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Sökning: WFRF:(Baldaque Silva Francisco)

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1.
  • Baldaque-Silva, Francisco, et al. (författare)
  • A Nerve-Wracking Cyst
  • 2021
  • Ingår i: Gastroenterology. - : Elsevier. - 0016-5085 .- 1528-0012. ; 161:5, s. e12-e13
  • Tidskriftsartikel (refereegranskat)
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2.
  • Baldaque-Silva, Francisco, et al. (författare)
  • Endoscopic assessment and grading of Barrett's esophagus using magnification endoscopy and narrow band imaging: Impact of structured learning and experience on the accuracy of the Amsterdam classification system
  • 2013
  • Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 48:2, s. 160-167
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. Several classification systems have been launched to characterize Barrett's esophagus (BE) mucosa using magnification endoscopy with narrow band imaging (ME-NBI). The good accuracy and interobserver agreement described in the early reports were not reproduced subsequently. Recently, we reported somewhat higher accuracy of the classification developed by the Amsterdam group. The critical question then formulated was whether a structured learning program and the level of experience would affect the clinical usefulness of this classification. Material & methods: Two hundred and nine videos were prospectively captured from patients with BE using ME-NBI. From these, 70 were randomly selected and evaluated by six endoscopists with different levels of expertise, using a dedicated software application. First, an educational set was studied. Thereafter, the 70 test videos were evaluated. After classification of each video, the respective histological feedback was automatically given. Results. Within the learning process, there was a decrease in the time needed for evaluation and an increase in the certainty of prediction. The accuracy did not increase with the learning process. The sensitivity for detection of intestinal metaplasia ranged between 39% and 57%, and for neoplasia between 62% and 90%, irrespective of assessor's expertise. The kappa coefficient for the interobserver agreement ranged from 0.25 to 0.30 for intestinal metaplasia, and from 0.39 to 0.48 for neoplasia. Conclusion: Using a dedicated learning program, the ME-NBI Amsterdam classification system is suboptimal in terms of accuracy and inter- and intraobserver agreements. These results reiterate the questionable utility of corresponding classification system in clinical routine practice.
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3.
  • Marques, Filipe, et al. (författare)
  • New through-the-needle brush for pancreatic cysts assessment : a randomized control trial
  • 2023
  • Ingår i: iGIE. - : Elsevier BV. - 2949-7086.
  • Tidskriftsartikel (refereegranskat)abstract
    • AbstractObjectiveCurrent endoscopic ultrasound technologies (EUS) are suboptimal in the assessment of pancreatic cystic lesions (PCLs). We developed a new through-the- needle brush, the "loop brush", to improve the cellular yield, and thereby sensitivity,of EUS fine needle aspiration (EUS-FNA) of pancreatic cysts. In this study, we aim to evaluate its safety and efficacy.DesignWe performed an in-vivo randomized controlled trial in pigs using artificial cysts. In one group, the loop brush was deployed through a 22G EUS-FNA needle into the cysts. In the control group, cystic punction was performed with standard EUS- FNA. Loop brushes were visually inspected post-procedure. Cytological assessment, cell counting, and hemoglobin analysis were performed in samples from both groups.ResultsArtificial cysts (n=114) were punctured in six pigs, 57 in each group. Neither adverse events nor significant device malfunction occurred during loop brushing. Samples collected with the brush had non-detectable concentrations of hemoglobin in 72% (41/57) of cases, and 26% (16/57) had less than 0.6 g/dL, with no significant difference to the controls (p=0.32). Brushing cell counts were associated with significantly increased cell counts (11.7× median difference, p<.0001). Cytological smears were diagnostic in 77% of cases in the brushing group, while 54% in the control group (p=0.01, Fisher’s exact test; p=0.006, Chi-square test).ConclusionsThe new loop brush procedure appears to be safe, causing neither significant bleeding nor device malfunction. Samples obtained with the loop brush were suitable for cytological analysis and showed significantly higher cell yield than controls. Further clinical studies are warranted.
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4.
  • Silva, Francisco Baldaque (författare)
  • Aspects on endoscopic characterization and clinical management of Barrett's esophagus
  • 2017
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Barrett's esophagus (BE) is considered to result from prolonged gastroesophageal reflux and is the only known precursor of esophageal adenocarcinoma. The clinical management of BE patients aims to control esophageal reflux to reduce mucosal injury and neoplastic progression, and to detect early neoplastic lesions in Barrett’s mucosa, suitable for curative endoscopic treatment. The first part of this thesis evaluates the effect of a stepwise increase in the dose of proton pump inhibitors (PPI), on esophageal acidic reflux, symptoms and histology in long segment BE patients (group 1, n=24). We also compare these outcomes in BE patients under PPI with the results of BE patients after clinically successful fundoplication (group 2, n=30). In all but one patient in group 1, it was possible to normalize acid reflux with PPI, resulting in improvements in symptom scores. However, symptomatic amelioration was only significant in the first step of PPI treatment. Patients with PPI or fundoplication had the same levels of symptom scores. Normalization of the acid reflux in both groups was associated with reductions of papillary length, thickness of the basal cell layers, dilation of intercellular spaces, and acute and chronic inflammation of the squamous epithelium. We did not find a significant change in markers of proliferation and differentiation in Barrett’s mucosa associated with normalization of acid reflux in either group. The second part of this thesis assesses 3 different endoscopic classification systems, Amsterdam, Kansas and Nottingham, developed for the characterization of Barrett’s mucosa. These classifications use magnification endoscopy with narrow band imaging (ME-NBI) for the identification of intestinal metaplasia and dysplasia in Barrett’s mucosa. We used 84 video segments from Barrett’s mucosa, that were randomly selected and blindly evaluated by 9 observers with different expertise in the field. All classifications were feasibly but showed suboptimal accuracy and low inter-observer agreement, with slightly better results for the Amsterdam classification. The last part of this thesis evaluates the role of a structured learning program for the application of the Amsterdam classification system. We used the first 70 videos from the 84 randomly selected videos from the previous study. While, during the learning process, there was a decrease in the time spent for evaluation and an increase in declared certainty of prediction, the accuracy in histological prediction did not improve. This classification system was found to be suboptimal in terms of accuracy and inter- and intra-observer agreements. This thesis shows that, in long segment BE patients, acid reflux and symptom scores correlated through several steps of the PPI treatment process, achieving the same level as after a successful fundoplication. If a single dose of PPI is associated with marked improvement of symptoms, higher doses still may be needed for complete acid suppression. Minor changes were found among morphological markers of reflux disease, both in the glandular and in the squamous epithelium, irrespective of medical or surgical treatment. Our results underscore the questionable utility of ME-NBI classification systems for clinical routine practice in BE.
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6.
  • Valente, Roberto, et al. (författare)
  • Lumen apposing metal stents vs double pigtail plastic stents for the drainage of pancreatic walled-off necrosis
  • 2022
  • Ingår i: Minerva gastroenterology. - : Edizioni Minerva Medica. - 2724-5365.
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Few studies compared lumen-apposing metal stents (LAMS) and standard double pigtail plastic stents (PS) for the endoscopic drainage of pancreatic walled-off necrosis (WON). Albeit sometimes large, previously described cohorts display considerable heterogeneity and often pooled together data from several centers, involving multiple operators and techniques. Moreover, they often lack a control group for the comparison of outcomes.AIM: to compare clinical efficacy and safety of PS versus LAMS for the endoscopic drainage of infected WON.METHODS: Single-centre, 1:1 case-control study. We compared patients undergoing endoscopic drainages of infected WON through LAMS (cases) or PS (controls). The primary endpoint was the clinical efficacy (resolution of the WON/sepsis), the secondary endpoint was safety (procedure-related complications).RESULTS: Thirty patients were enrolled between 2011 and 2017. Cases and controls were homogeneous in terms of etiology and clinical characteristics. 93% of cases and 86.7% of controls were clinically successfully treated, with no significant differences in rates of post-operative infections, bleedings and stent migrations (respectively 13.3% vs 21.4%; p=0.65; 13.3% vs 0%; p=0.48; 13.3% vs 7.1%; p=1.00). No difference was shown regarding the need for additional percutaneous or surgical treatments (33.3% vs 13.3%; p=0.39). Cases, however, displayed a significantly prolonged mean hospital stay (90.2 days vs 18.5 days; p<0.01) and a higher mean number of endoscopic procedures per patient (4.8 vs 1.5; p<0.01).CONCLUSIONS: PS might be not inferior to LAMS for the treatment WONs. Further prospective RCT is needed to compare clinical efficacy and safety in the two groups.
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7.
  • Vujasinovic, Miroslav, et al. (författare)
  • Paraduodenal pancreatitis - problem in the groove
  • 2022
  • Ingår i: Scandinavian Journal of Gastroenterology. - : TAYLOR & FRANCIS LTD. - 0036-5521 .- 1502-7708.
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Paraduodenal pancreatitis (PDP) is a particular form of chronic pancreatitis (CP) occurring in and around the duodenal wall. Despite its low prevalence, this rare condition presents a significant challenge in clinical practice. Methods We retrospectively analysed the electronic medical charts of all patients with a diagnosis of chronic pancreatitis and identified those with PDP, between January 1999 and December 2020. Results There were 35 patients diagnosed with PDP (86% males and 14% females); median age of 56 +/- 11 (range 38-80). Alcohol overconsumption was reported in 81% and smoking in 90% of patients. Abdominal pain was the leading symptom (71%), followed by weight loss, nausea and vomiting, jaundice, and diarrhoea. In 23 patients (66%), recurrent acute pancreatitis attacks were noted. Focal duodenal wall thickening was present in 34 patients (97%), cystic lesions in 80%, pancreatic duct dilatation in 54% and common bile duct dilatation in 46%. Endoscopic treatment was performed on nine patients (26%) and five patients (14%) underwent surgery. Complete symptom relief was reported in 12 patients (34%), partial symptom relief in three (9%), there was no improvement in five (14%), data were not available in three (9%) and 12 (34%) patients died before data analysis. Conclusions PDP is a rare form of pancreatitis, most commonly occurring in the 5th or 6th decade of life, with a predominance in males and patients with a history of smoking and high alcohol consumption. Focal thickening and cystic lesions of the duodenal wall are the most common imaging findings, followed by pancreatic duct and common bile duct dilatation. A minority of patients requires surgery.
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