Early work activities after sedation with propofol in digestive endoscopy.

The benefits of the sedation provided by propofol in digestive endoscopy, either by an endoscopist or an anesthetist, are now undeniable. One of these benefits is a shorter recovery time after endoscopy. Assessment scales are currently available that allow a more efficient discharge from endoscopy units.

Importance of assessing for cannabis use prior to propofol sedation for endoscopy.

Recently, we´ve noticed an increasing in the whole propofol dose in endoscopy in relation to cannabis use. This issue is not described in the current data (technical datasheet). We´re really concern that, unfortunately, it´ll be more and more frequent.

Cellulase, Coca-Cola®, pancreatin and ursodeoxycholic acid in the dissolution of gastric bezoars: why not all together?

Two cases of a chemical dissolution of gastric phytobezoars are presented. The novel approach of that management is the pharmacological mixture than completely made disappear the bezoars in patients fated to surgery removal.

A complication following a biopsy sample in eosinophilic esophagitis.

We present a case of a young 16 year old patient that had an esophageal perforation in the context of eosinophilic esophagitis. The esophagus showed vertical lacerations and mucosal thickness on endoscopy, thus a biopsy was performed in the proximal section which resulted in profuse bleeding due to a deep mucosal tear. A subsequent computed tomography scan revealed a perforation. Due to the absence of symptoms the patient was managed conservatively. The patient was discharged within 48 hours after admission. The histopathology analysis showed a massive eosinophilic infiltration of the mucosa that verified the clinical suspicion.

[Diagnostic capability of carcinoembryonic antigen elevation]. / Capacidad diagnóstica del antígeno carcinoembrionario.

INTRODUCTION: There is little information on the oncologic diagnostic accuracy of carcinoembryonic antigen (CEA) levels more than 3-fold above normal. OBJETIVES: To determine the prevalence of underlying cancer in patients with mild CEA elevation and the mean cost per patient of CEA determination. METHODS: A retrospective study was carried out in all patients with CEA elevation (3-10 ng/ml) and suspicion of cancer referred to the gastroenterology or internal medicine outpatient units from 2001 to 2007. RESULTS: We studied 100 patients (60 men and 40 women), with a mean age of 67.4 ± 14.2 years and baseline CEA of 5.8 ± 1.7 ng/ml. The most important symptoms and signs were laboratory abnormalities (19 patients [19%]). Cancer was diagnosed in 4 patients (one gastric, 2 lung and one colon). Among patients without malignancies, 49 patients (49%) had no related processes, and 47 (47%) had benign diseases. During follow-up, one laryngeal cancer, one acute myeloid leukemia, and one colon cancer were detected (54.3 ± 24.6 months). We found no differences between baseline CEA levels in patients with and without cancer (6.6 ± 2.4 vs. 5.8 ± 1.7 ng/ml, p = 0.2). The mean cost per patient was 503.6 ± 257.6 €. CONCLUSIONS: Cancer was detected in a small proportion (7%) of patients with mild CEA elevation. The study of these patients is directly and indirectly associated with a not inconsiderable cost.

[Adequate rate of response to hepatitis B virus vaccination in patients with inflammatory bowel disease]. / Eficacia de la vacuna contra el virus de la hepatitis B en pacientes con enfermedad inflamatoria intestinal.

BACKGROUND AND OBJECTIVE: Patients with Inflammatory Bowel Disease (IBD) may have an increased risk of developing hepatitis B virus (HB) infection. Invasive procedures such as colonoscopies and surgery might be some of the reasons for this. Moreover, the use of immunosuppressors may reactivate a latent infection. We assessed the immune status among IBD patients receiving HB vaccine and the circumstances that predicted its results. AIMS AND METHODS: Serological markers of B and C hepatitis virus in patients with IBD who were referred for consultation were assessed since 2006. The subsequent determination of antibodies against superficial antigen (HBsAb) could differentiate between responders and non responders to the vaccine and an adequate immunity to HB was defined as higher than 10mUI/ml. RESULTS: One hundred and twenty nine patients were included in our study. Fifty-six (43,4%) patients had received immunosuppressive medication before the first vaccine dose. Notably, 85 (65.9%) patients had inadequate levels of HBsAb: 36 had no detectable levels and 49 had less than 10mUI/ml. Younger patients had a better immunity response than older patients (30.91+/-14.8 vs 39.91+/-14.2) (p<0.001). CONCLUSION: More than half of the patients had a suboptimal serologic response after vaccination. Only the younger group showed a better rate of response. It was not demonstrated whether an additional fourth dose of vaccination or a complete revaccination improved the rate of responders.

[An atypical case of massive gastrointestinal hemorrhage]. / Caso atípico de hemorragia digestiva masiva.

Gastrointestinal stromal tumors (GIST) are an infrequent cause (<1%) of severe gastrointestinal hemorrhage. Treatment is mainly surgical through complete tumoral resection. We report the case of a 29-year-old woman who presented to the emergency room with severe gastrointestinal bleeding manifested by melena. On physical examination the patient had a painless, palpable mass in the left abdomen. Esophagogastroduodenoscopy, computed tomography, angiography and urgent surgical intervention led to diagnosis of a jejunal GIST.

[Diagnostic value of fecal calprotectin in predicting an abnormal colonoscopy]. / Precisión diagnóstica de la calprotectina fecal para predecir una colonoscopia patológica.

BACKGROUND AND OBJECTIVE: Abdominal pain and diarrhoea are common symptoms in the general population. The colonoscopy is the gold standard method of detecting an organic pathology in the colon. However, it is invasive; it can not be repeated frecuently; it is expensive; and the system is overloaded. Fecal calprotectin (FCP) is a marker that may detect organic pathologies of the colon. The aims of this study were to analyze the usefulness of FCP to predict an abnormal colonoscopy and to correlate the levels of FCP with the degree of activity in inflammatory bowel disease (IBD). PATIENTS AND METHOD: 190 people were included in the study. All of them underwent a colonoscopy and a stool sample. People were divided in: normal colonoscopy: 117 people, and 28 colon adenomas, 20 colorectal cancer (CRC) and 25 IBD. RESULTS: The mean (SD) FCP concentration was 2,171.1 (2,133.6) mg/kgin patients with IBD and 726.6 mg/kg (533) in CRC. Both results were significantly elevated compared with those of healthy controls [114 (113)] mg/kg In patients with IBD, their levels correlated directly with the activity of the inflammation. 217 mg/kg was the best cut-off for discriminating patients with organic colon disorders. The sensibility was 85% and NPV was 93%. NSAIDs use was a clinical variable which was connected with a high FCP concentration in patients with normal colonoscopy. CONCLUSIONS: The higher levels of FCP were found in people with IBD and CRC. The measurement of FCP is a non-invasive, inexpensive, reliable and easily measured test. Among people with abdominal pain and diarrhoea, testing for FCP allows us to select those who must undergo a colonoscopy. NSAIDs can raise the levels of FCP in people with normal colonoscopies.