Papilla of Vater morphology as an influencing factor in successful cannulation during resident training in advanced endoscopy. A prospective clinical study.

INTRODUCTION AND AIM: Endoscopic retrograde cholangiopancreatography (ERCP) is a complex procedure. Clinical guidelines assess competence in ERCP through a defined number of procedures, but multiple factors are involved. Our aim was to analyze the morphology of the papilla of Vater as an independent factor in selective common bile duct cannulation during resident training. MATERIAL AND METHODS: Patients that underwent ERCP were studied consecutively. All ERCPs were begun by a resident in training. The type of papilla was classified according to Haraldsson, including those with previous sphincterotomy. Cannulation difficulty and success and their relation to the type of papilla were documented. The analysis was divided into three 4-month periods. RESULTS: Of the 429 patients, cannulation was difficult in 101 (23.5%). The residents achieved selective cannulation of the common bile duct in 276 (64.3%) and the cannulation success rate at the end of their training was 81.7%. Cannulation was performed with the least difficulty in papillae with previous sphincterotomy (2.8%), unlike the type 4 papilla, which was difficult to cannulate in 50% of the cases. The lowest overall cannulation success was in the type 2 papilla (81.8%). CONCLUSION: Papilla type can influence cannulation success, but it is not the only related factor. Patients that underwent previous sphincterotomy appear to be the cases in whom ERCP training can be started.

[Clinical characteristics of acute pancreatitis in Mexico]. / Características clínicas de la pancreatitis aguda en México.

BACKGROUND: Acute pancreatitis (AP) etiology and frequency vary in relation to geographic region. AIMS: To determine the etiology, frequency, and mortality of AP in a Mexican population. PATIENTS AND METHODS: We carried out a prospective study of first episode AP patients over a period of 6 years. RESULTS: A total of 605 patients with a mean age of 40 years were included in the study. Sixty-four percent of them presented with overweight and/or obesity determined through BMI. Etiology was biliary in 66.60%, it was due to alcohol consumption in 15.90%, hypertriglyceridemia in 7.80%, it was post-endoscopic retrograde cholangiopancreatography (ERCP) in 2.10%, and was undetermined in 7.20%. Pancreatic infection was suspected in 70 patients and they underwent CT-guided fine needle aspiration. Thirty-two of those patients were diagnosed with pancreatic infection in which Staphylococcus spp was the most common microorganism. Overall mortality was 5.00% (2.60% < 30 years and 10.00% > 70 years). Necrosis, pancreatic infection, and mortality were more frequent in the cases in which etiology was due to alcohol ingestion. CONCLUSIONS: The most frequent AP etiology was biliary, but that caused by alcohol presented with more complications. Overall mortality was 5.00% and was higher in the elderly patients.

[Obscure gastrointestinal bleeding due to duodenal infiltration of a non-functioning pancreatic neuroendocrine tumor diagnosed by capsule endoscopy: a case report]. / Hemorragia gastrointestinal de origen obscuro secundaria a infiltración duodenal de tumor neuroendocrino pancreático no funcional diagnosticada por cápsula endoscópica; informe de un caso.

Non-functioning pancreatic neuroendocrine tumors (PNETs) are infrequent slow-growing, clinically-silent tumors. They are incidentally detected and some of them may present in advanced stages with local involvement of surrounding structures. The diagnostic accuracy of endoscopio ultrasound (EUS) and fine needle aspiration (FNA) biopsy is significantly lower in neuroendocrine tumors (46.7%) compared with adenocarcinoma (81.4%) and other histologies (75%). Therefore, preoperative diagnosis is very difficult. Exceptionally, hey present with gastrointestinal bleeding. We present a case of a non-functioning PNET initially diagnosed as cystic serous tumor of pancreas with EUS and FNA biopsy. Two years later patient presented obscure gastrointestinal bleeding due to duodenal infiltration. Diagnosis was made by capsule endoscopy.

Risk factors for colorectal polyps in a Mexican population [Corrected and republished].

BACKGROUND: The prevalence of colorectal polyps and adenomas in the general population of Mexico is unknown. AIM: To determine the prevalence and risk factors for colorectal polyps detected during flexible sigmoidoscopy (FSIG) in asymptomatic patients. MATERIAL AND METHODS: From 1995 to 2008, FSIG was performed as part of a complete check-up in patients who had lived in northeast Mexico for over 5 years. RESULTS: 946 (794 males/152 females) were included in the study. The mean age was 48.8 years (range 21-91). A family history of colorectal cancer (FHCRC) was present in 2.2 % of the cases. The adenoma prevalence found in patients with a BMI < 25, 26-30 or > 30 was 7.3%, 6.2% and 10.2% respectively. Independent risk factor for colorectal polyps and adenomas included a positive family history of colorectal cancer (OR 12.4, 95% CI 19.1-230, and OR 12.4, 95% CI 4.1-37.3, respectively) and a body mass index > 25 (OR 4.2, 95% CI 4.2-14.2 and OR 4.2, 95% CI 1.8-9.7, respectively). Seventy two patients had polyps (7.6%) and 29 patients had adenomas (3%). The prevalence of polyps and adenomas on FSIG in patients younger than 50 years was 5.8% and 1.9% respectively, and among those older than 50 years, it was 8.9% and 4.8% respectively. CONCLUSION: A positive family history of colorectal cancer and a body mass index > 25 are independent risk factors for colorectal polyps and adenomas. The adenoma prevalence found in our population was lower than the reported in developed countries.

[Hepatic actinomycosis ; presentation a case in a diabetic patient]. / Actinomicosis hepática; presentación de un caso en un paciente diabético.

We report the case of an Hispanic female diabetic patient admitted to our hospital complaining of progressive abdominal pain, weight loss, nausea and vomiting. Work-up included an abdominal computed tomography (CT) scan which reported a large liver mass consistent with atypical abscess. Serum alpha-fetoprotein value was normal, so a fine needle aspiration biopsy of the liver was performed and the report was consistent with an actinomycosis-induced abscess. Patient was treated with intravenous and oral amoxicillin with satisfactory clinical response.

[Resembling peritoneal tuberculois and gastric carcinoma with peritoneal carcinomatosis. Case report.]. / Tuberculosis gástrica y peritoneal semejando carcinoma gástrico con carcinomatosis peritoneal; informe de un caso.

We report the case of a woman with peritoneal and gastric tuberculosis who presented with clinical and radiologic features mimicking an advanced gastric neoplasia. We emphasize the relevance of including tuberculosis in the differential diagnosis of patients with gastric wall thickness.

Risk factors for colorrectal polyps in a Mexican population.

BACKGROUND: The prevalence of colorectal polyps and adenomas in the general population of Mexico is unknown. AIM: To determine the prevalence and risk factors for colorectal polyps detected during flexible sigmoidoscopy (FSIG) in asymptomatic patients. MATERIAL AND METHODS: From 1995 to 2008, FSIG was performed as part of a complete check-up in patients who had lived in northeast Mexico for over 5 years. RESULTS: 946 (794 males/152 females) were included in the study. The mean age was 48.8 years (range 21-91). A family history of colorectal cancer (FHCRC) was present in 2.2 % of the cases. The adenoma prevalence found in patients with a BMI < 25, 26-30 or > 30 was 7.3%, 6.2% and 10.2% respectively. Independent risk factor for colorrectal polyps and adenomas included a positive family history of colorrectal cancer (OR 12.4, 95% CI 19.1-230, and OR 12.4, 95% CI 4.1-37.3, respectively) and a body mass index < 25 (OR 4.2, 95% CI 4.2-14.2 and OR 4.2, 95% CI 1.8-9.7, respectively). Seventy two patients had polyps (7.6%) and 29 patients had adenomas (3%). The prevalence of polyps and adenomas on FSIG in patients younger than 50 years was 5.8% and 1.9% respectively, and among those older than 50 years, it was 8.9% and 4.8% respectively. CONCLUSION: A positive family history of colorectal cancer and a body mass index < 25 are independent risk factors for colorectal polyps and adenomas. The adenoma prevalence found in our population was lower than the reported in developed countries.