RESUMEN
BACKGROUND: Recommendations for the duration of antimicrobial therapy in cholangitis after successful endoscopic biliary drainage vary. The aim of this study was to compare the occurrence of local infectious complications in patients with acute cholangitis treated with antibiotics for 3 days or less compared with 4 days or more. METHODS: We performed a retrospective multicentre study in seven hospitals in the Netherlands. Patients who received a successful biliary drainage by endoscopic retrograde cholangio-pancreatography because of cholangitis due to common bile duct stones between 2012 and 2017 were included. The primary outcome was the occurrence of a local infectious complication within 3 months of endoscopic retrograde cholangio-pancreatography. Secondary outcomes included Clostridioides difficile infection, total length of hospital stay and all-cause mortality. RESULTS: A total of 426 patients with cholangitis were identified and 296 patients met all inclusion criteria. Therapy duration was ≤3 days in 137 patients (46.3%). During follow-up, 41 patients (13.9%) developed a local infectious complication. Occurrence of infectious complications did not differ between the two groups (p = 0.32). No patient developed Clostridioides difficile infection. Median hospital stay was 6 days (interquartile range 4-8 days) in the short antibiotic group compared with 7 days (interquartile range 5-9 days) in the long group (p = 0.03). Four (1.4%) patients died during follow-up, all were treated for ≥4 days (p = 0.13). CONCLUSIONS: Antimicrobial therapy of 3 days or less seems to be sufficient after successful biliary drainage in patients with acute cholangitis. Randomized trials should confirm our findings.
Asunto(s)
Profilaxis Antibiótica/estadística & datos numéricos , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Colangitis/cirugía , Coledocolitiasis/cirugía , Infecciones por Clostridium/epidemiología , Infección de la Herida Quirúrgica/epidemiología , Enfermedad Aguda/terapia , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Colangitis/etiología , Colangitis/mortalidad , Coledocolitiasis/complicaciones , Coledocolitiasis/mortalidad , Clostridioides difficile/aislamiento & purificación , Infecciones por Clostridium/diagnóstico , Infecciones por Clostridium/etiología , Infecciones por Clostridium/prevención & control , Conducto Colédoco , Drenaje/efectos adversos , Drenaje/métodos , Femenino , Estudios de Seguimiento , Mortalidad Hospitalaria , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Estudios Retrospectivos , Infección de la Herida Quirúrgica/diagnóstico , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/prevención & control , Factores de TiempoRESUMEN
BACKGROUND: Not much is known of the yield of endoscopy in relation to ethnic descent. The aim is to study endoscopy of the lower digestive tract in relation to the ethnicity. METHODS: A prospectively collected dataset was used. Presence four endoscopic findings (diverticuli, polyps, colorectal cancer, and signs of inflammation) was studied. The patients were divided in four groups. Group 1 patients of Western descent, group 2 patients of Turkish descent, group 3 patients originating from Morocco, Northern Africa and the Middle East, and, group 4 patients of Asian descent. RESULTS: In group 1, 35,340 procedures were done in 24,223 patients, in group 2 this was 1,776 in 1,338 patients respectively. In groups 3 and 4 this was 465 in 371 patients, and 416 in 305 patients. There was no difference in gender between the four groups, the number of women undergoing endoscopy was higher in all groups. Overall abnormalities in colon and rectum were significantly more often seen in group 1. Colorectal cancer was significantly less often diagnosed in patients of groups 3 and 4. Polyp(s) were significantly less often seen in patients of groups 2 and 3. While diverticulosis of the colon was significantly more often diagnosed in patients of group 1. Signs of inflammation in colon and/or rectum were significantly more often seen in patients of groups 2, 3, and 4. CONCLUSIONS: There are clear differences in presence of colorectal abnormalities in patients from different ethnic descent. The implication of this finding in daily practice is not obvious.
RESUMEN
BACKGROUND: Years ago, it was established that removal of adenomas will lead to a lower incidence of colorectal cancer. This study aims to establish the occurrence of colorectal cancer in unselected patients after index colonoscopy with polyp removal. METHODS: A prospectively collected dataset on colonoscopy covering 25 consecutive years was used. Patients in who during the index (first) procedure a polyp(s) was removed were included. Excluded were patients with colorectal cancer and patients belonging to Lynch families. In case of cancer time after the index and previous procedure, tumor stage, histology of earlier removed polyps, localization of the tumor and demographics were noted. RESULTS: In 1,617 patients polyp(s) were removed. Thirty (1.9%) patients developed colorectal cancer. In 18 cases adenomas were removed during prior endoscopies. Five patients only had hyperplastic polyp(s). Nine patients with cancer already were older than 75 years when the previous endoscopy was done. Patients with adenomas prior to the cancer were older compared with patients with hyperplastic polyps [mean (SD): 71.6 (5.8) versus 64.2 (10.5) years, P=0.046]. The majority of cancers were located in the proximal colon (75%). The time between diagnosing cancer and the previous colonoscopy was mean 70.6 months with a median of 60.0 months (range, 12.0-167.0 months). CONCLUSIONS: It is concluded that follow-up after removal of polyps in normal daily practice is associated with a low incidence of developing colorectal cancer.
RESUMEN
AIM: A high diagnostic yield of colonoscopy has been reported in elderly patients, but there is no data on the yearly yield. Our aim was to detect the yearly yield of colonoscopy in elderly patients. METHODS: All consecutive endoscopies in the years 1992-2009 were included. Important endoscopic diagnoses were defined as colorectal cancer (CRC), polyps, diverticuli and inflammation. RESULTS: In total, 19 569 endoscopies were performed, of which 1706 (8.7%) were in patients age 80 years or older. The number of women was significantly higher (P < 0.001). The percentage of patients who were 80 years or older was higher than in the general population and remained stable during the study period, though there has been a proportional increase of elderly people in the general population. Inconclusive procedures were present in 106 (6.2%) elderly patients compared with 277 (1.6%) patients under 80 years of age (P < 0.001). There were no significant changes in the consecutive years. A procedure revealing no endoscopic diagnosis was observed less often in patients who were 80 years or older (P < 0.001). CRC was diagnosed in 221 (19.6%) older patients. This figure remained more or less constant each year. Polyps were seen in 448 (8.8%) patients 80 years of age or older. The percentage of patients with diverticuli and inflammation was constant. The number of patients 80 years or older with CRC and polyps rose at a lower rate than the number of older people in the general population. CONCLUSION: The yield of colonoscopy in patients 80 years or older was high and constant over the years. The number of tumors rose less than expected compared to the increase of elderly in the general population.