Peroral endoscopic myotomy as treatment for Zenker's diverticulum (Z-POEM): a multi-center international study.

BACKGROUND: Peroral endoscopic myotomy for the treatment of Zenker's diverticulum (Z-POEM) is a novel technique that has been described in several recent reports. This method utilizes the third space (submucosal layer) to create a tunnel to facilitate complete visualization of the septum and hence cutting it entirely. Conventional endoscopic septotomy carries the risk of recurrence due to incomplete visualization of the septum. While surgical correction is a risky and lengthy procedure in old comorbid patients with Zenker's diverticulum. The aim of this study is to assess the efficacy and safety of Z-POEM. METHODS: The study enrolled 24 patients diagnosed with Zenker's diverticulum (ZD) who underwent Z-POEM at seven independent endoscopy centers in five different countries. RESULTS: Mean patient age ± standard deviation (SD) was 74.3 ± 11 years. Most of the patients were males (n = 20, 83.3%); four (16.7%) were females. More than 50% of the patients (n = 14, 58.3%) had associated comorbidities. The mean size of the diverticula was 4 cm (range 2-7 cm). The Kothari-Haber Score was used to assess clinical symptoms; values ranged from 6 to 14 (median = 9). We achieved 100% technical success with a median procedure time of 61 min and no adverse events. Median hospital stay was 1 day (range 1-5 days). There is a significant reduction in the Kothari-Haber Score after Z-POEM (P < 0.0001). Technical success was achieved in 100% of the patients. Clinical success was achieved in 23/24 (95.8%) of the patients with a median follow-up of 10 months (range 6-24 months). CONCLUSION: Z-POEM is a safe and effective modality for managing ZD.

Síndrome de Mallory-Weiss. Reporte de caso y breve revisión de la literatura / Mallory-Weiss syndrome. Case report and brief review of the literature

Resumen Introducción El síndrome de Mallory-Weiss se caracteriza por el desgarro longitudinal de la mucosa de la unión gastroesofágica. En el presente trabajo hemos realizado una breve revisión de la literatura de utilidad para el estudiante de medicina y la hemos acompañado de un caso clínico para ilustrar el contenido aquí desarrollado. Caso Paciente del sexo masculino, de 40 años de edad, que acudió al servicio de urgencias de nuestra institución por presentar hematemesis, melena, datos de hipovolemia, e hipo de 2 días de evolución. Como antecedentes de importancia refirió consumo de alcohol a razón de 15 copas cada tercer día. Durante la endoscopía diagnóstica se identificó en la unión esofagogástrica, un coágulo adherente a la mucosa de 5 mm, con lo que se diagnosticó un desgarro de Mallory-Weiss. El tratamiento se realizó mediante endoscopía. Se optó por una inyección local de adrenalina con colocación posterior de liga. El paciente fue dado de alta sin complicaciones. Conclusión Los estudios realizados sobre el síndrome de Mallory-Weiss han permitido actualizar la información que se tiene al respecto. El avance tecnológico y científico ha incrementado las tasas de éxito del manejo de esta identidad.

Abstract Introduction Mallory-Weiss syndrome is characterized by the longitudinal tear of the mucosa of the gastroesophageal junction. In the present work we have made a brief review of the literature useful for the medical student and we have accompanied a clinical case to illustrate the content developed here. Case A 40-year-old male attended the emergency department of our institution due to hematemesis, melena, hypovolemia, and 2-day history of hiccups. The patient referred alcohol consumption at a rate of 15 drinks every third day. During diagnostic endoscopy, a mucosal adherent clot of 5 mm was identified in the gastric esophageal junction, and a Mallory-Weiss tear was diagnosed. The treatment was performed by endoscopy. We opted for a local injection of Adrenaline with subsequent endoscopic ligation. The patient was discharged without complications. Conclusion The studies carried out on the Mallory-Weiss Syndrome have made it possible to update the information available. The technological and scientific advance has increased the success rates of the management of this identity.

Differential expression of miRNA-146a and miRNA-155 in gastritis induced by Helicobacter pylori infection in paediatric patients, adults, and an animal model.

BACKGROUND: Helicobacter pylori is a major aetiologic agent associated with gastritis. H. pylori infections increase the expression of the Toll-like receptor (TLR), which in turn modulates the expression of microRNA (miRNA)-146a and miRNA-155. The objective of this study was to compare the expression of miRNA-146a and miRNA-155 in gastric lesions of paediatric and adult patients with different pathologies and in Mongolian gerbils (Meriones unguiculatus) infected with H. pylori 26,695. METHODS: Quantification of miRNA expression was performed by quantitative real-time polymerase chain reaction (qRT-PCR) of paraffin-embedded gastric lesions of children with or without an infection (n = 25), adults with follicular gastritis and metaplasia (n = 32) and eight-week-old M. unguiculatus males (Hsd:MON) infected with H. pylori 26,695 for 0, 3, 6, 12 and 18 months (n = 25). The genes RNU48 and RNU6 were used as endogenous controls for data normalization. Statistical analyses were performed using Kruskal-Wallis, Mann-Whitney, ANOVA and Student's t-test. RESULTS: The expression of miRNA-146a and miRNA-155 in infected children increased by 247.6- and 79.4-fold (on average), respectively, compared to that observed in the control group. However, these results were not significant (p = 0.12 and p = 0.07 respectively). In some children a gradual increase in expression was observed, while in others, expression was very high. Additionally, the expression levels of miRNA-146a and miRNA-155 increased by an average of 21.7- and 62-fold, respectively, in adult patients with follicular gastritis when compared to those of the controls. In M. unguiculatus infected with H. pylori 26,695, the expression of both miRNAs increased as the infection progressed. CONCLUSION: This is the first report to show differences in the expression of miRNA-146a and miRNA-155 in paediatric and adult patients with gastritis who were infected with H. pylori. In addition, in M. unguiculatus infected with H. pylori, miRNA expression was associated with the progression of infection and the ability of the bacteria to adapt to the host.

Central is as effective as bilateral endoscopic ultrasound-guided celiac plexus neurolysis in patients with unresectable pancreatic cancer.

OBJECTIVE: The objective of this study is to compare the efficacy of central (single) vs bilateral (2-injections) endoscopic ultrasound (EUS)-celiac plexus neurolysis (CPN) for palliation of patients with pain related to pancreatic cancer. MATERIALS AND METHODS: Patients with unresectable pancreatic cancer were included. Central EUS CPN was used in the first group and bilateral EUS CPN in the second. The measurement of pain was made with a visual analog pain scale (VAPS) applied before and after the procedure. Follow-up was made at weeks 2 and 4 after the procedure. The use of morphine before and after EUS CPN was evaluated. Complications related to the procedure were recorded. RESULTS: A total of 53 patients underwent EUS CPN, 21 (39.6%) with the central technique and 32 (60.4%) with bilateral injection; 29 were women (54.7%) and the median age was 59 (30-85) years. The tumor was located in the head of the pancreas in 24 (45.3%) patients, the neck in 14 (26.4%), the body in 26 (49.1%) and in the tail of the pancreas in 8 (15.1%). Nearly, 14 (26.4%) patients had more than one pancreatic segment involved. There was no difference in the median (range) percent pain reduction from baseline-4 weeks later was 50% (0-100) vs 60% (0-100), for central and bilateral techniques, respectively; P = 0.18. In total, 60.4% of patients had a reduction of 50% punctuation in the VAPS. No major complications were detected. CONCLUSIONS: EUS CPN is useful for the management of pain in patients with unresectable pancreatic cancer, but there is no significant difference between central vs bilateral techniques.