Endoscopic follow-up and management of Barrett's esophagus in relation to its preneoplastic potential.

Barrett's esophagus is an acquired clinical condition in which the squamous epithelium of the distal esophagus is replaced by a columnar epithelium. The diagnosis requires histological confirmation of specialized intestinal metaplasia, in which goblet cells must be present. Barrett's esophagus is a risk factor for the development of esophageal adenocarcinoma, a tumor with an incidence and mortality have increased alarmingly in recent years in the western world. It has been estimated that the annual incidence of cancer in patients with Barrett's esophagus has increased from 0.2-2%. Once diagnosed, Barrett's esophagus is estimated to have an annual neoplastic transformation rate of 0.5% per patient. The highlights of the endoscopic diagnosis and treatment are reviewed here, as well as the screening and monitoring of this process.

Valor pronóstico de las micrometástasis linfoganglionares en pacientes con cáncer colorrectal en estadios A y B de Dukes (T1-T4, N0, M0) / Prognostic value of lymph node micrometastases in patients with colorectal cancer in Dukes stages A and B (T1-T4, N0, M0)

Introducción: un 30% de los pacientes con cáncer colorrectal(CCR) en estadios A y B de Dukes (T1-T4, N0, M0) presentan recidivatumoral y/o fallecen a los 5 años. Esta inesperada malaevolución, en casos presumiblemente curados podría deberse, entreotras causas, a la presencia de micrometástasis linfoganglionaresno detectadas en el estudio de rutina: hematoxilina-eosina(H&E).Objetivo: determinar si la presencia de micrometástasis linfoganglionaresdetectadas mediante inmunohistoquímica con anticuerposanticitoqueratina AE1/AE3, influyen en la evolución delCCR.Pacientes y métodos: se han estudiado los ganglios linfáticoslocorregionales de 85 pacientes con CCR en estadios A y Bde Dukes (T1-T4, N0, M0), mediante técnicas de inmunohistoquímicacon anticuerpos anticitoqueratinas AE1/AE3, para poner demanifiesto la presencia de micrometástasis. Se ha realizado un estudiodescriptivo, inferencial bivariante y de supervivencia, segúndistintos factores de riesgo, centrado en la presencia o no de micrometástasis.Resultados: hemos observado que el estadio de Dukes y laangioinvasión neoplásica son factores que influyen en el pronósticode estos pacientes. Sin embargo, no se ha demostrado que lapresencia de micrometástasis linfoganglionares se asocie a unapeor evolución en el CCR.Conclusiones: las micrometástasis linfoganglionares locorregionalesdetectadas mediante anticuerpos anticitoqueratinaAE1/AE3, en pacientes con CCR en estadios A y B de Dukes, nose asocian a una menor supervivencia(au9

Background: 30% of patients with colorectal cancer (CRC) inDukes stages A and B (T1-T4, N0, M0) present tumor recurrenceand die after 5 years follow up. This unexpectedly poor evolutionmight be attributable to the presence of lymph node micrometastasisundetected in routine examination with haematoxilin-eosine(H&E).Objective: to assess the presence of undetected micrometastasis.Patients and methods: we conducted a retrospective studyof the locoregional lymph nodes in 85 patients operated for CRCin Dukes stages A and B (T1-T4, N0, M0), using immunohistochemistrywith anticytokeratin antibodies AE1/AE3. In this descriptive,inferential bivariant and survival study, we analyzed differentrisk factors, including local infiltration T1/T4, Dukes A/B,number of dissected lymph nodes, vascular invasion, micrometastasis,tumor recurrence and death in the context of the presenceor absence of micrometastases.Results: Dukes stage and neoplastic angioinvasion are influentialin patient prognosis; however, lymph node micrometastaseswere not associated with a poorer outcome of CRC.Conclusions: locorregional lymph node micrometastases detectedwith anticytokeratine antibodies AE1/AE3 in Dukes A andB CRC patients are not associated with reduced survival(AU)

[Diagnosis and management of choledochal cysts. A review of 10 new cases]. / Diagnóstico y tratamiento de los quistes de colédoco. Presentación de 10 nuevos casos.

AIM: the aim of this study was to analyze the diagnostic and therapeutic options for the various types of this rare disease. PATIENTS AND METHODS: 10 patients with choledochal cysts (CC) were diagnosed in our hospital since 1991. Type of cyst was established according to the Alonso-Lej classification. RESULTS: we report 7 type-I, 1 type-III, 1 type-IVa, and 1 type-V CC cases. Clinical manifestations were abdominal pain in all cases with biliary or pancreatic features. The diagnosis was established using abdominal ultrasonography, computed tomography, and endoscopic retrograde cholangiopancreatography (ERCP). All 7 patients with type-I CC underwent total cyst excision with Roux-en-Y hepatojejunostomy. For type-III CC an endoscopic sphincterotomy (ES) was performed, and in type-IVa CC a transductal sphincterotomy and cholecistectomy was made. The patient with Caroli s disease (type V) underwent liver transplantation. We have followed up all patients for several years without significant complications. CONCLUSIONS: CC is more frequent in childhood, but is not exceptional in the adult. Imaging techniques and ERCP play an important role in the diagnosis, and also in the treatment of type-III cysts. Therapeutic options depend on cyst type, but due to the potential malignancy of this disease total cyst excision is recommended for types I, II and IV. In type-III CC endoscopic sphyncterothomy is recommended, while liver transplantation is sometimes necessary for type V. Long-term follow-up is crucial to prevent malignant transformation except for type-III CC where this complication is very unusual.

Diagnóstico y tratamiento de los quistes de colédoco. Presentación de 10 nuevos casos / No disponible

Objetivo: analizar las técnicas diagnósticas y las distintas posibilidadesterapéuticas de esta rara patología.Pacientes y métodos: presentamos un estudio retrospectivode todos los casos de quistes de colédoco diagnosticados en nuestrohospital desde 1991. Incluye 10 nuevos casos y distintos tiposde quistes de colédoco (QC).Resultados: de los 10 pacientes diagnosticados de QC sietetenían menos de 10 años. En cuanto a los diferentes tipos de QC:7 eran de tipo I, 1 de tipo III, 1 de tipo IVa y otro de tipo V. Lasmanifestaciones clínicas habitualmente tenían un perfil biliar opancreático. El diagnóstico se ha realizado mediante técnicas deimagen no invasivas (ECO, TAC) y CPRE. El tratamiento ha venidocondicionado por el tipo de quiste: quistectomía con hepaticoyeyunostomíaen “Y de Roux” en los de tipo I, CPRE con esfinterotomíaendoscópica en los de tipo III y trasplante hepático en laenfermedad de Caroli. En el único QC tipo IVa se realizó una papilotomíatransductal y una colecistectomía. Todos han sido controladosperiódicamente, sin que hayamos registrado complicacionesrelevantes durante el seguimiento.Conclusión: los QC son más frecuentes en niños pero no sonexcepcionales en adultos. Las técnicas de imagen y la CPRE sonesenciales en el diagnóstico de esta patología. El tratamiento dependerádel tipo de quiste de colédoco. Es aconsejable el seguimientoperiódico y prolongado de estos pacientes para detectarprecozmente complicaciones como la transformación maligna

Aim: the aim of this study was to analyze the diagnostic and therapeuticoptions for the various types of this rare disease.Patients and methods: 10 patients with choledochal cysts(CC) were diagnosed in our hospital since 1991. Type of cyst wasestablished according to the Alonso-Lej classification.Results: we report 7 type-I, 1 type-III, 1 type-IVa, and 1 type-VCC cases. Clinical manifestations were abdominal pain in all caseswith biliary or pancreatic features. The diagnosis was established usingabdominal ultrasonography, computed tomography, and endoscopicretrograde cholangiopancreatography (ERCP). All 7 patientswith type-I CC underwent total cyst excision with Roux-en-Y hepatojejunostomy.For type-III CC an endoscopic sphincterotomy (ES) wasperformed, and in type-IVa CC a transductal sphincterotomy andcholecistectomy was made. The patient with Caroli’s disease (type V)underwent liver transplantation. We have followed up all patients forseveral years without significant complications.Conclusions: CC is more frequent in childhood, but is not exceptionalin the adult. Imaging techniques and ERCP play an importantrole in the diagnosis, and also in the treatment of type-III cysts.Therapeutic options depend on cyst type, but due to the potentialmalignancy of this disease total cyst excision is recommended fortypes I, II and IV. In type-III CC endoscopic sphyncterothomy is recommended,while liver transplantation is sometimes necessary fortype V. Long-term follow-up is crucial to prevent malignant transformationexcept for type-III CC where this complication is very unusual

[Spontaneous aneurysmal portohepatic fistula: imaging diagnosis]. / Fístula aneurismática portohepática venosa espontánea: diagnóstico por imagen.

Intrahepatic portosystemic venous shunts not related to trauma or biopsy are infrequent and their etiology is controversial. A congenital or acquired origin due to cirrhosis and portal hypertension has been proposed. Hepatic encephalopathy is present when there is associated cirrhosis. We describe a case of aneurysmal portohepatic venous fistula that was incidentally diagnosed with conventional ultrasonography and was subsequently confirmed by Doppler ultrasonography and computed tomography scan. Because there were no symptoms of encephalopathy, no surgical or vascular percutaneous treatment was provided.