Om sammenhengene mellom religiøsitet/åndelighet og mental helse (Foredrag 2013)
HALO foredrag Endoskopi Sygeplejerskernes Årsmøde 2013.
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Transcript of HALO foredrag Endoskopi Sygeplejerskernes Årsmøde 2013.
HALO foredrag Endoskopi Sygeplejerskernes Årsmøde 2013
Hvordan går det med Barrets Patienter i Kongeriget Danmark
Study of 11.028 patients with BE
Patients• 11.028 Patients, entire Denmark
• Age 62,7 years (mean), 67% male
Follow-up• 67.105 patient-years (60.000 in all studies to date)
• 18 years (1992-2009)• Median follow-up 5,2 y
Hvid-Jensen et al, NEJM 2011; 365: 1375-83
Study of 11.028 patients with BE
Results11.028 BE patients
72 HGD
131 adenoc.
106 HGD 66 adenoc.
1st year
>1 year
Hvid-Jensen et al, NEJM 2011; 365: 1375-83
EAC in known BE patients
• 197 out of a total of 2602 EAC• 7.6 %
Hvid-Jensen et al, NEJM 2011; 365: 1375-83
Study of 11.028 patients with BE
Results11.028 BE patients
72 HGD
131 adenoc.
106 HGD 66 adenoc.
1st year
>1 yearRisk for adenocarcinoma
Risk for HGD1,2/1000 pyrs (95%CI:0,9-1,5) /0,12 % per year
1,9/1000 pyrs (95%CI:1,6-2,3)
Risk for adenocarcinoma or HGD2,6/1000 pyrs (95%CI:2,2-3,1)
2/3 within the first year !
Hvid-Jensen et al, NEJM 2011; 365: 1375-83
Study of 11.028 patients with BE
Are there High-risk subgroups ?
• Low Grade Dysplasi (LGD) 1st endoscopy (5%) : ”ever” LGD (8%):
• No LGD at 1st endoscopy (95%) 1,0/1000 pyrs (0,7-1,3)
5,1/1000 pyrs (3,0-8,6)5,5/1000 pyrs
(3,7-8,3)
Hvid-Jensen et al, NEJM 2011; 365: 1375-83
BarrxTM Flex Generator
20
BarrxTM RFA Catheters
Proximal
Distal
The following is a representation of the procedural steps used in prospective clinical trials for this device. This guide is not meant to replace physician judgment. Procedural steps may vary by patient according to patient tolerability, anatomy, motility, characteristics of the Barrett’s esophagus, and underlying health condition.
QUICK VIEW OF PROCEDURAL ASPECTS
1. Introduce endoscope, measure TIM/TGF, insert guidewire Flush with Mucomyst and suction out
2. Remove endoscope, leave GW in place Calibrate Sizing balloon
3. Introduce sizing balloon over GW 4. Start sizing 12 cm proximal to TGF, every 1 cm5. Remove sizing balloon, leave GW in place 6. Introduce HALO360+ ablation catheter over GW 7. Introduce endoscope along-side ablation catheter 8. Position proximal electrode edge 1-2 cm proximal to TIM 9. Ablate each 3 cm segment until overlapping TGF 10. Remove endoscope, catheter, and GW together (with direct
visualization) 11. Introduce endoscope and clean ablation zone 12. Inflate and clean ablation electrode (outside of body) 13. Re-Insert GW and remove endoscope, leave GW in place 14. Re-Introduce ablation catheter over GW 15. Repeat steps 7-1016. Remove both items, re-introduce scope and evacuate gastric
contents, inspect ablation zone
22
TGF
Quick Overview Circumferential Ablation
HALO 360
Courtesy of Charlie Lightdale, M.D., Columbia Presbyterian, New York
Focal RFA
Shaheen NJ, et al. N Engl J Med 2009
Complications
• Pain• Dysphagia• Bleeding• Fever• Vomiting
• Technical: Generel few problems – Captured HALO 90
Pain conclusions
• Bevare of the alcoholic patient• Pain is common, also after HALO 90• Be carefull with Barrettsegment longer 5-6 cm• Analgesic treatment?
KodeinmixtureWeak morfin - Tramadol
Dysphagia
Bleeding and fever
• 3 patients with bleeding 10. – 14. day postop.All 3 with antikoagulantia (2 Warfarin 1 asa)6 patients used antikoagulantiaComment: Use LMH 2-3 weeks after treatment before taking up Warfarin
4 patients with fever
GAVE Der er HALO godt men dyrt
Konklusion
• HALO er et godt værktøj til at abblation af fladeformet celleforandringer i specielt oesophagus.
• Giver nye behandlingsmuligheder af Barret’s Oesophagus. Specielt for de patienter med svære celleforandringer
• Det er forholdsvist nemt at bruge, men kræver dog en vis læringskurve
• Bagsiden at det er dyrt, og ikke uden komplikationer