Papers by Francisco Perez-Roldan
The Lancet Gastroenterology & Hepatology, Apr 1, 2022
BACKGROUND Endoscopic balloon dilation (EBD) is the established endoscopic treatment for short st... more BACKGROUND Endoscopic balloon dilation (EBD) is the established endoscopic treatment for short strictures in Crohn's disease. Fully covered self-expandable metal stents (FCSEMS) have been used for endoscopic treatment of patients for whom EBD was unsuccessful. We aimed to determine the efficacy and safety of the two endoscopic treatments in patients with Crohn's disease with stenosis and compare the mean cost of both treatments. METHODS This multicentre, open-label, randomised trial was done in 19 tertiary and secondary hospitals in Spain. Patients with Crohn's disease with obstructive symptoms and predominantly fibrotic strictures of less than 10 cm in length were eligible for inclusion. We excluded patients with stenosis treated with SEMS or EBD in the previous year and stenosis not accessible to a colonoscope. Patients were randomly assigned (1:1) to receive either EBD (EBD group) or FCSEMS (FCSEMS group) using a digital en-block randomisation system (block size of four). In the EBD group, dilation was done with a CRE Boston Scientific (Marlborough, MA, USA) pneumatic balloon with the diameter set at the discretion of the endoscopist; a maximum of two sessions of dilation were allowed with a minimum interval of 15-30 days between them. In the FCSEMS group, a 20 mm diameter Taewoong (Gimpo-si, South Korea) fully covered metal stent was placed; stent length was set at the discretion of the endoscopist. The primary outcome was to assess the efficacy of the endoscopic treatment, defined by the proportion of patients free of a new therapeutic intervention (EBD, FCSEMS, or surgery) due to symptomatic recurrence at 1 year of follow-up. Patients were analysed according to the intention-to-treat principle. Adverse events were recorded for all the patients; events were considered associated to be with the procedure when a causal association was possible, probable, or definite. This trial is registered with ClinicalTrials.gov, NCT02395354. FINDINGS From Aug 28, 2013, to Oct 9, 2017, we assessed the eligibility of 99 patients, of whom 19 (19%) patients were excluded. Thus, 80 (81%) patients were randomly assigned to treatment: 39 (49%) patients to the FCSEMS group and 41 (51%) patients to the EBD group. 33 (80%) of 41 patients in the EBD group and 20 (51%) of 39 patients in the FCSEMS group were free of a new therapeutic intervention at 1 year (odds ratio [OR] 3·9 [95% CI 1·4-10·6]; p=0·0061). Two (3%) of 80 patients had severe adverse events (one [2%] patient in the EBD group and one [3%] patient in the FCSEMS group); both patients had perforations. INTERPRETATION EBD is more effective than FCSEMS for Crohn's disease strictures, with a good safety profile for both treatments. FUNDING Spanish National Institute of Health, Foundation of Spanish Society of Digestive Endoscopy, Catalan Society of Gastroenterology, and Taweoong.
PubMed, Feb 1, 1995
We report the case of a 68-year-old male HVC+ diagnosed as cholestatic hepatitis induced by glybe... more We report the case of a 68-year-old male HVC+ diagnosed as cholestatic hepatitis induced by glybenclamide, following a non-insulin dependent diabetes mellitus treatment. When the drug was discontinued normal analytic parameters were obtained. However, HVC may induce more cholestatic and cytolysic changes on the hepatitis due to glybenclamide. When reviewing the literature only one similar case has been previously reported, although several disturbances in liver function tests have been described in other reports. Routine biochemical tests including liver function are indicated in patients receiving antidiabetic agents in order to make an early diagnosis of liver toxicity.
The Journal of emergency medicine, 2012
A 79-year-old woman was sent to the Emergency Department with intense abdominal pain after diagno... more A 79-year-old woman was sent to the Emergency Department with intense abdominal pain after diagnostic colonoscopy. Examination revealed marked abdominal distension with intense pain on both flanks. Postcolonoscopy complication was suspected, and plain radiographs were taken with the patient in decubitus position because she was too weak to assume other positions. The abdominal radiograph (Figure 1) revealed the football sign, the Rigler sign (with several intestinal loops clearly visible as a result of the colonoscopy), and the telltale triangle sign. These data were indicative of massive pneumoperitoneum. The chest radiograph (Figure 2) revealed extensive hyperlucency on the hepatic parenchyma, and the ligamentum teres was clearly visible. The patient underwent surgery, which revealed a perforation 5 cm in length on the anterior aspect of the sigmoid colon. Repair was by primary suture.
The New England Journal of Medicine, Jan 20, 2005
(183.0 µmol per liter). The serum was positive for hepatitis B surface antigen (HBsAg), hepatitis... more (183.0 µmol per liter). The serum was positive for hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), IgM antibodies against the HBV core antigen (anti-HBc), and HBV DNA. Other liv-er diseases were ruled out, including infiltrative dis-ease. The results of ...
Pancreatology, Jun 1, 2015
The aim of this study was to analyse the impact of this approach with regard to technical feasibi... more The aim of this study was to analyse the impact of this approach with regard to technical feasibility and overall postoperative outcome. Patients & methods: 32 patients who underwent a BioGlue ® sealed hand sutured fish-mouth closure of the pancreatic remnant during distal pancreatectomy between 2012 and 2014 at our institution were analysed for clinically relevant postoperative pancreatic fistula formation (Grade B and C according to ISGPF definition) and overall postoperative morbidity (according to Clavien). Results: 3 out of 32 patients (9.4 %) developed a grade B pancreatic fistula, which could all be treated conservatively. No grade C pancreatic fistulas were observed. A postpancreatectomy haemorrhage occurred in 1 patient (3.1 %). Overall postoperative complications > Clavien II were observed in 5 patients (15.6 %). There was no postoperative mortality. Conclusion: The performance of a BioGlue ® sealed hand sutured fishmouth closure of the pancreatic remnant was shown to be technically feasible and may lead to a significant decrease of postoperative pancreatic fistula formation after distal pancreatectomy. Based on the findings of this study a clinical trial was designed in which a possible benefit of this novel approach will be evaluated in a prospective randomized study design.
InTech eBooks, Nov 7, 2011
Gastrointestinal Endoscopy, May 1, 2016
with aggravation of preexisting pancreatitis) and 1 aggravation of cholangitis in PSC despite ant... more with aggravation of preexisting pancreatitis) and 1 aggravation of cholangitis in PSC despite antimicrobial prophylaxis. PEP was noted in 0 of 6 children with protective pancreatic stents vs. 4/43 without pancreatic stents. All complications were managed conservatively. No complications were attributed to mechanical stress on the GI tract. Discussion: ERCP in children only accounted for 3.3% of our ERCP caseload. Endoscopists must be aware of differing spectrum of pediatric biliary and pancreatic diseases. We underline this point by including the endoscopist and the pediatrician in the ERCP room. Failed cannulation was associated with small dimensions of young children. Accessories for small caliber duodenoscopes are limited, as is navigation at the papilla in babies. Complications were similar to rates reported in adults. Rectal NSAIDs in children were not yet standard in our cohort, but may be considered. Protective pancreatic stents were helpful but necessitate a second endoscopy or plain abdominal radiograph for stent removal or proof of spontaneous passage. In summary, ERCP in children appears to be safe and effective in selected indications. Close collaboration between endoscopists and pediatricians is necessary.
Gastroenterología y Hepatología, 2021
BACKGROUND AND STUDY AIMS Data from Japanese series show that surface morphology of laterally spr... more BACKGROUND AND STUDY AIMS Data from Japanese series show that surface morphology of laterally spreading tumors (LST) in the colon identifies lesions with different incidence and pattern of submucosal invasion. Such data from western countries are scarce. We compared clinical and histological features of LST in a western country and an eastern country, with special interest on mucosal invasiveness of LST, and investigated the effect of clinical factors on invasiveness in both countries. PATIENTS AND METHODS Patients with LST lesions ≥20mm were included from a multicenter prospective registry in Spain and from a retrospective registry from the National Cancer Center Hospital East, Japan.The primary outcome was the presence of submucosal invasion in LST. The secondary outcome was the presence of high-risk histology, defined as high-grade dysplasia or submucosal invasion. RESULTS We evaluated 1102 patients in Spain and 663 in Japan. Morphological and histological characteristics differed. The prevalence of submucosal invasion in Japan was six-fold the prevalence in Spain (Prevalence Ratio PR=5.66; 95%CI:3.96,8.08), and the prevalence of high-risk histology was 1.5 higher (PR=1.44; 95%CI:1.31,1.58). Compared to the granular homogeneous type and adjusted by clinical features, granular mixed, flat elevated, and pseudo-depressed types were associated with higher odds of submucosal invasion in Japan, whereas only the pseudo-depressed type showed higher risk in Spain. Regarding high-risk histology, both granular mixed and pseudo-depressed were associated with higher odds in Japan, compared with only the granular mixed type in Spain. CONCLUSION This study reveals differences in location, morphology and invasiveness of LST in an eastern and a western cohort.
Gastrointestinal Endoscopy, 2020
Objectiv: The New oral anticoagulant drugs (NOACs) have been used increasingly as alternatives to... more Objectiv: The New oral anticoagulant drugs (NOACs) have been used increasingly as alternatives to vitamin K agonists (VKAs) in prevention and management for various cardiovascular diseases. NOACs were known to be associated with an increased risk of gastrointestinal (GI) bleeding compared with VKAs. However, the etiologies and clinical courses remains still unknown. Thus, we aimed to evaluate in detail the clinical and endoscopic features of these anticoagulant-related GI bleeding and to assess the severity and disease courses after these events. Methods: This multicentre, retrospective cohort study included 381 subjects taking anticoagulants who underwent endoscopic due to overt GI bleeding between January 2014 and October 2017. Characteristics and clinical outcomes were compared between those with VKAs and NOACs. Results: Of 381 patients, a total 144 patients were prescribed NOACs and 237 patients were warfarin. Patients with NOACs were older than those with VKAs (mean age; 77.9AE7.8 vs.73.3AE11.9 years). With respect to the characteristics of GI bleeding, the proportion of vascular lesion was significantly lower in those with NOACs compared to those with VKAs (15.5% vs. 25.5%, PZ0.038). Bleeding in small bowel occurred lesser frequent in patients with NOACs, but did not reach a statistical significance (12.3% vs. 20.4%). As for clinical outcomes, patients with NOACs received a significantly small number of blood transfusions than those with VKAs (2.1AE0.3 vs. 3.1AE0.2, PZ0.009). Additionally, rebleeding was lesser common in patients with NOACs compared to those with VKAs (odds ratioZ0.42; PZ0.007). Conclusion: Patients with NOACs have different clinical or endoscopic features of GI bleeding compared to those with VKAs. The patients who experienced GI bleeding while taking NOACs show better clinical outcomes in aspect to severity or rebleeding.
Gastrointestinal Endoscopy, 2019
risk-scoring systems to predict risk of delayed bleeding after endoscopic mucosal resection of la... more risk-scoring systems to predict risk of delayed bleeding after endoscopic mucosal resection of large colorectal lesions,
Gastroenterología y Hepatología, 2006
Portal hypertension and enterostomy: a dangerous combination. Colostomy-induced varices as a rare... more Portal hypertension and enterostomy: a dangerous combination. Colostomy-induced varices as a rare cause of gastrointestinal hemorrhage. Report of a case and review of the literature.
Scandinavian Journal of Gastroenterology, 2003
There is very little information available on the incidence of complications and on the best prev... more There is very little information available on the incidence of complications and on the best prevention therapy in high-risk patients taking non-steroidal anti-inflammatory drugs (NSAIDs) and/or aspirin. Randomized-controlled trials in such patients are rare for ethical reasons. We studied the incidence of gastrointestinal complications in high-risk patients taking long-term low-dose aspirin or non-aspirin-NSAIDs combined with omeprazole in a real-life clinical setting. This was a multicentre, prospective and observational study including 247 consecutive high-risk patients who had a clinical indication for long-term treatment with either low-dose aspirin or non-aspirin NSAIDs and omeprazole therapy. The occurrence of gastrointestinal complications was measured. In addition to a recent history of peptic ulcer bleeding, all patients had at least 1 other risk factor and 112 (45.3%) had 3 or more risk factors; 78.9% were taking low-dose aspirin and the remainder non-aspirin NSAIDs. Mean follow-up was 14.6 +/- 10.38 months. Three patients taking low-dose aspirin developed upper gastrointestinal bleeding (1.2%; 95% CI 0.3-3.5; 1.0 event/100 patients/year). This was similar to the rate observed in studies involving non-high-risk patients taking low-dose aspirin and higher than that observed in patients not taking low-dose aspirin. Two additional patients developed a lower gastrointestinal bleeding event (0.81% (0.04%-3.12%); 0.67 events/100 patients/year), which was within the range expected in NSAID users. The use of omeprazole in the high-risk patient taking low-dose aspirin or NSAIDs seems to be a safe therapeutic approach in this population and is associated with a low frequency of upper gastrointestinal complications.
Gastrointestinal Endoscopy, 2013
Gastrointestinal Endoscopy, 2013
Alimentary Pharmacology & Therapeutics, 2012
SummaryBackgroundBalloon dilation (with or without steroid injection) is the endoscopic treatment... more SummaryBackgroundBalloon dilation (with or without steroid injection) is the endoscopic treatment of choice for short strictures in Crohn's disease (CD). The placement of a stent has only rarely been reported in this setting, and it may be a good alternative.AimTo describe the efficacy of temporary placement of a self‐expanding metallic stent (SEMS) in the endoscopic treatment of symptomatic strictures in CD.MethodsWe included 17 CD patients treated with SEMS (4 partially covered SEMS and 21 fully covered SEMS) for symptomatic strictures refractory to medical and/or endoscopic treatment.ResultsWe placed 25 stents in 17 patients with stenosis (<8 cm), in the colon and in the ileocolonic anastomosis. In two cases, two stents were placed in the same endoscopic procedure. All except three cases had previously been unsuccessfully treated with endoscopic dilatation. The stents were maintained for an average of 28 days (1–112). The treatment was effective in 64.7% of the patients af...
41 Congreso de la Sociedad Española de Endoscopia Digestiva (SEED), 2019
Revista Española de Enfermedades Digestivas, 2009
Background: recent advances in endoscopy have enabled us to explore the small intestine more effi... more Background: recent advances in endoscopy have enabled us to explore the small intestine more efficiently, both with capsule endoscopy and double-balloon enteroscopy. However, these methods are not available in all hospitals. Therefore, when capsule endoscopy reveals proximal jejunal lesions, a possible alternative for treatment could involve push enteroscopy combined with colonoscopy. Lesions can thus be marked for subsequent monitoring. Objectives: to describe the efficacy of pediatric colonoscopy for diagnosis, the marking of the area explored, and therapeutic options. Material and methods: between October 2007 and September 2008 a total of 21 enteroscopies were performed using a pediatric colonoscope. Nine of these were used to take jejunal biopsy samples due to suspected disease of the mucosa. In 10 of the remaining 12, capsule endoscopy revealed lesions (vascular malformations or jejunal bleeding), and in 2 intestinal transit time was analyzed due to suspected jejunal stenosis. We used a PEN-TAX EC-3470-LK pediatric colonoscope, whose 11.6-mm sectional diameter and 3.8-mm working channel make it possible to administer all the usual endoscopic treatments. Results: therapeutic endoscopy was performed on 7 men and 5 women (mean age 63.3 years). Jejunal lesions were observed in 10 cases (5 cases of angiodysplasia, 2 cases of jejunal stenosis, 1 case of nonmalignant thickened jejunal folds, 1 eroded submucosal tumor, and 1 case of duodenal and jejunal varices). The most distal area was marked with India ink (2), hemoclips (4), or both to help locate the lesions using simple abdominal radiography or capsule endoscopy. Conclusions: jejunal enteroscopy enabled a firm diagnosis to be made in most of the patients studied. We were able to treat 58% of patients and mark the areas explored for subsequent follow-up. With hemoclips we were able to locate the most distal point explored using simple abdominal radiography.
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Papers by Francisco Perez-Roldan