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We report the case of an 89-year-old female who presented with progressive weight loss, oropharyngeal dysphagia and food regurgitation.
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Transtornos de Deglutição , Divertículo de Zenker , Idoso de 80 Anos ou mais , Biópsia , Transtornos de Deglutição/etiologia , Feminino , Humanos , Divertículo de Zenker/complicações , Divertículo de Zenker/diagnóstico por imagemRESUMO
An 86-year-old female presented with anemia and dyspepsia. She underwent esophagogastroduodenoscopy, which revealed a giant pedunculated polyp located in the gastric corpus, protruding into the duodenal bulb, causing gastric outlet obstruction (GOO). Thus, an endoscopic resection was scheduled.
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Obstrução da Saída Gástrica , Linfoma de Zona Marginal Tipo Células B , Idoso de 80 Anos ou mais , Duodeno/patologia , Feminino , Obstrução da Saída Gástrica/diagnóstico por imagem , Obstrução da Saída Gástrica/etiologia , Obstrução da Saída Gástrica/cirurgia , Humanos , Tecido Linfoide/patologia , Linfoma de Zona Marginal Tipo Células B/complicações , Linfoma de Zona Marginal Tipo Células B/diagnóstico por imagem , Linfoma de Zona Marginal Tipo Células B/cirurgia , Mucosa/patologiaRESUMO
We present the case of a 25-year-old female who presented due to refractory chronic constipation and fecal incontinence. She had bowel movements every 7-30 days with an increased consistency (1-2 Bristol type stools), together with soiling and passive fecal incontinence (Wexner Scale: 12/20). She had previously undergone surgery shortly after birth for an anorectal malformation repair. The colonoscopy and histological study of the rectum were normal. A pelvic magnetic resonance imaging (MRI) was performed, which showed a right pararectal mass that compressed the rectum without invading it. This mass was compatible with a presacral teratoma or hamartoma. MRI also revealed coccyx agenesis and hypoplasia of the last sacral vertebrae (Image 1), which were consistent with Currarino syndrome (CS). The patient received 14 sessions of transcutaneous electrostimulation of the posterior tibial nerve, resulting in an increase in bowel movements (every 3 days) and a reduction in fecal incontinence. She was then referred to surgery for presacral mass removal.
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Anormalidades do Sistema Digestório , Incontinência Fecal , Adulto , Canal Anal/anormalidades , Constipação Intestinal/diagnóstico por imagem , Constipação Intestinal/etiologia , Anormalidades do Sistema Digestório/complicações , Anormalidades do Sistema Digestório/diagnóstico por imagem , Anormalidades do Sistema Digestório/cirurgia , Feminino , Humanos , Reto/anormalidades , Reto/diagnóstico por imagem , Reto/cirurgia , Sacro/anormalidades , Sacro/diagnóstico por imagem , Sacro/cirurgia , SiringomieliaRESUMO
INTRODUCTION: the aim of our study was to develop a peroral endoscopic myotomy (POEM) program in our Unit following a two-step sequence: training on animal models and supervision by an experienced endoscopist during the first human cases. METHODS: a single endoscopist experienced in advanced endoscopy was trained in POEM. After observing POEM in referral centers, training was implemented on swine models (preclinical phase). Technical aspects and adverse events were prospectively recorded. A first subset of cases (group A) was compared to a second one (group B) to assess our progression. Finally, POEM was implemented in humans under the supervision of an experienced endoscopist (clinical phase). The outcomes and adverse events were prospectively recorded. RESULTS: during the preclinical phase, 15 POEM procedures were performed on live pigs. Severe adverse events (AE) were less frequent in group B than in group A (12 % vs 57 %, p = 0.07). After nine cases, a plateau of adverse events was reached. During the clinical phase, eleven POEM procedures were performed in patients under expert supervision. Technical and clinical (Eckardt score ≤ 3) success were 100 % and 91 %, respectively (follow-up 3-21 months). In two cases, intervention of an experienced endoscopist was required (cases 2 and 3) because of a difficult orientation at the esophagogastric junction. One mild pneumoperitoneum occurred, with no severe adverse events reported. CONCLUSIONS: training in animal models and supervision by an experienced endoscopist during the first cases could provide the necessary skills to perform POEM safely and effectively.
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Acalasia Esofágica , Miotomia , Cirurgia Endoscópica por Orifício Natural , Animais , Acalasia Esofágica/cirurgia , Humanos , Estudos Retrospectivos , Suínos , Resultado do TratamentoRESUMO
We report the case of a 76-year-old female who underwent a colonoscopy for post-polypectomy follow-up. A nodular area was found in the proximal rectum that was suggestive of hyperplastic polyps by location and endoscopic appearance. Biopsies were taken due to its slightly atypical characteristics, with a final histological result of lymphoid aggregates.
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Pólipos do Colo , Linfoma não Hodgkin , Idoso , Colo/patologia , Pólipos do Colo/patologia , Colonoscopia , Feminino , Humanos , Mucosa Intestinal/patologia , Linfoma não Hodgkin/diagnóstico por imagem , Reto/patologiaRESUMO
Cap-polyposis is a rare benign condition characterized by inflammatory colorectal polyps covered by a "cap" of fibrinopurulent exudate. Mucous diarrhea and rectal bleeding are frequent symtoms. It can be difficult to diagnose and it is necessary to make a differential diagnosis from other entities. Its pathogenesis is unknown and it has a variable clinical course. The optimal treatment has not been established.
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Pólipos do Colo , Ressecção Endoscópica de Mucosa , Polipose Intestinal , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Pólipos Intestinais , RetoRESUMO
BACKGROUND/AIMS: Per-oral endoscopic myotomy (POEM) is a new minimally invasive technique to treat achalasia. METHODS: We performed a review of the literature of POEM with a special focus on technical details and the results obtained with this technique in patients with achalasia and other esophageal motility disorders. RESULTS: Thousands of POEM procedures have been performed worldwide since its introduction in 2008. The procedure is based on the creation of a mucosal entry point in the proximal esophagus to reach the cardia through a submucosal tunnel and then perform a myotomy of the muscular layers of the cardia, esophagogastric junction and distal esophagus, as performed in a Heller myotomy. The clinical remission rate ranges from 82 to 100%. Although no randomized studies exist and available data are from single-center studies, no differences have been found between laparoscopic Heller myotomy (LHM) and POEM in terms of perioperative outcomes, short-term outcomes (12 months) and long-term outcomes (up to three years). Procedure time and length of hospital stay were lower for POEM. Post-POEM reflux is a concern, and controversial data have been reported compared to LHM. The technique is safe, with no reported deaths related to the procedure and an adverse event rate comparable to surgery. Potential complications include bleeding, perforation, aspiration and insufflation-related adverse events. Thus, this is a complex technique that needs specific training even in expert hands. The indication for this procedure is widening and other motor hypercontractil esophageal disorders have been treated by POEM with promising results. POEM can be performed in complicated situations such as in pediatric patients, sigmoid achalasia or after failure of previous treatments. CONCLUSIONS: POEM is an effective treatment for achalasia and is a promising tool for other motor esophageal disorders. It is a safe procedure but, due to its technical difficulty and possible associated complications, the procedure should be performed in referral centers by trained endoscopists.
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Endoscopia Gastrointestinal/métodos , Acalasia Esofágica/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Doenças do Esôfago/cirurgia , HumanosRESUMO
BACKGROUND/AIMS: Endoscopy is the gold standard for assessing disease severity in inflammatory bowel disease (IBD), although it is an invasive procedure. Biological markers have been routinely used as a non-invasive means of determining disease activity. The aim of this study was to determine the correlation between common biological markers and endoscopic activity in IBD. METHODS: Consecutive patients with IBD were included. Serum concentrations of different biomarkers (C-reactive protein [CRP], orosomucoid [ORM], erythrocyte sedimentation rate [ESR], fibrinogen, platelets, leukocytes, neutrophils and hemoglobin [Hb]) were measured, and their accuracy in detecting endoscopic activity was determined. RESULTS: Eighty patients were included (mean age 46 years, 53% Crohn's disease), 70% with endoscopic activity. Among Crohn's disease patients, 24% had mild endoscopic activity, 12% moderate activity and 39% severe activity. Among ulcerative colitis patients, 35% had an endoscopic Mayo score of 0-1 points, 30% 2 points and 35% 3 points. None of the biomarkers included had a good correlation with endoscopic activity (Area Under the ROC curve [AUC]<0.70) in ulcerative colitis. ORM, fibrinogen and platelets had the best accuracy to detect endoscopic activity in Crohn's disease (AUC: 0.80-0.085). A sub-analysis in postoperative Crohn's disease patients found no correlation between endoscopic recurrence and biomarkers (AUC<0.70). CONCLUSION: Serological biomarkers, including CRP, have low accuracy to detect endoscopic activity in ulcerative colitis and postoperative Crohn's disease. ORM, fibrinogen and platelets have the best accuracy to detect endoscopic activity in Crohn's disease.
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Biomarcadores/sangue , Endoscopia do Sistema Digestório , Doenças Inflamatórias Intestinais/sangue , Doenças Inflamatórias Intestinais/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Contagem de Células Sanguíneas , Sedimentação Sanguínea , Proteína C-Reativa/análise , Feminino , Fibrinogênio/análise , Hemoglobinas/análise , Humanos , Doenças Inflamatórias Intestinais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Orosomucoide/análise , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Adulto JovemRESUMO
BACKGROUND: Overstitch endoscopic suturing system (Apollo Endosurgery. Austin, Texas) was created for NOTES procedures.As it demonstrated to be feasible, secure and effective in this field, further studies have evaluated its use in common gastrointestinal disorders in which current therapeutic tools, endoscopic or not, are not efficient or safe enough. Published results are promising. We present our initial experience with this system in the management of pathologies we usually face in our clinical practice. METHOD: Suturing system was evaluated for: 1. Endoscopic fixation of metallic stent to prevent migration in patients with gastrointestinal non-neoformative pathology. 2. Outlet reduction in patients with weight regain following Roux-en-Y gastric bypass. RESULTS: During a period of 6 months Overstitch endoscopic suturing system was used in 5 patients: For stent fixation in 3 and for outlet reduction in 2. Technical success: Suture was performed in all the patients. Only 1 stitch was lost. Effectiveness: Stent fixation and outlet reduction were achieved in all the patients.However, in 1 patient the final anastomotic size was not close enough. Clinical success: Clinical recovery was achieved in all the patients in whom endoscopic stent fixation was performed. Thepatient which appropriated outlet closure developed a significant weight loss. The patient in which final size was not close enough did not lose weight. CONCLUSIONS: We found Overstitch endoscopic suturing system feasible, safe and effective, as it has been previously described. We encourage the publication of further studies evaluating the real utility of this tool, mostly taking into account that it allows a successful management of usual disorders for which there are not current effective therapies.
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Endoscopia/métodos , Suturas , Derivação Gástrica , Humanos , StentsRESUMO
Boerhaave syndrome (BS) is a spontaneous esophageal perforation which carries high mortality. Surgical treatment is well established, but the development of interventional endoscopy has proposed new therapies. We expose our experience in a Gastrointestinal and Endoscopy Unit. With a retrospective, observational, open-label, single center, consecutive case series. All patients diagnosed with BS who were managed in our center were included. Treated conservatively, endoscopically or surgically, according to their clinical condition and lesion presentation. Fourteen patients were included. Ten were treated with primary surgery. One conservatively. In total, 7/14 patients required an endoscopic treatment. All required metallic stents deployment, 3 cases over-the-scope-clips concomitantly and one case a novel technique an internal drain. 6/7 cases endoscopically treated achieved complete esophageal healing. In conclusion, endoscopy is an useful tool at all stages BS management: difficult diagnosis, primary treatment in selected patients and as salvage when surgery fails. With mortality rates and outcomes comparables to surgery.
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Hemodinâmica/fisiologia , Hepatite/complicações , Hipertensão Portal/complicações , Isquemia/complicações , Cirrose Hepática/complicações , Pancitopenia/complicações , Esplenomegalia/complicações , Adulto , Biópsia , Transplante de Medula Óssea , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/patologia , Anemia de Fanconi/complicações , Hepatite/diagnóstico , Hepatite/patologia , Humanos , Hipertensão Portal/diagnóstico , Hipertensão Portal/patologia , Isquemia/diagnóstico , Isquemia/patologia , Leucemia Monocítica Aguda/etiologia , Fígado/patologia , Cirrose Hepática/diagnóstico , Cirrose Hepática/patologia , Testes de Função Hepática , Masculino , Pancitopenia/diagnóstico , Pancitopenia/patologia , Baço/patologia , Esplenomegalia/diagnóstico , Esplenomegalia/patologia , Tomografia Computadorizada por Raios X , Hipertensão Portal não Cirrótica IdiopáticaRESUMO
[This corrects the article DOI: 10.1055/s-0043-106577.].
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BACKGROUND AND STUDY AIMS: Postsurgical benign bilioenteric anastomotic strictures are a major adverse event of biliary surgery and endoscopic treatment, including endoscopic retrograde cholangiopancreatography (ERCP), is challenging in this setting. We present an innovative approach to treating this complication. PATIENTS AND METHODS: Patients underwent endoscopic ultrasound (EUS)-hepaticogastrostomy (HG) to treat nonmalignant biliary obstructions. A first endoscopy was performed to create the hepaticogastrostomy and to drain the biliary tree. The second step had a therapeutic purpose: antegrade dilation of the anastomosis. RESULTS: Four men and three women with benign bilioenteric anastomotic strictures were included. Patients presented with jaundice or recurrent cholangitis. A fully covered HG stent was successfully deployed during the first endoscopy. During the second step, repeat antegrade dilation was performed through the HG in four cases (1â-â4 dilations) followed by double pigtail stenting in three cases. In three other patients, the stenosis was not crossable and a double pigtail stent was placed to maintain biliary drainage. All patients had symptom relief at the end of follow-up (45 weeks, range 33â-â64). CONCLUSIONS: Dilation of anastomotic stenosis through a hepaticogastrostomy is feasible and may provide permanent biliary drainage or recurrent access to the biliary tree in patients with altered anatomy. Double pigtail stents might prevent migration.
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BACKGROUND AND OBJECTIVES: Endoscopy is the gold standard to assess disease severity in inflammatory bowel disease, although it is an invasive procedure. Clinical activity and biological markers have been routinely used to determine disease activity in a non-invasive manner. The aim of this study was to determine concordance between common biological markers (C reactive protein, orosomucoid, erythrocyte sedimentation rate, fibrinogen, platelets, leukocytes, neutrophils and haemoglobin) and clinical activity in inflammatory bowel disease. PATIENTS AND METHOD: Consecutive patients with inflammatory bowel disease were included. Clinical activity was evaluated according to the Harvey-Bradshaw index in Crohn's disease and to the partial Mayo score in ulcerative colitis. Serum concentrations of the different biomarkers were analysed. Concordance between clinical activity and elevation of the serological biomarkers was determined using the kappa statistic. RESULTS: In total, 350 patients were included (median age 46 years, Crohn's disease 59%). Eleven percent of patients had clinical activity. Crohn's disease patients had mild clinical activity in 44% of cases, moderate disease in 44% and only 12% of patients had severe clinical activity. In ulcerative colitis, patients had mild, moderate and severe clinical activity in 50, 42 and 8% of cases, respectively. None of the biomarkers included had an acceptable concordance with clinical activity (kappa statistic ≤ 0.30). CONCLUSIONS: Concordance between serological biomarkers and clinical activity in inflammatory bowel disease is remarkably low.