SlideShare a Scribd company logo
L’ (in) appropriatezza  dell’endoscopia superiore C.  Hassan
ENDOSCOPY PATIENT NON-GI REFERRING PHYSICIAN
Medico richiedente N % MMG 3794 60,5 Medico Osped.  2268 36,2 Specialista est.  124 2,0 n.i. 84 1,3 TOTALE 6270 100
ENDOSCOPY PATIENT NON-GI REFERRING PHYSICIAN GI GUIDELINES
[object Object],[object Object],[object Object]
“… on how endoscopy should be performed,  by whom, and for what purposes”
 
 
[object Object],[object Object]
RESULTS ,[object Object],8,252 pts. Main indication N° patients (%) Dyspepsia without reflux § 2,489 ( 30 ) Dyspepsia with reflux § 1,075 ( 13 ) Refl ux § 1,175 ( 14 ) Atypical manifestations of reflux § 129 (2) Alarm features 2,236 ( 27 ) Portal hypertension assessment 324 (4) Suspicion at RX 73 (1) Operative endoscopy 121 (1) Follow up benign/precancerous/malignant 381 (5) Duodenal biopsy 166 (2) EGD for other medical/surgical conditions 74 (1) Cancer of unknown origin 10 (0.1)
 
 
13 856 PATIENTS 22% NOT INDICATED Author N° patients Inappropriateness Rate % Hassan  et al. 6270 23 Rossi  et al. 1777 16 Chan  et al. 1076 12 Froelhich  et al. 1681 39 Bersani  et al. 2000 10 Al Romaih  et al. 80 28 Kaliszan  et al. 522 30 Gonvers  et al. 450 43
Età - Giudizio richiesta A P < 0.05
Tip. Esame   –   Giudizio rich. P < 0.05
INAPPROPR. Vs MEDICO P < 0.05
ASMaD Onlus www.santeugenioroma.org
[object Object],[object Object],[object Object]
RESULTS ,[object Object],Relevant findings Whole population (8,252 pts.) N° (%) Oesophagus Peptic oesophagitis 1,118 (13.5) Varices 427 ( 5.2) Barrett oesophagus * 150 (1.8) Micotic oesophagitis 67 ( 0.8) Cancer § 76 (1) Foreign body  28 ( 0.3) Peptic stricture 15 ( 0.2) Mallory-Weiss 16 (0.2) Anastomotic stricture 7  ( 0.1) Caustic lesion 7 ( 0.1) Caustic stricture 4 ( 0.05)
RESULTS ,[object Object],Relevant findings Whole population (8,252 pts.) N° (%) Stomach Erosive gastritis 989 (12.0) Hypertensive gastropathy 307 ( 3.7) Polyp 228 ( 2.8) Peptic ulcer  219 (2.7) Cancer § 111 (1.3) Stomitis 81 ( 1.0) Fundus varices 39 ( 0.5) Anastomotic ulcer  28 ( 0.3) Gastric antral vascular ectasia 24 ( 0.3) Angiodysplasia 20 ( 0.2) Lymphoma § 17 ( 0.2) Foreig body 20 ( 0.2) Anastomotic stricture 7 ( 0.1) Menetrier syndrome 2 ( 0.002)
RESULTS ,[object Object],Relevant findings Whole population (8,252 pts.) N° (%) Duodenum Erosive duodenitis 340 (4.1) Duodenal ulcer 300 (3.6) Signs of malabsorption 84 (1) Cancer § 15 (0.2) Ampulloma  4 (0.05)
RESULTS New malignancy 1.6% (132 pts.) -Cancer 128 pts. -Lymphoma    4 pts.
RESULTS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
13 856 PATIENTS 45% RELEVANT FINDINGS Author N° patients Relevant findings % Hassan  et al. 6270 49 Rossi  et al. 1777 45 Chan  et al. 1076 38 Froelhich  et al. 1681 54 Bersani  et al. 2000 51 Al Romaih  et al. 80 32 Kaliszan  et al. 522 46 Gonvers  et al. 450 46
51% 32% NOT INDICATED INDICATED 13 856 PATIENTS 78% 22% RELEVANT FINDINGS RELEVANT FINDINGS
Appropriateness of the indication for upper endoscopy:  a meta-analysis Di Giulio E, Hassan C, Zullo A, et al. , DLD 2009 ASGE guidelines Sens. Spec. PPV NPV Relevant finding 85% 28% 49% 70%
DIAGNOSI RILEVANTI vs APPROPRIATEZZA Endoscopic finding OR [99% CI] Clinically relevant Erosive esophagitis  1.28 [0.35-1.63]  Erosive gastritis  1.79 [1.35-2.36] * Esophageal varices  5.65 [2.96-10.8] * Duodenal ulcer  3.38 [1.98-5.76] * Barrett’s esophagus  3.58 [1.59-8.08] * Gastric ulcer  3.41 [1.51-7.71] * Not clinically relevant Nonerosive gastritis  0.78 [0.66-0.9] * Normal  0.40 [0.33-0.49] * Hiatal hernia  0.63 [0.51-0.77] *
2.4% 0.13% NOT INDICATED INDICATED 13 856 PATIENTS 78% 22% CANCER CANCER
b) Appropriateness of the indication for upper endoscopy:  a meta-analysis Di Giulio E, Hassan C, Zullo A, et al. , DLD 2009 ASGE guidelines Sens. Spec. PPV NPV Relevant finding 85% 28% 49% 70% Cancer 97% 22% 2% 99.8%
ASGE GUIDELINES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ASMaD Onlus www.santeugenioroma.org
[object Object]
RESULTS Table 4.  Multivariate analysis for the detection of relevant finding Clinical variable Relevant finding  OR (95% CI) Bleeding 3.51 (2.9  –  4.2) Relevant finding at previous EGD 2.76 (2.5  –  3.1) Appropriateness 2.7 (2.4  –  3) Male sex 1.77 (1.6  –  1.9) Age  > 45 1.55 (1.4  –  1.7) Alarm symptoms 1.39 (1.2  –  1.6) Weight loss 1.32 (1  –  1.6) Reflux 1.16 (1.05  –  1.3) PPI therapy 1.03 (0.93  –  1.1)
RESULTS Table 5.  Estimates of accuracy of the different strategies in selecting EGD referrals for the detection of relevant findings  b) Strategy Rate of EGDs indicated Sens. Spec. PPV NPV AUC ASGE guidelines 80% 88% 27% 51% 72% 0.55 Age  > 45/alarm  features 78% 82% 26% 49% 63% 0.52
RESULTS Figure 1.  Receiver operating curve (ROC) for multivariate and ANN models for relevant findings.  b)
RESULTS Table 4.  Multivariate analysis for the detection of malignancy b) Clinical variable New malignancy  OR (95% CI) Weight loss 15.2 (9.3 – 24.8) Dysphagia 9.3 (5.7 – 15.6) Alarm features 8 .78 (5.2 – 14.8) Age 8.2 (2.8 – 24) Age  > 45 years 8 (2.6 – 23.8) Age  > 45 years  or  alarm features 7.63 (2.3 – 24.7) Vomiting 5.64 (3.2 – 10.1) No previous EGD 7.5 (2 – 28) Anaemia 3.66 (2.2 – 6.1) Bleeding 1.91 (0.5 – 6.4) Family history for cancer 1.77 (0.5 – 6.7) Male sex 1.63 (1 – 2.6) Specialist 1.2 (1 – 2) NSAIDs/anti-COX2/aspirin 1 (0.5 – 2.2)
RESULTS Table 5.  Estimates of accuracy of the different strategies in selecting EGD referrals for the detection of cancer b) Strategy Sens. Spec. PPV NPV NNT AUC ASGE guidelines 98% 20% 2% 99.8% 50 0.59 Age > 45/alarm features 97% 22% 2% 99.8% 50 0.59
RESULTS Figure 1.  Receiver operating curve (ROC) for multivariate and ANN models for new cases of malignancy .  b)
CONCLUSIONS b) ,[object Object],[object Object],[object Object]
Buri L, Hassan C,Bersani G , Anti M, Bianco MA, Cipolletta L, Di Giulio E, Di Matteo G, Familiari  L, Ficano L, Loriga P, Morini S, Pietropaolo V,  Zambelli A, Grossi E, Intraligi M, and the SIED Appropriateness Working Group.* Appropriateness guidelines and predictive rules to select patients for upper endoscopy:  a nationwide, multicenter study on behalf of SIED
CANCER RELEVANT FINDINGS NO CANCER 4% 96%
METHODS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
METHODS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
METHODS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RESULTS b) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CONCLUSIONS ,[object Object],[object Object],[object Object]
“ In conclusion, our study showed that a simple rule based on age and alarm features may be as accurate as the more complex ASGE guidelines in predicting endoscopic outcome in an unselected EGD population.  The implementation of such predictive rule would immediately result in the exclusion of more than 20% of the patients from the EGD waiting list, with only a marginal loss of clinical information. Linear and ANN models may be useful to prioritize patients at higher risk of malignancy.”
b)
b)

More Related Content

What's hot

SENTINA Trial
SENTINA TrialSENTINA Trial
SENTINA Trial
Pradeep Dhanasekaran
 
040044947
040044947040044947
040044947
David Doyne
 
Evaluation of Alvarado Score
Evaluation of Alvarado ScoreEvaluation of Alvarado Score
Evaluation of Alvarado Score
Wan Yusof Wan Jeffery
 
Spectrum of Cervical Lesions by Papanicolaou (Pap) Smear Screening in Remote ...
Spectrum of Cervical Lesions by Papanicolaou (Pap) Smear Screening in Remote ...Spectrum of Cervical Lesions by Papanicolaou (Pap) Smear Screening in Remote ...
Spectrum of Cervical Lesions by Papanicolaou (Pap) Smear Screening in Remote ...
SSR Institute of International Journal of Life Sciences
 
Guideline Development Discussion
Guideline Development DiscussionGuideline Development Discussion
Guideline Development Discussion
accurayexchange
 
Trauma and urologic reconstruction network of surgeons - MMC and BNCX
Trauma and urologic reconstruction network of surgeons - MMC and BNCXTrauma and urologic reconstruction network of surgeons - MMC and BNCX
Trauma and urologic reconstruction network of surgeons - MMC and BNCX
jeremybmyers
 
NY Prostate Cancer Conference - H. Van Poppel - Session 8: Do I need a nomogr...
NY Prostate Cancer Conference - H. Van Poppel - Session 8: Do I need a nomogr...NY Prostate Cancer Conference - H. Van Poppel - Session 8: Do I need a nomogr...
NY Prostate Cancer Conference - H. Van Poppel - Session 8: Do I need a nomogr...
European School of Oncology
 
MCO 2011 - Slide 21 - P. Rougier - Adjuvant treatment (stage 2 and 3)
MCO 2011 - Slide 21 - P. Rougier - Adjuvant treatment (stage 2 and 3)MCO 2011 - Slide 21 - P. Rougier - Adjuvant treatment (stage 2 and 3)
MCO 2011 - Slide 21 - P. Rougier - Adjuvant treatment (stage 2 and 3)
European School of Oncology
 
Radical Salvage Prostatectomy with Pelvic Lymphadenectomy Extended Post Prima...
Radical Salvage Prostatectomy with Pelvic Lymphadenectomy Extended Post Prima...Radical Salvage Prostatectomy with Pelvic Lymphadenectomy Extended Post Prima...
Radical Salvage Prostatectomy with Pelvic Lymphadenectomy Extended Post Prima...
CrimsonPublishersUrologyJournal
 
NET - Kennecke
NET - KenneckeNET - Kennecke
Stereotactic Ablative RT in HCC
Stereotactic Ablative RT in HCCStereotactic Ablative RT in HCC
Stereotactic Ablative RT in HCC
accurayexchange
 
Landmark trials in Ovarian Cancer
Landmark trials in Ovarian CancerLandmark trials in Ovarian Cancer
Landmark trials in Ovarian Cancer
Pradeep Dhanasekaran
 
ECCLU 2011 - K. Fizazi - Prostate cancer: Locally advanced disease and patien...
ECCLU 2011 - K. Fizazi - Prostate cancer: Locally advanced disease and patien...ECCLU 2011 - K. Fizazi - Prostate cancer: Locally advanced disease and patien...
ECCLU 2011 - K. Fizazi - Prostate cancer: Locally advanced disease and patien...
European School of Oncology
 
Radiological evaluation aasld 2011
Radiological evaluation aasld 2011Radiological evaluation aasld 2011
Radiological evaluation aasld 2011
mbouattour
 
MCO 2011 - Slide 8 - E. Senkus-Konefka - Treatment of metastatic disease and ...
MCO 2011 - Slide 8 - E. Senkus-Konefka - Treatment of metastatic disease and ...MCO 2011 - Slide 8 - E. Senkus-Konefka - Treatment of metastatic disease and ...
MCO 2011 - Slide 8 - E. Senkus-Konefka - Treatment of metastatic disease and ...
European School of Oncology
 
NY Prostate Cancer Conference - V.E. Reuter - Session 2: Upgrading/downgradin...
NY Prostate Cancer Conference - V.E. Reuter - Session 2: Upgrading/downgradin...NY Prostate Cancer Conference - V.E. Reuter - Session 2: Upgrading/downgradin...
NY Prostate Cancer Conference - V.E. Reuter - Session 2: Upgrading/downgradin...
European School of Oncology
 
NY Prostate Cancer Conference - L. Klotz - Session 3: Active surveillance: PS...
NY Prostate Cancer Conference - L. Klotz - Session 3: Active surveillance: PS...NY Prostate Cancer Conference - L. Klotz - Session 3: Active surveillance: PS...
NY Prostate Cancer Conference - L. Klotz - Session 3: Active surveillance: PS...
European School of Oncology
 
Radiosurgery (CyberKnife) in Liver Tumours: Indian Experience
Radiosurgery (CyberKnife) in Liver Tumours: Indian ExperienceRadiosurgery (CyberKnife) in Liver Tumours: Indian Experience
Radiosurgery (CyberKnife) in Liver Tumours: Indian Experience
duttaradio
 
RECTUM CANCER MANAGEMENT
RECTUM CANCER MANAGEMENTRECTUM CANCER MANAGEMENT
RECTUM CANCER MANAGEMENT
Kanhu Charan
 
John Tidy - Adjunctive colposcopic technologies
John Tidy - Adjunctive colposcopic technologiesJohn Tidy - Adjunctive colposcopic technologies
John Tidy - Adjunctive colposcopic technologies
triumphbenelux
 

What's hot (20)

SENTINA Trial
SENTINA TrialSENTINA Trial
SENTINA Trial
 
040044947
040044947040044947
040044947
 
Evaluation of Alvarado Score
Evaluation of Alvarado ScoreEvaluation of Alvarado Score
Evaluation of Alvarado Score
 
Spectrum of Cervical Lesions by Papanicolaou (Pap) Smear Screening in Remote ...
Spectrum of Cervical Lesions by Papanicolaou (Pap) Smear Screening in Remote ...Spectrum of Cervical Lesions by Papanicolaou (Pap) Smear Screening in Remote ...
Spectrum of Cervical Lesions by Papanicolaou (Pap) Smear Screening in Remote ...
 
Guideline Development Discussion
Guideline Development DiscussionGuideline Development Discussion
Guideline Development Discussion
 
Trauma and urologic reconstruction network of surgeons - MMC and BNCX
Trauma and urologic reconstruction network of surgeons - MMC and BNCXTrauma and urologic reconstruction network of surgeons - MMC and BNCX
Trauma and urologic reconstruction network of surgeons - MMC and BNCX
 
NY Prostate Cancer Conference - H. Van Poppel - Session 8: Do I need a nomogr...
NY Prostate Cancer Conference - H. Van Poppel - Session 8: Do I need a nomogr...NY Prostate Cancer Conference - H. Van Poppel - Session 8: Do I need a nomogr...
NY Prostate Cancer Conference - H. Van Poppel - Session 8: Do I need a nomogr...
 
MCO 2011 - Slide 21 - P. Rougier - Adjuvant treatment (stage 2 and 3)
MCO 2011 - Slide 21 - P. Rougier - Adjuvant treatment (stage 2 and 3)MCO 2011 - Slide 21 - P. Rougier - Adjuvant treatment (stage 2 and 3)
MCO 2011 - Slide 21 - P. Rougier - Adjuvant treatment (stage 2 and 3)
 
Radical Salvage Prostatectomy with Pelvic Lymphadenectomy Extended Post Prima...
Radical Salvage Prostatectomy with Pelvic Lymphadenectomy Extended Post Prima...Radical Salvage Prostatectomy with Pelvic Lymphadenectomy Extended Post Prima...
Radical Salvage Prostatectomy with Pelvic Lymphadenectomy Extended Post Prima...
 
NET - Kennecke
NET - KenneckeNET - Kennecke
NET - Kennecke
 
Stereotactic Ablative RT in HCC
Stereotactic Ablative RT in HCCStereotactic Ablative RT in HCC
Stereotactic Ablative RT in HCC
 
Landmark trials in Ovarian Cancer
Landmark trials in Ovarian CancerLandmark trials in Ovarian Cancer
Landmark trials in Ovarian Cancer
 
ECCLU 2011 - K. Fizazi - Prostate cancer: Locally advanced disease and patien...
ECCLU 2011 - K. Fizazi - Prostate cancer: Locally advanced disease and patien...ECCLU 2011 - K. Fizazi - Prostate cancer: Locally advanced disease and patien...
ECCLU 2011 - K. Fizazi - Prostate cancer: Locally advanced disease and patien...
 
Radiological evaluation aasld 2011
Radiological evaluation aasld 2011Radiological evaluation aasld 2011
Radiological evaluation aasld 2011
 
MCO 2011 - Slide 8 - E. Senkus-Konefka - Treatment of metastatic disease and ...
MCO 2011 - Slide 8 - E. Senkus-Konefka - Treatment of metastatic disease and ...MCO 2011 - Slide 8 - E. Senkus-Konefka - Treatment of metastatic disease and ...
MCO 2011 - Slide 8 - E. Senkus-Konefka - Treatment of metastatic disease and ...
 
NY Prostate Cancer Conference - V.E. Reuter - Session 2: Upgrading/downgradin...
NY Prostate Cancer Conference - V.E. Reuter - Session 2: Upgrading/downgradin...NY Prostate Cancer Conference - V.E. Reuter - Session 2: Upgrading/downgradin...
NY Prostate Cancer Conference - V.E. Reuter - Session 2: Upgrading/downgradin...
 
NY Prostate Cancer Conference - L. Klotz - Session 3: Active surveillance: PS...
NY Prostate Cancer Conference - L. Klotz - Session 3: Active surveillance: PS...NY Prostate Cancer Conference - L. Klotz - Session 3: Active surveillance: PS...
NY Prostate Cancer Conference - L. Klotz - Session 3: Active surveillance: PS...
 
Radiosurgery (CyberKnife) in Liver Tumours: Indian Experience
Radiosurgery (CyberKnife) in Liver Tumours: Indian ExperienceRadiosurgery (CyberKnife) in Liver Tumours: Indian Experience
Radiosurgery (CyberKnife) in Liver Tumours: Indian Experience
 
RECTUM CANCER MANAGEMENT
RECTUM CANCER MANAGEMENTRECTUM CANCER MANAGEMENT
RECTUM CANCER MANAGEMENT
 
John Tidy - Adjunctive colposcopic technologies
John Tidy - Adjunctive colposcopic technologiesJohn Tidy - Adjunctive colposcopic technologies
John Tidy - Adjunctive colposcopic technologies
 

Viewers also liked

Mens urological health cme bph-luts- final- nov 13 2013
Mens urological health cme   bph-luts- final- nov 13 2013Mens urological health cme   bph-luts- final- nov 13 2013
Mens urological health cme bph-luts- final- nov 13 2013
Ihsaan Peer
 
Principles of management,bph
Principles of management,bphPrinciples of management,bph
Principles of management,bph
Ufuoma Robert Umuago
 
Benign Prostatic Hyperplasia & Incontinence New
Benign Prostatic Hyperplasia & Incontinence NewBenign Prostatic Hyperplasia & Incontinence New
Benign Prostatic Hyperplasia & Incontinence New
Anil Haripriya
 
Medical management of bph
Medical management of bphMedical management of bph
Medical management of bph
Omar Akhtar
 
Medical management of bph
Medical management of bphMedical management of bph
Medical management of bph
bbthapa
 
Benign Prostatic Hyperplasia (BPH and LUTS)
Benign Prostatic Hyperplasia (BPH and LUTS)Benign Prostatic Hyperplasia (BPH and LUTS)
Benign Prostatic Hyperplasia (BPH and LUTS)
Abdullah Mohammad
 
Benigh prostatic hyperplasia
Benigh prostatic hyperplasiaBenigh prostatic hyperplasia
Benigh prostatic hyperplasia
Vivian Barrera
 
Benign Prostatic Hyperplasia
Benign Prostatic HyperplasiaBenign Prostatic Hyperplasia
Benign Prostatic Hyperplasia
Rommel Luis III Israel
 

Viewers also liked (8)

Mens urological health cme bph-luts- final- nov 13 2013
Mens urological health cme   bph-luts- final- nov 13 2013Mens urological health cme   bph-luts- final- nov 13 2013
Mens urological health cme bph-luts- final- nov 13 2013
 
Principles of management,bph
Principles of management,bphPrinciples of management,bph
Principles of management,bph
 
Benign Prostatic Hyperplasia & Incontinence New
Benign Prostatic Hyperplasia & Incontinence NewBenign Prostatic Hyperplasia & Incontinence New
Benign Prostatic Hyperplasia & Incontinence New
 
Medical management of bph
Medical management of bphMedical management of bph
Medical management of bph
 
Medical management of bph
Medical management of bphMedical management of bph
Medical management of bph
 
Benign Prostatic Hyperplasia (BPH and LUTS)
Benign Prostatic Hyperplasia (BPH and LUTS)Benign Prostatic Hyperplasia (BPH and LUTS)
Benign Prostatic Hyperplasia (BPH and LUTS)
 
Benigh prostatic hyperplasia
Benigh prostatic hyperplasiaBenigh prostatic hyperplasia
Benigh prostatic hyperplasia
 
Benign Prostatic Hyperplasia
Benign Prostatic HyperplasiaBenign Prostatic Hyperplasia
Benign Prostatic Hyperplasia
 

Similar to 1 Hassan

1 Crespi Screening Rettocolon
1 Crespi Screening Rettocolon1 Crespi Screening Rettocolon
1 Crespi Screening Rettocolon
Gianfranco Tammaro
 
Update from CROI 2018: Focus on TB and Other Opportunistic Infections
Update from CROI 2018: Focus on TB and Other Opportunistic InfectionsUpdate from CROI 2018: Focus on TB and Other Opportunistic Infections
Update from CROI 2018: Focus on TB and Other Opportunistic Infections
UC San Diego AntiViral Research Center
 
12 Quimioterapia, 1ª - 2ª línea y mantenimiento. Cáncer de Pulmón
12 Quimioterapia, 1ª - 2ª línea y mantenimiento. Cáncer de Pulmón12 Quimioterapia, 1ª - 2ª línea y mantenimiento. Cáncer de Pulmón
12 Quimioterapia, 1ª - 2ª línea y mantenimiento. Cáncer de Pulmón
Effyciens Marketing Online SL.
 
CCO_Pancreatic_Cancer_Advances_Downloadable_4 (2).pptx
CCO_Pancreatic_Cancer_Advances_Downloadable_4 (2).pptxCCO_Pancreatic_Cancer_Advances_Downloadable_4 (2).pptx
CCO_Pancreatic_Cancer_Advances_Downloadable_4 (2).pptx
ANNELIESEKARINALVARA1
 
Clinical Impact of New NAFLD/NASH Data From San Francisco 2018
Clinical Impact of New NAFLD/NASH Data From San Francisco 2018Clinical Impact of New NAFLD/NASH Data From San Francisco 2018
Clinical Impact of New NAFLD/NASH Data From San Francisco 2018
hivlifeinfo
 
Appendix by drdamodhar.m.v
Appendix by drdamodhar.m.vAppendix by drdamodhar.m.v
Appendix by drdamodhar.m.v
Dr.Damodhar.M.V MBBS,CSSGB,MBA,CPHQ
 
NY Prostate Cancer Conference - K. Touijer - Session 4: Predicting clinical a...
NY Prostate Cancer Conference - K. Touijer - Session 4: Predicting clinical a...NY Prostate Cancer Conference - K. Touijer - Session 4: Predicting clinical a...
NY Prostate Cancer Conference - K. Touijer - Session 4: Predicting clinical a...
European School of Oncology
 
19 im resident future of rectal cancer
19 im resident future of rectal cancer19 im resident future of rectal cancer
19 im resident future of rectal cancer
Virginia Mason Internal Medicine Residency
 
Rare Solid Cancers: An Introduction - Slide 7 - A. Berruti - Adrenal cancer
Rare Solid Cancers: An Introduction - Slide 7 - A. Berruti - Adrenal cancerRare Solid Cancers: An Introduction - Slide 7 - A. Berruti - Adrenal cancer
Rare Solid Cancers: An Introduction - Slide 7 - A. Berruti - Adrenal cancer
European School of Oncology
 
Gallbladder CA.pptx
Gallbladder CA.pptxGallbladder CA.pptx
Gallbladder CA.pptx
TiwariKripa
 
Endoscopy in Gastrointestinal Oncology - Slide 10 - M. Barthet - Management o...
Endoscopy in Gastrointestinal Oncology - Slide 10 - M. Barthet - Management o...Endoscopy in Gastrointestinal Oncology - Slide 10 - M. Barthet - Management o...
Endoscopy in Gastrointestinal Oncology - Slide 10 - M. Barthet - Management o...
European School of Oncology
 
Crespi, there are conflicting data about efficacy of colonoscopy
Crespi, there are conflicting data about efficacy of colonoscopy Crespi, there are conflicting data about efficacy of colonoscopy
Crespi, there are conflicting data about efficacy of colonoscopy
Gianfranco Tammaro
 
L'esofago di Barrett - Gastrolearning®
L'esofago di Barrett -  Gastrolearning®L'esofago di Barrett -  Gastrolearning®
L'esofago di Barrett - Gastrolearning®
Gastrolearning
 
CT coronary angiography in ED chest pain patients
CT coronary angiography in ED chest pain patientsCT coronary angiography in ED chest pain patients
CT coronary angiography in ED chest pain patients
kellyam18
 
MCC 2011 - Slide 7
MCC 2011 - Slide 7MCC 2011 - Slide 7
MCC 2011 - Slide 7
European School of Oncology
 
Sciahbasi A - AIMRADIAL 2013 - Radiation exposure
Sciahbasi A - AIMRADIAL 2013 - Radiation exposureSciahbasi A - AIMRADIAL 2013 - Radiation exposure
Sciahbasi A - AIMRADIAL 2013 - Radiation exposure
International Chair on Interventional Cardiology and Transradial Approach
 
Integrating icosapent ethyl in clinical practice: which patients will benefits?
Integrating icosapent ethyl in clinical practice: which patients will benefits?Integrating icosapent ethyl in clinical practice: which patients will benefits?
Integrating icosapent ethyl in clinical practice: which patients will benefits?
Sociedad Española de Cardiología
 
MCC 2011 - Slide 14
MCC 2011 - Slide 14MCC 2011 - Slide 14
MCC 2011 - Slide 14
European School of Oncology
 
HCC20121001
HCC20121001 HCC20121001
HCC20121001
Chien-Wei Su
 
4 dr mario sideri m k
4  dr mario sideri  m k4  dr mario sideri  m k
4 dr mario sideri m k
Tariq Mohammed
 

Similar to 1 Hassan (20)

1 Crespi Screening Rettocolon
1 Crespi Screening Rettocolon1 Crespi Screening Rettocolon
1 Crespi Screening Rettocolon
 
Update from CROI 2018: Focus on TB and Other Opportunistic Infections
Update from CROI 2018: Focus on TB and Other Opportunistic InfectionsUpdate from CROI 2018: Focus on TB and Other Opportunistic Infections
Update from CROI 2018: Focus on TB and Other Opportunistic Infections
 
12 Quimioterapia, 1ª - 2ª línea y mantenimiento. Cáncer de Pulmón
12 Quimioterapia, 1ª - 2ª línea y mantenimiento. Cáncer de Pulmón12 Quimioterapia, 1ª - 2ª línea y mantenimiento. Cáncer de Pulmón
12 Quimioterapia, 1ª - 2ª línea y mantenimiento. Cáncer de Pulmón
 
CCO_Pancreatic_Cancer_Advances_Downloadable_4 (2).pptx
CCO_Pancreatic_Cancer_Advances_Downloadable_4 (2).pptxCCO_Pancreatic_Cancer_Advances_Downloadable_4 (2).pptx
CCO_Pancreatic_Cancer_Advances_Downloadable_4 (2).pptx
 
Clinical Impact of New NAFLD/NASH Data From San Francisco 2018
Clinical Impact of New NAFLD/NASH Data From San Francisco 2018Clinical Impact of New NAFLD/NASH Data From San Francisco 2018
Clinical Impact of New NAFLD/NASH Data From San Francisco 2018
 
Appendix by drdamodhar.m.v
Appendix by drdamodhar.m.vAppendix by drdamodhar.m.v
Appendix by drdamodhar.m.v
 
NY Prostate Cancer Conference - K. Touijer - Session 4: Predicting clinical a...
NY Prostate Cancer Conference - K. Touijer - Session 4: Predicting clinical a...NY Prostate Cancer Conference - K. Touijer - Session 4: Predicting clinical a...
NY Prostate Cancer Conference - K. Touijer - Session 4: Predicting clinical a...
 
19 im resident future of rectal cancer
19 im resident future of rectal cancer19 im resident future of rectal cancer
19 im resident future of rectal cancer
 
Rare Solid Cancers: An Introduction - Slide 7 - A. Berruti - Adrenal cancer
Rare Solid Cancers: An Introduction - Slide 7 - A. Berruti - Adrenal cancerRare Solid Cancers: An Introduction - Slide 7 - A. Berruti - Adrenal cancer
Rare Solid Cancers: An Introduction - Slide 7 - A. Berruti - Adrenal cancer
 
Gallbladder CA.pptx
Gallbladder CA.pptxGallbladder CA.pptx
Gallbladder CA.pptx
 
Endoscopy in Gastrointestinal Oncology - Slide 10 - M. Barthet - Management o...
Endoscopy in Gastrointestinal Oncology - Slide 10 - M. Barthet - Management o...Endoscopy in Gastrointestinal Oncology - Slide 10 - M. Barthet - Management o...
Endoscopy in Gastrointestinal Oncology - Slide 10 - M. Barthet - Management o...
 
Crespi, there are conflicting data about efficacy of colonoscopy
Crespi, there are conflicting data about efficacy of colonoscopy Crespi, there are conflicting data about efficacy of colonoscopy
Crespi, there are conflicting data about efficacy of colonoscopy
 
L'esofago di Barrett - Gastrolearning®
L'esofago di Barrett -  Gastrolearning®L'esofago di Barrett -  Gastrolearning®
L'esofago di Barrett - Gastrolearning®
 
CT coronary angiography in ED chest pain patients
CT coronary angiography in ED chest pain patientsCT coronary angiography in ED chest pain patients
CT coronary angiography in ED chest pain patients
 
MCC 2011 - Slide 7
MCC 2011 - Slide 7MCC 2011 - Slide 7
MCC 2011 - Slide 7
 
Sciahbasi A - AIMRADIAL 2013 - Radiation exposure
Sciahbasi A - AIMRADIAL 2013 - Radiation exposureSciahbasi A - AIMRADIAL 2013 - Radiation exposure
Sciahbasi A - AIMRADIAL 2013 - Radiation exposure
 
Integrating icosapent ethyl in clinical practice: which patients will benefits?
Integrating icosapent ethyl in clinical practice: which patients will benefits?Integrating icosapent ethyl in clinical practice: which patients will benefits?
Integrating icosapent ethyl in clinical practice: which patients will benefits?
 
MCC 2011 - Slide 14
MCC 2011 - Slide 14MCC 2011 - Slide 14
MCC 2011 - Slide 14
 
HCC20121001
HCC20121001 HCC20121001
HCC20121001
 
4 dr mario sideri m k
4  dr mario sideri  m k4  dr mario sideri  m k
4 dr mario sideri m k
 

More from Gianfranco Tammaro

Il Trattamento Insulinico del Diabete tipo 1
Il Trattamento Insulinico del Diabete tipo 1Il Trattamento Insulinico del Diabete tipo 1
Il Trattamento Insulinico del Diabete tipo 1
Gianfranco Tammaro
 
SANDRI G. La Nutrizione Clinica al S.Eugenio. ASMaD 2017
SANDRI G. La Nutrizione Clinica al S.Eugenio. ASMaD 2017SANDRI G. La Nutrizione Clinica al S.Eugenio. ASMaD 2017
SANDRI G. La Nutrizione Clinica al S.Eugenio. ASMaD 2017
Gianfranco Tammaro
 
GASBARRINI A. Nutrizione Clinica e Gastroenterologia. ASMaD 2017
GASBARRINI A. Nutrizione Clinica e Gastroenterologia. ASMaD 2017GASBARRINI A. Nutrizione Clinica e Gastroenterologia. ASMaD 2017
GASBARRINI A. Nutrizione Clinica e Gastroenterologia. ASMaD 2017
Gianfranco Tammaro
 
PALLAGROSI R. Gli Alimenti a fini medici speciali: nuova definizione e normat...
PALLAGROSI R. Gli Alimenti a fini medici speciali: nuova definizione e normat...PALLAGROSI R. Gli Alimenti a fini medici speciali: nuova definizione e normat...
PALLAGROSI R. Gli Alimenti a fini medici speciali: nuova definizione e normat...
Gianfranco Tammaro
 
DE SANTIS D. Il Supporto Nutrizionale in Ospedale: ieri, oggi, domani. ASMaD ...
DE SANTIS D. Il Supporto Nutrizionale in Ospedale: ieri, oggi, domani. ASMaD ...DE SANTIS D. Il Supporto Nutrizionale in Ospedale: ieri, oggi, domani. ASMaD ...
DE SANTIS D. Il Supporto Nutrizionale in Ospedale: ieri, oggi, domani. ASMaD ...
Gianfranco Tammaro
 
Giorgetti G.M. Il Supporto Nutrizionale in Ospedale: ieri, oggi, domani. ASMa...
Giorgetti G.M. Il Supporto Nutrizionale in Ospedale: ieri, oggi, domani. ASMa...Giorgetti G.M. Il Supporto Nutrizionale in Ospedale: ieri, oggi, domani. ASMa...
Giorgetti G.M. Il Supporto Nutrizionale in Ospedale: ieri, oggi, domani. ASMa...
Gianfranco Tammaro
 
Franceschi F. Il Ruolo del Gastroenterologo nel DEA. ASMaD 2016
Franceschi F. Il Ruolo del Gastroenterologo nel DEA. ASMaD 2016Franceschi F. Il Ruolo del Gastroenterologo nel DEA. ASMaD 2016
Franceschi F. Il Ruolo del Gastroenterologo nel DEA. ASMaD 2016
Gianfranco Tammaro
 
Pace F. La Malattia da Reflusso Gastroesofageo. ASMaD 2016
Pace F. La Malattia da Reflusso Gastroesofageo. ASMaD 2016Pace F. La Malattia da Reflusso Gastroesofageo. ASMaD 2016
Pace F. La Malattia da Reflusso Gastroesofageo. ASMaD 2016
Gianfranco Tammaro
 
Ianiro G. La Malattia Celiaca. ASMaD 2016
Ianiro G. La Malattia Celiaca. ASMaD 2016Ianiro G. La Malattia Celiaca. ASMaD 2016
Ianiro G. La Malattia Celiaca. ASMaD 2016
Gianfranco Tammaro
 
Corazziari E. La Stipsi. ASMaD 2016
Corazziari E. La Stipsi. ASMaD 2016Corazziari E. La Stipsi. ASMaD 2016
Corazziari E. La Stipsi. ASMaD 2016
Gianfranco Tammaro
 
Tringali A. La CPRE. ASMaD 2016
Tringali A. La CPRE. ASMaD 2016Tringali A. La CPRE. ASMaD 2016
Tringali A. La CPRE. ASMaD 2016
Gianfranco Tammaro
 
Gasbarrini A. Microbiota, Antibiotici e Probiotici in Gastroenterologia. ASMa...
Gasbarrini A. Microbiota, Antibiotici e Probiotici in Gastroenterologia. ASMa...Gasbarrini A. Microbiota, Antibiotici e Probiotici in Gastroenterologia. ASMa...
Gasbarrini A. Microbiota, Antibiotici e Probiotici in Gastroenterologia. ASMa...
Gianfranco Tammaro
 
Attili F. L'Ecoendoscopia. ASMaD 2016
Attili F. L'Ecoendoscopia. ASMaD 2016Attili F. L'Ecoendoscopia. ASMaD 2016
Attili F. L'Ecoendoscopia. ASMaD 2016
Gianfranco Tammaro
 
Petruzziello L. La Colonscopia di qualità e le Procedure operative. ASMaD 2016
Petruzziello L. La Colonscopia di qualità e le Procedure operative. ASMaD 2016Petruzziello L. La Colonscopia di qualità e le Procedure operative. ASMaD 2016
Petruzziello L. La Colonscopia di qualità e le Procedure operative. ASMaD 2016
Gianfranco Tammaro
 
Bellini M. La Manometria del Tratto Inferiore. ASMaD 2016
Bellini M. La Manometria del Tratto Inferiore. ASMaD 2016Bellini M. La Manometria del Tratto Inferiore. ASMaD 2016
Bellini M. La Manometria del Tratto Inferiore. ASMaD 2016
Gianfranco Tammaro
 
De Bortoli N. La Manometria del Tratto Superiore. ASMaD 2016
De Bortoli N. La Manometria del Tratto Superiore. ASMaD 2016De Bortoli N. La Manometria del Tratto Superiore. ASMaD 2016
De Bortoli N. La Manometria del Tratto Superiore. ASMaD 2016
Gianfranco Tammaro
 
Frazzoni M. La PH-Impedenzometria. ASMaD 2016
Frazzoni M. La PH-Impedenzometria. ASMaD 2016Frazzoni M. La PH-Impedenzometria. ASMaD 2016
Frazzoni M. La PH-Impedenzometria. ASMaD 2016
Gianfranco Tammaro
 
Cerro P. La Radiologia Convenzionale del Tubo Digerente - Studio della deglut...
Cerro P. La Radiologia Convenzionale del Tubo Digerente - Studio della deglut...Cerro P. La Radiologia Convenzionale del Tubo Digerente - Studio della deglut...
Cerro P. La Radiologia Convenzionale del Tubo Digerente - Studio della deglut...
Gianfranco Tammaro
 
Scaldaferri F. Breath Test cosa c'è di nuovo. ASMaD 2016
Scaldaferri F. Breath Test cosa c'è di nuovo. ASMaD 2016Scaldaferri F. Breath Test cosa c'è di nuovo. ASMaD 2016
Scaldaferri F. Breath Test cosa c'è di nuovo. ASMaD 2016
Gianfranco Tammaro
 
Caturelli E. L'Ecografia Operativa. ASMaD 2016
Caturelli E. L'Ecografia Operativa. ASMaD 2016Caturelli E. L'Ecografia Operativa. ASMaD 2016
Caturelli E. L'Ecografia Operativa. ASMaD 2016
Gianfranco Tammaro
 

More from Gianfranco Tammaro (20)

Il Trattamento Insulinico del Diabete tipo 1
Il Trattamento Insulinico del Diabete tipo 1Il Trattamento Insulinico del Diabete tipo 1
Il Trattamento Insulinico del Diabete tipo 1
 
SANDRI G. La Nutrizione Clinica al S.Eugenio. ASMaD 2017
SANDRI G. La Nutrizione Clinica al S.Eugenio. ASMaD 2017SANDRI G. La Nutrizione Clinica al S.Eugenio. ASMaD 2017
SANDRI G. La Nutrizione Clinica al S.Eugenio. ASMaD 2017
 
GASBARRINI A. Nutrizione Clinica e Gastroenterologia. ASMaD 2017
GASBARRINI A. Nutrizione Clinica e Gastroenterologia. ASMaD 2017GASBARRINI A. Nutrizione Clinica e Gastroenterologia. ASMaD 2017
GASBARRINI A. Nutrizione Clinica e Gastroenterologia. ASMaD 2017
 
PALLAGROSI R. Gli Alimenti a fini medici speciali: nuova definizione e normat...
PALLAGROSI R. Gli Alimenti a fini medici speciali: nuova definizione e normat...PALLAGROSI R. Gli Alimenti a fini medici speciali: nuova definizione e normat...
PALLAGROSI R. Gli Alimenti a fini medici speciali: nuova definizione e normat...
 
DE SANTIS D. Il Supporto Nutrizionale in Ospedale: ieri, oggi, domani. ASMaD ...
DE SANTIS D. Il Supporto Nutrizionale in Ospedale: ieri, oggi, domani. ASMaD ...DE SANTIS D. Il Supporto Nutrizionale in Ospedale: ieri, oggi, domani. ASMaD ...
DE SANTIS D. Il Supporto Nutrizionale in Ospedale: ieri, oggi, domani. ASMaD ...
 
Giorgetti G.M. Il Supporto Nutrizionale in Ospedale: ieri, oggi, domani. ASMa...
Giorgetti G.M. Il Supporto Nutrizionale in Ospedale: ieri, oggi, domani. ASMa...Giorgetti G.M. Il Supporto Nutrizionale in Ospedale: ieri, oggi, domani. ASMa...
Giorgetti G.M. Il Supporto Nutrizionale in Ospedale: ieri, oggi, domani. ASMa...
 
Franceschi F. Il Ruolo del Gastroenterologo nel DEA. ASMaD 2016
Franceschi F. Il Ruolo del Gastroenterologo nel DEA. ASMaD 2016Franceschi F. Il Ruolo del Gastroenterologo nel DEA. ASMaD 2016
Franceschi F. Il Ruolo del Gastroenterologo nel DEA. ASMaD 2016
 
Pace F. La Malattia da Reflusso Gastroesofageo. ASMaD 2016
Pace F. La Malattia da Reflusso Gastroesofageo. ASMaD 2016Pace F. La Malattia da Reflusso Gastroesofageo. ASMaD 2016
Pace F. La Malattia da Reflusso Gastroesofageo. ASMaD 2016
 
Ianiro G. La Malattia Celiaca. ASMaD 2016
Ianiro G. La Malattia Celiaca. ASMaD 2016Ianiro G. La Malattia Celiaca. ASMaD 2016
Ianiro G. La Malattia Celiaca. ASMaD 2016
 
Corazziari E. La Stipsi. ASMaD 2016
Corazziari E. La Stipsi. ASMaD 2016Corazziari E. La Stipsi. ASMaD 2016
Corazziari E. La Stipsi. ASMaD 2016
 
Tringali A. La CPRE. ASMaD 2016
Tringali A. La CPRE. ASMaD 2016Tringali A. La CPRE. ASMaD 2016
Tringali A. La CPRE. ASMaD 2016
 
Gasbarrini A. Microbiota, Antibiotici e Probiotici in Gastroenterologia. ASMa...
Gasbarrini A. Microbiota, Antibiotici e Probiotici in Gastroenterologia. ASMa...Gasbarrini A. Microbiota, Antibiotici e Probiotici in Gastroenterologia. ASMa...
Gasbarrini A. Microbiota, Antibiotici e Probiotici in Gastroenterologia. ASMa...
 
Attili F. L'Ecoendoscopia. ASMaD 2016
Attili F. L'Ecoendoscopia. ASMaD 2016Attili F. L'Ecoendoscopia. ASMaD 2016
Attili F. L'Ecoendoscopia. ASMaD 2016
 
Petruzziello L. La Colonscopia di qualità e le Procedure operative. ASMaD 2016
Petruzziello L. La Colonscopia di qualità e le Procedure operative. ASMaD 2016Petruzziello L. La Colonscopia di qualità e le Procedure operative. ASMaD 2016
Petruzziello L. La Colonscopia di qualità e le Procedure operative. ASMaD 2016
 
Bellini M. La Manometria del Tratto Inferiore. ASMaD 2016
Bellini M. La Manometria del Tratto Inferiore. ASMaD 2016Bellini M. La Manometria del Tratto Inferiore. ASMaD 2016
Bellini M. La Manometria del Tratto Inferiore. ASMaD 2016
 
De Bortoli N. La Manometria del Tratto Superiore. ASMaD 2016
De Bortoli N. La Manometria del Tratto Superiore. ASMaD 2016De Bortoli N. La Manometria del Tratto Superiore. ASMaD 2016
De Bortoli N. La Manometria del Tratto Superiore. ASMaD 2016
 
Frazzoni M. La PH-Impedenzometria. ASMaD 2016
Frazzoni M. La PH-Impedenzometria. ASMaD 2016Frazzoni M. La PH-Impedenzometria. ASMaD 2016
Frazzoni M. La PH-Impedenzometria. ASMaD 2016
 
Cerro P. La Radiologia Convenzionale del Tubo Digerente - Studio della deglut...
Cerro P. La Radiologia Convenzionale del Tubo Digerente - Studio della deglut...Cerro P. La Radiologia Convenzionale del Tubo Digerente - Studio della deglut...
Cerro P. La Radiologia Convenzionale del Tubo Digerente - Studio della deglut...
 
Scaldaferri F. Breath Test cosa c'è di nuovo. ASMaD 2016
Scaldaferri F. Breath Test cosa c'è di nuovo. ASMaD 2016Scaldaferri F. Breath Test cosa c'è di nuovo. ASMaD 2016
Scaldaferri F. Breath Test cosa c'è di nuovo. ASMaD 2016
 
Caturelli E. L'Ecografia Operativa. ASMaD 2016
Caturelli E. L'Ecografia Operativa. ASMaD 2016Caturelli E. L'Ecografia Operativa. ASMaD 2016
Caturelli E. L'Ecografia Operativa. ASMaD 2016
 

Recently uploaded

Physical demands in sports - WCSPT Oslo 2024
Physical demands in sports - WCSPT Oslo 2024Physical demands in sports - WCSPT Oslo 2024
Physical demands in sports - WCSPT Oslo 2024
Torstein Dalen-Lorentsen
 
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxDoes Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
walterHu5
 
Role of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of HyperthyroidismRole of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of Hyperthyroidism
Dr. Jyothirmai Paindla
 
Complementary feeding in infant IAP PROTOCOLS
Complementary feeding in infant IAP PROTOCOLSComplementary feeding in infant IAP PROTOCOLS
Complementary feeding in infant IAP PROTOCOLS
chiranthgowda16
 
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptxPost-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
FFragrant
 
share - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptxshare - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptx
Tina Purnat
 
Journal Article Review on Rasamanikya
Journal Article Review on RasamanikyaJournal Article Review on Rasamanikya
Journal Article Review on Rasamanikya
Dr. Jyothirmai Paindla
 
Tests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptxTests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptx
taiba qazi
 
Adhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.comAdhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.com
reignlana06
 
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.GawadHemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
NephroTube - Dr.Gawad
 
Integrating Ayurveda into Parkinson’s Management: A Holistic Approach
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachIntegrating Ayurveda into Parkinson’s Management: A Holistic Approach
Integrating Ayurveda into Parkinson’s Management: A Holistic Approach
Ayurveda ForAll
 
Histopathology of Rheumatoid Arthritis: Visual treat
Histopathology of Rheumatoid Arthritis: Visual treatHistopathology of Rheumatoid Arthritis: Visual treat
Histopathology of Rheumatoid Arthritis: Visual treat
DIVYANSHU740006
 
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptxEar and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Dr. Rabia Inam Gandapore
 
CBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdfCBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdf
suvadeepdas911
 
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
NARCOTICS- POLICY AND PROCEDURES FOR ITS USENARCOTICS- POLICY AND PROCEDURES FOR ITS USE
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
Dr. Ahana Haroon
 
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
rishi2789
 
All info about Diabetes and how to control it.
 All info about Diabetes and how to control it. All info about Diabetes and how to control it.
All info about Diabetes and how to control it.
Gokuldas Hospital
 
Histololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptxHistololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptx
AyeshaZaid1
 
The Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic PrinciplesThe Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic Principles
MedicoseAcademics
 
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPromoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
PsychoTech Services
 

Recently uploaded (20)

Physical demands in sports - WCSPT Oslo 2024
Physical demands in sports - WCSPT Oslo 2024Physical demands in sports - WCSPT Oslo 2024
Physical demands in sports - WCSPT Oslo 2024
 
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxDoes Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
 
Role of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of HyperthyroidismRole of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of Hyperthyroidism
 
Complementary feeding in infant IAP PROTOCOLS
Complementary feeding in infant IAP PROTOCOLSComplementary feeding in infant IAP PROTOCOLS
Complementary feeding in infant IAP PROTOCOLS
 
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptxPost-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
 
share - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptxshare - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptx
 
Journal Article Review on Rasamanikya
Journal Article Review on RasamanikyaJournal Article Review on Rasamanikya
Journal Article Review on Rasamanikya
 
Tests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptxTests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptx
 
Adhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.comAdhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.com
 
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.GawadHemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
 
Integrating Ayurveda into Parkinson’s Management: A Holistic Approach
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachIntegrating Ayurveda into Parkinson’s Management: A Holistic Approach
Integrating Ayurveda into Parkinson’s Management: A Holistic Approach
 
Histopathology of Rheumatoid Arthritis: Visual treat
Histopathology of Rheumatoid Arthritis: Visual treatHistopathology of Rheumatoid Arthritis: Visual treat
Histopathology of Rheumatoid Arthritis: Visual treat
 
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptxEar and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
 
CBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdfCBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdf
 
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
NARCOTICS- POLICY AND PROCEDURES FOR ITS USENARCOTICS- POLICY AND PROCEDURES FOR ITS USE
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
 
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
 
All info about Diabetes and how to control it.
 All info about Diabetes and how to control it. All info about Diabetes and how to control it.
All info about Diabetes and how to control it.
 
Histololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptxHistololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptx
 
The Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic PrinciplesThe Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic Principles
 
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPromoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
 

1 Hassan

  • 1. L’ (in) appropriatezza dell’endoscopia superiore C. Hassan
  • 2. ENDOSCOPY PATIENT NON-GI REFERRING PHYSICIAN
  • 3. Medico richiedente N % MMG 3794 60,5 Medico Osped. 2268 36,2 Specialista est. 124 2,0 n.i. 84 1,3 TOTALE 6270 100
  • 4. ENDOSCOPY PATIENT NON-GI REFERRING PHYSICIAN GI GUIDELINES
  • 5.
  • 6. “… on how endoscopy should be performed, by whom, and for what purposes”
  • 7.  
  • 8.  
  • 9.
  • 10.
  • 11.  
  • 12.  
  • 13. 13 856 PATIENTS 22% NOT INDICATED Author N° patients Inappropriateness Rate % Hassan et al. 6270 23 Rossi et al. 1777 16 Chan et al. 1076 12 Froelhich et al. 1681 39 Bersani et al. 2000 10 Al Romaih et al. 80 28 Kaliszan et al. 522 30 Gonvers et al. 450 43
  • 14. Età - Giudizio richiesta A P < 0.05
  • 15. Tip. Esame – Giudizio rich. P < 0.05
  • 18.
  • 19.
  • 20.
  • 21.
  • 22. RESULTS New malignancy 1.6% (132 pts.) -Cancer 128 pts. -Lymphoma 4 pts.
  • 23.
  • 24. 13 856 PATIENTS 45% RELEVANT FINDINGS Author N° patients Relevant findings % Hassan et al. 6270 49 Rossi et al. 1777 45 Chan et al. 1076 38 Froelhich et al. 1681 54 Bersani et al. 2000 51 Al Romaih et al. 80 32 Kaliszan et al. 522 46 Gonvers et al. 450 46
  • 25. 51% 32% NOT INDICATED INDICATED 13 856 PATIENTS 78% 22% RELEVANT FINDINGS RELEVANT FINDINGS
  • 26. Appropriateness of the indication for upper endoscopy: a meta-analysis Di Giulio E, Hassan C, Zullo A, et al. , DLD 2009 ASGE guidelines Sens. Spec. PPV NPV Relevant finding 85% 28% 49% 70%
  • 27. DIAGNOSI RILEVANTI vs APPROPRIATEZZA Endoscopic finding OR [99% CI] Clinically relevant Erosive esophagitis 1.28 [0.35-1.63] Erosive gastritis 1.79 [1.35-2.36] * Esophageal varices 5.65 [2.96-10.8] * Duodenal ulcer 3.38 [1.98-5.76] * Barrett’s esophagus 3.58 [1.59-8.08] * Gastric ulcer 3.41 [1.51-7.71] * Not clinically relevant Nonerosive gastritis 0.78 [0.66-0.9] * Normal 0.40 [0.33-0.49] * Hiatal hernia 0.63 [0.51-0.77] *
  • 28. 2.4% 0.13% NOT INDICATED INDICATED 13 856 PATIENTS 78% 22% CANCER CANCER
  • 29. b) Appropriateness of the indication for upper endoscopy: a meta-analysis Di Giulio E, Hassan C, Zullo A, et al. , DLD 2009 ASGE guidelines Sens. Spec. PPV NPV Relevant finding 85% 28% 49% 70% Cancer 97% 22% 2% 99.8%
  • 30.
  • 32.
  • 33. RESULTS Table 4. Multivariate analysis for the detection of relevant finding Clinical variable Relevant finding OR (95% CI) Bleeding 3.51 (2.9 – 4.2) Relevant finding at previous EGD 2.76 (2.5 – 3.1) Appropriateness 2.7 (2.4 – 3) Male sex 1.77 (1.6 – 1.9) Age > 45 1.55 (1.4 – 1.7) Alarm symptoms 1.39 (1.2 – 1.6) Weight loss 1.32 (1 – 1.6) Reflux 1.16 (1.05 – 1.3) PPI therapy 1.03 (0.93 – 1.1)
  • 34. RESULTS Table 5. Estimates of accuracy of the different strategies in selecting EGD referrals for the detection of relevant findings b) Strategy Rate of EGDs indicated Sens. Spec. PPV NPV AUC ASGE guidelines 80% 88% 27% 51% 72% 0.55 Age > 45/alarm features 78% 82% 26% 49% 63% 0.52
  • 35. RESULTS Figure 1. Receiver operating curve (ROC) for multivariate and ANN models for relevant findings. b)
  • 36. RESULTS Table 4. Multivariate analysis for the detection of malignancy b) Clinical variable New malignancy OR (95% CI) Weight loss 15.2 (9.3 – 24.8) Dysphagia 9.3 (5.7 – 15.6) Alarm features 8 .78 (5.2 – 14.8) Age 8.2 (2.8 – 24) Age > 45 years 8 (2.6 – 23.8) Age > 45 years or alarm features 7.63 (2.3 – 24.7) Vomiting 5.64 (3.2 – 10.1) No previous EGD 7.5 (2 – 28) Anaemia 3.66 (2.2 – 6.1) Bleeding 1.91 (0.5 – 6.4) Family history for cancer 1.77 (0.5 – 6.7) Male sex 1.63 (1 – 2.6) Specialist 1.2 (1 – 2) NSAIDs/anti-COX2/aspirin 1 (0.5 – 2.2)
  • 37. RESULTS Table 5. Estimates of accuracy of the different strategies in selecting EGD referrals for the detection of cancer b) Strategy Sens. Spec. PPV NPV NNT AUC ASGE guidelines 98% 20% 2% 99.8% 50 0.59 Age > 45/alarm features 97% 22% 2% 99.8% 50 0.59
  • 38. RESULTS Figure 1. Receiver operating curve (ROC) for multivariate and ANN models for new cases of malignancy . b)
  • 39.
  • 40. Buri L, Hassan C,Bersani G , Anti M, Bianco MA, Cipolletta L, Di Giulio E, Di Matteo G, Familiari L, Ficano L, Loriga P, Morini S, Pietropaolo V, Zambelli A, Grossi E, Intraligi M, and the SIED Appropriateness Working Group.* Appropriateness guidelines and predictive rules to select patients for upper endoscopy: a nationwide, multicenter study on behalf of SIED
  • 41. CANCER RELEVANT FINDINGS NO CANCER 4% 96%
  • 42.
  • 43.
  • 44.
  • 45.
  • 46.
  • 47. “ In conclusion, our study showed that a simple rule based on age and alarm features may be as accurate as the more complex ASGE guidelines in predicting endoscopic outcome in an unselected EGD population. The implementation of such predictive rule would immediately result in the exclusion of more than 20% of the patients from the EGD waiting list, with only a marginal loss of clinical information. Linear and ANN models may be useful to prioritize patients at higher risk of malignancy.”
  • 48. b)
  • 49. b)