Percorrer por autor "Vara-Luiz, Francisco"
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- Clinical nutrition in Portuguese gastroenterology departments : a multicentric studyPublication . Vara-Luiz, Francisco; Glória, Luísa; Mocanu, Irina; Curado, António; Medeiros, Isabel; Duarte, Maria Antónia; Banhudo, António; Ferreira, Susana; Vaz, Ana Margarida; Bastos, Isabel; Fonseca, JorgeBackground: Hospital nutrition is a major public health problem, as up to 50% of hospitalized patients suffer from undernutrition. Adequate nutritional support (NS) decreases morbidity/mortality, shortens the length of stay, and reduces costs. We aimed to evaluate the engagement of Portuguese gastroenterology departments in NS, especially in artificial nutrition (AN). Methods: Cross-sectional multicentric study, using an online survey sent to 31 Portuguese gastroenterology departments. Results: Nine centers were involved, and all departments were engaged in NS activities. The most performed nutrition technique was endoscopic gastrostomy and not all departments had the expertise to perform all nutrition procedures, namely, endoscopic jejunostomy. Two departments had an AN outpatient clinic. Five centers were involved in hospital nutrition committees. Only four performed systematic nutritional evaluation of every patient on admission. Two departments developed research in the nutrition field. An increase staff and nutrition training were pointed out as suggestions to improve NS. Conclusions: This study outlines a broad picture of NS/AN in Portuguese gastroenterology departments. Medical nutritional training and increasing nutrition teams’ staff may contribute to developing NS/AN. Multidisciplinary management of nutrition-related disorders is of utmost importance, and gastroenterologists are expected to be at the core of hospital nutrition.
- Pyogenic liver abscess and delayed massive gastrointestinal bleeding following endoscopic retrograde cholangiopancreatography (ERCP) : association of two rare complicationsPublication . Vara-Luiz, Francisco; Barbosa, Fábio Pé D’Arca; Albuquerque, Ana; Fernandes, Eduardo; Marques, Ana Valada; Spencer, Vanda; Nunes, Gonçalo; Fonseca, JorgeA liver abscess (LA) is the most common type of visceral abscess. While biliary tract disorders are its most common etiology, clinicians should also consider less frequent causes such as iatrogenic complications due to certain interventions. One of these unusual causes is related to endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES), a usually safe procedure that carries some risk of complications. We present the case of a 71-year-old female with a history of choledocholithiasis who underwent ERCP with ES without any immediate complications; she was discharged after 24 hours and readmitted three days later to the emergency room with fever and abdominal pain. An abdominal CT showed a liver abscess. Blood cultures were positive for Escherichia coli, Streptococcus anginosus, and Enterococcus faecalis, and the patient was started on directed antibiotic therapy with ampicillin, benzylpenicillin, and metronidazole. On day 17, due to hematochezia with hemodynamic instability, an urgent upper gastrointestinal endoscopy was performed, which revealed late post-ES bleeding, refractory to conventional endoscopic therapy. An ERCP was performed to control the bleeding by using a biliary fully covered self-expandable metal stent (FCSEMS), which was removed four weeks later. The follow-up CT showed a significant reduction of LA and the patient was discharged. This case highlights the association of two uncommon complications of ERCP: a LA and a major late post-ES bleeding. Clinicians should maintain a high index of suspicion for these complications in daily practice.