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Needle knife fstulotomy in flat and diverticular papillae:Is it time for redemption?

Hepatobiliary & Pancreatic Diseases International 2022年第2期21卷 175-181页

作者： João Fernandes Jorge Canena Marta Moreira Gonçalo Alexandrino Luísa Figueiredo Tarcísio Araújo Luís Lourenço David Horta Luís Lopes Department of Gastroenterology Santa Luzia Hospital-Unidade Local de Saúde Alto MinhoViana do CasteloPortugal Department of Gastroenterology Professor Doutor Fernando Fonseca HospitalAmadoraPortugal Department of Gastroenterology Nova Medical School/Faculty of Medical SciencesLisbonPortugal University Center of Gastrenterology-hospital cuf tejo LisbonPortugal Life and Health Sciences Research Institute(ICVS) School of MedicineUniversity of MinhoBragaPortugal ICVS/3B’s-PT Government Associate Laboratory Braga/GuimarãesPortugal

Background: European Society of Gastrointestinal Endoscopy( ESGE) recommends needle-knife fstulotomy(NKF) as the preferred precut technique in cases when standard cannulation techniques fail. Despite scarce scientifc 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 na?ve 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 classifcation 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 signifcant 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.

关键词： Endoscopic retrograde cholangiopancreatography Needle-knife fstulotomy Small papilla Diverticular papilla Complications

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促进慢性阻塞性肺疾病哮喘患者自我监控空气质量的护理干预措施: 整合性综述

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International Journal of Nursing Sciences 2024年第1期11卷 46-56页

作者： Bruna F.Sebastiao Raquel M.Hortelao Sara S.Granadas Jose M.Faria Joana R.Pinto Helga Rafael Henriques Nursing School of Lisbon LisbonPortugal hospital Center of Central Lisbon Portugal cuf tejo hospital LisbonPortugal University hospital Center of Northern Lisbon LisbonPortugal Nursing Research Innovation and Development Centre of Lisbon(CIDNUR)LisbonPortugal

目的哮喘-慢性阻塞性肺疾病肺重叠症(Asthma-chronie obst ructive pulmonary disease overlap,A-CO)患者的生活质量较低,肺功能较差,病情经常加重。由于暴露于污染环境会加重其症状,增加发病率和病死率,环境管理对其至关重要。旨在通... 详细信息

目的哮喘-慢性阻塞性肺疾病肺重叠症(Asthma-chronie obst ructive pulmonary disease overlap,A-CO)患者的生活质量较低,肺功能较差,病情经常加重。由于暴露于污染环境会加重其症状,增加发病率和病死率,环境管理对其至关重要。旨在通过系统性综述,寻找证据,以指导制订护理干预措施,促进ACO患者对空气质量的自我管理。方法2023年3月 ,系统检索CINAHL、Medline、Academie Search Complete .Scopus、WebofScience、Cochrane图书馆、乔安娜布里格斯研究所(JoannaBriggsInstitute,JBI)循证实践数据库,以及GoogleScholar。对纳人研究进行数据提取和综合,并对护理干预措施进行分类。采用JBI研究质量评估工具进行方法学质量评估。结果共纳入5篇来自不同国家的研究。促进ACO患者自我监控空气质量的干预措施包括:警觉性干预措施(医务人员定期巡诊、进行症状评估),监测干预措施(监测室内外诱发因素) ,教育干预措施(空气质量警报、避免接触过敏原),以及相关政策的影响,如无烟政策和改善空气质量的综合战略。尽管这些研究报告了不同的干预措施,方法质量也存在差异,但这些干预措施显示了预防患者病情恶化、尽量减少急诊就诊和住院治疗的潜力。这些关键点可作为护理干预措施的关键组成部分。结论有必要采取全面措施,让护士参与促进患者自我监控空气质量的多学科团队.提高认识、制订和实施护理干预,从而使ACO患者受益。同时,需要进--步开展研究,以扩大证据基础并完善这些干预措施。

关键词：空气质量哮喘哮喘-慢阻肺重叠慢性病慢性阻塞性肺疾病护理自我管理

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Imaging evaluation of the liver in oncology patients:A comparison of techniques

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World Journal of Hepatology 2021年第12期13卷 1936-1955页

作者： Patrícia S Freitas Catarina Janicas JoséVeiga António P Matos Vasco Herédia Miguel Ramalho Department of Radiology Centro Hospitalar Universitário de Lisboa CentralLisbon 1150-199Portugal Department of Radiology Centro Hospitalar de Lisboa OcidentalLisbon 1449-005Portugal Department of Radiology Hospital Garcia de OrtaEPEAlmada 2805-267Portugal Department of Radiology Hospital CUF TejoLisbon 1350-352Portugal Department of Radiology Hospital Espírito Santo deÉvora-EPEÉvora 7000-811Portugal Department of Radiology Hospital da LuzLisbon 1500-650Portugal

The liver is commonly affected by metastatic ***,it is essential to detect and characterize liver metastases,assuming that patient management and prognosis rely on *** imaging techniques that allow non-invasive assessment of liver metastases include ultrasonography,computed tomography(CT),magnetic resonance imaging(MRI),positron emission tomography(PET)/CT,and PET/*** this paper,we review the imaging findings of liver metastases,focusing on each imaging modality’s advantages and potential *** also assess the importance of different imaging modalities for the management,follow-up,and therapy response of liver *** date,both CT and MRI are the most appropriate imaging methods for initial lesion detection,follow-up,and assessment of treatment *** MRI is frequently used as a problem-solving technique for liver lesions and has evolved substantially over the past decade,including hardware and software developments and specific intravenous contrast *** studies have shown that MRI performs better in small-sized metastases and moderate to severe liver steatosis *** state-of-the-art MRI shows a greater sensitivity for detecting and characterizing liver metastases,CT remains the chosen *** also present the controversial subject of the"economic implication"to use CT over MRI.

关键词： Liver metastases Magnetic resonance imaging Computed tomography Oncology Ultrasound Follow-up

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Artificial intelligence in the endoscopic approach of biliary tract diseases:A current review

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Artificial Intelligence in Gastrointestinal Endoscopy 2022年第2期3卷 9-15页

作者： Fábio Pereira Correia Luís Carvalho Lourenço Department of Gastroenterology Hospital Prof.Dr Fernando FonsecaAmadora 2720-276Portugal Gastroenterology Center Hospital Cuf Tejo-Nova Medical School/Faculdade de Ciências Médicas da Universidade Nova de LisboaLisbon 1350-352Portugal

In recent years there have been major developments in the field of artificial *** different areas of medicine have taken advantage of this tool to make various diagnostic and therapeutic methods more effective,safe,and *** this way,artificial intelligence has been an increasingly present reality in *** the field of Gastroenterology,the main application has been in the detection and characterization of colonic polyps,but an increasing number of studies have been published on the application of deep learning systems in other pathologies of the gastrointestinal *** of the application of artificial intelligence in the assessment of biliary tract is still *** studies support the usefulness of these systems in the investigation and treatment of choledocholithiasis,demonstrating that they have the potential to be integrated into clinical practice and endoscopic procedures,such as endoscopic retrograde *** application in cholangioscopy for the investigation of undetermined biliary strictures also seems to be *** the bile duct through endoscopic ultrasound can be challenging,especially for less experienced operators,thus becoming an area of potential interest for artificial *** this review,we summarize the state of the art of artificial intelligence in the endoscopic diagnosis and treatment of biliary diseases.

关键词： Deep learning Artificial Neural Networks Bile duct Choledocholithiasis Biliary strictures

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促进慢性阻塞性肺疾病哮喘患者自我监控空气质量的护理干预措施:整合性综述（英文）

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International Journal of Nursing Sciences 2024年第1期 46-56页

作者： Bruna F.Sebasti?o Raquel M.Hortel?o Sara S.Granadas José M.Faria Joana R.Pinto Helga Rafael Henriques Nursing School of Lisbon hospital Center of Central Lisbon cuf tejo hospital University hospital Center of Northern Lisbon Nursing Research Innovation and Development Centre of Lisbon (CIDNUR)

目的哮喘-慢性阻塞性肺疾病肺重叠症(Asthma-chronic obstructive pulmonary disease overlap,ACO)患者的生活质量较低,肺功能较差,病情经常加重。由于暴露于污染环境会加重其症状,增加发病率和病死率,环境管理对其至关重要。旨在通过... 详细信息

目的哮喘-慢性阻塞性肺疾病肺重叠症(Asthma-chronic obstructive pulmonary disease overlap,ACO)患者的生活质量较低,肺功能较差,病情经常加重。由于暴露于污染环境会加重其症状,增加发病率和病死率,环境管理对其至关重要。旨在通过系统性综述,寻找证据,以指导制订护理干预措施,促进ACO患者对空气质量的自我管理。方法 2023年3月,系统检索CINAHL、Medline、Academic Search Complete、Scopus、Web of Science、Cochrane图书馆、乔安娜布里格斯研究所(Joanna Briggs Institute,JBI)循证实践数据库,以及Google Scholar。对纳入研究进行数据提取和综合,并对护理干预措施进行分类。采用JBI研究质量评估工具进行方法学质量评估。结果共纳入5篇来自不同国家的研究。促进ACO患者自我监控空气质量的干预措施包括:警觉性干预措施(医务人员定期巡诊、进行症状评估),监测干预措施(监测室内外诱发因素),教育干预措施(空气质量警报、避免接触过敏原),以及相关政策的影响,如无烟政策和改善空气质量的综合战略。尽管这些研究报告了不同的干预措施,方法质量也存在差异,但这些干预措施显示了预防患者病情恶化、尽量减少急诊就诊和住院治疗的潜力。这些关键点可作为护理干预措施的关键组成部分。结论有必要采取全面措施,让护士参与促进患者自我监控空气质量的多学科团队、提高认识、制订和实施护理干预,从而使ACO患者受益。同时,需要进一步开展研究,以扩大证据基础并完善这些干预措施。

关键词：空气质量哮喘哮喘-慢阻肺重叠慢性病慢性阻塞性肺疾病护理自我管理

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Impact of gastroesophageal reflux control through tailored proton pump inhibition therapy or fundoplication in patients with Barrett's esophagus

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World Journal of Gastroenterology 2017年第17期23卷 3174-3183页

作者： Francisco Baldaque-Silva Michael Vieth Mumen Debel Bengt Hakanson Anders Thorell Nuno Lunet Huan Song Miguel Mascarenhas-Saraiva Gisela Pereira Lars Lundell Hanns-Ulrich Marschall Institute of Medicine Karolinska InstitutetKarolinska University Hospital Department of Pathology Klinikum Bayreuth Department of Surgery Ersta Hospital Department of Clinical Sciences DanderydKarolinska Institutet Department of Clinical Epidemiology Predictive Medicine and Public HealthUniversity of Porto Medical School Department of Medical Epidemiology and Biostatistics Karolinska Institutet Department of Gastroenterology Manop H and Instituto CUF Clintec Karolinska InstitutetKarolinska University Hospital Department of Molecular and Clinical Medicine Sahlgrenska AcademyUniversity of Gothenburg

AIM To determine the impact of upwards titration of proton pump inhibition(PPI) on acid reflux, symptom scores and histology, compared to clinically successful *** Two cohorts of long-segment Barrett's esophagus(BE) patients were studied. In group 1(n = 24), increasing doses of PPI were administered in 8-wk intervals until acid reflux normalization. At each assessment, ambulatory 24 h p H recording, endoscopy with biopsies and symptom scoring(by a gastroesophageal reflux disease health related quality of life questionnaire, GERD/HRLQ) were performed. Group 2(n = 30) consisted of patients with a previous fundoplication. RESULTS In group 1, acid reflux normalized in 23 of 24 patients, resulting in improved GERD/HRQL scores(P = 0.001), which were most pronounced after the starting dose of PPI(P < 0.001). PPI treatment reached the same level of GERD/HRQL scores as after a clinically successful fundoplication(P = 0.5). Normalization of acid reflux in both groups was associated with reduction in papillary length, basal cell layer thickness, intercellular space dilatation, and acute and chronic inflammation of squamous epithelium. CONCLUSION This study shows that acid reflux and symptom scores co-vary throughout PPI increments in long-segment BE patients, especially after the first dose of PPI, reaching the same level as after a successful fundoplication. Minor changes were found among GERD markers at the morphological level.

关键词： Barrett’s esophagus Acid reflux Proton pump inhibitors Health related quality of life Gastroesophageal reflux Symptom control Antireflux surgery

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Candy cane syndrome:A systematic review

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World Journal of Gastrointestinal Endoscopy 2023年第7期15卷 510-517页

作者： Ricardo Rio-Tinto Jorge Canena Jacques Devière Digestive Oncology Unit Champalimaud FoundationLisbon 1600LisbonPortugal Centro de Gastrenterologia Hospital CUF Tejo-Nova Medical School/Faculdade de Ciências Médicas da UNLLisbon 1600LisbonPortugal Serviço de Gastrenterologia Hospital Amadora-SintraAmadora 1600LisbonPortugal Serviço de Gastrenterologia Hospital de Santo António dos Capuchos-CHLCLisbon 1600LisbonPortugal Cintesis-Center for Health Technology and Services Research Universidade do MinhoBraga 1600BragaPortugal Department of Gastroenterology Hepatopancreatologyand Digestive OncologyErasme Hospital-UniversitéLibre de BruxellesBrussels 1050BrusselsBelgium

BACKGROUND Candy cane syndrome(CCS)is a condition that occurs following gastrectomy or gastric *** remains underrecognized,yet its prevalence is likely to rise due to the obesity epidemic and increased use of bariatric *** previous literature review on this subject has been *** To collate the current knowledge on *** A literature search was conducted with PubMed and Google Scholar for studies from May 2007,until March *** bibliographies of the retrieved articles were manually searched for additional relevant *** Twenty-one articles were identified(135 patients).Abdominal pain,nausea/vomiting,and reflux were the most reported *** gastrointestinal(GI)series and endoscopy were performed for *** resection of the blind limb was performed in 13 studies with resolution of symptoms in 73%-100%.In surgical series,9 complications were reported with no *** study reported the surgical construction of a jejunal pouch with clinical *** studies described endoscopic approaches with 100%clinical success and no *** one case report,endoscopic dilation did not improve the patient’s *** CCS remains underrecognized due to lack of knowledge about this *** growth of the obesity epidemic worldwide and the increase in bariatric surgery are likely to increase its *** can be prevented if an elongated blind loop is avoided or if a jejunal pouch is constructed after total *** should be based on symptoms,endoscopy,and upper GI *** loop resection is curative but complex and associated with significant *** management using different approaches to divert flow is effective and should be further explored.

关键词： Candy cane syndrome Blind pouch syndrome Post-gastrectomy syndromes Side-to-side enteral anastomosis End-to-side enteral anastomosis

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Hyperbaric oxygen therapy as a complementary treatment for radiation proctitis:Useless or useful?-A literature review

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World Journal of Gastroenterology 2021年第27期27卷 4413-4428页

作者： Diogo Alpuim Costa Carla Espiney Amaro Ana Nunes Joana Santos Cardoso Pedro Modas Daniel Isabel Rosa João Vieira Branco Department of Haematology and Oncology CUF OncologiaLisboa 1998-018Portugal Centro de Medicina Subaquática e Hiperbárica(CMSH) Portuguese NavyLisboa 1649-020Portugal Centro de Investigação Naval(CINAV) Portuguese NavyBase Naval do AlfeiteAlmada 2810-001Portugal OVA Medical School Faculdade de Ciências MédicasLisboa 1169-056Portugal Department of Otorhinolaryngology Hospital das Forças Armadas(HFAR)Lisboa 1649-020Portugal Department of Gastroenterology Hospital das Forças Armadas(HFAR)Lisboa 1649-020Portugal Department of Vascular Surgery Centro Hospitalar Universitário de Lisboa CentralHospital de Santa MartaLisboa 1169-024Portugal Department of Intensive Care Unit Hospital das Forças Armadas(HFAR)Lisboa 1649-020Portugal Department of General Surgery Hospital das Forças Armadas(HFAR)Lisboa 1649-020Portugal

Radiotherapy(RT)is the backbone of multimodality treatment of more than half of cancer *** new modern RT techniques,late complications may occur such as radiation proctitis(RP).The natural history of RP is *** symptoms may resolve spontaneously or require conservative *** the other hand,for similar and uncomplicated clinical contexts,symptoms may persist and can even be refractory to the progressive increase in treatment *** the last decades,an enormous therapeutic armamentarium has been considered in RP,including hyperbaric oxygen therapy(HBOT).Currently,the evidence regarding the impact of HBOT on RP and its benefits is *** prospective and randomised studies are necessary to validate HBOT’s effectiveness in the‘real world’clinical *** article reviewed the relevant literature on pathophysiology,clinical presentation,different classifications and discuss RP management including a proposal for a therapeutic algorithm with a focus on HBOT.

关键词： Radiation proctitis Radiation proctopathy Radiotherapy Radio-induced lesion Late radiation tissue injury Delayed radiation injury Late sequelae Hyperbaric oxygen therapy Hyperbaric oxygen Review

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Essential role of small bowel capsule endoscopy in reclassification of colonic inflammatory bowel disease type unclassified

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World Journal of Gastrointestinal Endoscopy 2017年第1期9卷 34-40页

作者： Sara Monteiro Francisca Dias de Castro Pedro Boal Carvalho Bruno Rosa Maria Joao Moreira Rolando Pinho Miguel Mascarenhas Saraiva José Cotter Department of Gastroenterology Hospital da Senhora da Oliveira-Guimaraes ManopH-Endo-scopy and Digestive Motility Laboratory Portugal and cuf Institute School of Medicine University of Minho ICVS/3B’s PT Government Associate Laboratory

AIM To evaluate the role of small bowel capsule endoscopy(SBCE) on the reclassification of colonic inflammatory bowel disease type unclassified(IBDU).METHODS We performed a multicenter, retrospective study including patients with IBDU undergoing SBCE, between 2002 and 2014. SBCE studies were reviewed and the inflammatory activity was evaluated by determining the Lewis score(LS). Inflammatory activity was considered significant and consistent with Crohn's disease(CD) when the LS ≥ 135. The definitive diagnosis during follow-up(minimum 12 mo following SBCE) was based on the combination of clinical, analytical, imaging, endoscopic and histological *** Thirty-six patients were included, 21 females(58%) with mean age at diagnosis of 33 ± 13(15-64) years. The mean follow-up time after the SBCE was 52 ± 41(12-156) mo. The SBCE revealed findings consistent with significant inflammatory activity in the small bowel(LS ≥ 135) in 9 patients(25%); in all of them the diagnosis of CD was confirmed during follow-up. In 27 patients(75%), the SBCE revealed no significant inflammatory activity(LS < 135); among these patients, the diagnosis of Ulcerative Colitis(UC) was established in 16 cases(59.3%), CD in 1 case(3.7%) and 10 patients(37%) maintained a diagnosis of IBDU during follow-up. A LS ≥ 135 at SBCE had a sensitivity = 90%, specificity = 100%, positive predictive value = 100% and negative predictive value = 94% for the diagnosis of *** SBCE proved to be fundamental in the reclassification of patients with IBDU. Absence of significant inflammatory activity in the small intestine allowed exclusion of CD in 94% of cases.

关键词： Inflammatory bowel disease Inflammatory bowel disease type unclassified Capsule endoscopy Crohn’s disease Lewis score Reclassification

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Sleeve Gastrectomy with Duodenal Transit Bipartition (S-DTB): Preliminary Results and Technical Aspects of Its Metabolic Structure

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Surgical Science 2024年第4期15卷 244-264页

作者： Paulo Reis Esselin de Melo Ricardo Zorron Victor Ramos Mussa Dib Carlos Augusto Scussel Madalosso Rui Ribeiro Thonya Cruz Braga Paula Volpe Carlos Eduardo Domene Paulo Reis Institute Goiania GO Brazil Alfredo Nasser University Center (UNIFAN) Goiania GO Brazil Department of Bariatric and Metabolic Surgery CUF Descobertas Hospital Lisbon Portugal Victor Dib Institute Manaus AM Brazil Gastrobese Clinic Passo Fundo RS Brazil Lusiadas Amadora hospital Lisbon Portugal Clianest Group Renaissance Hospital Goiania GO Brazil Integrated Center for Advanced Medicine (CIMAMED) Sao Paulo Brazil

Obesity is a significant and escalating health issue both in Brazil and globally, with over 650 million overweight adults worldwide. The treatment of obesity can be performed clinically, endoscopically or surgically;surgical treatment proves to be safe and more effective in terms of weight loss and long-term maintenance. Objective: This study aimed to monitor the progress of weight loss and comorbidity control in patients undergoing sleeve gastrectomy with duodenal bipartition. Methods: This pilot project involved 8 patients divided into 2 arms. In the first arm, patients underwent sleeve gastrectomy with Roux-en-Y duodenoileal transit bipartition (S-RYDITB), while in the second arm, patients underwent sleeve gastrectomy with Roux-en-Y duodenojejunal transit bipartition (S-RYDJTB). Both procedures involved Roux-en-Y reconstruction without duodenal exclusion. In S-RYDITB, the duodenal-ileal anastomosis was performed 300 cm from the ileocecal valve (ICV), creating a 250 cm common channel and a 50 cm alimentary channel. In S-RYDJTB, a biliopancreatic loop was created 200 cm from the angle of Treitz, with a 1 m alimentary channel. Results: Five patients underwent the procedures, with one undergoing S-RYDITB and four undergoing S-RYDJTB. No adverse events such as hospitalizations, readmissions, reoperations, fistulas, bleeding, pulmonary embolism, diarrhea, dumping syndrome, or hypoglycemia occurred during the study period. The mean length of hospital stay was 2 days. The average BMI decreased from 37.27 kg/m2 preoperatively to 29.48 kg/m2 after 6 months. The significant percentage of weight loss was 21.22%, with excess weight loss of 63.6%. Ninety-five percent remission of comorbidities, including hypercholesterolemia, hypertriglyceridemia, diabetes, hypertension, steatosis, and pre-diabetes. Two patients underwent sleeve gastrectomy with duodenal bipartition using a single anastomosis. Conclusion: Duodenal switch surgery has gained worldwide recog

关键词： Obesity Bariatric Surgery Metabolic Surgery Duodenal Switch

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