Endoscopic submucosal dissection (ESD) is a well-established endoscopic technique for the treatment of gastrointestinal lesions. Colorectal ESD outcomes are less reported in the Western literature, and Portuguese data are still very scarce. Our aim was to describe our experience on colorectal ESD regarding its outcomes and safety profile.We conducted a retrospective evaluation of recorded data on ESDs performed between 2015 and 2020. Only ESDs performed on epithelial neoplastic lesions were selected for further analysis.Of a total of 167 colorectal ESDs, 153 were included. Technical success was achieved in 147 procedures (96%). The lesions were located in the colon (n = 24) and rectum (n = 123). The en bloc resection rate was 92% and 97%, the R0 resection rate was 83% and 82%, and the curative resection rate was 79% and 78% for the colon and the rectum, respectively. The need for a hybrid technique was the only risk factor for piecemeal or R1 resection. We report a perforation rate of 3.4% and a 4.1% rate of delayed bleeding; all the adverse events were manageable endoscopically, without the need of blood transfusions or surgery. Most of the lesions were laterally spreading tumours of the granular mixed type (70%), and 20% of the lesions were malignant (12% submucosal and 8% intramucosal cancer).Our series on colorectal ESD reports a very good efficacy and safety profile. This technique can be applied by endoscopists experienced in ESD.A dissecção endoscópica da submucosa é uma técnica com comprovada eficácia para o tratamento das lesões do tracto digestivo. As disseções endoscópicas da submucosa de lesões do colon ou recto são menos reportadas na literatura ocidental, e dados Portugueses publicados são escassos. O nosso objectivo foi reportar a eficácia e o perfil de segurança da nossa série nestas lesões.Avaliação retrospetiva das dissecções realizadas entre 2015 e 2020, relativamente a lesões epiteliais neoplásicas do colon e recto.De um total de 167 lesões colo-rectais, foram incluidas 153. O sucesso técnico foi de 96% (n = 147). As lesões estavam localizadas no colon (n = 24) e recto (n = 123). A taxa de resseção em bloco foi de 92% e 97%, de resseções R0 de 83% e 82% e de resseções curativas foi de 79% e 78% no colon e recto respectivamente. A necessidade de realização de técnica híbrida foi o único factor de risco identificado para ressecção em piecemeal ou R1. Obtivemos uma taxa de perfurado de 3.4% e 4.1% de hemorragia tardia; todos os eventos adversos foram tratados endoscopicamente, sem necessidade de transfusões sanguíneas ou cirurgia. A maioria das lesões eram lateral spreading tumours do tipo granular nodular misto (70%), e 20% das lesões eram malignas (12% com invasão submucosa, 8% carcinomas intramucosos).A nossa série de dissecções do colon e recto demonstrou uma muito boa eficácia e excelente perfil de segurança. Este procedimento terapêutico pode ser utilização por endoscopistas com experiência nesta técnica.
An 82 year-old female performed upper digestive endoscopy for diagnostic work-up of iron-deficiency anemia, which revealed a giant pedunculated gastric polyp obstructing the pylorus with extension to the second part of the duodenum. Biopsies were consistent with tubular adenoma with high-grade dysplasia. After multidisciplinary discussion, endoscopic submucosal dissection was performed and the lesion was successfully resected en-bloc without adverse events. Histopathological analysis of the specimen confirmed complete curative resection. This case highlights the expanding role of endoscopic submucosal dissection, which allowed a careful, controlled en-bloc resection of a giant gastric adenomatous polyp producing ball-valve syndrome.
Abstract Background and study aims Previous studies have suggested a high prevalence of musculoskeletal injuries (MI) in endoscopists. Little evidence has come from European countries. Our main aim was to evaluate the prevalence, type, and impact of MI among Portuguese endoscopists. We also sought to identify risk factors for the development, severity and number of endoscopy-related MI. Material and methods A 48-question electronic survey was developed by a multidisciplinary group. The electronic survey was sent to all members of Portuguese Society of Gastroenterology (n = 705) during May 2019. Study data were collected and managed using REDCap electronic data capture tools hosted at SPG – CEREGA. Results The survey was completed by 171 endoscopists (response rate of 24.3 %), 55.0 % female with a median age of 36 years (range 26–78). The prevalence of at least one MI related to endoscopy was 69.6 % (n = 119), the most frequent being neck pain (30.4 %) and thumb pain (29.2 %). The median time for MI development was 6 years (range 2 months-30 years). Severe pain was reported by 19.3 %. Change in endoscopic technique was undertaken by 61.3 % and reduction in endoscopic caseload was undertaken by 22.7 %. Missing work was reported by 10.1 %, with the median time off from work being 30 days (range 1–90). Female gender and ≥ 15 years in practice were independently associated with MI and severe pain. Years in practice, weekly-time performing endoscopy, and gender were significant predictors of the number of MI. Conclusions Prevalence of MI was significant among Portuguese endoscopists and had a relevant impact on regular and professional activities.
The endoscopic resection of gastrointestinal tract lesions embraces different types of techniques, ranging from conventional polypectomy/endoscopic mucosal resection (EMR) to the field of third-space endoscopy, including endoscopic submucosal dissection (ESD), full-thickness resection and peroral endoscopic myotomy (POEM). Parallelly, the advent of underwater techniques has served as an add-on for both basic and advanced procedures, since its first report in 2012. We aimed to provide a comprehensive update on the state of the art about the feasibility of underwater basic and advanced techniques for GI endoscopy. Underwater EMR (U-EMR) has proved effective and safe in treating > 10 mm sessile or flat or all-size recurrent colonic lesions. Conversely, although data show good effectiveness and safety for <10 mm lesions, it is preferred when high-grade dysplasia is suspected, favouring cold snare polypectomy for all other cases. Moreover, promising data are emerging regarding the feasibility of U-ESD for difficult-to-resect colonic lesions. U-EMR represents a standard of care for treating < 25 mm superficial non-ampullary duodenal epithelial tumours. Data regarding oesophageal, gastric and ampullary lesions remains limited to small cohorts. Finally, using water immersion for POEM has shown a reduction in procedure time compared to the CO
Abstract Background Antiretroviral therapy (ART) is highly effective in people living with HIV (PLHIV), but its success depends on treatment satisfaction and adherence. A determinant of satisfaction regards how the medication is delivered to the patient, namely how it is contained (e.g., bottles, blisters, etc). A new packaging of Biktarvy ® has been introduced as a monthly blister, aiming to improve satisfaction, facilitate traceability of daily medication, portability, and discretion (reducing stigma associated with ART), and, ultimately, enhance adherence. Goals The study’s objective was to assess the impact of changing the packaging of Biktarvy® (B/F/TAF) from a standard pill bottle to a monthly blister with a weekly calendar on therapy satisfaction. Additionally, the association between treatment satisfaction and selected patients’ characteristics (e.g., ART duration) was evaluated. A secondary goal was to characterize the association between the change of packaging on patient’s adherence. Methods This is an observational longitudinal (retrospective and prospective) study with patients following ART for at least six months (ambulatory clinical management) recruited according to a non-probabilistic sequential sampling. Satisfaction was measured at two different moments: at baseline, HIVTSQs were used to assess satisfaction within the previous six months’ use of medication containers (bottles). Six months later, patients filled in the HIVTSQc to assess their perception of satisfaction change with the new packaging (blister). Adherence was assessed by pharmacy medication dispensing at the hospital. Results The study enrolled 105 patients in two selected centers (102 patients completed the study). Patients were significantly more satisfied (HIVTSQc scores) with ART when using the new Biktarvy® blister pack package. Importantly, gains of ART satisfaction were higher among those less satisfied with the bottle packaging. No significant associations were found between HIVTSQc scores and sociodemographic or ART-related variables.
Introduction: Anemia is one of the most common systemic complication of gastrointestinal diseases, with a substantial impact on the quality of life, significant morbidity and mortality.Our objective was to evaluate the prevalence of anemia in patients admitted to the Gastroenterology wards, its causes and clinical impact on the follow-up. Methods: Retrospective single-center study that evaluated patients admitted to the Gastroenterology wards from January 2013 to January 2017. Demographic, clinical, and laboratory data were analyzed. Results: We evaluated 344 hospitalizations (209 patients), 61% men, with a median age of 57 years (IQR 43-67). The median follow-up after discharge was 15 months (IQR 6-23). The main reasons for hospitalization were decompensation of chronic liver disease (43%), inflammatory bowel disease (32%) and investigation of the etiology of anemia (10%). Anemia was present in 68% of hospitalizations (n=234), being severe (<8g/dl) in 20% and diagnosed on admission in 85%. In hospitalizations with diagnosed anemia, the median hemoglobin (Hb) at admission was 10.2 g/dl(IQR 8.2-11.3) and the lowest median value during hospitalization was 9.3 g/dl(IQR 8.0-10.4). The main causes of anemia were anemia of chronic disease (59%), iron deficiency (20%) and bleeding (18%), being multifactorial in 38%. Intravenous iron therapy and transfusion of red blood cells were performed in 14% and 8% of the hospitalizations, respectively. By the time of hospital discharge, 86% of the patients (n=202) remained with anemia [median Hb 10 g/dl (8.8-11.1)]. The presence of anemia was associated with a longer hospitalization (median 8 vs. 2 days, p< 0.001). In the logistic regression, severe anemia was independently associated with a higher in-hospital mortality rate (OR 7.0, 95% CI 1.7-29.1; p=0.007). In the follow-up, the presence of anemia was independently associated with a higher rate of rehospitalization at 30 days (HR 3.8, 95%CI 1.6-9.1; p=0.002),90 days (HR 4.6, 95%CI 2.0-10.8; p<0.001) and lower survival (mean 56±5 months vs. 83±2 months, p<0.001). In the multivariate analysis, the presence of anemia was independently associated with the survival estimate (HR 14.9, 95%CI 4.7-47.1;p<0.001). Conclusion: The prevalence of anemia in patients hospitalized in Gastroenterology wards is high, being associated with a negative clinical impact in the short and long term. Preventive strategies and appropriate treatment during hospitalization and in follow-up should be adopted.
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