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Browsing by Author "de Frutos, Diego"

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  • Delphi consensus statement for the management of delayed post-polypectomy bleeding
    Publication . Rodríguez de Santiago, Enrique; de la Iglesia, Sandra Pérez; de Frutos, Diego; Marín-Gabriel, José Carlos; Mangas-SanJuan, Carolina; Honrubia López, Raúl; Uchima, Hugo; Aicart-Ramos, Marta; Rodríguez Gandía, Miguel Ángel; Valdivielso Cortázar, Eduardo; Zabala, Felipe Ramos; Álvarez, Marco Antonio; Solano Sánchez, Marina; González Santiago, Jesús Manuel; Albéniz, Eduardo; Hijos-Mallada, Gonzalo; Quismondo, Nerea Castro; Fraile-López, Miguel; Martínez Ares, David; Tejedor-Tejada, Javier; Hernández, Luis; Gornals, Joan B.; Quintana-Carbo, Sergi; Ocaña, Juan; Neves, João A. Cunha; Martínez Martínez, Juan; Pinilla, María López-Cerón; Abadía, Carlos Dolz; Pellisé, María
    Background: Delayed post-polypectomy bleeding (DPPB) is the most common adverse event following colonic polypectomy, yet its management remains highly heterogeneous and lacks standardization. A considerable number of colonoscopies performed for DPPB may be unnecessary and do not result in hemostatic intervention.Objectives: To develop evidence-based statements to guide clinical decision-making in DPPB.Design: Multidisciplinary Delphi consensus statement.Methods: A panel of 29 experts in gastroenterology, hematology, radiology, and surgery was assembled. Through a systematic review of the literature and a modified Delphi process, consensus statements were developed through iterative rounds of anonymous voting. Statements were revised following anonymous voting and feedback at each round. Those achieving 80% agreement were accepted.Results: The expert panel reached a consensus on 36 statements, covering areas such as antithrombotic management, bowel preparation, colonoscopy indications, and therapeutic hemostatic modalities. Key recommendations include guidance for managing self-limited bleeding and risk stratification to reduce the rate of unnecessary colonoscopies, as well as recommendations for hemodynamically unstable patients who may require primary angioembolization. A practical clinical algorithm is proposed.Conclusion: This document provides a consensus-based framework for managing DPPB. These recommendations aim to improve patient outcomes and optimize healthcare resources while fostering a standardized approach to this common adverse event.
    2025-04Journal article Open access Show more
  • Western outcomes of circumferential endoscopic submucosal dissection for early esophageal squamous cell carcinoma
    Publication . de Santiago, Enrique Rodríguez; van Tilburg, Laurelle; Deprez, Pierre H.; Pioche, Mathieu; Pouw, Roos E.; Bourke, Michael J.; Seewald, Stefan; Weusten, Bas L.A.M.; Jacques, Jeremie; Leblanc, Sara; Barreiro, Pedro; Lemmers, Arnaud; Parra-Blanco, Adolfo; Magalhães, Ricardo Küttner; Libânio, Diogo; Messmann, Helmut; Albéniz, Eduardo; Kaminski, Michal F.; Mohammed, Noor; Ramos-Zabala, Felipe; Herreros-de-Tejada, Alberto; Koecklin, Hugo Huchima; Wallenhorst, Timothée; Antunes, João Santos; Neves, João A. Cunha; Koch, Arjun D.; Ayari, Myriam; Duran, Rodrigo Garces; Ponchon, Thierry; Rivory, Jérôme; Bergman, Jacques J.G.H.M.; Verheij, Eva P.D.; Gupta, Sunil; Groth, Stefan; Lepilliez, Vincent; Franco, Ana Rita; Belkhir, Sanaa; White, Jonathan; Ebigbo, Alanna; Probst, Andreas; Legros, Romain; Pilonis, Nastazja Dagny; de Frutos, Diego; Muñoz González, Raquel; Ribeiro, Mário Dinis
    Background and Aims: Circumferential endoscopic submucosal dissection (cESD) in the esophagus has been reported to be feasible in small Eastern case series. We assessed the outcomes of cESD in the treatment of early esophageal squamous cell carcinoma (ESCC) in Western countries. Methods: We conducted an international study at 25 referral centers in Europe and Australia using prospective databases. We included all patients with ESCC treated with cESD before November 2022. Our main outcomes were curative resection according to European guidelines and adverse events. Results: A total of 171 cESDs were performed on 165 patients. En bloc and R0 resections rates were 98.2% (95% confidence interval [CI], 95.0-99.4) and 69.6% (95% CI, 62.3-76.0), respectively. Curative resection was achieved in 49.1% (95% CI, 41.7-56.6) of the lesions. The most common reason for noncurative resection was deep submucosal invasion (21.6%). The risk of stricture requiring 6 or more dilations or additional techniques (incisional therapy/stent) was high (71%), despite the use of prophylactic measures in 93% of the procedures. The rates of intraprocedural perforation, delayed bleeding, and adverse cardiorespiratory events were 4.1%, 0.6%, and 4.7%, respectively. Two patients died (1.2%) of a cESD-related adverse event. Overall and disease-free survival rates at 2 years were 91% and 79%. Conclusions: In Western referral centers, cESD for ESCC is curative in approximately half of the lesions. It can be considered a feasible treatment in selected patients. Our results suggest the need to improve patient selection and to develop more effective therapies to prevent esophageal strictures.
    2024-04Journal article Restricted access Show more