RESUMEN
UNLABELLED: Clinical practice guidelines recommend video capsule endoscopy (VCE) studies in patients with iron-deficiency anemia (IDA) after conventional upper and lower endoscopies but there is a need for studies demonstrating the diagnostic yield, clinical impact, and cost in some patient subgroups. OBJECTIVES: 1.To determine the diagnostic yield of VCE in premenopausal women with IDA compared with that in men and postmenopausal women. 2. To identify the presence of VCE predictors in premenopausal women. 3. To estimate the cost-clinical impact relationship associated with VCE in this indication. MATERIAL AND METHOD: We retrospectively analyzed 408 patients who underwent VCE. Patients with IDA were enrolled (premenopausal, postmenopausal women, and men), with previous normal work-up by conventional endoscopies. RESULTS: A total of 249 patients were enrolled: 131 women (52.6%), of which 51 were premenopausal and 80 were post-menopausal, and 118 men. The mean age was 60.7±16 years. The diagnostic yield of VCE for the diagnosis of IDA was 44.6% (95% CI 39.9 - 50.8). Diagnostic yield was 50.8% vs 38.9% in men vs women (p=0.05) and was 55% vs 13.7% in postmenopausal vs premenopausal women (p<0.001). No predictors of small bowel lesions were found in premenopausal women. The most common findings in the postmenopausal group were angioectasias (70.5%) and erosions (57.1%) in the premenopausal group. The cost in premenopausal women was 44.727 and 86.3% of the procedures had no clinical impact. CONCLUSIONS: The diagnostic yield of VCE is low in the etiological study of IDA in premenopausal women and there is no cost-effectiveness in relation to clinical impact. No predictors of small bowel lesions were found in this group.
Asunto(s)
Anemia Ferropénica/etiología , Endoscopía Capsular , Hemorragia Gastrointestinal/diagnóstico por imagen , Premenopausia , Adulto , Anciano , Angiodisplasia/complicaciones , Angiodisplasia/diagnóstico por imagen , Endoscopía Capsular/economía , Análisis Costo-Beneficio , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/diagnóstico por imagen , Femenino , Hemorragia Gastrointestinal/complicaciones , Hemorragia Gastrointestinal/diagnóstico , Humanos , Intestino Delgado/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Úlcera Péptica/complicaciones , Úlcera Péptica/diagnóstico por imagen , Posmenopausia , Valor Predictivo de las Pruebas , Estudios RetrospectivosRESUMEN
Endoscopic retrograde cholangiopancreatography may be difficult in patients that have undergone Roux-en-Y gastric bypass. Due to the fact that prevalence of morbid obesity is increasing, and laparoscopic procedures for its treatment have increased, the incidence of biliary tract problems in patients of altered anatomy is also growing. We describe a laparoscopic technique to access the biliary tree by endoscope, through the excluded stomach.