Browsing by Issue Date, starting with "2020-04"
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- Small Bowel Enteroscopy - A Joint Clinical Guideline by the Spanish and Portuguese Small-Bowel Study GroupsPublication . Pérez-Cuadrado Robles, E; Pinho, R; González-Suárez, B; Mão-de-Ferro, S; Chagas, C; Esteban Delgado, P; Carretero, C; Figueiredo, P; Rosa, B; García-Lledó, J; Nogales, O; Ponte, A; Andrade, P; Juanmartiñena-Fernández, JF; San-Juan-Acosta, M; Lopes, S; Prieto-Frías, C; Egea Valenzuela, J; Caballero, N; Valdivieso-Cortázar, E; Cardoso, H; Gálvez, C; Almeida, N; Borque Barrera, P; Gómez Rodríguez, BJ; Sánchez Ceballos, FL; Bernardes, C; Alonso-Aguirre, P; Argüelles Arias, F; Mascarenhas Saraiva, MThe present evidence-based guidelines are focused on the use of device-assisted enteroscopy in the management of small-bowel diseases. A panel of experts selected by the Spanish and Portuguese small-bowel study groups reviewed the available evidence focusing on the main indications of this technique, its role in the management algorithm of each indication, and its diagnostic and therapeutic yield. A set of recommendations was issued accordingly.
- Asthma App Use and Interest Among Patients With Asthma: A Multicenter StudyPublication . Jácome, C; Almeida, R; Pereira, AM; Araújo, L; Correia, MA; Pereira, M; Couto, M; Lopes, C; Chaves Loureiro, C; Catarata, MJ; Santos, LM; Ramos, B; Mendes, A; Pedro, E; Cidrais Rodrigues, JC; Oliveira, G; Aguiar, AP; Arrobas, AM; Costa, J; Dias, J; Todo Bom, A; Azevedo, J; Ribeiro, C; Alves, M; Pinto, PL; Neuparth, N; Palhinha, A; Marques, JG; Martins, P; Trincão, D; Neves, A; Todo Bom, F; Santos, M A; Branco, J; Loyoza, C; Costa, A; Silva Neto, A; Silva, D; Vasconcelos, MJ; Teixeira, MF; Ferreira-Magalhães, M; Taborda Barata, L; Carvalhal, C; Santos, N; Sofia Pinto, C; Rodrigues Alves, R; Moreira, AS; Morais Silva, P; Fernandes, R; Ferreira, R; Alves, C; Câmara, R; Ferraz de Oliveira, J; Bordalo, D; Calix, MJ; Marques, A; Nunes, C; Menezes, F; Gomes, R; Almeida Fonseca, J
- A Machine-Based Approach to Preoperatively Identify Patients with the Most and Least Benefit Associated with Resection for Intrahepatic Cholangiocarcinoma: An International Multi-institutional Analysis of 1146 PatientsPublication . Tsilimigras, D; Mehta, R; Moris, D; Sahara, K; Bagante, F; Paredes, A; Moro, A; Guglielmi, A; Aldrighetti, L; Weiss, M; Bauer, T; Alexandrescu, S; Poultsides, G; Maithel, S; Pinto Marques, H; Martel, G; Pulitano, C; Shen, F; Soubrane, O; Koerkamp, B; Endo, I; Pawlik, TBackground: Accurate risk stratification and patient selection is necessary to identify patients who will benefit the most from surgery or be better treated with other non-surgical treatment strategies. We sought to identify which patients in the preoperative setting would likely derive the most or least benefit from resection of intrahepatic cholangiocarcinoma (ICC). Methods: Patients who underwent curative-intent resection for ICC between 1990 and 2017 were identified from an international multi-institutional database. A machine-based classification and regression tree (CART) was used to generate homogeneous groups of patients relative to overall survival (OS) based on preoperative factors. Results: Among 1146 patients, CART analysis revealed tumor number and size, albumin-bilirubin (ALBI) grade and preoperative lymph node (LN) status as the strongest prognostic factors associated with OS among patients undergoing resection for ICC. In turn, four groups of patients with distinct outcomes were generated through machine learning: Group 1 (n = 228): single ICC, size ≤ 5 cm, ALBI grade I, negative preoperative LN status; Group 2 (n = 708): (1) single tumor > 5 cm, (2) single tumor ≤ 5 cm, ALBI grade 2/3, and (3) single tumor ≤ 5 cm, ALBI grade 1, metastatic/suspicious LNs; Group 3 (n = 150): 2-3 tumors; Group 4 (n = 60): ≥ 4 tumors. 5-year OS among Group 1, 2, 3, and 4 patients was 60.5%, 35.8%, 27.5%, and 3.8%, respectively (p < 0.001). Similarly, 5-year disease-free survival (DFS) among Group 1, 2, 3, and 4 patients was 47%, 27.2%, 6.8%, and 0%, respectively (p < 0.001). Conclusions: The machine-based CART model identified distinct prognostic groups of patients with distinct outcomes based on preoperative factors. Survival decision trees may be useful as guides in preoperative patient selection and risk stratification.
- Endoscopic Management of Sigmoid Volvulus in a Debilitated Population: What Relevance?Publication . Coelho da Rocha, M; Capela, T; Silva, MJ; Ramos, G; Coimbra, JBackground: Colonic volvulus, mainly from the sigmoid, is a relatively common cause of intestinal obstruction, particularly in the elderly and in patients with debilitating conditions. The high morbi-mortality of emergency surgery places the endoscopic approach as the first-line treatment for the resolution of this acute obstructive condition. Objectives: To assess the importance of endoscopic treatment for the resolution of colonic volvulus in a debilitated population. Method: This is a retrospective analysis of emergency lower gastrointestinal endoscopies in patients with colonic volvulus as diagnosis, performed over a 9-year period (2009-2018), as well as population characterization and follow-up after the first exam. Results: We performed 88 procedures in 52 patients (56.4% males, median age 83 years, range 33-94). Endoscopic resolution was effective in 86.4% (76/88) of the exams, without procedure complications. Eighty-one percent of patients presented with volvulus recurrence, 50% of which occurred during the 3 months after the initial procedure. Twenty-one were submitted to surgery, 12 of which were emergency procedures after endoscopic failure as the primary treatment (5 of which had mucosal necrosis at endoscopy). There was no mortality in elective surgery. In the emergency plus necrosis group, mortality was 60% (3/5) and 14.3% (1/7) in the emergency without necrosis group. Conclusions: Despite the high recurrence of volvulus after endoscopic treatment, it seems to be an adequate and low-risk first-line therapy for sigmoid volvulus in debilitated patients, allowing improvement of surgical conditions.