Gastric variceal bleeding treated through endoscopic ultrasound-guided coiling and N-butyl-2-cyanoacrylate application.

OBJECTIVE: To evaluate efficacy and safety between dual angiotherapy (endocoil plus N-butyl-cyanoacrylate) guided by endoscopic ultrasound) versus N-butyl-cyanoacrylate in the secondary prophylaxis of gastroesophageal varices (GOV). METHOD: Prospective non-inferiority study comparing two gastric variceal eradication techniques. We evaluated technical and clinical success, GOV occlusion and eradication, rebleeding, reoperation, GOV-free period, complications, and mortality. Chi square for categorical variables and Student's t for numerical variables with a significance level of 0.05. RESULTS: There were 68 patients (average age 55.5 ± 10 years, women 44 (64.7%) and average body mass index 25.7 ± 3.5 kg/m2). The most frequent cause was alcoholic steatohepatitis (58%). Dual therapy had greater technical (100% vs. 94.3%) and clinical (100% vs. 85%) success. Obliteration was faster (100 vs. 79.2%). This group only required one session. The GOV size was 24 ± 14 mm and 1-2 endocoils were placed. The median follow-up was 221 days. The reoperation-free rate was high (100% vs. 94%; p = 0.9). CONCLUSIONS: Dual angiotherapy guided by endoscopic ultrasound and cyanoacrylate injection are effective for the eradication of GOV without differences in adverse event rates.

OBJETIVO: Evaluar la eficacia y la seguridad de la angioterapia dual (endo-coil más N-butil-cianoacrilato) guiada por ultrasonido endoscópico) frente a N-butil-cianoacrilato solo en la profilaxis secundaria de várices gásctricas. MÉTODO: Estudio prospectivo de no inferioridad comparando dos técnicas de erradicación de várices gástricas. Se evalúan el éxito técnico y clínico, la oclusión y la erradicación de GOV, el resangrado, la reintervención, el período libre de GOV, las complicaciones y la mortalidad. Análisis estadístico mediante prueba de χ2 para variables categóricas y t de Student para las numéricas, con nivel de significancia de 0.05. RESULTADOS: Fueron 68 pacientes (edad promedio 55.5 ± 10 años, mujeres 44 (64.7%) e índice de masa corporal promedio 25.7 ± 3.5 kg/m2). La causa más frecuente fue esteatohepatitis alcohólica (58%). La terapia dual tuvo mayor éxito técnico (100% vs. 94.3%) y clínico (100% vs. 85%), y la obliteración fue más rápida (100 vs. 79.2%); este grupo solo requirió una sesión. El tamaño de las GOV fue de 24 ± 14 mm y se colocaron uno o dos endo-coils. La mediana de seguimiento fue de 221 días. La tasa de libres de reintervención fue alta (100% vs. 94%; p = 0.9). CONCLUSIONES: La angioterapia dual guiada por ultrasonido y la inyección de cianoacrilato son efectivas para la erradicación de las GOV, sin diferencias en las tasas de eventos adversos.

Usefulness of optical enhancement endoscopy combined with magnification to improve detection of intestinal metaplasia in the stomach.

Background and study aims The light blue crest observed in narrow band imaging endoscopy has high diagnostic accuracy for diagnosis of gastric intestinal metaplasia (GIM). The objective of this prospective study was to evaluate the diagnostic accuracy of magnifying i-scan optical enhancement (OE) imaging for diagnosing the LBC sign in patients with different levels of risk for gastric cancer in a Mexican clinical practice. Patients and methods Patients with a history of peptic ulcer and symptoms of dyspepsia or gastroesophageal reflux disease were enrolled. Diagnosis of GIM was made at the predetermined anatomical location and white light endoscopy and i-scan OE Mode 1 were captured at the two predetermined biopsy sites (antrum and pyloric regions). Results A total of 328 patients were enrolled in this study. Overall GIM prevalence was 33.8 %. The GIM distribution was 95.4 % in the antrum and 40.5 % in the corpus. According to the Operative Link on Gastritis/Intestinal-Metaplasia Assessment staging system, only two patients (1.9 %) were classified with high-risk stage disease. Sensitivity, specificity, positive​ and negative predictive values, positive and negative likelihood ratios, and accuracy of both methods (95 % C. I.) were 0.50 (0.41-0.60), 0.55 (0.48-0.62), 0.36 (0.31-0.42), 0.68 (0.63-0.73), 1.12 (0.9-1.4), 0.9 (0.7-1.1), and 0.53 (0.43-0.60) for WLE, and 0.96 (0.90-0.99), 0.91 (0.86-0.94), 0.84 (0.78-0.89), 0.98 (0.94-0.99), 10.4 (6.8-16), 0.05 (0.02-0.12), and 0.93 (0.89-0.95), respectively. The kappa concordance was 0.67 and the reliability coefficient was 0.7407 for interobserver variability. Conclusions Our study demonstrated the high performance of magnifying i-scan OE imaging for endoscopic diagnosis of GIM in Mexican patients.

Experimental model standardizing polyvinyl alcohol hydrogel to simulate endoscopic ultrasound and endoscopic ultrasound-elastography.

BACKGROUND: Endoscopic ultrasound (EUS) and endoscopic ultrasound elastography (EUS-E) simulation lessens the learning curve; however, models lack realism, diminishing competitiveness. AIM: To standardize the mechanical properties of polyvinyl alcohol (PVA) hydrogel for simulating organs and digestive lesions. METHODS: PVA hydrogel (Sigma Aldrich, degree of hydrolysis 99%) for simulating EUS/EUS-E lesions was investigated in Unidad de Investigación y Desarrollo Tecnológico at Hospital General de México "Dr. Eduardo Liceaga", Mexico City. We evaluated physical, contrast, elasticity and deformation coefficient characteristics in lesions, applying Kappa's concordance and satisfaction questionnaire (Likert 4-points). RESULTS: PVA hydrogel showed stable mechanical properties. Density depended on molecular weight (MW) and concentration (C). PVA bblocks with the greatest density showed lowest tensile strength (r = -0.8, P = 0.01). Lesions were EUS-graphically visible. Homogeneous and heterogeneous examples were created from PVA blocks or PVA phantoms, exceeding (MW2 = 146000-186000, C9 = 15% and C10 = 20%) with a density under (MW1 = 85000-124000, C1 = 7% and C2 = 9%). We calculated elasticity and deformation parameters of solid (blue) areas, contrasting with the norm (Kappa = 0.8; high degree of satisfaction). CONCLUSION: PVA hydrogels were appropriate for simulating organs and digestive lesions using EUS/EUS-E, facilitating practice and reducing risk. Repetition amplified skills, while reducing the learning curve.

Acute dysphagia presentation and its association with esophagitis dissecans and concomitant diseases. A diagnostic challenge.

Esophagitis dissecans (ESD) is an uncommon disease that is associated with eosinophilic esophagitis (EoE), candidiasis and/or drugs. We aim to characterize the clinical, endoscopic and histological damage of the mucosal in subjects with dysphagia, its relation to concomitant entities and the treatment response. This is a retrospective observational study in patients with dysphagia and esophageal mucosal damage We included 23 patients (mean age = 55 years) who had GERD symptoms, dysphagia and/or odynophagia. There were 10, 9 and 4 cases of esophagitis dissecans, desquamative/esfacelante (ESD/ES) and fibrostenotic, respectively. ESD/SE is a rare entity with variable clinical, endoscopic and histological spectrum. The association with GERD was frequent.

La esofagitis disecante (ESD) es una enfermedad rara que puede asociarse a esofagitis eosinofílica, candidiásica o medicamentos. Se analizaron las características clinico-endoscópicas e histopatológicas en sujetos con disfagia de corta evolución asociada a afecciones concurrentes. Estudio observacional de cohorte retrospectiva con disfagia y daño mucoso. Se ingresaron 23 pacientes con edad media de 55 años. Todos tuvieron síntomas de reflujo gastroesofágico (ERGE), disfagia y odinofagia. Fueron 10, 9 y 4 casos de ESD, descamativa/esfacelante (ESD/ES) y fibroestenosis, respectivamente. La ESD/SE es una afección rara, con un espectro clínico, endoscópico e histológico variable.