ABSTRACT
Antecedentes y objetivosLas principales guías de práctica clínica recomiendan un adecuado manejo periprocedimiento de los fármacos antitrombóticos en caso de realización de técnicas invasivas. El principal objetivo de este estudio fue evaluar si existe mayor riesgo de eventos tromboembólicos por la supresión o la disminución de la dosis de anticoagulantes o antiagregantes en pacientes sometidos a una colangiopancreatografía retrógrada endoscópica (CPRE). Pacientes y métodos: Se realizó un estudio observacional prospectivo que incluyó 644CPRE realizadas con intención terapéutica durante el año 2019 en el Hospital Universitario Reina Sofía con un seguimiento de 30días posprocedimiento. Resultados: Seis pacientes presentaron un evento tromboembólico, no hallando diferencias entre la incorrecta retirada/reintroducción del tratamiento antitrombótico y una mayor proporción de eventos tromboembólicos o hemorrágicos tras el procedimiento (p>0,05). La incidencia de eventos trombóticos fue significativamente mayor en pacientes en tratamiento con heparina o apixabán (p=0,001), así como con antecedente de fibrilación auricular (p=0,05), valvulopatía reumática (p=0,037) y tromboembolismo pulmonar recurrente (p=0,035), siendo este además un factor de riesgo independiente. Asimismo, la incidencia de hemorragia en los 30días postesfinterotomía fue significativamente menor en aquellos con implantación de prótesis biliar (p=0,04).Conclusiones: El inadecuado manejo periprocedimiento de la terapia antitrombótica no se asocia a un aumento significativo de la incidencia de eventos tromboembólicos en los 30días posteriores a la CPRE. No obstante, se aconseja seguir las recomendaciones para una adecuada suspensión/reintroducción de fármacos antitrombóticos, realizando una vigilancia y un seguimiento estrechos tras el procedimiento en pacientes con factores que aumenten el riesgo trombótico.(AU)
Background and objectives: The main clinical practice guidelines recommend adequate periprocedural withdrawal and reintroduction of antithrombotic drugs in case of invasive techniques. The main objective of this study was to assess whether, in patients receiving anticoagulant or antiplatelet therapy, the suppression or reduction of the pharmacological dose for the performance of endoscopic retrograde cholangiopancreatography (ERCP) implies a greater risk of thromboembolic events. Patients and methods: A prospective observational study was carried out, which included 644ERCP performed with therapeutic intention during 2019 at the Reina Sofía University Hospital with follow-up during the 30days after the endoscopic intervention. Results: Six patients presented a thromboembolic event, finding no differences between the incorrect withdrawal/reintroduction of antithrombotic treatment and a higher proportion of thromboembolic or hemorrhagic events after the procedure (P>.05). The incidence of thrombotic events was significantly higher in patients treated with heparin or apixaban (P=.001), as well as with a history of atrial fibrillation (P=.05), rheumatic valve disease (P=.037) and recurrent pulmonary embolism (P=.035), this being also an independent risk factor. Likewise, the incidence of hemorrhage in the 30days post-sphincterotomy was significantly lower in those with implantation of a biliary prosthesis (P=.04). Conclusions: Inadequate periprocedural management of antithrombotic therapy is not associated with a significant increase in the incidence of thromboembolic events in the 30days after ERCP. However, close follow-up and surveillance during the days after this is essential in those patients with a condition that significantly increases the risk of thrombosis.(AU)
Subject(s)
Humans , Male , Aged , Cholangiopancreatography, Endoscopic Retrograde , Thromboembolism , Platelet Aggregation Inhibitors , Anticoagulants/therapeutic use , Sphincterotomy , Gastroenterology , Gastrointestinal DiseasesABSTRACT
BACKGROUND AND OBJECTIVES: The main clinical practice guidelines recommend adequate periprocedural withdrawal and reintroduction of antithrombotic drugs in case of invasive techniques. The main objective of this study was to assess whether, in patients receiving anticoagulant or antiplatelet therapy, the suppression or reduction of the pharmacological dose for the performance of endoscopic retrograde cholangiopancreatography (ERCP) implies a greater risk of thromboembolic events. PATIENTS AND METHODS: A prospective observational study was carried out, which included 644ERCP performed with therapeutic intention during 2019 at the Reina Sofía University Hospital with follow-up during the 30days after the endoscopic intervention. RESULTS: Six patients presented a thromboembolic event, finding no differences between the incorrect withdrawal/reintroduction of antithrombotic treatment and a higher proportion of thromboembolic or hemorrhagic events after the procedure (P>.05). The incidence of thrombotic events was significantly higher in patients treated with heparin or apixaban (P=.001), as well as with a history of atrial fibrillation (P=.05), rheumatic valve disease (P=.037) and recurrent pulmonary embolism (P=.035), this being also an independent risk factor. Likewise, the incidence of hemorrhage in the 30days post-sphincterotomy was significantly lower in those with implantation of a biliary prosthesis (P=.04). CONCLUSIONS: Inadequate periprocedural management of antithrombotic therapy is not associated with a significant increase in the incidence of thromboembolic events in the 30days after ERCP. However, close follow-up and surveillance during the days after this is essential in those patients with a condition that significantly increases the risk of thrombosis.
Subject(s)
Thromboembolism , Thrombosis , Humans , Anticoagulants/adverse effects , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Cholangiopancreatography, Endoscopic Retrograde/methods , Fibrinolytic Agents/adverse effects , Thromboembolism/epidemiology , Thromboembolism/etiology , Thromboembolism/prevention & control , Hemorrhage/etiology , Thrombosis/etiologyABSTRACT
Introducción y objetivos: La calidad de la colonoscopia es clave para asegurar la prevención del adenocarcinoma colorrectal (ACCR), aunque el riesgo de ACCR existe. Los objetivos del estudio fueron investigar la incidencia, las características y los factores predictores de ACCR poscolonoscopia (ACCRPC). Material y método: Estudio observacional retrospectivo y prospectivo sobre una población sometida a colonoscopia entre 1-01-1997 y 31-12-2014. Se analizaron variables demográficas, características de la colonoscopia diagnóstica de ACCR, de las previas y de las lesiones encontradas en ellas. Se aplicaron test de contraste de hipótesis para comparar el grupo de ACCRPC con el de ACCR sin colonoscopia previa y regresión logística múltiple para identificar factores independientes de ACCRPC (SPSS® 15), considerando significación estadística una p<0,05. Resultados: Se registraron 56.984 colonoscopias, 1.977 ACCR y 132 pacientes (edad media de 70,8 años y 56,8% varones) con al menos una colonoscopia en los 10 años previos (ACCRPC). El 70,5% de las colonoscopias previas fueron completas y el 63,7% tenían una preparación adecuada. Los factores de riesgo independientes relacionados con la aparición de ACCRPC fueron los antecedentes personales de pólipos colónicos (OR 35,01; IC 95% 11,1-110,8; p<0,001), antecedentes personales de ACCR (OR 176,64; IC 95% 51,5-606,1); p<0,001), antecedentes familiares de ACCR (OR 3,14; IC 95% 1,5-6,4); p=0,002) y la localización del ACCR en el colon derecho (OR 3,15; IC 95% 2,1-4,9; p<0,001). Conclusiones: La tasa de ACCRPC a 10 años fue del 6,7%. Realizar un adecuado seguimiento y una colonoscopia de calidad puede evitar la aparición del ACCRPC, especialmente en los pacientes con factores de riesgo (AU)
Introduction and aims: A high quality colonoscopy is key in preventing colorectal cancer, but the risk of colorectal cancer (CRC) exists. The aims of the study were to investigate the incidence, characteristics and predictive factors of post-colonoscopy colorectal cancer (PCCRC). Material and method: A retrospective and prospective observational study was designed. A population undergoing colonoscopy between 1-01-1997 and 31-12-2014 was included. We analysed demographic variables, characteristics of the diagnostic colonoscopy of CRC, of the previous ones and the lesions found in them. To compare the PCCRC group versus the CRC group without previous colonoscopy, the Student's t-test and multiple logistic regression were used to determine predictive factors of PCCRC (SPSS® 15). The statistical significance was P<.05. Results: A total of 56,984 colonoscopies, 1,977 CRC and 132 patients (mean 70.8 years old, 56.8% male) with at least one colonoscopy in 10 years before were registered (PCCRC). Seventy and a half percent of the previous colonoscopies were completed and 63.7% had an adequate bowel preparation. Predictive factors of PCCRC were personal history of polyps (OR 35.01; 95% CI 11.1-110.8; P<.001), previous CRC (OR 176.64; 95% CI 51.5-606.1); P<.001), family history of CRC (OR 3.14; 95% CI 1.5-6.4); P=.002) and proximal CRC (OR 3.15; 95% CI 2.1-4.9; P<.001). Conclusions: PCCRC rate in 10 years was 6.7%. An adequate follow-up and a high-quality colonoscopy could prevent PCCRC, especially in patients with risk factors (AU)
Subject(s)
Humans , Male , Female , Aged , Colonoscopy/trends , Colorectal Neoplasms/diagnosis , Predictive Value of Tests , Risk Factors , Neoplasm Staging/methods , Adenocarcinoma/epidemiology , Retrospective Studies , Prospective Studies , Logistic Models , Colonoscopy/statistics & numerical data , Mass Screening/methods , ROC Curve , Multivariate AnalysisABSTRACT
INTRODUCTION AND AIMS: A high quality colonoscopy is key in preventing colorectal cancer, but the risk of colorectal cancer (CRC) exists. The aims of the study were to investigate the incidence, characteristics and predictive factors of post-colonoscopy colorectal cancer (PCCRC). MATERIAL AND METHOD: A retrospective and prospective observational study was designed. A population undergoing colonoscopy between 1-01-1997 and 31-12-2014 was included. We analysed demographic variables, characteristics of the diagnostic colonoscopy of CRC, of the previous ones and the lesions found in them. To compare the PCCRC group versus the CRC group without previous colonoscopy, the Student's t-test and multiple logistic regression were used to determine predictive factors of PCCRC (SPSS® 15). The statistical significance was P<.05. RESULTS: A total of 56,984 colonoscopies, 1,977 CRC and 132 patients (mean 70.8 years old, 56.8% male) with at least one colonoscopy in 10 years before were registered (PCCRC). Seventy and a half percent of the previous colonoscopies were completed and 63.7% had an adequate bowel preparation. Predictive factors of PCCRC were personal history of polyps (OR 35.01; 95% CI 11.1-110.8; P<.001), previous CRC (OR 176.64; 95% CI 51.5-606.1); P<.001), family history of CRC (OR 3.14; 95% CI 1.5-6.4); P=.002) and proximal CRC (OR 3.15; 95% CI 2.1-4.9; P<.001). CONCLUSIONS: PCCRC rate in 10 years was 6.7%. An adequate follow-up and a high-quality colonoscopy could prevent PCCRC, especially in patients with risk factors.
Subject(s)
Adenocarcinoma/diagnostic imaging , Adenocarcinoma/epidemiology , Colonoscopy , Colorectal Neoplasms/diagnostic imaging , Colorectal Neoplasms/epidemiology , Adenocarcinoma/prevention & control , Adult , Aftercare , Aged , Aged, 80 and over , Colorectal Neoplasms/prevention & control , Female , Humans , Incidence , Male , Middle Aged , Prospective Studies , Retrospective Studies , Risk Factors , Spain/epidemiologyABSTRACT
INTRODUCTION: In patients who have undergone partial gastric resections, the difficulty of performing endoscopic retrograde cholangiopancreatography (ERCP) is increased due to the resulting anatomic abnormality. AIM: To review our experience of ERCP in patients with Billroth II gastrectomy and other types of gastrectomy (Billroth I and indeterminate) in our center. MATERIAL AND METHODS: We included all patients with Billroth II gastrectomy or other types of gastrectomy undergoing ERCP in a 19-year period. RESULTS: We included 233 patients (91% men and 9% women) from 1993 to 2012. A total of 88.4% of the patients had undergone Billroth II and 11.6% had undergone other types of gastrectomy, with an ERCP success rate of 51.9% and 55.6%, respectively. The most common causes of failure were inability to cannulate (44%) and failure to identify the papilla (39.6%). The final diagnosis was choledocholithiasis in 31.8%. The mean number of sessions was 1.09. The complications rate was 2.6%. CONCLUSIONS: The success of ERCP is influenced by the technical difficulty. For this reason, the success rate in our center was slightly over 50%, but with few complications.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Gastrectomy , Stomach/pathology , Stomach/surgery , Adult , Aged , Aged, 80 and over , Cholangiopancreatography, Endoscopic Retrograde/methods , Female , Gastrectomy/methods , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
BACKGROUND: There is scant information on the use of endoscopic retrograde cholangiopancreatography (ERCP) in patients under 18. OBJECTIVE: To analyze our experience in all patients under 18 who underwent ERCP. PATIENTS AND METHODS: We performed a retrospective study of all ERCP conducted in patients under 18 between 1993 and 2006. We analyzed indications, endoscopic and radiologic findings, diagnostic and therapeutic success, and complications. RESULTS: We included 31 patients who underwent 36 ERCP in total. The mean age was 9.89 +/- 5 years old. We used general anesthesia in 58.3% (21 patients), with a mean age of 8 +/- 5 years. The most frequent indications were complications after liver transplantation in 33.3% (12 patients), suspicion of biliary obstruction in 27.7% (10 patients), and pancreatitis in 22.2% (8 patients). We achieved cannulation and repletion in the selected duct in 94.4%. The most frequent pathologic findings were changes in the biliary tract after liver transplantation in 25% (9 patients). The results of ERCP were normal in 10 patients (27.7%). Therapeutic maneuvers were indicated in 17 out of the 34 (50%) examinations considered, achieving therapeutic success in 76.47% (13/17). Complications consisted of hemorrhage after simple sphincterotomy in one patient (2.8%) and mild pancreatitis in two patients (5.6%). CONCLUSIONS: We found ERCP to be a safe procedure with a high diagnostic and therapeutic success rate, and a low rate of early complications.
Subject(s)
Bile Duct Diseases/diagnosis , Cholangiopancreatography, Endoscopic Retrograde , Pancreatic Diseases/diagnosis , Adolescent , Age Factors , Bile Duct Diseases/therapy , Child , Child, Preschool , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Female , Humans , Infant , Male , Pancreatic Diseases/therapy , Retrospective StudiesABSTRACT
ANTECEDENTES: Hay una escasa información sobre el empleode la colangiopancreatografía retrógrada endoscópica(CPRE) en pacientes menores de 18 años.OBJETIVO: Analizar nuestra experiencia en todos los pacientesmenores de 18 años sometidos a CPRE.PACIENTES Y MÉTODOS: Estudio retrospectivo de todas lasCPRE realizadas a pacientes menores de 18 años entre 1993y 2006. Se analizaron las indicaciones, hallazgos endoscópicosy radiológicos, el éxito diagnóstico y terapéutico, y lascomplicaciones.RESULTADOS: Se incluyeron 31 pacientes a los que se realizaron36 exploraciones en total. La edad media fue de 9,89 ± 5años. Se utilizó la anestesia general en un 58,3% de los pacientes(n = 21), con una edad de 8 ± 5 años. Las indicacionesmás frecuentes fueron, por este orden, las complicacionespostrasplante hepático (12 casos; 33,3%), la sospecha de obstrucciónbiliar (10 casos; 27,77%) y la evaluación de pancreatitis(8 casos; 22,2%). Se logró la canulación y la replecióndel conducto deseado en un 94,4% de los casos. Los hallazgospatológicos más frecuentes fueron las alteraciones en la víabiliar postrasplante hepático (9 casos; 25%). La exploraciónfue compatible con la normalidad en 10 casos (27,7%). Se indicaronmaniobras terapéuticas en 17 de las 34 exploracionesconsideradas como éxito diagnóstico (50%), lográndose eléxito terapéutico en 13 de ellas (76,4%). Las complicacionesregistradas fueron un caso de hemorragia leve postesfinterotomía(2,8%) y 2 pancreatitis leves (5,6%).CONCLUSIONES: La realización de CPRE en nuestra serie hasido segura, con un alto índice de éxito diagnóstico y terapéutico,y pocas complicaciones precoces
BACKGROUND: There is scant information on the use of endoscopicretrograde cholangiopancreatography (ERCP) inpatients under 18.OBJECTIVE: To analyze our experience in all patients under18 who underwent ERCP.PATIENTS AND METHODS: We performed a retrospective studyof all ERCP conducted in patients under 18 between 1993and 2006. We analyzed indications, endoscopic and radiologicfindings, diagnostic and therapeutic success, and complications.RESULTS: We included 31 patients who underwent 36 ERCPin total. The mean age was 9.89 ± 5 years old. We used generalanesthesia in 58.3% (21 patients), with a mean age of 8 ±5 years. The most frequent indications were complicationsafter liver transplantation in 33.3% (12 patients), suspicionof biliary obstruction in 27.7% (10 patients), and pancreatitisin 22.2% (8 patients). We achieved cannulation and repletionin the selected duct in 94.4%. The most frequent pathologicfindings were changes in the biliary tract after livertransplantation in 25% (9 patients). The results of ERCPwere normal in 10 patients (27.7%). Therapeutic maneuverswere indicated in 17 out of the 34 (50%) examinations considered,achieving therapeutic success in 76.47% (13/17).Complications consisted of hemorrhage after simple sphincterotomyin one patient (2.8%) and mild pancreatitis in twopatients (5.6%).CONCLUSIONS: We found ERCP to be a safe procedure witha high diagnostic and therapeutic success rate, and a lowrate of early complications
