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INTRODUCTION: In patients who have undergone partial gastric resections, the difficulty of performing endoscopic retrograde cholangiopancreatography (ERCP) is increased due to the resulting anatomic abnormality. AIM: To review our experience of ERCP in patients with Billroth II gastrectomy and other types of gastrectomy (Billroth I and indeterminate) in our center. MATERIAL AND METHODS: We included all patients with Billroth II gastrectomy or other types of gastrectomy undergoing ERCP in a 19-year period. RESULTS: We included 233 patients (91% men and 9% women) from 1993 to 2012. A total of 88.4% of the patients had undergone Billroth II and 11.6% had undergone other types of gastrectomy, with an ERCP success rate of 51.9% and 55.6%, respectively. The most common causes of failure were inability to cannulate (44%) and failure to identify the papilla (39.6%). The final diagnosis was choledocholithiasis in 31.8%. The mean number of sessions was 1.09. The complications rate was 2.6%. CONCLUSIONS: The success of ERCP is influenced by the technical difficulty. For this reason, the success rate in our center was slightly over 50%, but with few complications.
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Colangiopancreatografia Retrógrada Endoscópica , Gastrectomía , Estómago/patología , Estómago/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Colangiopancreatografia Retrógrada Endoscópica/métodos , Femenino , Gastrectomía/métodos , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
INTRODUCTION: Pneumatic dilation and surgical myotomy are currently the procedures of choice to treat achalasia. The selection of one or other treatment depends on the experience of each center and patient preferences. BACKGROUND AND AIMS: To review the experience of pneumatic dilation in patients with achalasia in our center. MATERIAL AND METHODS: We included all patients with a clinical, endoscopic and manometric diagnosis compatible with achalasia who underwent pneumatic dilation in a 19-year period. All dilations were routinely performed with a Rigiflex(®) balloon, usually at pressures of 250, 250 and 300mm Hg in three inflations of one minute, each separated by one minute. The success of the dilation was assessed on the basis of the patient's symptoms, the number of sessions, the need for surgery, and the presence of complications. RESULTS: A total of 171 patients were included, 53.2% men and 46.8% women, with a mean age of 51.53±17.78 years (16-87 years), from June 1993 to October 2012. A 35-mm balloon was used in 157 patients, a 30-mm balloon in 9 patients and a 40-mm balloon in 7 patients. A single dilation session was required in 108 patients, two sessions were required in 56 patients, with a mean time between the first and second sessions of 25.23±43.25 months (1-215 months), and 3 sessions were required in 7 patients with a mean time between the second and third sessions of 6.86±5.33 months (1-15 months). Outcome after dilation was successful in 81% of the patients. Of the 140 responders, 121 had complete response (complete disappearance of symptoms without recurrence) and 19 partial response (initial disappearance of symptoms with subsequent reappearance). Surgery (Heller myotomy) was required in 15.8% of the patients. Perforation occurred in 4 of the 171 patients as a complication of the technique; these perforations were satisfactorily resolved, two by conservative treatment and two by surgery. There was no mortality associated with the technique or its complications. CONCLUSIONS: In our series, pneumatic dilation had a high success rate. In most patients, a single session was required and the complications rate was low. These results show that this technique is safe and effective in these patients, avoiding a large number of surgical interventions.
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Acalasia del Esófago/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Dilatación/instrumentación , Dilatación/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
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.
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Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Neoplasias Inducidas por Radiación/etiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios Transversales , Relación Dosis-Respuesta en la Radiación , Femenino , Fluoroscopía/efectos adversos , Humanos , Incidencia , Modelos Lineales , Masculino , Persona de Mediana Edad , Neoplasias Inducidas por Radiación/epidemiología , Órganos en Riesgo/efectos de la radiación , Dosificación Radioterapéutica , RiesgoRESUMEN
BACKGROUND AND OBJECTIVES: Before starting programs for colorectal cancer screening it is necessary to evaluate the quality of colonoscopy. Our objectives were to develop a group of quality indicators of colonoscopy easily applicable and to determine the variability of their achievement. PATIENTS AND METHODS: After reviewing the bibliography we prepared 21 potential indicators of quality that were submitted to a process of selection in which we measured their facial validity, content validity, reliability and viability of their measurement. We estimated the variability of their achievement by means of the coefficient of variability (CV) and the variability of the achievement of the standards by means of chi(2). RESULTS: Six indicators overcome the selection process: informed consent, medication administered, completed colonoscopy, complications, every polyp removed and recovered, and adenoma detection rate in patients older than 50 years. 1928 colonoscopies were included from eight endoscopy units. Every unit included the same number of colonoscopies selected by means of simple random sampling with substitution. There was an important variability in the achievement of some indicators and standards: medication administered (CV 43%, p<0.01), complications registered (CV 37%, p<0.01), every polyp removed and recovered (CV 12%, p<0.01) and adenoma detection rate in older than fifty years (CV 2%, p<0.01). CONCLUSIONS: We have validated six quality indicators for colonoscopy which are easily measurable. An important variability exists in the achievement of some indicators and standards. Our data highlight the importance of the development of continuous quality improvement programmes for colonoscopy before starting colorectal cancer screening.
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Colonoscopía/normas , Indicadores de Calidad de la Atención de Salud , Humanos , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: There is scant information on the use of endoscopic retrograde cholangiopancreatography (ERCP) in patients under 18. OBJECTIVE: To analyze our experience in all patients under 18 who underwent ERCP. PATIENTS AND METHODS: We performed a retrospective study of all ERCP conducted in patients under 18 between 1993 and 2006. We analyzed indications, endoscopic and radiologic findings, diagnostic and therapeutic success, and complications. RESULTS: We included 31 patients who underwent 36 ERCP in total. The mean age was 9.89 +/- 5 years old. We used general anesthesia in 58.3% (21 patients), with a mean age of 8 +/- 5 years. The most frequent indications were complications after liver transplantation in 33.3% (12 patients), suspicion of biliary obstruction in 27.7% (10 patients), and pancreatitis in 22.2% (8 patients). We achieved cannulation and repletion in the selected duct in 94.4%. The most frequent pathologic findings were changes in the biliary tract after liver transplantation in 25% (9 patients). The results of ERCP were normal in 10 patients (27.7%). Therapeutic maneuvers were indicated in 17 out of the 34 (50%) examinations considered, achieving therapeutic success in 76.47% (13/17). Complications consisted of hemorrhage after simple sphincterotomy in one patient (2.8%) and mild pancreatitis in two patients (5.6%). CONCLUSIONS: We found ERCP to be a safe procedure with a high diagnostic and therapeutic success rate, and a low rate of early complications.
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Enfermedades de los Conductos Biliares/diagnóstico , Colangiopancreatografia Retrógrada Endoscópica , Enfermedades Pancreáticas/diagnóstico , Adolescente , Factores de Edad , Enfermedades de los Conductos Biliares/terapia , Niño , Preescolar , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Femenino , Humanos , Lactante , Masculino , Enfermedades Pancreáticas/terapia , Estudios RetrospectivosRESUMEN
BACKGROUND: Placement of nasoenteral feeding tubes can require endoscopic support. AIM: To analyze the usefulness of transnasal ultrathin endoscopy in the placement of nasoenteral feeding tubes. PATIENTS AND METHODS: We performed an ambispective study of all patients who underwent nasoenteral feeding (4.9 mm) in 2007. RESULTS: Twenty-six procedures were performed. The mean age of the patients was 69.3+/-13 years. Nasal anesthesia was used in 23 patients (88.4%), and midazolam in 8 (30.8%). No anesthesia was used in 4 patients (15.3%). INDICATIONS: stenotic esophageal lesions (42.3%), distal placement to the pathological alteration (46.1%), and failure of placement through the normal route (11.5%). We placed 13 (50%) nasoduodenal, 7 (29.6%) nasogastric and 6 (23.1%) nasojejunal tubes. The success rate was 100%. The most frequently used calibre was 12 F. There were no complications. CONCLUSIONS: The use of transnasal ultrathin endoscopy in the placement of nasoenteral feeding tubes in our patients was safe, effective and relatively easy.
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Endoscopía , Intubación Gastrointestinal/métodos , Anciano , Endoscopios , Endoscopía/métodos , Diseño de Equipo , Femenino , Humanos , Masculino , Nariz , Estudios Prospectivos , Estudios RetrospectivosRESUMEN
INTRODUCTION AND AIMS: A high quality colonoscopy is key in preventing colorectal cancer, but the risk of colorectal cancer (CRC) exists. The aims of the study were to investigate the incidence, characteristics and predictive factors of post-colonoscopy colorectal cancer (PCCRC). MATERIAL AND METHOD: A retrospective and prospective observational study was designed. A population undergoing colonoscopy between 1-01-1997 and 31-12-2014 was included. We analysed demographic variables, characteristics of the diagnostic colonoscopy of CRC, of the previous ones and the lesions found in them. To compare the PCCRC group versus the CRC group without previous colonoscopy, the Student's t-test and multiple logistic regression were used to determine predictive factors of PCCRC (SPSS® 15). The statistical significance was P<.05. RESULTS: A total of 56,984 colonoscopies, 1,977 CRC and 132 patients (mean 70.8 years old, 56.8% male) with at least one colonoscopy in 10 years before were registered (PCCRC). Seventy and a half percent of the previous colonoscopies were completed and 63.7% had an adequate bowel preparation. Predictive factors of PCCRC were personal history of polyps (OR 35.01; 95% CI 11.1-110.8; P<.001), previous CRC (OR 176.64; 95% CI 51.5-606.1); P<.001), family history of CRC (OR 3.14; 95% CI 1.5-6.4); P=.002) and proximal CRC (OR 3.15; 95% CI 2.1-4.9; P<.001). CONCLUSIONS: PCCRC rate in 10 years was 6.7%. An adequate follow-up and a high-quality colonoscopy could prevent PCCRC, especially in patients with risk factors.
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Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/epidemiología , Colonoscopía , Neoplasias Colorrectales/diagnóstico por imagen , Neoplasias Colorrectales/epidemiología , Adenocarcinoma/prevención & control , Adulto , Cuidados Posteriores , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/prevención & control , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , Factores de Riesgo , España/epidemiologíaAsunto(s)
Pruebas de Coagulación Sanguínea , Colonoscopía , Hemorragia Gastrointestinal/prevención & control , Trastornos Hemorrágicos/diagnóstico , Cuidados Preoperatorios/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anticoagulantes/efectos adversos , Anticoagulantes/uso terapéutico , Pruebas de Coagulación Sanguínea/estadística & datos numéricos , Neoplasias del Colon/diagnóstico , Neoplasias del Colon/prevención & control , Neoplasias del Colon/cirugía , Pólipos del Colon/diagnóstico , Pólipos del Colon/cirugía , Colonoscopía/efectos adversos , Comorbilidad , Femenino , Hemorragia Gastrointestinal/etiología , Trastornos Hemorrágicos/complicaciones , Humanos , Enfermedades Intestinales/diagnóstico , Masculino , Persona de Mediana Edad , Factores de Riesgo , Procedimientos Innecesarios , Adulto JovenRESUMEN
AIM: To evaluate the rate of adverse events (AEs) during consecutive gastric and duodenal polypectomies in several Spanish centers. METHODS: Polypectomies of protruded gastric or duodenal polyps ≥ 5 mm using hot snare were prospectively included. Prophylactic measures of hemorrhage were allowed in predefined cases. AEs were defined and graded according to the lexicon recommended by the American Society for Gastrointestinal Endoscopy. Patients were followed for 48 h, one week and 1 mo after the procedure. RESULTS: 308 patients were included and a single polypectomy was performed in 205. Only 36 (11.7%) were on prior anticoagulant therapy. Mean polyp size was 15 ± 8.9 mm (5-60) and in 294 cases (95.4%) were located in the stomach. Hemorrhage prophylaxis was performed in 219 (71.1%) patients. Nine patients presented AEs (2.9%), and 6 of them were bleeding (n = 6, 1.9%) (in 5 out of 6 AE, different types of endoscopic treatment were performed). Other 24 hemorrhagic episodes could be managed without any change in the outcome of the endoscopy and, consequently, were considered incidents. We did not find any independent risk factor of bleeding. CONCLUSION: Gastroduodenal polypectomy using prophylactic measures has a rate of AEs small enough to consider this procedure a safe and effective method for polyp resection independently of the polyp size and location.
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Enfermedades Duodenales/cirugía , Endoscopía Gastrointestinal/efectos adversos , Microcirugia/efectos adversos , Pólipos/cirugía , Hemorragia Posoperatoria/epidemiología , Gastropatías/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Duodeno/patología , Duodeno/cirugía , Endoscopía Gastrointestinal/métodos , Femenino , Humanos , Incidencia , Masculino , Microcirugia/métodos , Persona de Mediana Edad , Hemorragia Posoperatoria/etiología , Hemorragia Posoperatoria/terapia , Estudios Prospectivos , Factores de Riesgo , España , Estómago/patología , Estómago/cirugía , Adulto JovenRESUMEN
A 31-year-old male was admitted with complaints of dysphagia and odynophagia. An upper gastrointestinal tract series revealed inflammatory changes in the mid and distal oesophagus with intramural extravasation of the barium. An upper endoscopy showed multiple ulcerations and inflammation. The patient developed a large stricture with no response to serial endoscopic dilations and a surgical resection of the oesophagus was required. Gross examination of the surgical specimen revealed transmural inflammation, deep ulcerations and non-necrotizing epithelioid cell granuloma. All these pathological findings were characteristic of Crohn's disease of the oesophagus. After 36 months of follow-up there has been no recurrence of symptoms or of other sites of involvement.
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Enfermedad de Crohn/diagnóstico , Esofagitis/diagnóstico , Adulto , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/cirugía , Trastornos de Deglución/etiología , Estenosis Esofágica/diagnóstico , Esofagitis/cirugía , Estudios de Seguimiento , Humanos , MasculinoRESUMEN
BACKGROUND AND AIMS: An evaluation is made of the utility of fecal calprotectin in predicting relapse in patients with inflammatory bowel disease (IBD). The possible differences in its predictive capacity in Crohn's disease (CD) versus ulcerative colitis (UC), and the different phenotypes, are also examined. METHODS: This is a prospective study with 135 patients diagnosed with IBD in clinical remission for at least 3 months. The patients submitted a stool sample within 24 hours after the baseline visit, for the measurement of fecal calprotectin. All patients were followed-up on for one year. RESULTS: Sixty-six patients had CD and 69 UC. Thirty-nine (30%) suffered from relapse. The fecal calprotectin concentration was higher among the patients with relapse than in those that remained in remission: 444 µg/g (95% CI 34-983) versus 112 µg/g (95% CI 22-996); p<0.01. Patients with CD and calprotectin>200 µg/g relapsed 4 times more often than those with lower marker concentrations. In UC, calprotectin>120 µg/g was associated with a 6-fold increase in the probability of disease activity outbreak. The predictive value was similar in UC and CD with colon involvement and inflammatory pattern. In this group, calprotectin>120 µg/g predicted relapse risk with a sensitivity of 80% and a specificity of 60%. Relapse predictive capacity was lower in patients with ileal disease. CONCLUSIONS: Fecal calprotectin may be a useful marker for predicting relapse in patients with IBD. Its predictive value is greater in UC and CD with colon involvement and inflammatory pattern, compared with ileal CD.
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Colitis Ulcerosa/metabolismo , Enfermedad de Crohn/metabolismo , Heces/química , Complejo de Antígeno L1 de Leucocito/análisis , Adulto , Biomarcadores/análisis , Colitis Ulcerosa/diagnóstico , Enfermedad de Crohn/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fenotipo , Pronóstico , Estudios Prospectivos , Recurrencia , Riesgo , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Biliary diseases represent particular diagnostic and therapeutic problems in elderly patients. METHODS: Patients 90 years of age or older who underwent ERCP from January 1993 to September 2001 were studied retrospectively. RESULTS: A total of 126 patients underwent 147 ERCP procedures (range 1-5 per patient). Twelve additional ERCPs were performed in 9 of the patients during follow-up because of recurrent symptoms. A total of 159 procedures were, therefore, available for analysis. The most frequent indications were suspicion of bile duct stones (46.8%) and obstructive jaundice (35.7%). Midazolam (95.6%) was used for conscious sedation and hyoscine (74.8%) for duodenal ileus. Patient tolerance of the procedure was good in 92.4% of sessions. Diagnoses included bile duct stones (54%), bile duct dilatation without any apparent obstruction (11.9%), and malignant stenosis (9.5%). Therapeutic procedures were indicated in 95.6% of diagnosed patients and completed in 96.3% of cases. Complications occurred in association with 2.5% of the ERCP procedures; the procedure-related mortality rate was 0.7%. CONCLUSIONS: ERCP in elderly patients is practicable. The complication rate is low, and therapeutic efficacy is good.