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Teles de Campos S, Diniz P, Castelo Ferreira F, Voiosu T, Arvanitakis M, Devière J. Assessing the impact of center volume on the cost-effectiveness of centralizing ERCP. Gastrointest Endosc 2024; 99:950-959.e4. [PMID: 38061478 DOI: 10.1016/j.gie.2023.11.058] [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: 08/30/2023] [Revised: 11/03/2023] [Accepted: 11/21/2023] [Indexed: 05/20/2024]
Abstract
BACKGROUND AND AIMS ERCP is a complex endoscopic procedure in which the center's procedure volume influences outcomes. With the increasing healthcare expenses and limited resources, promoting cost-effective care becomes essential for healthcare provision. This study was a cost-effectiveness analysis to evaluate the hypothesis that high-volume (HV) centers perform ERCP with higher quality at lower costs than low-volume (LV) centers. METHODS A baseline case compared the current distribution of ERCPs among HV and LV centers with a hypothetical scenario in which all ERCPs are performed at HV centers. A cost-effectiveness analysis was constructed, followed by 1- and 2-way sensitivity analyses, and probabilistic sensitivity analysis using Monte Carlo simulations. RESULTS In the baseline case, the incremental cost-effectiveness ratio was -$151,270 per year, due to the hypothetical scenario's lower costs and slightly higher quality-adjusted life years. The model was most sensitive to changes in transportation costs (109.34%), probability of significant adverse events (AEs) after successful ERCP at LV centers (42.12%), utility after ERCP with significant AEs (30.10%), and probability of significant AEs after successful ERCP at HV centers (23.53%); only transportation costs above $3655 changed the study outcome, however. The current ERCP distribution would only be cost-effective if LV centers achieved higher success (≥92.4% vs 89.3%), with much lower significant AEs (≤.5% vs 6.7%). The study's main findings remained unchanged while combining all model parameters in the probabilistic sensitivity analysis. CONCLUSIONS Our findings show that HV centers have high-performance rates at lower costs, raising the need to consider the principle of centralization of ERCPs into HV centers to improve the quality of care.
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Affiliation(s)
- Sara Teles de Campos
- Gastroenterology Department, Digestive Unit, Champalimaud Foundation, Lisbon, Portugal; Université Libre Bruxelles, Brussels, Belgium; Department of Bioengineering and iBB, Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Fondation Michel Cremer, Universidade de Lisboa, Lisbon, Portugal.
| | - Pedro Diniz
- Department of Bioengineering and iBB, Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Fondation Michel Cremer, Universidade de Lisboa, Lisbon, Portugal; Associate Laboratory i4HB, Institute for Health and Bioeconomy, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Frederico Castelo Ferreira
- Department of Bioengineering and iBB, Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Fondation Michel Cremer, Universidade de Lisboa, Lisbon, Portugal; Associate Laboratory i4HB, Institute for Health and Bioeconomy, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Theodor Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Carol Davila Faculty of Medicine, Bucharest, Romania
| | - Marianna Arvanitakis
- Université Libre Bruxelles, Brussels, Belgium; Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Brussels, Belgium
| | - Jacques Devière
- Gastroenterology Department, Digestive Unit, Champalimaud Foundation, Lisbon, Portugal; Université Libre Bruxelles, Brussels, Belgium; Department of Bioengineering and iBB, Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Fondation Michel Cremer, Universidade de Lisboa, Lisbon, Portugal; Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Brussels, Belgium
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Antonelli G, Voiosu AM, Pawlak KM, Gonçalves TC, Le N, Bronswijk M, Hollenbach M, Elshaarawy O, Beilenhoff U, Mascagni P, Voiosu T, Pellisé M, Dinis-Ribeiro M, Triantafyllou K, Arvanitakis M, Bisschops R, Hassan C, Messmann H, Gralnek IM. Training in basic gastrointestinal endoscopic procedures: a European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement. Endoscopy 2024; 56:131-150. [PMID: 38040025 DOI: 10.1055/a-2205-2613] [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] [Indexed: 12/03/2023]
Abstract
This ESGE Position Statement provides structured and evidence-based guidance on the essential requirements and processes involved in training in basic gastrointestinal (GI) endoscopic procedures. The document outlines definitions; competencies required, and means to their assessment and maintenance; the structure and requirements of training programs; patient safety and medicolegal issues. 1: ESGE and ESGENA define basic endoscopic procedures as those procedures that are commonly indicated, generally accessible, and expected to be mastered (technically and cognitively) by the end of any core training program in gastrointestinal endoscopy. 2: ESGE and ESGENA consider the following as basic endoscopic procedures: diagnostic upper and lower GI endoscopy, as well as a limited range of interventions such as: tissue acquisition via cold biopsy forceps, polypectomy for lesions ≤ 10 mm, hemostasis techniques, enteral feeding tube placement, foreign body retrieval, dilation of simple esophageal strictures, and India ink tattooing of lesion location. 3: ESGE and ESGENA recommend that training in GI endoscopy should be subject to stringent formal requirements that ensure all ESGE key performance indicators (KPIs) are met. 4: Training in basic endoscopic procedures is a complex process and includes the development and acquisition of cognitive, technical/motor, and integrative skills. Therefore, ESGE and ESGENA recommend the use of validated tools to track the development of skills and assess competence. 5: ESGE and ESGENA recommend incorporating a multimodal approach to evaluating competence in basic GI endoscopic procedures, including procedural thresholds and the measurement and documentation of established ESGE KPIs. 7: ESGE and ESGENA recommend the continuous monitoring of ESGE KPIs during GI endoscopy training to ensure the trainee's maintenance of competence. 9: ESGE and ESGENA recommend that GI endoscopy training units fulfil the ESGE KPIs for endoscopy units and, furthermore, be capable of providing the dedicated personnel, infrastructure, and sufficient case volume required for successful training within a structured training program. 10: ESGE and ESGENA recommend that trainers in basic GI endoscopic procedures should be endoscopists with formal educational training in the teaching of endoscopy, which allows them to successfully and safely teach trainees.
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Affiliation(s)
- Giulio Antonelli
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, Italy
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
| | - Andrei M Voiosu
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Katarzyna M Pawlak
- Endoscopy Unit, Gastroenterology Department, Hospital of the Ministry of Interior and Administration, Szczecin, Poland
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Tiago Cúrdia Gonçalves
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Nha Le
- Gastroenterology Division, Internal Medicine and Hematology Department, Semmelweis University, Budapest, Hungary
| | - Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
- Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium
| | - Marcus Hollenbach
- Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany
| | - Omar Elshaarawy
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | | | - Pietro Mascagni
- IHU Strasbourg, Strasbourg, France
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Theodor Voiosu
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Mário Dinis-Ribeiro
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
- MEDCIDS/Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Marianna Arvanitakis
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Helmut Messmann
- Department of Gastroenterology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Ian M Gralnek
- Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel
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Mateescu RB, Gheorghe C, Trifan AV, Saftoiu A, Seicean A, Diculescu MM, Banciu C, Gheorghe LS, Busuioc B, Goldis A, Dobru D, Fratila O, Eugen D, Bataga S, Constantinescu G, Gheonea D, Tantau A, Jinga M, Brisc C, Cijevschi Prelipcean C, Chira R, Fierbințeanu-Braticevici C, Dumitrascu D, State M, Voiosu T, Negreanu L. Safety, Efficacy and Persistence of Advanced Therapies in Inflammatory Bowel Disease: Results from ORIGINS. A Retrospective Observational Study. J Gastrointestin Liver Dis 2023; 32:444-451. [PMID: 38147607 DOI: 10.15403/jgld-5128] [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] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/21/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND AND AIMS Real-world assessments of efficacy and safety of advanced therapies used for inflammatory bowel disease (IBD) patients are limited. We aimed to report safety, efficacy and treatment persistence of new molecules (infliximab, adalimumab, vedolizumab, tofacitinib, ustekinumab) in a retrospective multicentric national Romanian analysis. METHODS We conducted a nationwide, retrospective observational multicentric study. Data were collected retrospectively from electronic and paper files. Patients who started on one of the five investigated molecules during December 2019-December 2021 were included. The main outcome measures were clinical remission, endoscopic healing, persistence on treatment and safety data. RESULTS A total of 678 adult patients from 24 Romanian IBD centers with a diagnosis of ulcerative colitis or Crohn's disease were included. Participants had previously failure to one (268, 39.5%), two (108, 15%) or more treatment lines and only 38% (259) were biologic naïve. In the 24 months study period, most patients were started on vedolizumab (192, 28%), followed by adalimumab, infliximab, ustekinumab and tofacitinib. In biologic-naïve patients, most physicians (72%) preferred anti-TNF treatment as first line biologic (93 patients started on infliximab, 92 on adalimumab), followed by vedolizumab, ustekinumab and tofacitinib. During follow-up, 71% (470, p=0.05) of patients achieved clinical remission and 36% (134, p=0.03) achieved mucosal healing. The 6 months milestone for persistence was reached in 78% (530) of cases. Almost half of patients (47%, 316 patients) persisted on their current treatment for over 12 months. Overall, an adverse reaction was reported for 67 (10.4%) patients, with no lethal events. CONCLUSIONS Population of biologic-experienced IBD patients in Romania is increasing and is becoming more difficult to achieve long-term disease control. Discontinuation rates for advanced therapies are high.
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Affiliation(s)
| | - Cristian Gheorghe
- Gastroenterology and Hepatology Center, Fundeni Clinical Institute,Bucharest, Romania.
| | - Anca Victorita Trifan
- Gastroenterology Department, St. Spiridon Emergency Clinical County Hospital, Iasi, Romania.
| | - Adrian Saftoiu
- Gastroenterology Department, Elias Emergency Hospital, Bucharest, Romania.
| | - Andrada Seicean
- Gastroenterology Department, Prof. Dr. Octavian Fodor Gastroenterology Institute, Cluj-Napoca, Romania.
| | | | - Christian Banciu
- Gastroenterology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
| | | | - Bogdan Busuioc
- Gastroenterology Department, Ion Cantacuzino Clinical Hospital, Bucharest, Romania.
| | - Adrian Goldis
- Gastroenterology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
| | - Daniela Dobru
- Gastroenterology Department , University of Medicine , Science and Tehnology G.E.Palade Targu-Mures.
| | - Ovidiu Fratila
- Third Internal Medicine Department, University of Oradea, Romania.
| | - Dumitru Eugen
- Gastroenterology Department, Emergency Clinical County Hospital, Constanta, Romania.
| | - Simona Bataga
- Gastroenterology Department, Emergency Clinical County Hospital, Targu-Mures, Romania.
| | | | - Dan Gheonea
- Gastroenterology Department, University of Medicine and Pharmacy of Craiova.
| | - Alina Tantau
- Internal Medicine and Gastroenterology Department, Iuliu-Hatieganu University of Medicine and Pharmacy, Cluj- Napoca, Romania.
| | - Mariana Jinga
- Internal Medicine and Gastroenterology Department, Dr Carol Davila Central University Emergency Military Hospital, Bucharest, Romania.
| | - Ciprian Brisc
- Gastroenterology Department, Emergency Clinical County Hospital, Oradea, Romania.
| | | | - Romeo Chira
- Gastroenterology Department, Emergency Clinical County Hospital, Cluj-Napoca, Romania.
| | | | - Dan Dumitrascu
- Second Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania.
| | - Monica State
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania.
| | - Theodor Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania.
| | - Lucian Negreanu
- Gastroenterology Department, Emergency University Hospital Bucharest, Romania.
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Teles de Campos S, Boskoski I, Voiosu T, Arvanitakis M, Costamagna G, Devière J. Face and content validity of a biological papilla designed for the Boškoski-Costamagna ERCP simulator. Gastrointest Endosc 2023; 98:822-829.e1. [PMID: 37390863 DOI: 10.1016/j.gie.2023.06.014] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND AND AIMS A biological papilla made of chicken heart tissue, incorporated into the Boškoski-Costamagna ERCP Trainer simulator, was recently designed to allow training in sphincterotomy. This study aimed to evaluate the face and content validity of this tool. METHOD Participants from 2 groups (nonexperienced and experienced [<600 or >600 lifetime ERCPs, respectively]) were invited to perform standardized assignments on the model: sphincterotomy and precut for both groups and papillectomy for the experienced group. Following these assignments, all participants filled out a questionnaire to rate their appreciation of the realism of the model, and experienced endoscopists were also asked to evaluate its didactic value using a 5-point Likert scale. RESULTS A total of 19 participants were included (nonexperienced, n = 10; experienced, n = 9). Parameters regarding the realism of the tool in terms of general appearance, sphincterotomy, precut, and papillectomy were overall considered realistic (4 of 5), with good agreement rates in terms of overall realism between groups. Experienced operators reported the highest realism for "positioning the scope and needle-knife in the field of view" and "during precut," "cutting in small increments during precut," and "controlling the scope during papillectomy," and they highly agreed that this papilla should be included for training novice and intermediate trainees in sphincterotomy, precut, and papillectomy. CONCLUSIONS Our results show good face validity and excellent content validity of this biological papilla combined with the Boškoski-Costamagna ERCP Trainer. This new tool provides a useful, inexpensive, versatile, and easy tool for training regarding sphincterotomy, precut, and papillectomy. Future studies should explore whether including this model in real-life training improves the learning curve of endoscopy trainees.
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Affiliation(s)
- Sara Teles de Campos
- Gastroenterology Department, Digestive Unit, Champalimaud Foundation, Lisbon, Portugal; Université Libre de Bruxelles, Brussels, Belgium.
| | - Ivo Boskoski
- Gastroenterology and Digestive Endoscopy, Fondazione Policlinico Gemelli, Rome, Italy
| | - Theodor Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Carol Davila Faculty of Medicine, Bucharest, Romania
| | - Marianna Arvanitakis
- Université Libre de Bruxelles, Brussels, Belgium; Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasmus University Hospital, Brussels, Belgium
| | - Guido Costamagna
- Gastroenterology and Digestive Endoscopy, Fondazione Policlinico Gemelli, Rome, Italy
| | - Jacques Devière
- Gastroenterology Department, Digestive Unit, Champalimaud Foundation, Lisbon, Portugal; Université Libre de Bruxelles, Brussels, Belgium; Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasmus University Hospital, Brussels, Belgium
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Dinescu B, Voiosu T, Benguş A, Mateescu RB, Voiosu MR, Voiosu A. The perfect biliary plastic stent: the search goes on. Ann Gastroenterol 2023; 36:490-496. [PMID: 37664231 PMCID: PMC10433249 DOI: 10.20524/aog.2023.0826] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 06/19/2023] [Indexed: 09/05/2023] Open
Abstract
The introduction of biliary plastic stents has been a landmark achievement in the field of endoscopic retrograde cholangiopancreatography, ensuring minimally invasive and highly effective relief of the obstructed biliary system. Attempts to improve the patency and avoid complications after biliary plastic stenting have led to several innovations, but complications due to stent occlusion are still frequent. Because these complications are clinically relevant, and may guide stent choice and patient management, efforts have been made to elucidate the causes of and ways to prevent occlusion of indwelling stents. In this narrative review we focus on biliary plastic stents and discuss the mechanisms of stent occlusion, existing evidence on salient outcomes, as well as options to overcome existing limitations and prolong plastic stent patency.
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Affiliation(s)
- Bianca Dinescu
- Carol Davila University of Medicine and Pharmacy (Bianca Dinescu, Theodor Voiosu, Andreea Benguş, Radu Bogdan Mateescu, Mihail-Radu Voiosu, Andrei Voiosu)
| | - Theodor Voiosu
- Carol Davila University of Medicine and Pharmacy (Bianca Dinescu, Theodor Voiosu, Andreea Benguş, Radu Bogdan Mateescu, Mihail-Radu Voiosu, Andrei Voiosu)
- Colentina Clinical Hospital (Theodor Voiosu, Andreea Benguş, Radu Bogdan Mateescu, Andrei Voiosu), Bucharest, Romania
| | - Andreea Benguş
- Carol Davila University of Medicine and Pharmacy (Bianca Dinescu, Theodor Voiosu, Andreea Benguş, Radu Bogdan Mateescu, Mihail-Radu Voiosu, Andrei Voiosu)
- Colentina Clinical Hospital (Theodor Voiosu, Andreea Benguş, Radu Bogdan Mateescu, Andrei Voiosu), Bucharest, Romania
| | - Radu Bogdan Mateescu
- Carol Davila University of Medicine and Pharmacy (Bianca Dinescu, Theodor Voiosu, Andreea Benguş, Radu Bogdan Mateescu, Mihail-Radu Voiosu, Andrei Voiosu)
- Colentina Clinical Hospital (Theodor Voiosu, Andreea Benguş, Radu Bogdan Mateescu, Andrei Voiosu), Bucharest, Romania
| | - Mihail-Radu Voiosu
- Carol Davila University of Medicine and Pharmacy (Bianca Dinescu, Theodor Voiosu, Andreea Benguş, Radu Bogdan Mateescu, Mihail-Radu Voiosu, Andrei Voiosu)
| | - Andrei Voiosu
- Carol Davila University of Medicine and Pharmacy (Bianca Dinescu, Theodor Voiosu, Andreea Benguş, Radu Bogdan Mateescu, Mihail-Radu Voiosu, Andrei Voiosu)
- Colentina Clinical Hospital (Theodor Voiosu, Andreea Benguş, Radu Bogdan Mateescu, Andrei Voiosu), Bucharest, Romania
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Voiosu T, Rimbaş M, Voiosu A. EUS-guided prophylactic drainage of the gallbladder: a bridge too far. Gastrointest Endosc 2023; 98:466. [PMID: 37597936 DOI: 10.1016/j.gie.2023.03.028] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 08/21/2023]
Affiliation(s)
- Theodor Voiosu
- Gastroenterology Department, Colentina Clinical Hospital; Carol Davila Faculty of Medicine, Bucharest, Romania
| | - Mihai Rimbaş
- Gastroenterology Department, Colentina Clinical Hospital; Carol Davila Faculty of Medicine, Bucharest, Romania
| | - Andrei Voiosu
- Gastroenterology Department, Colentina Clinical Hospital; Carol Davila Faculty of Medicine, Bucharest, Romania
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State M, Balanescu P, Voiosu T, Bengus A, Voiosu A, Coman A, Mustatea P, Negreanu L, Mateescu RB, Popp C. Real-World Endoscopic and Histologic Outcomes in Ulcerative Colitis Patients: A Retrospective Cohort Study. Biomedicines 2023; 11:1860. [PMID: 37509500 PMCID: PMC10376510 DOI: 10.3390/biomedicines11071860] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Histologic activity has emerged as an aspirational therapeutic goal in ulcerative colitis management. It is not yet a formal treatment target in ulcerative colitis. However, it could be used as an adjunct to mucosal healing to represent a deeper level of healing. We investigated mucosal and histologic remission rates and potential predictors of these outcomes in a cohort of UC patients. METHODS We conducted a retrospective analysis of data collected from UC patients enrolled in an ongoing prospective cohort study. Mucosal healing was defined as Mayo endoscopic score = 0. RESULTS A total of 131 patients with ulcerative colitis were enrolled in our study and were prospectively followed for a median length of 2 years (range 0-5 years), totaling 266 study visits. Mucosal healing was recorded for 27 patients at 70 (26%) different study visits. For patients with mucosal healing, histologic remission was achieved in 18/27 (66%) patients. On univariate analysis, sustained clinical remission, SIBDQ scores ≥ 5.5, CRP ≤ 5 mg/dL and absence of corticotherapy were associated with mucosal healing and SIBDQ scores ≥ 5.5 and CRP ≤ 5 mg/dL with histologic healing, respectively. After logistic regression analysis, none of the investigated factors were associated with mucosal and histologic healing. The number of CD8+ intraepithelial lymphocytes (IELs) was significantly greater than the number of CD4+ IELs in periods of disease activity, as well as during mucosal healing (p < 0.01 in both cases). CONCLUSIONS Mucosal healing and histologic remission rates are low in real-life settings. The results of univariate analysis indicate that a good quality of life (SIBDQ score) and normal inflammatory markers (CRP) are associated with mucosal and histologic healing. However, frequently used patient- and disease-related factors, including mucosal healing, are not reliable predictors for histologic remission. Greater CD8+ lymphocyte involvement and higher CD8+/CD4+ distribution can have a meaningful impact on understanding the pathogenesis and natural history of ulcerative colitis, as well as future treatment options for lymphocyte-targeting medications.
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Affiliation(s)
- Monica State
- Gastroenterology Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
- Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Paul Balanescu
- Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Theodor Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
- Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Andreea Bengus
- Gastroenterology Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Andrei Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
- Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Andrei Coman
- Pathology Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
- Pathology Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Petronel Mustatea
- Surgery Department, Ion Cantacuzino Clinical Hospital, 011437 Bucharest, Romania
| | - Lucian Negreanu
- Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Emergency University Hospital, 050098 Bucharest, Romania
| | - Radu Bogdan Mateescu
- Gastroenterology Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
- Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Cristiana Popp
- Pathology Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
- Pathology Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Voiosu A, de Santiago ER, Voiosu T. Getting the full picture: let's always include sustainability in trials reporting new technology! Gastrointest Endosc 2023; 97:601. [PMID: 36801019 DOI: 10.1016/j.gie.2022.09.014] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 09/27/2022] [Indexed: 02/23/2023]
Affiliation(s)
- Andrei Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Enrique Rodriguez de Santiago
- Gastroenterology and Hepatology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
| | - Theodor Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Crinò SF, Conti Bellocchi MC, Di Mitri R, Inzani F, Rimbaș M, Lisotti A, Manfredi G, Teoh AYB, Mangiavillano B, Sendino O, Bernardoni L, Manfrin E, Scimeca D, Unti E, Carlino A, Voiosu T, Mateescu RB, Fusaroli P, Lega S, Buscarini E, Pergola L, Chan SM, Lamonaca L, Ginès À, Fernández-Esparrach G, Facciorusso A, Larghi A. Wet-suction versus slow-pull technique for endoscopic ultrasound-guided fine-needle biopsy: a multicenter, randomized, crossover trial. Endoscopy 2023; 55:225-234. [PMID: 35915956 DOI: 10.1055/a-1915-1812] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [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: 12/10/2022]
Abstract
BACKGROUND : It is unknown whether there is an advantage to using the wet-suction or slow-pull technique during endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) with new-generation needles. We aimed to compare the performance of each technique in EUS-FNB. METHODS This was a multicenter, randomized, single-blind, crossover trial including patients with solid lesions of ≥ 1 cm. Four needle passes with 22 G fork-tip or Franseen-type needles were performed, alternating the wet-suction and slow-pull techniques in a randomized order. The primary outcome was the histological yield (samples containing an intact piece of tissue of at least 550 μm). Secondary end points were sample quality (tissue integrity and blood contamination), diagnostic accuracy, and adequate tumor fraction. RESULTS Overall, 210 patients with 146 pancreatic and 64 nonpancreatic lesions were analyzed. A tissue core was retrieved in 150 (71.4 %) and 129 (61.4 %) cases using the wet-suction and the slow-pull techniques, respectively (P = 0.03). The mean tissue integrity score was higher using wet suction (P = 0.02), as was the blood contamination of samples (P < 0.001). In the two subgroups of pancreatic and nonpancreatic lesions, tissue core rate and tissue integrity score were not statistically different using the two techniques, but blood contamination was higher with wet suction. Diagnostic accuracy and tumor fraction did not differ between the two techniques. CONCLUSION Overall, the wet-suction technique in EUS-FNB resulted in a higher tissue core procurement rate compared with the slow-pull method. Diagnostic accuracy and the rate of samples with adequate tumor fraction were similar between the two techniques.
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Affiliation(s)
- Stefano Francesco Crinò
- Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
| | | | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, Arnas Civico Di Cristina Benfratelli Hospital, Palermo, Italy
| | - Frediano Inzani
- Pathology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mihai Rimbaș
- Gastroenterology Department, Clinic of Internal Medicine, Colentina Clinical Hospital, Carol Davila University of Medicine, Bucharest, Romania
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | - Guido Manfredi
- Gastroenterology and Digestive Endoscopy Department, ASST Ospedale Maggiore Crema, Crema, Italy
| | - Anthony Y B Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Benedetto Mangiavillano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Oriol Sendino
- Endoscopy Unit, Department of Gastroenterology, Hospital Clínic Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Laura Bernardoni
- Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
| | - Erminia Manfrin
- Department of Diagnostics and Public Health, G.B. Rossi University Hospital, Verona, Italy
| | - Daniela Scimeca
- Gastroenterology and Endoscopy Unit, Arnas Civico Di Cristina Benfratelli Hospital, Palermo, Italy
| | - Elettra Unti
- Pathology Unit, ARNAS Civico Di Cristina Benfratelli Hospital, Palermo, Italy
| | - Angela Carlino
- Pathology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Theodor Voiosu
- Gastroenterology Department, Clinic of Internal Medicine, Colentina Clinical Hospital, Carol Davila University of Medicine, Bucharest, Romania
| | - R Bogdan Mateescu
- Gastroenterology Department, Clinic of Internal Medicine, Colentina Clinical Hospital, Carol Davila University of Medicine, Bucharest, Romania
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | | | - Elisabetta Buscarini
- Gastroenterology and Digestive Endoscopy Department, ASST Ospedale Maggiore Crema, Crema, Italy
| | - Lorena Pergola
- Pathology Department, ASST Ospedale Maggiore Crema, Crema, Italy
| | - Shannon M Chan
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Laura Lamonaca
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy
| | - Àngels Ginès
- Endoscopy Unit, Department of Gastroenterology, Hospital Clínic Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Gloria Fernández-Esparrach
- Endoscopy Unit, Department of Gastroenterology, Hospital Clínic Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Antonio Facciorusso
- Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy.,Department of Medical and Surgical Sciences, Section of Gastroenterology, University of Foggia, Foggia, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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10
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Voiosu AM, Wiese S, Goetze JP, Hartmann O, Voiosu T, Santos K, Møller S. Dipeptidyl peptidase-3 is associated with severity of liver disease and circulatory complications in patients with cirrhosis. Biomarkers 2021; 27:196-204. [PMID: 34964404 DOI: 10.1080/1354750x.2021.2024599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients with cirrhosis suffer from a complex multiorgan disturbance and their prognosis is influenced by the development of portal hypertension and systemic circulatory dysfunction. Although non-invasive techniques such as transient elastography aid in early detection, there is an unmet need for reliable markers of these clinically significant complications. METHODS We conducted an exploratory single-center study investigating dipeptidyl peptidase-3 (DPP3) concentrations in various vascular beds in a cohort of 48 patients with cirrhosis and 16 healthy controls. Liver vein catheterization with sampling from femoral artery and femoral, renal and hepatic veins as well as measurement of hepatic pressure and liver function via indocyanine green and galactose elimination tests were performed. RESULTS DPP3 concentrations were higher in cirrhotic patients compared to controls (12.6 vs. 7.4 ng/mL, p = 0.006) and increased according to the severity of cirrhosis. DPP3 associated with MELD-Na score, Child class, indocyanine green clearance, increased DPP3 with the increased hepatic venous pressure gradient (p = 0.015) as well as increased heart rate and reduced systemic vascular resistance. DPP3 concentrations predicted the presence of clinically significant portal hypertension in cirrhotic patients (AUROC 0.78, 95% CI 0.65 - 0.9). CONCLUSION DPP3 is a promising marker for portal hypertension and systemic hemodynamic changes in cirrhosis.
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Affiliation(s)
- Andrei Mihai Voiosu
- Department of Clinical Physiology and Nuclear Medicine, Centre of Functional and Imaging Research, Hvidovre Hospital, Denmark.,Gastroenterology and Hepatology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Signe Wiese
- Gastro Unit, Medical Division, Hvidovre Hospital, Hvidovre, Denmark
| | - Jens Peter Goetze
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark.,Department of Biomedical Sciences, Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark
| | | | - Theodor Voiosu
- Gastroenterology and Hepatology Department, Colentina Clinical Hospital, Bucharest, Romania.,Faculty of Medicine, UMF Carol Davila, Bucharest, Romania
| | | | - Søren Møller
- Department of Clinical Physiology and Nuclear Medicine, Centre of Functional and Imaging Research, Hvidovre Hospital, Denmark.,Department of Clinical Medicine, Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark
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11
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Rimbaş M, Anderloni A, Napoléon B, Seicean A, Forti E, Crinò SF, Tarantino I, Arcidiacono PG, Fabbri C, Rizzatti G, Amato A, Voiosu T, Fugazza A, Moșteanu O, Ginès À, de Nucci G, Fusaroli P, Nguyen NQ, Di Mitri R, Minelli Grazioli L, Mutignani M, Archibugi L, Binda C, Cominardi A, Barbera C, Fernández-Esparrach G, Palazzo L, Palazzo M, Poley JW, Spada C, Valerii G, Itoi T, Matsunami Y, Mateescu RB, Băicuș C, Costamagna G, Larghi A. Common bile duct size in malignant distal obstruction and lumen-apposing metal stents: a multicenter prospective study. Endosc Int Open 2021; 9:E1801-E1810. [PMID: 34790548 PMCID: PMC8589552 DOI: 10.1055/a-1526-1208] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 04/04/2021] [Accepted: 05/26/2021] [Indexed: 11/11/2022] Open
Abstract
Background and study aims Feasibility of EUS-guided choledochoduodenostomy (EUS-CDS) using available lumen-apposing stents (LAMS) is limited by the size of the common bile duct (CBD) (≤ 12 mm, cut-off for experts; 15 mm, cut-off for non-experts). We aimed to assess the prevalence and predictive factors associated with CBD size ≥ 12 and 15 mm in naïve patients with malignant distal biliary obstruction (MDBO). Patients and methods This was a prospective cohort study involving 22 centers with assessment of CBD diameter and subjective feasibility of the EUS-CDS performance in naïve jaundiced patients undergoing EUS evaluation for MDBO. Results A total of 491 patients (mean age 69 ± 12 years) with mean serum bilirubin of 12.7 ± 6.6 mg/dL entered the final analysis. Dilation of the CBD ≥ 12 and 15 mm was detected in 78.8 % and 51.9 % of cases, respectively. Subjective feasibility of EUS-CDS was expressed by endosonographers in 91.2 % for a CBD ≥ 12 mm and in 96.5 % for a CBD ≥ 15 mm. On multivariate analysis, age ( P < 0.01) and bilirubin level ( P ≤ 0.001) were the only factors associated with both CBD dilation ≥ 12 and ≥ 15 mm. These variables were poorly associated with the extent of duct dilation; however, based on them a prediction model could be constructed that satisfactorily predicted CBD size ≥ 12 mm in patients at least 70 years and a bilirubin level ≥ 7 mg/dL. Conclusions Our study showed that at presentation in a large cohort of patients with MDBO, EUS-CDS can be potentially performed in three quarters to half of cases by expert and less experienced endosonographers, respectively. Dedicated stents or devices with different designs able to overcome the limitations of existing electrocautery-enhanced LAMS for EUS-CDS are needed.
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Affiliation(s)
- Mihai Rimbaş
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Bertrand Napoléon
- Endoscopy Unit, Jean Mermoz Private Hospital, Ramsay Generale de Santé, Lyon, France
| | - Andrada Seicean
- Department of Gastroenterology, Regional Institute of Gastroenterology and Hepatology, Iuliu Haţieganu University of Medicine, Cluj-Napoca, Romania
| | - Edoardo Forti
- Digestive Endoscopy Unit, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
| | - Ilaria Tarantino
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, Istituto Mediterraneo per i Trapianti e Terapie ad alta Specializzazione, Palermo, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Italy
| | - Gianenrico Rizzatti
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,CERTT, Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy
| | - Arnaldo Amato
- Gastroenterology Division, Valduce Hospital, Como, Italy
| | - Theodor Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania,Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania
| | - Alessandro Fugazza
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Ofelia Moșteanu
- Department of Gastroenterology, Regional Institute of Gastroenterology and Hepatology, Iuliu Haţieganu University of Medicine, Cluj-Napoca, Romania
| | - Àngels Ginès
- Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, University of Barcelona, IDIBAPS, CIBEREHD, Barcelona, Spain
| | - Germana de Nucci
- Gastroenterology Unit, ASST Rhodense, Garbagnate Milanese, Italy
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Nam Quoc Nguyen
- Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, Australia
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, ARNAS Civico – Di Cristina – Benfratelli, Palermo, Italy
| | | | | | - Livia Archibugi
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Italy
| | - Anna Cominardi
- Gastroenterology Unit, Hospital of Imola, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Carmelo Barbera
- U.O.C. di Gastroenterologia ed Endoscopia Digestiva, Ospedale Giuseppe Mazzini, ASL Teramo, Italy
| | - Glòria Fernández-Esparrach
- Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, University of Barcelona, IDIBAPS, CIBEREHD, Barcelona, Spain
| | | | - Maxime Palazzo
- Digestive Endoscopy Unit, Beaujon University Hospital, Clichy-la-Garenne, France
| | - Jan Werner Poley
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italia
| | - Giorgio Valerii
- U.O.C. di Gastroenterologia ed Endoscopia Digestiva, Ospedale Giuseppe Mazzini, ASL Teramo, Italy
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yukitoshi Matsunami
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Radu Bogdan Mateescu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania,Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania
| | - Cristian Băicuș
- Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,CERTT, Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,CERTT, Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy
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12
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Voiosu A, Dinescu BA, Benguș A, Mateescu RB, Voiosu MR, Voiosu T. Delays in urgent endoscopic interventions in a gastrointestinal endoscopy referral center and dedicated COVID unit: Riding the waves? Dig Liver Dis 2021; 53:1228-1231. [PMID: 34376371 PMCID: PMC8349310 DOI: 10.1016/j.dld.2021.07.036] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Andrei Voiosu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Gastroenterology and Hepatology Department, Colentina clinical Hospital, Bucharest, Romania
| | | | - Andreea Benguș
- Gastroenterology and Hepatology Department, Colentina clinical Hospital, Bucharest, Romania
| | - Radu Bogdan Mateescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Gastroenterology and Hepatology Department, Colentina clinical Hospital, Bucharest, Romania
| | | | - Theodor Voiosu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Gastroenterology and Hepatology Department, Colentina clinical Hospital, Bucharest, Romania
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13
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Danielescu C, Voiosu T, Voiosu A. Delayed postsphincterotomy bleeding induced by severe thrombocytopenia in a patient with COVID-19. Gastrointest Endosc 2021; 94:191-192. [PMID: 33675776 PMCID: PMC7927584 DOI: 10.1016/j.gie.2021.02.032] [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] [Received: 10/11/2020] [Accepted: 02/26/2021] [Indexed: 02/08/2023]
Affiliation(s)
| | - Theodor Voiosu
- Colentina Clinical Hospital, Bucharest, Romania; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Andrei Voiosu
- Colentina Clinical Hospital, Bucharest, Romania; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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14
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State M, Negreanu L, Voiosu T, Voiosu A, Balanescu P, Mateescu RB. Surrogate markers of mucosal healing in inflammatory bowel disease: A systematic review. World J Gastroenterol 2021; 27:1828-1840. [PMID: 33967560 PMCID: PMC8072191 DOI: 10.3748/wjg.v27.i16.1828] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/02/2021] [Accepted: 04/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mucosal healing (MH) has emerged as a key therapeutic target in inflammatory bowel disease (IBD), and achievement of this goal is documented by endoscopy with biopsy. However, colonoscopy is burdensome and invasive, and substitution with an accurate noninvasive biomarker is desirable.
AIM To summarize published data regarding the performance of noninvasive biomarkers in assessing MH in IBD patients.
METHODS We conducted a systematic review of studies that reported the performance of biomarkers in diagnosing MH in patients with IBD. The main outcome measure was to review the diagnostic accuracy of serum and fecal markers that showed promising utility in assessing MH.
RESULTS We screened 1301 articles, retrieved 46 manuscripts and included 23 articles for full-text analysis. The majority of the included manuscripts referred to fecal markers (12/23), followed by circulatory markers (8/23); only 3/23 of the included manuscripts investigated combined markers (serum and/or fecal markers). Fecal calprotectin (FC) was the most investigated fecal marker for assessing MH. In ulcerative colitis, for cutoff levels ranging between 58 mcg/g and 490 mcg/g, the sensitivity was 89.7%-100% and the specificity was 62%-93.3%. For Crohn’s disease, the cutoff levels of FC ranged from 71 mcg/g to 918 mcg/g (sensitivity 50%-95.9% and specificity 52.3%-100%). The best performance for a serum marker was observed for the endoscopic healing index, which showed a comparable accuracy to the measurement of FC and a higher accuracy than the measurement of serum C-reactive protein.
CONCLUSION Several promising biomarkers of MH are emerging but cannot yet substitute for endoscopy with biopsy due to issues with reproducibility and standardization.
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Affiliation(s)
- Monica State
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest 020125, Romania
| | - Lucian Negreanu
- Department of Gastroenterology, Emergency University Hospital, Bucharest 050098, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Theodor Voiosu
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest 020125, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Andrei Voiosu
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest 020125, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Paul Balanescu
- Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
- Department of Internal Medicine and Research Methodology, Colentina Clinical Hospital, Bucharest 020125, Romania
| | - Radu Bogdan Mateescu
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest 020125, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
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15
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Voiosu T, Puscasu C, Orlandini B, Cavlina M, Bekkali N, Eusebi LH, Pizzicannella M, Blero D, Balanescu P, Voiosu A, Perretta S, Rustemovic N, Fuccio L, Mateescu RB, Hassan C, Wani S, Costamagna G, Boskoski I. Motion training on a validated mechanical ERCP simulator improves novice endoscopist performance of selective cannulation: a multicenter trial. Endosc Int Open 2021; 9:E145-E151. [PMID: 33532551 PMCID: PMC7834697 DOI: 10.1055/a-1315-1994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background and study aims Current data show that traditional training methods in endoscopic retrograde cholangiopancreatography (ERCP) fall short of producing competent trainees. We aimed to evaluate whether a novel approach to simulator-based training might improve the learning curve for novice endoscopists training in ERCP. Methods We conducted a multicenter, randomized controlled trial using a validated mechanical simulator (the Boškoski-Costamagna trainer). Trainees with no experience in ERCP received either standard cannulation training or motion training before undergoing standard cannulation training on the mechanical simulator. Trainees were timed and graded on their performance in selective cannulation of four different papilla configurations. Results Thirty-six trainees (16 in the motion training group, 20 in the standard group) performed 720 timed attempts at cannulating the bile duct on the simulator. Successful cannulation was achieved in 698 of 720 attempts (96.9 %), with no significant difference between the two study groups ( P = 0.37). Trainees in the motion training group had significantly lower median cannulation times compared to the standard group (36 vs. 48 seconds, P = 0.001) and better technical performance on the first papilla type ( P = 0.013). Conclusions Our findings suggest that motion training could be an innovative method aimed at accelerating the learning curve of novice trainees in the early phase of their training. Future studies are needed to establish its role in ERCP training programs.
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Affiliation(s)
- Theodor Voiosu
- Gastroenterology Department, Colentina Clinical, Hospital, Bucharest, Romania,Internal Medicine Department, Carol Davila School of Medicine, Bucharest, Romania
| | - Claudia Puscasu
- Gastroenterology Department, Colentina Clinical, Hospital, Bucharest, Romania
| | - Beatrice Orlandini
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Masa Cavlina
- Department of Gastroenterology and hepatology University Hospital Centre, Zagreb, Croatia
| | - Noor Bekkali
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - Daniel Blero
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Brussels, Belgium
| | - Paul Balanescu
- Internal Medicine Department, Carol Davila School of Medicine, Bucharest, Romania,Clinical Immunology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Andrei Voiosu
- Gastroenterology Department, Colentina Clinical, Hospital, Bucharest, Romania
| | | | - Nadan Rustemovic
- Department of Gastroenterology and hepatology University Hospital Centre, Zagreb, Croatia
| | - Lorenzo Fuccio
- Gastroenterology Unit, DIMEC, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Radu Bogdan Mateescu
- Gastroenterology Department, Colentina Clinical, Hospital, Bucharest, Romania,Internal Medicine Department, Carol Davila School of Medicine, Bucharest, Romania
| | - Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Sachin Wani
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Guido Costamagna
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ivo Boskoski
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
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16
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Voiosu T, Voiosu A. Lessons from a pandemic: Do not force your patients into the bed of Procrustes! J Eval Clin Pract 2021; 27:12-13. [PMID: 33146928 DOI: 10.1111/jep.13506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/07/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Theodor Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania.,Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Andrei Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
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17
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Negreanu L, Voiosu T, State M, Mateescu RB. Quality of colonoscopy preparation in patients with inflammatory bowel disease: retrospective analysis of 348 colonoscopies. J Int Med Res 2021; 48:300060520903654. [PMID: 32237946 PMCID: PMC7132801 DOI: 10.1177/0300060520903654] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objective Our aim was to prospectively assess bowel preparation in patients with inflammatory bowel disease (IBD) and to determine the impact of disease-related factors on preparation efficacy because few studies have addressed this issue. Methods We conducted a retrospective analysis of data collected from a cohort of patients with IBD enrolled at a tertiary center in Bucharest, Romania. Patients were evaluated every 12 months, with each study visit including collection of clinical, biological, and endoscopic data. We reviewed 348 colonoscopies from 169 consecutive patients prospectively followed for a median length of 2 (0–6) years. Results The median total Boston score and median score per bowel segment in our cohort were optimal at 6 (range 0–9) and 2 (maximum 3), respectively. There was no difference in bowel preparation between patients with endoscopic activity and patients with mucosal healing (median total Boston score 6). Disease- and patient-related parameters did not influence the quality of bowel preparation. Conclusions The quality of bowel preparation in patients with IBD was optimal for our cohort, and disease-related parameters did not significantly influence preparation efficacy.
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Affiliation(s)
- Lucian Negreanu
- Gastoenterology Department, Emergency University Hospital, Bucharest 050098, Romania; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Theodor Voiosu
- Gastoenterology Department, Colentina Clinical Hospital Bucharest, Romania; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Monica State
- Gastoenterology Department, Colentina Clinical Hospital Bucharest, Romania
| | - Radu Bogdan Mateescu
- Gastoenterology Department, Colentina Clinical Hospital Bucharest, Romania; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Voiosu T, Voiosu A, Boškoski I, Arvanitakis M, Bronswijk M, Hollenbach M, Benguş A, Bălănescu P, Orlandini B, Blero D, Van der Merwe S, Mateescu RB, Devière J, Costamagna G. Technical and clinical outcomes of endoscopic retrograde cholangiopancreatography (ERCP) procedures performed in patients with COVID-19. Therap Adv Gastroenterol 2020; 13:1756284820980671. [PMID: 33425011 PMCID: PMC7756189 DOI: 10.1177/1756284820980671] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/20/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The unprecedented situation caused by the coronavirus disease 2019 (COVID-19) pandemic has profoundly affected endoscopic practice in regard to access, volume, and workflow. We aimed to assess the potential changes in the technical outcomes of endoscopic retrograde cholangiopancreatography (ERCP) procedures carried out in patients with confirmed SARS-CoV-2 infection. METHODS We conducted an international, multicenter, retrospective, matched case-control study of ERCP procedures carried out in patients with confirmed COVID-19. The main outcome was technical success of the procedure as assessed by the endoscopist, and the secondary outcome was the development of procedure-related adverse events. Each case was matched in a 1:4 ratio with controls extracted from each center's database in order to identify relevant changes in outcome measures compared with the pre-pandemic era. RESULTS Eighteen procedures performed in 16 COVID-19 patients [14 men, 65 years (9-82)] and 67 controls were included in the final analysis. Technical success was achieved in 14/18 COVID-19 cases, which was significantly lower as compared with the control group (14/18 versus 64/67, p = 0.034), with an endoscopic reintervention required in 9/18 cases. However, the rate of procedure-related adverse events was low in both groups (1/18 versus 10/67, p = 0.44). On multivariable analysis, COVID-19 status remained the only risk factor for technical failure of the procedure [odds ratio of 19.9 (95% confidence interval 1.4-269.0)]. CONCLUSIONS The COVID-19 pandemic has affected the volume and practice of ERCP, resulting in lower technical success rates without significantly impacting patient safety. Prioritizing cases and following recommendations on safety measures can ensure good outcome with minimal risk in dedicated centers.
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Affiliation(s)
| | - Andrei Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Center for Endoscopic Research Therapeutics and Training (CERTT), Catholic University of Rome, Italy
| | - Marianna Arvanitakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Leuven, Belgium
| | - Marcus Hollenbach
- Division of Gastroenterology; Medical Department II (Oncology, Gastroenterology, Hepatology, Pulmonology, Infectious Diseases), University of Leipzig Medical Center, Leipzig, Germany
| | - Andreea Benguş
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Paul Bălănescu
- Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Beatrice Orlandini
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Center for Endoscopic Research Therapeutics and Training (CERTT), Catholic University of Rome, Italy
| | - Daniel Blero
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Schalk Van der Merwe
- Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Leuven, Belgium
| | - Radu Bogdan Mateescu
- Gastroenterology Department, Colentina Clinical Hospital Bucharest, Romania,Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Jacques Devière
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Center for Endoscopic Research Therapeutics and Training (CERTT), Catholic University of Rome, Italy
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Pop CS, Preda CM, Manuc M, Gheorghe LS, Istratescu D, Chifulescu AE, Voiosu T, Diculescu M, Tieranu C, Iliescu L. Occurrence and recurrence of hepatocellular carcinoma in patients with HCV genotype 1b related cirrhosis treated with Ledipasvir + Sofosbuvir ± Ribavirin. JGLD 2020; 29:690-691. [DOI: 10.15403/jgld-3148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/13/2020] [Indexed: 11/01/2022]
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20
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Gheorghe LS, Preda C, Iliescu L, Istratescu D, Chifulescu AE, Pop CS, Trifan A, Stanciu C, Diculescu M, Voiosu T, Baicus C, Tugui L, Iacob S, Tieranu C, Meianu C, Manuc M. Efficacy and Safety of Ledispavir/Sofosbuvir with or without Ribavirin in patients with Decompensated Liver Cirrhosis and Hepatitis C Infection: a Cohort Study. J Gastrointestin Liver Dis 2020; 29:385-390. [PMID: 32919421 DOI: 10.15403/jgld-2448] [Citation(s) in RCA: 2] [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: 04/26/2020] [Accepted: 07/07/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Ledipasvir/Sofosbuvir (LDV/SOF) with or without Ribavirin (RBV) has shown good results in terms of efficacy and safety in clinical trials in advanced liver cirrhosis, but real-life data are still needed in order to confirm this profile. We investigated the efficacy and safety of LDV/SOF in a large Romanian population with liver cirrhosis and genotype 1b hepatitis C virus (HCV). METHODS We analyzed a multicentric retrospective cohort enrolling 349 patients with decompensated liver cirrhosis due to HCV who received LDV/SOF±RBV 12/24 weeks (301/48). Patients were included between 2017-2018, all with genotype 1b. Main inclusion criteria were liver cirrhosis and detectable HCV RNA. The cases were followed-up monthly during therapy and 12 weeks after the end of therapy. RESULTS The cohort included 60% females with a median age of 61, 16% interferon (IFN) pre-treated, 53% with comorbidities, 40/53/7 % with Child Pugh A/B/C, 4% with virus B co-infection and 8% with previously treated hepatocellular carcinoma. Mean initial MELD score was 11.92 (6.82÷ 24.5). Six patients were lost during follow-up. Sustained virologic response (SVR) in intention-to-treat was reported in 85.1%. Predictive factors of SVR in decompensated cirrhosis were female gender (p=0.01), advanced age (p<0.001), lower bilirubin levels (p=0.002) and lower CTP score (p=0.02). In patients with CTP score B or C low bilirubin levels (p=0.003), low INR (p<0.001), increased platelet count (p=0.04), low CTP score (p<0.001), lack of encephalopathy (p=0.02), serum albumin >3.5g/dl (p=0.002) predicted improvement of liver function. Serious adverse events were reported in 16/349 (4.6%), most of them due to severe liver decompensation (9/16). CONCLUSIONS LDV/SOF±RBV proved to be highly efficient in our difficult to treat population with 85.1% SVR.
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Affiliation(s)
- Liliana Simona Gheorghe
- Carol Davila University of Medicine and Pharmacy, Gastroenterol and Hepatol Depart, Clinic Fundeni Institute, Bucharest, Romania. .
| | - Carmen Preda
- Carol Davila University of Medicine and Pharmacy, Gastroenterol and Hepatol Depart, Clinic Fundeni Institute, Bucharest, Romania. .
| | - Laura Iliescu
- Carol Davila University of Medicine and Pharmacy, Internal Medicine Depart, Clinic Fundeni Institute, Bucharest, Romania.
| | - Doina Istratescu
- Gastroenterol and Hepatol Depart, Clinic Fundeni Institute, Bucharest; 4) Carol Davila University of Medicine and Pharmacy, Internal Medicine Depart, Emergency Universitary Hospital, Bucharest, Romania.
| | - Andreea Elena Chifulescu
- Gastroenterol and Hepatol Depart, Clinic Fundeni Institute, Bucharest; 4) Carol Davila University of Medicine and Pharmacy, Internal Medicine Depart, Emergency Universitary Hospital, Bucharest, Romania.
| | - Corina Silvia Pop
- UMF "Carol Davila" Internal Medicine Department, Emergency Universitary Hospital, Bucharest, Romania.
| | - Anca Trifan
- Gr. T. Popa University of Medicine and Pharmacy, Gastroenterol and Hepatol Depart, Gastroenterol and Hepatol Institute, Iasi, Romania.
| | - Carol Stanciu
- Gr. T. Popa University of Medicine and Pharmacy, Gastroenterol and Hepatol Depart, Gastroenterol and Hepatol Institute, Iasi, Romania.
| | - Mircea Diculescu
- Carol Davila University of Medicine and Pharmacy, Gastroenterol and Hepatol Depart, Clinic Fundeni Institute, Bucharest, Romania.
| | - Theodor Voiosu
- Carol Davila University of Medicine and Pharmacy, Internal Medicine Depart, Colentina Hospital, Bucharest, Romania.
| | - Cristian Baicus
- Carol Davila University of Medicine and Pharmacy, Internal Medicine Depart, Colentina Hospital, Bucharest, Romania.
| | - Letitia Tugui
- Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania.
| | - Speranta Iacob
- Carol Davila University of Medicine and Pharmacy, Gastroenterol and Hepatol Depart, Clinic Fundeni Institute, Bucharest, Romania.
| | - Cristian Tieranu
- Carol Davila University of Medicine and Pharmacy, Gastroenterol and Hepatol Depart, Elias Emergency Hospital, Bucharest, Romania.
| | - Corina Meianu
- Carol Davila University of Medicine and Pharmacy, Gastroenterol and Hepatol Depart, Clinic Fundeni Institute, Bucharest, Romania
| | - Mircea Manuc
- Carol Davila University of Medicine and Pharmacy, Gastroenterol and Hepatol Depart, Clinic Fundeni Institute, Bucharest, Romania.
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Voiosu T, Băicuș C, Voiosu A. A very tall order for single-operator cholangioscopy. Endoscopy 2020; 52:819. [PMID: 32846445 DOI: 10.1055/a-1185-9495] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Theodor Voiosu
- Internal Medicine Department, Carol Davila School of Medicine, Bucharest, Romania.,Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Cristian Băicuș
- Internal Medicine Department, Carol Davila School of Medicine, Bucharest, Romania.,Internal Medicine Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Andrei Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
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Abstract
INTRODUCTION Chronic pancreatitis entails a heavy burden on the healthcare system because of its often protracted evolution, requiring complex diagnostic and therapeutic procedures. AREAS COVERED This review focuses on novel imaging and endoscopic diagnostic and therapeutic interventions that have changed the management of patients with chronic pancreatitis. We have conducted an extensive search of original papers and guidelines, in order to provide a comprehensive and up to date review of available evidence in these areas of interest. EXPERT OPINION The traditional challenges in managing chronic pancreatitis patients stemmed from the limitations of diagnostic modalities, which could not correctly identify patients in an early stage of the disease, as well as from the scarcity of therapeutic options available. Advances in imaging of CT-scan, MRI, and EUS have opened the way for early diagnosis and staging. This has allowed more aggressive and tailored therapeutic modalities, particularly in endoscopic therapy and minimally invasive surgical interventions. Although high-quality data from large RCTs is still scarce, evidence-based algorithms for diagnosis and therapy are now changing the way we address this chronic disease. In the near future, we can expect a tailored approach based on patient and disease-related predictive factors, relying on a vast armamentarium of endoscopic and surgical solutions.
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Affiliation(s)
- Theodor Voiosu
- Internal Medicine, Carol Davila School of Medicine , Bucharest, Romania.,Gastroenterology Department, Colentina Clinical Hospital , Bucharest, Romania
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome, Italy.,Centre for Endoscopic Research, Therapeutics and Training (CERTT), Università Cattolica Del Sacro Cuore Di Roma , Rome, Italy
| | - Andrea Tringali
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome, Italy.,Centre for Endoscopic Research, Therapeutics and Training (CERTT), Università Cattolica Del Sacro Cuore Di Roma , Rome, Italy
| | - Giuseppe Quero
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome, Italy
| | - Andrei Voiosu
- Gastroenterology Department, Colentina Clinical Hospital , Bucharest, Romania
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome, Italy.,Centre for Endoscopic Research, Therapeutics and Training (CERTT), Università Cattolica Del Sacro Cuore Di Roma , Rome, Italy
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23
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Wiese S, Voiosu A, Hove JD, Danielsen KV, Voiosu T, Grønbaek H, Møller HJ, Genovese F, Reese-Petersen AL, Mookerjee RP, Clemmesen JO, Gøtze JP, Andersen O, Møller S, Bendtsen F. Fibrogenesis and inflammation contribute to the pathogenesis of cirrhotic cardiomyopathy. Aliment Pharmacol Ther 2020; 52:340-350. [PMID: 32524673 DOI: 10.1111/apt.15812] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 01/16/2020] [Revised: 02/05/2020] [Accepted: 05/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fibrogenesis and inflammation contribute to the progression of cirrhosis. However, it is unknown if these processes also contribute to the development of cirrhotic cardiomyopathy (CCM). Novel magnetic resonance imaging with quantification of the extracellular volume (ECV) provides an estimate of the fibrotic remodelling in the liver and heart. AIM To investigate the relationship between liver and cardiac ECV in cirrhosis and their association with collagen turnover and inflammation. METHODS A prospective study of 52 patients with cirrhosis and 14 healthy controls. All patients underwent contrast-enhanced MRI with T1-mapping and quantification of myocardial and liver ECV, biochemical assessments of collagen turnover (PRO-C3, PRO-C5, PRO-C6, collagen type IV degradation fragment, collagen type V degradation fragment, LG1M) and inflammation (TNFα, IL-1β, IL-6, IL-8, IL-18, SDF1α, sCD163, sMR, soluble macrophage mannose receptor). RESULTS Myocardial and liver ECV were increased in patients compared with healthy controls (myocardial ECV 31.2 ± 5.5% vs 27.4 ± 2.9%, P = 0.037; liver ECV 44.1 ± 9.6% vs 33.7 ± 6.7%, P < 0.001). Myocardial ECV correlated strongly with liver ECV (r = 0.48, P = 0.001) and biomarkers of collagen formation and inflammation (P < 0.005). Similarly, liver ECV correlated with biomarkers of collagen formation and inflammation (P < 0.003). In a multivariate analysis, liver ECV was predicted by biomarkers of collagen formation (PRO-C3 and PRO-C6), whereas myocardial ECV was predicted by biomarkers of collagen formation (PRO-C6) and inflammation (IL-6 and sMR). CONCLUSION Structural myocardial changes seem closely related to liver fibrosis in patients with cirrhosis. The strong associations with biomarkers of collagen formation and inflammation provide new insight into the role of inflammation and fibrogenesis in the development of structural cardiac abnormalities, potentially leading to CCM.
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Voiosu T, Boskoski I, Voiosu AM, Bengus A, Ladic A, Klarin I, Bove V, Busuioc B, Rimbas M, Rustemovic N, Mateescu B, Jovanovic I, Costamagna G. Reply to Arvanitakis et al. Endoscopy 2020; 52:319. [PMID: 32212127 DOI: 10.1055/a-1089-9302] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Theodor Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania.,Internal Medicine Department, Carol Davila School of Medicine, Bucharest, Romania
| | - Ivo Boskoski
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Universita Cattolica del Sacro Cuore, Cetre for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy
| | - Andrei M Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Andreea Bengus
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | | | - Ivo Klarin
- Gastroenterology Department, Zadar General Hospital, Zadar, Croatia
| | - Vincenzo Bove
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Universita Cattolica del Sacro Cuore, Cetre for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy
| | - Bogdan Busuioc
- Endoscopy Division, Cantacuzino Clinical Hospital, Bucharest, Romania
| | - Mihai Rimbas
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania.,Internal Medicine Department, Carol Davila School of Medicine, Bucharest, Romania
| | | | - Bogdan Mateescu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania.,Internal Medicine Department, Carol Davila School of Medicine, Bucharest, Romania
| | - Ivan Jovanovic
- Clinic for Gastroenterology and Hepatology, University of Belgrade Medical School, Belgrade, Serbia
| | - Guido Costamagna
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Universita Cattolica del Sacro Cuore, Cetre for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy
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Voiosu T, Boskoski I, Voiosu AM, Benguș A, Ladic A, Klarin I, Bove V, Busuioc B, Rimbaș M, Rustemovic N, Mateescu B, Jovanovic I, Costamagna G. Impact of trainee involvement on the outcome of ERCP procedures: results of a prospective multicenter observational trial. Endoscopy 2020; 52:115-122. [PMID: 31766060 DOI: 10.1055/a-1049-0359] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 12/10/2022]
Abstract
BACKGROUND Training in advanced endoscopic techniques such as endoscopic retrograde cholangiopancreatography (ERCP) should be driven by key performance measures and standardized competence assessment in order to provide safe and high-quality interventions. We aimed to determine whether the involvement of trainees influences the outcome of the procedure and the incidence of ERCP-related adverse events. METHODS This was an international, multicenter, prospective, observational study conducted at six high- and low-volume centers across Europe between October 2016 and October 2018, and included independent operators and their trainees. Standard report forms documenting indication, trainee involvement, technical outcome, and complications over a 30-day follow-up of consecutive ERCP procedures were included in the analysis. Technical success of the procedure and procedure-related adverse events were compared between procedures in the trainee group and the control group using bivariable and multivariable analysis. RESULTS 21 trainees and 16 control endoscopists performed 1843 ERCPs during the study period. Trainee involvement in ERCP procedures did not decrease technical success (92.4 % vs. 93.7 %; P = 0.30) or increase the risk of adverse events (14.7 % vs. 14.6 %; P > 0.99). Conversely, there were significantly more moderate or severe adverse events in the control group compared with the trainee group (6.2 % vs. 3.4 %, P = 0.01). On multivariable analysis, only increased bilirubin levels, time to cannulation, and procedure difficulty level increased the risk of any procedure-related adverse event. CONCLUSION Trainee involvement in ERCP interventions within a proper teaching setting is safe and does not compromise the success of the procedure.
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Affiliation(s)
- Theodor Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania.,Internal Medicine Department, Carol Davila School of Medicine, Bucharest, Romania
| | - Ivo Boskoski
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Centre for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy
| | - Andrei M Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Andreea Benguș
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | | | - Ivo Klarin
- Gastroenterology Department, Zadar General Hospital, Zadar, Croatia
| | - Vincenzo Bove
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Centre for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy
| | - Bogdan Busuioc
- Endoscopy Division, Cantacuzino Clinical Hospital, Bucharest, Romania
| | - Mihai Rimbaș
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania.,Internal Medicine Department, Carol Davila School of Medicine, Bucharest, Romania
| | | | - Bogdan Mateescu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania.,Internal Medicine Department, Carol Davila School of Medicine, Bucharest, Romania
| | - Ivan Jovanovic
- Clinic for Gastroenterology and Hepatology, University of Belgrade Medical School, Belgrade, Serbia
| | - Guido Costamagna
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Centre for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy
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Voiosu T, Voiosu A, Benguş A, Rimbaş M, Mateescu B. Trainee involvement increases precut rates and delays access to the common bile duct without an increase in procedure-related adverse events: a brave new world of ERCP training? ACTA ACUST UNITED AC 2019; 56:55-61. [PMID: 29080394 DOI: 10.1515/rjim-2017-0041] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS Selective cannulation of the desired duct is a key element in ERCP procedures and an important step in the training of fellows. However, there is limited data about technical success and patient safety for ERCPs conducted in a training setting.We aimed to evaluate the impact of trainee involvement on the cannulation technique and procedure related outcomes at ERCP. MATERIALS AND METHODS We conducted an observational study of all ERCP conducted in an endoscopy unit with an on-going training program. Patient related data and procedure-related data (method of cannulation, time to cannulation, degree of trainee involvement, technical success and procedure-related adverse events) were collected using a standard form. The method of cannulation, time to cannulation and procedure-related adverse events were compared between ERCPs with trainee involvement and those without. RESULTS 641 consecutive ERCPs were evaluated and 474 native papilla cases performed by 4 trainers and 3 trainees were included in the final analysis. Trainees were involved in 171 procedures (36.1%), achieving cannulation of the desired duct in 50.8% of the cases. Cannulation rates were similar in the trainee group compared to the control group (91.7% vs. 88.7%) and there was no increase in the rate of adverse events. However, cannulation time was significantly longer in the trainee group with a significant increase in the rate of precut use (32.1% vs. 23.4%, p < 0.001). CONCLUSIONS Trainee involvement resulted in longer cannulation times and increased use of precut sphincterotomy, but, was not associated with an increased risk of procedure related adverse events.
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Affiliation(s)
- Theodor Voiosu
- UMF "Carol Davila" School of Medicine, Bucharest, Romania
| | - Andrei Voiosu
- UMF "Carol Davila" School of Medicine, Bucharest, Romania
| | - Andreea Benguş
- UMF "Carol Davila" School of Medicine, Bucharest, Romania
| | - Mihai Rimbaş
- UMF "Carol Davila" School of Medicine, Bucharest, Romania
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Negreanu L, Voiosu T, State M, Voiosu A, Bengus A, Mateescu BR. Endoscopy in inflammatory bowel disease: from guidelines to real life. Therap Adv Gastroenterol 2019; 12:1756284819865153. [PMID: 31384307 PMCID: PMC6657117 DOI: 10.1177/1756284819865153] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 04/13/2019] [Accepted: 06/21/2019] [Indexed: 02/04/2023] Open
Abstract
Endoscopy has a central role in the management of inflammatory bowel disease (IBD), providing crucial data for diagnostic and therapeutic decisions, treating disease-related complications, and assisting in the early detection of dysplasia and prevention of colorectal cancer in the setting of IBD. Treatment targets have significantly shifted in IBD, focusing on achieving mucosal healing, a more meaningful endpoint than clinical remission. With the emergence of novel therapies, we aim to alter the course of the disease and prevent irreversible damage to the bowel. To that end, obtaining reliable and reproducible assessments of endoscopic disease activity has become an issue of great importance. Although several guidelines include recommendations regarding endoscopic surveillance in patients with long-standing IBD, there is an open debate regarding the best examination method and the appropriate follow-up intervals. Another important issue is whether surveillance guidelines are actually implemented in real-life practice and what is the preferred surveillance method among endoscopists. Significant changes have occurred in the endoscopic world with the development of new diagnostic and therapeutic modalities and their incorporation in everyday practice. We aimed to assess the real-life application of guideline recommendations regarding endoscopy in IBD patients and to review newly emerged data which might impact these recommendations in the near future.
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Affiliation(s)
| | - Theodor Voiosu
- Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania
| | - Monica State
- Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania
| | - Andrei Voiosu
- Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania
| | - Andreea Bengus
- Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania
| | - Bogdan Radu Mateescu
- Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania
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Preda CM, Baicus C, Sandra I, Oproiu A, Manuc T, Constantinescu I, Gavrila D, Diculescu M, Dumitru R, Vasilescu C, Tieranu C, Istratescu D, Voiosu T, Manuc M. Recurrence rate of hepatocellular carcinoma in patients with treated hepatocellular carcinoma and hepatitis C virus-associated cirrhosis after ombitasvir/paritaprevir/ritonavir+dasabuvir+ribavirin therapy. United European Gastroenterol J 2019; 7:699-708. [PMID: 31210948 DOI: 10.1177/2050640619841254] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 03/08/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction Recent studies have suggested a higher recurrence rate of hepatocellular carcinoma (HCC) in patients with a history of HCC and hepatitis C virus (HCV)-associated cirrhosis treated with direct-acting antiviral (DAA) agents. Material and methods We conducted a prospective analysis of 24 patients with HCV-associated cirrhosis and treated HCC who received ombitasvir/paritaprevir/ritonavir+dasabuvir+ribavirin for 12 weeks. Prior therapies for HCC included resection (9/24 patients), radiofrequency ablation (RFA) (7/24) and trans-arterial chemoembolization (TACE) (8/24). All patients were eligible for treatment if they had no HCC recurrence 6 months after their last procedure. A control group was defined. All patients were followed every 6 months, with dynamic computed tomography and/or magnetic resonance imaging. Results The sustained virological response rate per protocol was 21/24 (87.5%). The study group included 14 (59%) males, median age 64 years (51-77), 50% with associated non-alcoholic steatohepatitis and 24% with Child-Pugh A6 points. HCC recurrence rate/100 patient-years was lower in the DAA-HCC group versus control: 5.5 versus 24.6% patient-years for the resection+RFA group (p = 0.044), respectively, and 18.6 versus 72.7% patient-years for TACE group (p = 0.002). Survival without recurrence was higher in the resection+RFA group (45 compared to 18 months (p < 0.001)) and also in the TACE group (44 compared to 11.5 months (p = 0.002)). Conclusions DAA therapy significantly reduced the recurrence rate of HCC and improved survival without recurrence in patients with treated HCV-associated HCC.
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Affiliation(s)
- Carmen M Preda
- Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Cristian Baicus
- Internal Medicine Department, Colentina Hospital, Bucharest, Romania
| | - Irina Sandra
- Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Alexandru Oproiu
- Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Teodora Manuc
- Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Ileana Constantinescu
- Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Daniel Gavrila
- Surgery Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Mircea Diculescu
- Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Radu Dumitru
- Radiology Department, Clinic Fundeni Institute, Bucharest, Romania
| | | | - Cristian Tieranu
- Gastroenterology and Hepatology Department, Elias Emergency Hospital, Bucharest, Romania
| | - Doina Istratescu
- Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Theodor Voiosu
- Internal Medicine Department, Colentina Hospital, Bucharest, Romania
| | - Mircea Manuc
- Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
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Voiosu T, Bălănescu P, Voiosu A, Benguş A, Preda C, Umans DS, Bogdan Mateescu R, van Hooft JE. Measuring trainee competence in performing endoscopic retrograde cholangiopancreatography: A systematic review of the literature. United European Gastroenterol J 2019; 7:239-249. [PMID: 31080609 PMCID: PMC6498806 DOI: 10.1177/2050640618817110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 09/12/2018] [Accepted: 11/09/2018] [Indexed: 12/13/2022] Open
Abstract
Background Current recommendations on training in endoscopic retrograde cholangiopancreatography are predicated on a performance-centred approach designed to ensure that trainees achieve appropriate skills. We aimed to analyse how competence in endoscopic retrograde cholangiopancreatography is defined in the literature and what proportion of trainees actually reach this threshold. Methods We conducted a systematic MEDLINE search for studies reporting on endoscopic retrograde cholangiopancreatography training programmes in a clinical setting. The main outcome measure was threshold for achieving competence in endoscopic retrograde cholangiopancreatography; the secondary outcome measure was assessment of trainee performance. Quality was assessed using the Cochrane Risk of Bias tool and the Methodological Index for Non-Randomized Studies criteria. Results Of 522 initially identified articles, 20 were included in the analysis; most studies showed a high risk of bias. Cannulation rate of the desired duct was the main marker of competence in all studies; however, only 8/20 studies reported on the performance of individual trainees, who achieved their respective standard of competence in only 25.6% of reported cases. Conclusions Current literature identifies cannulation rate of a native papilla to be the most appropriate measure of endoscopic retrograde cholangiopancreatography competence; however, most trainees do not reach predefined competence thresholds. Furthermore, due to the limitations of available studies, the most appropriate competence measure remains subject for debate.
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Affiliation(s)
- Theodor Voiosu
- Carol Davila School of Medicine, Bucharest, Romania
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | | | - Andrei Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Andreea Benguş
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Carmen Preda
- Carol Davila School of Medicine, Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, Bucharest, Romania
| | - Devica S Umans
- Department of Gastroenterology and Hepatology, University of Amsterdam, Amsterdam, the Netherlands
| | - Radu Bogdan Mateescu
- Carol Davila School of Medicine, Bucharest, Romania
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, University of Amsterdam, Amsterdam, the Netherlands
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Tringali A, Voiosu T, Schepis T, Landi R, Perri V, Bove V, Voiosu AM, Costamagna G. Pancreas divisum and recurrent pancreatitis: long-term results of minor papilla sphincterotomy. Scand J Gastroenterol 2019; 54:359-364. [PMID: 30880501 DOI: 10.1080/00365521.2019.1584640] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background and aims: Pancreas divisum (PD) is the most common congenital variant of the pancreatic ductal system and a potential cause of acute recurrent pancreatitis (ARP). Endoscopic therapy is a therapeutic option for symptomatic PD, but there is limited data on long-term results. We aimed to assess the effect of minor papilla endoscopic sphincterotomy (MiES) in the setting of ARP in patients with PD. Methods: Consecutive patients treated by MiES were included. Clinical data, including gender, age, smoking and drinking habits, number of episodes of acute pancreatitis (AP) as well as technical data pertaining to the endoscopic therapy were reviewed. Patients available for follow-up were contacted to assess the long-term impact of MiES using the Patient's Global Impression of Change (PGIC) questionnaire. Results: A total of 138 patients with PD including 77 patients with ARP underwent MiES; 48 patients were available for long-term follow-up using the PGIC score, with a mean follow-up period of 9.7 years. Procedure-related adverse events developed in 10 cases (12.9%): 5 post-MiES delayed bleeding and 5 mild pancreatitis. MiES was clinically successful in 35 patients (72.9%) who did not experience any more episodes of AP. Improvement in quality of life (PGIC ≥6) occurred in 41/48 patients (85.4%). On multivariate analysis, stenosis of the MiES was the only predictive factor for increased risk of recurrent pancreatitis after initial therapy. Conclusion: MiES resulted an efficient treatment for ARP in patients with PD with clinical benefit, patient satisfaction and improved quality of life even at long-term follow-up.
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Affiliation(s)
- Andrea Tringali
- a Digestive Endoscopy Unit, Policlinico Agostino Gemelli Foundation IRCCS , Rome , Italy.,b Centre for Endoscopic Research Therapeutics and Training - CERTT, Catholic University of the Sacred Heart , Rome , Italy
| | - Theodor Voiosu
- a Digestive Endoscopy Unit, Policlinico Agostino Gemelli Foundation IRCCS , Rome , Italy.,c Gastroenterology Department , Colentina Clinical Hospital , Bucharest , Romania.,d Carol Davila School of Medicine, Internal medicine , Bucharest , Romania
| | - Tommaso Schepis
- a Digestive Endoscopy Unit, Policlinico Agostino Gemelli Foundation IRCCS , Rome , Italy
| | - Rosario Landi
- a Digestive Endoscopy Unit, Policlinico Agostino Gemelli Foundation IRCCS , Rome , Italy.,b Centre for Endoscopic Research Therapeutics and Training - CERTT, Catholic University of the Sacred Heart , Rome , Italy
| | - Vincenzo Perri
- a Digestive Endoscopy Unit, Policlinico Agostino Gemelli Foundation IRCCS , Rome , Italy.,b Centre for Endoscopic Research Therapeutics and Training - CERTT, Catholic University of the Sacred Heart , Rome , Italy
| | - Vincenzo Bove
- a Digestive Endoscopy Unit, Policlinico Agostino Gemelli Foundation IRCCS , Rome , Italy.,b Centre for Endoscopic Research Therapeutics and Training - CERTT, Catholic University of the Sacred Heart , Rome , Italy
| | - Andrei Mihai Voiosu
- c Gastroenterology Department , Colentina Clinical Hospital , Bucharest , Romania
| | - Guido Costamagna
- a Digestive Endoscopy Unit, Policlinico Agostino Gemelli Foundation IRCCS , Rome , Italy.,b Centre for Endoscopic Research Therapeutics and Training - CERTT, Catholic University of the Sacred Heart , Rome , Italy.,e Chair of Digestive Endoscopy, IHU-USIAS , University of Strasbourg , Strasbourg , France
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Slavu I, Tulin A, Alecu L, Mihaila D, Braga V, Voiosu T, Tomescu L, Stanciulea O, Constantinoiu S. Clinical Pattern of Surgical Crohn Disease Patients. Chirurgia (Bucur) 2018; 113:497-502. [PMID: 30183580 DOI: 10.21614/chirurgia.113.4.497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2018] [Indexed: 11/23/2022]
Abstract
Backround/Objective: The aim of investigation was to evaluate if there is a pattern regarding the anatomical location of the disease and type of surgery performed/surgical indication. Also a analysis was performed regarding the complication rate in two subgroups deriving from urban and rural environments. Methods: Data was obtained from the medical records of patients with CD and centralized. Tests of statistical analysis included the CHY-SQUARE test and the results were presented as a retrospective, longitudinal study. Results: The group was formed of 60 patients. Patients with ileocolic disease were frequently diagnosed with obstruction and benefited from an enterectomy with anastomosis. Patients with colonic disease were frequently diagnosed with perforation and benefited from colectomy and stomy. Patients from rural areas had a milder evolution when compared with patients from urban enviroments. Conclusions: Although most patients with CD eventually require surgery, the indication could be anticipated by recognition of the concept of clinical patterns, and type of surgery required could be predicted if the clinical aspect of the patient/disease were identified.
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Voiosu T, Ionita M, Voiosu A, Bengus A, Popp C, Mateescu B. Cholangioscopy using the SpyGlass system for a rare cause of obstruction: inflammatory polyp of the common bile duct. J Gastrointestin Liver Dis 2018; 26:111. [PMID: 28617875 DOI: 10.15403/jgld.2014.1121.262.pyg] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Preda CM, Popescu CP, Baicus C, Constantinescu I, Oproiu A, Voiosu T, Diculescu M, Negreanu L, Gheorghe L, Sporea I, Trifan A, Ceausu E, Proca D, Manuc M. Risk of hepatitis B virus reactivation in hepatitis B virus + hepatitis C virus-co-infected patients with compensated liver cirrhosis treated with ombitasvir, paritaprevir/r + dasabuvir + ribavirin. J Viral Hepat 2018; 25:834-841. [PMID: 29397016 DOI: 10.1111/jvh.12872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 11/05/2017] [Accepted: 01/10/2018] [Indexed: 02/06/2023]
Abstract
Hepatitis B virus may reactivate in patients with chronic hepatitis C treated with direct-acting antivirals. The aim of this study was to investigate the risk of hepatitis B virus (HBV) reactivation in HBV + hepatitis C virus (HCV)-co-infected patients with compensated liver cirrhosis treated with paritaprevir/ombitasvir/ritonavir, dasabuvir with ribavirin. We reviewed prospectively gathered data from a national cohort of 2070 hepatitis C virus patients with compensated liver cirrhosis who received reimbursed paritaprevir/ombitasvir/r, dasabuvir with ribavirin for 12 weeks from the Romanian National Health Agency during 2015-2016. Twenty-five patients in this cohort were HBs antigen positive (1.2%); 15 untreated with nucleotide analogues agreed to enter the study. These patients were followed up: ALT monthly, serology for HBV and DNA viral load at baseline, EOT and SVR at 12 weeks. Hepatitis B virus (HBV)-co-infected patients were all genotype 1b and 52% females, with a median age of 60 years (51 ÷ 74); 76% were pretreated with peginterferon + ribavirin; 72% were with severe necroinflammatory activity on FibroMax assessment; 40% presented comorbidities; and all were HBe antigen negative. Hepatitis C virus (HCV) SVR response rate was 100%. Hepatitis B virus (HBV)-DNA viral load was undetectable in 7/15 (47%) before therapy, and for the other 8 patients, it varied between below 20 and 867 IU/mL. Five patients (33%) presented virological reactivation (>2 log increase in HBV-DNA levels) during therapy. One patient presented with hepatitis associated with HBV reactivation, and two started anti-HBV therapy with entecavir. Hepatitis B virus (HBV) virological reactivation was present in 33% in our patients. Generally, HBV-DNA elevations were mild (<20 000 IU/mL); however, we report one case of hepatitis associated with HBV reactivation.
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Affiliation(s)
- C M Preda
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - C P Popescu
- UMF "Carol Davila" Virology Department, Victor Babes Hospital, Bucharest, Romania
| | - C Baicus
- UMF "Carol Davila" Internal Medicine Department, Colentina Hospital, Bucharest, Romania
| | - I Constantinescu
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - A Oproiu
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - T Voiosu
- UMF "Carol Davila" Internal Medicine Department, Colentina Hospital, Bucharest, Romania
| | - M Diculescu
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - L Negreanu
- UMF "Carol Davila" Gastroenterology Department, Emergency Universitary Hospital, Bucharest, Romania
| | - L Gheorghe
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - I Sporea
- UMF Timisoara, Gastroenterology & Hepatology Department, Timisoara Emergency Hospital, Timisoara, Romania
| | - A Trifan
- UMF Gr T Popa Iasi, Gastroenterology & Hepatology Department, Gastroenterology & Hepatology Institute, Iasi, Romania
| | - E Ceausu
- UMF "Carol Davila" Virology Department, Victor Babes Hospital, Bucharest, Romania
| | - D Proca
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - M Manuc
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
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Slavu I, Alecu L, Tulin A, Mihaila D, Braga V, Voiosu T, Tomescu L, Constantinoiu S. Reintervention Rate Following Emergency Surgery for Crohn Disease. Chirurgia (Bucur) 2018; 113:227-233. [PMID: 29733016 DOI: 10.21614/chirurgia.113.2.227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2018] [Indexed: 11/23/2022]
Abstract
Backround/Objective: To assess the impact of emergency surgery and postoperative recurrence in Crohn's disease (CD) and to evaluate the disease course while observing different factors that may influence it. Methods: Information on 37 consecutive patients which were diagnosed and operated in emergency for CD complications and the the relapse rate (regarded as a second surgery) were retrospectively evaluated. Results: The risk of relapse and second surgery was increased in males under 50 years and in those who benefited from an anastomosis during the first invervention while stomy seemed to reduce the rate of surgical relapse. The median duration until relapse was 2,3 years while a percentage of 33% required reintervention. Conclusions: The majority of patients with CD will undergo at least one surgical intervention during their lifetime and one third of them will relapse requiring a second intervention. Although medical treatment has seen great advancements, surgery requirements have remained unchanged as the mainstay treatment in emergent complications of CD. The age of the patients, smoking status and the postoperative medication influence the rate of postoperative recurrence.
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Manuc M, Preda CM, Popescu CP, Baicuș C, Voiosu T, Pop CS, Gheorghe L, Sporea I, Trifan A, Tanțău M, Tanțău A, Ceaușu E, Proca D, Constantinescu I, Ruta SM, Fulger LE, Diculescu M, Oproiu A. New Epidemiologic Data Regarding Hepatitis C Virus Infection in Romania. J Gastrointestin Liver Dis 2017; 26:381-386. [PMID: 29253053 DOI: 10.15403/jgld.2014.1121.264.cvr] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Literature data suggest that HCV genotype-1b is present in 93-99% of the Romanian patients infected with hepatitis C virus (HCV). We present the genotyping tests recently performed on patients with HCV and advanced fibrosis eligible for the Direct-Acting Antiviral (DAA) therapy, as well as the prevalence of these cases across Romania. METHODS The genotyping method was performed on 7,421 HCV patients with advanced fibrosis. The detection method was automatic real time PCR platform M2000 (Abbott). Every subject was introduced into a database including age, sex, county and address. RESULTS Genotype 1b was almost exclusively present: 7,392/7,421 (99.6%). Genotype 1b patients were 19.6% from Bucharest, 49% were males, with a median age of 60 years. Genotype non-1b was encountered in 29/7,421 subjects (0.4%), 62% were males, 69% from Bucharest and the median age was 52 years. Most of the subjects (75%) were in the 6th and 7th age decade. The prevalence of these cases varied significantly across Romanian counties: the highest was in Bucharest (61.3/105), Bihor (47/105), Iasi (46/105) and Constanta (43/105), and the lowest in Ilfov (2.8/105), Harghita (3.7/105), Covasna (5.4/105) and Maramures (8.8/105) (p<0.001). CONCLUSIONS Genotype 1b is encountered in 99.6% of patients with chronic hepatitis C and advanced fibrosis from Romania. The presence of genotypes non-1b is more common in Bucharest, in males and at a younger age. There are significant differences regarding the distribution of these cases across Romania: the highest rates are in Bucharest, Bihor, Iasi and Constanta.
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Affiliation(s)
- Mircea Manuc
- Gastroenterology and Hepatology Dept., Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Carmen M Preda
- Gastroenterology and Hepatology Dept., Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Corneliu P Popescu
- Virology Dept., Victor Babes Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Cristian Baicuș
- Internal Medicine Dept., Colentina Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Theodor Voiosu
- Internal Medicine Dept., Colentina Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Corina S Pop
- Gastroenterology Dept., Emergency Universitary Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Liana Gheorghe
- Gastroenterology and Hepatology Dept., Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ioan Sporea
- Gastroenterology and Hepatology Dept., Timisoara Emergency Hospital, University of Medicine and Pharmacy, Timișoara, Romania
| | - Anca Trifan
- Gastroenterology and Hepatology Dept., Gastroenterology and Hepatology Institute, Gr. T. Popa University of Medicine and Pharmacy, Iași, Romania
| | - Marcel Tanțău
- Regional Institute of Gastroenterology and Hepatology, and Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alina Tanțău
- 4th Medical Clinic, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca
| | - Emanoil Ceaușu
- Virology Dept., Victor Babes Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Doina Proca
- Gastroenterology and Hepatology Dept., Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ileana Constantinescu
- Gastroenterology and Hepatology Dept., Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Simona M Ruta
- Virology Dept., Victor Babes Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Larisa E Fulger
- Gastroenterology and Hepatology Dept., Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Mircea Diculescu
- Gastroenterology and Hepatology Dept., Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Abstract
Cirrhotic cardiomyopathy and the hyperdynamic syndrome are clinically important complications of cirrhosis, but their exact pathogenesis is still partly unknown. Experimental models have proven the cardiotoxic effects of bile acids and recent studies of their varied receptor-mediated functions offer new insight into their involvement in cardiovascular dysfunction in cirrhosis. Bile acid receptors such as farnesoid X-activated receptor and TGR5 are currently under investigation as potential therapeutic targets in a variety of pathological conditions. These receptors have also recently been identified in cardiomyocytes, vascular endothelial cells and smooth muscle cells where they seem to play an important role in cellular metabolism. Chronic cholestasis leading to abnormal levels of circulating bile acids alters the normal signalling pathways and contributes to the development of profound cardiovascular disturbances. This review summarizes the evidence regarding the role of bile acids and their receptors in the generation of cardiovascular dysfunction in cirrhosis.
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Affiliation(s)
- Andrei Voiosu
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, Hvidovre, Denmark.,Gastroenterology and Hepatology Department, Colentina Clinical Hospital, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Signe Wiese
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, Hvidovre, Denmark.,Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Theodor Voiosu
- Gastroenterology and Hepatology Department, Colentina Clinical Hospital, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Flemming Bendtsen
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.,Gastro Unit, Medical Division, Hvidovre Hospital, Hvidovre, Denmark
| | - Søren Møller
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, Hvidovre, Denmark.,Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Furnari M, Buda A, Delconte G, Citterio D, Voiosu T, Ballardini G, Cavallaro F, Savarino E, Mazzaferro V, Meroni E. The Role of Wireless Capsule Endoscopy (WCE) in the Detection of Occult Primary Neuroendocrine Tumors. JGLD 2017; 26:151-156. [DOI: 10.15403/jgld.2014.1121.262.wce] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Background & Aims: Neuroendocrine tumors (NETs) are a heterogeneous group of neoplasms with unclear etiology that may show functioning or non-functioning features. Primary tumor localization often requires integrated imaging. The European Neuroendocrine Tumors Society (ENETS) guidelines proposed wireless-capsule endoscopy (WCE) as a possible diagnostic tool for NETs, if intestinal origin is suspected. However, its impact on therapeutic management is debated. We aimed to evaluate the yield of WCE in detecting intestinal primary tumor in patients showing liver NET metastases when first-line investigations are inconclusive.Method: Twenty-four patients with histological diagnosis of metastatic NET from liver biopsy and no evidence of primary lesions at first-line investigations were prospectively studied in an ENETS-certified tertiary care center. Wireless-capsule endoscopy was requested before explorative laparotomy and intra-operative ultrasound. The diagnostic yield of WCE was compared to the surgical exploration.Results: Sixteen subjects underwent surgery; 11/16 had positive WCE identifying 16 bulging lesions. Mini-laparotomy found 13 NETs in 11/16 patients (9 small bowel, 3 pancreas, 1 bile ducts). Agreement between WCE and laparotomy was recorded in 9 patients (Sensitivity=75%; Specificity=37.5%; PPV=55%; NPV=60%). Correspondence assessed per-lesions produced similar results (Sensitivity=70%; Specificity=25%; PPV=44%; NPV=50%). No capsule retentions were recorded.Conclusions: Wireless-capsule endoscopy is not indicated as second-line investigation for patients with gastro-entero-pancreatic NETs. In the setting of a referral center, it might provide additional information when conventional investigations are inconclusive about the primary site.Abbreviations: DBE: double balloon enteroscopy; GEP-NET: gastro-entero-pancreatic neuroendocrine tumor; GI: gastrointestinal; ENETS: European Neuroendocrine Tumor Society; NET: neuroendocrine tumor; SSRS: somatostatin receptor scintigraphy; WCE: wireless capsule endoscopy.
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Voiosu T, Tanţău A, Voiosu A, Benguş A, Mocanu C, Smarandache B, Baicuş C, Vişovan I, Mateescu B. Preparation regimen is more important than patient-related factors: a randomized trial comparing a standard bowel preparation before colonoscopy with an individualized approach. Rom J Intern Med 2017; 55:36-43. [PMID: 27736795 DOI: 10.1515/rjim-2016-0047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Optimal bowel preparation is one of the most important factors affecting the quality of colonoscopy. Several patient-related factors are known to influence the quality of bowel cleansing but randomized trials in this area are lacking. We aimed to compare an individualized bowel prep strategy based on patient characteristics to a standard preparation regimen. MATERIAL AND METHODS We conducted an endoscopist-blinded multicenter randomized control-trial. The Boston Bowel Prep Score (BBPS) was used to assess quality of bowel preparation and a 10 point visual analogue scale to assess patient comfort during bowel prep. Patients were randomised to either the standard regimens of split-dose 4L polyethylene-glycol (group A), split-dose sodium picosulphate/magnesium citrate (group B) or to either of the two depending on their responses to a 3-item questionnaire (individualized preparation, group C). RESULTS 185 patients were randomized during the study period and 143 patients were included in the final analysis. Patients in the individualized group had a median BBPS of 7 compared to a median of 6 in the standard group (p = 0.7). Also, there was no significant difference in patients' comfort scores, irrespective of study group or laxative regimen. However, on multivariable analysis, a split-dose 4L polyethylene-glycol was an independent predictor for achieving a BBPS>6 (OR 3.7, 95% CI 1.4-9.8), regardless of patient-related factors. CONCLUSION The choice of laxative seems to be more important than patient-related factors in predicting bowel cleansing. Comfort during bowel prep is not influenced by the type of strategy used.
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Voiosu T, Bengus A, Voiosu A, Rimbas M, Zlate A, Haidar A, Baicus C, Mateescu B. Trainee caseload correlates with ERCP success rates but not with procedure-related complications: results from a prospective study (the QUASIE cohort). Endosc Int Open 2016; 4:E409-14. [PMID: 27092319 PMCID: PMC4831939 DOI: 10.1055/s-0042-102248] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 10/07/2015] [Accepted: 01/19/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND STUDY AIM Endoscopy society guidelines recommend a minimum of 200 cases for endoscopic retrograde cholangiopancreatography (ERCP) trainees in order to ensure competency and quality standards. However, there are few data regarding procedure-related complication rates and added risk for patients during this learning process. We aimed to evaluate the correlation between trainee caseload and procedure- and patient-related outcomes in an ERCP training program, and to assess the risk factors for ERCP failure and complications. PATIENTS AND METHODS We conducted a prospective study of all procedures performed in the ERCP training program at Colentina Clinical Hospital, Bucharest, Romania. Relevant data for each procedure (diagnosis, cannulation method, outcome, and complications during the following 30 days) as well as operator experience were documented. Univariable and multivariable analysis of the risk factors for ERCP failure and complications was done by analyzing the procedures completed by expert and trainee endoscopists during the study period. RESULTS The analysis included 534 ERCPs performed by 1 expert and 3 supervised trainees during a 12-month period. Technical success rates were comparable in the trainee and expert groups, and no statistically significant difference was found between the two groups with regard to procedure-related complications and mortality. The more experienced trainees had a better chance of successfully completing a procedure (odds ratio of 1.1 for each additional 10 ERCPs performed), but post-ERCP complications were unrelated to individual trainee caseloads on multivariable analysis. CONCLUSION The ERCP technical success rate increases with trainee experience, reflecting the learning curve of individual operators. However, the complication rates are similar across different levels of operator experience, indicating that ERCPs performed by supervised trainees imply no additional risk for patients.
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Affiliation(s)
- Theodor Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania,Corresponding author Theodor Voiosu, MD, PhD Gastroenterology DepartmentColentina Clinical Hospital19-21 Stefan cel Mare BoulevardBucharestRomania+40-21-3180604
| | - Andreea Bengus
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Andrei Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Mihai Rimbas
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Alina Zlate
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Andrei Haidar
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Cristian Baicus
- Internal Medicine Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Bogdan Mateescu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
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Popp C, Nichita L, Voiosu T, Bastian A, Cioplea M, Micu G, Pop G, Sticlaru L, Bengus A, Voiosu A, Mateescu RB. Expression Profile of p53 and p21 in Large Bowel Mucosa as Biomarkers of Inflammatory-Related Carcinogenesis in Ulcerative Colitis. Dis Markers 2016; 2016:3625279. [PMID: 27578918 PMCID: PMC4992508 DOI: 10.1155/2016/3625279] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 07/05/2016] [Indexed: 12/11/2022]
Abstract
Ulcerative colitis (UC) is a chronic, relapsing inflammatory bowel disease that slightly increases the risk of colorectal cancer in patients with long-standing extended disease. Overexpression of p53 and p21 in colonic epithelia is usually detected in UC patients when no dysplasia is histologically seen and it is used by pathologists as a discriminator between regenerative changes and intraepithelial neoplasia, as well as a tissue biomarker useful to predict the risk of evolution toward malignancy. We present a one-year prospective observational study including a cohort of 45 patients with UC; p53 and p21 were evaluated in epithelial cells. p53 was positive in 74 samples revealed in 5% to 90% of epithelial cells, while 63 biopsies had strong positivity for p21 in 5% to 50% of epithelial cells. Architectural distortion was significantly correlated with p53 overexpression in epithelial cells. Thus, we consider that architectural distortion is a good substitute for p53 and p21 expression. We recommend use of p53 as the most valuable tissue biomarker in surveillance of UC patients, identifying the patients with higher risk for dysplasia. Association of p21 is also recommended for a better quantification of risk and for diminishing the false-negative results.
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Affiliation(s)
- Cristiana Popp
- 1Colentina University Hospital, 020125 Bucharest, Romania
- *Cristiana Popp:
| | - Luciana Nichita
- 1Colentina University Hospital, 020125 Bucharest, Romania
- 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Theodor Voiosu
- 1Colentina University Hospital, 020125 Bucharest, Romania
- 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alexandra Bastian
- 1Colentina University Hospital, 020125 Bucharest, Romania
- 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Mirela Cioplea
- 1Colentina University Hospital, 020125 Bucharest, Romania
| | - Gianina Micu
- 1Colentina University Hospital, 020125 Bucharest, Romania
| | - Gabriel Pop
- 1Colentina University Hospital, 020125 Bucharest, Romania
| | - Liana Sticlaru
- 1Colentina University Hospital, 020125 Bucharest, Romania
| | - Andreea Bengus
- 1Colentina University Hospital, 020125 Bucharest, Romania
| | - Andrei Voiosu
- 1Colentina University Hospital, 020125 Bucharest, Romania
| | - Radu Bogdan Mateescu
- 1Colentina University Hospital, 020125 Bucharest, Romania
- 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Voiosu T, Benguş A, Bălănescu P, Dinu R, Voiosu A, Băicuş C, Mateescu B. Rapid fecal calprotectin testing predicts mucosal healing better than C-reactive protein and serum tumor necrosis factor α in patients with ulcerative colitis. Romanian Journal Of Internal Medicine 2015; 53:253-60. [DOI: 10.1515/rjim-2015-0033] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background and Aims. Serum and fecal biomarkers have been used as noninvasive methods for assessing disease activity in ulcerative colitis. C-reactive protein, serum tumor necrosis factor-α and fecal calprotectin are among the most promising such biomarkers. However, their role in the management of ulcerative colitis patients remains to be clarified. We aimed to evaluate the accuracy of C-reactive protein, fecal calprotectin and tumor necrosis factor-α in detecting clinical and endoscopic activity and predicting disease outcome.
Methods. A cohort of ulcerative colitis patients was prospectively evaluated for clinical and endoscopic disease activity using the Mayo score. Serum C-reactive protein and tumor necrosis factor-α levels were measured and a point-of-care method was used for determining Calprotectin levels.
Results. Fifty-three patients with ulcerative colitis were followed for a median of 12 months. Fecal calprotectin and C-reactive protein levels were significantly higher in patients with clinically active disease at baseline, but only calprotectin levels correlated with endoscopic activity. Calprotectin values over 300 μg/g had 60% sensitivity and 90% specificity for detecting active endoscopic disease and 61% sensitivity and 89% specificity for predicting mucosal healing.
Conclusion. Rapid calprotectin testing is a better predictor of mucosal healing than serum biomarkers and it could improve the management of ulcerative colitis patients by decreasing the need for invasive investigations.
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Affiliation(s)
- T. Voiosu
- Gastroenterology Division, “Colentina” Clinical Hospital, 19-21 Ştefan cel Mare Bvd., Bucharest, Romania
- UMF Carol Davila School of Medicine, Eroii Sanitari Bvd., Bucharest, Romania
| | - Andreea Benguş
- Gastroenterology Division, “Colentina” Clinical Hospital, 19-21 Ştefan cel Mare Bvd., Bucharest, Romania
| | - P. Bălănescu
- Gastroenterology Division, “Colentina” Clinical Hospital, 19-21 Ştefan cel Mare Bvd., Bucharest, Romania
- UMF Carol Davila School of Medicine, Eroii Sanitari Bvd., Bucharest, Romania
| | - Roxana Dinu
- Gastroenterology Division, “Colentina” Clinical Hospital, 19-21 Ştefan cel Mare Bvd., Bucharest, Romania
| | - A. Voiosu
- Gastroenterology Division, “Colentina” Clinical Hospital, 19-21 Ştefan cel Mare Bvd., Bucharest, Romania
- UMF Carol Davila School of Medicine, Eroii Sanitari Bvd., Bucharest, Romania
| | - C. Băicuş
- Gastroenterology Division, “Colentina” Clinical Hospital, 19-21 Ştefan cel Mare Bvd., Bucharest, Romania
- Internal Medicine Division, “Colentina” Clinical Hospital, 19-21 Ştefan cel Mare Bvd., Bucharest, Romania
| | - B. Mateescu
- Gastroenterology Division, “Colentina” Clinical Hospital, 19-21 Ştefan cel Mare Bvd., Bucharest, Romania
- UMF Carol Davila School of Medicine, Eroii Sanitari Bvd., Bucharest, Romania
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Bălănescu P, Lădaru A, Bălănescu E, Voiosu T, Băicuş C, Dan GA. Endocan, Novel Potential Biomarker for Systemic Sclerosis: Results of a Pilot Study. J Clin Lab Anal 2015; 30:368-73. [PMID: 26331941 DOI: 10.1002/jcla.21864] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 07/23/2014] [Accepted: 06/27/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Systemic sclerosis (Ssc) is an autoimmune disease characterized by vascular alterations of small arteries and microvessels with subsequent tissue fibrosis. Endocan is expressed by endothelial cells and associated with endothelial dysfunction; therefore it could be a potential biomarker for Ssc patients. METHODS Twenty-one Ssc patients and 20 sex- and age-matched healthy controls were recruited for the study. Serum endocan levels were determined using ELISA method in all patients and controls. RESULTS Serum endocan levels were superior in Ssc patients (median 2.53 (1.10-7 ng/ml)) compared with controls (0.79 (0-2 ng/ml), P < 0.05). Higher serum endocan expression was seen in diffuse Ssc subset and associated with the presence of digital ulcers and daily Raynaud's phenomenon (P < 0.05). Higher serum endocan levels were associated with a modified Rodnan skin score >14 and longer disease duration (P < 0.05). Values of areas under the receiver operating curves showed that serum endocan had good discriminative power for Ssc diagnosis, differentiating diffuse from limited subset type and differentiating patients with modified Rodnan skin score above and under 14 (area under curve: 0.94, 0.81, 0.75, respectively). CONCLUSION The results of this pilot study suggest endocan as a potential biomarker for microvascular manifestations and complications in Ssc patients. These encouraging results could promote future prospective studies in order to determine the exact role played by endocan as a biomarker for Ssc.
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Affiliation(s)
- Paul Bălănescu
- CDPC Clinical Immunology Department, Colentina Clinical Hospital, Bucharest, Romania. .,Internal Medicine Chair, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania. .,Clinical Research Unit, RECIF (Réseau d' Epidémiologie Clinique International Francophone), Bucharest, Romania.
| | - Anca Lădaru
- Pediatrics Department, Institute for Mother and Child Protection "Alfred Rusescu," Bucharest, Romania
| | - Eugenia Bălănescu
- CDPC Clinical Immunology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Theodor Voiosu
- Internal Medicine Chair, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.,Clinical Research Unit, RECIF (Réseau d' Epidémiologie Clinique International Francophone), Bucharest, Romania
| | - Cristian Băicuş
- Internal Medicine Chair, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.,Clinical Research Unit, RECIF (Réseau d' Epidémiologie Clinique International Francophone), Bucharest, Romania.,Department of Internal Medicine, Colentina Clinical Hospital, Bucharest, Romania
| | - Gheorghe Andrei Dan
- Internal Medicine Chair, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.,Clinical Research Unit, RECIF (Réseau d' Epidémiologie Clinique International Francophone), Bucharest, Romania.,Department of Internal Medicine, Colentina Clinical Hospital, Bucharest, Romania
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Voiosu T. Reply: To PMID 25267955. J Gastrointestin Liver Dis 2014; 23:463. [PMID: 25532014] [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: 06/04/2023]
Affiliation(s)
- Theodor Voiosu
- Colentina Clinical Hospital, and Carol Davila University of Medicine and Pharmacy Bucharest, Romania.
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Voiosu T, Bengus A, Dinu R, Voiosu AM, Balanescu P, Baicus C, Diculescu M, Voiosu R, Mateescu B. Rapid Fecal Calprotectin Level Assessment and the SIBDQ Score Can Accurately Detect Active Mucosal Inammation in IBD Patients in Clinical Remission: a Prospective Study. JGLD 2014; 23:273-278. [DOI: 10.15403/jgld.2014.1121.233.thv] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Background & Aims: Mucosal healing is an important predictor of disease-related outcome in inflammatory bowel disease (IBD) patients, including those in clinical remission. However, colonoscopy is an invasive procedure and many patients decline repeated endoscopic examinations. We aimed to assess whether noninvasive biomarkers could accurately detect endoscopic mucosal inflammatory activity in IBD patients in clinical remission.Methods: We conducted a prospective observational cohort study on IBD patients in clinical remission at Colentina Hospital, Bucharest. Clinical activity was assessed using the Mayo score and Crohns Disease Activity Index (CDAI), quality of life was assessed using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). Serum C-reactive protein (CRP) and fecal calprotectin (FC) levels were determined. All patients underwent ileo-colonoscopy to assess mucosal inflammatory activity.Results: 48 patients were included in this study, with 67% showing endoscopic disease activity. SIBD questionnaire and FC performed well as noninvasive markers of intestinal inflammation (AUROC 0.78 and 0.77, respectively), while CRP could not accurately predict endoscopic disease activity. Fecal calprotectin levels > 30 ľg/g showed a 93% sensitivity and a 50% specificity for detecting inflammatory changes of the mucosa while a combined test using FC > 30µg/g and a SIBDQ score < 6 achieved 81.2% sensitivity and 75% specificity, respectively, in detecting active endoscopic disease.Conclusion: Fecal calprotectin and SIBDQ have good diagnostic accuracy in detecting mucosal inflammatory changes in IBD patients in clinical remission. Combining simple, noninvasive tests such as the SIBDQ and FC levels appears to be a practical method for monitoring disease activity in these patients, possibly reducing the need for repeat endoscopic examinations.
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Voiosu T, Bălănescu P, Benguş A, Voiosu A, Baicuş CR, Barbu M, Ladaru A, Nitipir C, Mateescu B, Diculescu M, Voiosu R. Serum endocan levels are increased in patients with inflammatory bowel disease. Clin Lab 2014; 60:505-10. [PMID: 24697130 DOI: 10.7754/clin.lab.2013.130333] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Endocan is a marker of angiogenesis previously studied in various types of cancer and inflammatory conditions. Its expression is influenced by vascular endothelial growth factor A (VEGF A) and tumor necrosis factor alpha (TNF alpha), cytokines involved in pathogenetic pathways in inflammatory bowel disease (IBD). The aim of this study was to determine whether serum endocan levels were increased in IBD patients. METHODS We conducted an exploratory pilot study. Serum endocan levels were determined in a group of 33 consecutive IBD patients from an observational cohort study ongoing at Colentina Hospital and compared to levels determined in two control groups: healthy controls and stage IV cancer patients. RESULTS Endocan levels were significantly higher in the IBD group as compared to both healthy controls (p < 0.001) and cancer patients (p < 0.01). There was no correlation found between endocan levels and disease activity as assessed by clinical or endoscopical activity scores. CONCLUSIONS There is a potential role for endocan in future biomarker studies in IBD patients.
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Voiosu T, Raţiu I, Hervoso CM, Furnari M, Voiosu A, Goldiş A, Mateescu B, Tacconi M, Dulbecco P, Haidar A, Voiosu MR, Sporea I. Polyp and endoscopist-related factors influencing complication rates in difficult colonic polypectomies: results of a multicenter observational study. Rom J Intern Med 2013; 51:172-178. [PMID: 24620630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Current polypectomy practices are highly variable. Endoscopists report increased size, nonpolypoid lesion type and unfavorable position as characteristic of difficult polypectomies. We studied reported difficult colonic polypectomies to determine polyp-related and operator-dependent factors influencing complication rates. PATIENTS AND METHODS We conducted an international multicenter observational prospective study of difficult colonic polypectomies. Endoscopists reported difficult cases of colonic polypectomies, techniques and complication rates. Per-polyp and per-endoscopist analyses were performed. RESULTS Ninety procedures were reported at 4 participating centers by 19 endoscopists. 43% of the lesions were pedunculated, 39% were sessile and 18% were flat. Lesion size ranged between 5-60 mm. Bleeding occurred in 18 out of 90 procedures (17 immediate, 1 delayed); no perforations were reported. Bleeding rate was independent of patient age or sex, polyp type, size and histology or resection method. Procedures were deemed difficult due to polyp size (37/90), unfavorable position (23/90), bleeding risk (12/90), lesion type (12/90) or other reasons (6/90) with no statistically significant difference between expert and beginner endoscopists (p = 0.14). CONCLUSION Difficult colonic polypectomies are unpredictable with a complication rate independent of polyp type or size. There was no difference between experts and beginners with regard to technical aspects of resection or complication rates.
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Voiosu T, Ratiu I, Voiosu A, Iordache T, Schipor A, Baicus C, Sporea I, Voiosu R. Time for individualized colonoscopy bowel-prep regimens? A randomized controlled trial comparing sodium picosulphate and magnesium citrate versus 4-liter split-dose polyethylene glycol. J Gastrointestin Liver Dis 2013; 22:129-134. [PMID: 23799210] [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: 06/02/2023]
Abstract
BACKGROUND & AIMS Good bowel cleansing is essential to achieving optimal endoscopic evaluation of the colon. There are many different regimens available, but none have shown consistently superior results in achieving a clean colon. We compared the efficiency of two regimens with regard to bowel cleansing and patient satisfaction. The study also aimed to identify patient-related factors that influenced the quality of the bowel cleansing. METHODS We conducted a single-blind, multicenter, randomized controlled trial comparing sodium picosulphate and magnesium citrate versus 4-liter split-dose polyethylene glycol (PEG). Consecutive patients presenting for colonoscopy at two tertiary referral centers were invited to participate. The main outcomes were colon cleanliness and patient satisfaction with the preparation regimen. The quality of bowel cleansing was assessed by the endoscopist with the use of a 4-grade scale. Patients completed questionnaires evaluating their experience during the preparation process. Multivariate analysis was conducted in order to compare the two regimens and identify patient-related factors that influenced the main outcomes. RESULTS One hundred eighty-one patients were randomized and 165 completed the trial (91.1%). PEG was slightly superior to sodium picosulphate with regard to bowel cleansing (p=0.01), while patient satisfaction was higher with sodium picosulphate (p=0.008). Patients with higher education and patients reporting high adherence to instructions achieved better colon cleansing using PEG. CONCLUSIONS There seems to be no clear advantage for one bowel preparation solution over the other. However, by taking into account individual patient characteristics, opting for a particular regimen could increase the likelihood of achieving a cleaner colon.
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Voiosu A, Voiosu T, Stănescu CM, Chirilă L, Băicuş C, Voiosu R. Novel predictors of intrapulmonary vascular dilatations in cirrhosis: extending the role of pulse oximetry and echocardiography. Acta Gastroenterol Belg 2013; 76:241-245. [PMID: 23898563] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND STUDY AIMS Intrapulmonary vascular dilatations (IPVDs) are a criterion for the diagnosis of hepatopulmonary syndrome in patients with liver cirrhosis. We aimed to show that IPVDs are more common than suspected in a heterogenous cirrhotic population and to identify new diagnostic parameters. PATIENTS AND METHODS Forty-three consecutive patients with cirrhosis admitted to our Gastroenterology department were included in this prospective study. History, physical examination, ECG and, when warranted, pulmonary function tests and chest radiograph were used to exclude patients with significant cardiac or pulmonary disease. Contrast enhanced transthoracic echocardiography (CEE) was used to determine the presence of IPVDs. Pulse oximetry readings were taken in the supine and standing positions. RESULTS We found 12 patients with IPVDs. Statistical analysis proved the correlation between IPVDs and systolic pulmonary artery pressure (sPAP) (p= .049), right ventricle wall width (RVW) (p = .013) and E/A ratio (p = .034) but not left atrial or ventricular diameter. Orthodeoxia was also present more frequently in patients with positive CEE. The difference between supine and standing oxygen saturation (changeSat) proved a fair diagnostic test for detecting IPVDs, with an area under the receiver operated curve (AUROC) of 0.823. CONCLUSIONS Our study shows that RVW, sPAP, E/A and orthodeoxia determined by pulse oximetry are valuable novel predictors of IPVDs, encouraging the routine use of pulse oximetry and echocardiography in cirrhotic patients.
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Affiliation(s)
- A Voiosu
- Colentina Clinical Hospital, Bucharest, Romania.
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Bălănescu P, Lădaru A, Voiosu T, Nicolau A, Ene M, Bălănescu E. Th17 and IL-17 immunity in chronic hepatitis C infection. Rom J Intern Med 2012; 50:13-18. [PMID: 22788089] [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: 06/01/2023]
Abstract
Hepatitis C virus (HCV) is one of the most important etiologic agents of postransfusional hepatitis and a common cause of chronic hepatitis, cirrhosis and hepatocarcinoma. T helper (Th)17 cells are a newly discovered Th cell subset with implications in both host defense and autoimmunity. Th17 implications in chronic HCV infection are not well characterized. Given the important role in multiple other immune and inflammatory conditions, they are of obvious interest. Specific HCV-Th17 cells are implicated in immune response modulation, correlated with fibrosis severity and intrahepatic inflammatory status. Serum IL-17 levels are higher in chronic HCV infected patients and Th17 cytokines are modulated within the therapeutic response at anti-viral treatment. However, novel intriguing data indicate that Th17 boost could be associated with spontaneous HCV clearance. It is possible that Th17 could play a dual role (both beneficial and harmful) and that an unbalance of regulating factors (chemokines, transcription factors, receptor expression, etc.) rather than the lymphocyte itself could tip the Th17 immune response one way or another. The role of Th17 cells in host anti HCV defense is beginning to emerge and one has to focus upon its potential beneficial aspects and not only on its destructive potential.
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Affiliation(s)
- P Bălănescu
- "Colentina" Clinical Hospital, Clinic of Internal Medicine, Bucharest, Romania.
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Voiosu T, Voiosu A, Rimbaş M, Voiosu R. Endoscopy: possibilities and limitations in the management of GIST of the upper GI tract. Rom J Intern Med 2012; 50:7-11. [PMID: 22788088] [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: 06/01/2023]
Abstract
Gastrointestinal stromal tumors (GISTs) have been a topic of increasing interest since the discovery of their cellular activation pathway via the receptor for tyrosine kinase (KIT) leading to the possibility of targeted molecular therapy in the form of imatinib mesylate. Endoscopic diagnostic and therapeutic possibilities have also been developing at a rapid pace in recent years. Endoscopic ultrasonography (EUS) allows for an accurate assessment of submucosal tumors and can provide tissue samples for diagnostic purposes using fine needle aspiration techniques. Several newer endoscopic techniques, including contrast enhanced EUS and endoscopic submucosal dissection, have also proven useful in the management of GISTs. Although the many recent studies have focused on the role of endoscopy in diagnosing and treating GISTs, we still need better evidence in order to formulate accurate guidelines.
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Affiliation(s)
- T Voiosu
- "Colentina" Hospital, Gastroenterology Division, Bucharest, Romania.
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