RESUMO
Gastrointestinal (GI) Endoscopy is a basic competence for the management of gastrointestinal diseases. However, it should not be regarded as an independent training technique. Rather it is a part of a continuous and accredited process that requires clinical knowledge from the gastroenterologist to keep skills up-to-date in a constantly evolving medical subspecialty. Thus, the only official accredited way for training in GI endoscopy is through the Specialized Health Training program in the Management of the Digestive Diseases administered by the Spanish Ministry of Health.
Assuntos
Gastroenterologistas , Gastroenteropatias , Humanos , Endoscopia Gastrointestinal/métodos , Currículo , Gastroenteropatias/diagnóstico por imagem , Gastroenteropatias/terapia , Competência ClínicaRESUMO
We would like to congratulate Drs. Espinel and Pinedo for their excellent results in single-ballon enteroscopy-assisted ERCP recently published in REED(1).We also want to share our experience. Between 2015 and 2021 we have performed 31 procedures in 26 patients. Half of the procedures (45.16%) were performed in patients with Roux-en-Y hepatic jejunostomy. Eight of these (22.80%) had prior primary bile duct surgery and six (19.35%) had prior Whipple surgery. The other half of the procedures (54.8%) presented native papilla: 10 (32.25%) subtotal gastrectomy and seven (22.58%) gastric bypass surgery.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Enteroscopia de Balão Único , Anastomose em-Y de Roux , Gastrectomia , Humanos , Estudos RetrospectivosRESUMO
Bariatric endoscopy (BE) encompasses a number of techniques -some consolidated, some under development- aiming to contribute to the management of obese patients and their associated metabolic diseases as a complement to dietary and lifestyle changes. To date different intragastric balloon models, suture systems, aspiration methods, substance injections and both gastric and duodenal malabsorptive devices have been developed, as well as endoscopic procedures for the revision of bariatric surgery. Their ongoing evolution conditions a gradual increase in the quantity and quality of scientific evidence about their effectiveness and safety. Despite this, scientific evidence remains inadequate to establish strong grades of recommendation allowing a unified perspective on prophylaxis in BE. This dearth of data conditions leads, in daily practice, to frequently extrapolate the measures that are used in bariatric surgery (BS) and/or in general therapeutic endoscopy. In this respect, this special article is intended to reach a consensus on the most common prophylactic measures we should apply in BE. The methodological design of this document was developed while attempting to comply with the following 5 phases: Phase 1: delimitation and scope of objectives, according to the GRADE Clinical Guidelines. Phase 2: setup of the Clinical Guide-developing Group: national experts, members of the Grupo Español de Endoscopia Bariátrica (GETTEMO, SEED), SEPD, and SECO, selecting 2 authors for each section. Phase 3: clinical question form (PICO): patients, intervention, comparison, outcomes. Phase 4: literature assessment and synthesis. Search for evidence and elaboration of recommendations. Based on the Oxford Centre for Evidence-Based Medicine classification, most evidence in this article will correspond to level 5 (expert opinions without explicit critical appraisal) and grade of recommendation C (favorable yet inconclusive recommendation) or D (inconclusive or inconsistent studies). Phase 5: External review by experts. We hope that these basic preventive measures will be of interest for daily practice, and may help prevent medical and/or legal conflicts for the benefit of patients, physicians, and BE in general.
Assuntos
Cirurgia Bariátrica , Balão Gástrico , Endoscopia , Medicina Baseada em Evidências , Humanos , Obesidade/prevenção & controleRESUMO
OBJECTIVE: The aim of this study was to compare and validate the different classifications of severity in acute pancreatitis (AP) and to investigate which characteristics of the disease are associated with worse outcomes. SUMMARY OF BACKGROUND DATA: AP is a heterogeneous disease, ranging from uneventful cases to patients with considerable morbidity and high mortality rates. Severity classifications based on legitimate determinants of severity are important to correctly describe the course of disease. METHODS: A prospective multicenter cohort study involving patients with AP from 23 hospitals in Spain. The Atlanta Classification (AC), Revised Atlanta Classification (RAC), and Determinant-based Classification (DBC) were compared. Binary logistic multivariate analysis was performed to investigate independent determinants of severity. RESULTS: A total of 1655 patients were included; 70 patients (4.2%) died. RAC and DBC were equally superior to AC for describing the clinical course of AP. Although any kind of organ failure was associated with increased morbidity and mortality, persistent organ failure (POF) was the most significant determinant of severity. All local complications were associated with worse outcomes. Infected pancreatic necrosis correlated with high morbidity, but in the presence of POF, it was not associated to higher mortality when compared with sterile necrotizing pancreatitis. Exacerbation of previous comorbidity was associated with increased morbidity and mortality. CONCLUSION: The RAC and DBC both signify an advance in the description and differentiation of AP patients. Herein, we describe the complications of the disease independently associated to morbidity and mortality. Our findings are valuable not only when designing future studies on AP but also for the improvement of current classifications.
Assuntos
Amilases/sangue , Pancreatite Necrosante Aguda/diagnóstico , Idoso , Biomarcadores/sangue , Progressão da Doença , Feminino , Seguimentos , Humanos , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Pancreatite Necrosante Aguda/sangue , Pancreatite Necrosante Aguda/mortalidade , Prognóstico , Estudos Prospectivos , Índice de Gravidade de Doença , Espanha/epidemiologia , Taxa de Sobrevida/tendências , Tomografia Computadorizada por Raios XAssuntos
Enterite/diagnóstico , Eosinofilia/diagnóstico , Gastrite/diagnóstico , Corticosteroides/uso terapêutico , Adulto , Idoso , Biópsia , Diagnóstico Precoce , Enterite/diagnóstico por imagem , Enterite/tratamento farmacológico , Eosinofilia/diagnóstico por imagem , Eosinofilia/tratamento farmacológico , Feminino , Gastrite/diagnóstico por imagem , Gastrite/tratamento farmacológico , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Tomografia Computadorizada por Raios X , UltrassonografiaAssuntos
Dilatação Gástrica/etiologia , Estenose Pilórica Hipertrófica/complicações , Idoso , Emergências , Esofagoplastia , Feminino , Gastrectomia , Dilatação Gástrica/cirurgia , Humanos , Jejunostomia , Pneumoperitônio/etiologia , Estenose Pilórica Hipertrófica/diagnóstico por imagem , Estenose Pilórica Hipertrófica/cirurgiaRESUMO
BACKGROUND AND AIMS: Pancreatic cysts and solid lesions are routinely examined by EUS-guided FNA (EUS-FNA). The aim of this study was to compare the incidence of adverse events (AEs) of this procedure by using the lexicon recommended by the American Society for Gastrointestinal Endoscopy (ASGE). METHODS: This was a prospective and comparative study of patients who underwent EUS-FNA in which a 22-gauge needle was used. In the pancreatic cystic lesions group (group I), complete fluid evacuation in a single needle pass was attempted, and ciprofloxacin was given during the procedure and for 3 days after. In the pancreatic solid lesions group (group II), the number of passes was determined by the on-site evaluation of the sample. AEs were defined and graded according to the lexicon recommended by the ASGE. Patients were followed for 48 hours, 1 week, and 1 month after the procedure. RESULTS: A total of 146 patients were included, 73 in group I and 73 in group II. Potential factors influencing the incidence of AEs (ie, access route for FNA) were similar in both groups. AEs occurred in 5 of 146 patients (3.4%; 95% confidence interval [CI], 1.3%-8%): 4 in group I (5.5%; 95% CI, 1.7%-13.7%) and 1 in group II (1.4%; 95% CI, -0.5% to 8.1%) (P = .03). Severity was mild in 1 of 5 patients (20%) and moderate in 3 of 5 patients (60%). One patient with a solid mass in the head of the pancreas had a duodenal perforation after EUS and died after surgery. All other AEs occurred in the first 48 hours and resolved with medical therapy. There were 3 incidents of transient hypoxia and self-limited abdominal pain in 1 and 2 patients, respectively. No patients were lost to follow-up. CONCLUSION: EUS-FNA of pancreatic cysts has an AEs rate similar to that of solid pancreatic masses, which is small enough to consider this procedure a safe and effective method for managing patients with both types of lesions. AEs occurred early after EUS-FNA, and patients should be closely followed during the first 2 days after the procedure.
Assuntos
Duodenopatias/etiologia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/efeitos adversos , Endoscopia Gastrointestinal , Perfuração Intestinal/etiologia , Cisto Pancreático/patologia , Neoplasias Pancreáticas/patologia , Sociedades Médicas , Terminologia como Assunto , Dor Abdominal/etiologia , Idoso , Feminino , Humanos , Hipóxia/etiologia , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosAssuntos
Constipação Intestinal/complicações , Hidronefrose/etiologia , Intestino Grosso/patologia , Adulto , Constipação Intestinal/sangue , Constipação Intestinal/diagnóstico por imagem , Enema , Humanos , Hidronefrose/sangue , Hidronefrose/diagnóstico por imagem , Intestino Grosso/diagnóstico por imagem , Masculino , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Self-expanding metal stents are an established treatment for malignant colon strictures, either as palliative treatment or as a bridge to later surgery. Little data exist regarding the use of stents for benign obstructions and the rate of subsequent complications related to the procedure is high. After reviewing the existing literature, we found only one case of stent placement in an intestinal obstruction caused by endometriosis, as a bridge to surgery. The use of prostheses in benign disease has a higher rate of complications such as stent migration and gut perforation. Such complications are even more likely to happen when the stent has been placed as a bridge to surgery and it is delayed for more than 7 days. This is the case of a young woman presenting an acute intestinal obstruction related to endometrioma. Stent placement was used in this case as a bridge to surgery with successful results.
Assuntos
Colectomia/métodos , Doenças do Colo/diagnóstico , Doenças do Colo/cirurgia , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/cirurgia , Stents , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Doenças do Colo/etiologia , Serviço Hospitalar de Emergência , Endometriose/complicações , Endometriose/diagnóstico , Feminino , Seguimentos , Humanos , Obstrução Intestinal/etiologia , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
BACKGROUND: Endoscopic submucosal dissection (ESD) is an effective but time-consuming treatment for early neoplasia that requires a high level of expertise. OBJECTIVE: The objective of this study was to assess the efficacy and learning curve of gastric ESD with a hybrid knife with high pressure water jet and to compare with standard ESD. MATERIAL AND METHODS: We performed a prospective non survival animal study comparing hybrid-knife and standard gastric ESD. Variables recorded were: Number of en-bloc ESD, number of ESD with all marks included (R0), size of specimens, time and speed of dissection and adverse events. Ten endoscopists performed a total of 50 gastric ESD (30 hybrid-knife and 20 standard). RESULTS: Forty-six (92 %) ESD were en-bloc and 25 (50 %) R0 (hybrid-knife: n = 13, 44 %; standard: n = 16, 80 %; p = 0.04). Hybrid-knife ESD was faster than standard (time: 44.6 +/- 21.4 minutes vs. 68.7 +/- 33.5 minutes; p = 0.009 and velocity: 20.8 +/- 9.2 mm(2)/min vs. 14.3 +/- 9.3 mm(2)/min (p = 0.079). Adverse events were not different. There was no change in speed with any of two techniques (hybrid-knife: From 20.33 +/- 15.68 to 28.18 +/- 20.07 mm(2)/min; p = 0.615 and standard: From 6.4 +/- 0.3 to 19.48 +/- 19.21 mm(2)/min; p = 0.607). The learning curve showed a significant improvement in R0 rate in the hybrid-knife group (from 30 % to 100 %). CONCLUSION: despite the initial performance of hybrid-knife ESD is worse than standard ESD, the learning curve with hybrid knife ESD is short and is associated with a rapid improvement. The introduction of new tools to facilitate ESD should be implemented with caution in order to avoid a negative impact on the results.
Assuntos
Endoscopia Gastrointestinal/instrumentação , Endoscopia Gastrointestinal/métodos , Neoplasias Gástricas/cirurgia , Instrumentos Cirúrgicos , Animais , Endoscopia Gastrointestinal/efeitos adversos , Curva de Aprendizado , Masculino , SuínosRESUMO
INTRODUCTION: Partially covered self-expanding metal stents (SEMS), have been suggested as an alternative to surgery in the treatment of esophageal fistulas of benign etiology. Nevertheless, uncomplicated removal remains difficult. The use of fully covered (FC) SEMSs could solve this problem. OBJECTIVES: To review our experience with FC-SEMS placement in patients with benign upper gastrointestinal leaks or perforations. We wanted to assess successful closure of the perforations and short-term and long-term complications. MATERIALS AND METHODS: Multicenter study, including 3 tertiary centers. Retrospective review of patients who underwent FC-SEMS placement for benign perforations. RESULTS: Eighty-eight stents were placed in 56 patients. We achieved leak closure in 44 patients (78.6%). There were 18 migrations. All of them could be solved endoscopically. A severe septic situation was associated with a higher mortality rate (27.6% vs. 7.4%; P=0.049) and a lower success rate (34.5% vs. 7.4%; P=0.088), compared with those patients who did not present severe sepsis. However, these differences could not be confirmed by multivariable analysis. The results in the subgroup of 11 patients with leaks after sleeve gastrectomy were also good (73% success without surgery and 0% mortality). CONCLUSIONS: Temporary placement of FC-SEMS for benign perforations, fistulas, and leaks is feasible in sealing the leaks. All migrations could be solved endoscopically. It is very important to insert the stent before sepsis is established. This article also would be an addition to the growing body of literature supporting stenting as a good alternative if not standard approach to controlling these leaks.
Assuntos
Fístula Esofágica/cirurgia , Perfuração Esofágica/cirurgia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Esofagoscopia/métodos , Estudos de Viabilidade , Feminino , Migração de Corpo Estranho/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoAssuntos
Endoscopia Gastrointestinal/normas , Mucosa Gástrica/cirurgia , Neoplasias Gastrointestinais/cirurgia , Mucosa Intestinal/cirurgia , Guias de Prática Clínica como Assunto , Neoplasias Colorretais/cirurgia , Dissecação/normas , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/métodos , Neoplasias Esofágicas/cirurgia , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , Medição de Risco , Espanha , Neoplasias Gástricas/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: The present study was conducted to determine the effectiveness of intralesional triamcinolone to improve the results of endoscopic dilation in esophageal strictures. METHODS: We treated 9 patients with complex strictures of different etiologies (2 postsurgery, 3 gastroesophageal reflux disease, and 4 caustic) with intralesional injections of triamcinolone followed by endoscopic dilations. Outcomes of triamcinolone-treated patients were compared with those of historical control. We injected triamcinolone before dilating the strictures. All the patients were followed up for 1 year. The interval between dilations, frequency of dilation, and refractory rates were calculated. RESULTS: There was no difference between the control group and the patients with steroids regarding baseline characteristics (age and sex distribution of patients and stricture etiologies, length, and location). The patients in the triamcinolone group had a bigger improvement of their dysphagia and had a lower refractority rate than the patients in control group, these differences being statistically significant. CONCLUSIONS: Intralesional triamcinolone presented a higher improvement of dysphagia and a lower refractority rate in patients with complex strictures with statistically significant differences.