A comprehensive examination of small-bowel capsule endoscopy in Spanish centers to meet European Society of Gastrointestinal Endoscopy standards.

Background and study aims In 2019, the European Society of Gastrointestinal Endoscopy (ESGE) created a working group to develop technical and quality standards for small-bowel capsule endoscopy (SBCE) to improve the daily practice of endoscopy services. They developed 10 quality parameters, which have yet to be tested in a real-life setting. Our study aimed to evaluate the accomplishment of the quality standards in SBCE established by the ESGE in several Spanish centers. Materials and methods An online survey of 11 multiple-choice questions related to the ESGE performance measures was sent to Spanish centers with experience in SBCE. In order to participate and obtain reliable data, at least 100 questionnaires had to be answered per center because that is the minimum number established by ESGE. Results 20 centers participated in the study, compiling 2049 SBCEs for the analysis. Only one of 10 performance measures (cecal visualization) reached the minimum standard established by the ESGE. In five of 10 performance measures (Indication, lesion detection rate, terminology, and retention rate) the minimum standard was nearly achieved. Conclusions Our study is the first multicenter study regarding SBCE quality performance measures in a real setting. Our results show that the minimum standard is hardly reached in most procedures, which calls into question their clinical applicability in real life. We suggest performing similar studies in other countries to evaluate whether there is a need for quality improvement programs or a need to reevaluate the minimum and target values published so far.

Impact of the European Society of Gastrointestinal Endoscopy 2020 guidelines on the number of scheduled post-polypectomy surveillance colonoscopies: Meeting presentations: Partial results of this research were published in abstract form at ESGE Days 2020.

Background and study aims In contrast with the European Society of Gastrointestinal Endoscopy (ESGE) 2013 and the US Multi-society Task Force (USMSTF) 2020 guidelines, the ESGE 2020 guideline considers patients with three to four adenomas < 10 mm or an adenoma with villous histology as low risk. The aim of this study was to quantify the influence of the application of the new ESGE 2020 guidelines, as opposed to the ESGE 2013 and USMSTF 2020 guidelines, on the number of scheduled colonoscopies, and to describe the main causes for changes in the surveillance intervals. Patients and methods A retrospective evaluation was conducted of a prospectively maintained fecal immunochemical test (FIT)-based regional colorectal cancer screening program database. Surveillance regimens following ESGE 2020, ESGE 2013, and USMSTF 2020 guidelines were compared. Results Overall, 1284 individuals with a positive FIT and undergoing colonoscopy were consecutively included. When applying the ESGE 2020 guidelines, 10.8 % of patients changed to a "no-surveillance" group (relative reduction in colonoscopies of 82.5 %). The main reason for these changes was considering three to four adenomas as low risk. The proportion of patients from the "3-year surveillance" group who moved to the "no-surveillance" group was lower when a sessile serrated lesion (SSL) was present (ESGE 2013, 32.0% vs 16.3 %; USMSTF 2020 17.2 % vs 6.8 %). Analyzing the 41 patients with SSLs who remained unchanged in the "no-surveillance" group, only in 15 (36.6 %) the cause was the presence of an SSL. Conclusions applying the new ESGE 2020 guidelines could reduce by 11 % the proportion of individuals being offered surveillance. SLLs have not a major influence on the change of surveillance intervals.

Limitación del ingreso en unidades de cuidados intensivos desde los servicios de urgencias y las plantas de hospitalización / Limiting ICU admission from emergency services and wards

Introducción: Las decisiones de no ingresar a un paciente en las unidades de cuidados intensivos (UCI) como forma de limitación de un tratamiento de soporte vital (LTSV) es una práctica que puede afectar al funcionamiento de los servicios de urgencias y a la forma en que los pacientes mueren.MétodosAnálisis post hoc del estudio ADENI-UCI. La principal variable analizada fue el motivo de negación de ingreso en UCI como medida de LTSV. Para el presente análisis post hoc se dividió a los enfermos registrados en 2 grupos: los enfermos consultados al servicio de medicina intensiva desde el área de urgencias y los pacientes consultados desde las áreas de hospitalización convencionales. En la estadística comparativa se utilizó la t de Student cuando se compararon los valores medios de las subcohortes de pacientes. Las variables categóricas se compararon con las pruebas de la χ2.ResultadosEl estudio ADENI-UCI incluía 2284 decisiones de no ingreso en UCI como medida de LTSV. La pobre calidad de vida estimada (p=0,0158), la presencia de enfermedad crónica grave (p=0,0169) y la futilidad de los tratamientos (p=0,0006) fueron decisiones porcentualmente con más peso dentro de la población de pacientes hospitalizados. El porcentaje de desacuerdo entre el médico consultor y el intensivista fue menor de forma significativa en los enfermos valorados desde los servicios de urgencias (p=0,0021).ConclusionesExisten diferencias apreciables en los motivos de consulta, así como en los de rechazo de ingreso en una UCI entre las consultas realizadas desde un servicio de urgencias y una planta de hospitalización convencional. (AU)

Introduction: Decisions not to admit a patient to intensive care units (ICU) as a way of limiting life support treatment (LLST) is a practice that can affect the operation of the emergency services and the way in which patients die.MethodsPost hoc analysis of the ADENI-UCI study. The main variable analysed was the reason for refusal of admission to the ICU as a measure of LLST. For the present post hoc analysis, the registered patients were divided into 2 groups: the patients assessed in the intensive medicine services from the emergency department and the patients assessed from the conventional hospitalization areas. Student t was used in the comparative statistics when the mean values of the patient sub-cohorts were compared. Categorical variables were compared with the χ2 tests.ResultsThe ADENI-ICU study included 2,284 decisions not to admit to the ICU as a measure of LLST. Estimated poor quality of life (p=.0158), the presence of severe chronic disease (P=.0169) and futility of treatment (P=.0006) were percentage decisions with greater weight within the population of hospitalized patients. The percentage of disagreement between the consulting physician and the intensivist was significantly lower in patients assessed from the emergency services (P=.0021).ConclusionsThere are appreciable differences in the reasons for consultation, as well as in those for refusal of admission to an ICU between the consultations made from an emergency department and a conventional hospitalization facility. (AU)

Oral ingestion versus endoscopic delivery of endoscopic capsule in patients with previous gastrointestinal surgery (ORENCES study): A Spanish multicentre observational study / Ingesta oral versus colocación endoscópica de la cápsula endoscópica en pacientes con cirugía gastrointestinal previa (estudio ORENCES): un estudio observacional multicéntrico español

Background: Small Bowel Capsule Endoscopy is the first-choice technique for investigating the majority of small bowel diseases. Its most common complications are related to incomplete examinations and capsule retention. There is no consensus on how patients with previous gastrointestinal surgery should receive the capsule. Objective: The primary endpoint was to compare the rate of complete small-bowel examinations (completion rate) between oral ingestion and endoscopic delivery of the capsule. The secondary endpoint was to compare diagnostic yield and adverse events in the two groups. Methods: A retrospective observational study was conducted in nine hospitals in Spain. Demographic data, previous surgery, indication for capsule endoscopy, intestinal transit time, diagnosis, completion rate (percentage of capsules reaching the caecum), diagnostic yield (percentage of results compatible with indication for the exam) and adverse events were collected. Results: From January 2009 to May 2019 fifty-seven patients were included (39 male, mean age 66±15 years). The most common indications for the exam were “overt” (50.9%) and “occult” (35.1%) small bowel bleeding. Previous Billroth II gastrectomy and Roux-en-Y gastric bypass were present in 52.6% and 17.5% of patients respectively. The capsule was swallowed in 34 patients and placed endoscopically in 23 patients. No significant differences were observed between the oral ingestion and endoscopic delivery groups in terms of completion rate (82.4% vs. 78.3%; p=0.742), diagnostic yield (41.2% vs. 52.2%; p=0.432) or small bowel transit time (301 vs. 377min, p=0.118). No capsule retention occurred. Only one severe adverse event (anastomotic perforation) was observed in the endoscopic delivery group. Conclusions: In our case series, there were no significant differences between oral ingestion and endoscopic delivery in terms of completion rate, diagnostic yield or safety.(AU)

Antecedentes: La cápsula endoscópica representa la técnica de primera elección para investigar la mayoría de las enfermedades del intestino delgado. Sus complicaciones más comunes frecuentes son las exploraciones incompletas y la retención a nivel de intestino delgado. Hasta el momento no hay acuerdo sobre cómo administrar la cápsula a los pacientes que han sido sometidos a una cirugía gastrointestinal previa. Objetivo: El objetivo principal fue comparar la tasa de estudios completos entre la ingestión oral y la administración endoscópica de la cápsula. Los objetivos secundarios fueron comparar el rendimiento diagnóstico y los eventos adversos en ambos grupos. Métodos: Se realizó un estudio observacional retrospectivo en 9 hospitales de España. Se recogieron datos demográficos, cirugía previa, indicación de cápsula endoscópica, tiempo de tránsito intestinal, diagnóstico, tasa de estudios completos (porcentaje de cápsulas que llegan al ciego), rendimiento diagnóstico (porcentaje de resultados compatibles con la indicación del examen) y eventos adversos. Resultados: Desde enero de 2009 hasta mayo de 2019 se incluyeron 57 pacientes (39 hombres, edad media 66 ± 15 años). Las indicaciones más frecuentes para el examen fueron hemorragia de intestino delgado «manifiesta» (50,9%) y «oculta» (35,1%). El 52,6% de los pacientes presentaba gastrectomía Billroth II y el 17,5% bypass gástrico en Y de Roux. La cápsula fue ingerida en 34 pacientes y colocada endoscópicamente en 23 pacientes. No se observaron diferencias significativas entre los grupos de ingesta oral y de colocación endoscópica en cuanto a tasa de estudios completos (82,4% vs. 78,3%; p = 0,742), rendimiento diagnóstico (41,2% vs. 52,2%; p = 0,432) y tiempo de tránsito del intestino delgado (301 vs. 377 min, p = 0,118). No hubo casos de cápsulas retenidas. Solo se observó un evento adverso severo (perforación anastomótica) en el grupo de colocación endoscópica...(AU)

[Decisiones de no ingreso en las Unidades de Cuidados Intensivos como medida de limitación de los tratamientos de soporte vital: variabilidad geográfica en España]. / Decisions of refusal intensive Care Units' admission as a measure of limitation of life support treatments: geographical variability in Spain.

From a post hoc analysis of the ADENI-UCI study (multicenter, observational, cohort, prospective study, with a follow-up period of 13 months, in 62 Intensive Medicine Services in Spain. geographical differences in the reason for denial of income in UCI as a LTSV measure are analyzed. A total of 2284 with an average age of 75.25 (12.45) years were included. 59.43% male. By means of multinominal regression adjusted by age, sex, APACHE and SOFA, was evident (by choosing the northern for reference) that age in the south was a less significantly exposed reason (OR: 0.48 (IC95%: 0.35-0.65). p.

Decisiones de no ingreso en las Unidades de Cuidados Intensivos como medida de limitación de los tratamientos de soporte vital: variabilidad geográfica en España / Decisions of refusal intensive Care Units’ admission as a measure of limitation of life support treatments: geographical variability in Spain

A través de un análisis post hoc del estudio ADENI-UCI (estudio multicéntrico, observacional, de co-hortes, prospectivo, con un período de seguimiento de 13 meses, en un total de 62 servicios de MedicinaIntensiva en España; se analizan las diferencias geográficas del motivo de negación de ingreso en UCI comomedida de LTSV. Se incluyeron 2284 pacientes con una edad media de 75,25 (12,45) años. El 59,43% varones.Mediante regresión multinominal ajustada por edad, sexo, APACHE II y SOFA, se evidenció (al elegir lazona norte como referencia) que la edad en la zona sur fue un motivo menos expuesto de forma significati-va (OR: 0.48 (IC95%: 0.35-0.65). p<0,001), que la enfermedad crónica severa era menos valorada en la zona mediterránea (OR: 0.70 (IC95%: 0.56-0.87). p=0,001), mientras que presentaba más peso en la zona centro(OR: 1.78 (IC95%: 1.43-2.23). p<0,001). La limitación funcional previa fue el motivo más esgrimido en regio-nes centro y sur (OR: 1.39, (IC95%: 1.12-1.72). p=0,002; OR: 1.50, (IC95%:1.15-1.94). p=0,002). Fue la futilidaden el tratamiento el motivo que mayores diferencias presentó entre las diversas regiones analizadas (dif:37,2%-68,8%). Por lo tanto, se puede concluir que existen diferencias geográficas en el territorio españolen las decisiones de rechazar el ingreso en una UCI como medida de LTSV, probablemente justificadas pordiferencias organizativas de los servicios de medicina intensiva participantes en el ADENI-UCI.(AU)

From a post hoc analysis of the ADENI-UCI study (multicenter, observational, cohort, prospective study,with a follow-up period of 13 months, in 62 Intensive Medicine Services in Spain. geographical differencesin the reason for denial of income in UCI as a LTSV measure are analyzed. A total of 2284 with an averageage of 75.25 (12.45) years were included. 59.43% male. By means of multinominal regression adjusted byage, sex, APACHE and SOFA, was evident (by choosing the northern for reference) that age in the southwas a less significantly exposed reason (OR: 0.48 (IC95%: 0.35-0.65). p<0.001), that severe chronic diseasewas less valued in the Mediterranean area (OR: 0.7% 0 (IC95%: 0.56-0.87). p-0.001), while it had moreweight in the central area (OR: 1.78 (95% CI: 1.43-2.23). The previous functional limitation was more raisedin central and southern regions (OR: 1.39, (IC95%: 1.12-1.72). p-0.002; OR:1.50, (IC95%:1.15-1.94). 0.002).It was futility in treatment that had the greatest differences between the various regions analysed (dif:37,2% - 68,8%). There are geographical differences in the Spanish territory in decisions to refuse entry intoan ICU as an LTSV measure, probably justified by organizational differences in intensive medicine servicesparticipating in the ADENI-UCI.(AU)

[Limiting ICU admission from emergency services and wards]. / Limitación del ingreso en unidades de cuidados intensivos desde los servicios de urgencias y las plantas de hospitalización.

INTRODUCTION: Decisions not to admit a patient to intensive care units (ICU) as a way of limiting life support treatment (LLST) is a practice that can affect the operation of the emergency services and the way in which patients die. METHODS: Post hoc analysis of the ADENI-UCI study. The main variable analysed was the reason for refusal of admission to the ICU as a measure of LLST. For the present post hoc analysis, the registered patients were divided into 2 groups: the patients assessed in the intensive medicine services from the emergency department and the patients assessed from the conventional hospitalization areas. Student t was used in the comparative statistics when the mean values of the patient sub-cohorts were compared. Categorical variables were compared with the χ2 tests. RESULTS: The ADENI-ICU study included 2,284 decisions not to admit to the ICU as a measure of LLST. Estimated poor quality of life (p=.0158), the presence of severe chronic disease (P=.0169) and futility of treatment (P=.0006) were percentage decisions with greater weight within the population of hospitalized patients. The percentage of disagreement between the consulting physician and the intensivist was significantly lower in patients assessed from the emergency services (P=.0021). CONCLUSIONS: There are appreciable differences in the reasons for consultation, as well as in those for refusal of admission to an ICU between the consultations made from an emergency department and a conventional hospitalization facility.

Oral ingestion versus endoscopic delivery of endoscopic capsule in patients with previous gastrointestinal surgery (ORENCES study): A Spanish multicentre observational study.

BACKGROUND: Small Bowel Capsule Endoscopy is the first-choice technique for investigating the majority of small bowel diseases. Its most common complications are related to incomplete examinations and capsule retention. There is no consensus on how patients with previous gastrointestinal surgery should receive the capsule. OBJECTIVE: The primary endpoint was to compare the rate of complete small-bowel examinations (completion rate) between oral ingestion and endoscopic delivery of the capsule. The secondary endpoint was to compare diagnostic yield and adverse events in the two groups. METHODS: A retrospective observational study was conducted in nine hospitals in Spain. Demographic data, previous surgery, indication for capsule endoscopy, intestinal transit time, diagnosis, completion rate (percentage of capsules reaching the caecum), diagnostic yield (percentage of results compatible with indication for the exam) and adverse events were collected. RESULTS: From January 2009 to May 2019 fifty-seven patients were included (39 male, mean age 66±15 years). The most common indications for the exam were "overt" (50.9%) and "occult" (35.1%) small bowel bleeding. Previous Billroth II gastrectomy and Roux-en-Y gastric bypass were present in 52.6% and 17.5% of patients respectively. The capsule was swallowed in 34 patients and placed endoscopically in 23 patients. No significant differences were observed between the oral ingestion and endoscopic delivery groups in terms of completion rate (82.4% vs. 78.3%; p=0.742), diagnostic yield (41.2% vs. 52.2%; p=0.432) or small bowel transit time (301 vs. 377min, p=0.118). No capsule retention occurred. Only one severe adverse event (anastomotic perforation) was observed in the endoscopic delivery group. CONCLUSIONS: In our case series, there were no significant differences between oral ingestion and endoscopic delivery in terms of completion rate, diagnostic yield or safety. Being less invasive, oral ingestion of the capsule should be the first-choice method in patients with previous gastrointestinal surgery.

New management of hepatolithiasis: Can surgery be avoided? (with video) / Nuevo manejo en hepatolitiasis: ¿podemos evitar la cirugía? (con vídeo)

BACKGROUND: The presence of hepatolithiasis (HL) is prevalent in eastern countries. It is a clinical entity which is rarely reported in non-surgical series because the standard treatment is the surgical option. Currently, treatment has evolved, with the use of endoscopic techniques being increased and the number of hepatectomies being decreased. SpyGlass™ is a small-calibre endoscopic direct cholangiopancreatoscopy developed to explore and perform procedures in the bile and pancreatic ducts. Single-operator peroral cholangioscopy (POC) is an endoscopic technique useful for treating difficult bile duct stones. AIMS: To assess the usefulness, efficacy, and safety of POC with the SpyGlass™ system in patients with HL. Primary OBJECTIVES: to achieve technical success of the procedure and clinical success of patients with HL. Study design and PATIENTS: Retrospective, single-centre cohort study of patients with HL from April 2012 to August 2018. SpyGlass™ was chosen in symptomatic patients referred from the surgery unit as the first-line procedure. To perform electrohydraulic lithotripsy (EHL), we used a Northgate Autolith IEHL generator with a 0.66-mm biliary probe. RESULTS: We performed a total of 13 procedures in 7 patients with HL. The mean age was 46 years (range 35-65) and 3/7 of patients were female. We achieved technical success in 5/7 cases (71.4%) and clinical success in 4/7 cases (57%). DISCUSSION: SpyGlass™ is safe and effective in the treatment of HL. With these results, we confirm the need for management of patients with HL in a multidisciplinary team. When the endoscopic approach is the option, this procedure must be performed by experts in advanced endoscopy

INTRODUCCIÓN: La presencia de hepatolitiasis (HL) es frecuente en los países orientales. Es una entidad poco descrita en series no-quirúrgicas. El tratamiento estándar para esta entidad es la opción quirúrgica. Actualmente el tratamiento ha evolucionado, aumentando el uso de técnicas endoscópicas y disminuyendo el número de resecciones hepáticas quirúrgicas. SpyGlass™ es un colangiopancreatoscopio endoscópico directo de pequeño calibre desarrollado para explorar y realizar procedimientos en el conducto biliar y pancreático. La colangioscopia peroral de operador único (POC) es una técnica endoscópica útil para tratar los cálculos complejos de las vías biliares. OBJETIVOS: Evaluar la utilidad, la eficacia y la seguridad de la colangioscopia POC con el sistema SpyGlass™ en pacientes con HL. Objetivos primarios: éxito técnico del procedimiento y el éxito clínico de pacientes con HL. DISEÑO: del estudio y pacientes Estudio de cohorte retrospectivo, unicéntrico de pacientes con HL desde abril de 2012 hasta agosto de 2018. SpyGlass™ fue elegido en pacientes sintomáticos remitidos desde la unidad de cirugía como procedimiento de primera línea. Para realizar litotricia electrohidráulica (EHL) se utilizó un generador Northgate Autolith® IEHL con una sonda biliar de 0,66mm. RESULTADOS: Se incluyó en el estudio un total de 13 procedimientos en 7 pacientes con HL. La edad media fue de 46 años (rango: 35-65) y 3/7 de los pacientes eran mujeres. Se logró éxito técnico en 5/7 casos (71,4%) y éxito clínico en 4/7 casos (57%). DISCUSIÓN: SpyGlass™ es seguro y efectivo en el tratamiento de HL. Con estos resultados, confirmamos la necesidad del manejo de pacientes con HL en un grupo multidisciplinar. Cuando el enfoque endoscópico es opción, este procedimiento debe realizarse para endoscopistas avanzados expertos

New management of hepatolithiasis: Can surgery be avoided? (with video).

BACKGROUND: The presence of hepatolithiasis (HL) is prevalent in eastern countries. It is a clinical entity which is rarely reported in non-surgical series because the standard treatment is the surgical option. Currently, treatment has evolved, with the use of endoscopic techniques being increased and the number of hepatectomies being decreased. SpyGlass™ is a small-calibre endoscopic direct cholangiopancreatoscopy developed to explore and perform procedures in the bile and pancreatic ducts. Single-operator peroral cholangioscopy (POC) is an endoscopic technique useful for treating difficult bile duct stones. AIMS: To assess the usefulness, efficacy, and safety of POC with the SpyGlass™ system in patients with HL. PRIMARY OBJECTIVES: to achieve technical success of the procedure and clinical success of patients with HL. STUDY DESIGN AND PATIENTS: Retrospective, single-centre cohort study of patients with HL from April 2012 to August 2018. SpyGlass™ was chosen in symptomatic patients referred from the surgery unit as the first-line procedure. To perform electrohydraulic lithotripsy (EHL), we used a Northgate Autolith IEHL generator with a 0.66-mm biliary probe. RESULTS: We performed a total of 13 procedures in 7 patients with HL. The mean age was 46 years (range 35-65) and 3/7 of patients were female. We achieved technical success in 5/7 cases (71.4%) and clinical success in 4/7 cases (57%). DISCUSSION: SpyGlass™ is safe and effective in the treatment of HL. With these results, we confirm the need for management of patients with HL in a multidisciplinary team. When the endoscopic approach is the option, this procedure must be performed by experts in advanced endoscopy.

Tuneable Acidity in Fluorinated Al-SBA-15 Materials for the Esterification of Valeric Acid to Alkyl Valerates.

The acidity of Al-SBA-15 materials functionalized by ball milling with several niobium loadings (0. 25-1 wt.%) as well as with several fluorine loadings (by wet impregnation using NH4F as a precursor) was characterized and materials investigated in the esterification of valeric acid to alkyl valerates. The parent Al-SBA-15 support as well as the modified materials loaded with Nb and/or F have been catalysts synthesized characterized by X-ray diffraction (XRD), N2 physisorption measurements, and diffuse reflection infrared spectroscopy (DRIFT) among others. A special interest was paid on the acidity of the materials that was investigated by temperature-programmed desorption of pyridine. Interestingly, the characterization results for the materials containing fluorine showed up an increase in the acidity strength despite of a reduction in the number of acid sites. The catalytic performance of the as-prepared catalysts was investigated in the microwave-assisted esterification reaction of valeric acid to valerate esters. Thus, while the materials modified with niobium exhibited a lower catalytic activity as compared with the catalytic support (Al-SBA-15), the materials loaded with fluorine either onto Al-SBA-15 or on Nb1%/Al-SBA-15 materials presented enhanced conversion values of valeric acid. Therefore, it can be said that the new acid sites with enhanced strength formed by the incorporation of fluorine boost the esterification of valeric acid with alcohols to form the respective valerate ester.

Rendimiento diagnóstico de la punción mediante ultrasonografía endoscópica de las lesiones quísticas del páncreas / Diagnostic yield of endoscopic ultrasound with fine-needle aspiration in pancreatic cystic lesions

Introducción: A pesar de los avances en las técnicas de imagen, en muchos casos son insuficientes para establecer el diagnóstico de las lesiones quísticas pancreáticas (LQP). Son escasas las publicaciones en nuestro medio que evalúan la combinación de varios métodos obtenidos mediante la punción aspirativa con aguja fina con ultrasonografía endoscópica (USE-PAAF). El objetivo del estudio fue evaluar la utilidad global de la USE-PAAF en el diagnóstico de las LQP. Material y métodos: Estudio retrospectivo a partir de una base de datos actualizada prospectivamente de una cohorte de pacientes remitidos para USE-PAAF por LQP. Se estudió la sensibilidad, la especificidad, el rendimiento diagnóstico del antígeno carcinoembrionario (CEA), la citología y la viscosidad para detectar lesiones mucinosas. Resultados: Desde noviembre de 2013 a abril del 2018 se realizaron 122 USE por LQP. Se realizó USE-PAAF en 94/122 (77%) y se intervinieron 21/122 (17,2%) pacientes. Se incluyeron 33/122 pacientes que tuvieron confirmación diagnóstica mediante histología, imagen (quiste seroso con patrón típico) o evolución clínica. El estudio de la curva ROC determinó el punto de corte ≥419ng/ml para diferenciar lesión quística mucinosa/no mucinosa. El rendimiento diagnóstico del CEA fue del 87,5% (21/24), de la citología del 81,8% (27/33) y de la viscosidad del 84,4% (27/32). Los 3 parámetros en combinación obtuvieron el mejor resultado (30/33, 90,9%). Conclusión: La combinación del análisis del CEA, la citología y la viscosidad del líquido pancreático obtenido mediante USE-PAAF aumenta el rendimiento en el diagnóstico de las lesiones quísticas pancreáticas mucinosas, siendo superior al 90%

Introduction: Despite advances in imaging techniques, in many cases they are insufficient to establish the diagnosis of pancreatic cystic lesions (PCL). There are few publications in our setting that evaluate the combination of several methods obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). The aim of the study was to evaluate the overall utility of EUS-FNA in the diagnosis of PCL. Material and methods: Retrospective study based on a database updated prospectively of a cohort of patients referred for EUS-FNA due to PCL detected in an imaging test. The sensitivity, specificity and diagnostic yield of carcinoembryonic antigen (CEA), cytology and viscosity were studied to detect mucinous lesions. Results: From November 2013 to April 2018, 122 EUS were performed for PCL. EUS-FNA was performed in 94/122 (77%) and 21/122 (17.2%) patients were operated on. We included 33/122 patients who had diagnostic confirmation by histology, imaging (serous cyst with typical pattern) or clinical evolution. The study of the ROC curve determined the cutoff point ≥419 ng/ml to differentiate mucinous/non-mucinous cystic lesions. The diagnostic yield of CEA was 87.5% (21/24), cytology 81.8% (27/33) and viscosity 84.4% (27/32). The three parameters in combination obtained the best result (30/33, 90.9%). Conclusion: The combination of CEA analysis, cytology and viscosity of pancreatic fluid obtained by EUS-FNA increases the performance in the diagnosis of mucinous pancreatic cystic lesions, with it being greater than 90%

Diagnostic yield of endoscopic ultrasound with fine-needle aspiration in pancreatic cystic lesions. / Rendimiento diagnóstico de la punción mediante ultrasonografía endoscópica de las lesiones quísticas del páncreas.

INTRODUCTION: Despite advances in imaging techniques, in many cases they are insufficient to establish the diagnosis of pancreatic cystic lesions (PCL). There are few publications in our setting that evaluate the combination of several methods obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). The aim of the study was to evaluate the overall utility of EUS-FNA in the diagnosis of PCL. MATERIAL AND METHODS: Retrospective study based on a database updated prospectively of a cohort of patients referred for EUS-FNA due to PCL detected in an imaging test. The sensitivity, specificity and diagnostic yield of carcinoembryonic antigen (CEA), cytology and viscosity were studied to detect mucinous lesions. RESULTS: From November 2013 to April 2018, 122 EUS were performed for PCL. EUS-FNA was performed in 94/122 (77%) and 21/122 (17.2%) patients were operated on. We included 33/122 patients who had diagnostic confirmation by histology, imaging (serous cyst with typical pattern) or clinical evolution. The study of the ROC curve determined the cutoff point ≥419 ng/ml to differentiate mucinous/non-mucinous cystic lesions. The diagnostic yield of CEA was 87.5% (21/24), cytology 81.8% (27/33) and viscosity 84.4% (27/32). The three parameters in combination obtained the best result (30/33, 90.9%). CONCLUSION: The combination of CEA analysis, cytology and viscosity of pancreatic fluid obtained by EUS-FNA increases the performance in the diagnosis of mucinous pancreatic cystic lesions, with it being greater than 90%.

One-Pot Cu/TiO2 Nanoparticles Synthesis for Trans-Ferulic Acid Conversion into Vanillin.

In this study, the co-synthesis of TiO2 and Cu metallic nanoparticles obtained via one-pot cost-efficient hydrothermal process has been addressed. Different nanocatalysts with Cu contents were characterized by X-ray diffraction, nitrogen porosimetry, scanning electron microscopy, and transmission electron microscopy. The TiO2 and Cu metallic nanoparticles were synthesized with copper loading up to one (Cu/Ti atomic ratio). Synthesized catalysts exhibited pore sizes in the mesoporous range and high surface areas above 150 m2/g. The particle size for TiO2 presented a homogeneous distribution of approximately 8 nm, moreover, Cu nanoparticles varied from 12 to >100 nm depending on the metal loading. The nanostructured materials were successfully tested in the conversion of trans-ferulic acid into vanillin under sustainable conditions, achieving the best performance for 0.3 Cu/Ti atomic ratio (70% vanillin yield).

Endoluminal radiofrequency ablation with SpyGlass(TM) in the management of cholangiocarcinoma

Most extrahepatic cholangiocarcinomas are unresectable at the time of diagnosis and even in case of a resectable cancer, surgery is not an option for the elderly or patients with comorbidities (1). Current treatment alternatives in these scenarios are very limited. Biliary stenting with self-expanding metal stents (SEMS) is the mainstay palliative treatment for biliary obstruction (2). However, emerging experience with endoscopic RF ablation (RFA) in this setting has been reported in the literature

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Endoluminal radiofrequency ablation with SpyGlass™ in the management of cholangiocarcinoma.

Most extrahepatic cholangiocarcinomas are unresectable at the time of diagnosis and even in case of a resectable cancer, surgery is not an option for the elderly or patients with comorbidities (1). Current treatment alternatives in these scenarios are very limited. Biliary stenting with self-expanding metal stents (SEMS) is the mainstay palliative treatment for biliary obstruction (2). However, emerging experience with endoscopic RF ablation (RFA) in this setting has been reported in the literature.