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Browsing by Author "Pinho, R"

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  • Multicenter survey on the use of device-assisted enteroscopy in Portugal
    Publication . Pinho, R; Mascarenhas-Saraiva, M; Mão-de-Ferro, S; Ferreira, S; Almeida, N; Figueiredo, P; Rodrigues, A; Cardoso, H; Marques, M; Rosa, B; Cotter, J; Vilas-Boas, G; Cardoso, C; Salgado, M; Marcos-Pinto, R
    BACKGROUND: Device-assisted enteroscopies (DAEs) are recent endoscopic techniques that enable direct endoscopic small-bowel evaluation. OBJECTIVE: The objective of this article is to evaluate the implementation of DAEs in Portugal and assess the main indications, diagnoses, diagnostic yield, therapeutic yield and complication rate. METHODS: We conducted a multicenter retrospective series using a national Web-based survey on behalf of the Portuguese Small-Bowel Study Group. Participants were asked to fill out two online databases regarding procedural data, indications, diagnoses, endoscopic therapy and complications using prospectively collected institutional data records. RESULTS: A total of eight centers were enrolled in the survey, corresponding to 1411 DAEs. The most frequent indications were obscure gastrointestinal bleeding (OGIB), inflammatory bowel disease and small-bowel tumors. The pooled diagnostic yield was 63%. A relation between the diagnostic yield and the indications was clear, with a diagnostic yield for OGIB of 69% (p = 0.02) with a 52% therapeutic yield. Complications occurred in 1.2%, with a major complication rate of 0.57%. Perforations occurred in four patients (0.28%). CONCLUSION: DAEs are safe and effective procedures, with complication rates of 1.2%, the most serious of which is perforation. Most procedures are performed in the setting of OGIB. Diagnostic and therapeutic yields are dependent on the indication, hence appropriate patient selection is crucial
    2016-04Journal article Open access Show more
  • Profilaxia de Úlceras de Stresse numa Unidade de Cuidados Intensivos: estado da arte
    Publication . Pinho, R; Romãozinho, JM
    As lesões da mucosa gastro-duodenal relacionadas com o stresse fisiológico são frequentes nos doentes internados em unidades de cuidados intensivos. Podem condicionar hemorragia digestiva com repercussão hemodinâmica, estando associadas a aumento da mortalidade. A hipoperfusão esplâncnica tem um papel central na sua fisiopatologia. Foram identificados vários factores de risco para a sua ocorrência, sendo os mais importantes a necessidade de ventilação mecânica e a presença de coagulopatia. A ressuscitação hemodinâmica atempada e a manutenção da nutrição entérica são medidas importantes para prevenir estas lesões. Em doentes com factores de risco deverá ser realizada profilaxia farmacológica. Os medicamentos mais estudados são os anti-ácidos, o sucralfato e os antagonistas H2. Têm surgido recentemente estudos sobre o papel dos inibidores da bomba de protões. A escolha da terapêutica farmacológica deverá ter em conta a via de administração, as vantagens e desvantagens de cada fármaco, incluindo o seu custo comparado e a evidência sobre a sua eficácia.
    2008Journal article Open access Show more