Artículos de revista (CUN)
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- Second-generation colon capsule endoscopy compared with colonoscopy(2011) Carretero, C. (Cristina); Costamagna, G. (Guido); Galmiche, J.P. (Jean-Paul); Toth, E. (Ervin); Johansson, G.W. (Gabriele Wurn); Petruzziello, L. (Lucio); Hassan, C. (Cesare); Muñoz-Navas, M. (Miguel); Gossum, A. (Andre) van; Nemeth, A. (Artur); Delvaux, M. (Michel); Fockens, P. (Paul); Sacher-Huvelin, S. (Sylvie); Frederic, M. (Muriel); Aminejab, L. (Leila); Neuhaus, H. (Horst); Spada, C. (Cristiano); Riccioni, M.E. (Maria Elena); Deviere, J. (Jacques); Dekker, E. (Evelien); Wientjes, C.A. (Caroline A.); Prieto-Frías, C. (Cesár); Coron, E. (Emmanuel); Mayershofer, R. (Rupert); Gay, G. (Gerard); Cesaro, P. (Paola)Background Colon capsule endoscopy (CCE) represents a noninvasive technology that allows visualization of the colon without requiring sedation and air insufflation. A second-generation colon capsule endoscopy system (PillCam Colon 2) (CCE-2) was developed to increase sensitivity for colorectal polyp detection compared with the first-generation system. Objective To assess the feasibility, accuracy, and safety of CCE-2 in a head-to-head comparison with colonoscopy. Design and Setting Prospective, multicenter trial including 8 European sites. Patients This study involved 117 patients (mean age 60 years). Data from 109 patients were analyzed. Intervention CCE-2 was prospectively compared with conventional colonoscopy as the criterion standard for the detection of colorectal polyps that are ≥6 mm or masses in a cohort of patients at average or increased risk of colorectal neoplasia. Colonoscopy was independently performed within 10 hours after capsule ingestion or on the next day. Main Outcome Measurements CCE-2 sensitivity and specificity for detecting patients with polyps ≥6 mm and ≥10 mm were assessed. Capsule-positive but colonoscopy-negative cases were counted as false positive. Capsule excretion rate, level of bowel preparation, and rate of adverse events also were assessed. Results Per-patient CCE-2 sensitivity for polyps ≥6 mm and ≥10 mm was 84% and 88%, with specificities of 64% and 95%, respectively. All 3 invasive carcinomas were detected by CCE-2. The capsule excretion rate was 88% within 10 hours. Overall colon cleanliness for CCE-2 was adequate in 81% of patients. Limitations Not unblinding the CCE-2 results at colonoscopy; heterogenous patient population; nonconsecutive patients. Conclusion In this European, multicenter study, CCE-2 appeared to have a high sensitivity for the detection of clinically relevant polypoid lesions, and it might be considered an adequate tool for colorectal imaging.
- Split-dose sodium picosulfate–magnesium citrate colonoscopy preparation achieves lower residual gastric volume with higher cleansing effectiveness than a previous-day regimen(2016) Carretero, C. (Cristina); Herraiz, M. T. (María Teresa); Riva, S. (Susana) de la; Angós, R. (Ramón); Lopez-Olaondo, L. (Luis); Muñoz-Navas, M. (Miguel); Alzina, A. (Alejandra); Prieto-Frías, C. (Cesár); Betes, M.T. (María Teresa)Background and Aims It is known that sodium picosulfate–magnesium citrate (SPMC) bowel preparations are effective, well tolerated and safe, and that split-dosing is more effective for colon cleansing than previous-day regimens. Anesthetic guidelines consider that residual gastric fluid is independent of clear liquid fasting times. However, reluctance to use split-dosing persists. This may be due to limited data on residual gastric fluid volumes (RGFVs) and split-dosing bowel preparations, and that these may not be perceived as standard clear liquids. Furthermore, no studies are available on RGFV/residual gastric fluid pH (RGFpH) and SPMC. We aimed to evaluate the cleansing effectiveness and the RGFV/RGFpH achieved after an SPMC split-dosing regimen compared with a SPMC previous-day regimen. Methods This was a single-center observational study. A total of 328 outpatients scheduled for simultaneous EGD and colonoscopy and following a split-dosing or previous-day regimen of SPMC were included. We prospectively measured colon cleanliness by using the Ottawa Bowel Preparation Scale, RGFV, and RGFpH. Results Ottawa Bowel Preparation Scale scores for overall, right, mid-colon, and colon fluid were significantly better in the split-dosing group. In the split-dosing group, the 3- to 4-hour fasting time consistently achieved the best cleansing quality. RGFV was significantly lower in the split-dosing group (11.09 vs 18.62, P < .001). No significant differences in RGFpH were detected. Conclusions Split-dosing SPMC provides higher colon cleansing quality with lower RGFVs than previous-day SPMC regimens. SPMC in split-dosing acts exactly as a standard clear liquid acts, and thus anesthetic guidelines on this issue may be applied with no concerns.
- Role of capsule endoscopy in suspected celiac disease: A European multi-centre study(2017) Carretero, C. (Cristina); Valle-Muñoz, J. (Julio); Herrerías-Gutiérrez, J. M. (Juan Manuel); Sanjuan-Acosta, M. (Mileidis); Gonzalez-Suarez, B. (Begoña); Juanmartiñena-Fernández, J.F. (José Francisco); Luján-Sanchís, M. (Marisol); Rosa, B. (Bruno); González-Vázquez, S. (Santiago); Jiménez-García, V. A. (Victoria Alejandra); Argüelles-Arias, F. (Federico); Borque-Barrera, P. (Pilar); Elli, L. (Luca); Fernandez-Urien, I. (Ignacio); Sempere-García-Argüelles, J. (Javier); Alonso-Lázaro, N. (Noelia); Xavier, S. (Sofía); Egea-Valenzuela, J. (Juan); Ruano-Díaz, L. (Lucía); Pérez-Cuadrado-Martínez, E. (Enrique); Pons-Beltran, V. (Vicente); García-Lledó, J. (Javier); Sánchez-Ceballos, F. (Francisco); Prieto-Frías, C. (Cesár); Branchi, F. (Federica); Pérez-Cuadrado-Robles, E. (Enrique); López-Higueras, A. (Antonio)METHODS This is a multi-centre, observational, analytical, retrospective study. A total of 163 patients with suspicion of celiac disease (CD) (mean age = 46.4 ± 17.3 years, 68.1% women) who underwent CE from 2003 to 2015 were included. Patients were divided into four groups: seronegative CD with atrophy (Group-I, n = 19), seropositive CD without atrophy (Group-II, n = 39), contraindication to gastroscopy (Group-III, n = 6), seronegative CD without atrophy, but with a compatible context (Group-IV, n = 99). DY, TI and the safety of CE were analysed. RESULTS The overall DY was 54% and the final diagnosis was villous atrophy (n = 65, 39.9%), complicated CD (n = 12, 7.4%) and other enteropathies (n = 11, 6.8%; 8 Crohn’s). DY for groups I to IV was 73.7%, 69.2%, 50% and 44.4%, respectively. Atrophy was located in duodenum in 24 cases (36.9%), diffuse in 19 (29.2%), jejunal in 11 (16.9%), and patchy in 10 cases (15.4%). Factors associated with a greater DY were positive serology (68.3% vs 49.2%, P = 0.034) and older age (P = 0.008). On the other hand, neither sex nor clinical presentation, family background, positive histology or HLA status were associated with DY. CE results changed the therapeutic approach in 71.8% of the cases. Atrophy was associated with a greater TI (92.3% vs 45.3%, P < 0.001) and 81.9% of the patients responded to diet. There was one case of capsule retention (0.6%). Agreement between CE findings and subsequent histology was 100% for diagnosing normal/other conditions, 70% for suspected CD and 50% for complicated CD. CONCLUSION CE has a high DY in cases of suspicion of CD and it leads to changes in the clinical course of the disease. CE is safe procedure with a high degree of concordance with histology and it helps in the differential diagnosis of CD.
- Prospective multicenter study to identify optimal target population for motorized spiral enteroscopy(2024) Carretero, C. (Cristina); Giordano, A. (Antonio); Gonzalez-Suarez, B. (Begoña); Compañy, L. (Luis); Urpi-Ferreruela, M. (Miguel); Fernández-Gil, P. L. (Pedro Luis); Aicart-Ramos, M. (Marta); Alonso-Lázaro, N. (Noelia); Parejo-Carbonell, S. (Sofía); Bógalo-Romero, C. (Cintia); Egea-Valenzuela, J. (Juan); Pons-Beltran, V. (Vicente); Ruiz-Gómez, F. (Francisco); Sola-Vera, J. (Javier); Dedeu-Cuscó, J. M. (Josep María); Alajarin-Cervera, M. (Miriam); Prieto-de-Frias, C. (César)Motorized spiral enteroscopy (MSE) enhances small bowel exploration, but the optimal target population for this technique is unknown. We aimed to identify the target population for MSE by evaluating its efficacy and safety, as well as detecting predictors of efficacy. A prospective multicenter observational study was conducted at 9 tertiary hospitals in Spain, enrolling patients between June 2020–2022. Analyzed data included demographics, indications for the procedure, exploration time, depth of maximum insertion (DMI), technical success, diagnostic yield, interventional yield, and adverse events (AE) up to 14 days from enteroscopy. Patients with prior gastrointestinal surgery, unsuccessful balloon enteroscopy and small bowel strictures were analyzed. A total of 326 enteroscopies (66.6% oral route) were performed in 294 patients (55.1% males, 65 years ± 21). Prior abdominal surgery was present in 50% of procedures (13.5% gastrointestinal surgery). Lower DMI (162 vs 275 cm, p = 0.037) and diagnostic yield (47.7 vs 67.5%, p = 0.016) were observed in patients with prior gastrointestinal surgery. MSE showed 92.2% technical success and 56.9% diagnostic yield after unsuccessful balloon enteroscopy (n = 51). In suspected small bowel strictures (n = 49), the finding was confirmed in 23 procedures (46.9%). The total AE rate was 10.7% (1.8% classified as major events) with no differences related to prior gastrointestinal/abdominal surgery, unsuccessful enteroscopy, or suspected small bowel strictures. The study demonstrates that MSE has a lower diagnostic yield and DMI in patients with prior gastrointestinal surgery but is feasible after unsuccessful balloon-enteroscopy and in suspected small bowel strictures without safety concerns.
- EchoBrush may be superior to standard EUS-guided FNA in the evaluation of cystic lesions of the pancreas(2011) Lozano, M.D. (María Dolores); Álvarez-Cienfuegos, J. (Javier); Subtil, J.C. (José Carlos); Echeveste, J.I. (José I.); Labiano, T. (Tania); Idoate, M.A. (Miguel Ángel); Prieto-Frías, C. (Cesár); Betes, M.T. (María Teresa)BACKGROUND: Cystic lesions of the pancreas are being detected with increasing frequency. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is one of the most precise methods of diagnosis but still has limited accuracy. A new, through-the-needle cytologic brush system (EchoBrush; Cook Medical, Bloomington, Ind) has been approved for use during EUS evaluation of cystic pancreatic lesions. METHODS: Data from 127 EUS-FNAs of pancreatic cystic lesions were analyzed to compare the cytologic yield of EchoBrush with conventional EUS-FNA. An attending cytopathologist was present on site to assess specimen adequacy in all the cases. Diagnostic yields of both procedures, as well as related adverse events, were recorded. Statistical analysis was performed with the SPSS 15.0 version software (SPSS, Chicago, Ill). RESULTS: A total of 127 cystic lesions of the pancreas from 120 patients (42 men and 78 women, mean age of 62.17 ± 12.17 years) were included in the study. Mean size of lesions was 23.58 ± 21.69 mm. Adequacy of the samples and diagnostic yield were higher using EchoBrush. In 80 (63 %) cases, conventional EUS-FNA was performed, whereas in 47 (37%), we used EchoBrush. Diagnostic material was obtained in 85.1% (40 of 47) of cases using EchoBrush and in 66.3% (53 of 80) with conventional EUS-FNA. (P < .05). There were very few clinically relevant complications related to EUS-FNA and EUS-EchoBrush techniques. CONCLUSIONS: This study suggests that cytological specimens from pancreatic cystic lesions obtained using EchoBrush at the time of EUS are superior to conventional EUS-FNA mainly because of the higher yield of epithelial cells. Larger studies are needed to compare both methods. Cancer (Cancer Cytopathol) 2011. © 2011 American Cancer Society.
- Neoadjuvant therapy versus upfront surgery in resectable pancreatic cancer: reconstructed patient-level meta-analysis of randomized clinical trials(Oxford University Press, 2024) Chopitea, A. (Ana); Rotellar, F. (Fernando); Rodriguez, J. (Javier); Pardo, F. (Fernando); Zozaya-Larequi, G. (Gabriel); Castañon, E. (Eduardo); Ponz-Sarvise, M. (Mariano); Blanco, N. (Nuria); Marti-Cruchaga, P. (Pablo); Aliseda, D. (Daniel)Background: Neoadjuvant treatment has shown promising results in patients with borderline resectable pancreatic ductal adenocarcinoma. The potential benefits of neoadjuvant treatment on long-term overall survival in patients with resectable pancreatic ductal adenocarcinoma have not yet been established. The aim of this study was to compare long-term overall survival of patients with resectable pancreatic ductal adenocarcinoma based on whether they received neoadjuvant treatment or underwent upfront surgery. Methods: A systematic review including randomized clinical trials on the overall survival outcomes between neoadjuvant treatment and upfront surgery in patients with resectable pancreatic ductal adenocarcinoma was conducted up to 1 August 2023 from PubMed, MEDLINE and Web of Science databases. Patient-level survival data was extracted and reconstructed from available Kaplan–Meier curves. A frequentist one-stage meta-analysis was employed, using Cox-based models and a non-parametric method (restricted mean survival time), to assess the difference in overall survival between groups. A Bayesian meta-analysis was also conducted. Results: Five randomized clinical trials comprising 625 patients were included. Among patients with resectable pancreatic ductal adenocarcinoma, neoadjuvant treatment was not significantly associated with a reduction in the hazard of death compared with upfront surgery (shared frailty HR 0.88, 95% c.i. 0.72 to 1.08, P = 0.223); this result was consistent in the non-parametric restricted mean survival time model (+2.41 months, 95% c.i. −1.22 to 6.04, P < 0.194), in the sensitivity analysis that excluded randomized clinical trials with a high risk of bias (shared frailty HR 0.91 (95% c.i. 0.72 to 1.15; P = 0.424)) and in the Bayesian analysis with a posterior shared frailty HR of 0.86 (95% c.i. 0.70 to 1.05). Conclusion: Neoadjuvant treatment does not demonstrate a survival advantage over upfront surgery for patients with resectable pancreatic ductal adenocarcinoma.
- Ablative radioembolization of hepatocellular carcinoma with total arterial supply originating from the superior adrenal artery achieved complete pathologic necrosis(Elsevier, 2022) Lewis, A.R. (Andrew R.); Arotzarena, G. (Gonzalo); Paz-Fumagalli, R. (Ricardo); Toskich, B.B. (Beau B.)Exclusively extrahepatic arterial perfusion to previously untreated, early-stage, hepatocellular carcinoma (HCC) is uncommon. We present a case of right superior adrenal artery completely supplying a subcapsular HCC in a 68-year-old male. The extrahepatic arterial territory targeted excluded structures potentially vulnerable to radiation, which allowed safe ablative Y-90 radioembolization that achieved complete pathological necrosis.
- The profile of social communication in Dravet syndrome(Elsevier, 2024) Laña, B. (Borja); Sanchez-Carpintero, R. (Rocío); Crespo-Eguilaz, N. (Nerea)Dravet syndrome (DS) presents a multifaceted clinical picture marked by epilepsy, cognitive impairments and behavioral disorders that progresses throughout development. Behavioral disorders include impairments in social relationships and communication, with frequent diagnosis of autism spectrum disorder. This study focused on comprehensively evaluating and comparing social communication profiles among a group of 43 children with Dravet syndrome, 30 children with level 1 autism spectrum disorder, 36 with social (pragmatic) communication disorder, and 18 with intellectual disability. Using validated tools like the Childhood Autism Spectrum Test and Children’s Communication Checklist, distinct patterns of social communication deficits were delineated. Our findings indicate that children with Dravet syndrome experience challenges in social relationships, primarily due to difficulties in use of pragmatic language. Areas such as range of interests and social interaction are less affected compared to those with ASD, emphasizing differing profiles between the conditions. While children with DS and ID may have similar intellectual functioning, the different social communication deficits in DS indicate their role in the DS phenotype beyond ID. These results underscore the unique social communication profile of DS and emphasizes the importance of tailored interventions and deep phenotyping efforts for effective DS management.
- Colaboración interprofesional en las sesiones clínicas de una unidad de cuidados intensivos: percepción de enfermeras y médicos. Una revisión sistemática de la literatura(Elsevier, 2024) Calderón-Breñosa, B. (B.); Alzate-Moreno, M. (M.); Sarasa-Monreal, M.M. (Mari Mar); Rodríguez-San Miguel, K. (K.)Introducción: Las Unidades de Cuidados Intensivos son unidades dinámicas y complejas que requieren del trabajo conjunto de varios profesionales. Esto se consigue mediante la práctica colaborativa interprofesional, que es el proceso en el que interactúan diferentes profesionales con metas y objetivos comunes en la toma de decisiones, proporcionando una atención segura y de calidad. Las sesiones clínicas conjuntas brindan a los profesionales la posibilidad de interactuar, mejorando la comunicación y los resultados en la práctica clínica. Objetivos: Explorar las percepciones de enfermeras y médicos sobre la práctica colaborativa en las sesiones clínicas conjuntas en una Unidad de Cuidados Intensivos. Metodología: Se realizó una revisión sistemática de la literatura en las bases de datos Medline, Pubmed, Cinahl, Web of Science y Psycinfo, incluyendo artículos publicados en los últimos diez años. Resultados: El análisis de las publicaciones detectó cinco categorías principales: 1) Concepto: definición de colaboración interprofesional según enfermeras y médicos; 2) Repercusión en la práctica clínica: valor otorgado a las sesiones clínicas por enfermeras y médicos; 3) Barreras: aspectos influyentes en las sesiones clínicas según la percepción de enfermeras y médicos; 4) Rol: papel percibido por cada profesional, y 5) Estrategias de mejora: propuestas planteadas por profesionales de enfermería y medicina. Conclusiones: A pesar de que médicos y enfermeras son conscientes de la importancia y repercusión de la práctica colaborativa interprofesional en la atención al paciente crítico, no resulta una práctica habitual en la asistencia.
- Experiencia de una enfermera de práctica avanzada en una unidad de cuidados intensivos(Elsevier, 2024) Goñi-Viguria, R. (Rosana)La estructura de las unidades de cuidados intensivos, el perfeccionamiento tecnológico y la gravedad de los pacientes, exigen que exista armonía entre todos los actores participantes del asistir al paciente crítico. A este contexto se añade que el rol actual de la supervisora pasa por asumir cada vez más competencias en gestión, sin perder de vista la necesidad de enmarcar la práctica profesional en el marco de una filosofía de cuidados. Ante este reto para la supervisora, la aparición en nuestro entorno de la figura de la enfermera de práctica avanzada (EPA) es una oportunidad. La EPA es fundamental para mejorar la atención al paciente, el desarrollo del personal y la implantación de la práctica basada en la evidencia. En este artículo se describe cómo trabaja la EPA con los diferentes miembros del equipo de salud y cuáles han sido los resultados desde su incorporación. La EPA lidera los esfuerzos para mantener la calidad del cuidado. Utiliza su conocimiento para evaluar las brechas dentro de la práctica y entre los entornos de práctica, y diseñar y liderar cambios en la práctica basados en la evidencia, para que los puntos de referencia puedan cumplirse de la manera más eficiente y oportuna. Además, apoya a la organización para responder a un entorno sanitario en constante cambio y es un instrumento para alcanzar sus metas.