45 results on '"Gonçalo Alexandrino"'
Search Results
2. Efficacy and safety of primary, early and late needle-knife fistulotomy for biliary access
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Jorge Canena, Luís Lopes, João Fernandes, Gonçalo Alexandrino, Luísa Figueiredo, Marta Moreira, Tarcísio Araújo, Luís Lourenço, David Horta, Pietro Familiari, and Mário Dinis-Ribeiro
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Medicine ,Science - Abstract
Abstract European Society of Gastrointestinal Endoscopy recommends needle-knife fistulotomy (NKF) as the preferred precut technique. However, there is little information on whether NKF performed at different times is associated with different success and adverse event rates. We compared the outcomes of 3 different timings of NKF. This was an observational study conducted at 4 institutions and this was a retrospective analysis of prospectively collected data. We included 330 consecutive patients submitted to NKF attempt for biliary access. Patients were divided into three groups: NKF as an initial procedure for biliary access (group A, n = 121); early NKF defined as after 5 min, 5 attempts, or 2 pancreatic passages (group B, n = 99); and late NKF: after at least 10 min of unsuccessful standard biliary cannulation (group C, n = 110). We assessed the success rate of biliary cannulation at initial ERCP, time to perform NKF until biliary cannulation, overall biliary cannulation rate (second ERCP when initial failure), adverse event rate, and predictors of post-ERCP pancreatitis (PEP). The initial cannulation rate was 98%, 91% and 94% for groups A, B and C respectively, p = 0.08, whereas overall biliary cannulation rate was 100%, 95% and 98%, p = 0.115. The adverse event rate/PEP was 4.1%/2.5%, 7.1%/4% and 10.9%/8.2%, for groups A, B and C respectively, (p = 0.197 and p = 0.190). Median time for creating the fistula was A = 4.0 min, B = 3.2 min, and C = 5.6 min, p
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- 2021
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3. Endoscopy Timing in Patients with Acute Upper Gastrointestinal Bleeding
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Gonçalo Alexandrino, Tiago Dias Domingues, Rita Carvalho, Mariana Nuno Costa, Luís Carvalho Lourenço, and Jorge Reis
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Endoscopy, gastrointestinal ,Endoscopy, digestive system ,Gastrointestinal hemorrhage ,Hemostasis, endoscopic ,Patient outcome assessment ,Internal medicine ,RC31-1245 ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background/Aims The role of very early (≤12 hours) endoscopy in nonvariceal upper gastrointestinal bleeding is controversial. We aimed to compare results of very early and early (12–24 hours) endoscopy in patients with upper gastrointestinal bleeding demonstrating low-risk versus high-risk features and nonvariceal versus variceal bleeding. Methods This retrospective study included patients with nonvariceal and variceal upper gastrointestinal bleeding. The primary outcome was a composite of inpatient death, rebleeding, or need for surgery or intensive care unit admission. Endoscopy timing was defined as very early and early. We performed the analysis in two subgroups: (1) high-risk vs. low-risk patients and (2) variceal vs. nonvariceal bleeding. Results A total of 102 patients were included, of whom 59.8% underwent urgent endoscopy. Patients who underwent very early endoscopy received endoscopic therapy more frequently (p=0.001), but there was no improvement in other clinical outcomes. Furthermore, patients at low risk and with nonvariceal bleeding who underwent very early endoscopy had a higher risk of the composite outcome. Conclusions Very early endoscopy does not seem to be associated with improved clinical outcomes and may lead to poorer outcomes in specific populations with upper gastrointestinal bleeding. The actual benefit of very early endoscopy remains controversial and should be further clarified.
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- 2019
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4. Outcomes of Single-Operator Cholangioscopy-Guided Lithotripsy in Patients with Difficult Biliary and Pancreatic Stones
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Jorge Canena, Luís Lopes, João Fernandes, Gonçalo Alexandrino, Luís Lourenço, Diogo Libânio, David Horta, Sílvia Giestas, and Jorge Reis
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Endoscopic retrograde cholangiopancreatography ,Cholangioscopy ,Laser lithotripsy ,Electrohydraulic lithotripsy ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and Aims: Endoscopic retrograde cholangiopancreatography is the preferred strategy for the management of biliary and pancreatic duct stones. However, difficult stones occur, and electrohydraulic (EHL) and laser lithotripsy (LL) have emerged as treatment modalities for ductal clearance. Recently, single-operator cholangioscopy was introduced, permitting the routine use of these techniques. We aimed to evaluate the clinical effectiveness of cholangioscopy-guided lithotripsy using LL or EHL in patients with difficult biliary or pancreatic stones. Methods: This is a prospective clinical study – conducted at two affiliated university hospitals – of 17 consecutive patients with difficult biliary and pancreatic stones who underwent single-operator cholangioscopy-guided lithotripsy using two techniques: holmium laser lithotripsy (HL) or bipolar EHL. We analyzed complete ductal clearance as well as the impact of the location and number of stones on clinical success and evaluated the efficacy of the two techniques used for cholangioscopy-guided lithotripsy and procedural complications. Results: Twelve patients (70.6%) had stones in the common bile duct/common hepatic duct, 2 patients (17.6%) had a stone in the cystic stump, and 3 patients (17.6%) had stones in the pancreas. Sixteen patients (94.1%) were successfully managed in 1 session, and 1 patient (5.9%) achieved ductal clearance after 3 sessions including EHL, LL, and mechanical lithotripsy. Eleven patients were successfully submitted to HL in 1 session using a single laser fiber. Six patients were treated with EHL: 4 patients achieved ductal clearance in 1 session with a single fiber, 1 patient obtained successful fragmentation in 1 session using two fibers, and 1 patient did not achieve ductal clearance after using two fibers and was successfully treated with a single laser fiber in a subsequent session. Complications were mild and were encountered in 6/17 patients (35.2%), including fever (n = 3), pain (n = 1), and mild pancreatitis (n = 1). Conclusions: Cholangioscopy-guided lithotripsy using LL or EHL in patients with difficult biliary or pancreatic stones is highly effective with transient and minimal complications. There is a clear need to further compare EHL and HL in order to assess their role in the success of cholangioscopy-guided lithotripsy.
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- 2018
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5. Comparison of the AIMS65 Score with Other Risk Stratification Scores in Upper Variceal and Nonvariceal Gastrointestinal Bleeding
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Gonçalo Alexandrino, Rita Carvalho, and Jorge Reis
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background/AimsTo determine the prognostic value of carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 in gallbladder cancer (GBC) during palliative chemotherapy.Methods : One hundred and twenty-three patients with pathologically confirmed unresectable GBC were included. Differences in serum CEA and CA 19-9 levels before and after chemotherapy were measured. Receiver operating characteristic curve analysis, Kaplan-Meier analyses of CEA, CA 19-9, and combined changes were performed to assess the optimal cutoff values and survival rates.Results : Patients with decreased tumor markers had significantly better progression-free survival (PFS) and overall survival (OS) than patients with increased tumor markers. The pre- and postchemotherapy CA 19-9 ratio had the highest area-under-the-curve values for predicting 3-month PFS and 1-year OS. In the multivariate analysis, increases in serum CA 19-9 during palliative chemotherapy in patients with unresectable GBC was an independent prognosticator of poor PFS and OS, with hazard ratios of 2.20 (p=0.001) and 1.67 (p=0.020), respectively. Patients with increases >10-fold were considered to have progressive disease, whereas individuals with increases >3-fold were likely to benefit from early imaging follow-up.Conclusion : sCA 19-9 kinetics was a reliable prognosticator of PFS and OS in patients with unresectable GBC who underwent palliative chemotherapy.
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- 2018
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6. Endometriosis: A Rare Cause of Large Bowel Obstruction
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Gonçalo Alexandrino, Luís Carvalho Lourenço, Rita Carvalho, Cisaltina Sobrinho, David Valadas Horta, and Jorge Reis
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Large bowel obstruction ,Stenosis ,Endometriosis ,Endoscopy ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Large bowel obstruction can result in significant morbidity and mortality, especially in cases of acute complete obstruction. There are many possible causes, the most common in adults being colorectal cancer. Endometriosis is a benign disease, and the most affected extragenital location is the bowel, especially the rectosigmoid junction. However, transmural involvement and acute occlusion are very rare events. We report an exceptional case of acute large bowel obstruction as the initial presentation of endometriosis. The differential diagnosis of colorectal carcinoma may be challenging, and this case emphasizes the need to consider intestinal endometriosis in females at a fertile age presenting with gastrointestinal symptoms and an intestinal mass causing complete large bowel obstruction.
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- 2017
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7. Splenic Rupture following Transnasal Endoscopy
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Mariana Ferreira Cardoso, Gonçalo Alexandrino, and Rita Carvalho
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Splenic rupture ,Transnasal endoscopy ,Ultraslim gastroscope ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2018
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8. Pancreatoscopy-guided electrohydraulic lithotripsy in a patient with calcific chronic pancreatitis
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Gonçalo Alexandrino, MD, Luís C. Lourenço, MD, David Horta, MD, Jorge Reis, MD, and Jorge Canena, MD, PhD
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2018
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9. Plasma ammonia levels predict hospitalisation with liver-related complications and mortality in clinically stable outpatients with cirrhosis
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Thomas H. Tranah, María-Pilar Ballester, Juan Antonio Carbonell-Asins, Javier Ampuero, Gonçalo Alexandrino, Andra Caracostea, Yolanda Sánchez-Torrijos, Karen L. Thomsen, Annarein J.C. Kerbert, María Capilla-Lozano, Manuel Romero-Gómez, Desamparados Escudero-García, Carmina Montoliu, Rajiv Jalan, Debbie L. Shawcross, Medical Research Council (UK), Instituto de Salud Carlos III, Fundación Ramón Areces, Generalitat Valenciana, European Commission, Tranah, Thomas H., Montoliu, Carmina, Jalan, Rajiv, and Shawcross, Debbie L.
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Liver Cirrhosis ,Liver-related complications ,Variceal bleeding ,Hepatology ,Ascites ,Esophageal and Gastric Varices ,Severity of Illness Index ,Hospitalization ,Cirrhosis ,Ammonia ,Hepatic Encephalopathy ,Outpatients ,Humans ,Hyperammonemia ,Prospective Studies ,Bacterial infection ,Gastrointestinal Hemorrhage ,Hepatic encephalopathy - Abstract
[Background & Aims] Hyperammonaemia is central in the pathogenesis of hepatic encephalopathy. It also has pleiotropic deleterious effects on several organ systems, such as immune function, sarcopenia, energy metabolism and portal hypertension. This study was performed to test the hypothesis that severity of hyperammonaemia is a risk factor for liver-related complications in clinically stable outpatients with cirrhosis., [Methods] We studied 754 clinically stable outpatients with cirrhosis from 3 independent liver units. Baseline ammonia levels were corrected to the upper limit of normal (AMM-ULN) for the reference laboratory. The primary endpoint was hospitalisation with liver-related complications (a composite endpoint of bacterial infection, variceal bleeding, overt hepatic encephalopathy, or new onset or worsening of ascites). Multivariable competing risk frailty analyses using fast unified random forests were performed to predict complications and mortality. External validation was carried out using prospective data from 130 patients with cirrhosis in an independent tertiary liver centre., [Results] Overall, 260 (35%) patients were hospitalised with liver-related complications. On multivariable analysis, AMM-ULN was an independent predictor of both liver-related complications (hazard ratio 2.13; 95% CI 1.89–2.40; p, [Conclusion] Ammonia is an independent predictor of hospitalisation with liver-related complications and mortality in clinically stable outpatients with cirrhosis and performs better than traditional prognostic scores in predicting complications., This research was funded by the Medical Research Council (MR/V006757/1) and Instituto de Salud Carlos III (FIS PI18/00150); Fundación Ramón Areces, Consellería de Educación Generalitat Valenciana (PROMETEOII/2018/051), co-funded with European Regional Development Funds (ERDF). THT is supported by a Medical Research Council, Clinical Research Training Fellowship (MR/V006757/1). MPB is supported by a Río Hortega award (CM19/00212), Instituto de Salud Carlos III.
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- 2022
10. Needle knife fistulotomy in flat and diverticular papillae: Is it time for redemption?
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Tarcísio Araújo, Luis Felipe Dias Lopes, Jorge Canena, João M. Fernandes, M Moreira, David Horta, Gonçalo Alexandrino, Luís Carvalho Lourenço, and Luísa Martins Figueiredo
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medicine.medical_specialty ,Fistulotomy ,Catheterization ,Sphincterotomy, Endoscopic ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Prospective Studies ,Needle knife ,Adverse effect ,Retrospective Studies ,Gastrointestinal endoscopy ,Cholangiopancreatography, Endoscopic Retrograde ,Endoscopic retrograde cholangiopancreatography ,Hepatology ,medicine.diagnostic_test ,business.industry ,Incidence (epidemiology) ,Gastroenterology ,medicine.disease ,3. Good health ,Surgery ,Major duodenal papilla ,Pancreatitis ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,business - Abstract
Background European Society of Gastrointestinal Endoscopy (ESGE) recommends needle-knife fistulotomy (NKF) as the preferred precut technique in cases when standard cannulation techniques fail. Despite scarce scientific evidence, flat and diverticular papillae are thought not to be ideal for NKF, as they are associated with poor outcomes. The present study aimed to determine the outcomes of the use of NKF in relation to flat and intradiverticular papillae. Methods This prospective multicenter study enrolled consecutive patients, evidencing naive flat (group A, n = 49) or diverticular papilla (group B, n = 28), who underwent NKF after failure of standard cannulation techniques. Diverticular morphology was subdivided into intradiverticular (group B1, n = 14) and diverticular border papillae (group B2, n = 14), using a previously validated endoscopic classification of the major papilla. The success of biliary cannulation at initial endoscopic retrograde cholangiopancreatography (ERCP), overall biliary cannulation, overall cannulation time, and the rate of adverse events were assessed in the study. Results The initial cannulation rates were 93.9%, 64.3% and 71.4% for group A, B1, and B2, respectively (P = 0.005); overall cannulation rates after a second ERCP were 98.0%, 92.9% and 85.7%, respectively (P = 0.134). Adverse events occurred in 11.7% of patients, with post-ERCP pancreatitis (PEP) being the most common adverse event (10.4%). Although there was a trend towards a higher incidence of PEP in flat papillae, univariate and multivariate analyses did not show any significant relationship between pancreatitis and trainee involvement, papillary morphology, nor overall cannulation time. Conclusions Although flat papillae are associated with high success rates of biliary cannulation using NKF, the rate of PEP is not negligible. NKF is feasible in diverticular papillae, but it is associated with a modest success rate in the initial ERCP.
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- 2022
11. Risk factors for the emergence of multidrug-resistant organisms in liver cirrhosis
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Rita Carvalho, Alexandra Martins, Gonçalo Alexandrino, Maria Ana Rafael, Mariana Costa, Luísa Martins Figueiredo, and Joana Carvalho e Branco
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Liver Cirrhosis ,Male ,medicine.medical_specialty ,Time Factors ,Cirrhosis ,medicine.drug_class ,Antibiotics ,Urine ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Drug Resistance, Multiple, Bacterial ,Internal medicine ,medicine ,Ascitic Fluid ,Humans ,In patient ,Prospective Studies ,Medical prescription ,Prospective cohort study ,Cross Infection ,Hepatology ,business.industry ,Gastroenterology ,Proton Pump Inhibitors ,General Medicine ,Bacterial Infections ,Length of Stay ,Middle Aged ,medicine.disease ,Patient Discharge ,Anti-Bacterial Agents ,Multiple drug resistance ,030220 oncology & carcinogenesis ,Cohort ,Female ,030211 gastroenterology & hepatology ,business - Abstract
Background Multidrug-resistant organisms (MDROs) are a reality that can alter the paradigm of treatment and prevention of infection in patients with liver cirrhosis (LC). Objective Identify risk factors for the occurrence of MDROs in patients with LC. Patients and methods Prospective study from October 2017 to March 2018 in consecutively hospitalized patients with decompensated LC with infection. Blood, urine and ascitic fluid cultures were analyzed. A p-value ≤0.05 was considered statistically significant. Results MDROs isolated in 18 of 52 episodes of infection. MDROs were associated with the use of proton pump inhibitors (PPIs) (p = 0.0312), antibiotic therapy in the last 90 days (p = 0.0033) and discharge within preceding 30 days or current hospitalization above 48 h (p = 0.0082). There was higher 90-day mortality in patients with MDROs infection (71.4% versus 35.7%, p = 0.0316). Conclusion MDROs infections were prevalent in this cohort and associated with 90-day mortality. Use of PPIs and antibiotics increased the risk of MDROs infections, suggesting that its prescription should be restricted to formal indication. Hospitalization was associated with the onset of MDROs, so LC patients should stay at the hospital the least possible. It is relevant to investigate other factors predisposing to the emergence of these microorganisms, in order to prevent it.
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- 2022
12. Efficacy and safety of primary, early and late needle-knife fistulotomy for biliary access
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Mário Dinis-Ribeiro, Jorge Canena, Luisa M. Figueiredo, Pietro Familiari, Tarcísio Araújo, João B. Fernandes, Luís Carvalho Lourenço, David Horta, Luis Felipe Dias Lopes, Gonçalo Alexandrino, M Moreira, and NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
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Adult ,Male ,medicine.medical_specialty ,Fistula ,Science ,Fistulotomy ,Article ,Group B ,Catheterization ,Young Adult ,Medical research ,Humans ,Medicine ,Needle knife ,Adverse effect ,General ,Aged ,Retrospective Studies ,Gastrointestinal endoscopy ,Aged, 80 and over ,Cholangiopancreatography, Endoscopic Retrograde ,Multidisciplinary ,business.industry ,Gastroenterology ,Odds ratio ,Middle Aged ,medicine.disease ,Surgery ,Biliary Tract Surgical Procedures ,Treatment Outcome ,Pancreatitis ,Female ,business - Abstract
European Society of Gastrointestinal Endoscopy recommends needle-knife fistulotomy (NKF) as the preferred precut technique. However, there is little information on whether NKF performed at different times is associated with different success and adverse event rates. We compared the outcomes of 3 different timings of NKF. This was an observational study conducted at 4 institutions and this was a retrospective analysis of prospectively collected data. We included 330 consecutive patients submitted to NKF attempt for biliary access. Patients were divided into three groups: NKF as an initial procedure for biliary access (group A, n = 121); early NKF defined as after 5 min, 5 attempts, or 2 pancreatic passages (group B, n = 99); and late NKF: after at least 10 min of unsuccessful standard biliary cannulation (group C, n = 110). We assessed the success rate of biliary cannulation at initial ERCP, time to perform NKF until biliary cannulation, overall biliary cannulation rate (second ERCP when initial failure), adverse event rate, and predictors of post-ERCP pancreatitis (PEP). The initial cannulation rate was 98%, 91% and 94% for groups A, B and C respectively, p = 0.08, whereas overall biliary cannulation rate was 100%, 95% and 98%, p = 0.115. The adverse event rate/PEP was 4.1%/2.5%, 7.1%/4% and 10.9%/8.2%, for groups A, B and C respectively, (p = 0.197 and p = 0.190). Median time for creating the fistula was A = 4.0 min, B = 3.2 min, and C = 5.6 min, p
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- 2021
13. I-CARE, a European Prospective Cohort Study Assessing Safety and Effectiveness of Biologics in Inflammatory Bowel Disease
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Laurent Peyrin-Biroulet, Jean-François Rahier, Julien Kirchgesner, Vered Abitbol, Sebastian Shaji, Alessandro Armuzzi, Konstantinos Karmiris, Javier P. Gisbert, Peter Bossuyt, Ulf Helwig, Johan Burisch, Henit Yanai, Glen A. Doherty, Fernando Magro, Tamás Molnar, Mark Löwenberg, Jonas Halfvarson, Edyta Zagorowicz, Hélène Rousseau, Cédric Baumann, Filip Baert, Laurent Beaugerie, Jean-Marc Gornet, Jean-Marie Reimund, Xavier Hebuterne, Aurélien Amiot, Franco Armelao, Pierre Blanc, Claudio Papi, Guillaume Pineton De Chambrun, Xavier Roblin, null Chu, Sohail Shariq, Nikolaos Viazis, Jimmy Limdi, Piotr Eder H, Georgios Michalopoulos, Andrew Bell, Livia Biancone, Marie Dewitte, Zia Mazhar, Denis Franchimont, Stephane Nancey, Gilles Macaigne, Maria Beatrice Principi, Mathurin Fumery, Gareth Parkes, Jean-Christophe Valats, Glen Doherty, Guillaume Bouguen, Hersin Tsai, Mohsin Gangi, Natalia Pedersen, Frédéric Heluwaert, Richard Shenderey, Sebastian Zeissig, Jeffrey Butterworth, Fabiana Castiglione, Lynsey Corless, Camille Zallot, Salil Singh, Sunil Sonwalkar, Elizabeth Clayton, Deven Vani, Guy Bellaiche, Martine De Vos, Uri Kopylov, Triana Lobaton, Christophe Locher, Gerassimos Mantzaris, George Abouda, Katie Smith, Michael Sprakes, Angeliki Theodoropoulou, Emma Wesley, Joëlle Bonnet, David Elphick, Cyrielle Gilletta, John Gordon, David Laharie, Antoine Nakad, Ambrogio Orlando, Patrick Dubois, Peter Hasselblatt, Christophe Michiels, Cathryn Preston, Anca Staicu, Lucine Vuitton, Mehdi Kaassis, Ally Speight, Deb Ghosh, Nicolas Mathieu, Anne-Laure Pelletier, Anne Phillips, Romain Altwegg, Irit Avni, null biron, Jonathon Landy, Maria Nachury, Achuth Shenoy, Caroline Trang, Georgios Bamias, Klaudia Farkas, Christian Maaser, Ariella Shitrit, Britta Siegmund, Jérôme Filippi, Colm O'morain, Laurent Costes, David Hobday, Zoltán Szepes, Emma Calabrese, Helen Dallal, Michael Fung, Arvind Ramadas, Bijay Baburajan, Konrad Koss, Christophe Barberis, Anthony Buisson, Morgane Amil, Paola Balestrieri, Matthew Johnson, Maria Tzouvala, Stéphanie Viennot, Ferenc Nagy, Nick Thompson, Laurent Alric, Sunil Samuel, Anne Bourrier, Elise Chanteloup, Emilie Del Tedesco, Marcus Harbord, Alan Lobo, Sally Myers, Richard Pollok, Tariq Ahmad, Rakesh Chaudhary, Christos Karakoidas, Ashraf Soliman, Carmen Stefanescu, Georgios Theocharis, Stijn Vanden Branden, Belén Beltran, Yoram Bouhnik, Arnaud Bourreille, Joana Branco, Ben Colleypriest, Rami Eliakim, Paul Knight, Aoibhlinn O'toole, Virgina Robles, Konstantinos Triantafyllou, Marta Maia Bosca, Guy Lambrecht, Lucia Marquez Mosquera, Simon Panter, Aikaterini Pappa, Marion Simon, Ganesh Sivaji, Christophe Bellanger, Arthur Belle, Natalia Borruel, Laurence Egan, Harald Peeters, Daniel Sharpstone, Ramesh Arasaradnam, José Manuel Benitez, Jens Frederik Dahlerup, Olga Giouleme, Miguel Minguez, Eftychia Tsironi, Angela Variola, Patrick Allen, Lucille Boivineau, Andy Cole, Nina Dib, Fernando Gomollon, Richard Johnston, Konstantinos Katsanos, Nick Kennedy, Marianne Kiszka-Kanowitz, Ignacio Marin-Jimenez, Pál Miheller, Pilar Nos, Othman Saraj, Lars Vinter-Jensen, Eran Zittan, Clotilde Baudry, Xavier Calvet, Marie-Christine Cazelles-Boudier, Jean-Louis Coenegrachts, Garret Cullen, Marco Daperno, Anjan Dhar, Romain Gerard, Nanna Jensen, Nitsan Maharshak, Mark Mcalindon, Simon Mcloughlin, Miles Parkes, Kamal Patel, Armando Peixoto, Dimitrios Polymeros, Francisco Portela, Rodolfo Rocca, Philippe Seksik, Sreedhar Subramanian, Ruth Tennenbaum, Raja Atreya, Oliver Bachmann, Arthur Berger, Renáta Bor, Maire Buckley, Daniel Carpio, María Chaparro, Francesco Costa, Eugeni Domenech, Maria Esteve, Stephen Foley, Jordi Guardiola, Ioannis Koutroubakis, Tanja Kuehbacher, Cécilia Landman, Alessandro Lavagna, Noemí Manceñido, Míriam Mañosa, Maria Dolores Martín-Arranz, Laurianne Plastaras, Maria Lia Scribano, Subhasish Sengupta, Nils Teich, My-Linh Tran-Minh, Evanthia Zampeli, Leila Amininejad, Teresa Arroyo, Alain Attar, Ann-Sofie Backman, Anita Bálint, John Beckly, Shomron Ben Horin, Sónia Bernardo, Ludovic Caillo, Bénédicte Caron, María Shanika de Silva, Anna FábiáN, Gionata Fiorino, Ana Gutierrez, Adi Lahat, Mohamed Masmoudi, Marco Mendolaro, Vinciane Muls, Florian Poullenot, Christopher Probert, Catherine Reenaers, Mariann Rutka, Zaman Sarwari, Joanne Sayer, Beatriz Sicilia, Helena Sousa, Catherine van Kemseke, Yamile Zabana, Marco Astegiano, Paul Banim, Dominik Bettenworth, Médina Boualit, Jacob Broder Brodersen, Angeliki Christidou, Rachel Cooney, João Cortez Pinto, Portugal Marília Cravo, Anneline Cremer, Silvio Danese, Antonio di Sabatino, Jan Fallingborg, Antonio Ferronato, Esther Garcia Planella, Sanjay Gupta, Eran Israeli, Samantha Kestenbaum, Lone Larsen, Elisabeth Macken, Nicoletta Mathou, Ágnes Milassin, Joanna Pofelski, Chiara Ricci, Francisco Rodriguez-Moranta, Martin Schmidt-Lauber, Ian Shaw, Marta Soares, Heithem Soliman, Christos Triantos, Konstantinos Zografos, Anurag Agrawal, Alexandre Aubourg, Manuel Barreiro-de Acosta, Jesús Barrio, Daniel Bergemalm, Fernando Bermejo, Giorgia Bodini, Johan Bohr, Dimitrios Christodoulou, Christophe Claessens, Paul Collins, Ruth de Francisco, Santiago Garcia, Sotirios Georgopoulos, Felix Goutorbe, Chrisostomos Kalantzis, Anastasia Kourikou, Vincent Mace, Georgia Malamut, Paula Ministro, Isabelle Nion Larmurier, Elena Ricart, Mélanie Serrero, Juliette Sheridan, Petra Weimers, Vibeke Andersen, Bruno Arroja, Bernd Bokemeyer, Luis Bujanda, Thibault Degand, Carl Eriksson, Cécile Garceau, Henning Glerup, Idan Goren, Lucina Jackson, Stéphane Koch, Francisco Mesonero, Ingrid Ordas, Pauline Riviere, Simone Saibeni, João Soares, Noémie Tavernier, Klaus Theede, Bella Ungar, Elke Bästlein, Antonio Gasbarrini, Andreas Protopapas, Wolfgang Reindl, Fabrizio Bossa, Ailsa Hart, Franz-Josef Heil, Anthony O'Connor, Bas Oldenburg, Luca Pastorelli, null Stephen patchett, Subramaniam Ramakrishnan, John de Caestecker, Ana Echarri, David Kevans, Jürgen Büning, Rosa Coelho, Jeroen Jansen, Benjamin Koslowski, Christopher Wells, Daniel Ceballos, Ingrid König, Hari Padmanabhan, Timi Patani, Raheel Qureshi, Matthieu Allez, Emmanouil Archavlis, Delphine Bonnet, Luisa Guidi, Deirdre Mcnamara, Piero Vernia, Michael Weidenhiller, Lang Alon, Trine Boysen, Charlotte Delattre, Richard Farrell, Rolf-Achim Krüger, Thierry Paupard, Ida Vind, Flavio Caprioli, Vladimir Gancho, Vincent Quentin, Benjamin Avidan, Geert D’Haens, Jane Mccarthy, Jonathon Snook, Konstantinos Soufleris, Frank Zerbib, Dan Carter, Annekatrien Depla, Thomas Eisenbach, Walter Fries, Nikolaos Grammatikos, Saskia Ilegems, Antonio Lopez-Sanroman, Jacques Moreau, Gabriele Riegler, Svend Rietdijk, Marta Rocha, Isabelle Rosa, Barbara Ryan, Yelena Yeremenko, Arnaud Boruchowicz, Filipe Damião, Foteini Laoudi, Andreas Lügering, Giampiero Macarri, Konstantinos Thomopoulos, Luísa Barros, Thomas Blixt, Aurélien Garros, Sam Khorrami, Harry Sokol, Andreas Sturm, Dan Livovsky, Jochen Maul, Heinrich Miks, Vasileios Papadopoulos, Carsten Schmidt, Yifat Snir, Lise Svenningsen, Wafaa Ahmed, Yelena Broitman, Emmanuel Cuillerier, Prashant Kant, Jan Leyden, Lev Lichtenstein, Susana Lopes, Chloé Martineau, Hugh Mulcahy, Axel Schweitzer, Fiona Van Schaik, Hagar Banai, Pauline Danion, Charlotte Dulery, Herma Fidder, Claire Gay, Hervé Hagege, Florence Harnois, Søren Peter Jørgensen, Jens Müller-Ziehm, Michail Oikonomou, Carolina Palmela, Jörg Schulze/Röske, Mark Smith, Tamar Thurm, Francesca Bresso, Hedia Brixi, John Jones, Padraig Macmathuna, Claire Painchart, Yulia Ron, Marianne Vester-Andersen, Gonçalo Alexandrino, Norbert Börner, Mariana Cardoso, Cristina Chagas, Axel Dignaß, Iris Dotan, Charlotte Hedin, Pantelis Karatzas, Panagiotis Kasapidis, Károly Palatka, Georgios Sakizlis, Ana Wilson, Nick Bosanko, Paulo Caldeira, Charlotte Gagniere, Louise Libier, Camille Meunier, Gero Moog, Audrey Pasquion, Roberta Pica, Ayesha Akbar, Nadia Arab, Guillaume Cadiot, João Carvalho, Claire Charpignon, Laus Fellermann, Sigal Fishman, Gerald Fraser, Nathan Gluck, Mark Hoesl, Jarosław Kierkus, Maria Klopocka, Eduardo Martin Arranz, Luis Menchen, Susanna Nikolaus, Anca Petrache, Cyriel Ponsioen, Sabino Riestra, Pilar Robledo, Cristina Rodriguez, Misheal Samer, Matthias Tischer, Joanna Wypych, Julien Baudon, Cristina Bezzio, Gilles Boschetti, Tom Creed, Maria Giulia Demarzo, Stefano Festa, Andrés Figueroa, Mette Julsgaard, Pablo Navarro, Pablo Perez-Galindo, Cléa Rouillon, Emanuele Sablich, Joan Tosca, Mathias Vidon, Marine Vidon, René-Louis Vitte, Anne Wampach, Isabelle Clerc Urmes, Marc Borie, Mathieu Uzzan, Kelly Chatten, Rimmer Peter, Iqbal Tariq, Marta Cossignani, Fiorella Cañete, Tom Holvoet, Susanne Krasz, Sandra Dias, Hadas Abalia, Aziza Abaza, Gal Abramovich, Ingrid Ackzell, Carol Adams, Catherine Addleton, Erika Alfambra, Alicia Algaba, Clare Allcock, Joanna Allison, Karine Amouriaux, Julie Anderson, Emma Anderson, Saskia Appelmans, Lisa Armstrong, Stacey Atkins, Masoumeh Attaran-Bandarabadi, Yvonne Bailey, Stephanie Bardot, Natasha Beck, Lillie Bennett, Jonathan Phil Bergfeld, Ramdane Berkane, Hanne Boey, Louise Bowlas, Joanne Bradley-Potts, Tracy Brear, Nicole Bretlander-Peters, Ellen Brown, Johanna Brown, Elizabeth Buckingham, Katrien Buellens, Rhian Bull, Maura Burke, Leighanne Burns, Julie Burton, Agness Bwalya, Karine Cabanas, Muriel Callaghan, Océane Camou, Debbie Campbell, Elvira Capoferro, Mandy Carnahan, Cornelia Carnio, Anne Carter, Concetta Casali Clack, Leïla Chedouba, Bessie Cipriano, Sophie Claeys, Manon Closset, Dilek Coban, Sara Cococcia, Carolann Coe, Helen Cole, Emilie Collet, Kayleigh Collins, Isabelle Combes, Emma Connor, Kathryn Constantin, Susan Cooke, Nathanaëlle Cornet, Estelle Corrihons, Pilar Corsino, Rosie Cortaville, Donna Cotterill, Amanda Cowton, Harriet Cox, Viktoria Cripps, Amanda Crowder, Tzufit Cukier, Amelia Daniel, Chris Dawe, Jose de Haan, Rosanna de la Croix, Evva Dejonckheere, Juan Delare Villanegro, Guillaume Delaval, Mariangela Delliponti, Aude Delommez, Emilie Detry, Melanie Dhanaratne, Laura Diez Galan, Marie Dodel, Emma Dooks, Joseph Du Cheyron, Linda Duane, Jennifer Dulling Vulgo Cochran, Simona Dyer, Harvey Dymond, Charlotte Ekblad, Kerry Elliott, Ingrid Emmerson, Irène Eugene-Jolchine, Lorna Fleming, Eve Fletcher, Sarah Ford, Greg Forshaw, Angela Foulds, Caroline Francois, Nicole Fuge, Gal Gafni, Miri Ganon, Olga Garcia Nuñez, Laura Garcia Ramirez, Sophie Gelder, Raimonda Gettkowski, Daniela Gilardi, Paolo Giuffrida, Vincent Gobert, Jo Godden, Nuala Godwin, Kay Goulden, Sharon Graham, Charlotte Green, Marie Green, Aboubakar Gueye, Tuba Guler, Ida Gustavsson, Helena Hadjisavvas, Fiona Hammonds, Christina Hantzi, Marion Hauke, Julie Haydock, Orla Hayes, Lizette Helbo Nislev, Jessica Hochstodter, Ashleigh Hogg, Manuela Hölbing, Maureen Holland, Maartje Holsbergen, Linda Howard, Aviya Hoyda, Robert Hull, Jane Irish, Wendy Jackson, Wendy Janssen, Lesley Jeffrey, Sofia Jourdan, Izabela Jutrowska, Chava Kaniel, Theofilos Karezos, Niamh Kelly, Jessica Kelly, Mary Kennedy, Una Kennedy, Joyce Kibaru, Gemma Kirkman, Janine Klaproth, Corinna Kneese, Andrea Koch, Kathleen Kokke, Martha Koppelow, Sabine Krause, Sabine Krauspe, Petra Kwakkenbos, Nunzia Labarile, Hannah Lang, Marianne Lassailly, Martine Leconte, Linda Lepczynski, Emma Levell, Nina Levhar, Kerstin Lindhort, Jessica Lisle, Beatriz Lopez Cauce, Gabriele Lorenz, Ambra Lovati, Tracey Lowry, Margareta Lund, Anne Lutz Vorderbrügge, Suzanne Maansson, Videsheka Madapathage, Maelys Cheviakoff, Alison Magness, Orla Manley, Catherine Manyoni, Ingke Marg, Antonella Marra, Carole Martins, Arianna Massella, Aurore Mathias, Danielle Mervyn, Charlotte Minsart, Sally Mitchell, Kathleen Monks, Mélanie Montero, Alson Moore, Maren Moser, Alison Moss, Angela Mullen, M. Francisca Murciano, Deanna Naylor, Ansgar Nehus, Anne Nicholson, Sarah Nöding, Sinead Nolan, Janet Nörenberg, Clare Northcott, Jim O'Connell, Alison O’Kelly, Noam Orbach-Zingboim, Judit Orobitg, Charlene Otieno, Charlotte Owen, Sarah Patch, Maor Pauker, Renate Pauli, Harriet Pearson, Falgon Peggy, Séverine Petit, Christine Petrissans, Simona Piergallini, Lucy Pippard, Laura Pitt, Gabriella Pócsik, Yoann Poher, Chloé Pomes, Lucy Pritchard, Laura Puchades, Sheena Quaid, Aleem Rana, Dana Raynard, Mykla Reilly, Sonja Reinert, Manuela Reinknecht, Baerbel Renner, Rob Reynolds, Giulia Rizzuto, Matthew Robinson, Joke Robrechts, Eva M. Rodriguez, Efrat Rosenblum, Tamlyn Russel, Ibiyemi Sadare, Noa Salama, Toos Schakel, Anja Schauer, Elisa Schiavoni, Caroline Shaw, Sarah Shelton, Virginie Sicart, Elodie Siouville, Orla Smith, Théo Soude, Sophie Stephenson, Elaine Stephenson, Marjan Steppe, An Sterkx, Jo Stickley, Kathleen Sugrue, Natalia Swietec, Charlotte Tasiaux, Bhavneet Thamu, Susane Thomas, Ogwa Tobi, Kahina Touabi, Shifra Tovi, Julie Tregonning, Laura Turchini, Julia Unkhoff, Olesya Unruh, Nurcan Uzun, Frauke Van Aert, Sandrine Vanden Bergh, Louise Vandenbroucke, Laura Vansteenkiste, Shay Vardit, Valentin Vergriete, Elaine Walker, Eleanor Warner, Olivia Watchorn, Ekaterina Watson, Marie-Claire Wauthier, Belgium Maria Weetman, Margaret Weston, Wiebke West-Petroschka, Susann Wienecke, Kerstin Wierling, Miriam Wiestler, Rebecca Wilcox, Elva Wilhelmsen, Angharad Williams, Georgina Williamson, Deborah Wilson, Kate Wistance, Nicolas Wortmann, Subie Wurie, Karin Yadgar, Gail Young, Megan Young, Julien Aucouturier, Marie- Jo Bertin, Hasnae Bougrine, Marie Coisnon, Antoine Defrance, Kati Gutierrez, Amel Harouz, Laure Jerber, Aida Khlifi, Amina Kirati, Nasaladjine Liworo, Maude Logoltat, Charlotte Mailhat, Chancely M'Bayi, Yasmina Medane, Dalal Merkhoufa, Saouda Mohamed Elhad, Bertille Monthe, Fanny Moyon, Pascaline Rabiega, Jennifer Sekela, Charlotte Thilloy, Naima Hamamouche, Frederic Partisotti, Patrick Blandin, Hocine Mokhtari, Laure Coutard, UCL - SSS/IREC/MONT - Pôle Mont Godinne, UCL - (MGD) Service de gastro-entérologie, Gastroenterology and hepatology, Gastroenterology and Hepatology, and AGEM - Amsterdam Gastroenterology Endocrinology Metabolism
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Biological Products ,Hepatology ,Efficacy ,Lymphoma ,Tumor Necrosis Factor-alpha ,Inflammatory Bowel Disease ,Gastroenterology ,Biologics ,Crohn Disease/diagnosis ,Inflammatory Bowel Diseases/chemically induced ,Colitis, Ulcerative/diagnosis ,Cohort Studies ,Necrosis ,Immunologic Factors/adverse effects ,Humans ,Female ,03.02. Klinikai orvostan ,Prospective Studies ,Safety ,I-CARE ,Cancer ,Immunosuppressive Agents - Abstract
BACKGROUND AND AIMS: There is a need to evaluate the benefit-risk ratio of current therapies in inflammatory bowel disease (IBD) patients to provide the best quality of care. The primary objective of I-CARE (IBD Cancer and serious infections in Europe) was to assess prospectively safety concerns in IBD, with specific focus on the risk of cancer/lymphoma and serious infections in patients treated with anti-tumor necrosis factor and other biologic monotherapy as well as in combination with immunomodulators.METHODS: I-CARE was designed as a European prospective longitudinal observational multicenter cohort study to include patients with a diagnosis of Crohn's disease, ulcerative colitis, or IBD unclassified established at least 3 months prior to enrollment.RESULTS: A total of 10,206 patients were enrolled between March 2016 and April 2019, including 6169 (60.4%) patients with Crohn's disease, 3853 (37.8%) with ulcerative colitis, and 184 (1.8%) with a diagnosis of IBD unclassified. Thirty-two percent of patients were receiving azathioprine/thiopurines, 4.6% 6-mercaptopurine, and 3.2% methotrexate at study entry. At inclusion, 47.3% of patients were treated with an anti-tumor necrosis factor agent, 8.8% with vedolizumab, and 3.4% with ustekinumab. Roughly one-quarter of patients (26.8%) underwent prior IBD-related surgery. Sixty-six percent of patients had been previously treated with systemic steroids. Three percent of patients had a medical history of cancer prior to inclusion and 1.1% had a history of colonic, esophageal, or uterine cervix high-grade dysplasia.CONCLUSIONS: I-CARE is an ongoing investigator-initiated observational European prospective cohort study that will provide unique information on the long-term benefits and risks of biological therapies in IBD patients. (EudraCT, Number: 2014-004728-23; ClinicalTrials.gov, Number: NCT02377258).
- Published
- 2022
14. Should we use papilla morphology to estimate the size of the terminal common bile duct during endoscopic retrograde cholangiopancreatography?
- Author
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Helena Ribeiro, Jorge Canena, Luis Felipe Dias Lopes, Tarcísio Araújo, Mário Dinis-Ribeiro, Gonçalo Alexandrino, Pietro Familiari, M Moreira, Luís Carvalho Lourenço, João Carlos Lopes Fernandes, Sílvia Giestas, José Ramada, João Gomes-Fonseca, Inês Costa, and David Horta
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Ampulla of Vater ,Morphology (linguistics) ,Supine position ,digestive system ,Catheterization ,03 medical and health sciences ,0302 clinical medicine ,Endoscopic retrograde cholangiopancreatography ,medicine ,Humans ,Aged ,Cholangiopancreatography, Endoscopic Retrograde ,Common Bile Duct ,Hepatology ,Common bile duct ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Anatomy ,University hospital ,Methods observational ,digestive system diseases ,Major duodenal papilla ,Cross-Sectional Studies ,surgical procedures, operative ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,business - Abstract
OBJECTIVE A small common bile duct (CBD) diameter has been associated with complications and with a difficult biliary cannulation. Previous studies suggested that this diameter can be predicted during the endoscopic retrograde cholangiopancreatography (ERCP) simply by observing the papillary morphology. Despite this published suggestion there is no study addressing this topic. This study evaluated a possible association between the morphology of the major papilla and the diameter of the terminal CBD (t-CBD). METHODS Observational cross-sectional study including consecutive patients with naive papillae was referred for ERCP in two affiliated university hospitals. The transverse (p-transv) and longitudinal measures (p-long) of the papilla were obtained using a visual method. Papillae were classified into nonprominent, prominent, bulging or other. The t-CBD was measured 1 cm from the papilla using fluoroscopic images in prone/supine. Measurements were performed by two senior endoscopists and outcomes were evaluated using correlation and linear regression model. RESULTS We included 245 patients with a median age of 76 years. The median p-transv for each type of papillae was as follows: nonprominent = 6 mm, prominent = 9 mm, bulging = 15 mm and other = 6 mm; P < 0.001. The median t-CBD for nonprominent = 7.62 mm, prominent = 8.34 mm, bulging = 8.60 mm and other = 8.52 mm; P = 0.40. The correlation between the transverse and longitudinal measures of papilla and the t-CBD were 0.0092 and 0.0614, respectively. In the regression model, the t-CBD diameter was not explained by papilla's size or morphology (R = 1.70%; P = 0.80). CONCLUSION The morphology of the papilla must not be used as a predictor of the diameter of the CBD as there is no correlation between these two items.
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- 2020
15. Endoscopy Timing in Patients with Acute Upper Gastrointestinal Bleeding
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Rita Carvalho, Gonçalo Alexandrino, Mariana Nuno Costa, Jorge Reis, Tiago Dias Domingues, and Luís Carvalho Lourenço
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Variceal bleeding ,medicine.medical_specialty ,lcsh:Internal medicine ,Medicine (miscellaneous) ,Endoscopy, digestive system ,Gastrointestinal hemorrhage ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Primary outcome ,law ,Hemostasis, endoscopic ,Medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,Gastrointestinal endoscopy ,Patient outcome assessment ,lcsh:RC799-869 ,lcsh:RC31-1245 ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Retrospective cohort study ,Acute upper gastrointestinal bleeding ,medicine.disease ,Intensive care unit ,Endoscopic hemostasis ,Endoscopy ,Surgery ,Endoscopy, gastrointestinal ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,lcsh:Diseases of the digestive system. Gastroenterology ,Original Article ,Upper gastrointestinal bleeding ,business - Abstract
BACKGROUND/AIMS: The role of very early (≤12 hours) endoscopy in nonvariceal upper gastrointestinal bleeding is controversial. We aimed to compare results of very early and early (12-24 hours) endoscopy in patients with upper gastrointestinal bleeding demonstrating low-risk versus high-risk features and nonvariceal versus variceal bleeding. METHODS: : This retrospective study included patients with nonvariceal and variceal upper gastrointestinal bleeding. The primary outcome was a composite of inpatient death, rebleeding, or need for surgery or intensive care unit admission. Endoscopy timing was defined as very early and early. We performed the analysis in two subgroups: (1) high-risk vs. low-risk patients and (2) variceal vs. nonvariceal bleeding. RESULTS: : A total of 102 patients were included, of whom 59.8% underwent urgent endoscopy. Patients who underwent very early endoscopy received endoscopic therapy more frequently (p=0.001), but there was no improvement in other clinical outcomes. Furthermore, patients at low risk and with nonvariceal bleeding who underwent very early endoscopy had a higher risk of the composite outcome. CONCLUSION: s: Very early endoscopy does not seem to be associated with improved clinical outcomes and may lead to poorer outcomes in specific populations with upper gastrointestinal bleeding. The actual benefit of very early endoscopy remains controversial and should be further clarified. info:eu-repo/semantics/publishedVersion
- Published
- 2018
16. Migrated Esophageal Metal Stent – Protection Hood to the Rescue!
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L Carvalho Lourenço, F Pereira Correia, Gonçalo Alexandrino, F Bordalo Ferreira, Rônan Vivian Carvalho, and Ana Isabel Martins
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Medicine ,Stent ,business ,Surgery - Published
- 2021
17. Recurrent Digestive Bleeding: The Essential Is Invisible To The Eyes
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Manuela Cardoso, L Martins Figueiredo, F Correia, David Horta, Américo Martins, Maria Ana Rafael, Gonçalo Alexandrino, J Carvalho e Branco, and Élia Coimbra
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- 2021
18. Self-Expandable Metallic Stent in Malignant Gastroduodenal Outlet Obstruction: A Viable Alternative?
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L Carvalho Lourenço, Joana Carvalho e Branco, Gonçalo Alexandrino, Ana Maria de Oliveira, F Pereira Correia, and Aires Martins
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medicine.medical_specialty ,Self-expandable metallic stent ,business.industry ,medicine ,business ,Surgery - Published
- 2021
19. Endoscopic Therapy In A Cohort Of Patients With Chronic Pancreatitis From A Portuguese Reference Center
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David Horta, Jorge Canena, Maria Ana Rafael, Ana Isabel Martins, Gonçalo Alexandrino, L Carvalho Lourenço, L Martins Figueiredo, and C Graça Rodrigues
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Pediatrics ,medicine.medical_specialty ,business.industry ,Cohort ,language ,Medicine ,Pancreatitis ,Center (algebra and category theory) ,Portuguese ,business ,medicine.disease ,language.human_language - Published
- 2021
20. The role of gastroduodenal stents in palliation of malignant gastroduodenal outlet obstruction, regarding the article by Alcalá-González et al
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Joana Carvalho e Branco, Fábio Pereira Correia, and Gonçalo Alexandrino
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medicine.medical_specialty ,Performance status ,business.industry ,Gastric Outlet Obstruction ,medicine.medical_treatment ,Food impaction ,General surgery ,Palliative Care ,Gastroenterology ,Self Expandable Metallic Stents ,Stent ,Terminally ill ,Gastric outlet obstruction ,General Medicine ,medicine.disease ,Stent placement ,Medicine ,Humans ,Tumor growth ,In patient ,Stents ,business ,Retrospective Studies - Abstract
Dear Editor, It was with great interest that we read the article of Luis Alcala-Gonzales et al (1). This work reinforces the scientific evidence regarding safety and effectiveness of self-expandable metal stent placement for the palliation of malignant gastric outlet obstruction (GOO). Our special interest about this topic makes us want to share the experience of our center and to strengthen some of the key points. Between January 2012 and December 2019, we placed 43 stents in patients with GOO. Interestingly, in contrast to the literature and this recently published paper, we had predominance of gastric stenosing neoplasms in relation to pancreatic neoplasms (60.4% vs 25.6%) (2), still achieving a technical (100%) and clinical (95.3%) success. The stent allows rapid clinical improvement, with shorter hospitalization compared to gastrojejunostomy, two important factors in the field of palliation. However, as we have also noted, there is a non-negligible need of reintervention (25.6% of our patients needed a second stent), either due to tumor growth, food impaction or stent migration. This fact becomes an important limitation in patients with reasonable performance status and expected survival, in which gastrojejunostomy should be considered primarily, with the use of gastroduodenal stents being more suited to individuals with shorter life expectancy (2,3). Thirty-day mortality of 46.5% and mean post-procedure survival of 81 ± 13 days are expected results for a technique with palliative purpose in a terminally ill patient. Thus, we consider that gastroduodenal stents constitute an effective and safe alternative to surgery, which is usually associated with greater morbility.
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- 2021
21. Predictors for incomplete response to ursodeoxycholic acid in primary biliary cholangitis. Data from a national registry of liver disease
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Helena Cortez‐Pinto, Rodrigo Liberal, Susana Lopes, Mariana V. Machado, Joana Carvalho, Teresa Dias, Arsénio Santos, Cláudia Agostinho, Pedro Figueiredo, Rafaela Loureiro, Alexandra Martins, Gonçalo Alexandrino, Isabel Cotrim, Carina Leal, José Presa, Mónica Mesquita, Joana Nunes, Catarina Gouveia, Ana Horta e Vale, Ana Luísa Alves, Mariana Coelho, Luís Maia, Isabel Pedroto, António Banhudo, João Sebastião Pinto, Marta Vargas Gomes, Joana Oliveira, Valeska Andreozzi, Filipe Calinas, null on behalf of Liver.pt, and Repositório da Universidade de Lisboa
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Male ,Cirrhosis ,PBC ,Gastroenterology ,Severity of Illness Index ,UDCA ,Liver disease ,0302 clinical medicine ,Risk Factors ,Registries ,Treatment Failure ,Liver Cirrhosis, Biliary ,Score ,Response ,gamma-Glutamyltransferase ,Middle Aged ,Ursodeoxycholic acid ,Oncology ,030220 oncology & carcinogenesis ,Disease Progression ,030211 gastroenterology & hepatology ,Female ,Original Article ,medicine.symptom ,medicine.drug ,Adult ,Barcelona ,medicine.medical_specialty ,Paris ,Asymptomatic ,03 medical and health sciences ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,GLOBE ,Aged ,Portugal ,business.industry ,Predictors ,Disease progression ,Primary biliary cholangitis ,Odds ratio ,medicine.disease ,Alkaline Phosphatase ,Confidence interval ,Logistic Models ,Multivariate Analysis ,National registry ,Hepatobiliary ,business - Abstract
Background The current standard of treatment in primary biliary cholangitis (PBC) is ursodeoxycholic acid (UDCA), although a considerable proportion of patients show incomplete response resulting in disease progression. Objective This study aimed to assess the prevalence of incomplete response to UDCA and determine associated patients' characteristics. Methods Patients with PBC as main diagnosis were included from a national multicentric patient registry—Liver.pt. Main endpoints included incomplete response to UDCA treatment according to Barcelona, Paris I and Paris II criteria, Globe and UK PBC scores and the association between baseline characteristics and incomplete response according to Paris II criteria. Results A total of 434 PBC patients were identified, with a mean age of 55 years and 89.2% females. Nearly half of patients were asymptomatic at diagnosis and 93.2% had positive anti‐mitochondrial antibodies. Almost all patients (95.6%) had been prescribed at least one drug for PBC treatment. At the last follow‐up visit, 93.3% were under treatment of which 99.8% received UDCA. Incomplete response to UDCA was observed in 30.7%, 35.3%, 53.7% and 36.4% of patients according to Barcelona, Paris I, Paris II criteria and Globe score, respectively. After adjusting for age and sex, and accordingly to Paris II criteria, the risk for incomplete biochemical response was 25% higher for patients with cirrhosis at diagnosis (odds ratio [OR] = 1.25; 95% confidence interval [95%CI]: 1.02–1.54; p = 0.033) and 35% (95%CI:1.06–1.72; p = 0.016) and 5% (OR = 1.05; 95%CI:1.01–1.10; p = 0.013) for those with elevated gamma‐glutamyl transferase (GGT) and alkaline phosphatase (ALP). Conclusion A considerable proportion of patients showed incomplete biochemical response to UDCA treatment according to Paris II criteria. Cirrhosis, elevated GGT and ALP at diagnosis were identified as associated risk factors for incomplete response. Early identification of patients at risk of incomplete response could improve treatment care and guide clinical decision to a more careful patient monitorization., Key summary Summarise the established knowledge on this subject Primary biliary cholangitis is a liver disease that can progress to end‐stage liver disease, with premature death or need for liver transplantation.Treatment with ursodeoxycholic acid (UDCA) significantly increases liver transplant‐free survival. However, incomplete response to UDCA reduces this beneficial effect. What are the significant and/or new findings of this study? By evaluating prevalence and risk factors for UDCA incomplete response through a large multicentric national registry it was found that 53.7% of patients were incomplete responders, according to Paris II criteria, with cirrhosis, elevated gamma‐glutamyl transferase and alkaline phosphatase at diagnosis as the main risk factors.These findings suggest that patients diagnosed at an advanced stage should be closely monitored and might benefit from novel therapies to improve outcomes if incomplete response is present.
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- 2021
22. The risk of residual or recurring adenoma after piecemeal endoscopic mucosal resection of large non-pedunculated colorectal polyps is predictable
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Luís Carvalho Lourenço, Maria Eduarda Leite Figueiredo, Rita Carvalho, Alexandra Martins, Tiago Dias Domingues, and Gonçalo Alexandrino
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Male ,medicine.medical_specialty ,Neoplasm, Residual ,Adenoma ,Endoscopic Mucosal Resection ,Colonic Polyps ,Endoscopic mucosal resection ,Residual ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Endoscopic resection ,Prospective Studies ,Aged ,Aged, 80 and over ,Hepatology ,business.industry ,Gastroenterology ,Colonoscopy ,Middle Aged ,medicine.disease ,Prognosis ,Predictive value ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Female ,Radiology ,Neoplasm Recurrence, Local ,business ,Colorectal Neoplasms ,Cohort study ,Index Colonoscopy ,Healthcare system - Abstract
INTRODUCTION/OBJECTIVE Piecemeal endoscopic mucosal resection is a safe and effective procedure for the management of large non-pedunculated colorectal polyps. Its major limitation is the possibility of residual or recurrent adenoma and the consequent need for scheduled surveillance colonoscopies, with the implied burden for the patient and health systems. We aimed to evaluate if the Size/Morphology/Site/Access (SMSA) and Sydney EMR Recurrence Tool (SERT) scores are effective in predicting residual/recurrent adenoma after piecemeal endoscopic resection of large non-pedunculated colorectal polyps. METHODS Prospective observational cohort study of piecemeal endoscopic mucosal resection of large non-pedunculated colonic polyps performed in a tertiary center. SMSA and SERT scores were calculated in the index colonoscopy and evaluated regarding the ability to predict residual/recurrent adenoma. RESULTS One hundred fifty-eight procedures were included. Lesions mean size was 31.6 ± 10.1 mm. 65.8% were flat and 61.4% were located in the right colon. Residual/recurrent adenoma was present in 17 (10.8%) cases. SMSA 2 and SERT 0 lesions had 0.0% and 5.7% of residual/recurrent adenoma rate at 6 months, respectively, while SMSA 3-4 and SERT 1-4 lesions had a 11.5% and 14.8% rate, respectively, at 6 months. SMSA grade 2 and SERT grade 0 had a negative predictive value of 100% and 94%, respectively, for residual/recurrent adenoma. SMSA score had an area under the receiver-operating characteristics curve of 0.732 (P = 0.003), while SERT score had a value of 0.730 (P = 0.002) for residual/recurrent adenoma. CONCLUSION SMSA and SERT scores are effective tools to identify lesions with a low risk of residual/recurrent adenoma.
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- 2020
23. OUTCOMES OF PRECUT NEEDLE KNIFE FISTULOTOMY BASED ON THE ENDOSCOPIC MORPHOLOGY OF THE AMPULLA OF VATER AND OF THE SIZE OF BILE DUCT
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João Carlos Lopes Fernandes, Gonçalo Alexandrino, M Moreira, Jorge Canena, Luis Felipe Dias Lopes, Tarcísio Araújo, David Horta, and Luís Carvalho Lourenço
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medicine.anatomical_structure ,Bile duct ,business.industry ,medicine ,Ampulla of Vater ,Anatomy ,Needle knife ,Fistulotomy ,business - Published
- 2020
24. OUTCOMES OF NEEDLE KNIFE FISTULOTOMY AS AN INITIAL METHOD OF BILIARY CANNULATION
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Gonçalo Alexandrino, Luis Felipe Dias Lopes, Tarcísio Araújo, Jorge Canena, Luís Carvalho Lourenço, M Moreira, João Carlos Lopes Fernandes, and David Horta
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medicine.medical_specialty ,business.industry ,medicine ,Needle knife ,Fistulotomy ,business ,Surgery - Published
- 2020
25. SINGLE-OPERATOR PERORAL CHOLANGIOSCOPY-GUIDED LITHOTRIPSY FOR DIFFICULT BILIARY STONES - A PROSPECTIVE MULTICENTER STUDY
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Jorge Canena, Dayane de Melo Costa, Sara Campos, Tarcísio Araújo, Tiago Bana e Costa, Luis Felipe Dias Lopes, David Horta, João Carlos Lopes Fernandes, Luís Carvalho Lourenço, Gonçalo Alexandrino, and M Moreira
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medicine.medical_specialty ,Multicenter study ,business.industry ,medicine.medical_treatment ,Operator (physics) ,medicine ,Radiology ,Lithotripsy ,business ,BILIARY STONES - Published
- 2020
26. Splenic Rupture following Transnasal Endoscopy
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Mariana Ferreira Cardoso, Rita Carvalho, and Gonçalo Alexandrino
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Ultraslim gastroscope ,medicine.medical_specialty ,medicine.diagnostic_test ,Transnasal endoscopy ,business.industry ,Gastroenterology ,MEDLINE ,Endoscopy ,Splenic rupture ,Images in Gastroenterology and Hepatology ,Surgery ,medicine ,General Earth and Planetary Sciences ,lcsh:Diseases of the digestive system. Gastroenterology ,lcsh:RC799-869 ,business ,General Environmental Science - Abstract
info:eu-repo/semantics/publishedVersion
- Published
- 2019
27. SINGLE-OPERATOR PERORAL CHOLANGIOPANCREATOSCOPY-GUIDED LITHOTRIPSY FOR DIFFICULT BILIARY AND PANCREATIC STONES – A PROSPECTIVE MULTICENTER STUDY
- Author
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T Bana e Costa, Luis Felipe Dias Lopes, M Certo, Tarcísio Araújo, Pedro Barreiro, F Lucas, Diogo Libânio, David Horta, Gonçalo Alexandrino, Jorge Canena, J Reis, H Ribeiro, Sílvia Giestas, João B. Fernandes, Luís Carvalho Lourenço, and M Moreira
- Subjects
medicine.medical_specialty ,Multicenter study ,business.industry ,Operator (physics) ,medicine.medical_treatment ,medicine ,Pancreatic stones ,Radiology ,Lithotripsy ,business - Published
- 2019
28. DOES THE MORPHOLOGY OF THE MAJOR PAPILLA INFLUENCE BILIARY CANNULATION? – A MULTICENTER PROSPECTIVE STUDY
- Author
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Inês Costa, Helena Ribeiro, F Lucas, David Martínez-Ares, Gonçalo Alexandrino, Jorge Canena, M Certo, Luis Felipe Dias Lopes, J Fonseca, Sílvia Giestas, Tarcísio Araújo, M Moreira, Diogo Libânio, José Ramada, Joana Reis, João B. Fernandes, Luís Carvalho Lourenço, and David Horta
- Subjects
Major duodenal papilla ,Pathology ,medicine.medical_specialty ,business.industry ,Medicine ,Morphology (biology) ,business ,Prospective cohort study - Published
- 2019
29. APPLICATION OF TWO SCORES TO PREDICT AND STRATIFY THE RISK OF RESIDUAL OR RECURRING ADENOMA AFTER PIECEMEAL EMR OF NON-PEDUNCULATED COLORECTAL POLYPS
- Author
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Luís Carvalho Lourenço, Rejane Hughes Carvalho, Gonçalo Alexandrino, J Reis, L Martins Figueiredo, and T Dias Domingues
- Subjects
medicine.medical_specialty ,Adenoma ,business.industry ,Medicine ,Radiology ,business ,medicine.disease ,Residual - Published
- 2019
30. Resultados da utilização da colangioscopia de operador único na litotrícia de cálculos difíceis biliares e pancreáticos
- Author
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David Horta, Gonçalo Alexandrino, Luis Felipe Dias Lopes, Jorge Reis, Jorge Canena, Sílvia Giestas, João Carlos Lopes Fernandes, Diogo Libânio, Luís Carvalho Lourenço, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), and Universidade do Minho
- Subjects
Colangioscopia ,medicine.medical_specialty ,medicine.medical_treatment ,Lithotripsy ,03 medical and health sciences ,0302 clinical medicine ,Cholelithiasis ,Endoscopic retrograde cholangiopancreatography ,medicine ,CPRE ,Cholangioscopy ,lcsh:RC799-869 ,Laser lithotripsy ,General Environmental Science ,Litotrícia eletrohidráulica ,Pancreatic duct ,Science & Technology ,medicine.diagnostic_test ,Common bile duct ,business.industry ,Gastroenterology ,medicine.disease ,Electrohydraulic lithotripsy ,3. Good health ,Surgery ,medicine.anatomical_structure ,Common hepatic duct ,Litotrícia por laser ,030220 oncology & carcinogenesis ,General Earth and Planetary Sciences ,Pancreatitis ,lcsh:Diseases of the digestive system. Gastroenterology ,Original Article ,030211 gastroenterology & hepatology ,business ,Pancreas - Abstract
"Published online: May 16, 2018", Background and Aims: Endoscopic retrograde cholangiopancreatography is the preferred strategy for the management of biliary and pancreatic duct stones. However, difficult stones occur, and electrohydraulic (EHL) and laser lithotripsy (LL) have emerged as treatment modalities for ductal clearance. Recently, single-operator cholangioscopy was introduced, permitting the routine use of these techniques. We aimed to evaluate the clinical effectiveness of cholangioscopy-guided lithotripsy using LL or EHL in patients with difficult biliary or pancreatic stones. Methods: This is a prospective clinical study – conducted at two affiliated university hospitals – of 17 consecutive patients with difficult biliary and pancreatic stones who underwent single-operator cholangioscopy-guided lithotripsy using two techniques: holmium laser lithotripsy (HL) or bipolar EHL. We analyzed complete ductal clearance as well as the impact of the location and number of stones on clinical success and evaluated the efficacy of the two techniques used for cholangioscopy-guided lithotripsy and procedural complications. Results:Twelve patients (70.6%) had stones in the common bile duct/common hepatic duct, 2 patients (17.6%) had a stone in the cystic stump, and 3 patients (17.6%) had stones in the pancreas. Sixteen patients (94.1%) were successfully managed in 1 session, and 1 patient (5.9%) achieved ductal clearance after 3 sessions including EHL, LL, and mechanical lithotripsy. Eleven patients were successfully submitted to HL in 1 session using a single laser fiber. Six patients were treated with EHL: 4 patients achieved ductal clearance in 1 session with a single fiber, 1 patient obtained successful fragmentation in 1 session using two fibers, and 1 patient did not achieve ductal clearance after using two fibers and was successfully treated with a single laser fiber in a subsequent session. Complications were mild and were encountered in 6/17 patients (35.2%), including fever (n = 3), pain (n = 1), and mild pancreatitis (n = 1). Conclusions: Cholangioscopy-guided lithotripsy using LL or EHL in patients with difficult biliary or pancreatic stones is highly effective with transient and minimal complications. There is a clear need to further compare EHL and HL in order to assess their role in the success of cholangioscopy-guided lithotripsy., Introdução: A CPRE é o exame preferencial para a remoção de cálculos biliares e pancreáticos. Em situações de cálculos difíceis foram propostas novas modalidades terapêuticas como a litotrícia electro-hidráulica (LEH) e a litotrícia por laser (LL). Recentemente a disponibilidade da colongioscopia de operador-único tornaram estas técnicas mais acessíveis e fáceis de realizar. Procuramos avaliar a eficácia clínica de litotrícia guiada por colangioscopia recorrendo à LEH ou à LL em doentes com cálculos biliares e pancreáticos difíceis. Métodos: Estudo prospetivo, conduzido em 2 Hospitais associados à Universidade e englobando 17 doentes consecutivos com cálculos difíceis biliares e pancreáticos, estes doentes foram tratados com litotrícia guiada por colangioscopia recorrendo a LEH ou LL. Analisamos a limpeza completa dos ductos, bem como o impato do número de pedras e localização no sucesso clínico, associada à avaliação das 2 técnicas de litotrícia e complicações desta abordagem terapêutica. Resultados: Doze doentes (70.6%) tinham cálculos no colédoco/hepático comum, 2 doentes (17.6%) tinham um cálculo único no coto do cístico e 3 doentes (17.6%) apresentavam cálculos pancreáticos. Dezasseis (94.1%) doentes foram tratados com sucesso numa única sessão e o restante (5.9%) doente necessitou de 3 sessões incluído LEH, LL e litotrícia mecânica para obter limpeza dos ductos. Onze doentes foram tratados com LL e obtiveram sucesso clínico numa única sessão com uma fibra única de laser. Seis doentes foram tratados com LEH: 4 doentes obtiveram sucesso clínico numa única sessão com 1 fibra; 1 doente necessitou de 2 fibras para obter limpeza ductal numa sessão única. O último doente falhou a limpeza dos ductos com duas fibras de LEH e necessitou de sessão adicional com Laser (uma fibra) para obter fragmentação adequada dos cálculos. As complicações foram ligeiras em 6/17 (35.2%) doentes e incluíram febre (n = 4), dor (n = 1) e pancreatite ligeira (n = 1). Conclusões: A litotrícia guiada por colangioscopia com recurso a LEH ou LL em doentes com cálculos difíceis biliares e pancreáticos é muito eficaz e está associada a complicações transitórias e ligeiras. Existe clara necessidade de realizar estudos comparativos entre LEH e LL., (undefined), info:eu-repo/semantics/publishedVersion
- Published
- 2019
31. Futility of care in patients with acute‐on‐chronic liver failure
- Author
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Rui Pereira, Gonçalo Alexandrino, Filipe S. Cardoso, and Luís Bagulho
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,medicine.medical_treatment ,MEDLINE ,Acute-On-Chronic Liver Failure ,030208 emergency & critical care medicine ,Liver transplantation ,Liver Transplantation ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,030211 gastroenterology & hepatology ,Acute on chronic liver failure ,In patient ,business ,Medical Futility - Published
- 2017
32. Su1545 SINGLE-OPERATOR PERORAL CHOLANGIOSCOPY-GUIDED LITHOTRIPSY FOR DIFFICULT BILIARY STONES - A PROSPECTIVE MULTICENTER STUDY
- Author
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João M. Fernandes, Jorge Canena, Luis Felipe Dias Lopes, Sara Campos, Tarcísio Araújo, Tiago Bana e Costa, David Horta, Gonçalo Alexandrino, Luís Carvalho Lourenço, Dalila Costa, and M Moreira
- Subjects
medicine.medical_specialty ,Multicenter study ,business.industry ,Operator (physics) ,medicine.medical_treatment ,Gastroenterology ,Medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Lithotripsy ,business ,BILIARY STONES - Published
- 2020
33. Su1567 OUTCOMES OF NEEDLE KNIFE FISTULOTOMY AS AN INITIAL METHOD OF BILIARY CANNULATION
- Author
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Luis Felipe Dias Lopes, M Moreira, Luís Carvalho Lourenço, João M. Fernandes, Jorge Canena, David Horta, Tarcísio Araújo, and Gonçalo Alexandrino
- Subjects
medicine.medical_specialty ,business.industry ,Gastroenterology ,medicine ,Radiology, Nuclear Medicine and imaging ,Needle knife ,Fistulotomy ,business ,Surgery - Published
- 2020
34. Su1547 OUTCOMES OF PRECUT NEEDLE KNIFE FISTULOTOMY BASED ON THE ENDOSCOPIC MORPHOLOGY OF THE AMPULLA OF VATER AND OF THE SIZE OF BILE DUCT
- Author
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David Horta, M Moreira, João M. Fernandes, Jorge Canena, Luis Felipe Dias Lopes, Tarcísio Araújo, Gonçalo Alexandrino, and Luís Carvalho Lourenço
- Subjects
medicine.medical_specialty ,medicine.anatomical_structure ,Bile duct ,business.industry ,Gastroenterology ,medicine ,Ampulla of Vater ,Radiology, Nuclear Medicine and imaging ,Needle knife ,Fistulotomy ,business ,Surgery - Published
- 2020
35. An exceptional cause of drug-induced colitis: cholestyramine
- Author
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Joana Carvalho e Branco, Gonçalo Alexandrino, António Alves, and Jorge Reis
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Colon ,Biopsy ,Cholestyramine Resin ,Adverse drug reactions ,Gastroenterology ,03 medical and health sciences ,Necrosis ,Internal medicine ,medicine ,Humans ,Colitis ,Intestinal Mucosa ,Anion Exchange Resins ,Aged, 80 and over ,Cholestyramine ,Cholestyramine resin ,business.industry ,Colonoscopy ,medicine.disease ,030104 developmental biology ,Female ,Drug-induced colitis ,business ,Crystallization ,medicine.drug - Abstract
Submitted by arminda sustelo (arminda.sustelo@hff.min-saude.pt) on 2018-11-21T16:48:32Z No. of bitstreams: 1 J Gastrointestin Liver Dis. 2018.pdf: 168396 bytes, checksum: e1509c4eec9ae0d5dcf78840bd7728a6 (MD5) Made available in DSpace on 2018-11-21T16:48:32Z (GMT). No. of bitstreams: 1 J Gastrointestin Liver Dis. 2018.pdf: 168396 bytes, checksum: e1509c4eec9ae0d5dcf78840bd7728a6 (MD5) Previous issue date: 2018 info:eu-repo/semantics/publishedVersion
- Published
- 2018
36. Correction: Pancreatoscopy-guided laser lithotripsy in a patient with difficult ductal stone
- Author
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Jorge Reis, Gonçalo Alexandrino, Jorge Canena, Luís Carvalho Lourenço, Catarina Graça Rodrigues, and David Horta
- Subjects
medicine.medical_specialty ,Endoscopic retrograde cholangiopancreatography ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Gastroenterology ,Endoscopy ,Laser lithotripsy ,Calculi ,medicine ,Radiology ,business ,Chronic pancreatitis - Abstract
Submitted by arminda sustelo (arminda.sustelo@hff.min-saude.pt) on 2019-02-18T16:31:49Z No. of bitstreams: 1 Endoscopy. 2018.pdf: 74392 bytes, checksum: fc5c58fd7e76c1a336392f3cb0f13056 (MD5) Made available in DSpace on 2019-02-18T16:31:49Z (GMT). No. of bitstreams: 1 Endoscopy. 2018.pdf: 74392 bytes, checksum: fc5c58fd7e76c1a336392f3cb0f13056 (MD5) Previous issue date: 2018 info:eu-repo/semantics/publishedVersion
- Published
- 2018
37. OUTCOMES OF ENDOSCOPIC MUCOSAL RESECTION OF LARGE NON-PEDUNCULATED COLORECTAL POLYPS – A PROSPECTIVE STUDY FROM A PORTUGUESE REFERRAL CENTER
- Author
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Jorge Reis, Gonçalo Alexandrino, Rita Carvalho, T Dias Domingues, and Luís Carvalho Lourenço
- Subjects
medicine.medical_specialty ,business.industry ,General surgery ,language ,Medicine ,Referral center ,Endoscopic mucosal resection ,Portuguese ,business ,Prospective cohort study ,language.human_language - Published
- 2018
38. ENDOSCOPY TIMING IN UPPER GASTROINTESTINAL BLEEDING: THE EARLIER THE BETTER?
- Author
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Joana Reis, M Nuno Costa, Rejane Hughes Carvalho, T Dias Domingues, Gonçalo Alexandrino, and Luís Carvalho Lourenço
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,General surgery ,medicine ,Upper gastrointestinal bleeding ,medicine.disease ,business ,Endoscopy - Published
- 2018
39. Pancreatoscopy-guided laser lithotripsy in a patient with difficult ductal stone
- Author
-
David Horta, Jorge Canena, Catarina Graça Rodrigues, Gonçalo Alexandrino, Jorge Reis, and Luís Carvalho Lourenço
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Lithotripsy ,Calculi ,Endosonography ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Endoscopy, Digestive System ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Pancreatic Diseases ,Endoscopy ,Middle Aged ,Lithotripsy, Laser ,Laser lithotripsy ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Radiology ,business - Abstract
Submitted by arminda sustelo (arminda.sustelo@hff.min-saude.pt) on 2019-02-28T15:27:24Z No. of bitstreams: 1 61.pdf: 660281 bytes, checksum: 18e6a3900e9ee73bb59817b556dbf717 (MD5) Made available in DSpace on 2019-02-28T15:27:24Z (GMT). No. of bitstreams: 1 61.pdf: 660281 bytes, checksum: 18e6a3900e9ee73bb59817b556dbf717 (MD5) Previous issue date: 2018 info:eu-repo/semantics/publishedVersion
- Published
- 2018
40. Comparison of the AIMS65 Score with Other Risk Stratification Scores in Upper Variceal and Nonvariceal Gastrointestinal Bleeding
- Author
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Rita Carvalho, Gonçalo Alexandrino, and Jorge Reis
- Subjects
Adult ,Male ,medicine.medical_specialty ,Gastrointestinal bleeding ,Esophageal and Gastric Varices ,Risk Assessment ,Severity of Illness Index ,Gastrointestinal hemorrhage ,Decision Support Techniques ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,Internal medicine ,Republic of Korea ,medicine ,Humans ,Letter to the Editor ,Aged ,Retrospective Studies ,Risk assessment ,Aged, 80 and over ,Hepatology ,business.industry ,Gastroenterology ,Middle Aged ,medicine.disease ,030220 oncology & carcinogenesis ,Risk stratification ,Female ,030211 gastroenterology & hepatology ,Gastrointestinal Hemorrhage ,business - Abstract
Various clinical scoring systems, including the Glasgow-Blatchford score (GBS), Rockall risk score (RS), and AIMS65 score (AIMS65), have been validated to predict the clinical outcomes in patients with upper gastrointestinal bleeding (UGIB). We compared the performance of these three scoring systems in predicting clinical outcomes in patients with UGIB in Korea.We retrospectively evaluated 286 patients with UGIB who visited emergency department. The primary outcome was the need for clinical intervention (endoscopic, radiologic, or surgical) and blood transfusion.The causes of UGIB were esophageal/gastric varices in 64 patients, peptic ulcer in 168, Mallory-Weiss tear in 32, malignancy of UGI tract in eight, and unknown in 14. One hundred seventy-four (61%) patients required blood transfusion, 166 (58%) required endoscopic intervention, and 10 (3.5%) required surgical intervention. The GBS outperformed the RS and AIMS65 in predicting the need for endoscopic intervention.The GBS and RS were more accurate than AIMS65 in predicting the need for clinical interventions and transfusion patients with UGIB, regardless of variceal or nonvariceal bleeding. The AIMS65 may not be optimal for predicting clinical outcomes of UGIB in Korea.
- Published
- 2018
41. A rare cause of fulminant acute liver failure in a young adult
- Author
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Gonçalo Alexandrino
- Published
- 2017
42. Endometriosis: A Rare Cause of Large Bowel Obstruction
- Author
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David Horta, Cisaltina Sobrinho, Luís Carvalho Lourenço, Rita Carvalho, Gonçalo Alexandrino, and Jorge Reis
- Subjects
medicine.medical_specialty ,Colorectal cancer ,Endometriosis ,Acute occlusion ,Gastroenterology ,Large bowel obstruction ,03 medical and health sciences ,0302 clinical medicine ,Complete obstruction ,Internal medicine ,medicine ,lcsh:RC799-869 ,General Environmental Science ,Stenosis ,medicine.diagnostic_test ,business.industry ,Endoscopy ,medicine.disease ,Clinical Case Study ,Intestinal obstruction ,030220 oncology & carcinogenesis ,General Earth and Planetary Sciences ,030211 gastroenterology & hepatology ,lcsh:Diseases of the digestive system. Gastroenterology ,Differential diagnosis ,business - Abstract
Large bowel obstruction can result in significant morbidity and mortality, especially in cases of acute complete obstruction. There are many possible causes, the most common in adults being colorectal cancer. Endometriosis is a benign disease, and the most affected extragenital location is the bowel, especially the rectosigmoid junction. However, transmural involvement and acute occlusion are very rare events. We report an exceptional case of acute large bowel obstruction as the initial presentation of endometriosis. The differential diagnosis of colorectal carcinoma may be challenging, and this case emphasizes the need to consider intestinal endometriosis in females at a fertile age presenting with gastrointestinal symptoms and an intestinal mass causing complete large bowel obstruction.A obstrução do cólon pode causar morbilidade e mortalidade significativas, especialmente em casos de obstrução aguda completa. Existem diversas causas, sendo a mais comum em adultos o cancro colorretal. A endometriose é uma doença benigna e o intestino é a localização extragenital mais afectada pela doença, sobretudo ao nível da transição rectossigmoideia. Contudo, o envolvimento transmural e oclusão aguda são situações extretamente raras. O diagnóstico diferencial com cancro colorretal pode ser desafiante e este caso enfatiza a necessidade de considerar a endometriose intestinal em mulheres em idade fértil com sintomas gastrointestinais e a presença de uma massa intestinal a causar obstrução completa do cólon.
- Published
- 2017
43. The albumin-bilirubin score predicting the mortality of patients with decompensated cirrhosis
- Author
-
Joana Carvalho e Branco, Gonçalo Alexandrino, Rita Carvalho, Alexandra Martins, Mariana Ferreira Cardoso, Vera Anapaz, and Sara Folgado Alberto
- Subjects
medicine.medical_specialty ,business.industry ,Bilirubin ,Gastroenterology ,MEDLINE ,Albumin ,Decompensated cirrhosis ,chemistry.chemical_compound ,Text mining ,chemistry ,Internal medicine ,Albumins ,Liver cirrhosis ,medicine ,business - Abstract
Submitted by arminda sustelo (arminda.sustelo@hff.min-saude.pt) on 2018-10-22T16:39:20Z No. of bitstreams: 1 Turk J Gastroenterol. 2017 Nov.pdf: 72686 bytes, checksum: 72ae414e65f8ddec976e5928c5538e4e (MD5) Made available in DSpace on 2018-10-22T16:39:21Z (GMT). No. of bitstreams: 1 Turk J Gastroenterol. 2017 Nov.pdf: 72686 bytes, checksum: 72ae414e65f8ddec976e5928c5538e4e (MD5) Previous issue date: 2017 info:eu-repo/semantics/publishedVersion
- Published
- 2017
44. Characteristics associated with non-response to ursodeoxycholic acid in primary biliary cholangitis
- Author
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T.H.V.T. Dias, A.M. Laranjo, Rodrigo Liberal, Susana Lopes, Marta Vargas Gomes, Joana Nunes, Isabel Pedroto, Jose Presa, Filipe Calinas, Gonçalo Alexandrino, C. M. F Fonseca, M. Sant’anna, A. Horta e Vale, I. Mocanu, Monica Mesquita, Luís Maia, Alcina Ferreira, Rafaela Loureiro, M. Bento-Miranda, João Carvalho, Cláudia Martins, Helena Cortez-Pinto, J. C. R. E. Oliveira, A. C. Santos, Albino Martins, Isabel Cotrim, A.L.C. Alves, and António Banhudo
- Subjects
medicine.medical_specialty ,Primary (chemistry) ,Hepatology ,business.industry ,Internal medicine ,medicine ,business ,Gastroenterology ,Ursodeoxycholic acid ,medicine.drug - Published
- 2018
45. Stroke in sports: a case series
- Author
-
R. Geraldes, Gonçalo Alexandrino, Teresa Pinho e Melo, Joana Damásio, Patrícia Canhão, Carlos Correia, and José M. Ferro
- Subjects
Adult ,Male ,medicine.medical_specialty ,Neurology ,MEDLINE ,Age Distribution ,Modified Rankin Scale ,Medicine ,Humans ,cardiovascular diseases ,Case report form ,Stroke ,Neuroradiology ,Aged ,Arterial dissection ,business.industry ,Middle Aged ,medicine.disease ,Dissection ,Athletic Injuries ,Physical therapy ,Female ,Neurology (clinical) ,business ,human activities ,Sports - Abstract
Regular physical activity decreases vascular risk. However, vascular events, including stroke, can occur while practicing physical activities. Stroke associated with sports is a rare clinical entity, whose risk factors and mechanisms are not fully understood. We report a case series of sports-related stroke, from tertiary care institutions. From the stroke registries of two University Neurology services and Stroke Units we retrieved all cases of stroke which occurred in temporal association with the practice of sports. Investigators had to fill a simple case report form, describing the demographic, clinical characteristics of the patients and the sport associated with the stroke. We included ten patients aged between 27 and 65 years, 8 being male. Only three subjects had vascular risk factors. Trauma to the head and/or neck was reported in two patients only. Cervicocerebral arterial dissection was the main cause of stroke, occurring in six of the ten cases. No patient died, but three were left disabled (modified Rankin Scale 3–5). This case series confirms that stroke associated with sport is very rare. The majority of the victims did not have vascular risk factors. Dissection was the most common cause of sport-associated stroke. Strokes were often disabling.
- Published
- 2014
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