ABSTRACT
INTRODUCTION: Dieulafoy's lesion of the small bowel is an uncommon cause of gastrointestinal (GI) bleeding that often recurs after endoscopic treatment. MATERIAL AND METHODS: we report an observational, descriptive, retrospective, single-center study in 15 patients with small bowel bleeding who were diagnosed with a Dieulafoy's lesion by capsule endoscopy or double-balloon enteroscopy. RESULTS AND CONCLUSIONS: all patients underwent combined endoscopic treatment. During a median follow-up of 33.5 months (range, 2-145), three of the 12 cases that stayed in follow-up (25 %) recurred, all within 48 hours after treatment. Two were successfully re-treated with a repeat endoscopic procedure.
Subject(s)
Capsule Endoscopy , Gastrointestinal Hemorrhage , Combined Modality Therapy , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Humans , Intestine, Small/diagnostic imaging , Intestine, Small/surgery , Retrospective StudiesABSTRACT
BACKGROUND AND AIM: Intermediate-risk patients following a colorectal cancer screening program may have differential risk of advanced lesions depending on the findings of an index colonoscopy. The aim of the present study was to comparatively assess advanced colorectal neoplasia risk at the first follow-up colonoscopy among the different intermediate-risk subgroups with a focus on patients with three to four adenomas. METHODS: All patients recruited for a baseline screening colonoscopy between 2006 and 2011 were included. Number, size and histopathological characteristics of adenomas were collected. Main outcome was an advanced colorectal neoplasia detection rate (invasive carcinoma or advanced adenoma) at the first follow-up colonoscopy. Low- and high-risk patients were excluded. RESULTS: Five hundred and sixty-one intermediate-risk patients (63.3% men, mean age: 59.01 ± 6.16 years) underwent indexing and follow-up colonoscopy. By multivariate analysis, three to four adenomas (OR: 3.613 [95% CI: 1.661-7.859], P = 0.001) and adenoma size ≥10 <20 mm (OR: 3.374 [95% CI: 1.618-7.034], P = 0.001) were independent factors associated with advanced colorectal neoplasia. Advanced lesions were detected in 7.66% of cases. Of patients with advanced colorectal neoplasia, 51.16% belonged to the three-to-four-adenoma group and ≥1 of ≥10 <20-mm subgroups (n = 132, 23.53%). These patients demonstrated a higher rate of advanced lesions [OR: 3.886 (95% CI: 2.061-7.325), P < 0.001] than patients with three to four small adenomas of <10 mm (16.67% vs 5.07%, P < 0.001). The association between patients with small adenomas (n = 217, 38.68%) and advanced lesions was not significant (OR: 0.521 [95% CI: 0257-1.056], P = 0.066). CONCLUSION: Intermediate-risk patients with three to four small adenomas achieved a very low advanced lesion rate at follow up. Surveillance interval should be lengthened because these patients should be considered low risk.
Subject(s)
Adenoma/diagnosis , Colonoscopy , Colorectal Neoplasms/diagnosis , Early Detection of Cancer , Aged , Colonic Polyps , Female , Follow-Up Studies , Humans , Male , Middle Aged , Risk FactorsABSTRACT
BACKGROUND AND AIM: Capsule endoscopy and double balloon enteroscopy are well-recognized procedures in obscure gastrointestinal bleeding, with many factors that may influence their diagnosis yield. The aim of the present study was to characterize the degree of agreement between both techniques with focus on the type of lesion in a large cohort of patients at a referral center. MATERIAL AND METHOD: One thousand two hundred and nine capsules were administered in 1,078 patients and 381 enteroscopies were performed in 361 patients with obscure-gastrointestinal bleeding from 2004 to 2014. RESULTS: Both procedures were carried out in 332 patients (mean age: 65.22 +/- 15.41, 183 men) and they have a similar diagnosis yield (70.5% vs. 69.6%, p = 0.9). Overall enteroscopy diagnosis yield was higher within patients with a previous positive capsule endoscopy (79.3% vs. 27.9%, p < 0.001). The degree of agreement was very good for polyps (0.89 [95% CI: 0.78-0.99]), good for vascular lesions (0.66 [95% CI: 0.55-0.77]) and tumors(0.66 [95% CI: 0.55-0.76]) and moderate for ulcers (0.56 [95% CI: 0.46-0.67]). Diverticula (0.39 [95% CI: 0.29-0.5]) achieved a fair agreement. The results of CE and DBE differed in 73 patients (22%). CONCLUSIONS: The present study confirms that although overall diagnostic yield by capsule endoscopy and double-balloon enteroscopy is similar, there are many factors which can modify these values, mainly the type of lesion.
Subject(s)
Capsule Endoscopy , Double-Balloon Enteroscopy , Gastrointestinal Hemorrhage/etiology , Adult , Aged , Female , Gastrointestinal Hemorrhage/diagnostic imaging , Humans , Male , Middle Aged , Retrospective Studies , Tertiary Care CentersABSTRACT
La hemorragia digestiva alta tiene su origen en una lesión situada entre el esfínter esofágico superior y el ángulo de Treitz. Las causas más frecuentes son la úlcera péptica y la hipertensión portal. El diagnóstico de este síndrome se basa en la anamnesis, exploración física, los datos de laboratorio y la endoscopia oral. Se discute cada uno de ellos, resaltando la importancia de la endoscopia. El tratamiento inmediato en urgencias incluye algunas medidas generales del paciente en shock y medidas hemostáticas especiales. Una vez estabilizado el enfermo hay que administrar el tratamiento farmacológico específico en la hemorragia no varicosa...
Injury between upper esophageal sphincter and Treitz angle is the common aetiology of upper gastrointestinal bleeding. Peptic ulcer disease and portal hypertension are the most frequent etiology. The diagnosis of this syndrome is based on the anamnesis, physical examination, laboratory tests and oral endoscopia. Every approach is discussed, stressing the significance of oral endoscopia. The immediate management in the emergency unit includes general treatment measures in shocked patients and a few specific hemostatic strategies. Once the patient is stabilized the administration of specific pharmacological treatment for not varicose hemorrhage...
Subject(s)
Diagnosis , Hemorrhage , TherapeuticsABSTRACT
La enfermedad de Ménétrier es una gastropatía muy infrecuente de etiología desconocida. Esta enfermedad produce engrosamiento de los pliegues gástricos. Es una condición preneoplásica, ya que se asocia a cáncer gástrico en un 15 por ciento de los casos. Presentamos a un paciente de 56 años que ingresa por dolor en la parte media de hemiabdomen superior, pérdida de apetito y vómitos. Se diagnostica la enfermedad por endoscopia y biopsia. Se realiza una puesta al día del tratamiento, que hasta la fecha no ha sido definido de forma clara.
Subject(s)
Male , Adult , Humans , Gastritis, Hypertrophic , ReviewABSTRACT
Las causas más frecuentes de hemorragia digestiva alta son la úlcera péptica gástrica y duodenal, seguida por las erosiones agudas en mucosa gástrica y en tercer lugar las várices esofagogástricas. La diverticulosis de intestino delgado es una causa muy rara de hemorragia digestiva alta, aunque debe tenerse en cuenta en pacientes con hemorragia digestiva sin causa evidente a nivel esofagogástrico; lo habitual es diagnosticar esta entidad de forma accidental en el curso de estudios endoscópicos, radiológicos o quirúrgicos. La escasa incidencia de complicaciones asociada a la diverticulosis duodenal justifica el mantener una actitud no quirúrgica en principio
Subject(s)
Female , Aged , Humans , Diverticulum , Gastrointestinal HemorrhageABSTRACT
La esofagitis eosinofílica (EE) es una enfermedad producida por la presencia de un infiltrado de eosinófilos en el esófago en ausencia de enfermedad por reflujo gastroesofágico (ERGE). Cursa con disfagia, impactación de alimentos en el esófago, pirosis y en niños son frecuentes los vómitos y regurgitaciones. Presentamos el caso de una mujer que consulta por disfagia de larga evolución, se realiza estudio endoscópico con toma de biopsias esofágicas, diagnosticando una EE. Tras realizar tratamiento con corticoides tópicos mejora de la disfagia.