GE Portuguese Journal of Gastroenterology最新文献

{"title":"Direct Mucosal-Side Fibrosis Cutting for Salvage Endoscopic Submucosal Dissection of Secondary Barrett's Neoplasia Adjacent Multiband Resection Scars.","authors":"Vincent Zimmer, Bert Bier","doi":"10.1159/000524269","DOIUrl":"https://doi.org/10.1159/000524269","url":null,"abstract":"A 54-year-old male patient with long-standing Barrett’s esophagus underwent multiband ligation endoscopic mucosal resection (MBL-EMR) 1 year previously due to low-risk early cancer (pT1m2, L0, V0, G2, R0). Of note, a nodular-type small Barrett’s neoplasia was resected en bloc in one EMR specimen, while the remaining specimens contained areas of low-grade dysplasia without circumscribed lesions. Radiofrequency ablation of the remaining non-dysplastic Barrett’s mucosa with preserved acetic acid whitening was scheduled; however, the patient missed several follow-up appointments. At repeat EGD, a secondary Paris 0-IIa lesion estimated at 15 mm and representing a second Barrett’s neoplasia emerged adjacent to MBL-EMR scars at oral (towards the mouth) and anterior (towards the sternum) aspects (Fig. 1a, linked color imaging). Acetic acid staining was only abrogated within the lesion itself and endoscopic biopsies confirmed well-differentiated adenocarcinoma. The patient presented for endoscopic submucosal dissection (ESD) after adequate counselling, including alternative surgery. First, an uncomplicated C-shaped incision from the anal side around the posterior (towards the back, or towards 6 o’clock) parts was performed. Unlike the conventional ESD approach to high-grade fibrosis (distant mucosal incision, submucosal approach to fibrosis with or without tunnel technique), direct cutting into the scar area was tried using an articulating ESD knife (3.5-mm ClutchCutter, Fuji, Düsseldorf, Germany). An initial injection of indigo carmine-saline mixture likewise failed to reasonably lift the mucosa. Special attention was paid to first cut in an ultra-superficial fashion as indicated by a crepe paper-like appearance (electrosurgical settings as for mucosal incision: endo cut 1, effect 2, duration 4, interval 1; hemostasis: soft coagulation, effect 4, 100 W; Fig. 1b). Of note, a hard and longer Inoue-type cap was used to adequately grasp the tissue in a superficial fashion. With the incised mucosa continuously pushed aside by the opened scissors, deeper cuts through dense high-","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"30 3","pages":"249-251"},"PeriodicalIF":0.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10305250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9736981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced Imaging in Gastrointestinal Endoscopy: A Literature Review of the Current State of the Art.","authors":"Pieter Sinonquel,&nbsp;Séverine Vermeire,&nbsp;Frederik Maes,&nbsp;Raf Bisschops","doi":"10.1159/000527083","DOIUrl":"https://doi.org/10.1159/000527083","url":null,"abstract":"<p><strong>Background and aims: </strong>Gastrointestinal (GI) endoscopy has known a great evolution in the last decades. Imaging techniques evolved from imaging with only standard white light endoscopes toward high-definition resolution endoscopes and the use of multiple color enhancement techniques, over to automated endoscopic assessment systems based on artificial intelligence. This narrative literature review aimed to provide a detailed overview on the latest evolutions within the field of advanced GI endoscopy, mainly focusing on the screening, diagnosis, and surveillance of common upper and lower GI pathology.</p><p><strong>Methods: </strong>This review comprises only literature about screening, diagnosis, and surveillance strategies using advanced endoscopic imaging techniques published in (inter)national peer-reviewed journals and written in English. Studies with only adult patients included were selected. A search was performed using MESH terms: dye-based chromoendoscopy, virtual chromoendoscopy, video enhancement technique, upper GI tract, lower GI tract, Barrett's esophagus, esophageal squamous cell carcinoma, gastric cancer, colorectal polyps, inflammatory bowel disease, artificial intelligence. This review does not elaborate on the therapeutic application or impact of advanced GI endoscopy.</p><p><strong>Conclusions: </strong>Focusing on current and future applications and evolutions in the field of both upper and lower GI advanced endoscopy, this overview is a practical but detailed projection of the latest developments. Within this review, an active leap toward artificial intelligence and its recent developments in GI endoscopy was made. Additionally, the literature is weighted against the current international guidelines and assessed for its potential positive future impact.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"30 3","pages":"175-191"},"PeriodicalIF":0.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/12/c0/pjg-0030-0175.PMC10305270.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10114473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treating Advanced Hepatocellular Carcinoma with Sorafenib: A 10-Year Single Center Experience.","authors":"José Presa Ramos,&nbsp;Sofia Tavares,&nbsp;Ana Barreira,&nbsp;Joana Liz Pimenta,&nbsp;Sónia Carvalho,&nbsp;Paulo Carrola,&nbsp;Inês Pinho","doi":"10.1159/000522572","DOIUrl":"https://doi.org/10.1159/000522572","url":null,"abstract":"<p><strong>Introduction: </strong>Sorafenib was the first therapy used for systemic treatment of unresectable hepatocellular carcinoma (HCC). Multiple prognosis factors associated with sorafenib therapy have been described.</p><p><strong>Objectives: </strong>The aim of this work was to evaluate survival and time to progression (TTP) on HCC patients treated with sorafenib, and check for predictive factors of sorafenib benefit.</p><p><strong>Materials and methods: </strong>Retrospectively, data from all HCC patients treated with sorafenib in a Liver Unit from 2008 to 2018 were collected and analyzed.</p><p><strong>Results: </strong>Sixty-eight patients were included; 80.9% were male, the median age was 64.5 years, 57.4% had Child-Pugh A cirrhosis and 77.9% were BCLC stage C. Macrovascular invasion (MVI) was present in 25% of the patients and 25% of the subjects had other extrahepatic metastasis. The median survival was 10 months (IQR 6.0-14.8) and median TTP was 5 months (IQR 2.0-7.0). Survival and TTP were similar between Child-Pugh A and B patients: 11.0 months (IQR 6.0-18.0) for Child-Pugh A and 9.0 months (IQR 5.0-14.0) for Child-Pugh B (<i>p</i> = 0.336). In univariate analysis, larger lesion size (LS >5 cm), higher alpha-fetoprotein (AFP >50 ng/mL), and no history of locoregional therapy were statistically associated with mortality (HR 2.17, 95% CI 1.24-3.81; HR 3.49, 95% CI 1.90-6.42; HR 0.54, 95% CI 0.32-0.93, respectively), but only LS and AFP were independent predictive factors, as shown in multivariate analysis (LS: HR 2.08, 95% CI 1.10-3.96; AFP: HR 3.13, 95% CI 1.59-6.16). MVI and LS >5 cm were associated with TTP shorter than 5 months in univariate analysis (MVI: HR 2.80, 95% CI 1.47-5.35; LS: HR 2.1, 95% CI 1.08-4.11), but only MVI was an independent predictive factor of TTP shorter than 5 months (HR 3.42, 95% CI 1.72-6.81). Regarding safety data, 76.5% of patients reported at least one side effect (any grade), and 19.1% presented grade III-IV adverse effects leading to treatment discontinuation.</p><p><strong>Conclusions: </strong>We observed no significant difference in survival or TTP in Child-Pugh A or Child-Pugh B patients treated with sorafenib, as compared to more recent real-life studies. Lower primary LS and AFP were associated with a better outcome, and lower AFP was the main predictor of survival. The reality of systemic treatment for advanced HCC has recently changed and continues to evolve, but sorafenib remains a viable therapeutic option.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"30 3","pages":"213-220"},"PeriodicalIF":0.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cd/f2/pjg-0030-0213.PMC10305257.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10114479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative Care in Advanced Liver Disease: Similar or Different Palliative Care Needs in Patients with a Prospect of Transplantation? Prospective Study from a Portuguese University Hospital and Transplantation Center.","authors":"Sara Neves Vieira da Silva,&nbsp;Patricia Baptista,&nbsp;Isabel Fonseca Silva,&nbsp;Elga Freire,&nbsp;Helena Pessegueiro Miranda","doi":"10.1159/000522172","DOIUrl":"https://doi.org/10.1159/000522172","url":null,"abstract":"<p><strong>Background and aims: </strong>End-stage liver disease (ESLD) is an important cause of morbidity and mortality, comparable to a large extent to other organ insufficiencies. The need for palliative care (PC) in patients with ESLD is high. In Portugal, in the only identified study, more than 80% of patients hospitalized with ESLD had criteria for PC. No results specified which needs they identified or their transplantation prospect status.</p><p><strong>Methods: </strong>Prospective observational study including 54 ESLD patients who presented to a university hospital and transplantation center, between November 2019 and September 2020. Assessment of their PC needs through the application of NECPAL CCOMS-ICO^© and IPOS, considering their transplantation perspective status.</p><p><strong>Results: </strong>Of the 54 patients, 5 (9.3%) were on active waiting list for transplantation and 8 (14.8%) under evaluation. NECPAL CCOMS-ICO^© identified 23 patients (n = 42.6%) that would benefit from PC. Assessment of PC needs by clinicians, functional markers and significant comorbidities were the most frequent criteria (47.8%, n = 11). IPOS also revealed a different sort of needs: on average, each patient identified about 9 needs (8.9 ±2.8). Among the symptoms identified, weakness (77.8%), reduced mobility (70.3%), and pain (48.1%) stood out, as well as the psychoemotional symptoms of depression (66.7%) and anxiety (77.8%). There were no significant differences between the subgroups of patients analyzed. Only 4 patients (7.4%) were followed by the PC team.</p><p><strong>Conclusion: </strong>All the ESLD patients included, independently of the group they belonged to, presented with PC needs. No significant differences between the subgroups of patients were identified, confirming that even patients with a transplantation prospect have important needs for PC.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"30 3","pages":"204-212"},"PeriodicalIF":0.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e9/66/pjg-0030-0204.PMC10305251.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9736980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical Analysis of the Applicability of Small Bowel Capsule Endoscopy Performance Measures among 2 Portuguese Centers with Different Capsule Endoscopy Platforms.","authors":"Catarina Gomes,&nbsp;Catarina O'Neill,&nbsp;Rolando Pinho,&nbsp;Rita Barosa,&nbsp;Ana Ponte,&nbsp;Pedro Magalhães-Costa,&nbsp;Adélia Rodrigues,&nbsp;Cristina Chagas,&nbsp;João Carvalho","doi":"10.1159/000523773","DOIUrl":"https://doi.org/10.1159/000523773","url":null,"abstract":"<p><strong>Introduction: </strong>The European Society of Gastrointestinal Endoscopy (ESGE) identified the need to benchmark the quality of small bowel capsule endoscopy (SBCE) and produced a set of performance measures (PM). The aim of this study is to critically evaluate the accordance of the PM for SBCE in two Portuguese centers with different SBCE platforms.</p><p><strong>Methods: </strong>The authors conducted a cross-sectional analysis of consecutive SBCE performed in an 18-month period in 2 Portuguese centers that used two different SBCE platforms Mirocam® (IntroMedic, Seoul, South Korea) and PillCam® (Medtronic, Yokneam, Israel). A total of 10 PM (6 key, 4 minor) were evaluated and compared between the 2 centers.</p><p><strong>Results: </strong>A total of 493 SBCE were included. The minimum standard established by ESGE was reached in 3/6 key PM (complete visualization, lesion detection rate, and capsule retention rate), and none of the 4 minor PM. PM compliance significantly differed between the 2 centers: complete small bowel visualization 95.9 and 90% (<i>p</i> = 0.01), diagnostic yield 50.6 and 63% (<i>p</i> = 0.005), adequate small bowel cleansing level according to Brotz scale 69.54 and 84.6% (<i>p</i> ≤ 0.001), patients with high risk of capsule retention offered a patency capsule 4.2 and 73% (<i>p</i> ≤ 0.001), respectively.</p><p><strong>Conclusion: </strong>This study highlights and critically discusses technical and organizational issues that should be considered in defining more realistic PM thresholds, aiming to improve SBCE quality.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"30 3","pages":"230-238"},"PeriodicalIF":0.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/75/2b/pjg-0030-0230.PMC10305259.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10114478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anastomotic Leakages after Surgery for Gastroesophageal Cancer: A Systematic Review and Meta-Analysis on Endoscopic versus Surgical Management.","authors":"Isabel Azevedo,&nbsp;Raquel Ortigão,&nbsp;Pedro Pimentel-Nunes,&nbsp;Pedro Bastos,&nbsp;Rui Silva,&nbsp;Mário Dinis-Ribeiro,&nbsp;Diogo Libânio","doi":"10.1159/000527769","DOIUrl":"https://doi.org/10.1159/000527769","url":null,"abstract":"<p><strong>Introduction: </strong>With the increase of esophageal and gastric cancer, surgery will be more often performed. Anastomotic leakage (AL) is one of the most feared postoperative complications of gastroesophageal surgery. It can be managed by conservative, endoscopic (such as endoscopic vacuum therapy and stenting), or surgical methods, but optimal treatment remains controversial. The aim of our meta-analysis was to compare (a) endoscopic and surgical interventions and (b) different endoscopic treatments for AL following gastroesophageal cancer surgery.</p><p><strong>Methods: </strong>Systematic review and meta-analysis, with search in three online databases for studies evaluating surgical and endoscopic treatments for AL following gastroesophageal cancer surgery.</p><p><strong>Results: </strong>A total of 32 studies comprising 1,080 patients were included. Compared with surgical intervention, endoscopic treatment presented similar clinical success, hospital length of stay, and intensive care unit length of stay, but lower in-hospital mortality (6.4% [95% CI: 3.8-9.6%] vs. 35.8% [95% CI: 23.9-48.5%]. Endoscopic vacuum therapy was associated with a lower rate of complications (OR 0.348 [95% CI: 0.127-0.954]), shorter ICU length of stay (mean difference -14.77 days [95% CI: -26.57 to -2.98]), and time until AL resolution (17.6 days [95% CI: 14.1-21.2] vs. 39.4 days [95% CI: 27.0-51.8]) when compared with stenting, but there were no significant differences in terms of clinical success, mortality, reinterventions, or hospital length of stay.</p><p><strong>Conclusions: </strong>Endoscopic treatment, in particular endoscopic vacuum therapy, seems safer and more effective when compared with surgery. However, more robust comparative studies are needed, especially for clarifying which is the best treatment in specific situations (according to patient and leak characteristics).</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"30 3","pages":"192-203"},"PeriodicalIF":0.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7d/f2/pjg-0030-0192.PMC10305273.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9736985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epithelioid Hemangioendothelioma in a Liver Transplant Recipient: A Case Report of an Extremely Rare Tumor.","authors":"Margarida Gonçalves, Helena Pessegueiro, Judit Gandara, José Ramón Vizcaíno, Vitor Lopes, Sofia Ferreira","doi":"10.1159/000529157","DOIUrl":"https://doi.org/10.1159/000529157","url":null,"abstract":"<p><p>Epithelioid hemangioendothelioma is a very rare vascular neoplasm, which is often multifocal or metastatic at diagnosis. Most frequently arises in the liver, followed by the lung and bones. The authors present a case of a liver transplant recipient who developed a pattern of hepatic cholestasis associated with the appearance of a proliferative hepatic lesion with infiltrative growth. Histological examination and immunohistochemical study were compatible with the diagnosis of epithelioid hemangioendothelioma. Pulmonary micronodules were detected and lung metastases were hypothesized. Therefore, bronchoscopy was performed, which turned out to be normal, and cytology was negative for neoplastic cells. After a multidisciplinary discussion, liver re-transplantation was decided. After 8 years of follow-up, the patient is clinically stable, with no graft dysfunction, no neoplastic recurrence, and dimensional stability of the pulmonary micronodules. Patients with organ transplant have higher risk of developing carcinoma compared to the general population. The development of cancer is a multifactorial process and little is known about the etiology of epithelioid hemangioendothelioma. No standard treatment strategy has been defined yet, and the natural course of the disease is heterogenous and the individual prognosis unpredictable. Complete surgical resection is offered to patients with unifocal disease, and those with unresectable disease should be evaluated for orthotopic liver transplantation.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"31 2","pages":"124-128"},"PeriodicalIF":0.9,"publicationDate":"2023-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10987069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EUS-Guided Choledochoduodenostomy after Failed Endoscopic Retrograde Cholangiopancreatography in Distal Malignant Biliary Obstruction.","authors":"Isabel Tarrio,&nbsp;Marta Moreira,&nbsp;Tarcísio Araújo,&nbsp;Luís Lopes","doi":"10.1159/000528808","DOIUrl":"https://doi.org/10.1159/000528808","url":null,"abstract":"<p><strong>Introduction: </strong>Malignant biliary obstruction drainage is essential, since jaundice is associated with morbidity and mortality. Endoscopic retrograde cholangiopancreatography (ERCP) is the recommended procedure for biliary drainage, with percutaneous biliary drainage being the classic alternative in cases of unsuccessful ERCP. Recently, endoscopic ultrasound-guided biliary drainage has been emerged as a new option, with EUS-guided choledochoduodenostomy (EUS-CDS) being considered an effective and safe method in the drainage of distal obstructions of the common bile duct.</p><p><strong>Aim: </strong>The aim of the study was to evaluate the efficacy and safety of EUS-CDS performed in patients with distal malignant biliary obstructions, after failed ERCP.</p><p><strong>Methods: </strong>Single-center retrospective cohort study between July 2017 and June 2022 including all consecutive patients submitted to EUS-CDS in our center. The primary outcomes were \"technical success\" and \"clinical success,\" defined as \"resolution of jaundice or improvement in total serum bilirubin level above 50% at 7th day and above 75% at 30th day after the procedure.\" Secondary outcomes were procedure-related adverse events, endoscopic reintervention, and survival time.</p><p><strong>Results: </strong>EUS-CDS was performed in 20 patients (65.0% male; median age 76 years). The most frequent etiology for the biliary obstruction was pancreatic adenocarcinoma (<i>n</i> = 17; 85.0%), and most patients presented at advanced stages of cancer (12/60% in stages III or IV). ERCP failure was mainly due to the presence of obstruction in the duodenal lumen (<i>n</i> = 11; 55.0%). Fully covered metallic stents were used in all patients, mostly HotAxios^TM (<i>n</i> = 15; 75.0%). The technical success rate was 100%, and the clinical success rate was 89.5% (<i>n</i> = 17/19) at 7th day and 93.3% (<i>n</i> = 14/15) at 30th day. Four patients (20.0%) developed cholangitis within the first 30 days after the procedure; there were no late complications, and no patient died as a complication of the procedure. In 2 patients (10.0%), endoscopic reintervention was necessary due to stent migration, incidentally detected. Median survival was 93 days (minimum 5-maximum 751).</p><p><strong>Conclusion: </strong>EUS-CDS was effective in biliary decompression of malignant obstructions of the common bile duct, with high clinical success and a favorable safety profile.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"30 Suppl 1","pages":"65-73"},"PeriodicalIF":0.9,"publicationDate":"2023-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/19/9f/pjg-0030-0065.PMC10561318.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41219859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Retrograde Cholangiopancreatography on Pediatric Patients: Experience of a Portuguese Adult Gastroenterology Department","authors":"Rita Ornelas Saraiva, Verónica Pavão Borges, Mário Jorge Silva, Rafaela Loureiro, Tiago Capela, Gonçalo Ramos, Jorge Canena, António Mateus Dias, Rui Alves, João Coimbra","doi":"10.1159/000529090","DOIUrl":"https://doi.org/10.1159/000529090","url":null,"abstract":"<b><i>Introduction:</i></b> Experience with endoscopic retrograde cholangiopancreatography (ERCP) in the pediatric population is limited. Few medical centers have experts specifically trained in pediatric therapeutic endoscopy. As a result, patients are generally referred to adult endoscopists with high experience in the procedure. The aim of this study was to characterize the experience of an adult endoscopy unit with ERCP on pediatric patients, with a special focus on very young patients. <b><i>Methods:</i></b> We retrospectively analyzed indications, technical success rate, final clinical diagnosis, and complications of ERCPs in children &amp;#x3c;18 years at our tertiary referral hospital center between January 1994 and June 2022. <b><i>Results:</i></b> Sixty-five ERCPs were performed on 57 children with a median age of 13 years (range 1–17 years). Eleven ERCPs were performed on 9 patients up to 5 years old. Indications for ERCP were as follows: biliary obstruction (<i>n</i> = 40), mainly due to choledocholithiasis, lithiasic acute pancreatitis (<i>n</i> = 19), recurrent pancreatitis (<i>n</i> = 3), stent extraction (<i>n</i> = 2), and post-operative biliary fistula (<i>n</i> = 1). The cannulation success rate was 95.1%. Therapeutic interventions were performed in 79% of ERCP. All patients were followed up as inpatients. Complications were recorded in two procedures (3.1%), and no procedure-related mortality occurred. <b><i>Conclusion:</i></b> In our experience, ERCP in children can be safely performed with high success rates by advanced adult-trained expert endoscopists at a high-volume center.","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136179187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transvenous Obliteration Procedure in the Management of Parastomal Variceal Bleeding: A Case Report.","authors":"João Estorninho,&nbsp;Pedro Patrão,&nbsp;Maria José Temido,&nbsp;David Perdigoto,&nbsp;Pedro Figueiredo,&nbsp;Paulo Donato","doi":"10.1159/000521325","DOIUrl":"https://doi.org/10.1159/000521325","url":null,"abstract":"<p><strong>Introduction: </strong>Parastomal variceal bleeding (PVB) is a recognized complication of ostomized patients in the presence of portal hypertension. However, since there are few reported cases, a therapeutic algorithm has not yet been established.</p><p><strong>Case presentation: </strong>A 63-year-old man, who had undergone a definitive colostomy, recurrently presented to the emergency department hemorrhage of bright red blood from his colostomy bag, initially assumed to be caused by stoma trauma. Accordingly, temporary success on local approaches such as direct compression, silver nitrate application and suture ligation was achieved. However, bleeding recurred, requiring transfusion of red blood cell concentrate and hospitalization. The patient's evaluation showed chronic liver disease with massive collateral circulation, particularly at the colostomy site. After a PVB with associated hypovolemic shock, the patient was submitted to a balloon-occluded retrograde transvenous obliteration (BRTO) procedure which stopped the bleeding successfully. The patient was subsequently proposed for a transjugular intrahepatic portosystemic shunt (TIPS) conjugated with percutaneous transhepatic obliteration (PTO). After an initial refusal by the patient, a new episode of self-limited PVB resulted in execution of the procedure. Four months later, in a routine consultation, the patient presented with grade II hepatic encephalopathy, successfully treated with medical therapy. After a 9-month follow-up, he remained clinically well and without further episodes of PVB or other adverse effects.</p><p><strong>Discussion: </strong>This report highlights the importance of a high index of suspicion when dealing with significant stomal hemorrhage. Portal hypertension as an etiology of this entity may compel to a specific approach to prevent recurrence of bleeding, including conjugation of endovascular procedures. The authors pre-sent a case of PVB, initially submitted to a variety of treatment options including BRTO, which was successfully addressed with conjugated treatment of TIPS and PTO.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"30 2","pages":"147-152"},"PeriodicalIF":0.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a7/1e/pjg-0030-0147.PMC10050841.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9235465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}