Publications by authors named "Michiel Bronswijk"

36 Publications

EUS-guided hepaticogastrostomy for patients with afferent loop syndrome: a comparison with EUS-guided gastroenterostomy or percutaneous drainage.

Surg Endosc 2021 Apr 28. Epub 2021 Apr 28.

Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Herestraat 49, 3000, Leuven, Belgium.

Objectives: Where palliative surgery or percutaneous drainage used to be the only option in patients with afferent loop syndrome, endoscopic management by EUS-guided gastroenterostomy has been gaining ground. However, EUS-guided hepaticogastrostomy might also provide sufficient biliary drainage. Our aim was to evaluate the feasibility of EUS-guided hepaticogastrostomy for the management of afferent loop syndrome and provide comparative data on the different approaches.

Methods: The institutional databases were queried for all consecutive minimally invasive procedures for afferent loop syndrome. A retrospective, dual-centre analysis was performed, separately analysing EUS-guided hepaticogastrostomy, EUS-guided gastroenterostomy and percutaneous drainage. Efficacy, safety, need for re-intervention, hospital stay and overall survival were compared.

Results: In total, 17 patients were included (mean age 59 years (± SD 10.5), 23.5% female). Six patients, which were ineligible for EUS-guided gastroenterostomy, were treated with EUS-guided hepaticogastrostomy. EUS-guided gastroenterostomy and percutaneous drainage were performed in 6 and 5 patients respectively. Clinical success was achieved in all EUS-treated patients, versus 80% in the percutaneous drainage group (p = 0.455). Furthermore, higher rates of bilirubin decrease were seen among patients undergoing EUS: > 25% bilirubin decrease in 10 vs. 1 patient(s) in the percutaneously drained group (p = 0.028), with > 50% and > 75% decrease identified only in the EUS group. Using the ASGE lexicon for adverse event grading, adverse events occurred only in patients treated with percutaneous drainage (60%, p = 0.015). And last, the median number of re-interventions was significantly lower in patients undergoing EUS (0 (IQR 0.0-1.0) vs. 1 (0.5-2.5), p = 0.045) when compared to percutaneous drainage.

Conclusions: In the management of afferent loop syndrome, EUS seems to outperform percutaneous drainage. Moreover, in our cohort, EUS-guided gastroenterostomy and hepaticogastrostomy provided similar outcomes, suggesting EUS-guided hepaticogastrostomy as the salvage procedure in situations where EUS-guided gastroenterostomy is not feasible or has failed.
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http://dx.doi.org/10.1007/s00464-021-08520-zDOI Listing
April 2021

Endoscopic full-thickness resection and post-procedural appendicitis: every advantage has its disadvantage.

Endoscopy 2021 05 22;53(5):561. Epub 2021 Apr 22.

Department of Gastroenterology and Hepatology, Imelda General Hospital, and Imelda Clinical GI Research Center, Bonheiden, and Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium.

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http://dx.doi.org/10.1055/a-1337-2523DOI Listing
May 2021

Laparoscopic versus EUS-guided gastroenterostomy for gastric outlet obstruction: an international multicenter propensity score-matched comparison (with video).

Gastrointest Endosc 2021 Apr 11. Epub 2021 Apr 11.

Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Leuven, Belgium.

Background And Aims: In the management of gastric outlet obstruction (GOO), EUS-guided gastroenterostomy (EUS-GE) seems safe and more effective than enteral stent placement. However, comparisons with laparoscopic gastroenterostomy (L-GE) are scarce. Our aim was to perform a propensity score-matched comparison between EUS-GE and L-GE.

Methods: An international, multicenter, retrospective analysis was performed of consecutive EUS-GE and L-GE procedures in 3 academic centers (Jan 2015 to May 2020), using propensity score-matching in order to minimize selection bias. A standard maximum propensity score difference of 0.1 was applied, also considering underlying disease and oncological staging.

Results: Overall, 77 patients were treated with EUS-GE and 48 patients with L-GE. By means of propensity score-matching, 37 patients were allocated to both groups, resulting in 74 (1:1) matched patients. Technical success was achieved in 35 out of 37 EUS-GE-treated patients (94.6%) versus 100% in the L-GE group (p=0.493). Clinical success, defined as eating without vomiting or GOO Scoring System ≥2, was achieved in 97.1% and 89.2%, respectively (p=0.358). Median time to oral intake (1 [IQR 0.3-1.0] vs 3 [IQR 1.0-5.0] days, p<0.001) and median hospital stay (4 [IQR 2-8] vs 8 [IQR 5.5-20] days, p<0.001) were significantly shorter in the EUS-GE group. Overall adverse events (AEs) (2.7% vs 27.0%, p=0.007) and severe AEs (0.0% vs 16.2%, p=0.025) were identified more frequently in the L-GE group.

Conclusion: For patients with GOO, EUS-GE and L-GE showed almost identical technical and clinical success. However, reduced time to oral intake, shorter median hospital stay, and lower rate of adverse events suggest that the EUS-guided approach might be preferable.
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http://dx.doi.org/10.1016/j.gie.2021.04.006DOI Listing
April 2021

Digital Cholangioscopy-guided Cold Snare Resection of an Inflammatory Intraductal Pseudopolyp.

Dig Endosc 2021 Apr 12. Epub 2021 Apr 12.

Department of Gastroenterology and Hepatology, University Hospitals Leuven, Belgium.

Digital single-operator cholangioscopy (DSOC) has revolutionized the endoscopic diagnosis and treatment of various hepato-pancreaticobiliary diseases, such as indeterminate biliary strictures and large balloon dilation-refractory common bile duct (CBD) stones, using either a retrograde or antegrade approach. Direct visualization provided by DSOC has furthermore paved the road towards minimally invasive treatment of intraductal neoplasms, although little evidence is available in this specific context. A 70-year-old patient was admitted following several episodes of colicky abdominal discomfort, mixed liver function abnormalities and non-intentional weight loss. Abdominal CT revealed predominantly extrahepatic bile duct dilation, after which EUS was performed, identifying a sessile obstructive intraductal lesion (Figure 1, left). ERCP subsequently confirmed presence of a distal polypoid lesion, which could be luxated out of the CBD using an extraction balloon (Figure 1, right). As intraductal extension was suspected and the exact dimensions could not be optimally evaluated, the patient was referred for DSOC. On introduction of the cholangioscope, a granulomatous sessile lesion was identified, without significant intraductal extension. The decision was made to remove the lesion using cholangioscopy-assisted cold snare resection. The polyp was dislocated into the duodenum using a dedicated cholangioscopy snare (Figure 2, left), followed by simple cold snare resection and complete removal of the lesion (Figure 2, right).
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http://dx.doi.org/10.1111/den.13991DOI Listing
April 2021

Gastrointestinal mucosal damage in patients with COVID-19 undergoing endoscopy: an international multicentre study.

BMJ Open Gastroenterol 2021 02;8(1)

Department of Gastroenterology, Newcastle upon Tyne hospitals NHS Trust, Newcastle upon Tyne, UK.

Background: Although evidence suggests frequent gastrointestinal (GI) involvement during coronavirus disease 2019 (COVID-19), endoscopic findings are scarcely reported.

Aims: We aimed at registering endoscopic abnormalities and potentially associated risk factors among patients with COVID-19.

Methods: All consecutive patients with COVID-19 undergoing endoscopy in 16 institutions from high-prevalence regions were enrolled. Mann-Whitney U, χ or Fisher's exact test were used to compare patients with major abnormalities to those with negative procedures, and multivariate logistic regression to identify independent predictors.

Results: Between February and May 2020, during the first pandemic outbreak with severely restricted endoscopy activity, 114 endoscopies on 106 patients with COVID-19 were performed in 16 institutions (men=70.8%, median age=68 (58-74); 33% admitted in intensive care unit; 44.4% reporting GI symptoms). 66.7% endoscopies were urgent, mainly for overt GI bleeding. 52 (45.6%) patients had major abnormalities, whereas 13 bled from previous conditions. The most prevalent upper GI abnormalities were ulcers (25.3%), erosive/ulcerative gastro-duodenopathy (16.1%) and petechial/haemorrhagic gastropathy (9.2%). Among lower GI endoscopies, 33.3% showed an ischaemic-like colitis.Receiver operating curve analysis identified D-dimers >1850 ng/mL as predicting major abnormalities. Only D-dimers >1850 ng/mL (OR=12.12 (1.69-86.87)) and presence of GI symptoms (OR=6.17 (1.13-33.67)) were independently associated with major abnormalities at multivariate analysis.

Conclusion: In this highly selected cohort of hospitalised patients with COVID-19 requiring endoscopy, almost half showed acute mucosal injuries and more than one-third of lower GI endoscopies had features of ischaemic colitis. Among the hospitalisation-related and patient-related variables evaluated in this study, D-dimers above 1850 ng/mL was the most useful at predicting major mucosal abnormalities at endoscopy.

Trial Registration Number: ClinicalTrial.gov (ID: NCT04318366).
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http://dx.doi.org/10.1136/bmjgast-2020-000578DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907837PMC
February 2021

EUS-guided hepaticogastrostomy as a gateway to intermittent access for biliary leak management.

Endoscopy 2021 Jan 27. Epub 2021 Jan 27.

Department of Gastroenterology and Hepatology, University Hospitals Leuven, Belgium.

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http://dx.doi.org/10.1055/a-1327-1849DOI Listing
January 2021

Technical and clinical outcomes of endoscopic retrograde cholangiopancreatography (ERCP) procedures performed in patients with COVID-19.

Therap Adv Gastroenterol 2020 21;13:1756284820980671. Epub 2020 Dec 21.

Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.

Background: The unprecedented situation caused by the coronavirus disease 2019 (COVID-19) pandemic has profoundly affected endoscopic practice in regard to access, volume, and workflow. We aimed to assess the potential changes in the technical outcomes of endoscopic retrograde cholangiopancreatography (ERCP) procedures carried out in patients with confirmed SARS-CoV-2 infection.

Methods: We conducted an international, multicenter, retrospective, matched case-control study of ERCP procedures carried out in patients with confirmed COVID-19. The main outcome was technical success of the procedure as assessed by the endoscopist, and the secondary outcome was the development of procedure-related adverse events. Each case was matched in a 1:4 ratio with controls extracted from each center's database in order to identify relevant changes in outcome measures compared with the pre-pandemic era.

Results: Eighteen procedures performed in 16 COVID-19 patients [14 men, 65 years (9-82)] and 67 controls were included in the final analysis. Technical success was achieved in 14/18 COVID-19 cases, which was significantly lower as compared with the control group (14/18 64/67,  = 0.034), with an endoscopic reintervention required in 9/18 cases. However, the rate of procedure-related adverse events was low in both groups (1/18 10/67,  = 0.44). On multivariable analysis, COVID-19 status remained the only risk factor for technical failure of the procedure [odds ratio of 19.9 (95% confidence interval 1.4-269.0)].

Conclusions: The COVID-19 pandemic has affected the volume and practice of ERCP, resulting in lower technical success rates without significantly impacting patient safety. Prioritizing cases and following recommendations on safety measures can ensure good outcome with minimal risk in dedicated centers.
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http://dx.doi.org/10.1177/1756284820980671DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756189PMC
December 2020

EUS-guided intrahepatic biliary drainage: a large retrospective series and subgroup comparison between percutaneous drainage in hilar stenoses or postsurgical anatomy.

Endosc Int Open 2020 Dec 17;8(12):E1782-E1794. Epub 2020 Nov 17.

Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium.

 Endoscopic ultrasound-guided intrahepatic biliary drainage (EUS-IBD) struggles to find a place in management algorithms, especially compared to percutaneous drainage (PTBD). In the setting of hilar stenoses or postsurgical anatomy data are even more limited.  All consecutive EUS-IBDs performed in our tertiary referral center between 2012 - 2019 were retrospectively evaluated. Rendez-vous (RVs), antegrade stenting (AS) and hepatico-gastrostomies (HGs) were compared. The predefined subgroup of EUS-IBD patients with proximal stenosis/surgically-altered anatomy was matched 1:1 with PTBD performed for the same indications. Efficacy, safety and events during follow-up were compared.  One hundred four EUS-IBDs were included (malignancies = 87.7 %). These consisted of 16 RVs, 43 ASs and 45 HGs. Technical and clinical success rates were 89.4 % and 96.2 %, respectively. Any-degree, severe and fatal adverse events (AEs) occurred in 23.3 %, 2.9 %, and 0.9 % respectively. Benign indications were more common among RVs while proximal stenoses, surgically-altered anatomy, and disconnected left ductal system among HGs. Procedures were shorter with HGs performed with specifically designed stents (25 vs 48 minutes,  = 0.004) and there was also a trend toward less dysfunction with those stents (6.7 % vs 30 %,  = 0.09) compared with previous approaches. Among patients with proximal stenosis/surgically-altered anatomy, EUS-IBD vs. PTBD showed higher rates of clinical success (97.4 % vs. 79.5 %,  = 0.01), reduced post-procedural pain (17.8 % vs. 44.4 %, p = 0.004), shorter median hospital stay (7.5 vs 11.5 days,  = 0.01), lower rates of stent dysfunction (15.8 % vs. 42.9 %,  = 0.01), and the mean number of reinterventions was lower (0.4 vs. 2.8,  < 0.0001).  EUS-IBD has high technical and clinical success with an acceptable safety profile. HGs show comparable outcomes, which are likely to further improve with dedicated tools. For proximal strictures and surgically-altered anatomy, EUS-IBD seems superior to PTBD.
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http://dx.doi.org/10.1055/a-1264-7511DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7671754PMC
December 2020

Cold snare piecemeal EMR of large sessile colonic polyps >20 mm: a call for dedicated snares.

Gastrointest Endosc 2020 11;92(5):1141-1142

Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.

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http://dx.doi.org/10.1016/j.gie.2020.05.059DOI Listing
November 2020

Cap-and-suction hemoclip closure of an iatrogenic cricopharyngeal perforation.

Endoscopy 2020 Nov 3. Epub 2020 Nov 3.

Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.

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http://dx.doi.org/10.1055/a-1283-5523DOI Listing
November 2020

EUS-guided gastroenterostomy: Less is more! The wireless EUS-guided gastroenterostomy simplified technique.

VideoGIE 2020 Sep 3;5(9):442. Epub 2020 Aug 3.

Pancreatobiliary Endoscopy and EUS Division, IRCSS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.

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http://dx.doi.org/10.1016/j.vgie.2020.06.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7482414PMC
September 2020

Endoscopic treatment of large symptomatic colon lipomas: A systematic review of efficacy and safety.

United European Gastroenterol J 2020 12 3;8(10):1147-1154. Epub 2020 Aug 3.

Department of Gastroenterology and Hepatology, University Hospitals, Leuven, Belgium.

Background: Various techniques have been described for endoscopic resection of large symptomatic colon lipomas. Lipoma unroofing might provide a safer, more time efficient and easier technique compared to dissection-based techniques, endoscopic mucosal resection (EMR) or loop-assisted resection. The aim of this systematic review was to compare efficacy and safety (endoscopic resolution rates, clinical remission rates and adverse events) of lipoma unroofing with respect to dissection-based techniques, EMR or loop-assisted resection.

Methods: As most outcomes were binary in nature and several outcomes did not occur in some studies, routine calculation of standard errors in outcome probability was not possible. Therefore, original patient data were extracted, after which efficacy and safety were compared.

Results: Twenty four studies met the selection criteria, which encompassed 77 lesions (46.8% female, mean age 63 years (interquartile range (IQR) 53-72 years), mean size 45.4 mm (IQR 30.0-60.0 mm). Ten patients underwent unroofing (13.0%), whereas 7 (9.1%), 31 (40.3%) and 29 patients (37.7%) underwent dissection-based techniques, EMR and loop-assisted-snare resection, respectively. Endoscopic resolution rates were 60%, 100% ( = 0.103), 93.6% ( = 0.024) and 93.1% ( = 0.028). Clinical remission rates were identical in all four groups (100%). Amongst patients who underwent EMR and loop-assisted techniques, adverse events were identified in 12.9% ( = 0.556) and 13.8% ( = 0.556), respectively, compared to none in the unroofing and dissection-based resection group.

Conclusions: In patients with large colon lipomas, endoscopic treatment by unroofing, dissection-based resection, EMR and loop-assisted resection provided similar clinical remission rates. Amongst patients undergoing EMR and loop-assisted resection, increased endoscopic resolution rates were seen at the expense of more adverse events, although the latter did not reach statistical significance. Until more reliable comparative data are available, the most optimal resection technique should rely on local expertise and patient profile.
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http://dx.doi.org/10.1177/2050640620948661DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7724534PMC
December 2020

Successful treatment of superior mesenteric artery syndrome by endoscopic ultrasound-guided gastrojejunostomy.

Endoscopy 2021 Feb 19;53(2):204-205. Epub 2020 Jun 19.

Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium.

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http://dx.doi.org/10.1055/a-1190-3228DOI Listing
February 2021

Recurrent acute pancreatitis due to a loop-shaped variant of the accessory pancreatic duct.

Gastrointest Endosc 2020 Sep 11;92(3):781-783. Epub 2020 Apr 11.

Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.

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http://dx.doi.org/10.1016/j.gie.2020.04.006DOI Listing
September 2020

Pancreatic Insufficiency and an Absent Gallbladder: Connecting the Dots.

Gastroenterology 2020 08 1;159(2):e8-e9. Epub 2020 Feb 1.

Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium.

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http://dx.doi.org/10.1053/j.gastro.2020.01.040DOI Listing
August 2020

Needle-knife deroofing of a symptomatic type III choledochal cyst.

Endoscopy 2020 06 9;52(6):E191-E192. Epub 2019 Dec 9.

Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium.

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http://dx.doi.org/10.1055/a-1067-4271DOI Listing
June 2020

Pantoprazole in Prevention of Gastroduodenal Events in Patients Receiving Rivaroxaban and/or Aspirin-A Short Word of Caution.

Gastroenterology 2020 01 5;158(1):283-284. Epub 2019 Nov 5.

Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.

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http://dx.doi.org/10.1053/j.gastro.2019.08.063DOI Listing
January 2020

A rare cause of dysphagia.

Eur J Intern Med 2019 Dec 2;70:e3-e4. Epub 2019 Nov 2.

Department of Gastroenterology and Hepatology, University Hospitals Leuven, Belgium; Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Belgium.

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http://dx.doi.org/10.1016/j.ejim.2019.10.005DOI Listing
December 2019

Reversal of protein-losing enteropathy following surgical revision of a jejunal Roux-en-Y loop after liver transplantation: Look for lymphangiectasia!

Am J Transplant 2019 12 23;19(12):3440-3441. Epub 2019 Oct 23.

Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.

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http://dx.doi.org/10.1111/ajt.15630DOI Listing
December 2019

An Unfortunate Consequence of Duodenogastric Reflux.

Gastroenterology 2020 03 9;158(4):836-837. Epub 2019 Aug 9.

Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium.

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http://dx.doi.org/10.1053/j.gastro.2019.07.059DOI Listing
March 2020

Evaluating Efficacy, Safety, and Pharmacokinetics After Switching From Infliximab Originator to Biosimilar CT-P13: Experience From a Large Tertiary Referral Center.

Inflamm Bowel Dis 2020 03;26(4):628-634

Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.

Background: The use of infliximab biosimilar CT-P13 has increased in patients with inflammatory bowel disease. Nevertheless, doubts about switching from infliximab originator to biosimilar still exist among patients and health care professionals.

Methods: Our tertiary referral center underwent a mandatory switch from infliximab originator to CT-P13 in 2017. We investigated pharmacokinetics, efficacy, and safety of this switch. The primary endpoint was infliximab discontinuation within 6 months of switching. Secondary endpoints included loss of clinical remission, need for treatment optimization, adverse events, evolution of patient-reported outcome, C-reactive protein, infliximab trough levels, and antidrug-antibodies.

Results: A total of 361 patients (54.0% male, 70.0% Crohn's disease, 55.6% in clinical remission) were enrolled. Infliximab discontinuation within 6 months was observed in 4%. Loss of clinical remission, adverse events, and antidrug-antibodies were identified in only 2.0%, 2.2%, and 1.1% of patients, respectively. C-reactive protein concentrations and infliximab trough levels remained stable. Independent factors associated with remission at 6 months were lower PRO2 at switch (HR 6.024; 95% CI, 4.878-8.000; P < 0.0001) and higher hemoglobin levels (HR 1.383; 95% CI, 1.044-2.299; P = 0.018).

Conclusions: Switching from infliximab originator to CT-P13 was not associated with an increased risk of treatment discontinuation, loss of clinical remission, or adverse events. No significant changes in infliximab trough levels or immunogenicity could be identified.
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http://dx.doi.org/10.1093/ibd/izz167DOI Listing
March 2020

Endoscopic ultrasound-guided ablation of pancreatic neuroendocrine tumors: with or without alcohol?

Endoscopy 2019 08 25;51(8):798. Epub 2019 Jul 25.

Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium.

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http://dx.doi.org/10.1055/a-0889-8106DOI Listing
August 2019

Endoscopic resection of giant colon lipomas: get rid of the roof!

VideoGIE 2019 Jul 27;4(7):341. Epub 2019 Jun 27.

Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.

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http://dx.doi.org/10.1016/j.vgie.2019.04.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6616925PMC
July 2019

Upper gastrointestinal bleeding due to Gurvits' syndrome.

Dig Liver Dis 2019 09 10;51(9):1347. Epub 2019 Jun 10.

Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium.

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http://dx.doi.org/10.1016/j.dld.2019.05.022DOI Listing
September 2019

Diffuse esophageal papillomatosis complicated by squamous cell carcinoma.

Dig Liver Dis 2019 08 28;51(8):1197. Epub 2019 May 28.

Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium.

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http://dx.doi.org/10.1016/j.dld.2019.05.008DOI Listing
August 2019

Circumferential Ulcerations in the Ascending Colon.

Gastroenterology 2019 09 6;157(3):e4-e5. Epub 2019 Apr 6.

Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium.

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http://dx.doi.org/10.1053/j.gastro.2019.03.067DOI Listing
September 2019

Cowden syndrome caused by a novel mutation: Endoscopy aided diagnosis.

Dig Liver Dis 2019 06 2;51(6):910. Epub 2019 Apr 2.

Department of Gastroenterology and Hepatology, University Hospitals Leuven, Belgium.

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http://dx.doi.org/10.1016/j.dld.2019.03.003DOI Listing
June 2019

A Presumed Double Appendiceal Orifice: Diagnosis of an Appendico-Cecal Fistula.

Clin Gastroenterol Hepatol 2020 04 28;18(4):e46. Epub 2019 Feb 28.

Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium.

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http://dx.doi.org/10.1016/j.cgh.2019.02.038DOI Listing
April 2020