103 results on '"Carlos Guarner-Argente"'
Search Results
2. A Framework for the Evaluation of Human Machine Interfaces of Robot-Assisted Colonoscopy.
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Martina Finocchiaro, Tommaso Banfi, Sònia Donaire, Alberto Arezzo, Carlos Guarner-Argente, Arianna Menciassi, Alicia Casals, Gastone Ciuti, and Albert Hernansanz
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- 2024
- Full Text
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3. Guía clínica para la resección mucosa endoscópica de lesiones colorrectales no pediculadas
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Eduardo Albéniz, María Pellisé, Antonio-Z. Gimeno-García, Alfredo-José Lucendo, Pedro-A. Alonso-Aguirre, Alberto Herreros-de-Tejada, Marco-Antonio Álvarez, María Fraile, Maite Herráiz-Bayod, Leopoldo López-Rosés, David Martínez-Ares, Akiko Ono, Adolfo Parra-Blanco, Eduardo Redondo, Andrés Sánchez-Yagüe, Santiago Soto, José Díaz-Tasende, Marta Montes-Díaz, Manuel Rodríguez-Téllez, Orlando García, Alba Zuñiga-Ripa, Marta Hernández-Conde, Fernando Alberca-de-las-Parras, Carla Gargallo, Esteban Saperas, Miguel Muñoz-Navas, Javier Gordillo, Felipe Ramos-Zabala, José-Manuel Echevarría, Marco Bustamante, Mariano González-Haba, Ferrán González-Huix, Begoña González-Suárez, Juan-José Vila-Costas, Carlos Guarner-Argente, Fernando Múgica, Julyssa Cobián, Joaquín Rodríguez-Sánchez, Bartolomé López-Viedma, Noel Pin, José-Carlos Marín-Gabriel, Óscar Nogales, Joaquín de-la-Peña, Francisco-Javier Navajas-León, Helena León-Brito, David Remedios, José-Miguel Esteban, David Barquero, Juan-Gabriel Martínez-Cara, Felipe Martínez-Alcalá, Ignacio Fernández-Urién, and Eduardo Valdivielso
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Endoscopic mucosal resection ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
RESUMEN Este documento resume el contenido de la Guía de resección mucosa endoscópica elaborada por el grupo de trabajo de la Sociedad Española de Endoscopia Digestiva (GSEED de Resección Endoscópica) y expone las recomendaciones sobre el manejo endoscópico de las lesiones neoplásicas colorrectales superficiales.
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4. ENDOSCOPIC VACUUM THERAPY FOR UPPER GASTROINTESTINAL LEAKS AND PERFORATIONS: ANALYSIS FROM A MULTICENTER SPANISH REGISTRY
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Dulce, Momblan, primary, Antonio-Z, Gimeno Garcia, additional, David, Busquets, additional, Diego, Juzgado, additional, Javier, García Lledó, additional, Esther, Ferrero, additional, Javier, Tejedor-Tejada, additional, Félix, Junquera, additional, José, Díaz-Tasende, additional, Maria, Moris, additional, Enrique, Rodriguez de Santiago, additional, Joan, Gornals, additional, Carmen, Garrido, additional, Santiago, Gonzalez-Vazquez, additional, Carlos, Guarner-Argente, additional, Alejandro, Repiso, additional, Jose Miguel, Esteban, additional, Carme, Loras, additional, Agustín, Seoane, additional, Alejandro, Fernández-Simon, additional, Henry, Cordova Guevara, additional, Ainitze, Ibarzabal, additional, Xavier, Morales, additional, Anna, Curell, additional, Andrés, Cardenas, additional, José, Ríos, additional, Antonio Maria, de Lacy, additional, and Oriol, Sendino, additional
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- 2023
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5. Location, morphology and invasiveness of lateral spreading tumors in the colorectum differ between two large cohorts from an eastern and western country
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Juan Gabriel Martínez-Cara, Liseth Rivero-Sánchez, Marco Antonio Alvarez-Gonzalez, Jesús M. González-Santiago, Felipe Ramos Zabala, Joaquin De La Peña, Kazuhiro Kaneko, Alberto Álvarez Delgado, Carla Jerusalén-Gargallo, Joaquín Rodríguez Sánchez, Orlando García-Bosch, Hiroaki Ikematsu, María Fraile, Carlos Guarner-Argente, Remedios Pardeiro, Shozo Osera, Maria Pellise, Alberto Herreros de Tejada, Jordi Gordillo, Oscar Nogales Rincon, David Martínez-Ares, Fernando Múgica, Carlos Marra-López, Bartolomé López Viedma, Carol J. Cobián, Eduardo Valdivielso Cortázar, Francisco Pérez-Roldán, Eduardo Redondo-Cerezo, Juan Colán-Hernández, Pedro Aguirre, Esteve Saperas, Manuel Rodríguez-Téllez, Berta Ibáñez, Santiago Soto, Eduardo Albéniz, and Leopoldo López-Rosés
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medicine.medical_specialty ,Colorectal cancer ,Mixed type ,Gastroenterology ,Polyp ,Internal medicine ,medicine ,Humans ,Neoplasm Invasiveness ,Intestinal Mucosa ,Lateral spreding tumors ,Retrospective Studies ,LST ,Hepatology ,business.industry ,Incidence (epidemiology) ,Cancer ,Histology ,Colonoscopy ,General Medicine ,medicine.disease ,Homogeneous ,Dysplasia ,Cohort ,Colorectal Neoplasms ,business - Abstract
Background and study aims Data from Japanese series show that surface morphology of laterally spreading tumors (LST) in the colon identifies lesions with different incidence and pattern of submucosal invasion. Such data from western countries are scarce. We compared clinical and histological features of LST in a western country and an eastern country, with special interest on mucosal invasiveness of LST, and investigated the effect of clinical factors on invasiveness in both countries. Patients and methods Patients with LST lesions ≥20 mm were included from a multicenter prospective registry in Spain and from a retrospective registry from the National Cancer Center Hospital East, Japan. The primary outcome was the presence of submucosal invasion in LST. The secondary outcome was the presence of high-risk histology, defined as high-grade dysplasia or submucosal invasion. Results We evaluated 1102 patients in Spain and 663 in Japan. Morphological and histological characteristics differed. The prevalence of submucosal invasion in Japan was six-fold the prevalence in Spain (Prevalence Ratio PR = 5.66; 95%CI: 3.96, 8.08), and the prevalence of high-risk histology was 1.5 higher (PR = 1.44; 95%CI: 1.31, 1.58). Compared to the granular homogeneous type and adjusted by clinical features, granular mixed, flat elevated, and pseudo-depressed types were associated with higher odds of submucosal invasion in Japan, whereas only the pseudo-depressed type showed higher risk in Spain. Regarding high-risk histology, both granular mixed and pseudo-depressed were associated with higher odds in Japan, compared with only the granular mixed type in Spain. Conclusion This study reveals differences in location, morphology and invasiveness of LST in an eastern and a western cohort.
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- 2022
6. Is a coaxial plastic stent within a lumen-apposing metal stent useful for the management of distal malignant biliary obstruction?
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Silvia Salord, Cristian Tebé, Albert Garcia-Sumalla, Juli Busquets, Xavier Andújar, Carlos Guarner-Argente, Berta Laquente, Julio G. Velasquez-Rodriguez, Joan B. Gornals, and C Loras
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Lumen (anatomy) ,Stent ,Retrospective cohort study ,Hepatology ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Internal medicine ,Therapeutic endoscopy ,medicine ,030211 gastroenterology & hepatology ,Prospective cohort study ,business ,Survival rate ,Abdominal surgery - Abstract
There are uncertainties concerning the possible benefits derived from the insertion of double-pigtail plastic stents (DPS) within lumen-apposing metal stents (LAMS) in EUS-guided choledochoduodenostomy (CDS). The aim of this study was to determine whether a DPS within a biliary LAMS offers a potential benefit in EUS-guided CDS for the palliative management of malignant biliary obstruction. This was a multicentre retrospective study at three tertiary institutions. Period: May 2015 to August 2020. Two interventional strategies (LAMS alone and LAMS plus DPS) were compared. The choice was the endoscopist’s discretion. Inclusion: unresectable/inoperable biliopancreatic tumours with previous failed ERCP. Clinical success: bilirubin decrease > 30% at 4 weeks. Forty-one consecutive cases of EUS-CDS using biliary LAMS were treated (22 women; mean age, 72.3 years) during the study period. The procedure was technically successful in 39 (95.1%), who were managed using the two strategies (22 LAMS alone; 17 LAMS plus DPS). No differences between the groups, in terms of clinical success (77.3 vs 87.5%, p = 0.67), adverse events (AEs, 13.6 vs 11.8%, p = 0.99), recurrent biliary obstruction (RBO, 13.6 vs 23.5%, p = 0.67), or survival rate (p = 0.67) were encountered. The LAMS alone group had a shorter length of procedure (50 min vs 66 min, p = 0.102). No risk factors related to clinical success, AEs, RBO, or survival were detected. The technical variant of adding a coaxial DPS within LAMS in EUS-CDS seems not to be enough to prevent biliary morbidities, and it is a time-consuming strategy. Although prospective studies are needed, these results do not support its routine use.
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- 2021
7. Predictors of the need for necrosectomy in patients with walled-off pancreatic necrosis treated with lumen apposition metal stents
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Beatriz de Riba, Germán Soriano, Juan Colán-Hernández, Juan Carlos Pernas, Anna Brujats, Mar Concepción, Sergio Bazaga, Carlos Guarner-Argente, Mireia Trias, Laura González-González, Raffaella Romito, Jordi Gordillo, Marianette Murzi, and Maria Poca
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medicine.medical_specialty ,Necrosis ,business.industry ,medicine.medical_treatment ,Lumen (anatomy) ,Stent ,Hepatology ,medicine.disease ,Surgery ,03 medical and health sciences ,Pseudoaneurysm ,Apposition ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,030211 gastroenterology & hepatology ,Embolization ,medicine.symptom ,business ,Abdominal surgery - Abstract
Endoscopic necrosectomy through lumen apposition metal stents (LAMS) is increasingly being used for complicated walled-off pancreatic necrosis (WOPN), but the need for necrosectomy after stent placement is not well understood. The aim of this study was to evaluate clinical, endoscopic, and radiologic predictors of the need for necrosectomy in patients treated with LAMS. We retrospectively reviewed patients with WOPN treated with LAMS from 2014 to 2017. Necrosectomy was performed only in patients who had recurrent fever or hemodynamic instability during follow-up. Univariate and multivariate analyses were performed. We included 15 patients, 67% men and median age was 75 (54–76) years. Two (13%) presented adverse events, one immediate and one delayed. In the first case, the stent migrated to the gastric cavity during deployment but was relocated in the same procedure. In the second case, the patient presented bleeding on day 36 due to a pseudoaneurysm that was successfully treated with embolization. Clinical success was 100%, but five patients (33%) required endoscopic necrosectomy (4 mechanical and 1 irrigation) and one (7%) required surgical necrosectomy of distant collections. The percentage of necrosis in the collection detected in a previous CT scan (45 [35–66]% vs 10 [5–17]%) was the only factor to predict the need for necrosectomy in the multivariate analysis (OR 1.18 [1.01–1.39]). LAMS is efficient to treat WOPN but more than a third will need necrosectomy. The percentage of necrosis in the collection detected in the CT scan seems to predict the need for necrosectomy.
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- 2021
8. CARACTERÍSTICAS Y EVOLUCIÓN DEL ESÓFAGO DE BARRETT EN NUESTRO MEDIO. ESTUDIO EPIBARRETT
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Marianette Murzi Pulgar, Alain Huerta Madrigal, Cristina Sánchez Montes, Gloria Fernández Esparrach, Marina Puya Gamarro, Luis Hernández Villalba, Manuel Domínguez Cajal, David Nicolás Pérez, Marta Aicart Ramos, Alba Lira Aguilar, Norberto Mañas Gallardo, Jorge López Vicente, Pablo Ruiz Ramírez, Elida Oblitas, Carlos Huertas Nadal, Eloi Núñez García, Lidia Arguello, Ángeles Pérez Aisa, Enrique de la Fuente Fernández, Carmen Loras, and Carlos Guarner Argente
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Hepatology ,Gastroenterology - Published
- 2023
9. 4 - ESTUDIO COMPARATIVO DE DIFERENTES INTERFACES HOMBRE-MÁQUINA PARA LA OPTIMIZACIÓN DE LA COLONOSCOPIA ROBÓTICA EN UN SIMULADOR VIRTUAL
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Martína Finocchiaro, Alberto Arezzo, Jordi Gordillo, Mar Concepción, Cristina Romero, Arianna Menciassi, Alicia Casals, Gastone Ciuti, Albert Hernansanz, and Carlos Guarner-Argente
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Hepatology ,Gastroenterology - Published
- 2023
10. 17 - VALIDACIÓN DE UN SISTEMA DE SIMULACIÓN VIRTUAL DE COLONOSCOPIA ROBÓTICA
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Martína Finocchiaro, Alberto Arezzo, Marianette Murzi, Raffaella Romito, Arianna Menciassi, Alicìa Casals, Gastone Ciuti, Albert Hernansanz, and Carlos Guarner-Argente
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Hepatology ,Gastroenterology - Published
- 2023
11. TERAPIA DE VACÍO ENDOSCÓPICA EN EL TRATAMIENTO DE LAS DEHISCENCIAS DE SUTURA ANASTOMÓTICAS Y PERFORACIONES DEL TRACTO DIGESTIVO SUPERIOR. RESULTADOS DEL REGISTRO MULTICÉNTRICO ESPAÑOL
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Oriol Sendino Garcia, David Busquets, Antonio Z. Gimeno-García, Diego Juzgado, Javier García-Lledó, Esther Ferrero, Javier Tejedor, Félix Junquera, José Díaz-Tasende, María Moris, Joan Gornals, Carmen Garrido, Santiago González, Carlos Guarner-Argente, Alejandro Repiso, José Miguel Esteban, Carme Loras, Agustín Seoane, Andrés Cárdenas, Henry Córdova, Alejandro Fernández-Simón, Ainitze Ibarzábal, Xavier Morales, Anna Curell, Irina Sofía Luzko, Antonio Maria de Lacy, Josep Llach, and Dulce Momblán
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Hepatology ,Gastroenterology - Published
- 2023
12. EUS-guided gastroenterostomy versus duodenal self-expandable metal stent for malignant gastric outlet obstruction: results from a nationwide multicenter retrospective study (with video)
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Rubén Sánchez-Aldehuelo, José Carlos Subtil Iñigo, Belén Martínez Moreno, Joan Gornals, Carlos Guarner-Argente, Alejandro Repiso Ortega, Sandra Peralta Herce, José Ramón Aparicio, Enrique Rodríguez de Santiago, Sergio Bazaga, Diego Juzgado, Fernando González-Panizo, Agustín Albillos, and Enrique Vázquez-Sequeiros
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Pancreatic Neoplasms ,Gastric Outlet Obstruction ,Self Expandable Metallic Stents ,Gastroenterology ,Humans ,Stents ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Gastroenterostomy ,Retrospective Studies - Abstract
Traditionally, palliative treatment of malignant gastric outlet obstruction (GOO) has been surgical, but surgical treatment carries significant morbidity and mortality rates. Endoscopic placement of a duodenal self-expandable metal stent (D-SEMS) has been proven to be successful for this indication in the short term. However, D-SEMSs are likely to malfunction over time. EUS-guided gastroenterostomy (EUS-GE) may help overcome these limitations. We aimed to evaluate stent failure-free survival at 3 months.A nationwide multicenter, observational study of D-SEMS and EUS-GE procedures for patients with malignant GOO was conducted at 7 academic centers from January 2015 to June 2020. Stent failure-free survival at 1, 3, and 6 months; technical and clinical success; adverse events (AEs); and patient survival were evaluated in both groups and compared.Ninety-seven patients were included in the D-SEMS group and 79 in the EUS-GE group. Pancreatic cancer was the main underlying malignancy in 53.4%. No statistically significant differences regarding technical (92.8% vs 93.7%) or clinical success (83.5% vs 92.4%) were found. AE rates did not differ between groups (10.3% vs 10.1%), although 2 events in the EUS-GE group required surgical management. Patients in the EUS-GE group had improved stent patency when compared with those patients in the D-SEMS group at 3 months (92.23% vs 80.6%; adjusted hazard ratio, .37; P = .033).EUS-GE seems to have improved patency outcomes when compared with D-SEMS placement for palliative treatment of malignant GOO. Prospective trials are needed to fully compare their efficacy and AE profile.
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- 2022
13. PLASTIC PIGTAIL VS. LUMEN-APPOSING METAL STENTS IN ENDOSCOPIC ULTRASOUND-GUIDED DRAINAGE OF WALLED-OFF PANCREATIC NECROSIS: A MULTICENTRE RANDOMISED TRIAL (THE PROMETHEUS STUDY)
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Julio G. Velasquez-Rodriguez, Francesc Bas-Cutrina, Enrique Vazquez-Sequeiros, Jose Miguel Esteban, Alvaro Teran, Ferran González-Huix, Manuel Perez-Miranda, Carlos Guarner-Argente, Juan J. Vila, Albert Garcia-Sumalla, Ana Garcia Garcia de Paredes, Joaquin Fisac- Vazquez, Maria Moris, Isabel Miguel, Carlos De La Serna, Marianette Murzi, Silvia Salord, José Ramón Foruny, Sandra Ruiz-Osuna, Nuria Pelaez-Serra, Mireia Sanllorente, Cristian Tebé, Pilar Hereu, and Joan B. Gornals-Soler
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Gastroenterology ,Radiology, Nuclear Medicine and imaging - Published
- 2022
14. REGISTRO ESPAÑOL DE EFICACIA Y SEGURIDAD DE LA TERAPIA DE VACÍO ENDOSCÓPICA COMO TRATAMIENTO DE PERFORACIONES Y DEHISCENCIAS DEL TRACTO DIGESTIVO SUPERIOR. RESULTADOS PRELIMINARES
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A. Lacy, José Miguel Esteban, Javier García-Lledó, Félix Junquera, Joan B. Gornals, Josep Llach, Diego Juzgado, Antonio Z. Gimeno-García, Dulce Momblan, Carlos Guarner-Argente, Carlos Huertas, Andrés Cárdenas, María Moris, Henry Córdova, David Busquets, Alejandro Repiso, Carmen Garrido, Oriol Sendino, Alejandro Bofill, Alejandro Fernandez-Simon, Álvaro Terán, Santiago González, Agustín Seoane, and Esther Ferrero
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- 2021
15. Técnica de retirada de las prótesis de aposición luminal y análisis de seguridad. Resultados de una serie de casos prospectiva multicéntrica
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Isabel Pinto, Sergio Bazaga, Rafael Villanueva, José Ramón Aparicio, Jose Luis Castro, Vicente Sanchiz, Juan Colán-Hernández, E Vázquez-Sequeiros, Leticia Pérez-Carazo, Joan B. Gornals, Manuel Perez-Miranda, Eloy Sánchez-Hernández, Francisco Javier García-Alonso, Carles Suria, Albert Garcia-Sumalla, Antonio Guardiola-Arévalo, Carlos Chavarría, Belén Martínez, Angels Vilella, Carlos Huertas, Álvaro Terán, Jose Carlos Subtil, Felipe de la Morena, Ignacio Couto-Worner, Jorge Nuñez-Otero, Carlos Guarner-Argente, Francisco Uceda, Ferran González-Huix, Francisco Jose García-Fernández, Antonio Pérez-Millán, Carlos De la Serna, Carme Loras, Victoria Busto, and Rafael Pedraza
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- 2021
16. ¿Reducen las prótesis plásticas tipo pigtail coaxiales a las prótesis de aposición luminal los eventos adversos en colecciones pancreáticas, drenajes vesiculares y coledocianos?
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Francisco Uceda, Ferran González-Huix, Isabel Pinto, Sergio Bazaga, Carme Loras, Victoria Busto, Antonio Guardiola-Arévalo, E Vázquez-Sequeiros, Vicente Sanchiz, Leticia Pérez-Carazo, Jose Carlos Subtil, Felipe de la Morena, Juan Colán-Hernández, Jorge Nuñez-Otero, Carlos Guarner-Argente, Eloy Sánchez-Hernández, Joan B. Gornals, Carlos Huertas, Carles Suria, Àngels Vilella-Martorell, Rafael Villanueva, Antonio Pérez-Millán, Rafael Pedraza, José Ramón Aparicio, Ignacio Couto-Worner, Álvaro Terán, Carlos De la Serna, Francisco Javier García-Alonso, Francisco Jose García-Fernández, Jose Luis Castro Urda, Manuel Perez-Miranda, Albert Garcia-Sumalla, Carlos Chavarría, and Belén Martínez
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- 2021
17. Use of electrosurgical units in the endoscopic resection of gastrointestinal tumors
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José Carlos Marín-Gabriel, Joaquín Rodríguez-Sánchez, Raffaella Romito, Takashi Toyonaga, Carlos Guarner-Argente, and José Santiago-García
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Pacemaker, Artificial ,medicine.medical_specialty ,Electrosurgery ,Gastrointestinal tumors ,medicine.medical_treatment ,Endoscopic mucosal resection ,Sphincterotomy, Endoscopic ,03 medical and health sciences ,0302 clinical medicine ,Microcomputers ,Electrosurgical unit ,Gastroscopy ,Humans ,Medicine ,Endoscopic resection ,Intraoperative Complications ,Gastrointestinal Neoplasms ,Hepatology ,medicine.diagnostic_test ,business.industry ,General surgery ,Burns, Electric ,Gastroenterology ,Equipment Design ,Endoscopic submucosal dissection ,Defibrillators, Implantable ,Endoscopy ,030220 oncology & carcinogenesis ,Equipment Failure ,030211 gastroenterology & hepatology ,business ,Electromagnetic Phenomena ,Procedures and Techniques Utilization ,Medical literature - Abstract
Electrosurgical units (ESUs) are indispensable devices in our endoscopy units. However, many endoscopists are not well-trained on their use and their physical bases are usually not properly studied or understood. In addition, comparative data concerning the settings that may be applied in different circumstances are scarce in the medical literature. Given that it is important to be aware of their strengths and risks, we conducted a review of the available information and research on this topic.
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- 2019
18. Low Grade Neoplasia And Colorectal (CR) Endoscopic Submucosal Dissection (ESD): Are The Adverse Events Acceptable? Results Of A Prospective Multicentre Registry
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P Miranda-García, H Uchima-Koecklin, S Parejo-Carbonell, R Durán-Bermejo, C Dolz-Abadía, José Carlos Marín-Gabriel, Alberto Herreros-de-Tejada, U Goikoetxea-Rodero, J Díaz-Tasende, A Álvarez-Delgado, F Ramos-Zabala, Liseth Rivero-Sánchez, Á Terán-Lantarón, D Pérez, A Amorós-Tenorio, David Busquets, Joaquín Rodríguez-Sánchez, B Peñas-García, Marco Bustamante-Balén, E Albéniz-Arbizu, H Cortés-Pérez, D García-Romero, P Gonçalves-da-Cunha, J Santiago-García, PJ Rosón-Rodríguez, A Burgos-García, J Gordillo-Ábalos, Carlos Guarner-Argente, Ó Nogales-Rincón, A del-Pozo-García, E Rodríguez-de-Santiago, Gloria Fernández-Esparrach, P De-María-Pallarés, Andres Sanchez-Yague, and O Díaz-Canel
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medicine.medical_specialty ,business.industry ,medicine ,Endoscopic submucosal dissection ,Adverse effect ,business ,Surgery - Published
- 2021
19. Endoscopic Band Ligation Without Resection Of Small-Sized Subepithelial Tumours: Results In Long-Term Follow Up Of A Multicentre Prospective Study (Banding-Set)
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Ferrán González-Huix, Raquel Ballester-Clau, S Maisterra, C Loras, L Pardo-Grau, Carlos Huertas, M Vilanova-Serra, X Andujar, P Ruiz-Ramírez, A Garcia-Sumalla, Carlos Guarner-Argente, A. Pardo, F Bas-Cutrina, JB Gornals, J Colán-Hernández, and CF Consiglieri
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medicine.medical_specialty ,Long term follow up ,business.industry ,Medicine ,Ligation ,business ,Prospective cohort study ,Surgery ,Resection - Published
- 2021
20. Is a coaxial plastic stent within a lumen-apposing metal stent useful for the management of distal malignant biliary obstruction?
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Albert, Garcia-Sumalla, Carme, Loras, Carlos, Guarner-Argente, Julio G, Velasquez-Rodriguez, Xavier, Andujar, Silvia, Salord, Juli, Busquets, Cristian, Tebe, Berta, Laquente, and Joan B, Gornals
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Male ,Cholestasis ,Neoplasms ,Drainage ,Humans ,Female ,Stents ,Plastics ,Aged ,Endosonography ,Retrospective Studies - Abstract
There are uncertainties concerning the possible benefits derived from the insertion of double-pigtail plastic stents (DPS) within lumen-apposing metal stents (LAMS) in EUS-guided choledochoduodenostomy (CDS). The aim of this study was to determine whether a DPS within a biliary LAMS offers a potential benefit in EUS-guided CDS for the palliative management of malignant biliary obstruction.This was a multicentre retrospective study at three tertiary institutions.May 2015 to August 2020. Two interventional strategies (LAMS alone and LAMS plus DPS) were compared. The choice was the endoscopist's discretion. Inclusion: unresectable/inoperable biliopancreatic tumours with previous failed ERCP. Clinical success: bilirubin decrease 30% at 4 weeks.Forty-one consecutive cases of EUS-CDS using biliary LAMS were treated (22 women; mean age, 72.3 years) during the study period. The procedure was technically successful in 39 (95.1%), who were managed using the two strategies (22 LAMS alone; 17 LAMS plus DPS). No differences between the groups, in terms of clinical success (77.3 vs 87.5%, p = 0.67), adverse events (AEs, 13.6 vs 11.8%, p = 0.99), recurrent biliary obstruction (RBO, 13.6 vs 23.5%, p = 0.67), or survival rate (p = 0.67) were encountered. The LAMS alone group had a shorter length of procedure (50 min vs 66 min, p = 0.102). No risk factors related to clinical success, AEs, RBO, or survival were detected.The technical variant of adding a coaxial DPS within LAMS in EUS-CDS seems not to be enough to prevent biliary morbidities, and it is a time-consuming strategy. Although prospective studies are needed, these results do not support its routine use.
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- 2020
21. ID: 3517677 ENDOSCOPIC BAND LIGATION WITHOUT RESECTION OF SMALL-SIZED SUBEPITHELIAL TUMOURS: RESULTS IN LONG-TERM FOLLOW UP OF A MULTICENTRE PROSPECTIVE STUDY (BANDING-SET)
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Claudia F. Consiglieri, Alberto Pardo Balteiro, Pablo Ruiz-Ramirez, Joan B. Gornals, Carme Loras, Ferran González-Huix, Albert Garcia-Sumalla, Magdalena Vilanova-Serra, Xavi Andujar, Sandra Maisterra, Juan Colán, Francesc Bas-Cutrina, Raquel Ballester, Carlos Huertas, Laura Pardo-Grau, and Carlos Guarner-Argente
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medicine.medical_specialty ,business.industry ,Long term follow up ,Gastroenterology ,Medicine ,Radiology, Nuclear Medicine and imaging ,Ligation ,business ,Prospective cohort study ,Surgery ,Resection - Published
- 2021
22. Reply
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Carlos Guarner-Argente, Juan Colán-Hernández, and Angels Ginès
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Endoscopic ultrasound ,medicine.medical_specialty ,Fine-needle aspiration ,Hepatology ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Medicine ,Radiology ,business - Published
- 2020
23. COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION: DO WE MEET THE RECOMMENDATIONS OF THE ESGE? A SPANISH MULTICENTRE PROSPECTIVE STUDY
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Andres Sanchez-Yague, J Santiago-García, Carlos Guarner-Argente, Ó Nogales-Rincón, AH de Tejada, PJ Rosón-Rodríguez, J Rodríguez-Sánchez, C Dolz-Abadía, JC Marín-Gabriel, D García-Romero, A Álvarez-Delgado, F Ramos-Zabala, E Albéniz-Arbizu, H Uchima-Koecklin, ER de Santiago, Gloria Fernández-Esparrach, R Durán-Bermejo, A Amorós-Tenorio, Á Terán-Lantarón, H Cortés-Pérez, AJ Del Pozo-García, and P de María
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medicine.medical_specialty ,business.industry ,General surgery ,medicine ,Endoscopic submucosal dissection ,Prospective cohort study ,business - Published
- 2020
24. COLORECTAL (CR) ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) IN WESTERN COUNTRIES WHEN HISTOLOGY SHOWS LOW GRADE DYSPLASIA: IS THE RISK ACCEPTABLE?
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A Amorós-Tenorio, P de María, F Ramos-Zabala, Carlos Guarner-Argente, Ó Nogales-Rincón, JC Marín-Gabriel, E Albéniz-Arbizu, H Uchima-Koecklin, AJ Del Pozo-García, A Álvarez-Delgado, J Santiago-García, RS Joaquín, H Cortés-Pérez, Andres Sanchez-Yague, ER de Santiago, GR Diana, R Durán-Bermejo, PJ Rosón-Rodríguez, C Dolz-Abadía, AH de Tejada, Gloria Fernández-Esparrach, and Á Terán-Lantarón
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Low grade dysplasia ,medicine.medical_specialty ,business.industry ,Medicine ,Histology ,Endoscopic submucosal dissection ,Radiology ,business - Published
- 2020
25. Clinical validation of risk scoring systems to predict risk of delayed bleeding after EMR of large colorectal lesions
- Author
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Felipe Martinez-Alcala, Eduardo Albéniz, Leopoldo López-Rosés, Esteban Saperas, Manuel Rodríguez-Téllez, David Remedios, O. Garcia, Alberto Herreros de Tejada, Joaquín Rodríguez-Sánchez, Juan Gabriel Martínez-Cara, María Fraile, Marco Antonio Álvarez, Mónica Enguita, Antonio Z. Gimeno-García, Remedios Pardeiro, Bartolomé López-Viedma, Alberto Alvarez, Berta Ibáñez, Eduardo Redondo-Cerezo, David Martínez-Ares, Joaquin De La Peña, Liseth Rivero, Jesús M. González-Santiago, Jorge C. Espinós, Fernando Sábado, Óscar Nogales, Julyssa Cobian, Mar Concepción-Martín, Francisco Navajas, Josep Merlo Mas, Jose Santiago, Carla J. Gargallo, Alfonso Elosua González, Patricia Huelin Álvarez, Pedro Alonso-Aguirre, Fernando Múgica, Santiago Soto, Jorge Carbó, Carlos Guarner-Argente, Juan Colán Hernández, María Rullán Iriarte, Alejandra Jiménez, Alain Huerta, Eduardo Valdivielso Cortázar, Francisco Pérez-Roldán, Maria Pellise, Felipe Ramos Zabala, La Caixa, and Caja Navarra
- Subjects
medicine.medical_specialty ,Endoscopic Mucosal Resection ,Colonoscopy ,Endoscopic mucosal resection ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Area under the curve ,Australia ,Odds ratio ,medicine.disease ,Comorbidity ,Confidence interval ,Clinical trial ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Radiology ,business ,Colorectal Neoplasms ,Cohort study - Abstract
[Background and Aims]: The Endoscopic Resection Group of the Spanish Society of Endoscopy (GSEED-RE) model and the Australian Colonic Endoscopic Resection (ACER) model were proposed to predict delayed bleeding (DB) after EMR of large superficial colorectal lesions, but neither has been validated. We validated and updated these models., [Methods]: A multicenter cohort study was performed in patients with nonpedunculated lesions ≥20 mm removed by EMR. We assessed the discrimination and calibration of the GSEED-RE and ACER models. Difficulty performing EMR was subjectively categorized as low, medium, or high. We created a new model, including factors associated with DB in 3 cohort studies., [Results]: DB occurred in 45 of 1034 EMRs (4.5%); it was associated with proximal location (odds ratio [OR], 2.84; 95% confidence interval [CI], 1.31-6.16), antiplatelet agents (OR, 2.51; 95% CI, .99-6.34) or anticoagulants (OR, 4.54; 95% CI, 2.14-9.63), difficulty of EMR (OR, 3.23; 95% CI, 1.41-7.40), and comorbidity (OR, 2.11; 95% CI, .99-4.47). The GSEED-RE and ACER models did not accurately predict DB. Re-estimation and recalibration yielded acceptable results (GSEED-RE area under the curve [AUC], .64 [95% CI, .54-.74]; ACER AUC, .65 [95% CI, .57-.73]). We used lesion size, proximal location, comorbidity, and antiplatelet or anticoagulant therapy to generate a new model, the GSEED-RE2, which achieved higher AUC values (.69-.73; 95% CI, .59-.80) and exhibited lower susceptibility to changes among datasets., [Conclusions]: The updated GSEED-RE and ACER models achieved acceptable prediction levels of DB. The GSEED-RE2 model may achieve better prediction results and could be used to guide the management of patients after validation by other external groups. (Clinical trial registration number: NCT 03050333.), Research support for this study was received from “La Caixa/Caja Navarra” Foundation (ID 100010434;project PR15/11100006).
- Published
- 2020
26. Antibiotic Prophylaxis Is Not Required for Endoscopic Ultrasonography-Guided Fine-Needle Aspiration of Pancreatic Cystic Lesions, Based on a Randomized Trial
- Author
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Albert Pardo, Mar Concepción, Juan Colán-Hernández, Angels Ginès, Cristina Sánchez-Montes, Xavier Andújar, Carme Loras, Cristina Rodríguez de Miguel, Oriol Sendino, Carlos Guarner-Argente, Marianette Murzi, Gloria Fernández-Esparrach, Joan B. Gornals, and Julio Velasquez-Rodriguez
- Subjects
0301 basic medicine ,Male ,medicine.medical_specialty ,Placebo ,law.invention ,Placebos ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Randomized controlled trial ,law ,Ciprofloxacin ,Internal medicine ,Preoperative Care ,medicine ,Humans ,Antibiotic prophylaxis ,Adverse effect ,Endoscopic Ultrasound-Guided Fine Needle Aspiration ,Pancreas ,Aged ,Hepatology ,medicine.diagnostic_test ,business.industry ,Incidence ,Gastroenterology ,Antibiotic Prophylaxis ,Middle Aged ,medicine.disease ,Anti-Bacterial Agents ,030104 developmental biology ,Fine-needle aspiration ,Spain ,Bacteremia ,Practice Guidelines as Topic ,Acute pancreatitis ,030211 gastroenterology & hepatology ,Female ,Pancreatic cysts ,Pancreatic Cyst ,business - Abstract
Background & Aims Guidelines recommend routine antibiotic prophylaxis for patients undergoing endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) of pancreatic cysts, but there is conflicting evidence for its necessity. We investigated whether performing the procedure without antimicrobial prophylaxis increases the incidence of infection. Methods We performed a multicenter, randomized, noninferiority trial to compare prophylaxis with ciprofloxacin vs placebo in patients with a pancreatic cyst requiring EUS-FNA at multiple centers in Spain. From September 2014 to June 2018, patients were randomly assigned to groups that received the prophylaxis with ciprofloxacin (n = 112) or saline solution (n = 114, placebo). We recorded patients' demographic data, lesion characteristics, and procedure data and followed patients for 21 days. A total of 205 patients completed the trial (90.7%), receiving ciprofloxacin or the control, with no statistically significant differences in demographics, baseline data, or procedure characteristics between groups. The primary outcome was FNA-related infection. Secondary outcomes were incidence of fever, procedure complications, and medication-related adverse events. Results The only case of FNA-related infection (0.44%) occurred in a patient in the placebo group (0.87%); this patient developed acute pancreatitis and bacteremia after the procedure. Prevention of infection was not inferior in the control group; the difference between proportions was 0.87% (95% confidence interval, –0.84% to 2.59%). There were no differences between groups in fever (2 patients in each group: 1.78% vs 1.76%; P = 1.00) or other adverse events. Conclusions In a randomized trial of patients undergoing EUS-FNA for pancreatic cyst evaluation, we found the risk of infection to be low. The incidence of infections did not differ significantly with vs without ciprofloxacin prophylaxis. (ClinicalTrials.gov, Number: NCT02261896).
- Published
- 2020
27. Hypertensive panesophageal pressurization in type II achalasia
- Author
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L Melcarne, Carlos Guarner-Argente, and Anna Sánchez Vilanova
- Subjects
medicine.medical_specialty ,business.industry ,Gastroenterology ,Achalasia ,POEM ,General Medicine ,medicine.disease ,Complete resolution ,digestive system diseases ,Hypotonia ,Internal medicine ,medicine ,Esophageal manometry ,medicine.symptom ,business ,Hypertensive panesophageal pressurization ,Esophageal motility - Abstract
We present a case-report about a patient with type II achalasia. In the high-resolution esophageal manometry (HRM), an atypical hypertensive panesophageal pressurizations were observed. Until now, the presence of hypertensive panesophageal pressurizations in type II achalasia was described in only one case-report. A POEM was performed. After the treatment, the patient presents a complete resolution of the symptoms. Control HRM showed a partial recovery of esophageal motility and the hypotonia of the gastro-esophageal junction.
- Published
- 2020
28. Multicenter Study Of Plastic Vs. Self-expanding Metal Stents In Endoscopic Ultrasound-drainage Of Walled-off Pancreatic Necrosis – Prometheus: A Randomised Controlled Trial Protocol
- Author
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joan b gornals, Manuel Perez-Miranda, Enrique Vazquez-Sequeiros, Juan Vila, Jose M Esteban, Ferran Gonzalez-Huix, Carlos Guarner-Argente, Andres Sanchez-Yague, Alvaro Teran, Francesc Bas-Cutrina, Carlos De La Serna, Ana Garcia Garcia De Paredes, Raquel Ballester, Julio Velasquez-Rodriguez, Silvia Salord, Cristian Tebe, Pilar Hereu, and Sebastia Videla
- Abstract
Background: It seems that the appearance of lumen-apposing metal stents (LAMS), are displacing the role of plastic stents in the therapy of pancreatic fluid collection as walled-off necrosis (WON). To date there is no quality of evidence to recommend LAMS as the standard treatment in management of WON. The theoretical benefit of LAMS over PLASTIC stents, need to be proved. Methods/design: This is a multicenter prospective study, superiority, randomized controlled clinical trial by parallel groups, without masking. One hundred fourteen patients with WON will be Endoscopic ultrasound (EUS)-guided transmural drained in 9 tertiary hospitals in Spain and will be randomized to the LAMS or PLASTIC stent group. The primary endpoint is to assess the short-term (4 weeks) clinical success determined by the reduction of the collection (to
- Published
- 2019
29. Multicenter study of plastic vs. self-expanding metal stents in endoscopic ultrasound-guided drainage of walled-off pancreatic necrosis – PROMETHEUS: a randomized controlled trial protocol
- Author
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A Terán, Enrique Vazquez-Sequeiros, Juan J. Vila, Manuel Perez-Miranda, Pilar Hereu, Carlos Guarner-Argente, José Miguel Esteban, Andres Sanchez-Yague, Cristian Tebé, Joan B. Gornals, Ferran González-Huix, Carlos De la Serna, Ana García García de Paredes, Raquel Ballester, Francesc Bas-Cutrina, Silvia Salord, Julio G. Velasquez-Rodriguez, and Sebas Videla
- Subjects
Endoscopic ultrasound ,Male ,Medicine (miscellaneous) ,Trial ,law.invention ,Pròtesis de Stent ,Walled-off necrosis, self-expanding metal stent ,Endosonography ,Tertiary Care Centers ,Study Protocol ,0302 clinical medicine ,Randomized controlled trial ,law ,Clinical endpoint ,Medicine ,Pharmacology (medical) ,Prospective Studies ,Aged, 80 and over ,lcsh:R5-920 ,medicine.diagnostic_test ,Pancreatitis, Acute Necrotizing ,Standard treatment ,Middle Aged ,Necrosi ,Treatment Outcome ,030220 oncology & carcinogenesis ,Drainage ,030211 gastroenterology & hepatology ,Female ,Randomized clinical trial ,lcsh:Medicine (General) ,Plastics ,Adult ,Transmural drainage ,medicine.medical_specialty ,Adolescent ,Self Expandable Metallic Stents ,Metal self-expanding stent ,self-expanding metal stent ,Lumen-apposing metal stent ,03 medical and health sciences ,Necrosis ,Young Adult ,Walled-off necrosis ,Humans ,Endoscòpia ,Aged ,Protocol (science) ,business.industry ,Endoscopy ,Surgery ,Clinical trial ,Multicenter study ,Pancreatitis ,Spain ,Plastic stent ,business ,Stents (Surgery) ,Follow-Up Studies - Abstract
Background It seems that lumen-apposing metal stents (LAMS) are displacing plastic stents in the therapy of pancreatic-fluid collection in walled-off necrosis (WON). To date, there is no quality of evidence to recommend LAMS as the standard treatment in the management of WON. The theoretical benefit of LAMS over plastic stents needs to be proven. Methods/design This is a randomized controlled, multicenter, prospective clinical trial with two parallel groups, without masking. One-hundred and fourteen patients with WON will undergo endoscopic ultrasound (EUS)-guided transmural draining in nine tertiary hospitals in Spain and will be randomized to the LAMS or plastic-stent group. The primary endpoint is the short-term (4 weeks) clinical success determined by the reduction of the collection (to Discussion The PROMETHEUS trial has been designed to determine whether LAMS are superior to plastic stents in EUS-guided transmural drainage of WON. Trial registration ClinicalTrials.gov, ID: NCT03100578. Registered on 4 April 2017. https://clinicaltrials.gov/ct2/home
- Published
- 2019
30. Comparative Randomized Multicenter Study Of Plastic Vs. Self-expanding Metal Stents In The Endoscopic Ultrasound-guided Drainage Of Walled-off Pancreatic Necrosis
- Author
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joan b gornals, Manuel Perez-Miranda, Enrique Vazquez-Sequeiros, Juan Vila, Jose M Esteban, Ferran Gonzalez-Huix, Carlos Guarner-Argente, Andres Sanchez-Yague, Alvaro Teran, Francesc Bas-Cutrina, Carlos De La Serna, Ana Garcia Garcia De Paredes, Raquel Ballester, Julio Velasquez-Rodriguez, Silvia Salord, Cristian Tebe, Pilar Hereu, and Sebastia Videla
- Abstract
Background: It seems that the appearance of lumen-apposing metal stents (LAMS), are displacing the role of plastic stents in the therapy of pancreatic fluid collection as walled-off necrosis (WON). To date there is no quality of evidence to recommend LAMS as the standard treatment in management of WON. The theoretical benefit of LAMS over PLASTIC stents, need to be proved.Methods/design: This is a multicenter prospective study, superiority, randomized controlled clinical trial by parallel groups, without masking. One hundred fourteen patients with WON will be Endoscopic ultrasound (EUS)-guided transmural drained in 9 tertiary hospitals in Spain and will be randomized to the LAMS or PLASTIC stent group. The primary endpoint is to assess the short-term (4 weeks) clinical success determined by the reduction of the collection (to
- Published
- 2019
31. Endoscopic ultrasound and endoscopic retrograde cholangiopancreatography: Can they be successfully combined?
- Author
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Joan B. Gornals, José Miguel Esteban, Carme Loras, Carlos Guarner-Argente, Oriol Sendino, Carlos Marra-López, and Alejandro Repiso
- Subjects
Endoscopic ultrasound ,medicine.medical_specialty ,Biliary Tract Diseases ,Biopsy, Fine-Needle ,Multimodal Imaging ,Endosonography ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Routine care ,Ultrasonography, Interventional ,Retrospective Studies ,Cholangiopancreatography, Endoscopic Retrograde ,Endoscopic retrograde cholangiopancreatography ,Hepatology ,medicine.diagnostic_test ,Therapeutic Technique ,business.industry ,Gastroenterology ,Pancreatic Diseases ,digestive system diseases ,030220 oncology & carcinogenesis ,Drainage ,030211 gastroenterology & hepatology ,Radiology ,business ,Learning Curve ,Forecasting - Abstract
Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) have much in common, including their main indications (biliopancreatic disorders), powerful therapeutic capacities and a steep learning curve. Over the years they have evolved from novel diagnostic procedures to interventional therapeutic techniques, but along different paths (different scopes or devices and endoscopists specializing exclusively in one or the other technique). However, EUS has gradually developed into a therapeutic technique that requires skills in the use of ERCP devices and stents, leading some ERCP specialists to explore the therapeutic potential of EUS. The corresponding literature, which has grown exponentially, includes recent experiments on combining the two techniques, which have gradually come to be used in routine care in a number of centers, with positive technical, clinical and financial outcomes. We review EUS and ERCP as individual or combined procedures for managing biliopancreatic disorders.
- Published
- 2016
32. ENDOSCOPIC BAND LIGATION WITHOUT RESECTION OF SMALL-SIZED SUBMUCOSAL TUMOURS: RESULTS IN SHORT-MEDIUM FOLLOW-UP TERM OF A MULTICENTER PROSPECTIVE STUDY (BANDING-SMT)
- Author
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X Andujar, JB Gornals, F Bas-Cutrina, Carlos Huertas, A. Pardo, Carlos Guarner-Argente, Ferrán González-Huix, Raquel Ballester, M Albert, C Loras, CF Consiglieri, and J Bosch-Schips
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Ligation ,business ,Prospective cohort study ,Surgery ,Term (time) ,Resection - Published
- 2019
33. UTILITY OF GASTROSCOPY AT THE TIME OF COLONOSCOPY IN PATIENTS WITH IRON-DEFICIENCY ANEMIA REFERRED TO A COLORECTAL CANCER DETECTION PROGRAM
- Author
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M Trias, M. Concepción Martín, Carlos Guarner-Argente, G Iborra Muñoz, D González-Juan, C Gomez Oliva, L Gonzalez Gonzalez, J Colan, S Bazaga Perez de Rozas, Anna Brujats, B Cuyàs Espí, S Sáinz Sáez-Torre, J Gordillo Abalos, C Guarner Aguilar, and M Murzi-Pulgar
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,Iron-deficiency anemia ,Colorectal cancer ,business.industry ,Internal medicine ,medicine ,Colonoscopy ,In patient ,medicine.disease ,business ,Gastroenterology - Published
- 2019
34. ¿ES ÚTIL EL USO DEL PIGTAIL EN EL DRENAJE BILIAR DE PATOLOGÍA BILIOPANCREÁTICA MALIGNA IRRESECABLE CON PRÓTESIS DE APOSICIÓN LUMINAL?
- Author
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Juli Busquets, Joan B. Gornals, Francesc Bas-Cutrina, Albert Garcia-Sumalla, Julio G. Velasquez-Rodriguez, Carlos Guarner-Argente, Berta Laquente, and Carme Loras
- Published
- 2019
35. EVALUACIÓN DEL APRENDIZAJE PRÁCTICO EN ECOANATOMÍA DE UN CURSO UNIVERSITARIO DE ESPECIALIZACIÓN EN ECOENDOSCOPIA
- Author
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Carlos Guarner Argente, Francesc Saigí Rubió, Marta Cruz Aparicio, Carme Loras Alastruey, Julio Guillermo Velásquez Rodríguez, and Joan Gornals Soler
- Published
- 2019
36. REGISTRO NACIONAL DE PRÓTESIS DE APOSICIÓN LUMINAL (PAL) TIPO AXIOS. RESULTADOS INICIALES DE UNA SERIE DE CASOS PROSPECTIVA MULTICÉNTRICA
- Author
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Vicente Soler, Joan Gornals Soler, Rafael Villanueva, Carlos Guarner Argente, Eloy Sánchez, Juan Colán, María Isabel Garcia Martinez, Antonio Guardiola, Carme Loras Alastruey, Álvaro Terán, Antonio Pérez Millán, Rafael Pedraza, Francisco Javier García-Alonso, Francisco Fernández, Jorge Núñez Otero, Jose Luis Castro Urda, Ignacio Couto, Belén Bernad, Angels Vilella, Francisco Uceda, Leticia Pérez Carazo, José Ramón Aparicio Tormo, Belén Pérez Martínez, Isabel Pinto, and Sergio Bazaga
- Published
- 2019
37. 1179 TO CLIP OR NOT TO CLIP AFTER EMR OF LARGE NONPEDUNCULATED COLORECTAL POLYPS. COST-EFFECTIVENESS ANSWERS BASED ON REAL DATA
- Author
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Antonio Z. Gimeno-García, Jorge C. Espinós, Gonzalo Gonzalez-Gete, Mónica Enguita, Alberto Herreros de Tejada, José Carlos Marín Gabriel, Fermin Estremera-Arevalo, Joaquín Rodríguez-Sánchez, Carlos Guarner-Argente, Eduardo Albéniz, P Rosón, Marco Antonio Alvarez-Gonzalez, and Berta Ibañez Berroiz
- Subjects
medicine.medical_specialty ,Cost effectiveness ,business.industry ,Gastroenterology ,medicine ,Radiology, Nuclear Medicine and imaging ,Medical physics ,business - Published
- 2020
38. Adverse Events and Acute Chronic Liver Failure in Patients With Cirrhosis Undergoing Endoscopic Retrograde Cholangiopancreatography: A Multicenter Matched-Cohort Study
- Author
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Marco Pavesi, Adrià Juanola, Verónica Prado, Oriol Sendino, Cristina Rodríguez de Miguel, Andrés Cárdenas, C. Gómez, Karina Chavez-Rivera, Pere Roura, Anabel Blasi, Javier Fernández, Carles Leal, Juan Colán, Carlos Guarner-Argente, and Carlos Guarner
- Subjects
Liver Cirrhosis ,Male ,medicine.medical_specialty ,Cirrhosis ,Population ,digestive system ,Gastroenterology ,Cohort Studies ,End Stage Liver Disease ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Risk Factors ,Internal medicine ,medicine ,Humans ,education ,Adverse effect ,Aged ,Retrospective Studies ,Cholangiopancreatography, Endoscopic Retrograde ,education.field_of_study ,Endoscopic retrograde cholangiopancreatography ,Hepatology ,medicine.diagnostic_test ,Bile duct ,business.industry ,Incidence (epidemiology) ,Retrospective cohort study ,medicine.disease ,digestive system diseases ,surgical procedures, operative ,medicine.anatomical_structure ,Spain ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Female ,business ,Cohort study - Abstract
BACKGROUND: Data on the outcome of adverse events (AEs) and the risk of developing acute-on-chronic liver failure (ACLF) after ERCP in patients with cirrhosis are unknown. We examined the incidence and risk factors of post-ERCP AEs in patients with cirrhosis and the appearance of ACLF after ERCP. METHODS: In this multicenter, retrospective, matched-cohort study, we evaluated ERCPs performed from January 2002 to 2015. A group of patients with cirrhosis with non-ERCP interventions and one without interventions was also analyzed for the development of ACLF. RESULTS: A total of 441 ERCPs were analyzed; 158 in patients with cirrhosis (cases) and 283 in patients without cirrhosis (controls). The overall rate of AEs after all ERCPs was significantly higher in cases compared to controls (17% vs 9.5, p = 0.02). Cholangitis developed more in cases compared to controls (6.3% vs 1.8%; p = 0.01). In a subanalysis of those with sphincterotomy, the rate of bleeding was higher in those with cirrhosis (9.4% vs 3.4%; p = 0.03). Logistic regression identified cirrhosis (OR, 2.48; 95% CI, 1.36-4.53; p = 0.003) and sphincterotomy (OR, 2.66; 95% CI, 1.23-5.72; p = 0.01) as risk factors of AEs. A total of 18/158 (11.4%) cases developed ACLF after ERCP. ACLF occurred in 7/27 cases with post-ERCP AEs and in 11/131 without post-ERCP AEs (25.9% vs 8.3%; p = 0.01). A total of 3.2% (13/406) patients without interventions developed ACLF compared to 17.5% (102/580) who developed ACLF after non-ERCP interventions. Patients with decompensated cirrhosis at ERCP had a higher risk of developing ACLF (17% vs 6.8%; p = 0.04). Patients with a MELD score >= 15 were 3.1 times more likely (95% CI: 1.14-8.6; p = 0.027) to develop ACLF after ERCP. CONCLUSIONS: The rate of AEs after ERCP is higher in patients with cirrhosis compared to the non-cirrhotic population. The incidence of ACLF is higher in those with AEs after ERCP compared to those without AEs, especially cholangitis. The development of ACLF is common after ERCP and other invasive procedures. ACLF can be precipitated by numerous factors which include preceding events before the procedure, including manipulation of the bile duct, and AEs after an ERCP.
- Published
- 2018
39. PREDICTIVE FACTORS FOR TECHNICALLY DIFFICULT ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD). IMPLICATIONS FOR CASE SELECTION: A SPANISH PROSPECTIVE MULTICENTER COHORT STUDY
- Author
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J Díaz-Tasende, J de la Peña-García, C Dolz-Abadía, AJ Del Pozo-García, F Múgica-Aguinaga, A Álvarez-Delgado, Gloria Fernández-Esparrach, E Albéniz Arbizu, Carlos Guarner-Argente, Ó Nogales-Rincón, H Cortés-Pérez, JC Marín-Gabriel, Andres Sanchez-Yague, A Herreros de Tajada-Echanojauregui, and F Ramos-Zabala
- Subjects
medicine.medical_specialty ,Case selection ,business.industry ,General surgery ,medicine ,Endoscopic submucosal dissection ,business ,Cohort study - Published
- 2018
40. Clinical guidelines for endoscopic mucosal resection of non-pedunculated colorectal lesions
- Author
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Felipe Martínez Alcalá, Santiago Soto, Antonio Z. Gimeno-García, Alfredo J. Lucendo, Joaquín Rodríguez Sánchez, Ferrán González-Huix, Óscar Nogales, Eduardo Redondo, Javier Gordillo, José Manuel Echevarría, Esteban Saperas, Felipe Ramos Zabala, Ignacio Fernandez-Urien, Maite Herráiz Bayod, Manuel Rodríguez-Téllez, José Miguel Esteban, Francisco Javier Navajas León, Carlos Guarner Argente, Alberto Herreros de Tejada, Maria Pellise, Eduardo Albéniz, O. Garcia, Fernando Alberca de Las Parras, Alba Zuñiga Ripa, Juan José Vila Costas, Mariano González-Haba, David Barquero, Miguel Muñoz Navas, Pedro Alonso-Aguirre, José Carlos Marín Gabriel, M.H. Conde, Noel Pin, David Remedios, Helena León Brito, Adolfo Parra Blanco, Juan Gabriel Martínez Cara, Bartolomé López Viedma, Leopoldo López Rosés, David Martínez Ares, Joaquín de la Peña, Marco Antonio Álvarez, José Díaz-Tasende, María Fraile, Eduardo Valdivielso, Fernando Múgica, Marta Montes Díaz, Andres Sanchez-Yague, Julyssa Cobian, Marco Bustamante, Akiko Ono, Begoña González-Suárez, and Carla J. Gargallo
- Subjects
medicine.medical_specialty ,Endoscopic Mucosal Resection ,MEDLINE ,Endoscopic mucosal resection ,Endoscopic management ,Endoscopy, Gastrointestinal ,03 medical and health sciences ,Digestive endoscopy ,Colonic Diseases ,0302 clinical medicine ,medicine ,Humans ,Endoscopic resection ,Intestinal Mucosa ,medicine.diagnostic_test ,business.industry ,Resección mucosa endoscópica ,General surgery ,Gastroenterology ,General Medicine ,Guideline ,Endoscopy ,Rectal Diseases ,Còlon -- Càncer ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,business ,Colorectal Neoplasms ,Colorectal Surgery ,Gastroscòpia - Abstract
RESUMEN Este documento resume el contenido de la Guía de resección mucosa endoscópica elaborada por el grupo de trabajo de la Sociedad Española de Endoscopia Digestiva (GSEED de Resección Endoscópica) y expone las recomendaciones sobre el manejo endoscópico de las lesiones neoplásicas colorrectales superficiales. ABSTRACT This document summarizes the contents of the Clinical Guidelines for the Endoscopic Mucosal Resection of Non-Pedunculated Colorectal Lesions that was developed by the working group of the Spanish Society of Digestive Endoscopy (GSEED of Endoscopic Resection). This document presents recommendations for the endoscopic management of superficial colorectal neoplastic lesions.
- Published
- 2018
41. POEM PARA TRASTORNOS MOTORES ESOFÁGICOS: RESULTADOS TRAS LOS PRIMEROS 50 PROCEDIMIENTOS REALIZADOS EN DOS CENTROS
- Author
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Fermín Estremera Arévalo, Rosa Iglesias Picazo, Carlos Guarner Argente, Jordi Serra, E. M. Targarona, Eduardo Albéniz Arbizu, Sonia Ezquer Iturbide, and Marianette Murzi
- Published
- 2018
42. Guía clínica para la resección mucosa endoscópica de lesiones colorrectales no pediculadas
- Author
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Carlos Guarner Argente, José Miguel Esteban, Joaquin De La Peña, Andres Sanchez Yague, David Barquero, Adolfo Parra Blanco, Maite Herráiz Bayod, Miguel Muñoz Navas, Fernando Alberca de Las Parras, Pedro Alonso Aguirre, Bartolomé López Viedma, Joaquín Rodríguez Sánchez, M.H. Conde, Francisco Leon, Felipe Martínez Alcalá, Manuel Rodríguez Téllez, José Carlos Marín Gabriel, Eduardo Redondo, Leopoldo López Rosés, David Martínez Ares, Marta Montes Díaz, Noel Pin, Juan José Vila Costas, Maria Pellise, David Remedios, Julyssa Cobian, Eduardo Albéniz, Marco Antonio Álvarez, Felipe Ramos Zabala, Ignacio Fernández Urién, Alba Zuñiga Ripa, José Díaz Tasende, Mariano González Haba, Juan Gabriel Martínez Cara, Óscar Nogales, Alfredo J. Lucendo, O. Garcia, Begoña González Suárez, Alberto Herreros de Tejada, Fernando Múgica, María Fraile, Antonio Z. Gimeno García, Javier Gordillo, Marco Bustamante, Akiko Ono, Ferran González Huix, José Manuel Echevarría, Esteban Saperas, Helena León Brito, Carla J. Gargallo, Santiago Soto, and Eduardo Valdivielso
- Subjects
Gynecology ,medicine.medical_specialty ,Hepatology ,business.industry ,Resección mucosa endoscópica ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Endoscopic mucosal resection ,030220 oncology & carcinogenesis ,Medicine ,lcsh:Diseases of the digestive system. Gastroenterology ,030211 gastroenterology & hepatology ,lcsh:RC799-869 ,business - Abstract
Resumen Este documento resume el contenido de la Guia de reseccion mucosa endoscopica elaborada por el grupo de trabajo de la Sociedad Espanola de Endoscopia Digestiva (GSEED de Reseccion Endoscopica) y expone las recomendaciones sobre el manejo endoscopico de las lesiones neoplasicas colorrectales superficiales.
- Published
- 2018
43. Rapid drink challenge test for the clinical evaluation of patients with Achalasia
- Author
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Ingrid Marin, Carlos Guarner-Argente, Noemí Caballero, and Jordi Serra
- Subjects
Adult ,Male ,medicine.medical_specialty ,Validation study ,Adolescent ,Manometry ,Physiology ,Treatment outcome ,Drinking ,Achalasia ,multiple water swallow ,Gastroenterology ,digestive system ,Young Adult ,03 medical and health sciences ,Esophagus ,0302 clinical medicine ,Internal medicine ,Healthy control ,medicine ,otorhinolaryngologic diseases ,Humans ,In patient ,Child ,high resolution esophageal manometry ,Aged ,rapid drink challenge test ,Endocrine and Autonomic Systems ,business.industry ,Middle Aged ,medicine.disease ,digestive system diseases ,Deglutition ,Esophageal Achalasia ,achalasia ,Diagnostic Techniques, Digestive System ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Previously treated ,business ,Clinical evaluation ,After treatment - Abstract
BackgroundPatients with achalasia develop a well-defined obstructive pattern of pressure in response to a rapid drink challenge test (RDC). Our aim was to determine if successful treatment of achalasia can revert the obstructive pattern of pressure in response to the RDC, and if this simple test could be useful in the follow-up of patients with achalasia. MethodsIn 26 healthy controls and 103 patients with achalasia, pressure responses to a RDC were prospectively analysed using high resolution esophageal manometry in two consecutive protocols: (a) Development study: one RDC was performed in 20 healthy controls, 63 patients with nontreated achalasia, and 21 patients with previously treated achalasia; (b) Validation study: two RDC were performed before, and 8-12weeks after treatment, in 19 patients with nontreated, newly diagnosed achalasia. Key ResultsIn the development study no healthy control, 19% of patients with previously treated achalasia and 96% of patients with nontreated achalasia developed an obstructive pressure pattern during the RDC (P3; P
- Published
- 2018
44. Profilaxis antibiótica en la USE-PAAF de quistes pancreáticos: Resultados preliminares del estudio multicéntrico, aleatorizado y doble ciego
- Author
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A. Pardo, J Colán Hernández, Oriol Sendino, J Gornals, Carlos Guarner-Argente, X Andujar, Angels Ginès, M Concepción, Cristina Sánchez-Montes, and C Loras
- Published
- 2017
45. Optimal timing for a second ERCP after failure of initial biliary cannulation following precut sphincterotomy: an analysis of experience at two tertiary centers
- Author
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Oriol Sendino, Juan Colán-Hernández, Andrés Cárdenas, Carlos Guarner-Argente, Alexandra Aldana, Miguel Martínez-Guillen, Karina Chavez, Mar Concepción, Carlos Guarner, Angela Mendez-Bocanegra, C. Gómez, Josep Llach, and Càndid Villanueva
- Subjects
Male ,Reoperation ,medicine.medical_specialty ,Time Factors ,Perforation (oil well) ,Needle-knife ,digestive system ,Catheterization ,Sphincterotomy, Endoscopic ,03 medical and health sciences ,ERCP ,0302 clinical medicine ,Endoscopic retrograde cholangiopancreatography ,Internal medicine ,Sphincterotomy ,medicine ,Humans ,Adverse effect ,Aged ,Retrospective Studies ,Aged, 80 and over ,Cholangiopancreatography, Endoscopic Retrograde ,medicine.diagnostic_test ,Bile duct ,business.industry ,Difficult biliary cannulation ,Middle Aged ,Hepatology ,medicine.disease ,digestive system diseases ,Surgery ,Major duodenal papilla ,Treatment Outcome ,surgical procedures, operative ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Pancreatitis ,Precut ,Female ,030211 gastroenterology & hepatology ,business ,Follow-Up Studies ,Abdominal surgery - Abstract
Precut sphincterotomy increases the success of deep biliary cannulation, but the method fails at the initial ERCP in 5-12% of cases. Although other invasive strategies are often used to access the bile duct, a second ERCP may be effective and safe. We evaluated the efficacy, safety, and factors related to a second ERCP after failed cannulation using a precut sphincterotomy. We reviewed all patients that underwent an ERCP with native papilla from 2006 to 2014 at two tertiary institutions. Efficacy was based on the cannulation rate of the second ERCP, and safety was assessed in terms of adverse events. We identified 112 patients with failed cannulation after precut, and a second ERCP was performed in 72 (64.3%). Median time between procedures was 7 days (IQR 5-11). Deep cannulation was achieved in 54 cases (75%). The only factor associated with cannulation failure was an ERCP within 4 days after the initial precut (cannulation success 44.4 vs. 79.4% after 4 days, p = 0.026). Adverse events were recorded after the first ERCP in 13 of 112 patients (11.8%): delayed bleeding in four, pancreatitis in five, and perforation in four. After the second ERCP, three of 72 patients (4.2%) presented adverse events: two delayed bleeding and one pancreatitis. A second ERCP after failure of initial biliary cannulation following precut appears to be safe and effective. A second ERCP should be delayed at least 4 days if feasible.
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- 2017
46. Somatostatin for prevention of post-ERCP pancreatitis: a randomized, double-blind trial
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S. Sáinz, Mar Concepción-Martín, C. Villanueva, Carlos Guarner, Xavier Díez, Carlos Guarner-Argente, Xavier Torras, Ana Juanes, Antoni Farré, Cristina Gómez-Oliva, and Daniel Prieto-Alhambra
- Subjects
Male ,Abdominal pain ,Placebo ,Severity of Illness Index ,law.invention ,Double-Blind Method ,Randomized controlled trial ,law ,medicine ,Humans ,Aged ,Hyperamylasemia ,Aged, 80 and over ,Cholangiopancreatography, Endoscopic Retrograde ,Endoscopic retrograde cholangiopancreatography ,Intention-to-treat analysis ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Middle Aged ,medicine.disease ,Hormones ,Abdominal Pain ,Intention to Treat Analysis ,Somatostatin ,Pancreatitis ,Anesthesia ,Acute pancreatitis ,Female ,medicine.symptom ,business - Abstract
Background and study aims: Meta-analyses suggest that an intravenous bolus or a high dose continuous infusion of somatostatin reduces the incidence of acute pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). Clinical guidelines, however, do not recommend this prophylaxis. The aim of this randomized, double-blind clinical trial was to evaluate the effect of somatostatin on the incidence of post-ERCP pancreatitis. Patients and methods: Patients undergoing ERCP at a single center were randomized to either intravenous bolus of somatostatin followed by a short (4-hour) continuous infusion, or to a similar placebo regimen. The primary outcome was post-ERCP pancreatitis, defined as abdominal pain with an amylase level at least three times higher than the upper limit of normality 24 hours after the ERCP and requiring admission for at least 2 days. Results: A total of 510 patients were enrolled (255 patients per group) and all completed follow-up. The main indications for ERCP were choledocholithiasis (62 %), and biliary malignant stricture (31 %). Post-ERCP pancreatitis occurred in 19 patients (7.5 %) in the somatostatin group and 17 patients (6.7 %) in the placebo group (relative risk [RR] 1.12, 95 % confidence interval [95 %CI] 0.59 – 2.1; P = 0.73). The number of cases of moderate or severe acute pancreatitis was similar in the somatostatin (2.4 %) and the placebo (3.5 %) groups (RR 0.67, 95 %CI 0.24 – 1.85, P = 0.43). No side effects were observed related to the use of somatostatin. Conclusions: Administration of an intravenous bolus of somatostatin followed by a short continuous infusion does not reduce the incidence of post-ERCP pancreatitis. Clinical Trials.gov number: NCT01060826.
- Published
- 2014
47. IL-6, IL-10 and TNFα do not improve early detection of post-endoscopic retrograde cholangiopancreatography acute pancreatitis : a prospective cohort study
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Xavier Díez, Ana Juanes, Cristina Gómez-Oliva, S. Sáinz, Silvia Vidal, Carlos Guarner, Mar Concepción-Martín, Carlos Guarner-Argente, Antoni Farré, Josefina Mora, Xavier Torras, and Càndid Villanueva
- Subjects
Male ,medicine.medical_specialty ,Abdominal pain ,Sensitivity and Specificity ,Severity of Illness Index ,Gastroenterology ,digestive system ,Article ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Amylase ,Prospective cohort study ,Interleukin 6 ,Aged ,Demography ,Cholangiopancreatography, Endoscopic Retrograde ,Multidisciplinary ,Endoscopic retrograde cholangiopancreatography ,biology ,medicine.diagnostic_test ,Interleukin-6 ,Tumor Necrosis Factor-alpha ,business.industry ,Lipase ,medicine.disease ,digestive system diseases ,Abdominal Pain ,Interleukin-10 ,Surgery ,Interleukin 10 ,Early Diagnosis ,surgical procedures, operative ,Pancreatitis ,ROC Curve ,030220 oncology & carcinogenesis ,Amylases ,biology.protein ,Acute pancreatitis ,Female ,030211 gastroenterology & hepatology ,medicine.symptom ,business - Abstract
The most reliable indicators for post-ERCP acute pancreatitis are elevated amylase levels and abdominal pain 24 hours after ERCP. As ERCP is often performed on an outpatient basis, earlier diagnosis is important. We aimed to identify early predictors of post-ERCP pancreatitis. We prospectively analyzed IL-6, IL-10, TNFα, CRP, amylase and lipase before and 4 hours after ERCP, and studied their association with abdominal pain. We included 510 patients. Post-ERCP pancreatitis occurred in 36 patients (7.1%). IL-6, IL-10, TNFα and CRP were not associated with post-ERCP pancreatitis. Levels of amylase and lipase were higher in patients with pancreatitis (522 U/L and 1808 U/L vs. 78 U/L and 61 U/L, respectively; p 3 ULN. Amylase and lipase were the only markers of post-ERCP pancreatitis 4 hours after the procedure.
- Published
- 2016
48. Outcomes of EMR of defiant colorectal lesions directed to an endoscopy referral center
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Anna M. Buchner, Carlos Guarner-Argente, and Gregory G. Ginsberg
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Adenoma ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Colonic Polyps ,Colonoscopy ,Argon plasma coagulation ,Adenocarcinoma ,Postoperative Complications ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Intestinal Mucosa ,Adverse effect ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,Rectal Neoplasms ,business.industry ,Gastroenterology ,Intestinal Polyps ,Retrospective cohort study ,Middle Aged ,Polypectomy ,Endoscopy ,Surgery ,Logistic Models ,Treatment Outcome ,Hyperplastic Polyp ,Colonic Neoplasms ,Female ,Histopathology ,Neoplasm Recurrence, Local ,business ,Follow-Up Studies - Abstract
Background Flat and sessile lesions are being identified more frequently because of increased awareness, improved endoscopic skills, and enhanced imaging. The defiant polyp (DP) is a lesion identified at colonoscopy that defies resection by the standard snare polypectomy technique. Increasingly, the DP undergoes photodocumentation and tissue sampling, and the patient is referred for an attempt at curative colonoscopic resection. Objective To evaluate the current nature of the DPs and outcomes of their endoscopic resection. Design Retrospective study. Setting Tertiary referral center. Patients and Interventions Patients with colorectal polyps not amenable to standard snare polypectomy were referred to a single endoscopist at a tertiary center for an attempt at curative endoscopic resection. The indication DP was applied prospectively, as defined previously, beginning in June 2007. An electronic endoscopy report database was searched for this indication from June 2007 to October 2009 for a single endoscopist at an endoscopy referral center. Data pertaining to patient age and sex, polyp site and histopathology, resection technique, use of adjunctive ablation, adverse events, and residual/recurrent neoplasia at follow-up were culled. Submucosal injection of varying quantities of normal saline solution tinted with methylene blue dye was used for endoscopic resection. Standard and mini-snares were used with pure coagulation current. Main Outcome Measurements Complete resection, complications, recurrence. Results This study included 274 patients (50.4% women, age 65 [standard deviation 12] years) with a total of 315 DPs who were referred for attempted endoscopic resection. The majority of DPs were located in the right side of the colon (226; 72%). The mean size was estimated at 23 mm (range 8-100 mm; standard deviation 13). In 29 DPs (10%), surgery was required because endoscopic resection was deemed unsuitable because of the unfavorable appearance (n = 3), the location (n = 9), or the inability to lift (n = 10) or because of submucosal invasion on post-EMR histopathology (n = 7). Complete endoscopic eradication (R0) was achieved in a single session in 286 DPs (91%). En bloc resection was performed in 153 polyps (53.5%) and piecemeal resection in 132 (46%). Histopathology revealed 178 tubular adenomas (56.5%), 62 serrated adenomas (20%), 27 tubulovillous adenomas (9%), 10 hyperplastic polyps (3%), and 14 adenocarcinomas (4.5%). Adjunctive ablation of focal residual neoplastic tissue was applied in 69 DPs (24%) to achieve R0. Procedure-related adverse events were recorded in 29 of 249 patients (11.6%). Acute bleeding occurred in 9 patients (1 required hospitalization and repeat endoscopy). There was 1 microperforation managed with clip closure and antibiotics. Delayed bleeding (1-6 days post-procedure) was observed in 18 patients (7.2%), of whom 8 required hospitalization and 4 colonoscopy for hemostasis. Among the patients who underwent follow-up surveillance colonoscopy (135 of 258 patients), residual/recurrent neoplastic tissue at the site of the previous EMR was identified in 36 (27%). Residual/recurrent neoplasia was successfully eradicated with further endoscopic resection or ablation. Limitations A retrospective design. Conclusions DPs consist predominantly of sessile and flat adenomas including serrated adenomas. Most DPs can be successfully eradicated at dedicated therapeutic colonoscopy by using adjunctive resection and ablation techniques. The R0 rate is high and the adverse event rate is low. A relatively high rate of local residual/recurrent neoplasia at the resection site underscores the importance of follow-up colonoscopy.
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- 2012
49. Gastric Emptying is Delayed in Transgastric Notes: A Randomized Study in Swine
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Mireia Beltrán, M. Àngels Martínez-Zamora, Christopher C. Thompson, Carlos Guarner-Argente, R. Navarro, Henry Córdova, Antonio M. Lacy, Jaume Comas, Gloria Fernández-Esparrach, Antonio Rodríguez-D’Jesús, Cristina Rodríguez de Miguel, and Graciela Martínez-Pallí
- Subjects
Natural Orifice Endoscopic Surgery ,medicine.medical_specialty ,Endoscope ,Swine ,Capsule Endoscopy ,law.invention ,Abdominal wall ,Random Allocation ,Stomach surgery ,Capsule endoscopy ,law ,Peritoneoscopy ,medicine ,Animals ,Laparoscopy ,Antrum ,medicine.diagnostic_test ,Gastric emptying ,business.industry ,Stomach ,digestive, oral, and skin physiology ,Surgery ,medicine.anatomical_structure ,Gastric Emptying ,Female ,business - Abstract
The aim of this study was to evaluate the restoration of gastrointestinal motility after NOTES using capsule endoscopy (CE).Twenty adult Yorkshire pigs were randomly assigned to four groups: transgastric NOTES (gNOTES), transrectal NOTES (rNOTES), transvaginal NOTES (vNOTES), and laparoscopy (LAP). At the end of a 30-min peritoneoscopy with identification of seven predetermined organs, an array of eight receivers and the recorder were attached to the abdominal wall. The CE was delivered into the antrum with the help of an endoscope and a polypectomy snare. Animals were kept alive for 14 d.Median time for surgery was longer in gNOTES (56 min, range 47-63) and vNOTES (54 min, range 44-79) than in LAP (32 min, range 32-33; P0.05 and P0.01) and in rNOTES (45.5 min, range 33-56) (P = ns). This increase was related to a larger incision and longer closure times. Images from the CE were successfully retrieved in 19 cases. The CE was retained in the stomach in all animals in gNOTES (459 min; range 360-600), but only in one animal in rNOTES and vNOTES and in none in the LAP group. Failure of passage of the CE beyond the stomach was associated with gNOTES and longer closure of the incision. Animals in the gNOTES group gained less weight than the others and this change was statistical significant when compared with vNOTES animals (1.7 kg, range -1.98 to 4.5 versus 8.4 kg, range 5.8 to 11.45; P0.01).Gastric emptying is delayed after gNOTES peritoneoscopy compared with rNOTES, vNOTES, and LAP and this effect is associated with less weight gain.
- Published
- 2012
50. Inflammatory impact of NOTES peritoneoscopy is not different from that of laparoscopy: a randomized comparative study in a survival porcine model
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Cristina Rodríguez de Miguel, Ricard Navarro-Ripoll, Antonio M. Lacy, Jaume Comas, Gloria Fernández-Esparrach, Antonio Rodríguez-D’Jesús, Mireia Beltrán, Henry Córdova, Clara Hernández-Cera, Carlos Guarner-Argente, Christopher C. Thompson, M. Àngels Martínez-Zamora, Xavier Filella, and Graciela Martínez-Pallí
- Subjects
Inflammation ,Natural Orifice Endoscopic Surgery ,medicine.medical_specialty ,medicine.diagnostic_test ,Interleukin-6 ,Tumor Necrosis Factor-alpha ,business.industry ,Interleukin-1beta ,Sus scrofa ,Hepatology ,Surgery ,Random Allocation ,Internal medicine ,Peritoneoscopy ,medicine ,Animals ,Female ,Laparoscopy ,sense organs ,skin and connective tissue diseases ,business ,Abdominal surgery - Abstract
Inflammatory changes of different NOTES approaches remain unknown. The aim of this study was to compare the inflammatory effects of NOTES and laparoscopy.Forty female pigs were assigned to transgastric, transrectal, and transvaginal NOTES and laparoscopic peritoneoscopy groups. Antiseptic technique was utilized for NOTES whereas laparoscopy was performed sterile. Intraperitoneal pressures were monitored and maintained below 15 mmH(2)O. Pneumoperitoneum was maintained with CO(2) in all groups. Pre- and postoperative blood samples of IL-6, Il-1β, and TNFα, and peritoneal fluid collected at surgery were analyzed. Animals were followed daily for 14 days. At necropsy, peritoneal fluid was collected for cytokine analysis.Thirty-nine peritoneoscopies were successfully completed. The median procedure time was longer in the NOTES groups (57 min, range = 33-109) than in the laparoscopy group (33 min, range 32-36; P0.001); this was related to longer incision time and closure time. All 39 completed follow-up. Severe bleeding in the post-transrectal approach required early sacrifice of the remaining animal. Besides this, complications were similar among groups. At necropsy, adhesions were seen in four animals in the gastric group, five in the rectal group, two in the vaginal group, and two in the laparoscopic group (P = ns). There were no statistical differences in serum levels of TNFα among the groups. When serum TNFα values were expressed as the difference from the baseline, in the transvaginal group they were significantly lower than in the transrectal at 2 h [0.5 pg/ml (range = -14 to 59) vs. 60 pg/ml (range = -8 to 303); P = 0.041] and at 8 h [-5.5 pg/ml (range = -86 to 55] vs. 37 pg/ml (range = -30 to 62); P = 0.031]. The limitations of this study were that the analyses of IL-6 and Il-1β were not possible because most of the samples were below detectable levels, it was an animal model, and the sample size was small.Inflammatory parameters are similar between NOTES and laparoscopic peritoneoscopy despite longer surgery time in the NOTES group. The vaginal route seems to reduce the inflammatory stress.
- Published
- 2011
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