Egea-Valenzuela, J. (Juan)
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- 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.
- 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.
- Small bowel enteroscopy - A joint clinical guideline from the spanish and portuguese small bowel study groups(Karger, 2020) Nogales, Ó. (Óscar); Carretero, C. (Cristina); Cardoso, H. (Hélder); Delgado, P.E. (Pilar Esteban); Alonso, P. (Pedro); Valdivieso-Cortazar, E. (Eduardo); Gómez-Rodríguez, B.J. (Blas José); Gonzalez, B. (Begoña); Almeida, N. (Nuno); Juanmartiñena-Fernández, J.F. (José Francisco); Rosa, B. (Bruno); Ponte, A. (Ana); Argüelles-Arias, F. (Federico); San-Juan-Acosta, M. (Mileidis); Borque-Barrera, P. (Pilar); Andrade, P. (Patricia); Bernardes, C. (Carlos); Mascarenhas-Saraiva, M. (Miguel); Lopes, S. (Sandra); Egea-Valenzuela, J. (Juan); Pérez-Cuadrado-Martínez, E. (Enrique); Pinho, R. (Rolando); Caballero, N. (Noemí); García-Lledó, J. (Javier); Chagas, C. (Crisitina); Sánchez-Ceballos, F. (Francisco); Prieto-Frías, C. (Cesár); Figueiredo, P. (Pedro); Gálvez, C. (Consuelo); Mão-de-Ferro, S. (Susana); Pérez-Cuadrado-Robles, E. (Enrique)The 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 on its diagnostic and therapeutic yields. A set of recommendations were issued accordingly.