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ABSTRACT: capsule endoscopy (CE) has revolutionized the study of small bowel. One major drawback of this technique is that we cannot interfere with image acquisition process. Therefore, the development of new software tools that could modify the images and increase both detection and diagnosis of small-bowel lesions would be very useful. The Flexible Spectral Imaging Color Enhancement (FICE) that allows for virtual chromoendoscopy is one of these software tools.
to evaluate the reproducibility and diagnostic accuracy of the FICE system in CE.
this prospective study involved 20 patients. First, four physicians interpreted 150 static FICE images and the overall agreement between them was determined using the Fleiss Kappa Test. Second, two experienced gastroenterologists, blinded to each other results, analyzed the complete 20 video streams. One interpreted conventional capsule videos and the other, the CE-FICE videos at setting 2. All findings were reported, regardless of their clinical value. Non-concordant findings between both interpretations were analyzed by a consensus panel of four gastroenterologists who reached a final result (positive or negative finding).
in the first arm of the study the overall concordance between the four gastroenterologists was substantial (0.650). In the second arm, the conventional mode identified 75 findings and the CE-FICE mode 95. The CE-FICE mode did not miss any lesions identified by the conventional mode and allowed the identification of a higher number of angiodysplasias (35 vs 32), and erosions (41 vs. 24).
there is reproducibility for the interpretation of CE-FICE images between different observers experienced in conventional CE. The use of virtual chromoendoscopy in CE seems to increase its diagnostic accuracy by highlighting small bowel erosions and angiodysplasias that weren´t identified by the conventional mode.
Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 05/2012; 104(5):231-6. · 1.55 Impact Factor
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ABSTRACT: Several prognostic systems have been developed and validated in general Intensive Care Units (ICUs). No assessment of these scores was performed in specialized Gastroenterology Intensive Care Units (GICUs).
To assess the prognostic accuracy of Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II and Sequential Organ Failure Assessment (SOFA) scores systems to predict mortality in a GICU.
Retrospective study of 300 consecutively admissions in a GICU. Demographics, indication for admission, APACHE II, SAPS II and SOFA scores and survival at GICU discharge were recorded. Discrimination was evaluated using receiver operations characteristic (ROC) curves and area under a ROC curve (AUC). Calibration was estimated using the Hosmer-Lemeshow goodness-of-fit test.
Overall GICU mortality was 5.3%. APACHE II, SAPS II and SOFA mean scores of nonsurvivors (21.9, 46.2 and 9.3, respectively) were found to be significantly higher than those of survivors (11.9, 26.7 and 2.2, respectively) (p < 0.001). Discrimination was excellent for all the prognostic systems, with AUC = 0.900, 0.903 and 0.965 for APACHE II, SAPS II and SOFA, respectively. Similarly, APACHE II, SAPS II and SOFA scores achieved good calibration, with p = 0.671, 0.928 and 0.775, respectively. Among the three scores, SOFA showed the best performance, with overall correctness of prediction of 94.0%, while it was 86.2% for APACHE II and 82.7% for SAPS II.
in GICU, APACHE II, SAPS II and SOFA scores have excellent prognostic accuracy and, among the three scores, SOFA has the greatest overall correctness of prediction.
Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 10/2010; 102(10):596-601. · 1.55 Impact Factor
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Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 12/2008; 100(11):731-3. · 1.55 Impact Factor
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Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 10/2008; 100(9):600-1. · 1.55 Impact Factor
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Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 04/2008; 100(3):171-2. · 1.55 Impact Factor
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Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 05/2007; 99(4):233-4. · 1.55 Impact Factor
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ABSTRACT: "Downhill" varices or upper esophageal varices are a rare cause of proximal digestive tract hemorrhage with only 16 cases described in the literature. In our series, hemorrhage due to "downhill" varices represents 0.1% of all acute esophageal variceal bleeding. Their etiology differs from that of the usual "uphill" varices secondary to portal hypertension, and the clinical management should be directed to vascular obstruction if present. We report a case of an 89-year-old male with hemorrhagic "downhill" varices not associated, as usually, with superior vena cava obstruction or compression, but with severe pulmonary hypertension and drug-related hemorrhagic risk factors, whose removal proved sufficient to prevent rebleeding.
Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 06/2006; 98(5):359-61. · 1.55 Impact Factor
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ABSTRACT: Dieulafoy's lesion is usually considered to be a rare cause of gastrointestinal bleeding and little information is available about the long-term follow-up of this condition. We studied the clinical pattern and long-term outcome in patients with Dieulafoy's lesion who were managed in a gastrointestinal intensive care unit.
We reviewed the data on the diagnosis, treatment, and outcome of 70 patients admitted to our unit for acute upper gastrointestinal bleeding due to Dieulafoy's lesion. Endoscopic hemostasis was performed in 69 cases. Patients underwent surgery if endoscopic therapy failed. A phone interview was carried out to assess the long-term clinical outcome.
Dieulafoy's lesion accounted for 4 % of cases of upper gastrointestinal bleeding in patients admitted during the period studied. The mean number +/- SD of endoscopies required to establish the diagnosis was 1.4 +/- 0.75. Endoscopic hemostasis was initially successful in 91.3 % of patients, while nearly 16 % of patients required surgery because endoscopic therapy failed. The overall mortality rate was 8.6 %. None of the 52 patients who were followed up by phone reported recurrent bleeding after discharge from hospital, in a mean follow-up period of 69 months.
Dieulafoy's lesion is a not uncommon cause of severe recurrent gastrointestinal bleeding. Endoscopic therapy is safe and effective in achieving permanent hemostasis. The long-term prognosis for Dieulafoy's lesion is excellent, even when patients are treated using endoscopic methods alone.
Endoscopy 06/2004; 36(5):416-20. · 5.21 Impact Factor
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ABSTRACT: Acute liver failure is rarely secondary to lymphoma or leukaemia and it is extremely uncommon as the initial presentation of malignancy. We report a case of a young adult patient with severe acute liver failure referred for liver transplant, in which a Burkitt acute lymphoblastic leukaemia was diagnosed by bone marrow examination. A complete recovery and long remission were obtained with chemotherapy.
European Journal of Gastroenterology & Hepatology 12/1997; 9(11):1113-5. · 1.76 Impact Factor
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ABSTRACT: Variceal bleeding is still associated with high mortality and balloon tamponade may be a lifesaving measure when endoscopic therapy is not available or feasible. The risk of esophageal perforation with balloon tamponade after endoscopic therapy is still uncertain. The aims of the study were to investigate balloon tamponade effectiveness and safety after endoscopic therapy.
Retrospective analysis of 100 consecutive episodes of acute variceal bleeding treated with the Sengstaken-Blakemore tube.
Balloon tamponade had an overall effectiveness of 61%. The Child-Pugh score was significantly higher in patients who failed balloon tamponade. In 48 cases balloon tamponade was preceded by failure of endoscopic therapy. Balloon tamponade was more effective if a previous attempt to perform endoscopic therapy happened (75% vs. 48%; p = 0.006). Aspiration was the most frequent complication. No cases of esophageal perforation were registered.
Currently balloon tamponade is only used as a temporary bridge to other strategies, when other forms of hemostatic therapies do not succeed. Balloon tamponade was more effective in patients with less severe hepatic dysfunction. Previous attempts to perform endoscopic therapy may augment tamponade effectiveness without increasing the risk of esophageal perforation.
Hepato-gastroenterology 53(70):536-9. · 0.66 Impact Factor
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D S Freitas,
C Sofia,
J M Pontes,
C Gregório,
J P Cabral,
P Andrade,
A Rosa,
E Camacho, M Ferreira,
F Portela,
J M Romãozinho,
L Tomé,
H Gouveia,
M Leitão,
I Pimenta,
A Donato
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ABSTRACT: To assess the value of octreotide in the control of acute bleeding esophageal varices, in a prospective randomized study.
One hundred and ninety-seven patients admitted for variceal bleeding confirmed at endoscopy were recruited and divided into two groups: group I (n = 111) with endoscopic stigmata of recent bleeding; and group II (n = 86) with active bleeding at emergency endoscopy. Patients in group I were randomized to receive a continuous infusion of octreotide (n = 58) or emergency sclerotherapy (n = 53). Patients in group II were assigned to sclerotherapy (n = 42) or to sclerotherapy plus octreotide (n = 44). At the end of the period of study (48 hours), patients were submitted to sclerotherapy or band ligation until variceal obliteration was achieved.
In group I, octreotide was found to be as effective as sclerotherapy regarding hemostasis at 48 hours and on day 7 after the index bleeding episode. Transfusion needs were not significantly different for the two treatment modalities. In group II, the association of octreotide with sclerotherapy was significantly better than sclerotherapy alone either in controlling acute active bleeding (P < 0.001) or in achieving hemostasis at 48 hours (P < 0.01). Transfusion needs were significantly fewer in patients treated with this therapeutic association as compared to sclerotherapy alone.
These results suggest that octreotide infusion is effective in the treatment of variceal bleeding. In patients with recent bleeding, octreotide infusion is as effective as emergency sclerotherapy. In active variceal bleeding, it is a valuable adjuvant treatment in association with emergency sclerotherapy.
Hepato-gastroenterology 47(35):1310-4. · 0.66 Impact Factor
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C Sofia,
F Portela,
C Gregório,
A Rosa,
E Camacho,
L Tomé, M Ferreira,
P Andrade,
P Cabral,
J Romãozinho,
H Gouveia,
M Leitão,
I Pimenta,
A Donato,
D Freitas
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ABSTRACT: A prospective randomized study was performed to assess the effectiveness and safety of 5 different methods of hemostasis in selected patients with high-risk bleeding peptic ulcers.
Two hundred and eight patients (n = 208; mean age: 61.6 yrs) with endoscopic stigmata of active hemorrhage, non-bleeding vessel or adherent fresh clot were randomized during emergency endoscopy to receive one of the following modalities of endoscopic therapy (with or without pharmacological therapy): I) injection of absolute alcohol (n = 44); II) multipolar electrocoagulation (BICAP; n = 42); III) Nd-YAG laser (n = 40); IV) injection of absolute ethanol + octreotide (n = 42); V) injection of absolute ethanol + omeprazole (n = 40).
The 5 treatment groups were clinically and endoscopically comparable. The initial hemostatic success was > 90% in every group. No significant differences between groups were found in any of the following parameters assessed during hospitalization: incidence of rebleeding (I = 14.8% vs. II = 19.0% vs. III = 16.6% vs. IV = 18.1% vs. V = 20.0%; P > 0.05 mean = 17.7%); incidence of definitive hemostasis (I = 89.3% vs. II = 85.7% vs. III = 86.6% vs. IV = 84.0% vs. V = 86.6%; P > 0.05; mean = 86.5%); incidence of emergency surgery (I = 8.5% vs. II = 11.9% vs. III = 10.0% vs. IV = 6.8% vs. V = 11.1%; P > 0.05; mean = 9.6%); mortality rate (I = 4.2% vs. II = 4.7% vs. III = 3.3% vs. IV = 13.6% vs. V = 4.4%; P > 0.05; mean = 6.2%). Mean age of deceased patients was significantly higher than living patients (71.2 +/- 13.4 vs. 60.9 +/- 14.4; P < 0.05). Approximately 2/3 of the fatal cases were strongly weakened by coexistent medical diseases. The duration of hospital stay was similar for all groups. The BICAP group required less units of blood transfusion (1.9 +/- 1.8 vs. I = 3.0 +/- 2.6; III = 3.5 +/- 3.6; IV = 2.8 +/- 2.3; V = 3.1 +/- 2.5; P < 0.05), perhaps due to the higher mean value of hemoglobin of these patients at hospital admission, compared to all other groups. No significant complications were reported.
This study provides good evidence that injection of absolute ethanol, multipolar electrocoagulation (BICAP) and Nd-YAG laser are equally safe and effective in the endoscopic therapy of acute bleeding peptic ulcers. In contrast, no additional hemostatic benefits arose from the association of pharmacological agents (octreotide or omeprazole) to sclerosis injection.
Hepato-gastroenterology 47(35):1332-6. · 0.66 Impact Factor
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ABSTRACT: Cytomegalovirus (CMV) infections are common in immunocompromised patients but rare in immunocompetent individuals. Gastrointestinal disease is frequent in systemic CMV infections but the small bowel is the least common site of involvement. We present the case of a 66 years-old man, with no evidence of immunological deficiency, hospitalized for unspecific symptoms of diarrhea, fever and abdominal pain, which developed massive mid-gastrointestinal bleeding during hospitalization. Enteroscopy revealed congestive, oedematous mucosa with multiple ulcers in the small bowel. Cytomegalic cells with intranuclear inclusions were found on histologic examination, allowing the diagnosis of CMV infection. Ganciclovir in full therapeutic dose was started and surgery was performed as a last resource treatment, but the patient died. This case highlights the rare condition of massive gastrointestinal bleeding due to CMV disease of the small bowel, the major importance of enteroscopy and pathologic evaluation for diagnosis and the poor prognosis of this situation.
Acta gastro-enterologica Belgica 72(2):245-8. · 0.64 Impact Factor
