Current management of bowel failure due to Crohn's disease in Spain: Results of a GETECCU survey. / Manejo actual del fracaso intestinal por enfermedad de Crohn en nuestro medio: resultados de una encuesta GETECCU.

INTRODUCTION: Intestinal failure is a rare pathology which requires knowledge and highly specialized multidisciplinary management. Crohn's disease (CD) being one of the most frequent causes in adults. MATERIAL AND METHODS: Survey format study carried out within the GETECCU group, included closed format questions about the diagnosis, management and current knowledge of intestinal failure in CD. RESULTS: Forty-nine doctors participated, belonging to different Spanish centers (19 cities). It was considered that a patient suffered from intestinal failure, in 67.3% (33/49 surveyed) when there was a disorder malabsorptive associated regardless of the intestinal length resected, with surgeries resective ileal repeated (40.8%, 20/49), the most frequent cause. It highlights frequent ignorance about the pathology (24.5%) did not know if there were patients in their center and also 40% did not know the pharmacological treatment. A total of 228 patients were registered for follow-up due to intestinal failure of any aetiology, 89 patients (39.5%) were identified with CD. Regarding the therapeutic management of patients with CD and intestinal failure (72.5%) were receiving total parenteral nutrition (NTP) and 24 patients (27%) with teduglutide. Regarding the response to the drug: 37.5% had no response to teduglutide, 37.5% partial response (reduce NTP) and 25% good response (withdrawal of home NTP). In questions related to knowledge about intestinal failure, it was considered limited (53.1%) or very limited (12.2%) by the surveyed. CONCLUSION: It is necessary to carry out a combined management of intestinal failure and CD in the context of a multidisciplinary approach.

Radio induced cancer risk during ERCP. Is it a real clinical problem?

BACKGROUND: in recent years many factors have been shown to influence dose received by the patient during ERCP. Therefore it is necessary to update radio induced cancer risk. OBJECTIVES: to calculate lifetime attributable risk of cancer during ERCP. To compare the risk with the most common X-ray examinations. DESIGN: descriptive study with 393 consecutive ERCP performed at one center. Equipment used was Philips BV pulsera. In each exploration demographic and anthropometric variables of the patient were collected. Dosimetric quantities were calculated from exposure parameters. Effective dose was estimated using specific conversion factors. Organ doses and radio induced cancer incidence was estimated. RESULTS: dose area product was 0.82 mGym2(IQR 0.4-1.5) with an average fluoroscopy time of 2 minutes and 45 seconds. Entrance surface dose was 30.7 mGy (IQR 15-60.8) and effective dose was 0.44 mSv (IQR 0.2-0.9). Multivariate analysis identified that difficult papillary cannulation (ß 0.4; p = 0.009), patient age (ß-0.01; p = 0.001) and therapeutic applied (ß= 0.89; p < 0.001) influenced dose-area product. The ERCP dose would be equivalent to the radiation received by twenty chest radiographs and would be about fourteen times smaller than a barium enema or twenty times less than that received during an abdominal CT. Life-time attributable risk of cancer incidence was 4.08 and 16.81 per million procedures in diagnostic and therapeutic ERCP respectively. CONCLUSIONS: from the radiological point of view, ERCP is a safe technique that uses low exposure levels compared to other explorations commonly used in medicine. It implies a reasonably low risk of radio induced cancer.

[Esophageal perforation following a biopsy in a patient with eosinophilic esophagitis]. / Perforación esofágica tras biopsia en paciente con esofagitis eosinofílica.

Eosinophilic esophagitis is an underdiagnosed disease that should be suspected in all patients with dysphagia and food impaction. Although these are the leading symptoms, the clinical and endoscopic spectrum is highly varied. Clinicians should be aware of the risk of endoscopy-related complications in this disorder. Precautions should be maximized in endoscopic examinations to avoid iatrogenic damage. We describe the case of a young patient with esophageal stricture and dysphagia who suffered a perforation following a biopsy.

[Early evaluation of anaemia in patients with acute gastrointestinal bleeding: venous blood gas analysis compared to conventional laboratory]. / Valoración precoz de la anemia en el paciente con hemorragia digestiva aguda: concordancia entre gasometría venosa y laboratorio convencional.

BACKGROUND AND OBJECTIVE: Evaluation of patients with acute gastrointestinal bleeding (AGB) requires early clinical evaluation and analysis. The aim of this study is to evaluate early concordance of hemoglobin (Hb) and hematocrit (HTC) levels determined by conventional venous blood gas analysis (VBG) and by conventional Laboratory in Emergencies (LAB). PATIENTS AND METHODS: Observational and prospective study of patients admitted in the Gastrointestinal Haemorrhage Unit with both high and low AGB. Demographic and clinical variables and simultaneous venous blood samples were obtained to determine Hb and HTC by VBG and LAB. Concordance in both methods was analysed by intra-class correlation coefficient (ICC) and Bland-Altman analysis. RESULTS: One hundred and thirty-two patients were included: 87 (65.9%) males, average age 66.8 years. VBG overestimated Hb in 0.49 g/dl (95% confidence interval: 0.21-0.76) with respect to LAB. Concordance was very high in Hb (ICC 0.931) and high in HTC (0.899), with the Bland-Altman graphs showing both concordance and overestimation of Hb levels determined by VBG. In 19 patients (14.39%), Hb by VBG exceeded in more than 1g/dL the final determination obtained by LAB. CONCLUSIONS: Early determination of Hb and HTC in patients with AGB by VBG provides reliable results in the initial evaluation of anaemia. VBG systematically overestimates Hb values by less than 0.5 g/dl, and therefore clinical and hemodynamic evaluation of the bleeding patient should prevail over analytical results.

Radio induced cancer risk during ERCP. Is it a real clinical problem? / Riesgo de cáncer por irradiación durante ERCP. ¿Es un problema clínico real?

Background: in recent years many factors have been shown to influence dose received by the patient during ERCP. Therefore it is necessary to update radio induced cancer risk. Objectives: to calculate lifetime attributable risk of cancer during ERCP. To compare the risk with the most common X-ray examinations. Design: descriptive study with 393 consecutive ERCP performed at one center. Equipment used was Philips BV pulsera. In each exploration demographic and anthropometric variables of the patient were collected. Dosimetric quantities were calculated from exposure parameters. Effective dose was estimated using specific conversion factors. Organ doses and radio induced cancer incidence was estimated. Results: dose area product was 0.82 mGym2 (IQR 0.4-1.5) with an average fluoroscopy time of 2 minutes and 45 seconds. Entrance surface dose was 30.7 mGy (IQR 15-60.8) and effective dose was 0.44 mSv (IQR 0.2-0.9). Multivariate analysis identified that difficult papillary cannulation (β0.4; p = 0.009), patient age (β-0.01; p = 0.001) and therapeutic applied (β= 0.89; p < 0.001) influenced dose-area product. The ERCP dose would be equivalent to the radiation received by twenty chest radiographs and would be about fourteen times smaller than a barium enema or twenty times less than that received during an abdominal CT. Lifetime attributable risk of cancer incidence was 4.08 and 16.81 per million procedures in diagnostic and therapeutic ERCP respectively. Conclusions: from the radiological point of view, ERCP is a safe technique that uses low exposure levels compared to other explorations commonly used in medicine. It implies a reasonably low risk of radio induced cancer (AU)

Valoración precoz de la anemia en el paciente con hemorragia digestiva aguda: concordancia entre gasometría venosa y laboratorio convencional / Early evaluation of anaemia in patients with acute gastrointestinal bleeding: venous blood gas analysis compared to conventional laboratory

Fundamento y objetivo: La valoración del paciente con hemorragia digestiva (HD) aguda requiere de una evaluación clínica y analítica precoz. El objetivo de este estudio es valorar la concordancia de la determinación de hemoglobina (Hb) y hematocrito (HTC) precozmente mediante gasometría venosa (GSV) y de forma convencional por el Laboratorio (LAB) de Urgencias. Pacientes y método: Estudio observacional y prospectivo de pacientes ingresados en la Unidad de Hemorragias Digestivas por HD aguda alta y baja. Se recogieron variables demográficas, clínicas y muestras de sangre venosa simultáneas para la determinación de Hb y HTC por GSV y LAB. Se analizó la concordancia de ambos métodos mediante el coeficiente de correlación intraclase (CCI) y el análisis de Bland-Altman. Resultados: Se incluyeron 132 pacientes. Un total de 87 (65,9%) eran varones y la edad media fue de 66,8 años. La GSV sobreestimó la Hb en 0,49 g/dl (intervalo de confianza del 95% 0,21-0,76) respecto al LAB. La concordancia fue muy buena en la Hb (CCI 0,931) y buena en el HTC (CCI 0,899), mostrando las gráficas de Bland-Altman tanto la concordancia como la sobreestimación de la determinación de la Hb por GSV. En 19 pacientes (14,39%) la Hb por GSV superó en más de 1 g/dl la determinación final obtenida por LAB. Conclusiones: La determinación precoz de Hb y HTC en pacientes con HD aguda mediante GSV resulta fiable en la valoración inicial de la anemia. La GSV sobreestima sistemáticamente el valor de Hb en al menos 0,5 g/dl, por lo que la evaluación clínica y hemodinámica del sangrante debe prevalecer sobre el resultado analítico (AU)

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Perforación esofágica tras biopsia en paciente con esofagitis eosinofílica / Esophageal perforation following a biopsy in a patient with eosinophilic esophagitis

La esofagitis eosinofílica (EE) es una enfermedad infradiagnosticada que hay que sospechar ante todo paciente con disfagia e impactación alimentaria. Aunque estos son los síntomas guía, el espectro clínico y endoscópico es muy variable. Es obligatorio tomar conciencia sobre las posibles complicaciones derivadas de las maniobras diagnósticas y terapéuticas en la EE. Un manejo cuidadoso de los procedimientos endoscópicos conseguirá extremar las precauciones necesarias para evitar iatrogenia. Presentamos el caso de un varón joven con disfagia y estenosis esofágica que en el curso de su diagnóstico sufre como complicación una perforación esofágica (AU)

Eosinophilic esophagitis is an underdiagnosed disease that should be suspected in all patients with dysphagia and food impaction. Although these are the leading symptoms, the clinical and endoscopic spectrum is highly varied. Clinicians should be aware of the risk of endoscopy-related complications in this disorder. Precautions should be maximized in endoscopic examinations to avoid iatrogenic damage. We describe the case of a young patient with esophageal stricture and dysphagia who suffered a perforation following a biopsy (AU)