Foreign body in a Zenker's diverticulum.

Zenker's diverticulum (ZD) is an uncommon disorder that can cause dysphagia with risk of aspiration. While surgical treatment has been the mainstay for many years, endoscopic diverticulotomy has emerged as a first-line option with favorable outcomes. We present the case of a 93-year-old woman with no significant past medical history who was diagnosed with a 6 cm ZD. Due to dysphagia, she experienced significant weight loss and was at risk of malnutrition. She developed aspiration pneumonia and required admission to our center. Given her condition and inability to swallow, a nasogastric tube was placed under radiological guidance for nutritional support pending definitive treatment. On radiographic localization of the ZD, a radiopaque metallic density image was observed that had not been identified in previous imaging. Suspecting a possible retained foreign body in the large diverticulum, a gastroscopy was performed. During the procedure, the ZD was accessed and a 10 mm metallic object was identified. The object was extracted using a Roth net, confirming the suspicion of a foreign body lodged in the ZD. The metallic piece was later identified as a patient's dental prosthesis. After resolution of the aspiration pneumonia, endoscopic-assisted diverticulotomy was performed. The procedure was carried out under deep sedation with cricopharyngeal myotomy without immediate complications. After 48 hours of hospitalization, the patient was discharged without requiring a nasogastric tube for feeding.

Hybrid-APC treatment for gastric vascular ectasia of atypical location after failed radiofrequency ablation.

A 76-year-old woman was being followed up for chronic anemia secondary to bleeding from vascular ectasias at the gastric antrum and the cardial and subcardial region. On several occasions the patient required fulguration of these lesions with conventional APC, which resulted in no clear improvement. Radiofrequency ablation of these lesions was then attempted using a 90-degree probe, which was successful on antral angiodysplasias but failed to remove lesions in the cardial and subcardial region since anatomy there prevented proper apposition of the probe onto the target mucosa. Given the absence of any improvement, it was decided to use fulguration for angiectasias at the cardial and subcardial level by means of Hybrid-APC, which consists of lifting the mucosa with an injection through the APC probe and then fulgurating in the pulsedAPC® mode, thus achieving a broader ablation area in a shorter time. During the subsequent review a clear reduction of vascular ectasias was observed.

Incidental finding of intraductal papillary mucinous tumor with adenocarcinoma focus after variceal bleeding.

Case of a young female patient with reflux symptoms. During gastroscopy, the patient presented an episode of gastrointestinal bleeding after biopsy of a fundic lesion. Imaging tests were requested, showing a 8cm pancreatic cyst causing obstruction of the splenic vein with presence of portal hypertension and secondary gastric varices.

The association between de novo inflammatory bowel disease and celiac disease.

INTRODUCTION: controversial data have been reported on the potential association between celiac disease (CeD) and inflammatory bowel disease (IBD). OBJECTIVE: to study the prevalence of CeD in patients newly diagnosed cases with IBD. METHODS: an observational, retrospective study was performed in patients with newly diagnosed IBD who were screened for CeD by anti-tissue transglutaminase antibodies (anti-tTG) measurements and an endoscopic duodenal biopsy. No patients had received corticosteroids, immunosuppressants or biologic drugs within the three months prior to gastroscopy. In the presence of Marsh 1, other causes were ruled out. CeD was diagnosed in patients positive for anti-tTG, compatible duodenal biopsy findings and a good response to a gluten-free diet. RESULTS: a total of 163 patients were screened for CeD. Of these, six (3.7%) were positive for anti-tTG and four were diagnosed with CeD (three had ulcerative colitis, one had Crohn's disease). All patients with both CeD and IBD had normal IgA levels, positive anti-tTG and CeD genetic markers. CONCLUSIONS: the prevalence of CeD in our patients with IBD was higher than that reported in the literature for other series of patients with IBD. A combination of anti-tTG testing and CeD genetics may screen patients for CeD in this population of patients with IBD.