Immuno-mediated colitis induced by nivolumab that mimics endoscopically and histologically an ulcerative colitis.

Immunotherapy has revolutionized the management of oncological pathology, demonstrating effectiveness in treating various cancers by stimulating the immune system against tumor cells. Among the immunotherapy drugs are programmed cell death protein 1 (PD-1) inhibitors, such as Nivolumab, which, by blocking this receptor on the surface of T lymphocytes, enhance the immune response. Despite their significant benefits, these agents present specific adverse effects on healthy tissues that need to be understood. One of these effects is immune-mediated colitis, a potentially serious gastrointestinal disorder that may require the permanent discontinuation of the drug. Although it can occur with various immunotherapy regimens, it occurs more frequently with anti-CTLA4 agents like Ipilimumab, with its incidence much lower with anti-PD1 agents. We present the case of a 62-year-old male diagnosed with metastatic clear cell renal carcinoma treated with radical nephrectomy and subsequent palliative systemic treatment with Nivolumab. After the third cycle of immunotherapy, he developed abdominal pain and diarrhea. Colonoscopy revealed continuous mucosal inflammation up to the cecum, erosions, exudates, and loss of the vascular pattern. Biopsies showed signs of active colitis, cryptic abscesses, and focal cryptitis, all consistent with a case of immuno-mediated colitis induced by Nivolumab that mimics, both endoscopically and histologically, the findings found in ulcerative colitis.

Intestinal stenosis developed after a complete response to chemotherapy in a patient with Crohn´s disease and lymphoma of the jejunum.

An increased risk of hematologic malignancies secondary to long-term immunomodulators and biologics has been described in patients with inflammatory bowel disease1. Here, we present a case of jejunal stricture after chemotherapy treatment in a patient with ileal Crohn´s disease (CD) and jejunal lymphoma. The patient was a 32-year-old male with ileal CD in remission presenting with abdominal pain and distension. Abdominal computed tomography (CT) showed a poorly defined mass in the proximal jejunum, and positron emission tomography (PET) - CT showed hypermetabolic activity at that level. An upper endoscopy evidenced an indurated, friable circumferential mass causing a significant reduction of the intestinal lumen. Histological and cytometry findings led to a diagnosis of large B cell lymphoma, for which the patient received standard treatment (R-CHOP and IPI), achieving complete response. Eight months later, the patient reported abdominal pain and distention. Abdominal CT showed a thickening of a short segment of the proximal jejunum. An upper endoscopy showed a punctiform stenosis, while multiple biopsies showed neither histological recurrence of lymphoma nor signs of IBD. The patient was diagnosed with a post-chemotherapy stricture and underwent progressive endoscopic balloon dilatation. He finally was scheduled for laparoscopic small bowel resection. An histological analysis of the surgical piece revealed a granulomatous reaction with multinucleated foreign body-like giant cells, without evidence of malignancy (recurrence of lymphoma) nor inflammatory infiltrate suggesting CD. The patient currently remains asymptomatic with no new episodes of abdominal pain.

Upper gastrointestinal bleeding and Rigler triad.

Gallstone ileus is a rare complication of cholelithiasis, characterized by mechanical bowel obstruction due to a biliary calculus originating from a bilioenteric fistula. The Rigler triad, consisting of aerobilia, ectopic gallstone, and intestinal obstruction, is rarely observed in its complete form. We present the case of a 92-year-old male with a history of acute lithiasic cholecystitis who presented to the Emergency department with acute epigastric pain. Initial evaluation revealed gallbladder dilatation, gallstones, and gallbladder wall thickening suggestive of acute cholecystitis. During hospitalization, the patient experienced an episode of hematemesis, leading to the diagnosis of a cholecystoduodenal fistula and a large blood clot in the duodenal bulb. Further imaging showed an ectopic gallstone causing small bowel obstruction. The patient underwent urgent surgery for stone extraction, followed by endoscopic intervention for the bleeding vessel identified at a subsequent gastroscopy. Unfortunately, the patient had a poor postoperative course and passed away seven days later. This case report highlights the exceptional occurrence of both the Rigler triad and upper gastrointestinal bleeding in a patient with gallstone ileus. Surgical intervention is crucial for the initial resolution of intestinal obstruction, followed by cholecystectomy and repair of the bilioenteric fistula. Awareness of these rare presentations is important for timely diagnosis and appropriate management of this uncommon complication of cholelithiasis.

Over-The-Scope clip closure of an acquired bronchoesophageal fistula secondary to an esophageal diverticulum.

Esophagorespiratory fistula is a rare entity that occurs as a result of malignant and non-malignant causes. This condition is associated with high morbidity and mortality. Surgical repair has traditionally been the most common treatment and self-expandable metal stent are the first choice among non-surgical techniques. Here, we report a non-malignant bronchoesophageal fistula secondary to an esophageal diverticulum that was successfully closed using an over-the-scope clip.

Acute upper gastrointestinal bleeding secondary to aortoesophageal fistula. Endoscopic treatment using the over-the-scope clip (OTSC®) system.

Aortoesophageal fistula is an extremely rare cause of upper gastrointestinal bleeding associated with high morbidity and mortality. Early clinical suspicion, as well as correct management since diagnosis, can increase the probability of survival of this gastrointestinal emergency. We present the first case reported of an aortoesophageal fistula successfully treated with the OTSC system, representing another therapeutic option for this high-risk entity.

Anal squamous cell carcinoma in HIV patients with HPV-16 condylomas: a serious complication in immunocompromised patients.

Human papillomavirus (HPV) infection is one of the most frequent sexually transmitted infections in the world, with great importance due to its oncogenic potential. Both the risk of infection and the development of neoplasia are increased in people with human immunodeficiency virus (HIV) infection, so HPV vaccination should be recommended in these patients.

Endoscopic diagnosis of primary aortoesophageal fistula: An extremely rare cause of acute upper gastrointestinal bleeding.

Primary aortoesophageal fistula, an abnormal communication between native aorta and oesophagus, is an extremely rare cause of upper gastrointestinal bleeding. The typical symptoms, known as the Chiari´s triad, are only present in 45% of cases. It has a high mortality, so early diagnosis is essential to increase the probability of survival. We present a case report of a patient with massive upper gastrointestinal bleeding due to primary aortoesophageal fistula.

Endoscopic full-thickness resection (EFTR) after neoadjuvant chemotherapy: is it feasible? A case report

Endoscopic full-thickness resection (EFTR) is a new technique for the resection of colonic lesions with limitations for other techniques such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) due to fibrosis, the location of the lesion or invasion depth. In addition, techniques such as ESD require a long learning curve and unfortunately they are not fully implemented in Western countries. EFTR has numerous indications, which are expanding daily. The Full-Thickness Resection Device(R) (FTRD) is a promising tool, although it has many limitations and is associated with some risks. One of the main limitations of this resection device is the size of the lesion and it is not recommended for the resection of lesions > 30 mm. Furthermore, tumor size is directly related to the "en bloc" resection rate. On the one hand, this case report suggests that neoadjuvant chemotherapy can modify the lesion size and larger lesions become candidates for EFTR in a second attempt. On the other hand, the concomitant use of systemic anticancer therapy could be a contraindication for the use of FTRD(R) as it may be associated with late perforations. It is necessary to establish the time between the use of chemotherapy and the use of FTRD(R) in order to avoid complications. These considerations must be analyzed in future prospective studies

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Primary squamous cell carcinoma of the stomach: a rare entity

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Endoscopic full-thickness resection (EFTR) after neoadjuvant chemotherapy: is it feasible?

Endoscopic full-thickness resection (EFTR) is a new technique for the resection of colonic lesions with limitations for other techniques such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) due to fibrosis, the location of the lesion or invasion depth. In addition, techniques such as ESD require a long learning curve and unfortunately they are not fully implemented in Western countries. EFTR has numerous indications, which are expanding daily. The Full-Thickness Resection Device® (FTRD) is a promising tool, although it has many limitations and is associated with some risks. One of the main limitations of this resection device is the size of the lesion and it is not recommended for the resection of lesions > 30 mm. Furthermore, tumor size is directly related to the "en bloc" resection rate. On the one hand, this case report suggests that neoadjuvant chemotherapy can modify the lesion size and larger lesions become candidates for EFTR in a second attempt. On the other hand, the concomitant use of systemic anticancer therapy could be a contraindication for the use of FTRD® as it may be associated with late perforations. It is necessary to establish the time between the use of chemotherapy and the use of FTRD® in order to avoid complications. These considerations must be analyzed in future prospective studies.

Primary squamous cell carcinoma of the stomach: a rare entity.

We present the case of a primary squamous cell carcinoma (PSCC) and inform about the evidence to date and also highlight the diagnostic criteria. We present the case report of a 78-year-old female was admitted due to a 2-week history of abdominal pain, weight loss and vomiting.

Implementación de la sedación con propofol: utilidad del análisis modal de fallos y efectos. Calidad y seguridad centrada en el paciente / Propofol sedation Quality and safety. Failure mode and effects analysis

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Propofol sedation Quality and safety. Failure mode and effects analysis.

Sedation is a key component of digestive endoscopy. While ensuring procedural safety and quality represents a primary goal, a detailed assessment of patient-focused risks and improvements is lacking on most occasions. Failure mode and effect analysis (FMEA) is a useful tool in this context as a means of raising barriers and defense mechanisms to prevent adverse events from developing.

Estenosis anastomótica de gastroyeyunostomía derivativa resuelta con endoprótesis tipo yo-yo / Derivative anastomotic gastrojejunostomic stenosis resolved with a yo-yo type stent

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