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Background and study aims In 2019, the European Society of Gastrointestinal Endoscopy (ESGE) created a working group to develop technical and quality standards for small-bowel capsule endoscopy (SBCE) to improve the daily practice of endoscopy services. They developed 10 quality parameters, which have yet to be tested in a real-life setting. Our study aimed to evaluate the accomplishment of the quality standards in SBCE established by the ESGE in several Spanish centers. Materials and methods An online survey of 11 multiple-choice questions related to the ESGE performance measures was sent to Spanish centers with experience in SBCE. In order to participate and obtain reliable data, at least 100 questionnaires had to be answered per center because that is the minimum number established by ESGE. Results 20 centers participated in the study, compiling 2049 SBCEs for the analysis. Only one of 10 performance measures (cecal visualization) reached the minimum standard established by the ESGE. In five of 10 performance measures (Indication, lesion detection rate, terminology, and retention rate) the minimum standard was nearly achieved. Conclusions Our study is the first multicenter study regarding SBCE quality performance measures in a real setting. Our results show that the minimum standard is hardly reached in most procedures, which calls into question their clinical applicability in real life. We suggest performing similar studies in other countries to evaluate whether there is a need for quality improvement programs or a need to reevaluate the minimum and target values published so far.
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Gastrointestinal stromal tumors (GIST) are rare mesenchymal tumors of the gastrointestinal tract and a rare cause of gastrointestinal bleeding. These tumors usually affect people over 50 years of age and they exhibit a wide range of clinical manifestations, including asymptomatic patients, nonspecific symptoms, obstruction or bleeding, which may delay diagnosis. Early diagnosis and treatment are crucial because GISTs can be aggressive and metastasize. This case highlights the importance of considering GISTs in the differential diagnosis of obscure gastrointestinal bleeding.
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A case of a patient with symptoms of gastric obstruction secondary to cholecystogastric fistula is presented and a brief review of the literature is done.
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Fístula Biliar , Doenças da Vesícula Biliar , Fístula Gástrica , Humanos , Endossonografia , Fístula Biliar/diagnóstico por imagem , Fístula Biliar/etiologia , Fístula Biliar/cirurgia , Doenças da Vesícula Biliar/diagnóstico por imagem , Doenças da Vesícula Biliar/cirurgia , Fístula Gástrica/diagnóstico por imagem , Fístula Gástrica/etiologiaRESUMO
BACKGROUND AND AIMS: Underwater EMR (UEMR) is an alternative procedure to conventional EMR (CEMR) to treat large, nonpedunculated colorectal lesions (LNPCLs). In this multicenter, randomized controlled clinical trial, we aimed to compare the efficacy and safety of UEMR versus CEMR on LNPCLs. METHODS: We conducted a multicenter, randomized controlled clinical trial from February 2018 to February 2020 in 11 hospitals in Spain. A total of 298 patients (311 lesions) were randomized to the UEMR (n = 149) and CEMR (n = 162) groups. The main outcome was the lesion recurrence rate in at least 1 follow-up colonoscopy. Secondary outcomes included technical aspects, en bloc resection rate, R0 resection rates, and adverse events, among others. RESULTS: There were no differences in the overall recurrence rate (9.5% UEMR vs 11.7% CEMR; absolute risk difference, -2.2%; 95% CI, -9.4 to 4.9). However, considering polyp sizes between 20 and 30 mm, the recurrence rate was lower for UEMR (3.4% UEMR vs 13.1% CEMR; absolute risk difference, -9.7%; 95% CI, -19.4 to 0). The R0 resection showed the same tendency, with significant differences favoring UEMR only for polyps between 20 and 30 mm. Overall, UEMR was faster and easier to perform than CEMR. Importantly, the techniques were equally safe. CONCLUSIONS: UEMR is a valid alternative to CEMR for treating LNPCLs and could be considered the first option of treatment for lesions between 20 and 30 mm due to its higher en bloc and R0 resection rates. (Clinical trial registration number: NCT03567746.).
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Pólipos do Colo , Neoplasias Colorretais , Ressecção Endoscópica de Mucosa , Humanos , Neoplasias Colorretais/patologia , Colonoscopia/métodos , Pólipos do Colo/patologia , Água , Ressecção Endoscópica de Mucosa/métodos , Mucosa Intestinal/patologiaRESUMO
BACKGROUND AND STUDY AIMS: Data from Japanese series show that surface morphology of laterally spreading tumors (LST) in the colon identifies lesions with different incidence and pattern of submucosal invasion. Such data from western countries are scarce. We compared clinical and histological features of LST in a western country and an eastern country, with special interest on mucosal invasiveness of LST, and investigated the effect of clinical factors on invasiveness in both countries. PATIENTS AND METHODS: Patients with LST lesions ≥20mm were included from a multicenter prospective registry in Spain and from a retrospective registry from the National Cancer Center Hospital East, Japan. The primary outcome was the presence of submucosal invasion in LST. The secondary outcome was the presence of high-risk histology, defined as high-grade dysplasia or submucosal invasion. RESULTS: We evaluated 1102 patients in Spain and 663 in Japan. Morphological and histological characteristics differed. The prevalence of submucosal invasion in Japan was six-fold the prevalence in Spain (Prevalence Ratio PR=5.66; 95%CI: 3.96, 8.08), and the prevalence of high-risk histology was 1.5 higher (PR=1.44; 95%CI: 1.31, 1.58). Compared to the granular homogeneous type and adjusted by clinical features, granular mixed, flat elevated, and pseudo-depressed types were associated with higher odds of submucosal invasion in Japan, whereas only the pseudo-depressed type showed higher risk in Spain. Regarding high-risk histology, both granular mixed and pseudo-depressed were associated with higher odds in Japan, compared with only the granular mixed type in Spain. CONCLUSION: This study reveals differences in location, morphology and invasiveness of LST in an eastern and a western cohort.
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Colonoscopia , Neoplasias Colorretais , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Humanos , Mucosa Intestinal/patologia , Invasividade Neoplásica/patologia , Estudos RetrospectivosRESUMO
An 85-year-old female with situs inversus totalis was admitted due to obstructive jaundice, secondary to multiple choledocholithiasis and distal biliary stenosis due to adenocarcinoma of the head of the pancreas, with duodenal infiltration and metastatic liver disease. An endoscopic retrograde cholangiopancreatography (ERCP) was attempted in the supine position but bile duct cannulation was not possible due to duodenal infiltration. Finally, a palliative biliary stent was placed percutaneously, with resolution of the jaundice.
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Coledocolitíase , Icterícia Obstrutiva , Situs Inversus , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica , Coledocolitíase/complicações , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/cirurgia , Duodeno , Feminino , Humanos , Icterícia Obstrutiva/diagnóstico por imagem , Icterícia Obstrutiva/etiologia , Situs Inversus/complicações , Situs Inversus/diagnóstico por imagemRESUMO
A 50-year-old patient with a history of hypopharyngeal cancer, laryngectomy, adjuvant chemoradiotherapy and incompetent tracheoesophageal fistula was admitted for elective pharingostomal surgery. During the surgery, he presented esophageal bleeding with hemodynamic instability. After stabilization, a gastroscopy was performed through the stoma, showing arterial bleeding 4-5 cm distal to the stoma, which was controlled with three hemostatic clips. After four hours, the patient presented a new episode of bleeding with hemodynamic instability and a Sengstaken-Blakemore tube was placed that stopped the bleeding. Computed tomography angiography (CT angiography) was performed, which showed an aberrant right subclavian artery with a retroesophageal pathway, in close contact with the area where the clips were placed. An endovascular stent was placed in the right subclavian artery with control of the bleeding after removal of the Sengstaken-Blakemore tube. The patient was discharged seven days later.
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Anormalidades Cardiovasculares , Fístula , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Subclávia/anormalidades , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgiaRESUMO
We present the case of a 55-year-old female with no history of interest and asymptomatic, who was admitted to perform studies due to findings of an abdominal ultrasound. A dilated left intrahepatic bile duct and a segment of the common hepatic duct, the proximal bile duct, was identified with irregular thickening of the wall, with an increased caliber (12 mm). A cystic lesion of 6 x 5.5 x 8 cm was also identified in the left liver lobe, with multiple septa. Computed tomography (CT) and magnetic resonance imaging (MRI) showed overlapping findings. Endoscopic retrograde cholangiopancreatography (ERCP) identified a filling defect in the common hepatic duct-left intrahepatic duct, which was not pulled with a Fogarty balloon, although it passed through it.
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Neoplasias dos Ductos Biliares , Cistadenoma Mucinoso , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Colangiopancreatografia Retrógrada Endoscópica , Cistadenoma Mucinoso/complicações , Cistadenoma Mucinoso/diagnóstico por imagem , Cistadenoma Mucinoso/cirurgia , Dilatação , Feminino , Ducto Hepático Comum , Humanos , Pessoa de Meia-IdadeRESUMO
We present the case of an 87-year-old female who presented with upper dysphagia to solids, weight loss of 5 kg and weakness in the upper limbs of a seven months duration. Gastroscopy showed a hiatal hernia and an esophagogram showed gastroesophageal reflux and contrast aspiration into the trachea. Esophageal manometry was not possible due to intolerance. Analytics showed elevated CPK (3,386 UI/l; 34-145) and positivity to anti-HMGCR antibodies. An electromyogram was performed, with more intense myopathy data in the proximal regions of the upper limbs and signs of myositis. A muscle biopsy was performed (deltoids and biceps) that showed signs of necrotizing myopathy. Treatment with oral steroids and methotrexate was started with a good subsequent evolution.
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Doenças Autoimunes , Transtornos de Deglutição , Doenças Musculares , Miosite , Idoso de 80 Anos ou mais , Autoanticorpos , Doenças Autoimunes/complicações , Doenças Autoimunes/tratamento farmacológico , Transtornos de Deglutição/etiologia , Feminino , HumanosRESUMO
We present the case of a 39-year-old male treated with Etanercept and debut of inflammatory bowel disease 11 months later. A literature review of the possible relationship between the debut and the treatment with Etanercept is done.
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Doença de Crohn/induzido quimicamente , Etanercepte/efeitos adversos , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adulto , Substituição de Medicamentos , Humanos , Infliximab/uso terapêutico , Masculino , Espondilite Anquilosante/tratamento farmacológicoRESUMO
BACKGROUND AND AIMS: The Endoscopic Resection Group of the Spanish Society of Endoscopy (GSEED-RE) model and the Australian Colonic Endoscopic Resection (ACER) model were proposed to predict delayed bleeding (DB) after EMR of large superficial colorectal lesions, but neither has been validated. We validated and updated these models. METHODS: A multicenter cohort study was performed in patients with nonpedunculated lesions ≥20 mm removed by EMR. We assessed the discrimination and calibration of the GSEED-RE and ACER models. Difficulty performing EMR was subjectively categorized as low, medium, or high. We created a new model, including factors associated with DB in 3 cohort studies. RESULTS: DB occurred in 45 of 1034 EMRs (4.5%); it was associated with proximal location (odds ratio [OR], 2.84; 95% confidence interval [CI], 1.31-6.16), antiplatelet agents (OR, 2.51; 95% CI, .99-6.34) or anticoagulants (OR, 4.54; 95% CI, 2.14-9.63), difficulty of EMR (OR, 3.23; 95% CI, 1.41-7.40), and comorbidity (OR, 2.11; 95% CI, .99-4.47). The GSEED-RE and ACER models did not accurately predict DB. Re-estimation and recalibration yielded acceptable results (GSEED-RE area under the curve [AUC], .64 [95% CI, .54-.74]; ACER AUC, .65 [95% CI, .57-.73]). We used lesion size, proximal location, comorbidity, and antiplatelet or anticoagulant therapy to generate a new model, the GSEED-RE2, which achieved higher AUC values (.69-.73; 95% CI, .59-.80) and exhibited lower susceptibility to changes among datasets. CONCLUSIONS: The updated GSEED-RE and ACER models achieved acceptable prediction levels of DB. The GSEED-RE2 model may achieve better prediction results and could be used to guide the management of patients after validation by other external groups. (Clinical trial registration number: NCT03050333.).
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Ressecção Endoscópica de Mucosa , Austrália , Estudos de Coortes , Colonoscopia , Neoplasias Colorretais/cirurgia , Humanos , Fatores de RiscoRESUMO
A case of endoscopically diagnosed systemic mastocytosis is presented and a brief literature review is done.
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Doenças do Colo/patologia , Colonoscopia , Mastocitose Sistêmica/patologia , Idoso , Humanos , MasculinoRESUMO
A endoscopically treated Boerhaave's syndrome is reported and a brief review of related literature is made.
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Perfuração Esofágica/cirurgia , Gastroscopia , Doenças do Mediastino/cirurgia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Giant fibrovascular polyps are very ucommon benign lesions. Due its size, they can be lethal, so an early diagnosis is important. A case report and diagnostic - therapeutic issues are described.
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Doenças do Esôfago/diagnóstico por imagem , Pólipos/diagnóstico por imagem , Gastropatias/diagnóstico por imagem , Adulto , Sulfato de Bário , Meios de Contraste , Doenças do Esôfago/cirurgia , Fundo Gástrico/diagnóstico por imagem , Gastroscopia , Azia , Humanos , Masculino , Pólipos/cirurgia , Gastropatias/cirurgia , Tomografia Computadorizada por Raios XRESUMO
We report the case of a 30-year-old female with a history of cannabis use from 16 years of age. The patient presented to the Gastroenterology Clinic due to cyclical epigastric pain associated with postprandial stomach heaviness, nausea and vomiting. She was admitted due to a worsening of her condition, which prevented her from leading a normal life.
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Dor Abdominal/etiologia , Canabinoides/efeitos adversos , Abuso de Maconha/diagnóstico , Vômito/etiologia , Adulto , Feminino , Humanos , Abuso de Maconha/complicações , SíndromeRESUMO
We report the case of a 65-year-old male patient with Down's syndrome and a deep venous thrombosis on anticoagulation with acenocoumarol. The case presented due to nonspecific, predominantly postprandial epigastric discomfort, meteorism and aerophagia. A thoracoabdominal computed tomography (CT) scan revealed a Morgagni hernia with a cephalad migration of part of the stomach, ascending colon and transverse colon. After laparotomy, the defect was repaired using a titanium mesh and the patient had a favorable outcome.
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Hérnias Diafragmáticas Congênitas/diagnóstico , Idade de Início , Idoso , Humanos , MasculinoRESUMO
A clinical case of an 85-year-old patient with cholangitis secondary to afferent loop syndrome from gastric stump adenocarinoma. A brief review of the literature on it is made.
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Adenocarcinoma/diagnóstico por imagem , Síndrome da Alça Aferente/diagnóstico por imagem , Colangite/diagnóstico por imagem , Coto Gástrico/diagnóstico por imagem , Neoplasias Gástricas/diagnóstico por imagem , Adenocarcinoma/complicações , Adenocarcinoma/cirurgia , Síndrome da Alça Aferente/complicações , Síndrome da Alça Aferente/cirurgia , Idoso de 80 Anos ou mais , Colangiopancreatografia por Ressonância Magnética , Colangite/etiologia , Colangite/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias Gástricas/complicações , Neoplasias Gástricas/cirurgiaRESUMO
Duodenal diverticula are an uncommon cause of upper gastrointestinal bleeding. Until recently, it was primarily managed with surgery, but advances in the field of endoscopy have made management increasingly less invasive. We report a case of duodenal diverticular bleeding that was endoscopically managed, and review the literature about the various endoscopic therapies thus far described.