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Adenocarcinoma/patología , Neoplasias del Colon/patología , Traumatismos de los Dedos/etiología , Uñas/patología , Adenocarcinoma/complicaciones , Neoplasias del Colon/complicaciones , Resultado Fatal , Femenino , Traumatismos de los Dedos/patología , Humanos , Persona de Mediana Edad , Uñas/lesiones , Metástasis de la NeoplasiaRESUMEN
BACKGROUND AND OBJECTIVES: plastic biliary stents are often used after an ERCP session without complete common bile duct stones (CBDS) extraction. Sometimes, the volume of biliary drainage with these stents may be insufficient. We present our experience with the use of fully covered self-expanding metal stents (FCSEMS) in the setting of incomplete CBDS extraction. PATIENTS AND METHODS: after an ERCP session with difficult CBDS not completely removed, biliary FCSEMS (Wallflex) were inserted in some patients when it was deemed that biliary sphincterotomy and a single plastic stent would not provide an adequate drainage. RESULTS: a retrospective study was performed. Biliary FCSEMS were inserted in 29 patients, mean age 81 years. CBDS could not be extracted through a biliary sphincterotomy due to its large size (n = 18) or because of the presence of inflammatory distal strictures (n = 11). The greatest biliary drainage with shortest ERCP time was considered mandatory due to clinical instability of patients and/or poor tolerance to conscious sedation administered by the endoscopist. Successful biliary drainage was obtained in all cases. FCSEMS were removed after a median of 199.5 days in 16 patients with a complete CBDS extraction in 15 (93.7%). FCSEMS were not removed in the remaining 13 patients due to their clinical condition, and a wait-and-see strategy was undertaken. CONCLUSIONS: in selected cases, utilization of removable FCSEMS can be a good option for a quick and adequate biliary drainage in the setting of difficult CBDS. Because of the higher cost of these stents its use needs to be individualized.
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Cálculos Biliares/cirugía , Stents , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Metales , Diseño de Prótesis , Estudios RetrospectivosAsunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Enfermedades de la Aorta/complicaciones , Implantación de Prótesis Vascular , Hemorragia Gastrointestinal/etiología , Fístula Intestinal/complicaciones , Complicaciones Posoperatorias/etiología , Fístula Vascular/complicaciones , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Aneurisma de la Aorta Abdominal/complicaciones , Enfermedades de la Aorta/diagnóstico , Enfermedades de la Aorta/diagnóstico por imagen , Rotura de la Aorta/etiología , Aortitis/complicaciones , Aortitis/tratamiento farmacológico , Comorbilidad , Medios de Contraste , Quimioterapia Combinada , Resultado Fatal , Gastroenterostomía , Hematemesis/etiología , Humanos , Imipenem/administración & dosificación , Imipenem/uso terapéutico , Fístula Intestinal/diagnóstico , Fístula Intestinal/diagnóstico por imagen , Masculino , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/complicaciones , Tomografía Computarizada por Rayos X , Vancomicina/administración & dosificación , Vancomicina/uso terapéutico , Fístula Vascular/diagnóstico , Fístula Vascular/diagnóstico por imagenRESUMEN
AIM: to study the possible differences in the final diagnosis of chronic pancreatitis by using standard classification described by Wiersema et al. and the new classification proposed recently by Rosemont. MATERIAL AND METHODS: forty-seven patients with the diagnosis of chronic pancreatitis were included in this study. The parenchymal and ductal criteria were studied, the patients were divided in two groups for Wiersema criteria: < 4 criteria, non-diagnostic for chronic pancreatitis and ≥ 4 criteria, diagnosis of chronic pancreatitis. The same patients were divided in four groups according to Rosemont classification: normal pancreas, indeterminate, suggestive and consistent with chronic pancreatitis. We analyzed these data with Chisquare test reported with 95% confidence intervals (CI). RESULTS: in patients with chronic pancreatitis the most frequent criteria observed were lobularity in 66% of cases and pancreatic duct dilatation and calcifications in 57.4% of cases each. We found a significant statistical association between the results of both classifications (p < 0.05). The highest association is found in patients with more than 4 standard criteria and definitive diagnostic of chronic pancreatitis according to Rosemont classification. In patients who have less than 4 standard criteria the diagnosis is suggestive of chronic pancreatitis by using the Rosemont classification in 27.66% (p < 0.05). CONCLUSION: these results show that no significant statistical differences are found for patients with > 4 criteria diagnosis by standard criteria. But 27.66% patients with less than 4 standard criteria would be suggestive according to Rosemont classification (p < 0.05). Hence, the new classification would be useful in patients with high suspicion of chronic pancreatitis with < 4 standard criteria but with more significance such as parenchymal lithiasis, lobularity or ductal calcifications.
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Endosonografía , Pancreatitis Crónica/diagnóstico por imagen , Adulto , Anciano , Algoritmos , Calcinosis/diagnóstico por imagen , Calcinosis/patología , Sedación Consciente , Dilatación Patológica/diagnóstico por imagen , Femenino , Humanos , Litiasis/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Páncreas/diagnóstico por imagen , Páncreas/patología , Conductos Pancreáticos/diagnóstico por imagen , Conductos Pancreáticos/patología , Pancreatitis Crónica/clasificación , Pancreatitis Crónica/diagnóstico , Estudios Retrospectivos , Factores de Riesgo , Grabación en VideoAsunto(s)
Infecciones por Bacteroides/diagnóstico , Citrobacter freundii/aislamiento & purificación , Neoplasias del Colon/diagnóstico , Errores Diagnósticos , Infecciones por Enterobacteriaceae/diagnóstico , Absceso Hepático/diagnóstico , Infecciones Estreptocócicas/diagnóstico , Infección de la Herida Quirúrgica/diagnóstico , Estreptococos Viridans/aislamiento & purificación , Anciano , Antibacterianos/uso terapéutico , Infecciones por Bacteroides/etiología , Infecciones por Bacteroides/cirugía , Colecistectomía , Colonoscopía , Terapia Combinada , Drenaje , Infecciones por Enterobacteriaceae/etiología , Infecciones por Enterobacteriaceae/cirugía , Fiebre/etiología , Humanos , Imipenem/uso terapéutico , Absceso Hepático/tratamiento farmacológico , Absceso Hepático/etiología , Absceso Hepático/cirugía , Masculino , Infecciones Estreptocócicas/etiología , Infecciones Estreptocócicas/cirugía , Infección de la Herida Quirúrgica/tratamiento farmacológico , Infección de la Herida Quirúrgica/microbiología , Infección de la Herida Quirúrgica/cirugía , Tomografía Computarizada por Rayos X , Ultrasonografía IntervencionalRESUMEN
This study assessed diagnostic yield and impact of capsule endoscopy on patient management. Seventy-five patients with obscure gastrointestinal bleeding were included. Clinical and followup information was collected by review of patient records and with personal contact with the referring physicians. All previous clinical information and interventions after capsule endoscopy and clinical outcome were noted. The indication was obscure-overt gastrointestinal bleeding in 36 patients (48%) and obscure-occult gastrointestinal bleeding in 39 patients (52%). Overall diagnostic yield was 66.7% considering relevant lesions. Followup was available in 31 patients. Capsule endoscopy changed clinical management in 61.4%. Multivariate analysis showed that patients with another potential source of bleeding and patients whose onset was hematochezia were not good candidates for capsule endoscopy. Capsule endoscopy has a high diagnostic yield and a positive influence on clinical management in a high proportion of patients with obscure gastrointestinal bleeding.
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Endoscopía Capsular , Enfermedades Gastrointestinales/diagnóstico , Hemorragia Gastrointestinal/etiología , Sangre Oculta , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Enfermedades Gastrointestinales/complicaciones , Enfermedades Gastrointestinales/terapia , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Valor Predictivo de las Pruebas , Estudios RetrospectivosRESUMEN
BACKGROUND AND OBJECTIVE: Self-expanding metal stents are being increasingly used to resolve malignant colonic obstruction. Subsequently, patients can either undergo elective surgery, or the stent can serve as a definitive palliative treatment in patients unfit for surgery. We present our experience with this technique in our hospital, a level II center within the Spanish National Health Service, which can be considered a community hospital. PATIENTS AND METHODS: A retrospective study was performed of a 42-month period (May 2002 to October 2005), during which malignant colonic obstruction was treated by means of endoscopically inserted stents on 43 occasions in 40 patients. RESULTS: Stent insertion was successfully performed in 41 attempts (95%) and good clinical results were obtained on 37 occasions (86%). Endoscopic means alone were used on 23 occasions (53.5%) and in the remaining 20 (46.5%), both endoscopy and fluoroscopy were employed. Of 38 patients with successfully inserted stents, clinical success was achieved, as a whole, in 34. Twenty-four of these patients (63%) subsequently underwent elective surgery while the stent served as a definitive palliative treatment in the remaining 14 (37%). One of these patients had to undergo further surgery due to a fistula between the colon and the bladder. There were eight other complications: three stent migrations and one stent obstruction occurred, two patients had tenesmus, one patient developed bacteremia after stent insertion, and a silent bowel perforation by the stent was found in an elective surgical procedure. There was no mortality. CONCLUSIONS: In our experience, endoscopically inserted stents seem to be a safe and effective method for the initial treatment of malignant colonic obstruction.