Endoscopic ultrasound-guided resolution of right hydronephrosis secondary to local compression by an inflammatory pancreatic mass.

We present the case of 67 years-old man with unremarkable medical history. He was admitted to our department for abdominal pain compatible with choledocholithiasis associated with acute cholecystitis. ERCP was performed but direct papillary canulation attempts failed by means of conventional sphincterotome. So, pre- cut papillotomy was successfully attempted getting free access to distal choledochus and retrieving a small lithiasis. Unfortunately, the patient developed severe post-ERCP acute pancreatitis.

Nakamura polyp, an extraordinarily rare finding.

The inflammatory myoglandular or Nakamura polyp is a very rare polyp, with about 100 cases having been described in the literature. It has specific endoscopic and histological characteristics, making its knowledge of it very important for its proper diagnosis. Its differential diagnosis with other types of polyps is of vital importance, both histologically and with respect to its endoscopic follow-up. We present the clinical case of a Nakamura polyp as an incidental finding in a screening colonoscopy.

Biliary obstruction secondary to duodenal follicular lymphoma with papillary involvement.

Duodenal-type follicular lymphoma is a clinical variant of follicular lymphoma located in the intestine, presenting as multiple small polyps. The estimated frequency is 1/7000 people and extraduodenal involvement is rare. It predominantly affects middle-aged women, although some cases of young patients have been published in the literature. They are usually located in the second periampullary portion of the duodenum. It is diagnosed incidentally or after performing an imaging test due to non-specific digestive symptoms (abdominalgia, diarrhea or hyporexia). The prognosis is usually favorable without specific treatment5.

Cecal ameboma and a liver abscess mimicking metastatic colonic cancer. An autochthonous infectious disease in Spain?

We present the case of 52 years-old male without any recent travel. He was admitted to our department for a history of fever and abdominal pain. A CT scan showed a cecal thickening and liver mass with suspected cecal carcinoma with infected necrotic liver metastasis. Although the colonoscopy revealed a bulky submucosal wall thickening with a fibrined ulcer with yellow granulating located in the cecum, the percutaneous drainage revealed a positive PCR for Entamoeba histolytica, with improvement with metronidazole treatment. Ameboma are ulcerative, exophytic, inflammatory masses up to 15 cm in diameter in patients with long standing colonic amoebic infections containing granulation tissue with pseudotumor appearance. It affects less than 1.5% of colonic invasive amebiasis. Moreover, concomitant hepatic amoebic can be observed up to 30%, mimicking colonic cancer with necrotic liver metastasis. Although no epidemiological risk factor for amoebic infection was detected. We therefore highlight the awareness of amoebic infection and different manifestation even in non-endemic areas.

Esophageal hyperkeratosis as an uncommon manifestation of gastroesophageal reflux disease.

We present the case of a 66-year-old woman with intermittent dysphagia and esophageal food impaction. The endoscopic examination showed an upper and middle esophagus with a diffuse circumferential, white, crackleware epithelium. Esophageal biopsies revealed acanthosis and papillomatosis with diffuse hyperkeratosis. High dose of Proton pump inhibitors was initiated with improvement of all symptoms 6 weeks later.

Subcutaneous infliximab cut-off points in patients with inflammatory bowel disease. Data from the ENEIDA registry.

BACKGROUND AND AIMS: Switching from the intravenous to the subcutaneous biosimilar infliximab (SC-IFX) has been shown to safely maintain clinical remission and increase drug levels in patients with Crohn's disease (CD) and ulcerative colitis (UC). The aim of this study was to evaluate long-term outcomes after switching from intravenous IFX (IV-IFX) to SC-IFX, the drug concentration thresholds for maintaining remission and other predictors for loss of response after the switch. METHODS: Multicenter observational study involving CD and UC patients who were in clinical remission for at least 24 weeks and scheduled to switch from IV-IFX to SC-IFX. RESULTS: Two hundred and twenty patients were included [74 UC (34%) and 146 (66%) CD]. IV-IFX was administered for 52.5 months [range 25-89]. Pre-switch, 106 (49%) patients were receiving intensified IV-IFX. While SC-IFX levels significantly increased following the switch from IV to SC-IFX, clinical parameters, C-reactive protein and faecal calprotectin remained unchanged during follow-up. SC-IFX levels were significantly higher between patients receiving the standard IV-IFX dose than those with the intensified dose. Immunomodulator therapy at baseline and perianal disease had no effect on IFX trough levels, whereas higher body mass index was associated with increased levels. The suggested optimal SC-IFX cut-off concentration for clinical and biochemical remission based on ROC analysis was 12.2 µg/mL (AUC: 0.62) at week 12 and 13.2 µg/mL (AUC: 0.57) at week 52. Drug persistence was 92% at week 52, with a good safety profile. CONCLUSION: Switching from IV-IFX to SC-IFX safely maintains long-term remission in patients with CD and UC. In maintenance, the optimal cut-off point associated with remission was 12-13 µg/mL.

The impact of obesity on postoperative complications and short-term survival after liver transplantation.

BACKGROUND AND AIMS: Obesity is considered a risk factor for perioperative complications, but its effect on patients undergoing liver transplantation (LT) remains unclear. This study was conducted to analyze the impact of obesity on early morbidity and mortality risk following LT. METHODS: A multicenter study of outcomes in patients submitted to LT between 2009 and 2019 was conducted. Recipients were stratified into obese (BMI ≥ 30 kg/m2) and nonobese patients (BMI < 30 kg/m2). Early postoperative complications were compared and 30-day and 1-year patient and graft survival were assessed by Kaplan-Meier method. Primary graft nonfunction (PGNF) was defined as the presence of total bilirubin > 10 mg/dl, INR > 1.6 or ALT > 2000 U/l within the first week after LT. RESULTS: A total of 1608 patients were included after applying exclusion criteria, nonobese (1149, 71.46%) and obese patients (459, 28.54%). There were no significant differences in age, sex, Model for End-stage Liver Disease, Charlson comorbidity score, ethnicity, waiting list time and ischemia time. There were significantly higher rates of vascular (17.58% vs 23.53%, P = 0.021) and biliary complications (27.68% vs 35.73%, P = 0.006) and PGNF (11.40% vs 12.20%, P = 0.021) in obese patients. There was a significantly increased risk for long-term graft failure; however, there was no significant difference in patient survival after LT. CONCLUSION: Obese patients have significantly increased morbidity in terms of vascular and biliary complications and PGNF after LT. They have a higher risk for worse 1-year graft survival in comparison to controls.

Postreperfusion Biopsy as a Predictor of Biliary Complication After Deceased Donor Liver Transplantation. A Retrospective Cohort Study.

BACKGROUND: Ischemia reperfusion injury (IRI) on postreperfusion biopsies is associated with worse outcomes after liver transplantation, although the influence on biliary complications (BC) remains poorly studied. Therefore, the primary aim of our study was to assess the influence of IRI on the incidence of BC. A secondary aim was to assess the influence of steatosis on biliary complications and determine factors that predictor BC. METHODS: We report a retrospective cohort study including patients with liver transplantation and postreperfusion injury. Biopsies were classified as relevant and nonrelevant ischemia reperfusion injury for assessment of BC. BC included anastomotic stricture, ischemic cholangiopathy, leaks, and bilomas. Independent predictive factors of biliary complications were assessed using univariate and multivariate analyses. RESULTS: 302 patients were included, and 125 patients fulfilled the criteria for relevant IRI (41.4%). Worse IRI was not associated with biliary complications (42.5% vs 40.1%; P = .68), nor was liver graft steatosis associated with BC (40.5% vs 41.5%, P = .95). The median time until biliary complications did not differ between the 2 groups (2 months; interquartile range = 1-15 vs 3 months; interquartile range = 1-12.5; P = .18). Hepatic artery thrombosis (odds ratio [OR] = 3.4; 95% confidence interval [CI], 1.4-8.2; P = .004), older donor age (OR = 2.1; 95% CI, 1.1-4.1; P = .024), and prolonged cold ischemia time (OR = 1.9; 95% CI, 1.1-3.2) were independent factors of biliary complications. CONCLUSION: Severe IRI on the postreperfusion injury does not predict development of biliary complications.

Pólipo de Nakamura, un hallazgo extraordinariamente infrecuente / Nakamura polyp, an extraordinarily rare finding

El pólipo mioglandular inflamatorio o de Nakamura es un pólipo muy infrecuente, habiendose descrito en la literatura unos 100 casos. Posee unas características tanto endoscópicas como histológicas específicas, cobrando gran importancia su conocimiento para su diagnóstico adecuado. Es de vital importancia su diagnóstico diferencial con otro tipo de pólipos tanto histológicamente como respecto a su seguimiento endoscópico. Presentamos el caso clínico de un pólipo de Nakamura como hallazgo incidental en una colonoscopia de cribado.(AU)