Lumen apposing metal stents versus tubular self-expandable metal stents for endoscopic ultrasound-guided choledochoduodenostomy in malignant biliary obstruction.

BACKGROUND AND AIMS: EUS-guided choledochoduodenostomy (EUS-CDS) is an effective option for biliary drainage in malignant biliary obstruction. Lumen apposing metal stents (LAMS) are increasingly been used for EUS-CDS. It is unknown how LAMS compare to tubular self-expandable metal stents (SEMS) for EUS-CDS. Our aim is to compare the clinical outcomes of LAMS versus SEMS for EUS-CDS. PATIENTS AND METHODS: Single-center retrospective cohort study of consecutive patients with unresectable malignant biliary obstruction who underwent EUS-CDS after failed ERCP for initial biliary drainage between 2011 and 2019. Clinical outcomes were compared between patients who had conventional covered SEMS and LAMS placed for EUS-CDS. Outcome measures included unplanned procedural events, technical success, clinical success, adverse events and reinterventions. Survival was analyzed by the Kaplan-Meier method. RESULTS: During the study period 57 patients met inclusion criteria (37 LAMS, 20 SEMS). All EUS-CDS were technically successful (LAMS group 95% CI 90.3-100%, SEMS group 95% CI 83.2-100%). There were no differences between groups in unplanned procedural events (4 LAMS deployment issues, 2 mild bleeding in SEMS group; 10 vs 10.8%), clinical success (37/37 [100%] vs 19/20 [95%]), and short-term adverse events (5/37 [13.5%] vs 4/20 [20%], p = 0.71). Complete follow-up data were available in 41 patients for a mean of 376 ± 145 days. Endoscopic reintervention was required for duodenal stent placement (n = 9) or biliary stent dysfunction (n = 4), with no difference between LAMS and SEMS group (6/37 [16.2%] vs 7/20 [35%]). There were no differences in overall survival between both groups. CONCLUSIONS: EUS-guided choledochoduodenostomy after failed ERCP has equally high technical and clinical success rates with either LAMS or SEMS in patients with malignant biliary obstruction. No differences in adverse events, reinterventions and survival were seen with either type of stent. The cost-effectiveness of LAMS vs SEMS for EUS-guided choledochoduodenostomy remains to be proven.

Role of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and classification of lymphomas.

BACKGROUND: endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a safe and effective technique in the diagnosis of mediastinal and abdominal masses. However, the usefulness of EUS-FNA in the diagnosis and classification of lymphomas is controversial. The aim of this study was to determine the yield of EUS-FNA in the diagnosis and classification of lymphomas. METHODS: a retrospective case series was performed in a tertiary referral center. All consecutive patients referred for EUS-FNA with a suspected diagnosis of lymphoma from March 2013 to June 2019 were included. RESULTS: thirty-five patients (54.3 % women, median age 72 years) were included. The most frequent location of the node was the abdomen (67.9 %). Nodes were punctured using a 22-gauge (85.7 %) and 19-gauge needle (14.3 %) with a slow-pull technique. The number of passes performed were three or more in 82.9 % of patients. The samples were processed by the cellblock method. Adequate samples for immunohistochemical and molecular biological study were obtained in 33 (94.3 %) patients. EUS-FNA correctly diagnosed lymphoma in 30 out of 35 patients (85.7 %), and subclassification was determined in 23 patients (65.7 %). The most frequent diagnosis was non-Hodgkin lymphoma (85.7 %). There was one moderate adverse event (bleeding), which was resolved during the procedure. CONCLUSIONS: EUS-FNA may be a valuable technique in the evaluation of suspected lymphomas with an adequate diagnostic yield and a very low rate of adverse events.

[Patient-Related Factors Affecting Bowel Preparation Prior to Colonoscopy.] / Factores relacionados al paciente que afectan la limpieza del colon previo a la colonoscopia.

INTRODUCTION: Colorectal cancer is a major health problem worldwide because it is the third most common cancer and the third leading cause of cancer mortality in western countries. Screening for colorectal cancer in asymptomatic patients is crucialfor reducing the incidence and colonoscopy is one of the methods of choice. The ability of colonoscopy in detecting small lesions is clearly influenced by the quality of the colonic preparation. OBJECTIVES: To know which are the variablesrelating to the patient and the type ofpreparation that affect the quality of colonic cleansing. MATERIALS AND METHODS: It was designed a cross-sectional study. It was administered a questionnaire for the enrolled subjects to assess the presence offactors that could affect the quality of colonic cleansing. Then they underwent a colonoscopy. The different variables between subjects with adequate or inadequate colonic cleansing were compared. RESULTS: We evaluated 277 subjects. In multivariate analysis the only variables that showed significant differences are split dose [OR 0.45 (0.21 to 0.99)] and age [OR 1.02 (1-1.05)]. Obesity showed no significant differences in multivariate analysis [OR 1.84 (0.9-3.78)]. CONCLUSIONS: Age and split-dose were the only variables significantly associated with the quality of bowel preparation prior to colonoscopy. Not so constipation or the presence ofdiverticula, so these patients do not require special preparation regimes.

[Gastric tuberculosis. Review apropos of a case]. / Tuberculosis gástrica: revisión a propósito de un caso.

Abdominal tuberculosis (TB) is infrequent in the Western world. This disease occurs more commonly among at-risk populations, mainly among older patients and patients with HIV infection. Abdominal TB usually manifests as intestinal TB, peritoneal TB, and mediastinal lymphadenitis. Gastric TB is a rare manifestation of abdominal TB. We present the case of an 80-year-old man, who had been diagnosed with anemia 2 years previously without establishing the etiology. Treatment consisted of oral iron administration without improvement. Symptoms included epigastralgia, nausea and vomiting, as well as asthenia, anorexia and weight loss (approximately 20 kg in 2 years). A computed tomography scan showed mediastinal and mesenteric adenopathy, ascites, splenomegaly, and thickening of the gastric wall. Diagnosis was made by endoscopic biopsy of the affected areas in the antral region, the result being granulomatous chronic gastritis suggestive of tubercular origin.

Tuberculosis gástrica: revisión a propósito de un caso / Gastric Tuberculosis. Review apropos

La tuberculosis (TBC) abdominal es una enfermedad poco común en los países occidentales. Aparece con más frecuencia en ciertos grupos de riesgo, entre los que destaca el de los pacientes infectados por el virus de la inmunodeficiencia humana y los ancianos. Las formas de presentación más frecuentes de la TBC abdominal son: TBC intestinal, peritonitis tuberculosa y linfadenitis mesentérica. La TBC gástrica es una forma poco frecuente de TBC abdominal. Presentamos el caso de un varón de 80 años de edad, con antecedente de anemia diagnosticada hace 2 años, sin etiología filiada, que fue tratada con hierro oral sin obtener mejoría. Presentaba epigastralgia, náuseas y vómitos, junto con astenia, anorexia y pérdida de unos 20 kg de peso de 2 años de evolución. En la tomografía computarizada se observaron adenopatías mediastínicas y mesentéricas, ascitis, esplenomegalia y engrosamiento de la pared y del antro gástrico. El diagnóstico se realizó por biopsia endoscópica de las lesiones en la región antral, con resultado de gastritis crónica granulomatosa sugestiva de origen fímico

Abdominal tuberculosis (TB) is infrequent in the Western world. This disease occurs more commonly among at-risk populations, mainly among older patients and patients with HIV infection. Abdominal TB usually manifests as intestinal TB, peritoneal TB, and mediastinal lymphadenitis. Gastric TB is a rare manifestation of abdominal TB. We present the case of an 80-year-old man, who had been diagnosed with anemia 2 years previously without establishing the etiology. Treatment consisted of oral iron administration without improvement. Symptoms included epigastralgia, nausea and vomiting, as well as asthenia, anorexia and weight loss (approximately 20 kg in 2 years). A computed tomography scan showed mediastinal and mesenteric adenopathy, ascites, splenomegaly, and thickening of the gastric wall. Diagnosis was made by endoscopic biopsy of the affected areas in the antral region, the result being granulomatous chronic gastritis suggestive of tubercular origin