PubMed Health⌕ Search

Biomedical subjects

J M Bordas

Publications and source records attributed to J M Bordas.

At least 19 recordsLinked to original sources
PubMed2005

The European panel on the appropriateness of gastrointestinal endoscopy guidelines colonoscopy in an open-access endoscopy unit: a prospective study.

BACKGROUND: The demand for gastrointestinal endoscopy is increasing in most developed countries, resulting in an important rise in overall costs and waiting lists for endoscopic procedures. Therefore, adherence to appropriate indications for these procedures is essential for the rational use of finite resources in an open-access system. AIM: To assess indications and appropriateness of colonoscopy according to the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) criteria. METHODS: From May to June 2004, all consecutive patients referred to our Unit for open-access colonoscopy were considered for inclusion in this prospective study. Appropriateness of each colonoscopy was established according to the EPAGE criteria. In order to evaluate whether appropriateness of use correlated with the diagnostic yield of colonoscopy, relevant endoscopic findings were also recorded. RESULTS: A total of 350 consecutive patients were included in the study. In 38 of them, the colonoscopy indication was not listed in the EPAGE guidelines and, consequently, they were not evaluated. In the remaining 312 patients, the indication for the procedure was considered inappropriate in 73 (23%) patients. Both referring doctor characteristics (specialty and health care setting) and patient data (age) correlated with appropriateness of endoscopy. The diagnostic yield was significantly higher for appropriate colonoscopies (42%) than in those judged inappropriate (21%) (P = 0.001). CONCLUSIONS: A noteworthy proportion of patients referred for colonoscopy to an open-access endoscopy unit are considered inappropriate because of their indication, with significant differences among specialties. These results suggest that implementation of validated guidelines for its appropriate use could improve this situation and, considering the correlation between appropriateness and diagnostic yield, even contribute to improve the prognosis of patients with colorectal diseases.

Adult↗
PubMed2005

[Emerging endoscopic techniques. The arrival of virtual histology].

Endoscopic technology has evolved in such a way that gastroenterologists can now visualize and store high-resolution images of the gastrointestinal tract. This has improved the approach to precancerous and cancerous lesions of the gastrointestinal tract and biliary tree. However, certain difficulties remain, especially in relation to diagnosis. In the last few years, multiple techniques have been developed that, using the properties of light, enable an instantaneous histologic diagnosis to be made while endoscopy is being performed. What has been called the "optical biopsy" allows highly exact information to be obtained, both from the morphological and functional point of view. Some of these techniques, such as chromoendoscopy and magnification, are already being performed in clinical practice while others are still under investigation. The aim of the present article is to review the underlying principles and applications of these emerging techniques.

Endoscopy, Gastrointestinal↗
PubMed2005

[Laparoscopic surgery of gastric cancer].

INTRODUCTION: The present state of minimally invasive surgery in gastric cancer is reviewed and its technical aspects are detailed. PATIENTS AND METHOD: The authors provide their personal experience in a non-randomized prospective study, in two different settings (the CHU Charleroi, Belgium and the Hospital of Zumárraga, the Basque Country, Spain) carried out between June 1993 and January 2004. In this study involving 101 patients with gastric adenocarcinoma, the mini-invasive laparoscopic approach was employed as a surgical tool with the "aim of treatment by laparoscopy". The average age of the patients was 67 years (37-83). RESULTS: Postoperativemortality after 60 days was 5 patients; 87 patients were subjected to an oncological follow-up averaging 41 months (7-129). The average of survival observed in the 10 non-resected patients was 4.5 months. The average of survival observed in the 10 patients subjected to a palliative resection was 7.1 months. The actuarial survival after 5 years observed following type RO exeresis was 34%. The 5-years actuarial survival of the resected patients was 29%. CONCLUSIONS: Laparoscopic gastrectomy associated with any type of lymphadenectomy is a significant but safe intervention, with acceptable rates of morbidity and mortality in patients with advanced gastric cancer, who frequently present a bad general status. The long term oncological results are similar to those obtained via laparotomy. More prospective studies are needed that evaluate the results of this approach, both its short-term benefits and the long range oncological result.

Actuarial Analysis↗
PubMed2004

Wireless capsule endoscopy in patients with obscure gastrointestinal bleeding: a comparative study with push enteroscopy.

BACKGROUND: The identification and treatment of lesions located in the small intestine in obscure gastrointestinal bleeding is always a clinical challenge. AIM: To examine prospectively the diagnostic precision and the clinical efficacy of capsule endoscopy compared with push enteroscopy in obscure gastrointestinal bleeding. METHODS: Forty-two patients (22 men and 20 women) with obscure gastrointestinal bleeding (overt bleeding in 26 cases and occult blood loss with chronic anaemia in 16) and normal oesophagogastroduodenoscopy and colonoscopy were analysed. All patients were instructed to receive the capsule endoscopy and push enteroscopy was performed within the next 7 days. Both techniques were blindly performed by separate examiners. The diagnostic yield for each technique was defined as the frequency of detection of clinically relevant intestinal lesions carrying potential for bleeding. RESULTS: A bleeding site potentially related to gastrointestinal bleeding or evidence of active bleeding was identified in a greater proportion of patients using capsule endoscopy (74%; 31 of 42) than enteroscopy (19%; eight of 42) (P = 0.05). The most frequent capsule endoscopy findings were: angiodysplasia (45%), fresh blood (23%), jejunal ulcers (10%), ileal inflammatory mucosa (6%) and ileal tumour (6%). No additional intestinal diagnoses were made by enteroscopy. In seven patients (22%), the results obtained with capsule endoscopy led to a successful change in the therapeutic approach. CONCLUSIONS: Compared with push enteroscopy, capsule endoscopy increases the diagnosis yield in patients with obscure gastrointestinal bleeding, and allows modification on therapy strategy in a remarkable proportion of patients.

Adolescent↗
PubMed2003

Clinical usefulness of KRAS mutational analysis in the diagnosis of pancreatic adenocarcinoma by means of endosonography-guided fine-needle aspiration biopsy.

AIM: To establish the usefulness of KRAS mutational analysis in the diagnosis of pancreatic adenocarcinoma by comparing this technique with conventional cytology in aspirates obtained by endosonography-guided fine-needle aspiration. METHODS: All consecutive patients with pancreatic focal lesions undergoing endosonography-guided fine-needle aspiration were included. Samples were obtained with the concurrence of an attendant cytopathologist. Detection of codon-12 KRAS mutations was performed by the restriction fragment length polymorphism-polymerase chain reaction method. The effectiveness of conventional cytology, KRAS mutational analysis and their combination was established with respect to the definitive diagnosis. A cost-effectiveness analysis was also performed. RESULTS: Thirty-three patients had pancreatic adenocarcinoma and 24 patients had other lesions. A total of 136 samples was obtained. In patients in whom specimens were adequate (93% for cytology; 100% for mutational analysis), the specificity of both techniques was 100%, whereas the sensitivity favoured cytology (97% vs. 73%). When inadequate samples were considered as misdiagnosed, a combination of both techniques reached the highest overall accuracy (cytology, 91%; mutational analysis, 84%; combination of both, 98%). CONCLUSIONS: Cytology from aspirates obtained by endosonography-guided fine-needle aspiration is the most precise single technique for the diagnosis of pancreatic adenocarcinoma. However, when adequate specimens are not available to reach a cytological diagnosis, the addition of KRAS mutational analysis represents the best strategy.

Adenocarcinoma↗
PubMed2003

[Role of capsule endoscopy in patients with obscure digestive bleeding].

INTRODUCTION: The identification and localization of lesions located in the small intestine that may provoke gastrointestinal bleeding is difficult. OBJECTIVE: To analyze the role of capsule endoscopy in patients with obscure digestive bleeding and to compare the results obtained with those of enteroscopy. PATIENTS AND METHODS: Twenty-one patients with obscure digestive bleeding (acute hemorrhage in 11 patients and chronic anemia in 10) and normal total fibergastroscopy and fibrocolonoscopy were analyzed. All patients were instructed to receive the capsule and enteroscopy was performed after 1 week. The results obtained using both procedures were independently compared and without knowledge of the results of the other procedure. RESULTS: Visualization of findings potentially related to gastrointestinal bleeding was significantly greater (p < 0.05) using the capsule (14 of 21 patients [66%]) than with enteroscopy (4 of 21 patients [19%]). The most frequent lesions were angiodysplasias and jejunal ulcers. In 4 patients, the results obtained led to a change in therapeutic approach. One patient with jejunal stenosis and two with ileal lesions underwent surgery, which confirmed the diagnosis of Crohn's disease in the first patient and carcinoid tumor in the remaining two. Another patient with evidence of angiodysplasia and bleeding was effectively treated with Argon-beam during enteroscopy. The capsule was well tolerated in all patients. In the patient with jejunal stenosis, capsule extraction was required during surgery. CONCLUSIONS: Capsule endoscopy allows adequate visualization of the entire small intestine and its diagnostic efficacy is greater than that of enteroscopy in patients with obscure digestive bleeding. Moreover, in our series, this procedure allowed modification of therapy in one out of every five patients.

Adolescent↗
PubMed2003

Follow-up of a large-B-cell pancreatic lymphoma by endoscopic ultrasonography.

Although computed tomography and endoscopic ultrasound (EUS) are well-established procedures used to evaluate pancreatic masses, it is well known that imaging techniques alone cannot be used to distinguish between adenocarcinoma and tumors of less common cellular origin, such as primary pancreatic lymphoma. Clinicians must always consider this kind of malignancy in their differential diagnosis since, although rare, its treatment is nonsurgical and it has a better prognosis than adenocarcinoma. Histological examination of focal masses in the pancreas is therefore mandatory in order to establish the best therapeutic approach for every patient. Endoscopic ultrasound has developed as a very useful tool for the diagnosis of pancreatic tumors but could also be considered as a very useful method in the follow-up of these patients after treatment.

Aged↗
PubMed2001

A multicenter, randomized, clinical trial of hormonal therapy in the prevention of rebleeding from gastrointestinal angiodysplasia.

BACKGROUND & AIMS: The efficacy of hormonal therapy for recurrent bleeding from gastrointestinal angiodysplasia remains uncertain. We investigated the efficacy of long-term estrogen-progestagen therapy in the prevention of rebleeding from gastrointestinal angiodysplasia. METHODS: Seventy-two noncirrhotic patients bleeding from gastrointestinal angiodysplasia confirmed by endoscopy or angiography were randomized to receive in double-blind conditions treatment with ethinylestradiol (0.01 mg) plus norethisterone (2 mg) (1 tablet/d), or placebo (1 tablet/d) for a minimum period of 1 year (range: 1-2 years). RESULTS: Four patients could not be assessed because they did not attend the first follow-up visit. Failure of treatment occurred in 13 of 33 (39%) patients in the treatment group and in 16 of 35 (46%) patients in the placebo group (P = NS). No significant differences between groups were found according to number of bleeding episodes (0.7 +/- 1.0 vs. 0.9 +/- 1.5) and transfusional requirements (0.9 +/- 1.9 vs. 0.7 +/- 1.5 units). Treatment received was not an independent predictor for rebleeding prevention in the multivariate regression analysis. Severe adverse events (2 vs. 1) and mortality (0 vs. 1 patient, respectively) were similar between the treatment and placebo groups. CONCLUSIONS: Continuous estrogen-progestagen treatment is not useful in the prevention of rebleeding from gastrointestinal angiodysplasia.

Adult↗
PubMed2001

Endoscopic injection therapy in bleeding Mallory-Weiss syndrome: a randomized controlled trial.

BACKGROUND: Endoscopic injection is widely used in the therapy of bleeding gastroduodenal ulcers, but its role in the management of bleeding Mallory-Weiss tears has not been properly assessed. METHODS: Sixty-three patients undergoing emergency endoscopy in whom there was a high index of suspicion that a Mallory-Weiss tear was the source of bleeding were randomly assigned to undergo endoscopic injection therapy (epinephrine and polidocanol) or no endoscopic therapy in 2 university-affiliated hospitals. Rates of recurrent bleeding, transfusion requirements, complications, mortality, and length of hospital stay were determined for both groups of patients. RESULTS: Bleeding recurred in 8 patients in the control group versus only 2 in the endoscopic treatment group (25.8% vs. 6.2%, p < 0.05). Hospital stay was longer for the control group (5.5 +/- 0.2, median 6.0, range 2.0-8.0 days vs. 3.4 +/- 0.2, median 3.0, range 2.0-6.0 days; p < 0.001). There was a trend toward a higher transfusion requirement after endoscopy in the control group versus the patients treated by injection (0.9 +/- 0.2, median 0.0, range 0.0-4.0 units vs. 0.2 +/- 0.1, median 0.0, range 0.0-2.0 units; p = 0.09). No complications or adverse events caused by endoscopic injection were noted. Two patients in the control group died of causes unrelated to bleeding. CONCLUSIONS: Endoscopic injection therapy is a useful option in the management of patients with Mallory-Weiss syndrome at high risk for recurrent bleeding.

Epinephrine↗
PubMed2001

Hydrocolonic sonography for evaluating inflammatory bowel disease.

OBJECTIVE: The purpose of our study was to compare the usefulness of hydrocolonic sonography and (99m)Tc-hexamethylpropyleneamine oxime (HMPAO)--labeled leukocyte scintigraphy in the examination of patients with inflammatory bowel disease, using precise sonographic criteria of bowel involvement. SUBJECTS AND METHODS: Sixty-eight consecutive patients with active inflammatory bowel disease (34 ulcerative colitis and 34 Crohn's disease), 12 with inactive inflammatory bowel disease, and 10 control subjects were prospectively studied. Patients with active disease underwent clinical assessment, hydrocolonic sonography, scintigraphy, and colonoscopy within 72 hr, whereas patients with inactive disease and control subjects underwent clinical examination and hydrocolonic sonography. RESULTS: Involvement of a colonic segment by active inflammatory bowel disease was best defined by mucosal thickness greater than 1.5 mm, bowel wall thickness greater than 4 mm, mucosal irregularity, or the absence of haustra; and involvement of the terminal ileum by bowel wall thickness greater than 4 mm. Using these criteria, hydrocolonic sonography had 100% sensitivity for identifying patients with active inflammatory bowel disease and a greater overall accuracy (87%) than scintigraphy (77%) in the assessment of disease extension. In addition, strong correlation was shown between a hydrocolonic sonography activity index and clinical and endoscopic activity indexes. CONCLUSION: This prospective study provides precise sonographic criteria for the definition of bowel involvement by active inflammatory bowel disease. Hydrocolonic sonography has a greater accuracy than scintigraphy for assessing disease extension and activity. Therefore, hydrocolonic sonography should be considered a first-choice technique to complete the study of inflammatory bowel disease after confirmation of the diagnosis by histology.

Adolescent↗