Esophageal lichen planus: a rare cause of dysphagia.

Lichen planus (LP) is an idiopatic inflammatory disorder of mucocutaneous tissue, most frequently involving the skin or oral cavity, and rarely the esophagus, resulting in symptomatic dysphagia. Esophageal lichen planus most commonly presents in middle-aged women and the endoscopic finding are not specific; erosions, exudates, pseudomembranes and even stenosis can be found. Treatment generally starts with oral glucocorticoid. The risk of malignant transformation justifies endoscopic follow-up.

[Analysis of the clinical benefits and cost-effectiveness of performing a systematic second-look gastroscopy in benign gastric ulcer]. / Estudio del beneficio clínico y de coste-efectividad tras efectuar sistemáticamente una segunda gastroscopia en la úlcera gástrica benigna.

INTRODUCTION: We analyzed the need to routinely perform a second gastroscopy after an initial diagnosis of benign gastric ulcer. METHOD: A total of 226 consecutive cases of gastric ulcer were reviewed. Sensitivity (S), specificity (Sp), positive and negative predictive value (PPV and NPV) and the accuracy of the initial gastroscopy plus biopsy were analyzed, both overall and according to the initial endoscopist's experience (attending or resident physician). The diagnostic accuracy of the initial and second-look gastroscopies was compared. The number of second endoscopies required to diagnose a new case of malignant gastric ulcer and their cost was calculated, both overall and according to the endoscopist's experience. RESULTS: There were 178 benign ulcers (79%) and 48 malignant ulcers (21%). The initial gastroscopy (S: 87.2%; Sp: 100%; PPV: 100%; PNV: 96.7%; accuracy: 96.7%) was performed by an attending physician in 74% of the patients and by a resident physician in the remaining 26%. Diagnostic accuracy was higher for attending physicians than for residents (98.2% vs. 94.8%; p=0.18). The accuracy of second-look endoscopy was 100%, with a significant improvement when compared with the initial procedure (p=0.035). Three new cases of MALT lymphoma and three new cases of gastric adenocarcinoma were diagnosed and could be treated with curative intent. The number of second gastroscopies required to diagnose a new case of malignant gastric ulcer and their economic cost was: 37.3 (4,675 Euros) for the whole group, 55.2 (6,845 Euros) for attending physicians and 19.3 (2,393 Euros) for residents. CONCLUSIONS: Initial gastroscopy showed high diagnostic accuracy, which was slightly lower when performed by resident physicians. Second-look gastroscopy significantly improved the results, confirming the clinical benefit of this procedure in diagnosing potentially curable malignant lesions. The mean cost of each new diagnosis of malignancy was 4,675 Euros, which was three times lower if the initial gastroscopy was performed by a less experienced endoscopist.

[Gastric plasmacytoma as an uncommon cause of upper gastrointestinal bleeding]. / Plasmocitoma gástrico como causa infrecuente de hemorragia digestiva alta.

Gastric plasmacytoma is an infrequent form of presentation of monoclonal gammopathy that, if ulcerated, can cause upper gastrointestinal bleeding. This entity is usually localized but may progress to multiple myeloma or other forms of monoclonal gammopathy. Differential diagnosis should be performed with other monoclonal gammopathies, based on laboratory and histological criteria, as well as with other gastric tumors such as adenocarcinoma, gastrointestinal stromal tumors, neuroendocrine tumors and lymphomas. Differential diagnosis can be based on radiological and endoscopic characteristics, although definitive diagnosis will undoubtedly be based on histological study and immunohistochemical techniques. We describe the case of a male patient who underwent investigations for upper gastrointestinal bleeding and iron deficiency anemia. The final diagnosis was multiple myeloma associated with gastric plasmacytoma.

Liquen plano esofágico como causa de disfagia / Esophageal lichen planus: a rare cause of dysphagia

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Perforación gástrica por palillo / Gastric perforation caused by a stick

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Estudio del beneficio clínico y de coste-efectividad tras efectuar sistemáticamente una segunda gastroscopia en la úlcera gástrica benigna / Analysis of the clinical benefits and cost-effectiveness of performing a systematic second-look gastroscopy in benign gastric ulcer

Introducción: se discute la necesidad de efectuar sistemáticamente una segunda gastroscopia de control tras el diagnóstico inicial de una úlcera gástrica benigna. Método: revisamos 226 casos consecutivos de úlcera gástrica. Analizamos la sensibilidad (S), la especificidad (E), el valor predictivo positivo y negativo (VPP, VPN) y la precisión de la primera exploración: gastroscopia con biopsias, de modo global y según la experiencia del primer explorador (médico de plantilla o MIR). Comparamos la precisión diagnóstica entre la primera y la segunda endoscopia. Calculamos el número necesario de segundas exploraciones (NNE) para diagnosticar un nuevo caso de úlcera maligna y su coste, tanto global como según la experiencia del explorador. Resultados: registramos 178 (79%) úlceras benignas y 48 (21%) malignas. La primera exploración fue efectuada por un médico de plantilla (74%) y MIR (26%): S 87,2%, E 100%, VPP 100%, VPN 96,7% y precisión 96,7%. La precisión del médico de plantilla fue superior (98,2%) a la del MIR (94,8%) (p=0,18). La segunda exploración de control tuvo una precisión del 100%, mejorando significativamente a la primera (p=0,035) y diagnosticando 3 nuevos linfomas MALT y 3 carcinomas tratados con intención curativa. El NNE y el coste de un nuevo diagnóstico de lesión maligna fueron los siguientes: global, 37,3 (4.675 euros); médico de plantilla, 55,2 (6.845 euros), y MIR, 19,3 (2.393 euros). Conclusiones: la primera exploración obtuvo una elevada precisión diagnóstica, ligeramente menor para los MIR. La segunda endoscopia de control mejora significativamente los resultados, confirmando su beneficio clínico al diagnosticar lesiones malignas potencialmente curables. El coste medio de cada nuevo diagnóstico de malignidad ascendió a 4.675 euros, siendo 3 veces inferior si la primera exploración la efectúa un médico con menos experiencia(AU)

Introduction: We analyzed the need to routinely perform a second gastroscopy after an initial diagnosis of benign gastric ulcer. Method: A total of 226 consecutive cases of gastric ulcer were reviewed. Sensitivity (S), specificity (Sp), positive and negative predictive value (PPV and NPV) and the accuracy of the initial gastroscopy plus biopsy were analyzed, both overall and according to the initial endoscopist's experience (attending or resident physician). The diagnostic accuracy of the initial and second-look gastroscopies was compared. The number of second endoscopies required to diagnose a new case of malignant gastric ulcer and their cost was calculated, both overall and according to the endoscopist's experience. Results: There were 178 benign ulcers (79%) and 48 malignant ulcers (21%). The initial gastroscopy (S: 87.2%; Sp: 100%; PPV: 100%; PNV: 96.7%; accuracy: 96.7%) was performed by an attending physician in 74% of the patients and by a resident physician in the remaining 26%. Diagnostic accuracy was higher for attending physicians than for residents (98.2% vs. 94.8%; p=0.18). The accuracy of second-look endoscopy was 100%, with a significant improvement when compared with the initial procedure (p=0.035). Three new cases of MALT lymphoma and three new cases of gastric adenocarcinoma were diagnosed and could be treated with curative intent. The number of second gastroscopies required to diagnose a new case of malignant gastric ulcer and their economic cost was: 37.3 (4,675 Euros) for the whole group, 55.2 (6,845 Euros) for attending physicians and 19.3 (2,393 Euros) for residents(AU)

Conclusions: Initial gastroscopy showed high diagnostic accuracy, which was slightly lower when performed by resident physicians. Second-look gastroscopy significantly improved the results, confirming the clinical benefit of this procedure in diagnosing potentially curable malignant lesions. The mean cost of each new diagnosis of malignancy was 4,675 Euros, which was three times lower if the initial gastroscopy was performed by a less experienced endoscopist(AU)

Plasmocitoma gástrico como causa infrecuente de hemorragia digestiva alta / Gastric plasmacytoma as an uncommon cause of upper gastrointestinal bleeding

El plasmocitoma gástrico es una forma rara de presentación de las gammapatías monoclonales, y puede ser una causa de hemorragia digestiva alta si se encuentra ulcerado. Suele ser localizado, pero puede evolucionar hacia un mieloma múltiple u otras formas de gammapatía monoclonal. El diagnóstico diferencial hay que hacerlo con otras gammapatías monoclonales, basándose en criterios analíticos e histológicos, y con otros tumores gástricos, como el adenocarcinoma, los tumores de la estroma gastrointestinal, los tumores neuroendocrinos y los linfomas. Para ello, nos podemos basar en las diferentes características radiológicas y endoscópicas, aunque, sin duda, el estudio histológico y las técnicas inmunohistoquímicas establecerán el diagnóstico definitivo. En esta observación clínica se describe el caso de un paciente que presentaba una hemorragia digestiva alta y una anemia ferropénica, con diagnóstico final de mieloma múltiple asociado a plasmocitoma gástrico

Gastric plasmacytoma is an infrequent form of presentation of monoclonal gammopathy that, if ulcerated, can cause upper gastrointestinal bleeding. This entity is usually localized but may progress to multiple myeloma or other forms of monoclonal gammopathy. Differential diagnosis should be performed with other monoclonal gammopathies, based on laboratory and histological criteria, as well as with other gastric tumors such as adenocarcinoma, gastrointestinal stromal tumors, neuroendocrine tumors and lymphomas. Differential diagnosis can be based on radiological and endoscopic characteristics, although definitive diagnosis will undoubtedly be based on histological study and immunohistochemical techniques. We describe the case of a male patient who underwent investigations for upper gastrointestinal bleeding and iron deficiency anemia. The final diagnosis was multiple myeloma associated with gastric plasmacytoma