G Fernández-Esparrach

University of Barcelona, Barcino, Catalonia, Spain

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Publications (174)703.42 Total impact

  • G Fernández-Esparrach, A Ginès
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    ABSTRACT: Incidental uniloculated cysts are diagnosed more frequently due to the increase in availability of highquality abdominal imaging. The prevalence of incidental pancreatic cysts detected on abdominal imaging is 2.6% and is even higher in old patients. Pancreatic cysts are also found in up to 25% of autopsies, 3% of which present progression to carcinoma in situ. The most frequently incidental cysts detected are <10 mm in size and the spectrum has changed from inflammatory to mucinous lesions. Although some morphological and cytological features can help to establish the nature of these cysts, it is unclear how many of them carry a risk of malignant degeneration, how to identify those accurately, and, once recognized, how to establish which ones are likely to harbor incipient cancer and how to manage them. In the last years, some guidelines have been elaborated that summarize all the evidence published up to now and provide clinicians with useful recommendations regarding the management of pancreatic uniloculated cysts.
    Minerva medica 05/2014; · 0.77 Impact Factor
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    ABSTRACT: The incidence of bacteremia after endoscopic ultrasonography (EUS) or EUS-guided fine-needle aspiration (EUS-FNA) is between 0% and 4%, but there are no data on this topic in cirrhotic patients. To prospectively assess the incidence of bacteremia in cirrhotic patients undergoing EUS and EUS-FNA. We enrolled 41 cirrhotic patients. Of these, 16 (39%) also underwent EUS-FNA. Blood cultures were obtained before and at 5 and 30min after the procedure. When EUS-FNA was used, an extra blood culture was obtained after the conclusion of radial EUS and before the introduction of the sectorial echoendoscope. All patients were clinically followed up for 7 days for signs of infection. Blood cultures were positive in 16 patients. In 10 patients, blood cultures grew coagulase-negative Staphylococcus, Corynebacterium species, Propionibacterium species or Acinetobacterium Lwoffii, which were considered contaminants (contamination rate 9.8%, 95% CI: 5.7-16%). The remaining 6 patients had true positive blood cultures and were considered to have had true bacteremia (15%, 95% CI: 4-26%). Blood cultures were positive after diagnostic EUS in five patients but were positive after EUS-FNA in only one patient. Thus, the frequency of bacteremia after EUS and EUS-FNA was 12% and 6%, respectively (95% CI: 2-22% and 0.2-30%, respectively). Only one of the patients who developed bacteremia after EUS had a self-limiting fever with no other signs of infection. Asymptomatic Gram-positive bacteremia developed in cirrhotic patients after EUS and EUS-FNA at a rate higher than in non-cirrhotic patients. However, this finding was not associated with any clinically significant infections.
    Gastroenterología y Hepatología 04/2014; · 0.57 Impact Factor
  • Endoscopy 04/2014; 46(4):361-70. · 5.74 Impact Factor
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    ABSTRACT: The prevalence of Barrett's esophagus (BE) varies from 0.45% to 2.2% in patients who undergo upper endoscopy and is >12% when the indication is for reflux symptoms. The prevalence has progressively increased in recent years but is unknown in the population of the province of Barcelona. To determine the prevalence of BE and its epidemiological characteristics in our population. We prospectively evaluated patients referred to the Endoscopy Unit of Hospital Clinic and Hospital General de Catalunya for an upper endoscopy. We excluded patients with known BE, prior upper endoscopy, esophagogastric surgery or refusal to participate in the study. Demographic data, alcohol intake, Helicobacter pylori infection and consumption of antisecretory agents were recorded, among other information. Participants completed a standardized questionnaire to assess the presence of gastroesophageal reflux disease (GERD) symptoms and their severity. Between July 2010 and July 2012, we included 200 patients (100 in each center). The mean age was 48.9±15.6 years and the majority were women (n=120, 60%). Symptoms of GERD were present in 46 patients (23%) and some degree of esophagitis was present in 31 (15.5%). Infection by H. pylori was present in 29.7%. BE was found endoscopically in 14 (7%) patients, but was histologically confirmed in only 8 (4%). The only variable that correlated with the finding of BE was male sex. The prevalence of BE in our environment is similar to that reported in Western countries. The absence of reflux symptoms does not rule out the possibility of BE.
    Gastroenterología y Hepatología 03/2014; · 0.57 Impact Factor
  • Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 02/2014; 106(2):120-132. · 1.65 Impact Factor
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    ABSTRACT: Background: Endoscopic submucosal dissection (ESD) is an effective but time-consuming treatment for early neoplasia that requires a high level of expertise.Objective: The objective of this study was to assess the efficacy and learning curve of gastric ESD with a hybrid knife with high pressure water jet and to compare with standard ESD.Material and methods: We performed a prospective non survival animal study comparing hybrid-knife and standard gastric ESD. Variables recorded were: Number of en-bloc ESD, number of ESD with all marks included (R0), size of specimens, time and speed of dissection and adverse events. Ten endoscopists performed a total of 50 gastric ESD (30 hybrid-knife and 20 standard).Results: Forty-six (92 %) ESD were en-bloc and 25 (50 %) R0 (hybrid-knife: n = 13, 44 %; standard: n = 16, 80 %; p = 0.04). Hybrid-knife ESD was faster than standard (time: 44.6 +/- 21.4 minutes vs. 68.7 +/- 33.5 minutes; p = 0.009 and velocity: 20.8 +/- 9.2 mm2/min vs. 14.3 +/- 9.3 mm2/min (p = 0.079). Adverse events were not different. There was no change in speed with any of two techniques (hybrid-knife: From 20.33 +/- 15.68 to 28.18 +/- 20.07 mm2/min; p = 0.615 and standard: From 6.4 +/- 0.3 to 19.48 +/- 19.21 mm2/min; p = 0.607). The learning curve showed a significant improvement in R0 rate in the hybrid-knife group (from 30 % to 100 %).Conclusion: despite the initial performance of hybrid-knife ESD is worse than standard ESD, the learning curve with hybrid knife ESD is short and is associated with a rapid improvement. The introduction of new tools to facilitate ESD should be implemented with caution in order to avoid a negative impact on the results.
    Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 02/2014; 106(2):98-102. · 1.65 Impact Factor
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    ABSTRACT: Background. Transesophageal natural-orifice transluminal endoscopic surgery (NOTES) mediastinoscopy has been described as a feasible, less-invasive alternative to video-assisted mediastinoscopy (VAM). We aimed to investigate hemodynamic and respiratory effects during transesophageal NOTES mediastinoscopy compared with VAM. Patients and methods. This was a short-survival experiment in 20 female pigs randomized to NOTES (n = 10) or VAM (n = 10) mediastinoscopy. In the NOTES group, an endoscopist accessed the mediastinum through a 5-cm submucosal tunnel in the esophageal wall, and CO2 was used to create the pneumomediastinum. Conventional VAM was carried out by thoracic surgeons. A 30-minute systematic exploration of the mediastinum was then performed, including invasive monitoring for hemodynamic and respiratory data. Blood samples were drawn for gas analyses. Results. All experiments except 2 in the NOTES group (one because of technical difficulties, the other because of thoracic lymphatic duct lesion) were completed as planned, and animals survived 24 hours. Also, 3 animals in the NOTES group presented a tension pneumothorax that was immediately recognized and percutaneously drained. VAM and NOTES animals showed similar pulmonary and systemic hemodynamic behavior during mediastinoscopy. Pulmonary gas exchange pattern was mildly impaired during the NOTES procedure, showing lower partial arterial oxygen pressure associated with higher airway pressures (more important in animals that presented with pneumothorax). Conclusions. NOTES mediastinoscopy induces minimal deleterious respiratory effects and hemodynamic changes similar to conventional cervical VAM and could be feasible when performed under strict hemodynamic and respiratory surveillance. Notably, serious complications caused by the injury of pleura are more frequent in NOTES, which mandates an improvement in technique and suitable equipment.
    Surgical Innovation 01/2014; · 1.54 Impact Factor
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    ABSTRACT: Introducción La incidencia de bacteriemia después de una ultrasonografía endoscópica (USE) o USE con punción aspirativa con aguja fina (USE-PAAF) se sitúa entre el 0-4%. No existen datos acerca de la incidencia en pacientes con cirrosis hepática. Objetivo Evaluar prospectivamente la incidencia de bacteriemia en pacientes cirróticos sometidos a USE y USE-PAAF. Pacientes y métodos Se incluyeron un total de 41 pacientes. Dieciséis (39%) fueron sometidos también a USE-PAAF. Se realizaron hemocultivos antes y a los 5 y 30 minutos después del procedimiento. Cuando se practicó USE-PAAF se obtuvo una muestra de sangre adicional después de acabar la USE radial y antes de la introducción del ecoendoscopio sectorial. Todos los pacientes fueron seguidos durante 7 días. Resultados Los hemocultivos fueron positivos en 16 pacientes. En 10 pacientes crecieron gérmenes que fueron considerados contaminantes (tasa de contaminación 9,8%, IC 95%: 5,7-16%). Los 6 pacientes restantes tuvieron hemocultivos positivos por gérmenes no contaminantes y fueron considerados verdaderas bacteriemias (15%, IC 95%: 4-26%). En 5 pacientes los hemocultivos fueron positivos después de la USE diagnóstica y solo en uno después de la USE-PAAF. Por lo tanto, la frecuencia de bacteriemia asociada a USE y USE-PAAF fue 12 y 6%, respectivamente (IC 95%: 2-22% y 0,2-30%, respectivamente). Solo uno de los pacientes presentó bacteriemia sintomática tras la USE que consistió en fiebre autolimitada sin otros signos de infección. Conclusión Los pacientes cirróticos presentan una incidencia de bacteremia asintomática por gérmenes gram-positivos después de la USE (con o sin PAAF) mayor que los pacientes sin esta patología. Sin embargo, este hecho no se asocia a una mayor incidencia de infecciones clínicamente significativas.
    Gastroenterología y Hepatología. 01/2014;
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    ABSTRACT: Endoscopic submucosal dissection (ESD) allows endoscopic, curative, en-bloc resection of superficial malignant or premalignant lesions. This procedure was conceived over 10 years ago in Japan, but has not experienced great expansion in Western countries for different reasons. This article reviews ESD indications and outcomes, and reflects on the reasons that prevent ESD from becoming common clinical practice in Western hospitals. Finally, recommendations on ESD training in our setting are made.
    Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 10/2013; 105(9):544-552. · 1.65 Impact Factor
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    ABSTRACT: Lung cancer is one of the most frequent neoplasms in our environment, and represents the first cause of cancer related death in western countries. Diagnostic and therapeutic approach to these patients may be complicated, with endoscopic ultrasound guided fine needle aspiration (EUS-FNA), classically performed by gastroenterologists, playing a very important role. As this disease is not closely related to the "digestive tract", gastroenterologists have been forced to update their knowledge on this field o adequately diagnose this significant group of patients. The recent advent of modern and promising techniques like endobronchial ultrasound guided fine needle aspiration (EBUS-FNA) have prompted new approaches for diagnosis and staging of this type of patients. In this clinical guideline, the "Sociedad Española de Endoscopia Digestiva" (SEED), "Sociedad Española de Patología Digestiva" (SEPD) and the "AsociaciónEspañola de Gastroenterología", have jointed efforts to update the existing knowledge on the field and provide their members with evidence based recommendations.
    Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 04/2013; 105(4):215-224. · 1.65 Impact Factor
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    ABSTRACT: BACKGROUND: The concept of natural orifice transluminal endoscopic surgery (NOTES) consists of the reduction of access trauma by using a natural orifice access to the intra-abdominal cavity. This could possibly lead to less postoperative pain, quicker recovery from surgery, fewer postoperative complications, fewer wound infections, and fewer long-term problems such as hernias. The Euro-NOTES Foundation has organized yearly meetings to work on this concept to bring it safely into clinical practice. The aim of this Euro-NOTES status update is to assess the yearly scientific working group reports and provide an overview on the current clinical practice of NOTES procedures. METHODS: After the Euro-NOTES meeting 2011 in Frankfurt, Germany, an analysis was started regarding the most important topics of the European working groups. All prospectively documented information was gathered from Euro-NOTES and D-NOTES working groups from 2007 to 2011. The top five topics were analyzed. RESULTS: The statements of the working group activities demonstrate the growing information and changing insights. The most important selected topics were infection issue, peritoneal access, education and training, platforms and new technology, closure, suture, and anastomosis. The focus on research topics changed over time. The principle of hybrid access has overcome the technical and safety limitations of pure NOTES. Currently the following NOTES access routes are established for several indications: transvaginal access for cholecystectomy, appendectomy and colon resections; transesophageal access for myotomy; transgastric access for full-thickness small-tumor resections; and transanal/transcolonic access for rectal and colon resections. CONCLUSIONS: NOTES and hybrid NOTES techniques have emerged for all natural orifices and were introduced into clinical practice with a good safety record. There are different indications for different natural orifices. Each technique has been optimized for the purpose of finding a safe and realistic solution to perform the procedure according to the specific indication.
    Surgical Endoscopy 03/2013; · 3.43 Impact Factor
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    ABSTRACT: The sixth EURO-NOTES workshop (4 - 6 October 2012, Prague, Czech Republic) focused on enabling intensive scientific dialogue and interaction between surgeons, gastroenterologists, and engineers/industry representatives and discussion of the state of the practice and development of natural orifice transluminal endoscopic surgery (NOTES) in Europe. In accordance with previous meetings, five working groups were formed. In 2012, emphasis was put on specific indications for NOTES and interventional endoscopy. Each group was assigned an important indication related to ongoing research in NOTES and interventional endoscopy: cholecystectomy and appendectomy, therapy of colorectal diseases, therapy of adenocarcinoma and neoplasia in the upper gastrointestinal tract, treating obesity, and new therapeutic approaches for achalasia. This review summarizes consensus statements of the working groups.
    Endoscopy 03/2013; 45(3):214-7. · 5.74 Impact Factor
  • Henry Córdova, Graciela Martinez-Pallí, Gloria Fernández-Esparrach
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    ABSTRACT: Thoracoscopy and mediastinoscopy are common procedures with painful incisions and prominent scars. Transesophageal endoscopic mediastinoscopy could reduce pain, improve cosmesis, and provide better access to the posterior mediastinal compartment, especially in patients with a complex mediastinum because of previous mediastinoscopy or with tracheostoma. We describe a new way to access the mediastinum through a natural orifice that provides excellent visualization of mediastinal structures.
    The Thoracic and Cardiovascular Surgeon 01/2013; · 0.93 Impact Factor
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    ABSTRACT: Natural orifice transluminal endoscopic surgery (NOTES) mediastinoscopy (MED) through the esophagus has proved to be feasible in the animal model. However, injury of the adjacent pleura and pneumothorax has been reported as a frequent adverse event when using a blind access. To assess the utility and safety of a CT-based image registration system (IRS) for navigation in the mediastinum. Prospective, randomized, controlled trial in 30 Yorkshire pigs. Thirty-minute MEDs were performed: 15 MEDs were performed with IRS guidance (MED-IRS), and 15 MEDs were performed with a blind access. Animal research laboratory. In both groups, the mediastinum was accessed through a 10-cm submucosal tunnel in the esophageal wall. Timed exploration was performed with identification of 8 mediastinal structures. Technical feasibility, adverse events, and the number of mediastinal structures identified. Thirty animals weighing 31.5 ± 3.5 kg were included in this study. MED was not possible in 2 animals in the "MED with blind access" group but was possible in all MEDs performed with IRS. The mean number of identified organs was slightly higher in "with IRS-MED" (6.13 ± 1.3) than with MED with blind access (4.7 ± 2.3; P = .066). Moreover, the right atrium and vena cava were identified in more cases with IRS-MED than in MED with blind access (13 vs 3 and 15 vs 11, P = .000 and P = .03, respectively). There were 3 (23%) adverse events with IRS-MED and 4 (27%) with "MED with blind access" (P = not significant), with pneumothorax being the most frequent (2 and 3, respectively). Nonsurvival animal study. This study demonstrates that the IRS system appears feasible in natural orifice transluminal endoscopic surgery MED and suggests that IRS guidance might be useful for selected procedures.
    Gastrointestinal endoscopy 01/2013; 77(1):102-7. · 6.71 Impact Factor
  • MICCAI 2013 CLIP; 01/2013
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    ABSTRACT: Endoscopic insufflation has been associated with marked increase in intra-abdominal pressure (IAP) and hemodynamic and respiratory changes during transgastric surgery. To investigate the hemodynamic and respiratory effects during intraperitoneal cavity exploration through 3 different natural orifice transluminal endoscopic surgery (NOTES) access locations compared with laparoscopy. Survival experiments using 40 female pigs randomized to transgastric, transcolonic, transvaginal, and laparoscopic peritoneoscopy. On-demand endoscopic insufflation of CO(2) with feedback pressure regulation was used in NOTES with a maximum pressure of 14 mm Hg. In the laparoscopy group, the IAP was maintained at 14 mm Hg. NOTES procedures were performed by an endoscopist (with the assistance of a gynecologist in the transvaginal group and a second endoscopist in the transgastric and transrectal groups) and laparoscopy by 2 surgeons. Invasive hemodynamic and respiratory data. Blood samples were drawn for gas analyses. All experiments except one in the transrectal group were completed. The IAP was significantly lower in all NOTES groups compared with the laparoscopy group. A significant increase in mean systemic arterial blood pressure was observed in the laparoscopy group at 15 and 30 minutes of intraperitoneal cavity exploration, but it remained unchanged during all NOTES procedures. An increase in airway pressures was observed at 15 and 30 minutes of peritoneoscopy in the animals undergoing laparoscopy, whereas those parameters remained unchanged in the NOTES groups. The laparoscopy group showed a significant impairment in pulmonary gas exchange (decrease in Pao(2), increase in Paco(2), and decrease in arterial pH) after 30 minutes of peritoneoscopy, whereas only a slight increase in Paco(2) was observed in the transrectal and transvaginal groups. Healthy animal model. On-demand endoscopic insufflation of CO(2) with feedback pressure regulation can minimize the risk of hemodynamic and respiratory compromise caused by acute changes in IAP.
    Gastrointestinal endoscopy 08/2012; 76(2):388-95. · 6.71 Impact Factor
  • Article: Response.
    Gastrointestinal endoscopy 04/2012; 75(4):928. · 6.71 Impact Factor
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    ABSTRACT: The quality and tolerability of antegrade gut lavage bowel preparation are key elements in the success of population-based colorectal cancer screening. To evaluate cleansing quality and tolerability according to the timing of polyethylene glycol administration in persons undergoing colorectal cancer screening. Participants in colorectal cancer screening were randomized to two groups: a) control group (colonoscopy scheduled at 9-12 h); preparation with polyethylene glycol on the previous afternoon; b) study group (colonoscopy scheduled at 12-15 h): preparation with polyethylene glycol on the morning of the colonoscopy, with the option of a split dose. The quality of cleansing was evaluated with the Boston scale and tolerability through a questionnaire. A total of 282 participants were included: preparation was carried out the day before the procedure in 134 and on the same day in 148, of which 26 received a split dose. Cleansing was adequate in 95% (n=268) of the participants. The quality of cleansing was higher in the study group (P=.045). The interval between the end of administration and the beginning of the procedure was inversely correlated with the Boston scale score (P=.036; r=-0.125). Tolerability was unrelated to the time of administration (P>.2). Acceptance of the timing of administration was lower in the study group than in the control group (26% vs 10%, respectively; P=.001). Preparation as close as possible to the colonoscopy improves the quality of cleansing with no detrimental effects on tolerability, although this option is less comfortable.
    Gastroenterología y Hepatología 03/2012; 35(4):236-42. · 0.57 Impact Factor
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    ABSTRACT: Solid pseudopapillary neoplasms (SPNs) are rare tumours of the exocrine pancreas. Although they can develop metastasis, the prognosis is good. The aim of this study was to describe the characteristics of these tumours attended in our hospital. All cases of SPN in the database of the Pathology Department between 1991 and 2010 were included. Age, sex, symptoms, type of surgery, pathologic and immunohistochemical characteristics, and clinical evolution were analyzed. Six cases were identified; all of them were women with a median age of 27.5 years. One patient presented haemoperitoneum, 2 abdominal pain and 3 were diagnosed incidentally. The most frequent localization was the pancreatic tail (n=4) and the median size was 7.7 cm. Four tumours were benign and 2 carcinomas. One of them had liver and lymph node metastases. Ki-67 proliferation index was low (1-3%). After a median follow-up of 33.5 months, all patients were alive and without evidence of relapse. SPNs occur in young women. In most cases surgical resection is curative. A low mitotic index confers a good prognosis and a long survival.
    Medicina Clínica 02/2012; 138(3):114-8. · 1.40 Impact Factor
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    ABSTRACT: Endoscopy with random biopsies is the standard technique for the diagnosis of Barrett's esophagus (BE). We studied the usefulness of endoscopic biopsies in the diagnosis and surveillance of patients with BE. We reviewed all patients with BE controlled at the Hospital Clínic from February 2002 to March 2010. During the study period, 493 endoscopies were performed in 206 patients. We excluded 86 patients who had undergone one endoscopy only, hence the final sample consisted of 117 patients (mean age 61 [12] years, 73% men) with 407 endoscopies and a mean follow-up of 45 (38) months. Fifty-seven patients had a short-BE (49%), 28 a long-BE (24%) and 32 (27%) could not be inferred from the report. In 25 cases (21%), intestinal metaplasia (IM) was not detected at the endoscopic index. During follow-up, biopsies were negative for IM at some point in 45 patients (38.4%) and there was a change in the histologic grade in 100 cases (24.6%). The presence of a short-BE (43% in short-BE vs 7% in long-BE, P=.001) and few biopsies (3 [1.5] vs 6.2 [4.5]; P=.005) were associated with a higher frequency of negative biopsies for IM. Random endoscopic biopsies are not a good tool for diagnosis and surveillance of patients with BE.
    Medicina Clínica 12/2011; 139(3):103-6. · 1.40 Impact Factor

Publication Stats

2k Citations
703.42 Total Impact Points

Institutions

  • 1997–2013
    • University of Barcelona
      • Department of Medicine
      Barcino, Catalonia, Spain
  • 1996–2013
    • Hospital Clínic de Barcelona
      • • Servicio de Gastroenterología
      • • Servicio de Hepatología
      Barcino, Catalonia, Spain
  • 2011
    • University of Geneva
      • Division of Gastroenterology and Hepatology
      Genève, GE, Switzerland
  • 2009–2010
    • Brigham and Women's Hospital
      • • Center for Brain Mind Medicine
      • • Department of Medicine
      Boston, MA, United States
  • 2005
    • Hospital Universitari i Politècnic la Fe
      Valenza, Valencia, Spain
  • 2004
    • IMD
      Lausanne, Vaud, Switzerland
  • 2002–2003
    • IDIBAPS August Pi i Sunyer Biomedical Research Institute
      Barcino, Catalonia, Spain