Melena after endoscopic retrograde cholangiopancreatography: A warning sign of an impending subcapsular hepatic hematoma / Melena posterior a colangiopancreatografía retrógrada endoscópica: un signo de alarma de inminente hematoma hepático subcapsular

No disponible

Colorectal penetration by two intrauterine devices

No disponible

Analysis of rebleeding in cases of an upper gastrointestinal bleed in a single center series

Background: upper gastrointestinal bleeding (UGIB) is one of the main causes of hospital admission in gastroenterology departments and is associated with a significant morbidity and mortality. Rebleeding after initial endoscopic therapy occurs in 10-20% of cases and therefore, there is a need to define predictive factors for rebleeding. Aim: the aim of our study was to analyze risk factors and outcomes in a population of patients who suffered a rebleed. Methods: five hundred and seven patients with gastrointestinal bleeding were included. Clinical and biochemical data, as well as procedures and outcome six months after admission, were all collected. Documented clinical outcome included in-hospital and six-month delayed mortality, rebleeding and six-month delayed hemorrhagic and cardiovascular events. Results: according to a logistic regression analysis, high creatinine levels were independent risk factors for rebleeding of non-variceal and variceal UGIB. In non-variceal UGIB, tachycardia was an independent risk factor, whereas albumin levels were an independent protective factor. Rebleeding was associated with in-hospital mortality (29.5% vs 5.5%; p < 0.0001). In contrast, rebleeding was not related to six-month delayed mortality or delayed cardiovascular and hemorrhagic events. Conclusions: tachycardia and high creatinine and albumin levels were independent factors associated with rebleeding, suggestive of a potential predictive role of these parameters. The incorporation of these variables into predictive scores may provide improved results for patients with UGIB. Further validation in prospective studies is required

No disponible

Pseudoaneurisma no traumático de la arteria cística como causa de hemobilia / Non traumatic pseudoaneurysm of the cystic artery as a cause of haemobilia

No disponible

Superior mesenteric artery pseudoaneurysm fistulised to the small intestine in a pancreas-kidney transplant recipient: Can it be detected by capsule endoscopy? / Seudoaneurisma de arteria mesentérica superior fistulizado a intestino delgado tras un doble trasplante renopancreático: ¿puede ser diagnosticado por cápsula endoscópica?

No disponible

Hemorragia digestiva grave secundaria a tumor yeyunal gigante del estroma gastrointestinal / Severe bleeding caused by giant gastrointestinal stromal tumor of the jejunum

No disponible

Localized gastrointestinal amyloidosis presenting with protein-losing enteropathy and massive hemorrhage

Amyloidosis of the gastrointestinal tract is usually a systemic disease. Localized gastrointestinal amyloidosis without evidence of extraintestinal involvement or an associated plasma cell dyscrasia is uncommon and does not usually cause death. We report a case of a patient with localized gastrointestinal amyloidosis who presented with protein-losing enteropathy and a fatal upper gastrointestinal bleed (AU)

No disponible

Pseudotumor gástrico ulcerado con afectación pancreática por enfermedad relacionada con inmunoglobulina G4: descripción de un caso y revisión de la literatura / An ulcerated gastric ulcer and pseudotumour with pancreatic affectation associated with immunoglobulin G4-related disease: a case report and literature review

Presentamos el caso de un varón de 67 años con una úlcera gástrica de 9 años de evolución, con clínica de hematemesis y melenas, que a nivel histológico mostró lesiones de fibrosis y acúmulos de células plasmáticas con positividad para inmunoglobulina G4, sin evidencia de malignidad. Esta lesión alcanzaba al páncreas, donde se observaron lesiones histológicas superponibles a las gástricas. El diagnóstico final fue el de pseudotumor gástrico ulcerado con afectación pancreática por enfermedad relacionada con inmunoglobulina G4 (AU)

We report the case of a 67 year old male who presented with a nine year history of a gastric ulcer with symptoms of hematemesis and melena. Histological analysis identified fibrotic lesions and the accumulation of immunoglobulin G4-positive plasma cells with no evidence of malignancy. The lesion extended into the pancreas, where histological lesions and gastric lesions were also observed. This is a case of an ulcerated gastric ulcer and pseudo-tumor with pancreatic affection that is associated with immunoglobulin G4-related disease (AU)

A rare cause of upper gastrointestinal bleeding in a patient with end stage renal disease: gastric amyloidosis

No disponible

Hipertensión portal idiopática no cirrótica y trombosis portal en paciente con infección por VIH / Idiopathic non-cirrhotic portal hypertension and portal vein thrombosis in a patient with HIV infection

No disponible

Úlcera gástrica penetrante en el hígado / Gastric ulcer penetrating the liver

No disponible

Eficacia de lanreótido en pacientes con angiodisplasias gastrointestinales refractarias al tratamiento con octreótido / Efficacy of lanreotide in patients with gastrointestinal angiodysplasia refractory to octreotide therapy

No disponible

Leer cápsulas consume tiempo y recursos. ¿Cómo podemos rentabilizarlo? / Capsule reading is resources consuming. How can we make the best of it?

No disponible

Obscure gastrointestinal bleeding: which factors are associated with positive capsule endoscopy findings?

BACKGROUND: Capsule endoscopy is a first line examination to evaluate obscure gastrointestinal bleeding. The identification of factors associated with the detection of lesions by capsule endoscopy could improve resource utilization and patient selection. OBJECTIVES: To identify factors associated with positive capsule endoscopy findings in patients with obscure gastrointestinal bleeding. METHODS: Retrospective, single-center study, including 203 patients (214 capsule endoscopy procedures) submitted to capsule endoscopy in the setting of obscure gastrointestinal bleeding. Type of obscure gastrointestinal bleeding, number of units of packed red blood cells transfused, type of positive finding, number of endoscopy studies performed prior to capsule endoscopy, comorbidities, medication and Charlson index were evaluated. Overt bleeding was subdivided into ongoing and previous gastrointestinal bleeding. Only lesions with high hemorrhagic potential (P2) were classified as positive findings. RESULTS: The mean age was 62.2 years and 59.7% of patients were female. Most patients were referred for occult gastrointestinal bleeding (64.5%), while 35.5% were referred for overt gastrointestinal bleeding (63.2% previous-overt gastrointestinal bleeding). The most frequent positive findings included ulcers/ erosions (34%) and angioectasias (32%). In univariate analysis, the identification of positive findings was significantly higher in those with ongoing-overt bleeding (p < 0.001), advanced age (p = 0.003), increasing number of pre-capsule endoscopies (p < 0.001), increasing transfusion requirements (p < 0.001), moderate/severe renal disease (p = 0.009) and antiplatelet drugs (p = 0.021) and NSAID intake (p = 0.005). In multivariate analysis, positive findings were significantly higher only in those with ongoing-overt bleeding (odds ratio [OR] 18.68, 95% confidence interval [CI] 3.98-85.6, p < 0.001), higher transfusion requirements (OR 1.23, 95% CI 1.1-1.4, p < 0.001) and NSAID intake (OR 5.9, 95% CI 2.1-17.3, p = 0.001). CONCLUSIONS: Capsule endoscopy should be used early in obscure gastrointestinal bleeding. Ongoing-overt bleeding, higher transfusion requirements and NSAIDs intake were associated with positive findings on capsule endoscopy

No disponible

Cápsula endoscópica y hemorragia digestiva de origen oscuro: ¿importa la forma de presentación? / Capsule endoscopy and obscure gastrointestinal bleeding: does the form of presentation matter?

INTRODUCCIÓN: La hemorragia digestiva de origen oscuro (HDOO) es aquella en la que no se consigue identificar su origen tras la evaluación mediante endoscopia digestiva alta y baja. En esos casos se sospecha un origen en intestino delgado. La HDOO puede ser oculta o manifiesta. El objetivo de este estudio es analizar las características clínico-analíticas, los hallazgos de la cápsula endoscópica e investigar qué factores se relacionan con la detección de lesiones en ambas formas de presentación. MÉTODOS: Estudio retrospectivo sobre las cápsulas endoscópicas realizadas entre noviembre de 2009 y noviembre de 2012 para el estudio de HDOO. RESULTADOS: Se analizaron 284 exploraciones de 272 pacientes. Inicialmente, 12 fueron no valorables y se repitieron, analizando finalmente las cápsulas evaluables (272). Ciento catorce (41,9%) fueron normales. Los pacientes con HDOO manifiesta tenían significativamente mayor edad (70,2 vs. 67,5 años; p = 0,04), consumían más AINE (24,2% vs. 11,9%; p = 0,01), tenían menores niveles de hemoglobina (9,3 vs. 10,4; p < 0,001) y requirieron más transfusiones (64,5% vs. 32,2%; p < 0,001) respecto a los pacientes con HDOO oculta. La detección de lesiones del tipo afta-úlcera y pólipo-masa no mostró diferencias significativas entre ambas formas de presentación. Las lesiones vasculares se detectaron con mayor frecuencia en la forma de HDOO manifiesta respecto a la forma oculta (40,3% vs. 25,7%, respectivamente), (p < 0,05). Considerando el total de diagnósticos realizados por la cápsula, no se observaron diferencias en la capacidad diagnóstica entre la forma manifiesta (57%) y la forma oculta (54%), (p = 0,6). El análisis multivariado mostró cómo el consumo de fármacos: AINE (OR 2,75; p = 0,01), antiagregantes y anticoagulantes (OR 2,64; p = 0,03), así como datos analíticos: hemoglobina (OR 3,23; p < 0,001) e INR (OR 1,8; p = 0,02) predijeron de forma estadísticamente significativa la detección de lesiones con la cápsula endoscópica en la forma de HDOO manifiesta. En la forma de presentación oculta, el análisis multivariado mostró que la edad (OR 1,9; p = 0,04) y el consumo de AINE (OR 2,1; p = 0,01) estaban estadísticamente relacionados con la detección de lesiones en la cápsula. CONCLUSIONES: La cápsula endoscópica es fundamental en la valoración de la HDOO. Aunque la capacidad diagnóstica fue similar entre ambas formas de presentación, las lesiones vasculares se detectaron con mayor frecuencia en el subtipo manifiesta. Teniendo en cuenta la forma de presentación de la HDOO (manifiesta vs. oculta) y algunas características clínico-analíticas de los pacientes (edad, consumo de fármacos, hemoglobina) se podría optimizar la capacidad diagnóstica de la cápsula

INTRODUCTION: Obscure gastrointestinal bleeding (OGIB) is defined as bleeding from the gastrointestinal tract with no obvious cause after assessment with upper and lower gastrointestinal endoscopy. In these cases, the source is suspected to be in the small bowel. Obscure bleeding can be occult or overt. The aim of this study was to analyze the clinical and analytical characteristics and findings on capsule endoscopy in patients with OGIB and to determine the factors related to the detection of lesions in both forms of presentation. METHODS: We performed a retrospective study of capsule endoscopies carried out between November 2009 and November 2012 for OGIB. RESULTS: We analyzed 284 capsule endoscopies in 272 patients. Initially, 12 procedures could not be evaluated and were repeated. A total of 272 procedures were finally included in the analysis. The results of 114 (41.9%) capsule endoscopies were normal. Compared with patients with occult OGIB, those with overt OGIB were significantly older (70.2 vs. 67.5 years; p = 0.04), consumed more NSAID (24.2% vs. 11.9%; p = 0.01), had higher hemoglobin levels (9.3 vs. 10.4; p < 0,001) and more frequently required transfusion (64.5% vs 32.2%; p < 0.001). No differences were found between the two forms of presentation in the detection of canker sores-ulcers and polyps-masses. Vascular lesions were more frequently detected in overt than in occult OGIB (40.3% vs. 25.7%, respectively), (p < 0.05). When the total number of diagnoses carried out by capsule endoscopy was analyzed, no differences were found in diagnostic yield between overt OGIB (57%) and occult OGIB (54%), (p = 0.6). In overt OGIB, multivariate analysis showed that the variables that significantly predicted the detection of lesions on capsule endoscopy were consumption of medication NSAID (OR 2.75; p = 0.01), antiplatelets and anticoagulants (OR 2.64; p = 0.03) and analytical data hemoglobin (OR 3.23; p < 0.001) and INR (OR 1.8; p = 0.02). In occult OGIB, multivariate analysis showed that the factors significantly related to the detection of lesions on endoscopy were age (OR 1.9; p = 0.04) and NSAID consumption (OR 2.1; p = 0.01). CONCLUSIONS: Capsule endoscopy is essential in the assessment of OGIB. Although the diagnostic yield was similar in both forms of presentation, vascular lesions were more frequently detected in overt OGIB. The diagnostic yield of capsule endoscopy could be optimized by taking into account the form of presentation (overt vs. occult) and certain clinical and analytic data (age, drug consumption, hemoglobin) (AU)

Hemosuccus pancreático, una causa rara de hemorragia digestiva alta / Pancreatic hemosuccus, a rare cause of upper gastrointestinal bleeding

No disponible

Neumatosis intestinal y aerobilia en recién nacida con sangre en heces / Pneumatosis intestinalis and aerobilia in newborn with blood in stools

La enumatosis intestinal en el recién nacido es un signo que típicamente se asocia a la presencia de enterocolitis necrotizante. Presentamos el caso de una recién nacida que debutó con sangre en las deposiciones, aerobilia y neumatosis intestinal en colon izquierdo, sin distensión de asas, diagnosticándose de colitis alérgica en base a la clínica, laboratorio, imágenes y respuesta a tratamiento. La supresión de la proteína de la leche de vaca en la dieta de la madre y el complemento con un sustituto libre de esta proteína, llevó a la resolución del cuadro (AU)

Pneumatosis intestinalis is newly born infants constitutes a clinical manifestation greatly associated with the presence of necrotizing enterocolitis. We provide a newborn´s case presenting with bloody stools, portal venous gas and left colon pneumatosis intestinalis, being diagnosed of allergic colitis based on clinical records, lab-tests, imaging and treatment responses. The suppression of cow´s milk protein in the maternal diet and the replacement of milk by a substitute free form that protein led to the complete resolution (AU)