Toronto, ON, Canada
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Lui RN, Wong SH, Lau LHS, Chan TT, Cheung KCY, Li A, Chin ML, Tang W, Ching JYL, Lam KLY, Chan PKS, Wu JCY, Sung JJY, Chan FKL, Ng SC. Faecal microbiota transplantation for treatment of recurrent or refractory Clostridioides difficile infection in Hong Kong. Hong Kong Med J 2019; 25:178-182. [PMID: 31178437 DOI: 10.12809/hkmj197855] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/05/2022] Open
Abstract
INTRODUCTION Clostridioides difficile infection (CDI) is a leading cause of healthcare-associated infection globally, causing significant morbidity and mortality. Faecal microbiota transplantation (FMT) has emerged as a promising option for recurrent and refractory CDI. This study aimed to assess the safety, efficacy, and feasibility of FMT for CDI in Hong Kong. METHODS We conducted a single-centre, retrospective study for all consecutive cases of recurrent or refractory CDI who underwent FMT from 2013 to 2018. Clinical demographics, outcome, and safety parameters were collected. RESULTS A total of 24 patients with recurrent or refractory CDI (median age 70 years, interquartile range=45.0-78.3 years; 67% male) were included. Over 80% had been recently hospitalised or were long-term care facility residents. Faecal microbiota transplantation was delivered by feeding tube in 11 (45.8%), oesophagogastroduodenoscopy in eight (33.3%), and colonoscopy in six (25%) of the patients. Resolution of diarrhoea without relapse within 8 weeks was achieved in 21 out of 24 patients (87.5%) after FMT. No deaths occurred within 30 days. The FMT was well tolerated and no serious adverse events attributable to FMT were reported. CONCLUSION Our results confirm that FMT is a safe, efficacious, and feasible intervention for patients with refractory or recurrent CDI in Hong Kong. Given the increasing disease burden and the lack of effective alternatives in Hong Kong for difficult-to-treat cases of CDI, we recommend that a territory-wide FMT service be established to address increasing demand for this treatment.
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Affiliation(s)
- R N Lui
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong
| | - S H Wong
- Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong.,Centre for Gut Microbiota Research, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - L H S Lau
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong
| | - T T Chan
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong
| | - K C Y Cheung
- Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - A Li
- Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - M L Chin
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - W Tang
- Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - J Y L Ching
- Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - K L Y Lam
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong
| | - P K S Chan
- Centre for Gut Microbiota Research, The Chinese University of Hong Kong, Shatin, Hong Kong.,Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - J C Y Wu
- Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - J J Y Sung
- Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - F K L Chan
- Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong.,Centre for Gut Microbiota Research, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - S C Ng
- Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong.,Centre for Gut Microbiota Research, The Chinese University of Hong Kong, Shatin, Hong Kong
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