Factors associated with complications during endoscopic esophageal dilation.

BACKGROUND: endoscopic dilation is considered as the treatment of choice for esophageal strictures. However, there are no studies in our region that have assessed the safety of the procedure. OBJECTIVE: to assess the safety of esophageal dilation and the factors associated with the development of complications. MATERIALS AND METHODS: a retrospective cohort was studied. All patients referred for esophageal dilation between January 2015 and June 2017 were included in the study. A complication rate was obtained and the association between nonadherence to the "rule of 3" and the development of complications was determined. Other predictive factors associated with complication development were also analyzed. RESULTS: a total of 164 patients that underwent 474 dilations were included in the study. Surgical anastomosis stricture was the most prevalent etiology. A total of six complications occurred, including three perforations (0.63%), two bleeding events (0.42%) and one episode of significant pain that required post-procedure observation (0.21%). Endoscopic esophageal dilation without adherence to the "rule of 3" was not associated with a higher risk of complications. Balloon dilation was the only predictive factor for complications. CONCLUSIONS: esophageal dilation is a safe procedure. Nonadherence to the "rule of 3" does not appear to be associated with a higher risk of complications, including esophageal perforation.

A bronchobiliary fistula treated with cyanoacrylate glue in a patient with liver cirrhosis.

A 60-year-old male was operated upon in 2002 for liver hydatidosis, which included partial right hepatectomy with cholecystectomy and bilioduodenal anastomosis. He then developed liver cirrhosis secondary to left hepatic duct stricture. He presents at the emergency room with dry cough, which he had for a month and then became associated with yellowish, bitter-tasting "fluid" expectoration. A chest-abdominal CT scan revealed a 6 x 5-cm collection roughly located somewhere between the middle pulmonary lobe and subphrenic area . A fistula was suspected, which prompted a sputum biochemistry test that was positive for bilirubin. Given the patient's impaired liver function because of his liver disease conservative treatment was initiated with an inner-outer drain under transparietal hepatic cholangiography (TPHC) to promote bile outflow via the duodenum. Subsequently, TPHC was used to locate the point where contrast leaked from the biliary tree into a pleural cavity, and the fistula was sealed using cyanoacrylate glue, which resulted in improved symptomatology.

[Frequency of proton pump inhibitor prescription based in clinical practice guidelines in hospitalized patients in two academic hospitals in Lima, Peru]. / Frecuencia de la prescripción de los inhibidores de bomba de protones basada en guías de práctica clínica en pacientes hospitalizados en dos hospitales docentes de Lima-Perú.

OBJECTIVES: To evaluate if Proton Pump Inhibitor (PPI) prescription is based in Clinical Practice Guidelines (CPG) in hospitalized patients at two academic hospitals of Lima. MATERIALS AND METHODS: The services of Intern Medicine, Tropical Medicine and General Surgery were visited. Therapeutic sheets and nursing transcript were checked. The prescription motifs were determined in patients who received PPI. These motifs were obtained according to a check list, which was made from different CPG. RESULTS: 54.57% of the PPI prescriptions in the two academic hospitals were not based in CPG. No statistic significant difference was found between the two academic hospitals in the PPI prescription based in CPG (p=0,208). Most of the prescriptions not base on CPG belong to the service of General Surgery (83.6%; p<0.0001). The main indication for the prescription of PPI based on CPG was prevention of NSAIDS induced gastric ulcers if advanced age (65.72%). CONCLUSIONS: There is a high rate of PPI overuse in two academic hospitals.

Frecuencia de la prescripción de los inhibidores de bomba de protones basada en guías de práctica clínica en pacientes hospitalizados en dos hospitales docentes de lima û perú / Frequency of prescribing of proton pump inhibitors based clinical practice guidelines in hospitalized patients in two teaching hospitals of lima - Peru

OBJETIVOS: evaluar si la prescripción de inhibidores de bomba de protones (IBP) está basada en guías de práctica clínica en pacientes hospitalizados en dos hospitales docentes de lima. MATERIALES Y METODOS: Se acudió a los servicios de Medicina Interna, Medicina Tropical y Cirugía General de dos hospitales docentes, y se procedió a revisar las hojas de terapéutica y kárdex de enfermería. En los pacientes que recibían IBP se procedió a determinar el motivo de su prescripción según una lista de chequeo obtenida de diferentes guías de práctica clínica (GPC). RESULTADOS: el 54,57% de las prescripciones de IBP en los dos hospitales docentes no estuvieron basadas en GPC. No se encontró diferencias estadísticamente significativas entre ambos hospitales en cuanto a la prescripción de IBP basada en GPC (p=0,208). En el servicio de cirugía general fue mayor la prescripción de IBP no basada en GPC con respecto al servicio de Medicina (83,6% versus 16.4%; p<0.0001). El principal motivo de prescripción de IBP basado en GPC fue la prevención de úlceras gástricas producidas por antiinflamatorio no esteroideo en pacientes con edad avanzada (65,72%). CONCLUSIONES: existe una elevada frecuencia de sobreuso de IBP en los dos hospitales docentes.

OBJECTIVES: To evaluate if Proton Pump Inhibitor (PPI) prescription is based in Clinical Practice Guidelines (CPG) in hospitalized patients at two academic hospitals of Lima. MATERIALS AND METHODS: The services of Intern Medicine, Tropical Medicine and General Surgery were visited. Therapeutic sheets and nursing transcript were checked. The prescription motifs were determined in patients who received PPI. These motifs were obtained according to a check list, which was made from different CPG. RESULTS: 54.57% of the PPI prescriptions in the two academic hospitals were not based in CPG. No statistic significant difference was found between the two academic hospitals in the PPI prescription based in CPG (p=0,208). Most of the prescriptions not base on CPG belong to the service of General Surgery (83.6%; p<0.0001). The main indication for the prescription of PPI based on CPG was prevention of NSAIDS induced gastric ulcers if advanced age (65.72%). CONCLUSIONS: There is a high rate of PPI overuse in two academic hospitals.