BMC Neuroscience. 01/2010;
ABSTRACT: The real accuracy of computed tomographic colonography (CTC) is still unknown. Objective: To perform a meta-analysis of the diagnostic accuracy of CTC for the detection of polyps and colorectal tumors.
Selection of studies:Studiesassessing the accuracy of CTC for the detection of colorectal polyps and tumors were selected. data synthesis: Meta-analyses combining sensitivities, specificities and likelihood ratios (LRs) for the diagnosis of polyps and colorectal tumors were carried out.
Forty-seven studies, providing data of 10,546 patients, were included. Overall per-polyp sensitivity of CTC was 66% (64-68%), for polyps 6-9 mm in size it was 59% (56-61%), and 76% (73-79%) for polyps larger than 9 mm. Overall per-patient sensitivity was 69% (66-72%), for polyps 6-9 mm 60% (56-65%), and 83% (70-85%) for lesions larger than 9 mm. Overall CTC specificity was 83% (81-84%). Positive and negative LRs were 2.9 (1.8-4) and 0.38 (0.27-0.53), respectively; for polyps 6-9 mm in size, they were 3.8 (2.5-5.7) and 0.4 (0.27-0.59), and 12.3 (7.7-19.4) and 0.19 (0.12-0.3) for polyps larger than 9 mm.
CTC is highly specific for the detection of colorectal polyps and tumors. Some studies reported high sensitivities, but the results of the studies were highly heterogeneous, while the studied variables explained only part of this discrepancy.
Digestion 06/2009; 80(1):1-17. · 2.05 Impact Factor
Medicina Clínica 10/2007; 129(9):360. · 1.38 Impact Factor
ABSTRACT: 1) To review clinical and endoscopic variables in patients hospitalized for upper gastrointestinal bleeding (UGIB) due to peptic gastroduodenal lesions over a period of 3 years; 2) to identify factors associated with unfavorable evolution; and 3) to evaluate characteristics of patients discharged immediately after endoscopy.
A 3-year retrospective analysis of all UGIB episodes was performed. Patients with gastroduodenal ulcer or erosive gastritis/duodenitis at endoscopy were included. The prognostic value of several clinical, endoscopic, and analytical variables was assessed. Persistence or recurrence of bleeding, surgery, and mortality were considered as outcome variables (evolution was classified as "unfavorable" when any of these was observed).
A total of 341 patients were identified, with a mean age of 62 years. Melena was the most frequent UGIB presentation (70%). Forty-five percent had associated diseases, and 45% were taking gastroerosive drugs. Duodenal ulcer was the most frequent cause of UGIB (48%), followed by gastric ulcer (32%). The evolution of UGIB was unfavorable in 7% of cases. Variables associated with unfavorable evolution in the multivariate analysis were: systolic blood pressure < or = 100 mm Hg, heart rate > or = 100 bpm, and a Forrest endoscopic classification of severe. Only 10% of patients were immediately discharged, with no subsequent complications. However, if predictive variables obtained in the multivariate analysis had been used, hospitalization could have been prevented in 115 patients (34%) without subsequent complications.
A number of clinical and endoscopic variables (blood pressure, heart rate, and endoscopic stigmata of bleeding) with prognostic value have been identified. These are easy to obtain and apply in clinical practice and allow an accurate estimation of the evolution of UGIB. This diagnostic strategy identifies a relatively high proportion of UGIB patients who can be managed on an outpatient basis.
Journal of Clinical Gastroenterology 02/2006; 40(2):129-34. · 3.16 Impact Factor
ABSTRACT: The main objectives of this study were to review the clinic and endoscopic variables of patients with upper gastrointestinal bleeding (UGB) due to peptic gastroduodenal lesions who were evaluated in our hospital during one year, to identify the characteristics associated with a negative evolution of the UGB and to analyse the characteristics of those patients who were discharged immediately after the endoscopy was performed.
A one-year retrospective analysis of all UGB episodes was performed. Patients having gastroduodenal ulcer or erosive gastritis/duodenitis at endoscopy were included. The prognostic value of several clinic, laboratory and endoscopic variables was evaluated. Persistence or recurrence of bleeding, surgery and mortality were considered as outcome variables (the variable evolution was categorized as negative when any of these was observed).
156 patients were identified, with a mean (SD) age of 61 (17) years. Melena was the most frequent UGB presentation (79%). 46% patients had associated diseases and 50% were taking gastroerosive drugs. Duodenal ulcer was the commonest cause of UGB (52%), followed by gastric ulcer (30%). The evolution of UGB was negative in 7% cases. Variables associated with a negative evolution in the multivariate analysis were: age, red hematemesis, systolic blood pressure >= 100 mmHg, heart rate >= 100 b.p.m. and a more severe Forrest endoscopic classification. 11% patients were discharged immediately, without complications afterwards. If predictive variables obtained in the multivariate analysis would have been applied, hospitalization would have been avoided in 59 patients (38%) without subsequent complications.
A number of clinic and endoscopic variables (UGB presentation form, blood pressure, heart rate, and Forrest endoscopic classification) with prognostic value have been identified in this study. These variables are easy to obtain and apply in clinical practice, allowing a precise estimate of the UGB evolution. Thus, a relatively high number of patients with UGB susceptible of ambulatory treatment and management can be reliably identified.
Medicina Clínica 04/2002; 118(13):481-6. · 1.38 Impact Factor