Pub Date : 2023-08-11eCollection Date: 2023-11-01DOI: 10.1159/000531409
Jéssica Chaves, Diogo Libânio
{"title":"Do Not Miss the Diagnosis: Not All Pink Findings Mean the Same in the Gastrointestinal Tract!","authors":"Jéssica Chaves, Diogo Libânio","doi":"10.1159/000531409","DOIUrl":"10.1159/000531409","url":null,"abstract":"","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10619998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71428998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-10eCollection Date: 2024-06-01DOI: 10.1159/000531396
João Correia, Andreia Freitas, António Marinho, Ana Ponte, Edgar Afecto, Manuela Estevinho
Common variable immunodeficiency enteropathy is a sprue-like disease, which may manifest as a severe malabsorption syndrome with nutritional deficits and cachexia. The authors report a case of a 33-year-old Afghan man, who presented to the emergency department due to chronic watery diarrhea and severe malnourishment. He had been previously misdiagnosed with celiac disease in his early adulthood; however, this was based on inconclusive findings. After a thorough diagnostic workup, the final diagnosis of common variable immunodeficiency enteropathy with symptomatic norovirus infection of the gut was obtained during his prolonged hospitalization. A slow but progressive improvement was observed with immunoglobulin replacement therapy, corticotherapy, and ribavirin treatment. This is a noteworthy case of a rare malabsorption disorder, and it reviews important aspects concerning the differential diagnosis of small bowel villous atrophy of unknown etiology, as well as gastrointestinal manifestations of common variable immunodeficiency disorder.
{"title":"Small Bowel Villous Atrophy in a Young Patient: A Challenging Diagnosis.","authors":"João Correia, Andreia Freitas, António Marinho, Ana Ponte, Edgar Afecto, Manuela Estevinho","doi":"10.1159/000531396","DOIUrl":"10.1159/000531396","url":null,"abstract":"<p><p>Common variable immunodeficiency enteropathy is a sprue-like disease, which may manifest as a severe malabsorption syndrome with nutritional deficits and cachexia. The authors report a case of a 33-year-old Afghan man, who presented to the emergency department due to chronic watery diarrhea and severe malnourishment. He had been previously misdiagnosed with celiac disease in his early adulthood; however, this was based on inconclusive findings. After a thorough diagnostic workup, the final diagnosis of common variable immunodeficiency enteropathy with symptomatic <i>norovirus</i> infection of the gut was obtained during his prolonged hospitalization. A slow but progressive improvement was observed with immunoglobulin replacement therapy, corticotherapy, and ribavirin treatment. This is a noteworthy case of a rare malabsorption disorder, and it reviews important aspects concerning the differential diagnosis of small bowel villous atrophy of unknown etiology, as well as gastrointestinal manifestations of common variable immunodeficiency disorder.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84201444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-03eCollection Date: 2023-12-01DOI: 10.1159/000530836
Filipe S Cardoso, Rui Perdigoto, Jorge Lamelas, João S Coelho, Hugo Pinto Marques, Luís Bagulho
{"title":"Acute-on-Chronic Liver Failure Remains a Minor Indication for Liver Transplant in Portugal.","authors":"Filipe S Cardoso, Rui Perdigoto, Jorge Lamelas, João S Coelho, Hugo Pinto Marques, Luís Bagulho","doi":"10.1159/000530836","DOIUrl":"10.1159/000530836","url":null,"abstract":"","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10697745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74858941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-02eCollection Date: 2024-02-01DOI: 10.1159/000531397
Mariana Verdelho Machado
Liver cancer is globally the third leading cause of death from cancer. Hepatocellular carcinoma (HCC) develops in patients with underlying liver disease. The fraction of HCC attributed to nonalcoholic fatty liver disease (NAFLD) shows an accelerated increase in the last decades, being already responsible for 15% of all HCC cases. Similar to other causes of liver cirrhosis, patients with NAFLD-associated cirrhosis should be enrolled in HCC-screening programs, yet these patients are under-screened, and currently are less than half likely to be proposed for HCC screening as compared to patients with HCV-associated cirrhosis. NAFLD-associated HCC has the peculiarity of occurring in precirrhotic phases in 20-50% of the cases. Currently, HCC screening in precirrhotic NAFLD patients is not routinely recommended, since the risk of developing HCC is very low. However, because NAFLD affects one-third of the worldwide population, noncirrhotic NAFLD already accounts for 6% of HCC cases. As such, it is pressing to develop stratification tools, in order to personalize the individual risk of HCC development in a patient with NAFLD, allowing precision HCC-screening programs. This review summarizes the epidemiology of NAFLD-associated HCC with a critical analysis of current HCC-screening recommendations.
{"title":"The Growing Landscape of NAFLD-Associated Hepatocellular Carcinoma and Its Impact in Surveillance.","authors":"Mariana Verdelho Machado","doi":"10.1159/000531397","DOIUrl":"10.1159/000531397","url":null,"abstract":"<p><p>Liver cancer is globally the third leading cause of death from cancer. Hepatocellular carcinoma (HCC) develops in patients with underlying liver disease. The fraction of HCC attributed to nonalcoholic fatty liver disease (NAFLD) shows an accelerated increase in the last decades, being already responsible for 15% of all HCC cases. Similar to other causes of liver cirrhosis, patients with NAFLD-associated cirrhosis should be enrolled in HCC-screening programs, yet these patients are under-screened, and currently are less than half likely to be proposed for HCC screening as compared to patients with HCV-associated cirrhosis. NAFLD-associated HCC has the peculiarity of occurring in precirrhotic phases in 20-50% of the cases. Currently, HCC screening in precirrhotic NAFLD patients is not routinely recommended, since the risk of developing HCC is very low. However, because NAFLD affects one-third of the worldwide population, noncirrhotic NAFLD already accounts for 6% of HCC cases. As such, it is pressing to develop stratification tools, in order to personalize the individual risk of HCC development in a patient with NAFLD, allowing precision HCC-screening programs. This review summarizes the epidemiology of NAFLD-associated HCC with a critical analysis of current HCC-screening recommendations.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10836954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90100331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-26eCollection Date: 2023-12-01DOI: 10.1159/000531270
Rui Caetano Oliveira, Susana Rodrigues, Joana Espírito Santo, On Behalf Of Hepatologia Em Rede
{"title":"\"Hepatologia em Rede\": A Portuguese Association for the Study of the Liver (APEF) Initiative for the Improvement of Research in Liver Disease in Portugal.","authors":"Rui Caetano Oliveira, Susana Rodrigues, Joana Espírito Santo, On Behalf Of Hepatologia Em Rede","doi":"10.1159/000531270","DOIUrl":"10.1159/000531270","url":null,"abstract":"","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10697756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77589449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-26eCollection Date: 2024-06-01DOI: 10.1159/000531380
Fábio Pereira Correia, Luísa Martins Figueiredo, Luís Carvalho Lourenço, Sofia Santos, Rita Theias Manso, David Horta
Gastrointestinal tuberculosis is an uncommon entity, in which clinical presentation can be widely variable, from mild and nonspecific symptoms to an acute abdomen and gastrointestinal bleeding. Gastric involvement by Mycobacterium tuberculosis is rare, especially when it occurs without other recognized infectious foci - primary gastric tuberculosis - with only a few reported cases. Endoscopic findings can be very heterogeneous, from areas of hyperemia to pseudotumor lesions. We present a case of primary gastric tuberculosis in an immunocompetent patient, in which the absence of an epidemiological context and nonspecific endoscopic findings led to a delay in the diagnosis. Bite-on-bite biopsies proved to be essential, allowing to obtain samples from deeper layers of the submucosa where M. tuberculosis was identified. This case aimed to increase awareness for this entity, especially in endemic countries or regions with a high prevalence of tuberculosis since the diagnosis is based mainly on a high index of suspicion.
{"title":"Primary Gastric Tuberculosis in an Immunocompetent Patient: The Truth Lying beneath the Surface.","authors":"Fábio Pereira Correia, Luísa Martins Figueiredo, Luís Carvalho Lourenço, Sofia Santos, Rita Theias Manso, David Horta","doi":"10.1159/000531380","DOIUrl":"10.1159/000531380","url":null,"abstract":"<p><p>Gastrointestinal tuberculosis is an uncommon entity, in which clinical presentation can be widely variable, from mild and nonspecific symptoms to an acute abdomen and gastrointestinal bleeding. Gastric involvement by <i>Mycobacterium tuberculosis</i> is rare, especially when it occurs without other recognized infectious foci - primary gastric tuberculosis - with only a few reported cases. Endoscopic findings can be very heterogeneous, from areas of hyperemia to pseudotumor lesions. We present a case of primary gastric tuberculosis in an immunocompetent patient, in which the absence of an epidemiological context and nonspecific endoscopic findings led to a delay in the diagnosis. Bite-on-bite biopsies proved to be essential, allowing to obtain samples from deeper layers of the submucosa where <i>M. tuberculosis</i> was identified. This case aimed to increase awareness for this entity, especially in endemic countries or regions with a high prevalence of tuberculosis since the diagnosis is based mainly on a high index of suspicion.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83267399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-21eCollection Date: 2023-09-01DOI: 10.1159/000531271
Joel Ferreira-Silva, Diogo Libânio, Eduardo Rodrigues-Pinto
In recent years, considerable strides have been made in therapeutic endoscopy and specifically in stent technology to overcome strictures and fistulas. As such, several types of devices with advanced designs and materials are continuously being developed, and this evolution has helped expand the applications of therapeutic endoscopy to new horizons. The best example of this is the use of lumen-apposing metal stents (LAMS) in therapeutic endoscopic ultrasound (EUS), allowing for the endoscopic treatment of pancreaticobiliary and luminal disease previously reserved for surgical or percutaneous treatment. Thinking outside the box and using new devices to seal fistulas that cannot be managed with conventional endoscopic devices is also sometimes needed. While exciting, this continuing evolution and the growing number of therapeutic endoscopy applications may present a challenge for gastroenterologists to keep updated with the state of the art. This special issue ofGE – Portuguese Journal of Gastroenterology is dedicated to therapeutic endoscopy including 8 articles that provide further evidence of the safety, feasibility, and favorable outcomes of different applications of stents and similar devices in endoscopic therapeutic procedures, in particular the application of stents in therapeutic ultrasound endoscopy, luminal stenting, and treatment of leaks, perforations, and fistulas. The review articles also include several technical tips and tricks from experts that can clearly be helpful to the majority of endoscopists. Canakis and Baron [1] performed a review article focused on current indications and innovations in therapeutic EUS. The therapeutic role of EUS has evolved to become a complementary technique to endoscopic retrograde cholangiopancreatography (ERCP) to provide adequate drainage in patients with pancreatic and biliary
{"title":"Luminal and Extraluminal Applications of Endoscopic Stenting: A Bright Future for Gastroenterology.","authors":"Joel Ferreira-Silva, Diogo Libânio, Eduardo Rodrigues-Pinto","doi":"10.1159/000531271","DOIUrl":"10.1159/000531271","url":null,"abstract":"In recent years, considerable strides have been made in therapeutic endoscopy and specifically in stent technology to overcome strictures and fistulas. As such, several types of devices with advanced designs and materials are continuously being developed, and this evolution has helped expand the applications of therapeutic endoscopy to new horizons. The best example of this is the use of lumen-apposing metal stents (LAMS) in therapeutic endoscopic ultrasound (EUS), allowing for the endoscopic treatment of pancreaticobiliary and luminal disease previously reserved for surgical or percutaneous treatment. Thinking outside the box and using new devices to seal fistulas that cannot be managed with conventional endoscopic devices is also sometimes needed. While exciting, this continuing evolution and the growing number of therapeutic endoscopy applications may present a challenge for gastroenterologists to keep updated with the state of the art. This special issue ofGE – Portuguese Journal of Gastroenterology is dedicated to therapeutic endoscopy including 8 articles that provide further evidence of the safety, feasibility, and favorable outcomes of different applications of stents and similar devices in endoscopic therapeutic procedures, in particular the application of stents in therapeutic ultrasound endoscopy, luminal stenting, and treatment of leaks, perforations, and fistulas. The review articles also include several technical tips and tricks from experts that can clearly be helpful to the majority of endoscopists. Canakis and Baron [1] performed a review article focused on current indications and innovations in therapeutic EUS. The therapeutic role of EUS has evolved to become a complementary technique to endoscopic retrograde cholangiopancreatography (ERCP) to provide adequate drainage in patients with pancreatic and biliary","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10618961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71428997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-19eCollection Date: 2024-06-01DOI: 10.1159/000531135
Ana Craciun, Inês Botto, João Lopes, Miguel Moura, Sofia Carvalhana, Helena Cortez-Pinto, Rui Tato Marinho
Background and objectives: Endoscopic band ligation (EBL) plays a critical role in patients with clinically significant portal hypertension, as variceal eradication (VE) is essential to prevent further variceal upper gastrointestinal bleeding (GI). The emergence of COVID-19 has led to a dramatic reduction in endoscopic activity. Our study aimed to evaluate the effect of COVID-19 on VE, GI, and 6-month mortality of patients treated with prophylactic EBL therapy. In addition, our goal was to identify the risk factors for our proposed outcomes.
Methods: A single-center retrospective cohort study included patients with esophageal varices treated with prophylactic EBL therapy between 2017 and 2021. To demonstrate the impact of COVID-19 on two independent groups on prophylactic EBL therapy with 1 year of follow-up, March 2019 was selected as the cut-off date. Clinical, laboratory, and endoscopic data were recovered from electronic reports.
Results: Ninety-seven patients underwent 398 prophylactic EBL sessions, 75 men (77.3%) with mean age 59 ± 12 years. Most achieved VE (60.8%), 14.4% had GI bleeding post-therapy, and 15.5% died at 6 months. The rate of variceal obliteration was significantly lower in the pandemic group (40.9% vs. 77.4% in the pre-pandemic group, p = 0.001). Mean number of EBL sessions and pandemic group were independently associated with incomplete VE, while MELD-Na, portal vein thrombosis and failed VE were identified as risk factors associated with mortality at 6 months.
Conclusions: Almost 60% of patients in the pandemic group failed to eradicate esophageal varices. Failure to achieve this result conferred a higher risk of GI bleeding and death at 6 months, the latter also significantly associated with the MELD-Na score and portal vein thrombosis. Our study is among the first to demonstrate the impact of COVID-19 in patients receiving prophylactic EBL therapy.
{"title":"Influence of COVID-19 on Patients with Esophageal Varices under Prophylactic Endoscopic Band Ligation Therapy.","authors":"Ana Craciun, Inês Botto, João Lopes, Miguel Moura, Sofia Carvalhana, Helena Cortez-Pinto, Rui Tato Marinho","doi":"10.1159/000531135","DOIUrl":"10.1159/000531135","url":null,"abstract":"<p><strong>Background and objectives: </strong>Endoscopic band ligation (EBL) plays a critical role in patients with clinically significant portal hypertension, as variceal eradication (VE) is essential to prevent further variceal upper gastrointestinal bleeding (GI). The emergence of COVID-19 has led to a dramatic reduction in endoscopic activity. Our study aimed to evaluate the effect of COVID-19 on VE, GI, and 6-month mortality of patients treated with prophylactic EBL therapy. In addition, our goal was to identify the risk factors for our proposed outcomes.</p><p><strong>Methods: </strong>A single-center retrospective cohort study included patients with esophageal varices treated with prophylactic EBL therapy between 2017 and 2021. To demonstrate the impact of COVID-19 on two independent groups on prophylactic EBL therapy with 1 year of follow-up, March 2019 was selected as the cut-off date. Clinical, laboratory, and endoscopic data were recovered from electronic reports.</p><p><strong>Results: </strong>Ninety-seven patients underwent 398 prophylactic EBL sessions, 75 men (77.3%) with mean age 59 ± 12 years. Most achieved VE (60.8%), 14.4% had GI bleeding post-therapy, and 15.5% died at 6 months. The rate of variceal obliteration was significantly lower in the pandemic group (40.9% vs. 77.4% in the pre-pandemic group, <i>p</i> = 0.001). Mean number of EBL sessions and pandemic group were independently associated with incomplete VE, while MELD-Na, portal vein thrombosis and failed VE were identified as risk factors associated with mortality at 6 months.</p><p><strong>Conclusions: </strong>Almost 60% of patients in the pandemic group failed to eradicate esophageal varices. Failure to achieve this result conferred a higher risk of GI bleeding and death at 6 months, the latter also significantly associated with the MELD-Na score and portal vein thrombosis. Our study is among the first to demonstrate the impact of COVID-19 in patients receiving prophylactic EBL therapy.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11095607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82078992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-19eCollection Date: 2024-08-01DOI: 10.1159/000531234
Maria Ana Rafael, Cristiana Sequeira, Sónia Isabel da Silva Barros, Bárbara Silva Abreu, Cristina Teixeira, Pierre Lahmek, Marine Besnard, Bruno Lesgourgues
Introduction: The outbreak of coronavirus disease 2019 (COVID-19) had affected clinical practice in several ways, including the restriction of nonessential endoscopic procedures. Therefore, our aim was to evaluate how colorectal cancer (CRC) diagnosis and management was affected during the first year of pandemics in Portugal.
Methods: This is a Portuguese substudy of the French retrospective multicentric study ETICC (Etude de l'Impact de la pandémie COVID-19 sur le diagnostic et la prise en charge du Cancer Colorectal). We compared patients' characteristics, clinical manifestations, CRC staging at diagnosis, delay to first medical appointment, histological diagnosis, surgical and medical treatments between the year previous to the pandemics (control) and the first year of pandemics.
Results: We included 766 patients: 496 in the control group and 270 in the COVID group. There was no significant difference in CRC staging at diagnosis between both groups, with 21% being diagnosed as metastatic in the control group and 22% in the first year of pandemics (p = 0.770). Contrary to what happened in France, there was a significant decrease in CRC diagnosis in asymptomatic patients (25-8.4%; p < 0.001) and after a positive fecal immunochemical test (20.8-11.3%; p = 0.002) during the pandemics. Although the increase in the overall complication rate at diagnosis was nonsignificant, in Portugal, there was a significant increase in diagnosis of abdominal occlusion (12.1-18.1%; p = 0.033). In Portugal, time between the beginning of symptoms and the first medical appointment significantly increased from a median of 50 days to 64 days during COVID (p < 0.001). On the contrary, time between histological diagnosis and tumor resection had significantly decreased from a median of 65 to 39 days (p < 0.001). Time between histological diagnosis and neoadjuvant treatment was not statistically different (median of 64-67 days; p = 0.590), as was time between histological diagnosis and palliative chemotherapy (median of 50-51 days; p = 1.000). Time from CRC resection and adjuvant treatment has significantly decreased from a median of 54 to 43 days (p = 0.001).
Discussion: We found a significant impact in CRC diagnosis in the first year of pandemics, more pronounced than what was found in France. These are likely related not only with the closing of endoscopy units but also with the difficulties patients had in finding an appointment with their general practitioners. On the other hand, both in France and Portugal, the first year of pandemics did not worsen CRC staging at diagnosis and did not significantly affect medical and surgical treatments once the diagnosis was made.
导言:冠状病毒病 2019(COVID-19)的爆发在多个方面影响了临床实践,包括限制非必要的内窥镜手术。因此,我们的目的是评估葡萄牙大流行第一年期间结直肠癌(CRC)诊断和管理受到的影响:这是法国回顾性多中心研究 ETICC(Etude de l'Impact de la pandémie COVID-19 sur le diagnostic et la prise en charge du Cancer Colorectal)的葡萄牙子研究。我们比较了大流行前一年(对照组)与大流行第一年之间患者的特征、临床表现、诊断时的 CRC 分期、首次就诊时间、组织学诊断、手术和药物治疗:我们纳入了 766 名患者:对照组 496 人,COVID 组 270 人。两组患者在确诊时的癌症分期没有明显差异,对照组中有 21% 的患者被诊断为转移性癌症,而在大流行的第一年则有 22% 的患者被诊断为转移性癌症(P = 0.770)。与法国的情况相反,在大流行期间,无症状患者(25-8.4%;p < 0.001)和粪便免疫化学检验阳性患者(20.8-11.3%;p = 0.002)的 CRC 诊断率显著下降。虽然确诊时的总体并发症发生率没有显著增加,但在葡萄牙,腹腔闭塞的确诊率显著增加(12.1%-18.1%;p = 0.033)。在葡萄牙,从开始出现症状到首次就诊的时间从 COVID 期间的中位数 50 天显著增加到 64 天(p < 0.001)。相反,从组织学诊断到肿瘤切除的时间从中位数 65 天大幅缩短至 39 天(p < 0.001)。组织学诊断与新辅助治疗之间的时间无统计学差异(中位数为 64-67 天;p = 0.590),组织学诊断与姑息化疗之间的时间也无统计学差异(中位数为 50-51 天;p = 1.000)。从癌症切除到辅助治疗的时间从中位数 54 天显著缩短至 43 天(p = 0.001):讨论:我们发现,大流行第一年对 CRC 诊断的影响很大,比在法国发现的更明显。这可能不仅与内窥镜检查机构的关闭有关,还与患者在与全科医生预约时遇到的困难有关。另一方面,在法国和葡萄牙,大流行的第一年并没有使诊断时的癌症分期恶化,也没有明显影响诊断后的内外科治疗。
{"title":"Portuguese Results of the ETICC Study: Impact of the Pandemic COVID-19 in the Diagnosis and Management of Colorectal Cancer in 2020 in Portuguese Hospitals.","authors":"Maria Ana Rafael, Cristiana Sequeira, Sónia Isabel da Silva Barros, Bárbara Silva Abreu, Cristina Teixeira, Pierre Lahmek, Marine Besnard, Bruno Lesgourgues","doi":"10.1159/000531234","DOIUrl":"10.1159/000531234","url":null,"abstract":"<p><strong>Introduction: </strong>The outbreak of coronavirus disease 2019 (COVID-19) had affected clinical practice in several ways, including the restriction of nonessential endoscopic procedures. Therefore, our aim was to evaluate how colorectal cancer (CRC) diagnosis and management was affected during the first year of pandemics in Portugal.</p><p><strong>Methods: </strong>This is a Portuguese substudy of the French retrospective multicentric study ETICC (<i>Etude de l'Impact de la pandémie COVID-19 sur le diagnostic et la prise en charge du Cancer Colorectal</i>). We compared patients' characteristics, clinical manifestations, CRC staging at diagnosis, delay to first medical appointment, histological diagnosis, surgical and medical treatments between the year previous to the pandemics (control) and the first year of pandemics.</p><p><strong>Results: </strong>We included 766 patients: 496 in the control group and 270 in the COVID group. There was no significant difference in CRC staging at diagnosis between both groups, with 21% being diagnosed as metastatic in the control group and 22% in the first year of pandemics (<i>p</i> = 0.770). Contrary to what happened in France, there was a significant decrease in CRC diagnosis in asymptomatic patients (25-8.4%; <i>p</i> < 0.001) and after a positive fecal immunochemical test (20.8-11.3%; <i>p</i> = 0.002) during the pandemics. Although the increase in the overall complication rate at diagnosis was nonsignificant, in Portugal, there was a significant increase in diagnosis of abdominal occlusion (12.1-18.1%; <i>p</i> = 0.033). In Portugal, time between the beginning of symptoms and the first medical appointment significantly increased from a median of 50 days to 64 days during COVID (<i>p</i> < 0.001). On the contrary, time between histological diagnosis and tumor resection had significantly decreased from a median of 65 to 39 days (<i>p</i> < 0.001). Time between histological diagnosis and neoadjuvant treatment was not statistically different (median of 64-67 days; <i>p</i> = 0.590), as was time between histological diagnosis and palliative chemotherapy (median of 50-51 days; <i>p</i> = 1.000). Time from CRC resection and adjuvant treatment has significantly decreased from a median of 54 to 43 days (<i>p</i> = 0.001).</p><p><strong>Discussion: </strong>We found a significant impact in CRC diagnosis in the first year of pandemics, more pronounced than what was found in France. These are likely related not only with the closing of endoscopy units but also with the difficulties patients had in finding an appointment with their general practitioners. On the other hand, both in France and Portugal, the first year of pandemics did not worsen CRC staging at diagnosis and did not significantly affect medical and surgical treatments once the diagnosis was made.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11249522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74301589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}