RESUMO
The increasing number of endoscopic explorations help recognize rare lesions of the gastrointestinal tract, such as lymphangiomas, rare benign vascular tumours in adults. Patients with lymphangioma are generally asymptomatic but if complications arise, the approach is endoscopic or surgical. Endoscopic ultrasound aids in distinguishing this tumour from other subepithelial lesions. We present the case of a patient who underwent upper endoscopy and endoscopic ultrasound with findings of two duodenal lymphangiomas.
RESUMO
INTRODUCTION: Endoscopic vacuum therapy (EVT) is a novel technique for closing upper gastrointestinal (UGI) defects. Available literature includes single-center retrospective cohort studies with small sample sizes. Furthermore, evidence about factors associated with EVT failure is scarce. We aimed to assess the efficacy and safety of EVT for the resolution of UGI defects in a multicenter study and to investigate the factors associated with EVT failure and in-hospital mortality. METHODS: This is a prospective cohort study in which consecutive EVT procedures for the treatment of UGI defects from 19 Spanish hospitals were recorded in the national registry between November 2018 and March 2022. RESULTS: We included 102 patients: 89 with anastomotic leaks and 13 with perforations. Closure of the defect was achieved in 84 cases (82%). A total of 6 patients (5.9%) had adverse events related to the EVT. The in-hospital mortality rate was 12.7%. A total of 6 patients (5.9%) died because of EVT failure and 1 case (0.9%) due to a fatal adverse event. Time from diagnosis of the defect to initiation of EVT was the only independent predictor for EVT failure (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05, P = 0.005). EVT failure (OR 24.5, 95% CI 4.5-133, P = 0.001) and development of pneumonia after EVT (OR 246.97, 95% CI 11.15-5,472.58, P = 0.0001) were independent predictors of in-hospital mortality. DISCUSSION: EVT is safe and effective in cases of anastomotic leak and perforations of the upper digestive tract. The early use of EVT improves the efficacy of this technique.
Assuntos
Tratamento de Ferimentos com Pressão Negativa , Trato Gastrointestinal Superior , Humanos , Estudos Retrospectivos , Estudos Prospectivos , Tratamento de Ferimentos com Pressão Negativa/efeitos adversos , Tratamento de Ferimentos com Pressão Negativa/métodos , Trato Gastrointestinal Superior/cirurgia , Fístula Anastomótica/cirurgia , Fístula Anastomótica/etiologia , Sistema de Registros , Resultado do TratamentoRESUMO
BACKGROUND AND AIMS: Initial reports suggest that fully covered self-expandable metal stents (FCSEMSs) may be better suited for drainage of dense pancreatic fluid collections (PFCs), such as walled-off pancreatic necrosis. The primary aim was to analyze the effectiveness and safety of FCSEMSs for drainage of different types of PFCs in a large cohort. The secondary aim was to investigate which type of FCSEMS is superior. METHODS: This was a retrospective, noncomparative review of a nationwide database involving all hospitals in Spain performing EUS-guided PFC drainage. From April 2008 to August 2013, all patients undergoing PFC drainage with an FCSEMS were included in a database. The main outcome measurements were technical success, short-term (2 weeks) and long-term (6 months) effectiveness, adverse events, and need for surgery. RESULTS: The study included 211 patients (pseudocyst/walled-off pancreatic necrosis, 53%/47%). The FCSEMSs used were straight biliary (66%) or lumen-apposing (34%). Technical success was achieved in 97% of patients (95% confidence interval [CI], 93%-99%). Short-term- and long-term clinical success was obtained in 94% (95% CI, 89%-97%) and 85% (95% CI, 79%-89%) of patients, respectively. Adverse events occurred in 21% of patients (95% CI, 16%-27%): infection (11%), bleeding (7%), and stent migration and/or perforation (3%). By multivariate analysis, patient age (>58 years) and previous failed drainage were the most important factors associated with negative outcome. CONCLUSIONS: An FCSEMS is effective and safe for PFC drainage. Older patients with a history of unsuccessful drainage are more likely to fail EUS-guided drainage. The type of FCSEMS does not seem to influence patient outcome.
Assuntos
Drenagem/instrumentação , Pâncreas/cirurgia , Pseudocisto Pancreático/cirurgia , Sistema de Registros , Stents Metálicos Autoexpansíveis , Idoso , Bases de Dados Factuais , Procedimentos Cirúrgicos do Sistema Digestório/instrumentação , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Drenagem/métodos , Endossonografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Necrose , Pâncreas/patologia , Estudos Retrospectivos , Fatores de Risco , Espanha , Cirurgia Assistida por Computador/instrumentação , Cirurgia Assistida por Computador/métodos , Resultado do TratamentoRESUMO
Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) have much in common, including their main indications (biliopancreatic disorders), powerful therapeutic capacities and a steep learning curve. Over the years they have evolved from novel diagnostic procedures to interventional therapeutic techniques, but along different paths (different scopes or devices and endoscopists specializing exclusively in one or the other technique). However, EUS has gradually developed into a therapeutic technique that requires skills in the use of ERCP devices and stents, leading some ERCP specialists to explore the therapeutic potential of EUS. The corresponding literature, which has grown exponentially, includes recent experiments on combining the two techniques, which have gradually come to be used in routine care in a number of centers, with positive technical, clinical and financial outcomes. We review EUS and ERCP as individual or combined procedures for managing biliopancreatic disorders.
Assuntos
Doenças Biliares/diagnóstico por imagem , Colangiopancreatografia Retrógrada Endoscópica/métodos , Endossonografia/métodos , Imagem Multimodal/métodos , Pancreatopatias/diagnóstico por imagem , Doenças Biliares/patologia , Doenças Biliares/cirurgia , Biópsia por Agulha Fina/métodos , Drenagem , Previsões , Humanos , Curva de Aprendizado , Pancreatopatias/patologia , Pancreatopatias/cirurgia , Estudos Retrospectivos , Ultrassonografia de Intervenção/métodosRESUMO
BACKGROUND: EUS-guided cholangiopancreatography (ESCP) allows transmural access to biliopancreatic ducts when ERCP fails. Data regarding technical details, safety, and outcomes of ESCP are still unknown. OBJECTIVE: To evaluate outcomes of ESCP in community and referral centers at the initial development phase of this procedure, to identify the ESCP stages with higher risk of failure, and to evaluate the influence on outcomes of factors related to the endoscopist. DESIGN: Multicenter retrospective study. SETTING: Public health system hospitals with experience in ESCP in Spain. PATIENTS: A total of 125 patients underwent ESCP in 19 hospitals, with an experience of <20 procedures. INTERVENTION: ESCP. MAIN OUTCOME MEASUREMENTS: Technical success and complication rates in the initial phase of implantation of ESCP are described. The influence of technical characteristics and endoscopist features on outcomes was analyzed. RESULTS: A total of 125 patients from 19 hospitals were included. Biliary ESCP was performed in 106 patients and pancreatic ESCP was performed in 19. Technical success was achieved in 84 patients (67.2%) followed by clinical success in 79 (63.2%). Complications occurred in 29 patients (23.2%). Unsuccessful manipulation of the guidewire was responsible for 68.2% of technical failures, and 58.6% of complications were related to problems with the transmural fistula. LIMITATIONS: Retrospective study. CONCLUSION: Outcomes of ESCP during its implantation stage reached a technical success rate of 67.2%, with a complication rate of 23.2%. Intraductal manipulation of the guidewire seems to be the most difficult stage of the procedure.
Assuntos
Doenças Biliares/terapia , Colangiografia/métodos , Drenagem/métodos , Endoscopia do Sistema Digestório/métodos , Endossonografia , Pancreatopatias/terapia , Ultrassonografia de Intervenção , Idoso , Idoso de 80 Anos ou mais , Doenças Biliares/diagnóstico por imagem , Drenagem/instrumentação , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pancreatopatias/diagnóstico por imagem , Ductos Pancreáticos/diagnóstico por imagem , Estudos Retrospectivos , Espanha , Stents , Resultado do TratamentoRESUMO
OBJECTIVES: To determine the diagnostic value of free perigastric fluid identified by echoendoscopy in patients with gastric cancer and to establish the factors related to the presence of peritoneal carcinomatosis in these patients. MATERIAL AND METHODS: We retrospectively included 100 patients with a histological diagnosis of gastric adenocarcinoma referred for echoendoscopy. A positive result was defined as the echoendoscopic identification of free perigastric fluid. This result was compared with the final study based on exploratory laparoscopy-laparotomy. The histological and endoscopic characteristics were compared with the final result. RESULTS: Free perigastric fluid was found in 21 patients (21%). Among these, 15 (71%) showed peritoneal carcinomatosis, confirmed by laparoscopy (12 patients) or echoendoscopy-guided fine-needle-aspiration biopsy (three patients). In seven of the 79 patients (8%) not showing the presence of ascites, peritoneal implants were identified by exploratory laparoscopy-laparotomy. The sensitivity, specificity, positive predictive value and diagnostic accuracy of free fluid in the diagnosis of carcinomatosis was 68%, 92%, 71%, 91% and 87%, respectively. No histologic or endoscopic factors related to the malignancy of echoendoscopically-detected fluid were identified. CONCLUSION: In patients with gastric cancer, free perigastric fluid identified by echoendoscopy is an important predictive factor of peritoneal carcinomatosis and may have significant implications in the management of these patients.
Assuntos
Líquido Ascítico/diagnóstico por imagem , Carcinoma/diagnóstico por imagem , Endossonografia , Neoplasias Peritoneais/secundário , Neoplasias Gástricas/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Ascite/etiologia , Ascite/fisiopatologia , Líquido Ascítico/citologia , Biópsia por Agulha Fina/métodos , Carcinoma/complicações , Carcinoma/fisiopatologia , Carcinoma/cirurgia , Feminino , Humanos , Laparoscopia , Laparotomia , Masculino , Pessoa de Meia-Idade , Neoplasias Peritoneais/complicações , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/fisiopatologia , Neoplasias Peritoneais/cirurgia , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia , Ultrassonografia de IntervençãoRESUMO
Linitis plastica of the rectum consists of intraparietal, subepithelial and circumferential tumoral infiltration of the wall of the rectum leading to a constricted rectum with mural thickening. There is often a delay between symptom onset and diagnosis because this entity mimics a large number of diseases and the findings of endoscopy and conventional biopsies are non-conclusive since the surface mucosa is not usually affected. We present the endoscopic and echoendoscopic findings of two patients with secondary linitis plastica of the rectum.
Assuntos
Carcinoma de Células em Anel de Sinete/secundário , Linite Plástica/secundário , Neoplasias Retais/secundário , Neoplasias Gástricas/patologia , Idoso , Biópsia por Agulha Fina , Carcinoma de Células em Anel de Sinete/diagnóstico , Constipação Intestinal/etiologia , Constrição Patológica , Diagnóstico Tardio , Evolução Fatal , Feminino , Humanos , Obstrução Intestinal/etiologia , Linite Plástica/diagnóstico por imagem , Linite Plástica/etiologia , Masculino , Neoplasias Peritoneais/secundário , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/etiologia , Reto/patologia , Ultrassonografia , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgiaRESUMO
Pancreatic metastases represent 2% of pancreatic tumors. The neoplasms most frequently metastasizing to the pancreas are breast, lung, melanoma and kidney tumors. We present the cases of two patients with pancreatic metastases from renal carcinoma diagnosed 4 and 8 years after the diagnosis and surgical treatment of the primary renal tumor. In both patients, endoscopic ultrasound was useful in the detection and characterization of these pancreatic lesions and allowed fine-needle aspiration for cytological study to be performed.
Assuntos
Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/secundário , Endossonografia , Neoplasias Renais , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/secundário , Biópsia por Agulha , Carcinoma de Células Renais/patologia , Feminino , Humanos , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia , Pâncreas/patologia , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia , Radiografia Abdominal , Radiografia Torácica , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
Cystic dystrophy of the duodenal wall is an uncommon complication of aberrant pancreas characterized by increased duodenal wall thickness associated with intraparietal cystic lesions. We present the case of a male patient with cystic dystrophy of the duodenal wall, which posed major diagnostic problems due to the difficulty of distinguishing this entity from tumors of the head of the pancreas. Echoendoscopy was useful in establishing the definitive diagnosis, allowing puncture-evacuation of the intracystic contents with resolution of obstructive symptoms.
Assuntos
Coristoma/diagnóstico , Cistos/diagnóstico , Duodenopatias/diagnóstico , Pâncreas , Adulto , Diagnóstico Diferencial , Duodenoscopia , Endossonografia , Humanos , Masculino , Neoplasias Pancreáticas/diagnósticoRESUMO
We report the case of a 74-year-old woman with elevated liver enzyme levels in whom abdominal sonographic examination revealed a diffusely heterogeneous liver parenchyma and multiple hypoechoic subcentimetric splenic nodules. Contrast-enhanced sonography (CEUS) revealed that the splenic focal lesions did not enhance. CT examination revealed a low-density, multinodular pattern both in the liver and in the spleen. Core biopsy of 1 hepatic nodule revealed noncaseating epithelioid cell granuloma, and the patient was diagnosed with systemic sarcoidosis. CEUS has shown to be useful in the diagnosis of focal hepatic lesions, but studies referring to splenic lesions are lacking.