48 results on '"E. Fuentes-Valenzuela"'
Search Results
2. TEMPORARY EUS-GUIDED ANASTOMOSES (TEAS) TO FACILITATE STAGED ENDOTHERAPY OF COMPLEX BENIGN BILIARY OBSTRUCTION (BBO)
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M. De Benito Sanz, M. Sciarretta, C. Maroto Martín, M. Durá Gil, E. Fuentes Valenzuela, A.Y. Carbajo López, A. Arrubla, R. Sánchez-Ocaña, C. De la Serna Higuera, and M. Pérez-Miranda
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- 2022
3. EUS-GUIDED TRANSESOPHAGEAL DRAINAGE OF A LIVER ABSCESS WITH A SELF-EXPANDABLE METAL STENT (SEMS) AS RESCUE THERAPY AFTER DOUBLE PIGTAIL STENT (DPS) MISDEPLOYMENT
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E. Fuentes-Valenzuela, B. Burgueño-Gomez, C. Chavarría, L. Sánchez-Delgado, C. Maroto-Martín, M. Dura Gil, M. De Benito Sanz, A.Y. Carbajo, R. Sanchez-Ocana, C. De la Serna Higuera, and M. Pérez-Miranda
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- 2022
4. PREVALENCE OF GASTRIC PRECURSOR LESIONS IN THE POPULATION WITHOUT PREVIOUS ENDOSCOPIC STUDY. PRELIMINARY ANALYSIS
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E. Fuentes-Valenzuela, L. Sánchez-Delgado, C. Maroto-Martín, S. Fernandez-Prada, L. Juan-Casamayor, J. Tejedor-Tejada, M. De Benito Sanz, B. Burgueño-Gomez, P. Diez Redondo, and H. Nuñez Rodriguez
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- 2022
5. ENDOSCOPIC ULTRASOUND (EUS)-GUIDED REPERMEABILIZATION WITH AN ENTERAL STENT THROUGH A GASTROENTERIC LUMEN-APPOSING METAL STENT (LAMS) BURIED BY TUMOR OVERGROWTH
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B. Burgueño, C. Chavarria, E. Fuentes-Valenzuela, R. Sánchez-Ocaña, M. De Benito-Sanz, A. Carbajo-López, C. de la Serna-Higuera, and M. Perez-Miranda
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- 2022
6. ENDOSCOPIC REPAIR OF POST-SURGICAL DISCONNECTED BILE DUCTS (DBDS) BY MAGNETIC COMPRESSION ANASTOMOSIS (MCA) VIA EUS-GUIDED ANASTOMOSES
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M. Dura-Gil, M. de Benito, E. Fuentes-Valenzuela, M. Sciarretta, J.A. Estradas-Trujillo, R. Sanchez-Ocana, C. de la Serna, and M. Perez-Miranda
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- 2022
7. [Proton-pump inhibitors treatment. Does your patient really need it?]
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E, Fuentes-Valenzuela, P, Díez Redondo, J, Tejedor-Tejada, R, Nájera-Muñoz, L, Sánchez-Delgado, and C, Maroto-Martín
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Adult ,Cross-Sectional Studies ,Polypharmacy ,Humans ,Inappropriate Prescribing ,Proton Pump Inhibitors ,Emergency Service, Hospital - Abstract
Proton-pump inhibitors (PPI) are frequently prescribed for wide gastrointestinal disorders. The indications are well established, although a high rate of misuse has been reported.Observation cross-sectional study conducted a tertiary hospital. Adult patients who attended the emergency department were eligible. The appropriate indication was evaluated. Also, the prescription period, dosage and the prescribing clinician were reviewed.300 patients were included. The indication was adequate in 142 patients (47.3%). The main indication was the primary prophylaxis for NSAIDs/ASA-induced enteropathy (n=95 patients, 31.7%). Polypharmacy was the main misuse indication (n=82 patients, 27.3%). The median prescription duration was 31 months (IQR 9-72), ranging from one month to 360 months. The duration was lower in those with correct indication (42.3 vs 59.6 months, P=.02). The primary care physician was the main responsible for prescription (n=165 patients, 55%), followed by gastroenterologist (n=38 patients, 12.7%) without significant differences in appropriateness by speciality.Studies like this raise awareness about the PPI overuse and misuse. Deprescribing should be considered as essential to reduce iatrogenic risk and redundant health expenditure.
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- 2021
8. P362 Influence of HLA DQA1*05 genotype in patients with inflammatory bowel disease and Anti-TNF treatment with proactive therapeutic drug monitoring
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E Fuentes-Valenzuela, F J García-Alonso, C Maroto-Martín, L Juan-Casamayor, J A Garrote Adrados, R Almendros Muñoz, Á de Prado, M Á Marinero, R Calleja Carbajosa, A Vara Castrodeza, and J Barrio
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Gastroenterology ,General Medicine - Abstract
Background The HLADQA1*05 variant increases the risk of developing antibodies against infliximab and adalimumab. Whether proactive therapeutic drug monitoring (PTDM) could overcome this immunogenicity remains unknown. The primary aim was to evaluate the influence of the allele HLADQA1*05 on treatment persistence. Methods We performed a single centre retrospective cohort study. IBD patients starting anti-TNF therapy between January, 2017 and March, 2021 were included. HLA DQA1*05 genotype screening was performed during, 2021. PTDM was defined as periodic drug level measurement (≥2 determinations during the first year of treatment and ≥1/annual determination during the following years), regardless of clinical condition, with according dose optimization. Patients not fulfilling these criteria were excluded. Target concentration during induction:, 25–30 mcg/ml (week, 2) and, 20 mcg/ml (week, 6) for Infliximab and >, 10 mcg/ml (week, 2 and, 4) for Adalimumab. During maintenance:, 3–10 mcg/ml for Infliximab and, 8–12 mcg/ml for Adalimumab. Clinical remission was defined as HBI 1 and biochemical remission as a fecal calprotectin Results 126 patients started anti-TNF therapy during the study period. Fourteen were excluded (8 lacked PTDM and, 6 declined the HLA DQA1*05 genotype), thus including, 112 patients with a median follow-up of, 73.9 (IQR:, 35.4–133.1) weeks, 52 (46.4%) HLADQA1*05 positive. Figure, 1 presents baseline characteristics. Combination therapy with thiopurines was more frequent among HLADQA1*05 negative patients (28 (46.7%) vs, 12 (23.1%), p=0.01). During their first year, patients underwent a median of, 3 (IQR, 2–4) drug level measurements. We performed, 497 determinations (4/patient (IQR:3–6);, 149 (30%), drove to dose modifications, 63 (42.3%) among symptomatic patients and, 86 (57.7%) among asymptomatic ones. Primary nonresponses were higher (8.1% vs, 0, p=0.06) among HLADQA1*05 negative patients. The HLADQA1*05 positive presented non-significant higher clinical remission rates at week, 14 (77.9% vs, 73.9%, p=0.69) and, 56 (73.2% vs, 68.4%, p=0.64) (figure 2). Figures, 3 and, 4 presents drug persistence, which was higher among HLADQA1*05 positive patients (HR:, 0.32, 95% CI:, 0.14–0.71, p=0.01). Multivariable Cox regression analysis identified systemic steroids at anti-TNF initiation (Hazard ratio (HR):, 4, 95% CI, 1.7–9.7) as a risk factor and a positive HLA DQA1*05 genotype (HR:0.31 (0.12–0.81)) as a protective factor of treatment cessation. Fig.1 Fig. 2. Fig.3 Fig.4. Conclusion: When PTDM is performed, a positive HLA DQA1*05 genotype does not associate a higher risk of treatment cessation.
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- 2022
9. Double Over-The-Scope Clip (OTSC) Closure Following Lumen-Apposing Metal Stent (LAMS) Dislodgement Allows Single-Session Eus-Directed Transgastric Ercp (EDGE)
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C De La Serna Higuera, M De Benito Sanz, M Pérez-Miranda, E Fuentes Valenzuela, C Chavarria Herbozo, and Ramon Sanchez-Ocana
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Closure (topology) ,Lumen (anatomy) ,Medicine ,Stent ,Over the scope clip ,Edge (geometry) ,business ,Single session ,Surgery - Published
- 2021
10. P319 Impact of biological agents on postoperative complications in inflammatory bowel disease: a multicentre study of GETECCU
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Javier P. Gisbert, M González-Vivó, Isabel Pérez-Martínez, C Rubín de Célix, A Gutiérrez, C Cagigas Fernández, Jesús Castro-Poceiro, E Leo-Carnerero, I El Hajra, Carmen Duenas, A Núñez, Grace Molina, B Castro, A Martín-Cardona, Edgardo J. Romero, Y Zabana, L Melcarne, Mercedes Izquierdo, I Gonzalez-Partida, Nelson Jiménez, Agnès Fernández-Clotet, Francisco Mesonero, Edmundo Caluña Sánchez, J Miranda-Bautista, D Casas-Deza, J Zorrilla, C Suarez Ferrer, Iria Bastón-Rey, B Del Val, P Ramírez de la Piscina, C Calvino-Suárez, M. Rivero, A Bouhmidi, O Sierra, David Monfort, N Hernández-Aretxabaleta, José María Huguet, E Fuentes-Valenzuela, M J García García, and M Chaparro
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Crohn's disease ,medicine.medical_specialty ,Ileus ,business.industry ,Gastroenterology ,General Medicine ,medicine.disease ,Preoperative care ,Ulcerative colitis ,Inflammatory bowel disease ,Vedolizumab ,Internal medicine ,Ustekinumab ,Necrotizing enterocolitis ,medicine ,business ,medicine.drug - Abstract
Background It has been suggested that biologic therapy may increase the risk of postoperative complications in inflammatory bowel disease (IBD), but the evidence is scarce. Our aim was to evaluate whether the treatment with anti-TNF agents, ustekinumab or vedolizumab increase the risk of complications after surgery. Methods IBD patients undergoing intra-abdominal surgery between 1st January 2009 and 31st December of 2019 were retrospectively selected. Data collection included clinical characteristic of IBD, biochemical parameters and surgical aspects. Postoperative complications (PC) were defined as those occurring within 30 days after surgery. Exposed cohort (EC): Patients who received the last dose of the biologic within 3 months before surgery. Non-exposed cohort (NEC): Patients who did not receive biologic treatment within 3 moths prior to surgery. Predictive factors for PC and for infections were identified by logistic regression analyses. A genetic matching score was performed to balance the clinical characteristics of both groups. Results A total of 1,535 surgeries performed in 37 centres were included: 81% in Crohn’s disease, 18% in ulcerative colitis and 1% in unclassified-IBD patients. A total of 711 surgeries (46.3%) had been exposed to biologics (583 under anti-TNF therapy, 58 under vedolizumab and 69 under ustekinumab) and 824 surgeries (53.7%) the NEC. PC were reported in 38% (n=267) of patients in the exposed cohort and in 34% (n=280) of patients in the non-exposed one (p=0.15), including dehiscence, infection, obstruction, ileus, bleeding, thrombosis, fistula and evisceration. The most frequent complications were infections (48% of all the cases). A 30-day hospital readmission was needed in 7% (n=110) of the patients, and 2% (n=29) required a new surgery with no differences (p>0.05). Multivariate analysis for PC and infections is presented in table 1. The frequencies of PC for each biologic in the univariate analysis are represented in figure 1. No specific treatment was associated to PC or infections in multivariate analysis. Conclusion Preoperative administration of biological therapy does not seem to be a risk factor for overall PC, although it may be for postoperative infections.
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- 2021
11. P606 Adherence to endoscopic surveillance guidelines for advanced lesions and colorectal cancer in Inflammatory Bowel Disease in Spain: a collaborative study of AEG and GETECCU
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R Ferreiro-Iglesias, José Manuel Benítez, Geteccu, C. Gómez, A Bouhmidi, R M Jurado, C Calviño Suárez, M P Ballester Ferré, B. Beltrán, E Castillo, Miguel Minguez, B Hermida, Agnès Fernández-Clotet, P Besó, Raquel Muñoz, C Calvino-Suárez, E Fuentes-Valenzuela, M Vela, Carmen Duenas, P Pérez, Á Algarra, Ángel Ponferrada, C Rubín de Célix, B. Botella, Nelson Jiménez, A López, C Senosiain, N Martín, J Yebra, P Flórez-Diez, R. Plaza, E Iyo, M González-Vivó, P. Soto, E Brunet, Francisco Mesonero, and J.A. Carbonell-Asins
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Crohn's disease ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Colorectal cancer ,Gastroenterology ,Colonoscopy ,General Medicine ,medicine.disease ,Ulcerative colitis ,Inflammatory bowel disease ,Endoscopy ,Log-rank test ,Dysplasia ,Internal medicine ,medicine ,business - Abstract
Background Patients with colon Inflammatory Bowel Disease (IBD) have a higher risk of colorectal cancer (CRC) than general population. Current guidelines establish endoscopic surveillance recommendations; however, epidemiological studies show poor compliance. The main aim of our study was to analyse adherence to endoscopic surveillance guidelines. Secondary aim was to evaluate the prevalence and time-to advanced lesions or CRC. Methods Retrospective multicentre study of patients with IBD followed-up in the participating centres between 2005 and 2020, who were diagnosed of IBD between 2005 and 2008, with criteria for CRC surveillance. Patients with CRC before IBD diagnosis were excluded. The ECCO 2013–2017 guidelines were used to evaluate adherence. Adenomatous lesions with >25% of villous component, >1cm or with high-grade dysplasia or serrated lesions >1cm or with any degree of dysplasia were considered advanced lesions. Software used for all analysis was R in its 3.6.1 version. Normality was checked with the Shapiro-Wilks test. Mean comparison was carried out using t-Student test while normality assumptions held true, otherwise, Mann-Whitney test. Time-to advanced lesions or CRC event between patients that had adherence to ECCO guidelines versus those who did not was performed through Kaplan-Meier and Log-rank test. P-values below 0.05 were considered significant. Results A total of 1004 (713 Ulcerative Colitis, 252 Crohn’s disease and 39 Indeterminate Colitis; 52% male) patients from 25 centres were recruited with a median age of 36 (26–47) years. 87% of all patients were included in the endoscopic surveillance programme. The main reasons for non-inclusion were the absence of indication by the physician (38%) and the presence of inflammatory activity (37%). Adherence to the first or subsequent surveillance colonoscopies was 45% and 61%, respectively, with a total adherence rate of 32%. Prevalence of advanced lesions or CRC was 4% and 7 cases of CRC were detected. Time-to-detection of these lesions since IBD diagnosis was significantly longer in non-adherent patients (13.4 + 1.3 vs13.04 + 1.7; p Conclusion Adherence to ECCO guidelines for endoscopic surveillance is low in this Southern European population. A higher and earlier detection of advanced lesions or CRC was identified in the adherent group. The results of this study highlight the need to improve compliance with the recommendations to obtain better outcomes.
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- 2021
12. Diagnosis of eosinophilic gastrointestinal disorders beyond eosinophilic esophagitis in adults. A brief review.
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Fuentes-Valenzuela E, Delgado-Guillena P, Velamazan-Sandalinas R, Sánchez JJ, García-Morales N, Barrio J, and Lucendo AJ
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- Humans, Adult, Diagnosis, Differential, Eosinophilia diagnosis, Eosinophilic Esophagitis diagnosis, Eosinophilic Esophagitis complications, Gastritis diagnosis, Gastritis complications, Enteritis diagnosis, Enteritis complications
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- 2024
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13. EUS-guided fine needle biopsy of an anal gland adenocarcinoma with submucosal rectal invasion after normal colonoscopy. An uncommon histology.
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Fuentes-Valenzuela E, Labarga F, Madrigal Rubiales B, Simó V, and de la Serna Higuera C
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- Humans, Male, Middle Aged, Endoscopic Ultrasound-Guided Fine Needle Aspiration, Anal Gland Neoplasms pathology, Anal Gland Neoplasms diagnostic imaging, Anus Neoplasms pathology, Anus Neoplasms diagnostic imaging, Rectal Neoplasms pathology, Rectal Neoplasms diagnostic imaging, Neoplasm Invasiveness, Rectum pathology, Rectum diagnostic imaging, Adenocarcinoma pathology, Adenocarcinoma diagnostic imaging, Colonoscopy
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We present the case of a 63-year-old male with long-term anal pain. A pelvic MRI was performed showing a tumor arising from the intersphincteric extending into the submucosal layer of the posterior rectal wall. The image was compatible with a cT4N0 ano-rectal carcinoma without any distant metastasis on the CT scan. Histopathology showed neoplastic proliferation cells arranged in nodules and nidus consistent with anal glands adenocarcinoma with a positive immunohistostaining for CK7 and MUC5+ .
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- 2024
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14. Rectal ultrasound as a unique diagnostic option in obstructive colorectal metastasis from breast adenocarcinoma.
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Sánchez-Delgado L, Burgueno-Gómez B, Abella-Santos LE, Colinas-Reyero D, Fuentes-Valenzuela E, and de la Serna-Higuera C
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- Humans, Female, Intestinal Obstruction etiology, Intestinal Obstruction diagnostic imaging, Endosonography, Rectum diagnostic imaging, Ultrasonography, Middle Aged, Aged, Breast Neoplasms pathology, Breast Neoplasms diagnostic imaging, Adenocarcinoma secondary, Adenocarcinoma diagnostic imaging, Colorectal Neoplasms pathology, Colorectal Neoplasms diagnostic imaging
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We present the case of an uncommon manifestation of metastatic breast cancer as an occlusive colorectal stenosis with submucosal location. The endoscopic rectal ultrasound allowed to confirm the diagnosis with transmural biopsies.
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- 2024
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15. Initial Management of Intra-abdominal Abscesses and Preventive Strategies for Abscess Recurrence in Penetrating Crohn's Disease: A National, Multicentre Study Based on ENEIDA Registry.
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Casas Deza D, Polo Cuadro C, de Francisco R, Vela González M, Bermejo F, Blanco I, de la Serna Á, Bujanda L, Bernal L, Rueda García JL, Gargallo-Puyuelo CJ, Fuentes-Valenzuela E, Castro B, Guardiola J, Ladrón G, Suria C, Sáez Fuster J, Gisbert JP, Sicilia B, Gomez R, Muñoz Vilafranca C, Barreiro-De Acosta M, Peña E, Castillo Pradillo M, Cerrillo E, Calvet X, Manceñido N, Monfort I Miquel D, Marín S, Roig C, Marce A, Ramírez de Piscina P, Betoré E, Martin-Cardona A, Teller M, Alonso Abreu I, Maroto N, Frago S, Gardeazabal D, Pérez-Martínez I, Febles González ÁD, Barrero S, Taxonera C, García de la Filia I, Ezkurra-Altuna A, Madero L, Martín-Arranz MD, Gomollón F, Domènech E, and García-López S
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- Humans, Male, Female, Adult, Spain, Middle Aged, Secondary Prevention methods, Crohn Disease complications, Abdominal Abscess etiology, Abdominal Abscess prevention & control, Abdominal Abscess therapy, Drainage methods, Registries, Anti-Bacterial Agents therapeutic use, Recurrence
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Introduction: Intra-abdominal abscesses complicating Crohn's disease [CD] are a challenging situation. Their management, during hospitalisation and after resolution, is still unclear., Methods: Adult patients with CD complicated with intra-abdominal abscess. who required hospitalisation, were included from the prospectively maintained ENEIDA registry from GETECCU. Initial strategy effectiveness and safety to resolve abscess was assessed. Survival analysis was performed to evaluate recurrence risk. Predictive factors associated with resolution were evaluated by multivariate regression and predictive factors associated with recurrence were assessed by Cox regression., Results: In all, 520 patients from 37 Spanish hospitals were included; 322 [63%] were initially treated with antibiotics alone, 128 [26%] with percutaneous drainage, and 54 [17%] with surgical drainage. The size of the abscess was critical to the effectiveness of each treatment. In abscesses < 30 mm, the antibiotic was as effective as percutaneous or surgical drainage. However, in larger abscesses, percutaneous or surgical drainage was superior. In abscesses > 50 mm, surgery was superior to percutaneous drainage, although it was associated with a higher complication rate. After abscess resolution, luminal resection was associated with a lower 1-year abscess recurrence risk [HR 0.43, 95% CI 0.24-0.76]. However, those patients who initiated anti-TNF therapy had a similar recurrence risk whether luminal resection had been performed., Conclusions: Small abscesses [<30mm] can be managed with antibiotics alone; larger ones require drainage. Percutaneous drainage will be effective and safer than surgery in many cases. After discharge, anti-TNF therapy reduces abscess recurrence risk in a similar way to bowel resection., (© The Author(s) 2023. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2024
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16. Beyond Crohn's disease: Deferasirox as possible agent for drug-induced ileocolitis.
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Fuentes-Valenzuela E, Carbajo AY, Fernández-Prada SJ, Rubiales BM, and Jimenez NC
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- Humans, Deferasirox adverse effects, Crohn Disease drug therapy, Colitis chemically induced, Ileitis chemically induced
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- 2024
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17. Endoscopic ultrasound-guided stent-in-stent bridging for a late buried gastroenteric lumen-apposing metal stent.
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Burgueño-Gomez B, Chavarría C, Fuentes-Valenzuela E, Sánchez-Ocaña R, de la Serna-Higuera C, and Perez-Miranda M
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- Humans, Ultrasonography, Interventional, Drainage, Endosonography, Stents
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Competing Interests: M. Perez-Miranda is a consultant for Boston Scientific, Olympus, Medtronic, and M. I.Tech.
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- 2023
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18. Endoscopic ultrasound-guided drainage of a liver abscess with a self-expandable metal stent as rescue therapy after plastic stent misdeployment.
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Fuentes-Valenzuela E, Burgueño Gomez B, Chavarría C, Sanchez-Ocana R, de la Serna-Higuera C, and Perez-Miranda M
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- Humans, Stents, Endosonography, Drainage, Ultrasonography, Interventional, Plastics, Self Expandable Metallic Stents, Liver Abscess diagnostic imaging, Liver Abscess etiology, Liver Abscess surgery
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Competing Interests: Dr. Manuel Perez-Miranda is a consultant for Boston Scientific, Olympus, Medtronic and M.I.Tech.
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- 2023
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19. History and clinical guidelines for chronic atrophic gastritis and the assessment of gastric cancer risk.
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Delgado-Guillena P, Velamazan-Sandalinas R, Jiménez Sánchez J, Fuentes-Valenzuela E, García-Morales N, Cuatrecasas M, Jimeno M, Moreira L, and Albéniz E
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- Humans, Risk, Gastric Mucosa, Gastritis, Atrophic complications, Gastritis, Atrophic diagnosis, Stomach Neoplasms diagnosis, Stomach Neoplasms etiology, Gastritis, Helicobacter pylori, Helicobacter Infections complications, Helicobacter Infections drug therapy
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- 2023
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20. Influence of HLADQA1*05 Genotype in Adults With Inflammatory Bowel Disease and Anti-TNF Treatment With Proactive Therapeutic Drug Monitoring: A Retrospective Cohort Study.
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Fuentes-Valenzuela E, García-Alonso FJ, Maroto-Martín C, Juan Casamayor L, Garrote JA, Almendros Muñoz R, De Prado Á, Vara Castrodeza A, Marinero MÁ, Calleja Carbajosa R, and Barrio J
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- Humans, Adult, Retrospective Studies, Cohort Studies, Drug Monitoring, Infliximab, Adalimumab therapeutic use, Genotype, Tumor Necrosis Factor-alpha, Tumor Necrosis Factor Inhibitors therapeutic use, Inflammatory Bowel Diseases drug therapy, Inflammatory Bowel Diseases genetics
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Background: Carriers of the human leucocyte antigen variant HLADQA1*05 (rs2097432) are at risk of developing antibodies against infliximab and adalimumab with reduced tumor necrosis factor (TNF) antagonist persistence. The impact of proactive therapeutic drug monitoring (PTDM) on this association has been barely assessed., Methods: We conducted a retrospective single-center cohort study including patients with inflammatory bowel disease starting anti-TNF therapy between January 2017 and March 2021. Proactive therapeutic drug monitoring was defined as periodic drug level measurement (≥2 determinations during the first year of treatment and ≥1/annual determination during the following years), regardless of clinical condition, followed by dose optimization. Variables associated with treatment persistence were assessed with multivariable Cox regression analysis., Results: A total of 112 patients were included, 52 (46.4%) HLA-DQA1*05 carriers, with a median follow-up of 73.9 (interquartile range, 35.4-133.1) weeks. Combination therapy with thiopurines was more frequent among HLA-DQA1*05 noncarriers (28 [46.7%] vs 12 [23.1%]; P = .01). Clinical remission rates at week 14 (77.9% vs 73.9%; P = .69) and 56 (73.2% vs 68.4%; P = .64) were similar between HLA-DQA1*05 noncarriers and carriers. Drug persistence was higher among HLA-DQA1*05 carriers (hazard ratio [HR], 0.32; 95% confidence interval, 0.14-0.71; P = .01). Multivariable Cox regression analysis identified systemic steroids at anti-TNF initiation (HR, 4; 95% confidence interval, 1.7-9.7) as a risk factor and HLA-DQA1*05 carriers (HR, 0.31; 95% confidence interval, 0.12-0.81) as a protective factor of treatment cessation., Conclusion: In adult patients with PTDM, a positive HLA-DQA1*05 genotype does not associate a higher risk of treatment cessation nor worse clinical outcomes., (© The Author(s) 2023. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2023
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21. Antimigration versus conventional fully covered metal stents in the endoscopic treatment of anastomotic biliary strictures after deceased-donor liver transplantation.
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Fuentes-Valenzuela E, de Benito Sanz M, García-Pajares F, Estradas J, Peñas-Herrero I, Durá-Gil M, Carbajo AY, de la Serna-Higuera C, Sanchez-Ocana R, Alonso-Martín C, Almohalla C, Sánchez-Antolín G, and Perez-Miranda M
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- Humans, Constriction, Pathologic etiology, Constriction, Pathologic surgery, Cholangiopancreatography, Endoscopic Retrograde methods, Retrospective Studies, Living Donors, Neoplasm Recurrence, Local etiology, Stents, Treatment Outcome, Liver Transplantation adverse effects, Cholestasis etiology, Cholestasis surgery
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Introduction: Migration of fully covered metal stents (FCMS) remains a limitation of the endoscopic treatment of anastomotic biliary strictures (ABS) following orthotopic liver transplantation (OLT). The use of antimigration FCMS (A-FCMS) might enhance endoscopic treatment outcomes for ABS., Methods: Single center retrospective study. Consecutive patients with ABS following OLT who underwent ERCP with FCMS placement between January 2005 and December 2020 were eligible. Subjects were grouped into conventional-FCMS (C-FCMS) and A-FCMS. The primary outcome was stent migration rates. Secondary outcomes were stricture resolution, adverse event, and recurrence rates., Results: A total of 102 (40 C-FCMS; 62 A-FCMS) patients were included. Stent migration was identified at the first revision in 24 C-FCMS patients (63.2%) and in 21 A-FCMS patients (36.2%) (p = 0.01). The overall migration rate, including the first and subsequent endoscopic revisions, was 65.8% in C-FCMS and 37.3% in A-FCMS (p = 0.006). The stricture resolution rate at the first endoscopic revision was similar in both groups (60.0 vs 61.3%, p = 0.87). Final stricture resolution was achieved in 95 patients (93.1%), with no difference across groups (92.5 vs 93.5%; p = 0.84). Adverse events were identified in 13 patients (12.1%) with no difference across groups. At a median follow-up of 52 (IQR: 19-85.5) months after stricture resolution, 25 patients (24.5%) developed recurrences, with no difference across groups (C-FCMS 30% vs A-FCMS 21%; p = 0.28)., Conclusions: The use of A-FCMS during ERCP for ABS following OLT results in significantly lower stent migration rates compared to C-FCMS. However, the clinical benefit of reduced stent migration is unclear. Larger studies focusing on stricture resolution and recurrence rates are needed., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2023
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22. Esophageal necrosis secondary to thoracic aortic aneurysm.
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Juan Casamayor L, Martínez Cuevas C, Fuentes-Valenzuela E, and Alonso-Martín C
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- Aged, Humans, Male, Gastroscopy, Necrosis complications, Aortic Aneurysm, Thoracic complications, Aortic Aneurysm, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic pathology, Esophageal Fistula complications, Esophageal Fistula pathology, Thrombosis complications, Dyslipidemias drug therapy, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use
- Abstract
We present the case of a 78-year-old man with dyslipidemia with ongoing treatment with statins. He was admitted for a history of 3-month dysphagia and weight loss. The physical exam was unremarkable. Blood tests revealed anemia (hemoglobin 11,5 g/dL). Gastroscopy showed a partially stenotic bulging ulcer in the middle esophagus, with a fibrinous base and residual clot Histopathology ruled out any malignancy and confirmed the presence of transmural necrosis with infiltration of inflammatory cells. Computed tomography (CT) revealed a 11x11x12 cm thoracic aortic aneurysm, with an intramural 4 cm thrombus in the anterolateral wall. The patient was referred for urgent Vascular Surgery, but unfortunately, he presented massive hematemesis with cardiorespiratory arrest, and despite cardiopulmonary resuscitation, he died.
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- 2023
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23. The impact of obesity on postoperative complications and short-term survival after liver transplantation.
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Tejedor-Tejada J, Garcia-Pajares F, Safadi R, Mauriz-Barreiro V, Molina E, Juan-Casamayor L, Fernández-Prada S, Helal A, Fuentes-Valenzuela E, Alonso-Martin C, and Almohalla-Alvarez C
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- Humans, Severity of Illness Index, Obesity complications, Risk Factors, Postoperative Complications epidemiology, Postoperative Complications etiology, Graft Survival, Retrospective Studies, Treatment Outcome, Liver Transplantation adverse effects, End Stage Liver Disease surgery
- Abstract
Background and Aims: Obesity is considered a risk factor for perioperative complications, but its effect on patients undergoing liver transplantation (LT) remains unclear. This study was conducted to analyze the impact of obesity on early morbidity and mortality risk following LT., Methods: A multicenter study of outcomes in patients submitted to LT between 2009 and 2019 was conducted. Recipients were stratified into obese (BMI ≥ 30 kg/m2) and nonobese patients (BMI < 30 kg/m2). Early postoperative complications were compared and 30-day and 1-year patient and graft survival were assessed by Kaplan-Meier method. Primary graft nonfunction (PGNF) was defined as the presence of total bilirubin > 10 mg/dl, INR > 1.6 or ALT > 2000 U/l within the first week after LT., Results: A total of 1608 patients were included after applying exclusion criteria, nonobese (1149, 71.46%) and obese patients (459, 28.54%). There were no significant differences in age, sex, Model for End-stage Liver Disease, Charlson comorbidity score, ethnicity, waiting list time and ischemia time. There were significantly higher rates of vascular (17.58% vs 23.53%, P = 0.021) and biliary complications (27.68% vs 35.73%, P = 0.006) and PGNF (11.40% vs 12.20%, P = 0.021) in obese patients. There was a significantly increased risk for long-term graft failure; however, there was no significant difference in patient survival after LT., Conclusion: Obese patients have significantly increased morbidity in terms of vascular and biliary complications and PGNF after LT. They have a higher risk for worse 1-year graft survival in comparison to controls., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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24. Endoscopic ultrasound guided diagnosis of a retroperitoneal extra-gastrointestinal stromal tumor.
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Moreta Rodríguez M, Martínez Ortega A, Maroto-Martín C, de la Serna Higuera C, Ponce Balaguer C, and Fuentes-Valenzuela E
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- Endosonography, Abdominal Pain etiology, Weight Loss, Tomography, X-Ray Computed, Biopsy, Fine-Needle, Humans, Female, Aged, 80 and over, Gastrointestinal Stromal Tumors pathology, Retroperitoneal Neoplasms pathology
- Abstract
GIST tumors are mesenchymal tumors that are usually positive for the CD-117 marker. They present mostly at middle ages of life and although the most frequent locations are the stomach, small intestine and rectum/colon, they can appear in unusual places such as the retroperitoneum. The case that we present reflects the diagnostic process with imaging tests such as echo-endoscopy with puncture, of a retroperitoneal GIST tumor.
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- 2023
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25. Effectiveness and Safety of Ustekinumab in Elderly Patients with Crohn's Disease: Real World Evidence From the ENEIDA Registry.
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Casas-Deza D, Lamuela-Calvo LJ, Gomollón F, Arbonés-Mainar JM, Caballol B, Gisbert JP, Rivero M, Sánchez-Rodríguez E, Arias García L, Gutiérrez Casbas A, Merino O, Márquez L, Laredo V, Martín-Arranz MD, López Serrano P, Riestra Menéndez S, González-Muñoza C, de Castro Parga L, Calvo Moya M, Fuentes-Valenzuela E, Esteve M, Iborra M, Dura Gil M, Barreiro-De Acosta M, Lorente-Poyatos RH, Manceñido N, Calafat M, Rodríguez-Lago I, Guardiola Capo J, Payeras MA, Morales Alvarado VJ, Tardillo C, Bujanda L, Muñoz-Nuñez JF, Ber Nieto Y, Bermejo F, Almela P, Navarro-Llavat M, Martínez Montiel P, Rodríguez Gutiérrez C, Van Domselaar M, Sesé E, Martínez Pérez T, Ricart E, Chaparro M, García MJ, López-Sanromán A, Sicilia B, Orts B, López-García A, Martín-Arranz E, Pérez-Calle JL, de Francisco R, García-Planella E, Domènech E, and García-López YS
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- Humans, Middle Aged, Aged, Remission Induction, Endoscopy, Registries, Treatment Outcome, Retrospective Studies, Ustekinumab adverse effects, Crohn Disease pathology
- Abstract
Background and Aims: Clinical trials and real-life studies with ustekinumab in Crohn's disease [CD] have revealed a good efficacy and safety profile. However, these data are scarcely available in elderly patients. Therefore, we aim to assess the effectiveness and safety of ustekinumab in elderly patients with CD., Methods: Elderly patients [>60 years old] from the prospectively maintained ENEIDA registry treated with ustekinumab due to CD were included. Every patient was matched with two controls under 60 years of age, according to anti-tumour necrosis factor use and smoking habit. Values for the Harvey-Bradshaw Index [HBI], endoscopic activity, C-reactive protein [CRP] and faecal calprotectin [FC] were recorded at baseline and at weeks 16, 32 and 54., Results: In total, 648 patients were included, 212 of whom were elderly. Effectiveness was similar between young and elderly patients during the follow-up. Steroid-free remission was similar at week 16 [54.6 vs 51.4%, p = 0.20], 32 [53.0% vs 54.5%, p = 0.26] and 54 [57.8% vs 51.1%, p = 0.21]. Persistence of ustekinumab as maintenance therapy was similar in both age groups [log-rank test; p = 0.91]. There was no difference in the rate of adverse effects [14.2% vs 11.2%, p = 0.350], including severe infections [7.1% vs 7.3%, p = 1.00], except for the occurrence of de novo neoplasms, which was higher in older patients [0.7% vs 4.3%, p = 0.003]., Conclusions: Ustekinumab is as effective in elderly patients with CD as it is in non-elderly patients. The safety profile also seems to be similar except for a higher rate of de novo neoplasms, probably related to the age of the elderly patients., (© The Author(s) 2022. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2023
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26. Prospective cohort study to evaluate premedication with simethicone and n-acetilcysteine for upper diagnostic gastrointestinal endoscopy.
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Fuentes-Valenzuela E, Pérez-Arenas E, de Benito Sanz M, Chavarría C, Miguel Peña A, Carbajo López A, Tejedor-Tejada J, Burgueño Gómez B, Sánchez-Ocaña R, Albillos-Blanco M, Salvador de Las Heras A, and García-Alonso FJ
- Subjects
- Adult, Female, Humans, Middle Aged, Aged, Acetylcysteine, Prospective Studies, Endoscopy, Gastrointestinal methods, Premedication methods, Simethicone, Propofol
- Abstract
Introduction: The use of premedication for upper gastrointestinal endoscopy (UGE) is not widely established in western countries. The primary aim of the study was to compare gastric visibility according to the total visibility score (TVS). The secondary aim was to assess complications, diagnostic yield, endoscopic procedure time, sedation dose and patient satisfaction., Methods: A single center prospective cohort study was performed of consecutive adults undergoing an UGE in the afternoon working shift. After completing enrolment in the control group, patients were administered 200 mg simethicone and 500 mg N-acetylcysteine diluted in 100 ml of water >15 minutes before the procedure. All procedures were recorded and a single, blinded endoscopist evaluated the TVS after recruitment of both cohorts. Patient satisfaction was evaluated using the Spanish translation of the American Society of Gastrointestinal Endoscopy satisfaction questionnaire., Results: 205 patients were included in the study, 103 females (50.2%) with a median age of 54.8-years (IQR: 41.2-65.2). 104 were enrolled to the control group and 101 to the intervention group. Patients receiving premedication presented a higher rate of adequate (74.3% vs 45.2; difference 95% CI: 16,3-41,9%, p<0.001) and excellent gastric visibility (23.8% vs 7.7%; difference 95% CI: 6,3-25,8%, p=0.002). Propofol dose was similar, although the median procedure time was lower in the group of no intervention [5 (IQR: 4-7) vs 6 minutes (IQR: 5-7); p=0.03]. Procedure related adverse events were similar, except that patient without premedication experienced more nausea episodes. Major and minor endoscopic findings and the satisfaction questionnaire showed no differences between both groups., Conclusion: Patients receiving premedication with simethicone and N-acetylcysteine had a better gastric visibility score, without any increase in adverse events or affecting the patients' satisfaction.
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- 2023
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27. Temporary EUS-guided gastrojejunostomy for gastric outlet obstruction caused by severe acute pancreatitis (with videos).
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Fuentes-Valenzuela E, Ruiz Rebollo L, Sánchez-Ocaña R, Burgueño Gómez B, Chavarría C, Serna-Higuera C, and Perez-Miranda M
- Abstract
Competing Interests: None
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- 2023
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28. Postreperfusion Biopsy as a Predictor of Biliary Complication After Deceased Donor Liver Transplantation. A Retrospective Cohort Study.
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Fuentes-Valenzuela E, Sánchez-Delgado L, Maroto-Martín C, Juan-Casamayor L, Fernández-Prada S, Rodríguez MM, Tejedor-Tejada J, Rubiales BM, Alonso-Martín C, Peñas-Herrero I, Álvarez CA, and García-Pajares F
- Subjects
- Humans, Retrospective Studies, Living Donors, Risk Factors, Biopsy adverse effects, Postoperative Complications diagnosis, Postoperative Complications etiology, Postoperative Complications epidemiology, Liver Transplantation adverse effects, Reperfusion Injury diagnosis, Reperfusion Injury etiology
- Abstract
Background: Ischemia reperfusion injury (IRI) on postreperfusion biopsies is associated with worse outcomes after liver transplantation, although the influence on biliary complications (BC) remains poorly studied. Therefore, the primary aim of our study was to assess the influence of IRI on the incidence of BC. A secondary aim was to assess the influence of steatosis on biliary complications and determine factors that predictor BC., Methods: We report a retrospective cohort study including patients with liver transplantation and postreperfusion injury. Biopsies were classified as relevant and nonrelevant ischemia reperfusion injury for assessment of BC. BC included anastomotic stricture, ischemic cholangiopathy, leaks, and bilomas. Independent predictive factors of biliary complications were assessed using univariate and multivariate analyses., Results: 302 patients were included, and 125 patients fulfilled the criteria for relevant IRI (41.4%). Worse IRI was not associated with biliary complications (42.5% vs 40.1%; P = .68), nor was liver graft steatosis associated with BC (40.5% vs 41.5%, P = .95). The median time until biliary complications did not differ between the 2 groups (2 months; interquartile range = 1-15 vs 3 months; interquartile range = 1-12.5; P = .18). Hepatic artery thrombosis (odds ratio [OR] = 3.4; 95% confidence interval [CI], 1.4-8.2; P = .004), older donor age (OR = 2.1; 95% CI, 1.1-4.1; P = .024), and prolonged cold ischemia time (OR = 1.9; 95% CI, 1.1-3.2) were independent factors of biliary complications., Conclusion: Severe IRI on the postreperfusion injury does not predict development of biliary complications., (Copyright © 2022 Elsevier Inc. All rights reserved.)
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- 2022
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29. Cecal ameboma and a liver abscess mimicking metastatic colonic cancer. An autochthonous infectious disease in Spain?
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Fuentes-Valenzuela E, Carbajo AY, Fernández-Prada SJ, Martínez Lara C, and García-Pajares F
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- Cecum diagnostic imaging, Humans, Male, Metronidazole, Middle Aged, Spain, Amebiasis diagnosis, Colonic Neoplasms, Communicable Diseases, Entamoeba histolytica, Liver Abscess, Liver Neoplasms
- Abstract
We present the case of 52 years-old male without any recent travel. He was admitted to our department for a history of fever and abdominal pain. A CT scan showed a cecal thickening and liver mass with suspected cecal carcinoma with infected necrotic liver metastasis. Although the colonoscopy revealed a bulky submucosal wall thickening with a fibrined ulcer with yellow granulating located in the cecum, the percutaneous drainage revealed a positive PCR for Entamoeba histolytica, with improvement with metronidazole treatment. Ameboma are ulcerative, exophytic, inflammatory masses up to 15 cm in diameter in patients with long standing colonic amoebic infections containing granulation tissue with pseudotumor appearance. It affects less than 1.5% of colonic invasive amebiasis. Moreover, concomitant hepatic amoebic can be observed up to 30%, mimicking colonic cancer with necrotic liver metastasis. Although no epidemiological risk factor for amoebic infection was detected. We therefore highlight the awareness of amoebic infection and different manifestation even in non-endemic areas.
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- 2022
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30. Diarrhea secondary to intestinal infiltration secondary to renal epidermoid carcinoma.
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Moreta Rodríguez M, Mateo Otero L, Cuevas González J, Peñas Herrero I, Burgueño-Gómez B, and Fuentes-Valenzuela E
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- Adult, Diarrhea complications, Endoscopy, Gastrointestinal, Humans, Carcinoma, Renal Cell complications, Carcinoma, Renal Cell diagnostic imaging, Carcinoma, Squamous Cell complications, Carcinoma, Squamous Cell diagnostic imaging, Kidney Neoplasms complications, Kidney Neoplasms diagnostic imaging
- Abstract
Renal squamous cell carcinoma is a rare neoplasm in adults, but with an aggressive behavior. It is diagnosed in most cases in advanced stages. The invasion of the digestive tract by this type of tumor is rare, due to the anatomical arrangement of the colon, however, when it occurs, it carries a poor prognosis for the patient. Digestive endoscopy allows us to reach a definitive diagnosis since these patients usually present digestive manifestations, such as diarrhoea, digestive bleeding or abdominal pain.
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- 2022
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31. Esophageal hyperkeratosis as an uncommon manifestation of gastroesophageal reflux disease.
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Sánchez-Delgado L, Fuentes-Valenzuela E, Burgueño-Gómez B, Oyarzún Bahamonde EP, Maroto-Martín C, Fernández-Prada S, Juan Casamayor L, and Moreta-Rodríguez M
- Subjects
- Aged, Biopsy, Endoscopy, Female, Humans, Proton Pump Inhibitors therapeutic use, Gastroesophageal Reflux complications, Gastroesophageal Reflux diagnosis, Gastroesophageal Reflux drug therapy
- Abstract
We present the case of a 66-year-old woman with intermittent dysphagia and esophageal food impaction. The endoscopic examination showed an upper and middle esophagus with a diffuse circumferential, white, crackleware epithelium. Esophageal biopsies revealed acanthosis and papillomatosis with diffuse hyperkeratosis. High dose of Proton pump inhibitors was initiated with improvement of all symptoms 6 weeks later.
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- 2022
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32. XI factor deficiency as cause of recurrent gastrointestinal bleeding.
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Juan-Casamayor L, Fuentes-Valenzuela E, Alonso-Martín C, Fernández-Fontecha E, and García-Pajares F
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- Aged, Female, Gastroscopy, Humans, Stomach, Gastrointestinal Hemorrhage etiology, Melena etiology
- Abstract
We present the case of a 73-year-old woman with no relevant medical history. She was admitted for a 3-month intermittent melena. The physical exam was unremarkable. Blood tests revealed anemia (hemoglobin 7.4 g/dL), raised urea (69 mg/dL), normal platelets and coagulation. Gastroscopy was performed with active oozing bleeding in the fundus and gastric body. Endoscopic fulguration of the potential lesions with holmium laser was performed. She was discharged with resolution of the symptoms and analytical improvement. However, the patient required hospitalization two weeks later due to recurrence of melena and anemia.
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- 2022
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33. Postreperfusion Liver Biopsy as Predictor of Early Graft Dysfunction and Survival After Orthotopic Liver Transplantation.
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Fuentes-Valenzuela E, Tejedor-Tejada J, García-Pajares F, Rubiales BM, Nájera-Muñoz R, Maroto-Martín C, Sánchez-Delgado L, Alonso-Martín C, Álvarez CA, and Sánchez-Antolín G
- Abstract
Background: Postreperfusion liver biopsy (PRB) can assess the degree of ischemia/reperfusion injury (IRI) after orthotopic liver transplantation (OLT). The influence of IRI on graft outcomes and overall survival is controversial., Aim: To determine the correlation between the severity of IRI in PRB and overall graft and patient survival and, secondarily, to identify factors on PRB that predict poor graft outcomes., Methods: This is a retrospective analysis of all patients who underwent OLT using donation after brain death (DBD) with PRB. The severity of IRI in PRB was graded. Predictors of IRI were assessed using univariate and multivariate analysis and the Kaplan-Meier with log rank test for the graft and overall survival, respectively., Results: We included 280 OLTs (64.7%). The histopathological assessment of IRI severity was as follows: no IRI (N = 96, 34.3%), mild IRI (N = 65; 23.2%), moderate IRI (N = 101; 36.1%), and severe IRI (N = 18; 6.4%). The incidence rates of initial good graft function (IGGF), primary nonfunction and early allograft dysfunction (EAD) were 32.5%, 3.9%, and 18.6%, respectively. Severe IRI was associated with a lower incidence of IGGF (OR: 0.34, 95% CI 0.12-0.92; P = 0.03). Patients with severe IRI tended to have a higher incidence of EAD (33.2% vs. 18.6, P = 0.23). The cold ischemia time was an independent predictor of severe IRI on the multivariate analysis. Severe IRI was associated with poor 1- and 5-year overall survival rates (67% and 44%, respectively, compared with 84 and 68% in nonsevere IRI). Patients with severe IRI exhibited worse graft and overall survival., Conclusions: Cold ischemia time predicts the development of severe IRI. Patients with severe IRI show worse graft and overall survival and a lower incidence of IGGF, suggesting that histopathological findings could be useful for identifying patients at high risk of worse outcomes after OLT., (© 2021 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved.)
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- 2022
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34. Endoscopic ultrasound-guided transportal cholangiography and jejunoduodenostomy to facilitate through-the-stent ERCP and transmural gallbladder drainage in Roux-en-Y gastrectomy.
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Fuentes-Valenzuela E, Sanchez-Ocana R, Chavarría C, de la Serna-Higuera C, and Perez-Miranda M
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- Anastomosis, Roux-en-Y, Cholangiography, Drainage, Gastrectomy, Humans, Stents, Ultrasonography, Interventional, Cholangiopancreatography, Endoscopic Retrograde, Gallbladder surgery
- Abstract
Competing Interests: Dr. Manuel Perez-Miranda is a consultant for Boston Scientific, Olympus, Medtronic, and M.I.Tech.
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- 2022
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35. Adherence to endoscopic surveillance for advanced lesions and colorectal cancer in inflammatory bowel disease: an AEG and GETECCU collaborative cohort study.
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Ballester MP, Mesonero F, Flórez-Diez P, Gómez C, Fuentes-Valenzuela E, Martín N, Senosiain C, Vela M, Fernández-Clotet A, Pérez P, Rubín de Célix C, Calviño-Suárez C, Hermida B, Muñoz R, González-Vivo M, Brunet E, Jiménez N, Botella B, Yebra J, Suárez-Ferrer C, Bouhmidi A, López-Serrano A, Ponferrada Á, Dueñas C, and Mínguez M
- Subjects
- Adult, Cohort Studies, Colonoscopy, Humans, Middle Aged, Risk Factors, Young Adult, Colitis, Ulcerative complications, Colitis, Ulcerative diagnosis, Colitis, Ulcerative epidemiology, Colorectal Neoplasms diagnosis, Colorectal Neoplasms epidemiology, Colorectal Neoplasms pathology, Inflammatory Bowel Diseases complications, Inflammatory Bowel Diseases diagnosis
- Abstract
Background and Aims: Patients with colonic inflammatory bowel disease (IBD) have a high risk of colorectal cancer (CRC). Current guidelines recommend endoscopic surveillance, yet epidemiological studies show poor compliance. The aims of our study were to analyse adherence to endoscopic surveillance, its impact on advanced colorectal lesions, and risk factors of non-adherence., Methods: A retrospective multicentre study of IBD patients with criteria for CRC surveillance, diagnosed between 2005 and 2008 and followed up to 2020, was performed. Following European guidelines, patients were stratified into risk groups and adherence was considered when surveillance was performed according to the recommendations (±1 year). Cox-proportional regression analyses were used to compare the risk of lesions. p-values below 0.05 were considered significant., Results: A total of 1031 patients (732 ulcerative colitis, 259 Crohn's disease and 40 indeterminate colitis; mean age of 36 ± 15 years) were recruited from 25 Spanish centres. Endoscopic screening was performed in 86% of cases. Adherence to guidelines was 27% (95% confidence interval, CI = 24-29). Advanced lesions and CRC were detected in 38 (4%) and 7 (0.7%) patients respectively. Adherence was associated with increased detection of advanced lesions (HR = 3.59; 95% CI = 1.3-10.1; p = 0.016). Risk of delay or non-performance of endoscopic follow-up was higher as risk groups increased (OR = 3.524; 95% CI = 2.462-5.044; p < 0.001 and OR = 4.291; 95%CI = 2.409-7.644; p < 0.001 for intermediate- and high- vs low-risk groups)., Conclusions: Adherence to endoscopic surveillance allows earlier detection of advanced lesions but is low. Groups at higher risk of CRC are associated with lower adherence., (© 2022 John Wiley & Sons Ltd.)
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- 2022
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36. Endoscopic treatment of a cecal Dieulafoy's lesion. An uncommon cause of massive lower gastrointestinal bleeding.
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Fuentes-Valenzuela E, Burgueño-Gómez B, and Chavarría C
- Subjects
- Aged, Cecum, Endoscopy, Humans, Male, Gastrointestinal Hemorrhage etiology, Gastrointestinal Hemorrhage surgery, Hemostasis, Endoscopic adverse effects
- Abstract
We present the case of a 71-year-old male with a history of pulmonary adenocarcinoma under palliative treatment. He was admitted to our hospital with hematochezia and anemia (hemoglobin 10.6 g/dl).
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- 2022
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37. Reply to: "Does it matter which plastic stents we use for the treatment of post-surgical leaks? Or is it a one-size-fits-all?"
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Fuentes-Valenzuela E, García-Alonso FJ, Tejedor-Tejada J, Nájera-Muñoz R, de Benito Sanz M, Sánchez-Ocaña R, de la Serna Higuera C, and Perez-Miranda M
- Subjects
- Humans, Plastics, Retrospective Studies, Stents, Treatment Outcome, Anastomotic Leak surgery, Drainage
- Abstract
We appreciate the interest of Sánchez-Luna et al. in our article "Endoscopic internal drainage using transmural double-pigtail stents in leaks following upper gastrointestinal tract surgery", and find their suggestion about using softer urological double pigtail stents (DPS) for endoscopic internal drainage (EID) interesting.
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- 2022
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38. [Proton-pump inhibitors treatment. Does your patient really need it?]
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Fuentes-Valenzuela E, Díez Redondo P, Tejedor-Tejada J, Nájera-Muñoz R, Sánchez-Delgado L, and Maroto-Martín C
- Subjects
- Adult, Cross-Sectional Studies, Emergency Service, Hospital, Humans, Polypharmacy, Inappropriate Prescribing prevention & control, Proton Pump Inhibitors adverse effects
- Abstract
Introduction: Proton-pump inhibitors (PPI) are frequently prescribed for wide gastrointestinal disorders. The indications are well established, although a high rate of misuse has been reported., Methods: Observation cross-sectional study conducted a tertiary hospital. Adult patients who attended the emergency department were eligible. The appropriate indication was evaluated. Also, the prescription period, dosage and the prescribing clinician were reviewed., Results: 300 patients were included. The indication was adequate in 142 patients (47.3%). The main indication was the primary prophylaxis for NSAIDs/ASA-induced enteropathy (n=95 patients, 31.7%). Polypharmacy was the main misuse indication (n=82 patients, 27.3%). The median prescription duration was 31 months (IQR 9-72), ranging from one month to 360 months. The duration was lower in those with correct indication (42.3 vs 59.6 months, P=.02). The primary care physician was the main responsible for prescription (n=165 patients, 55%), followed by gastroenterologist (n=38 patients, 12.7%) without significant differences in appropriateness by speciality., Conclusions: Studies like this raise awareness about the PPI overuse and misuse. Deprescribing should be considered as essential to reduce iatrogenic risk and redundant health expenditure., (Copyright © 2021 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)
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- 2022
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39. COVID-19 and Short- and Medium-term Outcomes in Liver Transplant Patients: A Spanish Single-center Case Series.
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Tejedor-Tejada J, Fuentes-Valenzuela E, Alonso-Martin C, Almohalla-Alvarez C, and Garcia-Pajares F
- Abstract
Background & Aims: The evidence suggests that most vulnerable subjects to COVID-19 infection suffer from patients with comorbidities or immunosuppression, including liver transplant recipients. Liver graft dysfunction may be a rare complication. Some patients complain about the post-COVID-19 syndrome. The aim of this study was to assess medium- and short-term outcomes in liver transplant patients., Patients and Methods: A retrospective case series was performed at a tertiary referral center. We screened 845 patients who had liver transplant (LT) in our center. All consecutive LT patients with COVID-19 during the Spanish outbreak from March 2020 to April 2021 were included. Demographics, pre-existing comorbidities, clinical and radiological data of COVID-19 infection, complications, and liver graft function were assessed at diagnosis and 3-month follow-up., Results: Overall, 20 LT patients were diagnosed with confirmed COVID-19. We included 16 patients that met the inclusion criteria, 8 nonhospitalized (50%) and 8 (50%) hospitalized patients were analyzed. The median follow-up was 5.33 months (IQR 3.06-8.26). One patient died during the follow-up. All patients presented some grade of respiratory or functional symptoms. Dyspnea and fatigue were the most prevalent symptoms during the 3-month follow-up. No liver graft dysfunction were reported despite of partial immunosuppression withdrawal in four patients (25%). One patient had cardiovascular complications., Conclusions: Our results suggest the presence of post-COVID-19 syndrome with mild residual physical and psychological dysfunction in this subgroup of patients at 3 months after COVID-19. However, no cases of loss or liver graft dysfunction were reported., (© 2021 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved.)
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- 2022
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40. Esophageal Papillomas as an Endoscopic Finding.
- Author
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Pacheco Bolaños JM, Andrés Calvo M, Fuentes-Valenzuela E, Curiel Martínez P, and Miramontes González JP
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- 2022
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41. Lumen apposing metal stents versus tubular self-expandable metal stents for endoscopic ultrasound-guided choledochoduodenostomy in malignant biliary obstruction.
- Author
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de Benito Sanz M, Nájera-Muñoz R, de la Serna-Higuera C, Fuentes-Valenzuela E, Fanjul I, Chavarría C, García-Alonso FJ, Sanchez-Ocana R, Carbajo AY, Bazaga S, and Perez-Miranda M
- Subjects
- Drainage, Endosonography, Humans, Retrospective Studies, Stents, Treatment Outcome, Ultrasonography, Interventional, Choledochostomy, Cholestasis etiology, Cholestasis surgery
- Abstract
Background and Aims: EUS-guided choledochoduodenostomy (EUS-CDS) is an effective option for biliary drainage in malignant biliary obstruction. Lumen apposing metal stents (LAMS) are increasingly been used for EUS-CDS. It is unknown how LAMS compare to tubular self-expandable metal stents (SEMS) for EUS-CDS. Our aim is to compare the clinical outcomes of LAMS versus SEMS for EUS-CDS., Patients and Methods: Single-center retrospective cohort study of consecutive patients with unresectable malignant biliary obstruction who underwent EUS-CDS after failed ERCP for initial biliary drainage between 2011 and 2019. Clinical outcomes were compared between patients who had conventional covered SEMS and LAMS placed for EUS-CDS. Outcome measures included unplanned procedural events, technical success, clinical success, adverse events and reinterventions. Survival was analyzed by the Kaplan-Meier method., Results: During the study period 57 patients met inclusion criteria (37 LAMS, 20 SEMS). All EUS-CDS were technically successful (LAMS group 95% CI 90.3-100%, SEMS group 95% CI 83.2-100%). There were no differences between groups in unplanned procedural events (4 LAMS deployment issues, 2 mild bleeding in SEMS group; 10 vs 10.8%), clinical success (37/37 [100%] vs 19/20 [95%]), and short-term adverse events (5/37 [13.5%] vs 4/20 [20%], p = 0.71). Complete follow-up data were available in 41 patients for a mean of 376 ± 145 days. Endoscopic reintervention was required for duodenal stent placement (n = 9) or biliary stent dysfunction (n = 4), with no difference between LAMS and SEMS group (6/37 [16.2%] vs 7/20 [35%]). There were no differences in overall survival between both groups., Conclusions: EUS-guided choledochoduodenostomy after failed ERCP has equally high technical and clinical success rates with either LAMS or SEMS in patients with malignant biliary obstruction. No differences in adverse events, reinterventions and survival were seen with either type of stent. The cost-effectiveness of LAMS vs SEMS for EUS-guided choledochoduodenostomy remains to be proven., (© 2020. Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2021
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42. Long-term clinical outcome and survival predictors in patients with cirrhosis after 10-mm-covered transjugular intrahepatic portosystemic shunt.
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Tejedor-Tejada J, Fuentes-Valenzuela E, García-Pajares F, Nájera-Muñoz R, Almohalla-Álvarez C, Sánchez-Martín F, Calero-Aguilar H, Villacastín-Ruiz E, Pintado-Garrido R, and Sánchez-Antolín G
- Subjects
- Adult, Aged, Aged, 80 and over, Ascites mortality, Ascites surgery, Esophageal and Gastric Varices complications, Esophageal and Gastric Varices mortality, Esophageal and Gastric Varices surgery, Female, Gastrointestinal Hemorrhage etiology, Gastrointestinal Hemorrhage mortality, Gastrointestinal Hemorrhage surgery, Hepatic Encephalopathy epidemiology, Hepatic Encephalopathy mortality, Hepatic Encephalopathy prevention & control, Hepatic Veins diagnostic imaging, Hepatic Veins surgery, Humans, Hydrothorax mortality, Hydrothorax surgery, Hypertension, Portal mortality, Kaplan-Meier Estimate, Liver Cirrhosis mortality, Male, Middle Aged, Polytetrafluoroethylene, Portasystemic Shunt, Transjugular Intrahepatic adverse effects, Portasystemic Shunt, Transjugular Intrahepatic mortality, Postoperative Complications epidemiology, Postoperative Complications mortality, Proportional Hazards Models, Prosthesis Design, Renal Insufficiency mortality, Retrospective Studies, Serum Albumin, Sodium blood, Treatment Outcome, Hypertension, Portal complications, Liver Cirrhosis complications, Portasystemic Shunt, Transjugular Intrahepatic methods, Stents
- Abstract
Background and Aims: Transjugular intrahepatic portosystemic shunts (TIPS) are successfully used in the management of portal hypertension (PH)-related complications. Debate surrounds the diameter of the dilation. The aim was to analyse the outcomes of and complications deriving from TIPS in patients with cirrhosis and identify predictors of survival., Methods: This was a retrospective single-centre study, which included patients with cirrhosis who had a TIPS procedure for PH from 2009 to October 2018. Demographic, clinical and radiological data were collected. The Kaplan-Meier method was used to measure survival and predictors of survival were identified with the Cox regression model., Results: A total of 98 patients were included (78.6% male), mean age was 58.5 (SD±/-9.9) and the median MELD was 13.3 (IQR 9.5-16). The indications were refractory ascites (RA), variceal bleeding (VB) and hepatic hydrothorax (HH). Median survival was 72 months (RA 46.4, VB 68.5 and HH 64.7) and transplant-free survival was 26 months. Clinical and technical success rates were 70.5% and 92.9% respectively. Age (HR 1.05), clinical success (HR 0.33), sodium (HR 0.92), renal failure (HR 2.46) and albumin (HR 0.35) were predictors of survival. Hepatic encephalopathy occurred in 28.6% of patients and TIPS dysfunction occurred in 16.3%., Conclusions: TIPS with 10-mm PTFE-covered stent is an effective and safe treatment for PH-related complications in patients with cirrhosis. Age, renal failure, sodium, albumin and clinical success are independent predictors of long-term survival., (Copyright © 2020 Elsevier España, S.L.U. All rights reserved.)
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- 2021
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43. Endoscopic internal drainage using transmural double-pigtail stents in leaks following upper gastrointestinal tract surgery.
- Author
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Fuentes-Valenzuela E, García-Alonso FJ, Tejedor-Tejada J, Nájera-Muñoz R, de Benito Sanz M, Sánchez-Ocaña R, de la Serna Higuera C, and Pérez-Miranda M
- Subjects
- Anastomotic Leak diagnostic imaging, Anastomotic Leak etiology, Anastomotic Leak surgery, Drainage, Female, Gastrectomy, Humans, Middle Aged, Retrospective Studies, Stents, Treatment Outcome, Gastric Bypass, Laparoscopy, Obesity, Morbid surgery, Upper Gastrointestinal Tract
- Abstract
Introduction: different endoscopic procedures have been proposed for the management of surgical leaks. Endoscopic internal drainage using trans-fistulary double-pigtail plastic stents has emerged as an alternative strategy, especially in fistulae presenting after laparoscopic gastric sleeve., Methods: a retrospective case series was performed at a single tertiary care center including all upper gastrointestinal post-surgical leaks primarily managed with endoscopic trans-fistulary insertion of double-pigtail plastic stents. Clinical success was defined as the absence of extravasation of oral radiographic contrast and radiological resolution of the collection with adequate oral intake Results: nine patients were included, six (66.6 %) females with a median age of 52.6 years (IQR 47-60). Five cases presented after laparoscopic gastric sleeve, two cases after distal esophagectomies, one after a Roux-en-Y gastric bypass and another one after a pancreaticoduodenectomy. Fistulae measured < 10 mm in five patients (55.6 %) and 10-20 mm in four patients (44.4 %). Six were early leaks. Technical and clinical success was achieved in nine (100 %) and seven (77.8 %) cases, respectively. Seven (77.8 %) patients required ≤ 3 endoscopic procedures. The median hospital stay after the first endoscopic procedure was 12 days (IQR 6.5-17.5 days), while the overall median time until leak healing was 118.5 days (IQR 84.5-170). One patient with a post-esophagectomy intrathoracic leak developed an esophageal-tracheal fistula 37 days after stent deployment., Conclusions: our results support the use of endoscopic internal drainage in postsurgical abdominal leaks, regardless of the type of surgery. Although only two patients with intrathoracic dehiscence were included.
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- 2021
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44. Primary synchronous rectal squamous-cell carcinoma and its exceptional response to chemoradiotherapy.
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Fuentes-Valenzuela E, Burgueño-Gómez B, Lucero-Salaverry MM, and Abella LE
- Subjects
- Anal Canal, Chemoradiotherapy, Female, Humans, Middle Aged, Rectum diagnostic imaging, Carcinoma, Squamous Cell diagnostic imaging, Carcinoma, Squamous Cell therapy, Rectal Neoplasms diagnostic imaging, Rectal Neoplasms therapy
- Abstract
We present the case of a 51-year-old female with a 2-month history of intense anal pain and rectal bleeding. A digital rectal exam revealed a possible lower rectal mass. A colonoscopy was then performed that showed a 5 x 6-cm lesion in the middle rectum and a second 3-cm lesion in the lower rectum, without affecting the anal canal. Multiple biopsies were taken and the histopathologic analysis revealed a moderately differentiated squamous-cell proliferation invading beyond the lamina propria. The CT scan confirmed a middle rectum T4N2bM0 and a lower rectum T3N0M0 synchronous neoplasia. These findings were compatible with a synchronous squamous-cell carcinoma (SCC).
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- 2021
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45. Impact of Biological Agents on Postsurgical Complications in Inflammatory Bowel Disease: A Multicentre Study of Geteccu.
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García MJ, Rivero M, Miranda-Bautista J, Bastón-Rey I, Mesonero F, Leo-Carnerero E, Casas-Deza D, Cagigas Fernández C, Martin-Cardona A, El Hajra I, Hernández-Aretxabaleta N, Pérez-Martínez I, Fuentes-Valenzuela E, Jiménez N, Rubín de Célix C, Gutiérrez A, Suárez Ferrer C, Huguet JM, Fernández-Clotet A, González-Vivó M, Del Val B, Castro-Poceiro J, Melcarne L, Dueñas C, Izquierdo M, Monfort D, Bouhmidi A, Ramírez De la Piscina P, Romero E, Molina G, Zorrilla J, Calvino-Suárez C, Sánchez E, Nuñez A, Sierra O, Castro B, Zabana Y, González-Partida I, De la Maza S, Castaño A, Nájera-Muñoz R, Sánchez-Guillén L, Riat Castro M, Rueda JL, Benítez JM, Delgado-Guillena P, Tardillo C, Peña E, Frago-Larramona S, Rodríguez-Grau MC, Plaza R, Pérez-Galindo P, Martínez-Cadilla J, Menchén L, Barreiro-De Acosta M, Sánchez-Aldehuelo R, De la Cruz MD, Lamuela LJ, Marín I, Nieto-García L, López-San Román A, Herrera JM, Chaparro M, Gisbert JP, and On Behalf Of The Young Group Of Geteccu
- Abstract
Background: The impact of biologics on the risk of postoperative complications (PC) in inflammatory bowel disease (IBD) is still an ongoing debate. This lack of evidence is more relevant for ustekinumab and vedolizumab., Aims: To evaluate the impact of biologics on the risk of PC., Methods: A retrospective study was performed in 37 centres. Patients treated with biologics within 12 weeks before surgery were considered "exposed". The impact of the exposure on the risk of 30-day PC and the risk of infections was assessed by logistic regression and propensity score-matched analysis., Results: A total of 1535 surgeries were performed on 1370 patients. Of them, 711 surgeries were conducted in the exposed cohort (584 anti-TNF, 58 vedolizumab and 69 ustekinumab). In the multivariate analysis, male gender (OR: 1.5; 95% CI: 1.2-2.0), urgent surgery (OR: 1.6; 95% CI: 1.2-2.2), laparotomy approach (OR: 1.5; 95% CI: 1.1-1.9) and severe anaemia (OR: 1.8; 95% CI: 1.3-2.6) had higher risk of PC, while academic hospitals had significantly lower risk. Exposure to biologics (either anti-TNF, vedolizumab or ustekinumab) did not increase the risk of PC (OR: 1.2; 95% CI: 0.97-1.58), although it could be a risk factor for postoperative infections (OR 1.5; 95% CI: 1.03-2.27)., Conclusions: Preoperative administration of biologics does not seem to be a risk factor for overall PC, although it may be so for postoperative infections.
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- 2021
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46. Severe sarcoidosis-like reaction in a patient with Crohn's Disease treated with infliximab. Any relationship?
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Fuentes-Valenzuela E, Navarro Cañadas C, Oyarzún Bahamonde E, Moreta Rodriguez M, and Barrio J
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- Antibodies, Monoclonal adverse effects, Gastrointestinal Agents adverse effects, Humans, Infliximab adverse effects, Treatment Outcome, Crohn Disease drug therapy, Sarcoidosis chemically induced, Sarcoidosis diagnosis
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- 2021
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47. Endoscopic ultrasound-guided choledocoduodenostomy with electrocautery-enhanced lumen-apposing metal stent for benign biliary obstruction: When all other options fail.
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Fuentes-Valenzuela E, de la Serna Higuera C, and Pérez-Miranda M
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- Cholangiopancreatography, Endoscopic Retrograde, Drainage, Electrocoagulation, Humans, Stents, Ultrasonography, Interventional, Cholestasis diagnostic imaging, Cholestasis etiology, Cholestasis surgery, Endosonography
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- 2021
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48. Evaluation of endoscopy requests in the resumption of activity during the SARS-CoV-2 pandemic: denial of nonindicated requests and prioritization of accepted requests.
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Díez Redondo P, Núñez Rodríguez MªH, Fuentes Valenzuela E, Nájera Muñoz R, and Perez-Miranda M
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- Adolescent, Adult, Aged, Aged, 80 and over, COVID-19, Clinical Protocols, Colonoscopy trends, Female, Gastroscopy trends, Health Care Rationing trends, Health Services Accessibility trends, Hospitals, Public standards, Hospitals, Public trends, Humans, Infection Control standards, Infection Control trends, Male, Middle Aged, Practice Guidelines as Topic, SARS-CoV-2, Spain, Tertiary Care Centers standards, Tertiary Care Centers trends, Young Adult, Betacoronavirus, Colonoscopy standards, Coronavirus Infections prevention & control, Gastroscopy standards, Health Care Rationing standards, Health Services Accessibility standards, Infection Control methods, Pandemics prevention & control, Pneumonia, Viral prevention & control
- Abstract
Introduction: the global SARS-CoV-2 pandemic forced the closure of endoscopy units. Before resuming endoscopic activity, we designed a protocol to evaluate gastroscopies and colonoscopies cancelled during the pandemic, denying inappropriate requests and prioritizing appropriate ones., Methods: two types of inappropriate request were established: a) COVID-19 context, people aged ≤ 50 years without alarm symptoms and a low probability of relevant endoscopic findings; and b) inappropriate context, requests not in line with clinical guidelines or protocols. Denials were filed in the medical record. Appropriate requests were classified into priority, conventional and follow-up. Requests denied by specialty were compared and the findings of priority requests were evaluated., Results: between March 16th and June 30th 2020, 1,658 requests (44 % gastroscopies and 56 % colonoscopies) were evaluated, of which 1,164 (70 %) were considered as appropriate (priority 8.5 %, conventional 48 %, follow-up 43 % and non-evaluable 0.5 %) and 494 (30 %) as inappropriate (20 % COVID-19 context, 80 % inappropriate context). The reasons for denial of gastroscopy were follow-up of lesions (33 %), insufficiently studied symptoms (20 %) and relapsing symptoms after a previous gastroscopy (18 %). The reasons for denial of colonoscopies were post-polypectomy surveillance (25 %), colorectal cancer after surgery (21 %) and a family history of cancer (13 %). There were significant differences in denied requests according to specialty: General Surgery (52 %), Hematology (37 %) and Primary Care (29 %); 31 % of priority cases showed relevant findings., Conclusions: according to our study, 24 % of endoscopies were discordant with scientific recommendations. Therefore, their denial and the prioritization of appropriate ones optimize the use of resources.
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- 2020
- Full Text
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