The Risk of Developing Disabling Crohn's Disease: Validation of a Clinical Prediction Rule to Improve Treatment Decision Making.

BACKGROUND: Crohn's disease (CD) is characterized by the development of complications over the course of the disease. It is crucial to identify predictive factors of disabling disease, in order to target patients for early intervention. We evaluated risk factors of disabling CD and developed a prognostic model. METHODS: In total, 511 CD patients were retrospectively analyzed. Univariate and multivariate logistic regression analyses were used to identify demographic, clinical, and biological risk factors. A predictive nomogram model was developed in a subgroup of patients with noncomplicated CD (inflammatory pattern and no perianal disease). RESULTS: The rate of disabling CD within 5 years after diagnosis was 74.6%. Disabling disease was associated with gender, location of disease, requirement of steroids for the first flare, and perianal lesions. In the subgroup of patients (310) with noncomplicated CD, the rate of disabling CD was 80%. In the multivariate analysis age at onset <40 years (OR = 3.46, 95% confidence interval [CI] = 1.52-7.90), extensive disease (L3/L4) (OR = 2.67, 95% CI = 1.18-6.06), smoking habit (OR = 2.09, 95% CI = 1.03-4.27), requirement of steroids at the first flare (OR = 2.20, 95% CI = 1.09-4.45), and albumin (OR = 0.59, 95% CI = 0.36-0.96) were associated with development of disabling disease. The developed predictive nomogram based on these factors presented good discrimination, with an area under the receiver operating characteristic curve of 0.723 (95% CI: 0.670-0.830). CONCLUSION: We identified predictive factors of disabling CD and developed an easy-to-use prognostic model that may be used in clinical practice to help identify patients at high risk and address treatment effectively.

Training and competence in Digestive Endoscopy: Statement Position Paper from the Spanish Society of Digestive Diseases.

Gastrointestinal (GI) Endoscopy is a basic competence for the management of gastrointestinal diseases. However, it should not be regarded as an independent training technique. Rather it is a part of a continuous and accredited process that requires clinical knowledge from the gastroenterologist to keep skills up-to-date in a constantly evolving medical subspecialty. Thus, the only official accredited way for training in GI endoscopy is through the Specialized Health Training program in the Management of the Digestive Diseases administered by the Spanish Ministry of Health.

Perforaciones duodenales tras colangiopancreatografía retrógrada endoscópica / Duodenal perforations after endoscopic retrograde cholangiopancreatography

INTRODUCCIÓN: La perforación duodenal tras colangiopancreatografía retrógrada endoscópica (CPRE) constituye un cuadro infrecuente. Su manejo es controvertido. El objetivo de este estudio fue analizar los resultados obtenidos en función de su manejo en una serie de 15 pacientes en los que se diagnosticó esta complicación. MÉTODOS: Estudio descriptivo retrospectivo de las perforaciones duodenales tras CPRE, diagnosticadas en un hospital de tercer nivel entre el 2001 y el 2011. Se analizaron las siguientes variables: edad; sexo; motivo de la CPRE; tipo de perforación; momento del diagnóstico; clínica; prueba de imagen; manejo inicial; técnica quirúrgica; estancia global y mortalidad. RESULTADOS: De un total de 1.923 CPRE realizadas se identificaron 15 perforaciones duodenales tras el procedimiento (0,78%). La localización de la perforación fue en la pared duodenal, lejos de la papila (3 casos) y periampulares (12 casos). En 11 pacientes el diagnóstico se sospechó durante el procedimiento. Las perforaciones de pared duodenal se trataron con cirugía urgente. En 7 de las 12 perforaciones periampulares se realizó manejo conservador inicial con evolución favorable en 5 de ellas. En 4 pacientes se realizó cirugía programada posterior. La estancia media hospitalaria fue de 21,2 días (rango: 3-49) y la mortalidad global del 20%. CONCLUSIONES: Las perforaciones tras CPRE constituyen un cuadro de elevada mortalidad, difícil diagnóstico y complicado abordaje terapéutico que precisa ser individualizado. El manejo conservador selectivo constituye una opción válida y segura

INTRODUCTION: Duodenal perforations after endoscopic retrograde cholangiopancreatography (ERCP) are an uncommon complication. The management of this kind of perforation is controversial. The aim of this study was to analyze the results of the management of a series of 15 patients who were diagnosed with this complication. METHODS: Retrospective study of duodenal perforations after ERCP diagnosed at a tertiary level hospital, between 2001 and 2011. The variables age, sex, ERCP indication, type of perforation, time of diagnosis, clinical presentation, radiographic findings, management, surgical technique, length of stay and intrahospital mortality were recorded and analyzed. RESULTS: Out of a total of 1923 ERCP performed, 15 duodenal perforations were detected (0,78%). Perforation site was the duodenal wall (3 cases) and periampullary (12 cases). Eleven perforations were suspected during the procedure. Patients with duodenal wall perforations underwent immediate surgery. Seven of 12 periampullary perforations were managed conservatively with a favorable outcome in 5 of them. Subsequent scheduled surgery was performed in 4 cases. The mean length of hospital stay was 21,2 days (range: 3-49) and intra-hospital mortality was 20%. CONCLUSIONS: Perforations after ERCP have high mortality rates, and require a complicated therapeutic approach that needs to be individualized. Selective conservative management is a valid and safe option in selected patients

[Duodenal perforations after endoscopic retrograde cholangiopancreatography]. / Perforaciones duodenales tras colangiopancreatografía retrógrada endoscópica.

INTRODUCTION: Duodenal perforations after endoscopic retrograde cholangiopancreatography (ERCP) are an uncommon complication. The management of this kind of perforation is controversial. The aim of this study was to analyze the results of the management of a series of 15 patients who were diagnosed with this complication. METHODS: Retrospective study of duodenal perforations after ERCP diagnosed at a tertiary level hospital, between 2001 and 2011. The variables age, sex, ERCP indication, type of perforation, time of diagnosis, clinical presentation, radiographic findings, management, surgical technique, length of stay and intrahospital mortality were recorded and analyzed. RESULTS: Out of a total of 1923 ERCP performed, 15 duodenal perforations were detected (0,78%). Perforation site was the duodenal wall (3 cases) and periampullary (12 cases). Eleven perforations were suspected during the procedure. Patients with duodenal wall perforations underwent immediate surgery. Seven of 12 periampullary perforations were managed conservatively with a favorable outcome in 5 of them. Subsequent scheduled surgery was performed in 4 cases. The mean length of hospital stay was 21,2 days (range: 3-49) and intra-hospital mortality was 20%. CONCLUSIONS: Perforations after ERCP have high mortality rates, and require a complicated therapeutic approach that needs to be individualized. Selective conservative management is a valid and safe option in selected patients.