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1.
Gastroenterol Hepatol ; 47(2): 119-129, 2024 Feb.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-36870477

RESUMO

INTRODUCTION AND AIMS: The outcomes of endoscopic submucosal dissection (ESD) in the esophagus have not been assessed in our country. Our primary aim was to analyze the effectiveness and safety of the technique. MATERIAL AND METHODS: Analysis of the prospectively maintained national registry of ESD. We included all superficial esophageal lesions removed by ESD in 17 hospitals (20 endoscopists) between January 2016 and December 2021. Subepithelial lesions were excluded. The primary outcome was curative resection. We conducted a survival analysis and used logistic regression analysis to assess predictors of non-curative resection. RESULTS: A total of 102 ESD were performed on 96 patients. The technical success rate was 100% and the percentage of en-bloc resection was 98%. The percentage of R0 and curative resection was 77.5% (n=79; 95%CI: 68%-84%) and 63.7% (n=65; 95%CI: 54%-72%), respectively. The most frequent histology was Barrett-related neoplasia (n=55 [53.9%]). The main reason for non-curative resection was deep submucosal invasion (n=25). The centers with a lower volume of ESD obtained worse results in terms of curative resection. The rate of perforation, delayed bleeding and post-procedural stenosis were 5%, 5% and 15.7%, respectively. No patient died or required surgery due to an adverse effect. After a median follow-up of 14months, 20patients (20.8%) underwent surgery and/or chemoradiotherapy, and 9 patients died (mortality 9.4%). CONCLUSIONS: In Spain, esophageal ESD is curative in approximately two out of three patients, with an acceptable risk of adverse events.


Assuntos
Ressecção Endoscópica de Mucosa , Neoplasias Esofágicas , Humanos , Neoplasias Esofágicas/cirurgia , Neoplasias Esofágicas/patologia , Ressecção Endoscópica de Mucosa/efeitos adversos , Ressecção Endoscópica de Mucosa/métodos , Espanha , Resultado do Tratamento , Estudos Retrospectivos
2.
Cir Esp (Engl Ed) ; 101(6): 435-444, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36565988

RESUMO

INTRODUCTION: Complex polyps require the use of advanced endoscopic techniques or minimally invasive surgery for their approach. In rectal polyps it is of special relevance to reach a consensus on the best approach to avoid under- or overtreatment that increases unnecessary morbidity and mortality. METHODS: We describe a prospective, multicenter, pilot clinical trial with a first-in-human medical device. It is hypothesized that UNI-VEC® facilitates transanal laparoendoscopic surgery for the removal of early rectal tumors. The primary objective is to evaluate that it is safe and meets the established functional requirements. Secondary objectives are to evaluate results, complications and level of satisfaction. RESULTS: 16 patients were recruited in 12 months with a minimum follow-up of 2 months. The mean size was 3.4 cm with the largest polyp being 6 cm. Regarding location, the mean was 6.6 cm from the anal margin. Endoscopic Mucosal Resection (EMR) (6.3%), Endoscopic Submucosal Dissection ESD (43.8%), REC (6.3%) and TAMIS (43.8%) were performed. The mean time was 73.25 min. The 56.3% used a 30° camera and 43.8% used the flexible endoscope as a viewing instrument. The 56.3% were benign lesions and 43.8% malignant. Complete resection is achieved in 87.5%. Regarding complications, mild bleeding (Clavien I) occurred in 25%, 6.3% and 21.4% at 24 h, 48 h and 7 days respectively. Continence was assessed according to the Wexner scale. At 7 days, 60% showed perfect continence, 26.7% mild FI and 13.3% moderate FI. At 30 days, 66.7% had perfect continence, 20% mild FI and 13.3% moderate FI. At 2 months, 4 patients were reviewed who at 30 days had a Wexner's degree higher than preoperative and perfect continence was demonstrated in 25% of the patients, 50% mild and 25% moderate. In no case did rectal perforation or major complications requiring urgent reintervention occur. As for the level of reproducibility, safety, level of satisfaction with the device and evaluation of the blister, the evaluation on a scale of 0-10 (9.43, 9.71, 9.29 and 9.50 respectively). All the investigators have previous experience with transanal devices. CONCLUSIONS: The study demonstrates the efficacy and safety of UNI-VEC® for the treatment of rectal lesions. It will facilitate the implementation of hybrid procedures that seek to solve the limitations of pure endoscopic techniques by allowing the concomitant use of conventional laparoscopic and robotic instrumentation with the flexible endoscope.


Assuntos
Laparoscopia , Neoplasias Retais , Humanos , Estudos Prospectivos , Reprodutibilidade dos Testes , Neoplasias Retais/cirurgia , Neoplasias Retais/patologia , Reto/cirurgia , Reto/patologia
3.
Rev Esp Enferm Dig ; 114(12): 742-743, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-35240851

RESUMO

A 66-year-old man with a history of tobacco and alcohol consumption was diagnosed with a severe peptic esophagitis. After treatment, an endoscopy showed the resolution of esophagitis, but revealed white multinodular plaques with a diffuse distribution. Histology showed esophageal mucosa with a prominent granular layer and hyperorthokeratotis, in keeping with epidermoid metaplasia. This unusual condition has been linked to esophageal squamous cell carcinoma. Therefore, diagnosis and endoscopic surveillance should be considered.


Assuntos
Doenças do Esôfago , Neoplasias Esofágicas , Carcinoma de Células Escamosas do Esôfago , Masculino , Humanos , Idoso , Neoplasias Esofágicas/patologia , Doenças do Esôfago/patologia , Metaplasia
4.
Rev Esp Enferm Dig ; 112(5): 418, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32338026

RESUMO

ereditary Angioedema (HAE) is a rare autosomal-dominant disease caused by serum C1 inhibitor deficiency. This deficiency leads to an up-regulation of complement, activating the bradykinin pathway and causing vascular permeability and subsequent mucosal edema. Abdominal angioedema is a less recognized type of angioedema and the clinical signs may range from subtle, diffuse abdominal pain and nausea, to overt peritonitis. We describe one case of abdominal angioedema in a patient with known HAE that were diagnosed by ultrasound.


Assuntos
Angioedema , Angioedemas Hereditários , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Angioedemas Hereditários/complicações , Angioedemas Hereditários/diagnóstico por imagem , Humanos , Náusea , Ultrassonografia
5.
Rev Esp Enferm Dig ; 111(4): 320-321, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30746955

RESUMO

A colonoscopy was performed as part of a colorectal screening program on a 77-year-old female with positive fecal occult blood test. During withdrawal, two metallic elongated foreign bodies, around 20 mm in length were found pinned into the transverse colon and rectal wall. A computed tomography with multiplanar reconstruction showed two metallic density T-shaped foreign bodies that resembled intrauterine devices (IUDs) that penetrated the intestinal wall , which ruled out other complications. The patient confirmed a previous loss of an IUD device 35 years previously and underwent a second IUD insertion a few years later. She refused another colonoscopy for endoscopic removal as she did not have any symptoms in the past.


Assuntos
Colo/lesões , Corpos Estranhos/diagnóstico por imagem , Perfuração Intestinal/diagnóstico por imagem , Dispositivos Intrauterinos/efeitos adversos , Reto/lesões , Idoso , Colo/diagnóstico por imagem , Colonoscopia , Feminino , Humanos , Perfuração Intestinal/etiologia , Sangue Oculto , Reto/diagnóstico por imagem , Tomografia Computadorizada por Raios X
6.
Rev Esp Enferm Dig ; 111(4): 330-331, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30511578

RESUMO

Mycophenolate mofetil (MMF) is an immunosuppressive agent that is used in transplanted patients, with frequent gastrointestinal adverse effects. We report the case of a patient, under chronic therapy with mycophenolate mofetil , during a diagnostic workup for a chronic diarrhea, which presents a duodenal villous atrophy ( VA) with negative celiac serology, which is a diagnostic challenge. VA secondary to MMF is a very unusual adverse effect. Just a few cases have been reported in the literature.


Assuntos
Duodeno/patologia , Imunossupressores/efeitos adversos , Ácido Micofenólico/efeitos adversos , Adulto , Atrofia/induzido quimicamente , Doença Celíaca/diagnóstico , Duodeno/efeitos dos fármacos , Endoscopia Gastrointestinal , Humanos , Rim , Transplantados
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