Juan Carlos Molina

Bio: Juan Carlos Molina is an academic researcher from Université de Montréal. The author has contributed to research in topics: Interstitial lung disease & Mediastinum. The author has an hindex of 3, co-authored 6 publications receiving 22 citations.

Lung Cryobiopsy Outside of the Operating Room: A Safe Alternative to Surgical Biopsy.

Abstract: ObjectiveTransbronchial lung cryobiopsy (TBLC) is a promising technique that can provide a histologic diagnosis in interstitial lung diseases (ILD) and is an alternative to surgical lung biopsy. Th...

The future of surgical lung biopsy: moving from the operating room to the bronchoscopy suite

Abstract: Assessment of patients with suspected interstitial lung disease includes a complete work-up consisting of history and physical examination, laboratory studies, lung function testing, high-resolution CT scan, bronchoscopy with bronchoalveolar lavage, and cardiology workup. Presently, definitive diagnosis of interstitial lung disease is even more important because of newly available therapeutics. The high risk/ benefit ratio perceived in the literature for surgical lung biopsy motivates research for new biopsy techniques that ideally would have the same or better diagnostic yield as surgical lung biopsy with less morbidity, mortality and cost. If endoscopic transbronchial lung cryobiopsy can be shown to be associated with a low morbidity rate and high accuracy, we may be able to obtain a definitive histological diagnosis in a great majority of interstitial lung disease cases and forego complex, inefficient and inaccurate methods of disease diagnosis. Several groups have published prospective and retrospective series on endoscopic transbronchial lung cryobiopsy for interstitial lung disease with promising results and diagnostic yields up to 83% (range, 74–91%). The main complications associated with endoscopic transbronchial lung cryobiopsy are pneumothoraces and bleeding. The optimal techniques and specific settings for endoscopic transbronchial lung cryobiopsy is currently being investigated. In this paper, we present a review of the literature for endoscopic transbronchial lung cryobiopsy and future perspectives.

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update.

Abstract: This is a collaboration between the British Society of Gastroenterology (BSG) and the European Society of Gastrointestinal Endoscopy (ESGE), and is a scheduled update of their 2016 guideline on endoscopy in patients on antiplatelet or anticoagulant therapy. The guideline development committee included representatives from the British Society of Haematology, the British Cardiovascular Intervention Society, and two patient representatives from the charities Anticoagulation UK and Thrombosis UK, as well as gastroenterologists. The process conformed to AGREE II principles and the quality of evidence and strength of recommendations were derived using GRADE methodology. Prior to submission for publication, consultation was made with all member societies of ESGE, including BSG. Evidence-based revisions have been made to the risk categories for endoscopic procedures, and to the categories for risks of thrombosis. In particular a more detailed risk analysis for atrial fibrillation has been employed, and the recommendations for direct oral anticoagulants have been strengthened in light of trial data published since the previous version. A section has been added on the management of patients presenting with acute GI haemorrhage. Important patient considerations are highlighted. Recommendations are based on the risk balance between thrombosis and haemorrhage in given situations.

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update.

Abstract: This is a collaboration between the British Society of Gastroenterology (BSG) and the European Society of Gastrointestinal Endoscopy (ESGE), and is a scheduled update of their 2016 guideline on endoscopy in patients on antiplatelet or anticoagulant therapy. The guideline development committee included representatives from the British Society of Haematology, the British Cardiovascular Intervention Society, and two patient representatives from the charities Anticoagulation UK and Thrombosis UK, as well as gastroenterologists. The process conformed to AGREE II principles, and the quality of evidence and strength of recommendations were derived using GRADE methodology. Prior to submission for publication, consultation was made with all member societies of ESGE, including BSG. Evidence-based revisions have been made to the risk categories for endoscopic procedures, and to the categories for risks of thrombosis. In particular a more detailed risk analysis for atrial fibrillation has been employed, and the recommendations for direct oral anticoagulants have been strengthened in light of trial data published since the previous version. A section has been added on the management of patients presenting with acute GI haemorrhage. Important patient considerations are highlighted. Recommendations are based on the risk balance between thrombosis and haemorrhage in given situations.

Lung cancer staging: State of the art in the era of ablative therapies and surgical segmentectomy

Abstract: Implementation of lung cancer screening and improvements in imaging are expected to increase the proportion of lung cancer diagnosed at an early stage. The standard of care has historically been anatomic lobectomy; however, there is now an array of surgical and non-surgical approaches for management of local disease either in active use or under investigation. By their nature, these new modalities offer a theoretical trade-off of reduced morbidity in exchange for reduced efficacy in the setting of advanced disease. It is therefore critical that patients being considered for these approaches (e.g. surgical segmentectomy and SABR) be accurately staged to maximize the potential for definitive treatment. In this article, we will review current approaches to the staging of patients being considered for segmentectomy or ablation. This will serve as a foundation to highlight important questions deserving further investigation.

Endoscopic ultrasound-guided transvascular needle biopsy of thoracic and abdominal lesions: a multicenter experience.

Abstract: Background and study aims Traditionally in the case of a vascular interposition, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has been contraindicated. A transvascular route (TV) is feasible and probably a safe alternative approach in selected patients, but data are scarce. The primary aim of this study was to analyze the diagnostic yield and safety of EUS-TV-FNA in thoracic and abdominal lesions. Secondary aims included evaluation of the clinical impact and technical aspects. Patients and methods A retrospective multicenter study was conducted with inclusion of all consecutive patients that underwent EUS-TV-FNA from July 2007 to January 2020. Feasibility, cytopathology, procedure details, and safety were evaluated. Univariate analysis was performed to identify variables associated with incidents, cytopathological diagnosis, and clinical impact. Results Data were collected from a total of 49 cases and 50 EUS-TV-FNAs. The aorta (n = 19) and portal system (n = 17) were the most frequently punctured. The most frequent lesions were mediastinal lymph nodes (n = 13) and pancreatic tumors (n = 11). The diagnostic yield was 86 %, and there were nondiagnostic samples in seven cases. Overall sensitivity, specificity, and accuracy were 88 % (95 %CI,0.74–0.96), 100 % (95 %CI,0.59–1), and 90 % (95 %CI,0.78–0.96), respectively. Only three incidents were detected: two mural hematomas and a self-limited bleeding of gastroduodenal artery. In most patients, there was a significant impact on clinical management (88 %). Arterial vessel and ASA-III had a trend with incidents (both, P Conclusions EUS-TV-FNA is feasible, seems to be safe, and can be recommended when no other targets are available, and the information obtained would impact on the clinical plan.